New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 44C - STANDARDS FOR COMMUNITY RESIDENCES FOR PERSONS WITH HEAD INJURIES
Subchapter 4 - SERVICE DELIVERY/REHABILITATION/ HABILITATION
Section 10:44C-4.4 - Transfer or discharge

Universal Citation: NJ Admin Code 10:44C-4.4

Current through Register Vol. 56, No. 18, September 16, 2024

(a) Should the licensee and the placing agency determine that a residence is no longer suitable or no longer meets the needs of a person served, the person shall not be maintained at that residence, provided substantive evidence is given to the person served and his or her guardian or advocate, as appropriate, and the placing agency.

1. The person and his or her legal guardian or advocate shall have the right to appeal the licensee's decision, in accordance with N.J.A.C. 10:44C-2.2(b)13.

(b) In the case of a planned transfer or discharge, at least 30 days prior to the anticipated discharge date, at a minimum, the following shall occur:

1. The person served, the family, the guardian, and the placing agency, as appropriate, shall receive 30 days' notice concerning a planned transfer or discharge;

2. An addendum to the ITP shall update the existing plan and include the specifics of the transition; and

3. The development of the discharge plan shall include the licensee, the person served and his or her guardian or POA, as appropriate, the TDT and a representative of the managed care organization, as applicable.
i. The discharge plan shall assess the continuing needs of the person served and recommend a plan for provision of follow-up services in the new environment of the person served.

ii. The full records of the person served shall be transferred.

(c) A transfer or discharge summary shall be prepared for each person served who is leaving the program, and shall contain:

1. The diagnosis or disability;

2. The strengths, abilities, needs, and preferences of the person served;

3. Desired outcomes and expectations established;

4. The services provided;

5. Desired outcomes and expectations achieved;

6. The reason for the transfer or discharge; and

7. Referrals and recommendations to assist the person served to maintain and/or improve functioning and increase independence.

(d) Upon an emergency transfer or discharge of a person served, the licensee shall make recommendations to the person, his or her legal guardian, interested family, and/or his or her personal advocate and the placing agency regarding follow-up care required.

1. The person or his or her legal guardian and/or advocate shall have the right to appeal the emergency discharge in accordance with N.J.A.C. 10:44C-2.2(b)13.

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