New Jersey Department of Health

RESIDENT CARE STAFFING REPORT

REPORT FOR
(Date)
NOTICE TO CONSUMER

Section 941 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) and N.J.S.A. 26:2H-5f et seq. requires skilled nursing facilities and nursing facilities to post daily for each shift the number of licensed and unlicensed nursing staff directly responsible for resident care in the facility. This information shall be displayed in a place where residents and the general public can easily view it.

Name of Nursing Home

Shift	Current Resident Census	Staff Category	Actual Hours

Worked	Number

of Staff Scheduled	Staff to Resident Ratio
Registered Nurses (RN)	RNs	1 RN: ___.___ Residents
Licensed Practical Nurses (LPN)	LPNs	1 LPN: ___.___ Residents
Certified Nurse Aides (CNA)	CNAs	1 CNA: ___.___ Residents

HFEL-6

AUG 12

HFEL-6, Resident Care Staffing Report

HFEL-6, HFEL, resident care staffing, nursing home, skilled nursing facility, staffing

ewhite

2008-04-01

NJDOH