Quick Answer
Every certified nursing home is inspected, unannounced, roughly every 9–15 months. Each violation ("deficiency") gets an F-tag identifying the rule broken and a letter from A to L rating how serious and widespread it was. Letters G and above mean actual harm; J, K, or L mean immediate jeopardy to residents' lives. Find reports free on Medicare.gov's Care Compare, and see how inspection data feeds into SunsetWell scores on every facility page in our search tool.
Table of Contents
How Nursing Home Inspections Work
Every nursing home that accepts Medicare or Medicaid — roughly 14,700 facilities nationwide, per the May 2026 CMS Provider Data Catalog — must pass regular inspections ("surveys") conducted by state survey agencies on behalf of CMS. There are two main types:
Standard (recertification) surveys
Comprehensive, unannounced inspections conducted roughly every 9–15 months. A team of surveyors spends several days in the facility: observing care, watching medication passes, inspecting the kitchen, reviewing medical records, and interviewing residents, families, and staff. They evaluate everything from infection control and pressure ulcer prevention to residents' rights and food safety.
Complaint surveys
Triggered when a resident, family member, or staff member files a complaint with the state. These are narrower investigations focused on the allegation, and can happen at any time. A facility with several substantiated complaint surveys between standard surveys deserves extra scrutiny — it means problems surfaced badly enough that people reported them, and inspectors confirmed them.
When surveyors find a violation of federal requirements, they write a deficiency in a public report (Form CMS-2567). The facility must then submit a plan of correction. Since July 2025, CMS bases a facility's health-inspection star rating on its two most recent standard surveys plus recent complaint surveys, so current reports carry real weight in the ratings you see.
The Scope & Severity Grid (A–L)
Every deficiency also gets a letter from A to L. The letter combines severity (how serious the harm was, or could have been) with scope (whether it was isolated, a pattern, or widespread). Higher letters are worse:
A–C: Potential for minimal harm
Technical violations unlikely to hurt anyone — for example, incomplete documentation. (A = isolated, B = pattern, C = widespread.) Common and rarely decision-changing.
D–F: No actual harm, but potential for more than minimal harm
The most common citations — e.g., a medication error caught before injury, or expired food in the kitchen. (D = isolated, E = pattern, F = widespread.) A few D-level findings are normal; many E/F findings suggest systemic sloppiness.
G–I: Actual harm occurred
A resident was actually hurt — an avoidable pressure injury, an injury fall linked to missed supervision. (G = isolated, H = pattern, I = widespread.) Treat any G-or-above citation as a serious warning and ask the administrator directly what changed afterward.
J–L: Immediate jeopardy
The most severe finding in the system: residents were in immediate danger of serious injury, impairment, or death. (J = isolated, K = pattern, L = widespread.) Facilities must correct these immediately and face heavy fines or termination from Medicare. A recent immediate-jeopardy citation should move a facility to the bottom of your list absent extraordinary explanation.
Context matters: surveys are graded on what inspectors find during a snapshot in time, and the average facility receives several lower-level deficiencies per survey. Zero deficiencies is excellent and uncommon; a long list of D-level tags is mediocre but survivable; anything G or above deserves a direct conversation.
Where to Find Inspection Reports
- Medicare.gov Care Compare — search the facility name, open the "Health & fire safety inspections" section, and you can read deficiency summaries and download full inspection reports for recent surveys, free.
- The facility itself — federal law requires nursing homes to make their most recent survey results available for examination on-site. Ask at the front desk; hesitation to produce them is itself a red flag.
- Your state health department — many states publish inspection and enforcement records, sometimes with more history than Care Compare shows.
- The long-term care ombudsman — every state has a free ombudsman program that knows local facilities' complaint histories and can speak candidly.
When comparing several facilities, our comparison tool puts inspection-based ratings side by side so you can spot the outliers quickly before digging into individual reports.
Red Flags That Should Change Your Decision
🚨 Walk away (or demand answers)
- • Immediate jeopardy (J, K, L) on a recent survey
- • Any abuse or neglect citation (F-600)
- • Actual-harm citations (G+) on consecutive surveys
- • CMS abuse icon shown on the facility's Care Compare page
- • "Special Focus Facility" status — CMS's list of persistently poor performers
⚠️ Investigate further
- • Repeat deficiencies — the same F-tag cited survey after survey means problems aren't being fixed
- • Deficiency counts well above the state average
- • Several substantiated complaint surveys between standard surveys
- • Infection control (F-880) plus staffing citations together
- • Fines or payment denials in the enforcement history
On a tour, it's fair — and effective — to ask the administrator about specific citations: "Your last survey cited F-689 at level G. What happened, and what's different now?" Good facilities answer openly and describe concrete fixes. Defensiveness or surprise that you read the report tells you something too. Our tour checklist includes these questions.
How SunsetWell Uses Inspection Data
SunsetWell scores are built from official CMS data, and health inspection results are a core input — alongside staffing levels and clinical quality measures. Because inspections reflect what trained surveyors actually observed on-site, they carry significant weight in how we rank facilities. When CMS releases updated inspection data, scores are recalculated to match.
Two recent CMS changes are worth knowing as you research in 2026: since July 2025, health-inspection star ratings are based on the two most recent standard surveys (rather than three), making ratings more responsive to recent performance; and in January 2026, CMS refreshed its quality measures, replacing the long-stay antipsychotic measure with a claims-supplemented version that is harder for facilities to underreport.
You can read the full methodology — what we weight and why — on our scoring methodology page.
Compare Inspection-Based Scores Near You
See how facilities in your area stack up on inspections, staffing, and quality measures — all from official CMS data, all free.
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Note: This guide is general information, not medical or legal advice. Inspection processes and rating methods are set by CMS and state agencies and can change; verify current details at Medicare.gov. If you witness abuse or neglect, report it to your state health department and long-term care ombudsman immediately.