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Complaint Investigation

North Auburn Care

December 29, 2025 · Auburn, WA · 2830 I Street Northeast
Citations 1
CMS Rating 3/5
Beds 125
Provider ID 505195
Healthcare Facility
North Auburn Care
Auburn, WA  ·  View full profile →
Inspection Summary

North Auburn Care in AUBURN, WA — inspection on December 29, 2025.

Found 1 citation. 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.

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Inspection Findings

FF0684
Quality of Life and Care Deficiencies
Potential for More Than Minimal Harm

was an on-call provider number staff should call to report.

Staff B stated when the on-call provider was called a progress note was automatically generated into the medical record.

Staff B stated there was no progress note in Resident 1's record showing the on-call provider was notified of the hip fracture.

Staff B stated the NP notified them on 12/13/2025 at about 7:30 AM that Resident 1 had a hip fracture.

Staff B stated the NP gave directions to send Resident 1 to the hospital.

Staff B stated they called the facility nurse assigned to Resident 1.

Staff B stated the nurse was not aware of Resident 1's x-ray results and told Staff B Resident 1 was at their dialysis appointment.

Staff B said they directed the nurse to call the dialysis clinic to send Resident 1 to the hospital.In an interview on 12/30/2025 at 9:58 AM, the NP stated they expected the nursing staff to review the x-ray results and report a fracture immediately to the provider, including calling the on-call provider if the report was after hours.

The NP stated the facility did not notify the provider of the fracture.

The NP stated they looked up the x-ray report in Resident 1's medical record on 12/13/2025 at 7:30 AM and tried calling the facility.

The NP stated when they could not reach the facility staff, they called Staff B to instruct the facility to send Resident 1 to the hospital immediately for the hip fracture from the 12/11/2025 incident.

The NP stated a hip fracture was a severe injury requiring ambulance transportation to the hospital for immediate intervention. In an interview on 12/30/2025 at 10:16 AM, Staff C stated they were the evening shift nurse on 12/12/2025 and received a phone call and report from the x-ray company about 10:00 PM, which was shift change.

Staff C stated they did not report the fracture to the Medical Provider. In an interview on 12/30/2025 at 10:21 AM, Staff D (LPN) stated they were the night shift nurse on 12/12/2025 and they were not informed by the prior shift that Resident 1 had a fracture.

Staff D stated when a report of a fracture was received the nurse was expected to notify the Medical Provider immediately.

Staff D stated there was an after-hours number to call the on-call provider.

Staff D stated Resident 1 should not have gone to dialysis on 12/13/2025 and should have gone to the hospital when the report of a fracture was received by the facility. In an interview on 12/30/2025 at 12:25 PM, Staff B stated they called the x-ray company to verify the report of Resident 1's x-ray results.

Staff B stated the x-ray company notified the facility of the fracture on 12/12/2025 at 10:30 PM and spoke with Staff C.

Staff B stated the nursing staff did not notify the NP or the on-call provider as required. In an interview on 12/30/2025 at 12:47 PM, Staff A (Director of Nursing) stated the investigation of Resident 1's injury did not identify the delay of nursing staff to process the Medical Provider's x-ray orders and did not identify the error of nursing staff to immediately notify the provider of Resident 1's fracture.

Staff A stated the nurse was expected to call the x-ray company right away when the NP provided the STAT x-ray order.

Staff A stated STAT x-rays should be completed within four hours of notification of the x-ray company.

Staff A stated the nurse was expected to notify the on-call provider immediately upon the report of Resident 1's fracture.

Staff A stated if Staff C notified the on-call provider as required, Resident 1 would have gone to the hospital on [DATE] and would not have been transported to dialysis on 12/13/2025.Reference: WAC 388-97-1060.

Facility ID:

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 North Auburn Care or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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