Samuel Mahelona Memorial Hospital — nursing home in Kapaa, HI

Facility type: Nursing home · SNF / NF
CMS provider type: Medicare and Medicaid
Certified beds: 66 CMS-certified beds (not state-licensed beds)
Licensed beds: State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead.
Average residents per day: 46.9 CMS, MDS-derived
CMS Certification Number: 125029
Certification status: Active CMS certification Verified
First approved (Medicare/Medicaid): Jul 15, 1976
Ownership type: Government - State
Operator (legal business name): Samuel Mahelona Memorial Hospital
CMS chain: Not part of a CMS-reported chain
Phone: (808) 822-4961
Resident & family council: Resident
Sprinklers in all required areas: Yes
Official profile: Medicare Care Compare ↗

Inspection record · CMS window

Verified

Inspections

6

latest May 14, 2026

Citations

20

18 health · 2 fire

Harm or worse

1

no immediate jeopardy

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G1	H·	I·
Potential harm	D14	E4	F1
Minimal	A·	B·	C·

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

CMS Five-Star ratings

Federal · CMS

Overall

Health inspections

Staffing

Quality measures

Penalties · about the last 3 years

Fines

1

$17,155

Payment denials

0

Latest

May 14, 2026

Federal certification

Federal · CMS

Authority: Centers for Medicare & Medicaid Services (CMS), surveyed by the state survey agency
CCN: 125029
Program: Medicare and Medicaid
Medicare (SNF): Certified
Medicaid (NF): Certified
Certified beds: 66
First approved: Jul 15, 1976
Located in a hospital: Yes
Status: Active CMS certification as of CMS release Oct 1, 2026
Evidence: Verified

State license

State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead. State coverage for Hawaii.

Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

Date	Domain	Survey types	Citations	Most severe	Open
May 14, 2026	Health	Health Complaint, Health Standard	8	Actual harm	—	Open →
Nov 22, 2024	Fire safety	Fire Safety Standard	0	No citations	—	Open →
Nov 22, 2024	Health	Health Standard	4	Potential harm	1	Open →
Dec 1, 2023	Fire safety	Fire Safety Standard	1	Potential harm	—	Open →
Dec 1, 2023	Health	Health Complaint, Health Standard	6	Potential harm	—	Open →
Sep 30, 2022	Fire safety	Fire Safety Standard	1	Potential harm	—	Open →

Enforcement

Penalties

Civil money penalties and denials of payment for new admissions, as published by CMS (about the last three years). Amounts may change on appeal.

Date	Type	Amount	Payment denial	Record
May 14, 2026	Civil money penalty (fine)	$17,155	—	125029\|Fine\|145832

Scope × severity

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G1	H·	I·
Potential harm	D14	E4	F1
Minimal	A·	B·	C·

By concept

Date	Tag	Deficiency	Scope / severity	Correction	Flags
May 14, 2026	F-0689	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care	G · Actual harm Isolated	Corrected Jun 26, 2026	Complaint
May 14, 2026	F-0552	Ensure that residents are fully informed and understand their health status, care and treatments. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jun 26, 2026
May 14, 2026	F-0628	Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jun 26, 2026
May 14, 2026	F-0656	Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care	E · Potential harm Pattern	Corrected Jun 26, 2026
May 14, 2026	F-0761	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. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Jun 26, 2026
May 14, 2026	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	E · Potential harm Pattern	Corrected Jun 15, 2026
May 14, 2026	F-0883	Develop and implement policies and procedures for flu and pneumonia vaccinations. Infection Control Deficiencies · Infection prevention	D · Potential harm Isolated	Corrected Jun 26, 2026
May 14, 2026	F-0887	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. Infection Control Deficiencies · Infection prevention	D · Potential harm Isolated	Corrected Jun 26, 2026
Nov 22, 2024	F-0584	Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jan 3, 2025
Nov 22, 2024	F-0761	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. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Dec 27, 2024
Nov 22, 2024	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	E · Potential harm Pattern	Plan of correction, not yet verified Dec 20, 2024
Nov 22, 2024	F-0842	Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Dec 27, 2024
Dec 1, 2023	K-0914	Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jan 14, 2024
Dec 1, 2023	F-0578	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. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jan 5, 2024
Dec 1, 2023	F-0584	Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jan 5, 2024
Dec 1, 2023	F-0609	Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jan 5, 2024	Complaint
Dec 1, 2023	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	F · Potential harm Widespread	Corrected Jan 5, 2024
Dec 1, 2023	F-0842	Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jan 5, 2024
Dec 1, 2023	F-0883	Develop and implement policies and procedures for flu and pneumonia vaccinations. Infection Control Deficiencies · Infection prevention	D · Potential harm Isolated	Corrected Jan 5, 2024
Sep 30, 2022	K-0363	Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Dec 28, 2022

“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.

Five-Star ratings

Federal · CMS

Overallstate 3.8

Health inspectionsstate 3

Staffingstate 4.5

Quality measuresstate 4.4

Long-stay QM

Short-stay QMNot rated

CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.

Nurse staffing · hours per resident per day

Total nurse staffing6.20

State avg 4.99US avg 3.90

Registered nurse (RN)2.27

State avg 1.73US avg 0.69

Licensed practical nurse0.38

State avg 0.35US avg 0.86

Nurse aide3.54

State avg 2.91US avg 2.35

Weekend total nurse5.65

State avg 4.41US avg 3.43

Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 7.06 (case-mix index 1.23).

Staff turnover

Total nursing staff turnover7.3%

State avg 34.5%US avg 45.3%

Registered nurse turnover4.8%

State avg 30.5%US avg 42.5%

Administrators who leftNot reported

State avg 0US avg 1

Health survey score

Cycle 1 standard survey: May 14, 2026
Cycle 1 health score: 56
Total weighted score: 48

Operating entity

Samuel Mahelona Memorial Hospital

CMS legal business name of the certified provider. Operates this facility only.

VerifiedLinked by exact legal name

CMS chain

Not part of a CMS-reported chain.

Ownership disclosures

Disclosures

16

Organizations

1

Individuals

14

Direct & indirect ownership

Owners of record

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Samuel Mahelona Memorial Hospital	Organization	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	100%	Mar 17, 2017

CMS Ownership file

All disclosed roles

Operator, owners, managers, officers and lenders are distinct roles and are never flattened into one entity. Organizations link across facilities by exact normalized legal name; individuals are listed per facility only.

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Samuel Mahelona Memorial Hospital	Organization	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	100%	Mar 17, 2017
Walter Barnes	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Jan 1, 2023
Ernest Kanekoa	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Nov 1, 2020
Glenda Nogami-Streufert	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Nov 1, 2020
Donna Okada-Asher	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Dec 7, 2015
Theodor Rintel	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Feb 13, 2023
Dennis Rowley	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Jul 1, 2023
Christopher Yuh	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Apr 1, 2024
Samuel Mahelona Memorial Hospital	Organization	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Apr 1, 2015
Christine Asato	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Apr 1, 2018
Nicholas Franklin	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Aug 16, 2022
Lance Segawa	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Apr 1, 2018
Christine Asato	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Apr 1, 2018
Lance Segawa	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Apr 1, 2018
Nicholas Franklin	Individual	Additional disclosable party	ADP OF THE SNF	not provided	Jan 30, 2025
Lance Segawa	Individual	Additional disclosable party	ADP OF THE SNF	not provided	Jan 29, 2025

No building or property record is linked to this facility yet. Parcel, assessor and building-permit joins will be added only where a valid site match exists.

Coordinates as published by CMS.

Address: 4800 Kawaihau Road, Kapaa, HI 96746
ZIP: 96746
County: Kauai County FIPS 15007
State: Hawaii
Urban / rural (CMS): Rural

Within ~25 km

Nearby nursing homes

Facility	Distance	Beds	CMS overall	Last inspection	Citations (window)	Fines
Garden Isle Healthcare and Rehabilitation Center 3-3420 Kuhio Highway, Suite 300, Lihue, HI 96766 CCN 125004	13.6 km	110		Feb 21, 2025	39	—

Source	Record	Facts	Evidence	Source release	Retrieved
CMS Provider Information US-CMS	125029	name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain	Verified	Oct 1, 2026	Nov 7, 2026
CMS Provider Information US-CMS	125029	ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only.	Verified	Oct 1, 2026	Nov 7, 2026

Record-level source links for CCN 125029

First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction