Inspection Reports for Esamya Koh Care Home LLC
94-229 Moena Pl, Waipahu, HI 96797, United States, HI, 96797
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Inspection Report
Annual Inspection
Deficiencies: 15
Oct 9, 2024
Visit Reason
The inspection was conducted as the annual licensing survey for Esamya Koh Care Home LLC to assess compliance with state regulations and licensing requirements.
Findings
The report identifies multiple deficiencies including missing consecutive years of fieldprint clearance, inadequate food sanitation practices, conflicting and incomplete medication orders, missing annual TB clearance documentation, lack of documented training for caregivers, missing care plans for expanded residents, and incomplete case management services. Plans of correction and future plans were submitted for each deficiency.
Deficiencies (15)
| Description |
|---|
| Two consecutive years of Fieldprint clearance unavailable. |
| Temperature of entrees containing meats not checked for minimum safe temperature when cooking. |
| Conflicting physician's medication orders not clarified and erroneous orders not discontinued. |
| Medication not being administered as prescribed by physician. |
| Medication order incomplete and did not include dosage to administer and frequency of administration. |
| Medication order missing dosage and frequency of administration. |
| Medication not available or unaccounted for; missing pills discarded near expiration. |
| Expired medication bottles available in resident inventory and not properly disposed of. |
| Annual TB clearance unavailable for resident. |
| Fire exit ramp obstructed with trash bag of clothes and laundry basket of clothes. |
| No documented evidence of expanded resident's case manager providing training and monitoring of daily personal and specialized care. |
| No documented evidence of monthly weights being obtained for residents. |
| No documented evidence of monthly face-to-face contacts with case manager. |
| Care plan unavailable for expanded resident. |
| No documented evidence of ongoing evaluation and monitoring of expanded resident's status and caregiver's skills by case manager. |
Report Facts
Working days for plan of correction submission: 10
Medication training hours completed: 6
Medication training hours remaining: 6
Inspection Report
Annual Inspection
Deficiencies: 20
Oct 27, 2023
Visit Reason
Annual inspection of Esamya Koh Care Home LLC to assess compliance with state licensing regulations for a Type I ARCH facility.
Findings
Multiple deficiencies were identified including lack of current annual physical exams and tuberculosis clearances for substitute care givers, missing first aid certification, dietary issues such as residents not receiving menu items, medication storage and administration issues, incomplete and unsecured records, inadequate fire drill documentation, and incomplete case management documentation for Resident #1.
Deficiencies (20)
| Description |
|---|
| Substitute Care Giver #2 had no current annual physical exam. |
| Substitute Care Givers #2, #3 had no current tuberculosis clearance. |
| Substitute Care Givers #2, #4 had no initial tuberculosis clearance. |
| Substitute Care Giver #1 had no first aid certification. |
| Lunch menu included Kale but Kale was not given to residents and no substitution was provided. |
| Resident #1 had a soft bite sized diet order not clarified and changed to regular diet without documented clarification. |
| Resident #1 and #2 had special diet orders changed to regular diet without documented evidence that special diet menus were provided. |
| Hot water in kitchen was at 124.7°F. |
| Ear Drops Carbamide Peroxide 6.5% was left unsecured in Resident #3's bedroom drawer. |
| Medication cabinet was not locked upon department arrival. |
| Resident #1's medication administration record showed Lisinopril given despite blood pressure below ordered hold level. |
| Resident #1's general medication order was not reviewed and signed by physician from 2/17/2023 to 9/1/2023. |
| Binder closet for resident records was not locked upon department arrival. |
| Resident #1's emergency information sheet did not include current medication list. |
| Permanent Resident Register missing 'Religion' for three residents and incomplete 'Discharged to' information for one discharged resident. |
| Only Low-splash and No-splash bleach was available to sanitize dishes. |
| Fire drill records for July to October 2023 only stated 'no problem noted' with no details or resident participant names. |
| Resident #1's physician medication orders were not listed in the care plan. |
| No record that case manager reviewed Resident #1's care plan monthly. |
| No record that comprehensive reassessment was conducted for Resident #1 six months after admission in August 2023. |
Report Facts
Temperature: 124.7
Medication dosage: 40
Dates: May 24, 2023
Dates: Jun 30, 2023
Dates: Jul 21, 2023
Dates: Feb 10, 2023
Dates: Sep 1, 2023
Dates: May 12, 2023
Dates: 202308
Dates: Oct 27, 2023
Inspection Report
Annual Inspection
Deficiencies: 7
Oct 20, 2022
Visit Reason
The inspection was conducted as an annual licensing inspection for Esamya Koh Care Home LLC to ensure compliance with state licensing requirements.
Findings
Multiple deficiencies were identified related to licensing requirements, personnel physical exams, tuberculosis screening, nutrition guidelines, medication storage, and documentation of medication administration and progress notes.
Deficiencies (7)
| Description |
|---|
| Primary Care Giver (PCG) and Substitute Care Giver (SCG) #1 had no Fieldprint results. |
| SCG #2 and #3 had no current annual physical exam. |
| SCG #4 had tuberculosis symptom screening results but no record of initial PPD skin test and chest x-ray results. |
| Posted menu did not meet dietary guidelines as it did not include portion sizes or specific foods. |
| Breakfast menu substitution for resident #2 was not recorded despite serving Spam, egg, coffee, and water. |
| Medications in resident #3's bathroom were left unsecured in a drawer. |
| Resident #1's medication administration and new prescription were not documented in progress notes. |
Inspection Report
Plan of Correction
Deficiencies: 10
Apr 21, 2022
Visit Reason
The document is a Statement of Deficiencies and Plan of Correction following an initial inspection of Esamya Koh Care Home LLC on April 21, 2022, to address licensing requirements and deficiencies found during the inspection.
Findings
Multiple deficiencies were identified related to licensing application requirements, admission policies, medication labeling and storage, personal care services, records and reports, residents' rights, and physical environment. The facility provided future plans to correct these deficiencies, with some corrections already initiated.
Deficiencies (10)
| Description |
|---|
| Substitute Caregiver (SCG) #1 – No Fieldprint available for department review. |
| Resident #1 – In 'Resident Clothing' form, the date of admission was noted as 4/1/22. Resident was admitted 4/4/22. |
| Senna-Time 8.6mg tablet label says, 'Take one tablet by mouth daily as needed for constipation.' 'as needed' was crossed out and 'Ad 2/18/22' was written on the label. The medication label was modified. |
| Resident #1 – External and internal medications were stored in the same container. Primary Caregiver (PCG) placed external medication in a Ziplock bag during inspection. |
| Resident #1 – Physician’s order stated, 'Fluticasone Propionate 110 mcg/puff inhale 1 puff po BID' dated 3/30/22. In April 2022 medication administration record (MAR), second dose was not documented. PCG corrected MAR during inspection. |
| Resident #1 – Flovent HFA 110 mcg inhaler bottle label says, '1 puff by mouth 2 times a day. Rinse mouth after use.' 'Rinse mouth after use' was not noted in MAR. |
| Resident #1 – No Plan of Care and Activities Schedule. |
| Resident #1 – In Permanent Resident Register, 'Admitted from' was left blank. |
| Resident #1 – In care home policy on page 2, 'X' was marked on #10 'Require use of wheelchair.' The home is not wheelchair approved. |
| No documentation that smoke detectors were tested in March 2022. |
Report Facts
Inspection Date: Apr 21, 2022
Medication label date: Feb 18, 2022
Physician order date: Mar 30, 2022
Medication administration record month: 202204
Flovent HFA inhaler dose frequency: 2
Admission date: Apr 4, 2022
Admission date noted: Apr 1, 2022
Plan of correction completion dates: Apr 21, 2022
Fingerprint appointment date: May 3, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresita Koh | Licensee/Administrator | Signed and dated the plan of correction on 5/9/2022 and 6/13/2022 |
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