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Ratings for Long-Term Care Facilities

Note: Both the state Adult Care Home Star Rating System and the federal Nursing Home Star Rating System provide a "snapshot view" of facilities and were designed to provide consumers information with which to make informed decisions about placement. While they provide valuable information, consumers should ALWAYS be encouraged to visit facilities, observe how residents are treated, speak with staff, ask questions and use their 5 senses when evaluating a facility. Star ratings are only one piece of the puzzle.

Adult Care Home Four Star Rating System

North Carolina's rating system for adult care homes is based on compliance with the State's minimum standards. State surveyors determine compliance during annual inspections.

  • The Adult Care Home Star Rating System is not like a restaurant star rating system which gives maximum stars for going above and beyond minimum standards.
  • Ratings are not based on a facility’s comparison with other adult care homes.
  • All facilities start with 100 points.
  • The highest rating that an Adult Care Home can receive is 4 stars. To receive 4 stars, a facility must score 100 or more points on two consecutive annual surveys.
  • Points can be subtracted for noncompliance with the minimum standards. Points can be added, e.g., for having a back-up generator or participating in quality improvement programs.

Ratings for individual adult care home facilities are available at

Nursing Home Five Star Rating System

The Nursing Home Five Star Rating System is a federal system based on compliance with minimum, federal standards. Ratings are based on health inspections, staffing ratios, and quality measures.

  • Health inspections look at ALL major aspects of nursing home care, about 180 different items, and are conducted by trained state surveyors, looking to assure compliance with FEDERAL regulations.
  • Staffing ratings are derived from a facility's self-reported staffing ratios 2 weeks prior to the (unannounced) annual survey. Keep in mind that this is merely a 2-week view reported by the facilities themselves and may not be reflective of staffing on a long-term basis.
  • Quality Measures provide an in-depth look at how well each nursing home performs on ten important aspects of care, including the residents' health, physical functioning, mental status, and general well being. Again, this is self-reported data and represents only a few of the many aspects of care important to residents.
  • Nursing Home ratings will remain in effect for one year, so consumers should check with their Ombudsmen to ask if anything has changed during that period of time. Turnover in key administrative staff can affect quality of care fairly quickly. Just because a facility received 5 stars on its annual inspection does not mean that it is still providing 5-star care; the same holds true for a 1 star facility.
  • Nursing Home Star Ratings are based upon their comparison with other nursing homes.

Ratings for individual skilled nursing facilities are available a