Health inspection·July 1, 2025

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on interviews, observation and policy review, the facility failed to ensure scheduled activities were completed as well as ensuring evening activities were scheduled. This affected 92 residents (except for Resident #233) who attend/participate in activities. The facility census was 93. Residents Affected - Some Findings include: Interview on 06/30/25 at 10:31 A.M. with Resident #301 in the activities room revealed the facility rarely does the activities that are posted on the board and stated They just sit out stuff on the table for us to do on our own. No activities in the evening so he gets bored a lot. Interview on 06/30/25 at 10:42 A.M. with Resident #302 revealed there are really never any activities occurring. There are items on the tables, but when it comes to the scheduled events, they rarely happen. There are no evening activities to do as well. She goes into the activities room a lot and can never find anyone with activities in there. Observation on 06/30/25 at 11:30 A.M. of the activities room revealed no move and groove activity being conducted as per schedule with a total of 9 residents throughout the area sitting at tables. No activity workers in the room. Observation on 06/30/25 at 11:47 A.M. of the activities room revealed no move and groove activity being conducted as per schedule with a total of 12 residents throughout the area sitting at tables. No activity workers in the room. Interview on 06/30/25 at 11:48 A.M. with Resident #333 revealed her to be waiting for the move and groove activity in the activity room and had been waiting for at least 10 minutes. Interview on 06/30/25 at 11:52 A.M. with the Activities Recreation Director revealed she was not sure why the move and groove activity was not occurring as scheduled and went to check with her Activity Aide. Interview on 06/30/25 at 12:47 P.M. with the Activities Recreation Director revealed that for evening activities, they always leave activities out on the tables, but no scheduled evening activities as the activities department goes home and no other staff conduct activities when the activities department are not there. Verified for July 2025 no scheduled activities after 2:00 P.M. every Saturday and Sunday and no weekday scheduled events after 4:00 P.M. Interview on 06/30/25 at 2:19 P.M. with the Activities Recreation Director said her assistant only asked two residents when they came in from smoking if they wanted to do the 11:30 A.M. activity (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 3 Event ID: 365644 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 365644 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Winchester 36 Lehman Dr Canal Winchester, OH 43110 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)