Reading a North Carolina star rating and survey report

Does North Carolina give assisted living homes a star rating?

Yes. DHSR gives each adult care home and family care home a rating of zero to four stars, calculated from its survey results, and publishes the rating, the score behind it, the survey documents and any penalties from the past 36 months on one public search page.

Of the 55 homes the state has rated in the five counties, 25 have four stars, 24 three, 4 two, 2 one and 0 zero.

Very few states rate assisted living at all, so this is a real advantage for North Carolina families. Remember what it measures, though: compliance with the licensing rules at inspection time. It does not measure food, friendliness, activities or how the building smells on a Tuesday afternoon.

How should we read a home's star rating?

As a summary of recent survey results: a four-star home had few or minor findings in its recent inspections, while a low rating means inspectors found serious or repeated problems, and the score next to the stars shows how close the home is to the next level.

Ratings move. A single survey with serious findings can cost a star, and a clean follow-up can win it back. So read the date of the rating and the documents behind it. A two-star home whose last three surveys were clean is in a different place from a two-star home whose newest survey is its worst. Our facility pages list the survey documents in date order so the direction of travel is easy to see.

What is in a statement of deficiencies?

A statement of deficiencies lists each rule inspectors found unmet, quotes the rule and describes what they saw, often with interviews and record reviews; the version with a plan of correction adds the home's written fix and the date it promised to finish.

Skim the rule citations first. Medication administration (13F .1004), personal care and supervision (13F .0901) and residents' rights (13F .0909) are common and matter a great deal. Then read the narrative under each one: whether a mistake hurt someone, how many residents it affected and whether the same problem appeared in an earlier survey. Repeat findings deserve a direct question to the administrator.

How do North Carolina's adult care penalties work?

Under N.C.G.S. 131D-34, the state fines adult care homes for the most serious violations: a Type A1 violation caused death or serious harm, abuse, neglect or exploitation, and a Type A2 violation created a substantial risk of those outcomes.

7 of the 60 licensed homes in the five counties are on DHSR's 36-month penalty list, carrying 22 fines that add up to $250,575.

Lesser problems are closed out with a plan of correction and no fine, so an empty penalty record is good but not the whole story. The penalty list shows the rule, the level, the amount and whether the fine was paid or appealed; our facility pages copy each entry with a link back to the inspection behind it.

Where are nursing home inspections published?

Nursing home surveys are published by CMS on Medicare's Care Compare site, which also gives each certified home one-to-five-star ratings for health inspections, staffing and quality measures and an overall rating; DHSR's nursing home section carries out those surveys for CMS.

The two systems should never be mixed. A three-star adult care home and a three-star nursing home are rated by different agencies, on different scales, against different rules. Our nursing home pages copy the CMS figures exactly as published, with the CMS data date, and set each home against the median for certified homes in the five counties. See how nursing homes are overseen.