**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, record review, observation, and interview, the facility failed to report an allegation of potential abuse/neglect to the abuse coordinator for hours after it was reported to a staff member for 1 of 1 resident (R)6, reviewed for abuse. Findings include: Review of the facility policy titled Abuse Prevention and Investigation reported under the policy, Neglect is the failure of the community, it's employees or service providers to provide goods and services necessary to avoid physical harm, mental anguish or emotional distress. Additionally the policy recorded, It is the policy of this Health Center to investigate different types of incidents and to identify the employees responsible for the initial reporting, investigation of alleged violations and reporting of results to the proper authorities. Each resident has the right to be from verbal, sexual, physical, physical and mental abuse .neglect . Identification; Licensed nursing home will identify events, such as .occurrence's, patterns and trends that may constitute abuse and determine the direction of the investigation. Reporting to the State Agency, and take all necessary corrective actions depending on the results of the investigation, the report of abuse should be reported no later than 2 hours after the allegation is made . Record review of education titled, Abuse dated 06/13/24, recorded a Staff In-Service. If you suspect any form of elder abuse, it is your duty to report it promptly. All suspected abuse and mistreatment of residents should be reported to the Abuse Coordinator immediately at, (phone number was recorded). There are no exceptions to this. Record review of R6's medical record revealed he was admitted to the facility on [DATE] with diagnoses that included, but were not limited to; gastro esophogeal reflux disease, ulcerative colitis, respiratory failure, and alzheimer's disease. Review of R6's quarterly Minimum Data Set (MDS) with an Assessment Reference Date of 10/18/24 revealed his Brief Interview of Mental Status (BIMs) score was 10, indicating moderately impaired cognition. On 10/22/24 at 11:02 AM, R6 was observed in the hallway. He stated, I requested a urinal last night. I rang the bell for help, but she refused. Requested further clarification, so R6 went to his room. He then said,I asked for the urinal. She told me to urinate in my brief. I've never worked with her before, she was new. I told her to get the h*** out of here. She left and never came back. R6 stated this occurred on the night shift. He was able to describe her. R6 stated, I put my light on again, and waited and someone else came into my room. I asked for the urinal and they did get it. I did not tell the nurses, but I told that person about it. He was a male. On 10/22/24 at 11:15 AM, an interview with Certified Nurse Assistant (CNA)1 revealed, R6 told me about the CNA. She refused to give him the urinal last night. I reported it to the Registered Nurse Unit Manager (RN/UM), my nurse assistant manager, and Licensed Practical Nurse (LPN)1, his primary nurse. That was about 8:30 AM, he reported that to me. On 10/22/24 at 11:35 AM, an interview with LPN1 revealed, R6 said that he asked for his urinal and the lady would not give it to him. He said it was sometime last night, a new CNA whom he had not seen before. He likes to hang it on the bedrails, at night he likes it closer to reach it. During the day, he likes it kept in the bathroom. He is independent with it for the most part. We will help him use it when we are in there with him. I have not told my RN/UM or Director of Nurses (DON) yet, but I will tell them. On 10/22/24 at 11:37 AM, an interview with the RN/UM revealed, It was just reported to me that a CNA refused to give him his urinal last night. I'm getting ready to find out about it now. On 10/22/24 at 11:53 AM, an interview with CNA2 revealed, I am the scheduler and a med tech as well and work on the Assisted Living (AL) side. CNA1 did tell me about the urinal, about 30-40 minutes ago. I was in AL this am giving medicine. On 10/22/24 at 11:58 AM, an interview with LPN1 revealed, I told the DON and the UM found out at the same time, after I spoke to you. R6 told me himself about 9:30 AM. CNA1 never told me about it, until after the fact, I had already found out. We have an abuse coordinator number we call immediately. If the DON or UM was not here, we would call the abuse hotline immediately. The UM should have told somebody when he first found out. We just had an in-service on abuse about 2 weeks ago. Different scenarios, the different kinds of abuse. That was for all staff. On 10/22/24 at 12:29 PM, an interview with the Administrator revealed, If a staff member finds out about a reportable, they are expected to contact the Abuse Coordinator within 5 minutes. If it was an allegation of abuse, it should have been reported. Based on what R6 reported and what the staff told us, it is more of a customer service situation. On 10/22/24 at 12:38 PM, an interview with the DON revealed, I am conducting an investigation on R6. She stated the staff have 5 minutes after they hear or learn of an allegation to report any allegation to me. They are educated on this. On 10/22/24 at 12:48 PM, an interview with CNA3 revealed, I work as needed, (PRN), about once a month. I was R6's CNA last night. I had not ever worked with him before. R6 rang the call bell. He said he needed to be changed. He did not ask for a urinal. When I grabbed his brief, he went off on me and told me to get the h*** out of his room. Another CNA went in and answered the call light. It was 5 minutes later. I could hear him yelling from the room. He did ask for a urinal from the CNA. The CNA told me afterward, he uses a urinal. No-one gave me a report on him. I could have asked a nurse, but I didn't. He had pull ups and regular briefs. I didn't get him a urinal, I didn't pay attention. I didn't know he used one. I did not report this to the nurse. This was between 12-1:30 am. I spoke with my DON earlier, she called me. I'm not scheduled to work until I let them know I'd like to pick up a shift. On 10/22/24 at 4:26 PM, an interview with the DON and the Administrator revealed, the DON stated the investigation was still still on-going. I became aware at 11:57 AM. Based on the statements so far, based on what the majority of the statements by staff were they didn't feel it was enough to report. Any suspicion of abuse is reported to me within 5 minutes. They stated, We did report this to Department of Health and Environmental Control (DHEC) as an allegation of neglect.

Based on observation, and staff interview, the facility failed to ensure discontinued medications were removed from the treatment cart with pharmacy labels that were blacked out in marker. Additionally, open treatment items were not dated for 1 medication room and 1 of 2 treatment carts reviewed for medication storage. Findings include: Multiple requests were made at the time of the survey for a policy on medication storage, none was provided. On 10/22/24 at 08:09 AM, an observation of the Medication Room revealed SPS Suspension Kaexalate 60 milliliters (ml) was not open, but was in the cabinent. Most of the label has been removed and a partial piece on the left side remains. An observation of the treatment cart revealed a Skin Prep Pump with a label that was blacked out with ink, but a resident's name remained visable with lot #86740. Additionally, an open bottle of normal saline, 100 ml Lot #230035050, undated with an open date. A box of Tubi Grip with a resident's name blacked out on the pharmacy label, but with a marker that was written House stock. On 10/22/2024 at 8:35 AM, an interview with Registered Nurse Unit Manager (RN/UM) revealed, The labels should be intact. He stated, I don't know why the items remain in the cart of residents whom discharged and said he wasn't sure why house stock was written on it. All open items should be dated. The Director of Nurses (DON) came into the medication room. The DON agreed that the labels should have been intact and confirmed the resident names on the labels were blacked out with ink and continued to remain on the cart. She stated, They should have been sent back to pharmacy or given to the resident upon discharge.

Based on interviews, record reviews, document reviews, and facility policy review, the facility failed to ensure allegations of abuse were reported immediately, but not later than two hours after an allegation was made, for 2 (Resident (R)1 and R2) of 3 sampled residents reviewed for abuse prohibition and failed to report the results of an investigation for 1 (R2) of 3 sampled residents reviewed for abuse prohibition. Findings included: A review of the facility's policy titled, Abuse Prevention, Reporting and Investigation dated 01/31/2018, revealed, 9. Reporting a. Licensed Nursing Home Administrator or Designee will report all alleged violations and all substantiated incidents to the State Agency and to all other agencies as required, and take all necessary corrective actions depending on the results of the investigation; the report of abuse or serious bodily injury should be reported no later than 2 hours after the allegation is made and no later than 24 hours if the allegation does not involve abuse and does not result in serious harm. 1. A review of R1's Profile Face Sheet revealed the facility admitted the resident on 09/13/2023, with diagnoses that included Alzheimer's disease, vascular dementia, contusion of the right knee, mild protein-calorie malnutrition, muscle weakness, difficulty in walking, pain in the right knee, dysphagia, and cognitive communication deficit. A review of a quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 12/18/2023, revealed R1 had a Brief Interview for Mental Status (BIMS) score of 13, which indicated the resident was cognitively intact. Per the MDS, the resident was independent with eating, toileting hygiene, showering/bathing self, upper body dressing, lower body dressing, and personal hygiene. The MDS revealed R1 required setup or clean-up assistance with rolling left and right, and with a sitting to standing position. The MDS revealed R1 received an antiplatelet medication. A review of a facility Five-Day Follow-Up Report, dated 12/14/2023, indicated Resident #1 reported to Certified Nursing Assistant (CNA)5 that a staff member grabbed the resident's arm which caused the discolored area to the right forearm. During an interview on 02/02/2024 at 8:56 AM, CNA5 revealed on 12/10/2023 between 7:30 AM and 8:00 AM, she was helping R1 get dressed for breakfast. She indicated that the R1 was sitting on the toilet and held their arm out and said, look at that. CNA5 revealed she asked what happened and R1 said a woman grabbed the resident the previous night and told the resident to shut up. R1 said they did not know why the woman was so mad at the resident. CNA5 revealed R1 had a bruise on the top of their right forearm that was dark blue and purple. CNA5 stated she notified Licensed Practical Nurse (LPN)6 of the resident's allegation. A review of LPN6's facility statement dated 12/10/2023, revealed R1 held up their right arm and reported she hurt my arm last night, she grabbed me, and I don't know why. She was so angry, but I don't know why. The LPN asked how they hurt the resident's arm and the resident replied, that girl last night. The resident pointed to a staff member's scrubs and stated, she was wearing that color outfit and gave the female's race. According to the statement, LPN6 reported the incident to the Director of Nursing (DON). During an interview on 02/02/2024 at 4:54 AM, LPN6 revealed CNA5 called her to R1's room. CNA5 asked R1 to repeat what the resident told her, and R1 held up their right arm and stated a female hurt their arm last night. R1 said she grabbed me, and they did not know why. R1 could not remember who the staff member was and was initially unable to describe them but later stated the person wore red scrubs, had brown hair, and the race of the person. LPN6 revealed she asked CNA1 to look at bruise to see if she remembered it since she worked with R1 the day before. CNA1 indicated that she did not recall seeing any bruises on R1 the previous day. LPN6 revealed that she did a full body audit and reported the incident to the DON on 12/10/2023 between 8:30 AM and 9:00 AM. A review of an Initial Report dated 12/11/2023, indicated the state survey agency was notified of the abuse allegation on 12/11/2023 at 5:15 PM, more than 24 hours after R1 reported the allegation of abuse. During an interview on 02/01/2024 at 12:35 PM, the Administrator stated the DON was out of the country. During an interview on 02/01/2024 at 4:35 PM, the Administrator revealed the DON initially reported R1's bruise was an injury of unknown origin since R1 was on long term use of aspirin. During a follow-up interview on 02/02/2024 at 4:18 PM, the Administrator revealed it was his expectation that staff report any abuse allegation immediately, or within five minutes, to the facility's abuse hotline, which went straight to the DON's cell phone. The Administrator further revealed that he expected the SA to be notified within two hours. The Administrator revealed he reported the abuse allegation when he became aware of it on 12/11/2023. 2. A review of R2's Profile Face Sheet indicated the facility admitted the resident on 12/18/2023. A review of the resident's Patient History Report dated 01/23/2024 revealed the resident had diagnoses that included anxiety, acute lateral meniscus tear of the left knee; pathological fracture of the left ankle, left tibia, left fibula, and a toe of the left foot due to age-related osteoporosis; closed displaced fracture of the phalanx of the left great toe; left tibial plateau fracture; close fracture of the neck of the left fibula; bimalleolar fracture of the left ankle; and a closed fracture of the medal plateau of left tibia. A review of R2's admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 12/24/2023, revealed the resident had a Brief Interview for Mental Status (BIMS) score of 13, indicating the resident was cognitively intact. According to the MDS, the resident was dependent on staff for toileting hygiene and required substantial/maximal assistance for rolling left and right. Further review of the MDS revealed R2 was always incontinent of urine and occasionally incontinent of bowel. The MDS revealed the resident had frequent pain that occasionally interfered with day-to-day activities. The resident rated the pain as severe. A review of the facility's Five-Day Follow-Up Report, dated 01/10/2024, revealed R2 reported that on 01/06/2024 at 12:00 AM, CNA11 entered their room in response to a call light and spoke to them in a manner that they perceived to be abusive. R2 reported they did not want CNA11 to roll them as part of a brief change because it would cause pain or discomfort. R2 reported that the staff member was angry and said she must change the brief the only way she knew how. R2 denied that CNA11 made any specific statements. R2 reported the CNA's tone was unacceptable and made them fearful. During an interview on 02/02/2024 at 2:21 PM, CNA10 revealed that on the night of the incident she went into R2's room and heard R2 talking with CNA11. CNA10 said she could tell R2 was getting upset. CNA10 stated she was assigned to provide care for R2 and CNA11 was helping since CNA10 was in another resident's room. CNA10 stated CNA11 was trying to assist R2 and the resident wanted the CNA to place two briefs on the resident. CNA10 stated she could not do that and was having issues getting the briefs from underneath R2 since the resident could not roll. CNA10 stated she changed R2's incontinence brief. CNA10 further stated R2 preferred to have a brief folded and placed between their legs to act as a pad inside a second brief. CNA10 stated R2 was crying and stated they were not double briefed. CNA10 stated R2 reported that CNA11 was not professional with the resident. CNA10 revealed R2 did not express that CNA11 was verbally abusive towards them or abusive otherwise. CNA10 further indicated that she did not witness CNA11 being verbally abusive or unprofessional toward R2. CNA10 stated she reported the incident to Licensed Practical Nurse (LPN)7. During an interview on 02/02/2024 at 4:45 PM, LPN7 stated she did not remember the date of the incident with R2. LPN7 stated CNA10 notified her that R2 was upset. LPN7 stated she spoke with R2, and the resident was upset because CNA11 would not double brief them. Per LPN7, R2 stated CNA11 was spiteful because the resident thought CNA11 took the water cup out of their room. LPN7 stated R2 informed her that they did not want CNA11 back in their room. LPN7 stated at that point she did not feel this was an allegation of abuse. However, later in the morning she called the Director of Nursing (DON) and notified her of R2's concern. A review of the facility Initial Report dated 01/08/2024, revealed no documentation to indicate the state agency (SA) was notified of the abuse allegation and no fax transmittal to support the time and date the alleged abuse allegation was reported to the SA. A review of an email dated 02/02/2024 at 11:22 AM, revealed the facility did not notify the SA of the allegation until 01/08/2024 at 5:55 PM, which was not submitted to the SA agency timely. A review of the Five-Day Follow-Up Report dated 01/10/2024 revealed no documented evidence the facility's required 5-day investigation report was submitted to the SA. According to an email dated 02/02/2024 at 11:22 AM, the SA did not receive the facility's five-day report. During an interview on 02/02/2024 at 4:18 PM, the Administrator stated he expected staff to report any abuse allegation immediately or within five minutes to the abuse hotline, which went straight to the DON's cell phone. The Administrator further stated he expected the DON to notify the SA, or he would notify the SA within two hours. The Administrator stated after a full investigation, the report should be submitted to the SA within five days. The Administrator stated he reported the abuse allegation when he became aware on 01/08/2024. The Administrator also stated the facility faxed the follow-up report on 01/10/2024; however, he did not have a fax transmittal to support it was sent.