State laws approved last year permitted the inspections, and in February, health department nurses began arriving without warning at adult residential care homes to check on some of Hawai'i's oldest residents.

They braced for a chilly reception but something unexpected happened: the nurses were welcomed without a problem and all sides now say the inspections seem to be a success.

Through June, none of the inspections has unearthed elder abuse or neglect. Only 12 of the homes were cited for problems. Most of the 77 "deficiencies," as officials call them, involved improper documentation, labeling of medicine and maintenance.

No problem was serious enough to close a home, said Dianne Okumura, head of the licensing section for the Office of Health Care Assurance, which oversees Hawai'i's 545 adult residential care homes.

Her nurses do not think anything is being hidden.

"The staff feels that going in unannounced is giving them a true picture of what the residents see on a day-to-day basis," Okumura said. "We are not seeing homes that are exceptionally dirty or anything like that. The homes are pretty clean."

The nurses like the visits — which last from 30 minutes to three hours — because they are simple and straightforward.

"It is more of an observation visit where they go in and look around to see if there is anything of concern," Okumura said.

All of the problems have been corrected and the care-home owners were told to provide a plan for how they would prevent them from reoccurring, Okumura said.

"What we are pleased about is we have not seen any serious resident care issues," Okumura said.

The idea of inspectors arriving unannounced had angered care-home owners for several years. At least 25 states allow unannounced inspections, but not in Hawai'i until this year.

Hawai'i's care-home owners were accustomed to getting a tentative schedule for annual relicensing inspections when former health director Bruce Anderson authorized unannounced annual inspections in November 1999.

But because other sections of the department's care-home rules were under review at the time, Anderson said the change could wait until those were finished.

Inspections were discussed by state regulators and care-home owners but nothing was resolved.

Last year, frustrated lawmakers crafted a compromise mandating unannounced visits to try to ensure the health and safety of the state's elderly residents. By design, the visits would be shorter than the annual inspection and presumably less traumatic for everyone.

Gallegos, the residential care-group president, said the first six months of the program have gone smoothly.

"I have had no complaints," Gallegos said. "The relationship with the Department of Health has really improved. They are doing a good job with the unannounced spot checks."

Last year, he said care-home owners feared their residents would be subjected to humiliating requests, such as disrobing to check for decubitus ulcers. Those ulcers, also known as pressure sores, have been linked to several neglect deaths since 1999.

None of that has happened.

Violet Sadural, a registered nurse who operates a care home in Salt Lake, believes the new visits are a good thing, but she has not had an inspector arrive at her doorstep unannounced.

The only problem is when a care-home owner leaves a qualified assistant in charge, because the assistant may be too nervous to answer questions from an inspector, Sadural said.

The care-home industry now is "more open," she said.

"I think that's the way to improve the industry," she said.

Shirley Souza, who supervises several of the nurses making visits, had always thought the program would run smoothly. Before they started, she and her nurses were more concerned about the nitty-gritty of what they would do once they arrived.

But they knew they wanted to spend more time with residents. In the past, when they would arrive for the annual inspection, the ones that were tentatively scheduled, the residents were not always in the home.

"Our main concern was to hopefully interview the residents, to sit down and literally talk story," Souza said. "To kind of have an overview of what is actually going on in the home."

The residents have been happy to see the nurses, she said —and most of the care-home owners, too.