SIGNATURE HEALTHCARE
Ownership rollup across 67 nursing homes in 5 states: Indiana, Kentucky, North Carolina, Tennessee, Virginia. The "follow the money" view of an operator’s whole portfolio — the pattern a single facility page can’t show.
The chain’s homes average 3.1 of 5 stars on the CMS overall rating — roughly in line with the ~3.0 average of the 5 states it operates in. It is improving: across the same 67 homes rated throughout, the average rose 0.55 stars between 2025-02 and 2026-06. We benchmark against its own states because CMS ranks the health-inspection star within each state, so a national comparison (national average ~3.0) partly measures where a chain operates rather than how it operates.
Where the rating comes from
The CMS overall star blends three different things. Split apart across the whole portfolio, they say different things about an operator: thin staffing is a budget decision made above the building, while a weak inspection score is what surveyors actually found inside it.
| Component | Chain average | Basis | |
|---|---|---|---|
| Health inspection | 2.9 of 5 | 67 rated homes | state surveyors’ findings, ranked within each state |
| Staffing | 2.8 of 5 | 67 rated homes | from payroll (PBJ) hours |
| Quality measures | 3.9 of 5 | 67 rated homes | largely self-reported clinical data |
Averaged across this chain’s rated homes. Health-inspection stars are assigned within each state’s own distribution, so for a chain spanning several states this component mixes distributions and is best read alongside each home’s actual citations.
Portfolio red flags
How many of this chain’s homes carry the most serious CMS markers. One flagged home can be local; a pattern across the portfolio is an operator-level signal worth researching.
1 of this chain’s 67 home is tied to a real-estate investment trust (REIT) in CMS ownership records. Private-equity and REIT operators are the focus of most research into how money is moved out of nursing homes — often through the related-party payments shown below. CMS under-reports these ties, so read this as a floor.
Follow the money — chain finances
Aggregated from each home’s CMS Medicare cost report (HCRIS). Related-party payments are dollars a home sends to landlords or management companies under common ownership — the main channel through which private-equity and REIT owners can pull money out of a home while its own books still show a thin margin.
Only homes with a cost report on file are included, so the related-party total is a floor. Cost reports are self-filed, unaudited, and a year or two behind.
Weighted by each home’s average daily census, across the all 67 homes that report both a usable payer mix and a census. Homes whose cost report fails the same validity check the facility pages apply are left out of this figure entirely rather than counted as zero.
Every home in this chain
Lowest-rated first, so the homes most worth a closer look sit at the top. Each links to its full inspection, staffing, fines, and ownership record.
Source: CMS Provider Data Catalog (nursing-home ratings, deficiencies, penalties, and ownership) and the CMS Medicare cost report (HCRIS) for finances. Chain membership is as reported to CMS. CMS extracts retrieved 30 August 2026; CMS refreshes them monthly, so counts here are as of that date. Verify with the facility and your state regulator.