**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility did not ensure that the resident had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. Specifically, for 1 out of 27 sampled residents, staff were unable to locate a resident for a period of time. There was an area of the facility that was locked an unaccessable to staff. There was a facility staff member in the locked area that the resident was observed to exit from. The resident made statements that the staff member engaged in sexual actions with her. In addition, the staff member had been talked to about not remaining in the facility after dinner time. This example was cited at Immediate Jeopardy. Resident identifiers: 4, 6, 12, 23, 28, 31, 36, 90 and 141. Findings included: Notice: On 4/11/24 at 12:15 PM, Immediate Jeopardy (IJ) was identified when the facility failed to implement Centers for Medicare and Medicaid Services recommended practices to prevent various forms of abuse. Notice of the IJ was given verbally and in writing to the facility Administrator, Chief Operating Officer, [NAME] President of Clinical Services, Director of Nursing (DON), and Regional Nurse Consultant (RNC). On 4/11/24 at 3:02 PM, the facility Administrator provided the following abatement plan for the removal of the IJ effective on 4/11/24 at 4:00 PM. [Facility name] is providing the following information to demonstrate that the immediacy of the cited deficiency F600 has been removed. Summary of Actions Take: Resident: Resident [31] Resident and staff member were separated immediately Police contacted immediately upon suspicion Resident assessed; no injury noted Notification to Physicians, POA [Power of Attorney] Incident reported by administrator to DHS [Department of Health Services], APS [Adult Protective Services], Ombudsman Resident interviewed with administrator Hospital evaluation completed, no trauma noted Resident care plan reviewed and updated as needed Provider to assess/evaluate residents including medication review SS [Social Services] wellness visits to be completed for resident x 2 and PRN [as needed] Behavioral health visit requested with [local mental health] provider Therapy: Therapy Staff Member (ST) Therapy staff member was immediately placed on administrative leave, facility keys/badge provided to administrator Therapy staff member was questioned and released by the police, pending potential charges Employee file was reviewed Therapy staff member will not return to the facility RDO [Regional Director of Operations] spoke to Therapy Regional Director and informed him that staff are not to stay in the facility after normal business hours without the approval of the facility administrator Facility will ensure the therapy staff working in the facility have background checks (DACS) [Direct Access Clearance System] that are connected to the facility. Other Residents at Potential Risk: All residents interviewed by administrator/designee to assess potential for abuse/neglect allegations Systemic Changes and Education Facility will ensure all staff working in the facility have background checks (DACS) that are connected to the facility. Locks will be removed from all doors and/or Master Key accessible to charge nurse on medication cart Staff Members will not remain in the facility after normal business hours without the approval of the facility administrator Administrator, DON and RNC reviewed Abuse & Neglect Policy Administrator, DON and IDT [Interdisciplinary team] were educated by RNC regarding Abuse & Neglect Policy Administrator/DON/designee will complete Abuse & Neglect education with all staff Education including post-test initiated immediately for all facility staff on Abuse/Neglect All employees will be educated at start of their next shift or if no scheduled shift by all staff meeting on 4/16/24 Monitoring and Quality Improvement Measures: The DON/designee will review incidents of sexually inappropriate behavior weekly x 4 weeks then monthly x3 months to ensure appropriate interventions are implemented and no trends are noted The Administrator/designee will conduct 5 random resident & staff interviews weekly x 4 weeks and then monthly thereafter x 3 months to ensure the Abuse & Neglect Policy have been followed and allegations have been investigated and reported timely The facility administrator/designee will do random facility visits during off hours 2x/week x 4 weeks and then monthly thereafter x 3 months to ensure that only staff clocked in and assigned to be working are in the facility and that the charge nurse has a Master Key to all locked doors in the facility The Administrator/designee will review 5 employee files (including contracted therapist) weekly x 4 weeks and then monthly thereafter times 3 months to ensure they have completed abuse training, verification of license and background checks (DACS) is connected to the facility. Medical Director was informed of the incident and QAA [Quality Assurance and Assessment] Review & Recommendations Results will be reported to the QAA committee from monitoring and follow-up The administrator is responsible for substantial compliance of this Plan of Action. The facility alleges the immediacy with deficient practice has been removed on April 11, 2024 by 4:00 PM. Findings included: Immediate Jeopardy Resident 31 was admitted to the facility on [DATE] with diagnoses which included rheumatoid arthritis, muscle weakness, dementia of unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, protein-calorie malnutrition, immunodeficiency, and chronic respiratory failure with hypoxia. On 4/9/24, between 9:50 AM and 10:05 AM, separate interviews were held with Licensed Practical Nurse (LPN) 1 and resident 4. During these interviews, LPN 1 informed the surveyor that late the previous evening, resident 31 had gone missing. LPN 1 reported that as staff searched for the resident, they noticed the therapy gym doors were locked. LPN 1 stated the therapy gym was the only location in the facility staff were unable to access to search for the resident. LPN 1 stated staff had been searching for resident 31 for about 20 minutes, when resident 31 was observed walking in the hall with therapy paperwork. LPN 1 stated resident 31 had vomited and had been incontinent of stool. Resident 4 informed the surveyor that on the evening of 4/8/24, there were five police officers in the facility. The resident stated she was uncertain why law enforcement was in the facility. On 4/9/24 an interview was conducted with resident 31. Resident 31 stated that she knew why police were at the facility last night but did not want to say anything. On 4/9/24 at approximately 11:00 AM, an interview was conducted with the Administrator. The Administrator stated that there was an allegation of abuse on 4/8/24, that she reported to the State Survey Agency (SSA). The Administrator provided the 358 report to surveyors. The 358 revealed on 4/8/24 at 9:40 PM, staff became aware that resident 31 stated that she wanted to have sex with a male staff member, but she did not have sex. A Physical Therapist was identified on the form as the alleged perpetrator. The steps taken immediately to ensure residents were protected revealed [Resident 31] was brought to her room by staff members. When resident stated that she wanted to have sex with a male staff member, the only male staff member on shift was placed on administrative leave pending investigation. RN [Registered Nurse] performed full body assessment and noted no injuries. BIMS [Brief Interview of Mental Status] was performed showing 14/15 cognitively intact. Physician notified, family notified. The incident was reported to law enforcement, APS, and Ombudsman. Resident 31's medical record was reviewed 4/8/24 through 4/11/24. On 8/18/23, a hospital History and Physical from the local hospital revealed resident 31 had a diagnosis of dementia. It was documented that resident 31 was oriented to person and place but not time, she knew it was August but thought it was the year 2080. Resident 31 was told the story from the St. Louis Mental Status testing, she was unable to recall any details. The assessment/plan for dementia revealed that resident 31 had significant dementia that had progressed. On 1/8/24, a state optional Minimum Data Set (MDS) assessment revealed resident 31 had a BIMS score of 15. The MDS further revealed resident 31 required supervision with bed mobility, transfers, and toilet use. A care plan dated 8/22/23 and revised on 9/4/23, revealed The resident has impaired cognitive function/dementia or impaired thought processes r/t [related to] Dementia and cognitive communication deficit. The goal was The resident will be able to communicate basic needs on a daily basis through the review date. Interventions included Communicate with the resident/family/caregivers regarding residents capabilities and needs and COMMUNICATION: Use the resident preferred name. Identify yourself at each interaction. Face the resident when speaking and make eye contact. Reduce any distractions- turn off TV, radio, close door etc. The resident understands consistent, simple, directive sentences. Provide the resident with necessary cues- stop and return if agitated. A care plan dated 9/4/23, revealed The resident has a communication problem and does not always understand others d/t [due to] dementia and cognitive communication deficit. The goal was The resident will be able to make basic needs known on a daily basis through the review date. Interventions included Anticipate and meet needs; Be conscious of resident position when in groups, activities, dining room to promote proper communication with others; and COMMUNICATION: Allow adequate time to respond, Repeat as necessary, Do not rush, Request clarification from the resident to ensure understanding, Face when speaking, make eye contact, Turn off TV/radio to reduce environmental noise, Ask yes/no questions if appropriate, Use simple, brief, consistent words/cues, Use alternative communication tools as needed. A progress note dated 3/26/24 at 4:02 PM, revealed Patient requires help with the following ADLs [activities of daily living]: dressing up to extensive assistance and showers up to extensive assistance. Patient has a diagnosis of dementia. At times patient can be very forgetful and need cueing and reminders. Patient has a history of falling and fell at home prior to coming to our facility r/t confusion and trying to do things on her own. Patient has a history of hallucinating and reports seeing dogs and cats doing various things around her. Patient takes medications to help with hallucinations and medications are managed by [local behavioral health company]. A progress note dated 4/8/24 at 9:40 PM, revealed Nursing staff found resident standing in the hallway with her walker. Resident was pale and nauseated. Full body assessment performed. No injuries noted. Resident was assisted to the bathroom and had a large BM [bowel movement]. She was assisted back to bed where she vomited x1 into her garbage can. MD [Medical Doctor], Administrator and family notified. A progress note dated 4/9/24 at 5:49 PM, revealed Admin [Administrator] had several interactions with resident this day. Resident joking and conversing with staff throughout shift. Resident denies any pain or emotional distress. Resident alert and oriented x 4 [person, place, time, and situation] with ability to recall facts and participate in conversations appropriately. On 4/9/24 at 3:25 PM, an observation was made of resident 31. Resident 31 was observed to be assisted by staff members into the facility van. On 4/9/24 at 3:46 PM, an interview was conducted with the DON. The DON stated resident 31 requested to go to the emergency room (ER). The DON stated she was unable to tell anyone why resident 31 was going to the ER. The DON stated it was still under investigation and she needed to talk to the Administrator prior to sharing information. On 4/9/24 at 4:17 PM, an interview was conducted with the Administrator. The Administrator stated that the facility was in the middle of an investigation with PTA [Physical Therapy Assistant] 1 and resident 31. The Administrator stated she talked to resident 31's family and the family wanted resident 31 evaluated at the emergency room. The Administrator stated resident 31's family stated to the Administrator that if anything happened between resident 31 and PTA 1 it would have been consensual from resident 31. The Administrator stated resident 31 had a history of dementia but her BIMS score on 4/8/24, was 14 out of 15. The Administrator stated she was not sure if resident 31 had a Montreal Cognitive Assessment test completed. The Administrator stated she was made aware of the situation at 9:42 PM on 4/8/24. The Administrator stated RN 1 informed her that facility staff found resident 31 in the hallway and that staff took resident 31 back to her room. The Administrator stated that RN 1 told her that resident 31 stated she wanted to have sex with someone but had not had sex with anyone. The Administrator stated she was not aware of any other statements made by resident 31. The Administrator stated there was no history of allegations against PTA 1. The Administrator stated she completed the exhibit 358 form to report to the allegation to the SSA. The Administrator stated she wrote that the alleged perpetrator was a Physical Therapist but it was actually a Physical Therapy Assistant. The Administrator stated PTA 1 worked four hours per day Monday through Friday, usually in the mid afternoon. The Administrator stated after talking to the Therapy Coordinator (TC), the TC reported she had a complaint last week that residents would rather do therapy earlier. The Administrator stated PTA 1 worked at another building first and then came to the facility later in the day. On 4/10/24 at 11:19 AM, a telephone interview was held with a facility medication aide certified, who was also Certified Nursing Assistant (CNA) 2. This staff member stated she had worked in the facility more than nine years and that she was very familiar with all the residents. CNA 2 stated on the evening of 4/8/24, she was completing the medication pass on the North end of the building when RN 1 approached her and stated she was unable to locate resident 31. CNA 2 stated six staff members began searching for resident 31, looking in all rooms, bathrooms, the family room, and shower rooms. CNA 2 stated a nursing student, precepting at the facility, searched outside the facility, as did CNA 1 and CNA 2. CNA 2 stated PTA 1's motorcycle was still parked at the facility. CNA 2 stated all staff then went to the two doors of the therapy room, which were locked and the lights in the room were off. CNA 2 stated the therapy room were usually unlocked and open. CNA 2 stated a light in an office within the therapy room was on, but the door was closed to the office area. CNA 2 stated she first observed resident 31 as she came back in through the south door and walked toward the east hallway. CNA 2 stated resident 31 looked sick, clammy, and like she was going to pass out. CNA 2 stated resident 31 told staff she did not want to talk about it. CNA 2 stated that she and CNA 1 stayed with resident 31 in her room, as they had established a rapport with her. CNA 2 stated resident 31 said she was sick to her stomach and she had spit up mucus two times in the trash. CNA 2 stated resident 31 said she had a crush on someone but did not want to say who because she did not want him to lose his job. CNA 2 stated she and CNA 1 asked resident 31 what had happened and resident 31 replied that they, resident 31 and the male staff member, wanted to try something. CNA 2 stated she asked resident 31 if her clothes were off, to which CNA 2 stated the resident replied they were off, for the most part. CNA 2 stated she asked resident 31 if the male staff member's clothes were off. CNA 2 stated resident 31 responded, yes. CNA 2 stated resident 31 told CNA 2 and CNA 1 that resident 31 and the male staff member were trying to have sex and it did not work. CNA 2 stated she asked resident 31 what she meant. CNA 2 stated resident 31 replied that it was like her crotch was sewn shut because it had been 25 years since she did something and pointed to her pelvic area. CNA 2 stated resident 31 further replied that they could not get it in. CNA 2 stated RN 1 was outside the room with a medication cart and CNA 2 told RN 1 to call the cops. CNA 2 stated resident 31 told her this was not the first time it had happened, but that resident 31 did not say when it had happened before. On 4/9/24 at 6:58 PM, a telephone interview was conducted with CNA 1. CNA 1 stated she worked in the facility since 2017 and was familiar with all the residents. CNA 1 stated she started a shift at 6:00 PM on 4/8/24, and should have been off at 10:00 PM. CNA 1 stated she left the facility between 12:00 AM and 12:30 AM on 4/9/24. CNA 1 stated on the evening of 4/8/24, she was working on the South end of the building and there were three other CNA's on duty. CNA 1 stated there was a nursing student who asked if she knew where resident 31 was. CNA 1 stated she had seen resident 31 about 30 minutes before which was about 8:30 PM, because she rubbed lotion on the resident's feet. CNA 1 stated it was common for resident 31 to walk around the facility with a walker in the evening. CNA 1 stated that the Student Nurse stated she must have missed her in the hallway. CNA 1 stated that the Student Nurse made another lap around the facility and stated to CNA 1 she could not find her. CNA 1 stated resident 31 had moved rooms a few times and had dementia, so she thought maybe resident 31 was in an old room or bathroom. CNA 1 stated she began looking through her previous rooms and bathrooms. CNA 1 stated the search expanded to every room and bathroom. CNA 1 stated the only area staff were unable to get into was the therapy gym. CNA 1 stated she looked into the therapy gym through the window on the door and it was dark. CNA 1 stated she thought resident 31 was in there, so she banged on the door and no one opened the door and did not see anyone in the gym. CNA 1 stated staff looked downstairs, even though that area had been locked. CNA 1 stated she had come upstairs and by the East entrance and turned the corner to the East hallway and saw resident 31 in the hallway. CNA 1 stated she went up to resident 31 and stood in front of her walker and asked where she was and what happened. CNA 1 stated resident 31 appeared white in color and was disoriented. CNA 1 stated resident 31 stated she did not want to talk to her. CNA 1 stated resident 31 pushed by her and sat down on her bed. CNA 1 stated resident 31 stated she was getting sick and then observed resident 31 vomit. CNA 1 stated resident 31 looked at the staff members in her room, because everyone was there at that time. CNA 1 stated she asked for everyone to step out of the room except for CNA 2. CNA 1 stated she and CNA 2 remained with resident 31 to discuss what had occurred. CNA 1 stated resident 31 told them she had a crush on someone but stated she did not want that person to be fired. CNA 1 stated resident 31 explained that she and a male staff member tried to have sex but he could not get it in. CNA 1 stated resident 31 pointed toward her private area. CNA 1 stated CNA 2 asked resident 31 if her clothing was off, to which resident 31 replied yes. CNA 1 stated CNA 2 asked resident 31 if the male staff member's clothing was off, to which resident 31 replied yes. CNA 1 stated resident 31 explained the male staff member was very gentle with her. CNA 1 stated resident 31 explained she and the male staff member had tried before and could not get it in before either. CNA 1 stated that resident 31 told her it was consensual. CNA 1 stated resident 31 did not have cognition to understand what had happened. CNA 1 stated PTA 1 was at the facility after 8:00 PM, at night sometimes and he started being there later within the last few weeks. CNA 1 stated other staff members were concerned about him being at the facility later. CNA 1 stated she did not know exact times PTA 1 was at the facility because they were usually really busy working with residents. On 4/9/24 at 5:20 PM, a telephone interview was conducted with the Student Nurse (SN). The SN stated on 4/8/24 shortly after 9:00 PM, she was unable to locate resident 31 and asked other facility staff to assist in finding her. The SN stated there were alarms on the exit doors but staff looked outside anyway's thinking maybe the alarms had glitched. The SN stated staff checked all the resident rooms, empty rooms, and the bathrooms in the resident rooms. The SN stated resident 31 was not known to be a flight risk or go outside. The SN stated the lights were off in the therapy room. The SN stated there were windows on the doors to the therapy room. The SN stated that she was not familiar with the vehicles of the staff but a staff member mentioned that PTA 1's motorcycle was in the parking lot. The SN stated staff went back to the therapy room and she noticed the light in the therapy office was on. The SN stated staff had knocked and yelled resident 31's name thinking resident 31 was in the office or therapy room and had fallen. The SN stated there were codes to the basement but staff looked in the basement for resident 31. The SN stated staff had gone to the basement and she remained on the main floor looking for resident 31. The SN stated she was near resident room [ROOM NUMBER] and started walking toward the South side of the facility when she observed resident 31 come out of the therapy room through the East door. The SN stated she yelled resident 31's name and resident 31 turned her head and started walking towards the SN. The SN stated she knocked on the basement door and yelled that she found resident 31. The SN stated that resident 31 looked pale, confused, and altered. The SN stated resident 31 was usually bubbly and smiley and resident 31 had a look on her face like she did not know what was going on, like a deer in the headlights. The SN stated that resident 31 did not look like her usual self. The SN stated it was approximately 20 minutes that staff had been looking for resident 31. The SN stated they started looking for resident 31 at approximately 9:10 PM. The SN stated that she asked resident 31 where she was and resident 31 stated I am okay why do you want to know. The SN stated that she told resident 31 that everyone had been looking for her but resident 31 did not want to answer the questions. The SN stated that resident 31 looked overwhelmed, pale, and asked to sit down. The SN stated that resident 31 started to vomit when they got her to sit down. The SN stated that resident 31 was comfortable with CNA 1 and CNA 2. The SN stated that the CNA's stayed in the room with resident 31 and asked resident 31 where she was. The SN stated that CNA 1 came out of resident 31's room crying and stated that resident 31 told her everything and they needed to call the police. The SN stated we called the police and ran to the therapy gym to see if PTA 1 was still in the room. The SN stated that PTA 1 came out of the therapy room and was trying to leave. The SN stated that PTA 1 went back into the therapy gym and slammed the door. The SN stated the staff stood by the therapy doors so PTA 1 could not leave the facility. The SN stated when the police arrived at the facility PTA 1 left the therapy room with his motorcycle gear on. The SN stated the police put PTA 1 in handcuffs. The SN stated when the staff were confronting PTA 1, resident 31 came out of her room and defecated on herself in the hallway. On 4/9/24 at 3:00 PM, a telephone interview was conducted with RN 1. RN 1 stated on 4/8/24 at about 9:00 PM, she was looking for resident 31 to Administer her medications. RN 1 stated resident 31 had asked for pain medication about five minutes before that. RN 1 stated resident 31 was not in her room or bathroom. RN 1 stated resident 31's roommate said she went out in the hallway. RN 1 stated she had the SN with her and asked her to look for resident 31. RN 1 stated the SN was unable to locate resident 31 after about five to 10 minutes. RN 1 stated the SN had looked in hallways and rooms near resident 31's room. RN 1 stated she asked the CNA's to help them look for resident 31. RN 1 stated the staff looked in all of the resident rooms, even the empty ones, and all the bathrooms. RN 1 stated the staff looked in any room they could get into and then looked outside. RN 1 stated staff looked in the basement. RN 1 stated it was not like resident 31 to be gone that long. RN 1 stated resident 31 had dementia but had not tried to elope or leave the facility. RN 1 stated after not being able to find her, there were a couple rooms that were locked like the activity room, the social services room, and the therapy gym. RN 1 stated staff looking outside and noticed PTA 1's motorcycle was there. RN 1 stated that PTA 1 was usually at the facility from 6:00 PM to 8:30 or 9:00 PM. RN 1 stated the therapy gym was usually not locked and the office light would be on. RN 1 stated after about 30 minutes staff found resident 31 in the hallway by the therapy gym that was next to the family room. RN 1 stated resident 31 had therapy handouts in her hand. RN 1 stated resident 31 looked really pale and she said she had been in the family room. RN 1 stated resident 31 said she needed to sit down. RN 1 stated resident 31 sat down on the bed and threw-up. RN 1 stated at that point, resident 31 appeared overwhelmed with everyone. RN 1 stated CNA 1 and CNA 2 stayed with resident 31. RN 1 stated that resident 31 had a large bowel movement and her periarea was assessed and there were no concerns or redness. RN 1 stated CNA 1 and CNA 2 talked with resident 31 and exited resident 31's room and was told to call the police at about 9:30 PM. RN 1 stated resident 31 did not provide any information to her directly. RN 1 stated staff were banging on the therapy gym doors and there was no answer. RN 1 stated she contacted resident 31's family members, the physician, and the administrator. RN 1 stated resident 31 was not physically injured and was not in any pain. RN 1 stated resident 31 was not in distress but had a deer in the headlights look. RN 1 stated that the SN was the first person to find resident 31. RN 1 stated that the SN told her resident 31 came out of the therapy gym. RN 1 stated she was not sure if a sexual assault exam was completed. RN 1 stated she did not remember seeing PTA 1 with resident 31 in the past and did not know if she was receiving therapy services. RN 1 stated she saw PTA 1 working with resident 28 and resident 36. RN 1 stated PTA 1 was usually at the facility between 6:00 PM to 6:30 PM until 9:00 PM. RN 1 stated the therapy gym was never locked. RN 1 stated the Maintenance Director had a key to the therapy gym. RN 1 stated the light in the therapy office was visible around the door frame through the windows in the therapy gym door. RN 1 stated the lights were turned off when she looked in there. RN 1 stated she was not sure where therapy paperwork was stored. RN 1 stated she had not seen therapy paperwork before. RN 1 stated she completed a full body assessment on resident 31. RN 1 stated when she performed the assessment resident 31 stated he never forced himself on her. RN 1 stated the Administrator directed her to not be specific with her charting and to keep it very clinical in resident 31's nursing progress notes. RN 1 stated she was able to document that resident 31 was pale, had a large bowel movement, and threw-up once. RN 1 stated she was able to document there was no trauma. RN 1 stated she was able to document details in the incident report. On 4/10/24 at 8:30 AM, an interview was conducted with the TC. The TC stated PTA 1 had been suspended as of 4/8/24. The TC stated PTA 1 clocked in and out on the computer. The TC stated she had talked to PTA 1 about how he was coming in too late in the evenings on 3/15/24. The TC stated residents were refusing therapy because it was so late. The TC stated PTA 1 was coming in late about 3:10 PM, and left between 6:00 PM and 8:00 PM. The TC stated she reminded PTA 1 that they want him to leave before 7:00 PM. The TC stated she thought he was having long days at another facility but after talking to the director of the other facility, that was not the case. The TC stated she left the therapy room doors open and unlocked with the light out. The TC stated she came in the morning a few times and one of the doors was locked to the therapy room. On 4/10/24 at 9:56 AM, a follow-up interview was conducted with the TC. The TC stated she did not know why PTA 1 would clock out at 6:45 PM, and still be at the facility after 9:00 PM. The TC stated she was not aware PTA 1 had stayed later than he had when clocked out. On 04/10/24 at 12:39 PM, an interview was conducted with the TC. The TC stated she left the facility between 2:00 PM and 4:00 PM, and PTA 1 was usually not at the facility when she left. The TC stated the staff completed point of care documentation. The TC stated that documentation should be completed as therapy was provided to the resident. The TC stated when PTA 1 signed out then he should be done with his day. The TC stated if PTA 1 was not done with his day then he should stay on the clock and the time would go toward patient care. On 4/10/24 at 4:16 PM, a follow-up interview was conducted with the TC. The TC stated she was unable to find therapy notes from PTA 1 for treatments that should have been provided on 4/8/24, for four additional residents. The TC stated she was only able to locate therapy notes for resident 6. On 4/11/24 at 8:08 AM, an interview was conducted with the TC. The TC stated PTA