Resident Trust Funds Exceeded Medicaid Asset Limit
Summary
The facility failed to maintain resident trust fund balances under the $2,000 Medicaid asset limit for 10 of 111 sampled residents. Review of the American Council on Aging website showed that in 2026, a single Medicaid nursing home applicant in Tennessee must have assets under $2,000. Medical record and trust fund statement reviews showed multiple residents had balances above that limit, including residents with diagnoses such as atrial fibrillation, dementia, depression, dysphagia, anxiety, hemiplegia, heart failure, diabetes, chronic kidney disease, anemia, bipolar disorder, chronic respiratory failure, Parkinson’s disease, traumatic subdural hemorrhage, malnutrition, and hypertension. Resident trust fund statements dated 4/22/2026 showed balances of $4,945.96 for Resident #11, $7,764.26 for Resident #16, $3,324.09 for Resident #38, $2,950.01 for Resident #86, $5,350.97 for Resident #92, $3,874.46 for Resident #101, $3,931.97 for Resident #110, $2,769.53 for Resident #119, $5,911.60 for Resident #128, and $9,020.33 for Resident #177, all above the $2,000 limit. During interview, the BOM stated the resident trust account limit was $2,000.00, and the Administrator also stated resident trust accounts should be under $2,000.00.
Penalty
Resources
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A resident with Alzheimer’s disease, severely impaired cognition, and documented communication problems was discharged with a remaining balance of $179.33 in a personal funds account. The facility’s own Resident Rights policy required that such funds be returned within 30 days of discharge, but the account was not closed and the refund check was not issued until more than a month after discharge. This delay in returning the resident’s personal funds was confirmed by the Regional Business Office Manager and constituted a failure to ensure timely distribution of personal funds after discharge.
Residents were charged monthly bank service fees against their personal funds, but the facility had no evidence that residents or their representatives were told in advance about these charges. Record review showed multiple residents with diagnoses including CHF, DM, dementia, Alzheimer’s disease, depression, paraplegia, and disorientation had bank service charges on their statements, and business office staff confirmed the fees varied by account balance and that they were unaware whether residents had been notified.
Unequal Allocation of Resident Trust Account Interest: Interest from the shared resident trust account was not credited equitably to individual resident trust accounts for four residents. Review showed interest was added randomly instead of being based on each account’s balance, and the SSD, ALD, and Administrator confirmed interest was distributed by alphabetical lists rather than by calculation of individual balances.
Residents were unable to access their personal funds outside of regular business office hours, as confirmed by staff and resident interviews. Personal funds were not available after 4:00 P.M. on weekdays, nor on weekends or holidays, and there was no alternative method for residents to obtain money when the business office was closed.
A resident's right to manage their own financial affairs was not honored, resulting in a violation of federal regulations regarding resident autonomy.
A resident with depression and quadriplegia did not receive a required $50 social security allowance for one month after a delay in the deposit of their check. The facility's system failed to recognize the need for a retroactive payment, resulting in the resident not receiving the allowance for that period, as confirmed by business office staff and record review.
Failure to Timely Return Discharged Resident’s Personal Funds
Penalty
Summary
The facility failed to honor a resident’s right to timely management of personal funds by not returning the resident’s personal funds account balance within 30 days of discharge. The resident, who had Alzheimer’s disease with late onset and severely impaired cognition as evidenced by a BIMS score of three, also had documented communication problems related to Alzheimer’s disease, dementia with behavioral disturbances, and a psychotic disorder with delusions, requiring staff to use simple questions, allow adequate response time, and verify understanding. At the time of discharge, the resident’s fund management services ledger showed an account balance of $179.33. However, the account was not closed and the refund check for the full balance was not issued until 37 days after discharge, contrary to the facility’s Resident Rights policy, which required that resident funds be returned within 30 days. The Regional Business Office Manager confirmed that the account was not closed and the refund was not issued within the required timeframe. This deficiency was identified during a complaint investigation and involved one of three residents reviewed for personal funds accounts, with a facility census of 141.
Residents Not Informed of Banking Service Fees
Penalty
Summary
The facility failed to ensure residents or their resident representatives were informed in advance of charges that could be imposed against residents’ personal funds. Record review showed that Resident #8, who had diagnoses including congestive heart failure, insomnia, diabetes, and transient ischemic attack, had a quarterly banking statement with a $7.05 bank service charge. Resident #5, with diagnoses including cognitive communication deficit, major depressive disorder, and paraplegia, had a $5.47 bank service charge on the banking statement. Resident #22, who had diagnoses including dementia, anxiety, Alzheimer’s disease, and major depressive disorder, had a $1.23 bank service charge, and the Personal Funds Disposition Form for this resident stated the resident and/or representative authorized the facility to manage personal funds while residing in the facility. Resident #35, who had diagnoses including restlessness and agitation, wandering, diabetes, anxiety, Alzheimer’s disease, and disorientation, had a $0.12 bank service charge on the banking statement. Interview with business office personnel confirmed that a banking service fee was charged to each resident, that the fee came from the bank and varied by resident based on account balance, and that staff were unaware whether residents had been notified about the fee. Review of the admissions packet, admission agreement cheat sheet notes, and facility rules, regulations, policies, and procedure guides found no evidence that residents or their representatives were made aware in advance of the monthly banking service fee charged by PNC Bank for managing resident funds.
Unequal Allocation of Resident Trust Account Interest
Penalty
Summary
The facility failed to equitably credit interest earned from the shared resident trust account to individual resident trust accounts for four residents out of 42 residents with accounts. Review of the trust account statements for Residents #8, #39, #46, and #51 showed that interest was added randomly rather than being calculated based on the balance of funds in each account. During interview, the SSD and ALD confirmed the facility did not calculate interest based on individual account balances and instead awarded interest monthly by alphabetical lists, with the accounts managed by the facility broken into fourths and rotated through each list quarterly. They also confirmed no calculations were made of account balances and that interest was awarded solely based on the alphabetical lists. The Administrator confirmed the facility had not allocated interest to the individual resident trust fund accounts in an equitable manner and that interest should be calculated based on the balance of the individual resident account.
Failure to Provide Resident Access to Personal Funds After Business Hours
Penalty
Summary
The facility failed to make residents' personal funds available outside of regular business office hours, affecting three residents reviewed for access to their funds. Residents reported being unable to obtain money from their personal accounts after 4:00 P.M. on weekdays, as well as on weekends and holidays, due to the business office being closed. Staff interviews confirmed that personal funds are not kept in the medication cart or otherwise accessible when the business office is closed. One resident was unaware of how much money was available or how to access it, only knowing that someone would assist with purchases when needed. Observations confirmed that posted banking hours were limited to Monday through Friday, 8:00 A.M. to 4:00 P.M., and that the business office was inconsistently open during the survey period.
Failure to Honor Resident's Right to Manage Financial Affairs
Penalty
Summary
A deficiency was identified regarding the facility's failure to honor a resident's right to manage his or her own financial affairs. The report notes that the resident's autonomy in handling personal finances was not respected, which is a violation of resident rights as outlined in federal regulations. No additional details about the specific actions or inactions, the resident's medical history, or their condition at the time of the deficiency are provided in the report.
Failure to Provide Resident Social Security Allowance Due to Missed Retroactive Payment
Penalty
Summary
The facility failed to ensure that a resident had access to his social security allowance as required. The resident, who was cognitively intact and had diagnoses including depression and quadriplegia, had his social security check for February recalled by Social Security and not deposited until April. As a result, the system did not recognize that the resident should have received his $50.00 allowance retroactively for February. The resident did not receive this allowance, even though subsequent months' allowances were properly allotted and withdrawn by the resident as documented by signed receipts. Interview with the Regional Business Office Manager confirmed that the oversight occurred because the system did not account for the late deposit of the February check, and the resident was not given his $50.00 allowance for that month. This deficiency was identified during a review of the resident's personal fund statements and was verified through interviews and record review.
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