Ensuring the quality of care in nursing homes is important to everyone.
To help ensure that quality of resident care is consistent from one facility to another, the legislature gave the Department of Health and Human Services (DHHS) the authority and responsibility to:
- license facilities
- define rules and procedures for facilities
- monitor facilities to ensure that the rules and procedures are being followed
- ensure that any problem areas were corrected.
The Department (DHHS) designated the Division of Health Services Regulation to handle oversight and regulation of all of the responsibilities listed above for nursing homes in North Carolina.
courtesy Division of Health Service Regulation
Please note that Continuing Care Retirement Communities (CCRCs) are another type of housing that has nursing home beds. They may offer either nursing home or adult care home levels of service and may provide both. Use the link below to find out more about them and how they are regulated.
The Division of Health Service Regulation (DHSR) is divided into to several sections/branches to handle the oversight and regulation of nursing homes. Some of them are:
- Certificate of Need Section
- Construction Section
- Nursing Home Licensure and Certification Section
- Nursing Home Complaints Investigation Section
Architects and engineers, funded by state appropriations, review plans and specifications, both for new and existing buildings, for facilities applying to be licensed by the Division (both nursing homes and adult care homes). Their purpose is to insure compliance with state licensure regulations for safety standards. They work with local building inspectors to make sure licensure regulations, fire protection codes, and building codes are met.
When all reviews are completed and approved, the Construction Section recommends licensure to the Nursing Home Licensure and Certification Section, which then assesses the program aspects of licensure that relate to delivery of resident services in order to issue a new or revised license to the applicant. In other words, at this time, the Nursing Home Licensure and Certification Section determines if the agency, group, or individual applying for licensure is able to deliver resident services in accordance with current rules and procedures.
After a facility is licensed to operate, construction inspections of some types of facilities are made, as time permits, to verify continued compliance with construction and safety standards. Inspections are made when indicated by complaints, requests by other agencies, and/or a facility's request.
This section also determines if a nursing home qualifies for Medicare/Medicaid reimbursement. As a part of this determination, the Construction Section has engineers, paid with federal funds, that survey nursing homes wishing to qualify for Medicare/Medicaid certification. The inspections are done initially and thereafter annually (unannounced) for safety and building compliance.
It is helpful to note several things here. First, licensure is a state process. Certification is a federal process. The requirements may be different. Licensure must be approved before a facility can apply for certification. The Construction Section handles the building and safety regulations portion of the process for both types of approval - licensure and certification. The Licensure and Certification Section waits for a positive recommendation from the Construction Section before it begins the health and care portion of the licensure and/or certification process. The Licensure and Certification Section makes the final determination as to whether or not a facility meets all the requirements.
Please also note the importance of Medicare/Medicaid certification. If a nursing home is not certified for Medicare/Medicaid, that means all the beds will be assigned as "private pay" beds (see Certificate of Need section above). Only those persons who could afford to pay for care out of their own pocket would be accepted. If the facility is certified for Medicare/Medicaid, then the facility will be told how many beds they may offer, what types of beds they may offer, and how many beds of each type they may offer. This makes a difference for a person seeking admission because the method of payment he or she will use will determine if there is an available bed for them.
Additionally, the Division of Medical Assistance determines eligibility for individuals to receive Medicaid reimbursement for nursing home care. This is different from eligibility for a facility to be able to receive reimbursement for Medicare/Medicaid. When a facility receives certification for Medicare/Medicaid, they may then accept residents who pay for their care with either Medicare or Medicaid.
This section is primarily responsible for conducting annual and follow up inspections in nursing homes.
The following agencies/organizations/programs have some degree of oversight of nursing homes, with direct or indirect regulatory authority.
Facilities that violate licensure rules or the certification standards can be subject to sanctions, including fines. Facilities vary according to the type of care they are licensed to provide. They may be licensed for nursing home care only. They may be licensed for adult care home services only. Or, they may be licensed for both. A nursing home may be licensed for nursing home care and have adult care home beds (unlicensed) available for residents whose condition improves and are no longer eligible for nursing home care.
Nursing homes may have an area that they call an "Alzheimer's Unit" or an area called by another name that is used to provide service to those with Alzheimer's disease and related dementias. These "units" have the same oversight and staffing ratios as skilled nursing beds. Nursing homes may also have "locked units".
Nursing homes do not have "Special Care Units" as adult care homes may have for caring for Alzheimer's patients since "units" in nursing homes already have the same oversight and staffing rations as skilled nursing beds. If you have questions about this, your Ombudsman can help you.
Be sure to inquire about the type of service for which the home is licensed. This will impact what agency monitors service and safety and how often they go in to ensure the quality of care. Pay special attention if the person needing care has Alzheimer's disease or dementia. Ask questions about oversight, staff training, and activities provided. Alzheimer's patients need specialized care to be safe.
In addition to the licensure and certification requirements, nursing homes must also honor the Residents' Bill of Rights. These rights are designed to promote and protect the well-being of residents.
The Nursing Home Branch of the Division of Health Service Regulation is responsible for nursing home oversight.
The Nursing Home Licensure and Certification Section is primarily responsible for conducting annual and follow up inspections in nursing homes. When conducting annual or follow-up inspections they also may conduct complaint investigations as part of the process. Surveys are generally conducted with four to five professionals that include a combination of nurses, dietitians, social workers and pharmacists. Annual surveys look at overall care in the nursing home using a variety of indicators: pressure sores, dehydration, abuse, and nutrition to name a few. The inspections usually last three days and at least 15% of the inspections are conducted during weekends, evening and/or early morning hours.
The Complaints Investigation Section of the Nursing Home Branch investigates regulatory complaints within nursing homes. The section has two functions: complaint intake and complaint investigations. The Complaint Intake Unit is generally staffed with two nurses who respond to calls between the hours of 8:00am and 5:00pm. During holidays and between hours there is an automated answering machine available to the public. The section provides a toll-free number for citizen complaints at 800-624-3004. Complaints are primarily taken by phone, however, letters and in-office visits are also accepted.
The Construction Section of the Division of Health Services Regulation determines if a facility qualifies for Medicare/Medicaid reimbursement. As a part of this determination, the Construction Section has engineers that survey nursing homes wishing to qualify for Medicare/Medicaid certification. The inspections are done initially and thereafter annually (unannounced) for safety compliance.
The Long-Term Care Ombudsman Program advocates on behalf of nursing home residents and provides a variety of services and assistance to nursing home residents, families, and providers. Complaint resolution is one of the services ombudsmen provide. The Ombudsmen are available to assist residents and families whenever they are needed. The Community Advisory Committee members visit nursing homes at least quarterly and work to resolve problems when identified. They are particularly well informed about Residents' Rights issues.
Community Advisory Committees
Locate an Ombudsman in Your Area
More About the Ombudsman Program
Fire Departments conduct safety inspections annually.
Health Departments conduct sanitation inspections annually.
|Nursing Home Licensure & Certification Section,
Division of Health Service Regulation
|Construction Section, Division of Health Service Regulation||Annually|
|Complaints Investigation Section
of the Nursing Home Branch, DFS
|Local Health Department||Annually|
|Abuse, Neglect, Exploitation
Department of Social Services
|Regional Long-Term Care Ombudsmen||As Needed|
|Community Advisory Committee Members,
|Occupational Health and Safety Administration||Randomly|
|Mental Health||As Requested|
|Home Health and Hospice||As Requested|
* Visits are minimums.
The legislature authorizes the Secretary of the Department of Health and Human Resources to establish a Penalty Review Committee of nine members to review all violations.
There are two basic types of violations:
Other Means of Enforcement
In addition to civil money penalties, the Division of Health Service Regulation has several other enforcement remedies available in state law for both adult care homes and nursing homes as follows:
The Division of Health Service Regulation encourages all involved to settle disputes through informal means. They give 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.
There are ways to find out if a facility is in compliance with state and federal rules and local regulations.
Check with your Ombudsman and/or the NC Division of Health Service Regulation for information on recent citations and complaints for a facility being considered. They identify how to access penalty information for nursing homes and what process is used to evaluate the facilities.
The United States Medicare website has a feature called "Nursing Home Compare". This feature allows a review of the state survey reports for a facility. These reports now indicate when updating last occurred which is very important. After reviewing this information, it may still be prudent to check with your Ombudsman and/or appropriate state agency to see what information they have on the facility(s) in which you have interest.
Any suspicion of the occurrence of Elder Abuse must be reported, according to North Carolina law.
|Complaints of immediate life-threatening conditions as well as abuse, neglect and misappropriation in adult care homes are referred to Adult Protective Services within each county Department of Social Service.|
You may make a confidential and anonymous report if you wish. Remember, the resident being abused needs your help.