Heritage Care Center: No Director of Nursing - MO
Federal inspectors visited the facility on September 9, 2025, responding to a complaint. What they found was a 105-resident nursing home operating without a full-time Director of Nursing who was free from charge nurse duties, a requirement that kicks in once a facility's population exceeds 60.
The facility's own policy, dated April 30, 2024, spelled out the rule plainly. The Director of Nursing could serve as charge nurse only when average daily occupancy was 60 or fewer residents. Heritage Care Center had 105.
The person filling the DON's role was the RN Supervisor. The problem was that the RN Supervisor was also providing direct RN coverage on the floor. Inspection records show he or she worked RN coverage on September 3, 4, 5, 8, and 9. A person cannot simultaneously be a non-charge-nurse Director of Nursing and the RN providing floor coverage. The facility's own policy defined charge nurse as a licensed nurse whose responsibilities may include staff supervision, emergency coordination, physician liaison work, and direct resident care. That was the role the interim DON was filling.
When inspectors spoke with the Assistant Director of Nursing on the afternoon of September 9, the picture that emerged was one of institutional confusion. The ADON said the DON was on medical leave and that he or she was unsure when the DON would return. The RN Supervisor was the interim DON, to the ADON's knowledge, but the ADON was not sure whether that person was providing RN coverage or functioning as interim DON. The answer, as the records showed, was both.
The Administrator's account, given in an interview the same afternoon, added a detail that did not help matters. She said the current DON was supposed to notify her of when he or she would return. The RN Supervisor had started as interim DON only the week before. On September 8 and 9, the Administrator confirmed, the RN Supervisor provided RN coverage, which meant the facility had no interim DON on those two days at all.
She also mentioned that RN staff from the corporate office were providing eight hours of coverage, with some coming in every other weekend. The situation had been raised in a Quality Assurance and Quality Improvement meeting. One option discussed was whether the DON could complete some tasks from home while on medical leave.
When inspectors interviewed the RN Supervisor directly, he or she confirmed the title: RN Supervisor.
Not interim DON. Not Director of Nursing. RN Supervisor.
The facility's staffing roster did list a DON. The Administrator confirmed in an earlier interview on September 3 that the facility had a full-time DON. Both things were true in a technical sense, in that a person held the title. But that person was on medical leave of indeterminate length, and the arrangement put in place to cover the absence did not meet the standard the facility's own written policy required.
CMS classified the deficiency as causing minimal harm or potential for actual harm, with some residents affected. The census of 105 was not in dispute.
A Director of Nursing is responsible for overseeing the entirety of nursing care in a facility, coordinating with physicians, supervising staff, and ensuring residents receive what they need. At Heritage Care Center, that role was either vacant, split across two functions in ways the policy prohibited, or assigned to someone who, when asked directly, identified themselves by a different title entirely. The DON's return date remained unknown as of the inspection.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Heritage Care Center from 2025-09-09 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 22, 2026 · Our methodology
HERITAGE CARE CENTER in SAINT LOUIS, MO was cited for violations during a health inspection on September 9, 2025.
Federal inspectors visited the facility on September 9, 2025, responding to a complaint.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.