A nursing home tour is not a social visit. It is your best opportunity to verify ??? in person ??? what the federal inspection record shows on paper. The facilities that perform well on paper usually hold up in person. The ones with concerning records often reveal exactly why during a tour, if you know what questions to ask.
Use the Questions to Ask section on each facility’s report card for questions tailored to that specific facility’s record. The questions below are the ones every family should ask, regardless of the facility’s score.
About staffing ??? the most important category
Understaffing is the strongest single predictor of poor inspection outcomes and poor care quality. These questions cut through the marketing language:
- “What is your current RN-to-resident ratio on the overnight shift?” (Not the day shift ??? nights and weekends show real coverage.)
- “Is your staffing data on CMS Care Compare self-reported, or verified against payroll records?” (Since 2016, CMS has required payroll-based verification ??? facilities that report significantly higher ratios than payroll data shows are a concern.)
- “What is your CNA turnover rate in the last 12 months?” (The national average is around 50???60%. Above 80% should prompt follow-up.)
- “On a typical Sunday morning, how many CNAs are assigned to this hall?” (Weekends are the highest-risk time for care gaps.)
About the most recent inspection
- “Can you walk me through the findings in your most recent state inspection report?” (Every facility should be able to do this clearly. Evasion is itself informative.)
- “What specific changes were made after the last inspection?” (Ask for specifics, not policy statements.)
- “Are there any citations from the last two surveys that were cited more than once?” (If yes, ask what was done differently the second time.)
If the inspection record shows serious findings
- “One or more past inspections identified deficiencies rated as causing actual harm ??? can you describe how those situations were resolved?” (Severity codes G and above indicate actual harm.)
- “Your most recent inspection identified [X] deficiency citations. Which of those are you still actively working to remediate?” (Legitimate administrators know their citation history.)
- “Has the facility ever been on the CMS Special Focus Facility list? If so, when was it removed, and what changed?” (This designation is public record ??? not knowing about it is a red flag.)
About complaint handling
- “How does a resident or family member file a formal complaint, and what happens after one is filed?”
- “In the last year, how many complaints were filed with the state? How many were substantiated?” (This is public record ??? cross-check their answer against the report card.)
- “Is there an active Resident Council? Can I speak with a council member?”
About the facility’s ownership and administration
- “How long has the current administrator been in this role?” (Frequent administrator turnover often precedes declining inspection scores.)
- “Has the facility had any ownership changes in the past two years?” (Ownership transitions are a known risk period for care quality ??? staffing decisions change, culture shifts.)
- “Is this facility part of a larger chain? If so, how much operational independence does local management have?”
Things to observe without asking
The tour itself answers questions no survey can:
- Are residents in common areas engaged and dressed, or sitting in hallways in gowns?
- Do staff greet residents by name when they pass?
- What does the facility smell like? Chronic odor is a reliable indicator of staffing and hygiene problems.
- Is the nursing station attended, or consistently empty?
- Ask to see the specific unit where your family member would live ??? not just the nicely furnished lobby.
The most important question of all
“Can I speak privately with two or three current residents or their family members?” Any facility confident in its care will say yes immediately. The answer to this question ??? and the ease with which it is given ??? tells you a great deal.
Senior Care Report Card generates tailored questions based on each facility’s specific inspection record. Search for any nursing home in our coverage area to get a personalized list alongside the full safety report card.