Other·February 11, 2021

Health and Safety Code 1289 (a) (a) No owner, employee, agent, or consultant of long-term health care facility, as defined in Section 1418, or member of his or her immediate family, or representative of a public agency or organization operating within the long-term health care facility with state, county or city authority, or member of his or her immediate family, shall purchase or receive any item or property with a fair market value of more than one hundred dollars ($100) from a resident in the long-term health care facility, unless purchase or receipt is made or conducted in the presence of a representative of the Office of the State Long-Term Care Ombudsman, as defined in subdivision (c) of Section 9701 of the Welfare and Institutions Code. The role of the ombudsman is to witness the transaction and to question the resident and others as appropriate, about the transaction. The ombudsman may submit written comments pertaining to the transaction into the health records of the resident. The Office of the State Long-Term Care Ombudsman shall establish guidelines concerning activities of ombudsmen pursuant to this section. Additionally, the transaction described in this subdivision shall be recorded by the facility in the health records of the resident. The record of the transaction shall include the name and address of the purchaser, date and location of the transaction, description of property sold, and purchase price. The instrument shall include signatures of the resident, the purchaser, and the witnessing ombudsman. Title 22 72523 - Patient Care Policies and Procedures (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facilities achieved 42 CFR 483.12 Freedom from Abuse, Neglect, and Exploitation 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. It was determined that the facility failed to ensure Patient 1 was free from misappropriation of property and exploitation by the facility staff. This failure had placed the patient at risk for financial hardship which could eventually affect the psychosocial wellbeing of Patient 1. On September 16, 2019, at 9 a.m., an unannounced visit was conducted to investigate a facility reported incident regarding misappropriation of property. On September 16, 2019, at 9 a.m., the facility Administrator (ADM) was interviewed. The ADM stated Patient 1's representative brought to his attention a potential problem involving one of the facility staff (Certified Nursing Assistant - CNA 3). The ADM stated CNA 3 was accepting gifts from Patient 1. Patient 1's record was reviewed. Patient 1 was admitted to the facility on October 15, 2018, and was readmitted under hospice care on July 25, 2019, with diagnoses which included Parkinson's disease (progressive disease that affects movement) and dementia (memory loss). A review of a document titled, "Initial Plan of Care/Physicians Orders," dated July 25, 2019, indicated, "...General Patient Assessment...A 78-year-old male patient with the hospice diagnosis of Parkinson's Dementia...Patient is alert and oriented to self and person but has been getting confused with place and time...He has been more and more confused now..." A review of Patient 1's Minimum Data Set (MDS - assessment tool) dated August 1, 2019, indicated, "Cognitive Patterns...BIMS (Brief Interview for Mental Status - level of cognitive status) Summary Score...3 (severely impaired cognition)." On October 1, 2019, at 2:30 p.m., an interview with CNA 1 was conducted. CNA 1 was asked how she would respond if a patient asked her to manage the patient's money transactions. CNA 1 stated she would tell the patient to talk to someone who was authorized to take care of patient's finances. CNA 1 stated she would report the patient's request to the charge nurse. On October 2, 2019, at 2:22 p.m., the Director of Nursing (DON) was interviewed. She stated the facility staff were expected to comply with the facility's code of conduct when it comes to accepting monetary gifts from the patients. On November 26, 2019, at 2:06 p.m., CNA 2 was interviewed. CNA 2 stated she was familiar with Patient 1, and was assigned to care for the patient. CNA 2 stated the CNAs were not allowed to work for a patient or accept money from the patient at the facility. On November 26, 2019, at 2:39 p.m., the Staff Scheduler (SS) was interviewed. The SS stated when a patient requested for a specific staff member to work for them (patient), the staff should inform the facility management. The SS stated the request had to go through the DON, the SSD (Social Service Director), and the DSD (Director of Staff Development). The SS stated staff were not allowed to work for a patient and get paid. In addition, the staff were not allowed to take money from the patients. On December 3, 2019, at 1:30 p.m., CNA 3 was interviewed. CNA 3 stated in March of 2019, Patient 1 had asked if she could run errands for him, and she agreed. She stated she had been accepting varied payments from Patient 1. CNA 3 stated Patient 1 would give her the debit card, and he would ask her to get money from the ATM (Automated Teller Machine) which would amount to four hundred dollars.CNA 3 stated she would buy "stuff" for him, and would keep the change from the four hundred dollars. In addition, Patient 1 would give her an extra one hundred dollars. CNA 3 stated she had done it for six (6) months or so. CNA 3 stated she did not inform the facility of her agreement with Patient 1. A review of the personnel records indicated CNA 3 had signed an acknowledgement document on December 15, 2018. The document indicated CNA 3 received a copy of the facility handbook which outlined the employees' privileges, terms and obligations as an employee of the facility. The facility's "Employee Handbook," dated May 2016, was reviewed. The handbook indicated, "...GIVING AND RECEIVING GIFTS. You may not solicit or accept tips, gifts, loans, gratuities, bequests, or any item of value from any resident...Accepting of tips for services rendered is strictly prohibited. You should not participate, directly or indirectly, in any payment or gift for the purpose of inducing special consideration for yourself or your residents...Employees are also not allowed to purchase items or borrow money from residents or become involved in any personal or business relationships. Such transactions give the appearance of influence regarding a business decision, relationship or service..." The facility policy and procedure titled, "Abuse Prevention Program," dated December 2016, was reviewed. The policy and procedure indicated, "...Our residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation...the administration will...Protect our resident from abuse by anyone including, but not necessarily limited to...facility staff..." Therefore, it was determined the facility failed to ensure Patient 1 was free from misappropriation of property and exploitation, when a facility staff accepted monetary gifts from Patient 1. This failure had placed the patient at risk for financial hardship which could eventually affect the psychosocial wellbeing of Patient 1. This failure of the facility to ensure Patient 1 was free from misappropriation of property had a direct relationship to the health, safety, or security of patients.