Pennsylvania Department of Health
HERMITAGE NURSING AND REHABILITATION
Patient Care Inspection Results

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HERMITAGE NURSING AND REHABILITATION
Inspection Results For:

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HERMITAGE NURSING AND REHABILITATION - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a State Licensure Monitoring survey on April 4, 2024, it was determined that Hermitage Nursing and Rehabilitation was not in compliance with the following requirements of the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.



 Plan of Correction:


201.13c (b) LICENSURE License renewal:State only Deficiency.
(b) In addition to the application form and fee under subsection (a), a facility shall submit an updated annual financial report that meets the requirements set forth in 201.12(b)(8) (relating to application for license of a new facility or change in ownership).
Observations:
Based on review of the facility submitted application for renewal of the license, it was determined that the facility failed to submit an annual financial report which shall include the following:

(i) Audited financial statements prepared in accordance with generally accepted accounting principles (GAAP). If GAAP requires consolidated financial statements, then consolidated statements shall be provided. (The GAAP indicates that the following is included in and audited financial statement: Balance Sheet, Cash Flow Statement, Income Statement, Statement of Shareholder Equity Changes and an auditor opinion)
(ii) A visual representation of the current ownership structure, which shall include parent companies, shareholders, and any related parties of the persons identified in paragraphs (1) through (6). (this would be an organizational chart rather than a list)
(iii) A supplemental schedule of annual gross revenues, prepared in accordance with GAAP. The supplemental schedule shall be broken out by payor type.

Findings:
Review of the submitted application revealed that there was no visual representation of ownership structure contained in the application.

The facility failed to meet the requirements as set forth in 28 Pa Code 201.13 c.



 Plan of Correction - To be completed: 04/22/2024

0980

Visual Representation of ownership structure of facility has been obtained for submission to DOH for correction of citation 0980 incurred on 4/4/24.

Non compliance to be corrected and by Monday 4/22/2024.

Plan to prevent future non compliance, will be for Administrator to request corporate attorney, or designee, each quarter for updated visual representation of ownership structure, of facility if any changes to previous ownership structure for one year.
Administrator will audit requests quarterly in QAPI and for one year.


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