Inspection·September 23, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessments were completed to accurately reflect the residents' current status for three of 20 sampled residents. (Residents 1, 2, and 7) Residents Affected - Few Findings include: Clinical record review revealed that Resident 1 had diagnoses that included cerebral atherosclerosis and coronary artery disease. A physician's order dated July 1, 2025, directed staff to administer an anti-platelet medication (clopidogrel bisulfate). Review of the MDS assessment dated [DATE], revealed that the resident was administered an anti-coagulant medication during the review period, not an anti-platelet medication. The MDS inaccurately reflected the use of an anti-coagulant medication. Clinical record review revealed that Resident 2 had diagnoses that included peripheral artery disease and depression. A physician's order dated October 9, 2023, directed staff to administer an anti-platelet medication (clopidogrel bisulfate). Review of the MDS assessments dated June 12, 2025, and August 28, 2025, revealed that the resident was administered an anti-coagulant medication during the review period, not an anti-platelet medication. The MDS assessments inaccurately reflected the use of an anti-coagulant medication. Clinical record review revealed that Resident 7 had diagnoses that included diabetes mellitus and adjustment disorder. A physician's order dated November 23, 2021, directed staff to administer an anti-depressant medication (sertraline). Review of the MDS assessment dated [DATE], revealed that the resident was not administered an antidepressant medication and that the resident had received a dose of insulin during the review period. Review of Resident 7's Medication Administration Record for August 2025 revealed that the resident did not receive any insulin and was administered an antidepressant medication in the during the review period. The MDS inaccurately reflected administration of insulin and non-use of an antidepressant medication. In an interview on September 23, 2025, at 9:42 a.m., the Registered Nurse Assessment Coordinator confirmed that Resident 1's, 2's, and 7's, MDS assessments were inaccurate and did not reflect the residents' current status. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395018 If continuation sheet Page 2 of 3 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 09/23/2025 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to develop a comprehensive care plan that addressed each resident's needs as identified in the comprehensive assessment for two of 20 sampled residents. (Residents 16 and 36)Findings include: Clinical record review revealed that Resident 16 was admitted to the facility on [DATE], and had diagnoses that included adjustment disorder. The Minimum Data Set (MDS) Care Area Assessment (CAA) summary dated March 20, 2025, noted that the resident's psychotropic drug use was to be addressed in the care plan. Review of the medication administration records for March through September 2025, revealed the resident received an antidepressant (sertraline), which was classified as a psychotropic drug, during the review period. There was no documented evidence that interventions to address Resident 16's psychotropic drug use were included in the current care plan. In an interview on September 22, 2025, at 3:20 p.m., Registered Nurse 1 (RN1) confirmed there was no documented evidence that the psychotropic drug use was addressed in the Resident's 16 current care plan. Clinical record review revealed that Resident 36 was admitted to the facility on [DATE], and had diagnoses that included spastic quadriplegia cerebral palsy and seizure disorder. Review of the MDS assessment dated [DATE], indicated that the resident received oxygen through her nose while she was a resident. A physician's order dated September 9, 2021, instructed staff to apply oxygen at two liters per minute through a nasal cannula every night. Review of the treatment administration record for September 2025 revealed that the resident received oxygen every night. There was no documented evidence that the use of oxygen was included in the resident's current care plan. In an interview on September 23, 2025, at 9:45 a.m., RN2 confirmed that there was no documented evidence that oxygen was addressed on Resident 36's current care plan. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Event ID: Facility ID: 395018 If continuation sheet Page 3 of 3