A list of the most recent deficiencies for Good Shepherd Health Center. The list is based on the information provided by CMS from both standard inspections and from complaints filed by residents.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-11-20 | 2023-12-20 | Y |
| Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2023-07-06 | 2023-08-06 | N |
| Ensure each resident receives an accurate assessment. | Health | 2023-07-06 | 2023-08-06 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-07-06 | 2023-08-06 | N |
| Post nurse staffing information every day. | Health | 2023-07-06 | 2023-08-06 | N |
| Dispose of garbage and refuse properly. | Health | 2023-07-06 | 2023-08-06 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-07-06 | 2023-08-06 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-07-13 | 2023-07-14 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-07-13 | 2023-07-13 | N |
| Meet requirements for the use and maintenance of medical gas equipment. | Fire Safety | 2023-07-13 | 2023-07-13 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-02-21 | 2023-03-17 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2022-06-02 | 2022-07-02 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-06-02 | 2022-07-02 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-06-02 | 2022-07-02 | N |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2022-06-02 | 2022-07-02 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-06-02 | 2022-07-02 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-06-02 | 2022-07-02 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-06-02 | 2022-07-02 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-06-02 | 2022-07-02 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-06-02 | 2022-07-02 | N |
| Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | Health | 2022-06-02 | 2022-07-02 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-06-08 | 2022-06-16 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2022-06-08 | 2022-06-16 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-06-08 | 2022-06-08 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-06-08 | 2022-06-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-04-14 | 2022-05-14 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-04-14 | 2022-05-14 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-12-19 | 2020-01-24 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-12-19 | 2020-01-24 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-12-19 | 2020-01-24 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-12-20 | 2020-01-02 | N |
| Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2019-12-20 | 2020-01-02 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-12-20 | 2020-01-02 | N |
| Meet requirements for the use and maintenance of medical gas equipment. | Fire Safety | 2019-12-20 | 2020-01-02 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-12-20 | 2019-12-31 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2019-12-20 | 2019-12-20 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2019-12-20 | 2019-12-20 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-12-20 | 2019-12-20 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-12-20 | 2019-12-20 | N |
