Health inspection·April 13, 2023

F 0557 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Based on observation, staff and resident Interview, and record review, the facility failed to honor residents rights for the use of personal property for 1 of 1 residents reviewed for resident rights. (Resident #74) Residents Affected - Few The findings include: On 4/10/23 at 2:54 PM, an interview was conducted with Resident #74. At that time, the resident stated that her family had purchased a motorized wheelchair for her use. She stated that the motorized wheelchair was more stable than the regular wheelchair that she used in the facility and would like to use it in the building. She stated that, when she talked to the Administrator about it, he told her that motorized wheelchairs had been banned from the facility except for a few people who were grandfathered in. During the course of the interview, the Administrator walked up and stated, the facility had decided against allowing them in the building due to safety concerns. He stated that there was not enough room in the building for them to move about safely. He acknowledged that there were other residents in the building with electronic wheelchairs. He stated that they were allowed to continue to use their electric wheelchairs as they already had them when the policy was changed. The Administrator was asked to produce the policy for motorized wheelchairs and a list of residents who were exempt from the policy. On 4/11/23 at 10:08 AM, Resident #53 was observed in a motorized wheelchair, driving it through the dining area to the front of the building. On 4/12/23 at 3:07 PM, the Administrator brought the list of residents currently using motorized wheelchairs which revealed two residents (Resident #53 ad Resident #54) were allowed to use motorized wheelchairs. At that time, he stated that there was not exactly a ban on motorized wheelchairs. He stated that it was more that they are trying to keep the number of them in the building down due to there not being a lot of room in the halls of the building and lack of available space for battery charging stations. He then stated that no one was grandfathered in, the facility was just not going to take away the electric wheelchairs from Residemts #53 or #54. On 4/12/23 at 03:22 PM, Resident #54 was observed in a motorized wheelchair coming from the outdoor smoking area into the dining area. A review was conducted of the facility policy, Risk Management Release Guidelines for Resident Use of Motorized Wheelchairs or Scooters dated 6/1/2011. The policy outlined the need for safety evaluation by therapy for the resident to use the motorized wheelchair and the need for routine maintenance. Nowhere in the policy was it stated that motorized wheelchairs were banned from the facility. Page 1 of 7 105265 105265 04/13/2023 Emerald Coast Center 114 Third Street SE Fort Walton Beach, FL 32548

F 0557 Level of Harm - Minimal harm or potential for actual harm On 4/13/23 at 9:36 AM, an interview was conducted with the Therapy Supervisor. She stated that she was familiar with Resident # 74. She stated that Resident #74 had not been evaluated for the use of a motorized wheelchair. She stated that, from her knowledge of the resident, there was no reason that the resident would be unable to safely use a motorized wheelchair, but that she had to receive approval from the Administrator to do the evaluation. Residents Affected - Few On 4/13/23 at 9:55 AM, an interview was conducted with the Administrator and Director of Nursing. When asked why Resident #74 specifically was not allowed to utilize her motorized wheelchair, the Administrator stated that it was not clinically necessary for her. He stated that Resident #74 did not go through the facility to get the chair and let her know that there was a process to follow. He stated that he let her know that it was restricted due to their size and ability to charge the batteries. When asked if the facility followed up to determine why she wanted the chair and if therapy completed an evaluation, he stated that, when he stated that it was restricted, the resident had her son pick it up from the facility and the resident did not complain. 105265 Page 2 of 7 105265 04/13/2023 Emerald Coast Center 114 Third Street SE Fort Walton Beach, FL 32548

F 0644 Level of Harm - Potential for minimal harm Residents Affected - Some Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** A review of Resident #22's record revealed the resident was originally admitted to the facility on [DATE]. Review of the resident's level I PASSAR dated 1/27/14 indicated she had no serious mental disorder or intellectual disability. A diagnosis of major depressive disorder was added on 6/11/19 and diagnoses of dementia, psychotic disturbance, and anxiety were added on 12/30/22. The record failed to contain evidence of a level II PASARR review. An interview was conducted with the Staff Development Registered Nurse on 4/12/23 at 12:18 PM. She reviewed the resident's record and stated the resident should have been evaluated for a level II PASARR when the diagnoses were added. A review of the PASARR for Resident #29 dated 3/15/2013 noted no diagnosis of Serious Mental Illness (SMI) or Intellectual Disability (ID), or a primary diagnosis of dementia. A Level II screening was not performed. A medical record review of the annual MDS assessments dated 6/12/2020 and 10/19/2021 for Resident #29 noted in Section A: Section 1500 that the resident is currently considered to not have a serious mental illness and/or intellectual disability or related condition. A medical record review of the Quarterly MDS for Resident #29 dated 1/12/2023 noted documented medication administration of antipsychotics 6 of 7 days reviewed and antidepressants 6 of 7 days reviewed. Diagnoses documented included Anxiety Disorder, Depression, and Post-Traumatic Stress Disorder (PTSD). In a medical record review of Resident #29 on 4/12/2023 at approximately 10:30 AM, diagnoses of Major Depressive Disorder and Recurrent Severe without Psychotic Features were added on 2/12/2020, Anxiety Disorder Unspecified was added on 6/20/2019, PTSD-Chronic was added on 6/20/2019, and Generalized Anxiety Disorder was added on 11/1/2021. In a medical record review on 04/12/2023, Resident #29 was noted to be prescribed Duloxetine HCl (Cymbalta) Oral Capsule Delayed Release Sprinkle 60 mg for depression, Amitriptyline HCl (Elavil) Oral Tablet 150 mg at bedtime for depression, and Aripiprazole 15 mg give 0.5 mg once a day for PTSD. A review of the Medication Administration Record for Resident #29 for the month of April 2023 noted the facility was documenting observations of resident behaviors and medication side effects every shift. A medical record review of three Psychiatry evaluations for Resident #29 from 12/27/2022 through 4/4/2023 referenced diagnoses of Post Traumatic Stress Disorder and Depression. A review of the Care Plan for Resident #29 noted care plans addressing: Trauma Informed Care for PTSD episode related to event as a child, Potential Mood Problem related to Diagnosis of Major Depressive Disorder, and Psychotropic Medication: Uses Two Antidepressants to Manage Depression, Antianxiety to Manage Anxiety. In an interview on 3/13/2023 with the Director of Nursing, Staff B, a Registered Nurse (RN), Staff 105265 Page 3 of 7 105265 04/13/2023 Emerald Coast Center 114 Third Street SE Fort Walton Beach, FL 32548

F 0644 Level of Harm - Potential for minimal harm C, a RN Unit Manager and the Assistant Director of Nursing (ADON), the DON acknowledged that Resident #29 did have diagnoses that were considered a Serious Mental Illness which included Major Depressive Disorder, Recurrent Severe without Psychotic Features, Anxiety Disorder Unspecified, Post-Traumatic Stress Disorder Chronic, and Generalized Anxiety Disorder. When asked if a [NAME] II PASARR was submitted for the new diagnosis for Resident #29, Staff B stated a Level II had not been completed. Residents Affected - Some A review of facility policy titled PASRR Requirements Level I and Level II - Florida dated February 2021 states: A resident review must to completed when there has a been a significant change in a resident mental or physical condition resident review is also required if a resident is transferred to a hospital for care and the stay last longer than 90 consecutive days prior to readmission. Level I PASRR must be completed it the below are listed but not limited to: o Is there an indication the resident has or may have had a disorder resulting in functional limitations in major life activities that would otherwise be appropriate for the individuals developmental stage o the resident has a primary or secondary diagnosis of dementia or related neurocognitive disorder, and a suspicion, or diagnosis of, SMI, , or both and are currently exhibiting interpersonal issues, o difficulty maintaining concentration, persistence and pace, o difficulty with adaptation to change, o an indication that the resident has received treatment for a mental illness with an indication that they have experienced at least one of the following: o psychiatric treatment more intensive than outpatient care (partial hospitalization or inpatient hospitalization) experienced an episode of significant disruption to the normal living situation, for which supportive services were required to maintain functioning at home, or in a residential treatment environment, or which resulted in intervention by housing.or law enforcement official Based on record review, staff interview, and policy review, the facility failed to refer a resident with a diagnosis of a serious mental disorder for a Level II Pre-admission Screening And Resident Review (PASARR) screening for 4 of 4 sampled residents reviewed. (Resident #43, #29, #80, and #22) The findings include: A review of Resident #43's medical record revealed a PASARR Level I Screening was completed upon admission on [DATE] with the only SMI (Serious Mental Illness) diagnosis noted as Bipolar Disorder, which was diagnosed on [DATE]. There was no other PASARR form in the chart. A review of the medical diagnoses documented in the chart for Resident #43 revealed newly added 105265 Page 4 of 7 105265 04/13/2023 Emerald Coast Center 114 Third Street SE Fort Walton Beach, FL 32548

F 0644 Level of Harm - Potential for minimal harm Residents Affected - Some diagnoses of Schizophrenia on 09/19/2022, Schizoaffective Disorder on 08/26/2022, and Unspecified Dementia with Unspecified Severity with other behavioral disturbance on 01/16/2023. A review of Resident #43's medical record noted the resident was currently prescribed Zyprexa 30mg by mouth at bedtime for treatment of Schizoaffective Disorder, Bipolar Type. The medical record also revealed Resident #43 was ordered psychiatric evaluation and treatment for schizophrenia. Resident #43 was also care planned for Mood & Behavior related to bipolar disorder, anxiety, depression, and psychotropic medication with side effect monitoring. A review of the Psychiatric Progress Notes dated 12/06/22, 01/13/23, and 03/28/23 reveal the resident was being treated for a diagnosis of Primary Insomnia, Schizoaffective Disorder-Bipolar Type, other specified anxiety disorders, and dementia with behavioral disturbance. Resident #43's annual Minimum Data Set (MDS), Section N, dated 05/31/2022, shows that the resident received an antipsychotic medication 7 of 7 days that were reviewed. The facility's PASARR policy states, A resident review must be completed when there has been a significant change in a residents mental or physical condition, resident review is also required if a resident is transferred to a hospital for care and the stay last longer than 90 consecutive days prior to readmission; Level II PASRR must be completed if the below are listed but not limited to: Is there an indication the resident has or may have had a disorder resulting in functional limitations in major like activities that would otherwise be appropriate for the individuals developmental stage; the resident has a primary or secondary diagnosis of dementia or related neurocognitive disorder, and a suspicion, or diagnosis of, SMI, ID (Intellectual Disability), or both and .an indication that the resident has received treatment for a mental illness . An interview was conducted with the DON, as well as Staff Members B, C, and D, on 04/13/2023 at 10:43am. The DON reviewed the record and confirmed that no other PASARR was in the chart, nor was a Level II PASARR conducted after receiving a new Schizophrenia diagnosis. Staff B responded and verified that a Level II review was not submitted after this new diagnosis but should have been. 105265 Page 5 of 7 105265 04/13/2023 Emerald Coast Center 114 Third Street SE Fort Walton Beach, FL 32548

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident interview, staff interviews, and policy review, the facility failed to provide recommended restorative services for 1 of 2 residents reviewed for limited range of motion. (Resident #99) The findings include: An observation of Resident #99 was conducted on 4/10/23 at 2:16 PM. The resident was not able to extend his left arm and stated he was not able to extend his left arm. He stated he was not receiving any therapy or other services for the limitation in range of motion. Review of Resident #99's medical record revealed a current diagnosis of subluxation (incomplete or partial dislocation of a joint) of the left shoulder joint. The admission minimum data set, with an assessment reference date of 2/9/23, indicated the resident had functional limitation of range of motion on one side's upper and lower extremities. Review of the physical therapy Discharge summary dated [DATE] indicated the discharge plan as follows: Patient will remain as a long term care resident of facility. Assistance from nursing staff as needed, restorative functional maintenance program will be implemented. An interview was conducted with Employee B (Staff Development Registered Nurse) on 4/11/23 at 2:58 PM. Employee B stated the resident was not receiving a restorative program for range of motion and had not received restorative at any time while in the facility. An interview was conducted with Employee A (Therapy Director) on 4/11/23 at 3:03 PM. Employee A reviewed Resident #99's record and confirmed the physical therapy notes indicated the resident would be placed on a restorative functional maintenance program. She stated they failed to communicate the need for a restorative program to begin until he was referred back to therapy on 3/22/23. A further interview with Employee A was conducted on 4/11/23 at 4:06 PM. She stated the intent was to refer him to restorative nursing when he was discharged from physical therapy on 2/24/23. On 4/11/23 at 4:08 PM, Employee B provided copies of therapy recommendations for a restorative/functional maintenance program dated 3/23/23 for passive range of motion to left lower extremity and right lower extremity strengthening and passive range of motion of left and right upper extremities dated 3/29/23. She stated he had not been added to the program yet because she had been on vacation. Review of the facility policy for Restorative Nursing Programs (revised October 2017) revealed the facility provides Restorative Nursing Programs that involve interventions to improve or maintain the optimal physical, mental, and psychological functioning. The interdisciplinary team, resident, and/or family identify the needs of the resident, and collaboratively determines appropriate Restorative Nursing Programs to achieve the resident's goals. The programs include: contracture management and prevention, mobility, activities of daily living, bowel and bladder continence, restorative dining, and communication. 105265 Page 6 of 7 105265 04/13/2023 Emerald Coast Center 114 Third Street SE Fort Walton Beach, FL 32548

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on record review, interview and facility policy review, the facility failed to monitor the facility kitchen's dishwasher wash and rinse temperatures for compliance to protect residents and machine efficiency. This had the potential to affect all residents that ate orally, which is 92 total residents. The findings include: On 4/10/23 at 10:52 AM, during a kitchen tour, the low temperature dishwasher log for April 2023 was reviewed. Wash temperatures were recorded lower than 120 degrees on April 5th and 7th. Temperature recordings were missing on April 3rd and 7th. On 04/10/23 at 10:54 AM, an interview was conducted with Staff E, one of the facility cooks. Staff E was asked the reason the temperatures recorded were lower than 120 degrees Fahrenheit (F) and she responded she was unsure. On 04/11/23 at 9:05 AM, an interview was conducted with the Certified Dietary Manager (CDM). The CDM indicated she started an educational in-service after becoming aware on 4/10/23 that dishwasher temperatures were out of range. The CDM further stated that the wash required more than one cycle to reach the proper temperature of 120 degrees F, which staff were unaware. A review of the facility policy Safe handling, storage, and reheating of food from visitors or outside source dated March 2022 was conducted. This policy stated, Wash dishes in c. Low temperature dish machine per manufacturer guideline plate or at 120 degrees F wash and rinse while maintaining the appropriate chemical saturation of 50 PPM (Parts Per Million) on dish surface in final rinse (or in accordance with State regulation). On 04/12/23 at 10:32 AM, a review of an in-service was conducted. Education provided included the topic Recording dishwasher temperatures. In-service started on 04/10/23 at 1:00 PM, after surveyor reviewed the log. In-service was on-going and had been signed by 5 of 7 cooks and kitchen aides. 105265 Page 7 of 7