Grading Methodology
Every ClearLTC grade is computed from public federal and state data. We don't generate opinions out of nothing, and we don't take payment to change a grade. This page lays out exactly what feeds into a grade, how the categories combine, and the guardrails that keep the result honest.
For source providers, coverage and guidance on interpreting dates, see Data Sources.
The grade scale
Letter grades are assigned by ranking a nursing home's composite score against every other Florida nursing home. The curve is fixed by construction so the distribution is meaningful: an A is genuinely top-decile in Florida, not a participation prize.
Strong inspection record, above-average staffing or compliance, and consistent resident outcomes across multiple categories.
Generally solid across categories with some areas to watch.
Typical for Florida — neither standout nor concerning. Most facilities land here.
Multiple weak categories. Worth additional research before placement.
Significant concerns across categories. Often combined with serious deficiencies, sanctions, or enforcement history.
Below 40% data completeness on the inputs that go into a grade, we don't publish a letter at all. We'd rather show no grade than a misleading one.
How the curve is shaped: the top decile of Florida facilities earns an A and the bottom decile earns an F, with B, C, and D distributed across the rest from above-median to below-median. The middle band is intentionally the widest, since most facilities cluster near the Florida median. Refreshed each scoring cycle.
Skilled nursing facility (SNF) grades
Each category contributes a fixed share of the 100-point composite. Within a category, individual measures are scored against Florida averages (or, when the state average is unavailable, against the published national benchmark for that measure). Facilities holding a Florida Gold Seal Award receive a small additive bonus on top of their composite.
Resident outcome measures from CMS — falls with injury, pressure ulcers, urinary infections, long-stay antipsychotic use, restraint use, ADL decline, unintended weight loss, depressive symptoms, walking decline, vaccination coverage, and short-stay measures — each compared to Florida averages.
Medicare claims-based hospital readmissions and emergency-department visits, scored against the rate CMS expects based on the facility's resident mix.
PBJ-reported nursing hours per resident day (RN, LPN, CNA, total) compared to Florida averages, plus weekend-vs-weekday consistency and physical-therapy presence.
Health-survey deficiency volume, fire-safety deficiencies, abuse-citation flags, and Special Focus Facility status (current or candidate).
Discharge-to-community rate against the national benchmark, plus the facility's Medicare Value-Based Purchasing performance score.
CMS-imposed fines and payment-denial days from the most recent inspection cycle.
Public Google rating, weighted by review volume — a 5.0 from a handful of reviews counts less than a 4.2 from many.
Assisted living facilities (ALFs)
Florida does not publish assisted living inspection results in a form that can be scored: violation counts are rarely reported, and a missing count can't be told apart from a clean one. A letter grade built on that would mostly reflect reviews and amenities, so we don't publish one.
Instead, every ALF profile shows its AHCA enforcement record for the last three years: fines and their total, serious actions against the license (moratoriums, suspensions, revocations, conditional licenses, emergency actions), and changes of ownership, each with its date and case number. Rule waivers and bankruptcy notices appear in the record but aren't counted as enforcement.
Guardrails
These rules constrain the algorithm so it can't produce results that disagree dramatically with regulator-blessed data, or rank facilities on too little information to be useful.
The CMS Overall Five-Star rating is built from the same inspections, staffing and quality measures we score, so we don't award points for it separately. Instead it bounds the composite: a 5-star building scores at least 75 points and a 1-star building at most 65, so our rank can't contradict CMS dramatically.
A facility must have at least 40% of its category inputs populated to receive a grade. Below that, we display "Not Enough Data" instead of an A–F. Newly licensed buildings and very small facilities often fall here while their record builds.
A 5-star Google rating from two reviews is not the same as a 4.2 from fifty. Low review counts carry less weight in our scoring; very low counts blend toward neutral.
We only publish "Top X% in [County]" when the county has at least 10 facilities of that type. Below that, county rank is omitted to avoid claims like "Top 33%" out of three buildings.
Facilities with identical composites share a percentile, so two identical buildings never land on different sides of a grade line.
The curve is computed against the current population of Florida nursing homes. Letter grades reflect Florida rank, not national rank. A grade can move when other buildings' data changes, so our alerts track changes in CMS ratings and state actions, not letters.
What we don't do
Some of these are obvious; we list them anyway because clarity matters more than brevity here.
Refresh cadence
Grades can change as the underlying published information is updated. Federal and state agencies publish on different schedules, and records may describe an earlier reporting period.
Check the dates and coverage notes provided with a facility profile or report. A recent update does not necessarily reflect current conditions at the facility.
View source coverage and limitations →Found something wrong?
If you're a facility, family, or researcher and you spot something that looks wrong on a profile or grade, we want to hear about it. Common cases: a closed building still listed active, an inspection result that doesn't match the AHCA report, a name change, an incorrect bed count.
We won't change a grade just because someone disputes it — but we will recheck the underlying data and correct an error if there is one.
Report an inaccuracy →A note on intended use. ClearLTC grades are an editorial summary of disclosed public-record inputs, computed by the methodology described above. They're intended to support research and shortlisting — not to replace direct verification with the facility, AHCA, or CMS, and not as the sole basis for clinical, placement, or business decisions. Public records can lag actual conditions, and facilities can change between updates. Always verify directly before acting on a grade.