What is a Special Focus Facility (SFF)?
Key takeaways
- The Special Focus Facility (SFF) program is how CMS gives closer oversight to nursing homes with a history of serious inspection findings.
- A home in the program gets a full inspection at least once every six months, and CMS does not publish star ratings for it.
- In the data processed Aug 1, 2026, CMS lists 84 homes as SFF and 441 as SFF candidates, out of 14,690 nursing homes.
- A candidate qualifies by its record but has not been selected, because each state has a limited number of places.
A Special Focus Facility, or SFF, is a nursing home that the Centers for Medicare & Medicaid Services (CMS) has placed under closer oversight because of its inspection record. The label describes that record over about three years. It does not tell you what has changed since the last inspection, which is why it is worth asking about.
How does a nursing home become a Special Focus Facility?
CMS scores every home on the number and seriousness of the deficiencies found in its inspections and complaint investigations. According to CMS, homes in the program have about twice the average number of deficiencies, more serious problems, and a pattern of problems that has lasted a long time.
Each state has a set number of SFF places. The homes with the highest scores in a state become candidates, and the state survey agency selects homes from that list to fill its places.
What is an SFF candidate?
A candidate is a home whose record qualifies it for the program but which has not been selected. CMS keeps five candidates for each place a state has, with at least 5 and at most 30 candidates per state.
In the CMS data processed Aug 1, 2026, 84 homes are listed as SFF and 441 as candidates, out of 14,690 certified nursing homes.
What happens to a home in the program?
- More inspections. A full on-site inspection at least once every six months, about twice as often as other homes.
- No star ratings. CMS does not publish an overall rating or any of the three component ratings for a home while it is in the program.
- A way out. A home graduates after it meets CMS's criteria on two standard inspections in a row, which takes about 12 months at the fastest. A home that misses the criteria starts over, and some stay in the program for two years or more. CMS keeps listing graduates for three years.
- Or an end to funding. A home that does not improve can be removed from Medicare and Medicaid.
How does it appear on this site?
A home's page shows a red label, "CMS Special Focus: SFF" or "CMS Special Focus: SFF Candidate," exactly as CMS publishes it. County lists and chain pages carry the same label, and the "Questions to ask" box on the home's page starts with a question about it.
What should you ask a home with this label?
- What did the most recent inspection find, and may I read the report?
- What is in the improvement plan, and what has changed so far?
- Have the administrator, the director of nursing or the owner changed in the past year?
- How have staffing hours and turnover changed since the home was listed?
CMS suggests visiting the home, talking with staff and residents, and contacting the state survey agency and the long-term care ombudsman for more information. See how to reach them.