{"ref":"NC-HC-ANE-01","title":"Reporting Abuse, Neglect, and Exploitation of Adults and Children","category":"Safeguarding","own":false,"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.","inShort":["If anyone is in danger, call 911 first.","If you think a client is being abused, neglected or exploited, or cannot care for themselves alone, report it yourself to the county department of social services right away, and never later than the end of your shift.","Our home county number is (919) 555-0121. For other counties, use the county directory.","Tell your supervisor too, but telling your supervisor does not replace your report. No one may stop you from reporting.","If you suspect a child is being abused or neglected, report to county social services; if a child has been hurt by a crime, also call the police right away.","You are protected when you report in good faith. Write down what you saw and heard on the report form."],"primaryCitation":"G.S. 108A-102","citations":["G.S. 108A-101","G.S. 108A-102","G.S. 108A-103","G.S. 7B-301","G.S. 14-318.6","G.S. 131E-144.3(6)","NC Medicaid Clinical Coverage Policy 3L, §6.1.2(f)","NC Medicaid Clinical Coverage Policy 3L, §7.9(c)","10A NCAC 13O .0102"],"federalCitations":["45 CFR §164.512(a), (b)(1)(ii), (c)"],"surveyorAsks":["If an aide thinks a client's son is taking her money, what must the aide do, and to whom is the report made?","There is no statewide adult protective services hotline in North Carolina. How do your staff find the right county number?","Can a supervisor decide that a report is not needed?","What do staff do if they see signs that a child in the home is being abused?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"NC-HC-ANE-01-A","title":"Report of Suspected Abuse, Neglect, or Exploitation"}],"sections":[{"heading":"Terms of Reference","body":["This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1."],"table":{"caption":null,"headers":[["Item"],["Detail"]],"rows":[[["Issued by"],["The governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}]],[["Document owner"],[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}]],[["Authority"],["Adopted under G.S. 108A-102(a), which states: \"Any person having reasonable cause to believe that a disabled adult is in need of protective services shall report such information to the director.\", G.S. 7B-301(a), and G.S. 14-318.6(b), and under each client's right \"(6) To be free of mental and physical abuse, neglect, and exploitation.\" (G.S. 131E-144.3(6))"]],[["Applies to"],["Every employee, contract worker, volunteer and member of the governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". The duty to report rests on each person individually."]],[["Status"],["Mandatory. Adherence is a condition of employment and of any contract for services. No provision may be waived, shortened, or varied by any employee."]],[["Not covered here"],["Allegations that an Agency worker abused, neglected or exploited a client, misappropriated property, diverted drugs or committed fraud, which must also be reported to the Health Care Personnel Registry under Policy NC-HC-ANE-02. Incident reporting in general, which is Policy NC-HC-INC-01. Emergency care, which is Policy NC-HC-SAF-02."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months, and within 30 days of any amendment to a rule or statute cited at Section 13. Each review is recorded at Section 16 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body and the issue of a new version number. Superseded versions are retained for six years."]],[["Distribution"],["Master copy held in the policy manual at the Agency's licensed premises, ",{"k":"field","name":"agency.address","text":"100 Example Street, Suite 100, Raleigh, North Carolina 27601"},", available to every member of staff and to the Division of Health Service Regulation on request (10A NCAC 13J .1001(a))."]],[["Questions"],["Direct to the document owner on ",{"k":"field","name":"agency.phone","text":"(919) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["This policy establishes how ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," (the \"Agency\") protects clients, and children and adults in their homes, from abuse, neglect and exploitation by making sure every staff member recognizes the signs and makes the reports North Carolina law requires, promptly and to the right place. It implements G.S. 108A-101 to 108A-103, G.S. 7B-301, G.S. 14-318.6, G.S. 131E-144.3(6) and, for NC Medicaid personal care services, NC Medicaid Clinical Coverage Policy 3L, §6.1.2(f) and §7.9(c)."],"edited":false},{"heading":"2. Scope","body":["This policy applies to suspected abuse, neglect or exploitation of any client by anyone (family, caregivers, neighbors, strangers, other providers or Agency staff), to self-neglect, and to suspected abuse, neglect or dependency of any child that staff see or hear about in the course of their work."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy:"],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Disabled adult"],["\"any person 18 years of age or over or any lawfully emancipated minor who is present in the State of North Carolina and who is physically or mentally incapacitated due to an intellectual disability, cerebral palsy, epilepsy or autism; organic brain damage caused by advanced age or other physical degeneration in connection therewith; or due to conditions incurred at any age which are the result of accident, organic brain damage, mental or physical illness, or continued consumption or absorption of substances.\" (G.S. 108A-101(d)) Most adult clients of a home care agency may meet this definition; staff do not decide whether they do. The county decides."]],[["In need of protective services"],["A disabled adult is \"in need of protective services\" \"if that person, due to his physical or mental incapacity, is unable to perform or obtain for himself essential services and if that person is without able, responsible, and willing persons to perform or obtain for his essential services.\" (G.S. 108A-101(e))"]],[["Abuse"],["\"the willful infliction of physical pain, injury or mental anguish, unreasonable confinement, or the willful deprivation by a caretaker of services which are necessary to maintain mental and physical health.\" (G.S. 108A-101(a))"]],[["Neglect"],["\"refers to a disabled adult who is either living alone and not able to provide for himself or herself the services which are necessary to maintain the person's mental or physical health or is not receiving services from the person's caretaker.\" (G.S. 108A-101(m)) Neglect therefore includes self-neglect by a disabled adult who lives alone."]],[["Exploitation"],["\"the illegal or improper use of a disabled adult or his resources for another's profit or advantage.\" (G.S. 108A-101(j))"]],[["Caretaker"],["\"an individual who has the responsibility for the care of the disabled adult as a result of family relationship or who has assumed the responsibility for the care of the disabled adult voluntarily or by contract.\" (G.S. 108A-101(b)) An Agency worker can be a caretaker."]],[["Director"],["\"the director of the county department of social services in the county in which the person resides or is present, or his representative as authorized in G.S. 108A-14.\" (G.S. 108A-101(c))"]],[["Juvenile (child)"],["As defined in G.S. 7B-101. Staff treat any client or household member under 18 as a juvenile for the purposes of this policy and report under Section 7."]],[["Reasonable cause to believe; cause to suspect"],["What a reasonable person would believe or suspect from what the staff member has seen, heard or been told. Proof is not needed, and the staff member does not investigate first."]]]},"edited":false},{"heading":"4. Policy Statement (G.S. 108A-102)","body":["Every staff member who has reasonable cause to believe that a disabled adult is in need of protective services reports it to the director of the county department of social services where the adult lives or is present (G.S. 108A-102(a); G.S. 108A-101(c)). As the Agency's own standard, every staff member makes the report immediately, and never later than the end of the shift in which the staff member forms the belief, and reports any concern about any adult client even if the staff member is not sure the client is a \"disabled adult\".\n\nIf the client receives personal care services paid by NC Medicaid, the Agency ensures \"that all incidents involving alleged, suspected, or observed beneficiary abuse, neglect, or exploitation are documented and reported immediately to the county Department of Social Services and the DHSR in accordance to N.C. G.S. 108A-102.\" (NC Medicaid Clinical Coverage Policy 3L, §7.9(c))\n\nAny staff member who has cause to suspect that a juvenile is abused, neglected or dependent, or has died as the result of maltreatment, reports it to the director of the county department of social services where the juvenile resides or is found (G.S. 7B-301(a)), and any staff member 18 or older who knows or should reasonably know that a juvenile has been or is the victim of a violent offense, sexual offense or misdemeanor child abuse reports it immediately to the local law enforcement agency in the county where the juvenile resides or is found (G.S. 14-318.6(b)).\n\nNo supervisor, manager or member of the governing body may stop, delay or change a report, and no one is disciplined or treated worse for making a report in good faith."],"edited":false},{"heading":"5. Signs to Look For","body":["Staff report what they see and hear; they do not need to know who is responsible. Signs include:"],"table":{"caption":["Table 1. Possible signs of abuse, neglect and exploitation"],"headers":[["Type"],["Examples"]],"rows":[[["Physical abuse"],["Bruises, burns, cuts, fractures or marks that are unexplained or do not match the explanation; injuries in different stages of healing; grip marks; the client is afraid of a particular person; the client is kept from seeing staff alone."]],[["Emotional or verbal abuse"],["Shouting, threats, insults, humiliation or isolation; the client is withdrawn, fearful, or agitated around a particular person."]],[["Sexual abuse"],["Unexplained genital injury, infection or bleeding; torn or stained underclothing; the client says something happened or is afraid of being touched."]],[["Unreasonable confinement"],["The client is locked in, tied, or kept in a room or bed without a care reason."]],[["Neglect by a caretaker"],["No food, heat, cooling, water or needed medicines; untreated sores or injuries; unsafe or filthy conditions; the client is left alone when the plan of care says someone must be present; needed glasses, hearing aids, dentures or walking aids withheld."]],[["Self-neglect"],["A client who lives alone and cannot provide for basic needs: not eating, not taking needed medicines, unsafe home, unpaid utilities shut off, refusing all help while in danger."]],[["Exploitation"],["Missing money, cards, checks or valuables; unpaid bills while someone else controls the money; sudden changes to a will, deed, bank account or power of attorney; a new \"friend\" taking over the client's finances; the client signing papers the client does not understand."]],[["Child abuse, neglect or dependency"],["Injuries a child cannot explain; a child left without supervision or food; a child who says someone is hurting them; a child exposed to violence in the home."]]]},"edited":false},{"heading":"6. Reporting Abuse, Neglect or Exploitation of an Adult","body":[],"list":[["If anyone is in immediate danger, call 911 first. Stay with the client if it is safe to do so."],["Report to the county department of social services in the county where the client lives or is present: ",{"k":"field","name":"fixed.abuseReportRoute","text":"the director of the department of social services in the county where the adult lives or is present (G.S. 108A-101(c), 108A-102), orally (by telephone or in person) or in writing; county department of social services contacts are listed at https://www.ncdhhs.gov/divisions/social-services/local-dss-directory, and the NCDHHS Customer Service Center (1-800-662-7030) can help find the right county office. If anyone is in immediate danger, call 911 first."}," The county where the Agency's office is located can be reached at ",{"k":"field","name":"agency.localProtectiveServicesPhone","text":"(919) 555-0121"},"; for a client in another county, use the county directory at ",{"k":"field","name":"fixed.localDssDirectory","text":"https://www.ncdhhs.gov/divisions/social-services/local-dss-directory"},". Reports may be made by telephone or in person (orally) or in writing (G.S. 108A-102(b)); after hours, the county department's after-hours number or 911 is used."],["Give the information G.S. 108A-102(b) lists, as far as you know it: the name and address of the disabled adult; the name and address of the disabled adult's caretaker; the age of the disabled adult; the nature and extent of the disabled adult's injury or condition resulting from abuse or neglect; and other pertinent information. Write down the name of the person you spoke to, the date and the time."],["Tell your supervisor or the on-call supervisor as soon as you have made the report, or at the same time if the supervisor is with you. If you cannot reach the county yourself, the supervisor helps you, but you remain responsible for making sure the report is made. Telling your supervisor does not replace the report."],["Complete the Report of Suspected Abuse, Neglect, or Exploitation (Form NC-HC-ANE-01-A) before the end of the shift and give it to the supervisor. Write facts: what you saw and heard, the client's own words, the date and time."],["If the client receives NC Medicaid personal care services, the Agency Director makes sure the DHSR is also told immediately (3L §7.9(c)), through the DHSR Complaint Intake Unit, ",{"k":"field","name":"fixed.complaintHotline","text":"1-800-624-3004 (within North Carolina) or 919-855-4500"},", and records the date, time and person spoken to."],["If the person suspected is an Agency worker, or the event is an injury of unknown source, the Agency Director also makes the Health Care Personnel Registry report within 24 hours under Policy NC-HC-ANE-02."],["If a crime may have been committed (for example assault, sexual assault or theft), the Agency Director also reports it to local law enforcement, unless the staff member has already done so."]],"ordered":true,"edited":false},{"heading":"7. Reporting Abuse, Neglect or Dependency of a Child","body":[],"list":[["If a child is in immediate danger, call 911."],["Report to the director of the department of social services in the county where the child resides or is found (G.S. 7B-301(a)): ",{"k":"field","name":"fixed.childAbuseReportRoute","text":"the director of the department of social services in the county where the child lives or is found (G.S. 7B-301), orally, by telephone or in writing; and, when a child has been the victim of a violent offense, a sexual offense or misdemeanor child abuse, the local law enforcement agency in that county, immediately (G.S. 14-318.6)"},". The report may be made orally, by telephone or in writing. Include, as known: the name and address of the child; the name and address of the parent, guardian or caretaker; the child's age; the names and ages of other children in the home; where the child is now if not at home; the nature and extent of any injury or condition; and anything else that might help. If you report by telephone, give your name, address and telephone number (G.S. 7B-301(a))."],["If you know or should reasonably know that the child has been or is the victim of a violent offense, sexual offense or misdemeanor child abuse, also report immediately to the local law enforcement agency in the county where the child resides or is found, giving the information G.S. 14-318.6(b) lists and your name, address and telephone number. This duty is in addition to the report to social services (G.S. 14-318.6(d))."],["Tell your supervisor and complete Form NC-HC-ANE-01-A before the end of the shift."],["Knowingly or wantonly failing to report under G.S. 7B-301, or knowingly or wantonly preventing another person from reporting, is a Class 1 misdemeanor (G.S. 7B-301(b)); knowingly or willfully failing to report under G.S. 14-318.6, or preventing another person from reporting, is also a Class 1 misdemeanor (G.S. 14-318.6(c))."]],"ordered":true,"edited":false},{"heading":"8. Protection for Reporters","body":[],"list":[["Anyone who makes a report under G.S. 108A-102, testifies in a judicial proceeding arising from the report, or participates in a required evaluation is immune from civil or criminal liability on account of the report, testimony or participation, unless the person acted in bad faith or with a malicious purpose (G.S. 108A-102(c))."],["A person who makes a report in good faith under G.S. 14-318.6, cooperates with law enforcement in an investigation, or testifies in a resulting proceeding is immune from civil or criminal liability, provided the person was acting in good faith (G.S. 14-318.6(f))."],["The Agency does not retaliate against any staff member, client or family member for making or helping with a report."],["Reports required by law are disclosures the HIPAA Privacy Rule permits (45 CFR §164.512(a), (b)(1)(ii), (c)). When the Agency reports abuse, neglect or exploitation of an adult, the privacy official makes sure the client is told promptly that a report was made, unless telling the client would place the client at risk of serious harm or the person who would be told is believed to be responsible (45 CFR §164.512(c)(2); Policy NC-HC-PRV-01)."]],"ordered":false,"edited":false},{"heading":"9. Protecting the Client and Cooperating with the County","body":[],"list":[["The supervisor makes sure the client is safe while the report is handled: for example, by keeping services in place, adding visits, changing the worker assigned, or helping the client reach family or other help. Staff do not confront the suspected person."],["Staff do not investigate the allegation themselves, interview the client in detail, or ask leading questions. They preserve anything that may be evidence and do not clean up or throw anything away."],["The county director must make a prompt and thorough evaluation, which includes a visit to the person, and may review and copy records related to the care and treatment of the disabled adult kept by any agency acting as a caretaker (G.S. 108A-103(a)). Private agencies \"shall cooperate fully with the director in the performance of his duties\" (G.S. 108A-103(b)). The Agency Director arranges access to records and staff and logs the disclosure (Policy NC-HC-PRV-01)."],["For information: the director must start the evaluation immediately if the report alleges a danger of death in an emergency, within 24 hours if it alleges danger of irreparable harm in an emergency, and within 72 hours otherwise, and complete it within 30 days for abuse or neglect and 45 days for exploitation (G.S. 108A-103(d)). These are the county's time limits; they do not change the Agency's duty to report at once."],["The registered nurse supervisor reviews the plan of care and the services after any report and records the changes made."]],"ordered":false,"edited":false},{"heading":"10. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[["Governing body"],["Makes sure this policy is followed, that no report is ever blocked, and receives a summary of reports at each meeting."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Owns this policy. Makes sure every report is made and documented, makes the DHSR report for PCS beneficiaries and the Health Care Personnel Registry report when required, reports crimes to law enforcement, and arranges cooperation with the county."]],[[{"k":"field","name":"people.alternate.name","text":"Jo Sample"},", ",{"k":"field","name":"people.alternate.title","text":"Alternate Administrator"}],["Acts for the Agency Director under this policy when the Agency Director is unavailable."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"},"; ",{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"},", ",{"k":"field","name":"people.alternateSupervisingNurse.title","text":"Alternate Supervising Nurse"},"; the companion and sitter supervisor designated on Form NC-HC-GOV-02-A"],["Help staff make reports at once, protect the client, review the plan of care, and complete supervisor sections of Form NC-HC-ANE-01-A."]],[[{"k":"field","name":"people.privacyOfficial.name","text":"Lee Sample"},", ",{"k":"field","name":"people.privacyOfficial.title","text":"HIPAA privacy official"}],["Makes sure the client is told of an adult protective services report where 45 CFR §164.512(c)(2) requires, and logs disclosures."]],[["Every staff member"],["Recognizes the signs, calls 911 when anyone is in danger, makes the report personally and immediately (never later than the end of the shift), tells the supervisor, and completes Form NC-HC-ANE-01-A."]]]},"edited":false},{"heading":"11. Records and Compliance Monitoring","body":["Each Form NC-HC-ANE-01-A, with the date and time of each report, the agency and person told, the supervisor's actions and the outcome when known, is kept in a confidential safeguarding file at the licensed premises for six years, as the Agency's own standard. The client record contains the facts observed and the care given, but not the report form. The disclosure is entered in the disclosure log (Policy NC-HC-PRV-01).\n\nEach quarter, as the Agency's own standard, the Agency Director reviews all reports for timeliness and follow-up and checks incident reports, complaints and supervisory visit notes for concerns that should have been reported but were not. Findings go to the annual program evaluation (Policy NC-HC-QA-01)."],"edited":false},{"heading":"12. Staff Training","body":["Every staff member is trained before first client contact (Policy NC-HC-HR-05) and at least every 12 months on the definitions, the signs in Table 1, the reporting steps in Sections 6 and 7, how to find the right county number, the PCS rule, and protection for reporters. For aides serving NC Medicaid PCS beneficiaries, training in \"Recognizing and reporting signs of abuse and neglect\" is documented in the personnel record (NC Medicaid Clinical Coverage Policy 3L, §6.1.2(f)). Each staff member keeps the county reporting numbers in the phone used for work."],"edited":false},{"heading":"13. References","body":["This policy implements the following authorities."],"list":[["G.S. 108A-101, Definitions; G.S. 108A-102, Duty to report; G.S. 108A-103, Duty of director upon receiving report"],["G.S. 7B-301, Duty to report abuse, neglect, dependency, or death due to maltreatment"],["G.S. 14-318.6, Failure to report crimes against juveniles"],["G.S. 131E-144.3(6), client rights"],["NC Medicaid Clinical Coverage Policy 3L, §6.1.2(f) and §7.9(c)"],["10A NCAC 13O .0102 (allegations against health care personnel)"],["45 CFR §164.512(a), (b)(1)(ii), (c)"]],"ordered":false,"edited":false},{"heading":"14. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Form NC-HC-ANE-01-A"],["Report of Suspected Abuse, Neglect, or Exploitation"]],[["Policy NC-HC-ANE-02"],["Allegations Against Staff and Health Care Personnel Registry Reporting"]],[["Policy NC-HC-INC-01"],["Incidents, Accidents, and Unusual Occurrences"]],[["Policy NC-HC-SAF-02"],["Management of Emergency Care Situations in the Home"]],[["Policy NC-HC-PRV-01"],["Confidentiality and HIPAA Privacy"]],[["Policy NC-HC-GRV-01"],["Complaints and Grievances"]],[["Policy NC-HC-ETH-01"],["Code of Conduct, Professional Boundaries, and Client Property"]],[["Policy NC-HC-HR-05"],["Orientation and In-Service Education"]],[["Policy NC-HC-BUS-03"],["NC Medicaid Personal Care Services and Other Public Programs"]],[["Policy NC-HC-QA-01"],["Annual Program Evaluation and Quality Improvement"]]]},"edited":false},{"heading":"15. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below."],"edited":false},{"heading":"16. Revision History","body":["Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule or statute cited in Section 13 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"nc-hca","state":"North Carolina","service":"Home care","guides":[{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}