Post-licensing visit·January 16, 2026

On January 16, 2026, Licensing Program Analyst (LPA) Arvin Villanueva arrived at the facility unannounced to conduct a post-licensing inspection and quarterly monitoring visit. LPA met with staff on duty, Mere Faletono (S1), and explained the purpose of the visit. Upon arrival, there was one staff member on duty (S1). During the visit, there were four residents in care. Later, S2 arrived to assist. According to the Personnel Report (LIC500), Administrator Tevita Kaloulasulasu (AD) was scheduled to work today from 8:00 a.m. to 3:00 p.m.; however, staff reported that AD was working at another facility. The licensee, Adi Lina Tuiloma (S2), arrived at the facility at approximately 10:45 a.m. Per conversation with Adi, there was a staff call out and she had to take a resident to their appointment. However, Adi did not ensure proper staffing as agreed during a Non-Compliance Conference on September 25, 2025. LPA conducted a physical inspection of the facility, including resident bedrooms, bathrooms, kitchen, common areas, and outdoor spaces. LPA also reviewed records for 4 of 6 residents and 4 of 8 staff members based on the LIC500 dated December 1, 2025. {Con't 809-C} The following deficiencies were observed during the visit: The licensee previously agreed during a Non-Compliance Conference on September 25, 2025, to have at least two caregivers on duty at all times. Today, only one staff member was present when LPA arrived. In the pantry, LPA observed a box of hygiene wipes stored with food items. In the kitchen refrigerator, LPA observed opened food items without labels or dates. The refrigerator did not have a thermometer, and its temperature could not be determined. The kitchen freezer temperature was 15 degrees Fahrenheit. A can of beer was found in the kitchen freezer, accessible to residents. Staff stated the beer belongs to a resident. LPA observed a couple of red ants in a kitchen drawer near the sink. The licensee stated they use insect spray to address pests. Knives were found in the dishwasher, and two meat thermometers were stored in a kitchen drawer. LPA could not confirm if an incident report for a former resident (R2) dated November 19, 2025, was submitted to the Department. LPA could not confirm if an incident report for resident (R3) dated December 22, 2025, was submitted to the Department. Resident R1 did not have a hospice care plan available for review. The licensee admitted that a hospice initiation notice for R1 was not submitted to the Department when hospice care began. The licensee admitted there is no evidence of staff training related to hospice care for R1, stated there was training but was not documented. Based on today's visit, deficiencies are being cited. Exit interview was conducted with Adi and a copy of this report and appeal rights were provided.