Country Club Center V, Inc
Country Club Center V, Inc Information
| Facility Name | Country Club Center V, Inc |
| Location | 478 S Sandusky St, Delaware, OH 43015 |
| County (SSA Code) | Delaware (210) |
| Phone Number | 740-369-8741 |
| Certification(s) | Medicare and Medicaid |
| Number of Beds | 50 |
| Average Number of Residents | 44.2 |
| CCRC Facility? | No |
| Medicare Overall Rating | |
| Survey Rating | |
| Quality Rating | |
| Long Stay Quality Rating | |
| Short Stay Quality Rating | |
| Staff Quality Rating | |
| Registered Nurse Quality Rating |
| Abuse Flag | No |
| Sprinklers Installed | Yes |
| Located In Hospital | No |
| Resident Family Council | Resident |
| Provider Business Name | COUNTRY CLUB RETIREMENT CENTER V LLC |
| Ownership Type | For profit - Corporation |
| Date First Approved | 1995-09-18 |
| Reported Nurse Aide Staffing Hours per Resident per Day | 2.04784 |
| Reported LPN Staffing Hours per Resident per Day | 0.83859 |
| Reported RN Staffing - Hours per Resident per Day | 0.43091 |
| Reported Licensed Staffing - Hours per Resident per Day (RN + LPN) | 1.26951 |
| Reported Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.31735 |
| Reported Physical Therapy Staffing - Hours per Resident Per Day | 0.02422 |
| Case-Mix Nurse Aide Staffing - Hours per Resident per Day | 2.11457 |
| Case-Mix LPN Staffing - Hours per Resident per Day | 0.77616 |
| Case-Mix RN Staffing - Hours per Resident per Day | 0.39555 |
| Case-Mix Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.28629 |
| Adjusted Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.21832 |
| Total Weighted Health Survey Score for three cycles | 20.667 |
| Rating cycle 1 Standard Survey Health Date | 2019-08-15 |
| Rating cycle 1 - Health Deficiency Score | 4 |
| Rating cycle 1 - Total Health Inspection Score | 40 |
| Date of Rating cycle 2 Standard Health Survey Date | 2018-07-03 |
| Rating cycle 2 - Health Deficiency Score | 40 |
| Date of Rating cycle 3 Standard Health Survey Date | 2017-05-25 |
| Rating cycle 3 - Health Deficiency Score | 8 |
| Rating cycle 3 - Total Health Inspection Score | 8 |
| Number of Facility-Reported Incidents | 0 |
| Number of Substantiated Complaints | 3 |
| Number of Substantiated Complaints | 3 |
| Total Number of Penalties | 0 |
| Data Filing Date | 2020-10-01 |
| Page Last Updated | 2020-11-28 |