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MALTREATMENT INVESTIGATION MEMORANDUM Minnesota Statutes, section 626.557, subdivision 1 states, “The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment.”
License Number and Program Type: 1070998-H_CRS (Home and Community-Based Services-Community Residential Setting) Investigator(s): Tessa Ripka 651-431-6612 Suspected Maltreatment Reported: It was reported that a staff person (SP) took cash from a vulnerable adult’s (VA) account, and it was unaccounted for. Date of Incident(s): September 6, 2023 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572, subdivision 15, and subdivision 9, paragraph (b), clause (1): In the absence of legal authority a person willfully uses, withholds, or disposes of funds or property of a vulnerable adult. Summary of Findings: Pertinent information for this investigation was obtained remotely, including documentation from the facility; and through four interviews conducted with two facility staff persons (P, SP), the VA’s case manager (CM), and the VA’s guardian (G). The VA was nonverbal and not able to provide any information about the incident. The VA was diagnosed with intellectual disabilities and autism. The VA enjoyed movies and music. The Annual Support Plan Addendum stated that the VA required assistance in the management of his/her checking, savings, or other bank accounts. Written approval was needed prior to completing a high dollar purchase exceeding $50. Staff persons assisted the VA with completing the purchase and obtained receipts. The Risk Assessment Detail stated the VA was at risk of misuse of his/her finances due to his/her diagnosis of autism. Staff persons managed the VA’s finances by balancing his/her checkbook on a monthly basis and reported any suspected misuse according to policy. The Internal Investigation and the P provided the following information: · On approximately September 13, 2023, the SP told the P that on September 6, 2023, the SP went to the bank with the VA’s debit card to withdraw $50 to take to his/her day program. The SP said s/he mistakenly took out $500. The SP then went to Walmart and purchased clothing and personal items for the VA but lost the receipt. The SP said s/he also put $150 in an envelope in the VA’s lunch box and sent it to his/her day program. · The P encouraged the SP to go to Walmart and see if s/he could obtain a receipt. The SP said s/he did not think s/he could get a receipt as the purchase was a cash purchase and the SP said s/he would keep looking for the receipt. · The P noticed the SP sent a text message to the P on the morning of the incident saying s/he bought items for the individuals at the facility at Walmart. There were no purchases noted for any of the other individuals on that day. The SP later said that s/he only purchased items for the VA on that day. · The P again checked with the SP to see if s/he had found a receipt. The SP said s/he had not found the receipt so the P asked the SP to write down all items purchased and check the prices on Walmart website to see if the items and spending could be accounted for. The SP made a list of items that s/he purchased for the VA including several pairs of jeans, t-shirts, socks, underwear, and toiletries totaling approximately $329.45. There was $20.55 in the VA’s wallet. · The P went to Walmart and a manger went through cash purchases made on September 6, 2023, looking for a similar priced transaction. The manager was not able to find any similar cash purchase made that day. · The P went to the facility and looked through the VA’s clothing and personal items. There were several pairs of newer jeans, t-shirts, underwear, and socks located in the VA’s bedroom. The P determined that these purchases were made in July 2023, when s/he found a corresponding receipt for those items. · The SP provided an email that appeared to be from the day program saying that they had received the $150 that was put in the VA’s lunch box. The P had previously contacted the day program and they said they did not receive any money and provided the P with a similar chain of emails but it appeared the SP had changed the email that s/he provided. · The SP knew the importance of safe keeping finances and saving receipts for purchases and “rarely ever” misplaced a receipt. It gave the P “pause” that the SP was “so cavalier” about locating the receipt and accounting for the items. It was also “odd” that the SP had not let anyone at the day program know that s/he was putting cash in the VA’s lunch box and did not follow up to see that they had received the money. · On the VA’s financial authorization form, the facility did not have responsibility for the VA’s cash and the VA did not use cash. · The P later found approximately 30 credit card applications filled out for another individual at the facility. The applications were found lying on the SP’s desk after the SP no longer worked at the facility. It appeared that all the applications were denied. Some were addressed to the other individual, but others had seemingly made-up names. It was not clear who completed the applications. The SP provided the following information: · The SP normally assisted the VA with all his/her finances including balancing his/her checkbook and paying bills. When the SP withdrew cash for the VA it was usually $50-$100 depending on why the VA needed the money. The VA’s debit card was kept in his/her wallet which was locked in the staff person office. The SP and the P were the only staff persons that had access to the debit card and wallet. The SP carried the wallet for the VA when they went out in the community and made purchases for the VA. · On the date of the incident, the SP went to an ATM and withdrew money from the VA’s account with the VA’s debit card. The SP hit the wrong button and took out too much money. · The SP went to Walmart and purchased the VA some clothing and personal items. Later the SP was not able to find the receipt and assumed it was left in a shopping bag and thrown away. The amount of the purchase was a little over $300. The SP made a list of items that s/he purchased. · The SP put $150 in an envelope and sent it to the VA’s day program in the VA’s lunchbox. The day program did not request any more money, but the SP thought that since the VA needed to spend down some money to stay eligible for assistance, the SP would send more money to the day program. The SP did not confirm the day program had received the money or communicate with them that s/he was sending money. · Initially the SP said that s/he emailed the day program later (confirmed to be October 18, 2023) and they confirmed that they received the money. When asked about the different email s/he provided, the SP confirmed that the “email is not right” but that s/he did not take the money. · The SP said s/he did not take any of the VA’s money or use the VA’s money for purchases that were not for the VA. In an email from a staff person at the VA’s day program sent on October 18, 2023, at 1:06 p.m., the SP asked, “Is [the VA] doing okay as far as petty cash goes?” and the staff person confirmed that the VA had $15.22 in his/her cash account which “should last [the VA] a bit.” In a second email that the SP provided to the P dated October 18, 2023, at 1:06 p.m., the email appeared to ask the same staff person if they received the $150 that the SP sent in the VA’s lunch box on September 7, 2023. The staff person responded, “Yes we did.” In an email to the G and CM from the SP dated October 19, 2023, the SP said s/he made an “error” when s/he went to the ATM on September 6, 2023, to get cash out for the VA. The SP “hit one too many zeros” and ended up getting $500 instead of $50. The SP said it was a busy day as s/he was shopping for “a couple” of the individuals, so s/he used the VA’s cash for purchases made that day. The SP thought s/he put the receipt in the VA’s wallet but could not find it. The SP wrote down everything s/he purchased and got prices on the website. The SP sent $150 to the VA’s day program and had $20.45 left. The SP said s/he knew that “logically” s/he should have redeposited the cash. The SP also mentioned that s/he did a “spend down” and got the VA a grill and air fryer that had been discussed. A withdrawal receipt from the VA’s bank showed that on September 6, 2023, at 9:15 a.m., there was a withdrawal in the amount of $500. The Petty Cash Ledger showed that on September 6, 2023, the SP deposited $500 into the VA’s petty cash. On September 10, 2023, a $150 withdrawal was made and documented as cash for the VA’s day program. After that entry was an entry dated for September 6, 2023, for Walmart for a total of $329.45 and next to it was noted “Aprox.” All entries were initialed by the SP. A Missing Receipt Voucher filled out by the SP showed a purchase at Walmart on September 6, 2023, for $329.45 “(Approx).” Underneath the voucher was a list of items purchased and the cost of each item including three pairs of jeans, two t-shirts, two packs of socks, 2 packs of underwear, and various toiletry items. Individual Client Petty Cash Ledger’s from the VA’s day program showed a balance of $18.82 through July and August 2023. In September the VA made two purchases for $1.67 and $1.93. The new balance was $15.22. The VA’s check register showed that on September 6, 2023, an ATM withdrawal was made for $500. There were Amazon purchases on September 7, 2023, for $42.72, September 12, 2023, for $271.43, and September 26, 2023, for $84.99 and $639.25. Attached receipts for Amazon purchases showed that the VA purchased an air fryer oven for $639.25, a four-year protection plan for $84.99, and a bladeless tower fan, a rechargeable shaver, an electric toothbrush, and toothbrush replacement heads for $271.43. (The P noted that all items purchased through Amazon were accounted for at the facility.) The Managing Funds of Persons Served policy stated that misuse of funds of property belonging to a person served by the facility may be considered misappropriation or financial exploitation and was not tolerated. All money transactions were promptly recorded on the corresponding transactions register. A receipt or similar transaction document must be obtained for all transactions. Alternatives to the use and handling of cash were encouraged due to inherent safety and security risks. The SP was trained on the VA’s plans, the facility’s policies and procedures, and the Reporting of Maltreatment of Vulnerable Adults Act prior to the incident. Conclusion: A. Maltreatment: Information was consistent that on September 6, 2023, the SP withdrew $500 cash from an ATM using the VA’s debit card. The P said that the SP told the P that s/he put $150 in the VA’s lunch box for spending at his/her day program and spent most of the remaining amount on purchases at Walmart that day. The VA’s day program confirmed that they did not receive the money. At the time of the incident, the VA had $18.82 cash at the day program and spent $3.60 through the month of September 2023. The P went to Walmart and with a manager’s assistance was unable to locate any cash purchases made that day for a similar dollar amount. The items that the SP said s/he purchased including clothing and some toiletries did not appear to be found at the facility. In an email dated October 18, 2023, the SP asked the day program if the VA was “doing okay” on petty cash. The day program responded that the VA had $15.22 in his/her account which would last the VA “a bit.” In an email the SP provided to the facility with the same date/time, the SP appeared to ask if the day program had received the money and they responded, “Yes we did.” The SP said s/he made purchases for the VA for a little over $300 at Walmart, put $150 in the VA’s lunch box for his/her day program spending and put the remainder in the VA’s wallet. The SP said that the email s/he provided “is not right” but that s/he did not take the money and did not use any of the VA’s money on any purchases that were not for the VA. Given that $500 was withdrawn from the VA’s account, that the day program never received the portion of the money that SP said s/he sent, and that the items that the SP said s/he purchased for the VA could not be accounted for, there was a preponderance of the evidence that the VA’s funds were willfully used or withheld. It was determined that financial exploitation occurred (in the absence of legal authority a person willfully uses, withholds, or disposes of funds or property of a vulnerable adult). B. Responsibility pursuant to Minnesota Statutes, section 626.557, subdivision 9c, paragraph (c): When determining whether the facility or individual is the responsible party for substantiated maltreatment or whether both the facility and the individual are responsible for substantiated maltreatment, the lead agency shall consider at least the following mitigating factors: (1) whether the actions of the facility or the individual caregivers were in accordance with, and followed the terms of, an erroneous physician order, prescription, resident care plan, or directive. This is not a mitigating factor when the facility or caregiver is responsible for the issuance of the erroneous order, prescription, plan, or directive or knows or should have known of the errors and took no reasonable measures to correct the defect before administering care; (2) the comparative responsibility between the facility, other caregivers, and requirements placed upon the employee, including but not limited to, the facility’s compliance with related regulatory standards and factors such as the adequacy of facility policies and procedures, the adequacy of facility training, the adequacy of an individual’s participation in the training, the adequacy of caregiver supervision, the adequacy of facility staffing levels, and a consideration of the scope of the individual employee’s authority; and (3) whether the facility or individual followed professional standards in exercising professional judgment. The SP was trained on the VA’s plans, the facility’s policies and procedures, and the Reporting of Maltreatment of Vulnerable Adults Act prior to the incident. Although the SP said s/he never took any of the of the VA’s money or used the VA’s money for purchases not for the VA, given the SP withdrew more money than was typical, put $150 in the VA’s lunch box and did not confirm they had received the money or let the day program know money was on the way, falsified an email saying the day program had received the money, and that similar items that the SP said s/he purchased for the VA could not be found, there was a preponderance of the evidence that the SP was responsible for the maltreatment of the VA. C. Recurring and/or Serious Maltreatment: The Office of Inspector General is required to evaluate whether substantiated maltreatment by an individual meets the statutory criteria to be determined as “recurring or serious.” Individuals determined to be responsible for recurring or serious maltreatment are disqualified from providing direct contact services. Minnesota Statutes, section 245C.02, subdivision 16, states: “Recurring maltreatment” means more than one incident of maltreatment for which there is a preponderance of evidence that maltreatment occurred and that the subject was responsible for the maltreatment. Minnesota Statutes, section 245C.02, subdivision 18, states: "Serious maltreatment" means sexual abuse, maltreatment resulting in death, neglect resulting in serious injury which reasonably requires the care of a physician whether or not the care of a physician was sought, or abuse resulting in serious injury. For purposes of this definition, "care of a physician" is treatment received or ordered by a physician, physician assistant, or nurse practitioner, but does not include diagnostic testing, assessment, or observation; the application of, recommendation to use, or prescription solely for a remedy that is available over the counter without a prescription; or a prescription solely for a topical antibiotic to treat burns when there is no follow-up appointment. For purposes of this definition, "abuse resulting in serious injury" means: bruises, bites, skin laceration, or tissue damage; fractures; dislocations; evidence of internal injuries; head injuries with loss of consciousness; extensive second-degree or third-degree burns and other burns for which complications are present; extensive second-degree or third-degree frostbite and other frostbite for which complications are present; irreversible mobility or avulsion of teeth; injuries to the eyes; ingestion of foreign substances and objects that are harmful; near drowning; and heat exhaustion or sunstroke. Serious maltreatment includes neglect when it results in criminal sexual conduct against a child or vulnerable adult. It was determined that the substantiated financial exploitation for which the SP was responsible did not meet statutory criteria to be determined as recurring or serious as it was a single incident, and the incident did not meet the definition of serious maltreatment. Action Taken by Facility: The facility completed an internal review and determined that policies and procedures were adequate but not followed. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: The SP was not disqualified from providing direct care services as a result of the maltreatment determination in this report. However, the SP was notified by the Office of Inspector General that any further substantiated act of maltreatment, whether or not the act meets the criteria for “serious,” will automatically meet the criteria for “recurring” and will result in the disqualification of the SP. The determination that the SP was responsible for maltreatment is subject to appeal.
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