Failure to Obtain Authorization for Resident's Trust Fund Transactions
Summary
The facility failed to properly manage a resident's trust fund by not obtaining the necessary authorization for transactions. The resident, identified as having severely impaired cognition, had two debits from their trust account: one for $124.61 and another for $300.00. The first transaction was for personal needs items, which was authorized by the resident's durable power of attorney (DPOA) due to the resident's inability to sign. However, the second transaction for a debit card purchase was not authorized by the DPOA, despite a receipt indicating the resident's signature and a note about buying a debit card for online orders. The DPOA was unaware of the $300.00 debit card purchase and expressed concern about the resident's vulnerability due to dementia. Administrative staff acknowledged that authorization from the DPOA should have been obtained for expenditures from the resident's trust fund, especially given the resident's cognitive impairment. The facility's policy requires written authorization for managing residents' funds, but this was not followed, leading to a risk of impaired rights and potential misappropriation of the resident's funds.
Penalty
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The facility failed to provide residents with access to their personal trust funds for more than two months during a transition to new bank accounts after a change in ownership. A cognitively intact resident who relied on staff to shop for toiletries using his trust account reported that staff had stopped making purchases, and his family had been supplying his personal items instead. Another resident with moderate cognitive impairment, who typically received monthly cash from her trust account to buy phone minutes, did not receive her usual payments for over two months and only received a partial amount later. Facility leadership and business office staff confirmed that there was no cash box, no cash available, and that residents and responsible parties had been unable to access any trust account funds during this period, affecting all residents with such accounts.
The facility failed to keep resident personal funds in an account separate from its operating account and did not issue timely refunds after several residents died or were discharged. Review of financial records showed that multiple residents had personal funds, totaling over $16,000, retained in the operating account for extended periods, with delays in refunding ranging from several weeks to several months. An Accounts Receivable Regional Manager reported that these delays were due to posting errors, waiting on insurance payments, repeatedly carrying credit balances forward, sending balances to the home office multiple times for review, and failing to process at least one refund.
A resident deposited $1000 in cash with facility staff for placement in the facility safe, and the deposit was correctly recorded in the safe log. When the resident later requested to withdraw the funds, the money was missing and there was no documentation of any authorized access, withdrawal, or release of the funds. Social services staff could not account for the missing money or provide records explaining its disposition, despite a facility policy requiring that all resident funds be handled to ensure the safety and integrity of each transaction.
The facility failed to honor residents’ financial rights by keeping resident personal funds in the facility’s operating account instead of a separate resident fund account and by not issuing timely refunds. Record review showed that dozens of residents had personal funds, ranging from small amounts to several thousand dollars, held in the operating account, including a large credit balance for a resident who had overpaid for services. Personal fund balance reports for multiple deceased residents were not sent to the state’s Medicaid division until after an investigation began. The BOM reported that a previous BOM had left without processing at least one refund, that refund requests for several residents were only later sent to the home office, and that some residents’ balances had been written off as bad debt rather than refunded.
A resident with intact cognition and multiple chronic conditions entrusted a wallet containing cash to the SSD for safekeeping. The SSD stored the wallet in an unlocked office drawer instead of securing it per the facility’s personal funds policy. When the resident’s family later requested a portion of the money, most of the cash was missing, and documentation showed the issue was discussed with the family but not directly with the resident, even though the facility’s policy required proper safeguarding and accounting of resident funds.
A resident with multiple medical conditions but no documented cognitive, mood, or behavior problems was asked by the BOM and SSA to transfer her funds into a resident fund management service account and explicitly declined, stating she wished to manage her own bank account. Despite facility policy requiring a signed delegation before opening such an account, the BOM later signed an authorization agreement to transfer the resident's funds without the resident's signature. The resident reported that she had not agreed to facility management of her funds and was very angry and upset about losing control of her money.
Failure to Provide Resident Access to Personal Trust Funds During Bank Transition
Penalty
Summary
The facility failed to honor residents' rights to manage their financial affairs by not providing access to personal trust accounts for more than two months. One resident, cognitively intact per a quarterly MDS assessment, reported that he maintained a trust account and routinely used his funds to purchase toiletries and personal items. He stated that facility staff had previously gone to the store monthly on his behalf and debited his account, but this practice had stopped for the past couple of months without explanation, and his family had been supplying his toiletries and other items during this time. Another resident, who was moderately cognitively impaired per a quarterly MDS assessment, reported that she had routinely received $70 in cash from her trust account at the beginning of each month but had not received any money for over two months until she was given $138 in cash by staff. She stated she used her money to buy phone minutes for herself and her son and indicated she was still owed additional funds. The Business Office Manager, Regional Business Office Manager, and Administrator each confirmed that, following a change in facility ownership and the transition to new bank accounts beginning in December, the facility had no cash box, no cash available, and residents and responsible parties had been unable to access trust account funds since January, affecting all residents with trust accounts and halting staff shopping for residents.
Failure to Maintain Separate Resident Funds and Issue Timely Refunds
Penalty
Summary
The facility failed to honor residents' rights to manage their financial affairs by not placing resident funds in an account separate from the facility operating account and by not issuing timely refunds of personal funds. Review of the facility’s Accounts Receivable Aging Report showed that six residents had personal funds, totaling $16,926.43, held in the facility’s operating account. Five of these residents had expired and one had been discharged, yet their personal funds remained in the operating account. The amounts held ranged from $18.00 to $6,902.43 for individual residents. Record review showed that the facility did not provide the Personal Fund Account Balance Report (TPL) to the Missouri HealthNet Division, Third Party Liability Unit or complete the refunds until weeks to months after the residents’ credits were generated, expirations, or discharge. The delays ranged from 49 to 136 days. During interview, the Accounts Receivable Regional Manager attributed the delays to a posting error that created a credit balance, waiting for insurance payment before refunding, repeatedly moving a credit balance forward each month, sending a credit balance to the home office multiple times for review, and simply not processing a refund, with one resident still not refunded at the time of the interview.
Failure to Safeguard and Account for Resident Trust Funds
Penalty
Summary
The facility failed to honor a resident’s right to manage personal financial affairs when cash entrusted to the facility for safekeeping went missing. According to interviews with the Administrator (ADM) and Director of Nursing (DON), the resident deposited $1000 in cash into the facility safe through the social services office on 9/25/25, and the funds were correctly logged as received in the safe log. When the resident later attempted to withdraw the money on 2/17/26, the funds were not in the safe, and there was no documentation of any authorized access, withdrawal, or release of the money. Social services staff were unable to account for the missing funds or provide any documentation showing an authorized transaction. Review of the facility’s resident trust policy indicated that all resident funds received in the facility were to be handled in a manner that ensured the safety and integrity of the transaction. This deficiency centers on the lack of documentation and accountability for the resident’s deposited funds, as evidenced by the safe log showing only the initial receipt entry with no corresponding record of withdrawal or release, and the inability of staff to explain or substantiate what happened to the money.
Failure to Maintain Separate Resident Fund Accounts and Issue Timely Refunds
Penalty
Summary
The deficiency involves the facility’s failure to honor residents’ rights to manage their financial affairs by not placing resident personal funds in an account separate from the facility’s operating account and not issuing timely refunds. Record review of the facility’s Accounts Receivable Aging Report showed that 39 residents had personal funds, totaling $39,158.17, held in the facility’s operating account rather than in a separate resident fund account. Individual amounts ranged from small balances of a few dollars to larger sums exceeding $11,000 for some residents. One resident had a credit balance of $1,834.00 due to paying for two months of services that should not have been paid, and this credit remained unrefunded for a period of time despite the issue being brought to the Business Office Manager’s (BOM) attention. The report also shows that the facility did not provide Personal Fund Account Balance Reports for multiple deceased residents to the Missouri HealthNet Division Third Party Liability Unit until after a case-managed investigation had already begun. These deceased residents’ personal fund balances were not timely reported as required. During interviews, the BOM acknowledged that a prior BOM had left without processing at least one resident’s refund and that refund requests for several residents had only been sent to the home office later. The BOM further stated that he or she was working with corporate staff to determine why some residents’ balances had been written off as bad debt instead of being refunded, indicating that these residents did not receive refunds of their personal funds when due.
Failure to Safeguard Resident Personal Funds
Penalty
Summary
The facility failed to safeguard a cognitively intact resident’s personal funds that had been entrusted to staff for safekeeping. The resident, who was self-responsible and had diagnoses including diabetes mellitus, benign prostatic hyperplasia, and chronic gout, had a Brief Interview for Mental Status (BIMS) score of 13, indicating intact cognition. According to the Administrator, the resident gave a wallet containing $180 in cash to the Social Services Director (SSD) for safekeeping. The SSD placed the wallet in an unlocked drawer in the SSD office, contrary to the facility’s policy and procedure for management of residents’ personal funds, which required the facility to hold, safeguard, manage, and account for residents’ personal funds when the facility manages them. Later, when the resident’s family requested $140 from the resident’s money, only $40 remained in the wallet, indicating that $140 was missing. The SSD no longer worked at the facility at the time of the investigation. A review of the Social Services Progress Notes from October through December did not show that the resident was informed about the missing $140, although the SSD had discussed the issue with the resident’s family. During an interview, the resident stated that the facility still had the wallet and that a man had visited his room and provided a number to call regarding the missing money. The facility’s policy required written authorization and proper safeguarding of funds when the facility manages a resident’s personal funds, but the wallet and cash were not secured in accordance with these procedures.
Unauthorized Transfer of Resident Funds to Managed Account
Penalty
Summary
The facility violated a resident's right to manage her own financial affairs by arranging for her pension checks to be deposited into a resident fund management service account without her written authorization. The facility's Resident Trust Account Policy, dated 1/1/2023, required that no account be opened until a Delegation of Responsibility for the Management of Personal Funds was signed by the resident or their representative. The resident, who had diagnoses including diabetes, peripheral vascular disease, osteoporosis, hypertension, delusional disorder, and cognitive/communication deficits, had an MDS dated 10/9/25 indicating no memory, recall, thinking, reasoning, mood, or behavior problems. On 12/6/23, a Business Office Activity Note documented that the Business Office Manager (BOM) and Social Service Assistant (SSA) approached the resident and asked her to have her funds transferred into a resident fund management service bank account, and the resident declined, stating she wanted to continue managing her own bank account. Despite this refusal, an Authorization Agreement to Handle Resident Funds showed that on 6/5/25 the BOM signed the authorization to have the resident's funds transferred into the resident fund management service account, without the resident's signature. In an interview on 10/17/25, the resident stated she understood the facility believed she was not competent but asserted that she was competent, wanted to manage her own bank account, had not agreed to the facility managing her funds, and was very angry and upset over no longer having control of her money.
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