How CMS rates nursing homes
What sits behind the stars on every Brooklyn nursing home page, in CMS's own words, with our plain-language notes in between.
CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.
“There is one Overall 5-star rating for each nursing home, and separate ratings for health inspections, staffing and quality measures.” (CMS) “Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.” (CMS)
Health inspections
“Nursing homes that participate in the Medicare and/or Medicaid programs have an onsite recertification (standard) “comprehensive” inspection annually on average.” (CMS Technical Users' Guide) “Inspections are unannounced and are conducted by a team of health care professionals who spend several days in the nursing home to assess whether the nursing home is in compliance with federal requirements.” (CMS)
Ratings for the health inspections domain are based on the number, scope, and severity of deficiencies identified during the two most recent annual inspection surveys, as well as findings from the most recent 36 months of complaint investigations and focused infection control surveys.
“Points are assigned to individual health deficiencies according to their scope and severity –more serious, widespread deficiencies receive more points, with additional points assigned for substandard quality of care (see Table 1).” (CMS) Here is that table, CMS's scope and severity grid. Each letter is a citation level; the number is the points CMS adds to a home's inspection score.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy to resident health or safety | J 50 points | K 100 points | L 150 points |
| Actual harm that is not immediate jeopardy | G 20 points | H 35 points | I 45 points |
| No actual harm with potential for more than minimal harm that is not immediate jeopardy | D 4 points | E 8 points | F 16 points |
| No actual harm with potential for minimal harm | A 0 points | B 0 points | C 0 points |
“If the status of the deficiency is “past non-compliance” and the severity is “immediate jeopardy” (i.e., J-, K- or L-level), then points associated with a G- level deficiency are assigned.” (CMS)
“The most recent standard survey (rating cycle 1) is assigned a weighting factor of 3/4, and the second most recent standard survey (rating cycle 2) is assigned a weighted factor of 1/4.” (CMS) “Note that a lower survey score corresponds to fewer deficiencies and revisits, and thus better performance on the health inspection domain.” (CMS)
“Note that results from the third most recent recertification health inspection and associated deficiencies are displayed on Care Compare but are not used for health inspection ratings.” (CMS) “Citations that are under dispute through the Informal Dispute Resolution (IDR) or Independent IDR processes are also displayed on Care Compare but not included in the health inspection score calculation until the dispute process is finished.” (CMS)
Brooklyn's citations by letter
Brooklyn citation counts and provider icon statuses on this page use CMS nursing home data released October 8, 2026, with a processing date of September 1, 2026. Counts are our tallies of that snapshot.
Our tally of the 670 citations in CMS's three-year file for the 40 Brooklyn homes:
- B 12
- C 17
- D 467
- E 130
- F 30
- G 9
- J 3
- K 2
14 citations are at G or above. Each home's page lists its own citations with CMS's description of each one.
The abuse icon
“Nursing homes that receive the abuse icon have their health inspection rating capped at a maximum of two stars.” (CMS) “Due to the methodology used to calculate the overall rating, the best overall rating a facility that receives the abuse icon can have is four stars.” (CMS)
The high-performing icon
“Nursing homes that perform highly, in addition to the traditional 5-star rating, have a trophy icon. These nursing homes have fewer citations (safety violations), higher staffing levels, and other quality indicators.” (CMS) In the current Brooklyn data, two homes have it: Bedford Center for Nursing and Rehabilitation, Shore View Nursing & Rehabilitation Center.
Staffing
“There is considerable evidence of a relationship between nursing home staffing levels and resident outcomes.” (CMS) “This includes three nurse staffing level measures (hours per resident per day) and three measures of staff turnover.” (CMS) “The staffing measures are derived from data submitted each quarter through the Payroll-Based Journal (PBJ) System, along with daily resident census derived from Minimum Data Set, Version 3.0 (MDS 3.0) assessments.” (CMS)
On each home's page we turn CMS's hours per resident per day into minutes (hours times 60), because "4.1 hours" is harder to picture than "about 246 minutes".
Quality measures
“Ratings for the quality measures are based on performance on 15 of the QMs that are currently posted on the Care Compare website.” (CMS) “In addition to an overall quality measure rating, separate QM ratings for short-stay measures and long-stay measures are also reported.” (CMS)
What the stars can't tell you
No rating system can address all of the important considerations that go into a decision about which nursing home may be best for a particular person.
Consumers should therefore use the website together with other sources of information for the nursing homes (including a visit to the nursing home) and State or local organizations (such as local advocacy groups and the State Ombudsman program).
Sources: CMS Five-Star Quality Rating System page; CMS Technical Users' Guide, September 2026 (PDF).