Inspection Reports for Evergreen ADC Hawaii
1124 Fort Street Mall #200 Honolulu, HI, 96813
Back to Facility ProfileDeficiencies per Year
4
3
2
1
0
Unclassified
Inspection Report
Annual Inspection
Deficiencies: 1
May 1, 2024
Visit Reason
The inspection was conducted as an annual survey to assess compliance with regulatory requirements for the Adult Day Care Center.
Findings
The report identified a deficiency related to personnel and staffing, specifically a staff member's physical examination and tuberculosis test had expired. A plan of correction was submitted indicating the lapse cannot be corrected retroactively but measures will be taken to prevent future lapses.
Deficiencies (1)
| Description |
|---|
| PE & TB for staff member expired on 8/10/2023 and was done on 11/2/2023 |
Report Facts
Date Plan of Correction is Due: Jun 1, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deborah Baumgart | LPN Compliance Manager | Named as CTA RN Compliance Manager overseeing the plan of correction |
| Hye Kim | Printed name and signature on the deficiency report and plan of correction |
Inspection Report
Renewal
Deficiencies: 0
Apr 28, 2023
Visit Reason
The document is a recertification deficiency report for the Adult Day Care Center (ADCC) Evergreen ADC in Hawaii, indicating a renewal inspection to assess compliance with state regulations.
Findings
All inspected chapters and requirements were found to be in compliance with no deficiencies noted, as indicated by the 'OK' status for all items and the checked box confirming that no corrective action is required.
Inspection Report
Annual Inspection
Deficiencies: 0
Apr 29, 2022
Visit Reason
This is an annual deficiency report for the Adult Day Care Center (ADCC) Evergreen ADC I, documenting compliance with various regulatory chapters.
Findings
All inspected chapters including Application for Certificate of Approval, Administration, Personnel and Staffing, Admissions, Participant Fees, Transportation, Services for Center Participants, Physical Location, Fire Protection, and Other Disasters and Evacuations were found to be in compliance with no deficiencies noted.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deborah Baumgart | Compliance Manager LPN | Named as Compliance Manager overseeing the inspection |
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