AN ACT to protect adult care home residents by increasing minimum continuing education, training, and competency evaluation requirements for adult care home medication aides, strengthening adult care home infection control requirements, and requiring the department of health and human services, division of health service regulation, to annually inspect adult care homes for compliance with safe infection control standards.

The General Assembly of North Carolina enacts:

SECTION 1.  G.S. 131D‑4.5(1) reads as rewritten:
"(1)	Establishing minimum medication administration standards for adult care homes. The rules shall include the minimum staffing and training requirements for medication aides and standards for professional supervision of adult care homes' medication controls. The requirements shall (i) include compliance with G.S. 131D‑4.5B and (ii) be designed to reduce the medication error rate in adult care homes to an acceptable level. The requirements shall include, but need not be limited to, all of the following:
a.	Training for medication aides, including periodic refresher training.
b.	Standards for management of complex medication regimens.
c.	Oversight by licensed professionals.
d.	Measures to ensure proper storage of medication."
SECTION 2.  G.S. 131D‑4.5(3) reads as rewritten:
"(3)	Establishing minimum training and education qualifications for supervisors in adult care homes and specifying the safety responsibilities of supervisors. The minimum training qualifications shall include compliance with G.S. 131D‑4.5C."
SECTION 3.  Article 1 of Chapter 131D of the General Statutes is amended by adding two new sections to read:
"§ 131D‑4.4A.  Adult care home infection prevention requirements.
(a)	As used in this section, "adult care home staff" means any employee of an adult care home involved in direct resident care.
(b)	In order to prevent transmission of HIV, hepatitis B, hepatitis C, and other bloodborne pathogens, each adult care home shall do all of the following, beginning January 1, 2012:
(1)	Implement a written infection control policy consistent with the federal Centers for Disease Control and Prevention guidelines on infection control that addresses at least all of the following:
a.	Proper disposal of single-use equipment used to puncture skin, mucous membranes, and other tissues, and proper disinfection of reusable patient care items that are used for multiple residents.
b.	Sanitation of rooms and equipment, including cleaning procedures, agents, and schedules.
c.	Accessibility of infection control devices and supplies.
d.	Blood and bodily fluid precautions.
e.	Procedures to be followed when adult care home staff is exposed to blood or other body fluids of another person in a manner that poses a significant risk of transmission of HIV, hepatitis B, hepatitis C, or other bloodborne pathogens.
f.	Procedures to prohibit adult care home staff with exudative lesions or weeping dermatitis from engaging in direct resident care that involves the potential for contact between the resident, equipment, or devices and the lesion or dermatitis until the condition resolves.
(2)	Require and monitor compliance with the facility's infection control policy.
(3)	Update the infection control policy as necessary to prevent the transmission of HIV, hepatitis B, hepatitis C, and other bloodborne pathogens.
(4)	Designate one on‑site staff member for each noncontiguous facility who is knowledgeable about the federal Centers for Disease Control and Prevention guidelines on infection control to direct the facility's infection control activities and ensure that all adult care staff is trained in the facility's infection control policy. Beginning October 1, 2013, any nonsupervisory staff member designated to direct the facility's infection control activities shall complete the infection control course developed by the Department pursuant to G.S. 131D‑4.5C.
"§ 131D‑4.4B.  Guidelines for reporting suspected communicable disease outbreaks.
The Department shall develop guidelines prescribing the manner in which an adult care home is to report a suspected communicable disease outbreak within the facility to the local health department."
SECTION 4.  G.S. 131D‑2.11(a) reads as rewritten:
"(a)	State Inspection and Monitoring. – The Department shall ensure that adult care homes required to be licensed by this Article are monitored for licensure compliance on a regular basis. All facilities licensed under this Article and adult care units in nursing homes are subject to inspections at all times by the Secretary. The Division of Health Service Regulation shall inspect all adult care homes and adult care units in nursing homes on an annual basis. Beginning July 1, 2012, the Division of Health Service Regulation shall include as part of its inspection of all adult care homes a review of the facility's compliance with G.S. 131D‑4.4A(b) and safe practices for injections and any other procedures during which bleeding typically occurs. In addition, the Department shall ensure that adult care homes are inspected every two years to determine compliance with physical plant and life‑safety requirements."
SECTION 5.  Article 1 of Chapter 131D of the General Statutes is amended by adding two new sections to read:
"§ 131D‑4.5B.  Adult care home medication aides; training and competency evaluation requirements.
(a)	By January 1, 2012, the Division of Health Service Regulation shall develop a mandatory, annual in‑service training program for adult care home medication aides on infection control, safe practices for injections and any other procedures during which bleeding typically occurs, and glucose monitoring. Each medication aide who successfully completes the in‑service training program shall receive partial credit, in an amount determined by the Department, toward the continuing education requirements for adult care home medication aides established by the Commission pursuant to G.S. 131D‑4.5.
(b)	Beginning October 1, 2013, an adult care home is prohibited from allowing staff to perform any unsupervised medication aide duties unless that individual has previously worked as a medication aide during the previous 24 months in an adult care home or successfully completed all of the following:
(1)	A five‑hour training program developed by the Department that includes training and instruction in all of the following:
a.	The key principles of medication administration.
b.	The federal Centers for Disease Control and Prevention guidelines on infection control and, if applicable, safe injection practices and procedures for monitoring or testing in which bleeding occurs or the potential for bleeding exists.
(2)	A clinical skills evaluation consistent with 10A NCAC 13F .0503 and 10A NCAC 13G .0503.
(3)	Within 60 days from the date of hire, the individual must have completed the following:
a.	An additional 10‑hour training program developed by the Department that includes training and instruction in all of the following:
1.	The key principles of medication administration.
2.	The federal Centers of Disease Control and Prevention guidelines on infection control and, if applicable, safe injection practices and procedures for monitoring or testing in which bleeding occurs or the potential for bleeding exists.
b.	An examination developed and administered by the Division of Health Service Regulation in accordance with subsection (c) of this section. (c)	By October 1, 2012, the Division of Health Service Regulation shall develop and administer an examination for individuals seeking employment as a medication aide in an adult care home.
"§ 131D‑4.5C.  Adult care home supervisors; infection control training requirements.
By December 1, 2011, the Department shall develop a mandatory, annual course for adult care home supervisors on federal Centers for Disease Control and Prevention guidelines on infection control. Each supervisor that successfully completes the mandatory infection control course shall receive credit, in an amount determined by the Department, toward the continuing education requirements for adult care home supervisors established by the Commission pursuant to G.S. 131D‑4.5."
SECTION 6.  This act is effective when it becomes law.
In the General Assembly read three times and ratified this the 25th day of May, 2011.

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		 Walter H. Dalton
	 President of the Senate

	_____________________________________
		 Thom Tillis
	 Speaker of the House of Representatives

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		 Beverly E. Perdue
	 Governor

Approved __________.m. this ______________ day of ___________________, 2011