Country Club Center: Infection Control Failures - OH
The 22-minute incontinence care session on August 26 violated basic infection control protocols at Country Club Center V, where federal inspectors found contamination risks that could spread infections among the facility's 44 residents.
Resident 31, who has been at the facility since August 2021, requires substantial to maximal assistance with daily care due to neurogenic bladder, urinary retention, and mobility impairments. The resident is cognitively intact but frequently incontinent of bowel and bladder, needing staff help with toileting and personal care.
CNA 144 began the care properly. She performed hand hygiene before entering the room at 11:31 AM, introduced herself to the resident, and put on gloves before removing blankets that revealed a soiled brief with noticeable urine and bowel movement odor.
The problems started after she began cleaning. The assistant wiped the resident's front area multiple times, each wipe visibly soiled with feces, discarding used materials into the bedside trash. She then removed her contaminated gloves and reached into her pocket for a walkie-talkie, bringing it to her mouth to request additional supplies.
When another staff member arrived with the requested items, CNA 144 received them directly and placed the clean supplies on the resident's bed. She then pulled new gloves from her pocket and put them on — without washing her hands between removing the soiled gloves and handling the clean materials.
The contamination spread further during the remaining care. After placing a clean pad and depends under the resident, the assistant continued cleaning and noted she needed additional wipes to reach feces between the resident's crevices. Bowel movement was again visible on her gloves while helping reposition the resident from side to side.
When she finished cleaning the resident's backside, CNA 144 moved to the front peri-area without changing gloves or performing hand hygiene. She cleaned visible bowel movement from the front area with the same contaminated gloves.
Hand sanitizer sat visibly available in the resident's room throughout the entire 22-minute care session. The assistant only washed her hands with soap and water in the restroom after completing all care, securing the clean brief, and covering the resident with blankets.
Minutes after the observation ended, CNA 144 acknowledged her error. In an interview at 11:55 AM, she confirmed that hand hygiene should have been performed after removing soiled gloves and before putting on new ones — steps she had skipped during Resident 31's care.
The Director of Nursing reinforced the policy violation the following day. During an August 27 interview, the DON confirmed that hand hygiene must be conducted after taking off soiled gloves and before putting on clean gloves.
Country Club Center's own policies require the infection control measures that CNA 144 ignored. The facility's incontinence care policy states that residents who are incontinent of bladder or bowel will receive appropriate treatment to prevent infections. The hand hygiene policy specifically requires employees to wash their hands after handling potentially contaminated objects and after removing gloves.
The violation affects vulnerable residents like Resident 31, who depends entirely on staff for toileting needs and personal care. Federal assessments show the resident requires substantial to maximal assistance with basic movements like rolling left and right in bed, making proper infection control during intimate care essential for preventing complications.
Resident 31's medical conditions compound the infection risks. The resident's diagnoses include chronic obstructive pulmonary disease, chronic pain syndrome, and bladder dysfunction requiring daily incontinence management. A bowel and bladder evaluation from August 19 documented daily stool incontinence and confirmed the resident sometimes recognizes the need to toilet but requires two-person assistance.
The inspection occurred following complaints filed under numbers 2564567 and 2569231. Federal investigators found the infection control failure represented a pattern of non-compliance that put residents at risk for preventable infections during routine personal care.
CNA 144's contaminated hands touched the walkie-talkie, clean supplies, the resident's bed, and fresh gloves — creating multiple opportunities for bacteria and pathogens to spread throughout the facility. Each contact point became a potential source of infection for other residents and staff members.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Country Club Center V, Inc from 2025-08-28 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
COUNTRY CLUB CENTER V, INC in DELAWARE, OH was cited for violations during a health inspection on August 28, 2025.
The resident is cognitively intact but frequently incontinent of bowel and bladder, needing staff help with toileting and personal care.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.