Average — CMS composite of the measures below.
The next survey window likely opens around December 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Heritage Manor South during CMS and state inspections, most recent first.
The facility failed to develop individualized care plans for two residents with significant clinical conditions. One resident with chronic kidney disease, diabetes, nocturnal enuresis, and multiple recent hospitalizations for UTIs and sepsis had no care plan addressing UTIs despite repeated episodes. Another resident with a documented stage IV sacral pressure injury, including detailed surgical and wound care notes, had no care plan for the stage IV pressure ulcer. An assessment RN acknowledged that both residents should have been care planned for these conditions.
Failure to provide nail care and hygiene for residents needing ADL assistance. Five residents with conditions including diabetes, dementia, schizophrenia, rheumatoid arthritis, and hemiplegia were observed with long, jagged fingernails and visible debris underneath. Several residents said they wanted or needed their nails cut and cleaned, and staff stated the nurse had to do it because the residents were diabetic; the DON confirmed the nails were long, dirty, and should have been cleaned and cut by the nurse.
Inaccurate MDS Medication Coding: A resident’s quarterly MDS incorrectly documented weekly insulin use even though the record showed no diabetes diagnosis and no insulin order. An LPN, the DON, and MDS staff confirmed the resident was not diabetic, did not receive insulin, and that the medication section had been coded incorrectly.
A resident with severe cognitive impairment and a history of elopement risk was able to leave the facility through an unlocked office door and an unsecured window, which lacked proper stops to prevent full opening. The resident was found offsite and returned without new injuries. Staff interviews and video review confirmed that the office door was unlocked and windows were not properly secured at the time of the incident.
A resident with multiple medical conditions and a documented DNR order was incorrectly care planned as full code, with interventions for CPR, despite advance directive consent and physician orders specifying DNR. Facility staff confirmed the care plan did not match the resident's documented wishes.
A resident with multiple chronic conditions was the subject of a family member's grievance regarding care issues such as dirty linens, uncertainty about meals, and inadequate hygiene. The complaint was recorded and forwarded to relevant departments, but there was no documentation of an investigation or resolution, nor evidence that the complainant was informed of any outcome, as required by facility policy.
The facility failed to develop a care plan for a resident's diabetic wound and did not obtain a physician order for another resident's oxygen therapy. Despite having physician orders for wound care, the diabetic wound was not included in the care plan. Additionally, a resident using continuous oxygen therapy lacked a documented physician order, which was confirmed by staff interviews.
A resident with severe cognitive impairment and multiple health conditions did not receive a full course of antibiotics as prescribed for a wound infection. The MAR indicated that five doses of Amoxicillin-Pot Clavulanate were missed over several days, which was confirmed by the DON during an interview.
The facility failed to ensure bed rails were securely attached for five residents, leading to potential accident hazards. Observations showed the rails were loose, and residents expressed fear of falling. Staff interviews confirmed the issue, revealing that maintenance checks were only conducted upon request, not routinely.
The facility failed to ensure proper use and maintenance of bed rails for multiple residents, lacking risk assessments, informed consent, and regular maintenance checks. Observations revealed loose bed rails and missing documentation, while interviews with staff highlighted systemic issues in managing bed rail safety.
The facility failed to monitor four residents for edema and bleeding as required, despite their medical conditions and prescribed medications. Residents with conditions such as CHF, COPD, and neurocognitive disorders were not monitored every shift for edema and bleeding, as acknowledged by the DON and ADON.
The facility failed to monitor three residents for side effects and behaviors associated with psychotropic medications. One resident with anxiety and depressive disorders was not monitored for side effects while on Zoloft, Buspirone, Duloxetine, and Bupropion. Another resident with anxiety and depression was not monitored while on Buspirone, Trazadone, and Mirtazapine. A third resident with dyskinesia and neurocognitive disorder was not monitored while on Sertraline, Alprazolam, and Quetiapine. The DON and ADON acknowledged these monitoring lapses.
A facility failed to provide a resident with a written Notice of Medicare Non-Coverage (NOMNC) or Advance Beneficiary Notice (ABN) when discharging them from Medicare Part-A services before benefit days were exhausted. The Account Manager admitted that the resident or their representative should have been notified earlier.
Failure to Care Plan for Recurrent UTIs and Stage IV Pressure Ulcer
Penalty
Summary
The facility failed to develop and implement individualized care plans to address identified clinical conditions for two residents. One resident, admitted with diagnoses including chronic kidney disease, type 2 diabetes mellitus, urinary tract infection (UTI) site not specified, and nocturnal enuresis, had multiple documented hospitalizations in February and March 2026 for UTIs and sepsis related to UTI, yet review of the medical record showed no care plan addressing urinary tract infections. Another resident, admitted with a diagnosis that included a stage IV sacral pressure ulcer, had surgical and wound care documentation describing a bilateral sacrococcygeal stage IV pressure injury, but the medical record lacked a care plan for the stage IV sacrum pressure ulcer. During an interview, the assessment RN acknowledged that the resident with recurrent UTIs was not care planned for UTIs and that the resident with the stage IV sacral pressure ulcer was not care planned for that wound, and confirmed that both should have been care planned for these conditions.
Failure to Provide Nail Care and Hygiene for Residents Needing Assistance
Penalty
Summary
The facility failed to ensure residents who were unable to complete activities of daily living received necessary grooming and hygiene services, as five of five residents reviewed for ADLs had fingernails that were not cleaned and trimmed. Residents #4, #31, #45, #69, and #100 were observed with fingernails that were long past the fingertips, jagged in some cases, and had brown, black, or yellow substance underneath. Each of these residents reported that they wanted or needed their fingernails cut and cleaned, and several stated that it had not been done in a long time. The residents involved had diagnoses including diabetes mellitus, diabetic neuropathy, rheumatoid arthritis, schizophrenia, dementia, hemiplegia, and lack of coordination. Resident #4 was cognitively intact and said staff kept telling him the nurse would do it because he was diabetic. Resident #31, also cognitively intact, said the nurse was supposed to cut her fingernails because she was diabetic, and a CNA confirmed she could not cut them because a nurse had to do it. The DON and an LPN confirmed the residents were diabetic and that the nurse should have cut and cleaned their fingernails, and the DON further confirmed the fingernails were long, dirty, and should have been cleaned and cut by the nurse.
Inaccurate MDS Medication Coding
Penalty
Summary
Ensure each resident receives an accurate assessment. Based on record review and interviews, the facility failed to ensure assessments were accurate for 1 of 37 residents reviewed for MDS assessments. Resident #13’s record showed an admission date of 08/29/2024 and did not reveal a diagnosis of diabetes. The physician orders also did not show an order for insulin. However, the quarterly MDS assessment dated [DATE] documented that the resident received 1 insulin injection every 7 days. During interviews, an LPN, the DON, and the MDS staff member each reviewed the record and confirmed the resident was not diabetic, did not receive insulin, and that the MDS medication section had been coded incorrectly.
Failure to Prevent Elopement Due to Unsecured Office and Window
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment and multiple diagnoses, including dementia, Alzheimer's disease, and delusional disorders, was able to elope from the facility. The resident had been assessed as an elopement risk and was care planned for a security bracelet. Despite these interventions, the resident was able to leave the facility through a window in an office that had a malfunctioning door lock. The window did not have a stop to limit how far it could open, and the office door was found to be unlocked at the time of the incident. On the day of the incident, the resident was last seen by a CNA approximately 10-15 minutes before being discovered missing. Video footage showed the resident entering the MDS office and not exiting through the door, indicating the resident left through the window. The resident was later found by staff at a convenience store nearly a mile away and was returned to the facility. Upon assessment, the resident had no new injuries, only pre-existing skin tears. Interviews with staff confirmed that prior to the incident, windows in offices and the therapy gym did not have stops, and the office door lock was not functioning as intended. Staff also confirmed that the system in place for securing office doors and monitoring residents at risk for elopement was not effectively implemented at the time, which allowed the resident to exit the building undetected.
Failure to Update Care Plan to Reflect DNR Status
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan that accurately reflected a resident's code status as Do Not Resuscitate (DNR), despite having physician orders and an advance directive consent from the resident's responsible party indicating DNR status. Instead, the care plan was initiated for full code, with interventions such as initiating CPR in the event of cardiac arrest, which contradicted the documented wishes and orders. This discrepancy was identified during a review of the resident's medical record and care plan by facility staff, who confirmed that the care plan did not align with the resident's documented DNR status. The resident involved had multiple diagnoses, including chronic obstructive pulmonary disease (COPD), severe protein-calorie malnutrition, anemia, hypertension, anxiety disorder, depression, and pain, and was unable to complete a mental status interview at the time of the deficiency.
Failure to Investigate and Document Grievance Resolution
Penalty
Summary
The facility failed to ensure that a grievance investigation and resolution were conducted and documented according to its own policy for one of three sampled residents. The facility's grievance policy requires that all grievances, including those made by family members, be promptly investigated and resolved, with documentation of the investigation and communication of the resolution to the complainant. In this case, a family member reported concerns regarding a resident's care, including dirty sheets, uncertainty about whether the resident had eaten, and the resident being found soaking wet and in the same clothing as the previous day. The complaint was recorded by the Social Services Director and forwarded to nursing and laundry, but there was no documentation of an investigation or resolution, nor evidence that the complainant was notified of any outcome. The resident involved had multiple diagnoses, including rheumatoid arthritis, type 2 diabetes, Alzheimer's disease, anxiety disorder, bipolar disorder, atherosclerotic heart disease, and mood disorder due to a physiological condition. The resident was rarely or never understood, as indicated by the MDS assessment. Despite the facility's policy outlining specific steps for grievance handling, including investigation and communication of findings, these steps were not followed or documented for the complaint in question. Interviews with the Director of Nursing and Social Services Director confirmed the lack of investigation and resolution documentation.
Failure to Develop Care Plans for Diabetic Wound and Oxygen Therapy
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for two residents. For one resident with a diabetic wound, the facility did not create a care plan addressing the diabetic foot ulcer on the left dorsum-1st digit (Hallux), despite having physician orders for wound care. The resident had severe cognitive impairment, as indicated by a BIMS score of 07, and weekly wound assessments were conducted. However, the care plan did not reflect the necessary interventions for the diabetic wound, which was acknowledged by the MDS Coordinator during an interview. For another resident, the facility did not obtain a physician order for continuous oxygen therapy, despite the resident's dependence on oxygen at 3 liters per minute (LPM) as noted in the Nurse Practitioner Progress Note. Observations confirmed the resident was using oxygen via nasal cannula, and interviews with the resident and staff, including the DON, confirmed the use of oxygen. However, there was no physician order documented for this therapy, which was acknowledged as an oversight by the DON.
Failure to Administer Full Course of Antibiotics
Penalty
Summary
The facility failed to ensure that a resident received treatment and care in accordance with professional standards of practice by not administering a full course of antibiotics as ordered by the physician. The resident, who had severe cognitive impairment and multiple diagnoses including type 2 diabetes mellitus, diabetic ulcer, and peripheral vascular disease, was prescribed Amoxicillin-Pot Clavulanate for a wound infection. The physician's order specified a 7-day course of the antibiotic, to be given every 12 hours. However, the Medication Administration Record (MAR) for September 2024 showed that five doses were missed, specifically the 8:00 p.m. doses on three consecutive days and the 8:00 a.m. doses on two consecutive days. This oversight was confirmed during an interview with the Director of Nursing, who acknowledged that the full course of antibiotics was not administered.
Failure to Secure Bed Rails Poses Accident Hazard
Penalty
Summary
The facility failed to ensure that bed rails were securely attached to the beds for five residents, leading to potential accident hazards. Observations revealed that the bed rails for these residents were loose and moved freely, posing a risk to the residents who relied on them for positioning and support. Interviews with the residents confirmed their awareness of the loose rails, with some expressing fear of falling due to the instability of the rails. The residents involved had various medical conditions, including dementia, bipolar disorder, and muscle weakness, and resided in the facility's secure memory care unit. Their cognitive abilities ranged from moderately impaired to severely impaired, with some residents being unable to communicate effectively. Despite these vulnerabilities, the facility did not ensure the bed rails were securely attached, compromising the safety of these residents. Interviews with facility staff, including CNAs, the ADON, and the DON, confirmed the issue with the bed rails. The maintenance department was identified as responsible for checking the bed rails, but it was revealed that inspections were only conducted when a work order was submitted, rather than on a routine basis. This lack of regular maintenance checks contributed to the deficiency in ensuring a safe environment for the residents.
Deficiencies in Bed Rail Use and Maintenance
Penalty
Summary
The facility failed to ensure the correct use and maintenance of bed rails for 12 residents, as identified through record reviews, observations, and interviews. The deficiencies included a lack of assessment for risks associated with bed rail use, failure to obtain informed consent from residents or their representatives, and inadequate documentation of monitoring and supervision during bed rail use. Additionally, the facility did not conduct scheduled maintenance according to the manufacturer's recommendations for the bed rails in use. Several residents were observed with bed rails in use without proper documentation or consent. For instance, one resident with quadriplegia and other severe conditions had bed rails up without any documentation of monitoring or supervision. Another resident with dementia and severe cognitive impairment had loose bed rails, and no consent was obtained for their use. Similar issues were noted for other residents, including incomplete consent forms and missing assessments for the necessity and safety of bed rail use. Interviews with facility staff, including the Director of Nursing (DON) and maintenance personnel, revealed systemic issues in the management of bed rails. The DON confirmed that consents were not obtained, and assessments were not conducted as required. Maintenance staff admitted to only inspecting bed rails when issues were reported, rather than performing regular maintenance checks. The facility lacked the manufacturer's guidelines for bed rail installation and maintenance, contributing to the improper use and potential safety hazards associated with bed rails.
Failure to Monitor Residents for Edema and Bleeding
Penalty
Summary
The facility failed to ensure that residents were free from unnecessary medications by not adequately monitoring for edema and bleeding in four out of six residents reviewed. Resident #28, diagnosed with conditions including congestive heart failure and end-stage renal disease, was prescribed Bumetanide for CHF. However, the facility did not monitor for edema every shift on multiple days in October 2024. The Director of Nursing acknowledged this oversight during an interview. Similarly, Resident #34, with diagnoses including chronic obstructive pulmonary disease and CHF, was on diuretic therapy and Apixaban. The facility failed to monitor for edema and bleeding every shift on several days in October 2024. Resident #79, with conditions such as anxiety disorder and acute embolism, was prescribed Eliquis and Furosemide but was not monitored for edema and bleeding every shift on numerous days. Lastly, Resident #87, with neurocognitive disorder and major depressive disorder, was on Eliquis but was not monitored for bleeding every shift on several days. The Assistant Director of Nursing acknowledged these monitoring failures during interviews.
Failure to Monitor Psychotropic Medication Side Effects
Penalty
Summary
The facility failed to ensure that residents were free from unnecessary psychotropic medications, as evidenced by the lack of monitoring for side effects and behaviors in three residents. Resident #34, diagnosed with anxiety disorder, mood disorder, insomnia, and major depressive disorder, was prescribed multiple psychotropic medications, including Zoloft, Buspirone, Duloxetine, and Bupropion. However, the facility did not monitor Resident #34 for side effects and behaviors on numerous days throughout October 2024, as confirmed by the Director of Nursing. Similarly, Resident #79, with diagnoses including anxiety disorder and depression, was prescribed Buspirone, Trazadone, and Mirtazapine. The facility failed to monitor this resident for side effects and behaviors on several days in October 2024. Resident #87, diagnosed with dyskinesia, neurocognitive disorder with Lewy bodies, and major depressive disorder, was prescribed Sertraline, Alprazolam, and Quetiapine. The facility also did not monitor this resident for side effects and behaviors on multiple days in October 2024. The Assistant Director of Nursing acknowledged the lack of monitoring for both Residents #79 and #87.
Failure to Provide Written Notification of Medicare Coverage Changes
Penalty
Summary
The facility failed to provide written notification to a resident regarding changes in their Medicare Part-A coverage and potential financial liability. Specifically, the facility initiated the discharge of a resident from Medicare Part-A services before the benefit days were exhausted, without issuing a Notice of Medicare Non-Coverage (NOMNC) or an Advance Beneficiary Notice (ABN) to the resident or their responsible party. The facility's records indicated that the resident might have to pay out of pocket for care starting on a specified date if no other insurance covered the costs. Despite a phone call made by the Account Manager to the resident's representative to discuss the notice, the required written notifications were not provided. The Account Manager acknowledged during an interview that the resident or their representative should have been notified earlier in the month.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Shreveport
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| The Guest House Skilled Nursing Rehabilitation | 1.3 mi | ★★★★★ | 0 | 0 |
| The Bradford Skilled Nursing And Rehabilitation | 1.9 mi | ★★★★★ | 8 | 0 |
| Southern Hills Healthcare And Rehabilitation | 2 mi | ★★★★★ | 3 | 0 |
| Garden Park Nursing & Rehab Ctr, Llc | 3.9 mi | ★★★★★ | 9 | 0 |
| Heritage Manor West | 4.5 mi | ★★★★★ | 8 | 0 |
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