Get NJ LCS-8 2017-2024

In order to afford timely due process to the individual so accused yet protect the vulnerable frail and/or elderly residents of licensed facilities the Department of Health NJDOH requests that you provide all of the information required by the Facility Reporting Incident Data and Analysis Yield FRIDAY form within 15 business days of the incident date. New Jersey Department of Health Office of Program Compliance Reporting P O Box 358 Trenton NJ 08625-0358 FACILITY REPORTING INCIDENT DATA AND ANALYSIS YIELD FRIDAY GUIDELINES Revised 9/2008 TO All Assisted Living and/or Long Term Care Facility Administrators An accused certified nurse aide CNA personal care assistant PCA or medication aide CMA is entitled to a hearing regarding the above-referenced allegation of abuse neglect or misappropriation of resident property. This Department requires that the entire form be completed together with all information and supporting documentation requested therein* Sections 1 through 14 shall be completed and the required supporting information submitted even if the facility or government agency or other investigation process did not substantiate the allegation* Further all information and supporting documentation shall be submitted in response to this letter regardless of whether it has already been supplied to another government agency or official* Please remember that certificates and/or wallet cards are not permitted to be photocopied for any reason* If more than one aide has been accused of this incident a report for each accused aide shall be completed and all of the requested information shall be attached to each form* For example if 3 aides have been identified please duplicate all information so that 3 separate packages are completed and submitted* You may place the 3 separate packages into one envelope for mailing/courier services. Return the completed original form and legible copies of all supporting documents and keep a copy of this form for your records. Packages shall be forwarded as follows Mailing Address via United States Postal Service Overnight Couriers DHL FedEx UPS Ms. Regina Reali 171 Jersey Street Building 5 2nd Floor Due to the volume of ongoing cases it is difficult to notify you of the status of a particular case. Once all information has been received and reviewed you will be notified of the determination in writing. Thank you for your anticipated cooperation with this important matter. This program cannot succeed in its mission to protect the frail and/or elderly population of our licensed health care facilities without your complete participation* Please be aware that the Nursing Home Administrators Licensing Board is notified of all instances where an administrator fails to respond to this request. Any sanctions that may be imposed against administrators are in accordance with N*J*A. C. 8 34-1 et seq. specifically N*J*A. C. 8 34-9. 1 a 9 and N*J*S*A. 26 2H-27 and 26 2H-28. If you are unable to meet the time frame required in this letter or have questions about the contents of this letter please contact Regina Reali via email regina*reali doh.