A list of the most recent deficiencies for Good Shepherd Village at Endwell. 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? |
|---|---|---|---|---|
| Respond appropriately to all alleged violations. | Health | 2022-09-20 | 2022-10-10 | Y |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2021-11-10 | 2022-01-06 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2021-11-10 | 2021-12-21 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-11-10 | 2021-12-21 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-11-10 | 2021-12-21 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2021-11-10 | 2021-12-21 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-11-10 | 2021-12-21 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2021-11-10 | 2021-12-21 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-11-10 | 2021-12-15 | N |
| Ensure that residents are free from significant medication errors. | Health | 2021-11-10 | 2021-12-15 | N |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Health | 2021-11-10 | 2021-12-15 | N |
| 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. | Health | 2021-11-10 | 2021-12-15 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2021-11-10 | 2021-12-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-11-10 | 2021-12-15 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-11-10 | 2021-12-15 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-11-10 | 2021-12-15 | Y |
| Keep all essential equipment working safely. | Health | 2021-11-10 | 2021-12-15 | Y |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2019-04-16 | 2019-06-15 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2019-04-16 | 2019-06-15 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2019-04-16 | 2019-06-15 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2019-04-16 | 2019-06-15 | N |
| Ensure residents have reasonable access to and privacy in their use of communication methods. | Health | 2019-04-17 | 2019-05-24 | N |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Health | 2019-04-17 | 2019-05-24 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-04-17 | 2019-05-24 | N |
| Install proper backup exit lighting. | Fire Safety | 2017-11-21 | 2018-01-19 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2017-11-21 | 2018-01-19 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2017-11-21 | 2018-01-19 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2017-11-21 | 2018-01-19 | N |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2017-11-21 | 2018-01-19 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2017-11-21 | 2018-01-19 | N |
| Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. | Health | 2017-11-21 | 2017-12-21 | N |
