County Informal Dispute Resolution Procedures

Summary: The Adult Care Licensure Section (ACLS) is the state government entity responsible for regulating and licensing adult care homes in North Carolina. The County Department of Social Services (DSS) is the county entity responsible for monitoring and investigating complaints or grievances in adult care home facilities within their respective county. The purpose of Informal Dispute Resolution (IDR) is to provide licensees an opportunity to dispute Type A1, Type A2 or Unabated Type B violations cited during a county monitoring visit or complaint investigation.

IDR Request Deadline: IDR requests must be submitted in writing within the 15 working days afforded the facility to submit a Plan of Correction, as indicated in the official Corrective Action Report (CAR) letter. The postmark date of the IDR request must be on or before the IDR request deadline. If the licensee exceeds this time frame, the IDR Coordinator will deny the request for IDR.

IDR requests must be submitted in writing to the Division of Health Service Regulation, Adult Care Licensure Section, at the following address:

IDR Coordinator, ACLS
2708 Mail Service Center

Raleigh, NC 27699-2708

IDR Request Letters: In accordance with G.S. § 131D-2.11(a3), each adult care home shall be offered an opportunity, at the facility's request, to informally resolve disputed findings from inspections conducted by the County Department of Social Services that resulted in the citation of a Type A1 violation, Type A2 violation, Unabated Type A1, Unabated Type A2 violation and/or Unabated Type B violation. Facilities may also contest the severity of noncompliance that resulted in a violation determination. To be given such an opportunity, facilities are required to send a written request for IDR clearly identifying the specific violation(s) being disputed. An explanation of why the violation(s) is being disputed (or why the severity of noncompliance is being disputed) along with any supporting documentation must be sent and postmarked by the IDR request deadline. The facility must submit two hard copies of the IDR request letter and any supplemental information.

Submission of Additional Written Material: The facility may submit additional written information for review. The material must be included with the IDR request letter or submitted separately on or before the IDR request deadline. The facility must submit two hard copies and highlight or clearly identify the information that is pertinent to the disputed violation(s) or finding(s). Any material that does not meet these requirements will not be reviewed. The IDR may be held without submission of additional written material. The submission of documentation at the IDR meeting is not allowed, however, the information can be presented verbally. Any written material pertaining to the performance of a County DSS Adult Home Specialist(s) shall be submitted directly to the County DSS Supervisor and not included in the IDR process.

Scheduling IDR Meetings: Upon receipt of a written request for IDR, the IDR Coordinator will determine if the request meets the requirements outlined in the IDR policies and procedures. If the request is postmarked past the 15-day deadline, the IDR Coordinator will notify the licensee that the request has been denied. However, any information submitted by the licensee will still be forwarded to the County DSS staff for their review and action.

If the IDR request is approved, the IDR Coordinator will schedule the IDR meeting and notify the licensee in writing. The request letter and any supporting documentation will first be shared with the County DSS staff to determine what effect the information may have on the cited violation or finding. The county’s decision should be communicated in writing to the IDR Coordinator within 10 days of receipt of the information. If the Adult Home Specialist, in conjunction with the County DSS Supervisor, decides to amend the Corrective Action Report (CAR), the IDR Coordinator will be notified of the specific changes and provided a copy of the amended report. The IDR Coordinator will then notify the licensee in writing of the county’s decision and ask the licensee to confirm whether or not the facility wants to proceed with the IDR. If the facility wishes to proceed, the IDR Coordinator will communicate the status of the IDR meeting to the County DSS staff, IDR panel, and ACLS management staff via email.

IDR Meeting Format: IDR meetings are typically scheduled for a one-hour timeframe unless the number of deficiencies being disputed cannot reasonably be reviewed and discussed within one hour. The IDR cannot be rescheduled. Providers should find an alternate representative to attend if they are unable to. The IDR will be conducted virtually using Cisco Webex Meetings for all parties to include: the facility, three panel members and the survey team. All panel members must be present to hold the IDR Meeting.

IDR Notification and Attendance: The IDR Coordinator ensures that the IDR panel members, County DSS staff, and state long-term care ombudsman are notified of the facility’s IDR request as well as the date, time, and format of the IDR meeting.

Attorneys and other legal representatives are not allowed to attend the IDR meeting.The following individuals may attend and are responsible for protecting the confidentiality of resident information:

  1. Facility representatives and staff;
  2. County DSS staff, ACLS observers and/or ACLS management staff;
  3. State and regional long-term care ombudsmen; and
  4. Resident(s) affected by the violation, the resident’s legal guardian and/or health care power of attorney. [Note: These individuals can only stay during the discussion of information pertinent to the specific resident.They must be identified prior to the start of the IDR meeting.]

Facility representatives and staff, ombudsmen, the resident, and the resident’s legal guardian or health care power of attorney may provide verbal information pertinent to the violations being disputed and respond to questions from the IDR panel members. With the exception of facility representatives and staff, oral statements will be limited to five minutes.

The facility representatives or staff will first present information to the panel. The County DSS staff may request to address the IDR panel to clarify information or to seek clarification of the information presented by the facility. The panel may ask questions of the facility and/or County DSS staff. Facility staff cannot ask direct questions to County DSS staff. All participants in the IDR process are expected to keep their demeanor professional, respectful and non-confrontational when presenting information which may be contradictory to information provided by others. ACLS observers and management will not participate in the discussion. However, ACLS management may intervene if the interaction or behavior of the participants is inappropriate and disruptive to the meeting. It is expected that the IDR Coordinator will direct and facilitate the meeting and intervene as necessary to maintain the rules of conduct as well as the focus of the presentations and interactions. The IDR meeting can be terminated if resolution of inappropriate behavior cannot be attained in a timely manner.

IDR Panel: The panel consists of one ACLS survey staff, one adult care home provider representative recommended by the North Carolina Assisted Living Association (NCALA) and/or the North Carolina Association of Long Term Care Facilities (NCALTCF) and approved by the ACLS, and one County DSS staff (not involved in the disputed inspection) recommended by the North Carolina Association of County Directors of Social Services (NCACDSS) and/or the North Carolina Adult Foster Care Association (NCAFCA) and approved by the ACLS. The IDR Coordinator will provide a copy of the IDR request packet to each panel member for review at least two weeks prior to the scheduled IDR meeting. The packet will include the IDR request letter, CAR, and any additional information submitted by the facility. Only those violations identified in the facility’s request will be reviewed in IDR. The panel members will not discuss the report or details of the report with County DSS staff, facility staff or any others before or following the IDR meeting. The panel members will have reviewed the IDR packet prior to the IDR meeting.

IDR Results: After the IDR meeting, panel members will convene privately to review and discuss the information provided. The IDR panel will decide that a violation or finding is to be upheld or deleted, that a violation is to be upheld with deletion of a finding(s), or that the severity of the violation should be lowered. The panel shall not decide to move a violation or suggest that a violation or finding is to be rewritten. The IDR panel will then provide their final decision in writing to the IDR Coordinator. At his or her discretion, the Section Chief may override the decision of the IDR panel. The IDR Coordinator will inform the licensee of the final IDR results in writing within 10 working days of the IDR meeting. A copy of the letter will be sent to the County DSS Staff, ACLS Regional Supervisor, and the state long-term care ombudsman.

Actions Generated by IDR: When the IDR panel decides that a violation or finding should not have been cited and the Section Chief approves the decision, the following actions shall occur as applicable:

  1. If changes are made, the facility will receive a marked CAR, the relevant violation or finding will be marked "deleted" and will be initialed and dated by the County DSS Adult Home Specialist.
  2. The facility will receive a new CAR with the relevant violation or finding deleted. The facility must complete and document the Plan of Correction on the new CAR and return it to the County DSS within 10 working days of receipt. A marked copy of the CAR will be entered into the facility file as the document of record if the Plan of Correction is not returned within the 10-day period.
  3. Any enforcement action imposed solely on the basis of a violation or finding that has been deleted as a result of the IDR will be rescinded.

Invalid Use of IDR: The facility cannot use the IDR process to delay the formal imposition of remedies or to challenge any other aspect of the inspection process, including the following:

  1. Remedy imposed by the enforcing agency;
  2. Failure of County DSS staff to comply with a requirement of the monitoring or complaint investigation process;
  3. Inconsistency of County DSS staff in citing violations among facilities;
  4. County DSS staff behavior; or
  5. Inadequacy or inaccuracy of the IDR process.

An incomplete IDR process will not delay the effective date of any enforcement action.