Every nursing home in our database receives a Safety Score from 0 to 100. This page explains exactly how that score is calculated, what each component measures, and what the limitations are.
What the score is — and is not
The Safety Score is a structured summary of publicly available federal data, designed to help families compare facilities and prioritize what to look at more closely. It is not a recommendation and should not replace an in-person visit, conversations with current residents and families, or professional advice.
Every data point used in the score comes from the Centers for Medicare & Medicaid Services (CMS) — the same agency that inspects nursing homes and publishes the Care Compare database. We do not add or modify any underlying data.
Score methodology — updated May 2026
The overall Safety Score is the weighted average of five sub-scores, each measuring a different dimension of a facility’s performance:
| Pillar | Weight | What it measures |
|---|---|---|
| Staffing | 25% | Registered nurse (RN) hours per resident per day and total nurse hours per resident per day. Adequate staffing is one of the strongest predictors of resident safety. We use actual staffing payroll data submitted to CMS, not self-reported figures. |
| Inspections | 22% | The number, severity, and scope of deficiency citations found during the most recent annual health inspections. Serious citations (rated G through L, meaning actual harm or immediate jeopardy) carry extra weight. Repeat citations — problems that recurred across inspection cycles — are weighted more heavily than one-time findings. |
| Penalties & Enforcement | 20% | Whether CMS escalated beyond a citation to impose actual financial or operational sanctions. Civil monetary penalties (CMPs) are only issued after a facility fails two levels of review. The total dollar amount and number of enforcement actions both affect this sub-score. |
| Complaints | 18% | Volume of complaint-triggered inspections. Complaint surveys are unannounced visits triggered by formal concerns from residents, families, or staff. They often surface problems that routine annual inspections miss. |
| Quality Outcomes | 15% | How residents actually fared clinically — falls with major injury, pressure ulcers, antipsychotic medication use, urinary tract infections, catheter use, loss of mobility and daily-living ability, and hospital or emergency-room visits. Measured from two CMS sources: MDS (Minimum Data Set) clinical assessments completed by nurses for every resident, and Medicare claims billing records. |
Quality Outcomes — how it works
The Quality Outcomes sub-score uses star-rated CMS measures only — the same measures CMS uses in its own 5-star Quality rating. For each measure, the facility’s rate is scored against the national distribution of that measure: a rate at the best 5% of facilities nationally earns 100 points, a rate at the worst 5% earns 0, with linear scoring in between. Every measure in the current set is one where a lower rate is better.
The sub-score is the average of available measure scores. If a facility has no quality measure data on file, the sub-score defaults to 50 (neutral) rather than penalizing the facility for a data gap.
Key measures used (12): ADL help need increased, walking ability worsened, falls with major injury, pressure ulcers, urinary tract infections, catheter left in bladder, antipsychotic medication (long-stay), antipsychotics newly received (short-stay), short-stay re-hospitalization, short-stay outpatient ER visits, hospitalizations per 1,000 long-stay resident days, and outpatient ER visits per 1,000 long-stay resident days — all risk-adjusted CMS star-rated measures.
How sub-scores translate to the 0–100 scale
Each pillar is scored from 0 to 100, where 100 represents the strongest possible performance on that dimension. For staffing: 100 = well above minimum federal staffing standards with strong RN coverage. For inspections: 100 = no deficiency citations in the trailing three-year period. For penalties: 100 = no enforcement actions on record.
The composite score is the weighted sum of all five pillar scores.
Score bands
| Score range | Band | What it means |
|---|---|---|
| 85–100 | Strong Safety Record | Among the top-performing facilities in the coverage area. Still recommend an in-person visit. |
| 70–84 | Generally Positive | Performs well overall. A few specific areas may be worth reviewing during your tour. |
| 55–69 | Use Caution | Mixed results. Some areas need a closer look. Ask management directly about flagged concerns. |
| 40–54 | Serious Concerns | Notable issues in the federal record. Do not choose without reviewing all citations and getting answers. |
| 0–39 | Critical Issues | Serious issues. Among the lowest-scoring facilities. We strongly recommend exploring other options. |
Important limitations
- Scores reflect public data, not direct observation. We cannot verify what happens inside a facility beyond what CMS documents.
- Timing matters. Inspection data is updated roughly annually. A facility may have improved or deteriorated since the most recent survey. Always verify the data date shown on each report.
- Geographic variation. State-by-state differences in inspection intensity and documentation practices mean facilities in some states may be scored more harshly on inspection components than those in others. State average comparisons on each facility report help calibrate this.
- Quality data coverage. MDS and claims quality data covers primarily Medicare and Medicaid residents. Facilities serving primarily private-pay residents may have fewer data points on file.
- The score is a starting point, not a conclusion. A high score is not a guarantee of quality care, and a low score does not mean a facility should automatically be avoided — it means questions need to be asked and answered.
Data sources
- CMS Care Compare — Provider Info dataset (facility characteristics, star ratings, staffing)
- CMS Care Compare — Health deficiency citations and enforcement actions
- CMS Care Compare — MDS Quality Measures (clinical assessments)
- CMS Care Compare — Claims-based Quality Measures (Medicare billing data)
All data is refreshed on a regular cadence through the CMS Socrata open data API. The data date shown on each facility report reflects when the underlying CMS data was last updated.
Methodology version history
- August 2026: Recalibrated the Quality Outcomes pillar. It now scores all 12 CMS star-rated quality measures (previously a subset) against national percentile benchmarks computed from the full CMS dataset: 0 points at the worst-5% level, 100 at the best-5%. Most facility scores moved by less than a point; facilities with unusually strong or weak clinical outcomes moved more, in the direction their data supports.
- May 2026: Added Quality Outcomes as a 5th scoring pillar (15% weight). Redistributed weights from existing pillars. Benchmarks use CMS national averages for star-rated measures.
- Initial release: Four-pillar model — Staffing (30%), Inspections (25%), Penalties (25%), Complaints (20%).