The Pavilion at Crescent Lake — nursing home in Crescent City, FL

Facility type: Nursing home · SNF / NF
CMS provider type: Medicare and Medicaid
Certified beds: 92 CMS-certified beds (not state-licensed beds)
Licensed beds: State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead.
Average residents per day: 72.7 CMS, MDS-derived
CMS Certification Number: 105808
Certification status: Active CMS certification Verified
First approved (Medicare/Medicaid): Jul 1, 1993
Ownership type: For profit - Limited Liability company
Operator (legal business name): The Pavilion at Crescent Lake for Nursing and Rehabilitation LLC
CMS chain: The Pavilion Group 7 facilities
Phone: (386) 698-2222
Resident & family council: Resident
Sprinklers in all required areas: Yes
Official profile: Medicare Care Compare ↗

Inspection record · CMS window

Verified

Inspections

7

latest Jan 8, 2026

Citations

39

16 health · 23 fire

Harm or worse

0

no immediate jeopardy

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D21	E3	F14
Minimal	A·	B·	C1

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

CMS Five-Star ratings

Federal · CMS

Overall

Health inspections

Staffing

Quality measures

Penalties · about the last 3 years

Fines

0

$0

Payment denials

0

Latest

—

Federal certification

Federal · CMS

Authority: Centers for Medicare & Medicaid Services (CMS), surveyed by the state survey agency
CCN: 105808
Program: Medicare and Medicaid
Medicare (SNF): Certified
Medicaid (NF): Certified
Certified beds: 92
First approved: Jul 1, 1993
Located in a hospital: No
Status: Active CMS certification as of CMS release Oct 1, 2026
Evidence: Verified

State license

State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead. State coverage for Florida.

Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

Date	Domain	Survey types	Citations	Most severe	Open
Jan 8, 2026	Fire safety	Fire Safety Standard	4	Potential harm	—	Open →
Jan 8, 2026	Health	Health Standard	9	Potential harm	—	Open →
Aug 1, 2024	Fire safety	Fire Safety Standard	0	No citations	—	Open →
Aug 1, 2024	Health	Health Standard	3	Potential harm	—	Open →
Nov 13, 2023	Fire safety	Fire Safety Complaint	1	Potential harm	—	Open →
Mar 23, 2023	Fire safety	Fire Safety Standard	18	Potential harm	—	Open →
Mar 23, 2023	Health	Health Standard	4	Potential harm	—	Open →

Enforcement

Penalties

Civil money penalties and denials of payment for new admissions, as published by CMS (about the last three years). Amounts may change on appeal.

No fines or payment denials in the CMS Penalties file for this CCN.

Scope × severity

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D21	E3	F14
Minimal	A·	B·	C1

By concept

Date	Tag	Deficiency	Scope / severity	Correction	Flags
Jan 8, 2026	E-0041	Implement emergency and standby power systems. Emergency Preparedness Deficiencies · Emergency preparedness	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	E-0042	Meet the requirements of an integrated health system. Emergency Preparedness Deficiencies · Emergency preparedness	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	K-0324	Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	K-0345	Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0584	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. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0641	Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0645	PASARR screening for Mental disorders or Intellectual Disabilities Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0656	Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0756	Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Pharmacy Service Deficiencies · Medication management	E · Potential harm Pattern	Corrected Feb 17, 2026
Jan 8, 2026	F-0757	Ensure each resident’s drug regimen must be free from unnecessary drugs. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0880	Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention	D · Potential harm Isolated	Corrected Feb 17, 2026
Jan 8, 2026	F-0732	Post nurse staffing information every day. Nursing and Physician Services Deficiencies · Staffing & supervision	C · Minimal Widespread	Corrected Feb 17, 2026
Aug 1, 2024	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Aug 30, 2024
Aug 1, 2024	F-0695	Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Aug 30, 2024
Aug 1, 2024	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	E · Potential harm Pattern	Corrected Aug 30, 2024
Nov 13, 2023	K-0531	Have elevators that firefighters can control in the event of a fire. Services Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Dec 22, 2023	Complaint
Mar 23, 2023	E-0006	Conduct risk assessment and an All-Hazards approach. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0007	Address patient/client population and determine types of services needed. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0024	Establish policies and procedures for volunteers. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0025	Create arrangements with other facilities to receive patients. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0030	List the names and contact information of those in the facility. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0031	Provide emergency officials' contact information. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0034	Provide a means of sharing information on occupancy/needs. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0035	Provide family notifications of emergency plan. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	E-0039	Conduct testing and exercise requirements. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected Jun 5, 2023
Mar 23, 2023	K-0225	Have stairways and smokeproof enclosures used as exits that meet safety requirements. Egress Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	K-0324	Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	K-0353	Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected May 3, 2023
Mar 23, 2023	K-0355	Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected May 3, 2023
Mar 23, 2023	K-0761	To conduct inspection, testing and maintenance of fire doors by qualified individuals. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Jun 5, 2023
Mar 23, 2023	K-0911	Meet requirements for the installation and maintenance of electrical systems. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected May 3, 2023
Mar 23, 2023	K-0914	Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	K-0918	Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected May 3, 2023
Mar 23, 2023	K-0920	Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected May 3, 2023
Mar 23, 2023	F-0641	Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 3, 2023
Mar 23, 2023	F-0645	PASARR screening for Mental disorders or Intellectual Disabilities Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 3, 2023
Mar 23, 2023	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 3, 2023
Mar 23, 2023	F-0695	Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 3, 2023

“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.

Five-Star ratings

Federal · CMS

Overallstate 3.3

Health inspectionsstate 2.9

Staffingstate 3.3

Quality measuresstate 4.3

Long-stay QM

Short-stay QM

CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.

Nurse staffing · hours per resident per day

Total nurse staffing3.44

State avg 3.86US avg 3.90

Registered nurse (RN)0.48

State avg 0.73US avg 0.69

Licensed practical nurse0.85

State avg 0.80US avg 0.86

Nurse aide2.11

State avg 2.33US avg 2.35

Weekend total nurse3.11

State avg 3.51US avg 3.43

Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 4.19 (case-mix index 1.15).

Staff turnover

Total nursing staff turnover26.7%

State avg 41.5%US avg 45.3%

Registered nurse turnover40.0%

State avg 46.1%US avg 42.5%

Administrators who left0

State avg 1US avg 1

Health survey score

Cycle 1 standard survey: Jan 8, 2026
Cycle 1 health score: 36
Total weighted score: 31

Operating entity

The Pavilion at Crescent Lake for Nursing and Rehabilitation LLC

CMS legal business name of the certified provider. Operates this facility only.

VerifiedLinked by exact legal name

CMS chain

The Pavilion Group

7 facilities in 3 states. CMS chain ID 514.

VerifiedAssigned by CMS

Chain average overall rating (CMS): 2.7

Ownership disclosures

Disclosures

18

Organizations

8

Individuals

10

Direct & indirect ownership

Owners of record

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Crescent City Holdings LLC	Organization	Direct owner	DIRECT OWNERSHIP INTEREST	not provided	Mar 3, 2021
Ftk Capital LLC	Organization	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2018
Npnh1 LLC	Organization	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2018
Shs Keren LLC	Organization	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2018
Ezra Birnbaum	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Shaye Hirsch	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Azriel Inzelbuch	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Rafael Moerman	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Simon Singer	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021

CMS Ownership file

All disclosed roles

Operator, owners, managers, officers and lenders are distinct roles and are never flattened into one entity. Organizations link across facilities by exact normalized legal name; individuals are listed per facility only.

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Crescent City Holdings LLC	Organization	Direct owner	DIRECT OWNERSHIP INTEREST	not provided	Mar 3, 2021
Ftk Capital LLC	Organization	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2018
Npnh1 LLC	Organization	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2018
Shs Keren LLC	Organization	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2018
Ezra Birnbaum	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Shaye Hirsch	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Azriel Inzelbuch	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Rafael Moerman	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Simon Singer	Individual	Indirect owner	INDIRECT OWNERSHIP INTEREST	not provided	May 1, 2021
Raymond Anderson	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Oct 9, 2023
Akiva Krieser	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	May 1, 2018
Rafael Moerman	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	May 1, 2021
Fasten Halberstam LLP	Organization	Additional disclosable party	ADP OF THE SNF	not provided	May 1, 2018
Pavilion Management Group LLC	Organization	Additional disclosable party	ADP OF THE SNF	not provided	May 1, 2018
Powerback Rehabilitation LLC	Organization	Additional disclosable party	ADP OF THE SNF	not provided	May 1, 2018
Richards Mitchell & Cross Pa	Organization	Additional disclosable party	ADP OF THE SNF	not provided	May 1, 2018
Raymond Anderson	Individual	Additional disclosable party	ADP OF THE SNF	not provided	Oct 9, 2023
Moustafa Eldick	Individual	Additional disclosable party	ADP OF THE SNF	not provided	May 1, 2021

Same chain in Florida

All 6 in chain →

Facility	Beds	CMS overall	Last inspection	Citations (window)	Fines
The Pavilion at Jacksonville 1771 Edgewood Ave W, Jacksonville, FL 32218 CCN 105826	60		Mar 12, 2026	30	—

No building or property record is linked to this facility yet. Parcel, assessor and building-permit joins will be added only where a valid site match exists.

Coordinates as published by CMS.

Address: 100 N Lake St, Crescent City, FL 32112
ZIP: 32112
County: Putnam County FIPS 12107
State: Florida
Urban / rural (CMS): Rural

Within ~25 km

Nearby nursing homes

No nearby facilities with coordinates.

Source	Record	Facts	Evidence	Source release	Retrieved
CMS Provider Information US-CMS	105808	name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain	Verified	Oct 1, 2026	Nov 7, 2026
CMS Provider Information US-CMS	105808	ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only.	Verified	Oct 1, 2026	Nov 7, 2026

Record-level source links for CCN 105808

First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction