How to read nursing home inspection citations

State inspectors visit every certified nursing home for a full standard inspection about once a year. The federal rule is that no home can go more than 15 months between inspections, and the statewide average can't exceed 12 months. Inspectors also come out to investigate complaints. Every problem they find becomes a deficiency, or citation, tied to a specific federal requirement.

The letters A through L

Each citation gets one letter. It combines how serious the problem was with how many residents it affected or could have affected:

How serious	One or a few residents	A pattern	Widespread
Immediate jeopardy to health or safety	J	K	L
Actual harm	G	H	I
No actual harm, but could cause more than minimal harm	D	E	F
No actual harm, could cause minimal harm	A	B	C

What we'd pay attention to

Anything from G to L. A resident was actually hurt or put in immediate danger. Read the description and ask the administrator what happened and what changed afterward.

The same problem coming back. One infection control citation is common. Infection control on every inspection for three years tells you something about how the place is run.

Complaint citations. These come from investigations started by residents, families or staff, so they often point to problems people living there actually noticed.

How long fixes took. Homes have to submit a plan of correction. A long gap before something was corrected is fair to ask about.

Don't panic over a long list

Almost every home gets cited for something, and D is by far the most common letter. Compare a home's count with the state average shown on its page here, look at the severity, and remember that a strong administrator can turn things around. Ask what has changed since the last inspection.