Lena Living Center

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

in my mind as to what [V5] was doing (when she grabbed Resident R1's nose). She was trying to get him to be quiet through twisting and pulling his nose. When she did that he squealed. V4 said after the physical abuse she separated Resident R1 from V5, reported the incident, and then V5 was escorted from the building. On 11/18/25 at 10:21 AM, V5 CNA stated Resident R1 .cussed me out V5 stated she is used to racial slurs, and it does not affect her ability to provide care. V5 denied the incident and stated the facility is lying. On 11/18/25 at 11:52 PM, V10 CNA Supervisor stated, I've never had a problem (with V4). She is respectful and quiet. She has never made an allegation against another staff member that I know of. V10 said V5 has very poor customer service. V10 said her demeanor and speech came off as lacking compassion; she would talk to them (residents) like children.I did hear her tell a resident that they should not be using their call light constantly because she had things to do. I pulled her aside and told her that we need to encourage the residents to use the call lights for safety and she cannot say that to the residents.She said she felt like she was going to get fired and she was fired from her previous job. She actually told me that. V10 stated V5 told her at her previous facility herself and other CNAs would turn off the call light system when residents would continue to use the call light. V10 said that 11/8/25 was V5's first day off training. V10 said it is known by the staff that Resident R1 does not like to be repositioned and he moans during care. V10 said V4 reported to her that V5 had told Resident R1 to shut the h*ll up and that V5 pinched and pulled his nose. V10 said Resident R1 and V5 were separated then V5 was escorted from the building. V10 said Resident R1 was upset and riled up following the incident; however, by the time supper was over he was at his baseline. V10 said she did not see any facial trauma on Resident R1.On 11/18/25 at 12:10 PM, V11 Registered Nurse (RN) stated she escorted V5 from the facility on 11/8/25. V11 stated she had not worked with V5. V11 stated, .[V4] is a sweet girl. She does her job. V11 stated Resident R1 does moan and groan during care due to his catheter. V11 stated Resident R1 is receiving an ointment for his catheter discomfort. V11 stated she assessed Resident R1 after the incident and he was aggravated. On 11/18/25 at 9:41 AM, V6 Resident R1's Power of Attorney/Resident R1's Daughter stated she did not see Resident R1 until the following Wednesday. (11/8/25 was a Saturday). V6 stated, her brother, Resident R1's Son, was in the facility shortly after the incident and Resident R1 reported to him there had been a ruckus. V6 stated she did not see any injuries to Resident R1's face. V6 said if this incident had occurred to Resident R1 and he was cognitively intact, he would have been upset; however, there would not have been any lasting consequences to his behavior or mood. V6 said Resident R1 has been experiencing a recent decline in cognition and health. On 11/18/25 at 9:59 AM, V7 Resident R1's Son stated he saw Resident R1 on Monday, 11/10/25. V7 stated, Resident R1 reported there had been a ruckus but could not provide any further details. V7 stated Resident R1 had no injuries to his face, and he would have shrugged off an incident like this if he was cognitively intact. V7 stated Resident R1 has started to experience a recent decline in his health and cognition. On 11/18/25 at 8:33 AM, V1 Administrator stated V4 was a trusted and valued staff member. V1 stated he believed V4's statement and substantiated the abuse. On 11/18/25 at 12:10 PM, V2 Director of Nursing stated V4 .is one of our best. Resident R1's admission Record (Face Sheet) showed he was admitted to the facility

on [DATE REDACTED] with diagnoses to include but not limited to dementia, psychosis, and pain. Resident R1's 9/2/25 Quarterly Minimum Data Set showed, during the assessment period, he had moderate cognitive impairment. The facility's Abuse policy (Dated 2/17/2020) showed, Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.It included verbal abuse, sexual abuse, physical abuse and [NAME] abuse. The policy continued, Employees are required to report all incidents of possible abuse, mistreatment or neglect of any resident. The policy showed accused staff should be removed from the facility and suspended.

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