Reading a Nursing Home Survey Report: What Deficiency Tags Mean for a Family

Every nursing home that takes Medicare or Medicaid is inspected by state surveyors who work under federal rules. The written result is a survey report. It lists each problem the surveyors found as a deficiency, and each deficiency carries a tag number and a letter grade. Families often open this report on Care Compare, meet codes like F880 and a letter like F or G, and close it none the wiser. This guide shows how to read the report line by line, so you can judge a home by its record and not by its lobby. Our nursing homes section holds our quality measures and staffing guides in this same category.

Where the report comes from

State survey teams inspect each certified home on a regular cycle, and they also inspect after a complaint. Surveyors tour the building, watch care, talk with residents and staff, and read records. What they find is written on a federal form, the Statement of Deficiencies and Plan of Correction, called Form CMS-2567.

The left side of the form states each deficiency: the rule, what the surveyors saw, and which residents were affected. The right side holds the home's plan of correction: what it says it fixed, and by what date. Results are posted on Medicare's Care Compare site, where each home's page shows its health inspection record. The home must also make its most recent survey results available to read in the building. Ask at the front desk if you cannot find them.

What a tag number means

A tag is a code for one federal requirement. F-tags cover health and care requirements. Two examples that come up often in the CMS tag list: F880 covers infection prevention and control, and F689 covers keeping residents free of accident hazards and giving needed supervision. K-tags cover the Life Safety Code, such as sprinklers, alarms, and fire doors.

You do not need to learn the full list. When a tag catches your eye, look up its title. The title alone tells you the area of care: infection control, food safety, care plans, resident rights, staffing of care, or drug handling. Then read the surveyors' own words under the tag. The narrative is the part that matters most. It tells you what was seen, on which unit, and for how many residents.

The scope and severity letter

The letter is a grid position, set by CMS surveyor guidance. Severity runs in four levels, from low to high:

Scope has three steps: isolated (one or a very small number of residents), pattern (more than a few residents or a wider part of the home), and widespread (found through the home, or a system fault).

Put the two together and you get one letter. Isolated, pattern, and widespread at Level 1 give A, B, and C. The same three scopes at Level 2 give D, E, and F. At Level 3 they give G, H, and I. At Level 4 they give J, K, and L. So a G means one or a very small number of residents suffered actual harm. An L means a widespread problem put residents in immediate jeopardy. CMS treats set high letters on set care tags as substandard quality of care, the grid's gravest label short of a full enforcement case.

• Level 1: no actual harm, with risk of no more than minimal harm.
• Level 2: no actual harm, but risk of more than minimal harm.
• Level 3: actual harm to a resident, short of immediate jeopardy.
• Level 4: immediate jeopardy, where a problem has caused, or is likely to cause, serious injury, harm, or death.

How to compare two homes

Start with severity, not count. A home with six A to C findings about records and labels is in a different place from a home with two G findings about falls and wounds. Counts alone mislead.

Next, look for repeats. The same tag cited on two surveys in a row means the fix did not hold. A tag that shows up once and is gone next time is a better sign, above all if the plan of correction names a system change, such as new training or a new check, and not just a one-time talk with one aide.

Then look at the area of care. Tags about harm to residents, infection control, food safety, abuse checks, and care plans weigh more for daily safety than tags about a form filed late. Both count. They do not count the same for a family.

Last, read dates. Care Compare shows more than one survey cycle. A bad survey two cycles ago with two clean ones since tells a different story from a home whose letters have risen each cycle. Ask the home what changed after its worst survey, and listen for facts: new leadership, new staffing, new systems. Our staffing guide in this category shows the staffing facts to check next to the survey record.

Who pays for what

• Original Medicare pays for a short skilled stay after a qualifying hospital stay, under its own limits. It does not pay for long-term custodial care in a nursing home.
• A Medicare Advantage HMO plan covers skilled care under its plan rules and network. It does not turn a long-term stay into a covered one.
• Part D pays toward covered drugs for a resident, under its own rules. It does not pay room and board.
• Medicaid is the main payer for long-term nursing home care for people who qualify under state income and asset tests. Most long stays in the United States are paid this way in the end.
• A Medigap policy pays toward cost sharing for care Original Medicare covers, such as a covered skilled stay. It does not pay for custodial care that Medicare does not cover.
• Private pay is the resident or family paying the home's own rate. Against the national medians in Ledger F5 ($9,581 per month, semi-private) and F6 ($10,798 per month, private), private funds can fall fast, which is why many families read the survey record with extra care before they sign.

Questions to ask on a tour

Write the answers down. A home that answers in facts is giving you a good sign of its own. A home that waves the report away is giving you a sign too.

• Can I read the full text of your most recent survey, not just the summary page?
• Which tags on the last survey were at G or above, and what did you change after them?
• Has any tag been cited on two surveys in a row? What system did you put in place?
• Who leads quality work here, and how do families hear about fixes?
• If a complaint survey happened this year, what did it find and what came of it?

Sample situation

Carol is choosing between two homes for her father after a stroke. Both charge rates near the national medians she has read: about $9,581 a month for a semi-private room and $10,798 for a private room. On Care Compare, Home A shows eleven deficiencies on its last survey, which at first looks worse. Carol reads the letters. Ten are A to D findings about records, labels, and a late form. One is an F on infection control, and the plan of correction shows a new audit system. The prior survey shows no infection tag. Home B shows five deficiencies. Two are G findings, one for a fall with injury and one for wound care, and the fall tag also appears on the survey before it. Carol picks Home A, and on her tour she asks Home A's nurse lead about the infection audit. She has read the report the way surveyors write it: severity first, repeats second, count last. Her father moves in the next week, and she keeps the report in her folder for the first care plan meeting.

Steps to read any report

A survey report looks hard to read for about ten minutes. Once you know that the tag names the rule and the letter joins harm with scope, the report turns into what it was meant to be: a public record a family can use. Read severity first, watch for repeats, and let the home's own answers fill in the rest.

• Open the home's page on Care Compare and find the health inspection detail.
• List each tag, its title, and its letter. Sort your list by letter, highest first.
• Read the surveyors' narrative for every tag at F or above.
• Check the prior survey for the same tags. Mark each repeat.
• Read the plan of correction and its dates. Note whether the fix is a system or a one-time act.
• Bring your list on the tour and ask about the top items by name.

Sources

• https://qsep.cms.gov/BHFS/M4/M4S3_100.aspx