Hi'olani Care Center at Kahala Nui

Inspectors wroteBased on observations and interviews the facility failed to dispose of food items that have passed the use by date, failed to assure food items were stored in accordance with professional standards, failed to test temperatures of all food on the trayline and stored clean pots and pans on a rack that had rusty colored debris. This deficient practice puts all the residents and staff at risk for foodborne illnessess. Findings Include: 1) On 06/24/24 at 08:30 AM an initial tour of kitchen was done with dietician and Head Chef (HC). The following food items were found in the kitchen: expired chicken base found with a use by date of 6/2/24, pork with a prep date of 6/9 but no use by date, three containers of cooked pork in metal containers with use by date of 6/23/24. The following items were found in the dry storage area opened with no open on and discard by date label: [...]

Inspectors wroteBased on interviews and record review, the facility failed to provide written notification to resident or resident's representative and the Long-Term Care Ombudsman (LTCO) forone of one sampled residents for hospitalizations, (Resident (R) 13). This deficient practice has the potential to affect all residents that are transferred to an acute care hospital. Findings Include: R13 is a [AGE] year-old female who was transferred and admitted to the hospital on [DATE]. A review of R13's Electronic Health Record (EHR) was conducted, and it did not contain any documentation that R13's family representative and the LTCO was provided with a written notification of R13's transfer to an acute care hospital. Interview was conducted on 06/26/24 at 01:44 PM with Social Worker (SW) 1. [...]

Inspectors wroteBased on interviews and record review, the facility failed to implement a comprehensive person-centered care plan for one of 16 sampled residents (Resident (R) 168). This deficient practice has the potential to negatively affect the resident's physical and overall well-being. Findings Include: R168 is a [AGE] year-old female admitted to the facility on [DATE]. R168 has a medical history including, but not limited to dementia, kidney disease, and poor food intake by mouth. A review of R168's Electronic Health Record (EHR) was conducted on 6/24/24. R168's EHR contained information on her measured weights. On 05/22/24, R168's weight was 89.8 pounds (lbs). On 05/28/24, R168's weight was 89.8 lbs. On 06/04/24, R168's weight was measured 0 lbs. On 06/11/24, R168's weight was 80.0 lbs. No other weights were documented since 06/10/24. A review of R168's care plan was conducted. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident received treatment and care in accordance with professional standard of practice for one of 16 residents sampled (Resident (R) 15). The facility did not follow the physician ordered bowel instruction. This failure could place the resident at risk of adverse consequences from diarrhea.

Inspectors wroteBased on interviews and records review, the facility failed to determine that drug records are in order and that an account of all controlled drugs is maintained and reconciled for two of two medication carts sampled. This deficient practice increases the risk of diversion of residents' medications. Findings Include: A review of the facility's records titled, Controlled Drug Count Record 4th Floor Cart A, dated June 2024 was conducted on 06/25/24. The record lacked documentation of licensed nurse signatures for two shifts on 06/24/24 and one shift on 06/25/24. A review of the facility records titled, Controlled Drug Count Record 4th Floor Cart B, dated June 2024 was conducted on 06/25/24. The record lacked documentation of licensed nurse signatures for one shift on 06/15/24, and one shift on 06/16/24. Interview was conducted with the Director of Nursing (DON) on 06/25/24 at 10:20 AM. [...]

Inspectors wroteBased on record review and interview with staff member, the facility failed to ensure the attending physician reviewed an identified irregularity from the pharmacist's monthly medication review (MRR) for one of five residents sampled (Resident (R) 8). This failure had the potential for medication error and adverse consequences; the potential for R8 administered an as needed (PRN) medication without a frequency indicated in the physician's order.

Inspectors wroteBased on interviews and record review, the facility failed to maintain complete medical records for two of 16 sampled residents (Resident (R) 168 and R4). This deficient practice has the potential to affect all the residents in the facility. Findings Include: A review of R168's Electronic Health Record (EHR) was conducted on 06/24/24. During the review, R168's EHR only had weights documented on 05/22/24 at 89.8 pounds (lbs.), 05/28/24 at 89.8 lbs., 06/04/24 at 0 lbs., and 06/11/24 at 80.0 lbs. A telephone interview was conducted on 06/26/24 at 11:10 AM with Director of Nursing (DON), regarding R168's documented significant weight loss. DON stated that with a significant weight loss, the assigned nurse would let the facility dietician know as soon as possible. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to provide a safe, sanitary, and comfortable environment to prevent the development and transmission of communicable diseases and infections for one of four residents sampled for infection control (Resident (R) 118). R118's humidifier bottle was not properly secured to the oxygen concentrator. This failure could place the resident at risk for infection.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure food items were stored under sanitary conditions and the sanitizing solution was at the appropriate concentration for the three compartments sink.

Inspectors wroteBased on observation and interview with staff members the facility failed to ensure R263's personal medical information was secured for confidentiality.

Inspectors wroteBased on observations and interiew with staff members,the facility failed to provide a homelike environment for two residents in the sample.

Inspectors wroteBased on record review and interview with staff member, the facility did not assure a resident's bowel protocol was implemented, which placed the resident at risk for constipation or bowel impaction related to use of an opioid (pain reliever with common side effect of constipation) for one of one resident in the sample.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a resident with limited range of mobility received treatment to prevent decrease in range of motion/mobility for one of one Resident (R)4 in the sample for limited range of motion.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide one resident (R)5 of one resident in the sample, adequate supervision and assistance to prevent falls. R5 was not receiving adequate hydration (cross reference (cr) to F692 Nutrition and hydration) and timely assistance to use the bathroom (cr to F690 bladder and bowel incontinence). The deficient practice places the resident at risk for injury.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide one resident (R)5 of one resident in the sample, adequate supervision, and assistance to prevent falls. R5 was not receiving adequate hydration (cross reference (cr) to F692 Nutrition and hydration) and timely assistance to use the bathroom (cr to F690 bladder and bowel incontinence). The deficient practice places the resident at risk for injury.

Inspectors wroteBased on observation, interview and record review, the facility failed to assist one Resident, (R)5 of one resident in the sample with enough fluids to maintain adequate hydration. The deficient practice placed the resident at a greater risk for dehydration, urinary tract infections and potentially increased the risk for injury (cross reference (cr) to F689 Free of Accident hazards/prevention/devices).

Inspectors wroteBased on record review and interview with staff member, the facility failed to ensure one of five residents sampled were free from unnecessary psychotropic medication. Resident (R)265 was prescribed an as needed (PRN) antidepressant for agitation/insomnia without the diagnosed specific condition documented in the clinical record and the facility failed to appropriately monitor the effectiveness of the medication and the resident's sleep pattern.

Inspectors wroteBased on observation, interview with staff and record review the facility failed to assure a resident was free of significant medication errors.

Inspectors wroteBased on observation and staff interview the facility failed to assure a resident's insulin was labeled with the discard by date.

Inspectors wroteBased on observation, interview and record review the facility failed to provide a safe, sanitary, and comfortable environment to prevent the development and transmission of communicable diseases and infections. Resident (R)263's drained bile from R263's gallbladder was left out in the resident's room and not discarded appropriately.

Inspectors wroteBased on observation and interview with staff members, the facility did not assure the nurse staffing posting included the facility's census for both units.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure comprehensive person-centered care plans were developed and/or implemented for one (1) resident, (Resident (R)2), of eight (8) residents sampled. As a result of this deficiency, resident is at risk to not achieve their highest quality of life. This has the potential to affect all residents in the facility.

Inspectors wroteBased on observations and staff interview, the facility failed to properly store and discard expired food from the walk-in refrigerator. As a result of this deficiency, the facility put all the residents at risk for foodborne illness.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to revise a comprehensive care plan after each assessment for one (1) resident, (Resident (R)12), of eight (8) residents sampled. As result of this deficiency, a resident's pain was not managed according to professional standards of practice and has the potential for harm.