Definitions, Governing Authority, Administration and Staffing, Participant Care Standards, Basic Services, Optional Supportive Services, Participant and Program Data, Emergency Management Plan, Physical Plant, Sanitary Conditions, Housekeeping ...
RULE NOS.:RULE TITLES:
58A-6.002Definitions
58A-6.006Governing Authority, Administration and Staffing
58A-6.007Participant Care Standards
58A-6.009Basic Services
58A-6.010Optional Supportive Services
58A-6.011Participant and Program Data, Emergency Management Plan
58A-6.013Physical Plant, Sanitary Conditions, Housekeeping Standards and Maintenance
58A-6.015Adult Day Care Center Employee Training Requirements
58A-6.0151Specialized Alzheimer's Services Adult Day Care Center Employee Training Requirements
58A-6.016Adult Day Care Center Training Provider and Curriculum Approval
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. 41 No. 27, February 10, 2015 issue of the Florida Administrative Register.
58A-6.002 Definitions.
(1) The following terms are defined in Sections 429.901 and 429.918, F.S., and are applicable to this rule chapter: “ADRD Participant”, “Adult Day Care Center” or “Center,” “Agency,” “Basic Services,” “Department,” “Multiple or Repeated Violations,” “Operator,” “Owner,” “Participant,” “Specialized Alzheimer’s Services,” and “Supportive and Optional Services.”
(2) Additional definitions applicable in this rule chapter are as follows:
(a) “Activities of Daily Living” or “ADL” shall mean the functions or tasks for self-care and shall include: ambulation, bathing, dressing, eating, grooming, transferring, and toileting, self-administration of medications, and other personal hygiene activities.
(b) “Adult” shall mean any person 18 years of age or older.
(c) “Applicant for Licensure” shall mean the Owner or Operator of a Center or, if the Owner is a business entity, the person (i.e., corporate officer, general or limited partner) acting on in behalf of the entity.
(d) “Assistant Operator” shall mean an individual designated in writing by the Owner or Operator as having full responsibility and authority for the daily operation of the facility when the Owner or Operator is not on-site. The Assistant Operator shall meet the same minimum qualifications as the Operator.
(e) “Participant Capacity” shall mean the number of Participants for which a Center is licensed to provide care to at any given time and shall be based upon required net floor space.
(f) “Comprehensive Emergency Management Plan” or “Plan” shall mean a plan developed by the Adult Day Care Center describing how the Center will prepare for and respond to an emergency, pursuant to Section 58A-6.011(10), F.A.C.
(2)(g) through (2)(p) No change.
(q) “Participant File” shall mean a written record, prepared and kept by the Center which shall include: a Participant Care Plan, documenting adult day health services provided to the Participant, if any; medical and social history or copies of an examination completed by a physician; diagnosis; disabilities and limitations; rehabilitation potential;, short and long-term goals; recommended activities; orders for medication or modified diet, including such` as Supervision of Self-administered Medication; special needs for health or safety; permitted levels of physical activity; frequency of attendance at the Center; and notes as required in this rule chapter.
(2)(r) through (2)(u) No change.
(v) “Staff Providing Direct Care for ADRD Participants” means Staff providing personal or Specialized Alzheimer’s Services to ADRD Participants or Participants with dementia-related disorders, including, but not limited to, Owners, Operators, and Assistant Operators providing such services.
(x) “Staff in Direct Contact with ADRD Participants” means all Staff who are not Staff Providing Direct Care to ADRD Participants or Participants with dementia-related disorders residents, but whose duties may require them to interact with ADRD Participants or Participants with dementia-related disorders on a daily basis.
(2)(y) through (2)(aa) No change.
(bb) “Transportation Services” shall mean the conveyance of Participants between the Center and a designated location, as well as to and from services provided directly or indirectly by the Center facility. No Participant’s transportation to and from a designated location and the Center shall exceed two hours if the transportation is provided or arranged by the Center.
(2)(cc) No change.
Rulemaking Authority 429.929 FS. Law Implemented 429.901, 429.918, 429.929 FS. History–New 7-8-81, Amended 2-27-84, Formerly 10A-6.02, 10A-6.002, 59A-16.002, Amended 11-9-95, 3-29-98, 10-23-01, ________.
58A-6.006 Governing Authority, Administration and Staffing.
(1) The Center shall have a Governing Authority which shall establish policies in compliance with this rule chapter. Governing Authority, as defined in this rule chapter, may consist of one or more people, and designation of its membership or composition shall be determined by the Owner or Operator. The Governing Authority shall be responsible for ensuring compliance with standards requiring that:
(a) Admission criteria shall be determined by the Owner, Operator or Governing Authority and it may limit Participant eligibility to adults with Functional Impairments, in need of a protective environment or a program of therapeutic social and health activities and services as defined in this rule chapter. The Owner or Operator will assure that the admission of each Participant shall be reviewed within the confines of specific requirements set forth below:
1. Within forty-five days prior to admission to the Center, each person applying to be a Participant shall provide a statement signed by a physician licensed under Chapters 458 and 459, F.S., a Florida licensed health care provider under the direct supervision of a physician, or a county public health unit. The statement must be signed within forty-five days prior to admission to the Center, and must state that the applicant is free from tuberculosis in the communicable form and free from signs and symptoms of any other communicable disease. Any Participant who is diagnosed as having a communicable disease shall be excluded from participation until deemed non-infectious. However, Participants who have Human Immunodeficiency Virus (HIV) infection may be admitted to the Center, provided that they would otherwise be eligible according to this rule.
(1)(a)2. through (2) No change.
(3) Each Center shall comply with all standards, rules and regulations and shall be under the administrative control of the Operator or Assistant Operator. The Operator may supervise more than one Center, provided that a qualified, responsible Assistant Operator, duly appointed in writing, is in charge of each facility during the Operator’s absence.
(4) through (5)(b)6. No change.
7. A signed statement from a Florida licensed physician, a Florida licensed health care provider under the direct supervision of a physician, or a county public health unit, that the employee is free from tuberculosis in a communicable form, and free from apparent signs and symptoms of other communicable diseases. The statement must be signed no less than within forty-five days prior to beginning work in the Center.
8. Training certificates or copies of training certificates as required by subsection Section 58A-6.016(7), F.A.C.
(6) The Owner or Operator shall also be responsible for the administration of all components of the facility and accountable for the implementation and enforcement of all policies and procedures, standards of care, and program development in accordance with the social, physical and mental capabilities and needs of the Participants served. The Operator must be at least twenty-one years of age and have a high school diploma or GED.
(7) through (8) No change.
(9) Center Staff whose conduct constitutes abuse, neglect, or exploitation of a Participant shall immediately be terminated from employment and shall be reported to the Department of Children and Families Family Services in accordance with Section 415.103, F.S.
(10) No administrator who has been terminated pursuant to the provisions of subsection (9)(10) shall accept employment in an Adult Day Care Center and no Owner or Operator of a Center shall knowingly employ any person who has been terminated pursuant to subsection (9)(10).
(11) The Governing Authority shall establish policies and procedures to facilitate reporting of abuse, neglect or exploitation as defined in Section 415.102, F.S., and in accordance with Section 415.103, F.S., and the Operator shall ensure that the statewide toll free telephone number of the Department of Children and Families central abuse hotline, accompanied by the words “To Report the Abuse, Neglect, or Exploitation of an Elderly or Disabled Person, Please Call the Toll Free Number 1(800)96-ABUSE” is posted in a prominent place in the Center and made clearly visible.
Rulemaking Authority 429.929, FS. Law Implemented 429.929, 760.50 FS. History–New 7-8-81, Amended 2-27-84, Formerly 10A-6.06, 10A-6.006, 59A-16.006, Amended 11-9-95, 3-29-98, 10-23-01, ________.
58A-6.007 Participant Care Standards.
(1) through (3) No change.
(4) The Center shall not be required to accept or retain any applicant or Participant whose behavior and physical limitations are deemed hazardous to the safety of the individual or other Participants. Such conditions shall constitute a basis for termination of Center participation. Participation may be terminated after reasonable alternatives have failed, and upon written notification of the Participant, guardian and responsible person. Fifteen calendar days shall be allowed for arranging for alternative services for the Participant except in cases of emergency as determined by the Governing Authority or Operator of the Center.
(5) No change.
Rulemaking Authority 429.929, 429.918(12)(10) FS. Law Implemented 252.355, 429.929, 429.918, 415.103, 760.50 FS. History–New 7-8-81, Amended 2-27-84, Formerly 10A-6.07, 10A-6.007, 59A-16.007, Amended 11-9-95, 3-29-98, 10-23-01, ________.
58A-6.009 Basic Services.
(1) No change.
(2) To be licensed as an Adult Day Care Center, the Center shall conduct and document a count of all ADRD Participants present in the Center a minimum of every three hours times throughout each day. The count must be reconciled against the Participants’ attendance record to ensure Participants are not missing. The Center is responsible for the Personal Supervision of all Participants to ensure the Participants’ safety and welfare.
(3) To be licensed as an Adult Day Care Center, the following nutrition services shall be provided by the Center:
(a) Participants attending or in transit to the Center for four or more hours daily shall be served a meal which shall adhere to the U.S. Department of Health and Human Services and U.S. Department of Agriculture’s Dietary Guidelines for Americans 2010 (DGAs) and provides at least one-third of the current Recommended Dietary Reference Intakes as referenced in the DGAs Allowances of the Food and Nutrition Board, National Academy of Sciences, National Research Council (RDA), adjusted for age, sex and activity. Modified diets, if required, shall meet these nutritional standards to the extent medically possible. Menus approved and provided by Title III-C of the Older Americans Act or the Adult Care Food Program of USDA shall be evidence of meeting the one-third of the Dietary Reference Intakes RDA requirement.
(b) The Ddietary Reference Intakes requirement allowances shall be met by offering a variety of foods adapted to the food habits, preferences, and physical abilities of the Participants and shall be prepared using standardized recipes. A copy of the DGAs, which are hereby incorporated by reference, RDA interpreted by a daily food guide shall be available at no cost by writing to the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 or the local county public health unit.
(3)(c) through (3)(d)3. No change.
4. Menus not approved by or meeting the requirements of Title III-C of the Older Americans Act or the Adult Care Food Program of USDA shall be reviewed by a registered or Florida licensed dietitian or a dietetic technician supervised by a registered or Florida licensed dietitian to ensure that the menus are commensurate with the Dietary Reference Intakes as referenced in the DGAs current RDA, adjusted for age, sex and activity. Documentation of review of the menus shall be maintained in the Center files and shall include the signature and registration or license number of the reviewer and date reviewed. Menus shall be kept on file for one year and shall be accessible to Participants and families of Participants.
(e) If food is catered from outside sources, the catered meals must be prepared in an approved food establishment. nNo warewashing may take place on-site. Catered food, once delivered to an Adult Day Care Center, must be adequately protected. In order to provide catered meals through a third party, there must be a formal contract between the Center and the third party provider containing assurances that the provider will meet all food service and dietary standards.
(3)(f) No change.
58A-6.010 Supportive and Optional Services.
(1) through (5) No change.
(6) Adult day health care services for disabled adults or aged persons, provided the Center complies with the following:
(a) Make services available for a minimum of five hours per day five days per week, excluding legally recognized public legal holidays as posted by the facility. For purposes of this subsection, legal holiday shall mean any day which, by the laws of this state or the United States, is designated or recognized as a legal or public holiday or any day on which businesses or institutions are customarily closed.
(b) Provide or coordinate, in addition to the Basic Services specified in Rule 58A-6.009, F.A.C., and Supportive and Optional Services, pursuant to subsections (1), (2), (3), (4) and (5), the following adult day health care services:
1. Medical screening emphasizing prevention and continuity of care which includes routine blood pressure checks or blood glucose diabetic maintenance checks;
2. Nursing services including a configuration of services at different levels of intensity as determined by the nursing assessment, Participant Care Plan, and physician’s orders. Services shall include:
a. Health education and counseling including nutritional advice, liaison with the Participant’s personal physician, and notification of the Participant’s physician, as well as the caregiver or family, of any changes in the Participant’s health status;
b. Coordination of the provision of other health services provided outside the Center;
c. Supervision of health services provided by program aides.
3. Social services including: counseling for Participants’ families and caregivers; compilation of a social history and psychosocial assessment of formal and informal support systems;, mental and emotional status;, caregiver data;, information on planning for discharge; and referral for persons not appropriate for adult day care.
4. Additional medical services such as dental, ophthalmological, optometric, hearing aid, or laboratory services.
5. Transportation Services to and from the adult day health care services.
(6)(c) through (6)(d) No change.
(e) Centers providing adult day care or adult day health care services to Medicaid clients through a Medicaid waiver must also comply with the following:
1. Be enrolled as a Medicaid provider through the Agency’s for Health Care Administration’s Medicaid office.
2. Have a current authorization for services from an enrolled Medicaid waiver case manager. Case managers in a specific waiver program will authorize adult day health care ADHC services for enrolled waiver recipients. Those adult day health care ADHC providers must also be enrolled in the same waiver as those for whom services are authorized.
3. Comply with all provisions of the program and Medicaid waiver requirements.
Rulemaking Authority 429.929 FS. Law Implemented 429.929 FS. History–New 7-8-81, Formerly 10A-6.10, 10A-6.010, 59A-16.010, Amended 11-9-95, 3-29-98, ________.
58A-6.011 Participant and Program Data, Comprehensive Emergency Management Plan.
(1) The Owner or Operator shall establish, maintain and make available and ready for immediate use to the Agency, complete and accurate social, medical and fiscal records which fully disclose the extent of services to be maintained by the Center and for a the periods of two years time required by State and Federal law.
(2) through (7) No change.
(8) Major Incidents, as defined in this rule chapter shall be reported immediately to the Agency’s Complaint Administration Unit at the following website: http://ahca.myflorida.com/MCHQ/Field Ops/CAU.shtml immediately. Reports shall be made by the individual having first-hand knowledge of the incident and performing functions and responsibilities as an authorized agent and may include paid, emergency and temporary Staff, Volunteers and student interns.
(9) No change.
(10) Pursuant to Section 429.929(1)(g), F.S., as a part of the licensure process, each Center shall develop and follow a written Comprehensive Emergency Management Plan for emergency care during an internal or external disaster in accordance with Emergency Management Planning Criteria for Adult Day Care Facilities, dated July 2001, incorporated by reference. A copy of the July 2001 Emergency Management Planning Criteria for Adult Day Care Facilities may be obtained from the Agency’s Website at: http://www.fdhc.state.fl.us/MCHQ/Health_Facility_Regulation/Assisted_Living/docs/adcc/ADCC_CEMP_2008.pdf
(10)(a) through (11) No change.
Rulemaking Authority 429.929 FS. Law Implemented 429.929 FS. History–New 7-8-81, Amended 2-27-84, Formerly 10A-6.11, 10A-6.011, 59A-16.011, Amended 11-9-95, 3-29-98, 10-23-01,________.
58A-6.013 Physical Plant, Sanitary Conditions, Housekeeping Standards and Maintenance.
(1) No change.
(2) The Participant Capacity shall be determined by the total amount of Net Floor Space available for all of the Participants. Centers licensed prior to the effective date of this rule shall provide 30 square feet of net floor area per Participant. For Centers initially licensed after November 9, 1995, there shall not be less than 45 square feet of net floor area per Participant. Centers shall be required to provide additional floor space for special target populations to accommodate activities required by Participant care plans. A change in space usage that increases or decreases the Participant Capacity must continue to comply with all requirements of part III of Chapter 429, Florida Statutes, and this rule.
(3) through (4) No change.
(5) Center facilities shall consist of, but not be limited to, the following:
(a) Bathrooms;
(b) Dining areas;
(c) Kitchen areas;
(d) Rest areas; and
(e) Recreation and leisure time areas.
(6) through (14) No change.
(15) Every Center shall be maintained for the comfort and safety of the Participants and. Centers providing their own maintenance shall have an effective written maintenance plan that ensures preventive maintenance as well as immediate attention to and correction of hazardous or potentially hazardous conditions. The plan shall provide for:
(a) Keeping the building in good repair and free of hazards such as: cracks in floors, walls, or ceilings; warped or loose boards, tile, linoleum, handrails or railings; broken window panes; and any similar hazards.
(b) Keeping all heating, air conditioning, electrical, mechanical, water supply, fire protection and sewage disposal systems in a safe and functioning condition. Electrical wiring cords and appliances shall be maintained in a safe condition. Emergency generators, where existing, shall be tested monthly.
(c) Keeping all plumbing fixtures in good repair, properly functioning and satisfactorily provided with protection to prevent infiltration and contamination of the water supply.
(d) Painting the interior and exterior of the building as needed to keep it reasonably attractive. Loose, cracked or peeling wallpaper or paint shall be promptly replaced or repaired to provide a satisfactory finish.
(e) Keeping all furniture and furnishings clean and in good repair.
(f) Keeping the grounds and buildings in a safe, sanitary and presentable condition. Grounds and buildings shall be kept free from refuse, litter, and insect and rodent breeding areas.
(16) (16) A change in space usage that increases or decreases the Participant Capacity shall not be made without prior approval from the Agency’s central office, which shall ensure that such space use change would not place a Center out of compliance with standards contained in this chapter.
Rulemaking Authority 429.929 FS. Law Implemented 429.929 FS. History–New 7-8-81, Amended 2-27-84, Formerly 10A-6.13, 10A-6.013, 59A-16.013, Amended 11-9-95, 3-29-98, _________.
58A-6.015 Adult Day Care Center Staff Training Requirements.
(1) Each Adult Day Care Center licensed under Part III of Chapter 429, F.S., shall provide the following training.
(a) All Staff in Direct Contact with ADRD Participants and Staff Providing Direct Care for ADRD Participants shall receive one initial hour of training within ninety days of employment after June 30, 2004, which shall satisfy the requirement referenced in subsection 429.917(1)(b), F.S. The curriculum for the Initial one-hour training shall address the following subject areas:
1. Understanding Alzheimer’s Disease and Related Disorders;
2. Characteristics of Alzheimer’s Disease and Related Disorders; and
3. Communicating with Participants with Alzheimer’s Disease or Related Disorders.
(b) All Staff Providing Direct Care for ADRD Participants shall receive three hours of additional training after June 30, 2004, within nine months of employment, which shall satisfy the requirement referenced in subsection 429.917(1)(c), F.S. The curriculum for the three hours of additional training must address the following subject areas as they apply to Alzheimer’s Disease and Related Disorders:
1. Behavior management;
2. Assistance with Activities of Daily Living to promote the patient’s independence;
3. Activities for Participants;
4. Stress management for the caregiver;
5. Family issues;
6. Participant environment; and
7. Ethical issues.
(c) All training providers and their curricula must be approved by the Department or its designee pursuant to Rule 58A-6.016, Florida Administrative Code, prior to the commencement of training activities pursuant to this Rule.
(2) through (3) No change.
Rulemaking Authority 429.917(1), FS. Law Implemented 429.917(1) FS. History–New 1-1-04, Amended______.
58A-6.0151 Specialized Alzheimer’s Services Adult Day Care Center Staff Training Requirements.
(1) No change.
(2) Within three months of employment, all Staff in Direct Contact with ADRD Participants and all Staff Providing Direct Care for ADRD Participants at a Center designated as a Specialized Alzheimer’s services adult day care center pursuant to Section 429.918, F.S., and hired on or after July 1, 2012, must obtain four hours of Alzheimer’s disease and related disorders training pursuant to Section 58A-6.015(1) F.A.C.
(3) Within six months of employment, all Staff Providing Direct Care for ADRD Participants at a Center designated as a Specialized Alzheimer’s services adult day care center pursuant to Section 429.918, F.S., and hired on or after July 1, 2012, must obtain an additional four hours of dementia-specific training approved by the Department. The curriculum for the additional four hours of training must address the following subject areas as they apply to Alzheimer’s disease and related disorders:
a. understanding brain disease
b. normal brain functions and normal aging
c. understanding treatable and irreversible dementia
d. mental status tests
e. communication and the effects of damage to brain cells
f. influences on behavior and brain deterioration
g. interventions
h. physical causes and pain indications
i. common Alzheimer’s disease and related disorders medications and& side effects
j. malnutrition and & dehydration
k. activities of daily living - routines and schedules
l. validation therapy
m. safety - new and proven technologies
n. caregiver stress management - physical, emotional, and financial; burden tests
(4) All training providers and their curricula must be approved by the Department or its designee pursuant to Rule 58A-6.016, Florida Administrative Code, prior to the commencement of training activities pursuant to this Rule.
(5) All Staff Providing Direct Care For ADRD Participants shall participate in four hours of continuing education annually in topics related to Alzheimer’s disease and related disorders.
(6) No change.
58A-6.016 Adult Day Care Center Training Provider and Curriculum Approval.
(1) Persons seeking approval as an adult day care Alzheimer’s disease or related disorders training provider, pursuant to Sections 429.917 and 429.818, F.S. and Rules 58A-6.015 and 58A-6.0151, F.A.C., shall:
(a) provide the Department of Elder Affairs or its designee documentation that he or she holds a Bachelor’s degree in a health-care, human service, or gerontology-related field from an accredited college or university, or holds a license as a registered nurse; and
1. Possess at least two years of teaching or training experience as an educator of caregivers for persons with Alzheimer’s Disease or Related Disorders; or
(1)(a)2. through (1)(a)4. No change.
(b) complete DOEA form ADC/ADRD-001, Application for Adult Day Care Alzheimer’s Disease or Related Disorders Training Provider Certification, dated March 2015 August 2014, which is incorporated by reference and available at the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 and the following website: (web-link effective date).
(2) Persons seeking to obtain approval of an adult day care Alzheimer’s disease or related disorders curriculum pursuant to Rule 58A-6.015, F.A.C. shall complete DOEA form ADC/ADRD-002, Application for Adult Day Care Three-Year Curriculum Certification, dated March 2015 August 2014, which is incorporated by reference and available at the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 and at the following website: (web-link effective date).
(3) Persons seeking to obtain approval of a specialized Alzheimer’s services adult day care center curriculum pursuant to Rule 58A-6.0151, F.A.C. shall complete DOEA form SAADC/ADRD-003, Application for Specialized Alzheimer’s Disease Adult Day Care Three-Year Curriculum Certification, dated March 2015 August 2014, which is incorporated by reference and available at the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 and the following website: (web-link effective date).
(4) No change.
(5) Upon receipt of a training provider or a training curriculum application, the Department or its designee shall respond in writing within 30 calendar days in one of the following ways:
(a) Notify the applicant that the application is approved or not approved pursuant to Rules 58A-6.015, 58A-6.0151 and 58A-6.016(1)-(3), Florida Administrative Code. If an application is not approved, the Department or its designee shall respond in writing indicating the reasons for not approving the application and describing the information or documentation needed for approval;
(5)(b) through (10) No change.
