Brenham Healthcare Center

have been notified.

She said a head-to-toe assessment was not enough.

She said there was no

jeopardy to resident health or crucial information.

She said the abuse should have been assessed and addressed with Resident #1. safety She said if the agency nurse had the information about Resident #1 being slapped by a nurse she would have known what to ask him and how to approach the situation.

She said it was problem that

communication challenges.

She said this investigation was not handled in a way where the residents were not exposed or free from abuse.

She said it was not possible for a person who had a BIMS of 99 to advocate for themselves, make their own decisions, and be their own RP.

She said as soon as the facility obtained information for a RP for Resident #1, the RP should have been called and informed that Resident #1 was slapped by a nurse.

She said all steps in the facility policies for investigating abuse and neglect should have been followed and documented.Interview on 08/17/25 at 12:48 pm ADON reflected she was responsible for the investigation, and she looked at the facility abuse and neglect policy concerning what to do when there was abuse and neglect.

The ADON said there were no written statements from any staff, but the facility policy said to take written statements.

She said the day after she learned of the incident, she was not at the facility and the Administrator was there and the Administrator did everything.

She was not aware of anyone speaking to Resident #1 about the incident except he had a head-to-toe assessment.

She said a head-to-toe assessment was different than a trauma assessment.

She said Resident #1 being slapped was trauma.

The ADON gave instructions by telephone to the AN to give Resident #1 the head-to-toe assessment. A head-to-toe assessment was different than a trauma assessment. In a trauma assessment, when the resident was slapped, the number one question you would ask was if the resident felt safe.

She did not know if the nurse asked him that question. In a trauma assessment you would want to ask if the resident was okay.

The ADON said maybe Resident #1 should have had a head to toe and trauma assessment, but she just told the AN to do a head-to-toe assessment.

She said the negative effect of not doing a trauma assessment would be you do not know if he felt safe or had information about previous abuse that might have affected his behavior.

There was no documentation that shows that someone asked him if he felt safe in the facility, a trauma informed assessment should have been done.

She said because it was not documented did not mean that he was not asked if he felt safe but stated that nursing policy was that if it was not documented, it did not happen.

The ADON said Resident #1 was not a fluent English speaker and if he was going to understand someone it needed to be spoken to him in Spanish.

The primary way of communicating with him was using the communication binder and when the AN administered his head-to-toe assessment, she should have had the communication binder.

The ADON said that LVN A said she slapped Resident #1, and that was assault and maybe the police should have been called.

She said more things should have been done and she did not know if everything was done to make sure that there was no additional abuse in the facility.

She said the possible negative effect of not following the procedures in the facility abuse and neglect investigation was that they were not making sure Resident #1 was okay and they were not making sure there was not any additional abuse.

The ADON said when obtained information to contact Resident #1's RP, she should have contacted her and let her know that he was slapped by a nurse.Interview on 08/17/25 at 1:55 pm with the [TRUNCATED]