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Complaint Investigation

North Village Park

November 18, 2025 · Moberly, MO · 2041 Silva Lane
Citations 2
CMS Rating 1/5
Beds 183
Provider ID 265330
Healthcare Facility
North Village Park
Moberly, MO  ·  View full profile →
Inspection Summary

NORTH VILLAGE PARK in MOBERLY, MO — inspection on November 18, 2025.

Found 2 citations. 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

FF0600
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Actual Harm

During an interview on 11/16/25, at 3:39 P.M. and 4:45 P.M. and 11/18/25 at 11:40 A.M., Resident #2 said the following:-Resident #3 attacked him/her because he/she thought Resident #2 took his/her $3.00;-LPN E got between the two of them and Resident #3 reached over LPN E to hit Resident #2, but LPN E blocked most of it;-Then Resident #3 reached around LPN E and pulled him/her by the hair to the ground;-The resident hit the floor really hard;-Resident #3 also hit him/her in the side and hit his/her hip which was now bruised;-His/Her ribs hurt, and he/she thought they were broken because Resident #3 hit him/her in the side.

During an interview on 11/16/25, at 1:30 P.M., Resident #3 said the following:-He/She tried to hit Resident #2, but staff was in the way;-He/She grabbed Resident #2 by the hair and pulled the resident to the floor; once Resident #2 was on the floor he/she struck the resident in the side;-He/She attacked Resident #2 because he/she thought Resident #2 stole his/her $3.00.

Review of Resident #12's written statement, dated 11/14/25, showed he/she took Resident #3's $3.00. He/She didn't think Resident #3 would put hands on Resident #2.

Observation on 11/16/25, at 3:39 P.M., showed Resident #2 with half dollar sized knot on the left temporal region of his/her forehead with purple spots in the center of the knot, yellow discoloration was present on his/her forehead from the knot down to his/her left eye.

The resident's left eye is bruised dark purple on his/her eye lid from the edge of the eye lid to the eyebrow, and dark purple under the residents left eye approximately 1.5 cm.

Observation on 11/18/25, at 11:45 A.M., showed the resident's right hip with a large bruise with a dark purple oval area, surrounded by green and yellow discoloration.

The area was the size of the resident's palm and oval in shape. No discoloration was noted on the resident's left ribs, but he/she said they were sore. 4.

During an interview on 11/16/25, at 3:15 P.M. the Assistant Administrator (AADM) said Resident #3 grabbed Resident #2 by the hair and pulled Resident #2 to the ground.

This was witnessed by staff and an investigation was completed by himself and the Administrator.

During an interview on 11/17/25, at 10:16 A.M., and 11/18/25, at 11:30 A.M., the Administrator said Resident #3 grabbed Resident #2 by the hair and pulled Resident #2 to the ground.

This was witnessed by staff and an investigation was completed by himself and the Assistant Administrator.

They did not think Resident #3 was truly trying to harm Resident #2.

When Resident #3 pulled Resident #2 to the ground by his/her hair, Resident #3 could have hit Resident #2 in the face, but he/she restrained himself/herself. Resident #3 could have hurt Resident #2 and struck him/her in the face, but he/she did not.

Complaint #2669277

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

11/18/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

North Village Park

2041 Silva Lane Moberly, MO 65270

SUMMARY STATEMENT OF DEFICIENCIES

Review of Resident #12's written statement, dated 11/14/25, showed he/she took Resident #3's $3.00. He/She didn't think Resident #3 would put hands on Resident #2.

Observation on 11/16/25, at 3:39 P.M., showed Resident #2 with half dollar sized knot on the left temporal region of his/her forehead with purple spots in the center of the knot, yellow discoloration was present on his/her forehead from the knot down to his/her left eye.

The resident's left eye is bruised dark purple on his/her eye lid from the edge of the eye lid to the eyebrow, and dark purple under the residents left eye approximately 1.5 cm.

Observation on 11/18/25, at 11:45 A.M., showed the resident's right hip with a large bruise with a dark purple oval area, surrounded by green and yellow discoloration.

The area was the size of the resident's palm and oval in shape. No discoloration was noted on the resident's left ribs, but he/she said they were sore. 4.

During an interview on 11/16/25, at 3:15 P.M. the Assistant Administrator (AADM) said Resident #3 grabbed Resident #2 by the hair and pulled Resident #2 to the ground. It was witnessed by staff and an investigation was completed by himself and the Administrator.

The incident with Resident #2 and Resident #3 was not reported to the state agency or law enforcement.

Both he and the Administrator did not report because they determined it was not abuse.

During an interview on 11/17/25, at 10:16 A.M., and 11//25, at A.M., the Administrator said Resident #3 grabbed Resident #2 by the hair and pulled Resident #2 to the ground.

This was witnessed by staff and an investigation was completed by himself and the Assistant Administrator.

The facility did not report to the state agency or to law enforcement because they did not think Resident #3 was trying to harm Resident #2.

The one time Resident #3 tried to hit Resident #2 staff softened it; when Resident #3 pulled Resident #2 to the ground by his/her hair, Resident #3 could have hit Resident #2 in the face but restrained himself/herself so he and the AADM determined it was not abuse and did not have to be reported.

Complaint #2669277

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 MOBERLY, 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 NORTH VILLAGE PARK or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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