Health inspection·February 14, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some him a party. He also stated that he called the facility around 8:30 PM and left a voice mail. I advised he cannot be out passed midnight if he did not already state that he would be out that long. He understood and said he is coming back. A review of a nurse's note dated June 6, 2023, at 12:51 AM revealed called {Resident A1) again at 12:51 AM resident stated he is on his way, the person driving him had to stop for gas. A review of a nurses note dated June 6, 2023, at 01:09 AM called resident again, resident states he is 15 minutes away. Nursing noted on June 6, 2023, at 01:37 AM revealed that Resident A1 was now back to facility and in room. A nurse's note dated August 4, 2023, at 5 PM revealed that Resident A1 was on LOA with family. Nursing noted on August 4, 2023, at 11:03 PM revealed nurse reported to this RN that resident isn't back to the facility. I advised calling him and when nurse called resident stated he is 15 minutes away. A nurses note dated August 5, 2023 at 02:00 AM revealed Nurse reported to this RN that resident isn't back to the facility. I advised calling him and when nurse called resident stated he is 15 min away. A review of a nurses note dated August 5, 2023, at 02:59 A.M. revealed that Resident A1 was back to facility now A nurses note dated August 19, 2023, at 4 PM revealed, Resident LOA with friends to clean a house. A review of a nurses note dated August 20, 2023 at 12:14 AM revealed Resident not yet back in the facility, gave him a call and he said he was coming. A review of a nurse's note dated August 20, 2023, at 04:01 AM revealed gave Resident a call and he confirmed he would be here shortly. Nursing noted on August 20, 2023 at 06:22 AM revealed that the resident not yet back from his evening out. A review of nursing documentation dated August 20, 2023 at 07:05 AM, revealed Resident telephone line not recharged, voice mail left on the sister's phone. A nurses note dated August 20, 2023 at 08:28 AM revealed that the resident returned back to the facility. A review of a nurse's note dated September 20, 2023, at 6:08 P.M. revealed Resident LOA to a friend's house. Resident stated he'll be back some time tonight. A review of a nurses note dated September 20, 2023, at 11:39 PM revealed Resident called the facility to let this Nurse know that he was waiting for his ride and he would be back to the facility in about an hour. The resident was educated about coming back to the faculty on time. A review of a nurses note dated September 21, 2023 at 1:32 A.M. revealed Resident called the facility at 1:30 A.M. to let this Nurse know that he was still waiting for his ride. RN Supervisor made aware. A review of a nurses note dated September 21, 2023, at 4:22 AM revealed that the resident had yet to return to the facility. A review of a nurses note dated September 21, 2023, at 07:09 AM revealed Resident LOA from facility for the tour of the shift. Spoke to resident several times during the night which he stated that he was waiting for a ride home. RN Supervisor made aware of the resident status. Will report to on boarding Nurse. A review of a nurses note dated September 21, 2023 at 08:42 A.M. revealed that the resident had returned to facility from LOA. The resident had been out of the facility from September 20, 2023, until September 21, 2023, at 8:42 AM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 2 of 5 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 395273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Scranton 824 Adams Avenue Scranton, PA 18510 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 0656 Level of Harm - Minimal harm or potential for actual harm A review of a facility investigation dated February 2, 2024, at 6:41 PM revealed that on February 1, 2024, at 2:05 PM Resident A1 left the facility with a friend. He had verbalized to nursing staff at approximately 12:45 PM that he would not be needing lunch as he would be going out. The report noted that the resident did have an LOA (leave of absence) physician order and was aware of the facility policy to sign out with nursing prior to leaving the facility. Residents Affected - Some However, the resident left the facility without signing out according to the facility LOA policy. The report further indicated that nursing staff attempted to contact the resident via his personal cell phone at approximately 4:38 AM on February 2, 2024, as the resident had yet to return to the facility. The resident did not answer his cell phone. Staff contacted the resident's emergency contact #2 and she did not know where the resident was at that time. The RN charge nurse was made aware per a nurses note in the clinical record. The Nursing Home Administrator (NHA) arrived at the facility at 7 AM on February 2, 2024. After reading the clinical nursing shift report, the NHA asked nursing staff if Resident A1 had returned to the facility as there was no documentation of the same in the resident's clinical record. Nursing staff, at that time had reported to the NHA that Resident A1 was still on leave of absence since 2:05 PM on February 1, 2024. The immediate action noted was the NHA attempted to contact the resident via his personal cell phone three times, but the resident did not answer. A facility and ground search was conducted. All hospitals in the county were contacted for possible hospital admission. The local police department was contacted and a missing person report was filed. On the facility security camera system, the NHA was able to identify the license plate number of the resident's friend who had left the facility with the resident. The resident was located at a local hotel with a friend by the local police department. The resident was deemed safe by the police and offered him a ride back to the facility by the facility van. Resident A1 refused, he reported to the NHA that he would be returning to the facility via his friend's car as soon as possible. Resident A1 returned to the facility February 2, 2024 at 12:48 PM. The care plan was not updated until February 2, 2024, to include the following {Resident A1} was made aware by the nursing home administrator and social services director, regarding facility policy of leave of absence and expresses understanding of same. During an interview on February 14, 2024, at approximately 2:00 p.m., the Nursing Home Administrator (NHA) confirmed that the facility failed to timely address the resident's repeated behavior of leaving the facility for extended periods of time without the facility's knowledge of his whereabouts and continued non-compliance with the facility's leave of absence policy to ensure resident safety. 28 Pa. Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 3 of 5 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 395273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Scranton 824 Adams Avenue Scranton, PA 18510 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 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. Based on observation and a review of clinical records and staff and resident interviews it was determined that the facility failed to efficiently deploy sufficient nursing staff to consistently provide timely quality of care and services to maintain the physical and mental well-being of the residents in the facility, including experiences reported by four out of 10 residents sampled (Residents B1, B2, B3, and B4). Findings include: During interview with Resident B1, a cognitively intact resident, on February 14, 2024, at 12:40 PM the resident stated that nursing staff do not answer call bells timely and residents must wait times more than 15 minutes. Resident B1 stated that staff are busy and today and as result morning hygiene care was not provided as of 12:40 PM. Resident B1 stated that the facility has also reduced showers from twice per week to just once per week because of insufficient nurse staffing to provide showers twice a week. During interview with Resident B2, a cognitively intact resident, on February 14, 2024, at 12:50 PM the resident stated when she rings for nursing staff assistance on the night shift for a brief change, the wait time for nursing staff to respond is often more than 30 minutes. Resident B2 stated that the facility is now only offering one shower per week because of staffing, and that she prefers two showers per week. Observation on February 14, 2024, at 1:05 PM revealed that Resident B3 was in bed wearing a hospital gown. During interview with Resident B3, a cognitively intact resident, at this time the resident stated that he is one of the last residents to get care in the morning. Resident B3 stated that he does not like to complain, but staff say they will get to me but it's 1:05 PM and the resident was still in bed, and not up and dressed for the day. Resident B3 stated that his preferred time to get up is between 10:00 AM and 10:30 AM. Resident B3 stated that his brief was last changed between 5:00 AM and 6:00 AM that morning, and it was now 1:05 PM. Resident B3 stated that ringing the call bell to request assistance from nursing staff is a joke because nursing staff do not answer. Resident B3 stated that he feels the facility is short on nursing staff because of the lack of response to call bells and untimely care. Interview with Employee 1 (agency nurse aide) on February 14, 2024, at 1:10 PM confirmed that when she works at this facility residents frequently complain about call bells not being answered and timely care not being provided. During interview with Resident B4 on February 14, 2024, at 1:15 PM, revealed that the resident stated that her preferred time for morning care is 10:00 AM. Resident B4 stated that she rang the call bell for nursing staff assistance at 10:45 AM, this morning, because nursing staff had not come in yet to change her brief and provide care. Resident B4 stated that that Employee 2 (agency nurse aide) answered the call bell but was then was called out of the room to go to do resident weights. Resident B4 stated that Employee 2 (agency nurse aide) did not return and provide care until approximately 11:30 AM. Interview with Employee 2 (agency nurse aide) at approximately 1:30 PM confirmed that at approximately 11:00 AM she entered Resident B4's room to answer the resident's call bell and provide morning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 4 of 5 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 395273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Scranton 824 Adams Avenue Scranton, PA 18510 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some care but was called out of the room to obtain residents' weights which further delayed Resident B4's care by approximately 10 minutes. During interview on February 14, 2024, at approximately 2:45 PM the administrator confirmed that facility does not consistently have sufficient nurse staffing to provide more than one shower per week to residents. The administrator failed to provide evidence that the facility consistently deploys sufficient nursing staff in a manner to provide timely quality of care and services to residents as desired by residents. 28 Pa. Code 211.12 (c)(d)(1)(2)(5) Nursing services 28 Pa. Code 201.18 (b)(e)(1)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 5 of 5