SUBCHAPTER 06R - ADULT DAY CARE STANDARDS FOR CERTIFICATION
SECTION .0100 - INTRODUCTION
10A NCAC 06R .0101 CERTIFICATION REQUIREMENT
(a) Subchapter 06R contains standards for certification of
adult day care programs. The standards relate to all aspects of operation of
an adult day care program including administration, facility, and program
operation. Adult day care programs, as defined in G.S. 131D‑6, shall be
certified as meeting these standards. Programs exempted from certification
requirements by G.S. 131D‑6 shall meet these standards for certification
only if receiving funds administered by the Division of Aging and Adult
Services for social services programs established by federal legislation.
Certification is the responsibility of the county department of social services
and the Department of Health and Human Services.
(b) Any program making application for certification or
making timely and sufficient application for renewal of certification shall be
in compliance with all standards for certification. If all standards are not
being met, certification shall be denied or limited as appropriate.
Certification of any program in willful violation of standards as defined in
Rule .0102(e) of this Subchapter shall be revoked. Procedures in G.S. 150B‑3
shall be followed.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1979;
Amended Eff. July 1, 2007; October 1, 2000; July 1, 1990; January 1, 1986.
10A NCAC 06R .0102 CORRECTIVE ACTION
(a) Adult day care programs shall be inspected annually and
monitored in accordance with the Division of Aging and Adult Services criteria
for making announced and unannounced visits to assure compliance with the
standards. Where a violation of G.S. 131D‑6 or of this Subchapter is
identified by staff of the county department of social services or the Division
of Aging and Adult Services, or other authorized inspectors such as environmental
health specialists, building and fire safety inspectors, the program director
of the adult day care program shall be notified in writing of the nature of the
violation by that inspector and requested to take corrective action by the
county department of social services. The county department of social services
shall determine, in consultation with the program director, the date by which
corrective action shall be completed based upon the severity of the violation
and the effect of the violation on the participants of the program.
(b) Where a violation presents an immediate danger to the
participants' health or safety, the program director shall take immediate
corrective action to correct the source of danger or to remove the participants
from the source of danger. Such action shall be documented in writing within 72
hours.
(c) Where a violation has the potential to endanger the
participants' health, safety, or welfare, the program director shall take
corrective action. The date specified for the completion of the corrective
action shall be no later than 30 days of written notification.
(d) Where a violation does not directly endanger the
participants, such as a violation of administrative or record keeping
standards, the program director shall take corrective action. The date
specified for the completion of the corrective action shall be within 90 days of
written notification.
(e) If the violation continues beyond the established time
for completion of corrective action, the program shall be considered to be in
willful violation of the standards and negative action shall be taken in
accordance with Rules .0802, .0804, and .0805 of this Subchapter.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2007; June 1, 2000; July 1, 1990.
SECTION .0200 - DEFINITION OF TERMS
10A ncac 06R .0201 DEFINITIONS
As used in this Subchapter, unless the context requires
otherwise, the following definitions shall apply:
(1) "Activities of Daily Living (ADL)" means
eating; dressing; bathing; toileting; bowel and bladder control; transfers; and
ambulation.
(2) "Adaptable space" means space in a
facility that can be used for several purposes with little effort and without
sacrificing safety and health standards; for example, an activities room that
is used for crafts in the morning, used to serve lunch and used for exercise
activities in the afternoon.
(3) "Adaptable activity" means an activity
where participation can be varied from individual, small group, or large group,
and can occur seated, standing or lying down.
(4) "Adult" means an individual 18 years of
age or older.
(5) "Adult Day Care Center" means a day care
program operated in a structure other than a single family dwelling.
(6) "Adult Day Care Home" means a day care
program for up to 16 people operated in a single family dwelling where the
owner resides.
(7) "Adult Day Care Program" means the
provision of group care and supervision in a place other than their usual place
of abode on a less than 24-hour basis to adults who may be physically or
mentally disabled. This term is used to refer to adult day care programs,
adult day health programs, and adult day care and combined adult day health
programs (i.e., combination programs).
(8) "Alzheimer's Disease" means a
progressive, degenerative disease of the brain resulting in impaired memory,
thinking and behavior. Characteristic symptoms of the disease include gradual
memory loss, impaired judgement, disorientation, personality change, difficulty
in learning and loss of language skills.
(9) "Ambulatory" means a person who is mobile
and does not need the continuing help of a person or object for support (except
a walking cane).
(10) "Capacity" means the number of
participants for which a day care program is certified.
(11) "Caretaker" (or "Caregiver") means
an adult who regularly provides an impaired adult with continuous supervision,
assistance with preparation of meals, assistance with housework and assistance
with personal grooming.
(l2) "Certification" means the process whereby
an adult day care program is approved as meeting the North Carolina Adult Day
Care Rules in 10A NCAC 06.
(13) "Certifying agency" means the Department
of Health and Human Services, Division of Aging and Adult Services.
(14) "Dementia" means the loss of intellectual
functions (such as thinking, remembering, and reasoning) of sufficient severity
to interfere with a person's daily functioning. Dementia is not a disease
itself but rather a group of symptoms that may accompany certain diseases or
conditions. Symptoms may also include changes in personality, mood and
behavior.
(15) "Group process" means at least three
persons engaged in a common activity.
(16) "Institution" means a facility that is
established to serve a particular purpose and is required by state law to be
provided and maintained by the state and any facility defined in federal
regulations as an institution. In North Carolina, the list of institutions includes:
general hospitals, state psychiatric hospitals, state centers for the mentally
ill, skilled nursing facilities, and intermediate care facilities.
(17) "Instrumental Activities of Daily Living (IADL)"
means meal preparation, medication intake, housekeeping, money management,
phone use, laundering, reading, shopping, communication such as speaking,
writing, signing, gestures, using communication devices and going to necessary
activities.
(18) "Medication schedule" means a listing of
all medications taken by participants with dosages, route of administration,
and times medications are to be taken.
(19) "Mental health disability" means disorders
with psychological or behavioral symptoms or impairment in functioning due to a
social, psychological, genetic, physical, chemical or biological disturbance.
(20) "Modifiable activity" means an activity
that can be simplified and adapted as a participant's abilities decline or
improve.
(21) "Non‑ambulatory" means a person who
is bedfast.
(22) "Nucleus area" means adult day care
programs located in a multi-use building and refers to the area not shared by
any other programs located in the building but used only by the adult day care
program.
(23) "Nursing care" means skilled nursing care
or intermediate care.
(24) "On-site" means the area certified for the
day care program.
(25) "Owner" means the person responsible for
management of a day care home or day health home.
(26) "Other special needs disease or condition"
means a diagnosis, disease or disability, such as AIDS/HIV, that benefits from
monitoring or oversight in a supervised setting.
(27) "Participant" means a person enrolled in
an adult day care program.
(28) "Personal care" means tasks that range
from assistance with basic personal hygiene and grooming, feeding, and
ambulation, to medical monitoring and other health care related tasks.
(29) "Physical therapy program" means a series
of activities prescribed by a licensed physical therapist or activities
administered under the supervision of a physical therapist.
(30) "Program director" means the person
responsible for program planning, development and implementation in a day care program.
(31) "Progress notes" means written reports in
the participant's file of staff discussions, conferences, or consultation with
family or other interested parties, for the purpose of evaluation of a
participant's progress and any other information regarding the participant's
situation.
(32) "Related disorders" means dementia or impaired
memory characterized by irreversible memory dysfunction.
(33) "Respite care," as a component of adult
day care programs, means a service provided to give temporary relief to the
family or caregiver. Primarily, respite is provided to families caring for children
or adults with disabilities or families caring for frail or disabled older
adults.
(34) "Responsible party" means the caretaker
with primary day-to-day responsibility for an impaired adult.
(35) "Semi-ambulatory" means a person who needs
and uses the assistance of objects such as a wheelchair, crutches, walker, or
other appliance or the support of another person on a regular and continuing
basis to move about.
(36) "Senior center" means a community or
neighborhood facility for the organization and provision of services including
health, social, nutritional and educational services and a facility for
recreational and group activities for older persons.
(37) "Special care services" means services by
a certified adult day care program that promotes itself as providing
programming, activities or care specifically designed for persons with
Alzheimer's or other dementias, or related disorders, mental health
disabilities, or other special needs diseases or conditions.
(38) "Supervising agency" means the county
department of social services in the county in which the day care program is
located. The county department is responsible for seeing that certification
standards are met on an on-going basis and for making a recommendation to the
Division of Aging and Adult Services regarding certification.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Eff. January 1, 1981;
Amended Eff. July 1, 1990; January 1, 1986; July 1, 1984;
Temporary Amendment Eff. September 28, 1999;
Amended Eff. July 1, 2007; July 17, 2000.
SECTION .0300 - ADMINISTRATION
10A NCAC 06R .0301 GOVERNING BODY
(a) Responsibility for management rests with the governing
body of the day care program. In a private for-profit program, responsibility
for management rests with the owner or board of directors; in a private,
non-profit program, with the board of directors; in a public agency, with the
board of that agency.
(b) The governing body of a day care program shall
establish and maintain management procedures, including:
(1) approval of organizational structure;
(2) adoption of an annual budget;
(3) regular review of financial status, making
sure that the program is under fiscal management; This includes conducting a
review of the annual budget, monthly accounts of income and expenditures to reflect
against the projected budget, and an annual audit;
(4) appointment of the program director who shall
delegate responsibility for conduct of specific programmatic and administrative
activities in accordance with policies adopted by the governing body; and
(5) adoption of written policies regarding
operation, including;
(A) program policies outlining program goals; enrollment
and discharge criteria and procedures; hours of operation; types of services
provided, including transportation if offered; rates and payments; and
management of medications. The policies shall be designed so copies may be
given to interested parties who request information about the day care program;
(B) personnel policies; and
(C) any other policies deemed necessary by the governing
body, such as agreements with other agencies and organizations.
(c) All policies affecting clients shall be written in direct
and understandable language.
(d) The owner of a day care home shall establish and
maintain operating procedures, including the following:
(1) develop an annual budget;
(2) maintain monthly accounts of income and
expenditures; and
(3) establish written policies regarding
operation, including:
(A) program policies outlining program goals; enrollment
and discharge criteria and procedures; hours of operation; types of services
provided, including transportation if offered; rates and payments; and
management of medications. The policies shall be designed so copies may be
given to interested parties who request information about the day care
program;
(B) personnel policies; and
(C) any other policies deemed necessary, such as
agreements with other agencies and organizations.
History Note: Authority G.S. 131D-6; 143B-153;
Eff. July 1, 1978;
Amended Eff. July 1, 1990; January 1, 1981;
Temporary Amendment Eff. October 1, 2001;
Amended Eff. July 1, 2007; August 1 2002.
10A NCAC 06R .0302 PROGRAM GOALS
The program shall have stated goals to guide the character
of the services given. These goals shall be in writing and consistent with the
definition of adult day care services as stated in 10A NCAC 71Q .0903.
History Note: Authority G.S. 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 1990; January 1, 1983.
10A NCAC 06R .0303 AGREEMENTS
(a) When a day care program is located in a multiple‑use
facility (e.g., school, church) there shall be a written agreement regarding
the facility's cooperative use. The agreement shall contain the following as
they apply to the adult day care program: time of use, maintenance of space,
use of equipment, security, liability, and insurance.
(b) For a program to utilize space currently certified or
licensed for another purpose by a state agency, such as the North Carolina Division
of Health Service Regulation or the North Carolina Division of Child
Development, a letter from the licensing agency shall be obtained granting
permission to use the space for a purpose other than the original licensed one.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007; March 1, 1992.
10A NCAC 06R .0304 INSURANCE
The governing body shall provide for adequate liability
insurance coverage for the facility and vehicles used by the program.
History Note: Authority G.S. 143B‑153;
Eff. July 1, 1978.
10A NCAC 06R .0305 PERSONNEL: CENTERS: HOMES WITH OPERATOR AND STAFF
(a) General Requirements
(1) The owner of adult day care homes initially
certified after January 1, 2003, or homes that make structural building
modifications after this date, shall reside in the home.
(2) Staff positions shall be planned and filled
according to the goals of the program and the manpower needed to develop and
direct the activities which meet these goals.
(3) There shall be a statewide criminal history
records search of all newly-hired employees of adult day programs for the past
five years conducted by an agency approved by the North Carolina Administrative
Offices of the Courts.
(4) There shall be a written job description
for each position, full‑time or part‑time. The job description
shall specify qualifications of education and experience; to whom employee is
responsible; duties and responsibilities; and salary range.
(5) References, including former employers,
shall be required in recruitment of staff.
(6) There shall be an established review
process for each employee at least annually and following any probationary
period.
(7) There shall be a written plan for
orientation and staff development of new employees and volunteers and ongoing
development and training of all staff. Documentation of such orientation,
staff development and training shall be recorded.
(8) There shall be a written plan for staff
substitutions in case of absences. The plan shall include the coverage of
usual responsibilities as well as maintenance of staff/participant ratio.
Substitute staff shall have the same qualifications and training as those
required by the position and in this Subchapter. Substitutes are not required
to have current certified CPR and First Aid training as long as other staff are
present with this training at all times. Trained volunteers may be used
instead of paid substitutes.
(9) Prior to beginning employment, each new
employee shall present a written medical statement, completed within the prior
12 months by a physician, nurse practitioner or physician’s assistant,
certifying that the employee has no illness or health condition that would pose
a health risk to others and that the employee can perform the duties assigned
in the job.
(b) Personnel Policies
(1) Personnel policies and their content are
the responsibility of each adult day care program. Each program shall state its
policies in writing. A copy of this statement of personnel practice shall be
given to each employee and shall state the program’s policy on the following:
(A) annual leave,
(B) educational opportunities,
(C) pay practices,
(D) employee benefits,
(E) grievance procedures,
(F) performance and evaluation procedures,
(G) criteria for advancement,
(H) discharge procedures,
(I) hiring and firing responsibility,
(J) use of any probationary period,
(K) staff participation in reviews of personnel
practices,
(L) maternity leave,
(M) military leave,
(N) civil leave (jury duty and court attendance), and
(O) protection of confidential information.
(2) All policies developed shall conform to the
United States Department of Labor wage and hour regulations.
(c) Staffing Pattern. The staffing pattern shall be
dependent upon the enrollment criteria and the particular needs of the
participants who are to be served. The ratio of staff to participants shall be
adequate to meet the goals and objectives of the program. Whenever regularly
scheduled staff are absent, substitutes shall be used to maintain the staff‑participant
ratio. The minimum ratios shall be as follows:
(1) Adult Day Care Homes
One full-time equivalent staff person
with responsibility for direct participant care for each six participants, up
to 16 participants total.
(2) Adult Day Care Centers
One full-time equivalent staff person
with responsibility for direct participant care for each eight participants.
(d) Program Director
(1) The program director shall have the
authority and responsibility for the management of activities and direction of
staff to ensure that activities and services are provided in accordance with
established program policies.
(2) The program director shall:
(A) be at least 18 years of age;
(B) have completed a minimum of two years of post
secondary education from an institution accredited by an accrediting agency recognized
by the United States Department of Education (including colleges, universities,
technical institutes, and correspondence schools) or have a high school diploma
or the equivalent and a combination minimum of five years experience and
training in services to elderly or adults with disabilities;
(C) have at least two years of work experience in
supervision and administration;
(D) present prior to employment, a written medical
statement, completed within the prior 12 months by a physician, nurse practitioner,
or physician's assistant, certifying that the employee has no illness or health
condition that would pose a risk to others and that the employee can perform
the duties assigned on the job; and
(E) provide at least three reference letters or the names
of individuals with whom a reference interview can be conducted, including at
least one former employer. The individuals providing reference information
shall have knowledge of the applicant program director's background and
qualifications.
(3) In employing a program director, the
governing body, agency or owner shall consider whether or not applicants
exhibit these characteristics:
(A) ability to make decisions and set goals;
(B) knowledge and understanding of the needs of the
aging and disabled;
(C) ability to design and implement a varied, structured
program of group and individual activities; and
(D) managerial and administrative skills ‑ ability
to supervise staff and to plan and coordinate staff training.
(4) The adult day care program shall have a
full‑time program director or a full-time substitute meeting the
requirements as specified in this Paragraph. The program director shall assign
authority and responsibility for the management of activities and direction of
staff when the program director is not on site.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. September 1, 2007; July 1, 2007; May 1, 1992; July 1, 1990; July 1, 1984; January 1, 1981.
10A NCAC 06R .0306 PERSONNEL: DAY CARE HOMES: ONLY STAFF
PERSON IS OPERATOR
(a) The operator of an adult day care program shall meet
the qualifications of director as defined in Rule .0305 of this Section.
(b) There shall be a minimum of one staff person during all
hours of operation meeting the requirements set forth in Rule .0305 of this Section.
(c) A day care home shall have substitute or relief staff to
enable the day care home to remain open on days when the operator is not
available to supervise the program. The substitute or relief staff shall meet
the requirements for this position as set forth in Rule .0305 of this Section.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. September 1, 2007; July 1, 2007; May 1, 1992; July 1, 1990; July 1, 1984; January 1, 1981.
10A NCAC 06R .0307 PERSONNEL: VOLUNTEERS
(a) When volunteers are used in an adult day care program,
adequate planning prior to the placement of the volunteers shall take place in
order to provide the volunteer with a written description of his duties and
responsibilities. This written description shall outline in detail the tasks
to be performed, qualifications for performing them, and specifics of hours,
days and length of commitment needed from the volunteer.
(b) The volunteer shall take part in a formal or informal
orientation and training session to inform him of the goals of the program, the
operation and daily schedule of the program, specific needs of the adults being
served and any necessary specialized approaches the volunteer shall be expected
to use.
(c) Paid staff of the program shall be properly informed of
the use of a volunteer prior to his working in the program, staff's
responsibility and role and the volunteer's responsibility and role. Paid
staff shall be involved in planning for the volunteer and shall assist in
writing up the duties the volunteer shall perform.
(d) Provision shall be made to evaluate the volunteer in
his execution of the job.
(e) Provision shall be made for recognition and
appreciation of the volunteer.
History Note: Authority G.S. 143B‑153;
Eff. July 1, 1978.
SECTION .0400 - THE FACILITY
10A NCAC 06R .0401 GENERAL REQUIREMENTS
(a) The facility and grounds of an adult day care program
shall be approved by the local environmental health specialist, the local fire
safety inspector, the county department of social services, and the North
Carolina Division of Aging and Adult Services.
(b) The facility shall comply with all applicable zoning
laws.
(c) There shall be adaptable spaces, as defined in Rule .0201(2)
of this Subchapter, suitable for activities for participants. Spaces shall
provide opportunities for participants to get together as a group as well as
privacy for quiet times.
(d) The facility shall provide at least 40 square feet of
indoor space for each participant in the portion of the buildings utilized for
adult day care programs. This minimum square footage excludes hallways,
offices, and restrooms.
(e) If meals are prepared within the facility, the kitchen
shall meet environmental health rules, as defined in 15A NCAC 18A .3300.
(f) Storage areas must be adequate in size and number for
storage of clean linens, dirty linens, cleaning materials, household supplies,
food, equipment, and program supplies. A separate locked area for storing poisons,
chemicals or other potentially harmful products (cleaning fluids,
disinfectants, etc.) shall be provided.
(g) A minimum of one male and one female toilet shall be
located in each facility and accessible in accordance with the North Carolina
Accessibility Code, which is hereby incorporated by reference, including any
subsequent amendments or additions and can be obtained through the North
Carolina Department of Insurance, 1202 Mail Service Center, Raleigh, NC
27699-1202 at a cost of sixty-two dollars and 00/100 ($62.00). One toilet
shall be available for each 12 adults, including staff and participants who
utilize the facility. One hand lavatory shall be provided for each two
toilets.
(h) All rugs and floor coverings must be fastened down.
Loose throw rugs are not allowed. Floors shall not be slippery.
(i) A telephone shall be available for participants to make
and receive calls. A pay station telephone is not acceptable for local calls.
(j) Unless identified by the Division of Aging and Adult Services
as shared space, the area certified for adult day care shall be used for the
sole purpose of the adult day care program and its activities during hours of
program operation.
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. September 1, 2007; July 1, 1990; January 1,
1981.
10A NCAC 06R .0402 BUILDING CONSTRUCTION
(a) An adult day care building shall meet the approval of
the local building inspector in terms of structural soundness and fire safety.
(b) The program shall provide at least one entrance at
ground level with no steps or an entrance ramp with rails and a maximum slope
of 1 in 12 (eight percent). The ramp shall be covered with a securely fastened
non‑skid floor covering which is secured at both ends.
(c) Facilities where 16 or fewer adults are served in a
single family dwelling shall meet building construction requirements for adult
day care homes specified in Section .0700 of this Subchapter.
(d) All facilities initially certified after January 1, 2003, or those that make structural building modifications after this date
shall meet the North Carolina State Building Code, which is hereby incorporated
by reference, including any subsequent amendments or additions and can be
obtained through the North Carolina Department of Insurance, 1202 Mail Service
Center, Raleigh, NC 27699-1202 at a cost of eighty dollars and 00/100 ($80.00).
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. September 1, 2007; July 1, 2007; July 1, 1990; July 1, 1984; January 1, 1981; September 1, 1978.
10A NCAC 06R .0403 EQUIPMENT AND FURNISHINGS
(a) Adult Day Care facility equipment and furnishings shall
meet the needs of participants and staff and enable efficient operation of the
program. The facility shall have:
(1) at least one sturdy straight back chair or
sturdy folding chair for each participant and each staff person, excluding
those in wheelchairs;
(2) table space adequate for all participants
to be served a meal at a table at the same time and for program activities;
(3) chairs or sofas that allow for position
changes, are upholstered or of soft material, and water and stain resistant, so
that at least half of the participants can relax and rest at the same time. If
all participants take a daily rest period at the same time, the facility shall
have enough of such seating for all participants; and
(4) a quiet space with a minimum of one bed or
cot so that participants can lie down as needed separate from other program
activities.
(b) All equipment and furnishings shall be in good condition
and safe for use by all participants and staff of the facility.
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007; January 1, 1981.
SECTION .0500 ‑ PROGRAM OPERATION
10A NCAC 06R .0501 PLANNING PROGRAM ACTIVITIES
(a) Enrollment Policies and Procedures
(1) Each adult program shall have enrollment
policies. Enrollment policies shall be in writing as a part of the program
policies and shall define the population served. These policies serve as the
basis for determining who shall be accepted into the program and for planning
activities appropriate for the participants. The policies shall be specific to
prevent enrolling people whose needs cannot be met by the planned activities
and shall provide for discharge of participants whose needs can no longer be
met or who can no longer be cared for safely. If a day care program serves
semi‑ambulatory or non‑ambulatory persons, it shall be so stated in
the admissions criteria.
(2) Prior to enrollment, the applicant, family
members or other caregiver shall have a minimum of one personal interview with
a minimum of one program staff member. During the interview, the staff shall
complete initial documentation identifying social and medical care needs, any
designated spiritual, religious or cultural needs, and a determination of
whether the program can meet the individual's expressed needs. The staff
person doing the interviewing shall sign the determination of needs and the applicant,
family member or other caregiver shall sign the application for enrollment. These
signed documents shall be obtained before the individual's first day of
attendance as a participant in the program.
(3) A medical examination report signed by a
physician, nurse practitioner or physician's assistant, completed within the
prior three months, shall be obtained by the program within 30 days of enrollment.
This report must be updated annually no later than the anniversary date of the
initial report.
(4) At enrollment, or in the initial interview,
the program policies shall be discussed with the applicant, family member or
other caregiver and a copy of the program policies shall be provided.
(5) Documentation of receipt of and agreement
to abide by the program policies by the applicant, family member or other
caregiver shall be obtained by the program and kept in the participant's file.
(6) The program policies shall contain:
(A) a discharge policy outlining the criteria for
discharge and notification procedures for discharge, the timeframe and
procedures for notifying the applicant, family member or other caregiver of
discharge, and referral or follow-up procedures;
(B) a medication policy as specified in Rule .0505 of
this Section;
(C) a description of participant's rights;
(D) grievance policies and procedures for families;
(E) advance directives policy;
(F) non-discrimination policies;
(G) procedure to maintain confidentiality;
(H) policy on reporting suspected abuse or neglect;
(I) description of the geographical area served by the
program; and
(J) inclement weather policies.
(b) Planning Services for Individual Participants
(1) Within 30 days of enrollment of a new
participant, the program shall perform a comprehensive assessment and written
service plan for each individual. The assessment shall address the individual's
ability to perform activities of daily living and instrumental activities of
daily living while in the program. The mental, social, living environment,
economic and physical health status of the individual shall also be assessed. The
service plan shall be signed and dated by the program director or the
director's designee. For adult day health participants the health component of
the service plan shall be written and signed by a registered nurse.
(2) In developing the written service plan, the
program shall include input from the participant, family members, or other
caregiver and other agency professionals with knowledge of the individual's
needs. The service plan shall be based on strengths, needs and abilities
identified in the assessment. The assessment and service plan shall be
reviewed at regular intervals, and no less than once every six months. The
service plan shall include:
(A) the needs and strengths of the participant;
(B) the interests of the participant;
(C) the measurable service goals and objectives of care
for the participant while in the day care program;
(D) the type of interventions to be provided by the
program in order to reach desired outcomes;
(E) the services to be provided by the program to
achieve the goals and objectives;
(F) the roles of participant, family, caregiver,
volunteers and program staff; and
(G) the time limit for the plan, with provision for
review and renewal.
(3) Progress notes in the participant's record
shall be updated at least every three months.
(4) The participant, caregiver, and other
service providers may contribute to the development, implementation and
evaluation of the service plan.
(5) Any unusual behavior, change in mood,
change in attitude or need for help or services shall be reported by the
program. If the participant is a social services client, the report shall be
made to the participant's family, caregiver, or responsible party and the
department of social services worker or the social worker designated as
consultant to the day care program by the department. If the participant is
not a social services client, the report shall be made to the person's family,
caregiver or responsible party. A note shall be made in the participant's
record of action taken.
(6) The participant or the responsible party
may choose the days and number of days the participant will attend, with the
program director's approval.
(7) The reason for any unscheduled participant
absence shall be determined by the program staff and documented on the day it
occurs. The program shall attempt to contact the absent participant or the
responsible party.
(8) The adult day care program is responsible
for the participant when a participant is registered in attendance. A
participant leaving the program for part of a day shall sign out relieving the
staff of further responsibility. If a participant has emotional or mental
impairment which requires supervision and that person needs or wants to leave
the program during the day, the social worker, family, caregiver, friend, or
responsible party shall sign the person out.
(c) Program Activities Plan
(1) The day care center or home shall have a
program activities plan which meets the following criteria:
(A) Overall planning of activities are based on elements
of the individual service plans.
(B) The primary program mode is the group process, both
large and small groups, with provision for individual activities and services
as needed.
(C) Activities are adaptable and modifiable to allow for
greater participation and to maintain participant's individual skill level.
(D) Activities are consistent with the stated program
goals.
(E) Activities are planned jointly by staff and
participants. Staff shall encourage participants to participate in the
planning and operation of the program as much as they are able, and to use
their skills, talent and knowledge in program planning and operation.
(F) All program activities are supervised by program
staff.
(G) Participants may refuse to participate in any given
activity.
(2) The activities schedule shall provide for
the inclusion of cognitive activities to be available on a daily basis, and be
designed to:
(A) stimulate thinking and creativity;
(B) provide opportunities for learning new ideas and
skills;
(C) help maintain existing reasoning skills and
knowledge base; and
(D) provide opportunities to utilize previously learned
skills.
(3) The activities schedule shall provide for
the inclusion of physical activities to be available on a daily basis, and be
designed to:
(A) improve or maintain mobility and overall strength;
and
(B) increase or maintain joint range of motion.
(4) The activities schedule shall provide for
the inclusion of psychosocial activities to be available on a daily basis, and
be designed to:
(A) provide opportunities for social interaction;
(B) develop a sense of belonging;
(C) promote goal-oriented use of time;
(D) create feelings of accomplishment;
(E) foster dignity and self-esteem;
(F) prompt self-expression; and
(G) provide fun and enjoyment.
(5) The activities schedule shall:
(A) be in writing, specifying the name of each activity
to be provided, the days of the week each activity shall be conducted, and the
approximate length of time of each activity;
(B) indicate the length of time the schedule is to be
followed; and
(C) be posted weekly or monthly in a prominent place in
the facility.
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. February 1, 2008; July 1, 2007; July 1, 1990; January 1, 1981.
10A NCAC 06R .0502 NUTRITION
(a) An adult day program shall provide a midday meal to
each participant in attendance. The meal shall provide at least one‑third
of an adult's daily nutritional requirement as specified by the United States
Department of Agriculture, Dietary Guidelines for Americans, which are
incorporated by reference, including any subsequent amendments or additions to
these guidelines. These guidelines may be viewed and downloaded from the
Internet at http://www.health.gov/dietaryguidelines/. A licensed
dietician/nutritionist shall approve the menu.
(b) An adult day program shall offer snacks and fluids to
meet the participant's nutritional and fluid needs. The adult day program
shall offer a mid‑morning and mid‑afternoon snack daily to
participants. Snacks shall be planned to keep sugar, salt and cholesterol
intake to a minimum.
(c) An adult day program shall provide a therapeutic diet,
if prescribed in writing by a physician, physician's assistant or nurse
practitioner for any participant. If therapeutic diets are prepared by program
staff, such staff shall have training in planning and preparing therapeutic
diets or shall provide documentation of previous training and education
sufficient to assure ability to prepare meals in accordance with a physician's
prescription.
(d) A licensed dietician/nutritionist shall give
consultation to the staff on basic and special nutritional needs and proper
food handling techniques and the prevention of foodborne illness.
(e) An adult day care program shall neither admit nor
continue to serve a participant whose dietary requirements cannot be
accommodated by the program.
(f) An adult day program shall store, prepare and serve
meals in a sanitary manner using safe food handling techniques such as those
recommended by the United States Department of Agriculture, at the following
website:
(http://www.fsis.usda.gov/Fact_Sheets/Safe_Food_Handling_Fact_Sheets/index.asp).
The food service provider shall abide by the food safety and sanitation
practices required by the Commission for Public Health rules applying to adult
day care facilities, including any subsequent amendments or additions, which
are incorporated by reference. Copies of the rules may be found at the
following website:
(http://www.deh.enr.state.nc.us/ehs/images/rules/t15a-18a.33.pdf).
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. February 1, 2008; July 1, 2007; March 1, 1992; October 1, 1981; January 1, 1981.
10A ncac 06R .0503 TRANSPORTATION
(a) For programs providing or arranging for public
transportation, the adult day care program shall have a transportation policy
that includes routine and emergency procedures. Accidents, medical
emergencies, weather emergencies and escort issues shall be addressed.
(b) When the adult day care program provides
transportation, the following requirements shall be met to ensure the health
and safety of the participants:
(1) Each person transported shall have a seat
in the vehicle.
(2) Participants shall be transported no more
than 30 minutes without being offered the opportunity to have a rest stop.
(3) Vehicles used to transport participants
shall be equipped with seatbelts. Participants shall be instructed to use
seatbelts while being transported.
(4) Vehicles shall be equipped with a first aid
kit, consisting of the items listed in 10A NCAC 06S .0301(a), and a fire
extinguisher.
(5) A copy of the transportation policy shall
be located in the vehicle used for transport.
History Note: Authority G.S. 131D-6; 143B-153;
Eff. July 1, 1978;
Amended Eff. January 1, 1981;
Temporary Amendment Eff. October 1, 2001;
Amended Eff. February 1, 2008; July 1, 2007; August 1, 2002.
10A NCAC 06R .0504 EMERGENCIES AND FIRST AID
(a) A fire safety and evacuation plan, approved by the
office of the fire marshal or its designee, shall be prepared and maintained by
each adult day care program in compliance with the North Carolina State Building
Code and Fire Prevention Code.
(b) Plan for Emergencies. A written plan for handling
emergencies shall be established and displayed prominently in the facility.
All staff shall be knowledgeable about the plan. The plan shall:
(1) relate to medical and non-medical
emergencies; and
(2) specifiy responsibilities of each staff
member in an emergency;
Quarterly drills
in handling emergencies, such as medical emergencies, natural disasters, fires,
and facility security shall be conducted. These drills shall be documented
including the date and kind of emergency.
(c) Evacuation Plan. An evacuation plan shall be posted in
each room and fire drills shall be conducted quarterly by programs with a fire
safety sprinkler system and monthly by programs without a fire safety sprinkler
system. A record shall be kept of dates and time required to evacuate the facility.
(d) All physically able staff who have direct contact with
participants shall complete certified training in standard first aid and cardio‑pulmonary
resuscitation (CPR). 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:
(1) 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;
(2) current, as determined by the organization
conducting the training and issuing the certification; and
(3) 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.
(e) The program shall arrange for medical assistance to be
available in the event of an emergency.
(f) The program shall have a portable basic emergency
information file available on each client that includes:
(1) hospital preference, physician of record
and telephone number;
(2) emergency contact (family or caregiver);
(3) insurance information;
(4) medications and allergies;
(5) current diagnosis and history; and
(6) advance directives, if any.
(g) Adult day care staff shall report actions taken in case
of sickness and all incidents resulting in physical injury or suspected
physical injury, including incidents involving missing participants to the
program director. The adult day care staff shall make sure that all persons
needing medical attention receive such attention as soon as possible. The
person taking emergency action shall notify the family or responsible party of
the participant involved and other program staff shall be notified of emergency
action taken as soon as possible. The program director shall compile and keep
on record a report of all emergency actions taken. A copy of the report shall
be sent to the county department of social services within 72 hours of the
incident.
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007; July 1, 1990; January 1, 1981.
10A NCAC 06R .0505 MEDICATIONS
(a) All adult day care programs shall have written policies
on participant medication use, medication administration order changes and
medical disposal.
(b) Medications shall be administered according to the
participant's medication schedule as defined in Rule .0508(a)(4) (E) of this
Section or as authorized by the participant's caregiver.
(c) A record of all medications given to each participant shall
be updated at a minimum of once every quarter and as needed and shall document the
following:
(1) participant's name;
(2) name, dosage, quantity and route of the
medication;
(3) instructions for giving medication;
(4) date and time medication is administered;
and
(5) name or initials of person giving the
medication. If initials are used, a signature equivalent to those initials
shall be entered on this record.
(d) Medications shall be kept in the original pharmacy containers
in which they were dispensed. The containers shall be labeled with the
participant's full name, the name and strength of the medicine, and dosage and
instructions for administration. Medicines shall be kept in a locked location.
(e) Only adult day health or adult day care and day health
combination programs shall enroll or serve participants who require
intravenous, intramuscular or subcutaneous medications while attending the
program.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007; March 1, 1992; January 1, 1981.
10A NCAC 06R .0506 HOURS AND DAYS OF OPERATION
(a) Supervision of adult day program participants and adult
day care program services shall be provided throughout all hours participants
are present at the program.
(b) The program shall operate for a minimum of six hours.
(c) Day care programs shall provide supervision of
participants and program activities at least five days per week, except that a
facility may be closed for designated holidays, for hazardous weather
conditions, for vacations, and for other reasons as agreed by the director and
the county department of social services. Late openings or early closures may
be scheduled on days when hazardous weather conditions exist or when emergency
situations arise.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007; March 1, 1992.
10A NCAC 06R .0507 availability and accessibility OF
PROGRAM policies
The adult day care program policies shall be provided to the
participant's family member, responsible party or caretaker at the time of
enrollment and available on request [.0301(b)(5)(A) or (c)(3)(A) of this
Subchapter].
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007; March 1, 1992.
10A NCAC 06R .0508 RECORDS
(a) Individual Participant Records. Each adult day care
program shall maintain records to document the progress of each participant and
to document program operation. These records shall be kept in a locked file.
An individual folder for each participant shall be established and maintained
and include the following:
(1) a signed application recording:
(A) participant's full name;
(B) address and telephone number;
(C) date of birth, marital status and living arrangement
of participant;
(D) time of day participant will arrive and time of day participant
will leave the program;
(E) travel arrangements to and from the program for the
participant;
(F) name, address and telephone number of at least two
family members or friends who are responsible for the participant and can be
contacted in emergencies;
(G) name, address and telephone number of a licensed
medical service provider who will see the participant on request; and
(H) personal concerns and knowledge of the caregiver
that may have an impact on the participant's care plan.
(2) copies of all current and former signed
authorizations for the day care program to receive and give out confidential
information on the participant. The current authorization shall include the
name of the party from whom information is requested and to whom information is
given. The current authorization shall be dated within the prior 12 months and
obtained each time a request for participant information is made.
(3) a signed authorization for the participant
to receive emergency medical care from any licensed medical practitioner, if
emergency care is needed by the participant;
(4) a medical examination report conducted
within three months before enrollment and updated annually, signed by a
licensed physician, physician's assistant or nurse practitioner. The report
shall include information on:
(A) current diseases and chronic conditions and the
degree to which these diseases and conditions require observation by day care
staff, and restriction of normal activities by the participant;
(B) presence and degree of psychiatric problems;
(C) amount of direct supervision the participant
requires;
(D) any limitations on physical activities;
(E) listing of all medications with dosages and times
medications are to be administered; and
(F) most recent date participant was seen by doctor.
(5) assessment forms as identified in Rule
.0501(a)(2) and (b)(1) and (b)(2) of this Section.
(6) progress notes which are the written report
of staff discussions, conferences, consultation with family or other interested
parties, evaluation of a participant's progress and any other information
regarding a participant's situation.
(7) service plans for the participant,
including scheduled days of attendance, for the preceding 12 months.
(8) a signed authorization if the participant
or his responsible party will permit photographs, video, audio recordings or
slides of the participant to be made by the day care program, whether for
medical documentation, publicity, or any other purpose. The authorization
shall specify how and where such photographs, videos, audio recordings or
slides will be used, and shall be obtained prior to taking any photographs,
videos, audio recordings or slides of the participant.
(9) a statement signed by the participant, a
family member or other responsible party (when applicable) acknowledging
receipt of the program policies and agreeing to uphold program policies
pertaining to the participant.
(b) The adult day program shall keep the following program
records a minimum of six years:
(1) copies of activity schedules;
(2) monthly records of expenses and income,
including fees collected, and fees to be collected;
(3) all bills, receipts and other information
which document expenses and income;
(4) a daily record of attendance of
participants by name;
(5) accident reports;
(6) a record of staff absences, annual leave
and sick leave, including dates and names of substitutes;
(7) reports on emergency and fire drills;
(8) individual personnel records on all staff
members including:
(A) application for employment;
(B) evidence of a state criminal history check on each
employee providing direct care;
(C) job description;
(D) medical certification of absence of a health
condition that would pose a risk to others;
(E) written note or report on any personnel action
taken with the employee;
(F) written report of annual employee review;
(G) CPR and first aid training documentation; and
(H) signed statement to keep all participant information
confidential.
(9) a copy of all written policies, including:
(A) program policies;
(B) personnel policies;
(C) agreements or contracts with other agencies or
individuals;
(D) plan for emergencies; and
(E) evacuation plan;
(10) program evaluation reports; and
(11) control file of DSS-5027 (SIS Client Entry
Form) for all participants for whom Social Services Block Grant (Title XX)
reimbursement is claimed.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. February 1, 2008; July 1, 2007; March 1, 1992; July 1, 1990; January 1, 1981.
10A NCAC 06R .0509 PROGRAM EVALUATION
(a) Each day care program shall have in writing a plan for
internal evaluation of its operation and services. The plan shall include the
timetable for initiating and completing the annual evaluation, the parties to be
involved, the areas which will be addressed and the methods to be used in
conducting the evaluation.
(b) A formal evaluation shall be conducted at regular
intervals, at least annually.
(c) The following parties shall be involved, to the extent
considered appropriate, in the evaluation process:
(1) governing body,
(2) program director,
(3) staff,
(4) participants,
(5) families of participants,
(6) department of social services.
(d) Evaluation shall focus on the following three areas, in
addition to any others the program may wish to address:
(1) the extent to which the program is
achieving its goals;
(2) the extent to which the program is meeting
the needs and interests of participants; and
(3) the extent to which the program is
efficient and effective in its operation, including the extent to which the
program is cost‑efficient.
(e) A written report of the program evaluation and findings
shall be made and kept on file.
History Note: Authority G.S. 143B‑153;
Eff. July 1, 1978;
Amended Eff. January 1, 1981.
10A NCAC 06R .0510 DAY CARE PROGRAMS IN MULTI‑USE
FACILITIES
Adult day care programs established in buildings which are
used at the same time for other activitites must adhere to the following
guidelines:
(1) The day care program must be self‑contained with
its own staff and separate area.
(2) Participation is open only to persons enrolled in
the program and to visitors on a planned basis. Depending on the nature of the
other activities in the building, it may or may not be appropriate for day care
participants to share in them on a planned basis. Such involvement must be as
part of the day care program plan and must be supervised by a day care staff
member. (Examples of appropriate involvement might include senior center
crafts and social events and lunch at a congregate meal site.)
History Note: Authority G.S. 143B‑153;
Eff. January 1, 1981;
Amended Eff. July 1, 1990.
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.
10A NCAC 06R .0602 CHANGES IN PERSONNEL
Whenever there is a change in program director or operator,
the qualifications of the new staff person as meeting the standards in Rule
.0305 or .0306 of this Subchapter must be documented in writing to the county department
of social services no later than the effective date of the change. The adult
day care consultant of the Division of Aging shall be notified in writing of
the change and the county department of social services' satisfaction that
standards are met.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2000.
SECTION .0700 ‑ CONSTRUCTION REQUIREMENTS FOR DAY CARE HOME
10A NCAC 06R .0701 RESIDENTIAL BUILDING CODE REQUIREMENTS
Adult Day Care Homes initially certified after January 1, 2003 and those that make structural building modifications after this date
shall meet the residential building code requirements of the North Carolina Commercial Building Code. The requirements shall include:
(1) standard wood frame, brick, block or veneer construction;
(2) attic shall not be used for storage;
(3) porches and stoops shall be protected by handrails;
(4) steps shall be protected by handrails; and
(5) all entrances, pathways and exits shall adhere to
the North Carolina State Accessibility Code.
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007.
10A NCAC 06R .0702 FIRE AND SAFETY REQUIREMENTS
Adult Day Care Homes shall:
(1) have fire extinguishers of the type
recommended by the fire inspector and governed by the North Carolina Fire
Prevention Code, centrally located in the kitchen;
(2) provide automatic station products of
combustion type smoke detectors as required by the North Carolina Fire
Prevention Code;
(3) provide listed heat detectors in the attic
and basement from the approved list in the North Carolina Fire Prevention Code;
and
(4) provide a fire safety and evacuation plan
to be prepared according to requirements of the North Carolina Fire Prevention
Code.
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007.
10A NCAC 06R .0703 OTHER
Adult day care programs initially certified after January 1, 2003, or those that make structural building modifications after this date,
shall comply with the North Carolina building codes where are hereby
incorporated by reference, including subsequent amendments and additions.
Copies of the building codes may be obtained from the North Carolina Department
of Insurance, Office of State Fire Marshall, 2101 Mail Service Center, Raleigh, NC 27699-2101, or telephone (919) 661-5880, at a cost of fifty dollars ($50.00); or available at the following website: http://www.ncdoi.com/OSFM/default.asp.
History Note: Authority G.S. 131D-6; 143B‑153;
Eff. July 1, 1978;
Amended Eff. July 1, 2007.
SECTION .0800 ‑ CERTIFICATION INFORMATION
10A NCAC 06R .0801 THE CERTIFICATE
(a) The certificate will be issued by the Division of Aging
when, in the division's judgment, minimum requirements for certification have
been met under the rules of this Subchapter. The certificate must be
conspicuously posted in a public place in the facility.
(b) The certificate will be in effect for 12 months from
the date of issuance unless revoked for cause, voluntarily or involuntarily
terminated, or changed to provisional certification status.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2000.
10A NCAC 06R .0802 PROVISIONAL CERTIFICATE
(a) A provisional certificate may be issued in accordance
with the following:
(1) A provisional certificate may be issued by
the Division of Aging when the certification renewal process identifies
violations and a plan for corrective action is in place. The provisional
certification will continue until timely corrections have been made and the
division so informed, or until revoked.
(2) A provisional certificate may be issued by
the Division of Aging when corrective action has not been completed by the
completion date established in a corrective action plan. The provisional
certification will continue until timely corrections have been made and the
division so informed, or until revoked.
(3) A provisional certificate may be issued by
the Division of Aging when renewal materials have not been submitted in a
timely fashion, but were received by the division prior to the expiration date
of the current period of certification. The provisional certificate will remain
in place until revoked or until replaced with full certification.
(b) In no instance will a provisional certificate be in
effect for longer than six months.
(c) When a provisional certificate is issued, the program
must post a copy of the notice from the Division of Aging, identifying the
reasons for it, adjacent to the current certificate.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2000; July 1, 1990.
10A NCAC 06R .0803 TERMINATION OF CERTIFICATION
The certificate will automatically terminate under the
following conditions:
(1) In a private for‑profit program, when
ownership in its entirety is transferred; in a private, non‑profit
program, when the board of directors is dissolved; in a public agency, when the
board of that agency is dissolved;
(2) When the program moves to another location;
(3) When the required certification renewal materials
are not received by the Division of Aging by the expiration date of the current
period of certification.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2000; July 1, 1990.
10A NCAC 06R .0804 DENIAL OR REVOCATION OF CERTIFICATE
(a) A certificate may be denied or revoked by the Division
of Aging at any time for failure to comply with the rules of this Subchapter.
(b) When a program fails to comply with the rules of this Subchapter
at the time initial certification is requested, certification will be denied by
the Division of Aging. A notice setting forth the particular reasons for such
action will be delivered personally or by certified mail to the applicant.
Such denial becomes effective 20 days after the receipt of the notice.
(c) Revocation of a certificate, when violations have not
been corrected by the date established by a corrective action plan, may be
effected by personal delivery or certified mail, of a notice setting forth the
particular reasons for such action. Such revocation becomes effective 20 days
after the receipt of the notice.
(d) In accordance with 150B‑3(c), if the division
finds that the health, safety, or welfare of the participants requires emergency
action and incorporates this finding in its notice, the certificate may be
summarily suspended. Notice of the summary suspension shall be effected by
serving the program director by personal delivery or certified mail. The
summary suspension will be effective on the date specified in the notice or
upon service of the notice, whichever is later.
(e) When a program receives a notice of denial or
revocation, the program director must inform each participant and participant
caretaker, as appropriate, of the notice and the basis on which it was issued.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2000; July 1, 1990.
10A NCAC 06R .0805 PENALTY
(a) If the program is in willful violation as specified in
Rule .0102 of this Subchapter, a penalty may be imposed.
(b) The amount of the penalty, within the limitation
established by G.S. 131D‑6, shall be determined based on the degree and
extent of the harm or potential harm caused by the willful violation.
(1) Where a violation presents a clear and
immediate danger to the participants a civil penalty of one hundred dollars
($100.00) per day will be imposed effective from the day that corrective action
was to have been completed.
(2) Where a violation has the potential to
endanger the participants' health, safety or welfare a civil penalty of fifty
dollars ($50.00) per day will be imposed effective from the day that corrective
action was to have been completed.
(3) Where a violation does not directly
endanger the participants a civil penalty of ten dollars ($10.00) per day will
be imposed effective from the date on which corrective action was to have been
completed.
(c) The Division of Aging shall determine the penalty
levied against a program based on the severity of the violation as described in
(b) of this Rule and will notify the program by registered or certified mail.
The penalty shall become due 20 days after receipt of the notice.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2000; July 1, 1990.
10A NCAC 06R .0806 PROCEDURE FOR APPEAL
(a) When the program is notified by the Division of Aging
of a negative action, the program may ask for an informal review by division
staff. If the review is not satisfactory, the program may request a hearing.
(b) The program may request a hearing within 60 days after
receipt of written notification from the division of a negative action, by
written notice through registered or certified mail to the Office of
Administrative Hearings, 424 North Blount Street, Raleigh, NC 27601. In addition, at any time before the hearing, the Division of Aging may rescind the
notice of negative action upon being satisfied that the reasons for such action
have been corrected.
(c) Except as provided for in Rule .0804(d) of this Subchapter,
upon receipt of a request for a hearing, the enforcement of the negative action
shall be suspended pending final agency decision.
(d) The petition for a hearing shall be filed with the
Office of Administrative Hearings in accordance with G.S. 150B‑23 and 26
NCAC 3 .0103. In accordance with G.S. 1A‑1, Rule 4 (j) 4, the petition
shall be served on a registered agent for service of process for the Department
of Health and Human Services. A list of registered agents may be obtained from
the Office of Legislative and Legal Affairs.
(e) Procedures for the processing of an appeal of an
adverse certification action and for the final decision are specified in G.S.
150B, Article 3 and 10A NCAC 01.
History Note: Authority G.S. 131D‑6; 143B‑153;
Eff. January 1, 1986;
Amended Eff. July 1, 2000; March 1, 1992; July 1, 1990.
SECTION .0900 - SPECIAL CARE FOR PERSONS WITH ALZHEIMER’S
DISEASE OR OTHER DEMENTIAS, MENTAL HEALTH DISABILITIES OR OTHER SPECIAL NEEDS
DISEASES OR CONDITIONS IN ADULT DAY CARE CENTERS
10A NCAC 06R .0901 DISCLOSURE
The rules of this Chapter are established to govern the
disclosure requirements for adult day care programs that provide or promote
themselves as providing special care services for persons with Alzheimer’s or
other dementias, mental health disabilities, or other special needs diseases or
conditions. Only those centers that meet these requirements may advertise or
represent themselves as providing special care services as defined in Rule
.0201.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Temporary Adoption Eff. September 28, 1999;
Eff. July 17, 2000.
10A NCAC 06R .0902 POLICIES AND PROCEDURES
Adult Day Care Centers shall assure that written special
care services policies and procedures are established, implemented by staff and
available for review within the center. In addition to all applicable policies
and procedures for adult day care centers, there should be policies and
procedures that address:
(1) The philosophy of the special care service which
includes a statement of mission and objectives regarding the specific
population to be served by the center which shall address, but not be limited
to, the following:
(a) a safe, secure, familiar and consistent
environment that maintains and encourages the use of skills for daily living;
(b) a structured program of daily activities
that allows for flexibility to respond to the needs, abilities, and preferences
of participants;
(c) individualized service plans that stress the
maintenance of participant’s abilities and promote the highest possible level
of physical and mental functioning; and
(d) methods of behavior management which
preserve dignity through design of the physical environment, physical exercise,
social activity, appropriate medication administration, proper nutrition and
health maintenance.
(2) The process and criteria for enrollment in and
discharge from the service.
(3) A description of the special care services offered
by the center.
(4) Participant assessment and service planning,
including opportunity for family involvement in the service planning and the
implementation of the service plan, including responding to changes in the
participant’s condition.
(5) Safety measures addressing specific dangers such as
wandering, ingestion, falls, smoking, and aggressive behavior.
(6) Lost or missing participants.
(7) Staff to participant ratios in the special care
service to meet the needs of participants.
(8) Amount and content areas of staff training both at
orientation and annually based on the special care needs of the participants.
(9) Physical environment and design features that
address the needs of the participants. These features can encompass an entire
center if the center promotes itself as providing special care or any section
separated by closed doors from the rest of the center and advertised especially
for special care of participants.
(a) Center or section exit doors may be locked
only if the locking devices meet the requirements outlined in the N.C. State
Building Code for special locking devices;
(b) Where exit doors are not locked, a system of
security monitoring shall be provided.
(10) Activities based on personal preferences and needs
of the participants that focus on the individual’s interests and abilities.
(11) Opportunity for involvement of families in
participant care, if applicable.
(12) The availability of or information on family support
groups and other community services.
(13) Additional costs and fees to the participant for the
special services provided.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Temporary Adoption Eff. September 28, 1999;
Eff. July 17, 2000.
10A NCAC 06R .0903 THE FACILITY – SPECIAL CARE SERVICES
In addition to meeting general requirements for facility
grounds in Rule .0401(a) of this Subchapter, an adult day care center or home
providing special care services shall assure that participants receiving this
service have access to an outside area. This area shall be secured or
supervised when participants have a physical or cognitive impairment and their
safety and well-being would otherwise be compromised.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Eff. July 17, 2000.
10A NCAC 06R .0904 ENROLLMENT – SPECIAL CARE SERVICES
In addition to meeting enrollment policies and procedures
requirements in Rule .0501(a) of this Subchapter, an adult day care center or
home shall assure the following requirements are met for participants who are
enrolled for special care services:
(1) Disclosure information shall be provided to an
individual or the responsible party of an individual seeking enrollment in a
center or home providing special care services. The disclosure information
shall be written and address policies and procedures listed in Rule .0902 of
this Subchapter.
(2) The participant’s medical examination report shall
specify a diagnosis, disability or condition consistent with the special care
service offered by the program.
(3) Any individual with a developmental disability being
considered for adult day services programming enrollment or discharge must
proceed through the Developmental Disabilities Single Portal of Entry and Exit
process pursuant to G.S. 122C-132.1 and 10A NCAC 29D .0200.
(4) A participant transferring from standard day care
services to special care services must meet the criteria for that special care
service. Family or responsible persons shall agree to the transfer decision.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Eff. July 17, 2000.
10A NCAC 06R .0905 INDIVIDUAL SERVICE PLANS – SPECIAL CARE
SERVICES
In addition to meeting individual service plan requirements
in Rule .0501(b) of this Subchapter, an adult day care center or home providing
special care services shall assure that the individual service plan is based on
the participant’s needs, interests and level of abilities. It shall specify
programming that involves environmental, social and health care strategies to
help the participant attain or maintain the maximum level of functioning
possible and compensate for lost abilities.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Eff. July 17, 2000.
10A NCAC 06R .0906 PROGRAM PLAN – SPECIAL CARE SERVICES
In addition to meeting program plan requirements in Rule
.0501(c) of this Subchapter, an adult day care center or home providing special
care services shall assure that the program plan provides for a balance of
activities that promote an optimum level of functioning in all activity areas
including personal care activities.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Eff. July 17, 2000.
10A NCAC 06R .0907 STAFF ORIENTATION AND TRAINING – SPECIAL
CARE SERVICES
An adult day care center or home providing special care
services shall assure that special care services staff receive at least the
following orientation and training:
(1) Prior to assuming responsibility for a special care
service, the program director shall document receipt of training specific to
the population(s) to be served.
(2) The program director shall have in place a written
plan for training staff that identifies content, sources, evaluations and
schedules of training. The plan shall be reviewed and updated annually.
(3) The program director shall assure that within a
month of employment, each staff person assigned to special care services shall
demonstrate knowledge of the needs, interests and levels of abilities of the
participants. This shall be documented in the center’s files.
(4) Within six months of employment, each staff person
assigned to special care service shall complete three training experiences.
The training shall include, but not be limited to, population specific
techniques for communication, behaviors and activities of daily living.
(5) Each staff person working directly with
participants in special care service shall complete a minimum of two population
specific educational or training experiences annually.
(6) All training experiences of each staff person shall
be documented in the center's files.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Eff. July 17, 2000.
10A NCAC 06R .0908 REQUIREMENTS FOR SPECIAL CARE SERVICES
UNIT
In addition to meeting all other special care services
requirements, an adult day care center with a special care services unit shall
assure the following:
(1) An area designated as a special care services unit
located within a center that also serves other participants, shall have the
unit providing special care separated by closed doors and located so that other
participants, visitors or staff do not have to pass through the section to reach
other areas of the building.
(2) A special care services unit separated by closed
doors from the rest of the adult day center shall meet equipment and furnishing
requirements as stated in Rule .0403(a)(1),(2),(3) and (b) of this Subchapter.
(3) At least one toilet shall be located in the unit.
(4) An area designated as a special care services unit
shall provide space on the unit for each participant as stated in Rule
.0401(d)(1) of this Subchapter.
(5) An area designated as a special care services unit
within an adult day center shall meet existing adult day care staffing ratio
requirements as stated in Rule .0305(c)(2) of this Subchapter.
History Note: Authority G.S. 131D-6; 143B-153; S.L.
1999-334;
Eff. July 17, 2000.
