Our data source
Every score on Senior Care Report Card is derived from the CMS Care Compare database, maintained by the U.S. Centers for Medicare & Medicaid Services. This is the same data the federal government uses to regulate nursing homes. It is public record, updated monthly, and covers all Medicare- and Medicaid-certified nursing homes in the United States — approximately 15,000 facilities nationwide, including 527+ across Maryland, Virginia, and Washington DC.
We do not accept data from facilities directly, and we do not accept payment from facilities to influence their scores. All source data is linked on every report so you can verify it yourself.
The Senior Care Report Card score
The Senior Care Report Card score is a 100-point weighted score that translates public inspection, staffing, complaint, and enforcement data into a clear, family-friendly risk signal. It is an independent summary of publicly available federal data — not a government rating, medical advice, or endorsement of any facility. Four components combine to produce the score:
Staffing (30%) — the most important factor
Measures whether the facility has enough nurses at the bedside. Looks at RN hours per resident per day and total nurse hours per resident per day, compared to national averages and the federal minimum of 0.75 RN hours per resident per day.
Why this is weighted highest: Every major peer-reviewed study of nursing home quality — including research published in Health Affairs, The Gerontologist, and the JAMA network — identifies staffing as the single strongest predictor of resident outcomes. Understaffed facilities have higher rates of pressure injuries, hospitalizations, infections, and falls. It is also the one factor families can ask about directly on a tour: "What is your RN-to-resident ratio on nights and weekends?" A high score on inspections or complaints means little if there aren't enough nurses to answer call buttons at 2 a.m.
Inspection history (25%)
Measures how the facility performed during health inspections. Looks at the CMS health inspection star rating and the number of serious (G+) deficiency citations in the last 36 months — those where an inspector found actual or potential harm to a resident. Repeat findings across inspection cycles receive additional weight.
Penalties & enforcement (25%)
Looks at formal enforcement actions that escalated beyond citations — civil money penalties, total fine amounts, number of separate enforcement actions, and active Special Focus Facility status. This component captures problems serious enough that CMS escalated to financial punishment after a facility failed a second level of regulatory review. Any federal CMP is treated as a meaningful signal, not background noise.
Complaint history (20%)
Looks at real-world concerns raised outside routine inspections — formal complaints filed by residents, families, and staff that triggered unannounced CMS surveys. Complaint surveys often surface problems that annual routine inspections miss, because they happen in response to something that already went wrong. This component reflects the lived experience of the people already inside the facility.
Safety override rules
Certain serious findings place hard caps on the maximum possible score, regardless of other metrics:
| Finding | Maximum score |
|---|---|
| Immediate Jeopardy in last 12 months | 45 |
| Multiple actual-harm findings in 24 months | 55 |
| Abuse or neglect citation in last 24 months | 50 |
| Same deficiency category cited 3+ times | 65 |
| Severe staffing shortage | 60 |
| Active Special Focus Facility status | 40 |
These rules exist because a facility should not receive a high safety score if it has recent serious harm, abuse, or repeat safety problems — even if other metrics look acceptable.
Score bands
| Score | Label | What it means |
|---|---|---|
| 85–100 | Excellent | No major safety flags in the public record — strong across all four pillars |
| 70–84 | Good | No serious flags; some areas worth asking about on a visit |
| 55–69 | Fair | Notable issues in the record — proceed carefully and ask specific questions |
| 40–54 | Concerning | Serious or repeated issues on record — requires direct investigation before deciding |
| 0–39 | Poor | Major recent or unresolved safety findings — seek alternatives if possible |
The Senior Care Report Card score is expressed as a 0–100 score mapped to five signal levels as described above. Across all 527 facilities in our coverage area, approximately 18% fall in the 'Serious concerns' band or below.
What our scores do not tell you
We are explicit about the limits of this data because we believe honesty is more useful than false confidence.
CMS data reflects what surveyors found during official visits — not everything that happens in a facility. Inspections are announced in some states and may not capture day-to-day conditions. Facilities with strong relationships with their state survey agency may receive more lenient citations than facilities in states with aggressive enforcement. A high score means the public record is clean; it does not mean the facility is perfect.
Our scores also do not capture: staff turnover rates (not publicly reported at the facility level), the quality of end-of-life care, family satisfaction surveys, or the culture and responsiveness of management. We strongly recommend visiting any facility in person and asking the questions listed in each report.
Data freshness
CMS updates the Care Compare database monthly, typically in the first week of the month. We update our scores within 72 hours of each CMS release. Every report shows the date of the most recent CMS update and the date of the facility's last inspection. If a facility has not been inspected in more than 15 months, we display a data staleness warning.
Corrections and disputes
If you are a facility operator and believe your CMS data contains an error, the correct path is to work directly with your state survey agency or CMS to correct the underlying record — we cannot change what the government reports. Once the CMS database is corrected, our scores update automatically on the next monthly refresh.
If you believe we have made an error in how we calculated or displayed your score, contact us at our contact page and we will review it within 5 business days.
Independence and funding
Senior Care Report Card is an independent publication. We do not accept placement referral fees, sponsored listings, or any payment from care facilities. Our scores are calculated solely from public CMS data and are not influenced by any commercial relationship.
Revenue comes from two sources: a one-time fee for downloadable PDF facility reports, and Google AdSense display ads on informational guide pages (never on individual facility score pages). See our About page for full details on our advertising policy.