Ann Pearl Nursing Facility
ANN PEARL NURSING FACILITY in KANEOHE, HI — inspection on March 20, 2025.
Found 2 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 report an allegation of abuse within 2 hours which resulted in the facility not implementing its policy and procedure to ensure the immediate safety of the alleged victim, timely reporting of an alleged crime, and a timely abuse investigation.
R12 is a [AGE] year-old female admitted to the facility on [DATE] with hospice services.
Review of Admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 01/18/25, revealed in Section C that R12 had a Brief Interview for Mental Status (BIMS) score of 5, which indicated R12 had severe cognitive impairment.
Section GG (Functional Abilities) noted that R12 required dependent assistance (requires full assistance from another person(s)) for self-care and bed mobility.
On 03/19/25 at 09:30 AM, a review of R12's Resident Progress Notes was done. A progress note dated 02/01/25 at 11:24 AM, with a notation, Recorded as Late Entry on 02/04/25 at 11:40 AM, was inputted by Registered Nurse (RN) 10 and stated, resident screaming she raped last night, in front of husband.
However, there was no documentation that the facility's Administrator or Director of Nursing (DON) was notified.
On 03/19/25 at approximately 11:45 AM, a form titled, [Provider] Alleged AMN (Abuse, Misappropriation, Neglect), with a submission date listed as 02/03/25, was reviewed.
The form listed 02/01/25 at 05:00 PM as the date and time of the alleged abuse event.
The date and time the Administrator and DON was notified of the alleged abuse event was listed as 02/03/25 at 09:00 AM.
On 03/19/25 at approximately 10:30 AM, a review of the facility policy titled, Abuse and Neglect, dated 03/03/21, documented in the section titled, Overview of the Seven Components included 5) Investigation: Abuse Policy Requirement: The facility's immediate response is to protect the alleged victim. To protect the alleged victim, the facility has clear delineated roles of those responsible for investigating and will respond to ensure protection of the alleged victim, identify any other alleged victims, ensure the safety of all other residents and the integrity of the investigation.
On 03/19/25 at 03:45 PM, interviewed the DON in her office.
The DON confirmed that she was made aware of the allegation of abuse two days later (02/03/25) but should have been sooner so the investigation could start immediately.
This would have provided immediate protection for the residents.
125048
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 125048 B.
Wing 03/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Ann Pearl Nursing Facility 45-181 Waikalua Road Kaneohe, HI 96744
The facility failed to prevent potential abuse for one of three residents sampled for abuse (Resident (R) 12) and other residents at risk due to delayed initiation of the investigation for R12's allegation of abuse.
1) On 03/19/25 at 09:00 AM, a review of the [State Agency] Event Report regarding an allegation of abuse was noted to be submitted to the State Agency (SA) on 02/03/25 at 11:08 AM via email.
The Initial Report section of the report was noted with a date and time of 02/03/25 at 11:06 AM.
The date and time of the incident (abuse allegation) noted on the report was 02/01/25 at 05:00 PM.
On 03/19/25 at 09:30 AM, a review of R12's Resident Progress Notes was done. A progress note dated 02/01/25 at 11:24 AM, with a notation, Recorded as Late Entry on 02/04/25 at 11:40 AM, was inputted by Registered Nurse (RN) 10 and stated, resident screaming she raped last night, in front of husband.
However, there was no documentation that the facility's Administrator or Director of Nursing (DON) was notified.
On 03/19/25 at approximately 11:45 AM, a form titled, [Provider] Alleged AMN (Abuse, Misappropriation, Neglect), with a submission date listed as 02/03/25, was reviewed.
The form listed 02/01/25 at 05:00 PM as the date and time the allegation was made.
The date and time the Administrator and DON was notified of the event was listed as 02/03/25 at 09:00 AM.
On 03/19/25 at 02:45 PM, interviewed the Administrator in her office.
The Administrator stated for any allegations of abuse, floor staff will notify the clinical on call person, who will then notify the Administrator.
This is usually done by phone.
She confirmed the incident occurred on 02/01/25, but was notified on 02/03/25, and she should have been notified right away.
On 03/19/25 at 03:45 PM, interviewed the DON in her office.
The DON stated that anytime there is an allegation of abuse, staff should immediately call the Administrator and DON.
She confirmed that she was notified on 02/03/25 and that was not immediate.
125048
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 125048 B.
Wing 03/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Ann Pearl Nursing Facility 45-181 Waikalua Road Kaneohe, HI 96744