Below average — CMS composite of the measures below.
The next survey window likely opens around December 2026
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Good Shepherd Health And Rehabilitation during CMS and state inspections, most recent first.
Unlabeled Open Medications and Expired Culture Tubes: An opened Nystatin cream tube for one resident and an opened Diclofenac gel tube for another resident were found without open date labels during treatment cart audits, and five culture tubes were found expired. The residents had orders for topical medications related to redness and pain, and the DON and Administrator stated open dates are needed so staff know when to discard products and that expired items are a concern.
A resident with cerebral palsy and bone disorders suffered a leg fracture after their foot frequently fell off a Broda chair footrest, leading to an accident with another resident's wheelchair. Despite staff awareness, the issue was not documented in the care plan or addressed with specific interventions. The facility's investigation confirmed the cause of the injury but failed to identify the footrest issue as a hazard.
A resident with dementia and dental issues was not provided routine dental care despite multiple requests and being at risk for dental pain. The facility's staff failed to coordinate with the contracted dental service provider, resulting in the resident not being included in the dental service lists for several months.
A resident with cerebral palsy sustained a fracture of unknown origin, which was later determined to be caused by a roommate's wheelchair. The facility failed to report the incident to the SSA and Adult Protective Services as required by state law, despite the injury initially being of unknown origin.
Unlabeled Open Medications and Expired Culture Tubes
Penalty
Summary
The facility failed to properly label opened medications and biologicals and failed to remove expired testing supplies. During observation, an opened tube of Diflonac 1% for R70 did not have an open date label, and an opened tube of Nystatin 100,000 units for R53 also did not have an open date label. In addition, five unopened culture tubes were observed to be outdated. The facility policy titled "Labeling and Storage" stated that all medications and biologicals are to be labeled to facilitate precautions and safe administration. R53 was admitted with diagnoses including diabetes, kidney disease, skin and subcutaneous tissue diseases, and heart failure, and had a telephone order for Nystatin external cream applied to the groin for redness. R70 was admitted with diagnoses including vascular dementia, pain in leg, heart failure, and right knee osteoarthritis, and had telephone orders for Diclofenac Sodium External Gel 1% for pain in the left shoulder and right knee. During cart audits, the opened Nystatin and Diclofenac tubes were labeled with the residents' names and delivery dates but lacked open date labels. Interviews with RN10, LPN3, the DON, and the Administrator confirmed that open dates are important for knowing when to discard products and that expired items and unlabeled open products were a concern.
Failure to Prevent Accident Due to Inadequate Supervision and Assistive Devices
Penalty
Summary
The facility failed to ensure adequate supervision and assistive devices to prevent accidents for a resident who utilized a Broda chair. The resident's foot frequently fell off the edge of the Broda chair footrest, a hazard that was not effectively addressed by the facility. On one occasion, the resident's leg was bumped by another resident's wheelchair, resulting in a fracture to the resident's left tibia. The resident, who had a history of cerebral palsy, bone disorders, and contractures, was dependent in all functional areas and required assistance for positioning in the Broda chair. Despite staff being aware of the resident's foot frequently falling off the chair, this issue was not documented in the care plan or addressed with specific interventions. Interviews with staff revealed that repositioning was done frequently, but no formal evaluation or adaptation of the Broda chair was conducted to prevent the resident's foot from falling. The facility's investigation confirmed that the injury was caused by the roommate's wheelchair hitting the resident's leg. However, the investigation did not identify the resident's foot falling off the chair as a potential hazard. The Director of Rehabilitation was not aware of the issue, and no therapy evaluation was conducted to address the problem. The lack of documentation and specific interventions in the care plan contributed to the deficiency in preventing the accident.
Failure to Provide Routine Dental Care
Penalty
Summary
The facility failed to assist a resident, identified as R89, in obtaining routine dental care. R89 was admitted to the facility with several medical conditions, including a wedge compression fracture, dementia, and weakness. Upon observation, R89 was found to have four natural carious teeth and expressed difficulty in chewing food, requesting dental care multiple times since admission. Despite being assessed as at risk for dental pain and having a care plan that included utilizing a mobile dentistry program, there was no documentation of R89 receiving dental services or refusing them since admission. Interviews with facility staff revealed a lack of coordination and oversight in ensuring R89 received the necessary dental care. The Director of Nursing stated that dental services were provided through a contracted company, and the Social Services Director (SSD) was responsible for managing the list of residents needing dental care. However, the SSD was unable to explain why R89 was not included in the dental service lists for May and July 2024, despite being aware of his need for dental services. The Administrator confirmed the SSD's responsibility and was also unable to determine why R89 was not seen in July, although efforts were made to ensure R89 would be seen in September.
Failure to Report Injury of Unknown Origin
Penalty
Summary
The facility failed to report an injury of unknown origin involving a resident to the State Survey Agency (SSA) and Adult Protective Services as required by state law. The incident involved a resident with cerebral palsy and other medical conditions, who was found to have a fracture in the left tibia after being sent to the hospital. The facility's policy mandates immediate reporting of such incidents, especially if they result in serious bodily injury, within two hours. However, the facility did not report the incident to the appropriate authorities, despite the injury being initially of unknown origin. The investigation revealed that the resident's leg was injured when a roommate, also with cerebral palsy, accidentally bumped into it with a wheelchair. The facility's administrator conducted an investigation and concluded the cause of the injury based on the roommate's admission. Despite this conclusion, the administrator did not report the incident to the SSA or Adult Protective Services, believing that the quick determination of the cause negated the need for reporting. This oversight constitutes a failure to comply with mandatory reporting requirements for suspected abuse or injury of unknown origin.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Phelps
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Trinity Health Care Of Mingo | 13.2 mi | ★★★★★ | 0 | 0 |
| Heritage Hall Grundy | 14.4 mi | ★★★★★ | 0 | 0 |
| Tug Valley Arh Skilled Nursing Facility | 15.3 mi | ★★★★★ | 0 | 0 |
| Elkhorn Health & Rehabilitation | 18.4 mi | ★★★★★ | 0 | 0 |
| Pikeville Nursing And Rehab Center, Llc | 21.8 mi | ★★★★★ | 2 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.