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STANDARDS
FOR
COMMUNITY RESIDENCES
FOR THE
DEVELOPMENTALLY DISABLED
N.J.A.C. 10:44A
State of New Jersey
Department of Human Services
Division of Developmental Disabilities
Office of Licensing and Inspections
February 7, 2000
TABLE OF CONTENTS
SUBCHAPTER I: GENERAL PROVISIONS PAGE NUMBER
10:44A-1.1 PURPOSE AND SCOPE
10:44A-1.2 SEVERABILITY
10:44A-1.3 DEFINITIONS
10:44A-1.4 APPLICATION FOR LICENSE
10:44A-1.5 PROCEDURE MANUAL
10:44A-1.6 ISSUANCE OF INITIAL LICENSE
10:44A-1.7 RENEWAL OF LICENSE
10:44A-1.8 DENIAL, REVOCATION, NON-RENEWAL OR
SUSPENSION OF A LICENSE
10:44A-1.9 ADMINISTRATIVE HEARINGS
10:44A-1.10 WAIVER OR VARIANCE
10:44A-1.11 COMPLAINTS
10:44A-1.12 VOLUNTARY CLOSURE
SUBCHAPTER 2: ORGANIZATION AND ADMINISTRATION
10:44A-2.1 GENERAL REQUIREMENTS
10:44A-2.2 DEVELOPMENT AND MAINTENANCE OF PROCEDURE
MANUAL
10:44A-2.3 IMPLEMENTATION OF PROCEDURE MANUAL
10:44A-2.4 PERSONNEL
10:44A-2.5 MINIMUM STAFF QUALIFICATIONS
10:44A-2.6 ORIENTATION
10:44A-2.7 STAFF TRAINING
10:44A-2.8 STAFF COVERAGE
10:44A-2.9 RECORDS; INDIVIDUALS RECEIVING SERVICES
10:44A-2-10 INDIVIDUAL FINANCIAL RECORDS: INDIVIDUAL
FUNDS
SUBCHAPTER 3: ADVOCACY AND RIGHTS
10:44A-3.1 GENERAL REQUIREMENTS
10:44A-3.2 RULES GOVERNING A RESIDENCE
10:44A-3.3 SELF-ADVOCACY
SUBCHAPTER 4:
SERVICE DELIVERY/HABILITATION
10:44A-4.1 PREADMISSION AND ADMISSION
10:44A-4.2 CHANGES IN SUPPORTS/SERVICES
10:44A-4.3 INDIVIDUALIZED HABILITATION PLAN
SUBCHAPTER 5: HEALTH & SAFETY
10:44A-5.1 GENERAL HEALTH CARE
10:44A-5.2 PRESCRIPTION MEDICATION
10: 44A-5.3 OVER THE COUNTER MEDICATIONS
10:44A-5.4 EMERGENCY TELEPHONE NUMBERS
10:44A-5.5 FOOD
10:44A-5.6 CLOTHING
10:44A-5.7 VEHICLE SAFETY
10:44A-5.8 WORKPLACE SAFETY
SUBCHAPTER 6:
FIRE SAFETY AND PHYSICAL ENVIRONMENT
10: 44A-6.I FIRE SAFETY
10:44A-6.2 FIRE EVACUATION PLANS
10:44A-6.3 EGRESS PROTOCOLS
10:44A-6.4 USE GROUP CLASSIFICATION REQUIREMENTS
10:44A-6.5 FIRE EXTINGUISHERS;
10:44A-6.6 GENERAL HOME REQUIREMENTS
10:44A-6.7 CERTIFICATE OF OCCUPANCY
10:44A-6.8 EXITS
10:44A-6.9 HEAT SOURCES
10:44A-6.10 WATER
10:44A-6.11 RAILINGS, STAIRS AND HALLWAYS
10:44W.612 WINDOWS
10:44A-6.13 BEDROOMS
10:44A-6-14 BATHROOMS
10:44A-6.15 KITCHENS
10:44A-6.16 BASEMENT USE
10:44A-6.17 MAINTENANCE REQUIREMENTS
APPENDIX. TABLE OF
COMMUNICABLE DISEASES
SUBCHAPTER 1: GENERAL PROVISIONS
10:44A-1.1 Purpose and Scope
(a) The purpose of this chapter is to establish minimum
requirements for the provision of residential services to people with
developmental disabilities.
(b) This chapter shall apply to a variety of program
models, to include group homes, supervised apartments, and supported
living, as specified in the licensee's program description and, as
applicable, in DDD contractual agreements.
(c) Community care residences, living arrangements in
which a Family Care or Skill Development program is provided in a private
home or apartment, are licensed under N.J.A.C. 10:44B.
(d) If none of the individuals with developmental
disabilities at a particular place of residence require personal guidance,
as determined by the interdisciplinary team, licensing shall be available
on a strictly voluntary basis, in recognition of an individual's right to
choose independent living.
10:44A-1.2 Severability
If any provision of this chapter or the application
thereof to any person or circumstances is held invalid, the invalidity
shall not affect other provisions or applications of this chapter which
can be given effect and to this end the provisions of this chapter are
severable.
10:44A-1. 3 Definitions
The following words and terms, when used in this
chapter, shall have the following meanings, unless the text clearly
indicates otherwise.
"Abuse" means any act or omission that deprives an
individual of his or her rights or which has the potential to cause or
causes actual physical injury or emotional harm or
distress. Examples of abuse include, but are not limited to: acts that cause
pain, cuts, bruises, loss of a body function; sexual abuse; temporary or
permanent disfigurement, death; striking with a closed or open hand; pushing
to the ground or shoving aggressively; twisting a limb; pulling hair;
withholding food; forcing an individual to eat obnoxious substances; use of
verbal or other communications to curse, vilify, degrade an individual or
threaten an individual with physical injury. Planned use of behavioral
intervention techniques which are part of an approved behavior modification
plan or Individual Habilitation Plan are not abuse or neglect.
"Advocate" means a public or private officer,
agency, or organization designated by State legislation, State plan, or the
Governor to represent the interest of persons with developmental
disabilities and speak on behalf of such individuals.
"Age appropriateness" means that aspect of
normalization that reinforces recognition of an individual as a person of a
certain chronological age. This includes, but is
not limited to, an individual's dress, behavior, and use of language, choice
of leisure and recreation activities, personal possessions and
self-perception.
"Annex A" means a detailed program narrative,
which includes a description of services and the staff coverage to be
provided for individuals living in community based settings. The Annex A is
reviewed as part of the licensing inspection process and the contract
renewal process.
"Application for licensure" means a document
supplied by the appropriate Division Regional Office that, when properly
completed, begins the licensing process.
"Capacity" means the maximum number of individuals
with developmental disabilities who may reside in the licensed residence.
"Case manager"
means the authorized representative of any agency who coordinates the
provision of social services and/or habilitation services to individuals
with developmental disabilities.
"Community residence for the developmentally
disabled" means any community residential facility housing up to 16
individuals with developmental disabilities which
provides food, shelter, personal guidance, and/or training. Such residences
shall not be considered health care facilities within the meaning of the
"Health Care Facilities Planning Act," P.L. 1971, c.136 (N.J.S.A. 26:2GH-1
et seq.), and shall include, but not be limited to, group homes, halfway
houses, supervised apartments, supported living arrangements, and hostels.
Skill development homes and family care homes are also community residences
for individuals with developmental disabilities; however, these
owner-occupied living arrangements are governed by N.J.A.C. 10:44B.
"Community Services" means a component of the
Division of Developmental Disabilities which provides housing and supportive
services to aid persons with developmental disabilities in establishing
themselves in the community. Geographic regions and locations of offices are
as follows:
1. Northern Regional Office, serving Sussex,
Warren, Morris, Bergen, Passaic, and Hudson Counties, at the Greenbrook
Regional Center, 275 Greenbrook Road, Green Brook, N.J. 08872;
2. Upper Central Regional Office, serving Essex,
Somerset, and Union Counties, at the Greenbrook Regional Center, 275
Greenbrook Road, Greenbrook, N.J. 08872;
3. Lower Central Regional Office, serving Mercer,
Middlesex, Ocean, Hunterdon, and Monmouth Counties, Capital Center, 50 East
State St., PO Box 726, Tinton, N.J. 08625-0726; and
4. Southern Regional Office, serving Camden,
Atlantic, Salem, Gloucester, Cumberland, Cape May, and Burlington Counties,
101 Haddon Avenue, Suite 17, Camden, N.J. 08103-1485.
"Deficiency" means that an applicant or licensee
has not complied with a rule contained in this chapter.
"Department" means the Department of Human
Services.
"Developmental disability" means a severe,
chronic disability of a person which:
1. Is attributable to a mental or physical
impairment or combination of mental or physical impairments;
2. Is manifest before age 22;
3. Is likely to continue indefinitely;
4. Results in substantial functional limitations
in three or more of the following areas of major activity: self-care;
receptive and/or expressive language; learning; mobility; self-direction;
and capacity for independent living or economic self-sufficiency; and
5. Reflects the need for a combination and
sequence of special interdisciplinary or generic care, treatment, or other
services which are of life-long or extended duration and are individually
planned or coordinated.
"Division" means the Division of Developmental
Disabilities.
"Executive director" means the person to whom the
licensee may delegate administrative authority over the licensee's community
based programs regulated by, or under contract with, the Division.
"Exploitation" means any unjust or improper use of
an individual or his or her resources for one's profit, advantage or
gratification.
"Falsification" means intentionally making a
record or a document false, giving a false appearance to a record or a
document, tampering with a record or a document.
"Fiduciary capacity" means that the licensee acts
with a high degree of good faith when handling money entrusted to the
licensee by individuals receiving services.
"Fire official" means a person certified by the
Commissioner of the Department of Community Affairs, and appointed or
designated to direct the enforcement of the Uniform Fire Safety Code by the
appointing authority of a local enforcing agency and also means any
certified fire inspector working under the direction of the fire official.
"Full license" means the authorization to operate
based upon substantial compliance with this chapter. A full license shall be
effective for up to one year.
"Group homes" means living arrangements operated
in residences leased or owned by the licensee, which provide the opportunity
for individuals with developmental disabilities to live together in a home,
sharing in chores and the overall management of the residence. Staff in a
group home provide supervision, training, and/or assistance in a variety of
forms and intensity as required to assist the individuals as they move
toward independence.
"Guardian" means an individual or agency appointed
by a court of competent jurisdiction who is otherwise legally authorized and
responsible to act on behalf of a minor or incompetent adult to assure
provision for the health, safety, and welfare of the individual and to
protect his or her rights.
"Imminent danger" means a situation that could
reasonably be expected to cause a serious risk to the health, safety or
welfare of an individual.
"Individual" means a person with developmental
disabilities residing in a licensed community residence for individuals with
developmental disabilities. "Individual with developmental
disabilities" will be used in this chapter as necessary to distinguish
between such persons and others, such as staff of the agency or staff of the
Division of Developmental Disabilities.
"Individual Habilitation Plan" (IHP) means a
written plan of intervention and action that is developed by the
interdisciplinary team in accordance with N.J.S.A. 30:6D-10 through 12, and
N.J.A.C. 10:44A-4.3. The IHP specifies both the prioritized goals and
objectives being pursued by each individual and the steps being taken to
achieve them, and may identify a continuum of skill development that
outlines progressive steps and the anticipated outcomes of services. The IHP
is a single plan that encompasses all relevant components, such as an
education plan, a behavior modification plan, a program plan, a
rehabilitation plan, a treatment plan and a health care plan. The complexity
of the IHP will vary according to the needs, capabilities and desires of the
person. In most instances, the IHP will address all of the major needs which
have been identified. The major needs are prioritized. For an individual who
makes only specific services requests, the IHP is a service plan that
addresses only those specific requests.
"Interdisciplinary Team" (IDT) means an
individually-constituted group responsible for the development of a single,
integrated IHP. The team consists of the person receiving services, the
legal guardian, the parents or family member (if the adult desires that the
parent or family member be present), those persons who work most directly
with the individual served, and professionals and representatives of service
areas who are relevant to the identification of the individual's needs and
the design and evaluation of programs to meet them.
"Least restriction" means that interventions in
the lives of individuals with developmental disabilities are carried out
with a minimum of limitation, intrusion,
disruption, or departure from commonly accepted patterns of living.
"License" means the authorization issued by the
Department of Human Services to operate a community residence providing
services to individuals with developmental disabilities.
"Licensee" means the individual, partnership, or
corporation responsible for providing services associated with the operation
of a community residence(s).
"Licensing agency" means the Office of Licensing
and Inspections, within the Department of Human Services, Division of
Developmental Disabilities.
"Mobile non-ambulatory individual" means an
individual capable of independent bed to wheelchair transfer and capable of
following procedures for evacuation from the
facility.
"Negative licensing action" means an action which
imposes a restriction on a licensee and may include suspension of
admissions, issuance of a provisional license, a
reduction in the licensed capacity, a denial of the license, a non-renewal
of the license, a suspension of the license, or a revocation of the
license.
"Neglect" means the failure of a paid or unpaid
caregiver to provide for the care and safety of individuals under his or her
supervision, or failure to provide and maintain proper and sufficient
food, clothing, health care, shelter, and/or supervision.
"Normalization" means making commonly accepted
patterns and conditions of everyday life available to people with
developmental disabilities. Age-appropriateness
and least restriction are two key aspects of normalization.
"Person-centered planning" means a process of
helping persons, in accordance with their needs and preferences, to achieve
a lifestyle that is consistent with the norms and
patterns of general society and in ways which incorporate the principles of
age appropriateness and least restrictive interventions.
"Personal advocate" means a person selected by an
individual with developmental disabilities to provide assistance or act on
his/her behalf in non-legal matters.
"Personal guidance" means the assistance provided
to an individual with developmental disabilities in activities of daily
living because he or she routinely requires help
completing such activities of daily living and/or cannot direct someone to
complete such activities when physical handicaps prevent self completion; or
there is a documented health or mental health problem requiring supervision
of the person for the protection of the individual or others. In the absence
of a court determination, the interdisciplinary team determines the need for
personal guidance for each individual, in accordance with N.J.A.C.
10:44A-4.3(c).
"Plan of correction" means a written response
outlining actions taken or to be taken to address deficiencies cited in a
licensing inspection report.
"Private placement" means the status of an
individual who does not receive services from the Division of Developmental
Disabilities at the time of his or her admission to a community
residence governed by this chapter.
"Program description" means a document submitted
to obtain a license and/or funding from the Division. A program description
includes a detailed description of services provided to individuals
and staff coverage, and is reviewed as part of the licensing inspection
process. The program description is also included in Annex A of the contract
and is amended annually as necessary.
"Provisional license" is a negative licensing
action issued to prompt corrective actions in existing community residences.
A provisional license is effective for less than
one year.
"Relocate" means providing an individual with
accommodations when the individual cannot evacuate a residence within three
minutes, which arrangement meets the individual's needs and enables
the individual to evacuate the residence within three minutes.
"Respite placement" means a service in which a
licensee provides short term supports for an individual with developmental
disabilities.
"Self-advocacy group" means a group of people with
developmental disabilities who meet on a regular basis to discuss common
goals, issues, needs and wishes. With the assistance of a
facilitator, if needed, a self-advocacy group can serve as a united voice
for people with disabilities.
"Special Response Unit" (SRU) means that component
of the Division responsible to investigate serious unusual incidents in
community programs licensed, contracted or regulated by the Division.
"Substantial non-compliance" means
1. The violation by an applicant, licensee or
executive director of the laws of the State of New Jersey pertaining to or
governing community residences for the developmentally disabled;
2. One or more licensing requirements have been
left unmet and the unmet licensing requirements directly endanger the
health, safety, or well-being of an individual;
3. The applicant, licensee or executive director
refuses to cooperate with Division personnel in gaining admission to a
residence or in conducting an investigation or
inspection;
4. The applicant, licensee or executive director
has failed to adhere to the approved Program description;
5. The applicant, licensee or executive director
has falsified any information in order to obtain a license; or
6. The applicant, licensee or executive director
has refused to furnish the Division with files, reports, or records as
required by N.J.A.C. 10:44A.
"Supervised apartments" means apartments that are
occupied by individuals with developmental disabilities and leased or owned
by the licensee. Staff provide supervision,
guidance, and training as needed in activities of daily living as defined by
the individual's needs and targeted future goals,
in accordance with the requirements of this chapter.
"Supported living" means a living arrangement in
which a highly flexible array of services and supports are provided in a
variety of settings.
"Variance" means written recognition by the
Division that the licensee has complied with the intent of a standard in a
Division-approved alternative manner, in accordance with N.J.A.C.
10:44A-1.10.
"Waiver" means the temporary suspension of a
standard that is granted in writing by the licensing agency.
"Willful non-compliance" means that action or
non-action of an applicant or licensee who has knowledge of the violations
of licensing rules and/or terms of the license,
has been advised of the consequences of not achieving compliance and has not
achieved compliance after being given an adequate opportunity to do so.
10:44A-1.4 Application for Licensure
(a) An application for licensure may be obtained
by contacting the appropriate Regional Assistant Director's Office (see
the definition of "Community Services" at N.J.A.C. 10:44A-1.3):
1. Northern Region and Upper Central Region
c/o Greenbrook Regional Center
275 Greenbrook Road
Green Brook, NJ 08812
2. Lower Central Region
Capital Center
50 East State Street
PO Box 726
Trenton, NJ 08625-0726
3. Southern Region
101 Haddon Avenue, Suite 17
Camden, NJ 08103-1485
(b) Except as otherwise provided in the
Rehabilitated Convicted Offenders Act (N.J.S.A. 2A:168A-1 et seq.), no
license shall be issued to any applicant or licensee who has been convicted
of forgery, embezzlement, obtaining money under false pretenses, extortion,
criminal conspiracy to defraud, crimes against the person or other like
offenses.
(c) An application for licensure as an operator of
a group home, supervised apartment, or supported living arrangement shall be
submitted to the appropriate Regional Assistant Director's Office of
Community Services.
1. The application shall be composed of the
following:
i. A table of organization;
ii. Curriculum vitae for the applicant and
executive director;
iii. Documentation that the applicant is not
disqualified from licensure, as provided in (b) above;
iv. A description of the applicant's experience
in providing services to developmentally disabled persons;
v. Documentation that the business is
incorporated or otherwise authorized to do business in the State of New
Jersey;
vi. A list of the governing body (for example,
board of directors/ trustees) and their occupations;
vii. References; and
viii. The program description.
2. Licensees operating community residences in New
Jersey on or before February 7, 2000 shall be required only to provide any
changes in (c)1 above as part of the application process.
3. Applicants shall document on the application
whether they will accept Division placements and/or seek Division funding.
(d) The program description shall be reviewed for
completeness by staff of the Regional Office, the licensing agency and other
Division staff deemed appropriate.
1. The program description shall be available for
review by developmentally disabled persons, their guardians and their
advocates, in accordance with N.J.A.C. 10:41-2.8(a).
(e) The applicant, the licensing agency and the
Division Administrative Practice Officer shall be informed in writing of the
approval or non-approval of the
application, within 20 working days of such approval or non-approval.
10:44A-1.5 Procedure Manual
(a) Prior to opening an initial residence an applicant
shall submit a procedure manual, which meets the requirements of N.J.A.C.
10:44A-2.2 to the licensing agency for approval.
1. This requirement shall not extend to licensees
currently operating community residences for the developmentally disabled
in New Jersey whose procedure manuals have been approved on or before
February 7, 2000.
10:44A-1.6 Issuance of an initial license
(a) Upon receipt of an approved program description, and upon approval of
the licensee's policy and procedure manual, the licensing agency shall
conduct an on-site initial inspection of the residence.
(b) Prior to the issuance of an initial license,
the following, at a minimum, shall be available:
1. Documentation which demonstrates
compliance with all certificate of occupancy (CO) requirements, including
any required inspection by the Fire Official and registration with the
Department of Community Affairs.
2. A fire evacuation plan;
3. A first aid kit that meets the requirements of
N.J.A.C. 10:44A-5.1(g);
4. Functioning utilities, including an operable
telephone;
5. If the building is not serviced by a public
water supply, written approval from the local health department that the
water supply is safe for human consumption;
6. Furniture and food for each individual served;
7. A staff schedule which conforms to the program
description approved by the Division in accordance with N.J.A.C.
10:44A-1.4;
8. A copy of the deed or lease; and
9. Documentation that all necessary residential
and vehicle insurance is in force.
(c) The Department shall issue a non-transferable
full license, effective from the date of the on-site inspection, upon
compliance with (a) and (b) above.
(d) If licensure is not approved, an applicant or
licensee shall submit a plan of correction regarding all deficiencies within
30 days after notification to the licensee.
1. Following receipt of the plan of correction,
the licensing agency shall conduct an on-site review to verify the
corrective action taken.
(e) The license shall document the location of
each residence and shall specify the maximum number of individuals with
developmental disabilities that may occupy the home or apartment, excluding
licensee's staff.
10:44A-1.7 Renewal of a license
(a) A full license shall be effective for up to
one year from the expiration date of the preceding license, unless
otherwise specified by the Division by the issuance of a provisional
license, a non-renewal of license, suspension of license or revocation of
license.
(b) Upon imposition of a provisional license or a
non-renewal of license a licensee shall submit a plan of correction
regarding all deficiencies within 30 days or in accordance with a shorter
time frame as established by the licensing agency.
1. A shorter time frame shall be established by
the Division in those instances where prompt remediation of a deficiency is
required in order to protect the health, safety, welfare and rights of
individuals receiving services.
(c) Following receipt of the plan of correction,
the licensing agency may conduct an on-site review to verify the corrective
action taken.
1. Following an on-site review, the findings of
the licensing agency regarding the licensee's plan of correction shall be
provided to the licensee. These findings shall indicate that each deficiency
is corrected, partially corrected, not corrected, or that further review is
required by the licensing agency.
i. Should there be continuing deficiencies, or
if new deficiencies are noted which document substantial or willful
noncompliance, the findings shall indicate that a second plan of correction
is required or that the licensing agency may impose a negative licensing
action.
(d) If a second plan of correction is required by
the licensing agency, the licensee shall submit the plan of correction
within the time frame specified by the licensing agency.
(e) Following receipt of the second plan of
correction, the licensing agency may conduct an on-site review to verify the
corrective action taken.
1. Subsequent to an on-site review, the findings
of the licensing agency regarding the licensee's second plan of correction
shall be provided to the licensee. These findings shall indicate whether or
not each deficiency is corrected.
i. Should there be continuing deficiencies which
the licensee has stated in the plan of correction have been corrected, or if
other deficiencies are noted which jeopardize the health, safety, welfare
and rights of the individuals, or which document substantial or willful
noncompliance, the licensing agency shall impose a negative licensing
action.
10:44A-1.8 Denial, revocation, non-renewal or suspension
of a license
( a) The licensing agency may deny,
suspend, revoke, or refuse to renew a license for substantial
non-compliance, or for willful non-compliance.
(b) If the licensing agency denies,
revokes or refuses to renew a license the licensee shall be prohibited
from re-applying for a license for one year from the date of license
revocation or non-renewal. After the one year period has elapsed, the
licensee may submit to the licensing agency a new application for a
license.
1. When a negative licensing action is
based upon falsification, willful noncompliance, criminal activity on the
part of the applicant, licensee or executive director, or when individuals
have suffered physical harm due to the applicant's, licensee's or
executive director's actions or failure to act, the Division may refuse to
accept any subsequent application.
(c) When a license is suspended, the
licensing agency shall reinstate the license when the licensee achieves
compliance with the provisions of this chapter. The Division shall not
require the licensee to submit a new application for a license unless such
application is expressly made a condition of the reinstatement of the
license.
(d) Each license issued to a licensee
shall remain the property of the Department of Human Services. If the
licensing agency suspends or revokes a license, the licensee shall, upon
notification, return the license to the licensing agency.
10:44A-1.9 Administrative hearings
(a) Upon imposition of a negative
licensing action, the licensee shall have the opportunity to request an
administrative hearing pursuant to N.J.A.C. 10:48-1.
(b) In the event of the imposition
of a non-renewal, suspension or revocation, if the Division determines that
individuals are not at risk and that no imminent danger(s) exist(s), the
Division may permit a residence, operated by a licensee who has requested an
administrative hearing as specified in (a) above, to continue to operate
until a final decision is rendered as a result of the hearing.
(c) If it is determined that the
occupants of a home are at risk, the Division may:
1. Remove the individuals from the
residence; or
2. Place staff approved by the
Division at the residence to ensure the safety of the individuals.
10:44A-1.10 Waiver or variance
(a) A waiver or variance shall be
granted by the licensing agency provided that such a waiver or variance
would present no danger to the health, safety, welfare or rights of the
individuals receiving services.
1. The licensee shall request the waiver
with substantial detail justifying the request.
2. Issuance of a waiver or variance
shall be limited to the following circumstances:
i.
Where enforcement of the standard would result in unreasonable hardship on
the residence; or,
ii. Where
the waiver or variance is in accordance with the particular needs of the
individuals with developmental disabilities.
10:44A-1.11 Complaints
(a) The Division shall have the authority to
investigate any complaint received regarding a licensee.
1. The licensee shall cooperate with the Division
in any investigation.
10:44A-1.12 Voluntary closure
A licensee shall give at least 60 days notice to the appropriate Regional
Office of Community Services, Division of Developmental Disabilities of any
planned closure.
SUBCHAPTER
2 ORGANIZATION AND ADMINISTRATION
10:44A-2.1 General requirements
(a) The purposes of the licensee's
organization and a description of the services that it provides shall be
made available to individuals with developmental disabilities, parents,
guardians, advocates and the general public. This document shall describe,
in general terms, who is served, the services provided, and the goals of
the licensee's organization.
(b) The licensee shall keep the
following on file:
1. A record of all admissions and
discharges, including names and dates, for the previous 24 month period;
2. A current copy of this chapter;
3. Copies of all current licenses; and
4. Written descriptions of any religious
practices or restrictions that are observed if a licensee has a particular
religious orientation, approved as part of the program description, in
accordance with this chapter.
(c) A licensee having non-profit status
in accordance with 26 U.S.C.A. §501(c)(3) shall have a Board of Trustees
which meets the following criteria:
1. A minimum of five persons shall
comprise the board.
2. Provisions shall exist for the
orientation of new board members; and
3. Meetings shall be held with a
frequency sufficient to discharge their responsibilities effectively; in
no event shall the full governing body meet less than three times a year.
10:44A-2.2 Development and maintenance
of procedure manual
(a) The licensee shall develop
and implement a manual of written procedures to ensure that the service
delivery system complies with State law and rules governing community
residences for individuals with developmental disabilities.
1. The procedures shall be reviewed
annually and revised as necessary.
2. Each procedure shall be designed
in accordance with the principles of normalization, age appropriateness,
least restriction, person centered planning and
shall be consistent with the organizational structure and management
philosophy of the licensee.
3. While specific content for
inclusion in a procedure shall be identified on an as-needed basis in these
rules, to ensure consistency, each procedure shall
include:
i. A descriptive title which is
unique so as to permit easy reference and retrieval of each document;
ii. An explanation regarding the
purpose of the document;
iii. A description of sequential
steps required to successfully complete a task or action;
iv. Assignment of staff
responsibilities at each step in the implementation; and
v. Reporting and recording
requirements for each person involved.
(b) The licensee shall maintain a
procedure manual containing the following documents and/or procedures:
1. A statement of philosophy,
values and goals so as to govern the organization's direction and character;
2. A table of organization that
illustrates lines of authority, responsibility and communication;
3. A procedure for implementing a
plan to deal with major emergencies requiring evacuation from the residence,
such as a fire or a gas leak;
4. A procedure for handling
medical emergencies;
5. A procedure for reporting all
unusual incidents;
6. A procedure for the reporting
of suspected abuse, neglect or exploitation of the individuals receiving
services, including, at a minimum:
i. A written statement expressly
prohibiting abuse, neglect or exploitation;
ii. A written statement regarding
the obligation to report each allegation as required by N.J.S.A. 9:6-8.10,
N.J.S.A. 52:27G-1et seq. and Division policy; and
iii. A written statement
regarding specific agency investigation procedures;
7. A procedure to ensure sound
fiscal management of individual's funds;
8. A procedure for resolving
complaints and grievances of individuals receiving services;
9. A procedure, separate from
individuals' records, for internal communication, to include the use of a
log to document critical information and the
associated action taken as necessary;
10. A procedure for admissions,
including admission criteria, discharges, and changes in supports/services,
which comply with the requirements of N.J.A.C. 10:44A-4;
11. A procedure to address the
development, implementation, review and evaluation of each individual's
habilitation plan as required by N.J.S.A. 30:6D-10 et seq.;
12. A statement regarding
maintaining confidentiality of individuals receiving services and records as
required by N.J.A.C.10:41-2;
13. Written procedures for
medication administration, including procedures for self-medication; and
14. A continuous quality
improvement system to identify opportunities to improve services and/or
supports and to resolve identified problems. The system shall include, at a
minimum:
i. A written plan to identify how
data is collected, analyzed and utilized to determine patterns which
identify process or systemic problems requiring
further in-depth review;
ii. Input from a variety of
sources, including persons receiving services, family members and others;
iii. A written summary of
satisfaction surveys;
iv. A written summary of outcomes
assessments; and
v. An action plan based upon an analysis of (b)14i
through iv above.
10:44A-2.3 Implementation of
procedure manual
(a) The procedure manual shall be
available and accessible for staff use.
(b) All staff shall be able to
describe procedures that they routinely implement.
(c) The procedure manual shall be
available for review by authorized representatives of the Division of
Developmental Disabilities.
10:44A-2.4 Personnel
(a)
Personnel practices shall comply with all applicable Federal, State and
local laws, ordinances, rules and regulations pertaining to employment,
including civil rights, retirement plans or social security, minimum
wages, hours and workers compensation.
(b) Except as otherwise provided in
the Rehabilitated Convicted Offenders Act (N.J.S.A. 2A:168A-1 et seq.), no
licensee shall employ any person who has been convicted of forgery,
embezzlement, obtaining money under false pretenses, extortion, criminal
conspiracy to defraud, crimes against the person or other like offenses.
1. A licensee shall not employ any
person who has been adjudged civilly or criminally liable for abuse of a
developmentally disabled person receiving services from the Department or
placed in a community residence regulated by this chapter.
(c) Prior to hiring any staff or
utilizing a volunteer who provides specific services on a planned basis, the
licensee shall secure and maintain:
1. A signed application for
employment from each applicant, indicating the applicant's name, address and
telephone number, education and disclosure of the presence or absence of
criminal convictions;
2. A minimum of two documented
references;
i. The licensee shall check a
minimum of two most recent work references or, if not available, a minimum
of two personal references.
ii. The licensee shall document
all reference checks and maintain such reference checks in the applicant's
personnel record; and
3. A current job description which,
at a minimum, shall include the following:
i. A position statement that
documents overall job responsibilities, including the requirement that the
employee cooperate with the licensee and Division staff in any
inspection or investigation;
ii. A list of specific duties;
iii. The minimum qualifications;
iv. The positions supervised, if
applicable; and
v. The reporting supervisor.
(d) Upon employment, direct
service staff shall submit a written statement from a licensed physician
indicating that he or she is in good health. Such statement shall be based
on a medical examination conducted within the six months immediately
preceding the direct service staff's starting date with the licensee.
(e) Within one year prior to or
upon beginning work and annually thereafter, each direct service staff
member shall take a Mantoux tuberculin skin test with five TU (tuberculin
units) of PPD tuberculin.
1. The direct service staff member
shall submit to the licensee written documentation of the results of any
testing or certification.
2. If the direct service staff
member has had a previous positive Mantoux tuberculin skin test, or if the
Mantoux tuberculin skin test is significant (10 or more millimeters (mm) of
induration), the staff member shall submit to the licensee a statement from
his or her physician certifying that he or she poses no threat of
tuberculosis contagion before he or she is allowed to come in contact with
individuals being served and other staff.
3. If the Mantoux tuberculin skin
test is insignificant (zero to nine mm of induration), no further testing
shall be required.
i. The licensing agency or the
licensee may, at any time, require a direct service staff member to retake
the Mantoux tuberculin skin test, if there is a reason to believe or
suspect that the staff member may have contracted tuberculosis or if the
State Department of Health and Senior Services recommends retesting.
4. The licensee shall prohibit any
direct service staff member who fails to submit satisfactory results from a
medical practitioner from having contact with the individuals receiving
services or other staff.
(f) The licensee shall maintain on
file the following for all direct service staff:
1. Mantoux tuberculin skin test
results; or chest x-ray or physician's certification; and
2. The results of a physical
examination.
10:44A-2.5 Minimum staff qualifications
(a) The licensee or the executive
director shall have:
1. A Bachelor's Degree or a high school
diploma or equivalent; and
2. Five years of experience working with
people with developmental disabilities, two of which shall have been
supervisory in nature.
(b) The supervisor responsible for the
operation of a residence shall have a high school diploma or equivalent
and one year of experience working with people with developmental
disabilities.
(c) Direct service staff shall be at
least 18 years of age and shall have a high school diploma or equivalent.
(d) Direct service staff shall have the
ability to communicate with the individuals with whom they are working.
(e) Direct service staff shall be
capable of providing any direct assistance required by individuals with
whom they are working.
(f) The licensee shall verify that all
persons providing a professional service, either through direct employment
or contract, possess credentials required by Federal or State law.
10:44A-2.6 Orientation
(a) Prior to working with individuals
receiving services, all staff shall receive an orientation to acquaint
them with:
1. Overview of developmental
disabilities;
2. Medication training;
3. Preventing abuse and neglect;
4. Emergency procedures as identified in
the procedure manual; for example, the fire evacuation plan, emergency
medical treatment, use of fire extinguishers;
5. An overview of developmental
disabilities and any special needs of the individuals being served, for
example, medical or behavioral problems requiring specific, tailored
training; and
6. The appropriate job description and
the personnel policies of the organization.
(b) Records of the orientation provided
shall include a dated, signed acknowledgment by the employee receiving and
the person(s) providing the orientation.
10:44A-2.7 Staff training
(a) Basic staff training programs
shall either be offered by the Division, or provided by the licensee after
obtaining approval from the Division, to ensure staff competency. Within
120 days of employment, each employee shall successfully complete New
Jersey Pre-Service Training that shall address, at a minimum:
1. Overview of developmental
disabilities;
2. Medication training;
3. Preventing abuse and neglect;
4. American Red Cross Standard
First Aid Training (and have a valid certificate on file); and
5. Cardiopulmonary resuscitation
training (and have a valid certificate on file).
(b) Staff shall receive training in
all policies and procedures not covered during orientation which are
relevant to the employee's job.
(c) Specialized training programs,
identified as necessary by the Division during the application process or,
subsequently, by the Interdisciplinary Team, shall include, but not be
limited to:
1. Persons who work with
individuals who require specialized feeding techniques shall receive
training in the use of those techniques.
i. Feeding tube responsibilities
shall be delegated to nursing personnel.
2. Persons who work with
individuals who use mobility devices shall receive training in mobility
procedures and the safe use of mobility devices.
3. Persons who work with
individuals with seizure disorders, physical disabilities or other
identified medical needs shall receive training in
the provision of training, assistance, and care to those individuals.
4.
Persons who work with individuals with identified mental health needs shall
receive training in the provision of training, assistance, and care to those
individuals.
(d) Training records shall be
maintained in the administrative offices and shall contain the following:
1. A curriculum describing the
courses or individual topics offered and a training plan addressing how the
content of each course or topic will be delivered;
2. Documentation of attendance
through a report that includes the dated signatures of the trainer and the
trainee; and
3. Results of those training
programs that the Division requires.
(e) The licensee may conduct, at
its discretion, and without specific prior approval from the Division,
training programs in addition to training required by this chapter.
10:44A-2.8 Staff coverage
(a) A description of the staff
coverage and the staff schedule shall be initially approved as part of the
Program description, reviewed at each inspection, and shall specify:
1. The on-site coverage; and
2. The emergency coverage and
access procedures in instances where on-site coverage is not necessary.
(b) Reduction of staff coverage as
specified in the Annex A shall be justified in writing and sent to the
licensing agency and the appropriate Regional Assistant Director's Office
for approval.
1. Documented approval(s) by the
Interdisciplinary Team that an individual or individuals can be left alone
for specific amounts of time shall be submitted as evidence justifying
modification of staff coverage.
2. Reduction of staff coverage
shall be jointly reviewed and approved by the Regional Office and the
licensing agency prior to implementation by the licensee, based on (b)1
above.
3. A written response shall be
provided by the Division within 15 working days, documenting any conditions
which must be met as part of the approval of the reduction of staff
coverage.
(c) Staff are not required to be
on-site when no individuals are present in the residence, but trained, paid
agency staff, familiar with the individual(s),
shall be available for emergencies.
(d) A written staff schedule, for
at least a two-week period, shall be available for review at each residence.
The employee in-charge shall be designated on the schedule for each shift.
1. At least one staff, currently trained and certified in first aid
and CPR, shall be on duty for each shift.
10:44A-2.9 Records; individuals
receiving services
(a) An individual file shall be
maintained for each individual receiving services in a licensed community
residence for individuals with developmental disabilities.
1. The file shall be legibly marked with
the individual's name.
(b) Files shall be maintained at the
residence or at the pre-determined location stated in the program
description /Annex A.
(c) An individual shall have access to
his or her records, unless clinically contra-indicated and documented.
(d) Individual records shall include:
1. Pre- admission information, as
follows:
i. The
individual's full name, date of birth, and sex;
ii. The
individual's Social Security, Medicaid numbers or medical insurance
numbers;
iii. The Date(s) of
admission, re-admission, transfer or discharge;
iv. The name and
addresses of persons or agencies responsible for placement;
v. The names
and addresses of all personal physicians and dentists;
vi. The name, address
and telephone number of the legal guardian (or guardianship worker), next
of kin, and other interested person(s), and a copy of the guardianship
determination, if applicable;
vii. Religious preference;
viii. Pre-admission data
including diagnosis, a psychological evaluation, as appropriate and/or
available and developmental history, including behavioral
characteristics.
ix.
Pre-admission data including diagnosis, a psychological evaluation, as
appropriate and/or available and developmental history, including
behavioral characteristics.
x. The
results of physical examination completed within 90 days prior to the
scheduled admission date;
xi. The results
of a Mantoux Skin Test, completed within the pat year, obtained within 30
days prior to admission;
xii. Certification
from a physician stating the individual is free of communicable disease
(written documentation shall be provided to the licensee within 72 hours
of admission); and
xiii. An immunization
record, as available as required for individuals under the age of 22.
2. The results of an annual physical
examination and the results of the Mantoux Skin Test, readministered every
year;
3. Annual reports from the dentist of
dental examinations and corrective work done;
4. Initial reports of unusual incidents;
5. Seizure records, where indicated;
6. The current IHP;
7. Monthly reports of individuals'
social and behavioral progress to correspond to the current IHP;
8. A medically prescribed diet, if
required;
9. Documentation of known allergies;
10. An inventory of valuable personal
property; and
11. An inventory of valuable personal
property; and
12. Financial records pursuant to
N.J.A.C. 10:44A-2.10.
10:44A-2.10 Individual financial
records: individual funds
(a) Each individual shall have the right
to manage his or her own personal funds consistent with his or her
abilities as documented in his or her IHP.
1. If it has been determined that the
individual cannot independently manage his or her funds/finances, the IDT
shall determine how much money, if any, can be managed by the individual
at any given time.
(b) The licensee shall develop
procedures regarding the management of individuals' funds for individuals
who have been determined in need of assistance by the IDT.
(c) At the time of admission each
individual shall be provided with a written statement listing the services
regarding the safekeeping and management of funds.
(d) The licensee shall obtain written
authorization for any of the individual's funds to be entrusted.
1. The authorization shall specify which
funds are to be entrusted to the licensee, including, but not limited to,
Personal Needs Allowance, paychecks, Patient Trust Fund, monetary gifts,
payment from family members, transportation reimbursements, public
assistance, income tax rebates and insurance claims.
2. The individual and his or her
guardian, where applicable, shall sign the authorization.
(e) For all funds entrusted to the
licensee, the licensee shall maintain records and receipts of all income
received and all disbursements of the individual's funds
1. All receipts related to disbursements
of an individual’s funds and purchases made on behalf of an individual
shall be maintained while the individual resides at the residence.
(f) If an individual's funds are
entrusted to an agency, moneys received by an individual in excess of
$100.00 shall be placed in an interest bearing account unless otherwise
determined by the IDT.
1. The account shall be in a form that
clearly indicates that the licensee is acting in a fiduciary capacity
regarding the individual's funds and that any interest from the account
shall accrue to the individual.
2. The licensee may keep up to $100.00
of an individual's money in a non-interest bearing account or petty cash
fund, to be readily available for current expenditures, providing it is
kept for safekeeping in an account separate from all other funds for the
residence.
i. Any increase
in this amount shall be authorized by the individual and his or her
guardian, where applicable.
(g) The licensee shall, upon written
request from the individual and his/her guardian, where applicable, return
any or all of the individual's funds given to the licensee for
safekeeping, including the interest accrued from deposits.
(h) There shall be no loans of finances,
resources or property from an individual receiving services to the
licensee, staff member, or any other individual receiving services.
(i) The licensee to whom the individual
entrusts his or her funds shall assure that the management of such funds
does not jeopardize the individual's entitlements to any appropriate
federal or private benefit.
(j) The licensee shall allow each
individual and guardian, where applicable, access to a written record of
all financial arrangements and transactions involving the individual's
funds, upon request.
1. Copies of this record shall be made
available to the individual and his/her guardian, upon request.
SUBCHAPTER
3 ADVOCACY AND RIGHTS
10:44A-3.1 General requirements
(a) The provision of services and
support shall demonstrate recognition that people with disabilities have
the same rights as all other citizens.
1. An individual's exercise of his
or her rights shall not be prohibited or be used as a cause for retribution
against him or her.
(b) Upon admission to the program
and then upon subsequent request, the licensee shall provide the individual
receiving services and his or her guardian, where applicable, with the
following:
1. A copy of the Division's rights
document;
2. The names, addresses and
telephone numbers of advocates available to assist the individual in
understanding and enforcing these rights, to include, at a minimum:
i. New Jersey Protection and
Advocacy, Inc.;
ii. Community Health Law Project;
iii. Office of Licensing and
Inspections;
iv. Bureau of Guardianship, if
applicable;
v. His or her case manager;
vi. Division of Youth and Family
Services' Child Abuse Control number (1-800-792-8610), if applicable; and
vii. Office of the Ombudsman
(1-877-582-6995), if applicable.
3. A copy of the licensee's rules
which apply to the individual's residence; and
4. A copy of the licensee's
grievance procedure for appealing agency decisions, which shall have a
minimum of two levels of appeal, the last of which shall involve the
executive director or the licensee.
(c) If an individual is unable to
read (b)1 through 4 above, the text shall be read or the meaning conveyed to
the individual in a language or manner the individual understands.
1. The licensee shall make
provisions to explain portions that are not understood and answer any
questions the individual may have regarding (b)1 through 4 above.
(d) A copy of a written
acknowledgment that (b)1 through 4 above has been explained and understood
shall be immediately signed and dated by the individual, the licensee's
representative(s) and the individual's guardian, if present.
1. If the guardian is not present,
the signed acknowledgment shall be sent to the guardian within five days.
i.
Documentation shall be maintained in the individual's record.
2. The acknowledgment may also be
witnessed by a personal advocate, if present.
3. The acknowledgment shall be
placed in the individual's record.
(e) The licensee shall ensure that
staff are familiar with and observe the rights and responsibilities
enumerated in the approved rights document.
(f) Individuals receiving services
shall receive training and support in order to understand options, make
choices and exercise rights and responsibilities.
1. The exercise of rights is not
limited when an individual has a guardian or interested family.
(g) The licensee shall be
responsible for utilizing a Human Rights Committee in accordance with
N.J.A.C. 10:41-4. Administrative change.
10:44A-3.2 Rules governing a residence
(a) The licensee may establish
reasonable rules that govern the conduct of individuals in a particular
residence, including, but not limited to, rules regarding smoking, pets
and visitors, provided:
1. The rules are commensurate with the
individuals' abilities and rights;
2. Individuals and their guardians,
where applicable, are informed of the rules governing a residence prior to
their admission;
3. The individuals affected by such
rules are consulted whenever a revision is considered, and there is
evidence the rules are necessary to promote order and to benefit the
collective group;
4. The rules include provisions to
ensure that an individual exercising his/her rights does so in such a way
so as to not infringe upon the rights of, or endanger, others; and
5. The licensee complies with the rules
contained in this chapter regarding the requirements for a grievance
process/appeal of a licensee decision (see N.J.A.C. 10:44A-2.2(b)8).
(b) An individual or a group of
individuals shall be given a copy of such rules, and additional copies
shall be made available upon subsequent request
(c) Each copy of the rules shall contain
a statement that an individual or a group of individuals has the right to
challenge such rules as to their appropriateness through the licensee's
grievance procedure, in accordance with N.J.A.C. 10:44A-2.2(b)8.
(d) The process of conducting house
meetings shall include the individual as much as possible unless the IDT
has determined otherwise. The scheduling of such meetings shall include
the individuals living in the home. Staff shall assist the individuals
with setting the schedules and agendas for house meetings.
10:44A-3.3 Self-advocacy
(a) The licensee shall identify
individuals who want a personal advocate or who wish to participate in a
self-advocacy group.
(b) Individuals with developmental
disabilities shall be given the opportunity to participate in a
self-advocacy group of their choice.
(c) Notices of advocacy or self-advocacy
conferences, seminars or meetings shall be made available to all
individuals in each residence unless determined otherwise by the IDT.
SUBCHAPTER
4 SERVICE DELIVERY / HABILITATION
10:44A-4.1 Pre - admission and admission
(a) The licensee shall have
written criteria for admission to a particular program, including
temporary (respite) placements. These criteria shall include, at a
minimum:
1. Specific services provided;
2. A non-discrimination statement
regarding admissions, assuring no one will be denied admission on the
grounds of race, sex, color, national origin,
religion, age, physical or mental disability, ancestry, sexual
preference/affiliation, including AIDS or HIV infection, atypical cellular
hereditary blood traits or any other legally protected status;
3. A statement regarding any
limitations an agency may have in providing services to an individual with a
specific developmental disability;
4. A statement affording all
individuals and/or their guardians the opportunity of preplacement visits to
the residence;
5. A statement regarding any
minimum and/or maximum age restrictions;
6. A statement regarding respite
criteria; and
7. Fee structures.
(b) The appropriate Regional
Office shall make referrals to licensed community residences funded by the
Division of Developmental Disabilities.
1. All admissions of private
placements shall be reported in writing to the licensing agency within five
days.
(c) The number of individuals with
developmental disabilities admitted to a residence shall not exceed the
licensed capacity.
(d) Prior to admissions, the
appropriate Regional Office shall provide the licensee with the following:
1. Information which complies with
N.J.A.C. 10:46 which addresses eligibility for services;
2. Results from a medical
examination conducted no more than 90 days prior to admission;
3. A current immunization record,
as available and hepatitis B screening results in accordance with N.J.A.C.
10:48-2;
4. The results of a Mantoux Skin
Test for tuberculosis, administered within one year prior to the date of
admission; and
5. Pre-admission information
required under N.J.A.C. 10:44A-2.9(a)1i through xi.
(e) The licensee shall, at the time
of admission, and without cost to the individual, provide the following:
1. A copy of the written
procedures for safekeeping of valuable personal possessions;
2. A written statement explaining
the individual's rights;
3. A copy of the rules governing
the residence, as applicable;
4. A copy of the grievance
procedure; and
5. A copy of the procedure
regarding toll calls/charges.
(f) The licensee shall make
provisions to explain (e)1 through 5 above and answer any questions the
individuals may have regarding this information.
(g) The individual's guardian
shall be notified, in writing, that the individual has had this information
explained to him or her.
1. A copy of the notifications
shall be maintained in the individual's record.
(h) Within 30 days of an
admission, an IHP shall be developed or modified in conjunction with the IDT
in accordance with N.J.S.A. 30:6D-10 et seq.
10:44A-4.2 Changes in supports /
services
(a) Any major change in an
individual's residential service and/or supports shall include the
utilization of the IDT.
1. In the case of a planned
transfer or discharge, at least 30 days prior to the anticipated discharge
date, at a minimum:
i. An addendum to the IHP shall
update the existing plan and include the specifics of the transition.
ii. The development of the
discharge plan shall include the licensee, the individual and his or her
guardian, as appropriate, the IDT and a representative of the placing
agency.
iii. The discharge plan shall
assess the individual's continuing needs and recommend a plan for provision
of follow-up services in the individual's new environment.
iv. The appropriate Division
regional office shall be notified.
v. The individual's full records
shall be transferred.
2. Should the licensee and the
placing agency determine a residence is no longer suitable or no longer
meets the needs of an individual, the individual shall not be maintained at
that residence, provided substantive evidence is given to the placing
agency.
i. All discharges of private
placements shall be reported in writing to the licensing agency within five
days.
10:44A-4.3 Individual Habilitation Plan
(IHP)
(a) The licensee shall establish and
implement a procedure to address the development, implementation, review
and evaluation of each individual's habilitation or service plan as
required by N.J.S.A. 30:6D -10 et seq.
(b) The individual's plan and monthly
documentation of progress shall be maintained as part of the individual's
record.
(c) The comprehensive IHP shall include,
at a minimum, the following elements:
1. A cover page;
2. Evaluation summaries;
3. A summary of progress toward previous IHP goals and objectives
4. Identification of person's preferences, capabilities and needs;
5. Goals;
6. Behaviorally stated, measurable,
sequential objectives;
7. A clearly stated method of achieving
each objective;
8. Identification of IDT members and
persons responsible for ensuring the delivery of services/ programs
described in the plan;
9. A listing of all current and planned
services /programs and their dates of initiation, anticipated duration and
frequency;
10. Barriers to meeting the individual's
needs;
12. A meeting summary / addendum, which
may include disagreement with any part of the plan;
13. A sign-off section, which indicates
attendance only; and
14. Authorization for approved
individual expenses.
SUBCHAPTER 5 HEALTH AND SAFETY
10:44A-5.1 General health care
(a) A personal, primary physician or
medical group/clinic shall be identified for each individual receiving
services.
(b) Each individual shall, at a minimum,
have an annual medical examination.
1. The examining physician shall sign,
date and document the results of the examination.
2. A copy of the results of the annual
examination shall be maintained in the individual's file. The
confidentiality of this document shall be maintained in accordance with
N.J.A.C. 10:41-2.
(c) Each individual shall, at a minimum,
have an annual dental or oral examination.
1. A record documenting the results of
the dental examination, signed and dated by the dentist, shall be
maintained in the individual's record.
(d) Each year the individual served
shall take a Mantoux tuberculin skin test.
1. If the individual has had a previous
positive Mantoux tuberculin skin test, or the result of the Mantoux
tuberculin skin test is significant (10 or more mm of induration), the
licensee shall require:
i. That the individual obtain a written statement
from a physician certifying that he or she poses no threat of tuberculosis
contagion; or
ii. A protocol to
follow, recommended by the physician, before allowing the individual to
come into contact with other individuals being served and staff.
2. The licensee shall support the
individual in adhering to the recommended follow-up testing, if any, by
the physician.
(e) The licensee shall follow-up on all
individual health needs including medical treatment, pharmaceutical,
dental or other needed services.
1. Documentation shall be maintained in the
individual's record.
(f) The licensee shall ensure that the
community residence is located in an area where a local rescue squad and
an area hospital are available for emergency medical care.
(g) Each licensed program site shall
have a first aid kit, to include:
1. Antixeptic;
2. Rolled gauze bandages;
3. Sterile gauze bandages;
4. Adhesive paper or ribbon tape;
5. Scissors;
6. Adhesive bandage (for example, Band-Aids); and
7. Either a standard type or a digital
thermometer.
(h) Upon confirmation that an individual
has contracted a communicable disease as identified in the chapter
Appendix, incorporated herein by reference, the licensee shall ensure
exposed individuals are placed under a physician's care.
1. The individual's physician shall
determine treatment and precautions to be taken.
i.
documentation of treatment and precautions shall be maintained in the
individual's file.
2. If the individual does not live
alone, the licensee shall contact the primary physician for all other
individuals in the residence.
(i) The licensee shall comply with
N.J.A.C. 10:48-2 regarding the screening, treatment and control of viral
Hepatitis B.
10:44A-5.2 Prescription medication
(a) Individuals receiving medication
shall take their own medication to the extent that it is possible, as
assessed and determined by the Interdisciplinary Team documented in the
individual's IHP and in accordance with licensee procedure.
(b) If the individual is not responsible
for or capable of taking his or her own medication, the licensee or his or
her designee shall assist and supervise the administration of the
medication as prescribed.
(c) A written record shall be maintained
of all medication administered by the licensee or the designee.
1. The record shall include the following:
i. The individual's name;
ii. The date;
iii. The name of medication;
iv. The type of medication;
v. The dosage;
vi. The frequency;
vii. The initials and corresponding
signatures of staff administering the medication; and
viii. All known allergies.
(d) If an individual is capable of
taking medication without assistance, no daily medication administration
record is required.
1. A list identifying the name of the
medication(s), type of medication(s), dosage, frequency, date prescribed
and the location of the medication(s) shall be filed in the individual's
record.
(e) Written documentation shall be filed
in the individual's record indicating that all prescribed medication was
re-evaluated at least annually by the prescribing physician.
(f) Staff shall have access to a
medication reference book, current within three years and written for lay
persons, which shall include information on side effects and drug
interaction.
(g) Any change in medication dosage by
the physician shall be immediately noted on the current written medication
record by staff consistent with the licensee's procedure.
1. Verbal orders from the physician
shall be confirmed in writing within 24 hours or by the first business day
following receipt of the verbal order.
2. The prescription shall be revised at
the earliest opportunity.
(h) A supply of medication, adequate to
insure no interruption in the medication schedule, shall be available to
individuals at all times.
(i) The licensee or designee shall
supervise the use and storage of prescription medication, ensuring that:
1. A storage area of adequate size for
both prescription and non-prescription medications shall be provided and
kept locked for those individuals who are not self-administering their own
medication.
2. Each individual who administers his
or her own medication shall receive training and monitoring by the
licensee regarding the safekeeping of medications for the protection of
others, as necessary.
i. Medication
shall be kept in an area that provides for the safety of others, if
necessary;
3. Staff shall have a key to permit
access to all medication at all times and to permit accountability checks
and emergency access to medication.
i. Specific
controls regarding the maintenance and use of the key to stored medication
shall be established by agency procedure;
ii. if necessary,
medications that require refrigeration shall be maintained in a manner
that provides for the safety of others, for example, by using locked
boxes.
5. All medications shall be kept in
their original containers from the pharmacy and shall be properly
identified with the pharmacist's label.
i. An
individual who is self-medicating may choose adaptive equipment that
continues to assure the safe storage of medication;
6. No stock supply of prescription
medications shall be kept;
7. Medications that are outdated or no
longer in use shall be destroyed according to licensee procedure;
8. Non-prescription medications shall be
properly safeguarded and stored separately from prescription medication;
9. When medication is prescribed PRN (as
needed), the prescription label shall include the following: The
individual's name, date, name of medication, dosage, specification of
interval between dosages, maximum amount to be given during a twenty-four
(24) hour period, a stop date, when appropriate, and under what conditions
the PRN medication shall be administered; and
10. The administration of PRN
medication, along with the time of administration, shall be documented on
the written medication record and shall be communicated to the on-coming
shift of residential staff.
10:44A-5.3 Over-the-counter medications
(a) A statement from the physician
regarding the usage and contraindications of over-the-counter medications
shall be available for staff reference and use and shall be updated
annually.
(b) Over-the-counter medications shall be documented
separately from the record utilized for prescription medication.
10:44A-5.4 Emergency telephone numbers
(a) The telephone number of the Division
of Developmental Disabilities' hotline, as well as the nearest hospital,
fire department, ambulance service, police department local Poison Control
Center (if applicable), and licensee's emergency telephone number (if
applicable) shall be easily accessed and located by each telephone.
1. If a minor is living in residence,
the telephone number for the Division of Youth and Family Services' Office
of Child Abuse Control (toll free in New Jersey at 1-800-792-8610) shall
also be easily accessed and located by each telephone.
2. If an individual 60 years of age or
older is living in the residence, the telephone number for the Office of
the Ombudsman (toll free in New Jersey at 1-800-624-4262) shall also be
easily accessed and located by each telephone.
10:44A-5.5 Food
(a) Sanitary practices shall be utilized
in the storage, handling, preparation and serving of all food and drink.
(b) All appliances, equipment and
utensils used for eating, drinking, preparation and serving of food shall
be kept clean and in good condition and thoroughly washed after each use.
(c) Food shall be readily accessible to
individuals receiving services unless limitations have been approved by
the IDT.
(d) The licensee shall ensure that each
individual is provided the opportunity for the following:
1. Three nutritionally balanced meals,
varietal in nature, in the home or in the community; and
2. Reasonable adjustments to individual
preferences, habits, customs and appetites.
(e) Individuals shall be afforded the
choice of dining with other individuals or dining by themselves.
(f) Food shall meet the medical and
dietary needs of the individuals receiving services.
1. When a medical or otherwise specified
diet is required, the licensee shall assure that all necessary equipment
is readily accessible.
2. Documentation of all such diets shall be maintained on the menu
(g) An individual shall be allowed to
eat at his or her own pace, unless otherwise determined by the IDT.
(h) Menus, to include all meals and
available snacks, shall be dated, prepared at least one week in advance,
and retained on file for a period of 30 days, unless an individual's IHP
documents independence in meal purchase and planning.
(i) Consistent with their abilities, the
individuals receiving services shall be consulted for preferences in
determining the weekly menu and/or changing it as desired.
(j) Any substitution of food from the
menu shall be of equal nutritional value and shall be documented on the
menu.
10:44A-5.6 Clothing
(a) Each individual shall have the
opportunity to select and purchase clothing according to individual taste
and preference.
(b) The licensee shall provide
assistance to individuals who require assistance in order to maintain
their own clothing.
(c) The licensee shall provide laundry
facilities without additional charge to individuals, unless there is
documentation in an individual’s IHP that the individual is to pay for
the laundering of his or her own clothing or there is a provision in the
licensee's contract for the individual to pay for the laundering of his or
her clothing.
10:44A-5.7 Vehicle safety
(a) All agency vehicles used to
transport individuals with developmental disabilities shall have the
following:
1. Emergency equipment which shall
include spare tire, jack and at least three portable red reflector warning
devices;
2. A first aid kit to include:
i. Antiseptic;
ii. Rolled gauze
bandages;
iii. Sterile gauze
bandages;
iv. Adhesive paper or
ribbon tape;
v. Scissors;
and
vi. Adhesive bandages
(for example, Band-Aids).
3. Snow tires, all weather tires, or
chains when weather conditions dictate their use; and
4. A 10:BC dry chemical extinguisher.
(b) The licensee shall verify that all vehicles under the auspices of the
licensee used to transport individuals with developmental disabilities
shall comply with all applicable safety and licensing regulations
established by the New Jersey Division of Motor Vehicles.
1. The licensee shall maintain or
document valid liability insurance on all vehicles used to transport
individuals with developmental disabilities.
2. All drivers shall have a driver's
license valid in the State of New Jersey.
3. Individuals receiving services whose
IHP has determined that being left unattended in a vehicle would present a
danger to themselves or others shall be supervised accordingly.
4. The interior of each vehicle shall be
maintained in a clean, safe condition and shall be free of obstacles
obstructing clear passage to operable doors.
10:44A-5.8 Workplace safety
(a) The licensee shall comply with the Occupational Safety and Health
Administration's (OSHA) regulations (29 CFR) as they may apply to a
particular type of residence the licensee operates, and shall ensure
consistent and sound enforcement.
1. The licensee shall maintain on file
all inspection reports and correspondence documenting non-compliance with
OSHA requirements.
2. All such reports and correspondence
shall be available for review by authorized representatives of the
Division.
SUBCHAPTER
6 FIRE SAFETY AND PHYSICAL ENVIRONMENT
10:44A-6.1 Fire safety
(a) Each community residence operated by
the licensee shall be registered with the Department of Community Affairs
(DCA) and shall be subject to inspection on an annual basis, consistent
with N.J.S.A. 52:27D - 192 et seq., and rules promulgated thereunder.
1. All written reports from such
inspections shall be maintained on file.
(b) Each community residence for
individuals with developmental disabilities shall comply with the
provisions of N.J.S.A. 52:27D-192 et seq. (Uniform Fire Safety Act).
1. The Division may identify, in a
contract with a licensee, any additional fire safety precautions required.
(c) Variances from regulations may be
requested in accordance with N.J.S.A. 52:27D-200.
10:44A-6.2 Fire evacuation plans
(a) The licensee shall design an
evacuation plan for each residence in accordance with the Uniform Fire
Safety Act ( N.J.S.A. 52: 27D-192 et seq. ) and the individual
characteristics of the home.
1. The plan shall be further developed
by evaluating each individual according to the following risk factors:
i. Mobility;
ii. Ability to
problem-solve;
iii. Ability to
evacuate;
iv. Compliance
issures;
v. Medical
factors; and
vi. Behavioral
factors.
(b) The evacuation plan shall be
reviewed at least annually and revised as needed;
1. Whenever a new individual moves into
the residence; and
2. Whenever current occupants develop
problems evacuating the residence.
(c) All individuals shall be able to
evacuate the residence in less than three minutes.
10:44A-6.3 Egress protocols
(a) Individuals residing in a community
residence are presumed to have a prompt self-evacuation capability when
the following conditions are met:
1. A site-specific evacuation plan is
drawn up and followed;
2. Fire drills, supervised by staff, are
performed a minimum of once per month;
3. Each shift performs at least four
fire drills a year;
4. Fire drills are performed at random
times so that individuals are engaged in a variety of routine activities
during the drills;
5. Fire drills assume different fire
location simulations that require that all means of egress be used;
6. The evacuation plan includes a
designated meeting spot at which the individuals assemble after evacuating
the premises;
7. A prompt egress time of three minutes
or less is attained and maintained;
8. Individuals are free from physical
restraint and are not locked in at any time; and
9. Written records are maintained
including the following information:
i. The date and time of the fire drill;
ii. The location of
the simulated fire;
iii. The evacuation plan
followed; and
iv. The names of
individuals and staff who participated in the drill.
(b) In the event that an individual
exceeds the allotted evacuation time, the licensee shall take one of the
following steps:
1. Provided training in evacuation to
the individual;
2. Add awake staff to assure the
three-minute time is met;
3. Relocate individuals so that the
three-minute time is met; or
4. Conform to the I-1 Use Group classification (N.J.A.C. 5:23).
(c) Within 24 hours of admission, each
individual shall participate in a fire drill to ensure knowledge of
emergency egress procedures.
10:44A-6.4 Use group classification
requirements
(a) Group homes housing five or fewer
individuals shall meet the requirements of Use Group R-3 of the Uniform
Construction Code, provided all individuals are either ambulatory or
mobile non-ambulatory (See N.J.A.C. 5:23).
(b) One- and two-family homes housing
six to 16 individuals with developmental disabilities shall meet the
requirements of Use Group R-2 of the Uniform Construction Code, provided
all individuals are either ambulatory or mobile non-ambulatory (see
N.J.A.C. 5:23).
(c) The classification of community
residences for individuals with developmental disabilities into Use Group
R-3 or R-2 when some individuals are not capable of prompt self-evacuation
shall be dependent upon the following:
1. Community residences for individuals
with developmental disabilities housing up to two people not capable of
prompt self-evacuation shall be classified as R-3 (for five or fewer) or
R-2 (for more than five people) provided the following provisions are met:
i. An
interconnected smoke detection system complying with the building subcode
for the designated use group shall be provided;
ii. The egress
protocol, including a site-specific evacuation plan, shall be followed;
iii. Within 24 hours of
admission, each new occupant shall participate in a fir drill to ensure
compliance with the egress protocols;
iv. One awake staff
shall be provided for overnight coverage. Additional awake staff
shall be added, as necessary, on a temporary or permanent basis to meet
the requirements of the egress protocols as specified in 10:44A-6.3;
v. An exit door
opening directly to the outside shall be available within 50 feet of each
bedroom; and
vi. Ramps shall be
provided at all required exits when necessary for wheelchair
accessibility.
2. Community residences for individuals
with developmental disabilities housing three to five people not capable
of prompt self-evacuation shall be classified as R-2 provided the
following additional conditions are met:
i. Emergency
egress lighting is provided;
ii. A sprinkler
system complying with NFPA 13 R is provided;
iii. The smoke detection
system is tied into a central station; and
iv. Two awake
overnight staff are provided.
3. Community residences housing more
than five people not capable of prompt self-evacuation shall meet the
requirements for an I-2 Use Group classification.
10:44A-6.5 Fire extinguishers
(a) Fire extinguishers shall be serviced
annually and shall be of a type and number as determined by the Fire
Official designated to enforce the Uniform Fire Safety Act (N.J.S.A.
52:27-197 et seq.)
1. Documentation of servicing shall be
available for review.
(b) Fire extinguishers and
battery-operated smoke detectors shall be checked quarterly by staff to
ensure all extinguishers and smoke detectors are fully charged and
operable.
1. Documentation shall be available on
the fire extinguisher or at the residence as part of the administrative
records.
10:44A-6.6 General home requirements
(a) For residences housing individuals
with physical disabilities, the licensee shall make accommodations to
ensure maximum physical accessibility feasible for entrance to and
movement within the residence based upon individual characteristics.
1. Any necessary modifications shall
conform to the requirements contained in the Barrier-Free Subcode, N.J.A.C.
5:23-7.
(b) The exterior of the residence and
the surrounding grounds shall be properly maintained and shall be free
from any hazard to health or safety.
(c) The interior of the residence shall
be properly maintained and shall be free from any hazard to health or
safety.
1. All interior doors shall be equipped
with standard hardware which can be readily opened in an emergency. Hooks
and eyes, bolts, bars and other similar devices shall not be used on
interior doors.
(d) Each individual receiving services
shall have access to a telephone.
(e) Non-slip surfaces shall be provided
as appropriate:
i. As non-skid
backing for scatter or throw rugs;
ii. On stairs and
landings; and
iii. In each shower or
bathtub.
(f) All furniture throughout the home
shall be clean and in good repair.
(g) All common areas for living and
dining shall be of sufficient size to provide enough seating for all
occupants of the home at one time.
(h) No temporary wiring shall be used
except UL listed extension cords, rated appropriate to the anticipated
load.
(i) Extension cords shall not run under
rugs, through walls, or through doorways.
10:44A-6.7 Certificate of Occupancy
A Certificate of Occupancy shall be
obtained by the licensee from the local construction official as required
by the Uniform Construction Code (N.J.A.C. 5:23) and/or local ordinance.
10:44A-6.8 Exits
(a) Exit/evacuation areas to be used for
mass evacuation shall not be permitted through furnace areas, storage
areas or bedrooms.
(b) Locks on doors used as an approved
means of egress shall be of the type that can be unlocked from the inside
without the use of a key.
10:44A-6.9 Heat sources
(a) Space heaters, including, but not
limited to, electrical, kerosene, and quartz heaters, shall be prohibited,
unless a waiver is granted by the licensing agency.
1. Written documentation shall be
maintained indicating that the local enforcing authority has authorized
such use.
(b) Every home shall have heating
facilities that are properly installed, maintained in good and safe
working condition, and capable of maintaining all habitable rooms at a
temperature of 65 degrees Fahrenheit (18° C) when the outdoor temperature
is 0 degrees Fahrenheit (-18° C).
(c) Heat sources exceeding 110 degrees
Fahrenheit (43° C) which are accessible to individuals requiring personal
guidance shall be equipped with protective guards or insulated to prevent
individuals from coming into direct contact with the heat source.
10:44A-6.10 Water
(a) Hot and cold running potable water
shall be available at all times.
10:44A-6.11 Railings, stairs and
hallways
(a) Every porch, balcony, staircase, or
place higher than 30 inches off the ground shall be provided with adequate
railings, according to the Uniform Construction Code.
(b) All outside stairways consisting of
four or more steps shall be provided with a secure handrail.
(c) All stairways and hallways shall be
kept free and clear of obstructions at all times.
(d) All carpeting and stair treads shall
be adequately secured.
10:44A-6.12 Windows
(a) Every bedroom shall have at least
one operable window opening directly to the outside.
(b) First floor bedroom windows shall
have an operable window space of five square feet.
(c) Second floor bedroom windows shall
have an operable window space of 5.7 square feet.
(d) From May through October, all
openable windows and doors used for natural ventilation shall be provided
with easily removable insect screening in good condition.
10:44A-6.13 Bedrooms
(a) Occupancy shall be limited to floors
on or above grade level. Bedrooms may be situated in basements under the
following conditions:
1. More than half the height of the room is above grade level;
2. The room is provided with two or more
independent means of egress, at least one of which leads directly outside;
and
3. There are no other conditions that
may adversely affect the health, safety, welfare or rights of individuals
with developmental disabilities.
(b) There shall be no access to common
areas or other bedrooms through an individual's bedroom.
(c) A maximum of two individuals shall share a bedroom.
(d) Bedrooms shall contain the following minimum space per person:
1. 70 square feet for occupancy by one person;
2. 130 square feet for occupancy by two persons.
(e) At least one half of the floor area
of every individual room shall have a ceiling height of 7½ feet.
1. The floor area of that part of any
room where the ceiling is less than five feet shall not be considered
allowable floor space.
(f) Each individual shall be provided
with the following bedroom furnishings, in good repair, the style of which
is consistent with his or her preference unless otherwise specified by the
IDT:
1. A standard or platform bed frame;
2. A minimum of a four inch thick
mattress of fire resistant material and of sufficient size;
3. A box spring of sufficient size, unless a platform bed is used;
i. Fold-up
convertible type beds, roll-aways, cots, hide-a-beds and double deck beds
shall be prohibited unless a situation warrants short-term use;
4. Lighting;
5. Ample linen supplies consisting of,
at a minimum:
i. A clean pillow, of non-allergenic material if
necessary;
ii. Two sets of bed
linens and pillowcases; and
iii. One mattress cover,
one blanket, and one bed covering.
6. Drawers or a closet for the storage
of personal possessions and in-season clothing, provided in the
individual's room; and
7. One mirror chosen by the individual,
securely fastened to the wall and/or fastened to a dresser at a height
appropriate for the use of the person(s) occupying the room.
(g) Individuals may choose to decorate
their bedrooms according to individual taste and preference.
10:44A-6.14 Bathrooms
(a) Every residence shall be provided
with one flush-type toilet and sink for every four persons and one bathtub
or shower for every six persons living in the home.
(b) Every toilet, sink, bathtub, or
shower shall be accessible without passing through any other sleeping unit
and shall be available within one floor above or below the individual's
room, unless it is a master bedroom type suite where the bathroom is used
solely by that bedroom's occupants.
(c) Toilet paper, soap and toweling
shall be available at each toilet and lavatory for access by each
individual living in a home.
(d) Bathroom doors shall be equipped
with standard hardware which provides a privacy lock and which can be
readily opened from the outside in an emergency. Hooks and eyes, bolts,
bars, and other similar devices shall not be used on bathroom doors.
10:44A-6.15 Kitchens
(a) Kitchens shall be clean and well ventilated.
(b) Containers of food shall be covered
and appropriately stored above the floor on shelves or other clean
surfaces and kept separate from cleaning supplies.
(c) Disposable dinnerware shall not be
used on a regular basis.
(d) Refrigeration and storage of food
shall be provided at not more than 45 degrees Fahrenheit (seven degrees
Celsius). Freezer compartments shall operate at no more than 32 degrees
Fahrenheit (zero degrees Celsius).
10:44A-6.16 Basement use
(a) Basements may be used for storage
and laundry, provided they are dry and have adequate lighting,
(b) Basements may be used as activity
rooms if they are dry, warm, adequately lighted and have been approved, in
writing, for such use by the local construction official.
10:44A-6.17 Maintenance requirements
(a) When maintenance is the
responsibility of another party, the licensee shall document that the
other party has been informed of the need to correct all deficiencies
relating to maintenance.
(b) Accumulation of garbage or waste
shall be prevented.
(c) When there is evidence of
infestation, pest control services shall be arranged in a timely manner.
1. The licensee shall retain
documentation of services.
(d) Floors, walls, ceilings, and other
interior surfaces shall be kept clean and in good repair.
(e) At each residence, doors opening to
the outside and outside walkways shall be kept free of ice, snow, leaves
and other hazards.
APPENDIX - TABLE OF COMMUNICABLE DISEASES
Respiratory Gastro-Intestinal Contact
Illnesses Illnesses Illnesses
Chicken pox Giardia lamblia Impetigo
German measles* Hepatitis A* Lice
Hemophilus Salmonella* Scabies
Influenza* Shigella*
Measles*
Meningococcus*
Mumps*
Strep throat
Tuberculosis*
Whooping cough*
*Reportable diseases,
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