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BUILDING  \u003Cbr>B. WING   |  |  |  | (X3) DATE SURVEY\u003Cbr>COMPLETED\u003Cbr>11/03/2023 |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| NAME OF PROVIDER OR SUPPLIER\u003Cbr>ARCADIA RETIREMENT RESIDENCE |  |  |  |  | STREET ADDRESS, CITY, STATE , ZIP CODE\u003Cbr>1434 PUNAHOU STREET\u003Cbr>HONOLULU, HI 96822 |  |  |  |\n| (X4) ID\u003Cbr>PREFIX\u003Cbr>TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |  |  | ID\u003Cbr>PREFIX\u003Cbr>TAG |  | PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) |  | (X5)\u003Cbr>COMPLETION\u003Cbr>DATE |\n| F 000\u003Cbr>F 550\u003Cbr>SS=D | INITIAL COMMENTS\u003Cbr>A recertification survey was conducted by the Office of Health Care Assurance (OHCA) on 10/31/23-11/03/23 . The facility was not in compliance with 42 CFR 483 Subpart B. Facility Reported Incidents (ACTS \\#10333, 10518) was also investigated. There was non-compliance in ACTS 10333.\u003Cbr>Survey Census: 72\u003Cbr>Sample Size: 21\u003Cbr>Resident Rights/Exercise of Rights CFR(s): 483. 10(a)(1)(2)(b)(1)(2)\u003Cbr>§483 . 10(a) Resident Rights.\u003Cbr>The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section.\u003Cbr>§483 . 10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident.\u003Cbr>§483 . 10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source.\u003Cbr>§483 . 10(b) Exercise of Rights. |  | F 000\u003Cbr>F 550 |  |  |  |  | 12/15/23 |\n\nLABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE Electronically Signed  \nTITLE  \n(X6) DATE 11/24/2023  \nAny deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients . (See instructions. ) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.  \nFORM CMS-2567(02-99) Previous Versions Obsolete Event ID: EPZJ11 Facility ID: HI02LTC5014 If continuation sheet Page 1 of 36  \nDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES  \nPRINTED: 08/23/2024  \nFORM APPROVED OMB NO. 0938-0391  \n\n| STATEMENT OF DEFICIENCIES\u003Cbr>AND PLAN OF CORRECTION |  | (X1) PROVIDER/SUPPLIER/CLIA\u003Cbr>IDENTIFICATION NUMBER:\u003Cbr>125014 | (X2) MULTIPLE CONSTRUCTION\u003Cbr>A. BUILDING  \u003Cbr>B. WING   |  |  | (X3) DATE SURVEY\u003Cbr>COMPLETED\u003Cbr>11/03/2023 |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| NAME OF PROVIDER OR SUPPLIER\u003Cbr>ARCADIA RETIREMENT RESIDENCE |  |  |  | STREET ADDRESS, CITY, STATE , ZIP CODE\u003Cbr>1434 PUNAHOU STREET\u003Cbr>HONOLULU, HI 96822 |  |  |  |\n| (X4) ID\u003Cbr>PREFIX\u003Cbr>TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR","cbCaiqrHJf6l7uoy","https://ap.wps.com/l/cbCaiqrHJf6l7uoy","pdf",159102,36,"English","# Statement of Deficiencies and Plan of Correction\n## Survey summary and non-compliance\n## Resident rights requirements\n## Findings and corrective action","[{\"question\":\"What survey was conducted and when was it completed?\",\"answer\":\"A recertification survey was conducted by the Office of Health Care Assurance (OHCA) and was completed on 11/03/2023.\"},{\"question\":\"Which regulatory area and requirement are referenced in the resident rights sections?\",\"answer\":\"The document references 42 CFR 483 Subpart B and includes requirements under §483.10 for resident rights, including protection from interference, coercion, discrimination, and reprisal.\"},{\"question\":\"What does the facility’s plan of correction address?\",\"answer\":\"The plan addresses the deficiencies found, including failure to ensure residents’ right to a dignified existence for sampled residents, and specifies corrective actions with completion dates.\"}]","Statement of Deficiencies and Plan of Correction - ARCADIA RETIREMENT RESIDENCE | PDF",1789518124]