Nursing Homes and Adult Care Homes Ratings

There are two separate Rating Systems for Long Term Care facilities.  The Adult Care Home Four Start Ratings are maintained by the State of North Carolina.  The Nursing Home Ratings System is maintained by the Federal Government Centers for Medicare and Medicaid Services.  The descriptions below are intended to help you understand the two ratings systems and the information they can provide.

Adult Care Home (including Assisted Living) Ratings

The STATE Adult Care Home Four Star Rating System, implemented January of 2009, is based on compliance with STATE rules or MINIMUM standards. Ratings can be found on the N.C. Division of Health Service Regulation’s (DHSR) Adult Care Licensure website. Here are some highlights:

• Adult Care Home Star Ratings are based on the results of annual and follow-up survey inspections by State Surveyors, and findings (Type A and Unabated Type B violations) by the local County Department of Social Services which have been reviewed and concurred by the Division of Health Service Regulation.
• The ACH Star Rating System is not like a restaurant star rating system which gives maximum stars for going above and beyond minimum standards.
• This rating system is based on an evaluation of the homes compliance with MINIMUM standards or STATE rules and is based on a 100 point scale.  All facilities start with 100 points.
• Ratings are not based on a facility’s comparison with other adult care homes.
• The highest rating that an Adult Care Home can receive is 4 stars, after scoring 100 or greater points on two consecutive annual surveys.  No Adult Care Home will receive 4 stars until 2010.
• Demerit points are subtracted from a facility’s rating score for citations and violations of non-compliance cited during an inspection. Demerit points may also be issued if action is taken by DHSR against a facility’s license.
• Facilities can receive merit points, which will positively affect their ratings, for correcting deficiencies and violations and for installing or contracting for a power backup generator or participating in a quality improvement program.
• A facility may request a follow-up inspection not less than 60 days after the date of the annual inspection if a facility receives citations on its annual inspection with no Type A or Type B violations and the rating from the annual inspection is one or zero stars. Follow-up inspections will be completed depending upon Division of Health Service Regulation (DHSR) staff availability.

Sources: NC DHSR letter to providers January, 2009; TJAAA Ombudsman Program

Nursing Home Ratings are based on three sources of data– health inspections, staffing and quality measures. Here are some details:

• 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.