Most audits arrive as a hundred slides of screenshots. Useful audits look at three things, in this order.
1. Where the money actually went
Open the search terms report for the last ninety days and sort by spend. In a healthy account the top twenty terms are things a customer would plausibly type before buying. In an unhealthy one they are broad, informational, or plainly irrelevant — and they are eating a third of the budget.
This single report tells you more than any account score. If the spend is going to the wrong queries, nothing downstream matters yet.
2. What counts as a conversion
Check what the conversion column is actually counting. Page views, any form submission, or a genuine sale? We regularly find accounts optimising toward a thank-you page that anyone can reach without buying anything, which teaches the algorithm to find people who like reading.
3. Whether the structure can be managed
Can you tell, in one screen, which campaign is profitable? If the account is one campaign with forty ad groups, or forty campaigns with one keyword each, the answer is no — and the fix is structural rather than a bid adjustment.
Everything else — ad copy, extensions, bidding strategy — is worth doing after those three are sound. Before that, it is decoration.