Liberty Commons Nursing & Rehab Center Of Southpor
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Resident #1 with terminal diagnosis of multiple myeloma. The Hospice Aide reported that when she arrived to give Resident #1 her bath this morning (10/2/25), she was noted to have several bruises to her body, she was uncomfortable and had possible injury to her left leg. The injuries had been reported to facility staff.
Upon arrival, Resident #1 was resting quietly in bed with her eyes closed, she aroused to voice and touch.
She smiled and had nonsensical conversation and was cognitively at baseline. She was oriented to person only. Resident #1 was noted to have dark purple bruising to the right forehead, blue/red bruising to the right periorbital (eye) area. Slight redness noted to the left side of her neck. Slight bruising noted to right shoulder, and right knee. Redness and bruising to left knee and foot. Resident #1 was able to move her right leg. Her left leg was pulled up, and she did not want the nurse to touch her left leg. There was obvious injury to the left lower extremity. This nurse did not attempt to move or perform range of motion to left leg.
Facility staff stated that x-rays have been ordered and will be done in house. Pain level was zero during visit. The facility nurse administered as needed Morphine concentrate (pain medication) with good effect at
this time. Unsure of cause of injury at this time, presumed fall, facility staff stated they were investigating the injury, and all appropriate agencies had been notified of the injuries. Resident #1 was comfortable during visit. A phone interview was conducted on 10/15/25 at 2:45 PM with Nurse # 1, the assigned nurse on 10/1/25 and 10/2/25 from 7:00 AM through 7:00 PM. She indicated Resident #1 was at baseline with no bruising on 10/1/25, and no falls or injuries were reported to her on 10/1/25. Nurse #1 stated when she returned to work the following morning on 10/2/25 at 7:00 AM the Hospice Aide was in Resident #1's room early before 8:00 AM, and Nurse Aide #2 asked Nurse #1 to go look at Resident #1. Nurse #1 went in to evaluate Resident #1 at that time and saw the facial bruising and bruising to her shoulder, both knees, and one of her toes. Nurse #1 stated the night shift nurse (Nurse #5) did not report anything at all to her that morning during shift report regarding Resident #1. Resident #1 did not seem to be in pain, at that time.
Nurse #1 assessed Resident #1, notified the Director of Nursing and the physician who ordered a mobile x-ray. During a follow up interview on 10/17/25 at 12:00 PM Nurse #1 stated she was an agency nurse and was not certain what the facility protocol was for checking neurological assessments following unwitnessed injuries. She stated the neurological assessments that she completed on 10/2/25 were only what was recorded in the electronic medical record. During a phone interview on 10/22/25 at 2:00 PM the Assistant Director of Nursing stated she recorded one of the neurological assessments on 10/2/25 and when she documented the assessment the electronic medical record pulled the most recent vital signs which were from 9/30/25. She stated that was done in error on her part and she should have ensured up to date vital signs were done and recorded in the medical record. During an interview on 10/17/25 at 11:00 AM the Director of Nursing (DON) stated a full investigation was initiated on 10/2/25 at 8:00 AM when unexplained bruising was observed on Resident #1 by the Hospice Nurse Aide who reported it to Nurse #1. The DON stated Resident #1 had no reported falls or trauma and was evaluated at the hospital and diagnosed with facial bruising and a tibia fibula fracture. The DON stated Nurse #5 should have gone to the room and checked Resident #1 and completed a full assessment at 5:00 AM on 10/2/25 when Nurse Aide #3 reported unexplained marks and bruising but Nurse #5 did not do that. The DON stated when the unexplained facial bruising was later observed by Nurse #1 at approximately 7:30 AM on 10/2/25 Nurse #1 should have initiated neurological assessments every hour for four hours, then every shift for a total of 48 hours. The DON stated up to date vital signs were part of the neurological assessments.
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Liberty Commons Nursing & Rehab Center of Southpor in Southport, NC 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 Southport, NC, (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 Liberty Commons Nursing & Rehab Center of Southpor or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.