The rating system features a rating of one to five stars based on a combination of three ratings. The main basis of the rating is the health inspection rating, which is increased or decreased if the staffing ratio is especially high or low (plus other quality measures).

1. Health Inspections Rating: This rating is based on outcomes from state health inspections, which are unannounced, annual, onsite, and comprehensive inspections. The average of the three most recent inspections also takes into account complaint investigations.
2. Staffing Ratios: Measures based on nursing home staffing levels:
   • Registered nurse hours per resident day.
   • Total care staffing hours per resident day.
3. Other Quality Measures: These are based on performance on 11 ratings. The data comes from what the facility submits as part of a federally mandated process for clinical assessment.