Country Club Center V: Kitchen Failures Leave Residents Hungry - OH
The mix-up at Country Club Center V revealed broader problems with meal service for residents requiring special diets. During an August inspection, state surveyors found that kitchen staff routinely failed to prepare complete meals according to the facility's own menu plans and individual resident meal tickets.
Resident #5, admitted in January 2021 with diagnoses including hemiplegia, vascular dementia and muscle weakness, was supposed to receive mechanical glazed ham, green beans, rice pudding, au gratin potatoes and a wheat dinner roll on August 26. Her meal ticket specifically listed green beans.
Instead, she got brussels sprouts.
Certified Nursing Assistant #165 brought the tray to the resident at 11:47 a.m. and confirmed green beans weren't on it. The CNA told inspectors she was unsure why, noting the ticket clearly stated green beans with no mention of brussels sprouts.
Kitchen Manager #174 confirmed no green beans were made that day according to the menu spreadsheet. When asked why, she told inspectors: "I am not the cook."
The problems were worse for residents needing pureed food. Resident #12, who has Alzheimer's disease, dementia and dysphagia, received only two items from her five-item meal.
The 12-year resident was supposed to get pureed glazed ham, pureed brussels sprouts, pureed rice pudding, pureed au gratin potatoes and pureed bread. At noon on August 26, inspectors observed her receiving only pureed meat and pureed brussels sprouts.
No pureed au gratin potatoes. No pureed rice pudding. No pureed bread.
Kitchen Manager #174 confirmed the resident didn't receive three of her five meal components. She told inspectors she was waiting for the blender to dry before making pureed au gratin potatoes, but couldn't explain why the other items weren't provided at time of service.
Only after inspectors intervened did the kitchen manager begin preparing the missing pureed potatoes.
The facility's own policy, dated December 17, 2024, states that menus "shall be served as written unless changed for preference or unavailability." Diet Tech #200 confirmed during an August 28 interview that residents should receive all items marked on their meal tickets.
But the kitchen consistently failed to follow through. Food Service Employee #145 took temperatures for lunch items at 11:19 a.m. on August 26, and inspectors noted that only pureed ham and pureed brussels sprouts were prepared for residents requiring pureed diets.
The facility identified nine residents total as needing modified diets: two requiring pureed food and seven needing mechanically soft textures. With a census of 44 residents, these specialized diets represented a significant portion of daily meal preparation.
Country Club Center V's meal service failures affected residents who depend entirely on staff for proper nutrition. Resident #5's conditions, including vascular dementia and senile degeneration of the brain, make her unable to advocate for correct meal service. Her diet order, dated February 27, specified she needed mechanical texture foods.
Resident #12's swallowing difficulties from dysphagia require all food to be pureed to prevent choking. Missing three-fifths of her prescribed meal components left her without adequate nutrition and variety.
The inspection found no evidence that kitchen staff communicated about menu changes or food unavailability. The kitchen manager's response that she didn't know why items weren't prepared, combined with her statement that she wasn't the cook, suggested unclear responsibility for ensuring complete meals.
State inspectors documented the violations under federal regulations requiring facilities to provide each resident with nourishing, palatable, well-balanced meals that meet daily nutritional and special dietary needs.
The facility's menu substitution policy allowed changes for resident preference or unavailability, but staff made no documentation of either reason for the missing food items. Brussels sprouts replaced green beans without explanation. Multiple pureed items simply weren't prepared.
For residents like #12, who has lived at the facility since July 2023, incomplete meals represent a pattern of inadequate care. Her Alzheimer's disease and dementia make her unable to request missing food or understand why her meal arrived incomplete.
The violations occurred during routine meal service, not during an emergency or staffing crisis. Kitchen staff followed normal procedures for taking food temperatures and delivering trays, but failed at the fundamental task of preparing what residents were supposed to receive.
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 mix-up at Country Club Center V revealed broader problems with meal service for residents requiring special diets.
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.