First Shamrock Care Center
1415 South Main Street, Kingfisher, OK 73750 · Kingfisher County · 55 certified beds · avg 38 residents/day · certified since Jun 5, 2002
Abuse citation flag (CMS)SFF Candidate
Part of chain: BGM ESTATE (15 facilities, chain avg rating 1.8★)
The abuse flag means inspectors cited this facility for abuse that caused harm to a resident within the past year, or potential for harm in each of the last two years. Source: CMS.
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★☆☆☆☆1/5 · CMS overall rating: 1/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Immediate jeopardy, repeated · May 6, 2026 · F-0656
The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines.
Why it matters: Without a complete, working care plan, important needs can slip through the cracks and no one is accountable for results.
Severity (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Jun 15, 2026 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · May 6, 2026 · F-0600 · triggered by a complaint
The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors.
Why it matters: Abuse and neglect cause direct physical and emotional harm and are among the most serious failures a nursing home can have.
Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.
Corrected: Jun 15, 2026 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · May 6, 2026 · F-0689
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.
Corrected: Jun 15, 2026 (Deficient, Provider has date of correction)
All citations in the current public record (34)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| May 6, 2026 | ▲ K · Immediate jeopardy, repeated | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. |
| May 6, 2026 | ▲ J · Immediate jeopardy, one-off | The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint |
| May 6, 2026 | ▲ J · Immediate jeopardy, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| May 6, 2026 | F · Potential for harm, facility-wide | The facility did not give residents important notices in a format and language they can understand — for example, translated documents or accessible formats for those with vision or hearing loss. |
| May 6, 2026 | F · Potential for harm, facility-wide | The facility did not make its inspection results easy for residents to see, or made it hard for residents to contact advocacy agencies like the ombudsman. |
| May 6, 2026 | F · Potential for harm, facility-wide | The facility did not honor residents' right to voice complaints without discrimination or retaliation, or did not have a working complaint process that resolves issues promptly. |
| May 6, 2026 | F · Potential for harm, facility-wide | The facility did not have a registered nurse on duty at least 8 hours a day, or did not have a registered nurse serving full-time as director of nursing. |
| May 6, 2026 | F · Potential for harm, facility-wide | The facility's menus did not meet residents' nutritional needs, or were not prepared in advance, followed as written, kept up to date, or reviewed by a dietician. |
| May 6, 2026 | E · Potential for harm, repeated | The facility gave residents unnecessary mind-altering (psychotropic) medications, or used drugs in a way that restrained residents by dulling their ability to think, move, or function. |
| May 6, 2026 | D · Potential for harm, one-off | The facility did not make sure residents were fully informed about their own health, care, and treatments in a way they could understand. |
| May 6, 2026 | D · Potential for harm, one-off | The facility did not create and follow a basic care plan covering a new resident's most immediate needs within 48 hours of admission. The first days are when a new resident is most vulnerable. |
| May 6, 2026 | D · Potential for harm, one-off | The facility did not have a licensed pharmacist review each resident's complete medication regimen and medical chart every month, or did not follow its own rules for reporting medication problems. |
| May 6, 2026 | D · Potential for harm, one-off | The facility did not serve food and drinks that were appetizing, attractive, and at a safe and pleasant temperature. |
| May 6, 2026 | D · Potential for harm, one-off | The facility was not managed in a way that uses its money, staff, and resources effectively and efficiently to care for residents. |
| May 6, 2026 | D · Potential for harm, one-off | The facility did not designate a physician to serve as medical director — the doctor responsible for overseeing resident care policies and coordinating medical care across the facility. |
| Aug 21, 2025 | E · Potential for harm, repeated | The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint |
| Aug 21, 2025 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Aug 21, 2025 | D · Potential for harm, one-off | The facility did not respond appropriately to alleged violations, such as reports of abuse, neglect, or mistreatment. Facilities must investigate every allegation and protect residents while they do. · from a complaint |
| Aug 21, 2025 | D · Potential for harm, one-off | The facility did not develop a resident's complete plan of care within 7 days of the full assessment, or the plan wasn't prepared, reviewed, and updated by a team of health professionals as required. · from a complaint |
| Aug 21, 2025 | D · Potential for harm, one-off | The facility did not provide necessary behavioral health care and services — support for residents' mental and emotional wellbeing, including conditions like depression and anxiety. · from a complaint |
| Jul 19, 2024 | D · Potential for harm, one-off | The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives. |
| Jul 19, 2024 | D · Potential for harm, one-off | When a resident had a planned discharge, the facility did not make sure the necessary information was communicated to the resident and to the doctors or facility taking over their care. |
| Jul 19, 2024 | D · Potential for harm, one-off | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Jul 19, 2024 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Jan 30, 2024 | F · Potential for harm, facility-wide | The facility did not have a registered nurse on duty at least 8 hours a day, or did not have a registered nurse serving full-time as director of nursing. · from a complaint |
| Jan 30, 2024 | E · Potential for harm, repeated | The facility did not honor residents' right to manage their own money and financial affairs. · from a complaint |
| Jan 30, 2024 | E · Potential for harm, repeated | The facility did not protect residents from misuse of their belongings or money — this is called misappropriation, and it includes theft or improper use of a resident's property or funds. · from a complaint |
| Jun 27, 2023 | E · Potential for harm, repeated | The facility did not honor residents' rights to request, refuse, or stop treatment, to decline participation in medical research, or to make an advance directive — a written statement of their wishes for future medical care. |
| Jun 27, 2023 | E · Potential for harm, repeated | The facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection. |
| Jun 27, 2023 | E · Potential for harm, repeated | The facility did not have a registered nurse on duty at least 8 hours a day, or did not have a registered nurse serving full-time as director of nursing. |
| Jun 27, 2023 | D · Potential for harm, one-off | The facility did not create and follow a basic care plan covering a new resident's most immediate needs within 48 hours of admission. The first days are when a new resident is most vulnerable. |
| Jun 27, 2023 | D · Potential for harm, one-off | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. |
| Jun 27, 2023 | D · Potential for harm, one-off | The facility did not make sure its nurses and nurse aides had the skills and training needed to properly care for every resident. |
| Jun 27, 2023 | D · Potential for harm, one-off | The facility did not provide timely, quality laboratory tests to meet residents' needs. |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (4 → 14).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 7 | 0 | E |
| 2024 | 7 | 0 | F |
| 2025 | 5 | 0 | E |
| 2026 | 15 | 3 | K ▲ |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
1 fine totaling $29,726.
| Date | Type | Amount / length |
|---|---|---|
| May 6, 2026 | Fine | $29,726 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Oklahoma avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.97 | 4.58 | 3.95 | bottom 17% in Oklahoma; top 41% in the U.S. |
| Registered Nurse hours | 0.17 | 0.41 | 0.69 | bottom 5% in Oklahoma; bottom 1% in the U.S. |
| Weekend total nurse staffing | 3.94 | 4.16 | 3.50 | bottom 38% in Oklahoma; top 25% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.26 | 0.28 | 0.48 | top 46% in Oklahoma; bottom 24% in the U.S. |
| Total nursing staff turnover (%) | 70.2 | 55.5 | 45.8 | bottom 14% in Oklahoma; bottom 6% in the U.S. |
| RN turnover (%) | 0.0 | 53.6 | 42.9 | — |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.26, RN 0.14, weekend 3.24. Staffing rating: 1/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 1/5 · long-stay residents: 1/5 · short-stay residents: —/5
Who owns this facility
For profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Angelus Holdings LLC | Organization | 5% or Greater Direct Ownership Interest | 13% | 12/12/2025 |
| BGM Estate LLC | Organization | 5% or Greater Direct Ownership Interest | 38% | 08/01/2019 |
| Mitchell, Kelly | Individual | 5% or Greater Indirect Ownership Interest | 9% | 08/01/2019 |
| Mitchell, Marcinda | Individual | 5% or Greater Indirect Ownership Interest | 9% | 08/01/2019 |
| Mitchell, Robert | Individual | 5% or Greater Indirect Ownership Interest | 9% | 08/01/2019 |
| Philip M. Green Revocable Trust | Organization | 5% or Greater Direct Ownership Interest | 25% | 08/01/2019 |
| Philip Marion Green Exempt Tr Cu Gilbert F Green Tr | Organization | 5% or Greater Direct Ownership Interest | 11% | 12/12/2025 |
| Tabor, Angela | Individual | 5% or Greater Indirect Ownership Interest | 9% | 08/01/2019 |
| Tiffany Seay Exempt Tr | Organization | 5% or Greater Direct Ownership Interest | 14% | 12/12/2025 |
| Advanced Wound Therapy | Organization | ADP of the SNF | NOT APPLICABLE | 11/01/2024 |
| Angelus Holdings LLC | Organization | ADP of the SNF | NOT APPLICABLE | 12/12/2025 |
| Belt, Miranda | Individual | Corporate Officer | NOT APPLICABLE | 12/09/2024 |
| BGM Estate LLC | Organization | ADP of the SNF | NOT APPLICABLE | 08/01/2019 |
| Cable, Ronald | Individual | Operational/Managerial Control | NOT APPLICABLE | 03/01/2022 |
| Cable, Ronald | Individual | ADP of the SNF | NOT APPLICABLE | 03/01/2022 |
| Forvis Mazars LLP | Organization | ADP of the SNF | NOT APPLICABLE | 01/01/2010 |
| Green, Philip | Individual | Individual Is an Owner, Partner or Trustee of Any ADP of the SNF | NOT APPLICABLE | 01/29/2026 |
| Jordan, Kristel | Individual | Operational/Managerial Control | NOT APPLICABLE | 10/28/2021 |
| Lipska, Lori | Individual | Operational/Managerial Control | NOT APPLICABLE | 04/18/2025 |
| Lipska, Lori | Individual | ADP of the SNF | NOT APPLICABLE | 12/01/2025 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "Can you show me an example care plan, and how are families included when it's created and updated?"
- "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "How do you communicate important notices to residents who speak another language or have trouble seeing or hearing?"
- "Where do you post your latest state inspection results and the ombudsman's contact information?"
- "Walk me through what happens when a resident or family files a grievance — who responds and how fast?"
- "How many hours a day is a registered nurse physically in the building, including weekends?"
- "Who reviews your menus, and can I see this week's menu and join my family member for a meal?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Cimarron Nursing Center | 0.3 mi | Kingfisher, OK | ★★★★★ | 5/5 | |
| Hennessey Nursing & Rehab | 18.2 mi | Hennessey, OK | ★☆☆☆☆ | 2/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 375416.