SNF
COUNTRY CLUB CENTER V, INC
CCN: 366026 · DELAWARE, OH 43015 · Delaware County
Overview
- Address
- 478 S SANDUSKY ST, DELAWARE, OH 43015
- Phone
- 7403698741
- Certified beds
- 50
- Avg daily residents
- 47 (93% of beds filled)
- Ownership
- For-profit corporation
- Provider type
- Medicare and Medicaid
- Medicare/Medicaid since
- 1995-09-18
- Setting
- Urban
5 /5
★★★★★
CMS Overall Rating
CMS 5-Star Ratings
CMS rates every Medicare/Medicaid-certified nursing home on four domains. The Overall rating is driven primarily by Health Inspection results, then adjusted up or down by Staffing and Quality Measures.
Staffing & Workforce
Direct-care staffing is the strongest operational driver of quality in nursing homes. Values are hours per resident per day, derived from payroll-based journal (PBJ) submissions. "Case-mix" adjusts for resident acuity; "Adjusted" is the CMS rating-input value.
| Role | Reported | Case-mix expected | Adjusted | Federal floor | |
|---|---|---|---|---|---|
| Total nurse All nursing staff combined: RN + LPN + Aide | 4.32 | 5.49 | 3.04 | ≥ 3.48 | |
| Registered Nurse (RN) Licensed RN hours. Strongest driver of clinical outcomes. | 1.06 | 0.96 | 0.75 | ≥ 0.55 | |
| Licensed Practical Nurse (LPN) LPN/LVN hours. Often handles medication administration. | 1.07 | 1.22 | 0.75 | — | |
| Nurse aide CNA hours. Bulk of direct resident care — bathing, feeding, mobility. | 2.19 | 3.31 | 1.54 | — | |
| Licensed (RN + LPN) Combined licensed nurse coverage. | 2.13 | — | — | — | |
| Physical therapist Rehabilitation therapist hours — important for post-acute / rehab admissions. | 0.01 | — | — | — |
Federal minimums (phasing in under the CMS 2024 minimum staffing rule) shown for reference. RN: 0.55 hrs/resident/day. Total nurse: 3.48 hrs/resident/day.
Weekend staffing
Total nurse (weekend)
3.94
hrs / resident / day
RN (weekend)
0.49
hrs / resident / day
Total nurse (adjusted, weekend)
2.77
hrs / resident / day
Weekend under-staffing is a common quality-of-care concern — adverse events are more frequent when licensed coverage drops.
Staff turnover
Total nursing staff turnover
40.7%
annual
RN turnover
10.0%
annual
Administrators departed
0
last 12 months
Resident acuity
Nursing Case-Mix Index
1.94
higher acuity than avg
Case-Mix Index Ratio
1.41
facility / state ratio
Health Inspections
CMS weights three inspection cycles to compute the Health Inspection rating: the most recent (50%), the second most recent (33%), and the oldest (17%). Each standard-survey deficiency is assigned a score based on scope and severity; complaint-survey findings and revisit scores are added to produce the cycle total.
| Cycle | Date | Total defs. | Standard | Complaint | Deficiency score | Revisits | Total score |
|---|---|---|---|---|---|---|---|
| Cycle 1 (most recent) | 2025-01-16 | 7 | 1 | 7 | 28 | 1 | 28 |
| Cycle 2/3 (prior) | 2022-05-12 | 4 | 2 | 2 | 16 | 1 | 16 |
Total weighted health score
25.0
lower is better
Deficiencies (15)
Individual survey findings. Scope/severity uses the CMS A–L matrix: letters further down the alphabet indicate greater harm and wider scope, up through J–L (immediate jeopardy).
1 A/B/C No actual harm — minor
14 D/E/F Actual harm — potential for minor
| Tag | Description | Scope/Severity | Survey date | Corrected |
|---|---|---|---|---|
| 0558 | Reasonably accommodate the needs and preferences of each resident. | D | 2025-08-28 | 2025-09-30 |
| 0561 | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | D | 2025-08-28 | 2025-09-30 |
| 0757 | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | 2025-08-28 | 2025-09-30 |
| 0800 | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | D | 2025-08-28 | 2025-09-30 |
| 0805 | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | D | 2025-08-28 | 2025-09-30 |
| 0880 | Provide and implement an infection prevention and control program. | D | 2025-08-28 | 2025-09-30 |
| 0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | 2025-02-28 | 2025-01-31 |
| 0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | 2025-01-16 | 2025-01-29 |
| 0610 | Respond appropriately to all alleged violations. | D | 2023-05-17 | 2023-05-26 |
| 0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | 2022-05-12 | 2022-05-27 |
| 0759 | Ensure medication error rates are not 5 percent or greater. | D | 2022-05-12 | 2022-05-27 |
| 0623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | D | 2019-08-15 | 2019-10-03 |
| 0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | 2019-08-15 | 2019-10-03 |
| 0814 | Dispose of garbage and refuse properly. | C | 2019-08-15 | 2019-09-06 |
| 0880 | Provide and implement an infection prevention and control program. | D | 2019-08-15 | 2019-10-03 |
Financial Health (FY 2023)
Payer mix (share of resident days)
Medicare 9.5% Medicaid 52.2% Other 38.3%
Operating performance
Operating Margin
2.6%
Total Margin
7.5%
Occupancy Rate
88.0%
Cost per Resident Day
$64
Revenue & costs
Net Patient Revenue
$5.1M
Total Costs
$1.0M
Net Income
$400K
Balance sheet
Total Assets
$1.5M
Total Liabilities
$313K
Fund Balance
$1.1M
Current Ratio
3.18
Source: CMS SNF Cost Report (FY 2023). Cost report data lags by ~2 years.
Ownership & Corporate Structure
Chain: COUNTRY CLUB REHABILITATION CAMPUS
- Chain ID
164- Facilities in chain
- 7
- Legal business name
- COUNTRY CLUB RETIREMENT CENTER V LLC
Chain-average star ratings (for peer context)
Overall
3.1
Health
2.6
Staffing
2.7
QM
4.4
Owner / manager organizations (1)
| Organization | Role | Association |
|---|---|---|
| HOLLAND GROUP II, LTD | 5% OR GREATER DIRECT OWNERSHIP INTEREST | since 10/01/2013 |
Owner / manager individuals (13)
| Name | Role | Association |
|---|---|---|
| HARRIS, JANET | 5% OR GREATER DIRECT OWNERSHIP INTEREST | since 10/01/2013 |
| GRESOCK, JOSHUA | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | since 08/01/2013 |
| HOLLAND, BENJAMIN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | since 08/01/2013 |
| HOLLAND, NICHOLAS | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | since 08/01/2013 |
| HOLLAND, NOAH | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | since 08/01/2013 |
| HOLLAND-GRESOCK, ADAM | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | since 08/01/2013 |
| HOLLAND-GRESOCK, PATRICIA | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | since 08/01/2013 |
| MUIRDEN-HOLLAND, JOHN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | since 08/01/2013 |
| HARRIS, JANET | OPERATIONAL/MANAGERIAL CONTROL | since 11/07/2024 |
| OLSON, LYLE | OPERATIONAL/MANAGERIAL CONTROL | since 01/01/2024 |
| ORTMAN, DIANNA | OPERATIONAL/MANAGERIAL CONTROL | since 01/01/2018 |
| HARRIS, JANET | CORPORATE DIRECTOR | since 12/31/2013 |
| HARRIS, JANET | CORPORATE OFFICER | since 12/31/2013 |
Source: CMS Nursing Home Ownership. Percent ownership is rarely disclosed — CMS only requires it for specific roles.
Facility Features
- CCRC
- No
- Hospital-based
- No
- Resident / family council
- Resident
- Sprinkler systems
- Yes
- Abuse citation flag
- No
Methodology & sources
- Nursing Home Provider Info (
nh-provider-info), vintage 2026, downloaded 2026-04-14 , 14,703 rows. - Nursing Home Health Deficiencies (
nh-deficiencies), vintage 2026, downloaded 2026-04-14 , 418,972 rows. - Nursing Home Ownership (
nh-ownership), vintage 2026, downloaded 2026-04-14 , 160,393 rows. - Skilled Nursing Facility Cost Report (
snf-cost-report), vintage 2023, downloaded 2026-04-14 , 14,120 rows.
All Data
Every labeled field shipped for this facility by CMS. No national median or percentile context is available for SNFs in the current release.
Show 113 rows
| Source | Metric | Value | Raw key |
|---|---|---|---|
| Cost Report | Cost per Resident Day ($) | $64 | metrics.cost_per_resident_day |
| Cost Report | Current Ratio | 3.18 | metrics.current_ratio |
| Cost Report | fiscal_year | 2,023 | fiscal_year |
| Cost Report | Medicaid Day Share (%) | 52.2% | metrics.medicaid_day_share |
| Cost Report | Medicare Day Share (%) | 9.5% | metrics.medicare_day_share |
| Cost Report | Net Income ($) | $400,352 | metrics.net_income |
| Cost Report | Net Patient Revenue ($) | $5,075,842 | metrics.net_patient_revenue |
| Cost Report | Occupancy Rate (%) | 88.0% | metrics.occupancy_rate |
| Cost Report | Operating Margin (%) | 2.6% | metrics.operating_margin |
| Cost Report | Total Assets ($) | $1,460,022 | metrics.total_assets |
| Cost Report | Total Costs ($) | $1,021,276 | metrics.total_costs |
| Cost Report | Total Fund Balances ($) | $1,147,225 | metrics.fund_balance |
| Cost Report | Total Liabilities ($) | $312,797 | metrics.total_liabilities |
| Cost Report | Total Margin (%) | 7.5% | metrics.total_margin |
| Provider Information | Abuse Icon | N | Abuse Icon |
| Provider Information | Adjusted LPN Staffing Hours per Resident per Day | 0.75355 | Adjusted LPN Staffing Hours per Resident per Day |
| Provider Information | Adjusted Nurse Aide Staffing Hours per Resident per Day | 1.54090 | Adjusted Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Adjusted RN Staffing Hours per Resident per Day | 0.74529 | Adjusted RN Staffing Hours per Resident per Day |
| Provider Information | Adjusted Total Nurse Staffing Hours per Resident per Day | 3.03975 | Adjusted Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Adjusted Weekend Total Nurse Staffing Hours per Resident per Day | 2.77047 | Adjusted Weekend Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Administrator turnover footnote | — | Administrator turnover footnote |
| Provider Information | Automatic Sprinkler Systems in All Required Areas | Yes | Automatic Sprinkler Systems in All Required Areas |
| Provider Information | Average Number of Residents per Day | 46.5 | Average Number of Residents per Day |
| Provider Information | Average Number of Residents per Day Footnote | — | Average Number of Residents per Day Footnote |
| Provider Information | Case-Mix LPN Staffing Hours per Resident per Day | 1.21820 | Case-Mix LPN Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Nurse Aide Staffing Hours per Resident per Day | 3.31078 | Case-Mix Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Case-Mix RN Staffing Hours per Resident per Day | 0.96020 | Case-Mix RN Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Total Nurse Staffing Hours per Resident per Day | 5.48918 | Case-Mix Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day | 4.83814 | Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Chain Average Health Inspection Rating | 2.6 | Chain Average Health Inspection Rating |
| Provider Information | Chain Average Overall 5-star Rating | 3.1 | Chain Average Overall 5-star Rating |
| Provider Information | Chain Average QM Rating | 4.4 | Chain Average QM Rating |
| Provider Information | Chain Average Staffing Rating | 2.7 | Chain Average Staffing Rating |
| Provider Information | Chain ID | 164 | Chain ID |
| Provider Information | Chain Name | COUNTRY CLUB REHABILITATION CAMPUS | Chain Name |
| Provider Information | City/Town | DELAWARE | City/Town |
| Provider Information | CMS Certification Number (CCN) | 366026 | CMS Certification Number (CCN) |
| Provider Information | Continuing Care Retirement Community | N | Continuing Care Retirement Community |
| Provider Information | County/Parish | Delaware | County/Parish |
| Provider Information | Date First Approved to Provide Medicare and Medicaid Services | 1995-09-18 | Date First Approved to Provide Medicare and Medicaid Services |
| Provider Information | Geocoding Footnote | — | Geocoding Footnote |
| Provider Information | Health Inspection Rating | 4 | Health Inspection Rating |
| Provider Information | Health Inspection Rating Footnote | — | Health Inspection Rating Footnote |
| Provider Information | Latitude | 40.2833 | Latitude |
| Provider Information | Legal Business Name | COUNTRY CLUB RETIREMENT CENTER V LLC | Legal Business Name |
| Provider Information | Location | 478 S SANDUSKY ST,DELAWARE,OH,43015 | Location |
| Provider Information | Long-Stay QM Rating | 5 | Long-Stay QM Rating |
| Provider Information | Long-Stay QM Rating Footnote | — | Long-Stay QM Rating Footnote |
| Provider Information | Longitude | -83.069 | Longitude |
| Provider Information | Most Recent Health Inspection More Than 2 Years Ago | N | Most Recent Health Inspection More Than 2 Years Ago |
| Provider Information | Number of administrators who have left the nursing home | 0 | Number of administrators who have left the nursing home |
| Provider Information | Number of Certified Beds | 50 | Number of Certified Beds |
| Provider Information | Number of Citations from Infection Control Inspections | — | Number of Citations from Infection Control Inspections |
| Provider Information | Number of Facilities in Chain | 7 | Number of Facilities in Chain |
| Provider Information | Number of Fines | 0 | Number of Fines |
| Provider Information | Number of Payment Denials | 0 | Number of Payment Denials |
| Provider Information | Nursing Case-Mix Index | 1.94457 | Nursing Case-Mix Index |
| Provider Information | Nursing Case-Mix Index Ratio | 1.41152 | Nursing Case-Mix Index Ratio |
| Provider Information | Overall Rating | 5 | Overall Rating |
| Provider Information | Overall Rating Footnote | — | Overall Rating Footnote |
| Provider Information | Ownership Type | For profit - Corporation | Ownership Type |
| Provider Information | Physical Therapist Staffing Footnote | — | Physical Therapist Staffing Footnote |
| Provider Information | Processing Date | 2026-03-01 | Processing Date |
| Provider Information | Provider Address | 478 S SANDUSKY ST | Provider Address |
| Provider Information | Provider Changed Ownership in Last 12 Months | N | Provider Changed Ownership in Last 12 Months |
| Provider Information | Provider Name | COUNTRY CLUB CENTER V, INC | Provider Name |
| Provider Information | Provider Resides in Hospital | N | Provider Resides in Hospital |
| Provider Information | Provider SSA County Code | 210 | Provider SSA County Code |
| Provider Information | Provider Type | Medicare and Medicaid | Provider Type |
| Provider Information | QM Rating | 5 | QM Rating |
| Provider Information | QM Rating Footnote | — | QM Rating Footnote |
| Provider Information | Rating Cycle 1 Health Deficiency Score | 28 | Rating Cycle 1 Health Deficiency Score |
| Provider Information | Rating Cycle 1 Health Revisit Score | 0 | Rating Cycle 1 Health Revisit Score |
| Provider Information | Rating Cycle 1 Number of Complaint Health Deficiencies | 7 | Rating Cycle 1 Number of Complaint Health Deficiencies |
| Provider Information | Rating Cycle 1 Number of Health Revisits | 1 | Rating Cycle 1 Number of Health Revisits |
| Provider Information | Rating Cycle 1 Number of Standard Health Deficiencies | 1 | Rating Cycle 1 Number of Standard Health Deficiencies |
| Provider Information | Rating Cycle 1 Standard Survey Health Date | 2025-01-16 | Rating Cycle 1 Standard Survey Health Date |
| Provider Information | Rating Cycle 1 Total Health Score | 28 | Rating Cycle 1 Total Health Score |
| Provider Information | Rating Cycle 1 Total Number of Health Deficiencies | 7 | Rating Cycle 1 Total Number of Health Deficiencies |
| Provider Information | Rating Cycle 2 Number of Standard Health Deficiencies | 2 | Rating Cycle 2 Number of Standard Health Deficiencies |
| Provider Information | Rating Cycle 2 Standard Health Survey Date | 2022-05-12 | Rating Cycle 2 Standard Health Survey Date |
| Provider Information | Rating Cycle 2/3 Health Deficiency Score | 16 | Rating Cycle 2/3 Health Deficiency Score |
| Provider Information | Rating Cycle 2/3 Health Revisit Score | 0 | Rating Cycle 2/3 Health Revisit Score |
| Provider Information | Rating Cycle 2/3 Number of Complaint Health Deficiencies | 2 | Rating Cycle 2/3 Number of Complaint Health Deficiencies |
| Provider Information | Rating Cycle 2/3 Number of Health Revisits | 1 | Rating Cycle 2/3 Number of Health Revisits |
| Provider Information | Rating Cycle 2/3 Total Health Score | 16 | Rating Cycle 2/3 Total Health Score |
| Provider Information | Rating Cycle 2/3 Total Number of Health Deficiencies | 4 | Rating Cycle 2/3 Total Number of Health Deficiencies |
| Provider Information | Registered Nurse hours per resident per day on the weekend | 0.49461 | Registered Nurse hours per resident per day on the weekend |
| Provider Information | Registered Nurse turnover | 10.0 | Registered Nurse turnover |
| Provider Information | Registered Nurse turnover footnote | — | Registered Nurse turnover footnote |
| Provider Information | Reported Licensed Staffing Hours per Resident per Day | 2.13095 | Reported Licensed Staffing Hours per Resident per Day |
| Provider Information | Reported LPN Staffing Hours per Resident per Day | 1.07135 | Reported LPN Staffing Hours per Resident per Day |
| Provider Information | Reported Nurse Aide Staffing Hours per Resident per Day | 2.19074 | Reported Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Reported Physical Therapist Staffing Hours per Resident Per Day | 0.00981 | Reported Physical Therapist Staffing Hours per Resident Per Day |
| Provider Information | Reported RN Staffing Hours per Resident per Day | 1.05960 | Reported RN Staffing Hours per Resident per Day |
| Provider Information | Reported Staffing Footnote | — | Reported Staffing Footnote |
| Provider Information | Reported Total Nurse Staffing Hours per Resident per Day | 4.32169 | Reported Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Short-Stay QM Rating | 5 | Short-Stay QM Rating |
| Provider Information | Short-Stay QM Rating Footnote | — | Short-Stay QM Rating Footnote |
| Provider Information | Special Focus Status | — | Special Focus Status |
| Provider Information | Staffing Rating | 3 | Staffing Rating |
| Provider Information | Staffing Rating Footnote | — | Staffing Rating Footnote |
| Provider Information | State | OH | State |
| Provider Information | Telephone Number | 7403698741 | Telephone Number |
| Provider Information | Total Amount of Fines in Dollars | 0.00 | Total Amount of Fines in Dollars |
| Provider Information | Total number of nurse staff hours per resident per day on the weekend | 3.93885 | Total number of nurse staff hours per resident per day on the weekend |
| Provider Information | Total Number of Penalties | 0 | Total Number of Penalties |
| Provider Information | Total nursing staff turnover | 40.7 | Total nursing staff turnover |
| Provider Information | Total nursing staff turnover footnote | — | Total nursing staff turnover footnote |
| Provider Information | Total Weighted Health Survey Score | 25.000 | Total Weighted Health Survey Score |
| Provider Information | Urban | Y | Urban |
| Provider Information | With a Resident and Family Council | Resident | With a Resident and Family Council |
| Provider Information | ZIP Code | 43015 | ZIP Code |