Failure to Thoroughly Investigate Missing Resident Property
Penalty
Summary
The facility failed to conduct and document a thorough investigation into the misappropriation of a resident's property, specifically a wedding ring belonging to a resident who had been admitted in July 2022. The resident's personal inventory included several rings of value, and the missing wedding ring was reported by a family member after noticing its absence during a visit. The family member had last seen the ring during a previous visit and, upon discovering it missing, reported it to the nurse on duty. The facility's investigation, as documented, included searching the resident's room and the unit, and interviewing the roommate's daughter, but did not include interviews with all staff who had access to the resident or the resident's belongings. Further, the investigation did not document interviews with all potentially involved staff, nor did it establish a clear timeline for when the ring was last seen. Interviews were conducted with the nurse and aide on duty at the time of the report and the ADON, but the findings from these interviews were not documented. The facility also did not rule out the possibility that misappropriation had occurred, and interviews with other residents were not completed due to their impaired cognition. These actions and omissions are contrary to the facility's own policy, which requires all allegations of abuse or neglect to be thoroughly investigated and documented.