Haven of Safford

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from the wrongful use of the resident's belongings or money.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

Pharmacy Service Deficiencies

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

Resident Rights Deficiencies

Keep residents' personal and medical records private and confidential.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

Pharmacy Service Deficiencies

Ensure each resident’s drug regimen must be free from unnecessary drugs.

Environmental Deficiencies

Make sure that a working call system is available in each resident's bathroom and bathing area.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Violation cited

Violation cited

Violation cited

Violation cited

Based on clinical record reviews, staff and resident interviews, facility documentation and policy and procedures, the facility failed to follow their abuse policy for one resident. (#128). Findings include: -Resident #128 was admitted at the facility on December 4, 2023 with diagnoses that included dementia, chronic obstructive pulmonary disease, and depression. Review of the quarterly Minimum Data Set (MDS) assessment dated on June 11, 2024 revealed the resident had a BIMS score of 4.0, which indicated severe cognitive impairment. Review of care plan initially dated on February 26, 2024 and revised on August 1, 2024 revealed that resident #128 use antidepressant medication. The interventions included to monitor/document/report to provider as needed ongoing signs and symptoms of depression which included fear of being alone with others, attention seeking, concern with body functions, anxiety, and constant reassurance. -Resident #66 (alleged perpetrator) was admitted at the facility on March 28, 2024 with diagnoses that included unspecified dementia, type 2 diabetes mellitus, and depression. Review of the admission Minimum Data Set (MDS) assessment dated April 3, 2024 revealed the resident had a Brief Interview for Mental Status (BIMS) score of 6, which indicated severe cognitive impairment. The MDS also included that the resident mood includes feeling down, depressed, or hopeless, rarely feel lonely or isolated, and has verbal behavioral symptoms directed towards others. For every day activities, no impairment on the upper and lower extremities, uses a walker and wheelchair. Review of care plan initially dated on April 10, 2024 and revised on July 8, 2024 revealed that resident #66 has a verbal behavior problem, inappropriate sexual behaviors towards staff and residents, and exhibits personal sexual needs in his room. The interventions included anticipate and meet resident's needs, encourage as much participation/interaction as possible during care activities, identify behavior triggers, and refer to psychiatric provider for consultation as ordered. A behavior progress note dated on July 7, 2024 revealed a resident identified as resident #128 yelling "quit touching me get your hands off of me". A staff saw resident #66 reaching for resident #128 and resident #66 was looking like he was going to expose himself to resident #128. Furthermore, the progress note revealed that resident #66 "is constantly going after our women here and scaring them". Furthermore, the progress note stated "spends too much of my time keeping him from sexually harassing them by touching and groping their breasts against their wills. I just saw him going down the hall with his penis hanging out and then realized that he had it hanging out and touching his penis with one hand and trying to grope a Resident with his other hand". A health status note dated July 7, 2024 revealed the administrator was notified of resident #66's behavior. A behavior progress note dated July 8, 2

Based on clinical record reviews, staff and resident interviews, facility documentation and policy and procedures, the facility failed to ensure an incident of abuse was reported to the state agency. Findings include: -Resident #128 was admitted at the facility on December 4, 2023 with diagnoses that included dementia, chronic obstructive pulmonary disease, and depression. Review of the quarterly Minimum Data Set (MDS) assessment dated on June 11, 2024 revealed the resident had a BIMS score of 4.0, which indicated severe cognitive impairment. Review of care plan initially dated on February 26, 2024 and revised on August 1, 2024 revealed that resident #128 use antidepressant medication. The interventions included to monitor/document/report to provider as needed ongoing signs and symptoms of depression which included fear of being alone with others, attention seeking, concern with body functions, anxiety, and constant reassurance. -Resident #66 (alleged perpetrator) was admitted at the facility on March 28, 2024 with diagnoses that included unspecified dementia, type 2 diabetes mellitus, and depression. Review of the admission Minimum Data Set (MDS) assessment dated April 3, 2024 revealed the resident had a Brief Interview for Mental Status (BIMS) score of 6, which indicated severe cognitive impairment. The MDS also included that the resident mood includes feeling down, depressed, or hopeless, rarely feel lonely or isolated, and has verbal behavioral symptoms directed towards others. For every day activities, no impairment on the upper and lower extremities, uses a walker and wheelchair. Review of care plan initially dated on April 10, 2024 and revised on July 8, 2024 revealed that resident #66 has a verbal behavior problem, inappropriate sexual behaviors towards staff and residents, and exhibits personal sexual needs in his room. The interventions included anticipate and meet resident's needs, encourage as much participation/interaction as possible during care activities, identify behavior triggers, and refer to psychiatric provider for consultation as ordered. A behavior progress note dated on July 7, 2024 revealed a resident identified as resident #128 yelling "quit touching me get your hands off of me". A staff saw resident #66 reaching for resident #128 and resident #66 was looking like he was going to expose himself to resident #128. Furthermore, the progress note revealed that resident #66 "is constantly going after our women here and scaring them". Furthermore, the progress note stated "spends too much of my time keeping him from sexually harassing them by touching and groping their breasts against their wills. I just saw him going down the hall with his penis hanging out and then realized that he had it hanging out and touching his penis with one hand and trying to grope a Resident with his other hand". A health status note dated July 7, 2024 revealed the administrator was notified of resident #66's behavior. A behavior progress note dated

Based on clinical record reviews, staff and resident interviews, facility documentation and policy and procedures, the facility failed to investigate an allegation of abuse. This deficient practice could result in further incidents of resident abuse. Findings include: -Resident #128 was admitted at the facility on December 4, 2023 with diagnoses that included dementia, chronic obstructive pulmonary disease, and depression. Review of the quarterly Minimum Data Set (MDS) assessment dated on June 11, 2024 revealed the resident had a BIMS score of 4.0, which indicated severe cognitive impairment. Review of care plan initially dated on February 26, 2024 and revised on August 1, 2024 revealed that resident #128 use antidepressant medication. The interventions included to monitor/document/report to provider as needed ongoing signs and symptoms of depression which included fear of being alone with others, attention seeking, concern with body functions, anxiety, and constant reassurance. -Resident #66 (alleged perpetrator) was admitted at the facility on March 28, 2024 with diagnoses that included unspecified dementia, type 2 diabetes mellitus, and depression. Review of the admission Minimum Data Set (MDS) assessment dated April 3, 2024 revealed the resident had a Brief Interview for Mental Status (BIMS) score of 6, which indicated severe cognitive impairment. The MDS also included that the resident mood includes feeling down, depressed, or hopeless, rarely feel lonely or isolated, and has verbal behavioral symptoms directed towards others. For every day activities, no impairment on the upper and lower extremities, uses a walker and wheelchair. Review of care plan initially dated on April 10, 2024 and revised on July 8, 2024 revealed that resident #66 has a verbal behavior problem, inappropriate sexual behaviors towards staff and residents, and exhibits personal sexual needs in his room. The interventions included anticipate and meet resident's needs, encourage as much participation/interaction as possible during care activities, identify behavior triggers, and refer to psychiatric provider for consultation as ordered. A behavior progress note dated on July 7, 2024 revealed a resident identified as resident #128 yelling "quit touching me get your hands off of me". A staff saw resident #66 reaching for resident #128 and resident #66 was looking like he was going to expose himself to resident #128. Furthermore, the progress note revealed that resident #66 "is constantly going after our women here and scaring them". Furthermore, the progress note stated "spends too much of my time keeping him from sexually harassing them by touching and groping their breasts against their wills. I just saw him going down the hall with his penis hanging out and then realized that he had it hanging out and touching his penis with one hand and trying to grope a Resident with his other hand". A health status note dated July 7, 2024 revealed the administrator was notified of resi

Based on observations, clinical record reviews, interviews, and facility documents and policy, the facility failed to ensure one resident (#54), had call light accessibility. The deficient practice could result in residents not having the means to communicate with staff leading to negative outcomes. Findings include: -Resident #54 was admitted to the facility on July 23, 2023, with diagnoses that included left sided paralysis, stroke, Type-2 Diabetes, repeated falls, and depression. The quarterly Minimum Data Set (MDS) dated September 8, 2024 included a Brief Interview for Mental Status (BIMS) score of 10, which indicated the resident had moderate cognitive impairment. The MDS also revealed that the resident experienced social isolation on rare occasion and is prescribed an antidepressant for mood support. A falls care plan initiated November 25, 2022 revealed resident #54 was at risk for falls related to deconditioning, with a noted intervention to assure the bed is against the wall, and the call light is within reach to ensure prompt response to all requests for assistance as needed. On November 6, 2024 at 12:10 p.m. the resident was observed in room sitting alone by bedside in a wheelchair. Upon closer inspection of resident, eyes appeared wet with tears, and resident was visibly shaking. The call light plug was securely inserted into the call light face plate. The call light cord extended straight down the wall, and was sandwiched between the mattress and the wall. The hand control for the call light system was not visible. On November 7, 2024 at 11:38 a.m. this surveyor returned to the resident's room and observed the call light system cord similar to the day prior, which extended down and was sandwiched between the wall and mattress. The call light hand control was not visible. This surveyor left the room with the resident who stated they were on the way to socialize in the hallway. This surveyor returned with a Unit Manager (admin/Staff #26) at 11:42 a.m. This surveyor observed staff #26 go to the head of the bed and follow the call light cord. staff #26 was able to use the cord and pull the call light from between the side of the wall and mattress. The Unit Manager then proceeded to affix the call light to the resident bedside to ensure control was reachable upon the resident return to room. An interview conducted on November 5, 2024 at 3:40 p.m. during initial pool screening with Resident #54. Resident #54 stated she does not have a call light, and needs one because she has already fallen out of bed "three times already". She stated she wants the staff to keep her door open so when she falls, she can scream for help when in trouble. An interview conducted on November 7, 2024 at 11:38 a.m., with Resident #54 revealed she still never got a call light button. When surveyor pointed to the call light face plate and cord on the wall, the resident stated "I can't get way over there to get that!". an interview was conducted with a unit manager (

Based on clinical record review, staff and family interviews, and facility documents and policy, the facility failed to ensure a resident's privacy was maintained during medication administration for one resident (resident # 23). Findings include: Resident #23 was initially admitted on June 6, 2027 and re-admitted on March 27, 2023 with diagnosis including Non-St Elevation (Nstemi) Myocardial Infarction, Chronic Obstructive Pulmonary Disease, Muscle Weakness, Atherosclerotic Heart Disease, and Gastrointestinal Hemorrhage. A review of the quarterly Minimum Data Set (MDS) assessment dated August 30, 2024 revealed a Brief Interview of Mental Status (BIMS) score of 12, indicating mild cognitive impairement. An interview was conducted on November 6, 2024 at 8:30 a.m. with a Registered Nurse and Unit Manager, (RN/Staff #26), where Staff #26 explained their expectations with respecting a resident's absolute privacy, that during patient care, doors should be closed, curtains should be drawn, that staff is expected to ask residents for their preferences, ensure resident's know their right to say no. Staff #26 also stated that staff has a learning management system that provides courses on Health Insurance Portability and Accountability Act (HIPAA) and resident rights. Staff #26 stated that the facility's expectations and professional standards apply to all staff when providing patient care. Staff #26 also stated that the expectation during medication administration is to ensure that any resident information is not viewable when staff is away from the medication cart, that the medication cart is locked when unattendance, that they introduce themselves to the resident and ensure the resident confirms their information, and that the resident is not being forced to take medications that they do not want to. However, during the interview with Staff #26 as stated above, an observation was made where Staff #26 provided a visual completion on how a nurse during medication administration is able to lock and unlock a resident's chart on their mobile devices. On November 6, 2024 at 10:12 a.m, a med cart located on the Long-Term Care (LTC) unit was observed unattended, and on the top of the medication cart, a device displayed Resident #23's name, date of birth, photo and the medications. A face bubble packet was also observed next to this device. An interview was conducted on November 6, 2024 at 10:12 a.m. with a Licensed Practical Nurse (LPN/Staff #88), where Staff #88 stated that the bubble packet does not have any medications in them and that they were left onto of the medication cart to remind her to re-order the medication. Staff #88 also stated that leaving the medication cart unattended with resident information being displayed and out in the open is not the facility's expectation and professional standards. Staff #88 acknowledged that she did leave Resident #23's information out in the open. An interview was conducted on November 6, 2024 at 2:43 p.m. with Dir

Based on clinical record reviews, staff and resident interviews, facility documentation and policy and procedures, the facility failed to ensure that one resident (#128) was free from abuse from another resident (#66). Findings include: -Resident #128 was admitted at the facility on December 4, 2023 with diagnoses that included dementia, chronic obstructive pulmonary disease, and depression. Review of the quarterly Minimum Data Set (MDS) assessment dated on June 11, 2024 revealed the resident had a BIMS score of 4, which indicated severe cognitive impairment. Review of care plan initially dated on February 26, 2024 and revised on August 1, 2024 revealed that resident #128 use antidepressant medication. The interventions included to monitor/document/report to provider as needed ongoing signs and symptoms of depression which included fear of being alone with others, attention seeking, concern with body functions, anxiety, and constant reassurance. -Resident #66 (alleged perpetrator) was admitted at the facility on March 28, 2024 with diagnoses that included unspecified dementia, type 2 diabetes mellitus, and depression. Review of the admission Minimum Data Set (MDS) assessment dated April 3, 2024 revealed the resident had a Brief Interview for Mental Status (BIMS) score of 6.0, which indicated severe cognitive impairment. The MDS also included that the resident mood includes feeling down, depressed, or hopeless, rarely feel lonely or isolated, and has verbal behavioral symptoms directed towards others. For every day activities, no impairment on the upper and lower extremities, uses a walker and wheelchair. Review of care plan initially dated on April 10, 2024 and revised on July 8, 2024 revealed that resident #66 has a verbal behavior problem, inappropriate sexual behaviors towards staff and residents, and exhibits personal sexual needs in his room. The interventions included anticipate and meet resident's needs, encourage as much participation/interaction as possible during care activities, identify behavior triggers, and refer to psychiatric provider for consultation as ordered. A a progress note for resident #128 dated on July 7, 2024 revealed resident #128 was yelling "Quit touching me! get your hands off of me!", and further revealed the writer quickly turned around and saw resident #66 reaching for resident #128 and he also was looking like he was going to expose himself to her. The note continued that resident #128 thanked the writer several times for stepping in and ordered resident #66 to get away from resident #128. The note concluded that resident #66 is "constantly going after our women here and scaring them" A behavior progress note for resident #66 dated on July 7, 2024 revealed a resident identified as resident #128 yelling "quit touching me get your hands off of me". A staff saw resident #66 reaching for resident #128 and resident #66 was looking like he was going to expose himself to resident #128. Furthermore, the progress note re

Based on clinical record review, staff interviews, and facility policy, the facility failed to ensure that necessary pain medications were given according to provider instruction for one resident (resident's #18) This deficient practice could result in ineffective medication management resulting in negative outcomes. findings include: -Resident #18 was admitted on September 20, 2024, with diagnoses that included surgical aftercare, surgery on the circulatory system, end stage renal disease, and sepsis. A physician's order dated October 3, 2024, revealed an order for Tramadol 50mg (milligrams) by mouth every 12 hours as needed for a pain scale of 6-10. An admission Minimum Data Set (MDS) assessment dated October 9, 2024, revealed the resident had a BIMS (Brief Interview for Mental Status) score of 15, which indicated the resident had no cognitive impairment. A care plan intervention with the initiated date of October 16, 2024, revealed that Resident #18 is at risk for pain and utilizes opioid medications per physician orders. Review of the Medication Administration Record (MAR) dated November 2024, revealed on November 3, 2024, Resident #18 was administered one tablet of Tramadol 50mg for a pain level of '4' at 3:50 a.m, and for a pain level of '4' at 7:06 p.m. An interview was conducted September 13, 2024 at 10:30 a.m. with a Registered Nurse (RN/Staff #55) to review Resident #18's physician orders and MAR. Staff #55 stated that the order of the Tramadol 50mg was given out of parameters on November 3, at 3:50 a.m. and 7:06 p.m. Staff #55 also stated that administering medications out of order parameters is not in professional standards as Resident #55 could have been offered an alternative medication or non-medicated intervention for the pain level of 4, rather than the Tramadol 50mg. An interview was conducted on November 6, 2024 at 2:43 p.m. with Director of Nursing (DON/Staff #48), where Staff #48 stated that the facility's expectation is medications are to be administered per physician orders, and that providing medication that is not within order parameters is not professional standards and does not properly treat the resident. The policy "Administering Medications" revealed that the administration of medications must be administered in accordance with the resident's order.

Based on observations, the facility failed to display a current hydraulic plate on the sprinkler riser. Failure to ensure that the sprinkler riser hydraulic plate was in place could result in errors during modifications and failure of the sprinkler system. NFPA 25 2011 Standard for the inspection, testing, and maintenance of water-based fire protection systems. 5.2.6* Hydraulic Design Information Sign. The hydraulic design information sign for hydraulically designed systems shall be inspected quarterly to verify that it is attached securely to the sprinkler riser and is legible. .5.2.6 The hydraulic design information sign should be secured to the riser with durable wire, chain, or equivalent. (See Figure .5.2.6.) Paragraph 5.2.6 requires that the hydraulic design information sign (also called a nameplate or placard) be inspected on a quarterly basis. NFPA 13 requires a hydraulic design information sign on hydraulically designed systems so that the design criteria and system demand can be readily determined. The hydraulic design information sign can provide useful information to the owner. If the design information sign is missing, the owner should contact a design professional to determine the demand for the system, which can be written on a new design information sign. The details are also documented on the approved plans and hydraulic calculations, but these plans can be misplaced and may not be available when the property changes owners. A hydraulic design information sign that is securely fastened to the riser can provide the details when these other data are missing (see Exhibit 5.21). If the sign becomes loose or is difficult to read, it must be repaired or replaced. Findings include: Observations made while touring the facility on November 13, 2024, revealed the sprinkler riser was missing the required hydraulic plate. The quarterly inspections did not identify the missing plate. During the exit conference on November 13, 2024, the management team confirmed that the sprinkler riser hydraulic plate was missing.

Based on observation the facility failed to maintain several doors in the building. Failing to maintain doors in the facility could allow heat and/or smoke to transfer which will cause harm to the patients and/or staff. NFPA 101, Life Safety Code, 2012 edition, Chapter 19, Section 19.3.6.3.5. "Doors shall be provided with a means for keeping the door closed that is acceptable to the authority having jurisdiction." Findings include: Observations made while on tour on November 13, 2024, revealed the following; 1) Room 219 not latching 2) The room across from the Activities Storage has a \'bc inch gap at the upper handle side, and 7/8 inch at the bottom 3) Room designated as the new employee break room had excessive gap across the top of the door During the exit conference conducted on November 13, 2024, the above findings were again acknowledged by the management team.

Based on clinical record reviews, facility documentation, resident and staff interviews, and policy review, the facility failed to ensure that two residents (#15) and (#50) were free from physical abuse resulting in injury by other residents (resident #50, and resident #75). Findings include: Regarding resident #15 and resident #50 -Resident #15 was admitted to the facility on August 27, 2023 with diagnoses that include Hemiplegia, sepsis, urinary tract infections, dysphagia, and hypertension. Review of the Quarterly Minimum Data Set (MDS) assessment September 8, 2024 revealed a Brief Interview for Mental Status (BIMS) score of 10 which indicated the resident had moderate cognitive impairment. A behavioral care plan revised December 6, 2023 revealed the resident was at risk of impaired cognitive function related to dementia with a noted intervention of keeping the resident's routine consistent and try to provide consistent care givers as much as possible in order to decrease confusion. -Resident #50 was admitted to the facility on November 22, 2019 with diagnoses that include Bipolar disorder, dysphagia, hypertension, depression, and post traumatic stress disorder. Review of the Admission Minimum Data Set (MDS) assessment dated September 18, 2024, revealed a Brief Interview for Mental Status (BIMS) score of 10 which indicated the resident had moderate cognitive impairment. A behavioral care-plan initiated August 31, 2021 revealed the resident has the potential to demonstrate abusive behaviors related to dementia, mental illness, and poor impulse control, with noted interventions for staff to intervene before agitation escalates, and guide away from source of distress. A review of the clinical record progress notes for resident #15 dated October 5, 2024 at 3:53 a.m. revealed the resident was being monitored for a recent one on one incident with another resident, and that the resident #15 was hit in the head with a hairbrush. However, no progress notes detailing the incident in question were noted in resident #15's clinical record. An interview was conducted with resident #15 on October 21, 2024 at 12:55 p.m. The resident stated that resident #50 hit her on her face and pointed to her head. The resident stated there was a little bit of blood after, and that she didn't know what to do. The resident further stated resident #50 had a big bulky brush, an old one, and that was the brush that was used. An interview was conducted with a Certified Nursing Assistant (CNA/staff #5) on October 21, 2024 at 1:01 p.m. The CNA reported that resident #50 has lots of behaviors, and is not really a people person. The CNA stated that resident #50 can be mean to other residents at times and is very bossy. The CNA also stated resident #50 has been physical in the past. The CNA also confirmed the incident happened. An interview with a Registered Nurse (RN/staff #22) was conducted on October 21, 2024 at 1:16 p.m. The RN stated that resident #50 is needy, and doesn't real

Based on clinical record reviews, facility documentation, resident and staff interviews, and policy review, the facility failed to ensure that two residents (#30) and (#60) were free from physical abuse resulting in injury by other residents (resident #90). The deficient practice could result in further incidents of resident to resident abuse. Findings include: Regarding resident #90 and resident #30 -Resident #30 was admitted to the facility on November 4, 2022, with diagnoses that include Gout, Alcohol dependence, chronic obstructive pulmonary disorder, and hypertension. A behavioral care plan revised December 6, 2023 revealed the resident was at risk of impaired cognitive function replaced to dementia with a noted intervention of keep resident's routine consistent to provide consistent caregivers in order to reduce confusion. Review of the Quarterly Minimum Data Set (MDS) assessment dated May 13, 2024 revealed a Brief Interview for Mental Status (BIMS) score of 03 which indicated the resident had significant cognitive impairment. -Resident #90 was admitted to the facility on May 4, 2024, with diagnoses that include Dementia, pneumonia, sepsis, alcohol abuse, transient ischemic attack, and hypertension. A behavioral care plan dated April 8, 2024 revealed the resident was at risk of wandering, sleeping in other resident's rooms, and physical behaviors towards staff and other residents. The goal was the resident will demonstrate effective coping, with noted interventions of allowing the resident to make decisions about his care, give clear explanations to the resident of all care activities, and administer medications as ordered. However, there was no noted interventions to address the wandering behavior, or the physically aggressive behaviors towards staff and residents. Review of the Admission Minimum Data Set (MDS) assessment dated August 10, 2024, revealed a Brief Interview for Mental Status (BIMS) score of 09 which indicated the resident had moderate cognitive impairment. A review of the clinical record progress notes for resident #90 dated July 30, 2024 at 11:49 a.m. revealed "the resident getting into residents and staffs face several times and yelling, and clenching his fists regarding his keys, when trying to redirect and distract became undoable." A second progress note dated August 4, 2024 at 8:05 a.m. revealed that resident #90 was wandering the halls, with multiple attempts to redirect the resident to dining room or resident's room due to angry outbursts. A third progress note dated August 4, 2024 at 12:40 p.m. revealed that the resident #90 had multiple angry outbursts this shift over many different events. Resident needing to be constantly redirected away from other residents as resident gets mad and upset very easily. An incident progress note dated August 7, 2024 at 9:17 a.m. revealed resident #90 had multiple angry outbursts this AM shift. Resident #30 had accidently bumped resident #90's knee with a wheelchair. Resident #90 ver