NC DSS Licensing Services

subchapter 70g – child placing agencies: foster care

section .0100 – general

10A NCAC 70G .0101 SCOPE

The rules in this Subchapter apply to persons defined by governing bodies in 10A NCAC 70F .0201(b) who receive children for the purpose of placement in family foster homes, or therapeutic foster homes.

History Note: Authority G.S. 131D‑10.5; 143B‑153; Eff. February 1, 1986; Amended Eff. July 18, 2002; July 1, 1990.

10A NCAC 70G .0102 ORGANIZATION AND ADMINISTRATION

Persons licensed or seeking a license to provide foster care or behavioral mental health treatment services for children shall comply with 10A NCAC 70C, 70E, 70F, and 70G.

History Note:Authority G.S. 131D‑10.5; 143B‑153;Eff. February 1, 1986;Amended Eff. July 18, 2002.

SECTION .0200 ‑MINIMUM LICENSING STANDARDS

10A NCAC 70G .0201 PERSONNEL

(a) Staff Qualifications and Functions.

(1) Administrator. The Administrator shall be responsible for the general management and administration of the agency in accordance with licensing requirements and policies of the governing body. The Director employed after the effective date of these standards must have at a minimum a bachelor's degree from a school, accredited by the Association of Colleges and Schools and at least four years experience in a human services program of which a minimum of two years has been in administration.

(2) Social Work Supervisor. The social work supervisor shall be responsible for supervising, evaluating, and monitoring the work and progress of the social services staff. The social work supervisor employed after the effective date of the rules of this Subchapter must have at a minimum a master's degree in social work or related area of study from a school, accredited by the Association of Colleges and Schools and at least two years of social work experience; or a bachelor's degree and four years of experience in social work or related field.

(3) Social Services Worker. The social services worker shall be responsible for intake services, providing casework or group work services for children and their families, conducting home‑finding and assessment studies related to family foster parents and planning and coordinating the services and resources affecting children and their families. The social services worker must have either a master's degree in social work or related field of study from a school, accredited by the Association of Colleges and Schools or a bachelor's degree in social work or a related field and two years experience working directly with children. If social work staff are not supervised by a person meeting the qualifications in (a)(2) of this Rule, all social work staff shall meet the qualifications in (a)(2) of this Rule.

(b) Staffing Requirements.

(1) When an agency employs five or more social services staff, the agency shall employ a social work supervisor.

(2) Social workers' caseloads must take into consideration the geographic area served, and must be limited to allow for the required contacts with the families, children, foster families, and collateral parties. The child placing agency's office must be no more than 150 miles from the most distant client or foster family. Branch offices must be established if broader coverage is desired. If branch offices are established, they must be equipped and maintained in a manner similar to that of the main office.

History Note: Authority G.S. 131D‑10.5; 143B‑153;Eff. February 1, 1986; Amended Eff. July 1, 1990.

10A NCAC 70G .0202 INTAKE PROCEDURES AND PRACTICES

(a) The policies for acceptance of an applicant for services must be clearly defined in writing and must relate to the stated purpose of the agency.

(b) Acceptance of an applicant for services shall be limited to those for whom the agency is qualified by staff, program and services to give appropriate service.

(c) There must be an application for services signed by the parent, legal custodian, or authorized representative of the agency having legal authority to place the child and a written intake study which includes identification of the specific needs of the child and family which warrant consideration of removal and placement of the child.

(d) The child must be accepted for placement by written placement agreement signed by the parent, legal custodian or authorized representative of the agency having legal authority to place the child or by court order.

History Note: Authority G.S. 131D‑10.5; 143B‑153; Eff. February 1, 1986.

10A NCAC 70G .0203 CASE PLAN

(a) The agency shall develop a written case plan upon completion of the intake study and prior to placement. The plan must be developed in cooperation with the child and his family or legal custodian when possible and appropriate. In cases of emergency placements, the assessment and case plan must be initiated within one week and completed within six weeks of placement. The case plan must include:

(1) goals stated in specific, realistic, and measurable terms; and

(2) plans that are action oriented, including specific responsibilities of staff, family members and the child if appropriate.

(b) When the agency has a written contract with another human services agency to provide home finding services only, and the contract specifies that the contracting agency meet the provisions of (a) of this Rule, then the child placing agency is not required to comply with the provisions of (a) of this Rule. A copy of the contract must be submitted to the Department.

(d) The case plan must be reviewed at least every three months to determine the child's and family's progress or lack of progress towards meeting the goals and objectives, and to determine changes that need to be made in the plan.

History Note: Authority G.S. 131D‑10.5; 143B‑153; Eff. February 1, 1986.

10A NCAC 70G .0204 PLACEMENT SERVICES

(a) Services to Parents.

(1) The agency shall make every reasonable effort to help the parent assume or resume their parental roles and responsibilities when appropriate to the case plan.

(2) The agency shall help the family gain access to the services necessary to preserve and strengthen the family and to accomplish the case plan goals. While the child is in care, the agency shall assist the parent with the problems and needs that brought about the need for placement.

(3) The agency shall encourage contacts between parents and children after placement, in accordance with the case plan.

(4) The agency shall have a signed agreement with the parents of the child in care which includes the expectations and responsibilities of the agency and the parents for carrying out the steps to meet the case plan goals, the financial arrangements for the child in care, and visitation plans.

(b) Selection of Care.

(1) The agency shall select the most appropriate form of care for the child consistent with the child's and family's needs for family foster care or residential group care. In choosing such care, the agency shall provide for any specialized services the child may need and shall make every effort when placing to select the least restrictive and most appropriate setting closest to the child's home.

(2) The agency shall document any need to place a child in a family foster home or residential group care facility that is beyond a radius of 150 miles from the child placing agency and the child's family.

(3) The agency, when selecting care, shall take into consideration a child's racial, cultural, ethnic, and religious heritage and preserve them to the extent possible without jeopardizing the child's right to care.

(4) The agency shall involve the parents in the selection of the placement to the maximum extent possible.

(5) The foster home or residential child care facility must be licensed.

(1) The agency social worker for the child shall become acquainted with the child and family prior to placement, except when a child is placed on an emergency basis or in the case of an infant.

(2) The agency social worker shall help the child understand the reasons for placement and prepare him for the new environment. The social worker shall, except when placing under emergency conditions, plan and participate in at least one preplacement visit and shall be available to the child, the parents, and foster parents for supportive services.

(3) The agency shall arrange for a physical examination performed by a physician, physician's assistant or nurse practitioner for each child at the time of placement or within 30 days of placement, unless there is written documentation of a physical examination within the 12 month period preceding placement.

(4) The agency shall obtain and record a developmental history for each child as appropriate.

(d) Services During Care.

(1) The agency shall supervise the care of the child and shall coordinate the planning and services for the child and family as stated in the case plan.

(2) The agency worker shall see a child as often as necessary to carry out the case plan. For children in family foster homes or residential child care facilities, visits shall be no less than once a quarter.

(3) The agency worker shall meet with the parents or legal custodian, and children, either separately or together on a regular basis to assess and work on the following:

(A) progress in resolving problems which precipitated placement;

(B) parent and child relationship difficulties;

(D) adjustment to placement; and

(E) achievement of case plan goals.

(4) The agency shall refer the child's family to other agencies in the community providing appropriate services when they require services which the agency does not offer. The agency shall maintain communication with the agency providing service when cooperative effort has been arranged.

(5) The agency shall make provisions for specialized services and health care services as stated in the case plan.

(6) The agency shall give foster parents assistance, training, consultation, and emotional support in caring for children and in resolving problems related to their role as foster parents.

(e) Contracting for Homefinding Services. When the child placing agency has a written contract with another human services agency to provide homefinding services only, and the contract specifies that the contractor meets the provisions of (a), (c) and (d)(1‑5) of this Rule, then the child placing agency is not required to comply with the provisions of (a) (c) (d)(1‑5) of this Rule. A copy of the contract shall be submitted to the Department.

History Note: Authority G.S. 131D‑10.5; 143B‑153; Eff. February 1, 1986.

10A NCAC 70G .0205 RECORDS

(a) The agency shall maintain an individual record for each child which contains:

(1) application for services which includes demographic information including name, address, sex, race, birth date, and birth place of child; names, addresses, telephone numbers, Social Security numbers, birth dates, races, religion and marital status of the child's parents; the names, addresses, and telephone numbers of siblings and other significant relatives; and when available a record of the child's prior placements with names of caregivers, addresses and dates of care;

(2) legal documents of importance to the child including a birth record and any court dispositions;

(3) medical reports including medical history, cumulative health history, immunization records, and available psychological and psychiatric reports;

(4) educational records and reports of school‑age children;

(5) intake study which includes initial social assessment and background of family members and the circumstances leading to the decision to place the child;

(6) signed case plan along with case reviews which reflect the status of all family members in relation to the case plan; any achievements or changes in the goals of the plan; the child's contacts with family members and an assessment of their relationships;

(7) dictation which reflects the dates and content of worker's visits with the child; the agency's involvement with the parents or legal custodian, including services offered, delivered, or rejected; and dictation which includes the content of any administrative or outside service reviews; and

(8) discharge summary including date of discharge, and the name, address, telephone number, and relationship of the person or agency to whom the child was discharged, a summary of services provided during care, needs which remain to be met, and plans for the services needed to meet these goals.

(b) When the child placing agency has a written contract with another human services agency to provide homefinding services only, and the contract specifies that the contractor meets the provisions of (a) of this Rule, then the child placing agency is not required to comply with (a) of this Rule. A copy of the contract must be submitted to the Department.

(c) If the agency maintains a separate record on the family of children whom they place into care, the family's record must contain:

(1) demographic information including names, addresses, birth dates, races, religion, family composition, and Social Security numbers of significant family members;

(2) social histories, including any psychological or psychiatric reports and medical histories;

(3) strengths and needs of the family and the services required;

(4) signed agreements between the agency and family;

(5) summary of dates of contacts and progress toward goals;

(6) case review reports; and

(7) discharge summary.

(d) The agency shall keep all records current and shall document in the record the following events within one month of their occurrence: intake study, case plan, case plan reviews, and major events in the lives of the child or family members.

(e) The agency shall keep separate records for each family foster home which contain:

(1) application;

(2) home study;

(3) medical reports;

(4) dates and content of worker's contacts with the foster family;

(5) references from at least three sources;

(6) annual assessment of strengths and weaknesses of the foster family in providing care to children;

(7) chronological record of all placements of children receiving care in the home, including the dates of their care and an assessment of the care;

(8) annual licensing compliance study and reports connected with it; and

(9) when closed, a summary containing reasons for the closing of the home.

History Note: Authority G.S. 131D‑10.5; 143B‑153; Eff. February 1, 1986.

10A NCAC 70G .0206 ASSESSMENT AND TREATMENT/HABILITATION OR SERVICE PLAN

(a) When behavioral mental health treatment services are provided, the agency shall complete an assessment for each child prior to the delivery of services that shall include, but not be limited to:

(1) the child's presenting problem;

(2) the child's needs and strengths;

(3) the provisional or admitting diagnosis with an established diagnosis determined within 30 days of placement,

(4) a social, family and medical history; and

(5) evaluations or assessments, such as psychiatric, psychological, substance abuse, medical, vocational and educational, as appropriate to the child's needs.

(b) When services are provided prior to the establishment and implementation of the treatment/habilitation or service plan, hereafter referred to as the "plan", strategies to address the child's presenting problem shall be documented.

(c) The plan shall be developed based on the assessment, in partnership with the child, if age appropriate, and the legal custodian. A preliminary treatment plan shall be developed within 24 hours following placement. A comprehensive treatment plan shall be developed within 30 days of placement for children who are expected to receive services beyond 30 days of placement.

(d) The plan shall include:

(1) outcomes that are anticipated to be achieved by the provision of the service and a projected date of achievement;

(2) strategies for achieving the outcomes;

(3) staff responsibilities;

(4) foster parent responsibilities;

(5) a schedule for review of the plan at least annually in consultation with the child and the legal custodian;

(6) basis for an evaluation or assessment of outcome achievement; and

(7) written consent or agreement by the child and legal custodian or a written statement by the agency stating the reason such consent could not be obtained.

History Note: Authority G.S. 131D-10.5; 143B-153; S.L. 1999-237; Eff. July 18, 2002.

10A NCAC 70G .0207 CLIENT RECORDS FOR CHILDREN RECEIVING MENTAL HEALTH TREATMENT SERVICES

(a) A client record shall be maintained for each child accepted for behavioral mental health treatment services. This record shall contain, but need not be limited to:

(1) an identification face sheet that includes:

(A) name (last, first, middle);

(B) client record number;

(D) date of birth;

(E) race;

(F) gender;

(G) placement date; and

(H) discharge date;

(2) documentation of mental illness, developmental disabilities or substance abuse diagnosis coded according to the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition - Revised (DSM IV);

(3) documentation of screening and assessment;

(4) treatment/habilitation or service plan;

(5) emergency information for each child that shall include the name, address and telephone number of the person to be contacted in case of sudden illness or accident and the name, address and telephone number of the child's preferred physician;

(6) a signed statement from the child and legal custodian granting permission to seek emergency care from a hospital or physician;

(7) documentation of services provided;

(8) documentation of progress toward outcomes;

(9) educational assessments, records and reports of school age children;

(10) incident reports, including name of child or children involved, date and time of the incident, brief description of the incident, action taken by parents and the agency, need for medical attention, name of staff or parent completing the report, name of child's legal custodian, date and time of notification to the legal custodian and signature of agency staff reviewing the report;

(11) documentation of searches, including date and time of the search, action taken by parents and the agency, name of parent informing the agency, the time the agency is informed of the search, the name of the child’s legal custodian and the date and time of notification and signature of agency staff; and

(12) if applicable:

(A) documentation of physical disorders diagnosis according to International Classification of Diseases (ICD-9-CM);

(B) medication orders and Medication Administration Record (MAR);

(D) documentation of medication and administration errors;

(E) documentation of adverse drug reactions;

(F) legal documents; and

(G) record of prior placements.

(b) Each agency shall ensure that information relative to AIDS or related conditions is disclosed only in accordance with the communicable disease laws as specified in G.S. 130A-143.

History Note: Authority G.S. 131D-10.5; 143B-153; S.L. 1999-237; Eff. July 18, 2002.

10A NCAC 70G .0208 MEDICATION REQUIREMENTS

(a) Medication disposal. The agency shall dispose of controlled substances in accordance with the North Carolina Controlled Substances Act, G.S. 90, Article 5, including any subsequent amendments.

(b) Medication education:

(1) The agency shall ensure that each child started or maintained on a medication by a physician receives either oral or written education regarding the prescribed medication by the physician or their designee. In instances where the ability of the child to understand the education is questionable, the agency shall ensure that a responsible person receives either oral or written education regarding the prescribed medication by the physician or their designee and provides either oral or written instructions to the child.

(2) The agency shall ensure that the medication education provided is sufficient to enable the child or other responsible person to make an informed consent, to safely administer the medication and to encourage compliance with the prescribed regimen.

History Note: Authority G.S. 131D-10.5; 143B-153; S.L. 1999-237; Eff. July 18, 2002.

10A NCAC 70G .0209 BEHAVIOR MANAGEMENT AND DISCIPLINE

When an agency has policies and procedures regarding physical restraints, the agency shall:

(1) Within 48 hours of each physical restraint hold, review the incident report to ensure that correct steps were followed and forward the report to the legal custodian and the licensing authority on a report form developed by the licensing authority. If a child dies as a result of a physical restraint hold, the agency shall immediately report the death of the child to the legal custodian and to the licensing authority;

(2) Submit a summary report to the licensing authority by the 10^th day of each month indicating the number of physical restraint holds used during the previous month on each child and any injuries that resulted;

(3) For foster parents who utilize physical restraint holds, provide or arrange for at least 16 hours of training in behavior management, including techniques for de-escalating problem behavior, the appropriate use of physical restraint holds, monitoring of vital indicators, and debriefing children and parents involved in physical restraint holds. Thereafter, the agency shall ensure that foster parents authorized to use physical restraint holds annually complete at least eight hours of behavior management training, including techniques for de-escalating problem behavior; and

(4) Complete an annual review of the discipline and behavior management policies and techniques to verify that the physical restraint holds being utilized are being applied properly and safely. The review of the policies and techniques shall be documented and submitted biennially at the time of licensure as part of the application process.

History Note:Authority G.S. 131D-10.5; 143B-153; S.L. 1999-237; Eff. July 18, 2002.

subchapter 70g – child placing agencies: foster care

SECTION .0300 – best practice STANDARDS

10A NCAC 70G .0301 staffing requirements

(a) Effective July 1, 2008, social workers or case managers serving children in family foster homes shall serve no more than 15 children. Effective July 1, 2008, licensing social workers shall serve no more than 32 foster families. Effective July 1, 2008, agencies providing family foster care services may combine the duties of the social worker or case manager and licensing social worker, and serve no more than ten children and ten foster families. Effective July 1, 2008, social workers or case managers serving children in therapeutic foster homes shall serve no more than 12 children. Effective July 1, 2008, agencies providing therapeutic foster care services may combine the duties of the social worker or case manager and licensing social worker, and serve no more than eight children and eight foster families.

(b) When an agency employs five or more social workers or case managers, the agency shall employ a social work supervisor.

Supervisors Required	Social Workers or Case Managers
0	0-4 (executive director serves as social work supervisor)
1	5
2	6-10
3	11-15
There shall be one additional supervisor for every one to five additional social workers.

History Note: Authority G.S. 131D‑10.5; 143B-153;

Eff. September 1, 2007.

10A NCAC 70G .0302 TRAINING REQUIREMENTS

(a) Effective July 1, 2008, social workers or case managers shall receive 24 hours of continuing education annually.

(b) Effective July 1, 2008, social work supervisors shall receive 24 hours of continuing education annually.

History Note: Authority G.S. 131D‑10.5; 143B-153;

Eff. September 1, 2007.