Inspection Reports for My Kind Heart
98-034 Kuleana Place, Pearl City, HI 96782, HI, 96782
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Inspection Report
Annual Inspection
Deficiencies: 32
Mar 3, 3022
Visit Reason
Annual inspection of the Type I ARCH facility to assess compliance with state regulations including personnel qualifications, nutrition, medication management, records, and physical environment.
Findings
Multiple deficiencies were found including incomplete training hours for primary care givers, missing physical examinations and tuberculosis clearances for staff, lack of certifications, incomplete or missing medication orders and records, absence of resident register, missing policies on surveillance camera use, and environmental safety issues such as unsecured toxic chemicals and lack of single-use hand drying towels.
Deficiencies (32)
| Description |
|---|
| Primary care giver had only three hours of training instead of required six hours. |
| Substitute care giver #3 and Helper had no physical examination prior to first contact with residents. |
| SCG #2 had no initial two-step tuberculosis clearance. |
| SCG #1 had no screening for symptoms consistent with pulmonary TB. |
| Helper had no initial two-step TB clearance. |
| SCG #2 and #3 had no first aid certification. |
| SCG #2 and #3 had no training by the primary care giver to make prescribed medications available to residents. |
| SCG #2 and #3 had no cardiopulmonary resuscitation certification. |
| No pureed diet menu for Resident #1. |
| No substitution list for menus. |
| Current menus were not posted in the kitchen or dining area. |
| Resident #1 diet orders did not specify type of diet and were not clarified with physician. |
| Toxic chemicals under kitchen sink and Hot Shot Flying Insect Killer Spray in outside laundry area were unsecured. |
| Resident #1 had no physician order to crush medication. |
| Resident #1 had no physician order for Melatonin 3 mg recorded from September 2021 to February 2022. |
| Resident #1 had OTC Cranberry tablets order without specified number of tablets to be taken. |
| Resident #1 medication orders were not updated every four months as required. |
| Resident #1 had no documentation of telephone order for Prednisone 10 mg x 7 days taken 1/24/22 to 1/30/22. |
| Expired cranberry capsules found and removed from medication supply. |
| Resident #1 medication records from July 2021 to February 2022 recorded medication taken with a check mark instead of caregiver initials. |
| Resident #1 medication taken on 2/28/22 was not initialed by caregiver. |
| No medication record for Resident #1 for March 2022. |
| Resident #1 had no screening for symptoms consistent with pulmonary TB at admission. |
| Resident #1 had no documentation of 1:1 supervision at meal time as ordered. |
| Resident #1 progress notes did not include observations of tolerance to modified consistency solids and liquids; caregiver gave thin liquids. |
| Resident #1 had no progress notes for November 2021, December 2021, and February 2022. |
| Resident #1 progress notes for July 2021 were not signed by the individual making the entry. |
| Blue ink was used on Resident #1 December 2021 medication record instead of black ink. |
| No permanent general register maintained to record all admissions and discharges; facility has two ARCH residents and one day care resident. |
| No policy for surveillance camera use. |
| No documented consent or disclosure for surveillance camera directed at Resident #1's bed. |
| No single use hand drying towels in resident's bathroom. |
Report Facts
Training hours documented: 3
Residents: 2
Residents: 1
Inspection Report
Annual Inspection
Deficiencies: 17
Mar 25, 2025
Visit Reason
Annual inspection conducted to assess compliance with licensing requirements and regulations for the facility My Kind Heart.
Findings
Multiple deficiencies were identified including lack of current fingerprint background check for a substitute caregiver, missing tuberculosis screening documentation, incomplete medication orders, improper medication storage, missing diet orders, refrigerator temperature violations, incomplete resident records, and failure to document treatments and incident reports.
Deficiencies (17)
| Description |
|---|
| Substitute caregiver #3 had no current fingerprint background check clearance; last completed 3/20/23. |
| Substitute caregiver #2 had no documentation of initial tuberculosis screening. |
| Substitute caregiver #1 had no record of training by primary caregiver to make medications available. |
| Resident #1 had no record of diet order since admission on 1/13/25. |
| Refrigerators for snacks and residents' foods registered temperatures above 45°F (50°F and 60°F respectively) and remained above after 2 hours. |
| Liquid cough syrup stored unsecured in small refrigerator; Zylet eye drops found on top of refrigerator. |
| Resident #1 medication orders dated 1/13/25 were incomplete, missing dosage, route, and frequency for multiple medications. |
| Resident #1 medications on MAR from January 2025 to present lacked physician orders. |
| Resident #1 pharmacy label and MAR did not match for Propanolol, Melatonin, and Calcium medications. |
| Resident #1 medication order for Midodrine HCL 2.5 mg was not given as instructed based on systolic blood pressure readings. |
| Resident #1 had no record of recent medical examination and current diagnosis within preceding 12 months of admission. |
| Resident #1 had no signed diet orders since admission on 1/13/25. |
| Resident #1 had no valid signed orders for medications and treatment since admission on 1/13/25. |
| Resident #1 whiteout was used on January 2025 blood pressure logs. |
| Resident #1 had no documentation of compression stockings application due to history of low blood pressure. |
| Resident #2 had no incident report generated following hospitalization on 6/23/24 due to pneumonia. |
| Resident #2 discharge summary report following hospitalization on 6/23/24 was unavailable for review. |
Report Facts
Temperature: 50
Temperature: 60
Date: Mar 25, 2025
Date: Jan 13, 2023
Date: Jun 23, 2023
Inspection Report
Annual Inspection
Deficiencies: 17
Mar 12, 2024
Visit Reason
The inspection was conducted as the annual survey for the facility My Kind Heart to assess compliance with state licensing regulations.
Findings
The report identifies multiple deficiencies related to nutrition, food sanitation, medication administration, personal care services, records and reports, and resident health care standards. Each deficiency includes a plan of correction with specific actions taken or future plans to prevent recurrence.
Deficiencies (17)
| Description |
|---|
| Resident #1 diet order dated 4/11/23 indicates minced, but resident is being served smoothies for lunch and dinner. |
| Small refrigerator for snacks did not have a thermometer to check if temperature was maintained at 45°F or lower. |
| Resident #1 consumes Boost Plus chocolate 2 cans daily, but order states only one can daily. |
| Medications found in resident #1's medication bin were not recorded on MAR. |
| Medications for resident #1 were not reviewed and signed by the doctor every four months. |
| Physician order for supplement Boost Plus chocolate one can daily not recorded in MAR. |
| Plan of care and activities for residents #1 and #2 do not reflect residents' meal schedule. |
| No PCG assessment upon readmission for resident #2 on 1/10/24. |
| PCG filled out assessment sheet late for resident #2's readmission on 1/10/2024. |
| Valuables and belongings for residents #1 and #2 were not current. |
| No signed physician orders obtained for several medications found in resident #1's medication bin. |
| No documentation in progress notes for response to oral antibiotic treatment for resident #1 as ordered on 2/11/24. |
| Resident #1's medications are crushed and mixed into food without physician order. |
| Progress notes do not reflect response to crushed oral medications and tolerance of minced diet for resident #1. |
| Permanent register not updated to reflect resident #1's readmission on 1/10/24. |
| Emergency form for resident #1 not updated to include current medications; last completed 5/31/21. |
| Progress notes regarding blood clots with urine for resident #1 not documented as reported to physician. |
Report Facts
Deficiencies cited: 16
Inspection Report
Annual Inspection
Deficiencies: 14
Mar 17, 2023
Visit Reason
The inspection was conducted as the annual licensing inspection for the facility My Kind Heart.
Findings
The report identifies multiple deficiencies related to missing documentation such as background checks, physical exams, tuberculosis clearances, medication labeling, medication administration records, consent forms, and fire drills. The facility submitted plans of correction for each deficiency with completion dates.
Deficiencies (14)
| Description |
|---|
| No documented evidence of Fieldprint background check for all adults and caregivers. |
| Substitute caregiver #2: No documented evidence of annual physical exam. |
| Household member #1: No documented evidence of annual tuberculosis clearance. |
| Resident #1: No documented evidence of annual physical exam. |
| Resident #1 and Resident #2: Medications pre-poured for the week, removed from original labeled container. |
| Resident #1: Unlabeled over the counter medications. |
| Resident #2: Unlabeled over the counter medications. |
| Resident #2: Frequency of ordered medications not properly transcribed to medication administration record. |
| Resident #1: White out used in March 2023 medication administration record. |
| Resident #1: Unknown abbreviation used in medication administration record, no legend provided. |
| Resident #1 and Resident #2: Consent forms not documented for video device in resident bedroom. |
| Fire drills not conducted at various times throughout the day. |
| Resident #1: Medications not reevaluated every six months as ordered by physician. |
| Resident #1: Resident certified at non self-preserving. Only one care giver in care home. |
Report Facts
Completion Date: Jun 22, 2023
Inspection Date: Mar 17, 2023
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