North Auburn Care
North Auburn Care in AUBURN, WA — inspection on April 21, 2025.
Found 5 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Findings included .
<Facility Policy>
According to a facility policy titled, Safety Device Application, revised 04/07/2023, showed the facility would apply the safety device as directed.
The policy showed staff would follow the safety device Care Plan (CP) and interventions.
According to a facility policy titled, Wound Prevention and Treatment, revised 02/03/2023, the facility would reduce the occurrence of pressure over bony prominence to minimize injury, manage risk factors, and provide preventive interventions.
The policy showed the staff would ensure residents received continuous preventative interventions to promote healing and prevent skin issues.
<Resident 6>
According to a 01/04/2025 Annual Minimum Data Set (MDS - an assessment tool) Resident 6 had no memory impairment.
The MDS showed Resident 6 was at risk of developing PUs and had three PUs.
Review of Resident 6's health records showed a 04/22/2023 physician order for air mattress settings to be at alternate level 5 and staff would check for correct settings every shift.
Residents 6's records showed a 10/24/2023 air mattress CP with an intervention for staff to monitor appropriate functioning of air mattress every shift. Resident 6's records showed a 03/05/2025 right heel PU CP with an intervention for staff to frequently reposition the resident to prevent new PU's or worsening of active PUs.
In an observation and interview on 04/14/2025 at 9:25 AM showed Resident 6's air mattress settings at float level 8.
Staff S (Registered Nurse) stated Residents 6's air mattress should be at alternate level 5.
Staff S stated nursing staff were responsible for checking the air mattress settings every shift to ensure they were set per physician orders to prevent skin breakdown.
In an interview on 04/14/2025 at 12:51 PM Resident 6 stated they depended on staff to reposition them in their bed with the air mattress. Resident 6 stated the staff were supposed to reposition them every two to three hours but often did not.
In a continuous observation on 04/17/2025 from 7:56 AM until 12:06 PM Resident 6 was lying in bed flat on their back.
505195
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 505195 B.
Wing 04/21/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002
F-F658 - Services Provided Meet Professional Standards.
Refer to
Findings included .
<Facility Policy>
Record review of the facility policy titled, Smoking, revised 06/2023, showed the facility would screen all residents for smoking via the nursing admission evaluation.
Residents who wished to continue smoking would have smoking reflected in their care plan.
The policy showed the facility would store all smoking materials in a locked storage cabinet in the resident's room, at the nurse's station, or another designated location in the facility.
<Resident 62>
According to the 01/03/2025 Admission Minimum Data Set (MDS - an assessment tool), Resident 62 had clear speech, their memory was intact, and they understood others during communication.
The MDS showed Resident 62 required one person assistance with transfers, toileting, and bed mobility.
The MDS showed Resident 62 used a wheelchair for mobility.
In an interview on 04/14/2025 at 10:57 AM, Resident 62 stated they smoked once or twice a day and had their smoking materials in a drawer in their room. Resident 62 stated they knew the rule to not smoke on facility property and they had to go 50 feet away from the facility property.
Review of Resident 62's record showed Resident 62 did not have a smoking assessment completed.
Review of a Social Services evaluation completed on 03/31/2025 showed Resident 62 as a smoker.
In an interview on 04/16/2025 at 7:44 AM, Resident 62 stated the facility staff knew they smoked. Resident 62 stated the facility staff provided them with a metal lock box to keep their smoking materials in their room in a drawer. Resident 62 stated they last smoked yesterday around 5:00 PM.
Observation on 04/16/2025 at 7:50 AM showed Resident 62 had a curtain of cigarettes and a lighter in a metal box in a drawer in Resident 62's room.
In an interview on 04/16/2025 at 8:44 AM, Staff G (Social Services Director) stated Resident 62 was not smoking currently.
Staff G stated Resident 62 was found vaping outside the facility a couple of months ago and it was discussed with the resident that the facility was a non-smoking facility.
Staff G stated they were not aware of Resident 62 currently smoking or of the lock box in their room.
In an interview on 04/16/2025 at 9:10 AM, Staff B (Director of Nursing) stated they were a non-smoking facility and everyone had to follow the facility policy.
505195
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 505195 B.
Wing 04/21/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002
Findings included .
<Failure to Follow/Clarify Physician Orders>
<Resident 52>
Resident 52 admitted to the facility on [DATE] and according to the most recent Quarterly Minimum Data Set (MDS-an assessment tool) received regularly scheduled and as needed pain medication.
Review of March 2025 Medication Administration Records (MARs) showed a Physician's Order for a pain patch Apply to bilateral (both) knees topically one time a day for Pain Do not exceed 3 patches for up to 12 hours (hr) with 24 hr period.
Wash hands after handling and remove per schedule.
The order directed staff to apply the patches at 9:00 AM and remove them at 5:59 AM next morning.
According to the MAR, staff applied the patches for 15 hours per day rather than the 12 hours as directed.
A second order directed staff to apply a pain patch to Bilateral shoulders topically one time a day for (joint disease). Do not exceed 3 patches for up to 12 hrs with 24 hr period.
Wash hands after handling and remove per schedule.
This order similarly directed staff to apply the patches at 9:00 AM and remove them at 5:59 AM.
According to the MAR, staff applied the patches for 15 hours per day rather than the 12 hours as directed.
After reviewing the MAR, in an interview on 04/16/2025 at 10:56 AM Staff C (Nurse Consultant) stated, The patch should only be on for 12 hours, the nurse should have clarified the order since the time code indicated a time of greater than 12 hours.
Staff C also confirmed that the nurses, by following the physicians orders would exceed the do not exceed 3 patches directive and should have clarified the order.
Observation of the resident on 04/15/2025 at 12:07 PM showed the resident had an undated white patch applied to the right shoulder.
Observations on 04/16/2025 at 10:26 AM showed the resident had an undated white patch applied to the right shoulder.
During observations of the resident on 04/16/2025 at 10:56 AM, Staff C stated the nurse who applied the patch to the right shoulder should have, but did not, initial and dated it upon application.
505195
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 505195 B.
Wing 04/21/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002
The facility failed to: ensure staff performed hand hygiene before and after resident care for 3 of 3 staff observed, ensure proper labeling and containment of resident's personal care items observed in 2 resident rooms, administer medications while maintaining infection control measures, and wear facility required face masks appropriately to prevent the spread of infection.
These failures placed residents at risk for the development of infectious diseases and living in an unclean environment.
Findings included .
<Facility Policy>
According to the facility's October 2023 revised Handwashing/Hand Hygiene policy, all personnel were trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections.
This policy showed staff were expected to perform hand hygiene before applying non-sterile gloves and before touching a resident.
<Environment>
<room [ROOM NUMBER]>
Observations during initial rounds showed: on 04/14/2025 at 9:14 AM the bathroom for room [ROOM NUMBER] had a blue basin on the floor that was not bagged or labeled, two unlabeled urinals with no lids on the back of the toilet and a bag of garbage on the floor.
Similar observations of the unbagged basin on the floor and unlabeled urinals on the toilet were made on 04/16/2025 at 5:52 AM and 04/17/2025 at 2:17 PM.
<room [ROOM NUMBER]>
Observation of the bathroom for room [ROOM NUMBER] on 04/14/2025 at 9:14 AM showed a lidless urinal on the back of the toilet not labeled or bagged; a blue basin in a bag on floor which was not labeled, one graduate cylinder (a plastic container used to collect or measure bodily fluids) on the back of the toilet labeled for 32-2 but not bagged, and a denture cup at the sink which was not labeled.
Similar observations of the urinal, basin, graduate cylinder were noted on 04/16/2025 at 6:06 AM.
In an interview on 04/21/25 12:15 PM Staff E (Assistant Director of Nursing) stated that personal care items in bathrooms should be labeled with resident names, anything stored on the floor should be bagged. and urinals should have lids and be stored in a bag.
<Medication Administration>
<Resident 2>
505195
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 505195 B.
Wing 04/21/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002