Assisted Living Facility Regulations and Requirements, Exams of Nursing

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CURRENTLY TESTING SOLUTIONS OF NJ CALA EXAM

QUESTIONS WITH ACTUAL CORRECT DETAILED

ANSWERS

A process whereby individuals remain in their living environment despite the physical and/mental decline and growing needs for supportive services that may occur in the course of aging. - ANSWER- Aging in Place The functions or tasks for self-care, which are performed either independently or with supervision or assistance, such as: dressing, bathing, toileting, transfer, locomotion, bed mobility, and eating. - ANSWER-ADLs (Activity of Daily Living) A coordinated array of supportive personal and health services 24 hours per day, to residents who have been assessed to need these services including persons who require nursing home level care. It promotes resident self direction and participation in decisions that emphasize independence, individuality, privacy, dignity, and homelike surroundings. - ANSWER-Assisted Living Limits places on a resident's choice as a result of an assessment, in accordance with N.J.A.C. 8:36 - 5.18, which indicates that such resident's choices or preference place the resident or others at a risk of harm or lead to consequences which violate the norms of the facility or program or the rights of others. - ANSWER-Bounded Choice A facility which is licensed by the Department of Health and Senior Services to provide room and board and to assure that assisted living services are available when needed, to four or more adults unrelated to the proprietor. Residential units in this type of facility have no more than two residents and have a lockable door on the unit entrance. - ANSWER-CPCH (Comprehensive Personal Care Home) A facility that has received a certificate of authority pursuant to the _________ and Financial Disclosure Act, N.J.S.A. 52:27D-300 et seq. - ANSWER-CCRC (Continuing Care Retirement Community)

A unit-of-use package prepared by a pharmacist for a specific resident comprising a series of containers and containing two or more prescribed sold oral dosage forms, and so designed or labeled as to indicate the day and time, or period of time, that the contents within each container are to be taken. - ANSWER- Customized Resident Medication Package A person appointed by a court of competent jurisdiction to handle the affairs and protect the rights of any resident of the facility who has been declared a mental incompetent. This does not include a person affiliated with the facility, its operations or personnel, unless so ordered by the court. - ANSWER- Guardian Any service provided to a resident of an assisted living or comprehensive personal care home that is ordered by a physician and required to be provided or delegated by a licensed, registered or certified health care professional. - ANSWER-Health Care Service A program of palliative and supportive services provided to terminally ill persons and their families in the form of physical, psychological, social, and spiritual care. - ANSWER-Hospice The process of balancing resident choice and independence with the health and safety of the resident and other persons in the facility or program. If a resident's preference or decision places the resident or others at risk and is likely to lead to adverse consequences, such risks or consequences are discussed with the resident, and, if the resident agrees, a resident representative, and a formal plan to avoid or reduce negative or adverse outcomes is negotiated, in accordance with the provisions of N.J.A.C. 8:36- 5.18. - ANSWER-Managed Risk The written formal plan developed in consideration of shared responsibility, bounded choice and assisted living values and negotiated between the resident and the facility or program to avoid or reduce the risk of adverse outcomes which may occur in an assisted living environment. - ANSWER-Manage Risk Agreement A procedure in which a prescribed medication or biological is given to a resident by an authorized individual in accordance with all laws and regulations governing such procedures. - ANSWER-Medication Administration 1.) Removing an individual dose from a previously dispensed, properly labeled container (including a unit dose or unit-of-use container).

2.) Verifying it with the prescriber's orders. 3.) Giving the individual dose to the resident. 4.) Seeing that the resident takes it (if oral). 5.) Recording the required information, including but not limited to the method of administration, time administered, initials of individuals who administered the medication, and effect of the medication when "PRN" or as-needed medications are administered. - ANSWER-Process of Medication Administration The self-worth of a resident. - ANSWER-Dignity The support and enhancement of resident capabilities and facilitation of resident abilities so that the resident's preferences and choices may be implemented within a barrier-free environment. - ANSWER- Independence Each resident's unique needs, capabilities, personalities, backgrounds and preferences. - ANSWER- Individuality An individual resident record that contains, but is not limited to: resident name, date of birth, diagnosis(es), age, physician, name and medication strength, dosage form, route of administration, frequency, date and time of administration, initials of individual administering the medication, a section containing the full signature and title of each individual who initials it, date medication ordered, stop date if appliacable, allergies, and all other professionally acceptable information that is appropriate. - ANSWER-MAR (Medication Administration Record) A MATCEP or Medication Aide Training Competency and Evaluation Program is a department approved minimum ____________ training course conducted by a Department approved registered professional nurse and registered pharmacist, to instruct CNA, CHHA, or PCAs, in the administration of medications to residents, within assisted living residences, comprehensive personal care homes and assisted living programs. - ANSWER- 30 - hour An individual requires this as defined by N.J.A.C. 8:85-2.1. It is provided to individuals who have chronic medical condition(s) resulting in moderate to severe impairments in physical, behavioral, cognitive, and/or psychosocial functioning. It is determined by a registered professional nurse and identified in a plan of care. - ANSWER-Nursing Home-Level Care

In accordance with N.J.A.C. 8:43E-6, means the assessment of pain and, if appropriate, treatment in order to assure the needs of patients or residents of health care facilities who experience problems with pain are met. Treatment of pain may include the use of medication or application of other modalities and medical devices such as, but not limited to, heat or cold, massage, transcutaneous electrical nerve stimulation (TENS), acupuncture, and neurolytic techniques such as radiofrequency coagulation and cryotherapy. - ANSWER-Pain Management A resident's degree of control over a specific physical area and/or time; levels of intimacy with family and others; and communication and contact with others outside the facility or program environment. - ANSWER-Privacy Residents (and if the resident wishes the resident's family) and providers of assisted living services share responsibility for planning and decision making affecting residents. To participate fully in this, residents shaw be provided with clear and understandable information about the possible consequences of their decision-making, in accordance with the provisions of N.J.A.C. 8:35-5.18(a)2. - ANSWER-Shared Responsibility Another term for resident census. - ANSWER-Total Bed Complement A system in which medications are delivered to the residents areas in single unit packaging, and which meets the following criteria: 1.) Each medication shall be individually wrapped and labeled with the generic or trade (brand) name and strength of medication, lot number or reference code, expiration date, and manufacturer's name, and shall be ready for administration to the resident. 2.) Cautionary instructions shall appear on the resident's record of medication administration, and the system shall include provisions for noting additional information, including but no limited to, special times or routes of administration and storage conditions. 3.) Commercial repackages shall comply with 21 CFR 201.1, incorporated herein by reference, as amended and supplemented, and N.J.A.C. 8:39. - ANSWER-Unit Dose Drug Distribution System A system of in which medications are delivered to the resident areas either in single unity packaging, bingo or punch cards, blister or strip packs, or other system where each medication is physically separate. Individually labeled unit dose medications may be combined in a "bingo or punch card" to create a unit-of-dose drug distribution system. - ANSWER-Unit-of-Use

An assisted living facility shall indicate within 36 months of after licensure, at least ______________ of the facility's residents shall be individuals with nursing home-level care. This percentage shall be computed based upon the number of residents days per calendar year and may include direct admissions as well as maintained residents with nursing home-level of care needs. - ANSWER-20 percent Each assisted living, comprehensive personal care home, and assisted living program will be assessed and inspected __________________. - ANSWER-Biennially This may be made to a facility at any time by authorized staff of the Department. Such may include, but not limited to, the review of all facility documents and resident records and conferences with residents. - ANSWER-Survey Visits A licensure shall be granted for a period of one year or less as determined by the Department. - ANSWER-Facility Licensure The license, unless suspended or revoked, shall be renewed annually on the original license date, or within 30 days thereafter as of the original licensure date. The facility will receive a request for renewal fee 30 days prior to the expiration of the license. A renewal license will not be issued unless the licensure fee is received by the Department. - ANSWER-Facility Licensure Renewal The facility shall notify each resident, the resident's physician, and any guarantors of payment at least 30 days prior to the voluntary surrender of a license, or as directed under an order of revocation, refusal to renew, or suspension of license. In such cases, the license shall be returned to the Long-Term Care Licensing Program of the Department within 7 working days after the voluntary surrender, revocation, non-renewal, or suspension of license. - ANSWER-Surrender of Facility License 1.) 21 years or older; 2.) Possess a high school diploma or equivalent; 3.) hold a CALA or LNHA license. - ANSWER-CALA Qualifications An applicant for certification as an assisted living administrator shall sit for the Assisted Living Competency Examination within ____________ of successful completion of the assisted living training course. - ANSWER-2 Years An assisted living administrator certification shall be valid for a period of ____________ from date of issue. - ANSWER-3 Years

At least once every ___________, on a schedule to be determined by the Department, an assisted living administrator shall file an application for renewal of current certification. - ANSWER-3 Years Complete at least ____________, of continuing education regarding assisted living concepts and related topics, as specified and approved by the Department of Health and Senior Services. - ANSWER-30 hours 1.) Complete 30 hours of CEUs, 2.) Criminal History Background Check - ANSWER-Eligibility for Renewal The applicant shall be required to complete 10 hours of continuing education credit for each year in which the certification was inactive in addition to the required 30 hours of continuing education for the last completed triennial certification period in which the applicant's certification was active. - ANSWER- Lapse of Certification In order to be an assisted living administrator trainer, they must complete at least ____________ of the basic concepts etc. of assisted living. - ANSWER-40 Hours 1.) Ensuring the development, implementation, and enforcement of all policies and procedures, including resident rights; 2.) Planning for, and administration of, the managerial, operational, fiscal, and report components of the facility; 3.) Ensuring that all personnel are assigned duties based upon their ability and competency to perform the job and in accordance with written job descriptions; 4.) Ensuring the provision of staff orientation and staff education; 5.) Establishing and maintaining liaison relationships and communication with facility staff and services and with residents and their families; 6.) Establishing and maintaining liaison relationships and communications with community hospitals, social services agencies, and mental health service agencies. - ANSWER-Administrator's Responsibilites An advocate who is an official in charge of representing the interests of the public by investigating and addressing complaints of maladministration or a violation of rights. - ANSWER-Ombudsman The resident has a right to refuse medication and treatment after the resident has been informed, in language that the resident understands, of the possible consequences of this decision. - ANSWER- Informed Consent in Different Languaes The resident has the right to receive written notice at least ___________ in advance when the facility requests the resident's transfer or discharge, except in an emergency. This written notice shall include

the name, address, and telephone number of the New Jersey Office of the Ombudsman for the Institutionalized Elderly, and shall also be provided to the resident's legally appointed guardian, if applicable, or, with the resident's consent, to the resident's family, ___________ in advance. - ANSWER- 30 Days 1.) Assistance with Personal Care; 2.) Nursing; 3.) Pharmacy; 4.) Dining; 5.) Activities; 6.) Recreational; 7.) and Social Work services. - ANSWER-Types of Services for ALF 1.) The resident requires 24/7 nursing supervision; 2.) The resident is bedridden for more than 14 days; 3.) The resident is consistently and totally dependent in four or more of the following activities of daily living: dressing, bathing, toilet use, transfer, locomotion, bed mobility, and eating; 4.) The resident has a cognitive decline severe enough to prevent the making of simple decisions regarding activities such as bathing, dressing, and eating and cannot respond appropriately to cueing and simple directions; 5.) The resident requires treatment of a stage 3 or 4 pressure sore or multiple stage two pressure sores; 6.) The residents requires than assistance with transfer; 7.) The resident is a danger to self or others; 8.) The resident has a medically unstable condition and/or has special health problems, and a regimen of therapy cannot be appropriately developed and implemented in the assisted living environmen - ANSWER-Nursing Home Level Care Characteristics A new or existing assisted living residence or comprehensive personal care home licensed on or after Sept. 1st, 2001, shall attain a level of occupancy by Medicaid-eligible persons of at least ______________ of its total bed complement within 3 years of licensure (for new ALFs) and shall maintain this level of Medicaid occupancy thereafter. In cases in which either the total bed complement or the total number of beds added in an existing facility is less than that amount, at least one bed shall be reserved for a Medicaid-eligible person. (p.34-35) - ANSWER-10 Percent Residents who shall not remain in the assisted living residence or comprehensive personal care home and shall be transferred to a long-term care facility. - ANSWER-Specialized Long-Term Care An individual who has been determined as satisfying the financial eligibility criteria for medical assistance under the Medicaid program, and has been assessed as being in need of nursing home-level care, and has been approved by the Department for participation in a Federally approved waiver program for assisted living services. - ANSWER-Medicaid-Eligible Person The facility shall report the number of resident days per calendar year to the Department's Long-Tern Care Licensing Program by _______________ of each year, for the prior calendar year. - ANSWER-April 15th

1.) Concepts of Assisted Living; 2.) Emergency plans and procedures; 3.) Infection Prevention & Control Program; 4.) Resident's Rights; 5.) Abuse & Neglect; 6.) Pain Management; 7.) Alzheimer's and related Dementia conditions. - ANSWER-Inservices Staffing is based upon the an assessment of the ___________ of residents' needs. - ANSWER-Acuity Policies and procedures for reporting all alleged and/or suspected cases of resident abuse or exploitation to the Complaints Program of the Division of Long-Term Care Systems. If the resident is ___________ years of age or older, the State of New Jersey Office of the Ombudsman for the Institutionalized Elderly shall be notified. - ANSWER- 60 The facility shall be capable of providing this, either directly or by arrangement, to and from health care services provided outside the facility, and shall promote reasonable plans for security and accountability for the resident and his or her personal possessions, as well as transfer of resident information to and form the provider of the service, as required by individual residents and specified in resident service plans. - ANSWER-Resident Transportation The facility or program shall have a written agreement or its equivalent, or a linkage for services not provided directly by the facility or program. - ANSWER-Written Agreements If the facility or program provides care to residents with _________________________, the facility or program shall also have a written agreement with one or more community mental health centers specifying which services will be provided by the mental health center. - ANSWER-Psychiartric Disorders The facility shall notify the Department immediately by telephone, followed by ________ by written confirmation for a reportable event. - ANSWER-72 Hours Interruption for ____________________ of basic physical plant services, such as heat, light, power, water, food, or staff is a reportable event. - ANSWER-3 or more hours Any major occurrence or incident of an unusual nature, including, but not limited to, all fires, disasters, elopements, and all deaths resulting from accidents or incidents in the facility or related to facility services. Incidents shall also contain information about injuries to residents and/or personnel disruption of services, and extent of damages; All suspected cases of resident abuse, neglect, or misappropriation

of resident property, including incidents reported to the Ombudsman; All alleged or suspected crimes which are serious crimes commitment by or against residents, reported at the time of occurrence to the local police department; Occurrence of epidemic disease in the facility; Termination of employment of the administrator, and the name and qualifications of his or her replacement. - ANSWER-Reportable Events 1.) All waivers granted by the Department 2.) A copy of the last annual licensure inspection survey report and the list of deficiencies from any valid complaint investigation during the past 12 months. 3.) Policies and procedures regarding resident rights. 4.) Business hours of the facility. 5.) Policies and procedures for maintaining security of the assisted living residence and comprehensive personal care homes. 6.) The toll-free hot line number of the Department; telephone numbers of county agencies and the of the State of New Jersey Office of the Ombudsman. 7.) The names of, and a means to formally contact, the owner and/or members of the governing agency.

• ANSWER-Notices for Residents & the Public The facility shall maintain an annual chronological listings of residents admitted and discharged, including the destination of residents who are discharged. It contains a current census of all residents, along with other pertinent information, shall be maintained by each assisted living residence, comprehensive personal care home, or assisted living program. The following standards for maintenance shall apply: 1.) The adminstrator or the administrator's desginee shall make all the entries and shall be responsible for its maintenance and safe-keeping. 2.) It shall be kept up-to-date at all times. Admissions, discharges and discharge destinations, and other changes shall be recorded within in 48 hours. 3.) It is a permanent record and shall be kept in a safe place. 4.) All entries into it shall be clear, legible, and written in ink or typed. - ANSWER-Register A register of residents are to be maintained, along with statistical data; such as resident census and facility characteristics shall be forwarded to the Department on request, in a format provided by the Department. - ANSWER-Maintenance of Records

This shall include at least orientation to the facility's or program's policies, business hours, fee schedule, services provided, residents rights, and criteria for admission and discharge. Documentation of this shall be included in the resident record. - ANSWER-Resident Interview If an applicant, after applying in writing, is denied admission to the assisted living residence, comprehensive personal care home, or assisted living program, the applicant and/or his or her family, guardian, or responsible person shall, upon written request, be given the reason for such denial in writing, signed by the administrator, within ____________ of the receipt of the written request. - ANSWER-15 Days Written notification of by the administrator shall be provided to a resident and/or his or family, guardian, or designated responsible person, of a decision to involuntarily discharge the resident from the facility or program. Such involuntary discharge shall only be upon grounds contained in the facility's or program's policies and procedures and shall only occur only if the resident has been notified and informed of such policies in advance. The notice of discharge shall be given at least __________ in advance and shall include the reason for discharge and the resident's right to appeal. This _________ advance notice shall not apply if the discharge is for reasons in accordance with the criteria specified at N.J.A.C. 8:36 - 5.1(d) (such as an emergency situation). A copy of the notice shall be entered into the resident's record. - ANSWER-30 Days 1.) The resident acquires an acute illness requiring medical care. 2.) Any serious accident, criminal act or incident occurs which involves the resident and results in serious harm or injury or results in the resident's arrest or detention. 3.) The resident is transferred from the facility. 4.) The resident expires. - ANSWER-Notification Requirements The facility or program shall demonstrate the ability to provide a means to communicate with any resident admitted who is non-English-speaking and/or has a communication disability, using available community or on-site resources. - ANSWER-Interpretation Services Each licensed assisted living residence and comprehensive personal care home shall maintain written referral and/or transfer agreements with at least one licensed acute care hospital in New Jersey, at least one licensed State, county, or private psychiatric hospital in New Jersey, and with at least one licensed New Jersey long-term care facility. A written agreement with an acute care hospital with licensed adult psychiatric beds in New Jersey shall enable compliance with psychiatric hospital component of the requirement. - ANSWER-Referral & Transfer Agreements

Upon admission and at the time of any changes in charges, inform the residents in writing, of any and all all fees for services provided and charges for supplies routinely provided by the facility. The facility shall also inform the resident of the costs of supplies which are specially ordered. At the resident's request, this information may be provided instead to the resident's family, guardian, or responsible person. - ANSWER-Financial Arrangements The administrator or his or her representative shall develop a policy and procedure for handling the monthly _______________________ for each resident who receives SSI or other forms of public assistance. Every administrator to whom resident's personal funds are entrusted shall maintain written records, such as a ledger, including the date each payment was received, the amount of payment, the date of each disbursement, the amount of each disbursement, the reason for each disbursement and to whom each disbursement was made. It shall not be commingled with any other facility operating account and shall be deposited into an interest bearing account. - ANSWER-Personal Needs Allowance Each resident shall receive his or her personal needs allowance within ____________ of the receipt of the check by the administrator. - ANSWER-72 hours The resident or, if the resident is not competent, the resident's representative with ________________________, shall sign to acknowledge receipt of funds, goods or services purchased with such funds at the time of disbursement. - ANSWER-Financial Power of Attorney Upon admission, each resident shall receive an initial assessment by a RN to determine the resident's needs. If this initial assessment indicates the resident has general needs, a general service plan shall be developed within ____________ of the resident's admission. - ANSWER-14 days 1.) The resident's need, if any, for assistance with ADLs. 2.) The resident's need, if any, for assistance with recreational and other activities. 3.) The resident's need, if any, for assistance with transportation. - ANSWER-General Service Plan Within ____________ prior to admission to the assisted living residence, comprehensive personal care home, or assisted living program, a physician, advanced practice nurse or physician assistant shall specify in writing that the resident is appropriate for this level of care to have a health service plan. - ANSWER- 30 days

At the time of admission, arrangements shall be made between the administrator and the resident, guardian, or responsible person regarding the _______________and ______________ to be called in case of illness, or the individual to be called for a resident who, because of religious affiliation, is opposed to medical treatment. - ANSWER-Physician and Dentist If the initial assessment of N.J.A.CC. 8:36-7.1(a) indicates that the resident requires health care services, a health care assessment shall be completed within __________ of admission by RN using an assessment instrument available from the Department, or an assessment instrument adopted by the facility or program, equivalent to the instrument available from the Department, and which meets the requirements. - ANSWER-14 days 1.) Need for assistance with ADLs. 2.) Cognitive patterns. 3.) Communication/hearing patterns. 4.) Vision Patterns. 5.) Physical functioning and structural problems. 6.) Continence. 7.) Psychosocial well-being. 8.) Mood and behavior problems. 9.) Activity pursuit patterns. 10.) Disease diagnoses. 11.) Health conditions and preventative health measures, including, but limited to, pain, falls, and lifestyle. 12.) Oral/nutritional status. 13.) Oral/dental status. 14.) Skill conditions. 15.) Medication Use* 16.) Special treatment and procedures. 17.) Restraint use. 18.) Outside service utilization. - ANSWER-Health Care Assessment 1.) Orders to treatment or services, medications, and diet, if needed.

2.) The resident's needs and preferences for himself or herself. 3.) The specific goals of treatment or services, if appropriate. 4.) The time intervals at which the resident's response to treatment will be reviewed. 5.) The measures to be used to assess the effects of treatment. - ANSWER-Health Service Plan The resident general service plan shall be reviewed and, if necessary, revised _______________, and more frequently as needed based upon the resident's response to the care provided and any changes in the resident's physical or cognitive status. - ANSWER-Semi-annually The resident health service plan shall be reviewed, and if necessary, revised ________________, and as needed, based upon the resident's response to the care provided and any changes in the resident's physical or cognitive status. - ANSWER-Quarterly The facility shall be responsible for reassessing residents who have neither a general service or health service plan in response to changes in the resident's functional and/or cognitive status at least ______________ and more frequently if such reassessment is predicted to change in the resident's functional and/or cognitive status. - ANSWER-Annually If a resident who has not been receiving a health care service requires a health care service on a temporary basis (meaning a period of time reasonably expected to be _____________________ and not involving a significant change in condition or a life-threatening illness), neither a health care assessment nor a health service plan be required. The administrator shall develop a system to identify the residents receiving a health care service on a temporary basis. - ANSWER-14 days or less Each resident shall have an ____________ physical examination by a physician, advanced practical nurse or physician assistant which shall be documented in the resident's record. The physician advanced practical nurse or physician assistant shall certify _________________ that the resident does not have any needs which exceed the are of that facility or program is capable of providing. - ANSWER-Annual, Annually If it is determined that there is a medical need for a transfer of a resident to another health care facility because of the assisted living residence, comprehensive personal care home, or assisted living program cannot meet the resident's needs, such transfers shall be initiated promptly. The RN shall be notified to ensure that the resident is receiving appropriate care during the transfer period. If the resident is not transferred within _____________, the Department shall be notified and assistance shall be requested from the Department to arrange for transfer of the resident. - ANSWER-7 day

A facility shall have a least one registered professional nurse available at all times. - ANSWER-Nursing Staff Requirments A nurse aide training course approved by the New Jersey State Department of Health and Senior Services in accordance with N.J.A.C. 8:39-43, and shall have passed the New Jersey Nurse Aide Certification Examination. - ANSWER-CNA A homemaker-home health aide training program approved by the New Jersey Board of Nursing and shall be certified by the Board in accordance with N.J.A.C. 13:37-14. - ANSWER-CHHA A personal care assistant training course approved by the New Jersey Department of Health and Senior Services and the competency evaluation program approved by the Department result in personal care assistant certification. - ANSWER-PCA Must be a CNA, CHHA, PCA. No individual shall be certified as a PCA pursuant unless that individual has completed the criminal history background check required by N.J.A.C. 8:43I. Each PCA and each direct caregiver shall receive orientation prior to or upon employment and on-going in-service education regarding the concepts of assisted living. - ANSWER-Qualifications of PCA, CMA, and Direct Caregivers Personal care assistant certification shall be valid for a period of __________ from the date of issue. At least once every ____________, on a schedule to be determined by the Department, a certified personal care assistant shall file an application for renewal of current certification and shall complete an updated criminal history background check as required by N.J.A.C. 8:43I. - ANSWER-2 years In order to be eligible to renew a current certification, the certified personal care assistant shall complete at least ____________ every two years of continuing education in assisted living concepts, and related topics, including cognitive and physical impairment and dementia. - ANSWER-20 hours Certified as a CNA, CHHA, or PCA; Successfully completion of medication administration training coursed approved by the Department; Successful completion of a Department of Health and Senior Services approved standardized examination regarding medication administration for PCAs. An oral examination shall not substitute for the written component of this examination. - ANSWER-CMA (Certified Medical Assistant)

Medication aide certification shall be valid for a period of ___________ from the date of issue. At least once every __________, on a schedule to be determined by the Department, a medication aide shall file an application for renewal of current certification. - ANSWER-2 years In order to be eligible to renew for a current certification, the medication aide have completed at least _________ of continuing education, seminars, or in-service training every two year certification period. This includes continuing education for review of the fundamental principles of medication administration, the skills and knowledge necessary for the task of medication administration, and topics of current drug use relevant to the elderly. - ANSWER-30 hours An applicant for medication aide certification shall sit for the standardized examination within __________ of successful completion of an approved medication administration training course. - ANSWER-6 Months The facility shall provide on the premises at all times (per building) the following minimum numbers of employees: 1.) At least one awake PCA in accordance with N.J.A.C. 8:36-9.1(a). 2.) At least one additional employee. - ANSWER-Minimum PCA Staffing The dietitian shall possess a bachelor's degree from an accredited collage or university with a major area of concentration in a nutrition-related field of study, and one year of full-time professional experience or graduate-level training in nutrition. - ANSWER-Dietician Qualifications The assisted living residence or comprehensive personal care home shall provide dining services to meet the daily nutritional needs of residents, directly in the facility. - ANSWER-Provision of Meals The facility shall designate a food service coordinator who, if not a dietitican, functions with scheduled consultation from a dietician. When meals are prepared in the facility, the food service coordinator or designee shall be present in the facility. The food service coordinator shall ensure that dining services are provided as specified in the dining portion of the health care plan. - ANSWER-Designation of a Food Coordinator If indicated, according to residents' needs, a dietitian shall be responsible for providing resident care, including, but not limited to, the following: 1.) Assessing the nutritional needs of the resident. If indicated, preparing the dietary portion of the health care plan on the basis of the assessment, providing

dietary services to the resident as specified in the dietary portion of the health plan, reassessing the resident, and revising the dietary portion of the health care plan. Each of these activities shall be documented in the resident's record; and 2.) Providing nutritional counseling and education to residents.

• ANSWER-Responsibilities of Dietitians Written, dated menus shall be planned at least _________ days in advance for all diets. - ANSWER- 14 days The same menu shall not be used more than once in any continuous __________ period. - ANSWER- 7 day Menus, with changes or substitutes, shall be kept on file in the facility for at least _____________. - ANSWER-30 days 1.) The facility or program shall document the provision of training (received from the RN or licensed pharmacists, and documented) to each employee who has been designated to provide resident supervision of self-administration of medications. 2.) The facility or program shall document any instances where medications are not taken in accordance with the prescribers orders. 3.) The facility shall keep a record of all prescribed medications for which the resident is receiving supervision of medication administration. - ANSWER-Supervision of Medication Administration _____________ solid and liquid dosage forms may be dispensed in a non unit-of-use or non unit-dose medication distribution system. - ANSWER-OTC (Over the Counter) ______________ conventional bottles or concentrates may be dispensed in a non unit-of-use, non unit- dose, or conventional medication distribution system. - ANSWER-Prescription Liquid Medications If the appropriate delegation is made, and in accordance with the facility's policies and procedures and all applicable State and Federal laws and regulations, the CMA may: i.) Administer medications through the routes of oral, ophthalmic, otic, inhalant, nasal, rectal, vaginal, topical, and by the percutaneous endoscopic gastrostomy (PEG) (g-tube) tube route of administration; ii.) Administer any prescription or OTC medication according to regulations; iii.) Administer regularly scheduled medications, including prescription, OTC, and Schedule II-V medications; iv.) Administer "PRN" or as needed medication, OTC, and Schedule II-V. - ANSWER-Delegation to CMA.

CMAs can adminster "PRN" or as needed prescription, OTC and Schedule II-V medications EXCEPT that residents receiving the following medications shall be assessed by the RN at least once every ______________: 1.) Residents receiving PRN Schedule II narcotic analgesics. 2.) Residents receiving Schedule III-IV narcotic analgesics. 3.) Residents receiving Schedule III-IV central nervous system agents. - ANSWER-7 days 1.) Administer any injection other than pre-drawn properly packaged labeled insulin. 2.) Calculate a medication dosage. 3.) Pre-pour medication for more than one resident at a time. 4.) Contact prescribers for changes in medication, to clarify an order, or contact the pharmacist for questions regarding a dispensed medication. 5.) Administer bolus doses of enteral feedings, or stop and/or start an existing enteral feeding pimp or gravity-fed system. - ANSWER-CMAs Cannot At least ____________ a RN shall review and sign off on any modifications or additions to the MAR that were made by the CMA under the RN's delegation. - ANSWER-Weekly Registered professional nurses and pharmacists who participate in certification medication aide training shall attend a Department offered ___________ Train-the-Trainer Medication Aide Workshop prior to providing such training to a Certified Medication Aides. - ANSWER-One Day Designation of Pharmacist 1.) Training of employees. 2.) Educating residents regarding medications. 3.) Establishing policies and procedures which ensure safe appropriate self-administration of medications. 4.) Reviewing medication administration records on ____________ basis, and at least ___________, inspecting all common areas of the facility or program where medication are stored or administered, documenting any problems and proposing solutions to these problems, and maintaining records of such inspections. - ANSWER-Quarterly

1.) The storage area shall be kept locked when not in use. 2.) The storage area shall be used only for storage of medication and medical supplies. 3.) The key to the storage area shall be kept on the person of the employee on duty who is responsible for resident supervision. - ANSWER-Storage and Control of Medications Discontinued or expired medications shall be destroyed within _____________ in the facility, or, if unopened and properly labeled, returned to the pharmacy for credit, if allowable, and in conformance with N.J.A.C. 13:39 and other State and Federal laws, codes, and regulations. - ANSWER-30 days All ________________________________ in the facility shall be witnessed and documented by two individuals, each of whom shall either be the administrator, the registered professional nurse, the licensed practical nurse, or the provider or consultant pharmacist. - ANSWER-Medication Destruction Residents shall have the opportunity to organize and participate in a ______________________ that presents the resident's concerns to the administrator of the facility. - ANSWER-Resident Council The facility shall arrange for the provision of social work services to residents who require them, by social workers licensed. Each social worker shall be licensed or certified by the New Jersey State Board of Social Work Examiners in accordance with N.J.A.C. 13:44G and N.J.S.A. 45:15BB. - ANSWER-Social Worker Emergency medical services shall be available to or arranged for residents requiring these services. The facility shall develop a written plan for arranging for emergency transportation of residents for medical care and returning them to the assisted living residence. - ANSWER-Emergency Medical Services At least _______ employee trained in cardiopulmonary resuscitation (CPR) and the Heimlich maneuver shall be available in the facility at all times. The facility shall have an automatic external defibrillator (AED) on site. At least _______ employee trained in the use of the AED shall be available in the facility at all times. - ANSWER-One The facility shall develop written emergency plans, policies, and procedures which shall include plans and procedures to be followed in case of medical emergencies, power failures, fire, and natural disasters. The emergency plan shall be filed with the Department and the Department shall be notified when the plans are changed. Copies of the emergency plans shall also be forwarded to other agencies in accordance with State and municipal laws. Nothing in these rule shall supersede or imply non-

compliance with the Uniform Fire Act or Uniform Fire Code, N.J.A.C. 5:70, or NFPA 101. - ANSWER- Emergency Plan and Procedures The facility shall conduct at least one drill of the emergency plans every _____________. - ANSWER- Month The 12 drills shall be conducted on a rotating basis, to ensure that _______drills occur during each working shift on an annual basis. - ANSWER- 4 The facility shall maintain documentation of all drills, including the date, hour, description of the drill, participating staff, and signature of the person in charge. In addition to the drills for emergencies due to fire, the facility shall conduct at least one drill per _________ for emergencies due to a disaster other than fire, such as storm, flood, other natural disaster, bomb threat, or nuclear accident (a total of 12 drills). - ANSWER-Year All staff shall participate in at least one drill ______________, and select residents may participate in drills. - ANSWER-Annually The facility shall request of the local fire department that at least one joint fire drill shall be conducted _______________. Upon scheduling a joint fire drill, the facility shall notify first aid and civil defense agencies of this drill and shall participate in community-wide disaster drills. - ANSWER-Annually The facility shall test at least one _______________ each month of the year and maintain documentation of test dates, location of each tested, persons testing the alarms, and its condition. - ANSWER-Manual Pull Alarm These shall be hung conspicuously, kept easily accessible, shall be visually examined monthly and shall be recorded on a tag which is attached to it. It shall also be inspected and maintained in accordance with manufacturers' and applicable NFPA requirements and N.J.A.C. 5:70. Each shall be labeled to show the date of such inspection and maintenance. - ANSWER-Fire Extinguishers All resident records shall be maintained for a period of _______________ after the discharge of a resident from the assisted living residence, comprehensive personal care home, or assisted living. - ANSWER-10 years

The register shall be kept up-to-date at all times. Admissions, discharges and discharge destination, and other changes shall be recorded within ____________. - ANSWER-48 hours 1.) The resident's completed admission application and all records forwarded to the facility; 2.) The resident's name, last name, date of birth, name and address of sponsor or interested agency, date of admission, date of discharge (and discharge destination) or death, the name, address and telephone number of physician to be called, and the name, address and of nearest relative, guardian, responsible person, or interested agency, together with any other information the resident wishes to have recorded; 3.) A copy of the resident's advanced directive, if applicable; and 4.) A copy of the resident's general service plan and/or health service plan, if applicable. - ANSWER- Residents' Individual Records 1.) Promptly notify a family member, guardian, or other designated person of the death of the resident. Notification shall be made at the time of the occurrence, and the time between the resident's death and notification shall not exceed one hour; and 2.) Including in the resident's record written documentation from the physician of the date and time of death, the name of the person who pronounced the death, disposition of the body, and a record of notification of the family. The administrator or administrator's designee shall include in the record of notification of the family confirmation and written documentation of that notification. 3.) A physician, registered nurse or paramedic may make a determination and pronouncement of death in accordance with N.J.A.C. 13:35-6.2(d) and (e). - ANSWER-Record of Death Means of _______________shall be provided in accordance with the Uniform Construction Code, N.J.A.C 5:23, either by windows or by mechanical ________________ for every habitable room. Means of ________________ shall be provided for every bathroom or water closet (toilet) compartment. ________________ shall be provided either by a window with an openable area or by mechanical _______________. - ANSWER-Ventilation The width of passageways, aisles and corridors shall have a minimum of ___________ of clear space. - ANSWER-44 inches These shall be provided in all residents' bedrooms, living rooms, and "studio apartment" units, whether or not the facility contains a comprehensive automatic fire suppression system throughout. - ANSWER- Smoke Detectors

Residential units occupied by one person shall have minimum of ______________ of clear and usable floor area. This excludes closets, bathroom, kitchenette, hallways, corridors, vestibules, alcoves, and foyers (unless the Department grants such a request). - ANSWER-150 square feet In units occupied by more than one resident, there shall be a minimum of ______________________ for an additional occupant. - ANSWER-80 additional square feet No residential unit in an assisted living shall be occupied by more than ________ individuals. - ANSWER- Two Total amount of clear and usable floor area for two person occupied assisted living residence. - ANSWER- 230 square feet Residential units shall be lockable by the occupant(s). All residential units shall be accessible by means of a master key or similar system which is available at all times in the facility, and available at all times for use by designated staff. - ANSWER-Lockable Residential Units The facility shall provide a minimum of ___________ per resident of community spaces for dining and for active and passive recreation. - ANSWER-30 square feet Each assisted living facility shall provide at least ________ non-commercial washer and dryer to be used exclusively for the residents' personal items. - ANSWER-One When a commercial type laundry equipment is utilized, it shall be installed in a separate laundry room. The remainder of the shall be protected from the laundry room by fire separation assemblies of a least ___________ rated construction. - ANSWER-One hour 1.) A grade level barrier-free entrance, sheltered from the weather and able to accommodate wheelchairs shall be provided, and shall include a reception and information counter or desk and waiting space for eating. 2.) Space for private interviews shall be provided. 3.) An individual mailbox for each resident shall be provided.

4.) General or individual offices for records, administrative and professional staff shall be provided. 5.) Space shall be provided for storing employee's personal possessions. 6.) Separate space shall be provided or storage of office supplies, sterile or pharmaceutical supplies, and housekeeping supplies. 7.) A room(s) for examination and treatment of residents, which is adequate for an overnight stay and include toilet facilities, may be provided. The room shall have a minimum floor area of 100 square feet, excluding space for vestibule, toilet and closet. The room shall contain a lavat - ANSWER-Administration and Public Areas A room(s) for examination and treatment of residents, which is adequate. The room shall have a minimum floor area of __________________, excluding space for vestibule, toilet and closet. The room shall contain a lavatory or sink equipped for handwashing, a work counter, storage facilities, and a desk, counter or shift for writing. - ANSWER-100 square feet If self-locking doors are used at the main entrance and other entrances which open onto a roof or balconies, they shall be equipped with a sounding device, such as a bell, buzzer, or chime, which is in operating condition. The sounding device shall be affixed to the outside of the door or to the adjacent exterior wall for use in the event that a person is unable to enter the building, and shall ring an area staffed 24 hours a day. - ANSWER-Sounding Devices For central kitchens, thermometers which are accurate to within _______________ shall be kept in a visible location within refrigerators, freezers, and storerooms used for perishable and other items subject to deterioration. - ANSWER-3 degrees Fahrenheit All household and cleaning product used by facility staff shall be identified, labeled, and secured. All poisonous and toxic materials shall be identified, labeled, and stored in a locked cabinet or room. The telephone number of the poison control center shall be conspicuously posted in the facility. - ANSWER- Household and Cleaning Products During the heating season, the temperature in the facility shall be kept at minimum of ____________ during the day (between sunrise and sunset). - ANSWER-72 degrees Fahrenheit During the heating season, the temperature in the facility shall be kept at minimum of ____________ during the night. - ANSWER-68 degrees Fahrenheit

During warm weather conditions, the temperature within the facility shall not exceed _____________. - ANSWER-82 degrees Fahrenheit According to current regulations, the temperature of the hot water used for bathing and handwashing shall be at least _________________. - ANSWER-95 to 120 degrees Fahrenheit This shall be stored in a ventilated, vermin proof-area, separate from other supplies, and shall be stored, sorted, rinsed, and laundered only in areas specifically designed for those purposes. It shall be stores, transported, collected, and delivered in a covered laundry bag or cart. Laundry carts shall be in good repair, kept clean, and identified for use when either clean or soiled laundry. - ANSWER-Soiled Laundry The facility shall develop, implement, and review at least _______________, written policies and procedures regarding infection prevention and control. Written policies and procedures shall be consistent withe the Centers for Disease Control publications and OSHA standards. - ANSWER-Annually The facility shall document evidence of ___________ vaccination against influenza for each residents, in accordance with the General Recommendations on Immunization of the Advisory Committee on Immunization Practice of the CDC. Influenza vaccines for all residents accepting the vaccine shall be completed by November 30th of each year. Residents admitted after this date, during the flu season and up to February 1, shall as medically appropriate, receive influenza vaccination prior to or on admission unless refused by the resident. - ANSWER-Annual The facility shall document evidence of vaccination against pneumococcal disease for all residents who are 65 years of age or older. The facility shall provide or arrange for pneumococcal vaccination of residents who have not received this immunization, prior to or on admission unless the resident refuses offer of the vaccine. - ANSWER-Pneumococcal Disease Provided the following information: 1.) The number of licensed and unlicensed staff providing direct care to residents diagnosed with Alzheimer's and related disorders. 2.) The activities that specifically directed towards residents disagnosed with Alzheimer's and related disorders, including but not limited to, those designed to maintain the resident's dignity and personal identity, enhance socialization and success, and accomodate the cognitive and functional ability of the resident. 3.) The frequency of the activities.

4.) The safety policies and procedures and any security monitoring system that is specific to residents diagnosed with Alzheimer's and related disorders. - ANSWER-Services for Residents with Alzheimer's/dementia Assisted living facilities are permitted to accept short-term residents who regular caregivers are participating in a respite care program. - ANSWER-Respite Defined as any individual, paid or unpaid, who provides regular in-home care for an elderly, disabled, or cognitively impaired person. - ANSWER-Caregiver The facility shall establish a written plan for a quality improvement program for resident care. The plan shall specify a timetable and the person(s) responsible for the quality improvement program and shall provide the ongoing monitoring of staff and resident care services. Polices and produces should be reviewed annually. The administrator shall implement measures to ensure that corrections or improvements area made. - ANSWER-Quality Improvement Program 1.) The facility shall develop policies and procedures that support a restraint-free environment for all residents. 2.) The use of any restraining devices shall be based on an assessment and shall require a physician, advanced practice nurse, or physician assistant order. 3.) The least restrictive device shall be used, in compliance with the prescriber's order. 4.) A specific plan of care shall be developed for the use of any restraining device. - ANSWER-Use of Restraints Regulations: Standards for Licensure of Assisted Living Residences, Comprehensive Personal Care Homes, and Assisted Living Programs. - ANSWER-N.J.A.C. 8:36 General Licensure Procedures and Enforcement of Licensure Regulations - ANSWER-N.J.A.C. 8:43E Refers to the Commissioner of the New Jersey Department of Health and Senior Services. - ANSWER- Commissioner

An order by the Department which requires a licensed health care facility to cease and desist all admissions and readmissions of patients or residents to the facility or affected service. - ANSWER- Curtailment A determination by the Department of one or more instances in which a State licensing regulation or Federal certification regulation has been violated. - ANSWER-Deficiency Refers to the New Jersey Department of Health and Senior Services. - ANSWER-Department Refers to the Division of Health Care Systems Analysis, New Jersey Department of Health and Senior Services. - ANSWER-Division The entity which has been issued a license to operate a health care facility pursuant to N.J.S.A. 26:2H- 1 et seq. For the purposes of this chapter, this includes ambulance and invalid coach services. - ANSWER- Facility A deficiency or violation that has caused or will imminently cause any time serious injury harm, impairment, or even death to residents or patients of the facility and therefore requires immediate corrective action. - ANSWER-Immediate and Serious Threat An individual under the medical and nursing care and supervision of a licensed health care facility. - ANSWER-Patient An individual residing in a licensed health care facility and under the supervision of that facility for the purpose of receiving medical, nursing, and/or personal care services. - ANSWER-Resident The evaluation of the quality of care and/or the fitness of the premises, staff, and services provided by a facility as conducted by the Department and/or designees to determine compliance or non-compliance with applicable State licensing regulations, statutes, or Federal Medicare/Medicaid certification regulations or statutes. - ANSWER-Survey At the conclusion of a survey or within ______________ thereafter, the Department shall provide a facility with a written summary of the factual findings used as a basis to determine that a licensure violation has occurred, and a statement of each licensure regulation to which the finding of deficiency