How to Read an NC DHSR Inspection Report Before Choosing a Facility
North Carolina requires every licensed adult care home and skilled nursing facility to undergo regular state inspections. The results are public record. The NC Division of Health Service Regulation publishes these inspection reports online, making them one of the most valuable and underused tools available to families evaluating a residential care facility.
The problem is that inspection reports are written for regulators, not families. Understanding what you are looking at requires knowing a few key concepts. This guide explains how to find reports, how to read them, what the different types of deficiencies mean, and what the findings actually tell you about care quality.
All inspection reports for licensed adult care homes and skilled nursing facilities in North Carolina are available through the NC Division of Health Service Regulation. You can access them in two ways:
For adult care homes (including assisted living facilities and small residential care homes): Visit the DHSR Adult Care Licensure website at ncdhhs.gov/dhsr/acls, select “Facility Lookup,” and search by county or facility name. Reports are downloadable as PDF documents.
For skilled nursing facilities (nursing homes): CMS (the federal Centers for Medicare and Medicaid Services) maintains inspection reports through Medicare’s Care Compare tool at medicare.gov/care-compare. This site also shows star ratings for nursing homes using a composite quality metric.
Reports include the inspection itself (called a “survey”), any complaint investigations triggered by family or staff complaints, and the facility’s plan of correction in response to any deficiencies found.
NC DHSR inspects licensed adult care homes at least annually. Surveys are typically unannounced, meaning the facility does not know in advance when inspectors will arrive. Inspectors observe care being delivered, review resident records, interview residents and staff, check medication administration records, review the physical environment, and assess whether the facility is meeting state regulatory standards.
Skilled nursing facilities are inspected under federal Medicare and Medicaid certification requirements, which are enforced by state surveyors acting on behalf of CMS. Federal nursing home standards are codified in federal regulations and are generally more detailed and prescriptive than state adult care home standards.
When inspectors find that a facility has not met a regulatory standard, they cite a deficiency and document it in the survey report. The facility must then submit a plan of correction explaining how they will remedy the problem and prevent recurrence.
Deficiencies are categorized by two dimensions: scope and severity. Understanding both is essential for interpreting what a deficiency actually tells you about a facility.
Severity reflects how serious the harm or potential harm is. Federal nursing home surveys use a severity scale:
- Level A, B, C: No actual harm. Potential for minimal harm (A), potential for more than minimal harm (B), or a pattern of potential harm (C).
- Level D, E, F: No actual harm, but potential for more than minimal harm with immediate jeopardy (D), or actual harm that is not immediate jeopardy (E-F).
- Level G, H, I: Actual harm. G is isolated, H is a pattern, I is widespread.
- Level J, K, L (Immediate Jeopardy): The most serious category. The deficiency represents a situation where the facility’s failure has caused or is likely to cause serious injury, harm, impairment, or death to a resident. Immediate jeopardy citations require the facility to take corrective action immediately or face closure.
Scope reflects how widespread the deficiency is: isolated (affecting one or a few residents), pattern (repeated or multiple instances), or widespread (affecting most residents or the facility’s entire system).
Any immediate jeopardy citation should be taken very seriously. These represent situations where the facility’s failures placed or placed residents at risk of serious harm. If a facility has one or more recent IJ citations, look carefully at what the deficiency was, what the plan of correction said, and whether the problem has recurred in subsequent surveys.
A facility that is cited for the same problem in consecutive surveys has either not been able to correct it or has not genuinely committed to doing so. Repeated deficiencies in areas like medication management, fall prevention, pressure wound prevention, or infection control indicate a systemic quality problem rather than an isolated incident.
Any G-level or higher deficiency (actual harm) deserves a close reading of the specific narrative. What happened? Was it an isolated incident or a pattern? Was the facility proactive or reactive in their response? The plan of correction language often reveals a facility’s genuine commitment to improvement or lack thereof.
DHSR reports include both routine annual surveys and surveys triggered by complaints. When a complaint investigation is marked as “substantiated” or when it leads to deficiency citations, it indicates that the reported concern was real and verifiable. Multiple substantiated complaints in a short period is a significant concern.
Deficiencies related to staffing levels, treating residents with dignity, honoring resident rights, or responding to resident calls in a timely manner speak to the culture of a facility, not just its systems. These are harder to fix than technical compliance failures and often reflect deeper organizational problems with how leadership views its residents.
A facility with some deficiency citations is not necessarily a bad facility. Very few facilities pass every survey with zero deficiencies, and a zero-deficiency survey sometimes reflects an easier inspection cycle or incomplete scrutiny rather than perfect care. Interpreting a report requires context.
Compare to peers. If every facility in Buncombe County has 5 to 10 deficiencies per survey and one has 2, that is meaningfully better. If the same facility has 18, that is meaningfully worse. Absolute numbers matter less than relative standing and trend direction.
Look at the trend over time. A facility with a difficult survey followed by sustained improvement is different from a facility with consistent problems across multiple years. Review at least two to three years of surveys rather than only the most recent one.
Read the actual narrative, not just the summary. A citation for “failure to ensure resident dignity” could reflect something ranging from a single uncomfortable conversation that was handled poorly, to a pervasive culture of disrespect. The narrative tells you which. Summaries and star ratings compress this into a number that often loses the most important information.
Ask the facility directly. When you have found a significant deficiency in a recent report, ask the administrator about it directly during your facility tour. How they respond, whether they are forthcoming, whether they take it seriously, whether they can describe what changed afterward, tells you as much as the report itself.
Inspection reports are a starting point, not a conclusion. The best approach combines report review with a direct facility tour and a structured set of questions. Our Choosing an Assisted Living Facility guide covers what to look for during a tour and what questions to ask staff and administrators, including questions that directly follow up on anything concerning you found in a facility’s inspection history.
The Council on Aging of Buncombe County also offers free benefits counseling and can connect you with local support services: (828) 277-8288.
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