Pennsylvania Department of Health
 EMBASSY OF SCRANTON
Patient Care Inspection Results

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EMBASSY OF SCRANTON
Inspection Results For:

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EMBASSY OF SCRANTON - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:Based on a Abbreviated Complaint survey completed on August 13, 2026, it was determined that Embassy of Scranton was not in compliance with the following requirements of 42 CFR Part 483 Subpart B Requirements for Long Term Care and the 28 PA Code Commonwealth of Pennsylvania Long Term Care Licensure Regulations.
 Plan of Correction:


483.25(g)(1)-(3) REQUIREMENT Nutrition/Hydration Status Maintenance:This is a more serious deficiency but is isolated to the fewest number of residents, staff, or occurrences. This deficiency results in a negative outcome that has negatively affected the resident's ability to achieve his/her highest functional status.
§483.25(g) Assisted nutrition and hydration.
(Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident-

§483.25(g)(1) Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise;

§483.25(g)(2) Is offered sufficient fluid intake to maintain proper hydration and health;

§483.25(g)(3) Is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet.
Observations: Based on clinical record review, review of facility policy, and staff and responsible party interviews, it was determined the facility failed to adequately monitor and respond to significant weight loss and declining food and fluid intake; failed to consistently obtain and evaluate weights; failed to consistently document meal and fluid intake; failed to timely notify the physician and responsible party of significant changes in weight and nutritional status; and failed to evaluate the effectiveness of nutritional and hydration interventions for one of ten residents reviewed (Resident 1) resulting in actual harm to Resident 1, who experienced progressive and significant weight loss and dehydration and subsequently required transfer to and admission at the hospital for acute kidney injury due to dehydration. Findings include: Review of the facility policy titled "Weight Policy," last reviewed March 26, 2026, revealed the facility's policy was to attain or maintain each resident's weight within the recommended range, as appropriate to the resident's medical and physical condition. The policy required weights to be obtained timely and accurately, documented, and appropriately addressed. The policy required residents to be weighed upon admission, weekly for the following three weeks, and monthly thereafter unless otherwise ordered by the physician. The policy required the dietitian to be notified of significant weight changes and other concerns related to diet and intake and to track weights for significant weight loss, including loss greater than 5 percent in one month, 7.5 percent in three months, or 10 percent in six months. The policy required the dietitian to work with facility staff to evaluate weight trends and determine additional interventions. The policy also required notification of the physician and responsible party when significant weight changes occurred and identified interventions that could include preferred foods, additional portions, snacks, nutritional supplements, and other individualized measures. In the event the dietitian and the facility staff have determined reasonable interventions have been offered and there is a continued weight loss, the facility will attempt to meet with the resident/resident representative and consult the physician in regard to the resident's choices and clinical indications to make decisions about the use of a feeding tube. Clinical record review revealed Resident 1 was admitted to the facility on March 25, 2026, with diagnoses that included chronic obstructive pulmonary disease (COPD, a chronic lung disease that can make breathing difficult) and dementia (a condition involving decline in memory, thinking, and other cognitive abilities that can interfere with daily functioning). A review of Resident 1's Quarterly Minimum Data Set assessment (MDS, a federally mandated standardized assessment process conducted periodically to plan resident care) dated July 2, 2026, revealed that Resident 1 was severely cognitively impaired with a BIMS score of 4 (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 0 through 7 indicates severe cognitive impairment). The MDS documented that Resident 1 required setup or cleanup assistance with eating. Clinical record review revealed that Resident 1 weighed 135.6 pounds on admission on March 25, 2026, and 139.0 pounds on March 27, 2026. According to the facility's Weight Policy, Resident 1 should have been weighed weekly for the following three weeks. However, the clinical record contained no weights for April 3, April 10, or April 17, 2026. The facility did not obtain another documented weight until May 21, 2026, eight weeks after the March 27, 2026, weight. On May 21, 2026, Resident 1 weighed 128.6 pounds, representing a loss of 10.4 pounds, or 7.5 percent significant weight loss, from the March 27, 2026, weight of 139.0 pounds. On May 27, 2026, the dietitian documented the significant weight loss and requested a reweight to verify the loss. The reweight obtained that day was 124.0 pounds. Resident 1 lost 15 pounds, or 10.8 percent, from the March 27, 2026, weight. The clinical record contained no evidence that the facility notified the physician or responsible party of this significant weight loss. On May 29, 2026, the dietitian documented that significant weight loss had been confirmed. The dietitian noted Resident 1 remained on a regular diet and documented meal intake of 75 to 100 percent. The dietitian documented that the cause of the weight loss was unclear, and they initiated fortified foods (products that have extra vitamins, minerals, or other nutrients added during processing to boost their nutritional value) to increase the nutritional content of meals, and ordered weekly weights for four weeks. Subsequent documented weights were: June 1, 2026: 127.4 pounds; June 7, 2026: 125.6 pounds; and June 14, 2026: 126.8 pounds. On June 24, 2026, the dietitian documented Resident 1's weight had been stable for four weeks and discontinued weekly weights in favor of monthly monitoring. However, the clinical record contained only three documented weekly weights following the May 27, 2026, weight. Four days later, on June 28, 2026, Resident 1 weighed 118.0 pounds, representing an 8.8-pound loss from the June 14, 2026, weight of 126.8 pounds, or 6.9 percent in 14 days. The clinical record contained no evidence that the dietitian evaluated the June 28, 2026, weight loss or that the facility notified the physician or responsible party of this additional significant decline. A nursing progress note dated July 3, 2026, documented that Resident 1's responsible party expressed concern regarding the resident's continued weight loss. The facility then communicated the concern to the Certified Registered Nurse Practitioner (CRNP), who ordered laboratory testing and mirtazapine (Remeron) 7.5 milligrams at bedtime. Mirtazapine is an antidepressant medication that may also increase appetite. A CRNP progress note dated July 6, 2026, documented that Resident 1 had experienced a significant decrease in appetite and a mild increase in oral intake after mirtazapine was initiated. The CRNP directed staff to continue mirtazapine, encourage and monitor Resident 1's nutritional intake, and provide fortified foods. Despite these interventions, Resident 1's documented weights continued to decline as follows: July 2, 2026: 113.2 pounds; July 7, 2026: 114.6 pounds; July 12, 2026: 114.0 pounds; July 19, 2026: 108.4 pounds; and July 21, 2026: 106.6 pounds. By July 21, 2026, Resident 1 had lost 29 pounds from the admission weight of 135.6 pounds, representing a severe weight loss of 21.4 percent of the resident's body weight in less than four months. Review of facility documentation further revealed significant gaps in monitoring Resident 1's nutritional and hydration intake. The April 2026 documentation survey report revealed 33 percent of required oral intake documentation was blank. Available meal documentation reflected intake ranging from 50 to 100 percent. The facility documented no fluid intake for 100 percent of the required shifts. The May 2026 documentation survey report revealed 24 percent of required intake documentation was blank. Available documentation reflected meal intake ranging from 51 to 100 percent. The June 2026 documentation survey report revealed 26 percent of required oral intake documentation was blank. Of the shifts containing documentation, 13 percent reflected Resident 1 consumed less than 50 percent of meals. The July 2026 documentation survey report revealed that Resident 1 consumed only 0 to 25 percent of meals on 26 percent of the documented shifts. Because the facility did not consistently document Resident 1's fluid intake, the clinical record did not provide a reliable means to determine the amount of fluid Resident 1 consumed during the period of progressive weight loss and declining oral intake. Laboratory testing obtained on July 9, 2026, revealed a blood urea nitrogen (BUN, a blood test that measures the amount of nitrogen from the waste product urea in the blood and is used, along with other clinical findings, to evaluate kidney function and hydration status) level of 22 milligrams per deciliter (mg/dL), above the laboratory reference range of 6 to 20 mg/dL. The creatinine (a waste product normally filtered from the blood by the kidneys and used to assess kidney function) level was 1.4 mg/dL, above the laboratory reference range of 0.6 to 1.2 mg/dL. The estimated glomerular filtration rate (eGFR, an estimate of how effectively the kidneys filter waste from the blood) was 48 milliliters per minute per 1.73 square meters (mL/min/1.73 mThe glucose (the amount of sugar in the blood) level was 65 mg/dL, below the laboratory reference range of 70 to 120 mg/dL. The clinical record contained no documentation demonstrating that the CRNP or physician evaluated or addressed these abnormal laboratory results at that time. On July 14, 2026, at 5:57 PM nursing documented that Resident 1 consumed no food at dinner and that the Registered Nurse Supervisor was informed. The clinical record contained no documentation that the physician was notified of the resident's failure to eat. Despite the resident's continuing weight loss and documented decline in oral intake, on July 15, 2026, the dietitian documented that Resident 1's weight had been stable for two weeks and made no new nutritional recommendations. The dietitian's note did not address the documented decline in meal intake. On July 19, 2026, Resident 1's responsible party contacted the facility and expressed concern that Resident 1 had not been weighed since July 12, 2026. Facility staff subsequently weighed Resident 1 and obtained a weight of 108.4 pounds, representing a loss of 5.6 pounds in seven days. The responsible party requested to speak with a supervisor because of the resident's continued weight loss. On July 19, 2026, the facility communicated the responsible party's concerns to the physician. The physician recommended increasing the appetite stimulant and discussed alternative nutritional support, including a possible tube feeding with the family. On July 20, 2026, staff documented Resident 1 received assistance with meals and exhibited possible swallowing difficulty. The facility obtained a speech-language pathology evaluation, which did not identify swallowing impairment. On July 21, 2026, laboratory testing demonstrated a marked deterioration in Resident 1's kidney function compared with the laboratory results obtained on July 9, 2026. Resident 1's blood urea nitrogen (BUN) increased from 22 milligrams per deciliter (mg/dL) on July 9, 2026, to 42 mg/dL on July 21, 2026. Resident 1's creatinine increased from 1.4 mg/dL to 2.8 mg/dL. Resident 1's estimated glomerular filtration rate (eGFR) decreased from 48 milliliters per minute per 1.73 square meters (mL/min/1.73 mto 21 mL/min/1.73 mAn eGFR of 21 represented severely decreased kidney filtration. These abnormal laboratory changes reflected a substantial decline in Resident 1's kidney filtration compared with the July 9, 2026, results in the context of the resident's significant weight loss and poor food and fluid intake. At 3:35 PM on July 21, 2026, nursing documented that CRNP was aware of the new laboratory results. The CRNP issued no new orders at that time. A CRNP progress note entered on July 21, 2026, at 4:45 PM documented that Resident 1 continued to have a very poor appetite despite the increased dose of mirtazapine and identified the resident's weight loss as a significant concern. The CRNP documented that the laboratory values were "stable." However, compared with the July 9, 2026, laboratory results, they were abnormal. The CRNP instructed facility staff to ensure Resident 1 was drinking, monitor the resident's urinary output, and transfer Resident 1 to the emergency department if the resident's condition worsened. On July 22, 2026, the dietitian documented that Resident 1 weighed 106.6 pounds. The dietitian documented review of Resident 1's July 9, 2026, laboratory results but did not document review or evaluation of the more recent July 21, 2026, laboratory results, which demonstrated the increased BUN and creatinine and decreased eGFR. On July 22, 2026, nursing documented Resident 1 consumed no food and that the Registered Nurse Supervisor was notified. The clinical record contained no documentation that the facility notified the physician or responsible party at that time that Resident 1 was not consuming food or fluids. On July 22, 2026, at 8:28 PM a physician's progress note documented review of Resident 1's laboratory results and identified acute renal failure likely due to dehydration, failure to thrive, and significant weight loss. The facility subsequently transferred Resident 1 to the hospital for further evaluation and treatment. Hospital records revealed Resident 1 arrived at the hospital on July 22, 2026, at 10:45 PM. Hospital physician documentation dated July 23, 2026, at 1:20 AM identified signs of dehydration, including pale appearance, dry mucous membranes (dryness of the moist tissues lining areas such as the mouth), delayed capillary refill (slower return of blood flow after pressure is applied to the skin), diminished peripheral pulses, and decreased skin turgor (reduced ability of the skin to return to its normal position after being gently pinched). Hospital documentation revealed Resident 1 was admitted with acute kidney injury, dehydration, and severe protein-energy malnutrition (a serious condition resulting from inadequate intake or use of protein and calories needed to maintain body tissues and normal body functions). The hospital nutritional assessment dated July 24, 2026, documented that Resident 1 met criteria for severe malnutrition, with fat loss, muscle loss, and significant weight loss present. During an interview on August 13, 2026, at 12:00 PM Resident 1's responsible party stated she had expressed concerns to facility staff for months because Resident 1 appeared to be losing weight each time she visited. She stated that her concerns in April, May, and June 2026 were not adequately addressed. The responsible party stated that on July 3, 2026, she personally contacted the attending physician's office regarding Resident 1's weight loss and was informed by the CRNP that she had not previously been aware of the resident's weight loss. The clinical record contained no documentation from March 25 through July 3, 2026, demonstrating that the facility notified the physician of Resident 1's progressive and significant weight loss. The facility failed to follow its established weight-monitoring process; consistently monitor and document Resident 1's food and fluid intake; timely identify, evaluate, and respond to significant and continued weight loss and declining oral intake; consistently notify the physician and responsible party of significant changes in the resident's nutritional and hydration status; and evaluate the effectiveness of nutritional and hydration interventions and revise those interventions when Resident 1 continued to experience significant weight loss and declining oral intake. These failures resulted in actual harm to Resident 1. From admission on March 25, 2026, through July 21, 2026, Resident 1's weight decreased from 135.6 pounds to 106.6 pounds, a loss of 29 pounds, or 21.4 percent of the resident's admission body weight. During this period, Resident 1 experienced declining food intake, the facility lacked consistent documentation to determine the resident's fluid intake, and laboratory testing demonstrated worsening kidney function. On July 22, 2026, the facility physician transferred Resident 1 to the hospital for acute renal failure likely secondary to dehydration, failure to thrive, and significant weight loss. Hospital evaluation subsequently identified clinical signs of dehydration, and Resident 1 was admitted with acute kidney injury, dehydration, and severe protein-energy malnutrition. A hospital nutritional assessment further documented severe malnutrition with fat loss, muscle loss, and significant weight loss. 28 Pa Code 211.10 (c) Resident care policies. 28 Pa. Code 211.12 (c) (d)(3)(5) Nursing services.
 Plan of Correction - To be completed: 09/08/2026

1. R1 no longer resides at the facility. He was discharged on 07/23/26.
2. Current residents will be reviewed to determine if a significant weight loss has occurred in the past month and, if so, a nutritional assessment will be completed, interventions will be implemented as appropriate, the residents care plan will be adjusted as appropriate and the resident's physician and responsible party will be notified.
3. The Registered Dietician will educate all licensed staff on identification of significant weight loss, initiation of nutritional assessment, implementation of interventions to prevent further weight loss, and an adjustment to the resident's care plan.
4. Directed Inservice will be completed with all staff by an approved Department of Health Directed Inservice provider on F0692 regulation and accompanying guidelines for these regulatory requirements. Directed in-service will be taking place August 25, 2026 at 10am and 2pm.
5. Residents with identified significant weight loss will be audited weekly for four weeks by the Registered Dietician, or designee, to ensure there is a new nutritional assessment completed, implementation of interventions to prevent further weight loss, and adjustments to the resident care plan.
6. Audits will be reviewed at the facility's monthly QAPI meeting for further actions, recommendations, and follow-up.

483.10(g)(14)(i)-(iv)(15) REQUIREMENT Notify of Changes (Injury/Decline/Room, etc.):This is a less serious (but not lowest level) deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status.
§483.10(g)(14) Notification of Changes.
(i) A facility must immediately inform the resident; consult with the resident's physician; and notify, consistent with his or her authority, the resident representative(s) when there is-
(A) An accident involving the resident which results in injury and has the potential for requiring physician intervention;
(B) A significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications);
(C) A need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or
(D) A decision to transfer or discharge the resident from the facility as specified in §483.15(c)(1)(ii).
(ii) When making notification under paragraph (g)(14)(i) of this section, the facility must ensure that all pertinent information specified in §483.15(c)(2) is available and provided upon request to the physician.
(iii) The facility must also promptly notify the resident and the resident representative, if any, when there is-
(A) A change in room or roommate assignment as specified in §483.10(e)(6); or
(B) A change in resident rights under Federal or State law or regulations as specified in paragraph (e)(10) of this section.
(iv) The facility must record and periodically update the address (mailing and email) and phone number of the resident
representative(s).

§483.10(g)(15)
Admission to a composite distinct part. A facility that is a composite distinct part (as defined in §483.5) must disclose in its admission agreement its physical configuration, including the various locations that comprise the composite distinct part, and must specify the policies that apply to room changes between its different locations under §483.15(c)(9).
Observations: Based on review of facility policy and clinical records, and staff and resident representative interviews, it was determined the facility failed to promptly notify the physician and resident representative of a significant change in condition involving ongoing weight loss for one of ten sampled residents (Resident 1). Findings include: Review of the facility policy titled "Notification of Changes," last reviewed March 26, 2026, revealed that the facility must promptly inform the resident, consult with the resident's physician, and notify the resident's representative when a change in the resident's condition requires notification. A review of the clinical record revealed Resident 1 was admitted to the facility on March 25, 2026, with diagnoses that included chronic obstructive pulmonary disease (a progressive lung condition that makes breathing difficult) and dementia (a general term for a loss of memory, language, problem-solving, and other thinking abilities that interfere with daily life). A review of Resident 1's Quarterly Minimum Data Set assessment (MDS, a federally mandated standardized assessment process conducted periodically to plan resident care) dated July 2, 2026, revealed that Resident 1 was severely cognitively impaired with a BIMS score of 4 (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 0 through 7 indicates severe cognitive impairment). The MDS further indicated that Resident 1 required set-up or clean-up assistance with eating. Review of Resident 1's clinical record revealed that the facility first identified weight loss on May 21, 2026, with continued episodes of weight loss documented through July 22, 2026. Despite the documented weight loss beginning May 21, 2026, the clinical record contained no documented evidence that facility staff notified or consulted Resident 1's physician regarding the resident's weight loss before July 3, 2026. The clinical record also contained no documented evidence that facility staff notified Resident 1's responsible party of the resident's weight loss during this period. The clinical record revealed that the physician first became aware of the resident's weight loss on July 3, 2026, after Resident 1's responsible party contacted the physician. The clinical record contained no documented evidence that facility staff had previously notified the physician of the resident's ongoing weight loss identified beginning May 21, 2026. During an interview on August 13, 2026, at 12:00 PM, Resident 1's responsible party stated that facility staff had not informed her that Resident 1 was experiencing weight loss. The responsible party further stated that she had previously expressed concern to facility staff because she believed Resident 1 was losing weight. During an interview with the Nursing Home Administrator on August 13, 2026, at 3:02 PM, the above findings were reviewed. The facility was unable to provide documented evidence that staff had timely notified Resident 1's physician or responsible party of the resident's ongoing weight loss beginning May 21, 2026, in accordance with the facility's notification policy. 28 Pa Code 211.10 (c) Resident care policies 28 Pa Code 211.12 (c)(d)(3)(5) Nursing services
 Plan of Correction - To be completed: 09/08/2026

1. R1 no longer resides at the facility. He was discharged on 07/23/26.
2. A whole house audit of resident weights will be completed by the Director of Nursing, or designee. Any significant weight changes, greater than 5% from the previous weight, will be reported to the resident physician at the time of audit.
3. Education will be completed with all licensed nurses by the Director of Nursing, or designee, on the Physician Notification policy, Notification of Change in Condition.
4. Resident weights will be added to the morning clinical meeting agenda and audited by the Director of Nursing, or designee, through the clinical meeting five times per week. This will include auditing physician notifications of significant weight change, new orders, and recommendations.
5. Audits will be reviewed at the facility's monthly QAPI meeting for further actions, recommendations, and follow-up.

§ 201.14(g) LICENSURE Responsibility of licensee.:State only Deficiency.
(g) A facility owner shall pay in a timely manner bills incurred in the operation of a facility that are not in dispute and that are for services without which the resident ' s health and safety are jeopardized.

Observations: Based on a review of the facility's outstanding accounts payable and interviews with staff, it was determined the facility failed to pay, in a timely manner, bills incurred in the operation of the facility, that are not in dispute and are for services without which the residents' health and safety are jeopardized. Findings include: During an interview on August 13, 2026, at 11:15 AM, the Nursing Home Administrator (NHA) stated the facility forwarded invoices to the corporate office for payment and that payment of outstanding bills was not completed at the facility level. A review of the facility's accounts payable aging report (a financial report that categorizes unpaid invoices based on the length of time they have remained outstanding) conducted during the survey ending August 13, 2026, revealed multiple unpaid balances for vendors providing goods and services necessary for facility operations. The report identified outstanding invoices that remained unpaid for periods exceeding 181 days and, for most vendors, more than 211 days. The aging report identified the following unpaid balances: Vendor #1 Pharmacy services: $43,127.00, outstanding for more than 211 days. Vendor #2 Respiratory therapy services: $14,423.50, outstanding for more than 211 days. During an interview with the Nursing Home Administrator and the Director of Nursing on August 13, 2026, at 3:15 PM, the facility was unable to provide evidence that the outstanding invoices for the above goods and services had been paid in a timely manner.
 Plan of Correction - To be completed: 09/08/2026

1The corporate accounts payable team was made aware of this citation. Invoices are not received or paid at the facility level.
The administrator will obtain the most current aging report at the beginning of each month to determine if any accounts require attention.
The administrator or designee will review the facilities aging reports, note any concerns, and hold bi-monthly Accounts payable meetings to monitor payment progress for the next 90 days.

The administrative team, along with regional directors will continue to ensure a safe living environment for our residents and we will ensure ongoing delivery of all necessary goods and services.

The company has verbal agreements with its primary suppliers/ affiliate companies to continue with weekly payments, ensuring no interruption in service. Results of these meetings will be included in the facilities monthly AQPI meeting

Regional Director will provide education about paying bills timely, monthly audits will be conducted by Regional Directors

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