The letter is a grid coordinate, not a grade
CMS scores each finding on two axes. Severity runs from “no actual harm, minimal potential” up through “no actual harm but potential for more than minimal harm”, then “actual harm”, and finally “immediate jeopardy” — the most serious category, meaning a situation likely to cause serious injury or death. Scope runs across three columns: isolated (one or a few residents), pattern (more than a few), and widespread (throughout the facility).
The letters fill that grid in reading order. A, B, C are the least severe band across the three scope columns; D, E, F the next; G, H, I are actual harm; J, K, L are immediate jeopardy. So within any band, a later letter means the same seriousness reached more residents — H is the same severity as G but affected a pattern of residents rather than one.
G is the line that matters
The single most useful thing to know is where actual harm begins. A through F all mean no resident was actually harmed — the finding identified a deficiency and, at worst, the potential for harm. G and above mean harm occurred, and J through L mean immediate jeopardy.
This site marks G–L as higher severity for exactly that reason, and facility pages show the letter on every citation so you can see the split yourself rather than taking a summary count on trust.
What a normal record looks like
Most citations at most facilities sit in the A–F band. Surveys are thorough and a facility of any size will accumulate findings; a record with several D and E citations across a few years is the ordinary shape of an inspected nursing home, not a warning sign.
What stands out against that background is a G or above, a cluster of findings from a single survey, or the same deficiency recurring across successive surveys. One resolved citation from three years ago and a repeating pattern through last month are very different records that produce similar-looking counts.
Standard survey or complaint investigation
Citations arrive through two routes. A standard survey is the routine comprehensive inspection every certified facility receives. A complaint investigation is triggered by someone reporting a specific concern, so it is narrower and targeted at what was alleged.
The distinction is worth noting because it changes what a finding implies. A citation from a complaint investigation means somebody raised a concern and a surveyor substantiated at least part of it. Facility pages here label which route each citation came through.
Correction status and dates
A citation is a point in time. Facilities submit a plan of correction and are re-checked, so the record also carries a correction date and current status where CMS reports them. A finding with a correction date recorded is a different situation from one still showing as open.
Read the dates before the counts. The inspection date tells you when this was true; the correction date tells you whether it stayed true. Both appear in the full citation table on every facility page.
What citations cannot tell you
A citation records a specific requirement not met on a specific day, written by one surveyor. It does not describe daily life in the building, and the absence of citations is not proof of good care — it can also mean a facility was surveyed at a quiet moment.
CMS publishes the full narrative for each finding, including what the surveyor actually observed. This site keeps the structured fields — date, tag, severity letter, route, correction status — and points you to Medicare's Care Compare for the narrative text, which is where the specifics live.