Guide

Nursing Home Visit Checklist: What to Look For

A practical, printable checklist for evaluating nursing homes during an in-person visit, with questions to ask and red flags to watch for.

TL;DR

Before visiting, check the facility's grade on CareGrader to review inspection results, staffing data, and quality measures. During the visit, evaluate cleanliness, staff responsiveness, resident engagement, and dining quality. Ask the administrator about staffing ratios, recent inspections, and fall prevention. Then compare facilities side by side.

Before the Visit: Do Your Research

Walking into a nursing home without context is like buying a car without checking its history. Start with the data.

✓Check the facility's CareGrader grade. Search by state and city to find the facility and review its A-F grade, which combines inspection results, staffing, quality measures, and penalty history.
✓Review recent deficiencies. Look at the type, severity, and scope of deficiencies from the most recent inspection. Note any citations for immediate jeopardy, abuse, or neglect.
✓Check staffing data. Review RN hours per resident per day, total nursing hours, weekend staffing levels, and turnover rates. Low staffing and high turnover are among the strongest predictors of poor care.
✓Note any fines or penalties. Facilities with recent monetary fines, payment denials, or Special Focus Facility (SFF) status deserve extra scrutiny during your visit.
✓Take the care assessment. Use our care assessment tool to clarify what level of care your loved one needs, so you can ask targeted questions during the visit.

During the Visit: Environment

Your senses will tell you a lot. Pay attention to what you see, smell, and hear the moment you walk in.

✓Cleanliness. Are floors, walls, and common areas clean? Are bathrooms well-maintained? Look at corners, baseboards, and less-visible areas, not just the lobby.
✓Odor. A faint cleaning product smell is normal. A persistent smell of urine, feces, or heavy air freshener masking something is a red flag.
✓Safety features. Check for handrails in hallways, grab bars in bathrooms, non-slip flooring, adequate lighting, and clear emergency exits. Are hallways free of obstructions?
✓Noise level. Is it reasonably quiet, or are alarms ringing unanswered? Constant background noise from unanswered call lights suggests understaffing.
✓Outdoor spaces. Is there a secure outdoor area where residents can get fresh air? Is it accessible and well-maintained?

During the Visit: Residents

The residents themselves are the best indicator of care quality. Observe them throughout your visit.

✓Appearance. Do residents appear clean, groomed, and appropriately dressed? Are they wearing their own clothes rather than hospital gowns?
✓Engagement. Are residents participating in activities, socializing, or watching TV with interest? Or are many sitting alone, unattended, or asleep in wheelchairs in hallways?
✓Dignity and autonomy. Do residents have personal items in their rooms? Can they choose when to wake up, eat, and go to bed? Are they addressed by name, not room number?
✓Talk to residents and families. If possible, ask residents or visiting family members about their experience. Ask what they like most and what they would change.

During the Visit: Staff

Staff quality is the single biggest differentiator between good and bad nursing homes. Watch how they work.

✓Responsiveness. How quickly do staff respond to call lights? Time it if you can. Anything beyond 5 minutes is concerning.
✓Staff-to-resident ratio. Count the number of staff you see on the floor versus the number of residents. Compare this to the staffing data on CareGrader.
✓Friendliness and respect. Do staff greet residents warmly? Do they knock before entering rooms? Do they explain what they are doing before providing care?
✓Staff morale. Do staff seem stressed, rushed, or disengaged? High turnover and low morale among staff directly affect resident care.

During the Visit: Dining

Try to schedule your visit during a mealtime. Food quality and the dining experience reveal a lot about a facility.

✓Meal quality. Does the food look appetizing and well-prepared? Are meals served at a proper temperature? Ask to see the weekly menu.
✓Assistance. Are residents who need help eating receiving it? Is assistance provided patiently and with dignity, not rushed?
✓Choice and dietary needs. Do residents have meal options? Are special diets (diabetic, low-sodium, pureed) accommodated? Can residents eat in their rooms if they prefer?
✓Dining environment. Is the dining room clean, well-lit, and pleasant? Are residents socializing during meals? Communal dining is an important part of quality of life.

During the Visit: Activities

A good activities program keeps residents mentally and physically engaged and reduces depression and behavioral issues.

✓Activity schedule. Ask to see the monthly activities calendar. Is it posted where residents can see it? Are activities happening during your visit?
✓Variety. Look for a mix of physical, social, creative, and cognitive activities. Are there options for residents with different ability levels, including those with dementia?
✓Participation. Are residents actually participating, or is a TV on in an empty room listed as an "activity"? Ask residents what they enjoy doing.

Questions to Ask the Administrator

Come prepared with specific questions. An administrator who is transparent and forthcoming is a positive sign. Evasiveness is not.

Staffing

✓What is the current RN-to-resident ratio on each shift?
✓What is your staff turnover rate? How long has your Director of Nursing been here?
✓Do you use agency (temp) staff? If so, how often?
✓Is there always an RN on-site 24/7, or only during certain hours?

Inspections & Quality

✓What were the findings from your most recent state inspection?
✓Have you received any fines or enforcement actions in the past three years?
✓What specific steps have you taken to address any deficiencies?

Safety & Protocols

✓What is your fall prevention protocol? What is the facility's current fall rate?
✓How do you handle medical emergencies after hours?
✓What is your infection control protocol?

Admissions & Costs

✓What is your discharge rate? Under what circumstances would a resident be asked to leave?
✓What happens when a resident's needs increase? At what point would you recommend transfer to another facility?
✓Do you accept Medicare and Medicaid? What costs are not covered by insurance?
✓How do you handle complaints from residents or families? Is there a formal grievance process?

Red Flags to Watch For

Any one of these should give you serious pause. Multiple red flags together should disqualify a facility.

!Persistent bad odors throughout the facility, not just in isolated areas. Heavy air freshener use can indicate an attempt to mask problems.
!Residents left unattended in wheelchairs or beds for extended periods, especially in hallways.
!Call lights going unanswered for more than 5 minutes. This is a direct indicator of inadequate staffing.
!Residents with poor hygiene — unkempt hair, dirty clothing, long or dirty fingernails, or unexplained bruising.
!Staff speaking harshly to residents, ignoring requests, or being visibly impatient.
!Restricted access to certain areas during your tour, or being told you cannot visit unannounced in the future.
!Administrator who is evasive about inspection results, staffing numbers, or discharge rates. Transparency is a baseline expectation.
!Excessive use of physical restraints or antipsychotic medications. Ask about their restraint-free care policy.

After the Visit: Compare and Decide

Your visit is one data point. Combine your observations with objective data to make the best decision.

✓Write down your impressions immediately after the visit, while they are fresh. Note specific observations, not just general feelings.
✓Compare facilities on CareGrader. Use the side-by-side comparison tool to evaluate inspection results, staffing data, quality measures, and penalty history across the facilities you visited.
✓Visit your top choice again at a different time of day, ideally unannounced. Evening and weekend visits reveal a facility's true staffing levels.
✓Cross-reference administrator claims with CareGrader data. If they said staffing is excellent but their CareGrader staffing score is low, trust the data.
✓Involve your loved one in the decision whenever possible. Their comfort and preferences matter most.

Frequently Asked Questions

How many nursing homes should I visit before deciding?

Visit at least three facilities so you have a meaningful basis for comparison. If possible, visit your top choice more than once, at different times of day, including evenings and weekends when staffing levels tend to drop. Use CareGrader's comparison tool to narrow your list before scheduling visits.

Should I schedule a tour or show up unannounced?

Do both. A scheduled tour lets you meet the administrator and ask detailed questions. An unannounced visit shows you the facility under normal conditions, without staff preparing for your arrival. Drop by during a meal or in the evening to see staffing and resident engagement at those times.

What is the most important thing to look for in a nursing home?

Staff-to-resident ratios and how staff interact with residents are the strongest predictors of quality care. Watch whether aides respond promptly to call lights, address residents by name, and treat them with dignity. Check CareGrader for the facility's staffing data, including RN hours per resident per day and turnover rates.

How do I find out about a nursing home's inspection history?

Every Medicare-certified nursing home is inspected by state surveyors, and the results are public. On CareGrader, you can view a facility's grade (A-F), recent deficiencies, severity levels, and any fines or enforcement actions. You can also ask the administrator directly for their most recent survey results.

What are the biggest red flags during a nursing home visit?

Strong, persistent odors (urine or feces) throughout the facility, residents left unattended in wheelchairs for extended periods, staff ignoring call lights, residents who appear unkempt or have unexplained bruising, and locked exits or overly restrictive environments. Any of these warrant serious concern.