Every number on this site comes from data the Centers for Medicare & Medicaid Services (CMS) publishes about the roughly 15,000 nursing homes it certifies. Nothing is estimated, extrapolated, or crowd-sourced. This page explains where the data comes from and how to read it.
CMS publishes nursing home inspection results on the Provider Data Catalog, refreshed roughly monthly. CareCheck ingests four datasets: Provider Information (facility details and star ratings), Health Deficiencies (every inspection citation), Penalties (federal fines and payment denials), and State & US Averages (benchmarks). Each page shows the CMS processing date of the data behind it. The current snapshot was processed by CMS on 2026-06-01.
State survey agencies inspect every certified nursing home on CMS's behalf, roughly annually (more often when complaints come in). Inspectors check compliance with the federal requirements for long-term care facilities, codified at 42 CFR Part 483. Each violation is recorded as a citation against a numbered requirement — an "F-tag" — with a scope & severity letter.
| Letters | What CMS means | Scope |
|---|---|---|
| A–C | No actual harm; minimal potential for harm | Within each band: first letter = isolated, second = pattern, third = widespread |
| D–F | No actual harm; potential for more than minimal harm | |
| G–I | Actual harm to a resident | |
| J–L | Immediate jeopardy to resident health or safety |
CareCheck highlights citations lettered G and above: those are the ones where CMS found actual harm or immediate jeopardy.
Two honest caveats about the citation record. First, it shows the rule that was violated, not the full story — the inspectors' complete narrative lives in the Statement of Deficiencies (Form CMS-2567), which CMS publishes as documents on each facility's Medicare.gov page; we link to it from every ledger. Second, the record can change: facilities may contest citations through informal dispute resolution (IDR/IIDR), which can reduce a citation's severity or remove it. We mark citations CMS reports as under dispute, and the record you see always matches the current CMS release. Our ledger covers health inspections; fire-safety (Life Safety Code) inspections are published by CMS as a separate dataset.
Each citation references a numbered federal requirement (F-689 is "free of accident hazards", F-880 is "infection prevention and control", and so on). CMS's own descriptions are written for regulators, so CareCheck adds a plain-language summary above each one. The official CMS text is always shown alongside, and it always governs — our summaries never add severity that isn't in the record.
CMS's Five-Star Quality Rating System combines three domains — health inspections, staffing, and quality measures — per the CMS Five-Star Technical Users' Guide. The stars on CareCheck are CMS's ratings, reproduced as published; we don't re-rate facilities. We show the citation and penalty record so you can see what's underneath the stars.
Stars don't compare across state lines. The health inspection rating — the backbone of the overall star — is assigned by ranking each facility against other facilities in the same state: roughly the top 10% in each state get 5 stars, the bottom 20% get 1, no matter how states differ in absolute terms. Identical inspection findings can earn 5 stars in one state and 1 star in another. Compare stars within a state; compare the underlying record — harm-level citations, fines, staffing hours — anywhere.
The rating counts less history than the ledger shows. Since July 2025, the health inspection star uses only the two most recent standard surveys (weighted toward the newest), while the public citation file still carries roughly three cycles. Our ledgers show everything CMS publishes. Note also that some facilities' most recent standard inspection is more than two years old — we flag those, with the survey date, on the facility page.
The quality-measures star is largely self-reported. It's built mostly from clinical assessments facilities submit about their own residents, and federal auditors have documented significant underreporting in that data. Inspection results and payroll-based staffing figures are generated independently of the facility, which is why our ledgers lead with them.
Fine amounts in CMS data (and on CareCheck) are amounts imposed. Federal rules (42 CFR Part 488) reduce a fine by 35% when a facility waives its right to appeal, and appeals or settlements can reduce amounts further — so what a facility ultimately pays may be less than the imposed figure shown.
Some facilities show no star rating by design: CMS withholds ratings for Special Focus Facilities (those in its program for persistent serious quality issues) and for facilities too new to rate. Separately, while a facility carries the abuse icon, CMS caps its health inspection rating — so a flagged facility's low star is partly mechanical. CareCheck labels each of these cases rather than showing a bare "not rated."
If you represent a facility and believe a page misstates what CMS publishes, email us with the CCN and the specific field; we correct any discrepancy against the source dataset promptly. Disputes about the underlying citations belong with CMS's IDR/IIDR process, and citations under dispute are marked in the data.