01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-01-08 | 9 | 2026-01-08 | 4 |
| Cycle 2 | 2024-08-01 | 3 | 2024-08-01 | 0 |
| Cycle 3 | 2023-03-23 | 4 | 2023-03-23 | 19 |
CMS CCN 1058082026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
The Pavilion At Crescent Lake
100 N Lake St · Crescent City, FL 32112 · Putnam County
Certified beds92CMS provider file
Recent citation rows39current 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
39 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 5 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-01-08 · FIREE0041Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · FIREE0042Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Meet the requirements of an integrated health system.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · HEALTHF0584Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · HEALTHF0645Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · HEALTHF0732Severity C · widespread; potential for minimal harm
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · HEALTHF0756Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · 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 · 2026-02-172026-01-08 · 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 · 2026-02-172026-01-08 · FIREK0324Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2026-02-172026-01-08 · FIREK0345Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2026-02-172024-08-01 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2024-08-302024-08-01 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2024-08-302024-08-01 · HEALTHF0812Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2024-08-302023-11-13 · FIREK0531Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Have elevators that firefighters can control in the event of a fire.
Correction field: Deficient, Provider has date of correction · 2023-12-22 · complaint2023-03-23 · FIREE0006Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct risk assessment and an All-Hazards approach.
Correction field: Deficient, Provider has date of correction · 2023-05-032023-03-23 · FIREE0007Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address patient/client population and determine types of services needed.
Correction field: Deficient, Provider has date of correction · 2023-05-032023-03-23 · FIREE0024Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish policies and procedures for volunteers.
Correction field: Deficient, Provider has date of correction · 2023-05-032023-03-23 · FIREE0025Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Create arrangements with other facilities to receive patients.
Correction field: Deficient, Provider has date of correction · 2023-05-032023-03-23 · FIREE0030Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
List the names and contact information of those in the facility.
Correction field: Deficient, Provider has date of correction · 2023-05-032023-03-23 · FIREE0031Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Provide emergency officials' contact information.
Correction field: Deficient, Provider has date of correction · 2023-05-032023-03-23 · FIREE0034Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Provide a means of sharing information on occupancy/needs.
Correction field: Deficient, Provider has date of correction · 2023-05-0303 / 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
- CRESCENT CITY HOLDINGS LLCOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 03/03/2021
- FTK CAPITAL LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2018
- NPNH1 LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2018
- SHS KEREN LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2018
- BIRNBAUM, EZRAIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2021
- HIRSCH, SHAYEIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2021
- INZELBUCH, AZRIELIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2021
- MOERMAN, RAFAELIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2021
- SINGER, SIMONIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2021
- ANDERSON, RAYMONDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/09/2023
- KRIESER, AKIVAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/01/2018
- MOERMAN, RAFAELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/01/2021
- FASTEN HALBERSTAM LLPOrganization · ADP OF THE SNFNOT APPLICABLE · since 05/01/2018
- PAVILION MANAGEMENT GROUP LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 05/01/2018
- POWERBACK REHABILITATION LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 05/01/2018
- RICHARDS MITCHELL & CROSS PAOrganization · ADP OF THE SNFNOT APPLICABLE · since 05/01/2018
- ANDERSON, RAYMONDIndividual · ADP OF THE SNFNOT APPLICABLE · since 10/09/2023
- ELDICK, MOUSTAFAIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/01/2021
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 hours3.57per resident day
RN hours0.54per resident day
Weekend nurse hours3.25per resident day
Staff turnover27.9%CMS reported field
06 / LOCAL RECORDS
Open the Florida ledger →Other published facilities nearby
No second facility in the same city met the directory rule.