How to read the inspection record of a nursing home
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The State Survey Agency of each state inspects nursing homes for the Centers for Medicare & Medicaid Services (CMS). CMS calls an inspection a survey. When the surveyors find that a home does not meet a federal requirement, they write a citation.
The page of each home on this site lists its health citations. This guide explains each part of that list.
The six parts of a citation
| Column | What it shows |
|---|---|
| Survey date | The date of the inspection. |
| F-tag | The number of the federal requirement that the home did not meet. |
| Requirement (CMS text) | The CMS summary of that requirement. It is the same for every home. |
| Scope and severity | A letter from A to L. The grid below shows what each letter means. |
| Survey type | Standard survey, complaint investigation or infection control inspection. |
| Corrected | The date of the correction, or a CMS status. |
The list does not contain the report of the surveyor. That report describes what the surveyors saw, and it is not in the CMS data files.
Three types of inspection
- Standard survey. A full inspection without notice. A team of surveyors is in the home for some days. On average, a home has one standard survey each year.
- Complaint investigation. An inspection after a complaint to the State Survey Agency. It can occur at any time.
- Infection control inspection. An inspection of infection control only.
| Type of inspection | Citations |
|---|---|
| Standard survey | 288,047 |
| Complaint investigation | 131,315 |
| Infection control inspection | 117 |
Survey cycles
The CMS file holds the citations of the last three survey cycles. Cycle 1 is the latest. Each cycle has one standard survey.
CMS puts the citations from complaint investigations and infection control inspections into cycles of 12 months. So a cycle can contain citations from more than one inspection.
The health inspection rating uses the two latest standard surveys. It also uses the citations from complaint investigations and infection control inspections of the last three years. CMS shows the citations of the third latest standard survey, but the rating does not use them.
Scope and severity letters
Each citation has one letter from A to L. Severity is the level of harm. Scope is the number of residents that the deficiency affected: isolated, pattern or widespread.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy to resident health or safety | J | K | L |
| Actual harm that is not immediate jeopardy | G | H | I |
| No actual harm, potential for more than minimal harm | D | E | F |
| No actual harm, potential for minimal harm | A | B | C |
In the current CMS file, 92% of the health citations have the letter D, E or F. 5% have a letter from G to L: actual harm or immediate jeopardy.
CMS gives points to each citation for its letter. A citation with a higher letter gets more points. The guide What an F-tag is has the table of points.
The "Corrected" column
Most citations have a correction date. A citation without a date has one of these CMS statuses:
- Deficient, Provider has date of correction
- Deficient, Provider has no plan of correction
- Deficient, Provider has plan of correction
- No revisit needed
- Past Non-Compliance
- Waiver has been granted
The guide What happens after a citation explains corrections, revisits and penalties.
Citations in dispute
A home can dispute a citation in an Informal Dispute Resolution (IDR). CMS shows such a citation. This site marks it "in dispute review". CMS does not count it in the health inspection rating until the dispute ends.
What a count of citations does not show
The states do not inspect in the same way. CMS writes that the inspection process and its results vary among the states. For that reason, CMS compares each home with the other homes in the same state for the health inspection rating.
The page of each home shows the state median beside each count. It also shows a CMS flag when the last standard survey is more than 2 years old.