THE PAVILION AT CRESCENT LAKE
100 N LAKE ST
CRESCENT CITY, FL, 32112
3866982222
CCN: 105808
5
Overall4
Health4
Staffing5
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
OIG Federal Exclusion Matches (1)
This facility's name matches one or more entities on the OIG List of Excluded Individuals/Entities (LEIE). Excluded parties are prohibited from participation in Medicare and Medicaid programs.
REHABILITATION CENTER AT HOLLY
1128b5
Excluded 2018-11-20
Ownership
| Name | Role | % |
|---|---|---|
| MOERMAN, RAFAEL | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 55% |
| ANDERSON, RAYMOND | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| KRIESER, AKIVA | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| MOERMAN, RAFAEL | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
Penalties (1)
| Date | Type | Amount |
|---|---|---|
| 2023-03-23 | Fine | $7K |
Health Deficiencies (13)
2024-08-01 · Health
E
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
2023-03-23 · Health
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
F645 · Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
D
F641 · Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
2021-10-07 · Health
F
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
D
F690 · Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F584 · 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.
E
F569 · Resident Rights Deficiencies
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day3.68
3.49
RN Hrs/Resident/Day0.54
0.46
LPN Hrs/Resident/Day0.81
0.90
CNA Hrs/Resident/Day2.33
2.12
PT Hrs/Resident/Day0.12
0.10
Data as of 2026-03-01