A notable proportion of cases of COVID-19 have occurred among older adults living in congregant settings.1 2 Once an outbreak occurs in such settings, few mitigation strategies exist. Identifying predictors of COVID-19 would facilitate enhanced surveillance to prevent future outbreaks. The Centers for Medicare and Medicaid Services have long required that all skilled nursing facilities (SNFs) report quality metrics, including the Five-Star Quality Rating System for comparing SNFs: 1 star (lowest score) to 5 star (highest score).3 This metric is predicated on patient and stakeholder perceptions. We examined the relationship of star ratings and other facility-related metrics to COVID-19 occurrence among nursing home residents using a newly established reporting mechanism by the state of California. Beginning 17 April 2020, the California Department of Public Health (CDPH) started reporting the daily and cumulative numbers of positive cases of COVID-19 among the residents and staff of SNFs.4 For this study, we used the category ‘Cumulative Positive Residents’, and compiled data available through 31 May 2020. SNF characteristics were obtained from the Facilities Compare Website3 as follows: Overall Star Rating, its three domains—Health Inspections, Staffing and Quality Measures, plus Provider and Ownership Types, Number of Certified Beds and Medicare Claims Quality Measures, and linked using the Federal Provider Number. Descriptive statistics were used for SNF characteristics with and without COVID-19 among the residents, and univariate-adjusted and …