Our rankings are computed directly from the upstream dataset — not editorially curated and not influenced by advertisers. Each ranking surfaces a clear, reproducible metric (for example, count of records per jurisdiction, share of records within a category, or rate per capita), and the underlying numbers are visible on the associated record pages so you can verify them. We recompute rankings whenever the upstream data refreshes, and we publish the refresh cadence on the methodology page.

What Rankings Mean (and What They Do Not)

A ranking is a useful lens — it tells you where to start looking — but it is not a judgment about quality, safety, or reputation. Being at the top of a count-based ranking typically reflects scale: more records in a jurisdiction, more entities in a category. It does not mean "better" or "worse." Whenever a ranking could be misread as a quality claim, we include an explanatory note on the page. When a ranking is rate-based (per capita, per thousand, share), we describe the denominator so you can sanity-check whether the normalization fits your question.

Why We Publish These Rankings

Rankings make large public datasets navigable. Most visitors arrive with a question ("Which jurisdiction has the most records?" or "Where is this category concentrated?") and benefit from seeing a ranked list with direct links to the full records. Publishing ranked views of public data is a long-established practice in civic journalism; we are careful to surface the raw numbers, link to the official source, and avoid editorial spin. If a ranking ever implies a value judgment not supported by the data, please email us at the address on the contact page and we will review the wording.

Methodology, Sources, and Corrections

Every ranking is derived from the source dataset linked on the methodology page. We do not blend proprietary signals; we do not substitute editor opinion for data. If you believe a ranking is miscomputed or that a record is misclassified, please contact us with the specific record ID and the expected correction, and we will investigate within the next refresh cycle. Corrections that affect the published ranking are rolled forward immediately; minor formatting fixes go out with the next scheduled refresh.

How CMS Star Ratings Are Computed

The Five-Star Quality Rating program issued by the Centers for Medicare & Medicaid Services aggregates three component scores per facility: health inspections (recent survey deficiencies, weighted by scope and severity), staffing (Registered Nurse hours per resident day plus total nurse staffing hours, adjusted for case-mix acuity), and quality measures (a basket of MDS-derived clinical indicators including pressure ulcer incidence, antipsychotic use, hospitalization rate, and functional decline). Each component is normalized against same-state peers to produce a 1-to-5 rating, then combined using CMS's published weighting rules into the overall star count. Because the overall star is force-curved within each state, a 3-star facility in one state is not directly comparable to a 3-star facility in another state on its overall score — but the underlying components (deficiency counts, RN HPRD, hospitalization rate) remain directly comparable across geographies.

The Civil Money Penalties (CMP) file, published quarterly on data.cms.gov, lists every monetary penalty assessed against a certified nursing facility along with the deficiency tag, scope-and-severity grade, and effective date. Our most-fined rankings sum these penalties over the trailing 36 months; the cumulative figure reflects both the frequency and the severity of cited deficiencies. A facility with a single seven-figure penalty for resident harm may appear above multiple repeat offenders cited for paperwork lapses — the dollar amount is set by the CMS regional office based on the underlying scope-and-severity grid published in Appendix Q of the State Operations Manual.

Best-rated and lowest-rated rankings draw from the Provider Information File. A facility ranks above its peers when its overall star equals 5 and its inspection star equals 5 (the most heavily weighted component). Tie-breakers fall to RN HPRD, then to total bed count — larger facilities at the same star tier rank slightly higher because they represent more residents under that quality profile. Lowest-rated rankings invert the same logic. Where ratings are tied at the floor, we surface facilities with the most recent serious deficiency citations first, because deficiency recency is a stronger signal of current operating condition than the rolling three-year star calculation.

Readers comparing rankings across our state pages should keep one structural fact in mind: CMS's star normalization happens within each state, so a 4-star facility in a state with high average staffing wages and strong regulatory enforcement may sit below the same operator's 4-star facility in a state with weaker oversight, even though both posted identical raw component scores. For cross-state comparisons, prefer the raw RN HPRD and deficiency-count fields over the overall star.

Reviewed byPlainnursing Editorial, Health Facilities Editorial Team · June 15, 2026