Reading a Nursing Home Inspection Report: What the Citations Mean

Every nursing home that takes Medicare or Medicaid gets inspected. Trained survey staff visit the home, watch care, read records, and talk to residents. When they find that the home broke a rule, they write it up. That write-up is called a citation, or a deficiency.

The full report can run many pages. It looks hard at first. It is not. Once you know the few parts that repeat in each report, you can read one in about fifteen minutes and learn a great deal about a home. This guide shows you where to find the report and how to read it. Our nursing homes hub holds the rest of our guides on choosing a home.

Where the report comes from

The federal rules for nursing homes are enforced by state survey teams that work under contract with CMS, the federal Medicare agency. The team makes a full survey of each home about once a year. The visit is not announced ahead of time. The team also comes back for complaint surveys when someone files a complaint about care.

Survey staff are trained for this work. They watch meals, med passes, and daily care. They sit with residents and ask how life in the home feels. They read charts and care plans. They check the kitchen, the call lights, and the fire safety gear. Each part of the visit tests a part of the federal rule book.

When the visit ends, the team writes up each problem it found. CMS posts the results on Care Compare, the federal site that lists nursing homes. Our guide to how much a nursing home costs per month covers the cost side of the same choice.

The parts of a citation

Each citation in the report has the same parts. Learn the parts once and every report reads the same way.

• The tag number. Each rule has a code, called an F-tag. The tag ties the citation to one rule in the federal rule book, such as the rule on food safety or the rule on care plans.
• The rule text. The report quotes or sums up the rule the home had to meet.
• The findings. This is the core of the citation. It tells what the survey team saw, in plain detail: dates, times, record entries, and what staff and residents said.
• The scope and severity grade. One letter grade sums up how wide the problem was and how much harm it did or could do.
• The plan of correction. The home's written reply sits in the same report, next to the citation it answers.

Scope and severity, in plain terms

Scope means how many residents the problem touched. A problem can be isolated, which means it hit one or a few residents. It can be a pattern, which means it hit more residents or showed up more than once. Or it can be widespread, which means it ran through much of the home.

Severity means how bad the problem was. The lowest level means no harm was done, but harm could have come from the problem. The next level means no real harm was found, but the problem could have caused more than a small harm. Above that sits actual harm: a resident was hurt, though the hurt was not the most grave kind. The top level is immediate jeopardy. That term means the problem caused, or was likely to cause, grave harm or death, and it had to be fixed at once.

CMS joins scope and severity into one letter grade for each citation. The letters run from A at the low end to L at the high end. You do not need to learn the whole grid. Read the findings first. Then use the grade to check how the survey team weighed what it saw.

What a plan of correction tells you

For each citation, the home must write a plan of correction. The plan must say what the home did for the residents the problem touched. It must say how the home will find other residents the same problem could touch. It must say what the home changed so the problem does not come back. And it must give the date the fix will be done.

Read the dates. A fix dated far in the future for a small problem is a weak sign. Read the steps too. A good plan names real steps, such as new training, a new check at each shift, or a change to who does a task. A weak plan says the home will "remind staff" and stops there.

The survey team may come back to check the fix. That return visit is called a revisit. If the home did not fix the problem, new citations can follow, and CMS can fine the home or stop new Medicare admissions until the home complies.

Who pays for what

An inspection report does not change who pays for the stay, but families often read the two side by side, so the basics sit here.

• Medicare: pays for skilled nursing facility care for a limited benefit period after a qualifying hospital stay, when the care rules are met. It does not pay for long term custodial care.
• Medicaid: can pay for nursing home care on an ongoing basis for a person who meets the state's income, asset, and care need tests.
• Private pay: many long stays are paid from savings, income, or a home sale until funds run low and Medicaid may step in.
• Private plans: Medicare Advantage plans cover skilled nursing facility care under their own terms and networks.

Sample situation

Dan is choosing a nursing home for his father, Paul, who needs rehab after a hip break and then long term care. Dan reads the reports for two homes on Care Compare before he visits either one.

The first home has four citations in its last survey. Two are low grade food and record issues, each with a plan of correction that names steps and dates close to the survey. One home health aide training citation shows a pattern grade, and the plan shows new training done for all aides.

The second home has two citations, but one is graded at actual harm. The findings say a resident fell twice at night with no new care plan steps after the first fall. The plan of correction is short and gives a fix date two months out.

Dan still visits both homes. But he goes to the second home with hard questions about night staffing and fall care plans, and he asks to see what changed since the survey. The report did not make the choice for him. It told him what to ask.

How to use a report on a visit

• Print the last two or three surveys for the home, not just the newest one. Look for the same tag cited more than once.
• Read the findings, not just the count. Three low grade citations about records are not the same as one citation about harm.
• Check the plan of correction dates. Fixes should be done by the time you read the report.
• Ask the home's director what changed after the worst citation. A good home can tell you, step by step.
• Ask if a revisit survey has checked the fix, and what it found.
• Match the report to what you see. Our guide to comparing nursing homes with public records and a visit puts the two side by side.

What the report cannot tell you

A survey is a sample of days, not a film of the whole year. A home can have a rough week that the team does not see, or a good week that hides a weak month. Staff change. A new director can lift a home fast, or a strong home can slip. The report is one strong tool. The visit, the talk with residents, and your own eyes are the rest.

If your loved one is in a home now and you see care that worries you, you do not have to wait for the next survey. You can file a complaint with the state survey office at any time, and the long term care ombudsman in your state can help free of charge. If the stay is in a nursing home after a hospital stay, our guide to hospice room and board in a nursing home explains a cost that often shocks families.

Sources

• https://www.medicare.gov/care-compare/