Current through Register Vol. 39, No. 6, September 16, 2024
(a) All
individuals, groups or organizations operating or wishing to operate an adult
day health program as defined by
G.S.
131D-6 shall apply for a certificate to the
county department of social services in the county where the program is to be
operated.
(b) A social worker shall
provide technical assistance and shall conduct a study of the program using the
Division of Aging and Adult Services form DAAS-6205, as set forth in
10A NCAC
06R .0601(b).
(c) The county department 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, as set forth in
10A NCAC
06R.0601(c)(4), showing
planned expenditures and resources available to carry out the program of
service for a 12 month period;
(5)
a floor plan of the facility showing measurements, restrooms and planned use of
space;
(6) Form DOA-1498 (Fire
Inspection Report) or the equivalent, 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, or fire inspector or fire marshal, if a building inspector
is not available, indicating approval of the facility, no more than 30 days
prior to submission with the certification package;
(8) Form DENR-4054 (Inspection of Adult Day
Service Facility), or the equivalent, as determined by a 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 health program;
(10) a copy of the articles of incorporation,
bylaws and names and addresses of board members for adult day health programs
sponsored by a non-profit corporation;
(11) the name and mailing address of the
owner of an adult day health 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 (CPR) certification for
each proposed staff member who is physically able and who will provide direct
participant care as defined in
10A NCAC
06R.0201. The requirements of
10A NCAC
06R.0504(d) 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 health 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-6205 (Adult Day
Health 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 Service 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, no more than 12 months prior to submission with the
certification package;
(2) Form
DOA-1499 (Building Inspection Report for Adult Day Care Centers), DOA-1499a
(Building Inspection Form for Adult Day Care Homes), or the equivalent, 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, or fire inspector or fire marshal, if a
building inspector is not available, indicating approval of the facility,
within 30 days following completion of the structural building
modifications;
(3) Form DENR-4054
(Sanitation Evaluation Report) or the equivalent, as determined by a 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 polices, 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;
(8) evidence of the
completion of a Statewide criminal history record that complies with
Subparagraph (c)(14) of this Rule; and
(9) DAAS-6205 (Adult Day Health 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) If during the study of the program it
does not appear that all standards can be met, the county department shall send
written notice to the applicant, stating the reasons the standards are not met,
and shall give the applicant an opportunity to withdraw the application or
remedy the defect by the deadline provided by the local department of social
services.
(f) Following review of
the certification package, a pre-certification visit for certification shall be
made by staff of Division of Aging and Adult Services.
(g) 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 and local departments of health of
the action taken after a review of the certification package and
visit.
Authority
G.S.
131D-6;
143B-153(2a);
143B-153(6);
42 USC
3032c;
Eff. May 1,
1992;
Amended Eff. July 1, 2000; March 1, 1993;
Readopted Eff. November 1, 2019.
