The purpose of the proposed rule is to update the standards for addictions receiving facilities.

 

DEPARTMENT OF CHILDREN AND FAMILIES

Substance Abuse Program

RULE NO.:RULE TITLE:

65D-30.005Standards for Addictions Receiving Facilities

PURPOSE AND EFFECT: The purpose of the proposed rule is to update the standards for addictions receiving facilities.

SUBJECT AREA TO BE ADDRESSED: The proposed rule addresses addictions receiving facilities.

RULEMAKING AUTHORITY: 397.321(5), FS.

LAW IMPLEMENTED: 397.311(19)(a), 397.321(1), 397.419, 397.901, FS.

IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE NOTICED IN THE NEXT AVAILABLE FLORIDA ADMINISTRATIVE REGISTER.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Wanda Carter, SAMH Program Information Unit, 1317 Winewood Boulevard, Building 6, Tallahassee, Florida 32399-0700, wanda.carter1@myflfamilies

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

65D-30.005 Standards for Addictions Receiving Facilities.

In addition to Rule 65D-30.004, F.A.C., the following standards apply to addictions receiving facilities.

(1) Designation of Addictions Receiving Facilities. The department shall designate addictions receiving facilities. The provider shall indicate on the licensure application for this service component that designation is requested.  Once the designation request is received by the regional Substance Abuse and Mental Health Program Office, the regional Director of Substance Abuse and Mental Health shall submit a written recommendation to the Office of Substance Abuse and Mental Health at headquarters in Tallahassee.  The headquarters Director of Substance Abuse and Mental Health may approve or deny the request and shall respond in writing to the Chief Executive Officer of  the requesting provider.  If the request is denied, the response shall specify the denial.  If the request is approved, the response shall include a certificate designating the facility.  The designation shall be valid for three years. process of designating such facilities shall begin with a written request from a provider and a written recommendation from the department’s District Administrator to the department’s Director for Substance Abuse. The Director for Substance Abuse shall submit written recommendations to the Secretary of the department approving or denying the request.

(2) Services.

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

(b) Supportive Counseling. Each  individual client shall be offered participate in supportive counseling on a daily basis, unless an individual a client is not sufficiently stabilized as defined in subsection 65D-30.002(69), F.A.C. Supportive counseling sessions shall be of sufficient duration to enable staff to make reasonable decisions regarding the individual’s client’s need for other services. Services shall be directed toward assuring that the individual’s client’s  most immediate needs are addressed and that the individual client is encouraged to remain engaged in treatment and to follow up on referrals after discharge.

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

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

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

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

(a) An individual who presents for voluntary admission A voluntary client who has a substance abuse problem to the extent that the person displays behaviors that indicate potential harm to self or others due to a substance use issue or who meets diagnostic or medical criteria justifying placement in a secure an addictions receiving facility; or

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

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

(d) Juveniles found in contempt as authorized under Section 985.037 Section 985.216, F.S.

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

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

(b) Persons found to be beyond the safe management capability of the provider as defined under subsection 397.311(3)(5), F.S., and as described under paragraph 397.6751(1)(f), F.S.

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

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

(9) Involuntary Assessment and Disposition.

(a) Involuntary Assessment. An assessment shall be completed for on each individual admitted to client placed in an addictions receiving facility under protective custody, emergency admission, alternative involuntary assessment for minors, and under involuntary assessment and stabilization. The assessment shall be completed by a qualified professional and based on the requirements in paragraph 65D-30.004(14)(b), F.A.C. The assessment shall be directed toward determining the individual’s client’s need for additional treatment and the most appropriate services and supports.

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

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

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

3. A petition for involuntary treatment will be initiated.

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

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

(12) Staff Coverage. A physician, P.A., or A.R.N.P. shall make daily visits to the facility for the purpose of conducting physical examinations and addressing the medical needs of individuals clients. A full-time R.N. shall be the supervisor of all nursing services. An R.N. or L.P.N. shall be on-site 24 hours per day, 7 days per week. At least one qualified professional shall be on staff and shall be a member of the treatment team. At least one member of the clinical staff shall be available on-site for 8 hours daily and be on-call thereafter. between the hours of 7:00 a.m. and 11:00 p.m. and on-call between 11:00 p.m. and 7:00 a.m.

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

 

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

 

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

(14) Seclusion Restraint and Restraint Seclusion. Addictions receiving facilities may utilize seclusion and restraint.  If seclusion or restraint is utilized, addictions receiving facilities shall adhere to all standards and requirements for seclusion and restraint as described in subsection 65E-5.180(7), F.A.C. Restraint and seclusion can only be used in emergency situations to ensure the physical safety of the client, other clients, staff, or visitors and only when less restrictive interventions have been determined to be ineffective. Restraint and seclusion shall not be employed as punishment or for the convenience of staff and shall be consistent with the rights of clients, as described in subsection 65D-30.004(29), F.A.C.

(a) Training. All staff who implement written orders for restraint or seclusion shall have documented training in the proper use of the procedures, including formal certification in control of aggression techniques, and this training shall be documented in their personnel file. Training shall occur initially and a minimum of two hours annually thereafter.

(b) Restraint and Seclusion Orders. Providers shall implement the following requirements regarding the use of restraint and seclusion orders.

1. Orders for the use of restraint or seclusion must not be written as a standing order or on an as needed basis.

2. The treating physician, or other medically qualified designee identified in accordance with the medical protocol established in subsection 65D-30.004(7), F.A.C., must be consulted as soon as possible, but no longer than one hour after the initiation of restraint or seclusion. Further, in the case of adults, the physician, or other medically qualified designee identified in accordance with the medical protocol established in subsection 65D-30.004(7), F.A.C., must conduct a face-to-face evaluation of the client within four hours of the initiation of restraint or seclusion. In the case of children age 17 and under, this shall occur within two hours of initiation of restraint or seclusion.

3. Each written order for restraint or seclusion is limited to 4 hours for adults, 2 hours for children and adolescents ages 9 to 17, and 1 hour for children under 9. The original order may only be renewed in accordance with these time limits for up to a total of 24 hours. After the original order expires, a physician or qualified professional licensed under Chapter 490 or 491, F.S., must see and assess the patient before issuing a new order.

4. The use of restraint and seclusion must be implemented in the least restrictive manner possible. In addition, restraint and seclusion must be applied in accordance with safe and appropriate techniques and ended at the earliest possible time.

5. Restraint and seclusion may not be used simultaneously unless a client is continually monitored face-to-face by an assigned staff member, or continually monitored by staff using both video and audio equipment.

6. The condition of the client who is in restraint or seclusion must be assessed, monitored, and reevaluated at least every 15 minutes.

(c) Restraint and Seclusion Log Book. A continuing log book shall be maintained by each provider that will indicate, by name, the clients who have been placed in restraint or seclusion, the date, and specified reason for restraint or seclusion, and length of time in restraint or seclusion. The log book shall be signed and dated by the R.N. on duty.

(d) Observation of Clients. Staff shall conduct a visual observation of clients who are placed in restraint or seclusion every 15 minutes. The observation shall be documented in the restraint and seclusion log book, and shall include the time of the observation and description of the condition of the client.

(e) Basic Rights. While in restraint or seclusion, clients shall be permitted to have regular meals, maintain personal hygiene, use the toilet and, as long as there is no present danger to the client or others, permitted freedom of movement for at least 10 minutes each hour.

(f) Post Restraint or Seclusion. Upon completion of the use of restraint or seclusion, the client shall receive a nursing physical screen by an R.N. that will include an assessment of the client’s vital signs, current physical condition, and general body functions. The screening shall be documented in the client record. In addition, supportive counseling shall be provided in accordance with the needs of the client in an effort to transition the client from restraint or seclusion.

(g) Seclusion Room Facility Requirements. If the provider utilizes seclusion and restraint, the provider Providers shall have at least one seclusion room located in the facility. Seclusion rooms shall incorporate the following minimum facility standards.

1. Seclusion rooms shall be free from sharp edges or corners and constructed to withstand repeated physical assaults. Walls shall be either concrete block or double layered to provide resistance. The ceilings shall be a minimum of eight feet in clear height, hard-coated, and fixtures shall be recessed and tamper proof. Lighting fixtures shall be non-breakable and shall be installed with tamper-proof screws, as shall any other items in the seclusion room. Seclusion room doors shall be heavy wood or metal at least 36 inches in width and shall open outward. The doorframe shall be resistant to damage and thoroughly secured.

2. A bed in the addictions receiving facility seclusion room is optional. If a bed is included, it shall be sturdily constructed, without sharp edges and bolted to the floor. Its placement in the room shall provide adequate space for staff to apply restraints and shall not permit individuals to tamper with the lights, smoke detectors, cameras, or other items that may be in the ceiling of the room. There shall be a rheostat control mechanism outside the room to adjust the illumination of the light in the seclusion room.

3. There shall be a vision panel in the door of the seclusion room, which provides a view of the entire room. This vision panel shall be Lexan or other suitable strong material and it shall be securely mounted in the door. Provisions shall be made to ensure privacy from the public and other clients while providing easy access for staff observation.

4. Seclusion rooms shall be a minimum of 70 square feet with no wall less than 8 feet.

5. Fire sprinkler heads shall be ceiling mounted and either recessed or flush-mounted without a looped spray dispersal head.

6. Each seclusion room will allow for two-way communication and emergency calling.

7. In those instances where the full interior of the seclusion room can not be seen from the nurse’s station, the seclusion room shall have an electronic visual monitoring system capable of viewing the entire room from the nurse’s station.

Specific Authority 397.321(5) FS. Law Implemented 397.311(18)(19)(a), 397.321(1), 397.419, 397.901 FS. History–New 5-25-00, Amended 4-3-03,                      .