Adult Care Home / Family Care Home

North Carolina assisted living compliance

A practical guide for operators of adult care home / family care home communities in North Carolina: who regulates you, what records you need to keep, and how to stay survey-ready every day.

Last reviewed: June 2026 General guidance, not legal advice

Who regulates assisted living in North Carolina

NC Department of Health and Human Services (DHHS), Division of Health Service Regulation

https://info.ncdhhs.gov/dhsr/acls/

North Carolina uses Adult Care Home (7+ residents) and Family Care Home (2–6 residents) as its primary assisted-living license categories.

NC DHHS-licensed adult care homes and family care homes: ~1,200

License types

  • Adult Care Home (ACH) — 7+ residents.
  • Family Care Home (FCH) — 2–6 residents.
  • Special care units (SCU) for memory care, with additional rules.

Records inspectors expect to see

  • FL2 (Medical examination form)
  • Service plan
  • MAR
  • Personnel files including PCA (Personal Care Aide) registry verification
  • Star rating documentation
  • Incident and abuse reports

Inspection cadence

DHHS surveys typically annual for ACH, less frequent for FCH unless triggered by complaints. NC uses a Star Rating system that surveyors update.

Top citation categories

  • FL2 form not updated within required timeframes
  • PCA registry verification gaps
  • Medication administration deficiencies
  • Special care unit documentation issues
  • Resident rights violations

See Kinnwell with North Carolina-specific templates

We'll walk you through a survey-readiness checklist for North Carolina, set up your Adult Care Home / Family Care Home workflow, and answer questions about your community's specific compliance posture.

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