An addendum to the Nursing Home Reform Act put in place in 1995 established a certification process applicable in every state. It requires the state to conduct unannounced surveys of long-term care facilities, including resident interviews on quality of care, life and services, at least once every 15 months. It also requires more targeted surveys or complaint investigations in response to specific complaints.
If a survey reveals that a nursing home is out of compliance, an enforcement process contained in the Nursing Home Reform Act is triggered. The severity of the actions taken during the enforcement process depends on a few factors, including how severe the compliance lapse is, whether it puts any residents in immediate danger, and whether it is an isolated incident or part of a more widespread pattern.