Failure to Safeguard and Manage Resident Trust Funds
Penalty
Summary
The facility failed to properly manage, safeguard, and account for the personal funds of nine residents who had trust fund accounts. Surveyors found that the facility did not monitor resident trust fund balances to ensure they did not exceed Medicaid resource limits, resulting in all nine residents having account balances well above the $2,000 threshold for Medicaid eligibility. In several cases, residents' balances remained over $3,000 for multiple months, with one resident's balance reaching over $9,700 after a large Social Security back payment. The facility did not take adequate steps to assist residents in spending down excess funds, and there was little evidence of proactive management or guidance provided to residents or their representatives regarding allowable purchases or spend-down options. Record reviews and interviews revealed that some residents had severe cognitive impairments, while others were their own responsible parties but lacked understanding of how to manage or spend their funds appropriately. Several residents had minimal personal belongings or room decorations, and there was no indication that the facility facilitated purchases to improve their quality of life or reduce their account balances. In some cases, responsible parties or family members were not notified of the over-resourced status, and documentation of notifications was incomplete or missing. The facility's process for notifying residents or their representatives about excess funds was inconsistent, and staff interviews indicated confusion or lack of involvement in the spend-down process. Staff interviews further highlighted that the business office manager (BOM) was primarily responsible for trust fund management but had been on leave, and the process for spending down funds was not clearly defined or consistently implemented. The activity director and social worker were not actively involved in the spend-down process, and the BOM reported limitations on how funds could be spent, including restrictions on online purchases and cash withdrawals. The facility's own policy assigned responsibility for trust fund management to the administrator, but there was no evidence of effective oversight or coordination among staff to prevent residents from becoming over-resourced and at risk of losing Medicaid eligibility.