COUNTRY CLUB RET CENTER I I I
925 E 26TH ST
ASHTABULA, OH, 44004
4409920022
CCN: 365642
4
Overall4
Health2
Staffing4
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
| Name | Role | % |
|---|---|---|
| HOLLAND, JOHN | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 35% |
| HOLLAND-GRESCOCK, TERESA | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 35% |
| HOLLAND GROUP II, LTD | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 31% |
| HARRIS, JANET | CORPORATE OFFICER | NOT APPLICABLE |
| AL-SHAHED, ABDALLAH | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| HARRIS, JANET | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| KOLTSOV, ARKADIY | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
Health Deficiencies (12)
2025-11-06 · Health
E
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
2024-05-09 · Health
E
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F842 · Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
D
F758 · Pharmacy Service Deficiencies
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
2023-05-16 · Health
D
F760 · Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
2023-04-03 · Health
C
F921 · Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F580 · Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
2020-02-27 · Health
D
F578 · Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day3.68
3.22
RN Hrs/Resident/Day0.54
0.53
LPN Hrs/Resident/Day0.81
0.75
CNA Hrs/Resident/Day2.33
1.94
PT Hrs/Resident/Day0.12
0.04
Data as of 2026-03-01