Country Club Retirement Center - Mount Vernon Nursing Home
General Information
UPDATEFederal Provider Number
365815
Provider Name
COUNTRY CLUB RETIREMENT CENTER
Provider Address
1350 YAUGER ROAD
MOUNT VERNON, OH 43050
MOUNT VERNON, OH 43050
Provider Phone Number
7403972350
Provider SSA County
430
Provider County Name
Knox
Ownership Type
For profit - Corporation
Number of Certified Beds
76
Number of Residents in Certified Beds
44
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MT VERNON ELDERLY SERVICES INC
Date First Approved to Provide Medicare and Medicaid services
1990-12-20
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
3
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
3.39318
Reported LPN Staffing Hours per Resident per Day
1.46250
Reported RN Staffing Hours per Resident per Day
0.94886
Reported Licensed Staffing Hours per Resident per Day
2.41136
Reported Total Nurse Staffing Hours per Resident per Day
5.80454
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04886
Expected CNA Staffing Hours per Resident per Day
2.35326
Expected LPN Staffing Hours per Resident per Day
0.67918
Expected RN Staffing Hours per Resident per Day
1.17177
Expected Total Nurse Staffing Hours per Resident per Day
4.20421
Adjusted CNA Staffing Hours per Resident per Day
3.53801
Adjusted LPN Staffing Hours per Resident per Day
1.78726
Adjusted RN Staffing Hours per Resident per Day
0.60506
Adjusted Total Nurse Staffing Hours per Resident per Day
5.56526
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-09-04
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
17
Cycle 2 Number of Standard Health Deficiencies
16
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
120
Cycle 2 Standard Health Survey Date
2013-06-25
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
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2012-04-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
72.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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
Country Court
1076 Coshocton Ave |
MOUNT VERNON OH 43050 | 0.5 mile away
Ohio Eastern Star Hlth Care Ctr The
1451 Gambier Road |
MOUNT VERNON OH 43050 | 0.6 mile away
Mount Vernon Health And Rehabilitation Center
1135 Gambier Road |
MOUNT VERNON OH 43050 | 0.8 mile away
Whispering Hills Care Center
416 Wooster Road |
MOUNT VERNON OH 43050 | 1.3 miles away
Laurels Of Mt Vernon The
13 Avalon Road |
MOUNT VERNON OH 43050 | 1.4 miles away
Centerburg Pointe
4531 Columbus Road |
CENTERBURG OH 43011 | 13.8 miles away
Heartland Of Centerburg
212 Fairview Avenue |
CENTERBURG OH 43011 | 14.4 miles away
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