North Carolina adult day care certification: county DSS study, DAAS rules and day health

Certification is the operating license here

North Carolina calls its adult day permit a certificate, but it is not optional and it is not tied to public funding. G.S. 131D-6 directs the Department of Health and Human Services to “annually inspect and certify all adult day care programs” ⁠¹. DAAS says on its adult day page that certification “is required for Adult Day Services providers regardless of funding” ⁠⁴.

The statute defines an adult day care program as “group care and supervision in a place other than their usual place of abode on a less than 24-hour basis to adults who may be physically or mentally disabled” ⁠¹. The rules define “adult” as 18 or older ⁠². The day program can be a stand-alone center, a program in your own house, or a space inside a church, school or senior center.

Three kinds of program are exempt ⁠¹:

• Programs that care for three people or fewer.
• Programs that care for two or more people, all of whom are related to the operator by blood or marriage.
• Programs that another statute requires DHHS to license.

The exemption has one catch. An exempt program that takes DAAS-administered Older Americans Act or Title XX social services money must still meet the 06R standards ⁠².

Some founders confuse this with residential licenses. If anyone sleeps over as a regular resident, you are looking at an adult care home or a family care home, which the Division of Health Service Regulation (DHSR) licenses. If you send aides to clients’ homes, see the home care agency license. Overnight respite inside a certified day program is a separate DHSR license, covered at the end of this guide ⁠⁷. How other states handle the same business is compared on the adult day care license page.

Choose your program type before you sign a lease

The rules set up five certification types. Each type carries its own ratio, space and nursing requirements, so the building you can use depends on the type you choose.

Scroll the table sideways to see every column.

Space figures exclude hallways, offices and restrooms ⁠²⁠³. Ratios count full-time-equivalent staff “with responsibility for direct participant care” ⁠²⁠³.

A day care home has two rules of its own. If the home was first certified after January 1, 2003, or has been structurally modified since then, the owner must live in it ⁠². If the operator is the only staff member, the operator must meet the program director qualifications, and you need qualified relief staff so the home can stay open when the operator is out ⁠².

The day health choice matters most for revenue. Only adult day health or combination programs may enroll or keep participants who need intravenous, intramuscular or subcutaneous medications during the day ⁠². Medicaid’s CAP/DA waiver pays only for adult day health ⁠¹⁰.

Who handles your file: the county DSS and DAAS

Two agencies are involved. The county department of social services is the “supervising agency”: it makes sure standards are kept and recommends certification to DAAS ⁠². DAAS is the “certifying agency” and issues the certificate ⁠². The DAAS information packet says consultation, monitoring and initial preparation for certification all happen at the county DSS ⁠⁵. For questions about opening a program or about building, renovating, leasing or buying a building for one, DAAS directs you to its adult day services consultant ⁠⁴.

So your first working contact is the adult day care coordinator or social worker at the DSS in the county where the program will operate, not Raleigh ⁠²⁠⁵. That worker gives technical assistance and conducts a “study” of your program. For a day care program the study uses Form DAAS-1500 (Adult Day Care Services Program Certification Report). For a day health or combination program it uses DAAS-6205 (Adult Day Health Services Program Certification Report) ⁠²⁠³. DAAS posts these on its forms page with the DAAS-6214 checklists, which cover the governing body, personnel, facility, nutrition, medications, emergencies, transportation, records, program evaluation and special care services ⁠⁶.

DAAS’s packet, dated September 2019, opens with a warning. Several programs have closed for financial reasons, and Home and Community Care Block Grant and State Adult Day Care Fund money has not grown, so “what money is available has been allocated to serve existing clients.” DAAS “strongly” advises applicants to consider whether they can operate without state or federal funding ⁠⁵.

Building, fire, sanitation and zoning sign-offs

The facility and grounds must be approved by the local environmental health specialist, the local fire safety inspector, the county department of social services and DAAS, and the facility must comply with all applicable zoning laws ⁠². The package also carries a signed building inspection report, so the local building inspector approves too ⁠². If a zoning variance was needed, the package must include written notice of it and its effective date ⁠².

• Building code. A facility first certified after January 1, 2003, or structurally modified since then, must meet the North Carolina State Building Code. The local building inspector must approve it for structural soundness and fire safety ⁠².
• Entrance. You need at least one ground-level entrance with no steps, or a ramp with rails, a slope no steeper than 1 in 12, and a non-skid surface secured at both ends ⁠².
• Toilets. At least one male and one female accessible toilet, one toilet per 12 adults (staff count), and one hand lavatory per two toilets ⁠²⁠³.
• Kitchen. If you cook on site, the kitchen must meet the food-service sanitation rules in 15A NCAC 18A .3300 ⁠².
• Floors and phone. Floor coverings must be fastened down, with no throw rugs, and participants must have a telephone they can use ⁠².
• Sole use. During program hours the certified area is for the program only, unless DAAS has identified it as shared space ⁠².

Day care homes have extra construction rules in Section .0700. Homes first certified or modified after 2003 must meet the listed residential code items: no attic storage, handrails on porches, stoops and steps, and accessible entrances, pathways and exits. Every home needs a fire extinguisher in the kitchen, smoke detectors, and listed heat detectors in the attic and basement ⁠².

Shared buildings need paperwork. A program in a church, school or other multi-use building needs a written agreement covering time of use, maintenance, equipment, security, liability and insurance. It must also be self-contained, with its own staff and its own area ⁠². If the space is already licensed for something else, for example by DHSR or the child care division, you need a letter from that licensing agency allowing the second use ⁠². Multi-use day health programs need a fire-rated “nucleus area” of at least 40 square feet per participant, plus at least 20 square feet per participant of other space in the facility ⁠³.

Furnishings are specified too. You need a sturdy chair for every participant and staff member, table space for everyone to eat at once, and cushioned, stain-resistant seating for at least half the participants to rest at the same time. If everyone rests at once, you need that seating for everyone. You also need a quiet room with at least one bed or cot ⁠².

Director, staffing and screening

The governing body is the owner or board for a for-profit, the board for a nonprofit, or the agency board for a public program. It must approve the organizational structure, adopt an annual budget, review finances monthly against the budget, get an annual audit, appoint the program director and adopt written policies ⁠². A day care home owner instead keeps an annual budget and monthly income and expense accounts ⁠². You must carry liability insurance on the facility and on any vehicles you use ⁠².

The program director must ⁠²:

• be at least 18;
• have two years of post-secondary education from an accredited institution, or a high school diploma (or the equivalent) plus at least five years of combined experience and training in services to older adults or adults with disabilities;
• have at least two years of supervisory and administrative work experience;
• present a medical statement from a physician, NP or PA, dated within the prior 12 months; and
• supply three references, one of them verifying previous employment.

A qualified director or substitute director must be on site whenever the program is open ⁠². If the director or operator changes, you must document the new person’s qualifications to the county DSS by the effective date of the change ⁠².

For all staff, the rules require the following ⁠²:

• A statewide criminal history search covering the past five years, run by an agency contracted with the Administrative Office of the Courts. The initial package must show this for the owner and every proposed direct-care staff member.
• A pre-employment medical statement dated within 12 months.
• References and a written job description for each position.
• An annual performance review.
• A written orientation and training plan.
• A written substitution plan that keeps the ratio when staff are absent.

Personnel policies must cover 15 listed topics, including maternity, military and civil leave, and must conform to the federal Fair Labor Standards Act ⁠². Every physically able direct-care staff member needs standard first aid and CPR. The instructor must be certified through the American Heart Association, American Red Cross, National Safety Council, American Safety and Health Institute or Emergency Medical Services ⁠². Substitutes may skip CPR and first aid only if trained staff are present at all times ⁠².

What the program must deliver every day

The 06R standards describe the service in operational detail.

• Hours. You must be open at least six hours a day and at least five days a week, apart from holidays, hazardous weather, emergencies and vacations. Tell the county DSS about weather or emergency late openings and early closures ⁠².
• Enrollment. Hold at least one personal interview before enrollment. Get the needs determination and the application signed before the first day ⁠². You need a medical examination report, completed within the prior three months, within 30 days of enrollment, and an annual update ⁠².
• Service plans. Within 30 days of enrollment, complete a comprehensive assessment and a written service plan. Review it at least every six months, and update progress notes at least every three months ⁠².
• Activities. Offer cognitive, physical and psychosocial activities daily, and post a written schedule weekly or monthly ⁠².
• Meals. Serve a midday meal that provides at least one-third of daily nutritional needs, on a menu approved by a licensed dietitian or nutritionist, plus mid-morning and mid-afternoon snacks. Provide prescribed therapeutic diets ⁠².
• Medications. Keep medications in the original pharmacy containers, labeled and locked, with a medication record updated at least quarterly ⁠².
• Emergencies. You need a fire safety and evacuation plan approved by the office of the fire marshal or its designee. Hold quarterly emergency drills (medical emergencies, natural disasters, facility security) and monthly fire drills, and document every drill. Post an evacuation plan in every room ⁠². Send incident reports to the county DSS within 72 hours ⁠².
• Transportation. The rules apply only when you provide it ⁠². If you do, every rider needs a seat and a seatbelt, a rest stop must be offered at least every 30 minutes, and each vehicle must carry a first aid kit, a fire extinguisher and the transportation policy ⁠².
• Evaluation. Write a plan for an annual internal evaluation, and keep the written report on file ⁠².

Your written program policies must include discharge criteria and notice procedures, the medication policy, participant rights, family grievance procedures, advance directives, non-discrimination, confidentiality, abuse and neglect reporting, the geographic area you serve, and inclement weather procedures. Each family gets a copy at enrollment ⁠².

Adult day health: the nurse and the treatment room

Adult day health is certified under 06S on top of most of 06R. 06S states its purpose directly: a provider must be certified to these standards before Medicaid (Title XIX) will pay for adult day health ⁠³. Participants must need at least one of the following during program hours: monitoring of a medical condition, help with or supervision of activities of daily living, or medication administration, special feedings or other health treatment ⁠³.

The added requirements are ⁠³:

• Health care coordinator. An RN or LPN licensed in North Carolina must be on site at least four hours a day. An LPN coordinator needs RN supervision, with on-site RN visits at least every two weeks. In a program with a capacity of 10 or fewer, one qualified person may serve as both director and coordinator.
• Personal care staff. They need nurse aide or home health aide training (or equivalent), or at least one year of experience caring for impaired adults.
• Facility. You need a private office and an enclosed treatment room. The room must have a sink (or connect to a room with one), a treatment table or bed, a locked supply cabinet and listed equipment, including a thermometer, blood pressure cuff, stethoscope and scales.
• Services. Required services include ADL help, health monitoring (vital signs, weight, dental health, nutrition and hygiene), help with treatment plans and diets, monthly health education and first aid.

Advertising dementia or special care

You may serve people with dementia without any extra filing ⁠¹. But if you provide or promote “special care services” for Alzheimer’s disease or other dementias, mental health disabilities or other special needs conditions, G.S. 131D-6 requires written disclosures to DHHS and to every family that inquires. The disclosures cover nine items, including your philosophy, staffing ratios, dementia-specific training, physical design and extra fees ⁠¹. DAAS checks them for accuracy at renewal, and you must report substantial changes when they happen ⁠¹.

Section .0900 of 06R adds operating requirements. Under Rule .0901, only programs that meet them may advertise special care ⁠². Those requirements include:

• an outdoor area that is secured or supervised;
• locked exits only with locking devices that meet the State Building Code’s special locking rules, and security monitoring where exits are not locked;
• training: each staff member must show knowledge of participants’ needs within a month, complete three training experiences within six months, and complete two population-specific trainings a year;
• for a separate unit: closed doors, a toilet inside the unit, and the same ratio as the center ⁠².

The certification package, in order

1. Talk to the county DSS

   Contact the department of social services in the county where the program will operate. That is where you apply, and its social worker provides technical assistance ⁠²⁠⁵.

2. Secure and furnish the site

   The DAAS packet says the forms and materials are assembled “once a location has been secured and furnished” ⁠⁵.

3. Write the governing documents

   Prepare program and personnel policies, an organizational diagram and job descriptions. A nonprofit sponsor also needs its articles of incorporation, bylaws and board member names and addresses ⁠².

4. Build the budget forms

   Complete Form 732a-ADS (Daily Rate Sheet) or an equivalent showing 12 months of planned spending and resources, including transportation costs and projected revenue. DAAS posts the daily rate sheet, a revenue sheet and directions for both ⁠²⁠⁶.

5. Draw the floor plan

   Show measurements, restrooms and the planned use of space ⁠².

6. Hire and screen staff

   For each proposed staff member, collect a medical statement (dated within 12 months) and, for direct-care staff, first aid and CPR proof. Run five-year statewide criminal checks on the owner and direct-care staff ⁠².

7. Schedule the inspections last

   Fire (DOA-1498), building (DOA-1499 for centers, DOA-1499a for homes) and sanitation (DENR-4054) reports must be signed no more than 30 days before the package is submitted. Add written notice of any zoning variance and its effective date ⁠².

8. Complete the county study

   The social worker completes DAAS-1500 or DAAS-6205 and submits the package to DAAS, with a copy to you. If the study shows the standards cannot all be met, the county must tell you in writing why and let you withdraw or fix the defect by its deadline ⁠³.

9. Host the DAAS visit

   After reviewing the package, DAAS staff may make a pre-certification visit under 06R; 06S says one shall be made for day health programs ⁠²⁠³.

10. Receive the decision

    DAAS notifies you and the county in writing within 14 business days of the package review and visit ⁠². If all standards are met, the program “is issued an annual certification and can begin operation” ⁠⁵.

DAAS publishes no overall processing time beyond the 14-business-day decision.

Fees, term and renewal

No certification fee appears in G.S. 131D-6, 06R or 06S, and none appears on the DAAS adult day pages checked October 12, 2026 ⁠¹⁠²⁠³⁠⁴. The overnight respite license is the exception, at $350 initial and $315 a year ⁠⁷. Your real costs are the inspections, the building work and staffing. DAAS’s 2019 packet relays a North Carolina Adult Day Services Association estimate: an annual operating budget of at least $150,000 for a center serving 20 to 25 participants, and start-up costs averaging $80,000 to $150,000. That estimate is the association’s, not a state figure ⁠⁵.

The certificate is issued by DAAS, must be posted where anyone entering can see it, and is valid 12 months from issuance ⁠². For renewal, the county submits a package no more than 90 days before the certificate ends, under both 06R and 06S. The DAAS-1500 (DAAS-6205 for day health) must reach DAAS at least 30 days before expiration ⁠²⁠³. The renewal package contains ⁠²:

• fire and sanitation reports dated within the past 12 months;
• a building report if you made structural changes;
• medical statements for staff hired since the last certification;
• any updated policies, diagrams or floor plan;
• a new 732a-ADS;
• CPR and first aid proof; and
• criminal check evidence.

If renewal materials arrive after DAAS’s requested date but before expiration, DAAS issues a provisional certificate. If they are not received by the expiration date, the certificate terminates ⁠². It also terminates automatically when a for-profit program’s ownership transfers in its entirety, when a nonprofit or public program’s board is dissolved, or when the program moves ⁠². A buyer or a relocating program therefore starts a new certification rather than inheriting the old one.

Inspections, corrective action and penalties

Programs are inspected annually, with both announced and unannounced visits ⁠². Corrective action deadlines depend on severity ⁠²:

• Immediate danger: correct on the spot and document in writing within 72 hours.
• Potential danger: correct within 30 days of written notice.
• No danger (records or administration): correct within 90 days.

Missing a deadline is a “willful violation.” That can lead to a provisional certificate (no longer than six months, or up to 180 days after a disaster), revocation, or daily civil penalties ⁠². The rules set the penalties at $100 a day for a clear and immediate danger, $50 a day for potential danger and $10 a day for violations that do not directly endanger participants, counted from the missed correction date ⁠². The statutory ceiling is $100 per violation, with each day a separate violation ⁠¹. Harming or willfully neglecting a participant is a Class 1 misdemeanor ⁠¹.

Denials and revocations take effect 20 days after you receive the notice, and DAAS can summarily suspend a certificate in an emergency ⁠². You can ask DAAS staff for an informal review, then petition the Office of Administrative Hearings within 60 days. Except after a summary suspension, enforcement is suspended while the appeal runs ⁠².

How North Carolina programs get paid

Certification does not guarantee any funding ⁠⁵. DAAS’s funding fact sheet lists these sources for certified programs ⁠⁵:

• Home and Community Care Block Grant. Older Americans Act and state money, run through the Area Agencies on Aging, for participants 60 or older. For adult day services, DAAS describes eligible people as “frail” and needing substantial help with at least two activities of daily living or substantial supervision ⁠⁴.
• State Adult Day Care Fund. Distributed to counties and used through vendor agreements with the county DSS.
• Medicaid CAP/DA. The packet lists programs with the day health component as potentially eligible.
• NC Innovations waiver. Covers adults with intellectual and developmental disabilities, through the LME/MCOs.
• VA. The packet lists day health programs as potentially eligible, through contracted reimbursement for qualifying veterans.
• Child and Adult Care Food Program. Reimburses meals for public and private nonprofit programs. You must still meet the 06R nutrition rules.
• Medicare Part B. It does not pay for daily care.

NC Medicaid’s CAP/DA policy (3K-2, amended September 1, 2025) covers a beneficiary’s attendance at a certified adult day health facility, for at least four hours a day on a regular schedule ⁠¹⁰. To bill, a provider must hold DAAS certification under 06R and 06S and meet the federal HCBS settings rule, and the beneficiary’s case management entity must issue a service authorization ⁠¹⁰. Check whether your target market is CAP/DA before choosing between a social day care center and day health.

Overnight respite and the July 2026 change

A certified adult day care or day health program can offer 24-hour overnight respite only with a separate annual DHSR license under G.S. 131D-6.1. DHSR inspects construction and operations, and the fees are $350 initial and $315 a year ⁠⁷. The Medical Care Commission’s rules are in 10A NCAC 13E ⁠⁸. Respite for each adult is limited to 14 consecutive days and 60 total days in any 365-day period, or the amount the Innovations or CAP/DA waiver allows ⁠⁷.

The version of G.S. 131D-6.1 that took effect July 1, 2026 (S.L. 2026-1) made two changes ⁠⁷:

• It raised the cap from six beds per adult day program to 12 beds per facility.
• It wrote staffing floors into the statute. One awake staff member, qualified to give medications, must be present for a census of one to six. Two awake staff, at least one medication-qualified, must be present for seven to 12. Neither may do housekeeping or food service during a care shift.

The statute still sends the detailed rules to the Medical Care Commission, so check DHSR for amendments to 13E ⁠⁷⁠⁸. DHSR’s overnight respite listing, checked October 12, 2026, showed one licensed facility statewide, in Wake County, licensed for six ⁠⁹.

Sources

1. 1
   North Carolina General Assembly, G.S. 131D-6: Certification of adult day care programs; purpose; definition; penalty Checked 12 Oct 2026 · Back to text ↑
2. 2
   North Carolina Office of Administrative Hearings, 10A NCAC 06R: Adult Day Care Standards for Certification Checked 12 Oct 2026 · Back to text ↑
3. 3
   North Carolina Office of Administrative Hearings, 10A NCAC 06S: Adult Day Health Standards for Certification Checked 12 Oct 2026 · Back to text ↑
4. 4
   NC DHHS, Division of Aging and Adult Services, Adult Day Services / Adult Day Health Services Checked 12 Oct 2026 · Back to text ↑
5. 5
   NC DHHS, Division of Aging and Adult Services, Certification of Adult Day Services: ADC Information Request Packet (September 2019) Checked 12 Oct 2026 · Back to text ↑
6. 6
   NC DHHS, Division of Aging and Adult Services, Adult Day Care Forms Checked 12 Oct 2026 · Back to text ↑
7. 7
   North Carolina General Assembly, G.S. 131D-6.1: Licensure to offer overnight respite; rules; enforcement Checked 12 Oct 2026 · Back to text ↑
8. 8
   North Carolina Office of Administrative Hearings, 10A NCAC 13E: Licensing of Overnight Respite Services Checked 12 Oct 2026 · Back to text ↑
9. 9
   NC DHHS, Division of Health Service Regulation, Overnight Respite Facilities Checked 12 Oct 2026 · Back to text ↑
10. 10
    NC Medicaid, NC DHHS, Clinical Coverage Policy 3K-2: Community Alternatives Program for Disabled Adults (CAP/DA), amended September 1, 2025 Checked 12 Oct 2026 · Back to text ↑

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