F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
Based on observations, staff interviews, and record review, the facility failed to honor residents right to
dignity for 1 of 1 sampled residents sampled. (Resident #59) The findings include:On 9/22/2025 at
approximately 10:32 AM, Resident #59 was observed lying in bed with a suprapubic catheter bag attached
to the bed rail uncovered and visible to roommates.On 9/22/2025 at approximately 12:25 PM, Resident #59
was observed in the dining room with her catheter bag attached to the back of the wheelchair uncovered
and visible to other residents in dining room.On 9/22/2025 at approximately 2:30 PM, Resident #59 was
observed in her wheelchair in the smoking area with the catheter bag attached to the wheelchair uncovered
and visible to other residents in smoking area.On 9/22/2025 at approximately 3:00 PM, an interview was
conducted with Nurse D. He confirmed that the bag was visible to other residents and indicated that it
should be covered for dignity with a dignity bag. Nurse D (Registered Nurse) indicated that he would get a
cover for the bag right away.On 9/22/2025 at approximately 3:15 PM, interview was conducted with resident
#59. The resident stated my bag is never covered and I don't like everyone seeing my pee. Record review of
the resident's care plan revealed the resident has a suprapubic catheter with risk for infection and/or
complications due to neurogenic bladder and/or bladder spasms. The goal is to minimize the risk of
complications associated with catheter usage with an intervention to use catheter bag that promotes
privacy and dignity. The Minimum Data Set (MDS) revealed the resident had an indwelling catheter with
diagnosis of Obstructive Uropathy and Neurogenic Bladder.
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 3
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
09/25/2025
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 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
Based on observations, record review, and interviews, the facility failed to develop and implement a
comprehensive person-centered care plan for 1 of 1 resident sampled for pain. (Resident #3)The findings
include:A review of the Quarterly Minimum Data Set (MDS) (a standardized assessment tool that measures
health status in nursing home resident) dated 9/1/2025, revealed a diagnosis of Aphasia (a language
disorder that affects a person's ability to communicate effectively) following Cerebral infarction.A review of
the physician's orders revealed an order dated 1/04/2025 for Tramadol HCL oral tablet 50 milligrams every
six hours as needed for non-acute pain. Further review revealed an order also dated 1/04/2025 to monitor
pain every shift and record the pain number on a 0-10 scale. A review of the comprehensive care plan
dated 9/11/2025 does not include a care plan for pain. On 9/24/25 at approximately 9:40 AM, an interview
was conducted with Staff B, Certified Nursing Assistant (CNA). Staff B was asked how she assesses
Resident #3 for pain. She replied that she just asks the resident if she is in pain. Resident #3 was observed
to be alert and sitting in her wheelchair. Staff B asked resident # 3 If she was in pain twice and then asked if
her foot was hurting. Resident # 3 did not respond by any observable means. Staff B was asked what other
ways she would assess for pain if the resident does not communicate. Staff B replied, You just have to know
them.On 9/24/25 at approximately 9:50 AM, an interview was conducted with the MDS coordinator. The
MDS Coordinator confirmed Resident # 3 has aphasia and cannot communicate. She stated Resident # 3
should have a care plan for pain and interventions which should indicate how to monitor for pain with a
non-verbal resident. On 9/25/2025 at approximately 9:35 AM, an interview with the Director of Nursing
(DON) was conducted. She confirmed Resident #3 should have a care plan for pain and stated she
reviewed the non-verbal cues for pain with Staff B, CNA.
Event ID:
Facility ID:
105265
If continuation sheet
Page 2 of 3
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
09/25/2025
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, staff interviews, and record reviews, the facility failed to complete an assessment of the
residents' capabilities and deficits to determine whether or not supervision and/or assistance was needed
for 1 of 3 sampled residents sampled for smoking. (Resident #80)The findings include: On 9/22/2025 at
10:30 AM, 9/22/2025 at 2:30 PM, and 9/23/2025 at 10:35 AM, Resident #80 was observed smoking in the
designated smoking area with staff supervision. An interview was conducted with Nurse D (Registered
Nurse) on 9/22/25 at approximately 10:50 AM. Nurse D indicated the resident enjoys sitting in the sun and
smoking daily. An interview was conducted with Employee E (Certified Nursing Assistant) on 9/22/2025 at
approximately 11:15 AM. Employee E confirmed resident #80 had a current smoker agreement that was
signed by the resident on 6/30/25.A record review of the resident's record revealed she was admitted to the
facility on [DATE] with active diagnoses of muscle wasting and atrophy, need for assistance with personal
care and generalized Muscle Weakness. The facility supplied smoker list on 9/22/2025 had Resident #80 on
active list. However, the resident evaluations only revealed one smoking evaluation completed on
09/22/2025 at 9:10 PM.
Event ID:
Facility ID:
105265
If continuation sheet
Page 3 of 3