01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2024-06-06 | 9 | 2024-06-06 | 0 |
| Cycle 2 | 2023-06-23 | 11 | 2023-06-23 | 0 |
| Cycle 3 | 2022-07-15 | 5 | 2022-07-15 | 0 |
CMS CCN 1250572026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Kulana Malama
91-1360 Karayan Street · Ewa Beach, HI 96706 · Honolulu County
Certified beds33CMS provider file
Recent citation rows25current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
25 rows in the current release
1 rows carry G–L scope/severity codes; 1 carry J–L. 6 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-09-26 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has date of correction · 2025-11-07 · complaint2025-06-18 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2025-06-20 · complaint2025-06-18 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Past Non-Compliance · 2025-03-30 · complaint2025-06-18 · HEALTHF0713Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Provide or arrange emergency care by a doctor 24 hours a day.
Correction field: Deficient, Provider has date of correction · 2025-06-20 · complaint · under IDR/IIDR2025-06-18 · HEALTHF0726Severity J · isolated immediate jeopardy
Nursing and Physician Services Deficiencies
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Correction field: Deficient, Provider has date of correction · 2025-06-20 · complaint · under IDR/IIDR2025-06-18 · HEALTHF0867Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Correction field: Deficient, Provider has date of correction · 2025-06-20 · complaint2024-06-06 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2024-07-282024-06-06 · HEALTHF0584Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2024-07-282024-06-06 · HEALTHF0661Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Correction field: Deficient, Provider has date of correction · 2024-07-282024-06-06 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2024-07-282024-06-06 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Past Non-Compliance · 2024-01-072024-06-06 · HEALTHF0791Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide or obtain dental services for each resident.
Correction field: Deficient, Provider has date of correction · 2024-07-282024-06-06 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has date of correction · 2024-07-282024-06-06 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2024-07-282023-06-23 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2023-07-142023-06-23 · HEALTHF0693Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Correction field: Deficient, Provider has date of correction · 2023-07-142023-06-23 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2023-07-142023-06-23 · HEALTHF0880Severity F · widespread; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2023-07-142023-06-23 · HEALTHF0887Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Correction field: Deficient, Provider has date of correction · 2023-07-142023-06-23 · HEALTHF0908Severity E · pattern; potential for more than minimal harm
Environmental Deficiencies
Keep all essential equipment working safely.
Correction field: Deficient, Provider has date of correction · 2023-07-142022-07-15 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2022-08-262022-07-15 · HEALTHF0609Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2022-08-262022-07-15 · HEALTHF0623Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Correction field: Deficient, Provider has date of correction · 2022-08-262022-07-15 · HEALTHF0625Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Correction field: Deficient, Provider has date of correction · 2022-08-2603 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-06-18 | Fine | $14,069 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- PACIFIC SKILLED HEALTHCARE LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 06/30/2022
- OLSEN, SPENCERIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST73% · since 06/30/2022
- SORENSEN, KRISTENIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST13% · since 06/30/2022
- ITO, RANDALLIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 02/01/2023
- ITO, RANDALLIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/2023
- LEFLER, TYRUSIndividual · CORPORATE OFFICERNOT APPLICABLE · since 09/23/2022
- OLSEN, SPENCERIndividual · CORPORATE OFFICERNOT APPLICABLE · since 09/23/2022
- PANG, BRIANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/2023
- YOSHIDA, CYNTHIAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/2023
- ITO, RANDALLIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2023
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours9.84per resident day
RN hours5.38per resident day
Weekend nurse hours9.24per resident day
Staff turnover41.0%CMS reported field
06 / LOCAL RECORDS
Open the Hawaii ledger →Other published facilities nearby
No second facility in the same city met the directory rule.