Nursing Home Important Information

About Nursing Home Inspections

To be part of the Medicare and Medicaid programs, nursing homes have to meet certain requirements set by Congress. The Centers for Medicare and Medicaid Services (CMS) has entered into an agreement with state governments to do health inspections and fire safety inspections of these nursing homes and investigate complaints about nursing home care.

Health Inspections

At all times, certified nursing homes must meet over 180 regulatory standards designed to protect nursing home residents. These standards cover a wide range of topics, from proper management of medications, protecting residents from physical or mental abuse and inadequate care, to the safe storage and preparation of food.

The health inspection team consists of trained inspectors, including at least one registered nurse. These inspections take place, on average, about once a year, but may be done more often if the nursing home is performing poorly.

Using the regulatory standards, the state inspection team looks at many aspects of life in the nursing home including the following:

• The care of residents and the processes used to give that care
• How the staff and residents interact
• The nursing home environment

In addition, inspectors review the residents’ clinical records, interview some residents and family members about their life in the nursing home, and interview caregivers and administrative staff.

Fire Safety Inspections

Fire safety specialists evaluate whether a nursing home meets Life Safety Code (LSC) standards set by the National Fire Protection Agency (NFPA). The fire safety inspection covers a wide range of fire protection concerns, including construction, protection, and operational features designed to provide safety from fire, smoke, and panic.

Nursing homes that have a waiver from the health occupancy provisions of the LSC or that have an acceptable Plan of Correction are considered “in compliance.”

Health and Fire Safety Deficiency Citations

When an inspection team finds that a nursing home doesn’t meet a specific standard, it issues a deficiency citation. Depending on the problem, the law permits Medicare to take a variety of actions. For example, Medicare may assess a fine, deny payment to the nursing home, assign a temporary manager, or install a state monitor. When Medicare takes an enforcement action, it considers how much harm was caused or could be caused when the nursing home fails to meet a standard.

If the nursing home doesn’t correct its problems, Medicare ends (terminates) its agreement with the nursing home. This means the nursing home is no longer certified to provide and be paid for care to people with Medicare and Medicaid. Those residents with Medicare or Medicaid who are living in the home at the time of the termination are moved to certified nursing homes.

The Complete Nursing Home Inspection

States record all the information they find during an inspection in the detailed inspection report (form HCFA-2567) which, in some cases, may be well over 100 pages. When the state finds a deficiency, it records the specific reasons for the deficiency in this report. Medicare makes every attempt to ensure all the states report their findings in a consistent and timely way.

Each nursing home that provides services to people with Medicare or Medicaid is required to make the results of its last full inspection available at the nursing home for the public to review. This website only shows some of the information from the inspection report.

What Inspection Results Mean

The inspections measure whether the nursing home meets certain “minimum” standards. If a nursing home has no deficiencies, it means that it met the minimum standards at the time of the inspection. Inspections don’t identify nursing homes that give outstanding care.

While reading these reports, keep in mind that the quality of a nursing home may get much better or much worse in a short period of time. These changes can occur when a nursing home's administrator or ownership changes or when a nursing home's finances suddenly change.

For the most current information on nursing homes, or to find out more about inspections, contact your Long Term Care Ombudsman's office or the State Survey Agency in your area. Their phone numbers can be found in the Helpful Contacts section of this website.

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