Inspection visit
Health inspection
5 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 5 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of clinical records and staff interview, it was determined the facility failed to timely notify the
resident's responsible representative of a change in condition for one resident out of 6 sampled (Resident
5).
Findings include:
A review of the clinical record revealed that Resident 5 was admitted to the facility on [DATE], with
diagnoses which included diabetes mellitus (commonly referred to as diabetes, is a group of metabolic
diseases in which there are high blood sugar levels over a prolonged period) and dementia (a condition in
which a person loses the ability to think, remember, learn, make decisions, and solve problems).
A review of a nurses note dated June 24, 2024 at 1:08 P.M. revealed, Resident 5 was complaining of right
upper extremity pain and edema (swelling) and the CRNP(certified registered nurse practioner) was made
aware. A new order noted for Doppler study (Doppler ultrasound is a noninvasive test that can be used to
measure the blood flow through the blood vessels. It works by bouncing high-frequency sound waves off
red blood cells that are circulating in the bloodstream. A regular ultrasound uses sound waves to produce
images, but can't show blood flow) of the resident's left upper extremity(LUE)
A review of a nurses note dated June 24, 2024 at 8:36 P.M. revealed, Venous doppler results received for
LUE due to edema and pain results showed no DVT (deep vein thrombosis, is a condition in which blood
clots (or thrombi) form in deep veins in the legs or other areas of the body. Veins are the blood vessels that
carry blood from the body's tissues to the heart. Deep veins are located deep in the body, away from the
skin's surface) and a large hematoma (collection of blood) of the resident's left forearm.
A nurses note dated June 25, 2024 at 12:44 P.M. revealed, Resident 5's LUE remains swollen, the resident
denied pain at this time and was seen by CRNP.
A nurses note dated June 27, 2024 at 06:32 A.M. revealed, Resident 5 woke up this morning crying and
yelling at staff and complained of left arm pain. The resident refused any pain medications.
A review of a CRNP note dated June 27,2024 at 11:04 A.M. revealed, Resident 5 was seen for medical
follow up re: left forearm edema/pain, panful but ice to arm helping. Resident does not want to keep taking
Tylenol. States today that she is unable to use left hand due to pain, she will not perform active ROM (
range of motion) or hand flexion/extension.
(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 11
Event ID:
395273
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
08/09/2024
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 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
According to this CRNP note te resident's left forearm is without bruising, redness, wounds. +1 non pitting
edema (pitting edema is graded on a scale from 1 to 4, which is based on both the depth the pit leaves and
how long the pit remains. A score of 1 has edema that is slight (roughly 2 mm in depth) and disappears
rapidly present at forearm). Good radial pulse but the resident is unable to fully extend and contract her left
hand. The CRNP was unable to assess the resident's strength due to this edema. The resident has bruising
noted into her phalanges (fingers).
Documentation dated June 27, 2024 at 2:06 P.M. revealed, new orders to obtain an X-Ray of the resident's
left arm, forearm & wrist regarding swelling.
A nurses note dated June 28, 2024 at 10:43 A.M. revealed the resident's left arm remains swollen and firm
and she complained of numbness in her left hand, with no discoloration. A new order by CRNP, indicated
send the resident to the emergency room for evaluation. The note indicated the resident and te responsible
representative is aware.
A nurses note dated June 29, 2024 at 12:50 A.M. revealed, the Resident was admitted to the hospital with
compartment syndrome ( a condition in which increased pressure within one of the body's anatomical
compartments results in insufficient blood supply to tissue within that space. Compartments of the leg or
arm are most commonly involved).
There was no documented evidence that the resident's resident representative was informed of the
changed in the residents condition until she was admitted to the hospital on [DATE]. The resident's
responsible representative was not made aware of the resident's reports of pain and swelling when initially
began on June 24, 2024 requiring assessment and testing.
An interview with the director of nursing on August 9, 2024, at approximately 2:00 PM confirmed the facility
failed to notify the resident's representative in a timely manner of the change in condition of the residents
left arm, swelling and pain and numbness.
28 Pa Code 211.12 (c)(d)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 2 of 11
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
08/09/2024
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 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
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, select facility policy facility documentation, and staff interview, it was determined
the facility failed to ensure that three residents out of 6 sampled were free from physical abuse (Residents
2, 3 and 4).
Findings include:
A review of facility policy entitled Abuse Reporting and Investigation (no revision date available) revealed,
the facility will thoroughly investigate all reports of suspected or alleged abuse.
Clinical record review revealed Resident 2 was admitted to the facility on [DATE] with diagnosis to include
but not limited to, psychosis, mood disorder, intermittant explosive disorder and seizure disorder.
An annual minimum data set assessment (Minimum Data Set - a federally mandated standardized
assessment conducted at specific intervals to plan resident care) dated May 3, 2024 indicated he was
moderately, cognitively impaired with a BIMS score of 9 (Brief Interview for Mental Status. The BIMS test is
used to get a quick snapshot of how well you are functioning cognitively at the moment 8 to 12 points
suggests moderate cognitive impairment) and required assistance from staff for activities of daily living.
A review of the resident's care plan dated January 22, 2024, indicated the resident has the potential to
demonstrate physical/verbal abusive behaviors towards peers and staff, it is noted he has a history of
kicking, punching and slapping peers, throwing things, kicking other residents wheelchairs, holding scissors
and pointing them at staff with refusal of giving up the scissors all related to intermittent explosive disorder.
The documented interventions for these behaviors include:
When the resident becomes agitated: Intervene before agitation escalates;
Guide the resident away from source of distress;
Engage the resident in calm conversation;
If the resident's response is aggressive, staff are to walk calmly away and approach the resident at a later
time;.
Assess the resident's coping skills and support system;
Analyze the residents behaviors for key times, places, circumstances, triggers, and what de-escalates the
resident's behavior and include documentation of the resident's behaviors.
A review of a facility investigation documentation dated May 9, 2024 at 11:00 A.M., revealed Resident 3(
cognitively intact with a BIMS score of 15) was self propelling in the hallway on her way to the activity room.
As she approached the end of the hallway, Resident 2 was sitting outside of his
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 3 of 11
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
08/09/2024
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 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
room and attempted to block Resident 3 from passing him (which she needed to do in order to get to the
activity area). When Resident 3 asked Resident 2 to move, Resident 2 wiggled the handles of her
wheelchair. Resident 2's physical touch to Resident 3's wheelchair was witnessed by the activity assistant.
A housekeeper heard residents shouting and responded and witnessed Resident 2 kick the back of
Resident 3's wheelchair as he began began cursing at her. The staff immediately separated the residents.
Resident 3 reported to staff that Resident 2 hit me on my arms and kicked me.
Resident 2 stated as documented indicated, I did it because I could. I did not kick her, I shook her chair.
New interventions to prevent this behavior for Resident 2 include a psychiatric evaluation and a change of
his room.
A nurses note dated June 2, 2024 at 3:45 P.M. revealed, Resident 2 was angry with Resident 4 and almost
went physical but was separated by the staff and sent to his room, Resident 2 issued threats to this
Resident 4 by telling him it's not over, hence keeping an eye on him.
On June 3, 2024 at 8:30 A.M., Resident 4 was seated in his wheelchair at the nurses station, taking his
medication and accidently spilled his drink on the floor. Resident 2 came out of his room and started yelling
at Resident 4 stating you are a scum bag and you pissed on the floor. Nursing staff separated the residents
and redirected both to their rooms. At 9:00 A.M. both residents were in the hallway. Resident 2 stood up
from his wheelchair and hit Resident 4 in the face with a closed fist. Resident 2 stated to Resident 4 that he
is going to continue going after him because he can and no one is going to stop him!.
The staff separated the residents. Resident 4 was noted with a nose bleed and received treatment and was
sent to the hospital for an evaluation.
A nurses note dated June 3, 2024 at 2:38 P.M., revealed due to te physical altercation between Resident 2
and Resident 4, Resident 2 was a 302 commitment ( A 302 commitment in Pennsylvania is an involuntary
commitment for psychiatric placement at an inpatient psychiatric unit) to a local hospital and then
transferred to an out of area (Philadelphia PA) psychiatric hospital for treatment.
A Nursing Note dated June 12, 2024 at 5:25 PM revealed, Resident 2 returned to facility around 2:55 PM
from the hospital.
Interventions dated June 14, 2024 to prevent re occurrence of Resident 2's behavior include, hospitalization
for noted behaviors and redirection from any interaction with Resident 4.
There was no evidence that effective interventions were put into place after the physical altercation initiated
by Resident 2 on Resident 3 on May 9, 2024 in an attempt to prevent any future altercations initiated by
Resident 2, resulting in an additional physical altercation between Resident 2 and Resident 4 and causing
injury, a bloody nose.
During an interview on August 9, 2024, at approximately 11:00 AM, the DON (director of nursing) and NHA
(nursing home administrator) confirmed the facility failed to protect the above residents from physical abuse
perpetrated by Resident 2. The DON and NHA confirmed that residents have the right to be free from
abuse, including physical abuse perpetrated by other residents.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 4 of 11
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
08/09/2024
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 0600
28 Pa. Code 201.14 (a) Responsibility of licensee
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code 201.18(e)(1) Management
28 Pa. Code 201.29(a) Resident Rights
Residents Affected - Some
28 Pa. Code 211.12(d)(5) Nursing Services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 5 of 11
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
08/09/2024
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 0626
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds
bed-hold policy.
Based on review of clinical records, facility policy provided to residents upon transfer from the facility, and
interview with facility staff revealed the facility failed to demonstrate the implementation of specifically
delineated procedures for Medicaid payor source bed holds and the provision of notices of the facility's bed
hold policy in an understandable language that allow a resident to return to the facility after a transfer to the
emergency room for one resident out of six reviewed. (Resident 5).
Findings include:
A review of a facility policy, Discharge/Transfer Letter Policy and Bed Hold Notices for bed-holds and
returns, (policy review date unavailable at the time of the survey), revealed, prior to transfers and
therapeutic leaves, residents or resident representatives will be informed in writing of the bed-hold and
return policy.
The policy revealed the residents may return to and resume residence in the facility after hospitalization or
therapeutic leave as outlined in this policy.
Prior to a transfer, written information will be given to the residents and the resident representatives that
explain in detail:
-the rights and limitations of the resident regarding bed-holds
-the reserve bed payment policy as indicated by the state plan (Medicaid)
-the facility per diem rate required to hold a bed(non-Medicaid residents), or to hold a bed beyond the state
bed-hold period (Medicaid residents) and
-the details of the transfer (per the notice of transfer).
If a Medicaid resident exceeds the state bed-hold limit and/or non-Medicaid residents who request a
bed-hold are responsible for the facility's basic per diem rate while his or her bed is held.
A review of Resident 5's clinical record revealed the resident was under managed care Medicaid insurance
at the time of the transfer to the hospital on July 5, 2024, due to a change in clinical condition.
A review of the copy of the facility's bed hold policy form prepared for Resident 5's transfer by the facility
staff revealed that a vacant bed will be held while the resident is at the hospital or on therapeutic leave,
Medicaid will pay the following:
Hospitalization 15 days and Therapeutic leave 30 days. During this time, the resident is permitted to return
and resume residence in the facility.
If the hospitalization or therapeutic leave exceeds the number of days indicated above, the resident will be
readmitted immediately upon the first availability of a vacant bed in a semi-private room if:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 6 of 11
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
08/09/2024
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 0626
Level of Harm - Minimal harm
or potential for actual harm
the resident requires the services provided by the facility, and if the resident is eligible for Medicaid nursing
facility services.
If the resident is transferred with the expectation that he or she will return, but it is determined that the
resident cannot return, that resident will be formally discharged .
Residents Affected - Some
The resident will be permitted to return to an available bed in the location of the facility that he or she
previously resided. If there is not an available bed in that part, the resident will be given
the option to take an available bed in another distinct part of the facility and return to the previous part of
the facility when a bed becomes available.
A review of a facility form for Resident 5 entitled Notification of Transfer, Emergency dated July 5, 2024, as
per the facility's admission agreement, the facility shall transfer/discharge a resident, when the facility
determines that such action is appropriate to meet the resident's needs for health care or other services.
This is to inform the resident that, (no resident name indicated on the form) will be transferred/discharged to
the hospital on July 5,2024 for the following reasons, psychiatric behaviors. This form was not signed by a
facility staff member and was noted to be mailed.
There was no evidence at the time of the survey the resident or her responsible party received the bed
hold/transfer form.
A review of a care plan dated April 13, 2024 revealed, Resident 5 has exhibited increased
behavioral symptoms-verbal/ physical abuse: racial slurs, yelling, hitting, throwing items at staff, cursing,
shouting orders, talking down to her roommate, making discriminatory statements towards staff, accusatory
statements towards staff, refusing to remove stored food from her room, and accusing others of stealing
from her and placing calls to 911.
Interventions implemented include Resident 5 prefers not to have African American staff provide care to
her.
A review of nursing documentation dated July 5, 2024 at 10:10AM revealed that Resident 5 was delusional,
making racial slurs to African American staff, the resident kicked a nurse aide in the stomach, and
continues to accuse room mate of stealing her belongings and money and threatens to hurt her. The
resident spit on the nursing supervisor and stated I will kick you in the face. The Director of Nursing made
the decision to send the resident to the hospital for an evaluation.
A review of a nursing documentation dated July 5, 2024 at 10:40 AM revealed the resident agreed to go to
the hospital for an evaluation, but she refused to go to a psychiatric facility. Resident 5 was then transferred
to the emergency room of the hospital for an evaluation.
A review of a nurses note written by the Director of Nursing, dated July 8, 2024 at 7:13 PM revealed, the
facility received a call from the hospital on Sunday July 7, 2024 regarding the resident, inquiring if she is a
bed hold or not. The hospital social worker stated that resident 5 was admitted to the hospital for a
UTI(urinary tract infection). This nurse (DON) informed social worker that resident 5 was not sent to the
hospital for a UTI, she was sent to the hospital for a psychiatric evaluation. She is know to have a bipolar (a
serious mental illness characterized by extreme mood swings,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 7 of 11
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
08/09/2024
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 0626
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
a mood disorder that causes radical emotional changes and mood swings, from manic, restless highs to
depressive, listless lows. Most bipolar individuals experience alternating episodes of mania and depression)
diagnosis and the resident's daughter is refusing to put her on (psychoactive )medication. The condition for
Resident 5's readmission to the facility, according to the DON, is for the resident and her daughter to agree
to start treatment of behavior medication. At this time the facility is unable to meet the residents needs due
to verbal abuse of staff and other residents. The DON will inform MD.
There was no evidence at the time of the survey of any additional information regarding Resident 5's
readmission to the facility. There was no discharge plan for this resident at the time of her admission to the
hospital.
There was no documented evidence at the time of the survey ending August 9, 2024, that Resident 5 was
afforded the opportunity to return to the facility after a stay in the hospital for a UTI.
During an interview August 9, 2024, the DON stated that Resident 5 and her daughter refused to accept
psychoactive medications. She stated that Resident 5 did not want certain nursing staff members taking
care of her. The DON stated that there were not enough staff that the resident would allow to care for her.
The DON stated that because of this, the facility could not meet this residents needs.
The facility had evaluated the resident's ability to return to the facility based on her past behavior, when
originally transferred to the hospital and the resident's clinical record failed to show that the facility made
efforts to work with the hospital to ensure the resident's condition and needs were able to be met by the
facility.
The facility was unable to provide documented evidence of the resident's or the resident's representative
decision to decline or accept the bed hold.
28 Pa. Code 201.29 (a)(c) Resident rights
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 8 of 11
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
08/09/2024
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 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a
review of select facility policy, and clinical records, and staff interview, it was determined the facility failed to
thoroughly assess and evaluate bowel function and implement individualized approaches to restore normal
bowel function to the extent possible for one out of 6 sampled residents (Resident 1).
Findings include:
A review of the facility policy entitled Continence Status Guidelines (no date as reviewed provided at the
time of the survey), revealed residents admitted to the facility will be assessed to determine their level of
bowel and bladder continence and appropriate interventions put into place when indicated.
Guidelines to include:
Residents will be assessed within two weeks of admission, upon significant change in status on
incontinence and routinely, to determine their continence status;
After an assessment residents will be placed in one of the following categories for bowel and bladder:
Continent-resident is continent of bowel and bladder. Residents will be provided products and assistance
per request.
Bowel and Bladder program-Resident is occasionally or frequently incontinent but is cognitively able to
assume more responsibility for being continent over time with staff assistance and reminders. May involve
being reminded to use bathroom at specific times, assistance to use the bathroom, etc. Resident will be
placed on an individual program to be reminded to use the bathroom, bedside commode or bedpan with
assistance as needed.
Check and change-a resident that would not benefit from a bowel and bladder program due to a cognitive
level (such as not recognizing why being placed on a commode, dementia, etc.), a physical condition that
makes the use of the bathroom, bedside commode or bedpan difficult or painful, or the resident's
unwillingness to participate in a program. Resident will wear the appropriate incontinence product, be
checked by staff routinely about every 2 hours and prn and changed when needed.
A review of the clinical record revealed that Resident 1 was admitted to the facility on [DATE], with
diagnoses to include, dementia (a condition in which a person loses the ability to think, remember, learn,
make decisions, and solve problems), and atrial fibrillation (an abnormal heartbeat).
A review of Resident 1's Minimum quarterly Data Set assessment (MDS- a federally mandated
standardized assessment process conducted periodically to plan resident care) dated March 5, 2024,
revealed that the resident was continent of bowel.
A bladder/bowel assessment dated [DATE] indicated that Resident 1 was continent of bladder and bowel.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 9 of 11
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
08/09/2024
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 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
A review of nursing documentation indicated the resident was hospitalized on [DATE] and was readmitted to
the facility on [DATE].
A review of a quarterly MDS dated [DATE] indicated the resident was now frequently incontinent of bowel.
A review of Resident 1's clinical record revealed the facility failed to initiate a bowel assessment after the
residents decline in bowel function.
A review of toileting records dated July 13, 2024 through August 9, 2024 (past 30 days) indicted the
resident was noted to be continent on three of the days and incontinent of bowel on the remaining days.
The facility failed to initiate a three day bowel activity assessment in order to determine the resident's
pattern of incontinence in response to the documented resident's decline in bowel function. Further, the
facility failed to identify the resident's habits or patterns of incontinence to develop an individualized toileting
plan to restore bowel function to the extent possible for the resident.
A review of the resident's current plan of care dated March 15, 2024 revealed that the resident is
incontinent of bowel at times.
Interventions to include, assist to toilet as needed and to identify incontinence pattern and establish a
toileting plan accordingly.
Interview with the Director of Nursing on August 9, 2024, at approximately 2:00 PM confirmed the facility
failed to thoroughly assess the resident's bowel and bladder function to identify each resident's habits,
patterns and plan to meet the residents' toileting needs and decrease incontinence.
28 Pa. Code 211.12 (d)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 10 of 11
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
08/09/2024
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 0943
Level of Harm - Minimal harm
or potential for actual harm
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to
report abuse, neglect, and exploitation.
Based on staff interviews and a review of employee personnel records it was determined that the facility
failed to provide abuse prevention training to four employee out of four reviewed. (Employees 1,2,3, and 4).
Residents Affected - Some
Findings include:
During an interview with Employee 1 (agency Licensed Practical Nurse) on August 9, 2024 at 9:45 AM she
stated that she worked at the facility on and off for the past four months. Employee 1 stated that she was
never trained on the facility's abuse prohibition policy prior to assuming her duties today.
During an interview with Employee 2 (agency registered nurse) on August 9, 2024 at 9:55 AM she stated
this is the fourth shift she had worked at the facility and stated she was never trained on the facility's abuse
prohibition policy prior to assuming her duties today.
During an interview with Employee 3 (agency nurse aide) on August 9, 2024 at 10:00 AM she stated that
she worked at the facility on and off for the past 6 months. Employee 3 stated she was never trained on the
facility's abuse prohibition policy prior to assuming her duties today.
During an interview with Employee 4 (agency nurse aide) on August 9, 2024 at 10:05 AM she stated that
she worked at the facility on and off for the past 4 months. Employee 4 stated that she was never trained on
the facility's abuse prohibition policy prior to assuming her duties today.
There was no documentation that Employee 1 (agency licensed practical nurse), 2 (agency registered
nurse), 3 (agency nurse aide) and 4 (agency nurse aide) was trained on the facility's abuse prohibition
policies and procedures as part of staff orientation and training on the prohibition of all forms of abuse,
neglect, and exploitation prohibition.
Interview with the Director of Nursing (DON) on August 9, 2024 at 2:00 PM., confirmed the facility had no
written records to show that Employee 1,2,3,and 4, all agency employees, were trained on the facility's
policy and procedures on as part of staff orientation and training before assuming their job duties. The DON
further stated that agency employees are not inserviced on the facility abuse policy prior to working at the
facility.
28 Pa. Code 201.20 (a)(b) Staff development
28 Pa. Code 201.19 (6)(7) Personnel policies and procedures
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395273
If continuation sheet
Page 11 of 11
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
5 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F626 - Transfer and discharge-
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F943 - Abuse, neglect, and exploitation
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
FAQ · About this visit
Common questions about this visit
What happened during the August 9, 2024 survey of EMBASSY OF SCRANTON?
This was a inspection survey of EMBASSY OF SCRANTON on August 9, 2024. The surveyor cited 5 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at EMBASSY OF SCRANTON on August 9, 2024?
Yes, 5 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) tha..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.