What You Need to Know About Nursing Home Inspections

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  • What do you know about nursing home inspections? Health officials investigate living conditions at nursing homes. Find out how this helps protect seniors.

Skilled nursing services are crucial for hundreds of thousands of people recovering from hospital care each year. Nursing homes treat adults with long-term health conditions and older adults whose needs have surpassed what's available in assisted living communities. These facilities must be safe, clean and professional places where residents receive the care they need to thrive. Routine nursing home inspections are an effective tool for making sure facilities meet or exceed standards of care for their residents.

Every state requires some form of nursing home inspection for the facilities it licenses. The schedule and intensity of these inspections vary, but as a rule, most should be inspected every one to two years. Nursing homes with active complaints or public concerns may be inspected more often than this, sometimes with little or no warning ahead of time. 

What Is a Nursing Home?

Nursing homes, or skilled nursing facilities (SNFs), are residential inpatient health care providers where people who need frequent nursing care can recover from serious illnesses. Stays at these facilities may be as short as a few days, or they may last months. Often, people check into an SNF for recovery services after surgery or a traumatic injury. Seniors frequently spend time in a nursing home after surgery or a fall that resulted in a broken bone. Nursing home staff typically includes at least one doctor, several RNs, nurses’ aides and various specialists, such as physical and occupational therapists. Each resident of a skilled nursing facility gets an individual treatment plan to follow as well as room and board, routine care services and community events designed to keep them engaged with their surroundings.

Nursing Home Inspection Authorities

States generally regulate residential care facilities, though the manner in which they do this varies. Some states regulate SNFs as health care facilities, somewhat akin to hospitals and outpatient clinics. Others regulate nursing homes with other kinds of senior care, such as residential homes, assisted living communities and hospice providers. Many states regulate all of these facilities through a public health department, though some have a department of senior services that's focused more on the needs of seniors.

However a state chooses to regulate its nursing care homes, the facility and care guidelines are broadly similar from place to place. Guidelines generally impose rules to create environments that are safe, clean, adequate and professional.


Safety is the first consideration for every nursing home resident. Regulations typically outline health and safety standards that must be kept up to maintain licensure. The grounds of a facility must not present obvious hazards, such as standing water or broken pavement. Guard rails and other safety equipment should be present and used correctly. Defibrillators and other emergency supplies should be in stock and charged up. Resident populations must be low enough to allow rapid evacuation in case of fire, and staff must be trained in emergency response techniques. All allegations of abuse, neglect or other safety issues must be reported, investigated and corrected as soon as possible.


Nursing homes are expected to keep up a clean appearance and routinely sanitize surfaces to reduce the risk of infection. Pests and other vermin must not be present. Bedding and bathroom fixtures must be kept clean, and kitchen equipment must be up to state standards. No mold, cosmetic or structural damage or other obvious upkeep issues may be present in most licensed nursing care homes.


Every resident of a nursing home has special needs, and regulations generally define the scope of care that an SNF is allowed to practice. As a rule, a new resident may not be admitted to any facility that can’t adequately care for all of their needs. These needs may include assistance with personal care, medication management and rehabilitation services as well as special dietary provisions.


Nursing home facilities almost always have minimum staff requirements to follow. These include training, background and professional qualification standards for each position that involves interaction with residents. Continuing training requirements are common, as are special modules on the needs of seniors and dementia management.

How Often Are Nursing Homes Inspected?

In order to keep up the standards set by state regulators, scheduled nursing home inspections usually occur annually or every two years. Annual inspections are often scheduled in advance, though state regulators may stage unannounced visits at any time. Inspections for specific issues can be scheduled as a result of public complaints, and follow-up inspections are routine for identified violations that need to be corrected. 

What Do Inspectors Look For?

The details of how inspectors work can get complicated, but most inspections follow similar procedures. First, inspections almost always include the general impression of the facility, whether it appears well-maintained or any obvious hazards are present. Next, inspectors usually note the appropriate posting of residents’ rights and contact information in prominent areas as well as the presence of safety equipment. Licensed care facilities generally have to keep medication in secure areas, with expired drugs properly disposed of. Inspectors will also commonly read through logs to make sure residents’ treatment plans are being followed and the laws regarding drug and equipment handling are being observed.

Nursing home inspections commonly review staff qualifications, continuing education credits and the results of pre-employment background checks. In states where a licensed doctor is required to be on call, the inspection might check in with the physician of record. Facility managers are usually required to have more training and higher certifications than staff members, which is also commonly verified.

Finally, many nursing home inspections include confidential talks with residents and their loved ones. During these voluntary meetings, residents can voice concerns about how a facility operates, or they may direct inspectors toward specific issues the inspection might otherwise have missed.

Making Inspection Findings Public

Most nursing home inspections are finished in a few hours or over the course of a single day. In some cases, a follow-up visit may be scheduled. After the inspection, investigators almost always write a report on the conditions they found. Members of the public can usually find the most recent report for any licensed facility they're considering. In many states, these reports are available directly through the state website, while in others, you can find a private service that summarizes the findings and assigns each facility a rating for how well they performed in their nursing home inspection. The federal Centers for Medicare and Medicaid Studies office has also begun posting inspection reports in response to the COVID-19 pandemic.