Failure to Obtain Proper Written Authorization for Resident Financial Transaction
Penalty
Summary
The facility failed to ensure proper safeguarding of a resident’s personal funds by not obtaining written authorization as required for financial transactions. A resident with a history of anxiety disorder, ureteral calculus, mood affective disorder, and vascular dementia was admitted and later became private pay after insurance coverage ended. An MDS assessment showed a BIMS score of 11, indicating moderate cognitive impairment. When the resident transitioned to private pay, the business office processed a credit card payment using a "Credit Card Authorization Form" that was completed by the Assistant Business Manager but did not contain the resident’s signature or a documented time of completion. The Credit Card Authorization Form listed the resident as the cardholder, described the services as private pay room and board for specific dates, and included the credit card number, expiration date, security code, and total amount to be charged. The form also contained a pre-printed statement agreeing to pay the total amount according to the card issuer agreement. However, in the signature section, staff documented only the words "via phone" instead of obtaining the resident’s written signature. Facility staff, including the Business Manager and Assistant Business Manager, stated that the form was required for each monetary transaction and that the resident had insisted on paying over the phone while away from the facility, but they did not document the details of the phone consent anywhere other than the notation "via phone" on the form. Financial records, including the Resident Ledger Report and Resident Activity Reports, showed the posting of room and board charges, a partial payment, and an outstanding balance. Later documentation indicated that, after the resident’s death, the resident’s private fiduciary reported to the facility that money had been taken from the resident while at the facility and that she was unable to pay the remaining balance. The fiduciary also reported that the resident’s mail, including financial statements and retirement fund information, had been kept in a nightstand drawer and left vulnerable to anyone entering the room. Review of the State Operations Manual and the facility’s job descriptions and policies showed that the facility was required to have systems and internal controls to ensure resident funds were maintained in accordance with federal and state regulations, including written authorization and documentation of date, time, amount, and source or recipient of funds, which were not followed in this case.
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