More than 14,800 nursing homes — nearly every active facility in America — have been cited for at least one violation since the beginning of 2021, according to data from the Centers for Medicare & Medicaid Services, the agency that administers federal health care programs covering more than 160 million Americans.
Those citations cover a wide variety of deficiencies and range in scope and severity; some point out isolated incidents that are not currently dangerous, but may cause problems in the future, while others identify widespread patterns that pose serious and immediate risk to the health and safety of residents.
To better understand the landscape of nursing home deficiencies, we analyzed a set of over 276,000 nursing home health citations given to facilities from 2021 through 2023 to see where violations occur most often and which types of deficiencies are most common.
Where are violations most common?
No state had more citations in the three-year period than California, with more than 31,200 violations handed out to facilities in the Golden State. Illinois, Texas, Pennsylvania, Ohio, Michigan, and Indiana also had at least 10,000 citations given, with Missouri, Florida, and Massachusetts rounding out the top 10.
But Massachusetts is the only one of those 10 states that isn’t also in the top 10 for most nursing homes in the state, and even it is 14th on the list. California and Texas each have over 1,000 nursing homes, representing 16% of the nation’s total facilities in just two states.
If we look at the average number of violations per facility by state, several states with relatively few providers rise to the top of the list. Illinois, Michigan, California, and Pennsylvania still rank highly because of especially high numbers of citations, but New Mexico (30th on the list of total violations) has the highest citation rate, with each of its 68 nursing homes — less than 6% of California’s total — being flagged for an average of nearly 40 violations from 2021 through 2023.
And predictably, the cities with the most violations are major metropolitan areas in the states with the largest violation totals. Chicago leads with nearly 3,900 violations, followed by Los Angeles; Cincinnati; San Antonio; Philadelphia; Indianapolis; Houston; St. Louis; Columbus, Ohio; and Pittsburgh.
There are 54 nursing homes with more than 100 citations, topped by the Seal Beach Health and Rehabilitation Center in Seal Beach, a city in Orange County, California. More than half of the repeat violators, including eight of the top 10, are located in either California or Illinois, with the remaining providers spread across 11 other states.
The top 25 nursing facilities in the U.S. by citations, 2021–2023
| Rank | Facility | City | State | Violations |
|---|---|---|---|---|
| 1 | Seal Beach Health And Rehabilitation Center | Seal Beach | CA | 185 |
| 2 | Watseka Rehab & Health Care Center | Watseka | IL | 168 |
| 3 | Alta View Post Acute | Los Angeles | CA | 166 |
| 4 | The Loft Rehab Of Rock Springs | Decatur | IL | 158 |
| 5 | Aventura At Terrace View | Olyphant | PA | 157 |
| 6 | Kingston Rehabilitation And Nursing Center | Kingston | PA | 153 |
| 7 | Artesia Palms Care Center | Artesia | CA | 148 |
| 8 | Park Avenue Healthcare & Wellness Center | Pomona | CA | 144 |
| 9 | El Paso Health Care Center | El Paso | IL | 143 |
| 10 | Accolade Healthcare Of Savoy | Savoy | IL | 139 |
| t-11 | Glen Brook Rehabilitation And Healthcare Center | Berwick | PA | 137 |
| t-11 | Bloomington Rehabilitation & Healthcare Center | Bloomington | IL | 137 |
| 13 | Ignite Medical Resort Oak Creek | Oak Creek | WI | 136 |
| 14 | Madison Health And Rehabilitation Center | Madison | WI | 135 |
| 15 | Arcadia Care Danville | Danville | IL | 131 |
| 16 | Chicago Ridge Skilled Nursing Facility | Chicago Ridge | IL | 127 |
| 17 | Inland Valley Care And Rehabilitation Center | Pomona | CA | 125 |
| 18 | The Terrace At Crystal LLC | Crystal | MN | 123 |
| 19 | Aperion Care Arbors Michigan City | Michigan City | IN | 123 |
| t-20 | Milford Healthcare And Rehabilitation Center | Milford | PA | 119 |
| t-20 | City View Multicare Center | Cicero | IL | 119 |
| t-22 | Ryze West | Chicago | IL | 118 |
| t-22 | Maclay Healthcare Center | Sylmar | CA | 118 |
| t-22 | Infinity Park Post-Acute And Rehabilitation Center | Overland Park | KS | 118 |
| 25 | Kei-Ai Los Angeles Healthcare Center | Los Angeles | CA | 117 |
What kinds of violations are cited most often?
The violation data we reviewed includes citations for 207 different deficiencies across 10 different categories, ranging from administrative issues like not having proper ethics training for staff to failing to report instances of abuse and neglect to the proper authorities in a timely manner.
Given the increased risk COVID-19 carries for older populations, it should come as no surprise that the most commonly cited violation from 2021 through 2021 was for failure to “provide and implement an infection prevention and control program,” with 7,700 facilities receiving that citation more than 16,000 times combined.
Other frequent citations relate to keeping facilities free of accident hazards, following food safety standards, drug safety and storage procedures, and protecting residents from abuse or neglect.
The 10 most commonly cited nursing home violations
| Rank | Deficiency | Category | Violations |
|---|---|---|---|
| 1 | Provide and implement an infection prevention and control program. | Infection Control | 16,752 |
| 2 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Quality of Life and Care | 15,212 |
| 3 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Nutrition and Dietary | 11,732 |
| 4 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Quality of Life and Care | 11,653 |
| 5 | Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured. | Resident Assessment and Care Planning | 8,964 |
| 6 | Provide care and assistance to perform activities of daily living for any resident who is unable. | Quality of Life and Care | 8,060 |
| 7 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Pharmacy Service | 8,015 |
| 8 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Quality of Life and Care | 7,223 |
| 9 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Freedom from Abuse, Neglect, and Exploitation | 6,786 |
| 10 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Freedom from Abuse, Neglect, and Exploitation | 5,899 |
Fortunately, fewer than 7% of all citations involved actual harm or immediate jeopardy to residents’ health and safety. Just over 60% of citations were scored as carrying the “potential for more than minimal harm (but) not immediate jeopardy” on an isolated basis (affecting only one resident) while only 741 citations — 0.3% of the total — were graded as having widespread immediate jeopardy to residents.
What about Kentucky, and more specifically, Louisville?
Kentucky performs well when comparing statewide metrics to the rest of the country. The state’s 273 nursing homes have been cited 1,226 times since 2021, the 40th-highest total of all states. But because of the number of facilities, those providers have received an average of just 4.5 violations, lower than every state except for Alabama.
And no state has had a larger drop-off in violations from 2021 to 2023 than Kentucky. Citations declined by 55% over the time period, an impressive turnaround given that three other Southern states — Mississippi, Georgia, and Louisiana — have seen violations double in the last three years.
But that doesn’t mean that there are no issues at nursing homes in the Bluegrass State.
Providers in Louisville, which have four of the five highest violation totals in Kentucky, account for 24% of the state’s violations — and a similar percentage of the violations that pose immediate jeopardy to residents’ health and safety — despite only representing 13% of nursing homes.
The worst offender in Kentucky, according to the CMS data, is Lyndon Woods Care & Rehab, LLC, in Louisville, which was cited 72 times in 2023 alone, and 81 times across the entire review period — more than twice as many as any other provider.
Lyndon Woods has been cited 12 times for violations deemed to carry immediate risk to residents’ health and safety, including a March 2023 citation that the facility was not providing enough everyday nursing staff to meet its residents’ needs — though it’s worth noting that the CMS data marks all 81 of Lyndon Woods’ violations as corrected as of September 2023.
The top 10 nursing homes in Kentucky by violations
| Provider | City | Violations |
|---|---|---|
| LYNDON WOODS CARE & REHAB, LLC | LOUISVILLE | 81 |
| CLIFTON OAKS CARE AND REHAB CENTER, LLC | LOUISVILLE | 39 |
| LANDMARK OF LOUISVILLE REHABILITATION AND NURSING | LOUISVILLE | 38 |
| LEXINGTON PREMIER NURSING & REHAB, LLC | LEXINGTON | 30 |
| SENECA PLACE | LOUISVILLE | 27 |
| MADISON HEALTH AND REHABILITATION CENTER | RICHMOND | 25 |
| STONECREEK HEALTH AND REHABILITATION | PADUCAH | 23 |
| EDGEWOOD ESTATES | FRENCHBURG | 22 |
| CHAUTAUQUA HEALTH AND REHABILITATION | OWENSBORO | 22 |
| CARMEL MANOR | FORT THOMAS | 21 |
Data sources and methodology
Data on nursing home citations comes from the Center for Medicare & Medicaid Services’ Health Deficiencies dataset, which was updated January 1, 2024, and released to the public January 31, 2024. We filtered to citations issued to providers in the 50 U.S. states and District of Columbia between January 1, 2021, and December 31, 2023.