{"pack":"nc-hca","path":"/policies/north-carolina/home-care/","name":"North Carolina Home Care Policy and Procedure Manual","state":"North Carolina","service":"Home care","license":"North Carolina home care agency license (in-home aide services)","count":50,"forms":65,"categories":[{"name":"Client rights","count":4},{"name":"Service delivery","count":10},{"name":"Clinical tasks","count":2},{"name":"Safeguarding","count":3},{"name":"Infection control","count":2},{"name":"Emergency preparedness","count":2},{"name":"Records","count":2},{"name":"Privacy","count":3},{"name":"Human resources","count":7},{"name":"Governance","count":5},{"name":"Quality","count":3},{"name":"Business","count":4},{"name":"Ethics","count":3}],"policies":[{"ref":"NC-HC-CR-01","path":"/policies/north-carolina/home-care/home-care-clients-bill-of-rights-client-responsibilities-and-required/","title":"Home Care Clients' Bill of Rights, Client Responsibilities, and Required Notices","category":"Client rights","citation":"G.S. 131E-144.3","summary":"Gives every client, before services start or during the initial evaluation visit, the declaration of home care clients' rights in G.S. 131E-144.3, the Agency's client responsibilities, the Agency's contact details, the address and telephone number of the Division of Health Service Regulation and its complaint hotline, and the notice of the right to object to review of the client's records; obtains the client's signed receipt; and makes sure every member of staff honors each right throughout the client's care.","sample":true},{"ref":"NC-HC-CR-02","path":"/policies/north-carolina/home-care/nondiscrimination-language-access-and-effective-communication/","title":"Nondiscrimination, Language Access, and Effective Communication","category":"Client rights","citation":"45 CFR Part 92","summary":"Prohibits discrimination in the Agency's services; finds out at first contact whether a client or companion needs an interpreter, translated documents or an auxiliary aid; provides qualified interpreters and aids free of charge; makes reasonable modifications for people with disabilities; names a Section 1557 Coordinator; handles discrimination grievances; and gives the federal notices of nondiscrimination and language assistance.","sample":false},{"ref":"NC-HC-CR-03","path":"/policies/north-carolina/home-care/responsible-parties-informed-consent-and-advance-directives/","title":"Responsible Parties, Informed Consent, and Advance Directives","category":"Client rights","citation":"G.S. 131E-144.3(1), (9)","summary":"Identifies and records who may act for each client, obtains the informed agreement of the client (or of the responsible party when the client has been found not competent) before services start and before any change, respects the client's right to refuse any service, and records whether the client has an advance directive, a portable do-not-resuscitate order or a MOST form so that staff know where to find it.","sample":false},{"ref":"NC-HC-GRV-01","path":"/policies/north-carolina/home-care/complaints-and-grievances/","title":"Complaints and Grievances","category":"Client rights","citation":"G.S. 131E-144.6(b)","summary":"Sets out how the Agency receives, records, investigates and resolves complaints. G.S. 131E-144.6(b) requires the Agency to investigate within 72 hours complaints made by a client or the client's family and to document both the complaint and its resolution; the Agency applies the same process to every complaint. It covers acknowledgment within 5, the resolution target of 30, review by the Agency Director, protection from reprisal, the DHSR Complaint Intake Unit and how to reach it, discrimination grievances under Section 1557, privacy complaints, and the PCS complaint record and logs NC Medicaid requires.","sample":false},{"ref":"NC-HC-ADM-01","path":"/policies/north-carolina/home-care/referral-intake-and-acceptance-of-clients/","title":"Referral, Intake, and Acceptance of Clients","category":"Service delivery","citation":"10A NCAC 13J .1101","summary":"Sets how the Agency receives referrals, screens each one against the eight acceptance factors in 10A NCAC 13J .1101, decides promptly whether it can accept the client, tells the referral source when it cannot meet the time frame requested, refers clients it cannot serve to other agencies, and records the referral source and the reasons for any nonacceptance.","sample":false},{"ref":"NC-HC-ADM-02","path":"/policies/north-carolina/home-care/initial-assessment-admission-and-service-agreement/","title":"Initial Assessment, Admission, and Service Agreement","category":"Service delivery","citation":"10A NCAC 13J .1107(d)","summary":"Requires a registered nurse to assess every in-home aide client in the client's home before the plan of care is written, covering the functional areas 10A NCAC 13J .1107(d) lists; sets how companion, sitter and respite clients are assessed; and sets the admission visit at which the client receives the required notices, signs the service agreement and approves the services before any service starts.","sample":false},{"ref":"NC-HC-COR-01","path":"/policies/north-carolina/home-care/coordination-of-services-and-referral-to-community-resources/","title":"Coordination of Services and Referral to Community Resources","category":"Service delivery","citation":"10A NCAC 13J .1001(a)(11)","summary":"Sets how the Agency coordinates each client's services with the client's physician, other providers, programs and family caregivers, keeps evidence of coordination when a client receives more than one in-home service, refers clients to other agencies and community resources when it cannot meet a need, and manages a client's hospital stay and return home.","sample":false},{"ref":"NC-HC-DC-01","path":"/policies/north-carolina/home-care/reduction-termination-transfer-and-discharge/","title":"Reduction, Termination, Transfer, and Discharge","category":"Service delivery","citation":"10A NCAC 13J .1101(7)","summary":"Sets when and how the Agency reduces, suspends or ends a service or discharges a client, the advance notice of at least 48 hours that 10A NCAC 13J .1101(7) requires and its exceptions, referral and coordination so that the client is not left without needed care, transfer to another provider, the discharge summary, and reporting NC Medicaid discharges to the assessment entity.","sample":false},{"ref":"NC-HC-POC-01","path":"/policies/north-carolina/home-care/plan-of-care-90-day-review-and-changes-to-services/","title":"Plan of Care, 90-Day Review, and Changes to Services","category":"Service delivery","citation":"10A NCAC 13J .1202","summary":"Requires a written plan of care for every client, established with the client from the initial assessment, containing everything 10A NCAC 13J .1202 lists and, for in-home aide services, the level of assistance for each ADL; sets who writes and signs it, the review every 90 days, how changes are made and communicated in advance, and how the licensure plan of care relates to the NC Medicaid PCS service plan.","sample":false},{"ref":"NC-HC-SCH-01","path":"/policies/north-carolina/home-care/scheduling-missed-visits-and-coverage-for-staff-absence/","title":"Scheduling, Missed Visits, and Coverage for Staff Absence","category":"Service delivery","citation":"10A NCAC 13J .1101(1)","summary":"Sets how the Agency schedules visits from the plan of care, matches qualified workers to clients, covers staff absence, handles late and missed visits, clients who are not at home, cancellations and requests for a different worker, and what it does when it cannot staff a client's services.","sample":false},{"ref":"NC-HC-SUP-01","path":"/policies/north-carolina/home-care/supervision-of-in-home-aides-supervisory-visits-and-nurse-availability/","title":"Supervision of In-Home Aides, Supervisory Visits, and Nurse Availability","category":"Service delivery","citation":"10A NCAC 13J .1110","summary":"Requires a registered nurse to supervise every in-home aide, to make a supervisory visit to each client's home every 90 days and, at least annually, while the aide is providing care, to document each visit with the date, findings and signature, to record any corrective action in the employee's record, and to be available for supervision during all hours in-home aide services are provided. Adds the NC Medicaid personal care services visit requirements and the Agency's own scheduling safeguards.","sample":false},{"ref":"NC-HC-SUP-02","path":"/policies/north-carolina/home-care/competency-and-supervision-of-companion-sitter-and-respite-staff/","title":"Competency and Supervision of Companion, Sitter, and Respite Staff","category":"Service delivery","citation":"10A NCAC 13J .1504","summary":"Requires documented competency for every task assigned to a companion, sitter or respite worker, and supervision by the designated companion and sitter supervisor through a client contact every three months, a supervisory visit to the home at least every six months, and at least one visit a year while the worker is providing services, each documented with the date, findings and signature. Sets the supervisor's availability and how hands-on needs are referred to the registered nurse.","sample":false},{"ref":"NC-HC-SVC-01","path":"/policies/north-carolina/home-care/scope-of-services-and-service-categories/","title":"Scope of Services and Service Categories","category":"Service delivery","citation":"10A NCAC 13J .1001(a)(1)","summary":"Describes the home care services the Agency is licensed for and offers, what each service includes, the tasks no worker performs under this manual, the Agency's position on medical equipment and supplies, how NC Medicaid personal care services fit within the services offered, and how a service is added to or dropped from the license.","sample":false},{"ref":"NC-HC-SVC-03","path":"/policies/north-carolina/home-care/companion-sitter-respite-and-homemaker-services/","title":"Companion, Sitter, Respite, and Homemaker Services","category":"Service delivery","citation":"10A NCAC 13J .1502","summary":"Sets out what companions, sitters, respite workers and homemakers do and never do, the rule that they never touch a client to carry out the plan of care, how the companion and sitter supervisor writes the plan of care and task sheet, how medication reminders, transportation, errands and respite are handled, and what these workers record and report.","sample":false},{"ref":"NC-HC-SVC-02","path":"/policies/north-carolina/home-care/in-home-aide-services-levels-of-assistance-and-nurse-aide-tasks/","title":"In-Home Aide Services, Levels of Assistance, and Nurse Aide Tasks","category":"Clinical tasks","citation":"10A NCAC 13J .1107","summary":"Sets out what in-home aides do, how the registered nurse records the level of assistance for each activity of daily living, when an aide must be listed on the Nurse Aide Registry, which Nurse Aide I and Nurse Aide II tasks may be assigned and on what conditions, how assignments and written instructions are given, what aides record and report, and how orders for in-home aide services are handled when a payer requires them.","sample":false},{"ref":"NC-HC-SVC-04","path":"/policies/north-carolina/home-care/medication-reminders-and-assistance-with-self-administration/","title":"Medication Reminders and Assistance with Self-Administration","category":"Clinical tasks","citation":"10A NCAC 13J .1107(c)(3)","summary":"Defines the only medication help the Agency's workers give: spoken reminders by any worker, and assistance with self-administration by in-home aides for a client the registered nurse has found able to direct his or her own medications. Sets the steps, what workers never do, how refusals, errors and reactions are reported, and confirms that the Agency does not administer medications.","sample":false},{"ref":"NC-HC-ANE-01","path":"/policies/north-carolina/home-care/reporting-abuse-neglect-and-exploitation-of-adults-and-children/","title":"Reporting Abuse, Neglect, and Exploitation of Adults and Children","category":"Safeguarding","citation":"G.S. 108A-102","summary":"Every staff member who has reasonable cause to believe that a disabled adult is in need of protective services must report it to the director of the county department of social services (G.S. 108A-102), and anyone who suspects a child is abused, neglected or dependent must report to the county department of social services (G.S. 7B-301); an adult who knows or should reasonably know a child is the victim of a violent offense, sexual offense or misdemeanor child abuse must also report immediately to local law enforcement (G.S. 14-318.6). This policy explains the definitions, the signs to look for, what to report and how, the Agency's own standard of reporting immediately and never later than the end of the shift, the immediate report to the county and the DHSR required for NC Medicaid PCS beneficiaries, immunity for good-faith reports, and how the Agency protects the client and cooperates with the county's evaluation.","sample":true},{"ref":"NC-HC-ANE-02","path":"/policies/north-carolina/home-care/allegations-against-staff-and-health-care-personnel-registry-reporting/","title":"Allegations Against Staff and Health Care Personnel Registry Reporting","category":"Safeguarding","citation":"10A NCAC 13O .0102","summary":"North Carolina requires every home care agency to report to the Department, within 24 hours of becoming aware, every allegation against its unlicensed staff with direct access to clients or their property (health care personnel), including injuries of unknown source, and to send the results of its investigation within five working days of the initial notification (10A NCAC 13O .0102; G.S. 131E-256(g)). This policy sets out the acts covered (abuse, neglect, misappropriation of property, diversion of drugs and fraud), the definitions, how the Agency protects the client by removing the worker from client contact while it investigates, how it investigates fairly, how it reports to Health Care Personnel Investigations, how allegations against licensed nurses go to the Board of Nursing, and how the Agency records the outcome.","sample":false},{"ref":"NC-HC-SAF-01","path":"/policies/north-carolina/home-care/client-and-staff-safety-in-the-home/","title":"Client and Staff Safety in the Home","category":"Safeguarding","citation":"10A NCAC 13J .1202(a)(4)","summary":"Sets how the Agency assesses and records safety in each client's home, writes safety measures and activity restrictions into the plan of care, prevents falls and injuries, handles fire, oxygen, firearms, animals and other hazards, never restrains clients, and protects its workers, including the right to leave an unsafe situation and the reporting of serious work injuries.","sample":false},{"ref":"NC-HC-IC-01","path":"/policies/north-carolina/home-care/infection-control-and-communicable-disease/","title":"Infection Control and Communicable Disease","category":"Infection control","citation":"10A NCAC 13J .1003(a)","summary":"Sets the Agency's infection control and communicable disease policy for care in clients' homes: employee exposure risk categories, standard precautions and hand hygiene, protective equipment, cleaning, laundry, waste and food safety, work restrictions for ill staff, care of clients with communicable diseases or infestations, respiratory protection if the Agency requires respirators, and cooperation with public health.","sample":true},{"ref":"NC-HC-IC-02","path":"/policies/north-carolina/home-care/bloodborne-pathogens-exposure-control-plan-and-hepatitis-b/","title":"Bloodborne Pathogens Exposure Control Plan and Hepatitis B","category":"Infection control","citation":"29 CFR §1910.1030","summary":"The Agency's written exposure control plan under the OSHA bloodborne pathogens standard, as North Carolina enforces it: who has occupational exposure, universal precautions, work practices and protective equipment in clients' homes, the free hepatitis B vaccination offered within 10 working days of initial assignment or the signed declination, what to do after an exposure incident, training at assignment and every year, records, the sharps injury log, and the annual review of the plan.","sample":false},{"ref":"NC-HC-EP-01","path":"/policies/north-carolina/home-care/emergency-preparedness-and-continuity-of-services/","title":"Emergency Preparedness and Continuity of Services","category":"Emergency preparedness","citation":"10A NCAC 13J .1001(a)(5)","summary":"Sets out how the Agency prepares for and keeps clients safe through hurricanes, tropical storms, flooding, tornadoes, winter storms and ice, extreme heat, long power outages, outbreaks, cyberattacks and loss of the office. 10A NCAC 13J requires a written policy on management of emergency care situations in the home and, where the Agency supplies medical equipment, backup for equipment or power failure; it sets no drill frequency for home care agencies. As the Agency's own standards, this plan ranks every client by priority, keeps an emergency contact and priority list current, gives each client an individual emergency plan, sets a staff call tree, keeps the office and records running, coordinates with county emergency management, and is tested every year.","sample":false},{"ref":"NC-HC-SAF-02","path":"/policies/north-carolina/home-care/management-of-emergency-care-situations-in-the-home/","title":"Management of Emergency Care Situations in the Home","category":"Emergency preparedness","citation":"10A NCAC 13J .1001(a)(5)","summary":"Sets what every worker does in a medical or other emergency in a client's home: call 911 first, give first aid within training, stay with the client, call the office and the on-call supervisor, and tell the family. Covers the Emergency Information Sheet kept in each home, specific emergencies, a client who does not answer the door, portable do-not-resuscitate orders and MOST forms, a death in the home, and follow-up and reporting.","sample":false},{"ref":"NC-HC-REC-01","path":"/policies/north-carolina/home-care/client-service-records-content-handling-and-retention/","title":"Client Service Records: Content, Handling, and Retention","category":"Records","citation":"10A NCAC 13J .1401","summary":"Sets out what every client record contains under 10A NCAC 13J .1402, how entries are dated, signed and corrected, how originals and copies are kept and secured on the licensed premises, the five-working-day return of a record removed for evaluation with a sign-out log, release only with the client's written authorization or as the law permits, and how long records are kept: the Agency keeps every client record at least six years after the most recent discharge, which meets the five years in 13J .1401(f), the NC Medicaid rule and the HIPAA documentation period, and longer for minors and records under audit.","sample":false},{"ref":"NC-HC-REC-02","path":"/policies/north-carolina/home-care/service-documentation-and-return-of-service-records/","title":"Service Documentation and Return of Service Records","category":"Records","citation":"10A NCAC 13J .1001(a)(6)","summary":"Sets the Agency's written time frame for completing and returning service records, which 10A NCAC 13J .1001(a)(6) requires: each visit is recorded before the worker leaves the home, and paper records for each service week reach the office no later than the second business day after the week ends. Also covers what each entry must show (date, time, services, signature), extra NC Medicaid PCS log rules (tasks against the service plan, deviations with reasons, separate logs, weekly signatures by aide and beneficiary), refusals and missed tasks, the office review of returned records, and how EVV fits with the service record.","sample":false},{"ref":"NC-HC-PRV-01","path":"/policies/north-carolina/home-care/confidentiality-and-hipaa-privacy/","title":"Confidentiality and HIPAA Privacy","category":"Privacy","citation":"45 CFR Part 164 Subpart E","summary":"Sets out how the Agency keeps client and employee information confidential, as 10A NCAC 13J .1001(a)(10) and G.S. 131E-144.3(5) require, and how it meets the HIPAA Privacy Rule: the privacy official, minimum necessary use, a table of who may receive client information (including mandated reports to county social services and law enforcement and the client's written right to object to state review of the record under G.S. 131E-141(b)), the Notice of Privacy Practices, the client's rights to see, copy, amend and get an accounting of disclosures within the federal time limits, business associates, sanctions and training.","sample":false},{"ref":"NC-HC-PRV-02","path":"/policies/north-carolina/home-care/hipaa-security-and-use-of-mobile-devices/","title":"HIPAA Security and Use of Mobile Devices","category":"Privacy","citation":"45 CFR Part 164 Subpart C","summary":"Sets out how the Agency protects client information held electronically, as the HIPAA Security Rule requires: a named security official, a written risk analysis and risk management plan, role-based access with unique logins, prompt removal of access, security training, incident response, backup and emergency access, business associate agreements, and physical and technical safeguards. It sets clear rules for the phones and tablets workers use for EVV, scheduling and messages, including screen locks, approved apps only, no client information in personal texts, photos or social media, and reporting a lost device at once.","sample":false},{"ref":"NC-HC-PRV-03","path":"/policies/north-carolina/home-care/breach-notification/","title":"Breach Notification","category":"Privacy","citation":"45 CFR §164.404","summary":"Sets out how the Agency responds when client or employee information may have been lost, stolen, seen or sent improperly: report at once to the privacy official, contain and investigate, apply the HIPAA four-factor risk assessment, and give notice without unreasonable delay and no later than 60 calendar days after discovery to affected individuals, to the U.S. Department of Health and Human Services (at the same time for 500 or more, or in the annual log for fewer), and to the media for more than 500 residents of a state. It also applies the North Carolina Identity Theft Protection Act, G.S. 75-65, when Social Security, driver's license, account or similar numbers are involved, including notice to the Attorney General's Consumer Protection Division.","sample":false},{"ref":"NC-HC-CMP-01","path":"/policies/north-carolina/home-care/in-home-aide-competency-verification-and-skills-training/","title":"In-Home Aide Competency Verification and Skills Training","category":"Human resources","citation":"10A NCAC 13J .1110(b)","summary":"Defines how the registered nurse verifies, by demonstration, that each in-home aide is competent in every client care task before the task is assigned, including the six core personal care skills the rules require for aides not on the nurse aide registry, how skills training is given, when competency is verified again, and the training content NC Medicaid requires for personal care aides. Confirms that North Carolina sets no training-hour minimum for in-home aides.","sample":false},{"ref":"NC-HC-HR-01","path":"/policies/north-carolina/home-care/staffing-personnel-qualifications-and-job-descriptions/","title":"Staffing, Personnel Qualifications, and Job Descriptions","category":"Human resources","citation":"10A NCAC 13J .1003(e)","summary":"Sets the qualifications for every position, requires a written job description with qualifications and specific responsibilities for each, sets the hiring steps, and makes sure staff are assigned only to duties they are trained, competent and, where needed, licensed to perform, with enough staff and back-up to cover the clients the Agency accepts.","sample":false},{"ref":"NC-HC-HR-02","path":"/policies/north-carolina/home-care/criminal-history-record-checks/","title":"Criminal History Record Checks","category":"Human resources","citation":"G.S. 131E-265","summary":"Requires every offer of a position that involves entering a client's home, and every move of a current employee into such a position, to be conditioned on consent to a criminal history record check; requires the check to be requested within five business days; sets when a national fingerprint check is needed; and sets how results are reviewed against the seven factors in G.S. 131E-265, kept confidential, and used for NC Medicaid billing.","sample":false},{"ref":"NC-HC-HR-03","path":"/policies/north-carolina/home-care/health-care-personnel-registry-and-nurse-aide-registry-checks/","title":"Health Care Personnel Registry and Nurse Aide Registry Checks","category":"Human resources","citation":"G.S. 131E-256(d2)","summary":"Requires the Agency to access the North Carolina Health Care Personnel Registry before hiring anyone with direct access to clients or their property and to note each access, forbids hiring anyone with a substantiated finding, and requires every in-home aide who gives extensive assistance to be listed on the Nurse Aide Registry, with re-checks at least once a year.","sample":false},{"ref":"NC-HC-HR-04","path":"/policies/north-carolina/home-care/tuberculosis-screening-and-employee-health/","title":"Tuberculosis Screening and Employee Health","category":"Human resources","citation":"10A NCAC 13J .1003(b)","summary":"Requires a baseline tuberculosis skin test for every hands-on care employee (and, as DHSR expects, every in-home caregiver), noninfectious status before assignment for anyone who tests positive, baseline and annual symptom verification for anyone previously positive, further testing when the Agency's risk assessment calls for it, and confidential records of all screening.","sample":false},{"ref":"NC-HC-HR-05","path":"/policies/north-carolina/home-care/orientation-and-in-service-education/","title":"Orientation and In-Service Education","category":"Human resources","citation":"10A NCAC 13J .1003(d)","summary":"Requires every employee to complete orientation before working with clients, sets the orientation topics required by North Carolina law and NC Medicaid, sets the Agency's in-service education requirement of at least 8 clock hours every 12 months for direct care staff (the rules leave the number to the Agency), and requires records of all orientation and in-service education and attendance.","sample":false},{"ref":"NC-HC-HR-06","path":"/policies/north-carolina/home-care/personnel-records-and-annual-performance-evaluation/","title":"Personnel Records and Annual Performance Evaluation","category":"Human resources","citation":"10A NCAC 13J .1003(f)","summary":"Lists everything that must be in each employee's personnel record under 10A NCAC 13J .1003(f) and the other rules, sets how records are kept confidential and available to DHSR on the premises, requires a written performance evaluation at least once a year, and sets how long personnel records are kept after employment ends.","sample":false},{"ref":"NC-HC-GOV-01","path":"/policies/north-carolina/home-care/governing-body-written-policies-organizational-chart-and/","title":"Governing Body, Written Policies, Organizational Chart, and Administrative Records","category":"Governance","citation":"10A NCAC 13J .1001(a)","summary":"Sets out who the governing body of the Agency is and what it is responsible for, how the written policies that 10A NCAC 13J requires are adopted, issued and reviewed, how the organizational chart is kept, and how the annual budget and the statistical records that the Division of Health Service Regulation may request are kept.","sample":false},{"ref":"NC-HC-GOV-02","path":"/policies/north-carolina/home-care/agency-director-order-of-authority-and-service-supervisors/","title":"Agency Director, Order of Authority, and Service Supervisors","category":"Governance","citation":"10A NCAC 13J .1001(b)","summary":"Requires the Agency to designate an Agency Director who meets the qualifications in 10A NCAC 13J, defines the Agency Director's authority and duties and the order of authority when the Agency Director is absent, requires a designated supervisor for each service (a registered nurse for in-home aide services, with an alternate registered nurse so one is always available), and sets the five-working-day notice to DHSR when the Agency Director position becomes vacant.","sample":false},{"ref":"NC-HC-GOV-03","path":"/policies/north-carolina/home-care/licensure-license-changes-and-notices-to-the-division-of-health/","title":"Licensure, License Changes, and Notices to the Division of Health Service Regulation","category":"Governance","citation":"G.S. 131E-138","summary":"Keeps the Agency's home care license valid: one license for each premises, renewed before it expires on December 31, posted where the public can see it, and covering every service the Agency provides. Sets out each change DHSR must be told about and when, how clients are told within 10 days of a change to the license, and what the Agency does if it stops a service or closes.","sample":false},{"ref":"NC-HC-GOV-04","path":"/policies/north-carolina/home-care/geographic-service-area/","title":"Geographic Service Area","category":"Governance","citation":"10A NCAC 13J .1001(g)","summary":"Defines the geographic area in which the Agency provides each service, applies the North Carolina limit on the area for in-home aide services (the Agency's county, contiguous counties, or within 90 minutes driving time of the office, whichever is greater), and requires 30 days' written notice to DHSR before the Agency expands its area without opening a new site.","sample":false},{"ref":"NC-HC-GOV-05","path":"/policies/north-carolina/home-care/inspections-state-complaint-investigations-and-plans-of-correction/","title":"Inspections, State Complaint Investigations, and Plans of Correction","category":"Governance","citation":"10A NCAC 13J .0904","summary":"Explains what happens when DHSR inspects the Agency or investigates a complaint, what staff do during a survey, how clients' right to object to record review is respected, how a plan of correction is prepared and filed within 10 working days, and how the Agency responds to an adverse action against its license.","sample":false},{"ref":"NC-HC-INC-01","path":"/policies/north-carolina/home-care/incidents-accidents-and-unusual-occurrences/","title":"Incidents, Accidents, and Unusual Occurrences","category":"Quality","citation":"NC Medicaid Clinical Coverage Policy 3L, §6.1.2(e)","summary":"Sets out how staff respond to and report accidents, injuries, falls, sudden illness, missing clients, deaths, medication assistance errors, property loss, staff injuries and other unusual events: make the client safe and call 911 when needed, tell the supervisor at once, complete an incident report before the end of the shift, and have the supervisor review it by the end of the next business day. Routes events to the right policy: injuries of unknown source and allegations against staff to the Health Care Personnel Registry within 24 hours, suspected abuse, neglect or exploitation to the county department of social services, and privacy events to the privacy official. Incidents are trended through the quality program.","sample":false},{"ref":"NC-HC-QA-01","path":"/policies/north-carolina/home-care/annual-program-evaluation-and-quality-improvement/","title":"Annual Program Evaluation and Quality Improvement","category":"Quality","citation":"10A NCAC 13J .1004(a)","summary":"Sets out the comprehensive evaluation of the Agency's total operation that the governing body or its designee must carry out every year under 10A NCAC 13J .1004: the policy and administration review of each required topic, the six data items the rule lists, how findings are used to fix problems and revise policies, and the required documentation of evaluators, criteria, methods and actions. It also sets up the Agency's ongoing quality improvement program, with quarterly quality indicators, and, for agencies serving NC Medicaid personal care services beneficiaries, the Policy 3L quality improvement plan updated at least quarterly, the annual written satisfaction survey and the attestation due by December 31.","sample":false},{"ref":"NC-HC-QA-02","path":"/policies/north-carolina/home-care/client-record-review-every-90-days/","title":"Client Record Review Every 90 Days","category":"Quality","citation":"10A NCAC 13J .1004(d)","summary":"Sets out the review of client records that the governing body or its designee must carry out every 90 days under 10A NCAC 13J .1004(d): a representative sample of active and closed records covering every home care service, direct and under contract, checked against the Agency's policies on Form NC-HC-QA-02-A. As the Agency's own standard, each review samples at least 10 percent of active and 10 percent of closed records, never fewer than five records, with every service represented; records removed for review come back within five working days under the sign-out log; findings are corrected within 30 days and feed the annual program evaluation.","sample":false},{"ref":"NC-HC-BUS-01","path":"/policies/north-carolina/home-care/charges-billing-and-the-written-statement-of-services/","title":"Charges, Billing, and the Written Statement of Services","category":"Business","citation":"G.S. 131E-144.3(7)","summary":"Gives every client a written statement of the services the Agency will provide and the charges the client is liable for paying before services start, bills only for services actually provided and recorded, explains how charges and services change, and treats NC Medicaid payment as payment in full for covered services.","sample":false},{"ref":"NC-HC-BUS-02","path":"/policies/north-carolina/home-care/electronic-visit-verification/","title":"Electronic Visit Verification","category":"Business","citation":"NC Medicaid Clinical Coverage Policy 3L, §7.4","summary":"If the Agency provides personal care or other services that NC Medicaid requires to be verified electronically, requires every visit to be recorded in an EVV system that captures the six data elements federal law requires, requires beneficiaries to be told about EVV in writing and staff to be trained at hire and at least every year, and sets how exceptions and manual edits are handled before any claim is billed.","sample":false},{"ref":"NC-HC-BUS-03","path":"/policies/north-carolina/home-care/nc-medicaid-personal-care-services-and-other-public-programs/","title":"NC Medicaid Personal Care Services and Other Public Programs","category":"Business","citation":"NC Medicaid Clinical Coverage Policy 3L, §6.0","summary":"If the Agency provides State Plan personal care services (PCS) paid by NC Medicaid, sets the provider requirements of NC Medicaid Clinical Coverage Policy 3L: enrollment, the Provider Interface, the on-line service plan and its deadlines, aide documentation, the conviction billing bar, the ban on inducements, cooperation with audits, the internal quality improvement program and its December 31 attestation, abuse reporting, and supervision and training. Refers to CAP/DA and block grant programs for their own requirements.","sample":false},{"ref":"NC-HC-HR-07","path":"/policies/north-carolina/home-care/contract-services-and-arrangements-with-other-agencies/","title":"Contract Services and Arrangements with Other Agencies","category":"Business","citation":"10A NCAC 13J .1111","summary":"Requires a written agreement, signed by both parties and containing the ten items in 10A NCAC 13J .1111, whenever another agency or individual provides services for the Agency; makes sure contract staff meet the same requirements as Agency staff and are supervised; keeps a complete client record at the Agency; and requires each agreement to be reviewed every year.","sample":false},{"ref":"NC-HC-ETH-01","path":"/policies/north-carolina/home-care/code-of-conduct-professional-boundaries-and-client-property/","title":"Code of Conduct, Professional Boundaries, and Client Property","category":"Ethics","citation":"G.S. 131E-144.3(2)","summary":"Sets the standards of conduct for everyone who works in a client's home: respect, dignity and privacy; professional boundaries; honesty in records; no gifts, loans or financial involvement with clients; careful handling of client money, keys and medications; and the duty to report misconduct. Misappropriation of client property, diversion of drugs and fraud are matters the Agency must report to the Health Care Personnel Registry.","sample":false},{"ref":"NC-HC-ETH-02","path":"/policies/north-carolina/home-care/smoking-prohibited-while-serving-clients/","title":"Smoking Prohibited While Serving Clients","category":"Ethics","citation":"G.S. 131E-143","summary":"Prohibits every Agency employee and contract worker from smoking while providing services in a client's home, as North Carolina law requires, extends the rule to e-cigarettes and vaping as the Agency's own standard, tells every client in writing that staff may not smoke in their home, and sets out how the rule is enforced.","sample":false},{"ref":"NC-HC-ETH-03","path":"/policies/north-carolina/home-care/compliance-program-fraud-prevention-and-exclusion-screening/","title":"Compliance Program, Fraud Prevention, and Exclusion Screening","category":"Ethics","citation":"10A NCAC 13J .0906(a)","summary":"Sets up the Agency's compliance program: a person responsible for compliance, written standards, training, a safe way to raise concerns, auditing, and prompt correction. Requires screening of every employee and contractor against the federal and NC Medicaid exclusion lists before hire and every month, explains the North Carolina and federal false claims and anti-kickback laws, and bans gifts or inducements to beneficiaries.","sample":false}],"copy":{"reviewed":"2026-11-08","intro":"For North Carolina home care agencies licensed by the Division of Health Service Regulation (DHSR) to provide in-home aide services, often with companion, sitter and respite services. The manual has 50 policies and 65 forms, with the forms for clients in English and Spanish. It is written to 10A NCAC 13J, the home care licensure rules, and, where an agency provides personal care paid by NC Medicaid, to Clinical Coverage Policy 3L. Each policy opens with a plain-English summary and names the rule section it follows, and every one is filled in with your agency's name and details. You get Word and PDF files to keep, and your staff read and sign each policy on their phone.","rulesTitle":"What North Carolina's rules ask your policies to cover","rules":[{"head":"Supervisory visits.","text":"A visit to each in-home aide client's home every 90 days, with or without the aide there, and once a year while the aide is giving care.","cite":"10A NCAC 13J .1110(c)"},{"head":"Plan of care.","text":"Each client's plan of care is reviewed every 90 days by the health care practitioner.","cite":"10A NCAC 13J .1202(a)"},{"head":"Notice before services change.","text":"At least 48 hours' notice before services are reduced or ended, unless the client agrees, there is danger to the client or a staff member, or the physician ends services.","cite":"10A NCAC 13J .1101(7)"},{"head":"Complaints.","text":"The agency investigates complaints from a client or the client's family within 72 hours, and documents each complaint and how it was resolved.","cite":"G.S. 131E-144.6(b)"},{"head":"Allegations against staff.","text":"Every allegation against unlicensed staff, including an injury of unknown source, is reported to the Department within 24 hours of the agency becoming aware, with the investigation results within five working days.","cite":"10A NCAC 13O .0102; G.S. 131E-256(g)"},{"head":"Criminal history checks.","text":"A job that involves entering a client's home is offered on condition of a criminal history check, requested within five business days of the offer.","cite":"G.S. 131E-265(a)"}],"asks":[{"ref":"NC-HC-SUP-01","title":"Supervision of In-Home Aides, Supervisory Visits, and Nurse Availability","category":"Service delivery","q":"Show me the last four supervisory visits for this client. Were they every 90 days, and when was the aide present providing care?","path":"/policies/north-carolina/home-care/supervision-of-in-home-aides-supervisory-visits-and-nurse-availability/"},{"ref":"NC-HC-GRV-01","title":"Complaints and Grievances","category":"Client rights","q":"A family member complains to an aide on a Friday evening. What happens next?","path":"/policies/north-carolina/home-care/complaints-and-grievances/"},{"ref":"NC-HC-ANE-01","title":"Reporting Abuse, Neglect, and Exploitation of Adults and Children","category":"Safeguarding","q":"There is no statewide adult protective services hotline in North Carolina. How do your staff find the right county number?","path":"/policies/north-carolina/home-care/reporting-abuse-neglect-and-exploitation-of-adults-and-children/"},{"ref":"NC-HC-HR-05","title":"Orientation and In-Service Education","category":"Human resources","q":"How many in-service hours does your policy require, and show me this aide's hours for the last 12 months.","path":"/policies/north-carolina/home-care/orientation-and-in-service-education/"},{"ref":"NC-HC-EP-01","title":"Emergency Preparedness and Continuity of Services","category":"Emergency preparedness","q":"A hurricane warning is issued for your counties. Which clients do you contact first, and how do you know?","path":"/policies/north-carolina/home-care/emergency-preparedness-and-continuity-of-services/"}],"faq":[{"q":"Is this the right manual for my license?","a":"It is for North Carolina home care agencies that provide in-home aide services, with or without companion, sitter and respite services. It does not cover nursing or therapy. A Medicare-certified home health agency needs the North Carolina home health manual, and a licensed hospice needs the North Carolina hospice manual."},{"q":"Does it cover NC Medicaid personal care services?","a":"Yes. Where your agency provides personal care paid by NC Medicaid, the policies add the provider rules of NC Medicaid Clinical Coverage Policy 3L (amended January 1, 2026) and electronic visit verification."},{"q":"Where do staff report suspected abuse of an adult client?","a":"North Carolina has no statewide adult protective services hotline. A report about a disabled adult goes to the director of the county department of social services (G.S. 108A-102). Policy NC-HC-ANE-01 gives staff your county's number and the directory for clients in other counties."},{"q":"How often does DHSR inspect a home care agency?","a":"At least every three years (G.S. 131E-140(b)). When DHSR cites a deficiency, the agency files a plan of correction within 10 working days of receiving it (10A NCAC 13J .0904(f))."},{"q":"What do the 50 policies cover?","a":"Client rights (4), service delivery (10), clinical tasks (2), safeguarding (3), infection control (2), emergency preparedness (2), records (2), privacy (3), human resources (7), governance (5), quality (3), business (4) and ethics (3)."}]},"guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"},{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/infection-control-policy/","h1":"What should a home care infection control policy include?"},{"path":"/guides/staff-policy-acknowledgment/","h1":"Staff policy acknowledgment: how read-and-sign works in home care"},{"path":"/guides/how-to-write-policies-and-procedures/","h1":"How to write policies and procedures for a home care agency"},{"path":"/guides/how-often-review-policies/","h1":"How often should policies and procedures be reviewed and updated?"}]}