One in four five-star nursing homes has a finding where a resident was harmed
From September, Medicare inspects five-star homes less often. So we read the inspection record of every five-star nursing home in the four states we cover — 347 of them — and found that 85 carry a finding where an inspector recorded a resident was actually hurt.
What we found
Of 347 five-star nursing homes across California, Arizona, Nevada and New Mexico, 85 carry at least one finding where an inspector recorded a resident was actually harmed.
66 of those 85 do not have a five-star inspection record. They reached the top rating on staffing and quality scores, which are averaged in with inspections.
From September these are the homes Medicare inspects less thoroughly — so the rating now decides who gets looked at closely, not just who looks good to families.
Next month Medicare starts inspecting some nursing homes less thoroughly than others. The homes that qualify for the lighter touch are the ones rated five stars with a clean recent record, and they will get a badge on their public page saying so.
So our watchdogs asked a simple question: what is actually in the inspection record of a five-star home?
We pulled every one of them across the four states we cover — 347 nursing homes rated five out of five — and read their citation histories.
85 of the 347 have at least one finding where a federal inspector recorded that a resident was actually harmed. That is close to one in four.
How a five-star home can have harm findings
This isn’t a scandal and it isn’t a gotcha. It is how the rating is built, and almost nobody explains it.
The overall star rating is not a measure of inspections. It starts from the inspection score, then moves up or down based on two other things: how many nursing hours the home reports per resident, and a set of quality measures. A home with a middling inspection record and strong staffing numbers can finish at five stars.
The data shows exactly that. Of the 85 five-star homes carrying a harm finding, 66 do not have a five-star inspection record. They reached the top rating on staffing and quality scores. Only 19 have five stars on inspections as well.
Put plainly: for most of these homes, the five stars on the front page are not telling you that inspectors found nothing. They are telling you something else, averaged in.
Where they are
| State | Five-star homes | With a harm finding | Share |
|---|---|---|---|
| New Mexico | 13 | 8 | 62% |
| California | 274 | 66 | 24% |
| Nevada | 20 | 4 | 20% |
| Arizona | 40 | 7 | 18% |
| All four | 347 | 85 | 24% |
New Mexico stands out, and we want to be careful about it rather than dramatic. Thirteen is a small number of homes — one more or one fewer moves that percentage by eight points. What it does tell you is that in a state with only 68 nursing homes in total, being rated at the top does not narrow the field as much as a family would hope.
What we are not saying
We are not saying these homes are bad, or that a five-star home is no better than a one-star home. On average it is, and the ratings are the best free starting point a family has.
We are also not saying a harm finding means your relative would be harmed. A finding is a moment, recorded by an inspector, sometimes years ago, usually corrected afterwards. Facilities can appeal them.
What we are saying is narrower and, we think, more useful: the star is a summary of several different things, and it can hide the one thing you most want to know. If you are choosing a home, the number of stars is where you start, not where you stop.
How to check any home in about two minutes
- Search the home by name on Medicare’s Care Compare.
- Ignore the big star for a moment and look at the health inspection rating underneath it. That is the one built from what inspectors found. If it is lower than the overall rating, the overall has been lifted by staffing or quality scores.
- Open the inspection findings and look at the severity letter on each one. A through F means no resident was recorded as harmed. G and above means one was. Nationally about 93 of every 100 findings are the first kind.
- Check the date of the last full inspection. From September, a five-star home with a clean recent record may be inspected less often — so an old date on a five-star home will start to mean something different from what it meant last year.
If you would rather not do it alone, send us the name of the home and we will send back what its record says. No charge, and it commits you to nothing.
Why we ran this
Because from September the star rating stops being only a consumer signal and starts being a regulatory one — it decides who gets looked at closely. A rating used that way deserves to be understood, including by the families it was built for.
We will re-run this every quarter and publish what moves.
Send us a name. We'll pull the record.
Give us the home or the caregiver and we'll tell you what the state's records actually say — in plain English, usually the same day. Free, and there's no obligation either way.
Someone will text you back within 15 minutes.
What should we look up?
A home, a caregiver, or both — whatever you've got.
How we did this
We downloaded the CMS "Provider Information" file on 12 August 2026 and selected every nursing home in California, Arizona, Nevada and New Mexico with an overall_rating of 5 — 347 facilities. For each, we queried the companion "Health Deficiencies" file for its full citation history and counted findings graded G, H, I, J, K or L, which are the grades CMS uses to record that a resident was actually harmed.
We then compared each home's overall_rating with its health_inspection_rating to see how many had reached five stars overall without a five-star inspection record.
Two limits worth stating. The deficiencies file holds roughly the last three inspection cycles, so "has a harm finding" means within that window, not ever. And a small state with few five-star homes produces a percentage that moves a lot on one facility — which is why we publish the counts alongside the percentages rather than the percentages alone.
Full method, including the exact fields, is on our How we count page. Every figure here is reproducible from files anyone can download free from the CMS Provider Data Catalog.
We quote official records rather than characterising them, and we say when a finding is under appeal. Where a home or an individual is named, we contact them first and publish any response in full.