How to Read a Nursing Home Inspection Report

Standard vs. complaint surveys, the A–L scope and severity grid, plans of correction, dispute resolution, and where to find Form CMS-2567.

Every nursing home that takes Medicare or Medicaid is inspected by its state survey agency on behalf of the Centers for Medicare & Medicaid Services (CMS). The results are public, and they are among the most useful information a family can read. This guide explains how inspections work, how to decode the letter codes attached to each citation, and where to find the full written report.

Standard surveys and complaint surveys

There are two main kinds of health inspection:

• Standard (recertification) surveys. These are comprehensive, unannounced inspections in which a team of surveyors spends several days in the building. CMS describes them as reviewing areas such as resident rights, quality of life, medication management, skin care, resident assessment, administration, environment, and food service (see the CMS Five-Star Technical Users' Guide).
• Complaint surveys. When someone reports a concern, the state agency must review it and investigate on site if a federal requirement may have been violated and only a survey can tell. Complaint surveys may be full or abbreviated and often focus on the issue raised.

Separate fire safety (Life Safety Code) inspections also take place. Those findings are posted separately and are not counted in the Five-Star health inspection rating. CMS also runs focused infection control surveys.

How often inspections happen

Under 42 CFR 488.308, a standard survey must take place no later than 15 months after the previous one, and the statewide average interval must be 12 months or less. So most homes are inspected about once a year, though an individual home can go a bit longer. States may also inspect as often as needed, including within 60 days of a change in ownership, management company, administrator, or director of nursing. Complaint investigations can happen at any time.

The scope and severity grid (A through L)

Each citation, called a deficiency or "F-tag," gets a letter from A to L. The letter combines two things: how serious the problem was (severity) and how many residents it affected or could affect (scope).

• A, B, C: no actual harm, with potential for only minimal harm.
• D, E, F: no actual harm, but potential for more than minimal harm.
• G, H, I: actual harm that is not immediate jeopardy.
• J, K, L: immediate jeopardy to resident health or safety.

Within each group, the first letter means the problem was isolated, the second means a pattern, and the third means widespread. For example, D is isolated, E is a pattern, and F is widespread, all at the same severity level.

"Actual harm" means a resident was actually hurt by the deficient practice, not just put at risk. "Immediate jeopardy" is defined in 42 CFR 488.301 as a situation in which the home's noncompliance "has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident." Certain higher-level citations in specified areas of the regulations are also labeled substandard quality of care, which triggers extra enforcement steps.

You may see a citation marked as past noncompliance. That means surveyors found a problem that had already been corrected by the time of the inspection. For Five-Star scoring, CMS counts a past-noncompliance immediate jeopardy citation at the G level.

Plans of correction

Findings are written on Form CMS-2567, the Statement of Deficiencies and Plan of Correction. Except for level A citations and past noncompliance, the home must submit a plan of correction within 10 calendar days of receiving the form, according to Chapter 7 of the CMS State Operations Manual. An acceptable plan must explain how the home will fix the problem for residents who were affected, find other residents at risk, change its systems so the problem doesn't happen again, monitor whether the fix holds, and finish by specific dates. Surveyors may come back for a revisit to confirm the fixes. The Five-Star rating adds points when a home needs a second, third, or fourth revisit.

When you read a plan of correction, keep in mind that it is the home's promise to fix the problem. It doesn't prove the problem was fixed. A later inspection is the best evidence.

Informal dispute resolution

A nursing home that disagrees with a citation can ask for informal dispute resolution (IDR) within the same 10-day window it has for the plan of correction. If a citation is removed through this process, any enforcement action based only on that citation is rescinded (42 CFR 488.331). When CMS imposes a civil money penalty that will be placed in escrow, the home can also ask for an independent IDR. Citations still under IDR or independent IDR are shown on Care Compare but don't count in the health inspection rating until the dispute is finished. IDR doesn't delay enforcement.

Where to read the full report

• Care Compare. On Medicare.gov Care Compare, each nursing home's profile lists inspection results and links to the full inspection report. CMS began posting redacted Form CMS-2567s online in 2012 (CMS Survey & Certification letter 13-21). CMS doesn't capture plans of correction electronically, so those are not posted with the reports.
• The nursing home itself. Federal rules (42 CFR 483.10(g)) require every home to post the results of its most recent survey where residents and families can easily see them. The home must also make inspection, certification, and complaint investigation reports from the past three years, along with any plan of correction in effect, available for anyone to review on request.
• Bulk data. The CMS Health Deficiencies dataset lists every citation with its tag, date, and scope/severity code.
• Your state survey agency can provide reports and plans of correction on request.

Tips for reading a report

1. Look first at the letter codes. A single G or higher deserves more attention than several D or E citations.
2. Read the narrative, not just the tag title. The surveyor's notes explain what actually happened.
3. Compare several inspection cycles. A problem that keeps coming back says more than a one-time slip.
4. Check the dates. A home's performance can change after new ownership or leadership.
5. Remember that inspection practices vary by state, which is one reason CMS rates homes against others in the same state.

This guide is general information, not legal or medical advice. If a report raises a concern, ask the administrator about it directly, or contact your state's long-term care ombudsman.

Updated 2026-09-30.