SECTION .0100 - GENERAL

10A NCAC 70K .0101 DEFINITION
"Residential Maternity Home" means a facility which provides continuing full time care for adolescent and adult women during pregnancy and after delivery when delivery takes place in a licensed hospital. The rules in this Subchapter shall apply to persons intending to organize, develop, or operate a residential maternity home.

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

10A NCAC 70K .0102 ORGANIZATION AND ADMINISTRATION
Persons licensed or seeking licensure to provide residential maternity home care shall comply with requirements as specified in 10A NCAC 70F.

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

SECTION .0200 - MINIMUM LICENSURE STANDARDS

10A NCAC 70K .0201 PERSONNEL

(a) Staff Qualifications and Functions.
(1) Administrator. There shall be an administrator employed for the general management and supervision of the maternity home. The Administrator employed after the effective date of the rules of this Subchapter must have a bachelor's degree from a college or university accredited by the Association of Colleges and Schools and no less than four years work experience in a human services program including supervision, administration, and management. The Administrator shall have the following responsibilities:
(A) direct the maternity home's program of care and services in accordance with policies established by the governing board and within license standards;
(B) recruit, employ, supervise and discharge staff;
(C) assure a training program for staff;
(D) prepare the annual budget, supervise expenditures, and operate within the budget established;
(E) establish and maintain good working relationships with other social agencies and represent the agency in the community; and
(F) delegate authority to a qualified staff member during his absence.
(2) Professional Services Staff. The maternity home must have available professional services personnel to assure appropriate services for each resident of the home. Professional personnel must include a doctor, dentist, nurse, social worker, psychologist, psychiatrist, member of the clergy, nutritionist, health educator, and teacher. Whether services are purchased through a contractual agreement or provided by members of the maternity home staff or obtained through public or private agencies or on a voluntary basis, professional services must be provided by qualified practitioners who are recognized and accepted by applicable professional organizations and appropriate state licensing boards.
(3) Social Work Supervisor. If the maternity home employs staff to provide social work services, they shall employ a person who 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 an accredited school, 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.
(4) Social Services Worker. If the maternity home employs social workers to be responsible for intake services, providing casework services to the residents and their families, coordinating the services and resources affecting the client and their families, the social worker must have either a master's degree in social work or related field of study from an accredited school, or a bachelor's degree in social work or a related field and two years experience working directly in human services. If the social work staff are not supervised by a person meeting the qualifications of (a) (3) of this Rule, all social work staff shall meet these qualifications of (a) (3) of this Rule.
(b) Staffing Requirements. When an agency employs five or more social worker staff, the agency shall employ a social work supervisor.
(c) Resident Care Staff.
(1) Full time resident house parents or counselors must be employed for direct care of maternity home residents.
(2) All resident care staff hired after the effective date of the rules of this Subchapter shall be at least 18 years of age.
(d) Volunteer Workers. If the maternity home uses volunteers to work directly with residents, the requirements of 10A NCAC 70F .0207, apply.
(e) Additional Personnel Requirements. In addition to those requirements specified in 10A NCAC 70F .0207, the following rules are applicable to maternity home programs:
(1) Health Examinations. All resident care staff and food service staff shall have a physical examination completed by a physician, physician's assistant, or nurse practitioner, hereafter referred to as "licensed medical provider," within at least six months before beginning work and biennially thereafter. A TB skin test is required prior to assuming the position and annually thereafter, except when the licensed medical provider advises against it. Examinations must include tests necessary to determine that the staff member is able to carry out assigned duties and does not have any communicable disease or condition which poses significant risk of transmission in the facility. A report of each examination must be made a part of the employee's personnel file.
(2) Leave for Resident Care Staff. Resident care staff shall have a minimum of eight 24 hour days off duty each month.
(3) Staff Development. The maternity home staff shall have a written staff development plan which provides staff training in the following areas: medical, physical, and psychological aspects of pregnancy; prenatal and postnatal care; developmental needs of adolescents and young adults; counseling skills; emergency medical care; and nutrition and food preparation.

History Note: Authority G.S. 131D-1; 143B-153;
Eff. February 1, 1986;
Amended Eff. June 1, 1990;
RRC Objection Eff. April 15, 1993 Due to Lack of Statutory Authority;
Amended Eff. July 2, 1993.

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10A NCAC 70K .0202 SERVICES
The maternity home shall have a written statement of purpose and objectives, services offered, eligibility requirements, application procedures, and procedures for implementing all services. This information must be available to persons or agencies making inquiries.
(1) Social Services. The maternity home shall provide admission, residential, and discharge services to applicants, residents in care, and their families or legal custodians.
(a) Admission services must include an assessment of the need for maternity home care, for specific services for the applicant's individual needs, and must include information to determine if the maternity home's program of care and services can meet these needs.
(b) When an applicant who lives out of state is being considered for admission and the applicant is under the age of eighteen years, the provisions of the North Carolina interstate placement laws (G.S. 110-50 through 110-57.1) must be met.
(c) Staff responsibility must be clearly established for decisions on admissions.
(d) Applicants or legal custodians shall complete a written application before or upon admission. Written agreements must be made concerning release of information, medical care, and fees for care and services.
(e) An applicant accepted for care must be referred to and have a working agreement with a licensed child placing agency or county Department of Social Services of the applicant's choice for planning and decision making in relation to her baby. No maternity home staff member shall directly or indirectly assume responsibility for placement of children for adoption.
(f) Residential services throughout the period of care shall include counseling for each resident and for their families and significant others as indicated.
(g) Each resident must have the opportunity to talk privately with staff, families, significant others and social workers from child placing agencies or county departments of social services and to express grievance.
(h) Each resident must have assistance as requested in making the best use of her time in the maternity home, adjusting to the living situation, accessing all services needed, resolving personal and family problems, and planning for discharge.
(i) Discharge services for residents must include planning for living arrangements, employment or education, and for those residents planning to keep their babies, preparation for parenthood and support services for single parents.
(2) Psychological and Psychiatric Services. When indicated, arrangements must be made for a resident to have the services of a psychologist or a psychiatrist and for consultation for the staff providing care and services to the resident.

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

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10A NCAC 70K .0203 CASE RECORD
A confidential case record must be maintained for each resident which includes:
(1) a completed application for admission and services with identifying information about the resident;
(2) a summary of the referral source, background information about the resident, and an assessment of the services needed;
(3) authorization for medical care;
(4) authorization for receiving or sending information concerning the resident;
(5) copy of financial agreements;
(6) a copy of the agreement with the licensed child placing agency or county Department of Social Services providing services to the resident;
(7) date of admission to the maternity home and documentation of services provided including hospital care and delivery dates;
(8) date and circumstances of discharge from the maternity home and the resident's plans for herself and baby; and
(9) correspondence and contacts with other persons or agencies concerning the resident.

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

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10A NCAC 70K .0204 PROGRAM OF CARE
(a) The program of care must be suited to the needs of adolescent and adult women experiencing a problem pregnancy. There must be opportunity provided for private time, for family contacts, and for group fellowship.
(b) The residents must be free from duress to make their own decisions about releasing or keeping their babies.
(c) The residents must be provided confidentiality concerning their situations and protection from harm insofar as possible.
(d) No resident shall be directly involved in the solicitation of funds. Written permission must be obtained from the resident, or the legal custodian if the resident is a minor, before pictures or other means of identifying residents are used in publicity or public relations for the maternity home.
(e) Educational opportunities must be provided in accordance with the needs of individual residents and resources available in the community. For those residents who are required to attend school under the compulsory school attendance laws of North Carolina, the maternity home shall arrange for attendance in a public or a nonpublic school which is operated in accordance with the laws of North Carolina. If a school or educational program is maintained and operated by the maternity home which residents attend in lieu of attending public schools, the maternity home shall comply with the North Carolina General Statutes governing nonpublic schools. Opportunity must be offered to residents who wish to participate in educational courses available in the community.
(f) Health education to include information about pregnancy, delivery, and family planning services must be provided residents. Information about the care of infants shall be made available to the residents who want this information.
(g) Recreational activities must be provided which meet the needs of residents. Suitable space must be provided at the maternity home for both indoor and outdoor activities. Participation in community activities must be provided when appropriate.
(h) Work assignments in the maternity home must be geared to the physical health and emotional well-being of the residents in care. Residents shall be given the opportunity to voluntarily seek paid employment when employment is in accordance with the recommendation of their physician and other professional staff of the maternity home. No resident must be required to work for the purpose of paying the maternity home for her care.
(i) The maternity home shall define in writing and make available to applicants and residents those rules and regulations which the residents are expected to follow. These rules and regulations must respect the personal freedom of the residents. These rules and regulations must not infringe on the residents' rights to send and receive uncensored mail and for planned visits with their families and significant others. Visitors must not be allowed to visit minors without prior consent of the parents or legal custodian.
(j) Nutritious, foods must be provided in the variety and amounts necessary to meet the National Research Council's Recommended Daily Dietary Allowances. Special diets must be planned to meet the modified needs of individual residents as prescribed by a physician. Menus must be planned and written by, or in consultation with, a registered dietitian or nutritionist. Menus must be planned and written at least one week in advance. Snacks are to be recorded on the regular menu.
(k) The maternity home shall have an agreement with one or more licensed physicians to provide maternal health care and general health care for each resident. The maternity home shall have an agreement with a registered nurse who shall have responsibility for the organization and operation of nursing services within the home. A registered nurse or a licensed practical nurse must be available to provide direct nursing care for residents.
(l) Each resident shall be provided prenatal care which includes:
(1) a complete medical and obstetrical history and examination before or within one week after admission to the home;
(2) periodic examinations during pregnancy as outlined by the physician;
(3) dental services as indicated; and
(4) specialized medical services as needed.
(m) Each resident must be provided delivery care in a licensed hospital or any facility licensed as a place for delivery of babies. There must be an agreement with a licensed hospital to accept residents. The agreements must include measures to provide for the resident who requests confidentiality.
(n) When residents return to the maternity home, post delivery care must be available to the residents in accordance with the recommendations of the resident's physician and the professional staff of the maternity home. A resident must not be required to remain in the maternity home after medical discharge. Referral to a physician or medical clinic or community family planning resource must be made if requested by the resident.
(o) A record must be maintained at the maternity home which includes information given by the provider concerning all medical, psychological, and dental services provided to each resident.

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

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10A NCAC 70K .0205 PHYSICAL FACILITIES
(a) Location. The maternity home location shall be accessible to community resources including medical and hospital services, transportation, schools, churches, shopping, and recreation. There shall be yard space to provide privacy for outdoor activities.
(b) General Construction Requirements. Any building to be used as a maternity home must meet the requirements of Section 411 - Residential Occupancy (R) and related parts of the North Carolina State Building Code, Volume I, General Construction; Volume II, State Plumbing Code; Volume III, State Heating, Air Conditioning, Refrigeration, and Ventilation Code and Volume IV, State Electrical National Code NFPA #70. The maternity home shall care for no greater number of residents at any time than is specified by the license.
(1) New Construction. All local building codes and zoning regulations shall be complied with in the construction of a new maternity home, in the conversion of an existing building for use as a maternity home, and in the remodeling of an existing maternity home. Schematic drawings, design development drawings, and final construction documents for the construction of new facilities and the remodeling and modification of existing facilities must be submitted for approval to the Department of Health and Human Services, Division of Facility Services, Construction Section prior to beginning construction.
(2) Existing Buildings. Any maternity home in existence at the effective date of the rules of this Subchapter must meet the requirements of the edition of the North Carolina State Building Code in existence at the time the building was constructed.
(c) Fire Safety. The maternity home must be approved by the local building inspector or fire marshal before the home opens and annually thereafter. Compliance with recommendations to correct any hazards is required. In order to be eligible for a license, the maternity home must receive a satisfactory rating on inspection by the local building inspector or fire marshal before the home opens, and annually thereafter. Emergency evacuation plans must be posted. All residents and staff residing in the maternity home shall regularly participate in fire drills and all new residents shall immediately be instructed in evacuating the building in the event of fire. If smoking is allowed, there shall be designated smoking areas.
(d) Living Spaces. There must be an activities room for the use of the residents. There must be a separate room for residents to talk privately with staff and to receive visitors. There must be private, comfortable living areas for staff who live in the maternity home. Staff shall have a separate bedroom and bathroom from residents in care. A maternity home developed after the effective date of the rules of this Subchapter must provide in each bedroom a minimum of 80 square feet of floor space for each occupant except that a bedroom for one occupant must provide a minimum of 100 square feet. Each resident shall have a bed of her own, provided with springs, a comfortable mattress, and adequate bed covering. No day-bed, convertible sofa or other bedding of a temporary nature shall be used. Bedrooms must be equipped with closet and drawer spaces for storage of clothing and other personal belongings.
(e) Bath and Toilet Facilities. There must be no less than one lavatory with hot and cold water, one toilet and one tub or shower with hot and cold water for every five residents.
(f) General Environmental Health Requirements. The maternity home shall meet the requirements set forth in 15A NCAC 18A .1600. A copy of the annual inspection report must be submitted to the licensing authority.

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

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