Compliance Risk Index / CMS Nursing Home / By State
Quality of Life and Care Deficiencies by State
Data coverage: 2017-03-23 through 2026-07-23 · Source: CMS Provider Data Catalog · 23 states ranked
Across the 107,674 real national quality of life and care 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 — Washington is highest at 13.7 per facility, and South Carolina is lowest at 3.4, a real 4x spread.
| # | State | Volume | Avg. penalty | Facilities cited | Citations/facility |
|---|---|---|---|---|---|
| 1 | Washington | 2,622 | $45,088 | 191 | 13.7 |
| 2 | Illinois | 8,904 | $51,141 | 659 | 13.5 |
| 3 | California | 13,254 | $28,189 | 1,133 | 11.7 |
| 4 | Maryland | 2,304 | $34,178 | 217 | 10.6 |
| 5 | Michigan | 4,189 | $43,477 | 412 | 10.2 |
| 6 | Pennsylvania | 5,984 | $32,595 | 620 | 9.7 |
| 7 | Virginia | 2,683 | $41,564 | 278 | 9.7 |
| 8 | Ohio | 8,457 | $44,834 | 902 | 9.4 |
| 9 | Missouri | 4,202 | $42,093 | 472 | 8.9 |
| 10 | Indiana | 4,019 | $32,503 | 481 | 8.4 |
| 11 | Wisconsin | 2,602 | $46,952 | 310 | 8.4 |
| 12 | Colorado | 1,680 | $19,753 | 207 | 8.1 |
| 13 | Massachusetts | 2,536 | $44,637 | 324 | 7.8 |
| 14 | Minnesota | 2,280 | $28,086 | 317 | 7.2 |
| 15 | Texas | 6,999 | $30,499 | 1,116 | 6.3 |
| 16 | Florida | 3,950 | $27,719 | 663 | 6 |
| 17 | New York | 2,898 | $42,160 | 562 | 5.2 |
| 18 | Arizona | 679 | $18,102 | 133 | 5.1 |
| 19 | New Jersey | 1,666 | $44,898 | 332 | 5 |
| 20 | North Carolina | 1,640 | $31,077 | 363 | 4.5 |
| 21 | Georgia | 1,367 | $22,448 | 319 | 4.3 |
| 22 | Tennessee | 981 | $48,538 | 271 | 3.6 |
| 23 | South Carolina | 561 | $13,022 | 165 | 3.4 |
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 quality of life and care deficiencies?
Washington, at a real 13.7 citations per already-cited facility (2,622 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?
Washington's real ratio (13.7 citations per cited facility) is about 4x South Carolina's (3.4) -- 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 107,674 citations.