Health inspection·April 1, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation and staff interview, it was determined the facility failed to maintain a safe, clean, and homelike environment in two areas of the facility (the kitchen entrance door and the laundry room entrance door), affecting the safety and security of the environment for both staff and residents. Findings include: On April 1, 2025, at 10:00 A.M. in the presence of the of the Dietary Manager, an observation of the kitchen's dishwasher entrance revealed the double entrance doors were broken. The doors could not be properly closed or locked. When attempting to open the doors, they swung off the hinges, making it difficult to completely open them for tray carts to pass through. This entryway was used for transporting both clean and soiled food carts. The door locks were inoperable, and instead, two sliding locks located at the top inside of the doors were used at night to secure the area. Staff would exit the kitchen through alternate doors. During an interview at the time of the observation, the Dietary Manager stated she was hired in December 2024 and that the doors were already broken at that time. She was unable to confirm how long the doors had been in disrepair. On April 1, 2025, at 1:00 P.M., an observation revealed that the laundry room entrance door was also broken. The door would not fully close and could not be secured with a lock. A document review of a repair quote dated August 21, 2024, showed the facility had received pricing for replacement and installation of both the kitchen and laundry room doors. However, there was no evidence presented during the survey that the facility had acted on the quote or made repairs to either door. An interview April 1, 2025, at 2 P.M., the Nursing Home Administrator confirmed that both the kitchen and laundry room doors were broken. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(e)(2) Management 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 3 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 04/01/2025 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)