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Key Takeaways
- 5.59% of nursing home citations involved actual harm or immediate jeopardy to residents as of March 2026
- 261,820 citations (62.68%) were rated severity level D, meaning isolated potential problems with no actual harm
- Only 673 citations nationwide reached the highest severity level L, indicating widespread immediate jeopardy
- 417,725 total citations were issued to U.S. nursing homes, with 85.3% rated at the two lowest severity levels
- 2,291 citations were rated severity K and 18 citations severity I, both indicating immediate jeopardy situations
If you're researching nursing homes for someone you love, understanding citation severity can help you separate minor paperwork issues from serious safety concerns. Federal inspectors use a 10-level severity scale to rate violations, from minor administrative oversights to life-threatening situations.
Of the 417,725 citations issued to U.S. nursing homes as of March 2026, only 5.59% rose to the level of actual harm or immediate jeopardy. The vast majority — nearly 86% — were rated at the lowest severity levels, meaning they had the potential for harm but didn't actually hurt residents.
How the federal severity scale works
The Centers for Medicare & Medicaid Services (CMS) rates every nursing home citation on a scale from B through L, with most falling between D and G. Here's what each level means:
- B & C: Administrative deficiencies with minimal potential for harm
- D: Isolated instances that could potentially harm residents but didn't
- E: Pattern of issues that could potentially harm residents but didn't
- F: Isolated instances that caused actual harm to residents
- G: Pattern of issues that caused actual harm to residents
- H, I, J, K, L: Immediate jeopardy situations that put residents at serious risk
What the numbers show about citation severity
The severity breakdown reveals that most citations don't involve actual resident harm:
- 62.68% (261,820 citations) were rated "D" — isolated potential problems
- 22.62% (94,486 citations) were rated "E" — widespread potential problems
- 6.78% (28,335 citations) were rated "F" — isolated actual harm
- 3.12% (13,019 citations) were rated "G" — widespread actual harm
- 2.4% (10,360 citations) were rated at immediate jeopardy levels (H through L)
Only 23,354 citations — about 5.59% of the total — reached the "actual harm or immediate jeopardy" threshold that signals residents were genuinely hurt or endangered.
What this means for your nursing home search
When reviewing a facility's inspection history, pay attention to both the number of citations and their severity levels. A home with many "D" citations might have paperwork issues but still provide safe care. However, multiple "F" or "G" citations suggest a pattern of problems that actually harmed residents.
Look for facilities that address high-severity citations quickly with concrete corrective action plans. During your tour, ask administrators about any citations rated "F" or above and what steps they've taken to prevent similar issues.
Frequently asked questions
What percentage of nursing home citations involve actual harm?
As of March 2026, 5.59% of all nursing home citations involved actual harm to residents or immediate jeopardy situations. This represents 23,354 out of 417,725 total citations.
What's the most common citation severity level?
Severity level "D" accounts for 62.68% of all citations (261,820 cases), representing isolated instances with potential for harm but no actual resident injury.
How many citations reach immediate jeopardy status?
Only 10,360 citations (2.4%) were rated at immediate jeopardy levels H through L, with the highest level "L" accounting for just 673 cases nationwide.
How to Read This
- Severity scale (A–L)
- CMS rates each citation A–L. A–C means no resident harm, D–F means potential for harm to residents, G–I means actual harm, and J–L means immediate jeopardy to resident health or safety.
Data source: Centers for Medicare & Medicaid Services (CMS). Data as of 2026-03-25.
Helpful resources
How we built this: Every Care Safety Insight is generated from the federal CMS Care Compare dataset and reviewed by our editorial team before publishing. We do not invent numbers, and we always tell you the date the data was collected. Read our methodology →