Auburn Post Acute
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Nurse's Assistant assigned to Resident 1 on 08/02/2025 from 2pm to 08/03/2025 at 6 am) were interviewed and stated they last saw Resident 1 around midnight in the resident's room. (Review of the security footage did not show Resident 1 returning to the facility.) The investigation showed on 08/03/2025 at 7:10 PM Staff B was notified that a phone call was received that a person that fit the description of the resident was found down the street in a residential backyard. A neighbor confirmed Resident 1 was seen on 08/02/2025 at 9:15 PM in the same spot where they were discovered on 08/03/2025 at 7:10 PM. The investigation showed Resident 1 was sent to the hospital for an evaluation that showed a minor skin issue.Review of Resident 1's clinical record showed on 08/02/2025, Staff C documented every half hour from 6:30 PM to 6:00 AM on 08/03/2025 that safety checks were performed on Resident 1.In an observation and interview on 08/11/2025 at 2:00 PM, Resident 1 was observed sitting in their wheelchair in their room with a wander guard bracelet on the left wrist. When asked what happened to their upper right arm, Resident 1 stated they did not recall. Resident 1's right upper arm was observed with slightly red discoloration and scabbed areas.
When asked about the elopement Resident 1 was not able to give any details or information as they did not recall the incident. Attempts to interview Resident 1's collateral contact were unsuccessful.During an
interview on 08/18/2025 at 11:42 AM, Staff A (Administrator) stated the facility front doors were locked and
an alarm was triggered when the door push bar was engaged and someone exited the facility. Staff A stated when a resident was not located in the facility, they would expect staff to follow the facility's protocol and activate a code white. When the resident was not found within fifteen minutes staff were expected to call the DNS, Administrator, local authorities, the facility medical director, and the resident representative.
Staff A stated Staff C and Staff D were primarily responsible for the care and safety for Resident 1 and both failed to monitor the residents' location. Staff A stated security measures, such as the locked and alarmed door and the residents' wander guard were all functioning properly at the time of the incident, but staff failed to investigate the front door wander guard alarm which enabled Resident 1 to leave the facility unattended.
Attempts to interview Staff C and Staff D who were responsible for Resident 1 during the time of the incident was unsuccessful as both were unavailable. REFERENCE: WAC 388-97- 1060(1)(3)(g) .
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AUBURN POST ACUTE in AUBURN, WA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in AUBURN, WA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from AUBURN POST ACUTE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.