How do I check a nursing home's inspection record in California?

Two places, and they show different things. Medicare’s Care Compare (medicare.gov/care-compare) shows the federal five-star ratings built from the three most recent annual health inspections plus complaint inspections from the last three years. CDPH’s Cal Health Find shows the state’s own file: who owns the facility, whether it is certified for Medicare and Medi-Cal, the deficiencies state surveyors found, complaints and self-reported incidents, and any enforcement actions or citations the state has issued. Read both before touring. A facility can look acceptable on one and alarming on the other.

What is a good star rating for a nursing home?

Treat the overall star as a screen, not a verdict. The overall rating starts from the health inspection stars, then moves up or down based on staffing and quality measures, so a facility with weak inspections cannot buy its way to five stars with good paperwork. In practice: treat one or two overall stars as a reason to look elsewhere, and treat four or five stars as permission to keep investigating, not a guarantee. Open the staffing detail separately and look at registered nurse hours, because that number is harder to dress up than the quality measures, which are largely self-reported.

Does Medi-Cal pay for a nursing home in California?

Yes. Medi-Cal covers long-term nursing facility care with no day cap for residents who qualify medically and financially. Since January 1, 2026 the asset limit is $130,000 for a single applicant and $195,000 for a couple, with the home, one vehicle, and personal belongings exempt, and most residents pay a monthly share of cost from their income. Before admission, confirm on Cal Health Find that the specific facility is Medi-Cal certified, because a facility that is not certified cannot bill Medi-Cal no matter how eligible the resident is.

How much does a nursing home cost in California if you pay privately?

Private rates vary widely by region and room type, and they change often enough that a static number ages badly. The reliable pattern: private nursing facility care in California costs five figures a month in most regions, Medicare pays only for the short rehab window after a qualifying hospital stay, and Medi-Cal picks up long-term care for eligible residents after that. For current regional figures, use a maintained dataset such as California Care Compass’s cost-of-care data page rather than a number frozen in an article, and ask each facility for its current daily private rate in writing.

What questions should I ask when touring a skilled nursing facility?

Ask for the actual direct-care staffing hours per patient day and how they compare to California’s 3.5-hour minimum, including the certified nursing assistant share. Ask what the staffing looks like on nights and weekends, not just the day shift. Ask how long the director of nursing and the administrator have been in their roles, because rapid leadership turnover usually shows up in care. Ask what happens when Medicare rehab days end: can the resident stay in the same bed under Medi-Cal, and is the facility Medi-Cal certified? Then stop asking and watch: call lights, mealtimes, whether staff know residents by name.

How to choose a nursing home in California

Why this decision usually happens too fast.

Most California families choose a skilled nursing facility in under 72 hours, because the choice usually arrives with a hospital discharge deadline attached. The hospital case manager hands over a list, the family calls the two closest names, and the decision is made on availability. If that is where you are right now, start with the hospital discharge guide and come back to this one with the shortlist.

The five checks below are designed to fit inside that compressed window. Each one uses a public record or a direct question, none of them requires an expert, and together they catch the failure modes that ratings alone miss. If you are still deciding whether a nursing facility is the right setting at all, read assisted living vs nursing home first.

Check 1: run the Care Compare ratings the right way.

Medicare’s Care Compare tool (medicare.gov/care-compare) rates every Medicare- and Medicaid-certified nursing facility from one to five stars, updated roughly monthly, across three domains: health inspections, staffing, and quality measures. The domains are not equal. The health inspection rating is built from the three most recent comprehensive annual surveys plus complaint inspections from the last three years, performed on site by state surveyors. The quality measures are largely self-reported by the facility. That is why the overall star is anchored to the health inspection score: a facility with a one-star inspection record cannot climb more than one star overall no matter how good its other numbers look.

The practical method: use the overall star to cut the list, then open the staffing tab on each surviving facility and read the registered nurse hours per resident day and total nurse staffing hours. Those come from payroll-based data, which makes them the hardest numbers on the page to dress up.

Check 2: read the state’s file on Cal Health Find.

California licenses skilled nursing facilities through the Department of Public Health, and CDPH publishes its file on every facility through Cal Health Find. For each facility you can see the licensing and certification status, whether it accepts Medicare and Medi-Cal, who owns it, the deficiencies state surveyors identified during inspections, the complaints and incidents reported to the state, and any enforcement actions or penalties the state has issued. The same site takes new complaints online.

The enforcement records use a grading system worth knowing, from Health and Safety Code § 1424, with the penalty ranges in effect in 2026. A class B citation means a violation with a direct or immediate relationship to residents’ health, safety, or security, with penalties of $100 to $1,000. A class A citation means imminent danger of death or serious harm, or a substantial probability of it, with penalties of $1,000 to $10,000. A class AAcitation means the state determined a violation was a substantial factor in a resident’s death, with penalties of $5,000 to $25,000. A single old class B is background noise. A class AA, or a pattern of class A citations, should end your interest in the building.

Ownership is on file too, and since SB 650 (2021), organizations that own or operate California skilled nursing facilities must file annual consolidated financial reports with the state under Health and Safety Code § 128734.1, covering the related companies behind the license. You do not need to read those reports. You do want to notice whether the operator runs one building or forty, and how the operator’s other buildings look on the same two databases.

Check 3: get the staffing numbers in writing.

California law sets a floor: skilled nursing facilities must provide at least 3.5 direct care hours per patient day, of which at least 2.4 hours must come from certified nursing assistants (Health and Safety Code § 1276.65). Ask each facility for its actual current numbers, not the required ones, and ask specifically about nights and weekends, which is when staffing thins and when most problems start.

A facility that meets the legal minimum is at the floor, not the standard. The follow-up questions that reveal the most: how much of the direct care is delivered by registry (temp agency) staff rather than employees, how long the director of nursing has been in the role, and what the certified nursing assistant turnover looked like over the past year. Stable leadership and low turnover predict daily care quality better than any brochure.

Check 4: confirm the payer fit before admission.

A skilled nursing stay has two financially different phases, and families get hurt when they plan for only one. The short-term rehab phase runs on Medicare; the long-term phase runs on Medi-Cal or private money. The full day-by-day mechanics are in the Medicare skilled nursing rehab guide; the decision-relevant summary:

The situation	Medicare	Medi-Cal	Private pay
Short-term rehab after a qualifying 3-day inpatient hospital stay	Days 1 to 20 in full; days 21 to 100 minus a $217.00 daily co-pay in 2026	Can cover the co-pay for residents with both Medicare and Medi-Cal	Medigap plans typically pay the days 21 to 100 co-pay
Long-term custodial care	Not covered	Covered with no day cap for eligible residents; a monthly share of cost usually applies	Monthly private rate until savings run down or Medi-Cal begins
When Medicare rehab days end mid-stay	Coverage stops when daily skilled need ends, often before day 100	Takes over only in a Medi-Cal-certified facility, after eligibility is established	Bridges any gap between the two programs

Three admission questions follow from the table. Is the facility certified for both Medicare and Medi-Cal (Cal Health Find shows this)? When the Medicare days end, can your parent stay in the same bed under Medi-Cal, or does the facility move long-term residents to a different unit or discharge them? And if Medi-Cal will eventually pay, has anyone started the eligibility work? Since January 1, 2026 the Medi-Cal asset limit is $130,000 for a single applicant and $195,000 for a couple, most long-term residents pay a monthly share of cost from their income, and the application takes weeks you do not want to lose. For current private rates by region, see the California cost of care dataset, and for what the long-term phase itself looks like, see long-term skilled nursing in California.

Check 5: tour twice, at the right times.

Every facility shows well at 2 p.m. on a quiet afternoon. Tour once on a weekday morning, when care is at its busiest, and once at a meal or a shift change. Notice how long call lights stay on. Notice whether the dining room has enough staff helping residents who cannot feed themselves, because unassisted meals are how nursing home residents lose weight. Notice smells, which tell you about both housekeeping and continence care. Notice whether staff greet residents by name, and whether residents are up, dressed, and out of their rooms by late morning.

Talk to a visiting family member in the hallway, without staff present, and ask the only question that matters: would you place your parent here again? Look for the ombudsman poster, which facilities are required to display, and write the number down. It works before admission too.

Red flags that should end the conversation.

A class AA citation, or repeated class A citations, on the CDPH record
Staffing answers that stay vague after a direct question, or heavy reliance on registry staff
A facility that will not put its current direct-care hours or private rate in writing
Pressure to sign admission paperwork on the spot, or an arbitration agreement presented as required. Under Health and Safety Code § 1599.81 arbitration must be on a separate form and cannot be a condition of admission
Residents still in bed, undressed, at 11 a.m. without a medical reason
An administrator or director of nursing who arrived within the last few months and cannot say where their predecessor went

Who to call when something goes wrong.

The Long-Term Care Ombudsman program, run through the California Department of Aging, advocates for residents of nursing facilities at no cost and handles complaints confidentially. The statewide CRISISline is 1-800-231-4024, answered 24 hours a day. For violations of licensing standards, file a complaint with CDPH directly through Cal Health Find; complaints route to the local Licensing and Certification district office for investigation. Use both channels at once when the concern is serious. They do different jobs, and neither requires the family to prove anything before calling.

What to do this week.

Build a shortlist of three to five facilities within visiting distance. Distance matters: a facility you can reach easily is a facility you will actually visit, and regular visits are the best oversight a family has.
Screen the shortlist on Care Compare, then read each survivor’s file on Cal Health Find. Cut anything with a class AA citation or a pattern of class A citations.
Call the survivors and ask the staffing and payer-fit questions above. Put the answers in a shared note.
Tour the top two, twice each, at a meal or shift change.
If Medi-Cal will pay for the long-term phase, start the eligibility conversation with the county now, not when the Medicare days run out.

Related guides and next steps

This guide explains planning options, not legal or financial advice. Talk to a California-licensed elder-law attorney about your specific situation. California Care Compass does not place referrals on Planning pages.

How to choose a skilled nursing facility in California: the 5-check method.