Facility Evaluation Report

While at the facility for a complaint (Complaint Control # 15-AS-20250514132244), Licensing Program Analyst (LPA) Delmundo conducted a Proof of Correction visit for the deficiencies/citations issued by LPA on 5/22/25. LPA met with Gladys Corpuz, staff. LPA called and spoke over the phone with House Manager (HM) Mateaki 'Mat' Ofenhengaue, and informed the reason for visit.

On 5/22/25, LPA conducted a case management visit and issued type B citations for the following deficiencies with proof of corrections (POCs) to be submitted by 6/05/25:

LPA only received the POC (copy of LIC602A Physician's Report) for deficiency section # 87458(a) on 6/04/25. The POC for deficiency section # 87211(a)(1)(D) is not received.

LPA discussed the above over the phone with HM and informed that POC for # 87211(a)(1)(D) shall be submitted by end of the day today. HM stated he will submit today. HM also stated he can not come to the facility and gave permission to Gladys Corpuz to sign and receive this report.

Exit interview conducted and copy of this report provided.