Based on observation, interview, and record review, the facility staff failed to effectively identify, treat, and reassess the effectiveness of pain management, for 1 (#8) of 9 residents. Findings include: During an interview on 5/9/23 at 7:58 a.m., staff member K stated resident #8 had, Frequent headaches since his fall a couple of months ago. Staff member K stated resident #8 had a muscle relaxer and Norco (for pain), and it seemed like the headaches were coming from the resident's neck. During an observation and interview on 5/9/23 at 3:52 p.m., resident #8 was in bed with blankets over his head, and his knees were pulled up to his abdomen. Resident #8 pulled his blanket down when addressed and had a distressed look on his face (scowling and frown). Resident #8 stated his neck hurts all the time, and now I've been stuck in this bed since the fall the other day, so I can't get up without help. Resident #8 stated his back and left shoulder are hurt, pain is a ten! The resident stated staff gave him pills, but he did not think the facility was, doing a damn thing for my pain, it's like they are trying to trick me with candy. Resident #8 stated, It does no good to tell those people (tell staff about his pain), I tell them all the time, and they do not listen, so I just suffer. Resident #8 was able to clearly convey the description and locations of his pain. During an interview on 5/9/23 at 3:55 p.m., this surveyor notified staff member K of resident #8's statement of 10/10 pain. Staff member K stated she assessed resident #8 using the FACES scale (non-verbal facial expression scale), and since he was sleeping, she had not given resident #8 any pain medications. Staff member K stated the resident had no had pain medication since the evening prior. Staff member K stated, If he was consistently complaining of pain, I would call for x-rays, but he is a 'woe is me type.' He just likes to complain but is not consistent, so I just document pain based off observation. During an observation and interview on 5/9/23 at 4:03 p.m., staff member J had just left resident #8's room. Staff member J stated, He (resident #8) declined physical and occupational therapy services for his fall, and stated, he's in a lot of pain. He also has some mental health and depression issues. [Resident #8] had a significant decline since January, but waxed and waned over the last year. During an interview on 5/9/23 at 4:35 p.m., staff member A was notified of resident #8's pain report. Staff member A stated he would immediately address resident #8's pain and re-educate staff member K on pain management. During an interview on 5/9/23 at 4:58 p.m., staff member A stated he addressed resident #8's pain, and tramadol was ordered for resident #8's pain. Staff member A stated resident #8 was being sent to the emergency room for x-rays and scans, to check for injuries related to the fall, on 5/7/23. During an interview on 5/10/23 at 10:05 a.m., resident #8 stated, Nothing changes, pain will never end, pain is a 5 or 6 (of 10 being the worst). Resident #8 stated the hospital told him the x-rays showed he had sprained his neck, arm, and shoulder. During an interview on 5/10/23 at 10:12 a.m., staff member K stated she had just given resident #8 pain medication and was waiting for it to kick in (medication to take effect). During an interview and observation on 5/11/23 at 7:35 a.m., resident #8 was in bed. Resident #8 stated he was still in a lot of pain in his left hip, shoulders, and neck. When asked how severe his pain was, using a number scale between 1 and 10, with 10 being the worst, resident #8 stated, I am not using that stupid scale anymore, I'm in A LOT (loudly) of pain. Resident #8 was grimacing with minimal movement while lying in bed. A review of resident #8's medication administration record, dated May 2023, reflected an order placed on 5/10/23 for tramadol 50 mg (milligram): Give 1 tablet by mouth every 8 hours as needed for moderate to severe pain for 5 days with a start date of 05/10/2023 at 08:45 a.m. Zero doses had been given as of 5/11/23 at 8:05 a.m. A review of resident #8's vitals record, Pain level summary, dated 5/7/23 to 5/10/23, showed facility staff failed to monitor the resident's pain after the fall on 5/7/23. During an interview on 5/11/23 at 8:08 a.m., staff member A reported the medication (for pain) had not arrived for resident #8 due to a wet signature (handwritten signature on a hard copy of a document) was needed and then there were pharmacy issues. Staff member A stated the facility did not have electronic signature capabilities at this time. Staff member A stated, there was nothing more he could do until he could get a wet signature on the tramadol order. Staff member A acknowledged the wet signatures were an area of concern the facility was working on to address. During an interview on 5/11/23 at 10:27 a.m., staff member G stated, No one made me aware that the tramadol was not being given all this week. I expect orders to be carried out immediately or at least told when that cannot happen. Staff member G acknowledged the resident's x-rays and scan at the emergency room (on the evening of 5/8/23) showed bulging disks from resident #8's neck to his lumbar, and the bulging disks would be cause for his significant pain. Staff member G stated, I just saw him moments ago and have changed his orders to a fentanyl patch and Oxycontin IR to help his pain until the patch gets into his system. I checked, and those medications are available onsite, so he can get them immediately. During an interview on 5/11/23 at 11:15 a.m., staff member A stated resident #8 received new orders, and medications were being administered immediately. Staff member A stated he understood the pain management failure for resident #8. The facility staff failed to adequately address resident #8's pain for four days while waiting on the medication order wet signature and pharmacy delays. A review of the facility's policy, Pain assessment and management, dated Qtr 3, 2018, reflected, The purposes of this procedure are to help the staff identify pain in the resident, and to develop interventions that are consistent with the resident's goals and needs and that address the underlying causes of pain. .Monitoring and Modifying Approaches: - 1. Reevaluate the resident's pain and consequences of pain at least each shift for acute pain or significant changes in levels of chronic pain at least weekly in stable chronic pain. - 2. Monitor the following factors to determine if the resident's pain is being adequately controlled: - a. The resident's response to interventions and level of comfort over time .