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Health Inspection

Ka Punawai Ola

April 3, 2025 · Kapolei, HI · 91-575 Farrington Highway
Citations 4
CMS Rating 5/5
Beds 120
Provider ID 125051
Healthcare Facility
Ka Punawai Ola
Kapolei, HI  ·  View full profile →
Inspection Summary

KA PUNAWAI OLA in KAPOLEI, HI — inspection on April 3, 2025.

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.

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Inspection Findings

FF641
Minimal harm or Few Based on interviews and record review, the facility failed to provide competent nursing services for two affected

Review of the resident's vitals documented on 02/08/25, the resident weighed 154 lbs. On 03/07/2025 and 03/09/25, R42 weighed 143.2 pounds which is a -7.01 % loss.

Review of R42's progress notes did not contain documentation addressing the resident's significant weight loss of more than 5% in a month.

Review the resident's most recent quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/27/25, Section K.

Swallowing and Nutritional Status K0300.

Weight Loss documented No or Unknown to a loss of 5% or more in the last month.

On 04/02/25 at 12:12 PM, conducted a concurrent review of R42's EHR and interview with the Dietician (D)1. D1 reviewed R42's weights on 02/08/25, 03/07/25, and 03/09/25 then confirmed R42 lost more than 5% in one month. D1 stated he/she was aware that R42 was losing weight, but did not identify the weight loss as being more than 5% in one month. D1 reported adding supplemental nutrition to R42's meals and confirmed he/she may have given the resident more calories and monitored the resident more closely had he/she identified R42 loss more than 5% in one month.

125051

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 125051 B.

Wing 04/03/2025

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

Ka Punawai Ola 91-575 Farrington Highway Kapolei, HI 96707

Review of R246's Electronic Health Record (EHR) was conducted.

The following orders for pain were noted: Hydrocodone-Acetaminophen Oral Tablet 10-325 mg every 6 hours as needed for severe pain and Hydrocodone-Acetaminophen Oral Tablet 5-325 mg every 6 hours as needed for moderate pain.

On 04/02/25 at 10:11 AM, a concurrent interview and record review was conducted with RN7 just outside R246's room.

Asked RN7 what numeric pain level is considered severe. RN7 said, Seven to 10 is considered severe.

Asked RN7 if the pain medication dose given to R246 earlier in the morning was correct. RN7 checked in the computer and said R246 should have been given Hydrocodone-Acetaminophen 5-325 mg since her pain level was only at six and considered moderate.

125051

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 125051 B.

Wing 04/03/2025

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

Ka Punawai Ola 91-575 Farrington Highway Kapolei, HI 96707

Review of the resident's vitals documented on 02/08/25, the resident weighed 154 pounds (lbs). On 03/07/25 and 03/09/25, R42 weighed 143.2 lbs, which is a -7.01 % loss in one month.

Review of R42's progress notes did not contain documentation addressing the resident's significant weight loss of more than 5% in a month.

Reviewed the resident's most recent quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/27/25, Section K.

Swallowing and Nutritional Status K0300.

Weight Loss documented No or Unknown to a loss of 5% or more in the last month, indicating R42 did not have a significant weight change.

On 04/02/25 at 12:12 PM, conducted a concurrent review of R42's EHR and interview with Dietician (D)1. D1 reviewed R42's weights on 02/08/25, 03/07/25, and 03/09/25, then confirmed R42 did lose more than 5% in one month. D1 confirmed he/she did was not aware that R42's weight loss was significant. D1 reviewed R42's quarterly MDS with an ARD of 03/27/25, Section K. and confirmed the MDS should have coded R42 for a weight loss of 5% or more, but did not.

125051

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 125051 B.

Wing 04/03/2025

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

Ka Punawai Ola 91-575 Farrington Highway Kapolei, HI 96707

During an interview with her Family Member (FM) at the bedside on 03/31/25 at 12:40 PM, FM stated that R294 had no skin problem or pressure ulcer prior to her admission. FM explained that R294 is now complaining of pain to her coccyx. FM stated that she visits every day and stays in the facility for up to six hours, and did not observe the staff repositioning R294 every two hours. FM stated most of the time R294 refuses to be moved.

On 04/02/25 at 10:29 AM, review of R294's Electronic Health Record (EHR) was conducted.

Care Plan Report dated 03/19/25, stated R294 was . at risk for break in skin integrity .

Skin assessment upon admission done on 03/19/25 documented skin condition as, . coccyx - brown discoloration . admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/21/25, Section M, documented R294 is at risk of developing pressure ulcers/injuries.

R294's Braden Scale assessment with a completion date of 03/26/25, noted a score of 12, which identified R294 as high risk for developing pressure ulcer and mobility as Very Limited.

Physical Therapy treatment encounter notes for 03/25/25 to 04/01/25, documented the resident's resistance to care. On 03/26/25, .

Resistive to sitting edge of bed .

Documentation for 03/27/25 stated .

Attempted to have the patient stand but she was combative .

Documentation for both 03/28/25 and 03/29/25 stated . exhibits heightened anxiety w/ activity .

Documentation for 04/01/25 stated .

She was agreeable for therapist to assist with mobility but then would resist movement or want to return to bed.

On 04/03/25 at 10:00 AM, conducted an interview with Certified Nurse Aide (CNA)9.

Asked how often CNA9 assist R294 with repositioning, she said, We try to reposition resident every two hours, but she always refuses to be moved or repositioned.

When asked what should staff do if R294 refuses to be turned, CNA9 stated that she is supposed to report to the nurse.

Then asked CNA9 if R294's refusal to be repositioned was reported to the nurse. CNA9 confirmed the resident's refusals was not reported until the open area was noticed on R294'c coccyx on 03/31/25, which is 12 days after the resident was admitted .

125051

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 125051 B.

Wing 04/03/2025

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

Ka Punawai Ola 91-575 Farrington Highway Kapolei, HI 96707

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 KAPOLEI, 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 KA PUNAWAI OLA or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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