North Carolina adult care home rules: what you must document about each resident

If you run an adult care home in North Carolina, the rules already ask for much of what good person-centered care depends on: who the resident was before they moved in, what they like, and how they want care delivered. Below we quote the relevant rules from 10A NCAC 13F and explain what each one asks you to write down.

Who these rules cover

In North Carolina statute, "assisted living residence" is the umbrella term, and the licensed setting most communities operate is the adult care home, defined as "an assisted living residence in which the housing management provides 24-hour scheduled and unscheduled personal care services to two or more residents."⁶ Homes with seven or more residents follow 10A NCAC 13F. Family care homes, defined as adult care homes "having two to six residents," follow a parallel set of rules in 10A NCAC 13G, which this page does not quote. Licensing and inspections sit with the Division of Health Service Regulation within the NC Department of Health and Human Services.

An adult care home, or a section, wing or program within one, that is "designated or advertised especially for special care of residents with Alzheimer's Disease or related disorders" is a special care unit with extra rules in Section .1300.⁴

The resident assessment: 30 days, and a real social history

The clock is simple:

The facility shall complete an assessment of each resident within 30 days following admission and annually thereafter.10A NCAC 13F .0801(a)

You may use the Department's assessment instrument or build your own, as long as yours "contains at least the same information." The rule describes the assessment as functional, covering "psychosocial well-being, cognitive status, and physical functioning in activities of daily living." Then it lists fifteen items the Department's instrument includes. Most are clinical: diagnoses, medications, ADLs, mood and behaviors, nutrition, skin, memory, vision and hearing. Item seven is the one that matters for this page:

social history, to include family structure, previous employment and education, lifestyle habits and activities, interests related to community involvement, hobbies, religious practices, and cultural background;10A NCAC 13F .0801(b)(7)

That is close to Washington's model. It asks for the resident's family, work life, schooling, daily habits, hobbies, faith and culture. It does not use the words "sources of comfort" or "personal identity," but the social history covers much of the same ground.

The assessment must be completed and signed by the person the administrator designates, who must meet the training requirements in Rule .0508.

Significant change

When staff notice a change in baseline condition, the facility may monitor for up to 10 days to decide whether it is significant. Once it identifies a significant change, the reassessment deadline is short:

The facility shall conduct an assessment of a resident within three days after the facility identifies that a significant change in the resident's baseline condition has occurred.10A NCAC 13F .0801(c)

The rule lists what counts, including decline in two or more ADLs, repeated falls, new pain, unplanned weight change, hospice enrollment, and "change in the pattern of usual behavior." That last item is a reason to know each resident's usual pattern in the first place.

The care plan: resident-centered, with preferences

The care plan rule was readopted effective June 1, 2025, and it now says plainly:

The care plan shall be resident-centered and include the resident's preferences related to the provision of care and services.10A NCAC 13F .0802(a)

The plan must describe the services, supervision, tasks and level of help to be provided for the needs found in the assessment, how often, and any licensed health professional tasks. It carries the assessor's dated signature and the physician's (or physician extender's) dated signature within 15 days of completion. The resident must be offered the chance to take part in writing it; if cognitive impairment prevents that, the responsible person is offered the chance instead.² The plan is revised as needed after a significant change assessment.

"Preferences related to the provision of care" is broad. Whether a resident showers in the morning or evening, likes a woman or man to help with bathing, or wants coffee before being spoken to are all fair game, and they are the details new staff most often miss.

Activities and social programming

North Carolina's activities rule is detailed and connects directly back to the admission record. The activity director must:

use information on the residents' interests and capabilities as documented upon admission and updated as needed to arrange for or provide planned individual and group activities for the residents, taking into account the varied interests, capabilities, and possible cultural differences of the residents;10A NCAC 13F .0905(c)(1)

Other requirements in the same rule:

• At least 14 hours per week of a variety of planned group activities that promote socialization, physical interaction, group accomplishment, creative expression, increased knowledge and new skills.³
• Opportunities for one-to-one interaction and activity by oneself.
• A legible monthly calendar of group activities posted by the first day of each month.
• At least one outing every other month for each resident, plus volunteer opportunities that are never required.
• An evaluation of the program's effectiveness at least every six months, "with input from the residents to determine what have been the most valued activities."

No resident may be required to join an activity against their will.

Special care units for Alzheimer's and related disorders

Special care units layer more requirements on top of the assessment and care plan rules. The central one is a written profile:

Within 30 days of admission to the special care unit and quarterly thereafter, develop a written resident profile containing assessment data that describes the resident's behavioral patterns, self-help abilities, level of daily living skills, special management needs, physical abilities and disabilities, and degree of cognitive impairment.10A NCAC 13F .1307(1)

The care plan is then developed or revised from that profile and must specify "environmental, social and health care strategies" to help the resident keep as much function as possible.⁵ The unit's written policies must address, among other things, family involvement in care planning and "activity plans based on personal preferences and needs of the residents."⁴

What surveyors tend to look for

Based only on what the rules ask you to document, a reviewer checking a resident record can expect to find:

• A signed assessment dated within 30 days of admission and within a year of the last one, with every item on the Department's list covered, including the social history.
• A care plan that reflects the assessment, names the resident's preferences, shows the resident or responsible person was offered a role, and has the physician signature within 15 days.
• A reassessment within three days of any identified significant change, with the care plan revised.
• Evidence that activity planning uses documented interests: the calendar, the 14 weekly hours, and the six-month program evaluation with resident input.
• For special care units: a resident profile within 30 days and every quarter, and a care plan built on it.

Gathering the social history well

A social history section can turn into one-word answers: "retired," "Baptist," "likes TV." A few habits make it useful to the people who read it later:

• Ask open questions in the first two weeks. "Tell me about your first job." "What did Sunday look like in your house?" "What were you known for?" You get work, faith, family and habits in one conversation.
• Include family. For residents with memory loss, children and old friends can fill in names, places and routines. Ask them the same open questions.
• Write down comforts and things to avoid. The hymn that settles someone, the nickname they prefer, a loss they do not want raised. These belong in the care plan as preferences.
• Feed it to the activity director. The rule expects activities to use interests documented at admission. Make sure the social history reaches that desk.
• Revisit at the annual assessment and quarterly SCU profile. Update what has changed, and add what you have learned since.

How Porchlight can help

Porchlight helps you gather and keep the social history and preferences the assessment and care plan ask for, in the resident's own words. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and the spoken answer is recorded and transcribed. More than 800 human-written questions are organized by life chapter; the resident or staff can pick a topic, skip any question, and nothing is scored. Staff can record profile facts, including topics to avoid. Family get a private page to listen, leave voice replies, and add their own questions and photos. Staff get a Know Your Resident briefing with conversation starters, story highlights, a printable life-story biography and a Monday email digest. The assessment, the care plan and compliance remain your team's responsibility.

Frequently asked questions

How soon must a North Carolina adult care home assess a new resident?

Within 30 days following admission, and annually after that, under 10A NCAC 13F .0801(a). A new assessment is also required within three days after the facility identifies a significant change in the resident's baseline condition.

Does North Carolina require a social history in the resident assessment?

Yes. The Department's assessment instrument must include a social history covering family structure, previous employment and education, lifestyle habits and activities, interests related to community involvement, hobbies, religious practices, and cultural background. A facility-built instrument must contain at least the same information.

Must the care plan include the resident's preferences?

Yes. Under 10A NCAC 13F .0802(a), the care plan must be based on the assessment, be resident-centered, and include the resident's preferences related to the provision of care and services. The resident, or the responsible person if the resident cannot participate, must be offered the chance to help develop it.

How many hours of activities does a North Carolina adult care home need?

At least 14 hours per week of a variety of planned group activities, plus opportunities for one-to-one and solo activities, an outing at least every other month, and volunteer opportunities. The activity director must plan around residents' interests as documented on admission and evaluate the program at least every six months with resident input.

What extra documentation does a special care unit need?

Within 30 days of admission to the special care unit and quarterly after that, the facility must write a resident profile describing behavioral patterns, self-help abilities, daily living skills, special management needs, physical abilities, and degree of cognitive impairment. The care plan is developed or revised from that profile, and the unit's policies must include activity plans based on personal preferences.