Health inspection·January 4, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, the facility's abuse prohibition policy, select facility incident reports, and information submitted by the facility, and staff interview, it was determined that the facility failed to ensure that one resident out of 12 residents sampled were free from physical abuse (Resident A9). Findings include: A review the facility's Abuse Protection policy dated as reviewed by the facility September 2022 revealed that The resident has the right to be free from verbal, physical and mental abuse, corporal punishment, involuntary seclusion, neglect and misappropriation of property. The facility shall have processes in place to include screening, training, prevention, identification, protection, investigation, reporting and response to allegations of potential or actual abuse. Clinical record review revealed that Resident A8 had diagnoses, which included depression. According to the resident's clinical record the resident had a history of verbal and physical aggression with other residents, including an incident on November 18, 2023. The resident's care plan revealed a problem area of physical/verbal aggression with peers last revised by the facility August 22, 2022. A quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated November 3, 2023, revealed that the resident was moderately cognitively impaired with a BIMS score of 12 (is used as an initial assessment tool to identify a resident' s cognitive function changes (a score of 8-12 indicates moderate cognitive impairment). Clinical record review revealed that Resident A9 had diagnoses, which included diabetes. A quarterly MDS assessment dated [DATE], revealed that the resident was cognitively intact and required staff assistance for activities of daily living. A review of a facility incident report and information dated December 19, 2023, submitted by the facility revealed that at 10:10 a.m. on December 19, 2023, Resident A9 was attempting to exit her room. Resident A8 was observed kicking Resident A9's shin as he self-propelled down the hallway. Staff immediately separated the residents. Interventions, which the facility noted were developed to prevent reoccurrence, was a new psych Page 1 of 15 395273 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0600 consult for Resident A8. Level of Harm - Minimal harm or potential for actual harm A review of the psych consult dated December 20, 2023, revealed new intervention was to increase resident's Seroquel, an antipsychotic drug. Residents Affected - Few The resident's care plan in place at time of survey on January 4, 2024, revealed no revisions had been made to resident's care plan to address the problem of physical aggression towards other residents following the incident on December 19, 2023, during which Resident A8 kicked Resident A9, as the previous care plan dated August 2022, was ineffective in preventing physical abuse of Resident A9. The facility failed to protect Resident A9 from physical abuse perpetrated by Resident A8. Interview with the administrator on January 4, 2024, at 2:00 PM confirmed that the facility failed to effectively manage and supervise Resident A8's behavior to prevent physical abuse of Resident A9. 28 Pa. Code 201.18 (e)(1)(3) Management. 28 Pa. Code 201.29 (a)(c) Resident Rights. 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing Services. 395273 Page 2 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to accurately monitor a fluid restriction prescribed to address a resident's clinical condition and maintain fluid balance and adequate hydration status for one resident (Resident B3) out of 12 sampled. Residents Affected - Few Findings include: Review of education provided to the facility licensed nursing staff dated November 15, 2023, indicated that all resident fluid} intakes and outputs need to have a task entered in POC (Point of Care) for accurate totaling. A review of the clinical record revealed that Resident B3 was admitted to the facility on [DATE], with diagnoses which included hypertension, chronic obstructive pulmonary disease, and malignant neoplasm (cancer) of the throat. A physician's order dated December 21, 2023, was noted for the resident to be maintained on a 1500 cc fluid restriction with the following breakdown of the fluid distribution: 7:00 AM - 3:00 PM shift nursing 240 mL and dietary 600 mL. 3:00 PM - 11:00 PM shift nursing 240 mL and dietary 240 mL. 11:00 PM - 7:00 AM. shift nursing 120 cc A review of the resident's December 2023 and January 2024 Documentation Survey Report failed to provide evidence of an accurate recording and/or accounting of the amount of fluids the resident consumed each day to assess compliance with physician ordered fluid restriction and hydration needs. An interview with the Nursing Home Administrator on January 4, 2024, at 2:15 PM confirmed that the facility failed to calculate resident's daily fluid intake. The facility was unable to confirm the amount of fluid consumed by the resident daily and if that amount of fluid consumed exceeded the physician prescribed fluid restriction or was sufficient to maintain adequate hydration. The facility was unable to provide documented evidence that this fluid restriction was maintained in accordance with physician orders. 28 Pa. Code: 211.12 (c)(d)(3)(5) Nursing services 28 Pa. Code 211.5(f) Medical records 395273 Page 3 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of nursing staffing hours and ratios, observations and resident, family and staff interviews it was determined that the facility failed to provide sufficient nursing staff to consistently provide timely quality of care and services to maintain the physical and mental well-being of the residents, in accordance with the resident's plan of care, including Resident 2. Findings include: Clinical record review revealed that Resident 2 was admitted to the facility on [DATE] with diagnosis to include diabetes, contractures of the right and left ankles, depression and anxiety and was cognitively intact. The resident's care plan revealed a problem/need of ADL deficit initiated May 30, 2022 and revised November 12, 2023, with an intervention dated August 16, 2023, for a bowel and bladder toileting program, 5 times a day at 6 AM 10 AM, 2 PM, 6 PM and 10 PM During an interview conducted on January 4, 2024 at 1:20 P.M. Resident 2 stated that nursing staff on the 11 PM to 7 AM shift provided her care, including incontinence care at approximately 6 AM that morning. The resident further stated that she received her breakfast and lunch tray, but did not receive any hygienic care prior to either meal or after those meals. She stated that she had been sitting in the same incontinence brief since 6 A.M. that morning and was currently incontinent of urine. Resident 2 stated that nursing staff do not provide care consistently and timely to meet her needs for assistance with activities of daily living, such as toileting and personal hygiene. She stated that she is unable to ambulate to the bathroom and relies on nursing staff for her incontinence care. She stated that she would like to be toileted more frequently, as per her plan of care. A review of nurse aide electronic toileting information on the day of the survey ending January 4, 2024, which had been completed as of the time of the interview with Resident 2, revealed no no documented evidence that Resident 2 was toileted at the frequency noted on her care plan. During an interview January 4, 2024 at 1:30 P.M., Employee 1, a nurse aide employed by a staffing agency, confirmed that Resident 2 had not yet received any care from staff on the dayshift. She stated that she was the only nurse aide on the floor and was working as a pair with Employee 3, (agency LPN), to provide direct care to all the residents on the third floor. She confirmed that Resident 3 had not received any care as of the time from either Employee 3 or Employee 1 as of the time of the interview. There were 40 residents residing on the third floor of the facility at the time of the survey. Staffing data revealed 3 LPNs and 1 nurse aide on duty for the 7 AM to 3 PM shift the day of the survey. One LPN, Employee 3, and the nurse aide, Employee 1, were both performing nurse aide duties for the shift. During the time period of November 2, 2023, through November 13, 2023, the facility provided an average of 2.84 hours of general nursing care per resident failing to meet the minimum state regulatory requirement for nursing time. 395273 Page 4 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0725 28 Pa. Code 211.12 (c)(d)(1)(2)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.18 (1)(3) Management Residents Affected - Some 395273 Page 5 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on staff interviews and observations it was determined that the facility failed to employ sufficient staff qualified staff to provide oversight of the food and nutrition services department. Residents Affected - Many Findings include: An interview with the Employee 2, AM cook, on January 4, 2024, at 11 AM, revealed that there was no qualified dietary manager in the facility and that the facility had employed a full-time Registered Dietitian (RD) for the past 2 weeks. However, she stated that the RD was not providing oversight of the food service and dietary department, but only performing clinical nutrition duties. Employee 2 (cook) stated that the current full-time RD only provided clinical nutrition services until the facility hired someone qualified to oversee the food service and dietary department. Observation January 4, 2023 at 12 P.M. on the third floor hallway, on the wall on the outside the resident dining room, revealed that the posted weekly resident menu (regular diet) was dated for Thursday January 11, 2024, indicating the menu for lunch was as follows; chicken vegetable stew over noodles, dinner roll, margarine, chocolate brownie, 2% milk, coffee or hot tea. A review of the menu, week one, (regular diet) dated January 4, 2024, the day of the survey, at the day's lunch was chicken tenders, dipping sauce, french fries, whole kernel corn, blushing peaches, 2% milk and coffee and hot tea. An observation January 4, 2024 at 11:45 A.M. in the facility kitchen, revealed that the lunch meal was linguini with tomato sauce, meatballs in tomato sauce, mixed vegetables and orange jello. According to the 28 Pa Code 211.6 Dietary services, records of menus and foods actually served shall be retained for 30 days. When changes in the menu are necessary, substitutions shall provide equal nutritive value. A review of the facility's dietary substitution log revealed an entry dated January 4, 2024, cycle date, week 1, lunch meal. The original meal item was noted as chicken tenders with the noted substitution as linguini with meatballs. The reason for the substitution was noted as didn't come in order. Further review of the substitution log revealed no additional food item substitutions were noted in the log. The previous noted substitution was noted to have occurred on August 22, 2019. During an interview January 4, 2024 at 2 PM Employee 2 (cook) stated that she does the food ordering and the food order comes in on Thursdays. She stated that the meal for today would have been ordered on last week's order. She stated that the chicken tenders did not come in the order that day and she decided to make linguini and meatballs for the lunch meal today. She was unable to state why the additional planned menu items, sides and desserts, were not included in the lunch meal according to the menu. Employee 2 (cook) stated that there have been many food substitutions made over the past few months. She stated that she did not know that food substitutions were to be documented in the substitution log and was only informed that day after the survey agency requested the dietary food substitution log. 395273 Page 6 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an interview with the Nursing Home Administrator (NHA) on January 4, 2024, at approximately 1:15 P.M., the NHA confirmed that the lack of a qualified staff providing oversight of the food service and dietary department and verified that the RD did not provide oversight of the kitchen, despite being employed full-time at the facility. The NHA confirmed that at the time of the survey the facility did not have a qualified dietary manager or food service supervisor. Refer F803 28 Pa Code 201.18 (e)(6) Management. 28 Pa. Code 211.6 (a) Dietary services 395273 Page 7 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and the facility's planned cycle menu, observation and staff and resident interviews it was determined that the facility failed to prepare, in advance, a nutritionally adequate menu, reflecting cultural and ethnic needs of one resident (Resident C1) and failed to follow planned menus, including the lunch meals observed served to two residents (Residents C2 and C3) out of 15 residents sampled (Resident C1). Findings include: A review of the clinical record revealed that Resident C1, was severely cognitively impaired, admitted to the facility on [DATE], with diagnoses that included dementia, muscle weakness, and vitamin deficiency. The resident dietary preferences indicated that he was a vegetarian. A review of the resident' meal tray card dated January 4, 2024, revealed that Resident C1 was to receive a regular diet and vegetarian preferences. Observation of Resident C1's lunch meal on January 4, 2024, revealed he was served mashed potatoes, mixed vegetables, pasta, peas and cut-p fruit. There were no beverages served to this resident with this lunch meal. The regular meal for the day was linguini, meatballs and jello. There was no comparable complete protein/combined protein served at this resident's lunch meal to replace the protein source, meatballs, planned for the regular diet. A review of a clinical progress note completed by the Registered Dietitian (RD) dated December 1, 2023, at 10:47 AM (last preference update) revealed that the RD Spoke with resident's grandson regarding his food preferences for a vegetarian diet. Updated food preferences in Blueprint (computer system to which the Nursing Home Administrator and the registered Dietitian RD solely have access) menu system. Family brings resident in food daily. He likes rice and bean, tofu and rice, veggie burgers, milk, cheese and peanut butter. No eggs or fish. A review of the current facility approved diet manual dated as reviewed October 2023 revealed that the diet manual did not include a pre-planned vegetarian diet. None of the resident's preferences that were identified in the RD's progress note of December 1, 2023, were provided on his lunch meal tray for protein, such as milk, beans/rice, tofu, cheese or peanut butter or cottage cheese. A review of the facility's plan of correction from the survey of October 20, 2023, regarding Resident C1's food preferences dated November 17, 2023 and November 24, 2023 revealed that Resident C1 was to receive whole milk with all meals An interview with Employee 1, a nurse aide, at the time of the lunch meal observation on January 4, 2024, revealed that Resident 1 refused his lunch tray. Employee 1 stated that he never accepted the meals served at the facility due to preferring vegetarian ethnic foods. Employee 1 stated that the 395273 Page 8 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident often refused his meal trays because he stated that they did not offer variety and mentioned that his family brought in vegetarian friendly foods to accommodate his preferences when they visit. Further observations of lunch meal services January 4, 2024, at 1:05 PM, revealed that Resident C1 was not offered alternatives/a meal substitute to reasonably accommodate his cultural preferences, or any nutritional supplements. A review of a dietary note dated January 4, 2024, at 12:51 P.M. revealed Weight Change Note Resident 1's weight on January 3, 2023 was 140.1#, a -3.0% change from last weight [ Comparison Weight 12/24/2023, 145.4#, -3.6%, -5.3#] Triggered for a weight loss in 10 days. Tolerating a regular, vegetarian diet. Will accept milk, milk products, eggs, veggie burgers, (try/offer yogurt, quinoa for variety). By mouth intake fluctuates from 0 to 25 to 76 to 100% depending what is on tray and what responsible party (RP) brings. RP brings resident supper meals daily (when able) consisting of vegetarian Indian foods including curry, rice, beans. He likes the home cooking and the company of family. He does like our food as well per RP. Receives ProHeal 30 ml's (a liquid protein supplement) BID, intake averages 59% over the past week and Boost liquid nutritional supplement 4 oz BID, average intake over the past week 79%. Interventions: Regular vegetarian diet. Monthly weights. ProHeal 30 ml BID Boost 4 oz BID. Add 4 oz nutritional dessert cup BID. Honor food preferences. Monitor: PO intake, weights and labs. The facility failed to provide a regular pre-planned nutritionally balanced vegetarian diet and failed to reasonably accommodate the resident's food preferences. During an interview on January 4, 2023 at 1:30 PM the facility's RD stated that the facility corporation informed her at the time of the facility's submitted plan of correction for the deficiency cited under the requirement for pre-planned menus during October 20, 2023 survey that the facility's diet manual did not have a diet exchange for vegetarian diet. She further stated that for the noted plan of correction, she had made up a 7 day vegetarian meal plan that included suggested meals. She confirmed that the facility's dietary department was not following the suggested meals. She further stated that she could not determine the resident's protein intake based on his meal intake to ensure adequate nutritional intake because she was unaware of the foods the resident's actually consumed and what he was served varied. She confirmed that Resident 1 continued to have weight loss. An interview on January 4, 2024 at 1:45 PM Employee 2 (cook) stated that there are no menus to follow for Resident 1's vegetarian meals. She stated that she just puts non-meat items that are being served at the meal on his trays. She stated that his family brings in food from home for him and he doesn't eat the food on his meal trays. An interview on January 4, 2024, at 2 P.M., the Nursing Home Administrator (NHA) confirmed that the facility diet manual did not contain a vegetarian preference planned diet exchange that had been developed to assure nutritionally adequacy and for staff in the dietary department to reference when serving the resident's meals. The NHA confirmed that the facility failed to plan, in advance, a nutritionally complete vegetarian diet to meet Resident 1's nutritional needs with real food versus daily reliance on family supplied food items. 395273 Page 9 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Clinical record review also revealed that Resident 1 continued to have weight loss in one month (December 2023 - January 2024). Observation January 4, 2023 at 12 PM on the third floor hallway, the wall on the outside the resident dining room, the posted weekly resident menu (regular diet) was dated for Thursday January 11, 2024, indicating the menu for lunch as follows: chicken vegetable stew over noodles, dinner roll, margarine, chocolate brownie, 2% milk, coffee or hot tea. A review of the menu, week one, (regular diet) dated January 4, 2024, (the day of the survey) lunch meal revealed chicken tenders, dipping sauce, french fries, whole kernel corn, blushing peaches, 2% milk and coffee and hot tea were to be served at the lunch meal. An observation January 4, 2024 at 11:45 A.M. in the facility kitchen, revealed that the lunch meal being served was linguini with tomato sauce, meatballs in tomato sauce, mixed vegetables and orange jello. Clinical record review revealed Resident C2 was admitted to the facility on [DATE] and had a physicians order dated November 19, 2022 for a 2 gram sodium, regular texture diet. A review of the resident's current lunch tray ticket dated January 4, 2024 revealed Resident C2 was to receive apple juice, 2 % milk, 8 fluid ounces, chicken tenders, french fried potaotes, whole kernel corn, coffee/hot tea and dipping sauce. An observation January 4, 2023 at 1:10 P.M., revealed that the resident was served linguini with tomato sauce, meatballs, orange jello, a cup or apple juice and 8 ounces of whole milk. Clinical record review revealed that Resident C3 was admitted to the facility on [DATE], with a diagnosis of stage 4 chronic kidney disease. The resident a current physician order dated December 7, 2023, for a liberal renal diet, regular texture. An observation January 4, 2023 at 1:14 PM revealed that the the resident was served linguini with tomato sauce, meatballs, orange jello and 8 ounces of whole milk. A review of Resident C3's lunch tray ticket dated January 4, 202, that the resident was to have received blushing peaches, fruit punch (8 ounces), chicken tenders, 1/2 cup rice or noodles, whole kernel corn, coffee or hot tea and dipping sauce. A review of the facility diet manual for the planned liberal renal diet, revealed that at the meal during which linguini/meatball entree was planned at lunch the following (based on the food items cooked for the lunch meal on January 4, 2024) menu should have been served to Resident C3: Meatballs (no tomato sauce) noodles. Further review of the diet manual, menus for the fall/winter 2023-2024 schedule indicated that the entire lunch meal was planned as: meatballs/noodles 395273 Page 10 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0803 garden salad with dressing Level of Harm - Minimal harm or potential for actual harm garlic bread sherbet Residents Affected - Some fruit punch and coffee /tea The facility failed to serve the correct planned therapeutic diet to Resident C3 at lunch on January 4, 2024. A review of the facility dietary substitution log revealed an entry dated January 4, 2024, cycle date, week 1, lunch meal. The original meal item was noted as chicken tenders. The noted substitution was linguini with meatballs and the reason for the substitution was noted as didn't come in order. The substitution log revealed no additional menu substitution since August 22, 2019. During an interview January 4, 2024 at 2 PM Employee 2 (cook) stated that she does the food ordering and the food order is delivered to the facility on Thursdays. She stated that the food for the today's lunch meal would have been ordered on last week's order. She stated that the chicken tenders did not come in the order that day and she decided to make linguini and meatballs for the lunch meal today. She was unable to state why the additional planned menu items, sides and desserts, were not served with the lunch meal. Employee 2 (cook) stated that there have been many food substitutions made over the past few months. She stated that she did not know that food substitutions were to recorded on a substitution log to maintain a record of the foods actually served to residents. Refer F 801 28 Pa. Code 211.6 (a) Dietary services 395273 Page 11 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, resident and staff interview, test tray results, and a review of select facility policy, it was determined that the facility failed to provide meals that are served at safe and palatable temperatures. Residents Affected - Some The findings include: Review of the current facility policy entitled Temperatures indicated that all hot food items must be held and served at a temperature of at least 135 degrees Fahrenheit and cold food items must be maintained at served at a temperature of 41 degrees Fahrenheit or below. A test tray was performed on the third floor on January 4, 2024, at 1:15 PM. Observation revealed that the lunch tray delivery cart arrived on the unit at 12:27 PM and nursing staff began passing lunch trays at 12:38 PM. The final tray was passed at 12:43 PM, a test tray was tested. Acceptable temperature for hot foods should be >/= 135 degrees Fahrenheit and cold food should be </= 41 degrees Fahrenheit. The test tray food temperatures results were as follows: linguini was at 120 degrees Fahrenheit, meatballs were at 100 degrees Fahrenheit, mixed vegetables were at 110 degrees Fahrenheit, and jello with whipped topping was at 85 degrees Fahrenheit. When tasted, the hot items were lukewarm and tasted bland without seasoning/flavor. The whipped topping was running down the sides jello as it was not sufficiently chilled and not served at a palatable temperature. An interview January 4, 2024 at 1:20 P.M., Resident 2 stated that the food served in the facility was lousy and bad. She stated that the hot food it is often cold. She stated that she is to get cold cereal on all her trays and did not receive any on her lunch tray for the lunch meal during the observation. She stated that she often does not receive the items noted on her meal ticket. Interview with the Nursing Home Administrator on January 4, 2024, at 2 PM, confirmed that the above food and beverage temperatures were not served at acceptable temperature parameters or at palatable temperatures. 395273 Page 12 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on observations, review of the statement of deficiencies from the survey ending October 20, 2023, and the activities of facility's quality assurance committee and staff interviews it was determined that the facility failed to implement effective plans to correct quality deficiencies in food and nutrition services, including planned nutritionally adequate menus, sufficient qualified staff, food temperature and taste, and hydration to ensure that corrective action plans designed to improve the delivery of care and services were consistently implemented to correct and deter future quality deficiencies. Findings included: During the survey ending October 20, 2023, quality deficiencies were cited under the requirements for nutrition/hydration, qualified dietary staff, planned menus, taste, and temperature and appearance of food. In response to these deficiencies, the facility developed plans of correction to correct the deficient practices that included quality assurance monitoring plans to assure solutions were sustained. These corrective plans were to be completed and functioning by December 12, 2023. However, during this revisit survey completed on January 4, 2024, continued deficiencies were identified under these same requirements. According to the facility's plan of correction for the deficiency cited under qualified dietary staff during the survey of October 20, 2023, the facility hired a part-time RD effective 10/23/23. The facility was actively seeking a full-time Dietary Manager through the centralized recruitment team and advertising. NHA will continue to interview potential candidates for the Dietary Manager Position. Completion (of the plan of correction ) once full time Dietary Manager is hired by December 12, 2023. The part time RD became full time at the facility on December 12, 2023 and at the time of the survey there was no qualified certified dietary manager. An interview with the Employee 2, AM cook, on January 4, 2024, at 11 AM, revealed that there was no qualified dietary manager in the facility and that although the facility employed a full-time Registered Dietitian (RD) for the past 2 weeks the RD provided no oversight of the facility's food service operations and dietary department. She stated that the RD was not providing oversight of the dietary department. Employee 2 (cook) stated that the current full-time RD only provided clinical nutrition services to residents and was working full-time until the facility hired someone qualified to oversee the dietary department. In response to the deficiency cited under failing to pre-plan and follow menus, the facility's plan of correction noted that that the RD was to develop pre planned written menu for vegetarian diets. RD will assist residents with meal selections/menus to meet individual preferences. RD to complete facility wide nutritional audit to ensure all residents are receiving adequate nutrition in line with resident personal preferences. Audits to be submitted to QAPI for review and recommendations. At the time of this revisit survey, continued deficient practice was identified under this same requirement whereas the facility failed failed to provide a pre-planned nutritionally adequate menu for 395273 Page 13 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the same resident and those desiring a vegetarian diet. The facility also failed to serve planned menus for the regular and renal diets according to the planned menu. In response to the deficiency cited during the October 20, 2023, survey in the area of food temperatures and palatability the facility's plan of correction was that the NHA was currently seeking repairs and replacement equipment quotes as necessary. Nursing staff to be re-inserviced on timely passing of resident trays once tray carts on the units. RD to in-service dietary staff on the appropriate preparation and appearance of food items. Facility dept. heads to continue food cart audits to ensure timely passing of trays once food carts on are the units. RD to monitor and audit food preparation techniques by dietary personnel three times per week for four weeks, weekly for four weeks, and monthly for two months. Audits to be submitted to QAPI for review and recommendations. At the time of this revisit survey, continued deficient practice was identified under food temperature and palpability. The facility failed to serve meals at safe and palatable temperatures. In response to the deficiency cited under hydration at the time of the survey ending October 20, 2023, the facility's plan of correction indicated that PCC (point click-care) was updated to reflect Resident #67's documentation of fluid intake by licensed staff. RN/LPN to document amount of fluid intake in POC q shift for all residents with fluids restrictions. For Resident # 48 and Resident # 5, if there is a weight discrepancy noted on scheduled weight, a reweight will be immediately obtained by CNA and RN/LPN. RD or designee will initiate staff education, to nursing staff, on facility weight protocol and discrepancies. DON or designee will educate licensed nursing staff on MD/RR dietary notifications/recommendations. 4. RD or designee will perform audit of fluid intakes, weight protocols/discrepancies, and MD/RR notifications three times per week for four weeks, weekly for four weeks, and monthly for two months. Audits However, at the time of this revisit survey ending January 4, 2024, it was determined that the facility failed to accurately monitor a fluid restriction prescribed to address a resident's clinical condition and maintain fluid balance and adequate hydration status for one resident (Resident B3) out of 12 sampled. The facility's quality assurance monitoring plans failed to identify these ongoing deficient practices and continued quality deficiencies. The facility's QAPI committee failed to identify that the facility's corrective action plans were not developed and/or implemented in a manner consistent with the regulatory guidelines for these deficiencies cited, to ensure that solutions to the problems were sustained. Refer F801, F803, F804, F692 28 Pa. Code 211.12 (c) Nursing services 28 Pa. Code 201.18 (e)(1)(3) Management. 395273 Page 14 of 15 395273 01/04/2024 Embassy of Scranton 824 Adams Avenue Scranton, PA 18510

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation and staff interview, it was determined the facility failed to maintain necessary electrical equipment in safe operating condition in the kitchen. Residents Affected - Many Findings include: A tour of the facility's kitchen on January 4, 2024, at approximately 10:00 AM revealed the steam table (a table having openings to hold containers of cooked food over steam or hot water circulating beneath them) was not fully functional. An interview at the time of the observation, Employee 1 (cook) stated that the steam table had been broken for months. She stated that it was operable, but if the temperature dial was placed to 8 ( the temperature was noted on the dial as 1, least hot to 10, most hot for holding food) whenever the steam table was in use the steam table would short out. She stated that the dial should be placed on 10 to provide the optimal heating capacity to keep hot foods at a safe temperature while in serving pans in the table and plating resident meals. Employee 1 (cook) stated that if the temperature was placed over 8 it would short out the table (electricity cut off). She further stated that pre-service food temperatures were taken when the food was placed in the steam table, but the temperatures were not monitored throughout the meal plating during meal service to ensure adquate food temperatures was maintained due to the malfunctioning steam table. An interview with the Nursing Home Administrator (NHA) on January 4, 2024, at 2 PM revealed NHA confirmed that the steam table had been broken since October 2023. The NHA also confirmed that she was unaware of any plan for monitoring food temperatures during meal plating service in the kitchen to ensure adequate hot food temperatures were maintained. 28 Pa. Code 201.18 (e)(2.1) Management 395273 Page 15 of 15