Palolo Chinese Home
Palolo Chinese Home in HONOLULU, HI — inspection on May 22, 2026.
Found 4 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
him. R12 reported he was shocked by the incident because he had a good relationship with CNA19.
conducted with the Infection Preventionist (IP).
The IP stated that after receiving CNA30's report of
able to describe being slapped on the back and side of the head by CNA19 without prompting, consistent with CNA30's report. On 05/22/26 at 8:53 AM, an interview was conducted with the Director of Nursing (DON).
When asked whether it was appropriate for CNA19 to push R12's head with her pointer finger, the DON stated CNA19 should not have placed her hands on the resident because the action was not related to providing care.
The DON confirmed the incident was considered physical abuse. On 05/22/26 at 9:27 AM, an interview was conducted with the Administrator and Assistant Administrator.
The Administrator and Assistant Administrator confirmed that, following completion of the facility's investigation, the facility concluded physical abuse had occurred.
They stated this determination was based on CNA19's admission that she pushed the resident's head with her finger and the consistent accounts provided by CNA30 and R12 regarding the incident.
Review of the facility's policy titled Abuse, Neglect, Mistreatment and Misappropriation of Resident Property, last reviewed on 02/26/24, stated: Physical Abuse includes but is not limited to, hitting, slapping, punching, kicking or controlling behavior through corporal punishments.
Corporal punishment, which is physical abuse includes, but not limited to, punching spanking, slapping hands, flicking, or hitting with an object.
The policy further stated, Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.
125059 05/22/2026
Palolo Chinese Home 2459 10th Avenue Honolulu, HI 96816
The facility failed to ensure that R12 remained free from abuse when a staff member was witnessed willfully pushing/hitting the resident's head without a care-related purpose. On 04/29/26, the facility submitted an initial event report to the State Agency (SA), Intake #2999087.
The report documented that on 04/21/26, between approximately 7:00 PM and 8:00 PM, Certified Nurse Aide (CNA) 30 reportedly witnessed CNA19 strike R12 twice on the head, once on the back of the head and once on the side of the head.
The facility's report revealed that the incident occurred on 04/21/26 but was not reported to the SA until 04/29/26, eight days after the alleged incident.
Review of the facility's completed investigation file showed that the facility interviewed CNA30, the witness, and the Infection Preventionist (IP).
Documentation indicated that CNA30 did not report the incident immediately because she feared retaliation from CNA19.On 05/21/26 at 10:51 AM, a telephone interview was conducted with CNA30. CNA30 confirmed she witnessed CNA19 hit R12 in the back and side of the head. CNA30 stated that she did not report the incident immediately because CNA19 had assisted her with housing and was a contract staff member.
She expressed concern that reporting the incident could negatively affect her living situation if retaliation occurred. CNA30 stated that she ultimately reported the allegation to the IP on 04/29/26.On 05/21/26 at 11:23 AM, an interview was conducted with the IP.
The IP stated that another staff member informed her on 04/29/26 that CNA30 had disclosed witnessing the incident.
The IP reported that she instructed CNA30 to formally report the allegation and provide a written statement because the allegation involved potential resident abuse.On 05/22/26 at 8:53 AM, an interview was conducted with the Director of Nursing (DON).
The DON stated that staff are required to immediately report any suspicion of abuse and confirmed that CNA30 should have reported the incident as soon as it occurred.
The DON acknowledged that CNA30 delayed reporting because she feared retaliation.
The DON further confirmed CNA19 continued to work with R12 after the incident due to the delay in reporting.
Review of the facility's nursing staff schedule from 04/21/26 through 04/29/26 revealed that CNA19 was assigned to provide care to R12 on 04/21/26, 04/22/26, 04/24/26, 04/25/26, 04/26/26, and 04/28/26.
Review of the facility's policy titled Abuse, Neglect, Mistreatment and Misappropriation of Resident Property, last reviewed on 02/26/24, stated: Any nursing home employee or volunteer who becomes aware of abuse, mistreatment, neglect, exploitation, or misappropriation shall immediately report it to the Nursing Home Administrator. If an incident or allegation is considered reportable, the Administrator or designee will make an initial (immediate or withing 24 hours) reported to the State Agency.
125059 05/22/2026
Palolo Chinese Home 2459 10th Avenue Honolulu, HI 96816
Administrator.
Administrator confirmed that AS10 did not meet competency evaluation requirements or a certification for nurse aide.
Administrator also stated that AS10 received on-the-job training as caregiver but would not be appropriate for the Long-Term Care program.
Administrator explained that the facility usually checks and requires complete education and training to include certified nurse aide (CNA) certification.
Administrator agreed that SA10 should not have worked in Long-Term Care. On 05/21/26 at 09:19 AM, an interview with the Director of Nursing (DON) was done.
When DON was queried if facility should verify nurse aide registry prior to hiring staff, DON confirmed and agreed.
receive retraining.
providing nurse aide services was listed on the state nurse aide registry prior to working in the
#2659390).
This deficient practice placed residents at risk for care being provided by unqualified staff and had the potential to affect resident safety and well-being.
Findings Include:Cross reference to
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.