What do the letters A through L mean on a nursing home inspection?

They are CMS scope and severity codes. Severity runs from potential for minimal harm (A–C) to potential for more than minimal harm (D–F), actual harm (G–I) and immediate jeopardy to resident health or safety (J–L). Within each row, the first letter means isolated, the second a pattern, and the third widespread.

How does CMS turn inspections into a star rating?

CMS scores citations from the two most recent standard inspections plus three years of complaint and infection control inspections, weighting by scope and severity and weighting the most recent standard inspection at 3/4 and the prior one at 1/4. Stars are relative within each state: the top 10% get five stars and the bottom 20% get one star.

Home › How to read an inspection report

How to read a nursing home inspection report

Every Medicare- and Medicaid-certified nursing home gets an unannounced standard inspection, on average once a year. A team of health care professionals spends several days there checking it against federal requirements. They look at resident rights, quality of life, medication management, skin care, resident assessment, administration, environment and kitchen/food service. Complaints and focused infection control surveys bring extra inspections. Every problem the team finds becomes a citation (also called a deficiency).

Source: CMS Five-Star Technical Users’ Guide: www.cms.gov · last checked October 24, 2026

1. The tag: what rule was broken

Each citation has a tag number. On this site, health inspection tags start with F (for example F-0689, accidents and supervision). Fire and life safety tags start with K (building and fire code) or E (emergency preparedness). CMS publishes a short description and a category for each one, such as “Quality of Life and Care Deficiencies.” Each facility page shows those descriptions.

Source: CMS Health Deficiencies dataset: data.cms.gov · data as of September 1, 2026 · last checked October 24, 2026

2. The letter: how serious and how widespread

The scope/severity code is the most important part. Severity runs from top to bottom: four levels, from immediate jeopardy down to potential for minimal harm. Scope runs left to right: isolated, pattern, or widespread. The points are what CMS adds to the facility’s health inspection score; a higher score means a worse rating.

Severity	Isolated	Pattern	Widespread
Immediate jeopardy to resident health or safety	J 50 (75 if substandard quality of care) points	K 100 (125 if substandard quality of care) points	L 150 (175 if substandard quality of care) points
Actual harm that is not immediate jeopardy	G 20 points	H 35 (40 if substandard quality of care) points	I 45 (50 if substandard quality of care) points
No actual harm, potential for more than minimal harm	D 4 points	E 8 points	F 16 (20 if substandard quality of care) points
No actual harm, potential for minimal harm	A 0 points	B 0 points	C 0 points

Higher points in parentheses apply when the citation counts as “substandard quality of care.” If an immediate jeopardy citation is marked past non-compliance, CMS scores it like a G (20 points).

Source: CMS Technical Users’ Guide, Table 1: www.cms.gov · last checked October 24, 2026

What to focus on: any G through L citation means inspectors found residents actually harmed or in immediate jeopardy. D–F citations are the most common. Look at what was cited and whether the same tag keeps coming back across inspections.

3. Where the citation came from

Standard: the routine annual-on-average inspection.
Complaint: an inspection triggered by a complaint. CMS counts three years of complaint citations in the rating.
Infection control: a focused infection control survey. CMS also counts three years of these.

One visit can be more than one type, so a citation can be flagged both standard and complaint.

4. Status and correction

CMS lists a status and, where there is one, a correction date for each citation. Common statuses in the data include “Deficient, Provider has date of correction,” “Past Non-Compliance,” “Deficient, Provider has plan of correction” and “Deficient, Provider has no plan of correction.” Some citations are under dispute through Informal Dispute Resolution (IDR) or Independent IDR. CMS displays them on Care Compare but leaves them out of the health inspection rating. Results from a home’s third most recent standard inspection are also displayed but not rated.

Source: CMS Technical Users’ Guide: www.cms.gov · last checked October 24, 2026

5. How inspections become stars

CMS scores the two most recent standard inspections. The most recent counts for 3/4 and the one before for 1/4. Three years of complaint and infection control citations are added, plus points for repeat revisits needed to confirm fixes.
Ratings are relative within each state: the top 10% of homes get five stars, the bottom 20% get one star, and the middle 70% split evenly across two, three and four stars. A 3-star home in one state is not directly comparable to a 3-star home in another.
Fire safety (K and E tags) is not part of the health inspection rating.
Current Special Focus Facility participants are not star-rated at all. Care Compare shows a warning sign instead.

CMS itself cautions that the star ratings are one tool and recommends visiting the home and using other sources too.

Source: CMS Five-Star Quality Rating System: www.cms.gov · last checked October 24, 2026

6. Get the full report

The CMS data files on this site have the tag, severity and dates, but not the inspectors’ written findings. To read the narrative (what inspectors saw, which resident, what the facility promised to fix), open the facility on Medicare Care Compare and view its inspection reports, or ask the facility for its most recent report and plan of correction. For assisted living, which CMS does not inspect, see your state: Louisiana, Texas, Florida, Georgia.