Initial Licensure Process, Survey Types & Licensure Action Adult Care Licensure Section

Initial Licensure Process Regulatory Authority 6 month initial license Full license issued upon survey recommendation Initial license expiration Initial license extension request Change of Ownership § 131D-2.5.  License and registration fees. § 131D-2.4.  Licensure of adult care homes for aged and disabled individuals; impact of prior violations on licensure; compliance history review; license renewal. § 131D-4.6.  Licensure of special care units Once the initial application is received, Construction approval is required, CON exemption or approval if an HA facility, review of the policies and Procedures which may include SCU disclosure/policies and an on-site pre-licensure survey. The pre-licensure survey is completed before any residents are admitted and all previous items have been verified and approved. The provider must have at least 2 residents admitted upon scheduling of the initial survey to determine compliance for full licensure. A recommendation is made by the surveyor and is forwarded to Mangement for review. If in compliance, a full license will be issued for the reminder of the calendar year. Any identification of non-compliance is reviewed and a decision is made by management. If the provider is unable to admit 2 residents before survey, they have the option to submit an extension request. This can only be completed twice, otherwise, the license will expire. Change of Ownership - No pre-licensure survey, Compliance History, Outstanding Penalties

Observation, Interviews and Record Reviews Regulatory Authority Survey Process § 131D-2.11.  Inspections, monitoring, and review by State agency and county departments of social services. Adult care homes and family care homes are required to comply with state rules and statutes to maintain a license to operate. The goal of the survey process is to ensure the health, safety and welfare of persons receiving services in adult care homes. The intent of the survey process is to effectively and efficiently identify the facility’s compliance status. The survey process focuses on the quality of care and life provided by adult care homes.

Survey Types Annual/Biennial Survey Follow-Up Survey Complaint Investigations Initial Survey Survey Types Annual/Biennial Survey - The annual/biennial survey assesses: Compliance with the Fundamental Rule Areas, Presence of a Quality Assurance Improvement Program and Staff Qualifications. Follow-Up Survey - Rule area(s) identified in the previous Statement of Deficiency. Complaint Investigations - Focused on the complaint rule allegations and named residents. Initial Survey - The same as for annual/biennial surveys.

Hierarchy of Licensure Actions Most Severe Summary Suspension License Revocation Provisional License Suspension of Admissions Hierarchy of Licensure Actions Least Severe

Suspension of Admissions N.C. G.S. 131D-2.7(d) The Department may suspend the admission of any new residents to an adult care home where the conditions of the adult care home are detrimental to the health or safety of the residents. New residents are not to be admitted during the effective date of the suspension. 6-month wait before licensee or any stockholder with 5% interest or more obtain a new license. Suspension of Admissions N.C. G.S. 131D-2.7(d) Letter imposing Suspension of Admissions emailed and sent by Certified Mail to facility. Suspension of Admissions effective when delivered to facility.

Provisional License N.C. G.S. 131D-2.7(a) There is a reasonable probability that the licensee can remedy the licensure deficiencies within a reasonable length of time; and There is reasonable probability that the licensee will be able thereafter to remain in compliance with the licensure rules for the foreseeable future. If a facility comes back into compliance, a full license is issued. If a facility fails to come back into compliance and no appeal is filed, the license expires. 6-month wait before licensee or any stockholder with 5% interest or more may obtain a new license. Provisional License N.C. G.S. 131D-2.7(a) Intent to issue a Provisional License (Suspension of Admissions also used) 1st Provisional License – up to 90 days (may be appealed) 2nd Provisional License – up to 90 days (may be appealed)

License Revocation N.C. G.S. 131D-2.7(b) The licensee has substantially failed to comply with the licensure statutes and rules; and It is not reasonably probable that the licensee can remedy the licensure deficiencies within a reasonable length of time. The failure to comply endangered the health, safety, or welfare of the residents. HUB Alert when Revocation in Effect issued Facility loses its license to operate, beds are lost 5 year wait before licensee or any stockholder with 5% interest or more may obtain a new license. License Revocation N.C. G.S. 131D-2.7(b) Although the licensee may be able to correct the deficiencies within a reasonable time, it is not reasonably probable that the licensee will be able to remain in compliance for the foreseeable future. Effective 20 days after the mailing or hand delivery of the notice, unless the applicant or licensee appeals within the 20 day period. Intent to issue a Notice of Revocation (Suspension of Admissions also issued) Notice of Revocation (may be appealed) Revocation in Effect – move to HUB issuance

Summary Suspension N.C. G.S. 131D-2.7(c) The Department may summarily suspend a license pursuant to G.S. 150B-3(c) whenever it finds substantial evidence of abuse, neglect, exploitation, or any condition which presents an imminent danger to the health and safety of any resident of the home. In almost every case, the Department will begin revocation of the facility’s license. Discussion with attorneys in policy. A HUB alert is issued. County DSS responsible for relocation of residents. 5 year wait before licensee or any stockholder with 5% interest or more may obtain a new license. Summary Suspension N.C. G.S. 131D-2.7(c) Facility not aware of action until notice served. A Summary Suspension is effective as soon as it is hand delivered to the facility and the process of relocating residents is immediately started unless a court stops the relocation (Suspension of Admissions also issued). Licensee can file a Temporary Restraining Order (TRO)