Hermitage Retirement Center

The facility failed to maintain a clean and safe environment due to the presence of live and dead cockroaches in the kitchen, medication cart, and resident rooms. Additionally, an unlocked closet containing cleaning products was accessible to residents on the Special Care Unit, creating a potential hazard.

The facility failed to ensure the administrator of a resident's estate received a refund of personal funds within 30 days after the resident's death. Specifically, for two out of three sampled residents, the required refund was not processed within the mandated timeframe.

The facility failed to ensure that the personal funds of deceased residents were refunded to the administrator of the estate or the Clerk of Superior Court within 30 days of death. Specifically, for 2 of 3 sampled residents, the refund process was delayed or incorrectly handled, including an instance where a check for Resident #6 was not written to the proper estate representative.

The facility failed to maintain an environment free of hazards because personal care products were left unsecured in residents' rooms within the Special Care Unit. Specifically, a bottle of body wash was found in the bathroom of resident room 67, which is a concern given the resident's history of ingesting non-food items.

The facility failed to maintain an environment free of hazards by leaving personal care products unsecured in residents' rooms within the Special Care Unit. Specifically, various items such as body wash, hand sanitizer, and hairspray with 'keep out of reach of children' warnings were found accessible in rooms 67, 71, and 49. This is particularly concerning as one resident has a known history of ingesting non-food items.

The facility failed to provide necessary personal care to a resident who requested assistance via a call bell. Specifically, the resident was left in her own feces for three hours on August 27, 2023, because staff did not respond to her bell. This failure occurred despite the resident's care plan requiring extensive assistance with toileting.

The facility failed to provide timely personal care to a resident who requested assistance via a call bell. As a result, the resident remained in feces for three hours, placing her at significant risk for skin breakdown.

The facility failed to provide adequate supervision for a resident with a known history of wandering and dementia. This lack of oversight allowed the resident to elope from the locked Special Care Unit through an outside porch, resulting in the resident being found deceased on the facility grounds approximately nine hours later.