Palolo Chinese Home - Honolulu Nursing Home

General Information

UPDATE
Federal Provider Number
125059
Provider Name
PALOLO CHINESE HOME
Provider Address
2459 10TH AVENUE
HONOLULU, HI 96816
Provider Phone Number
(808) 737-2555
Provider SSA County
20
Provider County Name
Honolulu
Ownership Type
Non profit - Corporation
Number of Certified Beds
43
Number of Residents in Certified Beds
42
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PALOLO CHINESE HOME
Date First Approved to Provide Medicare and Medicaid services
2008-06-13
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.76310
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
1.60714
Reported Licensed Staffing Hours per Resident per Day
1.60714
Reported Total Nurse Staffing Hours per Resident per Day
4.37024
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17024
Expected CNA Staffing Hours per Resident per Day
2.61220
Expected LPN Staffing Hours per Resident per Day
0.62412
Expected RN Staffing Hours per Resident per Day
1.00580
Expected Total Nurse Staffing Hours per Resident per Day
4.24211
Adjusted CNA Staffing Hours per Resident per Day
2.59545
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
1.19394
Adjusted Total Nurse Staffing Hours per Resident per Day
4.15265
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2015-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2012-12-21
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2011-09-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
39.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01

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