A new report revealing that federal enforcement has failed to improve quality at nursing homes indicates an underlying survey and certification problem, the head of a major nursing home association said.

The Government Accountability Office report “underscores the fact that the current Survey and Certification system for nursing homes is broken,” said Bruce Yarwood, president and chief executive officer of the American Health Care Association and the National Center for Assisted Living.

The GAO report, which became publicly available this week, found that some facilities with a history of quality problems have repeatedly failed to improve, despite numerous chances and what report authors saw as relatively light monetary penalties.