**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the right to a dignified existence and self-determination facility for 1 of 9 (Resident #1) residents reviewed for resident rights. The facility failed to ensure Resident #1 was treated with respect and dignity when she refused a shower on 05/21/25 around 9:30 PM and was showered despite her refusals by CNA A. This failure could place residents at risk for diminished quality of life, loss of dignity and self-worth, psychosocial harm and distrust with staff. The noncompliance was identified as Immediate Jeopardy Past Noncompliance (PNC). The Immediate Jeopardy began on 05/21/25 at 9:30 PM and ended on 05/28/25. The facility had taken actions noted in the findings that corrected the noncompliance before the incident investigation began on 06/17/25. Findings included: Review of Resident #1's Quarterly MDS, dated [DATE], reflected she was an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. She had the diagnoses of Chronic Obstructive Pulmonary Disease (COPD) with acute exacerbation (a lung disease with a sudden worsening symptoms including breathlessness, mucus, and cough), Alzheimer's disease (loss of cognition), chronic pain syndrome, and anxiety disorder (excessive or persistent worry or fear). Her BIMS score was a 5 (severely impaired cognition). Further review of Section GG-Functional Abilities reflected she usually required substantial/maximal assistance for bed to chair transfers. Record review of Resident #1's care plan reflected the resident had an activity of daily living (ADL) performance deficit and required one staff to assist with bathing and bed mobility, dated initiated 02/13/25. Further review reflected a focus area, dated initiated 05/23/25, The resident has a history of trauma that may have a negative impact. The trauma is [due to]: Feeling angry [due to] shower being done after she refused. Interventions included: .If resident refuses her shower stop immediately . If the resident has escalated, if at all possible do not touch the resident unless absolutely necessary for resident's or others safety ., dated initiated 05/23/25. Record review of Resident #2's Quarterly MDS, dated [DATE], reflected she was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. She had the diagnoses of cancer, heart failure, stroke with paralysis on her left non-dominant side, and major depression disorder (persistent feelings of sadness). Her BIMS score was a 7 (severely impaired cognition). Record review of Resident #2's care plan reflected the resident had impaired cognitive function/dementia or impaired thought processes; interventions included .Use residents preferred name . face the resident when speaking .Provide the resident with necessary cues- stop and return if agitated ., dated initiated 10/07/24. Record review of the Provider Investigation Report (PIR) (Form 3613-A of Texas Health and Human Services) reflected an incident date and time of 05/21/25 at 9:30 PM, dated reported 05/22/25 at 10:15 AM and signed by the Administrator on 05/28/25. Further review revealed on 05/21/25 around 8:40 AM, Resident #1 told her nurse that she needed to talk to someone in charge because she was upset about her care last night. Further review revealed on 05/21/25 around 9:30 PM Resident #1 told CNA A several times she did not want a shower and without Resident #1's consent, CNA A physically lifted Resident #1 from the armpits from the bed into the shower chair and Resident #1 was given a shower by CNA A and CNA B. Resident #1 did not have a history of similar allegations and was interviewable and had the capacity to make informed decisions. Resident #1 had a head-to-toe assessment on 05/22/25 at 10 AM and had no injuries. The facility immediately suspended CNA A and CNA B and obtained interviews from both CNA's and Resident #1, completed resident safe surveys on 05/22/25 with no other concerns, and started staff monitoring for 4 weeks (05/22/25-06/18/25). Staff were in-serviced on resident rights, including a resident's right to refuse a shower, and trauma informed care on 05/22/25. Record review of Resident #1's verbal statement written by the Administrator, undated, reflected that two CNA's came to her room to take her to the shower and she told them she did not want a shower and she was cold: Two aides came into my room to take me to the shower . I told them that I am cold and don't want a shower. [CNA A] said you are getting a shower tonight. I was begging to not get a shower and told her to stop and go away. They grabbed me by my wrist and pulled me up to put me in the chair. The first shower was cold and then she put me in the other shower[,] it was fine [the shower water temperature] but I kept saying I did not want a shower. [They] put me in the shower and started washing me. Barely gave me a towel to dry off and put me in a gown took me back to my room and put me to bed. I just did not like it. Record review of CNA A's verbal statement, undated, written by the Administrator reflected the following: .(Resident #1) was like do I even have to have a shower and I said yes you will feel better. She was being like her energy was she did not want a shower . Did she have an attitude? Yes, but she got a shower and will feel better. I picked her up under her armpits slid back in chair and took her to the shower room. When asked how many times did (Resident #1) say she did not want a shower? Her response was twice and I told her she would feel better after her shower . Do you know that [residents] have the right to refuse a shower? Yes, knows about the papers and getting a nurse to assist with refusal of showers. Record review of resident safe surveys, dated 05/22/25 reflected Resident #1 safe survey: 1. Do you feel safe at this facility: 'Yes and No' 2. Has anyone mistreated you or anyone in this facility: 'Yes last night' 3. If you have been mistreated or witnessed mistreatment, would you report it to someone: 'Yes I did' 4. Who did you report it to? 'My attorney and the police' . Further review of resident safe surveys with 17 residents on 05/22/25 revealed no concerns regarding abuse, they felt safe at the facility, and knew how to report mistreatment. In an interview and observation on 06/17/25 at 11:38 AM, Resident #1 was in bed and dressed wearing a nasal cannula, she was a poor historian. She stated there was an incident about a month ago, a staff member told her she had to get up out of bed and Resident #1 did not want to get up, she had pain and was not feeling good. She stated that the staff member told her she was getting up even though she kept saying no. She stated the staff member grabbed her by the wrists and put her in her wheelchair and was not sure was else happened. She stated she felt very angry, was swinging her hands around and tried to swat at and hit the staff member away and repeated she did not want to get up and said no but they got her up anyway. She stated she told her nurse. She stated she was not able to recall anything about a shower except for a time that her hair was left wet. She stated that she did not like to get up out of bed because she had pain and declined health and preferred bed baths. She stated she was an [AGE] year-old woman in her dying days and wanted to stay in bed. She stated she felt safe at the facility knowing the staff member was not there because someone from the facility told her they were not working for the facility anymore. She stated she was aware of her resident rights including to refuse a shower. Record review of Resident #1's progress notes from 05/01/25-06/17/25, reflected the following: A nursing progress note dated 05/22/25 at 8:45 AM written by ADON D: Resident reported to Charge Nurse an incident that happened last night. Resident stated that 2 CNA Staff grabbed her by the wrist, put her on the shower chair and took her to the shower room even though res. told the CNAs that she is not feeling well multiple times. Administrator and MD notified. A nursing progress note dated 05/22/25 at 9 AM with the note text of Trauma Informed Assessment written by the ADON D reflected Resident #1 had no previous trauma or diagnosis of PTSD and reported she had not experienced or witnessed a situation that was extremely frightening, and she had felt angry: has felt angry. Description: Yes what happened last night still make me angry. A nursing progress note dated 05/22/25 at 10:42 AM, written by ADON D, reflected Resident #1 had a head-to-toe skin assessment and resident had bruising to her right forearm 3 x 2.5 cm and on the right lateral side of her abdomen. Resident #1 was asked about how they obtained bruising and stated the bruise on her abdomen was from her applying pressure to the area when she coughed and was not sure how she obtained the bruise on her forearm. A nursing progress note dated 05/22/25 at 11:18 AM written by ADON D reflected Resident #1's physician was notified about the bruising to the resident's abdomen at 11 AM and the resident was their own responsible party, and there were no new orders and the resident was encouraged to avoid grabbing or pushing on her abdomen when coughing and reminded to call nursing if she had any pain or increased coughing so that PRN medications would be given. A nursing progress note dated 05/22/25 at 12:33 PM written by ADON D reflected a title of Event-Other reflected Resident #1's vitals were checked with no concerns and her cognition was oriented/no problem, she had no pain or injury and included the following Resident reported to Charge Nurse an incident that happened last night. Resident stated that 2 CNA Staff grabbed her by the wrist, put her on the shower chair and took her to the shower room even though [resident] told the CNAs that she is not feeling well multiple times .Resident Statement: Last night 2 ladies came to my room, one of them is big, the other is tiny. They asked me to shower but I refused. They grabbed me by my wrist, put me on the chair then took me to the shower room . ADON D notified Resident #1's physician on 05/22/25 at 9 AM, and there were no new orders. Resident #1 was their own representative with a date and time of notification as 05/22/25 at 8:45 AM, and the Administrator was notified. A social services progress note, dated 05/22/25 at 3:56 PM, written by the Social Worker: This [Social Worker] met w/ resident Re: complaint of two female staff that reportedly made resident participate in a shower when she verbally declined. Resident requested that these two female staff not be assigned to her again. [The Administrator] informed this [Social Worker] that both female staff have been removed from this facility permanently. This [Social Worker] assured resident that she would not encounter these two female staff in this facility again. This [Social Worker] also reached out to [the Psychologist] to request a post trauma follow up visit with resident as soon as possible. A nursing progress note dated 05/23/25 at 11:32 AM, written by the Social Worker, reflected she assisted Resident #1 with a post trauma therapeutic call with resident and [the Psychologist]. A general progress note dated 05/23/25 at 5:23 PM written by the Psychologist: (Resident #1) is a participant in a telehealth appointment per administrator request in regard to an incident that occurred Thursday (05/22/25). This patient is consulted with via phone assisted by the facility social worker. (Resident #1) is AOx4 [alert and oriented to person, place, time, and event] and able to articulate said needs. patient reported to me that yesterday she was feeling ill and had been in pain due to her couching and COPD symptomology. she reported that two aids came in to give her a shower and she requested to be left alone today, that she did not feel up to taking shower. she proceeded to explain to me one aid grabbed my right arm, and one grabbed my left arm and pulled me out of bed and into a shower chair. I said to them, I'm hurting and do not want a shower. they said to me you will be getting one regardless. the administrator was alerted promptly that patient requested to meet with who was in charge of facility. the administrator suspended both employees immediately pending further investigation. Patient was very happy and appeased to hear employees were suspended and said she does feel safe in building. she admits the incident was very upsetting to her when it occurred. she said when she returned to her room, she was not assisted by the two employees . In an observation and interview on 06/17/25 at 11:55 AM with Resident #1's roommate, Resident # 2, she was lying in bed and stated that about a month ago, she heard a female staff member come into their room, the privacy curtain was closed so she did not see who the staff member was and could hear the exchange. Resident #2 stated the staff member told Resident #1 it was time for her shower and Resident #1 responded that she did not want to take a shower- she did not feel good and had pain, and the staff member told Resident #1 that she was getting up for a shower. She stated it was exactly as Resident #1 described it, that was what she heard. She stated she did not think it was right that Resident #1 was made to get up and shower and no one had forced Resident #2 to take a shower or forced her to get up. She stated there are shower sheets residents sign when residents refused to take a shower. She stated she felt safe at the facility and understood her rights including her right to refuse a shower. In an interview on 06/17/25 at 12:10 PM with LVN C she stated that she was a charge nurse for Resident #1's hall. She stated she was in-serviced on the types of abuse and neglect including who to report to and resident rights including the resident's right to refuse a shower on 05/22/25 and did not work with Resident #1 until a day or two after the incident and when she saw Resident #1 next, her hair was knotted, and she was upset. She said Resident #1 told her that she was made to take a shower by staff when she did not want to take a shower. She stated that Resident #1 commonly refused showers and she offered to brush out her hair and Resident #1 let her brush her hair. She stated resident's had the right to refuse a shower and physically picking up a resident and showering them despite their refusals a violation of the resident's rights. In an interview on 06/17/25 at 12:45 PM with ADON D she stated she received a phone call from staff who relayed what Resident #1 had said about being forced to take a shower and she instructed staff to also contact the Administrator immediately. ADON D stated that she completed a head-to-toe assessment of Resident #1 on 05/22/25 and there were no bruises on her wrist, a small bruise on her forearm, and she had an unrelated bruise to the side of her abdomen. ADON D stated Resident #1 told her the bruise was on her abdomen was due to Resident #1 pushing on her side while coughing and she was sent out the same day due to an increase in COPD symptoms. ADON D stated she completed a trauma assessment and Resident #1 expressed she was still very angry about the incident, and she was referred to counseling services. She stated that in a conference call with one of the CNA's and the Administrator CNA A or CNA B said something like she needed a shower anyway. ADON D stated she considered the incident to be a violation of the resident's rights because residents had the right to refuse a shower and it could have caused physical or mental harm to the resident. Attempts to interview CNA A via phone on 06/17/25 at 1:44 PM and on 06/18/25 at 12:46 PM were unsuccessful with a disconnected dial tone. In an interview on 06/17/25 at 2:10 PM with the Social Worker she stated she spoke with Resident #1 with the Administrator on 05/22/25 and told them that there were aides that got her ready for a shower despite her telling them she did not want a shower. The Social Worker stated Resident #1 was very distraught when talking about the incident and she told Resident #1 that a psychologist was going to come in and meet with her. She stated that the Administrator had said in a morning meeting that the employees were not going to come back to the facility. She stated that she considered the incident Resident #1 described as a violation of the resident's rights and residents had the right to refuse a shower. She stated that Resident #1 seemed to be fine now and she met with her about a week after on 05/30/25 and she did not indicate she was still upset about the shower. In an interview on 06/17/25 at 3:49 PM with CNA B she stated that on the evening of 05/21/25 CNA A flagged her down and asked for help with showering Resident #1. She stated did not assist CNA A in getting the resident out of bed was they were already in the shower room at the time she was asked to be a witness. CNA B states when she entered the shower room Resident #1 was in the shower room and said multiple times she was going to call her lawyers, CNA A told CNA B that Resident #1 had been saying that since CNA A had gotten her up. CNA B stated she took the residents hair out of a ponytail and washed and conditioned her hair- she had a big knot in her hair and refused CNA B to brush it and said she was going to do it herself. CNA B stated she assisted with washing Resident #1 and dried her off and CNA A took her to her room. CNA B stated she had not worked with Resident #1 before and thought she was demented. When given a scenario of a resident who did not want to get up for a shower and was showered despite their refusals, CNA A stated that would be a violation of the resident right's. She stated she would have intervened and told her nurse and the Abuse Coordinator who was the Administrator immediately. She stated residents had the right to refuse a shower. She stated she was called by the Administrator on 05/22/25, was informed she was suspended pending the investigation and gave her statement, she no longer worked at the facility. In an interview on 06/17/25 at 4:10 PM with a family member of Resident #1, she stated Resident #1 called her the day the incident happened and told her she was forced to take a shower and sounded very angry. She stated that Resident #1 is her own representative and she had not spoken with the administrator or Resident #1 about the incident since it occurred. In an interview on 06/17/25 at 4:41 PM with the Psychologist she stated she received a phone call from the Administrator last month around 05/22/25 and was told an incident had occurred and was asked to come see the resident because it seemed very important. The Psychologist stated the Social Worker assisted in a telehealth visit via phone because she was out of town an unable to visit in person. She stated Resident #1 seemed very with it, sounded alert and oriented, and told her that aides had pulled her by the wrist from her bed and one aide told her you're going to get a shower today no matter what despite her telling them that she was hurting and did not want the aides back. The Psychologist stated that their call was cut short because Resident #1 was going to the hospital related to their COPD and increased coughing and she followed up with Resident #1 the following week and Resident #1 had concerns of the aides not coming back to the facility. The Psychologist stated she reassured Resident #1 that the aides were not coming back and she felt better. She stated that a resident being showered despite their refusals was a violation of their rights because they had the right to refuse a shower. In an interview on 06/17/25 at 6:10 PM with LVN F he stated he was the charge nurse for Resident #1's hall on the evening shift (6 PM-6 AM) 05/21/25. He stated he was familiar with Resident #1 and had worked with her when she was on the rehabilitation side of the facility. He stated that Resident #1 used to be a nurse and she did not want to be a bother to anyone and was particular about her care. He stated that at the beginning of the shift on 05/21/25, he was passing medications to residents and did not hear anything at the time but did notice she was not in her room and was pleasantly surprised that she had gotten up to take a shower because she typically did not want to get out of bed- she had a cough for a while and was not feeling well. He stated that he saw her later and her hair was still a little wet and she complained that they gave her a shower and left her hair damp. He stated that Resident #1 and seemed focused on her hair and he wanted to make her comfortable so he offered to look for a hair dryer to dry her hair. He stated that CNA A only told him that she got her to take a shower. He stated Resident #1 did not disclose to him anything about what had happened and neither CNA told him anything other than she CNA A said she got a shower, and he found out the following day and was in-serviced on 05/22/25 on resident rights including the right to refuse showers, and trauma informed care. He stated that if he had known what had happened he would have immediately ensured the resident felt safe, ensured the CNA did not provide her any care, and would have contacted the Administrator who was the abuse coordinator. He stated that giving a resident a shower despite their refusals could have caused physical or mental harm to the resident. LVN F stated that residents had the right to refuse showers. He stated the facility was the residents home, and if they are home they might not want anyone to get them up or to take a shower. In an interview on 06/18/25 at 9:28 AM with the Regional Compliance Nurse, she stated that she was contacted by the Administrator on 05/22/25 regarding an allegation of abuse. She stated that she assisted the Administrator via phone to ensure they followed their abuse and neglect policy. She stated that the Administrator suspended the two employees (CNA A & CNA B) pending the investigation and she updated Resident #1's care plan due to her anger at being made to shower despite her refusals. She stated that the facility's policy was to update the resident's care plan to indicate a traumatic event occurred and did not think Resident #1 had lasting trauma due to the incident and it was care planned as a trauma event due to the resident's expression of anger and to ensure staff were aware how to care for the resident and to stop immediately if the resident refused a shower. She stated showering a resident despite their refusals was a violation of the resident rights and could have caused physical and psychosocial harm to the resident. In an interview on 06/18/25 at 11:28 AM with LVN I revealed Resident #1 typically stayed in her bed and sometimes would ask to get up. She stated on 05/22/25 during her rounds, Resident #1 appeared furious told her that the previous night (05/21/25), two girls came into Resident #1's room and told her it was her shower day, she refused, and they picked her up anyway and took her to the shower room and washed her, and said she was going to sue the aides. LVN I stated Resident #1 stated that the aides picked her up by the wrists and looked at her wrists and saw no marks or bruising, made sure she was okay, and told the resident she was going to get someone to talk to her and immediately went to get the Administrator and the Administrator and Social Worker went to talk with Resident #1. She stated that she considered it was a violation of the resident's rights and a resident could be physically or mentally harmed by being showered despite her refusals. She stated that when resident's refused a shower CNA's were supposed to let the nurse know and talk to the resident to see if they might change their mind and if the resident still refused then they have a shower refusal sheet they had them sign. In an interview on 06/18/25 at 1:45 PM with the Administrator she stated a nurse came to her at the end of morning meeting and told her she needed to speak with Resident #1. The Administrator stated she immediately spoke with Resident #1 who told her, the night before (05/21/25), she was in her bed and it was her shower day, she didn't really want to take a shower, aides grabbed her by the wrists and put her in her chair and made her take a shower even though she didn't want to. She stated that Resident #1 told the Administrator that she did not want the aides to take care of her again and the Administrator assured her that they would not take care of her anymore. The Administrator stated she interviewed Resident #1's roommate, Resident #2, and she told the Administrator that everything Resident #1 told her happened- was what Resident #2 heard happen, and the privacy curtain was closed so she did not visually see the incident. The Administrator stated that Resident #1 provided a description that fit with two aides (CNA A & B) that worked on 05/21/25 6 PM- 6 AM shift, CNA A was assigned to Resident #3's hall. She stated she called and suspended both CNA A and CNA B pending the investigation on 05/22/25, they had not come back to the facility, and she interviewed them regarding the incident. She stated that CNA A told her that she had showered Resident #1 the evening of 05/21/25 and asked CNA B to help because Resident #1 was being difficult. She stated CNA A told her that Resident #1 said several times that she did not want a shower and CNA A told Resident #1 that she had to take a shower because she would feel better and CNA A physically picked her up under her armpits, slid her back into her chair and took her to the shower room. CNA A told the Administrator that she knew that resident's had the right to refuse a shower and knew about the refusal papers and they were to involve the nurse, but the resident got a shower and would feel better. The Administrator stated when she interviewed CNA B she told the Administrator that she heard the resident did say she didn't want a shower and CNA A told Resident #1 that she would feel better after a shower. CNA A told the Administrator Resident #1 kept saying she was going to call her lawyers. CNA A told the Administrator she had not worked with Resident #1 and thought she had dementia so she did not think much of what Resident #1 said and residents needed to take showers. The Administrator stated that resident's had a right to refuse a shower. She stated she expected when resident's refused showers for CNA's to wait a little while and try again later or get someone else to ask the resident, and then informed the charge nurse so they could attempt and document it with a refusal sheet. She stated that she in-serviced all staff on trauma informed care and that resident's had a right to refuse showers. Resident #1's physician was notified. She stated she attended an AD Hoc QAPI meeting on 05/22/25 with the Regional Compliance Nurse, Regional Director of Operations, the Medical Director, regarding the incident and what the Administrator needed to do. She stated that she had psychological services speak with Resident #1 and her care plan was updated. The Administrator stated the social worker completed safe surveys of residents with no other concerns. In an interview on 06/18/25 at 6:25 PM with CNA K she stated that she worked the evening shifts on Resident #1's hall and worked the evening after the incident on 05/22/25. CNA K stated Resident #1 was able to voice her needs and had never seen her out of bed in the year she had worked at the facility. She stated she had asked Resident #1 if she wanted a shower in the past and Resident #1 would reply no I'm not taking a shower and she had the resident sign a refusal form, informed the charge nurse who also signed the sheet, and there was a box they put it in at near the ADON's office. When provided the scenario of an aide giving a resident a shower despite their refusals, she stated it was a violation of the resident's rights and the resident could have been harmed physically and mentally. She stated she would have intervened immediately and ensured the resident felt safe and report to the Abuse Coordinator who was the Administrator. She stated that resident's have rights, the facility was the residents home and what they say goes. Interviews on 06/17/25 (12:10 PM) and 06/18/25 across both shifts (6 AM- 6 PM & 6 PM-6 AM) with various staff members (ADON D, CNA E, CNA G, CNA H, CNA J, CNA K, LVN C, LVN F, LVN I, LVN L, LVN M, LVN P, MA N, and Social Worker) revealed staff had been in-serviced on resident rights on 05/22/25. When provided a scenario where a resident refused a shower and a CNA transferred them by their wrists or under their armpits and gave a resident a shower despite the resident's refusals- all stated it was a violation of the resident's right to refuse a shower and would have intervened and ensured the resident was safe and immediately report it to the Abuse Coordinator. They staff were aware of the shower refusal process of having the resident and the nurse and aide signed the refusal sheet and they were turned into a box near the ADON D's office. Record review of facility's resident rights policy titled Resident Rights, undated, reflected: The resident has a right to a dignified existence, self-determination .A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident . Exercise of Rights - The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States. 1. The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility. 2. The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart. Respect and dignity - The resident has a right to be treated with respect and dignity . Self-determination - The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice. 1.The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, plan of care and other applicable provisions of this part. 2.The resident has the right to make choices about aspects of his or her life in the facility that are significant to the resident . Record review of the facility's Bathing/Shower Policy titled Bath, Tub/Shower, undated, reflected .The frequency and type of bathing depends on resident preference, skin condition, tolerance and energy level. Although a daily bath or shower is preferred and necessary for some, the aging skin can be maintained by bathing every two days or with partial bathing as needed . Procedure 1. The resident will receive assistance with bathing according to their resident centered plan of care. 2. Become familiar with type and pattern of bathing, assistance or aids needed, skin condition, presence of dressing or casts . Record review of CNA A's personnel file reflected she was hired on 05/01/25 with a last worked date of 05/21/25 and was terminated from employment on 05/23/25. The facility had conducted Texas Department of Public Safety Criminal History verification and Employee Misconduct Registry Employability status check without any concerns. Record review of CNA B's personnel file reflected she was hired on 04/18/25 with a last worked date of 05/21/25 and was terminated from employ[TRUNCATED]

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to ensure residents were free from abuse for two (Resident #1 and Resident # 2) of 9 residents reviewed for abuse. The facility failed to protect Resident #1, who was on mental health services, from mental anguish on 05/21/25 at 9:30 PM when, when despite her refusals, she was physically lifted, under her armpits, by CNA A from her bed to the shower chair was given a shower by despite her refusals. As a result, Resident #1 experienced mental anguish and anger. Resident #2 who was on mental health services experienced mental anguish/being upset after hearing her roommate being forced to shower by facility aides. This failure could place residents at risk for not having measures in place to protect them from serious harm, mental anguish, abuse, or neglect. The noncompliance was identified as Immediate Jeopardy Past Noncompliance (PNC). The Immediate Jeopardy began on 05/21/25 at 9:30 PM and ended on 05/28/25. The facility had taken actions noted in the findings that corrected the noncompliance before the incident investigation began on 06/17/25. Findings included: Review of Resident #1's Quarterly MDS, dated [DATE], reflected she was an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. She had the diagnoses of Chronic Obstructive Pulmonary Disease (COPD) with acute exacerbation (a lung disease with a sudden worsening symptoms including breathlessness, mucus, and cough), Alzheimer's disease (loss of cognition), chronic pain syndrome, and anxiety disorder (excessive or persistent worry or fear). Her BIMS score was a 5 (severely impaired cognition). Further review of Section GG-Functional Abilities reflected she usually required substantial/maximal assistance for bed to chair transfers. Record review of Resident #1's care plan reflected the resident had an activity of daily living (ADL) performance deficit and required one staff to assist with bathing and bed mobility, dated initiated 02/13/25. Further review reflected a focus area, dated initiated 05/23/25, The resident has a history of trauma that may have a negative impact. The trauma is [due to]: Feeling angry [due to] shower being done after she refused. Interventions included: .If resident refuses her shower stop immediately . If the resident has escalated, if at all possible do not touch the resident unless absolutely necessary for resident's or others safety ., dated initiated 05/23/25. Record review of Resident #2's Quarterly MDS, dated [DATE], reflected she was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. She had the diagnoses of cancer, heart failure, stroke with paralysis on her left non-dominant side, and major depression disorder (persistent feelings of sadness). Her BIMS score was a 7 (severely impaired cognition). Record review of Resident #2's care plan reflected the resident had impaired cognitive function/dementia or impaired thought processes; interventions included .Use residents preferred name . face the resident when speaking .Provide the resident with necessary cues- stop and return if agitated ., dated initiated 10/07/24. Record review of the Provider Investigation Report (PIR) (Form 3613-A of Texas Health and Human Services) reflected an incident date and time of 05/21/25 at 9:30 PM, dated reported 05/22/25 at 10:15 AM and signed by the Administrator on 05/28/25. Further review revealed on 05/21/25 around 8:40 AM, Resident #1 told her nurse that she needed to talk to someone in charge because she was upset about her care last night. Further review revealed on 05/21/25 around 9:30 PM Resident #1 told CNA A several times she did not want a shower and without Resident #1's consent, CNA A physically lifted Resident #1 from the armpits from the bed into the shower chair and Resident #1 was given a shower by CNA A with assistance in the shower room by CNA B. Resident #1 did not have a history of similar allegations and was interviewable and had the capacity to make informed decisions. Resident #1 had a head-to-toe assessment on 05/22/25 at 10 AM and had no injuries. The facility immediately suspended CNA A and CNA B and obtained interviews from both CNA's and Resident #1, completed resident safe surveys on 05/22/25 with no other concerns, and started staff monitoring for 4 weeks (05/22/25-06/18/25). Staff were in-serviced on abuse and neglect and resident rights, including a resident's right to refuse a shower, and trauma informed care on 05/22/25. Record review of Resident #1's verbal statement written by the Administrator, undated, reflected that two CNA's came to her room to take her to the shower and she told them she did not want a shower and she was cold: Two aides came into my room to take me to the shower . I told them that I am cold and don't want a shower. [CNA A] said you are getting a shower tonight. I was begging to not get a shower and told her to stop and go away. They grabbed me by my wrist and pulled me up to put me in the chair. The first shower was cold and then she put me in the other shower[,] it was fine [the shower water temperature] but I kept saying I did not want a shower. [They] put me in the shower and started washing me. Barely gave me a towel to dry off and put me in a gown took me back to my room and put me to bed. I just did not like it. Record review of CNA A's verbal statement, undated, written by the Administrator reflected the following: .(Resident #1) was like do I even have to have a shower and I said yes you will feel better. She was being like her energy was she did not want a shower . Did she have an attitude? Yes, but she got a shower and will feel better. I picked her up under her armpits slid back in chair and took her to the shower room. When asked how many times did (Resident #1) say she did not want a shower? Her response was twice and I told her she would feel better after her shower . Do you know that [residents] have the right to refuse a shower? Yes, knows about the papers and getting a nurse to assist with refusal of showers. Record review of resident safe surveys, dated 05/22/25 reflected Resident #1 safe survey: 1. Do you feel safe at this facility: 'Yes and No' 2. Has anyone mistreated you or anyone in this facility: 'Yes last night' 3. If you have been mistreated or witnessed mistreatment, would you report it to someone: 'Yes I did' 4. Who did you report it to? 'My attorney and the police' . Further review of resident safe surveys with 17 residents revealed no concerns regarding abuse, they felt safe at the facility, and knew how to report mistreatment. In an interview and observation on 06/17/25 at 11:38 AM, Resident #1 was in bed and dressed wearing a nasal cannula, she was a poor historian. She stated there was an incident about a month ago, a staff member told her she had to get up out of bed and Resident #1 did not want to get up, she had pain and was not feeling good. She stated that the staff member told her she was getting up even though she kept saying no. She stated the staff member grabbed her by the wrists and put her in her wheelchair and was not sure was else happened. She stated she felt very angry, was swinging her hands around and tried to swat at and hit the staff member away and repeated she did not want to get up and said no but they got her up anyway. She stated she told her nurse. She stated she was not able to recall anything about a shower except for a time that her hair was left wet. She stated that she did not like to get up out of bed because she had pain and declined health and preferred bed baths. She stated she was an [AGE] year-old woman in her dying days and wanted to stay in bed. She stated she felt safe at the facility knowing the staff member was not there because someone from the facility told her they were not working for the facility anymore. Record review of Resident #1's progress notes from 05/01/25-06/17/25, reflected the following: A nursing progress note dated 05/22/25 at 8:45 AM written by ADON D: Resident reported to Charge Nurse an incident that happened last night. Resident stated that 2 CNA Staff grabbed her by the wrist, put her on the shower chair and took her to the shower room even though res. told the CNAs that she is not feeling well multiple times. Administrator and MD notified. A nursing progress note dated 05/22/25 at 9 AM with the note text of Trauma Informed Assessment written by the ADON D reflected Resident #1 had no previous trauma or diagnosis of PTSD and reported she had not experienced or witnessed a situation that was extremely frightening, and she had felt angry: has felt angry. Description: Yes what happened last night still make me angry. A nursing progress note dated 05/22/25 at 10:42 AM, written by ADON D, reflected Resident #1 had a head-to-toe skin assessment and resident had bruising to her right forearm 3 x 2.5 cm and on the right lateral side of her abdomen. Resident #1 was asked about how they obtained bruising and stated the bruise on her abdomen was from her applying pressure to the area when she coughed and was not sure how she obtained the bruise on her forearm. A nursing progress note dated 05/22/25 at 11:18 AM written by ADON D reflected Resident #1's physician was notified about the bruising to the resident's abdomen at 11 AM and the resident was their own responsible party, and there were no new orders and the resident was encouraged to avoid grabbing or pushing on her abdomen when coughing and reminded to call nursing if she had any pain or increased coughing so that PRN medications would be given. A nursing progress note dated 05/22/25 at 12:33 PM written by ADON D reflected a title of Event-Other reflected Resident #1's vitals were checked with no concerns and her cognition was oriented/no problem, she had no pain or injury and included the following Resident reported to Charge Nurse an incident that happened last night. Resident stated that 2 CNA Staff grabbed her by the wrist, put her on the shower chair and took her to the shower room even though [resident] told the CNAs that she is not feeling well multiple times .Resident Statement: Last night 2 ladies came to my room, one of them is big, the other is tiny. They asked me to shower but I refused. They grabbed me by my wrist, put me on the chair then took me to the shower room . ADON D notified Resident #1's physician on 05/22/25 at 9 AM, and there were no new orders. Resident #1 was their own representative with a date and time of notification as 05/22/25 at 8:45 AM, and the Administrator was notified. A social services progress note, dated 05/22/25 at 3:56 PM, written by the Social Worker: This [Social Worker] met w/ resident Re: complaint of two female staff that reportedly made resident participate in a shower when she verbally declined. Resident requested that these two female staff not be assigned to her again. [The Administrator] informed this [Social Worker] that both female staff have been removed from this facility permanently. This [Social Worker] assured resident that she would not encounter these two female staff in this facility again. This [Social Worker] also reached out to [the Psychologist] to request a post trauma follow up visit with resident as soon as possible. A nursing progress note dated 05/23/25 at 11:32 AM, written by the Social Worker, reflected she assisted Resident #1 with a post trauma therapeutic call with resident and [the Psychologist]. A general progress note dated 05/23/25 at 5:23 PM written by the Psychologist: (Resident #1) is a participant in a telehealth appointment per administrator request in regard to an incident that occurred Thursday (05/22/25). This patient is consulted with via phone assisted by the facility social worker. (Resident #1) is AOx4 [alert and oriented to person, place, time, and event] and able to articulate said needs. patient reported to me that yesterday she was feeling ill and had been in pain due to her couching and COPD symptomology. she reported that two aids came in to give her a shower and she requested to be left alone today, that she did not feel up to taking shower. she proceeded to explain to me one aid grabbed my right arm, and one grabbed my left arm and pulled me out of bed and into a shower chair. I said to them, I'm hurting and do not want a shower. they said to me you will be getting one regardless. the administrator was alerted promptly that patient requested to meet with who was in charge of facility. the administrator suspended both employees immediately pending further investigation. Patient was very happy and appeased to hear employees were suspended and said she does feel safe in building. she admits the incident was very upsetting to her when it occurred. she said when she returned to her room, she was not assisted by the two employees . In an observation and interview on 06/17/25 at 11:55 AM with Resident #1's roommate, Resident # 2, she was lying in bed and stated that about a month ago, she heard a female staff member come into their room, the privacy curtain was closed so she did not see who the staff member was and could hear the exchange. Resident #2 stated the staff member told Resident #1 it was time for her shower and Resident #1 responded that she did not want to take a shower- she did not feel good and had pain, and the staff member told Resident #1 that she was getting up for a shower. She stated it was exactly as Resident #1 described it, that was what she heard. She stated she did not think it was right that Resident #1 was made to get up and take a shower and no one had forced Resident #2 to take a shower or forced her to get up. She stated there are shower sheets residents sign when residents refused to take a shower. She stated she felt safe at the facility. Record review of Resident #2 progress notes from 05/01/25 to 06/18/25 reflected the following: A general note written by the Psychologist, dated 05/23/25 at 6:36 PM, (Resident #2) is seen while maintaining routine rounds at facility. (Resident #2) is on mental health services as advised by care plan team for adjustment and optimal well-being while residing in long term care. (Resident #2) was assisted with phone consult due to an incident that occurred the evening prior. (Resident #2) said she was upset because her roommate was being forced to take a shower, and she did not want to. (Resident #2) said they were rough with her which upset her even though she says she feels safe in the building. (Resident #2) gets very emotional due to her diagnosis and emotional instability . Record review of Resident #2's progress notes reflected a late entry general note written by the Psychologist, dated 05/28/25 at 3 PM, reflected: (Resident #2) is seen while maintaining routine rounds at facility. (Resident #2) is on mental health services as advised by care plan team for adjustment and optimal well-being while residing in long term care. Resident #2 was doing well, expressed no new concerns . In an interview on 06/17/25 at 12:10 PM with LVN C she stated that she was a charge nurse for Resident #1's hall. She stated she was in-serviced on the types of abuse and neglect including who to report to and resident rights including the resident's right to refuse a shower on 05/22/25 and did not work with Resident #1 until a day or two after the incident and when she saw Resident #1 next, her hair was knotted, and she was upset. She said Resident #1 told her that she was made to take a shower by staff when she did not want to take a shower. She stated that Resident #1 commonly refused showers and she offered to brush out her hair and Resident #1 let her brush her hair. She stated resident's had the right to refuse a shower and physically picking up a resident from under their armpits or wrists and showering them despite their refusals was abuse and could have caused physical harm or mental harm to the resident. In an interview on 06/17/25 at 12:45 PM with ADON D she stated she received a phone call from staff who relayed what Resident #1 had said about being forced to take a shower and she instructed staff to also contact the Administrator immediately. ADON D stated that she completed a head-to-toe assessment of Resident #1 on 05/22/25 and there were no bruises on her wrist, a small bruise on her forearm, and she had an unrelated bruise to the side of her abdomen. ADON D stated Resident #1 told her the bruise was on her abdomen was due to Resident #1 pushing on her side while coughing and she was sent out the same day due to an increase in COPD symptoms. ADON D stated she completed a trauma assessment and Resident #1 expressed she was still very angry about the incident and she was referred to counseling services. She stated that in a conference call with one of the CNA's and the Administrator CNA A or CNA B said something like she needed a shower anyway. ADON D stated she considered the incident to be abuse. She stated that physically moving a resident by lifting under their armpits, despite their refusals, from the bed to a shower chair and showering them could have resulted in physical harm or mental distress. Attempts to interview CNA A via phone on 06/17/25 at 1:44 PM and on 06/18/25 at 12:46 PM were unsuccessful with a disconnected tone. In an interview on 06/17/25 at 2:10 PM with the Social Worker she stated she spoke with Resident #1 with the Administrator on 05/22/25 and she told them that there were aides that got her ready for a shower despite her telling them she did not want a shower. The Social Worker stated Resident #1 was very distraught when talking about the incident and she told Resident #1 that a psychologist was going to come in and meet with her. She stated that the Administrator had said in a morning meeting that the employees were not going to come back to the facility. She stated they are in-serviced regularly on abuse and neglect and was able to name the types and reporting requirements. She stated that she considered the incident Resident #1 described as abuse. She stated that Resident #1 seemed to be fine now and she met with her about a week after on 05/30/25 and she did not indicate she was still upset about the shower. In an interview on 06/17/25 at 3:49 PM with CNA B she stated that on the evening of 05/21/25 CNA A flagged her down and asked for help with showering Resident #1. She stated did not assist CNA A in getting the resident out of bed, they were already in the shower room at the time she was asked to be a witness. CNA B stated when she entered the shower room Resident #1 was in the shower room and said multiple times she was going to call her lawyers, CNA B told CNA A that Resident #1 had been saying that since CNA A had gotten her up. CNA B stated she took the residents hair out of a ponytail and washed and conditioned her hair- she had a big knot in her hair and refused CNA B to brush it and said she was going to do it herself. CNA B stated she assisted with washing Resident #1 and dried her off and CNA A took her to her room. CNA B stated that she was not concerned about abuse because she had not worked with Resident #1 before and thought she was demented. When given a scenario of a resident who did not want to get up for a shower and was physically picked up by their armpits and taken to be showered despite their refusals, CNA B stated that would be abuse and the resident could have been physically harmed. She stated she would have intervened and told her nurse and the Abuse Coordinator who was the Administrator immediately. She stated she was called by the Administrator on 05/22/25, was informed she was suspended pending the investigation and gave her statement, she no longer worked at the facility. In an interview on 06/17/25 at 4:10 PM with a family member of Resident #1, she stated Resident #1 called her the day the incident happened and told her she was forced to take a shower and sounded very angry. She stated that Resident #1 is her own representative and she had not spoken with the administrator or Resident #1 about the incident since it occurred. In an interview on 06/17/25 at 4:41 PM with the Psychologist she stated she received a phone call from the Administrator last month around 05/22/25 and was told an incident had occurred and was asked to come see the resident because it seemed very important. The Psychologist stated the Social Worker assisted in a telehealth visit via phone because she was out of town an unable to visit in person. She stated Resident #1 seemed very with it, sounded alert and oriented, and told her that aides had pulled her by the wrist from her bed and one aide told her you're going to get a shower today no matter what despite her telling them that she was hurting and did not want the aides back. The Psychologist stated that their call was cut short because Resident #1 was going to the hospital related to their COPD and increased coughing. She stated she followed up with Resident #1 the following week (05/28/25) and Resident #1 had concerns of the aides not coming back to the facility. The Psychologist stated she reassured Resident #1 that the aides were not coming back and she felt better. She stated she also saw Resident #1 on 04/02/25 and she was focused on discharging from the facility which was unrealistic due to her being non-ambulatory and increased COPD symptoms. She stated she was following up with the resident today on 06/17/25. In an interview on 06/17/25 at 6:10 PM with LVN F he stated he was the charge nurse for Resident #1's hall on the evening shift (6 PM-6 AM) 05/21/25. He stated he was familiar with Resident #1 and had worked with her when she was on the rehabilitation side of the facility. He stated that Resident #1 used to be a nurse and she did not want to be a bother to anyone and was particular about her care. He stated that at the beginning of the shift on 05/21/25, he was passing medications to residents and did not hear anything at the time but did notice she was not in her room and was pleasantly surprised that she had gotten up to take a shower because she typically did not want to get out of bed- she had a cough for a while and was not feeling well. He stated that he saw her later and her hair was still a little wet and she complained that they gave her a shower and left her hair damp. He stated that Resident #1 and seemed focused on her hair and he wanted to make her comfortable, so he offered to look for a hair dryer to dry her hair. He stated that CNA A only told him that she got her to take a shower. He stated Resident #1 did not disclose to him anything about what had happened and neither CNA told him anything other than she got a shower, and he found out the following day and was in-serviced on 05/22/25 on identifying and reporting abuse and neglect, resident rights including the right to refuse showers, and trauma informed care. He stated that if he had known what had happened, he would have immediately ensured the resident felt safe, ensured the CNA did not provide her any care, and would have contacted the Administrator who was the abuse coordinator. He stated that physically transferring a resident, under their armpits, and giving them a shower despite their refusals, was abuse and could have caused physical and mental harm to the resident. In an interview on 06/18/25 at 9:28 AM with the Regional Compliance Nurse, she stated that she was contacted by the Administrator on 05/22/25 regarding an allegation of abuse. She stated that she assisted the Administrator via phone to ensure they followed their abuse and neglect policy. She stated that the Administrator suspended the two employees (CNA A & CNA B) pending the investigation and she updated Resident #1's care plan due to her anger at being made to shower despite her refusals. She stated that the facility's policy was to update the resident's care plan to indicate a traumatic event occurred and did not think Resident #1 had lasting trauma due to the incident and it was care planned as a trauma event due to the resident's expression of anger and to ensure staff were aware how to care for the resident and to stop immediately if the resident refused a shower. She stated physically moving a resident from under her armpits or wrists and showering them despite their refusals was abuse and could have caused physical and psychosocial harm to the resident. In an interview on 06/18/25 at 11:28 AM with LVN I revealed Resident #1 typically stayed in her bed and sometimes would ask to get up. She stated on 05/22/25 during her rounds, Resident #1 appeared furious told her that the previous night (05/21/25), two girls came into Resident #1's room and told her it was her shower day, she refused, and they picked her up anyway and took her to the shower room and washed her, and said she was going to sue the aides. LVN I stated Resident #1 stated that the aides picked her up by the wrists and looked at her wrists and saw no marks or bruising, made sure she was okay, and told the resident she was going to get someone to talk to her and immediately went to get the Administrator and the Administrator and Social Worker went to talk with Resident #1. She stated that she considered it to be abuse. She stated that a resident could be harmed by being picked up from her bed under her armpits or by her wrists and made to take a shower despite their refusals both psychologically and physically. She stated that when resident's refused a shower CNA's were supposed to let the nurse know and talked to the resident to see if they might change their mind and if the resident still refused then they have a shower refusal sheet they had them sign. In an interview on 06/18/25 at 1:45 PM with the Administrator she stated a nurse came to her at the end of morning meeting and told her she needed to speak with Resident #1. The Administrator stated she immediately spoke with Resident #1 who told her, the night before (05/21/25), she was in her bed and it was her shower day, she didn't really want to take a shower, aides grabbed her by the wrists and put her in her chair and made her take a shower even though she didn't want to. She stated that Resident #1 told the Administrator that she did not want the aides to take care of her again and the Administrator assured her that they would not take care of her anymore. The Administrator stated she interviewed Resident #1's roommate, Resident #2, and she told the Administrator that everything Resident #1 told her happened- was what Resident #2 heard happen, and the privacy curtain was closed so she did not visually see the incident. The Administrator stated that Resident #1 provided a description that fit with two aides (CNA A & CNA B) that worked on 05/21/25 6 PM- 6 AM shift, CNA A was assigned to Resident #3's hall. She stated she called and suspended both CNA A and CNA B pending the investigation on 05/22/25, they had not come back to the facility, and she interviewed them regarding the incident. She stated that CNA A told her that she had showered Resident #1 the evening of 05/21/25 and asked CNA B to help because Resident #1 was being difficult. She stated CNA A told her that Resident #1 said several times that she did not want a shower. CNA A told the Administrator Resident #1 kept saying she was going to call her lawyers and she had not worked with Resident #1 and thought she had dementia so she did not think much of it. The Administrator stated that resident's had a right to refuse a shower and physically moving a resident, under their armpits, to a shower chair and showering them despite their refusals could be considered abuse and could physically or psychologically harm the resident. She stated she expected when resident's refused showers for CNA's to wait a little while and try again later or get someone else to ask the resident, and then inform the charge nurse so they could attempt and document it with a refusal sheet. She stated that she in-serviced all staff on abuse and neglect including recognizing abuse and reporting to her immediately, and on trauma informed care. Resident #1's physician was notified. She stated she attended an AD Hoc QAPI meeting on 05/22/25 with corporate involvement and the Medical Director, regarding the incident and what the Administrator needed to do. In an interview on 06/18/25 at 6:25 PM with CNA K she stated that she worked the evening shifts on Resident #1's hall and worked the evening after the incident on 05/22/25. CNA K stated Resident #1 was able to voice her needs and had never seen her out of bed in the year she had worked at the facility. She stated she had asked Resident #1 if she wanted a shower in the past and Resident #1 would reply no I'm not taking a shower. She stated when resident's refused showers she had the resident sign a refusal form, informed the charge nurse who also signed the sheet, and there was a box they put it in at near the ADON's office. She was able to name types of abuse including reporting to the Abuse Coordinator. When provided the scenario of an aide physically transferring a resident by lifting under their armpits and giving them a shower despite their refusals, she stated it was abuse and the resident could have experienced physical harm. She stated she would have intervened immediately and ensured the resident felt safe and report to the Abuse Coordinator who was the Administrator. In interviews on 06/17/25 and 06/18/25 across both shifts (6 AM- 6 PM & 6 PM-6 AM) with various staff members (ADON D, CNA E, CNA G, CNA H, CNA J, CNA K, LVN C, LVN F, LVN I, LVN L, LVN M, LVN P, MA N, and Social Worker) revealed staff had been in-serviced on abuse and neglect, resident rights (including residents had a right to refuse showers), and trauma informed care on 05/22/25. The above-mentioned staff members were able to verbalize abuse and different forms of abuse and neglect including reporting to the Administrator who was the facility's abuse coordinator. The above mentioned staff members stated they had received in-services on resident rights and trauma informed care and when a resident declined showers that meant no and they did not force resident's to do something they did not want to do. When provided a scenario where a resident refused a shower and a CNA transferred them by their wrists or under their armpits and gave a resident a shower despite the resident's refusals- all stated they considered it to be abuse and would ensure the resident was safe and immediately report it to the Abuse Coordinator. They stated physically transferring a resident under the armpits from the bed to shower chair and showering the resident despite refusals could result in physical and mental harm to the resident. Record review of the facility's AD Hoc QAPI (an unscheduled, as needed meeting for a Quality Assurance and Performance Improvement (QAPI) program) meeting, dated 05/22/25, attended by the Administrator, Medical Director, Regional Compliance Nurse regarding the incident and what steps they needed to take next. Record review of CNA A's personnel file reflected she was hired on 05/01/25 with a last worked date of 05/21/25 and was terminated from employment on 05/23/25. The facility had conducted Texas Department of Public Safety Criminal History verification and Employee Misconduct Registry Employability status check without any concerns. Record review of CNA B's personnel file reflected she was hired on 04/18/25 with a last worked date of 05/21/25 and was terminated from employment on 06/05/25. The facility had conducted Texas Department of Public Safety Criminal History verification and Employee Misconduct Registry Employability status check without any concerns. Record review of abuse and neglect in-services conducted by the facility on 05/22/25 reflected the facility staff were trained on abuse and neglect, types of abuse, who was the abuse coordinator and when abuse should be reported. Reco[TRUNCATED]