Law Office of Lance D. Collins
Lance D. Collins 8246
Post Office Box 179336
Honolulu, HI 96817
808.243.9292
Attorney for Plaintiff
KŌKUA COUNCIL FOR SENIOR CITIZENS
IN THE CIRCUIT COURT OF FIRST CIRCUIT
STATE OF HAWAII
KOKUA COUNCIL FOR SENIOR
CITIZENS, an unincorporated association,
Plaintiff
vs.
DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAI'I,
Defendants.

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Civil No. 16-1-1421-07 KTN
(Other Civil Action)
PLAINTIFF'S MOTION FOR SUMMARY
JUDGMENT; MEMORANDUM IN
SUPPORT OF MOTION; DECLARATION
OF JAMES SHON; EXHIBITS A-O; NOTICE
OF HEARING; CERTIFICATE OF SERVICE
Hearing
Judge; Hon. Karen T. Nakasone
Date: ______________________________
Time: ______________________________
No Trial Date Set.

PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT
Plaintiff KŌKUA COUNCIL FOR SENIOR CITIZENS, an unincorporated association based in
Hawai‘i (Kōkua Council), respectfully moves this Court to enter, pursuant to Rules 56 and 81.1 of
the Hawai‘i Rules of Civil Procedure (HRCP), summary judgment in its favor on Counts I through
III of the Complaint, filed July 25, 2016, and against Defendant DIRECTOR OF THE
DEPARTMENT OF HEALTH, STATE OF HAWAI‘I (Director or DOH). This motion is based
on grounds that the Director:
(1) violated sections 92F-11 and -12, Hawaii Revised Statute (HRS), by withholding
government records of inspection reports of health care facilities, which were also
required to be posted on the State of Hawai‘i Department of Health (DOH) website
pursuant to law;
(2) violated HRS §§ 92F-11 and -12 by heavily redacting government records without lawful
justification to constitute withholding of government records of inspection reports; and,
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 (3) failed a ministerial duty to post healthcare facility inspection reports to the DOH website
within five working days of the conclusion of each inspection and that is so plainly
described so as to be free from doubt, warranting an order in the nature of mandamus
requiring the Director to carry out the ministerial duty.
This motion is made pursuant to HRCP Rule 56 and Rule 7.1 of the Hawai‘i Rules of Circuit Court
and is based on the pleadings, evidence, and records in this case.

DATED:

Honolulu, Hawai'i

December 21, 2016

________________________________
LAW OFFICEOF LANCE D COLLINS
LANCE D. COLLINS
Attorney for Plaintiff

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 IN THE CIRCUIT COURT OF FIRST CIRCUIT
STATE OF HAWAII
KOKUA COUNCIL FOR SENIOR
CITIZENS, an unincorporated association,
Plaintiff
vs.
DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAI'I,
Defendants.

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Civil No. 16-1-1421-07 KTN
(Other Civil Action)
MEMORANDUM IN SUPPORT OF
MOTION

MEMORANDUM IN SUPPORT OF MOTION
I.

Introduction
Plaintiff KŌKUA COUNCIL FOR SENIOR CITIZENS, an unincorporated association

based in Hawai‘i (Kōkua Council) respectfully moves this Court to enter, pursuant to Rules 56 and
81.1 of the Hawai‘i Rules of Civil Procedure (HRCP), summary judgment in its favor on Counts I
through III of the Complaint, filed July 25, 2016, and against Defendant DIRECTOR OF THE
DEPARTMENT OF HEALTH, STATE OF HAWAI‘I (Director or DOH). This motion is based
on grounds that the Director: (1) violated sections 92F-11 and -12, Hawaii Revised Statute (HRS),
by withholding government records of inspection reports of health care facilities; (2) violated
chapter HRS §§ 92F-11 and -12 by heavily redacting government records so as to constitute
withholding of government records therein; and, (3) failed a ministerial duty to post healthcare
facility inspection reports to the DOH website within five working days of the conclusion of each
inspection and that such duty is so plainly described so as to be free from doubt, warranting an
order in the nature of mandamus requiring the Director to carry out the ministerial duty.
II.

Background
Established in 1977, Kōkua Council is one of Hawaii's oldest advocacy groups for seniors.

Kōkua Council seeks to empower seniors, their families, and other concerned citizens in order to be
effective advocates in shaping the future and well-being of our community and with particular
attention to those needing help in advocating for themselves. Declaration of James Shon (Shon
Decl.) ¶3. Many families, including Kōkua Council members, have been faced with or will be faced
with making a critical health care decision for a loved one - transferring a loved one from a critical
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 care facility to a long term care facility with sometimes only hours to make a decision. Shon Decl.
¶4. For many families, the Director’s online posting of inspection reports is the only accessible,
impartial information on quality of a long term care facility. The same is true for families seeking
impartial information about other types of health care facilities. Shon Decl. ¶5.
On June 27, 2013, Act 213 became law, requiring all of the Director’s inspections of health
care facilities occurring on or after January 1, 2015 to be posted on the DOH website within five
days of the completion of the inspection. See 2013 Haw. Sess. Laws Act 213, §2 (codified at HRS §
321-1.8 (Supp. 2013)).
On or about December 13, 2015, Kōkua Council accessed the DOH website and was only
able to view 469 healthcare facilities inspection reports, none of which were for adult residential care
homes (ARCHs) or expanded adult residential care homes (e-ARCHs), which were of particular
concern. Shon Decl. ¶6; see also Kōkua Council Complaint, ¶¶9-10, filed Jul. 25, 2016. As of
December 13, 2015, approximately 500 ARCHs and e-ARCHs were licensed to operate in the State
of Hawai‘i. Id.
By letter dated December 14, 2015, Kōkua Council, through its legal counsel, wrote to the
Director regarding the posting of inspection reports and submitted a Uniform Information Practice
Act (UIPA) request for public information pursuant to HRS chapter 92F. Shon Decl. ¶7; Exh. A.
At that time, only 469 inspection reports for the entirety of the eleven healthcare facility types had
been posted, and none for ARCHs and only three for E-ARCHs. Exh. A at 2. Many more EARCHs and ARCHs are licensed in the state. Kōkua Council noted the Director’s noncompliance
with Act 213, §2, and requested “access to all reports of inspections occurring on January 1, 2015 or
thereafter pursuant to HRS § 92F-11 and § 92F-12(a)(15)” and access to the inventory of all
facilities licensed under HRS § 321-15.62(e). Exh. A at 2-3. Kōkua Council specified its intent to
publicize and widely disseminate the requested records, making a fee waiver appropriate for its
request, and also requested copies in electronic format it they existed in that format. Exh. A at 3.
Kōkua Council also submitted its UIPA request to Keith Ridley, Chief Officer of DOH’s Office of
Healthcare Assurance (Ridley). Kōkua Council intended to publicize the healthcare facility
inspection reports via internet media, including preparation of reports of significant interest to Civil
Beat, the Honolulu Star-Advertiser and DisappearedNews.com. Shon Decl. ¶8.
Pursuant to HAR §2-71-13(a), the Director was required to disclose the requested
government records within a reasonable time not to exceed ten days. By email dated January 3,
2016, Ridley responded to Kōkua Council by stating, in part, “[t]he available inspection reports are
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 in the process of being posted” and would “be posted as soon as [DOH staff] are able by using the
dedicated and temporary staff resources and until such time as we obtain permanent full time
resources.” Shon Decl. ¶9; Exh. B. By email sent on January 4, 2016, Kōkua Council requested
assistance from the State of Hawai‘i Office of Information Practices (OIP) in obtaining access to
the requested records and ensuring compliance with HAR § 2-71-13(a) in light of Ridley’s
ambiguous and indefinite response concerning when, if ever, the records would be released. Shon
Decl. ¶10; Exh. C.
By letter dated January 26, 2016, OIP wrote to the Director concerning Kōkua Council’s
request for access to DOH records (OIP No. U RFA-P 16-26). Shon Decl. ¶11; Exh. D. OIP
advised the Director that she was required to: (1) provide the requested records in electronic format
within ten business days; or (2) provide a response to Kōkua Council indicating its reasons for
denying access to the requested records and the parts of the record that would not be disclosed
within ten business days. Exh. D at 2.
By letter dated January 29, 2016, Kōkua Council wrote to Ridley acknowledging his emailed
response earlier that day, and noting a total of 271 reports for ARCHs and E-ARCHs were currently
posted on the DOH website. Shon Decl. ¶12; Exh. E. Kōkua Council specified that its outstanding
requests were for the remainder of the inspection reports that had not yet been posted and an
inventory of licensed facilities that DOH was required to maintain pursuant to HRS §321-15.62(e).
Exh. E at 2.
On February 2, 2016, Kōkua Council responded to an email from Ridley, sent on January 30,
2016. Shon Decl. ¶13; Exh. F. Kōkua Council disputed DOH’s determination to deny access to the
requested records and included OIP in the exchange to apprise them of needed assistance in either
obtaining the government records or an appropriate denial based on a specific legal basis. Exh. F.
On July 25, 2016, Kōkua Council filed a complaint with this Court. The Director filed her answer
on August 15, 2016, and corrective errata on the following day.
On August 22, 2016, Kōkua Council filed its Request for Answers to Interrogatories and
Request for Production of Documents, which the Director answered on or about September 15,
2016. Shon Decl. ¶16, Exh. O.
As of October 24, 2016, approximately 433 ARCHs and e-ARCHs were licensed in the
State. Shon Decl. ¶17, Exh. K.
On November 7, 2016, local news outlet KHON stated that most posted inspection reports
its reporter investigated had “extensive blackouts.” Shon Decl. ¶18, Exh. I.
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 On December 12, 2016, 1,755 healthcare facilities inspection reports and 290 developmental
disabilities adult foster home annual inspection reports were posted on the DOH website. Shon
Decl. ¶19, Exh. “J”. Of the 1,755 healthcare facilities inspection reports, 230 were for e-ARCHs
and 203 were for ARCHs. Id. Many of the posted inspection reports contained extensive
redactions that rendered the reports useless for Kōkua Council members and supporters. Shon
Decl. ¶20, Exh. L.
III.

Standard of Review
[S]ummary judgment is appropriate if the pleadings, depositions, answers to interrogatories,
and admissions on file, together with the affidavits, if any, show that there is no genuine
issue as to any material fact and that the moving party is entitled to judgment as a matter of
law. A fact is material if proof of that fact would have the effect of establishing or refuting
one of the essential elements of a cause of action or defense asserted by the parties. The
evidence must be viewed in the light most favorable to the non-moving party. In other
words, we must view all of the evidence and the inferences drawn therefrom in the light
most favorable to the party opposing the motion.

Querubin v. Thronas, 107 Haw. 48, 56, 109 P.3d 689, 697 (2005) (citation omitted). “A party opposing
a motion for summary judgment cannot discharge his or her burden by alleging conclusions, ‘nor is
[the party] entitled to a trial on the basis of a hope that [the party] can produce some evidence at
that time.'" Henderson v. Prof'l Coatings Corp., 72 Haw. 387, 401, 819 P.2d 84, 92 (1991) (citation
omitted)).
IV.

Arguments
A.
Count 1: The Director violated HRS chapter 92F by withholding requested
government records
By letter dated December 14, 2015, Kōkua Council requested that the required-disclosed

inspection reports be provided to them pursuant to HRS §§ 92F-11 and -12(a)(15). Shon Decl. ¶7,
Exh. A. “All government records are open to public inspection unless access is restricted or closed
by law.” HRS §92F-11(a). HRS §92F-12(a)(15) further provides:
Disclosure required. (a) Any other provision in this chapter to the contrary
notwithstanding, each agency shall make available for public inspection and duplication
during regular business hours:
....
(15) Information collected and maintained for the purpose of making information available
to the general public;
Pursuant to HRS § 321-1.8, DOH collected and maintained healthcare facilities inspection reports

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 for purposes including posting them to its website, which is available to the general public. Pursuant
to HAR §2-71-13(a), the Director was required to disclose the requested public records within a
reasonable time not to exceed ten days. The Director did not disclose the reports within ten days of
Kōkua Council’s December 14, 2015 request.
Rather than disclosing the inspection reports, by email dated January 3, 2016, Ridley
responded to Kōkua Council by stating, in part, “[t]he available inspection reports are in the process
of being posted” and would “be posted as soon as [DOH staff] are able by using the dedicated and
temporary staff resources and until such time as we obtain permanent full time resources.” Shon
Decl. ¶9; Exh. B. As explained by OIP, this response was not compliant with HRS chapter 92F and
the Director was required to: (1) provide the requested records in electronic format within ten
business days; or (2) provide a response to Kōkua Council indicating its reasons for denying access
to the requested records and the parts of the record that would not be disclosed within ten business
days of its letter dated January 26, 2016. Shon Decl. ¶11; Exh. D at 2. DOH inappropriately
continued to deny Kōkua Council access to the requested public records by citing inapplicable
exceptions under HRS §§92F-13 and -22. Shon Decl. ¶13; Exh. F at 1. DOH’s Answer further
specified as a defense: “Inspection reports were property withheld from Plaintiffs pursuant to the
exception of ‘frustration of a legitimate government function.’ HRS §92F-13(3).” DOH Answer at
5 (Sixth defense). “When an agency chooses to invoke an exemption to shield information from
disclosure, it bears the burden of proving the applicability of the exemption.” Yonemoto v. Dep't of
Veterans Affairs, 686 F.3d 681, 688 (9th Cir. 2011) (citation omitted). Where agencies invoke
exemptions, they “may withhold only that information to which the exemption applies, and so must
provide all ‘reasonably segregable’ portions of that record to the requester.” Id. (citing 5 U.S.C. §
552(b)). DOH did not carry its burden of proving the applicability of exemptions under HRS
§§92F-13 and -22 and did not provide “reasonably segregable” portions of the records.
1.

Requested inspection reports were not “personal records” under HRS §92F-22.

HRS §92F-22 did not exempt the inspection reports from disclosure because the reports were not
personal records. A “personal record”:
means any item, collection, or grouping of information about an individual that is
maintained by an agency. It includes, but is not limited to, the individual's education,
financial, medical, or employment history, or items that contain or make reference to the
individual's name, identifying number, symbol, or other identifying particular assigned to the
individual, such as a finger or voice print or a photograph.

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 HRS §92F-3. Rather the inspection reports were maintained by DOH in written and electronic
forms, and thereby constituted “government records.” See HRS § 92F-3 (“government record"
means information maintained by an agency in written, auditory, visual, electronic, or other physical
form). Healthcare facilities were not “natural persons” and therefore were not “individuals” whose
inspection reports would constitute “personal records” within the meaning of HRS chapter 92F. See
HRS §92F-3 ("Individual" means a natural person). HRS §92F-22 exemptions did not apply to the
Kōkua Council request.
2.

DOH did not carry its burden of proving the applicability of exemptions for disclosures that would
frustrate a legitimate government purpose.

HRS § 92F–13 enumerates five exceptions to the general rule requiring agency disclosure of
government records. HRS §92F-13(3) did not exempt DOH from its duty to disclose the inspection
reports because they did not constitute “[g]overnment reports that, by their nature, must be
confidential in order for the government to avoid the frustration of a legitimate government
function.” Id. The legislature specifically targeted these healthcare inspection reports for
publication for the purpose of:
requir[ing] the department of health to make available to the public, free of charge,
information collected from the department's inspections in certain care facilities and
establish a working group to develop a new inspection form to be posted online with
information that is fair to care home operators and useful to the public.
Act 213 §1, 2013 Haw. Sess. Laws. It was the Director’s non-disclosure of the inspection reports that
frustrated the legitimate government function of providing the public “greater access to information
on the quality and conditions of care facilities in Hawaii.” Id. Inspection reports are required to
contain: (1) the date of the inspection; (2) a description of violations of relevant state laws or rules,
if applicable; (3) plans of correction and the status of corrective actions in response to any
violations, if applicable; (4) a list and description of all corrective actions taken by the facility, if
applicable, to be submitted by the facility and added to the report at a later time, as determined by
the department; and (5) other information regarding the quality and conditions of the facility the
department of health deems appropriate. HRS §321-1.8(b); see DOH Answer at 5 (eighth defense).
Disclosure of these items would not frustrate DOH’s government health care assurance functions
under HAR chapter 11-100.1, but would further those functions by invoking public scrutiny on
violations and areas of potential violation and ensure compliance with HRS § 321-1.8.
OIP has viewed the “frustration of legitimate government function” narrowly, prohibiting
exceptions to disclosure for law enforcement homicide reports. See OIP Opinion Ltr. No. 94-1
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 (Mar. 11, 1994) (homicide reports did not disclose information that would hinder investigations and
information in those reports would anyway be compiled into a public annual report). Similarly, the
healthcare facility inspection reports were anyway to be publicized on the DOH website pursuant to
HRS § 321-1.8. OIP has interpreted the “frustration of government function” exception in accord
with legal rights, for example, a report protected by the attorney work product doctrine or private
financial information. See OIP Opinion Ltr. No. 92-14, at *1 (Aug. 13, 1992) (concerning claim
reports submitted to agencies and containing personal information about the individual
claimant); OIP Opinion Ltr. No. 91-29 (Dec. 23, 1991) (protecting Matson Navigation company
workpapers held by the Department of Commerce and Consumer Affairs).
The “frustration of a legitimate government function” exception also applied where
disclosure of the government record would hinder an agency’s ability to “receive complaints and
candid information in the future” and those complaints and information were used by the agency to
investigate claims. See OIP Opinion Ltr. No. 98-1 at *1 (Jul. 7, 1998) (“the mere possibility that their
identities would be revealed and the fear of reprisal would discourage future callers and
complainants from seeking advice or reporting misconduct to the [Ethics] Commission.”). The
Report for Quality Improvement forms (RQIs) maintained by the Department of Emergency
Services (DES) were protected under HRS §92F-13(3) because the latter contained requested
comments on DES employee performance and those comments were necessary to DES
decisionmaking. See OIP Opinion Ltr. No. 05-05, at *4 (Mar. 16, 2005) (disclosure of RQIs may
have a “chilling effect on those persons providing comments as to the DES employees' performance
and recommendations” and thus hinder DES’ ability to assess its employees.) Similarly, candid
evaluations contained in the University of Hawai‘i Law School’s self-study were protected from
disclosure because the confidential nature of these evaluations were necessary to the law school’s
decision-making. See OIP Opinion Ltr. No. 91-15 (Sept. 10, 1991). By contrast, DOH’s inspection
reports assess healthcare facilities, not DOH’s performance, and therefore would not have a
“chilling” effect on DOH inspection functions as to the healthcare facilities. DOH did not and
could not establish the applicability of HRS §92F-13(3) exemptions to the reports.
3.

Mootness doctrine did not apply to foreclose Count I because the Director’s violation was capable of
repetition, yet evading review.

As of December 12, 2016, the DOH website has currently posted 433 inspection reports for
ARCHs and e-ARCHs. Shon Decl. ¶17; Exh. J. The Director cannot claim that Count I was

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 mooted by the current publication of the requested records on the DOH website because the
Director: (1) redacted information required to be disclosed in posted inspection reports; (2) failed to
post most of the reports in violation of HRS §321-1.8 at the time the complaint was filed; (3)
further failed to comply with HRS §92F-12 by referring to the website in response to Kōkua
Council’s December 14, 2015 UIPA request); (4) continues to fail its obligation to post its inspection
reports within five working days after completion of the report. Shon Decl. ¶27. Improper
redactions of non-significant private information from the posted inspection reports constitute nonposting with respect to HRS §321-1.8 and non-disclosure with respect to HRS §92F-12.
If the Court takes the position that DOH’s posting of requested inspection records has
removed “a present, live controversy of the kind that must exist if courts are to avoid advisory
opinions on abstract propositions of law[,]” Count I must anyway be addressed under exceptions to
the mootness doctrine. Kona Old Hawaiian Trails Group v. Lyman, 69 Haw. 81, 87, 734 P.2d 161, 165
(1987); see also City Bank v. Saje Ventures II, 7 Haw.App. 130, 134, 748 P.2d 812, 815 (1988) (“[a] case is
moot if the reviewing court can no longer grant effective relief.”). Violations giving rise to Count I
fall within both the “public interest” and “capable of repetition, yet evading review” exceptions to
the mootness doctrine. United Pub. Workers, AFSCME, Local 646, AFL-CIO v. Yogi, 101 Haw. 46, 58,
62 P.3d 189, 201 (2002) (Acoba, J. concurring) (discussing “two, sometimes overlapping, yet distinct
exceptions to the mootness doctrine: the ‘public interest’ exception and the ‘capable of repetition,
yet evading review’ exception.”).
The public interest exception applies where “an authoritative determination is desirable for
the guidance of public officials,” (Kaho'ohanohano v. State, 114 Haw. 302, 333, 162 P.3d 696, 727 (2007)
quoting Slupecki v. Admin. Dir. of Courts, State of Hawai‘i, 110 Haw. 407, 409 n. 4, 133 P.3d 1199, 1201
n. 4 (2006) (citations omitted)) and the following criteria render disposition of the issue appropriate:
(1) the public or private nature of the question presented, (2) the desirability of an authoritative
determination for the future guidance of public officers; and (3) the likelihood of future recurrence
of the question. Kaho'ohanohano, 114 Haw. at 333, 162 P.3d at 727 quoting Yogi, 101 Haw. at 58, 62
P.3d at 201 (Acoba, J., concurring). Act 213 §1 established that “greater access to information on
the quality and conditions of care facilities in Hawaii” was a matter of public importance. Id. An
authoritative determination would be desirable in light of DOH’s apparent misinterpretation of
HRS §321-1.8 requirements that inspection reports be disclosed and made available within five days
after the completion of the report. Finally, the question of whether the Director is required to
disclose health care facility inspection reports will likely reoccur unless and until DOH “obtain[s]
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 permanent full time resources.” See Exh. B (Email from Ridley to Kōkua Council). As described by
Ridley, DOH viewed its obligation to post the inspection reports as both contingent on agency
resources and as a substitute for their obligations under UIPA. Id. A clear determination that DOH
is required to comply with government records requests notwithstanding its internal schedules for
compliance with HRS § 321-1.8 is in the public’s interest.
Count I also falls outside of the mootness doctrine under the exception for actions “capable
of repetition, yet evading review.” Yogi, 101 Haw. at 58, 62 P.3d at 201 (Acoba, J. concurring). This
exception applies where two elements are present: “(1) the challenged action was in its duration too
short to be fully litigated prior to its cessation or expiration; and (2) there was a reasonable
expectation that the same complaining party would be subject to the same action again.” Yogi, 101
Haw. at 60, 62 P.3d at 203 (Acoba J. concurring) quoting C. Wright, Law of Federal Courts § 12 (4th
ed. 1983). DOH was required to post its inspection reports within five days and, alternatively, to
provide Kōkua Council with those reports within ten days pursuant to UIPA. See HRS § 321-1.8(b);
HAR §2-71-13(a). Ten days is too short a time period to fully litigate the Director’s noncompliance.
Kōkua Council and its members and supporters sometimes have only hours to make a decision
about whether and where to place a family member or loved one into a health care facility. Shon
Decl. ¶5. DOH has expressed its view that its duty to provide inspection reports on its website is
contingent on staffing resources. See Exh. B. DOH has also taken the position that it need not
provide these reports pursuant to HRS §§92F-13(3) and -22. DOH Answer at 5; see Exh. F (Kōkua
Council letter reciting statements in the January 29, 2016 email from Ridley). There is thus a
reasonable expectation that DOH will cause Kōkua Council to complain of unlawful delay in
disclosing inspection reports without court guidance to DOH. Shon Decl. ¶14.
Florida courts have also disfavored mootness arguments in public record request cases. See
Grapski v. City of Alachua, 31 So.3d 193, 196 (Fla. Dist. Ct. App. 2010) (city’s provision of meeting
minutes after suit was filed did not cure the injury of unreasonable delay and the policy was capable
of repetition yet evading review). In Grapski, the requested meeting minutes were created
immediately after the April 11, 2006 public meeting, yet were not disclosed until the “primary
usefulness” of the records had passed, thus constituting an unlawful refusal to comply with the
Florida public records law. Id. citing Barfield v. Town of Eatonville, 675 So.2d 223, 224 (Fla. 5th DCA
1996) (stating that “[a]n unjustified delay in complying with a public records request amounts to an
unlawful refusal”). Similarly, the inspection reports were already created and maintained by DOH
when Kōkua Council submitted its December 14, 2015 request. Yet, DOH unlawfully withheld
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 disclosure of those inspection reports until approximately a year later. This unlawful delay
amounted to an unlawful refusal to comply with HRS chapter 92F disclosure requirements.
The undisputed facts establish the Director failed to comply with the HRS chapter 92F provisions
requiring disclosure of public records, including those covered by HRS §§ 92F-11 and -12(a)(15),
within the less than ten day window provided by HAR §2-71-13(a). Summary judgment for Kōkua
Council on Count I is proper.
B.

Count 2: The Director violated HRS Chapter 92F by unreasonably and unjustifiably
redacting government records
Many of the currently posted inspection reports contained extensive redactions that

rendered the reports useless for Kōkua Council members and supporters. Shon Decl. ¶18, Exh. L.
Local newsmedia investigations likewise reported inspection reports had “extensive blackouts” and
further:
What does get posted leaves a lot to imagination. An inspection of the state’s own facility,
Maluhia, for example, includes 14 pages of deficiencies, another seven pages of rebuttals
and fixes. But much of it is blacked out. We don’t really know what happened, only that
they violated a section, and that’s about all that’s described.
Shon Decl. ¶18 & 19, Exhs. I & L. The inspection report for the Ann Pearl Nursing Skilled Nursing
Facility, for example, redacted nearly all but three findings concerning compliance with required
criteria under HAR chapter 11-100.1 out of a 44 page document. See Exh. L. Findings of
noncompliance with regulations of the governing body and management were nearly all redacted.
Exh. L at 1-2. Findings of noncompliance with regulations governing resident rights and facility
practices, resident accounts, resident care, nursing services, storage and handling of food,
pharmaceutical services, infection control, sanitation, housekeeping, and toilet and bathroom
construction requirements were entirely redacted. Exh. L. at 2-39. Such extensive redactions
rendered the reports useless for Kōkua Council members and supporters. Shon Decl. ¶20.
Healthcare facility reports containing such extensive redactions do not improve or expand public
access to information on the quality and conditions of care facilities in Hawai‘i. Shon Decl. ¶21; see
also Act 213 §1, 2013 Haw. Sess. Laws.
DOH claimed “[i]nspection reports were appropriately redacted to protect the significant
privacy interest of the residents in the facilities, pursuant to HRS §92F-14(b)(1).” DOH Answer at 5
(Seventh defense). HRS § 92F-14 provides in relevant part:
Significant privacy interest; examples. (a) Disclosure of a government record shall not
constitute a clearly unwarranted invasion of personal privacy if the public interest in
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 disclosure outweighs the privacy interest of the individual.
(b) The following are examples of information in which the individual has a significant
privacy interest:
(1) Information relating to medical, psychiatric, or psychological history, diagnosis,
condition, treatment, or evaluation, other than directory information while an individual is
present at such facility;
Id. (a) & (b)(1). The balancing test of public and privacy interest imposed by HRS §92F-14(a)
operates differently depending on whether the alleged privacy interest is “significant” or not. Id.
(“Disclosure of a government record shall not constitute a clearly unwarranted invasion of personal
privacy if the public interest in disclosure outweighs the privacy interest of the individual.”). The
requested information “is exempt from the general disclosure requirement unless ‘the public interest in
disclosure outweighs the privacy interests of the individual.’ ” Peer News LLC v. City & County of
Honolulu, 138 Haw. 53, 76, 376 P.3d 1, 24 (2016) (Pollack, J. concurring) quoting State of Haw. Org. of
Police Officers v. Soc'y of Prof'l Journalists (SHOPO v. SPJ), 83 Haw. 378, 400, 927 P.2d 386, 408 (1996)
(emphases in cited quotation) (quoting HRS § 92F–14(a)). As explained by Justice Pollack in a
recent decision concerning police officer personnel records:
[O]nce a significant privacy interest is found, the privacy interest will be balanced against the
public interest in disclosure. If the privacy interest is not ‘significant,’ a scintilla of public
interest in disclosure will preclude a finding of a clearly unwarranted invasion of personal
privacy.” SHOPO v. SPJ, 83 Haw. at 383-84, 927 P.2d at 391-92 (quoting Conf. Comm. Rep.
No. 112–88, in 1988 House Journal, at 817–18). In other words, where the privacy interest is
not considered “significant,” the information will always be disclosed so long as there is a
“scintilla” of public interest served by the disclosure of the information. Id. On the other
hand, where the privacy interest is considered “significant,” the information “is exempt from
the general disclosure requirement unless ‘the public interest in disclosure outweighs the
privacy interests of the individual.’” Id., 83 Haw. at 400, 927 P.2d at 408.
Peer News LLC, 138 Haw. at 76, 376 P.3d at 24 (Pollack, J. concurring) (citations reformatted). In this
case, the Director neither established that a significant privacy interest within the meaning of HRS
§92F-14 existed in the inspection reports, nor that any such alleged privacy interest was not
outweighed by significant public interests in disclosure of the reports. See Yonemoto v. Dep't of
Veterans Affairs, 686 F.3d 681, 688 (9th Cir. 2011) (burden is on the agency to establish the
exemption from records disclosure requirements apply). Where agencies invoke exemptions, they
“may withhold only that information to which the exemption applies, and so must provide all
‘reasonably segregable’ portions of that record to the requester.” Id. (citing 5 U.S.C. § 552(b)).
1.

Compliance with the requirements of HRS §321-1.8(b) did not suffice to discharge
DOH’s burden of establishing the applicability of the privacy exemption under HRS chapter 92F.
13

 DOH answered that it “is only required to post inspection reports” containing itemized
information under HRS §321-1.8(b), which includes “a description of violations of relevant state
laws or rules, if applicable[.]” DOH Answer at 5 (Eighth defense). By redacting findings that
describe the facts establishing those violations, DOH failed to meet the minimal requirements of
HRS §321-1.8. In any case, compliance with the minimum requirements of HRS §321-1.8(b) would
not suffice to discharge DOH’s burden of establishing the applicability of the significant privacy
exemption under HRS chapter 92F.
2.

The Director did not carry her burden of establishing health facility inspection records contained
information implicating significant privacy interests under HRS §92F-14(b)(1) or outweighed
public interest in the disclosure of the reports.

The Director did not carry the burden of establishing a significant privacy interest was
implicated by the requested healthcare facility reports. See Yonemoto, 686 F.3d at 688. Medical
information implicating significant privacy interests under HRS §92F-14(b)(1) includes: (1)
information protected by the Health Insurance Portability and Accountability Act of 1996, Public
Law 104-191 (“HIPAA”) rules (OIP Opinion Letter No. 03-05, at *1 (Apr. 11, 2003)); (2) an
individual's medical records (OIP Opinion Letter No. 95-16, at *3 (July 18, 1995)); or (3) any “highly
personal” or “intimate” information concerning medical condition, treatment, or diagnosis. See OIP
Opinion Letter No. 90-17, at *1 (Apr. 24, 1990) (records of employee sick leave or vacation leave,
severed of information relating to the medical condition, treatment, or diagnosis of the employee,
were to be disclosed to the public). The requested health facility inspection records did not fall into
the recognized categories of HRS §92F-14(b)(1) information and the Director did not establish
otherwise. Id.
The Director also did not establish a significant privacy interest outweighed public interest in
the disclosure of the healthcare facility inspection reports. HRS § 92F-14(a). An individual’s privacy
interests are balanced against the public interest “in the disclosure of official information that sheds
light on an agency's performance of its statutory purpose and the conduct of government officials,
or which otherwise promotes governmental accountability.” OIP Opinion Letter No. 07-08, at *3
(May 4, 2007) (opining that the Auditor may not, in response to a UIPA request, redact from the AG's
Response individually identifiable employee misconduct information about an audit analyst where
that information directly impacts on the performance of the Auditor) citing OIP Opinion Ltr. No.
91-19; OIP Opinion Ltr. No. 92-17. Even home telephone numbers may be subject to disclosure
14

 due to public interest in some circumstances. See OIP Opinion Letter No. 05-08, at *2 (Apr. 12,
2005) (declining to opine as to whether home telephone numbers may be redacted from unspecified
City-reimbursed cellular phone records). Here, significant public interest in the healthcare facilities
inspection reports far outweighed any alleged significant privacy interest. See Act 213 §1, 2013 Haw.
Sess. Laws; Shon Decl. ¶¶4, 5, 8. Because the Director did not establish a significant privacy interest
clearly outweighed public interest in the inspection reports, the reports should have been disclosed.
3.

DOH’s redactions were unreasonable and did not outweigh the public’s interest in this information.

Reasonable redaction does not thwart the public’s interest in inspection findings. OIP
Opinion Ltr. No. 03-04, at *4 (Apr. 8, 2003) (redaction of information that did not fall within the
bounds of the public's interest in learning about the qualifications of an appointed director was
appropriate). The Director did not reasonably segregate portions of the record, but rather
conducted extensive redactions that constituted significant incursions into the public’s interest in the
inspection records.
Redactions were much more extensive than necessary to protect significant private
information. Comparison of reports from inspections conducted on the same day, at the same
facility, and by the same inspector establish that the Director’s redactions were unreasonable. DOH
employees conduct inspections at healthcare facilities both for the purposes of completing State
inspection reports and reports required for federal Medicare certification. Shon Decl. ¶22. The
Medicare certification report is then submitted to the goes to the U.S. Department of Health and
Human Services, Centers for Medicare and Medicaid Services (CMS). CMS certifies compliance or
noncompliance and determines whether a facility will participate in the Medicare or Medicaid
programs. CMS also redacts the certification reports and posts them on their website. Shon Decl.
¶22; Exh. M.
On March 18, 2016, a DOH employee conducted a survey of the Liliha Healthcare Facility
in Honolulu for the purposes of completing a State healthcare facility inspection report and a CMS
medicare certification report. Shon Decl. ¶23-24; Exhs. M & N. The federal Medical Certification
report for the Liliha Healthcare Center provides much more material information about the status
of the facility and its services, with selective redactions that indicated the type of withheld material
by bracketed labels, such as “[DIAGNOSES REDACTED]” or “[MEDICATION NAME].” Shon
Decl. ¶23; Exh. M. By contrast, the State inspection report contains extensive redactions. Shon
Decl. ¶24; Exh. N. All findings concerning nursing services, pharmaceutical services and infection
15

 control were completely blacked out. Shon Decl. ¶24; Exh. N at 1-9, 12-14-32. The selective, less
invasive redactions on the federal Medicare Certification Report for the same facility did not
materially impact the ability of Kōkua Council members and supporters to understand CMS’
assessments, whereas the State inspection report was so heavily redacted as to be useless for any
purposes of Kōkua Council members and supporters. Shon Decl. ¶26.
C.

Count 3: An order in the nature of mandamus is necessary and appropriate to
ensure the Director carries out her ministerial duties.
Kōkua Council respectfully requests this Court grant an order in the nature of mandamus

directing the Director to post on its website electronic copies of reports for all inspections it
performs for (a) adult day health centers, (b) adult day care centers, (c) community care foster family
homes, (d) developmental disabilities domiciliary homes as defined in section 321-15.9, (e)
developmentally disabled adult foster homes,(f) long-term care facilities as defined in section
349-21(f), and (g) Special treatment facilities as defined in section 334-1 within five days of the
conclusion of the inspection and shall include (1) the date of the inspection, (2) a description of
violations of relevant state laws or rules, if applicable, (3) plans of correction and the status of
corrective actions in response to any violations, if applicable, (4) a list and description of all
corrective actions taken by the facility, if applicable, to be submitted by the facility and added to the
report at a later time, as determined by the department, and (5) other information regarding the
quality and conditions of the facility the department of health deems appropriate. HRS §321-1.8.
HRS §321-1.8 provides no discretion in posting the inspection reports and redactions for personally
identifiable health information is neither a discretionary act falling outside of a mandamus order nor
do those redactions create discretion in determining whether to post the inspection reports.
“An order in the nature of mandamus is appropriate only where the right to relief is ‘clear’
and the duty sought to be enjoined is performance of an act commanded to be performed by law
and involving no exercise of discretion.” Brown v. New York State Dept. of Soc. Services, 106 A.D.2d
740, 741 (N.Y. 1984) (citations and internal quotation marks omitted). “Mandamus is the proper
remedy to compel public officials to perform a purely ministerial duty imposed by law; it generally
may not be invoked to review or control the acts of public officers respecting discretionary matters.
However, mandamus will lie to review discretionary acts when the discretion appears to have been
abused or the action taken arbitrarily, capriciously, or in disregard of law.” Buckland v. Town of Haw
River, 541 S.E.2d 497, 499 (N.C. App. 2000) (citations omitted).
The Ninth Circuit held relief in the nature of mandamus appropriate to insure compliance
16

 officials performed a nondiscretionary duty to refrain from approving affirmative action plans that
lacked elements mandated by federal regulations, even if the court would be required to interpret
revised executive order to determine precise scope of agency's duties. Legal Aid Soc. of Alameda
County v. Brennan, 608 F.2d 1319, 1331–32 (9th Cir. 1979) (citations omitted). While recognizing
“areas of the administrative process so laced with discretion are traditionally shielded from direct
judicial intervention[,]” the Ninth Circuit noted relief requested was not applied to these
discretionary areas.
For this an order in the nature of mandamus will lie. It is no bar to such relief that the court
may be required to interpret [the executive order] to determine the precise scope of the
agency's duties. . . (O)nce the court interprets the law, the defendant's duty will become clear;
the court is not telling the defendant how to exercise his discretion.
Id., 608 F.2d at 1331-32 quoting Knuckles v. Weinberger, 511 F.2d 1221, 1222 (9th Cir. 1975). In this
case, the Director exercises no discretion in posting or disclosing inspection reports pursuant to
HRS §321-1.8. This Court may provide the scope of DOH’s duties to redact medical or other
private information contained within those inspection reports by directing DOH to the relevant
OIP opinions cited supra Part IV.B and the example of federal medicare certification reports. See
e.g., Exh. M. By so interpreting relevant laws – HRS §92F-14(b)(1) and HRS §321-1.8(b) – to
determine the precise scope of the Director’s duties, this Court would appropriately grant the
requested order in the nature of mandamus.
V. Conclusion
For the foregoing reasons, Kōkua Council respectfully requests this Court grant summary
judgment on Counts I and II of its complaint, as well as its request for an order in the nature of
mandamus under Count III.
DATED:

Honolulu, Hawaii

December 21, 2016

________________________________
LAW OFFICEOF LANCE D COLLINS
LANCE D. COLLINS
Attorney for Plaintiff

17

 IN THE CIRCUIT COURT OF FIRST CIRCUIT
STATE OF HAWAII

Civil No. 16-1-1421-07 KTN
KOKUA COUNCIL FOR SENIOR (Other Civil Action)
CITIZENS, an unincorporated association,
DECLARATION OF JAMES SHON
Plaintiff
vs.

HEALTH, STATE OF 











DIRECTOR OF THE DEPARTMENT OF 




Defendants. 
m)

DECLARATION OF SHON

SHON, do declare under penalty of law that the following is true and correct.

1. I am a resident of the City and County of Honolulu.

2. I am currently the vice president of the board of Directors for the Kokua Council
for Senior Citizens, an unincorporated organization based in Honolulu (Kokua Council).

3. Established in 1977, Kokua Council is one of Hawaii's oldest advocacy groups for
seniors. Kokua Council seeks to empower seniors, their families, and other concerned citizens in
order to be effective advocates in shaping the future and well-being of our community and with
particular attention to those needing help in advocating for themselves.

4. Many families, including those of Kokua Council members, have been faced with or
will be faced with making a critical health care decision for a loved one - transferring a loved one
from a critical care facility to a long term care facility with sometimes only hours to make a decision.

5. For many families, the Director of the Department of Health?s (DOH or Director)
online posting of inspection reports is the only accessible, impartial information on quality of a long
term care facility. The same is true for families seeking impartial information about other types of

health care facilities.

6. On or about December 13, 2015, Kokua Council accessed the DOH website and was
only able to View 469 healthcare facilities inspection reports, none of which were for ARCHs or e-
ARCHs, which were of particular concern. See a/m Kokua Council Complaint, ?led Jul. 25,
2016. As of December 13, 2015, approximately 500 ARCHs and were licensed to operate

in the State of Hawai?i.

7. By letter dated December 14, 2015, K?kua Council, through its legal counsel, wrote
to the Director regarding the posting of inspection reports and submitted a Uniform Information
Practice Act (UIPA) request for public information pursuant to HRS chapter 92F. See Letter from
Lance D. Collins, Esq, attorney for K?kua Council, to Dr. Virginia Pressler, Director, Dep?t of
Health, Re: Posting of Inspection Reports and Chapter 92F, HRS request (Dec. 14, 2015), a true
and correct copy of which is attached as Exhibit Kokua Council simultaneously submitted its
UIPA request to Keith Ridley, Chief Of?cer of Of?ce of Healthcare Assurance (Ridley).

8. K?kua Council intended to publicize the healthcare facility inspection reports via
internet media, including preparation of reports of signi?cant interest to Civil Beat, the Honolulu
Star-Advertiser and DisappearedNews.com.

9. By email dated January 3, 2016, Ridley responded to Kokua Council by stating, in
part, ?[t]he available inspection reports are in the process of being posted? and would ?be posted as
soon as staff] are able by using the dedicated and temporary staff resources and until such
time as we obtain permanent full time resources.? Email from Keith Ridley, Dep?t of Health, to
Lance Collins, Esq, attorney for Kokua Council, Subject: Re: Fwd: Letter to Dr. Virginia Pressler
dated December 14, 2015 (Jan. 3, 2016 at 1:42 PM), a true and correct copy of which is attached as
Exhibit 

10. By email sent on January 4, 2016, Kokua Council requested assistance from the State
of Hawai?i Of?ce of Information Practices (OIP) in obtaining access to the requested records and
ensuring compliance with I-IAR 2-71-13(a) in light of Ridley?s ambiguous and indefinite response
concerning when, if ever, the records would be released. Email from Lance D. Collins, Esq,
attorney for K?kua Council, to Of?ce of Information Practices Subj: Request for
Assistance (Jan. 4, 2016), a true and correct copy of which is attached as Exhibit 

11. By letter dated January 26, 2016, OIP wrote to the Director concerning K?kua
Council?s request for access to DOH records (OIP No. REA-P 16-26). Geller Decl. Letter
from Liza Onuma, Staff Attorney, Of?ce of Information Practices, State of Hawai?i, to
Virginia Pressler, Director, Department of Health, Re: Request for Assistance to Access Records (U
REA-P 16-26), 1 (Jan. 26, 2016), a true and correct copy attached as Exhibit 

12. By letter dated January 29, 2016, Kokua Council wrote to Ridley acknowledging his
emailed re5ponse earlier in the day, and noting a total of 271 reports for ARCHs and 

were currently posted on the DOH website. Letter from Lance D. Collins, Esq., attorney for Kokua

Council, to Keith Ridley, Dep?t of Health, Subj: Posting of Inspection Reports and Chapter 92F,
HRS request (Jan. 29, 2016), a true and correct copy of which is attached as Exhibit 

13. On February 2, 2016, Kokua Council responded to an email from Ridley, sent on
january 30, 2016. Letter from Lance D. Collins, Esq. to Keith Ridley, Dep?t of Health, Subj: Kokua
Council?s Chapter 92F, HRS request (Feb. 2, 2016), a true and correct copy of which is attached as
Exhibit Kokua Council disputed determination to deny access to the requested records
and included OIP in the exchange to apprise them of needed assistance in either obtaining the
government records or an appropriate denial based on a speci?c legal basis. Exh. F.

14. Should DOH fail to post healthcare facility inspection reports for reasons including
lack of resources, there is a reasonable expectation that Kokua Council would again submit a request
for government records and would further complain of unlawful delay if DOH failed to
disclose those inspection reports.

15. On july 25, 2016, Kokua Council filed a complaint with this Court.

16. On August 22, 2016, Kokua Council ?led its Request for Answers to Interrogatories
and Request for Production of Documents, which the Director answered on or about September
15, 2016, a true and correct copy of which is attached as Exhibit 

17. As of October 24, 2016, approximately 433 ARCHs and were licensed in
the State. Of?ce of Healthcare Assurance, Dep?t of Health, State of Hawai?i, ?Combined ARCH-
Expanded ARCH Vacancy Report by Area,? (accessed Dec. 12, 2016) available at:
health.hawaii.gov ohca ?les 201 3 06 acancy?
a true and correct copy of which is attached as Exhibit 

18. On November 7, 2016, local news outlet KHON stated that most posted inspection
reports its reporter investigated had ?extensive blackouts.? Gina Mangieri, ?Public access to health
care inspection reports ?lled with delays, redactions,? KHONZ (N 0v. 7, 2016) available an
a true and correct copy is attached as Exhibit 

19. On December 12, 2016, 1,755 healthcare facilities inspection reports and 290
developmental disabilities adult foster home annual inspection reports were posted on the DOH
website. Geller Decl. Exh. Of?ce of Healthcare Assurance, Dep?t of Health, State of
Hawai?i, ?Healthcare Facilities Inspection Reports,? (accessed Dec. 12, 2016) available at:
http:/ a true and correct copy of which is attached as
Exhibit Of the 1,755 healthcare facilities inspection reports, 230 were for and 203
were for ARCHs.

20. Many of the posted inspection reports contained extensive redactions that rendered
the reports useless for K?kua Council members and supporters. See rag. Of?ce of Healthcare
Assurance, Dep?t of Health, State of Hawai?i, ?2016 Ann Pearl Skilled Nursing Facility,? inspection
report (accessed Dec. 12, 2016) available at: health.hawaii.gov/ ohca/ ?les 2016 08 ANN-
a true and correct copy of which is attached as Exhibit 

21. Healthcare facility reports containing such extensive redactions do not improve or
expand public access to information on the quality and conditions of care facilities in Hawai?i.

22. DOH employees conduct inspections at healthcare facilities both for the purposes of
completing State inspection reports and reports required for federal Medicare certi?cation. The
Medicare certi?cation report is then submitted to the goes to the US. Department of Health and
Human Services, Centers for Medicare and Medicaid Services (CMS). A CMS regional of?ce
certi?es compliance or noncompliance and determines whether a facility will participate in the
Medicare or Medicaid programs. CMS also redacts the certi?cation reports and posts them on their
website.

23. On March 18, 2016, a DOH employee conducted a survey of the Liliha Healthcare
Facility in Honolulu, whose Provider/ Supplier/ CLIA Identi?cation Number is 125041, for the
purposes of completing a State healthcare facility inspection report and a CMS medicare
certi?cation report. US. Department of Health and Human Services, Centers for Medicare and
Medicaid Services, Form No. Liliha Healthcare Center, Facility ID No. 125041
(survey completed Mar. 18, 2016), a true and correct copy of which is attached as Exhibit and
State of Hawai?i, Department of Health, Of?ce of Health Care Assurance, Liliha Healthcare Center,
ID No. 125041 (survey completed Mar. 18, 2016), a true and correct copy of which is attached as
Exhibit 

24. The federal Medical Certi?cation report for the Liliha Healthcare Center provides
much more material information about the status of the facility and its services, with selective
redactions that indicated the type of withheld material by bracketed labels, such as 
or See Exh. M.

25. By contrast, the State inspection report contains extensive redactions. See Exh. N.
All ?ndings concerning nursing services, pharmaceutical services and infection control were
completely blacked out. See Exh. at 1-9, 12-14-32.

26. The selective, less invasive redactions on the federal Medicare Certi?cation Report

for Liliha Healthcare Center did not materially impact the ability of K?kua Council members and

supporters to read and understand the assessments made by CMS, whereas the State inspection
report was so heavily redacted as to be useless for any purposes of K?kua Council members and

supporters.

27. DOI-I has, since the ?ling of our complaint, failed its obligation to post its inspection

reports within ?ve working days after completion of the report.

DECLARANT FURTHER SAYETI-I NAUGHT

DATED: Honolulu, Hawai'i December 15, 2016

 

 

EXHIBIT A

 

December 14, 2015
Virginia Pressler, MD
Director
Department of Health
1250 Punchbowl St.
Honolulu, Hawaii 96813
Re:

Posting of Inspection Reports and Chapter 92F, HRS request

Dear Dr. Pressler,
I represent Kokua Council. Members of the Council have reviewed the website of your
Department's Office of Healthcare Assurance, specifically the Healthcare Facilities Inspection
Reports section. There appears to be 469 inspection reports currently posted to the website
covering 11 types of healthcare facilities. However, there are no inspection reports for ARCHs and
only three for E-ARCHs. It is the Council's understanding that there approximately 500 ARCHs and
E-ARCHs licensed in this State.
HAR § 11-100-1.2 states
“'Adult residential care home' or 'ARCH' means any facility providing twenty four hour
living accommodations, for a fee, to adults unrelated to the family, who require at least
minimal assistance in the activities of daily living, personal care services, protection, and
health care services, but who do not need the professional health services of an
intermediate, skilled nursing, or acute care facility. It does not include facilities operated by
the federal government.”
“'Expanded ARCH' means any facility providing twenty four hour living accommodations,
for a fee, to adults unrelated to the family, who require at least minimal assistance in the
activities of daily living, personal care services, protection, and health care services, and who
may need the professional health services provided in an intermediate care facility or skilled
nursing facility.”
HAR § 11-100.1-1.3(e) states
(1)

All ARCHs and expanded ARCHs shall be licensed to ensure the health, safety and

 welfare of the individuals placed therein. The department shall conduct unannounced visits,
other than the inspection for relicensing, to every licensed adult residential care home and
expanded adult residential care home on an annual basis and at such intervals as determined
by the department to ensure the health, safety and welfare of each resident. Unannounced
visits may be conducted during or outside regular business hours. All inspections relating to
follow-up visits, visits to confirm correction of deficiencies, or visits to investigate
complaints of suspicion of abuse or neglect shall be conducted unannounced during or
outside regular business hours. Inspections for relicensing may be conducted annually or at
intervals determined by the department during regular business hours. Inspections for
relicensing shall be conducted with notice, unless otherwise determined by the department.
(2)
Following an annual inspection, a list of deficiencies, if any, shall be given to the
licensee or primary care giver of the ARCH or expanded ARCH. The licensee or primary
care giver of the ARCH or expanded ARCH shall return a plan of correction for the
deficiencies cited within ten working days. An accepted plan for correcting deficiencies shall
include the time frame for correction and the preventive measures that will be instituted to
ensure compliance with this chapter; and
Section 2 of Act 213 of the Session Laws of Hawaii of 2013, codified at HRS § 321-1.8,
requires that inspection reports generated by inspections occurring on or after January 1, 2015 be
posted to the Department's website within five days after the inspection. As was noted above, it
appears that no inspection reports for ARCHs, which are to be inspected at least annual, have been
posted in the last year, and only three E-ARCH inspection reports have been posted.
The Kokua Council requests access to all reports of inspections occurring on January 1,
2015 or there after pursuant to HRS § 92F-11 and § 92F-12(a)(15). It is the Council's position that
because Act 213 requires these reports to be posted to the Department's website, the Department
must make these documents available for public inspection and duplication during regular business
hours within ten business days. See HAR § 2-71-13(a) (“When an agency receives a request for
access to a record that is [r]equired to be disclosed under section 92F-12, HRS, in its entirety... [t]he
agency shall disclose the record within a reasonable time not to exceed ten business days.”). Because
these documents are covered by HRS § 92F-12(a)(15) and HAR § 2-71-13(a), the Department may
not claim that extenuating circumstances exist under HAR § 2-71-13 or HAR § 2-71-15 to extend
the time within which to provide access to public inspection and duplication.

 Furthermore, the Council requests access to the “inventory of all facilities licensed under
[HRS § 321-15.62(e).]” See HRS § 321-15.62(e) (“The department shall maintain an inventory of all
facilities licensed under this section and shall maintain a current inventory of vacancies therein to
facilitate the placement of individuals in such facilities.”)
Because these records pertain to the operations and activities of the Department and are not
readily available in the public domain, the Council intends to publicize and widely disseminate the
government records obtained in these requests and therefore requests a waiver of fees in the public
interest pursuant to HAR § 2-71-32. The Council also requests copies of these records in electronic
format if they exist in such format.
I also have copied Keith R. Ridley of the Office of Health Care Assurance and by copying
him, simultaneously make the same request on behalf of the Kokua Council to his Office.
Please do not hesitate to contact me if you have any questions.
Very truly yours,
LAW OFFICE OF LANCE D COLLINS

LANCE D COLLINS
Attorney for Kokua Council
c:

Keith R. Ridley
Kokua Council

 EXHIBIT 

 

Re: Fwd: Letter to Dr. Virginia Pressler dated December 14, 2015

Subject: Re: Fwd: Le�er to Dr. Virginia Pressler dated December 14, 2015
From: "Ridley, Keith R." <Keith.Ridley@doh.hawaii.gov>
Date: 1/3/2016 1:42 PM
To: "Lance D. Collins, Ph.D" <lawyer@maui.net>, "Pressler, Virginia Ginny, M.D."
<Ginny.Pressler@doh.hawaii.gov>
Aloha, Dr. Collins.
The available inspec�on reports are in the process of being posted.
Our office has dedicated a staff person to this effort and away from other important and required
du�es. The deployment of this person may delay the processing of new license applica�ons or
conduc�ng of onsite inspec�ons which are also a required duty of this office.
In addi�on, we have hired a temporary person beginning tomorrow (Monday, January 4) to assist in
the pos�ng of back logged reports, specifically on the pos�ng of ARCH and E-ARCH reports. Be
advised, however, that many reports are not yet completed in their fullest, so their pos�ng was
delayed temporarily. Nevertheless, we will begin pos�ng the incomplete reports instead of wai�ng
longer. Unfortunately, this will mean incomplete informa�on being available to the public and may
convey an incomplete and distorted view of the residen�al care homes.
In short, please know that the reports will be posted as soon as we are able by using the dedicated
and temporary staff resources and un�l such �me as we obtain permanent full �me resources.
Thank you for your pa�ence and understanding.
Keith Ridley
Sent from Outlook Mobile

On Sun, Jan 3, 2016 at 1:28 AM -0800, "Lance D. Collins, Ph.D" <lawyer@maui.net> wrote:
Aloha Dr. Pressler,
I have not received a response or acknowledgment of the request my
office made on behalf of Kokua Council to access government records made
by e-mail and regular postal mail on December 14, 2015 to you and Mr.
Ridley. Please advise.
Mahalo
lance*
-------- Forwarded Message -------Subject: Le�er to Dr. Virginia Pressler dated December 14, 2015

 Re: Fwd: Letter to Dr. Virginia Pressler dated December 14, 2015
Date: Mon, 14 Dec 2015 08:52:35 -1000
From: Lance D. Collins, Ph.D <lawyer@maui.net>
To: Virginia Ginny Pressler, M.D. <Ginny.Pressler@doh.hawaii.gov>
CC: Keith Ridley <Keith.Ridley@doh.hawa.gov>
Original will be sent in today's mail.
-Law Office of Lance D Collins
A Law Corpora�on
Post Office Box 179336
Honolulu, HI 96817
808.243.9292
This e-mail is intended for the addressee shown. It contains informa�on
that is confiden�al and protected from disclosure. Any review,
dissemina�on or use of this transmission or its contents by persons or
unauthorized employees of the intended organiza�ons is strictly prohibited.

 EXHIBIT 

 

Request for Assistance

Subject: Request for Assistance
From: "Lance D. Collins, Ph.D" <lawyer@maui.net>
Date: 1/4/2016 1:27 AM
To: Office of Informa�on Prac�ces <oip@hawaii.gov>
Aloha,
On behalf of the Kokua Council, I request assistance in the accessing of the government
records mentioned in the attached letter. The Department has not denied the request -as noted in the e-mail below-- but has not complied with its obligations to grant access
pursuant to HRS 92F-11 and 92F-12(a)(15) (and HAR § 2-71-13(a)) and has given an
ambiguous and indefinitely declaration on when, if ever, it intends to release the
documents.
Mahalo
lance*
Lance D. Collins
Attorney for Kokua Council
-------- Forwarded Message -------Subject:
Re: Fwd: Letter to Dr. Virginia Pressler dated December 14, 2015
Date:
Sun, 3 Jan 2016 23:42:22 +0000
From:
Ridley, Keith R. <Keith.Ridley@doh.hawaii.gov>
To:
Lance D. Collins, Ph.D <lawyer@maui.net>, Pressler, Virginia Ginny,
M.D. <Ginny.Pressler@doh.hawaii.gov>

Aloha, Dr. Collins.
The available inspection reports are in the process of being posted.
Our office has dedicated a staff person to this effort and away from
other important and required duties. The deployment of this person may
delay the processing of new license applications or conducting of onsite
inspections which are also a required duty of this office.
In addition, we have hired a temporary person beginning tomorrow
(Monday, January 4) to assist in the posting of back logged reports,
specifically on the posting of ARCH and E-ARCH reports. Be advised,
however, that many reports are not yet completed in their fullest, so
their posting was delayed temporarily. Nevertheless, we will begin
posting the incomplete reports instead of waiting longer.
Unfortunately, this will mean incomplete information being available
to the public and may convey an incomplete and distorted view of the
residential care homes.
In short, please know that the reports will be posted as soon as we are
able by using the dedicated and temporary staff resources and until such
time as we obtain permanent full time resources.
Thank you for your patience and understanding.
Keith Ridley
Sent from Outlook Mobile <https://aka.ms/qtex0l>

 Request for Assistance

On Sun, Jan 3, 2016 at 1:28 AM -0800, "Lance D. Collins, Ph.D"
<lawyer@maui.net <mailto:lawyer@maui.net>> wrote:
Aloha Dr. Pressler,
I have not received a response or acknowledgment of the request my
office made on behalf of Kokua Council to access government records made
by e-mail and regular postal mail on December 14, 2015 to you and Mr.
Ridley. Please advise.
Mahalo
lance*
-------- Forwarded Message -------Subject: Letter to Dr. Virginia Pressler dated December 14, 2015
Date: Mon, 14 Dec 2015 08:52:35 -1000
From: Lance D. Collins, Ph.D <lawyer@maui.net>
To: Virginia Ginny Pressler, M.D. <Ginny.Pressler@doh.hawaii.gov>
CC: Keith Ridley <Keith.Ridley@doh.hawa.gov>
Original will be sent in today's mail.
-Law Office of Lance D Collins
A Law Corporation
Post Office Box 179336
Honolulu, HI 96817
808.243.9292
This e-mail is intended for the addressee shown. It contains information
that is confidential and protected from disclosure. Any review,
dissemination or use of this transmission or its contents by persons or
unauthorized employees of the intended organizations is strictly prohibited.

Attachments:

kokua council le�er to pressler 151214.pdf

97.7 KB

 EXHIBIT 

 

 

STATE OF HAWAII
OFFICE OF THE LIEUTENANT GOVERNOR
OFFICE OF INFORMATION PRACTICES 

LIEUTENANT GOVERNOR
N0. 1 CAPITOL DISTRICT BUILDING
250 SOUTH HOTEL STREET, SUITE 107
HONOLULU. HAWA 96813
Telephone: 1808] 586-1400 FAX: {808} 586-1412
E-MAIL: OIp@hawai gov


January 26, 2016

The Honorable Virginia Pressler, MD.
Director

Department Of Health

l250 Punchbowl Street

Honolulu, HI 96813

Re: Request for Assistance to Access Records (U RFA-P 16-26)
Dear Director Pressler:

The Office of Information Practices (OIP) has received a request for assistance from Lance
Collins, Esq. with respect to his request made under Part II ofthe Uniform Information Practices Act
(Modi?ed), chapter 92F, Hawaii Revised Statutes (HRS) (the for access to Healthcare
Facilities Inspection Reports. Specifically, he requested ?all reports Ofinspections occurring on
January I, 2015 or thereafter? and ?inventory ofall facilities licensed under 32l-l 
Mr. Collins indicated that he made a written request to the Department of Health (DOH) dated
December 2015, and that he has received an ?ambiguous and inde?nite [sic]? response from the
DOH because the response fails to provide ?when, if ever, it intends to release the documents.?
Copies Of Mr. Collins?s request to OIP and his record request to are enclosed for your
information.

In the e-mail to Mr. Collins dated January 3, 2016, Mr. Keith Ridley responds to Mr.
Collins?s request by explaining that ?[t]he available inspection reports are in the process of being
posted.? In OIP Opinion Letter Number 04?16 at 4, OIP has stated that agencies, when re5ponding to
record requests, cannot advise requesters that they can onty access records via the internet. This
means that, if, after advising a requester that the information sought is available through the website,
the requester advises the agency that he or she wants a paper [or electronic] copy and furnishes
prepayment for the paper [or electronic] copy, the agency is required to provide a paper [or
electronic] copy.

Mr. Collins has requested an electronic copy Of the records. Because it appears that the DOH
has granted Mr. Collins?s request, within ten business days from the date of this letter, please provide
an electronic copy of the requested records, if the records are maintained in that form or can be
readily made into that form. Ifthe DOH changes its position and now decides to deny access to all

The Honorable Virginia Pressler, MD.
January 26, 2016
Page 2

or part of Mr. Collins?s request, please provide the required response to Mr. Collins within that same
timeframe. HAR 2-7l-l3, 2-71-14, 2-7l-15. Speci?cally, ifdenying access, the DOH should (1)
specify the record, or parts, that will not be disclosed; and (2) cite the agency?s speci?c legal
authorities under which access is denied under HRS and other laws. HAR 2-71-14.
Please also provide OIP with notice of the action taken by the DOH.

This letter also serves as notice that OIP is not representing anyone in this request for
assistance. OlP?s role herein is as a neutral third party.

Thank you in advance for your cooperation and assistance in this matter. Please do not

hesitate to contact me if you have any questions or require assistance.

Very truly yours,

WW

Liza RH. Onuma

 

Staff Attorney

Enclosure
cc: Lance Collins, Esq. (without enclosure)
1 The UIPA also provides generally that when compliance with any provision ofthe UIPA

would cause an agency to lose or be denied funding or other assistance from the federal government,
compliance with that provisions shall be waived but only to the extent necessary to protect eligibility for
such federal assistance. HRS 92F-4.

EXHIBIT 

 

January 29, 2016
Keith R. Ridley
Office of Health Care Assurance
Department of Health
1250 Punchbowl St.
Honolulu, Hawaii 96813
Re:

Posting of Inspection Reports and Chapter 92F, HRS request

Dear Mr. Ridley,
Thank you for your e-mail response of January 29, 2016. As I indicated in my letter to Dr.
Pressler, on behalf of Kokua Council, on December 14, 2015, there were approximately 469
inspection reports on the website posted as of December 14, 2015 for all types of covered facilities.
Of those, only 3 were for E-ARCHs and none were for ARCHs. Kokua Council believes that there
are approximately 500 licensed ARCHs in the State in addition to the other types of covered
facilities.
Since my December 14, 2015 letter, it appears that there are now 271 inspection reports for
ARCHs and E-ARCHs. The posting of those reports and ability to access them online are
satisfactory to responding to the part of the request asking for access to those inspection reports.
Therefore, the outstanding request is for the remainder of the reports for ARCH and
eARCH and any other covered inspection reports under HRS §321-1.8 that have not been made
available to the public and posted to the website. If there are no additional inspection reports to
post, indicating that no further government records exist to satisfy the request would be helpful.
I would also like to call your attention to a particular pithy statement of the law made by
OIP in its letter to you:
In OIP Opinion Letter Number 04-16 at 4, OIP has stated that agencies, when responding
to record requests, cannot advise requesters that they can only access records via the
internet. This means that, if, after advising a requester that the information sought is
available through the website, the requester advises the agency that he or she wants a paper
[or electronic] copy and furnishes prepayment for the paper [or electronic] copy, the agency
is required to provide a paper [or electronic] copy.

 While the Kokua Council is not presently asking for separate electronic copies of inspection reports
that have become available online, by law, Kokua Council can still request such copies. Further,
Chapter 92F, HRS does not permit the Department to assess costs to a requestor to make records
available that are required to be made available to public inspection (and for those records required
to be made available online). In other words, there is no additional cost to providing electronic
copies of records that are already required, by law, to exist in electronic format. See HRS § 92F-11,
92F-12(a)(15), also HAR § 2-71-13.
Additionally, Kokua Council also asked for a copy of the inventory required to be
maintained pursuant to HRS § 321-15.62(e) and it does not appear that this inventory is posted on
the website. Because this inventory is required to be maintained by the Department, Kokua
Council's position is that it is not required to pay the costs associated with compiling this inventory
if it has not been compiled. If it has been compiled, Kokua Council will pay the costs for
segregating it from other records above the exemption threshold for those in the public interest if
any. The Council expects a clear explanation for that cost if it exceeds the exemption threshold.
Thank you for your consideration. We look forward to the Department's timely provision of
the remaining records by February 9, 2016 – the deadline established by the Office of Information
Practices and Chapter 92F, HRS.
Very truly yours,
LAW OFFICE OF LANCE D COLLINS

LANCE D COLLINS
Attorney for Kokua Council
c:

Office of Information Practices
Kokua Council

 EXHIBIT 

 

February 2, 2016
Keith R. Ridley
Office of Health Care Assurance
Department of Health
1250 Punchbowl St.
Honolulu, Hawaii 96813
Re:

Kokua Council's Chapter 92F, HRS request

Dear Mr. Ridley,
Thank you for your January 30, 2016 e-mail and notice to requester. As I mentioned in my
letter of January 29, 2016, Kokua Council believes there are approximately 500 ARCH and e-ARCH
licensed facilities. On January 29, 2016, the website indicated there were 271 reports posted. You
have indicated in your response regarding records being withheld that reports are not currently
posted, “because the ARCHs or eARCHs were not inspected or the inspection reports are not
finalized.” You continue by indicating “inspection reports are not available and the request cannot
be granted.” Please identify specifically each inspection report, preferably by ARCH or e-ARCH
facility, that you claim is “not finalized” and that the Department maintains but will not be releasing.
You have cited to HRS § 92F-13 and HRS § 92F-22. HRS § 92F-22 is not a valid basis to
deny access. Kokua Council is not seeking to access its personal records maintained by the agency,
but rather is seeking to access government records required by statute to be posted to the internet
within 5 days of the inspection. See HRS § 321-1.8
Second, while you have simply stated they are being withheld under HRS § 92F-13, the
Department is required to state specifically which provision of HRS § 92F-13 is being invoked to
deny access. HAR 2-71-14(b)(2) states that the agency notice must shall state: “[t]he specific legal
authorities under which the request for access is denied under section 92F-13, HRS[.]” There were
no specific legal authorities and there was no identification of which provisions of HRS § 92F-13
were being invoked.
You also noted in your e-mail accompanying the notice to requester that “the requirements
[of HRS § 321-1.8] are like an unfunded mandate, and we are unable (not unwilling) to do the

 work.” While Kokua Council disputes your present characterizations of the Department's budget
allocation by the legislature, the Department's inability or unwillingness to post those records online
is irrelevant and immaterial to its obligations under Chapter 92F, HRS, to disclose those records or
inspection upon request. There is no “unfunded mandate” exception in Chapter 92F, HRS. It is a
duty of every state and county agency to disclose government records that they maintain. 1
Otherwise, every state and county agency could claim that disclosing government records they
maintain constituted an unfunded mandate.
Please also clarify whether the not-current list of ARCH and e-ARCH vacancy report by
area you have cited in your e-mail – that has been posted online – constitutes the inventory covered
facilities required to be maintained by HRS § 321-15.62(e).
I am including the Office of Information Practices in this exchange as it appears my office
continues to need assistance in obtaining government records required to be made available to the
public or to get an appropriate denial specifying the particular inspection reports that are being
denied and the specific legal basis for such denial.
Very truly yours,
LAW OFFICE OF LANCE D COLLINS

LANCE D COLLINS
Attorney for Kokua Council
c:

Office of Information Practices
Kokua Council

1 Article VIII, Sections 4 and 5 were proposed by the 1978 Constitutional Convention and adopted by the voters.
These provisions regarding unfunded mandates were part of the expansion of county “home rule” powers and are
not applicable to state agencies. Furthermore, Article VIII, Section 6 limits the scope of these county “home rule”
provisions as being subordinate to laws of state-wide concern. Chapter 92F, HRS, is a law of state-wide concern and
even the counties which have a provision recognizing the prohibition of unfunded mandates on them, may not claim
such an exemption to record requests. The right to inspect public records and public documents is a long recognized
right of citizens upon our government that predates statutes such as Chapter 92F, HRS – which merely establishes
much clearer procedures to inspect and copy records and more clearly articulates state policy regarding such rights.
See Clement v. Graham, 63 A. 146 (Vt., 1906). The right to copy those public records available to inspection has also
been long recognized. See State ex rel. Conran v. Williams, 8 S.W. 771 (Mo., 1888)

 EXHIBIT 

 

ORIGINAL
DOUGLAS S. CHIN
6465
Attorney General of Hawaii
HEIDI M. RIAN
3473
ANGELA A. TOKUDA
9408
Department of the Attorney
General, State ofHawai'i
465 South King Street, Room 200
Honolulu, Hawai'i 96813
Telephone: (808) 587-3050
Attorneys for Defendant
DIRECTOR OF THE DEPARTMENT
OF HEALTH, STATE OF HAWAil
IN THE CIRCUIT COURT OF THE FIRST COURT
STATE OF HAWAII
KOKUA COUNCIL FOR SENIOR
CITIZENS, an unincorporated association,
Plaintiff,
vs.

DIRECTOR OF THE DEPARTMENT
OF HEALTH, STATE OF HAWAII,
Defendant.

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CIVIL NO. 16-1-1421-07 (KTN)
DIRECTOR OF THE DEPARTMENT
OF HEALTH, STATE OF HAWAII'S
RESPONSE TO PLAINTIFF'S FIRST
REQUEST FOR ANSWERS TO
INTERROGATORIES AND REQUEST
FOR PRODUCTION OF DOCUMENTS

----------------------------~)
DIRECTOR OF THE DEPARTMENT OF HEALTH, STATE OF HAWAII'S RESPONSE TO
PLAINTIFF'S FIRST REQUEST FOR ANSWERS TO INTERROGATORIES AND
REQUEST FOR PRODUCTION OF DOCUMENTS
Defendant Director of the Department of Health, State of Hawaii ("DOH" or
"Defendant") by and through its attorneys, DouglasS. Chin, Attorney General ofHawaii, Heidi
M. Rian and Angela A. Tokuda, Deputy Attorneys General, hereby responds to Plaintiff
KOKUA COUNCIL FOR SENIOR CITIZENS' First Request for Answers to Interrogatories and
Request for Production of Documents, dated August 22, 2016 (the "Request").

 GENERAL RESPONSES AND OBJECTIONS

1.

Defendant objects to each request to the extent that it is unreasonably

burdensome, oppressive, harassing, redundant, duplicative, or vexatious, in that the information
requested would be oflittle or no relevance to the issues in this action and/or would place an
unreasonable and oppressive burden on the Defendant in expenditure of cost, time and money.
2.

Defendant objects to each request that is so broad, vague, ambiguous, uncertain

and unintelligible that the Defendant cannot determine the nature of the information sought, and
to which the Defendant is therefore unable to respond.
3.

Defendant objects to each request that seeks information already available and

accessible to the public such that the information requested is meant to unduly burden and harass
Defendant.
4.

Defendant objects to each request to the extent that it requests the production of

documents for which the required good cause or substantial need, as dictated by applicable
statutes, court rules and case law, has not been shown.
5.

Defendant objects to each request that requests irrelevant information not

calculated to lead to the discovery of admissible evidence.
6.

Defendant objects to Plaintiffs request for tariffs, promissory notes, deeds, leases,

agreements of sale, mortgages, financial statements, balance sheets, profit and loss statements,
tax returns, loan applications, work papers, ledgers, journals, books of accounts, canceled
checks, deposit receipts, statements, bills, airbills, consignment notes, purchase orders, invoices,
and any other related financial documents as defined in section "B" of the Definitions section.
No such documents will be produced because they are not relevant to any claims or defenses
raised, and they are sought simply to overburden and harass Defendant.
2

 7.

Defendant objects to each request to the extent that it asks for the disclosure of

attorney-client privileged communications, information that is protected attorney work product,
and information concerning documents and tangible things prepared in anticipation of litigation
or trial.
8.

Counsel's signature below is incorporated into each and every one of Defendant's

specific objections. Without waiving any of the foregoing general objections, which the
Defendant incorporates by reference in response and/or objection to each of the following
individual requests as if fully set forth therein, the Defendant responds as follows.

DATED: Honolulu, Hawaii, September 15, 2016.

ANGELA A. TOKUDA
Deputy Attorneys General
Attorneys for Defendant
DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAII

3

 INTERROGATORIES

1. For each "adult residential care horne" and enhanced "adult residential care horne"
licensed on or since January 1, 2015 please:
A. identify its name
B. identify the name of the licensee (whether a person, group of persons or entity)
C. identify whether its an Type 1 ARCH, Type 2 ARCH, category 3 ARCH, Level 1 EARCH or a Level2 E-ARCH or some other category of ARCH orE-ARCH
D. identify the dates of each and all inspections from January 1, 2015 to present
E. identify whether an inspection report or other writing about the inspection was created or
generated
F. identify its licensed capacity
G. identify the names of its staff, primary care givers, care givers, substitute care giver(s), case
rnanager(s) and family members
H. identify whether it has been given any waivers including renewals of waivers

Objection:

Defendant objects to interrogatory 1(E), to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.
Defendant objects to interrogatory 1(G) on the grounds that it seeks information that are
irrelevant to this action and not reasonably calculated to lead to the discovery of admissible
evidence, and that it is overly broad and unduly burdensome.
However, without waiving the forgoing objections, Defendant responds as follows:
ANSWER:

Information on licensed adult residential care homes (ARCH) and expanded adult
residential care homes (eARCH), are available online via the Office of Health Care Assurance
(OHCA) website at: https://health.hawaii.gov/ohca/files/2013/06/Combined-ARCH-ExpandedARCH-Vacancy-Report-By-Area-7-27-16.pdf. As to staffing information, OHCA only
maintains information on the applicant, pursuant to HAR § 11-100.1.
Inspections for ARCHs and eARCHs are only conducted annually for license renewals.
See, HAR 11-100.1-3(e). Thus, inspection reports are generated only for license renewals.
These inspection reports are available online via ORCA's website at:
http://health.hawaii.gov/ohcalinspection-reports/.

4

 2. For each "adult day health centers" licensed on or since January 1, 2015 please:

A. identify its name
B. identify the name of the "licensee" (whether an individual or organization)
C. identify the dates of each and all inspections from January 1, 2015 to present
D. identify whether an inspection report or other writing about the inspection was created or
generated
E. identify the names of its "activity coordinator" and "administrator"
F. identify whether it has been given any waivers including renewals of waivers
Objection:
Defendant objects to interrogatory 2(D), to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
Information on licensed adult day health centers (ADHC), is available online via
ORCA's website at: http://health.hawaii.gov/ohca/medicare-facilities/adult-day-health-centers/
Inspections for ADHCs are only conducted annually for license renewals. See, HAR 1196-3. Thus, inspection reports are generated only for license renewals. These inspection reports
are available online via ORCA's website at: http://health.hawaii.gov/ohca/inspection-reports/

5

 3. For each "intermediate care facilities for individuals with intellectual disabilities" licensed
on or since January 1, 2015 please:

A. identify its name
B. identify the name of the "licensee" (including the name fo each person having, directly or
indirectly, an ownership interest of ten percent or more in such facility or who is the owner of an
mortgage, deed or trust, note or other obligation secured by such facility
C. identify the dates of each and all inspections from January 1, 2015 to present
D. identify whether its a small intermediate care facility for the mentally retarded or large
intermediate care facility for the mentally retarded
E. identify the dates of each and all inspections from January 1, 2015 to present
F. identify whether an inspection report or other writing about the inspection was created or
generated
G. identify whether it has been given any waivers including renewals of waivers
Objection:

Defendant objects to interrogatory 3(F), to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

Information on licensed intermediate care facilities for individuals with intellectual
disabilities (ICF-IID), is available online via OHCA's website at:
http://health.hawaii.gov/ohca/medicare-facilities/intermediate-care-facilites-for-individuals-withintellectual-disabilities/
Inspections for ICF-IIDs are only conducted annually for license renewals. See, HAR
11-99-3. Thus, inspection reports are generated only for license renewals. These inspection
reports are available online via OHCA's website at: http://health.hawaii.gov/ohca/inspectionreports.

6

 4. For each "adult day care centers" licensed on or since January 1, 2015 please:
A. identify its name
B. identify the name of the "licensee" (whether an individual or organization)
C. identify the dates of each and all inspections from January 1, 2015 to present
D. identify whether an inspection report or other writing about the inspection was created or
generated
E. identify whether it has been given any waivers including renewals of waivers
Objection:
Defendant objects to interrogatory 4(D), to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.
However, without waiving the forgoing objections, Defendant responds as follows:
ANSWER:
Information on licensed adult day care centers (ADCC), is available online via ORCA's
website at: http:/lhealth.hawaii.gov/ohca/files/2016/02/012016-ADCC-List.pdf.
Inspections for ADCCs are only conducted biannually for license renewals. See, RAR
§§17-1424-6 and -8. Thus, inspection reports are generated only for license renewals. These
inspection reports are available online via ORCA's website at:
http://health.hawaii.govI ohca/inspection-reports/.

5. For each "community care foster family" licensed on or since January 1, 2015 please:

A. identify its name
B. identify the name of the "licensee" (whether an individual or organization)
C. identify the dates of each and all inspections from January 1, 2015 to present
D. identify whether an inspection report or other writing about the inspection was created or
generated
E. identify whether it has been given any waivers including renewals of waivers
Objection:
Defendant objects to interrogatory 5(D), to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.

7

 However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
Community care foster family homes (CCFFH) are certified, not licensed. Information
on certified CCFFHs, is available online via ORCA's website at:
http://health.hawaii.gov/ohca/files/2013/06/Community-Care-Foster-Family-Homes-VacancyReport-6.1.16.pdf
Inspections for CCFFHs are only conducted annually or biannually for re-certification,
depending on whether the CCFFH is certified for one or two years. See, HAR §§ 17-c 1454-9 and
-11. Thus, inspection reports are generated only for re-certifications. These inspection reports
are available online via ORCA's website at: http://health.hawaii.gov/ohca/inspection-reports/

6. For each "developmental disabilities domiciliary home" licensed on or since January 1,
2015 please:

A. identify its name
B. identify the name of the "licensee" (whether an individual or organization)
C. identify the dates of each and all inspections from January 1, 2015 to present
D. identify whether an inspection report or other writing about the inspection was created or
generated
E. identify whether it has been given any waivers including renewals of waivers
Objection:
Defendant objects to interrogatory 6(D), to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attomey~client privilege.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
Information on licensed developmentally disabled domiciliary homes (DDDH), is
available online via ORCA's website at: http:/lhealth.hawaii.gov/ohca/files/2016/02/DDDH-inHawaii.pdf

8

 Inspections for DDDHs are only conducted annually for license renewals. See, HAR
§ 11-89-11. Thus, inspection reports are generated only for license renewals. These inspection
reports are available online via OHCA's website at: http://health.hawaii.gov/ohca/inspectionreports/

7. For each "long term care facility" other than "adult residential care home" and enhanced
"adult residential care home" subject to Interrogatory No. 11icensed on or since January 1, 2015
please:
A. identify its name
B. identify the name of the "licensee" (whether an individual or organization)
C. identify the dates of each and all inspections from January 1, 2015 to present
D. identify whether an inspection report or other writing about the inspection was created or
generated
E. identify whether it has been given any waivers including renewals of waivers
Objection:
Defendant objects to this interrogatory in its entirety as vague, ambiguous, redundant,
overbroad, and unduly burdensome.
Defendant further objects to interrogatory 7(D), to the extent it seeks information
protected by the work product doctrine, governmental deliberative process privilege, frustration
of a legitimate government function, or the attorney-client privilege.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
Information on licensed long term care facilities other than ARCHs and eARCHs, as
defined in Haw. Rev. Stat.§ 349-21(±), are available online via OHCA's websHe
at:http://health.hawaii.gov/ohca/medicare-facilities/skilled-nursingintermediate-care-facilities/
Inspections for licensed long term care facilities other than ARCHs and eARCHs, as
defined in Haw. Rev. Stat. § 349-21(±), are only conducted annually or biannually for license
renewals, depending on whether these long term care facilities are licensed for one or two years.
See, HAR §11-90-3 (for Assisted Living Facilities); HAR §11-94.1-10 (for Nursing FacilitiesSkilled Nursing Facilities/Intermediate Care Facilities). Thus, inspection reports are generated
only for license renewals. These inspection reports are available online via OHCA's website at:
http://health.hawaii.gov/ohca/inspection-reports/.

9

 8. Please state the annual compensation, job title, business address including office number,
business telephone number, job description, education and training background, previous work
experience, dates of first and last employment, position number, type of appointment, service
computation date, occupational group or class code, bargaining unit code (if any), employing agency
name and code, department, division, branch, office, section, unit, and island of employment of
Keith Ridley.

Objection:
Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is vague,
overbroad and unduly burdensome. The request is also compound and should be broken into
subparts.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
See Employee Personnel Action(s) Report for Keith Ridley in the enclosed CD.
9. Please state the name, the annual compensation (but only the salary range for employees
covered by or included in chapter 76, or bargaining unit (8)), job title, business address including
office number, business telephone number, job description, education and training background,
previous work experience, dates of first and last employment, position number, type of
appointment, service computation date, occupational group or class code, bargaining unit code (if
any), employing agency name and code, department, division, branch, office, section, unit, and island
of employment of each and every individual that has generated or assisting in generating an
inspection report for any adult residental care homes, expanded adult residential care homes, adult
day health centers, adult date care centers, community care foster family homes, developmental
disabilities domiciliary homes, developmentally disabled adult foster homes, other long-term care
facilities, or special treatment facilities from January 1, 2015 to present.

Objection:
Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is vague,
overbroad and unduly burdensome. The request is also compound and should be broken into
subparts. Defendant further objects on grounds that it does not maintain such records and in
doing so would require Defendant to create a roster of employees. See, Haw. Rev. Stat. § 92F12(a)(14).
10

 However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

All responsive, non-privileged documents are included in the enclosed CD.

10. Please state the name, job tide, business address including office number, business
telephone number, job description, education and training background, previous work experience,
dates of first and last employment, position number, type of appointment, service computation
date, occupational group or class code, bargaining unit code (if any), employing agency name and
code, department, division, branch, office, section, unit, and island of employment of each and
every individual that has been involved in posting inspection report for any adult residential care
homes, expanded adult residential care homes, adult day health centers, adult date care centers,
community care foster family homes, developmental disabilities domiciliary homes, developmentally
disabled adult foster homes, other long-term care facilities, or special treatment facilities from
January 1, 2015 to present to the Department of Health website.

Objection:

Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is
redundant, vague, overbroad and unduly burdensome. The request is also compound and should
be broken into subparts. Defendant further objects on grounds that it does not maintain such
records and in doing so would require Defendant to create a roster of employees. See, Haw. Rev.
Stat.§ 92F-12(a)(14).
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

See response to Interrogatory 9.

11

 11. Please state the name, job title, business address including office number, business
telephone number, job description, education and training background, previous work experience,
dates of first and last employment, position number, type of appointment, service computation
date, occupational group or class code, bargaining unit code ~f any), employing agency name and
code, department, division, branch, office, section, unit, and island of employment of each and
every individual that has been involved in the inspection of or the creation of inspection reports for
any adult residential care homes, expanded adult residential care homes, adult day health centers,
adult date care centers, community care foster family homes, developmental disabilities domiciliary
homes, developmentally disabled adult foster homes, other long-term care facilities, or special
treatment facilities from January 1, 2015 to present to the Department of Health website.

Objection:
Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is
redundant, vague, overbroad and unduly burdensome. The request is also compound and should
be broken into subparts. Defendant further objects on grounds that it does not maintain such
records and in doing so would require Defendant to create a roster of employees. See, Haw. Rev.
Stat.§ 92F-12(a)(l4).
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
See response to Interrogatory 9.

12. Please identify each and every computer and imaging device used by the Department in
the creating and/ or posting of inspection reports from January 1, 2015 to present including its
make, model, serial number, central processing unit speed measured in one hundred of one
gigahertz (for every computer and/ or device that has a central processing unit), amount of random
access memory measured in gigabytes (for every computer and/ or device that has random access
memory), and operating system including version number (for every computer and/ or device that
executes an operating system).

Objection:
Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is vague,
overbroad and unduly burdensome. Defendant further objects on the basis that this request seeks
information outside of its knowledge, and is more appropriately sought from other sources.
12

 13.
Please identify the name and title of each person who participated in providing
answers to these interrogatories.
Keith Ridley
Chief, Office of Health Care Assurance
Sharon Dellinger, RN, MPA
Supervisor, Licensing Section, Office of Health Care Assurance
Veronica Mitchell, RN
Supervisor, Medicare Section, Office of Health Care Assurance
ShaunaKim
Secretary, Office of Health Care Assurance
Angel England, RN
Supervisor, Community Ties of America (CTA)
(CTA is contracted to perform inspections and generate inspection reports for CCFFHs
andADCCs)

13

 REQUESTS
1.

Any documents identified in answers to Interrogatories Nos. 1 through 13.
Objection:

Defendant objects to this request in its entirety to the extent it seeks production of
documents protected by the work product doctrine, governmental deliberative process privilege,
frustration of a legitimate government function, or the attorney-client privilege. Such documents
include notes, and drafts of Defendant's staff, including, but not limited to, interview
memoranda, status memoranda, and recommendation memoranda.
Defendant further objects to this request in its entirety the grounds that it calls for the
production of documents that are irrelevant to this action and not reasonably calculated to lead to
the discovery of admissible evidence, and that it is redundant, vague, ambiguous, overly broad
and unduly burdensome.
Defendant further objects to this request in its entirety in that seeks information already
available and accessible to the public via ORCA's website and the request is meant to unduly
burden and harass Defendant.
As to requests for documents for interrogatories numbers 9 through 11, Defendant further
objects on grounds that it does not maintain such records and in doing so would require
Defendant to create a roster of employees. See, Haw. Rev. Stat.§ 92F-12(a)(14).
As to request for documents for interrogatory number 12, Defendant further objects on
the basis that this request seeks information outside of its knowledge, and is more appropriately
sought from other sources.
However, without waiving the forgoing objections, and in the spirit of discovery and
Cooperation, Defendant responds as follows:

ANSWER:
Information on licensed and certified homes and facilities requested in interrogatories
numbers 1 through 7, are available online via the Office of Health Care Assurance (ORCA)
website at: http://health.hawaii.gov/ohca/state-licensing-section/.
Inspection reports for licensed and certified homes and facilities requested in
interrogatories numbers 1 through 7, are only conducted annually or biannually for license or
certificate renewals, depending on whether these homes and facilities are licensed or certified
for one or·two years. These inspection reports are available online via ORCA's website at:
http ://health.hawaii. govI ohcalinspection-reports/.

14

 In addition, all responsive, non-privileged documents are included in the enclosed CD.

2.

Any documents used to answer Interrogatories Nos. 1 through 13 but not

identified in answers to Interrogatories Nos. 1 through 17.
Objection:

See response to Request 1. In addition, Interrogatories Nos. 14 through 17 does not exist
in Plaintiffs Request.

3.

Any and all documents regarding any individual seeking to access any inspection

reports for any adult residential care homes, expanded adult residential care homes, adult day health
centers, adult date care centers, community care foster family homes, developmental disabilities
domiciliary homes, developmentally disabled adult foster homes, other long-term care facilities, or
special treatment facilities from January 1, 2015 to present.

Objection:

Defendant objects to this request in its entirety on the grounds that it calls for the
production of documents that is ambiguous, vague, overly broad and unduly burdensome.
Defendant further objects to this request to the extent it seeks production of documents
protected by the work product doctrine, governmental deliberative process privilege, frustration
of a legitimate government function, or the attorney-client privilege.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

See response to Request 5.

15

 4

Any and all documents regarding any individual seeking to access any inspection

reports for any adult residential care homes, expanded adult residential care homes, adult day health
centers, adult date care centers, community care foster family homes, developmental disabilities
domiciliary homes, developmentally disabled adult foster homes, other long-term care facilities, or
special treatment facilities before January 1, 2015.
Objection:
Defendant objects to this request in its entirety the grounds that it calls for the production
of documents that is ambiguous, vague, overly broad and unduly burdensome.
Defendant further objects to this request to the extent it seeks production of documents
protected by the work product doctrine, governmental deliberative process privilege, frustration
of a legitimate government function, or the attorney-client privilege.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
See response to Request 5.

5.

Any and all e-mails or other documents authored or received by Keith Ridley

regarding the posting of inspection reports for any adult residential care homes, expanded adult
residential care homes, adult day health centers, adult date care centers, community care foster family
homes, developmental disabilities domiciliary homes, developmentally disabled adult foster homes,
other long-term care facilities, or special treatment facilities.
Objection:
Defendant objects to this request to the extent it seeks production of documents protected
by the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.
Defendant further objects to this request in its entirety the grounds that it calls for the
production of documents that is ambiguous, vague, overly broad and unduly burdensome.

16

 However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
All responsive, non-privileged documents are included in the enclosed CD.

6.

Any and all inspection reports or any adult residential care homes, expanded adult

residential care homes, adult day health centers, adult date care centers, community care foster family
homes, developmental disabilities domiciliary homes, developmentally disabled adult foster homes,
other long-term care facilities, or special treatment facilities from January 1, 2015 to present.

Objection:
Defendant objects to this request in its entirety the grounds that it calls for the production
of documents that is ambiguous, vague, overly broad and unduly burdensome.
Defendant further objects to this request to the extent it seeks production of documents
protected by the work product doctrine, governmental deliberative process privilege, frustration
of a legitimate government function, or the attomey-client privilege.
Defendant further objects to this request in its entirety in that seeks information already
available and accessible to the public via ORCA's website and the request is meant to unduly
burden and harass Defendant.
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:
Inspection reports for licensed and certified homes and facilities required under HRS
321-1.8, are only conducted annually or biannually for license or certificate renewals,
depending on whether these homes and facilities are licensed or certified for one or two years.
These inspection reports are available online via ORCA's website at:
http://health.hawaii.gov/ohca/inspection-reports/.
In addition, all responsive, non-privileged documents are included in the enclosed CD.

17

 DATED: Honolulu, Hawaii, September 15, 2016.

HEID(k~

ANGELA A. TOKUDA
Deputy Attorneys General
Attorneys for Defendant
DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAil

18

 VERIFICATION

STATE OF HAWAII

)

)

CITY AND COUNTY OF HONOLULU

ss.

)

On this 15th day of September 2016, before me personally appeared Keith Ridley, to me
known to be the person described in and who executed the forgoing answers to interrogatories,
and acknowledged that he executed the same as his free act and deed.

Subscribed and sworn to before me
2016.
this l~ day of

5Yp±. ,

~~)A.~

~ary Public's Signature

Print Name:
MICHELLE M. OHTA
Notary Public, State of Hawaii

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My commission expires:

ate ofDoc.: September 15, 2016
otary Name:
MICHELLE M. OHTA

#Pages:
IV[
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Doc. Description: DIRECTOR OF THE DEPARTMENT OF HEALTH,
STATE OF HAWAII'S RESPONSE TO PLAINTIFF'S FIRST RE.QUES.T
OR ANSWERS TO INTERROGATORIES AND REQUEST.F~E M. ;·· ••
RODUCTION OF DOCUMENTS
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 EXHIBIT 

 

September 28, 2016
Heidi M. Rian, Esq.
Angela A. Tokuda, Esq.
Deputy Attorneys General
465 S. King Street, Room 200
Honolulu HI 96813
Re: Kokua Council v. Director, Civ No. 16-1-1421-07 (KTN)
Dear Ms. Rian and Tokuda,
Thank you for the DIRECTOR OF THE DEPARTMENT OF HEALTH, STATE OF
HAWAII'S RESPONSE TO PLAINTIFF'S FIRST REQUEST FOR ANSWERS TO
INTERROGATORIES AND REQUEST FOR PRODUCTION OF DOCUMENTS which I
received by e-mail on September 21, 2016 and in the mail together with a CD on September 23,
2016. Plaintiff's position is that the interrogatories and requests were not fully answered or produced
as I explicate below:
Portions of Interrogatories Not Answered
With respect to the answer to Interrogatory No. 1, your client answered by providing a link
to a website of of a vacancy report ostensibly compiled on July 27, 2016. It then stated that
inspection reports are online at OHCA's website. While these answer do indirectly given
information that can be used to answer these questions, they do not directly identify the information
sought in the interrogatories. We therefore ask, in the minimum, that you supplement the answers by
identifying any and all instances where a facility exists on the vacancy list but its inspection reports
from January 1, 20015 to present are not posted online. This request is also made as to
Interrogatories Nos. 2 through 7.
Improper Invocation of Privileges/Doctrines
With respect to interrogatories Nos. 1 through 7, seeking to “identify whether an inspection
report or other writing about the inspection was created or generated”, an objection was lodged that
the interrogatory “seeks information protected by the work product doctrine, governmental
deliberative process privilege, frustration of a legitimate government function or attorney-client
privilege.
The interrogatories only seek to discovery on existential information regarding whether
inspection reports were created or generated and does not, in that particular subpart, seek
information contained therein.
The deliberative process privilege is inapplicable. “This privilege, which protects the
deliberative and decisionmaking processes of the executive branch, rests most fundamentally on the
1

 belief that were agencies forced to ‘operate in a fishbowl,’ the frank exchange of ideas and opinions
would cease and the quality of administrative decisions would consequently suffer.” Dudman
Communications Corp. v. Dep’t of Air Force, 815 F.2d 1565, 1567 (D.C. Cir 1987)
As OIP has stated with respect to “deliberative process privilege” invoked to deny record
requests:
In order to invoke the deliberative process privilege, an agency must show that the document
is “predecisional,” i.e., received by the decision-maker prior to the time the agency decision
or policy is made, and “deliberative,” i.e., a recommendation or opinion on agency matters
that is a direct part of the decision-making process. (OIP Ltr 07-11)
Inspection reports which by law are required to be made available to the public within five
days of creation are not pre-decisional or deliberative in nature as they are descriptive in nature and
required by law to be made available to the public within five days.
Second, the work product doctrine does not apply because inspection reports are required by
law to be made when an inspection, which is required by law to occur either annually or biennially,
occurs. These reports or the absence of these reports were not prepared in anticipation of litigation
or for trial. Therefore, work product privilege does not apply.
Third, there is no privilege or rule of court that allows a party to not answer a question
because it may or may not generally frustrates a legitimate government function. Such a rule would
have the effect of exempt government parties from participating in discovery, which even before the
merger of law and equity and the codification of the rules of procedure was not the law. The
frustration of a legitimate government function which is an exemption from compliance with the
open records law is inapplicable here because the request is a discovery request for which Chapter
92F, HRS exemptions do not apply and because the interrogatory seeks only answers to questions
of existence of records and not the records themselves.
Finally, there doesn't appear to be an nexus because the part of the interrogatories objected
to and the attorney-client privilege. The party asserting attorney-client privilege has the burden of
establishing all of the elements of the privilege. See United States v. Plache, 913 F.2d 1375, 1379 n.1
(9th Cir. 1990). The attorney-client privilege is strictly construed. Weil v. Investment/Indicators,
Research & Management, Inc., 647 F.2d 18, 24 (9th Cir.1981) The privilege “protects only those
disclosures necessary to obtain informed legal advice which might not have been made absent the
privilege.” Fisher v. United States, 425 U.S. 391, 403 (1976)
Answering whether inspection reports, required by law to be created based upon inspections
required to be performed, does not seek “disclosures necessary to obtain informed legal advice
which might not have been made absent the privilege.”
Information Regarding Staff
As to the staffing information requested in Interrogatory No. 1, I would refer you to HAR
11-100.1-6, 11-100.1-8, 11-100.1-9, 11-100.1-52, 11-100.1-53, 11-100.1-82 and 11-100.1-83. Is it the
Department's position that they do not keep information required by these administration rules or
that there are no ARCHs or E-ARCHs where the applicant/licensee has designated another staff
member to be “primary care givers”, etc.,?

2

 Information Regarding Certain DOH employees
With respect to Interrogatory No. 8, there was no document entitled “Employee Personnel
Action(s) Report for Keith Ridley” on the CD provided with the answers. Please kindly e-mail me
another copy.
With respect to Interrogatories Nos. 9 – 11, Haw. Rev. Stat 92F-12(a)(14), which was cited in
the objection, specifically requires that the Department of Health
shall make available for public inspection and duplication during regular business hours …
(14) The name, compensation (but only the salary range for employees covered by or
included in chapter 76, and sections 302A-602 to 302A-639, and 302A-701, or bargaining
unit (8)), job title, business address, business telephone number, job description, education
and training background, previous work experience, dates of first and last employment,
position number, type of appointment, service computation date, occupational group or
class code, bargaining unit code, employing agency name and code, department, division,
branch, office, section, unit, and island of employment, of present or former officers or
employees of the agency; provided that this paragraph shall not require the creation of a
roster of employees; and provided further that this paragraph shall not apply to information
regarding present or former employees involved in an undercover capacity in a law
enforcement agency[.]
While the obligations and exemptions of Chapter 92F, HRS are not directly applicable to
whether a party in litigation has an obligation to answer or refuse to an interrogatory, it is clear that
the Department does have an obligation not only to maintain said records but have them available
for public inspection and copying during regular business hours. Furthermore, whether the
Department keeps a compilation of this information it does not deny that it has this information.
Rule 33(b)(1), HRCP requires that “Each interrogatory shall be answered separately and fully[.]”
Plaintiff is asking for information about specific employees, not all Department employees.
Obtaining this information is highly relevant and clearly designed to discover admissible evidence in
this matter and is not privileged in any way – since it is required by law to be made available to
public inspection during regular business hours.
No Answer to Interrogatory No. 12
There was no answer at all to Interrogatory No. 9. Please provide the names of persons or
entities outside of the Department of Health (i.e. “other sources”) that would have information
regarding technical and identification information related to computer and imaging devices used in
creating and/or posting of inspection reports from January 1, 2015 to present.
Privilege Log for Production of Documents
The Department has asserted a number of privileges and the work product doctrine
regarding not producing documents. Plaintiff asserts that none of these privileges or doctrines
apply. Rule 26(b)(6), HRCP states:
(6) Claims of Privilege or Protection of Trial Preparation Materials. When a party withholds
information otherwise discoverable under these rules by claiming that it is privileged or
subject to protection as trial preparation material, the party shall make the claim expressly
and shall describe the nature of the documents, communications, or things not produced or
3

 disclosed in a manner that, without revealing information itself privileged or protected, will
enable other parties to assess the applicability of the privilege or protection.
Please provide me with the privilege log for each document the Department is claiming
privilege or work product doctrine for so that we can assess whether there is actually a colorable
claim for privilege for any document the Department is refusing the produce.
Please let me know immediately whether the Department will be supplementing answers to
the interrogatories described, a copy of the information related the answer to Interrogatory No. 8
that appears to have been inadvertently omitted and a privilege log for all documents the
Department is withholding. If the Department's position is that it does not intend to supplement its
answer or supplement its production, please let me know when we may meet in person or by
telephone to confer regarding these matters.
As I have previously mentioned, my clients would like to resolve this matter without the
litigating this to judgment or appeal and it is hopeful the Department is willing to take a pro-active,
cooperative approach to resolving these issues including discovery issues.
I look forward to your response.
Very truly yours,
LAW OFFICE OF LANCE D. COLLINS

LANCE D COLLINS
Attorney for Plaintiff
c:

client

4

 EXHIBIT I

 

11/29/2016

Public access to health care inspection reports filled with delays, redactions   KHON2

Public access to health care inspection reports lled with
delays, redactions
By Gina Mangieri (http://khon2.com/author/khonginamangieri/)
Published: November 7, 2016, 8:44 pm     Updated: November 7, 2016, 10:26 pm

Changes are in the works to better protect our kupuna in the wake of a backlog of inspections at
health care facilities.
It’s an issue Always Investigating looked into and learned state inspectors are about a year behind
on doing annual inspections of facilities.
More inspectors are being hired to get things back on track, and also to get the system into an
electronic age instead of on paper.

http://khon2.com/2016/11/07/public­access­to­health­care­inspection­reports­filled­with­delays­redactions/

1/6

 11/29/2016

Public access to health care inspection reports filled with delays, redactions   KHON2

When facilities nally do get their annual inspections, how transparent are the results to the
public?
We dug into the long-term care reports to track the trends of the most common violations, and
found extensive blackouts on most of them, but solutions from a lawsuit to high-tech eɃorts could
result in a change.
In 2013, lawmakers passed a bill to make the state Department of Health post health care facility
inspections online (http://health.hawaii.gov/ohca/inspection-reports/), even gave them plenty of
ramp up time to get started.
“The law requires them to post the inspection reports within ve days of completion, starting Jan. 1,
2015, and they did not do it,” said Larry Geller with Kokua Council, which advocates on behalf of
critical senior issues such as long-term care.
The Kokua Council sued. That’s still a pending case, and meanwhile, just recently a substantial
number have been posted.
“The people who really need to be able to see the reports are family members that are being
pressured by hospitals to move their loved ones out of hospitals and into long-term care facilities,”
said Kokua Council’s attorney, Lance Collins. “We’re talking about like 24, 48 hours type of short
period of time.”
The department that licenses and inspects facilities is behind not just on the visits, but on getting
all their ndings up online as well.
“It’s quite a challenge. We are using current staɃ,” said Keith Ridley, chief of the Hawaii Department
of Health’s Oéce of Health Care Assurance. “We have a good 88 percent approximately of the adult
residential care homes, for example.”
If 12 percent of them are missing, when will the public see those remaining 12 percent?
“We do aɃord the operator the license, an ability to provide us — in fact we require them to
provide us — with a plan of correction,” Ridley replied.
The department is waiting until they can merge both the ndings and the response then it goes
public.

http://khon2.com/2016/11/07/public­access­to­health­care­inspection­reports­filled­with­delays­redactions/

2/6

 11/29/2016

Public access to health care inspection reports filled with delays, redactions   KHON2

What does get posted leaves a lot to imagination. An inspection of the state’s own facility, Maluhia,
for example, includes 14 pages of de ciencies, another seven pages of rebuttals and xes. But
much of it is blacked out. We don’t know really what happened, only that they violated a section,
and that’s about all that’s described.
When asked why, Ridley responded, “The information that we’ve decided to redact is, for the most
part, personal health information.”
This pattern repeats itself time and again on hundreds and hundreds of the postings.
“The ndings, the deeper you look the blacker it gets,” Geller said. “Why post something like this if
there’s nothing for the public to learn? Twenty pages like this.”
“Is this health care entity working in good faith? Have they had terrible outcomes? That should be
public,” said Sen. Josh Green, D, Majority Floor Leader and an emergency room physician himself.
Everything but the description of rule broken, but not how it was broken, is completely black front
to back. More can be seen from the facility’s responses about how they’ll x the problems, though
the deadlines appear to vary and if there’s a consequence for not xing it quick enough, it could be
blacked out too.
We went through the state’s nearly 50 skilled nursing facilities reports to look for trends in the
de ciencies.
Infection control was a major problem for most of the sites. Food handling and food-related
sanitation was also in violation at a majority of facilities. Most also got dinged for not meeting
standards on comprehensive care plans, and proper drug documentation and storage was a
common error.

http://khon2.com/2016/11/07/public­access­to­health­care­inspection­reports­filled­with­delays­redactions/

3/6

 11/29/2016

Public access to health care inspection reports filled with delays, redactions   KHON2

While many of these things are typical ndings in the industry nationwide, Hawaii’s skilled nursing
facilities are caught with violations far more often than the national average for those infection
control and food-handling issues — double the rate of facilities have housekeeping and
maintenance problems and safe operating equipment, and ve times the rate of facilities were
caught without suécient 24-hour nurse staɃ per their care plans.
The state wants to be able to dig out this level of detail about de ciency patterns from all care
facilities, but they don’t yet have a database system to track the trends. New inspection fees they’ll
propose in draft rules coming out in a few weeks will cover the costs of such a system.
“We can begin identifying those sorts of things and go out to the industry and require the industry
to address those issues and make changes on an industry-wide basis,” Ridley said.
Meanwhile the public waits for the state to get staɃ hired up to catch up with inspecting, reviewing,
and posting all not just most of the required-by-law reports.
“There are enough that have violations that it’s not fair to make families play Russian roulette and
hope the bed that is available at that moment, they have to just go to it and hope their family
member will be cared for properly,” Collins said.
We’ll keep tabs on the state’s progress in lling positions it plans to hire in the coming months, as
well as those rules to expand licensing and pay for the database they want to better track
inspections and trends.
Top News
http://khon2.com/2016/11/07/public­access­to­health­care­inspection­reports­filled­with­delays­redactions/

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 EXHIBIT 1

 

12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

12/12/2016

(http://health.hawaii.gov/ohca)

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

State of Hawaii, Department of Health

Office of Health Care Assurance
(http://health.hawaii.gov/ohca)

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).

Home (http://health.hawaii.gov/ohca/) » Healthcare Facilities Inspection Reports

HEALTHCARE FACILITIES INSPECTION REPORTS

Show 100

entries

The Department of Health conducts regular state licensing or certification inspections of health
care facilities throughout the state to ensure their compliance with the state’s licensure or
certification requirements. As required by Hawaii Revised Statutes (HRS) Section 321-1.8, the
reports on these inspections shall be posted on the department’s website for access by the public.
The inspection reports on this website are for inspections conducted on or after January 1, 2015,
pursuant to HRS §321-1.8.

Name of

Facility

The inspection reports on this website are on the following types of health care facilities:

Kuakini -

Facility
Furukawa



Inspection Reports

ADCC

2016

ADCC

2016

ADCC

2016

ADCC

2016

Aiea
Pearl City
Hale

Developmental Disabilities Domiciliary Homes (DDDH)
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID)
Long-term care facilities as defined in HRS §349-21(f), including:

Puluma Na
Kupuna

Adult Residential Care Homes (ARCH) and Expanded Adult Residential Care Homes
(E-ARCH)
Assisted Living Facilities (ALF)

Aged to

Aged to

Skilled Nursing Facilities (SNF)

Perfection -

Special Treatment Facilities (STF)

Aloha

http://health.hawaii.gov/ohca/inspection-reports/

Beckwith

Casamina

Living

(http://health.hawaii.gov/ohca/files/2015/03/Furukawa-

Treasure -

ADCC-2015.pdf)

ADCC

2015 (http://health.hawaii.gov/ohca/files/2015/11/ALOHANURSING-ADCC-2015.pdf)

ADCC

2015

2016

ADCC

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/CasaminaADCC-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Redona

2015

2015

2016

TO-PERFECTION-WAIPAHU-ADCC-2015.pdf)

ADCC-2015.pdf)

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ADC-ADCC-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/AGED-

(http://health.hawaii.gov/ohca/files/2015/11/BECKWITH-

1/9

Corp.

ADCC

Nursing

1. The date of the inspection;
2. A description of violations of relevant state laws or rules, if applicable;
3. Plans of correction and the status of corrective actions in response to any violations, if
applicable;
4. A list and description of all corrective actions taken by the facility, if applicable, to be
submitted by the facility and added to the report at a later time, as determined by the
department; and
5. Other information regarding the quality and conditions of the facility the Department of
Health deems appropriate.

(http://health.hawaii.gov/ohca/files/2015/11/FUKUMOTO-

2016

TO-PERFECTION-WAHIAWA-ADCC-2015.pdf)

Waipahu

HRS §321-1.8 requires that each posted inspection report shall include the following information:

Adult Care

2015 (http://health.hawaii.gov/ohca/files/2015/11/AGED-

Wahiawa

Nursing Facilities (NF)

12/12/2016

ADCC

Perfection -

Intermediate Care Facilities (ICF)

ADCC

Inspection Reports

Brigham

Community Care Foster Family Homes (CCFFH)

Furukawa



Treasure -

Adult Day Care Center (ADCC)

ADCC

Type

Living

Adult Day Health

Fukumoto



Search:

2/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ADCC

2015
(http://health.hawaii.gov/ohca/files/2015/11/REDONAADCC-2015.pdf)

Sakura

2016

ADCC

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/SAKURA-

House

ADCC-2015.pdf)

Palolo
Seagull
Hale Hau'oli

ADCC

Honomu

ADCC

2015 (http://health.hawaii.gov/ohca/files/2015/11/HALE-

2016

ADCC

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/SEAGULL-

Schools

HAUOLI-ADCC-2015.pdf)

ADCC-2015.pdf)

2015

SECOH

ADCC

2015

2016

St. Francis

ADCC

2015 (http://health.hawaii.gov/ohca/files/2015/11/ST-

2016

(http://health.hawaii.gov/ohca/files/2015/11/HONOMU-

Adult Day

ADC-ADCC-2015.pdf)

Center

FRANCIS-ADCC-2015.pdf)
Hulu Makua

ADCC

Kona Adult

ADCC

2015 (http://health.hawaii.gov/ohca/files/2015/11/HULU-

2016
Waipahu

MAKUA-ADCC-2015.pdf)

ADCC

2016

HONGWANJI-ADCC-2015.pdf)

2016

ADC-ADCC-2015.pdf)

Day Center

Windward
Lotus ADCC

2015
(http://health.hawaii.gov/ohca/files/2015/11/WAIPAHU-

Hongwanji
2015 (http://health.hawaii.gov/ohca/files/2015/11/KONA-

ADCC

2015 (http://health.hawaii.gov/ohca/files/2015/11/LOTUS-

2016

ADCC-2015.pdf)

(http://health.hawaii.gov/ohca/files/2015/11/WINDWARDSENIOR-DAY-CARE-ADCC-2015.pdf)

2016

2015

Franciscan

ADCC

2015

2016

Ho'o Nani

ADCC

2015

2016

King Lunalilo

ADCC

2015

2016

Oceanview

Kuakini - Pali

ADCC

2015

Mililani Hale

Live Well at

ADCC

2015

ADCC

2015 #1

ADCC

2016

2015

Care
ADCC

Malama

2015

ADCC

Senior Day

Aloha

(http://health.hawaii.gov/ohca/files/2015/03/Malama-

Wellness

ADCC-2015.pdf)
Maui Adult

ADCC

2015 (http://health.hawaii.gov/ohca/files/2015/11/MAUI-

2016

LAHAINA-ADCC-2015.pdf)

Day Care -

Place

Lahaina
Maui Adult

ADCC

2015 (http://health.hawaii.gov/ohca/files/2015/11/MAUI-

2016

OCEANVIEW-ADCC-2015.pdf)

Day Care -

ADCC

2015

2016

HALE-ADCC-2015.pdf)
Na Puuwai

Palolo

ADCC

ADCC

Maui Adult
2016

Day Care -

PUUWAI-ADCC-2015.pdf)

Kahului

2015

2016

Maui Adult

2015 (http://health.hawaii.gov/ohca/files/2015/11/NA-

Chinese
Home
http://health.hawaii.gov/ohca/inspection-reports/

2016

Iwilei

(http://health.hawaii.gov/ohca/files/2015/11/MILILANI-

3/9

(http://health.hawaii.gov/ohca/files/2015/11/MAUIKAHULUI-ADCC-2015.pdf) 2015 #2
ADCC

2015 #1

Day Care -

(http://health.hawaii.gov/ohca/files/2015/11/MAUI-KIHEI-

Kihei

ADCC-2015.pdf) 2015 #2

http://health.hawaii.gov/ohca/inspection-reports/

4/9

 12/12/2016

Hawaii Kai

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ALF

12/12/2016

Roselani

2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ALF

2015

Retirement

Place

(http://health.hawaii.gov/ohca/files/2016/02/Roselani-

Community

Assisted

Place-Assisted-Living-Facility-ALF-2015.pdf)

Phase I & II

Living
Facility

15 Craigside

ALF

2016

Regency at

ALF

2016

The Plaza at

ALF

2015 (http://health.hawaii.gov/ohca/files/2016/01/ThePlaza-at-Mililani-ALF-2015.pdf)

Mililani

Hualalai
The Plaza at
The Plaza at

ALF

2016

ALF

2015 (http://health.hawaii.gov/ohca/files/2016/01/ThePlaza-at-Punchbowl-ALF-2015.pdf)

Punchbowl

Moanalua
All Hearts
The Plaza at

ALF

2016

ALF

2016

ARCH

2016

Fely Hidalgo

ARCH

2016

Guillermo

ARCH

2016

ARCH, LLC

Waikiki
The Plaza at
Pearl City

(http://health.hawaii.g

ARCH
Arcadia

ALF

2015 (http://health.hawaii.gov/ohca/files/2016/02/Arcadia-

ARCH-ARCH-2016.pd

Retirement-Residence-ALF-2015.pdf)

Retirement

Heart to

Residence
Hiolani

ALF

2015 (http://health.hawaii.gov/ohca/files/2016/02/Hiolani-

2016

ARCH

Heart Care

(http://health.hawaii.g

Home

Heart-Care-Home-AR

Assisted-Living-Center-at-Kahala-ALF-2015.pdf)

Assisted
Living Center

Norma Padre

ARCH

2016

Norma

ARCH

2016 #1, 2016 #2

ARCH

2016

at Kahala
Nui

Santos
Oceanside

ALF

2015

Hawaii

(http://health.hawaii.gov/ohca/files/2016/02/Oceanside-

TLC Care

Assisted

Hawaii-Assisted-Living-ALF-2015.pdf)

Home, LLC

2015 (http://health.hawaii.gov/ohca/files/2016/02/One-

Sharolyn L

Kalakaua-Senior-Living-ALF-2015.pdf)

Galamay,

(http://health.hawaii.g
Care-Home-LLC-ARC

Living
One

ALF

Kalakaua

2016

ARCH

2016

ARCH

2016

ARCH

2016

L.L.C.

Senior Living
Pohai Nani

ARCH

ALF

Good

2015 (http://health.hawaii.gov/ohca/files/2016/02/Pohai-

Serenity

Nani-Good-Samaritan-ALF-2015.pdf)

Hawaii
Carehome

Samaritan

LLC
Regency at

ALF

Puakea, LLC

2015
(http://health.hawaii.gov/ohca/files/2016/01/Regency-at-

R.K.C.

Puakea-LLC-ALF-2015.pdf)

ARCH
Lily Badua

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Zenaida's

5/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2016

Arsenia

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

Ramos
G.

6/9

2015 (http://health.hawaii.gov/ohca/files/2016/01/Arsenia-

2016

Ramos-ARCH-2015.pdf)

(http://health.hawaii.g

2016

ARCH

Ramos-ARCH-2016.p

Inocencio's
Aurora
Adelina

ARCH

2015

ARCH

2015

2016

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Aurora-

2016

Cabico-ARCH-2015.pdf)

Cabico

Sebastian
Benita's
Agustina

ARCH

Daoang-ARCH-2015.pdf)

Blue Ocean

ARCH

ARCH

Alaag, LLC

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Akalei-

Cabingabang

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Alaag-

Care-Home-ARCH-2015.pdf)

LLC-ARCH-ARCH-20151.pdf)

ARCH

Captain
ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ALDE-

2016

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Aloha-

ARCH

2016

Care Homes

ARCH

2015

2016

ARCH

2015

2016

ARCH

2015

Makua

2015 (http://health.hawaii.gov/ohca/files/2016/02/Amelita-

Carina

ARCH

Duldulao
ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Analani-

2016

Carmelita

ARCH-LLC-ARCH-2015.pdf)

ARCH, LLC

Angelita

2016

Cook-Care-Home-ARCH-2015.pdf)

by Hale

Samaniego-ARCH-ARCH-2015.pdf)

Samaniego

2015 (http://health.hawaii.gov/ohca/files/2016/01/Captain-

Home

Angel-Care-ARCH-2015.pdf)

Care

ARCH

Cook Care

Care-Home-ARCH-2015.pdf)

Home

Andaya's

2015
(http://health.hawaii.gov/ohca/files/2016/02/Cabingabang-

Care Home

Analani

2016

2016

Hale-ARCH-2015.pdf)

Amelita

2015 (http://health.hawaii.gov/ohca/files/2016/01/BlueOcean-Care-Home-ARCH-2015.pdf)

Care Home
Akalei Hale

Aloha Angel

2016

ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/02/Agustina-

Daoang

ALDE Care

2015 (http://health.hawaii.gov/ohca/files/2016/01/Benitas-

ARCH

ARCH

(http://health.hawaii.gov/ohca/files/2016/01/Carmelita-

Bolosan

Bolosan-ARCH-2015.pdf)

2015
(http://health.hawaii.gov/ohca/files/2016/02/Andayas-

Castro

ARCH-2015-1.pdf)

ARCH

2015

Castro's

ARCH

Arch-ARCH-2015.pdf)
ARCH

(http://health.hawaii.gov/ohca/files/2016/01/Angelita-

Balualua

2015 (http://health.hawaii.gov/ohca/files/2016/02/Castro-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Castros-

2016

ARCH-2015.pdf)

Balualua-ARCH-2015.pdf)
Celestina
Annelyn

ARCH

2015

2016

ARCH

2015

2016

ARCH

2015

2016

Olipares

(http://health.hawaii.gov/ohca/files/2016/01/Annelyn-

Raval

Raval-ARCH-2015.pdf)

Chanda's

(http://health.hawaii.gov/ohca/files/2016/03/ChandasAno Ano,
L.L.C.

ARCH

2015

2016

ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/02/AnoAnoL.L.C.-ARCH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

7/9

http://health.hawaii.gov/ohca/inspection-reports/

8/9

 12/12/2016

Cipriana

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

Luczon

12/12/2016

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

2015
(http://health.hawaii.gov/ohca/files/2016/01/CiprianaLuczon-ARCH-2015.pdf)

Claire

ARCH

Clarita Julian

2015 (http://health.hawaii.gov/ohca/files/2016/01/Claire-

2016

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).

Gabriel-ARCH-2015.pdf)

Gabriel
ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Clarita-

2016

Julian-ARCH-2015.pdf)
Comfort

ARCH

2015

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

2016

Show 100

entries

Name of

Facility

Facility



Type

Search:


Inspection Reports



Inspection Reports

Care Home,
L.L.C.

Cuaresma

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/CuaresmaConcepcion

ARCH

2015

ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Concepcion-

Agbayani

Agbayani-ARCH-2015.pdf)

D-Well Care

ARCH

2015

ARCH

2015

Services
Conchita

ARCH

Acosta

2015
(http://health.hawaii.gov/ohca/files/2016/01/Conchita-

Daquip Care

Acosta-ARCH-2015.pdf)

Home

(http://health.hawaii.gov/ohca/files/2016/03/DaquipCare-Home-ARCH-2015.pdf)

Cora's

ARCH

2015

2016
Dolores

Corazon

ARCH

Duran

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Corazon-

(http://health.hawaii.g

Duran-ARCH-2015.pdf)

Duran-ARCH-2016.pd

ARCH

2015

Domie

ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/03/Domie-

Bolosan
Cres Tamayo

ARCH

2016

Bautista

2015 (http://health.hawaii.gov/ohca/files/2016/02/Cres-

Bolosan-ARCH-2015.pdf)

Tamayo-ARCH-2015.pdf)
E. Ramos
Crescencia

ARCH

2015

ARCH

2016

2015 (http://health.hawaii.gov/ohca/files/2016/03/E.-

2016

Ramos-ARCH-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Crescencia-

Galamgam

Galamgam-ARCH-2015.pdf)

Showing 1 to 100 of 1,755 entries

Elizabeth

ARCH

2015

2016

ARCH

2015

2016

Maldonado

 Previous Next 

Elpidio Tablit

(http://health.hawaii.gov/ohca/files/2016/01/ElpidioTablit-ARCH-2015.pdf)
Emiliana

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Emiliana-

Ancheta

Ancheta-ARCH-2015.pdf)
Emily Lee

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Emma Rose

9/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

ARCH

ARCH

12/12/2016

2015

Fernando

(http://health.hawaii.gov/ohca/files/2016/01/Emma-

Care Home

2015

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Fernando-

Flordina

ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/02/Flordina-

Agustin

Castillo-ARCH-2015.pdf)
Esperanza

2/10

Care-Home-ARCH-2015.pdf)
2016

(http://health.hawaii.gov/ohca/files/2016/01/Enriqueta-

Castillo

2016

http://health.hawaii.gov/ohca/inspection-reports/

Rose-ARCH-2015.pdf)
Enriqueta

2015

Augustin-ARCH-2015.pdf)

2015

Florentina

Obrero

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Florentina-

Saludares

Saludares-ARCH-2015.pdf)
Esther

ARCH

2015
Francisca

Dumlao

ARCH

2015

ARCH

2015

Dalere
Estrelita

ARCH

2015
Garcia Care

Luczon

(http://health.hawaii.gov/ohca/files/2016/03/Garcia-

Home
Evangeline

ARCH

Aguinaldo

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Evangeline-

(http://health.hawaii.gov/

Aguinaldo-ARCH-2015.pdf)

Aguinaldo-ARCH-2016.p

2015

2016

Care-Home-ARCH-2015-2.pdf)
Gina's

ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Ginas-

Evelyn

ARCH

ARCH-2015.pdf)

Valdez
Glenda
Evelyn's

ARCH

2015

2016

ARCH

2015

2016

ARCH

2015

2016

Leano

(http://health.hawaii.gov/ohca/files/2016/01/EvelynsGloria

ARCH-2015-1.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Gloria-

Amodo
Faith Harbor

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Faith-

2016

Amodo-ARCH-2015.pdf)

Harbor-Adult-Care-ARCH-2015-1.pdf)

Adult Care

Gloria
Faye

ARCH

Felicidad

2015 (http://health.hawaii.gov/ohca/files/2016/01/Faye-

2016

ARCH

ARCH

2015

2016

Gloria

ARCH

Mariano

Mones-ARCH-2015.pdf)
Fely Irons'

ARCH

2015

2016

Blanco-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Felicidad-

Mones

2015
(http://health.hawaii.gov/ohca/files/2016/01/Gloria-

Blanco

Anastacio-ARCH-2015.pdf)

Anastacio

2016

Gloria V.

Adult

Atmospera,

Residential

ARCH

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Gloria-

(http://health.hawaii.gov/

Mariano-ARCH-2015.pdf)

Mariano-ARCH-2016.pd

2015
(http://health.hawaii.gov/ohca/files/2016/02/Gloria-V.Atmospera-ARCH-E-ARCH-2015.pdf)

Care Home
Golden
Fely Ugalde

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/Fely-

Acres

Ugalde-ARCH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/GoldenAcres-ARCH-2015.pdf)

3/10

http://health.hawaii.gov/ohca/inspection-reports/

4/10

 12/12/2016

Halawa Care

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

Home

12/12/2016

2015

Irenea B.

(http://health.hawaii.gov/ohca/files/2016/01/Halawa-

Alipio

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

2015

2016

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Irene-

2016

Care-Home-LLC-E-ARCH-2015.pdf)
Irene Della
Halawa

ARCH

2015

Heights

Residential

Home
Hale Lehua

Della-Adult-Residential-Care-Home-ARCH-20152.pdf)

Adult
Care Home

ARCH

CareHome

2015 (http://health.hawaii.gov/ohca/files/2016/01/Hale-

Island

Lehua-CareHome-ARCH-2015.pdf)

Promise

ARCH

(http://health.hawaii.gov/ohca/files/2016/01/IslandPromise-ARCH-L.L.C.-ARCH-2015.pdf)

ARCH, L.L.C
Hale

ARCH

Malamalama

2015 (http://health.hawaii.gov/ohca/files/2016/01/HaleMalamalama-Mauka-ARCH-2015-1.pdf)

Jaja ARCH

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/Hale-

Jerez Care

ARCH

Olu-Care-Home-L.L.C.-ARCH-2015.pdf)

Home

2015 (http://health.hawaii.gov/ohca/files/2016/01/JajaARCH-ARCH-2015.pdf)

Mauka
Hale Olu

2015

ARCH

Care Home,

2015 (http://health.hawaii.gov/ohca/files/2016/01/JerezCare-Home-ARCH-2015.pdf)

L.L.C.
Jessie
Haven

ARCH

ARCH

2015

ARCH

2015

2016

ARCH

2015

2016

Gacula

2015
(http://health.hawaii.gov/ohca/files/2016/01/Haven-

Johnny

ARCH-2015-1.pdf)

Fiesta
Hawaii Kai

ARCH

ARCH

Home Away

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Hawaii-Kai-

Joyce

ARCH-ARCH-2015.pdf)

Yamaoka

(http://health.hawaii.gov/ohca/files/2016/01/Joyce-

Care Home,

Yamaoka-Care-Home-LLC-ARCH-2015.pdf)

2015

2016

LLC

(http://health.hawaii.gov/ohca/files/2016/01/Home-

From Home

Juanita

Away-From-Home-ARCH-2015-1.pdf)

ARCH

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Juanita-

Garcia
Honesty

2015

Garcia-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/02/HonestyJuanita

ARCH-2015.pdf)

ARCH

ARCH

2015

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Juanita-

Sadoy
HooNani

2016

Sadoy-ARCH-20151.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/HooNani-

Care Home

Judy's

Care-Home-ARCH-2015.pdf)

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/JudysHouse of

ARCH

2015

2016

ARCH-20151.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/House-of-

Aloha

Kahuanani

Aloha-ARCH-2015.pdf)

ARCH

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Kahuanani-

Place
Hughes

2015

Place-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/03/Hughes-

Care Home

Care-Home-ARCH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Kailua Kare

5/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

2015

12/12/2016

2016

Loraine

(http://health.hawaii.gov/ohca/files/2016/02/Kailua-

Home

ARCH

2015

ARCH

Loretta De

Care Home

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/LoraineCabico-Perez-ARCH-20151.pdf)

Perez
2016

6/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Cabico-

Kare-Home-ARCH-2015.pdf)
KeAloha

http://health.hawaii.gov/ohca/inspection-reports/

ARCH

2015

ARCH

2015

Vera

Inc
Loretta G.
Korean Care

ARCH

2015

2016

ARCH

2015

Lota

(http://health.hawaii.gov/ohca/files/2016/01/Kuakini-

Bumanglag

(http://health.hawaii.gov/ohca/files/2016/02/Loretta-G.-

Domingo

Domingo-ARCH-2015.pdf)

Home
Kuakini
Home

ARCH

2015

2016 (http://health.hawa
Bumanglag-ARCH-2016

Home-ARCH-2015.pdf)
Loumaile
L&M

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/L-M-

ARCH

Lavigne-

ARCH

2015

Namoca

(http://health.hawaii.gov/ohca/files/2016/01/Lavigne-

Care Home

Namoca-Care-Home-ARCH-2015.pdf)

Cottage-ARCH-2015-Rev.pdf)
Lucina

2016

ARCH

2015

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LolitaQuiocho-ARCH-20151.pdf)

Lydia
Leonila

2015
(http://health.hawaii.gov/ohca/files/2016/04/Loumaile-

Cottage

ARCH-2015.pdf)

2016

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LydiaDeguzman-ARCH-2015.pdf)

Deguzman

Nuesca
Lydia
Leticia's

ARCH

2015

ARCH

(http://health.hawaii.gov/ohca/files/2016/03/Leticias-

Care Home

Lydia

Care-Home-ARCH-2015.pdf)

ARCH

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LydiaRamiro-ARCH-20151.pdf)

Ramiro
Lettie's

2015 (http://health.hawaii.gov/ohca/files/2016/02/LydiaQuemado-ARCH-2015.pdf)

Quemado

2015
(http://health.hawaii.gov/ohca/files/2016/02/Letties-

Maestro

ARCH-2015.pdf)

Care Home

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MaestroCare-Home-ARCH-20151.pdf)

Liabelle

ARCH

2015

Cadiz

(http://health.hawaii.gov/ohca/files/2016/02/Liabelle-

Makrina

ARCH,

Cadiz-ARCH-L.L.C.-ARCH-2015.pdf)

Sagasay

ARCH

(http://health.hawaii.gov/ohca/files/2016/03/MakrinaSagaysay-ARCH-2015.pdf)

L.L.C.
Lilia Cua

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Lilia-

Manoa

2016

Cua-ARCH-2015.pdf)
Lolita

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Lolita-

2016

ARCH

2015

Sunshine-

(http://health.hawaii.gov/ohca/files/2016/01/Manoa-

Residential

Sunshine-Residential-Care-Inc.-ARCH-2015.pdf)

Care, Inc.

Quiocho-ARCH-2015.pdf)

Quiocho

Marcelina
Lolita Suga

2015

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Lolita-

Amodo

Suga-ARCH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MarcelinaAmodo-ARCH-2015.pdf)

7/10

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8/10

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Marcelina

ARCH

Obaldo

12/12/2016

2015

Miriam

(http://health.hawaii.gov/ohca/files/2016/02/Marcelina-

Guerrero

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ARCH

ARCH

Guerrero-ARCH-2015.pdf)

2015

2016

Mona Liza

ARCH

(http://health.hawaii.gov/ohca/files/2016/01/Margarita-

Hipol

2016

ARCH-20151.pdf)

Showing 101 to 200 of 1,755 entries

2015

ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Mona-Liza-

Hipol-ARCH-2015.pdf)
Maria

2016

(http://health.hawaii.gov/ohca/files/2016/01/Miriam-

Obaldo-ARCH-2015.pdf)
Margarita

2015

 Previous Next 

(http://health.hawaii.gov/ohca/files/2016/03/Maria-

Respicio

Respicio-ARCH-2015.pdf)
Maria

ARCH

Sardon

Marie

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Maria-

(http://health.hawaii.gov/

Sardon-ARCH-2015.pdf)

Sardon-ARCH-2016.pdf

ARCH

2015

ARCH

2015

Viduya
Marilee

(http://health.hawaii.gov/ohca/files/2016/02/Marilee-

Abenoja

Abenoja-ARCH-2015.pdf)
Martha's

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MarthasARCH-2015.pdf)
Martin

2015

ARCH

2016

(http://health.hawaii.gov/ohca/files/2016/01/Martin-

Obaldo

Obaldo-ARCH-2015.pdf)
Martina

2015

ARCH

2016

(http://health.hawaii.gov/ohca/files/2016/01/Martina-

Padron

Padron-ARCH-2015.pdf)
Marylin Villar

ARCH

2015

May G.

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/May-

2016

G.-Viernes-ARCH-2015.pdf)

Viernes
Mely Mueller

2015 (http://health.hawaii.gov/ohca/files/2016/01/Mely-

ARCH

2016

Mueller-ARCH-20151.pdf)
Milagros

2015

ARCH

Cabico

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To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

Paradise

Name of
Facility

entries


Facility
Type

Inspection Reports

ARCH

ARCH

ARCH

Pascual's



Inspection Repor

2015

ARCH

Patricia

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Pascuals-

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/Myrna-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Patricia-

2016

Prime Health

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/PrimeHealth-Services-Care-Home-ARCH-2015.pdf)

Home

2016

Baptista-ARCH-2015.pdf)

Baptista

Priscilla Lucas
ARCH

2015

ARCH

2015

2016
(http://health.hawa

2016

Lucas-ARCH-2016

Selga
Negrillo's

2016

Inocencio-ARCH-2015.pdf)

Services Care

Natividad

2015 (http://health.hawaii.gov/ohca/files/2016/01/Paranada-

2016 (http://health
Care-Home-ARCH

ARCH

(http://health.hawa

ARCH-2015.pdf)

Home
Myrna

2016

ARCH-2015.pdf)

2-ARCH-2015.pdf)

Inocencio
Myles Care

2015 (http://health.hawaii.gov/ohca/files/2016/03/Paradise-

ARCH-ARCH-201
Paranada #2

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

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ARCH

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).
Show 100

http://health.hawaii.gov/ohca/inspection-reports/

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Negrillos-

Ramelb Adult

2016

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/RamelbAdult-Residential-Care-Home-ARCH-2015.pdf)

Residential

ARCH-ARCH-2015.pdf)

ARCH

Care Home
Nita's

ARCH

Nita's Quality

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/NitasRaymunda

ARCH-2015.pdf)

ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/02/Raymunda-

Nebreja
2015 (http://health.hawaii.gov/ohca/files/2016/01/Nitas-

2016

Nebreja-ARCH-2015.pdf)

Quality-Home-Care-Services-ARCH-20151.pdf)

Home Care

Remedios

Services

ARCH

ARCH

Norma

ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Remedios-

Atanes
Nods

2015 (http://health.hawaii.gov/ohca/files/2016/01/Nods-

Atanes-ARCH-2015.pdf)

ARCH-2015.pdf)
Remedios
2015 (http://health.hawaii.gov/ohca/files/2016/03/Norma-

Remedios
Ohanalani

ARCH

2015

ARCH

2015

Oamil

Downey-ARCH-2015.pdf)

Downey
ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Remedios-

Sambajon

(http://health.hawaii.gov/ohca/files/2016/03/Ohanalani-LLC-

L.L.C.

Sambajon-ARCH-2015.pdf)

ARCH-2015.pdf)
Reyes Care
Olivia Corpuz

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Olivia-

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/Reyes-

2016

Care-Home-ARCH-2015.pdf)

Home

Corpuz-ARCH-2015.pdf)
Robert Cabatu
Padre

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Padre-

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/RobertCabatu-ARCH-2015.pdf)

ARCH-2015.pdf)

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2/9

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ARCH

Tapat ARCH

12/12/2016

2015

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Vicky's

ARCH

Victoria

ARCH

(http://health.hawaii.gov/ohca/files/2016/01/Rogelio_Editha-

2015 (http://health.hawaii.gov/ohca/files/2016/01/VickysARCH-2015.pdf)

Tapat-ARCH-ARCH-2015.pdf)
Roger Apuya

ARCH

2015

Rose Hwang's

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/Rose-

Victoria

Hwangs-Care-Home-ARCH-2015.pdf)

Gabriel Care

Care Home

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/Victoria-

2016

ARCH-2015.pdf)
ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/VictoriaGabriel-Care-Home-ARCH-2015.pdf)

Home
Rosita

ARCH

Baybayan

2015 (http://health.hawaii.gov/ohca/files/2016/01/Rosita-

2016
Violeta

Baybayan-ARCH-2015.pdf)

ARCH

2015

Wailua Ohana

ARCH

2015

We Care

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/We-Care-

2016

Bumanglag
Shirley

ARCH

2015

ARCH

2015

Daguimol
Shirley

2016

Suetos Care

ARCH

Home
T. J. Factora

ARCH

Care Home
Tender Loving

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Suetos-

Wilson Senior

2016

Care-Home-ARCH-2015.pdf)

Living Kailua

2015 (http://health.hawaii.gov/ohca/files/2016/02/T.-J.-

Yoon's Care

Factora-Care-Home-ARCH-2015.pdf)

Home

2015

2016

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/WilsonSenior-Living-Kailua-ARCH-2015.pdf)

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/YoonsCare-Home-ARCH-2015.pdf)

ARCH

2015

Suenaga II

ARCH

2015

Bernardo

ARCH

2015

Emy's

ARCH

2015

TJ Factora

ARCH

2015

ARCH

2015

ARCH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Esther-

Soledad

Care
Tina Parubrub

Home-ARCH-2015.pdf)

Home

Magaoay

Pascual
ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/TinaParubrub-ARCH-2015.pdf)

Trinidad

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Trinidad-

2016

Care Home

Rosario-ARCH-2015.pdf)

Rosario
Ugalino ARCH

ARCH

United Family

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/03/UgalinoARCH-ARCH-2015.pdf)

2016

Care Home
2015 (http://health.hawaii.gov/ohca/files/2016/01/United-

2016
Consolacion

Family-Care-Home-LLC-ARCH-2015.pdf)

Care Home,

Ramos

LLC
Vallente Care

ARCH

Home
Veronica

ARCH

Esteban

2015 (http://health.hawaii.gov/ohca/files/2016/01/Vallente-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Veronica-

Furukawa

Esteban-ARCH-2015.pdf)

Residential

(http://health.hawaii.gov/ohca/files/2016/03/Furukawa-

Retreat

Residential-Retreat-ARCH-2016.pdf) , 2015 #2

12/12/2016

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CCCFH

2016

Pascual-ARCH-2015.pdf) , 2015 #2

Pascual

http://health.hawaii.gov/ohca/inspection-reports/

Athena Orden

Esther

2016

Care-Home-ARCH-2015.pdf)

ARCH

2015 #1

2016

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/Athena-

Erlinda

Orden-CCFFH-2015.pdf)

Ubaldo

5/9

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CCFFH

2016
(http://health.hawa
Ubaldo-CCFFH-20

Adela Suzuki

CCFFH

2016
(http://health.hawa

Estelita

SUZUKI-CCFFH-2

Casino

CCFFH

2016
(http://health.hawa
Casino-CCFFH-20

Aileen Navalta

CCFFH

2016
(http://health.hawa

Estrella

Navalta-CCFFH-2

Casiano

CCFFH

2016
(http://health.hawa
CASIANO-CCFFH

Andrea

CCFFH

2016
(http://health.hawa

Paeste

Faatu Ripley

CCFFH

Gina Mauricio

CCFFH

PAESTE-CCFFH-2
Archie Redor

CCFFH

2016 (http://health
Ripley-CCFFH-20

2016
(http://health.hawa

2016 (http://health
Mauricio-CCFFH-2

REDOR-CCFFH-2
Glenn Abara
Betty Vera

CCFFH

Cruz

CCFFH

2016

2016

(http://health.hawa

(http://health.hawa

Abara-CCFFH-201

VERA-CRUZ-CCF
Glorita Gilo
Brenda

CCFFH

Sanders

CCFFH

2016

2016

(http://health.hawa

(http://health.hawa

CCFFH-2016.pdf)

Sanders-CCFFH-2
Jaculino Delos
Caroline

CCFFH

2016

CCFFH

2016
(http://health.hawa

Santos

(http://health.hawa

Batacan

Delos-Santos-CCF

BATACAN-CCFFH
Jane
Christine

CCFFH

2016

CCFFH

2016 (http://health
Cabreros-CCFFH-

Cabreros

(http://health.hawa

Medrano-

Medrano-Gampay

Gampayon

Jane Cutaran

CCFFH

Janet Barrios

CCFFH

2016 (http://health
Cutaran-CCFFH-2

Doreen Torres

CCFFH

2016
(http://health.hawa

2016 #1
(http://health.hawa

TORRES-CCFFH-

BARRIOS-2016.pd
Edna Arciaga

CCFFH

2016
Janet Sugui

(http://health.hawa

CCFFH

2016
(http://health.hawa

ARCIAGA-CCFFH

SUGUI-CCFFH-20
Edna Leano

CCFFH

2016
(http://health.hawa

Jocelyn

LEANO-CCFFH-2

Alcaraz

CCFFH

2016
(http://health.hawa
Alcaraz-CCFFH-20

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6/9

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Joy Muncal

CCFFH

12/12/2016

2016 (http://health

Maribel

MUNCAL-CCFFH-

Felicelda

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2016
(http://health.hawa
Felicelda-CCFFH-

Julieta Cambe

2016

CCFFH

(http://health.hawa

Marilyn

Cambe-CCFFH-20

Speichinger

CCFFH

2016
(http://health.hawa
SPEICHINGER-CC

Lani Abara

2016

CCFFH

Marinellie
Leonida

CCFFH

2016

Agasid

CCFFH

2016
(http://health.hawa

Malvar

(http://health.hawa

Malvar-CCFFH-20

Agasid-CCFFH-20
Melecia
Leslie Ann

2016 (http://health

CCFFH

CCFFH

2016
(http://health.hawa

Andres

Ann-Ballesteros-C

Ballesteros
Lucita Galano

Lucrecia

CCFFH

CCFFH

Pastor

Andres-CCFFH-20

2016

Minda

(http://health.hawa

Pascual-

Galano-CCFFH-20

Arnold

2016

Mitci C

(http://health.hawa

Aguinaldo

2016

CCFFH

(http://health.hawa
PASCUAL-ARNOL
2016 (http://health

CCFFH

C-Aguinaldo-CCFF

PASTOR-CCFFHNicerita Rabut
Luz Agustin

CCFFH

2016

2016 (http://health

CCFFH

(http://health.hawa

Agustin-CCFFH-20
Lyma Rose

Rabut-CCFFH-201

Showing 201 to 300 of 1,755 entries

2016 (http://health

CCFFH

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Rose-Acosta-CCF

Acosta
Madelaine

CCFFH

2016
(http://health.hawa

Cachola

Cachola-CCFFH-2
Magda Galvan

2016

CCFFH

(http://health.hawa
Galvan-CCFFH-20
Margarita

2016

CCFFH

(http://health.hawa

Organistas

Organistas-Aquino

Aquino
Maria Editha

2016

CCFFH

(http://health.hawa

Castillo

EDITHA-CASTILL

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

8/9

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12/12/2016

(http://health.hawaii.gov/ohca)

9/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

State of Hawaii, Department of Health

Office of Health Care Assurance
(http://health.hawaii.gov/ohca)

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).

Home (http://health.hawaii.gov/ohca/) » Healthcare Facilities Inspection Reports

HEALTHCARE FACILITIES INSPECTION REPORTS

Show 100

entries

Name of

The Department of Health conducts regular state licensing or certification inspections of health
care facilities throughout the state to ensure their compliance with the state’s licensure or
certification requirements. As required by Hawaii Revised Statutes (HRS) Section 321-1.8, the
reports on these inspections shall be posted on the department’s website for access by the public.
The inspection reports on this website are for inspections conducted on or after January 1, 2015,
pursuant to HRS §321-1.8.

Facility



Nimfa Leslie

Facility
Type

Search:


Inspection
Reports

CCFFH



Inspection Reports



2016
(http://health.hawaii.gov/ohca/files/2016/01/NIMFALESLIE-CCFFH-2016.pdf)

Olivia Lewin

CCFFH

Oscar

CCFFH

The inspection reports on this website are on the following types of health care facilities:

2016 (http://health.hawaii.gov/ohca/files/2016/03/OliviaLewin-CCFFH-2016.pdf)

Adult Day Health
Adult Day Care Center (ADCC)
Developmental Disabilities Domiciliary Homes (DDDH)

Osmenia Aquino

2016 (http://health.hawaii.gov/ohca/files/2016/03/OscarAnunciacion-CCFFH-2016.pdf)

Anunciacion

Community Care Foster Family Homes (CCFFH)

CCFFH

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID)
Long-term care facilities as defined in HRS §349-21(f), including:

2016
(http://health.hawaii.gov/ohca/files/2016/03/OsmeniaAquino-CCFFH-2016.pdf)

Adult Residential Care Homes (ARCH) and Expanded Adult Residential Care Homes
(E-ARCH)
Assisted Living Facilities (ALF)

Pacita Agbisit

CCFFH

2016
(http://health.hawaii.gov/ohca/files/2016/01/PACITAAGBISIT-CCFFH-2016.pdf)

Intermediate Care Facilities (ICF)
Nursing Facilities (NF)

Paula Lazo

CCFFH

Skilled Nursing Facilities (SNF)

2016 (http://health.hawaii.gov/ohca/files/2016/03/PaulaLazo-CCFFH-2016.pdf)

Special Treatment Facilities (STF)
Renelda Raposas

CCFFH

Raposas-CCFFH-2016.pdf)

1. The date of the inspection;
2. A description of violations of relevant state laws or rules, if applicable;
3. Plans of correction and the status of corrective actions in response to any violations, if
applicable;
4. A list and description of all corrective actions taken by the facility, if applicable, to be
submitted by the facility and added to the report at a later time, as determined by the
department; and
5. Other information regarding the quality and conditions of the facility the Department of
Health deems appropriate.

http://health.hawaii.gov/ohca/inspection-reports/

2016
(http://health.hawaii.gov/ohca/files/2016/03/Renelda-

HRS §321-1.8 requires that each posted inspection report shall include the following information:

Rosario Cadelina

CCFFH

2016
(http://health.hawaii.gov/ohca/files/2016/03/RosarioCadelina-CCFFH-2016.pdf)

Rosemarie Pe

CCFFH

Benito

2016
(http://health.hawaii.gov/ohca/files/2016/03/RosemariePe-Benito-CCFFH-2016.pdf)

1/7

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2/7

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Shirly Layugan

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

12/12/2016

Anthony Jimenez

2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2016

(http://health.hawaii.gov/ohca/files/2016/01/SHIRLY-

Socorro Cardona

CCFFH

LAYUGAN-CCFFH-2016.pdf)

Aprilyn Pascual

CCFFH

2016

2016

Arlene Manuel

CCFFH

2016

CARDONA-CCFFH-2016.pdf)

Benilda Sagabaen

CCFFH

2016

2016

Bernadette

CCFFH

2016

Carina Ocampo

CCFFH

2016

Carmelita Makolo

CCFFH

2016

Carmen Sanchez

CCFFH

2016

Carolyn Duquez

CCFFH

2016

BYRNE-CCFFH-2016.pdf)

Catherine Edades

CCFFH

2016

2016

(http://health.hawaii.gov/ohca/files/2016/01/SOCORRO-

Teresita Pagtama

CCFFH

Aquino

(http://health.hawaii.gov/ohca/files/2016/03/TeresitaPagtama-CCFFH-2016.pdf)
Vincent Rayo

CCFFH

2016
(http://health.hawaii.gov/ohca/files/2016/03/VincentRayo-CCFFH-2016.pdf)

Violenda Byrne

CCFFH

2016
(http://health.hawaii.gov/ohca/files/2016/01/VIOLENDA-

Violeta Fiesta

CCFFH

Cesar Comiso

CCFFH

2016

Fiesta-CCFFH-2016.pdf)

Charly Micua

CCFFH

2016

2016

Cheryll Collado

CCFFH

2016

(http://health.hawaii.gov/ohca/files/2016/02/Violeta-

Virginia Vitin

CCFFH

(http://health.hawaii.gov/ohca/files/2016/03/Virginia-

Zeny Agonoy

CCFFH

Vitin-CCFFH-2016.pdf)

Chieko Riccio

CCFFH

2016

2016 (http://health.hawaii.gov/ohca/files/2016/01/ZENY-

Christine Bragado

CCFFH

2016

Clarita Manoja

CCFFH

2016

Clariza Rabanes

CCFFH

2016

Connie Felipe

CCFFH

2016

Conrado Pabalan

CCFFH

2016

Consolacion

CCFFH

2016

AGONOY-CCFFH-2016.pdf)
Adela Salacup

CCFFH

2016

Adelaide Pascual

CCFFH

2016

Alicia Abendanio

CCFFH

2016

Alma Abellanosa

CCFFH

2016

Alma Dacuycuy

CCFFH

2016

Lapitan

Alsen Saito

CCFFH

2016

Debra Alexander

CCFFH

2016

Anabel Cabebe

CCFFH

2016

Denise Yoshida

CCFFH

2016

Annette Rivera

CCFFH

2016

Dionisio Aguilar

CCFFH

2016

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12/12/2016

4/7

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Dolores Guiao

CCFFH

2016

Gloria Aves

CCFFH

2016

Eden Orpilla

CCFFH

2016

Gloria Sablay

CCFFH

2016

Eden Tumbaga

CCFFH

2016

Grace

CCFFH

2016

Edgar Tuazon

CCFFH

2016

Reyes

Editha Negrillo

CCFFH

2016

Grace Tungpalan

CCFFH

2016

Elena Sevilla

CCFFH

2016

Gracia Agcaoili

CCFFH

2016

Emily Saturnino

CCFFH

2016

Henry Caddali

CCFFH

2016

Emma Balallo

CCFFH

2016

Hilary Ubilas

CCFFH

2016

Emma Pasion

CCFFH

2016

Iluminada Morin

CCFFH

2016

Irene Redoble

CCFFH

2016

CCFFH

2016
Isabel Infante

CCFFH

2016

Jackielyn Bautista

CCFFH

2016

Jacqueline

CCFFH

2016

Constantino-

Cacho
Emy Lee
Erlinda Agcaoili

CCFFH

2016

Esther Skinner

CCFFH

2016

Fidela Batoon

CCFFH

2016

Atienza

Flordeliza Dela

CCFFH

2016

Jamaica Dalope

CCFFH

2016

Janet Sion

CCFFH

2016

Janeth Doruelo

CCFFH

2016

Jennifer Guillermo

CCFFH

2016

Jennifer Oguma

CCFFH

2016

Josefina Daga

CCFFH

2016

Josephine

CCFFH

2016

Cruz
Florentina Nunez

CCFFH

2016

Franco Estabillo

CCFFH

2016

Gemma Bautista

CCFFH

2016

Geovanee Laya

CCFFH

2016

Gerald Nakata

CCFFH

2016

Gilbert Julian Jr

CCFFH

2016

Agarpao

Gina Oen-Mitchell

CCFFH

2016

Judith Sanchez

CCFFH

2016

Glenda Felix

CCFFH

2016

Juvy Caslib

CCFFH

2016

Glenda Pita

CCFFH

2016

Krystle Agaton

CCFFH

2016

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Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Leoven Deloso

CCFFH

2016

Lolita Schimmel

CCFFH

2016

Lovelle Flores

CCFFH

2016

Mae Margarette

CCFFH

2016

Ludivina Farinas

CCFFH

2016

Luz Bareng

CCFFH

2016

Luzviminda Kaholi

CCFFH

2016

12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
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residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.
Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
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

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Mabelle Callorina

CCFFH

2016

Maria Fe Mabborang

CCFFH

2016

Maribel Tan

CCFFH

2016

Mariedel Garingo

CCFFH

2016

Marilyn Miguel

CCFFH

2016

Marilyn Palisbo

CCFFH

2016

Marcelina Tito

CCFFH

2016

Margaret Ibus

CCFFH

2016

Marites Falima

CCFFH

2016

Marites Manayan

CCFFH

2016

Mark Jara

CCFFH

2016

Marlina Fernando

CCFFH

2016

Mary Ann Katano

CCFFH

2016

Mary Fe Ricana

CCFFH

2016

Melanie Domer

CCFFH

2016

Marissa Garcia

CCFFH

2016

Melanie Valera

CCFFH

2016

Melanie Viernes

CCFFH

2016

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12/12/2016

CCFFH

2016

Rowena Visaya

Meloni Trias

CCFFH

2016

Merl Cabradilla

CCFFH

2016

Michelle Sabangan

CCFFH

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Milba Melchor
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CCFFH

2016

Ruby Balantac

CCFFH

2016

Sabrina Nishihara

CCFFH

2016

2016

Shallee Erorita

CCFFH

2016

CCFFH

2016

Sherry Bayangos

CCFFH

2016

CCFFH

2016

Sherry-Anne Viernes

CCFFH

2016

CCFFH

2016

Thelma Pagtama

CCFFH

2016

Melanie Jovenal

CCFFH

2016

Therese Vigilla

CCFFH

2016

Nancy Lopez

CCFFH

2016

Vi Balantac

CCFFH

2016

Natividad Ganal

CCFFH

2016

Vicenta Domingo

CCFFH

2016

Nora Holl

CCFFH

2016

Victorina Agustin

CCFFH

2016

Noreen Montijo

CCFFH

2016

Sunny Lee

CCFFH

2016

Poblezita Villator

CCFFH

2016

Susan Jung

CCFFH

2016

Regie Cacayorin

CCFFH

2016

Teresita Malvar

CCFFH

2016

Regina Rader

CCFFH

2016

Virgie Garo

CCFFH

2016

Remedios Manuel

CCFFH

2016

Virginia Montano

CCFFH

2016

Norma Camper

CCFFH

2016

Vivian Gamiao

CCFFH

2016

Norma Romero

CCFFH

2016

Welma Nalos

CCFFH

2016

Norma Tan

CCFFH

2016

Yeunsil Park

CCFFH

2016

Ofelia Sagucio

CCFFH

2016

Zenaida Ramos

CCFFH

2016

Rosalie Fischer

CCFFH

2016

Arceli Tabag

CCFFH

2016

Rosario Tabilisma

CCFFH

2016

Azucena Luiz

CCFFH

2016

Rose Ann Cabe

CCFFH

2016

Belinda Galinato

CCFFH

2016

Rose Galiza

CCFFH

2016

Benilda Dimaya

CCFFH

2016

Melody Yasay

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

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 12/12/2016

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12/12/2016

CCFFH

2016

Rosita Peneku

Cynthia Gima

CCFFH

2016

Editha Acupido

CCFFH

2016

Eliza Bonilla

CCFFH

Estela Aganos
Aleli Daligdig
Eufrocina Ledda

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2016

Esperanza Javier

CCFFH

2016

Glay-Ann Molina

CCFFH

2016

2016

Imelda Fagaragan

CCFFH

2016

CCFFH

2016

Janeth Dulig

CCFFH

2016

CCFFH

2016

Manilyn Nagtalon

CCFFH

2016

CCFFH

2016

May Simeon

CCFFH

2016

Ana Ramos

CCFFH

2016

Nadine Ganir

CCFFH

2016

Eva Francisco

CCFFH

2016

Natylia Miyat

CCFFH

2016

Evangeline Billena

CCFFH

2016

Norma Carino

CCFFH

2016

Bernadette Firme

Leonor Aglanao

CCFFH

2016

Luzviminda Padilla

CCFFH

2016

Marissa Domingo

CCFFH

2016

Mary Jhane Lazo

CCFFH

2016

MaryAnn Barrientos

CCFFH

2016

Melendrina Bumanglag

CCFFH

2016

Mercy Esteban

CCFFH

2016

Myung Suk Hiruko

CCFFH

2016

Ruth Bonilla

CCFFH

2016

Sheila Limon

CCFFH

2016

Vilma Rabena

CCFFH

2016

Violeta Bernardino

CCFFH

2016

Zita Gomes

CCFFH

2016

Necita Chaffin

CCFFH

2016

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entries

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Type



Inspection Reports 

Inspection
Reports

Pasiana Spellicy

CCFFH

2016

Angelita Sardena

CCFFH

2016

Bernadette Vera

CCFFH

2016

Cristina Basilio

CCFFH

2016

Fanny Tan

CCFFH
CCFFH

2016

Magdalena Banda

CCFFH

2016

Magielyn Dulay

CCFFH

2016

Marivyn Casino

CCFFH

2016

Melinda Benedicto

CCFFH

2016

Rosalia Roman

CCFFH

2016

Josephine Gamiao

CCFFH

2016

Maritess Ramirez

CCFFH

2016

Mary Jean Guira

CCFFH

2016

Mary Jane Ritumban

CCFFH

2016

Menes Saoit

CCFFH

2016

Rosa Ishihara
Thelma Maglines

http://health.hawaii.gov/ohca/inspection-reports/

CCFFH
CCFFH



2016

Lilibeth Badua

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

2016
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Giovannie Sibayan

CCFFH

2016

Jesusa Alcantara

CCFFH

2016

Juliet Acoba

CCFFH

2016

Leslie Domingo

CCFFH

2016

Maria Agbisit

CCFFH

2016

Roina Dumalag

CCFFH

2016

Romeo Salom Jr.

CCFFH

2016

Susan Bogle

CCFFH

2016

Trinidad Lameg

CCFFH

2016

Bonifacio Tan

CCFFH

2016

Gina Agpaoa

CCFFH

2016

Adoracion Castillo

CCFFH

2016

Ann Caddali

CCFFH

2016

Daisy Jane Madrid

CCFFH

2016

Edna Rice

CCFFH

2016

Erick Crisostomo

CCFFH

2016

Gina Domingo

CCFFH

2016

Eduardo Duquez

CCFFH

2016

Juliana Domingo

CCFFH

2016

Juanito Castanaga

CCFFH

2016

Juliana Aguinaldo

CCFFH

2016

Maritess Tenorio

CCFFH

2016

Theresa Elgar

CCFFH

2016

Wilson Verdadero

CCFFH

2016

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12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Chealeen Obrero

CCFFH

2016

Lourdes Macha

CCFFH

2016

Edward Baniqued

CCFFH

2016

Lyndon Redona

CCFFH

2016

Jane Fernandez

CCFFH

2016

Mae Dawn Lagmay

CCFFH

2016

Leilani Domingo

CCFFH

2016

Maria Casaje

CCFFH

2016

Leocadio Tactacan, Jr.

CCFFH

2016

Marissa Ruiz

CCFFH

2016

Nilda Whiting

CCFFH

2016

Noemi Antonio

CCFFH

2016

Ogilyn Ramos

CCFFH

2016

Elizabeth Galanto

CCFFH

2016

Perla Quijano

CCFFH

2016

Esmeralda Miyazaki

CCFFH

2016

Preciosa Rojas

CCFFH

2016

Evelyn Isabelo

CCFFH

2016

Rubylyn Fiesta

CCFFH

2016

Helen Sembran

CCFFH

2016

Vicenta Acosta

CCFFH

2016

Larry Quiabang

CCFFH

2016

Mila Rose Pasamonte

CCFFH

2016

Maricar Francisco

CCFFH

2016

Milagros Domingo

CCFFH

2016

Marina Khrapov

CCFFH

2016

Alejandrina Seatriz

CCFFH

2016

Marisa Viernes

CCFFH

2016

Amalia Garcia-Lindenmuth

CCFFH

2016

Remedios Laforga

CCFFH

2016

Analyn Kagimoto

CCFFH

2016

Roberto Sanchez

CCFFH

2016

Carina Aguilar

CCFFH

2016

Rowena Sabio

CCFFH

2016

Eredulin Julian

CCFFH

2016

Michelle Balisacan

CCFFH

2016

Flordeliza Braga

CCFFH

2016

Myrna Caro

CCFFH

2016

Grace Sacramento

CCFFH

2016

Sonia Pagdilao

CCFFH

2016

Juvy Perez

CCFFH

2016

Tessie Obaldo

CCFFH

2016

Estrella Rabago

CCFFH

2016

Thelma Ortal

CCFFH

2016

Llovelson Santos

CCFFH

2016

Vicenta Cadelina

CCFFH

2016

Ethelyn Nacion

CCFFH

2016

Victoria Baker

CCFFH

2016

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4/6

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Wilma Cervania

CCFFH

2016

Ruby Domingo

CCFFH

2016

Lilia Pulido

CCFFH

2016

Luzvelinda Wilson

CCFFH

2016

Marissa Roman

CCFFH

2016

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.
Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).
Show 100
Name of

Marites Quedding

CCFFH

2016

Bernadette Velasco

CCFFH

2016

Grace Andres

CCFFH

2016

Hilaria Panglao

CCFFH

2016

Leonor Malvar

CCFFH

2016

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

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2016

CCFFH

Bartolome
Steffens
Abigail

CCFFH

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ADELA-

2016

AGPAOA-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/AdelineCaraang-CCFFH-2015.pdf)

Caraang
Adora

2015 (http://health.hawaii.gov/ohca/files/2016/01/AbundiaTagaro-CCFFH-2015.pdf)

Agpaoa
Adeline

2016

NAVALTA-CCFFH-2015.pdf)

Tagaro
Adela

2015 (http://health.hawaii.gov/ohca/files/2016/01/ABIGAIL-

CCFFH

Harada

2015 (http://health.hawaii.gov/ohca/files/2016/01/Adora-

2016

Harada-CCFFH-2015.pdf)

(http://health.hawaii
Harada-CCFFH-201

Adriana

CCFFH

Pintor-CCFFH-2015.pdf)

Pintor
Agnes

CCFFH

CCFFH

CCFFH

Ramirez

2015 (http://health.hawaii.gov/ohca/files/2015/10/AhledDomingo-CCFFH-2015.pdf)

Domingo
Aileen

2015 (http://health.hawaii.gov/ohca/files/2016/03/AgrifinaMarcos-CCFFH-2015.pdf)

Marcos
Ahled

2015 (http://health.hawaii.gov/ohca/files/2015/10/AgnesGoya-CCFFH-2015.pdf)

Goya
Agrifina

2015 (http://health.hawaii.gov/ohca/files/2016/03/Adriana-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/03/Aileen-

2016

Ramirez-CCFFH-2015.pdf)

(http://health.hawaii
Ramirez-CCFFH-20

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 12/12/2016

Albert Gary

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Gardner

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/ALBERT-

Annabelle

GARY-GARDNER-CCFFH-2015.pdf)

Riel

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/ANNABELLERIEL-CCFFH-2015.pdf)

Alma

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Alma-

2016
Anontia

Acasio-CCFFH-2015.pdf)

Acasio

CCFFH

Alma

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Alma-

2016

Agpoon-CCFFH-2015.pdf)

Agpoon

Anthony

CCFFH

CCFFH

Antonette

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Amely-

2016

Supnet-CCFFH-2015.pdf)

Supnet

Antonia

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Ana-LizaAntonia

De-Guzman-CCFFH-2015.pdf)

De

2015 (http://health.hawaii.gov/ohca/files/2016/01/AntoniaArellano-CCFFH-2015.pdf)

Arellano
Ana Liza

2015 (http://health.hawaii.gov/ohca/files/2016/01/AntonetteSarmiento-CCFFH-2015.pdf)

Sarmiento
Amely

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/ALMIRAACASIO-CCFFH-2015.pdf)

Acasio

2015 (http://health.hawaii.gov/ohca/files/2015/11/ANTHONYCASTILLO-CCFFH-2015.pdf)

Castillo
Almira

2015 (http://health.hawaii.gov/ohca/files/2016/03/AnontiaJosue-CCFFH-2015.pdf)

Josue

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ANTONIADELOS-SANTOS-CCFFH-2015.pdf)

Delos

Guzman

Santos
Ana Marie

CCFFH

Acorda

2015 (http://health.hawaii.gov/ohca/files/2015/11/ANA-

2016 #1

MARIE-ACORDA-CCFFH-2015.pdf)

(http://health.hawaii

Anupama

Marie-Acorda-CCFF

Afu

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Anupama-

2016

Afu-CCFFH-2015.pdf)

(http://health.hawaii
Afu-CCFFH-2016.pd

Ana Marie

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ANAMARIE-ZARAGOZA-CCFFH-2015.pdf)

Zaragoza

Araceli

CCFFH

Danao
Analyn

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Andrea-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Angelina-

CCFFH

Ventura
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Anita-

2016

CCFFH

Antonio

2015 (http://health.hawaii.gov/ohca/files/2016/01/ANITA-

Aristotle

VENTURA-CCFFH-2015.pdf)

CCFFH

Ramos

CCFFH

Arlene

3/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ARLENE-

CCFFH

Beth

Hanks-CCFFH-2015.pdf)

Peralta
2016

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/ARLENEGAMBOA-CCFFH-2015.pdf)

12/12/2016

Betty

(http://health.hawaii.gov/ohca/files/2016/01/ARMANDO-

Biacan

2015

http://health.hawaii.gov/ohca/inspection-reports/

2015 (http://health.hawaii.gov/ohca/files/2015/11/Arlene-

2015

(http://health.hawaii

AGPALZA-CCFFH-2015.pdf)

Agpalza

http://health.hawaii.gov/ohca/inspection-reports/

Hanks

2016

JAMES-ANTONIO-CCFFH-2015.pdf)

RAMOS-CCFFH-2015.pdf)
Arlene

2015 (http://health.hawaii.gov/ohca/files/2015/11/Annabelle-

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2015/11/ARCHIE-

(http://health.hawaii.gov/ohca/files/2016/01/ARISTOTLE-

Gamboa

Armando

2016

James-Antonio-CCF
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Ann-Kim-

Banez-CCFFH-2015.pdf)

Banez

Arlene

2015 (http://health.hawaii.gov/ohca/files/2016/01/ARCELIREMOGAT-CCFFH-2015.pdf)

James

Locquiao-CCFFH-2015.pdf)

CCFFH-2015.pdf)
Annabelle

NAVARRO-CCFFH-2015.pdf)
CCFFH

Remogat
Archie

CCFFH

Locquiao

Ann Kim

2015 (http://health.hawaii.gov/ohca/files/2015/11/ARACELI-

Madrid-CCFFH-2015.pdf)

Madrid

Anita

CCFFH

Navarro

Abad-CCFFH-2015.pdf)
Arceli

Anita

(http://health.hawaii
Danao-CCFFH-2016

Araceli
CCFFH

Abad
Angelina

2016

DANAO-CCFFH-2015.pdf)

Galapon-CCFFH-2015.pdf)

Galapon
Andrea

2015 (http://health.hawaii.gov/ohca/files/2016/01/ARACELI-

2015 (http://health.hawaii.gov/ohca/files/2015/10/Analyn-

4/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/BethPeralta-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/BettyRumbaoa-CCFFH-2015.pdf)

Rumbaoa

BIACAN-CCFFH-2015.pdf)
Beverley
Arnolfa

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ARNOLFA-

2016

Blanchita
Asena

CCFFH

CCFFH

Orpiano
Aurelia

CCFFH

Jacob
Babylyn

CCFFH

Inglis
Baltazar

2015 (http://health.hawaii.gov/ohca/files/2016/01/BeverleyYoung-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/ASENA-

CCFFH

CCFFH

CABILES-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/Asuncion-

Brenda

Orpiano-CCFFH-2015.pdf)

Ragasa

2015 (http://health.hawaii.gov/ohca/files/2015/11/Aurelia-

Brigida

Jacob-CCFFH-2015.pdf)

Ramos

2015 (http://health.hawaii.gov/ohca/files/2015/10/Babylyn-

Candida

Inglis-CCFFH-2015.pdf)

Foronda

2015

2016

Caridad

(http://health.hawaii.gov/ohca/files/2016/01/BALTAZAR-

Mayo

2015
(http://health.hawaii.gov/ohca/files/2016/01/BLANCHITA-

Cabiles

MOALA-CCFFH-2015.pdf)

Moala
Asuncion

CCFFH

Young

UGOT-CCFFH-2015.pdf)

Ugot

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/BRENDA-

2016

RAGASA-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/BRIGIDA-

2016

RAMOS-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/CANDIDAFORONDA-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/CARIDADSUBIDO-CCFFH-2015.pdf)

Subido

MAYO-CCFFH-2015.pdf)
Carmelita
Beatriz

CCFFH

2016

Macalutas

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Belysilda-

2016

Carmelita

MACALUTAS-CCFFH-2015.pdf)

Cielo-CCFFH-2015.pdf)

Cielo

2015
(http://health.hawaii.gov/ohca/files/2016/01/CARMELITA-

Rivera-CCFFH-2015.pdf)

Rivera
Belysilda

2015 (http://health.hawaii.gov/ohca/files/2015/11/Beatriz-

CCFFH

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/CARMELITA-

Quemado

QUEMADO-CCFFH-2015.pdf)
Berlinda

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/BerlindaCarmelita

Villa-CCFFH-2015.pdf)

Villa

CCFFH

Bernadette

CCFFH

2015

RODRIGUEZ-CCFFH-2015.pdf)

CABAEL-CCFFH-2015.pdf)

Carmelita

CCFFH

CCFFH

2015

SABIO-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/03/Bernadette-

Carlson

Carlson-CCFFH-2015.pdf)

Carmencita
Asuncion

Sarmiento

2015
(http://health.hawaii.gov/ohca/files/2016/01/CARMELITA-

Sabio

Bernard

2016

(http://health.hawaii.gov/ohca/files/2016/01/BERNADETTE-

Cabael

Bernadette

2015
(http://health.hawaii.gov/ohca/files/2016/01/CARMELITA-

Rodriguez

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/BERNARD-

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/CARMENCITAASUNCION-CCFFH-2015.pdf)

SARMIENTO-CCFFH-2015.pdf)

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Carmencita

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Gamponia

12/12/2016

2015

Charity

(http://health.hawaii.gov/ohca/files/2016/01/CARMENCITA-

Sabangan

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Charity-

2016

Sabangan-CCFFH-2015.pdf)

GAMPONIA-CCFFH-2015.pdf)
Charlita
Carolina

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Carolina-

2016

CCFFH

Alhambra-CCFFH-2015.pdf)

Alhambra

Charlyne
Carolina

CCFFH

2015

CCFFH

Charrie

EALA-CCFFH-2015.pdf)

CCFFH

Carino
CCFFH

CARINO-CCFFH-2015.pdf)

Chatylee

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/CATALINA-

PATAO-CCFFH-2015.pdf)

GUZMAN-CCFFH-2015.pdf)

Guzman

Cherly
Catirina

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/CATIRINA-

CCFFH

Cherry
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/CECELIA-

2016

CCFFH

Chita
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/CECILIA-

2016

CCFFH

CCFFH

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/Cecilia-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Chona-

2016

Molina-CCFFH-2015.pdf)

Molina

Naboa-CCFFH-2015.pdf)

Naboa

Christine
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Celeste-

2016

CCFFH

CCFFH

Ventura

2015
(http://health.hawaii.gov/ohca/files/2016/01/CHRISTINE-

Dela Cruz

Domingo-CCFFH-2015.pdf)

Domingo
Cesar

2015 (http://health.hawaii.gov/ohca/files/2016/01/CHITAMADARIAGA-CCFFH-2015.pdf)

Madariaga
Chona

Celeste

2016

BELMES-CCFFH-2015.pdf)

Belmes
Cecilia

2015 (http://health.hawaii.gov/ohca/files/2016/01/CherryQuibol-CCFFH-2015.pdf)

Quibol

MARIANO-CCFFH-2015.pdf)

Mariano
Cecilia

2015 (http://health.hawaii.gov/ohca/files/2016/01/CHERLYSILAO-CCFFH-2015.pdf)

Silao

CONCEPCION-CCFFH-2015.pdf)

Concepcion
Cecelia

2015
(http://health.hawaii.gov/ohca/files/2016/01/CHATYLEE-

Patao
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/CHARRIE-

2015 (http://health.hawaii.gov/ohca/files/2016/01/CASTORADELA-CRUZ-CCFFH-2015.pdf)

Dela Cruz
Catalina

2015 (http://health.hawaii.gov/ohca/files/2015/11/CharlyneMenor-CCFFH-2015.pdf)

Menor

(http://health.hawaii.gov/ohca/files/2015/11/CAROLINA-

Eala

Castora

2015 (http://health.hawaii.gov/ohca/files/2016/03/CharlitaDumot-CCFFH-2015.pdf)

Dumot

DELA-CRUZ-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/CESAR-

Christopher

VENTURA-CCFFH-2015.pdf)

Ulep

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/CHRISTOPHERULEP-CCFFH-2015.pdf)

Cesaria

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Cesaria-

2016

Tabucol-CCFFH-2015.pdf)

Tabucol

Chun Hee

CCFFH

Charesse

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/CharesseTumaneng-CCFFH-2015.pdf)

Tumaneng

Claribel

CCFFH

CCFFH

Domingo

2015

2015 (http://health.hawaii.gov/ohca/files/2015/10/Claribel-

2016

Cabantog-CCFFH-2015.pdf)

Cabantog
Charisma

2015 (http://health.hawaii.gov/ohca/files/2016/01/CHUNHEE-KRATZKE-CCFFH-2015.pdf)

Kratzke

2016

(http://health.hawaii.gov/ohca/files/2016/01/CHARISMA-

Clemencia

DOMINGO-CCFFH-2015.pdf)

Bermejo

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/11/CLEMENCIABERMEJO-CCFFH-2015.pdf)

Charitie

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/CharitieGamiao-CCFFH-2015.pdf)

Gamiao

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Cleofe

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

CCFFH

2015

CCFFH

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).

2015 (http://health.hawaii.gov/ohca/files/2015/11/Connie-

2016

Show 100

Banda-CCFFH-2015.pdf)

Banda

Name of
Corazon
Agarpao

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Corazon-

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

2016

MANOG-CCFFH-2015.pdf)
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residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

2015 (http://health.hawaii.gov/ohca/files/2016/01/CLEOFE-

(http://health.hawaii.gov/ohca/files/2015/11/CONCEPCION-

Manog

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

BERMUDEZ-CCFFH-2015.pdf)

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CCFFH

Corazon

2015 (http://health.hawaii.gov/ohca/files/2016/01/Corazon-

2016

Benigno-CCFFH-2015.pdf)

Benigno
CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/CORAZON-

Cabantangan

CABANTANGAN-CCFFH-2015.pdf)
Corazon Dela

CCFFH

Corazon

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/CorazonSales-CCFFH-2015.pdf)

Sales
Corazon Tan

2015 (http://health.hawaii.gov/ohca/files/2015/11/CorazonDela-Rosa-CCFFH-2015.pdf)

Rosa

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Corazon-

2016

Tan-CCFFH-2015.pdf)
Corinne

CCFFH

Cristina

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Cristina-

2015 (http://health.hawaii.gov/ohca/files/2016/01/CRISTINA-

2016

DULLAGA-CCFFH-2015.pdf)

Dullaga
Cynthia Maulit

2016

Busbuso-CCFFH-2015.pdf)

Busbuso
Cristina

2015 (http://health.hawaii.gov/ohca/files/2015/11/CorinneMoreno-CCFFH-2015.pdf)

Moreno

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/CynthiaMaulit-CCFFH-2015-1.pdf)

Daisy

CCFFH

Daisy Kaneshi

2015 (http://health.hawaii.gov/ohca/files/2016/01/DAISYGANANCIAL-CCFFH-2015.pdf)

Ganancial
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/DaisyKaneshi-CCFFH-2015.pdf)

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Danette

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Zimmerman
David Yamane

Deanna Greig

12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Eden Bachiller

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/DAVID-

Ederlina

CCFFH

YAMANE-CCFFH-2015.pdf)

Manzano

2015 (http://health.hawaii.gov/ohca/files/2015/11/DANETTE-

2016

ZIMMERMAN-CCFFH-2015.pdf)
CCFFH

CCFFH

BACHILLER-CCFFH-2015.pdf)

Edeus

CCFFH

Agbulos

2016

(http://health.hawaii.gov/ohca/files/2016/01/EDERLINA-

(http://health.haw

MANZANO-CCFFH-2015.pdf)

MANZANO-CCFF

2015 (http://health.hawaii.gov/ohca/files/2016/01/EDEUSAGBALOG-CCFFH-2015.pdf)

Agbalog
CCFFH

2015

2015 (http://health.hawaii.gov/ohca/files/2016/01/DEANNAGREIG-CCFFH-2015.pdf)

Dedidia

2015 (http://health.hawaii.gov/ohca/files/2016/01/EDEN-

2015 (http://health.hawaii.gov/ohca/files/2016/01/DEDIDIAAGBULOS-CCFFH-2015.pdf)

Edgar Alba

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/EDGARALBA-CCFFH-2015.pdf)

Delailah

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/DELAILAHSATAKE-CCFFH-2015.pdf)

Satake

Edgar Chua

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/DignaEdita

Quemado-CCFFH-2015.pdf)

Quemado

CCFFH

CCFFH

Edith

CCFFH

CCFFH

2016

MAPANAO-CCFFH-2015.pdf)

Mapanao
Divinagrace

2015 (http://health.hawaii.gov/ohca/files/2016/01/DIVINA-

CCFFH

2015

Editha Soria

CCFFH

Edna Salom

CCFFH

CCFFH

Dominador

2015 (http://health.hawaii.gov/ohca/files/2015/10/Dolores-

Edsa Almazan

2016

CCFFH

Vicencio-CCFFH-2015.pdf)

Vicencio
CCFFH

Soria-CCFFH-20

2015 (http://health.hawaii.gov/ohca/files/2016/01/EDNA-

2015 (http://health.hawaii.gov/ohca/files/2016/01/EdsaAlmazan-CCFFH-2015.pdf)

2015

Efgeni Koh

CCFFH

Eilyn Belizon

CCFFH

Elena Diaz

CCFFH

Elena Etrata

CCFFH

(http://health.hawaii.gov/ohca/files/2015/11/DOMINADOR-

Balinbin

2016 (http://healt

Soria-CCFFH-2015.pdf)

SALOM-CCFFH-2015.pdf)

Ordonia-CCFFH-2015.pdf)
Dolores

2015 (http://health.hawaii.gov/ohca/files/2016/01/Editha-

2016

(http://health.hawaii.gov/ohca/files/2016/03/Divinagrace-

Ordonia

2015 (http://health.hawaii.gov/ohca/files/2016/01/EdithCadiente-CCFFH-2015.pdf)

Cadiente
Divina

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/DinaAgngarayngay-CCFFH-2015.pdf)

Agngarayngay

2015 (http://health.hawaii.gov/ohca/files/2016/01/EDITADOMINGO-CCFFH-2015.pdf)

Domingo
Dina

2015 (http://health.hawaii.gov/ohca/files/2016/01/EDGARCHUA-BARTOLOME-2015.pdf)

Bartolome
Digna

2015 (http://health.hawaii.gov/ohca/files/2016/01/EFGENIKOH-CCFFH-2015.pdf)

BALINBIN-CCFFH-2015.pdf)
Dominica

CCFFH

Doreen

2015 (http://health.hawaii.gov/ohca/files/2016/01/Dominica-

2015 (http://health.hawaii.gov/ohca/files/2016/01/EilynBelizon-CCFFH-2015.pdf)

Tabisola-CCFFH-2015.pdf)

Tabisola
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Doreen-

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELENADIAZ-CCFFH-2015.pdf)

Pagdilao-CCFFH-2015.pdf)

Pagdilao
Dy Malasan

CCFFH

Edelyn

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Dy-

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELENA-

2016

ETRATA-CCFFH-2015.pdf)

Malasan-CCFFH-2015.pdf)
Elena Fronda

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

3/8

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELENA-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELENA-

CCFFH

CCFFH

2016

Elma Saladino

CCFFH

2016

Elma Tierra

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELENITA-

Elmer Perez

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Elisa-

2016

Elsa Atis

CCFFH

2016

Elsie Estalilla

CCFFH

2016

Elsie Javier

CCFFH

CCFFH

Elizabeth

CCFFH

Cabanatuan
Elizabeth

CCFFH

Elsie Labayog

CCFFH

2016

Elvira

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELSIELABAYOG-CCFFH-2015.pdf)

2016

Cabantuan-CCFFH-2015.pdf)

Fernandez

2015

Emely Castro

2015 (http://health.hawaii.gov/ohca/files/2015/11/ELVIRA-

2016

FERNANDEZ-CCFFH-2015.pdf)
CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/ELIZABETH-

Calucag

2015 (http://health.hawaii.gov/ohca/files/2015/11/ElsieJavier-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELISHA-

2015 (http://health.hawaii.gov/ohca/files/2015/11/Elizabeth-

2015 (http://health.hawaii.gov/ohca/files/2016/01/ElsieEstalilla-CCFFH-2015.pdf)

MARIE-ACOL-CCFFH-2015.pdf)

Acol

2015 (http://health.hawaii.gov/ohca/files/2015/11/Elsa-AtisCCFFH-2015.pdf)

Suniga-CCFFH-2015.pdf)
Elisha Marie

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELMERPEREZ-CCFFH-2015.pdf)

VITUG-CCFFH-2015.pdf)
Elisa Suniga

2015 (http://health.hawaii.gov/ohca/files/2016/01/ElmaTierra-CCFFH-2015.pdf)

VILORIA-CCFFH-2015.pdf)
Elenita Vitug

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELMASALADINO-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/10/Elena-

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELENA-

4/8

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Sarte-CCFFH-2015.pdf)
Elena Viloria

Fronda-CCFFH-2

12/12/2016

PUESTA-CCFFH-2015.pdf)
Elena Sarte

2016 (http://healt

FRONDA-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

LARAGAN-CCFFH-2015.pdf)
Elena Puesta

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELENA-

Baltazar-CCFFH-2015.pdf)

Baltazar

Elena Laragan

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Edelyn-

2015 (http://health.hawaii.gov/ohca/files/2016/01/EMELY-

2016 #1 (http://he

CASTRO-CCFFH-2015.pdf)

CASTRO-CCFFH

CALUCAG-CCFFH-2015.pdf)
Emie Joy
Elizabeth

CCFFH

Catalan

2015

2016 (http://healt

(http://health.hawaii.gov/ohca/files/2016/01/ELIZABETH-

Catalan-CCFFH-

CCFFH

Emilia

CATALAN-CCFFH-2015.pdf)

CCFFH

CCFFH

Emilio Andres

CCFFH

Emilita Aquino

CCFFH

CCFFH

Elizabeth

CCFFH

Emily Justo

CCFFH

Ellen Grace
Ruiz

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Elizabeth-

2015 (http://health.hawaii.gov/ohca/files/2016/01/EMILYJUSTO-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/ELLEN-

2016 (http://healt

CRUZ-CCFFH-2015.pdf)

CCFFH-2016.pdf

2015 (http://health.hawaii.gov/ohca/files/2016/01/Ellen-

2016

Emily Mariano

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/EMILY-

2016

MARIANO-CCFFH-2015.pdf)
Emily Rivera

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/EmilyRivera-CCFFH-2015.pdf)

Grace-Ruiz-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

2015 (http://health.hawaii.gov/ohca/files/2016/01/EMILITAAQUINO-CCFFH-2015.pdf)

Soriano-CCFFH-2015.pdf)

Soriano
Ellen Cruz

2015 (http://health.hawaii.gov/ohca/files/2016/01/ElizabethPastor-CCFFH-2015.pdf)

Pastor

2015 (http://health.hawaii.gov/ohca/files/2015/10/EmilioAndres-CCFFH-2015.pdf)

ETRATA-CCFFH-2015.pdf)
Elizabeth

2016

2015
(http://health.hawaii.gov/ohca/files/2015/11/ELIZABETH-

Etrata

2015 (http://health.hawaii.gov/ohca/files/2016/01/EMILIANAVARRO-CCFFH-2015.pdf)

Navarro
Elizabeth

2015 (http://health.hawaii.gov/ohca/files/2015/11/EMIE-JOYPOMOY-CCFFH-2015.pdf)

Pomoy

5/8

http://health.hawaii.gov/ohca/inspection-reports/

6/8

 12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Emma

CCFFH

Banaticla
Emma Pasion

CCFFH

Cacho

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2015/11/Emma-

Esmeralda

Banaticla-CCFFH-2015.pdf)

Laxamana

2015 (http://health.hawaii.gov/ohca/files/2016/01/EMMA-

Esmeralda

PASION-CACHO-CCFFH-2015.pdf)

Racachot

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Esmeralda-

2016

Laxamana-CCFFH-2015.pdf)
CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/ESMERALDARACACHOT-CCFFH-2015.pdf)

Emmanuel

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/EmmanuelArreza-CCFFH-2015.pdf)

Arreza

Estela Galera

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ESTELAGALERA-CCFFH-2015.pdf)

Emmanuelle

CCFFH

Calaycay

2015
(http://health.hawaii.gov/ohca/files/2016/01/Emmanuelle-

Estela Ventura

CCFFH

Calaycay-CCFFH-2015.pdf)
Emylyn

CCFFH

Ventura-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/Emylyn-

2016

Estelita

Malapit-CCFFH-2015.pdf)

Malapit
Encarnacion

CCFFH

Mendez

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/ENCARNACION-

(http://health.haw

MENDEZ-CCFFH-2015.pdf)

MENDEZ-CCFFH

CCFFH

Era Luczon

CCFFH

Ester Nones

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Enrica-

CCFFH

2016

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/ESTERLYN-

Cruz

DELA-CRUZ-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/ERA-

2016

Esther Corpuz

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Ericson-

Estrelita

CCFFH

Aczon-CCFFH-2015.pdf)

Caramancion

LUCZON-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/ESTERNONES-CCFFH-2015.pdf)

Asio-CCFFH-2015.pdf)

Ericson Aczon

2015 (http://health.hawaii.gov/ohca/files/2015/11/EstelitaBatoon-CCFFH-2015.pdf)

Batoon

Esterlyn Dela
Enrica Asio

2015 (http://health.hawaii.gov/ohca/files/2015/10/Estela-

2015 (http://health.hawaii.gov/ohca/files/2015/03/EstherCorpuz-CCFFH-2015.pdf)
2015
(http://health.hawaii.gov/ohca/files/2015/11/ESTRELITACARAMANCION-CCFFH-2015.pdf)

Erlinda Ibarra

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Erlinda-

2016

Ibarra-CCFFH-2015.pdf)

Estrelita

CCFFH

Gaoiran
Erlinda Ibus

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ERLINDA-

2016 (http://healt

IBUS-CCFFH-2015.pdf)

IBUS-CCFH-201

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Erlinda-

Erlinda Ortal

CCFFH

CCFFH

Paguirigan
Erma Tagaca

CCFFH

2015
CARLOS-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/Erlinda-

Ethel Ah Lo

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ERLINDA-

Eufemia

CCFFH

PAGUIRIGAN-CCFFH-2015.pdf)

Aguada

Ortal-CCFFH-2015.pdf)
Erlinda

Gaoiran-CCFFH-

(http://health.hawaii.gov/ohca/files/2016/01/ESTRELLA-

Kimura-CCFFH-2015.pdf)

Kimura

2016 (http://healt

(http://health.hawaii.gov/ohca/files/2016/01/ESTRELITAGAOIRAN-CCFFH-2015.pdf)

Estrella Carlos
Erlinda

2015

2015 (http://health.hawaii.gov/ohca/files/2016/01/ETHELAH-LO-CCFFH-2015.pdf)
2015 (http://health.hawaii.gov/ohca/files/2015/11/EUFEMIAAGUADA-CCFFH-2015.pdf)

Showing 701 to 800 of 1,755 entries

2015 (http://health.hawaii.gov/ohca/files/2016/01/ERMA-

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TAGACA-CCFFH-2015.pdf)

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12/12/2016

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

Evelyn

Name of
Facility



Eufrocinia

entries
Facility
Type
CCFFH



Evelyn



2015

Inspection Reports

CCFFH

Eulalio

CCFFH

CCFFH

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Eunice-

2015 (http://health.hawaii.gov/ohca/files/2015/11/Eva-

CCFFH

Felicitas

Fely

Filipina

Evelyn

CCFFH

Filma

Evelyn

CCFFH

Evelyn
Curameng

2016

Filomena

CCFFH

CCFFH

CCFFH

2016 (http://health.haw

Manera-CCFFH-2015.pdf)

Manera-CCFFH-2016.

2015 (http://health.hawaii.gov/ohca/files/2015/11/FEBY-

2015 (http://health.hawaii.gov/ohca/files/2016/03/Feby-

2015 (http://health.hawaii.gov/ohca/files/2015/11/Felice-

2016

2015 (http://health.hawaii.gov/ohca/files/2015/03/Felicitas-

2015 (http://health.hawaii.gov/ohca/files/2016/01/FELY-

2016

2015
(http://health.hawaii.gov/ohca/files/2016/01/FILIPINAGANANCIAL-ANDRES-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/FilmaBenigno-CCFFH-2015.pdf)

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/FILOMENABONOAN-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/EvelynFina

CCFFH

Florante
Solis

2015 (http://health.hawaii.gov/ohca/files/2016/01/EVELYN-

2015 (http://health.hawaii.gov/ohca/files/2016/01/FINA-

2016

RAMOS-CCFFH-2015.pdf)

Ramos

2015 (http://health.hawaii.gov/ohca/files/2016/01/EVELYN-

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/11/FLORANTESOLIS-CCFFH-2015.pdf)

CURAMENG-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

2015 (http://health.hawaii.gov/ohca/files/2015/10/Fe-

BARAYUGA-CCFFH-2015.pdf)

Bonoan

BELTRAN-CCFFH-2015.pdf)

Beltran

2015 (http://health.hawaii.gov/ohca/files/2016/01/FE-

Pascual-CCFFH-2015.pdf)

Benigno

Arrocena-CCFFH-2015.pdf)

Arrocena

CCFFH

Andres

Argel-CCFFH-2015.pdf)

Argel

2016

Guillermo-CCFFH-2015.pdf)

Ganancial-

2015

2015 (http://health.hawaii.gov/ohca/files/2016/03/Evelyn-

2015 (http://health.hawaii.gov/ohca/files/2016/03/Evelyn-

Josue-CCFFH-2015.pdf)
CCFFH

Barayuga

2015

SUNAJO-CCFFH-2015.pdf)
CCFFH

2016

ADVIENTO-CCFFH-2015.pdf)
CCFFH

Pascual

2016

(http://health.hawaii.gov/ohca/files/2016/01/EVANGELINE-

Sunajo

CCFFH

Guillermo

2016

Dongalen-CCFFH-2015.pdf)

Evelyn

CCFFH

Felice

(http://health.hawaii.gov/ohca/files/2015/03/Evangeline-

Dongalen

Evangeline

Fe Manera

Josue

2016

Bantolina-CCFFH-2015.pdf)

Bantolina
Evangeline

CCFFH

Feby

Aguilar-CCFFH-2015.pdf)

Aguilar
Eva

2015 (http://health.hawaii.gov/ohca/files/2016/01/Eulalio-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Evelyn-

Ruiz-CCFFH-2015.pdf)

Adviento

2015 (http://health.hawaii.gov/ohca/files/2016/01/EUGINE-

Nana-CCFFH-2015.pdf)

Nana
Eunice

CCFFH

Fe Dumlao

Feby

GANIR-CCFFH-2015.pdf)

Ganir

2016

DUMLAO-CCFFH-2015.pdf)

2016
Mendoza-CCFFH-2016

Eugine

CCFFH

(http://health.hawaii.go

Mendoza

2015 (http://health.hawaii.gov/ohca/files/2015/11/EvelynJornacion-CCFFH-2015.pdf)

Ruiz

Search:
Inspection Reports

CCFFH

Mar-CCFFH-2015.pdf)

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
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Flordelisa

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Tomas

12/12/2016

2015

Francisco

(http://health.hawaii.gov/ohca/files/2016/01/Flordelisa-

Redona

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

CCFFH

2015

Redona-CCFFH-2015.pdf)
2016

Gay

(http://health.hawaii.gov/ohca/files/2016/01/FLORDELIZA-

Onaga

2016

(http://health.hawaii.gov/ohca/files/2015/11/Francisco-

Tomas-CCFFH-2015.pdf)
Flordeliza

2015

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Gay-

2016

Marie-Ruedo-CCFFH-2015.pdf)

Ruedo

ONAGA-CCFFH-2015.pdf)
Genevieve
Florence

CCFFH

2015

Gadian

(http://health.hawaii.gov/ohca/files/2016/01/FLORENCE-

Selser

GADIAN-SELSER-2015.pdf)
CCFFH

2015

(http://health.hawaii.gov/ohca/files/2016/01/GENEVIEVE-

2016

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/10/Genoveva-

Lagat

(http://health.hawaii.gov/ohca/files/2015/11/FLORENCE-

Gaygay

2015
WASSON-CCFFH-2015.pdf)

Genoveva
Florence

CCFFH

Wasson

Lagat-CCFFH-2015.pdf)

GAYGAY-CCFFH-2015.pdf)
Gerlie
Florencia

CCFFH

2015

CCFFH

Gina

Jose-CCFFH-2015.pdf)

CCFFH

CCFFH

Ramiro

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/Florencio-

Gina

Ramiro-CCFFH-2015.pdf)

Yoshikawa

2015

Ginalyn

2016

CCFFH

CCFFH

CCFFH

Domingo
Florily

CCFFH

Espina

PAGUIRIGAN-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/FLORIE-

Girlie

DOMINGO-CCFFH-2015.pdf)

Bigornia

2015

Gladys

(http://health.hawaii.gov/ohca/files/2015/11/FLORILY-

Asuncion

ESPINA-CCFFH-2015.pdf)
Florimar

CCFFH

2015

Gladys

CCFFH

2015

CCFFH

Glenda

Garcia-CCFFH-2015.pdf)
CCFFH

4/9

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2015

CCFFH

2016

2015 (http://health.hawaii.gov/ohca/files/2015/11/Gloria-

Hildegard

5/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/HILDEGARD-

Akee

AKEE-CCFFH-2015.pdf)
Iluminada

2016

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/ILUMINADA-

Domingo

Agtang-CCFFH-2015.pdf)

Agtang

2016

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

(http://health.hawaii.gov/ohca/files/2016/01/GLODYLYN-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/GlennaMcCabe-CCFFH-2015.pdf)

ARIOTA-CCFFH-2015.pdf)
Gloria

2015
(http://health.hawaii.gov/ohca/files/2016/01/GLENDA-

McCabe

http://health.hawaii.gov/ohca/inspection-reports/

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Glenda-

RAMO-CCFFH-2015.pdf)
Glenna

GAY-YA-CCFFH-2015.pdf)

Ariota

CCFFH

2015

12/12/2016

2015
(http://health.hawaii.gov/ohca/files/2016/01/GLADYS-

Ramo

(http://health.hawaii.gov/ohca/files/2016/01/FRANCES-

Gay-Ya

Glodylyn

Asuncion-CCFFH-2015.pdf)
CCFFH

Garcia

2016

BALAUAG-CCFFH-2015.pdf)
Frances

2015 (http://health.hawaii.gov/ohca/files/2015/10/Gladys-

CASTILLO-CCFFH-2015.pdf)
Glenda

(http://health.hawaii.gov/ohca/files/2015/11/FLORIMEL-

Balauag

2015 (http://health.hawaii.gov/ohca/files/2015/10/GirlieBigornia-CCFFH-2015.pdf)

CCFFH

Castillo

2016

JAY-MIYAT-CCFFH-2015.pdf)
Florimel

CCFFH

(http://health.hawaii.gov/ohca/files/2015/11/FLORIMAR-

Jay Miyat

2015
(http://health.hawaii.gov/ohca/files/2016/01/GINALYN-

SANDI-CCFFH-2015.pdf)
Florie

2015 (http://health.hawaii.gov/ohca/files/2015/11/GinaYoshikawa-CCFFH-2015.pdf)

Paguirigan

(http://health.hawaii.gov/ohca/files/2016/01/FLORENCIO-

Sandi

2015 (http://health.hawaii.gov/ohca/files/2015/11/GinaCacayan-CCFFH-2015.pdf)

Cacayan

Florencio

2016

(http://health.hawaii.gov/ohca/files/2015/10/Florencia-

Jose

Florencio

2015 (http://health.hawaii.gov/ohca/files/2016/01/GERLIEMIGUEL-CCFFH-2015.pdf)

Miguel

DOMINGO-CCFFH-2015.pdf)
Gloria

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/GLORIACABANERO-CCFFH-2015.pdf)

Cabanero

Imelda

CCFFH

Grace

CCFFH

Imelda

CCFFH

CCFFH

Imelda

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Grace-

2016

Tirador-CCFFH-2015.pdf)

Tirador

Imelda Del

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/GretaGamalog-CCFFH-2015.pdf)

Gamalog

Imelda

CCFFH

CCFFH

Cruz

Helen

CCFFH

Balila
Helen

CCFFH

Claveria
Helen

CCFFH

Mollman
Helen

CCFFH

Pascua

2015 (http://health.hawaii.gov/ohca/files/2015/11/ImeldaSausal-CCFFH-2015.pdf)

Sausal
Gudelia

2015 (http://health.hawaii.gov/ohca/files/2015/11/ImeldaDel-Rosario-CCFFH-2015.pdf)

Rosario
Greta

2015 (http://health.hawaii.gov/ohca/files/2015/11/ImeldaDeJesus-CCFFH-2015.pdf)

DeJesus
Grace

2016

2015 (http://health.hawaii.gov/ohca/files/2016/03/GraceJadulang-CCFFH-2015.pdf)

Jadulang

2015 (http://health.hawaii.gov/ohca/files/2016/01/IMELDACORDERO-CCFFH-2015.pdf)

Cordero
Grace

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/GRACEDOLOR-CCFFH-2015.pdf)

Dolor

2015 (http://health.hawaii.gov/ohca/files/2016/01/IMELDAALBANO-CCFFH-2015.pdf)

Albano

2015
(http://health.hawaii.gov/ohca/files/2016/01/GUDELIA-

Imelda

CRUZ-CCFFH-2015.pdf)

Vea

2015 (http://health.hawaii.gov/ohca/files/2016/01/HELEN-

Imelda

BALILA-CCFFH-2015.pdf)

Viernes

2015 (http://health.hawaii.gov/ohca/files/2016/01/HELEN-

Imelda

CLAVERIA-CCFFH-2015.pdf)

Villaspir

2015 (http://health.hawaii.gov/ohca/files/2015/10/Helen-

Irene

Mollman-CCFFH-2015.pdf)

Vidad

2015 (http://health.hawaii.gov/ohca/files/2015/11/Helen-

Jan

Pascua-CCFFH-2015.pdf)

Gladhar

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/ImeldaVea-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/IMELDAVIERNES-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/IMELDAVILLASPIR-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/IRENEVIDAD-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Jan-

2016

Gladhar-Rosario-CCFFH-2015.pdf)

Rosario
Herbert

CCFFH

Sales

Hermelita
Martinez

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/HERBERT-

Janet

SALES-CCFFH-2015.pdf)

Agbunag

2015

Janet

(http://health.hawaii.gov/ohca/files/2016/01/HERMELITA-

Bautista

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/03/JanetAgbunag-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/JanetBautista-CCFFH-2015.pdf)

MARTINEZ-CCFFH-2015.pdf)
Janette
Nino
http://health.hawaii.gov/ohca/inspection-reports/

6/9

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/JanetteNino-CCFFH-2015.pdf)

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7/9

 12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Jasmine

CCFFH

Rivera
Jason

2015 (http://health.hawaii.gov/ohca/files/2015/10/Jasmine-

Jerome

Rivera-CCFFH-2015.pdf)

Ulep

2015 (http://health.hawaii.gov/ohca/files/2015/10/Jason-

CCFFH

12/12/2016

CCFFH

Jessica

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JAYVIE-

CCFFH

2016

(http://health.hawaii.gov/ohca/files/2016/01/JEROME-

(http://health.hawaii.go

ULEP-CCFFH-2015.pdf)

Ulep-CCFFH-2016.pdf

2015

2016 #1 2016 #2

(http://health.hawaii.gov/ohca/files/2016/01/JESSICA-

Domingo
Jayvie

2015

2016

Arrocena-CCFFH-2015.pdf)

Arrocena

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

DOMINGO-CCFFH-2015.pdf)

SUMOBA-CCFFH-2015.pdf)

Sumoba

Jessie
Jayzel

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/03/Jayzel-

Pangilinan

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/JESSIESILAO-CCFFH-2015.pdf)

Silao

Pangilinan-CCFFH-2015.pdf)
Jessie

Jean

2015 (http://health.hawaii.gov/ohca/files/2015/11/Jean-

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JESSIEVILLANUEVA-CCFFH-2015.pdf)

Villanueva

Prieto-CCFFH-2015.pdf)

Prieto

Jesus
Jeanilette

CCFFH

Delos

2015

Malunao

(http://health.hawaii.gov/ohca/files/2016/03/Jeanilette-

Jr.

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JESUSMALUNAO-JR-CCFFH-2015.pdf)

Delos-Santos-CCFFH-2015.pdf)

Santos

Showing 801 to 900 of 1,755 entries
Jeanna

CCFFH

 Previous Next 

2015
(http://health.hawaii.gov/ohca/files/2016/01/JEANNA-

Mongco

MONGCO-CCFFH-2015.pdf)
Jeanne

2015

CCFFH

2016

(http://health.hawaii.gov/ohca/files/2016/01/JEANNE-

Reutirez

REUTIREZ-CCFFH-2015.pdf)
Jedeliah

2015

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/JEDELIAH-

Felix

FELIX-CCFFH-2015.pdf)
Jenifer

2015

CCFFH

2016

(http://health.hawaii.gov/ohca/files/2016/01/JENIFER-

Delos
Trinos

DELOS-TRINOS-CCFFH-2015.pdf)

Jennifer

2015 (http://health.hawaii.gov/ohca/files/2016/03/Jennifer-

CCFFH

2016

Kaukeano-CCFFH-2015.pdf)

Kaukeano
Jennivic

2015

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/JENNIVIC-

Batle

BATLE-CCFFH-2015.pdf)
Jeogy

2015 (http://health.hawaii.gov/ohca/files/2016/01/JEOGY-

CCFFH

PAGTAMA-CCFFH-2015.pdf)

Pagtama
Jeramie

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Jeramie-

2016

Ulep-CCFFH-2015.pdf)

Ulep

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

8/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

Jocelyn

Name of
Facility



entries
Facility
Type



Joel



Joerelyn

Inspection Reports

2015 (http://health.hawaii.gov/ohca/files/2015/10/JocelynLomboya-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Jocelyn-

2016

Ramelb-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JOELROSALES-CCFFH-2015.pdf)

Rosales

Search:
Inspection Reports

CCFFH

Ramelb

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).
Show 100

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Lomboya
Jocelyn

9/9

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/10/Joerelyn-

Bugauisan

Bugauisan-CCFFH-2015.pdf)
Jesusa

CCFFH

Guillermo

Jesusa

CCFFH

Ramos

2015
(http://health.hawaii.gov/ohca/files/2016/01/JESUSA-

John

GUILLERMO-CCFFH-2015.pdf)

Ignacio

2015 (http://health.hawaii.gov/ohca/files/2016/01/Jesusa-

Johnathan

Ramos-CCFFH-2015.pdf)

Abania

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JOHN-

2016

IGNACIO-CCFFH-2015.pdf)
CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/JOHNATHANABANIA-CCFFH-2015.pdf)

Jesusa

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Jesusa-

2016
Jojie

Sebastian-CCFFH-2015.pdf)

Sebastian

CCFFH

Jhanette

CCFFH

Navarrete

Jin-ok Ra

CCFFH

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/JHANETTE-

Jomar

NAVARRETE-CCFFH-2015.pdf)

Espiritu

2015 (http://health.hawaii.gov/ohca/files/2016/01/JIN-OK-

2016 #1

Jonathan

RA-CCFFH-2015.pdf)

(http://health.hawaii.gov

Beltran

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Jinalyn-

2015 (http://health.hawaii.gov/ohca/files/2015/11/JOMAR-

2016

ESPIRITU-CCFFH-2015.pdf)
CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/10/JonathanBeltran-CCFFH-2015.pdf)

Joni-Lyne

2016

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Joni-

2016

Lyne-April-Nocolas-Danao-CCFFH-2015.pdf)

April

Bulosan-CCFFH-2015.pdf)

Bulosan

2016

2015

CCFFH-2016.pdf) , 201
Jinalyn

2015 (http://health.hawaii.gov/ohca/files/2016/01/JOJIEFILBURN-CCFFH-2015.pdf)

Filburn

Nocolas
Joane

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JOANE-

Danao

2016

CARIAGA-CCFFH-2015.pdf)

Cariaga

Josefa
Joanne

CCFFH

CCFFH

Dela Cruz

BADUA-CCFFH-2015.pdf)

2015

Josefina

(http://health.hawaii.gov/ohca/files/2016/01/JOCELYN-

Ownbey

CCFFH

Lazo

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/JosefinaOwnbey-CCFFH-2015.pdf)

DELA-CRUZ-CCFFH-2015.pdf)
Jocelyn

2015
(http://health.hawaii.gov/ohca/files/2016/01/JOSEFA-

Baysa-CCFFH-2015.pdf)

Baysa
Jocelyn

CCFFH

Badua

2015 (http://health.hawaii.gov/ohca/files/2015/11/Joanne-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Jocelyn-

Josefina

Lazo-CCFFH-2015.pdf)

Saoit

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/11/JOSEFINASAOIT-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

2/9

http://health.hawaii.gov/ohca/inspection-reports/

3/9

 12/12/2016

Joseph

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Cauton
Josephine

CCFFH

Bio

Josephine

CCFFH

Cabalo

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2015/10/Joseph-

Jovelyn

Cauton-CCFFH-2015.pdf)

Sumaoang

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/JOVELYN-

(http://health.hawaii.gov

SUMAOANG-CCFFH-2015.pdf)

Sumaoang-CCFFH-20

2015
(http://health.hawaii.gov/ohca/files/2016/03/Josephine-

Jovy

Bio-CCFFH-2015.pdf)

Bumanglag

2015

Joyce

(http://health.hawaii.gov/ohca/files/2015/10/Josephine-

Albano

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JovyBumanglag-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JOYCEALBANO-CCFFH-2015.pdf)

Cabalo-CCFFH-2015.pdf)
Joyce
Josephine

CCFFH

2015

2016

CCFFH

Juanita

Domingo-CCFFH-2015.pdf)

CCFFH

2016 #1, 2016 #2

CCFFH

Ganancial

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/JOSEPHINE-

(http://health.hawaii.gov

Juanita

GANANCIAL-CCFFH-2015.pdf)

Ganancial-CCFFH-201

Ramos

2015

2016

2015 (http://health.hawaii.gov/ohca/files/2015/11/JuanitaNaone-CCFFH-2015.pdf)

Naone
Josephine

2015 (http://health.hawaii.gov/ohca/files/2015/11/JoyceSharsy-CCFFH-2015.pdf)

Sharsy

(http://health.hawaii.gov/ohca/files/2016/03/Josephine-

Domingo

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/JUANITARAMOS-CCFFH-2015.pdf)

Josephine

CCFFH

Jacinto

Josephine

CCFFH

Javar

(http://health.hawaii.gov/ohca/files/2015/11/Josephine-

Juanita

Jacinto-CCFFH-2015.pdf)

Sagon

2015

Judilyn

(http://health.hawaii.gov/ohca/files/2016/01/Josephine-

Arruda

CCFFH

Sagon-CCFFH-2015.pdf)
CCFFH

CCFFH

2015

ARRUDA-CCFFH-2015.pdf)
Judith De

2016

PASCUA-CCFFH-2015.pdf)
Josephine

CCFFH

Judy

Julia Balon

SAGAYAGA-CCFFH-2015.pdf)
Josephine

CCFFH

Josette

CCFFH

2015

Julien

TABUCBUC-CCFFH-2015.pdf)

Vergara

2015

Juliet

FALLE-CCFFH-2015.pdf)
Jovedelin

CCFFH

Julieta

Julita Porte

Suniga-CCFFH-2015.pdf)

Junie Sales

4/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Junie-

2015 (http://health.hawaii.gov/ohca/files/2015/11/JULIA-

2016

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/JULIEN-

2016

VERGARA-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/JULIETTACLAY-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/JulietaBonilla-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/JULITA-

2016

PORTE-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2016/03/JudyAguinaldo-CCFFH-2015.pdf)

CCFFH

Bonilla

2015
(http://health.hawaii.gov/ohca/files/2016/03/Jovedelin-

Suniga

CCFFH

Taclay

(http://health.hawaii.gov/ohca/files/2016/01/JOSETTE-

Falle

2016

BALON-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2015/11/JOSEPHINE-

Tabucbuc

2015 (http://health.hawaii.gov/ohca/files/2016/01/JUDITHDE-LOS-TRINO-CCFFH-2015.pdf)

Aguinaldo

2015
(http://health.hawaii.gov/ohca/files/2016/01/JOSEPHINE-

Sagayaga

CCFFH

Los Trino

(http://health.hawaii.gov/ohca/files/2016/01/JOSEPHINE-

Pascua

2015
(http://health.hawaii.gov/ohca/files/2015/11/JUDILYN-

Javar-CCFFH-2015.pdf)
Josephine

2015 (http://health.hawaii.gov/ohca/files/2015/10/Juanita-

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2016

Lani

Sales-CCFFH-2015.pdf)

5/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LANIKAMAKAHI-KAPAONA-CCFFH-2015.pdf)

KamakahiKapaona

Juvelyn

CCFFH

Edades

Karen

CCFFH

Asuncion
Karen

CCFFH

Cabuyadao

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/JUVELYN-

Laura Dela

EDADES-CCFFH-2015.pdf)

Cruz

2015 (http://health.hawaii.gov/ohca/files/2015/11/KAREN-

Lauren

ASUNCION-CCFFH-2015.pdf)

Paguirigan

2015 (http://health.hawaii.gov/ohca/files/2015/11/KAREN-

Lawrence

CABUYADAO-CCFFH-2015.pdf)

Sabangan

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/LauraDela-Cruz-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LaurenPaguirigan-CCFFH-2015.pdf)

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/LAWRENCESABANGAN-CCFFH-2015.pdf)

Karen Gay

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/KARENGAY-ANTONIO-CCFFH-2015.pdf)

Antonio

Leila

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/KAREN-

Leilanie

CCFFH

Leilanie

CCFFH

CCFFH

Fernando

Kayoko

CCFFH

Miura

2015 (http://health.hawaii.gov/ohca/files/2016/03/LeilanieSacro-CCFFH-2015.pdf)

Sacro
Katherine

2016

2015 (http://health.hawaii.gov/ohca/files/2016/03/KarenYamashita-CCFFH-2015.pdf)

Yamashita

2015 (http://health.hawaii.gov/ohca/files/2016/01/LeilanieFrazee-CCFFH-2015.pdf)

Frazee
CCFFH

2016

2016

TOMLINS-CCFFH-2015.pdf)

Tomlins
Karen

2015 (http://health.hawaii.gov/ohca/files/2015/10/LeilaStringer-CCFFH-2015.pdf)

Stringer
Karen

2015
(http://health.hawaii.gov/ohca/files/2015/10/Katherine-

Leilanie

Fernando-CCFFH-2015.pdf)

Tanaka

2015 (http://health.hawaii.gov/ohca/files/2016/01/Kayoko-

2016

Lene Rose

Miura-CCFFH-2015-1.pdf)

(http://health.hawaii.gov

Galiza

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Leilanie-

2016

Tanaka-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LENEROSE-GALIZA-CCFFH-2015.pdf)

MIURA-CCFFH-2016.p
Lenie
Kristine

CCFFH

2015

2016

CCFFH

(http://health.hawaii.gov/ohca/files/2015/11/KRISTINE-

Dalisay

Leonarda

DALISAY-CCFFH-2015.pdf)

CCFFH

CCFFH

2015

Batulayan-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2015/11/KRISTINE-

Vicente

Leonora

VICENTE-CCFFH-2015.pdf)

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LA-

2016

Antonio-CCFFH-2015.pdf)

VONNIE-FIKES-CCFFH-2015.pdf)

Fikes

Leslie
Laarnie

CCFFH

2015

Lewelyn

ANN-BUCCAT-CCFFH-2015.pdf)

Degracia
Arellano

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/LesliePascual-CCFFH-2015.pdf)

Pascual

(http://health.hawaii.gov/ohca/files/2016/01/LAARNIE-

Ann Buccat

Lani

2015
(http://health.hawaii.gov/ohca/files/2016/03/Leonora-

Antonio
La Vonnie

2015
(http://health.hawaii.gov/ohca/files/2015/11/Leonarda-

Batulayan
Kristine

2015 (http://health.hawaii.gov/ohca/files/2016/01/LENIEALLERA-CCFFH-2015.pdf)

Allera

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Lani-

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/LEWELYNDEGRACIA-CCFFH-2015.pdf)

Arellano-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

6/9

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7/9

 12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Lexter

CCFFH

2015

Bonquin

12/12/2016

2016

Lily

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Mendoza

(http://health.hawaii.gov/ohca/files/2016/01/LEXTER-

2015 (http://health.hawaii.gov/ohca/files/2016/01/LILYMENDOZA-CCFFH-2015.pdf)

BONQUIN-CCFFH-2015.pdf)
Lily
Liana

2015 (http://health.hawaii.gov/ohca/files/2016/01/Liana-

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/LilyZafaralla-CCFFH-2015.pdf)

Zafaralla

Giffard-CCFFH-2015.pdf)

Giffard

Liza
Liberty

2015

CCFFH

2016

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LIZA-

2016

GOZUM-CCFFH-2015.pdf)

Gozum

(http://health.hawaii.gov/ohca/files/2016/01/LIBERTY-

Albano

Lodenila

ALBANO-CCFFH-2015.pdf)

CCFFH

2015

CCFFH

2016
Lolita

EVANGELISTA-CCFFH-2015.pdf)

CCFFH

Lolita Lejat

(http://health.hawaii.gov/ohca/files/2016/01/LIBERTY-

Lagpacan

CCFFH

2016

CCFFH

Badua
CCFFH

Dugay

2015 (http://health.hawaii.gov/ohca/files/2016/01/LOLITA-

2016

LEJAT-CCFFH-2015.pdf)

LAGPACAN-CCFFH-2015.pdf)

Ligaya

2015 (http://health.hawaii.gov/ohca/files/2015/10/LolitaAgudelo-CCFFH-2015.pdf)

Agudelo
2015

CCFFH

Ligaya

2016 #1, 2016 #2

Ramos-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/LIBERTY-

Evangelista

Liberty

2015
(http://health.hawaii.gov/ohca/files/2015/11/Lodenila-

Ramos
Liberty

2015 (http://health.hawaii.gov/ohca/files/2016/03/Ligaya-

Lolita

Badua-CCFFH-2015.pdf)

Velasco

2015 (http://health.hawaii.gov/ohca/files/2016/01/LIGAYA-

Loreen

DUGAY-CCFFH-2015.pdf)

Troxel

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/LolitaVelasco-CCFFH-2015.pdf)

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/LOREENTROXEL-CCFFH-2015.pdf)

Ligaya

2015 (http://health.hawaii.gov/ohca/files/2016/01/LIGAYA-

CCFFH

Showing 901 to 1,000 of 1,755 entries

FERNANDEZ-CCFFH-2015.pdf)

Fernandez
Lilia Basilio

2015 (http://health.hawaii.gov/ohca/files/2015/10/Lilia-

CCFFH

 Previous Next 

2016

Basilio-CCFFH-2015.pdf)
Lilia

2015 (http://health.hawaii.gov/ohca/files/2016/01/LILIA-

CCFFH

GALUTIRA-CCFFH-2015.pdf)

Galutira
Lilia Rafael

CCFFH

Lilian

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LILIARAFAEL-CCFFH-2015.pdf)
2015 (http://health.hawaii.gov/ohca/files/2016/03/Lilian-

2016

Joaquin-CCFFH-2015.pdf)

Joaquin
Lilibeth

2015

CCFFH

2016

(http://health.hawaii.gov/ohca/files/2016/01/LILIBETH-

Maramag

MARAMAG-CCFFH-2015.pdf)
Lily Jacinto

2015 (http://health.hawaii.gov/ohca/files/2016/01/LILY-

CCFFH

JACINTO-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

8/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

Lucila

Name of
Facility



entries
Facility
Type

Inspection Reports

CCFFH

2015

2016

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/LUCRECIAUMAGAT-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Lucresia-

2016

Agtarap-CCFFH-2015.pdf)

Agtarap

2016

(http://health.hawaii.gov/ohca/files/2015/11/LORENZA-

Torres

Ludivina

TORRES-CCFFH-2015.pdf)

CCFFH

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/LUDIVINA-

Eder
Loreta

2015
(http://health.hawaii.gov/ohca/files/2016/03/Lucrecia-D-

Inspection Reports
Lucresia

Lorenza

MCCORMACK-CCFFH-2015.pdf)
CCFFH

Umagat



2015 (http://health.hawaii.gov/ohca/files/2015/11/LUCILA-

Paraon-CCFFH-2015.pdf)
Lucrecia

Search:


CCFFH

Paraon

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).
Show 100

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

McCormack
Lucrecia D

9/9

EDER-CCFFH-2015.pdf)

2015
(http://health.hawaii.gov/ohca/files/2015/11/LORETA-

Tabuc

Luz Alonzo

TABUC-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LUZALONZO-CCFFH-2015.pdf)

Loriella

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/LORIELLA-

Fiesta

Luz Ruiz

CCFFH

Luz Tarinay

CCFFH

Lorna

CCFFH

Losaline

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Losaline-

Luz Vea

CCFFH

Luzonica

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Louie-

2016

2016 (http://health.haw

TARIANY-CCFFH-2015.pdf)

Tarinay-CCFFH-2016.

2015 (http://health.hawaii.gov/ohca/files/2016/03/Luz-Vea-

2015
(http://health.hawaii.gov/ohca/files/2016/01/LUZONICA-

Dela Rosa

Bernardo-CCFFH-2015.pdf)

Bernardo

2015 (http://health.hawaii.gov/ohca/files/2016/01/LUZ-

CCFFH-2015.pdf)

Tupouniua-CCFFH-2015.pdf)

Tupouniua
Louie

2015 (http://health.hawaii.gov/ohca/files/2016/01/LORNAMACABURAS-CCFFH-2015.pdf)

Macaburas

2015 (http://health.hawaii.gov/ohca/files/2016/01/LUZRUIZ-CCFFH-2015.pdf)

FIESTA-CCFFH-2015.pdf)

DELA-ROSA-CCFFH-2015.pdf)
Lourdes

CCFFH

Bumanglag

Lovely

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/LOURDES-

Luzviminda

BUMANGLAG-CCFFH-2015.pdf)

Alcon

2015 (http://health.hawaii.gov/ohca/files/2016/01/Lovely-

Luzviminda

CCFFH

CCFFH

2015

Alcon-CCFFH-2016.pd

2015

2016

Godoy-CCFFH-2015.pdf)

2016
Lydia

ANDRES-CCFFH-2015.pdf)

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LYDIACARPIO-CCFFH-2015.pdf)

Carpio
Sibayan

(http://health.hawaii.go

Alcon-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/LUCENA-

Andres

Lucia

2016

(http://health.hawaii.gov/ohca/files/2016/01/Luzviminda-

(http://health.hawaii.gov/ohca/files/2016/01/Luzviminda-

Godoy
Lucena

2015

2016

Tongpalan-CCFFH-2015.pdf)

Tongpalan

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/LuciaLydia

Sibayan-CCFFH-2015.pdf)

Estelita
http://health.hawaii.gov/ohca/inspection-reports/

2/9

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LydiaEstelita-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

3/9

 12/12/2016

Lynn Agno

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LYNN-

12/12/2016

2016

Marcela

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/LYNN-

2016

Marcelina

ANN-LAU-CCFFH-2015.pdf)

Lau

CCFFH

Buted

AGNO-CCFFH-2015.pdf)
Lynn Ann

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

2015 (http://health.hawaii.gov/ohca/files/2015/11/Marcela-

2016

Buted-CCFFH-2015.pdf)
CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/10/Marcelina-

Ladines

Ladines-CCFFH-2015.pdf)
Macrene

CCFFH

Brown

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MACRENE-

Marcelina

BROWN-CCFFH-2015.pdf)

Saoit

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MARCELINASAOIT-CCFFH-2015.pdf)

Madeline

CCFFH

Sagun

2015
(http://health.hawaii.gov/ohca/files/2015/11/Madeline-

Margaret

Sagun-CCFFH-2015.pdf)

Danielewski

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/MARGARETDANIELEWSKI-CCFFH-2015.pdf)

Madeline

CCFFH

Ulep

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MADELINE-

Margarita

ULEP-CCFFH-2015.pdf)

Custodio

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/11/MargaritaCustodio-CCFFH-2015.pdf)

Madelyn

CCFFH

Juliano

Mae Ann

CCFFH

Chu-

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/MADELYN-

Margie

JULIANO-CCFFH-2015.pdf)

Agliam

2015 (http://health.hawaii.gov/ohca/files/2016/01/Mae-

2016 (http://health.haw

Margielyn

Ann-Chu-Calaycay-CCFFH-2015.pdf)

Ann-Chu-Calaycay-CC

Acierto

CCFFH

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MARGIELYNACIERTO-CCFFH-2015.pdf)

CCFFH

Baloran

Magdalena

2016

Agliam-CCFFH-2015.pdf)

Calaycay
Magdalena

2015 (http://health.hawaii.gov/ohca/files/2016/03/Margie-

CCFFH

Bonafe

2015

Mari

(http://health.hawaii.gov/ohca/files/2015/11/MAGDALENA-

Angelene

BALORAN-CCFFH-2015.pdf)

Maluyo

2015

Maria Bella

(http://health.hawaii.gov/ohca/files/2016/01/Magdalena-

Concepcion

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIANGELENE-MALUYO-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIABELLA-CONCEPCION-CCFFH-2015.pdf)

Bonafe-CCFFH-2015.pdf)
Maria
Magdalena

CCFFH

2015

2016

CCFFH

Maria

DULDULAO-CCFFH-2015.pdf)

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/ManuelMaria

Salazar-CCFFH-2015.pdf)

Salazar

CCFFH

CCFFH

2015

Quitevis
Maria

ZALES-CCFFH-2015.pdf)

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Marcela-

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/Maria-

2016

Concepcion-Ped-CCFFH-2015.pdf)

Concepcion
Ped

Briones-CCFFH-2015.pdf)

Briones

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Maria Dela

2016

(http://health.hawaii.gov/ohca/files/2016/01/MANUELA-

Zales

Marcela

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIACHARLOTTE-QUITEVIS-CCFFH-2015.pdf)

Charlotte
Manuela

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIACARIAGA-CCFFH-2015.pdf)

Cariaga
Manuel

2015 (http://health.hawaii.gov/ohca/files/2016/02/MariaCalape-CCFFH-2015.pdf)

Calape

(http://health.hawaii.gov/ohca/files/2015/11/MAGDALENA-

Duldulao

4/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Cruz

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIA-

Marie

DELA-CRUZ-CCFFH-2015.pdf)

Angelie

5/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIEANGELIE-VALENCIA-CCFFH-2015.pdf)

Valencia
Maria Lim

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIA-

2016

LIM-CCFFH-2015.pdf)

Mariefe

CCFFH

Maria

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIA-

GALVEZ-CCFFH-2015.pdf)

LOURDES-GALDONES-CCFFH-2015.pdf)

Lourdes

Marietta

Galdones

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARIA-

FAUSTORILLA-CCFFH-2015.pdf)

MARGARITA-VELEZ-CCFFH-2015.pdf)

Margarita

Marilin

Velez

CCFFH

Mooring
Maria

CCFFH

CCFFH

Mooring-CCFFH-2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/Maria-

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/MARIA-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/MarilouRivera-CCFFH-2015.pdf)

Rivera

SINGSON-BUENO-CCFFH-2015.pdf)

Singson-

Marilou

Bueno

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Maria-

2015
(http://health.hawaii.gov/ohca/files/2015/11/MARILOU-

Tomas
2016

TOMAS-CCFFH-2015.pdf)

Tabladillo-CCFFH-2015.pdf)

Tabladillo

Marilyn
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Mariah-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Marilyn-

2016

Aurelio-CCFFH-2015.pdf)

Aurelio

Angelica-Baloran-Gaerlan-CCFFH-2015.pdf)

Angelica
Baloran

Marilyn

Gaerlan

Castillo

Maribelle

2015 (http://health.hawaii.gov/ohca/files/2015/11/MarilouGuieb-CCFFH-2015.pdf)

Guieb
Marilou

Mariah

(http://health.hawaii.go

Ramos-CCFFH-2015.pdf)

Ramos

Maria

2016

Mooring-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/10/MariaMarilou

Maria

2015 (http://health.hawaii.gov/ohca/files/2016/01/Marilin-

Racachot-CCFFH-2015.pdf)

Racachot
Maria

2015
(http://health.hawaii.gov/ohca/files/2016/01/MARIETTA-

Faustorilla
Maria

2015
(http://health.hawaii.gov/ohca/files/2016/01/MARIEFE-

Galvez

CCFFH

2015

Marilyn

2016

(http://health.hawaii.gov/ohca/files/2015/10/Maribelle-

Agustin

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/MarilynCastillo-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Marilyn-

2016

Dela-Cruz-CCFFH-2015.pdf)

Dela Cruz

Agustin-CCFFH-2015.pdf)
Marilyn
Maricel

CCFFH

2015

CCFFH

FOSTER-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/MARICEL-

Ballares

2015
(http://health.hawaii.gov/ohca/files/2016/01/MARILYN-

Foster

BALLARES-CCFFH-2015.pdf)
Marilyn
Maricel

CCFFH

2015

Marina

ROSARIO-CCFFH-2015.pdf)

Fernandez
Rodriguez

2015 (http://health.hawaii.gov/ohca/files/2016/01/MarilynPurganan-CCFFH-2015.pdf)

Purganan

(http://health.hawaii.gov/ohca/files/2016/01/MARICEL-

Rosario

Maricris

CCFFH

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/MARICRIS-

(http://health.hawaii.go

RODRIGUEZ-CCFFH-2015.pdf)

Rodriguez-CCFFH-20

http://health.hawaii.gov/ohca/inspection-reports/

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/MARINAFERNANDEZ-CCFFH-2015.pdf)

6/9

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Marina

CCFFH

Gamatero

12/12/2016

2015

Marivic

(http://health.hawaii.gov/ohca/files/2015/11/MARINA-

Palting

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/MARIVIC-

GAMATERO-CCFFH-2015.pdf)
Mario

CCFFH

Patricio

2015
PALTING-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/MARIO-

Marivic

PATRICIO-CCFFH-2015.pdf)

Visaya

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/MARIVICVISAYA-CCFFH-2015.pdf)

Mariquit

2015 (http://health.hawaii.gov/ohca/files/2015/11/Mariquit-

CCFFH

Delong-CCFFH-2015.pdf)

Delong

Mariza

CCFFH

Marisol

CCFFH

Ibera
Marites

CCFFH

Marizel

GALZOTE-CCFFH-2015.pdf)

Bolosan

CCFFH

Domingo

2016

Marjorie

Gaspar-CCFFH-2015.pdf)

Yago

2015 (http://health.hawaii.gov/ohca/files/2015/11/Marissa-

Marjory

Ibera-CCFFH-2015.pdf)

Bumatay

2015 (http://health.hawaii.gov/ohca/files/2015/11/Marites-

Anacleto
Marites

(http://health.hawaii.gov/ohca/files/2016/01/MARISOL-

2015 (http://health.hawaii.gov/ohca/files/2016/03/Marissa-

CCFFH

Gaspar
Marissa

2016

Mark

Anacieto-CCFFH-2015.pdf)

Tapangan

2015

Marlene

(http://health.hawaii.gov/ohca/files/2016/01/MARITES-

Diego

CCFFH

CCFFH

2016

Marlin

Edades-CCFFH-2015.pdf)

Edades

2015 (http://health.hawaii.gov/ohca/files/2015/10/MarjorieYago-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Marjory-

2016

Bumatay-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/MARKTAPANGAN-CCFFH-2015.pdf)

CCFFH

2015

2016 #1 2016 #2

(http://health.hawaii.gov/ohca/files/2016/01/MARLENEDIEGO-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2015/11/Marites-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/MarizelBolosan-CCFFH-2015.pdf)

DOMINGO-CCFFH-2015.pdf)
Marites

2016

2015

CCFFH

Galzote

Marissa

2015 (http://health.hawaii.gov/ohca/files/2015/10/MarizaMagana-CCFFH-2015.pdf)

Magana

CCFFH

Reynon

2015 (http://health.hawaii.gov/ohca/files/2015/11/MARLIN-

2016

REYNON-CCFFH-2015.pdf)

(http://health.hawaii.go
Reynon-CCFFH-2016

Marites

2015 (http://health.hawaii.gov/ohca/files/2015/10/Marites-

CCFFH

Marlon

Fabro-CCFFH-2015.pdf)

Fabro

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/MARLON-

Manuel
Marites

2015

CCFFH

2015

2016

MANUEL-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/MARITES-

Fiesta

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Marites

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2015 (http://health.hawaii.gov/ohca/files/2016/03/Marites-

CCFFH

Potot-CCFFH-2015.pdf)

Potot
Maritess

2015

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/Maritess-

Mercado

Mercado-CCFFH-2015.pdf)
Marivic

2015 (http://health.hawaii.gov/ohca/files/2016/02/Marivic-

CCFFH

Gallardo-CCFFH-2015.pdf)

Gallardo

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Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

Marylou

Name of
Facility
Mary Ann

entries


Facility
Type
CCFFH



CCFFH

Cachola

2015
(http://health.hawaii.gov/ohca/files/2016/01/MARYLOU-

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Marysol-

Ganotisi

Ganotisi-CCFFH-2015.pdf)
May Ganton

CCFFH

Mayrose

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/MayGanton-CCFFH-2015.pdf)

Inspection Reports

2015
(http://health.hawaii.gov/ohca/files/2015/10/Mayrose-

Bocoboc

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARY-

Bocoboc-CCFFH-2015.pdf)

ANN-CACPAL-CCFFH-2015.pdf)

Cacpal
Mary

Inspection Reports

CCFFH

INOCENCIO-CCFFH-2015.pdf)
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Show 100

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2015 (http://health.hawaii.gov/ohca/files/2015/11/Mary-

Melanie

Cachola-CCFFH-2015.pdf)

Badua

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/MELANIEBADUA-CCFFH-2015.pdf)

Mary Jane

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARY-

2016
Melanny

JANE-DELA-PENA-CCFFH-2015.pdf)

Dela Pena

CCFFH

Mary Jane

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARY-

Lopez-CCFFH-2015.pdf)

JANE-LOPEZ-CCFFH-2015.pdf)

Lopez

Melany
Mary Jane

CCFFH

CCFFH

CCFFH

Pantoca
Mary Rose

2016

Raralio

2015 (http://health.hawaii.gov/ohca/files/2016/01/MARY-

2016

Melice Ariota

CCFFH

CCFFH

Melita

Pantoca-CCFFH-2015.pdf)

Agpaoa

CCFFH

CCFFH

2015

2016 #1

(http://health.hawaii.gov/ohca/files/2016/01/MELITA-

(http://health.hawaii.g

AGPAOA-CCFFH-2015.pdf)

AGPAOA-CCFFH-201

Melody

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/MELODY-

2016

PELEGREEN-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/MARYBETH-

Leano

LEANO-CCFFH-2015.pdf)

Melody

CCFFH

CCFFH

Farinas

2015

2016 #1

(http://health.hawaii.gov/ohca/files/2016/01/MARYLO-

(http://health.hawaii.g

Melvin

FARINAS-CCFFH-2015.pdf)

Farinas-CCFFH-2016

Pinera

2015 (http://health.hawaii.gov/ohca/files/2016/01/Melody-

2016

Ramiro-CCFFH-2015.pdf)

Ramiro
Marylo

2015

2016
Pelegreen

Marybeth

2015 (http://health.hawaii.gov/ohca/files/2015/10/MeliceAriota-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/03/Mary-

2015 (http://health.hawaii.gov/ohca/files/2015/10/Mary-

2016

RARALIO-CCFFH-2015.pdf)

Rose-Velez-CCFFH-2015.pdf)

Velez

2015
(http://health.hawaii.gov/ohca/files/2016/01/MELANY-

LOU-WATANABE-CCFFH-2015.pdf)

Watanabe
Mary

2015 (http://health.hawaii.gov/ohca/files/2015/11/Mary-

CCFFH

Jane-Mades-CCFFH-2015.pdf)

Mades
Mary Lou

2015
(http://health.hawaii.gov/ohca/files/2015/11/Melanny-

Lopez

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/MELVINPINERA-CCFFH-2015.pdf)

Marylou
Gorospe

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/02/MarylouGorospe-CCFFH-2015.pdf)

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Mercedes

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Arquitola

12/12/2016

2015

Miligrina Lim

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/MERCEDES-

(http://health.hawaii.gov/ohca/files/2016/03/Miligrina-Lim-

ARQUITOLA-CCFFH-2015.pdf)
Mercedita

CCFFH

Morgia

CCFFH-2015.pdf)

2015

Minerva

(http://health.hawaii.gov/ohca/files/2015/11/Mercedita-

Cabang

CCFFH

CCFFH

Tiangsing

Cabang-CCFFH-2015.pdf)

2015

Miriam

(http://health.hawaii.gov/ohca/files/2016/01/MERCEDITA-

Brillante

CCFFH

CCFFH

Nepomuceno

2015
(http://health.hawaii.gov/ohca/files/2016/01/MIRIAM-

TIANGSING-CCFFH-2015.pdf)
Mercy

2015
(http://health.hawaii.gov/ohca/files/2015/11/Minerva-

Morgia-CCFFH-2015.pdf)
Mercedita

2015

BRILLANTE-CCFFH-2015.pdf)

2015

Mitci Jose

(http://health.hawaii.gov/ohca/files/2015/11/MERCY-

Aguinaldo

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MITCIJOSE-AGUINALDO-CCFFH-2015.pdf)

NEPOMUCENO-CCFFH-2015.pdf)
Moises
Merly

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MERLY-

2015 (http://health.hawaii.gov/ohca/files/2015/10/Moises-

2016

Mercado-CCFFH-2015.pdf)

Mercado

CASTILLO-CCFFH-2015.pdf)

Castillo

Mona
Mharjurie

CCFFH

CCFFH

2015

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MONA-

2016

NICOLAS-CCFFH-2015.pdf)

Nicolas

(http://health.hawaii.gov/ohca/files/2016/01/MHARJURIE-

Magsanoc

Monaliza

MAGSANOC-CCFFH-2015.pdf)

CCFFH

CCFFH

Milagros

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/10/Monaliza-

Asuncion
Mila Vea

2015 (http://health.hawaii.gov/ohca/files/2016/01/Mila-

Asuncion-CCFFH-2015.pdf)

Vea-CCFFH-2015.pdf)
Mydanelle
2015

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Mydanelle-

Vila

(http://health.hawaii.gov/ohca/files/2015/10/Milagros-

Castro

Vila-CCFFH-2015.pdf)

Castro-CCFFH-2015.pdf)
Mylene Ceon
Milagros

CCFFH

Duropan

CCFFH

2015

2015

(http://health.hawaii.gov/ohca/files/2015/11/MYLENE-

(http://health.hawaii.gov/ohca/files/2016/01/MILAGROS-

CEON-CCFFH-2015.pdf)

DUROPAN-CCFFH-2015.pdf)
Myra
Milagros

CCFFH

2015

CCFFH

Myrna

VILORIA-CCFFH-2015.pdf)

CCFFH

CCFFH

2016

2015
Myrna Bahou

(http://health.hawaii.gov/ohca/files/2016/01/MILDRED-

Dacoco

2015 (http://health.hawaii.gov/ohca/files/2015/11/MyrnaAndres-CCFFH-2015.pdf)

Andres
Mildred

2015 (http://health.hawaii.gov/ohca/files/2015/10/MyraVenegas-CCFFH-2015.pdf)

Venegas

(http://health.hawaii.gov/ohca/files/2015/11/MILAGROS-

Viloria

CCFFH

2015

2016
(http://health.hawaii.g

DACOCO-CCFFH-2015.pdf)

Bahou-CCFFH-2016.p
Mildred Dela

CCFFH

Cruz

2015
(http://health.hawaii.gov/ohca/files/2016/01/MILDRED-

Myrna

DELA-CRUZ-CCFFH-2015.pdf)

Tumbaga

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Nancy

4/9

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CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Nancy-

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/MYRNA-

(http://health.hawaii.g

TUMBAGA-CCFFH-2015.pdf)

Tumbaga-CCFFH-201

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2016

Nonita

Daproza-CCFFH-2015.pdf)

Daproza

CCFFH

5/9

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CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/NONITA-

Acorda

ACORDA-CCFFH-2015.pdf)
Nancy

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/NancyNora Buccat

Modumo-CCFFH-2015.pdf)

Modumo

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/NORA-

2016

BUCCAT-CCFFH-2015.pdf)
Naneth Sue

CCFFH

D.

2015 (http://health.hawaii.gov/ohca/files/2015/10/Naneth-

2016

Sue-D.-Pancipanci-CCFFH-2015.pdf)

(http://health.hawaii.g

Noralyn

Sue-D-Pancipanci-CC

Malacas

Pancipanci

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/11/NORALYNMALACAS-CCFFH-2015.pdf)

Natti

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/NattiNoralyne

Asentista-CCFFH-2015.pdf)

Asentista

CCFFH

Nazer Efraim

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/NAZER-

2016

CANSANA-CCFFH-2015.pdf)

EFRAIM-PITPIT-CCFFH-2015.pdf)

Pitpit

Norita
Nelly

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Nelly-

CCFFH

CCFFH

Simbajon

MORRISON-CCFFH-2015.pdf)

2015

Norma

(http://health.hawaii.gov/ohca/files/2016/01/NELSON-

Cabus

CCFFH

CCFFH

Gouveia
Nercy

CCFFH

Nerissa

CCFFH

CCFFH

CCFFH

CCFFH

RAGASA-CCFFH-2015.pdf)
Nympha

CCFFH

CCFFH

2016

CCFFH

2015

Ofelia

CCFFH

Ofelia

2016 #1, 2016 #2

CCFFH

Ophelia

Arzaga

CCFFH

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/03/Ophelia-

Pabalan

Pabalan-CCFFH-2015.pdf)
Orlando

2015 (http://health.hawaii.gov/ohca/files/2016/01/NOEMI-

Ramos, Jr.

ARZAGA-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

2015 (http://health.hawaii.gov/ohca/files/2016/01/OfeliaSuarez-CCFFH-2015.pdf)

Suarez

2016

2015 (http://health.hawaii.gov/ohca/files/2015/10/OfeliaMendez-CCFFH-2015.pdf)

Mendez

DORO-CCFFH-2015.pdf)
Noemi

2015 (http://health.hawaii.gov/ohca/files/2015/10/OdetteJosue-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2015/11/NOBLEZA-

Doro

2016

RASAY-CCFFH-2015.pdf)
Odette Josue

2015 (http://health.hawaii.gov/ohca/files/2016/01/NIKK-

2015 (http://health.hawaii.gov/ohca/files/2016/03/Ninan-

2015
(http://health.hawaii.gov/ohca/files/2016/01/NYMPHA-

Rasay

2015 (http://health.hawaii.gov/ohca/files/2016/01/Nerissa-

2015 (http://health.hawaii.gov/ohca/files/2015/11/Nerriza-

2015
(http://health.hawaii.gov/ohca/files/2016/01/NORMA-

2015 (http://health.hawaii.gov/ohca/files/2016/03/Nercy-

Barnes-CCFFH-2015.pdf)

Barnes
Nobleza

Ragasa

RUMBAOA-CCFFH-2015.pdf)

Rumbaoa
Ninan

Gouveia-CCFFH-2015.pdf)

CCFFH

Domingcil-CCFFH-2015.pdf)

Domingcil
Nikk

Norma

Julian-CCFFH-2015.pdf)

Julian
Nerriza

CABUS-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/Nenita-

Kramarz-CCFFH-2015.pdf)

Kramarz

2015
(http://health.hawaii.gov/ohca/files/2016/01/NORMA-

SIMBAJON-CCFFH-2015.pdf)
Nenita

2015
(http://health.hawaii.gov/ohca/files/2015/11/NORITA-

Morrison

Hinoguin-CCFFH-2015.pdf)

Hinoguin
Nelson

2015
(http://health.hawaii.gov/ohca/files/2016/01/NORALYNE-

Cansana

6/9

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/ORLANDO-

(http://health.hawaii.g

RAMOS-JR-CCFFH-2015.pdf)

Ramos-Jr-CCFFH-20

http://health.hawaii.gov/ohca/inspection-reports/

7/9

 12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Pamela

CCFFH

Cabato

2015 (http://health.hawaii.gov/ohca/files/2016/01/Pamela-

12/12/2016

2016

Prescila

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Vierck

Cabato-CCFFH-2015.pdf)

2015
(http://health.hawaii.gov/ohca/files/2016/01/PRESCILAVIERCK-CCFFH-2015.pdf)

Paolo Allan

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/PAOLOPrincess Joy

ALLAN-DALUDDUNG-CCFFH-2015.pdf)

Daluddung

CCFFH

Pat

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/PAT-

2015
(http://health.hawaii.gov/ohca/files/2016/01/PRINCESS-

Domingo
2016

JOY-DOMINGO-CCFFH-2015.pdf)

TANGONAN-CCFFH-2015.pdf)

Tangonan

Priscila Lana
Patrick

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Patrick-

CCFFH

2016

Paulina

CCFFH

Alboroto
Pauline

CCFFH

LANA-CCFFH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/Paulina-

Priscilla

Alboroto-CCFFH-2015.pdf)

Brunn

2015 (http://health.hawaii.gov/ohca/files/2016/03/Pauline-

Prixie Cruz

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Paz-

Rachel

CCFFH

Remular-CCFFH-2015.pdf)

Castro

CCFFH

Paz Remular

Perla

CCFFH

CCFFH

Perla

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/PERLA-

2016

Raquel

Perlita Tabil

CCFFH

Perly

CCFFH

CCFFH

AGPAOA-CCFFH-2015.pdf)
Rasela

CCFFH

Raymond

CCFFH

GARCIA-CCFFH-2015.pdf)

Quiaoit

Rebecca
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Petty-

2016

Basa-CCFFH-2015.pdf)

(http://health.hawaii.g

CCFFH

CCFFH

2015

2016 #1 2016 #2

(http://health.hawaii.gov/ohca/files/2016/01/Rebecca-

Dulatre

Dulatre-CCFFH-2015.pdf)

Showing 1,101 to 1,200 of 1,755 entries

Basa-CCFFH-2016.pd
Philbert

2015
(http://health.hawaii.gov/ohca/files/2016/01/RAYMOND-

Garcia

2015 (http://health.hawaii.gov/ohca/files/2015/11/Perly-

2015 (http://health.hawaii.gov/ohca/files/2015/11/RaselaMataia-CCFFH-2015.pdf)

Mataia

2015 (http://health.hawaii.gov/ohca/files/2015/10/Perlita-

Calaycay-Quiaoit-CCFFH-2015.pdf)

Petty Basa

2015
(http://health.hawaii.gov/ohca/files/2016/01/RAQUEL-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Perla-

Tabil-CCFFH-2015.pdf)

Calaycay-

2015 (http://health.hawaii.gov/ohca/files/2016/03/RachelCastro-CCFFH-2015.pdf)

Agpaoa

Villanueva-CCFFH-2015.pdf)

Villanueva

2015 (http://health.hawaii.gov/ohca/files/2016/01/PRIXIECRUZ-CCFFH-2015.pdf)

AMISTAD-CCFFH-2015.pdf)

Amistad

2015 (http://health.hawaii.gov/ohca/files/2015/11/PriscillaBrunn-CCFFH-2015.pdf)

Agluba-CCFFH-2015.pdf)

Agluba

2016

(http://health.hawaii.gov/ohca/files/2015/11/PRISCILA-

Bartolome-CCFFH-2015.pdf)

Bartolome

2015

 Previous Next 

2015
(http://health.hawaii.gov/ohca/files/2016/01/PHILBERT-

Descalso

DESCALSO-CCFFH-2015.pdf)
Precy

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/PRECYVILLANUEVA-CCFFH-2015.pdf)

Villanueva

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

8/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

12/12/2016

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

Reymalou

Name of
Facility



entries
Facility
Type



CCFFH

2015

CCFFH

(http://health.hawaii.gov/ohca/files/2015/11/Reynaldo-

CCFFH

CCFFH

Rita

MADRID-CCFFH-2015.pdf)

CCFFH

CCFFH

Rous

CCFFH

(http://health.hawaii.gov/ohca/files/2015/11/Redentor-

Robert

Rous-CCFFH-2015.pdf)

Phillips

2015

Robert

2016

Rochelle

CCFFH

Corpuz

CCFFH

CCFFH

Onigama

CCFFH

Roderick

(http://health.hawaii.gov/ohca/files/2015/11/Remedios-

Haduca

CCFFH

Renely

CCFFH

Ubilas

Jacinto

CCFFH

2015
Haduca-CCFFH-2015.pdf)

2015

Roman

(http://health.hawaii.gov/ohca/files/2015/11/Remedios-

Queja
Romeo

CCFFH

CCFFH

2016

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/ROMEO-

Salom

2015 (http://health.hawaii.gov/ohca/files/2015/10/Renee-

2015 (http://health.hawaii.gov/ohca/files/2015/10/RomanQueja-CCFFH-2015.pdf)

SALOM-CCFFH-2015.pdf)

2015

Romina

(http://health.hawaii.gov/ohca/files/2015/11/RENELY-

Manaois

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/ROMINAMANAOIS-CCFFH-2015.pdf)

UBILAS-CCFFH-2015.pdf)
Revelyn

2016

(http://health.hawaii.gov/ohca/files/2015/11/Roderick-

Rames-CCFFH-2015.pdf)

Rames

2015
DOMINGO-CCFFH-2015.pdf)

2015

Onigama-CCFFH-2015.pdf)
Renee

2016

(http://health.hawaii.gov/ohca/files/2016/01/ROCHELLE-

Corpuz-CCFFH-2015.pdf)
Remedios

2015 (http://health.hawaii.gov/ohca/files/2016/03/RobertYabut-CCFFH-2015.pdf)

Domingo

2016 #1, 2016 #2

2015 (http://health.hawaii.gov/ohca/files/2015/10/RobertPhillips-CCFFH-2015.pdf)

CCFFH

CABUYADAO-CCFFH-2015.pdf)

Cabuyadao
Remedios

2015 (http://health.hawaii.gov/ohca/files/2016/01/RELLY-

CCFFH

Yabut

DELA-VEGA-CCFFH-2015.pdf)
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/RITA-

2015

(http://health.hawaii.gov/ohca/files/2015/11/REGINA-

Dela Vega

Relly

2016

GALANGA-CCFFH-2015.pdf)

Galanga

Regina

2015 (http://health.hawaii.gov/ohca/files/2016/01/RICKYMERICLE-CCFFH-2015.pdf)

Mericle

2016

2015 (http://health.hawaii.gov/ohca/files/2015/11/RhodaAgliam-CCFFH-2015.pdf)

Agliam

Inspection Reports

(http://health.hawaii.gov/ohca/files/2016/01/REBECCA-

Madrid

Redentor

2015
Tauyan-CCFFH-2015.pdf)

Ricky
Rebecca

2015
(http://health.hawaii.gov/ohca/files/2015/10/Reymalou-

Tauyan

Rhoda



CCFFH

Tagudin-CCFFH-2015.pdf)
Reynaldo

Search:
Inspection Reports

9/9

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Tagudin

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).
Show 100

http://health.hawaii.gov/ohca/inspection-reports/

2015

Ronnie

(http://health.hawaii.gov/ohca/files/2015/10/Revelyn-

Paguyo

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/RonniePaguyo-CCFFH-2015.pdf)

Jacinto-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

2/10

http://health.hawaii.gov/ohca/inspection-reports/

3/10

 12/12/2016

Rosalina

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Ayala

2015

12/12/2016

2016

Rosemarie

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Ibarra Orial

(http://health.hawaii.gov/ohca/files/2016/01/ROSALINA-

CCFFH

2015

IBARRA-ORIAL-CCFFH-2015.pdf)
2016

Rosemary

(http://health.hawaii.gov/ohca/files/2015/11/ROSALINA-

Balmilero

CCFFH

CCFFH

Basug

Cayabyab-CCFFH-2015.pdf)

2015

Rosemary

(http://health.hawaii.gov/ohca/files/2016/01/ROSALINA-

Pammit

CCFFH

CCFFH

2015

Pammit-CCFFH-2015.pdf)
2016

Roseminic

(http://health.hawaii.gov/ohca/files/2016/01/ROSALINA-

Mendoza

CCFFH

CCFFH

2015

Rosita

CCFFH

CCFFH

2015

LORENZO-CCFFH-2015.pdf)
2016

Rowena

(http://health.hawaii.gov/ohca/files/2016/01/ROSALINDA-

Lopez

CCFFH

CCFFH

2015

Agustin-CCFFH-2015.pdf)
2016

Rowena

(http://health.hawaii.gov/ohca/files/2016/01/ROSANA-

Perucho

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Rosarie-

2016

BAUTISTA-CCFFH-2015.pdf)
2016

Rowena

Marquez-CCFFH-2015.pdf)

Marquez

2015
(http://health.hawaii.gov/ohca/files/2015/11/ROWENA-

Bautista

PERUCHO-CCFFH-2015.pdf)
Rosarie

2015
(http://health.hawaii.gov/ohca/files/2015/10/Rowena-

Agustin

LOPEZ-CCFFH-2015.pdf)
Rosana

2015
(http://health.hawaii.gov/ohca/files/2016/01/ROSITA-

Lorenzo

Alfaro-CCFFH-2015.pdf)
Rosalinda

2016

ULEP-CCFFH-2015.pdf)
2016

(http://health.hawaii.gov/ohca/files/2015/11/Rosalinda-

Alfaro

2015
(http://health.hawaii.gov/ohca/files/2016/01/ROSEMINIC-

Ulep

MENDOZA-CCFFH-2015.pdf)
Rosalinda

2015
(http://health.hawaii.gov/ohca/files/2015/11/Rosemary-

BASUG-CCFFH-2015.pdf)
Rosalina

2015
(http://health.hawaii.gov/ohca/files/2016/01/Rosemary-

Cayabyab

BALMILERO-CCFFH-2015.pdf)
Rosalina

2016

(http://health.hawaii.gov/ohca/files/2015/11/ROSEMARIE-

AYALA-CCFFH-2015.pdf)
Rosalina

2015

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/10/Rowena-

Caoili

Caoili-CCFFH-2015.pdf)
Rosario

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/RosarioLaroya-CCFFH-2015.pdf)

Laroya

Rowena

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Rosario-

DALIGCON-CCFFH-2015.pdf)
Rowena

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Rose-

CCFFH

CCFFH

Balan

CCFFH-2015.pdf)

2015

Rowena

(http://health.hawaii.gov/ohca/files/2015/10/Rosebella-

Rabanes

CCFFH

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/ROWENA-

Balan-CCFFH-2015.pdf)
Roselle

2015
(http://health.hawaii.gov/ohca/files/2015/10/Rowena-Lat-

Lat

Marie-Pambid-CCFFH-2015.pdf)

Pambid
Rosebella

2016

Nivera-CCFFH-2015.pdf)

Nivera
Rose Marie

2015
(http://health.hawaii.gov/ohca/files/2016/01/ROWENA-

Daligcon
Rosario

RABANES-CCFFH-2015.pdf)

2015
(http://health.hawaii.gov/ohca/files/2015/11/ROSELLE-

Catamping

CATAMPING-CCFFH-2015.pdf)
http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Rowena

4/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Sales

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2015

Shane G.

(http://health.hawaii.gov/ohca/files/2016/01/ROWENA-

Gabon

5/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Shane-

2016

Gabon-CCFFH-2015.pdf)

SALES-CCFFH-2015.pdf)
Sharon
Rudilia

CCFFH

CCFFH

Ramos
Rufelia

2016

CCFFH

CCFFH

Tomas

2015
(http://health.hawaii.gov/ohca/files/2016/01/SHARON-

Gasmen

GASMEN-CCFFH-2015.pdf)

Agpoon-CCFFH-2015.pdf)

Agpoon
Rueda

2015 (http://health.hawaii.gov/ohca/files/2016/01/Rudilia-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Rueda-

Sharon

Ramos-CCFFH-2015.pdf)

Ranido

2015 (http://health.hawaii.gov/ohca/files/2016/01/Rufelia-

Shella

Tomas-CCFFH-2015.pdf)

Gem P.

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/SharonRanido-CCFFH-2015.pdf)

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/Shella-

2016

Gem-P.-Navalta-CCFFH-2015.pdf)

Navalta
Ruth

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/RUTH-

2016

BATANGAN-CCFFH-2015.pdf)

Batangan

Sherill

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/RuthCastulo-CCFFH-2015.pdf)

Castulo

Shervi

CCFFH

CCFFH

Agbayani

Sally

CCFFH

Aguinaldo

2015

2015 (http://health.hawaii.gov/ohca/files/2016/03/Shervi-

2016

Ragasa-CCFFH-2015.pdf)

Ragasa
Ruthie

2015 (http://health.hawaii.gov/ohca/files/2016/01/SherillAndres-CCFFH-2015.pdf)

Andres
Ruth

2016

(http://health.hawaii.gov/ohca/files/2015/11/RUTHIE-

Sheryl

AGBAYANI-CCFFH-2015.pdf)

Tagaca

2015 (http://health.hawaii.gov/ohca/files/2015/11/Sally-

Shevon

Aguinaldo-CCFFH-2015.pdf)

Lamug

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Sheryl-

2016

Tagaca-CCFFH-2015.pdf)
CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/11/SHEVONLAMUG-CCFFH-2015.pdf)

Sally

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/SALLY-

2016

BERMUDEZ-CCFFH-2015.pdf)

Bermudez

Shirley Ann

CCFFH

Agustin
Salthorn

CCFFH

Shirley

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/SAMVADISIRISAK-CCFFH-2015.pdf)

Simplicia

CCFFH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/SIMPLICIA-

Ventura
CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/ShirleyGapuz-CCFFH-2015.pdf)

Gapuz
CCFFH

Vadisirisak

2015

VENTURA-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/SANDRA-

Kapela

KAPELA-CCFFH-2015.pdf)

Soledad

CCFFH

Agabao
Santiago

(http://health.hawaii.gov
Ann-Agustin-CCFFH-20

HEFFRON-CCFFH-2015.pdf)

Sandra

2016

Ann-Agustin-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/SALTHORN-

Heffron

Sam

2015 (http://health.hawaii.gov/ohca/files/2016/01/Shirley-

2015

CCFFH

2015

2015

2016

(http://health.hawaii.gov/ohca/files/2015/11/SOLEDAD-

(http://health.hawaii.gov

AGABAO-CCFFH-2015.pdf)

Agabao-CCFFH-2016.p

2015

2016

(http://health.hawaii.gov/ohca/files/2015/10/Santiago-

Estelita

Estelita-CCFFH-2015.pdf)

Soliel Blas

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/SOLIELSara Choi

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/SARA-

BLAS-CCFFH-2015.pdf)

CHOI-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

6/10

http://health.hawaii.gov/ohca/inspection-reports/

7/10

 12/12/2016

Song Goya

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/SONG-

Teresita

GOYA-CCFFH-2015.pdf)

Koh

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Teresita-KohCCFFH-2015.pdf)

Sonia Agni

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/11/SONIATeresita

AGNI-CCFFH-2015.pdf)

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2016/03/Teresita-

Shuman
Sonia

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Sonia-

Shuman-CCFFH-2015.pdf)

Tabladillo-CCFFH-2015.pdf)

Tabladillo

Tereza
Soo Yeon

CCFFH

Phillips

2015 (http://health.hawaii.gov/ohca/files/2016/01/SOO-

CCFFH

Miranda-CCFFH-2015.pdf)

YEON-PHILLIPS-CCFFH-2015.pdf)
Tessie

Sosima

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Sosima-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Tessie-

2016

Domingo-CCFFH-2015.pdf)

Domingo

Sonson-CCFFH-2015.pdf)

Sonson

Thelma
Starlyn

2015 (http://health.hawaii.gov/ohca/files/2015/10/Tereza-

Miranda

CCFFH

2015

2015

CCFFH

Giron

(http://health.hawaii.gov/ohca/files/2016/01/THELMA-

(http://health.hawaii.gov/ohca/files/2016/01/STARLYN-

Cabading

GIRON-CCFFH-2015.pdf)

CABADING-CCFFH-2015.pdf)
Thelma
Steven

CCFFH

2015

CCFFH

2015

(http://health.hawaii.gov/ohca/files/2016/01/STEVEN-

Scott Jr.

2016

(http://health.hawaii.gov/ohca/files/2015/11/THELMA-

Tugaoen

TUGAOEN-CCFFH-2015.pdf)

SCOTT-JR-CCFFH-2015.pdf)
Tina
Susan

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/SUSAN-

2016

2016

GAGABI-CCFFH-2015.pdf)

Gagabi

INTONG-CCFFH-2015.pdf)

Intong

Trinidad
Teodora

2015 (http://health.hawaii.gov/ohca/files/2016/01/TINA-

CCFFH

CCFFH

2015

CCFFH

2015
(http://health.hawaii.gov/ohca/files/2015/11/Trinidad-

Tumbaga

(http://health.hawaii.gov/ohca/files/2016/01/TEODORA-

Unciano

Tumbaga-CCFFH-2015.pdf)

UNCIANO-CCFFH-2015.pdf)
Venus
Teresa

CCFFH

2015

2016

2015 (http://health.hawaii.gov/ohca/files/2016/03/Venus-

CCFFH

CANOY-CCFFH-2015.pdf)

Vicky

2015 (http://health.hawaii.gov/ohca/files/2015/11/VICKY-

CCFFH

GONZALES-CCFFH-2015.pdf)

Gonzales
Teresa

CCFFH

Mateo

Teresita

2016

Balinbin-CCFFH-2015.pdf)

Balinbin

(http://health.hawaii.gov/ohca/files/2016/01/TERESA-

Canoy

CCFFH

Dureg

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/TERESA-

Victor

MATEO-CCFFH-2015.pdf)

Laforteza

2015 (http://health.hawaii.gov/ohca/files/2015/11/Teresita-

Victoria

Dureg-CCFFH-2015.pdf)

Agregado

2015 (http://health.hawaii.gov/ohca/files/2015/10/Victor-

CCFFH

2016 #1 2016 #2

Laforteza-CCFFH-2015.pdf)
2015

CCFFH

2016

(http://health.hawaii.gov/ohca/files/2016/01/VICTORIAAGREGADO-CCFFH-2015.pdf)

Teresita

CCFFH

Gaoiran

2015

2016

(http://health.hawaii.gov/ohca/files/2015/10/Teresita-

Victoria

Gaoiran-CCFFH-2015.pdf)

Lova

2015

CCFFH

(http://health.hawaii.gov/ohca/files/2016/01/VICTORIALOVA-CCFFH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Vilma
Penuliar

8/10

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CCFFH

12/12/2016

9/10

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facility’s name. The table can also be sorted by name and facility type. Click on the link under the
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residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

2015 (http://health.hawaii.gov/ohca/files/2015/11/VilmaPenuliar-CCFFH-2015.pdf)

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Facility

Facility
Virgencita



Type
CCFFH



Inspection Reports



2015

Inspection Repo

2016

(http://health.hawaii.gov/ohca/files/2016/01/VIRGENCITA-

Postrero-

POSTRERO-AGETON-CCFFH-2015.pdf)

Ageton
Virginia

Search:

CCFFH

Smith

2015 (http://health.hawaii.gov/ohca/files/2015/11/VIRGINIA-

2016

SMITH-CCFFH-2015.pdf)

(http://health.haw
Smith-CCFFH-20

Virginia

CCFFH

SUNIGA-CCFFH-2015.pdf)

Suniga
Vising

CCFFH

CCFFH

CCFFH

CCFFH

CCFFH

CCFFH

CCFFH

Vera

http://health.hawaii.gov/ohca/inspection-reports/

10/10

2015 (http://health.hawaii.gov/ohca/files/2015/11/WILNA-

2016

2015 (http://health.hawaii.gov/ohca/files/2016/01/XZOR-JAY-

2016

DAGUIO-CCFFH-2015.pdf)

Daguio
Yolanda De

2015 (http://health.hawaii.gov/ohca/files/2015/11/Wilma-

MADAYAG-CCFFH-2015.pdf)

Madayag
Xzor Jay

2015 (http://health.hawaii.gov/ohca/files/2016/01/WILLIAM-

Cauton-CCFFH-2015.pdf)

Cauton
Wilna

2016

FLORES-JR-CCFFH-2015.pdf)

Flores Jr.
Wilma

2015 (http://health.hawaii.gov/ohca/files/2015/11/WerlinaYoung-CCFFH-2015.pdf)

Young
William

2015 (http://health.hawaii.gov/ohca/files/2016/01/WELMAABANTO-CCFFH-2015.pdf)

Abanto
Werlina

2015 (http://health.hawaii.gov/ohca/files/2015/11/VisingSantiago-CCFFH-2015.pdf)

Santiago
Welma

2015 (http://health.hawaii.gov/ohca/files/2016/01/VIRGINIA-

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2015/10/Yolanda-DeVera-CCFFH-2015-1.pdf)

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2/9

 12/12/2016

Yong Suk

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Rho Morita
Zenaida

CCFFH

Agsalda
Zenaida

CCFFH

Grace

2016

CCFFH

Palacio-

CCFFH

2015

2016

Jean Lim

CCFFH

2015

Jesus Garcia

CCFFH

2015

Jhoan

CCFFH

2015

Jolly Orozco

CCFFH

2015

Lemelyn

CCFFH

2015

CCFFH

2015

CCFFH

2015

2016 #1 2016 #2

CCFFH

2015

2016

Maria Jenks

CCFFH

2015

2016

Mayrose

CCFFH

2015

2016

CCFFH

2015

2016

CCFFH

2015

2016

CCFFH

2015

CCFFH

2015

Imelda

Agsalda-CCFFH-2015.pdf)

Bonilla

2015 (http://health.hawaii.gov/ohca/files/2015/10/Zenaida-

2016

2015 (http://health.hawaii.gov/ohca/files/2015/10/Zenaida-

2015 (http://health.hawaii.gov/ohca/files/2015/11/ZENAIDA-

CCFFH

CCFFH

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Zenaida-

Maluyo-

Tierra-CCFFH-2015.pdf)

Mabuti

2015 (http://health.hawaii.gov/ohca/files/2015/11/Zeny-

Lorena

2016

Duropan-CCFFH-2015.pdf)

Kawamoto

2015

Manelyn
Higa

Corpuz
Analyn Perez

CCFFH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Zenaida-

SUMAGIT-CCFFH-2015.pdf)

Duropan
Adela

2016

Acosta

Tierra
Zeny

2015

Jacinto

Palacio-Lazaro-CCFFH-2015.pdf)

Sumagit
Zenaida

CCFFH

Rho-Morita-CCFFH-2015.pdf)

Lazaro
Zenaida

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Miller-CCFFH-2015.pdf)

Miller
Zenaida

2015 (http://health.hawaii.gov/ohca/files/2015/11/Yong-Suk-

12/12/2016

CCFFH

2015

Lydia

2016

Ramiscal
Arlene Villar

CCFFH

2015

2016

Daisy

CCFFH

2015

2016

Dino Cacpal

CCFFH

2015

2016

Eliel Corpuz

CCFFH

2015

2016

Conchita

CCFFH

2015

Jovellanos

Bamba
Mineriza
Pascua
Melanie
Salgado

Batoto
Emerita Dela

CCFFH

2015

Nancy

Cruz
Gemma

Ybanez
CCFFH

2015

Nicole

Alvia
Genedina

Ganitano
CCFFH

2015

Albano
http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Modesta

3/9

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CCFFH

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Michelle

2015

Dela Cruz

4/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015

Noly Bacerra

CCFFH

2015

Orlina

CCFFH

2015

CCFFH

2015

CCFFH

2015

CCFFH

2015

CCFFH

2015

CCFFH

2015

CCFFH

2015

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Amy-

Champion

Leoncio
Rosalie

CCFFH

2015

CCFFH

2015

2016

Alcon

Barrientos
Thelma

Raquel

Agbayani

Lagpacan
Tomasa

CCFFH

2015
Rhoda

Tapat

Bolosan
Carmenchu

CCFFH

2015
Ronald

Cortez

Camper
Christina

CCFFH

2015

CCFFH

2015

CCFFH

2015

CCFFH

2015

2016
Royal

Kealoha

Solmerin
Diana

Scott

Machado

2016

Stubbert
Editha

Mirasol

Jacinto

Manley
Erlinda

Amy

Laasaga
Erlinda

CCFFH

2015

Melchor-

Melchor-Tamayo-CCFFH-2015.pdf) 2015 #2

Tamayo

(http://health.hawaii.gov/ohca/files/2016/01/AMY-MELCHORTAMAYO-CCFFH-2015-2.pdf)

Mirasol
Estela Leslie

CCFFH

2015

Gloria

CCFFH

2015

Juliet Orpilla

CCFFH

2015

Juliet Piano

CCFFH

2015

Julita Rivera

CCFFH

2015

Anita Pinera

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2015/11/Anita-

2016

Pinera-CCFFH-2015.pdf) 2015 #2
(http://health.hawaii.gov/ohca/files/2016/01/ANITA-PINERA-

Corpuz

CCFFH-2015.pdf)

Marilyn Juan

CCFFH

2015

Michelle

CCFFH

2015

Balbina

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/BalbinaRivera-CCFFH-2015.pdf) 2015 #2
(http://health.hawaii.gov/ohca/files/2016/02/Balbina-V-RiveraCCFFH-2015.pdf)

Corazon
Tubana

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/CorazonTubana-CCFFH-2015.pdf) 2015 #2
(http://health.hawaii.gov/ohca/files/2016/01/CORAZONTUBANA-CCFFH-2015-2.pdf)

Bolibol

http://health.hawaii.gov/ohca/inspection-reports/

CCFFH

Rivera

5/9

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6/9

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Ederlina

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2015/11/Ederlina-

12/12/2016

2016

Maribel

Tangonan-CCFFH-2015-2.pdf) 2015 #2

Tangonan

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Fernandez

Fernandez-CCFFH-2015.pdf) 2015 #2

(http://health.hawaii.gov/ohca/files/2015/10/Ederlina-

(http://health.hawaii.gov/ohca/files/2016/01/MARIBEL-

Tangonan-CCFFH-2015.pdf)
Edita

CCFFH

Magsipoc

Emelita

CCFFH

Laurente

Evelyn

CCFFH

FERNANDEZ-CCFFH-2015-2.pdf)

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Edita-

Maricor

Magsipoc-CCFFH-2015.pdf) 2015 #2

Malvar

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2015/11/Maricor(http://health.hawaii.gov/ohca/files/2015/10/Maricor-Malvar-

MAGSIPOC-CCFFH-2015.pdf)

CCFFH-2015.pdf)

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Emelita-

Mayrose

Laurente-CCFFH-2015.pdf) 2015 #2

Mendoza

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/03/Mayrose(http://health.hawaii.gov/ohca/files/2016/01/MAYROSE-

LAURENTE-CCFFH-2015-2.pdf)

MENDOZA-CCFFH-2015.pdf)
2016

Menchie

2016

Mendoza-CCFFH-2015-2.pdf) 2015 #2

(http://health.hawaii.gov/ohca/files/2016/01/EMELITA-

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/EVELYN-

2016

Malvar-CCFFH-2015-1.pdf) 2015 #2

(http://health.hawaii.gov/ohca/files/2015/11/EDITA-

AQUINO-CCFFH-2015.pdf) 2015 #2

Aquino

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Maribel-

CCFFH

2015 #1
(http://health.hawaii.gov/ohca/files/2015/11/MENCHIE-

Dawang

DAWANG-CCFFH-2015.pdf) 2015 #2
Imelda

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Imelda-

2016

(http://health.hawaii.gov/ohca/files/2016/01/MENCHIE-

Yadao-CCFFH-2015-.pdf) 2015 #2

Yadao

DAWANG-CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/IMELDA-YADAONorwena

CCFFH-2015-2.pdf)
Jean

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2015/03/Jean-

Margaret

Margaret-Flores-CCFFH-2015.pdf) 2015 #2

Flores

(http://health.hawaii.gov/ohca/files/2015/11/JEAN-

2016

CCFFH

Bacud-Visitacion-CCFFH-2015.pdf) 2015 #2

Visitacion

(http://health.hawaii.gov/ohca/files/2016/03/Norwena-BacudVisitacion-CCFFH-2015-2.pdf)

MARGARET-FLORES-CCFFH-2015.pdf)

Priscilla

CCFFH

CCFFH

Salom

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/PriscillaTagata-CCFFH-2015.pdf) 2015 #2

Tagata
Jopher

2015 #1 (http://health.hawaii.gov/ohca/files/2015/11/Norwena-

Bacud

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Jopher-

(http://health.hawaii.gov/ohca/files/2015/10/Priscilla-Tagata-

Salom-CCFFH-2015.pdf) 2015 #2

CCFFH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/JOPHER-SALOMResurreccion

CCFFH-2015-2.pdf)

CCFFH

CCFFH

Corcino

2015 #1

2016

(http://health.hawaii.gov/ohca/files/2015/10/Resurreccion-

Buan
Jovita

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Jovita-

Buan-CCFFH-2015.pdf) 2015 #2

Corcino-CCFFH-2015.pdf) 2015 #2

(http://health.hawaii.gov/ohca/files/2016/01/RESURRECCION-

(http://health.hawaii.gov/ohca/files/2016/03/Jovita-Corcino-

BUAN-CCFFH-2015-2.pdf)

CCFFH-2015-2.pdf)
Rosalie de
Julie Bonilla

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/JULIE-

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Rosaliede-Aquino-CCFFH-2015.pdf) 2015 #2

Aquino

BONILLA-CCFFH-2015.pdf) 2015 #2

(http://health.hawaii.gov/ohca/files/2016/01/ROSALIE-DE-

(http://health.hawaii.gov/ohca/files/2016/02/Julie-Bonilla-

AQUINO-CCFFH-2015-2.pdf)

CCFFH-2015.pdf)
Rowena Han

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Rowena-

2016

Han-CCFFH-2015.pdf) 2015 #2
(http://health.hawaii.gov/ohca/files/2016/01/ROWENA-HANCCFFH-2015-2.pdf)
http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Samuel

7/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

12/12/2016

8/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/SAMUELBUMATAY-CCFFH-2015.pdf) 2015 #2

Bumatay

http://health.hawaii.gov/ohca/inspection-reports/

(http://health.hawaii.gov/ohca/files/2016/01/SAMUELBUMATAY-CCFFH-2015-2.pdf)
Severino

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2015/10/Severino-

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).

2016

Fernandez-CCFFH-2015.pdf) 2015 #2

Fernandez

(http://health.hawaii.gov/ohca/files/2016/03/Severino-

Show 100

Fernandez-CCFFH-2015-2.pdf)

Name of
Susie Lee

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/SUSIE-

Facility

entries


Facility
Type

Search:


Inspection Reports



Inspection Reports

LEE-CCFFH-2015.pdf) 2015 #2
Gloria Cueco

(http://health.hawaii.gov/ohca/files/2016/01/SUSIE-LEE-

CCFFH

2015 #1, 2015 #2
(http://health.hawaii.gov/ohca/files/2015/10/Gloria-

CCFFH-2015-2.pdf)

Cueco-CCFFH-2015.pdf)
Teresita

CCFFH

2015 #1
Imelda Pacris

(http://health.hawaii.gov/ohca/files/2015/11/TERESITA-

Cummings

CCFFH

2015 #1
(http://health.hawaii.gov/ohca/files/2016/01/IMELDA-

CUMMINGS-CCFFH-2015.pdf) 2015 #2

PACRIS-CCFFH-2015.pdf) , 2015 #2

(http://health.hawaii.gov/ohca/files/2016/01/TERESITACUMMINGS-CCFFH-2015.pdf)
Janet Funtila
Arcelie

CCFFH

CCFFH

FUNTILA-CCFFH-2015.pdf) , 2015 #2

Weaver-CCFFH-2015.pdf) 2015 #2

Weaver

2015 #1
(http://health.hawaii.gov/ohca/files/2015/11/JANET-

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Arcelie(http://health.hawaii.gov/ohca/files/2016/01/ARCELIEJoel Solmerin

WEAVER-CCFFH-2015-2.pdf) 2015 #3

CCFFH

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2015/11/Arlene-

Marfe Retundo

2016

CCFFH

Retundo-CCFFH-2015.pdf) , 2015 #2

(http://health.hawaii.gov/ohca/files/2016/01/ARLENE-DEHITTA-CCFFH-2015.pdf) 2015 #3

Maridel Sagun

(http://health.hawaii.gov/ohca/files/2016/01/ARLENE-DE-

CCFFH

CCFFH

Emil
Novesteras

CCFFH

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Emil-

May Rose

2015 #1, 2015 #2

2016

(http://health.hawaii.gov/ohca/files/2015/11/MAYROSE-KUMAR-CCFFH-2015.pdf)

2016
Melda

Jr.

http://health.hawaii.gov/ohca/inspection-reports/

CCFFH

Kumar

Novesteras-Jr.-CCFFH-2015.pdf) , 2015 #2

Showing 1,301 to 1,400 of 1,755 entries

2016

Sagun-CCFFH-2015.pdf)

2015 #1 (http://health.hawaii.gov/ohca/files/2016/01/Beatriz-F.Camat-CCFFH-2015.pdf) , 2015 #2

Camat

2015 #1, 2015 #2
(http://health.hawaii.gov/ohca/files/2016/02/Maridel-

HITTA-CCFFH-2015-2.pdf)
Beatriz F.

2015 #1
(http://health.hawaii.gov/ohca/files/2016/01/Marfe-

De-Hitta-CCFFH-2015.pdf) 2015 #2

Hitta

2016

SOLMERIN-CCFFH-2015.pdf) , 2015 #2

WEAVER-CCFFH-2015-3.pdf)
Arlene De

2015 #1
(http://health.hawaii.gov/ohca/files/2016/01/JOEL-

(http://health.hawaii.gov/ohca/files/2016/01/ARCELIE-

Buenaventura

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CCFFH

2015 #1
(http://health.hawaii.gov/ohca/files/2016/01/MeldaBuenaventura-CCFFH-2015.pdf) , 2015 #2

9/9

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2/9

 12/12/2016

Mylene U

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

CCFFH

Maballo

2015 #1, 2015 #2

12/12/2016

Macaraeg

2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

DDDH

(http://health.hawaii.gov/ohca/files/2016/03/Mylene-U-

CCFFH

2015 #1

DDDH-2015.pdf)
2016

Macusi

DDDH

Tabbay-CCFFH-2015.pdf) , 2015 #2
CCFFH

2015 #1

Malbog

DDDH

2015 #1, 2015 #2

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Malbog-

Abrigo-CCFFH-2015.pdf) , 2015 #2
CCFFH

2016

DDDH-2015.pdf)
2016

(http://health.hawaii.gov/ohca/files/2016/01/Trina-

Jociel Domingo-

2015
(http://health.hawaii.gov/ohca/files/2016/02/Macusi-

(http://health.hawaii.gov/ohca/files/2016/01/Myrna-

Trina Abrigo

2016

(http://health.hawaii.gov/ohca/files/2016/02/Macaraeg-

Maballo-CCFFH-2015.pdf)
Myrna Tabbay

2015

DDDH-2015.pdf)
Ramirez

2016 #1 2016 #2

DDDH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Ramirez-

Nones

DDDH-2015.pdf)
Aloha Adult

DDDH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Aloha-

DDDH, LLC

RCH - Kapalama

DDDH

Adult-DDDH-LLC-DDDH-2015.pdf)
Aloha Care

DDDH

2015

2015 (http://health.hawaii.gov/ohca/files/2016/02/RCH-

2016

Kapalama-DDDH-2015.pdf)
RCH - Popolo

2016

(http://health.hawaii.gov/ohca/files/2016/01/Aloha-

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/02/RCH-

2016

Popolo-Place-DDDH-2015.pdf)

Place

Care-DDDH-2015.pdf)
Tanacio's
Bagasol

DDDH

2015

DDDH

2016

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Tanacios-

(http://health.hawaii.gov/ohca/files/2016/01/Bagasol-

DDDH-2015.pdf)

DDDH-2015.pdf)
The Arc in
C. Caraang

DDDH

Corpuz

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/01/C.-

2016

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/02/The-

2016

Arc-in-Hawaii-Ewa-A-DDDH-2015.pdf)

Hawaii - Ewa A

Caraang-DDDH-2015.pdf)
The Arc in
2015

2016

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/02/The-

2016

Arc-in-Hawaii-Halawa-DDDH-2015.pdf)

Hawaii - Halawa

(http://health.hawaii.gov/ohca/files/2016/01/CorpuzThe Arc in

DDDH-2015.pdf)

DDDH

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/01/F.-

2016

Lusitana B

Glenish-J.-Caraang-DDDH-2015.pdf)

Caraang

The Arc in
Funtanilla

2015 (http://health.hawaii.gov/ohca/files/2016/02/TheArc-in-Hawaii-Lusitana-B-DDDH-2015.pdf)

Hawaii F. Glenish J.

DDDH

2015

2016

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/02/TheArc-in-Hawaii-Lusitana-D-DDDH-2015.pdf)

Hawaii -

(http://health.hawaii.gov/ohca/files/2016/01/Funtanilla-

Lusitana D

DDDH-2015.pdf)
The Arc in
Galicinao

DDDH

2015

2016

Domiciliary

(http://health.hawaii.gov/ohca/files/2016/01/Galicinao-

Home

Domiciliary-Home-DDDH-2015.pdf)
DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/02/Jack-

2016

3/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

DDDH

Hawaii -

2015 (http://health.hawaii.gov/ohca/files/2016/02/The-

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/02/The-

2016

Arc-in-Hawaii-Waipahu-A-DDDH-2015.pdf)

Waipahu A

http://health.hawaii.gov/ohca/inspection-reports/

The Arc in

2016

Arc-in-Hawaii-Wahiawa-B-DDDH-2015.pdf)

Hawaii -

and-Jill-DDDH-2015.pdf)

12/12/2016

2015 (http://health.hawaii.gov/ohca/files/2016/02/The-

Wahiawa B
The Arc in

Jack and Jill

DDDH

Hawaii -

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

The Arc of Maui

2016

Arc-in-Hawaii-Waipahu-B-DDDH-2015.pdf)

4/9

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

DDDH

2015

Palma Nova

DDDH

2015

Valley

DDDH

2015

Angels from

DDDH

2015

County - Molokai

Waipahu B

Residence Hale
Maunaloa

The Arc of Kona

DDDH

DDDH

2015 (http://health.hawaii.gov/ohca/files/2016/02/The-

2016

Arc-of-Maui-Hale-Lahaina-DDDH-2015.pdf)

- Hale Lahaina
Yadao

2016

Arc-of-Kona-Kona-Krafts-DDDH-2015.pdf)

- Kona Kraft's
The Arc of Maui

2015 (http://health.hawaii.gov/ohca/files/2016/02/The-

DDDH

2015

2016

Heaven, Inc.

(http://health.hawaii.gov/ohca/files/2016/02/YadaoE-ARCH

2016

E-ARCH

2016

E-ARCH

2016

E-ARCH

2016

E-ARCH

2016

Ed & Rose

E-ARCH

2016

2015

Carmelita's

E-ARCH

2016

2015

Riingen

E-ARCH

2016

Manoa Senior

DDDH-2015.pdf)

Care A
Zennia's

The Arc in

DDDH

DDDH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Zennias-

Manoa Senior

DDDH-2015.pdf)

Care B

2015

Ka Malama
Home II

Hawaii Kamehame

Winmax Senior

Home
The Arc in

Care L.L.C.
DDDH

2015

Raza Adult

Hawaii -

Residential Care

Lusitana A
The Arc in

Home DDDH

Expanded Care

2015

Hawaii Lusitana C
Ligaya Navasca
Opportunities

DDDH
DDDH

2016

ARCH/Expanded

and Resources,

ARCH

Inc. - 2B
Opportunities

DDDH

2015

2016

DDDH

2015

2016

3J's

E-ARCH

Inc. - 2C
Opportunities
and Resources,
Inc. - Unit #10
Alma and

DDDH

2016

A&C

E-ARCH

2015

2016

A Better Living

E-ARCH

2015

2016

A.C.T.G. ARCH

E-ARCH

2015

#3

2015

(http://health.hawaii.gov/ohca/files/2016/01/A.C.T.G.ARCH-3-E-ARCH-2015.pdf)

Richard Pilar
http://health.hawaii.gov/ohca/inspection-reports/

2015 (http://health.hawaii.gov/ohca/files/2016/01/3JsE-ARCH-2015.pdf)

and Resources,

5/9

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6/9

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Abbie's

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

12/12/2016

2015

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Aloha ARCH

E-ARCH

2015

(http://health.hawaii.gov/ohca/files/2016/01/Abbies-E-

(http://health.hawaii.gov/ohca/files/2016/01/Aloha-

ARCH-2015.pdf)
Abner Sales

E-ARCH

2015

ARCH-E-ARCH-2015.pdf)
Aloha Lifeline

2016

ARCH/Expanded

(http://health.hawaii.gov/ohca/files/2016/01/Abner-

ARCH/E-ARCH,

ARCH

Sales-ARCH_Expanded-ARCH-E-ARCH-2015.pdf)

L.L.C.

Acnam's

E-ARCH

2015

ACTG Gallegos

E-ARCH

2015

2016

2015

E-ARCH

(http://health.hawaii.gov/ohca/files/2016/02/AlohaLifeline-ARCH-E-ARCH-L.L.C.-E-ARCH-2015.pdf)

Anita Lagunoy

E-ARCH

(http://health.hawaii.gov/ohca/files/2016/02/A.C.T.G.-

Anne-Drew's

E-ARCH

Gallegos-IV-E-ARCH-2015.pdf)

Gentle

2015 (http://health.hawaii.gov/ohca/files/2016/02/AnitaLagunoy-E-ARCH-2015.pdf)

IV

Adult Res Care

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Adult-

2016

2016

Drews-Gentle-E-ARCH-2015.pdf)

Apostol Care

Res-Care-Home-E-ARCH-2015.pdf)

Home

2015 (http://health.hawaii.gov/ohca/files/2016/01/Anne-

2015

E-ARCH

2016

(http://health.hawaii.gov/ohca/files/2016/02/Apostol-

Home ARCH

Care-Home-ARCH-E-ARCH-2015.pdf)
Aguinaldo's

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Aguinaldos-

Aura Sera

2015

E-ARCH

E-ARCH-2015-1.pdf)

(http://health.hawaii.gov/ohca/files/2016/02/AuroraSera-E-ARCH-2015-1.pdf)

Ai ARCH

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Ai-

2016

ARCH-E-ARCH-2015.pdf)

Aurora Patao

E-ARCH

2015

Aida's

E-ARCH

2016

(http://health.hawaii.gov/ohca/files/2016/02/Aurora-

ARCH
2015

Patao-ARCH-E-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Aidas-E-

Aiea Heights

E-ARCH

Senior Living

ARCH-2015.pdf)

Aurora's

E-ARCH

2015

2015 (http://health.hawaii.gov/ohca/files/2016/03/Aiea-

Bagain Cadiz

E-ARCH

2015

Heights-Senior-Living-E-ARCH-2015.pdf)

Care Home

2016

(http://health.hawaii.gov/ohca/files/2016/01/BagainCadiz-Care-Home-E-ARCH-2015-1.pdf)

Aina Haina

E-ARCH

2015

Balico's

E-ARCH

2015

2016

E-ARCH

2015

Barbara

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Akamai-

Cabanes
E-ARCH

2015

2016

2016

ARCH
Akamai Adult
Residential Care

Adult-Residential-Care-Home-E-ARCH-2015.pdf)

Home

Blandina Retuta
Aletha's

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Blandina-

(http://health.hawaii.gov/ohca/files/2016/01/Alethas-

Expanded ARCH

Retuta-E-ARCH-2015.pdf)

Expanded-ARCH-E-ARCH-2015.pdf)
Buenavista Adult
Alfe Expanded

E-ARCH

2015

2016

ARCH
ALFE II

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Alfe-

2015

E-ARCH

Residential Care

(http://health.hawaii.gov/ohca/files/2015/12/Buenavista-

Home

Adult-Residential-Care-Home-E-ARCH-2015.pdf)

2016

II-E-ARCH-2015-1.pdf)
http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Bueno #2

C.P. Gallegos

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Bueno-2-E-

(http://health.hawaii.

ARCH-2015-1.pdf)

2-E-ARCH-2016.pdf

2015 (http://health.hawaii.gov/ohca/files/2016/01/C.P.-

2016

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Callo-

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).

2016

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E-ARCH-2015.pdf)
Connie's
Caring Manoa

E-ARCH

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Connies-E-

(http://health.hawaii.gov/ohca/files/2016/01/Caring-

ARCH II

2015
ARCH-2015.pdf)

Manoa-ARCH-II_E-ARCH-2015.pdf)
Caring Manoa,

E-ARCH

L.L.C.

Debora's

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Caring-

Domingo's Care

E-ARCH

2015

2016

Manoa-L.L.C.-E-ARCH-2015.pdf)

Home

2015
(http://health.hawaii.gov/ohca/files/2016/01/DomingosCare-Home-E-ARCH-2015.pdf)

Carlina

E-ARCH

Fernandez

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Carlina-

E & J Adult

Fernandez-E-ARCH-20151.pdf)

Residential Care

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/E-J-

2016

Adult-Residential-Care-Home-E-ARCH-2015.pdf)

Home
Carlos Care

E-ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Carlos-

Home

E&R

E-ARCH

Care-Home-E-ARCH-2015.pdf)
Catherine
Salvador

E-ARCH

2015

E. F. Nicomedes

E-ARCH

(http://health.hawaii.gov/ohca/files/2016/01/Catherine-

2015 (http://health.hawaii.gov/ohca/files/2016/01/E-R-E-

2016 (http://healt

ARCH-2015.pdf)

E-ARCH-2016.pd

2015 (http://health.hawaii.gov/ohca/files/2016/01/E.-F.-

2016 (http://healt

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E. Mabini ARCH

E-ARCH

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2015 (http://health.hawaii.gov/ohca/files/2016/01/Edita-

2016

Castro-E-ARCH-2015.pdf)
Elena's Expanded
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E-ARCH

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Elisa Cabal

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12/12/2016

Floreliza Fiesta

2016

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E-ARCH

Cabal-E-ARCH-2015.pdf)

2015

2016

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Emelyn Ilar

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2015
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Emmy's

E-ARCH

2015

E-ARCH

2015

2016

E-ARCH

2015

2016

Maunawili

(http://health.hawaii.gov/ohca/files/2016/02/Emmys-EARCH-2015.pdf)

Galanto's ARCH

(http://health.hawaii.gov/ohca/files/2016/01/GalantosErlinda's

E-ARCH

2015

ARCH-E-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/03/Erlindas-EARCH-2015.pdf)

Galario's Care

E-ARCH

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E-ARCH

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Home
Espinoza's

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Espinozas-

Gaylord's

E-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Gaylords-EARCH-2015.pdf)

Estela Ellazar

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/02/Estela-

2016

Ellazar-E-ARCH-2015.pdf)
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2015

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(http://health.hawaii.gov/ohca/files/2016/02/Gaylords-III-

G.-Jamandre-E-ARCH-2015.pdf)

Jamandre-E-ARC

E-ARCH-2015.pdf)

2015

2016

Gelacio Care

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E-ARCH

Family Ties Adult

E-ARCH

2015

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Home

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2016

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2015

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Home

Adult-Residential-Care-Home-E-ARCH-2015.pdf)

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Felarca Care

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2015

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2016

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Golden Age Health

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2015

2016

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Island-ARCH-E-ARCH-2015.pdf)

Island-ARCH-E-A

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2016

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Cottage-E-ARCH-2015.pdf)

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2015 (http://health.hawaii.gov/ohca/files/2016/03/Hale-

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Hale Kupuna

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2015
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Hale Mohalu

E-ARCH

Hale Nohea, L.L.C.

E-ARCH

2015

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E-ARCH

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E-ARCH

Mohalu-E-ARCH-2015.pdf)

Helen Agbayani

E-ARCH

2015

Hernani T.

E-ARCH

2015

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ARCH/EC-ARCH

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Imelda G. Arreola

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LLC

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Indel's

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2015 (http://health.hawaii.gov/ohca/files/2016/01/Josies-

2016

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2015 (http://health.hawaii.gov/ohca/files/2016/02/Joy-S.-

2016

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JRR ARCH

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Juliana Ganiron

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Hope-Faith

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Huapala Senior

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ARCH II

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Kailua Gardens

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2015 (http://health.hawaii.gov/ohca/files/2016/02/Kailua-

2016

Gardens-E-ARCH-2015.pdf)

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2015 (http://health.hawaii.gov/ohca/files/2016/03/KinaOle-Estate-Ekolu-LLC-E-ARCH-2015.pdf)

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Kina Ole Estate

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

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LLC

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Office of Health Care Assurance   Healthcare Facilities Inspection Reports

2015 (http://health.hawaii.gov/ohca/files/2016/03/Kina-

Manayan's ARCH-

Ole-Estate-Elua-LLC-E-ARCH-2015.pdf)

EC-LLC

2015 (http://health.hawaii.gov/ohca/files/2016/03/Kina-

Manoa Cottage

Ole-Estate-LLC-E-ARCH-2015.pdf)

ARCH II

E-ARCH

2015

E-ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/01/ManoaCottage-ARCH-II_E-ARCH-2015.pdf)

Knight's Victoria

E-ARCH

2015
Manoa Cottage

House

E-ARCH

Kokua Gardens

E-ARCH

2015

2016

Koolau View

E-ARCH

2015

2016

Cottage-Too-ARCH-II_E-ARCH-2015.pdf)
Manoa Elder Care

(http://health.hawaii.gov/ohca/files/2016/01/Koolau-

E-ARCH

LLC ARCH II

View-E-ARCH-2015.pdf)
Legacy Villa

E-ARCH

2015

2016

Manoa Senior

(http://health.hawaii.gov/ohca/files/2016/01/Legacy-Villa-

E-ARCH

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E-ARCH-2015.pdf)
Leticia Bala

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2015 (http://health.hawaii.gov/ohca/files/2016/01/Leticia-

2016

Marietta

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Living Manoa

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2016

Luz Marquez

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2016

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2016

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Medy's ARCH I,

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E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Minda-

E-ARCH

E-ARCH

http://health.hawaii.gov/ohca/inspection-reports/

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).

2015 (http://health.hawaii.gov/ohca/files/2016/01/MJB-

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Monegas-

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Show 100

entries

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Facility

Facility

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Nayda
E-ARCH

2015

2016

Type

Search:


Inspection Reports



Inspection Reports

E-ARCH

2015

2016

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Nelia-

2016

Gamiao

(http://health.hawaii.gov/ohca/files/2016/01/Moonlight-

ARCH

Vista-ARCH-E-ARCH-2015.pdf)

Nelia A.

A.-Blanco-E-ARCH-2015.pdf)

Blanco
MSI

8/9

2015 (http://health.hawaii.gov/ohca/files/2016/01/MIVA-

Home and

Moonlight Vista

2015

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

2016

E-ARCH-2015.pdf)
Monegas Care

2015

12/12/2016

ARCH-Inc-E-ARCH-20151.pdf)
MJB

2015

Beltran-E-ARCH-2015.pdf)

Rocha-Care-Home-E-ARCH-20151.pdf)
E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Mary-

(http://health.hawaii.gov/ohca/files/2016/03/Milagros-

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Home

2015

ARCH-II-E-ARCH-2015.pdf)

2015

http://health.hawaii.gov/ohca/inspection-reports/

MIVA ARCH, Inc

2016

(http://health.hawaii.gov/ohca/files/2016/03/Medys-

(http://health.hawaii.gov/ohca/files/2016/01/Magsanides-

E-ARCH

2015

ARCH-I-INC-E-ARCH-2015.pdf)
Medy's ARCH II

Care-Home-LLC-E-ARCH-2015.pdf)

Minda Rocha Care

2016

(http://health.hawaii.gov/ohca/files/2016/03/Medys-

INC

Castillo-E-ARCH-2015.pdf)

12/12/2016

Senior-Care-LLC

2015

Anns-E-ARCH-2015-1.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Macrina-

Home, LLC

(http://health.haw

Senior-Care-Inc.-ARCH-II_E-ARCH-2015.pdf)

ARCH-2015.pdf)

ARCH-2015.pdf)

E-ARCH

2016

(http://health.hawaii.gov/ohca/files/2016/01/Manoa-

(http://health.hawaii.gov/ohca/files/2016/01/Marrhey-E-

(http://health.hawaii.gov/ohca/files/2016/03/Lusitana-E-

Magsanide's Care

Elder-Care-L.L.C

2015

Pascual-E-ARCH-2015.pdf)
Marrhey

Home-ARCH-II-E-ARCH-2015.pdf)
Lusitana

(http://health.haw

Elder-Care-LLC-ARCH-II_E-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Marissa-

2015 (http://health.hawaii.gov/ohca/files/2016/01/Lorys-

(http://health.hawaii.gov/ohca/files/2016/01/Lunalilo-

ARCH II

2016

(http://health.hawaii.gov/ohca/files/2016/01/Manoa-

Paguirigan-E-ARCH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/02/Living-

E-ARCH-2015.pdf)
Lunalilo Home

2015

(http://health.hawaii.gov/ohca/files/2016/01/Marietta-

Paguirigan

Manoa-E-ARCH-2015.pdf)
Lory's

2015
(http://health.hawaii.gov/ohca/files/2016/01/Manoa-

Too ARCH II

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/MSIARCH_EXPANDED-ARCH-E-ARCH-20151.pdf)

ARCH/EXPANDED

Nelly Aliga

E-ARCH

ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Nelly-

2016

Aliga-E-ARCH-2015.pdf)

(http://health.hawaii.gov/
Aliga-E-ARCH-2016.pdf

Myrna Fronda

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Myrna-

2016

Fronda-E-ARCH-2015.pdf)

Showing 1,501 to 1,600 of 1,755 entries

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Nenita's

E-ARCH

2015

Noemi's

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Noemis-

ARCH

ARCH-E-ARCH-2015.pdf)
Nonales'

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/02/Nonales-EARCH-2015.pdf)
Norma

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Norma-

Daligcon

Daligcon-E-ARCH-2015.pdf)
Oceanside

E-ARCH

2015

E-ARCH

2015

2016

Hawaii
Assisted
Living ARCH
II
Ohana Hale,
LLC

(http://health.hawaii.gov/ohca/files/2016/01/OhanaHale-LLC-E-ARCH-2015-1.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

9/9

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2/10

 12/12/2016

Okano Care

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

Home

12/12/2016

2015

Rainbow

(http://health.hawaii.gov/ohca/files/2016/01/Okano-

Adult

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

2015

E-ARCH

2015

Residential

Care-Home-E-ARCH-2015.pdf)

Care Home
Palolo

2015

2016

Expanded

Chinese

(http://health.hawaii.gov/ohca/files/2016/01/Palolo-

(http://health.hawaii.gov/

ARCH

Home ARCH

Chinese-Home-ARCH-II-E-ARCH-2015.pdf)

Chinese-Care-Home-E-A

E-ARCH

Raquel Care

II

(http://health.hawaii.gov/ohca/files/2016/01/Raquel-

Home
Pascua

E-ARCH

2015

Care-Home-E-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/Pascua-

ARCH, LLC

ARCH-LLC-E-ARCH-2015.pdf)

RC Golfview

E-ARCH

E-ARCH

Pohai Nani

E-ARCH

2015

E-ARCH

2015

2015 (http://health.hawaii.gov/ohca/files/2016/01/RCGolfview-ARCH-E-ARCH-2015.pdf)

ARCH
2015 (http://health.hawaii.gov/ohca/files/2016/02/Pats-

Pat's ARCH

2016
Rebecca

ARCH-E-ARCH-2015.pdf)

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Rebecca-

Navarro

Navarro-E-ARCH-2015.pdf)

Ahui Laulea
RJ Santiago
Pohai Nani

Pohai Nani

E-ARCH

2015

Rodriguez

E-ARCH

(http://health.hawaii.gov/ohca/files/2016/01/Poncethia-

Rosalinda

R.-Rambos-E-ARCH-2015.pdf)

Olivas

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/R-B-

Rosana

Ragonjan

E-ARCH

Ruby

Ruth's

2015
(http://health.hawaii.gov/ohca/files/2016/01/RaguindinMalama-Kauhale-E-ARCH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

3/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

Care Home

E-ARCH

2015

2016

E-ARCH

2015

2016

House,

(http://health.hawaii.gov/ohca/files/2016/01/Ruths-

L.L.C.

House-L.L.C.-E-ARCH-2015.pdf)

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

2015

Tacotaco

(http://health.hawaii.gov/ohca/files/2016/02/Sagadraca-

ARCH

E-ARCH

4/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Tacotaco-

Care-Home-E-ARCH-2015.pdf)
Scott ARCH

2016

Costales

(http://health.hawaii.gov/ohca/files/2016/01/Ragonjan-

Kauhale

2015
ARCH-2015.pdf)

2015

Malama

2016

(http://health.hawaii.gov/ohca/files/2016/01/Rosario-E-

Duran-LLC-E-ARCH-2015.pdf)

E-ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Rosana-

2015 (http://health.hawaii.gov/ohca/files/2016/01/R-M-

Care-Home-E-ARCH-2015.pdf)

Sagadraca

E-ARCH

Dumlao-E-ARCH-2015.pdf)
Rosario

E-ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Rosalinda-

ARCH_E-ARCH-LLC-E-ARCH-2015.pdf)

Care Home

Raguindin

E-ARCH

Dumlao

2016

ARCH LLC

Duran, LLC

2016

Olivas-ARCH-2015-1.pdf)

2015

E-ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/01/Rodriguez-

2015

E-ARCH

ARCH/E-

R&M

E-ARCH

Care-Home-E-ARCH-2015.pdf)

Aguinaldo
R&B

2016

Santiago-ARCH-and-E-ARCH-E-ARCH-2015.pdf)

Care Home

Rambo's

Purificacion

2015 (http://health.hawaii.gov/ohca/files/2016/02/RJ-

ARCH

Ahui Olu
Poncethia R.

E-ARCH

ARCH & E-

Ahui Malie

ARCH-E-ARCH-2015.pdf)

2015 (http://health.hawaii.gov/ohca/files/2016/01/Scott-

Tadeo

E-ARCH

ARCH-E-ARCH-2015.pdf)

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Tadeo-EARCH-2015.pdf)

Senior Living

E-ARCH

2015

2016

with Aloha,

(http://health.hawaii.gov/ohca/files/2016/01/Senior-

Tangonan

LLC

Living-with-Aloha-L.L.C-2015.pdf)

Adult

(http://health.hawaii.gov/ohca/files/2016/01/Tangonan-

Residential

Adult-Residential-Care-Home-E-ARCH-2015.pdf)

Serenity

E-ARCH

2015

2016

E-ARCH

2016

Care Home

(http://health.hawaii.gov/

Care Center

Care-Center-E-ARCH-2

Tanisue Care

E-ARCH

E-ARCH

2015

2015

2016

(http://health.hawaii.gov/ohca/files/2016/01/Tanisue-

Home
Shirley

2015

2016

Care-Home-ARCH-2015.pdf)

Serapion
Teresita
Simpliciano's

E-ARCH

2015

2016

E-ARCH

2015

2016

Home
Sun Moon

Susan

2016

Domingo-Care-Home-E-ARCH-2015.pdf)

Care Home
Tessie M.

2015
(http://health.hawaii.gov/ohca/files/2016/01/Teresita-

Domingo

ARCH
Soriano Care

E-ARCH

E-ARCH

2015

E-ARCH

2015

2016

E-ARCH

2015

2016

E-ARCH

Gaspar
E-ARCH

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/03/Sun-

2016

TLC Ohana

Moon-E-ARCH-2015.pdf)

Hale, Inc.

2015

Trans

(http://health.hawaii.gov/ohca/files/2016/01/Susan-E-

Haven, Inc.

ARCH-2015.pdf)
2015

2016

2015

(http://health.hawaii.gov/ohca/files/2016/01/Tuliao-

(http://health.hawaii.gov/

Adult

(http://health.hawaii.gov/ohca/files/2016/01/Susans-

ARCH-E-ARCH-2015.pdf)

ARCH-E-ARCH-2016.pd

Residential

Adult-Residential-Care-LLC-E-ARCH-2015.pdf)
2015

2016

Tuliao ARCH
Susan's

E-ARCH

Valdez Care

Care, LLC

E-ARCH

(http://health.hawaii.gov/ohca/files/2016/01/Valdez-

Home
Sweet Haven

E-ARCH

2015

Care-Home-E-ARCH-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/01/SweetHaven-E-ARCH-2015.pdf)

Valley View

E-ARCH

T & F Home

E-ARCH

2015

2016

2015
(http://health.hawaii.gov/ohca/files/2016/02/Valley-

Pearl City,

View-Pearl-City-LLC-E-ARCH-2015.pdf)

LLC

Service, LLC
Vargas Care
Tabora's

E-ARCH

2015

2016

Home

(http://health.hawaii.gov/ohca/files/2016/03/Taboras-E-

E-ARCH

2015
(http://health.hawaii.gov/ohca/files/2016/03/VargasCare-Home-E-ARCH-2015.pdf)

ARCH-2015.pdf)

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5/10

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6/10

 12/12/2016

Vilma's Adult

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

Care Home

12/12/2016

2015

Hale

(http://health.hawaii.gov/ohca/files/2016/03/Vilmas-

Harmony

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

E-ARCH

2015

2016

Mildred's

E-ARCH

2015

2016

Ohana

E-ARCH

2015

Gabriel Care

E-ARCH

2015

E-ARCH

2015

E-ARCH

2015

E-ARCH

2015

Adult-Care-Home-E-ARCH-2015.pdf)
Viloria-

E-ARCH

2015

Bautista

(http://health.hawaii.gov/ohca/files/2016/01/Viloria-

ARCH

Bautista-ARCH-E-ARCH-2015.pdf)

Violet's

E-ARCH

2015

Home Care

(http://health.hawaii.gov/ohca/files/2016/01/Violets-

LLC

Home-Care-LLC-E-ARCH-2015.pdf)

Waipahu

E-ARCH

Home

2016

Galan's Care
Home

2015

Oililua

(http://health.hawaii.gov/ohca/files/2016/01/Waipahu-

Hale

Eldercare,

Hale-E-ARCH-2015-1.pdf)
Weber's

E-ARCH

2015

Yamashiro

E-ARCH

2015

Hermelina
Apuya

(http://health.hawaii.gov/ohca/files/2015/12/Yamashiro-

Care Home,
LLC
Yaying

Inc. #1

E-ARCH

Care-Home-LLC-E-ARCH-2015.pdf)

Lita Soria

E-ARCH

2015

2015

Kalaupapa

E-ARCH

2015

E-ARCH

2015

Care Home

(http://health.hawaii.gov/ohca/files/2016/01/Yaying-

House

House-E-ARCH-2015.pdf)
Zen

E-ARCH

2015 (http://health.hawaii.gov/ohca/files/2016/01/Zen-

Rafael Care
Home

2016

Residences-LLC-E-ARCH-2015.pdf)

Residences,

Opportunities

LLC
Oililua Senior

E-ARCH

2015

2016

E-ARCH

2015

ICF-IID

2016

ICF-IID

2016

Resources,
Inc. House

Care, Inc. #II
Imelda

ICF-IID

and

1C

Ancheta

Opportunities

Fe Pena

E-ARCH

2015

Resources,

Lorenzo

E-ARCH

2015

and
Inc. House
3A

Care Home,
Opportunities

LLC

and
Oililua Elder

E-ARCH

2015

2016

Resources,

Care, Inc.,

Inc. House

#III

3C

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

The Arc in

7/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

12/12/2016

The Arc of

2016

ICF-IID

8/10

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/01/Arc-

2016

of-Maui-Mana-Ola-ICF-IID-2015.pdf)

Maui - Mana

Hawaii -

Ola

Kaimuki B
The Arc In

http://health.hawaii.gov/ohca/inspection-reports/

2016

ICF-IID

Arcadia

SNF

2016

SNF

2016

SNF

2016

SNF

2016

Retirement

Hawaii - 6A

Residence
The Arc In

2016

ICF-IID

Avalon Care

Hawaii - 6B

Center
Opportunities

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/01/ORIHouse-1A-ICF-IID-2015.pdf)

and

Hale Ho'ola

Resources,

Hamakua

Inc. House
Hale

1A

Malamalama
Opportunities

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/01/ORI-

Showing 1,601 to 1,700 of 1,755 entries

House-3B-ICF-IID-2015-1.pdf)

and

 Previous Next 

Resources,
Inc. House
3B
The Arc in

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/02/THEARC-IN-HI-EWA-B-ICF-IID-2015.pdf)

Hawaii - Ewa
B
The Arc in

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/01/TheArc-in-Hawaii-Ewa-C-ICF-IID-2015.pdf)

Hawaii - Ewa
C
The Arc in

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/01/TheArc-in-Hawaii-Kaimuki-A-ICF-IID-2015.pdf)

Hawaii Kaimuki A
The Arc in

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/01/The-

2016

Arc-in-Hawaii-Wahiawa-A-ICF-IID-2015.pdf)

Hawaii Wahiawa A
The Arc of

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/01/Arc-

2016

of-Maui-Hale-Kanaloa-ICF-IID-2015.pdf)

Maui - Hale
Kanaloa
The Arc of
Maui - Hale

ICF-IID

2015 (http://health.hawaii.gov/ohca/files/2016/02/TheArc-of-Maui-Hale-Kihei-ICF-IID-2015.pdf)

Kihei

http://health.hawaii.gov/ohca/inspection-reports/

9/10

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10/10

 12/12/2016

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

12/12/2016

To view the inspection report of a specific health care facility, use the search function and enter the
facility’s name. The table can also be sorted by name and facility type. Click on the link under the
Inspection Reports column to view that year’s report. Information that could identify individual
residents has been redacted, including conditions, diagnoses, treatment, medication,
observations, and other individual information.

Liliha

Name of
Facility

entries


Hale Ola

Facility
Type

Inspection Reports



SNF

2016

Maluhia

SNF

2016

Hale Kupuna

SNF

2016

Life Care

SNF

2016

SNF

2016

SNF

2016

SNF

2016

SNF

2016

Nuuanu Hale

SNF

2016

15 Craigside

SNF

2016

Pu'uwai 'O

SNF

2016

SNF

2016

SNF

2016

SNF

2016

Center

Search:


SNF

Healthcare

Click here (http://health.hawaii.gov/ocb/afhir/) to view the inspection reports of Adult Foster
Homes under the department’s Developmental Disabilities Division (DDD).
Show 100

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

Center Of

Inspection Reports

Hilo
Maunalani

2016

Nursing and

Kino

Rehab
Harry and

2016

SNF

Jeanette

Kahuku

Weinberg

Medical

Care Center

Center

Hi'olani Care

Yukio Okutsu

2016

SNF

Center at

State

Kahala Nui

Veterans
Home

Kauai Care

SNF

2016

SNF

2016

Leahi

Center

Hospital
KFHMalama
'Ohana
Nursing and
Rehab
Center

Makaha

Kula Hospital

SNF

2016

Kulana

SNF

2016

SNF

2016

HALE NANI
REHAB &
NURSING

Malama
Lanai

CENTER
Hale Makua -

Community

Wailuku

Hospital
Life Care

Oahu Care

2016

SNF

Facility

Center of
Kona

http://health.hawaii.gov/ohca/inspection-reports/

12/12/2016

Wahiawa

2/7

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12/12/2016

2016

SNF

http://health.hawaii.gov/ohca/inspection-reports/

Island

3/7

Office of Health Care Assurance   Healthcare Facilities Inspection Reports

SNF

2015 #1

General

Nursing

(http://health.hawaii.gov/ohca/files/2016/01/Island-

Hospital

Home

Nursing-Home-SNF-2015.pdf) 2015 #2
(http://health.hawaii.gov/ohca/files/2016/01/Island-

Ann Pearl

SNF

2015

Nursing

(http://health.hawaii.gov/ohca/files/2016/01/Ann-

Facility

Pearl-Nursing-Facility-SNF-2015.pdf)

2016

Nursing-Home-SNF-2015-2.pdf)
Kau Hospital

SNF

2015 #1
(http://health.hawaii.gov/ohca/files/2016/01/Kau-

2015

Hospital-SNF-2015.pdf) 2015 #2

T.C. Ching

(http://health.hawaii.gov/ohca/files/2015/11/Clarence-

(http://health.hawaii.gov/ohca/files/2016/01/Kau-

Villas at St.

T.C.-Ching-Villas-at-St.-Francis-SNF-2015.pdf)

Hospital-SNF-2015-2.pdf)

Clarence

SNF

Francis
Kohala
Hale

SNF

2015

SNF

2015 #1
(http://health.hawaii.gov/ohca/files/2016/01/Kohala-

Hospital

Anuenue

(http://health.hawaii.gov/ohca/files/2016/01/Hale-

Hospital-SNF-2015.pdf) 2015 #2

Restorative

Anuenue-Restorative-Care-SNF-2015.pdf)

(http://health.hawaii.gov/ohca/files/2016/04/KOHALA-

Care
Hilo Medical

HOSPITAL-SNF-2015-2.pdf)
SNF

Center

Ka Punawai

SNF

Ola

2015

Pearl City

(http://health.hawaii.gov/ohca/files/2016/01/Hilo-

Nursing

(http://health.hawaii.gov/ohca/files/2016/01/Pearl-

Medical-Center-SNF-2015.pdf)

Home

City-Nursing-Home-SNF-2015.pdf) 2015 #2

2015 (http://health.hawaii.gov/ohca/files/2016/01/Ka-

2016

Punawai-Ola-SNF-2015.pdf)

(http://health.hawaii.gov/o

SNF

City-Nursing-Home-SNF-20151.pdf)
Aloha

(http://health.hawaii.gov/ohca/files/2016/01/Kauai-

Benchmark

Memorial

Veterans-Memorial-Hospital-SNF-2015.pdf)

Behavioral

Hospital
2015

STF

2016

STF

2016

STF

2016

STF

2016

STF

2016

System, Inc.

2016

(http://health.hawaii.gov/ohca/files/2016/01/Kuakini-

Hale Kauoha

Care

Geriatric-Care-SNF-2015.pdf)

Kakou

SNF

2015

Chinese

(http://health.hawaii.gov/ohca/files/2016/01/Palolo-

Home

Chinese-Home-SNF-2015.pdf)

2016

Hoomau Ke
Ola II
Poailani Dual

2015

Diagnosis

Mahelona

(http://health.hawaii.gov/ohca/files/2016/01/Samuel-

Program

Memorial

Mahelona-Memorial-Center-SNF-2015.pdf)

Samuel

2016

Health
SNF

Geriatric

Palolo

STF

House, Inc.

2015

Veterans

Kuakini

2015 #1

(http://health.hawaii.gov/ohca/files/2016/01/Pearl-

Punawai-Ola-SNF-2016.p
Kauai

SNF

SNF

Women's

Center

Way

http://health.hawaii.gov/ohca/inspection-reports/

4/7

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Noho Ana

STF

2016

Poailani Inc.

STF

2016

C.A.R.E.

STF

2016

STF

2016

Ka Pa Ola

STF

2016

Hale

STF

2016

STF

2016

STF

2016

Hina Mauka

STF

2016

Bobby

STF

2016

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Ike
Residential
Treatment
Program

Cottage Hilo #2
C.A.R.E.
Cottage Hilo

Hoomakaana
The
Exclusive
Addiction
Treatment
Center
Sand Island
Treatment
Center

Benson
Center
Habitat, Inc.

STF

2015
(http://health.hawaii.gov/ohca/files/2016/01/HabilitatInc.-STF-2015.pdf)

Salvation

STF

2015

Army
Addiction
Treatment
Services

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 EXHIBIT 

 

Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aiea
Aina Haina
Aina Haina
Aina Haina
Aina Haina
Captain Cook
Captain Cook
Eleele
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Ewa Beach
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village

M
1
2
1
2
0
1
3
0
1
0
4
2
2
1
1
0
5
3
0
3
3
3
0
0
1
0
0
1
0
2
1
2
0
4
1
1
0
0
2
1
1
1
1
1
3
3
2
2
1
3

F
1
1
1
2
2
0
3
1
1
1
4
2
2
1
0
1
5
2
1
2
2
2
3
1
2
1
1
1
1
1
1
2
2
4
1
0
0
1
1
1
1
1
1
1
2
3
1
3
1
2

TYPE OF CH
ARCH II-Exp
Exp
Exp
ARCH I
ARCH I
ARCH I
Exp
ARCH I
Exp
ARCH I
ARCH II-Exp
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
Exp
ARCH II-Exp
ARCH I
ARCH I
Exp
ARCH I
Exp
Exp
Exp
Exp
Exp
ARCH I
ARCH I
Exp
Exp
Exp
ARCH I
ARCH I
Exp
ARCH I
ARCH I
Exp
Exp
ARCH II-Exp
Exp
Exp
ARCH I
Exp
Exp
Exp
ARCH I

LICNO
112-C
1400-C
1280-C
466-C
1086-C
971-C
1532-C
1375-C
1530-C
1257-C
1472-C
1277-C
1108-C
1445-C
638-C
1344-C
1508-C
1434-C
547-C
1456-C
1458-C
1470-C
1067-C
1320-C
1514-C
1162-C
666-C
1418-C
1111-C
1388-C
658-C
1498-C
978-C
1424-C
1251-C
1521-C
770-C
1363-C
1269-C
1398-C
1268-C
1341-C
1205-C
1353-C
1425-C
1503-C
1416-C
1323-C
1346-C
1473-C

NAME
AIEA HEIGHTS SENIOR LIVING
ALETHA'S EXPANDED ARCH
CALUCAG ARCH -I
DUMLAO, ESTHER
E. RAMOS (ARCH)
GARCIA CARE HOME
HALAWA CARE HOME LLC
HALAWA HEIGHTS HOME
HERNANI T. VALENZUELA AGUILAR ARCH/ECJOYCE S. YAMAOKA CARE HOME
KAAMILO HALE, L.L.C.
LAVIGNE-NAMOCA CARE HOME
MINDA ROCHA CARE HOME
MSI ARCH/EXPANDED ARCH
NITA'S
PASCUA ARCH L.L.C.
PRIME HEALTH SERVICES CARE HOME
TLC OHANA HALE, INC.
VICKY'S
AINA HAINA ARCH
AINA HAINA QUALITY LIVING
OHANALANI L.L.C.
RAMIRO, LYDIA
BUENAVISTA ADULT RESIDENTIAL CARE HOME
CAPTAIN COOK CARE HOME
BARBARA CABANES
AGUINALDO, PURIFICACION
ALOHA LIFELINE ARCH/E-ARCH, LLC
AURORA'S
BALICO'S
BAYBAYAN, ROSITA
BLUE OCEAN CARE HOME
EVELYN VALDEZ
FIDELIBUS COTTAGE
HILARIO ARCH
HUGHES CARE HOME
PASCUAL, SOLEDAD
PAT'S ARCH
R.K.C. ARCH
SHAROLYN L GALAMAY LLC
A.C.T.G. ARCH #3
A.C.T.G. GALLEGOS IV
ACTG ARCH #2
ALFE
ALFE II
COMFORT CARE HOME, L.L.C.
CP GALLEGOS
DEBORA'S
HALE KUPUNA
ISLAND PROMISE ARCH, L.L.C.

OPERATOR
Orbito, Krani Carlo II D. (Mr.), CoFayloga, Florence (Mrs.)
Calucag Care Home, Inc.
Dumlao, Esther (Mrs.)
Ramos, Erlinda (Mrs.)
Garcia, Fe (Mrs.)
Collado, Marites (Mrs.)
Pascual, Carlos (Mr.)
Valenzuela-Aguilar, Hernani T.
Kamiyama, Joyce S. (Mrs.)
Fardal, Carol (Ms.)
Ann Lavigne-Namoca (Ms.)
Rocha, Minda (Mrs.)
Ibera, Marcelo S. (Mr.)
Domingo, Anita (Mrs.)
Llarenas, Novelyn (Mrs.)
Antonio, Rafael Mr. (Ryan)
Caoile, Lilibeth (Mrs.)
Eischen, Victoria (Mrs.)
Chen, Lan (Mrs.)/Home Care
Murphey, Elizabeth,
Soriano-Trias, Nora V. (Mrs.)
Ramiro, Lydia (Mrs.)
Buenavista, Sandy (Mrs.)
Higuchi, Daniel, PCG
Cabanes, Barbara (Mrs.)
Aguinaldo, Purificacion (Mrs.)
Jornacion, Romera (Mrs.)
Alejandro, Aurora (Mrs.)
Balico, Leticia (Mrs.)
Baybayan, Rosita (Mrs.)
Kimoto, Sook Yang Lee (Mrs.)
Valdez, Evelyn (Mrs.)
Fidelibus, Dhy-Jeelen (Mrs.)
Hilario, Ceferino A. (Mr.)
Hughes, John (Mr.)
Pascual, Soledad (Mrs.)
Nunez, Patricia U. (Ms.)
Fitzgerald, Josephine (Ms.)
Galamay, Sharolyn Lucina (Mrs.)
Gallegos, Teofista (Mrs.)
Gallegos, Teofista (Mrs.)
Gallegos, Teofista (Mrs.)
Baptista, Virginia (Mrs.)/ROVICA
Rovica Enterprises, L.L.C.
Miller, Richard (Mr.)
Gallegos, Catalina P. (Mrs.)
Castro, Debora U. (Mrs.)
Weber, Barbara (Mrs.)
Felipe, Anita (Ms.)

EXPIRATION
8/31/2017
6/30/2017
10/31/2017
1/31/2017
2/28/2017
5/31/2017
10/31/2016
6/30/2017
5/31/2017
8/31/2017
1/31/2017
9/30/2017
7/31/2017
8/31/2017
5/31/2017
12/31/2016
11/30/2017
11/30/2016
4/30/2017
11/30/2016
1/31/2017
1/31/2017
12/31/2016
6/30/2017
6/30/2017
2/28/2017
1/31/2017
8/31/2017
12/31/2017
11/30/2017
6/30/2017
5/31/2017
3/31/2017
6/30/2017
3/31/2017
9/30/2017
11/30/2016
6/30/2017
3/31/2017
6/30/2017
1/31/2018
2/28/2017
10/31/2016
12/31/2017
11/30/2017
12/31/2016
1/31/2017

HOUSE_NO
99-1657
99-631
99-042
99-1079
98-063
99-568
99-626
99-619
98-864
98-388
98-570
98-609
98-562
99-603
98-029
98-209
99-1041
99-019
99-1002-D
237
5304
5339
187
81-2010
81-1993
4562
91-2176-B
91-983
91-1112
91-1204
91-810
91-1030
91-1129
91-827
91-1137
91-835
91-711
91-1029
91-938
91-1141
1453
1530
1447
1464
1214
1543
1550
1773
1783
1336

STREET
Aiea Heights Dr.
Ulune St.
Ie'Ie Pl.
Halawa Hts. Rd.
Puaole Pl.
Huakanu St.
Halawa Dr.
Pualaa St.
Kaamilo St.
Ponohana Lp.
Kaamilo St.
Kaamilo St.
Kaimu Lp.
Alia Pl.
Lii-Ipo St.
Kanuku St.
Halawa Heights Rd.
Kealakaha Dr.
Puumakani St.
East Hind Dr.
Limu Pl.
Oio Dr.
Nenue St.
Haku Nui Rd.
Haku Nui Rd.
Mimo Pl.
Fort Weaver Rd.
Ikulani St.
Kiwi St.
Kauiki St.
Haiamu St.
Keoneae Pl.
Kiwi St.
Oama St.
Ahona St.
Kauwili St.
Fort Weaver Rd.
Hanakahi St.
Hanakahi St.
Kauiki St.
Uila St.
Piikea St.
Uila St.
Puanakau St.
Kukila St.
Haloa Dr.
Epukane St.
Piikea St.
Piikea St.
Uila St.

CAP
22
5
5
5
5
5
5
4
4
5
8
5
5
5
5
5
5
5
5
5
8
5
5
4
4
5
5
5
5
5
5
3
5
5
5
3
4
5
3
4
5
5
8
5
5
5
5
5
5
5

D
S
S
S
S
S
S
S
S
S
R
S
S
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S

AMB TYPE WHC
FULLY
Y
AMB
Y
AMB
Y
AMB
N
AMB
Y
AMB
N
AMB
Y
AMB
Y
AMB
Y
AMB
N
AMB (BR#6)
Y
AMB
N
AMB
Y
AMB
Y
AMB
N
AMB
Y
AMB
Y
AMB
Y
AMB
Y (1)
AMB
Y
AMB
Y
AMB
Y
AMB
N
AMB
Y
AMB
Y
AMB
Y
AMB
N
AMB
Y
AMB
N
AMB
Y
AMB
Y (1)
AMB
N
AMB
Y
AMB
Y
AMB
Y
AMB
N
FULLY
N
FULLY(#3) Y(#1 &
AMB
Y
AMB
N
AMB
Y
AMB
Y(BR#
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y

PHONE
488-5521
487-1706
484-1335
200-4957
488-0878
486-3872
487-9530
486-7938
486-9243
488-9697
744-8136
485-0133
487-0624
487-2893
488-2088
699-9865
428-5844
255-1151
488-0504
373-3862
373-4141
377-5456
377-2361
323-2610
238-0494
335-5055
681-5364
689-5031
689-5936
689-7494
689-8662
783-6340
689-5997
664-0947
689-8670
689-5304
689-8569
689-6800
421-7375
689-7092
422-5888
423-8808
422-5888
422-8157
422-8568
422-1947
423-6262
422-5684
421-1673
423-6843

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village
Foster Village
Haleiwa
Hauula
Hawaii Kai
Hawaii Kai
Hawaii Kai
Hawaii Kai
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Hilo
Honokaa
Honolulu
Honolulu
Honolulu
Honolulu
Honolulu
Honolulu
Honolulu
Honolulu
Honolulu
Honolulu

M
1
2
1
3
5
0
0
5
5
3
5
21

F
0
2
1
2
5
0
1
5
1
2
5
21

1
0
0
0
0
0
0
1
0
0
0
0
0
0
1
1
0
1
1
2
4
0
0
3
1
0
0
3
5
2
8
8
8
1
8
4
5

0
1
0
0
0
1
0
0
2
0
0
0
0
0
1
0
2
0
0
1
4
0
0
2
0
1
0
3
5
2
8
8
8
1
8
4
5

TYPE OF CH
Exp
Exp
Exp
ARCH I
ARCH I
Exp
Exp
ARCH II-Exp
ARCH I
ARCH I
ARCH I
ARCH II-Exp
Exp
ARCH I
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp
Exp
Exp
ARCH I
ARCH I
ARCH I
Exp
ARCH I
Exp
ARCH I
ARCH I
Exp
Exp
ARCH I
ARCH I
Exp
Exp
Exp
ARCH I
ARCH I
ARCH I
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
Exp
ARCH II-Exp
Exp
ARCH I

LICNO
1225-C
516-C
1181-C
1411-C
1546-C
1143-C
1016-C
1528-C
1515-C
1410-C
1550-C
1295-C
1554-C
714-C
1188-C
1069-C
1010-C
958-C
597-C
674-C
1127-C
1068-C
1326-C
522-C
1282-C
553-C
989-C
1123-C
1043-C
1317-C
662-C
1245-C
1476-C
1501-C
687-C
793-C
1419-C
663-C
914-C
859-C
1529-C
1523-C
1526-C
1527-C
1534-C
1536-C
1511-C
1531-C
1502-C
1553-C

NAME
JOSIE'S OHANA
MACRINA CASTILLO
NONALES'
SUETOS CARE HOME
TLC CARE HOME, LLC
UNITED FAMILY CARE HOME, LLC
INDEL'S
OCEANSIDE HAWAII ASSISTED LIVING
FAITH HARBOR ADULT CARE
LANIOLU HALE LLC
LEGACY OF FRIENDSHIP ADULT RESIDENTIAL
LUNALILO HOME
A & C CARE HOME
ACEDO, MELBA
ACOSTA, CONCHITA
ALIGA, NELLY
BENITA'S
CORPUZ, OLIVIA
CUA, LILIA
DULDULAO, CARINA
EDITA CASTRO
ELENA'S EXPANDED CARE ARCH, LLC
ELISA CABAL
FERNANDEZ, CARLINA
G. INOCENCIO'S
GACULA, JESSIE
GUERRERO, MIRIAM
ILAR, EMELYN
INOCENCIO, PATRICIA
JOSEPHINE CABAL
MONES, FELICIDAD
PARANADA #2
PONCETHIA R. RAMBO'S
RAZA ADULT RESIDENTIAL CARE HOMERESPICIO, MARIA
SALUDARES, FLORENTINA
SALVADOR, CATHERINE
SOLMERIN, OFELIA
TULIAO ARCH, LLC
ANASTACIO, FAYE V.
FOREVER YOUNG SENIOR CARE, L.L.C.
HALE LEHUA CAREHOME
HUAPALA SENIOR CARE A, LLC
HUAPALA SENIOR CARE B, LLC
HUAPALA SENIOR CARE C, LLC
HUAPALA SENIOR CARE D, LLC
KEALOHA CARE HOME INC.
LIVING MANOA GARDENS
MEDY'S ARCH II
WAIALAE SENIOR LIVING

OPERATOR
Rodrigues, Josefina Velez (Mrs.)
Castillo, Macrina (Mrs.)
Nonales, Lilia O. (Mrs.)
Suetos, Ederlina (Mrs.)
Vicerra-Jaena, Macrina (Mrs.)
Go, Helen (Ms.)
Brillante, Indelicia (Mrs.)
Long, Walter (Mr.)
Popova, Vera Ms.
Defiesta, Anthony (Mr.)
Jose, Ruby (Mrs.)
Asam, J. Kuhio (M.D.), Exec. Dir.
Tabile, Armando (Mr.)
Daak, Melba (Mrs.)
Acosta, Conchita V. (Mrs.)
Aliga, Nelly (Mrs.)
Baruel, Benita (Ms.)
Corpuz-Santos, Olivia (Mrs.)
Cua, Lilia (Mrs.)
Duldulao, Carina (Mrs.)
Castro, Edita (Mrs.)
Bugarin, Elena (Mrs.)
Cabal, Elisa I. (Mrs.)
Fernandez, Carlina (Mrs.)
Inocencio, Gloria P. (Mrs.)
Gacula, Jessie (Mrs.)
Guerrero, Miriam (Mrs.)
Ilar, Emelyn (Mrs.)
Inocencio, Patricia (Mrs.)
Cabal, Josephine Viernes (Mrs.)
Mones, Felicidad (Mrs.)
Paranada, Leandro Jr. (Mr.)
Rambo, Poncethia R. (Ms.)
Raza, Ruth (Mrs.)
Respicio, Maria (Mrs.)
Saludares, Florentina (Mrs.)
Salvador, Catherine (Mrs.)
Solmerin, Ofelia (Mrs.)
Tuliao, Genevie (Mrs.)
Anastacio, Faye V. (Mrs.)
Ishida, Kaylen (Mrs.)
Valdez, Romeo (Mr.)
Manoa Senior Care, Mr. Robert
Manoa Senior Care, Mr. Robert
Manoa Senior Care, Mr. Robert
Manoa Senior Care, Mr. Robert
Lando, Tiare (Mrs.)
Pang, Todd (Mr.) Administrator
De Lara, Mediatrix (Mrs.)
Sukita, Ricky (Mr.), Saito, Sanford

EXPIRATION
7/31/2017
8/31/2017
12/31/2017
10/31/2017
5/31/2017
8/31/2017
2/28/2017
3/31/2017
7/31/2017
11/30/2016
1/31/2017
5/31/2017
8/31/2017
3/31/2017
3/31/2017
4/30/2017
12/31/2016
11/30/2017
12/31/2017
6/30/2017
4/30/2017
1/31/2017
6/30/2017
1/31/2017
6/30/2017
5/31/2017
11/30/2016
1/31/2017
8/31/2017
2/28/2017
7/31/2017
2/28/2017
9/30/2017
3/31/2017
11/30/2017
2/28/2017
2/28/2017
4/30/2017
12/31/2016
3/31/2017
1/31/2017
3/31/2017
3/31/2017
7/31/2017
8/31/2017
4/30/2017
5/31/2017
9/30/2017
7/31/2017

HOUSE_NO
1388
1789
1035
4415
1439
1328
58-109
53-594
5783
1261
7246
501
2294
2501-A
127
174
1121-A
664-D
464
417
201
77
228
137B
1262
55
66
1712
1423
2322
1370
16
1621
61
328
392
2318
366
298
45-507
668
984
2649 A
2649 B
2649 C
2649 D
3617
2385
1229
2945

STREET
Haloa Dr.
Piikea St.
Kukila St.
Ukali St.
Lehia St.
Molehu Dr.
Kaunala St.
Kamehameha Hwy.
Kalanianaole Hwy.
Lunalilo Home Rd.
Anakua St.
Kekauluohi St.
Awapuhi Street
Kinoole St.
W. Puainako St.
Lukia St.
Kahoa St.
Wainaku Ave.
Heahea St.
Ehehene Pl.
Kuhilani St.
Waianuhea Pl.
Hookano St.
Hokulani St.
Komohana St.
Ahona Pl.
Kaiwiki Road
Keone St.
Mailani St.
Awapuhi St., #1
Ala Kula St.
Hoolaulea St.
Nohoana Pl.
Kehaulani St.
Wainohia Pl.
Kaiwiki Rd.
Awapuhi St.
Kapualani St.
Olu St.
Kahili St.
Kauai St.
Ala Lehua St.
Huapala St.
Huapala St.
Huapala St.
Huapala St.
Puuku Mauka Dr.
Beckwith St.
Ala Pili Lp.
Kalei Road

CAP
5
5
5
5
5
5
4
26
5
5
5
42
5
4
5
5
5
2
5
4
4
5
5
5
4
5
5
5
5
5
5
5
5
5
5
3
5
5
5
3
3
5
8
8
8
8
5
8
5
5

D
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R

AMB TYPE
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB

WHC
Y(1)
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
N
N
N
N
Y
Y
Y
Y
N
N
N
Y
N
Y
Y(1)
N
Y
Y
Y
N
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
N

PHONE
422-4323
422-5376
421-1106
422-8757
422-6088
421-1775
638-0701
293-1100
381-7880
394-0770
744-7871
395-1000
203-8306
981-2909
959-0244
935-6208
961-3945
933-1273
959-5432
959-9996
959-4976
959-3824
981-2638
964-5275
959-5962
981-0250
896-0761
959-1247
959-4530
981-0058
959-5740
959-7394
959-8639
959-3166
959-7246
961-6120
981-0613
959-8421
981-5204
775-7324
673-1470
674-2563
988-7505
988-7394
988-7505
988-7505
423-2450
779-8871
833-0919
941-6960

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Kahului
Kahului
Kahului
Kahului
Kahului
Kahului
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua
Kailua-Kona
Kailua-Kona
Kailua-Kona
Kailua-Kona
Kailua-Kona
Kaimuki
Kaimuki
Kaimuki
Kaimuki
Kaimuki
Kaimuki
Kaimuki
Kaimuki
Kaimuki
Kaimuki
Kalama Valley
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi

M
4
0
2
1
0
1
3
1
3
0
0
0
1
2
5

F
4
0
2
0
0
0
2
2
2
1
1
1
1
2
5

2
0
22
2
2
2
2
0
3
1
1
1
0
4
4
3
4
3
2
2
0
2
2
1
2
0
2
0
0
0
1
1
2
0

3
0
22
2
1
2
2
0
2
1
1
1
1
4
4
2
4
2
2
1
0
2
2
0
2
0
2
0
0
0
0
1
2
1

TYPE OF CH
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
Exp
ARCH II-Exp
Exp
Exp
Exp
Exp
Exp
ARCH II
Exp
Exp
Exp
Exp
Exp
Exp
Exp
Exp
Exp
ARCH I
ARCH II-Exp
ARCH II-Exp
Exp
ARCH II-Exp
Exp
Exp
Exp
ARCH I
Exp
Exp
ARCH I
ARCH I
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp

LICNO
1547-C
575-C
1318-C
1271-C
1051-C
772-C
1436-C
1395-C
1463-C
1208-C
1479-C
1300-C
1379-C
1350-C
1489-C
1556-C
1370-C
1107-C
1513-C
1309-C
1442-C
1228-C
1374-C
1283-C
1423-C
1484-C
1202-C
1439-C
1278-C
1349-C
1358-C
1443-C
1313-C
1376-C
1219-C
1334-C
902-C
1041-C
1428-C
939-C
907-C
1362-C
731-C
979-C
732-C
966-C
1079-C
363-C
1062-C
1185-C

NAME
D & K OHANA CARE HOME LLC
GUILLERMO ARCH
IRENEA B. ALIPIO
JEREZ CARE HOME
MYLES CARE HOME
NODS
AKAMAI ADULT RESIDENTIAL CARE HOME
ANGEL HOME FOR SENIORS
FUJII CARE HOME AT MAUNAWILI
KAILUA GARDENS
KAILUA KARE HOME
KAILUA OHANA
KINA 'OLE ESTATE ELIMA, LLC
KOKUA GARDENS
OILILUA ELDER CARE, INC., #III
OILILUA ELDERCARE INC.
OILILUA SENIOR CARE, INC., #II
SERA, AURORA
WILSON SENIOR LIVING KAILUA
DOMINGO'S CARE HOME
E & J ADULT RESIDENTIAL CARE HOME
GALANTO'S ARCH
RUTH'S HOUSE, L.L.C.
TRANS HAVEN, INC.
CALUCAG III
COSTALES, RUBY
GLORIA V. ATMOSPERA, ARCH
HALE NOHEA, L.L.C.
HOME AWAY FROM HOME
KAIMUKI SENIOR CARE, L.L.C. (918)
KAIMUKI SENIOR CARE, L.L.C. (930)
SENIOR LIVING WITH ALOHA, L.L.C.
WINMAX SENIOR CARE L.L.C.
YAYING HOUSE, L.L.C.
E. F. NICOMEDES
3 J's
ABENOJA, MARILEE
ACNAM'S
ADULT RES CARE HOME
AGBAYANI, CONCEPCION
AMODO, MARCELINA
APUYA, ROGER
BALA, LETICIA
BAUTISTA, DOLORES
BUMANGLAG, VIOLETA
CABICO, AURORA
CABICO-PEREZ, LORAINE
CORA'S
DALIGCON, NORMA
E&R

OPERATOR
Ibera, Diana Mei (Mrs.)
Guillermo, Hilaria (Mrs.)
Alipio, Irenea B. (Mrs.)
Jerez, Leonora (Mrs.)
Paranada, Victoria R. (Mrs.)
Ines, Romualda Ibasan (Ms.)
Harris, Jocelyn (Mrs.)
Elite Services of Hawaii, L.L.C.
Fujii, Sam (Mrs.)/Fujii Care Home,
Anhalt, Zafira B. (Mrs.)
Prazoff, Bonnie (Mrs.)
Lomboy, Edna D. (Mrs.)
Slavens, Elizabeth (Mrs.)
Odrunia, Lyndon G.
Tenorio, Norma (Mrs.)
Tenorio, Geronimo
Tenorio, Norma (Mrs.)
Sera, Aurora (Mrs.)
Wilson, Shelley (Administrator),
Domingo, Myrna E.
Reyes, Evangeline D. (Mrs.)
Galanto, Elsa (Mrs.)
Huber, Leigha D. (Mrs.)
Transfiguracion, Eden (Ms.)
Kaimuki Care Home, L.L.C.
Costales, Ruby (Mrs.)
Atmospera, Gloria V. (Mrs.)
Mosher, Patricia (Ms.)
Ema P. Arelliano (Mrs.)
Manoa Senior Care, Mr. Robert
Manoa Senior Care, Mr. Robert
Rumi, Mohammed Jan (Mr.),
Manoa Senior Care, Mr. Robert
Liu, Yaying (Mrs.)/Yaying House,
Nicomedes, Edna F. (Mrs.)
Castillo, Geronimo (Mr.)
Abenoja, Marilee (Mrs.)
Acnam, Castora (Mrs.)
Laurena, Delia G. (Mrs.)
Agbayani, Concepcion (Mrs.)
Amodo, Marcelina (Mrs.)
Apuya, Roger (Mr.)
Bala, Leticia (Mrs.)
Bautista, Dolores (Mrs.)
Bumanglag, Violeta (Mrs.)
Cabico, Aurora (Mrs.)
Perez, Loraine (Mrs.)
Ingel, Corazon (Mrs.)
Daligcon, Norma (Mrs.)
Brion, Remedios (Mrs.)

EXPIRATION
6/30/2017
5/31/2017
9/30/2017
5/31/2017
5/31/2017
7/31/2017
1/31/2017
5/31/2017
12/31/2017
12/31/2017
10/31/2017
10/31/2016
8/31/2017
2/28/2017
8/31/2017
8/31/2017
2/28/2017
3/31/2017
6/30/2017
8/31/2017
5/31/2017
7/31/2017
6/30/2017
7/31/2017
10/31/2016
12/31/2017
9/30/2017
3/31/2017
9/30/2017
3/31/2017
3/31/2017
6/30/2017
7/31/2017
6/30/2017
5/31/2017
7/31/2017
9/30/2017
7/31/2017
6/30/2017
3/31/2017
5/31/2017
10/31/2017
7/31/2017
5/31/2017
7/31/2017
8/31/2017
10/31/2017
4/30/2017
8/31/2017
4/30/2017

HOUSE_NO
321
345
733
24
719
689
1259
1315
1221
120
566
1346
1368
340-B
429 B
429
711
1305
96
74-828
74-797
74-846
73-4318
74-5156
1050
3374-A
3544
5071
1321A
918
930
1419 A
3808
3285
1271
1624
1434
2467
1654
1705
1719
2517
1617
1939
2152
1721
1318
1711
1586
3034

STREET
Puumakani Pl.
S. Lehua St.
Iluna Pl.
Puukani St.
S. Kei Pl.
Holua Dr.
Akiahala St.
Kupau St.
Lola Pl.
Mookua St.
Auwina St.
Akamai St.
Kuloaa Pl.
Kawainui St.
Ulupaina St.
Ulupaina Street, Unit B1
Oneawa St.
Mokapu Blvd.
Kaneohe Bay Dr.
Ulua'oa St.
Ulua'oa St.
Uluaoa St.
Keo Keo St.
Kialoa Pl.
18th Ave.
Maunaloa Ave.
Pahoa Ave.
Maunalani Cir.
Palolo Ave.
12th Ave.
12th Ave.
16th Ave.
Harding Ave.
Olu St.
Kaeleku St.
Perry St.
Konia St.
North School St.
Hauiki St.
Maliu St.
Perry St.
Hoenui St.
Machado St.
Waikahe Pl.
North School St.
Merkle St.
Alani St.
Ema Pl.
Lehua St.
Kalihi St.

CAP
4
5
3
5
5
3
5
5
5
5
5
5
8
5
5
5
5
5
22
5
5
5
5
4
5
4
5
5
5
8
8
5
8
5
5
5
4
5
5
5
5
5
5
4
5
5
5
5
5
5

D
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
R
S
S
S
S

AMB TYPE WHC
AMB
Y
AMB
N
AMB
N
AMB
N
AMB
N
AMB
N
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
N
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
N
FULLY (2nd Y (1st
FULLY (bdrm
N
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
Y
AMB
N
AMB
Y
AMB
N
AMB
Y
AMB
Y
AMB
N
FULLY
N
AMB
N
AMB
Y
AMB
N
AMB
N
AMB
N
AMB
N
AMB
N
AMB
Y
AMB
Y

PHONE
264-8676
877-3669
872-9770
871-7881
877-7494
871-5052
282-7901
221-7766
261-9061
261-6081
263-6117
230-8131
233-4455
263-5624
263-7778
263-7778
263-7778
254-6124
253-7460
329-8203
334-1437
326-2356
325-6283
329-5023
227-8985
394-7402
734-8814
734-4680
739-0640
440-0560
440-0560
383-2597
440-0560
737-8307
395-6410
848-6592
888-8663
845-3589
845-9373
847-7108
312-3955
845-5472
843-0113
847-1610
845-1397
845-0113
841-6584
841-8596
848-1542
842-6115

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kalihi
Kamuela
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe

M
2
1
0
3
0
0
0
3
3
0
1
0
2
0
4
0
0
0
1
0
3
1
1
0
0
0
0
1
0
1
2
0
1
0
1
4
0
0
3
1
1
3
3
28
1
0
1
1
3
3

F
2
0
0
2
1
2
0
2
3
0
0
1
2
3
4
3
0
0
0
1
3
0
4
2
0
0
0
0
1
0
0
2
1
0
0
4
1
0
3
1
1
2
2
28
0
1
1
1
2
2

TYPE OF CH
Exp
ARCH I
Exp
Exp
Exp
ARCH I
ARCH I
Exp
Exp
ARCH I
ARCH I
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp
Exp
ARCH I
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
Exp
ARCH I
ARCH I
ARCH I
ARCH II-Exp
Exp
ARCH II-Exp
Exp
ARCH II-Exp
Exp
Exp

LICNO
1390-C
297-C
1377-C
1481-C
1307-C
718-C
865-C
1354-C
1345-C
920-C
1022-C
270-C
1331-C
762-C
1539-C
565-C
967-C
919-C
1459-C
981-C
1286-C
1000-C
1284-C
708-C
1212-C
791-C
812-C
802-C
761-C
1276-C
1366-C
1338-C
469-C
836-C
1054-C
1490-C
1285-C
1538-C
640-C
1260-C
947-C
1462-C
1480-C
1506-C
1288-C
1471-C
472-C
538-C
1357-C
1378-C

NAME
ERLINDA'S
ESTEBAN, VERONICA
FAMILY TIES
FAMILY TIES ADULT RESIDENTIAL CARE HOME
FERRER
FIESTA, JOHNNY
GARCIA, JUANITA
HALE HARMONY
HELEN Y. AGBAYANI
HIDALGO, FELY
HIPOL, MARGARITA
IBERA, EMERLINDA
JAMANDRE, EVANGELINE G.
JULIAN, CLARITA
LOUMAILE COTTAGE
LUCAS, PRISCILLA
LUCZON, CIPRIANA
MAGAOAY, SHIRLEY
MAGSANIDE'S CARE HOME, L.L.C.
MALDONADO, ELIZABETH
MANAYAN'S ARCH-EC-LLC
MARIANO, GLORIA
MERRY'S
OBRERO, ESPERANZA
OHANA
PASCUAL, ESTHER
REYES, CESARIA
SAGAYSAY, MAKRINA
SEBASTIAN, ADELINA
SORIANO CARE HOME
SUN MOON
SUSAN'S ADULT RESIDENTIAL CARE, LLC
TUGADE, LYDIA
ULEP, JUANITA
VICTORIA
VILMA'S ADULT CARE HOME
WEBER'S
HOONANI CARE HOME
AIDA'S
CEJ CHARITY ARCH-EC, L.L.C.
EMMA ROSE
FURUKAWA RESIDENTIAL RETREAT
GOLDEN ACRES
HALE KU'IKE BAYSIDE, LLC
HOKULAKI ELDER CARE, LLC
HOKULAKI SENIOR LIVING, L.L.C.
HOLY FAMILY ARCH I
HOLY FAMILY II
J&A
KA MALAMA HOME II

OPERATOR
Isidro, Erlinda (Mrs.)
Esteban, Veronica (Mrs.)
Bali, Mary-Ann Ganir (Mrs.)
Bali, Felizardo C., Jr. (Mr.)
Ferrer, Erlinda T.
Fiesta, Johnny (Mr.)
Garcia, Juanita (Mrs.)
Diaz, Tina Rhodes (Mrs.)
Agbayani, Helen Y. (Mrs.)
Hidalgo, Fely (Mrs.)
Hipol, Margarita (Mrs.)
Ibera, Emerlinda (Mrs.)
Jamandre, Evangeline G.
Julian, Clarita (Mrs.)
Drake, Maile (Ms.) President
Lucas, Priscilla (Mrs.)
Luczon, Cipriana (Mrs.)
Magaoay, Shirley (Mrs.)
Magsanide, Editha M. (Mrs.)
Maldonado, Elizabeth (Mrs.)
Manayan, Florence G. (Mrs.)
Mariano, Gloria (Mrs.)
Koh, Lynn (Mrs.)
Obrero, Esperanza (Mrs.)
Dona, Carmen B. (Mrs.)
Pascual, Esther (Mrs.)
Reyes, Cesaria (Mrs.)
Sagaysay, Makrina (Mrs.)
Sebastian, Adelina (Mrs.)
Helen V. Soriano (Mrs.)
Gallego, Maria T. (Mrs.)
Ramiro, Susan Maribel Y. (Mrs.)
Tugade, Lydia (Mrs.)
Ulep, Juanita (Mrs.)
Ragasa, Elena (Mrs.)
Yun, Vilma (Mrs.)
Weber, Perla C. (Ms.)
Clay, Karyn Beth (Mrs.)
Bautista, Zenaida (Mrs.)
Lazo, Carolyn B. (Mrs.)
Angeles, Adelaida (Ms.)
Or, Benjamin (Mr.),
Pascual, Miguel (Mr.)
Fitzgerald, David (Mr.)
Tabaniag, Robert M. (Mr.)
Tabaniag, Myriam R. (Mrs.)
Guillermo, Virginia (Mrs.)
Guillermo, Virginia (Mrs.)
Bondoc, Susan B. (Ms.)
Elizalde, Helen (Mrs.)

EXPIRATION
3/31/2017
4/30/2017
6/30/2017
4/30/2017
7/31/2017
12/31/2017
1/31/2017
7/31/2017
2/28/2017
5/31/2017
10/31/2017
4/30/2017
7/31/2017
4/30/2017
4/30/2017
2/28/2017
7/31/2017
8/31/2017
2/28/2017
6/30/2017
12/31/2016
12/31/2016
2/28/2017
1/31/2018
10/31/2017
9/30/2017
7/31/2017
12/31/2017
1/31/2018
3/31/2017
10/31/2017
6/30/2017
8/31/2017
2/28/2017
11/30/2017
2/28/2017
10/31/2017
3/31/2017
8/31/2017
4/30/2017
10/31/2016
5/31/2017
1/31/2017
3/31/2017
5/31/2017
5/31/2017

HOUSE_NO
2020
1342
1103-A
1119
1701
1411
1921
1631
1328
1308
3583
1631
2030
2364
1118
1560
1765
1529
1439
2316
1319
1614
2115 A
1609
2011
1802
2602
1112
1630
2307
1020
1315
2411
2817
1705
1805
3056
65-1267B
45-552
45-415
47-442
47-008
45-525
45-212
45-526
45-217A
47-410
47-410
45-349
45-332

STREET
Uhu St.
Kamehameha IV Rd.
Kahauiki Pl.
Kahauiki Pl.
Elua St.
Gulick Ave.
Ula St.
Owawa St.
Kamehameha IV Rd.
Middle St.
Kalihi St.
Kilohana St.
Uhu St.
Haumana Pl.
Kaili St.
Kealia Dr.
Gulick Ave.
Leilani St.
Middle St.
Keha Pl.
Gulick Ave.
Merkle St.
Gertz Ln.
Maliu St.
Kaumualii St.
Wahine Pl.
Nihi St.
Kopke St.
Leilani St.
North School St.
Hala Dr.
Gulick Ave.
Kini Pl.
Nihi St.
Ema Pl.
Aupuni St.
Nihi St.
Lindsey Rd.
Liula St.
Kulauli St.
Aialii Pl.
Okana Pl.
Duncan Dr.
Kaneohe Bay Dr.
Nakuluai St.
William Henry Rd.
Ahuimanu Rd.
Ahuimanu Rd.
Kenela St.
Ka Hanahou Cir.

CAP
4
5
5
5
5
5
4
5
5
3
5
5
5
4
4
5
5
5
3
4
5
5
5
5
4
4
2
5
5
5
5
5
4
5
4
5
5
5
5
5
5
5
5
28
5
8
5
40
5
5

D
S
S
S
S
S
R
R
S
S
R
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
S
R
S
S
S
S
S
S
S
S
S
S
S
R
R
S
S
S
S
S
S
S
S

AMB TYPE
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB

WHC
Y
N
Y
Y
Y
N
N
Y
Y
N
N
N
Y
N
Y
N
N
N
Y
N
Y
N
Y
N
N
N
N
N
N
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y

PHONE
842-7886
888-3402
841-1674
843-8544
845-9980
847-1096
845-5732
386-6493
843-8203
848-8866
847-6369
841-5115
842-6597
841-6783
699-4899
842-7424
848-0405
841-1448
842-1676
845-6675
848-7730
845-8436
847-4588
841-2142
842-3003
842-0227
843-0597
848-0451
845-2461
845-0512
595-1073
845-2879
845-8749
845-1459
845-1820
841-2202
843-2061
896-6417
235-1637
235-4574
239-5815
386-2006
235-7525
235-6770
234-0888
235-8388
239-7993
239-7993
234-1580
234-5555

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kaneohe
Kapaa
Kapaa
Kapaa
Kapa'au
Kapahulu
Kapolei
Kapolei
Kapolei
Kapolei
Kaunakakai
Kaunakakai
Keaau
Keaau
Keaau
Keaau
Keaau
Keaau
Keaau
Kihei
Koloa
Kuliouou
Kuliouou
Kuliouou
Kuliouou
Lihue
Lihue
Lihue
Lihue
Lihue
Liliha
Liliha
Liliha
Makakilo
Makakilo
Manoa

M
5
3
0
3
3
0
0
1
1
1
1
0
1
4
1
3
0
2
2
2
1
0
3
1
0
0
0
0
0
1
4
2
0
2
0
5
3
5
0
0
2
2
1
1
1
8
0
0
1
5

F
5
2
0
2
2
0
1
1
1
1
1
0
2
4
3
2
1
2
2
0
0
0
2
1
0
0
3
1
0
1
4
2
0
3
0
5
2
5
1
0
2
2
1
1
5
7
1
0
0
5

TYPE OF CH
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
Exp
Exp
ARCH I
Exp
Exp
Exp
Exp
Exp
ARCH I
ARCH I
Exp
Exp
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
ARCH I
Exp
Exp
Exp
Exp
ARCH I
Exp
Exp
Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
ARCH I
ARCH I
ARCH I
Exp
ARCH I
ARCH II
ARCH II
ARCH I
ARCH I
Exp
ARCH I

LICNO
1495-C
1430-C
1327-C
1383-C
1465-C
729-C
1183-C
1241-C
1242-C
1325-C
1324-C
817-C
1264-C
1403-C
1412-C
1392-C
1250-C
1438-C
1507-C
1382-C
1153-C
1372-C
1446-C
1281-C
874-C
1027-C
1057-C
653-C
1408-C
1525-C
1504-C
1524-C
1163-C
1074-C
984-C
1535-C
1482-C
1549-C
1144-C
779-C
1298-C
724-C
903-C
1485-C
105-C
106-C
1359-C
688-C
611-C
1548-C

NAME
KINA 'OLE ESTATE EKOLU, LLC
KINA 'OLE ESTATE ELUA, LLC
KINA 'OLE ESTATE, LLC
KOOLAU VIEW
LEGACY VILLA
OLIPARES, CELESTINA
PASCUAL, MARISSA G.
POHAI NANI - 'AHUI NANI
POHAI NANI - 'AHUI 'OLU
POHAI NANI 'AHUI LAULE'A
POHAI NANI 'AHUI MALIE
SELGA, NATIVIDAD
SUENAGA II
T & F HOME SERVICES, LLC
YAMASHIRO CARE HOME L.L.C.
ALL HEARTS ARCH, L.L.C.
RABAINO'S
WAILUA OHANA
ANO ANO, L.L.C.
CABATU, ROBERT
HERMELINA APUYA
ISLAND LIVING
ISLAND LIVING II
JML
BADUA, LILY
ESTRELITA LUCZON
AURORA PATAO ARCH
ELLAZAR, ESTELA
HALE PUUHONUA
OKANO CARE HOME
RAMELB ADULT RESIDENTIAL CARE HOME
RIINGEN ARCH/EXPANDED ARCH
TADEO
J.C.
AGUINALDO, EVANGELINE
HALE MALAMALAMA MAUKA
HAWAII KAI ARCH
HOME AWAY FROM HOME II CORPORATION
JOY S. ALCONCEL
AGUSTIN, FLORDELINA
CASTRO'S
DURAN, CORAZON
GANIRON, JULIANA
NEGRILLO'S ARCH
KOREAN CARE HOME
KUAKINI HOME
MARTHA'S
DAGUIMOL, SHIRLEY
LAGUNOY, ANITA
BECKWITH MANOA SENIOR CARE

OPERATOR
Slavens, Elizabeth (Mrs.)
Slavens, Elizabeth (Mrs.)
Slavens, Elizabeth (Mrs.)
Francisco, Purita (Mrs.)
Hironaka, Gary (Mr.), Owner/Mrs.
Olipares, Celestina (Mrs.)
Pascual, Marissa G. (Mrs.)
Evangel. Luth. Good Samar. Soc.
Evangel. Luth. Good Samar. Soc.
Evangel. Luth. Good Samar. Soc.
Evangel. Luth. Good Samar. Soc.
Selga, Natividad (Mrs.)
Perry, Stacy (Mrs.)
Mafua, Francesca M. (Mrs.)
Yamashiro, Vivian C. (Mrs.)
Rabaino, Lalaine (Ms.)
Rabaino, Lalaine (Mrs.)
Kobayashi, Conchita (Mrs.)
Melton, Marc S. (Mr.)
Cabatu, Robert (Mr.)
Apuya, Hermelina (Mrs.)
Oculto, Teresita (Mrs.)
Jatico, Narcisa
Lim, Merlyne G. (Mrs.)
Badua, Lily (Mrs.)
Luczon, Estrelita (Mrs.)
Patao, Aurora (Ms.)
Ellazar, Estela (Mrs.)
Olin, Robert (Mr.)
Okano, Stacey (Ms.)
Ramelb, Evelyn C. (Mrs.)
Riingen, Benita (Mrs.)
Handy, Rianalyn T. (Mrs.)
Garcia, Catalina R. (Mrs.)
Aguinaldo, Evangeline (Mrs.)
Fukumura, Pauline (Mrs.), Ono
Rol, Belarmina (Mrs.)
Arelliano, Ema (Ms.)
Alconcel, Jocelyn S. (Mrs.)
Agustin, Flordelina (Mrs.)
Castro, Julie (Mrs.)
Duran, Corazon (Mrs.)
Ganiron, Juliana
Negrillo, Shirley (Mrs.)
Yun Cannon, Sam Sil (Ms.)
William Oshima, RN
Taumalolo, Maata
Daguimol, Shirley (Mrs.)
Lagunoy, Anita (Mrs.)
Young, Beverley (Mrs.)

EXPIRATION
12/31/2016
7/31/2017
2/28/2017
9/30/2017
10/31/2017
8/31/2017
6/30/2017
1/31/2017
1/31/2017
1/31/2017
1/31/2017
12/31/2017
11/30/2016
6/30/2017
12/31/2016

3/31/2017
11/30/2016
9/30/2017
4/30/2017
7/31/2017
12/31/2016
11/30/2017
11/30/2016
12/31/2016
10/31/2016
8/31/2017
2/28/2017
10/31/2017
1/31/2017
5/31/2017
9/30/2017
5/31/2017
8/31/2017
5/31/2017
10/31/2016
10/31/2017
11/30/2016
5/31/2017
12/31/2017
6/30/2017
12/31/2017
2/28/2017
6/30/2017
2/28/2017
9/30/2017

HOUSE_NO
45-219
45-225A
45-225
45-650
47-704
45-693
45-220
45-090
45-090
45-090
45-090
45-933
45-390
45-339
45-386
5962
328
187
54-2489
3258-A
92-761
92-1269
92-1238
92-560
260
249-A
15-1395
17-162
15-1735
16-1397
16-1508
17-559
17-566
203
3787
246
308
6020
339-A
4354
3354
3920
4184
4719
525
347
516
92-603
92-642
2375

STREET
William Henry Rd.
William Henry Rd.
William Henry Rd.
Pua Alowalo St.
Lamaula Pl.
Keneke St.
Namoku St.
Namoku St.
Namoku St.
Namoku St.
Namoku St.
Keaahala Pl.
Kam. Hwy.
Kahowaa Pl.
Kamehameha Hwy.
Kawaihau Rd.
Hie St.
Lihau St.
Kynnersley Rd., Lot C
Hinano St.
Paakai St.
Umena St.
Umena St.
Pilipono St.
Ala Malama Ave.
Ala Malama Ave.
29th Ave.
Ipu'aiwaha St.
19th Ave.
35th Ave.
35th Ave., Orchidland
Ipuaiwaha St.
S. Ipu'aiwaha St.
Awa Pl.
Mamaki St.
Moomuku Pl.
Kuliouou Rd.
Kalanianaole Hwy.
Elelupe Rd.
Wena St.
Eono St.
Hoohuki St.
Kuia Pl.
Opukea St.
Kiapu Pl.
N. Kuakini St.
Ihe St.
Malahuna Lp.
Makakilo Dr.
Beckwith St.

CAP
8
8
8
5
5
4
5
5
5
5
5
5
5
5
5
4
3
4
5
5
5
5
5
5
5
5
5
5
5
5
4
5
4
5
3
5
5
5
5
4
5
5
5
5
31
34
4
5
5
5

D
S
S
S
S
S
R
S
S
S
S
S
R
S
S
S
R
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
S
S
S
S
S
S
S
S
S

AMB TYPE WHC PHONE
AMB
Y
236-4451
AMB
Y
233-4455
AMB
Y
233-4455
AMB
Y
234-1534
AMB
Y
239-2239
AMB
N 235-6993
AMB
Y
235-7515
AMB
Y
247-6211
AMB
Y
247-6211
AMB
Y
247-6211
AMB
Y
247-6211
AMB
N 247-1699
AMB
Y
236-3465
AMB
Y
590-7769
AMB
Y
285-2604
AMB
Y
822-7907
AMB
Y
822-9753
AMB
Y
823-8004
AMB
Y
884-5265
AMB
N 739-9543
AMB
Y
682-0642
AMB
Y
457-1066
AMB
Y
375-8933
AMB
Y
672-3406
FULLY
N 553-5581
AMB
N 553-3077
AMB
Y
966-6881
AMB
Y
966-9264
AMB
Y
982-5415
AMB
Y
982-7828
AMB
Y
966-9553
AMB
Y
982-3658
AMB
Y
982-7274
AMB
N 879-4827
AMB
N 742-2044
AMB
Y
396-0537
AMB
Y
396-4195
AMB
Y
312-3937
AMB
N 396-2283
AMB
N 245-2067
FULLY
N 245-4890
AMB
N 245-4170
AMB
N 245-4997
AMB
Y
241-1340
AMB
Y(C&D 533-3157
AMB
N 547-9208
FULLY
N 521-6181
AMB
N 682-5244
AMB
Y
672-5947
AMB/FULLY
Y
497-8489

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Manoa
Manoa
Manoa
Manoa
Manoa
Manoa
Manoa
Manoa
Manoa
McCully
McCully
Mililani
Mililani
Moanalua
Moanalua
Moanalua
Moanalua
Moanalua
Moanalua
Moanalua
Moanalua
Moiliili
Naalehu
Naalehu
Niu Valley
Niu Valley
Nuuanu
Nuuanu
Pahala
Palama
Palolo
Papaikou
Paukaa
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City

M
0
0
1
0
4
4
1
2
3
1
5
3
5
0
0
0
0
0
0
0
0
0
0
1
1

F
0
0
1
0
4
4
1
2
2
0
5
2
5
0
2
1
1
2
1
0
1
1
0
1
1

1
3
0
2
0
0
0
2
5
0
0
2
1
4
3
1
0
0
1
3
1
0
0
3

1
3
2
0
0
0
0
0
5
1
2
2
1
4
2
1
0
1
1
3
1
2
1
0

TYPE OF CH
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
ARCH II-Exp
ARCH I
Exp
Exp
Exp
Exp
Exp
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
Exp
ARCH I
Exp
Exp
ARCH I
ARCH II-Exp
ARCH I
ARCH I
Exp
ARCH II-Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
Exp
Exp
Exp
ARCH I
Exp
Exp
ARCH I
Exp

LICNO
1488-C
1279-C
1356-C
1433-C
1299-C
1253-C
1262-C
1292-C
1426-C
1381-C
1492-C
1404-C
1510-C
1369-C
941-C
458-C
1217-C
490-C
330-C
342-C
618-C
1417-C
668-C
1152-C
1149-C
1555-C
1348-C
333-C
1102-C
1289-C
226-C
962-C
1004-C
1135-C
1533-C
1321-C
1116-C
1497-C
1293-C
1120-C
1391-C
1305-C
1113-C
537-C
1347-C
1537-C
1249-C
1031-C
750-C
1385-C

NAME
CARING MANOA, L.L.C.
MANOA COTTAGE
MANOA COTTAGE TOO
MANOA COTTAGE TREE
MANOA ELDER CARE, L.L.C.
MANOA SENIOR CARE A
MANOA SENIOR CARE B
MANOA SENIOR CARE, LLC
MANOA SUNSHINE-RESIDENTIAL CARE, INC
GAYLORD'S
GAYLORD'S III
EMMY'S
RAINBOW ADULT RESIDENTIAL CARE
AI ARCH
CASTRO ARCH
GELACIO CARE HOME
HALE OLU CARE HOME L.L.C.
LETICIA'S CARE HOME
NITA'S QUALITY HOME CARE SERVICES
PASCUAL'S
RAMOS, CONSOLACION
GAYLORD'S II
LEE, EMILY
NELIA A. BLANCO
JAN'S HANAI
KNIGHT'S VICTORIA HOUSE
HALE KUIKE
LETTIE'S
BLANCO, GLORIA
CALLO CARE HOME
PALOLO CHINESE HOME
GABRIEL, CLAIRE
DALERE, FRANCISCA
ABAD, EDNA
ANALANI ARCH, L.L.C.
DOMINGO, MARIA-THERESA C.
FE PENA
FELY IRONS' ADULT RESIDENTIAL CARE HOME
FLOJO QUALITY AFFORDABLE CARE HOME
GINA'S
J. QUINABO ARCH #I
JAJA ARCH
JESUSA QUINABO ARCH #II
JUANITA'S
LORENZO CARE HOME, LLC
MAESTRO CARE HOME
MARY ANN'S
MOONLIGHT VISTA ARCH
QUITEVIS, ELENA
RAFAEL CARE HOME

OPERATOR
Pang, Todd (Mr.) Administrator
Shim, Sandra Y. (Mrs.)
Shim, Sandra Y. (Mrs.)
Shim, Sandra Y. (Ms.)/SYS Tree,
Manoa Senior Care, Mr. Robert
Manoa Senior Care, Mr. Robert
Manoa Senior Care, Mr. Robert
Manoa Senior Care, Mr. Robert
Nordyke, Michelle (Mrs.)
Gaylord, Wannette (Mrs.)
Gaylord, Wannette (Mrs.)
Esteban, Emalyn (Mrs.)
Borgonia, Debbie B. (Mrs.)
Harris, Josephine N. (Ms.),
Castro, Maria (Mrs.)
Gelacio, Zosima (Mrs.)
Zaharis, Sharlene B. (Mrs.)
Fernando, Tessie (Mrs.)
Salvador, Cionita (Mrs.)
Pascual, Trina (Mrs.)
Ramos, Consolacion (Mrs.)
Gaylord, Wannette (Mrs.)
Lee, Emily L. (Mrs.)
Blanco, Nelia A. (Mrs.)
Black, Janneth A. (Ms.)
Arciaga, MaeAnn (Ms.)
Colby, Dorothy (Ms.), Admin.,
Tesoro, Leticia (Mrs.)
Blanco, Gloria (Mrs.)
Callo, Teresita A. (Ms.)
Nakayama, Darlene (Ms.),
Gabriel, Claire (Mrs.)
Dalere, Francisca
Abad, Edna (Mrs.)
Saludares, Corazon (Ms.)
Domingo, Maria-Theresa C. (Mrs.)
Pena, Fe (Mrs.)
Irons, Fely M. (Mrs.)
Flojo, Cecile B. (Mrs.)
Rarogal, Gina (Mrs.)
J. Quinabo Care Home, LLC (Mrs.
Tabangcura, Agnes (Mrs.)
J. Quinabo Care Home, LLC (Mrs.
Fajardo, Juanita (Mrs.)
Lorenzo, Catherine (Mrs.)
Maestro, Amalia (Mrs.)
Ford, Mary Ann (Mrs.)
Rodriguez, Maria B. (Mrs.)
Quitevis, Elena (Mrs.)
Rafael, Marlene (Mrs.)

EXPIRATION
7/31/2017
10/31/2016
10/31/2016
11/30/2016
4/30/2017
6/30/2017
6/30/2017
4/30/2017
5/31/2017
9/30/2017
10/31/2017
11/30/2016
3/31/2017
3/31/2017
2/28/2017
1/31/2017
4/30/2017
2/28/2017
8/31/2017
12/31/2017
11/30/2016
1/31/2017
6/30/2017
6/30/2017
8/31/2017
12/31/2016
10/31/2017
6/30/2017
4/30/2017
5/31/2017
4/30/2017
6/30/2017
7/31/2017
7/31/2017
11/30/2016
10/31/2017
5/31/2017
11/30/2016

9/30/2017
12/31/2016
9/30/2017
5/31/2017
5/31/2017
12/31/2016

HOUSE_NO
2383
2035
2039
2220
2870
2250
2240
2872
2205
1723
2508
94-382
95-195
1329
1484
1746
1573
1375
1533
1521
1742
1110
94-5869
95-5573
272
268
95
739-D
96-3178
1027 A
2459
27-358
303-A
98-312
98-137
98-1651
1621
2036
1159
1233
1553
1459
1805
1902
98-1591
613
745
98-1282
1614
98-1713

STREET
Beckwith St.
Kamehameha Ave.
Kamehameha Ave.
McKinley St.
Oahu Ave.
Oahu Ave.
Oahu Ave.
Oahu Ave.
McKinley St.
Malanai St.
Coyne St.
Kaholo St.
Aumea Lp.
Ala Aolani St.
Ala Iolani St.
Ala Aolani Pl.
Ala Lani St.
Ala Hoku Pl.
Ala Iolani Pl.
Ala Iolani Pl.
Ala Aolani Pl.
Kaialiu St.
Kau Wela Pl.
Lokelani St.
Panio St.
Panio Street
Kawananakoa Pl.
N. Judd St.
Pakalana St.
Lowell Pl.
10th Ave.
Anderton Camp
Kulana Rd.
Kaluamoi Dr.
Kaluamoi Pl.
Hoomaike St.
Kaumoli St.
Komo Mai Dr.
Kuokoa St.
Puu Kipa St.
Kaweloka St.
Kaleilani St.
Hookupa St.
Palamoi St.
Hoomaike St.
Hoohale St.
Puu Kala St.
Hoohuali Pl.
Maluawai St.
Laauhuahua Wy.

CAP
8
8
8
8
8
8
8
8
5
5
5
5
5
5
5
5
3
5
4
5
3
5
4
5
5
5
26
5
4
5
50
4
1
4
5
5
5
5
5
5
5
5
5
5
5
4
5
5
5
5

D
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
S
S
R
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S
R
S
S
S
S
S
S
S
S

AMB TYPE
AMB
AMB/FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
FULLY
FULLY
FULLY
FULLY
FULLY
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB

WHC
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
N
N
N
N
N
Y
N
Y
Y
Y
Y
N
N
Y
Y
N
N
N
Y
Y
Y
Y
Y
N
Y
N
Y
Y
Y
Y
Y
Y
N
Y

PHONE
779-8871
943-8767
943-8767
943-8767
440-0560
440-0560
440-0560
440-0560
945-2657
227-7173
227-7173
625-4575
625-2425
489-6453
839-5419
839-2520
836-4727
839-4790
836-0489
834-2970
833-9812
227-7173
929-8320
929-7638
377-3104
373-7437
595-6770
537-2622
928-8959
843-1240
737-2555
964-5268
961-3109
487-1080
741-1770
455-3365
455-8341
455-7321
455-2853
456-5765
456-4190
664-1988
456-9375
455-1175
456-8878
741-4065
456-3138
456-8671
455-7346
455-9282

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pearl City
Pepeekeo
Pepeekeo
Punchbowl
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Salt Lake
Wahiawa
Wahiawa
Wahiawa
Wahiawa
Waialua
Waialua
Waialua
Waianae

M
0
0
0
0
2
2
5
2
4
5
3
0
1
2
1
2
1
2
0
1
3
0
3
2
1
1
2
2
3
2
1
0
0
0
2
1

F
2
2
0
0
2
1
5
2
4
5
2
0
1
2
1
0
1
2
1
0
2
1
2
2
1
1
2
1
3
3
1
1
1
1
0
0

1
0
0
0
0
4
2
2
1
0
1
1
0

1
2
1
0
0
4
2
2
1
2
1
1
3

TYPE OF CH
ARCH I
Exp
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
ARCH I
Exp
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp
ARCH I
ARCH I
Exp
Exp
Exp
Exp
Exp
Exp
Exp
ARCH I
ARCH I
Exp
ARCH I
Exp
Exp
Exp
ARCH I
Exp
Exp
Exp
Exp
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
Exp

LICNO
328-C
1029-C
1399-C
681-C
1394-C
1469-C
1520-C
1380-C
1541-C
1517-C
1460-C
576-C
1006-C
1409-C
1175-C
955-C
1129-C
290-C
877-C
862-C
1447-C
630-C
1316-C
1275-C
1435-C
701-C
1427-C
1157-C
1169-C
1311-C
1246-C
742-C
810-C
711-C
1186-C
1214-C
1552-C
1206-C
1360-C
764-C
1167-C
1117-C
1244-C
1393-C
712-C
882-C
415-C
477-C
488-C
1287-C

NAME
RIMANDO, ELNORA
RODRIGUEZ CARE HOME
ROSE HWANG'S CARE HOME
SNOUFFER, CELY
SWEET HAVEN
TANISUE CARE HOME
TJ FACTORA CARE HOME
VALLEY VIEW PEARL CITY, LLC
WE CARE HOME
YOON'S CARE HOME
ZEN RESIDENCES, L.L.C.
BAPTISTA, MYRNA
JUSTO, CHARING
LUSITANA
AGUINALDO'S
AMODO, GLORIA
CALUCAG ARCH, INC. II
CASTILLO, ENRIQUETA
DAOANG, AGUSTINA
DOWNEY, NORMA
D-WELL CARE SERVICES
FELARCA CARE HOME
GAMIAO, NAYDA
HAVEN
LORETTA G. DOMINGO
MEDY'S ARCH I, INC.
MJB
NENITA'S
OLIVAS, ROSALINDA
PAGUIRIGAN, MARIETTA B.
PRECIOUS MOMENT ADULT RESIDENTIAL CARE
PRIETO, GLORIA
QUIOCHO, LOLITA
RAMOS, ARSENIA
RC GOLFVIEW ARCH
SANTOS, NORMA
SERENITY CARE HOME
SUSAN
TACOTACO ARCH
TAMAYO, CRES
VIOLET'S CARE HOME, INC.
YOLANDA RAZON-COLLO
A BETTER LIVING
RAQUEL CARE HOME
ROSARIO, TRINIDAD
UGALINO ARCH
PADRON, MARTINA
SADOY, JUANITA
ZENAIDA'S
ALOHA ARCH

OPERATOR
Rimando, Elnora (Mrs.)
Rodriguez, Teresita (Mrs.)
Hwang, Rose (Ms.), President
Snouffer, Cely (Mrs.)
Fogata, Bernardo/Amelia
Tanisue, Clarisa B.L. (Mrs.)
Factora, Tessie (Mrs.)
Fardal, Carol (Ms.)
Raksilapa, Ganya (Ms.)
Yoon, Young B. (Mrs.)
Agbunag, Jarrah (Mrs.)
Baptista, Myrna (Mrs.)
Justo, Charing (Mrs.)
de Guzman, Carolyn (Mrs.)
Aguinaldo, Serafina (Mrs.)
Amodo, Gloria (Mrs.)
Calucag Care Home Inc.
Castillo, Enriqueta (Mrs.)
Daoang, Agustina (Mrs.)
Downey, Norma (Mrs.)
Dingle, Maria (Mrs.)
Felarca, Essie U. (Mrs.)
Gamiao, Nayda (Mrs.)
Abuan, Raquel G. (Ms.)
Domingo, Loretta G. (Mrs.)
De Lara, Mediatrix (Mrs.)
Barranco, Michelle J. (Mrs.)
Andrada-Jose, Nenita V. (Mrs.)
Olivas, Rosalinda T. (Mrs.)
Paguirigan, Marietta B.
Andres, Evangeline A. (Ms.)
Prieto, Gloria (Mrs.)
Quiocho, Lolita (Mrs.)
Ramos, Arsenia (Mrs.)
Cardenas, Romulo Romeo (Mr.)
Santos, Norma A. (Mrs.)
Vila, Anabel (Ms.)
Pulido, Susan B. (Mrs.)
Tacotaco, Cristeta (Mrs.)
Tamayo, Cres (Mrs.)
Sadural, Violet A. (Mrs.)
Razon-Collo, Yolanda (Mrs.)
McMurray, MaryAnn (Mrs.)
Raquel, Loreto (Mr.)
Rosario, Trinidad (Mrs.)
Ugalino, Josefina (Mrs.)
Padron, Martina (Mrs.)
Sadoy, Juanita (Mrs.)
Rivera, Zenaida (Mrs.)
Acuram, Marlyn (Mrs.)

EXPIRATION
6/30/2017
6/30/2017
11/30/2016
3/31/2017
12/31/2017
11/30/2017
2/28/2017
8/31/2017
6/30/2017
4/30/2017
7/31/2017
10/31/2016
8/31/2017
2/28/2017
11/30/2017
7/31/2017
11/30/2016
12/31/2016
9/30/2017
6/30/2017
7/31/2017
2/28/2017
1/31/2017
6/30/2017
12/31/2016
7/31/2017
5/31/2017
1/31/2017
7/31/2017
9/30/2017
6/30/2017
2/28/2017
1/31/2018
6/30/2017
12/31/2016
7/31/2017
10/31/2017
5/31/2017
10/31/2017
2/28/2017
4/30/2017
6/30/2017
12/31/2016
6/30/2017
8/31/2017
1/31/2018
3/31/2017

HOUSE_NO
1758
1647
1755
712
98-1274
1615
830
944
2256
1754
432
28-2845
28-2865
1925
4406
1437
1193
1067
1018
4038
5119 B
4679
3648
4475
1419
1447
4221
5193
3410
4007
4229
3504
4103
4028
1316
4240
1010 C
5145
1017
1075
1104
4345
83
1656
372
1017
67-361
67-439
67-435
86-107

STREET
Hoolana St.
Paaaina Pl.
Palamoi St.
Hoomalimali St.
Hoohuali Pl.
Hoolana St.
Second St.
Maiha Cir.
Aumakua St.
Komo Mai Dr.
Hoomalu St.
Makahana St.
Kukuikea Pl.
Lusitana St.
Likini St.
Ala Leleu St.
Ala Napunani St.
Ala Lilikoi St.
Luapele Dr.
Salt Lake Blvd.
Likini St.
Likini St.
Likini St.
Lua'ole St.
Ala Leleu St.
Ala Leleu St.
Likini St.
Likini St.
Aliamanu St.
Keaka Dr.
Keaka Dr.
Likini St.
Likini St.
Salt Lake Blvd.
Ala Puaala Wy.
Keaka Dr.
Wanaka St.
Likini St.
Ala Lehua St.
Puolo Dr.
Wiliki Dr.
Likini St.
Kilani Ave.
Hoolulu Rd.
Pakauwili Dr.
Ehoeho Ave.
Farrington Hwy.
Kukea Cir.
Kukea Cir.
Hoaha St.

CAP
5
5
4
5
4
5
5
5
4
5
5
3
4
5
5
4
5
5
5
4
5
5
5
5
3
5
5
5
5
5
5
5
4
3
3
5
5
5
5
5
5
5
5
4
5
5
4
5
5
5

D
S
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S
S
R
R
S
R
S
S
S
S
S
S
S
S
S
S
S
R
S
S

AMB TYPE
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
FULLY
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
FULLY
AMB
FULLY
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB

WHC
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
N
Y
N
N
N
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
N
Y
Y
Y
N
Y
Y(#4)
Y
Y
N
N
Y
N
Y
Y

PHONE
455-2392
455-4465
741-1611
454-0741
456-4749
455-9217
456-6084
664-5701
391-6089
392-1091
388-5285
987-3287
964-5445
545-8641
423-2196
839-4107
227-8985
839-1772
488-6159
423-7854
888-7694
833-5630
422-8018
488-2048
839-3091
833-0919
366-3021
833-6762
423-1002
421-0171
423-6358
422-2264
422-6128
422-4886
834-1634
423-7454
888-6489
833-6093
833-5178
422-4866
423-0553
422-7881
621-8635
621-4085
621-0819
621-6174
637-9918
637-9945
637-9770
696-2430

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Waianae
Waianae
Waianae
Waianae
Waianae
Waianae
Waianae
Wailuku
Wailuku
Wailuku
Wailuku
Wailuku
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu

M
0
0
1
1
1
3
3
2
10
0
5
2
0
3
1
1
4
0
0
1
1
1
1
3
0
1
0
2
1
0
0
0
1
1
0
0
1
1
1
4
0
1
0
1
0
2
2
1
2
0

F
0
0
0
0
1
2
2
2
10
1
5
2
1
3
1
1
4
0
0
2
1
1
1
0
0
0
0
0
0
1
0
0
1
0
0
1
0
0
0
4
0
0
1
0
1
2
2
1
1
1

TYPE OF CH
ARCH I
ARCH I
Exp
ARCH I
Exp
Exp
ARCH I
ARCH I
ARCH II
ARCH I
ARCH I
ARCH I
Exp
Exp
ARCH I
ARCH I
ARCH I
ARCH I
ARCH I
Exp
ARCH I
Exp
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
ARCH I
ARCH I
Exp
Exp
Exp
ARCH I
ARCH I

LICNO
589-C
1151-C
1312-C
1512-C
1224-C
1339-C
1340-C
645-C
1509-C
1236-C
1518-C
683-C
479-C
1200-C
481-C
1065-C
1499-C
1542-C
909-C
1239-C
1261-C
1367-C
844-C
1466-C
319-C
804-C
590-C
1421-C
569-C
845-C
785-C
1240-C
832-C
543-C
678-C
1060-C
615-C
549-C
1335-C
1496-C
696-C
676-C
1061-C
783-C
499-C
1296-C
1384-C
1405-C
1486-C
1035-C

NAME
ATANES, REMEDIOS
DAQUIP CARE HOME
GOLDEN ISLAND ARCH
HOUSE OF ALOHA
IMELDA G. ARREOLA
MIVA ARCH
PARADISE ARCH
AKALEI HALE
CARE HOMES BY HALE MAKUA
HONESTY
IRENE DELLA ADULT RESIDENTIAL CARE HOME
JUDY'S
ABBIE'S
AGRAAN, GLISERIA
ALAAG, L.L.C. ARCH
ALDE CARE HOME
ALOHA ANGEL CARE
AMELITA SAMANIEGO ARCH
ANCHETA, EMILIANA
ANCHETA, IMELDA
ANDAYA'S
ANNE-DREW'S GENTLE
ANNELYN RAVAL
APOSTOL CARE HOME ARCH
BAGAIN CADIZ CARE HOME
BALUALUA, ANGELITA
BELTRAN, MILAGROS
BERNARDO CARE HOME
BILLENA, MATHILDA
BOLOSAN, CARMELITA
BOLOSAN, DOMIE
BUENO #2
CABICO, MILAGROS
CABINGABANG CARE HOME
CACAL, EVELYN
CARINO CARE HOME
CARMELITA'S
CASTANAGA, IMELDA
CHANDA'S
CHARITY ADULT RESIDENTIAL CARE HOME
CHOYBETH'S
CONNIE'S
CUARESMA ARCH
DE VERA, LORETTA
DEGUZMAN, LYDIA
E. MABINI ARCH
ED & ROSE
EDEN LEI'S
EDITHA ROGELIO TAPAT ARCH, LLC
EMY'S

OPERATOR
Atanes, Remedios C. (Mrs.)
Daquip, Eunice (Mrs.)
Acuram, Marlyn (Mrs.)
Sister Ermelinda Tagnipez, O.P.
Arreola, Imelda G. (Mrs.)
Gante, Jane (Mrs.)
Acuram, Marlyn (Mrs.)
Villanueva, Elisa (Mrs.)
Grimes, Janinne (Ms.),
Valdez, Zenaida (Mrs.)
Della, Irene (Mrs.)
Dagdag, Judita (Mrs.)
Peralta, Florecita (Mrs.)
Agraan, Gliseria A. (Mrs.)
Guting, Linda (Mrs.)
Lampitoc, Delia (Mrs.)
Barsatan, Mildred (Mrs.)
Samaniego, Amelita (Mrs.)
Ancheta, Emiliana (Mrs.)
Ancheta, Imelda (Mrs.)
Andaya, Virginia (Mrs.)
Onato, Mary Jeanne (Mrs.)
Raval, Annelyn (Mrs.)
Apostol, Edwin C. (Mr.)
Bagain, Vicky C. (Mrs.)
Balualua, Angelita (Mrs.)
Beltran, Milagros (Mrs.)
Bernardo, Norma (Mrs.)
Billena, Mathilda (Mrs.)
Bolosan, Carmelita (Mrs.)
Bolosan, Domie (Mrs.)
Caballero, Felicitas B. (Mrs.)
Cabico, Milagros (Mrs.)
Cabingabang, Delia (Mrs.)
Cacal, Evelyn R. (Mrs.)
Carino, Lolita (Mrs.)
Casil, Carmelita (Mrs.)
Castanaga, Imelda (Mrs.)
Diocares, Chanda (Mrs.)
de Castro, Nette (Mrs.)
Ubaldo, Elizabeth A. (Mrs.)
Battulayan, Cion (Mrs.)
Cuaresma, Julia (Mrs.)
De Vera, Loretta (Ms.)
DeGuzman, Lydia (Mrs.)
Mabini, Eden (Mrs.)
Ramos, Rosalinda (Mrs.)
Galacgac, Editha Luis (Mrs.)
Tapat, Editha (Mrs.)/Editha
Remular, Emerita (Mrs.)

EXPIRATION
8/31/2017
12/31/2016
5/31/2017
5/31/2017
7/31/2017
5/31/2017
5/31/2017
1/31/2018
1/31/2017
1/31/2017
10/31/2017
9/30/2017
8/31/2017
7/31/2017
9/30/2017
11/30/2016
7/31/2017
9/30/2017
4/30/2017
2/28/2017
12/31/2016
12/31/2017
4/30/2017
10/31/2017
7/31/2017
10/31/2016
9/30/2017
3/31/2017
12/31/2016
12/31/2016
9/30/2017
5/31/2017
10/31/2017
10/31/2017
9/30/2017
8/31/2017
2/28/2017
11/30/2016
9/30/2017
4/30/2017
5/31/2017
1/31/2018
9/30/2017
9/30/2017
3/31/2017
10/31/2016
7/31/2017
6/30/2017
3/31/2017

HOUSE_NO
87-542
87-132
86-120
86-569
87-164
87-158
86-112
61
1540
775
189
934
94-579
94-1266
94-1032 A
94-1475
94-500
94-1064
94-1518
94-854
94-029
94-921
94-362
94-1244
94-1381
94-575
94-1382
94-1230
94-1169
94-087
94-039
94-916
94-418
94-1121
94-1161
94-1110
94-1020
94-972
94-350
94-232
94-935
94-1040
94-548
94-865
94-293
94-1083
94-1112
94-1095
94-432
94-1228

STREET
Manuu St.
Palani St.
Hoaha St.
Paheehee Rd.
Kaukamana St.
Kaukamana St.
Hoaha St.
Hoauna St.
Lower Main St.
Analio St.
Maika St.
Anohea Wy.
Apii Pl.
Hiapo St.
Lumikula St.
Hiapo St.
Apii St.
Halelehua St.
Kahualoa St.
Awanei St.
Poailani Cir.
Kahuailani St.
Apowale St.
Hinaea St.
Hiaai Pl.
Apii St.
Henokea St.
Hinaea St.
Limahana St.
Waikele Lp.
Waikele Lp.
Kumuao St.
Pilimai St.
Waipahu St.
Hinaea St.
Hilihua Pl.
Hapapa St.
Lumimoe St.
Apowale St.
Moena Pl.
Hiapo St.
Kuhaulua St.
Farrington Hwy.
Mokuahi St.
Kahualena St.
Kuhaulua St.
Kahuailani St.
Lumiaina St.
Kipou St.
Halelehua St.

CAP
4
5
5
5
5
5
5
5
22
5
5
5
5
5
5
5
5
3
3
5
5
5
5
5
5
4
5
4
5
5
5
5
5
5
5
3
5
5
5
5
5
5
5
5
5
5
5
5
5
2

D
S
S
S
S
S
S
S
S
S
S
R
S
S
S
S
S
S
S
S
S
R
S
R
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S

AMB TYPE
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB

WHC
N
N
Y
Y
Y
Y
Y
N
Y
N
N
N
N
Y
N
N
Y
N
N
Y
N
Y
N
Y
N
N
Y
N
N
N
N
Y
Y
N
N
N
N
Y
N
Y
N
N
N
N
N
Y
Y
Y
Y
N

PHONE
668-4214
696-4462
696-6507
696-3021
358-0746
358-0746
696-2430
244-1381
243-1700
986-0008
244-2238
244-8194
676-9349
676-1567
677-8669
671-0531
671-9234
351-7159
671-0384
677-7486
744-2730
678-3936
227-3790
671-5217
671-7308
671-1075
671-0354
216-7449
671-0670
671-2983
677-3743
678-9514
671-2656
671-7379
676-5756
678-3984
671-0756
671-2551
691-9995
744-2697
671-7010
680-0001
676-7232
671-5191
676-0681
678-9549
676-9336
677-7160
671-7804
676-1612

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu

M
0
1
2
1
1
0
0
0
1
0
0
1
2
1
5
1
0
3
3
1
0
1
2
1
1
0
2
1
0
0
0
0
1
0
1
0
2
1
1
0
0
0
0
1
1
1
2
2
0
0

F
1
0
2
0
1
2
1
1
1
0
2
1
2
0
5
1
2
2
2
1
2
0
0
1
1
1
2
0
0
1
1
1
1
2
0
0
2
0
1
1
1
1
1
0
0
1
3
2
1
0

TYPE OF CH
Exp
Exp
ARCH I
Exp
Exp
ARCH I
Exp
Exp
Exp
ARCH I
Exp
ARCH I
Exp
Exp
ARCH I
Exp
Exp
Exp
Exp
ARCH I
Exp
ARCH I
ARCH I
ARCH I
Exp
ARCH I
Exp
ARCH I
ARCH I
Exp
ARCH I
Exp
Exp
Exp
ARCH I
ARCH I
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
ARCH I
Exp
Exp
ARCH I
ARCH I
ARCH I

LICNO
1274-C
598-C
1042-C
641-C
1209-C
619-C
1273-C
1013-C
927-C
895-C
1109-C
878-C
617-C
1402-C
1544-C
1193-C
1112-C
1448-C
1259-C
1190-C
1137-C
331-C
586-C
1505-C
1160-C
460-C
1406-C
1220-C
573-C
1263-C
650-C
561-C
467-C
1091-C
1168-C
1140-C
1290-C
535-C
1055-C
1211-C
695-C
542-C
1192-C
600-C
871-C
1364-C
1294-C
745-C
824-C
781-C

NAME
ESPINOZA'S
ESTA'S
EVELYN'S
FABIA ARCH-EC, LLC
FAJOTINA E-ARCH
FERNANDO CARE HOME
FIESTA, FLORELIZA C.
FRONDA, MYRNA
GABRIEL CARE HOME
GALAMGAM, CRESCENCIA
GALAN'S CARE HOME
GALARIO, VIOLETA
GALARIO'S CARE HOME
GOLDEN AGE HEALTH CARE
HEART TO HEART CARE HOME
HOPE-FAITH
J&J
J.B.M. ARCH
JRR ARCH
KAHUANANI PLACE
KHRIST EMMANUEL
LEANO, GLENDA
LEONILA NUESCA
LIABELLE CADIZ ARCH
LITA SORIA
LOLITA SUGA
LORY'S
LOTA BUMANGLAG
LYDIA QUEMADO
MARIA NORMA JACINTO ARCH - EC
MARIE VIDUYA
MARINA MANUEL CARE HOME
MARQUEZ, LUZ
MARRHEY
MARTIN OBALDO
MELY MUELLER
MILDRED'S
MONA LIZA
MONEGAS CARE HOME AND EXPANDED ARCH
MOTHER & DAUGHTER
NAVARRO, REBECCA
NEBREJA, RAYMUNDA
NOEMI'S ARCH
OAMIL, REMEDIOS
OBALDO, MARCELINA
OHANA HALE, L.L.C.
OILILUA ELDERCARE, INC #I
PADRE, NORMA
PARUBRUB, TINA
PASCUA, ELENA

OPERATOR
Espinoza, Maria Adela (Ms.)
Esta, Lina (Mrs.)
Paco, Evelyn B. (Mrs.)
Fabia, Ninfa (Mrs.)
Fajotina, Lilia P. (Mrs.)
Fernando, Perlita (Mrs.)
Fiesta, Floreliza C. (Ms.)
Fronda, Myrna (Mrs.)
Gabriel, Juliet (Mrs.)
Galamgam, Crescencia (Mrs.)
Galan, Juanita T. (Mrs.)
Galario, Violeta (Mrs.)
Galario, Elena (Mrs.)
Picard, Marieta R. (Mrs.)
Lockhart, Tracy (Mrs.)
Lucas, Melanie G. (Mrs.)
Cadiz, Flora (Mrs.)
Mendoza, Janette B. (Mrs.)
Ramiro, Jean (Mrs.)
Jamon, Edith M. (Mrs.)
Peralta, Anita (Mrs.)
Leano, Glenda (Mrs.)
Nuesca, Leonila (Mrs.)
Liabelle Cadiz ARCH, L.L.C. (Cadiz,
Soria, Angelita (Mrs.)
Suga, Lolita (Ms.)
Parel, Lorenza (Mrs.)
Bumanglag, Lota (Mrs.)
Quemado, Lydia (Mrs.)
Jacinto, Maria Norma M. (Mrs.)
Viduya, Rose Marie (Mrs.)
Manuel, Marina (Mrs.)
Marquez, Luz (Mrs.)
Carlos, Marcela (Mrs.)
Obaldo, Martin (Mr.)
Ballocanag, Mely (Mrs.)
Bumanglag, Mildred A. (Mrs.)
Valentin, Presentacion (Mrs.)
Monegas, Brenda (Mrs.)
Guting, Raynilda T. (Mrs.)
Navarro, Rebecca (Mrs.)
Nebreja, Raymunda (Mrs.)
Laguit, Noemi B. (Mrs.)
Oamil, Remedios (Mrs.)
Obaldo, Marcelina (Mrs.)
Felicitas, Jerry (Mr.)
Tenorio, Geronimo (Mr.)
Padre, Norma (Mrs.)
Parubrub, Tina (Mrs.)
Pascua, Elena (Mrs.)

EXPIRATION
7/31/2017
11/30/2016
10/31/2017
7/31/2017
12/31/2016
1/31/2017
7/31/2017
12/31/2017
3/31/2017
1/31/2017
7/31/2017
12/31/2016
9/30/2017
6/30/2017
4/30/2017
4/30/2017
8/31/2017
9/30/2017
4/30/2017
6/30/2017
5/31/2017
7/31/2017
10/31/2016
3/31/2017
5/31/2017
8/31/2017
5/31/2017
8/31/2017
11/30/2016
9/30/2017
7/31/2017
8/31/2017
6/30/2017
7/31/2017
6/30/2017
8/31/2017
6/30/2017
1/31/2017
4/30/2017
10/31/2016
6/30/2017
11/30/2016
1/31/2017
10/31/2016
1/31/2017
4/30/2017
9/30/2017
9/30/2017

HOUSE_NO
94-1273
94-1110
94-824
94-301
94-438
94-1351
94-232
94-571
94-1034
94-1278
94-324
94-1440
94-929
94-1141
94-384
94-272
94-276
94-1282
94-564
94-284
94-1178
94-945
94-946
94-967
94-346
94-414
94-1492
94-366
94-1292
94-332
94-1177
94-1035
94-908
94-211
94-572
94-949
94-1273
94-455
94-913
94-369
94-1354
94-023
94-919
94-1011
94-852
94-1063
94-379
94-607
94-1108
94-301

STREET
Kahuanui St.
Hinaea St.
Kumukula St.
Hilihua Wy.
Hoaeae St.
Waipahu St.
Lehoula Pl.
Apii Pl.
Awanani St.
Peke Pl.
Kipou St.
Hiapo St.
Kuakahi St.
Lumiauau St.
Ana Ln.
Pupukoae St.
Pupukoae St.
Hiapaiole Pl.
Anaaina Pl.
Kahuanani Pl.
Hina St.
Kuhaulua St.
Mapala Pl.
Lumihoahu St.
Hene St.
Hianakiu St.
Waipahu St.
Kahuanani St.
Huakai St.
Kipou Pl.
Halelehua St.
Lumikula St.
Kumuao St.
Loaa St.
Apii Pl.
Lumiloke St.
Peke Pl.
Kahualena St.
Kuhaulua St.
Apowale St.
Hiaai Pl.
Poailani Cir.
Kumuao St.
Akihiloa St.
Kuhaulua St.
Halelehua St.
Oililua Pl.
Mahoe St.
Hina St.
Kahualena St.

CAP
5
5
5
5
5
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
2
5
5
2
5
5
3
5
5
5
5
5
5
5
5
5
5
5
5
4
5
5
5
5
5
5
4
4

D
S
S
S
S
S
S
S
S
S
S
S
R
S
S
S
S
S
S
S
R
S
R
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
R
R

AMB TYPE
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
AMB
FULLY
AMB
AMB

WHC
Y
Y
N
N
Y
N
Y
Y
Y
N
Y
N
N
Y
Y
Y
Y
Y
Y
N
Y
N
N
Y
Y
N
Y
Y
N
Y
Y
Y
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
N
Y
Y
N
N
N

PHONE
676-7313
677-3607
671-8725
671-6983
676-7399
671-4912
888-7012
676-7858
677-0123
671-1847
671-8337
888-7753
677-5362
671-7760
636-0904
678-8248
676-7027
677-0474
677-0245
744-3420
671-8607
677-0262
671-4791
744-7093
677-2174
729-2113
230-1903
678-1967
260-1872
680-7851
671-7662
671-8817
677-0932
671-0069
676-5384
677-9089
671-3752
677-0524
680-0636
676-8893
671-0294
671-2291
677-7875
676-1618
677-5838
677-9718
677-0882
677-7174
671-3637
680-9492

Update 10/24/16

 Combined ARCH/Expanded ARCH Vacancy Report-By Area

AREA
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu
Waipahu

M
1
2
0
2
0
1
1
1
3
0
0
2
1
3
0
5
2
0
0
0
0
0
0
1
0
0
0
5
0
3
1
4
2

F
1
2
1
2
0
2
1
0
3
1
1
0
0
0
1
5
2
0
1
1
0
0
1
0
0
1
0
5
1
3
0
4
2

TYPE OF CH
Exp
Exp
Exp
Exp
Exp
ARCH I
Exp
Exp
Exp
Exp
Exp
ARCH I
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
Exp
Exp
ARCH I
Exp
Exp
ARCH I
Exp
ARCH I
Exp
ARCH I
ARCH I
ARCH I
ARCH I
Exp
Exp

LICNO
1429-C
1315-C
1082-C
1025-C
1019-C
532-C
1204-C
1053-C
1494-C
1070-C
1343-C
677-C
713-C
1413-C
637-C
1545-C
1133-C
982-C
1106-C
1407-C
1124-C
539-C
1229-C
389-C
751-C
813-C
521-C
1540-C
1243-C
1551-C
876-C
1231-C
1454-C

NAME
R & B ARCH/E-ARCH LLC
R & M DURAN, L.L.C.
RAFAEL, EVELYN
RAGUINDIN MALAMA KAUHALE ARCH
RETUTA, BLANDINA
REYES CARE HOME
RJ SANTIAGO ARCH & E-ARCH
ROSANA DUMLAO
ROSARIO
SAGADRACA CARE HOME
SALES, ABNER
SAMBAJON, REMEDIOS
SARDON, MARIA
SCOTT ARCH
SERAPION, SHIRLEY
SERENITY HAWAII CAREHOME LLC
SIMPLICIANO'S ARCH
TABLIT, ELPIDIO
TABORA'S
TANGONAN ADULT RESIDENTIAL CARE HOME
TENDER LOVING CARE
TERESITA DOMINGO
TESSIE M. GASPAR
UGALDE, FELY
VALDEZ CARE HOME
VALLENTE CARE HOME
VARGAS CARE HOME
VICTORIA GABRIELLA CARE HOME
VIERNES, MAY G.
VILLAGE PARK ADULT RESIDENTIAL CARE
VILLAR, MARYLIN
VILORIA-BAUTISTA ARCH
WAIPAHU HALE

OPERATOR
Aguinaldo, Remedios (Mrs.)/R & B
Duran, Marenila L. (Mrs.)
Rafael, Evelyn (Mrs.)
Raguindin, Belma (Mrs.)
Retuta, Blandina (Mrs.)
Reyes, Corazon (Mrs.)
Santiago, Juliet V. (Mrs.)
Dumlao, Rosana (Mrs.)
Gomez, Rosario P. (Ms.)
Sagadraca, Aurora (Mrs.)
Sales, Abner (Mr.)
Sambajon, Remedios (Mrs.)
Sardon, Maria (Mrs.)
Scott, Juliet P. (Ms.)
Serapion, Shirley (Mrs.)
Cabrera-Prantl, Claudia
Simpliciano, Ofelia (Mrs.)
Tablit, Elpidio (Mr.)
Tabora, Lourdes (Mrs.)
Tangonan, Edna (Mrs.)
Ibon, Jovita (Ms.)
Domingo, Teresita (Mrs.)
Gaspar, Tessie M. (Mrs.)
Ugalde, Fely (Mrs.)
Valdez, Minda (Mrs.)
Vallente, Lolita (Mrs.)
Vargas, Levy (Mrs.)
Carlos Rufo, Aida (Mrs.)
Viernes, May G. (Mrs.)
Peralta, Marilou (Ms.)
Villar, Marylin (Mrs.)
Viloria, Elaine B. (Mrs.)
Antonio, Aga (Mr.)

EXPIRATION
6/30/2017
7/31/2017
10/31/2017
12/31/2017
5/31/2017
1/31/2017
10/31/2017
5/31/2017
12/31/2017
2/28/2017
7/31/2017
7/31/2017
11/30/2017
3/31/2017
4/30/2017
6/30/2017
5/31/2017
5/31/2017
8/31/2017
2/28/2017
5/31/2017
9/30/2017
7/31/2017
1/31/2018
10/31/2017
2/28/2017
1/31/2017
2/28/2017
4/30/2017
2/28/2017
3/31/2017
12/31/2016

HOUSE_NO
94-912
94-628
94-105
94-088
94-1116
94-931-A
94-571
94-871
94-1134
94-329
94-1156
94-1042
94-1311
94-1077
94-258
94-559
94-106
94-544
94-970
94-228
94-1227
94-905
94-112
94-537
94-1031
94-1341
94-296
94-100
94-1184
94-101
94-242
94-1087
94-1201

STREET
Kumuao St.
Loa'a St.
Haaa St.
Awamoku St.
Kahuailani St.
Lumihoahu St.
Loaa St.
Awanei St.
Hapapa St.
Kiokio Pl.
Halelehua St.
Halelehua St.
Waipahu St.
Kahuanui St.
Kahuahele St.
Apii Pl.
Kaupu Pl.
Hiahia Lp.
Lumihoahu St.
Moena Pl.
Kahuanui St.
Hiapo St.
Kaupu Pl.
Hiapaiole Lp.
Lumiauau St.
Waipahu St.
Kahuahele St.
Kauweke Pl.
Hina St.
Kauweke Pl.
Pupukahi St.
Kuhaulua St.
Huakai St.

CAP
5
5
5
5
5
5
5
5
5
5
5
5
1
4
5
5
5
5
5
5
5
5
5
5
5
4
5
5
5
5
5
5
5

D
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
R
S
S
R
S
S
S
S
S
S
S
S
S
S
S
S

AMB TYPE
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
FULLY
AMB
AMB
FULLY
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB
AMB

WHC
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
N
N
Y
Y
Y
Y
N
N
Y
N
Y
Y
N
Y
N
Y
Y
Y
N
Y
Y
Y

PHONE
234-8241
678-0150
671-9717
677-7464
676-4419
671-0606
671-8901
671-0166
671-2609
671-3695
676-5140
678-3612
677-0940
676-0846
671-6376
202-9465
671-0396
671-5255
677-8767
686-9357
671-0695
676-1126
676-9034
677-5207
677-5398
677-5810
671-2088
782-6184
676-4787
677-3520
678-1482
678-1275
677-1424

Update 10/24/16

 EXHIBIT 

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED
125040 8- 02/19/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS. CITY. STATE. ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY 96744
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIES ID PLAN QECORRE (xs)
pREFix (EACH DEFICIENCY MUST BE PRECEDED BY FULL anFix (EACH CORRECTIVE Agi SH BE ..  COMPLBE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED DATE
DEFICIENCY): 7: 
 . 
4 000 11-94.1 Initial Comments 4 000 g; 
A re-licensure survey was conducted by the 1335 
Hawaii State Survey Agency, SA, from February  i 5:  "f
16 to 19, 2016. The census upon entrance was :3 
96 residents. 
I. The facility alleges it does maintain a quality assessment 03/?7116
4 088 Governing body and management 4 088 and assurance committee consisting of tie directOr of
nursing services: a physician designated by the facility:
Each facility sha? have an organized and at least 3 other members of facility staff who meets
governing body, or designated persons quarterly to identify issues with respect to which quality
functioning as the governing body that has assessment and assurance activities are necessary; and
1 . . .
overall responsibility for the conduct of a? develops andimplements app'opriate plans of action to
activities. The facility shall maintain methods of 00?? 'dem'i'ed WW def'c'enc'es-
administrative management that assure that the . I . .
2 requirements of this section are met. Regarding F279. Resndent#116 has a comprehensive care
5 plan addressmg the use of- conSIstent w1th
. . . s'c'an orders. reasons for use and 3 r0 riaten 
This Statute Is not met as ewdenced bysuch,
. Based on observations and staff interVIews, the
facfmy d'd not deYe'?P, _and 'mp.lemen,t Plans Of Resident #121 no longer resides in the facility.
action to correct Identified quality defrorenCIes. .
Regarding F431: No residents were found to be negatively
F'nd'ngs 'nClUd93 affected by this find'ng. 
Regarding F463: Upon notification of the main shower call
light not functioning batteries were replaced immediately
and staff confirmed proper functioning. The one
malfunctioning pager was replaced immediately upon I
notification and all 3 other pagers on the Hale Ho'nlu unit 
were verified as functioning properly by staff. Hand bells
were placed in the main dining room bathrooms until
system could be reprogrammed. System was
reprogrammed on 2/22/16.
ll. Regarding F279: Any resident currently utilizing- 03/25/16
for any reason have had their medical record care
plan reviewed. Care plans have been updated to
appropriately reflect the useof- including
assessment. rationale. physiolans orders, and release
schedule to ensure? is used.
Continued on page 2
Office of Health Care Assurance
TITLE (xe) DATE

 

OR PPLIER 
MM 212/ aim/m
sass

7
STATE FORM WW

 

"009 

DGY211

 

lf continuation sheet 1 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING.
1 25048 B. WING 02/19/2016
NAME OF PROVIDER 0R SUPPLIER STREETADDRESS, CITY, STATE, ZIP CODE

ANN PEARL NURSING FACILITY

45-181 WAIKALUA ROAD

KAN EOHE, HI 96744

 

 

 

 

 

 

 

 

 

(x4) Io SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL pamx l? (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
Continued from page 1
4 088 commued From page 1 4 088 Residents admitted within the last month were identi?ed
have had their care plans and interventions reviewed to
ensure fall risk factOrs are identified and appropriate
prevention interventions are in effect.
Residents who have sustained a fall in the past 30 days
have had their records to review with a new falls
assessment completed as necessary with care plans
revised accordingly.
Residents who have demonstrated a change of condition
for improvement have had their falls assessment and care
plan interventions reviewed with appropriate action and
revisions made accordingly.
Regarding F431: A review of all medication rooms,
medication and treatment carts for any other opened and
. . expired items was conducted with no other items
The faCIlIty faIled to maintaIn the stated discovered,
in their previous Plan of Correction for their last
survey. Additionally, they failed to have systems Continued on page 2-2
in place to?address quality issues such as
environment, infection control, and sufficient
nurse staffing. 
See page 3 of 43
4123 11 Resident rights and facility 4123
practices
Written policies regarding the rights and
responsibilities of residents during the resident's
stay in the facility shall be established and shall
be made available to the resident, resident family,
legal guardian, surrogate, sponsoring agency or
representative payee, and the public upon
request. Afacility must protect and promote the
rights of each resident, including:
(12)The right to be fully informed in advance
about care and treatment and of any changes
in that care and treatment and the right to
participate in planning care and treatment,
Office of Health Care Assurance
STATE FORM ?99 0(5an it continuation sheet 2 of 43

 

 OF COMPLETEON DATE
Continued from page 1 (4 088)

Regarding F463: Ail call bells were audited to assure proper functioning of call lights
and proper functioning/programming of pagers on 2/19/16. Any cal! baits/pagers
found to be mal functioning were immediateiy fixed. No other residents were found to
be affected by this de?cient practice.

lil. Regarding F279: Restraint care plans will be reviewed duarteriy at care ptan 03/30/16
meeting to ensure intended use is unchanged, necessity exists, change of condition

warrants continued use. A therapy screen be conducted at any time the resident's

condition changes to ensure appropriateness of device used.

Fails care plans wilt be reviewed quarterty at care plan meeting to ensure interventions
remain current and aligned with resident?s current condition.

Any fail reviews wilt occur at morning ctinicai meetings with the interdisciplinary team
to ensure that a new falls assessment is conducted. identified risk factors wilt
be reviewed with appropriate prevention interventions implemented and care plan
revisions compieted.

MDS nurses and resident care managers (RCMs) be further educated on comparison
of RAI ?ndings and fails assessment to ensure all risk factors have been reviewed prior to
decision to proceed or not for fails care plan.

Regarding F431: Licensed staff has been fn?serviced on requirements for medication

expiration and destruction protocois. Newly hired licensed staff nave poiicy reviewed

as part of their unit orientation. Night shift staff witi be responsible for checking medication
rooms, medication and treatment carts nightiy and discard any undated or outdated medications.

Regarding F463: A preventative maintenance program was created based on manufacturers
recommendations to address calf light batteries, call light bulbs, cafl cords, caii bell computer
maintenance, pager batteries, and pager programming. An extra pager was programmed and
placed at each nursing station to be availabte 24/7 to staff in tire event that a pager malfunctions.
A pager check wiil be conducted at the change of every shift where a salt tight be pulled and
pager functionaiity be verified. Nursing staff were in?serviced on the of extra pagers
on each unit and how/when to conduct a pager check. Maintenance staff will check the primary
computer for the calf beii system for any warnings 3x per week and address any concerns
accordingly.

Quality assurance audits will continued to be conducted and reported at performance
improvement meeting until the following survey if 100% compliance has not been reached and
maintained for 3 consecutive months.

iV. Random audits will be conducted 3 and quarterly 3 of ail identified areas from 04/04/16
annual survey. Resuits of audit?ndings wiit be reviewed at facility Performance improvement

Committee meeting. An ongoing semiannual audit through an intra-cornpany process further

vaiidating compliance in this area.

Responsibie Party: Administrator and/or
Designee

Page 22

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

. FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION txa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING, COMPLETED
125048 B. WING 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL ING FA ILITY
Nuns KANEOHE, HI 96744
(X4) 10 SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5)
(EACH DEFICIENCY MUST BE PRECEDED BY FULL pagplx (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 123 Continued From page 2 4 123 I. Resident 195 no longer resides at the facility. 03/18/16
unless adjudged incompetent or II. All shower preferences for current residents was 03/22/16
incapacitated; conducted. documentation was updated as needed. No
other residents were found to be negatively affected by this
This Statute is not met as evidenced by: de?cient practice-
Based on Resident interview, staff interview, and 
record review the facility faited to create an Ill. Resrdent room change procedure will be updated to 03/30/16
environment that is respectful, of the right for one include shower preferences procedure. Facility staff will
resident in the Sample Survey to exercise - then be in-serviced on the policy. All room changes within
autonomy in making choices regarding aspects of the Mt month aUd'ted to assure Shower
I - me at the facimy preferences are beIng met.
IV. Audits will be conducted for shower preferences for any 04/04/16

 

 

 

Findings Include:

 

 

 

residents with room change x3 then quarterly
thereafter results of audit ?ndings will be reviewed at
facility Performance Improvement Comm?ttee meeting. An
ongoing semiannual audit through an infra-company
process further validating compliance in this area.

Responsible Party: Director Nursing and/or
Designee

 

 

 

Of?ce of Health Care Assurance

STATE FORM

6699

DGY211 if continuation sheet 3 of 43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
HawaII Dept. of Health, Office Of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING, COMPLETED
125048 e. WING 0211912016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY KANEOHE, HI 96744
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIEs to PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE FRECEDED BY FULL FREFIX (EACH CORRECTIVE ACTION SHOULD BE 
TAG REGULATORY OR LSC IDENTIFYING m3 TO THE APPROPRIATE DATE
DEFICIENCY)
4123 Continued From page 3 4 123
4 12A 11 Resident accounts 4 127 I. Facility reimbursed 4 Identi?ed trustees -. 03/11/16
In the event the resident or famin member ll. Facility audited all residents with trust funds who have 03/04/16
requests the facility to manage the resident's expired within the last 3 months and appropriate action

personal funds, an itemized account shall be taken as necessary-
made available in writing to the resident or the
legal guardian or surrogate, and shall be
maintained and kept current for the resident,
including:

Facility business of?ce was in-serviced on the policy 03/17/16
regarding Trust Fund: Refund Process. Business of?ce
will review any expired residents within the facility weekly
and initiate process accordingly.

(1) Written receipts for all personal

. . . iv. A audit will be conducted of all expired 04/04/16
a?zsesstl?gsfaag?ugg: recelved by or deposned residents with trust funds to assure that the facility is
executing its policy and procedure. Audit will be conducted
. . . x3 months then quarterly thereafter results of audit
wrmenbregel'fpt: 8" dISbmsements findings will be reviewed at facility Performance
ma 9 tor or on a [83' ent' Improvement Committee meeting. An ongoing semiannual

audit through an intra-company process further validating
compliance in this area.

This Statute Is not met as evrdenced by: 

Based on a review of residents' personal funds, Responsible party; Business Of?ce Managed
staff interview and facility policy review, the facility Designee

failed to refund residents' personal funds within
30 days upon death of 4 of 10 residents who had
trust fund accounts with the facility.

Findings include:

 

 

 

 

 

 

 

Of?ce of Health Care Assurance
STATE FORM 6399 Deyzn ll continuation sheet 4 0143

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
1 2504a 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE. ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) Io SUMMARY STATEMENT OF DEFICIENCIES lo PROVIDERS PLAN OF CORRECTION (x5)
(EACH DEFICIENCY MUST BE PRECEDED BY FULL peer-Ix (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCEO TO THE APPROPRIATE DATE
DEFICIENCY)
4 127 Continued From page 4 4 127

 

il. Upon notification facility assured resident #8 trust fund 02/17116

4 128 Resident accounts 4 128 requestwas processed.
. Responsible Party: Business Office Manager/
Upon request Of each resrdent or legal Designee
guardian or surrogate, articles kept for 
safekeeping Shall be released. II. No other residents were found to affected by this 02/17116

de?cient practice. Review of the facility concern log did not
indicate any further concerns regarding trust funds.

This Statute is not met as evidenced by: Emergency funds were found to be available to residents.

Based on resident and staff interviews and facility Responsible Party: Business Of?ce Manager/

policy review. the facility failed to ensure Designee

residents received their trust fund monies upon .

request. Facility staff were in~serviced on current policy and 04/01/16

procedure to include but not limited to the business office.
All current residents with trust fund accounts will be notified
of our current policy. All future residents who sign up for
trust funds with the facility will have policy reviewed with
them by the business of?ce.
Responsible Party: Business Of?ce Manager/
Designee

Findings include:

 

 

 

Continued on page 6

 

 

 

 

 

Woe of Health Care Assurance
STATE FORM 6599 DGY211 lf continuation sheet 5 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED
125043 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
PE FA ILITY
AN ARL NU SIN KANEOHE, HI 96744
(x4) 10 SUMMARY STATEMENT OF DEFICIENCIES PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL pREFix (EACH CORRECTIVE ACTION SHOULD BE 
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
. Continued from page 5
4 128 Continued From page 5 4 128
IV. A random sample of trust fund residents will be audited 04/04/16
to assure that the facility is executing its policy and
procedure. Audit will be conducted montth 3 months
then quarterly thereafter, results of audit ?ndings will be
reviewed at facility Performance Improvement Committee
meeting. An ongoing semiannual audit through an intra-
company process further validating compliance in this area
Responsible Party: Social Services/Designee
I. Resident 116 has a comprehensive care plan 03/17/16
. addressing the use of- consistent with physician
4 136 11'94'1'30 Res'dent care 4 136 orders, reasons for use and appropriateness of such.
The facmty Shall have written pom-?es and Resident# 121 no longer resides in the facility.
procedures that address all aspects of resrdent 
car? ne'eds ?0 the re?ldent to attain and Resident 3 had splint schedule assessed immediately
maintain the hlghest pfaCtlcabIe heaith and and applied accordingly. Resident has been further
medical status, including but not limited to: assessed? for anyfurther contracture
management with appropriate revisions taken.
(1) Respiratory care including ventilator use; .
(2) Dialysis; All residentwith splints had schedule pushed to Kardex.
(3) Skin care and prevention of skin breakdown; Staff have been educated on proper splint use and passive
(4) Nutrition and hydration; range of motion for resident#3. Splinting application and
(5) Fall prevention;
Continued on page 7

 

 

 

 

 

 

Of?ce of Health Care Assurance

STATE FORM

6899

DGY211 If continuation sheet 6 of 43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: BUILDING: COMPLETED
1 25048 B. WING 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY HI 96744
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 136 Continued From a 6 4 136 Continued from page 6
9 schedule have been updated on the Kardex and care plan
(6) Use of restraints; accordingly. No other residents found to be negatively
I (7) Communication; and affected.
I (8) Care that addresses appropriate growth and - . . 
II development when the facility provides care to ReSIdent# 121 no longer resrdes In the faculity.
infants, children. and outh. -
It. Any resident currently utilizing - for any reason 03/25/16
have had their medical record care plan reviewed. Care
plans have been updated to appropriater re?ect the use of

 

This Statute is not met as evidenced by:

Based on observation, staff interviews, and
record review the facility failed to ensure that 3
Residents received the appropriate care and
treatment to attain and maintain their highest
practicable ability (R #116 for restraints; #3 for
range of motion services; and #121 forfall
prevention).

Findings Include:

 

 

Office of Health Care Assurance

STATE FORM

 

 

 

  
   

including assessment, rationale, physicians

orders, and release schedule to ensure 

is used.

Residents admitted within the last month were identified
have had their care plans and interventions reviewed to
ensure fall risk factors are identi?ed and appropriate
prevention interventions are in effect.

Residents who have sustained a fall in the past 30 days
have had their records to review with a new falls
assessment completed as necessary with care plans
revised accordingly.

Residents who have demonstrated a change of condition
for improvement have had their falls assessment and care
plan interventions reviewed with appropriate action and
revisions made accordingly.

Resident's currently using splints or contracture manage-
ment devices have had their care plans and treatment
plans reviewed with appropriate action taken to ensure
compliance with all recommended interventions.

Staff have been educated on proper contracture manage-
ment and schedule with Kardex and care plan updated
accordingly.

Residents admitted within the last month were identified
have had their care plans and interventions reviewed to
ensure fall risk factors are identified and appropriate
prevention interventions are in effect.

 

 

 

Continued on page 8

 

 

easy [)3an If continuation sheet 7 of 43

 

PRINTED: 03/04/2016

 

FORM APPROVED
Hawaii Dept. of Health, Office Of Health Care Assuranc
STATEMENT OF (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: BUILDING: COMPLETED
125048 e. WING 02/19/2016

 

 

 

 

 

NAME OF PROVIDER OR SUPPLIER

ANN PEARL NURSING FACILITY

STREET ADDRESS. CITY. STATE. ZIP CODE
45-181 WAIKALUA ROAD

KANEOHE. HI 96744

 

 

 

 

Of?ce of Health Carnce
STATE FORM

 

 

plan meeting to ensure intended use is unchanged,
necessity exists, change of condition warrants continued
use. A therapy screen will be conducted at any time the
resident's condition changes to ensure appropriateness of
device used.

Falls care plans will be reviewed quarterly at care plan
I meeting to ensure interventions remain current and aligned
l-with resident's current condition.

Any fall reviews will occur at morning Clinical meetings with
the interdisciplinary team (IDT) to ensure that a new falls
assessment is conducted. care plan and interventions
updated appropriately. Identi?ed risk factors will be
reviewed with appropriate prevention interventions
implemented and care plan revisions completed.

MDS nurses and resident care managers (RCMs) will be

further educated on comparison of RAI ?ndings and falls

assessment to ensure all risk factors have been reviewed
prior to decision to proceed or not for falls care plan.

Resident's currently using splints for contracture manage-
ment have been screened by therapy. Splint use and
schedules for identi?ed residents have been updated on
the care plan, Kardex and reviewed with staff. Residents
with have been screened/reviewed by therapy
for splints and splints will be ordered per therapy
recommendations.

Upon discharge from therapy, therapist will bring
recommendations to morning meeting for IDT discussion
and appropriate resident speci?c interventions and care
plan updates. Resident care managers (RCM's) will then
in-service staff.

Splint usage will be documented through nursing assess-
ment and the treatment administration record

Continued on page 9

 

 

(x4) Io SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5,
PREHX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
DEFICIENCY)
. Continued from 7
4136 Continued From page 7 4 136 
Ill. Restraint care plans will be reviewed quarterly at care 

 

6699

DGY211

tt continuation sheet 8 0t 43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

. FORM APPROVED
Hawau Dept. of Health, Of?ce Of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
125043 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) In SUMMARY STATEMENT OF PROVIDERS PLAN OF CORRECTION (x5)
pREle (EACH DEFICIENCY MUST BE PRECEDED BY FULL pngpix (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCEO To THE APPROPRIATE DATE
DEFICIENCY)
. .Contrnued from 8
4136 Continued From page 8 4 136 p89
IV. Random care plan, splint, and fall audits will be 04/04/16

conducted 3 and quarterly 3. Results of audit
?ndings will be reviewed at facility Performance
Improvement Committee meeting. An ongoing semiannual
audit through an intra-ccmpany process further validating
compliance in this area.

Responsible Party: Director of Nursing and/or
Designee

 

 

 

 

 

 

 

 

 

 

Of?ce of Health Care Assurance
STATE FOFIM 5399 DGY211 It continuation sheet 9 of 43

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. COMPLETED
125048 3? 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
NN PEARL ING FACILITY
A "Rs KANEOHE, HI 96744
(x4) Io SUMMARY STATEMENT OF DEFICIENCIES Io PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 136 Continued From page 9 4 136
Office of Health Care Assurance
6899 DGY211 1f continuation sheet 10 of 43

STATE FORM

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED
125048 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES iD PROVIDER-s PLAN OF CORRECTION (XS)
(EACH DEFICIENCY MUST BE PRECEDED BY FULL pm;th (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) m3 CROSS-REFERENCED To THE APPROPRIATE DATE
4 136 Continued From page 10 4 136

 

 

 

 

 

 

 

 

 

 

 

Of?ce of Health Care AsSUIance
STATE FORM ?99 DGY211

If continuation sheet 11 of 43

Hawaii Dept. of Health, Office Of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

Of?ce of Health Care Assurance
STATE FORM

 

 

STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
125048 3' 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENOIES ID PROVIDERS PLAN OF CORRECTION (x5)
anplx (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
DEFICIENCY)
4 136 Continued From page 11 4 136

 

 

 

 

6899

DGY211

If continuation sheet 12 01 43

Hawaii Dept. Of Health, Office Of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION A. BUILDING: COMPLETED
125048 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE coMpLErE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
4 136 Continued From page 12 4 136

 

 

 

 

 

 

 

Office of Health Care Assurance
STATE FORM ?99 DGY211

If continuation sheet 13 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

FORM APPROVED
HawaiI Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING COMPLETED
1 25048 We 02/19/2016
NAME OF PROVIDER CR SUPPLIER STREET CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOH E, HI 96744
(x4) In SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE

DEFICIENCY)

 

4 136 Continued From page 13 4 136

 

 

The facility does provide suf?cient staffing on a 24 hour 02/20/16
basis to provide nursing care to all residents in accordance
with their care plan. Resident #135 has had -needs
met with no negative outcomes.

4148 Nursing services 4148

Each facility shall have nursing staff sufficient

in number and qualifications to meet the nursing . ..

needs of the residents. There shall be at Call logs lwgre 1Z9 for atreas of 03/22/16
least one registered nurse at work full-time on the concern U. 'n9 'un' an room orpa 

rm . . trends. Identi?ed patterns or trends have been IndIVIdually
day or 9'9 Consecui've ours? seven addressed and will continue to be monitored ongoing.
days a week, and at least one licensed nurse at i
Work 09 the eYemng and Sh'?sv unless Ill, All departments will educated on call bell response 03/30/16
otherWIse determlned by the department. expectations
Available agency staff have been utilized for any vacant

This Statute is not met as evidenced by: shin,
Based on resident, family, staff member 
interviews; observations, and record reviews the Company sponsored CNA class begins on 3/28/16 with a
facility failed to assure that there are adequate projected 18 students enrolled.

 

 

 

 

 

Continued On page 15

 

Office of Health Care Assurance
STATE FORM 539? DGY211 If continuation sheet 14 of 4a

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

. FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. COMPLETED
125048 3- WING 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY, STATE, ZIP CODE
45-1 81 WAIKALUA ROAD
ANN PEAR FACILITY
KANEOHE, HI 96744
(X4) in SUMMARY STATEMENT OF DEFICIENCIES PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4148 Continued From page 14 4 148 commued from page 14
staff to meet direct care needs, planning, Staffing is reviewed based on census and daily the nursing
evaluation, and supervision in a manner which administrat?cn reviews the acuity and determines the need
promotes each residenfs physical, mental, and for additional staffing and admission capabilities for thatday
well-being thus enhancing their . 
quality of life Staf?ng be rewewed for any protected

 

shortages and agency staff assignments or classes will be
proactiver scheduled accordingly.

Findings include:

l% of resident and/or responsible parties will be interviewed
via QIS staffing questionnaire weekly. Based on the
questionnaire if a negative response is solicited the
residents call light response time will be reviewed to
determine any issues or patterns.

 

of call Icg response times will be reviewed by
administration weekly for areas of concern or patterns with
appropriate action taken as needed.

V. Random staffing audits will be conducted 3 04/04/16
and quarterly 3. Results of audit ?ndings will be reviewed
at facility Performance Improvement Committee meeting.
An ongoing semiannual audit through an intra-company
process further validating compliance in this area.

Responsible Party: Director of Nursing and/or
Designee

 

 

 

 

 

 

 

 

 

Office of Health Care Assurance
STATE FORM 6899 DGY211 If continuation sheet 15 of 43

Hawaii Dept. Of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDWG COMPLETED
125048 8- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NUR ING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES .D PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL anFIx (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
4148 Continued From page 15 4148

 

 

 

 

I

 

 

 

Office of Health Care Assurance
STATE FORM 5399 DGY211

If continuation sheet 16 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (xa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING. COMPLETED
125040 8- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE. ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5)
pREle (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREHX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR IDENTIFYING INFORMATION) m3 CROSS-REFERENCED To THE APPROPRIATE DATE
4 148 Continued From page 16 4 148

 

 

 

 

 

 

 

 

 

 

Office of Health Care Assurance
STATE FORM ?99 DGY211

It contlnuation sheet 17 of 43

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

Office of Health Care Assurance
STATE FORM

 

 

 

STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING, COMPLETED
125048 8- 02/19/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES In PROVIDERS PLAN OF CORRECTION (x5,
pREle (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE 
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
DEFICIENCY)
4148 Continued From page 17 4148

 

 

 

 

 

6899

DGY211

If continuation sheet 18 of 43

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

Office of Health Care Assurance

STATE FORM

 

 

STATEMENT OF DEFICIENCIES (X1) (x2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
125048 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) Io SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL pHEle (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
DEFICIENCY)
4148 Continued From page 18 4 148

 

 

 

 

 

6889

DGY211

"continuation sheet 19 0143

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
125048 3 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
pREle (EACH DEFICIENCY MUST BE PRECEDED BY FULL anFIx (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 148 Continued From page 19 4 148

 

 

 

 

 

 

 

 

Office of Health Care Assurance

STATE FORM 60499 DGY211 If continuation sheet 20 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
HawaII Dept. of Health. Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED
125048 3- WING 02/19/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS. CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
NN PEARL RSING FA 
A TY KANEOHE, HI 96744
(X4) 10 SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 148 Continued From page 20 4 148
I. Resident 116 has a comprehensive care plan 03/17/16
4 149 Nursing services 4 149 addressmg the use 0- ConSIstent 
orders, reasons for use and appropnateness of such,
. Nursmg Shall mclude bUt are not Resident 121 no longer resides in the facility.
IImIted to the followrng:
Any resident currently utilizing- for any 03/25/16
(1) A comprehens've nurs'ng assessment 0f reason have had their medical record care plan reviewed.
each res'dent arid the development an? Care plans have been updated to appropriately re?ect the
Impleme?t?tlon Of a Plan.0f care Withln five use of -including assessment, rationale,
days Of admISS'On- .The ?PrS'l'lg Fla.? Of Care physicians orders, and release schedule to ensur'
shall be developed In conjunctIon With the is used.
physician's admission physical examination and .
initial orders. A nursing plan of care shall be Residents admitted within the last month were identi?ed
integrated with an overall plan of care have had theircare plans and interventions reviewed to
developed by an interdisciplinary team no later ensure fall risk factors are identified and appropriate
than the twenty- first day after, or simultaneously, prevention interventi0ns are in effect.
with the initial interdisciplinary care plan .
conference; Residents who have sustained a fall in the past 30 days
have had their records to review with a new falls
(2) written nursing Observations and assessment completed as necessary with care plans
revised accordingly.

 

 

 

 

 

Of?ce of Health Care Assurance Continued on page 22
STATE FORM 0899 It continuation sheet 21 0143

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (xn (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING.
125048 5 MW 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE, ZIP CODE

ANN PEARL NURSING FACILITY

45-181 WAIKALUA ROAD

KANEOHE, HI 96744

 

 

 

 

 

 

 

Of?ce of Health Care Assurance

STATE FORM

 

 

 

 

(x4) Io SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5,
(EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY 0R LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 149 Continued From page 21 4 149 conunued from page 21
summaries of the resident's status recorded, as Residents who have demonstrated a change of condition
appropriate, due to changes in the resident's for improvement have had their falls assessment and care
condition, but no less than quarterly; and plan Interventions reviewed with appropriate action and
revisions made accordingly.
(3) Ongoing evaluation and monitoring of - . . I
direct care staff to ensure quality resident care Ill. Restraint care plans be rewewed quarterly at care 
is provided. plan meeting to ensure Intended use Is unchanged.
necessity exists. change of condition warrants continued
use. A therapy screen will be conducted at any time the
This Statute is not met as evidenced by: resrdents condItIon changes to ensure appropriateness of
. . . deVIce used.
Based on Observations, staff InterVIews, and
record rev'ews the fac'll'ty :a'led tfo deVe'PdP a Falis care plans will be reviewed quarterly at care plan
comprehenswe care an or 2 30 ?33' ems (R meeting to ensure interventions remain current and aligned
#116 and #121) the Stage II sample? [with residents current condition.
Findings InClUde: Any fall reviews will occur at morning clinical meetings with
the interdisciplinary team (IDT) to ensure that a new falls
assessment is conducted. identi?ed risk factors will be
reviewed with appropriate prevention interventions imple-
mented and care plan revisions completed.
MDS nurses and resident care managers (RCMs) will be
further educated on comparison of RAI ?ndings and falls
assessment to ensure ali risk factors have been reviewed
prior to decision to proceed or not for tails care plan.
lV. Random care plan audits will be conducted X3 04/04/16
and quarterly 3. Results of audit ?ndings will be
reviewed at facility Pedormance Improvement Committee
meeting. An ongoing semiannual audit through an intra-
company process further validating compliance in this area.
Responsible Party: Director of Nursing and/0r
Designee

 

 

 

8899

DGY211

If continuation sheet 22 of 43

 

PFIINTED: 03/04/2016

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDWG. COMPLETED
125048 8- WING   .- 02/19/2015
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREHX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 149 Continued From page 22 4 149

 

 

 

 

 

 

 

 

 

Of?ce of Health Care Assurance

STATE FORM

6899

DGY211

If continuation sheet 23 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

FORM APPROVED
HawaII Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES 1x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
125048 We 02/19/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS, CITY, STATE. ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) .9 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
pggpix (EACH DEFICIENCY MUST BE PRECEDED BY FULL pngpix (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG To THE APPROPRIATE DATE

DEFICIENCY)

 

4149 Continued From page 23 4 149

 

I. The alleged out of date items were discarded. The dates 02/20/16
4 159 Storage and handling of food 4 159 located on the items were open dates vs. the alleged use
by dates. Sanitizer machine was verified by outside vendor

food she" be procured, stored, prepared, to be in proper working order before next scheduled meat

distributed, and served under sanitary conditions. service on 2/16/16. ice machine lid, two air conditioners,
radio. fans in kitchen and side of steam table was cleaned.
(1) Dry or staple food items She? be Stored There were no residents found to be affected by this
above the floor in a ventilated room not subject de?Cienl Practice

to seepage or wastewater backflow, or
contamination by condensation, leakages,
rodents, or vermin; and

II. Review of infection log reveals no residents were 02/20/16
negatively affected by this deficient practice. All open items
were checked for any expired products and appropriate

(2) perishable foods she" be stored at the action taken as needed. A quick guide for staff regarding

proper temperatures to conserve nutritive value food labeling dates was posted in kitchen. Sanitizer was
and prevent spoilage. monitored for proper following service by outside
vendor and verified by food services director to

be in proper working order. Staff were in-serviced on

This Statute is not met as evidenced by: Cleaning schedules and expectation.
Based on Observations, staff interview, and

 reviews    to store, prepare,  Open ?8315 be CIIeCked     

 

 

 

 

 

distribute, and serve food under sanitary staff for any expired IOOCI items. Dietary staff IO be
conditions, putting residents at risk for pathogen ln?selViced 0? Peliey Feed and Storage Dietary
Continued on page 25

 

Of?ce of Health Care Assurance
STATE FORM 6899 If continuation sheet 24 of 43

 

PRINTED: 03/04/2016

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A, BUILDING: COMPLETED
125048 3- WING 02/19/2016

 

 

 

 

 

NAME OF PROVIDER OR SUPPLIER

ANN PEARL NURSING FACILITY

STREET ADDRESS, CITYI STATE, ZIP CODE

45-181 WAIKALUA ROAD

KANEOH E, HI 96744

 

 

 

 

 

 

 

(x4) ID SUMMARY STATEMENT OF DEFICIENCIES Io PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
. Conmed from page 24
4 159 Continued From page 24 4 159
exposure and physical contamination of food, staff to be in-serviced on procedures in the event that
sanitizer reads out of range. Cleaning schedules were
Findings include: - updated and revised to include daily, weekly, and
quarterly cleanings. Dietary staff to be in?serviced on
updated cleaning schedules.
IV. Audits of dating and labeling, sanitizer ppm! and 04/04/16

cleaning schedules will be conducted x3 then
quarterly thereafter results of audit ?ndings will be
reviewed at facility Performance Improvement Committee
meeting. An ongoing semiannual audit through an
intra-company process further validating compliance in
this area,

Responsible Party: Food Services Director

and/or Designee

 

 

 

 

Office of Health Care Assurance

 

STATE FORM

6899

DGY211 If continuation sheet 25 of 43

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

Of?ce of Health Care Assurance
STATE FORM

 

 

STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: . COMPLETED
A. BUILDING.
125048 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE. ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER-S PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE 
TAG REGULATORY DR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 159 Continued From page 25 4 159

 

 

 

 

6599

DGY211

It continuation sheet 26 01 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Of?ce of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (x2) MULTIPLE CONSTRUCTION (st DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
125048 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
W) SUMMARY STATEMENT OF DEFICIENCIES .D PROVIDERS PLAN OF CORRECTION (x5)
(EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 159 Continued From page 26 4 159

 

 

 

 

 

 

 

 

Of?ce of HeaIth Care Assurance
STATE FORM

6899

DGY211

If continuation sheet 27 of 43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (XS) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED
125048 3- WING 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
NN PEA FACI
A RL NURSIN KANEOHE, HI 96744
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES in PROVIDER's PLAN OF CORRECTION (X5,
(EACH DEFICIENCY MUST BE PRECEDED BY FULL pREFix (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 197 Continued From page 27 4 197 I. No residents were found to be negatively affected by this 02/20/16
finding.
4 197 Pharmaceutical services 4 197 .
It. A review of all medication rooms, medication and 02/20/16
Discontinued and outdated prescriptions and treatment carts for any other opened and expired items was
containers with worn, illegible, or missing labels condUCIed W'th "0 Other ?ems d'scove?ed
shall be disposed of according to facility - . . 
policy Licensed staff has been inserwced on requirements for 03/30/16
medication expiration and destruction protocols. Newly
ghired licensed staff will have poticy reviewed as part of
This Statute is not met as evidenced by: xtheirlgnit oriegtation. Night shift Staff will bedresponSIblte for;c
Based on observation interview with staff chec ing me. Ication rooms, me ication an treatmen ca .
. . . . and discard any undated or outdated medications.
members and reVIew of the facuity's policy and
procedure' the iacmty falled to ensure drugs were IV. Random medication expiration audits will be conducted 04/04/16

 

 

labeled in accordance with currently accepted
professional principles and the expiration date
when applicable.

Findings include:

 

 

 

of medication rooms. medication and treatment carts
3 the quarterly thereafter with results reviewed
at performance improvement Committee. An ongoing
semiannual audit through an intra-company process
further validating compliance in this area.

Responsible Party; Director of Nursing and/or
Designee

 

 

 

O?i?fice of Health Care Assurance
STATE FORM

6889

DGY211

 

it continuation sheet 28 at 43

PRINTED: 03/04/2016

 

 

FORM APPROVED
HawaII Dept. of Health, Of?ce of Health Care Assuranc
STATEMENT OF DEFICIENCIES Ix1) (x2) MULTIPLE CONSTRUCTION Ixa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING: COMPLETED
125048 3- WING 02/19/2016

 

 

 

 

 

NAME OF PROVIDER OR SUPPLIER

ANN PEARL NURSING FACILITY

STREET ADDRESS. CITY. STATE, ZIP CODE

45-1 81 WAIKALUA ROAD

KANEOHE, HI 96744

 

 

 

 

 

11 -94.1 -53(a) Infection control

There shall be appropriate policies and
procedures written and implemented for the
prevention and control of infectious diseases
that shall be in compliance with all applicable
laws of the State and rules of the department
relating to infectious diseases and infectious
waste.

This Statute is not met as evidenced by:
Based on observation and staff interviews, the
facility did not implement practices to control or
prevent infection in the long term care facility as
well as the Adult Day Health shower room.

Findings include:
Based on observation and interview with staff

 

 

(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
DEFICIENCY)
4 197 Continued From page The facility does allege that there is an established and 02/20/16

maintained an Infection Control Program.

Resident 200 is not on the sample resident list therefore
unable to determine who was affected by this de?cient
practice.

The pulse oximeter and storage area were thoroughly
cleaned and sanitized.

Resident It 123 suffered no negative outcome from this
practice.

received education and counseling regarding
infection control practices during skin care treatments.

Shower gurney on Maile was pressure washed and
bleached. A new mat was ordered for shower gurney.
Nursing staff on unit were in-serviced on appropriate use of
disinfectant.

Continued on ?gs 30

 

 

 

Of?ce of Health Care Assurance

STATE FORM

6899

DGY211 If continuation sheet 29 of 43

 

PRINTED: 03/04/2016

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION Ixa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION 
A. BUILDING.
125048 8- 02/19/2016

 

 

 

 

 

 

NAME OF PROVIDER OR SUPPLIER

ANN PEARL NURSING FACILITY

STREET ADDRESS. CITY. STATE, ZIP CODE

45-181 WAIKALUA ROAD
KANEOHE, HI 96744

 

SUMMARY STATEMENT OF DEFICIENCIES

(X4) ID
(EACH DEFICIENCY MUST BE PRECEDED BY 

PREFIX
TAG

REGULATORY OR LSC IDENTIFYING INFORMATION)

ID
PREFIX
TAG

ULL

PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)

(X5)
COMPLETE
DATE

 

4 203 Continued From page 29

members the facility failed to maintain an
infection control program to provide a sat
sanitary and comfortable environment to
the transmission of disease and infection

Findings include:

 

 

 

Office of Health Care Assurance
STATE FORM

 

  

4 203

9.
prevent

 

Continued from page 29

Wash cloths were immediately removed from the shower
area.

II. Pulse oximeters and storage areas for vital sign equip-
ment were inspected and thoroughly sanitized as
necessary.

All shared shower equipment was checked and addressed
as appropriate.

All shower rooms where checked for any unlabeled wash
cloths.

No residents were found to be negatively affected by this
practice.

Review of the past 6 months of resident council minutes
regarding infection control practices will occur with action
plans developed to address.

Routine cleaning schedule will be conducted for pulse ox
machine.

A shower equipment cleaning schedule to be created and
maintained by environmental services staff. Schedule will
also include checks by environmental services staff for
equipment wear and tear to be addressed as deemed
appropriate. Night shift staff will check each night to assure
that disinfectant is stocked in designated area

Nursing staff wilf be educated on infection control practices
with equipment, storage areas, wash cloths and resident
care. Vital sign equipment and storage areas will be placed
on a routine Cleaning schedule to ensure sanitation is
achieved.

IV. Random infection control audits will be conducted
3 and quarterly 3. Results of audit findings
will be reviewed at facility Performance Improvement

Continued on page 31

 

 

02/90/16

041'04/ 1 6



 

6899

DGY211

If continuation sheet 30 of 43

 

 03/04/2016

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. Of Health Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: . COMPLETED
A. BUILDING.
1 25048 8- WING 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
. KANEOHE, HI 96744 
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 30 4 203 Commued from page 30

 

 

 

Of?ce of Health Care Assurance
STATE FORM

 

 

 

Committee meeting. An ongoing semiannual audit through
an intra-company process further validating compliance in
this area.

Responsible Party: Director of Nursing and/or
Designee

 

 

 

 

 

6899

DGY211 ll continuation sheet 31 0143

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016

 

STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

 

(X1) 
IDENTIFICATION NUMBER:

1 25048

 

 

FORM APPROVED
(x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
A. BUILDING: COMPLETED
02/19/2016

 

 

 

NAME OF PROVIDER OR SUPPLIER

ANN PEARL NURSING FACILITY

STREET ADDRESS, CITY, STATE, ZIP CODE

45-181 WAIKALUA ROAD

KANEOHE, HI 96744

 

PLAN OF CORRECTION

 

 

 

 

 

(x4) '0 SUMMARY STATEMENT OF DEFICIENCIES .0 (x5)
pm;le (EACH DEFICIENCY MUST BE PRECEDED BY FULL paEFIx (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG To THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 31 4 203

 

 

 

 

 

Of?ce of Health Care Assurance
STATE FORM

 

6899



If continuation sheet 32 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

I FORM APPROVED
Hawarr Dept. of Health Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: BUILDING, COMPLETED
125048 3- 02/19/2016
NAME OF PROVIDER SUPPLIER STREET ADDRESS. CITY, STATE, ZIP CODE
45-1 81 WAIKALUA ROAD
PEARL I
AN AC KANEOHE, HI 96744
(x4) .9 SUMMARY STATEMENT OF DEFICIENCIES to PROVIDER-s PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 32 4 203
I. After resident concern was addressed at time of incident 02/22/16
4 213 ?'94'1'54Idi San'tat'on 4 213 there were no other reported or observed issues.
Id) Every faculty Shall maintain _e?eCtIVe PQSI II. No residents found to be affected by this alfeged 02/22/16
CONTOI program 50 that the '3 free OI PGSIS de?cient practice. There have been no other similar
alld deenIS- concerns reported during a 6 month lookback period.
This Statute is not met as evidenced by: Facility pest control to be monitored daily by all staff and
Based on resident and family interview the facility any observed pest issues to be removed immediately as
failed to maintain an effective pest control well as verbalized to Administrator/Designee. Extermination
program to keep the facility tree of rodents, provider contacted to tour facility to evaluate and provide
recommended services for additional pest control.
Findings incrude; Monitoring for pests will be added to 
environmental rounds.
Continued on page 34

 

 

 

 

 

 

 

Of?ce of Health Care Assurance

STATE FORM

6699

DGY211

It continuation sheet 33 of 43

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii 0331. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED
125048 9- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY. STATE, ZIP CODE
45-181 WAIKALUA ROAD
PEARL ILITY
AN we FAG KANEOHE, HI 96744
(x4) to SUMMARY STATEMENT OF DEFICIENCIES to PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL pREFix (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
DEFICIENCY)
. Continued from page 33
4 213 Continued From page 33 4 213
IV. Audit of pest management to be performed daily x1 04/04/16
week then bi-weekly 3 weeks. Then thereafter
given no significant ?ndings. Facility extermination services
will be initiated with any observed or residenUfamin
concerns. Results of audit ?ndings will be reviewed at
facility Performance Improvement Committee meeting.
An ongoing semiannual audit through an intra-company
process further validating compliance in this area.
Responsible Party: Administrator and/or
Designee
4 218 Housekeeping 4 213 I. Review of infection and accident log confirmed that no 02/22/16
residents were found to be affected by the de?cient practice.
All floors, walls, ceilings, windows, and - 
?xtures Sha" be kept clean and in good repair. yll..There were no other resrdents found to'be affected by 03/22/16
de?crent practice. All fans and vents in the facrlity were
{checked for cleanliness and were cleaned as needed. All
     as    
Based on observation and interview with facility . . ..  . . 9
staff the facility failed to provide housekeeping maintenance was Initiated. oncerns Identi red duct
. 8 NC 8 . . tape In dining room were addressed and recti?ed. The
an "Pam enance 8 "6 essary 0 am flaking and peeling paintwere addressed to prevent paint
a sanitary, orderly, and comfortable Interior. from falling.
Findin inCIUde: Ill. On 3/14/16 3 job offer and acceptance was made to an 04/04/16
additional maintenance associate to assist facility with
de?ciencies related to baseboards, cracked tiles, wall
repairs. painting. ?00ring repairs and stained ?ooring. An
inventOry of all fans and vents within the facility was
conducted. A preventative maintenance log was created to
assure proper maintenance and cleanliness of fans and
vents within the facility. Facility to implement 
environmental services rounds to monitor for facility
cleanliness and general maintenance needs.
Continued on page 35

 

 

 

 

 

 

 

Of?ce of Health Care Assurance

STATE FORM



If continuation sheet 34 of 43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office Of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED
125048 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY. STATE. ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) Io SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSSREFERENCED To THE APPROPRIATE DATE
DEFICIENCY)
. Con'inued from 34
4 218 Continued From page 34 4 218 peg
IV. Audits of housekeeping and maintenance services will 04/04/16

 

 

 

 

 

be conducted x3 then quarterly thereafter results
of audit findings will be reviewed at facility Performance
Improvement Committee meeting. An ongoing semiannual
audit through an intra-company process further validat;ng
compliance in this area.

ReSponsib?e Party: Admin?strator and/or
Designee

 

 

 

 

Of?ce of Health Care Assmance

STATE FORM

8899

DGY211 If continuation sheet 35 of 43

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

Of?ce of Health Care Assurance

STATE FORM

 

 

 

STATEMENT OF DEFICIENCIEs (x1) (x2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING COMPLETED
1 25048 3 WM 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
pREle (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE 
TAG REGULATORY OR IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 218 Continued From page 35 4 218

 

 

6399

DGY211

If continuation sheet 36 of 43

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016

 

STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(X1) 
IDENTIFICATION NUMBER:

 

125048

 

 

FOFIM APPROVED
(x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
A. BUILDING: COMPLETED
8' 0211912016

 

 

 

NAME OF PROVIDER OR SUPPLIER

ANN PEARL FACILITY

45-181 WAIKALUA ROAD

KANEOHE, HI 96744

STREET ADDRESS. CITY. STATE, ZIP CODE

 

 

 

 

 

 

 

 

 

 

(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5,
anFIx (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE 
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 218 Continued From page 36 4 218
Of?ce of Health Care Assurance

STATE FORM

6699

DGY21 1

If continuation sheet 37 of 43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
HawaII Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING: COMPLETED
125040 8- WING 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
PEA
ANN RL NURSING FACILITY KANEOHE, 96744
(X4) in SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER's PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 218 Continued From page 37 4 218
I. Exit door was repaired immediately on 2/17/16 upon 02/20/16
notification. No residents were found to be affected by the
4 226 Life safety 4 226 de?c'e'? Pram-
Facilities shall have written procedures in 02/20/16
case of fire, disasters, and emergencies. . . 
de?CIent practice.
. A preventative maintenance program was created which 03/30/16
Statme '3 not me? as eV'denqu bY' will be conducted which will dso assure proper
Based on surveyor reVIew, the faculity dId not working order of an exit doors.
maintain fire exit doors, delayed egress .
meChamsmr e?ftmgU'?th SYStem (?when IV. Audits of exit door preventative maintenance will be 04/04/16
range hOOd). arid fire Spr'nk'ers- conducted x3 then quarterly thereafter results of
. . audit findings will be reviewed at facility Performance
Findings Include: Improvement Committee meeting. An ongoing semiannual
audit through an infra-company process further validating
Cross reference to Life Safety Survey, Citations compliance in this area.
K072. Responsible Party: Administrator and/or
Designee
4 270 conStrucnon requ'remems 4 270 l. Upon notification hand call bells were immediately made 02/20/16
. . . available in adult day health toilet facility. There were no
g1) hihefacmPy Shall have adequate tollet and adult day health participants found to be affected by this
at ac'lmes' de?cient practice.
(7) EaCh tOi'et and bath facmty Shall have a II. Review of accidents over the last 6 months yielded no 03/21/16
ca? SYStem {hat Permits: the occupant t0 Signal results related to adult day health toilet facility. No adult
the nursmg Statlon an emergency; day health participants were found to be affected by this
de?cient practice.
Continued on page 39

 

 

 

 

 

 

Of?ce of Health Care Assurance

STATE FORM

6899

DGY211

If continuation sheet 38 of 43

 

PRINTED: 03/04/2016

 

 

. FORM APPROVED
Hawaii Dept. of Health; Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A COMPLETED
. BUILDING.
125043 3- 02/19/2016

 

 

 

 

 

NAME OF PROVIDER 0R SUPPLIER

ANN PEARL NURSING FACILITY

STREET ADDRESS. CITY. STATE, ZIP CODE

45-181 WAIKALUA ROAD
KANEOHE, HI 96744

 

 

 

 

 

 

Construction requirements

The facility shall have resident bedrooms that
ensure the health and safety of residents:

(4) Single resident bedrooms shalt measure
at least one hundred square feet of usable

space, excluding closets, bathrooms,
alcoves, and 

This Statute is not met as evidenced by:

Based on staff interview, the facility failed to have
bedrooms measure at least 100 square feet in
single resident rooms in 1 of 6 rooms on one of 4
units in the facility.

Findings include:

 

(x4) Io SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5)
past-1x (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 270 Continued From page 38 4 270 conunued from page 38
This Statute is not met as evidenced by: to research and purchase appropriate/permanent 04(04/16
Based on Observations and staff interviews, the call light solution for adult day health toilet facility. Staff and
facility did not ensure each toilet facility have a IAdult day health participants will be in-serviced on use of
call system that permits the occupant to signal new system
the nursing station in an emergency for one of 2 .
toilets for the Adult Day Health clients. IV. Random audits will be conducted during adult day 04/04/16
Findin 3 include: health operational times to ensure functioning call bell
access X3 then quarterly X3, thereafter results of
audit findings will be reviewed at facility Performance
Improvement Committee meeting. An ongoing semiannual
audit through an intra?company process further validating
compliance in this area.
Responsible Party: Adult Day Health Director
and/or Designee
4 277 4 277 021'20/ 16

Ann Pearl Nursing Facilit has a current waiver for room
size in Hale Ho'olu?

 

 

 

 

Office of Health Care Assurance
STATE FORM

6899

DGY211 If continuation sheet 39 of 43

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 03/04/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

Findings include:

The facility shall have resident bedrooms that
ensure the heaith and safety of residents:

(5) Mufti-resident bedrooms shail provide a
minimum of eighty square feet per bed of
usable space, excluding closets, bathrooms,
alcoves, and 

This Statute is not met as evidenced by:
Based on staff interview,'the facility faiied to have
bedrooms measure at ieast 80 square feet per
resident in multiple resident bedrooms in 1 of 6
rooms on one of 4 units in the facility.

One room in Hale Ho'olu unit did not maintain the
required square footage for the number of
resident occupants. Room #3 was a multiple
resident room.

 

 

STATEMENT OF (x1) (x2) MULTIPLE (x3) DATE SURVEY
AND PLAN or NUMBER: A. COMPLETED
125948 02/19/2015
NAME OF Paowpae on SUPPLIER STREET ADDRESS, CITY, STATE, ZIP cons
45-181 ROAD
ANN PEARL. NURSING FACILITY Hi 96744
(x4) in SUMMARY STATEMENT OF I9 PROVIDERS PLAN OF CORRECTEON (x5)
PREFIX (EACH MUST BE PRECEDED av FULL pHEFrx (EACH CORRECTIVE ACTION SHOULD BE 
TAG REGULATORY OR TAG TO THE APPROPRIATE DATE
DEFICIENCY)
4 277 Continued From page 39 4 277
1) One room in Hale Ho'olu unit did not maintain
the required square footage for the number of
resident occupants. Room #1 measured 78
square feet. Room #1 was a private room fort
interview with the NOS on the morning of 2/18/16
confirmed that the room size for rooms 1 and 3
were not in compiiance with the requirement for
appropriate square footage. The NOS confirmed
that the facility rooms remained as noted in the
previous survey, and therefore were not in
ccmpiiance with the requirement for appropriate
square footage in Room 3 in Hale Ho'oiu unit.
4 278 Censtruc?on requirements 4 27.8 Arm Peart Nursing Facilit has a current waiver for room 02120/16
mm in Haie Ho olu

 

 

Office of Health Care Assurance

STATE FORM

6899



lf continuation sheet 40 of 43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc .
STATEMENT OF OEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A Emma: COMPLETED
125048 3- WING 0211912016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45-181 WAIKALUA ROAD
ANN PEARL NURSING FACILITY HI 967?
(x4) 19 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
ngFix (EACH DEFICIENCY MUST BE PRECEDED BY FULL pagpix (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY on Lee IDENTIFYING INFORMATION) TAG TO THE APPROPRIATE DATE
DEFICIENCY) 
4 278 Continued From page 40 4 278
interview with the NOS on the morning of 2/18/16
confirmed that the room Size for rooms 1 and 3
were not in compiiance with the requirement for
appropriate square footage. The N08 confirmed
that the facility roorns remained as noted in the
previous survey, and therefore were not in
compliance with the requirement for appropriate
square footage in Room 3 in Hale Ho'oiu unit.
4 281 114; 4_1_65(e) (8) Construction requirements 4 281 i. Upon notification oftiie main shower cali iigirt not 02122/16

functioning batteries were replaced immediately and staff
confirmed proper functioning. Tire one malfunctioning
pager was repiaced immediateiy upon notification and sit 3
other pagers on the l-iaie l-ic?olu unit were verified as

. . . . functioning properly by staff. Hand bails were placed in the
(8) Each regidem Shall be prov'ded w'th' main dining room bathrooms until system could be

reprogrammed. System was reprogrammed on 22216.

The facility shall have resident bedrooms that
ensure the health and safety Of residents:

(A) A separate bed of proper size and

height for the Com?femen?e  the rfaS?dem ll. Ail call belts were audited to assure proper functioning of 02/20116
and that perm?s an md'V'dual 3? a WheelCha" cali lights and proper functioning/programming of pagers bed unassisted; 2/19/16. Any cali belie/pagers found to be malfunctioning
(B) A comfortabie ma?reSS With were immediateiy ?xed. No other residents were found to
impermeable mattress cover, and a pillow with an be affected by this deficient practice.
impermeable cover; .
(C) Sufficient clean bed Iinen and ill. A preventative maintenance program was created base: 03/30/16
blankets to meet the resident's needs; on manufacturers recommendations to address call light
(D) Appropriate furniture, cabinets, and batteries, cail Eight bulbs, call cords, call bell computer
closets, accessible to and meeting maintenance, pager batteries. and pager programming. An
individuai resident?s needs, Locked extra pager was programmed and placed at each nursing
containers shat] be avajjable upon station to be availabie 24/7 to staff in the event that a pager

malfunctions. A pager check wili be conducted at the
change of every shift where a cail light will be pulled and
pager functionaiity wiiE be verified. Nursing staff were in-
serviced on the availability of extra pagers on each unit and
how/when to conduct a pager check. Maintenance staff
check the primary computer for the cali beii system for

- any warnings 3x per week and address any concerns
accordingly.

resident's request; and
(E) An effective signal cali system at the
resident?s bedside.

This Statute is not met as evidenced by:
Based on observation and staff interviews the Continued on page 42

 

 

 

 

 

 

Office of Heatth Care Assurance
STATE FORM 6399 seven if continuation street 41 Df43

 

PRINTED: 03/04/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health. Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A COMPLETED
125048 5- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE, ZIP CODE
45-181 WAIKALUA ROAD
ITY
ANN PEARL NURSING FACIL HI 96744
(x4) In SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL 95:15le (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 281 Continued From page 41 4 281 continued from page 41
facility failed to ensure that the call light system in IV. Audits of call bell system and call bell system 04/04/16
the secured (HH) unit is functioning properly. preventative maintenance will be conducted x3
then quarterly thereafter results of audit ?ndings will be
Findings include: reviewed at facility Performance Improvement Committee
meeting. An ongoing semiannual audit through an intra-
During the initial tour on 2/16/16 at 08:30 AM. it company process further validating Compliance in this

was found that the call light in the main shower area-
room of the secured/HH unit and room 5 were not -
working. Two maintenance staff members stated
that the batteries need to be changed.

Responsible Party: Administrator and/or
Designee

There are 4 pagers in the secured/HH area. One
of 4 pagers was not re isterin an calls from the
residents.

    

Currently, no preventative maintenance (PM)
being done for the beepers except to change
batteries at least once a month, the last time it
was done was on 10/2015 and 01/2016.

When surveyor pulled the call light in the
bathroom of the main dining room it did not
register on all four pagers. The Maintenance staff
member and the Director of Operations
acknowledged that the system was not set up to
accordingly and that they will call the vendor.

According to Licensed Nurse, LN during
change of shift, the staff do not check whether
the beepers are working or not, it is a hand off
from shift to shift.

The policy on "Preventative Maintenance
Schedule For Equipment" was reviewed. Under
procedure 1: "The Environmental Services
Supervisor is responsible for developing and
maintaining a schedule of maintenance services
to assure that all equipment are maintained in a
safe and operable manner."

Office of Health Care Assurance
STATE FORM 6899 0G,an If continuation sheet 42 of 43

 

 

 

 

 

 

 

 03/64/2016

 

 

 

 

 

 

 

 

FORM APPROVED
HawaiE Dept. of HeaSth, Office Of Health Care Assuranc
STATEMENT OF DEPICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTEON IDENTIFICATION NUMBER: A BUMENG COMPLETED
125043 3- 02/19/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
45?18? WAIKALUA ROAD
ANN PEARL NURSING FACILITY
KANEOHE, HI 96744
(x4) an SUMMARY STATEMENT OF DEFICIENCIES PROVIDERS PLAN DP CORRECTION (x5)
pagpax (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REPERENCED TO THE APPROPRIATE DATE

DEFICEENCY)

 

 

 

 

 

 

 

 

Of?ce of Health Care Assurance
STATE FORM

6899



[f continuazion Sheet 43 of 43

EXHIBIT 

 

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF
DEFICIENCIES
AND PLAN OF
CORRECTION

PRINTED:12/6/2016
FORM APPROVED
OMB NO. 0938-0391
(X3) DATE SURVEY
COMPLETED

(X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION
/ CLIA
A. BUILDING ______
IDENNTIFICATION
B. WING _____
NUMBER

125041
NAME OF PROVIDER OF SUPPLIER

03/18/2016

STREET ADDRESS, CITY, STATE, ZIP

LILIHA HEALTHCARE CENTER

1814 LILIHA STREET
HONOLULU, HI 96817
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)

F 0323

Make sure that the nursing home area is free from accident hazards and risks and provides
supervision to prevent avoidable accidents
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observations, medical record review and staff interviews, the facility failed to provide adequate supervision for
one resident, Resident #47, of 4 residents reviewed for accidents in the Stage 2 sample.
Findings include:
An interview with Resident #7 on the morning of 3/15/16 revealed that his roommate, Resident #47, often came into his space.
According to Resident #7, Resident #47 comes into his space and adjusts the air conditioner and turns the channels on his
personal TV. Resident #7's bed was closest to the window (where the air conditioner was located) and Resident #47's bed was
immediately next to him in a 4-bed bedroom. Resident #7 further stated that Resident #47 becomes agitated and
confrontational when Resident #7 asks him to stop touching his items. Resident #7 stated that Resident #47 will put up a
fist and come toward him in his bed. During the interview with the surveyor, Resident #47 came into #7's space and began
staring at Resident #7. Resident #7 stated to #47, I'm talking here. Please leave. Resident #47 had an angry look on his
face but turned and walked back to his bed. Resident #7 stated, Yes, I feel worried. I can't do much. When asked if he
thought the facility was sufficiently staffed, Resident #7 stated, Absolutely not.
A review of Resident #7's Minimum Data Set, MDS, with Assessment Reference Date, ARD, of 3/8/16, found a Brief Interview for
Mental Status (BIMS) score of 15/15 (completely alert and oriented to person, place, and time). The MDS noted he had a
[DIAGNOSES REDACTED].
Resident #47's room was the last room, furthest away from the nurses station. An observation of Resident #47 on the morning
of 3/15/16 at approximately 11:30 A.M. found him sitting on a chair in the hallway near his room. A staff member was seated
next to him while she charted on a computer. After 10 minutes, Resident #47 independently ambulated back to his bed. Lunch
was delivered to the unit at approximately 12:05 P.M. Resident #47 ambulated to the dining room and ate his lunch there.
When he was done, he independently returned to his room. Staff were busy assisting with the lunch meal. Throughout the rest
of the lunch meal, Resident #47 independently ambulated back and forth from his room to the hallway, to the dining room and
back to his room. Along the way staff would see the resident but no one staff member was assigned to supervise him.
Observation of Resident #47 on the afternoon of 3/16/16 found him wandering along the hallway, to his room, and into the
dining room. He independently wandered around without direct supervision by staff members.
Observation of Resident #47 on the morning of 3/17/16 found a Certified Nurses Aide, CNA, following him around. She was
sitting with him in the dining room and when he got up to walk down the hallway, she followed him. At approximately 2:00
P.M. the CNA was seated with him and provided him with ice cream.
A review of Resident #47's medical record found he was admitted to the facility on [DATE]. He had a strong history of
aggression. According to the medical record, the resident had been incarcerated in the past for attacking a staff member at
a facility he previously resided at. His [DIAGNOSES REDACTED]. When the resident has difficulty sleeping, he wanders at
night and will stand at the bedside of other residents and stare at them, startling them.
While in this facility, Resident #47 displayed several major episodes of aggression. On 9/17/15 at approximately 9:20 P.M.,
Resident #47 allegedly hit a female resident on the back of her head. The staff did not witness the incident. According to
the incident report, the female resident was seated near the door to her room while the CNA prepared the toilet for her.
The female resident stated that Resident #47 struck her on the back of head while he was walking by. The female resident
stated she didn't think Resident #47 knew what he did. No injuries were noted. The facility's investigation indicated the
nursing staff was neglectful by not closely monitoring the whereabouts of Resident #47.
Another documented incident occurred between Resident #7 and Resident #47 on 9/10/15 during night shift. The night shift CNA
was attempting to turn Resident #7 when Resident #47 shouted to turn off the light. Resident #47 moved toward the CNA and
threatened to hit her so she turned the light off. At that time, Resident #7 requested to speak with the Licensed Nurse,
who went over to him. Resident #7 informed the Licensed Nurse that if they (staff) cannot speak with Resident #47, then he
will be the one to speak with him because God told him to. While Resident #7 was speaking with the Licensed Nurse, Resident
#47 interrupted and said, Shut up. They exchanged more words and the Licensed Nurse was able to finally get Resident #47 to
return to his own space. The Licensed Nurse provided Resident #47 with his prn Trazodone.
Finally, an incident occurred on the morning of 8/9/15 with Resident #47 and another male resident. When staff arrived, they
found Resident #47 seated on the bed of the male resident. The male resident was on the floor facing the wall and grasping
Resident #47's right arm. Resident #47 stated, he hit me first so I hit him back five times on his face. No injuries were
noted. The facility's investigation indicated the nursing staff was neglectful for not closely monitoring Resident #47.
On the afternoon of 3/17/16 at approximately 2:05 P.M., the CNA assigned to Resident #47 was interviewed. The CNA stated, We
have to follow him because he wanders into everyone's rooms. All rooms are females except his room and the room right next
door. We have to distract him, provide a snack, and redirect him. She further stated the staff and female residents were
afraid of him because he was known to get aggressive and combative with other residents. She also stated that he can be
irritating to other residents because he wanders into their rooms. The CNA stated he has improved and hasn't shown
aggression lately. She further indicated the staff and female residents were no longer afraid of him. The CNA stated they
were required to monitor his behaviors every 30 minutes and document it. The CNA said it's sometimes difficult to monitor
him because they get busy with other residents.
An interview with night shift CNA on the morning of 3/18/16 revealed she worked in the facility over the past [AGE] years.
She stated since she started, the facility always staffed the night shift with 2 CNAs for each floor. The 1st floor had 45
beds and 44 were filled during the survey period. The 2nd floor had 47 beds and 45 were filled during the survey period.
Both floors maintained 2 CNAs for each floor on night shift. The night shift CNA reported that Resident #47 sometimes
experienced insomnia and had a history of [REDACTED]. The surveyor brought up the fact that Resident #47 is known to have
insomnia and will wander into residents rooms and stand over them at the bedside and stare at them, startling them. The CNA
reported that she knew Resident #47 would stand over Resident #7's bed at night. When asked how they respond, she stated
that Resident #7 is capable of using his call light. The surveyor then questioned what happens if both night shift CNAs
were busy with other residents. She replied, We would answer his call light and tell him to wait. He can wait. When asked
if the staffing was adequate for night shift, the CNA responded, It's okay.
An interview with the Director of Nursing, DON, on the morning of 3/18/16 revealed that managing care for Resident #47 has
been challenging. She stated that they continue to monitor his behaviors. She realizes that Resident #47 has been
physically aggressive to other residents in the recent past. She realizes that he requires close supervision and that she
does not have enough staff to dedicate one on one supervision to any resident in the facility. The psychiatrist comes to

Level of harm - Minimal
harm or potential for actual
harm
Residents Affected - Few

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
FORM CMS-2567(02-99)
Previous Versions Obsolete

Event ID: YL1O11

Facility ID: 125041

If continuation sheet
Page 1 of 6

 DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF
DEFICIENCIES
AND PLAN OF
CORRECTION

PRINTED:12/6/2016
FORM APPROVED
OMB NO. 0938-0391
(X3) DATE SURVEY
COMPLETED

(X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION
/ CLIA
A. BUILDING ______
IDENNTIFICATION
B. WING _____
NUMBER

125041
NAME OF PROVIDER OF SUPPLIER

03/18/2016

STREET ADDRESS, CITY, STATE, ZIP

LILIHA HEALTHCARE CENTER

1814 LILIHA STREET
HONOLULU, HI 96817
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)

F 0323

(continued... from page 1)
the facility to see Resident #47 and has made adjustments to his medications which has helped the resident. The DON further
indicated that she constantly reminds staff to closely monitor Resident #47 at least every 30 minutes. She says that since
the facility is unable to adequately staff the facility, it's difficult to manage and supervise residents with behavioral
disturbances. The DON stated that hiring additional staff is not possible with their current budget.

Level of harm - Minimal
harm or potential for actual
harm
Residents Affected - Few
F 0329
Level of harm - Minimal
harm or potential for actual
harm
Residents Affected - Few

F 0353
Level of harm - Minimal
harm or potential for actual
harm
Residents Affected - Many

1) Make sure that each resident's drug regimen is free from unnecessary drugs; 2) Each
resident's entire drug/medication is managed and monitored to achieve highest well being.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review and interview with staff members, the facility failed to ensure 1 (Resident #63) of 5 sampled
residents has adequate indication for the use of medications.
Findings include:
On 3/15/16 at 11:00 A.M. a record review was done for Resident #63. The physician's orders [REDACTED]. tablet, 1 tab at
bedtime; [MEDICATION NAME] 25 mg., 1 tab at bedtime; [MEDICATION NAME] 10 mg. daily; and [MEDICATION NAME] 1
mg. twice
daily. Further review on the morning of 3/17/16 found a discontinued order for [MEDICATION NAME] 10 mg., 1.5 tabs daily for
[DIAGNOSES REDACTED]. daily. Further record review done on 3/17/16 at 9:15 A.M. found there is no documentation in the
order for the [DIAGNOSES REDACTED].
Resident #63 was admitted to the facility on [DATE] with admitting [DIAGNOSES REDACTED].
A review of the Care Area Assessment for significant change with an assessment reference date of 2/24/16 notes the resident
triggered due to the use of antidepressant related to underlying anxiety, dementia with behavioral disturbance and [MEDICAL
CONDITION]. Resident #63 was also noted to have disorganized thinking with episodes of sluggishness and sleepiness as well
as refusing care; however, [MEDICATION NAME] is used at bedtime and [MEDICATION NAME] for the management of the
resident's
mood and behavior issues.
On 3/17/16 at 9:30 A.M. an interview was conducted with the Director of Nursing (DON) and the Assistant Director of Nursing
(ADON). A concurrent review of the physician's orders [REDACTED]. The DON confirmed that a [DIAGNOSES REDACTED].
Further
queried the DON regarding the use of two medications ([MEDICATION NAME] and [MEDICATION NAME]) to aide in sleeping,
the DON
responded the [MEDICATION NAME] was ordered 10/2015 and was not effective so [MEDICATION NAME] was added to the
order on
11/2015. Further inquired regarding the use of [MEDICATION NAME] for anxiety, the DON reported the physician is indicating
the resident has anxiety, its depression with anxiety. The DON clarified the resident has sun downing in the afternoon and
throughout the night she is awake, she will get out of bed and go to the bathroom and dining room. The ADON reported the
behavior Resident #63 exhibits include yelling/calling out loudly and getting out of bed and going to the bathroom
frequently. The ADON reported the monitoring of the behavior is provided to the geriatric psychiatrist.
On 3/18/16 at 8:15 A.M. an interview was conducted with the Licensed Nurse (LN). The LN reported the [MEDICATION NAME]
addresses the resident's restlessness, yelling and inability to sleep. The LN confirmed a [DIAGNOSES REDACTED]. The LN was
asked whether anxiety is a diagnosis. The LN confirmed anxiety is not a diagnosis. The LN reviewed the original physician
order [REDACTED].
The facility failed to provide the indication for the use of [MEDICATION NAME] and [MEDICATION NAME]. Also, the facility
failed to evaluate the use of both [MEDICATION NAME] and [MEDICATION NAME] for [MEDICAL CONDITION].
Have enough nurses to care for every resident in a way that maximizes the resident's well
being.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observations, resident interviews and staff interviews, the facility failed to adequately staff the facility to
meet the needs of the residents.
Findings include:
Cross reference to F323.
In an interview with Resident #7 on the morning of 3/15/16 at 10:00 A.M., the resident was asked if he thought the facility
was adequately staffed. The resident responded, Absolutely not! Further query to determine which shifts, the Resident #7
responded, All shifts, 24-7. The resident reported waiting long periods of time for staff to respond to his call light. The
resident had a [DIAGNOSES REDACTED]. Resident #7 stated the worst shift was night shift (11:00 P.M. to 7:00 A.M.) when
there was only 2 Certified Nurses Aides, CNAs, for the entire 1st floor (45 beds, 44 filled during the survey period). He
further stated the evening shift (3:00 P.M. to 11:00 P.M) was staffed with 4 CNAs while the day shift (7:00 A.M. to 3:00
P.M0 had the most, with 6 CNAs. Resident #7 stated that he had problems with Resident #47 wandering into his personal
space. He stated the staff were slow to respond when problems with the roommate occurred.
Observations of Resident #47 over the survey period found him wandering into residents' personal spaces and occasionally
getting agitated. The facility did not provide adequate supervision for him to avoid and prevent future incidents of
resident to resident altercations.
An interview with a night shift CNA on the morning of 3/18/16 found she worked at the facility for [AGE] years. The CNA
reported from the time of employment, the facility always staffed with only 2 CNAs for night shift on each floor. The
surveyor provided a scenario where she and the other CNA were busy caring for a dependent resident when Resident #7 calls
for assistance because Resident #47 is coming into his space and touching his things and getting agitated when Resident #7
corrects his behavior. The CNA responded, We answer his call light; Turn it off; and tell him he has to wait because we're
busy. He's okay. He can wait.
An interview with Resident #140's spouse on the afternoon of 3/15/16 revealed that she didn't think there was enough staff
to care for residents. She stated, I told my husband, go (bowel movement) in your diaper. That's their job to clean you up.
Resident #140's spouse reported the resident waited longer than reasonable for assistance. She was unable to provide actual
times the resident has to wait.
At the time of survey, the facility's census was 89 residents (44 on first floor, 45 on second floor). A review of the
staffing schedule for 3/1/16 - 3/31/16 found that day shift included 4 Registered Nurses, RNs, (2 assigned as
administrative (MDS) nurses) and 12 Certified Nurses Aides, CNAs. Evening shift included 2 RNs and 8 CNAs. Night shift
included 2 RNs and 4 CNAs.
An interview with the Director of Nursing, DON, on the morning of 3/18/16 revealed, Yes, I agree we have inadequate
staffing. It's been this way since I started working here (over [AGE] years ago). The DON stated that the staff is required
to be attentive to all residents but it becomes difficult when their bed census is 92 and sometimes only have 4 CNAs and 2
RNs (night shift) for the entire facility. The surveyor shared that a few residents and a family member complained of long
wait times for staff assistance. The DON was asked how she monitors/audits call light response times. She stated that while
at the nurses station, she will randomly see how long the staff takes to answer call lights/alarms. The facility's call
light system did not have a program which allowed staff to get a printout of response times. The DON stated she does not
have a monitoring system for call light response times. The DON further agreed that she does not have adequate staffing to
be able to supervise all residents.

F 0356

Post nurse staffing information/data on a daily basis.

Level of harm - Potential
for minimal harm

Based on observation and interview with staff members, the facility failed to post nurse staffing data on a daily basis in a
prominent place readily accessible to residents and visitors.
Findings include:
On the morning of 3/15/16 during the initial tour of the facility, the nurse staffing data on the first floor was posted on
a clipboard atop the water fountain. The water fountain is located behind the glass doors of the entry to the unit. The
view of the posting was obstructed by a plant which was placed in front of the posting. The date on the posting was 3/1/16
and the census was 91. The posting on the second floor was placed on a clipboard atop the water fountain. This water

Residents Affected - Many

FORM CMS-2567(02-99)

Event ID: YL1O11

Facility ID: 125041

If continuation sheet

  

Previous Versions Obsolete Page 2 of 6

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF
DEFICIENCIES
AND PLAN OF
CORRECTION

PRINTED:12/6/2016
FORM APPROVED
OMB NO. 0938-0391
(X3) DATE SURVEY
COMPLETED

(X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION
/ CLIA
A. BUILDING ______
IDENNTIFICATION
B. WING _____
NUMBER

125041
NAME OF PROVIDER OF SUPPLIER

03/18/2016

STREET ADDRESS, CITY, STATE, ZIP

LILIHA HEALTHCARE CENTER

1814 LILIHA STREET
HONOLULU, HI 96817
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)

F 0356

(continued... from page 2)
fountain is also located behind the glass doors of the entry to the unit. The posting was also dated 3/1/16 and the census
was 91.
On 3/15/16 at 8:15 A.M. concurrent observation and interview was done with the licensed nurse (LN) on the first floor. The
LN confirmed the data was incorrect, the date was 3/1/16. The LN stated the Administrator will be informed of the need for
a current posting. On 3/15/16 at 8:17 A.M. concurrent observation and interview was done with the Assistant Director of
Nursing (ADON). The ADON confirmed the posting of the date and census was not accurate. The ADON commented the posting
needs to be changed today.

Level of harm - Potential
for minimal harm
Residents Affected - Many

F 0371

Residents Affected - Many

Store, cook, and serve food in a safe and clean way
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation and staff interview, the facility failed to provide sanitary conditions for the dishwashing area and
storage area for cooking utensils and drinking jugs in the kitchen. The facility also failed to safely procure food in
resident snack refrigerator.
Findings include:
Observation on 3/14/2016 of the dishwashing area noted a broken tile area was visible with cement dust and tile dust
accumulating. A hose like tap hanging on a hook beside a sink was leaking onto the floor. Water was accumulating in the
broken tile area. The entire floor area was wet from the leaking tap. Beside the broken tile area was a shelved alcove area
that stored cooking utensils and drinking jugs.
Inspection of the residents' refrigerator on the 2nd floor nursing unit found it contained a Greek yogurt with an expiration
date of [DATE]. These findings in the kitchen dishwashing area and expired yogurt were confirmed by the kitchen manager and
staff during the observations.

F 0431

Maintain drug records and properly mark/label drugs and other similar products according
to accepted professional standards.

Level of harm - Minimal
harm or potential for actual
harm

Level of harm - Minimal
harm or potential for actual
harm
Residents Affected - Few

F 0441
Level of harm - Immediate
jeopardy
Residents Affected - Some

FORM CMS-2567(02-99)
Previous Versions Obsolete

Based on observations and staff interviews, the facility failed to ensure medications were not kept beyond their expiration
dates.
Findings include:
Observation of the second floor medication storage room on the morning of 3/18/16 at approximately 9:15 A.M. found several
expired medications: [REDACTED]
1) One vial of Influenza vaccine which was opened on 11/26/15. An interview of the Licensed Nurse on the second floor found
the vial was good for 3 months and therefore it should have been discarded on 2/26/16.
2) One vial of Procrit 10,000 U/mL expired February 2016.
3) Two bottles of Lactulose Solution 10 gm/15 mL expired 9/22/15.
A facility policy was requested of the Director of Nursing on the morning of 3/18/16 at approximately 9:30 A.M. At the time
of exit on 3/18/16, the policy was not provided to the survey team.
Have a program that investigates, controls and keeps infection from spreading.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observations, record reviews and interviews, the facility failed to protect a high number of residents from
gastrointestinal illness by failing to practice transmission based precautions, and failing to thoroughly investigate the
outbreak of the gastrointestinal illness among residents, which as a result, made for additional residents to become ill
with diarrhea/vomiting. Additionally, the facility failed to maintain an Infection Control Program designed to provide a
safe and sanitary environment and to help prevent the development and transmission of disease and infection.
Findings include:
A) The facility failed to follow and implement their infection control policies and procedures, including the Norovirus
Infection policy and procedure.
On 3/15/16, during the morning entrance conference, the Administrator stated their facility currently had a suspected
Norovirus outbreak. He presented the surveillance information and said as of 3/15/16, 12 residents were identified to be
ill. The outbreak was initially identified with 4 residents who developed symptoms of diarrhea and/or vomiting on 3/8/16.
He stated it was contained to the second floor nursing unit and was reported to the State epidemiology branch and the
facility's Medical Director.
However, during the initial tour of the second floor, it was found there was no signage on the unit to indicate that the 12
ill residents were on any form of transmission based and/or contact precautions due to the outbreak. There also was no EPA
approved disinfectant wipes in or by the rooms, nor visible personal protective equipment (PPEs) for the staff and visitors
to readily don/use at the entrance of the resident bedrooms.
On 3/15/16 at 2:33 PM, the Director of Nursing produced an updated surveillance form which showed 4 of the 12 residents
(Residents #147, #29, #63 and #16) had tested positive for the Norovirus in their stool sample. Yet, during the afternoon
observations, staff and visitors were observed freely walking in and out of the rooms with no PPEs or monitoring on the
unit. Please refer to second surveyors' observed findings below in Section B.
On 3/16/16 at 7:22 AM, a morning tour of the second floor found Resident #16 had a red sign on her door which stated,
Visitors: please report to the Nurses' station before entering the room. Otherwise, there still was no signage posted
although the Norovirus was confirmed by lab results on the afternoon of 3/15/16. Another resident (Res #102) had no signage
but was newly identified to have symptoms of diarrhea on 3/14/16 per the Administrator. Yet, this resident was found to be
out of his room although ill, without staff monitoring him. Please refer to second surveyor's observed findings below in
Section B.
On 3/16/16 at 7:29 AM, a CNA walked into the room of Res #63 to deliver meal trays. This staff wore no PPEs. This resident
had been identified to be positive for the Norovirus. Again, staff failed to adhere to their Norovirus policy and was not
being monitored.
On 3/16/16 at 8:08 AM, the Administrator produced an updated outbreak surveillance form and said another resident (Res #100)
was newly identified just this morning. The total count now is 15 residents. He said he would report this update to the
State epidemiology office.
On 3/16/16 at 12:22 PM, Res #100's lunch meal was delivered with disposable items on a yellow tray. There also was a plastic
bag containing PPE gowns on an overbed table at the foot of her bed. However, no staff were observed to wear them. The
disinfecting wipes being used for the resident's surrounding area were found to be bleach free wipes.
On 3/16/16 at 1:18 PM, during an interview with the Assistant Director of Nursing (ADON) and unit charge nurse, they stated
their signage for No Visitors allowed 3/8/16 was only posted yesterday afternoon (3/15/16) by the Administrator. The ADON
confirmed surveyors' observations that visitors were coming in and out of the residents' rooms, but we tell them they're
not supposed to go into the residents' rooms. The ADON said there were 5 visitors that came in and one stopped by the
charge nurse, but only after the surveyors queried what protocols were being implemented to prevent the spread of the
Norovirus. Review of the visitor's log book from 3/15/16 still showed numerous visitors coming to visit the facility with
no education or monitoring being provided by the staff. Please also refer to second surveyor's observed findings below in
Section B.
On 3/16/16 at 1:25 PM, during a walk through on the second floor with the ADON, she confirmed that Resident #100 is on
contact precautions. Yet, there was no signage on the resident's bedroom door. The ADON stated she should have signage. In
addition, the staff were still using the disinfectant wipes with no bleach to wipe down the resident's overbed table and
surroundings. Although by this time, the second floor unit was to have no visitors per the sign posted on 3/15/16, there
were two visitors who were noted to be in other residents' rooms. Staff continued to not monitor the visitations during the
outbreak. The ADON and charge nurse stated, we just did contact precautions. The ADON said it was her responsibility to
check the unit staff for handwashing and that they were following isolation contact precautions. When asked how this was
being done, she said she told the staff verbally, and if they did not follow the protocol, she issued a warning slip to
Event ID: YL1O11

Facility ID: 125041

If continuation sheet
Page 3 of 6

 DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF
DEFICIENCIES
AND PLAN OF
CORRECTION

PRINTED:12/6/2016
FORM APPROVED
OMB NO. 0938-0391
(X3) DATE SURVEY
COMPLETED

(X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION
/ CLIA
A. BUILDING ______
IDENNTIFICATION
B. WING _____
NUMBER

125041
NAME OF PROVIDER OF SUPPLIER

03/18/2016

STREET ADDRESS, CITY, STATE, ZIP

LILIHA HEALTHCARE CENTER

1814 LILIHA STREET
HONOLULU, HI 96817
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)

F 0441

(continued... from page 3)
them. She did not have any documentation or line implementation/ tracking measures to show how she was monitoring and
analyzing the potential for transmission due to breaks in technique/protocol. She also said they did not have a plan in
place for staff cohorting on the unit during this outbreak.
On 3/16/16 at 1:35 PM, an initial brief interview with the DON revealed she was not involved in monitoring this outbreak.
She had been at a nursing conference on 3/8/16, and said the Administrator was the one who started the surveillance and
taking the lead. She acknowledged however, that she is the facility's designated Infection Control Coordinator (ICC). The
DON also said the ADON is the one who has been monitoring the residents and nursing staff for hand hygiene and use of PPEs.
She stated she had no documentation for it.
On 3/16/16 at 1:57 PM, an interview with the Administrator was done. He verified the Norovirus Infection policy and
procedure is the current one that staff were to follow. He stated, it should be the nursing staff who has to ensure it is
being implemented and (the DON), she is the infection coordinator for many years now. The Administrator stated he was the
first one to identify the 4 residents on 3/8/16 with symptoms of foul-smelling, large watery stools and vomiting. He said
for their initial precautions, it meant limited visitation and volunteers were not allowed to go to the suspected outbreak
areas. The advice from their Medical Director at that time was follow your protocol.
The Administrator was asked about the potential cross-transmission of infection by staff and how it was being monitored. He
stated he was reinforcing the importance of handwashing and to clean with the bleach solution. He did not however, have an
explanation for the spread and said my initial reaction was to contain the possible infection on the unit. I was so
worried. We have to bring out all the PPEs that is needed and do everything to contain it.
Upon query for those residents who did not get a specimen sent for testing, the Administrator said they could not collect it
for everyone who became ill. He said he needed to discuss with the State epidemiology branch as to those residents without
a stool culture done, when they would be considered cleared of infection. However, for the 4 residents with the positive
Norovirus cultures, such as Res #29, whose last loose stool was on 3/11/16, the Administrator acknowledged they should have
kept her on contact precautions until the culture results came back, but did not. In fact, Res #29 was observed to be out
in activities with other residents on the unit on 3/15/16. Please also refer to second surveyor's observed findings below
in Section B.
On 3/16/16 at 4:14 PM, another interview with the DON was done. She has been the facility's ICC for [AGE] years. She has no
certification, but receives CDC updates and IC information via webinars and conferences to maintain her role as the ICC.
The DON was asked to produce her investigation or any documentation she had of this Norovirus outbreak from 3/8/16 to
present. She stated, Actually when I received it from 8th, I got the information on the 9th, and then I was so busy during
that time, I had to meet with the Chief Operating Officer for 2 days, so (Administrator) took over my place so that's why
he did the reporting, gathering the data and communicating with the State and to (Medical Director) of what's going on.
It's not really me--(Administrator) has been communicating with the nurses, he was the one who initiated the contact
precaution right away for the residents. So the contact person on this one is (Administrator).
She further stated, So today is the first time I have spoken with (individual) in the Department of Health, about the
surveillance and what's happening. (Administrator) is still the one going to the nurse's station and doing the preventive
measures. He talked to the CNAs, gave them instructions, posted signs.
The DON was queried who was ensuring it is being implemented, and her response was, Him, ADON and me too, but I took over
this Monday. I make sure that they have this one, the sanitizer, gloves, the disposable gowns, masks, it were all taken out
the first day. This was not observed when the survey team entered on 3/15/16.
The DON was asked what the facility's plan was to contain the outbreak. She said, the plan--it's all in the binder, the
infection control and this one given by (consultant) regarding Norovirus. We were set to meet with her yesterday, but it
was rescheduled. I never write anything about it, this is the only document I have (the Administrator's outbreak
surveillance spreadsheet). I did not document the things that we did.
She was asked what kind of precautions were implemented and responded, First, instructed all CNAs to observe handwashing use
of gloves everytime they handled the patients, they have PPEs. Contact precaution at first, but CNAs advised not to bring
them out of the room. All the patients listed in here with symptoms with vomiting and diarrhea cannot get out of the room.
Yeah, they were instructed and charge nurse to keep the patients inside the room. I base it from the last symptoms, when
they had symptoms on the 8th, they were not out until the 15th. Some came out because already free of symptoms. If still
awaiting a stool culture result? Then these people--when we're waiting for the culture--well, we only sent for 4. Really,
he (Administrator) is the one going in and out to the nurse's station as well.
For the newly identified Res #100, the DON stated she was informed, only this morning about the loose BM. Did you check to
see if she had the appropriate signage--everything as you stated? No, I did not, I did not check on her this morning. But
because the nurse should put the sign. Really, I didn't check if the sign is posted. Actually, since (Administrator) is the
one in communication with our staff all the time, I thought he did-- we work together and (ADON) too. The reason why too, I
didn't really go that side, but I have to go up and down (the first and second floors). I didn't wear PPEs.
The DON said if there is signage, if they are doing nursing care, they supposed to wear mask, gown, glove, but after
touching the patient, they supposed to use hand sanitizer, before they touch any other residents. We just had inservice
last week to use hand sanitizer after every patient after nursing care. Hand washing after 2 hand sanitizer use, they have
to do handwashing as much as possible. She confirmed their staff should use the hand sanitizers alternating with hand
washing (soap and water) by the third time. (Note: The final contact precaution sign posted on 3/18/16 stated, Handwashing
To Be Done With Soap and Water Only).
The DON was also asked if staff had to clean the residents' areas with the Sani-cloths and how she knew the appropriate ones
were being used. She replied, Yeah, yeah. Actually, we let them know and on the container, we have 2 mins, 5 mins--the
contact time. It's five minutes. She could not state that surveillance was being done for this because she stated she did
enter the second floor nursing unit where the outbreak was.
The DON confirmed she had no documentation or analysis of the Norovirus outbreak from the start. She also did not cohort
staff and stated, No, I thought (Administrator) doing this. I did not really document on this .I made sure they have all
preventive supplies what they need, like containers of their dirty items. I did not go up to the part there (the second
floor unit) and because I saw already on floor the ADON making rounds during this time.
Review of the facility's Norovirus Infection policy 2/08 (last reviewed 5/15), found: In the event that Norovirus infection
is suspected, precautions will be initiated immediately to prevent or minimize the transmission of infection. Policy
Implementation: 1. Norovirus infection will be suspected once there is a report of diarrhea and vomiting of at least 3
times per day on at least 3 residents. 2. Soon as Norovirus infection is suspected, facility must immediately initiate
Contact Isolation precautions. 3. Residents showing signs of infection will be confined in their rooms to minimize the risk
of transmission to other residents. 4. Limited or restricted visitation will be imposed immediately. 5. Stool specimen of
residents showing signs of infection will be sent to lab for Norovirus testing. 6. Once confirmed, no resident will be
allowed to go to other floor and staff will work only on the unit they are assigned. 7. All surfaces and equipment will be
cleansed with bleach wipes or spray .11. Admissions will be closed and group activities on the unit will be discontinued
until after 4 days of the last reported case . This policy was not consistently implemented such that by 3/9/16, 1 more
resident became ill, but notably that all 5 residents at that point in time were in different rooms. Then on 3/10/16, 6
more residents came down with the gastrointestinal illness, with an additional 2 more residents by 3/11/16, 1 more resident
on 3/14/16 and another resident on 3/15/16.
An undated Infection Surveillance policy found: Procedures .6. If infection is confirmed, Charge Nurse initiating treatment
should complete the Infection Report, filling up all details . The DON, with [AGE] years as the ICC, had no initial reports
or documentation to produce regarding this outbreak within their facility.
Another undated policy, Management of Outbreak of Communicable Diseases, found: Policy .5. Symptomatic residents and
employees are considered potentially infected and are cultured and isolated as indicated .For Director of Nursing .3.
Assigning nursing personnel to same residents group for the duration of the outbreak .For Nursing Staff .4. Initiating
isolation barriers as directed or as necessary. 5. Confining symptomatic residents to their rooms for at least 72 hours
after onset of infection .For the Medical Director .2. Overseeing the management of the outbreak. The Administrator said
their Medical Director's response was if the residents had no fever and were asymptomatic, the residents would be in the
clear. However, the Administrator noted that none of these residents had fever as one of their symptoms.
As of the result of the lack of following their own policies and procedures to prevent the spread of the Norovirus, on

Level of harm - Immediate
jeopardy
Residents Affected - Some

FORM CMS-2567(02-99)
Previous Versions Obsolete

Event ID: YL1O11

Facility ID: 125041

If continuation sheet
Page 4 of 6

 DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF
DEFICIENCIES
AND PLAN OF
CORRECTION

PRINTED:12/6/2016
FORM APPROVED
OMB NO. 0938-0391
(X3) DATE SURVEY
COMPLETED

(X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION
/ CLIA
A. BUILDING ______
IDENNTIFICATION
B. WING _____
NUMBER

125041
NAME OF PROVIDER OF SUPPLIER

03/18/2016

STREET ADDRESS, CITY, STATE, ZIP

LILIHA HEALTHCARE CENTER

1814 LILIHA STREET
HONOLULU, HI 96817
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)

F 0441

(continued... from page 4)
3/17/16 at 8:18 AM, the Administrator was notified of the IJ. He verified the LHC Norovirus Infection policy is current and
is what the staff had to follow. The Administrator developed an initial abatement plan on 3/17/16 at 2:50 PM, which was not
accepted by the survey team as it lacked immediate corrective measures to prevent further spread of the Norovirus.
On 3/18/16 at 8:30 AM, the Administrator produced an acceptable IJ abatement plan. Some of the corrective measures were
observed by surveyors on the unit as applicable, and included:
- The facility contracted with an infection prevention consultant to review the entire infection control program. The
consultant is to provide recommendations to correct areas related to staff knowledge of infection prevention, education
needs, need for isolation signage, proper placement and care of residents.
- New policies and procedures will be written and implemented.
- Temporary isolation signs have been placed on rooms for residents who continue to be ill with Norovirus.
- Rounds were completed by the IP consultant on the second floor on 3/17/16.
- Inservicing to be conducted by the Administrator for evening and night staff and EVS/laundry staff. Cleaning of the unit,
especially the bathrooms and floors to be more frequent, at least 3-4x/day.
- PPEs placed outside the door of each room on isolation, to be used before entering the room.
- Use of Sani cloths with bleach and Clorox solution to clean bathrooms and floors.
- No admissions on the second floor while it is on lockdown; visitation is not allowed unless necessary and visitor
instructed what to do and use PPE before entering the room.
- Resident will be cleared of infection 72 hours after the last diarrhea and vomiting is noted.
- Infection will be cleared after the last case has no symptoms for 72 hours.
- Terminal cleaning of the unit done once lockdown is lifted before any further admissions occur.
In addition, as verified by the DON during her interview, there was no documentation or active case finding upon her
knowledge (and others) when the Norovirus outbreak was suspected. She stated she had knowledge of it on 3/9/16, but as the
primary Infection Control Coordinator for the facility, failed to fully ensure the facility's policies were being
implemented. As a result, additional residents became symptomatically ill. The facility only took corrective action to
systemically implement measures once the IJ was identified and thus, failed to safeguard the health of the residents and
visitors.

Level of harm - Immediate
jeopardy
Residents Affected - Some

B) A review of the facility's policy and procedures for Norovirus Infection notes when norovirus is suspected, precautions
will be initiated immediately. Policy implementation includes the following: Residents showing signs of infection will be
confined in their rooms to minimize the risk of transmission to other residents . The facility failed to implement its
policy for residents on contact precaution with signs of infection and for residents not on contact precaution with signs
and symptoms of infection.
1. Observation during the lunch meal on 3/15/16 found Resident #102's meal tray with clear liquids. The staff member
delivering the trays reported the resident has diarrhea. On the afternoon of 3/15/16 a record review was done for Resident
#102. A physician's orders [REDACTED].#102 a liquid diet until diarrhea stops and to place the resident on contact
precaution. During the meal observation, Resident #102 was observed to be in the bathroom and used the toilet
independently.
On 3/15/16 at 2:10 P.M. an interview was done with the Licensed Nurse (LN). The LN confirmed Resident #102 was placed on
contact precaution, inquired what does this mean, contact precaution. The LN responded it means strict hand washing and use
of gloves. Further queried whether the resident is required to remain in his room, the LN reported that he usually mingles
with the other residents and the staff members will keep an eye on him to ensure he doesn't mingle with the other
residents. During the interview with the LN, Resident #102 was observed wheeling himself into the activity room. The
resident went to the refrigerator, opened the door and wheeled himself to the front of the refrigerator. A staff member
asked the resident what he wanted, the staff member was heard telling the resident to return to his room and they will
bring him some juice. A staff member wheeled him back to his room. The staff member confirmed the refrigerator contained
residents' food and drinks. The refrigerator was not sanitized after the resident on contact precaution went into the
refrigerator.
On 3/17/16 at 9:32 A.M. the DON was interviewed. Queried whether the refrigerator needed to be sanitized after the resident
went into the refrigerator, the DON responded that she had heard about it. The DON did not confirm the refrigerator
required sanitizing.
2. On the morning of 3/15/16, Resident #29 was observed seated on a large table with fell ow residents playing Bingo.
Resident #29 was seated between two residents. During lunch, the resident was seated in the dining room with another
resident. A review of the Outbreak Surveillance Form notes Resident #29's onset date of illness (diarrhea) was 3/10/16 with
last date of illness on 3/11/16. A stool sample taken on 3/10/16 was found to be positive for norovirus on 3/15/16.
Observations on 3/16/16 found Resident #29 confined to her room.
3. On 3/16/16 during the lunch meal, the following residents were observed dining the activity/dining room: Resident #86,
Resident #89 and Resident #96. Resident #86's onset date of vomiting and diarrhea was 3/8/16 and date of last illness was
3/9/16. Resident #89's onset date of diarrhea was 3/11/16 with last date of illness documented as 3/12/16. Resident #96's
onset date of diarrhea was 3/10/16 and last date of illness of 3/10/16. At this time, the Administrator and DON were unable
to provide information related to discontinuation of limiting residents with signs and symptoms of illness with other
residents. On 3/18/16, the Administrator reported residents without signs and symptoms of illness for 72 hours would be
able to join residents in the dining/activity room.
4. On the afternoon of 3/15/16, Resident #147 was observed ambulating with a forward wheel walker with the assistance of a
therapist. This resident was listed on the Outbreak Surveillance Form with onset date of vomiting and diarrhea of 3/9/16
with last date of illness of 3/10/16. The resident was not wearing personal protective equipment (gown, gloves and face
mask) This resident's stool was noted to be positive for norovirus on 3/15/16. The resident was treated with [MEDICATION
NAME].
On 3/17/16 at 2:00 P.M. an interview was done with the Speech Language Therapist (SLT). The SLT was able to confirm Resident
#147 participated in occupational and physical therapy on 3/16/16 at 2:42 to 3:40 P.M. The SLT reviewed the therapist's
note of 3/15/16 to confirm Resident #147 received therapy services for bed mobility and had complained of stomach pain.
The facility failed to confine Resident #147 with signs of infection and failed to ensure communication with the therapy
department was done to practice contact precautions (confine the resident to the room and to use appropriate personal
protective equipment).
5. On 3/16/16 during the lunch meal, Residents #116 and #113 were found to have non-disposable plates/bowls and utensils.
Resident #116 had an onset of vomiting and diarrhea on 3/8/16 and last date of illness on 3/9/16. Resident #116 was treated
with [MEDICATION NAME]. Resident #113's onset date of vomiting and diarrhea was 3/10/16 with last date of illness of
3/13/16. Other residents (Resident #63, Resident #147 and Resident #102) identified on the surveillance form were provided
meals on a yellow tray with disposable plates/bowls and utensils. Interview with the Administrator found residents with
infections require a special tray (yellow) with disposable plates/bowls and utensils.
6. The facility failed to limit visitors to the unit during the outbreak of norovirus. On 3/16/16 during the lunch meal
observation. There were three visitors present assisting residents with their meals. One visitor was observed to obtain a
meal tray from the cart without hand sanitizing.
On 3/16/16 at 12:05 P.M. a visitor was observed to enter the unit. The visitor reported she was going to visit a relative in
room [ROOM NUMBER], Resident #146. Inquired what information was provided to her while visiting her family member. The
visitor reported she was asked where and who she was going to visit and how long she was going to stay. The visitor
reported she was told there is a virus on the second floor. Further queried what other instructions were provided. The
visitor reported she is to take precautions, wear a mask and use the hand sanitizer. A review of the surveillance log found
Resident #146's roommate with onset of illness, vomiting and diarrhea on 3/11/16 with last date of illness dated 3/10/16.
C) A staff member failed to ensure hand hygiene/glove change was done during care of a resident on contact precaution. The
facility also failed to provide appropriate disinfecting solution for this resident with positive culture for ESBL E.coli
and ensure equipment use is designated for only this resident.
On 3/16/16 at 9:40 A.M. observed a Certified Nurse Aide (CNA #1) bringing Resident #81 out of the shower. Resident #81 was
seated in a shower commode. The CNA was wearing a yellow gown, booties, gloves and face mask. The CNA was placed the
FORM CMS-2567(02-99)
Previous Versions Obsolete

Event ID: YL1O11

Facility ID: 125041

If continuation sheet
Page 5 of 6

 DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF
DEFICIENCIES
AND PLAN OF
CORRECTION

PRINTED:12/6/2016
FORM APPROVED
OMB NO. 0938-0391
(X3) DATE SURVEY
COMPLETED

(X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION
/ CLIA
A. BUILDING ______
IDENNTIFICATION
B. WING _____
NUMBER

125041
NAME OF PROVIDER OF SUPPLIER

03/18/2016

STREET ADDRESS, CITY, STATE, ZIP

LILIHA HEALTHCARE CENTER

1814 LILIHA STREET
HONOLULU, HI 96817
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY
OR LSC IDENTIFYING INFORMATION)

F 0441

(continued... from page 5)
resident in her wheelchair at the foot of the bed. The CNA removed the resident's bed linen, put the resident's socks on,
went to the covered shelf and brought out clean linen. The CNA then made up the resident's bed. Subsequently, another CNA
provided assistance to transfer the resident to bed. CNA #1 removed a yellow gown from the plastic covering which was
placed on the chair between two armoires. CNA #2 was observed to put on a yellow gown, gloves and face mask at the linen
shelf. The two CNAs transferred the resident to bed. CNA #2 removed the gown, glove and face mask and tossed it in the
receptacle in the resident's room. CNA #1 placed the shower commode back into the bathroom. A disinfectant wipe was used to
wipe the top of the commode, the armrest and the plastic pipes at the base. CNA #1 did not change gloves during the
observation period. At 9:50 A.M. the CNA confirmed the wipes used to clean the shower commode was from the commercial
disinfectant wipes container and the equipment is wiped before and after the residents with a five minute wait time before
using the equipment again.
A record review was done on 3/17/16 at 8:39 A.M. Resident #81 was admitted to the facility on [DATE]. A review of the
physician's orders [REDACTED]. Subsequent note for 2/4/16 documents the resident is positive for ESBL and e. coli from
suctioned sputum. The resident was placed on contact isolation. The order for 3/17/16 notes to discontinue contact
isolation.
On 3/17/16 at 9:32 A.M. an interview was conducted with the Director of Nursing (DON). The care observation done on 3/16/16
from 9:40 A.M. to 9:50 A.M. was shared with the DON. Queried the DON whether a glove change was needed during the CNA's
care of Resident #81. The DON replied a glove change is not needed when you go from a clean area to another clean area.
Further queried whether a glove change was indicated following the removal of the bed linens and going into the clean linen
storage. The DON responded a glove change was indicated. The DON reported the commercial disinfectant wipes with bleach is
adequate to sanitize the shower commode; however, due to the resident's sputum being positive for ESBL and e.coli, the
equipment should be designated for only Resident #81. The DON further stated the wipes that were provided to the rooms this
week is adequate. The DON also confirmed the underside of the shower commode seat needed to be wiped down.
A review by two surveyors found the commercial disinfectant wipes did not include bleach. Subsequent observation found the
commercial disinfectant wipes were removed and replaced with a solution that includes bleach.

Level of harm - Immediate
jeopardy
Residents Affected - Some

D) On 3/15/2016 at approximately 12:30 PM, a physician was observed checking a resident's chest with a stethoscope. He then
went and placed his hand on another resident's forehead to tilt her head backwards and used his other hand to touch the
resident's eye area. He then went to the nurse's station and pulled a medical record out to write in. No hand washing or
hand hygiene was observed to be done by this physician between his examination of the residents or thereafter.

FORM CMS-2567(02-99)
Previous Versions Obsolete

Event ID: YL1O11

Facility ID: 125041

If continuation sheet
Page 6 of 6

 EXHIBIT 

 

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
VSTATEMENT OF (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORR ECTION IDENTIFICATION NUMBER: A BUILDING.  COMPLETED
.  
- - 
125041 5- 03/18/2016
NAME OF PROVIDER 0R SUPPLIER STREETADDRESS.CITY. STATEZIP CODE 233.3: 4i": ?l i" It," 52
1814 LILIHA STREET
HEALTHCARE CENTER HONOLULU, 9681? if}. .t . . .I 
(x4) .0 SUMMARY STATEMENT OF ID PROVIDERS PLAN oFcoRhEorION. . . (st
2 (EACH MUST BE PRECEDED BY FULL (EACH ACTION SHOULD BE COMPLETE
TAG . REGULATORY OR LSC IDENTIFYING TAG To THE APPROPRIATE DATE

4 0003 11.941 Initial Comments 4 000
 A State relicensure survey was conducted from 4 148 Nursing Services
 3/15 - 3/18/16. At the time of entrance, the
VGS'dem census was 89' Corrective actions Taken:
4 148? 11-94-1 39(3) 4 143 1. Consultants assisted facility staff in
 .. . . . erformin staf?n anal sis based
 Each faCIlIty shall have nursmg staff sulfICIent 2n CMS crieria DEN as; ned 4/14/15
5 in number and qualifications to meet the nursing 
 needs of the residents. There shall be at adfjmona' Staff to Work on 11'7
 least one registered nurse at work full-time on the Shift to more adequate
5 day shift, for eight consecutive hours, seven staff supervising resident?s needs.
days a week, and at least one licensed nurse at
work of? the eYen'ng a?d S'gm Sh'fts' Unless 2. Staff, residents, and families will be
I otherWIse determlned yt apartment. I informed Ofthe staf?ng Changes 4/29/16
into staf?ng needs.
This Statute is not met as evidenced by: . .
Based on observations. resident interviews and 3- Staff are monitorlng and
staff interviews, the facility failed to have nursing documenting resident behaviors 4/11/15
. staff sufficient in number/qualifications and and also add on their 24 hour 1 8L.
adequately staff the faCIlIty to meet the nursmg report which is reviewed by IDT. I ongOIng
needs of the resrdents.
Findings include: 4. DON and ADON will monitor call
light response time by asking
Cross reference to tag 4149. residents and family input and . 4/22/16
completing call light response 8"
observation audits at least weekly. ongo'ng
Findings will be reported to QAPI
committee for proper action.
Office of Health Care Assurance
LA RATORY OVIDERISUPPLIER REPRESENTATIVE-s SIGNATURE TITLE (st DATE
. mm 4/27?
STATE FORM I . 53? 5RDK11 "continuation {heat 1 of 31

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 04/01/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

consideration and approval.

 

STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. COMPLETED
  E'i-i '0 PGC
5- 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE, ZIP CODE
1814 LILIHA STREET
LILIHA HEALTHCARE CENTER HI 9681?

(X4) ID SUMMARY STATEMENT OF DEFICIENCIES .0 PROVIDERS PLAN OF CORRECTION (st
13525le (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSG IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE

4148 Continued From page 1 4 148 Identi?cation of other residents
Affected:
All residents have the potential to be
affected.
System Change to Ensure De?cient
Practice will not recur.
FacIlIty hIred more nursmg staff to 4/29/16
?ll up Open posmons. Scheduled 
additional staff on 11-7 shift to ongoing
have 3 nurse?s aides on each ?oor
or as determined by resident
need.
DON, ADON and SS WIll contInue 4/22/16
to monitor reSIdents and famIly 
concerns regarding the care ongoing
provided and discuss ?ndings
during IDT and QAPI meetings.
ResIdents with wandering 4/29/16
behaVIors WIll be assessed and 
care plans updated per new IDT .
ongOIng
process to determIne root causes
and identify effective
interventions
AdmInIstratorWIll commumcate 4/29/16
all QAPI findings and 
recommendations to upper .
ongomg
management for then

 

Office of Health Care Assurance
STATE FORM

$599

It continuation sheet 2 of 31

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 04/01/2016

 

STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION



-. 
a?

 

(X1) 
NUMBER:

1 25041

 

FORM APPROVED
(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
A. BUILDING: COMPLETED
03/18/2016

 

 

 

 

NAME OF PROVIDER OR SUPPLIER

HEALTHCARE CENTER

STREET ADDRESS. STATE. ZIP CODE

1814 STREET
HONOLULU, HI 96817

 

PLAN OF CORRECTION

 

 

 

 

Nursing services shall include but are not
i limited to the following:
i

 

(x4) )0 SUMMARY STATEMENT OF DEPICIENCIES .0 (X5)
pREpIx (EACH DEFICIENCY MUST BE PRECEDED BY FULL pREFix (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG I REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFEREN CED To THE APPROPRIATE DATE
 DEFICIENCY)
4148 Continued From page 2 4 148 .
Monltoring System Change to Ensure
De?cient Practice will not Recur:
Unannounced call light response
audIts WIll be completed on all 4/22/16
shifts at least weekly. Findings will 
be reVIewed to Idennfy reSIdent ongoing
concerns call lIght
response and trends related to
identi?ed concerns.
QAPI commItt-ee WIll evaluate 4/29/16
Quality IndIcators which 
re?ects the quaIIty of care ongoing
prOVIded.
Cross-reference to Plan of Corrections
4 149 Page 4 - 8
i
4 149' Nursing services 4149

 

 

Office of Health Care Assurance
STATE FORM

6599

It sheet 3 of 31

 

 04/01/2016

 

 

I FORM APPROVED
Hawaii Dept. of Health. Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) Ixz) MULTIPLE CONSTRUCTION Ixs) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
Air? BED POC
125041 9- 03/18/2016

 

 

 

 

 

NAME OF PROVIDER 0R SUPPLIER

LILIHA HEALTHCARE CENTER

STREET ADDRESS. CITY. STATE. ZIP CODE

1814 STREET
HONOLULU, HI 96817

 

 

 

 

 

 

 

 

 

 

 

(x4) Io SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER-s PLAN OF CORRECTION (x5)
(EACH DEFICIENCY MUST BE PRECEDED eY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4149 Continued From page 3 4149
(1) A comprehensive nursing assessment of 4 149 Nursmg Semices
each resident and the development and
implementation of a plan of care within five Corrective actions Ta ken:
days of admission. The nursing plan of care 1. Consultants assisted facility
shallbe developedm conjunction WIth the leadership in performing staf?ng
phySICIan admISSIon examInatIon and analysis based on CMS criteria. 
InItIal orders. A nursmg plan of care shall be . . . 4/14/16
integrated with an overall plan of care DON ass'gne?j a?dmona' SFaff t0 
developed by an interdisciplinary team no later work on 11'7 Sh'? t0 
than the twenty- first day after, or simultaneously, SUperViSion t0 promOte reSident
with the initial interdisciplinary care plan safety.
conference; 
i 2. New QAPI (Quality Assurance
(2) W?an nurs'rjg ohsewa?ons and Performance Improvement) IDT
summarIes of the reSIdents status recorded. as 
appropriate, due to Changes in the resident's (Interd'sF'Pl'nary team) meehng
I condition, but no less than quarterly; and Process inmatEd and Performed 4/6/16
Resident #47 assessment to
i (3) OnQOan eVall-la?on arid mOQitO?ng Oi analyze root causes of behaviors.
5 direct carenstaff to ensure quality reSIdent care The IDT developed interventions
'5 prowded' based on the behavior root causes
for the resident?s 
This Statute is not met as evidenced by:
Based on observations, medical record review 3. New interventions for resident
and staff interviews, the facility failed to provide #47 were incorporated in the plan
adequate SUPerViSion and 07190an of care and communicated to care
- evaluation/monitoring to ensure quality resident givers
care for one resident, Resident #47, of 4 
residents reviewed for accidents in the Stage 2
sample.
Findings include:
i
Office of Health Care Assurance
STATE FORM 6399 5RDK11 It continuation sheet 40131

 

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health. Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING. COMPLETED

silt?. ii ?5 i2:   

125041 B- 03/18/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS. CITY. STATE, ZIP CODE
1814 LILIHA STREET

HEALTHCARE CENTER HONOLULU, HI 9681?

(x4) .9 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (X5)
anFIx (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCEO TO THE APPROPRIATE DATE

DEFICIENCY)
4 149 Continued From page 4 4 149
4. Updatedinterventions were . 4/6/16
communIcated to all staff takIng
care of resident #47.
5. In response to incompatibility
- 
once ns from ResIdent a 4/5/16
reassessment of behaVIors led to
seeking permission from all
involved parties, and resident #47
was moved to another room.
6. This result of room change and
 'Other new interventions are thus
far effective. Resident #47
I . . .
eeping better, more engaged In 4/11/16
actIVItIes, In better mood.
I Resident #7
_reports 5 nO onger
concerned about resident #47.
Resident #47?5 new roommates
report not distress.
7. ministrat w'l ontin 
0 ,Ad _0 Ilc .4/15/16
to monitor effectiveness Of new 
approaches for resident #47 and .
. ongorng
 reassess, adding new approaches
where needed.
[Office of Health Care Assurance
STATE FORM "99 5RDK11 ?continuation sheet 50l31

Hawaii Dept. of Health, Office of Health Care Assuranc

04/01/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

apply QAPI principles (root cause
analysis etc.) to identi?ed
concerns. Input from direct care
givers is actively sought and
documented.

 

 

STATEMENT OF (X1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDWG: COMPLETED
F. 153-8336?.
125041 8- 03/18/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS. STATE, ZIP CODE
1814 LILIHA STREET
HEALTHCARE CENTER HONOLULU, HI 96817
W) In SUMMARY STATEMENT OF ID PROVIDERS PLAN OF CORRECTION (XS)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4149: Continued From a 5 4149
9 Identi?cation of other residents

Affected:

1. Nursing and SS will identify all 4/11/16
residents with socially disruptive
or physically intrusive behaviors.

System Change to Ensure De?cient

Practice will not recur.

1. For all presidents with wandering
behaviors, a comprehensive IDT, 4/6/16
including direct care giver 
assessment of root causes for ongoing
behaVIor Will be updated. The IDT
will identify appropriate
interventions, update the plan of
care, and communicate new
approaches to staff.

2. The IDT process Will Involve all 4/6/16
disciplines and direct care staff for 
the-Ir Input, and Iwhere ongoing
reSIdent/famIly Input.

3. Department heads began twice?
daily meetings focusing on the
POC progress, discuss trends and

4/6/16

 

 

 

Office of Health Care Assurance
STATE FORM

6899

5RDK11

ll continuation sheet 6 of 31

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION A BUILDING: COMPLETED
 12:35:) 

125041 5- 03/18/2016

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY. STATE, ZIP CODE
1814 LILIHA STREET
HEALTHCARE CENTER HONOLULU, HI 9681?
(X4) ID SUMMARY STATEMENT OF DEPICIENCIES ID  PROVIDERS PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL pREle I (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG i CROSS-REFERENCED TO THE APPROPRIATE DATE
1 

4149 Continued From page 6 4149 
I 4. Facility is hiring more nursing staff
I and will add a staff member to 4/1/16
I night shift to assure adequate 
i supervision of residents. ongo'?g


5. ADON will review the wandering
behavior monitor log and report 4/22/16
?ndings to QAPI committee for
further action.

Monitoring System Change to Ensure

Deficient Practice will not recur:

1. IDT will be conducting audits and
interviews of concerned residents 4/7/16
and families. Findings will be 
shared to all department heads Ongomg
during daily IDT meetings.

2. The committee will review 4/12/16
the results of the audits and 8"
develop interventions based on Ongo'ng
audit ?ndings.

3. DON will review all resident
supervision needs and adjust the 4/22/16

staf?ng level as necessary.

4. Administrator and DON will
review audit reports regularly to 4/22/16
identify and address potential
non-compliance.

Office of Health Care Assurance
STATE FORM 53? 5RDK11 It continuation sheet 7 of 31

 

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) Ix2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDWG, COMPLETED
.5 It}   Oil:
125041 3- 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CTTY. STATE. ZIP CODE
1 814 STREET
HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (st
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC INFORMATION) TAG TO THE APPROPRIATE DATE
DEFICIENCY)
4 149 Continued From page 7 4 149

 

5. Facility will encourage residents
and families to utilize our facility 4/11/16
grievance program and use the 
program to investigate and ongoing
resolve issues to resident and
family satisfaction whenever

 

 

possible.

6. The facility will address and 4/11/16
respond to the grievance 
submitted in a timely manner, ongoing

considering all party?s rights,
comfort and care.

 

  

 

 

 

 

 

 

 

 

Office of Health Care Assurance 

STATE FORM ?99 ll continuation sheet 8 of 31

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: BUILDING COMPLETED
'3;va :2 T.) 
125041 B. WING 03/18l2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE. ZIP CODE
1814 LILIHA STREET
HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) ID  SUMMARY STATEMENT OF DEFICIENCIES PLAN OF CORRECTION (X5)
PREFIX  (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG . REGULATORY OR IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 149g Continued From page 8 4 149

4 159 Storage and Handling of Food

Corrective actions Taken

1. Maintenance staff fixed the ?oor
tiles in the dishwashing room. Floor
and wall tiles was scrubbed well to 3/25/16
remove any mildew and dust.

 

 

2. Broken water spray nozzle was 3/21/16
replaced.

3. Nursing staff checked expiration
dates of other food and drink in the 3/18/16
refrigerator. Expired Greek yogurt
found in the refrigerator was
discarded.

 

 

4 159i 11-94.1-41 Storage and handling of food 4159

All food shall be procured, stored, prepared,
distributed, and served under sanitary conditions.

 

 

 

 

 

 

 

i
Office of Health Care Assurance
STATE FORM 599' 5RDK11 "continuation sheet 9 0131

Hawaii Dept. of Health, Office of Health Care Aesuranc

PHWTED: 04/01/2016

 

or (x1; PROVIDERISUPPUERIGLLA
AND PLAN OF connecnoru IDENTIFICATION NUMBER:
rearranges 
125941

 

 

 

 

 

FORM APPROVED
(X2) MULTIPLE co nsrnuonou {x3} DATE SURVEY
A. COMPLETED
a. 0311812015

 

NAME OF PROVIDER OR 

HEALTHCARE CENTER

STREEF ADDRESS, CETY. STATE. CODE

1814 

HONOLULU, HI 9681?

 

OF CORRECT ZON

 

 

 

 

 

 

 

(x4) [0 SUMMARY STATEMENT OF in 
PREHX (anon MUST BE av FULL pnggix (EACH ACTION SHOULD es comm:
TAG neceuvrcev on [.30 TAG TO THE APPROPRIATE DAVE
oeecrencv)
4 159 Continued From page 9 4159
identi?cation of other residents
(1) Dry or staple food items shall be stored Affected:
above the floor in a ventiiated room not subject 
to seepage or wastewater backtlow,.or res?dents can be a?ec?te?j-
i contamination by condensation, leakages,
rodents, or vermin; and System Change to Ensure De?cient
. Practice will not recur.
(2) Perishable foods shall be stored at the
proper temperatures to conserve nutritive value . .
and prevent Spo?age' l. Refrigerator Check log was reVIsed
to Include checkIng the 4/1/16
temperature, cleaning and
This Statute is not met as evidenced by: checking expiry dates of food items
Based on observation and staff interview, the stored.
facility failed to provide sanitary conditions for the
dishwashing area and storage area for cooking -
utensils and drinking jugs in the kitchen. The 2' ?231: ezazturrf?lfghe Lafigzratodr 4/1/16
facility also failed to eater procure food in EC 8 an 
resident snack refrigerator. recorde?j tw'ce a day' ongoing
Findings include: 3. Night shift nursing staff will check 4/1/16
. . . expiry dates of food and clean the 
Observance on 3/1 all/.2016 of the dishwashIng refrigerator daigy. Write comments 
area noted a broken his area was With and the to Oligomg
cement dust and tile dust accumulating. A hose g'
like tap hanging on a hook beside a sink was
leaking onto the floor. Water was accumulating in
the broken tile area. The entire floor area was wet 4. All food and drinks will be labeled 4/1/16
from the leaking tap. Beside the broken tile area indicating the date opened or 
was a shelved alcove area that stored cooking expiration dam 
utensils and drinking jugs. Ongomg
Inspection of the residents? refrigerator on the 2nd I 
fioor nursing unit found it contained a Greek 5- and '5 300? for 3 days
yogurt with an expiration date of Jan 30 2016- from date it was opened except for 4/1/16
These findings in the kitchen dishwashth area milk which is 24 hours. All expired 
and expired yogurt were confirmed by the kitchen unlabeied food will be discarded .
manager and staff during the observations - - Ongomg
Immediately.
Office of Health Care Assurance
SYATE FORM ?95 5RDK11 "continuation sheet toofG'l

 

a 3633?s? 

Completion Date
Continuation of 4 159 Storage and Handfing of Food

6. Dietary staff wilE clean the kitchen and dishwashing room floor daily. Will report 4/1/16 ongoing
broken equipment to maintenance staff to have it ?xed or replaced immediately.

7. General cleaning of the unit will be done at least every month. 4/29/16 ongoing

Monitoring System Change to Ensure De?cient Practice will not recur:

1. Dietary manager or designee wili check the refrigerators in the unit every 4/1/16 ongoing
morning to make sure it is clean and food items are not expired. Result of the
audit will be reported to QAPI committee for furthe:r action.

2. Day shift nursing staff wili also check the refrigerator making sure nothing is 4/1/16 ongoing
overlooked.
3. Dietary manager and maintenance supervisor or designees will conduct their 4/15/16 ongoing

environmental rounds daily and report their ?ndings to QAPI committee.

Page 10 A of 31

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health, Office Of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING, COMPLETED
AIR  9-.- 55;
125041 e. WING 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET CITY, STATE, ZIP CODE
1814 LILIHA STREET
HEALTHCARE CENTER
HONOLULU, HI 9681?
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIEs ID PROVIDERS PLAN OF CORRECTION (st
(EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
me, 5 REGULATORY OR IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE
1 DEFICIENCY)

4 184% Continued From page 10 4 184 4 184 Pharmaceutical Services

4 184- Pharmaceutical services 4184
Corrective actions Taken:
i Each facility shall employ a licensed
i pharmacist, or shall have a written contractual 1. Attending physician reviewed the
arrangement with a licensed pharmacist, to - of resident #63-
provide consultation on methods and procedures nd ordered to reduce
for ordering, storing, administering. disposing,
and recordkeeping of drugs and biologicals, and
provisions for emergency service.
2. Diagnosis/indication for use of

This Statute is not met as evidenced by: 3/30/16
Based on record review and interview with staff was remewe Wu yglCian;

members, the facility failed to ensure 1 (Resident same is now Clearly documented
#63) of 5 sampled residents has adequate on the medical record
indication for the use of medications. 

   

3/15/16

 
 

 

 

3. Geri physician came for a
follow up visi_to
reassess appropriate use of
medications for resident
conditions.

Findings include:

 

2 3/30/16

 

4. Geri physician talked to
resrdent s?hout-Jlan to 3/30/16
reduce the medications that
resident is taking. Risk/bene?ts of
various treatment approaches
discussed-prefers to maintain
resident #63 on the current
dosage of existing set of
medications rather than use
larger doses

 

 

 

 

 

 

 

 

Office Of Health Care Assurance
STATE FORM 5RDK11 If continuation sheet 11 of 31

Hawaii Dept. of Health. Office of Health Care Assuranc

PRINTED: 04/01/2016
FORM APPROVED

 

STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

.. 

. . -
i M?w

 

(x1) 
IDENTIFICATION NUMBER:

125041

 

(X2) MULTIPLE 
A. BUILDING:

B. WING

 

 

 

(X3) DATE SURVEY
COMPLETED

03/18/2016

 

NAME OF PROVIDER OR SUPPLIER

LILIHA HEALTHCARE CENTER

STREET ADDRESS, CITY, STATE. ZIP CODE

1814 LILIHA STREET
HONOLULU, HI 96817

 

(x4) ID 
PREFIX I
TAG

SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)

ID
PREFIX
TAG

PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)

(X5)
COMPLETE
DATE

 

4184

 

 

 

Office of Health Care Assurance
STATE FORM

Continued From page 11

 

 

4184

 

 

Identification of other residents
Affected:

l.

medications will be reviewed by
facility, and pharmacy consultant.
RCA is used to identify causes of
behavior and corresponding
effective interventions. Missing
elements (appropriate diagnosis/
indication, status of appropriate
dose reduction, non-pharm
approaches) will be evaluated and
changes made where needed.

System Change to Ensure De?cient
Practice will not Recur:

DON, ADON, Administrator and
Consultant met with licensed
nurses on 4/6/16. Reviewed with
them the components of correct
physician order.

Nurses were advised to always
clarify diagnosis when receiving
new orders and when doctors
come on-site for routine visits.

is auditing physician
orders to determine our
compliance. Result of the audit is
being reported to the QAPI
committee.

 

4/22/16

ongoing

4/6/16

4/6/16

4/7/16

ongoing

 

6899

5RDK11

ll continuation sheet 12 of 31

 

PRINTED: 04/01/2016

 

 

FORM APPROVED
Hawaii Dept. of Health. Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING COMPLETED
 90:22
125041 a. WING 03/18/2016

 

 

 

 

 

NAME OF PROVIDER OR SUPPLIER

LILIHA HEALTHCARE CENTER

STREET ADDRESS. CITY. STATE. ZIP CODE

1814 LILIHA STREET
HONOLULU, HI 96817

 

 

 

 

This Statute is not met as evidenced by:

Based on observations and staff interviews, the

i; facility failed to ensure medications were not kept
beyond their expiration dates.

I

i Findings include:

 

  

I
3
I


 

 

 

 

 

 

(x4) ID SUMMARY STATEMENT OF DEFICIENCIES PLAN OF CORRECTION (X5)
(EACH DEFICIENCY MUST BE PRECEDED BY FULL pm;le (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY 0R LSC IDENTIFYING INFORMATION) TAG TO THE APPROPRIATE DATE
DEFICIENCY)
4184: Continued From a 12 4184 .
4. and Administrator
will review Physician Order Sheets 4/22/16
to make sure all medication 
orders have appropriate diagnosis 1 ongoing
orindication for use. 
Monitoring System Change to Ensure
Deficient Practice will not recur:
1. Licensed nurses are reviewing the
Physician Order Sheet before the 4/29/16
end of the month will include  
checking medication orders to ongoing
make sure there is a diagnosis or
indication for use.
2. Licensed nurses receiving
physician orders towards the end 4/29/16
. . of the month will transcribe the 
4197 Pharmaceutical serVIces 4197 . . 
orders on the current OngOIng
?5 Discontinued and outdated prescriptions and order Sheet and p05 for the
containers with worn. illegible, or missing labels following month.
shall be disposed of according to facility
policv- 3. will continue to 4/15/16

review physician orders to make 

sure compliance is maintained. ongoing
4. Consultant pharmacist will be
checking medications to assure 4/29/16

appropriate diagnosis or 
indication for use is in place and ongoing
will include it in her 
report.

 

 

Office of Health Care Assurance

STATE FOR



6899

SRDK11

It continuation sheet 13 of 31

 

PRINTED: 04/01/2016

 

 

 . FORM APPROVED
HawaII Dept. of Health, Office Of Health Care Assuranc
STATEMENT OF DEFICIENCIEs (X1) (x2) MULTIPLE CONSTRUCTION (xa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A COMPLETED
. 
-: :3 r?i 
125041 e. WING 03/18/2016

 

 

 

 

 

NAME OF PROVIDER OH SUPPLIER

STREET ADDRESS. CITY, STATE, ZIP CODE
1814 LILIHA STREET

 

 

 

precautions, and failing to thoroughly investigate
the outbreak of the gastrointestinal illness among
residents, which as a result, made for additional
residents to become ill with diarrhea/vomiting.
Additionally, the facility failed to maintain an
Infection Control Program designed to provide a
safe and sanitary environment and to help

 

 

 

facility?s Norovirus infection policy
and procedure.

 

 

LILIHA HEALTHCARE ENT
ER HONOLULU, HI 96817
(x4) Io  SUMMARY STATEMENT OF DEFICIENCIES Io PROVIDERS PLAN OF CORRECTION (x5)
PREFIX  (EACH DEFICIENCY MUST BE PRECEOED BY FULL anHx (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
me, I REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENOED TO THE APPROPRIATE DATE
i DEFICIENCY)
4 197 Continued From page 13 4197 4 197 Pharmaceutical Services
1. Nursing staff checked the
medication storage room on both 3/18/16
?oors. Expiration dates of
medications and supplies were
checked
2. Expired medications were
discarded in accordance with 3/18/16
facility policy on Destruction of
Medications.
CONTINUED ON NEXT PAGE
4 203[ Infection control 4 203
There shall be appropriate policies and 
procedures written and implemented for the 4 203 '?femm c?ntr?l
prevention and control Of infectious diseases
that shall be in compliance with all applicable Corrective Actions Taken:
laws of the State and rules Of the department
relating to infectious diseases and infectious 1_ Second ?oor was placed on
waste' appropriate lockdown/isolation 3/16/16
status as soon as nurse received 
. . on om
This Statute is not met as eVIdenced by the pos't?Ve lab resu'ts- 
5 Based on observations, record reviews and
interviews, the facility failed to protect a high 2. Infection Control consultant came
number of residents from gastrointestinal illness to the facility and reviewed the
by failing to practice transmission based 3/ 17/16

 

Office of Health Care AsSurance
STATE FORM

?899

5RDK11

if continuation sheet 14 0131

 

Continuation of 4 197 Pharmaceuticai Services

Identi?cation of other residents Affected:

All residents have to potential to be affected.

System Change to Ensure De?cient Practice wiil not recur:

1.

DON, ADON, Administrator and Consuitant met with the licensed
nurses on 4/6/16. Reviewed the revised policy and procedure on
discontinued and expired medications and destroying medications.

it was made clear to all licensed nurses that multi?use vials must be
dated upon opening. This will be discarded after 30 days from the
date it was opened.

Expired medication log was revised to include the ?ndings and be
signed by the nurse.

All nurses receiving orders to discontinue medication must update
the and POS, document on the progress notes and remove the
discontinued medications from the med cart.

Night shift licensed nurse will continue to check the medication room
every Friday for expired medications, treatments and IV ?uids.

Discontinued medications will be separated and placed in a box for
disposai and will be prepared for disposai according to facility poiicy.

Expired medications will be disposed of according to policy.
Copy of the policy on expired medications and disposal of

medications is placed on the nursing communication binder for
everyone to review.

Monitoring System Change to Ensure De?cient Practice will not recur:

1.

DON will conduct audit of the medication room and med-carts,
report findings during our weekly meetings.

Administrator wili do random check of medication of the medication
carts and med room. Findings will be discussed with the 
committee.

Consuitant pharmacist will aiso conduct audits and include
her ?ndings on the pharmacy report.

DATE

4/6/16

4/6/16
ongoing

4/1/16

4/7/16

4/1/16 ongoing

4/1/16 ongoing
4/1/16 ongoing
4/8/16

4/8/16 ongoing

4/11/16 ongoing

4/29/16 ongoing

Page 14 A of 31

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM APPROVED

Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (xa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDWG: COMPLETED
- 

125041 a. 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY. STATE. ZIP CODE

1814 LILIHA STREET

LILIHA HEALTHCARE CENTER HONOLULU, Hi 9681?

(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
PREFIX DEFICIENCY MUST BE PRECEDED BY FULL pREle (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG - REGULATORY OR IDENTIFYING INFORMATION) TAG CROSS-REFERENCED To THE APPROPRIATE DATE

DEFICIENCY) 
4 203 Continued From page 14 4 203

. prevent the development and transmission of 3_ Isolation signage on the door was 
. disease and InfeCtIon. Changed with more Speci?c 3/17/15
. . . instruction.
FIndIngs Include:
4. were placed outside the door
of each room on isolation to be . 3/17/16
used by everyone entering the
room.
5. Nursing staff prevented family
members from visitin the
. . 3/17/16
reSIdents temporarily. NO new
admissions were accepted on the
second ?oor while unit is on
lockdown.
6. Direct care staff worked onl on
. . 3/18/16
the UM that they are aSSIgned,
. . 
staff workIng on 2 mm was not .
allowed. ongomg
7. All staff was advised to wash hands
. . 3/18/16
With soap and water and 
using alcohol based hand sanitizers. 
ongomg
i


 

 

 

 

 

 

 

Office of Health Care Assurance
STATE FORM ?99 5RDK11 ll continuation sheet 15 of 31

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 04/01/2016

 

STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

-r 'v   
4' 

 

(X1) 
IDENTIFICATION NUMBER:

125041

 

 

FORM APPROVED
(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
A. BUILDING: COMPLETED
3 Wm 03/18/2016

 

 

 

NAME OF PROVIDER OR SUPPLIER

LILIHA HEALTHCARE CENTER

STREET ADDRESS. CITY. STATE, ZIP CODE

1814 LILIHA STREET

HONOLULU, HI 9681 7

 

ID
PREFIX
TAG

SUMMARY STATEMENT OF DEFICIENCIES 
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)

ID
PREFIX
TAG

PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
TO THE APPROPRIATE
DEFICIENCY)

(XS)
CO PLET 
DATE

 

4 203

 

 

 

Of?ce of Health Care Assurance
STATE FORM

Continued From page 15

 

4 203

 

8. Bleach solution diluted according
to recommendation and
SaniBIeach wipes was used for
disinfecting equipment, bathroom
and ?oors.

9. Frequent cleaning of the
bathrooms and ?oor was done.

10. All residents in the unit remained
in the unit. Affected residents
were maintained on isolation
precaution in their rooms until
after 72 hours of the last


. Facility hired Pathway Health, a
group of consultants, to assist in
putting us back into compliance.

12. DON talked to the therapists and
advised them to always ask
nursing staff of the current
situation of the residents they are
attending to.

13. DON talked to the attending
physician and asked him to
sanitize his hands and
stethoscope in between resident
examination

 

 

i

 

3/18/16

ongoing

3/18/16

i 3/18/16


ongoing

4/4/16

4/5/16

4/5/16

 

GEM

5RDK11

If continuation shoot 16 01 31

 

Hawaii Dept. of Health, Offic of Health Care Assuranc

PRINTED: 04/01/2016

 

STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

.-. ?1.x r.



 

(X1) 

IDENTIFICATION 

125041

 

FORM APPROVED
(X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
A. BUILDING:   COMPLETED
03/18/2016

 

 

 

NAME OF PROVIDER OR SUPPLIER

HEALTHCARE CENTER

STREET ADDRESS. CITY, STATE, ZIP CODE

1814 STREET
HONOLULU, HI 96817

 

 

PLAN OF CORRECTION

 

 

 

 

 

 

 

 

 

 

 

(x4) ID SUMMARY STATEMENT OF DEFICIENCIES .0 (st
anPIx (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY on Lee IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 16 4 203
- Identification Of Other Residents
Affected:
Without proper infection prevention,
all residents and staff exposed could
be affected.
System Change to Ensure De?cient
Practice does not recur:
1. lnfection Control Consultant
reviewed the facility?s infection
control policies and practices; - 3/22/15
gave recommendations for facility
to improve our infection
prevention.
2. Isolation signs were revised. it
shows speci?c instructions to
follow for different kinds of 4/1/16
isolation and infection.
5 3. Residents on isolation precautions .
will be con?ned in their rooms 4/1/16
until 72 hours passed after the 
last is observed. ongoing
4. In compliance with CDC guideline,
everyone entering an isolation 3/18/16
room must wear the 
recommended PPE. ongoing
Office of Health Care Assurance
STATE FORM 58? ll cominuatlon sheet 170131

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 04/01/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION ix3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING: COMPLETED
CI  
125041 5- 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY. STATE, ZIP CODE
1814 LILIHA STREET
HEALTHCARE CENTER HONOLULU, HI 9681?
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION  (XS)
FREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL pgepix (EACH CORRECTIVE ACTION SHOULD BE 3 COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY) 
4 203 Continued From page 17 4 203 i
5. Facility organized isolation carts
where isolation signage,
and disinfectant wipe or spray is 4/7/16
kept. This will be placed by the 8?
room entrance if isolation of a ongomg
resident is necessary.
6. Staff education on infection 
control speci?c to Outbreak 4/15/16
Management was given on
3/30/16. This will continue until 1 
all staff has completed this i
training. I
7. All staff was trained and gave a
return demonstration on how to 4/15/16
properly use PPE and
handwashing technique. i
8. Facility will purchase only EPA
health care grade PPE to provide 4/1/16
adequate protection of residents 
and staff. ongomg
Office of Health Care Assurance
STATE FORM 5RDK11 ll continuation sheet 18 oi 31

 

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 04/01/2016

FORM APPROVED

 

STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

?ht

. 
'inErch, 



 

(X1) 
IDENTIFICATION NUMBER:

125041

 

(X2) MULTIPLE CONSTRUCTION
A. BUILDING:

 

B. WING

 

 

(X3) DATE SURVEY
COMPLETED

03/18/2016

 

NAME OF PROVIDER OR SUPPLIER

LILIHA HEALTHCARE CENTER

STREET ADDRESS. CITY. STATE. ZIP CODE
1814 LILIHA STREET

HONOLULU, HI 96817

 

PLAN OF CORRECTION (X5)

 

 

 

 

 

 

 

 

 

. SUMMARY STATEMENT OF DEFICIENCIEs
3 (EACH DEFICIENCY MUST BE PRECEDED ev FULL (EACH CORRECTIVE ACTION SHOULD BE I COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DAIF
I DEFICIENCY) I
.
I
4 2035 Continued From page 18 4 203

9. Medical Director sent a letter to
. . . 4/15/16
all attendIng phySICIans and I
reminding them of 
infection control and antibiotic i
stewardship.
10. Nursing staff will advise therapists 4/1/16
 and consultants what they are 
I supposed tO do if the resident .
. . 3 ongOIng
they are gomg to see IS currently I
on isolation.
11. Department heads are doing an
audit on infection control focusin
. . . 4/8/16
on hand sanItatIon In between
. . . . 
care of re5Ident, sanItIZIng 
. . . ongOIng
eqUIpment, handlIng of SOIled or
potentially infected materials and
cleanliness Of the environment
using the audit tools provided by
Pathway Health consultants.
12. De artment heads and API
. . 4/11/16
commIttee are meetTng regularly
. . . . 
to dIscuss ?ndIngs and agree WIth .
. ongoing
a proper solution.
Office OI Health Care Assurance
STATE FORM ?859 5RDK11 sheet 190(31

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 04/01/2016
FORM APPROVED

 

 

 

 

 

 

 

 

 

 

 

Office of Health Care Assurance
STATE FORM

4 203] Continued From page 19

 

 

 

STATEMENT OF DEFICIENCIES (X1) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED
   
125041 3- 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1314 LILIHA STREET
A HEALTHCARE CENTER
HONOLULU, HI 9681?
0(4) ID I SUMMARY STATEMENT OF DEFICIENCIES PROVIDERS PLAN OF CORRECTION (X5)
pagpix (EACH DEFICIENCY MUST BE PRECEDED BY FULL anpIx (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY oR LSC IDENTIFYING INFORMATION) TAG  To THE APPROPRIATE DATE
DEFICIENCY)
I I
4 203 

Monitoring System Change to Ensure
De?cient Practice will not Recur:

1. As recommended, facility will
designate 1 staff to be an infection
Preventionist and in-Service
Coordinator that will provide
necessary training and follow up on
infection prevention
implementation.

2. Meantime, DON will continue to
function as interim infection
control coordinator with the
assistance of all department heads
and Pathway consultants.

3. Department heads will help in
implementing our infection control
policy and monitor employee
practices in the different
departments. Findings will be

- reported during our QAPI meetings
and agree with a solution following
acceptable standard of practice.

4. Will seek guidance of consultants
and Medical Director if any new
situation is encountered.

 

5/30/16

 

BY

4/18/16

ongoing

3/15/16

4/15/16

ongoing

 

 

539? 5RDK11

It continuatiOn sheet 20 0131

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health. Office of Health Care Assuranc
STATEMENT OF DEEICIENCIEs (x1) Ixz) MULTIPLE CONSTRUCTION Ixa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDWG, COMPLETED
 Z. 5?0 1,
125041 3- 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE, ZIP CODE
1814 LILIHA STREET
LILIHA HEALTHCARE CENTER 4
HONOLULU, HI 96817
(x4) [9  SUMMARY STATEMENT OF DEFICIENCIES Io PROVIDERS PLAN OF CORRECTION (st
pREle (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREHX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG  REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSSREPERENCED To THE APPROPRIATE DATE
i DEFICIENCY)
I
4 203i Continued From page 20 4 203

 

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Office of Health Care Assurance
STATE FORM 559? 5RDK11 It continuation sheet 21 0131

 

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

FORM APPROVED
Hawaii Dept. of Health; Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES 1x1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING, COMPLETED
3332? Fuji;
125041 8- - 03/18/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS, CITY. STATE. ZIP CODE
1814 LILIHA STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) .0  SUMMARY STATEMENT OF DEFICIENCIES In PLAN OF CORRECTION (X5)
PREFIX i (EACH DEFICIENCY MUST BE PRECEDED BY FULL pREle (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG  REGULATORY 0R LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
 DEFICIENCY)
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I
Office of Health Care Assurance
STATE FORM 5RDK11 It cominuation sheeI 22 0131

 

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FORM APPROVED

Hawaii Dept. of Health, Office of Health Care Assuranc

STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY

AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDWG: COMPLETED

 2.2M I) It}. 
125041 B. WING 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY, STATE. ZIP CODE
1814 LILIHA STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) (9 SUMMARY STATEMENT OF DEFICIENCIES Io PLAN OF CORRECTION (x5)
(EACH DEFICIENCY MUST BE PRECEDED BY FULL I (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 22 4 203
KEPT INTE NTI NALLY 8 LAN 
I
I
I
Of?ce of Health Care Assurance
STATE FORM 6999 SRDK11 Hcon?nua?on sheet 23 of 31

 

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

. FORM APPROVED
Hawaii Dept. of Health, Of?ce of Health Care Assuranc
STATEMENT OF DEPICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDNG, COMPLETED
.- if.     
125041 8- 03/18/2016
NAME OF PROVIDER 0R SUPPLIER STREET ADDRESS. CITY, STATE. ZIP CODE
1814 STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) 10 SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (X5)
(EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) m3 CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 23 4 203

 

 

 

 

 

STATE FORM

Office of He?lth Care ASS-Urance

 

 

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6899

5RDK11

l1 continuation sheet 24 of 31

Hawaii Dept. of Health. Office of Health Care Assuranc

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FORM APPROVED

 

 

 

 

 

 

 

 

 

I


 

 

 

Of?ce of He?lth Care Assurance
STATE FORM

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STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDWG, COMPLETED
.2291  
1 25041 B. WING 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CTTY, STATE, ZIP CODE
1814 LILIHA STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
W) .D I SUMMARY STATEMENT OF DEFICIENCIEs ID PROVIDERS PLAN OF CORRECTION (st
PREFIX 1 (EACH DEFICIENCY MUST BE PRECEDED BY FULL paEFIx (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG I REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
. DEFICIENCY)
4 203? Continued From page 24 4 203

 

53? 

If continuation sheet 25 of 31

 

PRINTED: 04/01/2016

 

 

 

 

 

 

 

 

 

I FORM APPROVED
Hawaii Dept. of Health; Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (xa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING, COMPLETED
 :2 3 =30 
125041 5- 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY, STATE. ZIP CODE
1 814 LILIHA STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) I SUMMARY STATEMENT OF DEFICIENCIES (o PROVIDERS PLAN OF CORRECTION (X5)
pagmx (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
4 203 Continued From page 25 4 203

 

 

 

 

 

 

 

 

 

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Office of Heelth Care Assurance
STATE FORM

53? 5RDK11

II continuation sheet 26 at 31

Hawaii Dept. of Health, Office of Health Care Assuranc

PRINTED: 04/01/2016
FORM APPROVED

 

STATEMENT OF DEFICI ENCIES

 

(X1) 

 

(X2) MULTIPLE CONSTRUCTION

(X3) DATE SURVEY

 

 

 

 

 

 

 

 

4 203 Continued From page 26

 

 

 

AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUWNG: COMPLETED
23-;  
125041 B. WING 03/18/201 6
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE, ZIP CODE
1 814 LILIHA STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) ID 1 SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OP CORRECTION 5 (X5)
anFIx (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREHX (EACH CORRECTIVE ACTION SHOULD BE . COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 203

 

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Office of Health Care Assurance
STATE FORM

6599

SROK11

ii continuation sheet 27 0131

PRINTED: 04/01/2016

 

 

FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDWG. COMPLETED
  '1 :2
125041 8- 03/18/2016

 

 

 

 

 

NAME OF PROVIDER OR SUPPLIER

LILIHA HEALTHCARE CENTER

STREET ADDRESS. CITYI STATE, ZIP CODE

1814 LILIHA STREET
HONOLULU, HI 96817

 

 

4 203; Continued From page 27

 

 

 

 

 

 

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(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PLAN OF CORRECTION (X5)
PREHX (EACH DEFICIENCY MUST BE PRECEDED BY FULL I PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) I TAG CROSS-REFERENCED TO THE APPROPRIATE DATE

DEFICIENCY)
4 203

 

O?lce of Health Care Assurance
STATE FORM

0599

5RDK11

If sheet 28 of 31

 

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- FORM APPROVED
Hawaii Dept. of Health, Office of Health Care Assuranc .
STATEMENT OF DEFICIENCIES (X1) (X2) MULTIPLE CONSTRUCTION (x3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION A BUILDING, COMPLETED
 EH. 5 E23- 
1 25041 8. WING 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY. STATE, ZIP CODE
1814 LILIHA STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
(X4) ID 3 SUMMARY STATEMENT OF DEFICIENCIES Io PLAN OF CORRECTION (x5)
PREFIX - (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREHX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG I REGULATORY OR LSC IDENTIFYING INFORMATION) TAG TO THE APPROPRIATE DATE
1 DEFICIENCY)
4 203 Continued From page 28 4 203

 

 

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Office of Health Care Assurance
STATE FORM 65? 5RDK11 If continuation sheet 29 of 31

 

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Hawaii Dept. of Health, Office of Health Care Assuranc
STATEMENT OF DEFICIENCIES (x1) (x2) MULTIPLE CONSTRUCTION (xa) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION BUILDING: COMPLETED
 if;  5-3 7.3 19-1735;
125041 B. WING 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY. STATE. ZIP CODE
. 1814 LILIHA STREET
NTER
LILIHA HEALTHCARE CE HONOLULU, HI 96817
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDERS PLAN OF CORRECTION (x5)
pagmx (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 29 4 203
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Office of Haaith Care Assurance
STATE FORM ?99 5RDK11 continuation sheet SO 01 31

 

Hawa?ii Dept. of Health, Office of Health Care Assuranc

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STATEMENT OF DEFICIENCIES (X1) (x2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A BUILDING, COMPLETED
i i? 
125041 8- 03/18/2016
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY, STATE. ZIP CODE
1814 LILIHA STREET
LILIHA HEALTHCARE CENTER
HONOLULU, HI 96817
(x4) .0 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER-s PLAN OF CORRECTION (x5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSSREFERENCEO To THE APPROPRIATE DATE
DEFICIENCY)
4 203 Continued From page 30 4 203

 

 

 

I
Office Of Health Care Assurance
STATE FORM

?899

5RDK11

If continuation sheet 31 of 31

 

EXHIBIT 0

 

ORIGINAL 

DOUGLAS S. CHIN 6465
Attorney General of Hawaii
HEIDI M. RIAN 3473
ANGELA A. TOKUDA 9408
Department of the Attorney
General, State of Hawai?i
465 South King Street, Room 200
Honolulu, Hawai?i 96813
Telephone: (808) 587?3050

Attorneys for Defendant

DIRECTOR OF THE DEPARTMENT
OF HEALTH, STATE OF HAWAII

IN THE CIRCUIT COURT OF THE FIRST COURT

KOKUA COUNCIL FOR SENIOR
CITIZENS, an unincorporated association,

Plaintiff,

VS.

DIRECTOR OF THE DEPARTMENT
OF HEALTH, STATE OF HAWAII,

Defendant.



 

STATE OF HAWAII

CIVIL NO. 16?1-1421?07 (KTN)

DIRECTOR OF THE DEPARTMENT
OF HEALTH, STATE OF 
RESPONSE TO PLAIN FIRST
REQUEST FOR ANSWERS TO
INTERROGATORIES AND REQUEST
FOR PRODUCTION OF DOCUMENTS

DIRECTOR OF THE DEPARTMENT OF HEALTH, STATE OF RESPONSE TO
FIRST REQUEST FOR ANSWERS TO INTERROGATORIES AND
REQUEST FOR PRODUCTION OF DOCUMENTS

Defendant Director of the Department of Health, State of Hawaii or

?Defendant?) by and through its attorneys, Douglas S. Chin, Attorney General of Hawaii, Heidi

M. Rian and Angela A. Tokuda, Deputy Attorneys General, hereby responds to Plaintiff

KOKUA COUNCIL FOR SENIOR First Request for Answers to Interrogatories and

Request for Production of Documents, dated August 22, 2016 (the ?Request?).

GENERAL RESPONSES AND OBJECTIONS

1. Defendant objects to each request to the extent that it is unreasonably
burdensome, oppressive, harassing, redundant, duplicative, or vexatious, in that the information
requested would be of little or no relevance to the issues in this action and/or would place an
unreasonable and oppressive burden on the Defendant in expenditure of cost, time and money.

2. Defendant objects to each request that is so broad, vague, ambiguous, uncertain
and unintelligible that the Defendant cannot determine the nature of the information sought, and
to which the Defendant is therefore unable to respond.

3. Defendant objects to each request that seeks information already available and
accessible to the public such that the information requested is meant to unduly burden and harass
Defendant.

4. Defendant objects to each request to the extent that it requests the production of
documents for which the required good cause or substantial need, as dictated by applicable
statutes, court rules and case law, has not been shown.

5. Defendant objects to each request that requests irrelevant information not
calculated to lead to the discovery of admissible evidence.

6. Defendant objects to Plaintiff?s request for tariffs, promissory notes, deeds, leases,
agreements of sale, mortgages, financial statements, balance sheets, pro?t and loss statements,
tax returns, loan applications, work papers, ledgers, journals, books of accounts, canceled
checks, deposit receipts, statements, bills, airbills, consignment notes, purchase orders, invoices,
and any other related financial documents as de?ned in section of the De?nitions section.
No such documents will be produced because they are not relevant to any claims or defenses

raised, and they are sought simply to overburden and harass Defendant.

'2

7. Defendant objects to each request to the extent that it asks for the disclosure of
attorney-client privileged communications, information that is protected attorney work product,
and information concerning documents and tangible things prepared in anticipation of litigation
or trial.

8. Counsel?s signature below is incorporated into each and every one of Defendant?s
speci?c objections. Without waiving any of the foregoing general objections, which the
Defendant incorporates by reference in response and/or objection to each of the following

individual requests as if fully set forth therein, the Defendant responds as follows.

DATED: Honolulu, Hawaii, September 15, 2016.

an, an

M. RIAN
ANGELA A. TOKUDA
Deputy Attorneys General

 

Attorneys for Defendant
DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAII

INTERROGATORIES

1. For each "adult residential care home" and enhanced "adult residential care home"
licensed on or since January 1, 2015 please:

A. identify its name

B. identify the name of the licensee (whether a person, group of persons or entity)

C. identify whether its an Type 1 ARCH, Type 2 ARCH, category 3 ARCH, Level 1 
ARCH or a Level 2 or some other category of ARCH or 

D. identify the dates of each and all inspections from January 1, 2015 to present

E. identify whether an inspection report or other writing about the inspection was created or
generated

F. identify its licensed capacity

G. identify the names of its staff, primary care givers, care givers, substitute care giver(s), case 
manager(s) and family members

H. identify whether it has been given any waivers including renewals of waivers

Objection:

Defendant objects to interrogatory to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attomey?client privilege.

Defendant objects to interrogatory on the grounds that it seeks information that are
irrelevant to this action and not reasonably calculated to lead to the discovery of admissible
evidence, and that it is overly broad and unduly burdensome.

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

Information on licensed adult residential care homes (ARCH) and expanded adult
residential care homes are available online via the Of?ce of Health Care Assurance
(OHCA) website at: 
As to staf?ng information, OHCA only
maintains information on the applicant, pursuant to HAR ll?lOO. 1.

Inspections for ARCHs and are only conducted annually for license renewals.
E, HAR 11-100. 1 -3 (6). Thus, inspection reports are generated only for license renewals.
These inspection reports are available online Via website at:


2. For each "adult day health centers" licensed on or since January 1, 2015 please:

A. identify its name

B. identify the name of the "licensee" (whether an individual or organization)

C. identify the dates of each and all inspections from January 1, 2015 to present

D. identify whether an inspection report or other writing about the inspection was created or
generated

E. identify the names of its "activity coordinator" and "administrator"

F. identify whether it has been given any waivers including renewals of waivers

Objection:

Defendant objects to interrogatory to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.

However, Without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

Information on licensed adult day health centers (ADHC), is available online Via
website at: 

Inspections for ADHCS are only conducted annually for license renewals. E, HAR 11-
96-3. Thus, inspection reports are generated only for license renewals. These inspection reports
are available online via website at: 

3. For each "intermediate care facilities for individuals with intellectual disabilities" licensed
on or since January 1, 2015 please:

A. identify its name I
B. identify the name of the "licensee" (including the name f0 each person having, directly or

indirectly, an ownership interest of ten percent or more in such facility or who is the owner of an
mortgage, deed or trust, note or other obligation secured by such facility

C. identify the dates of each and all inspections from January 1, 2015 to present

D. identify whether its a small intermediate care facility for the mentally retarded or large
intermediate care facility for the mentally retarded

E. identify the dates of each and all inspections from january 1, 2015 to present

F. identify whether an inspection report or other writing about the inspection was created or

generated
G. identify whether it has been given any waivers including renewals of waivers

Objection:

Defendant objects to interrogatory t0 the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

Information on licensed intermediate care facilities for individuals with intellectual
disabilities is available online via website at:

intellectual-disabilities/

Inspections for ICF-IIDS are only conducted annually for license renewals. 533;, HAR
11-99-3. Thus, inspection reports are generated only for license renewals. These inspection
reports are available online via website at: 
reports.

4. For each "adult day care centers" licensed on or since January 1, 2015 please:

A. identify its name

B. identify the name of the "licensee" (whether an individual or organization)

C. identify the dates of each and all inspections from January 1, 2015 to present

D. identify whether an inspection report or other writing about the inspection was created or

generated
E. identify whether it has been given any waivers including renewals of waivers

Objection:

Defendant objects to interrogatory to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney?client privilege.

However, without waiving the forgoing objections, Defendant responds as follows: 

ANSWER:

Information on licensed adult day care centers (ADCC), is available online via 
website at: gov/ohca/?les/201 6/ 02/ 0 1 201 6-ADCC-List.pdf.

Inspections for ADCCS are only conducted biannually for license renewals. gee, HAR
??17-1424-6 and -8. Thus, inspection reports are generated only for license renewals. These
inspection reports are available online via website at:
://health.hawaii. gov/ohca/inSpection-reports/ .

5. For each care foster family" licensed on or since January 1, 2015 please:

A. identify its name

B. identify the name of the "licensee" (whether an individual or organization)

C. identify the dates of each and all inspections from January 1, 2015 to present

D. identify whether an inspection report or other writing about the inspection was created or

generated
E. identify whether it has been given any waivers including renewals of waivers

Objection:

Defendant objects to interrogatory to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.

7

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

Community care foster family homes are certi?ed, not licensed. Information
on certi?ed is available online via website at:
://health.hawaii . gov/ohca/?les/20 1 3/ 06/ Community-Care-Fo ster-Family?Homes-Vacancy-
Report-6.1.16.pdf

Inspections for are only conducted annually or biannually for re?certi?cation,
depending on whether the is certi?ed for one or two years. E, HAR ??17el454-9 and
-l 1. Thus, inspection reports are generated only for re?certi?cations. These inspection reports
are available online via website at: 

6. For each "developmental disabilities domiciliary home" licensed on or since January 1,
2015 please:

A. identify its name

B. identify the name of the "licensee" (whether an individual or organization)

C. identify the dates of each and all inspections from January 1, 2015 to present .

D. identify whether an inspection report or other writing about the inspection was created or
generated

E. identify whether it has been given any waivers including r?newals of waivers

Objection:

Defendant objects to interrogatory to the extent it seeks information protected by
the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attomey?client privilege. 

However, without waiving the forgoing objections, Defendant responds as follows:

M133:

Information on licensed developmentally disabled domiciliary homes is
available online Via website at: http://healthhawaii. gov/ohca/?les/2016/ 
Hawaiipdf

Inspections for are only conducted annually for license renewals. See, HAR
?11-89-l 1. Thus, inspection reports are generated only for license renewals. These inspection
reports are available online via website at: 
reports/

7. For each "long term care facility" other than "adult residential care home" and enhanced
"adult residential care home" subject to Interrogatory No. 1 licensed on or since January 1, 2015
please:

A. identify its name

B. identify the name of the "licensee" (whether an individual or organiZation)

C. identify the dates of each and all inspections from January 1, 2015 to present

D. identify whether an inspection report or other writing about the inspection was created or
generated

E. identify whether it has been given any waivers including renewals of waivers

Objection:

Defendant objects to this interrogatory in its entirety as vague, ambiguous, redundant,
overbroad, and unduly burdensome.

Defendant further objects to interrogatory to the extent it seeks information
protected by the work product doctrine, governmental deliberative process privilege, frustration
of a legitimate government function, or the attorney?client privilege.

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

Information on licensed long term care facilities other than ARCHs and as
defined in Haw. Rev. Stat. are available online via website


Inspections for licensed long term care facilities other than ARCHs and as
de?ned in Haw. Rev. Stat. are only conducted annually or biannually for license
renewals, depending on whether these long term care facilities are licensed for one or two years.
SQ, HAR ?l 1?90-3 (for Assisted Living Facilities); HAR ?l (for Nursing Facilities -
Skilled Nursing Facilities/ Intermediate Care Facilities). Thus, inspection reports are generated
only for license renewals. These inspection reports are available online via website at:


8. Please state the annual compensation, job title, business address including of?ce number,
business telephone number, job description, education and training background, previous work
experience, dates of ?rst and last employment, position number, type of appointment, service
computation date, occupational group or class code, bargaining unit code (if any), employing agency
name and code, department, division, branch, of?ce, section, unit, and island of employment of

Keith Ridley.

Objection:

Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is vague,
overbroad and unduly burdensome. The request is also compound and should be broken into
subparts.

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

See Employee Personnel Action(s) Report for Keith Ridley in the enclosed CD.

9. Please state the name, the annual compensation (but only the salary range for employees
covered by or included in chapter 76, or bargaining unit job title, business address including
of?ce number, business telephone number, job description, education and training background,
previous work experience, dates of ?rst and last employment, position number, type of
appointment, service computation date, occupational group or class code, bargaining unit code (if
any), employing agency name and code, department, division, branch, office, section, unit, and island
of employment of each and every individual that has generated or assisting in generating an
inspection report for any adult residental care homes, expanded adult residential care homes, adult
day health centers, adult date care centers, community care foster family homes, developmental
disabilities domiciliary homes, developmentally disabled adult foster homes, other long-term care
facilities, or special treatment facilities from January 1, 2015 to present.

Objection:

Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reaSOnably calculated to lead to the discovery of admissible evidence, and that it is vague,
overbroad and unduly burdensome. The request is also compound and should be broken into
subparts. Defendant further objects on grounds that it does not maintain such records and in
doing so would require Defendant to create a roster of employees. Haw. Rev. Stat. 92F-
12(a)(14).

10

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

All responsive, non?privileged documents are included in the enclosed CD.

10. Please state the name, job title, business address including of?ce number, business
telephone number, job description, education and training background, previous work experience,
dates of ?rst and last employment, position number, type of appointment, service computation
date, occupational group or class code, bargaining unit code (if any), employing agency name and
code, department, division, branch, of?ce, section, unit, and island of employment of each and
every individual that has been involved in posting inspection report for any adult residential care
homes, expanded adult residential care homes, adult day health centers, adult date care centers,
community care foster family homes, developmental disabilities domiciliary homes, developmentally
disabled adult foster homes, other long-term care facilities, or special treatment facilities from
January 1, 2015 to present to the Department of Health website.

Objection:

Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is
redundant, vague, overbroad and unduly burdensome. The request is also compound and should
be broken into subparts. Defendant further objects on grounds that it does not maintain such
records and in doing so would require Defendant to create a roster of employees. Haw. Rev.
Stat. 

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

See response to Interrogatory 9.

ll

11. Please state the name, job title, business address including of?ce number, business
telephone number, job description, education and training background, previous work experience,
dates of ?rst and last employment, position number, type of appointment, service computation
date, occupational group or class code, bargaining unit code (if any), employing agency name and
code, department, division, branch, of?ce, section, unit, and island of employment of each and
every individual that has been involved in the inspection of or the creation of inspection reports for
any adult residential care homes, expanded adult residential care homes, adult day health centers,
adult date care centers, community care foster family homes, developmental disabilities domiciliary
homes, developmentally disabled adult foster homes, other long-term care facilities, or special
treatment facilities from January 1, 2015 to present to the Department of Health website.

Objection:

Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is
redundant, vague, overbroad and unduly burdensome. The request is also compound and should
be broken into subparts. Defendant further objects on grounds that it does not maintain such
records and in doing so would require Defendant to create a roster of employees. E, Haw. Rev.

Stat. 
However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

See response to Interrogatory 9.

12. Please identify each and every computer and imaging device used by the Department in
the creating and/ or posting of inspection reports from January 1, 2015 to present including its
make, model, serial number, central processing unit speed measured in one hundred of one
gigahertz (for every computer and/ or device that has a central processing unit), amount of random
access memory measured in gigabytes (for every computer and/ or device that has random access
memory), and operating system including version number (for every computer and/ or device that

executes an operating system).
Objection:

Defendant objects to this interrogatory in its entirety as it is irrelevant to this action and
not reasonably calculated to lead to the discovery of admissible evidence, and that it is vague,
overbroad and unduly burdensome. Defendant further objects on the basis that this request seeks
information outside of its knowledge, and is more appropriately sought from other sources.

12

13. Please identify the name and title of each person who participated in providing
answers to these interrogatories.

Keith Ridley
Chief, Of?ce of Health Care Assurance

Sharon Dellinger, RN, MPA
Supervisor, Licensing Section, Of?ce of Health Care Assurance

Veronica Mitchell, RN
Supervisor, Medicare Section, Of?ce of Health Care Assurance

Shauna Kim 
Secretary, Of?ce of Health Care Assurance

Angel England, RN 

Supervisor, Community Ties of America (CTA)

(CTA is contracted to perform inspections and generate inspection reports for 
and ADCCs)

13

RE UESTS

1. Any documents identi?ed in answers to Interrogatories Nos. 1 through 13.

Objection:

Defendant objects to this request in its entirety to the extent it seeks production of
documents protected by the work product doctrine, governmental deliberative process privilege,
frustration of a legitimate government function, or the attorney?client privilege. Such documents
include notes, and drafts of Defendant?s staff, including, but not limited to, interview
memoranda, status memoranda, and recommendation memoranda.

Defendant further objects to this request in its entirety the grounds that it calls for the

production of documents that are irrelevant to this action and not reasonably calculated to lead to
the discovery of admissible evidence, and that it is redundant, vague, ambiguous, overly broad
and unduly burdensome. -



Defendant further objects to this request in its entirety in that seeks information already
available and accessible to the public via website and the request is meant to unduly
burden and harass Defendant.

As to requests for documents for interrogatories numbers 9 through 11, Defendant further
objects on grounds that it does not maintain such records and in doing so would require 
Defendant to create a roster of employees. E, Haw. Rev. Stat. 

As to request for documents for interrogatory number 12, Defendant further objects on
the basis that this request seeks information outside of its knowledge, and is more appropriately
sought from other sources.

However, without waiving the forgoing objections, and in the spirit of discovery and
Cooperation, Defendant responds as follows:

ANSWER:

Information on licensed and certi?ed homes and facilities requested in interrogatories
numbers 1 through 7, are available online via the Of?ce of Health Care Assurance (OHCA)
website at: 

Inspection reports for licensed and certi?ed homes and facilities requested in
interrogatories numbers 1 through 7, are only conducted annually or biannually for license or
certi?cate renewals, depending on whether these homes and facilities are licensed or certi?ed
for one or? two years. These inspection reports are available online via website at:


l4

In addition, all responsive, non?privileged documents are included in the enclosed CD.

2. Any documents used to answer Interrogatories Nos. 1 through 13 but not
identi?ed in answers to Interrogatories Nos. 1 through 17.
See response to Request 1. In addition, Interrogatories Nos. 14 through 17 does not exist

in Plaintiff Request.

3. Any and all documents regarding any individual seeking to access any inspection
reports for any adult residential care homes, expanded adult residential care homes, adult day health
centers, adult date care centers, community care foster family homes, developmental disabilities
domiciliary homes, developmentally disabled adult foster homes, other long?term care facilities, or

special treatment facilities from January 1, 2015 to present.

Objection:

Defendant objects to this request in its entirety on the grounds that it calls for the
production of documents that is ambiguous, vague, overly broad and unduly burdensome.

Defendant further objects to this request to the extent it seeks production of documents
protected by the work product doctrine, governmental deliberative process privilege, frustration

of a legitimate government function, or the attorney-client privilege.

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

See response to Request 5.

15

4. Any and all documents regarding any individual seeking to access any inspection
reports for any adult residential care homes, expanded adult residential care homes, adult day health
centers, adult date care centers, community care foster family homes, developmental disabilities
domiciliary homes, developmentally disabled adult foster homes, other long-term care facilities, or

special treatment facilities before January 1, 2015.

Obiection:

Defendant objects to this request in its entirety the grounds that it calls for the production
of documents that is ambiguous, vague, overly broad and unduly burdensome.

Defendant further objects to this request to the extent it seeks production of documents
protected by the work product doctrine, governmental deliberative process privilege, frustration
of a legitimate government function, or the attomey-client privilege.

However, without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

See response to Request 5.

5. Any and all e?mails or other documents authored or received by Keith Ridley
regarding the posting of inspection reports for any adult residential care homes, expanded adult
residential care homes, adult day health centers, adult date care centers, community care foster family
homes, developmental disabilities domiciliary homes, developmentally disabled adult foster homes,

other long?term care facilities, or special treatment facilities.

Objection:

Defendant objects to this request to the extent it seeks production of documents protected
by the work product doctrine, governmental deliberative process privilege, frustration of a
legitimate government function, or the attorney-client privilege.

Defendant further objects to this request in its entirety the grounds that it calls for the
production of documents that is ambiguous, vague, overly broad and unduly burdensome.

l6

However, without waiving the forgoing objections, Defendant responds as follows:

I ANSWER:

All responsive, non-privileged documents are included in the enclosed CD.

6. Any and all inspection reports or any adult residential care homes, expanded adult
residential care homes, adult day health centers, adult date care centers, community care foster family
homes, developmental disabilities domiciliary homes, developmentally disabled adult foster homes,

other long-term care facilities, or special treatment facilities from january 1, 2015 to present.

Objection:

Defendant objects to this request in its entirety the grounds that it calls for the production
of documents that is ambiguous, vague, overly broad and unduly burdensome.

Defendant further objects to this request to the extent it seeks production of documents
protected by the work product doctrine, governmental deliberative process privilege, frustration
of a legitimate govermnent function, or the attomey?client privilege.

Defendant further objects to this request in its entirety in that seeks information already
available and accessible to the public via website and the request is meant to unduly
burden and harass Defendant.

However, Without waiving the forgoing objections, Defendant responds as follows:

ANSWER:

Inspection reports for licensed and certi?ed homes and facilities required under HRS
321?l.8, are only conducted annually or biannually for license or certi?cate renewals,
depending on whether these homes and facilities are licensed or certi?ed for one or two years.
These inspection reports are available online via website at:


In addition, all responsive, non-privileged documents are included in the enclosed CD.

17

DATED: Honolulu, Hawaii, September 15, 2016.

mu

HEIDI M. RIAN
ANGELA A. TOKUDA
Deputy Attorneys General

Attorneys for Defendant

DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAII

18

VERIFICATION

STATE or HAWAII 
ss.

CITY AND COUNTY OF HONOLULU 
On this 15th day of September 2016, before me personally appeared Keith Ridley, to me

known to be the person described in and who executed the forgoing answers to interrogatories,
and acknowledged that he executed the same as his free act and deed.



If

  
    

Subscribed and sworn to before me

this 173?" day of' 2016Wary Public ?5 Signature
2909 in: :3 Print Name:  M. 
0043?,? Notary Public, State of Hawaii
.0 ?0 09?
6?
?Wiggins? My commission expires: 5 20
Date of Doc.: September 15, 2016 Pages: I
Name: MICHELLE M. OHTA 1St Circuit

 

Doc. Description: DIRECTOR OF THE DEPARTMENT OF HEALTH,

STATE OF RESPONSE TO FIRST REQUESJ

FOR ANSWERS TO INTERROGATORIES AND REQUESTOFQBLE M,  
a a 






 

PRODUCTION OF DOCUMENTS . 45: . 
:o ..v?gvgjwarm?; 5
v/?l g? a: 9000,17? 
Notary Signature 7 Date $3 3

4 ?32? 
?#330

"9iup009?

NOTARY CERTIFICATION

 

 

 

IN THE CIRCUIT COURT OF FIRST CIRCUIT
STATE OF HAWAII
KOKUA COUNCIL FOR SENIOR
CITIZENS, an unincorporated association,
Plaintiff
vs.
DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAI'I,
Defendants.

) Civil No. 16-1-1421-07 KTN
) (Other Civil Action)
)
) NOTICE OF HEARING
)
)
)
)
)
)

NOTICE OF HEARING
TO:

Douglas Chin, Esq.
Heidi Rian, Esq.
Angela A. Tokuda, Esq.
465 S. King Street, Room 200
Honolulu HI 96813
Attorneys for Defendant
PLEASE TAKE NOTICE THAT Plaintiff's Motion for Summary Judgment shall come on

for hearing before the Honorable Karen T. Nakasone in her courtroom at Kauikeaouli Hale, 1111
Alakea Street, City and County of Honolulu, State of Hawai'i, on __________________________,
2017 at ____________ or as soon thereafter as counsel may be heard.
DATED:

Honolulu, Hawaii

December 21, 2016

________________________________
LAW OFFICEOF LANCE D COLLINS
LANCE D. COLLINS
Attorney for Plaintiff

18

 Law Office of Lance D. Collins
Lance D. Collins 8246
Post Office Box 179336
Honolulu, HI 96817
808.243.9292
IN THE CIRCUIT COURT OF FIRST CIRCUIT
STATE OF HAWAII
KOKUA COUNCIL FOR SENIOR
CITIZENS, an unincorporated association,
Plaintiff
vs.
DIRECTOR OF THE DEPARTMENT OF
HEALTH, STATE OF HAWAI'I,
Defendants.

) Civil No. 16-1-1421-07 KTN
) (Other Civil Action)
)
) CERTIFICATE OF SERVICE
)
)
)
)
)
)

CERTIFICATE OF SERVICE
The undersigned hereby certifies that on this date a copy of the foregoing was served upon
the following party at its last known addresses by hand-delivery or US mail postage prepaid as
follows:
Douglas Chin, Esq.
Heidi Rian, Esq.
Angela A. Tokuda, Esq.
465 S. King Street, Room 200
Honolulu HI 96813
Attorneys for Defendant
DATED:

Honolulu, Hawaii

December 21, 2016

________________________________
LAW OFFICEOF LANCE D COLLINS
LANCE D. COLLINS
Attorney for Plaintiff

19