Health inspection·October 13, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to provide a comfortable, homelike environment for residents, staff and public on two of three nursing units. ([NAME] 3 and [NAME] 4) Findings include: Observation on October 11, 2023, at 10:22 a.m., revealed that the walls throughout the [NAME] 3 nursing unit were marred and scratched above and below the handrails, and the panels on the doors to resident rooms were also marred and scratched. The door jams to the main resident areas were marred and slightly damaged. Observations on October 11 and 12, 2023, at various times throughout the day, revealed that the lower half of the walls throughout the [NAME] 4 nursing unit were marred and scratched. The panels on the doors to resident rooms were marred, and the door jams to the main resident areas and the elevator doors had chipped paint and were slightly damaged. In room [ROOM NUMBER], the walls were marred and scratched. In room [ROOM NUMBER], there was exposed drywall with large areas of chipped paint near the bathroom. In room [ROOM NUMBER], the walls were marred with chipped paint and there was crumbled drywall in the corner near the bathroom. In room [ROOM NUMBER], there was crumbled drywall at the base of the wall. In room [ROOM NUMBER], the walls were marred with chipped paint, the sink countertop was chipped in several spots and the rubber baseboard molding around the room had multiple holes. In room [ROOM NUMBER], the base of the wall had crumbled drywall. 28 Pa. Code 201.18(b)(3)(e)(2.1) Management. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 395018 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 395018 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Good Shepherd Home Raker Center 601 St John Street Allentown, PA 18103 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)