Every skilled nursing facility in the country is rated by the federal Centers for Medicare and Medicaid Services (CMS) on a one to five star scale, and every fine, penalty, and abuse citation is published as public data. We pulled the complete record for all 1,165 California nursing homes and analyzed it: how the state's homes rate, which counties and operators carry the worst records, and what the numbers say about who owns them.
This is a factual analysis of public government data. It is not an allegation of wrongdoing against any facility or operator. Ratings and fines reflect the CMS processing date shown above and may have changed since.
Key findings
- California has 1,165 skilled nursing facilities, and 1,154 carry a current overall star rating.
- More than one in three (35.1%, or 405 homes) rate at one or two stars, the bottom two tiers. Only 43.5% rate at four or five stars.
- California nursing homes have accumulated $28.7 million in federal fines across 1,027 federal fines. More than four in ten homes (474) have been fined at least once.
- 113 homes, about one in ten, currently carry the CMS abuse icon, a flag CMS applies to facilities cited for abuse-related deficiencies.
- For-profit homes are about 2.4 times more likely to rate one or two stars than non-profit homes (37.8% versus 16.0%). 87.0% of California's nursing homes are for-profit.
- Los Angeles County alone accounts for 56.0% of the state's federal nursing home fines ($16.1 million), while holding about a third of its homes.
- Kern County is the worst-rated county in the state, with 13 of its 17 homes (76.5%) at one or two stars and an average rating of just 1.76.
- PACS Group is the largest operator in California with 133 homes, and also the most fined at $3.4 million.
How to read this report
Three of the four numbers we use come straight from CMS. The overall star rating blends three components: the health-inspection rating (from unannounced in-person state surveys, the most independent measure), the staffing rating, and the quality-measure rating. Fines and penalties are federal enforcement actions. The abuse icon flags homes cited for abuse-related deficiencies. A single number never tells the whole story, which is why we show ratings, fines, and abuse flags side by side.
Statewide overview
California's nursing homes split almost evenly between strong and weak, with a large middle. Here is the current distribution of overall star ratings across the 1,154 rated homes.
| Overall rating | Homes | Share |
|---|---|---|
| 5 stars | 273 | 23.7% |
| 4 stars | 229 | 19.8% |
| 3 stars | 247 | 21.4% |
| 2 stars | 214 | 18.5% |
| 1 star | 191 | 16.6% |
The bottom two tiers together hold 405 homes, more than a third of the state. On the enforcement side, the picture is heavier than most families expect: 474 homes carry at least one federal fine, the state total is $28,736,255, and 113 homes are currently flagged for abuse-related citations.
The ownership finding: for-profit versus non-profit
The clearest pattern in the data is about who owns the home. California's nursing homes are overwhelmingly for-profit, and those homes rate markedly worse than their non-profit counterparts.
| Ownership | Homes | Average rating | Share at 1-2 stars |
|---|---|---|---|
| Non-profit | 119 | 3.94 | 16.0% |
| Government | 33 | 3.69 | 21.9% |
| For-profit | 1,013 | 3.04 | 37.8% |
A for-profit home in California is about 2.4 times as likely to sit in the bottom two tiers as a non-profit home. This does not mean every for-profit home is unsafe or every non-profit is excellent, and there are strong and weak homes in every category. But when 89.2% of the state's certified beds are run for profit, the ownership gap is one of the most useful things a family can know going in.
Worst counties in California
Ranked by the share of homes rating one or two stars, among counties with at least ten facilities.
| County | Homes | 1-2 star share | Avg rating | Total fines | Abuse-flagged |
|---|---|---|---|---|---|
| Kern | 17 | 76.5% | 1.76 | $741,793 | 2 |
| Los Angeles | 369 | 57.2% | 2.46 | $16,092,884 | 48 |
| Marin | 11 | 45.5% | 3.09 | $474,034 | 3 |
| San Joaquin | 24 | 41.7% | 2.71 | $109,468 | 6 |
| Tulare | 16 | 37.5% | 3.06 | $361,948 | 0 |
| Fresno | 31 | 33.3% | 3.07 | $371,609 | 1 |
| Orange | 72 | 30.6% | 3.10 | $260,736 | 5 |
| Riverside | 54 | 30.2% | 3.21 | $875,788 | 1 |
| Stanislaus | 17 | 29.4% | 3.06 | $362,695 | 0 |
| Sonoma | 18 | 27.8% | 3.50 | $445,128 | 4 |
Kern County stands out sharply: with an average rating of 1.76, it is the only large county in the state where the typical nursing home rates below two stars. Marin County is a notable entry, because a wealthy county with only eleven homes ranks third in the state on this measure, with five of them in the bottom two tiers. Local affluence does not guarantee good care.
Best counties in California
Ranked by the share of homes rating four or five stars, among counties with at least ten facilities.
| County | Homes | 4-5 star share | Avg rating |
|---|---|---|---|
| Ventura | 19 | 78.9% | 4.37 |
| San Francisco | 18 | 77.8% | 4.28 |
| San Mateo | 14 | 71.4% | 3.86 |
| Santa Barbara | 14 | 71.4% | 4.07 |
| Contra Costa | 30 | 70.0% | 3.73 |
| Placer | 10 | 70.0% | 4.10 |
| San Diego | 83 | 69.1% | 3.95 |
| San Bernardino | 55 | 68.5% | 3.81 |
Even in these counties, averages hide individual homes that fall short, which is why a family should always check the specific facility rather than rely on the county's reputation.
Where the fines are
Total federal fines are heavily concentrated. Los Angeles County alone carries more than half of the statewide total.
| County | Total fines | Homes | Abuse-flagged |
|---|---|---|---|
| Los Angeles | $16,092,884 | 369 | 48 |
| San Diego | $1,106,785 | 83 | 4 |
| Alameda | $960,218 | 69 | 4 |
| Riverside | $875,788 | 54 | 1 |
| Madera | $780,208 | 5 | 1 |
| Kern | $741,793 | 17 | 2 |
| Sacramento | $696,733 | 37 | 13 |
| Santa Clara | $651,609 | 50 | 0 |
| Solano | $506,815 | 9 | 0 |
| Marin | $474,034 | 11 | 3 |
Two entries deserve a second look. Madera County has drawn $780,208 in fines across just five homes, and Solano $506,815 across nine. Those are the two highest per-home fine burdens in the state among counties with at least five homes, at about $156,000 and $56,000 per home. Sacramento is notable for a different reason: 13 of its 37 homes carry the abuse icon, the largest cluster of abuse-flagged homes in any county outside Los Angeles.
The operators behind the homes
Most California nursing homes belong to a larger operating company. Because a bigger operator naturally accumulates more total fines simply by running more homes, we show each operator's average rating and its share of low-rated homes alongside the fine totals, which is the fairer comparison.
| Operator | CA homes | Avg rating | 1-2 star share | Total fines | Abuse-flagged |
|---|---|---|---|---|---|
| PACS Group | 133 | 3.23 | 29.5% | $3,404,911 | 13 |
| The Ensign Group | 75 | 3.51 | 21.3% | $843,111 | 3 |
| Corporate Interface Services | 40 | 2.50 | 57.5% | $1,354,469 | 6 |
| Longwood Management | 38 | 2.16 | 65.8% | $1,147,777 | 3 |
| Aspen Skilled Healthcare | 34 | 3.74 | 14.7% | $744,402 | 1 |
| Cambridge Healthcare Services | 32 | 2.55 | 51.6% | $1,079,057 | 1 |
| Generations Healthcare | 26 | 4.08 | 11.5% | $378,169 | 2 |
| Links Healthcare Group | 25 | 3.04 | 36.0% | $318,113 | 2 |
| Windsor | 22 | 2.41 | 54.5% | $484,622 | 6 |
| Genesis Healthcare | 17 | 2.25 | 68.8% | $733,936 | 1 |
The two largest operators, PACS Group and Ensign, run middle-of-the-pack homes on average despite large total fines that track their size. The more striking entries are the mid-sized operators whose homes rate poorly across the board. Longwood Management averages 2.16 stars and Genesis Healthcare 2.25, the two lowest ratings among the ten, and Genesis carries the largest share of homes in the bottom two tiers at 68.8%, with Longwood at 65.8%. Corporate Interface Services and Windsor follow at 2.50 and 2.41 stars. At the other end, Generations Healthcare shows that scale and quality can coexist, averaging 4.08 stars across 26 homes. When you are comparing homes, the operator is worth knowing.
The most heavily fined facilities
These individual homes carry the largest federal fine totals in California. Some also hold one-star ratings or the abuse icon. All figures are public CMS data reported as published.
| Facility | City | Overall | Total fines | Abuse flag |
|---|---|---|---|---|
| Rancho Seco Care Center | Galt | not reported | $490,205 | Yes |
| Rio Hondo Subacute & Nursing Center | Montebello | not reported | $411,481 | No |
| Ararat Nursing Facility | Mission Hills | 1 star | $407,175 | Yes |
| Madera Rehabilitation & Nursing Center | Madera | 1 star | $373,733 | No |
| Maclay Healthcare Center | Sylmar | 2 stars | $361,118 | Yes |
| Friendship Manor Nursing & Rehab Center | National City | 5 stars | $297,367 | No |
| Miracle Mile Healthcare Center, LLC | Los Angeles | 1 star | $273,521 | Yes |
| Artesia Palms Care Center | Artesia | 1 star | $267,056 | Yes |
| Majestic Mountain Care Center | Oakhurst | 1 star | $252,683 | Yes |
| Skyline Healthcare Center - LA | Los Angeles | 1 star | $251,090 | No |
What families can do with this
A star rating is a starting point, not a verdict on your loved one's care, and a good rating does not prove that one resident was treated well any more than a bad rating proves neglect. But the public record is the best first filter available, and it is free.
Before choosing or evaluating a home, look up its overall rating, its health-inspection rating (the most independent of the three), its staffing numbers against the state benchmark, its fines, and whether it carries the abuse icon. You can do all of that through our California nursing home directory, which presents the same CMS data home by home, or directly on the federal Care Compare tool.
If you already believe a loved one was harmed, our guide on how to report nursing home abuse in California walks through the complaint process, and our pages on nursing home neglect and bedsores explain how these cases work under California's Elder Abuse Act.
Talk to a California nursing home abuse lawyer
If this data raised a concern about a home where your loved one lives, we can help you understand what the records show. Michael Young and Thomas Wallin are former nursing home defense attorneys who have recovered millions of dollars for elder abuse victims and their families. Call (888) 999-0169 for a free, confidential consultation. We serve families throughout California, and you pay nothing unless we win.
Methodology: figures are drawn from the CMS Provider Information dataset (data.cms.gov, Care Compare) covering all California skilled nursing facilities, at the August 2026 processing date. County and operator aggregates were calculated from that dataset. Operator groupings use the affiliated-entity and legal-business-name fields as published by CMS and may not capture every corporate relationship. "Low-rated" means an overall rating of one or two stars. Averages are among homes carrying a current overall rating.
Frequently asked questions
What is the average California nursing home star rating?
Across the 1,154 rated homes, the distribution is fairly even, with 43.5% at four or five stars and 35.1% at one or two stars. The single largest group is five-star homes (273), but the one and two star tiers together (405 homes) outnumber them.
Are for-profit nursing homes worse in California?
On average, yes. For-profit homes rate 3.04 stars on average with 37.8% in the bottom two tiers, compared with non-profit homes at 3.94 stars and 16.0% in the bottom two tiers. There are strong for-profit homes and weak non-profit homes, but the overall gap is large and consistent.
Which California county has the worst nursing homes?
By the share of homes rating one or two stars, Kern County is the worst among larger counties, with 76.5% of its 17 homes in the bottom two tiers and an average rating of 1.76. Los Angeles has the largest number of low-rated homes and by far the most fines.
What is the CMS abuse icon?
It is a warning symbol CMS places on the Care Compare profile of a facility that has been cited for abuse-related deficiencies on recent inspections. About 113 California homes currently carry it. It is drawn from public inspection data and is not, by itself, a finding about any individual resident.
How current is this data?
It reflects the CMS Care Compare processing date shown at the top of this report. CMS updates its data regularly, so individual ratings and fine totals can change. We refresh this analysis periodically.
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Disclaimer: all facility, operator, county, ratings, fines, penalty, and abuse-icon figures above are drawn from public CMS data (medicare.gov and data.cms.gov) and are reported as published as of the processing date shown. They may not reflect the most current findings, and inclusion of any facility or operator is not an allegation of wrongdoing. Past results do not guarantee a similar outcome in any future case. This page is attorney advertising and not legal advice.