Skilled nursing facility · CMS certification number 125059
Palolo Chinese Home
HONOLULU, Hawaii · Medicare and Medicaid
Certified beds, as filed in Care Compare: 113
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 29 August 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $21,555,910 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,909,313 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $18,646,597 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $22,025,777 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$3,379,180 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,873,750 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$505,430 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$505,430 (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 | 130 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 47,580 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,908 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 12,840 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 24,297 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 39,045 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 57 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 32 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 312 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 401 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 33.47 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 401.25 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 97.37 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1436533, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended 31 December 2023
Cost report for 1 January 2023 to 31 December 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 23 August 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $19,001,619 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,444,787 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,556,832 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $20,467,744 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$4,910,912 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $5,852,785 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $941,873 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $941,873 (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 | 130 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 37,774 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 415 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 27.42 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 468.71 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 91.02 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1392974, read from the public cost report file SNF10FY2023.zip.
Fiscal year 2022, ended 31 December 2022
Cost report for 1 January 2022 to 31 December 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 30 August 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $18,046,413 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,874,639 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,171,774 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $21,239,028 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$6,067,254 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,909,221 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$3,158,033 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$3,635,733 (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 | 130 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 38,348 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 350 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 27.42 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 538.48 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 109.57 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1363590, read from the public cost report file SNF10FY2022.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 23 September 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $18,090,083 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,007,301 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,082,782 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $18,687,370 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$3,604,588 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $5,477,466 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,872,878 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,872,878 (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 | 131 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 39,143 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 375 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 29.19 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 548.38 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 104.38 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1333790, 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 10 November 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $20,313,783 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $4,418,454 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,895,329 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $18,375,374 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,480,045 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,754,875 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $274,830 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $274,830 (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 | 131 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 42,140 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 403 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.75 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 486.13 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 104.57 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1304140, 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 30 October 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $19,488,494 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,601,378 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,887,116 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $16,962,405 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,075,289 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,444,740 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,369,451 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,369,451 (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 | 131 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 44,793 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 436 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 28.8 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 661.1 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 102.74 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1272851, 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 30 July 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $18,229,150 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,789,214 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,439,936 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $16,616,833 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,176,897 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,809,300 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $632,403 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $476,796 (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 | 130 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 43,615 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 521 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 26.99 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 607.93 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 83.71 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1238768, 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 21 August 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $18,167,187 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,144,257 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $16,022,930 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $16,126,914 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$103,984 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $830,830 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $726,846 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $726,846 (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 | 130 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 42,890 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 574 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 26.78 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 411.38 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 74.72 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1208484, 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 21 July 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,020,888 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,282,187 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $10,738,701 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,765,963 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,027,262 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,973,678 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $946,416 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $946,416 (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 | 130 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 32,495 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 294 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 30.46 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 119.4 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 110.53 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1170364, 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 17 August 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,208,470 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,323,118 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $10,885,352 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,256,742 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$371,390 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,385,352 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,013,962 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,013,962 (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 | 111 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 35,331 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 370 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 31.98 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 663.88 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 95.49 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1141673, 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 22 September 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,089,745 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,422,337 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $10,667,408 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,836,594 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$169,186 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,408,719 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,239,533 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,239,533 (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 | 111 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 38,023 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 248 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 40.13 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,573.5 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 153.32 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1110598, 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 29 August 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,839,692 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$723,890 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,563,582 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,508,540 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$944,958 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,689,684 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $744,726 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $744,726 (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 | 111 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 37,657 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 274 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 37.85 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 2,272 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 137.43 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1077351, 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 | $9,329,894 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $9,329,894 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,818,427 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,488,533 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $812,877 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$675,656 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$675,656 (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 | 111 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 36,710 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 216 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 45.19 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,229.2 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 169.95 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1046611, 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 24 January 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,576,712 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $9,576,712 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,330,237 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$753,525 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $20,849 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$732,676 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$732,676 (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 | 111 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 36,383 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 225 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 55.94 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 543.31 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 161.7 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1023615, 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 17 August 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $8,636,546 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,302,482 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$665,936 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $2,661,480 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $1,995,544 (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 | 111 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 31,034 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 236 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 58.07 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 397.61 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 131.5 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 415635, 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 27 July 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,942,240 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,682,111 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$739,871 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $999,915 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $260,044 (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 | 111 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 23,982 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 230 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 17.88 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 116.25 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 104.27 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 383739, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended 31 December 2008
Cost report for 13 June 2008 to 31 December 2008 — a reporting period of 201 days, not a full year, on form CMS-2540-96, settled, processed by CMS on 17 September 2009.
None of these figures is carried on this report.
CMS report record 356856, read from the public cost report file SNFFY2008.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 |
|---|---|---|---|---|
| PALOLO CHINESE HOME | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | since 01/01/1966 |
| AU, GORDON | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/07/2008 |
| BACKUS, PETER | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2014 |
| BLANCHETTE, PATRICIA | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/07/2008 |
| CHING, ANTHONY | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2017 |
| GOO, FRANCES | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/1996 |
| HWANG, RENA | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2020 |
| LAU, RUSSELL JAMES | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/07/2008 |
| LEE, GLADYS | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2008 |
| LEE, LENORA | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2019 |
| LO, ELVIRA | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2020 |
| MOATS, ANDREW | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2017 |
| OSHIMA, ISOO | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2015 |
| SCHMIDT, JEFFREY | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2013 |
| SIMON, GARY | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2019 |
| SMITH, DOUGLAS | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2014 |
| SOUZA, SANDRA | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2021 |
| TOKIOKA, TYLER | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2019 |
| TSEU, LAWRENCE | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/07/2008 |
| WATANABE, ERIC | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/07/2008 |
| WONG, STACEY | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2021 |
| WOO, BENJAMIN | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2019 |
| YEE, REGINALD | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2018 |
| NAKAYAMA, DARLENE | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 12/18/2003 |
| NAKAYAMA, DARLENE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 05/29/2014 |
Medicare enrollment
As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of PALOLO CHINESE HOME (enrollment ID O20080116000313).
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| PALOLO CHINESE HOME | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100 | 1/1/1966 | Private equity company: No Real estate investment trust: No Holding company: No |
| ANDREW MOATS | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2017 | 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. |
| ANTHONY CHING | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2017 | 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. |
| BENJAMIN WOO | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2019 | 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. |
| DOUGLAS SMITH | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2014 | 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. |
| ELVIRA LO | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2020 | 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. |
| ERIC WATANABE | Individual | CORPORATE DIRECTOR | 5.5 | 1/7/2008 | 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. |
| FRANCES GOO | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/1996 | 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. |
| GARY SIMON | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2019 | 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. |
| GLADYS LEE | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2008 | 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. |
| GORDON AU | Individual | CORPORATE DIRECTOR | 5.5 | 1/7/2008 | 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. |
| ISOO OSHIMA | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2015 | 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. |
| JEFFREY SCHMIDT | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2013 | 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. |
| LAWRENCE TSEU | Individual | CORPORATE DIRECTOR | 5.5 | 1/7/2008 | 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. |
| LENORA LEE | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2019 | 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. |
| PATRICIA A BLANCHETTE | Individual | CORPORATE DIRECTOR | 5.5 | 1/7/2008 | 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. |
| PETER BACKUS | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2014 | 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. |
| REGINALD YEE | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2018 | 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. |
| RENA HWANG | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2020 | 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. |
| RUSSELL JAMES LAU | Individual | CORPORATE DIRECTOR | 5.5 | 1/7/2008 | 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. |
| SANDRA SOUZA | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2021 | 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. |
| STACEY WONG | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2021 | 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. |
| TYLER TOKIOKA | Individual | CORPORATE DIRECTOR | 5.5 | 1/1/2019 | 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. |
| DARLENE NAKAYAMA | Individual | CORPORATE OFFICER | 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. | 12/18/2003 | 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. |
| DARLENE NAKAYAMA | Individual | OPERATIONAL/MANAGERIAL CONTROL | 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. | 5/29/2014 | 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. |
| DARLENE NAKAYAMA | Individual | OTHER | 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. | 1/1/2018 | 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: LAWRENCE TSEU no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PETER BACKUS no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PALOLO CHINESE HOME no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: ANDREW MOATS no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: LAWRENCE TSEU appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PETER BACKUS appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PALOLO CHINESE HOME appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: ANDREW MOATS appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 September 2024: ROGER LIU no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv
- 1 September 2024: PETER FONG no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv
Recent changes on this record
- 1 July 2026: LAWRENCE TSEU no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PETER BACKUS no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PALOLO CHINESE HOME no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: ANDREW MOATS no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: LAWRENCE TSEU appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PETER BACKUS appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: PALOLO CHINESE HOME appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: ANDREW MOATS appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 29 August 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- 1 September 2024: ROGER LIU no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv
- 1 September 2024: PETER FONG no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv
- 23 August 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- 30 August 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- 23 September 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- 10 November 2021: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- 30 October 2020: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- 30 July 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- 21 August 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- 21 July 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- 17 August 2016: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- 22 September 2015: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 29 August 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
- 24 January 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-10. SNF10FY2011.zip
- 17 August 2011: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- 27 July 2010: A cost report was filed for fiscal year 2009, on form CMS-2540-96. SNFFY2009.zip
- 17 September 2009: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2008.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 1 May 2025 | 1 May 2025 | 21 | 0 |
| 2 | 7 March 2024 | 7 March 2024 | 13 | 3 |
| 3 | 31 March 2023 | 31 March 2023 | 14 | 5 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
48 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 22 May 2026 | Health | F 0600 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Yes | Deficient, Provider has no plan of correction | |
| 22 May 2026 | 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. | D | Yes | Deficient, Provider has no plan of correction | |
| 22 May 2026 | Health | F 0728 | Nursing and Physician Services Deficiencies | Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training. | D | Yes | Deficient, Provider has no plan of correction | |
| 22 May 2026 | Health | F 0729 | Nursing and Physician Services Deficiencies | Verify that a nurse aide has been trained; and if they haven't worked as a nurse aide for 2 years, receive retraining. | D | Yes | Deficient, Provider has no plan of correction | |
| 5 September 2025 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | G | Yes | Deficient, Provider has date of correction | 9 October 2025 |
| 5 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 | 9 October 2025 |
| 23 May 2025 | Health | F 0583 | Resident Rights Deficiencies | Keep residents' personal and medical records private and confidential. | D | Yes | Deficient, Provider has date of correction | 13 June 2025 |
| 23 May 2025 | Health | F 0585 | Resident Rights Deficiencies | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | E | Yes | Deficient, Provider has date of correction | 13 June 2025 |
| 23 May 2025 | Health | F 0607 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | E | Yes | Deficient, Provider has date of correction | 13 June 2025 |
| 23 May 2025 | 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. | D | Yes | Deficient, Provider has date of correction | 13 June 2025 |
| 23 May 2025 | Health | F 0610 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Respond appropriately to all alleged violations. | D | Yes | Deficient, Provider has date of correction | 13 June 2025 |
| 1 May 2025 | 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 | 2 June 2025 |
| 1 May 2025 | Health | F 0558 | Resident Rights Deficiencies | Reasonably accommodate the needs and preferences of each resident. | D | No | Deficient, Provider has date of correction | 28 May 2025 |
| 1 May 2025 | Health | F 0561 | Resident Rights Deficiencies | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | D | No | Deficient, Provider has date of correction | 2 June 2025 |
| 1 May 2025 | Health | F 0578 | Resident Rights Deficiencies | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | D | No | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 2025 | 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 | 30 May 2025 |
| 1 May 2025 | Health | F 0641 | Resident Assessment and Care Planning Deficiencies | Ensure each resident receives an accurate assessment. | D | Yes | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 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 | No | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 2025 | Health | F 0657 | Resident Assessment and Care Planning Deficiencies | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | Yes | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 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 | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 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. | D | Yes | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 2025 | 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 | 30 May 2025 |
| 1 May 2025 | Health | F 0803 | Nutrition and Dietary Deficiencies | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | D | No | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 2025 | Health | F 0805 | Nutrition and Dietary Deficiencies | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | D | No | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 2025 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | D | No | Deficient, Provider has date of correction | 30 May 2025 |
| 1 May 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 30 May 2025 |
| 22 November 2024 | 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 | 12 December 2024 |
| 22 November 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 | Yes | Deficient, Provider has date of correction | 12 December 2024 |
| 26 July 2024 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Yes | Deficient, Provider has date of correction | 30 August 2024 |
| 26 July 2024 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | Yes | Deficient, Provider has date of correction | 30 August 2024 |
| 7 March 2024 | Health | F 0604 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | D | No | Deficient, Provider has date of correction | 28 March 2024 |
| 7 March 2024 | 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. | D | No | Deficient, Provider has date of correction | 28 March 2024 |
| 7 March 2024 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | No | Deficient, Provider has date of correction | 28 March 2024 |
| 7 March 2024 | 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 | 28 March 2024 |
| 7 March 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 March 2024 |
| 7 March 2024 | Health | F 0908 | Environmental Deficiencies | Keep all essential equipment working safely. | D | No | Deficient, Provider has date of correction | 28 March 2024 |
| 31 March 2023 | 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. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | 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 | 21 April 2023 |
| 31 March 2023 | Health | F 0641 | Resident Assessment and Care Planning Deficiencies | Ensure each resident receives an accurate assessment. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 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 | 21 April 2023 |
| 31 March 2023 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | Health | F 0756 | Pharmacy Service Deficiencies | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | Health | F 0757 | Pharmacy Service Deficiencies | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | Health | F 0759 | Pharmacy Service Deficiencies | Ensure medication error rates are not 5 percent or greater. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | Health | F 0885 | Infection Control Deficiencies | Report COVID19 data to residents and families. | E | No | Deficient, Provider has date of correction | 21 April 2023 |
| 31 March 2023 | Health | F 0886 | Infection Control Deficiencies | Perform COVID19 testing on residents and staff. | D | No | Deficient, Provider has date of correction | 21 April 2023 |
From the Care Compare health citations file NH_HealthCitations_Aug2026.csv, processed on 1 August 2026.
Penalties
Not yet extracted for this facility.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | For profit - Corporation |
| Legal Business Name | PALOLO CHINESE HOME |
| Date First Approved to Provide Medicare and Medicaid Services | 2008-06-13 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | Y |
| County/Parish | Honolulu |
| Telephone Number | 8087372555 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | Both |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Number of Certified Beds | 113 |
| Average Number of Residents per Day | 96.7 |
| Overall Rating | 2 |
| Health Inspection Rating | 2 |
| QM Rating | 4 |
| Long-Stay QM Rating | 5 |
| Short-Stay QM Rating | 4 |
| Processing Date | 2026-08-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.
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On 1 July 2026: LAWRENCE TSEU no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. That is one line of the alert.
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The citable document for Palolo Chinese Home
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