Kalakaua Gardens

Review of the refrigerator temperature log showed an out-of-range recording that was not followed up and not reported.

Staff interview on 01/16/25 at 10:00 AM, Director of Nursing (DON) acknowledged the out-of-range temperature recording and that follow up should be done. DON also said the out-of-range temperature may have been recorded in error.

Review of facility policy on Storage of Medication read; Policy, Medications and biologicals are stored properly, following manufacturers or provider pharmacy recommendations, to keep their integrity and to support safe, effective drug administration.

The medication supply shall be accessible only to licensed nursing personnel, pharmacy personnel or staff members lawfully authorized to administer medications .

Procedures .

Medications requiring refrigeration or temperatures between 2'C (36'F) and 8'C (46'F) are kept in a refrigerator with a thermometer to allow temperature monitoring.

Medications requiring storage in a cool place may be refrigerated unless otherwise directed on the label . A temperature log or tracking mechanism is maintained to verify that temperature has remained within accepted limits .

Medication storage conditions are monitored on a regular basis as a random quality assurance (QA) check. As problems are identified, recommendations are made for corrective action to be taken.

125066

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 125066 B.

Wing 01/17/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Kalakaua Gardens 1723 Kalakaua Avenue Honolulu, HI 96826

Review of the resident's most recent quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 12/06/24, Section C. functional Abilities, C.

Toileting Hygiene (the ability to maintain perineal hygiene, adjust clothes before and after using the toilet, commode, bedpan, or urinal) R22 requires partial/moderate assistance (helper does less than half the effort); Mobility Sit to stand: R22 requires partial/moderate assistance; F Toilet transfer (ability to get on and off the commode) R22 requires partial/moderate assistance.

Review of the facility's Fall Scene Investigation Tool form dated 09/05/24 documented R22's loss of balance while getting off the toilet as the root cause of the fall.

Staff's recommended interventions to prevent future falls documented R22 should be accompanied to the restroom and to not leave the resident unattended.

Review of comprehensive care plan documented R22 is at risk for falls related to gait/balance problems and a history of multiple falls.

After the fall on 09/05/24, where R22 sustained a pelvis fracture, the comprehensive care plan was not revised or updated. No interventions identified in the root cause or staff's recommendations to not leave the resident unattended in the bathroom were added to prevent a similar accident.

Review of progress notes documented on 11/25/524 at 11:40 PM, R22 had a second fall in the bathroom.

Again, R22 was assisted to the toilet, left unattended and had an unwitnessed fall. R22was found in a pool of blood which was coming from a cut on the resident's head. R22 also had a skin tear and multiple bruises. R22 reported she does not remember what happened. R22 was sent out to the acute hospital and returned with three sutures above the right eye.

125066

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 125066 B.

Wing 01/17/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Kalakaua Gardens 1723 Kalakaua Avenue Honolulu, HI 96826