Country Club Ret Center I I I
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Based on observation, interview, and facility policy review, the facility failed to ensure the environment remained free of accident hazards for residents who used the designated outdoor smoking area. The facility did not provide a safe environment for the disposal of smoking materials, resulting in potential fire hazard.
This had the potential to affect all residents, employees, and visitors who use the facility smoking areas.
The facility census was 72.Findings include:Observation of facility smoking areas on 11/05/25 at 10:45 A.M. revealed two large steel cigarette butt receptacles with the label butt cans that were overfilled and overflowing onto the pavement smoking area by the kitchen exit door. A large amount of cigarette butts were also present and scattered on the ground directly on top of a large amount dry leaves and debris.
Interview with Director of Maintenance (DM) #539 on 11/05/25 at 10:45 A.M. confirmed overfilled cigarette butt receptacles as well as the cigarette butts on top of a large amount of dry leaves and debris. DM #539 agreed that it was a fire hazard and was going to empty the cans and remove cigarette butts.Review of the facility policy titled, Resident Smoking Policy, reviewed 01/08/25, revealed residents who smoke must use
the facility designated outside area to smoke. Cigarette butts and matches used must be discarded in the appropriate receptacle.This deficiency is an incidental finding identified during the course of the complaint investigation.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
COUNTRY CLUB RET CENTER I I I in ASHTABULA, OH inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in ASHTABULA, OH, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from COUNTRY CLUB RET CENTER I I I or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.