The administrator or supervisor-in-charge shall furnish and review with the resident or his responsible person information on the family care home upon admission and when changes are made to that information.  A statement indicating that this information has been received upon admission or amendment as required by this Rule shall be signed and dated by each person to whom it is given.  This statement shall be retained in the resident’s record in the home.  The information shall include:

(1)           a copy of the home’s resident contract specifying rates for resident services and accommodations, including the cost of different levels of service, if applicable, any other charges or fees, and any health needs or conditions the home has determined it cannot meet pursuant to G.S. 131D-2(a1)(4).  In addition, the following applies:

(a)           The contract shall be signed and dated by the administrator or supervisor-in-charge and the resident or his responsible person and a copy given to the resident or his responsible person;

(b)           The resident or his responsible person shall be notified as soon as any change is known, but not less than 30 days for rate changes initiated by the home, of any rate changes or other changes in the contract affecting the resident services and accommodations and be provided an amended copy of the contract for review and signature;

(c)           A copy of each signed contract shall be kept in the resident’s record in the home;

(d)           Gratuities in addition to the established rates shall not be accepted; and

(e)           The maximum monthly rate that may be charged to Special Assistance recipients is established by the North Carolina Social Services Commission and the North Carolina General Assembly;

Note:  Facilities may accept payments for room and board from a third party, such as family member, charity or faith community, if the payment is made voluntarily to supplement the cost of room and board for the added benefit of a private room.

(2)           a written copy of any house rules, including the conditions for the discharge and transfer of residents, the refund policies, and the home’s policies on smoking, alcohol consumption and visitation  consistent with the rules in this Subchapter and amendments disclosing any changes in the house rules;

(3)           a copy of the Declaration of Residents’ Rights as found in G.S. 131D-21;

(4)           a copy of the home’s grievance procedures which shall indicate how the resident is to present complaints and make suggestions as to the home’s policies and services on behalf of self or others; and

(5)           a statement as to whether the home has signed Form DSS-1464, Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964 for Other Agencies, Institutions, Organizations or Facilities, and which shall also indicate that if the home does not choose to comply or is found to be in non-compliance the residents of the home would not be able to receive State-County Special Assistance for Adults and the home would not receive supportive services from the county department of social services.