According to a report from The Senior List, nearly 15,000 nursing homes that provide care for over 1.2 million individuals nationwide are certified under Medicare or Medicaid.

Admitting a family member to a nursing care facility is a challenging task. This decision is important since it involves trusting the facility and its staff to meet the needs of a family member. It can be devastating for the next of kin to learn that any nursing home resident has suffered negligence or maltreatment. According to AARP, nursing homes in the U.S. received more than 7,600 citations for abuse, neglect, or exploitation of residents in 2023.

Records pertaining to nursing home inspections help people choose the right nursing home. Knowing the basics of how these inspections run helps people better understand the notes they see in a facility’s history.

How the Inspection System Works Nationally

Nursing homes that take Medicare or Medicaid, which pay for care in most places, must be inspected without prior notice. State survey agencies do these visits for the federal Centers for Medicare and Medicaid Services.

The inspections usually occur about once each year and normally last for several days. A survey team checks many parts of care. They review resident charts, watch care staff at work. They look at how medicines are handled. And also check infection control steps. Surveyors talk with staff members and with residents. The facility does not receive advance notice to see what daily operations look like in real time. It is not meant to reflect the setting only after staff have prepared for visitors.

If there are problems identified, the evaluations are narrated in terms of ‘deficiencies.’ Every deficiency is assigned a score range based on the degree of scope and significance. Scope reflects how many residents were affected. Severity runs from small problems to immediate jeopardy. Immediate jeopardy is used when something caused, or could cause, serious harm or death.

How Inspection Results Become a Public Rating

The inspection results get used in Care Compare. This system is designed to provide the rating to every licensed Medicare and Medicaid-certified nursing home in the United States on the basis of one to five stars. The score constitutes a range of factors like health inspections, staff, and quality of medical care. Many people consider the health inspection part the strongest. It comes from independent, on-site surveys and does not rely on data a facility reports about itself. It also tends to matter the most for the final star rating.

Star ratings and inspection records are useful starting points, but they rarely answer every question a family has, especially when a placement decision overlaps with financial or legal planning. For families in Idaho, for instance, an elder law attorney from Boise can help connect a facility’s inspection history to broader considerations like Medicaid eligibility and guardianship.

Should a nursing home consistently exhibit severe conditions, then it may be classified as a Special Focus Facility. A facility under this label gets more frequent inspections. It also gets closer monitoring. Families can look for this designation when they want a clearer sign of past problems. It can point to a long pattern of substandard care, not just one bad visit.

How State-Level Inspection Processes Actually Run

The federal rules set the baseline, and state agencies handle the inspection work each day. Looking at one state can show families what they usually see. 

In Georgia, the Department of Community Health, through its Healthcare Facility Regulation section, runs unannounced surveys. Inspectors review resident rights and how care is delivered. They also look at infection control, food and fluids, medication handling, staffing numbers, and the overall upkeep of the building. If inspectors find problems, the facility gets a written report. It can reply and try to resolve the issues. Then follow-up visits are planned to verify that fixes were made.

Keep in mind that no written deficiencies do not always mean everything was fine. Nursing home inspections can overlook concerns, especially when neglect is not clear from paperwork. For that reason, a facility’s inspection history should be used as one piece of information when a family makes a choice. It should not be the only factor.

Using Inspection History as Part of a Broader Decision

Inspection reports and star ratings can help, but they usually fit better with other details. A facility’s overall rating summarizes a lot of complex information into a single number. Two different nursing homes may be awarded the same general rating, but their related scores will still be influenced by certain factors.

Families must not only assess a facility’s documentation dedicated to inspections but also understand whether there is any Special Focus Facility designation and examine the main reasons for the deficiencies in the reports. This method is more accurate in choosing a facility rather than relying entirely on the star rating.

Why This Matters Even After a Loved One Is Already Placed

Reviewing inspection history isn’t only useful before choosing a facility. Families benefit from periodically checking the current rating and recent inspection reports of the nursing home where their loved one resides, as ratings and deficiency histories change over time. A facility that previously scored well can have declining ratings. Staying informed about a facility’s ongoing inspection record is one of the more practical ways a family can continue advocating for a loved one’s care long after the initial placement decision has been made.