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North Carolina · Survey and inspections · 10A NCAC 13J .0904-.0907
Before you are licensed, DHSR surveys you on paper: it reviews the policies, procedures and personnel records you send. After that, it inspects in person, unannounced, at least every three years. Here is what DHSR reviews, what happens during a visit, how plans of correction work, and how to be ready without stress.
Quick answer
DHSR describes North Carolina’s initial home care survey as a review of documents. After you apply, DHSR emails you to request your policies, procedures and personnel documents, and "An initial survey is conducted by reviewing the policies, procedures, and personnel documents for compliance with licensure requirements." If nothing more is needed, it emails your approval letter. Everything must be finished within 12 months of applying.
Once licensed, DHSR must inspect each agency at least every three years, and can inspect at any time. Inspections and complaint investigations are unannounced. Inspectors identify themselves, and you allow immediate access to your premises and records. If they cite deficiencies, you file a plan of correction within 10 working days, and DHSR responds within 10 working days.
From DHSR’s Requirements for Establishing a Home Care Agency, its checklist and its FAQ (revised May 30, 2025). Tick steps off as you go; progress is saved in this browser only.
Your 12 months to finish licensing start when DHSR receives the application and the $510 fee.
After confirming receipt, DHSR emails you to request your policies, procedures and personnel documents.
Supporting documents, the policies and procedures on the Initial Survey Checklist, and complete personnel records for your director, supervisor and caregivers. DHSR does not return them.
This review is the initial survey. DHSR may ask for more information. It sets no time frame; it depends on how complete your documents are and on surveyor workload.
If the survey needs nothing more, DHSR emails the approval letter and instructions to print your license from its Enterprise system. Post it where the public can see it.
The form and fee are covered step by step in the North Carolina license application guide.
DHSR’s advice to applicants: "Review the Initial Home Care Survey Checklist and use it as your guide." The checklist has three parts. DHSR
1 · Supporting documents
2 · Policies and procedures
32 items: 14 administrative (scope of services, emergency preparedness, service area, job descriptions, program evaluation, infection control and more), 12 client care (client rights, acceptance, initial assessment, supervision, complaints with the state hotline, plan of care, client records and more) and 6 personnel (competency, personnel records, evaluations, in-service training, orientation, criminal background checks). Each is printed beside its rule.
DHSR asks you to "submit personnel records complete with all the items listed below". Personnel records show you have staff for the services you will provide, and "should contain evidence of all applicable items required by 10A NCAC 13J .1003 (f)". DHSR FAQ 16
| Item | Agency director | Service supervisor | In-home caregiver | Companion sitter |
|---|---|---|---|---|
| Application | N/A | ✓ | ✓ | ✓ |
| Resume | ✓ | N/A | N/A | N/A |
| Signed job description | ✓ | ✓ | ✓ | ✓ |
| License verification | If applicable | ✓ | N/A | N/A |
| Nurse Aide listing verification or Health Care Personnel Registry check | N/A | N/A | ✓ | ✓ |
| Competency verification | N/A | N/A | ✓ | ✓ |
| Proof of TB skin test or chest X-ray | ✓ | ✓ | ✓ | ✓ |
| Proof of bloodborne pathogen training | ✓ | ✓ | ✓ | ✓ |
| Proof of Hepatitis B immunization or declination | ✓ | ✓ | ✓ | ✓ |
| Proof of orientation | ✓ | ✓ | ✓ | ✓ |
| Reference check(s) | ✓ | ✓ | ✓ | ✓ |
| Signed consent for criminal background check | ✓ | ✓ | ✓ | ✓ |
DHSR, Home Care Initial Survey Checklist (rev. 9/21), Personnel Record Review. Columns as DHSR prints them; the companion sitter column applies if you offer those services.
Practical note: the checklist asks for TB, bloodborne pathogen and Hepatitis B proof in every column, while 13J ties those rules to hands-on care employees. If your director or supervisor will not give hands-on care, ask DHSR’s home care section (919-855-4620) what it wants in their file before you send it. DHSR
DHSR is direct about this: "The primary reason home care licensure applicants are not approved for licensure is because they do not understand and/or comply with the initial survey checklist and/or NC licensure rules." DHSR
CareRulebook
CareRulebook’s North Carolina manual covers every policy and procedure on DHSR’s Initial Survey Checklist, written for your agency, with the 13J rule quoted under each one and the records that show you follow it.
$199CareRulebook founding price for the first 50 North Carolina agencies, then $249. Not a DHSR fee.
Inspections are a normal part of holding a license. The statute says DHSR "shall conduct an inspection of each home care agency at least every three years." DHSR’s FAQ puts it simply: every 3 years. G.S. 131E-140(b) DHSR FAQ 33-34
The rules on a visit are short. Knowing them in advance makes the day straightforward for whoever is in the office.
DHSR representatives make their identities known to the person in charge before the inspection starts. Know who your person in charge is when the director is out: your policies must set the order of authority.
13J .0904(c); .1001(e)The agency must allow immediate access to its premises and the records needed to check compliance with the 13J rules.
13J .0904(e)Inspectors may review client records about admission, discharge, medication, treatment, condition or history, unless the client has objected in writing. Before any inspection, you must have told clients in writing that they can object.
G.S. 131E-141(b)DHSR may visit clients at home to check that care follows their plans of care and the rules. Your staff contact the client, with DHSR staff present, to ask permission to visit.
13J .0904(g)The agency, its employees and anyone interviewed are immune from liability for damages from disclosing information to DHSR during inspections. DHSR keeps confidential information confidential.
G.S. 131E-141(b)If you run more than one site, DHSR may inspect any or all of them, and with 72 hours’ notice ask for records from another site to be brought to the one it is inspecting.
13J .0905Access matters most. Rule .0904(e) says that not allowing immediate access "shall result in termination of the survey and may result in injunctive relief as outlined in G.S. 131E-142(b)", and G.S. 131E-142(b) lets the Secretary go to court over anyone who hinders an inspector. In practice that means making sure every staff member knows to welcome the inspectors and fetch the person in charge. 13J .0904(e) G.S. 131E-142(b)
If the inspection finds something out of line with the rules, DHSR cites it as a deficiency. Rule .0904(f) then sets two clocks, one for you and one for DHSR:
You · 10 working days
"An agency shall file a plan of correction for cited deficiencies within 10 working days of receipt."
13J .0904(f)DHSR · 10 working days
"The Department shall review and respond to a written plan of correction within 10 working days of receipt."
13J .0904(f)The rule sets the deadline, not the format. This is our suggested approach, not rule text.
Action on the license itself is for a substantial failure to comply, not for a deficiency you correct. The rules set out each step, and your right to appeal.
Practical guidance, not rule text: each card links to the rule behind it. An agency that keeps these up to date has little to prepare when DHSR arrives.
DHSR reads your policies as an assurance of compliance, and an inspector checks what happens in practice. Write policies you can follow with the staff you have, then follow them. If practice changes, change the policy.
DHSR FAQ 14-15; 13J .1001(a)Every item on DHSR’s personnel record review, for every person, before they start: signed job description, registry check, consent for the criminal history check, TB, training, orientation, references and competency verification. Keep each file at least a year after the person leaves.
13J .1003(f); DHSR checklistAn assessment at home before the plan of care, a plan reviewed every 90 days, service records returned on time, and the signed receipt for the client rights notice and DHSR hotline.
13J .1107(d), .1202(a); G.S. 131E-141(c)A record of each 90-day supervisory visit to the client’s home, and of the yearly visit while the aide is giving care. These are easy to do and easy to forget to write down.
13J .1110(c)Clients told in writing that they can object to DHSR reviewing their records, and any written objection kept in the client record so the person in charge can show it.
G.S. 131E-141(b)Each complaint investigated within 72 hours, with how it was resolved; the yearly evaluation of the whole agency and the 90-day client record reviews, documented.
G.S. 131E-144.6(b); 13J .1004One simple habit helps: keep an inspection folder at the office with your current policies, staff list, client list and an index of personnel records, and make sure everyone knows who is in charge when the director is out. For what the office and records rules require, see North Carolina office and premises rules. For the hiring checks behind each personnel file, see North Carolina caregiver background checks.
No. DHSR says all inspections and complaint investigations are unannounced. Inspectors make their identities known to the person in charge when they arrive, and the agency must allow immediate access to its premises and records.
"No, all inspections and complaint investigations are unannounced."
No. Not only. The statute requires an inspection at least every three years, but a licensed agency is subject to inspection at any time, and DHSR also carries out complaint investigations, which are unannounced too.
"Any agency licensed by the Department shall be subject to proper inspections by authorized representatives of the Department at any time as a condition of holding such license."
DHSR describes the initial survey as a review of documents: after you apply, it emails you to request your policies, procedures and personnel documents, and the initial survey is conducted by reviewing them for compliance with the licensing rules. If nothing more is needed, it emails your approval letter. Once licensed, agencies get unannounced on-site inspections.
The items on its Home Care Initial Survey Checklist: supporting documents (such as proof of training or past ownership, an organization chart, proof of premises and an annual projected budget), 32 policies and procedures, and complete personnel records for the agency director, service supervisor and caregivers. DHSR does not return what you send.
G.S. 131E-140(b) requires DHSR to inspect each home care agency at least every three years, and DHSR’s FAQ says every 3 years. A licensed agency is also subject to inspection at any time, and DHSR investigates complaints. All inspections and complaint investigations are unannounced.
The inspectors make their identities known to the person in charge. The agency must then allow immediate access to its premises and the records needed to check compliance. Inspectors may review client records unless a client has objected in writing, and may visit clients at home once your staff have asked the client’s permission in their presence.
File a plan of correction for cited deficiencies within 10 working days of receiving them (10A NCAC 13J .0904(f)). DHSR then reviews and responds to the written plan within 10 working days of receiving it.
Yes, to check compliance with their plans of care and the licensing rules. Your staff contact the client, with DHSR staff present, to ask permission for the visit.
It can, but only after a substantial failure to comply, or a failure that endangers clients. G.S. 131E-139 lets DHSR suspend, revoke, annul, withdraw, recall, cancel or amend a license in that case. Under 13J .0907, DHSR can first reduce a full license to a provisional one where the agency is likely to fix the problems, and any adverse decision can be appealed under the Administrative Procedure Act.
The Medical Care Commission makes the home care rules and DHSR updates its checklist and FAQ. Leave your email and we will tell you when a change affects your survey or your policies.
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