01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-01-24 | 3 | 2025-01-24 | 2 |
| Cycle 2 | 2023-10-24 | 5 | 2023-10-24 | 5 |
| Cycle 3 | 2022-08-18 | 5 | 2022-08-18 | 3 |
CMS CCN 3755542026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Saint Simeons Episcopal Home
3701 Martin Luther King Jr Blvd · Tulsa, OK 74106 · Tulsa County
Certified beds109CMS provider file
Recent citation rows23current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
23 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 2 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-03-04 · HEALTHF0557Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Correction field: Deficient, Provider has date of correction · 2025-04-15 · complaint2025-03-04 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2025-04-15 · complaint2025-03-04 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-04-15 · complaint2025-01-24 · HEALTHF0610Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Past Non-Compliance · 2024-12-13 · complaint2025-01-24 · HEALTHF0640Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Correction field: Deficient, Provider has date of correction · 2025-02-282025-01-24 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2025-02-282025-01-24 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2025-02-282025-01-24 · FIREK0347Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Properly provide smoke detection systems in areas open to corridors.
Correction field: Deficient, Provider has date of correction · 2025-03-272025-01-24 · FIREK0374Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Correction field: Deficient, Provider has date of correction · 2025-03-272024-10-09 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Past Non-Compliance · 2024-06-17 · complaint2024-05-22 · HEALTHF0622Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
Correction field: Deficient, Provider has date of correction · 2024-06-30 · complaint2023-10-24 · FIREE0004Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2024-05-312023-10-24 · FIREE0036Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish emergency prep training and testing.
Correction field: Deficient, Provider has date of correction · 2024-05-312023-10-24 · FIREK0222Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2024-05-312023-10-24 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2024-05-312023-10-24 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2024-05-312022-08-18 · HEALTHF0698Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2022-09-182022-08-18 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2022-09-182022-08-18 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2022-09-182022-08-18 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2022-09-182022-08-18 · FIREK0222Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2022-09-182022-08-18 · FIREK0321Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2022-09-182022-08-18 · FIREK0923Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Correction field: Deficient, Provider has date of correction · 2022-09-1803 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2024-05-22 | Fine | $4,017 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CHAFFIN, KYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2019
- GREEN, ANGELAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 08/01/2019
- GREEN, ANGELAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/01/2019
- CHAFFIN, KYIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 01/01/2019
- GREEN, ANGELAIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/01/2019
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours5.93per resident day
RN hours0.51per resident day
Weekend nurse hours5.43per resident day
Staff turnover—%CMS reported field
06 / LOCAL RECORDS
Open the Tulsa ledger →Other published facilities nearby
Ambassador Manor Nursing Center171 beds · CMS overall 2/536 citation rowsCovenant Living At Inverness44 beds · CMS overall 5/58 citation rowsColonial Manor Nursing Home120 beds · CMS overall 4/529 citation rowsEmerald Care Center Tulsa118 beds · CMS overall 1/590 citation rowsGracewood Health & Rehab121 beds · CMS overall 2/534 citation rowsGreen Country Care Center114 beds · CMS overall 2/538 citation rowsIgnite Medical Resort Tulsa, Llc104 beds · CMS overall 5/513 citation rowsLeisure Village Health Care Center117 beds · CMS overall 1/544 citation rows