Nursing home safety by state: what 312,541 federal inspection citations reveal
Haven analyzed the federal inspection records included in a dated CMS Provider Information snapshot for 10,304 CMS-certified nursing homes in the United States: 312,541 health-inspection citations, 1,021 facilities carrying the federal abuse flag, 396 under Special Focus scrutiny, and $346,312,926 in civil monetary penalties. The national average is 2.98 stars and 3.89 nurse hours per resident per day.
Free to cite and republish with attribution to Haven (havenforseniors.com). CMS released this Provider Information version on 2026-08-06; CMS lists the source data as last modified 2026-07-29.
CMS source snapshot: 20 days old. These are historical CMS fields from a dated source release, not live proof of availability, certification status, an inspection outcome, or an individual's care fit.
State CMS safety summaries
Listed in neutral alphabetical order. States with fewer than 15 rated facilities carry a small-sample label because an average over a dozen homes is not comparable to one over hundreds.
| State | Homes | Avg stars | Citations/home | Abuse-flagged | Nurse hrs/day | Penalties |
|---|---|---|---|---|---|---|
| Alabama | 149 | 2.74 | 11.4 | 7 (4.7%) | 3.81 | $2,615,479 |
| Arizona | 131 | 3.48 | 20.7 | 33 (25.2%) | 4.03 | $840,047 |
| Arkansas | 109 | 3.27 | 19.7 | 2 (1.8%) | 4.1 | $1,307,214 |
| California | 1,127 | 3.18 | 50.1 | 110 (9.8%) | 4.52 | $28,345,111 |
| Colorado | 155 | 3.17 | 26.2 | 35 (22.6%) | 3.73 | $4,246,169 |
| Delaware | 32 | 3.23 | 37.4 | 5 (15.6%) | 4.42 | $2,019,605 |
| Florida | 659 | 3.25 | 19.9 | 49 (7.4%) | 3.83 | $17,721,990 |
| Georgia | 207 | 2.59 | 17.6 | 13 (6.3%) | 3.65 | $3,469,719 |
| Hawaii | 31 | 3.72 | 36.2 | 0 (0%) | 5.2 | $762,854 |
| Idaho | 51 | 2.94 | 27.9 | 7 (13.7%) | 3.95 | $901,944 |
| Illinois | 414 | 2.53 | 39.5 | 121 (29.2%) | 3.42 | $52,355,528 |
| Indiana | 332 | 3.02 | 25.2 | 18 (5.4%) | 3.72 | $2,711,542 |
| Iowa | 161 | 2.88 | 23.8 | 7 (4.3%) | 3.96 | $3,431,456 |
| Kansas | 139 | 2.96 | 31.3 | 15 (10.8%) | 3.97 | $3,890,159 |
| Kentucky | 130 | 2.98 | 14.7 | 2 (1.5%) | 3.96 | $2,579,655 |
| Louisiana | 162 | 2.55 | 24.9 | 12 (7.4%) | 3.76 | $8,075,751 |
| Maine | 44 | 3.2 | 28.1 | 1 (2.3%) | 4.31 | $370,924 |
| Maryland | 197 | 3.23 | 51 | 26 (13.2%) | 3.89 | $4,520,160 |
| Massachusetts | 336 | 3.04 | 29.8 | 8 (2.4%) | 3.87 | $12,288,925 |
| Michigan | 313 | 3.04 | 34.7 | 49 (15.7%) | 3.95 | $10,526,405 |
| Minnesota | 198 | 3.12 | 26.2 | 11 (5.6%) | 4.17 | $4,293,993 |
| Mississippi | 63 | 2.84 | 17.5 | 5 (7.9%) | 4.35 | $1,622,840 |
| Missouri | 287 | 2.43 | 40 | 35 (12.2%) | 3.47 | $11,859,091 |
| Montana | 19 | 2.05 | 40.3 | 4 (21.1%) | 3.56 | $1,595,175 |
| Nebraska | 64 | 2.62 | 22.1 | 0 (0%) | 4.26 | $837,376 |
| Nevada | 56 | 3.36 | 32.5 | 7 (12.5%) | 4.32 | $740,647 |
| New Hampshire | 39 | 3.13 | 12.1 | 0 (0%) | 3.77 | $277,545 |
| New Jersey | 348 | 3.3 | 22.6 | 16 (4.6%) | 3.85 | $12,009,534 |
| New Mexico | 30 | 2.79 | 48.2 | 7 (23.3%) | 3.45 | $1,690,427 |
| New York | 517 | 3.08 | 20 | 41 (7.9%) | 3.66 | $12,597,905 |
| North Carolina | 293 | 3 | 19 | 24 (8.2%) | 3.88 | $11,308,753 |
| North Dakota | 24 | 3.22 | 19.5 | 3 (12.5%) | 4.58 | $730,405 |
| Ohio | 699 | 3.13 | 31.5 | 31 (4.4%) | 3.7 | $17,695,948 |
| Oklahoma | 139 | 2.63 | 24.5 | 15 (10.8%) | 3.81 | $2,967,610 |
| Oregon | 107 | 3.14 | 34.1 | 10 (9.3%) | 5.05 | $2,832,643 |
| Pennsylvania | 531 | 3.01 | 31.8 | 80 (15.1%) | 3.91 | $14,006,540 |
| Rhode Island | 72 | 2.92 | 28.1 | 8 (11.1%) | 3.71 | $4,853,693 |
| South Carolina | 147 | 3.04 | 12.8 | 8 (5.4%) | 3.88 | $2,047,393 |
| South Dakota | 27 | 2.72 | 20.4 | 5 (18.5%) | 3.82 | $1,084,953 |
| Tennessee | 195 | 2.89 | 15.2 | 14 (7.2%) | 3.86 | $5,917,513 |
| Texas | 843 | 2.55 | 28.8 | 110 (13%) | 3.4 | $44,241,533 |
| Utah | 77 | 3.32 | 28 | 8 (10.4%) | 4.06 | $2,077,360 |
| Vermont(small sample) | 7 | 2.57 | 25.6 | 0 (0%) | 4.37 | $672,228 |
| Virginia | 214 | 2.8 | 41.1 | 24 (11.2%) | 3.81 | $4,945,741 |
| Washington | 167 | 3.24 | 50.6 | 14 (8.4%) | 4.4 | $9,107,311 |
| West Virginia | 62 | 2.9 | 44.6 | 6 (9.7%) | 3.65 | $1,687,695 |
| Wisconsin | 194 | 2.87 | 30.3 | 14 (7.2%) | 4.27 | $9,392,564 |
| Wyoming(small sample) | 6 | 2.5 | 30.7 | 1 (16.7%) | 3.47 | $237,873 |
The downloadable file preserves the reported state summary and source-release details. It is not a Haven quality score, community ranking, recommendation, or current-availability report.
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Methodology and limitations
- Source and timing. CMS Care Compare Provider Information source data ↗ was released by CMS on 2026-08-06 and lists a source-data modification date of 2026-07-29. CMS health-citation and penalty fields are interpreted only within their published scope. Cost figures elsewhere on this site use separately labeled publisher benchmarks and derived models (Source-specific 2024 and 2025 observations; each band identifies its publisher and derivation).
- Scope. CMS-certified nursing homes only. Haven also lists state-licensed assisted living, which states inspect under different rules with no comparable federal citation record — including it would understate every rate here.
- Citations are not directly comparable across states. States run their own survey agencies and cite at different rates, so a higher count can reflect a stricter inspectorate rather than worse care. Compare within a state, and read the citations themselves.
- Small samples move. Several states have fewer than 15 rated homes; their averages swing on one or two facilities and are marked accordingly.
- Point in time. Ratings, flags and Special Focus status change as inspections occur. Figures reflect the CMS source version released 2026-08-06, whose source data CMS lists as last modified 2026-07-29.
Common questions
How many nursing homes have been cited for abuse?
1,021 of the 10,304 CMS-certified nursing homes in this analysis (9.9%) are listed with the federal abuse icon in the CMS snapshot used for this report. CMS applies the icon for abuse-related citations on a recent inspection.
What is a Special Focus Facility?
Special Focus Facilities are nursing homes CMS has identified as having a persistent record of poor care; they receive roughly twice the normal inspection frequency and face termination from Medicare and Medicaid if they do not improve. 396 facilities in this analysis carry Special Focus status or candidacy.
How many inspection citations does an average nursing home have?
Across 10,304 CMS-certified nursing homes, this analysis counted 312,541 health-inspection citations — an average of 30.3 per facility. Citation counts vary widely by state inspection practice, so comparisons are most meaningful within a state.
What is a good staffing level for a nursing home?
The national average in this data is 3.89 total nurse hours per resident per day. Research consistently associates higher nurse staffing — particularly registered-nurse hours — with better outcomes, so a facility meaningfully below its state average deserves questions.
Can I compare CMS average stars across states?
Use each state summary as CMS source context, not a quality ranking. States with fewer than 15 rated facilities are marked as small samples because one or two homes can move an average substantially. Inspection practices also vary by state, so read a specific home's CMS record before making a decision.
Checking on a specific community?
The national report remains available for research. Choose a state and metro only when you want to open a specific local research page; Salt Lake County is Haven's current public-record pilot.