Country Club Ret Center I I I - Ashtabula Nursing Home

General Information

UPDATE
Federal Provider Number
365642
Provider Name
COUNTRY CLUB RET CENTER I I I
Provider Address
925 E 26TH ST
ASHTABULA, OH 44004
Provider Phone Number
4409920022
Provider SSA County
30
Provider County Name
Ashtabula
Ownership Type
For profit - Partnership
Number of Certified Beds
65
Number of Residents in Certified Beds
53
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY CLUB RETIREMENT CENTER LLC
Date First Approved to Provide Medicare and Medicaid services
1984-12-13
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.61226
Reported LPN Staffing Hours per Resident per Day
0.94434
Reported RN Staffing Hours per Resident per Day
0.52547
Reported Licensed Staffing Hours per Resident per Day
1.46981
Reported Total Nurse Staffing Hours per Resident per Day
4.08207
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02170
Expected CNA Staffing Hours per Resident per Day
2.45278
Expected LPN Staffing Hours per Resident per Day
0.74411
Expected RN Staffing Hours per Resident per Day
1.38642
Expected Total Nurse Staffing Hours per Resident per Day
4.58330
Adjusted CNA Staffing Hours per Resident per Day
2.61324
Adjusted LPN Staffing Hours per Resident per Day
1.05335
Adjusted RN Staffing Hours per Resident per Day
0.28320
Adjusted Total Nurse Staffing Hours per Resident per Day
3.59008
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-03-20
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-01-07
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
3
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2011-09-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
16.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
64935
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

Nursiong Homes Nearby

Ashtabula County Medical Cente

2420 Lake Avenue | ASHTABULA OH 44004 | 0.3 mile away

Carington Park

2217 West Ave | ASHTABULA OH 44004 | 0.7 mile away

Saybrook Landing

2300 Center Road | ASHTABULA OH 44004 | 3.5 miles away

Ashtabula County Nursing Home

5740 Dibble Road | KINGSVILLE OH 44048 | 4.7 miles away

Austinburg Nsg And Rehab Ctr

2026 State Route 45 | AUSTINBURG OH 44010 | 7.8 miles away

Jefferson Healthcare Center

222 E Beech St | JEFFERSON OH 44047 | 9.8 miles away

Pine Grove Healthcare Center

840 Sherman Street | GENEVA OH 44041 | 10 miles away

Geneva Village Retirement Community, Ltd

1140 South Broadway | GENEVA OH 44041 | 10.5 miles away

Rae Ann Geneva

839 W Main Street | GENEVA OH 44041 | 10.6 miles away

Geneva Shores Nursing And Rehab

60 West St | GENEVA OH 44041 | 10.7 miles away

Lake Pointe Rehabilitation And Nursing Center

22 Parrish Road | CONNEAUT OH 44030 | 11.2 miles away

Andover Village Retirement Community

486 S Main St | ANDOVER OH 44003 | 22.4 miles away

Eagle Pointe Skilled Nursing & Rehab

87 Staley Road | ORWELL OH 44076 | 24.1 miles away

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