Health inspection·December 4, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on review of facility policies, observations, and staff interview, it was determined that the facility failed to ensure that food was stored in accordance with standards for food safety in one of two resident refrigerators (Nursing Unit Two); failed to label food brought into the facility with the resident's name and use by date in one of two resident refrigerators ( Nursing Unit Two); failed to maintain sanitary conditions in one of two resident refrigerators (Nursing Unit One); failed to maintain dishwashing machine water temperatures in accordance with manufacturer recommendations for food service safety for the kitchen dishwasher; and failed to prepare food items in accordance with professional standards in the facility's main kitchen. Findings include:Review of facility policy entitled, Food Brought by Family/Visitors with a policy review date of 1/1/25, indicated that Residents/families are asked that containers be labeled with the resident ' s name, the item, and the date. The nursing or housekeeping staff will discard foods that are past their use by / expiration date or that are visibly rotten or rotting if not done so by the resident or family. Review of facility policy entitled, Monitoring of Cooler/Freezer Temperature with a policy review date of 1/1/25, indicated that Refrigerated food shall be labeled, dated, and monitored so that it is used by the use by date, and refrigerators are to be cleaned weekly and remain free of spills, and spoiled foods. Review of facility policy entitled, Dishwasher Machine Use with a policy review date of 1/1/25, indicated to use Dish Machine Temperature log to record information at each use. High Temperature Dishwasher: wash 160 degrees F (Fahrenheit) minimum and final rinse 180 degrees F minimum and to stop dishwashing if wash and/or rinse temperatures are below required levels. Report to supervisor immediately and do not resume until temperatures are adjusted. Review of the facility temperature log sheets revealed that the minimum temperature requirements for the wash cycle was: Wash 150 degrees F and the Rinse 180 degrees F. Notify maintenance and supervisor if temperatures not appropriate. Review of facility policy entitled, Food Temperature Logs with a policy review date of 1/1/25, indicated that food temperatures must be recorded on hot and cold foods prior to service using the temperature evaluation form. Observations on 9/30/25, at 11:50 a.m. of the refrigerator in Nursing Station Two used for residents revealed a brown icy-like substance on the shelves, and walls of the freezer. During an interview on 9/30/25, at the time of observation, the Dietary Manager confirmed that the freezer was not clean. Observations on 10/1/25, at 9:55 a.m. of a refrigerator in Nursing Unit Two used for residents revealed an opened jar of pickled beets without a resident name or date; two extra cheesy pizza Lunchables without a resident name or date; a bag of cherries with a resident name and date of 8/16/25; and a Walmart bag with a resident name and dated 8/22/25 that contained an opened bag of cheese cubes, opened bag of turkey breast slices, and opened bag of ham slices. Further observations of the freezer revealed one opened bag of frozen strawberries without a name or date, and four frozen microwave meals without resident names or dates. During an interview on 10/01/25, at the time of observation, the Assistant Director of Nursing (continued on next page) 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 3 Event ID: 395231 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 395231 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hermitage Nursing and Rehabilitation 500 Clarksville Road Hermitage, PA 16148 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)