North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 06 - AGING - PROGRAMS OPERATIONS › Subchapter R - ADULT DAY CARE STANDARDS FOR CERTIFICATION › Section .0600 - CERTIFICATION PROCEDURE › Section 06R .0601 - PROCEDURE

Current through Register Vol. 39, No. 2, July 15, 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.