Adult Care Home Violations and Penalties


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.

Every effort is made to ensure accuracy of the information on this Web site; however, corrections, comments, and suggestions are welcome and can be made by e-mailing: [email protected]


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.

Examples of a Type A1 violation may include the following:

 Examples of a Type A2 violation may include the following:

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:

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.

Examples of Unabated Type B violations may include the following:

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.