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Health Licensing
  • Effective July 1, 2013, our offices have relocated to 301 Gervais St, Columbia, SC, 29201

Community Residential Care Facility Inspections Frequently Asked Questions

Why are Community Residential Care Facilities inspected?

Regulation 61-84, Standards For Licensing Community Residential Care Facilities (pdf), is part of the South Carolina Code of Law, therefore, every licensed Community Residential Care Facility must meet these minimum requirements. The inspections are to verify that a Community Residential Care Facility has substantially met licensing requirements, and therefore can continue to do business in South Carolina.

  • The Department of Health and Environmental Control (DHEC), in its role of monitoring public health in South Carolina, is responsible for ensuring Community Residential Care Facilities comply with the regulation through inspections by the Division of Health Licensing.
  • A Community Residential Care Facility may be inspected because it is new, having applied for a Community Residential Care Facility license, and so it is being inspected for compliance the first time.
  • A Community Residential Care Facility may be inspected because it must be inspected at least every two years (food service - Regulation 61-25 (pdf) - is annually).
  • A Community Residential Care Facility may be inspected because there has been a change of ownership, of management, of administrator, bed increase, or etc.
  • A Community Residential Care Facility may also be inspected because a complaint against the facility has been received.

Community Residential Care Facilities are inspected on a periodic basis by the Division of Health Licensing (food service - Regulation 61-25 (pdf) - annually), however, the Division of Health Licensing may inspect a Community Residential Care Facility as often as needed, if circumstances warrant special attention. When reviewing the inspection history, you may find that one place went two years, while another has two or more inspections in the same year.

Who does the Community Residential Care Facility inspections?

Community Residential Care Facilities are inspected by a team of experienced employees (pdf). The team may have as few as one member, or as many as five. The number of inspectors is determined by the size of the Community Residential Care Facility and the complexity of the survey. A one-person team may visit a 5-bed facility, while a five-person team may visit a 100-bed facility. Each inspector receives training in how to apply and interpret the regulations and how to conduct the inspections.

What happens at a Community Residential Care Facility inspection?

  1. The inspection team prepares before it goes there
    • Before our inspection team visits a Community Residential Care Facility, we review the licensing history of the facility. We want to know how this Community Residential Care Facility has performed during previous inspections. Complaints, exceptions, enforcement actions, serious incident and accident reports, and previous violations are all reviewed.
    • In other words, our inspection team does not enter the Community Residential Care Facility unprepared. When we arrive, we already have some idea what to look for and have prepared check sheets and a worksheet.
  2. Our team then introduces themselves at the site
    • When our team arrives at the Community Residential Care Facility, we introduce ourselves and let the staff know why we are there.
    • We ask the administrator (or in the absence of the administrator, the person in charge) to describe any special feature(s) of the facility's care. For instance, does the place have a special program for residents? The inspection team will invite the administrator (or another escort) to come along with us on our inspection. We will ask the administration to provide things like lists of key personnel, employee records, a copy of the document which is normally handed to residents advising them of their rights, samples of menus and mealtimes, lists of medications, lists of recent arrivals, activity schedules, lists of those receiving hospice services, home health care services, or dialysis, etc.
  3. We take an initial tour
    • Next, our inspectors make a tour of the facility. We may split up into groups, or go individually. Again, we have staff come with us as an escort. We want to get an overall impression of the place. Here are some of the things we are looking for:
      • Does the facility have a pervading unpleasant odor?
      • Are residents generally well-cared for?
      • Are residents restrained?
      • Does staff wash their hands?
      • Is the facility clean?
      • Is the facility well-maintained?
      • During this tour, our team will also compare what staff we find on duty with the staff schedule, looking for staffing discrepancies.
  4. We gather information. This information-gathering phase is the heart of the inspection. There are many areas looked at:
    • General Observation
      • Is the Community Residential Care Facility clean and well maintained? Are there vermin? Are there accident hazards? Are drugs stored safely?
    • Kitchen - Regulation 61-25
      • Is the food tasty? Is it hot, tepid, or just right? Is it fresh? Does it follow the menu? Are the meals nutritionally balanced? Are the dietary workers clean? Do they have the right equipment?
    • Resident Record Review
      • Has the resident been assessed? Does the resident have a care plan? And, is it followed? Each resident is supposed to have a care plan specific to him/her, based on an accurate, up-to-date assessment. In other words, he/she should not merely be warehoused; he/she should have a plan which aims at an outcome, and that plan needs to be followed.
    • Quality of Life
      • Does he/she receive the care he/she needs?
    • Medication
      • Inspectors review the drugs the resident has received to see whether the medication has been administered in accordance with physician orders.
    • Quality Assessment
      • Does the Community Residential Care Facility have an effective quality assurance program?.
    • Abuse Prevention
      • A Community Residential Care Facility should have policies and procedures in place to screen new hires, train staff, identify incidents of abuse, investigate such incidents, and respond to them. Are background checks being performed as required by the new South Carolina state law?
  5. We examine the information
    • Now our team re-groups to share what we found. We will decide which violations shall be documented in our Report of Visit. These are consensus decisions.
  6. We tell the Community Residential Care Facility what we found
    • Lastly, our inspection team advises the Community Residential Care Facility administrator and/or their designee of our findings. The Community Residential Care Facility may discuss the findings, voice their disagreement with violation findings, or even have violations removed, if they can provide compelling evidence. This Report of Visit, showing what standards were cited, is completely reviewed at the exit interview.

What's a violation?

A Community Residential Care Facility has certain standards which apply to the facility. For instance, there is a standard to keep the facility in good repair.

Then there are other standards which apply to each resident. For instance, there is a standard that a resident be free from abuse.

Failure to meet any standard is a violation.

Violations are categorized according to Class. There are three levels of Classes:

  • Class I violations are those which the Department determines to present an imminent danger to the residents of the facility or a substantial probability that death or serious harm could result therefrom.
  • Class II violations are those which the Department determines to have a direct or immediate relationship to the health, safety or security of the facility's residents other than Class I violations.
  • Class III violations are those which are not classified as serious in the regulation or those which are against the best practices as interpreted by the Department.

What is done about complaints?

A complaint is defined as an allegation that relates to unsafe or dangerous conditions or events relative to a licensed Community Residential Care Facility. The Division of Health Licensing is required to investigate any written or verbal complaint which indicates that there may be a violation of the licensing standards.

Complaints may originate from many different sources, e.g., relatives/friends of residents, other licensed activities, visitors of the Community Residential Care Facility, political authorities, law enforcement agencies, media, etc.

An investigation may also be conducted if the Division of Health Licensing receives information from certain sources such as the Department of Social Services or the Department of Mental Health regarding a resident or conditions at a Community Residential Care Facility.

Also, serious incident reports may indicate a need to investigate a Community Residential Care Facility.

What enforcement follows all this inspecting?

The authority to enforce is also granted in South Carolina state law. The Division of Health Licensing can:

  • Suspend or revoke a Community Residential Care Facility license
  • Impose monetary penalties
  • Require consultations
  • Require correction of violations
  • Require a plan of correction for violations

For additional information, contact: Division Director Gwendolyn Thompson - (803) 545-4370