Health inspection·January 28, 2026

F 0558 Level of Harm - Minimal harm or potential for actual harm March 5, 2026, at 12:15 PM, the Surveyor reviewed these findings, including the facility's failure to ensure a call bell was accessible for one resident who required staff assistance for basic needs, with the Nursing Home Administrator (NHA) and the Director of Nursing (DON). 28 Pa. Code 201.29 (a) Resident rights. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 2 of 12 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 01/28/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of clinical records, facility policies, facility investigative documentation, video surveillance, and resident and staff interviews, it was determined the facility failed to ensure that the environment remained as free of accident hazards as possible and failed to provide adequate supervision and environmental safety to prevent an avoidable accident. This failure placed one of eight residents reviewed (Resident 1) in Immediate Jeopardy to their health and safety due to the high likelihood of serious injury or death from falls or self-harm.Findings include: A clinical record review revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses to include anxiety (a mental health condition characterized by excessive worry or fear) and major depressive disorder (a mental health disorder characterized by persistent low mood, loss of interest in activities, low energy, poor concentration, appetite changes, sleep disturbances, and suicidal thoughts). A review of an admission Minimum Data Set assessment (MDS, a federally mandated standardized assessment process conducted periodically to plan resident care) dated November 24, 2025, revealed that Resident 1 was cognitively intact with a BIMS score of 15 (Brief Interview for Mental Status, a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 13 to 15 indicates cognition is intact). A review of an admission MDS assessment dated [DATE], revealed that Resident 2 (Resident 1's wife, who also resided in the same room) was cognitively intact with a BIMS score of 15 A review of Resident 1's care plan initiated on November 19, 2025, identified depression and anxiety with goals to reduce symptoms through medication and non-pharmacological interventions (such as one-to-one interaction, change in position or scenery, redirection, and diversional activities). The care plan did not include Resident 1's documented history of suicide attempts until after the incident on January 25, 2026. Resident 1's care plan revealed they had been identified by the state PASRR (Preadmission Screening and Resident Review) process as a level II PASRR (screening used to identify serious mental illness or intellectual disability requiring specialized services). A review of outside hospital documentation provided by the facility of a discharge summary with instructions dated November 19, 2025, revealed that during the hospital admission Resident 1's medication regimen had changed and the Prozac (an antidepressant medication) had increased from 40 mg (milligrams) to 60 mg daily, trazodone (an antidepressant medication) 25 mg had been ordered three times a day for anxiety, continued Ativan (antianxiety medication) 0.5 mg twice daily, discontinued their sertraline 100 mg (generic for Zoloft, an antidepressant), and instructed to follow up with a psychiatrist and primary care physician. A review of physician's orders dated November 19, 2025, revealed orders for fluoxetine 20 mg (generic for Prozac, an antidepressant), one tablet daily in the morning for depression, and lorazepam (generic for Ativan). 0.5 mg, one tablet twice a day for anxiety, and trazodone 0.5 mg (antidepressant used to treat depression, anxiety and sleep problems) every eight hours as needed for depression. A review of an elopement evaluation for Resident 1 dated November 19, 2025, revealed a score of 8, which indicated that a 5 or higher may be at risk for elopement from the facility. It was noted that Resident 1 stated he wanted to leave but made no attempt to leave, and he was documented as not currently being an elopement risk. A review of physician's orders dated November 24, 2025, revealed an order for hydroxyzine (an antihistamine, a medication used to treat allergies, that is also used to treat anxiety) 25 mg, one tablet every 8 hours as needed for anxiety, and an order for trazodone 50 mg, to give half a tablet at bedtime for depression. A review of Employee 8's, Certified Registered Nurse Practitioner (CRNP) progress notes dated December 2, 2025, revealed Resident 1 was admitted (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 3 of 12 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 01/28/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few for therapy services with possible long-term placement due to being unable to care for himself at home, particularly with his wife. Resident 1 verbalized stress regarding his wife and seemed very depressed. It was noted that the resident reported that he was so stressed at home because of the issues with his wife that he overdosed at some point. A review of a psychology progress note from the Licensed Clinical Social Worker (LCSW) for Resident 1, dated December 5, 2025, revealed the resident was evaluated due to his history of depression and anxiety and was previously admitted to an inpatient psychiatric hospital in December 2024 and August 2025. It was noted that Resident 1 appeared guarded and withdrawn throughout the session. A review of Employee 10's, Licensed Practical Nurse (LPN), progress note dated December 9, 2025, at 1:37 PM revealed Resident 1 was continuously pacing in his room and hallways and repeatedly struck his head against the wall despite verbal redirection. The note indicated his behavior appeared to be escalating, with increased restlessness and rapid breathing. No visible injury was noted. Resident 1 did not respond to verbal reassurance or orientation attempts. A review of physician's orders dated December 13, 2025, for Resident 1 revealed an order for fluoxetine 20 mg, two tablets daily in the morning for depression; clonazepam (an antianxiety medication) 0.25 mg daily at bedtime for anxiety; and hydroxyzine 25 mg twice a day, every morning and at bedtime for anxiety, with an additional 25 mg every 24 hours as needed for insomnia if the resident wakes up in the middle of the night. The resident's lorazepam was discontinued on December 13, 2025. A review of Employee 9's psychiatric CRNP progress note for Resident 1 dated December 16, 2025, revealed diagnoses that included depression and anxiety. The resident was observed sitting in his room drowsy but arousable and admitted to continued depression and intermittent anxiety. A review of Employee 8's, CRNP progress note dated December 17, 2025, revealed the resident reported feeling anxious and appeared to be having a panic attack. He stated that his wife's repetitive speech and fixation on topics significantly contributed to his anxiety and made it difficult for him to relax. The resident expressed a desire to go home but acknowledged that his home was not in livable condition. He did not want to move to a separate room or place fault on his wife due to her Alzheimer's disease (a brain disorder that progressively impairs memory and thinking). He stated he would feel better at home but admitted to experiencing similar anxiety there. The CRNP noted that Resident 1's desire to return home suggested the need to assess the viability of that option and address home condition issues. A review of Employee 6's, LPN, progress note, dated December 20, 2025, at 1:20 PM revealed Resident 1 was noted with increased anxiety and agitation and was pacing back and forth in his room and hallways. The resident pulled the nurse to the side and stated he felt that he was struggling and continued to make mistake after mistake. After speaking with Employee 6, he agreed to speak to the psychiatrist. A review of psychology progress notes from the LCSW dated December 26, 2025, revealed that the Director of Nursing provided additional clinical insight stating Resident 1 and his wife (Resident 2), who resided in the same room, were known to have had numerous attempted joint suicides with psychiatric hospitalizations. Resident 1 continued to present with high anxiety and reported his nerves were horrible and that he felt dizzy and trapped. Resident 1 repeatedly requested medication changes and stated, so there's really nothing you can do for me, and remained guarded. A review of Employee 7's, Registered Nurse (RN) progress notes dated December 26, 2025, at 11:47 PM revealed that while in session with psychology, Resident 1 sat in his wheelchair, leaning forward with his head on the bed, brought his knees to the floor, and then lay on his back in a manner described as purposeful. A review of Employee 8's, CRNP progress note dated December 26, 2025, revealed Resident 1 felt anxious and could not sleep. The plan was to continue current medications, follow psychology recommendations, and consider a room change to separate the resident from his wife to reduce nighttime (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 4 of 12 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 01/28/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few triggers. A review of a physician's orders for Resident 1 dated December 29, 2025, revealed an order for fluoxetine 20 mg, two tablets daily in the evening for depression, and for hydroxyzine 25 mg every 12 hours as needed for anxiety for 14 days. A review of Employee 9's psychiatric CRNP progress note for Resident 1 dated December 30, 2025, revealed the resident was being seen for his history of anxiety and depression and was seen pacing in the hallways. It was noted Employee 9 redirected him to a chair, and it was difficult due to the resident's anxiety and restlessness. Resident 1 appeared disheveled (disordered and untidy). The resident admitted to continued depression and anxiety. Staff reported frequent falls, likely related to increased restlessness. A review of Employee 8's CRNP progress note dated January 2, 2026, revealed Resident 1 continued to report anxiety, wanted to go home, and worried about his wife. The resident was noted to have significant psychiatric issues and was being followed by in-house psychiatric services. A review of Employee 9's psychiatric CRNP progress note for Resident 1 dated January 13, 2026, revealed the resident was being seen for his depression and anxiety and was lying in bed wringing his wrists and appeared noticeably restless and disheveled. Employee 9 redirected him to a chair with difficulty due to anxiety and restlessness. The resident reported depressed mood and continued anxiety and described new onset visual hallucinations (seeing things that are not present) and stated it has happened before. Staff reported increased confusion and depression. Employee 9 assessed the resident continued with worsening mood disturbances and an increase in hallucinations with worsening depression. At that time, Resident 1 met criteria for MDD (major depressive disorder) with psychotic disturbance (severe form of depression with persistent sadness and loss of interest along with psychotic symptoms or fixed false beliefs which can increase the risk of unsafe behavior or self-harm). A review of physician's orders dated January 14, 2026, revealed an order for fluoxetine 20 mg three tablets daily in the evening for depression, and clonazepam 0.25 mg (antianxiety medication) two times a day for anxiety. A review of psychology progress notes dated January 16, 2026, revealed the Resident 1 appeared less restless and stated he had been alright, though he avoided eye contact. A Geriatric Depression Scale screening was performed, and the resident scored in the range indicating major depression. Employee 8 CRNP reported the resident had been extremely anxious and encouraged separation from his wife throughout the day due to her triggering his distress. A review of psychology progress notes from the LCSW for Resident 1, dated January 16, 2026, revealed he was being seen for his history of depression and anxiety, and the resident appeared less restless than in previous sessions and stated he has been alright and avoided eye contact. A GDS (Geriatric Depression Scale) depression screening was performed, and the resident scored significantly, indicating major depression. They noted from the medical CRNP that it was reported that the resident was seen to be extremely anxious and encouraged to find separate space away from his wife throughout the day, as it seems she may trigger his distress. A review of Employee 1's, RN supervisor progress notes at 4:05 PM on January 25, 2026, revealed the note summarized events that occurred earlier that day. According to the entry, at the beginning of the shift Resident 1 was observed lying in bed and was at baseline with no complaints. At 11:00 AM staff were informed that Resident 1 had vomited and was having difficulty urinating. On assessment, the bladder was soft and not distended. The resident was offered medication for nausea but refused and became verbally abusive. Employee 1 encouraged the resident to calm down; however, the resident continued to be verbally abusive and laid himself on the floor. Resident 1 then got up independently and returned to bed. Employee 1 returned to the medication cart and was later informed by Resident 2 that her husband, Resident 1, had jumped out of the window. Employee 1 verified this information, activated emergency services by calling 911, and remained with Resident 2 due to safety concerns. A review of investigative (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 5 of 12 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 01/28/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few documentation provided by the facility dated January 25, 2026, documented by the Director of Nursing at 12:55 PM, revealed that Resident 1 was in his room with his wife, and during lunchtime he received his meal tray and complained of the inability to urinate and was assessed by the Employee 1, RN Supervisor, and noted to have no abdominal distension. When Employee 1 left the room after the assessment, the resident's wife (Resident 2) yelled out to staff that Resident 1 had jumped out of the second-floor window and landed on the first-floor landing that was below his window. Following the event, 911 was called immediately. Resident 1 was wrapped in blankets to keep him warm. The resident was also assessed by the EMTs (Emergency Medical Technicians) and was then taken to the hospital. The resident was noted to be talking with police when the ambulance arrived. The facility noted the safety screw was removed from Resident 1's window, which allowed the window to fully open. The facility audited all other resident windows after the incident occurred to ensure resident safety. The facility was unable to determine how the screws were removed from the window, no screws, tools, or sharp objects were found in the room. Resident 2 stated she observed Resident 1 jump out of the window and could not stop him. A review of Employee 2's, Nursing Aide (NA), witness statement dated January 25, 2026, at 12:57 PM revealed that while passing trays, the supervisor ran down the hallway yelling emergency and reported that Resident 1 had jumped out of the window. Employee 2 ran outside and observed Resident 1 on the ground while staff contacted 911. A review of a witness statement dated January 25, 2026, at 1:00 PM, from Employee 1, RN Supervisor, revealed that he was told by Resident 2 that Resident 1 jumped out of the window Employee 1 verified the information and activated emergency services and stayed with Resident 2 for safety and brought her to the dining area. A review of a witness statement dated January 25, 2026, at 1:15 PM, from Employee 3, NA, revealed that Resident 2 came out of the room yelling that Resident 1 had jumped out of the window, and they ran and saw Resident 1 lying outside. Employee 3 then ran to get help and blankets to cover him up while waiting for police and an ambulance to arrive. A review of a witness statement dated January 25, 2026, at 1:15 PM, from Resident 2, revealed she had watched Resident 1 open the window and jump out and did not stop Resident 1 from jumping out. A review of outside hospital documentation dated January 25, 2026, at 1:35 PM revealed that per EMS, Resident 1 fell from a second-story window and laid in the snow for 10 minutes. EMS documented a body temperature of 90.8 degrees Fahrenheit (hypothermia, a dangerously low body temperature that can be life-threatening). Resident 1 complained of back pain. Initial emergency department temperature at 1:28 PM was 92.3 degrees Fahrenheit by tympanic (ear). Physical examination revealed a laceration (torn wound of the skin) above the left eye, ecchymosis (bruising) of the abdomen and left knee, and a thigh abrasion. The emergency department physician documented a final diagnosis of chest wall contusion (bruise caused by a blow or impact) following a fall. A review of outside hospital psychiatric documentation dated January 27, 2026, at 8:39 AM, revealed the consultation was for a possible suicide attempt. Resident 1 reported not recalling jumping from the window and admitted to feeling sad at times, poor sleep, decreased energy and concentration, and anhedonia (loss of interest or pleasure). A 302 involuntary commitment (legal process that allows a person to be hospitalized for mental health treatment against their will when they are determined to be a threat to self or others) was petitioned by police and upheld by the emergency physician. Based on evaluation and history of prior suicide attempts and depression, inpatient psychiatric admission was recommended with one-to-one supervision for safety and elopement risk. During an interview on January 28, 2026, at 11:00 AM with Employee 4, Maintenance Director, revealed that at the time of the incident, Resident 1's right-side window was not secured and could open fully and that the screen had been knocked out. Employee 4 stated that windows were not routinely inspected and were last checked one (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 6 of 12 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 01/28/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few year prior. Employee 4 stated that after the incident an audit of all the windows was completed, and he inserted a regular [NAME] head screw into all the windows for safety. The facility was unable to provide evidence that the safety screws were in place immediately after the event. An observation of Resident 1's left side window, in the presence of Employee 4, at 11:00 AM, revealed it was secured to permit the window to open no more than 3.5 inches by utilizing a rubber window stopper. Employee 4 had stated prior to the incident that the rubber window stoppers are what was utilized at the facility to prevent the windows from opening fully. Observation of Resident 1's right-side window, from which he jumped out of, revealed it did not have a rubber stopper. The surveyor attempted to remove the rubber stopper that was present on the left side of the window, and it did not come off. Employee 4 stated you would most likely need a special tool to remove the rubber stopper, and they are not easily removed. Employee 4 confirmed it was possible that Resident 1's right-side window possibly did not have the rubber stopper prior to the incident, but that it was not known, due to no recent window inspections. Employee 4 stated that moving forward, they removed the regular [NAME] head screws that were inserted on January 25, 2026, and inserted a special star tip screw that requires a special drill bit to remove and a wooden dowel to prevent the windows from opening fully. This process with adding the star tip screws and wooden dowels was started on the evening of January 26, 2026, and currently was ongoing to complete all the windows at the facility. Employee 4 also noted there were windows on the first floor that were crank windows, and the facility had ordered special parts to prevent them from opening fully, but they had not arrived yet. An interview with Employee 1, RN Supervisor, on January 28, 2026, at 1:36 PM, revealed that Resident 1 had been at baseline and had been cared for since admission. Employee 1 stated Resident 1 was frequently concerned about Resident 2. Employee 1 left the room for 15 minutes after providing care to Resident 2 and was then informed that Resident 1 had jumped out of the window. Employee 1 returned to the room and observed the window open, activated EMS, removed Resident 2 from the room, and threw blankets down to Resident 1. Following surveyor inquiry on January 28, 2026, at 1:58 PM, the facility provided video surveillance evidence from January 25, 2026, with a timeline. Facility documentation indicated the resident exited the window at 1:07 PM, and the resident was located by staff at 1:11 PM and wrapped in blankets. EMS arrived at 1:13 PM, and the resident was on the stretcher in the ambulance at 1:23 PM. Resident 1 was transported to the hospital at 1:32 PM. A telephone interview conducted on January 28, 2026, at 2:30 P.M., with Employee 5, Nutrition Services, revealed he was delivering food to the unit on January 25, 2026, when he heard a nurse yell that Resident 1 went out the window. Employee 5 entered the room, and when he saw Resident 1, he left the building to attend to him. Employee 5 was the first to provide care to Resident 1 and reported that Resident 1 said ouch but did not communicate any additional information to him. Employee 5 covered Resident 1 with blankets that were being thrown to him from the open window. During an interview with Resident 2 on January 28, 2026, at 2:36 PM, it was revealed that Resident 1 opened the window easily and stated that he just opened it. Resident 2 stated that there was no one in the room at the time other than Resident 1 and denied any mention of anything related to jumping prior to the event. At the time of the incident, Resident 1's room window was capable of being opened fully without restriction. Facility-wide observation identified that some windows were restricted to opening three to four inches using rubber strips or other limiting devices, while other windows did not have security measures in place (rubber window stoppers). The facility's investigative documentation authored by the Director of Nursing stated that the resident had removed safety screws from the window to open it fully; however, interviews and observations revealed that no screws were in place on Resident 1's window prior to the incident. The facility's first placement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 7 of 12 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 01/28/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few of screws into windows occurred after the incident as an initial corrective action to restrict window openings. Observation of first-floor crank windows (no resident rooms; however, residents had access to these areas) on January 28, 2026, at 3:00 PM, revealed the windows could be opened 15.75 inches, and the facility was waiting for ordered parts to restrict them. This failure to ensure window security constituted an environmental hazard and placed residents at risk for falls and self-harm. On January 25, 2026, the resident jumped from the second-floor window, 25 feet, landing on a porch and into snow. The resident sustained chest trauma and was found with a body temperature of 90.8 degrees Fahrenheit by EMTs. The resident's injuries and hypothermia demonstrate actual serious harm. Given the resident's known history of suicidal ideation and worsening depression without increased supervision, the unsecured window created a high likelihood of death or serious injury. The presence of other unsecured windows created ongoing risk to additional residents. The facility was notified of the Immediate Jeopardy on January 28, 2026, at 3:10 PM, and the IJ template was provided to the facility at 3:24 PM. An immediate plan of correction was requested and received on January 28, 2026, and accepted on January 28, 2026, at 6:35 PM. The facility's corrective action plan included: 1. The resident was transported from the facility to the hospital emergency room and admitted , and a safety device was placed in all windows in the facility that would not allow them to open past 4 inches. 2. An audit was completed of all windows in residents' rooms and common areas to ensure that window safety devices are in place. Residents with a history of suicide attempts will be reviewed to ensure they have psychiatric services in place, psych medications are reviewed, care plans are updated if needed, and a suicide risk assessment is completed. Should they trigger for suicide risk, appropriate actions will be taken as per our Suicide Threats policy. Newly admitted residents from November 1, 2025, through November 28, 2025, will have their antidepressant medications reviewed and compared to their hospital discharge instructions to ensure that they are ordered correctly. 3. Maintenance will ensure that all windows have been addressed so that they cannot open past 4 inches, and maintenance or a designee will perform random window safety audits weekly x 4, then ongoing monthly. The DON/Designee will audit all new admissions during the morning meetings to check for a diagnosis or history of suicide attempts and clinical recommendations implemented if positive for suicidal ideations. The DON/Designee will also compare the hospital discharge summary for antidepressant medication orders to ensure they match the physician's orders. Results of audits will be presented to risk meetings weekly, then to the QUAPI committee once done monthly for further review and recommendations. 4. All facility staff will be educated on suicide prevention, suicide threats, the six steps to identifying and addressing behavioral symptoms, and window safety. 5. Maintenance or the designee will continue to monitor safety window checks weekly x 4, then monthly x 3. The DON/Designee will continue to audit all new admissions during morning meeting to check for a diagnosis or history of suicide attempts and clinical recommendations implemented if positive for suicidal ideations weekly x 4 weeks, then monthly x 3. The DON/Designee will also compare the hospital discharge summary for antidepressant medication orders to ensure they match the physician's orders weekly x 4 weeks and then monthly x 3. An interview with Employee 4, on January 28, 2026, at 5:05 PM, revealed that the new safety features, which included the new star tip screws and wood dowel were in place in all resident windows, common areas, and stairways as of January 28, 2026, at 5:05 PM, and all of the crank windows in the facility were screwed shut from the outside. Following verification of the implementation of the corrective action plan, a tour of the facility, and a review of education, the Immediate Jeopardy was lifted on January 28, 2026, at 6:45 PM. 28 Pa. Code 201.18 (e)(1) Management.28 Pa Code 211.10 (a)(c) Resident care policies.28 Pa. Code 211.2(d)(3) Medical Director.28 Pa. Code 211.12 (c)(d)(1)(3)(5) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 8 of 12 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 01/28/2026 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 0689 Nursing services. Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 9 of 12 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 01/28/2026 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, select facility policy, and staff interviews, it was determined the facility failed to implement procedures to ensure the accurate administration of prescribed medications for one of eight sampled residents (Resident 1).Findings include: A review of the facility policy titled Admission/ readmission Chart Review Process last reviewed January 22, 2026, revealed the facility will ensure there exist follow through of physician orders upon admission and / or readmission to the facility and a complete chart review will be conducted within 24 hours of the admission/ readmission. Review of the facility policy titled Use of Psychotropic Medication last reviewed January 22, 2026, revealed residents are not given psychotropic medications unless necessary to treat a specific condition and the medication is beneficial to the resident. The compliance guidelines in the policy indicated the attending physician will assume a leadership role in medication management by developing, monitoring, and modifying the medication regimen in collaboration with residents, their family / representatives, other professionals and the interdisciplinary team. A review of the clinical record revealed Resident 1 was admitted to the facility on [DATE], from an acute care hospital. admission diagnosis included but was not limited to cerebral palsy (a condition that permanently affects body movement and muscle coordination), anxiety (a feeling of worry, nervousness, or unease), and depression (mood disorder that causes a persistent feeling of sadness and loss of interest). A review of an admission Minimum Data Set assessment (MDS, a federally mandated standardized assessment process conducted periodically to plan resident care) dated December 2, 2025, identified Resident 1 was cognitively intact with a BIMS score of 15 (Brief Interview for Mental Status, a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 13-15 indicates cognition is intact). A review of the facility document titled Discharge Summary, written by the hospital medical doctor and dated November 19, 2025, revealed Resident 1 was hospitalized from [DATE], through November 19, 2025. Upon discharge from the hospital, Resident 1 was admitted to the facility on [DATE]. The hospital medical doctor documented that Resident 1 had multiple hospital admissions over the previous two months, including an admission to an inpatient psychiatric facility for treatment of generalized anxiety disorder (a mental health condition characterized by excessive, uncontrollable worry) and major depressive disorder (a mental health disorder characterized by persistent low mood, low self-esteem, and loss of interest). The hospital discharge summary documented that while Resident 1 was in the inpatient psychiatric facility, the medication Fluoxetine was increased from 40 milligrams (mg) to 60 mg daily. Fluoxetine (also known as Prozac, a medication used to treat depression and anxiety by affecting chemical messengers in the brain). The discharge summary indicated that Resident 1 received Trazodone 25 mg three times daily as needed for anxiety. Trazodone (also known as Desyrel, a medication used to treat depression and anxiety). Further review of the hospital discharge summary revealed that Lorazepam 0.5 mg twice daily was to be continued. Lorazepam (also known as Ativan, a medication that works by enhancing the activity of chemical messengers in the brain and is used to treat anxiety and insomnia/difficulty sleeping). The discharge summary also indicated Resident 1 was to follow up with psychiatry as an outpatient and that the facility was encouraged to provide frequent and continued reassurance related to Resident 1's wife, Resident 2. Recommendations from the medical doctor in the department of psychiatry were included in the hospital discharge summary. The psychiatric provider recommended that Resident 1 continue Fluoxetine 60 mg daily for improved anxiety management and that Trazodone 25 mg three times daily be administered as needed for anxiety or sleep. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 10 of 12 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 01/28/2026 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete psychiatric provider also recommended that Lorazepam be gradually decreased and eventually discontinued due to Resident 1's age and documented memory deficits. A review of facility medication orders revealed that upon admission to the facility on November 19, 2025, Employee 8, CRNP (certified registered nurse practitioner) ordered Fluoxetine HCl 20 mg once daily in the morning. Further review of facility records revealed that on December 13, 2025, the order was changed to Fluoxetine HCl 20 mg, two tablets once daily in the morning, for a total daily dose of 40 mg. On December 29, 2025, the administration time for Fluoxetine 40 mg was changed from morning to evening. On January 14, 2026, Fluoxetine 40 mg was discontinued and replaced with Fluoxetine 60 mg once daily in the evening. A review of facility records revealed Resident 1 did not receive the hospital-recommended dose of Fluoxetine 60 mg daily until January 14, 2026, despite documentation that the dose had been increased prior to admission to address symptoms of anxiety, panic, and depression. A review of medication orders further revealed Lorazepam 0.5 mg was administered twice daily from November 19, 2025, until December 13, 2025, when the medication was discontinued. No documentation was identified to show the dose was gradually reduced prior to discontinuation as recommended in the hospital discharge summary. During an interview with the Director of Nursing on January 28, 2026, at 11:30 AM, the above findings were reviewed, including that Resident 1 did not receive the hospital-recommended Fluoxetine 60 mg daily for several weeks after admission and that Lorazepam was discontinued without gradual dose reduction as recommended. The Director of Nursing was unable to provide a documented justification for why the recommended medication regimen was not implemented to meet the psychiatric needs of Resident 1. 28 Pa. Code 211.12 (d)(1)(5) Nursing services. 28 Pa Code 211.10 (a)(c) Resident care policies. 28 Pa Code 211.9 (c)(k) Pharmacy services. 28 Pa Code 211.5(f)(x) Clinical records. Event ID: Facility ID: 395273 If continuation sheet Page 11 of 12 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 01/28/2026 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm Based on a review of clinical records, employee job descriptions, and staff interviews, the facility's administration, including the Nursing Home Administrator (NHA) and Director of Nursing (DON), failed to effectively manage facility operations to ensure resident safety and to maintain the highest practicable physical and mental well-being of residents. This failure occurred because the facility did not ensure the environment was maintained as free of accident hazards as possible, did not ensure adequate supervision and environmental safety, and did not ensure appropriate management of a resident's psychiatric care and medication regimen for one of eight residents sampled (Resident 1), who was able to exit the facility through a second-floor window and landed on a porch into the snow. This failure resulted in Immediate Jeopardy to resident health and safety.Findings included: A review of the job description for the Nursing Home Administrator (NHA) signed and dated September 16, 2024, revealed the administrator will direct day-to-day functions of the facility in accordance with current federal, state and local standards, guidelines, and regulations that govern long-term care facilities to ensure that the highest degree of quality care can be always provided to the residents. The job description for Director of Nursing (DON), signed and dated March 12, 2024, revealed the DON will organize and direct nursing administration, nursing services, and resident care, developing, organizing, implementing, evaluating, and directing day-to-day functions of the nursing service department and its programs and activities.The failure of the Administrator and Director of Nursing to carry out their respective administrative responsibilities demonstrated ineffective use of facility resources. This included failure to ensure appropriate supervision, failure to ensure consistent implementation of facility policies related to resident safety, failure to ensure that windows were secured to reduce environmental hazards and placed residents at risk for falls and self-harm, and failure to ensure appropriate oversight of psychiatric treatment and medication management ( ensuring that prescribed drugs are given in the correct dose, at the correct time, and monitored for effectiveness and side effects). These failures showed a lack of coordinated administrative and clinical oversight. As a result of these administrative failures, the facility did not maintain an effective system to identify and mitigate risks for a resident with known psychiatric conditions, including suicidal ideation (thoughts of self-harm) and worsening depression. The combination of unsecured windows, lack of increased supervision, and ineffective management of the resident's psychiatric medications created a high likelihood of serious injury or death. The presence of additional unsecured windows created an ongoing risk to other residents. This deficient practice is related to the Immediate Jeopardy citation under F 689 (Accidents, 42 CFR S483.25(d)), which identified that the lack of effective administrative oversight, monitoring, and enforcement of policies by facility leadership contributed to the Immediate Jeopardy situation.Refer F 689 28 Pa. Code: 201.14 (a) Responsibility of licensee28 Pa. Code: 201.18 (e)(1) Management28 Pa. Code 211.12 (d)(3) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395273 If continuation sheet Page 12 of 12