**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of a facility self-reported incident (SRI), review of staff statements, review of the facility's abuse policy and procedure, and interviews, the facility failed to timely report and implement immediate and effective measures to protect residents following allegations of sexual abuse. This resulted in Immediate Jeopardy and the potential for actual harm including serious injury and psychosocial harm beginning on [DATE] at approximately 11:30 P.M. when Certified Nursing Assistant (CNA) #108 notified the supervisor, Licensed Practical Nurse (LPN) #115 she believed LPN #119 had assaulted Resident #22 and Resident #18 due to changes in the resident's behaviors, including yelling, screaming, crying, not complying with care, and shaking when LPN #119 was present with the resident(s). Upon notification, LPN #115 did not implement immediate safeguards to prevent further potential abuse including immediately assessing the residents, removing LPN #119 from resident care, and reporting the allegation to the Director of Nursing (DON) and/or Administrator. LPN #115 requested written statements from CNA staff to place in the DON's mailbox for review on [DATE]. As a result of LPN #115's inaction, CNA #108 called local police for assistance and to ensure resident safety. Upon police arrival, LPN #119 was removed from the facility. A police investigation remains ongoing at this time This affected two residents (#22 and #18) and had the potential to affect all 43 residents residing in the facility. On [DATE] at 5:28 P.M., the Regional Director of Operations, DON, and Administrator were notified Immediate Jeopardy began on [DATE] at approximately 11:30 P.M. when CNA staff reported allegations of staff to resident sexual abuse involving Resident #18 and Resident #22 to LPN #115. LPN #115 failed to immediately report the allegations to the Administrator and/or DON, failed to initiate a thorough and comprehensive investigation and failed to ensure LPN #119, the alleged perpetrator was removed from the facility to ensure resident safety, placing all 43 of 43 residents at risk for actual harm/abuse. The Immediate Jeopardy was removed on [DATE] when the facility implemented the following corrective action: On [DATE] at 7:00 A.M. the Administrator and DON initiated an investigation gathering statements from staff present at the time of the incident on [DATE]. Statements were gathered from LPN #115 and CNA #124 by 8:30 A.M. On [DATE] at 7:15 A.M. the DON completed skin assessments on Resident #22 and Resident #18. On [DATE] at 7:32 A.M. the detective notified Resident #22's family of the allegation. On [DATE] at 9:00 A.M. the Administrator notified the Medical Director of the sexual abuse allegation and investigation in progress and the DON, and LPNs #113 and #101 completed house wide skin assessments on 42 residents which were completed by 4:33 P.M. Resident interviews were conducted with 33 residents by Social Service Staff between 9:00 A.M. and 11:00 A.M. 10 residents were non-interviewable. On [DATE] at 10:05 A.M. the Quality Assurance nurse initiated an SRI regarding the sexual abuse allegation. On [DATE] at 11:04 A.M. the DON and Administrator notified Resident #18's family of the allegation. On [DATE] at 12:00 P.M. Human Resources (HR) and the Administrator initiated in person education regarding the abuse policy and procedure, reporting, and that if the nurse in charge was not addressing their issue or concerns to call the DON or Administrator. Six administrative staff, two housekeepers, one laundry aide, three CNAs, two dietary staff, two LPNs, one activity aide, and one medication technician received this in person training. In addition, at 3:40 P.M. the education was provided via phone to four LPNs, two registered Nurses (RNs), two housekeepers, one activity aide, eight CNAs, two medication technicians, one transport aide, and three dietary staff. On [DATE] at 6:00 P.M. a verbal statement was received by the DON and administrator from CNA #128. On [DATE] at 7:42 P.M. LPN #115 was suspended pending investigation for not following facility policy and procedure on abuse reporting. On [DATE] at 9:15 A.M. CNA #108's written statement was collected by Corporate Human Resource (HR) staff. On [DATE] at 5:53 P.M. re-education on the abuse policy and procedure, reporting, and that if the nurse in charge was not addressing their issue or concerns to call the DON or Administrator was completed for seven administrative staff, five CNAs, two dietary employees, four LPNs, two medication technicians, one activities employee, and one RN. The education was provided by HR and the Administrator. All staff not re-educated would receive reeducation prior to the start of their next shift by the Administrator, DON, or HR. On [DATE] between 6:52 P.M. and 8:00 P.M. 34 resident interviews related to abuse and safety were completed by Social Services #142. On [DATE] between 7:00 P.M. and 10:00 P.M. skin assessments for 43 residents were completed. On [DATE] between 7:15 P.M and 8:45 P.M. reeducation on the abuse policy and procedure, reporting, and that if the nurse in charge was not addressing their issue or concerns to call the DON or Administrator was reinitiated via phone by the Administrator for one administrative staff, four housekeepers, one laundry employee, seven CNAs, two dietary employees, four LPNs, two medication technicians, one activities aide, and one transport aide. On [DATE] at 7:30 P.M. a written statement was received from CNA #128 by the Administrator. On [DATE] at 1:46 A.M. re-education on abuse, reporting, and that if the nurse in charge was not addressing their issue or concerns to call the DON or Administrator was completed with one RN via phone by the Administrator. On [DATE] at 12:28 P.M. re-education on abuse, reporting, and that if the nurse in charge was not addressing their issue or concerns to call the DON or Administrator was completed via phone with one medication technician by HR. On [DATE] at 3:57 P.M. re-education on the abuse policy and procedure, reporting, and that if the nurse in charge was not addressing their issue or concerns to call the DON or Administrator was completed via phone with one CNA by HR. Any employee who had not received education would receive the education prior to the start of their next shift by the Administrator, DON, or HR. On [DATE] at 5:39 P.M. LPN #115 was terminated for not following facility policy and procedure on abuse reporting. Beginning on [DATE] the DON/Designee would interview three residents per day, five days a week for four weeks to rule out abuse. Beginning [DATE] the DON/ Designee would conduct three staff interviews per day, five days a week, for four weeks to ensure the abuse policy was being followed and allegations of abuse were reported timely. Beginning on [DATE] the DON/Designee would conduct three skin assessments per day of non-interviewable residents, five days a week for four weeks to ensure there were no signs of abuse beginning. An Ad-HOC Quality Assurance Performance Improvement (QAPI) was completed on [DATE] at 12:50 P.M. The topic was Abuse Policy and Procedure. The Abuse Policy, Abatement Plan and Root Cause Analysis related to late reporting and compromising the safety of the residents were reviewed. The Interdisciplinary Team (IDT) team met along with the Medical Director to review the Abuse Policy, Abatement plan and Root Cause Analysis related to late reporting and compromising the safety of the residents. The QAPI team was in agreement with the facility abatement plan and would continue to monitor those areas. Should any new concerns or issues arise, the QAPI team would reconvene at that time. Results of audits would be reviewed in monthly QAPI meetings with the Medical Director, Administrator, and DON. Results of audits would be reviewed in quarterly QAPI meetings with the IDT Team.Although the Immediate Jeopardy was removed on [DATE], the deficiency remained at Severity Level II (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility was in the process of implementing their corrective action and monitoring for effectiveness and on-going compliance.1. Review of Resident #22's medical record revealed an admission date of [DATE] with diagnoses including respiratory failure with hypoxia, depression and dementia. Record review revealed Resident #22 was receiving Hospice (end of life) services. Review of the Minimum Data Set (MDS) assessment completed [DATE] revealed Resident #22 had moderately impaired cognition and no documented behaviors.Review of Resident #22's progress notes revealed no concerns/incidents were documented by LPN #119 or LPN #115 from [DATE] through [DATE]. Review of a skin check dated [DATE] (no time noted) completed by LPN #113 revealed Resident #22 had moisture-associated skin damage, and no other areas of concern noted.Review of a facility Self- Reported Incident (SRI) tracking number 263598 dated [DATE] revealed one staff member (CNA #108) alleged another staff member (LPN #119) had inappropriately touched two residents (#18 and #22). The SRI included the staff member (LPN #119) was immediately suspended. Review of a statement by CNA #124 dated [DATE] revealed she did not witness any assault to residents but had overheard CNAs #108 and #128 say residents were bleeding, someone touched them, and Resident #22's brief smelled of some man. CNA #124's statement indicated no resident had reported any concerns to her. CNA #124's statement also indicated the police were called instead of management because nothing ever got done when reported, and when they did report to management, they got yelled at by their nurses, AKA LPN #115 who would not call management because it was too much work. Attempts to reach CNA #124 for interview during the investigation were unsuccessful.Review of a statement by LPN #115 dated [DATE] revealed he did not witness assault toward a resident. In the statement LPN #115 mentioned how CNA #108 stated what she thought LPN #119 was doing to residents; no resident told LPN #115 they were being assaulted. LPN #115 asked CNA #108 and CNA #128 to write statements so there was a paper trail and then LPN #115 would notify the DON. LPN #115's statement revealed he thought the police were called because CNA #108 wanted a quick response, but he was not sure. Interview on [DATE] at 8:06 A.M. with the granddaughter of Resident #22 (Granddaughter #200) revealed between [DATE] and [DATE] there was an allegation Resident #22 experienced sexual assault which was still under investigation by the sheriff's department. Granddaughter #200 revealed the family had previously placed a camera in the resident's room, but the camera did not have recording capability because the facility had informed the family they were not allowed to have recording devices in resident rooms. Granddaughter #200 stated she was unsure what had happened but knew two aides had called the police, and she heard another resident (#18) had rectal bleeding due to abuse. Granddaughter #200 stated following the incident, the family chose not to send Resident #22 to the hospital for a rape kit because of the resident's (terminal) condition but stated she was aware LPN #119 had been interrogated by police for a couple hours, DNA evidence was collected, and LPN #119 agreed to take a polygraph. During the interview, Granddaughter #200 stated she was not informed of the allegations by the facility when the allegations were made the night before, but rather she had been notified by the sheriff's department on [DATE] at 7:13 A.M. Granddaughter #200 stated Resident #22 would be mortified (of the allegations/situation) because she was a very private person and after her husband passed away in 1982 she did not remarry. Interview on [DATE] at 9:20 A.M. with Lieutenant (LT) #144 revealed the police department had been called related to reports by a caregiver that LPN #119 had possibly sexually assaulted a couple residents. At the time of the interview, LT #144 revealed the incident was still under police investigation and items had been sent to the lab for testing. LT #144 was aware one resident (#18) was bleeding from her anus but staff had reported the resident did have hemorrhoids, and the other resident (#22) had yelled get off me, leave me alone but this resident had a history of behaviors.Interview on [DATE] at 9:28 A.M. with Resident #22's representative (Resident Representative [RR] #201) revealed he found out at 7:07 A.M. on [DATE] from the sheriff's department there was an allegation the night before that Resident #22, and another lady had been sexually assaulted. RR #201 stated no details were shared and when family spoke to the facility, they did not say anything about the allegation. There were two detectives present for a meeting with the facility who did all the talking. RR #201 felt there was no resolution to the situation, so he installed a recording device in the resident's room on [DATE]. RR #201 stated he installed the recording device because staff kept turning off the previous device ([NAME]) monitor (virtual assistant technology) that was in the room. RR #201 stated he was aware the nurse involved in the incident was supposed to be suspended. RR #201 did not know what other staff were working at the time of the incident or when the allegation was made. Interview on [DATE] at 10:28 A.M. with Hospice Nurse (HN) #146 revealed she was the on-call nurse over the weekend from [DATE] to [DATE] and had not been made aware on [DATE] of any allegation of sexual abuse involving Resident #22. HN #146 stated any time there was an allegation of sexual abuse, an assessment of the resident needed completed.Interview on [DATE] at 10:38 A.M. with HN #147 revealed she was made aware of an allegation of sexual abuse to Resident #22 and completed a head-to-toe assessment on [DATE]. However, the assessment was not specific to sexual abuse as HN #147 revealed she was not qualified to perform that type of assessment. HN #147 stated Resident #22 was minimally responsive (behavior wise) due to the resident being end of life, but she did have some moaning and groaning when staff assisted with turning. HN #147 stated the facility should let hospice know of abuse allegations within 24 hours.On [DATE] at 11:04 A.M. an attempt to interview CNA #124 was unsuccessful. A voice message was left with no return call received.Interview on [DATE] at 11:25 A.M. with LPN #115 revealed he had written a statement which he felt was complete, thorough, and accurate and that was all the information he could provide (content of statement noted above). During the interview, LPN #115 declined to answer any questions related to why he did not assess the resident, write a progress note, notify the DON or Administrator, and remove LPN #119 from resident care following the allegation of sexual abuse being made to him. Interview on [DATE] at 1:15 P.M. with [NAME] (SGT) #145 revealed there was a report two residents had been sexually assaulted, he did not personally see the residents, and his main objective was to interview the alleged perpetrator, LPN #119. SGT #145 stated evidence was being submitted to the lab, concurrent investigative techniques were on-going and additional information could not be released at this time since a criminal investigation was ongoing.During an interview on [DATE] at 1:56 P.M. CNA #108 voiced concerns the facility did not investigate things like they should. CNA #108 stated on [DATE] she and CNA #128 were in Resident #18's room when they heard LPN #119 calling for help. The CNA went into the hallway and LPN #119 was standing outside Resident #22's room, pushing his hair back, and stated she needs put back in bed and I don't think she is breathing. CNA #108 stated Resident #22 was sitting partly on the bed and partly off, and kept repeating, I didn't have my underwear on, while holding on to her incontinence brief. Resident #22's lips looked torn, and she looked like she was about to pass out with her eyes rolling back in her head. When LPN #119 attempted to enter the room Resident #22 went stiff and started shaking. CNA #108 stated she thought Resident #22 looked like she had been over-medicated and raped. CNA #108 stated when LPN #119 walked in the room, he passed by the [NAME] device, and she thought maybe he had turned the camera on at that time as the CNA stated the family had complained in the past about it being turned off. After Resident #22 began to panic, LPN #119 took off down the hallway. CNA #108 was unable to get Resident #22 to scoot up in the bed because she was scared to death. The CNA revealed the concerns were reported to LPN #115 who was the manager working. CNA #108 stated after reporting the concerns, LPN #115 wanted to talk to her, said she could not go around making allegations, and a witness statement needed to be filled out. CNA #108 went back to check on Resident #22 was who still in the same position and would not allow anyone to change her. Resident #22 was shaking and turning her head. CNA #108 stated she realized no one was going to do anything about the concerns the CNA staff had, so she called 911 (emergency services). CNA #108 stated LPN #119 had just come back to work after being suspended following a similar allegation (of sexual abuse from another resident). CNA #108 stated a female sheriff came to the facility with investigators to look at Resident #22, and when they entered the room and Resident #22 saw a female deputy her whole body relaxed, and she started crying. CNA #108 rolled Resident #22 over so her backside would face the female deputy and CNA #108 thought The resident's anus was protruding. CNA #108 also stated Resident #22's family requested that a nurse from outside the facility assess Resident #22, but the DON would not allow it. During the interview, CNA #108 was frantic and crying.Interview on [DATE] at 3:45 P.M. with Granddaughter #202 revealed she had been watching the [NAME] camera to check on Resident #22 at about 10:00 P.M. on [DATE] to make sure she received her medicine, which she did. Granddaughter #202 stated she then checked at about 11:00 P.M. and noticed Resident #22 was seated at the edge of the bed and she called the facility. LPN #119 answered, headed straight to the room, and helped Resident #22 lay back down. Granddaughter #202 stated she went to check the camera a little bit later and it indicated the service was out or connection could not be made, so she kept checking in. At about 12:00 -12:30 A.M. on [DATE], she checked the camera, and it was back on and there were three aides in Resident #22's room, one stated they were not going to touch her, and they needed to get LPN #115 in the room. Then LPN #115 and three aides were in the room; the view of Resident #22 was blocked, and they were all whispering but she did hear them say LPN #119's name. Granddaughter #202 called the facility and LPN #119 answered and stated nothing was wrong, and when asked why four people were in Resident #22's room he stated, Oh, LPN #115 is in there? She's ok. LPN #119 did not say anything else but she stated she did miss a call from him at about 2:30 A.M. The missed call indicated Resident #22 was agitated, they were going to give her medication, and someone would sit with her for a little bit. Granddaughter #202 stated that was all she knew until the family was contacted by the sheriff's department the following morning.Interview on [DATE] at 4:20 P.M. with LPN #119 revealed he had no clue what happened on [DATE]-[DATE], but the sheriff's department showed up and stated a complaint was called in. LPN #119 stated he called the Administrator regarding the sheriff's department being at the facility but was unable to tell her why they were at the facility since he stated he did not know. LPN #119 stated on [DATE] at about 5:00 A.M. - 5:30 A.M. a detective wanted to speak to him outside and he left the facility with the police. During the interview LPN #119 stated he was new to the unit Resident #22 was on because his assignment had been switched after an allegation of inappropriate touching had been made against him by a resident on a different unit. During the interview, the LPN denied knowledge of being suspended but indicated he had not worked in the facility since leaving with police on [DATE]. Interview on [DATE] at 6:27 P.M. with CNA #128 revealed she and CNA #108 had finished cleaning up Resident #18 but were still cleaning the room when CNA #108 exited to assist LPN #119. A couple minutes later, CNA #128 went in Resident #22's room and saw CNA #108 crouched next to Resident #22 at the resident's bedside. Resident #22 was screaming and not acting like herself. The CNA stated Resident #22 always got up on the side of the bed facing the window, but this time she was facing the door. Resident #22 was frantic, alarmed, and stated she had only been this way one time before, on the night of [DATE] which was LPN #119's first time working the hall. CNA #128 stated she was not sure what made Resident #22 act out, but the resident was flustered and in a panic. When LPN #119 entered the room from behind CNA #108, it got worse and Resident #22 began screaming, get away from me, stop touching me, but no one was actually touching her at that time. CNA #108 was crouching at the bedside to keep Resident #22 from falling, and when she noticed Resident #22's reactions, CNA #108 told LPN #119 to get out, and told CNA #128 to get LPN #115. When CNA #128 re-entered Resident #22's room with LPN #115, Resident #22 was no longer screaming and allowed CNA #108 to soothe her. CNA #128 stated CNA #108 then looked at LPN #115 and stated, he (LPN #119) did something to her. CNA #108 began to get worked up and left the room, so LPN #115 followed her. CNA #128 stated Resident #22's brief had been undone on the left side, but barely reattached and when she tried to fix it, Resident #22 began screaming so she told Resident #22 she would not change the incontinence brief and it would be okay. Resident #22 yelled stop touching me, it's my right. Once Resident #22 was calmed down, CNA #128 left the room to try to find out what was going on because she was no longer comfortable with LPN #119 working with the residents since there was a big change in resident behaviors since he started working on the unit. CNA #128 stated LPN #119 had kept his medication cart outside Resident #22's room the entire night and did not leave the area. LPN #115 was not helpful regarding the incident and just directed CNA #128 to write a witness statement. CNA #128 stated she had previously reported several concerns to LPN #115, including suspicion of LPN #119 being on drugs at work, and he did not do anything to address the concern. The CNA revealed LPN #115 stated if they did not want to write statements, everyone could sit in the break room together to come to a resolution and discuss their feelings. LPN #115 stated if the staff wrote statements he would put the witness statements in DON's mailbox to review the following morning. After 1:00 A.M. on [DATE], CNA #128 stated she encouraged CNA #108 to call the police since no one else was doing anything and they were both uncomfortable with LPN #119 being around the residents. CNA #128 stated LPN #115 should have called the Administrator as soon as concerns were brought to his attention. CNA #128 stated she was not sure what had occurred or been done to Resident #22, but she knew it was something traumatic or an action which caused the resident distress to be uncomfortable and act the way she did. CNA #128 stated the police arrived at the facility at about 3:00 A.M. and LPN #119 remained in the facility after the allegations were reported, until at least 5:15 A.M. Review of a nursing note dated [DATE] timed 8:44 A.M. authored by the DON revealed Resident #22 had expired. Resident #22's time of death was 8:39 A.M., hospice was notified, and family was at bedside.A follow up interview on [DATE] at 2:21 P.M. with CNA #108 revealed when Resident #22 began shivering and tensing up, the CNA looked at LPN #119 and asked, you did it again, didn't you? referring to previous allegation against LPN #119. CNA #108 stated when LPN #115 came in the room she stated specifically, he's [LPN #119] hurting them. What are you going to do about this? LPN #115 wanted statements written, but the residents needed help then.2. Review of Resident #18's medical record revealed an admission dated of [DATE] with diagnoses including unspecified fracture of lumbar vertebra, schizoaffective disorder, and mild cognitive impairment. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #18's cognition was severely impaired, and she had verbal behaviors one to three days during the seven-day review period. Review of nursing notes dated [DATE] timed 7:30 A.M. and 8:52 A.M. authored by the DON revealed Resident #18's daughter was called with no success. Review of a nursing note dated [DATE] timed 11:04 A.M. revealed Resident #18's daughter was called and updated on her status.Review of a skin check dated [DATE] (no time noted) revealed Resident #18 had no new skin issues.Review of a facility Self- Reported Incident (SRI) tracking number 263598 dated [DATE] revealed one staff member (CNA #108) alleged another staff member (LPN #119) had inappropriately touched two residents (#18 and #22). The SRI included the staff member (LPN #119) was immediately suspended.Observation and attempted interview on [DATE] at 7:56 A.M. revealed Resident #18 was pleasantly confused, was smiling and appeared well-groomed.During an interview on [DATE] at 1:56 P.M. CNA #108 revealed on [DATE] she was assisting another aide (CNA #128) with providing care to Resident #18. During the care it was noted Resident #18's anus was bleeding, they could barely put cream on her anus, and the resident screamed men came in at night. CNA #108 stated Resident #18's anus looked like it had hairline rips or cuts and did not resemble hemorrhoids. CNA #108 also stated Resident #18's family had told her they had never seen Resident #18's anus bleed the way it had been for a couple weeks. Resident #18's family requested that a nurse from outside the facility assess Resident #18, but the DON would not allow it. CNA #108 described the blood at Resident #18's rectum as bloody with an almost jelly-like consistency. CNA #108 did not think the blood was from Resident #18 digging at the area. During the interview, CNA #108 was frantic and crying.Interview on [DATE] at 6:27 P.M. with CNA #128 revealed normally Resident #18 was very compliant with care, but she was not on the evening of [DATE]. Resident #18 required a lot of help that evening and CNA #108 was also in the room. They were in her room from about 8:30 P.M. to 9:00 P.M. CNA #128 stated Resident #18 screamed and screamed when cream was applied to her rectum, but it did not appear Resident #18 had hemorrhoids. Resident 18's rectum was red and sore, it was bleeding but not a lot and it looked like she had hairline cuts. CNA #128 stated the way Resident #18 was acting was not normal. CNA #128 stated the bleeding of Resident #18's rectum had been worse in the previous weeks. CNA #128 stated she did not believe Resident #18 was able to reach her own rectum to cause the bleeding. CNA #128 stated she had previously reported several concerns to LPN #115, including suspicion of LPN #119 being on drugs at work, and he did not do anything to address the concern. The CNA revealed LPN #115 stated if they did not want to write statements, everyone could sit in the break room together to come to a resolution and discuss their feelings. LPN #115 stated if the staff wrote statements he would put the witness statements in DON's mailbox to review the following morning. After 1:00 A.M. on [DATE], CNA #128 stated she encouraged CNA #108 to call the police since no one else was doing anything and they were both uncomfortable with LPN #119 being around the residents. CNA #128 stated LPN #115 should have called the Administrator as soon as concerns were brought to his attention. CNA #128 stated she was not sure what had occurred or been done to Resident #18, but she knew it was something traumatic or an action which caused the resident distress to be uncomfortable and act the way she was. CNA #128 stated the police arrived to the facility at about 3:00 A.M. and LPN #119 remained in the facility after the allegations were reported, until at least 5:15 A.M.Interview on [DATE] at 9:03 A.M. with the Administrator revealed she was not aware of any allegations of abuse/sexual abuse involving Resident #18 or Resident #22 until [DATE] at 7:30 A.M. when she first found out about the allegations. The Administrator reported the nurses did call her on [DATE] at about 4:00 A.M. to let her know the police were at the facility but they did not know why they were there. The Administrator confirmed LPN #115, who was the nursing supervisor, should have reported allegations (of abuse to her) as soon as they were made. The Administrator indicated when a supervisor did not address a concern, staff were to report directly to her or the DON. The Administrator stated no one had reported concerns to her from night shift previously and she would expect if concerns were reported to the nightshift supervisor they would be communicated to her or the DON.During an interview on [DATE] at 10:44 A.M. with the DON, the DON denied knowledge of concerns or reports being made to her about nightshift staff, including allegations of drug use or inappropriate behaviors. The DON stated abuse should be reported immediately to administration, then within two hours to the State agency. The DON said the alleged perpetrator should be removed from the facility as soon as allegations were made to ensure resident safety, the resident(s) should be assessed immediately, witness statements collected, family and physicians should be notified, and medical care should be obtained if needed. The DON stated she did not receive a call until about 4:00 A.M. on [DATE] when the first detective arrived at the facility, but during that call the nurses did not know what was happening. She was subsequently made aware the detectives took LPN #119 from the facility for questioning. The DON stated she arrived to the facility on [DATE] at about 4:35 A.M. and did not see LPN #119. The police informed the DON and Administrator of the allegations later that morning around shift change (shift change was at 6:00 A.M. for CNA staff and 7:00 A.M. for nurses). Interview on [DATE] at 2:01 P.M. to 2:34 P.M. with Resident #18's power of attorney (POA) (POA #203) revealed before the allegations, she was visiting Resident #18 and assisted in changing her incontinence brief when she noticed blood. The aide thought it could be vaginal bleeding but it went further back, so Resident #18 was rolled further and there was blood from her rectum. POA #203 stated Resident #18 had a history of irritable bowel syndrome, diverticulitis, constipation and hemorrhoids and had previously needed to manually remove stool from her rectum. A nurse checked over Resident #18 and POA #203 had no concerns at the time and reported seeing stool on her mom's fingers before so it made sense to her. POA #203 stated on the morning of [DATE], she received a phone call from the facility related to allegations of sexual abuse and was shocked because the allegations happened the night before but she had not been notified. She did not receive a phone call at the time but if she had she would have come to the facility to be with her mom and to make decisions related to the allegation. POA #203 revealed the Administrator was not aware until [DATE] because the police showed up to the facility. POA #203's initial reaction was nothing had happened, the aides were wrong and had jumped to conclusions. However, POA #203 stated she was informed of the allegations regarding the other resident (#22) as well. POA #203 stated she had spoken to SGT #145 and was aware they had collected evidence and would have additional information when the lab reported back. The police[TRUNCATED]