How to read a nursing home inspection report

Every nursing home that accepts Medicare or Medicaid agrees to follow a detailed set of federal health and safety rules. To make sure those rules are followed, trained inspectors visit each facility — usually unannounced — and write up what they find. That write-up is the inspection report, and in official language the visit itself is called a survey.

An inspection report is not a review or an opinion piece. It is a factual record of what inspectors observed during a specific visit: how residents were cared for, whether medications were handled safely, whether the building was clean and safe, and whether staff followed required procedures. When inspectors find that a facility fell short of a federal requirement, they document it as a deficiency — often called a citation.

These reports are public. You can find summaries for any Medicare- or Medicaid-certified nursing home on the official Medicare Care Compare website, and on this site we translate each facility's citations into plain language so you can understand them without decoding government terminology.

Inspections are carried out by state survey agencies — typically part of each state's health department — working under contract with the federal Centers for Medicare & Medicaid Services (CMS). CMS writes the rules and the inspection playbook; the states send the inspectors. Survey teams usually include registered nurses and may also include dietitians, social workers, and other specialists.

Federal law requires a full health inspection of every certified nursing home on average about once a year, and no more than 15 months can pass between standard inspections at any facility. Fire safety and emergency preparedness are checked in a separate life safety inspection.

A few details worth knowing:

• Inspections are unannounced. Facilities are not told the date in advance.
• Inspectors spend several days on site. They observe care directly, review medical records, and talk privately with residents and families.
• Homes with more problems tend to be inspected more often, because complaint visits and follow-up visits are added on top of the regular schedule.

When you look at a facility's inspection history, you will usually see two kinds of visits.

Standard surveys (also called recertification surveys) are the routine, comprehensive inspections that happen roughly once a year. Inspectors look at the whole picture: quality of care, residents' rights, food service, medication management, infection control, staffing, and the physical environment.

Complaint surveys happen when someone — a family member, a resident, a staff member, or anyone else — files a complaint with the state. Instead of reviewing everything, inspectors focus on investigating the specific concern that was reported. A complaint visit can happen at any time of year, and serious complaints trigger faster visits.

Neither type is automatically "worse" than the other. A complaint survey with no citations means inspectors investigated and did not substantiate a problem. On the other hand, a pattern of many substantiated complaints between standard surveys can tell you something the annual inspection alone would not. When you read a facility's history, it helps to note both what was cited and which kind of visit found it.

Federal nursing home requirements are spelled out in a regulation called 42 CFR Part 483. To make inspections consistent from state to state, CMS breaks that regulation into hundreds of numbered requirements, each with its own tag. For nursing homes, these are called F-tags — the letter F followed by a number, such as F689.

Each F-tag stands for one specific requirement. A few examples of what F-tags cover:

• Keeping residents free from abuse and neglect
• Preventing avoidable accidents, such as falls
• Managing medications safely
• Preventing and treating pressure ulcers (bed sores)
• Maintaining proper infection control
• Respecting residents' dignity and right to make choices

When a report says a facility was "cited under F689," it means inspectors found the facility did not meet that specific requirement during that visit. The report then describes the evidence in a narrative called a statement of deficiencies. On this site, each citation is shown with its F-tag and a plain-language explanation of what the requirement means, so you do not need to memorize tag numbers.

Not all citations are alike — a paperwork error and a life-threatening failure are both "deficiencies," but they mean very different things for residents. That is why every citation also gets a letter from A to L, assigned using a grid CMS publishes in its State Operations Manual. The letter answers two questions at once.

Question 1 — Severity: how much harm happened, or could have happened? There are four levels, from least to most serious:

1. No actual harm, potential for minimal harm — no one was hurt, and there was little chance anyone could be.
2. No actual harm, potential for more than minimal harm — no one was hurt, but the problem could have hurt residents if it had continued.
3. Actual harm — one or more residents were actually harmed, physically or emotionally.
4. Immediate jeopardy to resident health or safety — the situation put residents' lives or safety in immediate danger.

Question 2 — Scope: how widespread was it? There are three columns: Isolated (one or a few residents), Pattern (repeated across several residents or staff), and Widespread (found throughout the facility).

Put the two together and you get the letter:

A few reference points help put letters in context. An A is the least serious citation possible — a paperwork-level issue affecting one or a few residents, with little chance of harm. A D is the most common citation level nationally: no one was harmed, but the problem could have hurt one or a few residents if it had continued. Letters G and above mean residents were actually harmed. Letters J, K, and L mean immediate jeopardy — the facility must fix the situation immediately, and these citations often come with large fines. An L — a life-threatening or extremely dangerous situation existing throughout the facility — is the single most serious citation CMS can issue.

A citation is not the end of the story. After the inspection, the facility receives the written statement of deficiencies and must respond with a plan of correction — a written explanation of how it will fix each problem, who is responsible, and by when. State inspectors may return for a follow-up visit (called a revisit) to confirm the fixes actually happened.

For more serious or repeated problems, CMS and the states can apply enforcement remedies, including fines (civil money penalties), denial of payment for new admissions, required staff training, temporary outside management, and — in extreme cases — ending the facility's Medicare and Medicaid contract. Immediate jeopardy findings require the fastest correction of all.

For families, this means two dates matter when you read a report: when the problem was found, and whether it was later corrected. A facility with an old citation that was fixed promptly is a different situation from one with recent, repeated, or uncorrected problems.

When you sit down with a facility's inspection history, a simple routine works well:

1. Look at the letters first. Many citations at the A–C or D–F levels are common and mean no one was harmed; G and above deserve a closer look, and any J, K, or L deserves careful attention.
2. Read what actually happened. The same letter can cover very different situations. The narrative — or our plain-language translation of it — tells you whether a citation was about a missed signature or a missed safety check.
3. Look for repetition. One isolated citation years ago matters less than the same F-tag appearing inspection after inspection.
4. Check recency. Recent inspections tell you more about today's care than ones from several years ago.
5. Use inspections alongside other information, such as staffing levels and the star ratings explained in our guide to how star ratings work — and, whenever possible, visit in person and ask questions.

Inspection reports are one of the most direct windows into how a nursing home actually operates. You can browse every facility's citations, translated into plain language, right on this site, and verify anything you read against the official records on Medicare Care Compare.