Palo Alto Commons

The Inspection Grade is a proprietary Assisted Living Magazine score — a 0–100 score (shown as a letter) of a facility's regulatory inspection record, compared with other assisted living residences in California. It is built from several categories, each carrying a weighted share — ranking better than the typical facility in your state raises the grade, worse lowers it. Serious problems weigh more than clean marks, so one severe issue costs more than a good record earns.

It is not a government rating. CMS and state health agencies publish the underlying inspection records; the grade is our own calculation from them, and no regulator endorses or reviews it.

How the score is actually built — the categories, what share of the grade each one carries, the exact measure behind it, and how the pieces combine — is set out in the Methodology panel. This page covers what the grade is, what it is not, and when we decline to publish one.

Not every facility is graded on the same categories. A facility is scored only on the categories we have verified data for, and which exist at all depends on what its regulator publishes. CMS-certified nursing homes carry federal records for four. State-regulated facilities — assisted living and adult care — are graded on what their own state publishes: here that is the categories shown above, since this state classifies its own citations by severity and publishes a complaint register. Fines and problem-resolution data are collected only at the federal level, so they are never part of a state facility's grade. A grade can even rest on a single category when that's the only inspection data on record; it reflects what we actually know, and a facility is never penalized for data that simply doesn't exist for it.

The period we look at. Where a state publishes its own inspection record, the grade follows that record and the period the state reports on. Where we grade from inspection reports we have read ourselves, the grade covers the last five years. CMS-certified nursing homes are graded on the current records CMS publishes. Either way, old findings age out: a facility isn't judged forever on a problem it has long since fixed.

Data quality. We weigh every category by how much verified data we actually have — federal CMS inspection records count fully, a state's own published record counts nearly as much, and reports read by our AI count for less. When a record is thin, we grade more cautiously and won't publish a damaging grade we can't stand behind.

Severe events. A recent, verified severe event — immediate jeopardy, substantiated abuse, or a license / Medicare termination — can cap the grade regardless of the rest.

The scale. It's set so a typical facility lands around a B+. Most homes are fine; C, D, or F is a genuine warning flag worth a closer look.

Every measure below is compared against other state-licensed facilities in California — a facility's position among its peers, not a fixed target. Each category starts at 78, the neutral point, and a measure moves it up or down according to where the facility ranks.

1. Serious citations 42% of grade
   • Serious citations The state's own most-serious category of citations, divided by the number of inspections. 100% of this category · can only subtract — a clean record here earns nothing
2. Moderate citations 32% of grade
   • Moderate citations The state's lower-severity citations, divided by the number of inspections. 100% of this category · can add or subtract
3. Complaint visits 26% of grade
   • Complaint visits Visits the regulator made to investigate a complaint, divided by beds and shown per 100 beds. A visit is an allegation being checked, not a finding against the facility. 100% of this category · can only subtract — a clean record here earns nothing

The categories are averaged, each weighted by the share shown above, giving a score out of 100. Those shares assume every category has data behind it: where one is missing — because the regulator publishes nothing for it — that category is left out and the remaining ones take its share, rather than the facility being marked down for the gap. A result above 78 is then pulled back toward it in proportion to how complete the facility's record is, so a high grade cannot rest on thin evidence. A recent serious finding can cap the result regardless of the categories. The number is finally published on a 0–100 scale where a typical facility sits in the 70s and 80s, and the letter comes from cut-offs set within California — so every facility is compared only with state-licensed facilities in California.