Facility Evaluation Report

On 5/20/2025 at 11:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Manager, Mateaki Ofahengaue and explained the purpose of the visit.

LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, and outdoor area. Smoke and carbon monoxide detectors were observed. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 112.1 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mats/materials in the bathrooms. Resident rooms were observed to be cleaned and fully furnished. Fire extinguisher was observed to be full. First Aid kit is complete. Last fire drill was conducted on 3/15/2025. LPA reviewed 2 residents and 3 staff files starting at 12:30PM. LPA reviewed a sample of resident's medications during inspection.

At 11:30AM, LPA observed unlocked knives drawer, unlocked cleaning supplies in bathrooms, and unlocked gardening tools in the backyard. Manager locked up the items during inspection.

At 12:40PM, LPA observed R1 does not have admission agreement on file.

At 12:45PM, LPA observed R2 does not have medical assessment and TB test on file.

At 12:50PM, LPA observed R1 and R2 does not have current reappraisal needs and service plan on file.