HADLEY TOWNSHIP, Mich. -- The investigation continues at a local assisted living facility after an elderly woman was found dead after she managed to walk away from the home.

“It's a tragedy,” said Lapeer County Sheriff Ron Kalanquin. “It’s just a terrible, terrible thing."

The last few minutes of 84-year-old Rosemary Gubert's life were no doubt frightening and painful.

Autopsy results show the dementia patient, who was found in a watery ditch across the street from Green Valley Manor adult foster care home, died of hypothermia.

She somehow walked away from the Hadley Township facility on Pratt Road between 2 a.m. and 4 a.m. Tuesday.

She wasn't wearing shoes or even a sweater over her nightgown. "It was about 27 degrees that evening so you could see if she did fall down in that water, how agonizing her death had to be,” said neighbor Sandy Eddy.

Nearby residents and local police said this isn't the first time the center has been under investigation.

A number of code violations may have added up to make Tuesday’s tragedy possible.

Three of the six doors were not operating properly and locks were left undone.

The owner of the facility is also accused of not always filling out the residents’ prescriptions, including inhalers and Vicodin.

Turns out, Green Valley Manor has been investigated by the state at least seven times over the past few years.

A recent unannounced visit by the Department of Human Services revealed that one of the resident’s windows had a broken screen and lock.

Another investigation determined staff didn't seek medical help quickly enough when a patient show signs of an illness over several days.

The Lapeer County sheriff said his deputies have been called to home in the past several times for walkaways, but that this latest incident could ultimately result in a negligent homicide charge.

A Green Valley employee was charged with sexually assaulting a mentally disabled resident back in 2006.

Those who live near the facility are hoping something is done by the state to ensure this never happens again and in the meantime, they're praying for Gubert's loved ones.

"My heart goes out to her family,” said Eddy. “They assumed she was safe and obviously she wasn’t."

TV5 tried contacting Green Valley Manor's director Debra Field several times by phone and even stopped by the facility, but no one would come to the door or return our calls.

For a statewide search of adult foster care units, click here.