**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 7. A review of Resident #18's admission Record revealed the resident was initially admitted to the facility on [DATE] and was readmitted on [DATE] with diagnoses that included Crohn's disease, chronic obstructive pulmonary disease, hydronephrosis, colostomy, and hemiparesis and hemiplegia following a cerebral infarction. A review of Resident #18's Quarterly MDS, with an ARD of 06/26/2023, revealed Resident #18 had a BIMS' score of 15, which indicated the resident was cognitively intact. The MDS revealed the resident had no signs or symptoms of delirium, psychosis, or behavioral symptoms during the review period. A review of Resident #18's care plan revealed a focus statement initiated on 02/01/2023 that indicated the resident communicated verbally. Further review revealed a care plan focus statement initiated on 08/04/2023 that indicated the resident was at risk for psychosocial changes. Interventions directed staff to increase monitoring of the resident. A review of a Long Term Care Facility - Self-Reported Incident Form, which was identified as the Initial Report and dated 08/04/2023, revealed that on 08/04/2023 at approximately 1:15 PM, Resident #18 reported that SRNA #48 was rude to the resident the night before and stated the resident complained too much. The report indicated the facility suspended SRNA #48, placed the resident on 72-hour monitoring, and initiated an investigation for verbal abuse. A review of the 5 Day Follow up/Final Report, dated 08/10/2023, revealed the facility concluded that the incident did occur based on Resident #18's cognitive status. According to the report, SRNA #48 was hired on 06/27/2023, suspended on 08/04/2023, and terminated from employment on 08/10/2023. Supporting documents in the final report revealed the facility conducted interviews with 42 residents regarding care provided by SRNA #48. Further review of the report revealed the statement, The Director of Nursing responsible for oversight and supervision of the clinical department on 8/3/2023 [08/03/2023] gave verbal correction related to [SRNA #48's] bedside manner. A review of SRNA #48's timesheet revealed the last shift the SRNA worked was from 7:00 PM on 08/03/2023 to 7:00 AM on 08/04/2023 at 7:00 AM. This was confirmed by Human Resource Director (HR) #62 on 12/07/2023. During an interview on 12/04/2023 at 10:45 AM, Resident #18 stated they had no concerns with facility care and received assistance from staff with their care needs. Resident #18 said that in the past, there was one rude staff member (SRNA #48) who had a bad attitude and said the resident was a complainer. Resident #18 stated that SRNA no longer provided their care. During an interview on 12/07/2023 at 9:47 AM, the DON stated that when she walked past SRNA #48 at approximately midnight on 08/03/2023, the SRNA's speech, demeanor, body language, and tone were unprofessional. The DON stated she verbally educated SRNA #48 on professionalism. The DON stated the next day, 08/04/2023, they received the allegation from Resident #18 about SRNA #48. The DON stated after receiving the allegation, I said, well, I'm not surprised. The DON confirmed that SRNA #48 was suspended and terminated from employment on 08/10/2023. 8. A review of Resident #230's admission Record revealed the facility admitted Resident #230 on 09/29/2021 with diagnoses that included metabolic encephalopathy, hypothyroidism, and cardiomegaly. Dementia with severe agitation and Alzheimer's disease were listed with an onset date of 06/01/2023. A review of Resident #230's Quarterly MDS, with an ARD of 04/28/2023, revealed Resident #230 had a BIMS score of 00, which indicated the resident had severe cognitive impairment. The MDS revealed the resident had behavioral symptoms not directed toward others, which were documented as having occurred four to six days within the assessment period. A review of Resident #230's care plan revealed a focus area initiated on 11/30/2021 that revealed the resident had a behavior problem. Interventions directed staff to anticipate and meet the resident's needs, monitor behavior episodes, and attempt to determine the underlying cause of behaviors. A review of Resident #231's admission Record revealed the facility admitted Resident #231 on 03/14/2022 with diagnoses that included dementia without behavioral disturbance and Alzheimer's disease. A review of Resident #231's Quarterly MDS, with an ARD date of 09/14/2023, revealed the resident had a BIMS' score of 3, which indicated the resident had severe cognitive impairment. A review of Resident #231's care plan revealed a focus area initiated on 07/18/2022 that indicated the resident was at risk for bruising/bleeding related to the daily use of anticoagulants. Interventions directed staff to observe the resident's skin for discoloration and to notify the nurse. A review of a document titled Facility Investigation - 5 day Final Report, dated 04/08/2023, revealed Resident #231 and Resident #230 were sitting in the restorative dining area; Resident #230 was hitting the table repeatedly. The report revealed Resident #231 patted Resident #230 on the arm, and Resident #230, in response, grabbed Resident #231 on the left forearm with both hands over Resident #231's long-sleeve shirt, causing a skin tear and bruising to Resident #231's forearm. The report revealed the residents were immediately separated, and skin assessments were completed. The report revealed Resident #230 was removed from the restorative dining program. The report revealed Resident #231 was interviewed and had no lasting effects from the incident. A review of a typed interview statement included in the facility's investigation from Restorative Aide #52, dated 04/04/2023 at about 10:00 AM, indicated that Resident #231 grabbed Resident #230's arm, and staff asked them to let go; Resident #231 let go immediately. Restorative Aide #52 stated in response to Resident #231 grabbing Resident #230, Resident #230 grabbed Resident #231's arm. Restorative Aide #52 stated she separated the residents immediately and reported it to the nurse. A review of a typed statement included in the facility's investigation from the SSD, dated 04/05/2023, indicated the SSD had interviewed the residents. The document revealed Resident #230 did not recall the incident. The document further indicated Resident #231 laughed and said they got me. The document also indicated Resident #231 stated they were ok when asked. During an interview on 12/10/2023 at 12:47 PM, the DON confirmed Resident #231 had obtained an injury from another resident. She stated if Resident #230 had aggressive behavior toward staff, the resident could have aggressive behavior toward other residents. She stated the staff could have had the resident seated away from others. During an interview on 12/11/2023 at 12:57 PM, the Administrator stated abuse would not be tolerated and that staff should investigate why the resident was having behaviors. She stated they needed to educate facility staff on other avenues to ensure the resident could not harm another resident. 9. A review of the facility's policy titled The Dining Experience, dated 2019, revealed, 7. b. Positioning and assistance at mealtime must be appropriate for individual needs. The policy further revealed, 10. Staff will provide cueing, prompting, or assistance as needed in order to maintain, improve and prevent decline in eating ability. A review of Resident #21's admission Record revealed the facility admitted the resident on 02/25/2022 with diagnoses that included heart failure anemia, type II diabetes mellitus, major depressive disorder, anxiety, hemiplegia, and hemiparesis. Dementia was listed with an onset date of 10/01/2022. A review of Resident #21's Quarterly MDS, with an ARD of 10/29/2023, revealed Resident #21 had a BIMS' score of 0, which indicated the resident had severe cognitive impairment. The MDS revealed Resident #21 required substantial/maximal assistance for eating and was on a mechanically altered diet. Resident #21's weight was documented as 135 pounds, and there was no documented weight loss or gain during the review period. A review of Resident #21's care plan revealed a focus area initiated on 04/18/2022 that indicated the resident was at nutritional risk related to diagnoses of heart failure, dementia, reflux, anemia, high blood pressure, history of a stroke, diabetes, chronic kidney disease, having a mechanically altered diet, and a history of refusing meals. Interventions directed staff to provide a pureed diet as ordered, with fortified oatmeal and yogurt with breakfast, double portions, supplements as ordered, total assistance with meals, and monitor and record intake after each meal. A review of the Facility Investigation - 5 Day Final Report, dated 07/14/2023, indicated under Summary of Incident that on 07/09/2023 at approximately 8:13 PM, a licensed nurse reported to the Director of Nursing that Resident #51 reported SRNA #18 did not feed Resident #21 at supper time. The report revealed that SRNA #18 was suspended pending the investigation, and Resident #21 was placed on a 72-hour monitoring schedule. The report revealed the facility immediately offered a substantial meal to all residents. Per the report, SRNA #18 and SRNA #38 were immediately placed on the Do Not Return (DNR) list and were not able to work at the facility any longer. The report revealed Resident #51 was interviewed on 07/09/2023 by the DON, on 07/10/2023 by the Administrator, and on 07/11/2023 by the SSD. The report revealed the SSD followed up with Resident #51 to see if they had witnessed any nursing assistant bringing in a resident's tray, leaving it on the bedside table, and not feeding the resident. Resident #51 said that it had not happened again since they reported it on 07/09/2023. The report revealed the employment agency of SRNA #18 and SRNA #38 was notified of the incident, and the agency verbalized understanding that SRNA #18 and SRNA #38 were not allowed to return to the facility. The report revealed that during a review of camera footage, SRNA #38 was observed entering the room of Resident #21 and Resident #51; audio footage captured SRNA #18 and SRNA #38 discussing if Resident #21 needed assistance with feeding. The report revealed that film and audio footage also captured that Resident #51 walked out of the room and told SRNA #18 to feed Resident #21; SRNA #18 did go back into the resident's room for six minutes after being told repeatedly by Resident #51 to go in and feed their roommate. The report revealed that based on a thorough in-house investigation, it remained inconclusive if the incident happened. A review of Resident #21's Progress Notes, dated 07/09/2023 at 10:45 PM, revealed LPN #20 documented Resident #21's roommate reported to LPN #20 that Resident #21 had not been fed their evening meal. The note revealed that LPN #20 asked Resident #21 if the resident was hungry, and the resident responded, I'm not hungry. The note revealed Resident #21 did eat a chocolate pudding cup offered by LPN #20. The note revealed the DON was notified, and the DON notified kitchen staff to come back to the facility to cook a full tray for Resident #21. The note revealed the resident's family member was notified, and Resident #21 was placed on acute monitoring for food intake for 72 hours. An additional progress note dated 07/09/2023 at 11:01 PM documented by LPN #20 indicated Resident #21 was fed a full tray with staff assistance, and the resident ate 100% of the meal. During a phone interview on 12/12/2023 at 10:37 AM, SRNA #18 stated she could not recall the incident, that it was not her, and that she had stopped working at the facility because the facility no longer chose her to work. SRNA #18 said she did not do anything wrong. During an interview on 12/11/2023 at 9:01 AM, the DON stated Resident #21 needed total assistance when eating, was on a pureed diet, and ate in their room due to pain caused with movement. The DON stated Resident #51 advocated on behalf of Resident #21. The DON stated Resident #51 called the DON and put the nurse on the phone, and the nurse stated that Resident #21 had their meal tray sat in front of them and was not fed the meal. The DON stated the facility launched an investigation and offered Resident #21 a substantial meal, and the dietary department offered the meal to all the residents. The DON stated SRNA #18 was agency staff and was not allowed to return to the facility. The DON stated she expected staff to assist residents who need assistance with eating. During an interview on 12/11/2023 at 1:37 PM, the Administrator stated Resident #21 needed total assistance when eating, was on a pureed diet, and ate in their room. The Administrator said Resident #51 stated they had told an SRNA to feed Resident #21, and the SRNA did not assist the resident because the SRNA had other residents to assist. The Administrator stated Resident #51 came out of their room and told staff they needed to assist Resident #21. She stated SRNA #18 was in Resident #21's room for seven minutes. The Administrator stated they had staff return to the facility to ensure a snack was available and that residents were offered a meal. The Administrator stated SRNA #18 was put on the facility's Do Not Return list because SRNA #18 would not respond to the facility's calls. Based on interviews, record reviews, and facility policy review, it was determined the facility failed to protect 9 of 15 sampled residents from abuse and neglect. Specifically, the facility failed to protect Residents #79, #5, #63, #18, and #48 from staff-to-resident verbal and/or physical abuse and Resident #21 from staff neglect. In addition, the facility and failed to protect Residents #63, #34, #49, and #231 from resident-to-resident physical and/or verbal abuse. The findings included: Review of the facility's policy titled Resident Protection Plan, dated 09/15/2022, revealed, Our facility does not condone resident abuse by anyone, including staff members, physicians, consultants, volunteers, staff of other agencies serving the resident, family members, legal guardians, sponsors, other residents, friends, or other individuals. Further review of the policy revealed, Verbal Abuse - is defined as any use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance, to describe residents, regardless of their age, ability to comprehend, or disability. Physical Abuse - is defined as hitting, slapping, pinching, kicking, etc. It also includes controlling behavior through corporal punishment. Neglect - is defined as the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental or emotional anguish. 1. Review of Resident #79's admission Record revealed the facility admitted the resident on 09/13/2023 with diagnoses that included chronic obstructive pulmonary disease (COPD), dysphagia, diverticulosis of the large intestine, and gastrostomy status. A review of Resident #79's admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 09/14/2023, revealed the resident had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident was cognitively intact. Further review of the MDS revealed Resident #79 required limited assistance with toilet use and personal hygiene and received nutrition and hydration through a feeding tube. Review of Resident #79's care plan revealed a focus statement initiated on 10/19/2023 that indicated the resident had bowel and bladder incontinence. Interventions directed staff to frequently check the resident for incontinence and indicated the resident was to wear briefs or pull-ups (adult underwear for incontinence). Review of the Long Term Care Facility Self-Reported Incident Form Initial Report, dated 10/17/2023, revealed that Family Member (FM) #41 reported to the Administrator and the Director of Nursing (DON) that State Registered Nurse Aide (SRNA) #40 had been rough with Resident #79 during incontinence care provided on 10/15/2023. A telephone interview was held with FM #41 on 12/06/2023 at 1:00 PM. FM #41 stated they were unable to remember the exact date of the incident but recalled that it was in November 2023. FM #41 stated that during a visit with Resident #79, two staff members came into the resident's room to provide incontinence care. FM #41 stated when the resident's brief was removed, FM #41 noticed Resident #79's perineal area was red and excoriated. FM #41 stated staff used disposable wipes to cleanse the resident, and when the FM suggested using warm, wet washcloths, the staff was condescending. The FM stated the staff members acted as if they did not care. FM #41 said the staff was wiping Resident #79 roughly and causing the resident pain, and the resident started crying. FM #41 stated that even though Resident #79 was crying, the staff continued providing the incontinence care with no compassion and did not care that they were hurting the resident's sore, reddened skin. FM #41 stated no one should be treated as Resident #79 had been treated. A telephone interview was held with SRNA #34 on 12/07/2023 at 11:11 AM. SRNA #34 stated she had been assigned to provide care for Resident #79 on the day the incident occurred. SRNA #34 stated the resident's call light was on; she answered the light, and FM #41 told her Resident #79 required incontinence care. SRNA #34 stated FM #41 informed her that the resident said the call light had been on for two hours. The SRNA stated FM #41 then told her she was incompetent because the resident's skin was excoriated and red. SRNA #34 said when she realized how upset FM #41 was, she had Licensed Practical Nurse (LPN) #22 and SRNA #40 go into the resident's room with her to provide the incontinence care. SRNA #34 stated that SRNA #40 was the person who was accused of being too rough with Resident #79, and she agreed that during the incontinence care, SRNA #40 had been rough with the resident. SRNA #34 stated she held Resident #79 in position on his/her side while SRNA #40 provided the incontinence care. She stated that SRNA #40 used so much force to cleanse the resident she could feel the force pushing on her as she held the resident on his/her side during care. SRNA #34 stated FM #41 wanted Resident #79 to wear pull-ups, but SRNA #40 got upset and told FM #41 a brief would be easier. SRNA #34 stated SRNA #40 had been so rough she would call what happened abuse. SRNA #34 stated Resident #79 was crying and saying, Ouch! Ouch! The resident told SRNA #40 that the care was hurting, but SRNA #40 did not stop. A phone interview was held with LPN #22 on 12/07/2023 at 12:12 PM. LPN #22 acknowledged she had been working when the incident occurred between Resident #79 and SRNA #40. She stated another staff member asked her to go into the resident's room because the staff member had not thought the interaction was going well. LPN #22 stated the resident's buttocks were red due to incontinence and chronic diarrhea that Resident #79 had experienced since admission. The LPN stated she knew other staff were saying SRNA #40 had been rough with Resident #79, but she did not see it that way. LPN #22 added that she may not have been standing close enough to see if SRNA #40 was rough with the resident. She said she had been standing three to four feet from Resident #79's bed and near the foot of their roommate's bed. LPN #22 stated Resident #79 was wincing, but she thought that was because the resident was sore and not necessarily because SRNA #40 was doing anything wrong. LPN #22 stated that SRNA #40 apologized to Resident #79 the entire time she was providing incontinence care. A phone call was placed to SRNA #40 on 12/07/2023 at 11:22 AM, and the phone was out of service. An interview with the DON was held on 12/11/2023 at 12:48 PM. The DON stated the incident between Resident #79 and SRNA #40 had occurred on 10/15/2023 at 5:00 PM. She stated the facility's administration found out about the incident on 10/17/2023 at 1:00 PM when FM #41 reported the incident to her and the Administrator. The DON stated interviews were conducted with the alleged abuser, the reporter, the nurse on duty, and the SRNA who was in the room with the alleged abuser. The DON stated SRNA #34, who had been in the room, agreed that SRNA #40 had been rough with Resident #79 during incontinence care. She stated SRNA #40 denied all allegations, and LPN #22 stated she had no concerns with the care given by SRNA #40. The DON stated SRNA #40 had been immediately suspended. The Administrator was interviewed on 12/12/2023 at 10:31 AM. The Administrator stated she found out about the incident on 10/17/2023 from FM #41, who reported SRNA #40 had been rough with Resident #79 during incontinence care. The Administrator stated SRNA #40 was immediately suspended. 2. A review of Resident #5's admission Record revealed the facility admitted the resident on 08/08/2023 with diagnoses that included secondary malignant neoplasm of the large intestine and rectum (colon cancer) with colostomy and adult failure to thrive. A review of Resident #5's admission MDS, with an ARD of 08/20/2023, revealed the resident had a BIMS score of 15, which indicated the resident was cognitively intact. Further review of the MDS revealed Resident #5 required extensive assistance with toilet use and personal hygiene. The MDS revealed Resident #5 was always incontinent of urine, and bowel continence was not rated due to the presence of an ostomy. A review of Resident #5's care plan revealed a focus statement initiated on 08/08/2023 that indicated Resident #5 had bladder incontinence. Interventions directed staff to provide incontinence checks every two hours and keep the call light within the resident's reach. A review of a Long Term Care Facility Self-Reported Incident Form Initial Report dated 10/25/2023 revealed that on 10/25/2023 at approximately 7:15 AM, SRNA #34 reported to the DON that Resident #5 stated that SRNA #35 yanked Resident #5's brief while checking for incontinence and made the resident feel belittled. A review of a Grievance Form, dated 10/25/2023, indicated Resident #5 told the DON the agency SRNA (SRNA #35) refused to change his/her brief. The grievance form indicated that when Resident #5 called and requested that his/her brief be changed, SRNA #35 pulled the bed covers back and told the resident they did not need to be changed due to not being incontinent. The form indicated Kentucky Medication Aide (KMA) #13 overheard the conversation and got another staff member to change Resident #5's brief. A telephone interview was held with SRNA #34 on 12/07/2023 at 11:04 AM. SRNA #34 stated Resident #5 reported to her that another SRNA had been rough during care. The SRNA stated Resident #5 was cognitively intact and described the following incident. SRNA #34 stated Resident #5 said that when they called for help, SRNA #35 answered the call light, and Resident #5 told SRNA #35 they needed incontinence care. SRNA #34 stated that the resident said SRNA #35 pulled the bed covers back, shook the resident's brief, and told the resident they had not been incontinent. Telephone calls and voice messages were left for SRNA #35 on 12/07/2023 at 12:33 PM, 12/07/2023 at 7:15 PM, and 12/09/2023 at 8:47 AM. SRNA #35 did not return the calls. A telephone interview was held with KMA #13 on 12/07/2023 at 12:01 PM. The KMA recalled that on the day of the event, Resident #5 used their call light to request assistance a few times. She said SRNA #35 went into the resident's room and told Resident #5 they did not require incontinence care because the lines (indicators) on the brief had not changed colors; therefore, the resident had not been incontinent, and she was not changing the resident's brief. KMA #13 stated she had reported the incident to LPN #37, who was the nurse that day. KMA #13 stated LPN #37 went into Resident #5's room and told the resident that if they required changing the SRNA needed to change them regardless of whether the lines on the brief had changed colors. During an interview on 12/08/2023 at 1:54 PM, LPN #37 stated she had been working when the incident with Resident #5 occurred. LPN #37 stated Resident #5 called her into their room and wanted to know about the lines on the adult briefs. LPN #37 stated she told the resident that when the lines on the briefs changed colors, that meant there had been incontinence. LPN #37 stated she also told Resident #5 that because he/she was cognitively intact, staff should change their briefs when requested. She stated at that time, Resident #5 told her SRNA #35 said the lines on his/her brief had not changed color and did not warrant the resident being changed. LPN #37 stated she made Resident #5 an offer to switch SRNA #35's assignment with another staff member, and the resident told her they just wanted the nurse to know about the incident. The LPN stated Resident #5 had not communicated any rough treatment or pulling of the brief during care. LPN #37 stated that after the conversation with the resident, she explained to SRNA #35 that it was the expectation that she change a resident's brief as requested regardless of the color of the indicator lines on the brief. The DON was interviewed on 12/11/2023 at 11:16 AM. The DON stated that on 10/25/2023, SRNA #34 walked into her office and told her she had something important to tell her. SRNA #34 reported that on 10/22/2023, Resident #5 stated that at around 5:00 PM, SRNA #35 yanked Resident #5's brief and made the resident feel belittled while checking to see if the resident had been incontinent. The DON stated she gathered witness statements from SRNA #34 and SRNA #35, who denied the allegation; LPN #37, the nurse assigned that day, who stated she was unaware the incident occurred; and Resident #5. The DON stated Resident #5 reported that SRNA #35 yanked their brief while she checked the resident for incontinence and made the resident feel belittled. The DON stated Resident #5 told her that SRNA #35 checked the lines on the brief, told the resident they had not been incontinent, and refused to change the brief. She stated she called the agency on 10/25/2023 and requested SRNA #35 not return to the facility. The DON stated SRNA #35 had only worked in the facility since 10/22/2023. She stated the allegation of abuse for Resident #5 was substantiated. The Administrator was interviewed on 12/12/2023 at 9:40 AM. She stated she found out about the incident concerning Resident #5 and SRNA #35 on 10/25/2023 when an employee reported to the DON that an agency employee had yanked Resident #5's brief on 10/22/2023. 3. A review of Resident #63's admission Record revealed the facility admitted the resident on 06/28/2022 with diagnoses that included unspecified mood (affective) disorder, bipolar disorder, intellectual disabilities, and depression. A review of Resident #63's Quarterly MDS, with an ARD of 08/16/2023, revealed Resident #63 had a BIMS' score of 11, which indicated the resident had moderate cognitive impairment. The MDS revealed Resident #63 had physical behavioral symptoms directed toward others and rejected care for one to three days during the review period. The MDS revealed Resident #63 required extensive assistance with bed mobility, locomotion, and dressing and was dependent on staff for transfers, toilet use, and personal hygiene. A review of Resident #63's care plan revealed a focus statement with a revision date of 08/08/2022 that indicated Resident #63 displayed behavioral symptoms that included biting, hitting, screaming, shouting, yelling, refusing medications, being disruptive, and lashing out during physician's visits, using foul language and racial expletives, and throwing objects from their bedside table. Interventions directed staff to attempt interventions before behavioral symptoms begin, not seat Resident #63 around others who would disturb them, help the resident avoid people or situations that would disturb them, offer the resident diversions they enjoy, refer the resident to a psychologist/psychiatrist as needed, give medications as ordered, and remove the resident from an activity when negative behaviors begin, returning/resuming the activity when the behavior subsides. A review of a Long Term Care Facility Self-Reported Incident Form Initial Report, dated 11/09/2023, revealed Resident #63 made an allegation of staff-to-resident verbal abuse. Further review of the report revealed that Dietary Aide (DA) #45 overheard SRNA #46 being verbally abusive to Resident #63. DA #45 reported that on 11/08/2023 at approximately 6:30 PM, SRNA #46 was heard saying to Resident #63, I don't know who is stupid enough to buy these nails [artificial fingernails]. If you don't hold the [expletive] still, then I'm not going to put it back on you. A review of an incident report dated 11/09/2023 revealed that Resident #63 reported that SRNA #46 cussed at me. Review of the incident Progress Notes, dated 11/09/2023, revealed that Resident #63 stated he/she was cussed at by an SRNA. The notes indicated the resident was placed on 72-hour monitoring, and the provider was notified. Review of the Progress Notes, dated 11/09/2023, revealed Resident #63 exhibited increased nervousness due to an event with an SRNA. The notes indicated the primary purpose of the visit was to evaluate the mental state of Resident #63 after an incident with a staff member. The notes indicated Resident #63 was relatively calm as the provider spoke with the resident and responded appropriately to questions asked. There was no change in the resident's treatment plan. Review of acute monitoring nursing Progress Notes, dated 11/09/2023, revealed that Resident #63 screamed and cursed at staff off and on all shift because his/her artificial fingernails kept falling off and staff had no glue to reapply the fingernails. The note indicated staff had tried to explain the situation to Resident #63, who continued to scream and curse at staff. Review of a timesheet for SRNA #46 indicated she worked 12 hours on 11/08/2023, which was the date of the alleged incident, and worked on 11/09/2023 for 1 hour and 50 minutes. DA #45 was interviewed on 12/07/2023 at 2:11 PM. DA #45 stated that on the day of the incident, Resident #63 was wearing artificial fingernails that kept falling off, which made the resident upset. DA #45 stated she overheard SRNA #46 tell Resident #63 that if the resident did not [expletive] quit, she was not going to put the fingernails back on. DA #45 stated she left Resident #63's room, returned to the kitchen, and notified the Administrator and Director of Nursing (DON) within five minutes of the event. DA #45 stated there had been no physical abuse observed, and she had left the room because she had not liked how SRNA #46 had spoken to the resident. She stated that at the time of the incident, Resident #63 was upset, and she knew that because when the resident got upset, the resident's voice got louder, and at that time, the resident's voice got louder. The DON was interviewed on 12/11/2023 at 11:16 AM. The DON stated the incident between Resident #63 and SRNA #46 occurred on 11/08/2023 at 6:30 PM, and she became aware of the incident on 11/09/2023 at 8:45 AM. The DON stated her understanding of what happened was that SRNA #46 cursed at Resident #63 because the resident was calling out for the artificial fingernails to be reapplied, [TRUNCATED]