Health inspection·January 19, 2023

Regulation: §483.12 The facility must ensure that - The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. On 10/18/22, at 12:45 p.m., an unannounced visit was conducted at the facility to investigate an allegation of financial abuse. The facility failed to prevent a financial abuse for one of three residents (Resident 1), including but not limited to: 1. The previous Business Office Manager (BOM) A did not follow deposit processes after receiving blank checks from Resident 1's daughter and deposited Resident 1's checks into her personal bank account; 2. Business office staffs did not verify deposit slips and checks per their policy; 3. Business office staffs did not maintain copies of each deposit slip, receipt, and check in the month end closing folder per their policy; and, 4. The accounting department did not audit timely. This resulted in Resident 1's share of cost payments were not deposited into resident's account and left an outstanding balance on her account after she was discharged from the facility. It also had the potential to negatively affect resident's emotional wellbeing. Findings: Review of the facility reported Incident (FRI), dated, 8/2/22, stated "The facility had found reasonable suspicion that our previous Business Office manager [name of the manager] has committed financial abuse against one of our previous residents [Resident 1's name]. The resident is currently residing at a different skilled nursing facility [name of the facility] ...It was found that [the previous business office manager's name] deposited four of [Resident 1's name]'s share of cost checks into her personal bank account... Upon an audit of [Resident 1]'s account, it was found that she has an outstanding balance." It stated the current Business Office Manager (BOM) B sent a statement to Resident 1's daughter, upon receipt of the statement, the resident's daughter informed BOM B and the Administrator (ADM) that she had paid the share of cost every month with both check and cash payments since her mother had been at the facility. It stated "Upon further investigation and cooperation with the resident's daughter, the facility can substantiate that financial abuse had occurred" by BOM A. A review of Resident 1's Face sheet (a document that gives a resident's information at a quick glance, including contact details and a brief medical history) indicated, the resident was admitted to the facility on 5/20/18 and discharged to an acute care hospital on 3/6/22. Resident 1's daughter was next of kin (a person's closest living relative), who was also in charge of resident's finances. A review of Resident 1's cashed checks that the facility provided indicated: - Resident 1's personal check, dated, 7/3/21, indicated it made out to BOM A's name for $1896. A note under the comment section indicated, "[Resident 1's name]'s rent". - Resident 1's personal check, dated, 8/6/21, indicated it made out to BOM A's name for $1896; - Resident 1's personal check, dated, 9/15/21, indicated it made out to BOM A's name for $1896; and, - Resident 1's personal check, dated, 10/15/21, indicated it made out to BOM A's name for $1896. It further indicated the checks were signed by Resident 1's daughter and on the back of the checks, it had BOM A's signatures. A review of Resident 1's share of cost statements indicated: - On 6/23/21, there was a balance of $798 due; - On 7/31/21, the share of cost for 8/2021 was $1896 charged and the total balance was $2694. There was no evidence Resident 1's check, dated 7/3/21, was deposited to the resident's account; - On 8/31/21, the share of cost for 9/2021 was $1896, and the total balance was $4590. There was no evidence Resident 1's check, dated 8/6/21, was deposited to the resident's account; - On 9/21/21, the share of cost for 10/2021 was $1896, and a total balance was $2656 There was no evidence Resident 1's check, dated 9/15/21, was deposited to the resident's account; - On 10/26/21, the share of cost for 11/2021 was $1896, and a total balance was $4552. There was no evidence Resident 1's check, dated 10/15/21, was deposited to the resident's account. - On 4/20/22, after the resident was transferred to another facility, there was a balance of $3517.80 due. During an interview on 10/5/22, at 1:35 p.m., with BOM A, she stated Resident 1's daughter trusted her, gave her blank checks to pay for resident's share of cost when she was working at the facility in 2021, and she deposited the checks into her personal bank account. She admitted it was a mistake and she should have not done it. During an interview on 10/18/22, at 1:37 p.m., with the Director of Nursing (DON), he stated BOM A voluntarily quit in January 2022, Resident 1 was transferred to the hospital for a change of condition in March 2022 and was discharged from the facility to another skilled nursing facility. BOM B found out there was an outstanding balance on Resident 1's account in April 2022, and she reported it to the ADM. Upon investigation, the facility found that Resident 1's account was affected, and the facility had validated the financial abuse incident between BOM A and Resident 1, they called police department and reported the incident to California Department of Public Health (CDPH) right away when they determined it was an abuse case. He further stated, business office should have settled the account for outstanding balance upon discharge. During an interview on 10/18/22, at 1:47 p.m., with BOM B, she stated she noticed there was a remaining balance on Resident 1's account in the end of April, then she informed the ADM, she also contacted the resident's daughter. During an interview on 10/20/22, at 11:13 a.m., with DON, he stated the Resident1's daughter received a statement for an outstanding balance due in March, and again in April 2022. Resident's daughter called the facility to question why she was receiving a statement in April because she believed she had paid all share of cost owed in full. This prompted the facility to initiate internal research into past payments Resident 1's daughter claimed to have made. The facility worked with the daughter to trace checks she had provided to the facility, and she was able to provide the four cashed checks in July 2022 which made out to BOM A. Once the facility had this definitive proof that the checks had not been paid to the facility as intended, and then the matter was reported to authorities. During a concurrent interview and record review on 1/3/23, at 1:50 p.m., with BOM B, she stated, she was the bookkeeper back in March 2021 when she was working with BOM A, but she was not handling any funds. She was mainly in charge of insurance authorization. She stated when depositing a personal check, facility stamp should be on the back of the check. She further stated facility name should be always on the "Payable To" section of the check, if business office personnel received a blank check, they should inform the payer to properly fill out the check. She stated she could not provide monthly auditing reports, because the audits were not done between June 2021 and August 2022. She further confirmed BOM A should have copied the personal checks she received from Resident 1's daughter and she also should have had the other business office staff to verify the checks. During a concurrent interview and record review on 1/3/23, at 2:40 p.m., with Registered Nurse Consultant (RNC), she stated if the incident affected and involved in Resident 1 and her finance, it should be identified as an abuse. She also confirmed State of California (SOC - Report of Suspected Dependent Adult/Elder Abuse) 341, dated 8/1/22, indicated, the reported incident was a financial abuse, and abuse should not happen to the resident. A review of the facility's Policy, "Cash Receipts - Deposits and Posting", effective 8/2016, indicated, the business office is primarily responsible receiving payments from primary, secondary and tertiary payers, in addition to cash payments from patients and their representatives. The accounting department is responsible for auditing and reporting to the Business Office any discrepancies if found. The BOM and/or bookkeeper are responsible for keeping accurate records and making sure that all accounts are relieved as payments are received. It indicated "Business Office Responsibility... Depositing Payment...Personal checks: To avoid any discrepancies between the written (legal) and numerical amount on a check, each check should be reviewed prior to acceptance from the payer, prior to making the deposit, each check is copied as backup for the deposit total. The bookkeeper is responsible for generating an itemized deposit slip for the payment(s), adding each deposit item on a printed adding machine tape to verify totals, clipping that tape to deposit slip along with the check, and having that tape verified by another Business Office Staff member. Copies of each deposit slip, receipt and check are all attached and maintained in the month end closing folder, the deposit is then taken to the back by a staff member that was not the same person who generated the back deposit. The back website will issue a receipt for the deposit with the total amount, date and time deposited. This receipt must be attached to the deposit copies and maintained in the month end closing folder. End User Responsibility: after the back deposit has been made... Personal Check: If the patient or patient's representative pays with a personal check, the payment is posted using the deposit date as the transaction date. The money posted to the dates of service that are outstanding... Accounting for payment: Balancing: Each deposit must be entered on the Cash Summary Sheet on a daily basis. The Cash Summary is maintained on each facility's server with access to it by the user, the AR Consultant, and Accounting. Month End: as part of the month end closing procedure, all deposit totals are entered on the month end closing checklist, summarized by payer. The total on the checklist must match the total on the Cash Summary, which must match what was entered into the AR software. Recording: All deposits, with the backup documentation are maintained within the month end closing folder for not less than seven (7) years." A review of the facility's policy, "Identifying Exploitation, Theft and Misappropriation of Resident Property", dated April 2021, indicated, "1. Exploitation, theft and misappropriation of resident property are strictly prohibited... 3. Exploitation means taking advantage of a resident for personal gain, through the use of manipulation, intimidation, threats or coercion. 4. Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings or money without the resident's consent." In violation of the about cited standards, the facility failed to prevent a financial abuse for Resident 1. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of patients or residents.