North Carolina Administrative Code

section .1800 – reserved for future codification 10A NCAC 13D .1800 Reserved for future codification

SECTION .1900 - RESERVED FOR FUTURE CODIFICATION 10A NCAC 13D .1900 Reserved for future codification

subchapter 13D – rules for the licensing of nursing homes 10A NCAC 13D .2001 DEFINITIONS In addition to the definitions set forth in G.S. 131E-101, the following definitions shall apply throughout this Subchapter: (1) "Abuse" means the willful infliction of injury, unreasonable c…

SECTION .2100 - LICENSURE 10A NCAC 13D .2101 APPLICATION REQUIREMENTS (a) A legal entity shall submit an application for licensure for a new facility to the Nursing Home Licensure and Certification Section of the Division of Health Service Regulation at least 30 days prior to a l…

10A NCAC 13D .2102 ISSUANCE OF LICENSE (a) Only one license shall be issued to each facility. The Department shall issue a license to the licensee of the facility following review of operational policies and procedures and verification of compliance with applicable laws and rules…

10a NCAC 13d .2103 LENGTH OF LICENSURE Licenses shall remain in effect up to 12 months, unless any of the following occurs: (1) Department imposes an administrative sanction which specifies license expiration; (2) closure; (3) change of ownership; (4) change of site; (5) change i…

10A NCAC 13D .2104 REQUIREMENTS FOR LICENSURE RENEWAL OR CHANGES (a) The Department shall renew the facility's license at the end of each calendar year, if the following occur: (1) The licensee maintains and submits to the Department, at least 30 days prior to the licensure expir…

10A NCAC 13D .2105 TEMPORARY CHANGE IN BED CAPACITY (a) A continuing care retirement community, having an agreement to care for all residents regardless of level of care needs, may temporarily increase bed capacity by 10 percent or 10 beds, whichever is less, over the licensed be…

10A NCAC 13D .2106 DENIAL, AMENDMENT, OR REVOCATION OF LICENSE (a) The Department shall deny any licensure application upon becoming aware that the applicant is not in compliance with G.S. 131E, Article 9 and the rules adopted under that law. (b) The Department may amend a licens…

10A NCAC 13D .2107 SUSPENSION OF ADMISSIONS (a) The Department may suspend the admission of new patients to a facility when warranted under the provisions of G.S. 131E-109(c). (b) The Department shall notify the facility personally or by certified mail of the decision to suspend …

10A NCAC 13D .2108 PROCEDURE FOR APPEAL (a) The facility may appeal any decision of the Department to deny, revoke or alter a license or any decision to suspend admissions by making such an appeal in accordance with G.S. 150B and 10A NCAC 01. (b) A decision to issue a provisional…

10A NCAC 13D .2109 INSPECTIONS (a) The facility shall allow inspection by an authorized representative of the Department at any time. (b) At the time of inspection, any authorized representative of the Department shall make his or her presence known to the administrator or other …

10A NCAC 13D .2110 PUBLIC ACCESS TO DEPARTMENT LICENSURE RECORDS History Note: Authority G.S. 8-53; 108A-80; 131E-104; 131E-124(c); 132-1.1; Eff. January 1, 1996; Repealed Eff. July 1, 2012.

10A NCAC 13D .2111 ADMINISTRATIVE PENALTY DETERMINATION PROCESS History Note: Authority G.S. 131D-34; 131E-104; 143B-165; Eff. August 3, 1992; Amended Eff. March 1, 1995; Transferred and recodified from 10 NCAC 03H .0221 Eff. January 10, 1996; Amended Eff. July 1, 2014; Pursuant …

SECTION .2200 - GENERAL STANDARDS OF ADMINISTRATION 10A NCAC 13D .2201 ADMINISTRATOR (a) A facility shall be under the control of an administrator licensed by the North Carolina State Board of Examiners for Nursing Home Administrators. (b) If an administrator is not the sole owne…

10A NCAC 13D .2202 ADMISSIONS (a) No patient shall be admitted except by a physician. Admission shall be in accordance with facility policies and procedures. (b) The facility shall acquire, prior to or at the time of admission, orders for the immediate care of the patient from th…

10A NCAC 13D .2203 PATIENTS NOT TO BE ADMITTED (a) Patients who require health, habilitative or rehabilitative care beyond those for which the facility is licensed and is capable of providing shall not be admitted to the licensed nursing home. (b) No person requiring continuous n…

10A NCAC 13D .2204 RESPITE CARE (a) Respite care is not required as a condition of licensure. Facilities providing respite care, however, shall meet the requirements of this Subchapter with the following exceptions: Rules .2205, .2301, and .2501(b) and (c) of this Subchapter. (b)…

10A NCAC 13D .2205 DISCHARGE OF PATIENTS (a) The facility shall ensure a medical order for discharge is obtained for all patients except when a patient leaves against medical advice or is discharged for non-payment. (b) The facility shall ensure discharge planning is accomplished…

10A NCAC 13D .2206 MEDICAL DIRECTOR (a) The facility shall designate a physician to serve as medical director. (b) The medical director shall be responsible for implementation of patient care policies and coordination of medical care in the facility. History Note: Authority G.S. …

10A NCAC 13D .2207 PATIENT RIGHTS (a) The facility shall enforce the Nursing Facility Patient's Bill of Rights as described in G.S. 131E-115 through G.S. 131E-127. (b) In matters of patient abuse, neglect or misappropriation the definitions shall have the meaning defined in Rule …

10A NCAC 13D .2208 SAFETY (a) The facility shall have detailed written plans and procedures to meet potential emergencies and disasters, including but not limited to fire, severe weather and missing patients or residents. (b) The plans and procedures shall be made available upon …

10A NCAC 13D .2210 REPORTING AND INVESTIGATING ABUSE, NEGLECT OR MISAPPROPRIATION (a) A facility shall take measures to prevent patient abuse, patient neglect, or misappropriation of patient property, including orientation and instruction of facility staff on patients' rights and…

10A NCAC 13D .2211 PERSONNEL STANDARDS (a) The facility shall employ the types and numbers of qualified staff, professional and non-professional, necessary to provide for the health, safety and proper care of patients. (b) Each employee shall be assigned duties consistent with hi…

10A NCAC 13D .2212 QUALITY ASSURANCE COMMITTEE (a) The administrator shall establish a quality assessment and assurance committee that consists of the director of nursing, a physician designated by the facility, a pharmacist and at least three other staff members. (b) The committ…

SECTION .2300 - PATIENT AND RESIDENT CARE AND SERVICES 10A NCAC 13D .2301 PATIENT ASSESSMENT AND PLAN OF CARE (a) At the time each patient is admitted, the facility shall ensure medical orders are available for the patient's immediate care and that, within 24 hours, a nursing ass…

10A NCAC 13D .2302 NURSING SERVICES (a) The facility shall designate a registered nurse to serve as the director of nursing on a full-time basis. (b) The director of nursing shall be responsible for the administering of nursing services. (c) The director of nursing may serve also…

10A NCAC 13D .2303 NURSE STAFFING REQUIREMENTS (a) A facility shall provide licensed nursing staff sufficient to accomplish the following: (1) patient needs assessment; (2) patient care planning; and (3) supervisory functions in accordance with the levels of patient care advertis…

10A NCAC 13D .2304 NURSE AIDES (a) A facility shall employ or contract individuals as nurse aides in compliance with N.C. General Statute 131E, Article 15 and facilities certified for Medicare or Medicaid participation shall also comply with 42 CFR Part 483 which is incorporated …

10A NCAC 13D .2305 QUALITY OF CARE (a) The facility shall provide necessary care and services in accordance with medical orders, the patient's comprehensive assessment and on-going plan of care. (b) Acute changes in the patient's physical, mental or psychosocial status shall be e…

10A NCAC 13D .2306 MEDICATION ADMINISTRATION (a) The facility shall ensure that medications are administered in accordance with applicable occupational licensure regulations and manufacturer's recommendations. (b) The facility shall ensure that each patient's drug regimen is free…

10A NCAC 13D .2307 DENTAL CARE AND SERVICES (a) The facility shall ensure that routine and emergency dental services are available for all patients. (b) The facility shall, if necessary, assist the patient in making appointments and obtaining transportation to the dentist's offic…

10A NCAC 13D .2308 ADULT CARE HOME PERSONNEL REQUIREMENTS (a) The administrator of a combination home shall designate a person to be in charge of the adult care home residents at all times. The nurse-in-charge of the nursing facility may also serve as supervisor-in-charge of the …

10A NCAC 13D .2309 CARDIO-PULMONARY RESUSCITATION (a) Each facility shall develop and implement a Cardio-Pulmonary Resuscitation (CPR) policy. (b) The policy shall be communicated to all residents or their responsible party prior to admission. (c) Upon admission each resident or …

SECTION .2400 - MEDICAL RECORDS 10A NCAC 13D .2401 MAINTENANCE OF MEDICAL RECORDS (a) The facility shall establish a medical records service. It shall be directed, staffed and equipped to ensure: (1) records are processed, indexed and filed accurately; (2) records are stored in s…

10A NCAC 13D .2402 PRESERVATION OF MEDICAL RECORDS (a) A facility shall keep medical records on file for five years following the discharge of an adult patient. (b) Not withstanding Paragraph (c) of this Rule, if the patient is a minor when discharged from the nursing facility, t…

SECTION .2500 - PHYSICIAN'S SERVICES 10A NCAC 13D .2501 AVAILABILITY OF PHYSICIAN'S SERVICES (a) The facility shall ensure each patient's care is supervised by a physician and that provisions are made for emergency physicians when attending physicians are unavailable. The names a…

10A NCAC 13D .2502 PRIVATE PHYSICIAN (a) Each patient or legal representative shall be allowed to select his or her private physician except in those facilities affiliated with medical teaching programs and having written policies requiring all patients to participate in the medi…

10A NCAC 13D .2503 USE OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS (a) Any facility that employs nurse practitioners or physician assistants shall maintain the following information for each nurse practitioner and physician assistant: (1) verification of current approval to p…

10a NCAC 13D .2504 LABORATORY AND RADIOLOGY SERVICES The facility shall provide or obtain clinical laboratory and radiology services to ensure that each patient's needs are met. Such services shall include the following: (1) provision of laboratory and radiology services within t…

10A NCAC 13D .2505 BRAIN INJURY LONG-TERM CARE PHYSICIAN SERVICES History Note: Authority G.S. 131E-104; RRC objection due to lack of statutory authority Eff. July 13, 1995; Eff. January 1, 1996; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest E…

10A NCAC 13D .2506 PHYSICIAN SERVICES FOR VENTILATOR DEPENDENT PATIENTS History Note: Authority G.S. 131E-104; RRC objection due to lack of statutory authority and ambiguity Eff. July 13, 1995; Eff. January 1, 1996; Pursuant to G.S. 150B-21.3A, rule is necessary without substanti…

SECTION .2600 - PHARMACEUTICAL SERVICES 10A NCAC 13D .2601 AVAILABILITY OF PHARMACEUTICAL SERVICES (a) The facility shall provide pharmaceutical services under the supervision of a pharmacist, including procedures that ensure the accurate acquiring, receiving and administering of…

10A NCAC 13D .2602 PHARMACY PERSONNEL (a) If the pharmacist is an employee of the facility and performs vending or clinical services, an up-to-date job description and personnel file shall be maintained. (b) If pharmaceutical vending or clinical services are contracted, there sha…

10A NCAC 13D .2603 ADMINISTRATIVE RESPONSIBILITIES (a) The pharmacist shall report any potential drug therapy irregularities or discrepancies in drug accountability and administration with recommendations for change to the director of nursing and the attending physician. Recommen…

10A NCAC 13D .2604 DRUG PROCUREMENT (a) The facility shall not possess a stock of prescription drugs for general or common use except as permitted by the North Carolina Board of Pharmacy and as follows: (1) for all intravenous and irrigation solutions in single unit quantities ex…

10A NCAC 13D .2605 DRUG STORAGE AND DISPOSITION (a) A facility shall ensure that drug storage areas are clean, secure, well lighted and well ventilated; that room temperature is maintained between 59 degrees F. and 86 degrees F.; and that the following conditions are met: (1) All…

10A NCAC 13D .2606 PHARMACEUTICAL RECORDS (a) A facility shall ensure that accurate records of the receipt, use and disposition of drugs are maintained and readily available. (b) A facility shall ensure accountability of controlled substances as defined by the Disposal of Unused …

10A NCAC 13D .2607 EMERGENCY DRUGS (a) A facility shall maintain a supply of emergency drugs in compliance with 10A NCAC 26E .0408 which is hereby incorporated by reference including subsequent amendments. This Rule can be accessed online at http://reports.oah.state.nc.us/ncac.as…

SECTION .2700 - DIETARY SERVICES 10A NCAC 13D .2701 PROVISION OF NUTRITION AND DIETETIC SERVICES (a) A facility shall ensure that each patient is provided with a palatable diet that meets his or her daily nutritional and specialized nutritional needs. (b) The facility shall desig…