Country Club Retirement Ctr Iv
Inspection Findings
F-Tag F0692
F 0692 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
ounces of med pass BID for supplementation.The dietary progress noted dated 08/06/25 at 4:12 P.M. revealed current weight was 166.2 lbs. and was a 16.6% severe weight change since 07/05/25. Weight was down an additional 4.4 lbs. since 07/30/25. Meal intakes vary. Remeron started on 08/05/25 and Torsemide discontinued. Resident #1 more lethargic with labs ordered. Four ounce med pass daily started on 07/30/25 with good acceptance. Recommendation to increase med pass four ounces to three times per day. The nursing progress noted dated 08/07/25 revealed Resident #1 was taken to emergency room (ER) due to lethargy, refusing to eat, drink, or take medications. Physician notified and order given to transfer to ER.
Family notified.Interview on 08/26/25 at 3:26 P.M. with Registered Dietician (RD) #320 revealed she had noted Resident #1's med pass had been discontinued on 07/17/25 following a return from the ER and not restarted until 07/30/25. RD #320 stated she didn't know why the med pass had been discontinued but this was during the time of the transition of the previous Director of Nursing (DON) and current DON and she did notify nursing of the discrepancy. Resident #1 stated the resident's weight loss was initially attributed to fluctuations due to CHF and diuretic therapy, but the last couple of weeks the resident stated he didn't feel like eating and an appetite stimulant (Remeron) was added, and the med pass was increased to three times daily.Interview on 08/26/25 at 3:48 P.M. with the DON revealed Resident #1's med pass was discontinued on 07/17/25 and she isn't sure why. The DON confirmed the med pass should not have been discontinued and verified it was re-started on 07/30/25.Interview on 08/27/25 at 8:21 A.M. with the DON confirmed there was no documentation which indicated the physician was notified of the weight loss on 07/16/25 or 07/28/25.Review of the facility policy titled Resident Condition Changes dated 04/01/23 revealed the nurse will contact the resident's physician immediately when any resident has a perceived change in condition. A change in condition includes but is not limited to, a change in physical or mental status, refusal of medications or treatment, a need to alter treatment, an accident, need to transfer or discharge, development of wounds or other new condition, inability to provide an ordered medication or treatment, lab or radiology results. The nurse will notify the resident's responsible party of condition change.This deficiency represents non-compliance investigated under Master Complaint Number 2600641 and Complaint Number 2595112.
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COUNTRY CLUB RETIREMENT CTR IV in BELLAIRE, 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 BELLAIRE, 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 RETIREMENT CTR IV or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.