SECTION .0600 – CERTIFICATION PROCEDURE

 

10A NCAC 06R .0601       PROCEDURE

(a)  All individuals, groups or organizations operating or

wishing to operate an adult day care program as defined by G.S. 131D‑6

shall apply for a certificate to the county department of social services in

the county where the program is to be operated.

(b)  A social worker shall provide technical assistance and

shall conduct a study of the program using the Division of Aging Adult Services

Form DAAS-1500 or DASS-6205.

(c)  The county of social services shall submit the initial

certification package to the state Division of Aging and Adult Services.  The

materials and forms to be included in the package are: 

(1)           program policies;

(2)           organizational diagram;

(3)           job descriptions;

(4)           Form 732a-ADS (Daily Rate Sheet) or the

equivalent showing planned expenditures and resources available to carry out

the program of service for a 12 month period;

(5)           a floor plan of the facility showing

measurements, restrooms and planned use of space;

(6)           Form DOA-1498 (Fire Inspection Report) or

the equivalent completed and signed by the local fire inspector, indicating

approval of the facility, no more than 30 days prior to submission with the

certification package;

(7)           Form DOA-1499 (Building Inspection Report

for Adult Day Care Centers), DOA-1499a (Building Inspection Form for Adult Day

Care Homes), or the equivalent completed and signed by the local building

inspector indicating approval of the facility, no more than 30 days prior to

submission with the certification package;

(8)           Form DENR-4054 (Sanitation Evaluation

Report) or the equivalent completed and signed by a local sanitarian,

indicating approval of the facility, no more than 30 days prior to the

submission with the certification package;

(9)           written notice and the effective date if a

variance of local zoning ordinances has been made in order for property to be

utilized for an adult day care program;

(10)         a copy of the articles of incorporation,

bylaws and names and addresses of board members for adult day care programs

sponsored by a non‑profit corporation;

(11)         the name and mailing address of the owner if

a proprietary program;

(12)         a written medical statement from a

physician, nurse practitioner or a physician's assistant, completed within the

12 months prior to submission of the certification package, for each proposed

staff member certifying absence of a health condition that would pose a risk to

others and that the employee can perform the duties normally assigned on the

job;

(13)         verification of standard first aid and

cardio-pulmonary resuscitation certification (CPR) for each proposed staff

member who is physically able and who will have direct contact with

participants.  If a staff member is determined to be physically unable to complete

this training, a signature by a licensed physician, physician's assistant or

nurse practitioner attesting to such shall be provided indicating the time

limit of such physical inability.  The first aid and CPR training shall be:

(A)          taught by an instructor certified through the

American Heart Association, American Red Cross, National Safety Council,

American Safety and Health Institute, or Emergency Medical Services;

(B)          current, as determined by the organization

conducting the training and issuing the certification; and

(C)          documented on an official attendance card issued by

the organization certifying the training, or documented by the attendance

course roster, in which case the roster shall be signed by the instructor,

indicate pass or fail for each student, indicate the length of time the

training is valid and be accompanied by a copy of the instructor's

certification;

(14)         evidence of the completion of a statewide

criminal history records search for the past five years for the program owner

and each proposed staff member having direct contact with participants,

conducted by an agency approved by the North Carolina Administrative Offices of

the Courts; and

(15)         DAAS-1500 (Adult Day Care Certification

Report).  This form must be submitted by the county department of social

services with a copy to the program.

(d)  No more than 60 days prior to the end of the current

period of certification, the county department of social services shall submit

to the Division of Aging and Adult Services the following forms and materials

which make up a certification package for the renewal of a certification.

(1)           Form DOA-1498 (Fire Inspection Report) or

the equivalent completed and signed by the local fire inspector, indicating

approval of the facility, dated no more than 12 months prior to submission with

the certification package;

(2)           Form DOA-1499 (Building Inspection Report

for Adult Day Care Centers), DOA-1499a (Building Inspection Form for Adult Day

Care Homes), or the equivalent when structural building modifications have been

made during the previous 12 months, completed and signed by the local building

inspector indicating approval of the facility, within 30 days following

completion of the structural building modifications;

(3)           Form DENR-4054 (Sanitation Evaluation

Report) or the equivalent completed and signed by a local environmental health

specialist, indicating approval of the facility, no more than 12 months prior

to submission with the certification package;

(4)           a written medical statement from a

physician, nurse practitioner or physician's assistant for each staff member

hired subsequent to the previous certification or recertification expiration

date, certifying absence of a health condition that would pose a risk to others

and that the employee can perform the duties normally assigned on the job; 

(5)           an updated copy of the program policies,

organizational diagram, job descriptions, names and addresses of board members

if applicable, and a floor plan showing measurements, restrooms, and planned

use of space, if any changes have been made since the previous certification

package was submitted;

(6)           Form 732a-ADS (Daily Rate Sheet) or the

equivalent showing planned expenditures and resources available to carry out

the program of service for a 12 month period;

(7)           verification of standard first aid and

cardio-pulmonary resuscitation certification (CPR) for each proposed staff

member who is physically able and who will have direct contact with

participants.  If a staff member is determined to be physically unable to

complete this training, a signature by a licensed physician, physician's

assistant or nurse practitioner attesting to such shall be provided indicating

the time limit of such physical inability.  The first aid and CPR training

shall be:

(A)          taught by an instructor certified through the

American Heart Association, American Red Cross, National Safety Council,

American Safety and Health Institute or Emergency Medical Services;

(B)          current, as determined by the organization

conducting the training and issuing the certification; and

(C)          documented by an official attendance card issued by

the organization certifying the training, or documented by the attendance

course roster, in which case the roster shall be signed by the instructor, indicate

pass or fail for each student, indicate the length of time the training is

valid and be accompanied by the instructor's certification.

(8)           Evidence of the completion of a statewide

criminal history records search for the past five years for each staff member

hired subsequent to the previous certification or recertification expiration

date having direct contact with participants, conducted by an agency approved

by the North Carolina Administrative Offices of the Courts; and

(9)           DAAS-1500 (Adult Day Care Certification

Report).  This form must be submitted with the certification package by the

county department of social services to the Division of Aging and Adult

Services at least 30 days in advance of the expiration date of the certificate,

with a copy to the program.

(e)  Following review of the certification package, a pre‑certification

visit may be made by staff of the State Division of Aging and Adult Services.

(f)  Within 14 business days, the Division of Aging and

Adult Services shall provide written notification to the applicant and the

county department of social services of the action taken after a review of the

certification package and visit, if made.

 

History Note:        Authority G.S. 131D‑6; 143B‑153;

Eff. January 1, 1986;

Amended Eff. September 1, 2007; July 1, 2007; July 1, 2000; May 1, 1992; July 1, 1990.