Reading Nursing Home Inspection Reports and Star Ratings
Every senior care facility looks good in its brochure. Inspection reports and ratings are the closest thing families have to an objective record of how a facility actually treats people. This guide explains where those records live, how to read them, and — just as important — what they can’t tell you.
Nursing homes: the CMS five-star system
If a facility is a Medicare- or Medicaid-certified nursing home, it appears on Care Compare at medicare.gov/care-compare. Search by name or ZIP code and you’ll see an overall rating of one to five stars, built from three parts:
- Health inspections. Based on unannounced state surveys (roughly annual) and complaint investigations over about three years. Surveyors cite deficiencies and grade their severity, from paperwork problems up to “immediate jeopardy” — situations that put residents at risk of serious harm or death.
- Staffing. How many nurse and aide hours residents receive per day, adjusted for how sick the residents are, plus turnover measures. See our staffing ratios guide for why this number matters so much.
- Quality measures. Rates of things like pressure sores, falls with injury, antipsychotic drug use, and rehospitalizations.
The overall star is calculated from these three, with health inspections carrying the most weight.
How to actually use the stars
Stars are a screening tool, not a verdict. Use them like this:
- Treat one and two stars as a serious warning. Don’t tour without a compelling reason.
- Treat five stars as “worth a close look,” not a guarantee.
- Click past the stars to the actual inspection results. Read what the facility was cited for. A citation for a late report is different from a citation for an unexplained injury or medication error.
- Look for patterns: the same deficiency across multiple surveys means the problem isn’t being fixed.
- Check the dates. A facility can change fast — for better or worse — when ownership or administration changes. Ask on your tour who owns the facility and how long the current administrator has been there.
What insiders know: two of the three star components — quality measures and much of the staffing history — come from data the facility reports about itself. Only health inspections are fully independent. That’s why a facility can post five stars overall while sitting on a mediocre inspection rating; some chains have learned to optimize the self-reported numbers. When components disagree, believe the inspection rating. (Staffing data is now drawn from payroll records, which helped, but self-interest still shapes what gets reported.)
Also know the limits: surveys are a snapshot of a few days a year, surveyor strictness varies by state (so don’t compare stars across state lines), and Care Compare says nothing about food, activities, or kindness. A facility can pass every inspection and still be a joyless place to live.
Assisted living: state licensing reports
Here’s what surprises most families: CMS stars don’t exist for assisted living. Assisted living communities, memory care, and adult family homes are licensed and inspected by each state, not the federal government — so there is no national rating and no single website.
To find the records:
- Search “[your state] assisted living inspection reports” or “[your state] department of health facility lookup.” Most states post inspection results, citations, and enforcement actions (fines, license suspensions) online. In some states you must call or email the licensing agency to request reports — do it; they’re public records.
- Read the last two or three inspections, not just the latest one.
- Pay attention to citations involving medication errors, unexplained injuries, neglect, insufficient staffing, or failure to report incidents. Housekeeping and paperwork citations are common everywhere and matter less.
State standards for assisted living vary enormously — what earns a citation in one state is legal in the next. That makes reading the actual findings, in plain English, more useful than counting citations.
Ask this: on your tour, say “I read your last inspection report. Can you tell me what you changed after the citations?” A good administrator knows the report cold and answers specifically. Defensiveness, surprise, or “that was overblown” tells you how the facility handles being wrong.
Complaint records
Inspections are scheduled snapshots; complaints show what happened in between. Every state licensing agency logs complaints against facilities and investigates the credible ones — substantiated complaints usually appear alongside inspection results.
A large facility will accumulate some complaints over the years; that alone isn’t disqualifying. What matters is volume compared to similar facilities, whether complaints were substantiated, and whether the same issue keeps appearing. You can also ask the licensing agency for a facility’s complaint history directly.
The long-term care ombudsman: your inside source
Every state runs a long-term care ombudsman program — federally mandated advocates for residents of nursing homes and, in most states, assisted living. Ombudsmen visit facilities, take complaints, and work to resolve them. They are free, independent, and on the resident’s side by law.
Most families discover the ombudsman only after a problem. Use them before you choose: call the local office and ask whether they hear recurring complaints about the facilities on your shortlist. They can’t recommend facilities, but they can often tell you what kinds of concerns come up — and an experienced ombudsman’s pause when you say a facility’s name is data. Find yours through your state ombudsman program or the Eldercare Locator.
Put the record together with your own eyes
No report replaces visiting. A facility’s paper trail tells you its history; your tour — especially an unannounced one — tells you its present. Use the records to build questions, then watch whether what you see matches what the facility claims. The full decision process is laid out in our guide to choosing a senior care facility.
Common questions
Is a five-star nursing home always better than a three-star one? Not necessarily. The overall star can be lifted by self-reported measures. Compare their health inspection ratings and read the actual citations — a three-star facility with clean inspections and stable staff may be the better choice.
Where are the star ratings for assisted living? There aren’t any — no federal system covers assisted living. Use your state’s licensing inspection reports and complaint records, the local ombudsman, and your own repeated visits instead.
The facility says the citations were “just paperwork.” Should I believe that? Sometimes it’s true — documentation citations are common. Read the report yourself: surveyors describe what they found in plain language, and you can judge whether “paperwork” involved an unreported injury or a genuinely clerical issue.
How recent do reports need to be to matter? Focus on the last two to three years, and weight the newest most. Also ask whether ownership or the administrator changed since the last survey — either can make an old report obsolete in both directions.
Where to get help
- Care Compare (medicare.gov/care-compare) for nursing home ratings and inspection results.
- Your state licensing agency (health or human services department) for assisted living inspections and complaint records.
- Long-term care ombudsman programs in every state — free resident advocates who know local facilities.
- Eldercare Locator (1-800-677-1116) to find your ombudsman and Area Agency on Aging.