How to Check Nursing Home Violations (2026 Guide)

A complete, step-by-step guide to finding and understanding nursing home violation records before you place a loved one.

Why Checking Nursing Home Violations Matters

Most families get 24 to 48 hours to choose a nursing home. A hospital discharge planner hands you a list. You tour a couple of facilities, the hallways smell clean, the staff smiles. You make a decision that will affect your parent's daily life for months or years.

What you don't see during a tour: the government inspection report sitting in a filing cabinet showing that this facility was cited for failing to prevent pressure ulcers on 12 residents. Or that they were fined $150,000 last year for medication errors. Or that they've had three ownership changes in two years.

All of this information is public record. The federal government inspects every Medicare- and Medicaid-certified nursing home in the United States at least once every 15 months. The results are published online. But the data is scattered across multiple government databases, written in regulatory jargon, and genuinely difficult to interpret.

This guide walks you through exactly how to find and understand this information, step by step.

Step 1: Start With Medicare Care Compare

The Centers for Medicare & Medicaid Services (CMS) operates a free online tool called Care Compare at medicare.gov/care-compare. This is the primary federal database for nursing home quality information.

What Care Compare Shows You

• Overall star rating (1-5 stars) — A composite score combining health inspections, staffing, and quality measures. Five stars is the best. One star means significantly below average.
• Health inspection results — A summary of the most recent standard survey and any complaint investigations.
• Staffing data — How many nursing hours each resident receives per day, broken down by RNs, LPNs, and CNAs.
• Quality measures — Clinical outcome data like rates of falls, pressure ulcers, UTIs, and use of antipsychotic medications.
• Penalty history — Whether the facility has been fined or had its Medicare payments denied.

Limitations of Care Compare

Care Compare is a good starting point, but it has real limitations you should know about:

• Star ratings can be misleading. Facilities self-report some staffing data. CMS has acknowledged that some homes inflate their staffing numbers. A 2024 OIG report found discrepancies between reported and actual staffing at roughly 25% of facilities reviewed.
• The data is delayed. Inspection results can take months to appear. A facility cited in January might not show updated results until April or later.
• It doesn't show trends. You can see the most recent inspection, but not whether the facility is getting better or worse over time.
• The violation details are hard to read. The full inspection reports use CMS regulatory codes (F-tags) and dense compliance language that takes practice to interpret.
• No ownership context. You can see who owns the facility, but Care Compare doesn't tell you how that owner's other facilities are performing.

Step 2: Check Your State Health Department

Every state has its own health department or licensing agency that conducts nursing home inspections, often in coordination with CMS. Some states maintain their own databases that can contain information not found on the federal site.

What State Databases May Add

• State-only citations — Some violations are issued under state law rather than federal regulations. These won't appear on Care Compare.
• Complaint investigation details — States handle the intake and investigation of complaints. Their records may include outcomes of investigations that haven't yet reached the federal database.
• Licensing actions — States can suspend, revoke, or place conditions on a facility's license. These actions are separate from CMS penalties.
• More recent data — Some state databases update faster than the federal system.

The challenge: every state organizes this information differently. California has a relatively transparent online system. Other states require you to file a public records request. We maintain a list of state-level resources on our state pages.

Step 3: Use NurseCheck for a Complete Picture

We built NurseCheck specifically because the process described above is too hard for most families working under time pressure.

NurseCheck pulls data from seven official CMS datasets — provider information, health deficiencies, fire safety deficiencies, penalties, quality measures, ownership records, and survey summaries — and combines them into a single facility profile.

What NurseCheck Adds

• Trust Score — A transparent, independently calculated score that weighs violation severity, frequency, staffing levels, penalty history, and ownership stability. We show you exactly how the score is calculated.
• Plain English violation summaries — We translate regulatory codes into language anyone can understand.
• Trend tracking — See whether a facility is improving or declining over time, across multiple inspection cycles.
• Red flag and green flag detection — We automatically surface the most important signals, both positive and negative.
• Owner portfolio view — See how all facilities under the same ownership are performing.
• Side-by-side comparison — Compare up to three facilities across every metric.

Search 14,710 facilities now →

What to Look For in Violation Records: Severity Codes Explained

Every nursing home deficiency is assigned a severity code from A through L. This is the single most important thing to understand when reading violation records. The code tells you two things: how serious the harm was, and how many residents were affected.

Scope: How Many Residents Were Affected

Severity Levels and What They Mean

Key takeaway: Codes A through F are common and often minor. Codes G through I mean someone was actually harmed. Codes J through L are rare and represent the most dangerous conditions — if you see these, take them very seriously.

Red Flags That Should Concern You

When reviewing a nursing home's record, these findings should raise your level of concern significantly:

• Immediate jeopardy citations (J/K/L). These mean inspectors determined a resident's life or safety was in immediate danger. Less than 2% of facilities receive these. Any facility with recent J/K/L citations deserves serious scrutiny. See all 12 red flags →
• Abuse findings. Citations specifically related to physical abuse, sexual abuse, verbal abuse, or neglect (F-tags F600-F609). These are categorically different from procedural deficiencies.
• Unusually high fine amounts. CMS doesn't fine facilities for minor issues. If a facility was fined more than $50,000, the underlying violation was significant. Fines over $100,000 often indicate egregious conditions.
• High staff turnover. CMS now reports turnover rates. Facilities where more than 50% of nursing staff turned over in the past year often have systemic management problems.
• Repeated violations across inspection cycles. A single citation can reflect a bad day. The same type of citation appearing in two or three consecutive inspections signals a facility that is unable or unwilling to fix the problem.
• Medicare payment denials. CMS can deny payment for new admissions — essentially banning a facility from accepting new Medicare patients. This is one of the most severe enforcement actions and indicates ongoing, unresolved deficiencies.

Green Flags That Signal Quality

It's just as important to recognize positive signals:

• Low deficiency count. Facilities with fewer than 5 deficiencies on their most recent standard survey are performing well above average. (The national average is approximately 8-9 deficiencies per survey.)
• High staffing ratios. Look for facilities that provide more than 4.0 total nursing hours per resident per day, with at least 0.75 RN hours. This is above the national average and correlates with better outcomes.
• Stable ownership. Facilities that have been under the same ownership for 5+ years tend to have more consistent care. Frequent ownership changes often precede quality declines.
• No fines or payment denials in the past 3 years. This means the facility hasn't had severe enough problems to trigger financial penalties.
• Above-average quality measures. Low rates of falls, pressure ulcers, UTIs, and antipsychotic use compared to state and national averages.

How to Read a Nursing Home Inspection Report

Full inspection reports (called "Statements of Deficiencies" or "2567 reports") are public documents available through Care Compare and state health department websites. They can run 50 to 200+ pages. Here's how to navigate them efficiently:

1. Start with the summary page. Look at the total number of deficiencies and their scope/severity codes. This gives you the big picture in 30 seconds.
2. Focus on G-level and above. Read the full narrative for any citation at severity G or higher. These describe actual harm to residents.
3. Look at the F-tag numbers. Each deficiency references an F-tag (like F684 — "Quality of Care") that identifies which federal regulation was violated. Common F-tags across multiple inspections reveal patterns.
4. Check the "Plan of Correction." The facility is required to submit a plan explaining how they'll fix each deficiency. Vague or generic plans ("staff will be retrained") are less reassuring than specific, measurable commitments.
5. Look at complaint investigations separately. Reports include both standard survey findings (routine inspections) and complaint investigation findings (triggered by specific complaints). Pay close attention to substantiated complaints — these mean someone reported a problem, the state investigated, and confirmed it.
6. Check the inspection date. More recent inspections are more relevant. If the most recent inspection was more than 18 months ago, the facility may be overdue for a new survey.

What to Do If You Find Violations

Finding violations doesn't necessarily mean a facility is dangerous — every nursing home in the country has some deficiencies. What matters is the severity, the frequency, and whether the facility corrects problems when they're found.

But if you find serious violations (severity G or above, abuse citations, or large fines), here's what you can do:

1. Contact your state's Long-Term Care Ombudsman. Ombudsman programs exist in every state to advocate for nursing home residents. They can provide context about specific facilities, help you understand inspection findings, and investigate complaints. Find yours at theconsumervoice.org or call the Eldercare Locator at 1-800-677-1116.
2. File a complaint. If you're witnessing problems in real time, you can file a complaint with your state survey agency. They're required to investigate. Read our full guide to reporting nursing home abuse →
3. Consider your legal options. If your loved one has been harmed, you may have grounds for a legal claim. Elder law attorneys typically offer free initial consultations and work on contingency (no upfront cost to you).

4. Look at alternatives. If you're still in the decision-making phase, use the violation records to narrow your choices. Compare the facilities on your list using NurseCheck's comparison tool. Home care may also be a viable option depending on your loved one's needs.
5. Ask the facility directly. Bring up specific findings during your tour. A transparent administration will acknowledge past issues and explain what they've changed. Defensiveness or denial is itself a red flag.

Frequently Asked Questions