**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility's incidents, and policy and procedure, resident and staff interview, the facility failed to protect residents' right to be free from abuse for 1 (Resident #1) of 3 sampled residents reviewed. Resident #1 was admitted to the facility on [DATE] with diagnoses including bipolar disorder (mental health condition causing dramatic shifts in mood), and alcohol abuse. On 3/10/23 Resident #1 was agitated and shoving his walker at Certified Nursing Aide (CNA) Staff C. Therapy Staff observed CNA Staff C raise his right hand and made contact with the left side of the resident's face. The findings included: The facility's Abuse, Neglect and prohibition policy with a date effective 10/24/22 noted, Each resident has the right to be free of mistreatment, neglect, and abuse . Physical abuse includes hitting, slapping, punching, biting, and kicking. It also includes controlling behavior through corporal punishment . The facility will make efforts to ensure all residents are protected from physical and psychosocial harm, as well as additional abuse, during and after the investigation . Review of the clinical record revealed Resident #1 was admitted to the facility on [DATE] with diagnoses including bipolar disorder and ETOH (alcohol) abuse. The care plan initiated on 3/10/23 noted Resident #1 had behaviors of cursing at staff, using racial slurs, and spitting at staff. The goal was for the resident to demonstrate effective coping skills. The interventions included anticipate resident's needs: food, thirst, toileting needs, comfort level, body positioning, pain etc. Evaluate for side effects of medications. Give as many choices as possible about care and activities. Medications as ordered. Psychiatric evaluation as needed. Review of the facility's incidents investigations revealed on 3/10/23 at 10:35 a.m., Occupational Therapist (OT) Staff A and Physical Therapist (PT) Staff B reported they were in Resident #1's room to provide therapy services while Certified Nursing Assistant (CNA) Staff C was assisting the resident to get out of bed. Both therapists reported they observed Resident #1 sitting on the edge of the bed with the walker in front of him. CNA Staff C was standing to the resident's left side and the resident was repeatedly picking up the walker and slamming it back down on the floor. Both therapists reported they observed CNA Staff C raise his right hand and mad contact with the left side of the resident's face. The therapists did not hear any noise with the contact they observed. They then observed CNA Staff C immediately exit the room. Both therapists reported Resident #1 said, Did you see him hit me? That's abuse. On 3/10/23 at 10:40 a.m., the Nursing Home Administrator documented she interviewed CNA Staff C who reported he was in Resident #1's room providing personal care. CNA Staff C stated throughout the morning the resident had been swearing at him and calling him, the N-word. CNA Staff C reported therapy personnel entered the resident's room as he was assisting him up to the edge of the bed. Resident #1 took the walker that was in front of the bed as he sat up and was shoving it at him and hitting him in the groin repeatedly. CNA Staff C stated the resident was yelling to get the fuck out of the way. He reported he was to the resident's left side. CNA Staff C said Resident #1 continued to call him the N-word and hit him with the walker. He reacted and pushed against the left side of the resident's head with his right hand. CNA Staff C described the action as pushing with mild force and stated it was a reflex after being hit with the walker in the groin area. CNA Staff C was immediately removed from the facility with statement obtained and sent home. The investigation noted Registered Nurse (RN) Unit Manager completed a head to toe skin assessment on 3/10/23 with no injury noted. Resident #1 reported a mild headache to the RN Unit Manager on 3/10/23 around 11:00 a.m. On 3/13/23 the Clinical Psychologist documented Resident #1 reported that he was abused by the staff and documented a diagnosis of Acute Stress reaction. On 3/20/23 at 12:46 p.m., OT Staff A stated she and PT Staff B were going to do an evaluation, CNA Staff C was already present in the room when they got there. The CNA was attempting to get Resident #1 out of bed. The resident was agitated, had come to sitting part of the way, and became more frustrated. The CNA was standing next to the bed bedside the walker. The patient became agitated, took the walker and was slamming it down on the floor. The CNA said the walker hit him. That's when he took his right hand and hit the resident with an open hand. OT Staff A said she did not hear any sound but saw the resident kind of move in a backward motion. CNA Staff C walked out of the room. He just said, I am sorry, and walked out in general. On 3/20/23 at 12:46 p.m., PT Staff B said she saw the same thing OT Staff A reported. She said they made sure Resident #1 was toileted and safe then went directly to the Administrator and gave their statements. Resident #1 did not voice any complaint about his head hurting. There were no marks on the resident's face. She said, We did not hear a slap noise as you hear when someone is slapped. It just happened so fast. On 3/20/23 at 3:30 p.m., Resident #1 was observed in his room. The resident asked the surveyor if she's heard about, the guy hitting him. He said, I get very anxious, and I do have issues with mood. I yell when I am angry, and these people need to be put in their place. The resident added, I like things done a certain way, half of these people I don't even want them in my room, period!. Resident #1 said he felt safe after CNA Staff C was sent home.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the facility's policies and procedures, observation, staff, and resident interview the facility failed to promptly obtain needed dental services for 1 (Resident #18) of 1 resident reviewed with repeated requests to see a dentist for dental pain. The findings included: The facility policy Dental Services SHC04004.08 revised 8/29/2017 read, The facility provides each resident with access to dental services. Residents will be referred to a dentist based on assessed need. The facility will obtain services of a qualified dental provider.Basic services will be provided in-house. Facility staff will assess dental status through the interdisciplinary resident assessment process and daily provision of care. The physician, residents and family/responsibility party may request dental services at any time . Social Services designee will be responsible for coordinating dental services in the facility. Review of the clinical record revealed Resident #18 was admitted to the facility on [DATE]. The admission Minimum Data Set (MDS) assessment with a target date of 12/29/21 noted Resident #18 had no natural teeth or tooth fragments (edentulous). The Quarterly MDS assessment with a target date of 6/29/22 noted the resident scored 15 on the Brief Interview for Mental Status (BIMS), indicating intact cognition. The care plan initiated on 12/20/21 noted Resident #18 had dental health problems related to being edentulous. The goal was for the resident to be able to eat and drink free of pain through the next review date. The interventions included to monitor for signs and symptoms of oral/dental problems such as pain to gums, toothache, palate, abscess, teeth missing, loose, broken, eroded, decayed. Coordinate arrangements for dental care, transportation as needed/ordered. On 8/29/22 at 2:30 p.m., Resident #18 said for the past eight months she has repeatedly asked to see a dentist since her admission to the facility. The Resident said she had missing teeth and her gums hurt. Observation of the resident's mouth on 8/29/22 at 2:35 p.m., with her permission showed red gums and small pieces of damaged teeth. Resident #18 said she has not seen a dentist since her admission to the facility. On 8/31/22 at 10:38 a.m., Resident #18 said she has pain when chewing and when the food goes into the open pockets in her gums. The staff give her Tylenol, but feels she needs something stronger. Resident #18 said her brother has also called to find out why they have not done anything with her teeth since she has been here for almost a year. Resident #18 said she spoke to the social worker again one week ago about her teeth and seeing a dentist. Review of progress notes revealed on 4/1/22 the dentist documented, Unable to locate patient-attempted twice. On 5/2/2022 the dental hygienist documented Resident #18 stated she has pain all over and would like dental care. Finding/Observation: . Possible fistula (abnormal passage) #7 facial, generalized root tips and severe gingival (gums) redness and swelling. Very large bilateral mandibular [NAME] (bumps in both sides of the lower jaw made of bone tissue covered by gum tissue). She needs to be seen by a dentist and have radiographs to review. On 6/7/22 the dental hygienist documented Resident #18, stated she has pain all over and would like dental care. Finding/Observation: . She pointed to the root tips on the upper anterior and 31 area root tip. She expressed more interest in the area on the lower right (31) causing pain. She asked about pain medication. The floor nurse stated she will administer Tylenol. Informed the floor nurse she needs the dentist to examine and radiographs to determine treatment plan. I stressed the need for the dentist to examine the patient. Informed the resident of severe gingival swelling and redness especially lower right . Possible fistula #7 facial, generalized root tips and severe gingival redness and swelling . On 9/1/22 at 8:57 a.m., the Social Services Director said the dentist and or the dental hygienist are at the facility every month. He confirmed Resident #18 had not seen the dentist since her admission on [DATE] and said, I apologize for that. He said since Resident #18's admission, the only intervention implemented for her dental issues/pain was Tylenol. The Social Services Director said there was no system in place to follow up and ensure residents who need dental services were seen by the dentist. He said Resident #18 asks him to see the dentist almost every day. He has sent multiple emails to the dentist on her behalf. On 9/1/22 at 9:53 a.m., Certified Nursing Assistant (CNA) Staff H said Resident #18 complains of teeth pain at least twice a week and she informs the nurses. On 9/1/22 at 12:04 p.m., the Director of Nursing (DON) said she was aware of Resident #18's requests to see the dentist. She said, She did ask me to see the dentist. The DON said she thought the resident's request for dental care was being addressed. The Administrator who was present during the interview said, I am not the person to ask about a reasonable time frame when asked about suitable time frame to see a dentist. The DON said they will have Resident #18 see the dentist immediately.