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The facility is cited for failing to maintain minimum direct care staff-to-resident ratios required under the New Jersey Administrative Code and related staffing legislation. The document outlines corrective actions including daily monitoring of acuity and nursing staffing hours and CNA ratios, use of overtime/bonus/per diem staffing, and recruitment and retention efforts. 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BUILDING:  \u003Cbr>B. WING   |  | (X3) DATE SURVEY COMPLETED\u003Cbr>08/24/2021 |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| NAME OF PROVIDER OR SUPPLIER\u003Cbr>FOREST MANOR HCC |  | STREET ADDRESS, CITY, STATE, ZIP CODE\u003Cbr>145 STATE PARK ROAD\u003Cbr>HOPE, NJ 07844 |  |  |  |  |\n| (X4) ID\u003Cbr>PREFIX\u003Cbr>TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |  | ID\u003Cbr>PREFIX\u003Cbr>TAG | PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) |  | (X5)\u003Cbr>COMPLETE\u003Cbr>DATE |\n| S 000\u003Cbr>S 560 | Initial Comments\u003Cbr>THE FACILITY WAS NOT IN COMPLIANCE WITH THE STANDARDS IN THE NEW JERSEY ADMINISTRATIVE CODE, CHAPTER 8:39, STANDARDS FOR LICENSURE OF LONG TERM CARE FACILITIES. THE FACILITY MUST SUBMIT A PLAN OF CORRECTION, INCLUDING A COMPLETION DATE, FOR EACH DEFICIENCY AND ENSURE THAT THE PLAN IS IMPLEMENTED. FAILURE TO CORRECT DEFICIENCIES MAY RESULT IN ENFORCEMENT ACTION IN ACCORDANCE WITH THE PROVISIONS OF THE NEW JERSEY ADMINISTRATIVE CODE, TITLE 8, CHAPTER 43E, ENFORCEMENT OF LICENSURE REGULATIONS.\u003Cbr>8:39-5 . 1(a) Mandatory Access to Care\u003Cbr>(a) The facility shall comply with applicable Federal, State, and local laws, rules, and regulations.\u003Cbr>This REQUIREMENT is not met as evidenced by:\u003Cbr>Based on observation, interview, and review of pertinent facility documentation, it was determined the facility failed to maintain the required minimum direct care staff-to-resident ratios as mandated by the state of New Jersey. This deficient practice was evidenced by the following:\u003Cbr>Reference: NJ State requirement, CHAPTER\u003Cbr>112. An Act concerning staffing requirements for nursing homes and supplementing Title 30 of the Revised Statutes. |  | S 000\u003Cbr>S 560 | 1) The facility is monitoring acuity and nursing staffing hours and CNA ratios daily. Nursing overtime shifts, bonus shifts, and per diem shifts are being utilized when needed to maintain the required hours and ratios. The facility continues to aggressively to recruit, hire and retain nursing staff.\u003Cbr>2) The facility recognizes that all residents have the potential to be affected by this deficient practice. The facility will track |  | 10/1/21 |\n\nLABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE  \nElectronically Signed  \nTITLE  \n(X6) DATE 09/08/21  \nPRINTED: 03/16/2023 FORM APPROVED  \nNew Jersey Department of Health  \n\n| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |  | (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:\u003Cbr>062103 | (X2) MULTIPLE CONSTRUCTION\u003Cbr>A. BUILDING:  \u003Cbr>B. WING   |  |  | (X3) DATE SURVEY COMPLETED\u003Cbr>08/24/2021 |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| NAME OF PROVIDER OR SUPPLIER\u003Cbr>FOREST MANOR HCC\u003Cbr>STREET ADDRESS, CITY, STATE, ZIP CODE\u003Cbr>145 STATE PARK ROAD\u003Cbr>HOPE, NJ 07844 |  |  |  |  |  |  |  |\n| (X4) ID\u003Cbr>PREFIX\u003Cbr>TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |  |  | ID\u003Cbr>PREFIX\u003Cbr>TAG | PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) |  | (X5)\u003Cbr>COMPLETE\u003Cbr>DATE |\n| S 560 | Continued From page 1\u003Cbr>Be It Enacted by the Senate and General Assembly of the State of New Jersey:\u003Cbr>C.30:13-18 Minimum staffing requirements for nursing homes effective 2/1/21 .\u003Cbr>1. a. Notwithstanding any other staffing requirements as may be established by law, every nursing home as defined in section 2 of P. L. 1976, c.120 (C.30:13-2) or licensed pursuant to P. L. 1971, c.136 (C.26:2H-1 et seq. ) shall maintain the following minimum direct care staff-to-resident ratios:\u003Cbr>(1) one certified nurse aide to every eight residents for the day shift;\u003Cbr>(2) one","cbCaiqmfzemzUtuZ","https://ap.wps.com/l/cbCaiqmfzemzUtuZ","pdf",112591,"English","# Statement of Deficiencies and Plan of Correction\n## Initial Comments\n## Mandatory Access to Care\n## Minimum Direct Care Staffing Ratios\n## Provider's Plan of Correction","[{\"question\":\"What deficiency is cited in this statement?\",\"answer\":\"The facility is cited for not maintaining the required minimum direct care staff-to-resident ratios mandated by New Jersey regulations.\"},{\"question\":\"What staffing ratios does the document reference?\",\"answer\":\"It references ratios for day, evening, and night shifts, including certified nurse aide and direct care staff requirements.\"},{\"question\":\"What corrective actions does the facility plan to take?\",\"answer\":\"The plan includes daily monitoring of acuity, staffing hours, and CNA ratios, using overtime/bonus/per diem shifts as needed, and strengthening recruitment and retention efforts, followed by regular performance improvement reviews.\"}]","STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION - New Jersey Department of Health | PDF"]