Life Care Center of Hilo

Inspectors wroteBased on interview and record review the facility failed to provide unopened mail to one of four residents sampled for mail delivered to them. Resident (R) 23 reported approximately six months ago four bank statements from her credit union and two personal letters that included checks made out to her were delivered opened to her. This deficient practice violates R23 resident rights and may cause undue emotional stress. Findings Include:On 07/01/2026 at 09:29 AM met with four Residents (R) 169, R130, R185 and R23 and two staff, Activities Director (AD) and Discharge Coordinator (DC), in the conference room to conduct the Resident Council interview. During this interview surveyor asked residents, Is mail delivered unopened and on Saturdays? R23 spoke up and said No. [...]

Inspectors wroteBased on record reviews, staff interview and review of policy, the facility did not show proof of discharge written notification for one Resident (R)11 of two sampled for hospitalization.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to develop a written person-centered comprehensive care plan for two of three residents (Resident (R) 48 and R164) sampled for skin conditions. As a result of this deficient practice, staff did not have the information to adequately care for both resident's skin conditions.

Inspectors wroteBased on record review and interview the facility failed to assure one of five Residents, (R) 10, reviewed for unnecessary medication, had a completed Medication Informed Consent form that was shared with the resident's representative by phone which ensured the residents representative was informed of the risks versus benefits of R10 taking psychotropic medications. The deficient practice places residents at risk of the right to be informed of treatment. Findings Include:On 06/30/2026 at 3:01 PM record review of R10's Electronic Health Record found he is taking Citalopram Hydrobromide for a mood disorder secondary to his dementia, Trazodone at bedtime for sleep, Risperidone (an antipsychotic medication) twice a day for dementia with psychosis. Review of R10's consents for his medications found there was a Medication Informed Consent form partially filled out on 07/17/2025. [...]

Inspectors wroteBased on observations, interviews and record review, the facility failed to implement infection control policy related to Enhanced Barrier Precautions (EBP) for one of three residents sampled for skin conditions. The facility did not place Resident (R)48) on EBP who had a wound with cellulitis (a bacterial infection affecting deeper layer of skin) on his left lower leg. This deficient practice places the other residents in the facility at an increased risk of infection.

Inspectors wroteBased on interviews and record review, the facility failed to provide effective and timely pain management to a resident experiencing pain. Resident (R) 10 complained of pain 10 out of 10 (10/10 on the pain scale, indicating severe, intense agony) to the lower back after being in a wheelchair (w/c). The physician ordered an opioid medication at 01:47 PM, which was not administered until 09:00 PM, despite the resident's sustained pain level 8/10, which is severe. The delay in administration of an effective medication, the absence of non-pharmacological intervention, failure to seek higher level of care due to unrelieved pain caused R10 to experience unrelieved severe pain for 7.15 hours. As a result of this deficient practice, residents are at risk of physical harm.

Inspectors wroteBased on interviews and record review, the facility failed to ensure an injury of unknown source was reported immediately to the State Agency (SA), but not later than 2 hours after the allegation was made, which resulted in serious bodily injury. Resident (R) 10 sustained a serious injury of unknown origin to the Right Lower Extremity (RLE). The facility did not report the injury of unknown origin to the SA. As a result of this deficient practice, residents are at risk for the potential of harm.

Inspectors wroteBased on interviews and record review, the facility failed to investigate an injury of unknown origin to rule out the potential for abuse. Resident (R) 10 sustained a serious injury of unknown origin to the Right Lower Extremity (RLE). An investigation was not conducted into the origin of the injury and potential for abuse was not ruled out. As a result of this deficient practice, all residents are at risk for potential abuse until a thorough investigation is completed.

Inspectors wroteBased on observation, interviews, and record/document review, the facility failed to provide supervision to one resident (R)1, of a sample size of three, who was left alone in the facility van for an unknown period of time. As a result of this deficient practice, R1 was left in an unsafe environment with a high potential for negative physical and/or mental health outcomes. This deficient practice could affect any resident that used the transport van. After the event, the facility implemented interventions to reduce the risk of a similar event in the future and met the criteria for past noncompliance.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure sufficient nursing staff to assure residents attain or maintain the highest practicable physical, mental, and psychosocial well-being during meals times and during Activities of Daily Living (ADLs) for multiple residents on the second floor. Resident (R)203 reported having to wait up to an hour for staff to assist the resident to the bathroom due to insufficient staffing. An Anonymous Resident (AR) complained to Family Member (FM)1 about waiting for approximately 30 minutes for staff to answer the call light for assistance to the toilet, then staff rushing the resident off the toilet due to having to go and assist another resident, and staff not having enough time to assist the resident with meals due to the resident's slow pace of eating. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the residents' right to be treated with respect and dignity for 2 of 10 residents (Resident (R)14 and R43) sampled for dignity. R14 was left unattended in his bed with a towel loosely tied around his neck. R14 was left in bed wearing a T-shirt and adult brief uncovered with privacy curtain open while his roommate had a visitor present in the room. Staff did not promote R43's dignity while dining as evidenced by lunch observations on 11/28/23 and 11/29/23 during which Certified Nurse Aide (CNA)48 stood over R43 while assisting the resident lunch. As a result of this deficient practice, resident's are at risk for more than minimal psychosocial harm.

Inspectors wroteBased on observation and staff interview the facility failed to provide a clean environment for 1 of 35 Residents sampled, as evidenced by a portable fan positioned on the dresser of Resident (R)32 circulating air around his room, with a layer of dust on the front and back covers. In addition, the facility failed to provide a clean environment for the ground floor unit residents with water dripping from air conditioning ducts.

Inspectors wroteBased on record review and interview, the facility failed to accurately complete a comprehensive assessment of medications for 1 of 35 residents (R) in the sample.

Inspectors wroteBased on interview and record review, the facility failed to effectively care plan and manage constipation for 1 of 2 residents (Resident 7) sampled. As a result of this deficient practice, Resident 7 experienced stool impaction(s) that had to be manually removed, causing her pain, distress, and embarrassment. This deficient practice has the potential to affect all the residents at the facility at risk of constipation.

Inspectors wrote2) Record Review (RR) of R14's Electronic Health Record (EHR) found his diagnoses include, but are not limited to, history of traumatic brain injury, other muscle spasms, contracture to right and left hand. Fall risk assessments (NRSG: Fall Risk Evaluation) for R14 were completed quarterly on [DATE], [DATE], [DATE] and [DATE] and all have resident rated as a high risk for falls with a score of 14 each time. On the NRSG: Fall Risk Evaluation, a score of 10 or more is considered a high risk for falls. R14's Quarterly Minimum Data Set (MDS) that was dated [DATE] has resident listed as dependent on staff for mobility. R14 is totally dependent on staff for his care. On [DATE] at 11:30 AM, entered R14's room and observed R14 was alone, no staff were present in the room with him. At this time, noted resident's bed was raised off the ground to almost hip height. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that records for controlled medications are in order and that an accurate account is maintained and reconciled. The staff did not document the actual amount of medication in the container, and signed off on medications not yet administered. As a result of this deficiency, there is a potential for the diversion of a controlled medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Glucose Control Solutions used in the facility were labeled in accordance with professional standards and facility policy, and failed to ensure all drugs and biologicals are secured in a locked compartment. Proper labeling of Glucose Control Solutions is necessary to ensure the efficacy of the solutions used to test the facility's glucose monitors/test strips for accuracy. This deficient practice has the potential to affect all residents in the facility requiring point-of-care blood glucose tests.

Inspectors wroteBased on observation, record review and interview, the facility failed to monitor the temperatures to ensure the dishes used to serve food were appropriately sanitized in accordance with professional standards for food service safety. This deficient practice placed all the residents in the facility at risk for possible foodborne illnesses.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Binding Arbitration Agreements ([NAME]) they asked the residents (or their representatives) to enter into, were explained in a form and manner that they could understand, and that the [NAME] explicitly granted the residents/representatives the right to rescind the agreement within 30 calendar days of signing it. This is evidenced by 1 of 3 residents (Resident 7) sampled stating she did not have the BAA explained to her in a way that she understood what it meant, 2 of 3 residents (Residents 7 and 101) sampled could not remember signing it or what it was about, and the Facility BAA granting residents only 10 days to rescind.

Inspectors wroteBased on a Resident Council interview and policy review, the facility failed to protect and promote quality of life for the residents by ensuring they were treated with respect and dignity. Specifically, the facility failed to ensure that English was consistently spoken in all resident care areas, exposing residents to frustrating and awkward situations that impede their ability to attain or maintain their highest practicable well-being. This deficient practice has the potential to affect all residents at the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure the required postings were placed in a manner accessible to all residents and resident representatives. Specifically, there were no postings observed on the first floor listing the contact information for pertinent State agencies and resident advocacy groups, nor were there any postings observed on the first floor regarding a resident's right to file a complaint with the State Survey Agency (SA). In addition, despite the required postings being available on the second and third floor, not all residents residing there are aware where to find them. As a result, residents who have the capacity to comprehend their resident rights potentially are not aware of them, how to exercise them, or where they can find information about them. [...]

Inspectors wroteBased on observation and interview, the facility failed to make information on how to file a grievance or complaint available to all residents. Specifically, there were no postings observed on the first floor providing information on how to file a grievance for the first two days of the survey, nor were there comment cards available on the first floor to assist a resident in filing a written complaint or grievance. As a result, the process of filing a grievance is unclear for residents and resident representatives residing on the first floor. This deficient practice has the potential to affect all residents with the functional capacity to file a grievance.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that the care plans for nine residents (R), R131, R152, R151, R180, R55, R98, R169, R26 and R76, out of a sample of 36 residents, were appropriately developed and/or implemented to promote the highest practicable physical, mental, and/or psychosocial well-being of these residents. This deficient practice has the potential to affect all residents.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that there was an ongoing resident-centered activities program that fully identified and met the residents' needs for four residents, Resident (R)55, R98, R169, and R151, out of a sample of 12 residents, and for over half of the total of 26 residents in a secured dementia unit. Specifically, the facility failed to act on the residents' need for social engagement, failed to identify activities the residents found meaningful, and failed to develop and/or implement a person-centered activities program. Residents on the dementia unit were not engaged in group activities, they were not singing along or exercising and there were residents sitting in the multi-purpose (room for dining and activities) with their eyes closed. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure four residents (R), R55, R169, R26, and R76, in a sample of five residents were free from accident hazards by thoroughly assessing and developing a plan to keep them safe once they had been identified as elopement risks with wandering behavior. As a result of this deficient practice, the residents (R55, R169, R26, R76) were placed at risk of an avoidable accident, interpersonal altercation, and/or injury. This deficient practice has the potential to affect all the residents at the facility displaying wandering behavior.

Inspectors wroteBased on observations and interviews, the facility failed to ensure there was sufficient nursing staff to provide nursing and related services to meet the residents' needs safely and in a manner that promotes each resident's rights, in addition to their physical, mental, and psychosocial well-being. As a result of this deficient practice, the residents experienced a decreased quality of life and were unable to attain their highest practicable well-being.

Inspectors wroteBased on observations and interviews, the facility failed to ensure its nurse staffing information was prominently posted in a clear and visible place accessible to all residents and visitors. Specifically, the facility posted the nurse staffing information at the central nurses' station (fishbowl) on the second floor only, in a place not readily accessible to residents and visitors of the first and third floors. Moreover, the residents of the first floor reside in secured units, making the second floor posting completely inaccessible to them. This deficient practice has the potential to affect all residents and visitors to the first and third floors.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure all medications and biologicals used in the facility were labeled, stored, and/or disposed of in accordance with professional standards. Proper labeling and storage of medications and biologicals is necessary to promote safe administration practices and decrease the risk for medication errors. This deficient practice has the potential to affect all residents in the facility receiving medications or biologicals.

Inspectors wroteBased on observations, interviews with staff members, and review of the facility's policy and procedures, the facility did not assure food was stored under sanitary conditions and did not ensure staff members were accurately checking chemical ratio for sanitizing of dishes in the three-compartment sink, the staff member inaccurately identified the parts per million (ppm) of the solution and the new test strips were expired. This deficient practice encourages food-borne illnesses and has the potential to affect all residents, visitors, and staff who receive meals from the kitchen.

Inspectors wroteBased on interview and record review, the facility failed to identify, support, and honor one Resident's (R) bathing schedule preference. As a result of this deficient practice, R98 did not have her needs met and was placed at risk of not attaining her highest practicable well-being. This deficient practice has the potential to affect all the residents at the facility.

Inspectors wroteBased on interview and record review (RR), the facility failed to ensure valid Advance Health Care Directives were obtained and documented in two residents' medical records. As a result of this deficient practice, both Resident (R)98 and R162 were placed at risk of not having their (or their valid representatives') wishes honored for future health care decisions, should they become (or be determined) with diminished or no capacity. This deficient practice has the potential to affect all the residents at the facility.

Inspectors wroteBased on observations, the facility failed to assure comfortable sound levels for residents on a locked/secured dementia unit during dining and activities and for one resident (R)5 on another nursing unit. The residents residing on the secured unit are diagnosed with Alzheimer's disease and dementia with/without behavioral disturbances. R5 complained that the roommate's television was too loud. This deficient practice fails to provide a homelike environment and has the potential to affect all residents.

Inspectors wroteBased on observations, record review, and interview with staff member, the facility did not ensure one (Resident 82) of one resident sampled was free from physical restraints. This deficient practice has the potential to affect the resident's psychosocial well-being.

Inspectors wroteBased on observations, interviews, and record reviews, in a sample of three residents (R), R454, R167, and R111, out of six residents, the facility failed to implement their abuse prohibition policies and procedures to: 1) screen employees for a history of abuse and, 2) to prevent abuse for two residents (R), R167 and R111, involved in a friendship/relationship. The facility's failure to follow their own abuse prohibition policies and procedures could potentially cause irreparable harm to their residents.

Inspectors wroteBased on record reviews and interviews, the facility failed to appropriately protect two Residents (R), R199 and R454, out of a sample of three residents, from further abuse by failing to report to Adult Protective Services (APS) incidents that involved alleged staff-to-resident abuse. R454's staff-to-resident abuse incident was not reported to the Administration and state agency (SA) within the prescribed timeframes deemed by federal and state regulations. This deficient practice may result in the failure to identify abuse and can potentially affect all residents.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to develop a care plan that addressed the behavioral and emotional health needs of one newly admitted resident (R), R406, out of a sample of three residents. This deficient practice fails to provide non-pharmacological interventions for the behavioral and emotional health needs of a newly admitted resident and can potentially affect all incoming residents suffering from behavioral and emotional health issues.

Inspectors wroteBased on observation, interview and record review, the facility failed to update the care plan with treatment of one Resident (R)131 osteoarthritis of the left wrist. The deficient practice increased the resident's pain and discomfort, and updated interventions improve outcomes of the treatment plan for residents' osteoarthritis.

Inspectors wroteBased on record review and interview with staff members, the facility did not assure a resident with dementia received appropriate interventons to attain or maintain her highest practicable psychosocial well-being.

Inspectors wroteBased on observation, interview and record review, the facility failed to adequately monitor one resident (R)131 for pain management out of a sample of three residents. R131 was prescribed a stronger form of the medication (opioid) versus acetaminophen without indication for its use and for an excessive duration. The deficient practice potentially increases the likelihood for an adverse medication effect.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide assistance in obtaining emergency dental care for pain and bleeding gums for one Resident (R)188 of two residents investigated. The deficient practice potentially increases risk of illness due to the severity of R188's gingivitis (inflamation of the gums) and has the potential to affect all residents in the facility.

Inspectors wroteBased on record review and interview with staff member, the facility failed to assure a medical record was maintained in accordance with accepted professional standards and practices to ensure accurate documentation. This deficient practice has the potential to affect all residents in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure one resident (R)131 of five residents in the sample had the pneumococcal vaccine. The deficient practice has the potential to increase the resident's risk for illness and may potentially affect all residents.

Inspectors wroteBased on observations, the facility failed to provide one or more rooms designated for resident dining and activities, ensuring enough space is available and adaptable for a variety of uses and meet resident's needs.