Adult Care Licensure Section

Introduction

North Carolina's adult care home penalties are part of the Department of Health and Human Service's ongoing effort to provide information to citizens and family members faced with difficult health care decisions. A listing of adult care homes in North Carolina is available for download.

Difference Between Adult Care Homes and Nursing Homes

The primary difference between adult care homes and nursing homes is as follows:

"Adult Care Homes" provide care and assistance to people with problems carrying out activities of daily living and supervision to people with cognitive impairments whose decisions, if made independently, may jeopardize the safety or well-being of themselves or others and therefore require supervision. Medication in an adult care home may be administered by designated, trained staff. Smaller adult care homes that provide care to two to six unrelated residents are commonly called family care homes.

"Nursing Homes" are for people who need chronic or rehabilitative care, who, on admission are not acutely ill and who do not usually require special facilities such as an operating room, X-ray facilities, laboratory facilities, and obstetrical facilities. A "nursing home" provides care for people who have remedial ailments or other ailments, for which medical and nursing care are indicated; who, however, are not sick enough to require general hospital care. Nursing care is their primary need, but they will require continuing medical supervision.

Information on This Site

There are necessary regulatory delays between when an adult care home is inspected and when findings from the inspection will appear on this Web site. Therefore, when visiting an adult care home, we encourage you to request copies of more recent inspection results.

Inspections

The goal of inspections is to assess how well the adult care home complies with applicable laws and regulations affecting the quality of care provided. Inspections are typically conducted on an annual basis and when the state receives complaints. All inspections are unannounced. Inspections conducted on an annual basis typically last one to four days. Complaint inspections may last one or more days depending upon the number of allegations and what inspectors find during the course of the inspection.

Regarding Violations & Penalties in Adult Care Homes

Pursuant to G.S. 131-D-34 (a),  the Department shall impose an administrative penalty in accordance with provisions of the Article on any facility which is found to be in violation of requirements of G.S. 131D-21 or applicable State and federal laws and regulations. Citations for violations shall be classified and penalties assessed according to the nature of the violation.

Type A1 and A2 Violations & Penalties: A monetary penalty fine may be imposed when a "Type A1" or "Type A2" violation has occurred.

• "Type A1 Violation" means a violation by a facility of applicable laws and regulations governing a facility which results in death or serious physical harm, abuse, neglect, or exploitation of a resident. 
• "Type A2 Violation" means a violation by a facility of applicable laws and regulations governing the licensure of a facility which results in substantial risk that death or serious physical harm, abuse, neglect, or exploitation will occur.
• For family care homes (licensed for two to six beds), the penalty amount may range from $500.00 to $10,000 for each Type A violation.
• For adult care homes (licensed for seven beds or more), the penalty amount may range from $2000.00 to $20,000 for each Type A violation.

Examples of a Type A1 violation may include the following:

• The facility failed to provide supervision to a confused resident who exhibited wandering and exit seeking behaviors resulting in the resident leaving the facility unsupervised and without the knowledge of the facility’s staff. The resident was hit by a car and sustained multiple injuries causing death.
• The facility failed to administer an antibiotic medication for 7 days as ordered for a resident discharged from the hospital with diagnoses including pneumonia. The resident required a subsequent 11-day hospitalization for diagnoses including respiratory failure and an infection in the bloodstream.

 Examples of a Type A2 violation may include the following:

• The facility failed to send a resident to the hospital for evaluation after the resident drank approximately 24 ounces of hand sanitizer on one occasion; drank approximately 8 ounces of body wash and ate an unknown amount of solid deodorant on a second occasion; and failed to notify the resident’s primary care provider of the resident drinking non-consumable substances on more than one occasion which placed the resident at substantial risk of serious physical harm and neglect.
• A resident was administered medications that belonged to another resident. The medications administered had the strong potential of adverse side effects. The resident required emergent evaluation and treatment in the emergency department of the local hospital which placed the resident at substantial risk of serious physical harm.

Unabated Violations and Penalties:

If a facility has failed to correct any violation within the specified date of correction (30 days for Type A violations; 45 days for Type B violations), these are “unabated violations.” Additional penalty fines may be imposed for unabated violations.

Unabated Type A1 and A2 Violations & Penalties:

When a facility has failed to correct a "Type A1" or "Type A2" violation within 30 days, a monetary penalty fine may be imposed in the amount of up to $1,000 for each day that the Type A1 or Type A2 violation continued to occur beyond the date specified for correction.

The Department has legal authority to impose a monetary fine for:

• The inspection in which the Type A1 or Type A2 violation was first identified and
• Additional monetary penalty fines as a result of each inspection in which the unabated Type A1 violation or unabated Type A2 violation continued to occur beyond the specified date of correction

Unabated Type B Violations & Penalties:

Another unabated violation that could result in the imposition of penalty fines is a "Type B" violation that has not been corrected by the facility within the specified correction date (45 days per regulatory authority), known as an Unabated B violation.

• A "Type B” violation means a violation by a facility of applicable laws and regulations governing a facility which is detrimental to the health, safety, or welfare of any resident, but which does not result in substantial risk that death or serious physical harm, abuse, neglect, or exploitation will occur.
• The range of the fine for an Unabated "Type B" violation that was not corrected is up to $400.00 for each day that the violation continues beyond the date specified for correction.
• Additional penalty fines may be imposed as a result of each inspection in which the unabated Type B violation continued to occur beyond the specified date of correction.

Examples of Unabated Type B violations may include the following:

• Several residents have orders to receive pain medications every evening but on one evening, staff forget to give the residents the ordered pain medications. One resident suffers from back pain and could not sleep from the missed dose. Subsequent doses are given as ordered. The facility is cited a Type B violation for the non-compliance and on a follow-up visit, additional medication errors are noted; therefore, the facility is fined up to $400/day until compliance with medication administration is determined, which must be verified by another follow-up inspection.

• The facility's pest management program is not effective, and roaches are noted in a couple of the residents’ rooms on one out of two halls in the facility. The facility is cited a Type B violation for the non-compliance and on a follow-up visit, additional roaches and insects are noted; therefore, the facility is fined up to $400/day until compliance with pest management is determined, which must be verified by another follow-up inspection.

The Department will determine whether each violation has been corrected.

Pursuant to Chapter 150B and N.C. Gen. Stat. § 131D-34(e), adult care homes have the legal right to appeal the imposition of a penalty fine by filing a petition for contested case within 30 days after the Department mails a notice of the penalty imposition decision to a Licensee.

Once a penalty has been imposed, payment is due within 60 days unless an appeal is timely filed at the at the Office of Administrative Hearings (OAH).

If a penalty is appealed, it may go to hearing at the OAH. Alternatively, the Department and the Licensee may agree to resolve the penalty by executing  a settlement agreement.

A settlement agreement is a legally binding contract between the Department and Licensee.

When settling a dispute, the Department seeks resolutions that are resident focused, ensure the health, welfare, and safety of the residents, maintain the rights of the residents, and enhance the quality of care and service received by the residents.

Other Information

For adult care homes, months will typically pass between inspections and much could change for the better or worse in a facility between inspections. Therefore, it is advised that you inspect the facility yourself before making such an important decision.