F0602

E

Misappropriation of Resident Funds and Narcotic Medications by Nursing Staff

Seymour, Indiana Survey Completed on 01-12-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to prevent misappropriation of a cognitively intact resident’s money and misappropriation of multiple cognitively intact residents’ narcotic pain medications. One resident, diagnosed with heart failure, hypertension, and anemia, kept a large amount of cash in an envelope in her dresser drawer. She reported that over four hundred dollars was missing from this envelope, which she kept in her room where she had no roommate and no family visitors, and she rarely left the room except for showers or using the restroom. A close friend who was an LPN at the facility had helped her count the money the day after Christmas, documenting $510 on the outside of the envelope, but when they recounted the money in early January, only $77 remained, leaving $433 unaccounted for. The administrator later confirmed the envelope amounts and stated he had not known the resident had that much money in her possession.

Further review of the resident’s financial records showed that the business office had written a petty cash check for $767 from the resident’s account payable to the same LPN, with the resident’s name in the memo line, leaving only $0.81 in the resident’s facility account. The business office manager stated that the facility’s practice was to allow residents to receive up to $50 in cash per day, and for amounts over $50, checks were written so that a resident’s family could cash them; however, in this case, the check was written directly to the LPN, who reported that she cashed the check and returned the cash to the resident. The LPN stated that after the resident made some Christmas purchases and mailed a gift to an out-of-state loved one, there was still $510 left in the envelope. The administrator and DON reported they were unaware that a check for this resident had been written in the LPN’s name, and the resident had no family involvement.

The deficiency also includes misappropriation of narcotic pain medications for several cognitively intact residents with diagnoses such as COPD, cerebral palsy, heart failure, depression, anxiety, stroke, diabetes, and hypertension. For one resident receiving hydrocodone-acetaminophen as needed every eight hours, the MAR showed a single narcotic dose administered by an LPN on a specific date, while the controlled substance record showed another nurse signing out multiple doses that same day at different times. Another resident with heart failure, hypertension, diabetes, depression, and COPD had an order for hydrocodone-acetaminophen every 12 hours; the controlled substance record showed multiple doses signed out by an LPN on several days and times, including doses between scheduled intervals, while the MAR reflected only some of these administrations and lacked documentation for others. Similar discrepancies were found for two additional residents ordered oxycodone-acetaminophen as needed every six hours, where the controlled substance records showed multiple doses signed out by the same LPN at various times, but the MARs documented far fewer administrations.

The administrator and DON reported that the LPN who began working in early August had initially done well in orientation, but it was later reported that she appeared to have signed out too many narcotic pills over a weekend. Upon investigation, the DON identified multiple instances where this LPN had signed out narcotic doses between scheduled times for residents. Interviews with the involved residents confirmed they received their scheduled pain medications but did not receive any additional doses beyond what was ordered. When confronted with documentation showing narcotics signed out outside of scheduled doses, the LPN admitted in a written, signed statement that she had been taking narcotic medications from residents for her own use starting about two weeks after hire. A nurse described that narcotics were kept under double lock in medication carts, with each administration documented in a narcotic count book, and a random count of one cart on the day of survey was correct. The facility’s abuse policy defined misappropriation of resident funds or property as wrongful use of a resident’s property or money without consent, which was not adhered to in these instances.