Galena Nursing & Rehab Center

nurse and found out that night shift had reported it to the nurse, they also noticed wounds in the

always be present during cares.

She also stated that she felt unsettled when performing cares on R1

previously and was told to honor the AP's wishes of being present and let it be.On 03/30/26 at 11:55 AM, LN I stated she was the nurse on the south hall on 03/22/26 and she was notified by CNA O around 08:00AM that R1 needed to be seen by a nurse.

She said she went to R1's room and saw that R1 had blood and dried blood around her vaginal area along with vaginal bruising, LN I then found LN H, the nurse for that hall, and reported to her that R1 had bleeding and bruising around the vaginal area and informed her that further assessment was needed after the CNAs had finished with cares and cleaned her. LN I then stated that after 02:00 PM she and LN H assessed R1 and discovered extensive bruising on her thighs and abdominal area and the vaginal bruising was darkened. LN I also said that the AP was always present, even during intimate cares, and would not make eye contact at that time. LN I then notified Administrative Nurse D of the situation.On 03/31/26 at 08:06 AM, LN G stated that prior to returning a call to the state agency for interview she had spoken to Administrative Staff A and Consultant HH regarding the survey investigation, she then said that CNA M informed her that R1 had bruising that went down her right leg but did not recall the time. LN G said she looked at the bruising and the AP was in the room with R1, the bruise appeared to be linear and old. LN G also reported that she looked at the bruise with the AP and he told her that it was from therapy, and she said that she believed it was from the wheelchair and said that she reviewed the EMR and said that the bruise was noted on 03/02/26.

She also said that R1 would sit down hard and felt that that was the root cause of the bruising. LN G also stated that earlier in her shift the AP had told her that R1 had scratched her vaginal area and had a yeast infection, LN g had then provided CNA M antifungal cream and instructed him to clean R1 and apply the cream to the area but she did not asses this and she did not recall anything being reported to her about any injuries or bleeding when she received her shift report.On 03/31/26 at 12:55 PM, LN H stated she took R1's vital signs the morning of 03/22/26 but had not assessed her because she was busy with another resident.

She did not remember anything about wounds being reported during shift report that morning.The facility policy Abuse, Neglect and Exploitation, dated 2025, documented that the the facility would have reporting procedures for all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies (e.g., law enforcement when applicable) within specified time frames.

The policy further documented that the facility would report immediately, but not later than two hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury.By 03/24/26, prior to the onsite survey, the facility completed all corrective actions which included reeducation and training of staff regarding recognizing signs or potential abuse, and reporting signs of potential abuse to the facility Administrator immediately, and LE and SA within the required timeframes.

The deficient practice was deemed past noncompliance and existed at G (isolated, actual harm).

175233 03/30/2026

Galena Nursing & Rehab Center 1220 E 8th Street Galena, KS 66739

time. LN G said that she looked at the bruising and the AP was in the room with R1, the bruise

her that it was from therapy, and she said that she believed it was from the wheelchair and said that

sit down hard and felt that that was the root cause of the bruising. LN G also stated that earlier in her shift the AP had told her that R1 had scratched her vaginal area and had a yeast infection, LN G said she provided CNA M antifungal cream and instructed him to clean R1 and apply the cream to the area but she did not asses this and she did not recall anything being reported to her about any injuries or bleeding when she received her shift report. LN G confirmed she had not suspected abuse so had not reported the bruising or vaginal bleeding to anyone except the oncoming shift. On 03/31/26 at 12:55 PM, LN H stated she took R1's vital signs the morning of 03/22/26 but had not assessed her because she was busy with other residents and did not remember anything about wounds being reported during shift report that morning. LN H also said that she was called into R1's room around 02:30 PM in the afternoon on 03/22/26. On 04/01/26 at 02:07 PM, email correspondence was received from Consultant HH contained a Late Entry Nurse's Note with an effective date of 03/21/26 and time of 11:15 PM that was entered on 03/30/26 at 06:43 PM by LN G, after the surveyor had completed interviews with Administrative Staff A and Administrative staff D and other staff.

The Late Entry Nurse's Note documented that the CNA had notified the nurse that R1 had bruising that ran down the right side of her leg.

When the nurse went to R1's room the AP was at the bedside, and both appeared relaxed and were watching television.

The nurse observed a row of small, old purplish, fading bruises that ran down the back side of her right-lower-extremity and started from the upper thigh/hip region.

The nurse had asked the son if he knew what had happened and he told her he thought it could have been from something done in therapy.

They also talked about how R1 tended to lean towards the right and did not completely get centered in the wheelchair during her transfer. It appeared as if R1 had attempted to sit down in the wheelchair and bumped the arm rest of the wheelchair due to linear appearance. R1 took blood thinning medications Plavix (a medication used to prevent blood from clotting) and aspirin (a medication used to thin blood) which can cause bruising more easily.

The AP reported to the nurse that R1 had been scratching herself around the peri-area.

Later in the shift the CNA told the nurse that while performing peri care it had appeared that she had been scratching around her vaginal area due to redness and scant amounts of blood on the brief.

The nurse reported the findings to the oncoming day shift so they could attempt to notify the on-call or on the list to be seen during the Monday morning rounds.

The facility policy Abuse, Neglect and Exploitation, dated 2025, documented that the facility would implement policies and procedures to prevent and prohibit all types of abuse, neglect, misappropriation of resident property, and exploitation.

The policy further documented that the facility would ensure the health and safety of each resident regarding visitors such as family members or resident representatives.

The likelihood of a serious adverse outcome is evidenced by the existence of physical sexual abuse injuries which progressed during the time the resident was left alone with the AP as well as the likelihood for severe psychosocial trauma related to sexual abuse. By 03/24/26, prior to the onsite survey, the facility completed all corrective actions which included reeducation and training to staff regarding recognizing signs or potential abuse and implementing immediate protective measures to prevent further abuse.

The facility additionally implemented a visitors log to monitor visitors inside the facility including an individual log for R1 to ensure only authorized visitors attend R1.

The deficient practice was deemed past noncompliance and existed at G (isolated, actual harm).