License an Adult Care Home

The procedures listed below outline the required steps for licensing a new adult care home in North Carolina. Adult care homes are licensed under General Statute 131D. The N.C. Medical Care Commission has rulemaking authority. Rules are found in Title 10A of the North Carolina Administrative Code (NCAC) 10A NCAC 13F.

Contacts: For questions regarding any part of this process, please contact the appropriate section of the N.C. Division of Health Service Regulation or the local county Department of Social Services:

Adult Care Licensure Section 919-855-3765
Certificate of Need Section 919-855-3873
Construction Section 919-855-3893
Medical Facilities Planning Section 919-855-3865


  1. Review the State Medical Facilities Plan: Medical Facilities Planning Section
    1. Applicants can learn about the number of adult care home beds needed by reviewing the annual State Medical Facilities Plan, which is published each calendar year and which specifies in which areas of the state they will be needed.
    2. Applicants can also find the certificate of need review schedule and deadline for submittal of applications for beds in the State Medical Facilities Plan. No one may develop new adult care home beds without a certificate of need.
  2. Obtain a Certificate of Need: Certificate of Need Section
    1. The applicant submits a certificate of need (CON) application for the proposed adult care home beds according to the schedule outlined in the State Medical Facilities Plan. If the applicant is leasing the facility, both the prospective owner/lessor and the lessee of the home must submit a joint application.
    2. The Certificate of Need section schedules a review for each of the counties in which there is a need. Applications will only be accepted for proposed beds within a county where a review has been scheduled.
    3. Within 30 days of the beginning of the review period, written comments may be filed by any person, including the applicant regarding the proposals under review.
    4. A public hearing is conducted by the CON section within 30 to 50 days from the beginning of the review period. At this time the applicant is given the opportunity to respond to written comments submitted to the CON section and inquiries made at the hearing.
    5. A decision to approve or disapprove an application is made by the CON section within 150 days of the beginning of the designated review period.
    6. A certificate of need is issued 35 days after the date of approval unless a petition for a contested case hearing is filed.
    7. After a certificate of need is issued, the applicant contacts the Construction section and the Adult Care Licensure section about the respective requirements for the development of adult care home beds.
  3. Obtain construction approval: Construction Section
    1. The applicant sends two sets of floor plans (only one set if project is less than 10,000 square feet or if the local building jurisdiction has authority for Institutional plan review) and specifications to the Construction Section. The Construction section will invoice the applicant the cost of the review. Payment should be made in the form of a check, money order, or certified check made payable to: "Division of Health Service Regulation." The payment for plan review fee should be mailed to: Construction Section; 2705 Mail Service Center; Raleigh, NC 27699-2705 along with a copy of the invoice. Projects will not be reviewed until the invoice is paid in full.
    2. Construction will notify the Adult Care Licensure Section of the new project. Adult Care Licensure Section contacts the applicant for the application, policies and procedures, as well as any additional information if needed.
    3. The Construction section reviews the floor plans and notifies the applicant of requirements or review comments and instructions. The Construction section acts as the control point for distribution of plans and specifications to the Department of Insurance where required (see 3.a above). Plans are generally reviewed in three stages: schematic, design development, and final working drawings.
    4. Applicants and their designers work closely with local building officials and fire prevention officials as well as with the Construction section to ensure that the building is in compliance with applicable codes and licensure rules.
    5. At least two weeks before construction is complete, the applicant sends a letter to the Construction section requesting a final construction inspection; include project final documentation requested by the plan review letter. The facility must be ready with all systems operational and all construction completed by the final construction inspection date. The Construction section does not do punch-list inspections; which are the responsibility of the designer, contractor, and owner. In order to prevent a delay with licensing, please send a copy of the construction inspection request letter to the Adult Care Licensure section office.
    6. The Construction section sends a copy of the final inspection document list to the applicant, inspects the facility for licensure, and reviews the required final documentation.
    7. When all physical plant related items are acceptable, the Construction section sends a letter of construction approval to the applicant, and a transmittal form recommending licensure to the Adult Care Licensure section.
  4. Submission of all documentation and licensure application with fees: Adult Care Licensure Section
    1. The applicant submits the following information to the Adult Care Licensure section in Raleigh:
      1. Adult Care Home Initial License Application (PDF, 87 KB)
      2. Non-refundable licensure fee of $400.00 plus a per-bed fee of $19.00 in the form of a check, money order, or certified check payable to the "N.C. Division of Health Service Regulation."
      3. Administrator Certificate (Note: Assisted Living Administrator Certificates will be issued directly to the applicant administrators).
  5. Obtaining a license: Adult Care Licensure Section
    1. Unless there are identified unaddressed operational areas, incomplete information, or a disqualifying compliance history check of the applicant (according to G.S. 131D-2.4), the Adult Care Licensure section notifies the applicant in writing and the county Division of Social Services (DSS) that a recommendation will be made that the home be licensed.
    2. With Construction section's recommendation for licensure, the Adult Care Licensure section (ACLS) issues the license with a cover letter to the applicant. The county DSS will receive a copy of the cover letter and license from the ACLS office.
    3. Initial licenses are issued for a six (6) month period. An inspection or licensure survey by ACLS is required to ensure compliance with the regulations 10A NCAC 13F for continued licensure. If the facility does not have any residents during this time, and ACLS cannot ascertain compliance, then the licensee would have to reapply for an initial license.
    4. Licenses must be renewed annually using the Renewal License Application for Adult Care Homes and submission of the renewal license fee of $360.00 plus $17.50 per bed fee invoiced by the ACLS.