The proposed amendments effect Rules 58A-5.0131, 58A-5.014, 58A-5.015, 58A-5.016, 58A-5.0181, 58A-5.0182, 58A-5.0185, 58A-5.019, 58A-5.0191, 58A-5.023, 58A-5.024, 58A-5.0241, 58A-5.025, 58A-5.026, 58A-5.029, 58A-5.030, 58A-5.031, and 58A-5.033, F.A....

 

DEPARTMENT OF ELDER AFFAIRS
Federal Aging Programs

RULE NO: RULE TITLE
58A-5.014: License Application, Change of Ownership, and Provisional Licenses
58A-5.015: License Renewal and Conditional Licenses
58A-5.016: License
58A-5.019: Staffing Standards
58A-5.023: Physical Plant Standards
58A-5.024: Records
58A-5.025: Resident Contracts
58A-5.026: Emergency Management
58A-5.029: Limited Mental Health
58A-5.030: Extended Congregate Care Services
58A-5.031: Limited Nursing Services
58A-5.033: Administrative Enforcement
58A-5.0131: Definitions
58A-5.0181: Residency Criteria and Admission Procedures
58A-5.0182: Resident Care Standards
58A-5.0185: Medication Practices
58A-5.0191: Staff Training Requirements and Competency Test
58A-5.0241: Adverse Incident Report
PURPOSE AND EFFECT: The proposed amendments effect Rules 58A-5.0131, 58A-5.014, 58A-5.015, 58A-5.016, 58A-5.0181, 58A-5.0182, 58A-5.0185, 58A-5.019, 58A-5.0191, 58A-5.023, 58A-5.024, 58A-5.0241, 58A-5.025, 58A-5.026, 58A-5.029, 58A-5.030, 58A-5.031, and 58A-5.033, F.A.C. The proposed rule amendments will update and delete obsolete forms and applications; update and delete obsolete references to organizations and programs; provide definitions; conform the proposed rules to changes in Sections 400.419, 400.417, 400.452, F.S.; and will clarify and revise rule requirements relating to the noticed rule titles. The proposed amendments were developed in consultation with the Agency for Health Care Administration.
SUMMARY: The proposed rule amendments address changes in assisted living facility definitions; license application, change of ownership and provisional licenses; license renewal and conditional licenses; licensing criteria; residency criteria and admission procedures; resident care standards; medication practices; staffing standards; staff training requirements and competency test; physical plant standards; records; adverse incident reports; resident contracts; emergency management; limited mental health; extended congregate care services; limited nursing services; and administrative enforcement.
SUMMARY OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 400.4256, 400.402, 400.407, 400.415, 400.4178, 400.423, 400.424, 400.426, 400.427, 400.4275, 400.441, 400.442, 400.452 FS.
LAW IMPLEMENTED: 394.4574, 400.402, 400.404, 400.407, 400.4075, 400.408, 400.411, 400.412, 400.414, 400.415, 400.417, 400.4174, 400.4176, 400.4178, 400.419, 400.42, 400.423, 400.424, 400.4255, 400.4256, 400.426, 400.427, 400.4275, 400.428, 400.431, 400.434, 400.435, 400.441, 400.442, 400.444, 400.4445, 400.447, 400.452, 404.056, 409.912 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE TIME, DATE AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
TIME AND DATE: 9:00 a.m. through 12:00 p.m.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jim Crochet, Office of the General Counsel, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000, telephone [phone]. Email Address: [e-mail].

THE FULL TEXT OF THE PROPOSED RULE IS:

58A-5.0131 Definitions.

In addition to tThe following terms are defined in Section 400.402, F.S., and are applicable to this rule chapter: activities of daily living (ADLs), administrator, agency (AHCA), aging in place or age in place, applicant, assisted living facility (ALF), chemical restraint, community living support plan, cooperative agreement, department (DOEA), emergency, extended congregate care (ECC), guardian, limited nursing services (LNS), managed risk, mental health resident, personal services, physical restraint, relative, resident, resident’s representative or designee, service plan, shared responsibility, supervision, supplemental security income, supportive services, and twenty-four-hour nursing supervision. the following Additional definitions are applicable in this rule chapter are as follows:

(1) No change.

(2) “Agency Central Office or AHCA Ccentral Ooffice” means the Agency for Health Care Administration (also referred to as “Agency”), Assisted Living Unit (ALU), Agency for Health Care Administration located at 227 N. Bronough Street, Room 7100, Tallahassee, FL.  The mailing address for the Assisted Living Unit is 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL, 32308-5403., and Tthe ALU telephone number is (850)-487-2515.

(3) NO CHANGE.

(4) “Assistance with activities of daily living” (ADLs) means individual assistance with the following:

(a) through (e) No change.

(f) Toileting through Assisting the resident to the bathroom, helping to undress, positioning on the commode, and helping with related personal hygiene, including assistance with changing an adult brief. Assistance with toileting includes assistance with the routine emptying of a catheter or colostomy bag.

(5) through (12) No change.

(13) “DOEA Assisted Living Program” means the Assisted Living Program, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000.  The telephone number of the program is [phone].

(14) through (28) renumbered (13) through (27) No change.

(28)(29) “Owner” means the person, partnership, association or corporation, which owns or leases the facility, and is licensed by the Agency AHCA. whether licensed or not The term does not include a person, partnership, association, or corporation which contracts only to manage or operate the facility. When the person, partnership, association or corporation who owns the facility’s physical plant has leased it to another, but retains significant control over the day-to-day operations of the facility, such person is an owner of the facility.

(30) through (36) renumbered (29) through (35) No change.

(36) “Third Party” means any person or business entity providing services to residents who is not staff of the facility.

(37) No change.

Specific Authority 400.423, 400.441 FS.  Law Implemented 400.402, 400.407, 400.4075, 400.411, 400.414, 400.4178, 400.419, 400.4255, 400.423, 400.428, 400.441, 400.447, 400.452 FS.  History–New 9-30-92, Formerly 10A-5.0131, Amended 10-30-95, 6-2-96, 4-20-98, 10-17-99, 1-9-02,_______.

58A-5.014 License Application, Change of Ownership, and Provisional Licenses.

(1) LICENSE APPLICATION. An applicant for a standard assisted living facility (ALF) license, or a limited mental health (LMH), extended congregate care (ECC), or limited nursing services (LNS) license may obtain a license application package from the Agency AHCA Ccentral Ooffice.

(a) The completed application shall be signed, under oath, by an owner (or corporate officer if the owner is a corporation), the administrator, or an individual designated in writing by an owner or corporate officer, who is at least 18 years old., The application shall and include the following:

1. The Assisted Living Facilities (ALF) License Application, AHCA Form 3110-1008, January 2006 March 1999, and the Assisted Living Facility Licensure Application Addendum, AHCA Form 3110-1016, January 2006, which are is incorporated by reference and can be obtained from the Agency Central Office, with all requested information provided as specified in Section 400.411(3), F.S.

2. through 7. No change.

8. Documentation of a satisfactory fire safety firesafety inspection conducted by the local authority having jurisdiction over fire safety or by the State Fire Marshall.

9.  No change.

10. For each person specified in Section 400.4174(1), F.S.:

a. A signed Florida Abuse Hotline Information System Background Check, AHCA Form 3110-0003, July 1998, which is incorporated by reference;

a.b. A set of fingerprints obtained from the nearest available local law enforcement agency on the fingerprint card provided by the Aagency; and

b.c. A check or money order to cover the cost of screening.

11. In lieu of the requirements of subparagraph 10., the following may be substituted: proof of compliance with the Level 2 background screening requirements of Section 435.04, F.S., conducted within the last five (5) years pursuant to a facility or professional license requirement of the Agency AHCA or the Department of Health, a copy of the professional or facility license, and an affidavit of current compliance with Level 2 background screening standards. may be substituted;  Ffor owners, administrators, and financial officers of continuing care retirement communities, proof of compliance with the background screening requirements of Rule 4-193.060, F.A.C., conducted within the last five (5) years, plus signed AHCA Form 3110-0003, may be substituted.

12. through 14. No change.

(b) If the Agency Central Office delivers a letter notifying the applicant of apparent errors or omissions in the application, then the applicant must respond with the required information no later than twenty-one (21) days from the date of the Agency’s one omission letter.  If the required information is not received by the Agency within the twenty-one (21) day timeframe, the Agency shall deem the application incomplete and shall issue a notice of intent to deny the application.

(c)(b) An applicant for a limited mental health, extended congregate care, or limited nursing services license must concurrently apply for, or hold, a standard license and comply, in addition, with the applicable requirements of Rules 58A-5.029, 58A-5.030, and 58A-5.031, F.A.C., respectively. These specialty licenses A limited mental health, extended congregate care, or limited nursing license shall only be issued to a facility holding a standard license.

(d)(c) The application shall be submitted to the Agency AHCA Ccentral Ooffice and be accompanied by a license fee in the form of a check or money order payable to the State of Florida. The license fee shall be in accordance with Section 400.407, F.S.

1. through 3. No change.

(e)(d) Upon submission of all documentation required under this subsection and fees, and notification to the Aagency Field area Ooffice that the applicant is ready for survey, the agency Field area Ooffice shall conduct a survey of the facility in accordance with Section 400.428(3), F.S.

(2) CHANGE OF OWNERSHIP (CHOW).

(a) No change.

(b) Completed applications shall be filed with the Aagency by the transferee at least 60 days before the date of transfer of ownership as required by Section 400.412, F.S., and must include the information and fees required under subsection (1) of this rule. An application package for a change of ownership of a currently licensed facility is available from the Agency AHCA Ccentral Ooffice.

(c) through (d) No change.

(e) Failure to apply for a change of ownership of a licensed facility as required by Section 400.412, F.S., shall result in a fine set and levied by the Aagency pursuant to Section 400.419, F.S. This is also applicable to individual owners who incorporate and do not report the incorporation to the agency.

(f) No change.

(g) If applicable, the transferor shall comply with Section 408.831(2), F.S., prior to Agency approval of the change of ownership application.

(3) through (4) No change.

Specific Authority 400.407, 400.441 FS.  Law Implemented: 400.402, 400.404, 400.407, 400.408, 400.411, 400.412, 400.4174, 400.427, 400.4275, 400.441, 400.444, 400.4445, 400.447 FS.  History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.14, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.014, Amended 10-30-95, 4-20-98, 10-17-99,_________.

58A-5.015 License Renewal and Conditional Licenses.

(1) LICENSE RENEWAL.  Every two years, the Agency Central Office shall provide aApplications for license renewal shall be, either electronically or by mail, ed biennially by the AHCA central office to the licensees no less than 120 days prior to the expiration of the current license. Applications shall be postmarked or hand delivered to the Aagency a minimum of 90 days prior to the expiration date appearing on the currently held license. Failure to file a timely application shall result in a late fee charged to the facility as described in Section 400.417, F.S.

(a) All applicants for renewal of a license shall submit the following:

1. An Assisted Living Facilities (ALF) License Application, AHCA Form 3110-1008,  January 2006  March 1999 and the Assisted Living Facility Licensure Application Addendum, AHCA Form 3110-1016, January 2006, completed as required under Rule 58A-5.014.

(b) If the Agency Central Office delivers a letter notifying the applicant of apparent errors or omissions in the application, then the applicant must respond with the required information no later than twenty-one (21) days from the date of the Agency’s one omission letter.  If the required information is not received by the Agency within the twenty-one (21) day time frame, the Agency shall deem the application incomplete and shall issue a notice of intent to deny the application.

(c)(b) Applicants for renewal of a license shall not be required to provide proof of financial ability to operate unless the facility or any other facility owned or operated in whole or part by the same owner or business entity has demonstrated financial instability as described in Rule 58A-5.021, F.A.C.

(d)(c) Applicants for renewal of licenses shall remit license fees as required by Section 400.407, F.S., and Rule 58A-5.014, F.A.C. With respect to the fee per bed required for a standard license, the number of OSS recipients claimed shall be the average number per month residing in the facility during the previous license period. An additional per bed charge shall be added to the bed fee for facilities whose average number of OSS residents per month was less than the number of beds designated for OSS recipients during the previous license period.

(2) through (3) No change.

Specific Authority 400.441 FS. Law Implemented 400.402, 400.404, 400.407, 400.411, 400.414, 400.417, 400.4174, 400.427, 400.4275, 400.441, 400.447 FS.  History–New 10-17-99, Amended________.

58A-5.016 License Requirements.

(1) through (2) No change.

(3) A change in the use of space that increases or decreases a facility’s capacity shall not be made without prior approval from the Agency AHCA Ccentral Ooffice.  Approval shall be based on the compliance with the physical plant standards provided in Rule 58A-5.023, F.A.C., as well as documentation of compliance with applicable fire safety firesafety and sanitation requirements as referenced in Rule 58A-5.0161, F.A.C.

(4) A change in the use of space that involves converting an area to resident use an area, which has not previously been inspected for such use, shall not be made without prior approval from the Agency AHCA Field area Ooffice. Approval shall be based on the compliance with the physical plant standards provided in Rule 58A-5.023, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation standards as referenced in Rule 58A-5.0161, F.A.C.

(5) No change.

(6) A copy of the annual fire safety and sanitation inspections described in Rule 58A-5.0161, F.A.C., shall be submitted annually to the Agency Central Office.  The annual inspections shall be submitted no later than 30 calendar days after the inspections.  Failure to comply with this requirement may result in administrative action pursuant to Section 400.414, F.S., and Rule 58A-5.033, F.A.C.

Specific Authority 400.441 FS. Law Implemented: 400.407, 400.411, 400.412, 400.441, 400.444, 400.4445 FS. History–New 5-15-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.16, Amended 6-21-88, 9-30-92, Formerly 10A-5.016, Amended 10-30-95, 10-17-99,________.

58A-5.0181 Residency Criteria and Admission Procedures.

(1) ADMISSION CRITERIA. An individual must meet the following minimum criteria in order to be admitted to a facility holding a standard, limited nursing or limited mental health license.

(a) through (i) No change.

(j) Not have any stage 3 or 4 pressure sores.  A resident requiring care of a stage 2 pressure sore, may be admitted provided that:

1. through 2. No change.

3. If the resident's condition fails to improve within 30 days, as documented by a licensed nurse or physician, the resident shall be discharged from the facility.

(k) Not require any of the following nursing services:

1. Oral, or  nasopharyngeal, or tracheotomy suctioning;

2. through 3. No change.

4. Intermittent positive pressure breathing therapy; or

5. Skilled rehabilitative services as described in Rule 59G-4.290; or

5.6. Treatment of surgical incisions or wounds, unless the surgical incision or wound and the condition which caused it have been stabilized and a plan of care developed.

(l) No change.

(m) Not require skilled rehabilitative services as described in Rule 59G-4.290, F.A.C.

(n)(m) Have been determined by the facility administrator to be appropriate for admission to the facility by the facility administrator. The administrator shall base the his/her decision on:

1. through 2. No change.

3. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established under Section 400.441, F.S., and Rule Chapter 694A-40, F.A.C.

(o)(n) Resident admission criteria for facilities holding an extended congregate care license are described in Rule 58A-5.030, F.A.C.

(2) HEALTH ASSESSMENT.

(a) The medical examination report completed wWithin 60 days prior to the individual’s residents admission to a facility pursuant to Section 400.426(4), F.S. but no later than 30 days after admission, the individual shall be examined by a physician or advanced registered nurse practitioner who shall provide the administrator with a medical examination report, or a copy of the report, shall which addresses the following:

1. through 8. No change.

(b) Medical examinations completed after the admission of the resident to the facility must be completed within 30 days of the date of admission and conducted up to 30 days after the resident’s admission to the facility must be recorded on the Resident Health Assessment For Assisted Living Facilities (ALF), AHCA DOEA Form 1823, dated January 2006 March 1999, which is incorporated by reference. A faxed copy of the completed form is acceptable. A copy of AHCA DOEA Form 1823 may be obtained from the Agency Central Office or its website at http://ahca.myflorida.com DOEA Assisted Living Program.  Previous versions of this form completed up to six (6) months after (effective date of rule 10-17-99) are acceptable.

(c) Any information required by paragraph (a) that is not contained in the medical examination report conducted prior to the individual’s admission to the facility must be obtained by the administrator within 30 days after admission using AHCA Form 1823.

(d)(c) Medical examinations of residents placed by the department, by the Department of Children and Family Services, or by an agency under contract with either department must be conducted within 30 days before placement in the facility and recorded on AHCA DOEA Form 1823 as described in paragraph (b).

(d) Any information required by paragraph (a) that is not contained in the medical examination report conducted prior to the individual’s admission to the facility must be obtained by the administrator within 30 days after admission using DOEA Form 1823.

(e) through (g) No change.

(3) ADMISSION PACKAGE.

(a) The facility shall make available to potential residents a written statement or statements which includes the following information. A facility promotional brochure prepared by the facility or a copy of the facility resident contract form used by the facility which containings all of the required information shall meet this requirement:

1. through 10. No change.

11. A statement of the facility policy concerning Do Not Resuscitate Orders pursuant to Section 400.4255, F.S., and Advance Directives pursuant to Chapter 765, F.S.

1211. If the facility also has an extended congregate care program, the ECC program’s residency criteria;, and a deion of the additional personal, supportive, and nursing services provided by the program;, additional costs;, and any limitations, if any, on where ECC residents must reside based on the policies and procedures described in Rule 58A-5.030, F.A.C.; and

13.12. If the facility advertises that it provides special care for persons with Alzheimer’s disease or related disorders, a written deion of those special services as required under Section 400.4177, F.S.

(b) through (c) No change.

(4) CONTINUED RESIDENCY. Criteria for continued residency in a facility holding a standard, limited nursing services, or limited mental health license shall be the same as the criteria for admission, except as follows:

(a) No change.

(b) A resident requiring care of a stage 2 pressure sore, may be retained provided that:

1. through 2. No change.

3. If the resident's condition fails to improve within 30 days, as documented by a licensed nurse or physician, the resident shall be discharged from the facility.

(c) through (e) No change.

(5) DISCHARGE. If the resident no longer meets the criteria for continued residency, or the facility is unable to meet the resident's needs, as determined by the facility administrator or health care provider, the resident shall be discharged in accordance with Sections 400.426(8) and 400.428(1), F.S.

Specific Authority 400.407, 400.426, 400.441, FS.  Law Implemented 400.402, 400.407, 400.4075, 400.426, 400.441, FS.  History–New 9-17-84 Formerly 10A-5.181, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0181, Amended 10-30-95, 6-2-96, 10-17-99,________.

58A-5.0182 Resident Care Standards.

An assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility.

(1) SUPERVISION. Facilities shall offer personal supervision, as appropriate for each resident, including the following:

(a) through (d) No change.

(e) A written record, updated as needed, of any significant changes as defined in subsection 58A-5.0131(33), F.A.C., in the resident's normal appearance or state of health, any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services.

(2) SOCIAL AND LEISURE ACTIVITIES. Residents shall be encouraged to participate in social, recreational, educational and other activities within the facility and the community.

(a) through (b) No change.

(c) Scheduled activities shall be available at least six (6) 5 days a week for a total of not less than twelve (12) 10 hours per week.  Watching television shall not be considered an activity for the purpose of meeting the twelve (12) 10 hours per week of scheduled activities unless the television program is a special one-time event of special interest to residents of the facility.  A facility whose residents choose to attend day programs conducted at adult day care centers, senior centers, mental health centers, or other day programs may count those attendance hours towards the required twelve (12) hours per week of scheduled activities.  An activities calendar shall be posted in common areas where residents normally congregate.

(d) If residents assist in planning a special activity such as an outing, seasonal festivity, or an excursion, up to three (3) hours may be counted toward the required activity time.

(3) through (4) No change.

(5) NURSING SERVICES.

(a) Pursuant to Section 400.4255, F.S., the facility may employ or contract with a nurse to:

1. No change.

2. Manage weekly pill-organizers and administer medications as described under Rule 58A-5.0185, F.A.C.;

3. through 4. No change.

(b) No change.

(6) RESIDENT RIGHTS AND FACILITY PROCEDURES.

(a) A copy of the Resident Bill of Rights as described proscribed in Section 400.428, F.S., or summary provided by the Llong-Tterm Ccare Oombudsman Ccouncil shall be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to Rule 58A-5.0181, F.A.C.

(b) No change.

(c) The address and telephone number for lodging complaints against a facility or facility staff shall be posted in full view in a common area accessible to all residents. The addresses and telephone numbers are: with the Ddistrict Llong-Tterm Ccare Oombudsman Ccouncil, 1 through [phone];, the Advocacy Center for Persons with Disabilities, 1(800)342-0823;, the Florida Local Advocacy Council, 1(800)342-0825; Human Rights Advocacy Committee and the Aagency Consumer Hotline [phone] area office, shall be posted in full view in a common area accessible to all residents.

(d) through (f) No change.

(g) The facility shall provide residents with convenient access to a telephone to facilitate the resident's right to unrestricted and private communication, pursuant to Section 400.428 (1)(d), F.S. communicate on a private basis. The facility shall not prohibit unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there shall be, at a minimum, an accessible telephone on in each floor of each building where residents reside.

(h) No change.

(7) through (8) No change.

Specific Authority 400.402, 400.441 FS.  Law Implemented 400.402, 400.4255, 400.4256, 400.426, 400.428, 400.441 FS.  History–New 9-17-84, Formerly 10A-5.182, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0182, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99,_________.

58A-5.0185 Medication Practices.

Pursuant to Sections 400.4255 and 400.4256, F.S., and this rule, facilities holding a standard, limited mental health, extended congregate care, or limited nursing services license may assist with the self-administration or administration of medications to residents in a facility. A resident may not be compelled to take medications but may be counseled in accordance with this rule.

(1) SELF ADMINISTERED MEDICATIONS.

(a) No change.

(b) If facility staff note deviations which could reasonably be attributed to the improper self-administration of medication, staff shall consult with the resident concerning any problems the resident may be experiencing with the medications;, the need to notify the resident’s health care provider, or to permit the facility to aid the resident through the use of a pill organizer, provide assistance with self-administration of medications, or administer medications if such services are offered by the facility. The facility shall contact the resident’s health care provider when observable health care changes occur that may be attributed to the resident’s medications. The facility shall document such contacts in the resident’s record.

(2) WEEKLY PILL ORGANIZERS.

(a) A nurse may manage a weekly pill organizer for residents who self-administer. A “weekly pill organizer” means a container which is designed to hold solid doses of medication and is divided according to day and time increments not to exceed 7 days.

1. The nurse shall manage the pill organizer in the following manner:

a. Obtain the labeled medication container from the storage area or the resident;

b. Transfer the medication from the original container into a pill organizer, labeled with the resident’s name, according to the day and time increments as prescribed; and

c. Return the medication container to the storage area or resident.

2. The nurse is responsible for instructing the resident with respect to the proper use of the pill organizer.

(b) A resident who self-administers medications may use a pill organizer. 

(c) A nurse may manage a pill organizer to be used only by residents who self-administer medications. The nurse is responsible for instructing the resident in the proper use of the pill organizer.  The nurse shall manage the pill organizer in the following manner:

1. Obtain the labeled medication container from the storage area or the resident;

2. Transfer the medication from the original container into a pill organizer, labeled with the resident’s name, according to the day and time increments as prescribed;

3. Return the medication container to the storage area or resident; and

4. Document the date and time the pill organizer was filled in the resident’s record.

(d)(b) If there is a determination that the resident is not taking medications as prescribed after the medicinal benefits are explained, it shall be noted in the resident’s record and the facility shall consult with the resident concerning providing assistance with self-administration, or the

administration of medications if such services are offered by the facility. The facility shall

contact the resident’s health care provider regarding questions, concerns, or observations relating

to the resident’s medications. Such communication shall be documented in the resident’s record.

(3) ASSISTANCE WITH SELF-ADMINISTRATION.

(a) No change.

(b) Assistance with self-administration of medication includes verbally prompting a resident to take medications as prescribed, retrieving and opening a properly labeled medication container, and providing assistance as specified in Section 400.4256 (3), F.S. In order to facilitate assistance with self-administration, staff may prepare and make available such items as water, juice, cups, and spoons, etc., as needed by residents.  Staff may also return unused doses to the medication container.  Medication, which appears to have been contaminated, shall not be returned to the container.

(c) No change.

(d) When a resident who receives assistance with medication is away from the facility and from facility staff, the following options are available to enable the resident to take medication as prescribed:

1. through 2. No change.

3. The medication may be transferred to a weekly pill organizer pursuant to the requirements of subsection (2), and given to the resident, or a friend, or family member upon leaving the facility, with this fact noted in the resident’s medication record; or

4. No change.

(e) Pursuant to Section 400.4256(4)(h), F.S., the term “competent resident” means that the resident is cognizant of when a medication is required and understands the purpose for taking the medication.

(f) Pursuant to Section 400.4256(4)(i), F.S., the terms “judgment” and “discretion” mean interpreting vital signs and evaluating or assessing a resident’s condition.

(4) MEDICATION ADMINISTRATION.

(a) No change.

(b) Unusual reactions or a significant change in the resident’s health or behavior shall be documented in the resident’s record and reported immediately to the resident’s health care provider. The contact with the health care provider shall also be documented in the resident’s record.

(c) No change.

(d) A facility which performs clinical laboratory tests for residents, including blood glucose testing, must be in compliance with the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) and Part I of Chapter 483, F.S. A valid copy of the State Clinical Laboratory License and the CLIA Certificate A copy of the state license or a Certificate of Exemption must be maintained in the facility.  A state license or CLIA certificate of exemption is not required if the residents performs the test themselves himself/herself or if a third party assist residents in performing the test the test is performed by a third party. The facility is not required to maintain a State Clinical Laboratory License or a CLIA Certificate if facility staff assist residents in performing clinical laboratory testing with the residents’ own equipment.  Information about the State Clinical Laboratory License and CLIA Certificate laboratory licensing is available from the Clinical Laboratory Licensure Unit, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 32, Tallahassee, FL 32308; telephone [phone].

(5) MEDICATION RECORDS.

(a) For residents who use a weekly pill organizer managed under subsection (2), the facility shall keep either the original labeled medication container; or a medication listing with the preion number, the name and address of the issuing pharmacy, the health care provider’s name, the resident’s name, the date dispensed, the name and strength of the drug, and the directions for use.

(b) For residents who receive assistance with self‑administration or medication administration, Tthe facility shall maintain a daily up-to-date, medication observation record (MOR) for each resident who receives assistance with self- administration of medications or medication administration.  A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider’s telephone number; the name, strength, and directions for use of each medication prescribed, its strength, and directions for use; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered.

(c) No change.

(6) MEDICATION STORAGE AND DISPOSAL.

(a) In order to accommodate the needs and preferences of residents and to encourage residents to remain as independent as possible, a residents may keep their his/her medications, both preion and over-the-counter, in their possession on his/her person both on or off the facility premises; or in their his/her rooms or apartments, which must be kept locked when the residents are is absent, unless the medication is in a secure place within the rooms or apartments; or in some other secure place which is out of sight of other residents. However, both preion and over-the-counter medications for a residents shall be centrally stored if:

1. No change.

2. The resident requests central storage.  The facility shall maintain a list of all medications being stored pursuant to such a request;

3. through 6. No change.

(b) through (f) No change.

(7) MEDICATION LABELING AND ORDERS.

(a) No preion drug shall be kept or administered by the facility, including assistance with self-administration of medication, unless it is properly labeled and dispensed in accordance with Chapters 465 and 499, F.S., and Rule 64B16-28.108, F.A.C. If a customized patient medication package is prepared for a resident, and separated into individual medicinal drug containers, then the following information must be recorded on each individual container:

1. The resident’s name; and

2. Identification of each medicinal drug product in the container.

(b) Except with respect to the use of weekly pill organizers as described in subsection (2), no person other than a pharmacist may transfer medications from one storage container to another.

(c) through (e) No change.

(f) The facility shall make every reasonable effort to ensure that preions for residents who receive assistance with self-administration of medication or medication administration are filled or refilled in a timely manner.

(g) Pursuant to Section 465.0276(5), F.S., and Rule 64F-12.006, F.A.C., sample or complimentary preion drugs that are dispensed by a health care provider, must be kept in their original manufacturer’s packaging, which shall also include the practitioner’s name, the resident’s name for whom they were dispensed, and the date they were dispensed.  If the sample or complimentary preion drugs are not dispensed in the manufacturer’s labeled package, they shall be kept in a container that bears a label containing the following:

1. Practitioner’s name;

2. Resident’s name;

3. Date dispensed;

4. Name and strength of the drug;

5.  Directions for use; and

6. Expiration date.

(h) Pursuant to Section 465.0276(2)(c), F.S., before dispensing any sample or complimentary preion drug, the resident’s health care provider shall provide the resident with a written preion, or a fax copy of such order.

(8) No change.

Specific Authority 400.4256, 400.441 FS.  Law Implemented 400.4255, 400.4256, 400.441 FS.  History–New 10-17-99, Amended__________.

58A-5.019 Staffing Standards.

(1) ADMINISTRATORS. Every facility shall be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff and the provision of adequate care to all residents as required by Part III of Chapter 400, F.S., and this rule chapter.

(a) through (b) No change.

(c) Pursuant to Section 400.4176, F.S., facility owners shall notify both the Agency AHCA Field area Ooffice and Agency AHCA Ccentral Ooffice within ten (10) days of a change in a facility administrator on the Notification of Change of Administrator, using AHCA Form 3180-1006, January 2006 March 1999, which is incorporated by reference and may be obtained from the Agency Central Office. The Aagency AHCA Central Office shall conduct a background screening check on the new administrator in accordance with Section 400.4174, F.S., and Rule 58A-5.014, F.A.C.

(2) No change.

(3) BACKGROUND SCREENING.

(a) All staff, who are hired on or after October 1, 1998, to provide personal services to residents, must be screened in accordance with Section 400.4174, F.S., and meet the screening standards of Section 435.03, F.S. A packet containing background screening forms and instructions may be obtained from the Agency AHCA Background Screening Unit, 2727 Mahan Drive, Tallahassee, FL 32308; telephone [phone]. Within ten (10) days of an the individual’s employee’s employment starting work, the facility shall submit the following to the Agency AHCA Background Screening Unit central office:

1. A completed Level 1 Criminal History Request Check, AHCA Form 3110-0002, July 2005 June 1998, which is incorporated by reference and may be obtained in the screening packet referenced in paragraph (3)(a) of this rule; and

2. A signed Florida Abuse Hotline Information System Background Check, AHCA Form 3110-0003, July 1998; and

2.3. A check to cover the cost of screening.

(b) No change.

(c) Staff with the following documentation in their personnel records shall be considered to have met the required screening requirement:

1. A copy of their current professional license which required Level 1 background screening as a condition of licensing, proof that a criminal history and abuse registry screening has check have been conducted, and an affidavit of current compliance with Section 435.03, F.S.;

2. Proof of continuous employment in an occupation which requires Level 1 screening without a break in employment that exceeds 180 days, and proof that a criminal history and abuse registry screening check has been conducted within the previous two (2) years; or

3. No change.

(4) STAFFING STANDARDS

(a) through (c) No change.

(d) The facility shall be required to provide staff immediately when the Aagency determines that the requirements of paragraph (a) are not met.  The facility shall also be required to immediately increase staff above the minimum levels established in paragraph (a) if the Aagency determines that adequate supervision and care are not being provided to residents, resident care standards described in Rule 58A-5.0182, F.A.C., are not being met, or that the facility is failing to meet the terms of residents’ contracts.  The Aagency shall consult with the facility administrator and residents regarding any determination that additional staff is required.

1. through 2. No change.

3. Based on recommendations of the local fire safety authority with jurisdiction over fireafety, the Aagency may require additional staff when the facility fails to meet the fire safety firesafety standards described in, Section 400.441, F.S., and Rule Chapter 694A-40, F.A.C., until such time as the local fire safety firesafety authority informs the Aagency that fire safety firesafety requirements are being met.

(e) through (f) No change.

Specific Authority 400.441, 400.452, 400.4275 FS. Law Implemented 400.402, 400.404, 400.4174, 400.4176, 400.419, 400.424, 400.4255, 400.426, 400.4275, 400.441, 400.452 FS.

History–New 5-14-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.19, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.019, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99, ______.

58A-5.0191 Staff Training Requirements and Competency Test.

(1) through(8) No change.

(9) ALZHEIMER’S DISEASE AND RELATED DISORDERS (“ADRD”) TRAINING REQUIREMENTS.  Facilities which advertise that they provide special care for persons with ADRD, or who maintain secured areas as described in Rule 58A-5.023, F.A.C., must ensure that facility staff receive the following training:

(a) through (e) No change.

(f) Facility staff who have only incidental contact with residents with ADRD must receive general written information provided by the facility on interacting with such residents, as required under Section 400.4178, F.S., within three (3) months of employment.  Facility staff who are already employed prior to April 20, 1998 shall have 6 months from that date to receive this information.  “Incidental contact” means all staff who neither provide direct care nor are in regular contact with such residents.

(g) through (h) No change.

Specific Authority 400.407, 400.4178, 400.441, 400.452 FS.  Law Implemented 400.407, 400.4075, 400.4178, 400.441, 400.452 FS. History–New 9-30-02, Formerly 10A-5.0191, Amended 10-30-95, 6-2-96, 4-20-98, 11-2,98, 10-17-99, 7-5-05,_______.

58A-5.023 Physical Plant Standards.

(1) through (3) No change.

(4) BEDROOMS. Residents shall be given the option of choosing their own roommate or roommates if possible.

(a) through (f) No change.

(g) The facility shall maintain master or duplicate keys to resident bedrooms to be used in the event of an emergency.

(5) BATHROOMS.

(a) No change.

(b) Each bathroom shall have a door in working order to ensure assure privacy. The entry door to bathrooms with a single toilet shall have a lock that the resident can operate which is operable from the inside by the resident with no key needed. A non-locking door shall be permitted if the resident’s safety would otherwise be jeopardized. The facility shall maintain master or duplicate keys to resident bathrooms to be used in the event of an emergency.

(c) through (e) No change.

(6) through (8) No change.

Specific Authority 400.441 FS.  Law Implemented: 400.427, 400.441, 404.056 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.23, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.023, Amended 10-30-95, 6-2-96, 10-17-99,_________.

58A-5.024 Records.

The facility shall maintain the following written records in a form, place and system ordinarily employed in good business practice and accessible to Department of Elder Affairs department and Aagency staff.

(1) FACILITY RECORDS.  Facility records include:

(a) through (l) No change.

(m) All fire safety fire safety inspection reports issued by the local authority or the State Fire Marshall pursuant to Section 400.441, F.S., and Rule Chapter 694A-40, F.A.C., issued within the last two (2) years.

(n) through (p) No change.

(2) No change.

(3) RESIDENT RECORDS. Resident records shall be maintained on the premises and include:

(a) through (g) NO CHANGE.

(h) For facilities which manage a weekly pill organizer, assist with self-administration of medications or administer medications for a resident, the required medication records maintained pursuant to Rule 58A-5.0185, F.A.C.

(i) through (q) No change.

(4) No change.

Specific Authority 400.441, 400.4275 FS.  Law Implemented 400.407, 400.4075, 400.424, 400.427, 400.4275, 400.428, 400.435, 400.441 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.24, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.024, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99,________.

58A-5.0241 Adverse Incident Report.

(1) INITIAL ADVERSE INCIDENT REPORT. The preliminary adverse incident report required by Section 400.423(3), F.S., must be submitted within one (1) business day after the incident on AHCA Form 3180-1024, Assisted Living Facility Initial Adverse Incident Report through 1 Day, January 2006, and incorporated by reference.  The form shall be submitted via electronic mail to [e-mail]; on-line at www.fdhc.state.fl.us/reporting/index.shtml; by facsimile to [phone]; or by U.S. Mail to AHCA, Facility Data Analysis Unit, 2727 Mahan Drive, Mail Stop 47, Tallahassee, Florida, 32308, telephone [phone].  AHCA Form 3180-1024 is available from the Facility Data Analysis Unit at the address stated above.  The Initial Adverse Incident Report is in addition to, and does not replace, other reporting requirements specified in Florida Statutes.  Each facility licensed under Part III of Chapter 400, F.S., shall submit a preliminary report of each adverse incident by completing an Assisted Living Facility Initial Adverse Incident Report through 1 Day, DOEA Form 3180-1024, revised dated October 2001, which is incorporated by reference, available through the Agency for Health Care Administration at the address listed below, and mailing the form to the Agency for Health Care Administration, Facility Data Analysis Unit, 2727 Mahan Dr., MS 47, Tallahassee, Florida 32308, telephone [phone]. Each facility must comply with report timeframe and transmission requirements specified in Section 400.423(3), F.S. The Initial Adverse Incident Report is in addition to and does not replace other reporting requirements specified in Florida Statutes. If an adverse incident has not occurred within the facility, no report is required.

(2) FULL ADVERSE INCIDENT REPORT. For each adverse incident reported under subsection (1) above, the facility shall submit a full report within fifteen (15) days of the incident.  The full report shall be submitted on AHCA Form 3180-1025, Assisted Living Facility Full Adverse Incident Report through 15 Day, dated January 2006, and incorporated by reference.  The methods for obtaining and submitting the form are set forth in subsection (1) of this rule.  Each facility that has submitted a preliminary report by completing DOEA Form 3180-1024 shall submit a full report of each adverse incident by completing an Assisted Living Facility Complete Adverse Incident Report through 15 Day, DOEA Form 3180-1025, dated October 2001, which is incorporated by reference, available through the Agency for Health Care Administration as indicated in subsection (1) above, and mailing the form to the Agency for Health Care Administration, Facility Data Analysis Unit, at the address and telephone number indicated in subsection (1) above. Each facility must comply with report time frame and transmission requirements specified in Section 400.423(4), F.S.

Specific Authority 400.423 FS. Law Implemented 400.423 FS. History–New 1-9-02, Amended_________.

58A-5.025 Resident Contracts.

(1) Pursuant to Section 400.424, F.S., each resident or the resident’s legal representative, shall, prior to or at the time of admission, execute a contract with the facility which contains the following provisions:

(a) No change.

(b) The basic daily, weekly, or monthly rate. 

(c) through (j) No change.

(2) through (3) No change.

Specific Authority 400.424, 400.427, 400.441 FS. Law Implemented 440.424, 400.427, 400.441 FS. History–New 10-17-99, Amended_________.

58A-5.026 Emergency Management.

(1) through (4) No change.

(5) EMERGENCY SHELTER. In the event a state of emergency has been declared and the facility is not required to evacuate the premises, the facility may provide emergency shelter above the facility’s licensed capacity provided the following conditions are met:

(a) through (b) No change.

(c) The facility reports the over capacity and conditions causing it to the Aagency Field area Ooffice within forty-eight (48) hours or as soon as practical. As an alternative, the facility may report to the Agency Central Office AHCA  Assisted Living Unit in Tallahassee at [phone]. If the facility will continue to be over capacity after the declared emergency ends, the Aagency shall review requests for excess capacity and may approve the excess capacity on a case-by-case basis.

(d) No change.

Specific Authority 400.441 FS. Law Implemented 400.441 FS. History–New 10-17-99, Amended________.

58A-5.029 Limited Mental Health.

(1) LICENSE APPLICATION.

(a) Any facility intending to admit three or more mental health residents must complete a Limited Mental Health License Application, AHCA Form 3180-1023, September 1998, which is incorporated by reference, available from AHCA, and obtain a limited mental health license from the Aagency in accordance with Rule 58A-5.014, F.A.C., and Section 400.4075, F.S., prior to accepting the third mental health resident. The application shall be signed by the applicant, notarized, and include a statement certifying that specified staff have completed or will complete the limited mental health training course described under Rule 58A-5.0191, F.A.C.

(b) No change.

(2) RECORDS.

(a) through (b) No change.

(c) Resident records for mental health residents in a facility with a limited mental health license must include the following:

1. through 2. No change.

3. A Community Living Support Plan.

a. Each mental health resident and the resident’s mental health case manager shall, in consultation with the facility administrator, prepare a plan within 30 days of the resident’s admission to the facility or within 30 days after receiving the appropriate placement assessment under paragraph (c), whichever is later, which:

(i) through (iv) No change.

(v) Includes a deion of other services to be provided or arranged by the facility;

(vi)(v) Includes a list of factors pertinent to the care, safety, and welfare of the mental health resident and a deion of the signs and symptoms particular to the resident that indicate the immediate need for professional mental health services;

(vii)(vi) Is in writing and signed by the mental health resident, the resident’s mental health case manager, and the ALF administrator or manager designee and a copy placed in the resident’s file. If the resident refuses to sign the plan, the resident’s mental health case manager shall add a statement that the resident was asked but refused to sign the plan;

(viii)(vii) Is updated at least annually;

(ix)(viii) May include the Cooperative Agreement described in subparagraph 4. If included, the mental health care provider must also sign the plan; and

(x)(ix) Must be available for inspection to those who have a lawful basis for reviewing the document.

b. No change.

4. No change.

(3) No change.

Specific Authority 400.441 FS.  Law Implemented 394.4574, 400.402, 400.4075, 400.426, 400.441, 409.912 FS. History–New 8-15-90, Amended 9-30-92, Formerly 10A-5.029, Repromulgated 10-30-95, Amended 6-2-96, 11-2-98,_________.

58A-5.030 Extended Congregate Care Services.

(1) through (2) No change.

(3) PHYSICAL SITE REQUIREMENTS: Each extended congregate care facility shall provide a homelike physical environment which promotes resident privacy and independence including:

(a) No change.

(b) A bathroom, with a toilet, sink, and bathtub or shower, which is shared by a maximum of   four (4) other residents for a maximum ratio of four (4) residents to one (1) bathroom.  A centrally located hydro-massage bathtub may substitute for the bathtub or shower in two of the bathrooms.  The entry door to the bathroom shall have a lock which is operable from the inside by the resident with no key needed.  The resident’s service plan may allow for a non-locking bathroom door if the resident’s safety would otherwise be jeopardized.

1. A centrally located hydro-massage bathtub may substitute for the bathtub or shower and be considered equivalent to two bathrooms, increasing the resident to bathroom ratio from  four (4) to one (1) to eight (8) to one (1). The substitution of a centrally located hydro-massage bathtub for a bathtub or shower that increases the resident to bathroom ratio above four (4) to one (1) may occur only once in a facility. The one time substitution of a centrally located hydro-massage bathtub does not preclude the installation of multiple hydro-massage bathtubs in the facility. The limitation applies only to the one-time reduction in the total number of bathrooms in the facility.

2. The entry door to the bathroom shall have a lock that the resident can operate from the inside with no key needed.  The resident’s service plan may allow for a non-locking bathroom door if the resident’s safety would otherwise be jeopardized.

(4) through (10) No change.

Specific Authority: 400.407, 400.441 FS. Law Implemented 400.402, 400.407, 400.426, 400.428, 400.441 FS. History–New 9-30-92, Formerly 10A-5.030, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99,_________.

58A-5.031 Limited Nursing Services.

Any facility intending to provide limited nursing services as described in subsection (1) must meet the license requirements specified in Section 400.407, F.S., and obtain a license from the Aagency in accordance with Rule 58A-5.014, F.A.C.

(1) NURSING SERVICES. A facility with a limited nursing license may provide the following nursing services in addition to any nursing service permitted under a standard license pursuant to Section 400.4255, F.S.

(a) through (m) No change.

(n) Assisting, applying, caring for and monitoring the application of anti-embolism stockings or hosiery as prescribed by the health care provider and in accordance with the manufacturers’ guidelines.

(o) Administration and regulation of portable oxygen.

(p) Applying, caring for and monitoring a transcutaneous electric nerve stimulator (TENS).

(q) Catheter, colostomy, ileostomy care and maintenance.

(2) through (3) No change.

Specific Authority 400.402, 400.441 FS.  Law Implemented 400.402, 400.407, 400.4255, 400.426, 400.441 FS.  History–New 9-30-92, Formerly 10A-5.031, Amended 10-30-95, 10-17-99,______.

58A-5.033 Administrative Enforcement.

Facility staff shall cooperate with Aagency personnel during surveys, complaint investigations, monitoring visits, implementation of correction plans, license application and renewal procedures and other activities necessary to ensure compliance with Part III of Chapter 400, F.S., and this rule chapter.

(1) through (2) No change.

(3) SURVEY DEFICIENCY.

(a) Prior to or in conjunction with a notice of violation issued pursuant to Section 400.419 and Chapter 120, F.S., the Aagency shall issue a statement of deficiency for Class I, II, III, and IV and unclassified violations which are observed by Aagency personnel during any inspection of the facility. The deficiency statement shall be issued within ten (10) working days of the Aagency’s inspection and shall include:

1. through 5. No change.

(b) through (c) No change.

(4) No change.

(5) ADMINISTRATIVE SANCTIONS. Administrative fines shall be imposed for class I and class II violations, or class II, III, or IV violations which are not corrected within the time frame set by the Aagency, and for repeat class II or III violations, as set forth in Section 400.419, F.S.

(a) The Agency shall notify facilities of the imposition of sanctions, their right to appeal the sanctions, the remedies available, and the time limit for requesting such remedies as provided under Chapter 120. F.S., and Part II of Chapter 59-1, F.A.C. The agency shall impose a fine for unclassified violations which do not meet the criteria for either a Class I, II, III, or IV violation as provided under Section 400.419, F.S., but which are not trivial or are uncorrected. Unclassified violations include, but are not limited to, the following violations:

1. Exceeding licensed capacity except under emergency circumstances as permitted under Rule 58A-5.026, F.A.C.;

2. Providing services beyond the scope of the license;

3. Violation of a moratorium imposed pursuant to this rule; or

4. A prohibited solicitation by an agent, employee, owner, or representative of the facility as provided in Section 400.42, F.S.

(b) No change.

(c) Facilities shall be notified by the agency of the imposition of sanctions, their right to appeal the imposition of sanctions, the remedies available, and the time limit for requesting such remedies as provided under Chapter 120, F.S., and Part II of Chapter 59-1, F.A.C.

(6) MORATORIUMS.

(a) No change.

(b) The appropriate Agency Field Office shall notify the facility via telephone and written notification on the same day that a moratorium is being placed on admissions into the facility. The facility shall be notified of the placing of a moratorium by a telephone call from the appropriate agency area office. The effective date of the moratorium shall be the date the facility receives a verbal and written notification is received by the facility from the Field area Ooffice.  The notice shall and which contains the following information:

1. through 3. No change.

4. Directions to contact the appropriate Field area Ooffice when the conditions have been corrected so that an appraisal survey can be conducted; and

5. No change.

(c) through (e) No change.

(7) No change.

Specific Authority 400.415, 400.423, 400.441, 400.442 FS.  Law Implemented 400.407, 400.408, 400.411, 400.412, 400.414, 400.415, 400.417, 400.419, 400.42, 400.423, 400.427, 400.428, 400.431, 400.434, 400.441, 400.442 FS.  History–New 9-30-92, Formerly 10A-5.033, Amended 10-30-95, 10-17-99, 1-9-02,_________.