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2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.5 - License and registration fees.

§ 131D-2.5. License and registration fees.
(a) The Department shall charge each adult care home with six or fewer beds a nonrefundable annual license fee in the amount of three hundred fifteen dollars ($315.00). The Department shall charge each adult care home with more than six beds a nonrefundable annual license fee in the amount of three hundred sixty dollars ($360.00) plus a nonrefundable annual per-bed fee of seventeen dollars and fifty cents ($17.50).
(b) The Department shall charge each registered multiunit assisted housing with services program a nonrefundable annual registration fee of three hundred fifty dollars ($350.00). Any individual or corporation that establishes, conducts, manages, or operates a multiunit housing with services program, subject to registration under this section, that fails to register is guilty of a Class 3 misdemeanor and, upon conviction shall be punishable only by a fine of not more than fifty dollars ($50.00) for the first offense and not more than five hundred dollars ($500.00) for each subsequent offense. Each day of a continuing violation after conviction shall be considered a separate offense. (2009-451, s. 10.76(a1); 2009-462, ss. 1(e), 3(b).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.6 - Legal action by Department.

§ 131D-2.6. Legal action by Department.
(a) Notwithstanding the existence or pursuit of any other remedy, the Department may, in the manner provided by law, maintain an action in the name of the State for injunction or other process against any person to restrain or prevent the establishment, conduct, management, or operation of an adult care home without a license. Such action shall be instituted in the superior court of the county in which any unlicensed activity has occurred or is occurring.
(b) Any individual or corporation that establishes, conducts, manages, or operates a facility subject to licensure under this section without a license is guilty of a Class 3 misdemeanor and, upon conviction, shall be punishable only by a fine of not more than fifty dollars ($50.00) for the first offense and not more than five hundred dollars ($500.00) for each subsequent offense. Each day of a continuing violation after conviction shall be considered a separate offense.
(c) If any person shall hinder the proper performance of duty of the Secretary or the Secretary's representative in carrying out this section, the Secretary may institute an action in the superior court of the county in which the hindrance has occurred for injunctive relief against the continued hindrance, irrespective of all other remedies at law.
(d) Actions under this section shall be in accordance with Article 37 of Chapter 1 of the General Statutes and Rule 65 of the Rules of Civil Procedure. (2009-462, s. 1(e).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.12 - Training requirements; county departments of social services.

§ 131D-2.12. Training requirements; county departments of social services.
(a) The county departments of social services' adult home specialists and their supervisors shall complete:
(1) Eight hours of prebasic training within 60 days of employment;
(2) Thirty-two hours of basic training within six months of employment;
(3) Twenty-four hours of postbasic training within six months of the basic training program;
(4) A minimum of eight hours of complaint investigation training within six months of employment; and
(5) A minimum of 16 hours of statewide training annually by the Division of Health Service Regulation.
(b) The joint training requirements by the Department shall be as provided in G.S. 143B-139.5B. (2009-462, s. 1(e).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.13 - Departmental duties.

§ 131D-2.13. Departmental duties.
(a) Enforcement of Room Ventilation and Temperature. – The Department shall monitor regularly the enforcement of rules pertaining to air circulation, ventilation, and room temperature in resident living quarters. These rules shall include the requirement that air conditioning or at least one fan per resident bedroom and living and dining areas be provided when the temperature in the main center corridor exceeds 80 degrees Fahrenheit.
(b) Administrator Directory. – The Department shall keep an up-to-date directory of all persons who are administrators as defined in G.S. 131D-2.1.
(c) Departmental Complaint Hotline. – Adult care homes shall post the Division of Health Service Regulation's complaint hotline number conspicuously in a public place in the facility.
(d) Provider File. – The Department of Health and Human Services shall establish and maintain a provider file to record and monitor compliance histories of facilities, owners, operators, and affiliates of nursing homes and adult care homes.
(e) Report on Use of Restraint. – The Department shall report annually on October 1 to the Joint Legislative Oversight Committee on Health and Human Services the following for the immediately preceding fiscal year:
(1) The level of compliance of each adult care home with applicable State law and rules governing the use of physical restraint and physical hold of residents. The information shall indicate areas of highest and lowest levels of compliance.
(2) The total number of adult care homes that reported deaths under G.S. 131D-34.1, the number of deaths reported by each facility, the number of deaths investigated pursuant to G.S. 131D-34.1, and the number found by the investigation to be related to the adult care home's use of physical restraint or physical hold. (2009-462, s. 1(e); 2011-291, s. 2.47.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.14 - Confidentiality.

§ 131D-2.14. Confidentiality.
Notwithstanding G.S. 8-53 or any other law relating to confidentiality of communications between physician and patient, in the course of an inspection conducted under G.S. 131D-2.11:
(1) Department representatives may review any writing or other record concerning the admission, discharge, medication, care, medical condition, or history of any person who is or has been a resident of the facility being inspected.
(2) Any person involved in giving care or treatment at or through the facility may disclose information to Department representatives unless the resident objects in writing to review of the resident's records or disclosure of such information.
(3) The facility, its employees, and any other person interviewed in the course of an inspection shall be immune from liability for damages resulting from disclosure of any information to the Department. The Department shall not disclose:
a. Any confidential or privileged information obtained under this section unless the resident or the resident's legal representative authorizes disclosure in writing or unless a court of competent jurisdiction orders disclosure, or
b. The name of anyone who has furnished information concerning a facility without that person's consent.
The Department shall institute appropriate policies and procedures to ensure that unauthorized disclosure does not occur. All confidential or privileged information obtained under this section and the names of persons providing such information shall be exempt from Chapter 132 of the General Statutes.
(4) Notwithstanding any law to the contrary, Chapter 132 of the General Statutes, the Public Records Law, applies to all records of the State Division of Social Services of the Department of Health and Human Services and of any county department of social services regarding inspections of adult care facilities except for information in the records that is confidential or privileged, including medical records, or that contains the names of residents or complainants. (2009-462, s. 1(e).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.16 - Rules.

§ 131D-2.16. Rules.
Except as otherwise provided in this Article, the Medical Care Commission shall adopt rules necessary to carry out this Article. The Commission has the authority, in adopting rules, to specify the limitation of nursing services provided by assisted living residences. In developing rules, the Commission shall consider the need to ensure comparable quality of services provided to residents, whether these services are provided directly by a licensed assisted living provider, licensed home care agency, or hospice. In adult care homes, living arrangements where residents require supervision due to cognitive impairments, rules shall be adopted to ensure that supervision is appropriate and adequate to meet the special needs of these residents. Rule-making authority under this section is in addition to that conferred under G.S. 131D-4.3 and G.S. 131D-4.5. (2009-462, s. 1(e).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.17 - Impact on other laws; severability.

§ 131D-2.17. Impact on other laws; severability.
(a) Nothing in this section shall be construed to supersede any federal or State antitrust, antikickback, or safe harbor laws or regulations.
(b) If any provisions of this section or the application of it to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the section which can be given effect without the invalid provision or application, and to this end the provisions of this section are severable. (2009-462, s. 1(e).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-2.18 - Application of other laws.

§ 131D-2.18. Application of other laws.
(a) Certification of assisted living administrators shall be as provided under Article 20A of Chapter 90 of the General Statutes.
(b) Compliance with the Health Care Personnel Registry shall be as provided under G.S. 131E-256.
(c) Rules for the operation of the adult care portion of a combination home, as defined in G.S. 131E-101, shall be as provided in G.S. 131E-104. (2009-462, s. 1(e).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.1 - Adult care homes; legislative intent.

§ 131D-4.1. Adult care homes; legislative intent.
The General Assembly finds and declares that the ability to exercise personal control over one's life is fundamental to human dignity and quality of life and that dependence on others for some assistance with daily life activities should not require surrendering personal control of informed decision making or risk taking in all areas of one's life.
The General Assembly intends to ensure that adult care homes provide services that assist the residents in such a way as to assure quality of life and maximum flexibility in meeting individual needs and preserving individual autonomy. (1995, c. 449, s. 3; c. 535, s. 9.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.3 - Adult care home rules.

§ 131D-4.3. Adult care home rules.
(a) Pursuant to G.S. 143B-165, the North Carolina Medical Care Commission shall adopt rules to ensure at a minimum, but shall not be limited to, the provision of each of the following by adult care homes:
(1) Repealed by Session Laws 2000-111, s. 1.
(2) A minimum of 80 hours of training for personal care aides. The training for aides shall be comparable to State-approved Certified Nurse Aide I training.
The facility may exempt from the 80-hour training requirement any personal care aides who are or have been either licensed as a health care professional or listed on the Nurse Aide Registry.
(3) Monitoring and supervision of residents.
(4) Oversight and quality of care as stated in G.S. 131D-4.1.
(5) Adult care homes shall comply with all of the following staffing requirements:
a. First shift (morning): 0.4 hours of aide duty for each resident (licensed capacity or resident census), or 8.0 hours of aide duty per each 20 residents (licensed capacity or resident census) plus 3.0 hours for all other residents, whichever is greater;
b. Second shift (afternoon): 0.4 hours of aide duty for each resident (licensed capacity or resident census), or 8.0 hours of aide duty per each 20 residents plus 3.0 hours for all other residents (licensed capacity or resident census), whichever is greater;
c. Third shift (evening): 8.0 hours of aide duty per 30 or fewer residents (licensed capacity or resident census).
The facility shall provide staff to meet the needs of the facility's residents. Each facility shall post in a conspicuous place information about required staffing that enables residents and their families to ascertain each day the number of direct care staff and supervisors that are required by law to be on duty for each shift for that day.
(b) Rules to implement this section shall be adopted as emergency rules in accordance with Chapter 150B of the General Statutes.
(c) The Department may suspend or revoke a facility's license, subject to the provisions of Chapter 150B, to enforce compliance by a facility with this section or to punish noncompliance. (1995, c. 449, s. 3; c. 535, s. 10; 1997-443, s. 11A.118(a); 1998-212, s. 12.16B(a); 2000-111, s. 1; 2001-85, s. 1; 2001-487, s. 85(a); 2017-184, s. 3.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.4 - Adult care home minimum safety requirements; smoking prohibited inside long-term care facilities; penalty.

§ 131D-4.4. Adult care home minimum safety requirements; smoking prohibited inside long-term care facilities; penalty.
(a) In addition to other requirements established by this Article or by rules adopted pursuant to this Article or other provisions of law, every adult care home shall provide to each resident the care, safety, and services necessary to enable the resident to attain and maintain the highest practicable level of physical, emotional, and social well-being in accordance with:
(1) The resident's individual assessment and plan of care; and
(2) Rules and standards relating to quality of care and safety adopted under this Chapter.
(b) Smoking is prohibited inside long-term care facilities. As used in this section:
(1) "Long-term care facilities" include adult care homes, nursing homes, skilled nursing facilities, facilities licensed under Chapter 122C of the General Statutes, and other licensed facilities that provide long-term care services.
(2) "Smoking" means the use or possession of any lighted cigar, cigarette, pipe, or other lighted smoking product.
(3) "Inside" means a fully enclosed area.
(c) The person who owns, manages, operates, or otherwise controls a long-term care facility where smoking is prohibited under this section shall:
(1) Conspicuously post signs clearly stating that smoking is prohibited inside the facility. The signs may include the international "No Smoking" symbol, which consists of a pictorial representation of a burning cigarette enclosed in a red circle with a red bar across it.
(2) Direct any person who is smoking inside the facility to extinguish the lighted smoking product.
(3) Provide written notice to individuals upon admittance that smoking is prohibited inside the facility and obtain the signature of the individual or the individual's representative acknowledging receipt of the notice.
(d) The Department may impose an administrative penalty not to exceed two hundred dollars ($200.00) for each violation on any person who owns, manages, operates, or otherwise controls the long-term care facility and fails to comply with subsection (c) of this section. A violation of this section constitutes a civil offense only and is not a crime. (1999-334, s. 1.1; 2007-459, s. 1.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.4B - Guidelines for reporting suspected communicable disease outbreaks.

§ 131D-4.4B. Guidelines for reporting suspected communicable disease outbreaks.
The Department shall develop guidelines prescribing the manner in which an adult care home is to report a suspected communicable disease outbreak within the facility to the local health department. (2011-99, s. 3.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.5 - Rules adopted by Medical Care Commission.

§ 131D-4.5. Rules adopted by Medical Care Commission.
The Medical Care Commission shall adopt rules as follows:
(1) Establishing minimum medication administration standards for adult care homes. The rules shall include the minimum staffing and training requirements for medication aides and standards for professional supervision of adult care homes' medication controls. The requirements shall (i) include compliance with G.S. 131D-4.5B and (ii) be designed to reduce the medication error rate in adult care homes to an acceptable level. The requirements shall include, but need not be limited to, all of the following:
a. Training for medication aides, including periodic refresher training.
b. Standards for management of complex medication regimens.
c. Oversight by licensed professionals.
d. Measures to ensure proper storage of medication.
(2) Establishing training requirements for adult care home staff in behavioral interventions. The training shall include appropriate responses to behavioral problems posed by adult care residents. The training shall emphasize safety and humane care and shall specifically include alternatives to the use of restraints.
(3) Establishing minimum training and education qualifications for supervisors in adult care homes and specifying the safety responsibilities of supervisors. The minimum training qualifications shall include compliance with G.S. 131D-4.5C.
(4) Specifying the qualifications of staff who shall be on duty in adult care homes during various portions of the day in order to assure safe and quality care for the residents. The rules shall take into account varied resident needs and population mixes.
(5) Implementing the due process and appeal rights for discharge and transfer of residents in adult care homes afforded by G.S. 131D-21. The rules shall offer protections to residents for safe and orderly transfer and discharge.
(6) Establishing procedures for determining the compliance history of adult care homes' principals and affiliates. The rules shall include criteria for refusing to license facilities which have a history of, or have principals or affiliates with a history of, noncompliance with State law, or disregard for the health, safety, and welfare of residents.
(7) For the licensure of special care units in accordance with G.S. 131D-4.6, and for disclosures required to be made under G.S. 131D-8.
(8) For time limited provisional licenses and for granting extensions for provisional licenses.
(9) For the issuance of certificates to adult care homes as authorized under G.S. 131D-10. (1999-334, s. 1.1; 2000-111, s. 2; 2007-544, s. 3(a); 2011-99, ss. 1, 2; 2011-272, s. 2.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.5A - Fees for medication aides.

§ 131D-4.5A. Fees for medication aides.
The Department may impose a fee, not to exceed twenty-five dollars ($25.00), on an applicant seeking certification as an assisted living home medication aide to cover the costs of testing and materials in administering a certification examination. (2010-31, s. 10.36A(a).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.5B - Adult care home medication aides; training and competency evaluation requirements.

§ 131D-4.5B. Adult care home medication aides; training and competency evaluation requirements.
(a) By January 1, 2012, the Division of Health Service Regulation shall develop a mandatory, annual in-service training program for adult care home medication aides on infection control, safe practices for injections and any other procedures during which bleeding typically occurs, and glucose monitoring. Each medication aide who successfully completes the in-service training program shall receive partial credit, in an amount determined by the Department, toward the continuing education requirements for adult care home medication aides established by the Commission pursuant to G.S. 131D-4.5.
(b) Beginning October 1, 2013, an adult care home is prohibited from allowing staff to perform any unsupervised medication aide duties unless that individual has previously worked as a medication aide during the previous 24 months in an adult care home or successfully completed all of the following:
(1) A five-hour training program developed by the Department that includes training and instruction in all of the following:
a. The key principles of medication administration.
b. The federal Centers for Disease Control and Prevention guidelines on infection control and, if applicable, safe injection practices and procedures for monitoring or testing in which bleeding occurs or the potential for bleeding exists.
(2) A clinical skills evaluation consistent with 10A NCAC 13F .0503 and 10A NCAC 13G .0503.
(3) Within 60 days from the date of hire, the individual must have completed the following:
a. An additional 10-hour training program developed by the Department that includes training and instruction in all of the following:
1. The key principles of medication administration.
2. The federal Centers of Disease Control and Prevention guidelines on infection control and, if applicable, safe injection practices and procedures for monitoring or testing in which bleeding occurs or the potential for bleeding exists.
b. An examination developed and administered by the Division of Health Service Regulation in accordance with subsection (c) of this section.
(c) By October 1, 2012, the Division of Health Service Regulation shall develop and administer an examination for individuals seeking employment as a medication aide in an adult care home. (2011-99, s. 5.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.5C - Adult care home supervisors; infection control training requirements.

§ 131D-4.5C. Adult care home supervisors; infection control training requirements.
(a) The Department shall develop, in consultation with associations representing adult care home providers, model infection prevention and control policies and procedures that are consistent with accepted national standards and address the factors identified in G.S. 131D-4.4A(b)(1). The Department shall make these model infection prevention and control policies and procedures available to adult care homes on the Department's internet website.
(b) The Department shall develop a mandatory, annual course for adult care home supervisors on implementation of the model infection prevention and control policies and procedures developed by the Department in accordance with subsection (a) of this section. Each supervisor that successfully completes the mandatory infection control course shall receive credit, in an amount determined by the Department, toward the continuing education requirements for adult care home supervisors established by the Commission pursuant to G.S. 131D-4.5. (2011-99, s. 5; 2021-189, s. 3.2(b).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.6 - Licensure of special care units.

§ 131D-4.6. Licensure of special care units.
(a) As used in this section, the term "special care unit" means a wing or hallway within an adult care home, or a program provided by an adult care home, that is designated especially for residents with Alzheimer's disease or other dementias, a mental health disability, or other special needs disease or condition as determined by the Medical Care Commission.
(b) An adult care home that holds itself out to the public as providing a special care unit shall be licensed as such and shall, in addition to other licensing requirements for adult care homes, meet the standards established under rules adopted by the Medical Care Commission.
(c) An adult care home that holds itself out to the public as providing a special care unit without being licensed as a special care unit is subject to licensure actions and penalties provided under Part 1 of this Article, as well as any other action permitted by law. (1999-334, s. 1.1; 2009-462, s. 4(f).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-4.7 - Adult care home specialist fund.

§ 131D-4.7. Adult care home specialist fund.
There is established the adult care home specialist fund. The fund shall be maintained in and by the Department for the purpose of assisting county departments of social services in paying salaries of adult care home specialists. (1999-334, s. 1.1.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-7 - Waiver of rules and increase in bed capacity during an emergency.

§ 131D-7. Waiver of rules and increase in bed capacity during an emergency.
(a) The Division of Health Service Regulation may temporarily waive, during disasters or emergencies declared in accordance with Article 1A of Chapter 166A of the General Statutes, any rules of the Commission pertaining to adult care homes to the extent necessary to allow the adult care home to provide temporary shelter and temporary services requested by the emergency management agency. The Division may identify, in advance of a declared disaster or emergency, rules that may be waived, and the extent the rules may be waived, upon a disaster or emergency being declared in accordance with Article 1A of Chapter 166A of the General Statutes. The Division may also waive rules under this subsection during a declared disaster or emergency upon the request of an emergency management agency and may rescind the waiver if, after investigation, the Division determines the waiver poses an unreasonable risk to the health, safety, or welfare of any of the persons occupying the adult care home. The emergency management agency requesting temporary shelter or temporary services shall notify the Division within 72 hours of the time the preapproved waivers are deemed by the emergency management agency to apply.
(a1) In the event of a declaration of a state of emergency by the Governor in accordance with Article 1A of Chapter 166A of the General Statutes, a declaration of a national emergency by the President of the United States, a declaration of a public health emergency by the Secretary of the United States Department of Health and Human Services; or to the extent necessary to allow for consistency with any temporary waiver or modification issued by the Secretary of the United States Department of Health and Human Services or the Centers for Medicare and Medicaid Services under section 1135 or 1812(f) of the Social Security Act; or when the Division of Health Service Regulation determines the existence of an emergency that poses a risk to the health or safety of residents, the Division of Health Service Regulation may do either or both of the following:
(1) Temporarily waive any rules of the Commission pertaining to adult care homes.
(2) Allow an adult care home to temporarily increase its bed capacity.
(b) As used in this section, "emergency management agency" is as defined in G.S. 166A-19.3. (1999-307, s. 2; 2007-182, s. 1; 2012-12, s. 2(s); 2022-74, s. 9E.2(b).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-7.1 - Secretary to establish visitation protocols during declared disasters and emergencies.

§ 131D-7.1. Secretary to establish visitation protocols during declared disasters and emergencies.
(a) As used in this section and in G.S. 131D-7.2, the following terms have the following meanings:
(1) Disaster declaration. – As defined in G.S. 166A-19.3(3).
(2) Emergency. – As defined in G.S. 166A-19.3(6).
(3) Facility. – An adult care home, including a family care home, licensed under this Article.
(4) Normal visitation policy. – The visitation policy that was in effect at a facility on January 1, 2020.
(b) The Secretary shall, in consultation with licensed operators of adult care homes, including family care homes, and any other stakeholders the Secretary deems relevant, establish visitation protocols for residents of these facilities that will become effective during a disaster declaration or emergency that results in the suspension or curtailment of a facility's normal visitation policy for any reason. The visitation protocols shall provide for at least the following:
(1) Each resident shall have the right to designate one preapproved visitor and one preapproved alternate visitor. The preapproved visitor, or if the preapproved visitor is unavailable, the preapproved alternate visitor, shall be allowed to visit the resident at least twice per month during any period of time during which the facility's normal visitation policy is suspended or curtailed for any reason during the declared disaster or emergency.
(2) Prior to admission, each facility shall explain and provide to each resident written notification of the visitation protocols established by the Secretary under this section.
(3) Visitation under these protocols shall be subject to Centers for Medicare and Medicaid Services directives and to the guidelines, conditions, and limitations established by the facility as part of its normal visitation policy. (2021-145, s. 3(a).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-7.2 - Resident visitation rights for adult care homes, including family care homes, during a disaster declaration or emergency.

§ 131D-7.2. Resident visitation rights for adult care homes, including family care homes, during a disaster declaration or emergency.
Notwithstanding any provision of this Part, Chapter 166A of the General Statutes, or any other provision of law to the contrary, the visitation protocols established by the Secretary under G.S. 131D-7.1 shall be in effect during any period of time when (i) there is a declared disaster or emergency and (ii) an adult care home, including a family care home, licensed under this Article suspends or restricts the normal visitation policy for any reason. (2021-145, s. 3(a).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-8 - Adult care home special care units; disclosure of information required.

§ 131D-8. Adult care home special care units; disclosure of information required.
(a) An adult care home licensed under this Part that provides care for persons in special care units as defined in G.S. 131D-4.6 shall disclose the form of care or treatment provided that distinguishes the special care unit as being especially designed for residents with Alzheimer's disease or other dementias, a mental health disability, or other special needs disease or condition. The disclosure shall be in writing and shall be made to all of the following:
(1) The Department as part of its licensing procedures.
(2) Each person seeking placement within a special care unit, or the person's authorized representative, prior to entering into an agreement with the person to provide special care.
(3) The Office of State Long-Term Care Ombudsman, annually, or more often if requested.
(b) Information that must be disclosed in writing shall include, but is not limited to, all of the following:
(1) A statement of the overall philosophy and mission of the licensed facility and how it reflects the special needs of residents with Alzheimer's disease or other dementias, a mental health disability, or other special needs disease or condition.
(2) The process and criteria for placement, transfer, or discharge to or from the special care unit.
(3) The process used for assessment and establishment of the plan of care and its implementation, including how the plan of care is responsive to changes in the resident's condition.
(4) Staffing ratios and how they meet the resident's need for increased care and supervision.
(5) Staff training that is dementia-specific.
(6) Physical environment and design features that specifically address the needs of residents with Alzheimer's disease or other dementias.
(7) Frequency and type of programs and activities for residents of the special care unit.
(8) Involvement of families in resident care, and availability of family support programs.
(9) Additional costs and fees to the resident for special care.
(c) As part of its license renewal procedures and inspections, the Department shall examine for accuracy the written disclosure of each adult care home subject to this section. Substantial changes to written disclosures shall be reported to the Department at the time the change is made.
(d) Nothing in this section shall be construed as prohibiting an adult care home that does not offer a special care unit from admitting a person with Alzheimer's disease or other dementias, a mental health disability, or other special needs disease or condition. The disclosures required under this section apply only to an adult care home that advertises, markets, or otherwise promotes itself as providing a special care unit for persons with Alzheimer's disease or other dementias.
(e) As used in this section, the term "special care unit" has the same meaning as applies under G.S. 131D-4.6. (1999-334, s. 2.1; 1999-456, s. 61(a).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-9 - Immunization of employees and residents of adult care homes.

§ 131D-9. Immunization of employees and residents of adult care homes.
(a) Except as provided in subsection (e) of this section, an adult care home licensed under this Article shall require residents and employees to be immunized annually against influenza virus and shall require residents to also be immunized against pneumococcal disease.
(b) Upon admission, an adult care home shall notify the resident of the immunization requirements of this section and shall request that the resident agree to be immunized against influenza virus and pneumococcal disease.
(b1) An adult care home shall notify every employee of the immunization requirements of this section and shall request that the employee agree to be immunized against the influenza virus.
(c) An adult care home shall document the annual immunization against influenza virus and the immunization against pneumococcal disease for each resident and each employee, as required under this section. Upon finding that a resident is lacking one or both of these immunizations or that an employee has not been immunized against influenza virus, or if the adult care home is unable to verify that the individual has received the required immunization, the adult care home shall provide or arrange for immunization. The immunization and documentation required shall occur not later than November 30 of each year.
(d) For an individual who becomes a resident of or who is newly employed by the adult care home after November 30 but before March 30 of the following year, the adult care home shall determine the individual's status for the immunizations required under this section, and if found to be deficient, the adult care home shall provide the immunization.
(e) No individual shall be required to receive vaccine under this section if the vaccine is medically contraindicated, or if the vaccine is against the individual's religious beliefs, or if the individual refuses the vaccine after being fully informed of the health risks of not being immunized.
(f) Notwithstanding any other provision of law to the contrary, the Commission for Public Health shall have the authority to adopt rules to implement the immunization requirements of this section.
(g) As used in this section, "employee" means an individual who is a part-time or full-time employee of the adult care home. (2000-112, ss. 1, 2; 2007-182, s. 1.3.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1 - Adult Care Homes. › § 131D-10 - Adult care home rated certificates.

§ 131D-10. Adult care home rated certificates.
(a) Rules adopted by the North Carolina Medical Care Commission for issuance of certificates to adult care homes shall contain a rating based, at a minimum, on the following:
(1) Inspections and substantiated complaint investigations conducted by the Department to determine compliance with licensing statutes and rules. Specific areas to be reviewed include:
a. Admission and discharge procedures.
b. Medication management.
c. Physical plant.
d. Resident care and services, including food services, resident activities programs, and safety measures.
e. Residents' rights.
f. Sanitation grade.
g. Special Care Units.
h. Use of physical restraints and alternatives.
(b) The Division of Health Service Regulation shall issue ratings to a facility pursuant to the rules adopted under this section based on both of the following:
(1) Inspections and investigations of complaints conducted pursuant to G.S. 131D-2.11 and G.S. 131D-26 that revealed noncompliance with statutes and rules.
(2) The facility's participation in any quality improvement programs approved by the Department.
(c) Repealed by Session Laws 2017-184, s. 5, effective October 1, 2017.
(c1) The Division of Health Service Regulation shall issue a star rating to a facility within 45 days from the date the Division mails the survey or inspection report to the facility, except when a timely request has been made by the facility under G.S. 131D-2.11 for informal dispute resolution. If a facility makes a timely request for informal dispute resolution, the Division of Health Service Regulation shall issue a star rating to the facility within 15 days from the date the Division mails the informal dispute decision to the facility.
(d) Adult care homes shall display the rating certificate in a location visible to the public. Certificates shall include the Web site address for the Department of Health and Human Services, Division of Health Service Regulation, which can be accessed for specific information regarding the basis of the facility rating. For access by the public on request, adult care homes shall also maintain on-site a copy of information provided by the Department of Health and Human Services, Division of Health Service Regulation, regarding the basis of the facility rating.
(e) The Department shall make available free of charge to the general public on the Division of Health Service Regulation Web site each facility rating and specific information regarding the basis for calculating each facility rating. (2007-544, s. 3(b); 2017-184, s. 5.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1A - Control over Child Placing and Child Care. › § 131D-10.2B - Foster care until 21 years of age.

§ 131D-10.2B. Foster care until 21 years of age.
(a) A child placed in foster care who has attained the age of 18 years may continue receiving foster care services until reaching 21 years of age as provided by law. A child who initially chooses to opt out of foster care upon attaining the age of 18 years may opt to receive foster care services at a later date until reaching 21 years of age.
(b) A child who has attained the age of 18 years and chosen to continue receiving foster care services until reaching 21 years of age may continue to receive benefits pursuant to Part 4 of Article 2 of Chapter 108A of the General Statutes upon meeting the requirements under G.S. 108A-48(c). (2015-241, s. 12C.9(e).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1A - Control over Child Placing and Child Care. › § 131D-10.2C - (Contingent effective date see note) Allowable number of children in family foster home.

§ 131D-10.2C. (Contingent effective date – see note) Allowable number of children in family foster home.
(a) Except as provided in subsection (b) of this section, no more than five children shall reside in any family foster home at any time. These five children include the foster parent's own children, children placed for family foster care, licensed capacity for in-home day care children, children kept for babysitting, or any other children residing in the home. Children kept for in-home day care and babysitting are considered residents of the home.
(b) A family foster home may have more than five children if one of the following exceptions applies:
(1) If written documentation is submitted to the licensing authority for family foster care that siblings will be placed together and the foster home complies with all other licensure requirements. The out-of-home family services agreement for each sibling shall specify that siblings will be placed together and shall also address the foster parents' skill, stamina, and ability to care for the children.
(2) A family foster home that would otherwise qualify for family foster home licensure or placement of one child or siblings in foster care, but does not qualify solely due to the presence five children in the home, shall be eligible for licensure as a family foster home or placement of a child or siblings in foster care. Written documentation must be submitted to the licensing authority that siblings will be placed together to allow more than five children to be placed in the foster home under this section. The out-of-home family services agreement for each sibling shall specify that siblings will be placed together. Any family foster home qualifying for placement of more than five children under this section shall meet all other licensure requirements. (2023-82, s. 1.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1A - Control over Child Placing and Child Care. › § 131D-10.4 - Exemptions.

§ 131D-10.4. Exemptions.
This Article does not apply to any of the following:
(1) Any residential child-care facility chartered by the laws of this State (or operating under charters of other states which have complied with the corporation laws of this State) which has a plant and assets worth sixty thousand dollars ($60,000) or more and which is owned or operated by a religious denomination or fraternal order and which was in operation before July 1, 1977.
(2) State institutions for children with serious emotional disturbances, delinquent children, or individuals with mental illnesses, intellectual or other developmental disabilities, or substance use disorders.
(3) Secure detention facilities as specified in Part 3 of Article 13 of Chapter 143B of the General Statutes.
(4) Licensable facilities subject to the rules of the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services as specified in Article 2 of Chapter 122C of the General Statutes.
(5) Persons authorized by statute to receive and place children for foster care and adoption in accordance with G.S. 108A-14.
(6) Primarily educational institutions as defined in G.S. 131D-10.2(11).
(7) Individuals who are related by blood, marriage, or adoption to the child. (1983, c. 637, s. 2; 1985, c. 589, s. 39; 1991, c. 636, s. 19(b); 1998-202, s. 13(ii); 1999-423, s. 6; 2000-137, s. 4(gg); 2011-145, s. 19.1(ll); 2019-76, s. 16.)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1A - Control over Child Placing and Child Care. › § 131D-10.5 - Powers and duties of the Commission.

§ 131D-10.5. Powers and duties of the Commission.
In addition to other powers and duties prescribed by law, the Commission shall exercise the following powers and duties:
(1) Adopt, amend and repeal rules consistent with the laws of this State and the laws and regulations of the federal government to implement the provisions and purposes of this Article.
(2) Issue declaratory rulings as may be needed to implement the provisions and purposes of this Article.
(3) Adopt rules governing procedures to appeal Department decisions pursuant to this Article granting, denying, suspending or revoking licenses.
(4) Adopt criteria for waiver of licensing rules adopted pursuant to this Article.
(5) Adopt rules on documenting the use of physical restraint in residential child-care facilities.
(6) Adopt rules establishing personnel and training requirements related to the use of physical restraints and time-out for staff employed in residential child-care facilities.
(7) Adopt rules establishing educational requirements, minimum age, relevant experience, and criminal record status for executive directors and staff employed by child placing agencies and residential child care facilities.
(8) Adopt any rules necessary for the expansion of foster care for individuals who have attained the age of 18 years and chosen to continue receiving foster care services to 21 years of age in accordance with G.S. 131D-10.2B. (1983, c. 637, s. 2; 2000-129, s. 2(a); 2007-30, s. 2; 2009-188, s. 2; 2015-241, s. 12C.9(f).)
2023 North Carolina General Statutes › Chapter 131D - Inspection and Licensing of Facilities › Article 1A - Control over Child Placing and Child Care. › § 131D-10.5A - Collection of data on use of restraints in residential child-care facilities.

§ 131D-10.5A. Collection of data on use of restraints in residential child-care facilities.
A residential child-care facility that employs physical restraint of a child shall collect data on the use of the restraint. The data shall reflect for each incidence, the type of procedure used, the length of time employed, alternatives considered or employed, and the effectiveness of the procedure or alternative employed. The facility shall analyze the data on at least a quarterly basis to monitor effectiveness, determine trends, and take corrective action where necessary. The facility shall make the data available to the Department upon request. Nothing in this subsection abrogates State or federal law or requirements pertaining to the confidentiality, privilege, or other prohibition against disclosure of information provided to the Department under this subsection. In reviewing data requested under this subsection, the Department shall adhere to State and federal requirements of confidentiality, privilege, and other prohibitions against disclosure and release applicable to the information received under this subsection. (2000-129, s. 2(b).)