Survey (Health Inspection)
Nursing homes are subject to unannounced annual on-site health inspections or surveys. Surveyors are looking for health and safety problems within the facility, and they issue deficiencies based on their findings. The Survey star rating is based on the number, scope, and severity of the deficiencies.

Staffing
Several studies have shown that increased Staffing leads to better patient outcomes. As such, the Staffing star rating is based on the number of hours logged by nurses each day, adjusted for the number and clinical complexity of the residents they’re caring for.

Nursing facilities can earn a Bonus Star (+1) if the they are either 4 or 5 stars in Staffing and the Staffing Rating is higher than the Survey Rating. They can incur a Penalty Star (-1) if the facility is 1 star in Staffing.

Quality
The Quality star rating is based on a facility’s performance in more than a dozen measures of patient health and well being, covering both long-stay and short-stay (rehab) residents.

Nursing facilities can earn a Bonus Star (+1) if the facility is 5 stars in Quality and can incur a Penalty Star (-1) if the facility is 1 star in Quality.

Exceptions
Facilities that have had a history of severe abuse citations have their Survey Rating capped at 2. Sometimes, facilities are too new to have a Survey Rating. In that case, they will not receive an Overall Rating. Similarly, some facilities have been designated as Special Focus Facilities (SFFs) due to historical issues on their surveys. SFFs also do not receive an Overall Rating.