Health inspection·August 21, 2025

F 0569 Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to: (1) return resident trust fund balances for 46 residents (R1, R5-R49) reviewed for trust fund balances after being discharged /expired 30 days; and, (2) provide notification or trust fund balances reaching $200 less than the SSI/Supplemental Security Income resource limit for three residents (R2, R3, and R4), of 111 residents, reviewed for trust fund account balances, in a total sample of 111 residents. FINDINGS INCLUDE: 1) The facility admission Contract document: V. Deposits and Refunds: The Facility hereby acknowledges receipt of the deposit, if any, noted at the beginning of the contract. Any refund owed to the Resident for advance payments shall be paid by the Facility within forty-five (45) days after discharge or transfer or within the time frame required by State law. In the case of Medicaid residents, any such refund will be paid within thirty (30) days of the Facility's receipt of the final Medicaid payment for care of the Resident or as directed by the Department of Public Aid. The facility policy, entitled Resident Trust Fund Account, document: 10. All facilities should dispose of any remaining resident's funds in accordance with State, Medicaid and Federal specific regulations within 30 days of discharge or expiration; and Uncashed Checks: Payees will be contacted regarding checks issued to close a resident trust account that have not be cashed within 2 months of being issued. Checks will be voided and reissued as necessary. If unable to contact payees within 6 months of issuing a check that has not yet been cashed, the check will be voided and turned over to the State Unclaimed Property Division.On [DATE], at 9:00 a.m., V8/Complainant-R1's daughter confirmed money in R1 Resident Trust Fund has not been returned, within 30 days of R1's discharge on [DATE].R1's Electronic Medical Record/EMR document, R1 was admitted , to the facility, on [DATE] and discharged on [DATE].R1's admission Contract was signed, by R1, on [DATE].R1's Resident Trust Fund Current Balance Report, as of [DATE], indicates a balance of $69.00. There is no evidence in R1's record that indicates R1's remaining balance was refunded.In addition, the EMR's for R5-R49, document the following dates of discharge [or expiration/death] and the Current Balance Report dated [DATE], document the balances remaining in their trust fund account: R5-[DATE] $61.87; R6-[DATE] $52.00; R7-[DATE] $39.60; R8-[DATE] $98.01; R9-[DATE] $105.00; R10-[DATE] $37.00; R11-[DATE] $708.30; R12-[DATE] $78.00; R13-[DATE] $26.00; R14-[DATE] $10.00; R15-[DATE] $35.00; R16-[DATE] $9.00; R17-[DATE] $30.00; R18-[DATE] $10.00; R19-[DATE] $100.00; R20-[DATE] $169.00; R21-[DATE] $66.00; R22-[DATE] $36.00; R23-[DATE] $6.00; R24-[DATE] $6.00; R25-[DATE] $8.00; R26-[DATE] $120.08; R27-[DATE] $54.02; R28-[DATE] $26.00; R29-[DATE] $0.87; R30-[DATE] $40.00; R31-[DATE] $103.46; R32-[DATE] $3.00; R33-[DATE] $0.25; R34-[DATE] $47.00; R35-[DATE] $153.27; R36-[DATE] $37.00; R37-[DATE] $29.00; R38-[DATE] $1,797.00; R39-[DATE] 288.00; R40-[DATE] $150.01; R41-[DATE] $2.00; R42-[DATE] $100.00; R43-[DATE] $10.00; R44-[DATE] $48.00; R45-[DATE] $12.00; R46-[DATE] $40.00; R47-[DATE] $39.00; R48-[DATE] $46.00; and R49-[DATE] $9.97 On [DATE], at 12:00 p.m., V1 confirmed refunds are needed to be made for the residents discharged /expired. On [DATE], at 9:00 a.m., Residents Affected - Many Page 1 of 2 145598 145598 08/21/2025 Seminary Manor 2345 North Seminary Street Galesburg, IL 61401

F 0569 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many V1/Administrator confirmed V1 and V5/Corporate Accounts Receiving verified the Current Balance Report, dated [DATE], which documents resident trust fund balances. 2)) The facility policy, entitled Resident Trust Fund Account, document: 9. Notification of Responsible Party for SSI Resource Limit / Personal allowance. When a Medicaid Resident's RTF [Resident Trust Fund] account reaches $200.00 less than the SSI resource limit, the RTF Custodian will notify the Resident, Legal Representative, and Social Services. The Social Security Administration website, document the individual resource limit is $2000.00 The facility document, entitled Current Balance Report, dated [DATE] document the following individual balances which exceed the SSI resource limit: R2 $2925.88; R3 $4450.68; and R4 $3449.00. On [DATE], at 12:00 p.m., V1/Administrator confirmed R2, R3, and R4's trust fund accounts exceed the SSI resource limit. During this interview, V3/Business office Manager confirmed V3 started in V3's position four months ago; V3 is still training/learning; and V3 was unaware of the SSI resource limit. On [DATE], and 10:47 a.m., V1 confirmed there is no written documentation that R2, R3, and R4, were notified that their accounts reached the $200.00 less than the SSI resource limit. 145598 Page 2 of 2