South Carolina home care policies and procedures, section by section

Written policies for every section of the rule

Develop written policies and procedures addressing each section of R.60-122 on client care and operations, follow them, and keep them available to staff in print or electronically at all times.

"Written policies and procedures addressing each section of this regulation regarding client care and operation of the provider shall be developed."

Follow the policies; staff can reach them

Comply with the policies and keep them accessible to staff, in print or electronically, at all times.

"These policies and procedures shall be accessible to provider staff, in print or electronically, at all times."

Review at least every two years

Set a review period of no more than two years for all policies; document each review and have the administrator sign it.

"The provider shall establish a time period for review, not to exceed two (2) years, of all policies and procedures, and such reviews shall be documented and signed by the administrator."

Copy of R.60-122 available to caregivers

Keep a copy of the licensing standards at the provider, accessible to all caregivers, and comply with local, state and federal law.

"A copy of the licensing standards shall be maintained at the provider and accessible to all caregivers."

Care given according to policy

Render care effectively and safely according to the provider’s policies, and provide at least the services in the service agreement or care services plan.

"Care services shall be rendered effectively and safely in accordance with provider policies and procedures."

Licensed before operating or advertising

Do not operate, advertise or market as an in-home care provider before DPH issues the license.

"without first obtaining a license from the Department"

License posted

Post the license in a public area of the business office or keep it readily available.

"The license issued by the Department shall be posted in a conspicuous place in a public area of the provider’s business office or readily available to the public."

Separate lines of businessif the provider offers services other than in-home care

If the provider offers other services (for example private duty nursing), keep them separate: separate marketing, caregiver records and client records.

"This includes, but is not limited to, maintenance of separate representations to the public regarding these businesses, separate maintenance of caregiver records, and separate maintenance of client records."

In-state primary office, zoning permit

Keep at least one in-state primary office in a commercially zoned or unzoned area, with a county or municipal zoning permit, or a letter from the county or municipality if unzoned.

"For the primary office, the applicant must obtain a county or municipal zoning permit to operate the provider."

Register additional locations firstif the provider operates from more than one office

Register each additional site with DPH and get approval before operating from it.

"A provider desiring to obtain approval for the registration of a multiple location shall file with the Department an application on a form prescribed, prepared, and furnished by the Department."

Name rules

Use a name not the same as or similar to another licensee’s; franchises include their geographic area.

"No proposed provider shall be named, nor shall any existing provider have its name changed to, the same or similar name as any other provider licensed in South Carolina."

Accurate, sworn application

Submit a complete and accurate application with the oath, signed by the owners (or two corporate officers), naming the persons in control; pay outstanding fees and penalties first.

"The application includes both the applicant’s oath assuring that the contents of the application are accurate and true and the applicant will comply with this regulation."

Signers report convictions

Anyone who signed the application reports disqualifying convictions to DPH immediately.

"Person(s) signing the licensure application must immediately report to the Department any convictions for the above-referenced offenses."

Renew before expiry

File the renewal application with any required documentation and the $800 fee before the license expires; late filing adds $200, and 30 days late leaves the provider unlicensed.

"For a license to be renewed, applicants shall file an application with the Department, including any required documentation to evidence compliance with the regulation and pay a license fee of eight hundred dollars ($800)."

Amend the license before moving or renaming

Apply for an amended license before a change of location, or of name or postal address ($50 each).

"A provider shall request issuance of an amended license by application to the Department prior to any of the following circumstances:"

New license for a change of owner or entity

Apply for a new license before a change in controlling interest or legal entity.

"A change in the controlling interest even if, in the case of a corporation or partnership, the legal entity retains its identity and name; or"

Variances by requestif the provider seeks an alternative to a standard

Request any variance from the rule in the format DPH sets; DPH decides case by case and may revoke it.

"The provider may request a variance to this regulation in a format as determined by the Department."

Access for unannounced inspections

Allow inspections and investigations without notice; give access to all areas and records in a timely way; if staff are out, say when they will return.

"When staff members are not present, the provider shall provide information as to the expected return of staff."

Records produced promptly

Make all records readily accessible, in a timely manner, for DPH inspections and investigations.

"All records must be readily accessible, in a timely manner, for inspections and investigations by the Department."

Plan of correction

For any noncompliance, return an acceptable written plan of correction signed by the administrator by the date on the report, covering corrective action, prevention of recurrence and completion dates.

"When there is noncompliance with licensing standards, the provider shall submit an acceptable written plan of correction to the Department that shall be signed by the administrator"

Liability insurance or surety bond

Keep liability insurance or a surety bond of at least $100,000 per occurrence and $300,000 aggregate.

"The provider shall maintain either liability insurance coverage or, in lieu of liability insurance coverage, a surety bond."

Indemnity coverage for clients

Keep indemnity coverage to compensate clients for injuries and losses from services.

"The provider shall maintain indemnity coverage to compensate clients for injuries and losses resulting from services provided."

Workers’ compensation

Keep workers’ compensation insurance under S.C. Code 42-5-10 et seq.

"The provider shall maintain workers compensation insurance in accordance with S.C. Code Sections 42-5-10, et seq."

Administrator

Designate an administrator with authority and responsibility for all functions and activities of the provider.

"Each provider shall have an administrator who is responsible for the overall management and operation of the provider."

Criminal background check before employment

Run a criminal background check under 44-70-60(B) and 44-7-2910 before employing or contracting any caregiver.

"Before being employed as an in-home caregiver by a licensed in-home care provider, a person shall undergo a criminal background check as provided by S.C. Code Sections 44-70-60(B) and 44-7-2910."

Verify 12 months’ residency; federal check if needed

Have each applicant verify 12 months’ residency. SC residents: state check. Otherwise: state check before employment and a federal check started after, or the other state’s check if residency there is verified.

"A direct caregiver applicant shall provide verification of residency for the twelve months preceding the date of the employment application."

Checks through SLED or a SLED/FBI-based vendor

Use SLED, or a background check business using current SLED or FBI records; repeat the check after a year or more out of direct care work.

"Criminal record checks required pursuant to this article must be conducted by the State Law Enforcement Division or by a private business, organization, or association which conducts background checks"

Agency staff checked tooif the provider uses an employment or staffing agency

Use staffing agencies only if they have run a criminal record check on each worker supplied.

"An employment agency may not furnish employees to a direct care entity without conducting a criminal record check on each employee."

Sex Offender and Nurse Aide Registry checks

Confirm no adverse findings on the Sex Offender Registry or the Nurse Aide Registry for each caregiver (Class I). The rule sets no timing; checking before client contact is our suggestion.

"Not have adverse findings on the Sex Offender Registry or Nurse Aide Registry; and (I)"

Disqualifying offenses

Do not use a caregiver with a conviction or no-contest plea for forgery, larceny, embezzlement or false pretenses (10 years), drug offenses (10 years), abuse, neglect or exploitation of a vulnerable adult, or any violent crime (Class I).

"Criminal offenses involving drugs within ten (10) years of providing in-home care to clients;"

Pre-employment drug screen

5-panel screen (cannabis, cocaine, amphetamines, opiates, phencyclidine) no more than 30 days before the offer, reviewed by a nurse, the administrator or HR; no caregiver work until negative (Class I).

"The test must not be taken earlier than thirty (30) days before the provider’s offer of employment as a caregiver to the person."

Drug test documentation

Keep the lab result, or for in-house tests: name, date, time and signature of the person tested and of the reviewer, kit manufacturer and model, results, and kit lot number and expiry.

"Lot number and expiration date, as displayed on the original screening kit."

Random drug testing policy

Write policies that address random drug testing of the application signers and caregivers and describe the method chosen (minimum 5-panel). The rule asks for it with the initial application (§103.F.5); DPH’s Form 1307 also asks for it with each renewal.

"The provider’s policies and procedures must address random drug testing and describe the procedure chosen."

Positive random test: off caregiving

A caregiver with a positive random test does no caregiving until a physician confirms a prescribed medication or a later test is negative.

"Positive tests of caregivers as a result of the random drug testing shall be not be eligible for caregiver responsibilities"

Staff records

Keep accurate information on all staff: current address, phone, training, all drug test results, criminal background checks and self-assessments.

"The provider shall maintain accurate information on all staff members including, but not limited to, current address, phone number, training, all drug test results, criminal background checks, and self-assessments."

Keep DPH’s eligibility determinationif a fingerprint-based check is run through DPH

For fingerprint checks run through DPH, keep DPH’s eligibility determination in the caregiver’s file.

"The eligibility determination should be maintained by the direct care entity in the caregiver’s file."

Training for assigned duties

Caregivers receive or obtain the training needed for their duties, from appropriate resources (licensed or certified persons, books, electronic media).

"Caregivers shall receive or independently obtain necessary training to perform the duties for which they are responsible."

Signed training records

Trainer and trainee sign and date all in-service training records (trainer signature optional for computer-based training).

"Documentation of all in-service training shall be signed and dated by both the individual providing the training and the individual receiving the training."

Basic first aid

Basic first aid before client contact and at least annually (Class I).

"Basic first aid;"

Condition-specific caredepending on the clients served (for example dementia)

Depending on clients, training in care for their physical or mental conditions, for example Alzheimer’s disease, other dementias or cognitive disabilities.

"Depending on the type of clients, care services for persons specific to the physical and/or mental condition of the individual"

Confidentiality

Training in confidentiality of client information and records.

"Confidentiality of client information and records;"

Documentation and recordkeeping

Training in documentation and recordkeeping procedures.

"Documentation and recordkeeping procedures;"

Ethics and relationships

Training in ethics and interpersonal relationships.

"Ethics and interpersonal relationships;"

Lifting and transfersif caregivers help clients move or transfer

Training in proper lifting and transfer techniques, if caregivers help with transfers.

"Proper lifting and transfer techniques, if applicable;"

Infection control

Training in infection control techniques.

"Infection control techniques; and"

Preventing abuse, neglect and exploitation

Training in prevention of client abuse, neglect and exploitation.

"Prevention of client abuse, neglect, and exploitation."

Literacy and capability

Caregivers can read, write and communicate effectively, complete assigned duties, and follow the care services plan with minimal supervision.

"Be able to read, write, and communicate effectively with client and supervisor;"

Age 18, with ID

Caregivers are at least 18, shown by government ID or other valid documentation.

"Be at least eighteen (18) years of age, as evidenced by a government-issued identification card or other valid documentation;"

Drivers: license, insurance, driving recordif caregivers transport clients

Caregivers who transport clients hold a valid license and proof of insurance; verify the official driving record and keep a copy.

"Have a valid driver’s license and proof of insurance if transportation is a part of the caregiver’s duties."

Health self-assessment before client contact

Staff with client contact complete a self-assessment disclosing communicable diseases, reviewed and signed by a nurse, the administrator or HR before first client contact (Class I).

"The self-assessment shall be reviewed and signed by a nurse, the administrator, or human resources/hiring personnel prior to the staff member or caregiver’s initial client contact."

Communicable disease reporting and exclusion policy

Policies for caregivers to report communicable disease to the administrator, and for excluding or restricting caregivers with communicable diseases or symptoms.

"The policies and procedures shall further include provisions for excluding and/or restricting caregivers with communicable diseases or symptoms of such diseases."

Document and review every incident

Document every incident with a review, investigation, evaluation and any corrective action; keep incident records five years after the client leaves.

"The provider shall document every incident, and include an incident review, investigation, and evaluation as well as a corrective action taken, if any."

Report serious incidents within 24 hours

Report fractures, hospital admission or death from an incident, suspected crimes against a client by a caregiver, and suspected abuse, neglect or exploitation by a caregiver to the responsible party and to DPH’s electronic system within 24 hours or the next business day.

"The provider shall also notify the Department within twenty-four (24) hours or the next business day from the incident, via the Department’s electronic reporting system or as otherwise determined by the Department."

Five-day investigation report

Submit a separate written investigation report to DPH within 5 calendar days with the listed contents (license number, date, client age and sex, witnesses, injury and treatment, cause, internal findings, agencies notified, reporter).

"the date the incident occurred, the client age and sex, witness names, extent and type of injury and how treated, cause of incident"

Report abuse allegations to APS or CPS

Report any allegation of abuse, neglect or exploitation of clients to DSS Adult Protective Services under 43-35-25, or to Child Protective Services as appropriate.

"The provider shall report any allegation of abuse, neglect, or exploitation of clients to the Adult Protective Services Program in the Department of Social Services in accordance with S.C. Code Section"

Caregivers are mandated reporters

Caregivers who have reason to believe a vulnerable adult has been or is likely to be abused, neglected or exploited must personally report within 24 hours or the next working day (APS for home settings).

"A person required to report pursuant to this section is personally responsible for making the report"

Policy must not get in the way of reporting

The Act bars a facility’s internal procedures (telling a supervisor first) from interfering with the reporter’s own duty to report; by our reading an in-home care provider should follow the same rule, as the Act’s facility definition does not name in-home care providers.

"No facility may develop policies or procedures that interfere with the reporting requirements of this section."

Police for emergencies and sexual assault

In an emergency, serious injury or suspected sexual assault, contact law enforcement immediately as well.

"in cases of an emergency, serious injury, or suspected sexual assault law enforcement must be contacted immediately"

No retaliation against reporters

Do not change an employee’s status because they report or cooperate with an investigation.

"It is against the public policy of South Carolina to change an employee’s status solely because the employee reports or cooperates with an investigation"

Reporting suspected child abuseif the provider serves children or may observe children in clients’ homes

Where children are served or seen, report suspected abuse or neglect to county DSS or law enforcement. Caregivers are not on the mandated list, so this is recommended practice beyond R.60-122 §501.D.

"may report, and is encouraged to report, in accordance with this section"

Notify DPH before closing

Give DPH written notice of intent and date; within 10 business days before closure, give records arrangements, clients needing transfer, and (permanent) refunds or (temporary) reopening date. Return the license on permanent closure; after more than a year closed, DPH decides whether to inspect before reopening.

"On the date of closure, the provider shall return the license to the Department."

Notify clients and help them move

Give all clients written notice at least 10 business days before closure, notify them promptly and give them a list of licensed providers for continued care.

"the provider shall ensure continuity of care services by promptly notifying the client and/or the client’s responsible party and providing a listing of licensed providers for continued care"

Preserve records on closure

Before closing, arrange for preservation of records and tell DPH in writing where they will be.

"The licensee shall notify the Department, in writing, describing these arrangements and the location of records."

An organized record for each client

Keep an organized record per client identifying the client and the person responsible for care; paper or electronic; legible, complete, signed and dated promptly (late signatures dated).

"The provider shall initiate and maintain an organized record for each client."

Backup for electronic recordsif records are kept electronically

If records are electronic, provide for backup and retrieval in a shutdown or power outage.

"Providers that use electronic systems must provide for data backup and retrieval in the event of a system shutdown or power outage."

Visit notes, updated weekly

Document each visit: services provided, significant changes in physical or behavioral condition, caregiver name and signature or electronic verification, and date; maintain or update weekly.

"Documentation shall be maintained or updated on a weekly basis."

Service agreement signed before care

A service agreement with the services, fee disclosure and advance notice of fee changes, refund policy and timing, and termination terms, signed and dated by the provider and client or responsible party before care. Later changes recorded and agreed. Not required for Medicaid clients.

"Refund policy to include when monies are to be forwarded to client upon termination of care services; and"

Recording changes to the agreement

Changes in services may be handled by recording in the client record the specific change and that it was discussed and agreed with the person who signed, before the change.

"Subsequent revisions to the initial service agreement may be handled by the provider documenting in the client’s record the specific changes in care services that will occur"

Care services plan

Within seven business days of starting care: types of services, expected times and frequency, expected duration, goals and objectives; revise when any of these change.

"Goals and objectives of the care services."

Secure record storage

Provide space, supplies and equipment adequate to protect and store client records.

"The licensee shall provide accommodations, space, supplies, and equipment adequate for the protection and storage of client records."

Close records in 30 days; keep 5 years

Complete the record within 30 calendar days of discharge and keep it at least five years after services end.

"Upon termination of care services to a client, the record shall be completed within thirty (30) calendar days, and filed in an active or closed file maintained by the licensee."

Non-medical tasks only

Caregivers do only non-medical tasks from the permitted list (Class I section).

"Care services provided by caregivers are strictly limited to non-medical tasks."

Medication remindersif the provider offers medication reminders

The rule lists medication reminders as the medication service. Our recommendation: the agency policy says what caregivers may and may not do, with no administering and no setting up doses (the rule does not mention setting up doses).

"Medication reminders."

Shopping: receipts and written accountingif caregivers shop for clients

For any shopping for a client, give the client receipts and account for the client’s money in writing.

"For any shopping on behalf of a client, receipts must be provided to the client and client funds for such shopping must be accounted for in writing."

Transportationif caregivers transport clients

Transportation to appointments and shopping is a permitted service; the driver rules in 405.D apply.

"Providing transportation to appointments, shopping, etc."

Home safety hazards

Caregivers may address safety hazards found in clients’ homes; the policy says how hazards are spotted, fixed or reported.

"Addressing safety hazards found in clients’ homes."

Infection control practices

Maintain and implement staff practices that prevent the spread of infectious diseases, including screening, standard precautions and transmission-based precautions (Class I).

"The provider shall maintain and implement staff practices that prevent the spread of infectious, contagious, and communicable diseases, including but not limited to, screening, standard precautions, and transmission-based precautions."

Rights and assurances

Assure clients of: the agreed services; respect for property; freedom from abuse, neglect and exploitation; respect and dignity; and confidentiality of records, including privacy and disclosure (Class I).

"Confidentiality of client records, to include privacy and disclosure requirements."

Rights in writing, signed before care

Give clients the rights in writing before care starts; the provider and client or responsible party sign and date it.

"The documentation of informed rights and assurances shall be signed and dated by the provider and the client and/or client’s responsible party."

Disaster plan

Develop a disaster plan setting out the services, if any, provided in a disaster and how clients or responsible parties are notified if staff cannot come.

"The provider shall develop a disaster plan that identifies the care services obligations, if any, of the provider to be provided to the client during a disaster event."

Document disaster notifications; give clients the plan

Document notification (or attempts) when services cannot be given in a disaster, and give the plan to each client or responsible party.

"the provider’s notification (or attempted notification) to the client and/or responsible party shall be documented"

Emergency call numbers for caregivers

Keep readily available to caregivers: fire, police, ambulance and poison control numbers, and the staff to notify in an emergency.

"Emergency call data, including telephone numbers of fire and police departments, ambulance service, and poison control center, shall be readily available to the caregiver."

Complaints procedure

Recommended: a written complaints procedure that also tells clients they can contact DPH (online form or 1-800-922-6735). R.60-122 has no complaints section.

"The hotline number is 1-800-922-6735."

Supervision of caregivers

Recommended: a supervision policy (who supervises, check-ins, visit spot checks). The rule expects caregivers to follow the plan with minimal supervision but sets no supervision schedule.

"Be capable of providing care as provided in the care services plan with minimal supervision, if applicable;"