Hale Nani Rehabilitation And Nursing Center
HALE NANI REHABILITATION AND NURSING CENTER in HONOLULU, HI — inspection on July 19, 2024.
Found 3 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
The facility failed to ensure R29 are treated with respect, dignity, and care in a manner and in an environment that promotes maintenance or enhancement to her quality of life. R29 was not provided accessibility to her belongings, including clothes, when moved to a different room/unit after returning to the facility.
On 07/15/24 at 10:09 AM, R29 expressed she was confused on why she was in this room.
Observed her room to have peeled paint behind her bed. R29 inquired why the facility would put her in a room with wall damage and pointed out the paint peeling all around her room.
Concurrently observed the paint to be peeled off all around the room.
On 07/18/24 at 11:18 AM, an interview with DOM was done. DOM reported the maintenance department does a walk around the facility once a week and if they see paint peeling in a room, they will patch the room when it is unoccupied due to the smell. It takes about 24 hours for them to mud, sand, and paint the walls. DOM stated they just patched up R29's room yesterday, 07/17/24, after the resident moved back to her previous room. DOM confirmed the maintenance department did not get a work order to patch the peeled paint in the room prior to the facility putting R29 in the room with peeled paint across the walls.
125011
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 125011 B.
Wing 07/19/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Hale Nani Rehabilitation and Nursing Center 1677 Pensacola Street Honolulu, HI 96822
The facility failed to carry out daily living activities (ADLs) to maintain good grooming for R29 dependent on ADL care. R29 did not receive proper foot nail care.
This puts the resident at risk for cuts and wounds on her feet.
R29 was admitted to the facility on [DATE] with diagnoses, not limited to, restless legs syndrome, type 2 diabetes, hyperlipidemia, hypertension, dementia, and peripheral vascular disease.
On 07/16/24 at 10:11 AM, an interview with Family Member (FM) 4 was done. FM4 reported R29's left big toe was amputated due to an infection and gangrene. FM4 was not sure how she got the wound on her toe in the first place because R29 was not mobile and stated after the facility informed her of the wound and the progression to an infection, it happened so fast. FM4 mentioned that the facility does not cut R29's toenails, her toenails are long, thick, and close to the nail bed. FM4 did not recall the last time R29 had her toenails cut, and believed she did not get them cut since she was admitted in 2022. FM4 stated R29 has not seen a podiatrist.
On 07/16/24 at 01:00 PM, concurrent observation of R29's right foot toenails with FM4 were done. R29's toenails were long, thick, and digging into her nailbed.
On 07/17/24 at 02:27 PM, an interview with Certified Nurse's Aide (CNA) 5 was done. CNA5 reported the facility had never cut R29's toenails because she was diabetic.
On 07/17/24 at 01:48 PM, an interview and concurrent record review with Nurse Manager (NM) 1 was done. NM1 reported that nail care for diabetic residents is done by the charge nurse, however, for toenails, it is normally referred to the podiatrist if the nails are thickened and the resident is diabetic.
Concurrent review of R29's EHR, found R29's care plan did not include foot nail care for diabetes and/or to be referred to a podiatrist for foot care. NM1 stated this should be care planned.
125011
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 125011 B.
Wing 07/19/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Hale Nani Rehabilitation and Nursing Center 1677 Pensacola Street Honolulu, HI 96822
The facility failed to provide Restorative Nurse Assistant (RNA) and other services as scheduled to help prevent/minimize the formation and worsening of contractures in Residents (R)199 and R20.
43414
2) On 07/18/24 at 01:57 PM, during an interview with resident council members, R50 reported during their monthly resident council meetings, residents expressed the facility is short staffed and it has not been resolved.
Resident council members reported that the residents have been told there should be at least six certified nurse's aides (CNA) on each floor, the same number of workers, but not based on units' acuity and census.
However, residents are finding that there are only four to five CNAs on the units.
Resident council members expressed the facility should staff the units based on acuity and census, and there are units with residents who need one on one supervision, but the facility cannot provide an assigned person which effects the other residents' care.
Staff who are floaters, take long to provide care because they are not familiar with the resident and their routine.
Instead of following the residents wishes on how they prefer to receive care they treat them as a task and just do it how they want to provide the care.
Review of the resident council minutes for May 2024, June 2024, and July 2024 document short staffing on all floors, Nurses not assisting w/CNA when short on the floor, More Staffing on the floor.
Scheduler removing staff who has already completed 3 hrs. [hours], More Staffing (CNA), Resident express more staffing (CNA) is needed on the floors, Resident had concerns regarding floating probation. DON [Director of Nursing] to follow up with staffing, and More Staffing.
On 07/18/24 at 10:57 AM, during an interview with Director of Nursing (DON), DON reported staff members have expressed they are short staffed, and the RNA staff will volunteer to provide extra support when short staffed.
On 07/19/24 at 12:12 PM, interview with Scheduler (S) 1 and S2 was done. S1 reported there is a criteria flow sheet (CNA matrix) they follow based on the census amount for each unit and staff accordingly. If there are residents who need one to one supervision, nursing staff communicate this and the schedulers will try to accommodate.
Concurrent review of the facility's CNA matrix includes the ratio of one CNA for seven residents (1:7).
During a full census on sampled units, Unit 2, Unit 4, and Unit 5, a minimum 36 residents. the matrix indicates six CNA's to be scheduled during the day shift on each unit.
125011
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 125011 B.
Wing 07/19/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Hale Nani Rehabilitation and Nursing Center 1677 Pensacola Street Honolulu, HI 96822