65D-30.005. Standards for Addictions Receiving Facilities

An addictions receiving facility is a secure, acute-care or sub-acute, residential facility operated 24 hours-per-day, 7 days-per-week, designated by the Department to serve individuals found to be substance use impaired as described in section 397.675, F.S., and who meet the placement criteria for this component. In addition to rule 65D-30.004, F.A.C., the following standards apply to addictions receiving facilities.

(1) Designation of Addictions Receiving Facilities. The Department shall designate addictions receiving facilities. The provider shall indicate on the licensure application for this service component that designation is requested. Once the designation request is received by the Regional Substance Abuse and Mental Health Program Office, the Regional Substance Abuse and Mental Health Program Director shall submit a written recommendation to the Office of Substance Abuse and Mental Health headquarters in Tallahassee, Florida. The headquarters Director of Substance Abuse and Mental Health may approve or deny the request and shall respond in writing to the Chief Executive Officer of the requesting provider.

(a) Criteria for Department approval of addictions receiving facility designation:

1. The Department ensures provider’s policies and procedures achieve at least 80 percent compliance with applicable licensing standards; and

2. The Department assesses that the provider is capable of providing a secure, acute care facility to include compliance with seclusion and restraint; and

3. A Regional Substance Abuse and Mental Health Director recommends in writing that the Department designate the provider’s facility as a designated addictions receiving facility.

(b) If the request is denied, the response shall specify the reasons for the denial. If the request is approved, the response shall include a certificate designating the facility. The designation shall be valid for as long as the provider’s license for the addiction receiving facility is valid.

(2) Services.

(a) Stabilization and Detoxification. Following the nursing physical screen, and in cases where medical emergency services are unnecessary, the individual shall be stabilized in accordance with their presenting condition. Detoxification shall be initiated if this course of action is determined to be necessary.

(b) Supportive Counseling. Each individual shall be offered supportive counseling on a daily basis, unless an individual is not sufficiently stabilized as defined in subsection 65D-30.002(78), F.A.C. Supportive counseling sessions shall be of sufficient duration to enable staff to make reasonable decisions regarding the individual’s need for other services. Services shall be directed toward assuring the individual’s most immediate needs are addressed and that the individual is encouraged to remain engaged in treatment and to follow up on referrals after discharge.

(c) Daily Schedule. The provider shall develop a daily schedule that shall be posted in clear view of all program participants and include recreational and educational activities. Participation in daily activities by the individual shall be documented in the individual’s clinical record.

(3) Facility Requirements Related to Screening and Assessment. Providers shall designate an area of the facility that is properly equipped and furnished for conducting screening and assessment. The area shall be conducive to privacy and freedom from distraction, and shall be accessible to transportation, including law enforcement vehicles and ambulances.

(4) Observation of Individuals. Individuals requiring close medical observation, as determined by medical staff, shall be visible and readily accessible to the nursing staff 24 hours per day and 7 days per week. Staff shall perform visual checks minimally every 15 minutes, which shall be documented in the individual’s clinical record. Individuals who do not require close medical observation shall be in a bed area that allows for general nursing observation.

(5) Eligibility Criteria. To be considered eligible for placement, a person must be unable to be placed in another component and must also fall into one (1) of the following categories:

(a) An individual who presents for voluntary admission who displays behaviors that indicate potential harm to self or others due to a substance use issue or who meets diagnostic or medical criteria justifying admission in a secure facility; or

(b) An individual who meets the criteria for involuntary admission specified in section 397.675, F.S., or

(c) An adult or juvenile offender who is ordered for assessment or treatment under sections 397.705 and 397.706, F.S., and who meets diagnostic or medical criteria justifying placement in an addictions receiving facility, or

(d) Juveniles found in contempt as authorized under section 985.037, F.S.

(6) Exclusionary Criteria for Addictions Receiving Facilities. Persons ineligible for placement include:

(a) Persons found not to be using substances or whose substance use is at a level which permits them to be served in another component, with the exception of persons placed for purposes of securing an assessment for the court; and

(b) Persons found to be beyond the safe management capability of the provider as defined under section 397.311(3), F.S., and as described under section 397.6751(1)(f), F.S.

(7) Admission Procedures. Following the nursing physical screen, the individual shall be screened to determine eligibility for admission. The decision to admit or not to admit shall be made by a physician, a qualified professional, or an R.N., and shall be based upon the results of screening information and face-to-face consultation with the person to be admitted.

(8) Notification and Referral. In the event that the addictions receiving facility has reached full capacity or it has been determined that the screened individual cannot be safely managed, the provider shall attempt to notify the referral source and document the attempt. In addition, the provider shall provide assistance in referring the person to another component, in accordance with section 397.6751, F.S.

(9) Involuntary Assessment and Disposition.

(a) Involuntary Assessment. An assessment shall be completed for each individual admitted to an addictions receiving facility under protective custody, emergency admission, alternative involuntary assessment for minors, and under involuntary assessment and stabilization. The assessment shall be completed by a qualified professional and based on the requirements in paragraph 65D-30.0042(2)(b), F.A.C. The assessment shall be directed toward determining the individual’s need for additional treatment and the most appropriate services and supports.

(b) Disposition Regarding Involuntary Admissions. Within the assessment period, one (1) of the following actions shall be taken, based upon the needs of the individual and, in the case of a minor, after consultation with the parent(s) or guardian(s).

1. The individual shall be released and notice of the release shall be given to the applicant or petitioner and to the court, pursuant to section 397.6758, F.S. In the case of a minor that has been assessed or treated through an involuntary admission, that minor must be released to the custody of his parent(s), legal guardian(s), or legal custodian(s).

2. The individual shall be asked if they will consent to voluntary treatment at the provider, or consent to be referred to another provider for voluntary treatment in another service component.

3. A petition for involuntary treatment will be initiated.

(10) Notice to Family or Legal Guardian. In the case of a minor, the minor’s parent(s) or legal guardian(s) shall be notified upon admission to the facility. Such notification shall be in compliance with the requirements of Title 42, Code of Federal Regulations, Part 2.

(11) Staffing. Providers shall conduct clinical and medical staffing of individuals admitted for services. Participation in staffing shall be dictated by the individual’s needs. At a minimum, staffing shall include participation by a physician, nurse, primary counselor, and the individual served unless clinically contraindicated.

(12) Staff Coverage. A physician, P.A., or A.R.N.P. shall make daily visits to the facility for the purpose of conducting physical examinations and addressing the medical needs of individuals. A full-time R.N. shall be the supervisor of all nursing services. An R.N. or L.P.N. shall be on-site 24 hours per day, 7 days per week. At least one (1) qualified professional shall be on staff and shall be a member of the treatment team. At least one (1) member of the clinical staff shall be available on-site for eight (8) hours daily and be on-call thereafter.

(13) Staffing Requirement and Bed Capacity. The staffing requirement for nurses and nursing support personnel for each shift shall consist of the following:

Licensed Bed Capacity	Nurses	Nursing Support
1-10	1	1
11-20	1	2
21-30	2	2

The number of nurses and nursing support staff shall increase in the same proportion as the pattern described above. In those instances where a provider operates a crisis stabilization unit and addictions receiving facility within the same facility, the combined components shall conform to the staffing requirement of the component with the most restrictive requirements.

(14) Seclusion and Restraint.

(a) Addictions receiving facilities may utilize seclusion and restraint. If seclusion or restraint is utilized, addictions receiving facilities shall adhere to all standards and requirements for seclusion and restraint as described in rule 65E-5.180, F.A.C.

(b) If an addictions receiving facility chooses not to conduct any seclusions and restraints, the provider shall not maintain a seclusion and restraint room, and the provider’s policies and procedures shall prohibit staff from conducting seclusions and restraints.

(c) De-escalation techniques shall be employed before seclusion or restraint and in accordance with the provider’s policies and procedures. If seclusion or restraint is utilized, it shall be documented in the clinical record and reported using the Department’s web-based reporting system as described in chapter 65E-5, F.A.C.

(d) Under no circumstances shall individuals being served be involved in the seclusion or restraint of other individuals. Additionally, seclusion, or restraint shall not be utilized as punishment or for the convenience of staff.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.311(26), 397.321, 397.4014, 397.410 FS. History–New 5-25-00, Amended 4-3-03, 8-29-19.