Reading a Nursing Home Inspection Report
State surveyors inspect nursing homes at least once every 15 months. Learn to interpret the deficiencies, the scope-and-severity grid, and complaint findings.
Updated
This guide is informational and is not medical advice.
Category: ratings-inspections · Updated 2026
The inspection report is the underlying evidence for a nursing home's health inspection star rating. It documents what surveyors observed, how serious each finding was, and the corrective action the facility must take. Reports can stretch to dozens of pages and read like regulatory paperwork, yet the format is predictable once you recognize the pieces.
This guide covers who conducts inspections and how often, decodes the letter codes, and shows how to tell whether a deficiency is an isolated slip or a recurring pattern.
Who conducts inspections, and on what schedule
For facilities participating in Medicare or Medicaid, state survey agencies carry out on-site inspections for CMS. Federal rules call for a standard recertification survey no later than 15 months after the prior standard survey, per 42 CFR ยง488.308. Complaint surveys are triggered when someone raises a concern and may occur at any time. Findings are recorded in a statement of deficiencies, historically on Form CMS-2567, and published on Care Compare.
The grid of scope and severity
Every deficiency lands on a grid measuring scope (how many residents were affected) and severity (how grave the harm was). CMS assigns a letter from A through L across the four-grid and the broader grid. As a general guide:
| Category | What it indicates |
|---|---|
| No actual harm, potential for minimal harm (A, B, C) | Lower-level findings, often fixed during the survey |
| No actual harm, potential for more than minimal harm (D, E, F) | More serious practice problems; E and F signal a pattern or widespread issue |
| Actual harm (G, H, I) | Residents were harmed; I denotes widespread harm |
| Immediate jeopardy (J, K, L) | Serious injury, harm, or death is likely; L denotes widespread |
Immediate jeopardy findings are the gravest and can trigger enforcement, including fines or removal from the program.
Making sense of one deficiency
Most deficiencies share a structure: the violated regulation, the facts the surveyor documented, and the facility's plan of correction. Focus on the facts, not merely the citation. Ask:
- Was anyone harmed, or could harm have occurred?
- Is the problem isolated or repeated throughout the building?
- Had the facility put a process in place to prevent it?
- What did the facility pledge to correct, and by what date?
- Did earlier surveys cite this same issue?
Repeated findings of the same kind are the clearest indication of a lasting problem.
Penalties, denials, and enforcement
CMS may levy civil money penalties, deny payment for new admissions, or terminate a facility from Medicare and Medicaid. Enforcement data, including total fines and payment denials, is published with the provider data. A single large fine tied to an immediate jeopardy finding is serious, and so is a run of smaller fines spanning several surveys. See Spotting Red Flags in CMS Data.
A sensible order for reading
When you open a report, proceed in this sequence:
- Locate the survey date to gauge how current the findings are.
- Scan for immediate jeopardy and actual harm letters (G through L).
- Tally the deficiencies and count repeat citations.
- Read the facts section of the most serious items.
- Review the plan of correction and whether the deadlines were realistic.
- Compare against the prior one or two surveys for patterns.
Sources: Medicare Care Compare; 42 CFR Part 488; CMS Nursing Home Quality.
Related guides
- Understanding the CMS Five-Star Ratings
- Red Flags to Spot in CMS Nursing Home Data
- Special Focus Facilities: What the CMS Program Involves
- Comparing Nursing Homes: A Step-by-Step Method
- How to File a Nursing Home Complaint
Frequently asked questions
How far back are inspection reports available?
What does an immediate jeopardy citation mean?
If a facility has a deficiency, is it unsafe?
Are complaint investigation results available to the public?
Do inspection reports equal the star rating?
Data sources
CMS Provider Data Catalog · CMS Care Compare. This guide is provided for information and is not medical advice. Processing date: 2026-10-06.
Required disclosures
For general information only, not medical advice. This website shares public data and general information. It does not offer medical advice, diagnosis, or treatment guidance, and it cannot replace a consultation with a qualified health care professional or with Medicare.
Independent and unaffiliated. NursingFacilities.org is a private, independently run directory. It is not affiliated with, nor endorsed or operated by, the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. CMS has not reviewed or endorsed this site.
Confirm details before acting. Facility records come from public federal datasets and may lag or contain errors. Always verify current ratings, services, availability, and coverage directly with the provider and on Medicare.gov.
Certain outbound links on this site are partner or affiliate links. If you use them we may receive a commission, and your price does not change. This never influences the data we publish.