**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interviews, the facility failed to ensure the resident was treated with dignity and respect for 1 (#2) of 1 (#2) sampled residents who complained of a long call light response. The facility failed to ensure resident #2's call light was answered in a timely manner, after the resident had requested assistance from staff on 08/11/2024. Findings: Review of the medical record revealed resident #2 was admitted to the facility on [DATE] with diagnoses including a colostomy. Further review revealed that resident #2 had a documented brief interview for mental status score of 14. A score of 13-15 indicated that resident #2 was cognitively intact with daily decision making skills. On 08/12/2024 at 10:23 a.m., an interview with resident #2 revealed he had used his call light three times on 08/11/2024 and requested staff assistance with the emptying of his colostomy bag. Review of the [NAME]-Care Report (a reporting system by which the facility obtained all nurse call activity) revealed a maximum response time of 32:34 (thirty two minutes and 34 seconds) on 08/11/2024. On 08/14/2024 at 11:56 a.m., S1Administrator was notified of resident #2's complaint of a long call light response on 08/11/2024. After reviewing the [NAME]-Care Report with S1Administrator, she confirmed a maximum wait time of 32:34 was too long of a response time.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to ensure a resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing and to prevent infection for 1(#3) of 2 (#1 and #3) sampled residents reviewed for pressure ulcers. The facility failed as evidence by resident #3 not having a dressing covering her sacral wound, in accordance with the physician's orders. Findings: Review of the medical record revealed resident #3 was admitted to the facility on [DATE]. Resident #3's documented diagnoses included obesity, cerebral infarction, and an unstageable pressure ulcer of the sacrum. Review of the medical record revealed a physician's order dated 07/11/2024. Review of the order revealed that staff were to cleanse resident #3's sacral wound with wound cleanser, pat the wound dry, and apply Calcium Alginate to the wound bed. Further review of the order revealed to cover the wound with a silicone dressing, to change the dressing every other day and as needed. Upon entering resident #3's room on 08/12/2024 at 11:00 a.m., S4Certified Nursing Assistant (CNA) was observed repositioning the resident in bed. During the observation, a visual inspection of resident #3's skin with S4CNA revealed resident #3 had an open wound to her sacrum. Observation revealed there was no dressing covering the wound, therefore leaving it opened and exposed with feces inside of the wound bed. S4CNA revealed that she had bathed resident #3 at 9:30 a.m. and observed that resident #3 did not have a dressing in place at that time. She revealed that she had notified the nurse (referring to S5Licensed Practical Nurse) (LPN) of resident #3 not having a dressing on her sacrum. On 08/12/2024 at 11:28 a.m., S3Wound Care Nurse (WCN) was notified of the finding and the interview with S4CNA. S3WCN revealed that she was not aware of resident #3's sacral dressing being off. She confirmed that resident #3 should have had a dressing in place to cover the sacral pressure ulcer. On 08/12/2024 at 11:30 a.m., S1Administrator and S2Assistant Administrator were notified of the above findings. On 08/12/2024 at 11:35 a.m., S5LPN was notified of the interview with S4CNA. S5LPN revealed that she did not recall anyone notifying her of resident #3's sacral dressing being off.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews the facility failed to ensure a resident who is unable to carry out activities of daily living received the necessary services to maintain good grooming, and personal hygiene for 1 (#5) of 2 (#5, and #14) residents investigated for assistance with activities of daily living (ADL). The failed practice was evidenced by resident #5 having long and dirty fingernails. Findings: Resident #5 Record review revealed resident #5 was admitted to the facility on [DATE] with diagnoses that included hypertension, chronic obstructive pulmonary disease, seizure disorder, and congestive heart failure. Further review of the record revealed a Minimum Data Set (MDS) assessment completed on 04/05/2024. The assessment revealed resident #5 had a brief interview of mental status (BIMS) score of 15 which indicated he had no cognitive impairment. Further review of the MDS data, under section G - ADL assistance, revealed resident #5 required assistance with all activities of daily living with at least one person assistance. On 05/28/2024 at 2:52 p.m. an interview and observation with resident #5 revealed he had long fingernails with black grime observed underneath the nails. Resident #5 reported staff came by a couple of weeks ago and soaked his fingernails in warm water and reported they would be back to trim his nails but no one returned to trim his nails. Resident #5 reported he asked staff to cut them again on a different day but the person he asked never returned to trim his nails. On 05/29/2024 at 3:34 p.m., an observation of resident #5 revealed he had long fingernails with black grime observed underneath the nails. On 05/29/2024 at 10:20 a.m., an observation of resident #5 was conducted in his room with S3Licensed Practical Nurse (LPN). Observation revealed resident #5 had long fingernails with black grime observed underneath the nails. S3LPN confirmed resident #5 was in need of nail care. On 05/30/2024 at 11:32 a.m., S2Director of Nurses (DON) was informed of resident #5 having long dirty fingernails and S2DON agreed nail care should have been provided.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Resident #219 Review of the medical record for resident #219 revealed the resident was admitted on [DATE] with diagnoses of hypertension, insomnia, restless legs syndrome, atherosclerotic heart disease, osteoarthritis, neuropathy, and osteoporosis. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident scored a 10 on the Brief Interview for Mental Status (BIMS) which indicated moderately impaired cognitive skills for daily decision making. Review of the physician orders for May 2024 revealed an order dated 05/10/2024 for Geodon (antipsychotic) 20 mg at bedtime daily. Review of the record revealed the following care plan: antipsychotic drug use, at risk for side effects - takes Geodon. An interview with S8Assistant Director of Nursing on 05/30/2024 at 9:50 a.m. confirmed the resident did not have a diagnosis documented in the clinical record for receiving Geodon. An interview with S2Director of Nursing on 05/30/2024 at 1:10 p.m. confirmed the resident did not have an acceptable diagnosis documented in the clinical record for receiving the antipsychotic medication, Geodon. Based on record reviews and interviews, the facility failed to ensure resident's drug regimens were free from unnecessary psychotropic medications for 2 (#24 and #219) of 5 (#12, #16, #24, #54, #219) residents reviewed for unnecessary medications. The facility failed to ensure 1) lab work was obtained for resident #24 while receiving a psychotropic medication and 2) a psychotropic medication was used only when there was an acceptable diagnosis documented in the medical record for resident #219. Findings: Resident #24 Review of the medical record for resident #24 revealed an admission date of 08/05/2021 with diagnoses including esophageal obstruction, diabetes mellitus, depression, bipolar, psychosis, and dementia. Review of the May 2024 physician orders revealed an order dated 05/01/2022 for Seroquel (antipsychotic) 25 milligrams (mg) to be administered by mouth at hour of sleep. Further review of the May 2024 orders revealed an order dated 10/26/2022 to obtain Glycated Hemoglobin (HbA1c) annually in February. Review of the current care plan revealed antipsychotic drug use related to diagnosis of bipolar and to obtain lab work as ordered. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident scored a 15 on the Brief Interview for Mental Status (BIMS) which indicated intact cognitive skills for daily decision making. Review of the medical record revealed no documented evidence of a HbA1c obtained in February 2024 as ordered. Interview with S2Director of Nursing (DON) on 05/29/2024 at 3:00 p.m. confirmed there was no documentation of the HbA1c obtained for resident #24 in February 2024. Interview with S2DON on 05/30/2024 at 1:10 p.m. confirmed the facility should obtain the HbA1c when a resident was administered Seroquel.

Based on observations, interview and record reviews, the facility failed to honor and accommodate food preferences for 5 (#4, #17, #22, #39, #47) of 6 (#4, #6, #17, #22, #39, #47) residents investigated for dining concerns. The failed practice was evidenced by residents not being provided condiments with their meals. Findings: Resident #39 Record review revealed resident #39 had a quarterly Minimum Data Set (MDS) assessment completed on 05/03/2024. Section C (cognitive patterns) of the MDS revealed a Brief Interview of Mental Status (BIMS) was completed with a score of 13 which indicated she was cognitively intact. Further review of active physician orders for May 2024 revealed an order for resident #39 to receive a regular diet. On 05/28/2024 at 09:18 a.m., observation revealed resident #39 was served pancakes with no syrup. During an interview at this time with resident # 39, she reported she was agitated and she stated enough was enough. Resident # 39 complained about the kitchen staff rarely providing the necessary condiments to go with the food served. Resident # 39 reported she had to ask for condiments the majority of the times when she ate meals in her room. Resident #17 Record review revealed a quarterly MDS assessment data was collected on 04/19/2024. Section C (cognitive patterns) revealed resident #17 had a BIMS score of 12 which indicated mild cognitive impairment and had the ability to make her wants and needs known. Further review of active physician orders for May 2024 revealed an order for resident #17 to receive a regular diet. On 05/28/2024 at 09:24 a.m., an observation and interview with resident #17 was conducted in her room as she was being served breakfast. She was served bacon and pancakes with no syrup. Resident #17 reported she wanted syrup with her pancakes and she frequently had to ask for condiments such as salt, pepper and ketchup because it was not provided on her meal tray. Resident #17 reported she normally ate in her room. Resident #4 Record review revealed resident #4 had a quarterly MDS assessment completed on 03/24/2024. Section C (cognitive patterns) of the MDS revealed a BIMS was completed with a score of 15 which indicated she was cognitively intact. Further review of active physician orders for May 2024 revealed an order for resident #4 to receive a regular renal diet. On 05/28/2024 at 09:27 a.m., an observation and interview was conducted in resident #4`s room. Resident #4 reported she never got condiments with her meals. Resident #47 Record review revealed resident #47 had a quarterly MDS assessment completed on 04/12/2024. Section C (cognitive patterns) of the MDS revealed a BIMS was completed with a score of 15 which indicated he was cognitively intact. Further review of active physician orders for resident #47 revealed an order for resident #47 to receive a regular diet with no concentrated sweets. On 05/30/2024 at 1:10 p.m., an interview was conducted with resident #47 in his room. Resident #47 was alert and oriented. He reported he was not served condiments with all of his meals served in his room. Resident #22 Record review revealed resident #22 had a quarterly MDS assessment completed on 03/01/2024. Section C (cognitive patterns) of the MDS revealed a BIMS score of 15 which indicated she was cognitively intact. Further review of active physician orders revealed an order for resident #22 to receive a regular diet. On 05/30/2024 at 1:00 p.m., an interview was conducted with resident #22 in her room. Resident #22 was alert and oriented. Resident #22 reported condiments were not always on her tray when meals were served. Resident # 22 reported she occasionally ate meals in her room and it was a problem if she had to wait for condiments to be delivered after her food was dropped off in her room. On 05/30/2024 at 11:30 a.m. an interview was conducted with S2 Director of Nurses (DON). S2DON confirmed all residents should have been served condiments with their meals in accordance with their diet ordered.

Based on observations and interviews, the facility failed to prepare and distribute food in accordance with professional standards for food service safety. The facility failed to ensure 1) that all staff operating the three compartment sink and dishwasher could test for the proper amount of sanitizer, and 2) contamniated serving utensils did not come in contact with the food on the steam table. According to interview with S4Dietary Manager (S4DM), there were 72 residents who received meals served from the kitchen. Findings: During a tour of the kitchen with S4DM on 05/28/2024 at 8:35 a.m., an observation revealed S5Dietary Worker in the dishwashing room. She was observed placing dishes in the three compartment sink. Further observation revealed water in all three individual compartments of the sink. S5Dietary Worker removed a test strip from the Auto-Chlor (Test strips used to test for chemical sanitizer levels) bottle. S5Dietary Worker dipped the test strip into the water of each of the compartments. S5Dietary Worker revealed that she was checking the water with the test strip and if it (referring to the test strip) turned purple, the water was warm enough. Observation of the test strip revealed there was no color change to indicate the sanitizer level. S6Dietary Worker was present in the dishwashing room and was observed preparing dishware for the dishwashing machine. S6Dietary Worker revealed that when she used the strips (Referring to test strips used to check the sanitizer level), she was to check the temperature of the water. She pointed to one of the dishwasher's hose that was located at the top of the dishwashing machine and revealed she could see the water that contained the sanitizer coming out of the hose. S6Dietary Worker confirmed that she did not check the machine's water during the rinse cycle to determine the amount of sanitizer in the water. S4DM was present in dishwashing room during the observations and interviews with S5Dietary Worker and S6Dietary Work and confirmed the dietary staff needed further training on the testing for sanitation of the three compartment sink and the dishwashing machine. During an observation of the lunch service on 05/28/2024 at 11:45 a.m., S5Dietary Worker was observed using a pair of tongs to retrieve sliced turkey from a pan that was located on the steam table. When attempting to pick the meat up, she dropped the tongs in the pan with the handle submerged in the gravy and in direct contact with the sliced turkey. S5Dietary Worker had held the tongs with her bare hands. S5Dietary Worker picked the tongs up from the gravy with the same bare hands and continued with the meal service. Further observation revealed S7Dietary Worker retrieved the rolls from a different pan on the steam table. After handling the tongs with her bare hands, S7Dietary Worker was observed placing the tongs including the handles, on top of the rolls. The handle of the tongs were on top of and in direct contact with the rolls. S4DM was present in the kitchen during the meal service and was notified of the observations and interviews with S5Dietary Worker and S7Dietary Worker. S4DM confirmed that S5Dietary Worker should have replaced the dropped tongs and S7Dietary Worker should not have placed the tong handles on top of an in direct contact with the rolls. On 05/30/2024 at 3:02 p.m., S1Administrator and S9Administrator-In-Training were notified of the observations during the lunch meal service.

Based on observation and interview, the facility failed to maintain all mechanical equipment in a safe operating condition by having a large buildup of grease in the deep fryer. Findings: On 05/28/2024 at approximately 12:30 p.m., an observation of the kitchen revealed one large gas deep fryer. Further observation revealed the deep fryer had a lower compartment that housed the fryer's internal components. Observation of the lower compartment revealed a large, thick buildup of grease and grease splatters throughout the compartment and in direct contact with the fryer's internal components. S4Dietary Manager was present during the observation and confirmed the deep fryer was not in safe working condition and needed to be cleaned. On 05/30/2024 at 3:02 p.m., S1Administrator and S9Administrator-In-Training were notified of the observation of the deep fryer.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interviews, the facility failed to ensure that all alleged violations involving abuse or mistreatment are reported immediately to the administrator of the facility for 1 (#1) of 3 (#1, #2, and #3) residents who reported an allegation of alleged abuse. The facility failed to ensure an allegation of abuse related to Resident #1 was reported immediately to the administrator by an employee that was made aware of the allegation of alleged abuse. Findings: Review of resident #1's medical record revealed she was admitted to the facility on [DATE] with diagnoses that included in part, bullous pemphigoid, long term (current) use of non-steroid anti-inflammatories (NSAID), contracture of muscle, multiple sites, age-related osteoporosis without current pathological fracture, and abnormal posture. Review of the quarterly minimum data set (MDS), dated [DATE], revealed Resident #1 had a brief interview for mental status score of 08. A score of 8-12 indicated that resident #1 had mild cognitive impairment with daily decision making. Further review of the (MDS) revealed Resident #1 required extensive assistance with one person physical assist with toilet use, dressing, personal hygiene, and total dependence with one person assist with bathing. Further review also revealed resident #1 had impairment to both her upper and lower extremities. An Observation on 10/30/2023 at 9:30 a.m., revealed Resident #1 lying in bed, in her room. Further observation revealed resident #1's arms and hands were contracted. During an interview, Resident #1, reported that S5CNA/Former Employee had broken her arm. Resident #1 reported that S5CNA/Former Employee had been rough with her and she had pulled on her left arm when getting her dressed. Resident #1 further reported that she (Resident #1) had pain in her left arm after S5CNA/Former Employee had pulled on her left arm. During a telephone interview with S5CNA/Former Employee on 10/30/2023 at 1:05 p.m., S5CNA/Former Employee reported that upon her return to work on a Wednesday, she (S5CNA/Former Employee) could not recall the exact date, Resident #1 had reported that she (S5CNA/Former Employee) had broken her left arm and left leg. S5CNA/Former Employee revealed that she reported Resident #1's complaint to S4LPN. During an interview with S4LPN on 10/30/2023 at 2:23 p.m., S4LPN revealed that on Wednesday, 10/11/2023, S5CNA/Former Employee had reported to her (S4LPN) that the resident #1 had complained of pain in her arm. S4LPN reported that she had asked resident #1 if she was hurting and resident #1 reported yes, that her arm was hurting, but did not say which arm. S4LPN further revealed that resident #1 had reported to her (S4LPN) that S5CNA/Former Employee had had been rough with resident #1, pulled resident #1's arm, and that resident #1 had reported that she had been having pain in her arm since the incident had occurred. S4LPN confirmed that she did not immediately report to S1Administrator the allegation of alleged abuse involving resident #1 and S5CNA/Former Employee, upon S4LPN first becoming aware of the allegation on 10/11/2023. On 10/31/2023 at 3:15 p.m., S1Administrator was notified of the findings. S1Administrator confirmed S4LPN should have immediately notify her (S1Administrator) on 10/11/2023 when S4LPN first became aware of the allegation of alleged abuse involving Resident #1 and S5CNA/Former Employee.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to maintain an infection prevention and control program designed to provide a sanitary environment and to help prevent the development and transmission of communicable diseases and infections for 2 (#1 and #2) of 2 (#1 and #2) residents observed during pericare. The failed practice was evidenced by staff not performing proper hand hygiene after providing pericare for residents #1 and #2. Findings: Resident #1 Review of Resident #1's medical record revealed she was admitted to the facility on [DATE]. Resident #1's documented diagnoses included in part, bullous pemphigoid, long term (current) use of non-steroid anti-inflammatories (NSAID), contracture of muscle, multiple sites, age-related osteoporosis without current pathological fracture, abnormal posture, and a comminuted proximal humeral head fracture left. Review of the quarterly minimum data set (MDS) dated [DATE] revealed Resident #1 had a brief interview for mental status score of 08. A score of 08-12 indicated that resident #1 had mild cognitive impairment with daily decision making. Review revealed Resident #1 required extensive assistance with one person physical assist with toilet use, dressing, personal hygiene, total dependence with one person assist with bathing, and Resident #1 had impairment to both the upper and lower extremities. During an observation of pericare on 10/31/2023 at 1:50 p.m., S6Certified Nursing Assistant (CNA) gathered the supplies that were needed for the pericare procedure for Resident #1. S6CNA donned a pair of clean disposable gloves and began cleaning resident #1's perineal area. Resident #1 was then repositioned on her right side. Observation revealed feces on the resident's buttocks. S6CNA continued with the pericare procedure. After completing the procedure, S6CNA retrieved a clean brief and place in on the Resident #1. S6CNA did not remove her dirty, contaminated gloves, and she did not perform hand hygiene after providing pericare for Resident #1. S6CNA placed a clean brief on Resident #1 while wearing the contaminated gloves. S6CNA then retrieved a large pillow from the end of the bed and repositioned Resident #1 by using the pillow. S6CNA was observed touching the resident's bed linens and body using the same pair of contaminated gloves worn during pericare. Resident #2 Review of the Resident t #2's medical record revealed the resident was admitted to the facility on [DATE]. The resident's documented diagnoses included in part, muscle wasting left upper arm, right upper arm, need for assistance with personal care, age-related osteoporosis with without current pathological fracture, bowel and urinary incontinence, and muscle weakness (generalized). Review of the Minimum Data Set, dated [DATE] revealed Resident #2 had a documented brief interview for mental status score of 03. A score of 00-07 indicated that Resident #2 was severely cognitively impaired with daily decision making. Further review revealed resident #2 required extensive assistance with two+ persons physical assist with bed mobility, extensive assistance with one person physical assist with dressing, and limited assistance with one person assist with personal hygiene. Review further revealed Resident #2 had impairment on one side of the upper and lower extremities. During an observation of pericare on 10/31/2023 at 1:30 p.m., S6CNA gathered the supplies needed for the pericare procedure for resident #2. S6CNA then donned a clean pair of disposable gloves and began to clean urine from Resident #2's perineal area and buttocks. After the pericare procedure was finished, S6CNA removed the resident's soiled brief. She then retrieved a clean brief from resident's bedside table while wearing the contaminated gloves and placed the brief on resident #2. S6CNA then retrieved a large pillow from the foot of resident #2's bed and used the pillow to reposition the resident's body. She then touched the Resident #2's clothing and bed linens using the same pair of dirty and contaminated gloves she had used to provide pericare for Resident #2. On 10/30/2023 at 3:30 p.m., S1Administrator, S2Administrator in Training (AIT), and S3 Director of Nursing (DON) were notified of the findings during the pericare procedures for Residents #1 and #2. S3DON confirmed that S6CNA did not perform pericare for resident #1 and resident #2 in a sanitary manner that would help prevent cross contamination.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, and interviews, the facility failed to treat each resident with respect and dignity and care in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for 1 (#52) of 3 (#52, #54, and #70) residents reviewed for nutrition. Resident #52 was not assisted with his meals in a timely manner while other residents at his table were provided their meals. Findings: Review of the medical record for resident #52 revealed the resident was admitted on [DATE] with diagnoses of extrapyramidal and movement disorder, anxiety disorder, reduced mobility, lack coordination, muscle weakness, right wrist drop, need for assistance with personal care, cognitive communication deficit, Huntington's disease, and encephalopathy. Review of the Minimum Data Set, dated [DATE] revealed the resident had severely impaired cognitive skills for daily decision making. The resident required extensive assistance with eating, bed mobility, transfer, dressing, toilet use and personal hygiene. Observation on 05/15/2023 at 12:02 p.m. revealed resident #52, resident #63, resident #29 and resident #62 were sitting at the table. S5CNA (Certified Nursing Assistant) was assisting resident #63 with eating, S6Certified Nursing Assistant was assisting resident #29 with eating and resident #62 was eating her lunch meal. Resident #52 was sitting at the table with no food or drink. Observation on 05/15/2023 at 12:18 p.m. revealed S4Licensed Practical Nurse started to assist resident #52 with eating. Observation on 05/16/2023 at 8:02 a.m. revealed resident #52, resident #29, and resident #54 were sitting at the table. S5CNA was assisting resident #29 with eating and resident #54 was eating. Resident #52 was sitting at the table without with his meal. An interview on 05/17/2023 at 1:15 p.m. with S4LPN (Licensed Practical Nurse) confirmed on Monday, 05/15/2023, and Tuesday, 05/16/2023, resident #52 waited without his meal at the table while the other residents were eating. S4LPN confirmed resident #52 should have been provided his meal at the same time as the other residents at the table. An interview on 05/17/2023 at 1:55 p.m. with S2Director of Nursing confirmed resident #52 should be provided his meal at the same time as the other residents at his table.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, and interviews, the facility failed to ensure that a resident who is unable to carry out activities of daily living receives the necessary services to maintain grooming for 1 (#52) of 1 sampled residents reviewed for activities of daily living. Findings: Review of the medical record for resident #52 revealed the resident was admitted on [DATE] with diagnoses of extrapyramidal and movement disorder, anxiety disorder, reduced mobility, lack coordination, muscle weakness, right wrist drop, need for assistance with personal care, cognitive communication deficit, Huntington's disease, and encephalopathy. Review of the Minimum Data Set, dated [DATE] revealed the resident had severely impaired cognitive skills for daily decision making. The resident required extensive assistance with eating, bed mobility, transfer, dressing, toilet use and personal hygiene. The resident required total assistance with bathing. The resident was incontinent of bowel and bladder. Review of the care plan revealed the resident requires extensive assistance for activities of daily living due to unintentional, involuntary movements related to Huntington's disease. Observations on 05/15/2023 at 9:15 a.m., 05/16/2023 at 8:33 a.m., and 05/17/2023 at 8:15 a.m. and 1:55 p.m. revealed the resident's facial hair was unkempt and in need of shaving. An interview on 05/17/2023 at 1:15 p.m. with S4Licensed Practical Nurse confirmed resident #52's facial hair needed to be shaved. An interview on 05/17/2023 at 1:55 p.m. with S2Director of Nursing confirmed resident #52's facial hair needed to be shaved.