By Raleigh Senior Advisor Care Team · May 21, 2026
Before you set foot in a single community, North Carolina's own regulator publishes licensing status, inspection reports, and penalty history for every adult care home in the state. Here's exactly how to use those tools, and how to read a report instead of just counting citations.
Don't Let the Brochure Be Your First Source
Every assisted living community you'll tour in the Triangle has a polished website, a warm sales team, and a beautifully staged model room. None of that tells you how the community actually performs when regulators aren't watching, or what happens on an overnight shift when staffing is thin. North Carolina's Department of Health and Human Services, Division of Health Service Regulation (DHSR) — specifically its Adult Care Licensure Section (ACLS) — maintains two public tools that do tell you that, and both are free, official, and take about ten minutes to use before you ever schedule a tour.
This guide walks through exactly how to use those two tools, what North Carolina's licensing categories actually mean, and — most importantly — what to actually read inside an inspection report rather than just counting how many citations a community has.
Tool One: The Regulated Facilities Search
Start with DHSR's Regulated Facilities search. This tool lets you search by county, city, or facility name to confirm whether a specific community is currently licensed, what type of facility it's licensed as, and pull up basic facility information along with deficiency statements. This is your baseline check: confirm the license is active and current before investing any more time.
For families searching across the Triangle, it helps to search by county rather than city alone, since a community's mailing address and marketing name don't always match its official license location. Search Wake, Durham, Orange, Johnston, Chatham, Franklin, or Harnett county to pull a full list of licensed adult care homes in that area, which is often a more complete picture than whatever a single senior-living referral service shows you.
Understanding NC's Single License Category
One thing that surprises families researching across state lines: North Carolina does not use a tiered "Type A / Type B / Type C" licensing system based on acuity level, the way some other states do. Instead, NC uses one overarching license category — "adult care home" — governed by N.C. General Statutes Chapter 131D and administrative rules at 10A NCAC 13F. Family care homes (small settings with 2-6 unrelated residents) are licensed as a subset of adult care home, not a separate license class, and larger communities (7+ beds) operate under the same statutory framework, just with different fee schedules and penalty tiers by bed count.
The one meaningful add-on to this single license category is the Special Care Unit (SCU) designation, which a community can add to its existing adult care home license specifically for memory care or other specialized units, contingent on state approval of a required disclosure statement under G.S. 131D-8. If a community advertises "memory care" or "Alzheimer's care," it's worth confirming through DHSR whether it actually holds an approved SCU designation, since that designation carries specific disclosure and, in some cases, staffing requirements that a general adult care home license does not. We cover the safety implications of this in more detail in our guide to memory care safety in NC communities.
Tool Two: Inspections, Ratings, and Penalties
The more revealing tool is DHSR's Adult Care Home Facility Inspections, Ratings and Penalties search, sometimes referred to by its ACLS star-rating name. This gives you a state-specific, compliance-based star rating along with the actual inspection reports, corrective action reports, and any penalties assessed against the facility in the last 36 months.
It's important to understand what this tool is and isn't. Unlike nursing homes, which receive the federal CMS Five-Star Quality Rating System through Medicare Care Compare — a standardized score comparable across all fifty states — adult care homes and family care homes in North Carolina are not covered by CMS Five-Star at all. DHSR's own rating system is real and useful, but it's a state-specific, compliance-history-based measure, not standardized against other states' systems. Treat it as a genuine data source, but don't assume a 4-star or 5-star rating means the same thing it would in a federal nursing home rating context — read the underlying reports, not just the star count.
What to Actually Read in an Inspection Report
The single biggest mistake families make with these reports is treating citation count as the whole story. A community with three citations for minor paperwork issues — a slightly outdated staff training log, a missing signature on a form — is in a very different position than a community with one citation involving resident supervision, medication administration errors, or elopement risk. Read the actual narrative description of each citation, not just the tally.
Pay particular attention to citations involving: medication errors (wrong dose, wrong resident, missed doses), falls or injuries linked to inadequate supervision, staffing ratios below required levels, elopement or wandering incidents, and any citation that recurred across multiple inspection cycles rather than being corrected after the first visit. A repeated citation for the same underlying problem is a much stronger warning sign than an isolated first-time citation, because it suggests the community either can't or won't fix the root cause.
Also look at how recently a facility was inspected, and whether the report reflects a routine annual inspection or a complaint-triggered investigation. A complaint investigation report exists because someone — a resident, family member, or staff member — filed a specific concern with DHSR's Complaint Intake Unit, and those reports often contain more detail about a specific incident than a routine inspection would.
Cross-Referencing With the Long-Term Care Ombudsman
DHSR's inspection tools cover regulatory compliance, but they don't capture everything a resident or family might experience day to day. The North Carolina Long-Term Care Ombudsman Program, run through the Division of Aging and Adult Services with regional offices housed in local Area Agencies on Aging, advocates for residents and investigates complaints separately from DHSR's licensing enforcement. For most of the Triangle — Wake, Durham, Orange, Chatham, Johnston, and Harnett counties — the regional Ombudsman office operates through Central Pines Regional Council (formerly Triangle J Council of Governments); Franklin County is covered separately by the Kerr-Tar Regional Council of Governments' Ombudsman program.
If you're seriously considering a specific community, it's reasonable to call the appropriate regional Ombudsman office and ask general questions about that facility's reputation, though be aware ombudsmen are bound by confidentiality rules around specific resident complaints. This is a useful supplementary step, not a replacement for reading the DHSR inspection reports yourself.
Filing a Complaint or Reporting a Concern
If your research turns up something concerning, or if you have a concern about a facility you or a family member is already living in, DHSR's Complaint Intake Unit accepts complaints at 1-800-624-3004 (in NC) or 919-855-4500, during business hours (9:00 a.m.-12:00 p.m. and 1:00 p.m.-4:00 p.m. weekdays, excluding holidays). Complaints specifically about conditions inside a licensed facility are forwarded by DHSR to the local county Department of Social Services for investigation, reflecting North Carolina's county-based structure for Adult Protective Services.
If someone is in immediate danger, call 911 first — DHSR's complaint line is for reporting concerns for investigation, not for emergency response. For non-emergency concerns about abuse, neglect, or exploitation more broadly (not necessarily tied to a licensed facility), contact the Adult Protective Services division of the county Department of Social Services where the person resides; each of the seven Triangle counties runs its own APS intake line rather than sharing a single regional number.
Putting It Together Before You Tour
A reasonable pre-tour research routine takes about fifteen to twenty minutes per community: confirm active licensure and basic facility details on the Regulated Facilities search, pull the inspection and ratings history from the ACLS star search, read the narrative of any citations from the last two inspection cycles rather than just the count, and note any Special Care Unit designation if memory care matters to your family. Bring specific questions from what you find directly into the tour — asking a community's staff to explain a citation you read about often reveals more about their culture than any question you could have thought of on your own.
For a broader view of what else to evaluate once licensing checks out, our guide on signs it's time for assisted living covers the family-side decision process, and our cost comparison guide can help you understand whether a specific community's pricing is in line with Triangle norms.
