**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect the resident's right to be free from verbal abuse from another resident when one resident (Resident #1) was yelled by repeatedly another resident (Resident #2), his/her roommate, making the resident (Resident #1) obviously anxious and upset. The facility census was 102. Record review of the facility policy titled, Abuse and Neglect Policy and Procedures, revised on 11/28/23, showed the following: -This policy and procedure is implemented to provide a system to prevent and detect abuse, neglect, exploitation, and mistreatment and to provide a system of reporting suspected cases of abuse and neglect and to assure thorough investigation and appropriate follow-up action in alleged incidents of abuse, neglect, exploitation, and mistreatment; -The facility has zero tolerance of verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, neglect, or misappropriation of resident property; -This facility is committed to protecting residents from abuse by anyone including, but not necessarily limited to: facility staff, other residents, consultants, volunteers, staff from other agencies providing services to our residents, family members, legal guardians, surrogates, sponsors, friends, visitors, or any other individual; -Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm or pain or mental anguish, or deprivation by any individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This presumes that all instances of abuse of any resident, even if in a coma, causes physical harm, or pain, or mental anguish; -Verbal abuse is defined as any use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to a resident or their families, or within hearing distance, regardless of their age, ability to comprehend, or disability. Examples of verbal abuse include, but are not limited to, threats of harm; saying things to frighten a resident, such as telling a resident that she will never see her family again; -The safety of the resident involved during and after any such allegations will be assured by the facility; -When the accused or suspected individual is not an employee, while the investigation is being conducted the accused individual will not be allowed to remain alone with the resident. It shall be the responsibility of the administrator, or designee, to inform the individual of any limitation on visitation. If the accused individual is another resident, immediate interventions shall occur to prevent a future incident. 1. Record review of Resident #1's face sheet an admission date of 10/31/19. Record review of the resident's annual minimum data set (MDS - a federally-mandated assessment tool completed by facility staff), dated 11/09/22, showed the following: -Moderate cognitive impairment; -Inattention and disorganized thinking, behavior present, fluctuates (comes and goes, changes in severity); -Experienced hallucinations (perceptual experiences in the absence of real external sensory stimuli); -Experienced delusions (misconceptions or beliefs that are firmly held contrary to reality); -Experienced wandering 4 to 6 days, but less than daily; -Required supervision from staff with transfers, and eating; -Required limited assistance from staff with dressing and toilet use; -Used a wheelchair for mobility; -Diagnoses included Lewy-body dementia (disease that causes a progressive decline in mental abilities, may cause visual hallucinations and changes in alertness and attention), anxiety disorder, and depression; -Staff administered antipsychotic medication, antianxiety medication, and antidepressant medication to the resident on a daily basis. Record review of the resident care plan showed: -Undated, resident used psychoactive medication for anxiety disorder and depression; -Target date 2/27/23, resident will be free from discomfort or adverse reactions or be free to choose an acceptable level of what effects he/she can tolerate when taking this medication by review date; -Undated, if staff notice that the resident is very anxious, encourage the resident to play the piano to help calm the resident; -Undated, remove resident from stressful situations that will increase the resident's anxiety; -Undated, administer medication as ordered; -Undated, monitor for behaviors. -Undated, resident have a behavior problem related to Lewy-Body dementia and obsessive compulsive disorder; -Target date 2/27/23, resident will have no evidence of behavior problems by review date; -Undated, administer medications as ordered. Monitor for side effects and effectiveness; -Undated, intervene as necessary to protect the rights and safety of others. Approach/speak in a calm manner. Divert attention. Remove the resident from situation and take to alternative location as needed. -Undated, monitor behavior episodes and attempt to determine underlying cause. Consider location, time of day, persons involved, and situations. Document behavior and potential causes. Record review of the resident's progress notes showed the following: -On 4/3/22, at 3:48 P.M., Resident #1 approached the nurse and said Resident #2 was being mean to him/her and he/she was having a difficult time. A certified nurse assistant (CNA) later told the nurse that the resident asked about moving rooms because Resident #2 is difficult for him/her; -On 4/5/22, at 10:06 P.M., Resident #1 was visibly upset after Resident #2 left the room. Resident #1 said he/she was having difficulty dealing with Resident #2 being mean to him/her and he/she did not know what to do. Resident #1 became quiet when Resident #2 came back into the room and looked at the floor. Will continue to monitor; -On 4/20/22, at 12:40 P.M., Resident #1's confusion appear to be starting to make Resident #2 in the room very worried and stressed. Resident #2 had been yelling at Resident #1 more and this makes Resident #1 worse; -On 4/29/22, at 8:57 A.M., Resident #1 was more anxious today as he/she was playing the piano for a funeral. He/she began visible hand shaking when Resident #2 began raising his/her voice at Resident #1. Will continue to monitor; -On 5/12/22, at 2:11 P.M., care conference held with Director of Nursing (DON), MDS, Activities, Dietary Manager (DM) and restorative nurse assistant present. Resident #1 invited, but did not come. Resident #1 had a decline in cognition and can get very anxious at times. This does upset Resident #2 and Resident #2 can be rude to Resident #1 at times; -On 8/4/22, at 3:25 P.M., Resident #1 came to the nurses' station and said the person in his/her room told the resident that what his/her cleaning of the room was terrible and the the person really hurt the resident's feelings. The nurse directed the resident to stay and hang out away from the room for a while and that the resident had a right to be hurt about the situation and could come to the nurse to talk; -On 8/8/22, at 12:18 P.M., Resident #1 became upset when he/she could not remember when he/she got a shower. The resident was reminded and redirected two times. The resident became visibly upset when his/her when Resident #2 began yelling at Resident #1 while Resident #1 was wheeling in to the bathroom and Resident #2 thought Resident #1 was going to back into his/her feet that were sticking out on a pillow. Resident #1 was removed from the room and sat in a dayroom for a few minutes, so Resident #2 could cool down. Will continue to monitor; -On 8/17/22, at 1:24 P.M., Resident #1 packed up his/her belongings and bedding in a trash bag. Resident #2 was yelling at the resident, asking what Resident #1 was doing. This nurse put the resident's things away while Resident #1 was not in the room. Will continue to monitor; -On 9/25/22, at 1:38 P.M., Resident #1 came to staff and said he/she did not feel comfortable in his/her room with Resident #2. Resident #1 said that he/she needed space and Resident #2 would not allow Resident #1 to go to another room. Resident was redirected; -On 10/25/22, at 11:34 A.M., due to recent issues between Resident #1 and Resident #2. It was decided to move Resident #1 to a different table in the dining room away from Resident #1. Resident #2 did make a scene and upset Resident #1 when re-entering the dining room. Staff sat with Resident #1 and calmed the resident's anxiety so Resident #1 could eat his/her lunch; -On 10/25/22, at 3:30 P.M., staff reported incident of Resident #2 yelling at Resident #1 loudly this morning. Upon Social Services Designee (SS) and DON going to the room to check on the situation. Resident #1 was acting confused. When staff suggested that Resident #1 and Resident #2 possibly eat at different tables at mealtimes to have a break, Resident #1 did not appear to fully understand, but Resident #2 was refusing to allow this. DON stressed importance of trying this. At lunch time, Resident #1 was sitting with a group of peers and doing okay. Resident #2 came in the dining room and insisted Resident #1 come to Resident #2's table. When staff encouraged her to remain at the other table, Resident #2 loudly objected and asked to go back to his/her room. This morning even though Resident #1 was confused while staff were talking with both resident's in their room. Resident #1 said, Maybe I should just be quiet and take it. After Resident #1 ate his/her meal, Resident #2 agreed to eat if Resident #2 were allowed to return to the dining room and have Resident #1 at his/her side which staff allowed. Kitchen staff were in the dining room. Nursing staff have been educated to separate the two residents, if any further incidents of yelling at Resident #1 until Resident #2 calms down. SS spoke with the long-term care ombudsman in the past about the behaviors and the ombudsman suggested getting books on dementia for Resident #2 to read to help him/her to understand Resident #1's disease process. SS has also spoken with the resident's family member to get extra support to encourage different behaviors from Resident #2. Administration made aware of the situation as well and the resident's physician's assistant (PA); -On 10/26/22, at 1:37 P.M., Resident #1 was upset that Resident #2 was upset in the dining room because Resident #1 was not at Resident #2's table. Resident appeared to calm down and become happier when a family member arrived to facility. After the family member left, the resident again became confused and upset; -On 11/10/22, at 11:02 A.M., care plan reviewed. Resident #1 having increased confusion. Resident #2 gets frustrated with Resident #1 and will yell and Resident #1. Attempted to sit Resident #1 at a different table in the dining room to help with Resident #1's anxiety, but Resident #1 wanted to return to Resident #2's table. Will continue to monitor for any needs and assist as indicated. 2. Record review of Resident #2's face sheet showed an admisison date of 12/12/18. Record review of the resident's significant change MDS, dated [DATE], showed the following: -Severe cognitive impairment; -No physical, verbal, or other behaviors directed toward others; -Required extensive staff assistance with bed mobility, transfers, dressing, toileting, and personal hygiene; -Required staff supervision with eating; -Used a wheelchair for mobility; -Diagnoses of post-hemorrhagic (bleeding) anemia, congestive heart failure (CHF - inability for heart to pump enough blood.), high blood pressure, diabetes mellitus (a group of diseases that affect how the body uses blood sugar), and depression. Record review of the resident's care plan showed: -Undated, resident has a behavior problem; -Target date of 1/3/23, resident will have fewer episodes of yelling at staff and spouse, resistance to care through the review period; -Undated, in the past, resident has been known to yell at my Resident #1, as he/she can get frustrated with his/her psychosis behaviors. Resident's physician, ombudsman, and family are aware of impatience with Resident #1 at times. Family and Resident #2 have declined to split them. Staff will continue to redirect and educate Resident #2 when he/she get out of line; -Undated, intervene as necessary to protect the rights and safety of others. Approach/speak in a calm manner. Divert attention. Remove from situation and take to an alternate location as needed. Record review of Resident #2's progress notes showed the following: -On 4/15/22, at 1:12 P.M., staff was standing in the main dining room and heard loud yelling coming from the resident's room. Staff opened the door and Resident #2 was yelling at Resident #1, because Resident #1 could not find the soap for handwashing. The nurse assisted Resident #1 until finished and then moved Resident #1 away from the sink, so Resident #2 could use the sink. Resident #2 said he/she was getting agitated with Resident #1's forgetfulness. Social services notified; -On 4/15/22, at 4:20 P.M., the DON and the SS staff spoke with Resident #2 and Resident #1 about the incident that morning where Resident #2 yelled and Resident #1. Resident #2 stated Resident #1 was looking for the soap dispenser and could not find it and Resident #2 got very frustrated. Resident #2 admits that he/she gets very frustrated at times with Resident #1's forgetfulness and that he/she needs to not do this. Resident #2 agreed to work on this and even possibly go out to the room when frustrated in the future. Resident #2 and Resident #1 state that they love each other and do not want to live in separate rooms. The resident's family member was aware of the incident and will encourage Resident #2 to try not to get frustrated. The resident's family member requested extra visits from the facility chaplain as well. Social services to pass on to the chaplain; -On 4/21/22, at 1:01 P.M., care conference held with the DON, MDS nurse, SS, the restorative nurse assistant, and Resident #2. Resident #2 is having issues with losing his/her temper with Resident #1, who is his/her roommate. Offered moving Resident #1 in the dining room to a different table, but Resident #2 refused and said he/she wouldn't even consider the changes. Will monitor for future needs. Will continue current plan of care; -On 4/29/22, at 8:54 A.M., the resident was becoming increasingly agitated with Resident #1 today. Resident #2 starting yelling at Resident #1 and staff removed Resident #1 from the room until Resident #2 calmed down. Will continue to monitor; -On 5/2/22, at 12:15 P.M., Resident #1 stated he/she was sleepy and did not want to go to lunch, but instead wanted to go to bed. Resident #2 quite loudly told Resident #1 to stop because Resident #1 was going to the dining room. Resident #1 put own hand over mouth and began to softly cry. In the dining room, Resident #2 ate his/her own food, and then began to eat Resident #1's food. Will continue to monitor; -On 8/11/22, at 10:08 A.M., Resident #2 was yelling at Resident #1 when staff entered the room. Resident #1 finally did tell Resident #1 to stop and that he/she was not feeling well; -On 9/6/22, at 12:45 P.M., Resident #2 was yelling at Resident #1 multiple times in the dining room, about a purse, making Resident #1 cry. Resident #2 again began yelling at Resident #1 in their room and would not stop until the nurse and other staff asked the resident to stop. The nurse removed Resident #1 from the room until Resident #2 calmed down; -On 9/7/22, at 2:19 P.M., Resident #2 continued yelling at staff and was yelling at Resident #1 in the dining room to the point that Resident #1 was almost in tears. The dietary staff notified the nurse of Resident #2's behaviors. This nurse has talked to Resident #2 several times this week about doing this. The nurse notified the DON, and the DON spoke to Resident #2; -On 9/8/22, at 12:38 P.M., Resident #2 continued to yell at Resident #1 in the dining room making Resident #1 cry. Will continue to monitor; -On 9/15/22, at 2:14 P.M., earlier Resident #2 was yelling at Resident #1 in their room so loud you could hear every word through the door. Resident #1 was taken out of the room and this nurse told Resident #2 that yelling at Resident #1 was not okay to do; -On 10/3/22, at 2:51 P.M., Resident #2 was yelling at Resident #1 in the dining room and staff moved Resident #1 to a different table with the nurse. Resident #2 was again yelling at Resident #1 in their room. Will continue to monitor; -On 10/3/22, at 3:55 P.M., the nurse had a lengthy conversation with Resident #2's family member regarding yelling behaviors toward Resident #1 and staff. Resident's family member stated that he/she would talk with Resident #2 about the behaviors toward staff and request sitting the residents at separate tables at meals. The facility will want to hear from the family member with a response from the above mentioned concerns; -On 10/25/22, at 11:35 A.M., Resident #2 was very upset when he/she went to the dining room for lunch related to Resident #1 being moved to a different table due to his/her yelling/belittling Resident #1 during meals. SS took Resident #2 back to his/her room upon the resident's request. Staff will monitor when Resident #1 goes back to their room; -On 10/25/22, at 12:48 P.M., staff reported that morning that Resident #2 was yelling loudly at Resident #1 in their room. The DON and SS went to the resident's room to speak with Resident #2. The resident neither admitted nor denied. When staff suggested the residents possibly needed to eat at separate table in the dining room to help ease frustration. Resident #2 stated, Absolutely not. That is not acceptable. In the dining room, various times staff have reported Resident #2 makes Resident #1 nervous to the point that Resident #1 does not want to eat, then Resident #2 will eat Resident #1's food. At the noon meal, staff moved Resident #1 to another table. Resident #2 then approached Resident #1 and told Resident #1 that Resident #1 needed to come to their table. Staff asked Resident #2 to give eating at separate tables, but the resident raised his/her voice and said he/she would not eat without Resident #1 at his/her side. SS asked Resident #2 no to disrupt the dining room as it affects other residents at meal time. Resident #2 requested to go to his/her room. The DON offered Resident #2 a meal. The resident said, if he/she could go to the dining room with Resident #1 by his/her side, then Resident #2 would eat. Took both residents to the dining room for Resident #1 to eat. Kitchen staff in the dining room to observe the residents. Educated staff to remove Resident #1 from the situation if there are any further incidents of Resident #2 yelling. Ombudsman had suggested offering to give Resident #2 books on dementia so Resident #2 could further understand the disease process. Resident #2 refused. Also, have offered psychologist to visit with Resident #2 to help with coping, but he/she also refused. Will continue to monitor and assist with coping as indicated; -On 10/25/22, at 3:43 P.M., administration and the resident's physician assistant (PA) made aware of today's behaviors and interventions; -On 10/26/22, at 12:14 P.M., Administrator spoke with the resident's family member about the dining room seating arrangement. The resident refused to eat without Resident #1 by his/her side. Agreement was made that Resident #1 and #2 can resume eating at the same table with Resident #1 across from Resident #2 rather than next to one another. The administrator reminded Resident #2 that he/she could not yell at Resident #1 even though staff understand that Resident #1 irritates Resident #2 with certain behaviors. Staff continue to educate and give support to understand her disease process. Per administration, the resident's family member agrees with the plan of care also; -On 10/27/22, at 7:52 A.M., Resident #2 had an agreement about seating arrangement in the dining room with the Administrator. Per the agreement, Resident #1 was to sit across from Resident #2, not next to Resident #2. When Resident #2 got to the dining room, he/she said, this is not going to work, Resident #1 needs to be moved next to him/her. Resident #2 was reminded of the agreement, but Resident #2 said he/she did not agree to that. Resident #1 was moved as Resident #1 wished to avoid an incident in the dining room. 3. During an interview on 1/5/23, at 3:05 P.M., Licensed Practical Nurse (LPN) D said the following: -Resident #1 did whatever Resident #2 told him/her to do; -Resident #2 frequently yelled at Resident #1 to shut up and would yell loudly at Resident #1 to the point Resident #1 would cry; -Resident #2 yelled at Resident #1 in their room and in the dining room; -Staff attempted to separate the two residents in the dining room, but Resident #2 refused to eat until the two were allowed to sit together again; -LPN D attempted to talk with Resident #2 and tell him/her the yelling was inappropriate and would bring Resident #1 out of the room when Resident #2 was yelling; -LPN D notified the Director of Nursing (DON) and the Administrator and they both spoke with Resident #2 about the yelling and treatment of Resident #1; -The DON mentioned to LPN D that the facility might have to notify DHSS of the yelling, because the DON thought Resident #2's yelling might be abuse; -On one occasion, Resident #2 was yelling at Resident #1 loudly enough that staff could hear the yelling from down the hall; -LPN D thought the yelling was abusive. Resident #1's would say that Resident #2 hurt his/her feelings and LPN D would bring the resident out of the room and away from Resident #1 temporarily; -LPN D charted the yelling behavior in the residents' progress notes; -LPN D did not notify the resident's physician or physician assistant because they generally read resident progress notes when they came to the facility; -LPN D notified social services (SS) about the yelling and staff discussed the issues during care plan meetings; -If someone was abusing a resident, LPN D would separate the resident from the alleged perpetrator, ensure the resident's safety, and notify the DON immediately. 4. During an interview on 1/5/23, at 3:15 P.M., Certified Medication Technician (CMT) E said the following: -Resident #2 frequently yelled at Resident #1 and told Resident #1 to shut up and treated Resident #1 like a child. Resident #1 would become upset and cry; -CMT E said this behavior had occurred since he/she began working at the facility approximately one year ago and occurred every day or every other day between the residents; -CMT E told Resident #2 the yelling was not okay and tried to educate Resident #2 on Resident #1's forgetfulness; -CMT E reported the yelling to the charge nurses and they charted the behaviors in the progress notes; -CMT E told the DON in the past; -CMT E said that yelling at a resident was a form of verbal abuse; -If CMT E saw someone abusing a resident, he/she would immediately separate the residents, and notify the charge nurse. 5. During an interview on 1/5/23, at 3:26 P.M., Certified Nurse Assistant (CNA) F said the following: -Resident #2 was verbally abusive to Resident #1; -Resident #2 yelled at Resident #1 and would tell Resident #1 to shut up and would interrupt Resident #1 while he/she was trying to talk with staff; -Resident #1's voice would tremble, he/she would cry, become more anxious, and confused when Resident #2 yelled at him/her; -CNA F said he/she always reported the abuse to the charge nurse and had reported to the DON in the past; -CNA F attempted to redirect the residents and separate the two when the abuse occurred, but this was difficult due to Resident #1's dementia. 6. During an interview on 1/5/23, at 3:30 P.M., LPN G said the following: -Resident #2 yelled at Resident #1 and this yelling lead to the majority of Resident #1's anxiety; -Resident #1 would try to explain something, but Resident #2 and he/she would belittle him/her for doing so; -Resident #2 would tell Resident #1 not to ask questions and would not allow Resident #2 to explain things; -Resident #1 would then become upset and start shaking, worrying about what he/she was trying to say; -As Resident #2's anxiety increased, so did his/her confusion; -On one occasion in the dining room Resident #2 would not allow Resident #1 to eat until after Resident #2 was finished eating; -At times, Resident #2 would tell Resident #1 how much to eat; -Resident #2 was verbally abusive to Resident #1 and LPN G spoke to the previous DON about the issue. 7. During an interview on 1/6/23, at 10:30 A.M., CNA A said the following: -Resident #2 had Resident #1 on a schedule, including telling Resident #1 when he/she could go to the bathroom; -On five or six occasions in the past, CNA A heard Resident #2 yell at Resident #1 in their room from down the hallway; -Resident #2 yelled at Resident #1, if he/she did something that Resident #2 did not like or if Resident #1 tried to leave the room; -Resident #2's yelling upset Resident #1 and he/she would cry. -Staff attempted to comfort Resident #1 during these times and tried to explain to Resident #2 not to yell. Resident #2 would agree not to yell at Resident #1; -He/she reported to different nurses over the last several months when Resident #2 yelled at Resident #1. The nurse would then talk with the residents; -He/she did not report the yelling to anyone else in management; -Verbal abuse is one type of abuse. 8. During an interview on 1/6/23, at 10:50 A.M., CMT B said the following: -The types of abuse included verbal. -If he/she observed abuse, he/she would separate the persons involved and immediately to the charge nurse, DON, or administrator; -Resident #2 was loud with Resident #1; -CMT B said that Resident #2 was sometimes verbally abusive to Resident #1 and he/she notified the nurses; -The nurses would try to redirect Resident #1 and would talk with Resident #2 about his/her actions. 9. During an interview on 1/6/23, at 10:55 A.M., LPN C said the following: -He/she was responsible for resident MDS and care plans; -Resident #2 yelled at staff, but most of his/her yelling was toward Resident #1; -Staff addressed the yelling with Resident #2 and with the resident's family; -Resident #2 wanted to attend Resident #1's care plan meetings, but he/she did not want Resident #1 to attend the meetings. Resident would get upset if staff tried to invite Resident #1 to the meetings; -Resident #2 yelled at Resident #1; -At times in the dining room Resident #2 would yell at Resident #1 to stop pilfering, and tell Resident #1 to eat his/her own food. If Resident #2 did not eat, Resident #1 would eat the food; -Resident #2's yelling was upsetting to Resident #1, but then Resident #1 would forget about it 5 to 10 minutes later due to the dementia; -Resident #1 would say Resident #2 yelled at him/her; -Staff tried to separate the residents in the dining room, but Resident #2 refused to eat until allowed to sit with Resident #1; -Staff offered counseling from the pastor to Resident #2 and SS offered the resident education regarding dementia; -LPN C was unsure if Resident #1 was offered counseling or psychosocial services; -The residents were offered separate rooms, but Resident #2 refused; -LPN C worked on resident care plan for Resident #2 related to his/her yelling, the yelling would decrease for a little while, but he/she would get frustrated with Resident #1 pilfering in their room and would yell at Resident #1; -LPN C tried to take Resident #1 out of the room for a while to separate the two residents when this occurred; -LPN C reported the yelling to the DON, Social Service Designee (SS), and the Administrator; -The DON would talk with the residents' about the issues; -The LPN thought the DON and Administrator had discussed the issues with the resident's family; -The LPN said he/she did not report the yelling to the resident's PA or physician, but he/she did not frequently work the floor; -He/she was unsure if notifying the resident's physician would have been beneficial; -Resident #2 was offered psychologist, but he/she refused; -The nurse said Resident #2 was verbally abusive to Resident #1; -Resident #2 would belittle Resident #1 and would tell the resident he/she did not know what he/she was doing; -Resident #2's yelling was upsetting to Resident #1, he/she was guarded and would hug a purse and cross arms over his/her chest; -The yelling occurred over the last 4 to 5 months of Resident #2's stay at the facility; -The different types of abuse include verbal and emotional; -The facility tried in-house counseling from the facility chaplain, the ombudsman and family were notified of the issues; -Different staff mentioned Resident #2 yelled at Resident #1 on multiple occasions; -When the care plan team putting interventions in place due to the yelling, they placed the interventions in Resident #2's care plan and not in Resident #1's care plan, because Resident #2 had the behaviors and Resident #1 did not have these behaviors. 10. During an interview on 1/6/23, at 11:55 A.M., the SS said the following: -Different types of abuse included physical, verbal, and emotional abuse; -If he/she was made aware of an allegation of abuse, he/she would remove the resident from the situation and take them to a safe place; -He/she would then notify the DON or Administrator; -Resident #2 would get frustrated with Resident #1 and would yell at her at times, but it is documented in the progress notes. Resident #1's dementia was frustrating for Resident #2; -He/she spoke with the ombudsman about Resident #2 yelling at Resident #1 and the ombudsman wanted the SS to provide Resident #2 reading material on dementia, but Resident #2 refused. Resident #2 took offense at the offer and said he/she was perfectly well aware and did not need; -SS said he/she offered Resident #2 a psychologist to talk with, but the resident refused and said he/she did not need the service; -SS also informed a family member of the issues; -The DON and SS contacted the resident's family and informed them that Resident #2 would yell at Resident #1 in the dining room which would make Resident #1 nervous and not eat; -Staff tried to separate Resident #1 from Resident #2 in the dining room, but Resident #2 would refuse to eat; -Staff reported to SS that Resident #2 yelled at Resident #1 in the dining room and in their room, but SS did not personally witness the yelling; -The DON was aware of the yelling; -Staff reported the yelling made Resident #1 more anxious; -The SS was unsure if Resident #1 was offered any psychological services related to his/her increased anxiety due to the yelling; -The family said yelling was Resident #2's way of communicating with Resident #1. 11. During an interview on 1/6/23, at 12:35 P.M., the Assistant Director of Nursing (ADON) said the following: -He/she was aware of Resident #2 yelling at Resident #1 and that it was upsetting to Resident #1; -The facility tried to offer Resident #2 education regarding dementia, but he/she refused; -The facility notified the family of Resident #2 and Resident #1; -The facility care planned Resident #2's behavior of yelling and put interventions in place; -Unsure if any psychological services were offered to Resident #1; -The DON and ADON usually review all resident progress notes on a daily basis; -The ADON said it would be hard to say whether Resident #2 yelling at Resident #1 would constitute resident abuse, because he/she never witnessed the yelling. 12. During an interview on 1/6/23, at 1:50 P.M., the DON said the following: -Resident #1 and Resident #2 were initially in separate rooms, but sometime in the late spring or early summer of 2022 a room opened up and the residents moved into that room together; -At fi