Definitions, Licensure Procedure, Fees and Exemptions, Classification of Deficiencies, Responsibilities for Operation, Fiscal Standards, Admission Policies and Requirements, Personnel Standards, Training, Habilitation, Active Treatment Professional, ...
AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing
RULE NOS.:RULE TITLES:
59A-26.001Definitions
59A-26.002Licensure Procedure, Fees and Exemptions
59A-26.003Classification of Deficiencies
59A-26.004Responsibilities for Operation
59A-26.005Fiscal Standards
59A-26.006Admission Policies and Requirements
59A-26.007Personnel Standards
59A-26.008Training, Habilitation, Active Treatment Professional, and Special Programs and Services
59A-26.009Dietary Services
59A-26.010Dental Services
59A-26.011Psychological Services
59A-26.012Drugs and Pharmaceutical Services
59A-26.013Administration of Medications to ICF/DD Residents by Unlicensed Medication Assistants
59A-26.014Training and Validation Required for Unlicensed Medication Assistants
59A-26.015Plant Maintenance and Housekeeping
59A-26.016Fire Protection, Life Safety, Systems Failure and External Emergency Communication
59A-26.017Plans Submission and Fees Required
59A-26.018Physical Plant Codes and Standards for ICF/DD
59A-26.019Construction and Physical Environment Standards
59A-26.020Disaster Preparedness
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 40 No. 247, December 23, 2014 issue of the Florida Administrative Register.
59A-26.001 Definitions.
(1) Active Treatment – Active treatment is defined in Section 400.960, F.S. Active treatment includes aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. Active treatment does not include services to maintain generally independent clients who are able to function with little supervision or in the absence of a continuous active treatment program.”
(1)(2) Administrator – The person who is responsible for the overall management of an Intermediate Care Facilities for the Developmentally Disabled (hereinafter referred to as ICF/DD) licensed under this part and certified under 42 CFR 483 Subpart I. The Administrator must meet the following criteria:
(a) Be a Qualified Developmental Disabilities Professional (QDDP); or
(b) Be a licensed nursing home administrator; or
(c) Have a Bachelor’s degree in a human services field and at least one year of experience working with persons with developmental disabilities or related conditions; or
(d) If the individual does not have a Bachelor’s degree in a human services field, Have five years of experience working with persons with developmental disabilities or related conditions is sufficient. This requirement is for administrators who become effective after the date of this Rule.
(2)(3) No change.
(4) Age Appropriate – Services, programming, equipment and supplies that are appropriate for persons who do not have a developmental disability and who are of approximately the same chronological age as the client.
(3)(5) No change.
(6) Chemical Restraint – A chemical restraint means a medication used to control the person’s behavior or to restrict his or her freedom of movement.
(7) Client – Any person determined by the Agency for Persons with Disabilities to be eligible for developmental services.
(8) through (12) are renumbered to (4) through (8) No change.
(13) General Supervision – Means the responsible supervision of supportive personnel by a licensed practitioner who need not be present when such procedures are performed, but is available and who assumes legal liability.
(14) through (16) are renumbered to (9) through (11) No change.
(12)(17) Level of Care – The type of care required by a Medicaid applicant or recipient based on medical and related needs as defined by the criteria established in Rule Chapter 65B-38 59G-4.170, F.A.C.
(18) through (23) are renumbered to (13) through (19) No change.
(24) Physical Restraint – A physical restraint as defined in Section 400.960(7)(a), F.S. This includes but not limited to, a half-bed rail, a full-bed rail, a geriatric chair, and a posey restraint. The term “physical restraint” shall also include any device which was not specifically manufactured as a restraint but which has been altered, arranged, or otherwise use for this purpose. The term shall not include bandage material used for the purpose of binding a wound or injury.
(25) through (28) are renumbered to (20) through (23) No change.
(24)(29) Qualified Intellectual Disabilities Professional (QIDP) Qualified Developmental Disabilities Professional (QDDP) – A person who meets the requirements for a QIDP QDDP as required by 42 C.F.R. Part 483, Subpart I, Ssection 483.430, F.S.
(25)(30) No change.
(26)(31) No change.
(32) Seclusion – Seclusion is defined in accordance with Section 400.960(8), F.S. In addition to the definition, when a person is involuntarily confined in a room or a restricted space and is prevented from leaving, or reasonably believes that he or she will be prevented from leaving, by means that include, but are not limited to:
(a) Manually, mechanically, or electronically locked doors;
(b) One-way doors, which when closed or unlocked, cannot be opened from the inside;
(c) Physical intervention of staff; or
(d) Coercive measures, such as the threat of restraint or sanctions, or the loss of privileges that the client would otherwise have.
(33) Self-Mobile – The ability to use a walker, cane, wheelchair or other mobility device independently without human assistance, including the ability to transfer into and out of the mobility device without human assistance.
(34) Severe Maladaptive Behavior – Actions of an individual absent environmental, behavioral, physical, or chemical intervention, result in or have the potential to damage the individual or others. Such actions require medical attention or occur with sufficient frequency, magnitude, or duration that a life-threatening situation might result.
(35) Shared Facilities and Services – Those central services or facilities such as food preparation, maintenance, laundry and management that are shared by living units within a facility or with other facilities, including day treatment programs.
(27)(36) No change.
Rulemaking Authority 400.967, 400.9685 FS. Law Implemented 400.967, 400.9685 FS. History–New________.
59A-26.002 Licensure Procedure, Fees and Exemptions.
(1) through (4) No change.
(5) In addition to the provisions of Chapter 400, Part VIII, Chapter 408, Part II, Chapter 409, F.S. and Rule Chapter 59G-4, F.A.C., a license may be suspended, revoked or denied in any case where the Agency finds that there has been substantial failure to comply with certification or re-certification requirements as a Medicaid.
Rulemaking Authority 400.967, 408.819 FS. Law Implemented 400.962, 400.965, 400.967, 408.804, 408.805, 408.806, 408.807, 408.809, 408.810 408.811, FS. History–New________.
59A-26.003 Classification of Deficiencies.
(1) Violations of Chapter 400, Part VIII, and Chapter 408, Part II, F.S., shall be classified according to the nature of the violation and the gravity of its probable effect on clients as required in Section 408.813(2), F.S. The scope of a violation may be cited as an isolated, patterned, or widespread deficiency. An isolated deficiency is a deficiency affecting one or a very limited number of clients, or involving one or a very limited number of staff, or a situation that occurred only occasionally or in a very limited number of locations. A patterned deficiency is a deficiency in which more than a very limited number of clients are affected, or more than a very limited number of staff are involved, or the situation has occurred in several locations, or the same client or clients have been affected by repeated occurrences of the same deficient practice but the effect of the deficient practice is not found to be pervasive throughout the provider. A widespread deficiency is a deficiency in which the problems causing the deficiency are pervasive in the provider or represent systemic failure that has affected or has the potential to affect a large portion of the provider’s clients. The definitions of classifications in this subsection control over conflicting definitions in authorizing statutes. This subsection does not affect the legislative determination of the amount of a fine imposed under authorizing statutes. Violations shall be classified on the written notice as follows:
(1)(a) through (1)(d) no change
Rulemaking Authority 400.967 408.813, 408.819 FS. Law Implemented 400.967(3), 408.813, 408.815 FS. History–New________.
59A-26.004 Responsibilities for Operation.
(1) The licensee must be in compliance with all conditions and standards in Title 42, CFR, Subpart I, sections 483.410 through 483.480, Conditions of Participation for Intermediate Care Facilities for Persons with Mental Retardation, June 3, 1988, as incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX and http://www.gpoaccess.gov/cfr/index.html. The licensee must ensure compliance with state regulations in Chapter 400, Part VIII, Chapter 408, Part II, Chapter 409, F.S., and Chapter 59G-4, F.A.C.
(2) Within 60 days of initial licensure, the licensee must be certified in accordance with federal regulations as stated in Title 42, Code of Federal Regulations 483 Subpart I, sections, 483.410 through 483.480.
Rulemaking Authority 400.967 FS. Law Implemented 400.967FS. History–New_______.
59A-26.005 Fiscal Standards.
(1) No change.
(2) Maintain financial and statistical records in accordance with Title 42 CFR, Ssections 483.420(b)(1)-(2) 413.24 (a), (b), (c) and (e), effective October 1, 2014, as incorporated by reference and located at http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/xml/CFR-2011-title42-vol5-sec483-420.xml. http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=bdbe912e59f6e76c8e19d6825dd1e23f&r=PART&n=42y2.0.1.2.13#42:2.0.1.2.13.2.59 2. The licensee is required to detail all of its costs for its entire reporting period making appropriate adjustments for determination of allowable costs as required by the Florida Title XIX Intermediate Care Facility for the Mentally Retarded and Developmentally Disabled Reimbursement Plan for Not Publicly Owned and Operated or Publicly Owned and Operated Facilities Version VIII, Effective Date July 1, 2012, and incorporated herein by reference https://www.flrules.org/Gateway/reference.asp?No=Ref-03075. A copy of the Plan may be obtained by writing to the Deputy Secretary for Medicaid, Agency for Health Care Administration, Mail Stop 8, Tallahassee, Florida 32308. A cost report must be prepared and submitted to the Agency using accrual basis of accounting in accordance with Generally Accepted Accounting Principles as incorporated by reference in Rule 61H1-20.007, F.A.C., except as modified by:
(a). The method of reimbursement and cost finding of Title XVIII (Medicare) Principles of Reimbursement described in 42 CFR 413.5 – 413.35, effective October 1, 2014, as incorporated by reference and
(b). Further interpreted by the Provider Reimbursement Manual CMS PUB. 15-1, as incorporated by reference in Rule 59G-6.010, F.A.C., or
(c). As further modified by Reimbursement Plan.
(3) Comply with requirements of Rules 59G-6.040 and 59G-6.045, F.A.C.
(4)(3) through (7)(6) No change.
59A-26.006 Admission Policies and Requirements.
(1) through (2) No change.
(3) The licensee must comply with the admission agreement. The admission agreement must include a description of the program and services to be provided, including at a minimum:
(3)(a) through (3)(e) No change.
(3)(f) Sufficient seasonal clothing as required by the client and applicable to the client’s needs for instances when the client or client’s representative does not provide sufficient clothing. Sufficient seasonal clothing must be provided and include a basic wardrobe for the client, including a five-day supply of sleepwear, socks, shoes, undergarments, outer clothing to include shirts, pants, or dresses; a winter coat; raingear; and personal grooming and hygiene items. The licensee must maintain an inventory of the client’s clothing and provide a copy of the inventory to the client or client’s representative within 14 seven calendar days of a written request;
(3)(g) through (4)(c)1. No change.
(4)(c)2. If a client insists on persists in leaving, the licensee will assist the client in locating an appropriate alternative placement.
(5) through (6) No change.
(7) If a pre-existing medical condition exists, if medical problems are identified by the nursing admissions assessment, or if a client is admitted who does not have a complete medical record including medical history, positive physical findings, diagnosis, and signed physician’s orders for treatment, nursing care or diets, the client must be examined by the admitting physician within 96 hours of admission unless the registered nurse determines that the physician should examine the client sooner.
Rulemaking Authority 400.967 FS. Law Implemented 400.967(2)(f) FS. History–New________.
59A-26.007 Personnel Standards.
(1) through (2) No change.
(3) Regardless of the organization or design of client living units, the minimum overall direct care staff-client ratios must comply with those specified in 42 CFR 483.430(d)(3), dated October 1, 2014 2011, as incorporated by reference and available at http://www.gpo.gov/fdsys/pkg/CFR-2014-title42-vol5/xml/CFR-2014-title42-vol5-sec483-430.xml. http://www.gpoaccess.gov/cfr/index.html.
(4) through (7)(f) No change.
Rulemaking Authority 400.962, 400.967 FS. Law Implemented 400.964, 400.967(2)(b), 400.967(2)(h), 408.809, FS. History–New________.
59A-26.008 Training, Habilitation, Active Treatment, Professional, Special Programs and Services.
(1) through (1)(a)1. No change.
2. For school age clients, when services are provided by the local school district, the licensee must make regular and consistent efforts to include the school system, the client, and client’s representative in the habilitation planning process. The licensee’s individual program plan shall be in addition to any individual education plan prepared by the school district.
(1)(b) through (1)(i) No change.
(j) Client rights as required by the Bill of Rights of Persons Who Are Developmentally Disabled, Section 393.13(3)(a)-(j), F.S. through Section 393.13(4)(j), F.S.
(1)(k) through (7) No change.
(8) When a psychotropic medication is initiated based upon a recommendation by the IDT, a physician, ARNP, registered nurse or pharmacist must ensure assure or make provisions for the instruction of the facility staff regarding side effects and adverse effects of the prescribed medication including when to notify the physician if undesirable side effects or adverse effects are observed. The staff must document in the progress notes that these instructions have been given. Any time a psychotropic medication is initiated, changed, increased or decreased, the facility must assure the physician writes a progress note. At a minimum, Tthe facility must ensure the physician makes a progress note every 30 calendar days. The effect of the medication on targeted symptoms must be reviewed and monitored at least quarterly by the IDT.
(9) through (13) No change.
Rulemaking Authority 400.962, 400.967 FS. Law Implemented 400.967(2)(d),(f),(h) FS. History–New________.
59A-26.009 Dietary Services.
(1) through (6) No change.
(7) As required by the Department of Health, aAll matters pertaining to food service must comply as required by the following regulations based on the number of beds to be licensed:
(a) For facilities with 25 or more beds the provisions of Rule Chapter 64E-11, F.A.C., Food Hygiene.
(b) For facilities with 24 beds or fewer the provisions of Rule Chapter 64E-12, F.A.C., Community Based Residential Facilities.
59A-26.010 Dental Services.
No change.
59A-26.011 Psychological Services.
Psychologists providing services to the clients of the facility must be licensed pursuant to Sections Chapter 490.005 and 490.006, F.S., and have a minimum of one year of experience or training in the field of intellectual or developmental disabilities.
59A-26.012 Drugs and Pharmaceutical Services.
(1) An ICF/DD must have a Class I Institutional Pharmacy Permit as required by the Department of Health in Section 465.019, F.S. All prescription medications must be compounded and dispensed by a pharmacy registered in Florida.
A consultant pharmacist must be responsible for implementation of the pharmacy program as defined by each licensee even when the consultant pharmacist is not the vendoring pharmacist.
(2) Labeling of prescription medications must be done as required by the Department of Health in Sections Chapters 465.0235, 465.186 and 499.0054, F.S. and Rule Chapter 64B16-27, F.A.C., as required by the Department of Health. Stock bottles of nonprescription drugs which are properly labeled according to the regulations related to the Drug and Cosmetic Act, Section Chapter 499.0054, F.S., are permitted.
(3) through (4) No change.
(5) All drugs listed in Schedules II through V must be handled, used, administered and dispensed as required by the Florida Comprehensive Drug Abuse Prevention and Control Act in Section Chapter 893.06, F.S.
(6) A count of controlled drugs listed in Schedules II-V of Section Chapter 893.03, F.S., must be made jointly between shifts by the licensed nurse beginning duty and the licensed nurse leaving duty. For facilities licensed for six beds or less, the count must be done by the supervising registered nurse on a weekly basis. For facilities licensed for more than six beds, a medication count of controlled substances must be made at every change of shift by the licensed nurse or an unlicensed medication assistant (UMA) as defined in Rule 59A-26.002, F.A.C. The count at shift change must be witnessed by another licensed nurse or another staff member trained in medication administration.
(7) A record must be maintained for all drugs listed in Section 893.03, F.S., of the Florida Comprehensive Drug Abuse Prevention and Control Act as Schedules II, III, IV, and V for continuous reconciliation.
(8) Medicinal substances classified as controlled substances by the Drug Enforcement Administration (DEA), as provided in the Drug Abuse Prevention and Control Act of 1970 and related regulations, and Ssection Chapter 893.03, F.S., as required by the Florida Comprehensive Drug Abuse Prevention and Control Act and related regulations must be disposed of as required by Rule Chapter 64B-16-28.303, F.A.C., as required by the Department of Health.
(9) through (11)(a) No change
(11)(b) All controlled drugs not administered to a client due to wastage, loss, or returned to the pharmacy must be documented in each client’s medical record and accounted for by a licensed nurse as required by the Florida Comprehensive Drug Abuse Prevention and Control Act in Section Chapter 893.07, F.S.
(12) All verbal orders must be written on the physician’s order sheet by the licensed nurse receiving the order and countersigned by the physician within 72 hours. Verbal orders for Schedule II drugs are permitted only in emergency situations but is limited to a 72-hour supply. In an emergency situation, the physician must directly contact the pharmacist and the pharmacist must receive a copy of the original or direct copy of the physician’s order within 72 hours as required by the Florida Comprehensive Drug Abuse Prevention and Control Act in Section 893.04, F.S.
(13) No change.
59A-26.013 Administration of Medications to ICF/DD Clients by Unlicensed Medication Assistants.
(1) through (5) No change.
(5)(a) A current informed consent has been signed by the client or client’s representative. The consent must acknowledge and permit UMAs to administer specifically listed medications prescribed by a licensed health care professional to the client. The informed consent must be updated and signed at least annually;
(5)(b) through (6)(a) No change.
(6)(b) Prior to assigning tasks to an UMA, the supervisory nurse must verify the training and validation of the unlicensed medication assistant as required by this Rule Chapter.
(6)(c) through (7) No change.
(7)(a) Outdated medication must be properly destroyed by the supervising nurse. The disposal must will be witnessed by one other staff of the facility and a record of the medication disposal must be maintained by the facility and signed by the supervising nurse and witness.
(b) Torn, damaged, illegible or mislabeled prescription labels must should be reported immediately to the dispensing pharmacy or pharmacist.
(7)(c) through (7)(d) No change.
(8) When administering medications to clients,; the UMA must:
(8)(a) through (8)(f) No change.
59A-26.014 Training and Validation Required for Unlicensed Medication Assistant.
(1) Required medication administration training must include criteria to ensure that competency is demonstrated through validation and revalidation of the qualification of the UMA and all requirements of UMAs specified in this Rule Chapter.
(2) Medication administration training must will be conducted by a registered nurse, ARNP or physician for UMAs and will be provided by the ICF/DD licensee. Any person providing medication administration training sessions or conducting skills validation or revalidation tests must first complete a trainer orientation session, which includes requirements of this rule and information to be covered during medication administration training sessions. Documentation of the trainer’s completed orientation must will be provided to each UMA that he or she trains or validates.
(3) through (3)(i) No change.
(j) Each duty of UMAs as required in this Rule Chapter.
(4) Validation or revalidation of the effective completion of the training is required for each UMA to assess that competency has been achieved after completion of required training. To become validated or revalidated, the UMA must be able to successfully demonstrate, in a practical setting, his or her ability to correctly administer or supervise the self-administration of medications to clients in a safe and sanitary manner and to correctly and accurately document actions related to the administration of medications, in accordance with the requirements of this Chapter. At completion of the training, an UMA must attain an overall score of 100% on knowledge tests that cover the training and facility specific questions. The UMA will have three attempts to achieve a 100% score. If after the third attempt a score of 100% is not achieved, the UMA must repeat the training and may not administer medication to clients until such time as a score of 100% is achieved. Additionally, an UMA must be able to state the purpose, common side effects, and signs and symptoms of adverse reactions for a list of commonly used medications from memory or demonstrate how they obtain that information and maintain it for easy access.
(5) Validation or revalidation of competency will be conducted by an RN, physician, or ARNP. The ICF/DD licensee will maintain documentation containing the following information:
(5)(a) No change.
(b) Validation or revalidation date, with expiration date of 365 days from the validation;
(5)(c) through (6) No change.
(7) The following must be validated or revalidated for each UMA:
(7)(a) through (b) No change.
(7)(c) Demonstration of the ability to perform as required in this Rule Chapter.
(7)(d) through (10) No change.
59A-26.015 Plant Maintenance and Housekeeping.
(1) through (3)(a) No change.
(3)(b) Keep floors clean and as non-slip as practicable to ensure client safety;
(3)(c) through (4)(g) No change.
59A-26.016 Fire Protection, Life Safety, Systems Failure, and External Emergency Communications.
(1) Standards for fire prevention for the facility are those adopted pursuant to Rule 69A-3.012, F.A.C., as required by the Division of State Fire Marshal at Department of Financial Services, and Chapter 69A-38, Uniform Fire Safety Standards for Residential Facilities for Individuals with Developmental Disabilities, F.A.C., as required by the Agency for Persons with Disabilities, as applicable to the classifications of occupancy therein.
(2) No change.
(3) ICF/DD’s providing personal care, as defined in the Life Safety Code NFPA 101 as adopted pursuant to Rule 69A-3.012, F.A.C., as required by the Division of State Fire Marshal at the Department of Financial Services, and Rule Chapter 69A-38, F.A.C., as required by the Agency for Persons with Disabilities, will be reviewed as a Residential Board and Care occupancy under the Florida Specific Edition of NFPA 101 Life Safety Code, as adopted pursuant to Rule 69A-3.012, F.A.C., as required by the Division of State Fire Marshal at the Department of Financial Services, and Rule Chapter 69A-38, F.A.C. as required by the Agency for Persons with Disabilities. ICF/DD’s providing services to clients that receive chronic, skilled/acute nursing or medical care or designated as a Level of Care 9 will be reviewed as a Health Care occupancy status under the Florida Specific Edition of NFPA 101 Life Safety Code, as adopted pursuant to Rule 69A-3.012, F.A.C., as required by the Division of State Fire Marshal at Department of Financial Services and Rule Chapter 69A-38, F.A.C., as required by the Agency for Persons with Disabilities. To ensure the life safety code requirements are appropriate for all clients served in an ICF/DD, each licensure survey shall establish or confirm the occupancy status. Beginning December January 1, 2015, upon renewal of each ICF/DD license, the license shall display the occupancy status. The ICF/DD licensee must receive written approval from the Agency, including the Office of Plans and Construction, prior to a change in the occupancy status. A client requiring chronic, skilled/acute nursing or medical care, or designated as a Level of Care 9 client, may not reside in an ICF/DD with a Residential Board and Care occupancy status.
(4) Each licensee must provide fire protection through the elimination of fire hazards as evidenced by compliance with the fire codes referenced in Rule 59A-26.016(1) requirements of Rule 69A-3.012 and Chapter 69A-38, F.A.C.
(5) No change.
(6) In As required by NFPA 101, Life Safety Code, in the event of a system failure of the fire alarm system, smoke detection system, or sprinkler system, the following actions must be taken immediately by the licensee:
(6)(a) through (7) No change.
59A-26.017 Plans Submission and Fee Requirements.
(1) through (4) No change.
(5) Plans and specifications submitted for review shall be subject to a plan review fee pursuant to section 400.967(5), F.S. A non-refundable initial fee of $2,000 will be charged for all projects. The agency will also collect a fee, not to exceed one percent of the estimated construction cost or the actual cost of review, whichever is less, for the portion of the review which encompasses initial review through the initial revised construction document review. Additionally, the Agency will collect its actual costs on all subsequent portions of the review and construction inspections. All fees must be paid by check made payable to the Agency for Health Care Administration, with the check noted with the Office of Plans and Construction facility log number and identified that it is for the Agency’s Health Care Trust Fund. Fees will be accepted only from the ICF/DD licensee or prospective licensee.
(6) Plans and specifications may be submitted for review at any of the three stages of development described in this rule. Approval of a Stage III submission is required to begin construction. Limited early construction may be permitted for projects with an approved Stage II submission, submission of construction documents limited to the scope of work for early construction, and a letter from the facility holding the Agency for Health Care Administration harmless for any changes required as a result of the final construction document review. Plans and specifications shall be submitted in three stages of development described in this rule. Exceptions to the requirement for Stage I and/or Stage II submissions may be granted upon review of the size, scope and complexity of a project by the Agency’s Office of Plans and Construction.
(6)(a) through (8) No change.
(9) through (10) are renumbered to (8) through (9) No change.
(10)(11) Stage II preliminary plans will be approved by the Agency upon successful demonstration that the construction will comply with applicable life safety code requirements, flood requirements and that the layout will accommodate all required functional space as evidenced by a thorough examination of documents submitted as required by this subsection. Stage II, preliminary plans must include:
(11)(a) through (i) are renumbered to (10)(a) through (i) No change.
(11)(12) Stage III, construction documents. Stage III construction documents will be approved by the Agency upon successful demonstration that the construction will comply with all applicable codes and standards as evidenced by a thorough examination of documents submitted as required by this subsection.
(12)(a) through (12)(a)9.b. are renumbered to (11)(a) through (11)(a)9.b. No change.
(b) All construction documents must be well coordinated to provide consistency of design intent throughout the documents. It is specifically required that in the case of additions to facilities, the mechanical and electrical, especially existing essential electrical systems and all other pertinent conditions, must be a part of this submission.
(c) All subsequent addenda, change orders, field orders and other documents altering the above must also be signed, sealed, dated and submitted in advance to the Agency’s Office of Plans and Construction for review. The Agency will either approve or disapprove the submission based on compliance with all applicable codes and standards and shall provide a listing of deficiencies in writing written approval.
(13) is renumbered to (12) No change.
(13)(14) Additions or revisions that substantially change the original scope of the project or are submitted by different design professionals will be required to be submitted as a new project. A substantial change is one which deviates from the approved documents or additions.
Rulemaking Authority 400.467 FS. Law Implemented 400.967(2), (4), (5), FS. History- New __________.
59A-26.018 Physical Plant Codes and Standards for ICF/DD.
(1) All construction of new facilities or conversions and all additions, modifications, alterations, renovations, and refurbishing to the site, facility, equipment or systems of a facility must be in compliance with all applicable the following codes and standards. In addition to the standards in this rule, the following codes apply to design and construction of ICF/DD facilities:
(a) The Florida Building Code as adopted pursuant to Rule 61G20-1.001, F.A.C., by the Florida Building Code Commission at the Department of Business and Professional Regulation.
(b) The fire codes adopted by the State Fire Marshal pursuant to Rule 69A-38 69A-3.012, F.A.C., by the Division of State Fire Marshal at the Department of Financial Services.
(c) For the purpose of determining life safety occupancy classification, facilities When the licensee is providing services to clients that receive chronic, skilled/acute nursing or medical care or designated as a Level of Care 9 will be classified as a health care occupancy , NFPA 101, Chapter 18 (Health Care Occupancies) must be applied.
(d) For the purpose of determining life safety occupancy classification, facilities When the licensee is providing personal care services will be classified as a residential board and care occupancy, as defined in the Life Safety Code NFPA 101, incorporated in Rule 69A-3.012, F.A.C., NFPA 101, Chapter 32 (Residential Board and Care) must be applied.
(2) The Fire Safety Evaluation System (FSES) NFPA-101 adopted pursuant to Rule 69A-38 69A-3.012, F.A.C., as required by the Division of State Fire Marshall at the Department of Financial Services, shall not be used to meet the required codes and standards for new construction, renovations, or for conversion of an existing building to a new licensed ICF/DD.
(3) Where additions, modifications, alterations, refurbishing, renovations or reconstruction are undertaken within a facility, all such additions, modifications, alterations, refurbishing, renovations or reconstruction must comply with sections of the applicable codes for new facilities. Where major structural elements make total compliance impractical or impossible, the licensee or potential licensee must submit to the Agency’s Office of Plans and Construction a request to utilize alternate materials and methods. The Agency will evaluate the request in accordance with standards as required by Florida Building Code.
(4) All existing facilities classified as Residential Board and Care must be in compliance with the requirements of Chapter 33, Existing Residential Board and Care Occupancy, of the National Fire Protection Association (NFPA) Life Safety Code 101, as incorporated in Rule 69A-3.012, F.A.C.
(5) At a minimum all existing facilities classified as Health Care Occupancies must be in compliance with the requirements of Chapter 19, Existing Health Care Occupancies, of the NFPA Life Safety Code 101, as incorporated in Rule 69A-3.012, F.A.C.
59A-26.019 Construction and Physical Environment Standards for Facilities Providing Services to Clients that Receive Chronic, Skilled/Acute Nursing or Medical Care or Designated as a Level of Care 9.
All new facilities and all additions, renovations and alterations of existing facilities must be in compliance with the following physical plant standards:
(1) through (2)(f)1. No change.
2. The dimensions and arrangement of the client bedrooms must provide a minimum of three feet wide (0.91m) clear access space to each bed along at least 75 percent of the length of one side of the bed and must be designed to allow the use of a wheelchair and other portable equipment (0.91 meter) between the sides and foot of the bed and any wall or any other fixed obstruction or adjacent bed. In multiple-bed rooms, a clearance of 3 feet 8 inches (1.11 meters) to any fixed obstruction must be available at the foot of each bed to permit the passage of equipment and beds. For beds equipped with a piped in medical gas headwall unit, there must be minimum clearance of 3 feet (0.91m) along the entire length of the bed between both sides of the bed and any other bed, wall or any other fixed obstruction. The maximum number of clients sharing a bedroom shall be two.
(2)(g) through (3)(i) No change.
(j) Only recessed soap dishes may be allowed in client use tubs and showers. Towel bars must be provided at each bathing area.
(3)(k) through (n) No change.
(3)(o) Where it is not possible to inspect smoke barriers partitions because of the fire-tested membrane, fire-rated access panels must be installed adjacent to each side of the smoke barriers partitions at intervals not exceeding 30 feet (9.14 meters) and in such locations as necessary to view all surfaces of the barriers partition.
(3)(p) through (5)(h)1. No change.
(5)(h)2. An emergency calling station of the pull cord type must be provided and must be conveniently located for client use at each client toilet, bath or shower room, but not inside the shower unless the nurse call device is listed for wet locations. The call signal must be the highest priority and shall be cancelled only at the emergency calling station. The emergency station must activate distinctive audible and visual signals immediately at the client room door or wireless page, and activate a visual and audible signal in the staff work areas or mobile nurse station receiver and the master station of the client unit. If a mobile nurse station receiver is utilized to receive the client call it will be worn by all staff who are assigned to the client unit and must identify the specific client and or room from which the call was placed;
3. The nurse call master station must not block incoming client calls. The master station control settings must not prevent the activation of the incoming audible and visual signals. In wireless systems, all orphaned calls to mobile nurse station receivers will register at the nurse call master station;
4. In multi-client rooms, activation of an emergency call shall not cancel a normal call from the same room; and
5. A corridor dome light must be located directly outside of any client care area that is equipped with a wired nurse call station.
(5)(i) through (6)(a) No change.
(6)(b) An accessible, potable supply of water must be provided in all facilities and must be operated as required by Chapter 64E-8, F.A.C.
(c) An adequate and safe method of sewage collection, treatment and disposal must be provided in each facility as required by Chapter 62-600, F.A.C., Domestic Wastewater Facilities or Chapter 64E-6, F.A.C., Standards of Onsite Sewage Treatment and Disposal. Whenever a municipal or public sewer system is available to the property such system must be used.
(d) In all facilities vermin must be controlled in all areas of the facility as required by Chapter 64E-11, F.A.C. Insecticides and rodenticides must be handled as required by Rules 5E-14.102-.113, F.A.C.
(7) through (7)(a) No change.
(7)(a)1. Existing Facility means a facility that prior to December January 1, 2015:
(7)(a)1. a. through (7)(a)2. No change.
(7)(a)2. a. An ICF/DD licensed after December January 1, 2015; or
b. A facility that receives a Stage II Preliminary Plan approval after December January 1, 2015; or
(7)(a)2.c. through (7)(b)2. No change.
(7)(b)2. a. The Except as permitted by Section 1612 of the Florida Building Code (FBC), the lowest floor of all new facilities shall be elevated to the "Base flood elevation" as defined in FBC Section 1612, plus 2 feet (61 cm), or to the height of hurricane Category 3 (Saffir-Simpson scale) surge inundation elevation, as described by the Sea, Lake, and Overland Surge (SLOSH) from Hurricanes model developed by the Federal Emergency Management Agency (FEMA), United States Army Corps of Engineers (USACE), and the National Weather Service (NWS), whichever elevation requirement is more stringent. The Base flood elevation shall be defined as the elevation of an area having a 1 percent chance of being equaled or exceeded by flood waters in any given year.
b. For all existing facilities, the lowest floor elevations of all additions, and all resident support areas including food service, and all resident support utilities, including mechanical, and electrical (except fuel storage as noted in sub-subparagraph 59A-26.019 59A-26.022(7)(b)9.e., F.A.C.) for the additions shall be at or above the elevation of the existing building, if the existing building was designed and constructed to comply with either the site standards of this rule or local flood resistant requirements in effect at the time of construction, whichever requires the higher elevation, unless otherwise permitted by FBC Section 1612. If the existing building was constructed prior to the adoption of either the site standards of this rule or local flood resistant requirements, then substantial improvements, the addition and all resident support areas and utilities for the addition as described in this section shall either be designed and constructed to meet the requirements of this rule or be designed and constructed to meet the dry flood proofing requirements of the Florida Building Code FBC Section 1612.
c. Substantial improvement shall include any repairs, reconstruction(s), rehabilitation(s), additions(s) or improvement(s) to the building over a five year period, the cost of which cumulatively exceeds the market value of the building prior to the start of work, as defined by FBC Section 1612, to all existing facilities located within flood areas or within a Category 3 surge inundation zone as described in this rule, shall be designed and constructed to comply with the requirements in FBC Section 1612.
(7)(b)2.d. through (7)(b)9.b. No change.
(7)(b)9.c. At a minimum, Tthere must be one clothes washer and one clothes dryer for laundry service.
(7)(b)9.d. through (7)(b)10. No change.
(7)(b)10.a. On-site water storage capacity to continue sprinkler coverage in accordance with the fire codes adopted by the state fire marshal, as required by NFPA 13, “Sprinkler Systems,” or a fire watch, must be conducted as required by NFPA 601.
b. If the facility provides a fire watch in lieu of water storage to continue sprinkler coverage, then one 4-A type fire extinguisher or equivalent must be provided for every three or less 2-A fire extinguishers as required by NFPA 10, “Portable Extinguishers” for the area served. These additional extinguishers must be equally distributed throughout the area they are protecting.
(7)(b)11. No change.
59A-26.020 Disaster Preparedness.
(1) through (1)(c)5.c. No change.
(1)(c)5.d. A 72 hour Seventy-two hour supply of all essential supplies and client medications; and
(1)(c)5.e. through (d) No change.
