Country Club Ret Center I I I
Country Club Ret Center I I I Information
| Facility Name | Country Club Ret Center I I I |
| Location | 925 E 26th St, Ashtabula, OH 44004 |
| County (SSA Code) | Ashtabula (30) |
| Phone Number | 440-992-0022 |
| Certification(s) | Medicare and Medicaid |
| Number of Beds | 65 |
| Average Number of Residents | 60.4 |
| CCRC Facility? | Yes |
| 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 LLC |
| Ownership Type | For profit - Partnership |
| Date First Approved | 1984-12-13 |
| Reported Nurse Aide Staffing Hours per Resident per Day | 2.25177 |
| Reported LPN Staffing Hours per Resident per Day | 0.72954 |
| Reported RN Staffing - Hours per Resident per Day | 0.56237 |
| Reported Licensed Staffing - Hours per Resident per Day (RN + LPN) | 1.29192 |
| Reported Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.54369 |
| Reported Physical Therapy Staffing - Hours per Resident Per Day | 0.05994 |
| Case-Mix Nurse Aide Staffing - Hours per Resident per Day | 2.28105 |
| Case-Mix LPN Staffing - Hours per Resident per Day | 0.91846 |
| Case-Mix RN Staffing - Hours per Resident per Day | 0.56037 |
| Case-Mix Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.75987 |
| Adjusted Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.00487 |
| Total Weighted Health Survey Score for three cycles | 20.667 |
| Rating cycle 1 Standard Survey Health Date | 2020-02-27 |
| Rating cycle 1 - Health Deficiency Score | 4 |
| Rating cycle 1 - Total Health Inspection Score | 12 |
| Date of Rating cycle 2 Standard Health Survey Date | 2018-12-13 |
| Rating cycle 2 - Health Deficiency Score | 12 |
| Date of Rating cycle 3 Standard Health Survey Date | 2017-11-08 |
| Rating cycle 3 - Health Deficiency Score | 4 |
| Rating cycle 3 - Total Health Inspection Score | 4 |
| Number of Facility-Reported Incidents | 1 |
| Number of Substantiated Complaints | 2 |
| Number of Substantiated Complaints | 2 |
| Total Number of Penalties | 0 |
| Data Filing Date | 2020-10-01 |
| Page Last Updated | 2020-11-28 |