Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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.
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 7
Event ID:
105265
Printed: 05/28/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
105265
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Emerald Coast Center
114 Third Street SE
Fort Walton Beach, FL 32548
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
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.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105265
If continuation sheet
Page 2 of 7
Printed: 05/28/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
105265
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Emerald Coast Center
114 Third Street SE
Fort Walton Beach, FL 32548
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
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
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105265
If continuation sheet
Page 3 of 7
Printed: 05/28/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
105265
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Emerald Coast Center
114 Third Street SE
Fort Walton Beach, FL 32548
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
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
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105265
If continuation sheet
Page 4 of 7
Printed: 05/28/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
105265
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Emerald Coast Center
114 Third Street SE
Fort Walton Beach, FL 32548
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
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.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105265
If continuation sheet
Page 5 of 7
Printed: 05/28/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
105265
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Emerald Coast Center
114 Third Street SE
Fort Walton Beach, FL 32548
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
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.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105265
If continuation sheet
Page 6 of 7
Printed: 05/28/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
105265
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Emerald Coast Center
114 Third Street SE
Fort Walton Beach, FL 32548
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
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.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105265
If continuation sheet
Page 7 of 7
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
4 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F557 - Respect and Dignity
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
F644 - Coordination
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
F688 - Mobility
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.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
FAQ · About this visit
Common questions about this visit
What happened during the April 13, 2023 survey of EMERALD COAST CENTER?
This was a inspection survey of EMERALD COAST CENTER on April 13, 2023. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at EMERALD COAST CENTER on April 13, 2023?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.