About the Ratings & Data Sources

About the Ratings & Data Sources

Cal Long Term Care Compare is a valuable resource when seeking information about the quality of care at skilled nursing facilities (SNF), home health agencies, and hospice agencies and types of care at assisted living facilities, continuing care retirement communities, and adult day health centers. We obtain and analyze data from multiple state and federal sources to provide as much information as possible about how well these California providers are performing.  When appropriate, the website provides performance ratings for specific measures. These ratings can assist consumers with evaluating the quality of care offered. When possible, quality measures have been “risk-adjusted” to enable fair and accurate comparisons between facilities; we account for factors like SNF or agency size and complexity of care provided to individuals. Cal Long Term Care Compare ratings rely on the accuracy of publicly available state and federal data. You can also refer to the CMS ratings and learn more about the provider data at Medicare.gov/care-compare. (Note: data may not match precisely between the CMS and CLTCC websites due to different reporting periods.)

Not all reported measures receive ratings. One reason for a measure not having a rating is when scores are tightly clustered together, making it challenging to highlight meaningful differences between the facilities. Another reason is the data may be incomplete.

About the Rating System

Cal Long Term Care Compare uses five performance levels, represented by badges, to rate facilities and agencies. The highest-performers are labeled “Superior,” while the lowest-performers are labeled “Poor.” The cut-off criteria for each level are as follows:

    • Superior: providers that scored in the top 10% in California
    • Above Average: providers that scored in the 75-90% range (top quartile, excluding top decile) in California
    • Average: providers that scored in the 25.1-74.9% range in California
    • Below Average: providers that scored in the 10.1-25% range (bottom quartile, excluding bottom decile) in California
    • Poor: providers that scored in the bottom 10% in California
    • N/A: providers identified in grey shade did not report data

In cases where a significant proportion of SNFs, home health, or hospice agencies perform exceptionally well or poorly in specific measures, the 5 performance rating categories collapse to 4 (or 3) categories. As a result, facilities in two collapsed categories (e.g., above average and superior) cannot be differentiated and would receive the same rating. When performance levels are collapsed for specific measures, it is noted in the respective provider type description (below).

Skilled Nursing Facilities

In the SNF category, staffing ratings play a crucial role in the quality of care provided to nursing home residents. Adequate staffing levels, lower turnover, and higher retention have a positive impact on residents’ health. Cal Long Term Care Compare publishes ratings for staff turnover and staff retention using the aforementioned five performance levels. The site reports nursing home staffing data (hours per resident per day) exactly as reported by the facilities, without adjusting for the complexity of resident needs. It’s important for SNFs to adjust their staffing levels to ensure they adequately meet the needs of all residents.

The Quality-of-Care measures are divided into three categories: Vaccinations, Short-stay Resident Health and Safety (for post-hospitalization rehabilitation stays), and Long-stay Resident Health and Safety (for extended periods of residency). The Short Stay and Long Stay ratings are obtained directly from the Centers for Medicare and Medicaid Services (CMS). Cal Long Term Care Compare rates some of the short-stay Quality of Care measures using the same performance levels mentioned earlier. However, none of the long-stay measures receive ratings due to the unavailability of total resident numbers for the nursing homes that submitted data.

In the Health and Safety Inspections section, there are two ratings. The “Combined Federal and State Health Inspections Rating” considers the number and type of state citations issued between July 2019 and June 2022, as well as federal deficiencies found during the nursing home’s two most recent standard health inspections. More weight is given to the most recent inspection. It’s worth noting that a facility may receive a citation from the state for the same violation that the federal government assigns a deficiency, while other times the federal and state violations are entirely different. This rating also uses the five performance levels mentioned earlier. The second rating focuses on substantiated complaints over the last three years, reflecting the total number of complaints made about the facility that were substantiated following investigation by state inspectors.

Currently, there are 3 SNF measures that use 4 (instead of 5) performance rating categories (Poor, Below Average, Average, Superior):

  • Percentage of SNF residents whose medications were reviewed and received follow-up care for identified medication issues
  • Percentage of SNF residents with new or worsened pressure ulcers/pressure injuries
  • Substantiated SNF complaints in the last 3 years

Similarly, there is one SNF measure that uses three categories (Poor, Average, Superior):

  • Percentage of infections patients acquired during their SNF stay that resulted in hospitalization

Home Health Care Agencies

There is one rating for quality of care in Home Health Agencies: Percentage of patients who remained in the community after being discharged from home health. We were unable to rate the rest of the quality measures due to incomplete data (no denominator), lack of differentiation in performance outcomes, or use of process measures that do not capture an individual’s health outcome. Our research team will continue to search for meaningful measures and data that can be rated in the future. Note: Some home health care agencies may be licensed but do not appear on this website because they reported no patients and no quality data as of the dates cited in the website’s data sources.

Hospice Care Agencies

No ratings are reported for Hospice agencies due the use of process measures that do not capture an individual’s health outcome or the lack of data (denominator information). The website features data on Quality of Care and Family Caregiver experience. Our research team will continue to search for meaningful measures and data that can be rated in the future. Note: Some hospice agencies may be licensed but do not appear on this website because they reported no patients and no quality data as of the dates cited in the website’s data sources.

Assisted Living Facilities

There are no quality measures reported for assisted living facilities.

Continuing Care Retirement Communities

There are no quality measures reported for continuing care retirement communities.

Adult Residential Facilities

There are no quality measures reported for adult residential facilities.

Adult Day Health Care Centers

There are no quality measures reported for adult residential facilities.

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