Inspection·February 12, 2026

<table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFERRED TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td colspan="2">ID PREFERRED TAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0583 SS = D</td><td colspan="2">Continued from page 1(ii) The facility must allow representatives of the Office of the State Long-Term Care Ombudsman to examine a resident&#x27;s medical, social, and administrative records in accordance with Slate law.This REQUIREMENT IS NOT MET as evidenced by:Based on interviews and record review, the facility failed to ensure the protection of residents&#x27; personal privacy and confidentiality of medical information due to staff utilizing personal cellular phones to take photographs and videos of residents for the purpose of communicating clinical concerns to the facility&#x27;s Nurse Practitioner for 1 of 3 residents reviewed for personal privacy (Resident #2).The findings include:Review of a narrative nursing note, dated revealed that Resident #2 was observed by nursing staff sliding himself on the floor while yelling and screaming with .A written email statement by the facility&#x27;s Nurse Practitioner (NP), dated , was reviewed. In her statement, she reported that she was contacted by staff who provided a video of Resident #2 and requested clinical guidance based on these behaviors.On at approximately 3:35 PM, an interview was conducted with Staff A, Registered Nurse (RN).Staff A stated that, on , she took a video recording of Resident #2 on her personal cell phone to send to the NP. Staff A acknowledged awareness that the use of personal devices is technically not permitted.She stated she was aware that images were not to be posted on social media. Additionally, she stated that staff also take photographs of resident&#x27;s skin concerns to send to the nurse practitioner. Staff A stated she was unaware if there were signed consents from residents regarding this form of communication with the facility&#x27;s practitioners.On at approximately 4:20 PM, an interview was conducted with Staff L, Care Nurse, Staff L explained that she routinely uses her personal cell phone to take pictures of residents&#x27; and send them via text message to the Nurse Practitioner for assessment and treatment recommendations. She further indicated that this was her routine method of communication where the photographs are stored on her personal device. Staff L stated she was unaware if there were signed consents from residents regarding</td><td>F0583</td><td></td><td></td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td colspan="2">(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="4">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFERRED TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PREFERRED TAG</td><td colspan="3">PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0609 SS = D</td><td>Continued from page 3$483.12(c)(1) Ensure that all alleged violations involving, neglect, or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures.</td><td>F0609</td><td colspan="3">Continued from page 3Resident interviews were conducted on to determine if any other residents had allegations of or neglect. Allegations that rose to the level of or neglect were reported. Facility staff were educated on the and Neglect policy, which included identifying types of and reporting, including . This education was completed on . New employees will receive this education during orientation, and agency nurses will be educated prior to working their first shift. The Risk Manager was educated on regarding the facility&#x27;s and Neglect policy, identifying, and filing reports timely. The Risk Manager will review incidents and grievances weekly to determine if there are any allegations of or neglect. If allegations are made, they will be investigated and reported per regulation. The Administrator will review reportable incidents weekly to ensure they are reported timely. The results of reviews will be reported to the QA&amp;A Committee monthly by the Risk Manager. The results of reportable incident review will be reported to the QA&amp;A Committee monthly by the Administrator. The QA&amp;A Committee will determine the need for auditing beyond three months.</td><td></td></tr><tr><td colspan="7">$483.12(c)(4) Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken. This REQUIREMENT is NOT MET as evidenced by: Based on observations, interviews and record reviews, the facility failed to ensure timely reporting of alleged violations of and neglect within 2 hours in 1 of 7 incident reports reviewed. The findings include: A report of filed on at 4:00 PM was reviewed. The report placed the incident on however, further review revealed the incident occurred on . The report stated that the facility Administrator was notified on , however, the Administrator was aware of the incident that occurred on . The incident was reported after an investigator from Adult Protective Services entered the facility on at 4:00 PM. The summary of the event described Resident #1, a adult with , with her pressed against the side rails of her bed that sustained physical injuries on , including , to the outside of her cheek requiring and a subsequent transfer to a local hospital. On at approximately 2:46 PM, an interview was conducted with the facility Risk Manager. The Risk Manager explained that she decided to report the</td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFERRED TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PREFERRED TAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td><td></td></tr><tr><td>F0609 SS = D</td><td>Continued from page 4 incident involving Resident #1 after the investigator from Adult Protective Services entered the facility on at 4:00 PM to investigate the allegation. She further stated that her expectation is that any suspected observed by staff must be reported immediately so she can initiate an investigation. She defined as including pushing, hitting, kicking, slapping, mocking, verbal threats, or yelling to name a few. She noted that facility Certified Nurse Assistants should report any concerns of to the nurse on duty, who will then contact her directly to begin the investigation. She also stated that any injury of unknown origin must be reported within two hours, after which she will submit a five-day report with the findings of the full investigation. The Risk Manager did not explain her reason for the delay in reporting this incident. Review of the facility policy titled &quot; or Misappropriation-Reporting and Investigating&quot; last revised revealed, &quot;All reports of resident (including injuries of unknown origin), neglect ... are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported. If resident, neglect ... or Injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law. &quot;Immediately&quot; is defined as: within two hours of an allegation involving or result in serious bodily injury; or within 24 hours of an allegation that does not involve or result in serious bodily injury.&quot;</td><td>F0609</td><td></td><td></td><td></td></tr><tr><td rowspan="4">F0610 SS = E</td><td>Investigate/Prevent/Correct Alleged Violation CFR(s): 483.12(c)(2)-(4)</td><td rowspan="4">F0610</td><td rowspan="4">This plan of correction does not constitute an admission or agreement by the provider of the truth or conclusions set forth in this statement of deficiencies. This plan of correction is prepared solely because it is required by state and federal law. Investigations for resident #1, #4, and #9 were reviewed on to ensure investigations were thorough and complete. Staff S was immediately educated on and Staff X is no longer employed by facility. An audit of Federal reports from the last six months was conducted on to ensure investigations were through and complete. There were no concerns identified. Facility staff were educated on and Neglect</td><td rowspan="4">/2026</td><td></td></tr><tr><td>$483.12(c)(2) Have evidence that all alleged violations are thoroughly investigated.</td><td></td></tr><tr><td>$483.12(c)(3) Prevent further potential, neglect, or mistreatment while the investigation is in progress.</td><td></td></tr><tr><td>$483.12(c)(4) Report the results of all investigations</td><td></td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td colspan="2">(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST , PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PRIX TAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PRIX TAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0610 SS = E</td><td colspan="2">Continued from page 5 to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken. This REQUIREMENT is NOT MET as evidenced by: Based upon record review and interview, the facility failed to conduct a thorough investigation into allegations of involving 3 of 4 residents (Resident #1, #4, and #9). The findings include: Resident #1 Review of the incident report submitted on for Resident #1 showed the facility reported that Resident #1 sustained injuries that required a transfer to a higher level of care for medical attention and . The injuries that were documented on showed the skin assessment performed on Resident #1 revealed &quot;gashes to right and jaw&quot;. The facility&#x27;s Internal investigation concluded Resident #1 caused the injuries to her own skin by striking her on the siderails. Review of hospital records revealed Resident #1 had 2 to her right lower which required repair and an . An interview was conducted on at 1:30 PM with Staff G, Certified Nursing Assistant (CNA). Staff G stated Resident #1&#x27;s former roommate, Resident #6 had a history of behaviors and becoming upset with other residents at the facility. She recalled Resident #6 had gotten upset with Resident #1 for making noises at one point. Employee G also recalled Resident #6 became upset with another facility resident for sitting in her chair. During an interview on at 2:45 PM, the facility Administrator, Director of Nursing, and Risk Manager stated they believed Resident #1 created her injuries by wiggling herself from side to side into the bed sideral. When asked if they had investigated Resident #1&#x27;s prior roommate, Resident #6 based on her documented history of aggressive behaviors, they stated they had no reason to investigate Resident #6 but that they had moved Resident #1 into a room with a more compatible resident. Review of an email dated from Hospice staff revealed they had requested the Administrator move</td><td>F0610</td><td colspan="2">Continued from page 5 policy, which included identifying types of and reporting, including . This education was completed on . New employees will receive this education during orientation, and agency nurses will be educated prior to working their first shift. The Risk Manager was educated on regarding the facility&#x27;s and Neglect policy, identifying , and filing reports timely. The Risk Manager will review incidents and grievances weekly to determine if there are any allegations of or neglect. If allegations are made, they will be investigated and reported per regulation. The Administrator will review reportable incidents weekly to ensure they are reported timely. The results of reviews will be reported to the Q&amp;A Committee monthly by the Risk Manager. The results of reportable incident review will be reported to the Q&amp;A Committee monthly by the Administrator. The Q&amp;A Committee will determine the need for auditing beyond three months.</td><td></td></tr></table> Event ID: 1E34F2-H1 Facility ID: 11706A <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:106051</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIERCORAL BAY AT PENSACOLA, LLC</td><td colspan="4">STREET ADDRESS, CITY, STATE, ZIP CODE600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETIONDATE</td></tr><tr><td>F0610SS = E</td><td colspan="2">Continued from page 6Resident #1 because of concerns about Resident #6&#x27;s history of violent behaviors. The facility moved Resident #1 five days after she returned from the hospital.Cross reference issues in F689Resident #4Review of the incident report submitted onfor Resident #4 showed the facility reported an allegation of involving Resident #4. The report stated that Staff Q, Dietary Personnel witnessed Staff S, CNA pull Resident #4 by the arm of his wheelchair and yell at him. The facility&#x27;s internal investigation concluded the allegation was unsubstantiated, stating they could not gather adequate information from Staff Q due to his resignation.Facility leadership was aware that Staff Q resigned due to workplace harassment after reporting the allegation. The facility Administrator confirmed that no further investigation was conducted.Cross reference F895 for failure to implement retribution policies.Resident #9Review of the incident report submitted onfor Resident #9 revealed the facility reported an allegation of that Resident #9 stated occurred on . Resident #9 reported that Staff X Registered Nurse, became upset with him and threw a clipboard at him. He reportedly used his to her clipboard from hitting his abdomen. Staff documented a on Resident #9&#x27;s after the incident.During an interview conducted on at approximately 3:25 PM, the facility Administrator, Director of Nursing, and Risk Manager stated that the Assistant Director of Nursing (ADON) reported Resident #9 had retracted his allegation and had &quot;signed something with the Police Department.&quot; The facility&#x27;s internal investigation concluded that the allegation was unsubstantiated based on this reported. The Interdisciplinary Team subsequently added &quot;confabulation - allegations of staff dated&quot; to Resident #9&#x27;s medical record.When informed that Resident #9 stated he only declined to press charges and did not retract the allegation, the Risk Manager stated Resident #9 was upset about not receiving his medication timely and that was the reason</td><td>F0610</td><td></td><td></td><td></td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFERRED TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PREFERRED TAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0610 SS = E</td><td>Continued from page 7 he verbalized the allegation of Review of the Police Report dated revealed the responding officer questioned the Risk Manager why the facility reported the incident two days after it occurred. The Risk Manager stated Adult Protective Services (APS) advised her to call and make the report. The Police Report also documented that Resident #9 declined to press battery charges against Staff X. Review of the investigation provided by the facility showed the Risk Manager made a written statement that Resident #9 declined to press charges. No other investigation was provided for review.</td><td>F0610</td><td></td><td></td><td></td></tr><tr><td rowspan="2">F0656 SS = E</td><td>Develop/Implement Comprehensive Care Plan CFR(s): 483.21(b)(1)(3) $483.21(b) Comprehensive Care Plans</td><td>F0656</td><td colspan="2">This plan of correction does not constitute an admission or agreement by the provider of the truth or conclusions set forth in this statement of deficiencies. This plan of correction is prepared solely because it is required by state and federal law.</td><td>/2026</td></tr><tr><td>$483.21(b)(1)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at $483.10(c)(2) and $483.10(c)(3), that includes measurable objectives and timeframes to meet a resident&#x27;s medical, nursing, and mental and needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following - (i) The services that are to be furnished to attain or maintain the resident&#x27;s highest practicable physical, mental, and well-being as required under $483.24, $483.25 or $483.40; and (ii) Any services that would otherwise be required under $483.24, $483.25 or $483.40 but are not provided due to the resident&#x27;s exercise of rights under $483.10, including the right to refuse treatment under $483.10(c)(6). (iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident&#x27;s medical record. ( ) In consultation with the resident and the resident&#x27;s representative(s) - (A) The resident&#x27;s goals for admission and desired outcomes.</td><td>F0656</td><td colspan="3">Confabulation care plans for residents #9, 11,12, and 13 were revised between and Care plans were spot checked to ensure that they are accurate and documented in a resident-centered manner by MDS Coordinators and Social Services on . Any care plans found to affect by this alleged deficient practice were corrected. Re-education by the DON/Designee was completed with MDS Coordinators on . regarding developing comprehensive care plans. MDS Coordinators will review five care plans weekly to ensure they are accurate and comprehensive. The results of the MDS Coordinator audits will be presented to the facility&#x27;s QA&amp;A Committee monthly by the DON. The results of the Social Services reviews will be presented to the facility&#x27;s QA&amp;A Committee monthly by the Social Services Director. The QA&amp;A Committee will determine the need for auditing beyond three months.</td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td>(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="2">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PRIX TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PRIX TAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0656 SS = E</td><td colspan="4">Continued from page 8(B) The resident&#x27;s preference and potential for future discharge. Facilities must document whether the resident&#x27;s desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.\$483.21(b)(3) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-(iii) Be culturally-competent and -informed.This REQUIREMENT is NOT MET as evidenced by:Based on a review of records and staff interviews, the facility failed to ensure that resident assessments and care plans were documented accurately and in a resident-centered manner for 4 of 5 residents reviewed for care plans (Residents #9, #11, #12, and #13)The findings include:During an interview conducted on at approximately 11:17 AM, the facility Director of Social Services (DSS), Grievance Officer, and Minimum Data Set (MDS) Registered Nurse (RN) and Licensed Practical Nurse (LPN) were asked about a clinical rationale for labeling Resident #9 with &quot;confabulation&quot; on the care plans (Confabulation is a symptom, often referred to as &quot;honest lying,&quot; where a person generates false or distorted memories without the intent to deceive. It is not a standalone medical diagnosis but rather a clinical indicator of an underlying - or condition.)The MDS LPN identified the DSS as the individual responsible for entering behavior items onto resident&#x27;s care plans. The DSS indicated that such directives could originate from any member of upper management, including the Administrator, Risk Manager, or Director of Nursing. When asked why Resident #9&#x27;s care plan for confabulation was added shortly after allegations of , the team did not answer. When asked if they reviewed documentation to support adding confabulation to any resident&#x27;s care plan, the DSS deferred the responsibility to the Administrator.During a follow up interview conducted on at 3:25 PM, the facility Administrator and Director of Nursing (DON) stated that Resident #9 retracted his</td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFERRED TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PREFERRED TAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0656 SS = E</td><td>Continued from page 9 statement of &quot;which was the reason why they added &quot;confabulation&quot; to his care plan. On at 10:01 AM, the DON provided documentation of &quot;confabulation&quot; being used for Residents #11, #12, and #13. Resident #11 - After 1 grievance where the resident stated, &quot;resident says she has not been charged for 30 minutes after activating the call light&quot; The summary of the investigation stated, &quot;there is some sort of confabulation.&quot; Resident #12- Confabulation was used in 4 nurses&#x27; notes showing that Resident #12 refused care. Resident #13- Confabulation was used in 1 nurse&#x27;s note stating that the resident requested to be changed after it had already been done. The administrator and DON did not give further reasoning for why &quot;confabulation&quot; was being used so frequently in the resident&#x27;s charts.</td><td>F0656</td><td></td><td></td><td></td></tr><tr><td>F0689 SS = G</td><td>Free of Accident Hazards/Supervision/Devices CFR(s): 483.25(d)(1)(2) §483.25(d) Accidents. The facility must ensure that - §483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and §483.25(d)(2)Each resident receives adequate supervision and assistance devices to prevent accidents. This REQUIREMENT is NOT MET as evidenced by: Based on observations, interviews and record reviews, the facility failed to take reasonable precautions, including adequate supervision and failed to assess and address the foreseeable risk of harm posed by a resident with documented violent behaviors when roomed with a resident and failed to implement sufficient interventions to mitigate that risk for 2 of 10 residents reviewed (Residents #1 and #6) The findings include: Review of medical records dated from</td><td>F0689</td><td>This plan of correction does not constitute an admission or agreement by the provider of the truth or conclusions set forth in this statement of deficiencies. This plan of correction is prepared solely because it is required by state and federal law. Resident #1 expired . Resident #6 had a room changed completed on . There have been no issues reported. The IDT team reviewed roommate compatibility on . Any resident or staff expressing issues with/between roommates were addressed immediately. Facility&#x27;s monitoring of roommate compatibility will be on-going. Re-education was completed by the Administrator/Designee on with licensed nurses regarding reporting concerns with roommate compatibility. The Administrator and IDT team will review room changes weekly ensure room changes are appropriate. The results of these reviews and audits will be presented to the facility&#x27;s Q&amp;A Committee monthly by the Administrator. The Q&amp;A Committee will determine the need for further auditing beyond three months.</td><td>/2026</td><td></td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFERRED TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PREFERRED TAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td><td></td></tr><tr><td>F0689 SS = G</td><td>Continued from page 11 under the impression that Resident #1&#x27;s originated internally caused by her because of the presence of in her and confirmed that there were no witnesses to the incident. The Risk Manager acknowledged that the, were located on the outside of Resident #1&#x27;s cheek and could not have been caused by her .On at approximately 3:30 PM, a combined interview was conducted with the facility Administrator, Director of Nursing (DON), and Risk Manager (RM). They explained that Resident #1 had resided in a different room for several months and was transferred to her new room last week. They explained that Resident #1&#x27;s room change was initiated by the facility after Resident #1 sustained unwitnessed physical injuries on including a requiring transfer to a higher level of care. They indicated the reason for the room change was to improve roommate compatibility with a resident who was similarly alert, talkative, and ambulatory, as they were consider a better match in terms of status and functional abilities. Regarding the incident for Resident #1 that occurred on , the Administrator added that, based on observations, statements, and the Nurse Practitioner&#x27;s assessment, it was believed that the injuries were consistent with contact from the bed side rails and that the injury resulted from the resident&#x27;s .She explained that her investigation did not include Resident #1&#x27;s roommate, Resident #6, as she had no reason to believe Resident #6 would have caused the injuries, despite her documented history of aggressive behaviors.</td><td>F0689</td><td></td><td></td><td></td></tr><tr><td>F0842 SS = E</td><td>Resident Records - Identifiable Information CFR(s): 483.20(f)(5),483.70(h)(1)-(5) §483.20(f)(5) Resident-identifiable information. (i) A facility may not release information that is resident-identifiable to the public. (ii) The facility may release information that is resident-identifiable to an agent only in accordance with a contract under which the agent agrees not to use or disclose the information except to the extent the facility itself is permitted to do so. §483.70(h) Medical records. §483.70(h)(1) In accordance with accepted professional standards and practices, the facility must maintain</td><td>F0842</td><td>This plan of correction does not constitute an admission or agreement by the provider of the truth or conclusions set forth in this statement of deficiencies. This plan of correction is prepared solely because it is required by state and federal law. Resident #1 expired on .Documentation for resident #2 and #9 were corrected between and .Unit Managers also spot-checked ADL documentation on to review for accuracy. Concerns were addressed as identified. Re-education was conducted by the DON/Designee with CNAs and was completed by on accurate ADL documentation. Unit Managers will audit ADL documentation for five residents weekly to ensure medical records are accurate.</td><td>/2026</td><td></td></tr></table> <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFER TAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PREFER TAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0842 SS = E</td><td colspan="2">Continued from page 13(i) Sufficient information to identify the resident; (ii) A record of the resident&#x27;s assessments; (iii) The comprehensive plan of care and services provided; (i) The results of any preadmission screening and resident review evaluations and determinations conducted by the State; (v) Physician&#x27;s, nurse&#x27;s, and other licensed professional&#x27;s progress notes; and (vi) Laboratory, ... and other diagnostic services reports as required under §483.50.This REQUIREMENT is NOT MET as evidenced by: Based on observations, interviews, and record reviews, the facility failed to ensure a resident&#x27;s medical record accurately reflected the resident condition for 3 out of 3 resident records reviewed (Resident #1, #2, #9).The findings include: Resident #9A review of Activities of Daily Living (ADL) task documentation for Resident #9 showed entries indicating that he ambulated 150 independently on at 3:41 AM, with partial assistance on at 2:59 PM, and at 6:59 AM. Documentation also reflected that Resident #9 transferred from bed to chair independently on at 3:40 AM, with supervision on at 2:59 PM, at 6:59 AM, and ... at 6:37 AM.A review of diagnoses confirmed that Resident #9 was a paraplegic. Observations made on and revealed that Resident #9 was bed bound with no active movement in his lower extremities.During an interview on at 2:25 PM, Staff T, Licensed Practical Nurse (LPN) and Staff U, Certified Nursing Assistant (CNA) confirmed that Resident #9 iwas paralyzed and unable to walk or transfer independently. When presented with the above charting entries Staff T and Staff U stated it would be impossible.Resident #1</td><td>F0842</td><td></td><td></td></tr></table> Event ID: 1E34F2-H1 Facility ID: 11706A <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS</td><td colspan="2">(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106051</td><td>(X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING</td><td>(X3) DATE SURVEY COMPLETED</td></tr><tr><td colspan="3">NAME OF PROVIDER OR SUPPLIER CORAL BAY AT PENSACOLA, LLC</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE 600 W GREGORY ST., PENSACOLA, Florida, 32502</td></tr><tr><td>(X4) ID PREFERRED TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td colspan="2">ID PREFERRED TAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F0895 SS = D</td><td>Continued from page 18 $483.85(e) Annual review. The operating organization for each facility must review its compliance and ethics program annually and revise its program as needed to reflect changes in all applicable laws or regulations and within the operating organization and its facilities to improve its performance in deterring, reducing, and detecting violations under the Act and in promoting quality of care. This REQUIREMENT is NOT MET as evidenced by: Based on observation, interviews, and record review, the facility failed to implement its prevention and policies to protect an employee from retaliation and harassment after reporting. (Staff Q) The findings include: During an interview conducted on at 10:10 AM, the Dietary Manager reported that Staff Q, Dietary Aide, informed her on that he was resigning because staff were harassing him after he reported alleged involving Resident #4. She stated she did not investigate the harassment allegation personally but did notify the facility Administrator and Risk Manager. On , the 3rd Floor Unit Manager was interviewed and stated she was not present during the incident. In a follow up interview conducted on at 2:45 PM, she acknowledged hearing that Staff Q resigned due to harassment but stated that staff to staff harassment was outside her scope and handled by Human Resources (HR). During a group interview conducted on at 3:25 PM with the facility Administrator, Director of Nursing (DON), and Risk Manager, the DON and Risk Manager stated Resident #4 was not a reliable witness. The Risk Manager reported she attempted to contact Staff Q twice but was unable to reach him and subsequently unsubstantiated the allegation of and did not investigate further. The Administrator stated she was aware that Staff Q reported being harassed by staff but confirmed no investigation into the harassment had been conducted. Facility leadership stated staff did not witness harassment and they had relied on statements from individuals who were not present during the alleged incident, though the Administrator asserted they were &quot;staff from that same</td><td></td><td></td><td></td><td></td></tr></table>