Star RatingCalculating a Rating Score

What is the Star Rating based on?

Star Ratings are based on the results of:

  1. DHSR annual inspections
  2. DHSR follow-up inspections
  3. DHSR Construction inspections (Type A and Type B violations cited)
  4. Recommendations of Type A and uncorrected Type B violations from the County Department of Social Services (DSS), which have been reviewed and concurred by DHSR.

Learn more about the Survey Inspection Process and Type A and Type B violations.

Beginning January 1, 2009, upon annual inspection by DHSR each facility begins with a base score of 100 points. Based on the facility's compliance or non-compliance with rule areas during inspections, the facility earns merit or demerit points which are added or subtracted from the 100 base points respectively. After each annual inspection, a rating certificate (showing a numeric score and number of stars earned) and the worksheet used to calculate the rating score will be sent to the facility within 45 days of the survey report (called a "Statement of Deficiencies") being mailed. A new certificate and worksheet will be generated after each annual inspection, after subsequent inspections, and each time the rating score changes for administrative licensure actions. Facilities are required to post the most recent certificate and worksheet in the facility in a location visible to the public.

Demerit Points

Demerit points are points that are subtracted from the base score for citations and violations cited. Citations and Type B violations cited by DHSR under the fundamental rule areas will count against a facility's rating score. If a citation or Type B violation is not from a fundamental rule area, it will not count against the facility's rating. Type A and Uncorrected Type B violations from any rule area cited by DHSR or DSS will count against the rating score.

Demerit point values are as follows:

Administrative licensure action issued by DHSR will also result in demerit points being deducted from the rating score:

*Note: This does not include a Suspension of Admissions that is issued for the facility's failure to submit a Cost Report.

Merit Points

Merit points are points that are added to a facility's score for correction of citations and violations upon follow-up inspection.

Administrative licensure actions rescinded by DHSR will also result in merit points being added to the rating score:

Also, if a facility corrects the citation for which a Type A violation was identified, they will receive the 2.5 merit points upon correction, and will receive an additional 2.5 merit points following the next annual inspection if no further Type A violations are identified.

Additional Merit Point Opportunities

There are four opportunities for a facility to earn extra merit points at each annual inspection.

It is important to note that these extra merit point opportunities are just that, extra. The extra merit points are given to recognize when a facility has taken additional measures to go above and beyond what is minimally required by state rules to ensure the health, safety, welfare, and quality of life of their residents. Facilities do not lose points by not putting these measures in place.

The four extra merit point opportunities are:

1. Emergency Power Back-Up
Facilities who have made arrangements for emergency power back-up (i.e. have a generator on-site or have a current contract with an emergency power back-up provider) will receive extra merit points at their annual inspection.

Facilities will receive the extra merit points for emergency power back-up based on whether it is "new" or "existing." Merit points will be issued as follows:

2. Automatic Sprinkler System
Facilities who have installed an automatic sprinkler system in the facility will receive extra merit points at their annual inspection.
Facilities will receive the extra merit points for an automatic sprinkler system based on whether the system is "new" or "existing." Merit points will be issued as follows:

3. NC NOVA Designation
Better Jobs Mean Better Care
The North Carolina New Organizational Vision Award, or NC NOVA, is a voluntary special license awarded to adult care homes, home care agencies and nursing facilities that meet rigorous workplace standards for their direct care workers.

Successful applicants receive a special state license over and above their operating license, designating them as NC NOVA providers committed to the idea that better jobs mean better care. NC NOVA recognizes long-term care employers that take extra steps to support their workers on the job. NC NOVA licensure tells families this provider has met higher workforce standards designed to keep a well-trained, effective, and satisfied team of quality caregivers. Any licensed provider in good standing may apply for NC NOVA licensure. NC NOVA licensure is issued for two years.

Upon each annual inspection, facilities will receive +2.5 additional merit points for having a current NC NOVA special licensure designation.

For more information and a list of current NC NOVA designees, visit the website at

4. Participation in a Quality Improvement Program Approved by DHHS
Facilities who participate in a Quality Improvement (QI) program that has been approved by DHHS will be issued +2.5 extra merit points.

QI Program approval will be performed on-site by the DHSR survey team during a facility’s annual inspection.

There are some facilities that participate in QI programs offered through various departments of DHHS, such as the Division of Aging. QI programs offered through DHHS are approved for Star Rating merit points. In order for facilities in these programs to receive the extra points they must be enrolled in the program and participating at the time of their annual inspection.