F 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interviews, record review, and facility policy and procedure review, the facility failed to develop
and implement a comprehensive person-centered care plan that addressed the sexual relationship for two
(Residents #1 and #2) out of 5 residents whose care plans were reviewed.
The findings include:
A review of the clinical record revealed that Resident #1 was a [AGE] year-old female admitted to the facility
on [DATE] with diagnoses that included Multiple Sclerosis, Epilepsy, Parkinson's, and Chronic Kidney
Disease.
A review of the quarterly minimum data set (MDS) assessment dated [DATE], revealed the resident had a
brief interview for mental status (BIMS) score of 13 out of a possible 15 points, indicating cognitively intact.
Resident #1 was documented as having adequate hearing and vision, clear speech pattern, able to make
herself understood and able to express her ideas and wants.
A review of the clinical record revealed Resident #2 was a [AGE] year-old male admitted to the facility on
[DATE] with diagnoses that included respiratory failure, encephalopathy, and alcohol abuse withdrawal.
A review of the quarterly MDS dated [DATE], revealed the resident had a BIMS score of 14 out of a
possible 15 points, indicating cognitively intact. Resident #2 was documented as having adequate hearing
and vision, clear speech pattern, able to make himself understood and able to express his ideas and wants.
On 12/6/23 at 2:48 PM, Resident #1 and #2 were interviewed in the main dining room. Both were asked to
be interviewed separately but they wished to remain together during the interview. Resident #2 stated he
and Resident #1 wanted to get married, and asked if they could get married at the facility today. Resident
#1 replied, As long as he can get me into bed without hurting me, and then she laughed. When asked if
both wanting to be in a relationship with each other. They both agreed and said they had been dating for a
few months and would like a room together to make things easier on everyone but were having a hard time
making that happen.
Further review of the clinical records for Resident #1 and Resident #2 revealed the Interdisciplinary team
comprised of the resident's physician's, Psych services, and Director of Nursing (DON) had deemed both
residents capable of consenting to a sexual relationship.
(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 2
Event ID:
105565
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
105565
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/06/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Coastal Health and Rehabilitation Center
820 N Clyde Morris Blvd
Daytona Beach, FL 32117
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
A review of Resident #1 and Resident #2's care plans revealed neither resident had a care plan that
addressed a focus, goal or interventions/tasks regarding their sexual relationship.
A joint interview was conducted with the administrator and DON on 12/6/23 at 11:15 AM. They were asked
if Resident #1 and Resident #2 had a care plan for their sexual relationship. The administrator and DON
stated they were care planned for their relationship and sexual behavior. The DON was asked to verify that
the care plans for Resident #1 and Resident #2 were in place. The DON stated, It should be care planned,
we talk about it just about every morning and everyone is aware. She said she would check their care plans
and follow back up.
On 12/6/23 at 11:30 AM, the DON confirmed that Resident #1 and Resident #2 were not care planned for
being in a sexual relationship with one another.
A review of the facility's policy and procedure titled, Care Plans, Comprehensive Person-Centered (revised
12/2016): revealed:
Page. 1, Policy Interpretation and Implementation, item 8, The comprehensive, person-centered care plan
will:
b. Describe the services that are to be furnished to attain or maintain the resident's highest practicable
physical, mental, and psychosocial well-being.
Pg. 2, item 13, Assessment of resident are ongoing and care plans are revised as information about the
residents and residents' conditions change.
.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105565
If continuation sheet
Page 2 of 2
