North Auburn Care: Nail Care Documentation Failures - WA
The resident, identified in inspection records only as Resident 31, was found lying in bed on the morning of April 17, 2025, with their right foot exposed. The toenails were long enough to extend past the toes. Staff X, a certified nursing assistant who was present during the observation, confirmed what inspectors could see. Then Staff X removed the sock from the left foot. The same condition was there too.
What made the finding harder to explain was what the documentation showed. North Auburn Care's CNA task records for April 2025 required staff to log every day shift whether nail care had been provided to Resident 31. On April 15, two days before inspectors observed the overgrown toenails, a staff member had documented "Y" for yes, nail care was provided. The entry did not specify whether that care was to the resident's fingernails or toenails. It offered no detail about what was actually done or observed.
The care plan offered no guidance either. Resident 31's physician orders from April 16 and the Activities of Daily Living care plan from March 31 contained no directions about what nail care the resident needed, who was supposed to provide it, or when it should happen. The resident's February 2025 admission assessment had established that Resident 31 was cognitively impaired but could speak clearly, was usually understood, and could usually understand others. The assessment noted the resident needed supervision or hands-on assistance with personal hygiene. None of that translated into a specific plan for nail care.
When inspectors interviewed a staff member identified as Staff E on April 21, the explanation was that nail care should be done "as needed." Staff E said they expected CNAs to flag long toenails to a nurse if they noticed them, and expected nurses to catch the same problem during weekly skin checks and trim as needed.
What that system produced, in this case, was a resident whose toenails had grown past their toes while a daily checklist recorded that care was being given.
The gap between what the documentation said and what inspectors found sitting in plain view is the center of the violation. CMS rated the harm as minimal, and the inspection covered residents beyond Resident 31, noting that some residents were affected. But the mechanics of how this particular failure happened are worth following: a care plan with no specifics, a documentation field that accepted a yes-or-no answer without requiring detail, and an expectation that staff would notice and escalate a problem that the existing records suggested had already been addressed.
Staff E's account described a system that relied on observation and communication rather than scheduled, assigned, documented care. Nurses would catch it on weekly skin checks. CNAs would report it if they saw it. Someone would address it as needed. Resident 31's toenails suggest that chain did not hold.
The inspection was completed April 21, 2025. The facility, located at 2830 I Street Northeast in Auburn, is identified in CMS records under provider number 505195.
Resident 31 was cognitively impaired and needed help with hygiene. They could not independently manage their own nail care. The record said it had been done. A nursing assistant pulled back a sock and showed that it hadn't.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for North Auburn Care from 2025-04-21 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
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Last verified: October 29, 2026 · Our methodology
North Auburn Care in AUBURN, WA was cited for violations during a health inspection on April 21, 2025.
The resident, identified in inspection records only as Resident 31, was found lying in bed on the morning of April 17, 2025, with their right foot exposed.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.