Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

GOLDEN GOOD SHEPHERD HOME

GOLDEN, IL · 46 certified beds · Last Life Safety survey November 26, 2024

CMS Certification Number 146111 · first certified July 2007

Ownership

Independently operated (no chain recorded by CMS) · Non profit - Other

No change of ownership on CMS record since January 1, 2016, when the records begin.

16
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
5
Tags cited more than once
Across separate surveys
11
Inspection & testing records
Of the citations on file

Position within IL

16 citations — more than 54% of the 666 certified nursing homes in IL. Compared within IL rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Holding steadyabout the same at the latest survey as at its earlier surveys in the window.

The latest survey found 5 citations; the earlier surveys in the window averaged 5.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (October 2025 to January 2026), and past the point by which nine in ten IL facilities have been surveyed. This facility’s last Life Safety survey was November 2024. Facilities in IL are typically surveyed 11–13 months after the last one (median 12), measured over 759 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

5 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

3 of the 16 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

3 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 16 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in IL, and nationally. Surveyors differ markedly between states, so the IL figure is the meaningful one.

This facility16IL median15National median11
Citations on file over three years, compared
MeasureCitations
This facility16
Median facility in IL15
Median facility nationally11

Survey history

Citations at each Life Safety survey
72022-0842023-0952024-11
Citations at each Life Safety survey
Survey dateCitations
August 18, 20227
September 7, 20234
November 26, 20245

Most-cited tags

Most-cited tags at this facility
K-07612K-07122K-09182K-03452K-03532E-00371K-01331K-09141
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.22024-11-26
K-0712Have simulated fire drills held at unexpected times.22023-09-07
K-0918Have generator or other power source capable of supplying service within 10 seconds.22024-11-26
K-0345Have approved installation, maintenance and testing program for fire alarm systems.22023-09-07
K-0353Inspect, test, and maintain automatic sprinkler systems.22023-09-07
E-0037Establish staff and initial training requirements.12024-11-26
K-0133Install a two-hour-resistant firewall separation.12022-08-18
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.12024-11-26

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 4
  • Miscellaneous Deficiencies 4
  • Gas, Vacuum, and Electrical Systems Deficiencies 3
  • Emergency Preparedness Deficiencies 3
  • Other 2
Citations by CMS category
CategoryCitations
Smoke Deficiencies4
Miscellaneous Deficiencies4
Gas, Vacuum, and Electrical Systems Deficiencies3
Emergency Preparedness Deficiencies3
Construction Deficiencies1
Egress Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

November 26, 2024 — 5 citations

Citations issued on November 26, 2024
TagWhat the surveyor checksStatus
E-0037Establish staff and initial training requirements.Deficient, Provider has date of correction (February 1, 2025)
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (February 1, 2025)
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.Deficient, Provider has date of correction (February 1, 2025)
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.Deficient, Provider has date of correction (December 18, 2024)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (January 10, 2025)

September 7, 2023 — 4 citations

Citations issued on September 7, 2023
TagWhat the surveyor checksStatus
E-0026Establish roles under a Waiver declared by secretary.Deficient, Provider has date of correction (October 6, 2023)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (September 12, 2023)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (December 4, 2023)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (September 11, 2023)

August 18, 2022 — 7 citations

Citations issued on August 18, 2022
TagWhat the surveyor checksStatus
K-0133Install a two-hour-resistant firewall separation.Deficient, Provider has date of correction (October 15, 2022)
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (October 15, 2022)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (October 27, 2022)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (October 15, 2022)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (October 15, 2022)
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.Deficient, Provider has date of correction (October 15, 2022)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (October 15, 2022)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.