Above average — CMS composite of the measures below.
The next survey window likely opens around February 2027
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hale Kupuna Heritage Home, Llc during CMS and state inspections, most recent first.
The facility failed to provide adequate supervision and fall prevention for multiple high‑risk residents, resulting in unwitnessed falls and serious injuries. One resident with a history of repeated unwitnessed falls and documented weakness fell in the bathroom while adjusting clothing and using a FWW, sustaining head abrasions and hematomas; he was discovered by housekeeping staff after calling for help, and an RN later stated he needed more supervision. Another resident with dysphagia, prior falls, and declining mobility attempted to stand from a newly issued wheelchair while a CNA was behind a closed curtain assisting another resident, fell forward onto her face, and suffered a scalp laceration, facial contusions, and facial fractures. A third resident with prior falls and on sedating, hypotension‑associated psychotropic and antidepressant medications was placed in a dining area but left unsupervised when nursing staff were called away; she attempted to ambulate to the bathroom without her walker, fell, and sustained a right hip fracture. Her care plan had not been updated to reflect her current need for consistent walker use, and staff did not fully follow existing interventions regarding walker availability and use.
Resident Council concerns about daily menu boards were not sustained in practice. Surveyors observed outdated or missing menu postings in multiple wings, and residents reported they did not know what meals were being served. Staff gave conflicting answers about who was responsible for updating the boards, while the DM stated she printed the menus and was responsible for posting them.
Insufficient nursing coverage left residents without immediate help during unwitnessed falls. One resident fell on a wing with no nursing staff present and sustained a hip fracture requiring ER transfer and surgery, while another resident fell in a bathroom, suffered a head injury, and reported waiting 10 to 15 minutes for help. Staffing records showed only one LPN covering both wings in each building and limited CNA coverage, with weekend staffing flagged as excessively low.
A sampled lunch tray included a cold item that measured 69 degrees F instead of the expected 40 degrees F. A dietary aide said the item should have been served cold, and the preparer stated it may have warmed while being transported with other trays to the unit for lunch distribution. Resident interviews also noted that some food was bland, late, or lacked taste.
Expired and unlabeled food items were found in the walk-in refrigerator during kitchen observations. Surveyors saw hot dogs past their expiration date, an open container of yogurt without a label, and later a container of mayonnaise that had also expired. Staff confirmed the items were expired or unlabeled and discarded them. The facility policy required food items to be properly labeled and dated, and opened foods to have a use-by date.
Staff failed to follow infection control practices during meal service when a Dietary Staff member served lunch to seven residents in a common area without performing hand hygiene between residents. The facility policy for meal service called for hand hygiene as appropriate, and the IP confirmed staff are to perform hand hygiene when moving from one resident to another to prevent possible spread of infections.
A resident with debility, legal blindness, CHF, DM, medication side effects, and a history of falls had a care plan identifying fall risk and requiring standby assist with ambulation. Despite this, staff left the resident unsupervised while the RN walked away and the CNA was busy with another resident, and the resident attempted to ambulate without a walker, leading to an unwitnessed fall and hip fracture. The care plan had not been fully updated to reflect the need for consistent walker use, and staff did not fully follow existing interventions related to walker availability and use.
A facility failed to provide proper discharge notification for a resident admitted for short-term rehab after removal of an internal fixation device, with diagnoses including acute osteomyelitis and infection/inflammatory reaction due to an internal right hip prosthesis. The resident was discharged into police custody for an out-of-state warrant, but the EHR contained no documentation that the State LTCO was notified, and the RDO confirmed the notification was not made.
Inaccurate MDS coding showed a resident received insulin injections when the EHR documented no insulin order and instead showed Mounjaro (tirzepatide) for DM. The MDS quarterly assessment recorded 1 day of insulin use and 0 days of insulin order changes, while the MDSC stated the resident was not on insulin and may have been confused with hyperglycemia.
The facility failed to ensure proper food storage and thawing practices, as well as adequate hand hygiene during food distribution, which could lead to foodborne illness among residents. Salmon fillets were improperly thawed, a scooper was stored in a thickener container, and a manager did not perform hand hygiene after removing gloves and distributing lunch trays.
The facility failed to ensure proper PPE use for staff caring for residents on isolation precautions. A CNA was observed moving between rooms without doffing PPE, and staff lacked understanding of correct doffing procedures. The Infection Preventionist confirmed that all PPE, including N95 masks, should be doffed before exiting rooms, highlighting a breach in infection control practices.
A resident with cognitive decline was not reassessed for capacity to consent to psychotropic medications, despite multiple hospital admissions and a decline in health status. The facility's policy on educating residents about medication risks and benefits was not followed, leading to a deficiency in informed consent procedures.
A resident was punched by another resident after attempting to take a lighter from their personal bag, while a CNA was present but unable to intervene. The incident resulted in harm to the resident, although no major injury occurred.
A resident with cognitive and communication deficits was found with bruises on the left eyebrow and eyelid, classified as an injury of unknown source due to the resident's inability to verbalize the cause and lack of witnesses. The facility failed to report this injury to the State Agency and Adult Protective Services within the required 24-hour period, as confirmed by a review of the resident's EHR and interviews with facility staff.
A resident with cognitive communication deficits was found with bruises on the left eyebrow and eyelid, but the LTC facility failed to investigate the injury's origin. Despite the resident's vulnerability and potential for abuse, the facility did not recognize the bruises as an injury of unknown source. Interviews confirmed no investigation was conducted, indicating a deficiency in the facility's response.
A resident transferred to the hospital for low blood pressure and a UTI did not receive written notice of the bed-hold policy. The facility's policy requires providing this notice, but it was not given, as acknowledged by the Administrator.
Failure to Provide Adequate Supervision and Fall Prevention for High‑Risk Residents
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to ensure an environment free from accident hazards and to provide supervision based on individual residents’ assessed needs. One resident with a history of multiple unwitnessed falls was observed with a bandage on his head and later with visible bruising and abrasions after an unwitnessed bathroom fall. His care plan documented several prior falls, including unwitnessed falls with head pain, bruising, and sliding out of bed while reaching for a urinal. On the date of the most recent fall, he was found on the bathroom floor on his right side with his pants and underwear around his thighs, reporting that he had been attempting to adjust his clothing while walking with a front‑wheeled walker. He sustained multiple abrasions and hematomas to the top and sides of his head, reported 8/10 head pain and nausea, and required transfer to the ER. Nursing staff reported that a housekeeper, not direct care staff, discovered him after hearing him call for help, and the RN stated that the resident needed more supervision, especially given increased weakness since his prior fall. Another resident with dysphagia, a history of falling, and generalized muscle weakness experienced a fall with major injury after attempting to stand from a newly issued wheelchair. She reported that she stood up and did not expect the wheelchair to be so high, lost her balance, and fell forward onto her face while the CNA was in the same room but behind a closed curtain assisting another resident. The resident sustained an approximately two‑inch actively bleeding scalp laceration, facial contusions, and later ER documentation confirmed a closed fracture of the left maxillary sinus, a closed fracture of the left orbital floor, a scalp laceration, and a closed head injury. The MDS showed that, prior to this fall, she had already demonstrated decline in eight of ten mobility areas, and she later returned from the hospital with 8 staples in her scalp and extensive bruising and swelling to the left eye, scalp, and ear. The resident and her family member expressed that the fall should not have happened and attributed it to short staffing. A third resident with a documented fall history and on medications including quetiapine and mirtazapine, both of which have side effects of drowsiness, dizziness, and orthostatic hypotension, sustained an unwitnessed fall resulting in a right hip fracture. She was found on the floor on her right side without shoes, socks, or her walker, and stated she had been trying to go to the bathroom. The care plan had not been updated to fully reflect her current needs for consistent walker use, and staff did not fully adhere to existing interventions regarding walker availability and use at the time of the incident. Nursing staff interviews indicated that this resident required line‑of‑sight supervision and “eyes on her” because she would suddenly stand without warning and was unsteady, yet at the time of the fall she had been placed in the dining area in front of the nurse’s station and was left unsupervised when the RN and CNA were called away. Kitchen staff later found her on the floor, and she reported being on the floor for about 15 minutes before help arrived. She was diagnosed with a right hip fracture, underwent surgery, was admitted to the ICU for hypotension, and subsequently died; the unwitnessed fall with hip fracture was determined to be a contributing event that exacerbated her overall medical decline, though not the primary cause of death.
Resident Council Menu Board Grievance Not Sustained
Penalty
Summary
The facility failed to ensure that its response to a Resident Council grievance about daily menu boards was carried out and maintained in practice. Residents had raised concern that the menu boards were not being updated regularly, and the facility documented action plans stating that menus would be posted the night before and that staff had been educated. Despite this, the menu boards in the buildings were still not consistently updated or accessible to residents. On 03/09/26, surveyors observed that the posted daily menu in Building 1, B Wing was not current: the breakfast and dinner menus had not been updated, and the lunch menu was not posted in the designated area but was instead found on a side table in front of the menu board showing the previous day’s turkey sandwich. A Wing did not have a menu board for posting daily menus. During interviews that same day, multiple residents stated they did not know what lunch would be served, and one resident said she was hungry and waiting for lunch but did not know what would be served. The facility’s planned menu showed that lunch for that day was meatloaf with gravy, steamed rice, mixed vegetables, and chocolate pudding. Resident Council minutes from November 2025 and January 2026 showed the same concern had been raised previously, with residents requesting timely menu updates and reporting that the boards continued not to be updated regularly. On 03/11/26 and 03/12/26, residents again reported that the menu boards were still not updated, and survey observations found outdated menus in Building 1 and no menu board in D Wing of Building 2. Staff interviews showed conflicting responses about who was responsible for updating the boards, with some staff naming housekeeping, others dietary, and others nursing, while the Dietary Manager stated she printed the menus and was responsible for posting them.
Insufficient Nursing Coverage During Resident Falls
Penalty
Summary
The facility failed to provide sufficient nursing staff in areas where vulnerable residents with high fall risk lived, and it failed to have a licensed nurse in charge on each shift in a way that ensured immediate supervision was available. The report states that on 02/06/26, Resident 54 had an unwitnessed fall on the B wing and was later found to have a hip fracture, requiring transfer to the ER and surgery to repair the right hip. At the time of the fall, the staffing schedule showed one licensed nurse covering both wings in building 1 and one CNA on the B wing, with one charge nurse and one CNA floating between buildings 1 and 2; staff reported there was no nursing staff present on the B wing when the resident fell, and kitchen dining staff found the resident on the floor and notified nursing. The report also states that on 03/07/26, Resident 7 had an unwitnessed fall in the bathroom that resulted in a head injury and transfer to the ER for evaluation and treatment. The staffing schedule for that day showed one licensed nurse covering both wings in building 2 and one CNA on the C wing, with one CNA floating between buildings 1 and 2. During interviews, Resident 7 said he had to yell for help and waited 10 to 15 minutes for someone to come, and another resident said she heard him yelling from the bathroom and had to go find someone to help him. Additional observations noted one or fewer staff and residents present on A and D wings, increased resident activity on B and C wings, and the PBJ report triggered for excessively low weekend staffing.
Cold Food Served at Improper Temperature
Penalty
Summary
Food was not served at a preferable temperature for one sampled lunch tray. During observation and interview, a test tray from the tray line was checked with Dietary Aide 12, and the beets and mayonnaise salad measured 69 degrees Fahrenheit even though it was expected to be served at 40 degrees Fahrenheit. A second container of the beets and mayonnaise also measured 69 degrees Fahrenheit. The dietary staff member who prepared the item stated that it had been kept in the cooler but may have become too warm while inside the warmer with the other trays during transport to the unit for lunch distribution. Earlier resident interviews also reflected complaints that some food was bland, sometimes late, and lacked taste.
Expired and Unlabeled Food Stored in Walk-In Refrigerator
Penalty
Summary
Food items were stored in the walk-in refrigerator past their expiration dates and an opened food item was left without a required label. During a kitchen tour on 03/09/26 at approximately 09:15 AM, surveyors observed a clear plastic container of hot dogs with a prep date of 03/02/26 and an expiration date of 03/08/26, along with an open container of yogurt that was about one-third full and had no label. The cook was interviewed at 09:25 AM and, when asked to verify the items, removed the hot dogs and yogurt from the walk-in refrigerator and discarded them, stating they should have been thrown away. On 03/11/26 at 11:15 PM, surveyors again observed a clear container of mayonnaise in the walk-in refrigerator labeled with an expiration date of 03/09/26. The Dietary Aide was asked to check the date and confirmed that the mayonnaise had expired on 03/09/26, then removed and discarded it. The Dietary Manager was interviewed on 03/11/26 at 11:35 AM and the Food Service Director was interviewed on 03/11/26 at 11:40 AM; both were informed of the findings. The facility's Food and Nutrition Policy dated 10/01/24 stated that food items shall be properly labeled and dated, and that opened foods must have a use-by date if not in packaging that identifies one.
Failure to Perform Hand Hygiene During Meal Service
Penalty
Summary
The facility failed to ensure staff followed infection control and prevention measures while providing care for residents. On 03/09/26 at 12:03 PM, Dietary Staff 3 brought the meal cart to the unit, where seven residents were waiting in the common area for lunch. After opening the cart, DS3 removed trays and placed food items and drinks on the table in front of the residents, then returned to the cart and immediately pulled another tray for the next resident. DS3 was not observed performing hand hygiene while serving lunch to all seven residents. The facility policy titled Meal Service, effective 01/05/26, stated to prepare the room or serving area for mealtime and provide hand hygiene as appropriate. On 03/11/26 at 01:53 PM, the Infection Preventionist confirmed that staff are to perform hand hygiene when moving from one resident to another to prevent possible spread of infections.
Failure to Implement Standby Assist and Walker Use Care Plan Resulting in Fall Injury
Penalty
Summary
The facility failed to implement a person-centered intervention for standby assistance with ambulation as outlined in the comprehensive care plan for one resident, resulting in an unwitnessed fall with major injury. The resident had multiple risk factors for falls, including debility, legal blindness, congestive heart failure, diabetes mellitus, medication side effects, and a history of prior falls. The care plan, revised on 01/23/2026, identified the resident as at risk for falls and included an intervention for standby assist with ambulation, updated on 01/22/2026, with a goal that the resident would be free of falls through the review date of 03/25/26. Prior to the incident, the resident had experienced two falls in the facility, one witnessed fall onto the buttocks while fixing clothing by a mirror and one guided fall after losing balance while walking. On 02/06/26, the resident sustained an unwitnessed fall in building 1 on the B unit while attempting unsupervised ambulation without her walker, resulting in a right hip fracture and transfer to the ER for evaluation and surgery. Interviews with nursing staff confirmed that the resident was known to suddenly stand without warning, was unsteady, and required someone present when walking, and that she needed continuous visual supervision due to her fall risk. At the time of the fall, the RN reported having to walk away and the CNA was occupied with another resident, leaving no one available to assist the resident to get up. The final investigation summary noted that the care plan had not been updated to fully reflect the resident’s current needs for consistent walker use and that staff did not fully adhere to existing care plan interventions regarding the availability and use of the walker at the time of the incident.
Failure to Notify State Ombudsman of Resident Discharge
Penalty
Summary
The facility failed to provide proper notification of transfer/discharge for one of three residents reviewed in a closed records sample. Resident 53, a [AGE]-year-old resident admitted for short-term rehabilitation after removal of an internal fixation device, had diagnoses including acute osteomyelitis and infection and inflammatory reaction due to an internal right hip prosthesis. The record showed that the resident was discharged and placed under the custody of the police department on 11/05/25 for an out-of-state warrant of arrest, but there was no documentation in the electronic health record that the facility notified the State Long Term Care Ombudsman of the discharge. During an interview on 03/12/26, the Regional Director of Operations, who was serving as Administrator at the time of the discharge, confirmed that the State LTCO was not notified.
Inaccurate MDS Coding for Insulin Use
Penalty
Summary
The facility inaccurately coded a resident’s MDS quarterly assessment to show that he received insulin injections during the last 7 days, even though insulin was not ordered for him. The resident was a [AGE]-year-old male with a diagnosis of Type 2 Diabetes Mellitus with hyperglycemia, and his EHR showed an order for Mounjaro (tirzepatide) 5 mg subcutaneously every Monday for diabetes mellitus, started on 11/10/25. The MDS quarterly assessment with an ARD of 01/06/26 recorded that the resident had insulin injections for 1 day and that his insulin orders were changed 0 days during the assessment period. During telephone interviews, the MDS coordinator stated that the assessment was completed by another MDS coordinator and may have confused the resident’s hyperglycemia with an insulin injection. The other MDS coordinator stated that the resident was not on insulin injections, but on Mounjaro, and said he would check the EHR and inquire whether it had been coded incorrectly.
Deficiencies in Food Handling and Hand Hygiene
Penalty
Summary
The facility failed to ensure proper food storage and thawing practices, as well as adequate hand hygiene during food distribution, which could lead to foodborne illness among residents. During an observation in the kitchen, individually wrapped salmon fillets were found thawing in water in a sink, with an internal temperature of 62.8 degrees Fahrenheit, which is above the safe temperature range. Kitchen Staff 2 confirmed that the salmon had been in the water for about an hour. The Food Service Director and Dietician acknowledged that the temperature was out of range and that the salmon would defrost quicker than other meats like chicken. Additionally, a scooper was observed stored inside a thickener container, which was confirmed by the Kitchen Manager and the Food Service Director as inappropriate. Furthermore, during a lunch observation on the Makalapua Unit, Manager 5 did not perform hand hygiene after removing gloves and proceeded to distribute lunch trays to three residents without performing hand hygiene between or after the distribution of the trays. The Administrator acknowledged that hand hygiene should have been performed during the distribution of lunch trays.
Improper PPE Use in Isolation Precautions
Penalty
Summary
The facility failed to ensure staff adhered to the Infection Prevention and Control policies and procedures for the proper use of personal protective equipment (PPE) when caring for residents on isolation precautions. Observations revealed that a Certified Nurse Aide (CNA) did not correctly doff PPE after providing care to Covid-19 positive residents. The CNA was seen moving between rooms of residents on isolation precautions without removing PPE, and doffing PPE in the hallway instead of inside the resident's room. This practice was confirmed by a Registered Nurse (RN) who stated that the staff did not have a bin in the room to dispose of PPE, leading to improper doffing practices. Further observations and interviews highlighted a lack of understanding among staff regarding the correct procedures for doffing PPE. A CNA incorrectly advised that the N95 mask did not need to be changed when doffing PPE, which was contradicted by the Infection Preventionist who confirmed that all PPE, including the N95 mask, should be doffed before exiting the room. The facility's Infection Prevention and Control Program emphasizes the importance of educating staff and ensuring adherence to proper techniques, which was not followed in this instance.
Failure to Reassess Resident's Capacity to Consent
Penalty
Summary
The facility failed to ensure that a resident, identified as R42, was fully informed and understood the risks and benefits of proposed care, specifically regarding the use of psychotropic medications. R42, who had a decline in cognitive function due to health issues, was not reassessed for the capacity to consent to medications or treatments. Despite this cognitive decline, R42 signed a consent form for the use of antidepressant and antipsychotic medications, which was filled out by a registered nurse. The facility's policy requires that residents or their representatives be educated on the risks and benefits of psychotropic drug use, as well as alternative treatments, but this was not adequately followed in R42's case. R42 was admitted to the facility with several diagnoses, including hemiplegia, epilepsy, hypertension, and cognitive communication deficits. The resident experienced multiple hospital admissions due to various health issues, including unresponsiveness and seizures, indicating a decline in health and cognitive status. Despite these changes, the facility did not reassess R42's capacity to consent, and the resident's cognitive ability to make informed decisions was not evaluated by a physician. Interviews with facility staff confirmed that R42's cognitive status had declined, and the resident's capacity to consent should have been reassessed but was not.
Resident-to-Resident Altercation Due to Inadequate Supervision
Penalty
Summary
The facility failed to protect a resident from abuse when a resident-to-resident altercation occurred. Resident 39 was punched by Resident 20 after attempting to take a lighter from Resident 20's personal bag. This incident happened in the presence of a Certified Nurse Aide (CNA) who was not close enough to intervene and prevent the physical contact. The altercation resulted in harm to Resident 39, although no major injury was sustained. The incident was reported to the Office of Healthcare Assurance, and it was determined that the facility did not ensure the safety of Resident 39 from abuse by another resident. The CNA present during the incident failed to intervene effectively to prevent the altercation. The deficiency was identified through interviews and record reviews, highlighting the facility's failure to maintain a safe environment for its residents.
Failure to Report Injury of Unknown Source
Penalty
Summary
The facility failed to report an injury of unknown source for a resident, identified as R42, to the State Agency (SA) and Adult Protective Services (APS) within the required 24-hour timeframe. R42, who has a medical history including hemiplegia, hemiparesis, epilepsy, hypertension, and cognitive communication deficits, was found with bruising on the left eyebrow and eyelid. The resident's inability to verbalize or express what happened, combined with the absence of witnesses, classified the bruises as an injury of unknown source. Despite this, the facility did not recognize the bruises as such and failed to report them to the appropriate authorities. The deficiency was identified during a review of R42's Electronic Health Record (EHR) and interviews with facility staff, including the President of Clinical Operations, the new Director of Nursing, and the Infection Preventionist. The review confirmed that the facility did not submit a report of the injury to the SA or APS, as verified by the SA's database, Aspen Complaints/Incident Tracking System (ACTS). This oversight placed residents at risk for more than minimal harm, as the facility did not adhere to the mandatory reporting requirements for injuries of unknown source.
Failure to Investigate Injury of Unknown Origin
Penalty
Summary
The facility failed to thoroughly investigate an injury of unknown origin for a resident, identified as R42, which could potentially prevent further abuse. R42, who has cognitive communication deficits and is unable to verbalize, was found with bruises on the left eyebrow and eyelid. These injuries were not witnessed by staff, and the source was unknown. Despite the resident's vulnerability and the potential for abuse, the facility did not recognize the bruises as an injury of unknown source and did not conduct a thorough investigation into their origin. The resident's medical history includes hemiplegia and hemiparesis of the left dominant side following an intracranial hemorrhage, epilepsy, and hypertension. The facility's records show that R42 was sent to the emergency room and returned without bruises, but later, staff reported the bruises. Interviews with the facility's administration and clinical operations confirmed that no investigation was conducted to determine how R42 sustained the bruises, highlighting a deficiency in the facility's response to potential abuse of a vulnerable resident.
Failure to Provide Bed-Hold Policy Notification
Penalty
Summary
The facility failed to provide written notice of the bed-hold policy to a resident who was transferred to the hospital. The resident was transferred on 10/25/23 due to low blood pressure and a urinary tract infection. Upon review of the Electronic Health Record, it was found that there was no documentation of a written notice of the bed-hold policy being provided to the resident or their representative. During an interview with the Administrator on 09/05/24, it was acknowledged that the facility did not provide the required written notification of the bed-hold policy to the resident or their representative. The Administrator mentioned that the facility had been using other forms for discharge and written notifications at the time of the resident's discharge. The facility's policy on discharge and transfer procedures requires that a copy of the bed-hold policy be given to the resident or their representative, which was not adhered to in this case.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Koloa
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Garden Isle Healthcare And Rehabilitation Center | 8.5 mi | ★★★★★ | 0 | 0 |
| Kauai Care Center | 11.7 mi | ★★★★★ | 1 | 0 |
| Kauai Veterans Memorial Hospital | 11.8 mi | ★★★★★ | 8 | 0 |
| Samuel Mahelona Memorial Hospital | 16.1 mi | ★★★★★ | 8 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release October 2026) and official state health department websites.