What share of US nursing homes have a 1-star CMS rating?

Of the 14,582 Medicare-certified nursing homes with a CMS overall star rating, 2,985 (20.5%) are rated 1 star — the lowest — while 3,007 (20.6%) earn the top 5-star rating. The national average overall rating is 2.99 stars.

Which state has the lowest average nursing-home rating?

Louisiana has the lowest average CMS nursing-home rating at 2.50 stars, with 52% of its 265 rated facilities at 1 or 2 stars. Hawaii has the highest average at 3.68 stars.

What does the CMS nursing-home overall star rating mean?

CMS assigns each Medicare-certified nursing home an overall rating from 1 (much below average) to 5 (much above average) stars, combining health inspections, staffing levels, and quality measures. The rating is published on CMS Care Compare and updated on a roughly monthly cadence.

DATA STUDY · 2025 EDITION

Nursing Home Star Ratings by State

20% of US nursing homes carry CMS's lowest 1-star rating — and only 21% earn the top 5 stars. We analyzed the CMS overall star rating for 14,582 Medicare-certified nursing homes to map where care quality is weakest, which states rank worst, and which large facilities sit at the bottom. Updated annually against the latest CMS Care Compare release.

20.5%

RATED 1 STAR

20.6%

RATED 5 STARS

2.99

AVG OVERALL RATING

14,582

FACILITIES ANALYZED

National distribution

How nursing homes split across the 5 stars

5 stars

3,007 (20.6%)

4 stars

2,753 (18.9%)

3 stars

2,848 (19.5%)

2 stars

2,989 (20.5%)

1 star

2,985 (20.5%)

States with the most low-rated homes

Share of nursing homes rated 1–2 stars — top 12 states

States ranked worst → best

Average nursing-home rating, by state

Mean CMS overall star rating per state, with the share of nursing homes rated 1 or 2 stars. States with at least 20 rated facilities. Tap any state to browse its nursing homes.

#	State	Avg rating	% 1–2 star	Facilities
1	Louisiana	2.50	52%	265
2	Missouri	2.51	53%	480
3	Illinois	2.56	53%	663
4	Texas	2.65	49%	1,165
5	Oklahoma	2.67	50%	281
6	Georgia	2.68	49%	354
7	Mississippi	2.75	50%	200
8	Nebraska	2.78	48%	178
9	Vermont	2.82	42%	33
10	South Dakota	2.84	48%	94
11	New Mexico	2.85	46%	67
12	Montana	2.87	47%	60
13	Rhode Island	2.92	46%	72
14	North Carolina	2.94	43%	416
15	Tennessee	2.96	40%	298
16	Virginia	2.96	42%	285
17	Wyoming	2.97	46%	35
18	Pennsylvania	2.97	43%	653
19	West Virginia	2.98	38%	122
20	New Hampshire	2.99	44%	73
21	Wisconsin	2.99	42%	321
22	Connecticut	3.00	45%	190
23	Alabama	3.00	39%	223
24	South Carolina	3.01	39%	186
25	Kentucky	3.02	39%	266
26	New York	3.03	41%	593
27	Massachusetts	3.04	40%	338
28	Iowa	3.08	37%	388
29	Maine	3.08	38%	77
30	Kansas	3.09	38%	295
31	Michigan	3.11	37%	421
32	Oregon	3.12	39%	127
33	Maryland	3.12	38%	219
34	Colorado	3.13	38%	208
35	Indiana	3.14	37%	504
36	Idaho	3.14	33%	79
37	Ohio	3.15	38%	913
38	North Dakota	3.17	35%	71
39	California	3.17	34%	1,155
40	Minnesota	3.18	36%	336
41	Delaware	3.23	35%	43
42	Washington	3.23	36%	192
43	Florida	3.26	33%	691
44	Nevada	3.26	38%	65
45	New Jersey	3.30	32%	346
46	Utah	3.30	31%	96
47	Arizona	3.38	31%	139
48	Alaska	3.45	20%	20
49	Arkansas	3.47	24%	218
50	Hawaii	3.68	24%	41

The bottom of the barrel

The 50 largest 1-star nursing homes

1-star (lowest) CMS overall rating, ranked by certified bed count — the biggest facilities carrying the worst rating. Tap any name for its full CareLens profile: inspections, staffing, complaints, and ownership.

#	Nursing home	Location	Ownership	Beds	Rating
1	FAIR ACRES GERIATRIC CENTER	LIMA, PA	Government - County	778	1★
2	NORTHAMPTON COUNTY-GRACEDALE	NAZARETH, PA	Government - County	688	1★
3	Woodbury Heights Nursing and Rehabilitation Center	Woodbury, NY	For profit - Limited Liability company	606	1★
4	A Holly Patterson Extended Care Facility	UNIONDALE, NY	Government - State	589	1★
5	Friendship Rehab and Health	BEAVER, PA	For profit - Limited Liability company	589	1★
6	LORETTO HEALTH AND REHABILITATION CENTER	SYRACUSE, NY	Non profit - Corporation	583	1★
7	Monroe Community Hospital	Rochester, NY	Government - County	566	1★
8	LINCOLN PARK CARE CENTER	LINCOLN PARK, NJ	For profit - Corporation	547	1★
9	St. John's Health Care Corporation	Rochester, NY	For profit - Corporation	455	1★
10	BISHOP REHABILITATION AND NURSING CENTER	SYRACUSE, NY	For profit - Corporation	440	1★
11	SINAI POST-ACUTE NURSING & REHAB CENTER	NEWARK, NJ	For profit - Corporation	430	1★
12	CARE PAVILION NURSING AND REHABILITATION CENTER	PHILADELPHIA, PA	For profit - Corporation	396	1★
13	ORLANDO HEALTH AND REHABILITATION CENTER	ORLANDO, FL	Non profit - Other	391	1★
14	SANTA ANITA CONVALESCENT HOSPITAL	TEMPLE CITY, CA	For profit - Corporation	391	1★
15	CRESTVIEW HEALTH & REHAB CTR	ATLANTA, GA	Non profit - Other	388	1★
16	PLEASANT ACRES REHABILITATION AND NURSING CENTER	YORK, PA	For profit - Limited Liability company	375	1★
17	South Pointe Rehabilitation and Care Center	Oklahoma City, OK	For profit - Limited Liability company	375	1★
18	VAN RENSSELAER MANOR	TROY, NY	Government - County	362	1★
19	CAPITOL CITY REHAB AND HEALTHCARE CENTER	WASHINGTON, DC	For profit - Limited Liability company	360	1★
20	SAN MATEO MEDICAL CENTER D/P SNF	SAN MATEO, CA	Government - County	345	1★
21	GLENDORA GRAND, INC	GLENDORA, CA	For profit - Corporation	342	1★
22	OPTIMA CARE FOUNTAINS	SECAUCUS, NJ	For profit - Limited Liability company	334	1★
23	BRIA OF FOREST EDGE	CHICAGO, IL	For profit - Limited Liability company	328	1★
24	CEDAR HAVEN HEALTHCARE CENTER	LEBANON, PA	For profit - Partnership	324	1★
25	MASONIC CARE COMMUNITY OF NEW YORK	UTICA, NY	Non profit - Corporation	320	1★
26	Medford Multicare Center For Living	Medford, NY	For profit - Corporation	320	1★
27	NEW VANDERBILT REHABILITATION AND CARE CENTER, INC	STATEN ISLAND, NY	For profit - Corporation	320	1★
28	Normandy Terrace Nursing & Rehabilitation Center	San Antonio, TX	For profit - Limited Liability company	320	1★
29	North Ridge Health And Rehab	NEW HOPE, MN	For profit - Corporation	320	1★
30	NORTHERN MANHATTAN REHABILITATION AND NURSING CTR	NEW YORK, NY	For profit - Partnership	320	1★
31	Landmark of Hyde Park Rehabilitation and Nursing C	CHICAGO, IL	For profit - Individual	318	1★
32	HUDSON HILL CENTER FOR REHABILITATION & NURSING	YONKERS, NY	For profit - Corporation	315	1★
33	APERION CARE LAKESHORE	CHICAGO, IL	For profit - Limited Liability company	313	1★
34	ELEVATE CARE CHICAGO NORTH	CHICAGO, IL	For profit - Limited Liability company	312	1★
35	Complete Care at Margate Park	CHICAGO, IL	For profit - Limited Liability company	310	1★
36	BRIA OF RIVER OAKS	BURNHAM, IL	For profit - Corporation	309	1★
37	GARDENS AT WEST SHORE, THE	CAMP HILL, PA	For profit - Corporation	309	1★
38	BAY HARBOR POST ACUTE HEALTHCARE CENTER	SALISBURY, MD	For profit - Limited Liability company	305	1★
39	COUNTRY HILLS POST ACUTE	EL CAJON, CA	For profit - Limited Liability company	305	1★
40	RYZE ON THE AVENUE	CHICAGO, IL	For profit - Corporation	302	1★
41	Maple Heights Health & Rehab Center, LLC	EBENSBURG, PA	For profit - Corporation	301	1★
42	ALDEN LAKELAND REHAB & HCC	CHICAGO, IL	For profit - Corporation	300	1★
43	KEI-AI LOS ANGELES HEALTHCARE CENTER	LOS ANGELES, CA	For profit - Limited Liability company	300	1★
44	RUNNELLS CENTER FOR REHABILITATION & HEALTHCARE	BERKELEY HEIGHTS, NJ	For profit - Corporation	300	1★
45	WILLOW POINT REHABILITATION AND NURSING CENTER	VESTAL, NY	Government - County	300	1★
46	BALANCED HEALTHCARE	SAINT PETERSBURG, FL	For profit - Limited Liability company	299	1★
47	MIRAGE POST ACUTE	LANCASTER, CA	For profit - Partnership	299	1★
48	SUNNYSIDE NURSING CENTER	TORRANCE, CA	Non profit - Corporation	299	1★
49	Villa Feliciana Chronic Disease	Jackson, LA	Government - State	299	1★
50	Harmony Park Ridge	PARK RIDGE, IL	For profit - Limited Liability company	298	1★

Methodology

Figures come from the CMS Care Compare skilled nursing facility (SNF) dataset — the official Medicare quality program. The overall star rating runs from 1 (much below average) to 5 (much above average) and blends health inspections, staffing, and quality measures. We include every Medicare-certified nursing home with a published overall rating (14,582 facilities).

State averages cover states with at least 20 rated facilities so a handful of homes can't swing the mean. The worst-rated table is limited to 1-star facilities with 60 or more certified beds, ranked by bed count, to surface the largest low-rated providers rather than tiny outliers. CMS ratings lag real conditions by several months and roll up to the facility, not the specific unit — use them alongside an in-person visit.

Want the detail behind any number? Browse all nursing homes, or jump to Louisiana nursing homes.

▸ USE THIS RESEARCH

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This research is free to reference. Journalists and researchers are welcome to cite the figures with a link back to CareLens.

CITATION

CareLens. (2025). Nursing Home Star Ratings by State. Retrieved from https://carelens.io/nursing-home-ratings

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<a href="https://carelens.io/nursing-home-ratings" style="display:inline-block;border-left:4px solid #84cc16;padding:10px 14px;font:14px/1.4 system-ui,sans-serif;color:#0f172a;text-decoration:none;background:#f8fafc;border-radius:4px;max-width:520px"><strong>20% of US nursing homes carry CMS's lowest 1-star rating</strong><br>Source: CareLens — Nursing Home Star Ratings by State (2025)</a>

PREVIEW

20% of US nursing homes carry CMS's lowest 1-star rating
Source: CareLens — Nursing Home Star Ratings by State (2025)