Health inspection·January 6, 2026

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interviews, review of facility policy, the facility failed to ensure residents were free from significant medication errors when they incorrectly transcribed physician orders and failed to administer medication as physician ordered. This affected one (Resident #501) of three residents reviewed for medication administration. The facility census was 63. Findings include:Review of the medical record for Resident #501 revealed they were admitted on [DATE] with diagnoses including chronic respiratory failure with hypoxia, emphysema, and rheumatoid arthritis.Review of the Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed Resident #501 was cognitively intact. 1. Review of Resident #501's hospice physician orders dated 10/16/25 revealed an order for 0.25 milliliter (mL), equal to five milligrams (mg), of morphine solution 20 mg per one mL, to be administered by mouth every four hours.Review of the medication administration record for October 2025 for Resident #501 revealed an order was incorrectly entered on 10/16/25 for 0.25 mL of morphine solution 20 mg per five mL, equivalent to one mg per dose instead of the ordered five mg per dose, to be administered by mouth every four hours.Review of the controlled medication count sheet for October 2025 for Resident #501's morphine revealed a printed pharmacy label indicating morphine solution of 20 mg per five mL was dispensed to the facility to be administered at 1.25 mL per dose; equivalent to five mg per dose as ordered. The dose printed on the pharmacy label had been changed by hand to 0.25 mL per dose. The controlled medication count sheet revealed this dispensed medication was administered at 0.25 mL per dose, equivalent to one mg per dose instead of the ordered five mg per dose, on 14 occasions on 10/16/25, 10/17/25, and 10/18/25.Interview on 01/06/26 at 9:00 A.M. with the Director of Nursing (DON) confirmed Resident #501 was given one mg of morphine, instead of the ordered five mg of morphine, on 14 occasions on 10/16/25, 10/17/25, and 10/18/25.2. Review of hospice physician orders for Resident #501 revealed an order dated 10/18/25 for 0.5 mL, equal to ten mg, of morphine solution 20 mg per one mL, to be administered by mouth every two hours.Review of the medication administration record for October 2025 for Resident #501 revealed an order was incorrectly entered on 10/18/25 for 0.5 mL of morphine solution 20 mg per five mL, equivalent to two mg per dose instead of the ordered ten mg per dose, to be administered by mouth every two hours.Review of the controlled medication count sheet for October 2025 for Resident #501's morphine revealed a printed pharmacy label indicating morphine solution 20 mg per five mL was dispensed to the facility. Further review of this controlled medication count sheet revealed this dispensed medication was administered at 0.5 mL per dose, equivalent to two mg per dose instead of the ordered ten mg per dose, on 14 occasions on 10/18/25, 10/19/25, and 10/20/25.The progress note dated 10/20/25 for Resident #501 written by Registered Nurse #106 revealed Resident #501 was administered incorrect doses of morphine at two mg instead of the ordered ten mg.Interview on 01/06/26 at 9:00 A.M. with the DON confirmed Resident #501 was given two mg of morphine, instead of the ordered ten mg of morphine, on 14 occasions on 10/18/25, 10/19/25, and 10/20/25.Review of the facility policy titled Medication Administration dated 08/22/22 revealed the facility would administer medications as ordered by the physician.This deficiency represents non-compliance investigated under Complaint Number 2647291. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366073 If continuation sheet Page 2 of 3 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 366073 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/06/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Swanton 214 S Munson Rd Swanton, OH 43558 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interviews, review of facility policies, and review of protocols from Centers for Disease Control and Prevention, the facility failed to ensure infection prevention measures were maintained during wound care. This affected one (Resident #503) of one resident observed for wound care. The facility census was 63.Findings include:Review of the medical record for Resident #503 revealed they were admitted on [DATE] with diagnoses including surgical aftercare on the respiratory system, pulmonary embolism, and traumatic subdural hemorrhage.Review of the Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed Resident #503 was cognitively impaired and did not display any behaviors at the time of the assessment. He was bedbound and dependent on staff for all care.Review of the physician order dated 12/04/25 for Resident #503 revealed a wound care order to cleanse the distal midline abdominal wound with normal saline, pat dry, apply alginate, and cover with an absorbent silicone dressing once daily and as needed.Observation on 01/05/26 at 10:10 A.M. revealed Licensed Practical Nurse (LPN) #101 performed the dressing change for Resident #503. LPN #101 did not change her gloves after removing the soiled dressing and cleansing the wound before applying the clean dressing. LPN #101 did not disinfect the scissors prior to cutting the alginate and placing it in the wound bed.Interview on 01/05/26 at 10:15 A.M. with LPN #101 confirmed she did not change her gloves after removing the soiled dressing and before applying the clean dressing to Resident #503's abdominal wound, nor did she disinfect the scissors prior to cutting the alginate and placing it in the wound bed.Interview on 01/05/26 at 10:30 A.M. with the Director of Nursing (DON) revealed gloves should be changed after removing a soiled dressing and before applying a clean dressing to a wound, and scissors should be disinfected prior to cutting any dressing items during wound care.Review of the facility policy titled Wound Treatment Management dated 12/01/21 revealed the facility would provide wound treatments in accordance with current standards of practice.Review of the facility policy titled Infection Prevention and Control Program dated 01/07/25 revealed the facility would maintain an infection prevention program that would help prevent infections. All reusable equipment would be cleaned.Review of Centers for Disease Control and Prevention (CDC) protocols revealed bandage scissors should be disinfected prior to use and gloves should be changed when moving from a dirty site to a clean site.This was an incidental finding discovered during the course of the complaint investigation. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366073 If continuation sheet Page 3 of 3