Palolo Chinese Home

2459 10TH AVENUE
HONOLULU, HI, 96816
8087372555
CCN: 125059
2
Overall
2
Health
4
Staffing
4
Quality
Special FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
NameRole%
PALOLO CHINESE HOME5% OR GREATER DIRECT OWNERSHIP INTEREST100%
AU, GORDONCORPORATE DIRECTORNOT APPLICABLE
BACKUS, PETERCORPORATE DIRECTORNOT APPLICABLE
BLANCHETTE, PATRICIACORPORATE DIRECTORNOT APPLICABLE
CHING, ANTHONYCORPORATE DIRECTORNOT APPLICABLE
GOO, FRANCESCORPORATE DIRECTORNOT APPLICABLE
HWANG, RENACORPORATE DIRECTORNOT APPLICABLE
LAU, RUSSELL JAMESCORPORATE DIRECTORNOT APPLICABLE
LEE, GLADYSCORPORATE DIRECTORNOT APPLICABLE
LEE, LENORACORPORATE DIRECTORNOT APPLICABLE
LO, ELVIRACORPORATE DIRECTORNOT APPLICABLE
MOATS, ANDREWCORPORATE DIRECTORNOT APPLICABLE
WOO, BENJAMINCORPORATE DIRECTORNOT APPLICABLE
YEE, REGINALDCORPORATE DIRECTORNOT APPLICABLE
OSHIMA, ISOOCORPORATE DIRECTORNOT APPLICABLE
SCHMIDT, JEFFREYCORPORATE DIRECTORNOT APPLICABLE
SIMON, GARYCORPORATE DIRECTORNOT APPLICABLE
SMITH, DOUGLASCORPORATE DIRECTORNOT APPLICABLE
SOUZA, SANDRACORPORATE DIRECTORNOT APPLICABLE
TOKIOKA, TYLERCORPORATE DIRECTORNOT APPLICABLE
TSEU, LAWRENCECORPORATE DIRECTORNOT APPLICABLE
WATANABE, ERICCORPORATE DIRECTORNOT APPLICABLE
WONG, STACEYCORPORATE DIRECTORNOT APPLICABLE
NAKAYAMA, DARLENECORPORATE OFFICERNOT APPLICABLE
NAKAYAMA, DARLENEOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
Penalties (1)
DateTypeAmount
2025-09-05Fine$13K
Health Deficiencies (44)
2025-09-05 · Health
D
F842 · Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
G
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
2025-05-23 · Health
D
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
D
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
E
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
E
F585 · Resident Rights Deficiencies
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
D
F583 · Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
2025-05-01 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F805 · Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
D
F803 · Nutrition and Dietary Deficiencies
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
D
F761 · Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
D
F726 · Nursing and Physician Services Deficiencies
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F657 · Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
D
F656 · Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
D
F641 · Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
D
F584 · Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
D
F578 · Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
D
F561 · Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
D
F558 · Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
D
F550 · Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
2024-11-22 · Health
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F656 · Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
2024-07-26 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
2024-03-07 · Health
D
F908 · Environmental Deficiencies
Keep all essential equipment working safely.
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F761 · Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
D
F677 · Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
D
F604 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
2023-03-31 · Health
D
F886 · Infection Control Deficiencies
Perform COVID19 testing on residents and staff.
E
F885 · Infection Control Deficiencies
Report COVID19 data to residents and families.
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
F
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F759 · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
D
F757 · Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
D
F756 · Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
F656 · Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
D
F641 · Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
D
F625 · Resident Rights Deficiencies
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
D
F623 · Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day
4.25
3.68
RN Hrs/Resident/Day
1.49
0.54
LPN Hrs/Resident/Day
0.06
0.81
CNA Hrs/Resident/Day
2.70
2.33
PT Hrs/Resident/Day
0.01
0.12
Data as of 2026-03-01