The DAIL Division of Licensing and Protection surveys Vermont nursing homes on behalf of the Centers for Medicare and Medicaid Services (CMS). The core licensing requirements are established by CMS. Surveys are conducted annually and when significant complaints, including self-reports form facilities, are received. When surveyors cite a deficiency at a nursing home, the deficiency is given a rating from A though L based on the scope and severity. Although all deficiencies are taken seriously and must be corrected, deficiencies rated F and higher indicate either actual harm to a resident(s) has occurred or the deficiency is widespread at the facility. The higher the number of facilities with F ratings or higher, the higher the number of facilities that have been found to provide substandard quality of care.