Health inspection·October 15, 2021

F602 483.12 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. Title 22- 72527 (a) (16) (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (16) To retain and use personal clothing and possessions as space permits, unless to do so would infringe upon the health, safety or rights of the patient or other patients. The facility failed to ensure Resident 1’s right to be free from misappropriation of resident property was not violated. Resident 1's lottery ticket scratcher was not properly handled by the facility staff resulting to possible loss of $500 dollars. This failure violated Resident 1's right and had the potential to cause psychological trauma (a mental illness that affects ones thinking, feelings, and behaviors) which might affect psychosocial well-being of the resident. On 8/25/21, an unannounced visit was made to the facility to investigate a Facility-Reported Incident (FRI) regarding resident abuse. A review of Resident 1's face sheet indicated the resident was admitted to the facility on 8/18/14 with diagnoses that included dementia (a mental disorder in which a person loses the ability to think, remember, learn, make decisions and solve problems) without behavioral disturbance and paranoid schizophrenia (predominantly positive symptoms of schizophrenia, including delusions and hallucinations). A review of Resident 1's Minimum Data Set (MDS, a resident assessment and care screening tool), dated 6/24/21, indicated Resident 1 had clear speech, make self-understood and had the ability to understand others. Resident 1 had intact cognitive status (ability to think and process information). A review of the facility's incident report dated 8/18/21 indicated on 8/15/21, approximately 3 pm, Resident 1 gave 4 lottery ticket scratchers (scratchers/gambling tickets) to Certified Nursing Assistant 2 (CNA 2) while CNA 2 was on his way out of the facility at the end of his shift. CNA 2 took Resident 1's 4 lottery ticket scratchers, cashed out at 7-Eleven store and came back the next day (8/16/21) with $14 dollars winning money from 3 of 4 scratchers. Resident 1 claimed the 4th scratcher he gave to CNA 2 was a winning ticket of $500 dollars which CNA 2 did not bring the winning money back to Resident 1. During an observation and concurrent interview on 8/25/21 at 11:06 am, Resident 1 was observed lying in bed awake, and calm. Resident 1 stated he did not remember what happened, or whom he gave the lottery ticket scratchers to. Resident 1 opened his bedside nightstand drawer and took out several lottery ticket scratchers in a folded pack. Resident 1 refused to answer more questions regarding lottery tickets. During an interview on 8/25/21 at 12:11 pm, Licensed Vocational Nurse 1 (LVN 1) stated Resident 1 was alert, oriented, had very good memory and was able to make short conversations, and normally calm. LVN 1 stated lottery ticket scratchers were considered valuable items especially when they were winning tickets. LVN 1 stated facility staff should not take any valuable items from the resident because it is considered financial abuse. LVN 1 stated all types of abuse should be reported to police, ombudsman (an official appointed by the government for citizen advocate) and the Department within 2 hours. LVN 1 stated requests from resident related to valuables should be directed to Social Service Director (SSD). LVN 1 stated that SSD was the personnel handling residents' fund, trust account. LVN 1 stated he did not know if the facility had a policy and procedure in place for this situation but knew that he should not take any valuables from resident from his previous working experience. LVN 1 stated it is important to keep residents free from any types of abuse for their psychosocial well being. During an interview on 8/25/21 at 12:26 pm, CNA 1 stated Resident 1 was alert, orientated, able to make needs known, did not make up stories and had a good memory. CNA 1 stated facility staff should not take money and valuables including lottery tickets directly from residents because it might be potential financial abuse to a resident. CNA 1 stated all these money related issues should be handled by SSD. During an interview on 8/25/21 at 1:03 pm, the Administrator (ADM) stated the facility did not have a written procedure specifically on how to handle resident's lottery tickets. The ADM stated winning lottery tickets carries cash value that should be considered as valuable properties of resident. The ADM stated resident's valuables should be handled by the SSD. The ADM stated staffs other than the SSD should not take valuables from resident directly. During an interview on 8/25/21 at 1:30 pm, the SSD stated CNA 3 reported this incident to her on 8/16/21 morning, then SSD reported to the ADM right away. The SSD stated it was her responsibility to handle residents' fund account and other money related issues. The SSD stated it is the facility's policy that staffs should not take valuables directly from residents, staffs should refer residents to the SSD. The SSD stated winning lottery tickets carry cash value and should be considered as valuables, thus, should be handled by the SSD. A review of the Social Services Designee job description indicated some specific job functions for SSD were to assist in coordination of resident's financial affairs and complies with abuse prevention & reporting policies and procedures. During a telephone interview on 8/31/21 at 2:45 pm, CNA 3 stated in the morning of 8/16/21 around 8:30 am or 9 am, Resident 1 told him what happened between Resident 1 and CNA 2 regarding the lottery tickets. CNA 3 stated he reported the incident to the SSD right away. CNA 3 stated Resident 1 was very angry and looked sad. CNA 3 stated Resident 1 was normally calm, nice, had good memory and was non-aggressive. CNA 3 stated this was the first time he has seen Resident 1 upset. CNA 2 stated all monetary related issues should be referred to and handled by the SSD. CNA 2 stated if the SSD asked him to buy stuff from outside for the resident, CNA 2 should take money from the SSD, sign a slip, make the purchase, and come back with a receipt. CNA 2 stated lottery tickets might have cash value and he will not take them from resident. CNA 2 stated taking valuable or cash from the resident was considered as financial abuse and will affect resident's mood and hurt his feeling. During a telephone interview on 9/1/21 at 11:01 am, Resident 1's daughter/responsible party (RP 1) stated she brought Resident 1 lottery tickets scratchers every time she visited Resident 1. RP 1 stated normally Resident 1 asked RP 1 to cash out lottery tickets, but sometimes he asked the facility staff to cash out. RP 1 stated Resident 1/father felt hurt and sad after this incident and told RP 1 that he cannot trust facility staff anymore. RP 1 stated this is avoidable and should not happen this way. A review of the facility's policy and procedure, titled "Abuse Prevention/ Prohibition," updated November 2018 indicated the facility conducts mandatory facility staff training programs during orientation, annually, and as needed on prohibiting and preventing all forms of abuse, neglect, misappropriation of resident property, and exploitation, identifying what constitutes abuse, neglect exploitation and misappropriation of resident property, recognizing signs of abuse, neglect, exploitation and misappropriation of resident property, such as physical and psychosocial indicators. The facility failed to ensure Resident 1’s right to be free from misappropriation of resident property was not violated. Resident 1's lottery ticket scratcher was not properly handled by the facility staff resulting to possible loss of $500 dollars. As a result, this failure violated Resident 1's right and had the potential to cause psychological trauma which might affect psychosocial well-being of the resident This violation jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of residents.