Understanding Your Report

Where does this information come from?

All data on Senior Living Watch comes directly from the Centers for Medicare & Medicaid Services (CMS), the U.S. federal agency that oversees Medicare and Medicaid. CMS is part of the U.S. Department of Health and Human Services.

By law, every nursing home that accepts Medicare or Medicaid payments must undergo regular inspections by state health departments on behalf of CMS. The results of those inspections (including any problems found and any fines issued) are public record and are published in CMS's Provider Data Catalog, which Senior Living Watch reads and displays.

What does the CMS star rating mean?

CMS gives most nursing homes an overall rating from 1 to 5 stars. 5 stars is the highest rating; 1 star is the lowest.

The rating is built from three things: the results of health inspections, how many nursing hours each resident receives, and a set of quality measures drawn from resident health records. The health inspection result is the starting point. A facility can then gain or lose a star depending on its staffing and quality measure scores. We show all three underneath the overall rating on every facility page, and they are worth reading.

Here is the part that surprises most people. The star rating is not a score against a fixed standard. It is a ranking against other nursing homes in the same state. CMS sorts every nursing home in a state by its health inspection results and then divides them up:

• The top 10% receive 5 stars
• The next 23.3% receive 4 stars
• The middle 23.3% receive 3 stars
• The next 23.3% receive 2 stars
• The bottom 20% receive 1 star

So a 5-star facility is one of the better-inspected homes in its own state. It does not mean the facility met some national bar for excellence, and it does not mean inspectors found nothing wrong. Because the ranking is relative, a 5-star home in one state and a 5-star home in another are not necessarily comparable to each other.

Some facilities show No rating available. This is normal for newly certified homes, or homes without enough inspection history yet for CMS to rate. It is not a bad sign in itself.

What are the three ratings underneath?

Under the overall star on each facility page, we show the three separate ratings that the overall rating is made from. They are worth more attention than the single number above them, because two facilities with the same overall rating can be completely different places.

The three do not come from the same place, and they are not equally reliable.

Health inspections

What state inspectors found when they walked in and looked. They observe care being given, read medical records, and interview residents and staff. This is the rating the overall score starts from, and it is the hardest of the three for a facility to influence.

Staffing

How many nursing hours each resident receives per day, with registered nurse hours counted most heavily. This one comes from the facility's actual payroll records, which federal law requires it to submit and which can be audited. It is the most trustworthy number of the three, and it is the one most people never think to look at.

Quality measures

Things like how many residents developed pressure sores, fell and were injured, or ended up in the hospital. Much of this is drawn from assessments the facility fills out about its own residents, along with some Medicare billing records. It is the least independent of the three, and in practice it is also the most generous: roughly a third of nursing homes earn 5 stars on quality measures, while only about one in ten earns 5 stars from inspectors.

A facility with no overall rating shows no breakdown either. And occasionally one of the three will read Not rated, usually because the facility has not reported enough data in that area yet.

What is a Health Deficiency?

A Health Deficiency is a problem found during a nursing home inspection where the facility failed to meet a federal care standard. Think of it as a citation, similar to a failing grade on a specific item in an official report card.

Inspectors visit nursing homes at least once a year, and also whenever a complaint is filed. During a visit, they observe care being given, review medical records, and interview residents and staff. If they find that a standard is not being met (for example, a resident wasn't given their medication on time, or the facility wasn't clean) they issue a deficiency citation.

Having some deficiencies does not necessarily mean a facility is dangerous. Most deficiencies are minor and corrected quickly. What matters most is the severity of the deficiency and whether it was corrected.

What is a Tag?

Every federal care standard that nursing homes must follow has been assigned a number called an F-tag. When an inspector finds a problem, they record which numbered standard was violated. This number appears in the "Tag" column.

The tag number itself does not tell you how serious the problem is. That is what the Scope/Severity code is for. The tag simply identifies what area of care the problem was in.

Some common examples:

What does the Scope/Severity code mean?

This is one of the most important columns in the report. Every deficiency is assigned a single letter (A through L) that tells you two things at once: how serious the harm was and how many residents were affected.

The table below is color-coded to help you quickly spot the most serious issues.

What is a Penalty?

When a nursing home is cited for deficiencies and fails to correct them (or when the problems are serious enough to warrant immediate action), CMS can impose a financial penalty. There are two types:

• Civil Money Penalty (fine): The facility is charged a dollar amount. This may be a one-time fine or a daily charge that continues until the problem is fixed. Daily fines can reach thousands of dollars per day for serious violations.
• Payment Denial: CMS stops reimbursing the facility for new admissions under Medicare or Medicaid until the problem is corrected. This is a strong financial incentive for facilities to fix problems quickly.

A penalty on a facility's record means the federal government took the deficiency seriously enough to take formal financial action. Look at the penalty date and the fine amount to understand the context.

What is a Correction Date?

After a deficiency is cited, the facility is required to fix the problem by a specific date. The Correction Date column shows when CMS verified that the deficiency was resolved. A correction date is a positive sign: it means the problem was identified and addressed.

If a correction date is missing, it may mean the issue is still open, the correction date was not yet recorded at the time the data was last updated, or the deficiency is part of an ongoing process.

How current is the data?

CMS publishes updated nursing home data on a quarterly basis (roughly every three months). Senior Living Watch automatically downloads and imports the latest data each time CMS releases a new update, so what you see reflects the most recent publicly available information.

Because data is updated quarterly, very recent inspections (those completed in the past few weeks) may not yet appear. For the absolute latest information on a specific facility, you can also check Medicare Care Compare, CMS's official consumer tool.

How to use this information

Inspection records are one important piece of the picture, but not the whole story. Here are a few things to keep in mind as you research:

• Look for patterns, not single incidents. One deficiency in three years is very different from repeated citations for the same problem.
• Pay attention to severity. A facility with many D-level citations may be less concerning than one with a single J, K, or L.
• Corrections matter. A facility that identifies problems and fixes them quickly is showing accountability.
• Visit in person. No report replaces a personal visit. Talk to staff, observe the environment, and trust your instincts.
• Ask questions. You have every right to ask a facility's administrator about past deficiencies and what steps were taken.