How to Read a Nursing Home Inspection Report

Every nursing home that participates in Medicare or Medicaid is inspected by state surveyors on behalf of the Centers for Medicare and Medicaid Services. These inspections — formally called surveys — are conducted unannounced, typically once every 12 to 15 months, and they evaluate nearly every aspect of how a facility operates. The results are public, and learning how to read them can give you a much deeper understanding of a facility's quality than star ratings alone.

What inspectors look for

State surveyors spend several days in a facility during a standard survey. They observe care being delivered, review medical records, interview residents and staff, examine the physical environment, and evaluate the facility's compliance with federal regulations covering hundreds of specific requirements.

These requirements fall into broad categories including resident rights, quality of care, quality of life, nursing services, dietary services, pharmacy services, infection control, physical environment, and administration. The surveyors are looking for whether the facility meets the minimum federal standards in each of these areas.

Understanding deficiencies

When a surveyor finds that a facility is not meeting a standard, they issue a deficiency — a formal citation documenting what went wrong. Each deficiency is categorized by two dimensions: scope (how many residents were affected) and severity (how serious the harm or potential for harm was).

Scope ranges from isolated (affecting one or a very small number of residents) to pattern (affecting multiple residents) to widespread (affecting most or all residents in the facility).

Severity ranges from no actual harm with potential for minimal harm at the low end, up through actual harm to immediate jeopardy at the high end. Immediate jeopardy is the most serious category — it means that a situation exists where serious injury, harm, impairment, or death is likely.

The combination of scope and severity determines how serious the deficiency is. An isolated deficiency with no actual harm and potential for minimal harm is relatively minor. A widespread deficiency that caused actual harm is very serious. And any deficiency categorized as immediate jeopardy is a major red flag, regardless of scope.

What to focus on

When reviewing a facility's inspection report, pay attention to several things. First, look at the total number of deficiencies. Every facility has some deficiencies — that is normal. The national average is around seven to eight deficiencies per inspection cycle. A facility with significantly more than average warrants closer scrutiny.

Second, look at the severity levels. A facility with many minor deficiencies may simply have documentation issues or minor procedural gaps. A facility with even one or two high-severity deficiencies — especially those involving actual harm or immediate jeopardy — has had a serious quality failure that families should understand before making a decision.

Third, look at the categories. Deficiencies in areas directly related to resident care (quality of care, nursing services, infection control) are more concerning than deficiencies in administrative areas. A citation for failing to maintain proper medical records is different from a citation for failing to prevent pressure ulcers.

Fourth, look at patterns over time. A facility that had a bad inspection cycle but improved in the next survey is different from a facility with recurring deficiencies in the same areas year after year. Persistent problems suggest systemic issues rather than isolated incidents.

Where to find inspection reports

CMS publishes inspection results through the Care Compare website and through the data that feeds into CareNav. On CareNav, the health inspection rating for each facility reflects the results of the most recent survey cycles. A facility with a 1-star health inspection rating has had significantly more or more serious deficiencies than average.

For the detailed deficiency-by-deficiency breakdown, you can visit the Medicare Care Compare website and search for the facility by name. The full inspection report, including the specific deficiencies cited, the scope and severity of each, and the facility's plan of correction, is available as a public document.

Putting it in context

Inspection reports are valuable, but they are snapshots in time. A survey conducted 14 months ago may not reflect changes the facility has made since then. Similarly, a clean survey does not guarantee that problems won't emerge later.

Use inspection data as one input among many. Combine it with the CMS star ratings, family reviews on Google, your own observations during a facility visit, and conversations with staff and current families. Together, these sources give you the most complete picture of a facility's quality.

On CareNav, the CMS health inspection rating provides a quick summary of each facility's inspection history. For families who want to go deeper, the detailed reports are a powerful tool for understanding what the numbers really mean.