01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-04-21 | 10 | 2026-04-21 | 2 |
| Cycle 2 | 2025-01-16 | 2 | 2025-01-16 | 0 |
| Cycle 3 | 2022-05-12 | 2 | 2022-05-12 | 4 |
CMS CCN 3660262026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Country Club Center V, Inc
478 S Sandusky St · Delaware, OH 43015 · Delaware County
Certified beds50CMS provider file
Recent citation rows20current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
20 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-04-21 · FIREE0039Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2026-05-082026-04-21 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2026-05-082026-04-21 · HEALTHF0692Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Correction field: Deficient, Provider has date of correction · 2026-05-082026-04-21 · HEALTHF0740Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
Correction field: Deficient, Provider has date of correction · 2026-05-082026-04-21 · HEALTHF0761Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2026-05-082026-04-21 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2026-05-082025-08-28 · HEALTHF0558Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Correction field: Deficient, Provider has date of correction · 2025-09-30 · complaint2025-08-28 · HEALTHF0561Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Correction field: Deficient, Provider has date of correction · 2025-09-30 · complaint2025-08-28 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2025-09-30 · complaint2025-08-28 · HEALTHF0800Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.
Correction field: Deficient, Provider has date of correction · 2025-09-30 · complaint2025-08-28 · HEALTHF0805Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Correction field: Deficient, Provider has date of correction · 2025-09-30 · complaint2025-08-28 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-09-30 · complaint2025-02-28 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Past Non-Compliance · 2025-01-31 · complaint2025-01-16 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
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.
Correction field: Deficient, Provider has date of correction · 2025-01-29 · complaint2022-05-12 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2022-05-272022-05-12 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2022-05-272022-05-12 · FIREK0281Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Install proper backup exit lighting.
Correction field: Deficient, Provider has date of correction · 2022-05-272022-05-12 · FIREK0321Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2022-05-272022-05-12 · FIREK0372Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2022-05-272022-05-12 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2022-05-2703 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- HOLLAND GROUP II, LTDOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST70% · since 10/01/2013
- HARRIS, JANETIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST30% · since 10/01/2013
- GRESOCK, JOSHUAIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST10% · since 08/01/2013
- HOLLAND, BENJAMINIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST10% · since 08/01/2013
- HOLLAND, NICHOLASIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST10% · since 08/01/2013
- HOLLAND, NOAHIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST10% · since 08/01/2013
- HOLLAND-GRESOCK, ADAMIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST10% · since 08/01/2013
- HOLLAND-GRESOCK, PATRICIAIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST10% · since 08/01/2013
- MUIRDEN-HOLLAND, JOHNIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST10% · since 08/01/2013
- HARRIS, JANETIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/31/2013
- HARRIS, JANETIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/31/2013
- HARRIS, JANETIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/07/2024
- OLSON, LYLEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2024
- ORTMAN, DIANNAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2018
- HOLLAND GROUP II, LTDOrganization · ADP OF THE SNFNOT APPLICABLE · since 12/31/2023
- GRESOCK, JOSHUAIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/01/2013
- HARRIS, JANETIndividual · ADP OF THE SNFNOT APPLICABLE · since 11/18/2024
- HOLLAND, BENJAMINIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/01/2013
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.64per resident day
RN hours0.93per resident day
Weekend nurse hours3.37per resident day
Staff turnover39.0%CMS reported field
06 / LOCAL RECORDS
Open the Delaware ledger →