How to Check an Assisted Living License and Inspection Reports in North Dakota

The Facility Brochure Shows You What They Want You to See

Every assisted living and basic care facility in North Dakota has a regulatory record — a documented history of inspections, deficiency citations, complaints, and corrective actions that tells you things the marketing materials never will. Checking this record before placing a parent isn't optional diligence. It's the difference between choosing a facility based on a curated tour and choosing one based on how it actually operates.

Where to Find Licensing and Inspection Records

North Dakota's care facilities fall under two separate regulatory bodies depending on their license type. You need to know which one covers the facility you're researching.

Assisted living facilities and basic care facilities are regulated by the Food and Lodging Unit within the North Dakota Department of Health and Human Services. This unit conducts periodic inspections, investigates complaints, and maintains licensing records. You can access inspection reports and verify a facility's current license status through the ND HHS website.

Skilled nursing facilities (nursing homes) are regulated by the Health Facilities Unit within ND HHS, which conducts surveys on behalf of the federal Centers for Medicare and Medicaid Services (CMS). Nursing home inspection reports, staffing data, and quality metrics are also available on the federal Medicare Care Compare website — a searchable national database that rates facilities on a five-star scale.

NDCareChoice is the state's consumer-facing facility directory at ndcarechoice.hhs.nd.gov. It provides basic facility information, locations, and license types. Use it as a starting point to identify facilities in your parent's area, then dig into the inspection records from the appropriate regulatory unit.

What to Look For in an Inspection Report

Inspection reports can be dense and filled with regulatory codes. Focus on these categories:

Severity and scope of deficiencies. Not all citations are equal. A deficiency for a minor documentation error is fundamentally different from a deficiency for failing to provide adequate personal care or administering medication incorrectly. Look for patterns, not isolated incidents. A facility that received one minor citation in three years has a different profile than one that receives the same category of citation every inspection cycle.

Staffing-related citations. Deficiencies related to inadequate staffing, untrained staff, or failure to maintain required staff-to-resident ratios directly affect the quality of care your parent will receive. If a facility was cited for staffing problems, ask the administrator what they changed — and check the next inspection report to see if the citation recurred.

Personal care failures. Citations for residents not receiving timely assistance with bathing, toileting, dressing, or meals are the most directly relevant to your parent's daily experience. These are harder for facilities to explain away than administrative or documentation deficiencies.

Medication management issues. Any citation involving medication errors — wrong dose, wrong time, wrong medication, missed dose — should be investigated thoroughly. For a parent on blood thinners, insulin, or cardiac medications, medication errors carry life-threatening consequences.

Complaint investigation outcomes. When the state investigates a complaint against a facility, the findings and any resulting citations become part of the public record. Look specifically for substantiated complaints, which indicate the state found evidence supporting the complainant's concerns.

How to Read a Plan of Correction

When a facility receives a deficiency citation, it must submit a Plan of Correction (POC) describing exactly what steps it will take to fix the problem and prevent recurrence. The state reviews and approves this plan, and subsequent inspections verify compliance.

What to look for in a POC:

• Does the correction address the root cause, or just the symptom? A POC that says "staff will be reminded to check call lights" after a citation for slow response times is a band-aid. A POC that says "we will add one direct-care staff member per shift on the memory care unit and install an electronic call-light monitoring system" addresses the underlying problem.
• Was the correction actually implemented? Check the next inspection report. If the same deficiency appears again, the POC failed.
• How quickly did the facility respond? A POC submitted promptly with specific, measurable steps signals a facility that takes regulatory compliance seriously. Delays, vague language, or pushback signals the opposite.

Checking Nursing Homes Specifically

For skilled nursing facilities, the federal Medicare Care Compare website offers a level of transparency that assisted living and basic care facilities don't have:

Overall star rating. Medicare rates nursing homes on a one-to-five-star scale based on health inspections, staffing, and quality measures. A one-star facility has been identified as having "much below average" quality. Use this as a screening tool — a one-star rating doesn't mean the facility is dangerous, but it means you need to dig into the specific reasons before considering it.

Health inspection ratings. This component tracks the number, severity, and recency of deficiency citations from federal surveys. Recent serious citations weigh more heavily than older minor ones.

Staffing ratings. Medicare tracks the total nursing hours per resident per day — including RN hours, LPN/LVN hours, and CNA hours — and rates the facility against national benchmarks. A facility with below-average staffing ratios is stretching fewer people across more residents, which directly affects response times and care quality.

Quality measure ratings. These track clinical outcomes like the percentage of residents who fell, developed new pressure sores, experienced unexpected weight loss, or were physically restrained. These are outcome measures, not process measures — they tell you what actually happened to residents, not what the facility says it does.

Questions to Ask the Facility About Its Record

Once you've reviewed the regulatory history, bring your findings to the facility administrator during a tour or intake meeting:

• "I see you received a citation for [specific issue] during your [date] inspection. What changes did you make, and has the issue been resolved in subsequent inspections?"
• "What is your current staff-to-resident ratio during day, evening, and overnight shifts?"
• "How many complaint investigations has the state conducted here in the past two years, and what were the outcomes?"
• "Can I see your most recent inspection report?" If they hesitate, that hesitation is informative.

Red Flags That Should Stop a Placement Decision

A single citation rarely disqualifies a facility. But certain patterns warrant serious reconsideration:

• The same category of deficiency appearing in three or more consecutive inspections, indicating a systemic problem the facility hasn't resolved
• Any citation involving immediate jeopardy — a finding that the facility's noncompliance caused, or was likely to cause, serious injury, harm, impairment, or death
• A pattern of complaint investigations, especially substantiated complaints from multiple unrelated sources
• A facility operating under a waiver or variance for a standard licensing requirement, which may indicate it cannot meet baseline regulatory standards

The North Dakota Care Decision Guide includes a facility comparison worksheet and tour scorecard designed to help you evaluate multiple facilities systematically — combining what you find in public records with what you observe during visits.

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