**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record review, the facility policies titled, Social Media Use, Personal Cell Phones, Resident Photographs, and Abuse, Neglect and Exploitation, review of Facility Reported Incidents (FRIs) received by the Alabama State Survey Agency, review of the facility's investigative files, and review of an Incident/Offense Report, the facility failed to: 1) ensure Resident Identifier (RI) #101 was free from mental and physical abuse perpetrated by staff at the facility. On 04/24/2024, Certified Nursing Assistant (CNA) #19 used her phone to record a video of CNA #18 physically and mentally abusing RI #101, who was in bed. In the recording CNA #18 taunted and laughed at RI #101 as she used aggressive force to pull up the resident's pants into the resident's perineum and buttocks. After CNA #18 pulled the resident's pants up, RI #101 pointed at CNA #18 and CNA #18 slapped RI #101's hand. The video was posted and circulated on social media showing what had been done to the resident and showing the resident's face. The video was sent anonymously by a non-staff member to the Social Worker/Director of Social Service (DSS) who reported the video to the Administrator (ADM) on 05/06/2024. It was determined the facility's noncompliance with one or more requirements of participation had cause, or was likely to cause, serious injury, harm, impairment, or death to residents. The Immediate Jeopardy (IJ) was cited in reference to 483.12 Freedom from Abuse, Neglect and Exploitation. On 07/15/2024 at 5:17 PM, the ADM and Director of Nursing (DON) were provided the IJ template and notified of the findings at the immediate jeopardy level and substandard quality of care in the area of Freedom From Abuse, Neglect, and Exploitation at F 600-Free from Abuse and Neglect. The IJ began on 04/24/2024 and continued until 05/14/2024 when the facility implemented corrective actions to correct the identified deficient practice and prevent reoccurrence. This deficiency was cited as a result of a Facility Reported Incident, complaint/report number AL00047806. 2) Further the facility failed to protect RI #43's right to be free from physical abuse by RI #86. On 03/06/2024 RI #86 hit RI #43. This deficient practice affected RI #43, but this did not rise to the Immediate Jeopardy Level. This deficiency was cited as a result of a Facility Reported Incident, complaint/report number AL00047108. 3) Further the facility failed to protect RI #59's right to be free from physical abuse by RI #108. On 04/27/2024 RI #108 hit RI #59. This deficient practice affected RI #59, but this did not rise to the Immediate Jeopardy Level. This deficiency was cited as a result of a Facility Reported Incident, complaint/report number AL00047709. 4) Further the facility failed to protect RI #95's right to be free from physical abuse by RI #48. On 05/06/2024 RI #48 slapped RI #95. This deficient practice affected RI #95, but this did not rise to the Immediate Jeopardy Level. This deficiency was cited as a result of a Facility Reported Incident, complaint/report number AL00047805. 5) Further the facility failed to protect RI #43's right to be free from physical abuse by RI #123. On 06/12/2024 RI #123 spit at RI #43 and RI #43 hit RI #123. This deficient practice affected RI #43 and RI #123, but this did not rise to the Immediate Jeopardy Level. This deficiency was cited as a result of a Facility Reported Incident, complaint/report number AL00048127. 6) Further the facility failed to protect RI #123's right to be free from physical abuse by RI #45. On 06/24/2024 RI #123 spit at RI #45 and RI #45 hit RI #123. This deficient practice affected RI #123 and RI #45, but this did not rise to the Immediate Jeopardy Level. This deficiency was cited as a result of a Facility Reported Incident, complaint/report number AL00048224. 7) Further the facility failed to protect RI #45's right to be free from physical abuse by RI #115. On 07/01/2024 RI #115 hit RI #45. This deficient practice affected RI #45, but this did not rise to the Immediate Jeopardy Level. This deficiency was cited as a result of a Facility Reported Incident, complaint/report number AL00048276 . These deficient practices affected seven of 17 residents reviewed for abuse. Findings Include: Review of a facility policy titled Social Media Use, with an implemented date of 08/30/2023, and a revised dated of 05/07/2024 revealed: Policy: It is the policy of this company to avoid inappropriate use of social media and to protect the residents . of this facility against misuse of social media content. Taking, keeping, or distributing unauthorized photographs or recordings of residents through multimedia messages or on social media networks is a violation of a resident's right to privacy and confidentiality. Staff members must recognize that they have an ethical and legal obligation to maintain resident privacy and confidentiality at all times. Policy Explanation and Compliance Guidelines: 1. Employees are strictly prohibited from transmitting by way of any electronic media any resident-related image or information that may be reasonable anticipated to violate resident rights to confidentiality or privacy. This includes information that could degrade or embarrass the resident. 2. Photographs or recordings of a resident and/or his or her private space without the resident's or designated representative's written consent, is prohibited. Examples include taking unauthorized photographs/videos of: a. a resident's room or furnishing (which may or may not include the resident). d. taking unauthorized photographs or recordings of residents in an state of dress or undress using any type of equipment . Review of a facility policy titled Personal Cell Phones, with a revised date of 05/07/2024 revealed: . Policy Explanation and Compliance Guidelines: 1. This facility prohibits employees from using personal cell phones for any reason, on the nursing units or in working areas of the facility . 3. Under no circumstances should employee take pictures, videos . of any resident . Review of a facility policy titled Resident Photographs, with a revised dated of 05/07/2024 revealed: Policy: Taking photographs and/or videos of residents or their personal belongings is a violation of residents' rights to privacy and confidentiality. Policy Explanation and Compliance Guidelines: . 3. Any employee or past employee that takes photographs or videos of any resident that is not authorized will be considered abuse. 4. No current or past employee will post pictures, videos, comments, etc., on social media of any kind that pertains to anyone within this facility . Review of the facility's policy titled, Abuse, Neglect and Exploitation, with an implemented date of 08/30/2023, and a revised date of 05/07/2024, revealed: Policy It is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation, and misappropriation of property. Definitions: Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, which can include staff to resident abuse and certain resident to resident altercations . Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology . Mental Abuse includes, but is not limited to, humiliation, harassment . Mental abuse also includes abuse that is facilitated or cued by nursing home staff taking or using photographs or recording in a manner that would demean or humiliate a resident(s) . Physical Abuse includes, but is not limited to hitting, slapping, punching, biting and kicking . Verbal Abuse means the use of oral, written or gestured communication or sounds that willfully includes disparaging and derogatory terms to residents . regardless of their age, ability to comprehend, or disability . RI #101 was admitted to the facility on [DATE], and readmitted on [DATE]. RI #101 had diagnoses that included Aphasia Following other Cerebrovascular Disease and Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Dominant Side. A review of RI #101's Quarterly Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 03/04/2024, indicated RI #101's Brief Interview Mental Status (BIMS) was ten of 15, which indicated that RI #101 had moderately impaired cognition. RI #101 also had impairment on one side of the upper and lower extremities during the assessment period. The Alabama Department of Public Health Online Incident Reporting System form, submitted on 05/06/2024 at 9:20 PM documented: . Incident Type . Abuse - Physical . Incident Detail . Name(s) of resident(s) involved: (RI #101) . Name of alleged perpetrator(s): (CNA #18) . Narrative summary of incident: The Social Worker called the administrator to inform the administrator that she received a video from an outside source of our employee (CNA #18) mistreating one of our residents , Action (s) taken by the facility in response to the incident. .The employee was contacted and asked not to come to work in the morning as scheduled. The employee will be called in for questioning and suspended pending investigation. The resident was assessed, and no injuries were noted. The resident was unable to answer question appropriately. The MD (Medical Director) and sponsor were notified. (local) Police Department was notified . Ombudsman was notified. The video of the incident was provided to ADPH. The video showed a resident, identified as RI #101, in the bed on his/her back clothed with pants and shirt. The resident was pointing with his/her right arm toward the right side of the bed where a CNA, identified as CNA #18, was standing. A smiley face emoji covered RI #101 for about ten seconds of the video as the CNA approached the bed. The staff recording the video, identified as CNA #19, and CNA #18 were speaking, but the audio was not clear enough to hear what was said. The emoji was removed, and RI #101 was positioned on his/her left side while his/her back was toward the camera and CNA #18. Next, CNA #18 grasped the top portion of RI #101's brief that was exposed above his/her pants and pulled upward forcible and with a jerking motion. Loud noises were heard on the video and CNA #18 stepped away from the resident. RI #101 repositioned himself/herself onto his/her back and immediately pointed at CNA #18. A staff's voice was heard saying you going to hell . (he/she) said stop playing with me . and laughing was heard. Another voice was heard saying, go on now while RI #101 was pointing at CNA #18. At this time, CNA #18 stepped back toward RI #101's bed and used the back of her right hand to swat at RI #101's right hand that was pointing at her. CNA #18 then swatted at RI #101's right hand with her left hand and appeared to swat his/her hand away. CNA #19 was laughing during the video. On 07/10/2024 at 2:39 PM, an interview was conducted with the DSS who said she became aware of the video and that it had been posted to social media in May of 2024 when an anonymous source sent a text to her phone. The DSS said when she first observed the video there was an emoji over RI #101's face. The DSS said CNA #18 pulled on the back of RI #101's pants extremely rough and after she pulled on RI #101's pants, RI #101 pointed at CNA #18. The DSS said RI #101's face was on the video. The DSS said she could see CNA #18 laughing and swinging her hands toward RI #101 and popping RI #101 on his/her hand. The DSS said CNA #19 was later identified as the person recording the video. The DSS said the incident would cause a reasonable person to feel embarrassed, like their privacy had been violated, and scared of the CNAs coming back and doing that to them again. The DSS said the incident was physical and emotional abuse. On 07/11/2024 at 5:47 PM, a follow-up interview was done with the DSS. The DSS said when she reviewed the video, RI #101 was not smiling from what she could see. When asked to describe RI #101's demeanor, the DSS said RI #101 looked frustrated to her. The facility's investigative file was reviewed and a handwritten EMPLOYEE STATEMENT dated 05/07/2024, and signed by CNA #18, documented the following: On April 24, I was in (RI #101's) room giving (him/her) care and getting (him/her) dressed another employee recorded . it was a playing matter that just was took into the wrong way . On 07/10/2024 at 4:16 PM, a telephone interview was conducted with CNA #18. When asked what she could tell the surveyor about an incident involving a video being made of RI #101 when she provided care for him; and the video ended up on social media. CNA #18 said she was aware CNA #19 had her cell phone out but she was not aware CNA #19 was recording her providing care for RI #101 until the video came out and she was called into the ADM office. CNA #18 said the ADM discussed with her how she had grabbed and pulled RI #101's pants up forcibly. CNA #18 said the ADM said it looked like she had given RI #101 a wedgie. CNA #18 said her being rough with RI #101 could be considered physical abuse. CNA #18 when she saw the video it seemed like she was making fun of RI #101 and mocking him/her. The facility's investigative file contained a handwritten EMPLOYEE STATEMENT dated 05/07/2024 and signed by CNA #19 that documented: I (CNA #19) recorded the video to show fellow employes . the video was sent from my phone . On 07/11/2024 at 8:28 AM, a telephone interview was conducted with CNA #19. CNA #19 said RI #101 could not physically speak. CNA #19 said a CNA requested her assistance and when she entered RI #101's brief was already fastened. CNA #19 said when she began recording, the other CNA was in the process of pulling RI #101's pants up. CNA #19 said she knew she was not to record anything about the resident, but she recorded the incident to show other staff. CNA #19 denied posting the video on social media. On 07/15/2024 at 8:55 AM a follow-up interview was conducted with CNA #19 via phone. CNA #19 said she did not know the video was posted on social media until the other CNA (CNA #19) called her later the evening the video was recorded and asked her to remove it from social media. CNA #19 denied posting the video on social media but said no one else had access to her phone. CNA #19 said she must have accidentally posted the video on social media. On 07/10/2024 at 5:16 PM, an interview was conducted with the ADM. who said when she viewed the video. The ADM said she the video showed CNA #18 pull up RI #101's pants forcibly. The ADM said RI #101 was on his/her side, and when RI #101 turned on his/her back RI #101 started pointing at CNA #18 and CNA #18 walked away and was laughing. The ADM said when CNA #18 returned, CNA #18 and RI #101's hand made contact, then CNA #18 laughed and walked away again. The ADM said identified CNA #18 in the video and notified her to not report to work as scheduled. The ADM said when CNA #18 was initially interviewed she was asked when she last worked with RI #101. CNA #18 out of the blue said April 24th and said she knew why she was being interviewed. CNA #18 revealed to her that CNA #19 was doing the recording. The ADM said the incident was physical abuse and could have easily affected RI #101 mentally when the resident's pants were pulled up forcibly, staff laughed about the situation, and the video was posted on social media for everyone to see. On 07/12/2024 at 7:30 AM during a follow-up interview with the ADM, she said when she reviewed the video, RI #101's pants were pulled up with force. The ADM said when RI #101 tuned over he/she pointed his/her finger at CNA #18. The ADM said she did not think RI #101 was smiling. When asked to describe RI #101's demeanor, the ADM said when RI #101 turned over RI #101 made a noise, pointed his/her finger and it seemed like RI #101 may have been a little upset for what CNA #18 had done to him/her. On 07/10/2024 at 8:47 AM, a telephone interview was conducted with RI #101's Responsive Party (RP). The RP said the facility made him aware a video of RI #101 had been posted to social media. When asked how he thought RI #101 would feel to know someone had videoed him/her and posted the video to social media, the RP said RI #101 would have been mad and would not have liked that at all. Review of the reported results from an onsite visit made by IBH (Integrated Behavioral Health) after the incident on 05/09/2024, revealed the following: . History of Present Illness . patient was reportedly abuse by a CNA at the facility and that the incident was recorded by a separate CNA. The patient is non-verbal . (He/She) is calm and pleasant. Interview is limited due to patient being non-verbal but (he/she) is able to participate by shaking (his/her) head yes or no, giving a thumbs up . The facility's incident summary dated 05/13/2024, documented: Physical Abuse .CONCLUSION (RI #101), resident, was provided care by (CNA #18) on April 24, 2024. While in the room providing care for (RI #101) (CNA #19) videoed (CNA #18) as she finished the care of (RI #101). In the video it was noted that (CNA #18) used aggressive force to pull up the pants of (RI #101). After forcefully pulling up the resident's pants, the employee is shown laughing and the resident is shown pointing at her . we can substantiate physical abuse . A review of the facility's IMMEDIATE QUALITY ASSURANCE REVIEW documentation regarding the incident revealed corrective action was initiated from 05/07/2024 through 05/14/2024. Upon review and verification of the information provided in the facility's corrective action plan, in-service/education records, the facility's investigation, as well as staff interviews, the survey team determined the facility implemented corrective actions from 05/07/2024 to 05/14/2024, with on-going monitoring implemented; thus, immediate jeopardy past noncompliance was cited. 2) RI #43 admitted to the facility 05/07/2015, with a diagnosis of Anxiety Disorder and Aphasia following Cerebral Infarction. A Quarterly MDS assessment with an ARD date of 01/26/2024, identified RI #43 to score a 12 of 15 on the BIMS indicating RI #43 had moderately impaired cognition. RI #86 was admitted to the facility on [DATE] and readmitted [DATE], with a diagnosis of Cocaine Abuse, Insomnia and Dysphagia, Oropharyngeal Phase. An Annual MDS assessment with an ARD date of 05/21/2024, identified RI #86 to score a 12 of 15 on the BIMS indicating RI #86 had moderately impaired cognition. The Alabama Department of Public Health Online Incident Reporting System form, dated 03/06/2024 documented: . Incident Type . Abuse - Physical . Incident Detail . Name(s) of resident(s) involved: (RI #43) . Name of alleged perpetrator(s): (RI #86) . Narrative summary of incident: (RI #43) was rolling in (his/her) wheelchair down the hallway. (RI #86) was sitting in the hallway. (He/she) said (RI #43) ran over (his/her) foot and (he/she) hit (him/her) . The facility's incident summary dated 03/11/2024 documented: . Resident to Resident Physical Abuse . CONCLUSION (RI #86) was sitting on the hallway at the nurse's station. (RI #43) was ambulating down the hallway in (his/her) wheelchair and accidentally rolled over (RI #86's) foot. The two residents exchanged words and (RI #86), who has a history of trying to hit a resident (if) they try to run over (his/her) feet while (he/she) is sitting in the hallway, hit (RI #43) . we are substantiating resident to resident physical abuse with (RI #86) . On 07/11/2024 at 6:05 PM an interview was conducted with Licensed Practical Nurse (LPN) #11. She was asked to explain what she saw with RI #86 and RI #43, she said both were in wheelchairs in front of the nurses' station when she heard them cursing each other. LPN #11 said she saw RI #86 hit RI #43 on the arm and she and the CNA separated the two. LPN #11 said there was no sign of injury to either resident when assessed. LPN #11 said the incident was resident to resident physical abuse. 3) RI #59 was readmitted to the facility on [DATE] and readmitted on [DATE], with diagnoses to include Anxiety Disorder and End Stage Renal Disease. A Quarterly MDS assessment with an ARD of 04/11/2024 identified RI #59's had a BIMS score of 15 of 15 which indicated RI #59 was cognitively intact. RI #108 was admitted to the facility 03/02/2023, with diagnoses to include Adjustment Disorder with Mixed Anxiety and Depressed Mood. A review of RI #108's Annual MDS assessment with an ARD of 03/04/2024 indicated RI #108 had a BIMS score of 15 of 15 which indicated RI #108 was cognitively intact. The Alabama Department of Public Health Online Incident Reporting System form, dated 04/27/2024 documented: . Incident Type . Abuse - Physical . Incident Detail . Name(s) of resident(s) involved: (RI #59) . Name of alleged perpetrator(s): (RI #108) What was reported . (RI #59) reported that (RI #108) hit (him/her) in (his/her) face . Action(s) taken by the facility in response to the incident. The residents were separated . RI #108 is on one-to-one monitoring . No new injuries . The facility's incident summary dated 05/01/2024, documented that the facility's investigation determined: It was found that RI #108 engaged in a conversation with an employee in the dining room and proceeded to use profanity towards the employee. RI #59 intervened and asked RI #108 to leave the employee alone. The employee then witnessed RI #108 raising his/her hand at RI #59. As a result, RI #108 was escorted out of the dining room by the employee. Upon the employee's return, RI #59 informed her that RI #108 had hit him/her. Two other residents in the dining room confirmed witnessing RI #108 hit RI #59. Following a thorough review of acknowledgments and interviews, the facility confirmed resident-to-resident physical abuse. An interview was conducted with RI #59 on 07/12/2024 at 5:47 PM regarding the incident with RI #108. During the interview, RI #59 mentioned being in the dining room when RI #108 was verbally abusing an employee. RI #59 intervened and confronted RI #108 about the behavior, which resulted in RI #108 hitting RI #59, leaving a red mark on his/her face. RI #59 stated that there had been no additional incidents following the altercation. An interview was conducted with RI #108 on 07/13/2024 at 9:53 PM regarding the incident with RI #59. RI #108 said he/she was in the dining room and was talking to an employee. RI #108 said RI #59 got into the middle of the conversation and he/she told him/her to mind their own business. RI #108 said he/she raised his/her hand back but did not hit RI #59. An interview was conducted with Certified Nursing Assistant (CNA) #14 on 07/13/2024 at 10:44 AM regarding the incident involving RI #59 and RI #108. CNA #14 reported that while she was in the dining room, RI #108 became upset and started yelling and using profanity toward her. CNA #14 ignored RI #108, but RI #59 said something to RI #108 about the way he/she was talking. CNA #14 said she witnessed RI #108 approaching RI #59's table draw his hand back, but did not see RI #108 physically strike RI #59. CNA #14 intervened and separated the two residents and escorted RI #108 out of the dining room. Upon her return, RI #59 informed CNA #14 that RI #108 had hit him/her in the face. CNA #14 said RI #59's allegation was supported by two other residents who were sitting nearby. CNA #14 said this was considered physical abuse. An interview was conducted with the ADM on 07/13/2024 at 10:36 AM regarding the incident involving RI #59 and RI #108. The ADM stated that upon reviewing the investigation, she concluded that RI #108 physically abused RI #59. 4) RI #48 was admitted to the facility on [DATE], with diagnoses to include Vascular Dementia and Major Depressive Disorder. A Quarterly MDS assessment with an ARD date of 04/16/2024, identified RI #48's BIMS was 12 of 15 which indicated that RI #48 had moderately impaired cognition. RI #95 was admitted to the facility on [DATE], with diagnoses to include Schizophrenia and Generalized Anxiety. An Annual MDS assessment with an ARD date of 04/30/2024, identified RI #95's BIMS was nine of 15 which indicated that RI #95 had moderately impaired cognition. The Alabama Department of Public Health Online Incident Reporting System form, dated 05/06/2024 documented: . Incident Type . Abuse - Physical . Incident Detail . Name (s) of resident (s) involved: (RI #95) . Name of alleged perpetrator(s): (RI #48) . Narrative summary of incident: . The residents were out on smoke break when (RI #48) asked for a cigarette. (RI #95) stuck (his/her) foot out and (RI #48) . slapped (RI #95) . The residents were separated . (RI #48) was sent to the (emergency room) . (RI #95) was placed on one-to-one monitoring . The facility's incident summary dated 05/12/2024, documented: . Physical Abuse (Resident to Resident) . CONCLUSION The residents were taken outside to smoke . While outside (RI #95) and (RI #48) were arguing about cigarettes . (RI #95) stuck (his/her) feet out, (RI #95) and (RI #48) exchanged words and (RI #48) slapped (RI #95) .(RI #48) fell to the ground . we can substantiate physical abuse with (RI #48) and (RI #95) . The facility's investigative file was reviewed and revealed an interview done by the ADM with RI #118, 05/07/2024, which documented the following: . Physical Abuse . (RI #118), can you tell me what happened on the back porch yesterday, May 6, 2024? Answer: the residents were going back and forth with each other . (RI #48) walked over and slapped (RI #95) . On 07/12/2024 at 2:22 PM, during an interview with the ADM, she stated she substantiated that abuse had occurred. The ADM said following the incident, the facility began to take residents out to smoke in two separate groups and times to limit the number of residents smoking at one time. 5) RI #123 was admitted to the facility on [DATE], with diagnoses to include Adjustment Disorder with Anxiety and Depression. A Quarterly MDS assessment with an ARD date of 04/15/2024, identified RI #123 BIMS was 15 of 15 which indicated that RI #123 was cognitively intact. The Alabama Department of Public Health Online Incident Reporting System form, dated 06/12/2024 documented: . Incident Type . Abuse - Physical . Incident Detail . Name(s) of resident(s) involved: (RI #43) . Name of alleged perpetrator(s): (RI #123) . Narrative summary of incident: There were 4 residents sitting at the table playing dominos. (RI #123) was asked to play, and (he/she) got mad and pushed the dominos down and spit on (RI #43). (RI #43) got up and hit (RI #123). Staff separated the residents . The facility's incident summary dated 06/19/2024, documented: . Physical Abuse . CONCLUSION The residents were in the dining room in an activity of [NAME]. It's usually the same group of people that play every day. (RI #123) is usually not in the dining room playing every day. (RI #123) was playing (his/her) dominos but was taking longer than the rest of the players. (RI #43) was trying to rush (RI #123) to play (his/her) dominos and they began to have a verbal altercation that led to a physical altercation . we can substantiate physical abuse . On 07/12/2024 at 12:04 PM, during an interview with the ADM, she recalled RI #43 and RI #123 were with a group playing dominos. RI #43 told RI #123 to hurry up and play and RI #123 said shut up and spit on RI #43. RI #43 got up to hit RI #123 but the CNAs got to them and separated them. RI #123 was placed on one-to-one supervision until he/she could be sent out when a bed became available. She said the form of abuse was resident to resident physical abuse. The ADM said following the incident interventions implemented included (but not limited to) education with the residents to not rush others while playing in the groups, and educated the staff when they first hear residents raise their voice to redirect or stop the games if necessary. 6) RI #45 was admitted to the facility on [DATE], readmitted on [DATE] and discharged on 07/08/2024. A Quarterly MDS assessment with an ARD date of 04/15/2024, identified RI #45's BIMS was 15 of 15 which indicated that RI #118 was cognitively intact. The Alabama Department of Public Health Online Incident Reporting System form, dated 06/24/2024 documented: . Incident Type . Abuse - Physical . Incident Detail . Name(s) of resident(s) involved: (RI #123) . Name of alleged perpetrator(s): (RI #45) . Narrative summary of incident: The residents were in the dining room playing a game and (RI #123) spit on (RI #45). (RI #45) hit (RI #123) in the face . The facility's incident summary dated 06/27/2024 documented: . The residents were in the dining room playing dominos and (RI #123) and (RI #45) began to tap each other on the hand. (RI #123) said (RI #45) tapped him/her on the hand harder than he/she tapped him/her and (RI #123) spit in (RI #45's) face. (RI #45) hit him/her in the face. (RI #123) went down the hallway and told the nurse what happened . we can substantiate resident to resident physical abuse . On 07/11/2024 at 6:15 PM, RI #104, another resident who witnessed the incident between RI #45 and RI #123 was interviewed. RI #104 said he/she was sitting at the table while they were playing dominos back on June 24. RI #104 said RI #123 spit in RI #45's face, then RI #45 hit RI #123 around the nose area. RI #104 said RI #123 raised his/her arm to block the hit. RI #104 said he/she did not know if RI #45 hit RI #123's arm or actually hit RI #123 on the nose, but RI #45 hit RI #123. RI #104 said RI #123 got up and went to the nurses' station. On 07/12/2024 at 4:44 PM, a telephone interview was conducted with LPN #21. LPN #21 said RI #123 reported to her that RI #45 had hit him/her in the face. LPN #21 said she took RI #123 to his/her room and assessed RI #123. LPN #21 said she left RI #123 in his/her room with a CNA and went to find the other resident involved, RI #45. LPN #21 said RI #45 said he/she hit RI #123 because RI #123 spit in his/her face. When asked what type of abuse would this incident be considered, LPN #21 said physical. On 07/09/2024 at 5:19 PM, RI #123 was observed sitting on the side of the bed in his/her room. There was a sitter in the room who said someone had to be with RI #123 at all times. The surveyor asked RI #123 had he/she ever been in any type altercation with another residents. RI #123 said someone hit him/her in the face when they were playing dominos. RI #123 said it made him/her feel mad to be hit in the face. When asked why the other resident hit him/her in the face, RI #123 said he/she did not know. On 07/12/2024 at 2:22 PM, an interview was conducted with the DON. The DON said RI #45 hitting RI #123 in the nose was physical abuse. When asked what the facility had put in place to ensure an incident like this one would not occur again, the DON said RI #123 was place on one-on-one monitoring and dominos was made a supervised [TRUNCATED]