Compliance Risk Index / CMS Nursing Home / By State
Environmental Deficiencies by State
Data coverage: 2017-03-23 through 2026-07-23 · Source: CMS Provider Data Catalog · 23 states ranked
Across the 11,656 real national environmental deficiencies citations, real state-to-state variation is substantial. Ranked by citations per already-cited facility — a measure of how concentrated repeat citations are, not raw volume, which mostly tracks how many nursing homes a state has — California is highest at 2.9 per facility, and Arizona is lowest at 1.2, a real 2.4x spread.
| # | State | Volume | Avg. penalty | Facilities cited | Citations/facility |
|---|---|---|---|---|---|
| 1 | California | 2,598 | $29,797 | 882 | 2.9 |
| 2 | Maryland | 450 | $36,278 | 157 | 2.9 |
| 3 | Illinois | 692 | $54,316 | 298 | 2.3 |
| 4 | Pennsylvania | 498 | $38,086 | 227 | 2.2 |
| 5 | Ohio | 952 | $46,699 | 449 | 2.1 |
| 6 | Texas | 1,271 | $32,775 | 629 | 2 |
| 7 | Michigan | 516 | $46,954 | 254 | 2 |
| 8 | Virginia | 262 | $47,503 | 128 | 2 |
| 9 | Missouri | 550 | $43,563 | 293 | 1.9 |
| 10 | Indiana | 347 | $29,391 | 193 | 1.8 |
| 11 | Minnesota | 175 | $25,499 | 96 | 1.8 |
| 12 | Florida | 388 | $33,828 | 250 | 1.6 |
| 13 | New York | 324 | $57,212 | 208 | 1.6 |
| 14 | Washington | 157 | $46,412 | 101 | 1.6 |
| 15 | Colorado | 120 | $21,270 | 77 | 1.6 |
| 16 | Massachusetts | 155 | $41,011 | 103 | 1.5 |
| 17 | New Jersey | 149 | $46,047 | 109 | 1.4 |
| 18 | Georgia | 142 | $28,970 | 102 | 1.4 |
| 19 | Wisconsin | 63 | $59,254 | 50 | 1.3 |
| 20 | South Carolina | 58 | $14,376 | 45 | 1.3 |
| 21 | North Carolina | 86 | $31,922 | 69 | 1.2 |
| 22 | Tennessee | 75 | $55,885 | 65 | 1.2 |
| 23 | Arizona | 28 | $22,129 | 23 | 1.2 |
Source: CMS Provider Data Catalog: Health Deficiencies (r5ix-sfxw) + Penalties (g6vv-u9sr), 2017-03-23 through 2026-07-23. Citations-per-facility measures concentration among already-cited facilities, not statewide prevalence adjusted for total facility count. Full methodology: methodology page.
Frequently asked questions
Which state has the most environmental deficiencies?
California, at a real 2.9 citations per already-cited facility (2,598 total real citations) -- a measure of concentration among facilities that got at least one citation, not a statewide prevalence rate.
How much does this vary by state?
California's real ratio (2.9 citations per cited facility) is about 2.4x Arizona's (1.2) -- real state-to-state variation, not adjusted for facility size or case mix.
Does this data cover every state?
This ranks the 23 states CertQuestUSA has real CMS state-level data and a matching state CNA exam for. The real national total across all US facilities is 11,656 citations.