How to Read a Nursing Home Inspection Report

State surveyors inspect nursing homes every 15 months. Learn how to read the deficiencies, scope-and-severity grid, and complaint findings.

Category: ratings-inspections · Updated 2026

A nursing home inspection report is the raw evidence behind the health inspection star rating. It lists what surveyors found, how serious each finding was, and what the facility must do to fix it. Reports can run for dozens of pages and read like regulatory documents, but the structure is consistent once you know what to look for.

This guide explains who inspects facilities, how often, what the codes mean, and how to judge whether a deficiency is a one-off or a pattern.

Who inspects nursing homes and how often

State survey agencies conduct on-site inspections on behalf of CMS for facilities that participate in Medicare or Medicaid. Federal rules require a standard recertification survey no later than 15 months after the previous standard survey, under 42 CFR §488.308. Complaint surveys happen when someone reports a concern, and they can occur at any time. The findings are documented in a statement of deficiencies, historically on Form CMS-2567, and posted to Care Compare.

The scope-and-severity grid

Every deficiency is placed on a grid with scope (how many residents were affected) and severity (how serious the harm was). CMS assigns a letter, from A through L, in the four-grid and the broader grid. As a rule of thumb:

Category	What it means
No actual harm, potential for minimal harm (A, B, C)	Lower-level findings, often corrected during the survey
No actual harm, potential for more than minimal harm (D, E, F)	More serious practice problems; E and F mean a pattern or widespread
Actual harm (G, H, I)	Residents were harmed; I means widespread harm
Immediate jeopardy (J, K, L)	Serious injury, harm, or death is likely to occur; L is widespread

Immediate jeopardy findings are the most serious and can trigger an enforcement action, including fines or termination from the program.

Reading a single deficiency

Each deficiency usually follows a pattern: the regulation that was violated, the facts the surveyor observed, and the facility's plan of correction. Read the facts, not just the citation. Ask:

Was a resident harmed, or was harm possible?
Is this an isolated event or a pattern across the building?
Did the facility have a process to prevent it?
What did the facility promise to fix, and by when?
Was this issue cited on earlier surveys too?

Repeat findings of the same type are the clearest signal of a persistent problem.

Fines, denials, and enforcement

CMS can impose civil money penalties, deny payment for new admissions, or terminate a facility from Medicare and Medicaid. The penalties data, including total fines and payment denials, is published as part of the provider data. A single large fine for an immediate jeopardy finding is serious, and so is a pattern of smaller fines over several surveys. See Spotting Red Flags in CMS Data.

A practical reading order

When you open a report, work in this order:

Find the survey date, so you know how current the findings are.
Scan for immediate jeopardy and actual harm letters (G through L).
Count deficiencies and note how many are repeat citations.
Read the facts section of the most serious items.
Check the plan of correction and whether deadlines were realistic.
Compare with the previous one or two surveys for patterns.

Sources: Medicare Care Compare; 42 CFR Part 488; CMS Nursing Home Quality.

Related guides

Frequently asked questions

How far back do inspection reports go?

Care Compare shows recent survey cycles and complaint findings, and CMS keeps older reports in its data systems. You can also request inspection records directly from the state survey agency or the facility.

What is an immediate jeopardy citation?

Immediate jeopardy means a facility's noncompliance caused, or is likely to cause, serious injury, harm, impairment, or death to a resident. It is the most serious severity level and can lead to fines or removal from Medicare and Medicaid.

Does a deficiency mean the facility is dangerous?

Not necessarily. Many deficiencies are low severity and corrected during the survey. The pattern matters more than any single finding: repeated serious citations over multiple surveys are a stronger warning than one isolated problem.

Can I see complaint investigation results?

Yes. Complaint survey findings are part of the public inspection record and generally appear on Care Compare. Ask the facility or the state survey agency if a specific complaint result is not posted.

Are inspection reports the same as the star rating?

No. The report is the evidence; the health inspection star is a weighted summary of recent surveys. Reading the report gives you context the star cannot.

Data sources

CMS Provider Data Catalog · CMS Care Compare. This guide is informational and is not medical advice. Processing date: 2026-10-05.

Important disclosures

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