Surveyors focused on centers’ person-centered approach
Centers have reported they have been cited for F620 relative to resident property. F620 is based on 42 CFR 483.15. The subsection reported is (a)(2)(iii) which reads: “[The facility must] not request or require residents or potential residents to waive potential facility liability for losses of personal property.”
This tag is typically cited as the result of review of the facility contract. Compliance is not difficult; however, it appears that language which has been accepted for years is now not acceptable. Centers are caught unawares, so we’re sharing the necessary information to ensure your compliance.
First, review your contract. Also look at other documents you have relative to property: policies and procedures, resident’s handbook and anywhere else you may have guidance as to resident property.
The issue that arises relates to language which purports to hold the center harmless from loss of resident property. According to the interpretive guidelines, you may not require a resident to agree that you will not be responsible for property unless given to the facility for safeguarding, either in the trust account or locked in a secure area.
This does not mean that you are responsible under all circumstances, but you must at least investigate and ascertain how the loss occurred and determine if you should be liable.
Why the concern? The resident’s right to a home-like environment has been a requirement for a long time. Today there is an enhanced emphasis on person-centered care, which means surveyors are now looking more closely at how the center makes this happen. The Interpretive Guidelines require the center to ensure residents can use their property and that they have ready access to their property.
Residents are not entitled to have any property they want. Your staff should, however, have a procedure for determining when property is appropriate under all the circumstances. What a resident in a private room can have is likely different than what a resident in a two-bedroom unit can have. The rights of the roommate must be considered. Will the property intrude on the roommate’s space? Will it compromise either resident’s safety?
Suppose the property is offensive to the roommate. You should have a system of determining if the item is appropriate and, if so, work out an arrangement involving the roommate. An example could be keeping the item on the resident’s side of the room and out of sight of the roommate.
You must exercise due care in protecting the resident’s property, but you cannot guarantee that property will never be lost or stolen. You should have a system of inventory in which you expect that residents will advise you when they bring something of value (a ring perhaps) that they wish to maintain on their person. By placing it on the inventory list, you are protecting not only the center but the resident as well. Educate the residents about this. Community living is substantially different from living in a private home, and many residents may not even think about the risks of having valuables in their rooms.
If the resident can secure his or her own valuable, a locked drawer or a small safe in the room could be a reasonable approach. If the resident only wants access to the item from time to time, such as a ring she only wants to wear when the family visits, the center’s safe may be the appropriate choice with arrangements being made for that resident to get access when the ring is requested. Reminding the resident that family is coming to visit and offering to get her the ring may be the appropriate method to safeguard the property yet make it readily available to the resident. The bottom line – know what the resident’s reason is for wanting that property and work with the resident.
Medical/assistive devices are of particular concern. Think outside the box in developing procedures for safeguarding them and take reasonable steps to protect those devices.
If personal property is lost or stolen, you should have a procedure for investigating the loss. At some point in the investigation, you will make a determination if the center is going to take responsibility for that loss. Document the investigation and the reason for your choice.
In conclusion, you must have policies and procedures that permit residents to bring personal property in to the center for their own use. You can require an inventory, although you should not make a blanket statement that if it is not inventoried it was not there. Staff should be trained to recognize when a resident has a new piece of property and to verify it has been inventoried. The residents should be educated about the risks and participate in the determination of the best way to protect the property. Family likewise should be educated. Options as to safeguarding the property should be discussed as appropriate. When something is missing, an investigation should be done. When that investigation is concluded, the center should make a determination as to its responsibility.
For more information about resident property, see the State Operations Manual, Tags F584 and F602.