Health inspection·February 16, 2024

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the resident's right to be free from abuse for 3 of 5 residents (Resident #1, #2 and #3) reviewed for abuse: Residents Affected - Some CNA A, as part of a CNA chat group, took a video recording of Resident #1, naked, in the shower having a bowel movement, with a close-up view of her exposed bottom with feces on it and he shared it with the chat group. CNA B, as part of a CNA chat group, took a digital picture of Resident #2, naked, in the shower with her back toward the camera and not aware of the photo and she shared it with the chat group. CNA C as part of a CNA chat group, took a photo of Resident #3 after he had fallen on the floor without pants on, and shared it with the chat group. The noncompliance was identified as PNC. The IJ began on February 5th and ended on February 6th 2024. The facility had corrected the noncompliance before the survey began. This deficient practice could affect residents who require assistance with ADL's and result in emotional abuse and exploitation. The findings included: 1. Record review of Resident #1's electronic face sheet dated 02/14/2024 reflected she was admitted to the facility on [DATE]. Her diagnoses included: weakness (lacking strength), contracture of muscle, left hand (tissues tighten or shorten causing a deformity, pain, and loss of function), cognitive communication deficit (difficulty with thinking and how someone uses language) and hemiplegia (paralysis of one side of body), and hemiparesis (one sided weakness) following unspecified cerebrovascular disease ( a group of conditions that affect blood flow and the blood vessels of the brain) affecting left non-dominant side. Record review of Resident #1's quarterly MDS with an ARD of 05/02/2023 reflected she scored a 99 on her BIMS assessment which signified the resident had 4 or more items coded 0 because she chose not to answer or game a nonsensical response. She sometimes could understand and sometimes be understood. Resident #1 required extensive assistance with ADL's. Record review of Resident #1's comprehensive person-centered care plan revised 09/28/2023 reflected Focus .has ADL self-care performance deficit r/t limited mobility, CVA, hemiplegia, contractions, Page 1 of 17 676325 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some muscle wasting and atrophy (decrease in size and wasting of muscle tissue), lack of coordination and pain .Interventions/Tasks .converse with resident while providing care .explain all procedures and tasks before starting .BATHING .requires total assistance. Further review of Resident #1's comprehensive person-centered care plan revised 02/07/2024 reflected Focus .is at risk for communication problem r/t hearing deficit, stroke, confusion .Interventions/Tasks .ensure/provide a safe environment .anticipate and meet needs. Review of a video of Resident #1 taken by CNA A, who admitted to taking the video (unknown date) revealed a picture of a buttock with feces covered on it hanging through the seat hole of a shower chair. A white trash can with a plastic liner was positioned below the shower chair. A close up of the feces coming out of the buttocks was then seen. The video then zooming out and back up to Resident #1's face with an anguished expression and her naked upper half of body exposed as she looked directly at CNA A. The camera zooms out and focuses on Resident #1's anguished face and naked torso with her breast exposed and a partial gown draped over her bottom half sitting in the shower chair. The camera zooms back down to the buttocks with feces coming out positioned over a white plastic lined trash can. As the camera zooms back out to the shower chair legs and trash can the video ends. Observation on 02/14/2024 at 2:40 p.m. of Resident #1 lying in her bed revealed she was quiet, appeared withdrawn and when asked how she was, she responded OK. She did not respond to any other questions. Record review of Resident #1's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #1's psychiatric services note dated 02/06/2024 reflected Visit Note-Initial Psychiatric Diagnostic Interview .seen today for depression/sadness .patient is evaluated laying in her bed .is pleasantly confused and does not appear to be in any emotional or psychosocial distress. Patient states she is not well as she is sick .Mental Status Exam: Behavior was withdrawn and hypoactive .speech was mumbling, slow and soft .attention span and concentration was poor .oriented to person .recent memory severely impaired .severe dementia .Diagnosis-Major depressive disorder .Treatment Plan of Care: Future visits are recommended once a week for 12 months. Interview on 02/15/2024 at 08:50 a.m. with CNA B who admitted to being part of the of the CNA chat group , she stated she saw the video of Resident #1 and did not know why she did not report it. She stated she was trained on abuse and neglect. Interview on 02/16/2024 at 08:20 a.m. with CNA A who admitted to being part of the CNA chat group and who took the video of Resident #1, he stated he did not know what he was thinking when he videotaped Resident #1 naked in the shower room having a bowel movement. He stated he violated Resident #1's rights, privacy, disrespected and abused her. He stated now, he realized how serious it was. He stated he was trained on abuse and neglect. 2. Record review of Resident #2's electronic face sheet dated 02/14/2024 reflected she was originally admitted to the facility on [DATE]. Her diagnoses included: chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing-related problems), cognitive communication deficit (difficulty with thinking and how someone uses language), bipolar disorder (a mental illness that causes unusual shifts in a person's mood, energy, activity levels, and concentration), need for assistance with personal care and major depressive disorder (feeling of sadness and loss of 676325 Page 2 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0600 interest and can interfere with activities of daily living). Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #2's quarterly MDS assessment with an ARD of 01/06/2024 reflected she scored a 14/15 on her BIMS which signified she was cognitively intact. She required assistance with her ADLs to include bathing. Residents Affected - Some Record review of Resident #2's comprehensive person-centered care plan revised 01/11/2023 reflected Focus .has ADL self-care deficit performance r/t shortness of breath .Interventions/Tasks .Requires staff participation with bathing. Record review of a photo on a phone with the chat group titled Bitches [facility name] and a phone number with pluses to indicate other contact numbers reflected a photo (undated) time stamped 06:31 a.m. of Resident #2 sitting in a shower chair naked with her back toward the camera. Under the photo in Spanish was Anexo prubas hahaha which interpreted in English Attached Evidence hahaha. A responding comment from (unknown) in Spanish jajajaja te la banos translated in English hahaha we wash you. Record review of Resident #2's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #2's psychiatric services note dated 02/06/2024 reflected Visit Note-Subsequent Evaluation/Management Visit .seen today for depression/sadness, high risk behavior, psychosis (a collection of symptoms that affect the mind, where there has been some loss of contact with reality) and restlessness .patient is seen sitting on bed eating a snack and watching TV .Patient states I'm good .Diagnoses: Bipolar II disorder (a pattern of depressive episodes and hypomanic episodes) and major depressive disorder .Treatment Plan .future visits recommended once a week for 6 months. Observation on 02/15/2024 at 4:00 p.m. of Resident #2 revealed she was lying on her bed watching television. In an interview on 02/15/2024 at 4:05 p.m. with Resident #2, after being informed of the picture, which she was unaware was taken and what was in the photo, she stated she always trusted CNA B and really liked her. She stated she felt like her rights and privacy were violated . Interview on 02/15/2024 at 07:50 a.m. with CNA F who admitted to being part of the CNA chat group, she stated she saw the photo that CNA B posted of Resident #2 in the shower naked, but she did not report it at that time because she was afraid of retaliation, and she didn't want to get anyone in trouble. She stated she knew taking photos and videos of residents violated their rights and could be considered abuse. She stated she was trained about abuse and neglect. Interview on 02/15/2024 at 08:00 a.m. with CNA D who admitted to being part of the CNA chat group, she stated she did not know how long the group was active. She stated that CNA C started the group and that CNA E posted the first picture . She stated that CNA A posted the video of Resident #1 and she knew it was wrong. She stated she knew better; had training and she did not report and did not know why she did not. She admitted that the resident rights were violated. Interview on 02/15/2024 at 08:50 a.m. with CNA B who admitted to being part of the CNA chat group , she stated she took the picture of Resident #2, naked in the shower chair to show the others in the group she was busy. She stated she knew she violated Resident #2's rights and it was not ok. She stated she knew it could be considered abuse, but she did it anyway . 676325 Page 3 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 3. Record review of Resident #3's electronic face sheet dated 02/14/2024 reflected he was initially admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included: unspecified dementia (condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain), anxiety disorder (persistent and excessive worry that interferes with daily activities), diabetes (body doesn't make enough insulin or doesn't use it well), chronic pain (pain that lasts for over 3 months), overactive bladder (causes a frequent and sudden urge to urinate), difficulty walking (problems with joints, bones and circulation) and need for assistance with personal care. Record review of Resident #3's quarterly MDS assessment with an ARD of 02/05/2024 reflected he scored a 09/15 on his BIMS which signified he was moderately cognitively impaired. He was able to understand and be understood. He required total assistance with ADL's. Record review of Resident #3's comprehensive person-centered care plan revised 01/16/2023 reflected Focus .is at risk for impaired cognitive function or impaired thought processes .Interventions/Tasks .keep routine consistent and try to provide consistent care givers as much as possible to avoid confusion. Further record review of Resident #3's comprehensive person-centered care plan revised 01/16/2023 reflected Focus .has an ADL self-care performance deficit r/t limited mobility .Interventions/Tasks .Promote dignity by ensuring privacy. Further record review of Resident #3's comprehensive person-centered care plan revised 01/24/2024 reflected Focus .is at risk for falls r/t unsteady gait and poor safety awareness .Interventions/Tasks .Anticipate and meet needs .follow facility fall protocol. Record review of a photo taken by CNA C (who admitted to taking the photo), (undated, time stamped 11:30 a.m.) reflected Resident #3 sitting on the floor (right side angle looking down), he was naked from the waist down and his legs were spread apart on the floor. Under the photo was an emoji (a small digital image or icon used to express and idea or emotion) laughing so hard there were flooding tears and 2 hearts which indicated others viewing the posting and reacting to the emoji. Underneath the photo was a comment by CNA C in Spanish, Un soldado caido which interprets in English as A fallen soldier. Observation on 02/15/2024 of Resident #3 revealed he was sitting on the side of his bed, and when asked about someone taking a picture of him sitting on the floor when he fell, he stated I don't like it . Record review of Resident #3's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #3's psychiatric services note dated 02/06/2024 reflected Visit Note-Subsequent Evaluation/Management Visit .seen today for anxiety, dementia and depression/sadness .patient is evaluated in his wheelchair completing a word search. is calm and maintains good eye contact with provider .patient states he is not too good as he has chest congestion and reports he has pain in his left hand .Diagnoses: Major depressive disorder, anxiety and dementia .Treatment Plan .see once a week for 6 months. 676325 Page 4 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #3's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #3's psychiatric services note dated 02/06/2024 reflected Visit Note-Subsequent Evaluation/Management Visit .seen today for anxiety, dementia and depression/sadness .patient is evaluated in his wheelchair completing a word search. is calm and maintains good eye contact with provider .patient states he is not too good as he has chest congestion and reports he has pain in his left hand .Diagnoses: Major depressive disorder, anxiety and dementia .Treatment Plan .see once a week for 6 months. Interview on 02/14/2024 at 4:10 p.m. with CNA H, she stated that she received training on abuse and neglect and reporting of violations. She stated that she worked the evening shift on 02/04/2024 with CNA E, and CNA E wanted to show her something that had bothered her. She stated it was the photos of Residents #2 and #3 and the video of Resident #1. She stated CNA E stated she was afraid that she did not know how to report it to the Administrator. CNA H stated she planned to report the incidents in the morning, but she was so disturbed by what she had seen that she reported it at 06:00 a.m. instead of 08:00 a.m. as she had planned. She stated she knew she should have reported the violations immediately and she had other things she had to do, so she waited. Interview on 02/15/2024 at 09:40 a.m. with CNA C who admitted to being part of the CNA chat group, she stated she started the group as an intent to talk and mingle as friends. She stated she started the chat group in November of 2023. She stated she saw the video of Resident #1, but did not open it, but commented on it. She stated she realized the pictures could harm the residents by violating their rights and privacy. She stated she could not recall any other photos or videos and said she was sorry for what happened. She stated she was trained on abuse and neglect. Interview on 02/16/2024 at 09:00 a.m. with the DON, she stated she did not know why staff did not report the photos or video immediately. She stated that training on abuse and neglect was ongoing. She stated she had no idea how it happened. She stated she and the Administrator found out about the chat group and the activities when CNA H reported to them on February 5th. She stated she and the Administrator were accountable for staff actions. She stated there was zero tolerance for abuse and neglect at the facility. Interview on 02/16/2024 at 09:20 a.m. with the Administrator, he stated he received a call from CNA H the morning of February 5th, 2023, and he stated when they figured out who participated in the chat group, all 7 of them were terminated. He reported it and started an investigation immediately. He stated he had no idea why it happened, but that it was unacceptable. He stated he reported the incident as soon as possible and he started an investigation. Interview on 02/16/2024 at 09:35 a.m. with the SW, she stated that she met with Resident's #1, #2 and #3 and she spoke with them about the incident, and Residents #2 and #3 had adapted and felt safe at the facility. She stated she did not think that Resident #1 was aware of what was going on. Record review of the facility Access and Confidentiality Agreements which stipulated confidentiality reflected you will not record or take pictures of anyone or anything in our workplace for your own use without the written permission of the Administrator. Further review reflected CNA A signed on 10/21/2022, CNA B signed on 10/21/2022, CNA C signed on 06/26/23, CNA D signed on 04/12/2023, CNA E signed on 04/12/2023, CNA F signed on 04/12/2023 and CNA G signed on 04/12/2023. 676325 Page 5 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0600 The facility course of action prior to surveyor entrance included: Level of Harm - Immediate jeopardy to resident health or safety Record review revealed : All required notifications were made: the Medical Director, Responsible Party, Physician, Nurse Practitioner, HHS, and to the local police department. Case #24028379. Residents Affected - Some Record review revealed : Initially the 3 CNAs involved in the photo taking and video were terminated and the other 4 suspended. All 7 CNAs (CNA A, CNA B, CNA C, CNA D, CNA E, CNA F and CNA G) were eventually terminated by the time the surveyor exited the facility. Record review of the CNA's personnel folders reflected suspension and termination dates as follow: CNA A, Terminated 02/06/2024, CNA B, Terminated 02/06/2024, CNA C, Suspended 02/06/2024, Terminated 02/07/2024, CNA D, Suspended 02/06/2024, Terminated 02/07/2024, CNA E, Terminated 02/06/2024, CNA F, Suspended 02/06/2024, Terminated 02/07/2024, CNA G, Suspended 02/06/2024, Terminated 02/07/2024. Record review dated : 02/06/2024-Head to toe assessment completed on all residents. The SW evaluated the 3 residents. Record review dated: 02/06/2024- In-serviced 131 staff, all staff, using a staff roster were checked off and signed for In-services titled: Record review in-services dated 02/06/2024, titled: Abuse/Neglect, Dignity, Privacy and Hipaa and Phone Use-Do not take pics or videos of residents. 02/06/2024-Orders and consults for and completed by Psychiatric Services to see all 3 residents. Record review of an in-service titled Reporting Abuse/Neglect Right Away dated 02/14/2024 revealed it was provided for CNA H by the DON. STAFF INTERVIEWS ON TRAINING: 02/15/2024 from 1:10 p.m. to 3:00 p.m. On 02/15/2024 interviewed 8 staff on day shift, 3 CNA's, 2 COTA's, 1 Physical Therapy Assistant, and 2 LVNs revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. On 02/15/2024 interviewed 5 staff on evening shift, 3 CNAs, and 1 LVN and one RN revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. On 02/15/2024 interviewed 4 staff on night shift, 2 LVN's 1, CNA and one 1 MA revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. The noncompliance was identified as past noncompliance IJ. The noncompliance began on 02/05/2024 and ended on 02/06/2024 when all staff had been in-serviced on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. The 7 CNAs were either terminated or suspended before the surveyor entrance. 676325 Page 6 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, The facility failed to develop and implement written policies and procedures to prohibit and prevent abuse, neglect and exploitation of residents and misappropriation of residents property for 3 residents (Residents #1, #2 and #3) out of 5 residents reviewed for abuse and neglect in that: Residents Affected - Some CNA A, as part of a CNA chat group, took a video recording of Resident #1, naked, in the shower having a bowel movement, with a close-up view of her exposed bottom with feces on it and he shared it with the chat group. CNA B, as part of a CNA chat group, took a digital picture of Resident #2, naked, in the shower with her back toward the camera and not aware of the photo and she shared it with the chat group. CNA C as part of a CNA chat group, took a photo of Resident #3 after he had fallen on the floor without pants on, and shared it with the chat group. CNA D as part of a CNA chat group, failed to report the video of Resident #1. CNA E as part of the CNA chat group, failed to report the photos of Resident #2 and Resident #3. CNA F, as part of the CNA chat group, failed to report the photo of Resident #2. The noncompliance was identified as PNC. The IJ began on February 5th and ended on February 6th 2024. The facility had corrected the noncompliance before the survey began. This deficient practice could affect residents who require assistance with ADL's and result in emotional abuse and exploitation. The findings included: 1. Record review of Resident #1's electronic face sheet dated 02/14/2024 reflected she was admitted to the facility on [DATE]. Her diagnoses included: weakness (lacking strength), contracture of muscle, left hand (tissues tighten or shorten causing a deformity, pain, and loss of function), cognitive communication deficit (difficulty with thinking and how someone uses language) and hemiplegia (paralysis of one side of body), and hemiparesis (one sided weakness) following unspecified cerebrovascular disease ( a group of conditions that affect blood flow and the blood vessels of the brain) affecting left non-dominant side. Record review of Resident #1's quarterly MDS with an ARD of 05/02/2023 reflected she scored a 99 on her BIMS assessment which signified the resident had 4 or more items coded 0 because she chose not to answer or game a nonsensical response. She sometimes could understand and sometimes be understood. Resident #1 required extensive assistance with ADL's. Record review of Resident #1's comprehensive person-centered care plan revised 09/28/2023 reflected Focus .has ADL self-care performance deficit r/t limited mobility, CVA, hemiplegia, contractions, muscle wasting and atrophy (decrease in size and wasting of muscle tissue), lack of coordination and pain .Interventions/Tasks .converse with resident while providing care .explain all procedures and 676325 Page 7 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0607 tasks before starting .BATHING .requires total assistance. Level of Harm - Immediate jeopardy to resident health or safety Further review of Resident #1's comprehensive person-centered care plan revised 02/07/2024 reflected Focus .is at risk for communication problem r/t hearing deficit, stroke, confusion .Interventions/Tasks .ensure/provide a safe environment .anticipate and meet needs. Residents Affected - Some Review of a video of Resident #1 taken by CNA A, who admitted to taking the video (unknown date) revealed a picture of a buttock with feces covered on it hanging through the seat hole of a shower chair. A white trash can with a plastic liner was positioned below the shower chair. A close up of the feces coming out of the buttocks was then seen. The video then zooming out and back up to Resident #1's face with an anguished expression and her naked upper half of body exposed as she looked directly at CNA A. The camera zooms out and focuses on Resident #1's anguished face and naked torso with her breast exposed and a partial gown draped over her bottom half sitting in the shower chair. The camera zooms back down to the buttocks with feces coming out positioned over a white plastic lined trash can. As the camera zooms back out to the shower chair legs and trash can the video ends. Observation on 02/14/2024 at 2:40 p.m. of Resident #1 lying in her bed revealed she was quiet, appeared withdrawn and when asked how she was, she responded OK. She did not respond to any other questions. Record review of Resident #1's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #1's psychiatric services note dated 02/06/2024 reflected Visit Note-Initial Psychiatric Diagnostic Interview .seen today for depression/sadness .patient is evaluated laying in her bed .is pleasantly confused and does not appear to be in any emotional or psychosocial distress. Patient states she is not well as she is sick .Mental Status Exam: Behavior was withdrawn and hypoactive .speech was mumbling, slow and soft .attention span and concentration was poor .oriented to person .recent memory severely impaired .severe dementia .Diagnosis-Major depressive disorder .Treatment Plan of Care: Future visits are recommended once a week for 12 months. Interview on 02/15/2024 at 08:50 a.m. with CNA B who admitted to being part of the of the CNA chat group , she stated she saw the video of Resident #1 and did not know why she did not report it. She stated she was trained on abuse and neglect. Interview on 02/16/2024 at 08:20 a.m. with CNA A who admitted to being part of the CNA chat group and who took the video of Resident #1, he stated he did not know what he was thinking when he videotaped Resident #1 naked in the shower room having a bowel movement. He stated he violated Resident #1's rights, privacy, disrespected and abused her. He stated now, he realized how serious it was. He stated he was trained on abuse and neglect. 2. Record review of Resident #2's electronic face sheet dated 02/14/2024 reflected she was originally admitted to the facility on [DATE]. Her diagnoses included: chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing-related problems), cognitive communication deficit (difficulty with thinking and how someone uses language), bipolar disorder (a mental illness that causes unusual shifts in a person's mood, energy, activity levels, and concentration), need for assistance with personal care and major depressive disorder (feeling of sadness and loss of interest and can interfere with activities of daily living). 676325 Page 8 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #2's quarterly MDS assessment with an ARD of 01/06/2024 reflected she scored a 14/15 on her BIMS which signified she was cognitively intact. She required assistance with her ADLs to include bathing. Record review of Resident #2's comprehensive person-centered care plan revised 01/11/2023 reflected Focus .has ADL self-care deficit performance r/t shortness of breath .Interventions/Tasks .Requires staff participation with bathing. Record review of a photo on a phone with the chat group titled Bitches [facility name] and a phone number with pluses to indicate other contact numbers reflected a photo (undated) time stamped 06:31 a.m. of Resident #2 sitting in a shower chair naked with her back toward the camera. Under the photo in Spanish was Anexo prubas hahaha which interpreted in English Attached Evidence hahaha. A responding comment from (unknown) in Spanish jajajaja te la banos translated in English hahaha we wash you. Record review of Resident #2's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #2's psychiatric services note dated 02/06/2024 reflected Visit Note-Subsequent Evaluation/Management Visit .seen today for depression/sadness, high risk behavior, psychosis (a collection of symptoms that affect the mind, where there has been some loss of contact with reality) and restlessness .patient is seen sitting on bed eating a snack and watching TV .Patient states I'm good .Diagnoses: Bipolar II disorder (a pattern of depressive episodes and hypomanic episodes) and major depressive disorder .Treatment Plan .future visits recommended once a week for 6 months. Observation on 02/15/2024 at 4:00 p.m. of Resident #2 revealed she was lying on her bed watching television. In an interview on 02/15/2024 at 4:05 p.m. with Resident #2, after being informed of the picture, which she was unaware was taken and what was in the photo, she stated she always trusted CNA B and really liked her. She stated she felt like her rights and privacy were violated . Interview on 02/15/2024 at 07:50 a.m. with CNA F who admitted to being part of the CNA chat group, she stated she saw the photo that CNA B posted of Resident #2 in the shower naked, but she did not report it at that time because she was afraid of retaliation, and she didn't want to get anyone in trouble. She stated she knew taking photos and videos of residents violated their rights and could be considered abuse. She stated she was trained about abuse and neglect. Interview on 02/15/2024 at 08:00 a.m. with CNA D who admitted to being part of the CNA chat group, she stated she did not know how long the group was active. She stated that CNA C started the group and that CNA E posted the first picture . She stated that CNA A posted the video of Resident #1 and she knew it was wrong. She stated she knew better; had training and she did not report and did not know why she did not. She admitted that the resident rights were violated. Interview on 02/15/2024 at 08:50 a.m. with CNA B who admitted to being part of the CNA chat group, she stated she took the picture of Resident #2, naked in the shower chair to show the others in the group she was busy. She stated she knew she violated Resident #2's rights and it was not ok. She stated she knew it could be considered abuse, but she did it anyway . 3. Record review of Resident #3's electronic face sheet dated 02/14/2024 reflected he was initially 676325 Page 9 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included: unspecified dementia (condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain), anxiety disorder (persistent and excessive worry that interferes with daily activities), diabetes (body doesn't make enough insulin or doesn't use it well), chronic pain (pain that lasts for over 3 months), overactive bladder (causes a frequent and sudden urge to urinate), difficulty walking (problems with joints, bones and circulation) and need for assistance with personal care. Record review of Resident #3's quarterly MDS assessment with an ARD of 02/05/2024 reflected he scored a 09/15 on his BIMS which signified he was moderately cognitively impaired. He was able to understand and be understood. He required total assistance with ADL's. Record review of Resident #3's comprehensive person-centered care plan revised 01/16/2023 reflected Focus .is at risk for impaired cognitive function or impaired thought processes .Interventions/Tasks .keep routine consistent and try to provide consistent care givers as much as possible to avoid confusion. Further record review of Resident #3's comprehensive person-centered care plan revised 01/16/2023 reflected Focus .has an ADL self-care performance deficit r/t limited mobility .Interventions/Tasks .Promote dignity by ensuring privacy. Further record review of Resident #3's comprehensive person-centered care plan revised 01/24/2024 reflected Focus .is at risk for falls r/t unsteady gait and poor safety awareness .Interventions/Tasks .Anticipate and meet needs .follow facility fall protocol. Record review of a photo taken by CNA C (who admitted to taking the photo), (undated, time stamped 11:30 a.m.) reflected Resident #3 sitting on the floor (right side angle looking down), he was naked from the waist down and his legs were spread apart on the floor. Under the photo was an emoji (a small digital image or icon used to express and idea or emotion) laughing so hard there were flooding tears and 2 hearts which indicated others viewing the posting and reacting to the emoji. Underneath the photo was a comment by CNA C in Spanish, Un soldado caido which interprets in English as A fallen soldier. Observation on 02/15/2024 of Resident #3 revealed he was sitting on the side of his bed, and when asked about someone taking a picture of him sitting on the floor when he fell, he stated I don't like it . Record review of Resident #3's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #3's psychiatric services note dated 02/06/2024 reflected Visit Note-Subsequent Evaluation/Management Visit .seen today for anxiety, dementia and depression/sadness .patient is evaluated in his wheelchair completing a word search. is calm and maintains good eye contact with provider .patient states he is not too good as he has chest congestion and reports he has pain in his left hand .Diagnoses: Major depressive disorder, anxiety and dementia .Treatment Plan .see once a week for 6 months. Record review of Resident #3's Active Orders as of: 02/14/2024 reflected Refer to psychiatric 676325 Page 10 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0607 services to evaluate and treat .Active as of 02/06/2024. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #3's psychiatric services note dated 02/06/2024 reflected Visit Note-Subsequent Evaluation/Management Visit .seen today for anxiety, dementia and depression/sadness .patient is evaluated in his wheelchair completing a word search. is calm and maintains good eye contact with provider .patient states he is not too good as he has chest congestion and reports he has pain in his left hand .Diagnoses: Major depressive disorder, anxiety and dementia .Treatment Plan .see once a week for 6 months. Residents Affected - Some Interview on 02/14/2024 at 4:10 p.m. with CNA H, she stated that she received training on abuse and neglect and reporting of violations. She stated that she worked the evening shift on 02/04/2024 with CNA E, and CNA E wanted to show her something that had bothered her. She stated it was the photos of Residents #2 and #3 and the video of Resident #1. She stated CNA E stated she was afraid that she did not know how to report it to the Administrator. CNA H stated she planned to report the incidents in the morning, but she was so disturbed by what she had seen that she reported it at 06:00 a.m. instead of 08:00 a.m. as she had planned. She stated she knew she should have reported the violations immediately and she had other things she had to do, so she waited. Interview on 02/15/2024 at 09:40 a.m. with CNA C who admitted to being part of the CNA chat group, she stated she started the group as an intent to talk and mingle as friends. She stated she saw the video of Resident #1, but did not open it, but commented on it. She stated she realized the pictures could harm the residents by violating their rights and privacy. She stated she could not recall any other photos or videos and said she was sorry for what happened. She stated she was trained on abuse and neglect. Interview on 02/16/2024 at 09:00 a.m. with the DON, she stated she did not know why staff did not report the photos or video immediately. She stated that training on abuse and neglect was ongoing. She stated she had no idea how it happened. She stated she and the Administrator found out about the chat group and the activities when CNA H reported to them on February 5th. She stated she and the Administrator were accountable for staff actions. She stated there was zero tolerance for abuse and neglect at the facility. Interview on 02/16/2024 at 09:20 a.m. with the Administrator, he stated he received a call from CNA H the morning of February 5th, 2023, and he stated when they figured out who participated in the chat group, all 7 of them were terminated. He reported it and started an investigation immediately. He stated he had no idea why it happened, but that it was unacceptable. He stated he reported the incident as soon as possible and he started an investigation. Interview on 02/16/2024 at 09:35 a.m. with the SW, she stated that she met with Resident's #1, #2 and #3 and she spoke with them about the incident, and Residents #2 and #3 had adapted and felt safe at the facility. She stated she did not think that Resident #1 was aware of what was going on. Record review of the facility Access and Confidentiality Agreements which stipulated confidentiality reflected you will not record or take pictures of anyone or anything in our workplace for your own use without the written permission of the Administrator. Further review reflected CNA A signed on 10/21/2022, CNA B signed on 10/21/2022, CNA C signed on 06/26/23, CNA D signed on 04/12/2023, CNA E signed on 04/12/2023, CNA F signed on 04/12/2023 and CNA G signed on 04/12/2023. The facility course of action prior to surveyor entrance included: 676325 Page 11 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review revealed : All required notifications were made: the Medical Director, Responsible Party, Physician, Nurse Practitioner, HHS, and to the local police department. Case #24028379. Record review of the CNA's personnel folders reflected suspension and termination dates as follow: CNA A, Terminated 02/06/2024, CNA B, Terminated 02/06/2024, CNA C, Suspended 02/06/2024, Terminated 02/07/2024, CNA D, Suspended 02/06/2024, Terminated 02/07/2024, CNA E, Terminated 02/06/2024, CNA F, Suspended 02/06/2024, Terminated 02/07/2024, CNA G, Suspended 02/06/2024, Terminated 02/07/2024. Record review dated : 02/06/2024-Head to toe assessment completed on all residents. The SW evaluated the 3 residents. Record review dated: 02/06/2024- In-serviced 131 staff, all staff, using a staff roster were checked off and signed for In-services titled: Record review in-services dated 02/06/2024, titled: Abuse/Neglect, Dignity, Privacy and Hipaa and Phone Use-Do not take pics or videos of residents. 02/06/2024-Orders and consults for and completed by Psychiatric Services to see all 3 residents. Record review of an in-service titled Reporting Abuse/Neglect Right Away dated 02/14/2024 revealed it was provided for CNA H by the DON. STAFF INTERVIEWS ON TRAINING: 02/15/2024 from 1:10 p.m. to 3:00 p.m. On 02/15/2024 interviewed 8 staff on day shift, 3 CNA's, 2 COTA's, 1 Physical Therapy Assistant, and 2 LVNs revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. On 02/15/2024 interviewed 5 staff on evening shift, 3 CNAs, and 1 LVN and one RN revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. On 02/15/2024 interviewed 4 staff on night shift, 2 LVN's 1, CNA and one 1 MA revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. The noncompliance was identified as past noncompliance IJ. The noncompliance began on 02/05/2024 and ended on 02/06/2024 when all staff had been in-serviced on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. The 7 CNAs were either terminated or suspended before the surveyor entrance. 676325 Page 12 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record reviews, the facility failed to report abuse immediately but no later than 2 hours after the incident for 3 of 3 residents (Residents #1, #2, and #3) reviewed for reporting abuse and neglect in that: Residents Affected - Some CNA H was informed about the abuse of Residents #1, #2 and #3 by CNA F of text chat group and did not report it to the Administrator until February 5th at 06:00 a.m. (8 hours later). CNA F, as part of the CNA chat group, failed to report the phone of Resident #2. CNA D, as part of the CNA chat group, failed to report the video of Resident #1. CNA E, as part of the CNA chat group, failed to report the photos of Resident #2 and Resident #3. The noncompliance was identified as PNC. The IJ began on February 5th and ended on February 6th 2024. The facility had corrected the noncompliance before the survey began. This failure could place the residents at further risk of abuse and neglect due to lack of reporting of incidents. The findings included : 1. Record review of Resident #1's electronic face sheet dated 02/14/2024 reflected she was admitted to the facility on [DATE]. Her diagnoses included: weakness (lacking strength), contracture of muscle, left hand (tissues tighten or shorten causing a deformity, pain, and loss of function), cognitive communication deficit (difficulty with thinking and how someone uses language) and hemiplegia (paralysis of one side of body), and hemiparesis (one sided weakness) following unspecified cerebrovascular disease ( a group of conditions that affect blood flow and the blood vessels of the brain) affecting left non-dominant side. Record review of Resident #1's quarterly MDS with an ARD of 05/02/2023 reflected she scored a 99 on her BIMS assessment which signified the resident had 4 or more items coded 0 because she chose not to answer or game a nonsensical response. She sometimes could understand and sometimes be understood. Resident #1 required extensive assistance with ADL's. Record review of Resident #1's comprehensive person-centered care plan revised 09/28/2023 reflected Focus .has ADL self-care performance deficit r/t limited mobility, CVA, hemiplegia, contractions, muscle wasting and atrophy (decrease in size and wasting of muscle tissue), lack of coordination and pain .Interventions/Tasks .converse with resident while providing care .explain all procedures and tasks before starting .BATHING .requires total assistance. Further review of Resident #1's comprehensive person-centered care plan revised 02/07/2024 reflected Focus .is at risk for communication problem r/t hearing deficit, stroke, confusion .Interventions/Tasks .ensure/provide a safe environment .anticipate and meet needs. Review of a video of Resident #1 taken by CNA A, who admitted to taking the video (unknown date) 676325 Page 13 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some revealed a picture of a buttock with feces covered on it hanging through the seat hole of a shower chair. A white trash can with a plastic liner was positioned below the shower chair. A close up of the feces coming out of the buttocks was then seen. The video then zooming out and back up to Resident #1's face with an anguished expression and her naked upper half of body exposed as she looked directly at CNA A. The camera zooms out and focuses on Resident #1's anguished face and naked torso with her breast exposed and a partial gown draped over her bottom half sitting in the shower chair. The camera zooms back down to the buttocks with feces coming out positioned over a white plastic lined trash can. As the camera zooms back out to the shower chair legs and trash can the video ends. Observation on 02/14/2024 at 2:40 p.m. of Resident #1 laying in her bed revealed she was quiet, appeared withdrawn and when asked how she was, she responded OK. She did not respond to any other questions. Record review of Resident #1's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Record review of Resident #1's psychiatric services note dated 02/06/2024 reflected Visit Note-Initial Psychiatric Diagnostic Interview .seen today for depression/sadness .patient is evaluated laying in her bed .is pleasantly confused and does not appear to be in any emotional or psychosocial distress. Patient states she is not well as she is sick .Mental Status Exam: Behavior was withdrawn and hypoactive .speech was mumbling, slow and soft .attention span and concentration was poor .oriented to person .recent memory severely impaired .severe dementia .Diagnosis-Major depressive disorder .Treatment Plan of Care: Future visits are recommended once a week for 12 months. Interview on 02/15/2024 at 08:00 a.m. with CNA D who admitted to being part of the CNA chat group, she stated she did not know how long the group was active. She stated that CNA C started the group and that CNA E posted the first picture . She stated that CNA A posted the video of Resident #1 and she knew it was wrong. She stated she knew better; had training and she did not report and did not know why she did not. She admitted that the resident rights were violated. Record review of Resident #2's electronic face sheet dated 02/14/2024 reflected she was originally admitted to the facility on [DATE]. Her diagnoses included: chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing-related problems), cognitive communication deficit (difficulty with thinking and how someone uses language), bipolar disorder (a mental illness that causes unusual shifts in a person's mood, energy, activity levels, and concentration), need for assistance with personal care and major depressive disorder (feeling of sadness and loss of interest and can interfere with activities of daily living). Record review of Resident #2's quarterly MDS assessment with an ARD of 01/06/2024 reflected she scored a 14/15 on her BIMS which signified she was cognitively intact. She required assistance with her ADLs to include bathing. Record review of Resident #2's comprehensive person-centered care plan revised 01/11/2023 reflected Focus .has ADL self-care deficit performance r/t shortness of breath .Interventions/Tasks .Requires staff participation with bathing. Record review of a photo on a phone with the chat group titled Bitches [facility name] and a phone number with pluses to indicate other contact numbers reflected a photo (undated) time stamped 06:31 a.m. of Resident #2 sitting in a shower chair naked with her back toward the camera. Under the photo 676325 Page 14 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0609 Level of Harm - Immediate jeopardy to resident health or safety in Spanish was Anexo prubas hahaha which interpreted in English Attached Evidence hahaha. A responding comment from (unknown) in Spanish jajajaja te la banos translated in English hahaha we wash you. Record review of Resident #2's Active Orders as of: 02/14/2024 reflected Refer to psychiatric services to evaluate and treat .Active as of 02/06/2024. Residents Affected - Some Record review of Resident #2's psychiatric services note dated 02/06/2024 reflected Visit Note-Subsequent Evaluation/Management Visit .seen today for depression/sadness, high risk behavior, psychosis (a collection of symptoms that affect the mind, where there has been some loss of contact with reality) and restlessness .patient is seen sitting on bed eating a snack and watching TV .Patient states I'm good .Diagnoses: Bipolar II disorder (a pattern of depressive episodes and hypomanic episodes) and major depressive disorder .Treatment Plan .future visits recommended once a week for 6 months. Observation on 02/15/2024 at 4:00 p.m. of Resident #2 revealed she was lying on her bed watching television. In an interview on 02/15/2024 at 4:05 p.m. with Resident #2, after being informed of the picture, which she was unaware was taken and what was in the photo, she stated she always trusted CNA B and really liked her. She stated she felt like her rights and privacy were violated. Interview on 02/15/2024 at 07:50 a.m. with CNA F who admitted to being part of the CNA chat group, she stated she saw the photo that CNA B posted of Resident #2 in the shower naked, but she did not report it at that time because she was afraid of retaliation, and she didn't want to get anyone in trouble. She stated she knew taking photos and videos of residents violated their rights and could be considered abuse. She stated she was trained about abuse and neglect. Record review of Resident #3's electronic face sheet dated 02/14/2024 reflected he was initially admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included: unspecified dementia (condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain), anxiety disorder (persistent and excessive worry that interferes with daily activities), diabetes (body doesn't make enough insulin or doesn't use it well), chronic pain (pain that lasts for over 3 months), overactive bladder (causes a frequent and sudden urge to urinate), difficulty walking (problems with joints, bones and circulation) and need for assistance with personal care. Record review of Resident #3's quarterly MDS assessment with an ARD of 02/05/2024 reflected he scored a 09/15 on his BIMS which signified he was moderately cognitively impaired. He was able to understand and be understood. He required total assistance with ADL's. Record review of Resident #3's comprehensive person-centered care plan revised 01/16/2023 reflected Focus .is at risk for impaired cognitive function or impaired thought processes .Interventions/Tasks .keep routine consistent and try to provide consistent care givers as much as possible to avoid confusion. Further record review of Resident #3's comprehensive person-centered care plan revised 01/24/2024 reflected Focus .is at risk for falls r/t unsteady gait and poor safety awareness .Interventions/Tasks .Anticipate and meet needs .follow facility fall protocol. 676325 Page 15 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Record review of a photo taken by CNA C (undated, time stamped 11:30 a.m.) reflected Resident #3 sitting on the floor (right side angle looking down), he was naked from the waist down and legs were spread apart on the floor. He was not aware of the photo being taken. Under the photo was an emoji (a small digital image or icon used to express and idea or emotion) laughing so hard there were flooding tears and 2 hearts which indicated others viewing the posting and reacting to an emoji. Underneath the photo was a comment by CNA C in Spanish Un soldado caido which interprets in English as A fallen soldier. Residents Affected - Some Interview on 02/14/2024 at 4:10 p.m. with CNA H, she stated that she received training on abuse and neglect and reporting of violations. She stated that she worked the evening shift on 02/04/2024 with CNA E, and CNA E wanted to show her something that had bothered her. She stated it was the photos of Residents #2 and #3 and the video of Resident #1. She stated CNA E stated she was afraid that she did not know how to report it to the Administrator. CNA H stated she planned to report the incidents in the morning, but she was so disturbed by what she had seen that she reported it at 06:00 a.m. instead of 08:00 a.m. as she had planned. She stated she knew she should have reported the violations immediately and she had other things she had to do, so she waited. Interview on 02/15/2024 at 09:15 a.m. with CNA E who admitted to being part of the CNA chat group, she stated she was not part of the group conversation, but was at CNA F's house when she saw the photos (unknown date and time) and the video. She stated that she made a wrong decision and did not report it right away. She stated she showed CNA H and she was aware that she reported the incidents to the Administrator. Interview on 02/16/2024 at 09:00 a.m. with the DON, she stated she did not know why staff did not report the photos or video immediately. She stated that training on abuse and neglect was ongoing. She stated she had no idea how it happened. She stated she and the Administrator were accountable for staff actions. She stated there was zero tolerance for abuse and neglect at the facility. She stated she had no idea that CNA H did not report the violations immediately to the Administrator. Interview on 02/16/2024 at 09:20 a.m. with the Administrator, he stated he received a call from CNA H on February 5th at 06:00 a.m., and he stated when they figured out who participated in the chat group, all 7 (CNA A, CNA B, CNA C, CNA D, CNA E, CNA F and CNA G) of them were terminated. He stated he was told CNA H reported immediately and was not aware she did not. Record review of the facility policy and procedure titled Abuse, Prevention of and Prohibition Against revised 10/2022 reflected H. Reporting/Response .all allegations of abuse, neglect, misappropriation of resident property, or exploitation will be reported immediately to the Administrator. The facility course of action prior to surveyor entrance included: Record review revealed : All required notifications were made: the Medical Director, Responsible Party, Physician, Nurse Practitioner, HHS, and to the local police department. Case #24028379. Record review of the CNA's personnel folders reflected suspension and termination dates as follow: CNA A, Terminated 02/06/2024, CNA B, Terminated 02/06/2024, CNA C, Suspended 02/06/2024, Terminated 02/07/2024, CNA D, Suspended 02/06/2024, Terminated 02/07/2024, CNA E, Terminated 02/06/2024, CNA F, Suspended 02/06/2024, Terminated 02/07/2024, CNA G, Suspended 02/06/2024, Terminated 02/07/2024. Record review dated : 02/06/2024-Head to toe assessment completed on all residents. The SW 676325 Page 16 of 17 676325 02/16/2024 Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245

F 0609 evaluated the 3 residents. Level of Harm - Immediate jeopardy to resident health or safety Record review dated: 02/06/2024- In-serviced 131 staff, all staff, using a staff roster were checked off and signed for In-services titled: Residents Affected - Some Record review in-services dated 02/06/2024, titled: Abuse/Neglect, Dignity, Privacy and Hipaa and Phone Use-Do not take pics or videos of residents. 02/06/2024-Orders and consults for and completed by Psychiatric Services to see all 3 residents. Record review of an in-service titled Reporting Abuse/Neglect Right Away dated 02/14/2024 revealed it was provided for CNA H by the DON. STAFF INTERVIEWS ON TRAINING: 02/15/2024 from 1:10 p.m. to 3:00 p.m. On 02/15/2024 interviewed 8 staff on day shift, 3 CNA's, 2 COTA's, 1 Physical Therapy Assistant, and 2 LVNs revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. On 02/15/2024 interviewed 5 staff on evening shift, 3 CNAs, and 1 LVN and one RN revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. On 02/15/2024 interviewed 4 staff on night shift, 2 LVN's 1, CNA and one 1 MA revealed they received training on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. The noncompliance was identified as past noncompliance IJ. The noncompliance began on 02/05/2024 and ended on 02/06/2024 when all staff had been in-serviced on abuse/neglect, reporting, dignity, resident rights, privacy and HIPAA, and phone use to include pictures and videos. The 7 CNAs were either terminated or suspended before the surveyor entrance. 676325 Page 17 of 17