North Auburn Rehab & Health Center
2830 I Street Northeast, Auburn, WA 98002


North Auburn Rehab & Health Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 505195. The address is 2830 I Street Northeast, Auburn, WA 98002. The zip code is 98002. The phone number is 2535618100.


North Auburn Rehab & Health Center · 2830 I Street Northeast, Auburn, WA 98002

Federal Provider Number 505195
Provider Name NORTH AUBURN REHAB & HEALTH CENTER
Address 2830 I STREET NORTHEAST
AUBURN, WA 98002
Phone Number 2535618100
SSA County Code 160
County Name King
Ownership Type For profit - Corporation
Certified Beds 125
Certified Beds Residents 79
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name FMG I STREET NORTHEAST WASHINGTON LLC
Date First Approved to Provide Medicare Medicaid Services 01/01/1983
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 3
Health Inspection Rating 2
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.43734
Reported LPN Staffing Hours per Resident per Day 0.75886
Reported RN Staffing Hours per Resident per Day 0.63481
Reported Licensed Staffing Hours per Resident per Day 1.39367
Reported Total Nurse Staffing Hours per Resident per Day 3.83101
Reported Physical Therapist Staffing Hours per Resident Per Day 0.13544
Expected CNA Staffing Hours per Resident per Day 2.37561
Expected LPN Staffing Hours per Resident per Day 0.63388
Expected RN Staffing Hours per Resident per Day 1.0086
Expected Total Nurse Staffing Hours per Resident per Day 4.01809
Adjusted CNA Staffing Hours per Resident per Day 2.51746
Adjusted LPN Staffing Hours per Resident per Day 0.99364
Adjusted RN Staffing Hours per Resident per Day 0.47029
Adjusted Total Nurse Staffing Hours per Resident per Day 3.84322
Cycle 1 Total Number of Health Deficiencies 19
Cycle 1 Number of Standard Health Deficiencies 15
Cycle 1 Number of Complaint Health Deficiencies 4
Cycle 1 Health Deficiency Score 132
Cycle 1 Standard Survey Health Date 03/17/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 132
Cycle 2 Total Number of Health Deficiencies 13
Cycle 2 Number of Standard Health Deficiencies 12
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 60
Cycle 2 Standard Health Survey Date 01/29/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 60
Cycle 3 Total Number of Health Deficiencies 14
Cycle 3 Number of Standard Health Deficiencies 11
Cycle 3 Number of Complaint Health Deficiencies 3
Cycle 3 Health Deficiency Score 92
Cycle 3 Standard Health Survey Date 02/26/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 92
Total Weighted Health Survey Score 101.333
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 3
Number of Fines 1
Total Amount of Fines in Dollars $2600.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · North Auburn Rehab & Health Center

Owner Name Role Association Date
DETARY, TIMOTHY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
DETARY, TIMOTHY (Individual) OFFICER since 07/01/2015
ELLIOTT, JARED (Individual) OFFICER since 01/30/2017
FMG OPERATING NH, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 07/01/2015
FORTIS MANAGEMENT GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
FORTIS MANAGEMENT HOLDINGS INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
GURKA, RICHARD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
JENKINS, ALLYSON (Individual) MANAGING EMPLOYEE since 07/01/2015
KEATING, DAVID (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
KEATING, DAVID (Individual) OFFICER since 07/01/2015
MANN, DYLAN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
MANN, DYLAN (Individual) OFFICER since 07/01/2015

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