subchapter 13G – licensing of family care homes
section .0100 - definitions
10A NCAC 13G .0101 DEFINITIONS
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984; June 26, 1980;
Repealed Eff. July 1, 2005.
SECTION .0200 - licensing
10A NCAC 13G .0201 DEFINITIONS
The following definitions shall apply throughout this
Section:
(1) "Person" means an individual; a trust or
estate; a partnership; a corporation; or any grouping of individuals, each of
whom owns five percent or more of a partnership or corporation, who
collectively own a majority interest of either a partnership or a corporation.
(2) "Owner" means any person who has or had
legal or equitable title to or a majority interest in an adult care home.
(3) "Affiliate" means any person that
directly or indirectly controls or did control an adult care home or any person
who is controlled by a person who controls or did control an adult care home.
In addition, two or more adult care homes who are under common control are
affiliates.
(4) "Principal" means any person who is or
was the owner or operator of an adult care home, an executive officer of a
corporation that does or did own or operate an adult care home, a general
partner of a partnership that does or did own or operate an adult care home, or
a sole proprietorship that does or did own or operate an adult care home.
(5) "Indirect control" means any situation
where one person is in a position to act through another person over whom the
first person has control due to the legal or economic relationship between the
two.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0113; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13G .0202 THE LICENSE
(a) Except as otherwise provided in Rule .0203 of this
Subchapter, the Department of Health and Human Services shall issue a family
care home license to any person who submits an application on the forms
provided by the Department with a non-refundable license fee as required by
G.S. 131D-2(b)(1) and the Department determines that the applicant complies
with the provisions of all applicable State family care home licensure statutes
and rules. All applications for a new license shall disclose the names of
individuals who are co-owners, partners or shareholders holding an ownership or
controlling interest of five percent or more of the applicant entity.
(b) The license shall be conspicuously posted in a public
place in the home.
(c) The license shall be in effect for 12 months from the
date of issuance unless revoked for cause, voluntarily or involuntarily
terminated, or changed to provisional licensure status.
(d) A provisional license may be issued in accordance with
G.S. 131D-2(b).
(e) When a provisional license is issued, the administrator
shall post the provisional license and a copy of the notice from the Division
of Health Service Regulation identifying the reasons for it, in place of the full
license.
(f) The license is not transferable or assignable.
(g) The license shall be terminated when the home is
licensed to provide a higher level of care or a combination of a higher level
of care and family care home level of care.
History Note: Authority G.S. 131D-2; 131D-4.5; 143B-165;
S.L. 1999-0113; 2002-0160; 2003-0284;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. January 1, 1998;
Amended Eff. April 1, 1999;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10a NCAC 13G .0203 PERSONS NOT ELIGIBLE FOR NEW ADULT CARE
HOME LICENSES
(a) A new license shall not be issued for an adult care
home if any of the conditions specified in G.S. 131D-2(b)(1b) apply to the
applicant for the adult care home license.
(b) Additionally, no new license shall be issued for any
adult care home to an applicant for licensure who is the owner, principal or
affiliate of an adult care home that has had its admissions suspended until six
months after the suspension is lifted.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0113; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13G .0204 APPLYING FOR A LICENSE TO OPERATE A HOME
NOT CURRENTLY LICENSED
(a) An application for a license to operate a family care
home for adults in an existing building where no alterations are necessary or a
home which is to be constructed, added to or renovated shall be made at the
county department of social services.
(b) If during the study of the administrator and the home,
it does not appear that the qualifications of the administrator or requirements
for the home can be met, the county department of social services shall so
inform the applicant, indicating in writing the reason and give the applicant
an opportunity to withdraw the application. Upon the applicant's request, the
application shall be completed and submitted to the Division of Health Service
Regulation for consideration.
(c) The applicant shall submit the following forms and
reports through the county department of social services to the Division of Health
Service Regulation:
(1) the Initial Licensure Application;
(2) an approval letter from the local zoning
jurisdiction for the proposed location;
(3) a photograph of each side of the existing
structure and at least one of each of the interior spaces if an existing
structure;
(4) a set of blueprints or a floor plan of each
level indicating the layout of all rooms, room dimensions (including closets),
door widths (exterior, bedroom, bathroom and kitchen doors), window sizes and
window sill heights, type of construction, the use of the basement and attic,
the proposed resident bedroom locations including the number of occupants and
the bedroom and number (including the ages) of any non-resident who will be
residing within the home;
(5) a cover letter or transmittal form prepared
by the adult home specialist of the county department of social services
identifying the prospective home site address, the name of the contact person
(including address, telephone numbers, fax numbers), the name and address of
the applicant (if different from the contact person) and the total number and
the expected evacuation capability of the residents; and
(6) a construction review fee according to G.S.
131E-267.
(d) The Construction Section of the Division of Health Service
Regulation shall review the information and notify the applicant and the county
department of social services of any required changes that must be made to the
building to meet the rules in Section .0300 of this Subchapter along with the
North Carolina State Building Code. At the end of the letter there shall be a
list of final documentation required from the local jurisdiction that must be
submitted upon completion of any required changes to the building or completion
of construction.
(e) Any changes to be made during construction that were not
proposed during the initial review shall require the approval of the
Construction Section to assure that licensing requirements are maintained.
(f) Upon receipt of the required final documentation from the
local jurisdiction, the Construction Section shall review the information and
may either make an on-site visit or approve the home for construction by
documentation. If all items are met, the Construction Section shall notify the
Adult Care Licensure Section of the Division of Health Service Regulation of
its recommendation for licensure.
(g) Following review of the application, references, all forms
and the Construction Section's recommendation for licensure, a pre-licensing
visit shall be made by a consultant of the Adult Care Licensure Section. The
consultant shall report findings and recommendations to the Division of Health
Service Regulation which shall notify, in writing, the applicant and the county
department of social services of the decision to license or not to license the
family care home .
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1987; April 1, 1984;
ARRC Objection Lodged November 14, 1990;
Amended Eff. May 1, 1991;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. July 1, 2005; July 1, 2004.
10A NCAC 13G .0205 APPLICATION TO LICENSE A NEWLY
CONSTRUCTED OR RENOVATED BUILDING
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004;
Repealed Eff. July 1, 2005.
10A NCAC 13G .0206 CAPACITY
(a) Pursuant to G.S. 131D-2(a)(5), family care homes have a
capacity of two to six residents.
(b) The total number of residents shall not exceed the
number shown on the license.
(c) A request for an increase in capacity by adding rooms,
remodeling or without any building modifications shall be made to the county
department of social services and submitted to the Division of Health Service
Regulation, accompanied by two copies of blueprints or floor plans. One plan
showing the existing building with the current use of rooms and the second plan
indicating the addition, remodeling or change in use of spaces showing the use
of each room. If new construction, plans shall show how the addition will be
tied into the existing building and all proposed changes in the structure.
(d) When licensed homes increase their designed capacity by
the addition to or remodeling of the existing physical plant, the entire home
shall meet all current fire safety regulations.
(e) The licensee or the licensee's designee shall notify
the Division of Health Service Regulation if the overall evacuation capability
of the residents changes from the evacuation capability listed on the homes
license or of the addition of any non-resident that will be residing within the
home. This information shall be submitted through the county department of
social services and forwarded to the Construction Section of the Division of Health
Service Regulation for review of any possible changes that may be required to
the building.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1984;
January 1, 1983.
10A NCAC 13G .0207 CHANGE OF LICENSEE
When a licensee wishes to sell or lease the family care home
business, the following procedure is required:
(1) The licensee shall notify the county department of
social services that a change is desired. When there is a plan for a change of
licensee and another person applies to operate the home immediately, the
licensee shall notify the county department and the residents or their
responsible persons. The county department shall talk with the residents,
giving them the opportunity to make other plans if they so desire.
(2) The county department of social services shall
submit all forms and reports specified in Rule .0204 (b) of this Subchapter to
the Division of Health Service Regulation.
(3) The Division of Health Service Regulation shall
review the records of the facility and may visit the home.
(4) The licensee and prospective licensee shall be
advised by the Division of Health Service Regulation of any changes which must
be made to the building before licensing to a new licensee can be recommended.
(5) Frame or brick veneer buildings over one story in
height with resident services and accommodations on the second floor shall not
be considered for re-licensure.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004.
10A NCAC 13G .0208 RENEWAL OF LICENSE
(a) The license shall be renewed annually, except as
otherwise provided in Rule .0209 of this Subchapter, if the licensee submits an
application for renewal on the forms provided by the Department and the
Department determines that the licensee complies with the provisions of all
applicable State adult care home licensure statutes and rules. When violations
of licensure rules or statutes are documented and have not been corrected prior
to expiration of license, the Department may approve a continuation or
extension of a plan of correction, or may issue a provisional license or revoke
the license for cause.
(b) All applications for license renewal shall disclose the
names of individuals who are co-owners, partners or shareholders holding an
ownership or controlling interest of 5% or more of the applicant entity.
History Note: Authority G.S. 131D‑2; 131D-4.5;
143B‑165; S.L. 1999-0334;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. December 1, 1992; July 1, 1990; April 1,
1987; April 1, 1984;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000.
10A NCAC 13G .0209 CONDITIONS FOR LICENSE RENEWAL
(a) Before renewing an existing license of an adult care
home, the Department shall conduct a compliance history review of the facility
and its principals and affiliates.
(b) In determining whether to renew a license under G.S.
131D-2(b)(6), the Department shall take into consideration at least the
following:
(1) the compliance history of the applicant
facility;
(2) the compliance history of the owners,
principals or affiliates in operating other adult care homes in the state;
(3) the extent to which the conduct of a
related facility is likely to affect the quality of care at the applicant
facility; and
(4) the hardship on residents of the applicant
facility if the license is not renewed.
(c) Pursuant to G.S. 131D-2(b)(1), an adult care home is
not eligible to have its license renewed if any outstanding fines or penalties
imposed by the Department have not been paid; provided, however that if an
appeal is pending the fine or penalty will not be considered imposed until the
appeal is resolved.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13G .0210 TERMINATION OF LICENSE
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1984;
Temporary Amendment Eff. January 1, 1998;
Amended Eff. April 1, 1999;
Repealed Eff. July 1, 2005.
10A NCAC 13G .0211 CLOSING OF HOME
If a licensee plans to close a family care home, the licensee
shall provide written notification of the planned closing to the Division of Health
Service Regulation, the county department of social services and the residents
or their responsible persons at least 30 days prior to the planned closing.
Written notification shall include date of closing and plans made for the move
of the residents.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004.
10A NCAC 13G .0212 DENIAL AND REVOCATION OF LICENSE
(a) A license may be denied by the Division of Health
Service Regulation for failure to comply with the rules of this Subchapter.
(b) Denial by the Division of Health Service Regulation
shall be effected by mailing to the applicant, by registered mail, a notice
setting forth the particular reasons for such action.
(c) A license may be revoked by the Division of Health
Service Regulation in accordance with G.S. 131D-2(b) and G.S. 131D-29.
(d) When a facility receives a notice of revocation, the
administrator shall inform each resident and his responsible person of the
notice and the basis on which it was issued.
History Note: Authority G.S. 131D‑2;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984; May 1, 1981;
Temporary Amendment Eff. January 1, 1998;
Amended Eff. April 1, 1999.
10A NCAC 13G .0213 APPEAL of licensure action
(a) In accordance with G.S. 150B‑2(2), any person may
request a determination of his legal rights, privileges, or duties as they
relate to laws or rules administered by the Department of Human Resources. All
requests must be in writing and contain a statement of facts prompting the
request sufficient to allow for appropriate processing by the Department of
Health and Human Services.
(b) Any person seeking such a determination shall comply
with G.S. 150B‑22 concerning informal remedies.
(c) All petitions for hearings regarding matters under the
control of the Department of Health and Human Services shall be filed with the
Office of Administrative Hearings in accordance with G.S. 150B‑23 and 26
NCAC 03 .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 at 2005 Mail Service Center, Raleigh, North Carolina 27699-2005.
(d) An administrator of a facility which has its license
revoked may not apply to operate another facility except according to the terms
set forth by the Director of the Division of Health Service Regulation in his
final closure notice.
History Note: Authority G.S. 131D‑2; 143B‑153;
150B‑23;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1984.
10A NCAC 13G .0214 suspension of admissions
(a) Either the Secretary or his designee shall notify the
domiciliary home by certified mail of the decision to suspend admissions. Such
notice will include:
(1) the period of the suspension,
(2) factual allegations,
(3) citation of statutes and rules alleged to
be violated,
(4) notice of the facility's right to contested
case hearing or the suspension.
(b) The suspension will be effective when the notice is
served or on the date specified in the notice of suspension, whichever is
later. The suspension will remain effective for the period specified in the
notice or until the facility demonstrates to the Secretary or his designee that
conditions are no longer detrimental to the health and safety of the residents.
(c) The home shall not admit new residents during the
effective date of the suspension.
(d) Any action taken by the Division of Health Service
Regulation to revoke a home's license or to reduce the license to a provisional
license shall be accompanied by a recommendation to the Secretary or his
designee to suspend new admissions. A suspension may be ordered without the
license being affected.
History Note: Authority G.S. 130‑9.7(e);
Eff. January 1, 1982;
Amended Eff. July 1, 1990.
10A NCAC 13G .0215 APPEAL of suspension of admissions
A home may appeal the decision of the Secretary or his
designee to suspend new admissions by making such an appeal in accordance with
10A NCAC 01A .0200.
History Note: Authority G.S. 131D‑2(h);
Eff. January 1, 1982;
Amended Eff. January 4, 1994.
10A NCAC 13G .0216 ADMINISTRATIVE PENALTY DETERMINATION
PROCESS
(a) The county department of social services or the
Division of Health Service Regulation shall identify areas of non-compliance
resulting from a complaint investigation or monitoring or survey visit which
may be violations of residents' rights contained in G.S. 131D-21 or rules
contained in this Subchapter. If the county department of social services or
the Division of Health Service Regulation decides that the violation is a Type
B violation as defined in G.S. 131D-34(a)(2), it shall require a plan of
correction pursuant to G.S. 131D-34(a)(2). If the county department of social
services or the Division of Health Service Regulation decides that the
violation is a Type A violation as defined in G.S. 131D-34(a)(1), it shall
follow the procedure required in G.S. 131D-34(a)(1)(a-c) and prepare an
administrative penalty proposal for submission to the Department. The proposal
shall include a copy of the written confirmation required in G.S. 131D-34(a)(1)(c)
and documentation that the licensee was notified of the county department of
social services' or the Division of Health Service Regulation's intent to
prepare and forward an administrative penalty proposal to the Department;
offered an opportunity to provide additional information prior to the
preparation of the proposal; after the proposal is prepared, given a copy of
the contents of the proposal; and then extended an opportunity to request a
conference with the agency proposing the administrative penalty, allowing the
licensee 10 days to respond prior to forwarding the proposal to the
Department. The conference, if requested of the county department of social
services, shall include the county department director or his designee. The
licensee may request a conference and produce information to cause the agency
recommending the administrative penalty to change its proposal. The agency
recommending the administrative penalty may rescind its proposal; or change its
proposal and submit it to the Department or submit it unchanged to the
Department pursuant to G.S. 131D-34(c2).
(b) An assistant chief of the Adult Care Licensure Section
shall receive the proposal, review it for completeness and evaluate it to
determine the penalty amount.
(1) If the proposal is complete, the assistant
chief shall make a decision on the amount of penalty to be submitted for
consideration and whether to recommend training in lieu of an administrative
penalty pursuant to G.S. 131D-34(g1).
(2) If the proposal is incomplete, the
assistant chief shall contact the agency that submitted the proposal to request
necessary changes or additional material.
(3) When the proposal is complete and the
amount of penalty determined, the assistant chief shall forward the proposal to
the administrative penalty monitor for processing. If the assistant chief
recommends training in lieu of an administrative penalty pursuant to G.S.
131D-34(g1), the recommendation shall be forwarded with the proposal.
(c) The Department shall notify the licensee by certified
mail within 10 working days from the time the proposal is received by the
administrative penalty monitor that an administrative penalty is being
considered.
(d) The licensee shall have 10 working days from receipt of
the notification to provide both the Department and the county department of
social services any additional information relating to the proposed
administrative penalty.
(e) If a facility fails to correct a Type A or a Type B
violation within the time specified on the plan of correction, an assistant
chief of the Adult Care Licensure Section shall make a decision on the amount
of penalty pursuant to G.S. 131D-34(b)(1) and (2) and submit a penalty proposal
for consideration by the Penalty Review Committee.
(f) The Penalty Review Committee shall consider Type A
violations and Type A and Type B violations that have not been corrected within
the time frame specified on the plan of correction. Providers, complainants,
affected parties and any member of the public may attend Penalty Review
Committee meetings. Upon written request of any affected party for reasons of
illness or schedule conflict, the department may grant a delay until the
following month for Penalty Review Committee review. The Penalty Review
Committee chair may ask questions of any of these persons, as resources, during
the meeting. Time shall be allowed during the meeting for individual
presentations which provide pertinent additional information. The order in
which presenters speak and the length of each presentation shall be at the
discretion of the Penalty Review Committee chair.
(g) The Penalty Review Committee shall have for review the
entire record relating to the penalty recommendation shall make recommendations
after review of administrative penalty proposals, any supporting evidence, any
additional information submitted by the licensee as described in Paragraph (d)
and the factors specified in G.S. 131D-34(c).
(h) There shall be no taking of sworn testimony or
cross-examination of anyone during the course of the Penalty Review Committee
meetings.
(i) If the Penalty Review Committee determines that the
licensee has violated applicable rules or statutes, the Penalty Review
Committee shall recommend an administrative penalty for each violation pursuant
to G.S. 131D-34. Recommendations for adult care home penalties shall be
submitted to the Chief of the Adult Care Licensure Section who shall have five
working days from the date of the Penalty Review Committee meeting to determine
and impose administrative penalties for each violation or require staff
training pursuant to G.S. 131D-34(g1) and notify the licensee by certified
mail.
(j) The licensee shall have 60 days from receipt of the
notification to pay the penalty or must file a petition for a contested case
with the Office of Administrative Hearings within 30 days of the mailing of the
notice of penalty imposition as provided by G.S. 131D-34.
History Note: Authority G.S. 131D‑2; 131D‑34;
143B‑153;
Eff. December 1, 1992;
Amended Eff. March 1, 1995; December 1, 1993;
Temporary Amendment Eff. December 8, 1997;
Amended Eff. April 1, 1999.
SECTION .0300 ‑ THE building
10A NCAC 13G .0301 APPLICATION OF PHYSICAL PLANT
REQUIREMENTS
The physical plant requirements for each family care home
shall be applied as follows:
(1) New construction and existing buildings proposed
for use as a Family Care Home shall comply with the requirements of this
Section;
(2) Except where otherwise specified, existing licensed
homes or portions of existing licensed homes shall meet licensure and code
requirements in effect at the time of construction, change in service or bed
count, addition, renovation or alteration; however, in no case shall the
requirements for any licensed home, where no addition or renovation has been
made, be less than those requirements found in the 1971 "Minimum and
Desired Standards and Regulations" for "Family Care Homes",
copies of which are available at the Division of Health Service Regulation, 701
Barbour Drive, Raleigh, North Carolina 27603 at no cost;
(3) New additions, alterations, modifications and
repairs shall meet the requirements of this Section;
(4) Rules contained in this Section are minimum
requirements and are not intended to prohibit buildings, systems or operational
conditions that exceed minimum requirements;
(5) Equivalency: Alternate methods, procedures, design
criteria and functional variations from the physical plant requirements shall
be approved by the Division when the home can effectively demonstrate to the
Division's satisfaction, that the intent of the physical plant requirements are
met and that the variation does not reduce the safety or operational
effectiveness of the home; and
(6) Where rules, codes or standards have any conflict,
the most stringent requirement shall apply.
History Note: Authority G.S. 131D-2; 143B –165;
Eff. July 1, 2005.
10A NCAC 13G .0302 DESIGN AND CONSTRUCTION
(a) Any building licensed for the first time as a family
care home shall meet the applicable requirements of the North Carolina State
Building Code. All new construction, additions and renovations to existing
buildings shall meet the requirements of the North Carolina State Building Code
for One and Two Family Dwellings and Residential Care Facilities if
applicable. All applicable volumes of The North Carolina State Building Code,
which is incorporated by reference, including all subsequent amendments, may be
purchased from the Department of Insurance Engineering Division located at 322 Chapanoke Road, Suite 200, Raleigh, North Carolina 27603 at a cost of three hundred
eighty dollars ($380.00).
(b) Each home shall be planned, constructed, equipped and
maintained to provide the services offered in the home.
(c) Any existing building converted from another use to a
family care home shall meet all the requirements of a new facility.
(d) Any existing licensed home when the license is
terminated for more than 60 days shall meet all requirements of a new home
prior to being relicensed.
(e) Any existing licensed home that plans to have new
construction, remodeling or physical changes done to the facility shall have
drawings submitted by the owner or his appointed representative to the Division
of Health Service Regulation for review and approval prior to commencement of
the work.
(f) If the building is two stories in height, it shall meet
the following requirements:
(1) Each floor shall be less than 2500 square
feet in area if existing construction or, if new construction, shall not exceed
the allowable area for R-4 occupancy in the North Carolina State Building Code;
(2) Aged or disabled persons are not to be
housed on any floor above or below grade level;
(3) Required resident facilities are not to be
located on any floor above or below grade level; and
(4) A complete fire alarm system with pull
stations on each floor and sounding devices which are audible throughout the
building shall be provided. The fire alarm system shall be able to transmit an
automatic signal to the local emergency fire department dispatch center, either
directly or through a central station monitoring company connection.
(g) The basement and the attic shall not to be used for storage
or sleeping.
(h) The ceiling shall be at least seven and one-half feet
from the floor.
(i) In homes licensed on or after April 1, 1984, all
required resident areas shall be on the same floor level. Steps between levels
are not permitted.
(j) The door width shall be a minimum of two feet and six
inches in the kitchen, dining room, living rooms, bedrooms and bathrooms.
(k) All windows shall be maintained operable.
(l) The local code enforcement official shall be consulted
before starting any construction or renovations for information on required
permits and construction requirements.
(m) The building shall meet sanitation requirements as
determined by the North Carolina Department of Environment and Natural
Resources; Division of Environmental Health.
(n) The home shall have current sanitation and fire and
building safety inspection reports which shall be maintained in the home and
available for review.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1984; January 1,
1983;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004.
10A NCAC 13G .0303 LOCATION
(a) A family care home shall be in a location approved by
local zoning boards.
(b) The home shall be located so that hazards to the
occupants are minimized.
(c) The site of the home shall:
(1) be accessible by streets, roads and
highways and be maintained for motor vehicles and emergency vehicle access;
(2) be accessible to fire fighting and other
emergency services;
(3) have a water supply, sewage disposal
system, garbage disposal system and trash disposal system approved by the local
health department having jurisdiction;
(4) meet all local ordinances; and
(5) be free from exposure to pollutants known
to the applicant or licensee.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1984;
Recodified from 10A NCAC 13G .0301 Eff. July 1, 2005.
10A NCAC 13G .0304 LIVING ARRANGEMENT
A family care home shall provide living arrangements to meet
the individual needs of the residents, the live-in staff and other live-in
persons.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984;
Recodified from 10A NCAC 13G .0303 Eff. July 1, 2005.
10A NCAC 13G .0305 LIVING ROOM
(a) Family care homes licensed on or after April 1, 1984
shall have a living room area of at least 200 square feet.
(b) All living rooms shall have operable windows to meet
the North Carolina State Building Code and be lighted to provide 30 foot
candles of light at floor level.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1984;
Recodified from 10A NCAC 13G .0304 Eff. July 1, 2005.
10A NCAC 13G .0306 DINING ROOM
(a) Family care homes licensed on or after April 1, 1984
shall have a dining room or area of at least 120 square feet. The dining room
may be used for other activities during the day.
(b) When the dining area is used in combination with a
kitchen, an area five feet wide shall be allowed as work space in front of the
kitchen work areas. The work space shall not be used as the dining area.
(c) The dining room shall have operable windows and be
lighted to provide 30 foot candles of light at floor level.
History Note: Authority G.S. 131D-2; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1984;
Recodified from 10A NCAC 13G .0305 Eff. July 1, 2005.
10A NCAC 13G .0307 KITCHEN
(a) The kitchen in a family care home shall be large enough
to provide for the preparation and preservation of food and the washing of
dishes.
(b) The cooking unit shall be mechanically ventilated to
the outside or be an unvented, recirculating fan provided with any special
filter per manufacturers' instructions for ventless use.
(c) The kitchen floor shall have a non-slippery water-resistant
covering.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Amended Eff. April 22, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984;
Recodified from 10A NCAC 13G .0306 Eff. July 1, 2005.
10A NCAC 13G .0308 BEDROOMS
(a) There shall be bedrooms sufficient in number and size
to meet the individual needs according to age and sex of the residents, the
administrator or supervisor-in-charge, other live-in staff and any other
persons living in a family care home. Residents are not to share bedrooms with
staff or other live-in non-residents.
(b) Only rooms authorized by the Division of Health Service
Regulation as bedrooms shall be used for bedrooms.
(c) A room where access is through a bathroom, kitchen or
another bedroom shall not be approved for a resident's bedroom.
(d) There shall be a minimum area of 100 square feet,
excluding vestibule, closet or wardrobe space, in rooms occupied by one person
and a minimum area of 80 square feet per bed, excluding vestibule, closet or
wardrobe space, in rooms occupied by two persons.
(e) The total number of residents assigned to a bedroom
shall not exceed the number authorized by the Division of Health Service Regulation
for that particular bedroom.
(f) A bedroom shall not be occupied by more than two
residents.
(g) Each resident bedroom must have one or more operable
windows and be lighted to provide 30 foot candles of light at floor level. The
window area shall be equivalent to at least eight percent of the floor space.
The windows shall have a maximum of 44 inch sill height.
(h) Bedroom closets or wardrobes shall be large enough to
provide each resident with a minimum of 48 cubic feet of clothing storage space
(approximately two feet deep by three feet wide by eight feet high) of which at
least one-half shall be for hanging clothes with an adjustable height hanging
bar.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1984;
Recodified from 10A NCAC 13G .0307 Eff. July 1, 2005.
10A NCAC 13G .0309 BATHROOM
(a) Adult care homes licensed on or after April 1, 1984,
shall have one full bathroom for each five or fewer persons including live-in
staff and family.
(b) The bathrooms shall be designed to provide privacy. A
bathroom with two or more water closets (commodes) shall have privacy
partitions or curtains for each water closet. Each tub or shower shall have
privacy partitions or curtains.
(c) Entrance to the bathroom shall not be through a kitchen,
another person's bedroom, or another bathroom.
(d) The required residents' bathrooms shall be located so
that there is no more than 40 feet from any residents' bedroom door to a
resident use bathroom door.
(e) Hand grips shall be installed at all commodes, tubs and
showers used by the residents.
(f) Nonskid surfacing or strips must be installed in
showers and bath areas.
(g) The bathrooms shall be lighted to provide 30 foot
candles of light at floor level and have mechanical ventilation at the rate of
two cubic feet per minute for each square foot of floor area. These vents
shall be vented directly to the outdoors.
(h) The bathroom floor shall have a non-slippery water-resistant
covering.
History Note: Authority G.S. 131D-2; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1984;
Recodified from 10A NCAC 13G .0308 Eff. July 1, 2005.
10A ncac 13G .0310 STORAGE AREAS
(a) Storage areas shall be adequate in size and number for
separate storage of clean linens, soiled linens, food and food service
supplies, and household supplies and equipment.
(b) There shall be separate locked areas for storing
cleaning agents, bleaches, pesticides, and other substances which may be
hazardous if ingested, inhaled or handled. Cleaning supplies shall be
supervised while in use.
History Note: Authority G.S. 131D‑2; 131D-4.5;
143B‑165; S.L. 1999-0334;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1987; April 1, 1984;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Recodified from 10A NCAC 13G .0309 Eff. July 1, 2005.
10A NCAC 13G .0311 CORRIDOR
(a) Corridors shall be a minimum clear width of three feet
in family care homes.
(b) Corridors shall be lighted with night lights providing
1 foot-candle power at the floor.
(c) Corridors shall be free of all equipment and other
obstructions.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984;
Recodified from 10A NCAC 13G .0310 Eff. July 1, 2005.
10A NCAC 13G .0312 OUTSIDE ENTRANCE AND EXITS
(a) In family care homes, all floor levels shall have at
least two exits. If there are only two, the exit or exit access doors shall be
so located and constructed to minimize the possibility that both may be blocked
by any one fire or other emergency condition.
(b) At least one entrance/exit door shall be a minimum
width of three feet and another shall be a minimum width of two feet and eight
inches.
(c) At least one principal outside entrance/exit for the residents'
use shall be at grade level or accessible by ramp with a one inch rise for each
12 inches of length of the ramp. For the purposes of this Rule, a principal
outside entrance/exit is one that is most often used by residents for vehicular
access. If the home has any resident that must have physical assistance with
evacuation, the home shall have two outside entrances/exits at grade level or
accessible by a ramp.
(d) All exit door locks shall be easily operable, by a
single hand motion, from the inside at all times without keys. Existing
deadbolts or turn buttons on the inside of exit doors shall be removed or
disabled.
(e) All entrances/exits shall be free of all obstructions
or impediments to allow for full instant use in case of fire or other
emergency.
(f) All steps, porches, stoops and ramps shall be provided
with handrails and guardrails.
(g) In homes with at least one resident who is determined
by a physician or is otherwise known to be disoriented or a wanderer, each exit
door for resident use shall be equipped with a sounding device that is
activated when the door is opened. The sound shall be of sufficient volume
that it can be heard by staff. If a central system of remote sounding devices
is provided, the control panel for the system shall be located in the bedroom
of the person on call, the office area or in a location accessible only to
staff authorized by the administrator to operate the control panel.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1987; July 1, 1984;
April 1, 1984;
Recodified from 10A NCAC 13G .0311 Eff. July 1, 2005.
10A NCAC 13G .0313 LAUNDRY ROOM
The laundry equipment in a family care home shall be located
out of the living, dining, and bedroom areas.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984;
Recodified from 10A NCAC 13G .0312 Eff. July 1, 2005.
10A NCAC 13G .0314 FLOORS
(a) All floors in a family care home shall be of smooth,
non-skid material and so constructed as to be easily cleanable.
(b) Scatter or throw rugs shall not be used.
(c) All floors shall be kept in good repair.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984;
Recodified from 10A NCAC 13G .0313 Eff. July 1, 2005.
10A NCAC 13G .0315 HOUSEKEEPING AND FURNISHINGS
(a) Each family care home shall:
(1) have walls, ceilings, and floors or floor
coverings kept clean and in good repair;
(2) have no chronic unpleasant odors;
(3) have furniture clean and in good repair;
(4) have a North Carolina Division of
Environmental Health approved sanitation classification at all times;
(5) be maintained in an uncluttered, clean and
orderly manner, free of all obstructions and hazards;
(6) have supply of bath soap, clean towels,
washcloths, sheets, pillow cases, blankets, and additional coverings adequate
for resident use on hand at all times;
(7) make available the following items as
needed through any means other than charge to the personal funds of recipients
of State‑County Special Assistance:
(A) protective sheets and clean, absorbent, soft and
smooth pads;
(B) bedpans, urinals, hot water bottles, and ice caps;
and
(C) bedside commodes, walkers, and wheelchairs;
(8) have television and radio, each in good
working order;
(9) have curtains, draperies or blinds at
windows in resident use areas to provide for resident privacy;
(10) have recreational equipment, supplies for
games, books, magazines and a current newspaper available for residents;
(11) have a clock that has numbers at least 1½
inches tall in an area commonly used by the residents; and
(12) have at least one telephone that does not
depend on electricity or cellular service to operate.
(b) Each bedroom shall have the following furnishings in
good repair and clean for each resident:
(1) A bed equipped with box springs and
mattress or solid link springs and no‑sag innerspring or foam mattress.
Hospital bed appropriately equipped shall be arranged for as needed. A water
bed is allowed if requested by a resident and permitted by the home. Each bed
is to have the following:
(A) at least one pillow with clean pillow case;
(B) clean top and bottom sheets on the bed, with bed
changed as often as necessary but at least once a week; and
(C) clean bedspread and other clean coverings as
needed;
(2) a bedside type table;
(3) chest of drawers or bureau when not
provided as built‑ins, or a double chest of drawers or double dresser for
two residents;
(4) a wall or dresser mirror that can be used
by each resident;
(5) a minimum of one comfortable chair (rocker
or straight, arm or without arms, as preferred by resident), high enough from
floor for easy rising;
(6) additional chairs available, as needed, for
use by visitors;
(7) individual clean towel, wash cloth, and
towel bar within bedroom or adjoining bathroom; and
(8) a light overhead of bed with a switch
within reach of person lying on bed; or a lamp. The light shall provide a
minimum of 30 foot‑candle power of illumination for reading.
(c) The living room shall have functional living room
furnishings for the comfort of aged and disabled persons, with coverings that
are easily cleanable.
(d) The dining room shall have the following furnishings:
(1) tables and chairs to seat all residents
eating in the dining room; and
(2) chairs that are sturdy, non‑folding,
without rollers unless retractable or on front legs only, and designed to
minimize tilting.
(e) This Rule shall apply to new and existing homes.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; September 1, 1987; April 1,
1987; April 1, 1984;
Recodified from 10A NCAC 13G .0314 Eff. July 1, 2005.
10A NCAC 13G .0316 FIRE SAFETY and Disaster Plan
(a) Fire extinguishers shall be provided which meet these
minimum requirements in a family care home:
(1) one five pound or larger (net charge)
"A‑B‑C" type centrally located;
(2) one five pound or larger "A‑B‑C"
or CO/2 type located in the kitchen; and
(3) any other location as determined by the
code enforcement official.
(b) The building shall be provided with smoke detectors as
required by the North Carolina State Building Code and U.L. listed heat detectors
connected to a dedicated sounding device located in the attic and basement.
These detectors shall be interconnected and be provided with battery backup.
(c) Any fire safety requirements required by city
ordinances or county building inspectors shall be met.
(d) A written fire evacuation plan (including a diagrammed
drawing) which has the approval of the local code enforcement official shall be
prepared in large print and posted in a central location on each floor. The
plan shall be reviewed with each resident on admission and shall be a part of
the orientation for all new staff.
(e) There shall be at least four rehearsals of the fire
evacuation plan each year. Records of rehearsals shall be maintained and
copies furnished to the county department of social services annually. The
records shall include the date and time of the rehearsals, staff members
present, and a short description of what the rehearsal involved.
(f) A written disaster plan which has the written approval
of, or has been documented as submitted to, the local emergency management
agency and the local agency designated to coordinate special needs sheltering
during disasters, shall be prepared and updated at least annually and shall be
maintained in the home. This written disaster plan requirement shall apply to
new and existing homes.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Amended Eff. April 22, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1987;
April 1, 1984;
Recodified from 10A NCAC 13G .0315 Eff. July 1, 2005.
10A NCAC 13G .0317 BUILDING SERVICE EQUIPMENT
(a) The building and all fire safety, electrical,
mechanical, and plumbing equipment in a family care home shall be maintained in
a safe and operating condition.
(b) There shall be a central heating system sufficient to
maintain 75 degrees F (24 degrees C) under winter design conditions. Built-in
electric heaters, if used, shall be installed or protected so as to avoid
hazards to residents and room furnishings. Unvented fuel burning room heaters
and portable electric heaters are prohibited.
(c) Air conditioning or at least one fan per resident
bedroom and living and dining areas shall be provided when the temperature in
the main center corridor exceeds 80 degrees F (26.7 degrees C).
(d) The hot water tank shall be of such size to provide an
adequate supply of hot water to the kitchen, bathrooms, and laundry. The hot
water temperature at all fixtures used by residents shall be maintained at a
minimum of 100 degrees F (38 degrees C) and shall not exceed 116 degrees F
(46.7 degrees C).
(e) All resident areas shall be well lighted for the safety
and comfort of the residents. The minimum lighting required is:
(1) 30 foot‑candle power for reading;
(2) 10 foot‑candle power for general
lighting; and
(3) 1 foot‑candle power at the floor for
corridors at night.
(f) Where the bedroom of the live‑in staff is located
in a separate area from residents' bedrooms, an electrically operated call
system shall be provided connecting each resident bedroom to the live‑in
staff bedroom. The resident call system activator shall be such that it can be
activated with a single action and remain on until deactivated by staff. The
call system activator shall be within reach of resident lying on his bed.
(g) Fireplaces, fireplace inserts and wood stoves shall be
designed or installed so as to avoid a burn hazard to residents. Fireplace
inserts and wood stoves must be U.L. listed.
(h) Gas logs may be installed if they are of the vented
type, installed according to the manufacturers' installation instructions,
approved through the local building department and protected by a guard or
screen to prevent residents and furnishings from burns.
(i) Alternate methods, procedures, design criteria and
functional variations from the requirements of this Rule or other rules in this
Section because of extraordinary circumstances, new programs or unusual
conditions, shall be approved by the Division when the facility can effectively
demonstrate to the Division's satisfaction that the intent of the requirements
are met and that the variation does not reduce the safety or operational
effectiveness of the facility.
(j) This Rule shall apply to new and existing family care
homes.
History Note: Authority G.S. 131D‑2; 143B‑165;
S.L. 1999-0334;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984; July 1, 1982;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2005; July 1, 2000;
Recodified from 10A NCAC 13G .0316 Eff. July 1, 2005.
10A NCAC 13G .0318 OUTSIDE PREMISES
(a) The outside grounds of new and existing family care
homes shall be maintained in a clean and safe condition.
(b) If the home has a fence around the premises, the fence
shall not prevent residents from exiting or entering freely or be hazardous.
(c) Outdoor stairways and ramps shall be illuminated by no
less than five foot candles of light at grade level.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. April 1, 1984;
Amended Eff. July 1, 2005; July 1, 1990;
Recodified from 10A NCAC 13G .0317 Eff. July 1, 2005.
SECTION .0400 – staff qualifications
10A NCAC 13G .0401 QUALIFICATIONS OF ADMINISTRATOR
The administrator must meet certain requirements before and
after being approved to manage a licensed home. The administrator is
responsible for the home, including the development and management of services
and accommodations and the hiring and training of qualified staff so that the
home meets the rules of this Subchapter even in his absence. All of the
following requirements must be met:
(1) The potential administrator must apply on the
License Application (DSS‑1860). The Recommendation for a License (DSS‑1861)
is to be completed by the county department of social services and forwarded
along with references and other appropriate forms to the Division of Health Service
Regulation for approval or disapproval;
(2) The administrator must be 18 years of age or older;
(3) The administrator must be willing to work with bona
fide inspectors and the monitoring and licensing agencies toward meeting and
maintaining the rules of this Subchapter and other legal requirements,
including those of the Civil Rights Act of 1964 when the administrator has
signed Form DSS‑1464;
(4) The administrator, or a person designated in
writing by the administrator to act as his agent and make decisions on his
behalf, must meet with the Adult Homes Specialist at the Specialist's request
at an agreed time in the home as often as necessary to insure compliance with
the standards;
(5) The administrator must meet the general health
requirements specified in Rule .0405 of this Subchapter;
(6) The administrator must provide at least three
current reference letters or the names of individuals with whom a reference
interview can be conducted. The individuals providing reference information
must be knowledgeable of the applicant administrator's background and
qualifications and must include at least one former employer.
(7) The administrator must provide written
documentation about convictions of criminal offenses from the clerk of court in
the county in which the conviction was made, and about any driving offenses
other than minor traffic violations from the motor vehicles office;
(8) The administrator must meet the requirements of
either (a) or (b) of this Paragraph in accordance with procedures established
by the Department of Health and Human Services:
(a) The administrator must verify that he has
worked in a licensed domiciliary facility for at least 30 days in an on‑the‑job
training program approved by the Department of Health and Human Services; or
(b) The administrator must verify that he has
past education, training and experience related to the management and operation
of adult residential care facilities;
(9) The administrator must verify that he earns 15
hours a year of continuing education credits related to the management of
domiciliary homes and care of aged and disabled persons in accordance with
procedures established by the Department of Health and Human Services. The
requirement for earning continuing education credits does not apply in those
situations where the administrator is also a currently licensed nursing home
administrator;
(10) Persons applying for approval to be an administrator
must demonstrate an adequate working knowledge of the rules of this Subchapter
by passing a written examination in accordance with procedures established by
the Department of Health and Human Services;
(11) The administrator (approved on or after August 1,
1991) must be at least a high school graduate or certified under the GED
Program.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; September 1, 1987; April 1,
1987; April 1, 1984;
ARRC Objection Lodged January 18, 1991;
Amended Eff. August 1, 1991.
10A NCAC 13G .0402 QUALIFICATIONS OF SUPERVISOR‑IN‑CHARGE
The supervisor‑in‑charge is responsible to the
administrator for carrying out the program in the home in the absence of the
administrator. All of the following requirements must be met:
(1) The applicant must complete the Application for
Supervisor‑in‑Charge (DSS‑1862);
(2) The qualifications of the administrator and co‑administrator
referenced in Paragraphs (2), (5), (6), and (7) of Rule .0401 of this
Subchapter shall apply to the supervisor‑in‑charge. The supervisor‑in‑charge
(employed on or after August 1, 1991) must meet a minimum educational
requirement by being at least a high school graduate or certified under the GED
Program or by passing an alternative examination established by the Department
of Health and Human Services. Documentation that these qualifications have
been met must be on file in the home prior to employing the supervisor‑in‑charge;
(3) The supervisor‑in‑charge must be
willing to work with bonafide inspectors and the monitoring and licensing
agencies toward meeting and maintaining the rules of this Subchapter and other
legal requirements;
(4) The supervisor‑in‑charge must verify
that he earns 12 hours a year of continuing education credits related to the
management of domiciliary homes and care of aged and disabled persons in
accordance with procedures established by the Department of Health and Human
Services;
(5) When there is a break in employment as a supervisor‑in‑charge
of one year or less, the educational qualification under which the person was
last employed will apply.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
ARRC Objection June 16, 1988;
Amended Eff. July 1, 1990; December 1, 1988; April 1,
1987; January 1, 1985;
ARRC Objection Lodged January 18, 1991;
Amended Eff. August 1, 1991.
10A NCAC 13g .0403 QUALIFICATIONS OF MEDICATION STAFF
(a) Family care home staff who administer medications,
hereafter referred to as medication aides, and staff who directly supervise the
administration of medications shall have documentation of successfully
completing the clinical skills validation portion of the competency evaluation
according to Paragraphs (d) and (e) of Rule .0503 of this Subchapter prior to
the administration or supervision of the administration of medications.
Persons authorized by state occupational licensure laws to administer
medications are exempt from this requirement.
(b) Medication aides and their direct supervisors, except
persons authorized by state occupational licensure laws to administer
medications, shall successfully pass the written examination within 90 days
after successful completion of the clinical skills validation portion of a
competency evaluation according to Rule .0503 of this Subchapter.
(c) Medication aides and staff who directly supervise the
administration of medications, except persons authorized by state occupational
licensure laws to administer medications, shall complete six hours of
continuing education annually related to medication administration.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334; 2002-0160; 2003-0284;
Temporary Adoption Eff. January 1, 2000; December 1,
1999;
Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13G .0404 QUALIFICATIONS OF ACTIVITY DIRECTOR
There shall be a designated family care home activity
director who meets the following qualifications: qualifications set forth in
this Rule.
(1) The activity director (employed on or after
August 1, 1991) shall meet a minimum educational requirement by being at least
a high school graduate or certified under the GED Program or by passing an
alternative examination established by the Department of Health & Human Services.
(2) The activity director hired on or after
July 1, 2005 shall have completed or complete, within nine months of employment
or assignment to this position, the basic activity course for assisted living
activity directors offered by community colleges or a comparable activity
course as determined by the Department based on instructional hours and
content. A person with a degree in recreation administration or therapeutic
recreation or who is state or nationally certified as a Therapeutic Recreation
Specialist or certified by the National Certification Council for Activity
Professional meets this requirement as does a person who completed the activity
coordinator course of 48 hours or more through a community college before July
1, 2005.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
2002-0160; 2003-0284;
Eff. April 1, 1984;
Amended Eff. July 1, 1990; April 1, 1987; January 1,
1985;
ARRC Objection Lodged March 18, 1991;
Amended Eff. August 1, 1991;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13G .0405 TEST FOR TUBERCULOSIS
(a) Upon employment or living in a family care home, the
administrator, all other staff and any live‑in non‑residents shall
be tested for tuberculosis disease in compliance with control measures adopted
by the Commission for Public Health as specified in 10A NCAC 41A .0205
including subsequent amendments and editions. Copies of the rule are available
at no charge by contacting the Department of Health and Human Services.
Tuberculosis Control Program, 1902 Mail Service Center, Raleigh, NC 27699-1902.
(b) There shall be documentation on file in the home that
the administrator, all other staff and any live-in non-residents are free of
tuberculosis disease that poses a direct threat to the health or safety of
others.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160;
Eff. January 1, 1977;
Amended Eff. October 1, 1977; April 22, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. December 1, 1993; April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004.
10A NCAC 13G .0406 OTHER Staff Qualifications
(a) Each staff person of a family care home shall:
(1) have a job description that reflects actual
duties and responsibilities and is signed by the administrator and the employee;
(2) be able to apply all of the home's
accident, fire safety and emergency procedures for the protection of the residents;
(3) be informed of the confidential nature of resident
information and shall protect and preserve such information from unauthorized
use and disclosure;
Note: G.S. 131D‑2(b)(4), G.S. 131D‑21(6),
and G.S. 131D‑21.1 govern the disclosure of such information;
(4) not hinder or interfere with the exercise
of the rights guaranteed under the Declaration of Residents' Rights in G.S.
131D-21;
(5) have no substantiated findings listed on
the North Carolina Health Care Personnel Registry according to G.S. 131E-256;
(6) have documented annual immunization against
influenza virus according to G.S. 131D-9, except as documented otherwise
according to exceptions in this law.
(7) have a criminal background check in
accordance with G.S. 114-19.10 and G.S. 131D-40;
(8) maintain a valid driver's license if
responsible for transportation of residents; and
(9) be willing to work with bona fide
inspectors and the monitoring and licensing agencies toward meeting and
maintaining the rules of this Subchapter.
(b) Any staff member left in charge of the care of
residents shall be 18 years or older.
(c) If licensed practical nurses are employed by the
facility and practicing in their licensed capacity as governed by their
practice act and occupational licensing laws, there shall be continuous
availability of a registered nurse consistent with Rules 21 NCAC 36 .0224(i) and
21 NCAC 36 .0225.
Note: The practice of licensed practical nurses is governed
by their occupational licensing laws.
History Note: Authority G.S. 131D‑2; 131D-4.5;
143B-165; S.L. 1999-0334; 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004.
10A NCAC 13G .0407 Fiscal QUALIFICATIONS
The administrator or corporation must be able to obtain
credit or have other verified resources to meet operating costs and provide
required services when unexpected situations arise, such as extended resident vacancies
and major home repairs. Verification of ability to obtain credit or the
availability of other resources must be documented by the administrator or
corporation.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. July 1, 1990.
section .0500 – staff orientation, training, competency and
continuing education
10A NCAC 13G .0501 Personal care training and competency
(a) The facility shall assure that personal care staff and
those who directly supervise them in facilities without heavy care residents
successfully complete a 25-hour training program, including competency
evaluation, approved by the Department according to Rule .0502 of this
Section. For the purposes of this Subchapter, heavy care residents are those
for whom the facility is providing personal care tasks listed in Paragraph (i)
of this Rule. Directly supervise means being on duty in the facility to
oversee or direct the performance of staff duties.
(b) The facility shall assure that staff who perform or
directly supervise staff who perform personal care tasks listed in Paragraph
(i) of this Rule in facilities with heavy care residents successfully complete
an 80-hour training program, including competency evaluation, approved by the
Department according to Rule .0502 of this Section and comparable to the
State-approved Nurse Aide I training.
(c) The facility shall assure that training specified in
Paragraphs (a) and (b) of this Rule is successfully completed six months after
hiring for staff hired after July 1, 2000. Staff hired prior to July 1, 2000,
shall have completed at least a 20-hour training program for the performance or
supervision of tasks listed in Paragraph (i) of this Rule or a 75-hour training
program for the performance or supervision of tasks listed in Paragraph (j) of
this Rule. The 20 and 75-hour training shall meet all the requirements of this
Rule except for the interpersonal skills and behavioral interventions listed in
Paragraph (j) of this Rule, within six months after hiring.
(d) The Department shall have the authority to extend the
six-month time frame specified in Paragraph (c) of this Rule up to six
additional months for a maximum allowance of 12 months for completion of
training upon submittal of documentation to the Department by the facility
showing good cause for not meeting the six-month time frame.
(e) Exemptions from the training requirements of this Rule
are as follows:
(1) The Department shall exempt staff from the
25-hour training requirement upon successful completion of a competency
evaluation approved by the Department according to Rule .0502 of this Section
if staff have been employed to perform or directly supervise personal care
tasks listed in Paragraph (h) and the interpersonal skills and behavioral
interventions listed in Paragraph (j) of this Rule in a comparable long-term
care setting for a total of at least 12 months during the three years prior to
January 1, 1996, or the date they are hired, whichever is later.
(2) The Department shall exempt staff from the
80-hour training requirement upon successful completion of a 15-hour refresher
training and competency evaluation program or a competency evaluation program
approved by the Department according to Rule .0502 of this Section if staff
have been employed to perform or directly supervise personal care tasks listed
in Paragraph (i) and the interpersonal skills and behavioral
interventions listed in Paragraph (j) of this Rule in a comparable long-term
care setting for a total of at least 12 months during the three years prior to
January 1, 1996, or the date they are hired, whichever is later.
(3) The Department shall exempt staff from the
25 and 80-hour training and competency evaluation who are or have been licensed
health professionals or Certified Nursing Assistants.
(f) The facility shall maintain documentation of the
training and competency evaluations of staff required by the rules of this
Subchapter. The documentation shall be filed in an orderly manner and made
available for review by representatives of the Department.
(g) The facility shall assure that staff who perform or
directly supervise staff who perform personal care tasks listed in Paragraphs
(h) and (i), and the interpersonal skills and behavioral interventions listed
in Paragraph (j) of this Rule receive on-the-job training and supervision as
necessary for the performance of individual job assignments prior to meeting
the training and competency requirements of this Rule.
(h) For the purposes of this Rule, personal care tasks
which require a 25-hour training program include, but are not limited to the
following:
(1) assist residents with toileting and
maintaining bowel and bladder continence;
(2) assist residents with mobility and
transferring;
(3) provide care for normal, unbroken skin;
(4) assist with personal hygiene to include
mouth care, hair and scalp grooming, care of fingernails, and bathing in
shower, tub, bed basin;
(5) trim hair;
(6) shave resident;
(7) provide basic first aid;
(8) assist residents with dressing;
(9) assist with feeding residents with special
conditions but no swallowing difficulties;
(10) assist and encourage physical activity;
(11) take and record temperature, pulse,
respiration, routine height and weight;
(12) trim toenails for residents without diabetes
or peripheral vascular disease;
(13) perineal care;
(14) apply condom catheters;
(15) turn and position;
(16) collect urine or fecal specimens;
(17) take and record blood pressure if a
registered nurse has determined and documented staff to be competent to perform
this task;
(18) apply and remove or assist with applying and
removing prosthetic devices for stable residents if a registered nurse,
licensed physical therapist or licensed occupational therapist has determined
and documented staff to be competent to perform the task; and
(19) apply or assist with applying ace bandages,
TED's and binders for stable residents if a registered nurse has determined and
documented staff to be competent to perform the task.
(i) For the purposes of this Rule, personal care tasks
which require a 80-hour training program are as follows:
(1) assist with feeding residents with
swallowing difficulty;
(2) assist with gait training using assistive
devices;
(3) assist with or perform range of motion
exercises;
(4) empty and record drainage of catheter bag;
(5) administer enemas;
(6) bowel and bladder retraining to regain
continence;
(7) test urine or fecal specimens;
(8) use of physical or mechanical devices
attached to or adjacent to the resident which restrict movement or access to
one's own body used to restrict movement or enable or enhance functional
abilities;
(9) non-sterile dressing procedures;
(10) force and restrict fluids;
(11) apply prescribed heat therapy;
(12) care for non-infected pressure ulcers; and
(13) vaginal douches.
(j) For purposes of this Rule, the interpersonal skills and
behavioral interventions include, but are not limited to the following:
(1) recognition of residents' usual patterns of
responding to other people;
(2) individualization of appropriate
interpersonal interactions with residents;
(3) interpersonal distress and behavior
problems;
(4) knowledge of and use of techniques, as
alternatives to the use of restraints, to decrease residents' intrapersonal and
interpersonal distress and behavior problems; and
(5) knowledge of procedures for obtaining
consultation and assistance regarding safe, humane management of residents'
behavioral problems.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000.
10A NCAC 13G .0502 personal care
training and competency program approval
(a) The 25 hour training specified in Rule .0501 of this
Section shall consist of at least 15 hours of classroom instruction, and
the remaining hours shall be supervised practical experience. Competency
evaluation shall be conducted in each of the following areas:
(1) personal care skills;
(2) cognitive, behavioral and social care for
all residents and including interventions to reduce behavioral problems for
residents with mental disabilities, and;
(3) residents' rights as established by G.S.
131D-21.
(b) The 80-hour training specified in Rule .0501 of this
Section shall consist of at least 34 hours of classroom instruction and at
least 34 hours of supervised practical experience. Competency evaluation shall
be conducted in each of the following areas:
(1) observation and documentation;
(2) basic nursing skills, including special
health-related tasks;
(3) personal care skills;
(4) cognitive, behavioral and social care for
all residents and including interventions to reduce behavioral problems for
residents with mental disabilities;
(5) basic restorative services; and
(6) residents' rights as established by G.S.
131D-21.
(c) The following requirements shall apply to the 25 and
80-hour training specified in Rule .0501 of this Section:
(1) The training shall be conducted by an
individual or a team of instructors with a coordinator. The supervisor of
practical experience and instructor of content having to do with personal care
tasks or basic nursing skills shall be a registered nurse with a current,
unencumbered license in North Carolina and with two years of clinical or direct
patient care experience working in a health care, home care or long term care
setting. The program coordinator and any instructor of content that does not
include instruction on personal care tasks or basic nursing skills shall be a
registered nurse, licensed practical nurse, physician, gerontologist, social
worker, psychologist, mental health professional or other health professional
with two years of work experience in adult education or in a long term care
setting; or a four-year college graduate with four years of experience working
in the field of aging or long term care for adults.
(2) A trainee participating in the classroom
instruction and supervised practical experience in the setting of the trainee's
employment shall not be considered on duty and counted in the staff-to-resident
ratio.
(3) Training shall not be offered without a
qualified instructor on site.
(4) Classroom instruction shall include the
opportunity for demonstration and practice of skills.
(5) Supervised practical experience shall be
conducted in a licensed adult care home or in a facility or laboratory setting
comparable to the work setting in which the trainee will be performing or
supervising the personal care skills.
(6) All skills shall be performed on humans
except for intimate care skills, such as perineal and catheter care, which may
be conducted on a mannequin.
(7) There shall be no more than 10 trainees for
each instructor for the supervised practical experience.
(8) A written examination prepared by the
instructor shall be used to evaluate the trainee's knowledge of the content
portion of the classroom training. The trainee shall score at least 70 on the
written examination. Oral testing shall be provided in the place of a written
examination for trainees lacking reading or writing ability.
(9) The trainee shall satisfactorily perform
all of the personal care skills specified in Rule .0501(h) and the skills
specified in 10A NCAC 13G .0401(j) of this Section for the 25-hour training and
in Rule .0501(h), (i) and (j) of this Section for the 80-hour training.
The instructor shall use a skills performance checklist for this competency
evaluation that includes, at least, all those skills specified in Rules
.0501(h) and .0501(j) of this Section for the 25-hour training and all
those skills specified in Rules .0501(h), (i) and (j) of this Section for the
80-hour training. Satisfactory performance of the personal care skills and
interpersonal and behavioral intervention skills means that the trainee
performed the skill unassisted; explained the procedure to the resident;
explained to the instructor, prior to or after the procedure, what was being
done and why it was being done in that way; and incorporated the principles of
good body mechanics, medical asepsis and resident safety and privacy.
(10) The training provider shall issue to all
trainees who successfully complete the training a certificate, signed by the
registered nurse who conducted the skills competency evaluation, stating that
the trainee successfully completed the 25 or 80-hour training. The trainee's
name shall be on the certificate. The training provider shall maintain copies
of the certificates and the skills evaluation checklists for a minimum of five
years.
(d) An individual, agency or organization seeking to
provide the 25 or 80-hour training specified in Rule .0501 of this Section
shall submit the following information to the Adult Care Licensure Section of
the Division of Health Service Regulation:
(1) an application which is available at no
charge by contacting the Division of Health Service Regulation, Adult Care
Licensure Section, 2708 Mail Service Center, Raleigh, North Carolina
27699-2708;
(2) a statement of training program philosophy;
(3) a statement of training program objectives
for each content area;
(4) a curriculum outline with specific hours
for each content area;
(5) teaching methodologies, a list of texts or
other instructional materials and a copy of the written exam or testing
instrument with an established passing grade;
(6) a list of equipment and supplies to be used
in the training;
(7) procedures or steps to be completed in the
performance of the personal care and basic nursing skills;
(8) sites for classroom and supervised
practical experience, including the specific settings or rooms within each
site;
(9) resumes of all instructors and the program
coordinator, including current RN certificate numbers as applicable;
(10) policy statements that address the role of
the registered nurse, instructor to trainee ratio for the supervised practical
experience, retention of trainee records and attendance requirements;
(11) a skills performance checklist as specified
in Subparagraph (c)(9) of this Rule; and
(12) a certificate of successful completion of
the training program.
(e) The following requirements shall apply to the
competency evaluation for purposes of exempting adult care home staff from the
25 or 80-hour training as required in Rule .0501 of this Section:
(1) The competency evaluation for purposes of
exempting adult care home staff from the 25 and 80-hour training shall consist
of the satisfactory performance of personal care skills and interpersonal and
behavioral intervention skills according to the requirement in
Subparagraph (c)(9) of this Rule.
(2) Any person who conducts the competency
evaluation for exemption from the 25 or 80-hour training shall be a registered
nurse with the same qualifications specified in Subparagraph (c)(1) of this
Rule.
(3) The competency evaluation shall be
conducted in a licensed adult care home or in a facility or laboratory setting
comparable to the work setting in which the participant will be performing or
supervising the personal care skills.
(4) All skills being evaluated shall be
performed on humans except for intimate care skills such as perineal and
catheter a care, which may be performed on a mannequin.
(5) The person being competency evaluated in
the setting of the person's employment shall not be considered on duty and
counted in the staff-to-resident ratio.
(6) An individual, agency or organization
seeking to provide the competency evaluation for training exemption purposes
shall complete an application available at no charge from the Division of
Health Service Regulation, Adult Care Licensure Section, 2708 Mail Service Center, Raleigh, North Carolina 27699-2708 and submit it to the Adult Care
Licensure Section along with the following information:
(A) resume of the person performing the competency
evaluation, including the current RN certificate number;
(B) a certificate, with the signature of the evaluating
registered nurse and the participant's name, to be issued to the person
successfully completing the competency evaluation;
(C) procedures or steps to be completed in the
performance of the personal care and basic nursing skills;
(D) a skills performance checklist as specified in
Subparagraph (c)(9) of this Rule; a site for the competency evaluation; and a
list of equipment, materials and supplies;
(E) a site for the competency evaluation; and
(F) a list of equipment, materials and supplies.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000.
10A NCAC 13G .0503 MEDICATION ADMINISTRATION COMPETENCY
EVALUATION
(a) The competency evaluation for medication administration
shall consist of a written examination and a clinical skills evaluation to
determine competency in the following areas: medical abbreviations and
terminology; transcription of medication orders; obtaining and documenting
vital signs; procedures and tasks involved with the preparation and
administration of oral (including liquid, sublingual and inhaler), topical
(including transdermal), ophthalmic, otic, and nasal medications; infection
control procedures; documentation of medication administration; monitoring for
reactions to medications and procedures to follow when there appears to be a
change in the resident's condition or health status based on those reactions;
medication storage and disposition; regulations pertaining to medication
administration in adult care facilities; and the facility's medication
administration policy and procedures.
(b) An individual shall score at least 90% on the written
examination which shall be a standardized examination established by the
Department.
(c) A certificate of successful completion of the written
examination shall be issued to each participant successfully completing the
examination. A copy of the certificate shall be maintained and available for
review in the facility. The certificate is transferable from one
facility to another as proof of successful completion of the written
examination. A medication study guide for the written examination is available
at no charge by contacting the Division of Health Service Regulation, Adult
Care Licensure Section, 2708 Mail Service Center, Raleigh, NC 27699-2708.
(d) The clinical skills validation portion of the
competency evaluation shall be conducted by a registered nurse or a registered
pharmacist consistent with their occupational licensing laws and who has a
current unencumbered license in North Carolina. This validation shall be
completed for those medication administration tasks to be performed in the
facility. Competency validation by a registered nurse is required for
unlicensed staff who perform any of the personal care tasks related to
medication administration specified in Rule .0903 of this Subchapter.
(e) The Medication Administration Skills Validation Form
shall be used to document successful completion of the clinical skills
validation portion of the competency evaluation for those medication
administration tasks to be performed in the facility employing the medication
aide. Copies of this form and instructions for its use may be obtained at no cost by contacting the Adult Care
Licensure Section, Division of Health Service Regulation, 2708 Mail Service Center, Raleigh, NC 27699-2708. The completed form shall be maintained and available
for review in the facility and is not transferable from one facility to
another.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. January 1, 2000; December 1,
1999;
Eff. July 1, 2000.
10A NCAC 13G .0504 COMPETENCY VALIDATION FOR LICENSED
HEALTH PROFESSIONAL SUPPORT TASKS
(a) A family care home shall assure that non-licensed
personnel and licensed personnel not practicing in their licensed capacity as
governed by their practice act and occupational licensing laws are competency
validated by return demonstration for any personal care task specified in
Subparagraph (a)(1) through (28) of Rule .0903 of this Subchapter prior to
staff performing the task and that their ongoing competency is assured through
facility staff oversight and supervision.
(b) Competency validation shall be performed by the following
licensed health professionals:
(1) A registered nurse shall validate the
competency of staff who perform personal care tasks specified in Subparagraphs (a)(1)
through (28) of Rule .0903 of this Subchapter.
(2) In lieu of a registered nurse, a respiratory
care practitioner licensed under G.S. 90, Article 38, may validate the
competency of staff who perform personal care tasks specified in Subparagraphs
(a)(6), (11), (16), (18), (19) and (21) of Rule .0903 of this Subchapter.
(3) In lieu of a registered nurse, a registered
pharmacist may validate the competency of staff who perform the personal care
task specified in Subparagraph (a)(8) of Rule .0903 of this Subchapter
(4) In lieu of a registered nurse, an
occupational therapist or physical therapist may validate the competency of
staff who perform personal care tasks specified in Subparagraphs (a)(17) and (a)(22)
through (27) of Rule .0903 of this Subchapter.
(c) Competency validation of staff, according to Paragraph
(a) of this Rule, for the licensed health professional support tasks specified
in Paragraph (a) of Rule .0903 of this Subchapter and the performance of these
tasks is limited exclusively to these tasks except in those cases in which a
physician acting under the authority of G.S. 131D-2(a1) certifies that
non-licensed personnel can be competency validated to perform other tasks on a
temporary basis to meet the resident's needs and prevent unnecessary
relocation.
History Note: Authority 131D-2; 143B-165; S.L.
2002-0160;
Temporary Adoption Eff. September 1, 2003;
Eff. July 1, 2004.
10A NCAC 13G .0505 TRAINING ON CARE OF DIABETIC RESIDENTS
A family care home shall assure that training on the care of
residents with diabetes is provided to unlicensed staff prior to the
administration of insulin as follows:
(1) Training shall be provided by a registered nurse,
registered pharmacist or prescribing practitioner.
(2) Training shall include at least the following:
(a) basic facts about diabetes and care involved
in the management of diabetes;
(b) insulin action;
(c) insulin storage;
(d) mixing, measuring and injection techniques for insulin administration;
(e) treatment and prevention of hypoglycemia and
hyperglycemia, including signs and symptoms;
(f) blood glucose monitoring; universal
precautions; appropriate administration times; and
(g) sliding scale insulin administration.
History Note: Authority 131D-2; 143B-165; S.L.
2002-0160;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004.
10A NCAC 13G .0506 TRAINING ON PHYSICAL RESTRAINTS
(a) A family care home shall assure that all staff
responsible for caring for residents with medical symptoms that warrant
restraints are trained on the use of alternatives to physical restraint use and
on the care of residents who are physically restrained.
(b) Training shall be provided by a registered nurse and
shall include the following:
(1) alternatives to physical restraints;
(2) types of physical restraints;
(3) medical symptoms that warrant physical
restraint;
(4) negative outcomes from using physical
restraints;
(5) correct application of physical restraints;
(6) monitoring and caring for residents who are
restrained; and
(7) the process of reducing restraint time by
using alternatives.
History Note: Authority 131D-2; 143B-165; S.L.
2002-0160;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004.
10A NCAC 13G .0507 TRAINING ON CARDIO-PULMONARY
RESUSCITATION
Each family care home shall have at least one staff person on the
premises at all times who has completed within the last 24 months a course on
cardio-pulmonary resuscitation and choking management, including the Heimlich
maneuver, provided by the American Heart Association, American Red Cross,
National Safety Council, American Safety and Health Institute and Medic First
Aid, or by a trainer with documented certification as a trainer on these
procedures from one of these organizations. If the only staff person on site
has been deemed physically incapable of performing these procedures by a
licensed physician, that person is exempt from the training.
History Note: Authority 131D –2; 143B-165; S.L.
2002-0160;
Temporary Adoption Eff. September 1, 2003;
Eff. July 1, 2004.
10A NCAC 13G .0508 ASSESSMENT Training
The person or persons designated by the administrator to
perform resident assessments as required by Rule .0801 of this Subchapter shall
successfully complete training on resident assessment established by the
Department before performing the required assessments. Registered nurses are
exempt from the assessment training. The instruction manual on resident
assessment is available on the internet website,
http://facility-services.state.nc.us/gcpage.htm, or it is available at the cost
of printing and mailing from the Division of Health Service Regulation, Adult
Care Licensure Section, 2708 Mail Service Center, Raleigh, NC 27699-2708.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 2002-0160;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004.
10A NCAC 13G .0509 FOOD SERVICE ORIENTATION
The family care home staff person in charge of the
preparation and serving of food shall complete a food service orientation
program established by the Department or an equivalent within 30 days of hire
for those staff hired on or after July 1, 2004. The orientation program is
available on the internet website,
http://facility-services.state.nc.us/gcpage.htm, or it is available at the cost
of printing and mailing from the Division of Health Service Regulation, Adult
Care Licensure Section, 2708 Mail Service Center, Raleigh, NC 27699-2708.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
2002-0160; 2003-0284;
Temporary Adoption Eff. July 1, 2004;
Temporary Adoption Expired March 12, 2005;
Eff. June 1, 2005.
10A NCAC 13G .0510 reserved for future codification
10a ncac 13g .0511 reserved for future codification
10A NCAC 13G .0512 DOCUMENTATION OF TRAINING AND COMPETENCY
VALIDATION
A family care home shall maintain documentation of the
training and competency validation of staff required by the rules of this
Section in the facility and available for review.
History Note: Authority 131D-2; 143B-165; S.L.
2002-0160;
Temporary Amendment Eff. September 1, 2003;
Eff. June 1, 2004.
SECTION .0600 – staffing of the home
10A NCAC 13G .0601 MANAGEMENT and other staff
(a) A family care home administrator shall be responsible
for the total operation of a family care home and shall also be responsible to
the Division of Health Service Regulation and the county department of social
services for meeting and maintaining the rules of this Subchapter. The co-administrator,
when there is one, shall share equal responsibility with the administrator for
the operation of the home and for meeting and maintaining the rules of this
Subchapter. The term administrator also refers to co-administrator where it is
used in this Subchapter.
(b) At all times there shall be one administrator or
supervisor-in-charge who is directly responsible for assuring that all required
duties are carried out in the home and for assuring that at no time is a
resident left alone in the home without a staff member. Except for the
provisions cited in Paragraph (c) of this Rule regarding the occasional absence
of the administrator or supervisor-in-charge, one of the following arrangements
shall be used:
(1) The administrator shall be in the home or
reside within 500 feet of the home with a means of two-way telecommunication
with the home at all times. When the administrator does not live in the
licensed home, there shall be at least one staff member who lives in the home
or one on each shift and the administrator shall be directly responsible for
assuring that all required duties are carried out in the home;
(2) The administrator shall employ a supervisor-in-charge
to live in the home or reside within 500 feet of the home with a means of
two-way telecommunication with the home at all times. When the supervisor-in-charge
does not live in the licensed home, there shall be at least one staff member
who lives in the home or one on each shift and the supervisor-in-charge shall
be directly responsible for assuring that all required duties are carried out
in the home; or
(3) When there is a cluster of licensed homes
located adjacently on the same site, there shall be at least one staff member
in each home, either live-in or on a shift basis, and at least one
administrator or supervisor-in-charge who lives within 500 feet of each home
with a means of two-way telecommunication with each home at all times and who
is directly responsible for assuring that all required duties are carried out
in each home.
(c) When the administrator or supervisor-in-charge is
absent from the home or not within 500 feet of the home, the following shall apply:
(1) For absences of a non-routine nature that
do not exceed 24 hours per week, a relief-person-in-charge designated by the
administrator shall be in charge of the home during the absence and in the home
or within 500 feet of the home according to the requirements in Paragraph (b)
of this Rule. The administrator shall assure that the relief-person-in-charge
is prepared to respond appropriately in case of an emergency in the home. The
relief-person-in-charge shall be 18 years or older.
(2) For recurring or planned absences, a relief-supervisor-in-charge
designated by the administrator shall be in charge of the home during the
absence and in the home or within 500 feet of the home according to the
requirements in Paragraph (b) of this Rule. The relief-supervisor-in-charge
shall meet all of the qualifications required for the supervisor-in-charge as
specified in Rule .0402 of this Subchapter with the exception of Item (4) pertaining
to the continuing education requirement.
(d) Additional staff shall be employed as needed for
housekeeping and the supervision and care of the residents.
(e) Information on required staffing shall be posted in the
facility according to G.S. 131D-4.3(a)(5).
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990; April 1, 1987;
April 1, 1984; June 26, 1980.
10A NCAC 13G .0602 THE CO‑ADMINISTRATOR
(a) The co‑administrator shares the responsibilities
with the administrator for the total operation of the home and for complying
with the rules of this Subchapter.
(b) It shall be the shared responsibility of the co‑administrators
to notify the county department of social services in writing whenever any one
of the co‑administrators is unable or unwilling to continue managing the
total operation of the home and must therefore be removed from the license.
The county department will submit the written notice to the Division of Health
Service Regulation.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984.
SECTION .0700 ‑ ADMISSION and discharge
10A NCAC 13G .0701 ADMISSION of residents
(a) Any adult (18 years of age or over) who, because of a
temporary or chronic physical condition or mental disability, needs a
substitute home may be admitted when, in the opinion of the resident,
physician, family or social worker, and the administrator the services and
accommodations of the home will meet his particular needs.
(b) Exceptions. People are not to be admitted:
(1) for treatment of mental illness, or alcohol
or drug abuse;
(2) for maternity care;
(3) for professional nursing care under
continuous medical supervision;
(4) for lodging, when the personal assistance
and supervision offered for the aged and disabled are not needed; or
(5) who pose a direct threat to the health or
safety of others.
History Note: Filed as a temporary amendment Eff.
October 14, 1992 for a period of 180 days or until the permanent rule becomes
effective, whichever is sooner;
Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. February 1, 1993; April 1, 1992; July 1,
1990; January 1, 1989.
10A ncac 13G .0702 Tuberculosis Test and MEDICAL
EXAMINATION
(a) Upon admission to a family care home each resident
shall be tested for tuberculosis disease in compliance with the control
measures adopted by the Commission for Public Health as specified in 10A NCAC
41A .0205 including subsequent amendments and editions. Copies of the rule are
available at no charge by contacting the Department of Health and Human
Services, Tuberculosis Control Program, 1902 Mail Service Center, Raleigh, Nor th Carolina 27699-1902.
(b) Each resident shall have a medical examination prior to
admission to the home and annually thereafter.
(c) The results of the complete examination are to be
entered on the FL-2, North Carolina Medicaid Program Long Term Care Services,
or MR-2, North Carolina Medicaid Program Mental Retardation Services, which
shall comply with the following:
(1) The examining date recorded on the FL‑2
or MR‑2 shall be no more than 90 days prior to the person's admission to
the home.
(2) The FL‑2 or MR‑2 shall be in
the facility before admission or accompany the resident upon admission and be
reviewed by the administrator or supervisor‑in‑charge before
admission except for emergency admissions.
(3) In the case of an emergency admission, the
medical examination and completion of the FL-2 or MR-2 shall be within 72 hours
of admission as long as current medication and treatment orders are available
upon admission or there has been an emergency medical evaluation, including any
orders for medications and treatments, upon admission.
(4) If the information on the FL-2 or MR-2 is
not clear or is insufficient, the administrator or supervisor‑in‑charge
shall contact the physician for clarification in order to determine if the
services of the facility can meet the individual's needs.
(5) The completed FL‑2 or MR‑2 shall
be filed in the resident's record in the home.
(6) If a resident has been hospitalized, the
facility shall have a completed FL-2 or MR-2 or a transfer form or discharge
summary with signed prescribing practitioner orders upon the resident’s return
to the facility from the hospital.
(d) Each resident shall be immunized against pneumococcal
disease and annually against influenza virus according to G.S. 131D-9, except
as otherwise indicated in this law.
(e) The home shall make arrangements for any resident, who
has been an inpatient of a psychiatric facility within 12 months before
entering the home and who does not have a current plan for psychiatric care, to
be examined by a local physician or a physician in a mental health center
within 30 days after admission and to have a plan for psychiatric follow‑up
care when indicated.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. December 1, 1993; July 1, 1990; April 1,
1987; April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004.
10A NCAC 13G .0703 RESIDENT REGISTER
(a) A family care home's administrator or
supervisor-in-charge and the resident or the resident's responsible person
shall complete and sign the Resident Register within 72 hours of the resident's
admission to the home. The Resident Register is available on the internet
website, http://facility-services.state.nc.us/gcpage.htm, or at no charge from
the Division of Health Service Regulation, Adult Care Licensure Section, 2708 Mail Service Center, Raleigh, NC 27699-2708. The facility may use a resident information form
other than the Resident Register as long as it contains at least the same
information as the Resident Register.
(b) The administrator or supervisor-in-charge shall revise
the completed Resident Register with the resident or his responsible person as
needed.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
2002-0160; 2003-0284;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1987; April 1, 1984;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13G .0704 resident contract and INFORMATION ON
HOME
The administrator or supervisor-in-charge shall furnish and
review with the resident or his responsible person information on the family
care home upon admission and when changes are made to that information. A
statement indicating that this information has been received upon admission or
amendment as required by this Rule shall be signed and dated by each person to
whom it is given. This statement shall be retained in the resident's record in
the home. The information shall include:
(1) a copy of the home's resident contract specifying
rates for resident services and accommodations, including the cost of different
levels of service, if applicable, any other charges or fees, and any health needs
or conditions the home has determined it cannot meet pursuant to G.S.
131D-2(a1)(4). In addition, the following applies:
(a) The contract shall be signed and dated by
the administrator or supervisor-in-charge and the resident or his responsible
person and a copy given to the resident or his responsible person;
(b) The resident or his responsible person shall
be notified as soon as any change is known, but not less than 30 days for rate
changes initiated by the home, of any rate changes or other changes in the
contract affecting the resident services and accommodations and be provided an
amended copy of the contract for review and signature;
(c) A copy of each signed contract shall be kept
in the resident's record in the home;
(d) Gratuities in addition to the established
rates shall not be accepted; and
(e) The maximum monthly rate that may be charged
to Special Assistance recipients is established by the North Carolina Social
Services Commission and the North Carolina General Assembly;
Note: Facilities may accept
payments for room and board from a third party, such as family member, charity
or faith community, if the payment is made voluntarily to supplement the cost
of room and board for the added benefit of a private room.
(2) a written copy of any house rules, including the
conditions for the discharge and transfer of residents, the refund policies,
and the home's policies on smoking, alcohol consumption and visitation
consistent with the rules in this Subchapter and amendments disclosing any changes
in the house rules;
(3) a copy of the Declaration of Residents' Rights as
found in G.S. 131D-21;
(4) a copy of the home's grievance procedures which
shall indicate how the resident is to present complaints and make suggestions
as to the home's policies and services on behalf of self or others; and
(5) a statement as to whether the home has signed Form
DSS-1464, Statement of Assurance of Compliance with Title VI of the Civil
Rights Act of 1964 for Other Agencies, Institutions, Organizations or
Facilities, and which shall also indicate that if the home does not choose to comply
or is found to be in non-compliance the residents of the home would not be able
to receive State-County Special Assistance for Adults and the home would not
receive supportive services from the county department of social services.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160; 2003-0284;
Eff. April 1, 1984;
Amended Eff; July 1, 1990; April 1, 1987;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13G .0705 DISCHARGE OF RESIDENTS
(a) The discharge of a resident initiated by the facility
shall be according to conditions and procedures specified in Paragraphs (a)
through (g) of this Rule. The discharge of a resident initiated by the facility
involves the termination of residency by the facility resulting in the resident's
move to another location and the facility not holding the bed for the resident
based on the facility's bed hold policy.
(b) The discharge of a resident shall be based on one of
the following reasons:
(1) the discharge is necessary for the resident's
welfare and the resident's needs cannot be met in the facility as documented by
the resident's physician, physician assistant or nurse practitioner;
(2) the resident's health has improved
sufficiently so the resident no longer needs the services provided by the
facility as documented by the resident's physician, physician assistant or
nurse practitioner;
(3) the safety of other individuals in the
facility is endangered;
(4) the health of other individuals in the
facility is endangered as documented by a physician, physician assistant or
nurse practitioner;
(5) failure to pay the costs of services and
accommodations by the payment due date according to the resident contract after
receiving written notice of warning of discharge for failure to pay; or
(6) the discharge is mandated under G.S.
131D-2(a1).
(c) The notices of discharge and appeal rights as required
in Paragraph (e) of this Rule shall be made by the facility at least 30 days
before the resident is discharged except that notices may be made as soon as
practicable when:
(1) the resident's health or safety is
endangered and the resident's urgent medical needs cannot be met in the
facility under Subparagraph (b)(1) of this Rule; or
(2) reasons under Subparagraphs (b)(2), (b)(3),
and (b)(4) of this Rule exist.
(d) The reason for discharge shall be documented in the
resident's record. Documentation shall include one or more of the following as
applicable to the reasons under Paragraph (b) of this Rule:
(1) documentation by physician, physician
assistant or nurse practitioner as required in Paragraph (b) of this Rule;
(2) the condition or circumstance that
endangers the health or safety of the resident being discharged or endangers
the health or safety of individuals in the facility, and the facility's action
taken to address the problem prior to pursuing discharge of the resident;
(3) written notices of warning of discharge for
failure to pay the costs of services and accommodations; or
(4) the specific health need or condition of
the resident that the facility determined could not be met in the facility
pursuant to G.S. 131D-2(a1)(4) and as disclosed in the resident contract signed
upon the resident's admission to the facility.
(e) The facility shall assure the following requirements
for written notice are met before discharging a resident:
(1) The Adult Care Home Notice of Discharge
with the Adult Care Home Hearing Request Form shall be hand delivered, with
receipt requested, to the resident on the same day the Adult Care Home Notice
of Discharge is dated. These forms may be obtained at no cost from the
Division of Medical Assistance, 2505 Mail Service Center, Raleigh, NC
27699-2505.
(2) A copy of the Adult Care Home Notice of
Discharge with a copy of the Adult Care Home Hearing Request Form shall be hand
delivered, with receipt requested, or sent by certified mail to the resident's
responsible person or legal representative on the same day the Adult Care Home
Notice of Discharge is dated.
(3) Failure to use and simultaneously provide
the specific forms according to Subparagraphs (e)(1) and (e)(2) of this Rule
shall invalidate the discharge. Failure to use the latest version of these
forms shall not invalidate the discharge unless the facility has been
previously notified of a change in the forms and been provided a copy of the
latest forms by the Department of Health and Human Services.
(4) A copy of the completed Adult Care Home
Notice of Discharge, the Adult Care Home Hearing Request Form as completed by
the facility prior to giving to the resident and a copy of the receipt of hand
delivery or the notification of certified mail delivery shall be maintained in
the resident's record.
(f) The facility shall provide sufficient preparation and
orientation to residents to ensure a safe and orderly discharge from the
facility as evidenced by:
(1) notifying staff in the county department of
social services responsible for placement services;
(2) explaining to the resident and responsible
person or legal representative why the discharge is necessary;
(3) informing the resident and responsible
person or legal representative about an appropriate discharge destination; and
(4) offering the following material to the
caregiver with whom the resident is to be placed and providing this material as
requested prior to or upon discharge of the resident:
(A) a copy of the resident's most current FL-2;
(B) a copy of the resident's most current assessment
and care plan;
(C) a copy of the resident's current physician orders;
(D) a list of the resident's current medications;
(E) the resident's current medications; and
(F) a record of the resident's vaccinations and TB
screening.
(5) providing written notice of the name,
address and telephone number of the following, if not provided on the discharge
notice required in Paragraph (e) of this Rule:
(A) the regional long term care ombudsman; and
(B) the protection and advocacy agency established
under federal law for persons with disabilities.
(g) If an appeal hearing is requested:
(1) the facility shall provide to the resident
or legal representative or the resident and the responsible person, and the
Hearing Unit copies of all documents and records that the facility intends to
use at the hearing at least five working days prior to the scheduled hearing;
and
(2) the facility shall not discharge the
resident before the final decision resulting from the appeal has been rendered,
except in those cases of discharge specified in Paragraph (c) of this Rule.
(h) If a discharge is initiated by the resident or
responsible person, the administrator may require up to a 14-day written notice
from the resident or responsible person which means the resident or responsible
person may be charged for the days of the required notice if notice is not
given or if notice is given and the resident leaves before the end of the
required notice period.. Exceptions to the required notice are cases in which
a delay in discharge or transfer would jeopardize the health or safety of the
resident or others in the facility. The facility's requirement for a notice
from the resident or responsible person shall be established in the resident
contract or the house rules provided to the resident or responsible person upon
admission.
(i) The discharge requirements in this Rule do not apply
when a resident is transferred to an acute inpatient facility for mental or
physical health evaluation or treatment and the adult care facility's bed hold
policy applies based on the expected return of the resident. If the facility
decides to discharge a resident who has been transferred to an acute inpatient
facility and there has been no physician-documented level of care change for
the resident, the discharge requirements in this Rule apply.
History Note: Authority G.S. 131D-2; 131D-4.5; 131D-21;
143B-165; S.L. 99-0334; 2002-0160;
Temporary Adoption Eff. January 1, 2000; December 1,
1999;
Eff. April 1, 2001;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2004.
section .0800 - RESIDENT ASSESSMENT AND CARE plan
10A NCAC 13G .0801 RESIDENT ASSESSMENT
(a) A family care home shall assure that an initial
assessment of each resident is completed within 72 hours of admission using the
Resident Register.
(b) The facility shall assure an assessment of each
resident is completed within 30 days following admission and at least annually
thereafter using an assessment instrument established by the Department or an
instrument approved by the Department based on it containing at least the same
information as required on the established instrument. The assessment to be
completed within 30 days following admission and annually thereafter shall be a
functional assessment to determine a resident's level of functioning to include
psychosocial well-being, cognitive status and physical functioning in
activities of daily living. Activities of daily living are bathing, dressing,
personal hygiene, ambulation or locomotion, transferring, toileting and
eating. The assessment shall indicate if the resident requires referral to the
resident's physician or other licensed health care professional, a provider of
mental health, developmental disabilities or substance abuse services or a community
resource.
(c) The facility shall assure an assessment of a resident
is completed within 10 days following a significant change in the resident's
condition using the assessment instrument required in Paragraph (b) of this
Rule. For the purposes of this Subchapter, significant change in the resident's
condition is determined as follows:
(1) Significant change is one or more of the
following:
(A) deterioration in two or more activities of daily
living;
(B) change in ability to walk or transfer;
(C) change in the ability to use one's hands to grasp small
objects;
(D) deterioration in behavior or mood to the point where
daily problems arise or relationships have become problematic;
(E) no response by the resident to the treatment for an
identified problem;
(F) initial onset of unplanned weight loss or gain of
five percent of body weight within a 30-day period or 10 percent weight loss or
gain within a six-month period;
(G) threat to life such as stroke, heart condition, or
metastatic cancer;
(H) emergence of a pressure ulcer at Stage II, which is
a superficial ulcer presenting an abrasion, blister or shallow crater, or
higher;
(I) a new diagnosis of a condition likely to affect
the resident's physical, mental, or psychosocial well-being over a period of
time such as initial diagnosis of Alzheimer's disease or diabetes;
(J) improved behavior, mood or functional health
status to the extent that the established plan of care no longer matches what
is needed;
(K) new onset of impaired decision-making;
(L) continence to incontinence or indwelling catheter;
or
(M) the resident's condition indicates there may be a
need to use a restraint and there is no current restraint order for the
resident.
(2) Significant change is not any of the
following:
(A) changes that suggest slight upward or downward
movement in the resident's status;
(B) changes that resolve with or without intervention;
(C) changes that arise from easily reversible causes;
(D) an acute illness or episodic event;
(E) an established, predictive, cyclical pattern; or
(F) steady improvement under the current course of
care.
(d) If a resident experiences a significant change as
defined in Paragraph (c) of this Rule, the facility shall refer the resident to
the resident's physician or other appropriate licensed health professional such
as a mental health professional, nurse practitioner, physician assistant or
registered nurse in a timely manner consistent with the resident's condition
but no longer than 10 days from the significant change, and document the
referral in the resident's record. Referral shall be made immediately when
significant changes are identified that pose an immediate risk to the health
and safety of the resident, other residents or staff of the facility.
(e) The assessments required in Paragraphs (b) and (c) of
this Rule shall be completed and signed by the person designated by the
administrator to perform resident assessments.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004.
10A NCAC 13G .0802 RESIDENT CARE PLAN
(a) A family care home shall assure a care plan is
developed for each resident in conjunction with the resident assessment to be
completed within 30 days following admission according to Rule .0801 of this
Section. The care plan shall be an individualized, written program of personal
care for each resident.
(b) The care plan shall be revised as needed based on
further assessments of the resident according to Rule .0801 of this Subchapter.
(c) The care plan shall include the following:
(1) a statement of the care or service to be
provided based on the assessment or reassessment; and
(2) frequency of the service provision.
(d) The assessor shall sign the care plan upon its
completion.
(e) The facility shall assure that the resident's physician
authorizes personal care services and certifies the following by signing and
dating the care plan within 15 calendar days of completion of the assessment:
(1) the resident is under the physician's care;
and
(2) the resident has a medical diagnosis with
associated physical or mental limitations that justify the personal care
services specified in the care plan.
(f) The facility shall assure that the care plan for each
resident who is under the care of a provider of mental health, developmental
disabilities or substance abuse services includes resident specific
instructions regarding how to contact that provider, including emergency
contact. Whenever significant behavioral changes described in Rule
.0801(c)(1)(D) of this Subchapter are identified, the facility shall refer the
resident to a provider of mental health, developmental disabilities or
substance abuse services in accordance with Rule .0801(d) of this Subchapter.
History Note: Authority G.S. 131D-2; 131D-4.3;
131D-4.5; 143B-165; S.L. 99-0334; 2002-0160;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. January 1, 2001;
Temporary Amendment Expired October 13, 2001;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004.
SECTION .0900 – resident care and SERVICES
10A NCAC 13G .0901 PERSONAL CARE and supervision
(a) Family care home staff shall provide personal care to
residents according to the residents' care plans and attend to any other
personal care needs residents may be unable to attend to for themselves.
(b) Staff shall provide supervision of residents in
accordance with each resident's assessed needs, care plan and current symptoms.
(c) Staff shall respond immediately in the case of an
accident or incident involving a resident to provide care and intervention
according to the facility's policies and procedures.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; May 1, 1999; July 1, 1990;
April 1, 1987; April 1, 1984.
10a NCAC 13G .0902 HEALTH CARE
(a) A family care home shall provide care and services in
accordance with the resident's care plan.
(b) The facility shall assure referral and follow-up to
meet the routine and acute health care needs of residents.
(c) The facility shall assure documentation of the
following in the resident's record:
(1) facility contacts with the resident's
physician, physician service, other licensed health professional, including
mental health professional, when illnesses or accidents occur and any other
facility contacts with a physician or licensed health professional regarding
resident care;
(2) all visits of the resident to or from the
resident's physician, physician service or other licensed health professional,
including mental health professional, of which the facility is aware.
(3) written procedures, treatments or orders
from a physician or other licensed health professional; and
(4) implementation of procedures, treatments or
orders specified in Subparagraph (c)(3) of this Rule.
(d) The following shall apply to the resident's physician
or physician service:
(1) The resident or the resident's responsible
person shall be allowed to choose a physician or physician service to attend
the resident.
(2) When the resident cannot remain under the
care of the chosen physician or physician service, the facility shall assure
that arrangements are made with the resident or responsible person for choosing
and securing another physician or physician service within 45 days or prior to
the signing of the care plan as required in Rule .0802 of this Subchapter.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
99-0334; 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. December 1, 1993; May 1, 1992, July 1, 1990;
September 1, 1987;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004.
10A NCAC 13G .0903 LICENSED HEALTH PROFESSIONAL SUPPORT
(a) A family care home shall assure that an appropriate
licensed health professional, participates in the on-site review and evaluation
of the residents' health status, care plan and care provided for residents requiring
one or more of the following personal care tasks:
(1) applying and removing ace bandages, ted
hose, binders, and braces and splints;
(2) feeding techniques for residents with
swallowing problems;
(3) bowel or bladder training programs to
regain continence;
(4) enemas, suppositories, break-up and removal
of fecal impactions, and vaginal douches;
(5) positioning and emptying of the urinary
catheter bag and cleaning around the urinary catheter;
(6) chest physiotherapy or postural drainage;
(7) clean dressing changes, excluding packing
wounds and application of prescribed enzymatic debriding agents;
(8) collecting and testing of fingerstick blood
samples;
(9) care of well-established colostomy or
ileostomy (having a healed surgical site without sutures or drainage);
(10) care for pressure ulcers, up to and
including a Stage II pressure ulcer which is a superficial ulcer presenting as
an abrasion, blister or shallow crater;
(11) inhalation medication by machine;
(12) forcing and restricting fluids;
(13) maintaining accurate intake and output data;
(14) medication administration through a
well-established gastrostomy feeding tube (having a healed surgical site
without sutures or drainage and through which a feeding regimen has been
successfully established);
(15) medication administration through injection;
Note: Unlicensed staff may only
administer subcutaneous injections as stated in Rule .1004(q) of this
Subchapter;
(16) oxygen administration and monitoring;
(17) the care of residents who are physically
restrained and the use of care practices as alternatives to restraints;
(18) oral suctioning;
(19) care of well-established tracheostomy, not
to include indo-tracheal suctioning;
(20) administering and monitoring of tube feedings
through a well-established gastrostomy tube (see description in Subparagraph
(14) of this Paragraph);
(21) the monitoring of continuous positive air
pressure devices (CPAP and BIPAP);
(22) application of prescribed heat therapy;
(23) application and removal of prosthetic
devices except as used in early post-operative treatment for shaping of the
extremity;
(24) ambulation using assistive devices that
requires physical assistance;
(25) range of motion exercises;
(26) any other prescribed physical or
occupational therapy;
(27) transferring semi-ambulatory or
non-ambulatory residents; or
(28) nurse aide II tasks according to the scope
of practice as established in the Nursing Practice Act and rules promulgated
under that act in 21 NCAC 36.
(b) The appropriate licensed health professional, as
required in Paragraph (a) of this Rule, is:
(1) a registered nurse licensed under G.S. 90,
Article 9A, for tasks listed in Subparagraphs (a)(1) through (28) of this Rule;
(2) an occupational therapist licensed under
G.S. 90, Article 18D or physical therapist licensed under G.S. 90-270.24,
Article 18B for tasks listed in Subparagraphs (a)(17) and (a)(22) through (27) of
this Rule;
(3) a respiratory care practitioner licensed
under G.S. 90, Article 38, for tasks listed in Subparagraphs (a)(6), (11),
(16), (18), (19) and (21) of this Rule; or
(4) a registered nurse licensed under G.S. 90,
Article 9A, for tasks that can be performed by a nurse aide II according to the
scope of practice as established in the Nursing Practice Act and rules
promulgated under that act in 21 NCAC 36.
(c) The facility shall assure that participation by a
registered nurse, occupational therapist or physical therapist in the on-site
review and evaluation of the residents' health status, care plan and care
provided, as required in Paragraph (a) of this Rule, is completed within the
first 30 days of admission or within 30 days from the date a resident develops
the need for the task and at least quarterly thereafter, and includes the
following:
(1) performing a physical assessment of the
resident as related to the resident's diagnosis or current condition requiring
one or more of the tasks specified in Paragraph (a) of this Rule;
(2) evaluating the resident's progress to care
being provided;
(3) recommending changes in the care of the
resident as needed based on the physical assessment and evaluation of the
progress of the resident; and
(4) documenting the activities in Subparagraphs
(1) through (3) of this Paragraph.
(d) The facility shall assure action is taken in response
to the licensed health professional review and documented, and that the
physician or appropriate health professional is informed of the recommendations
when necessary.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004.
10A NCAC 13G .0904 NUTRITION AND FOOD SERVICE
(a) Food Procurement and Safety in Family Care Homes:
(1) The kitchen, dining and food storage areas
shall be clean, orderly and protected from contamination.
(2) All food and beverage being procured,
stored, prepared or served by the facility shall be protected from
contamination.
(3) All meat processing shall occur at a
USDA-approved processing plant.
(4) There shall be at least a three-day supply
of perishable food and a five-day supply of non-perishable food in the facility
based on the menus, for both regular and therapeutic diets.
(b) Food Preparation and Service in Family Care Homes:
(1) Sufficient staff, space and equipment shall
be provided for safe and sanitary food storage, preparation and service.
(2) Table service shall include a napkin and
non-disposable place setting consisting of at least a knife, fork, spoon, plate
and beverage containers. Exceptions may be made on an individual basis and
shall be based on documented needs or preferences of the resident.
(3) Hot foods shall be served hot and cold
foods shall be served cold.
(4) If residents require feeding assistance,
food shall be maintained at serving temperature until assistance is provided.
(c) Menus in Family Care Homes:
(1) Menus shall be prepared at least one week
in advance with serving quantities specified and in accordance with the Daily
Food Requirements in Paragraph (d) of this Rule.
(2) Menus shall be maintained in the kitchen
and identified as to the current menu day and cycle for any given day for
guidance of food service staff.
(3) Any substitutions made in the menu shall be
of equal nutritional value, appropriate for therapeutic diets and documented to
indicate the foods actually served to residents.
(4) Menus shall be planned to take into account
the food preferences and customs of the residents.
(5) Menus as served and invoices or other
receipts of purchases shall be maintained in the facility for 30 days.
(6) Menus for all therapeutic diets shall be
planned or reviewed by a registered dietitian. The facility shall maintain
verification of the registered dietitian's approval of the therapeutic diets
which shall include an original signature by the registered dietitian and the
registration number of the dietitian.
(7) The facility shall have a matching
therapeutic diet menu for all physician-ordered therapeutic diets for guidance
of food service staff.
(d) Food Requirements in Family Care Homes:
(1) Each resident shall be served a minimum of
three nutritionally adequate, palatable meals a day at regular hours with at
least 10 hours between the breakfast and evening meals.
(2) Foods and beverages that are appropriate to
residents' diets shall be offered or made available to all residents as snacks
between each meal for a total of three snacks per day and shown on the menu as
snacks.
(3) Daily menus for regular diets shall include
the following:
(A) Homogenized whole milk, low fat milk, skim milk or
buttermilk: One cup (8 ounces) of pasteurized milk at least twice a day.
Reconstituted dry milk or diluted evaporated milk may be used in cooking only
and not for drinking purposes due to risk of bacterial contamination during
mixing and the lower nutritional value of the product if too much water is
used.
(B) Fruit: Two servings of fruit (one serving equals 6
ounces of juice; ½ cup of raw, canned or cooked fruit; 1 medium-size whole
fruit; or ¼ cup dried fruit). One serving shall be a citrus fruit or a
single strength juice in which there is 100% of the recommended dietary allowance
of vitamin C in each six ounces of juice. The second fruit serving shall be of
another variety of fresh, dried or canned fruit.
(C) Vegetables: Three servings of vegetables (one
serving equals ½ cup of cooked or canned vegetable; 6 ounces of vegetable
juice; or 1 cup of raw vegetable). One of these shall be a dark green, leafy
or deep yellow three times a week.
(D) Eggs: One whole egg or substitute (e.g., 2 egg
whites or ¼ cup of pasteurized egg product) at least three times a week at
breakfast.
(E) Protein: Two to three ounces of pure cooked meat
at least two times a day for a minimum of 4 ounces. A substitute (e.g., 4
tablespoons of peanut butter, 1 cup of cooked dried peas or beans or 2 ounces
of pure cheese) may be served three times a week but not more than once a day,
unless requested by the resident.
Note: Bacon is considered to be fat and not meat
for the purposes of this Rule.
(F) Cereals and Breads: At least six servings of whole
grain or enriched cereal and bread or grain products a day. Examples of one
serving are as follows: 1 slice of bread; ½ of a bagel, English muffin or
hamburger bun; one 1 ½ -ounce muffin, 1- ounce roll, 2-ounce biscuit or 2-ounce
piece of cornbread; ½ cup cooked rice or cereal (e.g., oatmeal or grits); ¾ cup
ready-to-eat cereal; or one waffle, pancake or tortilla that is six inches in
diameter. Cereals and breads offered as snacks may be included in meeting this
requirement.
(G) Fats: Include butter, oil, margarine or items
consisting primarily of one of these (e.g., icing or gravy).
(H) Water and Other Beverages: Water shall be served to
each resident at each meal, in addition to other beverages.
(e) Therapeutic Diets in Family Care Homes:
(1) All therapeutic diet orders including
thickened liquids shall be in writing from the resident's physician. Where
applicable, the therapeutic diet order shall be specific to calorie, gram or
consistency, such as for calorie controlled ADA diets, low sodium diets or
thickened liquids, unless there are written orders which include the
definition of any therapeutic diet identified in the facility's therapeutic
menu approved by a registered dietitian.
(2) Physician orders for nutritional
supplements shall be in writing from the resident's physician and be brand
specific, unless the facility has defined a house supplement in its
communication to the physician, and shall specify quantity and frequency.
(3) The facility shall maintain an accurate and
current listing of residents with physician-ordered therapeutic diets for
guidance of food service staff.
(4) All therapeutic diets, including
nutritional supplements and thickened liquids, shall be served as ordered by
the resident's physician.
(f) Individual Feeding Assistance in Family Care Homes:
(1) Sufficient staff shall be available for
individual feeding assistance as needed.
(2) Residents needing help in eating shall be
assisted upon receipt of the meal and the assistance shall be unhurried and in
a manner that maintains or enhances each resident's dignity and respect.
(g) Variations from the required three meals or time
intervals between meals to meet individualized needs or preferences of
residents shall be documented in the resident's record.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160;
Eff. January 1, 1977;
Amended Eff. October 1, 1977; April 22, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. August 3, 1992; July 1, 1990; September 1,
1987; April 1, 1987;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004.
10A NCAC 13G .0905 ACTIVITIES PROGRAM
(a) Each family care home shall develop a program of
activities designed to promote the residents' active involvement with each
other, their families, and the community.
(b) The program shall be designed to promote active
involvement by all residents but is not to require any individual to
participate in any activity against his will. If there is a question about a
resident's ability to participate in an activity, the resident's physician
shall be consulted to obtain a statement regarding the resident's capabilities.
(c) The activity director, as required in Rule .0404 of
this Subchapter, shall:
(1) use information on the residents' interests
and capabilities as documented upon admission and updated as needed to arrange
for or provide planned individual and group activities for the residents,
taking into account the varied interests, capabilities and possible cultural
differences of the residents;
(2) prepare a monthly calendar of planned group
activities which shall be easily readable with large print, posted in a
prominent location by the first day of each month, and updated when there are
any changes;
(3) involve community resources, such as
recreational, volunteer, religious, aging and developmentally disabled-associated
agencies, to enhance the activities available to residents;
(4) evaluate and document the overall
effectiveness of the activities program at least every six months with input
from the residents to determine what have been the most valued activities and
to elicit suggestions of ways to enhance the program;
(5) encourage residents to participate in
activities; and
(6) assure there are adequate supplies,
supervision and assistance to enable each resident to participate. Aides and
other facility staff may be used to assist with activities.
(d) There shall be a minimum of 14 hours of a variety of
planned group activities per week that include activities that promote
socialization, physical interaction, group accomplishment, creative expression,
increased knowledge and learning of new skills. Homes that care exclusively
for residents with HIV disease are exempt from this requirement as long as the
facility can demonstrate planning for each resident's involvement in a variety
of activities. Examples of group activities are group singing, dancing, games,
exercise classes, seasonal parties, discussion groups, drama, resident council
meetings, book reviews, music appreciation, review of current events and
spelling bees.
(e) Residents shall have the opportunity to participate in
activities involving one to one interaction and activity by oneself that
promote enjoyment, a sense of accomplishment, increased knowledge, learning of
new skills, and creative expression. Examples of these activities are crafts,
painting, reading, creative writing, buddy walks, card playing, and nature
walks.
(f) Each resident shall have the opportunity to participate
in at least one outing every other month. Residents interested in being
involved in the community more frequently shall be encouraged to do so.
(g) Each resident shall have the opportunity to participate
in meaningful work-type and volunteer service activities in the home or in the
community, but participation shall be on an entirely voluntary basis, never
forced upon residents and not assigned in place of staff.
History Note: Authority G.S. 131D‑2; 143B‑165;
S.L. 2002-0160; 2003-0284;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. August 3, 1992; April 1, 1987; April 1,
1984;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13G .0906 OTHER resident SERVICES
(a) Transportation. The administrator must assure the
provision of transportation for the residents to necessary resources and
activities, including transportation to the nearest appropriate health
facilities, social services agencies, shopping and recreational facilities, and
religious activities of the resident's choice. The resident is not to be
charged any additional fee for this service. Sources of transportation may
include community resources, public systems, volunteer programs, family members
as well as facility vehicles.
(b) Mail.
(1) Residents shall receive their mail promptly
and it must be unopened unless there is a written, witnessed request
authorizing management staff to open and read mail to the resident. This
request must be recorded on Form DSS‑1865, the Resident Register or the
equivalent;
(2) Outgoing mail written by a resident shall
not be censored; and
(3) Residents shall be encouraged and assisted,
if necessary, to correspond by mail with close relatives and friends.
Residents shall have access to writing materials, stationery and postage and,
upon request, the home is to provide such items at cost. It is not the home's
obligation to pay for these items.
(c) Laundry.
(1) Laundry services must be provided to
residents without any additional fee; and
(2) It is not the home's obligation to pay for
a resident's personal dry cleaning. The resident's plans for personal care of
clothing are to be indicated on Form DSS‑1865, the Resident Register.
(d) Telephone.
(1) A telephone must be available in a location
providing privacy for residents to make and receive a reasonable number of
calls of a reasonable length;
(2) A pay station telephone is not acceptable
for local calls; and
(3) It is not the home's obligation to pay for
a resident's toll calls.
(e) Personal Lockable Space.
(1) Personal lockable space must be provided
for each resident to secure his personal valuables. One key shall be provided
free of charge to the resident. Additional keys are to be provided to
residents at cost upon request. It is not the home's obligation to pay for
additional keys; and
(2) While a resident may elect not to use
lockable space, it must still be available in the home since the resident may
change his mind. This space shall be accessible only to the resident and the
administrator or supervisor‑in‑charge. The administrator or
supervisor‑in‑charge must determine at admission whether the
resident desires lockable space, but the resident may change his mind at any
time.
(f) Visiting.
(1) Visiting in the home and community at
reasonable hours shall be encouraged and arranged through the mutual prior
understanding of the residents and administrator;
(2) There must be at least 10 hours each day
for visitation in the home by persons from the community. If a home has
established visiting hours or any restrictions on visitation, information about
the hours and any restrictions must be included in the house rules given to
each resident at the time of admission and posted conspicuously in the home;
(3) A signout register must be maintained for
planned visiting and other scheduled absences which indicates the resident's
departure time, expected time of return and the name and telephone number of
the responsible party;
(4) If the whereabouts of a resident are
unknown and there is reason to be concerned about his safety, the person in
charge in the home must immediately notify the resident's responsible person,
the appropriate law enforcement agency and the county department of social
services.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. December 1, 1991; April 1, 1987; April 1,
1984.
10A NCAC 13G .0907 RESPITE CARE
(a) For the purposes of this Subchapter, respite care is
defined as supervision, personal care and services provided for persons
admitted to a family care home on a temporary basis for temporary caregiver
relief, not to exceed 30 days.
(b) Respite care is not required as a condition of
licensure. However, respite care is subject to the requirements of this
Subchapter except for Rules .0703, .0705, .0801, .0802 and .1201.
(c) The number of respite care residents and family care
home residents shall not exceed the facility's licensed bed capacity.
(d) The respite care resident contract shall specify the
rates for respite care services and accommodations, the date of admission to
the facility and the proposed date of discharge from the facility. The
contract shall be signed by the administrator or designee and the respite care
resident or his responsible person and a copy given to the resident and
responsible person.
(e) Upon admission of a respite care resident into the
facility, the facility shall assure that the resident has a current FL-2 and
been tested for tuberculosis disease according to Rule .0702 of this Subchapter
and that there are current physician orders for any medications, treatments and
special diets for inclusion in the respite care resident's record. The
facility shall assure that the respite care resident's physician or prescribing
practitioner is contacted for verification of orders if the orders are not
signed and dated within seven calendar days prior to admission to the facility
as a respite care resident or for clarification of orders if orders are not
clear or complete.
(f) The facility shall complete an assessment which allows
for the development of a short-term care plan prior to or upon admission to the
facility with input from the resident or responsible person. The assessment
shall address respite resident needs, including identifying information,
hearing, vision, cognitive ability, functional limitations, continence, special
procedures and treatments as ordered by physician, skin conditions, behavior
and mood, oral and nutritional status and medication regimen. The facility may
use the Resident Register or an equivalent as the assessment instrument. The
care plan shall be signed and dated by the facility's administrator or
designated representative and the respite care resident or responsible person.
(g) The respite care resident's record shall include a copy
of the signed respite care contract; the FL-2; the assessment and care plan;
documentation of a tuberculosis test according to Paragraph (e) of this Rule;
documentation of any contacts (office, home or telephone) with the resident's
physician or other licensed health professionals from outside the facility;
physician orders; medication administration records; a statement, signed and
dated by the resident or responsible person, indicating that information on the
home as required in Rule .0704 of this Subchapter has been received; a written
description of any acute changes in the resident's condition or any incidents
or accidents resulting in injury to the respite care resident, and any action
taken by the facility in response to the changes, incidents or accidents; and
how the responsible person or his designated representative can be contacted
in case of an emergency.
(h) The respite care resident's responsible person or his
designated representative shall be contacted and informed of the need to remove
the resident from the facility if one or more of the following conditions exists:
(1) the resident's condition is such that he is
a danger to himself or poses a direct threat to the health of others as
documented by a physician; or
(2) the safety of individuals in the home is
threatened by the behavior of the resident as documented by the facility.
Documentation of the emergency discharge shall be on file in
the facility.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
2000-50; 2002-0160; 2003-0284;
Temporary Adoption Eff. November 1, 2000;
Eff. July 18, 2002;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13G .0908 COOPERATION WITH CASE MANAGERS
The administrator shall cooperate with and assure the
cooperation of facility staff with case managers in their provision of case
management services to the appropriate residents.
History Note: Authority G.S. 131D-2; 131D-4.3;
143B-153;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997.
10A NCAC 13G .0909 RESIDENT RIGHTS
A family care home shall assure that the rights of all
residents guaranteed under G.S. 131D-21, Declaration of Residents' Rights, are
maintained and may be exercised without hindrance.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
2002-0160; 2003-0284;
Temporary Adoption Eff. July 1, 2004;
Eff. July 1, 2005.
SECTION .1000 – MEDICATIONS
10A NCAC 13G .1001 MEDICATION ADMINISTRATION POLICIES AND
PROCEDURES
In addition to the requirements in Rule .1211(a)(1) of this
Subchapter, a family care home shall ensure the following:
(1) orientation to medication policies and procedures
for staff responsible for medication administration prior to their
administering or supervising the administration of medications; and
(2) compliance of medication policies and procedures
with requirements of this Section and all applicable state and federal
regulations, including definitions in the North Carolina Pharmacy Practice Act,
G.S. 90-85.3.
For the purposes of this Subchapter, medications include
herbal and non-herbal supplements.
History Note: Authority G.S. 131D-2; 131D-4.5; 143B-165;
S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Amended Eff. July 1, 2005.
10A NCAC 13G .1002 MEDICATION ORDERS
(a) A family care home shall ensure contact with the
resident's physician or prescribing practitioner for verification or
clarification of orders for medications and treatments:
(1) if orders for admission or readmission of
the resident are not dated and signed within 24 hours of admission or
readmission to the facility;
(2) if orders are not clear or complete; or
(3) if multiple admission forms are received
upon admission or readmission and orders on the forms are not the same.
The facility shall ensure that this verification or
clarification is documented in the resident's record.
(b) All orders for medications, prescription and
non-prescription, and treatments shall be maintained in the resident's record
in the facility.
(c) The medication orders shall be complete and include the
following:
(1) medication name;
(2) strength of medication;
(3) dosage of medication to be administered;
(4) route of administration;
(5) specific directions of use, including frequency
of administration; and
(6) if ordered on an as needed basis, a stated
indication for use.
(d) Verbal orders for medications and treatments shall be:
(1) countersigned by the prescribing
practitioner within 15 days from the date the order is given;
(2) signed or initialed and dated by the person
receiving the order; and
(3) accepted only by a licensed professional
authorized by state occupational licensure laws to accept orders or staff
responsible for medication administration.
(e) Any standing orders shall be for individual residents
and signed and dated by the resident's physician or prescribing practitioner.
(f) The facility shall assure that all current orders for
medications or treatments, including standing orders and orders for
self-administration, are reviewed and signed by the resident's physician or
prescribing practitioner at least every six months.
(g) In addition to the requirements as stated in Paragraph
(c) of this Rule, psychotropic medications ordered "as needed" by a
prescribing practitioner, shall not be administered unless the following have
been provided by the practitioner or included in an individualized care plan
developed with input by a registered nurse or licensed pharmacist:
(1) detailed behavior-specific written
instructions, including symptoms that might require use of the medication;
(2) exact dosage;
(3) exact time frames between dosages; and
(4) the maximum dosage to be administered in a
twenty-four hour period.
(h) The facility shall assure that personal care aides and
their direct supervisors receive training annually about the desired and
undesired effects of psychotropic medications, including alternative behavior
interventions. Documentation of training attended by staff shall be maintained
in the facility.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Amended Eff. July 1, 2005.
10A NCAC 13G .1003 MEDICATION LABELS
(a) Labeling of prescription legend medications, except for
medications prepared for a resident's leave of absence in accordance with Rule .1010(d)(4)
of this Section, shall be legible and include the following information:
(1) the name of the resident for whom the
medication is prescribed;
(2) the most recent date of issuance;
(3) the name of the prescriber;
(4) the name and concentration of the
medication, quantity dispensed, and prescription serial number;
(5) unabbreviated directions for use stated;
(6) a statement of generic equivalency shall be
indicated if a brand other than the brand prescribed is dispensed;
(7) the expiration date, unless dispensed in a
single unit or unit dose package that already has an expiration date;
(8) auxiliary information as required of the
medication;
(9) the name, address, and telephone number of
the dispensing pharmacy; and
(10) the name or initials of the dispensing
pharmacist.
(b) For medication systems in which two or more prescribed
solid oral dosage forms are packaged and dispensed together, labeling shall be
in accordance with Paragraph (a) of this Rule and the label or package shall
also have a physical description or identification of each medication contained
in the package.
(c) The facility shall assure any changes in directions of
a resident's medication by the prescriber are on the container at the refilling
of the medication by the pharmacist or dispensing practitioner. The facility
shall have a procedure for identifying direction changes until the container is
correctly labeled in accordance with Paragraph (a) of this Rule. No person
other than a licensed pharmacist or dispensing practitioner shall alter a
prescription label.
(d) Non-prescription medications shall have the
manufacturer's label with the expiration date visible, unless the container has
been labeled by a licensed pharmacist or a dispensing practitioner in
accordance with Paragraph (a) of this Rule. Non-prescription medications in
the original manufacturer's container shall be labeled with at least the
resident's name and the name shall not obstruct any of the information on the
container. Facility staff may label or write the resident's name on the
container.
(e) Medications, prescription and non-prescription, shall
not be transferred from one container to another except when prepared for a
resident's leave of absence or administration to a resident.
History Note: Authority G.S. 131D-2.16; 131D-4.5;
143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Amended Eff. April 1, 2015.
10A NCAC 13G .1004 MEDICATION ADMINISTRATION
(a) A family care home shall assure that the preparation
and administration of medications, prescription and non-prescription and
treatments by staff are in accordance with:
(1) orders by a licensed prescribing
practitioner which are maintained in the resident's record; and
(2) rules in this Section and the facility's
policies and procedures.
(b) The facility shall assure that only staff meeting the
requirements in Rule .0403 of this Subchapter shall administer medications,
including the preparation of medications for administration.
(c) Only oral solid medications that are ordered for
routine administration may be prepared in advance and must be prepared within
24 hours of the prescribed time for administration. Medications prescribed for
prn (as needed) administration shall not be prepared in advance.
(d) Liquid medications, including powders or granules that
require to be mixed with liquids for administration, and medications for
injection shall be prepared immediately before administration to a resident.
(e) Medications shall not be crushed for administration
until immediately before the medications are administered to the resident.
(f) If medications are prepared for administration in
advance, the following procedures shall be implemented to keep the drugs
identified up to the point of administration and protect them from
contamination and spillage:
(1) Medications are dispensed in a sealed
package such as unit dose and multi-paks that is labeled with the name of each
medication and strength in the sealed package. The labeled package of
medications is to remain unopened and kept enclosed in a capped or sealed
container that is labeled with the resident's name, until the medications are
administered to the resident. If the multi-pak is also labeled with the
resident's name, it does not have to be enclosed in a capped or sealed
container;
(2) Medications not dispensed in a sealed and
labeled package as specified in Subparagraph (1) of this Paragraph are kept
enclosed in a sealed container that identifies the name and strength of each
medication prepared and the resident's name;
(3) A separate container is used for each
resident and each planned administration of the medications and labeled
according to Subparagraph (1) or (2) of this Paragraph; and
(4) All containers are placed together on a
separate tray or other device that is labeled with the planned time for
administration and stored in a locked area which is only accessible to staff as
specified in Rule .1006(d) of this Section.
(g) The facility shall ensure that medications are
administered within one hour before or one hour after the prescribed or
scheduled time unless precluded by emergency situations.
(h) If medications are not prepared and administered by the
same staff person, there shall be documentation for each dose of medication
prepared for administration by the staff person who prepared the medications
when or at the time the resident's medication is prepared. Procedures shall be
established and implemented to identify the staff person who prepared the
medication and the staff person who administered the medication.
(i) The recording of the administration on the medication
administration record shall be by the staff person who administers the
medication immediately following administration of the medication to the
resident and observation of the resident actually taking the medication and
prior to the administration of another resident's medication. Pre-charting is
prohibited.
(j) The resident's medication administration record (MAR)
shall be accurate and include the following:
(1) resident's name;
(2) name of the medication or treatment order;
(3) strength and dosage or quantity of
medication administered;
(4) instructions for administering the
medication or treatment;
(5) reason or justification for the
administration of medications or treatments as needed (PRN) and documenting the
resulting effect on the resident;
(6) date and time of administration;
(7) documentation of any omission of
medications or treatments and the reason for the omission, including refusals;
and
(8) name or initials of the person
administering the medication or treatment. If initials are used, a signature
equivalent to those initials is to be documented and maintained with the
medication administration record (MAR).
(k) The facility shall have a system in place to ensure the
resident is identified prior to the administration of any medication or
treatment.
(l) The facility shall assure the development and
implementation of policies and procedures governing medication errors and
adverse medication reactions that include documentation of the following:
(1) notification of a physician or appropriate
health professional and supervisor;
(2) action taken by the facility according to
orders by the physician or appropriate health professional; and
(3) charting or documentation errors,
unavailability of a medication, resident refusal of medication, any adverse
medication reactions and notification of the resident's physician when
necessary.
(m) Medication administration supplies, such as graduated
measuring devices, shall be available and used by facility staff in order for
medications to be accurately and safely administered.
(n) The facility shall assure that medications are
administered in accordance with infection control measures that help to prevent
the development and transmission of disease or infection, prevent
cross-contamination and provide a safe and sanitary environment for staff and
residents.
(o) A resident's medication shall not be administered to
another resident except in an emergency. In the event of an emergency, the
borrowed medications shall be replaced promptly and that the borrowing and
replacement of the medication shall be documented.
(p) Only oral, topical (including ophthalmic and otic
medications), inhalants, rectal and vaginal medications, subcutaneous
injections and medications administered by gastrostomy tube and nebulizers may
be administered by persons who are not authorized by state occupational
licensure laws to administer medication.
(q) Unlicensed staff may not administer insulin or other
subcutaneous injections prior to meeting the requirements for training and
competency validation as stated in Rules .0504 and .0505 of this Subchapter.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Amended Eff. July 1, 2005.
10A NCAC 13G .1005 SELF-ADMINISTRATION OF MEDICATIONS
(a) The facility shall permit residents who are competent
and physically able to self-administer to self-administer their medications if
the following requirements are met:
(1) the self-administration is ordered by a
physician or other person legally authorized to prescribe medications in North
Carolina and documented in the resident's record; and
(2) specific instructions for administration of
prescription medications are printed on the medication label.
(b) When there is a change in the resident's mental
or physical ability to self-administer or resident non-compliance with
the physician's orders or the facility's medication policies and procedures,
the facility shall notify the physician. A resident's right to refuse
medications does not imply the inability of the resident to self-administer
medications.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10a NCAC 13G .1006 MEDICATION STORAGE
(a) Medications that are self-administered and stored in
the resident's room shall be stored in a safe and secure manner as specified in
the facility's medication storage policy and procedures.
(b) All prescription and non-prescription medications stored
by the facility, including those requiring refrigeration, shall be maintained
in a safe manner under locked security except when under the immediate or
direct physical supervision of staff in charge of medication administration.
(c) The medication storage area shall be clean,
well-lighted, well-ventilated, large enough to store medications in an orderly
manner, and located in areas other than the bathroom, kitchen or utility room.
Medication carts shall be clean and medications shall be stored in an orderly
manner.
(d) Accessibility to locked storage areas for medications
shall only be by staff responsible for medication administration and
administrator or person in charge.
(e) Medications intended for topical or external use,
except for ophthalmic, otic and transdermal medications, shall be stored in a
designated area separate from the medications intended for oral and injectable
use. Ophthalmic, otic and transdermal medications may be stored with
medications intended for oral and injectable use. Medications shall be stored
apart from cleaning agents and hazardous chemicals.
(f) Medications requiring refrigeration shall be stored at
36 degrees F to 46 degrees F (2 degrees C to 8 degrees C).
(g) Medications shall not be stored in a refrigerator
containing non-medications and non-medication related items, except when stored
in a separate container. The container shall be locked when storing
medications unless the refrigerator is locked or is located in a locked
medication area.
(h) The facility shall only possess a stock of
non-prescription medications or the following prescription legend medications
for general or common use:
(1) irrigation solutions in single unit
quantities exceeding 49 ml. and related diagnostic agents;
(2) diagnostic agents;
(3) vaccines; and
(4) water for injection and normal saline for
injection.
Note: A prescribing practitioner's order is required for
the administration of any medication as stated in Rule .1004 (a) of this
Section.
(i) First aid supplies shall be immediately available,
stored out of sight of residents and visitors and stored separately in a secure
and orderly manner.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13G .1007 MEDICATION DISPOSITION
(a) Medications shall be released to or with a resident
upon discharge if the resident has a physician's order to continue the
medication. Prescribed medications are the property of the resident and shall
not be given to, or taken by, other staff or residents according to Rule
.1004(o) of this Subchapter.
(b) Medications, excluding controlled medications, that are
expired, discontinued, prescribed for a deceased resident or deteriorated shall
be stored separately from actively used medications until disposed of.
(c) Medications, excluding controlled medications,
shall be destroyed at the facility or returned to a pharmacy within 90
days of the expiration or discontinuation of medication or following the death
of the resident.
(d) All medications destroyed at the facility shall be
destroyed by the administrator or the administrator's designee and witnessed by
a pharmacist, a dispensing practitioner, or their designee. The destruction
shall be conducted so that no person can use, administer, sell or give away the
medication.
(e) Records of medications destroyed or returned to the
pharmacy shall include the resident's name, the name and strength of the
medication, the amount destroyed or returned, the method of destruction if
destroyed in the facility and the signature of the administrator or the
administrator's designee and the signature of the pharmacist, dispensing
practitioner or their designee. These records shall be maintained by the
facility for a minimum of one year.
(f) A dose of any medication prepared for administration
and accidentally contaminated or not administered shall be destroyed at the
facility according to the facility's policies and procedures.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13G .1008 CONTROLLED SUBSTANCES
(a) A family care home shall assure a readily retrievable
record of controlled substances by documenting the receipt, administration and
disposition of controlled substances. These records shall be maintained with
the resident's record and in such an order that there can be accurate
reconciliation.
(b) Controlled substances may be stored together in a
common location or container. If Schedule II medications are stored together
in a common location, the Schedule II medications shall be under double lock.
(c) Controlled substances that are expired, discontinued or
no longer required for a resident shall be returned to the pharmacy within 90
days of the expiration or discontinuation of the controlled substance or
following the death of the resident. The facility shall document the
resident's name; the name, strength and dosage form of the controlled
substance; and the amount returned. There shall also be documentation by the
pharmacy of the receipt or return of the controlled substances.
(d) If the pharmacy will not accept the return of a
controlled substance, the administrator or the administrator's designee shall
destroy the controlled substance within 90 days of the expiration or
discontinuation of the controlled substance or following the death of the
resident. The destruction shall be witnessed by a licensed pharmacist,
dispensing practitioner, or designee of a licensed pharmacist or dispensing
practitioner. The destruction shall be conducted so that no person can use,
administer, sell or give away the controlled substance. Records of controlled
substances destroyed shall include the resident's name; the name, strength and
dosage form of the controlled substance; the amount destroyed; the method of destruction;
and, the signature of the administrator or the administrator's designee and the
signature of the licensed pharmacist, dispensing practitioner or designee of
the licensed pharmacist or dispensing practitioner.
(e) Records of controlled substances returned to the
pharmacy or destroyed by the facility shall be maintained by the facility for a
minimum of three years.
(f) Controlled substances that are expired, discontinued,
prescribed for a deceased resident or deteriorated shall be stored securely in
a locked area separately from actively used medications until disposed of.
(g) A dose of a controlled substance accidentally
contaminated or not administered shall be destroyed at the facility. The
destruction shall be documented on the medication administration record (MAR)
or the controlled substance record showing the time, date, quantity, manner of
destruction and the initials or signature of the person destroying the
substance.
(h) The facility shall ensure that all known drug
diversions are reported to the pharmacy, the local law enforcement agency and
Health Care Personnel Registry as required by state law and that all suspected
drug diversions are reported to the pharmacy. There shall be documentation of
the contact and action taken.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Amended Eff. July 1, 2005.
10A NCAC 13G .1009 PHARMACEUTICAL CARE
(a) The facility shall obtain the services of a licensed
pharmacist, prescribing practitioner or registered nurse for the provision of
pharmaceutical care at least quarterly for residents or more frequently
as determined by the Department, based on the documentation of significant
medication problems identified during monitoring visits or other
investigations in which the safety of the residents may be at risk.
Pharmaceutical care involves the identification, prevention and resolution of
medication related problems which includes at least the following:
(1) an on-site medication review for each
resident which includes at least the following:
(A) the review of information in the resident's record
such as diagnoses, history and physical, discharge summary, vital signs,
physician's orders, progress notes, laboratory values and medication
administration records, including current medication administration records, to
determine that medications are administered as prescribed and ensure that any
undesired side effects, potential and actual medication reactions or
interactions, and medication errors are identified and reported to the
appropriate prescribing practitioner; and,
(B) making recommendations for change, if necessary,
based on desired medication outcomes and ensuring that the appropriate
prescribing practitioner is so informed; and,
(C) documenting the results of the medication review in
the resident's record;
(2) review of all aspects of medication
administration including the observation or review of procedures for the
administration of medications and inspection of medication storage areas;
(3) review of the medication system utilized by
the facility, including packaging, labeling and availability of medications;
(4) review the facility's procedures and
records for the disposition of medications and provide assistance, if
necessary;
(5) provision of a written report of findings
and any recommendations for change for Items (1) through (4) of Paragraph (a)
of this Rule to the facility and the physician or appropriate health
professional, when necessary;
(6) conducting in-service programs as needed for
facility staff on medication usage that includes, but not limited to the
following:
(A) potential or current medication related problems
identified;
(B) new medications;
(C) side effects and medication interactions; and
(D) policies and procedures.
(b) The facility shall assure action is taken as needed in
response to the medication review and documented, including that the physician
or appropriate health professional has been informed of the
findings when necessary.
(c) The facility shall maintain the findings and reports
resulting from the activities in Subparagraphs (1) through (6) of Paragraph (a)
of this Rule in the facility, including action taken by the facility.
History Note: Authority G.S. 131D-2; 131D-4.5;
143B-165; S.L. 1999-0334;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13G .1010 PHARMACEUTICAL SERVICES
(a) A family care home shall allow the residents the right
to choose a pharmacy provider as long as the pharmacy provides services that
are in accordance with requirements of this Section and all applicable state
and federal regulations and the facility's medication management policies and
procedures.
(b) There shall be a current, written agreement with a
licensed pharmacist or a prescribing practitioner for pharmaceutical care
services in accordance with Rule .1009 of this Section. The written agreement
shall include a statement of the responsibility of each party.
(c) The facility shall assure the provision of
pharmaceutical services to meet the needs of the residents including procedures
that assure the accurate ordering, receiving and administering of all
medications prescribed on a routine, emergency, or as needed basis.
(d) The facility shall assure the provision of medication
for residents on temporary leave from the facility or involved in day
activities out of the facility. The facility shall have written policies and
procedures for a resident's temporary leave of absence. The policies and
procedures shall facilitate safe administration by assuring that upon receipt
of the medication for a leave of absence the resident or the person
accompanying the resident is able to identify the medication, dosage, and
administration time for each medication provided for the temporary leave of absence.
The policies and procedures shall include at least the following provisions:
(1) The amount of resident's medications
provided shall be sufficient and necessary to cover the duration of the
resident's absence. For the purposes of this Rule, sufficient and necessary
means the amount of medication to be administered during the leave of absence
or only a current dose pack, card, or container if the current dose pack, card,
or container has enough medication for the planned absence;
(2) Written and verbal instructions for each
medication to be released for the resident's absence shall be provided to the
resident or the person accompanying the resident upon the medication's release
from the facility and shall include at least:
(A) the name and strength of the medication;
(B) the directions for administration as prescribed by
the resident's physician;
(C) any cautionary information from the original
prescription package if the information is not on the container released for
the leave of absence;
(3) The resident's medications shall be
provided in a capped or closed container that will protect the medications from
contamination and spillage; and
(4) Labeling of each of the resident's
individual medication containers for the leave of absence shall be legible,
include at least the name of the resident and the name and strength of the
medication, and be affixed to each container.
The facility shall maintain documentation in the resident's
record of medications provided for the resident's leave of absence, including
the quantity released from the facility and the quantity returned to the
facility. The documentation of the quantities of medications released from and
returned to the facility for a resident's leave of absence shall be verified by
signature of the facility staff and resident or the person accompanying the
resident upon the medications’ release from and return to the facility.
(e) The facility shall assure that accurate records of the
receipt, use, and disposition of medications are maintained in the facility and
available upon request for review.
History Note: Authority G.S. 131D-2.16; 131D-4.5;
143B-165;
Eff. July 1, 2005;
Amended Eff. April 1, 2015.
SECTION .1100 – management of resident's funds and refunds
10A NCAC 13G .1101 management of RESIDENT'S FUNDS
(a) Residents shall manage their own funds if possible.
(b) In situations where a resident is unable to manage his
funds, a legal representative or payee shall be designated in accordance with
Rule .1102 of this Section.
(c) Residents shall endorse checks made out to them unless
a legal representative or payee has been authorized to endorse checks.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984.
10A NCAC 13G .1102 LEGAL REPRESENTATIVE OR PAYEE
(a) In situations where a resident of a family care home is
unable to manage his funds, the administrator shall contact a family member or
the county department of social services regarding the need for a legal
representative or payee. The administrator and other staff of the home shall
not serve as a resident's legal representative, payee, or executor of a will,
except as indicated in Paragraph (b) of this Rule.
(b) In the case of funds administered by the Social
Security Administration, the Veteran's Administration or other federal
government agencies, the administrator of the home may serve as a payee when so
authorized as a legally constituted authority by the respective federal
agencies.
(c) The administrator shall give the resident's legal
representative or payee receipts for any monies received on behalf of the
resident.
History Note: Authority G.S. 35A-1203; 108A-37; 131D-2;
143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984.
10A NCAC 13G .1103 ACCOUNTING FOR resident's PERSONAL FUNDS
(a) To document a resident's receipt of the State-County
Special Assistance personal needs allowance after payment of the cost of care,
a statement shall be signed by the resident or marked by the resident with two
witnesses' signatures. The statement shall be maintained in the home.
(b) Upon the written authorization of the resident or his
legal representative or payee, an administrator or the administrator's designee
may handle the personal money for a resident, provided an accurate accounting
of monies received and disbursed and the balance on hand is available upon
request of the resident or his legal representative or payee.
(c) A record of each transaction involving the use of the
resident's personal funds according to Paragraph (b) of this Rule shall be
signed by the resident, legal representative or payee or marked by the
resident, if not adjudicated incompetent, with two witnesses' signatures at
least monthly verifying the accuracy of the disbursement of personal funds. The
record shall be maintained in the home.
(d) A resident's personal funds shall not be commingled
with facility funds. The facility shall not commingle the personal funds of residents
in an interest-bearing account.
(e) All or any portion of a resident's personal funds shall
be available to the resident or his legal representative or payee upon request
during regular office hours, except as provided in Rule .1105 of this
Subchapter.
(f) The resident's personal needs allowance shall be
credited to the resident's account within 24 hours of the check being deposited
following endorsement.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. April 1, 1984;
Amended Eff. July 1, 2005; April 1, 1987.
10A NCAC 13G .1104 REFUND POLICy
A family care home's refund policy shall be in writing and
signed by the administrator. A copy shall be given to the resident or the
resident's responsible person at time of admission. A copy shall also be filed
in the resident's record.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; July 1, 1990.
10A NCAC 13G .1105 refund of PERSONAL FUNDS
(a) When the administrator or the administrator's designee
handles a resident's personal money at the resident's or his payee's request,
the balance shall be given to the resident or the resident's responsible person
within 14 days of the resident's leaving a family care home.
(b) If a resident dies, the administrator of his estate or
the Clerk of Superior Court, when no administrator for his estate has been
appointed, shall be given all of his personal funds within 30 days after death.
History Note: Authority G.S. 131D‑2; 143B‑165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1984.
10A NCAC 13G .1106 SETTLEMENT OF COST OF CARE
(a) If a resident of a family care home, after being
notified by the home of its intent to discharge the resident in accordance with
Rule .0705 of this Subchapter, moves out of the home before the period of time
specified in the notice has elapsed, the home shall refund the resident an
amount equal to the cost of care for the remainder of the month minus any
nights spent in the home during the notice period. The refund shall be made
within 14 days after the resident leaves the home.
(b) If a resident moves out of the home without giving
notice, as may be required by the home according to Rule .0705(h) of this
Subchapter, or before the home's required notice period has elapsed, the
resident owes the home an amount equal to the cost of care for the required
notice period. If a resident receiving State‑County Special Assistance
moves without giving notice or before the notice period has elapsed, the former
home is entitled to the required payment for the notice period before the new
home receives any payment. The home shall refund the resident the remainder of
any advance payment following settlement of the cost of care. The refund shall
be made within 14 days from the date of notice or, if no notice is given,
within 14 days of the resident leaving the home.
(c) When there is an exception to the notice as provided in
Rule .0705(h) of this Subchapter to protect the health or safety of the
resident or others in the home, the resident is only required to pay for any
nights spent in the home. A refund shall be made to the resident by the home
within 14 days from the date of notice.
(d) When a resident gives notice of leaving the home, as
may be required by the home according to Rule .0705(h) of this Subchapter, and
leaves at the end of the notice period, the home shall refund the resident the
remainder of any advance payment within 14 days from the date of notice. If
notice is not required by the home, the refund shall be made within 14 days
after the resident leaves the home.
(e) When a resident leaves the home with the intent of
returning to it, the following apply:
(1) The home may reserve the resident's bed for
a set number of days with the written agreement of the home and the resident or
his responsible person and thereby require payment for the days the bed is
held.
(2) If, after leaving the home, the resident
decides not to return to it, the resident or someone acting on his behalf may
be required by the home to provide up to a 14-day written notice that he is not
returning.
(3) Requirement of a notice, if it is to be
applied by the home, shall be a part of the written agreement and explained by
the home to the resident and his family or responsible person before signing.
(4) On notice by the resident or someone acting
on his behalf that he will not be returning to the home, the home shall refund
the remainder of any advance payment to the resident or his responsible person,
minus an amount equal to the cost of care for the period covered by the
agreement. The refund shall be made within 14 days after notification that the
resident will not be returning to the home.
(5) In no situation involving a recipient of
State‑County Special Assistance may a home require payment for more than
30 days since State‑County Special Assistance is not authorized unless
the resident is actually residing in the home or it is anticipated that he will
return to the home within 30 days.
(6) Exceptions to the two weeks' notice, if
required by the home, are cases where returning to the home would jeopardize
the health or safety of the resident or others in the home as certified by the
resident's physician or approved by the county department of social services,
and in the case of the resident's death. In these cases, the home shall refund
the rest of any advance payment calculated beginning with the day the home is
notified.
(f) If a resident dies, the administrator of his estate or
the Clerk of Superior Court, when no administrator for his estate has been
appointed, shall be given a refund equal to the cost of care for the month
minus any nights spent in the home during the month. This is to be done within
30 days after the resident's death.
History Note: Authority G.S. 131D‑2; 131D-4.5;
143B‑165; S.L. 99-0334;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; June 1, 1987; April 1, 1984;
Temporary Amendment Eff. January 1, 2001;
Temporary Amendment Expired October 13, 2001;
Amended Eff. July 1, 2005.
SECTION .1200 – policies, RECORDS AND REPORTS
10A NCAC 13G .1201 RESIDENT RECORDS
(a) The following shall be maintained on each resident in
an orderly manner in the resident's record in the family care home and made
available for review by representatives of the Division of Health Service
Regulation and county departments of social services.
(1) FL-2 or MR-2 Forms and patient transfer
form or hospital discharge summary, when applicable;
(2) Resident Register;
(3) receipt for the following as required in Rule
.0704 of this Subchapter:
(A) contract for services, accommodations and rates;
(B) house rules as specified in Rule .0704(2) of this
Subchapter;
(C) Declaration of Residents' Rights (G.S. 131D-21);
(D) home's grievance procedures; and
(E) civil rights statement;
(4) resident assessment and care plan;
(5) contacts with the resident's physician,
physician service or other licensed health professional as required in Rule
.0902 of this Subchapter;
(6) orders or written treatments or procedures
from a physician or other licensed health professional and their
implementation;
(7) documentation of immunizations against
influenza virus and pneumococcal disease according to G.S. 131D-9 or the reason
the resident did not receive the immunizations based on this law; and
(8) the Adult Care Home Notice of Discharge and
Adult Care Home Hearing Request Form if the resident is being or has been
discharged.
When a resident leaves the facility for a medical
evaluation, records necessary for that medical evaluation such as Items (1),
(4), (5), (6) and (7) above may be sent with the resident.
(b) A resident financial record providing an accurate
accounting of the receipt and disbursement of the resident's personal funds, if
handled by the facility according to Rule .1103 of this Subchapter, shall be
maintained on each resident in an orderly manner in the facility and be readily
available for review by representatives of the Division of Health Service
Regulation and county departments of social services. When there is an
approved cluster of licensed facilities, financial records may be kept in one
location among the clustered facilities
History Note: Authority G.S. 131D‑2; 143B‑165;
S.L. 2002-0160; 2003-0284;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1987; April 1, 1984;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13G .1202 transfer of RESIDENT'S RECORDS
At the request of the resident or his responsible person,
copies of all pertinent information shall be given to the administrator of the
licensed home to which the resident moves. The FL‑2 or MR‑2 shall be
provided unless:
(1) It was completed more than 90 days before the move;
or
(2) There has been an apparent change in the mental or
physical condition of the resident.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1984.
10A NCAC 13G .1203 DISPOSAL OF RESIDENT's RECORDS
After a resident has left a family care home or died, the
resident's records shall be filed in the home for at least one year and then
stored for at least two more years.
History Note: Authority G.S. 131D‑2; 143B-165;
S.L. 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 1987; April 1, 1984.
10A NCAC 13G .1204 report of ADMISSIONs and DISCHARGEs
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. May 1, 1992;
Repealed Eff. July 1, 2005.
10A NCAC 13G .1205 POPULATION REPORT
History Note: Authority G.S. 131D‑2; 143B‑153;
143B-165; S.L. 2002-160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. May 1, 1992; April 1, 1984;
Temporary Repeal Eff. September 1, 2003;
Repealed Eff. June 1, 2004.
10A NCAC 13G .1206 HEALTH CARE PERSONNEL REGISTRY
The facility shall comply with G.S. 131E-256 and supporting
Rules 10A NCAC 13O .1001 and .1002.
History Note: Authority G.S. 131D-2; 131D-4.5;
131E-256; 143B-165; S.L. 1999-0334;
Temporary Adoption Eff. January 1, 2000;
Eff. July 1, 2000.
10A NCAC 13G .1207 ADVERTISING
The administrator may use acceptable methods of advertising
provided:
(1) The name used is as it appears on the license.
(2) Only the services and accommodations for which the
home is licensed are used.
(3) The home is listed under proper classification in
telephone books, newspapers or magazines.
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984.
10a NCAC 13G .1208 facilties to report resident deaths
For purposes of this Section, facilities licensed in
accordance with G.S. 131D-2 shall report resident deaths to the Division of
Health Service Regulation.
History Note: Authority G.S. 131D-2; 131D-34.1;
Temporary Adoption Eff. May 1, 2001;
Eff. July 18, 2002.
10A NCAC 13G .1209 Death REPORTING procedures
(a) Upon learning of a resident death as described in
Paragraphs (b) and (c) of this Rule, a facility shall file a report in
accordance with this Rule. A facility shall be deemed to have learned of a resident
death when any facility staff obtains information that the death occurred.
(b) A written notice containing the information listed
under Paragraph (d) of this Rule shall be made immediately for the following:
(1) a resident death occurring in an adult care
home within seven days of the use of a physical restraint or physical hold on
the resident; or
(2) a resident death occurring within 24 hours
of the resident's transfer from the adult care home to a hospital, if the death
occurred within seven days of physical restraint or physical hold of the
resident.
(c) A written notice containing the information under
Paragraph (d) of this Rule shall be made within three days of any death
resulting from violence, accident, suicide or homicide.
(d) Written notice may be submitted in person or by
telefacsimile or electronic mail. If the reporting facility does not have the
capacity or capability to submit a written notice immediately, the information
contained in the notice may be reported by telephone following the same time
requirements under Subparagraphs (b) and (c) of this Rule until such time the
written notice may be submitted. The notice shall include at least the
following information:
(1) Reporting facility: Name, address, county,
license number (if applicable), Medicare/Medicaid provider number (if
applicable), facility administrator and telephone number, name and title of
person preparing report, first person to learn of death and first staff to
receive report of death, and date and time report prepared;
(2) Resident information: Name, Medicaid
number (if applicable), date of birth, age, sex, race, primary admitting
diagnoses, and date of most recent admission to an acute care hospital.
(3) Circumstances of death: place and address
where resident died, date and time death was discovered, physical location
decedent was found, cause of death (if known), whether or not decedent was
restrained at the time of death or within 7 days of death and if so, a
description of the type of restraint and its usage, and a description of events
surrounding the death; and
(4) Other information: list of other
authorities such as law enforcement or the County Department of Social Services
that have been notified, have investigated or are in the process of
investigating the death or events related to the death.
(e) The facility shall submit a written report, using a
form pursuant to G.S. 131D-34.1(e). The facility shall provide, fully and
accurately, all information sought on the form. If the facility is unable to
obtain any information sought on the form, or if any such information is not
yet available, the facility shall so explain on the form.
(f) In addition, the facility shall:
(1) Notify the Division of Health Service
Regulation immediately whenever it has reason to believe that information
provided may be erroneous, misleading, or otherwise unreliable;
(2) Submit to the Division of Health Service
Regulation, immediately after it becomes available, any information required by
this rule that was previously unavailable; and
(3) Provide, upon request by the Division of
Health Service Regulation, other information the facility obtains regarding the
death, including, but not limited to, death certificates, autopsy reports, and
reports by other authorities.
(g) With regard to any resident death under circumstances
described in G.S. 130A-383, a facility shall notify the appropriate law
enforcement authorities so the medical examiner of the county in which the body
is found may be notified. Documentation of such notification shall be
maintained by the facility and be made available for review by the Division
upon request.
(h) In deaths not under the jurisdiction of the medical
examiner, the facility shall notify the decedent's next-of-kin, or other
individual authorized according to G.S. 130A-398, that an autopsy may be
requested as designated in G.S. 130A-389.
History Note: Authority G.S. 131D-2; 131D-34.1;
Temporary Adoption Eff. May 1, 2001;
Eff. July 18, 2002.
10A NCAC 13G .1210 DEFINITIONS applicable to death
reporting
The following definitions shall apply throughout this
Section:
(1) "Accident" means an unexpected,
unnatural or irregular event contributing to a resident's death and includes,
but is not limited to, medication errors, falls, fractures, choking, elopement,
exposure, poisoning, drowning, fire, burns, or thermal injury, electrocution,
misuse of equipment, motor vehicle accidents, and natural disasters.
(2) "Immediately" means at once, at
or near the present time, without delay.
(3) "Violence" means physical force
exerted for the purpose of violating, damaging, abusing or injuring. or abusing
another person .
History Note: Authority G.S. 131D-2; 131D-34.1;
Temporary Adoption Eff. May 1, 2001;
Eff. July 18, 2002.
10A NCAC 13G .1211 WRITTEN POLICIES AND PROCEDURES
(a) A family care home shall develop written policies and
procedures that comply with applicable rules of this Subchapter, on the
following:
(1) ordering, receiving, storage,
discontinuation, disposition, administration, including self-administration,
and monitoring the resident's reaction to medications, as developed in
consultation with a licensed health professional who is authorized to dispense
or administer medications;
(2) use of alternatives to physical restraints
and the care of residents who are physically restrained, as developed in
consultation with a registered nurse;
(3) accident, fire safety and emergency
procedures;
(4) infection control;
(5) refunds;
(6) missing resident;
(7) identification and supervision of wandering
residents;
(8) management of physical aggression or
assault by a resident;
(9) handling of resident grievances;
(10) visitation in the facility by guests; and
(11) smoking and alcohol use.
(b) In addition to other training and orientation
requirements in this Subchapter, all staff shall be trained within 30 days of
hire on the policies and procedures listed as Subparagraphs (3), (4), (6), (7),
(8), (9), (10) and (11) in Paragraph (a) of this Rule.
(c) Policies and procedures on which staff have been
trained shall be available within the facility to staff for their reference.
History Note: Authority 131D –2; 143B-165; S.L.
2002-0160; 2003-0284;
Temporary Adoption Eff. July 1, 2004;
Temporary Adoption Expired March 12, 2005;
Eff. June 1, 2005.
10A NCAC 13G .1212 RECORD OF STAFF QUALIFICATIONS
A family care home shall maintain records of staff
qualifications required by the rules in Section .0400 of this Subchapter in the
facility. When there is an approved cluster of licensed facilities, these
records may be kept in one location among the clustered facilities.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
2002-0160; 2003-0284;
Temporary Adoption Eff. July 1, 2004;
Eff. July 1, 2005.
10A NCAC 13G .1213 REPORTING OF ACCIDENTS AND INCIDENTS
(a) A family care home shall notify the county department
of social services of any accident or incident resulting in resident death or
any accident or incident resulting in injury to a resident requiring referral
for emergency evaluation, hospitalization, or medical treatment other than
first aid.
(b) Notification as required in Paragraph (a) of this Rule
shall be by a copy of the death report completed according to Rule .1208 of
this Subchapter or a written report that shall provide the following
information:
(1) resident's name;
(2) name of staff who discovered the accident
or incident;
(3) name of the person preparing the report;
(4) how, when and where the accident or
incident occurred;
(5) nature of the injury;
(6) what was done for the resident, including
any follow-up care;
(7) time of notification or attempts at
notification of the resident's responsible person or contact person as required
in Paragraph (e) of this Rule; and
(8) signature of the administrator or
administrator-in-charge.
(c) The report as required in Paragraph (b) of this Rule
shall be submitted to the county department of social services by mail,
telefacsimile, electronic mail, or in person within 48 hours of the initial discovery
or knowledge by staff of the accident or incident.
(d) The facility shall immediately notify the county
department of social services in accordance with G.S. 108A-102 and the local
law enforcement authority as required by law of any mental or physical abuse,
neglect or exploitation of a resident.
(e) The facility shall assure the notification of a
resident's responsible person or contact person, as indicated on the Resident
Register, of the following, unless the resident or his responsible person or
contact person objects to such notification:
(1) any injury to or illness of the resident
requiring medical treatment or referral for emergency medical evaluation, with
notification to be as soon as possible but no later than 24 hours from the time
of the initial discovery or knowledge of the injury or illness by staff and
documented in the resident's file; and
(2) any incident of the resident falling or
elopement which does not result in injury requiring medical treatment or
referral for emergency medical evaluation, with notification to be as soon as
possible but not later than 48 hours from the time of initial discovery or
knowledge of the incident by staff and documented in the resident's file,
except for elopement requiring immediate notification according to Rule
.0906(f)(4) of this Subchapter.
(f) When a resident is at risk that death or physical harm
will occur as a result of physical violence by another person, the facility
shall immediately report the situation to the local law enforcement authority.
(g) In the case of physical assault by a resident or
whenever there is a risk that death or physical harm will occur due to the
actions or behavior of a resident, the facility shall immediately:
(1) seek the assistance of the local law
enforcement authority;
(2) provide additional supervision of the
threatening resident to protect others from harm;
(3) seek any needed emergency medical
treatment;
(4) make a referral to the Local Management
Entity for Mental Health Services or mental health provider for emergency
treatment of the threatening resident; and
(5) cooperate with assessment personnel
assigned to the case by the Local Management Entity for Mental Health Services
or mental health provider to enable them to provide their earliest possible
assessment.
(h) The facility shall immediately report any assault
resulting in harm to a resident or other person in the facility to the local
law enforcement authority.
History Note: Authority G.S. 131D-2; 143B-165;
Eff. July 1, 2005.
10A NCAC 13G .1214 AVAILABILITY OF CORRECTIVE ACTION AND
SURVEY REPORTS
A family care home shall make available within the facility,
upon request, corrective action reports by the county departments of social
services and facility survey reports by state licensure consultants that have
been approved by the Adult Care Licensure Section of the Division of Health
Service Regulation within the past 12 months to residents and their families or
responsible persons and to prospective residents and their families or
responsible persons.
History Note: Authority 131D-2; 143B-165;
Eff. July 1, 2005.
section .1300 - use of physical restraints and alternatives
10A NCAC 13G .1301 USE OF PHYSICAL RESTRAINTS AND
ALTERNATIVES
(a) A family care home shall assure that a physical
restraint, any physical or mechanical device attached to or adjacent to the
resident's body that the resident cannot remove easily and which restricts
freedom of movement or normal access to one's body, shall be:
(1) used only in those circumstances in which
the resident has medical symptoms that warrant the use of restraints and not
for discipline or convenience purposes;
(2) used only with a written order from a
physician except in emergencies, according to Paragraph (e) of this Rule;
(3) the least restrictive restraint that would
provide safety;
(4) used only after alternatives that would
provide safety to the resident and prevent a potential decline in the resident's
functioning have been tried and documented in the resident's record.
(5) used only after an assessment and care
planning process has been completed, except in emergencies, according to
Paragraph (d) of this Rule;
(6) applied correctly according to the
manufacturer's instructions and the physician's order; and
(7) used in conjunction with alternatives in an
effort to reduce restraint use.
Note: Bed rails are restraints when used to keep a resident
from voluntarily getting out of bed as opposed to enhancing mobility of the
resident while in bed. Examples of restraint alternatives are: providing
restorative care to enhance abilities to stand safely and walk, providing a
device that monitors attempts to rise from chair or bed, placing the bed lower
to the floor, providing frequent staff monitoring with periodic assistance in
toileting and ambulation and offering fluids, providing activities, controlling
pain, providing an environment with minimal noise and confusion, and providing
supportive devices such as wedge cushions.
(b) The facility shall ask the resident or resident's legal
representative if the resident may be restrained based on an order from the
resident's physician. The facility shall inform the resident or legal
representative of the reason for the request and the benefits of restraint use
and the negative outcomes and alternatives to restraint use. The resident or
the resident's legal representative may accept or refuse restraints based on
the information provided. Documentation shall consist of a statement signed by
the resident or the resident's legal representative indicating the signer has
been informed, the signer's acceptance or refusal of restraint use and, if
accepted, the type of restraint to be used and the medical indicators for
restraint use.
Note: Potential negative outcomes of restraint use include
incontinence, decreased range of motion, decreased ability to ambulate,
increased risk of pressure ulcers, symptoms of withdrawal or depression and
reduced social contact.
(c) In addition to the requirements in Rule 13F .0801,
.0802 and .0903 of this Subchapter regarding assessments and care planning, the
resident assessment and care planning prior to application of restraints as
required in Subparagraph (a)(5) of this Rule shall meet the following
requirements:
(1) The assessment and care planning shall be
implemented through a team process with the team consisting of at least a staff
supervisor or personal care aide, a registered nurse, the resident and the
resident's responsible person or legal representative. If the resident or
resident's responsible person or legal representative is unable to participate,
there shall be documentation in the resident's record that they were notified
and declined the invitation or were unable to attend.
(2) The assessment shall include consideration
of the following:
(A) medical symptoms that warrant the use of a
restraint;
(B) how the medical symptoms affect the resident;
(C) when the medical symptoms were first observed;
(D) how often the symptoms occur;
(E) alternatives that have been provided and the
resident's response; and
(F) the least restrictive type of physical restraint
that would provide safety.
(3) The care plan shall include the following:
(A) alternatives and how the alternatives will be used
prior to restraint use and in an effort to reduce restraint time once the
resident is restrained;
(B) the type of restraint to be used; and
(C) care to be provided to the resident during the time
the resident is restrained.
(d) The following applies to the restraint order as required
in Subparagraph (a)(2) of this Rule:
(1) The order shall indicate:
(A) the medical need for the restraint;
(B) the type of restraint to be used;
(C) the period of time the restraint is to be used; and
(D) the time intervals the restraint is to be checked
and released, but no longer than every 30 minutes for checks and two hours for
releases.
(2) If the order is obtained from a physician
other than the resident's physician, the facility shall notify the resident's
physician of the order within seven days.
(3) The restraint order shall be updated by the
resident's physician at least every three months following the initial order.
(4) If the resident's physician changes, the
physician who is to attend the resident shall update and sign the existing order.
(5) In emergency situations, the administrator
or administrator-in-charge shall make the determination relative to the need
for a restraint and its type and duration of use until a physician is
contacted. Contact with a physician shall be made within 24 hours and
documented in the resident's record.
(6) The restraint order shall be kept in the
resident’s record.
(e) All instances of the use of physical restraints and
alternatives shall be documented by the facility in the resident's record and
include the following:
(1) restraint alternatives that were provided
and the resident's response;
(2) type of restraint that was used;
(3) medical symptoms warranting restraint use;
(4) the time the restraint was applied and the
duration of restraint use;
(5) care that was provided to the resident
during restraint use; and
(6) behavior of the resident during restraint
use.
(f) Physical restraints shall be applied only by staff who
have received training according to Rule .0506 of this Subchapter and been
validated on restraint use according to Rule .0504 of this Subchapter.
History Note: Authority G.S. 131D-2; 143B-165; S.L.
2002-0160; 2003-0284;
Temporary Adoption Eff. July 1, 2004;
Temporary Adoption Expired March 12, 2005;
Eff. June 1, 2005.
section .1600 – rated certificates
10A NCAC 13G .1601 SCOPE
(a) This Section applies to all licensed family care homes
for two to six residents that have been in operation for more than one year.
(b) As used in this Section a "rated certificate"
means a certificate issued to a family care home on or after January 1, 2009
and based on the factors contained in G.S. 131D-10.
History Note: Authority G.S. 131D-4.5; 131D-10;
Eff. July 3, 2008.
10A NCAC 13G .1602 ISSUANCE OF RATED CERTIFICATES
(a) A rated certificate shall be issued to a facility by
the Division of Health Service Regulation within 45 days completion of a new
rating calculation pursuant to Rule .1604 of this Subchapter.
(b) If the ownership of the facility changes, the rated
certificate in effect at the time of the change of ownership shall remain in
effect until the next annual survey or until a new certificate is issued
pursuant to Rule .1604(b) of this Subchapter.
(c) The certificate and any worksheet the Division used to
calculate the rated certificate shall be displayed in a location visible to the
public.
(d) The facility may contest the rated certificate by
requesting a contested case hearing pursuant to G.S. 150B. The rated
certificate and any subsequent certificates remain in effect during any
contested case hearing process.
History Note: Authority G.S. 131D-4.5; 131D-10;
Eff. July 3, 2008.
10A NCAC 13G .1603 Statutory and rule requirements
affecting rATED CERTIFICATES
The following Statutes and Rules comprise the standards that
contribute to rated certificates:
(1) G.S. 131D-21 Resident's Rights;
(2) 10A NCAC 13G .0300 The Building;
(3) 10A NCAC 13G .0700 Admission and Discharge
Requirements;
(4) 10A NCAC 13G .0800 Resident Assessment and Care
Plan;
(5) 10A NCAC 13G .0900 Resident Care and Services;
(6) 10A NCAC 13G .1000 Medications; and
(7) 10A NCAC 13G .1300 Use of Physical Restraints and
Alternatives.
History Note: Authority G.S. 131D-4.5; 131D-10;
Eff. July 3, 2008.
10A NCAC 13G .1604 RATING CALCULATION
(a) Ratings shall be based on:
(1) Inspections completed pursuant to G.S.
131D-2(b)(1a)a;
(2) Statutory and Rule requirements listed in
Rule .1603 of this Section;
(3) Type A or uncorrected Type B penalty violations
identified pursuant to G.S. 131D-34; and
(4) Other items listed in Subparagraphs (c)(1)
and (c)(2) of this Rule.
(b) The initial rating a facility receives shall remain in
effect until the next inspection. If an activity occurs which results in the
assignment of additional merit or demerit points, a new certificate shall be
issued pursuant to Rule .1602(a) of this Section.
(c) The rating shall be based on a 100 point scale.
Beginning with the initial rating and repeating with each annual inspection,
the facility shall be assigned 100 points and shall receive merits or demerits,
which shall be added or subtracted from the 100 points, respectively. The
merits and demerits shall be assigned as follows:
(1) Merit Points
(A) If the facility corrects citations of noncompliance
with the statutes or rules listed in Rule .1603 of this Subchapter, which are
not related to the identification of a Type A violation or an uncorrected Type
B violation, the facility shall receive 1.25 merit points for each corrected
deficiency;
(B) If the facility receives citations on its annual
inspection with no Type A or Type B violations and the rating from the annual
inspection is one or zero stars, the facility may request Division of Health
Service Regulation to conduct a follow-up inspection not less than 60 days
after the date of the annual inspection. A follow-up inspection shall be
completed depending upon the availability of Division of Health Service
Regulation staff. As determined by the follow-up review, the facility shall
receive 1.25 merit points for each corrected deficiency;
(C) If the facility corrects the citation for which a Type
A violation was identified, the facility shall receive 2.5 merit points and
shall receive an additional 2.5 merit points following the next annual
inspection if no further Type A violations are identified;
(D) If the facility corrects a previously uncorrected
Type B violation, the facility shall receive 1.25 merit points;
(E) If the facility's admissions have been suspended,
the facility shall receive 5 merit points if the suspension is removed;
(F) If the facility participates in any quality
improvement program pursuant to G.S. 131D-10, the facility shall receive 2.5
merit points;
(G) If the facility receives NC NOVA special licensure
designation, the facility shall receive 2.5 merit points;
(H) On or after the effective date of this Rule, if the
facility permanently installs a generator or has a contract with a generator
provider to provide emergency power for essential functions of the facility,
the facility shall receive 2 merit points. For purposes of this Section,
essential functions mean those functions necessary to maintain the health or
safety of residents during power outages greater than 6 hours. If the facility
has an existing permanently installed generator or an existing contract with a
generator provider, the facility shall receive 1 merit point for maintaining
the generator in working order or continuing the contract with a generator
provider; and
(I) On or after the effective date of this Rule, if
the facility installs automatic sprinklers in compliance with the North
Carolina Building Code, the facility shall receive 3 merit points. If the
facility has an existing automatic sprinkler, the facility shall receive 2
merit points for subsequent ratings for maintaining the automatic sprinklers in
good working order.
(2) Demerit Points
(A) For each citation of noncompliance with the statutes
or rules listed in Rule .1603 of this Subchapter, the facility shall receive a
demerit of 2 points. The facility shall receive demerit points only once for
citations in which the findings are identical to those findings used for
another citation;
(B) For each citation of a Type A violation, the
facility shall receive a demerit of 10 points;
(C) For each citation of a Type B violation, the
facility shall receive a demerit of 3.5 points and if the Type B violation
remains uncorrected as the result of a follow-up inspection, the facility shall
receive an additional demerit of 3.5 points;
(D) If the facility's admissions are suspended, the
facility shall receive a demerit of 10 points; however, if the facility's
admissions are suspended pursuant to G.S. 131D-4.2, the facility shall not
receive any demerit points; and
(E) If the facility receives a notice of revocation
against its license, the facility shall receive demerit of 31 points.
(d) Facilities shall be given a rating of zero to four
stars depending on the score assigned pursuant to Paragraph (a), (b) or (c) of
this Rule. Ratings shall be assigned as follows:
(1) Four stars shall be assigned to any
facility whose score is 100 points or greater on two consecutive annual
inspections;
(2) Three stars shall be assigned for scores of
90 to 99.9 points, or for any facility whose score is 100 points or greater on
one annual inspection;
(3) Two stars shall be assigned for scores of 80
to 89.9 points;
(4) One star shall be assigned for scores of 70
to 79.9 points; and
(5) Zero stars shall be assigned for scores of
69.9 points or lower.
History Note: Authority G.S. 131D-4.5; 131D-10;
Eff. July 3, 2008.
10A NCAC 13G .1605 CONTENTS OF RATED CERTIFICATE
(a) The certificate shall contain a rating determined
pursuant to Rule .1604 of this Subchapter.
(b) The certificate or accompanying worksheet from which
the score is derived shall contain a breakdown of the point merits and demerits
by the factors listed in Rules .1603 and .1604(c) of this Subchapter in a
manner that the public can determine how the rating was assigned and the
factors that contributed to the rating.
(c) The certificate shall be printed on the same type of
paper that is used to print the facility's license.
(d) The Division of Health Service Regulation shall issue
the certificate pursuant to Rule .1602 of this Subchapter.
History Note: Authority G.S. 131D-4.5; 131D-10;
Eff. July 3, 2008.
