Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record
SAMUEL MAHELONA MEMORIAL HOSPITAL
KAPAA, HI · 66 certified beds · Last Life Safety survey November 22, 2024
CMS Certification Number 125029 · first certified July 1976
Ownership
Independently operated (no chain recorded by CMS) · Government - State
No change of ownership on CMS record since January 1, 2016, when the records begin.
Position within HI
2 citations — more than 26% of the 43 certified nursing homes in HI. Compared within HI rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated
The latest survey found 0 citations; the earlier surveys in the window averaged 1. With 3 surveys on file this is a direction of travel, not a conclusion.
When is the next survey likely?
Past the typical window (December 2025 to April 2026). Most US facilities have been surveyed by January 2027. This facility’s last Life Safety survey was November 2024. Nursing homes nationally are typically surveyed 12–17 months after the last one (median 14), measured over 19,385 consecutive surveys in the last two years of CMS records. HI has too few recent surveys to measure on its own, so the national interval is used.
A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured
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Physical environment (health survey)
3 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 2 Life Safety citations above. The Physical Environment Index
- F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- F-0584 Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
How that compares
Compared with the median facility in HI, and nationally. Surveyors differ markedly between states, so the HI figure is the meaningful one.
| Measure | Citations |
|---|---|
| This facility | 2 |
| Median facility in HI | 4 |
| Median facility nationally | 11 |
Survey history
| Survey date | Citations |
|---|---|
| September 30, 2022 | 1 |
| December 1, 2023 | 1 |
| November 22, 2024 | 0 |
Most-cited tags
| Tag | What the surveyor checks | Times cited | Last cited |
|---|---|---|---|
| K-0363 | Install corridor and hallway doors that block smoke. | 1 | 2022-09-30 |
| K-0914 | Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | 1 | 2023-12-01 |
What the citations cover
- Gas, Vacuum, and Electrical Systems Deficiencies 1
- Smoke Deficiencies 1
| Category | Citations |
|---|---|
| Gas, Vacuum, and Electrical Systems Deficiencies | 1 |
| Smoke Deficiencies | 1 |
Every citation on file
As published by CMS, newest survey first. Descriptions are CMS’s own wording.
December 1, 2023 — 1 citation
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0914 | Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Deficient, Provider has date of correction (January 14, 2024) |
September 30, 2022 — 1 citation
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0363 | Install corridor and hallway doors that block smoke. | Deficient, Provider has date of correction (December 28, 2022) |
Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.