North Carolina home care agency director and RN requirements

Who can be the agency director

The rules define the agency director as "the person having administrative responsibility for the operation of the agency". For an agency providing in-home aide services, 10A NCAC 13J .1001(b) gives three routes. The director must meet one or more of them:

The director’s file for the initial survey

DHSR’s initial survey is a review of the documents you send, and its checklist includes the agency director job description among the administrative policies and a personnel record review with a column for the agency director. For the director it lists: DHSR checklist

• Resume (DHSR asks for it only for the agency director)
• Signed job description
• License verification, if applicable
• Proof of TB skin test or chest X-ray
• Proof of bloodborne pathogen training
• Proof of Hepatitis B immunization or declination
• Proof of orientation
• Reference check(s)
• Signed consent for criminal background check

The resume is how DHSR sees which route your director meets, so make the supervisory or management experience, dates and employers easy to find. The full table for every role is on the North Carolina survey page. DHSR checklist, Personnel Record Review

Companion, sitter and respite agencies

Rule .1503 sets separate director rules for companion, sitter and respite services. DHSR’s FAQ lists them under the heading "For agencies licensed to provide Companion, Sitter, and Respite services only." An agency that also provides in-home aide services uses the three routes above. DHSR FAQ 37

Can the owner be the director, and can the director be the RN?

Most new agencies start small, so these are the first questions founders ask. Here is what the saved rule text supports.

What the agency director is responsible for

Agency duties a director usually carries

Practical guidance, not rule text: the rules place these duties on the agency or its governing body, and in a small agency they usually sit with the director. Each card links to the rule.

If the agency director leaves

Directors move on, and the rule makes the next step simple. "If the position of agency director becomes vacant, the Department shall be notified within five working days in writing of such vacancy along with the name of the replacement, if available." 13J .1001(e)

1. Within 5 working days

   Write to DHSR

   Say the post is vacant and name the replacement, if you have one.

   13J .1001(e)

2. With the notice

   Send the evidence

   The effective date, and the documents showing the new director qualifies, such as a resume, licenses and credentials.

   DHSR FAQ 38

3. By mail or email

   Where to send it

   DHSR Acute and Home Care Licensure and Certification Section, 2712 Mail Service Center, Raleigh NC 27699, or DHSR.homecare@dhhs.nc.gov.

   DHSR FAQ 38

4. After review

   DHSR’s letter

   "Once the Agency Director is approved, a notification letter will be mailed to the Agency."

   DHSR FAQ 38

The RN for in-home aide services

The 13J rules speak of the "health care practitioner"; DHSR’s FAQ describes the same work as the RN’s. "A home care agency must have a RN available for supervision and consultation during the hours that in-home aide services are provided." That holds even where Medicaid’s independent assessment nurses assess the client: "the Home Care agency RN must conduct a home visit to make observations, collect data and develop the POC." DHSR FAQ 43 FAQ 44

DHSR sums up the role: "The RN assesses the client, develops the plan of care, validates the competency of In-Home Caregivers (other RN’s, LPN, In-Home Aides, Nurse Aides), supervises the In-Home Caregivers, and coordinates the delivery of services." DHSR FAQ 45

1. 01

   Assess the client at home

   Before the plan of care, the health care practitioner assesses the client in their home: functional status in the social, mental, physical health, environmental and economic areas, ADLs and IADLs. The assessment is signed and dated.

   13J .1107(d), (e)

2. 02

   Write and sign the plan of care

   The plan of care is signed and dated by the health care practitioner and the client or their responsible party, and sets the level of assistance for each ADL. Aides follow the practitioner’s written care instructions.

   13J .1107(a)-(c)

3. 03

   Check each aide’s skills

   Aides show the practitioner each task before they are assigned it. For aides not on the Nurse Aide Registry, an RN verifies six core skills: mobility, bathing, toileting, dressing, eating and continence.

   13J .1003(g); .1110(a), (b)

4. 04

   Visit every 90 days

   A supervisory visit to each client’s home every 90 days, with or without the aide there, and once a year while the aide is giving care. The visit reviews the client’s condition, progress and response to the services.

   13J .1110(c)

5. 05

   Write it down

   Each visit record shows the date, the findings and the signature of the person who made the visit. Any corrective action goes in the employee’s record.

   13J .1110(d), (e)

6. 06

   Be available

   The practitioner is available for supervision and consultation while in-home aide services are provided. DHSR says the RN supervisor must be available to aides and clients and able to go on site when necessary.

   13J .1110(g); DHSR FAQ 46

Supervising companions and sitters

Companion, sitter and respite services have their own supervision schedule under Rule .1504, on top of the general rule in .1110. The agency’s designated supervisor supervises the staff "by contacting the client receiving care every three months and by making a supervisory visit to each client's place of residence at least every six months", and at least once a year while the companion or sitter is in the home. 13J .1504(2)

Myths