F0602

D

Misappropriation of Narcotic Medication and Healthcare Spending Cards by Staff

Fayetteville, North Carolina Survey Completed on 03-13-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to protect residents from misappropriation of their property, including a controlled substance and healthcare spending cards. For one resident receiving Oxycodone 10 mg every 4 hours as needed for pain, the contracted pharmacy documented delivery of 180 tablets, but the packing slip was not signed by a receiving nurse. A nurse working the day shift reported that at the end of her shift she counted 103 Oxycodone tablets for this resident on the narcotic cart with another nurse who presented herself as the oncoming agency nurse, took the keys, and assumed control of the cart. The following morning, another nurse reported that the resident had no Oxycodone available. Statements indicated that when the night nurse later counted narcotics with the next nurse, all narcotic counts and sheets matched what was called out, but there were no medications or narcotic sheets for this resident. The Quality Assurance nurse reported that the nurse who had taken over the cart was not actually scheduled to work that shift, had previously worked as an agency nurse, and left within about an hour of assuming the cart, after which the Oxycodone tablets and narcotic sheets for this resident were discovered missing.

The deficiency also includes misappropriation of healthcare spending cards belonging to two cognitively intact residents by an Activities Assistant. One resident reported that her healthcare spending card, which she kept in a wallet in the bottom drawer of her nightstand, was missing and could not be located when staff searched her room. The resident’s insurance provider confirmed that the card had been used at a local retail store for a transaction of $95.00. The Activities Assistant stated that the resident had given her permission to take and use the card to purchase items for the resident and claimed she returned the card and cash, explaining that about $50.00 represented her portion of the items purchased. The resident denied giving permission for the Activities Assistant to take or use the card, denied knowing the Activities Assistant had possession of the card, and denied receiving any cash. The resident reported that the Activities Assistant later told her the purchases were made because the Activities Assistant’s children were hungry, and the resident expressed disappointment and concern that a similar incident could occur again.

During the investigation of this first misappropriation, the facility identified a second cognitively intact resident whose healthcare spending card had also been used without permission. This resident had previously reported her card as misplaced to the Activities Assistant, who assisted her in canceling the card and ordering a replacement. Transaction records showed that the card had been used for multiple in-store purchases totaling $337.01, both before and after it was identified as missing. The resident stated she never made any in-store purchases with the card and that her last use of the card was for an online purchase with the help of the Activities Assistant. She reported being upset and believed the Activities Assistant should be held accountable for using her card without permission. The Activities Director confirmed that the Activities Assistant facilitated online shopping for residents using a tablet and that healthcare spending cards were supposed to be used only when the resident was present during the transaction. The Activities Director also reported that the Activities Assistant later claimed to have gone to a store after hours for one resident with alleged permission to use the card, while the resident denied granting such permission.

The Administrator stated that her expectation was that all staff follow the facility’s policy related to misappropriation of resident property. The facility’s abuse policy defined misappropriation as the deliberate misplacement, exploitation, or wrongful use of a resident’s money or belongings and affirmed residents’ right to be free from misappropriation of their property. Despite this policy, the events described show that a resident’s narcotic pain medication and two residents’ healthcare spending cards were wrongfully taken or used without their knowledge or consent, constituting misappropriation of resident property.