Inspection·May 6, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, staff, and resident interviews, it was determined that the facility failed to provide Activity of Daily Living (ADL) assistance for three out of nine residents (Resident R2, R3, and R4). Residents Affected - Few Findings include: Review of the facility Activities of Daily Living last reviewed 2/19/25, indicated that residents who are unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. Review of the facility policy Personal Care Procedure last reviewed 2/19/25, indicates the facility will provide/assist resident care and hygiene to each resident based on their individual status and needs. Bath/showers may be given at any time the resident chooses. They may be done in the morning, before bed or any other time of the resident's preference. Review of Resident R2's admission record indicated resident was admitted to facility on 1/15/24, with the diagnosis of multiple sclerosis (MS- an autoimmune disease that damages the nerve cells that causes problems between your brain and body), quadriplegia (paralysis of both the arms and legs), and trigeminal neuralgia (chronic pain disorder that causes pain in the face). Review of Resident R2's physician orders dated 2/23/25, indicate shower Monday/Thursday 2:00 p.m. 10:00 p.m. During an interview completed on 5/6/25, at 10:45 a.m. Resident R2 was in bed reading a book. Upon asking Resident R2 about her bathing schedule she replied, the shower room is still under renovations so we get bed baths upon further query Resident R2 indicated she utilizes the shower bed, she can sit in the shower chair, however it is not safe for her to do so as she feels she will fall out. Resident R2 also indicated she has not received a shower since the end of March and would like to have one. Review of Resident R3's admission record indicated resident was admitted to facility on 5/29/23, with the diagnosis of multiple sclerosis, paraplegia (paralysis that affects the lower half of the body), and diabetes (high sugar in the blood). Review of Resident R3's physician orders dated 6/25/24, indicate shower days Tuesdays and Friday ' s daylight shift. During an interview completed on 5/6/25, at 10:50 a.m. Resident R3 was resting in bed. Upon asking (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: 395160 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 395160 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Saxonburg 223 Pittsburgh St Saxonburg, PA 16056 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)