Public inspection data is a great starting point, but it's historical — it tells you what happened, not necessarily what's happening today. Combine it with in-person observation.

In the data

• Repeated Type A citations, especially for the same issue
• A pattern of substantiated complaints
• A long gap since the last inspection visit (ask why, if unclear)

In person

• Unpleasant odors that staff wave off as "just today"
• Residents who appear unengaged or under-stimulated for long stretches
• Staff who seem rushed, irritated, or unable to answer basic questions
• Call lights or assistance requests that go unanswered during your visit
• Visible short-staffing — ask what the ratio is right now, not in general

In conversations with current families

If possible, talk to a resident's family member who is not a staff-arranged reference. Ask directly: would you choose this facility again?

No single red flag automatically disqualifies a facility — but several together are worth taking seriously, and worth digging into with direct questions to administration before making a decision.