BACKGROUND AND OBJECTIVES: Nursing home (NH) quality often varies across socioeconomic gradients. The purpose of this study was to explore the relationship between social deprivation and NH quality. RESEARCH DESIGN AND METHODS: Integrating resource dependence theory with Donabedian's structure-process-outcome model, this study utilized 2019 data from Payroll Based Journal, Care Compare: Five-Star Quality Rating System, and LTCFocus.org. The analytic file included 12,900 free-standing NH observations. The primary variable of interest was severe social deprivation index (SDI) defined as SDI ≥85/100. Structural equation modeling was used to explore the effects of severe deprivation on NH structural (nursing staff), processes (antipsychotic medications [APMs]), and outcomes (falls, pressure ulcers, activities of daily living [ADL] decline, and hospitalizations) quality indicators among long-stay NH residents. RESULTS: Nursing homes in communities with severe SDI showed a decrease of 0.02 registered nurse (RN) hours per resident day (PRD) ( DISCUSSION AND IMPLICATIONS: Severe social deprivation affected nursing staff patterns, affecting care quality. These findings highlight the importance of considering environmental factors in the NH quality policymaking process.