Other·May 17, 2024

42 CFR § 483.12 - Freedom from abuse, neglect, and exploitation (b) The facility must develop and implement written policies and procedures that: (1) prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property. Health & Safety Code Section 1418.91 (a) A long-term health care facility shall report all incidents of alleged abuse or suspected abuse of a resident of the facility to the department immediately, or within 24 hours. Health & Safety Code Section 1418.91 (b) A failure to comply with the requirements of this section shall be a class "B" violation. Findings On 8/22/2023, an unannounced visit was conducted at the facility to investigate a facility reported incident regarding misappropriation of Patient 1's funds. The facility failed to report suspected financial abuse (misappropriation of resident property) to the Department within 24 hours, as required per regulation, and per their own policy and procedures, when Patient 1's family member (DPOA- Durable Power of Attorney- person legally appointed to manage the finances and/or make healthcare decisions for another individual) did not consistently pay Patient 1's residential fees. The alleged financial abuse was identified by Finance Case Worker (FCW) 1 on 8/25/2022 and was not reported to the State Agency (CDPH) until 7/19/2023, 327 days after the mandated reporting timeframe, when the amount of misused funds identified totaled $11,801.21. Review of Patient 1's clinical record indicated Patient 1 was admitted to the facility on 2/20/2001, with diagnoses that included severe cognitive impairment (problems with memory and thought processes). A review of the facility document to calculate Patient 1's monthly fees, effective 1/1/2022, indicated Patient 1's monthly income of $1,688.74, and total monthly fees (residential fees) of $1,012.02. A review of the facility's Delinquent Fees spreadsheet included the following notes documented by Financial Case Worker (FCW) 1: 8/25/2022- "Left a voicemail (to DPOA) and sent him an e-mail regarding the payment status...I will be completing the APS report requested by upper management." 9/13/2022- "Received an e-mail from DPOA notifying him that I will have to complete an APS report because we have not received a payment since July... He states he is unable to make a payment prior to the 1st of October." 10/17/2022- "...he told us he would be making a payment on 10/3, but now he is pushing it back again, notified Finance Manager (FM 1). Received notification from FM 1 to complete APS report...Notified Social Worker (SW 1) of case and received confirmation to complete APS report." A review of an e-mail from FCW 2 to DPOA dated 10/31/2022, indicated that Patient 1's payment was delinquent... A subsequent unsigned note in the Delinquent Fees spreadsheet dated 1/17/2023, included, "I did not report the DPOA to APS. There was not enough evidence or documentation to file the report." During an interview with FCW 2 on 11/14/2023, FCW 2 stated she took over managing Patient 1's account after FCW 1 left in October 2022, and upon reviewing the file, she suspected Patient 1's DPOA was misusing the money in Patient 1's personal bank account. FCW 2 stated she did not report to APS, at that time, because she did not have enough documentation to "make a case" for financial abuse. FCW 2 stated she did not know the suspicion of financial abuse needed to be reported immediately to CDPH. FCW 2 confirmed she did not submit an SOC 341 to APS until July 2023 A review of the SOC 341 dated 7/17/2023 and submitted by FCW 2 included the statement that she suspected DPOA financially abused the patient's funds.... "She [Patient 1] currently has an outstanding balance of $11,801.21 in residential fees." During an interview with the Facility Administrator (FA 1) on 11/29/2023 at 1:50 PM, he stated he attended periodic meetings to discuss delinquent patient accounts with FM 1 and the Social Work Manager (SWM 1). FA 1 stated they should have identified financial abuse by Patient 1 's DPOA when the account became delinquent, and said, "We missed it." FA 1 acknowledged the suspected abuse should have been reported to CDPH immediately. A review of the facility's Policy and Procedure, "Elder Abuse, Prevention and Reporting," dated 6/8/2023, indicated, "Reporting... Supervisors will report...suspected elder abuse to the Home Administrator... or designee (who) will report to officials in accordance with State law, including the State Agency (CDPH) and Adult Protective Services (APS)...all alleged violations will be reported...no later than twenty-four (24) hours..." The alleged financial abuse of Patient 1's funds by her DPOA was identified by FCW 1 on 8/25/2022. The alleged financial abuse was not reported to the State Agency (CDPH) until 7/19/2023, 327 days after the mandated reporting timeframe, when the amount of misused funds identified totaled $11,801.21. This/ these violation/s had a direct or immediate relationship to the health, safety, or security of patients or residents.