North Carolina

Residential assisted living licensing rules and official state resources

Licensure term: Assisted Living Residences, Adult Care Home
Resident capacity: Adult Care - 7 +
Staff ratios: Each ACH must have at least one staff person on the premises at all times who has completed within the last 24 months a course on cardiopulmonary resuscitation and choking management, including the Heimlich maneuver.
Cost of licensing: Adult Care - $400 + $19/bed
Bedroom square footage: There shall be a minimum area of 100 square feet excluding vestibule, closet or wardrobe space in rooms occupied by one person and a minimum area of 80 square feet per bed, excluding vestibule, closet or wardrobe space, in rooms occupied by two people; A bedroom may not be occupied by more than two residents.
Memory care: Dementia Care Staff. At least one staff person is required for every eight residents on the first and second shift, plus 1 hour of staff time for each additional resident; and one staff person for every ten residents on the third shift, plus 0.8 hour of staff time for each additional resident. A care coordinator must be on-duty in the SCU at least 8 hours a day, 5 days a week. The care coordinator may be counted in the minimal staffing requirements. In SCUs with more than 16 units, the care coordinator is not counted in determining the minimal staffing requirement.

Full requirements

Regulatory Agency: Division of Health Service Regulation - Adult Care Licensure Section
Contact Phone Number: Megan Lamphere, Section Chief - 919-855-3765
Licensure Term(s): Assisted Living Residences, Adult Care Home
Census Requirements: Adult Care - 7 + Family Care - 6 or Fewer
Qualifications for Managers: ACH administrators must complete 30 hours of continuing education every 2 years. Administrators-in-charge and supervisors-in-charge must complete 12 hours of continuing education per year. At all times there must be one administrator or supervisor/administrator-in-charge who is directly responsible for ensuring that all required duties are carried out and that residents are never left alone. ACHs must also have a designated activity director.
Qualifications for Caregivers: Staff who directly provide personal care or who directly supervise those who do, must complete an 80-hour personal care training and competency evaluation program established by the state. Licensed health professionals, staff listed on the Nurse Aide Registry, or staff who document completion of a 40-45 hour or 75-80 hour training program or competency evaluation program are exempt from this training requirement. The 80-hour training program includes at least 34 hours of classroom instruction and 34 hours of supervised practical experience. The competency evaluation includes observation and documentation; basic nursing skills, including special health-related tasks; personal care skills; cognitive and behavioral skills, including interventions for individuals with mental disabilities; basic restorative services; and resident's rights. Experienced staff may take the competency exam without undergoing training.
Staff Ratios: Each ACH must have at least one staff person on the premises at all times who has completed within the last 24 months a course on cardiopulmonary resuscitation and choking management, including the Heimlich maneuver.
Cost of Licensing: Adult Care - $400 + $19/bed Family Care - $350.00
Square Footage Requirements: There shall be a minimum area of 100 square feet excluding vestibule, closet or wardrobe space in rooms occupied by one person and a minimum area of 80 square feet per bed, excluding vestibule, closet or wardrobe space, in rooms occupied by two people; A bedroom may not be occupied by more than two residents.
Bathrooms Required: Minimum bathroom and toilet facilities shall include a toilet and a hand lavatory for each 5 residents and a tub or shower for each 10 residents or portion thereof; Each home shall have at least one bathroom opening off the corridor with: (A) a door of three feet minimum width; (B) a three feet by three feet roll‑in shower designed to allow the staff to assist a resident in taking a shower without the staff getting wet; (C) a bathtub accessible on at least two sides; (D) a lavatory; and (E) a toilet. (8) If the tub and shower are in separate rooms, each room shall have a lavatory and a toilet;
Memory Care Requirements: Dementia Care Staff. At least one staff person is required for every eight residents on the first and second shift, plus 1 hour of staff time for each additional resident; and one staff person for every ten residents on the third shift, plus 0.8 hour of staff time for each additional resident. A care coordinator must be on-duty in the SCU at least 8 hours a day, 5 days a week. The care coordinator may be counted in the minimal staffing requirements. In SCUs with more than 16 units, the care coordinator is not counted in determining the minimal staffing requirement. Dementia Staff Training. Prior to establishing an SCU, the administrator must document receipt of at least 20 hours of training specific to the population to be served for each SCU to be operated, and must have in place a plan to train other staff assigned to the unit. Within the first week of employment, each employee assigned to perform duties in the SCU must complete 6 hours of orientation about residents' needs. Within 6 months of employment, staff responsible for personal care and supervision within the unit must complete 20 hours of training specific to the population being served, in addition to other specified orientation and training requirements. Dementia Facility Requirements. Private units are not required. A toilet and sink must be provided within the SCU for every five residents and a tub and shower for bathing must be in the unit. Facilities must provide direct access to a secured outside area and avoid or minimize the use of potentially distracting mechanical noises. Unit exit doors may be locked only if the locking devices meet the requirements outlined in the state building code for special locking devices. If exit doors are not locked, facilities must have a system of security monitoring.