Methodology

Every facility page on ACD-HUB shows the same data, from the same sources, scored the same way. No advertiser placement, no preferred partners, no hidden weighting. This page explains exactly what you're seeing.

The ACD-HUB Quality & Safety Score

Every facility page on ACD-HUB carries a 0–10 Quality & Safety Score at the top — a single number meant to summarize the CMS data into something families can compare at a glance. Here's exactly how it's computed.

Step 1 — Weighted base score

We start with three CMS sub-ratings, each on a 1–5 star scale, weighted the same way CMS itself weights them for the Overall rating:

• Health Inspection rating — 50% of the base score
• Staffing rating — 25% of the base score
• Quality Measures rating — 25% of the base score

The weighted average (on a 1–5 scale) is multiplied by 2 to get the base score on a 0–10 scale. If one of the three sub-ratings is missing, the remaining weights are normalized so the present sub-ratings still sum to 100%.

Step 2 — Penalty deductions

Facilities with serious findings receive deductions from the base score:

• Abuse Citation (CMS abuse icon): −2.5 points
• Special Focus Facility (SFF): −2.0 points
• Federal penalties over $100k: −1.5 points
• Federal penalties $50k–$100k: −0.75 points
• Federal penalties $10k–$50k: −0.25 points
• Health-deficiency count over 15: −0.5 points

Step 3 — Google review blend (optional)

For facilities with 5 or more Google reviews, we blend the Google star rating into the final score at 15% weight: final = (score after penalties × 0.85) + (Google ★ score × 0.15). Facilities with fewer than 5 reviews use only the CMS-derived score — we don't trust ratings built on a tiny review base.

Step 4 — Score label

• Excellent: 8.5–10.0
• Good: 7.0–8.4
• Average: 5.0–6.9
• Below Average: 3.0–4.9
• Poor: under 3.0

The formula is published in the open at src/lib/qualityScore.ts in our repository. Every facility on the site is scored by the same function — no manual overrides, no advertiser influence, no chain-level adjustments.

Data sources

Our facility records come from three sources:

• CMS Provider Data — the official Centers for Medicare & Medicaid Services dataset, refreshed monthly. This is the same data CMS surveyors use during inspections.
• Google Business data — verified facility names, addresses, phone numbers, hours, and photos as published on Google Maps.
• Google reviews — real reviews left by visitors, family members, and former residents on Google.

CMS Five-Star ratings

CMS rates every skilled nursing facility on a 1–5 star scale across four dimensions:

• Overall rating — a composite of the three below.
• Health inspection rating — based on the last three annual surveys plus complaint investigations. Weighted most recent survey heaviest.
• Staffing rating — based on registered nurse, licensed practical nurse, and certified nursing assistant hours per resident day, adjusted for resident acuity.
• Quality measures rating — based on 15 clinical outcomes including hospital readmissions, falls, weight loss, and pain management.

A rating of 5 stars means "much above average." 1 star means "much below average." 3 stars is the national median.

Warning indicators

We surface two CMS warning flags prominently on facility pages:

• Special Focus Facility (SFF) — CMS designation for facilities with a sustained record of serious quality problems. SFF facilities are inspected twice as often as standard facilities.
• Abuse icon — CMS flag indicating the facility has been cited for abuse during one of the two most recent reporting cycles.

Deficiencies and penalties

We display health and fire-safety deficiency counts from the most recent annual inspection, plus the cumulative dollar amount of any federal penalties assessed in the previous three years. These numbers come directly from CMS — we do not adjust or weight them.

Reviews

Reviews come from Google. We import them verbatim — reviewer name, rating, date, and full text. We do not solicit reviews from facilities or curate which ones appear. Reviews flagged as spam or removed by Google are also removed from ACD-HUB.

Update cadence

CMS data is refreshed once per month, on the 27th, when CMS publishes its next monthly snapshot. Google reviews and business data are refreshed continuously throughout each month.

What we don't do

• We do not accept payment for placement or higher rankings.
• We do not remove negative reviews on request from facilities.
• We do not adjust ratings based on owner relationships or chain affiliation.
• We do not show facilities CMS has flagged as duplicates, closed, or renamed without an audit trail.