Country Club Retirement Ctr Iv - Bellaire Nursing Home
General Information
UPDATEFederal Provider Number
365699
Provider Name
COUNTRY CLUB RETIREMENT CTR IV
Provider Address
55801 CONNO-MARA DRIVE
BELLAIRE, OH 43906
BELLAIRE, OH 43906
Provider Phone Number
7406762300
Provider SSA County
60
Provider County Name
Belmont
Ownership Type
For profit - Corporation
Number of Certified Beds
62
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY CLUB RETIREMENT CENTER IV, INC
Date First Approved to Provide Medicare and Medicaid services
1987-06-23
Continuing Care Retirement Community
Y
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
5
QM Rating Footnote
Staffing Rating
2
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
1.87813
Reported LPN Staffing Hours per Resident per Day
0.76354
Reported RN Staffing Hours per Resident per Day
1.02813
Reported Licensed Staffing Hours per Resident per Day
1.79167
Reported Total Nurse Staffing Hours per Resident per Day
3.66980
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03854
Expected CNA Staffing Hours per Resident per Day
2.53538
Expected LPN Staffing Hours per Resident per Day
0.70723
Expected RN Staffing Hours per Resident per Day
1.32997
Expected Total Nurse Staffing Hours per Resident per Day
4.57258
Adjusted CNA Staffing Hours per Resident per Day
1.81763
Adjusted LPN Staffing Hours per Resident per Day
0.89608
Adjusted RN Staffing Hours per Resident per Day
0.57762
Adjusted Total Nurse Staffing Hours per Resident per Day
3.23507
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-05-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
10
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-02-13
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
16
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
108
Cycle 3 Standard Health Survey Date
2011-10-14
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
54
Cycle 3 Total Health Score
162
Total Weighted Health Survey Score
51.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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
Heartland-lansing
68222 Commercial Drive |
BRIDGEPORT OH 43912 | 3.6 miles away
Shadyside Care Center
60583 State Route 7 |
SHADYSIDE OH 43947 | 4.4 miles away
East Ohio Regional Hospital
90 North Fourth Street |
MARTINS FERRY OH 43935 | 6.3 miles away
Emerald Pointe Health And Rehab Ctr
100 Michelli Street |
BARNESVILLE OH 43713 | 19.4 miles away
Astoria Place Of Barnesville
400 Carrie Avenue |
BARNESVILLE OH 43713 | 21.5 miles away
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