Hale Nani Rehabilitation And Nursing Center
Inspection Findings
F-Tag F0725
F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many
Staff members are expected to maintain compliance with safe handling/transfer practices. Resident lifting and transferring will be performed according to resident's individual plan of care. 4) Resident R8 is a resident that requires one-to-one (1:1) around-the-clock supervision (sitter). Review of Resident R8's Provider Orders revealed the following order since 06/18/2025, 1:1 supervision due to wandering and to meet resident's needs until alternate placement can be found.
On 11/18/25 at 01:30 PM, during an interview with Registered Nurse (RN) 6, discovered that the 1:1 sitter for Resident R8 had not shown up yet. RN6 stated that the staff member previously assigned to Resident R8 had finished their shift at 12:30 PM. Verified through observation that there was no 1:1 sitter in Resident R8's room. RN6 stated that Resident R8 required a sitter due to elopement risk. 5) On 11/17/25 at 06:14 AM, observed on the PK2 floor that there were two licensed nurses, and three CNAs assigned. Concurrent interview with RN7 confirmed a census of 49 residents that RN7 stated usually meant at least 4 CNAs would be assigned. RN7 agreed that 3 CNAs were not enough to adequately meet
the needs of the residents in a timely manner.
On 11/17/25 at 11:37 AM, an interview was done with CNA14 on PW2. CNA14 confirmed a census of 45 residents and stated that usually there would be 6 CNAs [assigned] for day shift and 5 CNAs [assigned] for evening [shift] and night [shift]. CNA14 reported that since 11/02/25, sometimes between 12:00 PM and 06:00 PM, there was only 1 or 2 CNAs scheduled.
On 11/17/25 at 12:15 PM, observed on LW1 that there was 1 CNA (CNA15) assigned to relieve the 2 CNAs getting off at 12:30 PM. Confirmed with CNA15 and RN8 that with a census of 18 residents, 1 CNA would be very difficult to meet all of their needs in a timely manner.
On 11/18/25 at 04:07 PM on PW2, during an interview with RN9, confirmed that as of 03:30 PM, she was
the only nurse on the floor assigned with 3 CNAs for a census of 45 residents. RN9 stated it is very difficult to work so short. RN9 added that she tries to help the CNAs but how can I when I have to also pass meds, document, and make sure residents are safe?
On 11/19/25 at 09:48 AM, review of the staff schedule for Friday 11/14/25 noted that from 03:30 PM to 06:00 PM on PK2, there was 1 CNA working on the floor of 49 residents and no 1:1 sitter assigned to Resident R8.
Confirmed by interview with the Scheduler (S1) that there was 1 CNA at that time. S1 agreed that the goal is to ensure more than 1 CNA is working on any of the floors.
On 11/19/25 at 11:30 PM, an interview was done with the Director of Nursing (DON), Assistant Director of Nursing (ADON), and the Chief Nursing Officer (CNO). During a concurrent review of the Letter of Understanding re [regarding] Work Load from the 2023-2025 Collective Bargaining Agreement, CNO, DON, and ADON confirmed that for the PW and PK floors, the goal is to ensure there are a minimum of 4 CNAs assigned at any given time, and for the LW floors, a minimum of 2 CNAs.
On 11/19/25 at 12:50 PM, an interview was done with S1. During a concurrent review of the 11/13/25 staff schedule, S1 confirmed that there was 1 CNA on PK2 from 03:30 PM to 04:30 PM when she was joined by 1 other CNA (besides the 1:1 sitter). S1 also confirmed that there was 1 CNA on LWG that day from 03:30 PM to 06:00 PM. S1 agreed that when she makes the schedule, her goal is to ensure there is more CNA staff than that.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Hale Nani Rehabilitation and Nursing Center
1677 Pensacola Street Honolulu, HI 96822
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-Tag F0732
F 0732
Post nurse staffing information every day.
Level of Harm - Minimal harm or potential for actual harm
Based on observation, interview, and record review, the facility failed to ensure its nurse staffing information was posted in a prominent place readily accessible to all residents. In addition, the facility failed to ensure
the staff information that was posted met the data requirements, specifically, facility name, resident census, and the total number and actual hours worked by licensed and unlicensed staff. Findings include:On 11/17/25 at 11:53 AM, observations made on the ground floor of the main building noted a staff assignment posting on the table at the main entrance, and a copy posted near the time clock. Review of the staff posting noted it did not include the facility name, resident census, or the total number and actual hours worked by licensed and unlicensed staff. A tour of the facility later that day noted the staff assignment (still lacking the aforementioned data) was also posted by the time clocks on the first floor of the main building, and the first floor of 1 of 2 other buildings. The same observations were made during tours of the facility on 11/18/25 and 11/19/25.On 11/19/25 at 10:30 AM, an interview was done with the Administrator, the Assistant Director of Nursing (ADON), and the Chief Nursing Officer (CNO). When asked about the staff posting, the Administrator explained that the Scheduler is responsible to post the information at the start of every shift and confirmed that it is posted at the main entrance and by the time clocks. The ADON listed the location of the time clocks on the property (1 on the ground floor of the main building, and 2 on resident units) and confirmed that there were no other time clocks. When asked how the staff posting would be accessible to residents that cannot or do not leave the 5 other units on property where it is not posted, the CNO nodded and acknowledged that it is not currently posted in a prominent area accessible to those residents. On 11/19/25 at 10:50 AM, during a concurrent review of the staff posting, the Administrator agreed that it did not contain all the components to meet the requirements of a staff posting.Review of the facility's policy and procedure on Nurse Staffing Posting Information, last reviewed on 04/28/25, revealed
the following: This facility's policy is to make nurse staffing information readily available in a readable format to residents, staff, and visitors at all times.
Residents Affected - Many
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Hale Nani Rehabilitation and Nursing Center
1677 Pensacola Street Honolulu, HI 96822
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-Tag F0838
F 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many
FORM CMS-2567 (02/99) Previous Versions Obsolete
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and review of the current Facility Assessment, the facility failed to review and update the assessment when there was a change to a six-hour Certified Nurse Aide (CNA) shift schedule on 11/02/25.
As a result of this deficient practice, the assessment did not reflect that the facility assessed how many CNAs were needed on each shift to safely care for the needs of the residents.Findings include:On 11/17/25 at 06:15 AM, a memo posted on the wall by the main building time clock was reviewed. The memo dated 09/29/25 contained the following information:Addressed to: CNA(s) at [Facility]From: [Facility] LeadershipRegarding: Implementation of six (6) hour shift schedule for CNA(s)Content: .facility will be moving to a six (6) hours schedule for CNA(s).effective 11/2/25The new CNA schedule was listed as: 06:00 AM -12:30 PM, 12:00 PM - 06:30 PM, 06:00 PM - 12:30 AM, 12:00 AM - 06:30 [NAME] 11/17/25 at 10:25 AM, the Facility Assessment was reviewed. The Date Completed/Updated was documented as 11/17/25 and Completed By the Administrator. Page 20 of the Facility Assessment, under the section titled, Staffing Needs as per Resident Unit, did not list the staffing needs for the 4 six-hour CNA shifts implemented on 11/02/25. On 11/19/25 at 10:30 AM, the Administrator, Director of Nursing (DON), Assistant Director of Nursing (ADON), and Chief Nursing Officer (CNO) were interviewed in the Conference room located on the ground floor of the main building. The CNO stated that the facility assessment staff matrix was not updated.
Event ID:
Facility ID:
If continuation sheet
HALE NANI REHABILITATION AND NURSING CENTER in HONOLULU, HI inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in HONOLULU, HI, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from HALE NANI REHABILITATION AND NURSING CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.