NCALA Membership

No. GS 131D-4.3(a)(5) requires homes to post information on required staffing that indicates the number, not names, of direct care staff and supervisors that must be on each shift.

Employees from staffing agencies must meet the appropriate qualifications in the rules for the position they are filling. The facility must have the appropriate documentation of staff qualifications (usually obtained from the employment agency) on file in the facility.

Under General Statute 131E-256 Health Care Personnel Registry, the facility is obligated to report to the Health Care Personnel Registry allegations that appear to be related to the neglect or abuse of a resident, misappropriation of property, diversion of drugs, and fraud by healthcare personnel. Healthcare personnel in adult care homes are defined in this statute as “adult care personal care aide who is any person who either performs or directly supervises others who perform task functions in activities of daily living which are personal functions essential for the health and well being of residents …” Since the definition says “any person,” the person does not have to be an employee or payroll staff of the facility for the facility to report an allegation. Even if the person is employed from a staffing agency by a family member of the resident and this person is performing tasks as stated in the law, the facility is responsible for reporting any allegations specified in the law against this individual. The facility is responsible for the safety and protection of residents under its care and, therefore, is responsible for reporting according to the requirements of the law, regardless of the employment status of the individual authorized to provide or supervise personal care tasks.

Respite care in adult care homes is intended for a short-term stay that does not exceed 30 days. A respite care period must be established by contract that specifies the date of admission and discharge as required in Rules 13F and 13G .0907. Subsequent respite care stays by the same resident must also be established by separate contracts and all the requirements of the respite rule would apply, i.e., admission, discharge dates, current FL-2, short-term assessment, verification of orders if not signed and dated within 7 days prior to admission, etc, for each separate respite stay period. The person is to be admitted as a respite resident, not a daily visitor, for a limited time period (30-day maximum) as specified in the contract, and provided care, services, and accommodations as any resident is entitled to receive according to law and rule. The respite resident must have a resident-designated bedroom and must be counted as a resident of the home for capacity, census, and staffing purposes. The rule does not allow for a contract to provide unlimited respite care throughout the year, whether it is on a daily or overnight basis. Each respite stay must be contracted and time-limited. How the respite period, as specified in the contract with an admission and discharge date, is used by the caregiver seeking respite, e.g., overnight stays or day/partial-day stays, depends on that caregiver.

Resident records can be released to the resident, guardian of the resident, or the resident’s power of attorney/healthcare power of attorney, provided the POA/HCPOA documentation authorizes such disclosure. Pursuant to Resident Right #6 (GS 131D-21), the resident may identify to whom he/she wants the records to be released. Additionally, most HIPPA forms allow the resident to name persons with whom he/she wants the records shared. If the resident is deceased, the personal representative of the estate (court-appointed administrator or executor of the will) is the person who is authorized to request records.

10A NCAC 13F .0302: Design and Construction—The community shall have current sanitation and fire and building safety inspection reports maintained in the community and available for review.

10A NCAC 13F .0501: Personal Care Training and Competency—Documentation of the successful completion of the 80-hour training and competency evaluation program shall be maintained in the community and available for review. Documentation of the on-the-job training shall be maintained in the community and available for review.

10A NCAC 13F .0502: Personal Care Training Content and Instructors—The training provider shall maintain copies of the certificates and the skills evaluation checklists for a minimum of five years.

10A NCAC 13F .0503: Medication Administration Competency—A copy of the certificate (written exam) shall be maintained and available for review in the community.

10A NCAC 13F .1002: Medication Orders—Documentation of training attended by staff shall be maintained in the community.

10A NCAC 13F .1007: Medication Disposition—These records shall be maintained in the community for a minimum of one year.

10A NCAC 13F .1008: Controlled Substance—Records of controlled substances returned to the pharmacy or destroyed by the community shall be maintained by the community for a minimum of three years.

10A NCAC 13F .1202: Disposal of Resident Records—Shall be filed at the community for at least one year and then stored for at least two more years.

10A NCAC 13F .1213: Availability of Corrective Action and Survey Reports—Make available to residents and their families or responsible persons and to prospective residents and their families or responsible persons, upon request and within the community, corrective action reports by the county departments of social services and community survey reports by state licensure consultants that have been approved by the Adult Care Licensure Section of the Division of Health Service Regulation within the past 12 months.

Refusal to follow medication orders must be documented on the MAR as required by Rules 13F and 13G .1004(j)(7). In order to comply with Rules 13F and 13G .0902, the facility should notify the resident’s physician about refusals. The facility should advise the resident about the importance of following physician’s orders and what the health repercussions are of not following orders. The resident’s responsible person should also be informed. If the physician does not change the order and the resident continues to refuse, the facility should continue to document refusals and inform the resident that a discharge may be necessary because the facility is unable to meet the resident’s needs. Depending on the circumstances, i.e., how serious a health threat it is, the facility can do less than a 30-day discharge according to Part (b)(1) of the rule or a 30-day discharge according to Part (b)(6) of the rule. For refusal of payment (not lack of funds to pay), the facility must follow 30-day discharge procedures according to Part (b)(5) of the rule. The facility is still responsible for assuring medications are administered as ordered, as long the person is a resident of the facility, regardless of refusal or inability to pay.

While such time frames are not specified in the rules, it is highly recommended that the facility’s policies and procedures address time lapses for starting administration of new orders such as emergency or stat orders, antibiotics, routine medication, and methods of legal borrowing of doses. The type of medication as well as the resident’s condition should be considered. For example, the facility’s policy for medications prescribed for acute problems, such as antibiotics, would require a more timely start of administration than for routine medications or those for chronic conditions. It is recommended that the facility get the assistance of a licensed health professional, such as a pharmacist, in determining an appropriate lapse time for starting new orders since it is the facility’s responsibility to assure the availability of medication in a time frame that would not put the residents’ health or safety at risk.

No, although it would be a good practice because it would provide a list of the medications that the resident is taking. If a MAR is maintained, it is also good practice to indicate self-administration on the form, especially if staff document when the resident takes his/her medication, or so staff will know why there is no documentation on the MAR, especially when a resident self-administers some medications but not all of them. The resident’s ability to self-administer should be evaluated on an ongoing basis.

Residents and staff are to be notified of the immunization requirements according GS 131D-9 (pneumococcal vaccine for residents and flu vaccine for residents and employees). The law requires facilities to notify residents and employees of the immunization requirements and request that they be immunized, but they can refuse immunization after being fully informed of the health risks. If a person refuses immunization, the facility must document refusal by, at a minimum, a statement signed by the person refusing immunization stating that he/she was notified of the immunization requirement and fully informed of the health risks of not being immunized. This documentation should be maintained in the resident’s record or personnel file.