Adult Care Licensure Section

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What Type of Information is Available

To assist consumers in making informed decisions regarding care options and provide information regarding the inspections in adult care facilities (family care homes and adult care homes) the following resources are available: statement of deficiencies or inspection reports by DHSR; Star Rating; County Corrective Action Reports (CARS) resulting in penalties by DSS; and, any penalties imposed in the previous 36 months for each adult care facility.

What Types of Inspections are Posted

Adult care facilities are routinely inspected to ensure the provider is operating in compliance with applicable laws and regulations, in a manner that protects the health and safety of their residents. The Adult Care Licensure Section (ACLS), County Department of Social Services (DSS) and Construction Section (Constr) of the Division of Health Service Regulation inspect or survey adult care homes. The types of inspections conducted by both sections include routine inspection (annual or biennial), complaint investigation and follow-up inspection.

Statements of Deficiencies

The survey report, or Form 2567, is the form used by the state to document inspections or surveys. The report form is divided into two columns as illustrated below:

Form 2567
Statement of Deficiencies (SOD)	Plan of Correction (POC)
State agency (DSHR) completes this section, listing any deficiencies found during the survey, if any.	The adult care facility completes this section.

Statements of Deficiencies are posted for adult care facilities with survey dates beginning November 1, 2014 and deficiencies or violations were identified. Inspections are conducted year-round. If you do not see a listing for a home in which you are interested, please check this site for monthly updates.

Statement of Deficiencies – The written report or findings of the inspection; if violation with an applicable law or regulation is found during an inspection or investigation, it is cited as a deficiency on the Statement of Deficiencies (Form 2567). The Statement of Deficiencies (Form 2567) includes the citation(s) on the left-hand side of the page and the right side for the provider's plan of correction.

IDR Pending - A Yes under the column, IDR Pending, indicates the facility has requested Informal Dispute Resolution (IDR), a process that gives a facility the opportunity to dispute all or some of the findings of a state inspection. If the Statement of Deficiency is changed as a result of IDR, the web page will be updated.

Statement of Deficiencies with Plan of Correction - The written report or findings of the inspection and the provider’s approved plan of correction.

Statement of Deficiencies with deficiencies corrected -  A follow-up inspection conducted with deficiencies on the Statement of Deficiencies (Form 2567) and the adult care home corrected one or more of the previously cited deficiencies. 

No Deficiencies Cited - The Statement of Deficiencies (Form 2567) is not posted. No violation with an applicable law or regulation was found during an inspection or investigation. For follow-up inspections, all previous citations were corrected.

Corrective Action Reports

Corrective Action report, or Form 4607, is the form used by the county to document inspections or monitoring visits. The report form is divided into two columns as illustrated below:

Form 4607
Corrective Action Report (CAR)	Plan of Correction (POC)
County agency (DSS) completes this section, listing any violations of Type A and uncorrected Type B violations from the County Department of Social Services (DSS), which have been reviewed and concurred by DHSR.	The adult care facility completes this section.

Corrective Action Reports are posted for adult care facilities with inspection dates beginning January 1, 2023 and violations were identified. Inspections are conducted year-round.

Corrective Action Reports – The written report or findings of the inspection which have been reviewed and concurred by DHSR; if violation with an applicable law or regulation is found during an inspection or investigation, it is cited as a violation on the Corrective Action Report (Form 4607). The Corrective Action Report (Form 4607) includes the violaton(s) on the left-hand side of the form and the right side for the provider's plan of correction.

IDR Pending - A Yes under the column, IDR Pending, indicates the facility has requested Informal Dispute Resolution (IDR), a process that gives a facility the opportunity to dispute all or some of the findings of a county investigation. If the Corrective Action Report is changed as a result of IDR, the web page will be updated.

Corrective Action Reports with Plan of Correction - The written report or findings of the inspection and the provider’s approved plan of correction.

Corrective Action Report - The written report or findings of the county monitoring or investigation and the provider’s approved plan of correction.

Star Rating

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.

In an annual inspection by Adult Care Licensure Section, 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.

Agency Enforcement Actions

Pursuant Articles 1 and 3 of Chapter 131-D, the Department has legal authority to impose enforcement actions when a facility has failed to maintain substantial compliance with the regulations governing adult and/or family care homes. Enforcement actions may include licensure action(s) and/or monetary penalty fines.

Penalties

Pursuant to North Carolina General Statute 131D, Articles 1 and 3, the Department of Health and Human Services 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:

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.

Unabated Violations: 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), additional penalty fines may be imposed. These are “unabated violations.”

Unabated Type A1 and A2 Violations:

• 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.
• Additional penalty fines may be imposed as a result of each inspection in which the unabated Type A1 or unabated Type A2 violation continued to occur beyond the date specified for correction.

Unabated Type B Violations: 

Another type unabated violation that could result in the imposition of penalty fines would be when a "Type B" violation has not been corrected by the facility within the specific date of correction (45 days per regulatory statute), 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. There is no penalty fine for a Type B violation.
• 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 date specified for correction.

The Department or its authorized representative shall determine whether the violation has been corrected.

As provided in North Carolina General Statute 150B, Adult care homes have the legal right to appeal the imposition of a penalty fine within 30 days after the Department mails a notice of penalty to a licensee. If a penalty fine is appealed, it may go to hearing or a settlement agreement may be reached between the State and the facility.

In addition to the penalty fines, the Department may implement administrative licensure action.

Administrative Licensure Action: 

As set forth in Articles 1 and 3 of Chapter 131-D, the Department may impose licensure action(s) as follows:

• Suspension of Admissions: Pursuant to N.C. Gen. Stat. § 131D 2.7 (d), the admission of any new residents to an adult care home may be suspended where the conditions of the adult care home are detrimental to the health or safety of the residents. The "Suspension of Admissions" shall remain in effect until conditions or circumstances merit removing the suspension as determined by the State.
• Provisional License: Pursuant to N.C. Gen. Stat. § 131D 2.7 (a), the license to operate an adult care facility may be amended from a full license and reduced to a “Provisional License” whenever:
1. The licensee has substantially failed to comply with the provisions of Articles 1 and 3 of this Chapter and the rules adopted pursuant to these Articles;
2. There is a reasonable probability that the licensee can remedy the licensure deficiencies within a reasonable length of time; and
3. There is a reasonable probability that the licensee will be able thereafter to remain in compliance with the licensure rules for the foreseeable future.
• Revocation of License: Pursuant to N.C. Gen. Stat. § 131D 2.7 (b), the license to operate an adult care facility may be revoked when the facility has substantially failed to comply with the licensure statutes and rules; and

• The licensee has substantially failed to comply with the licensure statues and rules; and it is not reasonably probable that the licensee can remedy the licensure deficiencies within a reasonable length of time.
• The licensee has substantially failed to comply with the licensure statues and rules; and although the licensee may be able to remedy the deficiencies within a reasonable time; it is not reasonably probably that the licensee will be able to remain in compliance for the foreseeable future.
• The licensee has substantially failed to comply with the licensure statues and rules; and the failure to comply endangered the health, safety, or welfare of the residents.

• Summary Suspension: Pursuant to N.C. Gen. Stat. § 131D 2.7 (c), the license for an adult care facility may be summarily suspended whenever substantial evidence of abuse, neglect, exploitation or any condition which presents imminent danger to the health and safety of any resident of the home is determined.

Adult care homes have the right to appeal licensure action(s) imposed by the Department by filing an appeal with the North Carolina Office of Administrative Hearings (OAH) within the designated timeframe. Licensure actions that are appealed may go to hearing or a settlement agreement may be reached between the State and the licensee.

How to Use the Information

The statement of deficiencies, corrective action report, the Star Rating system and the penalties are just some of the resources you should use when looking for placement for yourself or a loved one in an adult care home. Additionally, be sure you have a complete and accurate picture of the care provided in an adult care facility through the following:

1. Tour the Facility
   A tour of the facility that you are considering allows you to take a first-hand look at different aspects of the physical environment such as cleanliness. It also gives you a chance to speak with staff and residents about the care and services offered at the facility to help you decide if it's the right fit for you or your loved one. While you are there, ask to see the facility's inspection reports, including any reports from the county department of social services and from the state. Facilities are required to make inspection reports from the past 12 months available to residents and families and prospective residents and families upon request.
2. Contact your local County Department of Social Services
   The county DSS adult services staff visit each adult care facility at least quarterly throughout the year and are a good source of current information. Ask your local DSS adult home specialist about the care and services provided, as well as any recent complaints made against the facility.
3. Contact your local Regional Long-Term Care Ombudsman
   Regional Long-Term Care Ombudsmen are advocates for residents in long-term care facilities. They provide guidance to residents and families on long-term care options in their area, how to select a long-term care facility that fits your needs and preferences and provide information on Medicare and Medicaid programs. Ombudsmen can also provide information on the care provided in the facilities in their area, as well as recent complaints.
4. Contact the Division of Health Service Regulation, Adult Care Licensure Section
   Adult care homes are licensed and inspected by the Division of Health Service Regulation (DHSR), Adult Care Licensure Section (ACLS). To assist consumers in making informed decisions regarding care options and provide information regarding the inspections in adult care facilities (family care homes and adult care homes) the following resources are available: statement of deficiencies or inspection reportsby DHSR; Corrective Action Reports resulting in penalty by DSS, Star Rating; and, any penalties imposed in the previous 36 monthsfor each adult care facility.