New Jersey Administrative Code
Title 5 - COMMUNITY AFFAIRS
Chapter 27A - STANDARDS FOR LICENSURE OF RESIDENTIAL HEALTH CARE FACILITIES NOT LOCATED WITH, AND OPERATED BY, LICENSED HEALTH CARE FACILITIES
Subchapter 9 - HEALTH SERVICES
Section 5:27A-9.2 - Provision of health services
Current through Register Vol. 56, No. 6, March 18, 2024
(a) The facility shall arrange for health services to be provided to residents as needed.
(b) At the time of admission, arrangements shall be made between the administrator and the resident, guardian, or designated community agency regarding the physician, advanced practice nurse, or physician assistant, and dentist to be called in case of illness, or the person to be called for a resident who because of religious affiliation is opposed to medical treatment.
(c) The registered professional nurse shall notify the resident's physician, advanced practice nurse, or physician assistant of any significant change in the resident's physical or psychological condition.
(d) Each resident shall receive an initial nursing assessment from the registered professional nurse. Thereafter, each resident shall be reassessed annually or whenever there is a significant change in the resident's condition. The nursing assessment shall include, at a minimum, evaluation of the following:
(e) The nursing assessment required by (d) above shall be documented on the Minimum Data Set for resident assessment and care screening (MDS 2.0, 3.0, or the latest version required by the Center for Medicare and Medicaid Services), or an equivalent assessment instrument, which has been developed by the facility and approved by the Department of Health prior to its use. Copies of the MDS may be obtained by contacting the Department of Health.
(f) Nurses' monitoring notes shall be written on an ongoing basis and shall reflect the current health status of the resident. Events and/or situations to be addressed in the nurse's monitoring notes shall be as follows, where appropriate:
(g) The registered professional nurse or a physician, advanced practice nurse, or physician assistant shall be called at the onset of illness of any resident to arrange for an evaluation of the resident's nursing care needs or medical needs and for needed nursing care intervention or medical care.
(h) A resident with a temporary illness may be cared for in a residential health care facility for a period not to exceed 14 days. If a resident needs bed care for a more extended period, arrangements shall be made for his or her prompt transfer to an appropriate health care facility.
(i) Each resident shall have an annual physical examination by a physician, advanced practice nurse, or physician assistant, which shall be documented in the resident's record. The physician, advanced practice nurse, or physician assistant shall certify annually that the resident does not have needs which exceed the care provided by the residential health care facility.
(j) Residents shall be permitted free choice of a physician, advanced practice nurse, or physician assistant.
(k) The administrator shall arrange for a physician, advanced practice nurse, or physician assistant to be available for emergencies, including injuries or accidents to residents, or when required by a resident's condition.
(l) If the physician, advanced practice nurse, or physician assistant determines the need for a transfer to another health care facility because the residential health care facility cannot meet the resident's needs, such transfers shall be initiated promptly. The registered professional nurse shall be notified to ensure that the resident is receiving appropriate care during the transfer period.
(m) Upon completion of the annual physical required in (i) above, or more often, as determined by the physician, advanced practice nurse, or physician assistant, a licensed physician, advanced practice nurse or physician assistant shall certify that the resident does not have medical or personal care needs which exceed the level of services provided in a residential health care facility, is free from communicable diseases (that is, does not have a reportable, communicable disease which is not controlled through prophylaxis or medication), and does not require skilled nursing care.