What Did the 2024 North Carolina Nursing Home Audit Find?

If your loved one lives in a Raleigh nursing home, a December 2024 state audit should concern you. The North Carolina Office of the State Auditor released a performance audit finding that the state agency responsible for inspecting nursing homes and investigating abuse complaints had been consistently failing to meet its legal obligations. For families across Wake County and Raleigh, the findings raise serious questions about whether the facility caring for your loved one has been properly monitored, and what your options are if something has gone wrong.

What Agency Is Responsible for Nursing Home Oversight in North Carolina?

The North Carolina Department of Health and Human Services Division of Health Service Regulation (DHSR) is the state agency responsible for inspecting licensed nursing homes and investigating complaints of abuse, neglect, and mistreatment. Under state and federal law, DHSR is required to inspect each nursing home on a regular schedule and investigate complaints within specific timeframes. The December 2024 audit found that the agency had been falling significantly short of both obligations over several years.

How Many North Carolina Nursing Homes Failed to Receive Timely Inspections?

The numbers are alarming. The audit found that 68 percent of North Carolina's 425 certified nursing homes received late inspections during the period reviewed. One in 10 facilities went more than 20 months without a state inspection. At higher-risk facilities, which are supposed to be inspected every six months due to their history of serious problems, the agency exceeded that deadline in 67% of cases.

Nursing homes are required by federal guidelines to be inspected at least every 15 months. When a facility goes 20 months or longer without anyone from the state walking through the door, a lot can happen to residents in that time. The audit made clear that when inspectors did eventually show up at long-overdue facilities, they found evidence of abuse, untreated medical conditions, expired medications being distributed to residents, and serious dignity violations. Residents were found with unmet hygiene needs and had experienced injuries that should have been caught and addressed far sooner.

Were Nursing Home Abuse Complaints Investigated on Time in North Carolina?

No, and that finding is just as troubling as the inspection failures. State law requires nursing home complaints to be investigated within 60 days. The audit found that the Division failed to meet that deadline for 39 percent of all complaints that required investigation during the five-year period reviewed. That means tens of thousands of complaints about North Carolina nursing homes, including complaints involving potential abuse and neglect, sat without a completed investigation for longer than the law allows.

The audit also raised concerns about how complaints were being classified. Serious complaints involving potential abuse are supposed to trigger faster investigations, sometimes within three business days. The auditors found evidence that the agency was not always classifying complaints at the appropriate severity level, which allowed serious concerns to fall into slower investigation tracks when they should have been treated as urgent.

What Excuse Did the State Give for These Failures?

The Department of Health and Human Services pointed to COVID-19 disruptions and chronic understaffing as the reasons for the backlog. The agency acknowledged it had requested additional staff from the state legislature four years in a row and had been denied each time. Surveyor turnover rates ranged from 20 to 24 percent annually during the audit period, meaning the agency was losing nearly a quarter of its inspection workforce each year.

The Office of the State Auditor was not satisfied with that explanation. Auditors pushed back directly on the state's response, accusing the department of making misleading statements and noting that the audit had already excluded the periods when inspections were officially suspended during the pandemic. The auditors made clear that the failures documented in the report could not be fully explained away by COVID-19.

What Does This Mean If Your Loved One Was Harmed in a Raleigh Nursing Home?

This audit matters for Raleigh families in a very practical way. If your loved one was abused, neglected, or mistreated in a North Carolina nursing home during the years covered by the audit, there is a real possibility that the facility's dangerous conditions went undetected for longer than they should have because the state was not conducting timely inspections. Abuse that should have been caught and stopped may have continued because no one from the state was checking.

This does not mean your family is without recourse. The state's failure to inspect a facility on time does not protect that facility from civil liability. A nursing home that abused or neglected your loved one can still be held legally and financially accountable through a lawsuit, regardless of whether the state cited them for violations. In fact, when a facility has gone months or years without an inspection, the absence of state oversight can support the argument that systemic failures within the facility went uncorrected for an extended period.

How Do I Know If a Raleigh Nursing Home Has Violations or a History of Complaints?

The North Carolina Division of Health Service Regulation maintains public records of nursing home inspections, citations, and penalties. You can request inspection history and complaint records for any licensed facility in the state. The federal Centers for Medicare and Medicaid Services also maintains a publicly searchable database of nursing home inspection results, deficiency citations, and staffing information for facilities that receive Medicare or Medicaid funding.

Reviewing this information before placing a loved one in a facility is always a good idea. If your loved one is already in a facility and you have concerns, pulling the inspection history can help you understand whether the problems you are seeing have been previously documented by state regulators.

What Should Raleigh Families Do If They Suspect Nursing Home Abuse or Neglect?

Don't wait for the state to act. The audit made clear that the state's complaint investigation process is backlogged and slow. Relying solely on a state complaint to protect your loved one or hold a facility accountable is not enough. Here is what our Raleigh nursing home abuse lawyers recommend you do right now if you have concerns.

Document everything you observe during visits. Write down dates, times, and exactly what you saw. Photograph any injuries, unsanitary conditions, or physical signs of neglect. If your loved one can communicate, listen carefully and record what they say.

Report your concerns to the North Carolina Division of Health Service Regulation and the North Carolina Long-Term Care Ombudsman Program. Both agencies accept complaints and are required to investigate. Reporting creates an official record that supports any future legal claim.

Call a Raleigh nursing home abuse lawyer before you speak with anyone at the facility. Nursing homes are notified when complaints are filed, and their legal teams move quickly to protect the facility's interests. The sooner our nursing home abuse attorneys get involved, the better your chances of preserving evidence and building a strong case.

Can a Raleigh Nursing Home Be Held Accountable Even If the State Never Cited Them?

Yes, absolutely. A civil lawsuit for nursing home abuse or neglect is entirely separate from the state inspection and complaint process. You do not need the state to have cited the facility, investigated a complaint, or taken any regulatory action in order to pursue a legal claim. Our Raleigh nursing home abuse lawyers build cases using medical records, staffing records, internal facility documents, witness accounts, and expert testimony, regardless of what the state did or did not do.

In fact, the 2024 audit findings are a useful context for any nursing home abuse case in North Carolina. They demonstrate that the regulatory oversight system families rely on to catch dangerous facilities has been operating with serious gaps for years. That context matters when holding a facility accountable for harm that occurred during a period when inspections were overdue, and complaints were going uninvestigated.

Talk to a Raleigh Nursing Home Abuse Lawyer Today

If your loved one was harmed in a Raleigh or Wake County nursing home, the state's oversight failures do not have to be your family's problem to solve. The Law Offices of John M. McCabe represents nursing home abuse and neglect victims, and their families throughout Raleigh and North Carolina, and our nursing home abuse lawyers are ready to review your case at no cost to you. Contact us today to schedule your free consultation.