Nursing home inspection records, state by state
Across all 14,690 Medicare-certified nursing homes, 27.3% were cited for actual harm to a resident on two or more separate inspections. Which state the home is in changes that figure more than almost anything else: Illinois 71.8%, New Hampshire 0.0%.
CMS publishes every citation. It does not publish this: the share of a state's homes that were cited at harm level more than once, which is what separates a bad week from a pattern. That spread is as much a fact about state inspectors as about the homes — the limits section below says so plainly, and you should read it before using the ranking.
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Every state, ranked by repeat-harm share
“Repeat harm” means the home was cited at scope and severity G or worse — actual harm to a resident, or immediate jeopardy — on two or more separate survey dates in the citation file we hold, covering surveys from 23 Mar 2017 to 23 Jul 2026.
| State | Certified homes | Repeat harm | Any harm | Fined | Median fine | Median nurse turnover | Median nurse hours per resident day | Abuse icon |
|---|---|---|---|---|---|---|---|---|
| Illinois IL | 666 | 71.8% | 87.1% | 68.6% | $122,236 | 43.4% | 3.29 | 183 |
| the District of Columbia DC | 17 | 64.7% | 82.4% | 64.7% | $97,607 | 32.5% | 4.84 | 2 |
| Delaware DE | 44 | 56.8% | 75.0% | 72.7% | $58,380 | 41.7% | 3.92 | 8 |
| Rhode Island RI | 72 | 51.4% | 80.6% | 73.6% | $59,978 | 39.3% | 3.58 | 9 |
| South Dakota SD | 96 | 51.0% | 78.1% | 74.0% | $27,967 | 46.6% | 3.62 | 13 |
| Colorado CO | 210 | 48.1% | 79.5% | 61.4% | $26,891 | 46.6% | 3.49 | 49 |
| Wyoming WY | 36 | 47.2% | 75.0% | 63.9% | $29,120 | 47.8% | 3.56 | 10 |
| Utah UT | 97 | 46.4% | 71.1% | 51.5% | $30,684 | 50.5% | 3.69 | 11 |
| Michigan MI | 422 | 45.0% | 68.7% | 39.1% | $50,895 | 44.6% | 3.81 | 62 |
| Montana MT | 61 | 44.3% | 77.0% | 68.9% | $53,227 | 53.4% | 3.86 | 9 |
| Texas TX | 1,177 | 42.0% | 70.7% | 69.0% | $32,184 | 52.1% | 3.27 | 137 |
| Washington WA | 193 | 42.0% | 72.0% | 60.6% | $59,762 | 43.1% | 4.13 | 17 |
| New Mexico NM | 68 | 41.2% | 69.1% | 60.3% | $64,153 | 52.8% | 3.42 | 11 |
| North Dakota ND | 72 | 38.9% | 72.2% | 58.3% | $36,372 | 50.0% | 4.37 | 10 |
| Kansas KS | 296 | 36.1% | 66.6% | 50.7% | $24,492 | 47.4% | 3.95 | 23 |
| Wisconsin WI | 323 | 35.3% | 66.6% | 42.1% | $68,087 | 46.2% | 4.02 | 19 |
| Minnesota MN | 338 | 31.4% | 66.0% | 42.3% | $26,153 | 40.0% | 4.16 | 22 |
| Connecticut CT | 191 | 30.9% | 67.5% | 56.5% | $20,872 | 35.8% | 3.71 | 45 |
| Oregon OR | 128 | 30.5% | 62.5% | 50.8% | $31,369 | 45.8% | 4.95 | 11 |
| Vermont VT | 33 | 30.3% | 66.7% | 72.7% | $100,198 | 58.5% | 4.11 | 4 |
| North Carolina NC | 419 | 29.4% | 58.7% | 56.1% | $34,632 | 48.6% | 3.53 | 34 |
| Iowa IA | 387 | 28.7% | 56.6% | 36.2% | $28,916 | 41.8% | 3.68 | 17 |
| Missouri MO | 487 | 28.1% | 56.9% | 42.5% | $46,303 | 56.1% | 3.36 | 64 |
| Pennsylvania PA | 656 | 27.0% | 52.4% | 42.5% | $25,140 | 44.1% | 3.63 | 100 |
| Mississippi MS | 202 | 26.2% | 58.4% | 54.5% | $12,606 | 44.3% | 4.00 | 17 |
| California CA | 1,165 | 26.0% | 52.4% | 40.7% | $36,796 | 36.3% | 4.24 | 113 |
| Ohio OH | 922 | 25.4% | 56.4% | 30.5% | $45,997 | 48.5% | 3.57 | 40 |
| Hawaii HI | 43 | 23.3% | 67.4% | 51.2% | $21,830 | 31.9% | 4.61 | 0 |
| Virginia VA | 289 | 22.8% | 56.4% | 35.6% | $33,822 | 48.3% | 3.44 | 28 |
| Oklahoma OK | 283 | 22.6% | 55.8% | 51.2% | $21,828 | 55.2% | 3.67 | 28 |
| Louisiana LA | 265 | 21.5% | 49.1% | 49.1% | $45,434 | 46.9% | 3.62 | 16 |
| South Carolina SC | 187 | 21.4% | 56.7% | 51.9% | $15,646 | 45.3% | 3.55 | 12 |
| Massachusetts MA | 341 | 18.8% | 54.0% | 48.4% | $33,180 | 37.7% | 3.70 | 7 |
| West Virginia WV | 123 | 17.9% | 58.5% | 52.0% | $38,352 | 43.2% | 3.47 | 10 |
| Maryland MD | 221 | 16.7% | 52.0% | 39.4% | $24,125 | 41.5% | 3.60 | 30 |
| New Jersey NJ | 348 | 15.2% | 48.9% | 40.8% | $45,152 | 38.9% | 3.60 | 15 |
| Tennessee TN | 303 | 14.5% | 43.9% | 35.3% | $22,925 | 50.0% | 3.64 | 14 |
| Nebraska NE | 180 | 14.4% | 34.4% | 23.3% | $29,630 | 47.1% | 3.95 | 1 |
| Indiana IN | 507 | 14.2% | 40.4% | 18.1% | $22,118 | 45.3% | 3.55 | 32 |
| Kentucky KY | 267 | 13.9% | 38.2% | 34.1% | $15,646 | 45.0% | 3.75 | 5 |
| Idaho ID | 80 | 12.5% | 56.2% | 35.0% | $28,232 | 50.0% | 3.85 | 7 |
| Florida FL | 694 | 11.8% | 38.2% | 38.8% | $33,790 | 41.8% | 3.63 | 47 |
| New York NY | 593 | 11.1% | 38.6% | 30.4% | $40,346 | 38.4% | 3.49 | 44 |
| Arizona AZ | 140 | 10.7% | 35.7% | 27.9% | $10,358 | 46.0% | 3.75 | 39 |
| Alaska AK | 20 | 10.0% | 25.0% | 30.0% | $77,988 | 45.7% | 6.82 | 1 |
| Maine ME | 78 | 9.0% | 38.5% | 35.9% | $13,842 | 46.9% | 4.18 | 1 |
| Nevada NV | 66 | 7.6% | 36.4% | 36.4% | $32,206 | 45.1% | 3.91 | 9 |
| Georgia GA | 356 | 7.0% | 38.5% | 34.6% | $15,880 | 45.9% | 3.42 | 21 |
| Arkansas AR | 221 | 5.4% | 31.2% | 31.7% | $15,928 | 48.2% | 3.91 | 7 |
| Alabama AL | 224 | 3.6% | 23.7% | 17.0% | $26,275 | 46.7% | 3.88 | 12 |
| New Hampshire NH | 73 | 0.0% | 30.1% | 30.1% | $15,900 | 43.6% | 3.64 | 0 |
| Guam GU | 1 | Fewer than 10 certified homes — no share or median is printed | ||||||
| Puerto Rico PR | 9 | Fewer than 10 certified homes — no share or median is printed | ||||||
Median fine is over fined homes only. Median nurse turnover and nurse hours per resident day are CMS's own reported figures, over the homes in that state that report them; a home that reports none is left out of the median rather than counted as zero. “Abuse icon” is CMS's own flag, a count of homes, not a share. Each state's homes link through to the Nursing Home Record, which reports one home at a time against its own state's median.
What this table does not tell you
- It measures inspectors as much as homes. Surveys are run by state agencies under federal rules, and they do not cite alike. A state at the top of this table may be inspecting harder, not housing worse homes — and a state at the bottom is not thereby safe. Never compare a home in one state with a home in another using these shares.
- It is a window, not a history. Only surveys between 23 Mar 2017 and 23 Jul 2026 are in the citation file. A home that changed hands, or changed completely, inside that window looks the same here as one that did not.
- A citation is not a court finding. Homes can and do dispute citations through informal and independent dispute resolution; the file records that a dispute is under way, not how it ended.
- Staffing figures are payroll-based and self-reported to CMS. Where a home reports none, the cell says “not published” — it is never filled with a zero or a state average.
- It does not rank care. Nothing here measures whether residents are happy, whether food is good, or whether the staff you will meet are the staff who were there at the last survey.
- Small states are not comparable. A state with a handful of certified homes moves several points on one home, so states below the floor are listed separately with no shares at all.
To act on any of this you need the individual home, not the state: the Nursing Home Record compares up to three named homes on repeat problems, serious citations, fines, staffing against their own state median, and who owns them.
Where these figures come from
Dataset: US nursing home repeat-harm, penalty and staffing shares by state · spatial coverage United States · 14,690 certified homes · 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. Every row of every file is loaded and reconciled against the publisher's own count; nothing on this page is sampled.
Scope and severity letters are defined by CMS in the State Operations Manual, Appendix PP; the star ratings CMS publishes alongside them are described in the Five-Star Quality Rating System. This page uses the citations, not the stars.
Questions people ask
What does it mean when a nursing home is cited at G or above?
Scope and severity letters G through L mean an inspector found actual harm to a resident: G, H and I are harm that is not immediate jeopardy, and J, K and L are immediate jeopardy to resident health or safety. Letters A through F mean no actual harm was found. The grid is set out in the CMS State Operations Manual, Appendix PP, and each letter is explained in our glossary.
Which state has the highest share of nursing homes cited for repeat harm?
Of states with at least 10 certified homes, Illinois is highest at 71.8% of its 666 homes, and New Hampshire lowest at 0.0% of 73. That range is too wide to be about the homes alone — state survey agencies differ in how readily they cite harm, so treat this as a map of enforcement as much as of care.
Is a nursing home in a low-citation state safer?
Not necessarily, and this table cannot tell you. A low share can mean good homes or a lenient survey agency, and the two look identical in the data. Compare homes within a state, and read the actual citations for the home you care about.
Where does CMS publish this data?
In the Care Compare provider data files — provider information, health deficiencies, and penalties — listed with their capture dates above. This page adds the per-state computation, which CMS does not publish.