**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's policy, record review, video surveillance review and interviews, the facility failed to protect Resident (R)4 from physical abuse by R5, 2 of 8 residents reviewed for abuse. Findings include: Review of the facility policy titled, Abuse, Neglect, and Exploitation last revised 9/22, revealed It is policy of this facility to provide protections for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation, and misappropriation of resident property. Abuse: the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Neglect: the failure of the facility, its employees, or service to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. R4 was admitted to the facility on [DATE] with diagnoses including, but not limited to congestive heart failure, type 2 diabetes, and dementia with behaviors. Review of the Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/05/23, revealed R4 had a Brief Interview of Mental Status (BIMS) score of 7 out of 15, indicating cognitive impairment. R5 was admitted to the facility on [DATE] with diagnoses including, but not limited to heart failure, type 2 diabetes, and muscle weakness. Review of the discharge with return not expected MDS with an ARD date of 02/02/23, revealed R5 has a BIMS score of 15 out of 15, which indicates they are cognitively intact. R8 was admitted to the facility on [DATE] with diagnoses including, but not limited to hypertension, type 2 diabetes, and hypertension. Review of the Annual MDS with an ARD date of 12/28/22 revealed R8 has a BIMS score of 13 out of 15, which indicates they are cognitively intact. Review of a witness statement written by Licensed Practical Nurse (LPN)2, dated 12/29/22, revealed Around 8:30 PM resident came out of dining room and hollered help they are fighting. This nurse and 2 Certified Nursing Assistants (CNA)s ran to help. At the time I arrived, R4 was rolling away from the table where R5 and R8 sat. When I asked what happened, R8 stated R4 was digging in R5's basket that's on his motorized wheelchair. When I spoke with R4 she only stated that people are mean to her. The following morning R4 asked her nurse if she had any bruises on her face, when the nurse questioned why, she stated he hit me really hard last night. Nurse asked R8 if anyone hit each other last night and she said R5 hit R4 but he (R5) was hit first. R5 stated she (R4 smacked my glasses off of me so I smacked her (R4). An observation and interview on 03/20/23 at 11:15 AM of R4 revealed them wandering and self-propelling on the unit, appropriately dressed. R4 was unable to recall the resident to resident altercation with R5, but stated she feels safe living at the facility. An observation and interview on 03/20/23 at 12:45 PM of R8 revealed that they were unable to recall a resident to resident altercation between R4 and R5 in the dining room. An interview with Social Services (SS) on 03/21/23 at 9:20 AM revealed R4 was hit on purpose by R5 while they were in the dining room. R5 was upset because R4 touched his basket on his motorized wheelchair. R4 has been known to wander into other resident rooms and touch their things but she has never damaged any property and does not take others belongings. After the incident the altercation another resident (R8) reported to nursing staff that R5 was hitting R4. The residents were separated and police were notified along with the resident representative, ombudsman, and the state agency. After the police watched the camera footage they reached out to R4 resident rep and pressed charges on R5 and he was later taken to jail for striking R4 multiple times. An interview with the Administrator and SS on 03/21/23 at 9:45 AM revealed We have video footage of the incident. Upon review of the footage, R5 was observed striking R4, 5 times along with waving his hands in a threatening motion towards R4. R4 was observed putting up their hands and attempting to block the hits from R5 while grimacing, there was no sound on this video evidence. We spoke with R4's Resident Representative and they stated they wanted to press charges on R5. The police reviewed the footage as well and R5 was taken to jail and given the option to pay $100 or face jail time/ have a court case with a jury. R5 decided to pay the fine and was admitted back into the facility under supervision to avoid contact with R4 and was later discharged home with home health services because of the incident. Review of the video surveillance on 03/21/23 at 10:00 AM of the resident to resident altercation on 12/28/22 revealed R5 in the dining room using his motorized wheelchair to grab and shove R4. R5 was observed striking R4 in the face, back of the head, arms, and holding R4's left arm behind her back. Other residents were observed in the video and witnessed this altercation and then went to alert staff. Review of a Progress Note dated 12/29/22 for R4 revealed, R4 asked nurse this morning if she had any bruises on her face, when nurse questioned why she would ask that, resident stated another resident hit her really hard last night. Incident reported to Medical Director (MD) and Director of Nursing (DON). Skin audit completed, and no new bruising or injuries noted, resident is safe and separated from other resident, will continue to monitor. Review of a Progress Note dated 12/29/22 for R4 revealed spoke with resident husband regarding resident being hit by another resident. He was updated on the reporting process and that the investigation is in process. Review of a Progress Note dated 12/28/22 for R5 revealed fellow resident with complaints of this resident (R5) hitting another resident last night in the dining room. When asked, this resident stated the other resident involved smacked his glasses off and so he hit her back. No new injuries visible, MD and DON made aware, resident is safe and separated from other involved party, will continue to monitor. Review of a SS Progress Note dated 12/29/22 for R5 revealed This morning around 8:30 am resident-on-resident incident was reported to me that occurred last evening 12/28/22 around 8:30 pm. R5 who is alert and oriented made physical contact with a cognitively impaired resident, R4. Police Department was then called to report the incident and officer arrived to interview the residents that were involved in the incident. I escorted him to R5's room and stated that R4 was looking and touching things that were in his basket attached to his wheelchair. R5 made claims that R4 made contact to his face causing his glasses to fall off. He admitted that he pushed her away, hit her and then refrained himself from hitting her again. The officer was able to watch on video as there are cameras in the room that this incident occurred in (dining room). The officer spoke with R4 and determined that she is non-interviewable and then spoke with her Resident Representative. R4's Resident Representative explained to the office that he would like to file charges against R5 for assault. The officer informed staff that he would have to get in contact with a judge to issue a warrant for R5 arrest and there was no timeline on how long that may take to get. R5 will be under 1:1 supervision until he is placed under arrest by the Police Department. DON and I went down and explained this situation to R5. He is his own responsible party, we offered to call his family and he stated that he would call them himself. This is an ongoing case with the Police Department and will be handled by them now. Social Services will continue to offer psychosocial support throughout the remainder of this situation. Review of a Progress Note for R5 dated 12/30/22 revealed Police showed up at facility to transport resident to jail. Resident left facility with Police Officer at 1:14 pm. A phone interview on 03/21/23 at 1:27 PM with LPN2 revealed that she confirmed her witness statement and was able to recall the resident asking her if she had bruises on her face from being hit by another resident. Review of a Police Incident Report dated 12/28/22 revealed The Victim (R4) advised she saw the Suspect (R5) and other residents playing a card game in the dining hall. The Victim advised while playing the Suspect was making rude remarks towards her. The Victim advise the Suspect then approached her and began to pull her by the arm. The Victim advised she was then slapped in the face by the Suspect. The Victim advised her left arm was hurting after the incident, no visible injuries during time of report. After speaking with R4 Resident Representative, charges will be pursed against R5, a warrant for Assault of 3rd degree.