About the Ratings
CalQualityCare.org provides performance ratings on important measures of long term care quality. Ratings will help users assess the quality of care available and serve as a guide when comparing and choosing care providers.
This site gives performance ratings for aspects of care provided by nursing homes, home health care agencies, and hospice programs. The ratings are based on California state and U.S. government data sources. The data are gathered in various ways — including facility visits, self-reported data, and information submitted by clients or family members — and at different times. Some data may be as old as eight years, as in the case of inspection visits to hospice programs. Other data are updated annually. CalQualityCare.org aggregates new data every three months and updates the Web site accordingly. Consumers should pay attention to the date data were collected, which can be accessed through the “more information” popup link found on the provider profile pages (represented by a question mark button). While we make every effort to ensure the data are as current as possible, we are limited by how often the state and federal governments gather the information.
The CalQualityCare Ratings are:
The site does not give performance ratings for assisted living, congregate living health facilities, continuing care retirement communities, adult day health care, or adult day care because these providers are subject to different standards that do not allow for collecting similar performance data. As data on these facilities become available, ratings will be assigned to those providers.
Hospice Programs
CalQualityCare.org provides performance ratings for hospice programs in a single area: the Quality of Program. The rating is based on the number and type of deficiencies the program receives during routine inspections or complaint investigations over the most recent survey period.
The California Department of Public Health’s Licensing and Certification Program (L&C) surveys hospice programs at least every eight years to ensure that minimum federal standards of care and safety are being met. When a surveyor finds that a standard is not met, the program receives a “deficiency.” Deficiencies for violating federal standards fall under two categories: condition-level or standard-level deficiencies. Condition-level deficiencies are the most serious and indicate harm or the potential to harm clients. An agency is in danger of losing its certification if it does not correct the problem within 28 or 90 days, depending on severity. Standard-level deficiencies are less serious than condition-level deficiencies, and require the agency to submit a plan of corrective action. Hospice programs may also receive a deficiency in response to a complaint substantiated by the state.
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Superior: Because of the limited data and because program surveys are so infrequent, no hospice programs received a Superior rating.
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Above Average: Hospice program had no deficiencies (about 63% of hospice programs).
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Average: Hospice program had relatively fewer standard-level deficiencies.
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Below Average: Hospice program had relatively more standard-level deficiencies.
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Poor: Hospice program had one or more condition-level deficiency (about 14% of hospice programs).
If a hospice had two or more complaints, then the rating was lowered one level.
For the specific deficiencies for a hospice program, see the California Department of Public Health’s Licensing and Certification Program (L&C).
Home Health Care
CalQualityCare.org provides performance ratings for home health care agencies in two areas: Quality of Agency and Quality of Care.
Quality of Agency
The CalQualityCare Rating is based on the number and type of deficiencies the agency receives during routine inspections or complaint investigations over the most recent three-year period. Deficiencies for violating federal standards fall under two categories: condition-level or standard-level deficiencies. Condition-level deficiencies are the most serious and indicate harm or the potential to harm clients. An agency is in danger of losing its certification if it does not correct the problem within 28 or 90 days, depending on severity. Standard-level deficiencies are less serious than condition-level deficiencies, and require the agency to submit a plan of corrective action.
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Superior: Agency has had no deficiencies (about 50% of home health agencies in California).
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Above Average: Agency is in the top third group with the fewest standard-level deficiencies.
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Average: Agency is in the middle third group with regard to the number of standard-level deficiencies.
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Below Average: Agency is in the bottom third group with the most standard-level deficiencies.
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Poor: Agency has had one or more condition-level deficiency (about 12% of agencies).
If an agency had two or more complaints, then the rating was lowered one level, however the minimum level is poor.
Quality of Care
There are ten quality of care measures. The CalQualityCare Rating is determined by grouping the scores for each quality measure into fifths by level of performance. Agencies are rated as follows:
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Superior: Agency ranks in the 81 – 100% range.
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Above Average: Agency ranks in the 61 – 80% range.
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Average: Agency ranks in the 41 – 60% range.
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Below Average: Agency ranks in the 21 – 40% range.
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Poor: Agency ranks in the 0 – 20% range.
Each quality measure is given an equal weight. If an agency has any missing scores, then the summary score is calculated based on the quality measures that are available.
For the specific deficiencies for a home health care program, see the California Department of Public Health’s Licensing and Certification Program (L&C).
Nursing Homes
CalQualityCare.org gives performance ratings to nursing homes in four areas: Overall, Quality of Facility, Staffing, and Quality of Care.
Quality of Facility
The CalQualityCare Rating for Quality of Facility in nursing homes is based on three measures: (1) federal inspection reports; (2) state citations; and (3) substantiated complaint and incident reports. The rating uses the three most recent standard surveys for each nursing home and any complaint investigations during the most recent three-year period. More recent surveys are weighted more heavily than earlier surveys.
Because facilities with more beds and nursing home residents may have more complaints, the number of substantiated complaints and incidents are standardized by the total number of beds.
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Superior: Facility scored in the best 10%.
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Above Average: Facility scored in the 66.7 - 90% range.
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Average: Facility scored in the 43.4 - 66.6% range.
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Below Average: Facility scored in the 20.1 - 43.3% range.
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Poor: Facility scored in the worst 20%.
Staffing
Research shows that adequate staffing levels and lower staff turnover have a positive effect on the health of nursing home residents. The CalQualityCare Rating for Staffing takes into account three measures: RN staffing levels, total nursing hours, and nursing staff turnover rates.
In addition, scores are adjusted to account for varying levels of resident care needs. Facilities should adjust staffing levels to ensure adequate staff to meet the needs of all the residents living in a facility. Because Medicare residents are often in nursing homes immediately following an acute hospital stay, facilities with a high percentage of Medicare days are expected to have higher RN and total staffing hours to meet the greater needs of these residents.
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RN staffing levels. RN staffing levels are the average number of hours of RN time available to care for residents per day over a one-year period. To receive a Superior rating, the threshold was set at 0.55 RN hours per resident day for facilities with a “low” number of Medicare days and at 3.0 hours for facilities with a “high” number of Medicare days.
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Total nursing hours. Total nursing hours includes all RNs, licensed vocational or practical nurses (LVNs), nursing assistants (NAs), and nursing supervisors. The measure shows the average number of hours of nursing staff time available to care for residents per day over a year. To receive a Superior rating, the threshold was set at a minimum of 4.1 total hours per resident per day for facilities with a “low” number of Medicare days and at 6.5 total hours per resident per day for facilities with a “high” number of Medicare days. Facilities with a “low” number of Medicare days received a Poor rating if they reported 3.26 total hours per resident day or less. Facilities with a “high” number of Medicare days received a Poor rating if total hours were 3.5 per resident day or less.
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Nursing staff turnover rates. High turnover rates may result in poor quality and coordination of care. Low turnover rates may reflect better management, staff wages and benefits, or other enhanced employment conditions. Facilities with turnover levels of 90% or higher had their overall staffing rating reduced by one level unless they were already rated as Poor.
The CalQualityCare Rating was based on the combination of RN and total staffing (RNs, LPNs/ LVNs, CNAs) ratings for each facility with equal weights given to the RN and the total staffing ratings. To receive a Superior rating, facilities must meet both RN and total nursing thresholds. In addition to meeting those thresholds, nursing homes with turnover rates greater than 90% during the most recent year received a reduction of one degree.
Quality of Care
The CalQualityCare Rating for Quality of Care in nursing homes is based on ten measures that address a broad range of functioning and health status in multiple care areas. They include seven long-stay resident measures and three short-stay resident measures.
For each measure, points are assigned based on the facility quintile. Performance on two measures (percent of residents whose need for help with daily activities has increased and percent of residents whose ability to move about their room got worse) are given more weight to reflect the greater importance of these measures. These two measures make up 40% of the overall weight on the long-stay measures.
Once the summary Quality of Care score is computed for each facility, a rating is assigned based on the nationwide distribution of the scores:
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Superior: Facility scored in the best 10%.
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Above Average: Facility scored in the 66.7 – 90% range.
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Average: Facility scored in the 43.4 – 66.6% range.
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Below Average: Facility scored in the 20.1 – 43.3% range.
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Poor: Facility scored in the worst 20%.
Overall Rating
The Overall Rating is based on combining the CalQualityCare Ratings for Quality of Facility, Staffing, and Quality of Care, giving priority to the Quality of Facility rating.
For the specific deficiencies for a nursing home, see the California Department of Public Health’s Licensing and Certification Program (L&C).