Complaint Investigation

Linden Grove Health Care Center

August 20, 2025 · Puyallup, WA · 400 - 29th Street Northeast

Citations 1

CMS Rating 1/5

Beds 130

Provider ID 505485

Healthcare Facility

Linden Grove Health Care Center

Puyallup, WA · View full profile →

Inspection Summary

LINDEN GROVE HEALTH CARE CENTER in PUYALLUP, WA — inspection on August 20, 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.

Inspection Findings

FF0760

Pharmacy Service Deficiencies

Immediate Jeopardy

Review of the narcotic log showed that Resident 5 received doses of clonazepam (a Schedule 4 controlled narcotic medication to treat anxiety) on 07/22/2025 at 6:00 PM; 07/24/2025 at 4:00 AM and 8:00 PM; 07/26/2025 at 10:00 AM; 07/27/2025 at 9:00 PM; 07/28/2025 at 9:00 PM; 07/30/2025 at 9:00 PM; 07/31/2025 at 8:00 PM, and oxycodone on 07/26/2025 at 4:00 AM and 10:00 AM; 07/27/2025 at 4:00 AM and 7:00 PM; 07/28/2025 at 1:00 AM; 07/29/2025 at 4:00 PM and 10:00 PM; 07/30/2025 at 4:00 AM, 9:00 AM and 5:00 PM; 07/31/2025 at 6:00 PM; 08/01/2025 at 1:00 AM; 08/03/2025 at 8:43 AM, none of which were documented in Resident 5's eMAR.

Review of the narcotic log showed that Resident 6 received doses of oxycodone on 07/31/2025 at 6:00 PM and 08/01/2025 at 2:00 AM, neither of which were documented in Resident 6's eMAR. In an interview on 08/14/2025 at 2:30 PM Staff A, Director of Nursing Services (DNS), stated that when Staff B, LPN, was questioned about why the extra dose of morphine was signed out of Resident 2's narcotic book, Staff B, LPN, stated I don't know.

Staff A, DNS, stated that based on the facility investigation and pattern of incorrect narcotic administration documentation, Staff B, LPN's, employment was terminated.

Reference WAC 388-97-1060 (3)(k)(iii).

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 PUYALLUP, 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 LINDEN GROVE HEALTH CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.

Linden Grove Health Care Center

Inspection Findings

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