Care Compare reports health inspection, staffing and quality measure ratings, plus an overall rating. A change in one domain can change the overall result. We use the July 2026 CMS Technical Users’ Guide here; older explanations based on three standard surveys or a four-star staffing bonus no longer describe the current calculation.
Health inspections: two standard surveys
Since July 2025, the rating uses the two most recent standard health inspections, alongside a 36-month lookback for complaint and focused infection control findings. The third standard survey can remain publicly visible without contributing to the rating. Severity, scope, applicable substandard quality findings and repeat revisits affect the inspection score.
Facilities are compared within their state. Lower inspection point totals are better: the best 10 percent receive five stars, the worst 20 percent receive one, and the middle 70 percent are split across two, three and four stars. A citation does not cause a fixed one-star loss or automatically expire from every calculation exactly three years later.
Staffing and quality measures
Staffing uses three adjusted hours measures and three turnover measures from PBJ and MDS data. Quality measure ratings use selected assessment and claims measures; not every measure displayed on Care Compare contributes to the rating. Data periods, exclusions and risk adjustment differ by measure.
CMS raised the quality measure rating thresholds in July 2026. The long-stay antipsychotic measure also changed in January 2026, with a further exclusion correction in April. Before comparing periods, check the measure definition and rating thresholds that applied to each release.
How the overall rating is calculated
- Start with the health inspection rating.
- Add one star for five-star staffing, or subtract one for one-star staffing, keeping the result between one and five. Four-star staffing does not add a star.
- Add one star for five-star quality measures, or subtract one for one-star quality measures, again keeping the result between one and five.
- If health inspections are one star, staffing and quality measures together can raise the overall rating by no more than one star.
Current Special Focus Facilities receive no overall or domain star ratings. CMS displays a warning sign and unavailable ratings. A candidate listing is a different status. Missing data can also affect whether a rating is assigned; it is not always replaced by a default star.
How to investigate a drop
Save the preview report and identify which domain moved. Check its reporting period, underlying records and any methodology change. For inspection findings, review the citation and available dispute process without delaying corrections. For staffing, reconcile the accepted PBJ file. For quality measures, have the appropriate clinical and assessment staff review the applicable specifications.
Sources and applicability
We checked these sources on . This guide covers federal requirements for Medicare- and Medicaid-certified nursing homes. State licensing and assisted living requirements need a separate check. Use the current agency notice for your facility and involve the appropriate clinical or legal adviser for decisions.
- CMS Five-Star Technical Users’ Guide — July 2026 (opens in a new tab)
Inspection, staffing and quality measure methodology; overall rating and SFF exceptions.