Understanding “Licensed Capacity” in Family Care Homes Presented by: Megan Lamphere, MSW Chief, DHSR Adult Care Licensure Section Anthony Brinson, Architectural/Engineering Technician Team Leader, DHSR Construction Section

Definitions Family Care Home G.S. 131D (9) An adult care home having two to six residents. Capacity 10A NCAC 13G .0206 (b) The total number of residents shall not exceed the number shown on the license. (e) The licensee shall notify DHSR if the overall evacuation capability of the residents changes from the evacuation capability listed on the home’s license or of the addition of any non-resident that will be residing in the home.

How Do I Know the Licensed Capacity of a Family Care Home? HERE!

What Does “Ambulatory” and “Non-Ambulatory” Mean?

“Ambulatory” As Used in Licensing of Family Care Homes Defined per the N.C. Building Code as: Able to respond to an alarm and evacuate a facility without physical or verbal prompting from the staff or another person.

“Non-Ambulatory” As Used in Licensing of Family Care Homes Defined per the N.C. Building Code as: NOT able to respond to an alarm and evacuate a facility without physical or verbal prompting from the staff or another person.

Examples of Residents Who May Be “Non-Ambulatory” Residents who are physically disabled to the point where they are unable to evacuate from a facility without physical assistance from another person. Residents who have dementia or other cognitive impairment to the point where they are unable to evacuate from a facility without verbal cueing and/or physical assistance.

Why Is This Important? SAFETY! The licensed capacity of a family care home is determined by the DHSR Construction Section based on the fire safety measures in the home, ambulatory status of residents, and staffing in the home in order to keep the residents SAFE during an emergency. Ambulatory Status of Residents Fire Safety Measures Staffing

FIRE SAFETY MEASURES may be: Number of exits and whether exits go to the outside Smoke detectors Special interior wall and ceiling finishes Fire-resistant and self-closing doors Fire alarm system Sprinkler system STAFFING How many staff work in the facility? 3rd shift? Are the staff awake at night? AMBULATORY STATUS OF RESIDENTS Physically unable to evacuate Cognitively unable to evacuate

ALL AMBULATORY!

CAN HAVE UP TO 3 NON-AMBULATORY RESIDENTS!

What Is The Family Care Home’s Responsibility? Only admit residents whose needs do not exceed the licensed capacity Make sure the resident admission agreement/contract specifies what conditions or health needs the facility cannot meet and the facility’s discharge policy Continuously monitor and assess residents for changes in conditions, i.e. ambulatory status Call the Construction Section and ACLS immediately if the facility wishes to change it’s licensed capacity in order to serve non-ambulatory residents OR Initiate discharge of a resident that has become “non-ambulatory” and put measures in place to supervise the resident until discharge (such as awake staff)

What Should A Surveyor/Adult Home Specialist Do? Look at the license hanging in the facility when you visit (look at Capacity) and compare to the residents who are living there. Be on the lookout for changes in residents’ conditions (look at assessment/care plan, supervision, resident contract, and discharge rules). Ask questions of and report FCH’s that are advertising/marketing themselves as “memory care” if they are licensed as “All Ambulatory” or are exceeding their licensed capacity. Be on the lookout for “non-residents” who are unable to evacuate on their own---they count toward the number of “non-ambulatory” people that can reside in the home (i.e. babies and children, live-in relatives, sometimes the owners themselves) Report concerns about the licensed capacity and/or the ambulatory status of residents in a FCH to the DHSR Construction Section and the Adult Care Licensure Section. DSS Adult Home Specialist should consider reporting to the local Fire Marshal or Code Enforcement Official (zoning violation).

A Note About AWAKE STAFF in Family Care Homes Awake staff (24/7) is required when any resident in the home: Is cognitively disoriented Exhibits wandering or exit-seeking behaviors (elopement) Is not able to use a call bell or other call system Does not have the ability to know where and how to re-enter the facility Regulatory Authority: A family care home or adult care home with 12 or fewer residents must be able to provide supervision according to a resident’s care plan, assessed needs, and current symptoms (rule 13G .0901b). Family care homes must employ additional staff as needed for supervision and care of residents (rule 13G .0601(d)).

Contact Information Anthony Brinson, DHSR Construction Section 919-855-3920 or Anthony.Brinson@dhhs.nc.gov ACLS Regional Supervisors Go to https://www2.ncdhhs.gov/dhsr/acls/adultcarestaff.html Karisa Merrill, ACLS County Liaison 919-855-3791 or Karisa.L.Merrill@dhhs.nc.gov