San Francisco, California's San Francisco County seat, has 18 Medicare-certified nursing homes with approximately 2,322 beds. Families have good options, with many facilities exceeding state averages.

San Francisco vs. California: Above Average Quality

San Francisco nursing homes outperform the state average on key quality metrics. The city's average CMS rating of 4.24 stars exceeds California's statewide average of 3.15 stars by 1.1 stars—a meaningful difference that suggests stronger local standards.

10 of 18 facilities earn a B grade or better, giving families good options. While 3 facilities still warrant caution, the overall picture is positive for San Francisco families.

Understanding Our Trust Score System

The Trust Score is a 0-100 rating calculated from CMS's official nursing home database. The score combines five data categories:

• Health Inspection Results — Recent deficiencies, their severity, and patterns over time
• Staffing Levels — RN hours, total nursing hours, and weekend staffing
• Quality Measures — Clinical outcomes like falls, pressure ulcers, and rehospitalizations
• Penalties — Fines, payment denials, and enforcement actions
• Complaints — Substantiated complaints and their severity

In San Francisco, 10 facilities score a B grade or better, indicating they meet quality benchmarks across these categories. We recommend families prioritize these facilities and carefully research any facility rated C or below before visiting.

Staffing: Meeting Standards in San Francisco

Staffing levels are among the most important predictors of nursing home quality. Research consistently shows that facilities with more nursing staff—especially registered nurses—have better outcomes for residents.

San Francisco facilities average 1.36 RN hours per resident day, which meets the CMS-recommended threshold of 0.75 hours. The typical San Francisco resident receives approximately 82 minutes of RN attention daily—compared to the 45 minutes experts recommend.

8 San Francisco facilities exceed CMS staffing recommendations. Families prioritizing staffing should look for facilities with the "Top Staffing" badge and ask specifically about RN hours during facility visits.

Ownership: Mix of For-Profit and Non-Profit

San Francisco has 6 non-profit nursing homes and 11 for-profit facilities. 8 of 18 facilities are chain-owned, with the remainder independently operated.

Research suggests non-profit facilities often have higher staffing levels and fewer deficiencies on average, though ownership type alone does not guarantee quality. Families should evaluate each facility individually using inspection data, staffing levels, and recent deficiency reports.

Nearby Alternatives Worth Considering

Families may also want to consider nearby California cities for additional options. The following California cities offer multiple nursing home options:

• Los Angeles — 78 facilities
• Long Beach — 25 facilities
• Sacramento — 22 facilities
• San Diego — 21 facilities
• Fresno — 19 facilities
• San Jose — 19 facilities