Harmony Healthcare International (HHI) Blog

Health Inspection: Five Star Impact



Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Five Star

The Health Inspection Star Rating is calculated using the results of the last 3 years of onsite inspections and includes both standard surveys and any complaint surveys.  The most recent survey findings are weighted more than the prior two years.  Points are assigned to individual health deficiencies per their scope and severity. CMS assigns more points to facilities with deficiencies of greater scope or severity and recent surveys are weighted more heavily.  The score is calculated based on: 

  • the most recent survey accounts for half of the points
  • the previous survey accounts for one-third of the points and
  • the next most recent survey accounts for one-sixth of the points 

The Facility is encouraged to retrieve their Survey Score via the Quality Improvement and Evaluation System (QIES) Certification and Survey Provider Enhanced Reporting (CASPER) site to gauge when deficiencies will age off or move to a different time with decreased weight.  Details are provided within the report. 

Survey Report is accessed in the QIES ASAP System using the following steps: 

  1. Log in to CASPER
  2. Select MDS 3.0 Nursing Home Provider Reports
  3. Select the MDS 0003D/0004D Package Report which provides access to the CASPER Standard reports.  The 0003D is the Provider History Profile and 0004D is the Provider Full Profile.
  4. Retrieve a copy of the report under the Folders Tab and in the User’s In-Box 

Calculate Survey Points with Below Grid 

Health Inspection Score: Weights for Different Types of Deficiencies









Immediate jeopardy to resident health or safety


50 points*

(75 points)


100 points*

(125 points)


150 points*

(175 points)

Actual harm that is not immediate jeopardy


20 points



35 points

(40 points)


45 points

(50 points)

No actual harm with potential for more than minimal harm that is not immediate jeopardy


4 points


8 points


16 points

(20 points)

No actual harm with potential for minimal harm


0 points


0 points


0 points


  •  Figures in parentheses indicate points for deficiencies that are for substandard quality of care.
  • The * indicates that If the status of the deficiency is “past non-compliance” and the severity is Immediate Jeopardy, points associated with a “G-level” deficiency (i.e., 20 points) are assigned.
  • Shaded cells denote deficiency scope/severity levels that constitute substandard quality of care if the requirement which is not met is one that falls under the following federal regulations: 42 CFR 483.13 resident behavior and nursing home practices, 42 CFR 483.15 quality of life, 42 CFR 483.25 quality of care. 

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Items that could change the health inspection score include the following events or scenarios: 

  1. A new Health Inspection
  2. Complaint Investigation that results in one or more deficiency citations
  3. A second, third, or fourth revisit
  4. Resolution of an Informal Dispute Resolutions (IDR) or Independent Informal Dispute Resolutions (IIDR) resulting in changes to the scope and/or severity of deficiencies
  5. The aging of complaint deficiencies. The complaint surveys are assigned to a time period based on the most recent 12-month period in which the complaint survey occurred; therefore, when a complaint deficiency ages into a different cycle, it receives less weight in the scoring process, resulting in a lower health inspection score and potentially a change in health inspection rating. 

Click Here to Request a Free Five-Star Quality Measure AnalysisHarmony Healthcare International (HHI) offers a unique approach to Auditing and Monitoring. Our program combines QAPI, Compliance and Medical Record Review into a user-friendly, process refinement methodology.  Please call us to hear more about our monthly service plans (Platinum, Gold and Silver) and knowledge center (HarmonyHelp).  

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Topics: Five-Star, Survey

Kris Mastrangelo, OTR/L, LNHA, MBA


Kris Mastrangelo, OTR/L, LNHA, MBA

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