subchapter 13f – licensing of adult care homes of seven or more beds
section .0100 - definitions
10A NCAC 13F .0101 DEFINITIONS
History Note: Authority G.S. 131D‑2; 143B‑153;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Repealed Eff. July 1, 2005.
10A NCAC 13F .0102 LISt of definitions
As used in this Subchapter, the following definitions shall apply:
(1) "Abuse" means the term as defined in G.S. 131D-2.1.
(2) "Activities of daily living" or "ADL's" means eating, dressing, bathing, toileting, bowel and bladder control, transfers, ambulation, and communication.
(3) "Acute care needs" means symptoms or a condition that develops quickly and is not a part of the resident's baseline health or mental health status or is a change or worsening in the symptoms of a resident's chronic condition, which may have a slower onset and worsen over time.
(4) "Administrator" means the term as defined in G.S. 90-288.13 and G.S. 131D-2.1.
(5) "Adult care home" means the term as defined in G.S. 131D-2.1.
(6) "Alternative examination" means a test developed and administered by the Department to meet the educational requirements of an activity director, administrator-in-charge, manager, or personal care aide supervisor for those applicants who do not possess a high school diploma or General Education Diploma (G.E.D.) prior to September 1, 2024.
(7) "Aide duty" means time spent by qualified staff providing assistance with activities of daily living, medication administration, or supervision of residents as determined by the resident's assessment, care plan, physician's orders, and current symptoms.
(8) "Department" means the North Carolina Department of Health and Human Services.
(9) "Discharge" means a resident's termination of their residency at the adult care home, resulting in the resident's move to another location.
(10) "Exploitation" means the term as defined in G.S. 131D-2.1.
(11) "Facility" means a licensed adult care home.
(12) "First shift" means the hours of work between 7:01 a.m. and 3:00 p.m.
(13) "Food service duties" means tasks performed by staff related to serving meals to residents, including assisting with food preparation, arranging and setting the dining tables, serving food and beverages, and cleaning the dining room after meal service is complete.
(14) "Housekeeping duties" means tasks performed by staff such as cleaning and sanitizing facility common areas and resident rooms.
(15) "Legal representative" means a person authorized by state or federal law (including, but not limited to, power of attorney, legal guardian, or representative payee) to act on behalf of the resident to support the resident in decision-making; access medical, social, or other personal information of the resident; and manage financial matters or receive notifications.
(16) "Long-term care" means a continuum of care and services available in an individual's community that provides the care and support required during a persistent or chronic health condition, such as when a person is unable to independently perform some or all activities of daily living or requires supervision due to physical or cognitive impairment.
(17) "Manager" means an individual responsible for the day-to-day operation of an adult care home in the absence of the administrator and under the direction and supervision of the administrator as described in Rule .0402 of this Subchapter.
(18) "Medication aide" means an individual who administers medications to residents and meets all requirements as set forth in Rule .0403 of this Subchapter.
(19) "Neglect" means the term as defined in G.S. 131D-2.1.
(20) "On-call" means able to be contacted by two-way telecommunication.
(21) "On-duty" in reference to an administrator means the administrator is on-site and directly responsible for the day-to-day operations of a facility. "On-duty" in reference to a manager means a manager designated by the administrator as required in Rule .0402 of this Subchapter and who is on-site and directly responsible for the day-to-day operations of a facility under the direction and supervision of the administrator.
(22) "Personal care aide" means a staff member who performs personal care services as defined by G.S. 131D-2.1.
(23) "Physical restraint" means 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.
(24) "Physician extender" means a licensed physician assistant or a licensed nurse practitioner.
(25) "Resident" means the term as defined in G.S. 131D-2.1.
(26) "Responsible person" means a person chosen by the resident to act on their behalf to support the resident in decision-making; have access to medical, social, or other personal information of the resident; manage financial matters; or receive notifications.
(27) "Second shift" means the hours of work between 3:01 p.m. and 11:00 p.m.
(28) "Staff" means any person who performs duties as an employee, paid or unpaid, on behalf of the adult care home.
(29) "Supervision" means oversight, monitoring, and interventions implemented by the facility for the purpose of mitigating the risk of an accident, incident, illness, or injury to a resident to ensure the health, safety, and welfare of the resident and other residents.
(30) "Supervisor" means a personal care aide supervisor as defined in Rule .0609 of this Subchapter.
(31) "Third shift" means the hours of work between 11:01 p.m. and 7:00 a.m.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. September 1, 2024.
sECTION .0200 – licensing
10A NCAC 13F .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-2.4; 131D-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0202 THE LICENSE
(a) Except as otherwise provided in G.S. 131D-2.4, the Department shall issue an adult care home license to any person who submits the application material according to Rule .0204 of this Section and the Department determines that the applicant complies with the provisions of all State adult care home licensure statutes and rules of this Subchapter. 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 posted in a publicly viewable place in the home.
(c) When a provisional license is issued according to G.S. 131D-2.7, 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 a publicly viewable place in the home and in place of the full license.
(d) The license is not transferable or assignable.
(e) An adult care home shall be licensed only as an adult care home and not for any other level of care or licensable entity or service. 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 adult care home level of care.
History Note: Authority G.S. 131D-2.4; 131D-2.7; 131D-2.16; 131D-4.5; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. June 1, 2020.
10A NCAC 13F .0203 PERSONS NOT ELIGIBLE FOR NEW ADULT CARE HOME LICENSES
History Note: Authority G.S. 131D-2.4; 131D-2.5; 131D-4.5; 131D-2.16; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Repealed Eff. January 1, 2020.
10A NCAC 13F .0204 APPLying for a LICENSE to operate a facility not currently licensed
(a) Prior to submission of a license application, all Certificate of Need requirements shall be met according to G.S. 131E, Article 9.
(b) In applying for a license to operate an adult care home to be constructed or renovated, or in an existing building that is not currently licensed, the applicant shall submit the following to the Division of Health Service Regulation:
(1) the Initial License Application that is available online at https://info.ncdhhs.gov/dhsr/acls/pdf/fcchgapp.pdf at no cost and includes the following:
(A) contact person, facility site and mailing addresses, and administrator;
(B) operation disclosure including names and contact information of the licensee, management company, and building owner;
(C) ownership disclosure including names and contact information of owners, principals, affiliates, shareholders, and members; and
(D) bed capacity including that of any special care unit for Alzheimer's and Related Disorders;
(2) plans and specifications as required in Section .0300 of this Subchapter and a construction review fee according to G.S. 131E-267 to be calculated and invoiced by the DHSR Construction Section;
(3) an approved fire and building safety inspection report from the local fire marshal to be submitted upon completion of construction or renovation;
(4) an approved sanitation report or a copy of the permit to begin operation from the sanitation division of the county health department to be submitted upon completion of construction or renovation;
(5) a nonrefundable license fee as required by G.S. 131E-272; and
(6) a certificate of occupancy or certification of compliance from the local building official to be submitted upon completion of construction or renovation.
(c) Issuance of an adult care home license shall be based on the following:
(1) completion of and approval in accordance with Subparagraphs (b)(1) through (b)(6) of this Rule;
(2) the Division of Health Service Regulation's Construction Section's recommendation of licensure based on compliance with rules in Section .0300 of this Subchapter;
(3) a compliance history review of the facility and its principals and affiliates according to G.S. 131D-2.4;
(4) approval by the Adult Care Licensure Section of the facility's operational policies and procedures based on compliance with the rules of this Subchapter; and
(5) the facility's demonstration of compliance with Adult Care Home statutes and rules of this Subchapter as determined by a pre-licensing survey of the facility by the Adult Care Licensure Section.
(d) The Adult Care Licensure Section shall notify in writing the applicant licensee and the county department of social services of the decision to license or not to license the adult care home based on compliance with adult care home statutes and the rules of this Subchapter within 14 days from the decision to license or not to license the facility.
History Note: Authority G.S. 131D-2.4; 131D-2.5; 131D-2.16; 143B-165;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. June 1, 2020.
10A NCAC 13F .0205 APPLICATION TO LICENSE A NEWLY CONSTRUCTED OR RENOVATED BUILDING
History Note: Authority G.S. 131D‑2; 143B‑153; 143B-165; S.L. 2002-160; 2003-0284;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Repealed Eff. June 1, 2004.
10A NCAC 13F .0206 CAPACITY
(a) The licensed capacity of adult care homes licensed pursuant to this Subchapter is seven or more residents.
(b) The total number of residents shall not exceed the number shown on the license.
(c) A facility shall be licensed for no more beds than the number for which the required physical space and other required facilities in the building are available.
(d) The bed capacity and services shall be in compliance with G.S. 131E, Article 9, regarding the certificate of need.
History Note: Authority G.S. 131D-2.4; 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0207 CHANGE OF LICENSEE
Prior to the sale of an adult care home business, the current and prospective licensee shall meet the requirements of this Rule.
(1) The current licensee shall provide written notification of a planned change of licensee 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 date of the planned change of licensee.
(2) If the prospective licensee plans to purchase the building, the prospective licensee shall provide the Healthcare Planning and Certificate of Need Section of the Division of Health Service Regulation with prior written notice as required by G.S. 131E-184(a)(8) prior to the purchase of the building.
(3) The prospective licensee shall submit the following license application material to the Division of Health Service Regulation:
(a) the Change Licensure Application for Adult Care Home (7 or more Beds) that is available on the internet website, https://info.ncdhhs.gov/dhsr/acls/pdf/acchgapp.pdf at no cost and includes the following:
(i) facility administrator and building owner information;
(ii) operation disclosure including new licensee information and management company, if any; and
(iii) ownership disclosure including new owners, principles, affiliates, shareholders, and members;
(b) a fire and building safety inspection report from the local fire marshal dated within the past 12 months;
(c) a sanitation report from the sanitation division of the county health department dated within the past 12 months; and
(d) a nonrefundable license fee as required by G.S. 131D-2.5.
History Note: Authority G.S. 131D-2.4; 131D-2.5; 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. September 1, 2003; July 1, 2003;
Amended Eff. June 1, 2004;
Readopted Eff. January 1, 2020.
10A NCAC 13F .0208 RENEWAL OF LICENSE
(a) The licensee shall file a license renewal application annually on a calendar year basis on the forms provided by the Department at no cost with a nonrefundable annual license fee according to G.S. 131D-2.5. The renewal application form includes the following:
(1) contact person, facility site and mailing address, and administrator;
(2) operation disclosure including names and contact information of the licensee, management company, and building owner;
(3) ownership disclosure including names and contact information of owners, principals, affiliates, shareholders, and members holding an ownership or controlling interest of five percent or more of the applicant entity;
(4) bed capacity including that of any special care unit for Alzheimer's and Related Disorders; and
(5) population and census data.
(b) In determining whether to renew a license under G.S. 131D-2.4, the Department shall take into consideration at least the following:
(1) the compliance history of the applicant facility with the provisions of all State adult care home licensure statutes and rules of this Subchapter;
(2) the compliance history of the owners, principals, and affiliates of the applicant facility in operating other adult care homes in the State;
(3) the extent to which the conduct of the licensee, including owners, principals, affiliates, and persons and those with indirect control as defined in Rule .0201 of this Section, 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) When violations of licensure rules or statutes are documented by the Department and have not been corrected by the facility prior to license expiration, the Department shall either approve a continuation or extension of a plan of correction, issue a provisional license, or deny the license.
History Note: Authority G.S. 131D-2.4; 131D-2.5; 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. June 1, 2020.
10A NCAC 13F .0209 CONDITIONS FOR LICENSE RENEWAL
History Note: Authority G.S. 131D-2.4; 131D-2.16; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Repealed Eff. June 1, 2020.
10A ncac 13F .0210 TERMINATION OF LICENSE
History Note: Authority G.S. 131D‑2; 143B‑153; 143B-165; S.L. 2002-160; 2003-0284;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Repealed Eff. June 1, 2004.
10A NCAC 13F .0211 Notification About CLOSING OF HOME
If a licensee plans to close a 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-2.4; 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0212 DENIAL OR 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 of a license by the Division of Health Service Regulation shall be effected by mailing to the applicant licensee, 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-2.7(b) and G.S. 131D-29.
(d) When a facility receives a notice of revocation, the administrator shall inform each resident and the resident's responsible person in writing of the notice and the basis on which it was issued within five calendar days of the notice of revocation being received by the licensee of the facility.
History Note: Authority G.S. 131D-2.7; 131D-2.16; 131D-4.3; 131D-29; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. June 1, 2020.
10A NCAC 13F .0213 APPEAL OF LICENSURE ACTION
The licensee of an adult care home may appeal a licensure action by commencing a contested case according to G.S. 150B-23 following attempts at informal resolution according to G.S. 150B-22.
History Note: Authority G.S. 131D-2.4; 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0214 SUSPENSION OF ADMISSIONS
History Note: Authority G.S. 131D-2.7;
Eff. January 1, 1982;
Repealed Eff. January 1, 2020.
10A NCAC 13F .0215 ADMINISTRATIVE PENALTY DETERMINATION PROCESS
History Note: Authority G.S. 131D‑34; 143B-165;
Eff. December 1, 1993;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Repealed Eff. October 1, 2016.
SECTION .0300 - physical plant
10A NCAC 13F .0301 APPLICATION OF PHYSICAL PLANT REQUIREMENTS
The physical plant requirements for each adult care home shall be applied as follows:
(1) New construction shall comply with the requirements of this Section.
(2) Except where otherwise specified, existing licensed facilities or portions of existing licensed facilities 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 facility where no addition or renovation has been made, be less than those requirements found in the 1971 "Minimum and Desired Standards and Regulations" for "Homes for the Aged and Infirm", 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 technical requirements of this Section;
(4) Effective July 1, 1987, resident bedrooms and resident services shall not be permitted on the second floor of any facility licensed for seven or more beds prior to April 1, 1984 and classified as two-story wood frame construction by the North Carolina State Building Code;
(5) Rules in this Section are minimum requirements and are not intended to prohibit buildings, systems or operational conditions that exceed minimum requirements;
(6) The bed capacity and services provided in a facility shall be in compliance with G.S. 131E, Article 9 regarding Certificate of Need. A facility shall be licensed for no more beds than the number for which required physical space and other required facilities are available;
(7) Equivalency: Alternate methods, procedures, design criteria and functional variations from the physical plant requirements shall be approved by the Division when the facility can effectively demonstrate that the intent of the physical plant requirements are met and that the variation does not reduce the safety or operational effectiveness of the facility; and
(8) Where rules, codes or standards have any conflict, the most stringent requirement shall apply and any conflicting requirement shall not apply.
History Note: Authority G.S. 131D-2.16; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Eff. July 1, 2005.
10A NCAC 13F .0302 Design and CONSTRUCTION
(a) Any building licensed for the first time as an adult care home shall meet the requirements of the North Carolina State Building Code for new construction. All new construction, additions and renovations to existing buildings shall meet the requirements of the North Carolina State Building Code for I-2 Institutional Occupancy if the facility houses 13 or more residents or the North Carolina State Building Code requirements for Large Residential Care Facilities if the facility houses seven to twelve residents. The North Carolina State Building Code, all applicable volumes, 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). The facility shall also meet all of the rules of this Section.
(b) Each facility shall be planned, constructed, equipped and maintained to provide the services offered in the facility.
(c) Any existing building converted from another use to an adult care home shall meet all requirements of a new facility.
(d) Any existing licensed facility that is closed or vacant for more than one year shall meet all requirements of a new facility.
(e) The sanitation, water supply, sewage disposal and dietary facilities shall comply with the rules of the
North Carolina Division of Environmental Health, which are incorporated by reference, including all subsequent amendments. The "Rules Governing the Sanitation of Hospitals, Nursing and Rest Homes, Sanitariums, Sanatoriums, and Educational and Other Institutions", 15A NCAC 18A .1300 are available for inspection at the Department of Environment and Natural Resources, Division of Environmental Health, 2728 Capital Boulevard, Raleigh, North Carolina. Copies may be obtained from Environmental Health Services Section, 1632 Mail Service Center, Raleigh, North Carolina 27699-1632 at no cost.
(f) The facility 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-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; September 1, 1986; April 1, 1984;
Temporary Amendment Eff. September 1, 2003;
Amended Eff. June 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13F .0303 LOCATION
(a) An adult care home shall be in a location approved by local zoning boards.
(b) The facility shall be located so that hazards to the occupants are minimized.
(c) Plans for the building and site are to be reviewed and approved by the Construction Section of the Division of Health Service Regulation prior to licensure.
(d) An adult care home may be located in an existing building or in a building newly constructed specifically for that purpose.
(e) The site of the proposed facility shall be approved by the Division of Health Service Regulation prior to construction and 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 zoning laws; and
(5) be free from exposure to pollutants known to the applicant or licensee.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. January1, 1991; April 1, 1984;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Recodified from Rule .0301 Eff. July 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0304 PLANS AND SPECIFICATIONS
(a) When construction or remodeling of an adult care home is planned, two copies of Construction Documents and specifications shall be submitted by the applicant or appointed representative to the Division for review and approval. As a preliminary step to avoid last minute difficulty with final plan approval, Schematic Design Drawings and Design Development Drawings may be submitted for approval prior to the required submission of Construction Documents.
(b) Approval of Construction Documents and specifications shall be obtained from the Division prior to licensure. Approval of Construction Documents shall expire after one year unless a building permit for the construction has been obtained.
(c) If an approval expires, renewed approval shall be issued by the Division, provided revised Construction Documents meeting all current regulations, codes and standards are submitted by the applicant or appointed representative and reviewed by the Division.
(d) Any changes made during construction shall require the approval of the Division to assure that licensing requirements are maintained.
(e) Completed construction or remodeling shall conform to the requirements of this Section including the operation of all building systems and shall be approved in writing by the Division prior to licensure or occupancy. Within 90 days following licensure, the owner or licensee shall submit documentation to the Division that "as built" drawings have been received from the builder.
(f) The applicant or designated agent shall notify the Division when actual construction or remodeling starts and at points when construction is 50 percent, 75 percent and 90 percent complete and upon final completion.
History Note: Authority G.S. 131D-2.16; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Eff. July 1, 2005.
10A NCAC 13F .0305 PHYSICAL ENVIRONMENT
(a) An adult care home shall provide living arrangements to meet the individual needs of the residents, the live-in staff and other live-in persons.
(b) The requirements for each living room and recreational area are:
(1) Each living room and recreational area shall be located off a lobby or corridor. At least 50 percent of required living and recreational areas shall be enclosed with walls and doors;
(2) In buildings with a licensed capacity of 15 or less, there shall be a minimum area of 250 square feet;
(3) In buildings with a licensed capacity of 16 or more, there shall be a minimum of 16 square feet per resident; and
(4) Each living room and recreational area shall have windows.
(c) The requirements for the dining room are:
(1) The dining room shall be located off a lobby or corridor and enclosed with walls and doors;
(2) In buildings with a licensed capacity of 15 or less, there shall be a minimum of 200 square feet;
(3) In building with a licensed capacity of 16 or more, there shall be a minimum of 14 square feet per resident; and
(4) The dining room shall have windows.
(d) The requirements for the bedroom are:
(1) The number of resident beds set up shall not exceed the licensed capacity of the facility;
(2) There shall be bedrooms sufficient in number and size to meet the individual needs according to age and sex of the residents, any live-in staff and other persons living in the home. Residents shall not share bedrooms with staff or other live-in non-residents;
(3) Only rooms authorized as bedrooms shall be used for residents' bedrooms;
(4) Bedrooms shall be located on an outside wall and off a corridor. A room where access is through a bathroom, kitchen, or another bedroom shall not be approved for a resident's bedroom;
(5) 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 people;
(6) The total number of residents assigned to a bedroom shall not exceed the number authorized for that particular bedroom;
(7) A bedroom may not be occupied by more than two residents.
(8) Resident bedrooms shall be designed to accommodate all required furnishings;
(9) Each resident bedroom shall be ventilated with one or more windows which are maintained operable and well lighted. The window area shall be equivalent to at least eight percent of the floor space and be provided with insect screens. The window opening may be restricted to a six-inch opening to inhibit resident elopement or suicide. The windows shall be low enough to see outdoors from the bed and chair, with a maximum 36 inch sill height; and
(10) 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.
(e) The requirements for bathrooms and toilet rooms are:
(1) Minimum bathroom and toilet facilities shall include a toilet and a hand lavatory for each 5 residents and a tub or shower for each 10 residents or portion thereof;
(2) Entrance to the bathroom shall not be through a kitchen, another person's bedroom, or another bathroom;
(3) Toilets and baths for staff and visitors shall be in accordance with the North Carolina State Building Code, Plumbing Code;
(4) Bathrooms and toilets accessible to the physically handicapped shall be provided as required by Volume I-C, North Carolina State Building Code, Accessibility Code;
(5) The bathrooms and toilet rooms shall be designed to provide privacy. Bathrooms and toilet rooms 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;
(6) Hand grips shall be installed at all commodes, tubs and showers used by or accessible to residents;
(7) Each home shall have at least one bathroom opening off the corridor with:
(A) a door of three feet minimum width;
(B) a three feet by three feet roll‑in shower designed to allow the staff to assist a resident in taking a shower without the staff getting wet;
(C) a bathtub accessible on at least two sides;
(D) a lavatory; and
(E) a toilet.
(8) If the tub and shower are in separate rooms, each room shall have a lavatory and a toilet;
(9) Bathrooms and toilet rooms shall be located as conveniently as possible to the residents' bedrooms;
(10) Resident toilet rooms and bathrooms shall not be utilized for storage or purposes other than those indicated in Item (4) of this Rule;
(11) Toilets and baths shall be well lighted and mechanically ventilated at two cubic feet per minute. The mechanical ventilation requirement does not apply to facilities licensed before April 1, 1984, with natural ventilation;
(12) Nonskid surfacing or strips shall be installed in showers and bath areas; and
(13) The floors of the bathrooms and toilet rooms shall have water-resistant covering.
(f) The requirements for storage rooms and closets are:
(1) General Storage for the Home. A minimum area of five square feet (40 cubic feet) per licensed capacity shall be provided. This storage space shall be either in the facility or within 500 feet of the facility on the same site;
(2) Linen Storage. Storage areas shall be adequate in size and number for separate storage of clean linens and separate storage of soiled linens. Access to soiled linen storage shall be from a corridor or laundry room;
(3) Food Storage. Space shall be provided for dry, refrigerated and frozen food items to comply with sanitation rules;
(4) Housekeeping storage requirements are:
(A) A housekeeping closet, with mop sink or mop floor receptor, shall be provided at the rate of one per 60 residents or portion thereof; and
(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 monitored while in use;
(5) Handwashing facilities with wrist type lever handles shall be provided immediately adjacent to the drug storage area;
(6) Storage for Resident's Articles. Some means for residents to lock personal articles within the home shall be provided; and
(7) Staff Facilities. Some means for staff to lock personal articles within the home shall be provided.
(g) The requirements for corridors are:
(1) Doors to spaces other than reach-in closets shall not swing into the corridor;
(2) Handrails shall be provided on both sides of corridors at 36 inches above the floor and be capable of supporting a 250 pound concentrated load;
(3) Corridors shall be lighted with night lights providing 1 foot-candle power at the floor; and
(4) Corridors shall be free of all equipment and other obstructions.
(h) The requirements for outside entrances and exits are:
(1) Service entrances shall not be through resident use areas;
(2) All steps, porches, stoops and ramps shall be provided with handrails and guardrails;
(3) All exit door locks shall be easily operable, by a single hand motion, from the inside at all times without keys; and
(4) 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 accessible by residents 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 office of the administrator or in a location accessible only to staff authorized by the administrator to operate the control panel.
(i) The requirements for floors are:
(1) All floors shall be of smooth, non‑skid material and so constructed as to be easily cleanable;
(2) Scatter or throw rugs shall not be used; and
(3) All floors shall be kept in good repair.
(j) Soil Utility Room. A separate room shall be provided and equipped for the cleaning and sanitizing of bed pans and shall have handwashing facilities.
(k) Office. There shall be an area within the home large enough to accommodate normal administrative functions.
(l) The requirements for laundry facilities are:
(1) Laundry facilities shall be large enough to accommodate washers, dryers, and ironing equipment or work tables;
(2) These facilities shall be located where soiled linens will not be carried through the kitchen, dining, clean linen storage, living rooms or recreational areas; and
(3) A minimum of one residential type washer and dryer each shall be provided in a separate room which is accessible by staff, residents and family, even if all laundry services are contracted.
(m) The requirements for outside premises are:
(1) The outside grounds of new and existing facilities shall be maintained in a clean and safe condition;
(2) If the home has a fence around the premises, the fence shall not prevent residents from exiting or entering freely or be hazardous; and
(3) Outdoor walkways and drives shall be illuminated by no less than five foot-candles of light at ground level.
(n) Alternate methods, procedures, design criteria and functional variations from the physical environment requirements, 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 physical environment requirements are met and the variation does not reduce the safety or operational effectiveness of the facility.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1987; July 1, 1984; April 1, 1984;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Recodified from Rule .0303 Eff. July 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13F .0306 HOUSEKEEPING AND FURNISHINGS
(a) Adult care homes 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 in facilities with 12 beds or less and North Carolina Division of Environmental Health sanitation scores of 85 or above at all times in facilities with 13 beds or more;
(5) be maintained in an uncluttered, clean and orderly manner, free of all obstructions and hazards;
(6) have a 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 1˝ 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 shall 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 in the bedroom or an 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) small tables serving from two to eight persons and chairs to seat all residents eating in the dining room; tables and chairs equal to the resident capacity of the home shall be on the premises; and
(2) chairs that are sturdy, without rollers unless retractable or on front legs only, non-folding and designed to minimize tilting.
(e) This Rule shall apply to new and existing facilities.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984;
Temporary Amendment Eff. September 1, 2003.
Amended Eff. June 1, 2004;
Recodified from Rule .0304 Eff. July 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10a NCAC 13F .0307 FIRE ALARM SYSTEM
(a) The fire alarm system in adult care homes shall be able to transmit the fire alarm signal automatically to the local emergency fire department dispatch center, either directly or through a central station monitoring company connection.
(b) Any applicable fire safety requirements required by city ordinances or county building inspectors shall be provided.
(c) In a facility licensed before April 1, 1984 and constructed prior to January 1, 1975, the building, in addition to meeting the requirements of the North Carolina State Building Code in effect at the time the building was constructed, shall be provided with the following:
(1) A fire alarm system with pull stations within five feet of each exit and sounding devices which are audible throughout the building;
(2) Products of combustion (smoke) U/L listed detectors in all corridors. The detectors shall be no more than 60 feet from each other and no more than 30 feet from any end wall;
(3) Heat detectors or products of combustion detectors in all storage rooms, kitchens, living rooms, dining rooms and laundries;
(4) All detection systems interconnected with the fire alarm system; and
(5) Emergency power for the fire alarm system, heat detection system, and products of combustion detection with automatic start generator or trickle charge battery system capable of operating the fire alarm systems for 24 hours and able to sound the alarm for five minutes at the end of that time. Emergency egress lights and exit signs shall be powered from an automatic start generator or a U/L approved trickle charge battery system capable of operation for 1-1/2 hours when normal power fails.
(d) When any facility not equipped with a complete automatic fire extinguishment system replaces the fire alarm system, each bedroom shall be provided with smoke detectors. Other building spaces shall be provided with such fire detection devices as required by the North Carolina State Building Code and requirements of this Subchapter.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Recodified from Rule .0305 Eff. July 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13F .0308 FIRE EXTINGUISHERS
(a) At least one five pound or larger (net charge) A‑B‑C type fire extinguisher is required for each 2,500 square feet of floor area or fraction thereof.
(b) One five pound or larger (net charge) A‑B‑C or CO/2 type is required in the kitchen and, where applicable, in the maintenance shop.
History Note: Authority G.S. 131D‑2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1987; April 1, 1984;
Recodified from Rule .0306 Eff. July 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0309 PLAN FOR EVACUATION
(a) A written fire evacuation plan (including a diagrammed drawing) which has the written approval of the local Code Enforcement Official shall be prepared in large print and posted in a central location on each floor of an adult care home. The plan shall be reviewed with each resident on admission and shall be a part of the orientation for all new staff.
(b) There shall be rehearsals of the fire plan quarterly on each shift in accordance with the requirement of the local Fire Prevention Code Enforcement Official.
(c) 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, the shift, staff members present, and a short description of what the rehearsal involved.
(d) 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 facility.
(e) A facility that elects to be designated as a special care shelter during an impending disaster or emergency event shall follow the guidelines established by the latest Division of Social Services' State of North Carolina Disaster Plan which is available at no cost from the N.C. Division of Social Services, 2401 Mail Service Center, Raleigh, NC 27699-2401. The facility shall contact the Division of Health Service Regulation to determine which licensure rules may be waived according to G.S. 131D-7 to allow for emergency care shelter placements prior to sheltering during the emergency event.
(f) This Rule shall apply to new and existing facilities.
History Note: Authority G.S. 131D.2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984;
Recodified from Rule .0307 Eff. July 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13F .0310 ELECTRICAL outlets
All adult care home electrical outlets in wet locations at sinks, bathrooms and outside of building shall have ground fault interrupters.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Recodified from Rule .0308 Eff. July 1, 2004;
Temporary Amendment July 1, 2004;
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0311 OTHER REQUIREMENTS
(a) The building and all fire safety, electrical, mechanical, and plumbing equipment in an adult care home shall be maintained in a safe and operating condition.
(b) There shall be a heating system sufficient to maintain 75 degrees F (24 degrees C) under winter design conditions. In addition, the following shall apply to heaters and cooking appliances.
(1) Built-in electric heaters, if used, shall be installed or protected so as to avoid burn hazards to residents and room furnishings.
(2) Unvented fuel burning room heaters and portable electric heaters are prohibited.
(3) 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 shall be U.L. listed.
(4) Ovens, ranges and cook tops located in resident activity or recreational areas shall not be used except under facility staff supervision. The degree of staff supervision shall be based on the facility's assessment of the capabilities of each resident. The operation of the equipment shall have a locking feature provided, that shall be controlled by staff.
(5) Ovens, ranges and cook tops located in resident rooms shall have a locking feature provided, controlled by staff, to limit the use of the equipment by residents who have been assessed by the facility to be incapable of operating the equipment in a safe manner.
(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 system shall be of such size to provide an adequate supply of hot water to the kitchen, bathrooms, laundry, housekeeping closets and soil utility room. 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 multi-story facilities shall be equipped with elevators.
(f) In addition to the required emergency lighting, minimum lighting shall be as follows:
(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.
(g) The spaces listed in this Paragraph shall be provided with exhaust ventilation at the rate of two cubic feet per minute per square foot. This requirement does not apply to facilities licensed before April 1, 1984, with natural ventilation in these specified spaces:
(1) soiled linen storage;
(2) soil utility room;
(3) bathrooms and toilet rooms;
(4) housekeeping closets; and
(5) laundry area.
(h) In facilities licensed for 7-12 residents, 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 they can be activated with a single action and remain on until deactivated by staff at the point of origin. The call system activator shall be within reach of the resident lying on the bed.
(i) In newly licensed facilities without live-in staff, an electrically operated call system shall be provided connecting each resident bedroom and bathroom to a staff station. The resident call system activator shall be such that they can be activated with a single action and remain on until deactivated by staff at the point of origin. The call system activator shall be within reach of the resident lying on the bed.
(j) Except where otherwise specified, existing facilities housing persons unable to evacuate without staff assistance shall provide those residents with hand bells or other signaling devices.
(k) This Rule shall apply to new and existing facilities with the exception of Paragraph (e) which shall not apply to existing facilities.
History Note: Authority G.S. 131D-2.16; 143B-165;
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 Rule .0309 Eff. July 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005.
10A NCAC 13F .0312 Building Code and Sanitation Requirements
History Note: Authority G.S. 131D-2; 143B-165; S.L .2002-0160; 2003-0284;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Recodified from Rule .0310 Eff. July 1, 2004;
Temporary Repeal Eff. July 1, 2004;
Repealed Eff. July 1, 2005.
SECTION .0400 - staff qualifications
10A NCAC 13F .0401 CERTIFICATION OF ADMINISTRATOR (Transferred to 10A NCAC 13F .1701)
10A NCAC 13F .0402 QUALIFICATIONS OF MANAGER
The facility shall designate a manager when the administrator is absent from the facility. The manager, is responsible for carrying out the day-to-day operations of an adult care home in the absence of the administrator. The administrator remains ultimately responsible for the adult care home, and the manager shall serve under the direction and supervision of the administrator. The manager shall meet the following requirements:
(1) be 21 years or older;
(2) be a high school graduate or certified under the G.E.D. program, or if hired before September 1, 2024, have passed the alternative examination established by the Department;
(3) have six months training or experience related to management or supervision in long term care or health care settings or be a licensed health professional such as a mental health professional, nurse practitioner, physician assistant, or registered nurse, a nursing home administrator certified pursuant to G.S. 90-276(4), or an assisted living administrator certified pursuant to G.S. 90-288.14; and
(4) earn 12 hours a year of continuing education credits in the management of adult care homes or care of the elderly and individuals with physical, intellectual, or developmental disabilities, cognitive impairment, and mental illness.
History Note: Authority G.S. 131D.2.16; 131D-4.5; 131D-25; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Readopted Eff. September 1, 2024.
10A NCAC 13F .0403 QUALIFICATIONS OF MEDICATION STAFF
(a) Adult care home staff who administer medications, hereafter referred to as medication aides, and their direct supervisors shall complete training, clinical skills validation, and pass the written examination as set forth in G.S. 131D-4.5B. 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 complete six hours of continuing education annually related to medication administration.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.5B; 143B-165;
Temporary Adoption Eff. January 1, 2000; December 1, 1999;
Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005;
Readopted Eff. July 1, 2021.
10A NCAC 13f .0404 QUALIFICATIONS OF ACTIVITY DIRECTOR
Adult care homes shall have an activity director who meets the following qualifications:
(1) The activity director hired after September 30, 2022 shall meet a minimum educational requirement by being a high school graduate or certified under the GED Program.
(2) The activity director hired after September 30, 2022 shall 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. An activity director shall be exempt from the required basic activity course if one or more of the following applies:
(a) be a licensed recreational therapist or be eligible for certification as a therapeutic recreation specialist as defined by the North Carolina Recreational Therapy Licensure Act in accordance with G.S. 90C;
(b) have two years of experience working in programming for an adult recreation or activities program within the last five years, one year of which was full-time in an activities program for patients or residents in a health care or long term care setting;
(c) be a licensed occupational therapist or licensed occupational therapy assistant in accordance with G.S. 90, Article 18D;
(d) be certified as an Activity Professional by the National Certification Council for Activity Professionals; or
(e) the required basic activity course was completed prior to September 1, 2024.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005;
Readopted Eff. October 1, 2022;
Amended Eff. September 1, 2024.
10A NCAC 13F .0405 QUALIFICATIONS OF FOOD SERVICE SUPERVISOR
Each facility shall have a food service supervisor that is experienced in food service in commercial, healthcare, or congregate care settings who shall consult with a licensed dietitian/nutritionist as necessary to meet the dietary needs of the residents in accordance with Rule .0904 of this Subchapter.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984;
Readopted Eff. February 1, 2022.
10A NCAC 13F .0406 TEST FOR TUBERCULOSIS
(a) Upon employment or moving into an adult care home, the administrator, all other staff, and any persons living in the adult care home 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, which is hereby incorporated by reference, including subsequent amendments.
(b) There shall be documentation on file in the adult care home that the administrator, all other staff, and any persons living in the adult care home are free of tuberculosis disease.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. September 1, 2003; July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. July 1, 2021.
10A NCAC 13F .0407 OTHER STAFF qualifications
(a) Each staff person at an adult care home shall:
(1) have a job description that reflects the position's duties and responsibilities and is signed by the administrator and the employee;
(2) be able to implement all of the adult care 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 the information from unauthorized use and disclosure, in accordance with G.S. 131D-21(6) and 131D-21.1;
(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 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, and exceptions as provided in the law shall be documented in the staff person's personnel record;
(7) have a criminal background check completed in accordance with G.S. 131D-40 and results available in the staff person's personnel file;
(8) have an examination and screening for the presence of controlled substances completed in accordance with G.S. 131D-45 and results available in the staff person's personnel file;
(9) maintain a current driver's license if responsible for transportation of residents; and
(10) be willing to cooperate with state and local inspectors when determining and maintaining compliance with the rules of this Subchapter.
(b) At all times, there shall be at least one staff person in the facility in charge of resident care who 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 the North Carolina Board of Nursing, there shall be a registered nurse available in accordance with the rules set forth in 21 NCAC 36 .0224 and 21 NCAC 36 .0225, which are hereby incorporated by reference including subsequent amendments.
History Note: Authority G.S. 131D-2.16; 131D 4.5(4); 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. September 1, 2003; July 1, 2003.
Amended Eff. June 1, 2004;
Readopted Eff. October 1, 2022.
10A NCAC 13F .0408 Qualifications of Personal Care Aide Supervisor
(a) Facilities with a census of 31 or more residents shall employ a Personal Care Aide Supervisor as defined in Paragraph (b) of this Rule. The term "Supervisor" as used throughout Section .0600 of this Subchapter refers to the Personal Care Aide Supervisor.
(b) A supervisor shall meet the following qualifications:
(1) be 21 years or older;
(2) be a high school graduate or certified under the G.E.D. program or if hired before September 1, 2024, have passed an alternative examination established by the Department;
(3) meet the health requirements according to Rule .0406 of this Section;
(4) have six months of experience in performing or supervising the performance of the duties to be supervised during the period of three years prior to July 1, 2000 or the date of hire, whichever is later, or be a licensed health professional such as a mental health professional, nurse practitioner, physician assistant, or registered nurse, or a nursing home administrator certified pursuant to G.S. 90-276(4);
(5) meet the same minimum training and competency requirements of the aides being supervised; and
(6) earn 12 hours a year of continuing education credits related to the care of the elderly and individuals with physical, intellectual, or developmental disabilities, cognitive impairment, and mental illness.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 143B-165;
Eff. September 1, 2024.
section .0500 - staff orientation, training, competency and continuing education
10A NCAC 13F .0501 PERSONAL CARE TRAINING AND COMPETENCY
(a) The facility shall assure that staff who provide or directly supervise staff who provide personal care to residents complete an 80-hour personal care training and competency evaluation program established by the Department. For the purpose of this Rule, "directly supervise" means being on duty in the facility to oversee or direct the performance of staff duties. A copy of the 80-hour training and competency evaluation program is available online at https://info.ncdhhs.gov/dhsr/acls/training/index.html#80hr, at no cost. The 80-hour personal care training and competency evaluation program curriculum shall include:
(1) observation and documentation skills;
(2) basic nursing skills, including special health-related tasks;
(3) activities of daily living and personal care skills;
(4) cognitive, behavioral, and social care;
(5) basic restorative services; and
(6) residents' rights as established by G.S. 131D-21.
(b) The facility shall assure that training specified in Paragraph (a) of this Rule is completed within six months after hiring for staff hired after September 30, 2022. Documentation of the successful completion of the 80-hour training and competency evaluation program shall be maintained in the facility and available for review by the Division of Health Service Regulation and the county department of social services.
(c) The facility shall assure that staff who perform or directly supervise staff who perform personal care receive training and supervision on the performance of individual job assignments prior to meeting the training and competency requirements of this Rule. Documentation of training shall be maintained in the facility and available for review by the Division of Health Service Regulation and the county department of social services.
(d) The Department shall exempt staff from the 80-hour training and competency evaluation program who are:
(1) licensed health professionals;
(2) listed on the Nurse Aide Registry; or
(3) documented as having completed one of the following previously approved training programs:
(A) a 40-hour or 75-hour training and competency evaluation program prior to July 1, 2000; or
(B) a 45-hour or 80-hour training and competency evaluation program for training exemption from July 1, 2000 through August 31, 2003.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 143B-165;
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;
Readopted Eff. October 1, 2022.
10A NCAC 13F .0502 personal care training content and instructors
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 143B-165;
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;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Repealed Eff. October 1, 2022.
10A NCAC 13F .0503 MEDICATION ADMINISTRATION COMPETENCY
(a) The competency evaluation for medication administration required in Rule .0403 of this Subchapter shall consist of a written examination and a clinical skills validation to determine competency in the following areas:
(1) medical abbreviations and terminology;
(2) transcription of medication orders;
(3) obtaining and documenting vital signs;
(4) procedures and tasks involved with the preparation and administration of oral (including liquid, sublingual and inhaler), topical (including transdermal), ophthalmic, otic, and nasal medications;
(5) infection control procedures;
(6) documentation of medication administration;
(7) 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;
(8) medication storage and disposition;
(9) rules pertaining to medication administration in adult care facilities; and
(10) 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) Verification of an individual's completion of the written examination and results can be obtained at no charge on the North Carolina Adult Care Medication Aide Testing website at https://mats.ncdhhs.gov/test-result.
(d) The clinical skills validation portion of the competency evaluation shall be conducted by a registered nurse or a licensed pharmacist who has a current unencumbered license in North Carolina. The registered nurse or licensed pharmacist shall conduct a clinical skills validation for each medication administration task or skill that will 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 listed in Subparagraphs (a)(4), (a)(7), (a)(11), (a)(14), and (a)(15) as 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. The form requires the following:
(1) name of the staff and adult care home;
(2) satisfactory completion date of demonstrated competency of task or skill with the instructor's initials or signature;
(3) if staff needs more training on skills or tasks, it should be noted with the instructor's signature; and
(4) staff and instructor signatures and date after completion of tasks.
Copies of this form and instructions for its use may be obtained at no cost on the Adult Care Licensure website, https://info.ncdhhs.gov/dhsr/acls/pdf/medchklst.pdf. 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-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. January 1, 2000; December 1, 1999;
Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Readopted Eff. October 1, 2022.
10A NCAC 13F .0504 COMPETENCY EVALUATION AND VALIDATION FOR LICENSED HEALTH PROFESSIONAL SUPPORT TASKS
(b) The licensed health professional shall evaluate the staff person's knowledge, skills, and abilities that relate to the performance of each personal care task. The licensed health professional shall validate that the staff person has the knowledge, skills, and abilities and can demonstrate the performance of the task(s) prior to the task(s) being performed on a resident.
(1) A registered nurse shall validate the competency of staff who perform any of the personal care tasks specified in Subparagraphs (a)(1) through (a)(28) of Rule .0903 of this Subchapter;
(2) In lieu of a registered nurse, a licensed respiratory care practitioner may validate the competency of staff who perform personal care tasks specified in Subparagraphs (a)(6), (a)(11), (a)(16), (a)(18), (a)(19), and (a)(21) of Rule .0903 of this Subchapter;
(3) In lieu of a registered nurse, a licensed pharmacist may validate the competency of staff who perform the personal care tasks specified in Subparagraph (a)(8) and (a)(11) of Rule .0903 of this Subchapter. An immunizing pharmacist may validate the competency of staff who perform the personal care task specified in Subparagraph (a)(15) of Rule .0903 of this Subchapter; and
(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 (a)(27) of Rule .0903 of this Subchapter.
(d) If a physician certifies that care can be provided to a resident in an adult care home on a temporary basis in accordance with G.S. 131D-2.2(a), the facility shall ensure that the staff performing the care task(s) authorized by the physician are competent to perform the task(s) in accordance with Paragraphs (b) and (c) of this Rule. For the purpose of this Rule, "temporary basis" means a length of time as determined by the resident's physician to meet the care needs of the resident and prevent the resident's relocation from the adult care home.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. September 1, 2003;
Eff. July 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. October 1, 2022; July 1, 2021.
10A NCAC 13F .0505 TRAINING ON CARE OF DIABETIC RESIDENTS
An adult 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;
(g) universal precautions;
(h) appropriate administration times; and
(i) sliding scale insulin administration.
History Note: Authority 131D-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0506 TRAINING ON PHYSICAL RESTRAINTS
(a) An adult 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-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0507 TRAINING ON CARDIO-PULMONARY RESUSCITATION
Each adult 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 or Medic First Aid, or by a trainer with documented certification as a trainer on these procedures from one of these organizations. The staff person trained according to this Rule shall have access at all times in the facility to a one-way valve pocket mask for use in performing cardio-pulmonary resuscitation.
History Note: Authority 131D-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004;
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0508 ASSESSMENT Training
The person or persons designated by the administrator to perform resident assessments as required by Rule .0801 of this Subchapter shall read the Resident Assessment Self-Instructional Manual for Adult Care Homes established by the Department and certify completion by signature on the last page of the manual before performing the required resident assessments. Registered nurses are exempt from this requirement. The Resident Assessment Self-Instructional Manual for Adult Care Homes is herein incorporated by reference including subsequent amendments and editions and is available on the Adult Care Licensure website, https://info.ncdhhs.gov/dhsr/acls/pdf/assessmentmanual.pdf, at no cost.
History Note: Authority G.S. 131D-2.15; 131D-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. October 1, 2022; April 1, 2022.
10A NCAC 13F .0509 FOOD SERVICE ORIENTATION
(a) The food service supervisor and adult care home dietary staff who prepare and serve food shall complete a food service orientation training that provides an overview of food service in adult care homes, including the preparation of therapeutic diets, established by the Department or an equivalent that contains at least the same information as required in the training approved by the Department within 30 days of hire. The food service orientation training is available at https://info.ncdhhs.gov/dhsr/acls/pdf/foodsrvman.pdf, at no cost.
(b) Licensed dietitian/nutritionists are exempt from this orientation.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Temporary Adoption Expired March 12, 2005;
Eff. June 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. January 1, 2022.
10a ncac 13f .0510 RESERVED FOR FUTURE CODIFICATION
10a ncac 13f .0511 RESERVED FOR FUTURE CODIFICATION
10A NCAC 13F .0512 DOCUMENTATION OF TRAINING AND COMPETENCY VALIDATION
An adult 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-2.16; 143B-165;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
section .0600 - staffing
10A NCAC 13F .0601 MANAGEMENT OF FACILITIES - General administrator and MANAGER responsibilities
(a) Each adult care home shall have an administrator who is certified in accordance with Rule .1701 of this Subchapter. The administrator shall be responsible for the total operation and management of the facility to assure that all care and services are provided to maintain the health, safety, and welfare of the residents in accordance with all applicable local, state, and federal regulations and codes. The administrator shall also be responsible to the Division of Health Service Regulation and the county department of social services for complying with 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) An adult care home manager shall be responsible for carrying out the day-to-day operations and all required duties of an adult care home in the absence of an administrator.
(c) The administrator shall have knowledge of and shall ensure the following:
(1) the investigation and reporting of any allegations of resident abuse, neglect, and exploitation as specified in Rule .1212(d) of this Subchapter;
(2) the investigation and reporting of any suspicion of or allegations of drug diversion as specified in Rule .1008 of this Subchapter;
(3) the reporting of any incidents of resident elopement or when a resident is missing from the facility, as required in Rule .1212(e)(2) and Rule .0906(f)(4) of this Subchapter; and
(4) the investigation and reporting of any incident or accident resulting in the hospitalization or death of a resident, as specified in Rule .1208 and Rule .1212 of this Subchapter.
(d) The administrator shall be made aware when the facility is unable to meet the staffing requirements of this Section.
(e) The administrator shall be made aware any time the facility seeks the assistance of the local law enforcement authority.
(f) For facilities with a census of 7 to 30 residents, the manager or staff person on duty shall immediately notify the administrator of any of the circumstances listed in Paragraphs (c), (d), and (e) of this Rule.
(g) For facilities with a census of 31 or more, the manager or supervisor shall immediately notify the administrator of any of the circumstances listed in Paragraphs (c), (d), and (e) of this Rule.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.4; 131D-4.5; 131D-25; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 1990; April 1, 1987; April 1, 1984;
Temporary Amendment Eff. January 1, 2000; December 1, 1999;
Amended Eff. July 1, 2000;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004;
Readopted Eff. September 1, 2024.
10A NCAC 13F .0602 MANAGEMENT OF FACILITIES WITH A CAPACITY OR CENSUS OF Seven to thirty RESIDENTS
In a facility with a census of greater than seven but less than 31 residents, there shall be one administrator or manager who is directly responsible for assuring that all required duties are carried out in the facility. One or more of the following arrangements shall be used to manage a facility with a census of seven to 30 residents:
(1) the administrator is in the facility or within 500 feet of the facility with a means of two-way telecommunication with the facility at all times;
(2) a manager is in the facility or within 500 feet of the facility with a means of two-way telecommunication with the facility at all times; or
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 131D-25; 143B-165;
Temporary Adoption Eff. January 1, 2000;
Eff. July 1, 2000;
Readopted Eff. September 1, 2024.
10A NCAC 13F .0603 MANAGEMENT OF FACILITIES WITH A CENSUS OF 31 to 80 RESIDENTS
Each facility with a census of greater than 30 but less than 81 residents shall:
(1) have an administrator on-call at all times when not in the building; and
(2) have a manager on-duty in the facility when the administrator is not on-duty in the facility. The personal care aide supervisor, as required in Rule .0608 of this Section, may serve simultaneously as the manager.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 131D-25; 143B-165;
Temporary Adoption Eff. January 1, 2000; December 1, 1999;
Eff. July 1, 2000;
Amended Eff. July 1, 2005;
Readopted Eff. September 1, 2024.
10A NCAC 13F .0604 MANAGEMENT OF FACILITIES WITH A CENSUS OF 81 OR MORE RESIDENTS
(a) For an adult care home with a census of 81 or more residents, there shall be an administrator on-duty at the facility at least eight hours per day, five days per week, and shall not serve simultaneously as a personal care aide supervisor or other staff to meet staffing requirements while on duty as an administrator or be an administrator for another adult care home. If there is more than one facility under the same ownership on a contiguous parcel of land or campus setting, and the combined licensed capacity of the facilities is 200 beds or less, there may be one administrator on duty for all the facilities on the campus. The administrator shall not serve simultaneously as a personal care aide supervisor or other staff in this campus setting.
(b) When the administrator is not on-duty, there shall be a manager on-duty. The supervisor may serve simultaneously as the manager if the individual meets the qualifications required in Rule .0402 of this Subchapter. Each facility on a contiguous parcel of land or campus setting, as described in Paragraph (a) of this Rule, shall have a person designated as the manager in the facility when the administrator is not on-duty.
(c) The administrator shall be on-call, at all times when not on-duty.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-25; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. December 1, 1991; September 1, 1990; July 1, 1990; April 1, 1984;
Temporary Amendment Eff. January 1, 2000; December 1, 1999;
Amended Eff. July 1, 2005; July 1, 2000;
Readopted Eff. September 1, 2024.
10A NCAC 13F .0605 General Staffing Requirements FOR ADULT CARE HOMES
(a) Adult care homes shall staff based on the facility's resident census and provide staffing to meet the care and supervision needs of the residents in accordance with the rules of this Subchapter.
(b) At no time shall residents be left alone without a staff member in the facility.
(c) The facility shall maintain a daily census log which lists current residents by name, room assignment and date of admission, which shall be available for review by the Division of Health Service Regulation and the county departments of social services.
(d) The facility shall post daily staffing information in a location accessible to residents and visitors in accordance with G.S. 131D-4.3(a)(5). The information shall include:
(1) the name and contact information of the administrator and manager;
(2) the number of required supervisors on each shift; and
(3) the number of aides required on each shift.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 143B-165;
Temporary Adoption Eff. January 1, 2000; December 1, 1999;
Eff. July 1, 2000;
Readopted Eff. September 1, 2024.
10A NCAC 13F .0606 STAFFING FOR FACILITIES WITH A CENSUS OF SEVEN TO TWELVE RESIDENTS
(a) In a facility with a census of greater than six but less than 13 residents, there shall be an administrator or manager in the facility or within 500 feet of the facility with a means of two-way telecommunication at all times.
(b) When the administrator or manager is not on-duty, there shall be at least one staff member on-duty on the first and second shifts and at least one staff member available within the building, who need not be on-duty, on third shift. There shall be a call system connecting the bedroom of the available staff member, who may be asleep on the third shift, with each resident's bedroom. If there are residents in the facility who are disoriented or known to have wandering behavior, there shall be at least one staff member on-duty and awake at all times.
(c) When the administrator or manager is on duty on the first or second shifts and available within the facility on third shift, another staff member (i.e., co‑administrator, manager or aide) shall be in the building or within 500 feet of the facility with a means of two-way telecommunication at all times.
(d) The administrator shall prepare a plan of operation for each licensed facility specifying the staff involved, their regularly assigned duties and the amount of time estimated to be spent for each duty. There shall be a current plan of operation on file in the facility, available for review by the Division of Health Service Regulation and the county department of social services.
(e) Each facility shall assign at least one staff member per shift to provide personal care services and supervision of residents as needed by the residents. The staff member so assigned shall not perform food service duties during the shift of rendering care services and supervision. The staff member so assigned shall not perform housekeeping duties during the shift of rendering care services and supervision, except:
(1) between the hours of 7:00 a.m. and 9:00 p.m., and then only when the housekeeping duties are incidental to the rendering of care services; and
(2) between the hours of 9:00 p.m. and 7:00 a.m. and then only to the extent that the housekeeping duties do not hinder the assigned staff's duties of care or immediate response to residents, nor impede the assigned staff member's ability to monitor the residents.
(f) There shall be additional staff to provide daily housekeeping and food service duties.
(g) A cluster of facilities, each with capacity or census of 12 or fewer residents, shall comply with the following staffing:
(1) When there is a cluster of up to six licensed facilities located adjacently, there shall be at least one administrator or manager who lives within 500 feet of each of the facilities with a means of two-way telecommunication at all times.
(2) The administrator or manager on-duty shall be directly responsible for assuring that all required daily duties are carried out in each facility.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 143B-165;
Temporary Adoption Eff. January 1, 2000;
Eff. July 1, 2000;
Readopted Eff. September 1, 2024.
10A NCAC 13F .0607 STAFFING for facilities with a census of 13 to 20 Residents
(a) In a facility with a census of greater than 12 but less than 21 residents, there shall be an administrator or manager in the facility or within 500 feet of the facility with a means of two-way telecommunication at all times.
(b) When the administrator or manager is not on duty within the facility, there shall be at least one awake staff member on duty on the first, second, and third shifts.
(c) When the administrator or manager is on duty within the facility, another staff member (i.e. co‑administrator, manager or aide) shall be in the building or within 500 feet of the facility with a means of two-way telecommunication at all times and available to assist if needed.
(1) between the hours of 7:00 a.m. and 9:00 p.m., and then only when the housekeeping duties are incidental to the rendering of care services; and
(2) between the hours of 9:00 p.m. and 7:00 a.m., and then only to the extent that the housekeeping duties do not hinder the assigned staff's duties of care or immediate response to residents, nor impede the assigned staff member's ability to monitor the residents.
(e) There shall be additional staff to provide daily housekeeping and food service duties.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 143B-165;
Eff. September 1, 2024.
10A NCAC 13F .0608 STAFFING FOR FACILITIES WITH A CENSUS of 21 or more residents
(a) Each facility with a census of 21 or more residents shall have staff on duty to meet the needs of the residents.
(b) In addition to the requirement in Paragraph (a) of this Rule, each facility with a census of 21 or more residents shall comply with the following staffing requirements:
(1) On first shift and second shift, the total aide duty hours shall be at least:
(A) 16 hours of aide duty for facilities with a census of 21 to 40 residents.
(B) 20 hours of aide duty for facilities with a census of 41 to 50 residents.
(C) 24 hours of aide duty for facilities with a census of 51 to 60 residents.
(D) 28 hours of aide duty for facilities with a census of 61 to 70 residents.
(E) 32 hours of aide duty for facilities with a census of 71 to 80 residents.
(F) 36 hours of aide duty for facilities with a census of 81 to 90 residents.
(G) 40 hours of aide duty for facilities with a census of 91 to 100 residents.
(H) 44 hours of aide duty for facilities with a census of 101 to 110 residents.
(I) 48 hours of aide duty for facilities with a census of 111 to 120 residents.
(J) 52 hours of aide duty for facilities with a census of 121 to 130 residents.
(K) 56 hours of aide duty for facilities with a census of 131 to 140 residents.
(L) 60 hours of aide duty for facilities with a census of 141 to 150 residents.
(M) 64 hours of aide duty for facilities with a census of 151 to 160 residents.
(N) 68 hours of aide duty for facilities with a census of 161 to 170 residents.
(O) 72 hours of aide duty for facilities with a census of 171 to 180 residents.
(P) 76 hours of aide duty for facilities with a census of 181 to 190 residents.
(Q) 80 hours of aide duty for facilities with a census of 191 to 200 residents.
(R) 84 hours of aide duty for facilities with a census of 201 to 210 residents.
(S) 88 hours of aide duty for facilities with a census of 211 to 220 residents.
(T) 92 hours of aide duty for facilities with a census of 221 to 230 residents.
(U) 96 hours of aide duty for facilities with a census of 231 to 240 residents.
(2) On third shift, the total aide duty hours shall be at least:
(A) 8 hours of aide duty for facilities with a census of 21 to 30 residents.
(B) 16 hours of aide duty for facilities with a census of 31 to 60 residents.
(C) 24 hours of aide duty for facilities with a census of 61 to 90 residents.
(D) 32 hours of aide duty for facilities with a census of 91 to 120 residents.
(E) 40 hours of aide duty for facilities with a census of 121 to 150 residents.
(F) 48 hours of aide duty for facilities with a census of 151 to 180 residents.
(G) 56 hours of aide duty for facilities with a census of 181 to 210 residents.
(H) 64 hours of aide duty for facilities with a census of 211 to 240 residents.
(3) If the Department determines the needs of the residents at a facility are not being met by staffing requirements of Paragraph (b) of this Rule, the Department shall require the facility to employ staff to meet the needs of the residents.
(c) The aide shall provide personal care services and supervision needed by the residents.
(d) Aides shall not provide housekeeping duties except:
(1) Between the hours of 7:00 a.m. to 9:00 p.m.:
(A) to prevent an accident or injury;
(B) when occasionally attending to an individual resident housekeeping need; and
(C) when the number of aides on duty exceeds the minimum required by Paragraph (a) of this Rule.
(2) Between the hours of 9:00 p.m. to 7:00 a.m., as long as the housekeeping duties do not:
(A) hinder the aide's care of residents or immediate response to resident calls;
(B) do not disrupt the residents' normal lifestyles and sleeping patterns; and
(C) do not take the aide out of view of where the residents are as the aide shall be prepared to care for the residents since that remains his or her primary duty.
(e) Aides shall not be assigned food service duties except when providing assistance to individual residents who need help with eating and carrying plates, trays, or beverages to residents.
(f) In addition to the staffing required for management and aide duties, there shall be additional staff to perform housekeeping and food service duties.
Note: The following chart illustrates the required aide, supervisory and management staffing requirements for each eight-hour shift in facilities with a census of 21 or more residents according to Rules .0602, .0603, .0604, .0608, and .0609 of this Section.
|
|
||||
|
Census |
Position Type |
First Shift |
Second Shift |
Third Shift |
|
21 - 30 |
Aide |
16 |
16 |
8 |
|
Supervisor |
Not Required |
Not Required |
Not Required |
|
|
Administrator |
In the building, or within 500 feet and immediately available. |
|||
|
31-40 |
Aide |
16 |
16 |
16 |
|
Supervisor |
8* |
8* |
In the building, or within 500 feet and immediately available.** |
|
|
Administrator |
On call |
|||
|
41-50 |
Aide |
20 |
20 |
16 |
|
Supervisor |
8* |
8* |
In the building, or within 500 feet and immediately available.** |
|
|
Administrator |
On call |
|||
|
51-60 |
Aide |
24 |
24 |
16 |
|
Supervisor |
8* |
8* |
In the building, or within 500 feet and immediately available.** |
|
|
Administrator |
On call |
|||
|
61-70 |
Aide |
28 |
28 |
24 |
|
Supervisor |
8* |
8* |
4 hours within the facility/4 hours within 500 feet and immediately available.** |
|
|
Administrator |
On call |
|||
|
71-80
|
Aide |
32 |
32 |
24 |
|
Supervisor |
8 |
8 |
4 hours within the facility/4 hours within 500 feet and immediately available.** |
|
|
Administrator |
On call |
|||
|
81-90
|
Aide |
36 |
36 |
24 |
|
Supervisor |
8 |
8 |
4 hours within the facility/4 hours within 500 feet and immediately available.** |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
91-100 |
Aide |
40 |
40 |
32 |
|
Supervisor |
8 |
8 |
8** |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
101-110 |
Aide |
44 |
44 |
32 |
|
Supervisor |
8 |
8 |
8** |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
111-120 |
Aide |
48 |
48 |
32 |
|
Supervisor |
8 |
8 |
8** |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
|
|
|
||
|
121-130 |
Aide |
52 |
52 |
40 |
|
Supervisor |
8 |
8 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
131-140 |
Aide |
56 |
56 |
40 |
|
Supervisor |
8 |
8 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call |
|||
|
141-150 |
Aide |
60 |
60 |
40 |
|
Supervisor |
8 |
8 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
151-160
|
Aide |
64 |
64 |
48 |
|
Supervisor |
16 |
16 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
161-170 |
Aide |
68 |
68 |
48 |
|
Supervisor |
16 |
16 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
171-180 |
Aide |
72 |
72 |
48 |
|
Supervisor |
16 |
16 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
181-190 |
Aide |
76 |
76 |
56 |
|
Supervisor |
16 |
16 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
191-200 |
Aide |
80 |
80 |
56 |
|
Supervisor |
16 |
16 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
201-210 |
Aide |
84 |
84 |
56 |
|
Supervisor |
16 |
16 |
8 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
211-220 |
Aide |
88 |
88 |
64 |
|
Supervisor |
16 |
16 |
16 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
221-230 |
Aide |
92 |
92 |
64 |
|
Supervisor |
16 |
16 |
16 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
|
231-240
|
Aide |
96 |
96 |
64 |
|
Supervisor |
24 |
24 |
16 |
|
|
Administrator |
5 days/week: Minimum of 40 hours. When not in facility, on call. |
|||
*Supervisor may conduct up to four hours of aide duty.
** Supervisor's time on duty in the facility may be counted as required aide duty if the facility is sprinklered.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 143B-165;
Eff. September 1, 2024.
10a ncac 13f .0609 pERSONAL cARE AIDE SUPERVISORS
(a) The personal care aide supervisor shall be responsible for the direct supervision of personal care aides, including those who administer medications, to assure that care and services are provided to residents by personal care aides in in accordance with their training, the facility's policies and procedures, the licensure rules of this Subchapter, and Chapter 131D of the general statutes. The personal care aide supervisor shall also be responsible for observing personal care aides in the performance of their duties; instructing, correcting, and consulting with aides as needed; and reviewing documentation by aides.
(b) During the first and second shifts in facilities with a census of 31 or more residents, and on third shift in facilities with a census of 91 or more residents, the facility shall have supervisors on-duty during each shift as follows:
(1) One supervisor on duty in the facility for less than 64 hours of aide duty per shift.
(2) Two supervisors for 64 to less than 96 hours of aide duty per shift.
(3) Three supervisors for 96 to less than 128 hours of aide duty per shift.
(c) Supervisors shall not provide hours of aide duty while servicing as a supervisor except as follows:
(1) On third shift, in facilities with a census of 31 to 120 residents and a sprinkler fire suppression system.
(2) On first and second shifts, up to four hours, in facilities with a census of 31 to 70 residents.
(3) On first and second shifts, in facilities with a census of 71 or more residents in which some personal care duties are performed, but the time involved in performing any personal care cannot be counted as required aide hours.
(d) On third shift, in facilities with a census of 31 to 60 residents, the supervisor shall be in the facility or within 500 feet and immediately available, as defined in Rule .0608 of this Section.
(e) On third shift, in facilities with a census of 61 to 90 residents, the supervisor shall be on duty in the facility for at least four hours and within 500 feet and immediately available, as defined in Rule .0608 of this Section, for the remaining four hours.
(f) The supervisor on duty shall not serve simultaneously as the administrator but may serve simultaneously as the manager in the absence of the administrator.
History Note: Authority G.S. 131D-2.16; 131D-4.3; 131D-4.5; 143B-165;
Eff. September 1, 2024.
section .0700 - admission and discharge
10A NCAC 13F .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 to an adult care home 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) People shall not 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: Authority G.S. 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0702 DISCHARGE OF RESIDENTS (effective until march 31, 2024)
(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;
(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-2.1; 131D-2.16; 131D-4.5; 131D-4.5; 131D-21; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2004.
10A NCAC 13F .0702 DISCHARGE OF RESIDENTS (effective april 1, 2024)
(a) The discharge of a resident initiated by the facility shall be according to conditions and procedures specified in Paragraphs (a) through (h) 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 initiated by the facility at the direction of the administrator or their designee shall be based on one of the following reasons:
(1) the discharge is necessary to protect the welfare of the resident and the facility cannot meet the needs of the resident, as documented by the resident's physician, physician assistant, or nurse practitioner in the resident's record;
(2) the health of the resident has improved sufficiently so that the resident is no longer in need of the services provided by the facility, as documented by the resident's physician, physician assistant, or nurse practitioner in the resident's record;
(3) the safety of the resident or other individuals in the facility is endangered as determined by the facility at the direction of the administrator or their designee in consultation with the resident's physician, physician assistant, or nurse practitioner;
(4) the health of the resident or other individuals in the facility is endangered as documented by a physician, physician assistant, or nurse practitioner in the resident's record; or
(5) the resident has failed to pay the costs of services and accommodations by the payment due date according to the resident's contract after receiving written notice of warning of discharge for failure to pay.
(c) The facility administrator or their designee 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 completed and 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 Health Benefits, on the internet website https://policies.ncdhhs.gov/divisional/health-benefits-nc-medicaid/forms. The Adult Care Home Notice of Discharge shall include the following:
(A) the date of notice;
(B) the date of transfer or discharge;
(C) the reason for the notice;
(D) the name of responsible person or contact person notified;
(E) the planned discharge location;
(F) the appeal rights;
(G) the contact information for the long-term care ombudsman; and
(H) the signature and date of the administrator.
(2) A copy of the completed Adult Care Home Notice of Discharge and 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 and the individual identified upon admission to receive a discharge notice on behalf of the resident on the same day the Adult Care Home Notice of Discharge is dated. For the purposes of this Rule "responsible person" means a person chosen by the resident to act on their behalf to support the resident in decision-making; access to medical, social, or other personal information of the resident; manage financial matters; or receive notifications. The Adult Care Home Hearing Request Form shall include the following:
(A) the name of the resident;
(B) the name of the facility;
(C) the date of transfer or discharge;
(D) the date of scheduled transfer or discharge;
(E) the selection of how the hearing is to be conducted;
(F) the name of the person requesting the hearing; and
(G) for the person requesting the hearing, their relationship to the resident, address, telephone number, their signature, and date of the request.
(3) Provide the following material in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to the resident and the resident's legal representative and the individual identified upon admission to receive a copy the discharge notice on behalf of the resident:
(A) a copy of the resident's most current FL-2 form required in Rule .0703 of this Subchapter;
(B) a copy of the resident's current physician's orders, including medication order;
(4) Failure to use and simultaneously provide the specific forms according to Subparagraphs (c)(1) and (c)(2) of this Rule shall invalidate the discharge.
(5) A copy of the completed Adult Care Home Notice of Discharge, the Adult Care Home Hearing Request Form as completed by the facility administrator or their designee 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.
(d) The notices of discharge and appeal rights as required in Paragraph (c) of this Rule shall be made by the facility administrator or their designee, at least 30 days before the resident is discharged except that notices may be made as soon as practicable when:
(1) the discharge is necessary to protect the welfare of the resident and the facility cannot meet the needs of the resident under Subparagraph (b)(1) of this Rule; or
(2) reasons under Subparagraphs (b)(3) and (b)(4) of this Rule exist.
(e) The following shall be documented in the resident record and shall be made available upon request to potential discharge locations pursuant to the HIPAA Standards for Privacy of Individually Identifiable Health Information which is hereby incorporated by reference, including any amendments and subsequent editions, and can be found at no cost at https://www.federalregister.gov/documents/2002/08/14/02-20554/standards-for-privacy-of-individually-identifiable-health-information:
(1) The reason for discharge to include one or more of the following as applicable to the reasons under Paragraph (b) of this Rule:
(A) documentation by physician, physician assistant or nurse practitioner as required in Paragraph (b) of this Rule;
(B) 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;
(C) written notices of warning of discharge for failure to pay the costs of services and accommodations; or
(D) 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-2.2(a)(4) and as disclosed in the resident contract signed upon the resident's admission to the facility; and
(2) any known involvement of law enforcement with the resident due to threatening behavior or violence toward self or others.
(f) The facility administrator or their designee shall document contacts with possible discharge locations and responses and make available this documentation, upon request, to the resident, legal representative, the individual identified upon admission to receive a discharge notice on behalf of the resident and the adult care home resident discharge team if convened. For the purposes of this Rule, "the individual identified upon admission to receive a discharge notice on behalf of the resident" may be the same person as the resident's legal representative or responsible person as identified in the resident's record.
(g) The facility administrator or their designee shall provide sufficient preparation and orientation to residents to ensure a safe and orderly discharge from the facility as evidenced by:
(1) explaining to the resident and responsible person or legal representative and the individual identified upon admission to receive a copy of the discharge notice on behalf of the resident why the discharge is necessary;
(2) informing the resident and responsible person or legal representative and the individual identified upon admission to receive a copy of the discharge notice on behalf of the resident about an appropriate discharge destination that is capable of meeting the needs of the resident; and
(A) If at the time of the discharge notice the discharge destination is unknown or is not capable of meeting the needs of the resident, the facility administrator or their designee shall contact the local adult care home resident discharge team as defined in G.S. 131D-4.8(e) to assist with placement; and
(B) The facility, at the direction of the administrator or their designee, shall inform the resident, the resident's legal representative, the individual identified upon admission to receive a copy of the discharge notice on behalf of the resident, and the responsible person of their right to request the Regional Long-Term Care Ombudsman to serve as a member of the adult care home resident discharge team; and
(3) offering the following material to the resident, the resident's legal representative, or the facility where 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 form required in Rule .0703 of this Subchapter;
(B) a copy of the resident's most current assessment and care plan;
(C) a list of referrals to licensed health professionals, including mental health;
(D) a copy of the resident's current physician orders;
(E) a list of the resident's current medications;
(F) the resident's current medications; and
(G) a record of the resident's vaccinations and TB screening;
(4) providing written notice of the name, address and telephone number of the following, if not provided on the discharge notice required in Paragraph (c) of this Rule:
(A) the regional long-term care ombudsman; and
(B) Disability Rights North Carolina, the protection and advocacy agency established under federal law for persons with disabilities;
(5) providing the resident, responsible person, or legal representative, and the individual identified upon admission who received a copy of the discharge notice on behalf of the resident with the discharge location as determined by the adult care home resident discharge team, if convened, at or before the discharge hearing, if the location is known to the facility.
(h) If an appeal hearing is requested:
(1) the facility administrator or their designee shall provide to the resident or legal representative or the resident and the responsible person, 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 administrator or their designee 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 (d) of this Rule.
(i) If a discharge is initiated by the resident, the resident's legal representative, or responsible person, the administrator may require up to a 14-day written notice from the resident, the resident's legal representative, or responsible person which means the resident 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, the resident's legal representative, or responsible person shall be established in the resident contract provided to the resident or responsible person upon admission.
(j) 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 administrator or their designee 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-2.1; 131D-2.16; 131D-4.5; 131D-4.8; 131D-21; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2004;
Readopted Eff. April 1, 2024.
10A NCAC 13F .0703 tuberculosis test, medical examination and IMMUNIZATIONS
(a) Upon admission to an adult 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.
(b) Each resident shall have a medical examination completed by a licensed physician or physician extender prior to admission to the facility and annually thereafter. For the purposes of this Rule, "physician extender" means a licensed physician assistant or licensed nurse practitioner. The medical examination completed prior to admission shall be used by the facility to determine if the facility can meet the needs of the resident.
(c) The medical examination shall be completed no more than 90 days prior to the resident's admission to the facility, except in the case of emergency admission.
(d) In the case of an unplanned, emergency admission, the medical examination of the resident shall be conducted within 72 hours after admission. Prior to an emergency admission, the facility shall obtain current medication and treatment orders from a licensed physician or physician extender.
(e) The result of the medical examination required in Paragraph (b) of this Rule shall be documented on the North Carolina Medicaid Adult Care Home FL-2 form which is available at no cost on the Department's Medicaid website at https://medicaid.ncdhhs.gov/media/6549/open. The Adult Care Home FL-2 shall be signed and dated by the physician or physician extender completing the medical examination. The medical examination shall include the following:
(1) resident's identification information, including the resident's name, date of birth, sex, admission date, county and Medicaid number, current facility and address, physician's name and address, a relative's name and address, current level of care, and recommended level of care;
(2) resident's admitting diagnoses, including primary and secondary diagnoses and dates of onset;
(3) resident's current medical information, including orientation, behaviors, personal care assistance needs, frequency of physician visits, ambulatory status, functional limitations, information related to activities and social needs, neurological status, bowel and bladder functioning status, manner of communication of needs, skin condition, respiratory status, and nutritional status including orders for therapeutic diets;
(4) special care factors, including physician orders for blood pressure, diabetic urine testing, physical therapy, range of motion exercises, a bowel and bladder program, a restorative feeding program, speech therapy, and restraints;
(5) resident's medications, including the name, strength, dosage, frequency and route of administration of each medication;
(6) results of x-rays or laboratory tests determined by the physician or physician extender to be necessary information related to the resident's care needs; and
(f) If the information on the Adult Care Home FL-2 is not clear or is insufficient, or information provided to the facility related to the resident's condition or medications after the completion of the medical examination conflicts with the information provided on the Adult Care Home FL-2, the facility shall contact the physician or physician extender for clarification in order to determine if the facility can meet the individual's needs.
(g) The results of the medical examination shall be maintained in the resident's record in accordance with Rule .1201 of this Subchapter. Discharge medication orders shall be clarified in accordance with Rule .1002(a) of this Subchapter.
(h) Upon a resident's return to the facility from a hospitalization, the facility shall obtain and review the hospital discharge summary or discharge instructions, including any discharge medication orders. If the facility identifies discrepancies between the discharge orders and current orders at the facility, the facility shall clarify the discrepancies with the resident's physician or physician extender.
(i) Each resident shall be immunized against pneumococcal disease and annually against influenza virus according to G.S. 131D-9, except as otherwise indicated in law.
(1) has been an inpatient of a psychiatric facility within 12 months prior to admission to the facility and does not have a current plan for follow-up psychiatric care; or
(2) has been hospitalized due to threatening or violent behavior, suicidal ideation or self-harm, or other psychiatric symptoms that required hospitalization within 12 months prior to admission to the facility and does not have a current plan for follow-up psychiatric care.
History Note: Authority G.S. 131D-2.16; 143B-165;
Temporary Adoption Eff. September 1, 2003;
Eff. June 1, 2004;
Readopted Eff. June 1, 2024.
10A NCAC 13F .0704 Resident Contract, INFORMATION ON facility, and Resident Register
(a) An adult care home administrator or their management designee shall furnish and review with the resident or the resident's authorized representative as defined in Rule .1103 of this Subchapter information on the facility upon admission and when changes are made to that information. The facility shall involve the resident in the review of the resident contract and information on the facility unless the resident is cognitively unable to participate in the discussion. 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 and retained in the resident's record in the facility. The information shall consist of the following:
(1) the resident contract to which the following applies:
(C) the contract shall be signed and dated by the administrator or management designee and the resident or the resident's authorized representative, a copy given to the resident or the resident's authorized representative and a copy kept in the resident's record;
(D) the resident or the resident's authorized representative shall be given a written 30-day notice prior to any change in charges for resident services and accommodations, including the cost of different levels of service, description of level of care and services, and any other charges or fees, and be provided an amended contract or an amendment to the contract for review and confirmation of receipt;
(E) gratuities in addition to the established rates shall not be accepted; and
(F) the maximum monthly adult care home rate that may be charged to Special Assistance recipients as established by the North Carolina Social Services Commission and the North Carolina General Assembly.
(2) a written copy of all house rules, including facility policies on smoking, alcohol consumption, visitation, refunds and the requirements for discharge of residents consistent with the rules of this Subchapter, and amendments disclosing any changes in the house rules. The house rules shall be in compliance with G.S. 131D-21;
(3) a copy of the Declaration of Residents' Rights as found in G.S. 131D-21;
(4) a copy of the facility's grievance procedures that shall indicate how the resident is to present complaints and make suggestions as to the facility's policies and services on behalf of himself or herself or others; and
(5) a statement as to whether the facility 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 facility does not choose to comply or is non-compliant, the residents of the facility would not be able to receive State-County Special Assistance for Adults and the facility would not receive supportive services from the county department of social services.
(b) The administrator or their management designee and the resident or the resident's representative shall complete and sign the Resident Register initial assessment within 72 hours of the resident's admission to the facility in accordance with G.S. 131D-2.15. The facility shall involve the resident in the completion of the Resident Register unless the resident is cognitively unable to participate. The Resident Register shall consist of the following:
(2) resident's current care needs including activities of daily living and services, use of assistive aids, orientation status;
(3) resident's preferences including personal habits, food preferences and allergies, community involvement, and activity interests;
(4) resident's consent and request for assistance including the release of information, personal funds management, personal lockable space, discharge information, and assistance with personal mail;
(5) name of the individual identified by the resident who is to receive a copy of the notice of discharge per G.S. 131D-4.8; and
(6) resident's consent including a signature confirming the review and receipt of information contained in the form.
The Resident Register is available on the internet website, https://info.ncdhhs.gov/dhsr/acls/pdf/resregister.pdf at no charge. The facility may use a resident information form other than the Resident Register as long as it contains the same information as the Resident Register. Information on the Resident Register shall be kept updated and maintained in the resident's record.
History Note: Authority 131D-2.15; 131D-2.16; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Eff. July 1, 2005;
Amended Eff. April 1, 2022;
Readopted Eff. June 1, 2024.
section .0800 - resident assessment and care plan
10A NCAC 13F .0801 RESIDENT ASSESSMENT
(a) An adult 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, provider of mental health, developmental disabilities or substance abuse services or 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 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-2.16; 131D-4.4; 131D-4.5; 143B-165;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. September 1, 2003; July 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004.
10A NCAC 13F .0802 RESIDENT CARE PLAN
(a) An adult 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 is 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 Section.
(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-2.16; 131D-4.3; 131D-4.4; 131D-4.5; 143B-165;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. September 1, 2003; July 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004.
SECTION .0900 – resident care and SERVICES
10A NCAC 13F .0901 PERSONAL care and supervision
(a) Adult 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-2.16; 131D-4.3; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005; April 1, 2004; April 1, 1984;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10a NCAC 13F .0902 HEALTH CARE
(a) An adult 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-2.16; 131D-4.3; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. September 1, 2003; July 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0903 LICENSED HEALTH PROFESSIONAL SUPPORT
(a) An adult 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, excluding anticoagulants such as heparin.
(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(a)(14) of this Rule);
(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 9, 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. 90-270.90, Article 18E, for tasks listed in Subparagraphs (a)(17) and (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 9, 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-2.16; 131D-4.5; 143B-165;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. September 1, 2003; July 1, 2003;
Amended Eff. June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. July 1, 2021.
10A NCAC 13F .0904 NUTRITION AND FOOD SERVICE
(a) Food Procurement and Safety in Adult Care Homes:
(1) Facilities with a licensed capacity of 7 to 12 residents shall ensure food services comply with Rules Governing the Sanitation of Residential Care Facilities set forth in 15A NCAC 18A .1600 which are hereby incorporated by reference, including subsequent amendments, assuring storage, preparation, and serving food and beverage under sanitary conditions.
(2) Facilities with a licensed capacity of 13 or more residents shall ensure food services comply with Rules Governing the Sanitation of Hospitals, Nursing Homes, Adult Care Homes and Other Institutions set forth in 15A NCAC 18A .1300 which are hereby incorporated by reference, including subsequent amendments, assuring storage, preparation, and serving of food and beverage under sanitary conditions.
(3) Only meat processed at a USDA-approved processing plant shall be served.
(4) There shall be a three-day supply of perishable food and a five-day supply of non-perishable food in the facility based on the menus established in Paragraph (c) of this Rule for both regular and therapeutic diets. For the purpose of this Rule "perishable food" is food that is likely to spoil or decay if not kept refrigerated at 40 degrees Fahrenheit or below, or frozen at zero degrees Fahrenheit or below and "non-perishable food" is food that can be stored at room temperature and is not likely to spoil or decay within seven days.
(b) Food Preparation and Service in Adult Care Homes:
(1) Table service shall include a napkin and non-disposable place setting consisting of at least a knife, fork, spoon, plate, and beverage containers.
(2) Hot foods shall be served hot and cold foods shall be served cold as set forth in Rule 15A NCAC 18A .1620(a) for facilities with a licensed capacity of 7 to 12 residents and as set forth in Rule 15A NCAC 18A .1323 Food Protection in Activity Kitchens, Rehabilitation Kitchens, and Nourishment Stations for facilities with a licensed capacity of 13 or more residents, which are hereby incorporated by reference, including subsequent amendments.
(3) If residents require feeding assistance, food shall be maintained at serving temperature until assistance is provided.
(c) Menus in Adult 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 for guidance of food service staff.
(3) Any substitutions made in the menu shall be of equal nutritional value, in order to maintain the daily dietary requirements in Subparagraph (d)(3) of this Rule, appropriate for therapeutic diets, and documented in records maintained in the kitchen to indicate the foods actually served to residents.
(4) Menus shall be planned to take into account the food preferences of the residents as documented on the Resident Register.
(5) Menus as served, invoices, and other receipts for food or beverage purchases shall be maintained in the facility for 30 days.
(6) Menus for all therapeutic diets shall be planned or reviewed by a licensed dietitian/nutritionist. The facility shall maintain verification of the licensed dietitian/nutritionist's approval of the therapeutic diets.
(7) The facility shall have a matching therapeutic diet menu for any resident's physician-ordered therapeutic diet for guidance of food service staff.
(d) Food Requirements in Adult Care Homes:
(1) Each resident shall be served a minimum of three nutritionally adequate meals based on the requirements in Subparagraph (d)(3) of this Rule. Meals shall be served at regular times comparable to normal meal times in the community. There shall be at least 10 hours between the breakfast and evening meals.
(2) Foods and beverages shall be offered in accordance with each residents' prescribed diet 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 be based on the U.S. Department of Agriculture Dietary guidelines for Americans 2020-2025, which are hereby incorporated by reference including subsequent amendments and editions. These guidelines can be found at https://dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf for no cost.
(4) Water shall be served to each resident at each meal, in addition to other beverages.
(e) Therapeutic Diets in Adult 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 that include the definition of any therapeutic diet identified in the facility's therapeutic menu approved by a licensed dietitian/nutritionist. For the purpose of this Rule "therapeutic diet" is a diet ordered by a physician, physician assistant, nurse practitioner, or a licensed dietician/nutritionist as delegated by the physician that is part of the treatment for a disease or clinical condition, to eliminate, decrease, or increase certain substances in the diet (e.g., sodium or potassium), or to provide mechanically altered food when indicated.
(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 a 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 Adult Care Homes:
(1) The facility shall provide staff for individual feeding assistance in accordance to residents' needs.
(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. Each resident shall receive three meals in accordance with resident preferences as documented in the resident's record.
History Note: Authority G.S. 131D-2.1(4); 131D-2.16; 131D-4.4; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Readopted Eff. March 1, 2023.
10A NCAC 13F .0905 ACTIVITIES PROGRAM
(a) Each adult 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 or her 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 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 in a format that is legible and shall be posted in a location accessible to residents by the first day of each month, and updated when there are any changes;
(3) involve community resources, such as recreational, volunteer, and religious organizations, 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, supplies necessary for planned activities, 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 at least 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.
(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.
(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) Residents shall have the opportunity to participate in volunteer service activities in the facility or in the community. Participation in volunteer activities shall not be required of residents and shall not involve any duties or responsibilities that are outlined in the job descriptions of facility staff.
History Note: Authority G.S. 131D-2.16; 131D-4.1; 131D-4.3;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2004;
Temporary Amendment Eff. July 1, 2004 (This temporary amendment replaces the permanent rule approved by RRC on May 20, 2004);
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. October 1, 2022.
10A NCAC 13F .0906 OTHER Resident Care and Services
(a) Transportation. The administrator shall assure the provision of transportation for the residents of adult care homes 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 shall not 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 shall be unopened unless there is a written, witnessed request authorizing management staff to open and read mail to the resident. This request shall 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 shall provide such items at cost. It is not the home's obligation to pay for these items.
(c) Laundry.
(1) Laundry services shall 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 shall be indicated on Form DSS‑1865, the Resident Register.
(d) Telephone.
(1) A telephone shall be available in a location providing privacy for residents to make and receive calls.
(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 shall be provided for each resident to secure his personal valuables. One key shall be provided free of charge to the resident. Additional keys shall 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 shall 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 shall 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 shall 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 shall 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 shall 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 shall 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-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1987; April 1, 1984;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A ncac 13F .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 an adult 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 .0702, .0704(b), .0801, .0802 and .1201.
(c) The number of respite care residents and adult care home residents shall not exceed the facility's licensed bed capacity.
(d) If the facility is staffing to census, the respite care residents shall be included in the daily census for determination of appropriate staffing levels according to the rules of this Subchapter.
(e) 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.
(f) 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 .0703 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.
(g) 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.
(h) 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 (f) 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(a) 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.
(i) 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-2.16; 143B-165;
Temporary Adoption Eff. November 1, 2000;
Eff. July 18, 2002;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .0908 COOPERATION WITH CASE MANAGERS
History Note: Authority G.S. 131D-2.16; 131D-4.3; 143B-165;
Temporary Adoption Eff. January 1, 1996;
Eff. May 1, 1997;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Expired Eff. April 1, 2018 pursuant to G.S. 150B-21.3A.
10A NCAC 13F .0909 RESIDENT RIGHTS
An adult 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-2.16; 131D-21; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
section .1000 - medications
10A NCAC 13F .1001 MEDICATION ADMINISTRATION POLICIES AND PROCEDURES
In addition to the requirements in Rule .1211(a)(1) of this Subchapter, an adult 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-2.16; 131D-4.5; 143B-165;
Eff. January 1, 1977;
Amended Eff. April 22, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2005; July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1002 MEDICATION ORDERS
(a) An adult 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-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .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;
Eff. July 1, 2005;
Amended Eff. April 1, 2015;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1004 MEDICATION ADMINISTRATION
(a) An adult 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 to residents 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 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-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1005 SELF-ADMINISTRATION OF MEDICATIONS
(a) An adult care home shall permit residents who are competent and physically able 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-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10a NCAC 13F .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 by the adult care home's medication storage policy and procedures.
(b) All prescription and non-prescription medications stored by the facility, including those requiring refrigeration, shall be maintained under locked security except when under the direct physical supervision of staff in charge of medication administration.
(c) The medication storage area shall be routinely cleaned, include functional lighting, ventilated to circulate fresh air, 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 routinely cleaned and medications shall be stored in an orderly manner.
(d) Locked storage areas for medications shall only be accessible by staff responsible for medication administration, the administrator, or the administrator-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 may possess a stock of non-prescription medications or the following prescription legend medications for general or common use in accordance with physicians' orders:
(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.
(i) First aid supplies shall be immediately available to staff within the facility, stored out of sight of residents and visitors, and stored separately from medications.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Readopted Eff. October 1, 2022.
10A NCAC 13F .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 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 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 licensed pharmacist, dispensing practitioner or designee of the licensed pharmacist or dispensing practitioner. 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-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1008 CONTROLLED SUBSTANCES
(a) An adult care home shall assure a record of controlled substances by documenting the receipt, administration, and disposition of controlled substances. These records shall be maintained with the resident's record in the facility and in such an order that there can be accurate reconciliation of controlled substances.
(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 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 conducted so that no person can use, administer, sell, or give away the controlled substance. 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, 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-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Readopted Eff. October 1, 2022.
10A NCAC 13F .1009 PHARMACEUTICAL CARE
(a) An adult care home shall obtain the services of a licensed pharmacist or a prescribing practitioner for the provision of pharmaceutical care at least quarterly. The Department may require more frequent visits if it documents during monitoring visits or other investigations that there are medication problems in which the safety of residents may be at risk.
Pharmaceutical care involves the identification, prevention and resolution of medication related problems which includes the following:
(1) an on-site medication review for each resident which includes 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 Subparagraphs (a)(1) through (4) 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 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 (a)(1) through (6) of this Rule in the facility, including action taken by the facility.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1010 PHARMACEUTICAL SERVICES
(a) An adult 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, all applicable State and federal rules and 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 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:
(A) the name and strength of the medication;
(B) the directions for administration as prescribed by the resident's physician; and
(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 medication 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.
(f) A facility with 12 or more beds shall have a current, written agreement with a pharmacy provider for dispensing services. The written agreement shall include a statement of the responsibility of each party.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Amended Eff. April 1, 2015;
Readopted Eff. October 1, 2022.
section .1100 – resident's funds and refunds
10A NCAC 13F .1101 management OF RESIDENTS 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 .1103 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. 35A-1203; 108A-37; 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1102 REFUND POLICy
An adult care home's refund policies shall be in writing and signed by the administrator. A copy shall be given to each 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-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1103 authorized REPRESENTATIVE
(a) In situations where the facility determines a resident of an adult care home is unable to manage their monetary funds, the administrator shall contact the resident's responsible person or the county department of social services regarding the need for an authorized representative. For the purposes of this Section, an "authorized representative" shall mean a person who is legally authorized or designated in writing by the resident to act on his or her behalf in the management of their funds.
(b) The administrator and other staff of the home facility shall not serve as a resident's authorized representative, payee, or executor of a will except in the case of funds administered by the Social Security Administration, the Veteran's Administration or other federal government agencies. The administrator of the facility 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 authorized representative or payee receipts for any monies received on behalf of the resident.
History Note: Authority G.S. 35A-1203; 108A-37; 131D-2.16; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. June 1, 2024.
10A NCAC 13F .1104 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. If the statement is marked by the resident, there shall be one witness signature. For residents who have been adjudicated incompetent, the signature of the resident's authorized representative shall be required. Witnesses cannot include the staff handling the residents' personal funds transactions. The statement shall be maintained in the facility.
(c) The facility shall provide each resident or the resident's authorized representative a written monthly accounting of the resident's funds handled by the administrator or the administrator's designee. The facility shall maintain at the facility a record signed by the resident or their authorized representative indicating whether the resident or their authorized representative agrees that the monthly accounting is accurate. The records shall be maintained by the facility for at least one year.
(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 their authorized representative upon request during the facility's established business days and hours except as provided in Rule .1105 of this Section.
(f) The resident's personal needs allowance shall be credited to the resident's account within one business day of the funds being available in the facility's resident personal funds account.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. June 1, 2024.
10A NCAC 13F .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 the 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-2.16; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1106 SETTLEMENT OF COST OF CARE
(a) If a resident of an adult care home, has been notified by the facility of its intent to discharge in accordance with Rule .0702 of this Subchapter, the facility shall refund the resident an amount equal to the cost of care for the remainder of the month minus the amount charged for any nights spent in the facility during the notice period. The refund shall be made within 14 days after the resident leaves the facility. For the purposes of this Rule, "cost of care" means any monies paid by the resident or the resident's legal representative in advance for room and board and services provided by the facility as agreed upon in the resident's contract.
(b) When a resident moves out of the facility without giving notice, as may be required by the facility according to Rule .0702(i) of this Subchapter, or before the facility's required notice period has elapsed, the facility shall charge the resident no more than the amount equal to the cost of care for the required notice period. If a resident receiving State‑County Special Assistance moves before the facility's required notice period has elapsed, the facility may charge the resident for the required notice period. The facility 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 after the resident leaves the facility.
(c) When there is an exception to the notice as provided in Rule .0702(i) of this Subchapter, to protect the health or safety of the resident or others in the facility, or when there is a sudden, unexpected closure of the facility that requires the resident to relocate, the facility shall only charge the resident for any nights spent in the facility. A refund shall be made to the resident by the facility within 14 days from the date of notice.
(d) When a resident gives notice of leaving the facility, as may be required by the facility according to Rule .0702(i) of this Subchapter, and leaves at the end of the notice period, the facility 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 facility, the refund shall be made within 14 days after the resident leaves the facility.
(e) When a resident leaves the facility and the resident or his or her responsible person has notified the facility of the intent of returning to it, the following apply:
(1) If the resident or their responsible party reserves their bed for a set number of days, the facility shall have a written agreement for the payment for the days the bed is held in accordance with Rule .0704(a)(1)(A) of this Subchapter.
(2) If, after leaving the facility, the resident decides not to return to it, the facility shall require no more than a 14-day written notice that he or she is not returning.
(3) If the facility requires a 14-day written notice, the requirement shall be a part of the written agreement and explained by the facility to the resident and his or her family or responsible person before signing.
(4) When a resident or someone acting on his or her behalf notifies the facility that he or she will not be returning to the facility, the facility shall refund the remainder of any advance payment to the resident or his or her responsible person. The refund shall include the 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 facility.
(5) The facility shall not require payment from a resident that receives State County Special Assistance for more than 30 days unless the resident is actually residing in the facility or it is anticipated that he or she will return to the facility within 30 days.
(6) Exceptions to the 14-day notice, if required by the facility, are cases where returning to the facility would jeopardize the health or safety of the resident or others in the facility 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 facility shall provide a refund the rest of any advance payment calculated beginning with the day the facility is notified. The facility shall provide the refund to the authorized representative with 14 days after the resident leaves the facility or within 30 days after the resident's death.
(f) If a resident dies, the administrator of his or her estate or the Clerk of Superior Court, when no administrator for his or her estate has been appointed, shall be given a refund equal to the cost of care for the month minus any nights spent in the facility during the month. This is to be done within 30 days after the resident's death.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 143B-165;
Eff. July 1, 2005;
Readopted Eff. June 1, 2024.
section .1200 – policies, records and reports
10A NCAC 13F .1201 RESIDENT RECORDS
(a) The following shall be maintained on each resident in an orderly manner in the resident's record in the adult 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 the 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(a)(2) of this Subchapter;
(C) Declaration of Residents' Rights (G.S. 131D-21);
(D) the 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 Subparagraphs (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 .1101 of this Subchapter shall be maintained on each resident in an orderly manner in the facility and made 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-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. April 1, 1984;
Temporary Amendment Eff. July 1, 2004;
Amended Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1202 DISPOSAL OF RESIDENT RECORDS
After a resident has left an adult care home or died, the resident's records shall be filed in the facility for at least one year and then stored for at least two more years.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2005; June 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1203 REPORT OF ADMISSIONS AND dISCHARGES
History Note: Authority G.S. 131D‑2; 143B-165; S.L. 2002-0160;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. June 1, 2004;
Repealed Eff. July 1, 2005.
10A NCAC 13F .1204 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;
Temporary Amendment Eff. July 1, 2003;
Temporary Repeal Eff. September 1, 2003;
Repealed Eff. June 1, 2004.
10A NCAC 13F .1205 HEALTH CARE PERSONNEL REGISTRY
The facility shall comply with G.S. 131E-256 and supporting Rules 10A NCAC 13O .0101 and .0102.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131E-256; 143B-165;
Temporary Adoption Eff. January 1, 2000;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1206 marketing
An adult care home may market 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; and
(3) the home is classified by licensure status.
History Note: Authority G.S. 131D-2.1; 131D-2.16; 143B-165;
Eff. January 1, 1977;
Readopted Eff. October 31, 1977;
Temporary Amendment Eff. July 1, 2003;
Amended Eff. July 1, 2004;
Readopted Eff. January 1, 2020.
10A NCAC 13F .1207 facilties to report resident deaths
The facility shall report resident deaths to the Division of Health Service Regulation in accordance with G.S. 131D-34.1.
History Note: Authority G.S. 131D-2.4; 131D-2.16; 131D-34.1; 143B-165;
Temporary Adoption Eff. May 1, 2001;
Eff. July 18, 2002;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018;
Amended Eff. October 1, 2022.
10A NCAC 13F .1208 death REPORTING REQUIREMENTS
(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 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-2.16; 131D-34.1;
Temporary Adoption Eff. May 1, 2001;
Eff. July 18, 2002;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1209 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-2.16; 131D-34.1;
Temporary Adoption Eff. May 1, 2001;
Eff. July 18, 2002;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1210 RECORD OF STAFF QUALIFICATIONS
An adult 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-2.16; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1211 WRITTEN POLICIES AND PROCEDURES
(a) An adult 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 G.S. 131D-2.16; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Temporary Adoption Expired March 12, 2005;
Eff. June 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1212 REPORTING OF ACCIDENTS AND INCIDENTS
(a) An adult 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 medical 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-2.16; 143B-165;
Eff. July 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1213 AVAILABILITY OF CORRECTIVE ACTION AND SURVEY REPORTS
An adult care home shall make available to residents and their families or responsible persons and to prospective residents and their families or responsible persons, upon request and in a location accessible to residents and visitors in the home the following:
(1) the most recent annual or biennial and subsequent facility survey reports issued by the Adult Care Licensure Section of the Division of Health Service Regulation;
(2) any other reports issued by the Adult Care Licensure Section of the Division of Health Service Regulation within the past 12 months; and
(3) corrective action reports issued by the county department of social services within the past 12 months.
History Note: Authority G.S. 131D-2.16; 143B-165;
Eff. July 1, 2005;
Readopted Eff. January 1, 2022.
section .1300 - SPECIAL CARE UNITS FOR ALZHEIMER AND RELATED DISORDERS
10A NCAC 13F .1301 DEFINITIONS APPLICABLE TO SPECIAL CARE UNITS
The following definitions shall apply throughout this Section:
(1) "Alzheimer's Disease" means a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior. Characteristic symptoms of the disease include gradual memory loss, impaired judgment, disorientation, personality change, difficulty in learning, and loss of language skills.
(2) "Related disorders" means dementing or memory impairing conditions characterized by irreversible memory dysfunction.
(3) "Special care unit for persons with Alzheimer's Disease or related disorders" means an entire facility or any section, wing or hallway within an adult care home separated by closed doors from the rest of the home, or a program provided by an adult care home, that is designated or advertised especially for special care of residents with Alzheimer's Disease or related disorders.
(4) "Care coordinator" means a staff person in a special care unit who oversees resident care and coordinates, supervises and evaluates resident services to assure that each resident receives services appropriate to the individual's needs.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1302 SPECIAL CARE UNIT DISCLOSURE
(a) Only those facilities with units that meet the requirements of this Section may advertise, market or otherwise promote themselves as providing special care units for persons with Alzheimer's Disease or related disorders.
(b) The facility shall disclose information about the special care unit according to G.S. 131D-8 and which addresses policies and procedures listed in Rule .1305 of this Section.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10a NCAC 13F .1303 LICENSURE OF FACILITIES WITH SPECIAL CARE UNITS
A facility that advertises, markets or otherwise promotes itself as having a special care unit for residents with Alzheimer's Disease or related disorders and meets the requirements of this Section for special care units and the rules set forth in this Subchapter shall be licensed as an adult care home with a special care unit. The license shall indicate that a special care unit for residents with Alzheimer's Disease or related disorders is provided.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1304 SPECIAL CARE UNIT BUILDING REQUIREMENTS
In addition to meeting all applicable building codes and licensure regulations for adult care homes, the special care unit shall meet the following building requirements:
(1) Plans for new or renovated construction or conversion of existing building areas shall be submitted to the Construction Section of the Division of Health Service Regulation for review and approval.
(2) If the special care unit is a portion of a facility, it shall be separated from the rest of the building by closed doors.
(3) Unit exit doors may be locked only if the locking devices meet the requirements outlined in the N.C. State Building Code for special locking devices.
(4) Where exit doors are not locked, a system of security monitoring shall be provided.
(5) The unit shall be located so that other residents, staff and visitors do not have to routinely pass through the unit to reach other areas of the building.
(6) At a minimum the following service and storage areas shall be provided within the special care unit: staff work area, nourishment station for the preparation and provision of snacks, lockable space for medication storage, and storage area for the residents' records.
(7) Living and dining space shall be provided within the unit at a total rate of 30 square feet per resident and may be used as an activity area.
(8) Direct access from the facility to a secured outside area shall be provided.
(9) A toilet and hand lavatory shall be provided within the unit for every five residents.
(10) A tub and shower for bathing of residents shall be provided within the unit.
(11) Use of potentially distracting mechanical noises such as loud ice machines, window air conditioners, intercoms and alarm systems shall be minimized or avoided.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13F .1305 SPECIAL CARE UNIT POLICIES AND PROCEDURES
The facility shall assure that special care unit policies and procedures are established, implemented by staff and available for review within the facility. In addition to all applicable policies and procedures for adult care homes, there shall be policies and procedures that address the following:
(1) the philosophy of the special care unit which includes a statement of mission and objectives regarding the specific population to be served by the unit which shall address, but not be limited to, the following:
(a) safe, secure, familiar and consistent environment that promotes mobility and minimal use of physical restraints or psychotropic medications;
(b) a structured but flexible lifestyle through a well developed program of care which includes activities appropriate for each resident's abilities;
(c) individualized care plans that stress the maintenance of residents' abilities and promote the highest possible level of physical and mental functioning; and
(d) methods of behavior management which preserve dignity through design of the physical environment, physical exercise, social activity, appropriate medication administration, proper nutrition and health maintenance;
(2) the process and criteria for admission to and discharge from the unit;
(3) a description of the special care services offered in the unit;
(4) resident assessment and care planning, including opportunity for family involvement in care planning, and the implementation of the care plan, including responding to changes in the resident's condition;
(5) safety measures addressing dementia specific dangers such as wandering, ingestion, falls and aggressive behavior;
(6) staffing in the unit;
(7) staff training based on the special care needs of the residents;
(8) physical environment and design features that address the needs of the residents;
(9) activity plans based on personal preferences and needs of the residents;
(10) opportunity for involvement of families in resident care and the availability of family support programs; and
(11) additional costs and fees for the special care provided.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1306 ADMISSION TO THE SPECIAL CARE UNIT
In addition to meeting all requirements specified in the rules of this Subchapter for the admission of residents to the home, the facility shall assure that the following requirements are met for admission to the special care unit:
(1) A physician shall specify a diagnosis on the resident's FL-2 that meets the conditions of the specific group of residents to be served.
(2) There shall be a documented pre-admission screening by the facility to evaluate the appropriateness of an individual's placement in the special care unit.
(3) Family members seeking admission of a resident to a special care unit shall be provided disclosure information required in G.S. 131D-8 and any additional written information addressing policies and procedures listed in Rule .1305 of this Subchapter that is not included in G.S. 131D-8. This disclosure shall be documented in the resident's record.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1307 SPECIAL CARE UNIT RESIDENT PROFILE AND CARE PLAN (effective until march 31, 2024)
In addition to the requirements in Rules 13F .0801 and 13F .0802 of this Subchapter, the facility shall assure the following:
(1) Within 30 days of admission to the special care unit and quarterly thereafter, the facility shall develop a written resident profile containing assessment data that describes the resident's behavioral patterns, self-help abilities, level of daily living skills, special management needs, physical abilities and disabilities, and degree of cognitive impairment.
(2) The resident care plan as required in Rule 13F .0802 of this Subchapter shall be developed or revised based on the resident profile and specify programming that involves environmental, social and health care strategies to help the resident attain or maintain the maximum level of functioning possible and compensate for lost abilities.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000.
10A NCAC 13F .1307 SPECIAL CARE UNIT RESIDENT PROFILE AND CARE PLAN (effective april 1, 2024)
In addition to the requirements in Rules .0801 and .0802 of this Subchapter, the facility shall:
(1) Within 30 days of admission to the special care unit and quarterly thereafter, develop a written resident profile containing assessment data that describes the resident's behavioral patterns, self-help abilities, level of daily living skills, special management needs, physical abilities and disabilities, and degree of cognitive impairment.
(2) Develop or revise the resident's care plan required in Rule .0802 of this Subchapter based on the resident profile and specify programming that involves environmental, social and health care strategies to help the resident attain or maintain the maximum level of functioning possible and compensate for lost abilities.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Readopted Eff. April 1, 2024.
10A NCAC 13F .1308 SPECIAL CARE UNIT STAFFING
(a) Staff shall be present in the unit at all times in sufficient number to meet the needs of the residents; but at no time shall there be less than one staff person, who meets the orientation and training requirements in Rule .1309 of this Section, for up to eight residents on first and second shifts and 1 hour of staff time for each additional resident; and one staff person for up to 10 residents on third shift and .8 hours of staff time for each additional resident.
(b) There shall be a care coordinator on duty in the unit at least eight hours a day, five days a week. The care coordinator may be counted in the staffing required in Paragraph (a) of this Rule for units of 15 or fewer residents.
(c) In units of 16 or more residents and any units that are freestanding facilities, there shall be a care coordinator as required in Paragraph (b) of this Rule in addition to the staff required in Paragraph (a) of this Rule.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1309 SPECIAL CARE UNIT STAFF ORIENTATION AND TRAINING
The facility shall assure that special care unit staff receive at least the following orientation and training:
(1) Prior to establishing a special care unit, the administrator shall document receipt of at least 20 hours of training specific to the population to be served for each special care unit to be operated. The administrator shall have in place a plan to train other staff assigned to the unit that identifies content, texts, sources, evaluations and schedules regarding training achievement.
(2) Within the first week of employment, each employee assigned to perform duties in the special care unit shall complete six hours of orientation on the nature and needs of the residents.
(3) Within six months of employment, staff responsible for personal care and supervision within the unit shall complete 20 hours of training specific to the population being served in addition to the training and competency requirements in Rule .0501 of this Subchapter and the six hours of orientation required by this Rule.
(4) Staff responsible for personal care and supervision within the unit shall complete at least 12 hours of continuing education annually, of which six hours shall be dementia specific.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAc 13F .1310 OTHER APPLICABLE RULES FOR SPECIAL CARE UNITS
In addition to specific rules pertaining to special care units for residents in this Section, such units shall also meet all other applicable requirements governing the operation of adult care homes as set forth in this Subchapter.
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
section .1400 – special care units for mental health disorders
10A NCAC 13F .1401 DEFINITIONS APPLICABLE TO SPECIAL CARE UNITS
10A NCAC 13F .1402 SPECIAL CARE UNIT DISCLOSURE
10A NCAC 13F .1403 LICENSURE OF FACILITIES WITH SPECIAL CARE UNITS
10A NCAC 13F .1404 SPECIAL CARE UNIT BUILDING REQUIREMENTS
10A NCAC 13F .1405 SPECIAL CARE UNIT POLICIES AND PROCEDURES
10A NCAC 13F .1406 ADMISSION TO THE SPECIAL CARE UNIT
10A NCAC 13F .1407 SPECIAL CARE UNIT RESIDENT PROFILE AND CARE PLAN
10A NCAC 13F .1408 SPECIAL CARE UNIT STAFFING
10A NCAC 13F .1409 SPECIAL CARE UNIT STAFF ORIENTATION AND TRAINING
10A NCAC 13F .1410 RESIDENTS' RIGHTS
10A NCAC 13F .1411 OTHER APPLICABLE RULES FOR SPECIAL CARE UNITS
History Note: Authority G.S. 131D-2.16; 131D-4.5; 131D-4.6; 131D-8; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Expired Eff. April 1, 2018 pursuant to G.S. 150B-21.3A.
section .1500 - use of physical restraints and alternatives
10A NCAC 13F .1501 USE OF PHYSICAL RESTRAINTS AND ALTERNATIVES
(a) An adult 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 Rules 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-2.16; 143B-165;
Temporary Adoption Eff. July 1, 2004;
Temporary Adoption Expired March 12, 2005;
Eff. June 1, 2005;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
section .1600 – rated certificates
10A NCAC 13F .1601 SCOPE
(a) This Section applies to all licensed adult care homes for seven or more 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 an adult 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 13F .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 13f .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 13F .0300 Physical Plant Requirements;
(3) 10A NCAC 13F .0700 Admission and Discharge Requirements;
(4) 10A NCAC 13F .0800 Resident Assessment and Care Plan;
(5) 10A NCAC 13F .0900 Resident Care and Services;
(6) 10A NCAC 13F .1000 Medication Management;
(7) 10A NCAC 13F .1300 Special Care Units for Alzheimer's and Related Disorders;
(8) 10A NCAC 13F .1400 Special Care Units for Mental Health Disorders; and
(9) 10A NCAC 13F .1500 Use of Physical Restraints and Alternatives.
History Note: Authority G.S. 131D-4.5; 131D-10;
Eff. July 3, 2008.
10A NCAC 13F .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 13F .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.
Section .1700 –Administrator Certification AND RENEWAL
10A NCAC 13F .1701 CERTIFICATION OF ADMINISTRATOr
The administrator of an adult care home licensed on or after January 1, 2000, shall be certified by the Department under the provisions of G.S. 90, Article 20A.
History Note: Authority G.S. 90-288.12; 131D-2.16; 131D-2.18; 131D-4.3; 143B-165;
Temporary Adoption Eff. December 1, 1999;
Eff. July 1, 2000;
Amended Eff. June 1, 2004;
Transferred and Recodified from 10A NCAC 13F .0401 Eff. February 29, 2016;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 6, 2018.
10A NCAC 13F .1702 ADVERSE ACTION ON CERTIFICATION
(a) The Department shall deny, suspend, or revoke the certification of an administrator if the administrator or applicant administrator:
(1) has not completed the continuing education credits required by Rule .1703 of this Section;
(2) has been convicted by any jurisdiction of a felony unless rights of citizenship have been restored and all of the following have been considered and determined by the Department to allow certification:
(A) the date of conviction;
(B) the circumstances surrounding the committing of the crime, if known;
(C) the nexus between the criminal conduct of the person and the duties of an administrator; and
(D) the prison, jail, probation, parole, rehabilitation, and employment records of the person since the date the crime was committed;
(3) has been convicted by any jurisdiction of a misdemeanor unless all terms of the judgment imposed for said misdemeanor have been met and the following have been considered and determined by the Department to allow certification:
(A) the date of conviction;
(B) the circumstances surrounding the committing of the crime, if known;
(C) the nexus between the criminal conduct of the person and the duties of an administrator; and
(D) the prison, jail, probation, parole, rehabilitation, and employment records of the person since the date the crime was committed;
(4) was the administrator of an adult care home or family care home whose license was summarily suspended pursuant to G.S. 131D-2.7(c) or a notice of revocation of the facility's license was issued pursuant to G.S. 131D-2.7(b). In these circumstances, the Department shall take into consideration the length of time the administrator was serving in that capacity at the facility and the nexus between the reason for the summary suspension or revocation of the facility's license and the job duties of the administrator in deciding whether to deny, suspend, or revoke the certification of an administrator;
(5) is unable to perform as administrator with reasonable skill and safety to residents by reason of any observable or documented condition, such as dementia or other disease condition known to result in irreversible cognitive deterioration or drug or alcohol dependency, that impairs the individual in such a way that it endangers the health, safety, or welfare of residents;
(6) tested positive for a controlled substance or refused to consent to drug testing according to G.S. 131D-45;
(7) prior or subsequent to applying for administrator certification, has a finding on the North Carolina Health Care Personnel Registry pursuant to G.S. 131E-256; or
(8) fails to report any arrest or conviction for a felony or misdemeanor to the Department within ten days after such arrest or conviction.
(b) The Department shall suspend the certification of an administrator who has been arrested because of alleged criminal conduct, if the relationship between the alleged criminal conduct and the administrator's duties indicates a need to seek action in order to further protect facility residents pending adjudication by a court. Serving as an administrator while the administrator's certification is suspended shall be grounds for revocation of certification. Examples of criminal conduct the Department may consider in relation to the administrator's duties include fraud, physical assault, theft, abuse, neglect, exploitation, and drug diversion.
History Note: Authority G.S. 90-288.18; 131D-2.16; 131D-2.18; 131D-4.3; 143B-165;
Eff. April 1, 2017.
10A NCAC 13F. 1703 RENEWAL OF ADMINISTRATOR CERTIFICATION
(a) The Department shall renew an administrator's certification at the end of the year following the year of initial certification if the administrator submits documentation of completed coursework related to long term care management or the care of aged and disabled persons dated and issued by the course provider after certification. The required number of hours of coursework shall be prorated by the Department based on 30 hours of required continuing education biennially and the number of months from the date of the administrator's initial certification until December 31 of the next year following issuance.
(b) The Department shall continue to renew an administrator's certification biennially, pursuant to G.S. 90-288.15, based on an expiration date of December 31. For each renewal following initial renewal the administrator shall submit documentation totaling 30 hours of completed coursework related to long term care management or the care of aged and disabled persons dated and issued by the course provider within the current two-year certification period and a renewal fee of thirty dollars ($30.00) pursuant to G.S. 90-288.15.
(c) For the purposes of this Rule, examples of coursework related to long term care management or the care of aged and disabled persons include financial management, human resource management, medication administration, dementia care, diabetic care, managing aggressive behaviors, and infection control.
History Note: Authority G.S. 90-288.15; 90-288.15A; 131D-2.16; 131D-4.3; 143B-165;
Eff. April 1, 2017.
SECTION .1800 - INFECTION PREVENTION AND CONTROL
10A NCAC 13F .1801 INFECTION PREVENTION AND CONTROL POLICIES AND PROCEDURES
(1) utilize the set of policies and procedures for infection prevention and control approved by the Department;
(2) develop policies and procedures for infection prevention and control that are consistent with the set of Department approved policies and procedures; or
(3) develop policies and procedures for infection prevention and control that are based on nationally recognized standards in infection prevention and control that are consistent with the federal CDC published guidelines on infection prevention and control.
(b) The facility's infection and control policies and procedures shall be implemented by the facility and shall address the following:
(1) Standard and transmission-based precautions, including:
(A) respiratory hygiene and cough etiquette;
(B) environmental cleaning and disinfection;
(C) reprocessing and disinfection of reusable resident medical equipment;
(D) hand hygiene;
(E) accessibility and proper use of personal protective equipment (PPE); and
(F) types of transmission-based precautions and when each type is indicated, including contact precautions, droplet precautions, and airborne precautions;
(2) When and how to report to the local health department when there is a suspected or confirmed reportable communicable disease case or condition, or communicable disease outbreak in accordance with Rule .1802 of this Section;
(3) Measures for the facility to consider taking in the event of a communicable disease outbreak to prevent the spread of illness, such as isolating infected residents; limiting or stopping group activities and communal dining; limiting or restricting outside visitation to the facility; screening staff, residents, and visitors for signs of illness; and use of source control as tolerated by the residents; and
(4) Strategies for addressing potential staffing issues and ensuring staffing to meet the needs of the residents during a communicable disease outbreak.
(c) When a communicable disease outbreak has been identified at the facility or there is an emerging infectious disease threat, the facility shall ensure implementation of the facility's infection prevention and control policies and procedures, and when issued, guidance or directives specific to the communicable disease outbreak or emerging infectious disease threat that have been issued in writing by the North Carolina Department of Health and Human Services or local health department.
(d) In accordance with Rule .1211 of this Subchapter and G.S. 131D-4.4A(b)(4), the facility shall ensure all staff are trained within 30 days of hire and annually on the policies and procedures listed in Subparagraphs (b)(1) through (b)(2) of this Rule.
(e) The policies and procedures listed in Paragraph (b) of this Rule shall be maintained in the facility and accessible to staff working at the facility.
History Note: Authority G.S. 131D-2.16; 131D-4.4A; 143B-165;
Emergency Adoption Eff. October 23, 2020;
Temporary Adoption Eff. December 30, 2020;
Eff. August 23, 2022.
10A NCAC 13F .1802 REPORTING AND NOTIFICATION OF A SUSPECTED OR CONFIRMED COMMUNICABLE DISEASE OUTBREAK
(a) The facility shall report suspected or confirmed communicable diseases and conditions within the time period and in the manner determined by the Commission for Public Health as specified in 10A NCAC 41A .0101 and 10A NCAC 41A .0102(a)(1) through (a)(3), which are hereby incorporated by reference, including subsequent amendments.
(b) The facility shall provide the residents and their representative(s) and staff with an initial notice within 24 hours following confirmation by the local health department of a communicable disease outbreak. The facility, in its initial notification to residents and their representative(s), shall:
(1) not disclose any personally identifiable information of the residents or staff;
(2) provide information on the measures the facility is taking to prevent or reduce the risk of transmission, including whether normal operations of the facility will change; and
(c) Following the initial notice to residents and their representative(s) of a communicable disease outbreak, the facility shall provide the following:
(1) an update every two weeks until the communicable illness within the facility has resolved, as determined by the local health department; and
(2) an update that the communicable illness within the facility has resolved, as determined by the local health department.
History Note: Authority G.S. 131D-2.16; 131D-4.4B; 131D-4.5; 143B-165;
Emergency Adoption Eff. October 23, 2020;
Temporary Adoption Eff. December 30, 2020;
Eff. August 23, 2022.