Inspection·April 21, 2025

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interview, review of a job description, and policy review, the facility failed to ensure the call light system was functioning for all residents and timely repairs were made to the system. This affected 23 of 77 facility residents including nine (#1, #11, #16, #28, #40, #50, #55, #62, and #71) residents with no functioning call light and an additional 14 (#18, #22, #26, #34, #37, #47, #53, #56, #58, #60, #63, #70, #75, and #76) residents with intermittent functioning call lights. The facility census was 77. Residents Affected - Some Findings include: Interview on 04/21/25 at 8:52 A.M., with the Administrator revealed there were a few rooms on the north end of the facility where the call lights were not working and would have to check how long they had not been working. The Administrator revealed the residents were given hand bells and revealed she had gotten a couple of quotes for repair and replacement of the call light system. The Administrator revealed the staff had increased the frequency of rounding for the rooms with hand bells, but could not say how often the rounding was done. During the interview, the Administrator was asked to provide the documentation of service provider quotes to repair or replace the call light system. Interview on 04/21/25 at 9:17 A.M., with Licensed Practical Nurse (LPN) #206 revealed the call lights on the north unit were not working and the residents had hand bells. LPN #206 revealed if she was at the nurse's station she would leave the door open so the hand bells could be heard. Interview on 04/21/25 at 9:29 A.M., with Resident #50 revealed her call light had not been working for months. Resident #50 stated the call light would stay on for a few minutes then would just shut off. Resident #50 revealed she called the facility via telephone when she needed assistance. Interview on 04/21/25 at 9:33 A.M., with Resident #28 revealed her call light was not working since her admission on [DATE]. Resident #28 had a hand bell but stated her roommate would call the facility for her via telephone when she needed help. Interview on 04/21/25 at 9:35 A.M., with Resident #58 revealed her call light had not been working for a couple of weeks. Resident #58 had a hand bell and stated it took forever for the staff to answer it. Interview on 04/21/25 at 9:37 A.M., with Resident #62 revealed her call light and her roommate's (#71) call light had not been working for a week or two. Resident #62 and Resident #71 had hand bells. Interview on 04/21/25 at 9:42 A.M., with Resident #75 revealed his call light had not been working (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 5 Event ID: 365329 Printed: 05/15/2026 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 365329 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Marion 175 Community Drive Marion, OH 43302 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)