Adult Care Home Violations and Penalties

North Carolina's adult care home penalties are part of the NC Department of Health and Human Service's ongoing effort to provide information to citizens and family members faced with difficult health care decisions. 

The Department of Health and Human Services shall impose an administrative penalty in accordance with provisions of this 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 (G.S. 131D-34) shall be classified and penalties assessed according to the nature of the violation as follows:

  • Type A1 Violation  
    A violation by a facility which results in death or serious physical harm, abuse, neglect, or exploitation. 
  • Type A2 Violation
    A violation by a facility which results in substantial risk that death or serious physical harm, abuse, neglect or exploitation.
  • Type B
    A violation by a facility 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. 
  • Repeated Violations
    The Department shall impose a civil penalty which is treble the amount assessed under subsection (a) of G.S. 131D-24 when a facility under the same management or ownership has received a citation during the previous 12 months for which the appeal rights are exhausted and penalty payment is expected or has occurred, and the current violation is for the same specific provision of a statute or regulation for which is received a violation during the previous 12 months.

Civil monetary penalties will be imposed for Type A violations and if a facility fails to correct a Type B violation by a specified timeframe, a civil monetary penalty will be imposed.

Survey Inspections

North Carolina's adult care home and family care home facilities are inspected annually by the Division of Health Service Regulation (DHSR), Adult Care Licensure Section.

The goal of inspections is to assess the facility's compliance with applicable laws and regulations affecting the quality of care provided. Follow-up inspections to the annual survey are conducted if a facility has demonstrated significant non-compliance during the annual inspection. All inspections are unannounced.

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.

Other Means of Enforcement

In addition to civil money penalties, DHSR has several other enforcement remedies available in state law for both rest homes and nursing homes as follows:
  • Provisional License – Reduction from a full to a provisional license can occur when the provider fails to substantially comply with applicable laws and rules and there is  reasonable expectation that the home will comply in a reasonable amount of time and
    remain in compliance.
  • Suspension of Admissions  Suspension of new admissions may also be imposed when the provider fails to substantially comply with applicable laws and rules. This is a more severe penalty than a provisional license and is normally not imposed unless it is felt that continued admissions would place a threat on the safety and welfare of residents.
  • Temporary Management  The General Assembly passed a law in 1993 which enables DHSR, in lieu of using revocation or summary suspension action, to ask the courts to appoint a temporary manager to operate a facility where conditions exist that create a substantial risk of death or serious physical harm to residents. Unfortunately, in the situations in which the Division has needed to use this option, we could not afford to have the court take up to 20 days to act.
  • Revocation  Revocation of a license can occur when a provider fails to substantially comply with applicable laws and rules and there is no reasonable expectation for the facility to come into compliance within a reasonable amount of time or remain in compliance even if it comes into compliance. Obviously, this is the most severe action short of summarily suspending a license.
  • Summary Suspension of a License  A license can be summarily suspended and residents relocated (closing the home and moving the residents) without prior due process in the event that there are imminent life-threatening conditions in a facility.

The Division, in compliance with G.S. 150B-3, which encourages the state to settle disputes through informal means, gives providers an opportunity to informally dispute actions taken against them and to provide additional information that may not have been available to the surveyors at the time of the monitoring visit.  

Following all informal appeals, the Administrative Procedures Act governs through use of a contested case process (except for summary suspension of a license which is implemented without prior due process). If a provider is dissatisfied with the decision at the administrative level, the provider can appeal to superior court.