How to Evaluate a Nursing Home.

LoCal Care — Helping families find care they can trust, close to home.

You will almost certainly do this in a hurry.

Almost nobody researches skilled nursing calmly, over months, in advance.

What actually happens is a fall, or a stroke, or a hospitalization — and then a discharge planner tells you your mother cannot go home, and you have about forty-eight hours to choose a facility from a printed list.

That is a terrible way to make one of the more consequential decisions of your life, and it is how nearly everyone makes it.

So here is what to look at, in the order that matters, and what to ignore.

Start by ignoring the star rating on the map.

We publish restaurant and gym guides built partly on Google ratings.

For a taqueria, a 4.6 across nine hundred reviews tells you something real.

For a nursing home, it tells you almost nothing.

These facilities typically have somewhere between five and a hundred reviews — a rounding error compared to a restaurant.

They are written by families in the middle of the worst month of their lives, in both directions.

And a facility can sit at four and a half stars while carrying a review describing a resident left in a soiled brief long enough to develop sores.

Both of those things are often true at once, and the average tells you which one you will experience: nothing.

There is far better data, it is free, and it is federal.

Medicare Care Compare is the actual tool.

Every nursing home that accepts Medicare or Medicaid — roughly 15,000 nationally — is inspected by the state and rated by the Centers for Medicare & Medicaid Services.

You can look any of them up at care.medicare.gov.

Each facility gets an overall rating from one to five stars, plus three separate ratings underneath it.

Those three are the part worth your time.

Health inspections. Built from state inspection surveys — as of the July 2025 methodology change, the two most recent standard surveys, plus complaint and infection-control inspections over a three-year lookback.

This is the base of the overall score and the heaviest single component.

Staffing. Nursing hours per resident per day, split into registered nurse hours and total nursing hours, which includes RNs, licensed vocational nurses, and certified nurse aides. To earn five stars a facility has to hit five on both RN and total staffing — not one or the other.

Quality measures. Clinical data on residents. Scored against every other facility in the country: the top ten percent get five stars, the bottom twenty percent get one, and everyone else lands in between.

The overall rating is not an average of those three. It starts with the health inspection score, then adds or subtracts based on the other two — and critically, if a facility scores one star on health inspections, its overall rating cannot climb more than one star no matter how good the rest looks.

If you only look at one number, look at staffing.

Almost everything families complain about downstream — call lights unanswered, briefs not changed, medications late, falls — traces back to how many people are working the floor.

Staffing is reported as hours per resident per day, and it is the number that most directly predicts whether someone will come when your father presses the button at two in the morning.

A beautiful lobby and a courtyard tell you what the operator spent money on.

Nursing hours tell you what they spend money on every single day.

Care Compare also publishes staff turnover and weekend staffing.

Weekend numbers are worth a look, because plenty of facilities are adequately staffed Tuesday at 10am and thin on Sunday.

Read the inspection reports, not just the stars.

This is the step nearly everyone skips, and it is the most useful hour you will spend.

The actual survey findings are published — what inspectors found, what rule it violated, how severe, and how many residents it affected.

You will see plain descriptions of real incidents rather than a star average.

What you are looking for is pattern.

One citation for a labeling error is a facility being run by humans.

Repeated findings on the same issue across two surveys is a system that is not being fixed.

Are nursing home ratings comparable between states?

The health inspection rating is scored relative to other facilities in the same state.

A four-star inspection rating in California means four stars compared to California peers, not compared to Ohio.

That is deliberate, because inspection practices differ by state.

But it means the ratings are useful for comparing facilities near you and less meaningful across state lines.

Ratings also refresh on a schedule — health inspection scores monthly, staffing and quality measures quarterly — so check the current data rather than something you read last spring.

Assisted living is a completely different system.

This is the part that catches families out, and it matters enormously.

Care Compare does not cover assisted living.

It covers Medicare and Medicaid certified nursing homes only.

In California, assisted living communities are licensed as Residential Care Facilities for the Elderly and regulated by the state Department of Social Services, Community Care Licensing Division — not by CMS.

There is no federal five-star rating.

The inspection regime is lighter, the staffing requirements are different, and there is no equivalent national database.

So when you compare a skilled nursing facility against an assisted living community, you are not comparing like with like.

You can research the first one thoroughly.

You largely cannot do the same for the second, and any site presenting both with the same tidy star rating is flattening a real difference.

For assisted living, you can request the facility's licensing file and inspection history from Community Care Licensing.

Ask for it.

A facility that hesitates has told you something.

Who is the Long-Term Care Ombudsman?

Every state has a Long-Term Care Ombudsman program. It is free, it is confidential, and it exists specifically to advocate for residents and their families.

They investigate complaints, they know which facilities in your area generate them, and they will talk to you before you have placed anyone.

Most families discover the ombudsman only after something has gone wrong.

Calling first is considerably better.

Then go see it — properly.

No amount of data replaces walking in. But tour like an inspector, not like a guest.

• Go unannounced, on a weekend or an evening. Everywhere looks good at 11am on a Tuesday with a scheduled tour.

• Use your nose in the hallway. Persistent odor is a staffing problem, not a cleaning problem.

• Watch the call lights. Stand somewhere for ten minutes and count how long they stay on.

• Look at the residents, not the building. Are people out of their rooms, dressed, engaged with someone? Or parked in a hallway facing a wall?

• Ask what the nurse-to-resident ratio is on the night shift, and on Sunday. Ask how long the director of nursing has been there.

• Ask what the staff turnover rate is. They know. Care Compare knows too, so you can check the answer.

The honest bottom line.

There are excellent facilities across the Los Angeles area and there are facilities you would not want anyone you love inside of, and they are not reliably distinguishable by their websites, their lobbies, or their Google ratings.

They are distinguishable by inspection history, staffing hours, and what you see when you walk in unannounced on a Sunday afternoon.

That is an afternoon of work in the worst week of your life. We know. Do it anyway.

Quick answers.

How do you choose a nursing home when you only have a day or two?

Look up the facility on care.medicare.gov and check staffing hours and inspection history first, then visit unannounced on a weekend or an evening. Most families get roughly forty-eight hours after a hospital discharge.

Are Google star ratings useful for nursing homes?

Far less than for a restaurant. These facilities typically carry between five and a hundred reviews, written by families in the middle of the worst month of their lives in both directions, so the average tells you very little. Federal inspection data is free and much better.

What is the single most important number when comparing nursing homes?

Staffing — nursing hours per resident per day. Almost everything families complain about downstream, from unanswered call lights to late medications and falls, traces back to how many people are working the floor.

Can a nursing home have a good overall rating but poor inspections?

Only up to a point. The overall rating starts with the health inspection score, and a facility scoring one star on health inspections cannot climb more than one star overall no matter how strong its staffing and quality measures look.

Does Medicare Care Compare cover assisted living?

No. It covers Medicare and Medicaid certified nursing homes only. In California, assisted living is licensed as Residential Care Facilities for the Elderly by the Department of Social Services, Community Care Licensing Division, and there is no federal five-star rating.

What does a Long-Term Care Ombudsman do?

Every state has one. The program is free and confidential, it investigates complaints, it knows which facilities in your area generate them, and it will talk to you before you have placed anyone.

Ask what the staffing is on a Sunday night. Everything else follows from the answer.

General guidance, not medical, legal, or financial advice. Verify current ratings at care.medicare.gov and licensing status with California Community Care Licensing before making any decision. Run a care facility in Southern California? Tell us about it. Or recommend a business you love.

Read next.

• Who Pays for a Nursing Home Stay? — the coverage rules that decide what you can actually afford.
• One Day, the Roles Reverse. — what this series covers, and what we will never do.
• How to Become a CNA in California. — 160 hours, no diploma required, and often free at a community college. The realistic path into a healthcare career — and what the work is actually like.