Home Scope and severity grid
Nursing Home Scope and Severity Grid (A–L)
A nursing home inspection code combines severity — how serious a deficiency is — with scope — how broadly it affects or could affect residents. The A–L grid below shows both.
This CMS system applies to federal nursing home surveys. It is not an assisted-living license classification or an overall facility rating.
The A–L grid
Severity increases toward the top. Read across each row to compare isolated, pattern and widespread scope.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy to resident health or safety | J | K | L |
| Actual harm, without immediate jeopardy | G | H | I |
| No actual harm; potential for more than minimal harm, without immediate jeopardy | D | E | F |
| No actual harm; potential for minimal harm | A | B | C |
Example: G and I both identify actual harm without immediate jeopardy. G has isolated scope; I has widespread scope. J, K and L are immediate jeopardy: serious harm has occurred or is likely, so actual harm need not already have occurred.
What scope tells you
Isolated means a very limited extent; it does not always mean exactly one resident. Pattern extends beyond a very limited number of cases or locations. Widespread describes a pervasive or systemic problem that affects or could affect a large part of the facility. The survey report provides the context behind the label.
Read the code with the inspection record
Check the survey date, the specific findings and available correction information. Ask the facility what changed and how it checks that the correction continues to work. A code describes a survey finding; it does not establish conditions today.
Browse nursing home inspection records to read each code alongside its survey information.
Common questions
What does scope and severity mean on a nursing home inspection?
The A–L code combines the seriousness of a cited deficiency with how broadly it affected or could affect residents. Surveyors assign the code using the CMS grid.
Which nursing home inspection codes mean a resident was actually harmed?
Codes G, H and I identify actual harm that is not immediate jeopardy. Read the survey report for the findings behind the code.
What does immediate jeopardy mean in a nursing home?
Codes J, K and L identify immediate jeopardy. The facility's noncompliance caused serious injury, harm, impairment or death, or made such an outcome likely. The code alone does not establish that actual harm occurred.
What is the most serious nursing home inspection citation?
L. It combines immediate jeopardy with widespread scope. All three immediate-jeopardy codes share the highest severity level; their scope differs.
Does a citation mean a nursing home is unsafe today?
Not by itself. Read the survey date, findings and correction information. A historical citation does not establish current conditions, and facilities may dispute findings through informal dispute resolution.
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.
Official sources
- CMS: Nursing Home Enforcement
- CMS State Operations Manual, Chapter 7, section 7203.3.2 — grid and definitions; revision 244, June 26, 2026.
- 42 CFR 488.404 — severity and scope factors.
Guide definitions checked September 10, 2026. Facility-data release dates are shown separately.