**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, staff and nurse practitioner interviews the facility failed to protect a resident's right to be free from abuse (Resident #13) when another resident (Resident #44) pulled out a section of hair from Resident #13. This deficient practice occurred for 1 of 3 residents reviewed for physical abuse. The reasonable person concept was applied for Resident #13 due to a reasonable person would feel pain and emotional distress having his or her hair pulled out of their head by another person. Findings included: Resident #44 was admitted to the facility on [DATE] with diagnoses of unspecified dementia and hallucinations. Resident #44's most recent Minimum Data Set (MDS) dated [DATE] showed her to be cognitively intact, required moderate staff assistance to complete activities of daily living, and she used a wheelchair to propel herself. Resident #44's care plan showed she had been care planned for physical behaviors on 4/23/24 which included hitting, scratching, and throwing objects at staff during care. Interventions included removing resident from triggering behavior, approach resident warmly and softly, and allow resident time to de-escalate when agitated. Resident #13 was admitted to the facility on [DATE] with diagnoses of Alzheimer's dementia and orthostatic hypotension. Resident #13's quarterly MDS assessment dated [DATE] revealed she was moderately cognitively impaired, and she used a wheelchair to propel herself. A review of a facility reported incident revealed that on 4/30/24 at around 4:00 pm, Resident #44 was seen sitting in her wheelchair behind Resident #13, who was also in her wheelchair, in the common area in front of the nurse's station on the 400 hall. Resident #44 was observed to be holding a moderate amount of hair in her hand by Nurse Aide #1. The report stated that both residents were immediately separated and 1:1 supervision immediately began for Resident #44 until a psychiatric evaluation was obtained. Resident #13 was immediately assessed, and an approximately two-inch reddened area was noted to her back hairline near her neck. Resident #13 voiced no complaints at that time. The nurse practitioner was made aware of the incident and both responsible parties were notified. An interview with Resident #44 was attempted on 5/20/24 at 10:32 am. Resident #44 was noted to be oriented to self only. When asked if she had any recollection of an incident with Resident #13, she became agitated, and the interview ceased. An observation on 5/20/24 at 10:50 am of Resident #13 showed approximately ½ inch of new hair growth where the hair had been pulled out near her neckline. There was no redness noted. Resident #13's hair was fairly thin and most of it was curled toward the top. She had very little near the bottom and around her neckline where it was thinner. An interview with Resident #13 on 5/20/24 at 10:50 am revealed that she had no memory of the incident and denied any past or current issues with staff or other residents. During an interview with Nurse Aide #1 (NA#1) on 5/22/24 at 2:58 pm, she stated that she saw both residents sitting in the common area on the 400-hall watching television. She stated that when she came back to the common area a few minutes later, she saw Resident #44 had propelled herself over to Resident #13 and was holding some of Resident #13's hair in her hand. She stated that she did not hear Resident #13 yell out in pain. NA#1 stated that Resident #13 did not complain of any pain when asked and only stated that she wanted her hair back. NA#1 stated that Resident #13 had about a 2-inch reddened area where her hair was at her neckline. She stated that she immediately separated the two residents, and the Director of Nursing (DON) was made aware of the incident. During an interview with the Social Worker on 5/22/24 at 12:13 pm she stated that Resident #13 had no memory of the incident and was seen smiling at her within minutes of the incident occurring. The social worker stated that Resident #44 had become combative with staff and increasingly agitated since she realized she could not propel her wheelchair as easily as she could before even with rehabilitation services. The social worker stated this was the first time she had touched a resident. She added that the facility is trying new interventions with Resident #44 such as taking her on walks when it's nice outside and spending more time doing one-on-one activities. During an interview with the DON on 5/22/24 at 3:30 pm, she stated that she was made aware of the incident as soon as it occurred. She stated that Resident #44 was immediately put on 1:1 until they were able to get her to the hospital for a psychiatric evaluation. She stated that she reviewed the incident via camera footage of the 400-hall common area. She saw Resident #44 propel herself a couple feet over to Resident #13, reach out and pull out a section of Resident #13's hair. She stated she saw staff intervene within seconds of it occurring and separating the two. She stated she was immediately notified of the incident. The DON stated that Resident #44 had been displaying behaviors over the last month such as kicking and spitting on staff and throwing her food at staff members. She stated that they have done bloodwork and radiology scans to see if there is a metabolic reason for her behavior change and they have not found one. The DON did state that she was recently treated for a urinary tract infection, and she also had COVID infection. Per psychiatry recommendation, they are keeping her on 1:1 supervision for the foreseeable future. Camera footage of the 400-hall common area for the incident was not downloaded and saved by the facility. It was not available for review during the investigation. During an interview with the psychiatric Nurse Practitioner on 5/23/24 at 3:20 pm, she stated that she has spent a lot of time with both residents. She stated that Resident #44 has become very agitated over the last month or two and had recently started exhibiting behaviors such as kicking and spitting on staff, including her. She stated she has seen her twice since the incident, changing medication dosages each time. She added that she feels like this is a progression of her dementia following two significant infections and that the staff are doing all they can to redirect her when she becomes agitated and keeping her on 1:1 supervision while they are adjusting her medications so that no further incidents occur. During an interview with the Administrator on 5/23/24 at 3:45 pm, she stated she has reached out to both responsible parties to discuss the incident. She stated that she has spoken with Resident #44's daughter at length regarding her change in behavior and the possibility of her having to eventually have constant 1:1 supervision to keep others safe. She stated that Resident #44's daughter is open to any help the facility can provide.