The Madison Senior Living

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 state-licensed facilities in Missouri. 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.

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.

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 Methodology panel lists the categories this facility is graded on.

The period we look at. This grade is built from inspection reports we have read ourselves. To be graded, a facility needs at least three from the past five years; the grade then counts every report we hold for it, not equally. Recent inspections count more: those from the last 2 years count in full, those 2–5 years old count half, and older ones count a quarter. So a facility is judged mostly on how it runs now, and an old problem fades rather than following it forever.

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.

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 Missouri — 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.

Every inspection on record counts, but not equally. Recent inspections count more: those from the last 2 years count in full, those 2–5 years old count half, and older ones count a quarter. A facility is judged mostly on how it runs now, and an old problem fades rather than following it forever.

1. Serious deficiencies 57% of grade
   • Severity by class Every deficiency we read from inspection reports, weighted by its class and divided by the number of inspections, with recent inspections weighted more. Missouri law (RSMo 198.085) sorts every deficiency into three classes. Class I: a violation that presents an imminent danger to the health, safety or welfare of any resident, or a substantial probability that death or serious physical harm would result. Class II: a violation with a direct or immediate relationship to the health, safety or welfare of any resident, but no imminent danger. Class III: a violation with an indirect or potential impact on the health, safety or welfare of any resident. The grade weighs each class by the midpoint of its fine range under RSMo 198.067 ($1,000-$10,000, $250-$1,000 and $50-$250), so one Class I counts as much as about 37 Class III deficiencies and one Class II as about 4. Each deficiency's class comes from the regulation it cites, which names the class in its own text; where a rule allows two classes, from the inspection report. A deficiency we could not place in a class counts in the totals but carries no class weight. 100% of this category · can only subtract — a clean record here earns nothing
2. Deficiencies 43% of grade
   • Deficiencies per inspection All deficiencies divided by the number of inspections, with recent inspections weighted more. 66.7% of this category · can add or subtract
   • Deficiencies per bed All deficiencies divided by resident beds, with recent inspections weighted more. 33.3% of this category · can add or subtract

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. The letter comes from cut-offs set within Missouri — so every facility is compared only with state-licensed facilities in Missouri.