Clearpol analyzed 1,871 North Carolina nursing-home surveys and 9,265 F-tag citations across 403 facilities and 29 counties, and categorized every citation by how care broke down. North Carolina has the most severe survey profile of the states we've studied: the highest citation intensity (4.95 per survey), the highest harm-level share (9.1%), and an Immediate-Jeopardy rate of 16.3% — roughly one survey in six.
The headline trend
Citations easing, jeopardy entrenched
Like New Jersey, North Carolina's citation intensity has come down — 44% since 2023, from 4.81 to 4.35 deficiencies per survey (the 2.69 early-2026 figure is a partial year). But its Immediate-Jeopardy rate stayed in the mid-to-high teens: 16% in 2023, 19% in 2024, 16% in 2025. When a North Carolina survey goes wrong, it goes seriously wrong.
The severity ladder
Harm is the outlier
North Carolina's harm-level share — citations scoped G or above — is 9.1%, several times what a documentation-heavy state posts. The jeopardy letters are heavy too: of 509 IJ citations, 447 are scoped J. This is not a paperwork state; it is a state where the serious end of the severity ladder is unusually full.
Immediate Jeopardy anatomy
Accidents, abuse, and quality of care
Accidents and supervision (F689) dominate with 114 of 509 jeopardy citations. Abuse and neglect (F600, 80) and quality of care (F684, 74) follow, and failure to notify of changes (F580, 45) rounds out a distinctive North Carolina cluster: the state's jeopardy is frequently about missing a resident's decline and failing to escalate it.
North Carolina rewards clinical vigilance over paperwork. Drill supervision and accident prevention (F689), abuse prevention and reporting (F600), and above all change-of-condition recognition and physician/family notification (F580) — the tag that separates a caught decline from a jeopardy citation. Manage repeat-IJ buildings individually.
The playbook
What gets cited across North Carolina
Kitchen sanitation (F812) and accidents (F689) lead, but North Carolina over-indexes on two systems tags: QAPI/QAA improvement activities (F867), its third-most-cited tag, and accuracy of assessments (F641). A working quality-assurance process is the throughline behind much of the state's citation volume.
| F-Tag | What it covers | Citations | % of all |
|---|---|---|---|
| F812 | Food storage / prep sanitation | 456 | 4.9% |
| F689 | Accident hazards / supervision | 415 | 4.5% |
| F867 | QAPI / QAA improvement activities | 412 | 4.4% |
| F641 | Accuracy of assessments | 380 | 4.1% |
| F761 | Label / store drugs | 380 | 4.1% |
| F880 | Infection prevention & control | 343 | 3.7% |
North Carolina isn't a paperwork state. One survey in six reaches Immediate Jeopardy — and most of that is missed clinical decline.
We pulled North Carolina's three largest county markets apart in their own reports: