Inspection Reports for Evergreen ADC Hawaii

1124 Fort Street Mall #200 Honolulu, HI, 96813

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Deficiencies per Year

4 3 2 1 0
2022
2023
2024
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
NameTitleContext
Deborah BaumgartLPN Compliance ManagerNamed as CTA RN Compliance Manager overseeing the plan of correction
Hye KimPrinted 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
NameTitleContext
Deborah BaumgartCompliance Manager LPNNamed as Compliance Manager overseeing the inspection

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