The scope & severity grid, decoded

Every citation gets one letter from A to L. The row is how much harm; the column is how many residents. Percentages show where the last three inspection cycles of citations landed nationwide.

SeverityScope
IsolatedOne or a few residents
PatternMore than a few, not most
WidespreadMost or all residents
Level 4Immediate jeopardySerious injury, harm, or death was caused or likely
J1.7%6,976 citationsCan trigger substandard quality of care.
K0.6%2,370 citationsCan trigger substandard quality of care.
L0.2%695 citationsCan trigger substandard quality of care.
Level 3Actual harmAt least one resident was harmed
G3.2%13,273 citations
H0.1%499 citationsCan trigger substandard quality of care.
I0%18 citationsCan trigger substandard quality of care.
Level 2No actual harmPotential for more than minimal harm
D62.5%262,091 citations
E22.7%95,113 citations
F6.8%28,588 citationsCan trigger substandard quality of care.
Level 1Minimal harmPotential for only minimal harm
A0%0 citations
B1.2%5,195 citations
C1.1%4,634 citations
  • Level 1 (A–C)
  • Level 2 (D–F)
  • Level 3 (G–I)
  • Level 4 (J–L)
  • Can trigger “substandard quality of care”

Most-cited F-tags nationwide

Ranked by citations in the last three inspection cycles. The harm bar is the share of those citations rated G or worse.

  1. F880Infection controlAn infection prevention and control program must be established and followed.23,352 citations · 11,742 facilities1% harm
  2. F689Quality of life & careThe facility must be free of accident hazards and provide adequate supervision to prevent accidents.21,405 citations · 10,041 facilities33% harm
  3. F812Nutrition & dietaryFood must be stored, prepared, and served under sanitary conditions.19,893 citations · 11,043 facilities0% harm
  4. F656Assessment & care planningA care plan that covers every identified need, with measurable goals and timetables.14,820 citations · 8,451 facilities3% harm
  5. F761Pharmacy servicesDrugs and biologicals must be labeled and stored properly.13,378 citations · 8,623 facilities0% harm
  6. F677Quality of life & careResidents who cannot care for themselves must get help with daily activities.10,325 citations · 6,385 facilities1% harm
  7. F695Quality of life & careRespiratory care (oxygen, suctioning) must be provided safely.9,401 citations · 6,753 facilities2% harm
  8. F550Resident rightsResidents must be treated with dignity and respect.8,999 citations · 6,264 facilities2% harm
  9. F609Abuse, neglect & exploitationSuspected abuse or crimes must be reported to the state and law enforcement on time.8,932 citations · 5,866 facilities3% harm
  10. F584Resident rightsThe facility must be safe, clean, comfortable, and homelike.8,840 citations · 5,751 facilities1% harm
  11. F755Pharmacy servicesPharmacy services must be provided, including accurate acquiring, dispensing, and administering of drugs.8,756 citations · 5,532 facilities2% harm
  12. F657Assessment & care planningCare plans must be reviewed and revised by the care team, including the resident.8,745 citations · 6,131 facilities1% harm
All 169 F-tags with their own page

How to read a citation

Every line on an inspection report has the same three parts. Once you can read them, a 40-page survey turns into a short list of what went wrong and how badly.

  1. The tag number names the federal requirement (42 CFR Part 483) the facility failed to meet. The same number means the same rule in every state.
  2. The letter is the scope and severity: how much harm (A–L runs from minimal to immediate jeopardy) and how many residents were affected.
  3. The correction date is when the state accepted the facility’s plan of correction. A missing date means the fix is still pending.

Source: CMS Provider Data Catalog, Nursing Home Health Citations, standard surveys and complaint investigations from the current three inspection cycles. Facilities can dispute citations through CMS’s IDR and IIDR processes.

Look up a tag

Frequently asked questions

What is the scope and severity grid?
A 12-cell grid CMS uses to rate every nursing home deficiency. Rows are severity (no actual harm with minimal potential, no actual harm with more than minimal potential, actual harm, immediate jeopardy) and columns are scope (isolated, pattern, widespread). Letters A through L walk the grid; D is the most common, G or higher means a resident was harmed, and J through L mean immediate jeopardy.
What is an F-tag?
F-tags are the numbered federal requirements for nursing homes in 42 CFR Part 483. A citation is written against the tag the facility violated: F684 is quality of care, F689 is accident prevention and supervision, F880 is infection control. The same tag means the same requirement in every state.
Which F-tags are cited most often?
Nationally, quality of care (F684), accident hazards and supervision (F689), infection prevention and control (F880), care plans (F656), and resident dignity and rights tags top the list. This page ranks every tag by citations in the last three inspection cycles and shows the ranking for each state.
How do I find the citations for a specific nursing home?
Use the Nursing Home Report Card lookup: search the facility by name, city, or ZIP and every citation from the last three inspection cycles is listed with the tag, date, severity letter decoded, and correction date.
Can a facility dispute a citation?
Yes. Facilities can request Informal Dispute Resolution (IDR) with the state or Independent IDR (IIDR) with CMS. A citation that is overturned is removed from Care Compare in a later data release; the data here reflects what CMS currently publishes.

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