**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect the residents' right to be free from sexual abuse by not appropriately determining their capacity to consent to sexual interactions and implementing an effective plan to address the sexual activity between 2 residents for 2 of 2 resident's reviewed for abuse. (Resident 14 and Resident 28). The Immediate Jeopardy started on 5/5/22 when two cognitively impaired residents engaged in a sexual activity. Resident 14 and 28 continued to have sexual encounters after the 5/5/22 incident; resulting in increased falls, initiation of a prophylactic antibiotic, increase in antidepressant medication, initiation of a medication used to suppress sexual desire and emotional distress. The facility was unable to provide evidence an effective plan was in place to address the residents' sexual interactions and determining if Residents 28 and 14 had the mental capacity to consent to sexual activities. The Executive Director (ED), Director of Nursing Services (DNS), Nursing Clinical Support (NC) 3, Nursing Clinical Support 4, Registered Nurse 6, and Registered Nurse 7 were notified of the immediate jeopardy on 1/6/23 at 3:20 p.m. The Immediate Jeopardy was removed, and the deficient practice was corrected by 1/9/23 after the facility implemented a systemic plan that included the following actions: develop and implement a plan to address the residents' sexual interactions, their capacity to consent to such interactions, and ensure all staff are educated on sexual abuse. Findings include: 1a. The clinical record for Resident 14 was reviewed on 1/5/23 at 9:32 a.m. The Resident's diagnosis included, but were not limited to, Parkinson's disease, dementia, cognitive impairment, and depression. A Psychiatric Evaluation/ Follow-up note, dated 1/6/22, indicated Resident 14 was being seen for depression, dementia, and Parkinson's disease. He is alert and oriented to person only. His cognition is fairly declined, with long term memory fair to poor, short term memory and concentration poor. His executive functioning and abstract thinking are very impaired. His MOCA (Montreal Cognitive Assessment Test for Dementia) was 13/30 (10 to 17 points indicate moderate cognitive impairment). A care plan, initiated 1/7/22, indicated Resident 14 had impaired cognition with associated short term memory impairment and risk for confusion, disorientation, altered mood, and impaired or reduced safety awareness related to his dementia. The goal was for him to remain safe and not injure himself secondary to his impaired decision making. The interventions included, but were not limited to, assess his degree of hearing ability, impulsive behavior, and decrease in visual perception, initiated 1/7/22, observe for exit seeking behaviors, wandering into unsafe areas, and entering other resident rooms un-invited, initiated 1/7/22, redirect him when agitated behavior occurs or potential for injury is evident, initiated 1/7/22, determine if his decisions endanger himself or others. Intervene as necessary, initiated 1/7/22, give him feedback when inappropriate decisions are made, initiated 1/7/22, and pay attention to basic needs and provide ADL (Acts of Daily Living) care as required. Provide cues and supervision for decision making, initiated 1/7/22. A Quarterly MDS (Minimum Data Set) Assessment, completed 4/11/22, indicated Resident 14 had moderately impaired cognition. 1b. The clinical record for Resident 28 was reviewed on 1/5/23 at 2:30 p.m. The diagnoses for Resident 28 included, but were not limited to, stroke, major depressive disorder, mild cognitive impairment, and dementia with behavioral disturbance. The resident had previously been living in an assisted living and was transferred to long term care on 11/22/21 in the same facility. A care plan dated 4/3/20 indicated Resident [28] has impaired cognition with associated short term memory impairment and risk for confusion, disorientation, altered mood, impaired or reduce safety awareness .long term goal .Resident will remain safe and not injure self-secondary to impaired decision making Approach .Calm resident if signs or distress develop during the decision making process .Determine if decisions made by the resident endanger the resident or others. Intervene if necessary .Re-direct resident when agitated behaviors are present or potential for injury is evident . A physician order dated 11/22/21 indicated Resident 28 was to receive 30 milligrams of Paxil daily for depression. A Quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated Resident 28 was moderately cognitively impaired. A Quarterly MDS assessment dated [DATE] indicated Resident 28 was cognitively intact. An Annual MDS assessment dated [DATE] indicated Resident 28 was moderately cognitively impaired. A care plan dated 12/1/21 indicated Resident demonstrates physically abusive and resistive behaviors toward staff during hands on care/combative with care .Approach .Approach resident in a calm and unhurried manor to deliver care and provide services .Explain care process prior to delivery of care as needed .Observe for signs and sensory overstimulation and encourage resident to move into less stimulating environment as needed. Offer choices in all hands-on care and contacts. Psych to continue to follow . A physician order dated 5/3/22 indicated Resident 28 was to receive 125 milligrams and 250 milligrams of Depakote to total of 375 milligrams at bedtime for aggression and mood stabilization. A physician order dated 5/3/22 indicated Resident 28 was to receive 250 milligrams of Depakote twice a day for aggression and mood stabilization. A nursing progress note dated 5/4/22 indicated Res [Resident] [28] was in hall with another resident [Resident 14]and put her hand in his lap. Resident were separated at that time. No further action required. A nursing progress note, dated 5/05/22 at 9:00 p.m., indicated Resident 14 was in another resident's (Resident 28) room and the other resident was touching him inappropriately. The families of both residents were notified. A Behavior Event dated 5/5/22 for Resident 28 indicated .Describe behavior exhibited .sexual behavior towards other residents . Does resident's mental function vary over the course of the day? For example: Sometimes better, sometimes worse; behaviors sometimes present, sometimes not. [marked as] Yes .Indicate Non-Pharmacological measures taken - check all that apply . [marked as] redirection and relocated to quite (sic) location . A reportable incident to the Indiana Department of Health was provided by the ED on 1/5/23 at 2:23 p.m. It indicated a sexual interaction had occurred between Resident 28 and 14 on 5/5/22. The .brief description of incident .Both residents were in female resident's room. when staff entered room the observed resident with her hand under his shorts .Preventative Measures Taken .Psych to continue to follow for behaviors and make recommendations as needed .Follow us: No further resident to resident contact made. Psych to continue to follow for behaviors and make recommendations as needed . A Psych visit note for Resident 28 dated 5/5/22 completed by Psych Nurse Practitioner (NP) 1 indicated .Treatment Plan .5/5/22 .Staff reports she had an episode of putting her hand in the pants of a male peer. Writer notes the patient has a male peer in her room with the door shut. Nursing did remove the male from the room. The patient's Depakote was reduced last visit for a GDR. this has failed. The patient has been having behavior issues with being sexually aggressive and preoccupied. Her dose was increased back up to 250 [milligrams] mg bid [twice a day] and 375 mg hs [nightly] 2 days ago. If the patient's symptoms do not improve in 1 week we are going to look at increasing her Paxil from 30 mg to 40 mg daily. The patient was noted today to have a male in her room with the door shut. She is saying that she feels sex is normal and she is going to do what she wants .Her cognition continues to be very declined .The Psychiatric Examination:Appearance and Behavior: .Cooperative: no, .Memory: poor, Attention: fair, Thought Content: .Insight: poor, judgment: poor, .thought process: more confused, Orientation: Person: yes, Place: no, Time: no . An Interdisciplinary Team (IDT) note dated 5/6/22 indicated Last evening [5/5/22] resident [28] was in her room and another male resident [14] came to visit her. When staff entered room the observed resident with her hand under his shorts. Resident separated and skin assessments completed, no findings. Psych informed and had been in to visit resident earlier in day and medication adjustments made. Psych to continue to follow and make recommendations made as needed. A nursing progress note dated 5/6/22 at 8:35 p.m. indicated resident [28] has had sexual comments and behavior towards male resident [14] and staff members this shift . A Quarterly MDS Assessment, completed 5/10/22, indicated Resident 14 had moderately impaired cognition Resident 28's and Resident 14's clinical records did not include a plan of care and/or interventions in place for sexual behaviors at that time. A nursing progress note, dated 5/13/22 at 1:16 a.m., indicated Resident 14 was found in another resident's (Resident 28) room sitting on his knees beside her bed. The wheelchair was positioned in front of the door. He was returned to his own room and instructed to not enter other resident's rooms. A Behavior Event for Resident 28 dated 5/24/22 indicated .Description: inappropriately touching a male resident [Resident 14] . Event details:resident had her hand on male resident leg near privates .where did the behavior occur? resident [28]'s room .who was involved in the behavior? .2. possible triggers (contributing factors) .[marked as] other - expressed feelings toward male resident .3. intervention: [marked as] quieted environment .other resident removed from situation and taken back to room Evaluation notes: resident's monitored for inappropriate behavior and staff intervene as needed . A reportable incident to the Indiana Department of Health was provided by the ED on 1/5/23 at 2:23 p.m. It indicated a sexual interaction had occurred between Resident 28 and 14 on 5/24/22. The .brief description of incident .Resident [14] was found in resident [28]'s room and she was inappropriately touching him .Immediate Action Taken: .Residents were immediately separated. Head to toe assessments completed without injuries noted . Preventative Measures Taken .No further resident to resident contact made. Psych to continue to follow for behaviors and make recommendations as needed .Follow up: Resident's monitored for inappropriate behavior and staff continue to intervene as needed. Family aware and informed of resident's desire to be spend time together and socialize. Care plan updated. Residents continue to be followed by psych services and medications adjusted as needed. A physician order dated 5/25/22 indicated Resident 28 was to receive 2.5 milligrams of Zyprexa at night for sexual aggression. A progress note, dated 5/26/22 at 4:14 p.m., indicated Resident 14 was being monitored for inappropriate behavior and staff continued to intervene as needed. His family was aware and informed of residents' desire to be spend time together and socialize. The family was agreeable to allowing residents to spend time together and aware of their desire to be intimate. Residents continue to be followed by psych services. A progress note for Resident 28, dated 5/26/22, by Executive Director indicated, Resident's monitored for inappropriate behavior and staff continue to intervene as needed. Family aware and informed of resident's desire to spend time together and socialize. Family agreeable to allow resident to spend time together and aware of resident's desire to be intimate. Residents continue to be followed by psych services. A progress note dated 5/29/22 at 9:04 p.m. indicated Resident 14 was agitated when the CRCA (Certified Resident Care Assistant) and QMA (Qualified Medication Assistant) separated him from a female resident (Resident 28). He was sitting in the doorway of the female resident's room. Resident 14 stated that the workers were crows and always watching over him and the female resident. He was educated on why they needed to be separated and did not agree. He expressed that it was like a prison. Resident 14 was easily calmed down and did not attempt to go back into the female's room. A care plan for Resident 28, initiated 5/31/22, indicated Resident demonstrates inappropriate behaviors including: touching another male resident in a sexual manner .long term goal .Residents behaviors will not result in disruption of others environment and resident will remain safe .Approach .Assess for unmet needs such as need for toileting, rest, food, companionship, etc .Assist resident to away from other residents as needed .Determine cause for inappropriate behavior and refer to physician as needed for intervention .Encourage participation in structured activities as appropriate .Observe for triggers of inappropriate behaviors and alter environment as needed . A care plan for Resident 28, initiated 5/31/22, indicated Resident enjoys to[sic] company of another male resident/enjoys visiting with male resident in her room. Family aware of relationship although not 100% supportive .Long term goal .Resident will be safe .Approach .Family aware and consents of resident spending time with and socializing with male resident in her room .Intervene as needed .Psych to continue to follow . A care plan, initiated 5/31/22, indicated Resident 14 enjoyed the company of a female resident and visits with her in her room. The family was aware of the relationship although not 100% supportive. The goal was to keep Resident 14 safe. The approaches, initiated 5/31/22, were to intervene as needed, the family was aware and consented to resident's desire to spend time and socialize with the other resident, and for psychiatric services to continue to follow Resident 14. A care plan, initiated 5/31/22, indicated Resident 14 demonstrated inappropriate behaviors including touching another resident in a sexual manner. The goal was for the behavior not to result in disruption of others environment. The approaches were to determine the cause for the inappropriate behavior and refer to physician as needed for intervention, initiated 5/31/22, psychiatric services would continue to follow, initiated 5/31/22, encourage Resident 14 to participate in structured activities as appropriate, initiated 5/31/22, observe for triggers of inappropriate behaviors and alter the environment as needed, initiated 5/31/22, assess for unmet needs such as need for toileting, rest, food, companionship, etc., initiated 5/31/22, assist resident away from other residents as needed, initiated 5/31/22, and to administer anti-depressant medication as ordered, initiated 6/12/22. The clinical records for Resident 14 and Resident 28 did not contain information of informed consent to sexual activity such as, understanding of risks or benefits of sexual activity and knowledge of when sexual advances are appropriate such as time and place. A Psychiatric Evaluation/ Follow-up note, dated 6/2/22, indicated Resident 14 continued to receive Zoloft (anti-depressant) for depression and had no difficulty with side effects. His cognition remains somewhat confused but stable. He had been visiting a particular female (Resident 28) on his hall and was found allowing her to touch him privately He was provided with information about this being inappropriate and needing to avoid that female which he agreed to. A Psych Visit Note for Resident 28 dated 6/2/22 by Psych NP 1 indicated Interval History .6/2/22 Staff report the patient is continuing to have ongoing difficulty with sexual aggression. She was found fondling a male peer while lying in her bed. She makes frequent sexual comments about him. She was started on Zyprexa 2.5 mg hs to address her difficulty with delusions and sexual aggression .Presenting Problem & Patient Interview .She is fairly loud during our visit. She states nursing staff have been treating her poorly due to her affair. She describes this as something she enjoys, and she feels it is appropriate. She also states there should be no rule against people having sex in the facility. she also tells writer a story where she says that staff had blood on their shirts when they came in her room and they told her that a male peer had been in a motorcycle accident. She found out later this was not true and that he was fine. she says she is angry with staff for making up the story. The patient is illogical with this information. The patient was provided reality feedback. He (sic) also was provided with direction regarding inappropriateness of sexual relations in the facility with male peers. The patient disagrees with this somewhat loudly but is not derogatory during the discussion. Writer is unable to assist the patient to recent due to her level of cognitive decline .Treatment Plan .6/2/22 The patient is continuing significant difficulty with behavior issues and psychosis. Paxil is ordered for sexual aggression. we are going to increase from 30 mg to 40 mg daily due to her ongoing sexual aggression. The patient has fondled a male peer in her room. She continues to seek him out and talk about her relationship with him sexually. We are going to increase Zyprexa for psychosis. she was started on 2.5 [mg] last week and has not had improvement. She is delusional today talking about staff telling her male peer had a motorcycle accident. her cognition continues to be declining slowly . A physician order dated 6/3/22 indicated Resident 28 was to receive 40 mg of Paxil daily for sexual aggression. A physician order dated 6/3/22 indicated Resident 28 was to receive 5 mg of Zyprexa for psychosis with delusions, which was discontinued on 7/5/22. A Behavior Event for Resident 28 date 6/3/22 indicated .Description. med changes: Zyprexa and paxil - monitor behaviors of sexual nature. What behavioral expression was exhibited? behaviors of sexual nature Where did the behavior occur? room [ROOM NUMBER]. Evaluation Possible Triggers (contributing factors): Recent change in Medications - Zyprexa and paxil .3. Interventions: Engaged in a different activity .conversation .called family to talk .psych notified .Evaluation notes: Resident [28] has dx [diagnosis] of dementia with behaviors. Psych services aware and managing medications . A nursing progress note dated 6/4/22 for Resident 28 indicated resident lifting front of dress to male resident [14] x 2 [twice]. staff monitored closely and resident redirected when seen. resident spoke to male resident that she is not supposed to do that. resident monitored closely by staff this shift. A nursing progress note dated 6/7/22 for Resident 28 indicated .One episode of inappropriate talk with a male resident [Resident 14]. staff intervened and separated them. resident did not have any more behaviors after that. A nursing progress note dated 6/8/22 for Resident 28 indicated Resident up in wheelchair, able to move self around hallways. Resident was saying that she wanted a male resident friend [Resident 14] to eat dinner with or to eat in the [NAME] dining hall with her. Resident was easily redirected. Later resident was taking clothes off in hallway. She was wheeled back into her room and dressed 3 different times, each time wheeling back into the hallways and stripping again. A care plan dated 6/9/22 indicated Resident demonstrates inappropriate behaviors AEB [as evidenced by] taking clothes off in hallway/stripping .Approach .Assess for unmet needs such as toileting, rest, food, companionship, etc .Assist resident to away from other residents as needed .Determine cause for inappropriate behavior and refer to physician as needed for intervention .Encourage participation in structured activities as appropriate .Observe for triggers of inappropriate behaviors and alter environment as needed . A nursing progress note dated 6/9/22 for Resident 28 indicated .She was at the HUB [common area] after dinner and was tearful and sad. She was looking for her male companion she stated. She was tearful until she was ready for bed. A nursing progress note dated 6/10/22 for Resident 28 indicated .She was yelling in the hallway outside of her room at staff. She was trying to go into another male resident [14]'s room. When she was redirected away from male resident's room, she started yelling and crying and said she was going to throw a fit like a 2 year old. She wheeled herself out of her room and was talking inappropriately with another resident. Resident then wheeled into her room when asked to not talk like that . An Event Report, dated 6/11/22 at 10:25 p.m., indicated Resident 14 had a fall in another resident's (Resident 28) room. He was sexually active with another patient (Resident 28) at the time of the fall. There were no injuries noted. He was alert and oriented to person and place. He refused to stay out of the other resident's room. The notes include that he was found on his knees next to a recliner. He had his right hand on the other patient's body and his left hand on his penis. He had been incontinent of bladder. We was assisted to the wheelchair and assessed to have no injuries. He was agitated with staff for interrupting with multiple attempts to make care as difficult as possible. He threatened to have his family come to the facility to physically assault the staff. His family and the physician were called and notified. The Director of Health Services was notified. A nursing progress note, dated 6/12/22 at 10:05 a.m., indicated a message was left for the psychiatric nurse practitioner notifying her of Resident 14's behaviors on 6/11/22 with another resident (Resident 28). A nursing progress note, dated 6/12/22 at 11:33 a.m. indicated NP (Nurse Practitioner) 1 had returned call and given a new order for Resident 14 to receive Paxil (anti-depressant) 10 mg(milligram) daily. A care plan for Resident 28, initiated 6/13/22, indicated Resident demonstrates inappropriate behaviors AEB [as evidence by] inappropriate sexual comments in conversing with others .Approach .Assess for unmet needs such as need for toileting, rest, food, companionship, etc .Determine cause for inappropriate behavior and refer to physician as needed for intervention .Encourage participation in structured activities as appropriate .Observe for triggers of inappropriate behaviors and alter environment as needed .Psych to continue to follow . A care plan for Resident 28, initiated 6/13/22, indicated Resident demonstrates verbally abusive behaviors/yelling at staff .Approach .Encourage resident to express wants and needs during hands on care and contacts. Encourage resident to voice feelings constructively to staff as appropriate. Observe for patterns of behaviors that may trigger verbally abusive language. Alter as appropriate. Observe mood, affect, and behaviors with all hands on care and contacts. Psych to continue to follow. Re-direct resident during periods of frustration and anger . An IDT note for Resident 28 dated 6/15/22 indicated Patient continues to be monitored for behaviors. Was noted to yell out at times, have statements and behaviors of a sexual nature toward a male resident [Resident 14] and making inappropriate comments. Patient has a diagnosis of cerebral infarction, Major depressive disorder, Mild cognitive impairment and Unspecified dementia with behavioral disturbance. Is followed by psych with recommendations made as indicated. Patient started on Depakote 5/3 and takes it BID and was started on Paxil and zyprexa 6/3. Will continue to monitor for changes and further behaviors and consult psych as indicated. A nursing progress note for dated 6/16/22 for Resident 28 indicated this resident and a male resident in hallway sitting together. this resident unbutton top and let male resident rub all over her breast. Staff separated residents and took to room. resident sat in room quietly until put to bed. A nursing progress note for Resident 14, dated 6/16/22 at 8:41 p.m., indicated that he was with another resident in the hallway and found rubbing all over her breasts. He was redirected to his room and informed to stay away from the other resident. An Event Report, dated 6/18/22 at 7:30 p.m., indicated Resident 14 had a fall while he was transferring himself. There were no injuries noted from the fall. He was alert and oriented to person, place, time, and situation. He required assistants to transfer and ambulate and refused to comply with safety measures such as call light use, alarms, and appliances. He was taken to his room and assisted to bed after the fall. The notes for the event included, but were not limited to, the following: 6/18/22 at 8:20 p.m., Resident 14 was in Resident 28's room sitting in high fowlers (upright with legs extended in front of him). His wheelchair was on his right side and his back was against the door. It took a lot of encouragement by numerous staff to get him to move far enough away from the door to allow staff to enter the room. Staff entered the room after approximately 15 minutes and assisted him back to his wheelchair. He was fully dressed, and no inappropriate behaviors were noted. 6/23/22 at 1:35 p.m., Resident 14 had a fall while visiting Resident 28 in her room. The door was shut, and he was sitting with his back against the door. An intervention of leaving the door open when visiting was initiated. 6/25/22 at 1:46 p.m., Resident 14 was found in Resident 28's room. He often seeks companionship from this female resident. He was removed from room and returned to his own room. 6/27/22 at 3:06 a.m., Resident 14 was found to be returning to his room at 1:05 a.m. He was noted to have BM (Bowel Movement) on bilateral upper extremities from his fingertips to his elbows. He became agitated when being cleaned up and struck out at staff. A nursing progress note dated 7/1/22 for Resident 28 indicated she was admitted to hospital with urinary tract infection and pneumonia. Resident 28 returned from the acute care hospital on 7/5/22, with a physician's order to receive 300 mg cefdinir twice a day with a discontinuation date of 7/7/22. A Pharmacy Recommendations Event Report for Resident 14, dated 7/5/22 at 9:03 a.m., indicated he had Paxil added on 6/12/22 due to some inappropriate sexual behaviors. He was also receiving sertraline (anti-depressant) 50 mg, which is another SSRI (Selective Serotonin Reuptake Inhibitor). It is not recommended to use both, please review. A physician's order for Resident 14, dated 7/7/22, indicated to discontinue the Zoloft (Sertraline). A Psych Visit note dated 7/7/22 by Psych NP 1 indicated .Interval history .7/7/22 The patient had an episode of inappropriate talk with a male peer and also lifted the front of her dress for him. She also was noted to be undressing in the hall several times. She told staff she has performed sexual acts with the male peer. She has observed allowing him to touch her breast. She was sent to ER [emergency room] 7/1/22. she has been back for 2 days with no sexual behaviors since her return. Her cognition is significantly declined. it is unchanged from last visit. An Event Report, dated 7/17/22 at 3:11 p.m., indicated Resident 14 was displaying sexual gestures to another female resident by attempting to stick his foot into Resident 28's private area while sitting in the open hub area. The possible changes included recent discontinuation of Zoloft and sexual desires. The interventions were that he was assisted to his room and his family was called. The notes for the event included, but were not limited to, the following: 7/17/22 at 3:08 p.m., Resident 14 was sitting in the hub area when noted to have his foot between another female resident's legs. He was educated that this was not appropriate, and he laughed and said heck, let's just screw right here. 7/18/22 at 8:38 p.m., Resident 14 and Resident 28 were in the hallway outside of Resident 28's room. She was manipulating his penis. A family member came to the nursing station to report the incident. The residents were immediately separated, and the Executive Director was informed. 7/21/22 at 8:27 p.m., Resident 14 was visiting Resident 28 with the door shut for a consensual visit. 7/26/22 at 1:30 a.m., Resident 14 was found on his knees in another resident's room without pants or a brief on. He had placed his wheelchair in front of the door to prevent staff from entering. He was assessed and found to have abrasions on both knees and complained of knee pain. The female resident in the room reported that they had engaged in sexual relations. He refused to leave room or let staff assist him off of the floor. The female resident asked him to kiss her and that she was going to bite his lip. Family notified of the incident an appears increasingly frustrated with the situation. A Behavior Event Note for Resident 28 dated 7/17/22 indicated .Description: sexual gestures to another male resident. What behavioral expression was exhibited? exposing herself to male resident who was trying to stick his foot in her private areas .Where did the behavior occur? in hub area. 2. Evaluation possible triggers (contributing factors) . under-stimulation (boredom) - sexual desires. 3.) Intervention: address unmet needs - she just wants [Resident 14]'s penis, assist to different area - away from [Resident 14], call family to talk - no answer Evaluation: IDT note: resident sexual gestures are consensual. staff encouraged to redirect and educate on safe/healthy habits. Encouraged to room for sexual desires for privacy . Resident 14's and 28's medical records did not include an assessment at that time for capacity to consent to sexual activity, nor plan of care plan with interventions in place to ensure safety regarding sexual encounters. A nursing progress note for Resident 28 dated 7/18/22 at 1:38 p.m. indicated resident told male staff member to stick his finger in her belly button after pulling her gown up. She then expressed the desire to stick her finger into a specific male resident [Resident 14]'s belly button. Then stated she was only joking to get a reaction out of writer. A nursing progress note for Resident 28 dated 7/18/22 at 1:42 p.m. indicated resident has been in hallway yelling twice for a specific male resident [Resident 14]. resident was asked to please not yell in the hallway as it disrupts other residents resting. resident got louder and yelled at writer and other staff around to push her up the hallway to this male resident's room. staff encouraged resident to propel her own chair which she did and that the other resident she was seeking was resting in his room. this resident then asked to go sit in the common area, which staff assisted with mobility. A nursing progress note for Resident 28 dated 7/20/22 indicated up in w/c sitting in doorway yelling down hall for male resident [Resident 14] .to get down to her room. No close contact with this resident as of yet today. An IDT note for Resident 28 dated 7/22/22 indicated Resident continues to have intimate relationship with another resident. Both residents enjoy the company of each other. They hand [sic] out in common area and in resident room. Residents are encouraged to go to room when having sexual desires for privacy. Resident educated and agreeable. Resident 28's POA made aware and understands situation, no concerns voiced. Discussed safety concerns with both resident and resident [28's POA]. A nursing progress note dated 7/26[TRUNCATED]