Home What the inspection codes mean
What a nursing home inspection code actually means
Every citation a nursing home receives carries a single letter, A through L. Medicare publishes that letter and almost never explains it. It encodes two things at once: how serious the failure was, and how many residents it touched.
The letter is the most useful thing on an inspection record and the least understood. A family reading "scope/severity K" has no way to know they are looking at CMS's finding of immediate jeopardy — that a facility's failure caused, or was likely to cause, serious injury, harm, impairment or death to a resident. That is the most serious determination a surveyor can make.
The four levels of seriousness
No harm, minimal risk
Codes A, B, C
Potential for harm
Codes D, E, F
Actual harm
Codes G, H, I
Immediate jeopardy
Codes J, K, L
The full A–L grid
Reading down, the failure gets more serious. Reading across, it affected more people: an isolated case, a repeated pattern, or something widespread across the facility.
| Code | Means | What CMS found |
|---|---|---|
| A | No harm, minimal risk | A minor issue affecting one resident, with little potential for harm. |
| B | No harm, minimal risk | A minor issue that showed up in more than one case, with little potential for harm. |
| C | No harm, minimal risk | A minor issue found throughout the facility, with little potential for harm. |
| D | Potential for harm | No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. |
| E | Potential for harm | No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. |
| F | Potential for harm | No resident was harmed, but the failure could have caused more than minimal harm, and it affected the facility broadly. |
| G | ACTUAL HARM | A resident was actually harmed. CMS found real harm occurred, affecting one resident. |
| H | ACTUAL HARM | Residents were actually harmed, in a repeated pattern rather than a one-off. |
| I | ACTUAL HARM | Actual harm occurred and the problem was widespread across the facility. |
| J | IMMEDIATE JEOPARDY | CMS found the facility's failure caused, or was likely to cause, serious injury, harm, impairment, or death to a resident. This is the most serious finding a surveyor can make. Affected one resident or instance. |
| K | IMMEDIATE JEOPARDY | CMS found a pattern of failures that caused, or were likely to cause, serious injury, harm, impairment, or death. This is the most serious finding a surveyor can make. |
| L | IMMEDIATE JEOPARDY | CMS found facility-wide failures that caused, or were likely to cause, serious injury, harm, impairment, or death. This is the most serious finding a surveyor can make, at the widest possible scope. |
How to use this
A single D citation on an otherwise clean record is ordinary; almost every nursing home has some. A G means a resident was actually harmed. A J, K or L means CMS believed someone could have died. Look at how recent the citation is, whether it came from a complaint rather than a routine survey, and whether the facility reported a correction date.
Citations are published by the Centers for Medicare & Medicaid Services from state inspections. A citation reflects conditions found on the survey date shown and may since have been corrected. Facilities may dispute findings through informal dispute resolution. Always tour a facility and ask about anything you see here.
Definitions on this page are CMS's own, from 42 CFR 488.404 and the CMS State Operations Manual Appendix P. They describe a government term and are not a judgment about any facility.