Failure to Thoroughly Investigate Report of Missing Resident Money
Penalty
Summary
The deficiency involves the facility’s failure to conduct a thorough investigation into a cognitively intact resident’s report of missing money. The resident was admitted for orthopedic aftercare and had an admission MDS BIMS score of 14/15, indicating intact cognition. On 02/13/26 at approximately 5:30 PM, the resident reported to a facility nurse that $115.00 was missing from their wallet and stated the last time they saw the money was about a week earlier. The facility initiated an investigation, notified the police, and conducted a thorough search of the resident’s room. Staff who worked on the unit between 02/06/26 and 02/13/26 were interviewed, but the missing money was not found. Despite these steps, the investigation did not include interviews with other residents on the unit to determine whether there were additional reports of missing money or property, or to identify any related concerns, risks, or trends. The facility’s policy on abuse, neglect, misappropriation, exploitation, resident-to-resident altercations, injury of unknown origin, and caregiver misconduct, last reviewed on 08/07/25, states that monitoring will include identification of any department, caregiver, and/or resident trends. On 03/17/26, the surveyor reviewed the investigation and confirmed that other residents on the unit had not been interviewed as part of this incident. During interviews on that date, the Nursing Home Administrator and Social Services staff acknowledged that residents were not specifically interviewed in connection with this investigation.
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