Country Aire Retirement Center
Inspection Findings
F-Tag F0563
F 0563 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
that time;-The ADON could not restrict family from visiting a resident unless it was at the guardian's direction. That needed to go through the chain of command. During an interview on 9/24/25 at 3:30 P.M and 9/29/25 at 2:15 P.M. the Administrator said the following:-Visitors could come and visit residents anytime.
The facility did not have a policy regarding visitation rights.-Resident #2 had a guardian and the guardian had provided a list of family members that he/she did not want visiting Resident #2. The facility staff did not know why the guardian restricted those visitors, but staff would honor the guardian's wishes. Staff had not discussed the rationale for the restricted visitors with the guardian;-On 9/20/25 the ADON called her at home and was concerned about a visitor (Family Member G) who was at the facility visiting Resident #2.
She directed the ADON to call the police to assure everyone was safe as she was not at the facility; -The facility was not allowing anyone to visit Resident #2 that was on the list provided by the guardian;-The SSD had put a list in the chart at admission on visitor restrictions for resident #2. Intake 2625783
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Country Aire Retirement Center
18540 State Highway 16 Lewistown, MO 63452
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0580
F 0580
medication if they were not a legal POA. Intake 2612003
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Country Aire Retirement Center
18540 State Highway 16 Lewistown, MO 63452
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0658
F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
pass;-He/She was unaware when administering insulin that he/she was to keep pressure on the plunger and keep the needle in the skin for 6 seconds to assure the resident received the full dose of insulin. During
an interview on 9/29/25 at 2:00 P.M. the Director of Nursing said the following:-Staff should not remove medications from the packaging until time of administration; -Preparing all the medications ahead of the medication pass could cause a medication error;-Staff should hold the insulin pen needle in the skin for 10 seconds to assure the resident received the full dose of medication. During an interview on 9/29/25 at 2:15 P.M. the Administrator said the facility should follow the facility's policy on medication pass and insulin administration.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Country Aire Retirement Center
18540 State Highway 16 Lewistown, MO 63452
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0760
F 0760
Ensure that residents are free from significant medication errors.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to ensure one resident (Resident #4) in a sample of six residents, remained free of a significant medication error when staff crushed and administered glipizide 24 hour extended release (used to manage blood sugars, the form of medication is gradually released throughout 24 hours) and metoprolol 24 hour extended release (used to manage high blood pressure, the form of medication is gradually released throughout 24 hours) to Resident #4. The facility census was 34.Review of the facility policy, Crushed Medications, dated 6/10/25, showed the following:-Medications shall be crushed in accordance with standards of practice for safety and accuracy in medication administration;-Medications shall be crushed in accordance with physician orders;-Medications that typically should not be crushed include enteric coated medications and sustained-release or extended-release absorption. Review of drugs.com showed inform patients that glipizide ER tablets should be swallowed whole. Inform residents that they should not chew, divide or crush tablets. Review of drugs.com showed Metoprolol ER tablets were not to be crushed or chewed. 1 Review of Resident #4's undated, face sheet showed the following:-The resident was admitted to the facility on [DATE REDACTED];-Diagnoses included diabetes and hypertension (high blood pressure). Review of the resident's physician orders, dated September 2025, showed the following:-Glipizide ER 5 milligrams (mg) extended release 24-hour tablet one tablet one time a day for diabetes;-Metoprolol ER extended release 24 hour/25 mg, one tablet one time daily for hypertension. Observation on 9/29/25 at 11:55 A.M. showed the following:-Certified Medication Technician (CMT) C removed a medication cup from the medication cart which contained two tablets. CMT C said one tablet was glipizide and the other tablet was metoprolol;-CMT crushed both tablets and placed
the medication in yogurt and administered the medication to the resident. Review of the resident's Medication Administration Record (MAR), dated September 2025, showed the following:-On 9/29/25 CMT C documented he/she administered the resident's glipizide ER 5 mg in the morning;-On 9/29/25 CMT C documented he/she administered metoprolol 25 mg ER in the morning. During an interview on 9/29/25 at 1:40 P.M. CMT C said the following:-He/She was not aware the resident's glipizide and metoprolol was extended release medications;-Extended-release medications should not be crushed because it would be absorbed all at once instead of over 24 hours. During an interview on 9/29/25 at 2:00 P.M. and 3:00 P.M. the Director of Nursing said glipizide extended release and metoprolol extended release should not be crushed because the resident would get too much medication at once instead of over 24 hours, which could affect blood sugar and blood pressure. During an interview on 9/29/25 at 2:15 P.M. the Administrator said staff should follow the medication policy for crushed medications. Intake 2612003
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
COUNTRY AIRE RETIREMENT CENTER in LEWISTOWN, MO 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 LEWISTOWN, MO, (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 COUNTRY AIRE RETIREMENT CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.