License, Residency Criteria and Admission Procedures, Resident Care Standards, Advance Directives and Do Not Resuscitate Orders (DNRO), Medication Practices, Staffing Standards, Staff Training Requirements and Competency Test, Physical Plant ...  


  • RULE NO: RULE TITLE
    58A-5.016: License
    58A-5.0181: Residency Criteria and Admission Procedures
    58A-5.0182: Resident Care Standards
    58A-5.0183: Advance Directives and Do Not Resuscitate Orders (DNRO)
    58A-5.0185: Medication Practices
    58A-5.019: Staffing Standards
    58A-5.0191: Staff Training Requirements and Competency Test
    58A-5.023: Physical Plant Standards
    58A-5.025: Resident Contracts
    58A-5.033: Administrative Enforcement
    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. 35 No. 49, December 11, 2009 issue of the Florida Administrative Weekly.

    The following changes are being made as a result of comments received from the rule hearing conducted on January 7, 2010, and comments submitted by the Joint Administrative Procedures Committee.

    58A‑5.016 License Requirements.

    (1) through (4) No change.

    (5) CONTIGUOUS PROPERTY.

    If a facility consists of more than one building, all buildings included under a single license must be on contiguous property. “Contiguous property” means property under the same ownership separated by no more than a two-lane street that traverses the property. A licensed location may be expanded to include additional contiguous property with the approval of the agency to ensure continued compliance with the requirements and standards of Part I III, Chapter 429 400, F.S., and this rule chapter.

    (6) through (7) No change.

    (8) THIRD PARTY SERVICES.

    (a) In instances when residents require services from a third party provider, the facility administrator or designee must take action to assist, if necessary, in facilitating the provision of those services and coordinate with the provider to meet the specific service goals, unless residents or their representatives decline the assistance. The declination of assistance must be reviewed at least annually. These actions must be documented in the resident’s record.

    (b) In instances when residents or their representatives arrange for third party services that are not included in the documents listed in paragraph (a) of this subsection, the facility administrator or designee, when requested by residents or representatives, must take action to assist, if necessary, in facilitating the provision of those services and coordinate with the provider to meet the specific service goals. These actions must be documented in the resident’s record.

    (c) The facility’s facilitation and coordination as described under this subsection does not represent a guarantee that residents will receive third party services. If the facility’s efforts at facilitation and coordination are unsuccessful, the facility should include documentation in the resident’s record explaining the reason or reasons its efforts were unsuccessful, which will serve to demonstrate its compliance with this subsection.

    Rulemaking Specific Authority 429.41 FS. Law Implemented 429.12, 429.41, 429.44, 429.445 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, 7-30-06,________.

     

    58A-5.0181 Admission Procedures, Appropriateness of Placement and Continued Residency Criteria.

    (1) No change.

    (2) HEALTH ASSESSMENT. As part of the admission criteria, an individual must undergo a face-to-face medical examination completed by a licensed health care provider, as specified in either paragraph (a) or (b) of this subsection.

    (a) A The medical examination report must be completed within 60 calendar days prior to the individual’s admission to a facility pursuant to Section 429.26(4), F.S. The examination report must be based on a face-to-face examination and must address the following:

    1. through 6. No change.

    7. A statement on the day of the examination that, in the opinion of by the examining licensed health care provider, that the individual’s needs can be met in an assisted living facility; and

    8. No change.

    (b) A mMedical examinations completed after the resident’s admission to the facility must be completed within 30 calendar days of the admission date. The examination and must be recorded on AHCA Form 1823, Resident Health Assessment For Assisted Living Facilities and Adult Family-Care Homes,_______2010. The form is hereby incorporated by reference. A faxed copy of the completed form is acceptable. A copy of AHCA Form 1823 may be obtained from the Agency Central Office or its website at: www.fdhc.state.fl.us/MCHQ/Long_Term_Care/Assisted_living/pdf/AHCA_Form_1823%.pdf. The form must be completed as follows:

    1. The resident’s licensed health care provider must complete all of the required information in Sections 1, Health Assessment, and 2, Self-Care and General Oversight Assessment, based on a face-to-face examination.

    a. through c. No change.

    2. The facility administrator, or designee, must complete Section 3 of the form, Services Offered or Arranged by the Facility, or may use electronic documentation, which at a minimum includes the elements in Section 3. This requirement does not apply except for residents receiving:

    a. through d. No change.

    (c) through (g) No change.

    (3) No change.

    (4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (e) of this subsection, criteria for continued residency in any licensed facility holding a standard, limited nursing services, or limited mental health license shall be the same as the criteria for admission. As part of the continued residency criteria, a resident must have a face-to-face medical examination by a licensed health care provider A determination of the appropriateness of a resident’s continued residency must be completed at least every 3 years after the initial assessment, or after a significant change, whichever comes first. A significant change is defined in Rule 58A-5.0131, F.A.C. The results of the examination must be recorded on The facility must make the determination of continued residency using AHCA Form 1823, which is incorporated by reference in paragraph (2)(b) of this rule. The form must be completed in accordance with that paragraph. After the effective date of this rule, providers shall have up to 12 months to comply with this requirement.

    (a) through (e) No change.

    (5) No change.

    Rulemaking Specific Authority 429.07, 429.26, 429.41 FS. Law Implemented 429.02, 429.07, 429.075, 429.26, 429.41 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, 7-30-06, 10-9-06,________.

     

    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) through (6) No change.

    (7) THIRD PARTY SERVICES. Nothing in this rule chapter is intended to prohibit a resident or the resident’s representative from independently arranging, contracting, and paying for services provided by a third party of the resident’s choice, including a licensed home health agency or private nurse, or receiving services through an out‑patient clinic, provided the resident meets the criteria for continued residency and the resident complies with the facility’s policy relating to the delivery of services in the facility by third parties. The facility’s policies may must require the third party to coordinate with the facility regarding the resident’s condition and the services being provided pursuant to subsection (8) of Rule 58A-5.016, F.A.C. Pursuant to subsection (6) of this rule, the facility shall provide the resident with the facility’s policy regarding the provision of services to residents by non-facility staff.

    (8) through (9) No change.

    Rulemaking Specific Authority 429.41 FS. Law Implemented 429.02, 429.255, 429.256, 429.26, 429.28, 429.41 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, 7-30-06, 10-9-06,________.

     

    58A-5.0183 Do Not Resuscitate Orders (DNROs).

    (1) POLICIES AND PROCEDURES.

    (a) Each assisted living facility (ALF) must have written policies and procedures, which delineate its position with respect to state laws and rules relative to DNROs. The policies and procedures shall not condition treatment or admission upon whether or not the individual has executed or waived a DNRO. In the event of conflict between the facility’s policies and procedures and the resident’s properly executed DNRO, provision should be made in accordance with Chapter 765, F.S. The ALF must provide the following to each resident, or resident’s representative, at the time of admission:

    1. through 3. No change.

    (b) No change.

    (2) No change.

    (3) DNRO PROCEDURES.

    Pursuant to Section 429.255, F.S., an ALF must honor a properly executed DNRO as follows:

    (a) In the event a resident experiences cardiopulmonary arrest distress, staff trained in cardiopulmonary resuscitation (CPR), or a licensed health care provider present in the facility, may withhold cardiopulmonary resuscitation.

    (b) In the event a resident is receiving hospice services and experiences cardiopulmonary arrest distress, facility staff must immediately contact the hospice. The hospice procedures shall take precedence over those of the assisted living facility.

    (c) If a facility has a written policy not to honor a properly executed DNRO, the facility must make this fact clearly known in writing to the resident, or legal representative, at the time of admission and in its contract with the resident. The facility must also inform the resident, or legal representative, in writing at the time of admission and in its contract with such resident that the facility will administer CPR until the “911” contact person arrives. This must be documented in the resident’s record. In such a facility, when a resident, who has a properly executed DNRO, experiences cardiopulmonary distress, staff must immediately contact “911.”

    1. A trained staff member must administer CPR until emergency services arrive.

    2. Once emergency services arrive, the facility must present the properly executed DNRO to the “911” contact person.

    3. Cardiopulmonary resuscitation may then be withheld or withdrawn by the “911” contact person pursuant to Section 401.45, F.S.

    (4) No change.

    Rulemaking Authority 429.255 FS. Law Implemented 429.255 FS. History–New________.

     

    58A-5.0185 Medication Practices.

    Pursuant to Sections 429.255 and 429.256, F.S., and this rule, licensed 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) through (7) No change.

    (8) OVER THE COUNTER (OTC) PRODUCTS MEDICATIONS.

    For purposes of this subsection, the term OTC includes, but is not limited to, OTC medications, vitamins, nutritional supplements and nutraceuticals, hereafter referred to as OTC products, which can be sold without a prescription.

    (a) A stock supply of OTC products medications for multiple resident use is not permitted in any facility.

    (b) When centrally stored, OTC products medications, including those prescribed by a licensed health care provider, must be labeled with the resident’s name and. In addition, the manufacturer’s label with directions for use, or the licensed health care provider’s order with directions for use, must be kept with the medication. No other labeling requirements are necessary nor should be required.

    (c) No change.

    (d) A facility cannot require a licensed health care provider’s order for all OTC products medications as part of its policies and procedures when a resident self-administers his or her own medications, or when staff provides assistance with self-administration or administration of medications. However, in the event staff becomes concerned over a resident’s health, safety and welfare regarding OTC medications that may be contraindicated when taken with one another or in combination with prescribed medications, the following shall apply:

    1. Staff must bring the issue to the attention of the resident, or representative, the resident’s licensed health care provider and the administrator. This action must be documented in the resident’s record. The resident’s licensed health care provider shall make the determination as to whether the OTC medication is:

    a. Contraindicated and should be discontinued; or

    b. Can be taken as directed; or

    c. Can be taken with other directions for use.

    2. The facility must document the health care provider’s directives and keep a copy of the health care provider’s written order, if applicable, in the resident’s record.

    (e) The facility must include the provisions in this subsection in resident contracts or house rules pursuant to Rule 58A-5.025, F.A.C.

    Rulemaking Specific Authority 429.256, 429.41 FS. Law Implemented 429.255, 429.256, 429.41 FS. History–New 10-17-99, Amended 7-30-06,________.

     

    58A‑5.019 Staffing Standards.

    (1) through (3) No change.

    (4) STAFFING STANDARDS.

    (a) through (b) No change.

    (c) The facility must maintain a written work schedule which reflects its 24-hour staffing pattern for a given time period. Upon request, the facility must make the daily work schedules for direct care staff available to residents or representatives, specific to the resident’s care.

    (d) through (f) No change.

    Rulemaking Specific Authority 429.41, 429.52, 429.275 FS. Law Implemented 429.02, 429.04, 429.174, 429.176, 429.19, 429.24, 429.255, 429.26, 429.275, 429.41, 429.52 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, 7-30-06,________.

     

    58A-5.0191 Staff Training Requirements and Competency Test.

    (1) through (7) No change.

    (8) LIMITED MENTAL HEALTH TRAINING.

    (a) Pursuant to Section 429.075, F.S., the administrator, managers and staff, who have direct contact with mental health residents in a licensed limited mental health facility, must receive the following training:

    1. No change.

    2. A minimum of 3 hours of continuing education, which may be provided by the ALF administrator or through distance learning, or in-service training biennially thereafter in subjects dealing with one or more of the following topics:

    a. through b. No change.

    3.c. For administrators and managers, the continuing education this requirement under this subsection will satisfy 3 of the 12 hours of continuing education required biennially pursuant to Section 429.52(4), F.S., and subsection (1) of this rule.

    4.d. Administrators, managers and direct contact staff affected by the continuing education this requirement under this subsection shall have up to 6 months after the effective date of this rule to meet the continuing education or in-service training requirement.

    (b) No change.

    (9) through (10) No change.

    (11) DO NOT RESUSCITATE ORDERS TRAINING REQUIREMENT.

    (a) Currently employed facility administrators, managers, direct care staff and staff involved in resident admissions must receive at least one hour of attend training in the facility’s policies and procedures regarding DNROs within 60 30 days after the effective date of this rule.

    (b) Newly hired facility administrators, managers, direct care staff and staff involved in resident admissions must receive at least one hour of attend training in the facility’s policy and procedures regarding DNROs within 30 days after employment.

    (c) No change.

    (12) No change.

    Rulemaking Specific Authority 429.178, 429.41, 429.52 FS. Law Implemented 429.07, 429.075, 429.178, 429.41, 429.52 FS. History– New 9-30-92, Formerly 10A-5.0191, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-5-05, 7-30-06, 10-9-06, 7-1-08,________.

     

    58A‑5.023 Physical Plant Standards.

    (1) NEW FACILITIES.

    (a) Newly Constructed Facilities.

    Newly constructed facilities that are to be licensed as assisted living facilities and any subsequent additions, modifications, alterations, renovations or refurbishing of such facilities should be aware of must comply with the following standards:

    1. No change.

    2. Section 633.022, F.S., Uniform Firesafety Standards, and Rule Chapter 69A-40, F.A.C., The Uniform Fire Safety Standards for Assisted Living Facilities, except for the specific National Fire Protection Association codes described in Section 429.41, F.S.

    (b) New Facilities in Converted Buildings.

    Existing structures not previously licensed as assisted living facilities that are to be converted to assisted living facilities and any subsequent additions, modifications, alterations, renovations or refurbishing of such facilities should be aware of must comply with the following standards:

    1. No change.

    2. Section 633.022, F.S., Uniform Firesafety Standards, and Rule Chapter 69A-40, F.A.C., The Uniform Fire Safety Standards for Assisted Living Facilities, except for the specific National Fire Protection Association codes described in Section 429.41, F.S.

    (2) EXISTING FACILITIES.

    (a) An assisted living facility that was initially licensed prior to the effective date of this rule must comply with the rule or building code in effect at the time of initial licensure, except that any part of the facility included in additions, modifications, alterations, refurbishing, renovations or reconstruction must comply with the currently adopted codes and standards referenced in subsection (1) of this rule. Determination of the installation of a fire sprinkler system in an existing facility must comply with the requirements described in Section 429.41, F.S.

    (b) No change.

    (3)(4) OTHER REQUIREMENTS.

    (a) through (d) No change.

    (4)(5) FACILITIES WITH 16 OR FEWER RESIDENTS.:

    Rulemaking Specific Authority 429.41 FS. Law Implemented 429.27, 429.41 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, 7-30-06,________.

     

    58A-5.025 Resident Contracts.

    (1) Pursuant to Section 429.24, F.S., prior to or at the time of admission, each resident or legal representative, shall execute a contract with the facility, which contains the following provisions:

    (a) through (j) No change.

    (k) A provision that residents must be assessed upon admission pursuant to subsection (2) of Rule 58A-5.0181, F.A.C., and every 3 years periodically thereafter, or after a significant change, pursuant to subsection (4) of that rule.

    (1) The facility’s policies and procedures for self-administration, assistance with self-administration and administration of medications, if applicable, pursuant to Rule 58A-5.0185, F.A.C. This also includes provisions regarding requirements for over-the-counter (OTC) products medications pursuant to subsection (8) of that rule.

    (m) The facility’s policies and procedures related to a properly executed Do Not Resuscitate Order. If a facility has a policy not to honor a properly executed DNRO, the facility must inform the resident, or legal representative, in writing of the policy pursuant to paragraph (3)(c) of Rule 58A-5.0183, F.A.C.

    (2) through (3) No change.

    Rulemaking Specific Authority 429.24, 429.41 FS. Law Implemented 429.24, 429.41 FS. History–New 10-17-99, Amended 7-30-06,________.

     

    58A-5.033 Administrative Enforcement.

    Facility staff shall cooperate with Agency 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 I of Chapter 429, F.S., and this rule chapter.

    (1) through (5) No change.

    (6) MORATORIUMS.

    (a) An immediate moratorium on admissions to the facility shall be placed on the facility when it has been determined that any condition in the facility presents an immediate or direct threat to the health, safety, or welfare of the residents in the facility. The following conditions are examples of threats constituting grounds for a moratorium:

    1. Presence of residents with stage 3 or 4 pressure sores;

    2. The presence of residents who require 24-hour nursing supervision;

    3. Food supply inadequate to provide proper nutrition to residents;

    4. Lack of sufficient staff to supervision or meet immediate residents’ needs;

    5. Notification by the fire marshal or the county health department that conditions exist which pose an imminent threat to residents; or

    6. Failure to provide medications as prescribed;

    (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 effective date of the moratorium shall be the date the facility receives a verbal and written notification from the Field Office. The notice shall contain the following information:

    1. Confirmation of the placement of the moratorium;

    2. A detailed explanation of the reasons for placing the moratorium;

    3. The criteria which the facility shall be required to meet before the moratorium will be lifted;

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

    5. Advising the facility of their right to request a hearing in accordance with Part II of Chapter 59-1, F.A.C. and Chapter 120, F.S.

    (c) Moratoriums shall not be lifted until the deficiencies have been corrected and the agency has determined through an appraisal survey that there is no longer any threat to the residents’ health, safety, or welfare. The removal of the moratorium will be communicated by a telephone call and confirmed by written notification.

    (d) During the moratorium, no new residents or previously discharged residents shall be admitted to the facility. Residents for whom the facility is holding a bed may return to the facility only after being informed that the facility is under a moratorium and with the prior approval of the local agency office.

    (e) When a moratorium is placed on a facility, agency notice of the moratorium shall be posted and visible to the public at the facility until the moratorium is lifted.

    (7) No change.

    Rulemaking Specific Authority 429.15, 429.23, 429.41, 429.42 FS. Law Implemented 429.07, 429.08, 429.11, 429.12, 429.14, 429.15, 429.17, 429.19, 429.256, 429.26, 429.23, 429.27, 429.28, 429.34, 429.41, 429.42 FS. History–New 9‑30‑92, Formerly 10A‑5.033, Amended 10‑30‑95, 10-17-99, 1-9-02, 7-30-06,________.