Current through Register Vol. 39, No. 6, September 16, 2024
(a) All
individuals, groups or organizations operating or wishing to operate an adult
day care program as defined by
G.S.
131D-6 shall apply for a certificate to the
county department of social services in the county where the program is to be
operated.
(b) A social worker shall
provide technical assistance and shall conduct a study of the program using the
State Division of Aging and Adult Services Form DAAS-1500 or DAAS-6205. Form
DAAS-1500 (The Adult Day Care Services Program Certification Report) shall
include the type of action requested, type of program, identifiable information
about the program including the name, address, name of director and email
address, and document whether the adult day care program meets certification
standards. Form DAAS-6205 (The Adult Day Health Services Program Certification
Report) shall include the type of action requested, type of program,
identifiable information about the program including the name, address, name of
director and email address, and document whether the adult day health program
meets certification standards. A copy of DAAS-1500 or DAAS-6205 can be obtained
on the North Carolina Department of Health & Human Services'
website.
(c) The county of social
services shall submit the initial certification package to the Division of
Aging and Adult Services. The materials and forms to be included in the package
are:
(1) program policies;
(2) organizational diagram;
(3) job descriptions;
(4) Form 732a-ADS (Daily Rate Sheet) or the
equivalent showing planned expenditures and resources available to carry out
the program of service for a 12 month period. The 732a-ADS form shall contain
the provider's name, county, current budget period, projected client
transportations costs, projected service days, average daily participation
utilizing transportation, average daily cost of round trip per client,
projected revenue including local match, and projected transportation costs. A
copy of the form may be obtained at the North Carolina Department of Health
& Human Services' website.
(5)
a floor plan of the facility showing measurements, restrooms and planned use of
space;
(6) Form DOA-1498 (Fire
Inspection Report) or the equivalent, as determined by the local fire
inspector, completed and signed by the local fire inspector, indicating
approval of the facility, no more than 30 days prior to submission with the
certification package;
(7) Form
DOA-1499 (Building Inspection Report for Adult Day Care Centers), DOA-1499a
(Building Inspection Form for Adult Day Care Homes), or the equivalent, as
determined by the local building inspector, completed and signed by the local
building inspector indicating approval of the facility, no more than 30 days
prior to submission with the certification package;
(8) Form DENR-4054 (Sanitation Evaluation
Report) or the equivalent, as determined by the local registered environmental
health specialist, completed and signed by a local registered environmental
health specialist indicating approval of the facility, no more than 30 days
prior to the submission with the certification package;
(9) written notice and the effective date if
a variance of local zoning ordinances has been made in order for property to be
utilized for an adult day care program;
(10) a copy of the articles of incorporation,
bylaws and names and addresses of board members for adult day care programs
sponsored by a non-profit corporation;
(11) the name and mailing address of the
owner of an adult day care program;
(12) a written medical statement from a
physician, nurse practitioner or a physician's assistant, completed within the
12 months prior to submission of the certification package, for each proposed
staff member certifying absence of a health condition that would pose a risk to
others and that the employee can perform the duties assigned to him or her on
the job;
(13) verification of
standard first aid and cardio-pulmonary resuscitation certification (CPR) for
each proposed staff member who is physically able and who will provide direct
participant care. The requirements of Rule.0504(d) of this Subchapter shall be
applicable to this Rule.
(14)
evidence of the completion of a Statewide criminal history records search for
the past five years for the adult day care program owner and each proposed
staff member who provides direct participant care, conducted by an agency
approved by the North Carolina Administrative Office of the Courts;
and
(15) DAAS-1500 (Adult Day Care
Certification Report). This form must be submitted by the county department of
social services with a copy to the program.
(d) No more than 90 days prior to the end of
the current period of certification, the county department of social services
shall submit to the Division of Aging and Adult Services the following forms
and materials that make up a certification package for the renewal of a
certification.
(1) Form DOA-1498 (Fire
Inspection Report) or the equivalent, as determined by the local fire
inspector, completed and signed by the local fire inspector, indicating
approval of the facility, dated no more than 12 months prior to submission with
the certification package;
(2) Form
DOA-1499 (Building Inspection Report for Adult Day Care Centers), DOA-1499a
(Building Inspection Form for Adult Day Care Homes), equivalent, as determined
by the local building inspector, when structural building modifications have
been made during the previous 12 months, completed and signed by the local
building inspector indicating approval of the facility, within 30 days
following completion of the structural building modifications;
(3) Form DENR-4054 (Sanitation Evaluation
Report) or equivalent, as determined by the local registered environmental
health specialist, completed and signed by a local registered environmental
health specialist, indicating approval of the facility, no more than 12 months
prior to submission with the certification package;
(4) a written medical statement from a
physician, nurse practitioner or physician's assistant for each staff member
hired subsequent to the previous certification or recertification expiration
date, certifying absence of a health condition that would pose a risk to others
and that the employee can perform the duties normally assigned on the
job;
(5) an updated copy of the
program policies, organizational diagram, job descriptions, names and addresses
of board members if applicable, and a floor plan showing measurements,
restrooms, and planned use of space, if any changes have been made since the
previous certification package was submitted;
(6) Form 732a-ADS (Daily Rate Sheet) or the
equivalent showing planned expenditures and resources available to carry out
the program of service for a 12 month period;
(7) verification of standard first aid and
cardio-pulmonary resuscitation certification (CPR) for each proposed staff
member who is physically able and who will provide direct participant care. The
requirements of Rule.0504(d) shall be applicable to this Rule;
(8) Evidence of the completion of a Statewide
criminal history record which complies with Subparagraph (c)(14) of this Rule;
and
(9) DAAS-1500 (Adult Day Care
Certification Report). This form must be submitted with the certification
package by the county department of social services to the Division of Aging
and Adult Services at least 30 days in advance of the expiration date of the
certificate, with a copy to the program.
(e) Following review of the certification
package, a pre-certification visit for certification shall be made by staff of
the Division of Aging and Adult Services.
(f) Within 14 business days, the Division of
Aging and Adult Services shall provide written notification to the applicant
and the county department of social services of the action taken after a review
of the certification package and visit.
Authority
G.S.
131D-6;
143B-153(2a);
143B-153(6);
Eff. January 1, 1986;
Amended Eff. September 1, 2007; July 1, 2007;
July 1, 2000; May 1, 1992; July 1, 1990;
Readopted Eff. September
1, 2019.
