General Requirements | NJ

GENERAL REQUIREMENTS

 

8:36-5.1         Types of services provided to residents

 

• The assisted living residence, comprehensive personal care home or assisted living program shall provide and/or coordinate personal care and services to residents, based on assessment by qualified persons, in accordance with the New Jersey Nurse Practice Act, N.J.S.A. 45:11-23 and N.J.A.C. 13:37, this chapter, and the individual needs of each resident, in a manner which promotes and encourages assisted living

 

• The assisted living residence or comprehensive personal care home shall be capable of providing at least the following services: assistance with personal care, nursing, pharmacy, dining, activities, recreational, and social work services to meet the individual needs of each

 

• The assisted living residence, comprehensive personal care home, or assisted living program shall provide supervision of self-administration of medications, and administration of medications by trained and supervised personnel, as needed by residents and in accordance with this

 

• The assisted living residence, comprehensive personal care home, or assisted living program shall be capable of providing nursing services to maintain residents, including residents who require nursing home level of care. However, the resident may be, but is not required to be moved from the facility or program if it is documented in the resident record that a higher level of care is required, as demonstrated by one or more of the following characteristics:

 

1. The resident requires 24-hour, seven day a week nursing supervision;

 

2. The resident is bedridden for more than 14 consecutive days;

 

3. The resident is consistently and totally dependent in four or more of the following activities of daily living: dressing, bathing, toilet use, transfer, locomotion, bed mobility, and eating;

 

4. The resident has a cognitive decline severe enough to prevent the making of simple decisions regarding activities such as bathing, dressing and eating and cannot respond appropriately to cueing and simple directions;

 

5. The resident requires treatment of a stage three or four pressure sore or multiple stage two pressure sores. However, a resident who requires treatment of a single stage two pressure sore shall be retained and a plan of care developed and implemented to stabilize the pressure sore and the condition which caused it;

 

6. The resident requires more than “assistance with transfer”;

 

7. The resident is a danger to self or others; or

 

8. The resident has a medically unstable condition and/or has special health problems, and a regimen of therapy cannot be appropriately developed and implemented in the assisted living

 

• The facility’s or program’s admission agreement with each resident shall clearly specify if the facility or program will or will not retain residents with one or more characteristics described in (d) above, to what extent, and, if applicable, at what additional cost. This subsection shall not apply when a continuing care retirement community (CCRC) contracts with its residents to provide assisted living pursuant to a continuing care agreement. This subsection shall apply, however, when a CCRC provides assisted living to a person who is not a party to a continuing care

 

• Residents who require “specialized long-term care” shall not remain in the assisted living residence or comprehensive personal care home and shall be transferred to a long-term care facility that provides the applicable form of specialized care.

 

• The assisted living residence, comprehensive personal care home, or assisted living program shall adhere to applicable Federal, State, and local laws, rules, regulations, and

 

• In accordance with N.J.S.A. 26:2H-12.16 et seq., a new assisted living residence or comprehensive personal care home licensed on or after September 1, 2001, shall attain a level of occupancy by Medicaid-eligible persons of at least 10 percent of its total bed complement within three years of licensure and shall maintain this level of Medicaid occupancy

 

• An existing assisted living residence or comprehensive personal care home which increases its number of licensed beds on or after September 1, 2001, shall occupy at least 10 percent of the additional beds with Medicaid- eligible persons and shall maintain this level of Medicaid occupancy

 

• In cases in which either the total bed complement or the total number of beds added in an existing facility is less than 10, at least one bed shall be reserved for a Medicaid-eligible

 

• For the purposes of this section, “Medicaid-eligible person” means an individual who has been determined as satisfying the financial eligibility criteria for medical assistance under the Medicaid program, has been assessed as being in need of nursing home-level care as specified at N.J.A.C. 8:85-2.1, and has been approved by the Department for participation in a Federally approved waiver program for assisted living services. “Medicaid-eligible person” includes persons who were:

 

1. Admitted to the facility as private paying residents and subsequently became eligible for Medicaid; and

 

2. Admitted directly to the facility as Medicaid-eligible.

 

• The Commissioner or his or her designee may waive or reduce the 10 percent Medicaid occupancy requirement in (i) through (k) above for some or all regions of the State if it is determined that sufficient numbers of licensed beds are available in the State to meet the needs of Medicaid-eligible persons within the limits of the Federally approved waiver program for assisted living

 

1. The Commissioner or his or her designee shall waive this 10 percent Medicaid occupancy requirement if there are limitations on

 

2. A licensed assisted living residence or comprehensive personal care home may submit a written request for a waiver of the 10 percent Medicaid occupancy requirement in accordance with N.J.A.C. 8:36-2.7.

 

• In accordance with N.J.S.A. 26:2H-12.16 et seq., this section shall not apply to an assisted living residence or a comprehensive personal care home operated by a continuing care retirement

 

8:36-5.2         Ownership

 

• The ownership of the facility or program and the property on which it is located shall be disclosed to the

 

• No facility or program shall be owned or operated by any person convicted of a crime relating adversely to the person’s capability of owning or operating the facility or

 

• The owner or governing authority of the facility or program shall assume legal responsibility for the management, operation, and financial viability of the facility or

 

8:36-5.3         Transfer of ownership

 

(a) Prior to transferring ownership of a facility or program, the prospective new owner shall submit an application to the Long-Term Care Licensing Program, including the following items:

 

1. The transfer of ownership fee of $ 1,500, in accordance with N.J.A.C. 8:36-2.2(i);

 

2. A cover letter stating the applicant’s intent to become the licensed operator of the facility and identification of the facility by name, address, county, and number and type of licensed beds;

 

3. A description of the proposed transaction including:

 

1. Identification of the current owner(s) (the “seller”);

 

1. Identification of 100 percent of the proposed new owner, including the names and addresses of all principals (individuals and/or entities with 10 percent or greater ownership), and for non-profits the names and addresses of the members of the Board;

 

• A copy of organizational charts, including parent companies and wholly owned subsidiaries, if applicable;

 

1. A copy of the agreement of sale or letter of intent, signed by both parties, and if applicable, any lease or management agreements; and

 

1. Disclosure of any licensed health care facilities owned, operated, or managed in New Jersey or any other If facilities are owned, operated or managed in other states, letters from the regulatory agencies in each of the respective states, verifying that the facilities have operated in substantial compliance during the last 12-month period and have had no enforcement actions during that period of time, shall be included in the application.

 

4. Approval of a transfer of ownership is contingent upon a review of the applicant’s track record in accordance with N.J.A.C. 8:33-4.10 and 8:43E-5.1.

 

5. Approval of a transfer of ownership is contingent upon payment of all outstanding State penalties issued by the Department against the current owner, or written verification by the applicant that the applicant will assume responsibility for payment of such State

 

6. When a transfer of ownership application has been reviewed and deemed acceptable, an approval letter from the Long-Term Care Licensing Program shall be sent to the applicant along with licensure application forms and the licensure fee

 

7. Within five working days after the transaction has been completed, the applicant shall submit the following documents to the Long-Term Care Licensing Program:

 

1. Completed licensure application forms and the licensure fee;

 

1. A notarized letter stating the date when the transaction occurred; and

 

• A certificate of continuing occupancy from the local authority or a letter from the local authority verifying a policy of not issuing any such document for changes of

 

8:36-5.4         Submission and availability of documents

 

• The facility or program shall, upon request, submit in writing any documents which are required by this chapter to the Director of the Long Term Care Licensing and Certification Unit of the Department. Additionally, upon request of the Department, the facility or program shall submit in writing data related to utilization, demographics, costs, charges, staffing, and other planning and financial data necessary to evaluate the services

 

• The facility shall report the number of resident days per calendar year to the Department’s Long-Term Care Licensing Program by April 15 of each year, for the prior calendar

 

8:36-5.5         Personnel

 

• The facility or program shall develop and implement written job descriptions to ensure that all personnel are assigned duties based upon their education, training, and competencies and in accordance with their job descriptions.

 

• All personnel who require licensure, certification, or authorization to provide resident care shall be licensed, certified, or authorized under the appropriate laws or rules of the State of New

 

8:36-5.6         Staffing requirements

 

• The facility or program shall maintain and implement written staffing schedules. Actual hours worked by each employee shall be

 

• The facility or program shall develop and implement a staff orientation and a staff education plan, including plans for each service and designation of person(s) responsible for training. All personnel shall receive orientation at the time of employment and at least annual in-service education regarding, at a minimum, the following:

 

1. The provision of services and assistance in accordance with the concepts of assisted living and including care of residents with physical impairment;

 

2. Emergency plans and procedures;

 

3. The infection prevention and control program;

 

4. Resident rights;

 

5. Abuse and neglect;

 

6. Pain management; and

 

7. The care of residents with Alzheimer’s and related dementia conditions and in accordance with N.J.A.C. 8:36-19.

 

• The staffing level in this chapter is minimum only and the assisted living residence, comprehensive personal care, or assisted living program shall employ staff in sufficient number and with sufficient ability and training to provide the basic resident care, assistance, and supervision required, based on an assessment of the acuity of residents’

 

• Personnel, including staff under contract, with a reportable communicable disease or infection shall be excluded from the assisted living residence, comprehensive personal care home, or assisted living program until examined by a physician who shall certify to the administrator that the condition will not endanger the health of residents or other

 

• The facility or program shall employ reasonable efforts to ensure that no employee has been convicted of a crime relating adversely to the person’s ability to provide resident care, such as homicide, assault, kidnapping, sexual offenses, robbery, and crimes against the family, children or incompetents, except where the applicant or employee with a criminal history has demonstrated his rehabilitation in order to quality for employment at the facility or

 

8:36-5.7         Policy and procedure manual

 

• A policy and procedure manual(s) for the organization and operation of the facility or program shall be developed, implemented, and reviewed at least annually. Each review of the manual(s) shall be documented, and the manual(s) shall be available in the facility or program to representatives of the Department at all times. The manual(s) shall include at least the following:

 

1. An organizational chart delineating the lines of authority, responsibility, and accountability for the administration and resident care services of the facility or program;

 

2. A description of the services which the assisted living residence, comprehensive personal care home or assisted living program is capable of providing;

 

3. Policies and procedures for maintaining security;

 

4. Policies and procedures for reporting all alleged and/or suspected cases of resident abuse or exploitation to the Complaints Program of the Division of Long-Term Care Systems at 1-800-792-9770. If the resident is 60 years of age or older, the State of New Jersey Office of the Ombudsman for the Institutionalized Elderly shall also be notified, in compliance with J.S.A.

 

 

5. Policies and procedures for maintaining confidentiality of resident records, including policies and procedures for examination of resident records by the resident and other authorized persons and for release of resident records to any individual outside the facility or program, as consented to by the resident or as required by law or third-party payor;

 

6. Policies and procedures for the maintenance of personnel records for each employee, including at least his or her name, previous employment, educational background, credentials, license number with effective date and date of expiration (if applicable), certification (if applicable), verification of credentials, records of physical examinations, job description, records of orientation and inservice education, and evaluation of job performance;

 

7. Policies and procedures, including content and frequency, for physical examinations and immunizations and tuberculin testing upon employment and subsequently for employees and individuals providing direct resident care services in the facility through contractual arrangements or written agreement; and

 

8. Policies and procedures delineating the responsibilities of the facility’s staff in making prompt notification regarding the death of a resident as required by N.J.S.A. 26:2H-5e and N.J.A.C. 8:36-15.7(a).

 

• The facility shall have a policy and procedure that addresses how policy and procedure manuals will be made available to residents, guardians, designated responsible individuals, prospective applicants, and referring agencies.

 

8:36-5.8         Resident transportation

 

• The facility shall be capable of providing resident transportation, either directly or by arrangement, to and from health care services provided outside the facility, and shall promote reasonable plans for security and accountability for the resident and his or her personal possessions, as well as transfer of resident information to and from the provider of the service, as required by individual residents and specified in resident service

 

• The facility or program shall assist residents, if needed, in arranging for transportation to activities of social, religious, and community groups in which the resident chooses to

 

8:36-5.9         Written agreements

 

The facility or program shall have a written agreement or its equivalent, or a linkage for services not provided directly by the facility or program. If the facility or program provides care to residents with psychiatric disorders, the facility or program shall also have a written agreement with one or more community mental health centers specifying which services will be provided by the mental health center. The written agreements shall require that services be provided in accordance with this chapter.

 

8:36-5.10       Reportable events

 

• The facility shall notify the Department immediately by telephone at 609-633-9034 (609-392-2020 after business hours), followed within 72 hours by written confirmation, of the following:

 

1. Interruption for three or more hours of basic physical plant services, such as heat, light, power, water, food, or staff;

 

2. Any major occurrence or incident of an unusual nature, including, but not limited to, all fires, disasters, elopements, and all deaths resulting from accidents or incidents in the facility or related to facility Reports of such incidents shall contain information about injuries to residents and/or personnel, disruption of services, and extent of damages;

 

3. All suspected cases of resident abuse, neglect, or misappropriation of resident property, including, but not limited to, those which have been reported to the State of New Jersey Office of the Ombudsman for the Institutionalized Elderly for residents over 60 years of age;

 

4. All alleged or suspected crimes which are serious crimes committed by or against residents, which have also been reported at the time of occurrence to the local police department;

 

5. Occurrence of epidemic disease in the facility; and

 

6. Termination of employment of the administrator, and the name and qualifications of his or her

 

8:36-5.11       Notices

 

(a) The facility shall conspicuously post a notice that the following information is available in the facility during normal business hours, to residents and the public:

 

1. All waivers granted by the Department;

 

2. A copy of the last annual licensure inspection survey report and the list of deficiencies from any valid complaint investigation during the past 12 months;

 

3. Policies and procedures regarding resident rights;

 

4. Business hours of the facility;

 

5. Policies and procedures for maintaining security of the assisted living residence and comprehensive personal care home;

 

6. The toll-free hot line number of the Department; telephone numbers of county agencies and of the State of New Jersey Office of the Ombudsman; and

 

7. The names of, and a means to formally contact, the owner and/or members of the governing

 

8:36-5.12       Maintenance of records

 

• The facility shall maintain an annual chronological listing of residents admitted and discharged, including the destination of residents who are discharged.

 

• Statistical data, such as resident census and facility characteristics, shall be forwarded to the Department on request, in a format provided by the Department.

 

8:36-5.13       Admission and retention of residents

 

• The administrator of the assisted living residence, comprehensive personal care home, or assisted living program or the administrator’s designee shall conduct an interview with the resident and, if the resident agrees, the resident’s family, guardian, or interested agency, prior to or at the time of the resident’s admission. The interview shall include at least orientation to the facility’s or program’s policies, business hours, fee schedule, services provided, resident rights, and criteria for admission and discharge. Documentation of the resident interview shall be included in the resident

 

• At the initial interview prior to, or at the time of, admission of each resident, the administrator or the administrator’s designee should be provided with the name, address, and telephone number of a family member, guardian, or responsible person who can be notified in the event of the resident’s illness, incident, or other emergency. This information is voluntary on the part of the resident. A resident shall not be denied admission to the facility or program solely for declining to provide this

 

• If a facility or program has reason to believe, based on a resident’s behavior, that the resident poses a danger to himself or herself or others, and that the facility or program is not capable of providing proper care to the resident, then the attending physician or the physician on call, in consultation with facility or program staff and a resident representative, shall determine whether the resident is appropriately placed in that facility or program. The facility or program or resident representative shall initiate the mental health screening process in accordance with N.J.S.A. 30:4-27.1 et seq., and N.J.A.C. 10:31, Screening and Screening Outreach Process, and, based on the results and recommendations of that screening process, shall attempt to locate a new placement if

 

• If an applicant, after applying in writing, is denied admission to the assisted living residence, comprehensive personal care home, or assisted living program, the applicant and/or his or her family, guardian, or responsible person shall, upon written request, be given the reason for such denial in writing, signed by the administrator, within 15 days of the receipt of the written

 

• If there is an infirmary in the facility, residents shall be transferred to the infirmary only if they have consented to such transfer and shall remain in the infirmary for a limited time only, generally not to exceed one

 

8:36-5.14       Involuntary discharge

 

• Written notification by the administrator shall be provided to a resident and/or his or her family, guardian, or designated responsible person, of a decision to involuntarily discharge the resident from the facility or program. Such involuntary discharge shall only be upon grounds contained in the facility’s or program’s policies and procedures and shall occur only if the resident has been notified and informed of such policies in advance. The notice of discharge shall be given at least 30 days in advance and shall include the reason for discharge and the resident’s right to appeal. This 30 day advance notice shall not apply if the discharge is for reasons in accordance with the criteria specified at N.J.A.C. 8:36-5.1(d). A copy of the notice shall be entered in the resident’s

 

• In an emergency situation, as stated in N.J.A.C. 8:36-5.1(d), for the protection of the life and safety of the resident or others, the facility or program may transfer the resident without 30 days notice. The Department shall be notified in the event of such

 

8:36-5.15       Notification requirements

 

• The resident’s family, guardian, and/or designated responsible person or community agency shall be notified, when known, and with the resident’s consent, immediately after the occurrence, in the event of the following:

 

1. The resident acquires an acute illness requiring medical care;

 

2. Any serious accident, criminal act or incident occurs which involves the resident and results in serious harm or injury or results in the resident’s arrest or detention;

 

3. The resident is transferred from the facility; or

 

4. The resident

 

• Notification of any occurrence noted in (a) above shall be documented in the resident’s record. The documentation with regard to an occurrence noted in (a)4 above shall include confirmation and written documentation of that notification.

 

8:36-5.16       Interpretation services

 

The facility or program shall demonstrate the ability to provide a means to communicate with any resident admitted who is non-English-speaking and/or has a communication disability, using available community or on-site resources.

 

8:36-5.17       Referral and transfer agreements

 

Each licensed assisted living residence and comprehensive personal care home shall maintain written referral and/or transfer agreements with at least one licensed acute care hospital in New Jersey, at least one licensed State, county, or private psychiatric hospital in New Jersey, and with at least one licensed New Jersey long-term care facility. A written agreement with an acute care hospital with licensed adult psychiatric beds in New Jersey shall enable compliance with the psychiatric hospital component of this requirement.

 

8:36-5.18       Managed risk agreements

 

• The choice and independence of action of a resident may need to be limited when a resident’s individual choice, preference and/or actions are identified as placing the resident or others at risk, lead to adverse outcome and/or violate the norms of the facility or program or the majority of the residents. When the resident assessment process identified in N.J.A.C. 8:36-7 indicates that there is a high probability that a choice or action of the resident has resulted or will result in any of the preceding, the assisted living residence, comprehensive personal care, home or assisted living program shall:

1. Identify the specific cause(s) for concern;

 

2. Provide the resident (and if the resident agrees, the resident’s family or representative) with clear, understandable information about the possible consequences of his or her choice or action;

 

3. Seek to negotiate a managed risk agreement with the resident (or legal guardian) that will minimize the possible risk and adverse consequences while still respecting the resident’s preferences; and

 

4. Document the process of negotiation and, if no agreement can be reached, the lack of agreement and the decisions of the parties

 

• Managed risk agreements shall be negotiated with the resident or legal guardian and shall address the following areas in writing:

1. The specific cause(s) for concern;

 

2. The probable consequences if the resident continues the choice and/or action identified as a cause for concern;

 

3. The resident’s preferences;

 

4. Possible alternatives to the resident’s current choice and/or action;

 

5. The final agreement reached by all parties involved; and

 

6. The date the agreement is executed and, if needed, the time frames in which the agreement will be

• A copy of the managed risk agreement shall be provided to the resident or legal guardian and a copy shall be placed in the resident’s record at the time it is