Inspection·December 19, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 resident interview and observation, it was determined that the facility failed to provide a clean and comfortable environment on the nursing unit. Findings include: During a confidential resident interview on December 17, 2024, at 12:34 p.m., it was reported that the floors in resident rooms were not cleaned thoroughly. During a group interview on December 18, 2024, at 10:05 a.m., two of four residents reported that the floors on the nursing unit are not always cleaned thoroughly. On December 17, 2024, at 12:29 p.m., there was dirt and debris on the floor of room [ROOM NUMBER]. Observations on December 18, 2024, between 9:29 a.m. and 1:26 p.m., revealed the following: There was dirt and debris on the floors of rooms 204, 217, 219, and 221. The dirt and debris remained on the floor of room [ROOM NUMBER]. There was dirt, debris, and a white substance smudged on the floor of room [ROOM NUMBER] that remained through the end of the observation period. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(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 2 Event ID: 396108 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 396108 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Good Shepherd Home-Bethlehem 2855 Schoenersville Road Bethlehem, PA 18017 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)