Inspection Reports for
Country Club Center II
1350 YAUGER ROAD, MOUNT VERNON, OH, 43050
Back to Facility ProfileCitations (last 4 years)
Citations (over 4 years)
10 citations/year
Citations are regulatory findings recorded during state inspections.
117% worse than Ohio average
Ohio average: 4.6 citations/yearCitations per year
20
15
10
5
0
Inspection Report
Complaint Investigation
Census: 65
Citations: 1
Date: Jun 10, 2025
Visit Reason
The inspection was conducted following a self-reported incident involving Resident #10 eloping from the facility without staff knowledge, to investigate the facility's compliance with safety and supervision requirements.
Complaint Details
This deficiency represents non-compliance investigated under Self-Reported Incident, Control Number OH00166053.
Findings
The facility failed to maintain a safe environment and adequate supervision to prevent Resident #10, who was cognitively impaired and at risk for elopement, from leaving the facility unsupervised. Corrective actions were implemented promptly after the incident, including one-on-one supervision, reassessment of elopement risk for residents, staff education, and enhanced monitoring procedures.
Citations (1)
F 0689: The facility failed to ensure a nursing home area was free from accident hazards and provided adequate supervision to prevent Resident #10 from eloping. Resident #10 removed his Wanderguard and left the facility unnoticed, posing a safety risk.
Report Facts
Facility census: 65
Elopement risk scores: 7
Elopement risk scores: 6
Elopement risk scores: 5
Elopement risk scores: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) #215 | Noted Resident #10 was missing and initiated search | |
| Director of Nursing (DON) | Notified immediately, arrived within ten minutes, coordinated response | |
| Assistant Director of Nursing (ADON) | Participated in search efforts around the community |
Inspection Report
Complaint Investigation
Census: 69
Citations: 3
Date: Oct 3, 2024
Visit Reason
The inspection was conducted following complaints and incidents involving staff-to-resident physical abuse, misappropriation of resident narcotic medication, and failure to prevent falls with injury.
Complaint Details
The investigation was complaint-driven, involving allegations of staff-to-resident physical abuse, narcotic medication misappropriation, and inadequate fall prevention. The abuse and misappropriation allegations were substantiated, and the fall prevention failure resulted in actual harm to Resident #60.
Findings
The facility was found to have failed to prevent physical abuse of Resident #51 by a staff member, failed to prevent misappropriation of narcotic medication for Resident #12, and failed to implement adequate fall prevention interventions for Resident #60, resulting in actual harm including fractures.
Citations (3)
F 0600: The facility failed to ensure Resident #51 was free from staff-to-resident physical abuse when a State Tested Nursing Assistant slapped the resident's hand during care. The staff member was terminated.
F 0602: The facility failed to prevent misappropriation of Resident #12's narcotic medication, Percocet, resulting in eight tablets missing. The suspected staff member was terminated and reported to the state boards.
F 0689: The facility failed to develop and implement individualized fall prevention interventions for Resident #60, who sustained multiple falls including one resulting in fractures requiring emergency room transfer.
Report Facts
Facility census: 69
Missing narcotic tablets: 8
Number of falls: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| STNA #267 | State Tested Nursing Assistant | Named in physical abuse finding for slapping Resident #51's hand |
| LPN #265 | Licensed Practical Nurse | Named in narcotic medication misappropriation investigation for Resident #12 |
| RN #213 | Registered Nurse | Reported abuse incident and involved in investigation of Resident #51 |
| STNA #222 | State Tested Nursing Assistant | Assisted Resident #60 during fall on 09/04/24 |
| RN #163 | Registered Nurse | Provided information on narcotic count procedures and fall intervention processes |
| Director of Nursing (DON) | Director of Nursing | Involved in investigations and interviews related to abuse, narcotic misappropriation, and fall prevention |
Inspection Report
Routine
Census: 60
Citations: 12
Date: May 16, 2024
Visit Reason
Routine inspection of Country Club Retirement Center to assess compliance with healthcare regulations including resident rights, abuse prevention, care quality, infection control, and medication management.
Findings
The facility had multiple deficiencies including failure to maintain accurate advance directives, incidents of staff-to-resident abuse, failure to report and investigate abuse allegations thoroughly, inadequate bathing and personal care, failure to follow bowel management policies, missing hospice communication, inadequate pressure ulcer care, failure to offer nutritional supplements, incomplete dialysis communication, delayed pharmacy recommendation follow-up, serving food at unsafe temperatures, and failure to implement enhanced barrier precautions timely.
Citations (12)
F 0578: Facility failed to have correct advance directives in Resident #22's medical record, affecting one resident out of three reviewed.
F 0600: Facility failed to protect Residents #4 and #17 from staff-to-resident physical and verbal abuse and failed to report and investigate abuse allegations properly.
F 0609: Facility failed to timely report suspected staff-to-resident verbal abuse involving Resident #47 to the state agency.
F 0610: Facility failed to thoroughly investigate allegations of abuse for Residents #4 and #17, with incomplete documentation and follow-up.
F 0677: Facility failed to provide scheduled bathing to Residents #12, #22, #28, #30, and #43 who were dependent on staff for care.
F 0684: Facility failed to follow bowel management policy for Residents #22 and #39 and failed to ensure Hospice communication was onsite for Resident #9.
F 0686: Facility failed to comprehensively assess and provide adequate interventions and treatment for Resident #31's stage II and stage III pressure ulcers.
F 0692: Facility failed to offer alternative meal choices or nutritional shakes when Resident #42 consumed less than 50% of meals.
F 0698: Facility failed to ensure dialysis communication forms were completed and returned for Resident #267 post dialysis treatment.
F 0756: Facility failed to address pharmacy recommendations timely for Residents #22 and #32, including dose reduction and PRN medication duration.
F 0804: Facility failed to ensure food was served at a palatable and safe temperature; food was served lukewarm or cold.
F 0880: Facility failed to implement enhanced barrier precautions timely for residents with indwelling medical devices to prevent infection transmission.
Report Facts
Residents affected: 1
Residents affected: 2
Residents affected: 1
Residents affected: 2
Residents affected: 5
Residents affected: 2
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 2
Residents affected: 60
Residents affected: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| STNA #102 | State Tested Nursing Assistant | Named in physical abuse incident with Resident #4 and subsequent involuntary termination |
| STNA #5 | State Tested Nursing Assistant | Witness and reporter of abuse incident involving Resident #4 |
| STNA #40 | State Tested Nursing Assistant | Named in verbal abuse allegations involving Resident #17 |
| STNA #42 | State Tested Nursing Assistant | Reported verbal abuse incident involving Resident #17 |
| ADON #47 | Assistant Director of Nursing | Involved in abuse investigation and interview regarding Resident #17 and STNA #40 |
| Corporate Nurse #100 | Corporate Nurse | Interviewed regarding abuse investigations, bowel management, nutritional supplements, dialysis communication, and pharmacy recommendations |
| DON | Director of Nursing | Interviewed regarding abuse investigations, bathing schedules, hospice communication, nutritional supplements, and infection control |
| RN #45 | Registered Nurse | Could not locate Hospice communications for Resident #9 |
| NP #400 | Nurse Practitioner | Provided wound care assessment and treatment orders for Resident #31 |
| Dietary Supervisor #24 | Dietary Supervisor | Observed and reported food temperature issues |
| Dietary Assistant Manager #16 | Dietary Assistant Manager | Measured food temperatures during meal service |
| Cooperate Nurse #100 | Corporate Nurse | Interviewed multiple times regarding various deficiencies |
| Supply Company Associate #600 | Supply Company Associate | Interviewed regarding delays in delivery of isolation supplies |
Inspection Report
Complaint Investigation
Citations: 3
Date: Mar 15, 2024
Visit Reason
The inspection was conducted due to a complaint investigation regarding alleged misappropriation of resident funds at the facility.
Complaint Details
The complaint investigation involved Resident #68's funds, where $389.00 was found missing from an envelope of spend down money. Law enforcement was notified but the investigation was unsubstantiated due to inconclusive evidence. The facility replaced the missing funds and notified the resident's son and ombudsman. The investigation lacked resident interviews, suspension of staff with safe access, and use of security cameras.
Findings
The facility failed to properly hold, secure, and manage a resident's personal funds, resulting in missing money and failure to follow accounting principles. An investigation was conducted but misappropriation was unsubstantiated due to inconclusive evidence. The facility did not fully follow policies for investigating and handling the incident.
Citations (3)
F 0568: The facility failed to properly hold, secure, and manage Resident #68's personal money deposited with the nursing home, resulting in missing funds and lack of reconciliation.
F 0602: The facility failed to protect Resident #68 from wrongful use of belongings or money, with missing funds not properly investigated or accounted for.
F 0607: The facility failed to develop and implement adequate policies and procedures to prevent abuse, neglect, and theft, and did not thoroughly investigate misappropriated funds.
Report Facts
Amount withdrawn: 2500
Amount spent: 346.49
Missing funds: 389
Remaining funds: 2153.51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Business Office Manager #117 | Business Office Manager | Named in findings related to failure to reconcile resident funds and handling of spend down money |
| Corporate Business Office Manager #300 | Corporate Business Office Manager | Confirmed facility did not follow accounting principles and audited resident funds |
| Administrator | Named in findings related to cash handling, safe access, and investigation |
Inspection Report
Complaint Investigation
Census: 63
Citations: 3
Date: Nov 7, 2023
Visit Reason
The inspection was conducted as a complaint investigation under Complaint Number OH00147679 regarding medication administration, dietary service, and infection control concerns.
Complaint Details
This deficiency report represents non-compliance investigated under Complaint Number OH00147679.
Findings
The facility failed to administer insulin via an insulin pen according to manufacturer guidelines, failed to ensure residents received diet items as ordered, and failed to properly cleanse the glucometer used for finger stick blood sugar testing. Additionally, the facility failed to ensure ice used for ice pass was free of contamination.
Citations (3)
F 0760: The facility failed to administer insulin via an insulin pen according to manufacturer instructions, affecting one resident. The insulin pen was not primed with the required two-unit air shot before injection.
F 0800: The facility failed to ensure residents received diet items as ordered, affecting two residents. One resident received an unrequested biscuit, and another resident did not receive a breakfast tray on time and was missing mandarin oranges on the tray.
F 0880: The facility failed to properly cleanse the glucometer between uses and allowed residents to obtain ice that may have been contaminated, potentially affecting all 63 residents. The glucometer was wiped but not disinfected for the required contact time.
Report Facts
Facility census: 63
Residents affected by insulin pen error: 1
Residents affected by dietary errors: 2
Residents affected by infection control issues: 3
Residents potentially affected by ice contamination: 63
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) #240 | Observed and interviewed regarding insulin administration and FSBS testing procedures | |
| Licensed Practical Nurse (LPN) #300 | Interviewed regarding dietary service and resident #30's meal | |
| State Tested Nursing Assistant (STNA) #260 | Interviewed and observed regarding meal tray service for resident #30 | |
| Clinical Consultant #230 | Interviewed regarding insulin pen use and infection control policies | |
| State Tested Nursing Assistant (STNA) #210 | Interviewed regarding resident ice use and ice cooler removal |
Inspection Report
Annual Inspection
Citations: 0
Date: Sep 12, 2023
Visit Reason
Annual inspection survey of Country Club Retirement Center to assess compliance with health and safety regulations.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Complaint Investigation
Census: 67
Citations: 1
Date: Aug 29, 2023
Visit Reason
The inspection was conducted as a complaint investigation related to pressure ulcer care and prevention at the Country Club Retirement Center.
Complaint Details
This deficiency represents non-compliance investigated under Complaint Number OH00145762.
Findings
The facility failed to implement adequate skin risk interventions and treatment for Resident #5, resulting in the development of a Stage III pressure ulcer on the left heel. Treatment orders were delayed by ten days after the ulcer was identified, and there was no physician order or documentation for the use of pressure relieving boots.
Citations (1)
F 0686: The facility failed to provide appropriate pressure ulcer care and prevent new ulcers from developing. Resident #5 developed a Stage III pressure ulcer on the left heel, and treatment orders were not implemented until ten days after identification.
Report Facts
Facility census: 67
Pressure ulcer size: 3.5
Pressure ulcer size: 3
Pressure ulcer size: 1.2
Pressure ulcer size: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nurse Practitioner (CNP) | Assessed Resident #5's pressure ulcer and issued treatment orders | |
| Assistant Director of Nursing (ADON) | Completed wound evaluation flow sheet for Resident #5 | |
| Corporate Nurse (CN) | Verified lack of documentation and delayed treatment implementation for Resident #5 |
Inspection Report
Routine
Census: 70
Citations: 14
Date: Apr 20, 2023
Visit Reason
Routine inspection of Country Club Retirement Center to assess compliance with healthcare regulations including resident care, safety, infection control, and facility operations.
Findings
The facility had multiple deficiencies including inaccurate advance directives documentation, failure to maintain resident privacy, unsanitary environment, incomplete care plans, inadequate fall prevention and neurological checks, improper respiratory equipment maintenance, missed laboratory tests, delayed dental services, incomplete pureed diet provision, improper food storage, and lapses in infection control and hand hygiene.
Citations (14)
F 0578: The facility failed to ensure advance directives and plan of care were accurate for Resident #18, with conflicting DNR and Full Code documentation.
F 0583: The facility failed to provide resident privacy by not knocking before entering rooms of Residents #54 and #271.
F 0584: The facility failed to maintain a clean and sanitary environment affecting Residents #35 and #56 and potentially 17 others, including unclean toilets and blood stains.
F 0644: The facility failed to update PASRR with new mental illness diagnoses for Residents #5, #43, and #33.
F 0656: The facility failed to develop a care plan for oxygen use for Resident #18 despite physician orders.
F 0684: The facility failed to perform neurological checks after a fall with head injury for Resident #56.
F 0689: The facility failed to implement fall prevention interventions for Residents #42 and #56 and failed to initiate new interventions after Resident #56's second fall.
F 0695: The facility failed to ensure respiratory equipment was dated, clean, and stored properly for Residents #18, #29, and #36.
F 0773: The facility failed to ensure laboratory tests ordered by the physician were completed for Resident #19.
F 0791: The facility failed to ensure timely dental services for Resident #18 despite documented dental needs.
F 0803: The facility failed to provide all items on the pureed diet menu for Residents #14 and #21, omitting pureed bread.
F 0804: The facility failed to prepare pureed food according to recipe instructions, resulting in poor taste and possible nutritional loss for Residents #14 and #21.
F 0812: The facility failed to properly store food items with undated, uncovered, or improperly sealed foods in refrigerators, freezers, and dry storage.
F 0880: The facility failed to ensure timely blood cleanup after a fall, proper hand hygiene during medication administration, wound care, blood sugar checks, and meal tray passing, affecting multiple residents including #54, #56, #271, #273, and others.
Report Facts
Residents affected: 1
Residents affected: 2
Residents affected: 2
Residents affected: 3
Residents affected: 1
Residents affected: 1
Residents affected: 2
Residents affected: 3
Residents affected: 1
Residents affected: 1
Residents affected: 2
Residents affected: 5
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Clinical Services #99 | Director of Clinical Services | Verified advance directive discrepancy, oxygen care plan absence, neurological check absence, fall prevention failures, blood cleanup, and hand hygiene issues |
| Licensed Practical Nurse #48 | Licensed Practical Nurse | Observed failing to knock before entering Resident #54's room and improper wound care hand hygiene |
| Licensed Practical Nurse #52 | Licensed Practical Nurse | Observed failing to knock before entering Resident #271's room and improper hand hygiene during blood sugar check |
| Registered Nurse #70 | Registered Nurse | Observed improper hand hygiene after medication administration for Resident #273 |
| Social Service #76 | Social Service | Confirmed PASRR update failures and dental service scheduling issues |
| Dietary Manager #16 | Dietary Manager | Confirmed pureed diet omissions and food storage deficiencies |
| Housekeeping Supervisor #27 | Housekeeping Supervisor | Confirmed blood cleanup failures and environmental sanitation issues |
| State Tested Nurse Aide #66 | State Tested Nurse Aide | Observed failing to wash hands between resident rooms during meal tray passing |
| State Tested Nurse Aide #69 | State Tested Nurse Aide | Observed failing to wash hands between resident rooms during meal tray passing |
Inspection Report
Citations: 3
Date: May 20, 2021
Visit Reason
The inspection was conducted to evaluate compliance with regulatory requirements related to resident safety, pain management, infection control, and other care standards at Country Club Retirement Center.
Findings
The facility failed to prevent a resident from ingesting a liquid cleaning solution, failed to provide timely and effective pain management for a resident following a fall with injury, and failed to maintain adequate infection control practices during incontinence care and isolation precautions. These deficiencies affected multiple residents and involved inadequate supervision, delayed pain assessment and treatment, and improper use of personal protective equipment.
Citations (3)
F 0689: The facility failed to prevent Resident #4 from ingesting a liquid cleaning solution used for perineal care, resulting in potential harm. The resident required extensive assistance and had severe cognitive impairment.
F 0697: The facility failed to provide timely and effective pain management for Resident #35 after a fall resulting in a displaced hip fracture. Pain assessments and physician notifications were inadequate, and pain medication effectiveness was not documented.
F 0880: The facility failed to maintain adequate infection control during incontinence care for Resident #46 and during personal care for Resident #21, including improper use and removal of personal protective equipment, risking infection spread.
Report Facts
Residents reviewed for accidents: 6
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents reviewed for isolation precautions: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #22 | Licensed Practical Nurse | Responded to Resident #35's fall and pain complaints; provided information on pain management and medication administration. |
| STNA #27 | State Tested Nursing Assistant | Provided incontinence care to Resident #46 and confirmed failure to sanitize bedside table after placing contaminated articles. |
| STNA #19 | State Tested Nursing Assistant | Observed wearing PPE improperly during care of Resident #21, carrying meal tray while still wearing gown and gloves. |
| Director of Nursing | Director of Nursing (DON) | Interviewed regarding audits for new admissions and education following Resident #4's ingestion incident and pain management issues. |
| Assistant Director of Nursing | Assistant Director of Nursing (ADON) | Interviewed regarding pain management, STAT x-ray procedures, and documentation following Resident #35's fall. |
| Director of Clinical Services | Director of Clinical Services (DCS) | Interviewed about removal of periwash from Resident #4's room and staff education. |
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