How DHSR Inspections Work
The NC Division of Health Service Regulation (DHSR) conducts annual unannounced inspections of all licensed family care homes under 10A NCAC 13G. Surveyors can show up any day, any time — no advance notice required. A typical inspection lasts 4–8 hours depending on facility size.
Inspections cover two broad categories: residential care (resident rights, medication management, individual service plans) and facility/staffing compliance (staff qualifications, training records, background checks, physical plant safety). Most citation deficiencies fall into the staffing and training category — which is the part you control most directly.
Under 10A NCAC 13G .0702, all required training records must be available for immediate review during the inspection. "I'll get it later" is not an acceptable response. If a surveyor asks for a record and you can't produce it on the spot, it's treated as a deficiency.
The 6 Areas Surveyors Focus On
While every inspection covers the full regulatory scope, these six areas generate the most citations for family care homes:
Staff Training Records
CPR, First Aid, medication training, emergency preparedness — all must be current, documented, and available immediately.
Medication Management
MAR records, medication storage security, and staff Medication Aide certifications from NC-SNAP.
TB Testing
Current negative TB test for all staff, residents, and anyone with regular facility access. Annual requirement.
Fire Safety
Fire drill logs, extinguisher inspection tags, smoke detector tests, emergency exit maps posted and visible.
Background Checks
NC Background Check Center clearance for all employees within 30 days of hire. No exceptions, no delays.
Individual Service Plans
Current ISPs for each resident, reviewed and updated at least annually or when health status changes.
Staff Training Records: The #1 Deficiency
Training record deficiencies are the single most common citation in NC family care home inspections. Surveyors will ask for a complete staff roster, then pull records for each employee and verify that every required training is current.
What they're looking for:
- Completion date and expiration date on each certificate
- Provider name (must be an approved NC provider for some training types)
- Whether the training is currently valid — not expired as of inspection day
- That the staff member completed training within the required window after hire
- CPR/BLS certification — current, from AHA or Red Cross approved course
- First Aid certification — current
- Medication Administration training — if staff administer meds
- NC Medication Aide Certification (NC-SNAP) — if applicable, current within 24 months
- Emergency Preparedness training — annually
- Background Check clearance — within 30 days of hire date
- TB test — current negative result on file
- Initial 5-hour orientation for new staff — completed within 30 days of hire
An expired certification on the day of inspection counts as a deficiency even if you have a renewal appointment scheduled. Surveyors cite based on record status at time of inspection, not intention to renew. Stay ahead of expirations by at least 30 days.
Medication Management Checks
For facilities where staff administer or assist with medications, surveyors will review:
- Medication Administration Records (MARs) — current, signed, and matching physician orders
- Medication storage — locked cabinet, organized, no expired medications
- NC Medication Aide Certification — any staff who administer medications must hold current NC-SNAP certification. The certification renews every 24 months and requires a refresher course.
- PRN medication logs — documentation of as-needed medication administration, with reason and outcome noted
The most common medication deficiency: a staff member administering medications whose NC Medication Aide Certification has lapsed. The renewal course takes 8 hours — get ahead of it by scheduling renewals 60 days before expiration.
Fire Safety Documentation
Surveyors will physically inspect the facility for fire safety compliance and review your drill logs. Specifically:
- Fire drill log — one drill per quarter minimum, documented with date, time, duration, and participants
- Fire extinguisher annual inspection tag — current within 12 months
- Smoke detector test log — tested monthly, log entries signed
- Emergency exit maps — posted in visible locations throughout the facility
- Emergency evacuation plan — current and accessible to all staff
- Sprinkler system inspection record — if applicable
Our Emergency Preparedness guide covers fire drill documentation requirements in detail, including required log fields, evacuation time benchmarks, and how to document resident-specific evacuation assignments.
TB Testing Requirements
All staff must have a documented negative TB test result on file. The NC requirement:
- Initial TB screening within 30 days of hire
- Annual re-screening thereafter (or per physician recommendation based on risk)
- If a skin test (Mantoux) is used: the reading must be documented within 48–72 hours of administration
- If positive: documentation of chest X-ray clearance and physician review
- QuantiFERON blood test is acceptable in place of skin test
Keep a single binder per staff member with all compliance records: background check, TB test, all training certificates. When a surveyor asks, you hand them the binder — no hunting through folders. Physical organization is half the battle.
What Happens During an Inspection
- Surveyor arrives, shows credentials. Ask to see their identification badge. They're required to provide it.
- Entrance conference. Brief meeting with the administrator. Surveyor explains the purpose and scope.
- Tour of the facility. Physical inspection of common areas, resident rooms, medication room, kitchen, and outdoor spaces.
- Record review. Surveyor pulls resident files, staff files, medication logs, fire drill records. This is where most citations originate. Have your staff records organized and accessible.
- Staff and resident interviews. Surveyors may speak with staff privately and ask residents about their experience. Staff should know their training requirements and be able to locate their own records.
- Exit conference. Surveyor summarizes findings, preliminary deficiencies. You'll receive a formal Statement of Deficiencies within 10 working days.
- Plan of Correction. If deficiencies are cited, you have 10 calendar days to submit a Plan of Correction explaining how each deficiency will be fixed.
How to Prepare Before an Inspection
You won't know the inspection date — but you can maintain permanent readiness. These habits eliminate most citation risk:
- Audit staff records monthly. Any training expiring in the next 45 days gets flagged for renewal scheduling.
- Maintain a master compliance dashboard. Know at a glance which certs are current vs. expiring for every staff member.
- Keep physical binders organized by staff member. Surveyor-ready: background check, TB test, all training certificates together.
- Complete fire drills on schedule. Set a calendar reminder — one per quarter. Document immediately. See our Emergency Preparedness guide for the exact fields every drill log needs.
- Never let a background check lapse before a new hire starts. The 30-day window begins at hire date, not when you get around to it.
If you treat any expiration within 45 days as already expired, you'll never be caught with a lapsed certification at inspection time. The lead time absorbs scheduling delays, course availability, and the fact that DHSR can show up any day.
Common Citation Types and What They Mean
NC DHSR citations are classified by severity:
- Type A (Immediate Jeopardy) — constitutes actual harm or serious risk to residents. Can result in license suspension.
- Type B — not immediate jeopardy but represents a clear regulatory violation. Requires Plan of Correction.
- Type C (Technical) — paperwork or administrative gaps. Lower severity, but still requires correction.
Most first-time training record deficiencies are Type B or C. Type A is rare and usually involves resident care issues, not training paperwork. That said, repeated Type B citations across inspections can lead to enhanced oversight.