How to read a nursing home inspection report
Every certified nursing home is inspected regularly by state surveyors, and the findings are public. Learning to read them turns an intimidating wall of codes into a clear picture of how a facility actually operates.
What a deficiency is
When surveyors find a facility out of compliance with a federal rule, they cite a deficiency. Each one has a date, an F-tag (the code for the specific regulation, like F-689 for accident hazards), a written description of what they found, and a scope-and-severity letter.
The A–L grid — the part that matters most
A single letter carries two separate facts, and almost everyone reads only the first one. The rows are severity — how bad it was. The columns are scope — how many people it reached. The letter is the cell where they meet.
The four severity rows, from the bottom up:
- A, B, C — no actual harm, and little potential for it. The lowest row.
- D, E, F — potential for more than minimal harm, but no harm yet. Worth reading, especially if repeated.
- G, H, I — actual harm occurred to a resident. A real red flag.
- J, K, L — immediate jeopardy: a situation likely to cause serious injury, impairment, or death. The most serious finding a home can receive.
Now the part the letter hides. Within each row, the three letters are scope, and they go in the same order every time:
- First letter of the row — isolated. One resident, or a very limited number. (A, D, G, J)
- Second letter — pattern. More than a very limited number of residents or staff, or the same problem recurring, or turning up in several places. (B, E, H, K)
- Third letter — widespread. A large number of residents or staff; pervasive or systemic — a problem with the facility, not with one shift. (C, F, I, L)
Why this changes how a “low” citation reads
Because scope runs left to right inside each row, a C is not a small finding. C is the widespread cell of the no-harm row: surveyors are saying the practice was systemic across the building and nobody happened to be hurt by it yet. An A is one resident, once. Both sit in the “no actual harm” row, and they describe very different homes. The same logic runs all the way up: an F is a facility-wide risk of harm, and an L is immediate jeopardy that reached a large share of the building.
This is the single most useful thing to know about the grid, and it is the thing families are most often told wrong — including, until recently, on this page, which called A–C “minor or isolated.” A and C are both real, and only one of them is isolated.
A facility page here labels each citation with its severity tier in plain language, so you don’t have to memorize letters. We flag any home with immediate-jeopardy citations. When you are reading the raw report, though, look at both axes: a stack of C's and F's is a facility telling on itself.
Sources: the scope-and-severity matrix used by CMS and state survey agencies, as published by state health departments (for example Indiana’s scope-and-severity matrix ↗) and by the Long Term Care Community Coalition ↗.
Read for pattern, not perfection
Almost every facility has some deficiencies — a spotless record can even mean a light inspection. What matters is the pattern: Are findings clustered at the harm end (G and above)? Are the same problems cited again and again across years? Did fines or payment denials follow? One old, low-level citation is not the same as a repeated pattern of harm-level findings backed by penalties.
Put it together
Read the inspection star separately from the overall rating, scan the deficiencies for severity and repetition, check whether the facility was fined, and look at staffing. Together those four things tell you far more than any single star. The full record for every U.S. nursing home is on this site, straight from the government, with nothing sold to a salesperson.
This guide is general information, not medical, legal, or financial advice. Rules vary by state and change over time. For personalized, unbiased help, your Area Agency on Aging and your state’s Long-Term Care Ombudsman are free.