The Pavilion At Creekwood

Inspection history (21)

• August 6, 2025 · D

  Citation F0684

  Federal surveyors cited this nursing home on 2025-08-06 under CMS tag F0684 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Provide appropriate treatment and care according to orders, resident’s preferences and goals. The deficiency was recorded as corrected on 2025-08-07. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-08-06.GOV

• August 6, 2025 · E

  Citation F0686

  Federal surveyors cited this nursing home on 2025-08-06 under CMS tag F0686 (CMS scope/severity E: pattern, no actual harm, potential for more than minimal harm) for Provide appropriate pressure ulcer care and prevent new ulcers from developing. The deficiency was recorded as corrected on 2025-08-07. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-08-06.GOV

• February 26, 2025 · D

  Citation F0655

  Federal surveyors cited this nursing home on 2025-02-26 under CMS tag F0655 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted. The deficiency was recorded as corrected on 2025-02-27. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-02-26.GOV

• February 26, 2025 · D

  Citation F0585

  Federal surveyors cited this nursing home on 2025-02-26 under CMS tag F0585 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. The deficiency was recorded as corrected on 2025-02-27. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-02-26.GOV

• February 26, 2025 · D

  Citation F0755

  Federal surveyors cited this nursing home on 2025-02-26 under CMS tag F0755 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. The deficiency was recorded as corrected on 2025-02-27. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-02-26.GOV

• February 26, 2025 · E

  Citation F0759

  Federal surveyors cited this nursing home on 2025-02-26 under CMS tag F0759 (CMS scope/severity E: pattern, no actual harm, potential for more than minimal harm) for Ensure medication error rates are not 5 percent or greater. The deficiency was recorded as corrected on 2025-02-27. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-02-26.GOV

• January 5, 2025 · J

  Citation F0684

  Federal surveyors cited this nursing home on 2025-01-05 under CMS tag F0684 (CMS scope/severity J: isolated, immediate jeopardy) for Provide appropriate treatment and care according to orders, resident’s preferences and goals. The deficiency was recorded as corrected on 2025-01-06. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-01-05.GOV

• January 5, 2025 · J

  Citation F0689

  Federal surveyors cited this nursing home on 2025-01-05 under CMS tag F0689 (CMS scope/severity J: isolated, immediate jeopardy) for Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. The deficiency was recorded as corrected on 2025-01-06. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-01-05.GOV

• January 5, 2025 · J

  Citation F0742

  Federal surveyors cited this nursing home on 2025-01-05 under CMS tag F0742 (CMS scope/severity J: isolated, immediate jeopardy) for Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. The deficiency was recorded as corrected on 2025-01-06. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2025-01-05.GOV

• August 27, 2024 · J

  Citation F0578

  Federal surveyors cited this nursing home on 2024-08-27 under CMS tag F0578 (CMS scope/severity J: isolated, immediate jeopardy) for Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. The deficiency was recorded as corrected on 2024-08-28. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2024-08-27.GOV

• May 20, 2024 · D

  Citation F0757

  Federal surveyors cited this nursing home on 2024-05-20 under CMS tag F0757 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Ensure each resident’s drug regimen must be free from unnecessary drugs. The deficiency was recorded as corrected on 2024-05-21. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2024-05-20.GOV

• May 20, 2024 · E

  Citation F0755

  Federal surveyors cited this nursing home on 2024-05-20 under CMS tag F0755 (CMS scope/severity E: pattern, no actual harm, potential for more than minimal harm) for Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. The deficiency was recorded as corrected on 2024-05-21. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2024-05-20.GOV

• January 25, 2024 · F

  Citation F0812

  Federal surveyors cited this nursing home on 2024-01-25 under CMS tag F0812 (CMS scope/severity F: widespread, no actual harm, potential for more than minimal harm) for Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. The deficiency was recorded as corrected on 2024-01-27. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2024-01-25.GOV

• January 25, 2024 · D

  Citation F0558

  Federal surveyors cited this nursing home on 2024-01-25 under CMS tag F0558 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Reasonably accommodate the needs and preferences of each resident. The deficiency was recorded as corrected on 2024-01-27. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2024-01-25.GOV

• December 12, 2023 · D

  Citation F0695

  Federal surveyors cited this nursing home on 2023-12-12 under CMS tag F0695 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Provide safe and appropriate respiratory care for a resident when needed. The deficiency was recorded as corrected on 2023-12-13. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2023-12-12.GOV

• November 21, 2023 · E

  Citation F0880

  Federal surveyors cited this nursing home on 2023-11-21 under CMS tag F0880 (CMS scope/severity E: pattern, no actual harm, potential for more than minimal harm) for Provide and implement an infection prevention and control program. The deficiency was recorded as corrected on 2023-12-18. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2023-11-21.GOV

• November 21, 2023 · D

  Citation F0919

  Federal surveyors cited this nursing home on 2023-11-21 under CMS tag F0919 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Make sure that a working call system is available in each resident's bathroom and bathing area. The deficiency was recorded as corrected on 2023-11-22. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2023-11-21.GOV

• November 30, 2022 · D

  Citation F0656

  Federal surveyors cited this nursing home on 2022-11-30 under CMS tag F0656 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. The deficiency was recorded as corrected on 2022-12-06. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2022-11-30.GOV

• November 30, 2022 · E

  Citation F0730

  Federal surveyors cited this nursing home on 2022-11-30 under CMS tag F0730 (CMS scope/severity E: pattern, no actual harm, potential for more than minimal harm) for Observe each nurse aide's job performance and give regular training. The deficiency was recorded as corrected on 2022-12-19. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2022-11-30.GOV

• November 30, 2022 · D

  Citation F0558

  Federal surveyors cited this nursing home on 2022-11-30 under CMS tag F0558 (CMS scope/severity D: isolated, no actual harm, potential for more than minimal harm) for Reasonably accommodate the needs and preferences of each resident. The deficiency was recorded as corrected on 2022-12-01. Source: CMS Care Compare Health Deficiencies (as of 2026-06-01).

  View original record (opens in a new tab)Source: CMS Care Compare · Updated 2022-11-30.GOV

Penalties

Total fines on file: $39,674

Staffing

Latest: 3.13 nurse staffing hours per resident per day (2026-06-01)

Ownership

For profit - Limited Liability company

1. Parent organization: Thi Of Texas LLC

   parent · PAC 6901890128