The Facility Description section includes some of the information found in the At-A-Glance section as well as additional information on the types of care available in the nursing homes.

Special Focus Facility (Data Source: CMS Provider Data: through 03/31/2022)

“Yes” identifies facilities that are designated a “Special Focus Facility” due to a history of serious quality issues. The U.S. Centers for Medicare & Medicaid Services (CMS) created the Special Focus Facility (SFF) initiative to stimulate improvements in quality of care. CMS has found that a small number of nursing homes have more problems than others; more serious problems than most other nursing homes (including harm or injury experienced by residents); and a pattern of serious problems that has persisted over at least three years before the date the nursing home was first put on the SFF list. CMS requires that SFF nursing homes be visited in person by survey teams twice as frequently as other nursing homes to ensure improvements are being made. The longer the problems persist, the more stringent the enforcement actions will be. For more information, see the CMS website.

Facility type (Data Source: CMS Provider Data; CDPH Licensed and Certified Healthcare Facility Listing: through 06/30/2022)

There are two basic types of skilled nursing facilities. They differ based on the population they serve (adult or pediatric or both) as well as whether they are freestanding, or a distinct part of a hospital as described below. In addition, freestanding nursing homes may be associated with a Continuing Care Retirement Community.

All nursing homes offer basic care services such as:

• Dietary services
• Social services
• Pharmaceutical services
• Recreational therapy services
• Access to dental care
• Emphasis on rehabilitation and maintenance of function, such as gait training and bowel and bladder training
• Administration of medications, which may include potent injectable medications and intravenous medications and solutions
• Physical, occupational, and speech therapy if ordered by a physician, nurse practitioner, or physician assistant

Freestanding: Freestanding facilities provide 24-hour skilled nursing care to assist with short term recovery from a surgery, injury, or acute illness (short stay) or provide on-going nursing home care for those who need more permanent long-term care.

Distinct Part of acute care hospital: A Distinct Part facility is always associated with a hospital organization. It must be physically distinguishable from the larger institution (separate address) and fiscally separate for cost reporting purposes. A Distinct Part Facility provides the same services as a freestanding facility as well as treatment for acute illness or injury and intensive rehabilitation services. Most residents stay a short time, usually a maximum of three weeks, and then are discharged to either a SNF or back to their own home.

Resident population (Data Source: CMS Provider Data; CDPH Licensed and Certified Healthcare Facility Listing: through 06/30/2022)

Payments accepted (Data Source: CDPH Licensed and Certified Healthcare Facility Listing: through 04/15/2022)

All nursing homes in California accept payment directly from individuals through private insurance (including long-term care insurance) for long-stay residents and self-pay. In addition, many are certified to receive payment from the Medicare program for short term stays (defined as stays through the first 100 days of care). Medicare pays most costs (excluding co-pays) for those who are Medicare beneficiaries. For stays beyond 100 consecutive days, residents are considered to be long-term care residents and facilities are no longer eligible for Medicare reimbursement. Some facilities accept payment from the Medi-Cal program, which generally covers care for long term residents with low incomes and few assets.

Number of beds (Data Source: CDPH Licensed and Certified Healthcare Facility Listing: through 04/15/2022)

The number of skilled nursing beds at this facility, which is licensed by the California Department of Public Health Division of Licensing and Certification.

Type of Specialty Care Available

Nursing homes provide various types of care. This information is especially useful for selecting a facility that meets the specific medical and nursing needs of an individual who may need higher levels of care. Staffing requirements may vary based on the types of specialty care, so readers should make sure to review the staffing section of the website.

• Subacute Care (Data Source: CDPH Licensed and Certified Healthcare Facility Listing, 4/15/2022): More intense care than skilled nursing care, but less intense than acute hospital care. It involves intensive nursing and supportive and therapeutic care provided by licensed nurses for residents with fragile medical conditions.

• Ventilator Beds (Data Source: LTC Facility Integrated Disclosure and Medi-Cal Cost Report Data 12/31/2020): A facility must be licensed by the California Department of Public Health to operate ventilators or respirators, which are machines that mechanically assist patients with breathing and are sometimes referred to as artificial respiration. Ventilator beds are part of a subacute nursing home.

• HIV/AIDS Program (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report 12/31/2020): A facility must be certified by CMS to treat patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS) or HIV-related diseases.

• Alzheimer’s/Dementia Program (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report 12/31/2020): A facility must be certified by CMS to have a specialized unit to treat patients diagnosed with Alzheimer’s disease. Alzheimer’s is a progressive brain disorder that gradually destroys a person’s memory and ability to learn, reason, make judgments, communicate, and carry out daily activities. Some nursing homes specialize only in dementia care and others may have a designated memory care unit.

• Hospice Program (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report 12/31/2020): A facility must be certified by CMS to provide hospice care to a patient. Most nursing homes contract with an outside certified Hospice Provider. In hospice, the team focuses on making the resident as comfortable as possible to maximize their quality of life by providing comprehensive comfort care including pain management as well as counseling services for residents and their families.

• Long-term Rehabilitation (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report 12/31/2020): A facility must be licensed by the California Department of Public Health to provide intensive rehabilitation services (such as intensive physical and occupational therapy), which are designed to make a patient as independent as possible after an illness or injury.

• Behavioral health/psychiatric (Data Source: CDPH Licensed and Certified Healthcare Facility Listing, 4/15/2022): In California, Behavioral Health facilities, also called Psychiatric Health Facilities, are licensed by the State Department of Health Care Services. They provide 24-hour inpatient care for people meeting legal definitions of mental disorder or incompetence. Specialty care includes, but is not limited to: psychiatry, clinical psychology, psychiatric nursing, social work, rehabilitation, drug administration.

• Continuing Care Retirement Community (Data Source: CMS Provider Data; CDPH Licensed and Certified Healthcare Facility Listing 3/31/2022): These facilities provide a continuum of services, including independent living services, assisted living services, and nursing home care on a single campus. Residents can move between independent living, assisted living, and nursing home care based on changing needs at each point in time. Residents entering CCRCs sign a contract that provides for housing, services, and nursing care.

Age (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report: 01/01/2020 through 12/31/2020)

The percentage of residents in each age group on the day the facility completed its most recent cost report.

Gender (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report: 01/01/2020 through 12/31/2020)

The percentage of male and female residents as reported on the day the facility completed its most recent cost report.

Race and Ethnicity (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report: 01/01/2020 through 12/31/2020)

The percentage of residents for different racial groups and ethnicity on the day the facility completed its most recent cost report.

Nursing Hours per Resident per Day (Data Source: CMS Provider Data: 10/01/2021 through 12/31/2021)

Nurse staffing levels are reported as hours-per-resident-day (HPRD). The hours in this measure have not been adjusted for residents’ complexity of care and reflect average numbers across all residents. These numbers do not represent the amount of nursing time each resident receives daily.

Having an adequate number of each type of nursing staff in a facility is essential to providing quality care, and differs based on the care level a resident requires. California requires nursing homes to provide different HRPD depending on the type of care the facility provides.

All nursing homes must have a Director of Nursing (DON).  In NHs with 59 or fewer licensed beds, the director can be an RN or LVN and they may be a direct caregiver in addition to their administrative role as director. Nursing homes must specify the direct care assignments for staff who have both administrative and patient care responsibilities. A DON cannot provide charge nurse duties in NHs with 60 or more beds.

There are several types of nursing homes or sections of nursing homes that require greater HPRD than a standard nursing home. The best nursing homes adjust the staffing based on the complexity of the types of residents in their facility each day; however, there is no specific requirement on how to make that calculation; therefore, some nursing homes stay closer to 3.5 HPRD, which is the minimum nurse staffing requirement. Each nursing home must have at least one RN on duty 24 hours per day for NH with 60 beds or more; smaller NHs (59 beds or fewer) must have at least one RN or LVN/LPN 24 hours per day. Every nursing home must also have a designated full-time infection preventionist, who is not considered a direct caregiver.

Freestanding: Most nursing homes provide general nursing care to a combination of individuals who are discharged from the hospital for rehabilitation or are in the nursing home for long term care. These facilities must have at least 3.5 HPRD of direct nursing care with at least 2.4 HPRD of CNA staffing

Distinct Part of acute care hospital: There are some nursing homes that are organizationally connected to a hospital system, which requires higher staffing levels; they are known as Distinct Part (DP) facilities. They are required to follow the staffing standards of the hospital, which are slightly higher than a standard (freestanding) nursing home.

In addition to the facility types described above, nursing homes may also offer specialty care services that require higher level care and greater staff-to-resident ratios.  Those looking for a nursing home should consider the type of care the new resident requires to ensure adequate staffing coverage.

Subacute: There are both pediatric and adult subacute units that require more staffing HPRD than freestanding facilities. Subacute units provide specialized care to individuals (children or adults) who require significantly higher levels of nursing care such as management of tracheostomies, intravenous medications, and severe trauma. If a freestanding nursing home also has a section designated as subacute, they must apply the higher HRPD staffing standards to those subacute beds.

Behavioral health/psychiatric care: There are also different staffing requirements for psychiatric and behavioral health nursing homes where psychiatric technicians may provide direct patient care.  Direct patient caregivers include RNs, LVN/LPNs, CNAs, and licensed psychiatric technicians in behavioral health nursing homes.

The table below shows the minimum direct care staffing requirements for standard and specialty care.

Nursing hours per resident per day : This measure shows the average number of hours of care that different types of nursing staff provide per resident per day during the reporting period. The total includes registered and licensed vocational nurses, nursing assistants, and directors of nursing, including part-time, full time, and temporary employees. Hours-per-resident-per-day (HPRD) is based on nursing staff hours worked (excluding time for vacations, sick time, disability, and other paid time off) and the total resident days of care during the reporting period. This does not indicate the number of nurses working at any given time, how they are allocated among shifts, or the amount of care given to each resident on an individual basis. Higher numbers are better for all these staff hours.

The different types of nurses and their staffing requirements based on California regulations are:

Registered nurse (RN) hours per resident per day: This is the reported number of HPRD that RNs are available to take care of residents (including RN supervisors). RNs have two to six years of professional education and are trained in the management and care of patients. The RN staffing is critical as they supervise the other nursing staff. Additionally, only RNs can complete resident assessments and care plans and have the training to give complex nursing care and treatments. RNs can evaluate acute and chronic conditions and determine when medical attention is needed. While the minimum RN hours are not specified as a ratio to residents, experts suggest that residents should have at least 0.75 HPRD (45 minutes) of RN time. Some experts recommend a ratio of one RN or LVN to every 15 residents during the day, one to every 20 residents in the evening, and one to every 30 residents at night. RNs have two to six years of professional education and are trained in the management and care of patients.

Licensed vocational/practical nurses (LVN/LPN) per resident per day: This is the reported number of HPRD that LVNs/LPNs take care of residents. This does not indicate the number of nurses working at any given time, how well they are organized, or the amount of care given to each resident on an individual basis. While the minimum LVN/LPN hours are not specified as a ratio to residents, experts suggest that facilities should have at least 0.55 HPRD (33 minutes) of LVN/LPN time per resident. LVN/LPNs have only one year of training. They work under the supervision of RNs to pass medications, provide treatments, and to evaluate residents’ responses to care. They may also serve as a unit charge nurse. If a nursing home has substantially more LVN/LPNs and low numbers of RNs, that may result in a lower quality of care.

Some experts recommend a ratio of one RN or LVN to every 15 residents during the day, one to every 20 residents in the evening, and one to every 30 residents at night.

Nursing assistant (NA) hours per resident per day:  This is the reported number of HPRD that NAs take care of residents. This does not indicate the number of NAs working at any given time, how well they are organized, or the amount of care given to each resident on an individual basis.  At minimum, facilities must have 2.4 HPRD for NAs; however, many experts recommend 2.8 to 3.2 HPRD (168 to 192 minutes) of nursing assistant time. This is about one NA for every 6 to 8 residents during the day and evening shifts, and one NA for every 20 residents on the night shift. NAs provide most of the direct resident care, such as bathing, dressing, toileting, and eating. They work under the direction of a licensed nurse (RN or LVN/LPN). All NAs must become certified (CNAs) within four months of employment. In California, they must take 160 hours of training and pass an exam to become certified.

Total number of nurse staff hours per resident per day: This measure shows the average number of hours of nursing staff time (RN, including supervisors; LVN/LPN; and NA) available to care for residents each day, including weekends, during the reporting period. It does not indicate the number of nurses working at any given time, how well they are organized, or the amount of care given to each resident. California requires nursing homes to provide at least 3.5 HPRD of direct nursing care.

Total number of nurse staff hours per resident per weekend: This measure shows the average number of hours of nursing staff time (RN, including supervisors; LVN/LPN, and NA) available to care for residents during the weekend (Saturday and Sunday) over a year. It does not indicate the number of nurses working at any given time, how well they are organized, or the amount of care given to each resident. Many nursing homes reduce the number of staff on-site during weekends even though resident care needs do not change substantially on the weekends; however, nursing homes are still required to meet staffing minimums (3.5 Total HPRD and 2.4 NA HPRD) over the weekend. Comparing nursing staff hours per day to weekend hours gives residents and family members an idea of how much nursing staff may be reduced during weekends.

Nursing staff turnover (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report: 01/01/2020 through 12/31/2020)

The turnover measure shows the percentage of all nursing staff (not including supervisors) who leave the facility during the year (turnover rate) prior to the day the facility completed its most recent cost report for the Office of Statewide Health Planning and Development (OSHPD), now called the Department of Health Care Access and Information (HCAI). When nursing staff is constantly changing, it may be stressful and disruptive for residents who receive care from new staff who are unfamiliar with their routines or special needs.  Evidence shows that the lower the nursing staff turnover rate at a nursing facility, the better the quality, continuity, and stability of care.

Note that high nursing staff turnover is usually associated with lower retention of staff. Occasionally, a nursing home may have both high nursing staff turnover (“poor” or “below average”) and high retention (“superior” or “above average”), meaning that most staff stayed all year, but many staff also joined or left the facility during the year. This pattern may result from a change in the type or number of patients, or in the number of staffed beds, or in the management of the facility.

Nursing Staff Turnover RATING (Data Source: Cal Quality Care 12/6/2021)

High turnover rates may be associated with poor quality of care. A lower rate is desirable because it indicates less staff turnover. Family members should ask the nursing home about their staffing if the facility’s staff turnover is rate is “below average” or “poor”.  Click on the rating badge for an explanation of the ratings.

Nursing staff retention (Data Source: HCAI Long-Term Care Facilities Annual Utilization Report: 01/01/2020 through 12/31/2020)

The retention measure reflects the percentage of the nursing staff who stayed in their job for the past 12 months.  Nursing staff who remain in the nursing home are generally more satisfied with their jobs. Higher nursing staff retention rates can be associated with higher quality of care because there is more stability of the nursing home workforce.

Note that high nursing staff retention is usually associated with lower turnover of staff. Occasionally, a nursing home may have both high retention (“superior” or “above average”) and high nursing staff turnover (“poor” or “below average”), meaning that most staff stayed all year, but a smaller number of staff positions had a lot of employees joining and leaving the facility during the year. This pattern may result from the management of the facility or a change in the type or number of patients, or a change in the number of staffed beds.

Nursing Staff Retention RATING (Data Source: Cal Quality Care 12/6/2021)

Low retention rates may be associated with poor quality. A higher rate is desirable because it indicates better staff retention and greater stability. Family members should ask the nursing home about their staffing if the facility’s staff retention is “below average” or “poor.” Click on the rating badge for an explanation of the ratings.

Physical therapist staff minutes per resident per day (Data Source: CMS Provider Data: 10/01/2021 through 12/31/2021)

Physical therapist (PT) staffing level information shows the average minutes spent per resident day across all residents, including those who receive no therapy. This measure does not indicate the number of physical therapists working at any given time or the amount of care given to any one resident. The amount of physical therapy given depends on the needs of each resident and must be ordered by a physician, nurse practitioner, or physician assistant.  It is best to compare the PT minutes between the nursing homes you are considering and the state average to see if there is a difference in the amount of time.

All physical therapists are licensed with the state of California. Physical therapists help residents improve their movement and manage their pain.  PTs often work with primary care providers, nurses, and occupational therapists to create customized plans targeting muscle strength, joint flexibility, and the ability to walk or move to improve a resident’s physical function and well-being.

This section provides details about measures that can inform residents, their families, and others about the quality of care in nursing homes and how the quality is measured. In general, nursing homes should ensure that they are working with residents and families to address the residents’ goals of care. They should also have systems in place to prevent harm (e.g., falls, pressure injuries, infections) to residents.

Patients who are newly admitted to the nursing home from the hospital and are receiving rehabilitation services and/or intensive nursing are usually considered short-stay residents. While they may have up to 100 days paid by Medicare, the average patient spends a few weeks in the nursing home for rehabilitation and then finishes their rehabilitation at home. When short-stay residents have achieved their short-stay goals or are no longer making any progress in their rehabilitation, they no longer qualify for Medicare coverage, at which point they are discharged home or transitioned to long-stay.

The ultimate goal for short-stay residents is to be discharged back to their homes to live independently; improving and sustaining gains in their function and ability to care for themselves should be high priorities for the nursing home to support.

Long-stay residents are in the nursing home either as a direct-admission from home without a qualifying hospital admission; as short-stay residents who convert to long-stay because they are no longer making progress in rehabilitation; or because they reached the Medicare 100-day maximum coverage. Patients who are not Medicare beneficiaries can also be admitted to the nursing home from the hospital or home – the rules for those residents depend on their insurance status.  These residents pay for services through Medi-Cal, long term care insurance, or pay out of pocket.

The goals for long-stay residents are to maintain the highest functional ability possible or at least to slow the loss of functional abilities and to maintain the best possible quality of life.

CMS 5-Star rating for short stay (Data Source: CMS Provider Data: through 06/30/2022)

The US Centers for Medicare & Medicaid Services (CMS) created a five-star quality rating system to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. Nursing homes with five stars are considered to have above average quality, and nursing homes with one star are considered to have below average quality. For more information, see the CMS website. This rating is a composite rating of six select short-stay measures:

Derived from Claims Data:

• Percentage of short-stay residents who were re-hospitalized after a nursing home admission
• Percentage of short-stay residents who have had an outpatient emergency department visit
• Rate of successful return to home and community from a SNF

Derived from Minimum Data Set Assessment:

• Percentage of short-stay residents who got antipsychotic medication for the first time
• Percentage of short-stay residents who improved in their ability to move around on their own
• Percentage of residents with pressure ulcers/pressure injuries that are new or worsened

CMS 5-Star rating for long stay (Data Source: CMS Provider Data: through 06/30/2022)

The US Centers for Medicare & Medicaid Services (CMS) created a five-star quality rating system to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. Nursing homes with five stars are considered to have above average quality, and nursing homes with one star are considered to have below average quality. For more information, see the CMS website. This rating is a composite rating of nine select long-stay measures:

Derived from Claims Data:

• Number of hospitalizations per 1,000 long-stay resident days
• Number of outpatient emergency department visits per 1,000 long-stay resident days

Derived from the Minimum Data Set Assessment

• Percentage of long-stay residents who got an antipsychotic medication
• Percentage of long-stay residents experiencing one or more falls with major injury
• Percentage of long-stay, high risk residents with pressure ulcers
• Percentage of long-stay residents with a urinary tract infection
• Percentage of long-stay residents who have or had a catheter inserted and left in their bladder
• Percentage of long-stay residents whose ability to move independently worsened
• Percentage of long-stay residents whose need for help with activities of daily living increased

Older adult residents are particularly vulnerable to COVID-19, influenza (flu), and pneumonia. Vaccines are important tools for preventing serious disease and death. This section reports vaccination rates for three types of disease: COVID-19, influenza (flu), and pneumonia.

COVID-19 Vaccination Rates (Data Source: CMS COVID-19 Nursing Home Data: through 08/14/2022)

Studies have shown that nursing home residents who are eligible for and receive COVID-19 vaccinations, including booster shots, have significantly fewer hospitalizations and deaths from this serious disease. Likewise, nursing home staff vaccinated for COVID-19 and boosted also experience fewer infections and serious illness and are less likely to transmit the virus to residents and co-workers. All vaccine measures are not risk-standardized by CMS. Higher vaccination rates are an indicator of greater safety from COVID-19.

As of May 11, 2021, the Centers for Medicare & Medicaid Services (CMS) required that all nursing homes report the COVID-19 vaccine status of both staff and residents including booster shots.  Vaccine status is updated weekly on the CMS website. Due to frequent updates, we recommend checking the CMS Care Compare site and asking the nursing home for their current vaccination rates.

Weighted staff COVID-19 vaccination + booster

This measure represents the percent of all regular staff who work in the nursing home for at least one day per week and have been fully vaccinated against COVID-19 at any time to date including at least one booster shot. Studies consistently show that COVID-19 vaccinations and boosters significantly reduced hospitalizations and deaths.

Weighted staff COVID-19 vaccination + booster RATING

Currently, there are still some nursing homes with inadequate COVID-19 vaccination and booster rates. Staff who are vaccinated with only the primary COVID-19 vaccine have reduced ability to fight against the COVID-19 virus compared to those who have had the primary series plus a booster. Therefore, we give half credit for each staff member who completed the primary series and full credit for each staff member who received at least one booster. Nursing homes with higher staff vaccination + booster rates are given a better rating. Click on the rating badge for an explanation of the ratings.

Weighted resident COVID-19 vaccination + booster

This measure represents the percent of all residents within the nursing home who have been fully vaccinated, including at least one booster shot, against COVID-19 at any time to date.

Influenza Vaccination (Data Source: CMS MDS Quality Measures: 01/01/2021 through 03/31/2022)

The Centers for Disease Control and Prevention (CDC) require that influenza vaccinations be offered to residents and staff to prevent the spread of influenza in nursing homes.  The staff influenza vaccination rate data are not publicly available, so we are unable to report it here; however, residents and families may want to ask the nursing home about their staff influenza vaccination rates.

Percentage of short-stay residents who needed and got a flu shot for the current flu season and

Percentage of long-stay residents who needed and got a flu shot for the current flu season:

These measures report the percentage of short-stay and long-stay residents who were: given, and appropriately received, the influenza vaccine during the most recent influenza season. Residents are excluded if they have a contraindication to the influenza vaccine, have an order not to immunize, are moderately to severely ill, have a history of Guillain-Barre Syndrome, or are immunocompromised. Higher percentages are better.

Pneumonia Vaccination (Data Source: CMS MDS Quality Measures: 01/01/2021 through 03/31/2022)

Pneumonia vaccines are strongly recommended for children with certain medical conditions and for most adults aged 65 years or older who are not immunocompromised. Like the flu vaccine, pneumonia vaccines also are required to be offered to all nursing home residents who are eligible.

Percentage of short-stay residents who needed and got a vaccine to prevent pneumonia and  Percentage of long-stay residents who needed and got a vaccine to prevent pneumonia: 

Pneumonia is a significant cause of death from a bacterial disease in older adults. These measures report the percentage of short-stay and long-stay residents aged 65 or older who have an up-to-date pneumonia vaccine during the 12-month reporting period. Residents are excluded if they have a contraindication to the pneumonia vaccine; have an order not to immunize or a history of Guillain-Barre Syndrome; are moderately to severely ill; or are immunocompromised. Higher percentages are better.

The short-stay measures section includes assessment and outcome measures for short-stay residents, who typically stay in a nursing home for up to 100 days after acute hospitalization for the purpose of rehabilitation. Each of these measures may have some residents who are excluded; for example, they are enrolled in hospice or have serious brain injuries.

Rehospitalizations and Emergency Department Visits

Percentage of short-stay residents who were re-hospitalized after a nursing home admission (Data source: CMS Medicare Claims Quality Measures 1/1/2021 – 12/31/2021):

The measure reports the percentage of short-stay residents who initially entered or reentered the nursing home from a hospital and were then re-admitted to a hospital for an unplanned inpatient or observation stay within 30 days of the start of the nursing home stay for any condition that could have been prevented. This measure is risk-standardized by CMS. Nursing homes should ensure that short-stay residents can be safely discharged home in a stable condition. High rates of hospital readmissions may indicate that the nursing home did not prevent complications when caring for the resident. Lower percentages are better.

Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (Data source: CMS SNF Quality Reporting Program-Provider Data 7/1/2019-6/30/2021):

This measure estimates the risk-adjusted rate of unplanned, potentially preventable readmissions for short-stay nursing home residents within 30 days of discharge from the nursing home. This measure is risk-standardized by CMS based on resident characteristics such as age, prior functional status, medical conditions, and comorbidities. Some residents are excluded such as those with a planned hospital readmission, with multiple nursing home admissions, or were discharged against medical advice. Hospital readmissions place residents at higher risk from infections, falls, and pressure injuries, are costly, and are often avoidable. Studies have identified specific diagnoses that could be managed in the nursing home with stronger prevention measures and early detection of changes in residents’ conditions. Better staffing has been shown to decrease the rate of potentially avoidable readmissions. Lower rates are better.

Percentage of short-stay residents who have had an outpatient emergency department visit (Data source: CMS Medicare Claims Quality Measures 1/1/2021 – 12/31/2021):

This measure reports the percentage of short-stay residents who entered or reentered the nursing home from a hospital and were sent to an emergency department within 30 days of the start of the nursing home stay, but in which the ED visit did not result in an inpatient or observation stay. High rates of ED visits may indicate that the nursing home is not providing adequate care. Nursing homes must assess short-stay residents frequently for subtle signs that their condition is deteriorating, notify their primary care provider about early changes of condition, and implement appropriate treatments. This measure is risk-standardized by CMS. Lower percentages are better.

Medications

Percentage of short-stay residents who got antipsychotic medication for the first time (Data source: CMS MDS Quality Measures, 01/01/2021 through 03/31/2022):

Antipsychotic medications are used to treat a very specific group of mental health conditions such as schizophrenia; however, these drugs have historically been used to manage agitated behaviors in residents without schizophrenia or other appropriate medical conditions. This measure reports the percentage of short-stay residents who received an antipsychotic for the first time in the nursing home. This class of medications can cause serious harm and should not be given to control mood or behavior, particularly in residents with dementia. Some residents were excluded from this measure such as those already on an antipsychotic at admission or have a diagnosis of schizophrenia, Tourette’s syndrome, or Huntington’s disease, for which antipsychotics are appropriate. High rates of antipsychotic use may indicate poor quality of care.  Nursing homes should employ alternative methods to reduce agitation such as increased exercise, improved pain management, music therapy, and other non-drug interventions. This measure is not risk-standardized. Lower percentages are better.

Percentage of short-stay residents whose medications were reviewed and who received follow-up care when medication issues were identified (Data source CMS SNF Quality Reporting Program-Provider Data, 10/1/2020 – 9/30/2021):

This measure reports the percentage of short-stay residents who had a drug regimen review at admission and timely follow-up with a physician, nurse practitioner, or physician assistant when significant medication issues were identified while in the nursing home. Resident conditions may change rapidly during the post-hospitalization stay in the nursing home and may require frequent changes in medication management. Nursing homes should ensure that primary care providers are notified promptly of changes in health status and that timely medication changes, if ordered, are implemented. This measure is not risk-standardized. Higher percentages are better.

Percentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified RATING:  When residents transfer from the hospital to the nursing home, there is an increased risk for medical errors particularly in the type of medications that are to be stopped from the hospital and ones that need to be started in the nursing home. Higher ratings on this Long Term Care Compare measure means the nursing home completed a greater percentage of medication reviews with appropriate treatment. Click on the rating badge for an explanation of the ratings.

Resident Safety (Data Source: CMS SNF Quality Reporting Program- Provider Data: 10/01/2020 through 09/30/2021)

This measure reports the percentage of residents who develop new or worsening Stage II-IV pressure ulcers (also known as pressure injuries). Pressure ulcers are areas of damaged skin caused by the resident staying in one position for too long; prolonged pressure in that area causes breakdown in the skin and underlying tissue resulting in a pressure sore. Residents who develop new pressure ulcers/injuries are likely not being turned and repositioned adequately, which can result in serious consequences including pain, infection, and death. If the resident cannot turn independently, nursing home staff should turn and reposition residents frequently, keep their skin dry, use appropriate support surfaces (e.g., special beds), and minimize injury from medical devices that cause pressure on the skin. This measure is risk-standardized by CMS.  Lower percentages are better.

Percentage of residents with pressure ulcers/pressure injuries that are new or worsened RATING:Pressure ulcers/injuries are associated with significant morbidity and mortality. Higher ratings on this Cal Long Term Care Compare measure mean that the nursing home is doing a better job of preventing pressure ulcers/injuries. Click on the rating badge for an explanation of the ratings.

Percentage of short-stay residents who experience one or more falls with major injury during their SNF stay:

Falls with a major injury are considered a “never event” (because they should never happen) and may reflect lower quality of care. This measure reflects the percentage of short-stay residents who experience one or more falls associated with a major injury such as a fracture, loss of consciousness, or head injury while in the nursing home.  Falls must be balanced with the importance of resident mobility, so the key is to prevent injury if there is a fall. Nursing homes should have some type of prevention program in place to help prevent major injuries from falls. This measure is not risk-standardized. Lower percentages are better.

Resident Change in Ability and Mobility

Rate of successful return to home and community from a nursing home (Data source: CMS SNF Quality Reporting Program-Provider Data, 7/1/2019-6/30/2021):

This measure reports the percentage of short-stay residents admitted to the nursing home from a hospital who were then discharged to the community within 100 calendar days of admission, and who remained in the community for at least 30 consecutive days following discharge to the community. This is a CMS-risk-standardized measure based on resident characteristics such as age, prior functional status, and medical conditions and comorbidities. If nursing homes have high numbers of residents who are readmitted to the hospital after discharge, it may indicate they are not adequately preparing residents for discharge or appropriately evaluating residents’ readiness to successfully care for themselves at home. Higher rates are better.

Short-stay residents’ rate of successful return to home and community RATING:Higher ratings on this Cal Long Term Compare measure are better and mean that a greater percentage of residents were safely discharged; click on the rating badge for an explanation of the ratings.

Change in residents’ ability to move around (at discharge) (Data source CMS SNF Quality Reporting Program-Provider Data, 10/1/2020 – 9/30/2021):  

This measure estimates the average change in the residents’ mobility score between admission into the nursing home and discharge. Greater mobility improves the residents’ independence and ability to care for themselves once they are discharged. Scores above 0 mean that mobility improved and scores below 0 mean that mobility worsened. This measure is risk-standardized by CMS, which means that the residents’ age, chronic conditions, and pre-existing conditions are taken into consideration. Higher scores are better.

Change in residents’ ability to move around RATING: This measure reports the nursing home’s average change in the ability to move around for all short-stay residents. Higher ratings for this Cal Long Term Compare measure mean that a greater percentage of residents met or exceeded their expected ability to move around at discharge. Click on the rating badge for an explanation of the ratings.

Percentage of residents who are at or above an expected ability to move around at discharge (Data source CMS SNF Quality Reporting Program-Provider Data, 10/1/2020 – 9/30/2021)

This measure estimates the percentage of short-stay residents who meet or exceed the expected discharge mobility scores. The scores range from 15-90 and are risk-adjusted based on resident characteristics such as age, prior functional status, and complex medical conditions. Mobility items include activities such as the ability roll from side to side, change positions from lying to sitting to standing, move from bed to chair or toilet, and walk or climb stairs. Higher percentages are better.

Short stay residents at or above expected ability to move around at discharge RATING: Higher ratings for this Cal Long Term Compare measure mean that a greater percentage of residents met or exceeded their expected level of mobility on discharge. Click on the rating badge for an explanation of the ratings.

Percentage of residents who are at or above an expected ability to care for themselves at discharge (Data source CMS SNF Quality Reporting Program-Provider Data, 10/1/2020 – 9/30/2021): This measure estimates the percentage of short-stay residents who meet or exceed the expected self-care score at discharge.  Scores range from 7-42 and are risk-adjusted based on resident age, prior functioning, and medical conditions. Self-care activities, such as eating, oral hygiene, toileting, bathing, upper and lower body dressing, are evaluated using a 6-point scale for each item.  Higher percentages are better.

Short-stay residents at or above expected ability to care for themselves at discharge RATING: It is important that nursing homes prepare residents to care for themselves when they are discharged home. Higher ratings for this Cal Long Term Compare measure mean that a greater percentage of discharged residents met or exceeded the expected ability to care for themselves. Click on the rating badge for an explanation of the ratings.

Change in residents’ ability to care for themselves (at discharge) (Data source CMS SNF Quality Reporting Program-Provider Data, 10/1/2020 – 9/30/2021): This measure estimates the average change in the residents’ self-care score between admission into the nursing home and discharge. The goal of the short-stay nursing home stay is to improve the residents’ ability to care for themselves so that they can return safely to home or the community. Scores above 0 mean that the self-care core improved and scores below 0 mean that the self-care score worsened. This measure is risk-standardized by CMS, which means that the residents’ age, chronic conditions, and pre-existing conditions are taken into consideration. Higher scores are better.

Percentage of short-stay residents who improved in their ability to move around on their own (at discharge) (Data source: CMS MDS Quality Measures, 1/1/2021 – 3/31/2022):This measure estimates the CMS risk-standardized change between the short-stay residents’ discharge mobility score and the admission mobility score. Risk-adjusted means that the resident’s age, prior functional status, medical condition, and comorbidities are considered. The measure is reported as the average change in mobility scores among all residents. Mobility scores include activities such as the ability to roll from side to side, change positions from lying to sitting to standing, move from bed to chair or toilet, and walk or climb stairs. Residents are rated on a 6-point scale and scores range from 15-90. Nursing homes should ensure that every effort is being made to improve resident mobility. Higher percentages are better and indicate greater independence.

Percentage of SNF residents whose functional abilities were assessed, and functional goals were included in their treatment plan (Data source CMS SNF Quality Reporting Program-Provider Data,  10/1/2020 – 9/30/2021):

This measure reports the percentage of short-stay residents who had a functional assessment at admission, a care plan that addresses function, and another assessment at discharge. Functional goals include bathing, grooming, dressing, and walking. Residents with incomplete nursing home stays are excluded. Ensuring positive functional outcomes is essential for person-centered care and a safe discharge from the nursing home. This measure is not risk-standardized. Higher percentages are better.

The measures in this section apply to residents who reside in the nursing home for more than 100 days. These residents may stay in the nursing home for months, years, or the rest of their lives. In general, the goals of long-term care are to maintain physical and mental function, prevent harm, and provide an environment to enhance the quality of life for residents. The care should be focused on the individual resident and family goals for care.

There are general exclusions in some of these measures for residents in hospice care, who are comatose, are paralyzed, or have severe brain injuries. Other measure-specific exclusions are described below.

Hospitalizations and Emergency Department Visits (Data Source: CMS Medicare Claims Quality Measures: 01/01/2021 through 12/31/2021)

Number of hospitalizations per 1,000 long-stay resident days

This measure reports the number of unplanned inpatient admissions or outpatient observation stays at an acute care or critical access hospital that occurred in the target period while the individual was a long-term care nursing home resident. Residents with a planned hospital inpatient admission, who were not a Medicare beneficiary, or were in hospice are excluded. It is risk-standardized by CMS. Lower numbers are better.

Number of outpatient emergency department visits per 1,000 long-stay resident days

This measure represents the number of unplanned outpatient emergency department visits for any reason that do not result in an outpatient observation or inpatient hospital stay and that occurred in the target period while the individual was a long-term care nursing home resident. Residents who were not a Medicare beneficiary or were on hospice are excluded. It is risk-standardized by CMS. Lower numbers are better.

Medications (Data Source: CMS MDS Quality Measures: 04/01/2021 through 03/31/2022)

Percentage of long-stay residents who received an antipsychotic medication

Antipsychotic medications are used to treat a very specific group of mental health conditions such as schizophrenia; however, these drugs have historically been used to manage agitated behaviors in residents without schizophrenia or other appropriate medical conditions. This measure reports the percentage of long-stay residents who received an antipsychotic medication during the reporting period. This class of medications can cause serious harm and should not be given to control mood or behavior, particularly in residents with dementia.  Those who have a diagnosis of schizophrenia, Tourette’s syndrome, or Huntington’s disease were excluded from this measure as antipsychotics are appropriate for these residents. Nursing homes should employ alternative methods to reduce agitation such as increased exercise, improved pain management, music therapy, and other non-drug interventions. High rates of antipsychotic use may indicate poor quality of care.  Nursing homes should have non-pharmacological programs to manage resident behavioral issues. This measure is not risk-standardized by CMS. Lower percentages are better.

Percentage of long-stay residents who got an antianxiety or hypnotic medication

This measure reports the prevalence of antianxiety or hypnotic medication use for long-stay residents during the target period. Residents were excluded if they were in hospice care where these medications may be helpful. Nursing homes should look for underlying causes of resident anxiety or inability to sleep prior to use of medications because both classes of medications may have serious side effects such as excessive sleepiness. These side effects could lead to falls with injury and pressure ulcers among other problems. This measure is not risk-standardized by CMS. Lower percentages are better.

Resident Safety (Data Source: CMS MDS Quality Measures: 04/01/2021 through 03/31/2022)

Percentage of long-stay residents experiencing one or more falls with major injury

Falls with a major injury are considered a “never event” (because they should never happen) and may reflect lower quality of care. This measure reports the percentage of resident stays during which one or more falls with a major injury (bone fracture, joint dislocation, closed head injury with altered consciousness, or subdural hematoma) occurred. Falls must be balanced with the importance of resident mobility, so the key is to prevent injury if there is a fall. Nursing homes should have some type of prevention program in place to help prevent major injuries from falls. This measure is not risk-standardized by CMS. Lower percentages are better.

Percentage of long-stay, high risk residents with pressure ulcers

Pressure ulcers (also known as pressure injuries or sores) are areas of damaged skin caused by the resident staying in one position for too long; prolonged pressure in that area causes breakdown in the skin and underlying tissue resulting in a pressure sore, ulcer or open wound. Long-stay residents who have at least one of the following conditions are considered to be at high-risk for pressure ulcers: impaired mobility (difficulty moving), difficulty staying nourished (poor nutrition), or are in a coma. This measure reports high-risk, long-stay residents who have pressure ulcers/injuries. These residents are dependent upon the nursing staff to turn and reposition them frequently to avoid pressure ulcers/injuries. Nursing homes should have a strong pressure ulcer/injury program that emphasizes frequent repositioning in residents at high risk. This measure is not risk-standardized by CMS. Lower percentages are better.

Percentage of long-stay residents who were physically restrained

The measure reflects the percentage of long-stay residents who were physically restrained on a daily basis during the reporting period. Restraints are defined as any manual, physical, or mechanical device, material or equipment that prevents or restricts the resident from being mobile. Examples include vests, straps or belts, limb ties, wheelchair trays or bars that cannot be removed by the resident, as well as bed siderails, particularly siderails that extend the full length of the bed. Physical restraints have been known to cause significant injury and death and should rarely be used. Nursing homes should ensure that residents with any type of restraint always be able to be directly observed by staff for safety reasons. Alternative options for restraints may include lowering the bed and placing a floor pad next to it to protect the patient if they roll off the bed or fall when getting up. This provides a safer environment that allows a resident more freedom. This measure is not risk-standardized by CMS. Lower percentages are better.

Resident Change in Ability and Mobility (Data Source: CMS MDS Quality Measures: 04/01/2021 through 03/31/2022)

Percentage of long-stay residents whose ability to move independently worsened

This measure reports the percent of long-stay residents who experienced a decline in independence of locomotion (bed mobility, transferring, or walking) during the target period. Residents are excluded from this measure if they are comatose, in hospice or with prognosis of < 6 months to live, or were totally dependent on previous assessments. Nursing home staff should provide restorative care or physical therapy to prevent these losses when possible. This measure is risk-standardized by CMS. Lower percentages are better.

Percentage of long-stay residents whose need for help with activities of daily living increased

This measure reports the percentage of long-stay residents who have an increased need for help with activities of daily living (ADLs) since the last assessment. It measures four specific activities thought to be lost only late in life: bed mobility, bed transfers, eating, and toileting. Residents are excluded if they were totally dependent for all four activities or 3 of 4 activities in prior assessments, are comatose, have a life expectancy < 6 months, or are on hospice. While some loss of these functions might be expected in some residents, nursing homes with very high scores may indicate poor quality of care. Nursing home staff should provide restorative care or occupational or physical therapy to prevent these losses when possible. This measure is not risk-standardized by CMS. Lower percentages are better.

Health Care Quality (Data Source: CMS MDS Quality Measures: 04/01/2021 through 03/31/2022)

Percentage of long-stay residents who have symptoms of depression

This measure reflects the percent of long-stay residents who have had symptoms of depression. The symptoms are measured by loss of interest or pleasure, feeling down, depressed, or hopeless either verbally expressed in an interview or observed by staff. Residents who are comatose are excluded. Depression is not uncommon in older adults and may reflect a poor quality of life. Some residents may need medications, which must be ordered by their primary care or psychiatric care provider. However, caution should be taken as some medications may increase risk for falls or have serious side effects. Nursing homes should engage residents in meaningful ways with individual and group activities such as music therapy, socialization with friends and family, and efforts to improve their mobility and participation in activities of daily living to prevent or reduce symptoms of depression. This measure is not risk-standardized by CMS. Lower percentages are better.

Percentage of long-stay residents who lose too much weight

Unexpected or unintentional weight loss is often associated with poor health outcomes and could be associated with an underlying illness. However, it may also be associated with certain medications, difficulty chewing or swallowing food, poor dental health, and depression among other causes. Nursing home staff should monitor each resident’s weight regularly and if there is unintentional, significant weight loss (5% or more in the last month or 10% or more in the last 6 months), they should notify the primary care provider who may order diagnostic tests, a dietary consultation, and changes in the type of diet. This measure is not risk-standardized by CMS. Lower percentages are better.

Percentage of long-stay residents with a urinary tract infection

This measure reports the percentage of long-stay residents who have had a urinary tract infection (UTI) within a 30-day period, where the resident has positive signs or symptoms and laboratory findings requiring medication. UTIs are common in nursing homes and may be prevented with proper hydration, nutrition, mobility, improved voiding habits, and better perineal hygiene. Higher numbers of residents with UTIs may indicate poor care.  Nursing homes should use regular hydration processes and prompted or scheduled voiding processes, which may reduce the incidence of UTIs. This measure is not risk-standardized by CMS. Lower percentages are better.

Percentage of low-risk long-stay residents who lose control of their bowels or bladder

This measure reports the percent of low-risk, long-stay residents who frequently lose control of their bowel or bladder (are incontinent). Low risk means that the resident does not have cognitive impairment, is not dependent for help with bed mobility or bed transfer, does not have a catheter left in their bladder or an ileostomy.  Over half of nursing home residents are incontinent of urine, which can increase their risk for falls with injury and pressure ulcers/injuries. Residents who are incontinent often avoid group activities due to embarrassment and may have a lower quality of life. Staff can reduce incontinence episodes by employing strategies such as bladder training and prompted or scheduled voiding. This measure is not risk-standardized by CMS. Lower percentages are better.

Percentage of long-stay residents who have or had a catheter inserted and left in their bladder

A catheter is a tube placed in the body to drain and collect urine from the bladder, which may be necessary for residents who have lost bladder function. This measure reports the number of residents who have a catheter left in their bladder during a 7-day reporting period. Residents with neurogenic bladder or obstruction in the urine system are excluded from this measure because an indwelling catheter (left in place) is necessary. Residents with indwelling catheters are at high risk for bladder infections. One alternative is intermittently inserting a catheter and removing it once the bladder is empty, which helps to reduce the risk of bladder infections. This measure is risk-standardized by CMS. Lower percentages are better.

The California Department of Public Health (CDPH) state inspectors conduct nursing home inspections on behalf of the federal government (Centers for Medicare and Medicaid-CMS) and the state to ensure that facilities are meeting federal and state health and safety standards. Examples of standards include adequate staffing, managing medications properly, storing and preparing food properly, protecting residents from physical or mental abuse or neglect.

There are multiple types of inspections including standard health inspections that occur approximately every 9-15 months, complaint investigations, infection control investigations, and special incident investigations. CMS issues federal deficiencies for serious health and safety violations that are found during these inspections.  Similarly, the state of California issues citations to enforce the state’s nursing home quality and safety standards. Details below show the specific areas where health and safety violations occurred. Readers can use this information to help determine the right fit for a resident and ask questions of nursing home administrators about corrections the facility is making to address the problem(s). Residents and family members have the right to review the inspection reports issued by CDPH.

Combined Federal and State Health Inspections Rating (Data Source: Cal Long Term Care Compare: through 08/01/2022)

This rating is based on the number and type of state citations issued between July 2018 and June 2021, and federal deficiencies that were found during the nursing home’s two most recent health inspections. More weight is given to the most recent health inspection. The state may cite a facility for the same violation that the federal government assigns a deficiency, while other times the federal and state violations are completely different.

More weight is given to the most recent inspection and, therefore, the most recent violations. 

Higher ratings are better and mean that the nursing home has fewer and/or less serious violations than those with average or below average ratings. Click on the badge for an explanation of the ratings.

Complaints about nursing home quality of care may be filed with the California Department of Public Health by residents, family members, nursing home staff, or long term care ombudsman from the California Department of Aging. Complaints are investigated within 24 hours of a death or serious harm and 10 days for other potential violations. Complaint investigations must be completed within 60 days. These complaints may result in one or more federal deficiencies and/or state citations and possible fines.

Substantiated complaints from last three years (Data Source: CMS Provider Data: 04/01/2019 through 03/01/2022)

This number represents the total number of complaints made about the facility that were substantiated by state inspectors following an investigation and compares it to the state average number of substantiated complaints. Lower numbers are better Note: Some facilities that had 0 substantiated complaints had too few residents to be rated as “superior.” Lower numbers are better.

Substantiated complaints from the last three years RATING

This rating is based on the number of complaints that were substantiated by state inspectors over the last three years. Higher ratings are better and indicate that the nursing home has fewer complaints than those with average or below average ratings. Click on the badge for an explanation of the ratings.

This section shows details about the types of federal deficiencies issued for violations among 10 inspection categories.

Number of federal deficiencies (Data Source: CMS Health Deficiencies: see dates in the table)

This measure shows the number of federal deficiencies issued for serious violations by the nursing home based on health and infection control inspections and complaint and special incident investigations. The nursing home’s total is compared with the state average number of deficiencies. Lower numbers are better.

Dates of two most recent health inspections (Data Source: CMS Health Deficiencies: see dates in the table)

This shows the dates of the nursing home’s last two standard health inspections by the California Department of Public Health. More recent dates are better because residents and family members can be more confident that the reported measures reflect the nursing home’s current safety and quality of care and adherence to laws and regulations. It is important to note that very few nursing homes received health inspections in 2020 and 2021 due to the COVID-19 pandemic, which is why these dates may be earlier than 2020.

Type, Scope and Severity of Deficiencies (Data Source: CMS Health Deficiencies: see dates in the table)

The standard health inspection usually occurs unannounced once per year and covers 10 different topic areas: Freedom from Abuse, Neglect, and Exploitation, Quality of Life and Care, Infection Control, Resident Assessment and Care Planning, Nursing and Physician Services, Pharmacy Service, Resident Rights, Nutrition and Dietary, Environmental, and Administration. This shows the number of deficiencies issued within each category. Lower numbers are better.

Number of deficiencies by severity and number of deficiencies by scope

CMS instructs inspectors to assess the severity and scope of deficiencies and select the appropriate enforcement action. The severity level reflects the impact of a deficiency and is categorized by four levels of harm. The severity harm levels are: no actual harm with potential for minimal harm; no actual harm with a potential for more than minimal harm that is not immediate jeopardy; actual harm that is not immediate jeopardy and; immediate jeopardy to resident health or safety. Immediate jeopardy means the situation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident. Lower numbers in all categories are better. The scope level of a deficiency reflects how many residents were affected by a deficiency. There are three scope levels assigned to a deficiency: isolated, pattern, or widespread. The survey agency determines the scope and severity levels for each deficiency.

This measure focuses on the number of residents (potentially) affected by a particular deficiency. “Many” means it is a widespread problem for residents throughout the nursing home; “Some” means that a particular deficiency represents a pattern among a smaller group of residents; and “Few” means that the deficiency is isolated to one or a small percentage of residents with no apparent pattern. Note that a deficiency affecting “few” is not necessarily reflective of the severity of the deficiency (death vs. a fall with no injury). Likewise, a widespread problem that affects many may not be severe though it still requires correction. Lower numbers in all categories are better.

For more details about the scope and severity weights table, see: https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/downloads/usersguide.pdf

This measure shows the number of state citations issued for serious health and safety violations by the nursing home occurring between July 2018- June 2021 and compares it with the state average number of citations over the same period. Lower numbers are better

State citations are similar to federal deficiencies but focus on violations of state laws and regulations in 15 health and safety categories. Citations may arise from complaint or special incident investigations, or annual health inspections or even from facility self-reported problems. State citations and federal deficiencies sometimes overlap. The citations are classified by severity into 3 categories:

Number of class AA citations (resident death) (Data Source: CA Health Facilities State Enforcement Actions: 07/01/2018 through 06/30/2021)

This citation is issued when health and safety violation(s) by a facility have been shown to cause a resident death. Fines range between $25,000 to $100,000 per incident. These citations are the most severe but are rare.

Number of class A citations (resident danger) (Data Source: CA Health Facilities State Enforcement Actions: 07/01/2018 through 06/30/2021)

This citation is issued when residents experience imminent danger (i.e., probability of serious harm or death) due to violations of state or federal laws and regulations. They are more serious and less common than the Class B citations.  Fines range between $2,000 to $20,000 per violation.

Number of class B citations (resident care) (Data Source: CA Health Facilities State Enforcement Actions: 07/01/2018 through 06/30/2021)

This citation is issued for health and safety violations that are less serious than Class A or AA violations. These are the most common citations. Fines range from $100-$2,000 per violation.

Total number of state citations (Data Source: CA Health Facilities State Enforcement Actions: 07/01/2018 through 06/30/2021)

This is the total number of citations issued during the reporting period.

In addition to deficiencies and citations, the federal government (Centers for Medicare and Medicaid Services-CMS) and state government (California Department of Public Health) may issue financial penalties to nursing homes for serious health and safety violations or their failure to correct violations over a long period of time. The penalty can be a lump sum, a daily fine until corrections are complete, or CMS may withhold Medicare payments or restrict new admissions to the nursing home until the facility corrects the violation(s). If corrections are not made in a timely manner, a nursing home can lose its federal certification and/or state license and be forced to close and residents would need to move to another certified and licensed facility.

Federal fines issued for violations from the last three years ($) (Data Source: CMS Penalities: 04/01/2019 through 03/31/2022)

This is the dollar amount charged by CMS to the nursing home for violating health and safety standards during April 1, 2019 – March 31, 2022 as compared with the state average. Fine amounts vary according to the scope (how many residents were or could be affected) and to the severity (the seriousness of potential or actual harm ranging from death to administrative violations). Most nursing homes do not have any federal fines. Lower numbers are better.

State fines issued for violations ($) (Data Source: CA Health Facilities State Enforcement Actions: 07/01/2018 through 06/30/2021)

This is the dollar amount charged by CDPH to the nursing home for violating health and safety standards during July 2018-June 2021. Most nursing homes do not have any state fines. Lower numbers are better.

Fines are classified into three categories described above in the State Citations section: Class AA, Class A, and Class B.

Total federal and state fines ($) (Data Source: CMS Penalities; CA Health Facilities State Enforcement Actions: 07/01/2018 through 03/31/2022)

This measure shows the total dollar amount for deficiencies and citations that are charged to the nursing home for violating federal and/or state health and safety standards. Most nursing homes do not have any federal or state fines. Lower numbers are better.

Number of days the facility was denied payment due to unresolved violations (Data Source: CMS Penalities: 04/01/2019 through 03/31/2022)

This is the number of days the nursing home was denied payment by Medicare for newly admitted residents as compared with the state average. Most nursing homes do not have any denials of payment. Lower numbers are better.