How to Check a Nursing Home's Ratings and Inspection History

The CMS Five-Star Quality Rating Explained

The federal Care Compare website rates every nursing home that participates in Medicare or Medicaid on a one-to-five-star scale.^[1] Search a facility by name or location and you get an overall rating built from three separate components.

• Health inspections. Based on the most recent three years of state survey results, weighted toward the latest. This component reflects the deficiencies surveyors actually found in the building.
• Staffing. Based on the hours of nursing care per resident per day, drawn from payroll data. It accounts for both total nurse staffing and registered nurse coverage.
• Quality measures. Based on clinical data such as rates of pressure ulcers, falls with injury, weight loss, and antipsychotic use.

The overall star is a composite, with the health inspection score carrying the most weight. A facility can hold a respectable overall rating while scoring poorly on one component that matters to your loved one's specific risks, which is why it pays to look past the headline number.

How to Read the Staffing Rating

Of the three components, the staffing rating is the one to trust most. It is built from the Payroll-Based Journal, the auditable payroll data every facility must file, so it is far harder to game than self-reported measures.

A one-star or two-star staffing rating means the facility provides fewer hours of nursing care per resident than its peers. That is the single biggest predictor of the harms that fill these cases: pressure ulcers from missed repositioning, falls from missed supervision, malnutrition from skipped meal assistance. Our guide to understaffing and negligent care explains how that data is used as evidence.

A low staffing star is the facility telling on itself. Most serious nursing home injuries are not accidents, they are what happens when the floor is short, and the rating is the public record of how short it runs.

Reading the Inspection History

The stars summarize, but the inspection reports tell the real story. Care Compare links to each facility's recent health inspection results, and the underlying document is the CMS Form 2567.

• The deficiencies cited. Each one ties to a numbered F-tag standard, such as F600 for abuse and neglect, F686 for pressure injuries, or F689 for falls and accidents.
• The scope and severity. CMS grades each deficiency on a grid from isolated and minor up to widespread and immediate jeopardy. The high end signals serious, ongoing risk.
• Repeat citations. The same deficiency cited survey after survey shows a problem the facility was told about and did not fix, which is powerful in a lawsuit.
• The plan of correction. The facility's required response, which can reveal whether it took the problem seriously or papered over it.

You can also request a facility's full survey history from the state survey agency. The same documents that warn a family before move-in become evidence when a resident is harmed.

Red Flags Beyond the Star Rating

A few specifics deserve attention even when the overall stars look acceptable.

• High antipsychotic use. An above-average rate of antipsychotic medication can signal chemical restraint, covered in our guide to nursing home restraint abuse.
• Low nursing hours per resident. Check the actual staffing numbers, not just the star, and pay attention to registered nurse coverage.
• Repeat or severe deficiencies. Recurring F600, F686, or F689 citations point to unresolved safety problems.
• A recent ownership change. A facility recently acquired by a private equity firm or chain can see staffing cut to widen margins, even before the rating catches up.

None of these is proof of harm on its own. Together, they sketch the kind of facility where the harms in these cases tend to happen.

What a Bad Rating Means if Your Loved One Was Already Hurt

If you are reading ratings after an injury rather than before a move-in, they take on a different role. A facility's poor staffing score, its repeat deficiencies, and its documented prior citations all help show it was on notice of the very risks that harmed your loved one.

That notice matters. A facility that was cited for inadequate fall prevention and then allowed a fatal fall, or that ran a one-star staffing level and then produced a Stage IV pressure ulcer, has a much harder time calling the result an accident. The rating history becomes part of the proof, alongside the chart and the staffing data. Our guide to who is liable for nursing home negligence explains how that record reaches the facility and its owner.

Ratings Are a Starting Point, Not a Guarantee

The Five-Star system is useful, but it has limits worth knowing. The quality measure component relies partly on data the facility reports about itself, which can be optimized. A high overall rating reflects averages and cannot promise that any single resident will be safe, and a serious harm can happen at a well-rated facility.

Use the ratings to narrow choices and to spot warning signs, then look at the actual inspection reports and trust what you see in person. If your loved one has already been hurt, the rating is one piece of the picture, not the whole of it. Knowing the signs of nursing home abuse matters more than any star.