How to read a nursing home inspection record
Every Medicare-certified nursing home's inspection record is public and free. The part that decides what it means is a single letter on each citation — the scope and severity code — and the part almost nobody checks is whether the same serious problem came back. Nationally, 27.3% of the 14,690 certified homes were cited at harm level on two or more separate inspections.
The short version: read the letters first. A to F means no actual harm was found. G and above means an inspector found a resident was actually harmed. J, K and L mean immediate jeopardy. Then check whether any G-or-above tag appears on more than one survey date — a single bad survey is a bad week, the same finding twice is a pattern. Everything else, including the star rating, is secondary to those two reads.
What each scope and severity letter means
Severity runs down the grid, scope across it. Defined by CMS in the State Operations Manual, Appendix PP.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy to resident health or safety | J | K | L |
| Actual harm that is not immediate jeopardy | G | H | I |
| No actual harm, potential for more than minimal harm | D | E | F |
| No actual harm, potential for minimal harm | A | B | C |
Source: CMS State Operations Manual, Appendix PP. Our reports call G and above “serious” and J and above “immediate jeopardy”, matching these definitions.
Reading one home's record
- Find the home by its CCN, not its name. The six-character CMS Certification Number follows the home through ownership changes and rebrandings; a name search can miss a home that has been renamed, and match one that has not.
- Scan the scope and severity letters. Count anything from G upward. Nothing else in the record outranks a finding that a resident was actually harmed.
- Check for repeats. Take each G-or-above tag number and ask whether it appears on more than one survey date. That is the difference between one bad inspection and an unfixed problem — and it is the check the published star rating does not make for you.
- Look at complaint citations separately from standard ones. A standard survey is scheduled. A complaint investigation happened because somebody called.
- Read the correction status, carefully. The file records whether a correction date was logged, not whether the problem stopped. “Provider has plan of correction” means a plan, not a fix.
- Check fines and payment denials. A large fine is a signal; so is a home with many citations and none.
- Look at nurse turnover and nurse hours per resident day against that home's own state median — never against another state's. Turnover describes who will actually be on the floor.
- Then visit, and ask about what you found, by name and date.
What “normal” looks like nationally
Medicare-certified nursing homes in the file, across 53 states and territories
were cited at harm level (G or worse) on two or more separate survey dates
that share in Illinois, the highest state — against 0.0% in New Hampshire
earliest survey in the citation file; the latest is 23 Jul 2026
The full state-by-state table, and why the spread is a fact about inspectors as well as homes, is on Nursing home inspection records, state by state.
What an inspection record can't tell you
- Do not compare across states. State survey agencies cite differently, and the national spread above is far too wide to be about the homes alone. Compare a home with other homes in its own state.
- A citation is not a court finding. Homes dispute citations through informal and independent dispute resolution; the file shows a dispute is under way, not how it ended.
- The record is a window. Only surveys inside the published file are there. A home that changed hands or changed management inside that window looks the same as one that did not.
- No record measures the thing you care about most — whether your relative will be looked after by people who know them. Read the record to know what to ask, then go and ask it.
- Staffing is self-reported payroll data. Where a home reports none, it is missing, not zero.
Everything in this guide can be done free from the CMS files. The Nursing Home Record exists because doing it by hand for three homes, with the repeat check and the ownership network, takes hours — not because the data is hidden.
Every figure on this page, and where it came from
Every number above is recomputed from the loaded records each time this page is built. Last rebuilt 2026-09-28.
| Dataset | Dataset ID | Captured |
|---|---|---|
| CMS Care Compare - Nursing Home Health Deficiencies | NH_HealthCitations_Aug2026.csv | 2026-09-14 |
| CMS Care Compare - Nursing Home Penalties | NH_Penalties_Aug2026.csv | 2026-09-14 |
| CMS Care Compare - Nursing Home Provider Information | NH_ProviderInfo_Aug2026.csv | 2026-09-14 |
CMS Care Compare provider data, loaded in full and reconciled against the publisher's own row count.
Questions people ask
What does a G-level citation mean for a nursing home?
It means the inspector found actual harm to a resident that was not immediate jeopardy, isolated in scope. G, H and I are all actual harm; J, K and L are immediate jeopardy. A to F mean no actual harm was found. See the glossary.
How can I tell if a nursing home problem is a pattern?
Check whether the same tag number appears at G or above on more than one survey date. Nationally 27.3% of certified homes have that pattern, so it is common enough to be worth checking and serious enough to be worth asking about.
Where can I look up a nursing home's inspection record for free?
CMS publishes the underlying files at data.cms.gov, and Medicare's Care Compare shows them per home. The letters are defined in Appendix PP.
Should I rely on the star rating?
It is a reasonable first filter and a poor last word. The five-star system blends inspections, staffing and quality measures into one number, and the blend can hide exactly the thing you most want to see: a serious citation that came back.