South Carolina DHEC Regulations on Assisted Living

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Entrusting the life and welfare of a loved one to an assisted living facility requires a great deal of thought and planning. Protection against abuse and neglect is always a priority. Equally as important are the quality-of-life issues, such as social interaction and recreational activities. Because of these and other concerns, the state of South Carolina, through its Department of Health and Environmental Control, has passed regulations on assisted living facilities.

Weather Emergency Planning

Because of South Carolina is in a hurricane zone as of 2001, according to South Carolina Code Ann. (44-7-20), all facilities must have emergency planning. This includes an evacuation plan, because many residents are infirm and cannot evacuate on their own. Another part of the plan is that all facilities must have on hand an emergency power supply for a minimum of 72 hours' power and enough food, water and medicine (including individual prescriptions) to last for 72 hours. Furthermore, adequate staff must always be on hand to provide adequate assistance to the residents.

License Requirements

Before a facility can open, a license is required. A pre-license inspection, and the correction of any deficiencies, are criteria to receive a license. Compliance with structural standards is required, such as nonlead paint and electrical systems up to code. Other criteria include staff training prior to engaging residents, and proper medication protocols that will be instituted. Licenses are not transferable. If the facility changes ownership, the new owners have to apply for a license--in effect starting from scratch.

Staff Ratio

The staff to resident ratio must be at least 1-8 (one staff member for every eight residents) during peak times. At nighttime, this ratio can be 1-30. For facilities that have more than eight residents, at least one staff person must be awake and dressed at all hours. If there is a resident who cannot self-rescue, there must be at least one staff member awake and dressed at all times even if the total number of residents is less than eight.

If the facility has more than 10 resident beds and of a multistory design, there must be an awake and dressed staff member on each floor. These are minimum numbers. If a health care professional deems that a resident requires a higher level of assistance (such as one-on-one care), the orders have to be abided by.

Staff Training

An assisted living facility must provide in-service staff training. This includes training on CPR, abuse and neglect protocols and reporting, and taking vital signs. Other areas include condition-specific training, such as for Alzheimer's or developmental disabilities. Further training includes Occupational Safety and Health Administration standards on blood-borne pathogens.


All incidents must be reported to the Division of Health Licensing. If serious, they must be reported within 12 hours of the occurrence; if not serious, within 10 days. Examples of serious injuries would be broken bones or lacerations. Other serious incidents would be suspected or witnessed abuse/neglect/exploitation incidents and theft of a resident's property.

Examples of nonserious incidents would be minor injuries that were witnessed (such as a resident bumping into a chair, causing a small bruise) or a resident refusing to eat his meal.

Accountability of Medication

All medications must be accounted for. This includes accurate counts of pills on hand and accurate recording of pills taken by residents. Any discrepancy has to be treated as an incident and reported accordingly. Some areas would include pill shortages, and medication errors or adverse reactions to prescribed medications.