Based on record review, review of facility policy and procedures, resident and staff interviews, the facility failed to protect the resident's right to be free from physical abuse for 1 (Resident #899) of 3 residents reviewed for abuse. The findings included:A review of the facility policy Identifying Types of Abuse documented, Abuse of any kind against residents is strictly prohibited. Abuse prevention includes recognizing and understanding the definitions and types of abuse that can occur. It is understood by the leadership in this facility that preventing abuse requires staff education, training, and support, and a facility wide culture of compassion and caring. Possible indicators of physical abuse include an injury that is suspicious because the source of the injury is not observed, the extent or location of the injury is unusual or because of the number of injuries either at a single point in time or overtime .Examples of injuries that could indicate physical abuse include but are not limited to: fractures, sprains or dislocations . Review of the facility's incident investigations revealed on 6/25/25 Resident #899 reported that on 6/23/25 Certified Nursing Assistant (CNA) Staff A handed her the call light and then tried to take it back. Resident #899 did not want to give the call light back. She alleged that the CNA tore the call light out of her hand, twisted her fingers around and pulled the call light out of her hands. The investigation noted Resident #899 left hand with bruising to the left 4th and 5th fingers.The facility interviewed CNA Staff A who stated on 6/25/25 she took care of Resident #899 and did not recall any issues with the resident who was on her regular assignment. CNA Staff A said Resident #899 asked for a pain pill that morning and to talk to the nurse. She advised the nurse of the resident's request. Around 1:00 p.m., Resident #899 asked to get out of bed for her care plan meeting. The resident's representative showed her that she had a bruise on her left hand. The representative and the resident did not say that anyone had hurt the resident.On 6/25/25 at 4:07 p.m., CNA Staff A wrote on a witness statement, On 6/25/25 at 1:30 p.m., I got her out of bed to get into her w/c so I can take her to the care plan meeting. The caregiver showed me she had a bruised hand. She did not say anything else or tell me anyone hurt her, only that look that the bruise is there.Licensed Practical Nurse (LPN) Staff B said Resident #899 requested to speak with a nurse. The resident stated that the nurse last night was rough and twisted my hand. Resident #899 showed her left hand to LPN Staff B who observed swelling and bruising of the resident's left 5th finger. Resident #899 could not recall the name or provide a description of the staff who was rough and twisted her hand. LPN Staff B notified the Administrator and Director of Nursing (DON).The facility's investigation documented on 7/7/25 the analysis of the incident (apparent cause): This injury was found to be an injury of unknown origin. All allegations have been unsubstantiated.Review of the clinical record for Resident #899 revealed an admission date of 5/6/25. Diagnoses included history of breast cancer, malignant neoplasm of lung and brain. Resident #899 was admitted to hospice services on 6/9/25.Review of the admission Minimum Data Set (MDS) assessment with a target date of 6/15/25 documented Resident #899 required partial to moderate assistance with bed mobility and hygiene. The MDS noted the resident scored 8 on the Brief Interview for Mental Status, indicating the residents' cognitive skills for daily decision making were moderately impaired.On 7/8/25 at 8:45 a.m., in an interview Resident #899 said a Certified Nursing Assistant (CNA) grabbed the call light out of her hand. She said she did not know the name of the CNA but she was very strong. Resident #899 pointed to her left hand. Dark bruising was observed on the dorsal area of the resident's left hand, and the palmar area of the 4th and 5th fingers.Resident #899 said, She (the CNA) was angry and was very strong. I was very upset that day about it. I think I was telling her to stop when she was trying to get the call light out of my hand, and she let up after a couple of minutes. It happened so fast, I think I was yelling. She was trying to get the wires out of my hand, and I was being grabbed. I don't know why she was trying to take it from me. They removed her and she has not been back since. When I use the call light now, they come. The facility did an x-ray and they took pictures of my hand and I have a fractured finger on the pinky finger of the left hand.The resident said, I felt and still feel when caring for people who have disabilities that you should treat them well.On 6/25/25 the Physician documented in a progress note, Chief Complaint: Per nursing, left small finger swelling and pain, and abdominal rash. The nurse reports today that there is some swelling and pain of the left little finger. Apparently, the patient is reporting that her hand may have been twisted and states she was trying to use a remote by a caregiver. When seen in her room, she was enjoying an eclair dessert using her left arm. There is swelling and an area of ecchymosis (bruising). She said that she did have some pain with movement but was able to use her hand. Otherwise, she was alert and enjoying her desert. She does have some forgetfulness. The left hand particularly the left fifth finger has an area of ecchymosis, tracking down to the left anterior hands with evident swelling. There was decreased range of motion. No gross dislocation. She was able to do some range of motion. The wrist has full range of motion including the elbow and she was able to raise her left upper extremity. Alert and oriented x I to 2, oriented to self with some confusion. Assessment: Left fifth finger swelling ecchymosis. Generalized weakness. Lung cancer with brain metastasis. Plan: Ordered stat (without delay) x-ray of the hand, focusing on the left fifth finger to see. She was wanting to use her left hand. Will await results. I did meet the POA (Power of Attorney) in the hallway and I did report that x-ray was being done. I did ask the nurse to call Director of Nursing (DON) to report incident at this time.Review of Resident #899's left-hand x-ray obtained 6/25/25 revealed an acute mildly displaced fracture of the fifth finger.On 7/8/25 at 10:12 a.m., in an interview CNA Staff A said on 6/25/25, she was asked to get Resident #899 up and dressed for a care plan meeting. CNA Staff A said, That day I saw her hand bruised. I told the nurse, the DON came and spoke to me. She said the resident was confused and always grabs the side rail when you turn her, and she yells. CNA Staff A said The resident holds the side rail so tight, she could have hit her hand on it, and she moves her hands around, maybe she hit something. I never tried to take the call light from her, it is my job to give it and answer it. The CNA said she always puts the bed down when she is done providing care and always gives the resident the call light, the bed control, the table and remote control for the television.CNA Staff A said, The resident's friend came to visit on 6/25/25, and showed me her hand and I told the nurse. They gave me education in person and in writing on abuse. I never tried to take the call light from her, I don't know why she says that.A follow-up observation of Resident #899's bed noted there were no side rails attached to the bed.On 7/8/25 at 2:26 p.m., in a telephone interview LPN Staff B said on 6/25/25 she was working the day shift and went to give Resident #899 her medication.She said, The resident told me a nurse came in last night and twisted her hand. Her left hand was swollen, and she had bruising from the left pinky to the wrist. I don't think she can tell the difference between a CNA or a nurse but I believe she can tell you what happened to her. I notified the supervisor and called the doctor. The Abuse person is the Administrator, so I told him too.On 7/8/25 at 1:05 p.m., in an interview the Administrator verified he was the abuse coordinator for the facility. He said he spoke with Resident #899's Health Care Surrogate after the incident. He said, I spoke to her in person but did not take her statement, she seemed exhausted, and she spoke to the police department at length. I did not get a copy of the police report.The Administrator said the root cause of Resident #899's injury was, We determined the cause with the primary care physician, and we could not determine if the cause was forceful. The physician thought the fracture would be splintered if it was abuse. We checked to see if she hit her hand on something. We could not rule out that it was trauma. The Physician said it could have happened by bumping it on something. Ultimately, we could not pinpoint the cause of the fracture itself. He said CNA Staff A does not have access to the resident; she is not allowed in her room. He said the CNA is supervised on each shift so the Supervisor will ensure the CNA is not going in the room. The Supervisor will ensure that they are providing care in pairs.On 7/8/25 at 2:20 p.m., in an interview the Medical Director said she was aware of the incident with Resident #899's fracture. She said, I saw her right after, and she had swelling and bruising to the left hand. I figured some type of trauma occurred and ordered a STAT X-ray. The X-ray showed demineralization which means the bone is thin and there was a fracture of the 5th finger. The resident is very frail. She has lung cancer with metastasis (spreading) to the brain and the bone. She has some confusion, and she did tell me the aid tried to grab the call light out of her hand. It is up to the facility to investigate it and see what happened. The resident was seen last week, and she had no pain, the bruising was there but the swelling was gone. I did not want to order any splint because she could move the fingers and she was feeding herself. The injury could be you could bang it. It was some kind of trauma because there was swelling and bruising. The fracture was caused by trauma, but what, I don't know. The resident has some confusion but she has some thought and insight.On 7/9/25 at 5:07 p.m., in a telephone interview Resident #999's friend said she saw Resident #899 the day before the incident and her left hand was fine. There was no swelling or bruising. The next day she came again and her left hand was swollen and bruised. Resident #899 said they tried to take the call light from her hand and that is how she hurt her hand. She said the person twisted her hand trying to get the call light.The friend said she was not there when it happened but she did not have any injury the day before. She let the nurse know. The DON came and spoke with me. The police were notified and she spoke to them for a long while.