Country Club Center I
Country Club Center I Information
| Facility Name | Country Club Center I |
| Location | 860 Iron Avenue, Dover, OH 44622 |
| County (SSA Code) | Tuscarawas (800) |
| Phone Number | 330-343-5568 |
| Certification(s) | Medicare and Medicaid |
| Number of Beds | 72 |
| Average Number of Residents | 54.8 |
| 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 CENTER HOMES, INC |
| Ownership Type | For profit - Individual |
| Date First Approved | 1979-05-01 |
| Reported Nurse Aide Staffing Hours per Resident per Day | 1.38114 |
| Reported LPN Staffing Hours per Resident per Day | 0.91379 |
| Reported RN Staffing - Hours per Resident per Day | 0.5484 |
| Reported Licensed Staffing - Hours per Resident per Day (RN + LPN) | 1.46219 |
| Reported Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 2.84333 |
| Reported Physical Therapy Staffing - Hours per Resident Per Day | 0.06933 |
| Case-Mix Nurse Aide Staffing - Hours per Resident per Day | 2.08954 |
| Case-Mix LPN Staffing - Hours per Resident per Day | 0.81635 |
| Case-Mix RN Staffing - Hours per Resident per Day | 0.47464 |
| Case-Mix Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.38053 |
| Adjusted Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 2.68155 |
| Total Weighted Health Survey Score for three cycles | 103.333 |
| Rating cycle 1 Standard Survey Health Date | 2019-11-26 |
| Rating cycle 1 - Health Deficiency Score | 18 |
| Rating cycle 1 - Total Health Inspection Score | 124 |
| Date of Rating cycle 2 Standard Health Survey Date | 2018-12-12 |
| Rating cycle 2 - Health Deficiency Score | 124 |
| Date of Rating cycle 3 Standard Health Survey Date | 2017-10-12 |
| Rating cycle 3 - Health Deficiency Score | 36 |
| Rating cycle 3 - Total Health Inspection Score | 36 |
| Number of Facility-Reported Incidents | 0 |
| Number of Substantiated Complaints | 3 |
| Number of Substantiated Complaints | 3 |
| Number of Fines | 1 |
| Total Amount of Fines (in Dollars) | 23563 |
| Total Number of Penalties | 1 |
| Data Filing Date | 2020-10-01 |
| Page Last Updated | 2020-11-28 |