How the ALM Inspection Grade is built

Every measure is compared against other facilities of the same kind in the same state — a facility’s position among its peers, not a fixed target. Each category starts at the neutral point, and a measure moves it up or down according to where the facility ranks.

Each category on a grade card shows the share of the grade it carries, the exact measure behind it, that measure’s share of the category, and whether it can add or subtract — or can only subtract, where a clean record earns nothing rather than credit.

The categories are averaged, each weighted by the share shown on the card, 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 the neutral point is 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.

Where the letter comes from. For a state-licensed facility the letter comes from cut-offs set within its own state, so it is compared only with other state-licensed facilities there. For a Medicare-certified nursing home the measures are still ranked in-state, but the letter is cut from one national scale built from every CMS-certified facility in the country — the federal inspection record is the same measurement in every state.

Data quality is weighed too. 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.

The Inspection Grade is a proprietary Assisted Living Magazine grade — a 0–100 score (shown as a letter) of a facility’s regulatory inspection record, compared with other facilities of its own kind in its own state. It is built from several categories, each carrying a weighted share — ranking better than that group 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. For Medicare-certified nursing homes it can disagree with the CMS Health Inspection rating, which does not factor in enforcement and persistence.

It covers inspections, and nothing else. This grade reads a facility’s regulatory inspection record. It does not measure staffing levels, clinical quality, food, activities, or what residents and families think of the place. A facility with a strong inspection record can still be a poor fit, and a weaker record is a reason to ask questions rather than a verdict.

Not every facility is graded on the same categories. Which categories exist at all depends on what a facility’s regulator publishes — fines and problem-resolution data, for instance, are collected only at the federal level, so they are never part of a state-licensed facility’s grade. A grade can even rest on a single category when that is the only inspection data on record. It reflects what we can actually verify, and a facility is never marked down for data that does not 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.

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.