Our data source
Every score on Care Safety Check is derived from the CMS Care Compare database, maintained by the U.S. Centers for Medicare & Medicaid Services. This is the same data the federal government uses to regulate nursing homes. It is public record, updated monthly, and covers all Medicare- and Medicaid-certified nursing homes in the United States — approximately 15,000 facilities nationwide, including 527+ across Maryland, Virginia, and Washington DC.
We do not accept data from facilities directly, and we do not accept payment from facilities to influence their scores. All source data is linked on every report so you can verify it yourself.
The Care Safety Signal™ score
The Care Safety Signal™ is a 100-point weighted score that translates public inspection, staffing, complaint, and enforcement data into a clear risk signal. It is an independent summary of publicly available federal data — not a government rating, medical advice, or endorsement of any facility. Four components combine to produce the score:
Inspection history (30%)
Measures how the facility performed during health inspections. Looks at the total weighted CMS health survey score and the CMS health inspection star rating. Inspectors review care practices, resident safety, medication handling, infection control, and facility operations. Higher penalties and lower CMS star ratings produce a lower component score.
Violation & penalty record (25%)
Looks at formal enforcement actions beyond citations — civil money penalties, number of fines, total fine dollar amounts, payment denials, and active Special Focus Facility status. This component captures problems serious enough to trigger financial penalties or the federal government's highest-concern designation.
Staffing (25%)
Measures whether the facility has enough consistent care staff. Looks at RN hours per resident day and total nurse staffing hours per resident day, compared to national averages. Staffing is one of the strongest independent predictors of resident outcomes in peer-reviewed research.
Complaint history (20%)
Looks at real-world concerns raised outside routine inspections — complaint deficiencies across inspection cycles, infection control citations, and abuse or neglect complaint flags. Complaint activity often surfaces problems that routine inspections miss between visits.
Safety override rules
Certain serious findings place hard caps on the maximum possible score, regardless of other metrics:
| Finding | Maximum score |
|---|---|
| Immediate Jeopardy in last 12 months | 45 |
| Multiple actual-harm findings in 24 months | 55 |
| Abuse or neglect citation in last 24 months | 50 |
| Same deficiency category cited 3+ times | 65 |
| Severe staffing shortage | 60 |
| Active Special Focus Facility status | 40 |
These rules exist because a facility should not receive a high safety score if it has recent serious harm, abuse, or repeat safety problems — even if other metrics look acceptable.
Score bands
| Score | Label | What it means |
|---|---|---|
| 85–100 | Low apparent risk | Public record shows no major safety flags |
| 70–84 | Generally favorable | No serious flags; some items worth reviewing |
| 55–69 | Meaningful issues | Public record has notable issues to investigate |
| 40–54 | Serious concerns | Serious or repeated issues in public record |
| 0–39 | Critical — major unresolved | Major recent or unresolved safety findings |
The Care Safety Signal™ is expressed as a 0–100 score mapped to five signal levels as described above. Across all 527 facilities in our coverage area, approximately 18% fall in the 'Serious concerns' band or below.
What our scores do not tell you
We are explicit about the limits of this data because we believe honesty is more useful than false confidence.
CMS data reflects what surveyors found during official visits — not everything that happens in a facility. Inspections are announced in some states and may not capture day-to-day conditions. Facilities with strong relationships with their state survey agency may receive more lenient citations than facilities in states with aggressive enforcement. A high score means the public record is clean; it does not mean the facility is perfect.
Our scores also do not capture: staff turnover rates (not publicly reported at the facility level), the quality of end-of-life care, family satisfaction surveys, or the culture and responsiveness of management. We strongly recommend visiting any facility in person and asking the questions listed in each report.
Data freshness
CMS updates the Care Compare database monthly, typically in the first week of the month. We update our scores within 72 hours of each CMS release. Every report shows the date of the most recent CMS update and the date of the facility's last inspection. If a facility has not been inspected in more than 15 months, we display a data staleness warning.
Corrections and disputes
If you are a facility operator and believe your CMS data contains an error, the correct path is to work directly with your state survey agency or CMS to correct the underlying record — we cannot change what the government reports. Once the CMS database is corrected, our scores update automatically on the next monthly refresh.
If you believe we have made an error in how we calculated or displayed your score, contact us at our contact page and we will review it within 5 business days.
Independence and funding
Care Safety Check is an independent publication. We do not accept placement referral fees, sponsored listings, or any payment from care facilities. Our scores are calculated solely from public CMS data and are not influenced by any commercial relationship.
Revenue comes from two sources: a one-time fee for downloadable PDF facility reports, and Google AdSense display ads on informational guide pages (never on individual facility score pages). See our About page for full details on our advertising policy.