{
 "metadata": {
  "title": "Nursing Home Violation Index by state",
  "publisher": "Nursing Home Violations (nursinghomeviolations.org)",
  "source": "CMS Care Compare",
  "source_url": "https://data.cms.gov/provider-data/dataset/4pq5-n9py",
  "cms_release": "2026-10-08",
  "inspection_window": {
   "first_survey": "2017-03-23",
   "last_survey": "2026-08-26"
  },
  "rows": 53,
  "license": "Compilation CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/); the CMS records are US federal public domain"
 },
 "states": [
  {
   "rank": 1,
   "state": "Illinois",
   "homes": 666,
   "ranked": true,
   "serious_citations_per_home": 4.55,
   "immediate_jeopardy_citations_per_home": 0.77,
   "citations_per_home": 38.1,
   "fines_usd_per_home": 111013,
   "one_star_share_pct": 37.1,
   "avg_staff_turnover_pct": 44.5,
   "nurse_hours_per_resident_day": 3.45,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 2,
   "state": "Rhode Island",
   "homes": 72,
   "ranked": true,
   "serious_citations_per_home": 3.12,
   "immediate_jeopardy_citations_per_home": 1.51,
   "citations_per_home": 27.8,
   "fines_usd_per_home": 60948,
   "one_star_share_pct": 18.3,
   "avg_staff_turnover_pct": 40.6,
   "nurse_hours_per_resident_day": 3.71,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 3,
   "state": "Utah",
   "homes": 97,
   "ranked": true,
   "serious_citations_per_home": 3.09,
   "immediate_jeopardy_citations_per_home": 0.63,
   "citations_per_home": 27.2,
   "fines_usd_per_home": 23954,
   "one_star_share_pct": 9.4,
   "avg_staff_turnover_pct": 50.7,
   "nurse_hours_per_resident_day": 4.09,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 4,
   "state": "South Dakota",
   "homes": 96,
   "ranked": true,
   "serious_citations_per_home": 2.49,
   "immediate_jeopardy_citations_per_home": 0.36,
   "citations_per_home": 17.4,
   "fines_usd_per_home": 40815,
   "one_star_share_pct": 20.2,
   "avg_staff_turnover_pct": 48.2,
   "nurse_hours_per_resident_day": 3.79,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 5,
   "state": "Vermont",
   "homes": 33,
   "ranked": true,
   "serious_citations_per_home": 2.48,
   "immediate_jeopardy_citations_per_home": 0.88,
   "citations_per_home": 27.6,
   "fines_usd_per_home": 87304,
   "one_star_share_pct": 21.9,
   "avg_staff_turnover_pct": 55.4,
   "nurse_hours_per_resident_day": 4.22,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 6,
   "state": "Delaware",
   "homes": 44,
   "ranked": true,
   "serious_citations_per_home": 2.41,
   "immediate_jeopardy_citations_per_home": 1.05,
   "citations_per_home": 37.0,
   "fines_usd_per_home": 67512,
   "one_star_share_pct": 4.7,
   "avg_staff_turnover_pct": 41.3,
   "nurse_hours_per_resident_day": 4.35,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 7,
   "state": "Colorado",
   "homes": 210,
   "ranked": true,
   "serious_citations_per_home": 2.33,
   "immediate_jeopardy_citations_per_home": 0.41,
   "citations_per_home": 25.0,
   "fines_usd_per_home": 22802,
   "one_star_share_pct": 12.5,
   "avg_staff_turnover_pct": 47.1,
   "nurse_hours_per_resident_day": 3.72,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 8,
   "state": "Texas",
   "homes": 1177,
   "ranked": true,
   "serious_citations_per_home": 2.26,
   "immediate_jeopardy_citations_per_home": 1.83,
   "citations_per_home": 27.8,
   "fines_usd_per_home": 44141,
   "one_star_share_pct": 27.6,
   "avg_staff_turnover_pct": 55.3,
   "nurse_hours_per_resident_day": 3.39,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 9,
   "state": "Montana",
   "homes": 61,
   "ranked": true,
   "serious_citations_per_home": 2.2,
   "immediate_jeopardy_citations_per_home": 0.33,
   "citations_per_home": 31.1,
   "fines_usd_per_home": 55610,
   "one_star_share_pct": 22.0,
   "avg_staff_turnover_pct": 54.8,
   "nurse_hours_per_resident_day": 4.05,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 10,
   "state": "Mississippi",
   "homes": 202,
   "ranked": true,
   "serious_citations_per_home": 2.06,
   "immediate_jeopardy_citations_per_home": 0.86,
   "citations_per_home": 18.2,
   "fines_usd_per_home": 17231,
   "one_star_share_pct": 25.6,
   "avg_staff_turnover_pct": 45.7,
   "nurse_hours_per_resident_day": 4.18,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 11,
   "state": "Wisconsin",
   "homes": 323,
   "ranked": true,
   "serious_citations_per_home": 2.03,
   "immediate_jeopardy_citations_per_home": 0.89,
   "citations_per_home": 28.1,
   "fines_usd_per_home": 48150,
   "one_star_share_pct": 21.8,
   "avg_staff_turnover_pct": 46.9,
   "nurse_hours_per_resident_day": 4.21,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 11,
   "state": "Wyoming",
   "homes": 36,
   "ranked": true,
   "serious_citations_per_home": 2.03,
   "immediate_jeopardy_citations_per_home": 0.22,
   "citations_per_home": 20.6,
   "fines_usd_per_home": 28128,
   "one_star_share_pct": 20.0,
   "avg_staff_turnover_pct": 51.8,
   "nurse_hours_per_resident_day": 3.87,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 13,
   "state": "Washington",
   "homes": 193,
   "ranked": true,
   "serious_citations_per_home": 2.02,
   "immediate_jeopardy_citations_per_home": 0.28,
   "citations_per_home": 49.5,
   "fines_usd_per_home": 52633,
   "one_star_share_pct": 11.5,
   "avg_staff_turnover_pct": 45.1,
   "nurse_hours_per_resident_day": 4.36,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 14,
   "state": "New Mexico",
   "homes": 68,
   "ranked": true,
   "serious_citations_per_home": 1.97,
   "immediate_jeopardy_citations_per_home": 1.01,
   "citations_per_home": 50.4,
   "fines_usd_per_home": 45849,
   "one_star_share_pct": 17.9,
   "avg_staff_turnover_pct": 53.3,
   "nurse_hours_per_resident_day": 3.54,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 15,
   "state": "Michigan",
   "homes": 422,
   "ranked": true,
   "serious_citations_per_home": 1.96,
   "immediate_jeopardy_citations_per_home": 0.26,
   "citations_per_home": 32.2,
   "fines_usd_per_home": 29376,
   "one_star_share_pct": 17.1,
   "avg_staff_turnover_pct": 44.1,
   "nurse_hours_per_resident_day": 3.99,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 16,
   "state": "North Carolina",
   "homes": 419,
   "ranked": true,
   "serious_citations_per_home": 1.79,
   "immediate_jeopardy_citations_per_home": 0.99,
   "citations_per_home": 18.3,
   "fines_usd_per_home": 36617,
   "one_star_share_pct": 21.9,
   "avg_staff_turnover_pct": 49.0,
   "nurse_hours_per_resident_day": 3.85,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 17,
   "state": "Missouri",
   "homes": 487,
   "ranked": true,
   "serious_citations_per_home": 1.71,
   "immediate_jeopardy_citations_per_home": 0.62,
   "citations_per_home": 35.9,
   "fines_usd_per_home": 37425,
   "one_star_share_pct": 34.0,
   "avg_staff_turnover_pct": 56.0,
   "nurse_hours_per_resident_day": 3.43,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 18,
   "state": "Kansas",
   "homes": 296,
   "ranked": true,
   "serious_citations_per_home": 1.58,
   "immediate_jeopardy_citations_per_home": 0.75,
   "citations_per_home": 27.6,
   "fines_usd_per_home": 20430,
   "one_star_share_pct": 19.1,
   "avg_staff_turnover_pct": 48.1,
   "nurse_hours_per_resident_day": 4.07,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 19,
   "state": "North Dakota",
   "homes": 72,
   "ranked": true,
   "serious_citations_per_home": 1.53,
   "immediate_jeopardy_citations_per_home": 0.47,
   "citations_per_home": 17.1,
   "fines_usd_per_home": 27629,
   "one_star_share_pct": 19.7,
   "avg_staff_turnover_pct": 48.8,
   "nurse_hours_per_resident_day": 4.42,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 20,
   "state": "Kentucky",
   "homes": 267,
   "ranked": true,
   "serious_citations_per_home": 1.49,
   "immediate_jeopardy_citations_per_home": 0.94,
   "citations_per_home": 12.2,
   "fines_usd_per_home": 15373,
   "one_star_share_pct": 22.2,
   "avg_staff_turnover_pct": 46.4,
   "nurse_hours_per_resident_day": 3.95,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 21,
   "state": "Oregon",
   "homes": 128,
   "ranked": true,
   "serious_citations_per_home": 1.45,
   "immediate_jeopardy_citations_per_home": 0.41,
   "citations_per_home": 34.1,
   "fines_usd_per_home": 27522,
   "one_star_share_pct": 17.3,
   "avg_staff_turnover_pct": 47.4,
   "nurse_hours_per_resident_day": 5.03,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 21,
   "state": "Virginia",
   "homes": 289,
   "ranked": true,
   "serious_citations_per_home": 1.45,
   "immediate_jeopardy_citations_per_home": 0.48,
   "citations_per_home": 38.7,
   "fines_usd_per_home": 23688,
   "one_star_share_pct": 21.0,
   "avg_staff_turnover_pct": 48.1,
   "nurse_hours_per_resident_day": 3.76,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 23,
   "state": "Connecticut",
   "homes": 191,
   "ranked": true,
   "serious_citations_per_home": 1.41,
   "immediate_jeopardy_citations_per_home": 0.41,
   "citations_per_home": 36.6,
   "fines_usd_per_home": 23730,
   "one_star_share_pct": 18.9,
   "avg_staff_turnover_pct": 37.4,
   "nurse_hours_per_resident_day": 3.73,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 23,
   "state": "Massachusetts",
   "homes": 341,
   "ranked": true,
   "serious_citations_per_home": 1.41,
   "immediate_jeopardy_citations_per_home": 0.29,
   "citations_per_home": 28.5,
   "fines_usd_per_home": 34265,
   "one_star_share_pct": 19.2,
   "avg_staff_turnover_pct": 38.2,
   "nurse_hours_per_resident_day": 3.86,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 25,
   "state": "Minnesota",
   "homes": 338,
   "ranked": true,
   "serious_citations_per_home": 1.36,
   "immediate_jeopardy_citations_per_home": 0.7,
   "citations_per_home": 23.4,
   "fines_usd_per_home": 24507,
   "one_star_share_pct": 19.0,
   "avg_staff_turnover_pct": 42.2,
   "nurse_hours_per_resident_day": 4.19,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 26,
   "state": "Iowa",
   "homes": 387,
   "ranked": true,
   "serious_citations_per_home": 1.31,
   "immediate_jeopardy_citations_per_home": 0.46,
   "citations_per_home": 20.6,
   "fines_usd_per_home": 19286,
   "one_star_share_pct": 20.3,
   "avg_staff_turnover_pct": 44.0,
   "nurse_hours_per_resident_day": 3.82,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 26,
   "state": "West Virginia",
   "homes": 123,
   "ranked": true,
   "serious_citations_per_home": 1.31,
   "immediate_jeopardy_citations_per_home": 0.85,
   "citations_per_home": 41.5,
   "fines_usd_per_home": 29505,
   "one_star_share_pct": 20.5,
   "avg_staff_turnover_pct": 44.1,
   "nurse_hours_per_resident_day": 3.67,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 28,
   "state": "Tennessee",
   "homes": 303,
   "ranked": true,
   "serious_citations_per_home": 1.27,
   "immediate_jeopardy_citations_per_home": 0.82,
   "citations_per_home": 14.4,
   "fines_usd_per_home": 22907,
   "one_star_share_pct": 19.3,
   "avg_staff_turnover_pct": 48.9,
   "nurse_hours_per_resident_day": 3.8,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 29,
   "state": "Pennsylvania",
   "homes": 656,
   "ranked": true,
   "serious_citations_per_home": 1.25,
   "immediate_jeopardy_citations_per_home": 0.42,
   "citations_per_home": 31.6,
   "fines_usd_per_home": 25774,
   "one_star_share_pct": 22.2,
   "avg_staff_turnover_pct": 44.5,
   "nurse_hours_per_resident_day": 3.89,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 30,
   "state": "California",
   "homes": 1165,
   "ranked": true,
   "serious_citations_per_home": 1.2,
   "immediate_jeopardy_citations_per_home": 0.3,
   "citations_per_home": 49.8,
   "fines_usd_per_home": 23986,
   "one_star_share_pct": 16.1,
   "avg_staff_turnover_pct": 36.7,
   "nurse_hours_per_resident_day": 4.52,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 31,
   "state": "Hawaii",
   "homes": 43,
   "ranked": true,
   "serious_citations_per_home": 1.19,
   "immediate_jeopardy_citations_per_home": 0.16,
   "citations_per_home": 34.0,
   "fines_usd_per_home": 19339,
   "one_star_share_pct": 7.3,
   "avg_staff_turnover_pct": 36.4,
   "nurse_hours_per_resident_day": 4.97,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 31,
   "state": "Louisiana",
   "homes": 265,
   "ranked": true,
   "serious_citations_per_home": 1.19,
   "immediate_jeopardy_citations_per_home": 0.79,
   "citations_per_home": 24.4,
   "fines_usd_per_home": 46795,
   "one_star_share_pct": 33.7,
   "avg_staff_turnover_pct": 47.6,
   "nurse_hours_per_resident_day": 3.76,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 33,
   "state": "Ohio",
   "homes": 922,
   "ranked": true,
   "serious_citations_per_home": 1.16,
   "immediate_jeopardy_citations_per_home": 0.31,
   "citations_per_home": 31.0,
   "fines_usd_per_home": 26381,
   "one_star_share_pct": 12.9,
   "avg_staff_turnover_pct": 48.7,
   "nurse_hours_per_resident_day": 3.69,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 34,
   "state": "Oklahoma",
   "homes": 283,
   "ranked": true,
   "serious_citations_per_home": 1.11,
   "immediate_jeopardy_citations_per_home": 0.68,
   "citations_per_home": 22.8,
   "fines_usd_per_home": 18268,
   "one_star_share_pct": 26.3,
   "avg_staff_turnover_pct": 55.5,
   "nurse_hours_per_resident_day": 3.79,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 35,
   "state": "South Carolina",
   "homes": 187,
   "ranked": true,
   "serious_citations_per_home": 1.09,
   "immediate_jeopardy_citations_per_home": 0.81,
   "citations_per_home": 12.6,
   "fines_usd_per_home": 14833,
   "one_star_share_pct": 21.0,
   "avg_staff_turnover_pct": 45.9,
   "nurse_hours_per_resident_day": 3.84,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 36,
   "state": "Georgia",
   "homes": 356,
   "ranked": true,
   "serious_citations_per_home": 1.07,
   "immediate_jeopardy_citations_per_home": 0.6,
   "citations_per_home": 16.8,
   "fines_usd_per_home": 12749,
   "one_star_share_pct": 28.8,
   "avg_staff_turnover_pct": 46.0,
   "nurse_hours_per_resident_day": 3.56,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 37,
   "state": "Florida",
   "homes": 694,
   "ranked": true,
   "serious_citations_per_home": 1.02,
   "immediate_jeopardy_citations_per_home": 0.68,
   "citations_per_home": 19.7,
   "fines_usd_per_home": 24361,
   "one_star_share_pct": 12.9,
   "avg_staff_turnover_pct": 41.4,
   "nurse_hours_per_resident_day": 3.82,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 37,
   "state": "New Jersey",
   "homes": 348,
   "ranked": true,
   "serious_citations_per_home": 1.02,
   "immediate_jeopardy_citations_per_home": 0.65,
   "citations_per_home": 23.2,
   "fines_usd_per_home": 34926,
   "one_star_share_pct": 9.5,
   "avg_staff_turnover_pct": 39.7,
   "nurse_hours_per_resident_day": 3.85,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 39,
   "state": "Maryland",
   "homes": 221,
   "ranked": true,
   "serious_citations_per_home": 0.99,
   "immediate_jeopardy_citations_per_home": 0.45,
   "citations_per_home": 51.6,
   "fines_usd_per_home": 21934,
   "one_star_share_pct": 15.1,
   "avg_staff_turnover_pct": 40.2,
   "nurse_hours_per_resident_day": 3.87,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 40,
   "state": "Idaho",
   "homes": 80,
   "ranked": true,
   "serious_citations_per_home": 0.9,
   "immediate_jeopardy_citations_per_home": 0.11,
   "citations_per_home": 26.8,
   "fines_usd_per_home": 13374,
   "one_star_share_pct": 20.3,
   "avg_staff_turnover_pct": 50.3,
   "nurse_hours_per_resident_day": 4.04,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 41,
   "state": "Alabama",
   "homes": 224,
   "ranked": true,
   "serious_citations_per_home": 0.79,
   "immediate_jeopardy_citations_per_home": 0.64,
   "citations_per_home": 10.1,
   "fines_usd_per_home": 12315,
   "one_star_share_pct": 18.8,
   "avg_staff_turnover_pct": 46.9,
   "nurse_hours_per_resident_day": 3.88,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 42,
   "state": "New York",
   "homes": 593,
   "ranked": true,
   "serious_citations_per_home": 0.76,
   "immediate_jeopardy_citations_per_home": 0.35,
   "citations_per_home": 20.4,
   "fines_usd_per_home": 23070,
   "one_star_share_pct": 18.8,
   "avg_staff_turnover_pct": 40.3,
   "nurse_hours_per_resident_day": 3.63,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 43,
   "state": "Nebraska",
   "homes": 180,
   "ranked": true,
   "serious_citations_per_home": 0.72,
   "immediate_jeopardy_citations_per_home": 0.21,
   "citations_per_home": 18.9,
   "fines_usd_per_home": 11975,
   "one_star_share_pct": 28.7,
   "avg_staff_turnover_pct": 48.7,
   "nurse_hours_per_resident_day": 3.98,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 44,
   "state": "Indiana",
   "homes": 507,
   "ranked": true,
   "serious_citations_per_home": 0.68,
   "immediate_jeopardy_citations_per_home": 0.19,
   "citations_per_home": 23.2,
   "fines_usd_per_home": 8742,
   "one_star_share_pct": 17.9,
   "avg_staff_turnover_pct": 45.9,
   "nurse_hours_per_resident_day": 3.69,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 45,
   "state": "Arizona",
   "homes": 140,
   "ranked": true,
   "serious_citations_per_home": 0.55,
   "immediate_jeopardy_citations_per_home": 0.07,
   "citations_per_home": 21.5,
   "fines_usd_per_home": 8928,
   "one_star_share_pct": 7.2,
   "avg_staff_turnover_pct": 45.2,
   "nurse_hours_per_resident_day": 3.98,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 46,
   "state": "Maine",
   "homes": 78,
   "ranked": true,
   "serious_citations_per_home": 0.53,
   "immediate_jeopardy_citations_per_home": 0.23,
   "citations_per_home": 30.7,
   "fines_usd_per_home": 7386,
   "one_star_share_pct": 19.5,
   "avg_staff_turnover_pct": 46.7,
   "nurse_hours_per_resident_day": 4.34,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 47,
   "state": "Arkansas",
   "homes": 221,
   "ranked": true,
   "serious_citations_per_home": 0.5,
   "immediate_jeopardy_citations_per_home": 0.36,
   "citations_per_home": 18.0,
   "fines_usd_per_home": 9209,
   "one_star_share_pct": 11.0,
   "avg_staff_turnover_pct": 49.5,
   "nurse_hours_per_resident_day": 4.02,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 47,
   "state": "Nevada",
   "homes": 66,
   "ranked": true,
   "serious_citations_per_home": 0.5,
   "immediate_jeopardy_citations_per_home": 0.15,
   "citations_per_home": 33.0,
   "fines_usd_per_home": 13952,
   "one_star_share_pct": 21.5,
   "avg_staff_turnover_pct": 45.1,
   "nurse_hours_per_resident_day": 4.34,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": 49,
   "state": "New Hampshire",
   "homes": 73,
   "ranked": true,
   "serious_citations_per_home": 0.32,
   "immediate_jeopardy_citations_per_home": 0.19,
   "citations_per_home": 13.4,
   "fines_usd_per_home": 7928,
   "one_star_share_pct": 16.4,
   "avg_staff_turnover_pct": 44.1,
   "nurse_hours_per_resident_day": 3.9,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": null,
   "state": "Alaska",
   "homes": 20,
   "ranked": false,
   "serious_citations_per_home": 1.1,
   "immediate_jeopardy_citations_per_home": 0.2,
   "citations_per_home": 25.7,
   "fines_usd_per_home": 26572,
   "one_star_share_pct": 10.0,
   "avg_staff_turnover_pct": 50.4,
   "nurse_hours_per_resident_day": 6.88,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": null,
   "state": "District of Columbia",
   "homes": 17,
   "ranked": false,
   "serious_citations_per_home": 3.0,
   "immediate_jeopardy_citations_per_home": 1.24,
   "citations_per_home": 62.6,
   "fines_usd_per_home": 74232,
   "one_star_share_pct": 5.9,
   "avg_staff_turnover_pct": 34.0,
   "nurse_hours_per_resident_day": 4.72,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": null,
   "state": "Guam",
   "homes": 1,
   "ranked": false,
   "serious_citations_per_home": 1.0,
   "immediate_jeopardy_citations_per_home": 0.0,
   "citations_per_home": 51.0,
   "fines_usd_per_home": 13247,
   "one_star_share_pct": 0.0,
   "avg_staff_turnover_pct": 15.6,
   "nurse_hours_per_resident_day": 7.72,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  },
  {
   "rank": null,
   "state": "Puerto Rico",
   "homes": 9,
   "ranked": false,
   "serious_citations_per_home": 0.78,
   "immediate_jeopardy_citations_per_home": 0.56,
   "citations_per_home": 43.1,
   "fines_usd_per_home": 4537,
   "one_star_share_pct": 22.2,
   "avg_staff_turnover_pct": 35.7,
   "nurse_hours_per_resident_day": 3.8,
   "rank_change_since_previous_release": null,
   "cms_release": "2026-10-08"
  }
 ]
}
