How to Read a Nursing Home Inspection Report and Star Rating

Lilisity · October 26, 2026

A nursing home's overall star rating from Medicare starts with its health inspection rating. Staffing and quality measures can then move it up or down by a star each. The inspection report behind it lists every deficiency the inspectors cited, and each one carries a letter from A to L that tells you how serious it was and how many residents it affected.

So read past the overall stars. Look at the inspection rating, the letters on each deficiency, and whether the same problems show up survey after survey. For assisted living, there are no federal stars. Each state runs its own inspections and publishes its own reports, in its own format.

How the overall star rating is built

The Centers for Medicare & Medicaid Services (CMS) rates every nursing home that takes Medicare or Medicaid. Each one gets an overall rating of one to five stars, plus separate ratings for health inspections, staffing and quality measures. The ratings are posted on Medicare.gov Care Compare.

CMS builds the overall rating in three steps:

1. Start with the health inspection rating.
2. Add a star if the staffing rating is five stars. Take one away if it is one star.
3. Add a star if the quality measure rating is five stars. Take one away if it is one star.

The overall rating stays between one and five. A home with a one-star inspection rating can't be raised by more than one star. CMS explains that staffing and quality data should not outweigh what trained inspectors found on site.

Health inspection stars are graded within each state. In each state, the 10 percent of nursing homes with the best inspection scores get five stars, the bottom 20 percent get one star, and the middle 70 percent are split evenly across two, three and four stars. CMS does this because inspections vary from state to state. It also means a three-star home in one state can't be compared directly with a three-star home in another.

What goes into the inspection rating. Since July 2025, CMS uses the two most recent standard inspections, with the newer one counting for three quarters of the score. It adds deficiencies from complaint investigations and infection control inspections over the last three years, with the most recent year counting most. Homes that needed more than one follow-up visit to show they fixed their problems get extra points, and on this score more points is worse.

Staffing is rated on six measures: three for nurse staffing hours per resident per day and three for staff turnover. The data comes from payroll records that nursing homes submit to CMS each quarter.

Quality measures are 15 measures of residents' health and care, such as how many long-stay residents have pressure ulcers. Nine cover long-stay residents and six cover short-stay rehab patients, and Care Compare shows separate short-stay and long-stay ratings.

Icons to watch for

• The abuse icon. CMS marks a nursing home that was cited for abuse that harmed a resident (on its latest standard inspection, or a complaint or infection control inspection in the past year), or that was cited for abuse with potential for harm on two recent inspections. The home's inspection rating is capped at two stars while the icon is on, so its overall rating can be no higher than four.
• The yellow warning sign. Homes in CMS's Special Focus Facility program, which is for homes with a history of serious quality problems, get no star ratings. A warning sign is shown instead.
• The trophy. Starting with the September 2026 update, CMS adds a trophy icon for high-performing homes with fewer citations and higher staffing.

What a deficiency is

A deficiency, also called a citation, means inspectors found the nursing home did not meet a federal requirement. Each one has a code called an F-tag (for example, F600 is the tag for protecting residents from abuse) and a short description of the rule. Inspectors write their findings on a form called the Statement of Deficiencies, CMS Form 2567. That's the "full report." It describes what they saw and heard.

The A to L letters: scope and severity

Each deficiency gets one letter. The row tells you how serious it was. The column tells you how many residents it affected or could affect.

Letters G and above mean a resident was actually hurt or put in immediate danger, and those are the ones to read first. A widespread letter (C, F, I or L) means the problem affected many residents, or could have.

Standard inspections and complaint inspections

A standard inspection happens about once a year on average. It is unannounced, and a team of health care professionals spends several days in the building. They review practices across the home, from resident rights and medication management to skin care and the kitchen.

A complaint inspection happens when someone files a complaint with the state about a nursing home, and it looks into that concern. Deficiencies found on complaint inspections count toward the star rating too.

What a plan of correction is

After an inspection, the nursing home gets its Statement of Deficiencies. For most deficiencies it must send back a plan of correction within 10 calendar days. CMS says an acceptable plan explains:

• How the home will fix things for the residents who were affected
• How it will find other residents at risk from the same problem
• What it will change so the problem doesn't happen again
• How it will keep checking that the fix holds
• The date each correction will be done

The state must accept the plan. Inspectors may come back for a revisit to confirm the home is back in compliance. A plan of correction is a promise. It doesn't prove the problem was fixed, which is why a repeat citation for the same issue matters.

You can say on a tour: "I saw the citation from your last inspection about medications. What did you change, and how do you check that it's working?"

Why one bad inspection can matter less than a pattern

Any nursing home can have a hard inspection. One cluster of D-level citations in an otherwise clean history is worth asking about, and it may not be a reason to rule the home out. These are more worrying:

• The same F-tag or the same kind of problem cited on two or three inspections in a row
• Any G-level or higher deficiency, especially about falls, abuse, neglect or medications
• Several complaint inspections that found problems
• Needing more than one revisit to get back into compliance
• Low staffing hours combined with high turnover

Medicare's own checklist for choosing a nursing home asks whether the home has corrected all the citations from its last inspection. CMS also says no rating system can cover everything, and that a home close to family may be a better choice than a higher-rated home far away.

Assisted living inspections are run by each state

Assisted living is licensed and regulated by the states, not by CMS. There are no federal star ratings, and each state decides how often to inspect, what to call a violation and what it publishes. What each state posts online varies, and your state's licensing agency can tell you how to get them.

Two examples from Lilisity show how different the records look. California's records sort citations into Type A (an immediate risk to residents) and Type B (a potential risk if not corrected), and list complaint investigations with how many allegations were substantiated. Washington's records list inspection reports, investigation reports after reported concerns, and enforcement letters.

How to read inspection history on Lilisity

On every Lilisity nursing home page, the CMS ratings are near the top: the overall stars and the stars for health inspections, staffing and quality measures, with a CMS abuse icon badge when the home has one. Below that you'll see:

• Staffing hours and turnover next to the state and national averages
• The date of the most recent inspection, how many deficiencies it found, the health inspection score (lower is better) and any fines
• "What inspectors found": each deficiency with its severity label (potential for harm, actual harm or immediate jeopardy), its category, its date and a link to the full report

On assisted living and memory care pages, look for "What the public record shows." It gathers the state's licensing and inspection record, lists citations newest first where the state publishes them (with plan of correction due dates in states like California), and compares the counts with the nearest communities. It also explains the state's own terms and links to every report on the state's site. Lilisity doesn't give assisted living communities a score or ranking, and communities can't edit this part of the page. Where a community publishes prices or has testimonials, they are on the same page, so you can read them next to the record.

If something on a report worries you, call your state's Long-Term Care Ombudsman. The service is free. Our post on whether you can trust online reviews of senior living covers what else to check.

This is general information, not legal or medical advice.

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