Unauthorized Use and Poor Accounting of Resident Trust Funds
Summary
The deficiency involves the facility’s failure to properly manage resident personal funds, including making unauthorized purchases from resident trust accounts and failing to provide required quarterly account statements. For multiple residents, surveyors identified debits to online retailers that were not signed or authorized by the residents or their representatives, despite facility policy requiring such authorization via vouchers or check request forms. The facility also did not document that quarterly resident fund statements were sent to the residents or their representatives for the fourth quarter of 2025 and the first quarter of 2026. One affected resident had congestive heart failure, Alzheimer’s disease, and aphasia, was severely cognitively impaired, and required staff assistance with ADLs. This resident’s fund statement showed debits for online retailer purchases in specific amounts on two dates, and the resident’s representative had not authorized these transactions. The Administrator verified that these purchases were made from the resident’s funds without authorization and confirmed that quarterly statements for the relevant quarters had not been provided to the resident or representative. Another resident, cognitively intact with type 2 diabetes mellitus, PTSD, and osteoarthritis, had a substantial increase in account balance over a quarter, yet there was no documentation that quarterly statements were sent, which the Administrator also confirmed. Additional residents with varying levels of cognitive impairment and medical conditions, including type 2 diabetes mellitus, pulmonary hypertension, generalized anxiety disorder, epilepsy, end stage renal disease, aphasia following cerebral infarction, anxiety disorder, cerebral infarction, and Alzheimer’s disease, were similarly affected. Their quarterly fund statements showed multiple debits to an online retailer on various dates and in specific amounts, none of which were signed or authorized by the residents or their representatives. For each of these residents, record review showed no documentation that quarterly statements for the fourth quarter of 2025 or the first quarter of 2026 were sent, and in interviews, the Administrator consistently verified both the unauthorized nature of the purchases and the failure to provide the required quarterly statements. Review of the facility’s undated Resident Trust Funds policy showed that resident fund withdrawals were supposed to be supported by signed vouchers or check request forms and invoices, which was not followed in these cases. Across all six residents reviewed for this issue, the survey findings demonstrated that the facility did not maintain resident fund accounts using basic accounting principles as required by its own policy. Unauthorized online purchases were repeatedly charged to resident accounts without the required signatures or documented consent, and there was a systemic lack of documentation that quarterly fund statements were provided to residents or their representatives for two consecutive quarters. These actions and omissions formed the basis of the cited deficiency related to the management and safeguarding of resident personal funds.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
Failure to provide quarterly personal funds statements to designated representatives for several residents with severe cognitive impairment. A resident with dementia, another with Alzheimer’s disease and bipolar disorder, and a third with Alzheimer’s disease, schizophrenia, and CKD had personal funds accounts, but the facility could not show that required statements were sent to the proper contacts. The DSS said statements were supposed to be mailed for cognitively impaired residents, but documentation was missing and one resident’s rep said they never received any statements.
Failure to Provide Quarterly Personal Trust Fund Statements: The facility did not provide quarterly P&I account statements for 3 sampled residents. One resident had toxic encephalopathy, respiratory failure, and pulmonary disease with moderate cognitive impairment; two other residents were cognitively intact and able to make decisions. A third-party representative documented repeated requests for ledgers, but facility staff could not verify that statements were sent. The DON stated the facility had been without a permanent BOM for months and could not explain how quarterly statements were being ensured.
Failure to Provide Resident Fund Statements: The facility did not ensure that quarterly resident fund statements or statements upon request were provided to residents or their properly designated financial POAs. Several residents reported not receiving statements for their personal funds, and the BOM stated that statements were sent to POAs without distinguishing financial POAs from health care POAs. The facility also had no tracking to verify when statements were sent or to whom they were provided.
Failure to provide quarterly trust fund statements for two residents with facility-managed funds. One resident had severe cognitive impairment and the other had moderate cognitive impairment; records showed account activity, but the BOM stated statements were only given if requested, and family representatives confirmed they did not receive the required quarterly trust fund statements.
Incomplete personal funds statements were not provided for two residents whose money was managed by the facility. One resident had dementia-related cognitive impairment, and statements for several months were missing during a management transition. Another resident with normal cognition said he did not receive yearly statements, did not get a prior balance after the ownership change, and believed he was missing funds because monthly charges increased and credits were not shown. The BOM confirmed the statements were not fully available and the facility had no policy for personal funds accounting.
The facility failed to provide quarterly written accountings for resident trust funds and did not consistently give statements upon request. Residents with no cognitive impairment stated they had not received recent trust statements, one resident said it had been months and another said only one statement had been received in 2 years, and a family member for a cognitively impaired resident also reported not receiving a statement. The Administrator and CFO were unsure how prior statements were distributed, and the Administrator could not determine that the March statements were received.
Failure to Provide Quarterly Personal Funds Statements
Penalty
Summary
The facility failed to ensure that residents or their designated representatives received quarterly personal funds account statements for residents whose money was deposited with the nursing home. Record review and interviews showed that the facility could not provide documentation that quarterly statements were given to the designated representatives of Residents #74 and #101 for the quarters ending 06/30/2025, 09/30/2025, 12/31/2025, and 03/31/2026, and to the designated representative of Resident #15 for the quarters ending 09/30/2025 and 12/31/2025. Resident #101 had diagnoses including dementia, Type 2 diabetes, and epilepsy. The Minimum Data Set dated 03/25/2026 documented severe cognitive impairment and indicated that family involvement in care discussions was very important. The resident face sheet identified the resident's designated representative as the first contact and next of kin. During interview, the designated representative stated they were unaware the resident maintained a personal funds account at the facility and had never received quarterly account statements. Resident #15 had diagnoses including Alzheimer's disease, dysphagia following a cerebral infarction, and bipolar disorder, and the Minimum Data Set documented severe cognitive impairment. Resident #74 had diagnoses including Alzheimer's disease, schizophrenia, and severe chronic kidney disease, and the Minimum Data Set documented severe cognitive impairment and inability to report preferences related to clothing choice, family involvement in care discussions, and care of personal belongings. The Director of Social Services stated they were responsible for providing quarterly statements and believed statements had been mailed for Residents #15 and #74, but could not provide documentation verifying they were sent; they also stated quarterly statements were not mailed to Resident #101's designated representative because no mailing address was on file. The Administrator stated the Director of Social Services was responsible for mailing quarterly statements to the resident's designated primary contact and documenting compliance by retaining a photocopy of the dated mailing envelope.
Failure to Provide Quarterly Personal Trust Fund Statements
Penalty
Summary
The facility failed to provide quarterly statements for residents' personal trust fund accounts for 3 of 3 sampled residents. The report states that each resident with personal funds managed by the facility was supposed to receive an individual quarterly accounting showing the beginning balance, deposits, withdrawals, interest earned, ending balance, petty cash on hand, and total funds on deposit, but the facility did not provide those statements to the residents or their representatives. Resident 2 was admitted with diagnoses including toxic encephalopathy, respiratory failure, and pulmonary disease, and the MDS dated 4/1/2026 indicated moderate cognitive impairment and a need for moderate assistance with ADLs. Resident 3 was admitted with respiratory failure, contracture of the left ankle, and malignant neoplasm of the right kidney; the H&P dated 2/23/2026 stated the resident had capacity to understand and make decisions, and the MDS dated 11/8/2025 described the resident as cognitively intact and needing only supervision with most ADLs. Resident 4 was admitted with fibromyalgia, rheumatoid arthritis, and epilepsy; the H&P dated 4/14/2026 stated the resident had capacity to understand and make decisions, and the MDS dated 12/3/2025 described the resident as cognitively intact and needing only set up or clean up assistance for eating, oral hygiene, toileting, and dressing. A note transcript from the third-party representative documented repeated requests to facility staff for P&I ledgers and accounting information, including requests dated 12/29/2025, 01/28/2026, 03/25/2026, and 04/16/2026, with a note that prior requests had not been answered and ledgers dating back to November 2025 had not been received. During interviews, the regional office representative and the Facilities Regional Consultant could not verify that quarterly statements had been provided, and the DON stated the facility had been without a permanent BOM for approximately five months and could not explain how quarterly statements were ensured. Resident 2 stated she was unaware of her personal funds and had not received statements, while Resident 3 and Resident 4 each stated they had never received statements showing their account balances and wanted to know whether money was available in their accounts.
Failure to Provide Resident Fund Statements
Penalty
Summary
The facility failed to ensure that residents and/or their designated financial powers of attorney received individual quarterly resident fund statements, as well as fund statements or receipts upon request, for four of four residents reviewed for personal funds. R20 reported having $20 in the account and keeping a personal written record of spending, but stated that monthly statements were not received; R20 also had a financial POA. R16 reported not receiving statements for the account. R18 reported having $60 in the account and not receiving a statement from the facility. R4 stated that monthly or quarterly fund statements were not received. R4, R16, and R18 did not have financial POAs documented. The Business Office Manager stated that resident fund statements were sent to the resident's POA but that health care POAs were not distinguished from financial POAs. The Business Office Manager also acknowledged that statements were not provided directly to alert and oriented residents and had not previously considered doing so. In addition, although quarterly statements were printed, there was no documentation or tracking to verify when statements were sent or to whom they were provided. Review of R4's fund account statement showed Social Security deposits transferred to the facility for management, a $200 resident advance, and a remaining balance of $280, with no documentation showing the statement had been provided to R4 or to an appropriate financial POA.
Failure to Provide Quarterly Trust Fund Statements
Penalty
Summary
The facility failed to provide quarterly trust fund statements for two residents whose personal money was deposited with the nursing home. The facility policy dated April 2021 states that individual accounting records are to be available to the resident or representative through quarterly statements showing the beginning balance, deposits and withdrawals, interest earned, funds available through petty cash, and the total petty cash on hand. R12 had severe cognitive impairment per the MDS, and the record showed resident trust fund statements and resident account activity, but the Business Office Manager stated quarterly trust fund statements had only been provided to residents who asked for them and that no quarterly statements had been provided to R12's family representative. R13 had moderate cognitive impairment per the MDS, and although the record showed resident trust fund statements and account activity, the resident stated being unaware of any statements for the account. R13's family representative stated they did not receive statements, and the Business Office Manager confirmed quarterly statements had not been provided to that representative.
Incomplete Personal Funds Statements
Penalty
Summary
The facility failed to ensure complete and accurate personal funds accounting statements were provided for two residents whose money was managed by the nursing home. One resident had impaired cognitive function related to dementia, and the facility’s records showed that bank statements for February through June 2025 were not available. The Business Office Manager stated the facility had gone through a transition from one management company to another in February 2025 and acknowledged that quarterly account statements should have been provided to residents whose funds were managed by the facility, but confirmed the resident’s statements had not been issued as requested. The second resident had a Brief Interview for Mental Status score of 15 out of 15, indicating normal thinking and good memory. The resident stated he had not received statements for the year, had not received a previous balance before the ownership change, and believed he was missing $800 because of monthly overcharges. He reported receiving no statements in 2025 and said he could not see the credits, so he did not notice anything missing. The Business Office Manager provided photocopies of statements that did not include funds from previous ownership and stated the resident’s funds were still in transition, with prior account information and statements not available. The facility had no policy for accounting and personal funds.
Failure to Provide Quarterly Resident Trust Account Statements
Penalty
Summary
The facility failed to provide individual financial records for residents and/or their POAs in the form of quarterly statements and upon request for resident trust funds. The record review, resident and family interviews, staff interviews, and facility policy showed that residents with money deposited with the nursing home were not consistently given written accountings of their trust fund activity, even though the policy stated residents or authorized representatives could request an accounting at any time and that a written statement must be provided at least quarterly. Resident #2, whose MDS documented a BIMS of 15 with no cognitive impairment, stated the facility had not given her a quarterly statement for her resident trust account to show how much money she had in it. Resident #5, also with a BIMS of 15, stated she had not received a statement reflecting the amount in her resident trust account in a while and said it had been longer than 4 or 5 months since she received one, recalling only one statement in the last 2 years. Resident #5 also stated she would like to buy items at the facility, such as pop, if she had money. Resident #6, whose MDS documented a BIMS of 15, stated he kept money in the resident trust and used it to buy cigarettes, but it had been more than 3 months since he received a statement showing the amount in the account. He stated the facility told him they did not know how much he had in his resident trust since the new company took over in March, and he only learned the amount the day before the interview. Resident #7's family member, for a resident with a BIMS of 5, stated the resident had money in resident trust but the family member did not receive a statement with the amount. The Administrator and Staff G stated quarterly statements should be generated, but they were not sure how the prior process worked or whether the March 31 statements were distributed, and the Administrator later stated she could not determine that residents received the trust statement.
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