Based on observation, record review, and resident interviews, the facility failed to provide appropriate dementia care and services for 1 of 1 sampled resident (Resident #65) with a diagnosis of dementia and wandering behaviors. Failure to adequately assess for necessary care and services, and monitor behaviors and implement effective behavior management interventions resulted in a decreased level of psychosocial well-being for Resident #65 as well as other residents affected by the behaviors. Findings include: The facility failed to provide a policy on dementia care. Review of Resident #65's medical record occurred on all days of survey. Diagnoses included dementia, psychotic and mood disturbance, anxiety and restlessness, and agitation. Current physician's orders included: * Seroquel (an antipsychotic) 50 milligrams (mg) by mouth three times a day (started on 12/29/23) related to dementia, psychotic and mood disturbance and anxiety. * Remeron (an antidepressant) 0.75 mg tablet by mouth one time a day (started on 01/17/24) related to restlessness and agitation. Resident #65's current care plan stated, . Focus . Alteration in thought process . and impaired communication related to Dementia . Interventions . Accept memory deficits . Assess individuals stress level . Call resident by name . Cue and supervise as needed . Repeat information . Give simple direct directions . Focus . Alteration in behavior as indicated by restlessness, insomnia, agitated, combative, easily annoyed and angered, has been noted to wander throughout the unit daily . Encourage resident to attend and participate in activities . NP [nurse practitioner] to consult . Secure care lock [device to notify staff if the resident attempts to exit the building] . [Resident's name] likes to carry rosary with her and it provides comfort . [Resident's name] loves animals and responds well to sitting with the animatronic cat . INTERESTS: her dog . Introduce resident to staff and residents. Show resident where activity calendar is in activity room, where activity board and menu are located in hallway and where activities will take place . Staff will do 1:1 visits as needed . Resident #65's nurses' notes identified the following: * 01/03/24 at 11:29 a.m. Narrative: 12-28-23 @ [at] 18:10 [6:10 p.m.] Nurse was informed that this resident was in the room of another resident. She was found lying on the floor between the bed and the window. * 01/04/24 at 4:39 p.m. Resident removed her slip on and urinated on the side of her bed. She then wandered out to the common area. Writer assisted her back to her room and into the bathroom, cares provided. A new slip on [incontinent product] and pants put on. Resident then pulled the pants and slipon [sic] down to her ankles and attempted to walk. Writer removed pants and underwear she had around her waist; put on the slip on. * 01/08/24 at 1:58 p.m. Resident has been wandering the unit most of shift. She has been going into other residents rooms and at times picking up items- she took and wore a pair of glasses . * 01/08/24 at 10:03 p.m. Resident has wandered a lot this shift especially the first half of shift. She has been in numerous resident rooms going [sic] resident drawers and picking up personal items. * 01/09/24 at 4:48 a.m. Resident made a direct and concentrated attempt to exit through the new entrance. Two staff persons intervened to direct her away and back towards safety before she could get out. Resident became combative and started yelling. * 01/09/24 at 1:45 p.m. Resident has been in and out [sic] multiple residents rooms this shift. Resident was found rummaging through other residents belongs when she was in their rooms. Staff has assisted resident back to her room multiple times. Resident was in her room and voided on floor. When staff was cleaning up the urine, resident stated, Is he still in here? CNA [certified nurse aide] said, there is no one else in here. Resident pointed to the urine on the floor and stated that [expletive]. * 01/09/24 at 3:12 p.m. Continually going into other Residents room this afternoon, other Residents are becoming upset. It is getting harder to redirect this Resident. * 01/09/24 at 3:27 p.m. Resident went into another Residents room and took his shoes, throwing them into hallway. * 01/09/24 at 6:40 p.m. Resident has been in and out of other residents rooms, removing items (ie: shirt). Moving furniture in the common area. Walked down towards the kitchen pulled down her pants and pooped on the floor. * 01/10/24 2:58 p.m. Resident wandered across the hall. She was found laying on top of the resident in bed 1 with her pants and slip-on between the door and the bed and urine in the trashcan [sic] next to it. Resident difficult to redirect to her room. * 01/11/24 at 1:54 a.m. Resident was found standing in room with her fists up. 2 staff entered room and calmed resident down. Resident had removed her pants and slip on. She then urinated next to the bed on the floor. She then placed her Christmas tree in the urine. Staff cleaned up the resident and the room. She was assisted back to bed. About 10 minutes later she wandered out to the common area. * 01/11/24 at 8:43 p.m. Resident has been wandering the unit throughout the shift. She is wandering into other resident's rooms and going through their belongings. She then went into a different residents room and laid down at the foot of the bed. Difficult to redirect. * 01/12/24 at 3:36 a.m. Resident is on contact precautions for Influenza, she has no concept of what this means. She exited her room and was found in [another room]. She had voided on the floor [in this room]. She was found sitting on the resident [in this room] having a bowel movement. * 01/12/24 at 8:31 a.m. Addendum: Visited with nursing staff [staff name] to confirm and resident appeared to be sitting at the foot end of the bed on residents leg. Other resident appeared unaware of situation of being defecated on. * 01/16/24 at 11:12 p.m. Resident wandered this shift . assisted into bed twice and resident got up and went across the hall to another room. CNA found her with her pants down sitting on another residents bed. * 01/17/24 at 7:59 p.m. Resident wandering halls and into other resident's rooms. Swinging at anyone who attempts to redirect her. She wandered over to unit A Meadow Lane dayroom and sat in recliner and fell asleep. she was found in a resident's bed up on A [unit A]. * 01/18/24 at 7:36 a.m. Resident wander [sic] out of her room and into the activity room around 430 [4:30 a.m.] and urinated on a chair. Staff assisted her back to her room and cleaned her up. She went back to bed for another hour then got up and wandered the unit. Resident is not willing to talkto [sic] writer and walks faster when writer attempts to talk to her. Review of Resident #65's activity logs showed only six 1:1 activities with Resident #65 in the last 30 days. Observations on all days of survey showed Resident #65 wandering throughout the facility including several resident rooms, therapy room, dining room, and other areas within the facility. During a confidential interview on 01/16/24 at 2:45 p.m. Resident A stated, woken up a few nights ago by Resident #65 who had entered the resident's room in the middle of the night. During an observation on the afternoon of 01/17/24 showed two CNAs (#4 and #5) entered Resident #31's room to assist her from bed. Resident #65 followed the CNAs into the room. Resident #31 stated, Oh that [expletive]. Get her out of here. The CNA (#4) stated, Ok, ok, she's going, and assisted Resident #65 from Resident #31's room. The facility failed to assess and monitor patterns and trends of behaviors in an effort to minimize Resident #65's behaviors, recognize unmet needs, or prevent situations/triggers which may lead to behaviors or physical aggression toward staff and other residents. The facility failed to develop an effective behavior management program, consistently implement purposeful and meaningful activities in an attempt to manage the behaviors exhibited by Resident #65, evaluate the behavior management program on a continuous basis, and modify interventions as needed. The facility failed to ensure Resident #65 did not infringe upon the rights of others while still allowing her to achieve her highest level of well-being.