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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 Beds72
Average Number of Residents54.8
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 InstalledYes
Located In Hospital No
Resident Family CouncilResident

Provider Business NameCOUNTRY CLUB CENTER HOMES, INC
Ownership TypeFor profit - Individual
Date First Approved1979-05-01

Reported Nurse Aide Staffing Hours per Resident per Day1.38114
Reported LPN Staffing Hours per Resident per Day0.91379
Reported RN Staffing - Hours per Resident per Day0.5484
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 Day0.06933
Case-Mix Nurse Aide Staffing - Hours per Resident per Day2.08954
Case-Mix LPN Staffing - Hours per Resident per Day0.81635
Case-Mix RN Staffing - Hours per Resident per Day0.47464
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 cycles103.333
Rating cycle 1 Standard Survey Health Date2019-11-26
Rating cycle 1 - Health Deficiency Score18
Rating cycle 1 - Total Health Inspection Score124
Date of Rating cycle 2 Standard Health Survey Date2018-12-12
Rating cycle 2 - Health Deficiency Score124
Date of Rating cycle 3 Standard Health Survey Date2017-10-12
Rating cycle 3 - Health Deficiency Score36
Rating cycle 3 - Total Health Inspection Score36

Number of Facility-Reported Incidents0
Number of Substantiated Complaints3
Number of Substantiated Complaints3
Number of Fines1
Total Amount of Fines (in Dollars)23563
Total Number of Penalties1

Data Filing Date2020-10-01
Page Last Updated2020-11-28