SECTION .0500 ‑ PROGRAM OPERATION

10A NCAC 06R .0501      PLANNING PROGRAM ACTIVITIES

(a)  Enrollment Policies and Procedures

(1)           Each adult day care program shall have written program policies including enrollment policies that define the population served. These policies shall serve as the basis for determining who shall be accepted into the program and for planning activities for the participants. The planned activities shall be created to meet the needs of the participant to satisfy their service plan. The enrollment policies shall outline the criteria for people whose needs cannot be met by the planned activities. The enrollment policies shall provide for discharge of participants whose needs can no longer be met by the adult day care program. If a day care program serves semi‑ambulatory or non‑ambulatory persons, it shall be stated in the enrollment policies.

(2)           Prior to enrollment, the applicant, family members or caregiver shall have a minimum of one personal interview with a program staff member. During the interview, the staff shall complete initial documentation identifying support networks, activities enjoyed by the participant, medical care needs, any spiritual, religious or cultural needs, and a determination of whether the program can meet the individual's expressed needs. The staff person doing the interviewing shall sign the determination of needs and the applicant, family member or caregiver shall sign the application for enrollment. These signed documents shall be obtained before the individual's first day of attendance as a participant in the program.

(3)           A medical examination report signed by a physician, nurse practitioner or physician's assistant, completed within the prior three months, shall be obtained by the program within 30 days of enrollment. This report must be updated annually no later than the anniversary date of the initial report. The requirements for the medical examination report shall be found in Rule .0508 of this Section.

(4)           At enrollment, or in the initial interview, the program policies shall be discussed with the applicant, family member or caregiver and a copy of the program policies shall be provided.

(5)           Documentation of receipt of and agreement to abide by the program policies by the applicant, family member or caregiver shall be obtained by the program and kept in the participant's file.

(6)           The program policies shall contain:

(A)          a discharge policy outlining the criteria for discharge and notification procedures for discharge, the timeframe and procedures for notifying the applicant, family member or other caregiver of discharge, and referral or follow-up procedures;

(B)          a medication policy as specified in Rule .0505 of this Section;

(C)          a description of participant's rights while enrolled in the adult day care program;

(D)          the grievance policies and procedures for families;

(E)           the advance directives policy;

(F)           the non-discrimination policies;

(G)          the procedure to maintain confidentiality;

(H)          the policy on reporting suspected abuse or neglect;

(I)            the description of the geographical area served by the program; and

(J)            the inclement weather policies.

(b)  Planning Services for Individual Participants

(1)           Within 30 days of enrollment of a new participant, the program shall perform a comprehensive assessment and written service plan for each individual. The comprehensive assessment shall address the individual's ability to perform activities of daily living and instrumental activities of daily living while in the program. The mental, social, living environment, economic and physical health of the individual shall also be assessed. The service plan shall be signed and dated by the program director or the director's designee. For adult day health participants the health component of the service plan shall be written and signed by a registered nurse.

(2)           In developing the written service plan, the program shall include input from the participant, family members, or caregiver and other agency professionals with knowledge of the individual's needs. The service plan shall be based on strengths, needs and abilities identified in the assessment. The assessment and service plan shall be reviewed at regular intervals, and no less than once every six months. The service plan shall include:

(A)          the needs and strengths of the participant;

(B)          the interests of the participant;

(C)          the measurable service goals and objectives of care for the participant while in the adult day care program;

(D)          the type of interventions to be provided by the program in order to reach desired outcomes;

(E)           the services to be provided by the program to achieve the goals and objectives;

(F)           the roles of participant, family, caregiver, volunteers and program staff; and

(G)          the time limit for the plan, with provision for review and renewal.

(3)           Progress notes in the participant's record shall be updated at least every three months.

(4)           The participant, caregiver, and other service providers may contribute to the development, implementation and evaluation of the service plan.

(5)           Any change in behavior, mood, or attitude or need for help or services shall be reported by the program. If the participant is a department of social services client, the report shall be made to the participant's family, caregiver, or responsible party and the department of social services worker or the social worker designated as consultant to the adult day care program by the department. If the participant is not a social services client, the report shall be made to the person's family, caregiver or responsible party. A note shall be made in the participant's record of action taken.

(6)           The participant or the responsible party may choose the days and number of days the participant will attend, with the program director's approval.

(7)           The reason for any unscheduled participant absence shall be determined by the program staff and documented on the day it occurs. The program shall attempt to contact the absent participant or the responsible party to determine why the participant was absent on a scheduled day of attendance.

(8)           The adult day care program is responsible for the participant's safety when a participant is registered in attendance. A participant leaving the program for part of a day shall sign out relieving the program of further responsibility. If a participant has emotional or mental impairment that requires supervision and that person needs or wants to leave the program during the day, the social worker, family, caregiver, friend, or responsible party shall sign the person out.

(c)  Program Activities Plan

(1)           The day care center or home shall have a program activities plan that meets the following criteria:

(A)          Overall planning of activities shall be based on elements of the individual service plans.

(B)          Program activities shall follow the group process, both large and small groups, with provision for individual activities and services as needed.

(C)          Activities shall be adaptable and modifiable to allow for greater participation and to maintain participant's individual skill level.

(D)          Activities shall be consistent with the stated program goals.

(E)           Activities shall be planned jointly by staff and participants. Staff shall encourage participants to participate in the planning and operation of the program as much as the participant is able, and to use their skills, talent and knowledge in program planning and operation.

(F)           All program activities shall be supervised by program staff.

(G)          Participants may refuse to participate in any given activity.

(2)           The activities schedule shall provide for the inclusion of cognitive activities to be available on a daily basis, and be designed to:

(A)          stimulate thinking and creativity;

(B)          provide opportunities for learning new ideas and skills;

(C)          help maintain existing reasoning skills and knowledge base; and

(D)          provide opportunities to utilize previously learned skills.

(3)           The activities schedule shall provide for the inclusion of physical activities to be available on a daily basis, and be designed to:

(A)          improve or maintain mobility and overall strength; and

(B)          increase or maintain joint range of motion.

(4)           The activities schedule shall provide for the inclusion of psychosocial activities, as determined by the client's service plan, to be available on a daily basis, and be designed to:

(A)          provide opportunities for social interaction;

(B)          develop a sense of belonging;

(C)          promote goal-oriented use of time;

(D)          create feelings of accomplishment;

(E)           foster dignity and self-esteem;

(F)           prompt self-expression; and

(G)          provide fun and enjoyment.

(5)           The activities schedule shall:

(A)          be in writing, specifying the name of each activity to be provided, the days of the week each activity shall be conducted, and the approximate length of time of each activity;

(B)          indicate the length of time the schedule is to be followed; and

(C)          be posted weekly or monthly in the facility and visible to anyone into the facility.

History Note:        Authority G.S. 131D-6; 143B‑153(2a); 143B‑153(6);

Eff. July 1, 1978;

Amended Eff. February 1, 2008; July 1, 2007; July 1, 1990; January 1, 1981;

Readopted Eff. September 1, 2019.