Failure to Maintain Separate Resident Fund Accounts and Issue Timely Refunds
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.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
Failure to provide a resident’s representative timely access to trust funds. A resident with dementia had a court-appointed conservator who requested a check from the resident trust account to cover the resident’s bills, but the AP manager said the facility would not send the money to the conservator’s office. The conservator reported repeated calls and emails went unanswered, and the ADM said he had received the request but had not read it because staff were handling it.
Failure to promptly refund an overpayment of room and board charges for a resident. The resident’s representative paid more than the amount billed, creating a $2,720 overpayment, and later reported repeatedly requesting the money be returned after discovering the error during tax review. The ADM stated an audit found incorrect room rates in the system and corporate directed the facility to apply the overpayment to a billing mistake.
Failure to obtain written authorization before depositing a resident’s pension funds into the facility operating account. A cognitively intact resident with dx including dementia, DM, COPD, and obstructive uropathy said a pension check addressed to him/her was opened by the BOM and deposited without permission, leaving the resident upset that mail was not delivered and money was taken without authorization. The BOM said the resident brought in the check and asked for it to be deposited, but there was no signed receipt, no endorsed check, and no authorization on file.
Failure to Monitor Resident Trust Fund Deposits: A resident with severe cognitive impairment, dementia, and disorientation had authorized the facility to manage personal funds and receive monthly income on the resident’s behalf. The facility failed to notice that two pension checks stopped being deposited into the resident’s trust account, while funds continued to be used for patient liability, insurance premiums, and personal needs. Staff stated the missing deposits were not identified until the account balance had significantly declined, and the BOM and Administrator acknowledged the account should have been reviewed and reconciled monthly.
A resident with severely impaired cognition and diagnoses including schizoaffective disorder, anxiety, alcohol dependence, and dementia was allowed to sign financial documents despite prior guardianship history. Financial records showed the resident signed an authorization to manage funds and later refused to sign trust account statements, and the DON confirmed the facility permitted the resident to sign her own financial documents.
Failure to Provide Access to Resident Surplus SSI/SSA Funds: The facility did not provide surplus SSI/SSA funds on demand for three residents who had authorized the facility to manage their funds. A resident reported being denied access to surplus funds, and the BOM confirmed the funds were not available until later because the prior owner did not send the SSI/SSA money until after the month in question; the first disbursement of surplus funds occurred later.
Failure to Provide Representative Access to Resident Trust Funds
Penalty
Summary
The facility failed to ensure timely access to one resident’s personal funds by the resident’s representative. The resident was admitted with dementia, and the record showed that a county conservator was appointed for the resident and asked to be added as the responsible party. A later letter from the conservator requested that the facility return $1,300 from the resident trust account because the balance had continued to increase, and asked that the check be made payable to the resident and sent to the conservator’s office for use in paying the resident’s bills. During interviews, the AP manager stated the conservator handled the resident’s money and had requested that the facility send money from the resident’s facility account to the conservator’s office, but the facility could not do that. The AP manager further stated the Administrator said the facility would not send money to the conservator because it was the resident’s money. The conservator stated they were responsible for the resident’s finances, monitored the resident’s account, requested checks when funds exceeded a certain amount, and needed the money to pay the resident’s bills, but the facility never responded to calls and emails. The Administrator stated he had received an email from the conservator but had not read it because his team was handling the issue, and he acknowledged receiving a May 2026 email requesting a check be sent in the resident’s name to the conservator’s office.
Failure to Promptly Refund Resident Overpayment
Penalty
Summary
The facility failed to promptly refund an overpayment of monthly charges for one resident, R2, whose representative paid $12,650.00 for room and board on 2/28/24 while the resident’s transaction report showed the monthly room and board charge was $9,920.00. The cancelled check signed by R2’s representative matched the payment amount, creating an overpayment of $2,720.00. R2’s census documents show the resident was admitted to the facility on [DATE] and was in a private room with a shared bath, while the signed contract dated 6/10/22 documented a semiprivate room with a shared bath. On 6/17/26, R2’s representative stated she was not aware of the overpayment until reviewing taxes and had repeatedly requested that the overpayment be returned. She also stated she had been told by corporate that the facility made a mistake and undercharged for the room type, and that she had paid the amount billed every month since R2 came to the nursing home. The Administrator stated that in May the facility audited room rates and found two residents with incorrect rates in the system, including R2, and that corporate instructed the facility to apply the overpayment to the billing mistake made by the business office. The facility’s resident funds policy states a resident may designate a representative to manage personal funds and that the resident and/or representative are provided quarterly accounting reports and upon request.
Failure to Obtain Authorization Before Depositing Resident Pension Funds
Penalty
Summary
The facility failed to obtain written authorization from a resident before depositing the resident’s pension personal funds into the facility operating account. Facility policy stated that residents are not required to deposit personal funds with the facility, and if they choose to do so, the facility must keep the funds in a separate interest-bearing account and maintain a copy of the resident’s or representative’s authorization in the financial record. Review of the resident’s trust fund authorizations showed no authorization in place for the facility to manage the resident’s pension check. The resident’s quarterly MDS dated 3/30/26 showed the resident was cognitively intact and had diagnoses including obstructive uropathy, diabetes, dementia, and COPD. During interview, the resident stated a pension check addressed to him/her was not delivered and was instead taken to the BOM, who opened the mail and deposited the check into the facility bank account without permission or a signature. The BOM stated the resident brought the pension check to her and told her to deposit the full amount into the operating account to offset what was owed, but she did not have a signed receipt, a signed endorsement on the check, or a signed authorization allowing the facility to manage the resident’s pension check. The operating fund record showed a deposit of $283.59 from the resident’s check with no endorsement signature or receipt on file.
Failure to Monitor Resident Trust Fund Deposits
Penalty
Summary
The facility failed to identify and act upon interruptions in monthly funds being deposited into one resident’s trust fund after it had assumed fiduciary responsibility for the resident’s personal funds. The resident had severe cognitive impairment with a BIMS score of 5, diagnoses including type 2 diabetes mellitus, hypertension, major depressive disorder, anxiety, altered mental status, and dementia, and lived in the facility’s secure unit with wandering risk, disorientation, and impaired safety awareness. The resident’s admission agreement showed the resident’s POA authorized the facility to manage personal funds and receive funds on the resident’s behalf for deposit into a resident trust account. The resident’s trust fund ledgers showed the resident had been receiving Social Security and two pension checks totaling $175.23 in pension income each month, but beginning in December 2025 the pension checks were no longer received by the facility and were not deposited into the resident’s trust fund account. The account balance decreased from $963.96 on 11/30/2025 to $138.78 on 5/31/2026, while the facility continued paying the resident’s patient liability, insurance premium, and personal needs allowance from the account. The Business Office Manager stated the facility did not notice the pension checks had stopped because the resident still had enough funds to pay bills and there was money left in the account. During interviews, the Business Office Manager stated the facility should have noticed the checks stopped coming and should have contacted the POA when the deposits ceased, but the first contact with the POA occurred only after the issue was discovered in May 2026. The Administrator stated the facility should have identified the missing checks by reviewing the resident’s trust fund account and looking for money depletion, and that the PTF accounts should be reviewed and balanced each month. The facility policy stated that when the resident authorizes it, the nursing facility shall hold, safeguard, manage, and account for the resident’s personal funds, and that ledger and bank accounts are reconciled monthly.
Resident with Severe Cognitive Impairment Allowed to Sign Financial Documents
Penalty
Summary
The facility failed to ensure that a resident with severely impaired cognition was not permitted to sign financial documents. Resident #66 was admitted with diagnoses including schizoaffective disorder-bipolar type, anxiety disorder, alcohol dependence, and dementia with mood disturbance, and the admission MDS showed severely impaired cognition. Guardianship records showed the resident previously had a temporary guardian, and financial records showed the resident signed an Authorization to Manage Resident Funds and later refused to sign trust account statements. The Administrator stated that the resident's niece initially volunteered for guardianship, the resident's daughter objected, and the facility assisted the daughter in obtaining guardianship, although the daughter had not been involved in the resident's care at either the prior or current facility before that time. The guardianship order later appointed the daughter as guardian, and the Administrator confirmed the facility allowed the resident to sign her own financial documents despite the severely impaired cognition.
Failure to Provide Access to Resident Surplus SSI/SSA Funds
Penalty
Summary
The facility failed to honor residents’ right to manage their financial affairs by not providing access to surplus SSI/SSA funds on demand for April 2026 for 3 of 14 residents reviewed, including Residents #3, #11, and #13. A complaint reviewed by surveyors alleged that the facility did not provide resident surplus SSI/SSA funds when requested. Resident #3 stated that he/she was denied access to surplus SSI/SSA funds for April 2026 and said the facility did not inform him/her that access would not be available after the change in ownership in February 2026. The Administrator stated he/she was unaware of any financial issues with resident accounts and said resident funds were managed through the Business Office Manager. The Business Office Manager confirmed that the facility was responsible for resident funds and distributing surplus SSI/SSA funds for residents who had given permission for the facility to manage those funds. He/she stated the former owner did not send the residents’ SSI/SSA funds until 4/17/26, so surplus funds were not available to residents until 5/1/26, and the facility under the new owners could not issue checks until 6/1/26. Financial statements for Residents #3, #11, and #13 confirmed that SSI/SSA funds were not available for facility use until 4/17/26 and that the first disbursement of surplus SSI/SSA funds did not occur until 5/1/26.
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