Contact Information

COUNTRY CLUB CENTER V, INC
COUNTRY CLUB RETIREMENT CENTER V LLC
478 S SANDUSKY ST
DELAWARE, OH 43015
(740) 369-8741
For profit - Corporation
Medicare certification date2: September 18, 1995
The is the date the nursing home was certified to participate in the Medicare program.

1 Nursing homes can be run by private for-profit corporations, non-profit corporations, religious affiliated organizations or government entities.

2 Agencies that are Medicare Certified are able to participate in Medicare related programs.


Nursing Home Information

  41 residents

  50 certified beds

  Participates in Medicare and Medicaid

  Continuing Care Retirement Community

  In hospital

  Resident Council only

  Automatic sprinklers in all required areas

Quality rating
Health inspection rating
Staffing rating
Substantiated complaints 10
Facility reported incidents 1
Number of fines None
Number of penalties None
Number of payment denials None

Staffing

Staffing for 41 residents Ohio Average National Average
Hours by Registered Nurse (RN) per resident per day 26 minutes 38 minutes 41 minutes
Hours by Licensed Practial Nurse (LPN & LVN) per resident per day 1 hour, 3 minutes 58 minutes 53 minutes
Hours by Certified Nursing Assistant (CNA) per resident per day 2 hours, 14 minutes 2 hours, 8 minutes 2 hours, 20 minutes
Physical therapy (PT) staff hours per resident per day 4 minutes 5 minutes 7 minutes

Staffing hours per resident is the total number of hours worked by the staff divided by the total number of residents. It doesn't necessarily show the number of nursing staff present at any given time or the amount of care given to any one resident.

Ownership

5% OR GREATER DIRECT OWNERSHIP INTEREST

  • HOLLAND GROUP II, LTD
  • HARRIS, JANET

MANAGING EMPLOYEE

  • HARRIS, JANET

OFFICER

  • HARRIS, JANET

Nursing Home Report

In 2016, COUNTRY CLUB CENTER V, INC charged a total of $1,433,543 for 69 Medicare Beneficiaries. The average age of residents at this skilled nursing facility is about 73.

The report covers only calendar year 2016.

Chronic Condition of Residents
Atrial Fibrillation 38% Alzheimer's 25%
Asthma 48% Cancer 14%
Congestive Heart Failure 42% Kidney Disease 58%
COPD 48% Depression 42%
Diabetes 55% Hyperlipidemia 68%
Hypertension n/a Ischemic Heart Disease 61%
Osteoporosis 13% RA / OA 70%
Schizophrenia 6% Stroke 10%
Demographics
Medicare Beneficiaries 69 Average Age 73
Male 28 Female 41
White 66
Black n/a
Asian 0
Hispanic 0
American Indian 0
Other n/a

Health & Fire Inspection

Most recent health inspection: Jul 03, 2018; fire safety inspection: Jul 09, 2018

Health Deficiencies as of 07/03/2018
Freedom from Abuse, Neglect, and Exploitation None
Quality of Life and Care 1
Resident Assessment and Care Planning 2
Nursing and Physician Services None
Resident Rights 1
Nutrition and Dietary Deficiencies None
Pharmacy Service 1
Environmental Deficiencies 2
Administration Deficiencies None
Fire Deficiencies as of 07/09/2018
Emergency Preparedness None
Automatic Sprinkler Systems None
Construction Deficiencies None
Services Deficiencies None
Corridor Walls and Doors None
Egress Deficiencies 1
Electrical Deficiencies None
Emergency Plans and Fire Drills None
Fire Alarm Systems None
Smoke Deficiencies None
Interior Deficiencies None
Gas, Vacuum, and Electrical Systems 1
Hazardous Area None
Illumination and Emergency Power None
Laboratories Deficiencies None
Medical Gases and Anesthetizing Areas None
Smoking Regulations None
Miscellaneous Regulations None

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See also