Nursing home safety by state: what 313,550 federal inspection citations reveal
Haven analyzed every current federal inspection record for 10,311 CMS-certified nursing homes in the United States: 313,550 health-inspection citations, 1,021 facilities carrying the federal abuse flag, 390 under Special Focus scrutiny, and $340,549,889 in civil monetary penalties. The average in this analysis is 2.98 stars and 3.89 nurse hours per resident per day.
Free to cite and republish with attribution to Haven (havenforseniors.com). Based on the CMS records in Haven’s directory; this is not a live CMS feed.
Every state, ranked
Sorted by average CMS overall star rating. States with fewer than 15 rated facilities are listed but not ranked — 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 |
|---|---|---|---|---|---|---|
| Hawaii | 31 | 3.55 | 37 | 0 (0%) | 5.18 | $699,682 |
| Arizona | 131 | 3.43 | 20.6 | 35 (26.7%) | 4.03 | $887,354 |
| New Jersey | 348 | 3.31 | 22.7 | 15 (4.3%) | 3.85 | $12,167,453 |
| Utah | 79 | 3.31 | 28.5 | 9 (11.4%) | 4.09 | $1,921,828 |
| Nevada | 56 | 3.29 | 32.4 | 7 (12.5%) | 4.32 | $726,312 |
| Delaware | 32 | 3.29 | 37 | 6 (18.8%) | 4.42 | $2,272,879 |
| Florida | 659 | 3.26 | 19.9 | 47 (7.1%) | 3.83 | $16,787,454 |
| Maryland | 197 | 3.24 | 51.1 | 24 (12.2%) | 3.89 | $4,046,983 |
| Washington | 167 | 3.23 | 50.9 | 13 (7.8%) | 4.4 | $9,133,603 |
| New Hampshire | 39 | 3.23 | 12.1 | 0 (0%) | 3.77 | $277,545 |
| North Dakota | 24 | 3.22 | 19.7 | 3 (12.5%) | 4.58 | $730,405 |
| Arkansas | 109 | 3.21 | 19.4 | 3 (2.8%) | 4.1 | $1,352,629 |
| Maine | 44 | 3.2 | 28.5 | 1 (2.3%) | 4.31 | $353,228 |
| Oregon | 107 | 3.17 | 34.3 | 8 (7.5%) | 5.04 | $3,113,481 |
| California | 1,127 | 3.16 | 50.3 | 109 (9.7%) | 4.52 | $27,603,794 |
| Colorado | 155 | 3.16 | 26.2 | 32 (20.6%) | 3.73 | $3,940,728 |
| Ohio | 699 | 3.12 | 31.6 | 30 (4.3%) | 3.7 | $18,729,880 |
| Minnesota | 198 | 3.1 | 26.3 | 12 (6.1%) | 4.18 | $4,265,526 |
| New York | 517 | 3.08 | 20.2 | 39 (7.5%) | 3.66 | $12,740,795 |
| South Carolina | 147 | 3.05 | 13 | 10 (6.8%) | 3.88 | $2,041,667 |
| Michigan | 313 | 3.04 | 34.4 | 47 (15%) | 3.95 | $9,763,365 |
| Massachusetts | 336 | 3.04 | 29.2 | 7 (2.1%) | 3.86 | $11,659,690 |
| Indiana | 332 | 3.03 | 25.2 | 21 (6.3%) | 3.72 | $2,734,749 |
| Pennsylvania | 534 | 3.01 | 31.8 | 91 (17%) | 3.92 | $14,068,328 |
| North Carolina | 293 | 3 | 18.7 | 23 (7.8%) | 3.91 | $10,749,783 |
| Kentucky | 130 | 3 | 14.3 | 1 (0.8%) | 3.99 | $2,192,974 |
| Kansas | 139 | 2.99 | 31.6 | 13 (9.4%) | 3.97 | $3,697,557 |
| Tennessee | 195 | 2.95 | 15.2 | 10 (5.1%) | 3.86 | $5,916,485 |
| Idaho | 51 | 2.9 | 28.2 | 7 (13.7%) | 3.95 | $871,961 |
| West Virginia | 62 | 2.89 | 44.8 | 5 (8.1%) | 3.65 | $1,728,018 |
| Rhode Island | 72 | 2.89 | 28.3 | 9 (12.5%) | 3.71 | $4,681,317 |
| Iowa | 161 | 2.86 | 23.9 | 10 (6.2%) | 3.96 | $3,992,027 |
| Wisconsin | 194 | 2.84 | 30.7 | 14 (7.2%) | 4.27 | $9,845,138 |
| Mississippi | 63 | 2.82 | 17.9 | 5 (7.9%) | 4.33 | $1,483,035 |
| Virginia | 214 | 2.78 | 41.2 | 25 (11.7%) | 3.8 | $5,344,851 |
| New Mexico | 30 | 2.76 | 48.4 | 6 (20%) | 3.45 | $1,640,308 |
| Alabama | 149 | 2.73 | 11.5 | 7 (4.7%) | 3.81 | $2,452,262 |
| South Dakota | 27 | 2.72 | 20.8 | 7 (25.9%) | 3.75 | $1,313,493 |
| Oklahoma | 139 | 2.65 | 24.7 | 16 (11.5%) | 3.82 | $2,794,732 |
| Nebraska | 64 | 2.57 | 22.3 | 0 (0%) | 4.26 | $790,760 |
| Louisiana | 162 | 2.57 | 24.9 | 10 (6.2%) | 3.76 | $8,091,086 |
| Vermont(small sample) | 7 | 2.57 | 26.1 | 0 (0%) | 4.37 | $672,228 |
| Georgia | 207 | 2.56 | 17.7 | 14 (6.8%) | 3.65 | $3,219,839 |
| Texas | 843 | 2.55 | 29 | 103 (12.2%) | 3.4 | $42,152,516 |
| Illinois | 416 | 2.55 | 39.5 | 124 (29.8%) | 3.42 | $50,934,425 |
| Wyoming(small sample) | 6 | 2.5 | 30.7 | 1 (16.7%) | 3.47 | $237,873 |
| Missouri | 287 | 2.41 | 40.3 | 38 (13.2%) | 3.48 | $12,151,296 |
| Montana | 19 | 2 | 41.1 | 4 (21.1%) | 3.56 | $1,576,567 |
Methodology and limitations
- Source. CMS Care Compare provider information, health-citation and penalty files. Check the source dates when comparing records. Cost figures elsewhere on this site use published survey medians (2024–2026 published survey medians).
- Scope. CMS-certified nursing homes included in Haven’s directory, not a complete census of all U.S. nursing homes. Averages summarize the records analyzed and are not population estimates. 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 records available in Haven’s directory, which may lag CMS updates. Check the linked community records and CMS source before making a care decision.
Common questions
How many nursing homes have been cited for abuse?
1,021 of the 10,311 CMS-certified nursing homes in this analysis (9.9%) carry the federal abuse icon in the records analyzed, meaning CMS flagged them 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. 390 facilities in this analysis carry Special Focus status or candidacy.
How many inspection citations does an average nursing home have?
Across 10,311 CMS-certified nursing homes, this analysis counted 313,550 health-inspection citations — an average of 30.4 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 average among homes with staffing data in this analysis 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.
Which states have the highest-rated nursing homes?
Ranked by average CMS overall star rating among states with at least 15 rated facilities, the highest are Hawaii (3.55), Arizona (3.43), New Jersey (3.31), Utah (3.31), Nevada (3.29). The lowest are Montana (2), Missouri (2.41), Illinois (2.55), Texas (2.55), Georgia (2.56). Small-state averages move on a handful of facilities, so facility counts are shown alongside every figure.
Checking on a specific community?
Every facility page on Haven shows that home's own inspection record — what inspectors actually found, when, and how severe — next to its staffing and pricing. Free, with no login.