The Pavilion at Creekwood
2100 Cannon Dr, Mansfield, TX 76063
Phone: 8177796500
CMS ratings and facility information
The Pavilion at Creekwood is a Medicare-certified nursing facility in Mansfield, Tarrant County, Texas. CMS data for this profile was updated August 2026. Ratings and facility details can change; confirm current information with CMS and the facility.
| CMS overall rating | 2 of 5 stars |
|---|---|
| Health inspection rating | 2 of 5 |
| Staffing rating | 2 of 5 |
| Quality measures rating | 4 of 5 |
| Certified beds | 126 |
| Ownership | For profit - Limited Liability company |
| CMS certification number | 676388 |
Staffing
| Total nurse hours per resident day | 3.21 |
|---|---|
| RN hours per resident day | 0.38 |
| Nurse aide hours per resident day | 1.89 |
| Total nursing staff turnover percent | 47 |
| RN turnover percent | 35.7 |
Resident outcome measures
| Measure | Value | Unit | Period |
|---|---|---|---|
| Hospitalizations | 2.84 | events_per_1000_resident_days | 20250101-20251231 |
| Emergency-department visits | 1.68 | events_per_1000_resident_days | 20250101-20251231 |
| Falls with major injury | 2.65 | percent | 2025Q2-2026Q1 |
| Pressure ulcers | 3.47 | percent | 2025Q2-2026Q1 |
| Urinary tract infections | 0 | percent | 2025Q2-2026Q1 |
| Antipsychotic medication use | 4.19 | percent | 2025Q2-2026Q1 |
Health inspection citations
| Survey date | Tag | Citation | Severity |
|---|---|---|---|
| 2026-04-14 | 0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E |
| 2026-04-14 | 0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | E |
| 2026-04-14 | 0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E |
| 2026-04-14 | 0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D |
| 2026-04-14 | 0558 | Reasonably accommodate the needs and preferences of each resident. | D |
| 2026-04-14 | 0636 | Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | D |
| 2026-04-14 | 0760 | Ensure that residents are free from significant medication errors. | D |
| 2025-02-26 | 0759 | Ensure medication error rates are not 5 percent or greater. | E |
| 2025-02-26 | 0585 | 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. | D |
| 2025-02-26 | 0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D |
| 2025-02-26 | 0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D |
| 2024-01-25 | 0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F |
| 2024-01-25 | 0558 | Reasonably accommodate the needs and preferences of each resident. | D |
Penalties
| Date | Type | Amount |
|---|---|---|
| 2025-01-05 | Fine | ,901 |
| 2025-01-05 | Fine | ,901 |
| 2024-08-27 | Fine | ,872 |
Ownership records
| Name | Type | Role |
|---|---|---|
| LEBLANC, RYAN | Individual | CORPORATE OFFICER |
| THI OF TEXAS LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL |
| LEBLANC, RYAN | Individual | OPERATIONAL/MANAGERIAL CONTROL |
| FUNDAMENTAL ADMINISTRATIVE SERVICES LLC | Organization | ADP OF THE SNF |
| FUNDAMENTAL CLINICAL AND OPERATIONAL SERVICES, LLC | Organization | ADP OF THE SNF |
| LEBLANC, RYAN | Individual | ADP OF THE SNF |
| RIGSBY, CAMELIA | Individual | ADP OF THE SNF |
Compare nursing homes in Tarrant County, Texas.
Source: Centers for Medicare & Medicaid Services Care Compare data. Data snapshot: August 2026. Read Our Data & Methodology. This directory does not provide medical or legal advice.