Nursing Home Abuse Glossary

Plain-language definitions of the terms families run into when they research a California nursing home, read an inspection report, or talk to a lawyer. Each entry stands on its own.

Abuse icon. A warning symbol CMS places on a facility's Care Compare profile when the home has been cited for abuse-related deficiencies on recent inspections. About one in ten California homes currently carries it.

Actual harm. A federal survey severity level meaning an inspector found that a facility's failure caused real, negative harm to a resident, short of immediate jeopardy. It is a serious finding.

Adult Protective Services (APS). The county agency that investigates reports of abuse or neglect of elders and dependent adults. For someone inside a licensed nursing home, CDPH usually leads, but APS still takes reports. Call 911 if a resident is in immediate danger; our reporting guide lists every agency.

Arbitration agreement. A contract, often tucked into admission paperwork, that sends disputes to a private arbitrator instead of a jury. A facility cannot require it for admission; have a lawyer review one before assuming it is enforceable.

Bedsore (pressure ulcer). A wound caused by sustained pressure on the skin, usually over a bony area like the tailbone or heels, when a resident is not repositioned often enough. Advanced sores are generally treated as preventable with proper care. See our bedsores page.

Cal Health Find. The California Department of Public Health's online system for looking up licensed facilities, reading their inspection history, and filing complaints. It shows state citations that never appear on the federal Care Compare site. Our CDPH complaint guide explains how to use it.

Care plan. The written plan a nursing home must create for each resident, covering repositioning schedules, fall precautions, diet, and wound care. The facility must update it when the resident's condition changes, and it must actually follow it. In a neglect case, the gap between the plan and what staff actually did is often the core evidence.

CCN (CMS Certification Number). The identification number CMS assigns to every certified nursing home. It stays with the facility even when the name or owner changes, so it is the most reliable way to track a home's history. It appears on Care Compare and in our directory of California nursing homes.

CDPH. The California Department of Public Health, the state agency that licenses skilled nursing facilities, inspects them, investigates complaints, and issues state citations.

Chemical restraint. A drug used to control a resident's behavior or sedate them for staff convenience rather than to treat a medical condition. Antipsychotics given to residents with dementia without informed consent are the most common example, and it can support an abuse claim. See our medication errors page.

Citation, class AA, A, and B. The three levels of state citation CDPH issues against nursing homes, each with a civil penalty. A class AA citation is a class A violation that the Department of Public Health determined was a direct proximate cause of a resident's death. A class A citation is a violation the Department determined presented an imminent danger of death or serious harm to residents, or a substantial probability that death or serious physical harm would result. A class B citation is a violation the Department determined had a direct or immediate relationship to residents' health, safety or security, other than a class AA or A violation. Citation histories are collected on our California nursing home report card.

Clear and convincing evidence. The heightened standard of proof required for the Elder Abuse Act's enhanced remedies, higher than the "more likely than not" standard in ordinary negligence cases. A family must prove recklessness, oppression, fraud, or malice at this level to recover attorney's fees and the other enhanced damages.

CMS. The federal Centers for Medicare and Medicaid Services, which certifies nursing homes that accept Medicare or Medicaid, sets federal care standards, and publishes ratings and inspection results on Care Compare. CDPH performs the inspections on its behalf.

Contingency fee. A fee arrangement where the lawyer is paid a percentage of the recovery instead of by the hour, and nothing if the case recovers nothing. Nearly all nursing home abuse cases run this way, so families can hire a lawyer with no money up front. Our settlement value guide covers what moves case value.

Custodial neglect. The failure by those responsible for a dependent adult's care to provide basic needs: food, water, hygiene, repositioning, supervision, and access to medical care. It is the core of most nursing home claims under the Elder Abuse Act, and courts treat it differently from ordinary medical malpractice.

Dependent adult. Under California law, an adult between 18 and 64 with physical or mental limitations that restrict their ability to carry out normal activities or protect their rights. The Elder Abuse Act covers dependent adults as well as elders (65 and older).

Elder Abuse Act (EADACPA). California's Elder Abuse and Dependent Adult Civil Protection Act, Welfare and Institutions Code section 15600 and following, the central statute in most nursing home cases. Where a family proves reckless neglect, or oppression, fraud, or malice, by clear and convincing evidence, it allows enhanced remedies, including attorney's fees and the victim's pre-death pain and suffering.

Elopement. When a resident who needs supervision leaves the facility unnoticed, often through an unsecured door. It can be fatal, and residents with dementia are the usual victims. See our elopement and wandering page.

F-tag. The code number CMS assigns to each federal nursing home regulation. When a survey finds a violation, the deficiency is recorded under the matching F-tag, so an inspection history reads as a list of F-tags with severity grades attached.

Hospice waiver. A permission the state grants an assisted living facility (RCFE) so it can keep a resident who has gone on hospice instead of transferring them to a nursing home. The waiver does not lower the facility's duty to meet the resident's growing needs.

HPRD (hours per resident per day). The standard measure of staffing: total nursing and aide time divided by the number of residents. California's average is about 4.52 total nursing hours per resident per day. Low staffing predicts most kinds of neglect.

Immediate jeopardy. The most serious federal survey finding, meaning a facility's failure caused, or was likely to cause, serious injury, harm, or death. It requires immediate correction and usually brings the largest federal fines.

Long-term care ombudsman. A free, independent advocate who visits facilities, investigates concerns, and presses homes on residents' behalf. The ombudsman is often the fastest first step for an ongoing care problem, and calling one does not stop a CDPH complaint or a lawsuit.

If something has already gone wrong, you do not have to sort out the vocabulary on your own. Call (888) 999-0169 for a free consultation with Young & Wallin, or reach us online. You pay nothing unless we win.

MDS (Minimum Data Set). The detailed assessment a nursing home must complete for every resident at admission and at regular intervals, covering mobility, skin condition, nutrition, and cognition. MDS data feeds the star rating's quality measures, and the facility reports it about itself. In litigation, MDS records often contradict the daily charting.

MICRA. California's Medical Injury Compensation Reform Act, which caps non-economic damages and sets shorter deadlines for medical professional negligence claims: three years from the injury or one year from discovering it, whichever comes first. True Elder Abuse Act claims for custodial neglect are generally treated differently from MICRA malpractice.

Neglect. The failure to provide the care a resident needs to stay safe and healthy, including repositioning, feeding, hydration, hygiene, supervision, and medical attention. Under California law, serious neglect is a form of elder abuse. See our neglect page and the signs of nursing home neglect guide.

Pressure ulcer stages. Bedsores are graded from stage 1 (intact, reddened skin) through stage 4 (a deep wound exposing muscle, tendon, or bone), plus "unstageable" wounds whose depth cannot be seen. A sore that reached stage 3 or 4 inside a facility almost always raises neglect questions.

RCFE (residential care facility for the elderly). California's license category for assisted living. RCFEs are licensed by the Department of Social Services, not CDPH, and are not medical facilities. Residents there still have legal protections; see our assisted living abuse page.

Scope and severity. The letter grade, A through L, that federal surveyors assign to each deficiency. Severity runs from potential for minimal harm up to immediate jeopardy, and scope runs from isolated to widespread. G or higher means actual harm; J through L mean immediate jeopardy.

Sepsis. The body's life-threatening response to an infection, which can shut down organs within hours. In a nursing home it often begins with an untreated bedsore, urinary tract infection, or pneumonia that staff failed to catch in time. See our sepsis and infections page.

Skilled nursing facility (SNF). A licensed nursing home providing 24-hour nursing care. It is a medical facility, unlike assisted living, and it is the facility type CMS certifies and rates. Our directory covers California SNFs.

Special focus facility. A CMS designation for the nursing homes with the worst persistent inspection records in each state. These facilities are surveyed more often and can lose Medicare and Medicaid funding if they do not improve.

Staffing rating. One of the three components of the CMS star rating, based on payroll records showing how much nurse and aide time residents actually received. Because it comes from payroll data rather than the facility's own claims, it is harder to inflate.

Star rating (Five-Star Quality Rating System). CMS's one-to-five-star score for every certified nursing home, blending health inspections, staffing, and quality measures. Part of the data is self-reported, which is why a five-star home can still be dangerous. Our guide to reading CMS star ratings shows what to check.

Statement of deficiencies (Form 2567). The official written report a surveyor issues after an inspection, listing every violation with its F-tag and its scope and severity grade. Recent 2567s are public records that facilities must make available on request, and they are often the first hard evidence a family sees.

Statute of limitations. The legal deadline to file a claim. In California, most nursing home negligence and wrongful death claims must be filed within two years, medical professional negligence follows MICRA's shorter rules, and claims against government-run facilities require a government claim within six months. Our deadlines guide covers each rule.

Survey. The unannounced inspection every certified nursing home must undergo, performed in California by CDPH on behalf of CMS, plus extra visits triggered by complaints. Surveyors observe care, interview residents and staff, and review records; the findings become the Form 2567.

Survival action. A claim the deceased person's estate brings for the harm the person suffered before death, as opposed to the family's own losses. Under the Elder Abuse Act, it can include the victim's pre-death pain and suffering where reckless neglect is proven. It usually runs alongside a wrongful death claim; see who can file a wrongful death claim.

Wrongful death. A claim under Code of Civil Procedure section 377.60 by specific family members, usually the spouse and children, for their own losses from a death caused by another's wrongful act or neglect. It compensates what the family lost; the survival action covers what the resident went through. See our wrongful death page.

If a loved one was harmed

If you are here because something happened to someone you love, call (888) 999-0169 for a free, confidential consultation. Thomas Wallin and Michael Young defended nursing homes before they started representing families, so they know how facilities explain away the terms on this page. We have recovered millions for elder abuse victims, and you pay nothing unless we win. You can also contact us online.

Sources and authoritative references

• CMS Care Compare: https://www.medicare.gov/care-compare/
• California Department of Public Health, Cal Health Find: https://calhealthfind.cdph.ca.gov/
• California Elder Abuse Act, Welfare and Institutions Code section 15600: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=15600.

Disclaimer: these definitions are general information, not legal or medical advice, and do not create an attorney-client relationship. This page is attorney advertising.