{"ref":"NC-HC-CR-01","title":"Home Care Clients' Bill of Rights, Client Responsibilities, and Required Notices","category":"Client rights","own":false,"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.","inShort":["Every client gets the rights and the admission packet before services start.","The supervisor explains the packet and the client signs the receipt. Aides do not explain it.","Respect each right in your daily work: privacy, dignity and the right to refuse.","Pass every complaint to Pat Sample the same day.","Never treat a client worse for complaining or for calling the State hotline."],"primaryCitation":"G.S. 131E-144.3","citations":["G.S. 131E-144.3","G.S. 131E-144.4","G.S. 131E-144.5","G.S. 131E-141(b), (c)","G.S. 131E-144.6(b)","G.S. 131E-143(a)","10A NCAC 13J .1007","10A NCAC 13J .1402(a)(1)(B)","10A NCAC 13J .1110(g)","10A NCAC 13J .1504(6)","NC Medicaid Clinical Coverage Policy 3L, §7.9(a), (b)"],"federalCitations":["45 CFR §164.520"],"surveyorAsks":["Show me the signed receipt for the declaration of rights and the contact information in this client's record. On what date was it given, and was that before the first service?","Where and when does a client receive the Division of Health Service Regulation hotline number?","How do you tell clients that they may object in writing to the Department reviewing their records?","What are your client responsibilities, and how do you explain them to a client who does not read English?","Who is responsible for implementing the bill of rights, and how are staff trained on it?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"NC-HC-CR-01-A","title":"Declaration of Home Care Clients' Rights and Client Responsibilities"},{"ref":"NC-HC-CR-01-B","title":"Receipt of Rights, Responsibilities, and Contact Information"}],"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. 131E-144.3 to 131E-144.5 (Home Care Clients' Bill of Rights) and 10A NCAC 13J .1007, which require that \"An agency shall provide each client with a written notice of the client's rights and responsibilities in advance of furnishing care to the client or during the initial evaluation visit before the initiation of services.\""]],[["Applies to"],["Every client of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," and the client's responsible party; the Agency Director; the registered nurse supervisors and the companion and sitter supervisor who admit clients; office staff; and every in-home aide, companion, sitter and respite worker, contractor and volunteer who has contact with clients."]],[["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"],["Responsible parties, consent and advance directives, which are Policy NC-HC-CR-03. Language access and nondiscrimination, which are Policy NC-HC-CR-02. How complaints are investigated, which is Policy NC-HC-GRV-01. Reporting abuse, neglect and exploitation, which is Policy NC-HC-ANE-01. Notice to clients of a change in the license, which is Policy NC-HC-GOV-03."]],[["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 16. Each review is recorded at Section 19 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\") tells each client about the rights North Carolina law gives home care clients and about the client's responsibilities, gives the notices the law requires before services start, keeps proof that each client was informed, and makes sure staff respect those rights in their daily work. It implements G.S. 131E-144.3, 131E-144.4 and 131E-144.5, G.S. 131E-141(b) and (c), and 10A NCAC 13J .1007."],"edited":false},{"heading":"2. Scope","body":["This policy applies to every client of the Agency, whatever services the client receives (in-home aide, companion, sitter or respite services) and whoever pays for them, and to every member of staff, contractor and volunteer who has contact with clients. It applies at admission and readmission, whenever the declaration of rights or a required notice changes, and for as long as the client receives services."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy:"],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Client"],["\"Home care client\" means \"an individual who receives home care services\" (G.S. 131E-136(2b), adopted by 10A NCAC 13J .0901(4)). NC Medicaid Clinical Coverage Policy 3L calls a client whose personal care services are paid by NC Medicaid a \"beneficiary\"; the two words mean the same person in this manual."]],[["Responsible party"],["The person who acts for the client when the client cannot act alone or chooses to have help, such as a guardian, a health care agent, or a family member the client names. The rules use the term in 10A NCAC 13J .1101(7) and .1107(a). Who may act, and for what, is set out in Policy NC-HC-CR-03."]],[["Declaration of rights"],["The fifteen rights listed in G.S. 131E-144.3, reproduced word for word on Form NC-HC-CR-01-A."]],[["Client responsibilities"],["The Agency's policies \"regarding client responsibilities as it relates to safety and care plan compliance\" (G.S. 131E-144.4(a)(2)), set out in Section 7 and on Form NC-HC-CR-01-A."]],[["Initial evaluation visit"],["The first home visit, before services start, at which the registered nurse supervisor (in-home aide services) or the companion and sitter supervisor (companion, sitter or respite services only) assesses the client and admits the client (Policy NC-HC-ADM-02)."]],[["Admission packet"],["The documents listed in Table 2, given to each client at or before the initial evaluation visit."]],[["DHSR"],[{"k":"field","name":"fixed.licensingAgency","text":"North Carolina Department of Health and Human Services, Division of Health Service Regulation, Acute and Home Care Licensure and Certification Section"},", the section of the Department of Health and Human Services responsible for enforcing the home care licensure law and the Home Care Clients' Bill of Rights."]]]},"edited":false},{"heading":"4. Policy Statement (G.S. 131E-144.3)","body":["Each client of the Agency has the rights listed in G.S. 131E-144.3. In advance of furnishing care, or during the initial evaluation visit before services start, the Agency gives each client a written notice of the client's rights and responsibilities and keeps documentation showing that the client has been informed of them. (10A NCAC 13J .1007(a)) At the same visit it gives the items G.S. 131E-144.4(a) requires, the written notice of the Division of Health Service Regulation hotline number (G.S. 131E-141(c)), and the written advice that the client may object to review or release of the client's records (G.S. 131E-141(b)). The client signs a receipt, which is kept in the client record. (G.S. 131E-144.4(b); 10A NCAC 13J .1402(a)(1)(B))\n\nResponsibility for implementing the Home Care Clients' Bill of Rights rests with the Agency Director, ",{"k":"field","name":"people.administrator.name","text":"Pat Sample"},". The Agency provides appropriate training to implement it. (G.S. 131E-144.5)"],"edited":false},{"heading":"5. The Declaration of Home Care Clients' Rights","body":["G.S. 131E-144.3 provides: \"Each client of a home care agency shall have the following rights:\" Each right is set out below word for word, with the way the Agency meets it."],"table":{"caption":["Table 1.  The fifteen rights and how the Agency meets them"],"headers":[["Right (G.S. 131E-144.3)"],["How the Agency meets it"]],"rows":[[["(1) \"To be informed and participate in his or her plan of care.\""],["The plan of care is established in collaboration with the client, signed by the client or responsible party, and a copy is kept in the home. The client is told in advance of any change. (10A NCAC 13J .1107(a), .1202(a); Policy NC-HC-POC-01)"]],[["(2) \"To be treated with respect, consideration, dignity, and full recognition of his or her individuality and right to privacy.\""],["Staff follow the code of conduct (Policy NC-HC-ETH-01): they use the name the client prefers, knock and wait before entering a room, keep the client covered during personal care, and respect the client's home, routines, culture and beliefs. Services are provided without discrimination (Policy NC-HC-CR-02)."]],[["(3) \"To receive care and services that are adequate, appropriate, and in compliance with relevant federal and State laws and rules and regulations.\""],["Services follow the plan of care and are given only by staff who are qualified and have shown competency for each assigned task, under supervision. (Policies NC-HC-HR-01, NC-HC-CMP-01, NC-HC-SUP-01, NC-HC-SUP-02)"]],[["(4) \"To voice grievances about care and not be subjected to discrimination or reprisal for doing so.\""],["The Agency investigates, within 72 hours, complaints made by a client or the client's family and documents the complaint and its resolution (G.S. 131E-144.6(b); Policy NC-HC-GRV-01). No one is treated worse for complaining."]],[["(5) \"To have his or her personal and medical records kept confidential and not be disclosed except as permitted or required by applicable State or federal law.\""],["Client information is protected under Policy NC-HC-PRV-01. The client is told in writing of the right to object to review of the client's records (Section 9)."]],[["(6) \"To be free of mental and physical abuse, neglect, and exploitation.\""],["Staff never abuse, neglect or exploit a client, and report any suspicion at once (Policies NC-HC-ANE-01 and NC-HC-ANE-02). Gifts, loans and use of client property are prohibited (Policy NC-HC-ETH-01)."]],[["(7) \"To receive a written statement of services provided by the agency and the charges the client is liable for paying.\""],["Form NC-HC-BUS-01-A is given and explained before services start (Policy NC-HC-BUS-01)."]],[["(8) \"To be informed of the process for acceptance and continuance of service and eligibility determination.\""],["The supervisor explains how the Agency decides to accept a client and to continue services, and, for clients whose services are paid by NC Medicaid or another program, that the program decides eligibility and hours (Policies NC-HC-ADM-01 and NC-HC-BUS-03)."]],[["(9) \"To accept or refuse services.\""],["The client consents to the plan of care and may refuse any service or task. A refusal is respected, recorded and reported to the supervisor (Policy NC-HC-CR-03)."]],[["(10) \"To be informed of the agency's on-call service.\""],["The client is told the office hours (",{"k":"field","name":"agency.officeHours","text":"Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern"},"), the after-hours number (",{"k":"field","name":"agency.afterHoursPhone","text":"(919) 555-0199"},"), who answers it, and what help is available outside office hours."]],[["(11) \"To be informed of supervisory accessibility and availability.\""],["The client is given the name and telephone number of the registered nurse supervisor, ",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"}," (",{"k":"field","name":"people.supervisingNurse.phone","text":"(919) 555-0113"},"), or of the companion and sitter supervisor, and is told that a supervisor is available during all hours services are provided (10A NCAC 13J .1110(g), .1504(6)). The client is told when the supervisor changes."]],[["(12) \"To be advised of the agency's procedures for discharge.\""],["The discharge procedure, including the 48 hours' advance notice of a reduction or termination of services, is summarized on Form NC-HC-CR-01-A (Policy NC-HC-DC-01)."]],[["(13) \"To receive a reasonable response to his or her requests of the agency.\""],["As the Agency's own standard, office staff acknowledge a client's request by the end of the next business day and tell the client the outcome, or when to expect it."]],[["(14) \"To be notified within 10 days when the agency's license has been revoked, suspended, canceled, annulled, withdrawn, recalled, or amended.\""],["The Agency notifies clients under Policy NC-HC-GOV-03, using Form NC-HC-GOV-03-B."]],[["(15) \"To be advised of the agency's policies regarding patient responsibilities.\""],["The client responsibilities in Section 7 are given and explained at admission on Form NC-HC-CR-01-A."]]]},"edited":false},{"heading":"6. The Admission Packet","body":["The admission packet contains the documents in Table 2. The items required by G.S. 131E-144.4(a) and G.S. 131E-141(b) and (c) are combined on Forms NC-HC-CR-01-A and NC-HC-CR-01-B so that nothing is missed."],"table":{"caption":["Table 2.  Contents of the admission packet"],"headers":[["Document"],["Where it is"],["Required by"]],"rows":[[["The declaration of home care clients' rights"],["Form NC-HC-CR-01-A"],["G.S. 131E-144.4(a)(1); 10A NCAC 13J .1007(a)"]],[["The Agency's policies on client responsibilities as they relate to safety and care plan compliance"],["Form NC-HC-CR-01-A"],["G.S. 131E-144.4(a)(2)"]],[["The address and telephone number for information, questions or complaints about the Agency's services: ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},", ",{"k":"field","name":"agency.address","text":"100 Example Street, Suite 100, Raleigh, North Carolina 27601"},", ",{"k":"field","name":"agency.phone","text":"(919) 555-0100"},"; complaints to ",{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.phone","text":"(919) 555-0111"}],["Forms NC-HC-CR-01-A and NC-HC-CR-01-B"],["G.S. 131E-144.4(a)(3)"]],[["The address and telephone number of the DHSR section responsible for enforcement: ",{"k":"field","name":"fixed.licensingAgency","text":"North Carolina Department of Health and Human Services, Division of Health Service Regulation, Acute and Home Care Licensure and Certification Section"},", ",{"k":"field","name":"fixed.licensingAgencyAddress","text":"2712 Mail Service Center, Raleigh, NC 27699-2712"},", ",{"k":"field","name":"fixed.licensingAgencyPhone","text":"(919) 855-4620"}],["Forms NC-HC-CR-01-A and NC-HC-CR-01-B"],["G.S. 131E-144.4(a)(4)"]],[["The DHSR hotline number: ",{"k":"field","name":"fixed.complaintHotline","text":"1-800-624-3004 (within North Carolina) or 919-855-4500"},", ",{"k":"field","name":"fixed.complaintHours","text":"9:00 a.m. to 12:00 p.m. and 1:00 p.m. to 4:00 p.m., weekdays, except holidays"}],["Forms NC-HC-CR-01-A and NC-HC-CR-01-B"],["G.S. 131E-141(c)"]],[["Written advice of the right to object to review or release of the client's records"],["Form NC-HC-CR-01-B"],["G.S. 131E-141(b)"]],[["Statement of services and charges"],["Form NC-HC-BUS-01-A"],["G.S. 131E-144.3(7)"]],[["Client service agreement"],["Form NC-HC-ADM-02-B"],["Agency's own standard (Policy NC-HC-ADM-02)"]],[["Notice that staff may not smoke in the client's home"],["Form NC-HC-ETH-02-A"],["G.S. 131E-143(a)"]],[["Notice of nondiscrimination and language assistance"],["Form NC-HC-CR-02-A"],["45 CFR §§92.10, 92.11 (Policy NC-HC-CR-02)"]],[["Responsible party and advance directive information"],["Form NC-HC-CR-03-A"],["Agency's own standard (Policy NC-HC-CR-03)"]],[["Notice of privacy practices"],["Form NC-HC-PRV-01-A"],["45 CFR §164.520 (Policy NC-HC-PRV-01)"]],[["Electronic visit verification notice (NC Medicaid personal care beneficiaries)"],["Form NC-HC-BUS-02-A"],["NC Medicaid Clinical Coverage Policy 3L, §7.4 (Policy NC-HC-BUS-02)"]],[["The plan of care, once signed (a copy stays in the home)"],["Form NC-HC-POC-01-A"],["10A NCAC 13J .1107(a) (Policy NC-HC-POC-01)"]]]},"edited":false},{"heading":"7. Client Responsibilities","body":["These are the Agency's policies regarding client responsibilities \"as it relates to safety and care plan compliance\" (G.S. 131E-144.4(a)(2)). They are explained at admission and printed on Form NC-HC-CR-01-A. They do not take away any right in Section 5. If a client cannot meet one, the supervisor works with the client and the responsible party to find a solution before any change to services is considered (Policy NC-HC-DC-01). The client is asked to:"],"list":[["Give the Agency accurate and complete information about the client's health, medicines, needs and wishes, and tell the Agency about changes, including a fall, a new diagnosis, a hospital stay or a move."],["Take part in developing the plan of care, follow it as far as the client is able, and tell the Agency if the client does not want, or cannot follow, any part of it."],["Not ask staff to do tasks that are not on the plan of care, such as giving medicines, handling bank accounts, or caring for other members of the household."],["Keep the home reasonably safe for the client and for staff while staff are there: pets secured during visits, walkways clear, weapons stored out of sight, and no threats, harassment or violence toward staff by anyone in the home."],["Be at home for scheduled visits, or tell the Agency as early as possible if a visit must be canceled or changed. As the Agency's own standard, the Agency asks for at least 24 hours' notice when the client can give it."],["Treat staff with respect, without harassment or discrimination."],["Tell the Agency about any problem or complaint so that it can be put right. The client will not be treated worse for doing so."],["Check and sign the service record, or confirm the visit in the electronic visit verification system, only for services the client actually received (Policy NC-HC-REC-02)."],["Not offer staff gifts, money, loans or other favors, because staff may not accept them (Policy NC-HC-ETH-01)."],["Pay the charges the client is liable for paying, as set out in the statement of services and charges (Policy NC-HC-BUS-01)."],["Tell the Agency who the client's responsible party is and whether the client has an advance directive, a portable do-not-resuscitate order or a MOST form (Policy NC-HC-CR-03)."]],"ordered":false,"edited":false},{"heading":"8. Giving the Rights and Notices","body":[],"list":[["The registered nurse supervisor (for in-home aide services) or the companion and sitter supervisor (for companion, sitter or respite services only) gives and explains the admission packet at the initial evaluation visit. This is never left to an aide or companion to explain."],["The packet is given in advance of furnishing care or during the initial evaluation visit, before services start. (10A NCAC 13J .1007(a); G.S. 131E-144.4(a); G.S. 131E-141(c)) No service is provided before the packet has been given, including when services must start urgently."],["The supervisor explains each right and responsibility in plain language, reads the documents aloud when that helps, and checks understanding by asking the client to say in the client's own words what the client will do if the client has a complaint. A client with limited English proficiency is given the Spanish forms or a qualified interpreter, and a client with a disability is given the aids the client needs, free of charge (Policy NC-HC-CR-02)."],["The client signs Form NC-HC-CR-01-B, the receipt for the declaration of rights and the contact information. (G.S. 131E-144.4(b)) If the client cannot write, the client may make a mark, witnessed by a second person. If a guardian or other responsible party acts for the client because the client lacks capacity or is a minor, the responsible party signs and the supervisor records who signed and why. If the client refuses to sign, the supervisor records on the form the date the packet was delivered and the refusal, and signs it; the rule accepts \"documentation of its delivery\" (10A NCAC 13J .1402(a)(1)(B))."],["The client keeps the packet in the home folder. The signed receipt is filed in the client record before the first scheduled service."],["If the responsible party was not present, the supervisor gives or mails a copy of the packet to the responsible party within two business days, as the Agency's own standard, and records the date on Form NC-HC-CR-01-B."],["Office staff do not release the first visit on the schedule until the signed receipt (or the documentation of delivery) and the signed plan of care are in the client record (Policies NC-HC-ADM-02 and NC-HC-SCH-01)."]],"ordered":true,"edited":false},{"heading":"9. Right to Object to Review of Records, and the DHSR Hotline","body":["G.S. 131E-141(b) allows the Department to review client records during inspections, but requires: \"Prior to releasing any information or allowing any inspections referred to in this section, the client must be advised in writing by the licensed agency that the client has the right to object in writing to release of information or review of the client's records and that by an objection in writing the client may prohibit the inspection or release of the records.\" G.S. 131E-141(c) requires: \"An agency must provide each client with a written notice of the Division of Health Service Regulation hotline number in advance of furnishing care to the client or during the initial evaluation visit before the initiation of services.\""],"list":[["Both notices are printed on Form NC-HC-CR-01-B, which the client signs at admission, and the hotline number is also on Form NC-HC-CR-01-A, which stays in the home."],["If the client objects in writing, the objection is placed at the front of the client record, the client is flagged on the client list, and the objection is honored at every survey until the client withdraws it in writing (Policy NC-HC-GOV-05)."],["Staff never discourage a client from objecting or from calling the hotline, and never ask a client what the client told the Division of Health Service Regulation."]],"ordered":false,"edited":false},{"heading":"10. Keeping Clients Informed During Services","body":[],"list":[["If the declaration of rights, the client responsibilities, the Agency's contact information, or the DHSR address or hotline number changes, each current client receives the updated form. As the Agency's own standard, this is done within 30 days of the change, and the supervisor reviews the change with the client at the next supervisory visit or contact."],["Any client or responsible party may ask for another copy of the packet at any time, and receives it."],["When a new responsible party begins to act for a client, that person receives the packet and signs a new Form NC-HC-CR-01-B."],["When a supervisor changes, clients are told how to reach the new supervisor (G.S. 131E-144.3(11); Policy NC-HC-GOV-02)."],["If the Agency's license is revoked, suspended, canceled, annulled, withdrawn, recalled or amended, clients are notified within 10 days under Policy NC-HC-GOV-03."],["A client who is discharged and later readmitted receives a new packet and signs a new receipt."]],"ordered":false,"edited":false},{"heading":"11. Upholding Rights in Daily Work","body":[],"list":[["Every member of staff treats each client in line with the rights in Section 5. A staff member who sees or hears that a right is not being honored tells the supervisor the same day."],["A complaint made to any staff member, in any form, is passed to ",{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"}," the same day and handled under Policy NC-HC-GRV-01, so that the investigation begins within 72 hours (G.S. 131E-144.6(b))."],["A suspicion of abuse, neglect or exploitation is reported at once under Policy NC-HC-ANE-01."],["No staff member retaliates against, threatens, or reduces the services of a client or family member because the client complained, objected to a record review, called the DHSR hotline, or refused a service."],["Staff do not ask a client to sign anything the client has not had explained, and never ask a client to sign a blank or incomplete form."]],"ordered":false,"edited":false},{"heading":"12. Clients Whose Services Are Paid by NC Medicaid","body":[],"list":[["If the Agency provides personal care services paid by NC Medicaid, it must \"implement and demonstrate compliance with all beneficiary rights and responsibilities, as specified in 10A NCAC 13J\" (NC Medicaid Clinical Coverage Policy 3L, §7.9(a)). The same packet, receipt and procedures in this policy apply to every beneficiary."],["The Agency keeps a comprehensive record of beneficiary complaints about personal care services (3L §7.9(b); Policy NC-HC-GRV-01)."],["Each beneficiary is told in writing about electronic visit verification, and the notice is kept in the beneficiary's file (Form NC-HC-BUS-02-A; Policy NC-HC-BUS-02)."]],"ordered":false,"edited":false},{"heading":"13. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Owns this policy and, as Agency Director, is responsible for implementing the Home Care Clients' Bill of Rights (G.S. 131E-144.5). Keeps Forms NC-HC-CR-01-A and NC-HC-CR-01-B current and arranges staff training."]],[[{"k":"field","name":"people.alternate.name","text":"Jo Sample"},", ",{"k":"field","name":"people.alternate.title","text":"Alternate Administrator"}],["Carries out every duty of the Agency Director under this policy whenever the Agency Director is unavailable."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"},", and ",{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"}],["Give and explain the admission packet to in-home aide clients at the initial evaluation visit, obtain the signed receipt, and review changes with clients at supervisory visits."]],[["Companion and sitter supervisor (named on Form NC-HC-GOV-02-A)"],["Does the same for clients who receive only companion, sitter or respite services."]],[[{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.title","text":"Administrator"}],["Receives complaints and makes sure investigation begins within 72 hours (Policy NC-HC-GRV-01)."]],[["Office staff"],["Check that the signed receipt is in the record before the first visit is scheduled, send copies to responsible parties, and send updated forms to current clients."]],[["In-home aides, companions, sitters and respite workers"],["Respect every right, pass on complaints and requests the same day, and report concerns about abuse, neglect or exploitation at once."]]]},"edited":false},{"heading":"14. Records and Compliance Monitoring","body":["The signed Form NC-HC-CR-01-B (or the documentation of delivery), any written objection to record review, and the dates updated forms were given are kept in the client record (10A NCAC 13J .1402(a)(1)(B)) and retained with it under Policy NC-HC-REC-01. The current and superseded versions of Forms NC-HC-CR-01-A and NC-HC-CR-01-B are kept with the policy manual. During the client record review every 90 days (Policy NC-HC-QA-02), the reviewer checks that each sampled record contains a signed receipt dated on or before the first service date and, where the forms changed, evidence that the updated form was given. Any missing receipt is corrected at once and reported in the annual program evaluation (Policy NC-HC-QA-01)."],"edited":false},{"heading":"15. Staff Training","body":["Every member of staff is trained on the Home Care Clients' Bill of Rights, the client responsibilities and this policy during orientation, before first contact with clients, and again each year as part of in-service education (G.S. 131E-144.5; Policy NC-HC-HR-05). Supervisors who admit clients are also trained to explain the admission packet in plain language, to use interpreters, and to complete Form NC-HC-CR-01-B correctly. Training is recorded on Forms NC-HC-HR-05-A and NC-HC-HR-05-B."],"edited":false},{"heading":"16. References","body":["This policy implements the following authorities."],"list":[["G.S. 131E-144.1 to 131E-144.7, Home Care Clients' Bill of Rights, in particular G.S. 131E-144.3, 131E-144.4, 131E-144.5 and 131E-144.6(b)"],["G.S. 131E-141(b), (c), Inspections and confidentiality; notice of the hotline number"],["G.S. 131E-143(a), Smoking prohibited"],["10A NCAC 13J .1007, Client rights and responsibilities"],["10A NCAC 13J .1402(a)(1)(B), Content of record"],["10A NCAC 13J .1110(g); .1504(6), Supervisor availability"],["NC Medicaid Clinical Coverage Policy 3L, §7.9 (amended January 1, 2026)"],["45 CFR §164.520, Notice of privacy practices"]],"ordered":false,"edited":false},{"heading":"17. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Form NC-HC-CR-01-A"],["Declaration of Home Care Clients' Rights and Client Responsibilities"]],[["Form NC-HC-CR-01-B"],["Receipt of Rights, Responsibilities, and Contact Information"]],[["Policy NC-HC-CR-02"],["Nondiscrimination, Language Access, and Effective Communication"]],[["Policy NC-HC-CR-03"],["Responsible Parties, Informed Consent, and Advance Directives"]],[["Policy NC-HC-ADM-01"],["Referral, Intake, and Acceptance of Clients"]],[["Policy NC-HC-ADM-02"],["Initial Assessment, Admission, and Service Agreement"]],[["Policy NC-HC-POC-01"],["Plan of Care, 90-Day Review, and Changes to Services"]],[["Policy NC-HC-DC-01"],["Reduction, Termination, Transfer, and Discharge"]],[["Policy NC-HC-BUS-01"],["Charges, Billing, and the Written Statement of Services"]],[["Policy NC-HC-BUS-02"],["Electronic Visit Verification"]],[["Policy NC-HC-ETH-01"],["Code of Conduct, Professional Boundaries, and Client Property"]],[["Policy NC-HC-ETH-02"],["Smoking Prohibited While Serving Clients"]],[["Policy NC-HC-GOV-03"],["Licensure, License Changes, and Notices to the Division of Health Service Regulation"]],[["Policy NC-HC-GOV-05"],["Inspections, State Complaint Investigations, and Plans of Correction"]],[["Policy NC-HC-PRV-01"],["Confidentiality and HIPAA Privacy"]],[["Policy NC-HC-GRV-01"],["Complaints and Grievances"]],[["Policy NC-HC-ANE-01"],["Reporting Abuse, Neglect, and Exploitation of Adults and Children"]],[["Policy NC-HC-HR-05"],["Orientation and In-Service Education"]],[["Form NC-HC-BUS-01-A"],["Statement of Services and Charges"]],[["Form NC-HC-ETH-02-A"],["No-Smoking Notice to Clients"]],[["Form NC-HC-GOV-03-B"],["Notice to Clients of a Change in the Agency's License"]]]},"edited":false},{"heading":"18. 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":"19. 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 16 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/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}}