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North Carolina Assisted Living Administrator State
Exam QUESTIONS AND DETAILED SOLUTIONS
North Carolina Assisted Living Administrator State Exam
Point-Form Exam Coverage
Based on the NC DHSR Adult Care Licensure Section requirements and 10A NCAC 13F & 13G, the exam
covers the following core areas :
1. LICENSING & REGULATORY FRAMEWORK (~15%)
• Regulating agency: NC Department of Health and Human Services (DHHS) / Division of Health
Service Regulation (DHSR)
• Primary codes: 10A NCAC 13F (Adult Care Homes) and 10A NCAC 13G (Family Care Homes)
• License renewal: Annual requirement for assisted living facilities
• License changes: Must be reported to DHSR within 30 days
• Facility closure: 30 days written notice required to DHSR, county DSS, and residents
• Age requirement: Minimum 21 years old for administrator certification
• License types: Adult care homes (7+ beds), family care homes (2-6 beds), multi-unit assisted
housing with services (registered, not licensed)
• Change of licensee: Requires notification to DHSR
2. ADMINISTRATOR CERTIFICATION & AIT PROGRAM (~10%)
• Administrator-in-Training (AIT) program: Minimum 480 total hours
• AIT components: 20 hours coursework + 100 hours on-the-job training under preceptor +
additional structured hours
• Education requirement: High school diploma or equivalent plus either 2 years college
coursework OR 60 months supervisory experience
• Supervisory experience: Full-time management responsibility, including hiring/firing, over at
least 2 FTEs with direct resident care, within past 7 years
• Criminal background check: SBI report required; FBI required if NC resident <5 years
• Continuing education: 20 hours annually for administrator renewal (30 hours every 2 years for
full certification renewal cycle)
• Initial certification expires Dec 31 of following year; then biennial renewal with 30 hours CE
3. RESIDENT RIGHTS & ADVOCACY (~20%)
• Resident Bill of Rights: Legal document defining residents' rights
• Right to refuse treatment: Residents may refuse medications and treatments
• Right to privacy: During personal care, required by law
• Right to voice grievances: Without fear of retaliation
• Right to manage personal finances: Access to funds during normal business hours
• Grievance procedure: Must be written and available to residents
• Involuntary discharge: 30 days written notice required
• Care plan: Must be developed within 14 days of admission
• Resident rights explained: At admission and upon request
• Informed consent: Required for any treatment or medication change
• Dignity: Using respectful language and privacy measures
• HIPAA: Protects residents' personal information
4. PHYSICAL PLANT & ENVIRONMENTAL STANDARDS (~10%)
• Dining room (family care home, licensed after 4/1/84): Minimum 120 sq ft
• Living room (family care home, licensed after 4/1/84): Minimum 200 sq ft
• Lighting: 30 foot-candles at floor level in dining and living rooms
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• Indoor temperature: Maintained between 71-81°F
• Water temperature for bathing: Not to exceed 120°F
• Kitchen: Must be large enough for food preparation, preservation, and dishwashing
• Living arrangements: Each resident must have access to private or semiprivate room
• Pest control: Documented and regularly maintained program required
• Laundry: Handled to prevent cross-contamination
• Facility vehicles: Safe, insured, and maintained
• Windows: Operable in dining and living rooms
5. MEDICATION ADMINISTRATION & HEALTH SERVICES (~15%)
• Five rights: Right patient, drug, dose, route, time
• Medication administration window: Within 1 hour before/after scheduled time (2-hour window)
• MAR (Medication Administration Record): Must be signed immediately after administration
• Controlled substances: Stored in double-locked cabinet
• Medication errors: Must be reported immediately to supervisor
• Expired medications: Must be discarded per policy
• PRN medications: Require current physician's order
• Self-administration: Allowed when resident is capable and documented as such
• Medication aides: Must be trained and listed on NC Medication Aide Registry
• Medication aides may NOT: Assess resident conditions (nursing assessment required)
• Health assessments: Updated annually
• FL-2 form: Required within 90 days prior to admission (90/72 rule allows 72-hour grace for
emergencies)
6. EMERGENCY PREPAREDNESS & SAFETY (~10%)
• Emergency preparedness plan: Written, reviewed annually, updated as needed
• Fire drills: Conducted quarterly on each shift
• Fire extinguishers: Inspected monthly
• Disaster drills: Must include all staff on all shifts
• Emergency contact numbers: Posted near telephones and staff areas
• First step in disaster response: Assess situation and activate emergency plan
• Wandering residents: Secured perimeter alarm and individualized prevention plan required
• Physical restraints: Prohibited except with physician order, consent, last resort
• Negotiated risk: Cannot waive liability for negligence; documents informed consent
7. STAFFING REQUIREMENTS & PERSONNEL MANAGEMENT (~10%)
• Direct care staff initial training: Minimum 16 hours
• Training topics: Resident rights, safety, infection control, fire safety
• Staff-to-resident ratio: Based on resident needs and census
• Person in charge when administrator absent: Must be designated in writing
• Criminal background checks: Must be completed before hire
• Volunteer orientation: Required before contact with residents
• Training documentation: Must be kept in employee files
• Staff responsible for resident finances: Requires written authorization, separate ledgers
8. ADMISSION, ASSESSMENT & DISCHARGE (~5%)
• Pre-admission assessment: Completed before resident moves in
• Care plan development: Within 14 days of admission
• Discharge notice: 30 days written notice required
• FL-2 health assessment: 90 days prior to admission (or 72 hours for emergency)
• Conditions NOT appropriate for adult care homes: Ventilator dependency, stage III/IV pressure
ulcers, IV therapy, NG tubes, continuous skilled nursing
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9. INCIDENT REPORTING & COMPLIANCE (~5%)
• Reportable incidents: Falls with serious injury, fractures, hospitalization, death
• Medication errors: Immediate report to supervisor
• Abuse/neglect/exploitation: Mandatory report to Adult Protective Services (local DSS)
• Complaint reporting: Residents may file without retaliation
• Documentation: Internal incident reports required for all accidents/incidents
10. RESIDENT CARE & SERVICES (~5%)
• Activities of daily living (ADLs): Bathing, dressing, eating, toileting, ambulation
• Household tasks: Telephone, finances, shopping, housekeeping, laundry
• Personal care services: Hands-on assistance with ADLs
• Unintentional weight loss: Requires care plan response, physician notification, monitoring
• Pressure ulcers: Stage 2 or less may be admitted with appropriate care plan
Question 1
A candidate for initial administrator certification asks about the Administrator-in-Training (AIT) program
requirements. What is the minimum total number of hours required for the AIT program in North
Carolina?
A) 120 total hours (20 coursework + 100 OJT)
B) 200 total hours (40 coursework + 160 OJT)
C) 480 total hours (20 coursework + 100 OJT + additional structured hours)
D) 600 total hours
Answer: C
NC requires 480 total AIT hours; 20 hours of coursework and 100 hours of OJT under a preceptor are core
components, with additional structured training hours completing the total.
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Question 2
An applicant for an assisted living administrator license is 20 years old and has completed all education
and training requirements. Can this applicant be certified?
A) Yes, if they have a high school diploma
B) Yes, with a signed waiver from a supervising administrator
C) No, the minimum age requirement is 21 years
D) Yes, if they complete an additional 6 months of supervised experience
Answer: C
NC law requires assisted living administrators to be at least 21 years old to ensure a minimum level of
maturity and legal capacity to manage resident care, finances, and regulatory compliance .
Question 3
A facility administrator receives a complaint from a resident's family member about poor food quality.
The resident is afraid to complain directly. Under the Resident Bill of Rights, what must the
administrator ensure?
A) The family member files a written complaint on official forms only
B) The resident may voice grievances without fear of retaliation
North Carolina Assisted Living Administrator State
Exam QUESTIONS AND DETAILED SOLUTIONS
North Carolina Assisted Living Administrator State Exam
Point-Form Exam Coverage
Based on the NC DHSR Adult Care Licensure Section requirements and 10A NCAC 13F & 13G, the exam
covers the following core areas :
1. LICENSING & REGULATORY FRAMEWORK (~15%)
• Regulating agency: NC Department of Health and Human Services (DHHS) / Division of Health
Service Regulation (DHSR)
• Primary codes: 10A NCAC 13F (Adult Care Homes) and 10A NCAC 13G (Family Care Homes)
• License renewal: Annual requirement for assisted living facilities
• License changes: Must be reported to DHSR within 30 days
• Facility closure: 30 days written notice required to DHSR, county DSS, and residents
• Age requirement: Minimum 21 years old for administrator certification
• License types: Adult care homes (7+ beds), family care homes (2-6 beds), multi-unit assisted
housing with services (registered, not licensed)
• Change of licensee: Requires notification to DHSR
2. ADMINISTRATOR CERTIFICATION & AIT PROGRAM (~10%)
• Administrator-in-Training (AIT) program: Minimum 480 total hours
• AIT components: 20 hours coursework + 100 hours on-the-job training under preceptor +
additional structured hours
• Education requirement: High school diploma or equivalent plus either 2 years college
coursework OR 60 months supervisory experience
• Supervisory experience: Full-time management responsibility, including hiring/firing, over at
least 2 FTEs with direct resident care, within past 7 years
• Criminal background check: SBI report required; FBI required if NC resident <5 years
• Continuing education: 20 hours annually for administrator renewal (30 hours every 2 years for
full certification renewal cycle)
• Initial certification expires Dec 31 of following year; then biennial renewal with 30 hours CE
3. RESIDENT RIGHTS & ADVOCACY (~20%)
• Resident Bill of Rights: Legal document defining residents' rights
• Right to refuse treatment: Residents may refuse medications and treatments
• Right to privacy: During personal care, required by law
• Right to voice grievances: Without fear of retaliation
• Right to manage personal finances: Access to funds during normal business hours
• Grievance procedure: Must be written and available to residents
• Involuntary discharge: 30 days written notice required
• Care plan: Must be developed within 14 days of admission
• Resident rights explained: At admission and upon request
• Informed consent: Required for any treatment or medication change
• Dignity: Using respectful language and privacy measures
• HIPAA: Protects residents' personal information
4. PHYSICAL PLANT & ENVIRONMENTAL STANDARDS (~10%)
• Dining room (family care home, licensed after 4/1/84): Minimum 120 sq ft
• Living room (family care home, licensed after 4/1/84): Minimum 200 sq ft
• Lighting: 30 foot-candles at floor level in dining and living rooms
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• Indoor temperature: Maintained between 71-81°F
• Water temperature for bathing: Not to exceed 120°F
• Kitchen: Must be large enough for food preparation, preservation, and dishwashing
• Living arrangements: Each resident must have access to private or semiprivate room
• Pest control: Documented and regularly maintained program required
• Laundry: Handled to prevent cross-contamination
• Facility vehicles: Safe, insured, and maintained
• Windows: Operable in dining and living rooms
5. MEDICATION ADMINISTRATION & HEALTH SERVICES (~15%)
• Five rights: Right patient, drug, dose, route, time
• Medication administration window: Within 1 hour before/after scheduled time (2-hour window)
• MAR (Medication Administration Record): Must be signed immediately after administration
• Controlled substances: Stored in double-locked cabinet
• Medication errors: Must be reported immediately to supervisor
• Expired medications: Must be discarded per policy
• PRN medications: Require current physician's order
• Self-administration: Allowed when resident is capable and documented as such
• Medication aides: Must be trained and listed on NC Medication Aide Registry
• Medication aides may NOT: Assess resident conditions (nursing assessment required)
• Health assessments: Updated annually
• FL-2 form: Required within 90 days prior to admission (90/72 rule allows 72-hour grace for
emergencies)
6. EMERGENCY PREPAREDNESS & SAFETY (~10%)
• Emergency preparedness plan: Written, reviewed annually, updated as needed
• Fire drills: Conducted quarterly on each shift
• Fire extinguishers: Inspected monthly
• Disaster drills: Must include all staff on all shifts
• Emergency contact numbers: Posted near telephones and staff areas
• First step in disaster response: Assess situation and activate emergency plan
• Wandering residents: Secured perimeter alarm and individualized prevention plan required
• Physical restraints: Prohibited except with physician order, consent, last resort
• Negotiated risk: Cannot waive liability for negligence; documents informed consent
7. STAFFING REQUIREMENTS & PERSONNEL MANAGEMENT (~10%)
• Direct care staff initial training: Minimum 16 hours
• Training topics: Resident rights, safety, infection control, fire safety
• Staff-to-resident ratio: Based on resident needs and census
• Person in charge when administrator absent: Must be designated in writing
• Criminal background checks: Must be completed before hire
• Volunteer orientation: Required before contact with residents
• Training documentation: Must be kept in employee files
• Staff responsible for resident finances: Requires written authorization, separate ledgers
8. ADMISSION, ASSESSMENT & DISCHARGE (~5%)
• Pre-admission assessment: Completed before resident moves in
• Care plan development: Within 14 days of admission
• Discharge notice: 30 days written notice required
• FL-2 health assessment: 90 days prior to admission (or 72 hours for emergency)
• Conditions NOT appropriate for adult care homes: Ventilator dependency, stage III/IV pressure
ulcers, IV therapy, NG tubes, continuous skilled nursing
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9. INCIDENT REPORTING & COMPLIANCE (~5%)
• Reportable incidents: Falls with serious injury, fractures, hospitalization, death
• Medication errors: Immediate report to supervisor
• Abuse/neglect/exploitation: Mandatory report to Adult Protective Services (local DSS)
• Complaint reporting: Residents may file without retaliation
• Documentation: Internal incident reports required for all accidents/incidents
10. RESIDENT CARE & SERVICES (~5%)
• Activities of daily living (ADLs): Bathing, dressing, eating, toileting, ambulation
• Household tasks: Telephone, finances, shopping, housekeeping, laundry
• Personal care services: Hands-on assistance with ADLs
• Unintentional weight loss: Requires care plan response, physician notification, monitoring
• Pressure ulcers: Stage 2 or less may be admitted with appropriate care plan
Question 1
A candidate for initial administrator certification asks about the Administrator-in-Training (AIT) program
requirements. What is the minimum total number of hours required for the AIT program in North
Carolina?
A) 120 total hours (20 coursework + 100 OJT)
B) 200 total hours (40 coursework + 160 OJT)
C) 480 total hours (20 coursework + 100 OJT + additional structured hours)
D) 600 total hours
Answer: C
NC requires 480 total AIT hours; 20 hours of coursework and 100 hours of OJT under a preceptor are core
components, with additional structured training hours completing the total.
, Page 4 of 175
Question 2
An applicant for an assisted living administrator license is 20 years old and has completed all education
and training requirements. Can this applicant be certified?
A) Yes, if they have a high school diploma
B) Yes, with a signed waiver from a supervising administrator
C) No, the minimum age requirement is 21 years
D) Yes, if they complete an additional 6 months of supervised experience
Answer: C
NC law requires assisted living administrators to be at least 21 years old to ensure a minimum level of
maturity and legal capacity to manage resident care, finances, and regulatory compliance .
Question 3
A facility administrator receives a complaint from a resident's family member about poor food quality.
The resident is afraid to complain directly. Under the Resident Bill of Rights, what must the
administrator ensure?
A) The family member files a written complaint on official forms only
B) The resident may voice grievances without fear of retaliation
