Country Club Center I - Dover Nursing Home
General Information
UPDATEFederal Provider Number
365417
Provider Name
COUNTRY CLUB CENTER I
Provider Address
860 IRON AVENUE
DOVER, OH 44622
DOVER, OH 44622
Provider Phone Number
3303435568
Provider SSA County
800
Provider County Name
Tuscarawas
Ownership Type
For profit - Corporation
Number of Certified Beds
72
Number of Residents in Certified Beds
51
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY CLUB CENTER HOMES, INC
Date First Approved to Provide Medicare and Medicaid services
1979-05-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.01471
Reported LPN Staffing Hours per Resident per Day
1.23235
Reported RN Staffing Hours per Resident per Day
0.96863
Reported Licensed Staffing Hours per Resident per Day
2.20098
Reported Total Nurse Staffing Hours per Resident per Day
5.21569
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08824
Expected CNA Staffing Hours per Resident per Day
2.67147
Expected LPN Staffing Hours per Resident per Day
0.80067
Expected RN Staffing Hours per Resident per Day
1.36234
Expected Total Nurse Staffing Hours per Resident per Day
4.83448
Adjusted CNA Staffing Hours per Resident per Day
2.76896
Adjusted LPN Staffing Hours per Resident per Day
1.27749
Adjusted RN Staffing Hours per Resident per Day
0.53126
Adjusted Total Nurse Staffing Hours per Resident per Day
4.34875
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-07-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-04-04
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
96
Cycle 3 Standard Health Survey Date
2012-01-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
96
Total Weighted Health Survey Score
51.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
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DOVER OH 44622 | 0.1 mile away
Amberwood Manor
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NEW PHILADELPHIA OH 44663 | 2 miles away
Park Village Health Care Center Inc
1525 Crater Avenue |
DOVER OH 44622 | 2.2 miles away
Hennis Care Centre Of Dover
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DOVER OH 44622 | 2.3 miles away
Schoenbrunn Healthcare
2594 East High Avenue |
NEW PHILADELPHIA OH 44663 | 5 miles away
Beacon Pointe Rehab Center
5166 Spanson Drive Se |
UHRICHSVILLE OH 44683 | 9.5 miles away
Hennis Care Centre Of Bolivar
300 Yant Street, Nw |
BOLIVAR OH 44612 | 9.6 miles away
Oak Pointe Nursing & Rehab Center
130 Buena Vista Street |
BALTIC OH 43804 | 13.9 miles away
Riverside Manor Nrsg & Rehab Ctr
1100 East State Road |
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