Inaccurate Accounting of Resident Funds
Summary
The facility failed to maintain an accurate and up-to-date accounting system for residents' personal funds, as required by state regulations. This deficiency was identified through observations, record reviews, and interviews with residents and their representatives. Specifically, the facility's Resident Funds Management System (RFMS) did not accurately reflect the cost of care withdrawals and Social Security direct deposits for three residents. For instance, Resident #6 expressed concerns about the accuracy of her trust fund balance, noting discrepancies in room and board payments. Similarly, Resident #3's representative suspected fraudulent activity after a $500 withdrawal from the resident's account. Additionally, a grievance filed by Resident #5 highlighted inconsistencies in fund transactions, with a noted withdrawal that did not align with the expected cost of care. The review of the residents' financial records revealed that the cost of care charges did not consistently match the patient liability amounts determined by Medicaid Access. For example, Resident #5's account showed a withdrawal of $3015.60, which was inconsistent with the Medicaid-determined liability of $1,790.60 per month. Furthermore, the facility's Business Office Manager, who was responsible for handling resident trust accounts, had recently left the position, leaving the facility without a person in charge of these accounts. The Nursing Home Administrator acknowledged the inaccuracies in the RFMS and mentioned a Performance Improvement Plan, but no corrective actions were provided to the survey team during the survey.
Plan Of Correction
Resident #3, 5, and 6 cost of care was verified with the Medicaid access eligibility portal and verified to match the Resident Fund Management Services (RFMS). A finance coordinator was hired on to ensure oversight and maintenance of the Resident Fund Management Services. Social Security deposits were found, added to account, and balanced for Residents #3, #5, and #6. Resident #5 cost of care payment of $3,015.60 was verified and accurate. Resident #5 patient liability for 2025 was updated based off of the Medicaid Access system. Resident #3 RFMS account was reconciled and patient liability amount updated. Resident #6 RFMS account was reconciled, patient liability updated, and debit was explained to resident and responsible party. All residents with personal funds accounts were audited to ensure the correct resident cost of care was accurate and in Resident Fund Management Services. Findings were corrected and accounts reconciled to reflect accurate amounts and balances. Residents that have been discharged for the past 30 days, accounts were closed out in RFMS and refunds sent to responsible party/resident. Quality measure audit tool was completed on all active residents with a personal funds account to ensure the facility is maintaining a system that assures a full and complete and separate accounting according to general accounting principles of each resident's personal funds entrusted to the facility on the resident's behalf. The Nursing Home Administrator was re-educated by the COO to ensure the facility is maintaining a system that assures a full and complete and separate accounting according to general accounting principles of each resident's personal funds entrusted to the facility on the resident's behalf. The Nursing Home Administrator or designee will complete quality reviews weekly for four (4) weeks, then monthly for 2 months thereafter to ensure ongoing and sustained compliance. Findings from the quality review audits will be reviewed and discussed by the Quality Assurance Performance Improvement (QAPI) Committee monthly for two (2) months. Non-compliance will be reviewed by the QAPI committee with direct changes to the plan as deemed necessary to ensure ongoing and sustained compliance.
Penalty
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