Health inspection·February 23, 2026

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Based on a review of facility policy, clinical and facility records, and resident and staff interviews, it was determined that the facility failed to provide a shower/bath as resident preference for seven of 13 residents reviewed (Residents R8, R9, R19, R20, R21, R22, and R23). Findings include: A facility policy entitled Personal Care Procedure dated 8/29/25, revealed it is the policy of this facility to provide/assist resident care and hygiene to each resident based on their individual status and needs. This includes such things as baths/showers (may be a bed bath), oral care (mouth care, denture care) resident grooming and peri-care/catheter care. Our residents are different in terms of how much resident care they can do their own. Some residents: can take care of their own resident care needs without our help, others need a little help, some need a lot of help with this care, and still others can do nothing on their own and are dependent on staff to provide all of their resident care to them. Independent Residents - provide privacy, and assist as needed. (May need help with setting up supplies, or to reach body parts. Self-care and independence should be encouraged but not forced. Bath/showers may be given at any time the resident chooses. They may be done in the morning, before bed or any other time of the resident's preference. A shower may only be necessary 2-3 times per week if the resident choose this. More showers can be given per resident request. A bed bath should be given on days a resident does not get a shower per their preference. Residents who are incontinent of urine and/or stool and those that perspire a lot may need to be given personal hygiene more than once a day. Refusals - If resident refuses care, encourage but don't threaten or force. Re-offer care at a later time. Attempt to identify reason for refusal - modify schedule or procedure when possible when medical/safety parameters to honor resident preferences. Keep responsible party aware of patterns of refusal. Resident R8's clinical record revealed an admission date of 6/16/25, with diagnoses that included epilepsy (a chronic neurological disorder that involves unprovoked recurring seizures), Crohn's disease (a chronic inflammatory bowel disease), cerebral infarction (a life threatening medical emergency where blood flow to part of the brain is blocked causing brain tissue to die), monoplegia of upper limb following cerebral infarction (loss of muscle function of one arm caused by cerebral infarction). Resident R8's clinical record revealed that during 1/21/26, through 2/19/26, he/she was offered a shower/bath on 1/23/26, 1/30/26, 2/10/26, and 2/13/26. An interview with Resident R8 on 2/18/26, at 12:30 p.m. revealed he/she would like to have a shower everyday but would be satisfied with one twice weekly, which is his/her schedule. Resident R8 indicated he/she has not received a shower since last Friday 2/13/26, but should have received a shower on Tuesday 2/17/26. Resident R8 stated, I would love to get a shower every day. I can do it myself, but not allowed for safety reasons. I got myself in trouble when I was on the other unit, when I showered by myself. The showers were in our rooms. Resident R8 was observed with greasy hair. Resident R9's clinical record revealed an admission date of 7/19/22, with diagnoses that included atrial fibrillation (an irregular and often rapid heart rhythm), diabetes mellitus (a chronic disease that affects how blood sugar is regulated resulting in high levels in the blood stream), morbid obesity (severely overweight resulting in chronic health conditions), and cardiac heart failure (a condition when the heart cannot pump enough blood allowing fluid to build up in the lungs and body). Resident R9's clinical record revealed that during 1/21/26, through 2/19/26, he/she was offered a shower/bath on 1/21/26, 1/25/26, 2/08/26, 2/11/26, and 2/15/26. An interview with Resident R9 on 2/18/26, at 12:15 p.m. revealed he/she should receive his/her shower on Sundays and Wednesdays, however, did not receive his/her shower on Wednesday 2/18/26, due to no hot water situation/available in the facility. A review of facility documentation for showers for 2/18/26, revealed Resident R9 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395588 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 395588 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Park Avenue 14714 Park Ave Extension Meadville, PA 16335 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete refused. An interview with Resident R9 on 2/19/26, at 12:30 p.m. revealed Resident R9 did not refuse his/her shower on 2/18/26. Further review of residents to receive showers/baths on 2/18/26, revealed Residents R19, R20, R21, R22, and R23 did not receive a shower/bath, but received a bed bath instead due to no hot water situation/available indicated by Certified Nursing Assistant (CNA) Employee E11 during an interview on 2/18/26, at 11:45 a.m. and Licensed Practical Nurse (LPN) Employee E12 during an interview on 2/18/26, at 12:00 p.m. Interview on 2/18/26, at approximately 1:00 p.m. with the Maintenance Director further confirmed that hot water was available for above noted residents' showers/baths. Interview with the Nursing Home Administrator (NHA) on 2/19/26, at 2:15 p.m. confirmed Residents R9, R19, R20, R21, R22, and R23 did not receive their shower/bath on 2/18/26, per each residents' preference. Interview with the Director of Nursing (DON) on 2/19/26, at 2:30 p.m. further confirmed that Resident R9 should have received a bath/shower at least twice weekly per his/her preference, and the facility lacked evidence that Resident R9 received a bath/shower twice weekly per his/her preference. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.12 (d) (1)(5) Nursing services Event ID: Facility ID: 395588 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 395588 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Park Avenue 14714 Park Ave Extension Meadville, PA 16335 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on review of facility policies, facility records, observations, and resident and staff interviews, it was determined that the facility failed to ensure meals were prepared and served in accordance with planned menus and failed to note or update menu changes and notify residents of a change to the posted menu for five of 18 residents interviewed (Residents R7, R11, R16, R24 and R25).Findings include: Review of a facility policy dated 8/29/25, entitled Menu change policy revealed To ensure that all menu changes within the skilled nursing facility support resident preferences, nutritional adequacy, regulatory compliance, and safe food-service operations; any change to the posted or planned menu must be intentional, documented, and communicated to residents and staff; substitutions must be of equal nutritional value and meet resident preferences and dietary restrictions; menu changes require documentation on the monthly menu substitution log; menu changes must be communicated to the dietary staff during pre-meal huddles, nursing staff, residents via menu board or general communication. Interviews on 2/18/26, between 11:30 a.m. and 5:30 p.m. with Residents R7, R11, R16, R24 and R25 revealed that they have lately received foods that were not on the menu and were not notified of the changes prior to being served. Interview with LPN Employee E3 on 2/23/26, at approximately 11:00 a.m. revealed that he/she has noticed some food substitutions on resident trays at mealtimes without the kitchen advising the nursing staff or residents of the changes. During a confidential interview on 2/18/26, at approximately 10:00 a.m. it was revealed that cabbage was provided to 12-15 residents last week due to running out of the brussels sprouts and that the residents were not notified of the food substitution. It was also revealed that some food items ordered were not received at the facility. As a result there have been necessary substitutions to the menu due to those items not received and residents aren't notified of those changes. During a confidential interview on 2/19/26, at 11: 00 a.m. it was revealed that food is ordered twice a week for the facility and over the last few weeks, items ordered have been removed or substituted. Cream of broccoli soup was on the menu for dinner 2/23/26 with an anticipated delivery date of 2/19/26. The soup was not delivered as ordered and subsequently ordered again. Substitutions have to be made to the menu due to items not being received and without resident notification. During a confidential interview on 2/18/26, at 3:00 p.m. it was revealed that substitutions to the menu have been made over the last few weeks due to not receiving needed food items that were ordered. Mashed potatoes were served in place of biscuit mix for pot pie and pears instead of apples for dessert. Menus were not updated and residents not notified of the changes. During a follow-up confidential interview on 2/23/26, at 10:35 a.m. it was confirmed that the facility failed to follow planned menus, complete documentation on the monthly menu substitution log, update the menus, or alert residents of changes in the menu. 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 211.6(a) Dietary services Event ID: Facility ID: 395588 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 395588 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Park Avenue 14714 Park Ave Extension Meadville, PA 16335 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, observations, and staff interview, it was determined the facility failed to properly maintain safe operation of essential equipment in the main kitchen and prevent excessive buildup of frost in the walk-in freezer. Findings include: Review of facility policy entitled Freezer with a policy review date of 8/29/25, indicated that all walk-in freezers shall be cleaned at least every six months; remove excess ice build-up; report any damage or any need of repair to the Maintenance Department. Observations of the walk-in freezer in the Main Kitchen on 2/18/26, at 10:30 a.m. revealed areas with an accumulation of ice including on the ceiling that extended out from the condenser to the other side of the walk-in-freezer, as well as multiple areas on the floor by the entrance to the freezer. Ice accumulation was observed on frozen food item boxes on the top of the shelves to the right and left of the entrance door. Condenser coils were observed frozen in ice. During an interview on 2/18/26, at the time of observation, the Dietary Manager confirmed that there was an accumulation of ice to include on the ceiling that extended out from the condenser to the other side of the walk-in-freezer, as well as multiple areas on the floor by the entrance to the freezer; ice accumulation was observed on frozen food item boxes on the top of the shelves to the right and left of the entrance door; and condenser coils were observed frozen in ice, and that the ice should be removed. 28 Pa. Code 201.14(a) Responsibility of licensee28 Pa. Code 201.18(b)(1)(3) Management28 Pa. Code 201.18(e)(2.1) Management Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395588 If continuation sheet Page 5 of 5