Skilled nursing facility · CMS certification number 125057
Kulana Malama
EWA BEACH, Hawaii · Medicare and Medicaid
Certified beds, as filed in Care Compare: 33
Finances, as filed
From this facility’s Medicare cost reports on form CMS-2540, each figure with the worksheet, line and column it was read from.
Cost report for 1 January 2024 to 31 December 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 23 June 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $14,578,571 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $521,513 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $14,057,058 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $13,760,329 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $296,729 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $780,183 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,076,912 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,076,912 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 66 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 24,156 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicaid (Title XIX) patient days | 10,693 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 547 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 11,240 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicaid discharges | 19 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Total discharges, all components | 19 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 591.58 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1429813, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended 31 December 2023
Cost report for 1 February 2023 to 31 December 2023 — a reporting period of 333 days, on form CMS-2540-10, settled, processed by CMS on 22 August 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $11,293,617 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,484,007 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,809,610 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,616,992 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,807,382 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $379,342 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,428,040 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,428,040 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 9,096 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 15 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 606.4 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1392870, read from the public cost report file SNF10FY2023.zip.
Fiscal year 2021, ended 31 December 2021
Cost report for 1 January 2021 to 31 December 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 20 September 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $11,026,337 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $12,314 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,014,023 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,550,402 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $463,621 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $316,362 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $779,983 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $752,685 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,333 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 13 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 794.85 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1332962, read from the public cost report file SNF10FY2021.zip.
Fiscal year 2020, ended 31 December 2020
Cost report for 1 January 2020 to 31 December 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 24 November 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,626,920 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $372,821 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,254,099 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,444,948 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,190,849 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,446,497 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,255,648 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,233,328 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 9,962 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 14 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 711.57 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1305323, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended 31 December 2019
Cost report for 1 January 2019 to 31 December 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 20 November 2020.
None of these figures is carried on this report.
CMS report record 1274106, read from the public cost report file SNF10FY2019.zip.
Fiscal year 2018, ended 31 December 2018
Cost report for 1 January 2018 to 31 December 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 26 August 2019.
None of these figures is carried on this report.
CMS report record 1242285, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended 31 December 2017
Cost report for 1 January 2017 to 31 December 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 29 August 2018.
None of these figures is carried on this report.
CMS report record 1210909, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended 31 December 2016
Cost report for 1 January 2016 to 31 December 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 22 August 2017.
None of these figures is carried on this report.
CMS report record 1174499, read from the public cost report file SNF10FY2016.zip.
Fiscal year 2015, ended 31 December 2015
Cost report for 1 January 2015 to 31 December 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 26 August 2016.
None of these figures is carried on this report.
CMS report record 1142775, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended 31 December 2014
Cost report for 1 January 2014 to 31 December 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 25 August 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,835,091 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $529,649 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,305,442 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,241,980 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $63,462 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $577,148 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $640,610 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $640,489 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,310 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 22 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 468.64 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1108713, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended 31 December 2013
Cost report for 1 January 2013 to 31 December 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 9 September 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,780,461 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $496,879 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,283,582 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,104,106 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $179,476 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $436,002 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $615,478 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $605,620 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,115 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 30 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 337.17 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1077819, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended 31 December 2012
Cost report for 1 January 2012 to 31 December 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 16 August 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,815,897 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $711,319 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,104,578 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,100,671 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $3,907 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $167,916 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $171,823 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $165,271 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 90 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 9,938 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 29 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 342.69 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1046691, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended 31 December 2011
Cost report for 1 January 2011 to 31 December 2011 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 31 January 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,865,636 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $661,337 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,204,299 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,019,809 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $184,490 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $11,410 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $195,900 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $179,347 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 90 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,023 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 34 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, all patients, in days | 294.79 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1024359, read from the public cost report file SNF10FY2011.zip.
Fiscal year 2010, ended 31 December 2010
Cost report for 1 January 2010 to 31 December 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 1 August 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,013,480 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,764,761 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $248,719 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $124,977 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $40,359 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: $333,337 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 9,984 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 35 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 469 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 340.08 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 285.26 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 414197, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended 31 December 2009
Cost report for 1 January 2009 to 31 December 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 2 August 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,106,580 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,504,404 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $602,176 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $137,695 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $669 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: $739,202 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 30 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 787 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 8 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 103.5 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 72.25 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 98.38 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 384551, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended 31 December 2008
Cost report for 1 January 2008 to 31 December 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 31 August 2009.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,181,133 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,182,737 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$1,001,604 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $90,569 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $3,039 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: −$914,074 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 90 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 7,465 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 47 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 65.67 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 187.97 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 158.83 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 356000, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended 31 December 2007
Cost report for 1 May 2007 to 31 December 2007 — a reporting period of 244 days, not a full year, on form CMS-2540-96, settled, processed by CMS on 8 November 2010.
None of these figures is carried on this report.
CMS report record 389398, read from the public cost report file SNFFY2007.zip.
Nurse staffing
Nurse staffing hours from the Payroll-Based Journal, quarter by quarter, are on this facility’s staffing page, each quarter with the file it came from.
Ownership, as filed with CMS
Care Compare
As filed in the CMS file dated 1 August 2026 (Care Compare ownership).
| Owner or manager | Role | Type | Ownership percentage | Association |
|---|---|---|---|---|
| PACIFIC SKILLED HEALTHCARE LLC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | since 06/30/2022 |
| OLSEN, SPENCER | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 73% | since 06/30/2022 |
| SORENSEN, KRISTEN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 13% | since 06/30/2022 |
| ITO, RANDALL | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 02/01/2023 |
| LEFLER, TYRUS | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 09/23/2022 |
| OLSEN, SPENCER | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 09/23/2022 |
| PANG, BRIAN | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 02/01/2023 |
| YOSHIDA, CYNTHIA | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 02/01/2023 |
| ITO, RANDALL | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 02/01/2023 |
| ITO, RANDALL | W-2 MANAGING EMPLOYEE | Individual | NOT APPLICABLE | since 02/01/2023 |
Medicare enrollment
As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of PSH KM LLC (enrollment ID O20230405000474).
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| PACIFIC SKILLED HEALTHCARE LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100 | 6/30/2022 | Private equity company: No Real estate investment trust: No Holding company: No |
| AARON MAYER | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 15 | 6/30/2022 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| KRISTEN SORENSEN | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 12.5 | 6/30/2022 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| SPENCER E OLSEN | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 72.5 | 6/30/2022 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| BRIAN PANG | Individual | CORPORATE OFFICER | 0 | 2/1/2023 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| CYNTHIA LC YOSHIDA | Individual | CORPORATE OFFICER | 0 | 2/1/2023 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| RANDALL H ITO | Individual | CORPORATE OFFICER | 0 | 2/1/2023 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| SPENCER E OLSEN | Individual | CORPORATE OFFICER | 0 | 9/23/2022 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| TYRUS LEFLER | Individual | CORPORATE OFFICER | 0 | 9/23/2022 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| RANDALL H ITO | Individual | OPERATIONAL/MANAGERIAL CONTROL | 100 | 2/1/2023 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| RANDALL H ITO | Individual | W-2 MANAGING EMPLOYEE | 100 | 2/1/2023 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
Changes in ownership
- 1 July 2026: CYNTHIA LC YOSHIDA no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: CYNTHIA LC YOSHIDA appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 15 September 2023: RANDALL H ITO no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: MAEDENE S WAKABAYASHI no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: SHERRY LOO no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BRIAN PANG no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: ROBYN R MCKINNEY no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BYRON Y AOKI no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BYRON Y AOKI no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: ITO FAMILY HOLDINGS CORP no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: CYNTHIA LC YOSHIDA no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: AARON MAYER appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: KRISTEN SORENSEN appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: PACIFIC SKILLED HEALTHCARE LLC appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: TYRUS LEFLER appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BRIAN PANG appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: SPENCER E OLSEN appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: SPENCER E OLSEN appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: CYNTHIA LC YOSHIDA appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
Recent changes on this record
- 1 July 2026: CYNTHIA LC YOSHIDA no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: CYNTHIA LC YOSHIDA appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 23 June 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- 22 August 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- 31 October 2023: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2022.zip
- 15 September 2023: RANDALL H ITO no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: MAEDENE S WAKABAYASHI no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: SHERRY LOO no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BRIAN PANG no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: ROBYN R MCKINNEY no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BYRON Y AOKI no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BYRON Y AOKI no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: ITO FAMILY HOLDINGS CORP no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: CYNTHIA LC YOSHIDA no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: AARON MAYER appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: KRISTEN SORENSEN appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: RANDALL H ITO appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: PACIFIC SKILLED HEALTHCARE LLC appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: TYRUS LEFLER appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: BRIAN PANG appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: SPENCER E OLSEN appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: SPENCER E OLSEN appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 15 September 2023: CYNTHIA LC YOSHIDA appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-09-15.csv
- 20 September 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- 24 November 2021: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- 20 November 2020: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- 26 August 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- 29 August 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- 22 August 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- 26 August 2016: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- 25 August 2015: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 9 September 2014: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- 16 August 2013: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- 31 January 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-10. SNF10FY2011.zip
- 1 August 2011: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- 8 November 2010: A cost report was filed for fiscal year 2007, on form CMS-2540-96. SNFFY2007.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 6 June 2024 | 6 June 2024 | 9 | 0 |
| 2 | 23 June 2023 | 23 June 2023 | 11 | 0 |
| 3 | 15 July 2022 | 15 July 2022 | 5 | 0 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
25 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 26 September 2025 | Health | F 0842 | Resident Assessment and Care Planning Deficiencies | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | Yes | Deficient, Provider has date of correction | 7 November 2025 |
| 18 June 2025 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Yes | Deficient, Provider has date of correction | 20 June 2025 |
| 18 June 2025 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Yes | Past Non-Compliance | 30 March 2025 |
| 18 June 2025 | Health | F 0713 | Nursing and Physician Services Deficiencies | Provide or arrange emergency care by a doctor 24 hours a day. | D | Yes | Deficient, Provider has date of correction | 20 June 2025 |
| 18 June 2025 | Health | F 0726 | Nursing and Physician Services Deficiencies | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | J | Yes | Deficient, Provider has date of correction | 20 June 2025 |
| 18 June 2025 | Health | F 0867 | Administration Deficiencies | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | D | Yes | Deficient, Provider has date of correction | 20 June 2025 |
| 6 June 2024 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | No | Deficient, Provider has date of correction | 28 July 2024 |
| 6 June 2024 | Health | F 0584 | Resident Rights Deficiencies | 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. | D | No | Deficient, Provider has date of correction | 28 July 2024 |
| 6 June 2024 | Health | F 0661 | Resident Assessment and Care Planning Deficiencies | Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | D | No | Deficient, Provider has date of correction | 28 July 2024 |
| 6 June 2024 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | No | Deficient, Provider has date of correction | 28 July 2024 |
| 6 June 2024 | Health | F 0760 | Pharmacy Service Deficiencies | Ensure that residents are free from significant medication errors. | D | No | Past Non-Compliance | 7 January 2024 |
| 6 June 2024 | Health | F 0791 | Quality of Life and Care Deficiencies | Provide or obtain dental services for each resident. | D | No | Deficient, Provider has date of correction | 28 July 2024 |
| 6 June 2024 | Health | F 0842 | Resident Assessment and Care Planning Deficiencies | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | No | Deficient, Provider has date of correction | 28 July 2024 |
| 6 June 2024 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 28 July 2024 |
| 23 June 2023 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | No | Deficient, Provider has date of correction | 14 July 2023 |
| 23 June 2023 | Health | F 0693 | Quality of Life and Care Deficiencies | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | D | No | Deficient, Provider has date of correction | 14 July 2023 |
| 23 June 2023 | Health | F 0761 | Pharmacy Service Deficiencies | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | D | No | Deficient, Provider has date of correction | 14 July 2023 |
| 23 June 2023 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | F | No | Deficient, Provider has date of correction | 14 July 2023 |
| 23 June 2023 | Health | F 0887 | Infection Control Deficiencies | Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | D | No | Deficient, Provider has date of correction | 14 July 2023 |
| 23 June 2023 | Health | F 0908 | Environmental Deficiencies | Keep all essential equipment working safely. | E | No | Deficient, Provider has date of correction | 14 July 2023 |
| 15 July 2022 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | No | Deficient, Provider has date of correction | 26 August 2022 |
| 15 July 2022 | Health | F 0609 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | E | No | Deficient, Provider has date of correction | 26 August 2022 |
| 15 July 2022 | Health | F 0623 | Resident Rights Deficiencies | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | E | No | Deficient, Provider has date of correction | 26 August 2022 |
| 15 July 2022 | Health | F 0625 | Resident Rights Deficiencies | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. | D | No | Deficient, Provider has date of correction | 26 August 2022 |
| 15 July 2022 | Health | F 0761 | Pharmacy Service Deficiencies | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | E | No | Deficient, Provider has date of correction | 26 August 2022 |
From the Care Compare health citations file NH_HealthCitations_Aug2026.csv, processed on 1 August 2026.
Penalties
| Penalty date | Type | Fine amount | Payment denial began | Payment denial, days | Fine ID |
|---|---|---|---|---|---|
| 18 June 2025 | Fine | $14,069 | 134198 |
From the Care Compare penalties file NH_Penalties_Aug2026.csv, processed on 1 August 2026.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | For profit - Limited Liability company |
| Legal Business Name | PSH KM LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 2007-05-01 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | Y |
| County/Parish | Honolulu |
| Telephone Number | 8086811200 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | None |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Number of Certified Beds | 33 |
| Average Number of Residents per Day | 33.5 |
| Overall Rating | 5 |
| Health Inspection Rating | 4 |
| QM Rating | 5 |
| Long-Stay QM Rating | 5 |
| Processing Date | 2026-08-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.
Get an email when this record changes
One email a day naming what moved on Kulana Malama: the field, the value before, the value after, and the date of the file that first showed it.
The facility alert follows this one record: a cost report filed or a figure on one changed, an inspection, a deficiency or a penalty recorded, an owner added or removed. The certification number arrives filled in.
On 1 July 2026: CYNTHIA LC YOSHIDA no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. That is one line of the alert.
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The citable document for Kulana Malama
This page shows the record as it stands today. The report is the citable document: the same figures with the cell each came from, and beyond this page — five facilities of a similar size in Hawaii at the same fiscal year, listed by name; every change on the record rather than the recent ones below; the inspection and staffing history in blocks of their own; and a citation block naming every CMS file it was read from.
Every figure on this page is printed as it appears in the CMS file named beside it. A figure that does not match its file? Tell us on the corrections page, quoting certification number 125057.