PITTSBURGH -- Choosing a nursing home for your loved one can be a huge, overwhelming decision.

A new report showed the quality of care isn't getting better, but worse.

Who are the worst offenders in Pittsburgh?

The report included what's called a Nursing Home Quality Monitor.

It looked at staffing issues, hazardous conditions and repeat offenders in the state of Pennsylvania.

Consumer reports recommended that people ask the nursing home for a copy of their state inspection survey or form 2567. They are required by law to be accessible to visitors and residents.

There were others in the Pittsburgh area that the report recommended people avoid.

The Web site www.consumerreports.org provides the best and worst 10 percent in each state.

Saxon Graham visits her mother Daisy multiple times a day.

She made the decision to put her in a nursing home when Daisy's Alzheimer’s got worse.

Her one consolation was that she felt she'd chosen a good home with a good staff.

But a new study from Consumer Reports showed those homes are hard to find.

They listed the best and worst in every state.

In its list of nursing homes to consider, the report cited Butler Memorial Hospital in Butler, Somerset Hospital in Somerset and Westmoreland Skilled Care Center in Greensburg.

Homes the report recommended to avoid were the Heritage Shadyside in Pittsburgh, Manorcare Health Services in North Hills and Westwood Nursing and Rehab Center in Pittsburgh.

For all of them, this isn't the first time they've been on a watch list.

Pennsylvania has the authority to fine nursing homes for violations. The report showed it doesn't seem to be working.

With regulations not being enforced, the report recommended that when you consider a nursing home for a loved one that you visit the home and see it for yourself.