How we grade
The whole formula, in public. Every input is a published CMS field, every weight is listed below, and every facility profile shows its own arithmetic so you can check ours.
The five components
A home starts from 100 points spread across five components. Points are deducted, not awarded, in the two components where the federal record shows something went wrong.
Inspection safety
30 ptsCitations from the last three years of state health inspections, weighted by how much harm CMS says they caused. An immediate-jeopardy finding costs far more than a documentation slip, and total citation volume is compared against the national median rather than a fixed threshold.
Staffing
30 ptsTotal nursing hours per resident per day, adjusted for how sick the residents actually are, scored against national percentiles. RN hours and weekend consistency are scored separately, because a good weekday average can hide a thin Sunday.
Staff stability
15 ptsThe share of nursing staff who left over the last year, plus administrator departures. Continuity is care: a caregiver who knows a resident notices when something is wrong.
Resident outcomes
15 ptsThe CMS quality-measure rating, built from clinical outcomes such as pressure ulcers, falls with injury, infections and antipsychotic use.
Enforcement history
10 ptsFederal fines and denials of payment. A payment denial means CMS stopped paying for new admissions — a serious step regulators do not take lightly.
Findings that cap a grade outright
Some things should not be averaged away by good staffing. These are hard ceilings, applied after the points are totalled:
-
Special Focus Facility → capped at 54 (grade D)
CMS placed the home in its programme for persistently poor care.
-
Abuse icon on record → capped at 64 (grade C)
CMS flags the home for citations of abuse that harmed residents, or had potential to.
-
Immediate jeopardy in the last 3 years → capped at 64 (grade C)
Inspectors found a failure likely to cause serious injury, harm or death.
The letter bands
| Grade | Score | Meaning | Homes | Share |
|---|---|---|---|---|
| A | 85+ | Excellent | 1,915 | 13.1% |
| B | 70+ | Above average | 4,779 | 32.6% |
| C | 55+ | Average | 4,249 | 29% |
| D | 40+ | Below average | 2,139 | 14.6% |
| F | 0+ | Poor | 1,564 | 10.7% |
Note the shape: most homes land at B or C. A grading system where everyone gets an A tells you nothing, and one where everyone fails is just as useless.
The benchmarks, recomputed each release
Staffing thresholds are not hard-coded. They are percentiles of the current national population, so the curve moves when CMS republishes rather than drifting out of date.
| Staffing p25 | 3.27 |
| Staffing p50 | 3.77 |
| Staffing p75 | 4.43 |
| Staffing p90 | 5.23 |
| Rn p50 | 0.58 |
| Rn p75 | 0.81 |
| Deficiency median | 17 |
When we refuse to grade
47 of the 14,693 facilities on this site carry no grade. Those homes have neither a staffing report nor an inspection rating in the current CMS release. We could put a plausible-looking C on them. We do not, because a family making a decision deserves to know the difference between "average" and "we do not know".
What this grade is not
- — It is not a substitute for visiting. Data cannot tell you how a place smells at 6pm on a Sunday.
- — It is not current to the day. CMS republishes on a cycle; a home that changed hands last month may not yet look different here.
- — It is not medical, legal or financial advice.
- — It is not for sale. No facility, chain or placement agency pays us anything, and none can change a grade.