10,187 Chain-Owned Nursing Homes in the United States
10,187 of the 14,697 Medicare-certified nursing homes in the United States (69%) are chain-owned, and all are listed below. 1307 of the 10167 graded homes earn an A and 743 earn a D or F. They average 3.7 nursing hours per resident per day, 0.16 hours below the 3.86 for every home in the United States. Deerfield Health Care Center in Urbandale grades highest at A (100 out of 100).
How chain-owned homes in the United States compare
This group set against every nursing home in the United States, from the current CMS release.
Avantara Milbank runs on thin staffing even before the weekends hit. At 3.23 nurse hours per resident day, it sits roughly 16% under the national average, and weekend coverage drops another 9% below its own weekday level, so the thinnest shifts are also the least supervised. The bigger warning sign is turnover: 91.5% annually, double the national rate, meaning most of the people caring for residents weren't there a year ago. Its inspection record shows 30 deficiencies, including 8 at harm or jeopardy level and 5 tied to abuse, plus three fines totaling $55,361. The most recent inspection was March 2025. For-profit corporate ownership, 55 beds, and a pattern of problems that keep recurring rather than resolving.
Avantara Norton runs 110 certified beds under for-profit limited liability ownership, and its nurse staffing sits right at the national average of 3.86 hours per resident day, essentially no cushion. Weekends drop about 10% below its own weekday coverage, so the thinnest shifts are when families tend to visit. What stands out more is the inspection record: 75 deficiencies, 19 of them at harm or jeopardy level, 5 abuse-related, plus six CMS fines totaling $153,638. Staff turnover is 55.7% against a 45.8% national average, meaning more than half the nursing staff leaves each year. CMS has placed this home in its Special Focus Facility program, a designation reserved for homes with a persistent record of serious problems.
Avantara Watertown is a 51-bed for-profit home, and the numbers that stand out most are on the inspection side. CMS has it in its Special Focus Facility program, a designation reserved for homes with a persistent record of serious problems, and the current file shows 31 deficiencies, including four at the harm or jeopardy level and three tied to abuse. A single CMS fine of $6,368 sits on the record, and the most recent inspection was April 29, 2026. Nurse staffing runs 3.57 hours per resident day, about 8% under the national average, and weekends drop roughly 20% below the home's own weekday levels. Staff turnover, at 44.2%, is close to the national figure, so retention isn't the outlier here. The inspection record is.
Riverview Healthcare Center is a 63-bed for-profit home in Flandreau, and the numbers behind its record deserve a hard look. Nurse staffing sits at 3.62 hours per resident per day, about 6% under the national average, and it thins out further on weekends, roughly 12% below the home's own weekday levels. Annual turnover runs 66.7% against a national 45.8%, so caregivers are cycling through constantly.
That instability shows up in the inspection record: 35 deficiencies, 14 at harm or jeopardy level, 10 abuse-related, and six fines totaling $176,867. CMS has placed it in the Special Focus Facility program, the agency's watchlist for homes with persistent serious problems. If you're considering this one, ask pointed questions about what's changed since the February 2025 inspection.
Lyonsview runs 222 certified beds in Knox County, and the numbers there deserve a hard look before you sign anything. Nurse staffing sits at 3.55 hours per resident per day, roughly 8% under the national figure, and weekends drop about 9% below what the home manages on weekdays, so the thinnest coverage lands exactly when families tend to visit. Staff turnover is 59.4% against a 45.8% national average, which means more than half the caregivers you'd meet are likely gone within a year. The current record shows 18 deficiencies, 8 serious enough to involve harm or jeopardy, 4 tied to abuse, and CMS has placed the home in its Special Focus Facility program.
Spring Gate runs 206 beds in Memphis under for-profit LLC ownership, and its last inspection was in October 2024. The raw staffing number looks fine, 3.95 nurse hours per resident day, just above the national average, but that figure hides two problems: weekend coverage drops about 13% below the home's own weekday level, and annual turnover sits at 67.5% against a national 45.8%, meaning most of the people providing that care are new or on their way out. The inspection record is where it gets serious: 37 deficiencies, three at harm or jeopardy level, two tied to abuse, and $128,974 in fines. Quality measures score well, but a 1-star inspection rating and 2-star staffing tell you where to look first.
Church Hill Post-Acute and Rehabilitation Center carries 35 deficiencies on its current record, and 12 of those rose to the level of actual harm or jeopardy, a count that should stop you before anything else. Six are abuse-related, and CMS has placed the home in its Special Focus Facility program, which is reserved for the homes with the most persistent problems. Nurse staffing sits at 3.51 hours per resident day, roughly 9% under the national average, and weekends run about 12% below the home's own weekday level. Staff turnover is 52.4%, well above the 45.8% national figure. One fine on record totals $250,780. The last inspection was February 12, 2026.
Nursing aides and nurses here give each resident about 2.96 hours of care a day, and the national average is 3.86, so this home runs roughly a quarter leaner than most. That shortfall shows up worse on weekends, when staffing drops about 15% below its own weekday level, and nearly six in ten staff left over the past year against a national rate closer to 46%. The inspection record is the harder read: 35 deficiencies, seven serious enough to put residents in harm's way, three tied to abuse, and one $205,329 fine. CMS flags it as a Special Focus Facility, meaning it's on a watch list for homes with a pattern of poor care. Its last inspection was September 2023.
Eaton Creek Post Acute has more direct-care nursing hours than most homes, 5.04 per resident day against a national average of 3.86, and it holds that level through the weekend, which many places don't. The problems sit elsewhere. Thirty-five deficiencies are on the current record, twelve of them serious enough to put residents in harm's way and five tied to abuse, with $122,242 in federal fines across three cases. Staff turnover runs 52.9% a year, above the 45.8% norm, and CMS has placed the home in its Special Focus Facility program, a designation reserved for the most persistent poor performers. The last inspection was August 30, 2023.
Rainbow Rehab And Healthcare runs 115 certified beds in Bartlett under for-profit limited liability ownership. Nurse staffing sits at 3.41 hours per resident day, roughly 12 percent under the national average, and weekends drop about 17 percent below the home's own weekday coverage, so the thinnest shifts land when families tend to visit. Turnover is 43.7 percent, slightly better than the national 45.8 percent, and the current record shows seven deficiencies with none at harm or jeopardy level and no abuse findings. What stands out is timing: the last inspection was June 30, 2022, meaning the two-year-old findings behind that 2/5 inspection rating may not reflect how the building runs today.
Beech Tree runs 3.29 nursing hours per resident per day, roughly 15% under the national average, with weekends even thinner than weekdays. The inspection record is the harder problem: 23 deficiencies, eight of them at harm or jeopardy level and five tied to abuse, plus a $138,802 fine. That combination landed it in CMS's Special Focus Facility program, a designation reserved for the homes regulators watch most closely. Staff turnover, at 44.7%, is actually a hair better than average, so the trouble looks less like a retention crisis than a home that hasn't fixed the practices inspectors keep flagging since its April 2024 visit.
Avir At Longview runs on a hospital district's license with 115 certified beds, and the staffing numbers are the first thing to notice: 3.56 nurse hours per resident day, roughly 8% under the national average, with weekends dropping about 9% below its own weekday level. Staff turnover sits at 73.3% against a national 45.8%, which means the people caring for residents are, more often than not, new to the building. The inspection record backs that up, 55 deficiencies, 8 of them at harm or jeopardy level, 5 tied to abuse, and two fines totaling $262,731. The most recent inspection was May 2025. If you're considering this one, ask hard questions about who's actually on the floor on a Sunday.
Afton Oaks is a 169-bed for-profit home in Houston that CMS has placed in its Special Focus Facility program, a designation reserved for homes with a persistent record of serious problems. The numbers back that up: 37 deficiencies on the current record, 16 of them at the harm or jeopardy level and 5 tied to abuse, plus four fines totaling $115,512. Nurse staffing runs about 7% below the national average, and weekends drop roughly 8% below the home's own weekday levels, when residents still need care. Its last inspection was in April 2025. If you're considering this one, ask directly what's changed since CMS flagged it.
Town And Country runs on thinner nursing coverage than most homes, 3.33 hours per resident day against a national average of 3.86, with weekends dipping about 10% below its own weekday levels. That shortfall shows up in the federal staffing rating, which sits at the bottom of the scale, and in an annual turnover rate of 65.9% compared with 45.8% nationally: roughly two of every three caregivers left within the year.
The inspection record carries 57 deficiencies, including three at the harm or jeopardy level and five tied to abuse, with $150,922 in fines. A 4/5 quality measure score and a May 2025 inspection are the brighter spots, but they sit alongside a 2/5 inspection rating and government hospital-district ownership.
Kennedy Health & Rehab has been flagged for CMS's Special Focus Facility program, which is reserved for homes with a persistent record of serious problems. The inspection history backs that up: 49 deficiencies on the current record, including 10 at the harm or jeopardy level and 8 tied to abuse. Federal fines total $268,507 across four penalties.
Staffing sits at one star, and so do the health inspection and quality measure ratings, all three below what you'd want to see. This is a 145-bed for-profit home owned by an individual, most recently inspected in June 2025. If you're considering it for someone you love, the pattern here is consistent and serious, not a one-time slip.
Arlington Residence and Rehabilitation Center runs 118 certified beds under corporate ownership, and the staffing numbers tell you a lot before you even get to inspections. At 3.12 nurse hours per resident day, it sits about 19 percent under the national average of 3.86, and weekends dip another 8 percent below its own weekday levels, so coverage thins out exactly when families tend to visit. Turnover is 46 percent, roughly in line with the national 45.8. The inspection record is where it gets heavier: 57 deficiencies, including 4 at harm or jeopardy level and 6 tied to abuse, plus six fines totaling $111,622. Its most recent inspection was February 2025.
Deer Creek runs about 30% below the national average on nurse staffing, 2.69 hours per resident day against 3.86, and weekends dip another 13% below its own weekday level. That thin coverage shows up on the inspection side too: 35 deficiencies on the current record, 6 of them at the harm or jeopardy level, plus 2 abuse-related findings and $75,581 in fines across 4 citations. Staff turnover sits at 56.1%, well above the 45.8% national figure, which matters most when residents need consistent hands on deck. The last inspection was recent, so the picture is current, and the ownership is a for-profit corporation.
Avir At Lubbock runs on 3.39 nursing hours per resident per day, about 12% under the national average, and weekends dip another 6% below its own weekdays, so the thinnest coverage lands when families visit most. Annual turnover sits at 70% against a national 45.8%, meaning most of the people caring for residents this year likely won't be there next year. The inspection record is where it gets serious: 63 deficiencies, 7 at harm or jeopardy level, 10 abuse-related, four fines totaling $69,307, and CMS has placed the home in its Special Focus Facility program. A 4/5 quality measure score can't offset a 1/5 inspection rating and staffing this thin.
Mission At Alpine Rehabilitation Center is a 52-bed nonprofit home in Pleasant Grove that federal regulators have placed in the Special Focus Facility program, the designation CMS reserves for the homes it considers among the poorest performers in the country. The inspection record explains why: 44 deficiencies, eight serious enough to cause harm or jeopardy, seven tied to abuse, and $125,737 in fines across two actions. Staffing sits at 3.13 nurse hours per resident day, roughly 19% under the national average, with weekends about 12% thinner than weekdays and turnover at 65.1% against a national 45.8%. The quality measure stars look strong, but that's what families see on paper; the staffing and inspection numbers are what happen on the floor.
Provo Rehabilitation and Nursing runs 220 certified beds under corporate ownership, and its staffing sits at 3.88 nurse hours per resident day, essentially the national average, though weekends drop about 11% below its own weekday level. The bigger issue is what inspectors keep finding: 75 deficiencies on the current record, 27 of them at harm or jeopardy level and 12 tied to abuse, with two fines totaling $82,617. Staff turnover hits 54.5% against a national 45.8%, and CMS has placed the home in its Special Focus Facility program, a designation reserved for homes with a persistent pattern of poor care. A 1/5 inspection rating and a last visit in October 2024 tell you the oversight is ongoing.
Frequently asked questions
How many chain-owned nursing homes are there in the United States?
There are 10,187 chain-owned Medicare-certified nursing homes in the United States, 69% of the 14,697 nursing homes there.
Are chain-owned nursing homes better staffed?
In the United States they average 3.7 total nursing hours per resident per day, against 3.86 for all nursing homes in the United States, a difference of -0.16 hours. Staff turnover averages 46.8% against 45.8%.
Which chain-owned nursing home grades best in the United States?