(a)  Enrollment Policies and Procedures

(1)           Each adult program shall have enrollment policies.  Enrollment policies shall be in writing as a part of the program policies and shall define the population served.  These policies serve as the basis for determining who shall be accepted into the program and for planning activities appropriate for the participants.  The policies shall be specific to prevent enrolling people whose needs cannot be met by the planned activities and shall provide for discharge of participants whose needs can no longer be met or who can no longer be cared for safely.  If a day care program serves semi‑ambulatory or non‑ambulatory persons, it shall be so stated in the admissions criteria.

(2)           Prior to enrollment, the applicant, family members or other caregiver shall have a minimum of one personal interview with a minimum of one program staff member.  During the interview, the staff shall complete initial documentation identifying social and medical care needs, any designated spiritual, religious or cultural needs, and a determination of whether the program can meet the individual's expressed needs.  The staff person doing the interviewing shall sign the determination of needs and the applicant, family member or other caregiver shall sign the application for enrollment.  These signed documents shall be obtained before the individual's first day of attendance as a participant in the program.

(3)           A medical examination report signed by a physician, nurse practitioner or physician's assistant, completed within the prior three months, shall be obtained by the program within 30 days of enrollment.  This report must be updated annually no later than the anniversary date of the initial report.

(4)           At enrollment, or in the initial interview, the program policies shall be discussed with the applicant, family member or other caregiver and a copy of the program policies shall be provided.

(5)           Documentation of receipt of and agreement to abide by the program policies by the applicant, family member or other caregiver shall be obtained by the program and kept in the participant's file.

(6)           The program policies shall contain:

(A)          a discharge policy outlining the criteria for discharge and notification procedures for discharge, the timeframe and procedures for notifying the applicant, family member or other caregiver of discharge, and referral or follow-up procedures;

(B)          a medication policy as specified in Rule .0505 of this Section;

(C)          a description of participant's rights;

(D)          grievance policies and procedures for families;

(E)           advance directives policy;

(F)           non-discrimination policies;

(G)          procedure to maintain confidentiality;

(H)          policy on reporting suspected abuse or neglect;

(I)            description of the geographical area served by the program; and

(J)            inclement weather policies.

(b)  Planning Services for Individual Participants

(1)           Within 30 days of enrollment of a new participant, the program shall perform a comprehensive assessment and written service plan for each individual.  The assessment shall address the individual's ability to perform activities of daily living and instrumental activities of daily living while in the program.  The mental, social, living environment, economic and physical health status of the individual shall also be assessed.  The service plan shall be signed and dated by the program director or the director's designee.  For adult day health participants the health component of the service plan shall be written and signed by a registered nurse.

(2)           In developing the written service plan, the program shall include input from the participant, family members, or other caregiver and other agency professionals with knowledge of the individual's needs. The service plan shall be based on strengths, needs and abilities identified in the assessment.  The assessment and service plan shall be reviewed at regular intervals, and no less than once every six months.  The service plan shall include:

(A)          the needs and strengths of the participant;

(B)          the interests of the participant;

(C)          the measurable service goals and objectives of care for the participant while in the day care program;

(D)          the type of interventions to be provided by the program in order to reach desired outcomes;

(E)           the services to be provided by the program to achieve the goals and objectives;

(F)           the roles of participant, family, caregiver, volunteers and program staff; and

(G)          the time limit for the plan, with provision for review and renewal.

(3)           Progress notes in the participant's record shall be updated at least every three months.

(4)           The participant, caregiver, and other service providers may contribute to the development, implementation and evaluation of the service plan.

(5)           Any unusual behavior, change in mood, change in attitude or need for help or services shall be reported by the program.  If the participant is a social services client, the report shall be made to the participant's family, caregiver, or responsible party and the department of social services worker or the social worker designated as consultant to the day care program by the department.  If the participant is not a social services client, the report shall be made to the person's family, caregiver or responsible party.  A note shall be made in the participant's record of action taken.

(6)           The participant or the responsible party may choose the days and number of days the participant will attend, with the program director's approval.

(7)           The reason for any unscheduled participant absence shall be determined by the program staff and documented on the day it occurs.  The program shall attempt to contact the absent participant or the responsible party. 

(8)           The adult day care program is responsible for the participant when a participant is registered in attendance.  A participant leaving the program for part of a day shall sign out relieving the staff of further responsibility.  If a participant has emotional or mental impairment which requires supervision and that person needs or wants to leave the program during the day, the social worker, family, caregiver, friend, or responsible party shall sign the person out.

(c)  Program Activities Plan

(1)           The day care center or home shall have a program activities plan which meets the following criteria:

(A)          Overall planning of activities are based on elements of the individual service plans.

(B)          The primary program mode is the group process, both large and small groups, with provision for individual activities and services as needed.

(C)          Activities are adaptable and modifiable to allow for greater participation and to maintain participant's individual skill level.

(D)          Activities are consistent with the stated program goals.

(E)           Activities are planned jointly by staff and participants.  Staff shall encourage participants to participate in the planning and operation of the program as much as they are able, and to use their skills, talent and knowledge in program planning and operation.

(F)           All program activities are supervised by program staff.

(G)          Participants may refuse to participate in any given activity.

(2)           The activities schedule shall provide for the inclusion of cognitive activities to be available on a daily basis, and be designed to: 

(A)          stimulate thinking and creativity;

(B)          provide opportunities for learning new ideas and skills;

(C)          help maintain existing reasoning skills and knowledge base; and

(D)          provide opportunities to utilize previously learned skills.

(3)           The activities schedule shall provide for the inclusion of physical activities to be available on a daily basis, and be designed to:

(A)          improve or maintain mobility and overall strength; and

(B)          increase or maintain joint range of motion.

(4)           The activities schedule shall provide for the inclusion of psychosocial activities to be available on a daily basis, and be designed to:

(A)          provide opportunities for social interaction;

(B)          develop a sense of belonging;

(C)          promote goal-oriented use of time;

(D)          create feelings of accomplishment;

(E)           foster dignity and self-esteem;

(F)           prompt self-expression; and

(G)          provide fun and enjoyment.

(5)           The activities schedule shall:

(A)          be in writing, specifying the name of each activity to be provided, the days of the week each activity shall be conducted, and the approximate length of time of each activity;

(B)          indicate the length of time the schedule is to be followed; and

(C)          be posted weekly or monthly in a prominent place in the facility.


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

Eff. July 1, 1978;

Amended Eff. February 1, 2008; July 1, 2007; July 1, 1990; January 1, 1981.