How our data works

Our sources

Our nursing home reports use public Medicare records from the Centers for Medicare & Medicaid Services, or CMS. Nursing Home Reporter is an independent website. We are not a government agency.

Court opinions are presented separately from CMS records. An allegation, a published opinion, and an administrative fine are different kinds of records; none alone establishes that a particular resident has a legal claim.

Publisher and editorial approach

Nursing Home Reporter is published by Top Tier Legal LLC. Facility summaries combine imported government records with consistent explanations of ratings, rule codes, and dates. Our editorial score and keyword matches are separate from official CMS findings.

A government source link does not mean that CMS endorses our summaries. Family guides are informational resources; they are not individualized medical or legal advice.

If you notice an error, compare the CMS provider number and record dates with the original source. For website questions or corrections, email contact@toptier.legal. See our publisher and corrections process for what to include.

What the dates mean

Medicare file prepared

When Medicare prepared the file we use. Individual inspections and staffing records may be older than this date.

Our record last updated

When we added or refreshed a home’s record on this website. This does not mean Medicare inspected the home that day.

Inspection and penalty dates

When an inspection took place or a penalty was reported. These dates can differ from home to home.

Dates covered by staff hours

Staff hours are averages over a period of time. Our source does not give that period for each number. The file date and our update date do not tell you when those hours were worked.

We refresh public extracts periodically. Coverage counts describe available imported records in the 50 states and Washington, DC. CMS nursing home files concern Medicare- and Medicaid-certified facilities, not every assisted living or senior housing community. Check the original CMS record for the latest information.

Medicare ratings and warnings

Medicare rates homes from one to five stars. Five is the highest rating. There is one overall rating and separate ratings for inspections, nursing staff, and health and care results. These ratings come from records, not family reviews.

An abuse warning means Medicare flagged the home under its abuse rules. Extra oversight means the home is in, or being considered for, a program for homes with repeated quality problems. Being a candidate is different from being in that program. An infection-control warning means inspectors found an infection-control problem in the records we have.

A missing icon does not guarantee that a home is safe. A warning does not establish what happened to a particular resident. Read the dates, findings, and severity of the underlying citations.

Read CMS’s Five-Star Quality Rating System explanation ↗

What we add to the records

We explain technical terms, group problems by inspection date, and add up reported problems and fines. These totals cover the records we have. They do not cover every event in a home’s history. A reported fine may not have been paid.

Our summary text and “neglect signals” are editorial indicators for further review. They are not CMS ratings, medical conclusions, or findings of liability. Lower-rated lists use overall ratings of two stars or fewer where that filter is stated.

How local inspection record searches work

Injury topic pages search the imported health inspection records for active local homes. Regulatory codes are matched exactly, including CMS codes with a leading zero. Wandering and elopement searches require those specific terms in the rule description or category rather than a general supervision code. We require a valid inspection date and a readable rule summary, and show the number of homes checked so readers can follow the evidence.

These searches are not medical diagnoses or lists of confirmed injuries. F689 covers accident hazards and supervision; a match does not establish a fall or elopement. The imported descriptions are CMS rule summaries, not detailed incident narratives. We do not build wrongful-death facility lists from inspection records. No match means only that no qualifying dated finding was found in the searched records. Read the full inspection and resident records before drawing conclusions.

Local topic pages without supporting dated records remain available for research but are excluded from our sitemap and marked not to appear in search results. A city having a nursing home is not, by itself, enough to support every injury topic. The same evidence rules control sitemap eligibility and the page’s search-indexing instructions.

How to compare homes fairly

We point out differences in overall and nursing staff ratings when all the homes have those ratings in the same dated Medicare file. Inspections can still have happened at different times. We show staff hours, problem counts, and fines so you can ask questions. We do not choose a winner from those numbers because their dates may differ.

Staff hours are an average, not a promise of one-to-one care. Larger homes and homes with more inspections may have different totals. Read the reports, ask questions, and visit homes you are considering.

What “zero” and “unavailable” mean

Zero means our record gives a count or amount of zero. “Unavailable” means we do not have a usable number or date. Neither tells you that a home has never had a problem. Medicare records may arrive late, leave things out, or change after we copy them.

If you spot a discrepancy, follow the source link on the report card and compare the facility’s CMS provider number, source dates, and inspection records.