How Nursing Home Ratings Work

NursingHomeGrade turns public CMS staffing, inspection and quality evidence into an A–F grade when the evidence is sufficient. It also tells you when data are partial — and withholds the grade entirely when current inspection evidence is missing rather than pretending missing means clean.

How the A–F grade is calculated

Each sufficiently documented facility starts with a 0–100 base score built from four CMS measures:

RN Staffing (35%) Reported RN hours per resident per day compared with the 2024 benchmark of 0.55 hours. The federal rule that created this benchmark was repealed in February 2026; we retain the value as a disclosed grading benchmark, not as a current legal minimum.

Inspection Record (30%) Number of health deficiencies CMS records for the most recent rating cycle. A verified zero-deficiency survey receives full base-score credit; missing inspection evidence never does.

Quality Measures (20%) CMS quality-measure star rating, normalized from one to five stars.

Staffing Rating (15%) CMS staffing star rating, normalized from one to five stars.

What happens when CMS data are missing

We classify each grade by evidence completeness before publishing it:

Complete: all Grade 1.x score inputs and the current inspection evidence are present.
Partial: current inspection evidence is present, but RN staffing, the CMS quality rating, or the CMS staffing rating is unavailable. The missing component earns no points and we do not inflate the remaining components to fill the gap. The displayed score is therefore a conservative lower bound.
Insufficient / Not rated: the current inspection evidence needed to tell a real zero-deficiency survey from missing data is unavailable. We withhold the NursingHomeGrade score and letter.

Missing evidence can never improve a grade. That is the core rule.

Safety penalties are applied after the base score

The weighted base score is not necessarily the final score. We then apply two penalty terms from the CMS Health Deficiencies file:

Unresolved findings: up to 25 points can be deducted for deficiencies that CMS still records as uncorrected. More severe and more recent findings receive larger penalties, and a finding with no correction plan is weighted more heavily than one with a plan awaiting verification.
Actual harm: up to another 25 points can be deducted for scope/severity G–L findings. Immediate-jeopardy findings (J–L) carry a larger penalty than G–I findings.

No-plan rule: if CMS records any deficiency with no plan of correction, the facility cannot receive an A even if its numeric score remains 80 or higher. Its letter grade is capped at B.

For the exact arithmetic, missing-data behavior, recency weights, severity weights and changelog, see the full methodology.

What the letter grades mean

The letter is a band applied to the final score after applicable penalties. It is a composite result, not a promise that every individual metric is equally strong.

AFinal score 80–100, with no active no-plan cap.

BFinal score 65–79, or a score of 80+ capped because CMS records a deficiency with no plan of correction.

CFinal score 50–64 after applicable penalties.

DFinal score 35–49 after applicable penalties.

FFinal score 0–34 after applicable penalties.

NRNot rated because critical current inspection evidence is insufficient.

Where the data comes from

All underlying evidence comes from public CMS nursing-home datasets. NursingHomeGrade does not alter the CMS source records; our grade is a reproducible calculation over those records. See data sources for the exact files and release dates currently in production.

What Grade 2.0 adds

Grade 2.0 is being built in shadow mode from lower-level federal evidence: Survey Summary inspection records, richer case-mix-adjusted staffing measures, measure-level MDS outcomes and Medicare claims outcomes. Those sources do not change the public grade until the new model has been backtested and its migration reviewed.

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