Norterre
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Based on observation, interview and record review the facility failed to ensure that a resident's environment remained free of accident hazards when the facility used a portable electric heater in a resident's room (Resident #1). The facility census was 55. The facility did not provide the requested policy for safe environment and/or accident hazards.1.Review of Resident #1's Quarterly Minimum Data Set (MDS, a federally mandated assessment completed by facility staff) dated 10/23/23 showed:-Severe cognitive impairment;-Impairment on both sides upper and lower extremities;-Dependent on staff for all Activities of Daily Living (ADL)s;-Diagnosis included respiratory failure and anxiety.Review of the resident's care plan dated 10/29/25 showed:-The resident had a self-care deficit related to disease process;-The resident was dependent on staff for all aspects of care.Observation of the resident's room on 11/20/25 at 11:38 A.M., showed:-A portable heater plugged in and running in the corner of the room;-The heat was set to 87 degrees Fahrenheit;-A hose ran from the heating unit to the window and was held in place by white tape;-There were no staff in the room.During an interview on 11/20/25 at 11:49 A.M., Licensed Practical Nurse (LPN) A said:-He/She was not sure how long the heat had not been working in the resident's room;-He/She was not sure how long the portable heater had been in place;-He/She had not been instructed to complete any extra checks on the resident due to the use of the heater and a fire risk.During
an interview on 11/20/25 at 12:32 P.M., the Maintenance Director said:-On 10/17/25 the repair company came out do repairs but did not finish;-The company is coming back this week to finish the repairs in the resident's room;-The portable heating unit was put in the resident's room until the repair company could return to fix the heat in the resident's room;-He was not sure when the heater was put in the resident's room;-He though it would be ok to use the portable heating unit until the heating could be fixed in the resident's room because it was vented to the outside;-He should not have used a portable heater to heat
the resident's room.During an interview on 11/20/25 at 1:13 P.M., the Administrator said:-She was aware that heater was used as a temporary solution;-She thought it would be ok the use the heater because it was vented to the outside;-Portable heaters should not be used in resident rooms. Intake 2644857
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
NORTERRE in LIBERTY, 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 LIBERTY, 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 NORTERRE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.