10A NCAC 06R .0601. PROCEDURE

(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 Division of Aging Adult Services Form DAAS-1500 or DASS-6205.

(c)  The county of social services shall submit the initial certification package to the state 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;

(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 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 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 completed and signed by a local sanitarian, 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 if a proprietary 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 normally assigned 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 have direct contact with participants.  If a staff member is determined to be physically unable to complete this training, a signature by a licensed physician, physician's assistant or nurse practitioner attesting to such shall be provided indicating the time limit of such physical inability.  The first aid and CPR training shall be:

(A)          taught by an instructor certified through the American Heart Association, American Red Cross, National Safety Council, American Safety and Health Institute, or Emergency Medical Services;

(B)          current, as determined by the organization conducting the training and issuing the certification; and

(C)          documented on an official attendance card issued by the organization certifying the training, or documented by the attendance course roster, in which case the roster shall be signed by the instructor, indicate pass or fail for each student, indicate the length of time the training is valid and be accompanied by a copy of the instructor's certification;

(14)         evidence of the completion of a statewide criminal history records search for the past five years for the program owner and each proposed staff member having direct contact with participants, conducted by an agency approved by the North Carolina Administrative Offices 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 60 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 which make up a certification package for the renewal of a certification.

(1)           Form DOA-1498 (Fire Inspection Report) or the equivalent 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), or the equivalent 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 the equivalent completed and signed by a local 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 have direct contact with participants.  If a staff member is determined to be physically unable to complete this training, a signature by a licensed physician, physician's assistant or nurse practitioner attesting to such shall be provided indicating the time limit of such physical inability.  The first aid and CPR training shall be:

(A)          taught by an instructor certified through the American Heart Association, American Red Cross, National Safety Council, American Safety and Health Institute or Emergency Medical Services;

(B)          current, as determined by the organization conducting the training and issuing the certification; and

(C)          documented by an official attendance card issued by the organization certifying the training, or documented by the attendance course roster, in which case the roster shall be signed by the instructor, indicate pass or fail for each student, indicate the length of time the training is valid and be accompanied by the instructor's certification.

(8)           Evidence of the completion of a statewide criminal history records search for the past five years for each staff member hired subsequent to the previous certification or recertification expiration date having direct contact with participants, conducted by an agency approved by the North Carolina Administrative Offices of the Courts; 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 may be made by staff of the State 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, if made.

 

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

Eff. January 1, 1986;

Amended Eff. September 1, 2007; July 1, 2007; July 1, 2000; May 1, 1992; July 1, 1990.