Start from the constraints you already have
Location decides who can visit on a weekday and who can get there after a hospital discharge. Medicare coverage for a skilled stay, Medicaid eligibility, and a private rate are different payment paths, and the Provider Information file does not list a daily private-pay price. Ask the home what it charges, which payers it accepts, and whether a bed is open for the kind of stay you need: a short stay after a hospital visit, or a longer stay.
Clinical fit matters before stars do. A home that offers dialysis, a ventilator unit, or a memory-care unit is not interchangeable with one that does not, even when the stars match. The file records ownership type, whether the home is in a hospital, whether it is part of a continuing-care retirement community, and chain affiliation when CMS has a chain name. Those fields describe structure. They are not quality scores.
Read the four ratings, not only the overall star
The overall star starts from the health inspection rating and then moves, by the rules in the September 2026 Technical Users' Guide, if staffing or quality measures are at five stars or at one star. The star-rating guide states those steps. A home can carry five staffing stars and a weak inspection record, or the reverse. Look at health inspections, staffing, and quality measures on the facility page before you treat the overall number as the comparison.
Health inspection stars are assigned within the state. If you are choosing between two states, compare weighted inspection scores and the citations themselves, not only the star, and read the cut points on the state page. Staffing stars and quality-measure stars use national bands, so they travel more cleanly across state lines. State lists here are ordered by the published overall rating. That sort is a reading aid. CMS does not publish it as a ranking of the best homes.
Open the citations
The count of deficiencies is a rough size. The letters and the tags are the content. On the facility page, citations are grouped by survey date. Each row has a tag linked to the glossary, a scope and severity letter, and whether the survey was a standard inspection, a complaint, or an infection-control inspection.
- J, K, and L are immediate jeopardy. G, H, and I are actual harm that is not immediate jeopardy. A, B, and C contribute no points to the health inspection score.
- Complaint dates tell you that someone reported a concern and surveyors cited the home. They are not the same thing as a standard annual survey.
- A correction date, or a status of corrected or past non-compliance, is CMS's statement about that citation. It is worth asking the home what changed.
- A flag for informal dispute resolution means the citation is public and, until the dispute ends, CMS keeps it out of the star calculation.
Repeated tags are a pattern even when each one is in a lower severity letter. Infection prevention (F880), accident hazards (F689), food storage and preparation (F812), and care planning (F656) are among the tags with the most rows in this file. Frequency in the national file is not a judgment about a particular home. It tells you which requirements surveyors cite often, so you know what you are looking at when the same code appears on a record.
Read staffing next to the averages
The staffing guide explains hours per resident per day, the case-mix adjustment, and turnover. On a facility page, compare the home's reported hours with the state average and the U.S. average from the same release. Then look at weekend registered-nurse hours separately. Ask, when you visit, how many nurses and aides are on the evening shift and on Sunday, and how the home covers call-outs. The quarterly average will not answer that.
Turnover percentages near the national figure in this release are common, because the national nurse-turnover average itself is high. A figure far above the state average is a specific question for the administrator: whether the number reflects people leaving, agency staff cycling through, or an employee-identifier change that CMS tries to exclude but does not always catch. Footnotes on the page say when CMS suppressed or could not calculate the measure.
Fines and payment denials
The Penalties file lists civil money penalties and denials of payment for new admissions. A fine amount is the dollar figure CMS published for that penalty date. A denial has a start date and a number of days. The Provider Information file also carries totals for the window CMS uses in that file. Totals and individual rows can look different because they cover the periods CMS defined for each column. Neither one is a complete history of every enforcement action the state has ever taken under state licensure.
Icons that change how you read the stars
If the special-focus field is filled in, CMS has placed the home in a program for homes with a history of serious quality problems, and the star ratings are suppressed. Footnote 18 is the dictionary code. If the abuse icon is on, the September 2026 guide has capped the health inspection rating at two stars. The facility page states the citation pattern the guide uses for tags F600, F602, and F603. If the high-performing icon is on, CMS has applied the additional mark described in memorandum QSO-26-14-NH. If the file says the latest health inspection is more than two years old, the stars are resting on an older standard survey plus whatever complaint surveys came later. An ownership change in the twelve months before the processing date means the operator CMS recorded is new, while many of the citations may date from the previous owner. Ask what carried over.
Visit, and use the checklist Medicare already publishes
Medicare's Care Compare site includes a nursing home checklist for a visit. The public version asks families to look at cleanliness, odors, call-light response, how staff speak to residents, whether residents are dressed and engaged, how food is served, and whether residents and families describe the same building you are seeing. Use that checklist rather than a private scoring sheet. Go more than once if you can, including a weekend or an evening, because the staffing file itself treats weekends as a separate measure.
Talk with the director of nursing about the citations you actually saw: the tag, the date, and the severity letter. A precise question is easier to answer than a general request for reassurance. Ask to see the posted survey results. Federal rules require homes to make recent inspection results available to residents, which is also why tag F577 exists.
Who else will talk with you
Every state has a Long-Term Care Ombudsman program. Ombudsmen are advocates for residents. They are not the inspectors, and they are not employed by the home. The National Consumer Voice for Quality Long-Term Care keeps a directory at theconsumervoice.org/get-help. You can ask an ombudsman what families in that home have raised, without treating the conversation as a star rating.
The state survey agency is the office that inspects the home and takes complaints about care. CMS lists contact information for state survey agencies on its quality and safety oversight pages. A complaint to that office can produce a complaint investigation, which may later appear as citation rows in the Health Deficiencies file. State licensure findings are not always the same as the federal citations in this file.
Compare puts up to four homes side by side, or lists every home in a ZIP code or city from this file. Bring the citations and the weekend hours to the visit. Leave with the current answers from the people who work there.
Sources
- Medicare Care Compare, including the nursing home checklist linked from the nursing home resources.
- September 2026 Technical Users' Guide for stars, the abuse icon, Special Focus Facilities, and the high-performing icon.
- Long-Term Care Ombudsman directory, National Consumer Voice.
- CMS contact information for state survey agencies.
- CMS Provider Data Catalog, nursing homes, processing date September 1, 2026, released October 8, 2026.