Every nursing home licensed to operate in the United States is required to undergo regular federal inspections ??? typically every 12 to 15 months ??? conducted by state health agency surveyors on behalf of the Centers for Medicare & Medicaid Services (CMS). The results of every inspection are public record.
Most families never see them. This article explains what those records contain, why they matter, and how to read them without a background in healthcare regulation.
What a nursing home inspection actually is
A standard nursing home inspection (called a “survey”) involves state health inspectors spending several days on-site observing care, interviewing residents and staff, reviewing medical records, and checking physical safety conditions. When inspectors find a problem, they issue a deficiency citation.
Each citation has two dimensions:
- The scope ??? whether the problem affected an isolated resident, a pattern of residents, or was widespread throughout the facility
- The severity ??? how serious the potential or actual harm was, ranging from no actual harm (potential only) to immediate jeopardy to resident health or safety
These two dimensions are combined into a grid that ranges from “A” (isolated, no harm) to “L” (widespread, immediate jeopardy). Most citations fall in the B???D range. Citations at G or above indicate actual harm occurred.
What “deficiency” actually means in plain English
A deficiency citation means an inspector observed a specific regulatory requirement was not being met. It does not necessarily mean a resident was harmed ??? many citations are for documentation failures, procedural gaps, or physical plant issues. But patterns of deficiencies, serious severity codes, or citations that appear in multiple consecutive inspections are meaningful signals about how a facility operates.
Why the five-star rating system is not enough
CMS publishes nursing home ratings using a five-star system. The problem: a facility can have one star for health inspections and four stars overall, with no plain-English explanation bridging the gap. The star system rewards self-reported staffing data and quality measures that facilities have incentives to game. The inspection sub-score ??? based on actual on-site observations ??? is the hardest to manipulate and arguably the most informative, but it gets averaged away in the headline rating.
Senior Care Report Card weights inspection outcomes more heavily precisely because they reflect independent, third-party observations of actual care delivery.
What to look for in a facility’s inspection history
Repeat citations. If the same regulatory area was cited in two consecutive surveys, the problem was not fixed after the first inspection. This is a materially different situation than a single citation. We flag repeat citations on every report card.
Severity codes G and above. These indicate a surveyor determined that actual harm occurred to a resident. Any citation in this range warrants a direct conversation with the facility’s administrator.
Special Focus Facility status. CMS designates a small number of nursing homes as Special Focus Facilities ??? nursing homes with a persistent pattern of serious problems. These facilities receive more frequent inspections and are under enhanced federal oversight. If a facility you are considering has this designation, treat it as a significant warning.
Trend over time. A facility that had problems five years ago but has shown consistent improvement is different from one that had problems two years ago and still has them. Look at the trajectory, not just the snapshot.
How to check a nursing home’s inspection record
You have two options:
- Senior Care Report Card: Search for any nursing home in our coverage area. Every report card translates the inspection history into plain English ??? deficiency codes explained, severity levels described, repeat citations flagged. No government database navigation required.
- Medicare.gov Care Compare: The official federal source. More complete historical data, but in its raw form ??? regulatory codes, no plain-English translation.
Both sources pull from the same underlying data. Senior Care Report Card is designed for families under time pressure who need the information quickly, in plain English, alongside practical questions to ask.
Senior Care Report Card summarizes publicly available CMS inspection and enforcement data. Information is updated monthly and may have a publication lag. Always verify directly with official sources before making care decisions.