Who Regulates Nursing Homes?
Nursing facilities in New Jersey are licensed, regulated, inspected and/or certified by a number of public and private agencies at the state and federal levels, including the New Jersey Department of Health and the U.S. Department of Health and Human Services, The Centers for Medicare and Medicaid Services (CMS). These agencies have separate - yet sometimes overlapping jurisdictions.
The New Jersey Department of Health is responsible for ensuring nursing facility compliance with mandatory state regulations. The Department, under a contractual agreement with CMS, is also responsible for ensuring that facilities accepting Medicare and Medicaid payment for services rendered to program beneficiaries meet federal regulations and certification rules. Each year, the Department conducts approximately 400 full, on-site licensure inspections of nursing facilities and responds to approximately 2,650 complaints. These inspections, called surveys, are conducted to evaluate the fitness and adequacy of the nursing facility, its equipment, staff, policies, procedures and finances.
The New Jersey Office of the Ombudsman for the Institutionalized Elderly investigates allegations of abuse and exploitation of residents of long term care facilities who are 60 years of age and older. The office is charged with serving as an advocate for individual residents who are unable, because of illness or vulnerability, to advocate for themselves.
In addition to inspection by the state, some New Jersey nursing facilities are members of national accrediting organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF), which independently inspect their member facilities to assess performance.
Oversight of practices in nursing facilities is not limited to the facilities themselves. Key health care professionals who work in nursing facilities are also licensed or certified by state agencies, such as the State Board of Medical Examiners, New Jersey Board of Nursing, Nursing Home Administrators Licensing Board, and the Department of Health' Certified Nurses Aide (CNA) Program. Health care workers are subject to disciplinary action from these bodies for failure to comply with standards of practice.
New Jersey Inspection Surveys
This report includes the findings of New Jersey Department of Health standard inspections and complaint investigations conducted and concluded during the past 15 months. The regulations and procedures followed by the Department are intended to promote the health, safety and welfare of New Jersey nursing facility residents and to give nursing facilities the opportunity to contest Department findings and penalty assessments. New Jersey employs a team concept in inspecting nursing facilities. There are currently 12 survey teams each consisting of a team leader, registered professional nurse(s) (RN), a nutrition consultant, and a registered pharmacist. On inspections, the teams may be joined by other professionals, such as sanitarians or life safety code experts, if necessary. Complaint surveys are conducted by a separate unit consisting registered nurses.
New Jersey's licensure inspection surveys are generally conducted on-site over a three- to four-day period during which the state's inspection teams evaluate all aspects of resident care and nursing facility procedures and practices, assessing facility compliance with more than 1,500 specific state and federal standards. Samples of specific areas of care reviewed include resident rights, access to care, activities, assessment and care plans, health care and dietary services, housekeeping, staffing, quality of care and quality assurance.
The Department's evaluation may include an inspection of medical records, observation of resident care, inspection of all areas of the nursing facility, and interviews of residents, family members, staff or other individuals. The Department may also evaluate the quality of resident care through an analysis of statistical data reported by nursing facilities or by a review of reportable event information or other notices filed with the Department. Reportable events include administrator or director of nursing personnel changes; interruptions of three or more hours of services essential to the health and safety of residents; alleged or suspected crimes investigated at the facility by police; and all fires, disasters, deaths or other risks to resident life or health resulting from accidents or incidents at the facility.
Inspections in response to complaints are generally shorter in duration than licensure surveys and focus primarily on those areas of resident care alleged to be at fault. If, during the course of a complaint investigation additional problems are uncovered, a full on-site inspection may be initiated.
Nursing facilities are inspected at least once every six to fifteen months. The state-wide average is once every twelve months. Nursing facility inspections, whether standard or in response to complaints, are conducted without notice to the facility. Survey schedules are changed annually to make it difficult for facilities to anticipate when inspections will be conducted. Generally, facilities with poor surveys and numerous verified complaints are surveyed more frequently than facilities with a history of minimal or no deficiencies.
Long term care surveys are typically conducted during weekdays, although our survey teams do conduct a percentage of inspections early in the morning, at night, on weekends and during holidays. On occasion, Department staff has been assigned to monitor operations at a facility on a 24 hour-a-day basis.
Complaint surveys are scheduled according to the seriousness of the complaint received. Scheduling often includes off-hours and weekend visits.
At the conclusion of each inspection, the Department's findings are shared with nursing facility administrative staff in an exit interview and are documented in a survey report which is later forwarded to the facility. If the Department has determined that the nursing facility failed to comply with all applicable state and federal licensure standards, the survey report will contain statements of all deficiencies found.
Deficiencies & Plans of Correction
A deficiency is a determination by the Department that a nursing facility has violated one or more specific state licensure or federal certification regulations. Deficiencies range in scope and severity from isolated violations with no actual resident harm to widespread violations which cause injuries or put residents in immediate jeopardy of harm. Deficiencies may be cited as a result of an on-site inspection or evaluation of written reports or documentation.
When deficiencies are cited, the Department requires the nursing facility to submit a written plan of correction within 10 business days detailing how and when each deficiency will be corrected. In some cases, the Department will direct specific corrective measures that must be implemented. In situations where current conditions at the facility pose a serious risk to the health and safety of residents or staff, the Department can demand or initiate immediate corrective actions.
In many cases, nursing facilities are given the opportunity to correct less serious deficiencies without incurring fines or other penalties. If warranted, however, the Department may impose a fine, curtail admissions, appoint a temporary manager, revoke a nursing facility's license, close an unlicensed facility, or impose other remedies, as provided by state or federal law, or as authorized by federal survey, certification, and enforcement regulations.
The most common penalty imposed by the Department is a civil money penalty. Under state law, the maximum fine the Department of Health may impose is $5,000 per violation, per day. Fines for violations of federal standards range from $50 to $10,000 per day or per instance. While the Department has authority to impose state fines, federal fines are recommended to CMS which has the sole authority to impose federal monetary fines.
Although rare, nursing facilities with repeat or severe violations of federal licensing standards may be denied payments for new residents admitted after the survey and may have their Medicare or Medicaid certification suspended or revoked by CMS. These nursing facilities would not receive reimbursement for services provided to residents while the facility was subject to such a sanction.
When a nursing facility is cited for a state/federal regulatory deficiency that results in a fine, suspension or revocation of a license/certification, the Department issues a penalty letter identifying the specific violations, charges or reasons for the Department's enforcement action.
Please note that penalty actions may be the result of a one-time "snap-shot" in time of nursing facility compliance with established standards. To more fully assess the quality of care provided by a facility, it is important that you review current and past survey reports to obtain an historical overview of the quality of care provided at the facility. You may also wish to discuss services and performance levels with your doctor and with family members or friends who have used the facility.
Complete survey reports and nursing facility plans of correction - edited to ensure resident confidentiality - are available for review by appointment at each nursing facility as well as at the Trenton offices of the Department of Health' Division of Health Facilities Evaluation and Licensing. If consumers want to know the nature of specific deficiencies, they should visit CMS's Nursing Home Compare Database or contact the nursing home in question because the most recent survey results are required to be posted.
- To review an inspection file at the division, write to:
New Jersey Department of Health
P.O. Box 360, John Fitch Plaza
Trenton, New Jersey 08625-0360
Attn.: Legal and Regulatory Affairs
- Media inquiries must be made to the Office of Communications at 609-984-7160.
- If you wish to file a complaint about a New Jersey nursing home, call the Department toll-free at 1-800-792-9770.
Open Public Records Act
The Open Public Records Act, P.L. 2001, c. 404, (OPRA) provides a process whereby Citizens desiring access to public records may request them. Not all records are public; therefore, not all records will be available. There are charges for photocopies and other costs may be incurred. The law includes time frames for the provision of records and an appeal procedure.
- A citizen, who wants access to public records from the Division of Health Facilities Evaluation and Licensing, files a record request with the LTC records custodian.
- The request must be in writing. Requests cannot be accepted by telephone.
- Each specific record sought should be accurately described.
- The form to request records is available on the Internet at https://www.state.nj.us/OPRA/. It can be completed and submitted on-line or it may be faxed or mailed to the Division. Alternately the form may be obtained by calling 609-633-8981.
Informal Dispute Resolution
Nursing facilities have the opportunity to dispute survey findings in an informal setting. Facilities may request to discuss the accuracy of factual survey findings during the course of a survey or during the exit interview. After the survey is completed, a facility may request an Informal Dispute Resolution Conference before Department supervisory staff who were not directly involved in the survey. Informal Dispute Resolution may result in elimination or modification of deficiencies or no change at all. The Informal Dispute Resolution panel’s decision is recommended to CMS, in the case of nursing homes.
Formal Administrative Hearings
Nursing facilities may also request a formal hearing before the Office of Administrative Law to appeal deficiencies and enforcement actions, including any imposed penalties. At any time before or during the hearing, the Department and the nursing facility may agree to a settlement, however, in no case can a settlement reduce a penalty below $250, or $500 for second and subsequent offenses.
Designation of Penalty Monies
All penalty monies collected on violations in nursing facilities are deposited into a special fund used by the Department to make corrections to health care facilities which violate licensure standards and in which the owner or operator is unable or unwilling to make necessary corrections. The Health Care Facilities Improvement Fund allows the Department to quickly bring facilities back into compliance with licensure standards and safeguard facility residents. The owner must then repay the fund, plus interest, the monies expended by the State to correct violations at the facility.
Nursing Home Quality Improvement Initiatives
New Jersey is committed to continuously improving the quality of care provided by its nursing facilities. In addition to its vigorous inspection and enforcement program, the Department of Health is working with the nursing facility industry in a number of unique ways to enhance services and ensure the health, safety and welfare of nursing facility residents.
Advisory Standards -- The current licensing standards for long-term care facilities include both mandatory standards, which facilities must meet, and advisory standards, which are optional and voluntary. The advisory standards represent ways that facilities can strive to go beyond the minimum requirements to provide their residents with excellent care. Advisory standards are evaluated only during the annual survey. Facilities with serious deficiencies in mandatory regulations are not evaluated for their achievements in advisory standards.
Altogether, the advisory standards cover 21 areas of nursing home care and services. To achieve this distinction, the facility must meet at least 65 percent of the advisory standards in a specific area. To verify that a facility meets these standards, the Department of Health surveyors randomly select up to 30 advisory standards to check during their annual inspection of the nursing home. Facilities, which are in compliance with at least 90 percent of the standards they claim to meet, are credited with overall advisory standards compliance in those subchapters. You may verify a facility’s participation in the Advisory Standards by selecting the Advisory Standards tab included in the facility detailed information found on the Search for Long-Term Care Facilities page.