Deficiency Records for The Shepherd's Center
Updated as of November 01, 2020
This is not the most recent data for The Shepherd's Center. For the most recent information, click here.
A list of the most recent deficiencies for The Shepherd's 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? |
---|---|---|---|---|
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2020-03-02 | 2020-04-03 | Y |
Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | Health | 2020-03-02 | 2020-04-03 | Y |
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. | Health | 2019-06-06 | 2019-07-08 | N |
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2019-06-06 | 2019-07-08 | N |
Assess the resident when there is a significant change in condition | Health | 2019-06-06 | 2019-07-08 | N |
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-06-06 | 2019-07-08 | 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 | 2019-06-06 | 2019-07-08 | N |
Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2019-06-06 | 2019-07-08 | N |
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | Health | 2019-06-06 | 2019-07-08 | N |
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2019-06-06 | 2019-07-08 | N |
Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2019-06-06 | 2019-07-08 | N |
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | Health | 2019-06-06 | 2019-07-08 | N |
Provide and implement an infection prevention and control program. | Health | 2019-06-06 | 2019-07-08 | N |
Establish an Emergency Preparedness Program (EP). | Fire Safety | 2019-04-12 | 2019-05-28 | N |
Develop Emergency Preparedness policies and procedures. | Fire Safety | 2019-04-12 | 2019-05-28 | N |
Develop a communication plan. | Fire Safety | 2019-04-12 | 2019-05-28 | N |
Establish emergency prep training and testing. | Fire Safety | 2019-04-12 | 2019-05-28 | N |
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2018-06-19 | 2018-06-29 | Y |
Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | Health | 2018-06-19 | 2018-06-29 | Y |
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2018-06-19 | 2018-06-29 | Y |
Respond appropriately to all alleged violations. | Health | 2018-06-19 | 2018-06-29 | Y |
Try to resolve each resident's complaints quickly. | Health | 2017-12-01 | 2017-12-29 | Y |
Allow residents the right to participate in the planning or revision of care and treatment. | Health | 2017-12-01 | 2017-12-29 | Y |
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2017-12-01 | 2017-12-29 | Y |
Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. | Health | 2017-08-25 | 2017-09-24 | Y |
Review or revise the resident's care plan after any major change in physical or mental health. | Health | 2017-08-25 | 2017-09-24 | Y |
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2017-08-25 | 2017-09-24 | Y |
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2017-06-06 | 2017-06-26 | N |
Provide a written emergency evacuation plan. | Fire Safety | 2017-06-06 | 2017-06-26 | N |
Have simulated fire drills held at unexpected times. | Fire Safety | 2017-06-06 | 2017-06-26 | N |
Send unopened mail from residents and promptly deliver unopened mail to residents. | Health | 2016-05-25 | 2016-06-24 | N |
Ensure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care. | Health | 2016-05-25 | 2016-06-24 | N |
Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2016-05-25 | 2016-06-24 | N |
Allow residents the right to participate in the planning or revision of care and treatment. | Health | 2016-05-25 | 2016-06-24 | N |
Provide necessary care and services to maintain or improve the highest well being of each resident . | Health | 2016-05-25 | 2016-06-24 | N |
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2016-05-25 | 2016-06-24 | N |
Ensure residents maintain acceptable nutritional status. | Health | 2016-05-25 | 2016-06-24 | N |
Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. | Health | 2016-05-25 | 2016-06-24 | N |
Store, cook, and serve food in a safe and clean way. | Health | 2016-05-25 | 2016-06-24 | N |
At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. | Health | 2016-05-25 | 2016-06-24 | N |
Record of quarterly fire drills for each shift under varying conditions. | Fire Safety | 2015-12-14 | 2015-12-28 | N |