The purpose and effect of the proposed rule amendments is to: include an additional requirement for determining continued residency resulting in amendments to AHCA Form 1823, which is incorporated by reference; include changes to resident care ...

DEPARTMENT OF ELDER AFFAIRS
Federal Aging Programs

RULE NO: RULE TITLE
58A-5.0131: Definitions
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-5.029: Limited Mental Health
58A-5.033: Administrative Enforcement
PURPOSE AND EFFECT: The purpose and effect of the proposed rule amendments is to: include an additional requirement for determining continued residency resulting in amendments to AHCA Form 1823, which is incorporated by reference; include changes to resident care standards as it pertains to third party services; include providing the work schedule for direct care staff as part of the staffing standards; include amendments to medication practices, specifically in regards to over the counter medications; include changes to staff training requirements, specifically in regards to HIV/AIDS, pursuant to Section 381.0035, F.S., additional limited mental health training, and establishing the minimum score for successful completion of the core training competency exam; amend the physical plant standards to coincide with the Florida Building Code, 2007 Edition; and Chapter 633, F.S., Fire Prevention and Control; include changes to the resident contract, specifically notification that the resident must be assessed for admission as well as for continued residency, and statements regarding self-administration, assistance with self-administration and administration of medications, including over-the-counter medications, in resident contracts or written statement of house rules; amend language to stress that facilities must take appropriate action to assist, if necessary, in facilitating the provision of services for residents in facilities holding standard, extended congregate care, limited nursing services and limited mental health licenses; and deletion of the use of a temporary license under administrative enforcement. The purpose and effect of a new rule is to address procedures for do not resuscitate orders.
SUBJECT AREA TO BE ADDRESSED: Additional requirement for determining continued residency; changes to AHCA Form 1823, which is incorporated by reference; changes to resident care standards as in pertains to third party services; provision of the work schedule for direct care staff for residents or representatives; amendments to medication practices, specifically in regards to over-the-counter medications; changes to staff training requirements, specifically HIV/AIDS, additional limited mental health training and establishing a minimum score for the core training examination; amendments to the physical plant standards to coincide with the Florida Building Code, 2007 Edition, and Chapter 633, F.S., Fire Prevention and Control; notification that the resident must be assessed for admission as well as for continued residency, requiring use of AHCA Form 1823 for the latter determination; requirement regarding the facility’s policies and procedures for self-administration, assistance with self-administration and administration of medications, including over-the-counter medications, to be included in resident contracts; amendment to stress that facilities must take appropriate action to assist, if necessary, in facilitating the provision of services for residents in facilities holding standard, extended congregate care, limited nursing services and limited mental health licenses; deletion of the use of a temporary license; and procedures for do not resuscitate orders.
SPECIFIC AUTHORITY: 429.15, 429.178, 429.23, 429.24, 429.255, 429.26, 429.275, 429.41, 429.42, 429.52 FS.
LAW IMPLEMENTED: 429.02, 429.04, 429.075, 429.12, 429.14, 429.15, 429.17, 429.176, 429.178, 429.19, 429.24, 429.255, 429.256, 429.23, 429.26, 429.27, 429.275, 429.28, 429.34, 429.41, 429.42, 429.44, 429.445, 429.47, 429.52 FS.
A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: September 22, 2009, 9:00 a.m. – 12:30 p.m. EDT
PLACE: Department of Elder Affairs, Conference Room 301, 4040 Esplanade Way, Tallahassee, Florida 32399-7000
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, Florida 32399-7000; telephone number: [phone]; Email address: [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, Florida 32399-7000; telephone number: [phone]; Email address: [e-mail]
THE TEXT OF THE PROPOSED RULE DEVELOPMENT AND AHCA FORM 1823, INCORPORATED BY REFERENCE, IS LOCATED ON THE WEBSITE BELOW UNDER THE HEADING ENTITLED “ASSISTED LIVING FACILITIES, RULE CHAPTER 58A-5, F.A.C.” http://elderaffairs.state.fl.us/english/rulemaking.php

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

58A‑5.0131 Definitions.

In addition to the terms defined in Section 429.02, F.S., the following definitions are applicable in this rule chapter:

(1) through (34) No change.

(35) “Temporary license” means a license issued by Agency for Health Care Administration to an assisted living facility that supersedes and temporarily replaces the current license and remains in place pending the final disposition of a proceeding involving the suspension or revocation of an assisted living facility license.

(36) through (37) renumbered (35) through (36) No change.

Rulemaking Specific Authority 429.23, 429.41 FS. Law Implemented 429.02, 429.07, 429.075, 429.11, 429.14, 429.178, 429.19, 429.255, 429.23, 429.28, 429.41, 429.47, 429.52 FS. History–New 9‑30‑92, Formerly 10A‑5.0131, Amended 10‑30‑95, 6‑2‑96, 4‑20‑98, 10-17-99, 1-9-02, 7-30-06,________.

 

58A‑5.016 License Requirements.

(1) SERVICE PROHIBITION.

(SUBSECTION TITLE ADDED. NO CHANGE TO LANGUAGE)

(2) LICENSE TRANSFER PROHIBITION.

(SUBSECTION TITLE ADDED. NO CHANGE TO LANGUAGE)

(3) CHANGE IN USE OF SPACE REQUIRING CENTRAL OFFICE APPROVAL.

(SUBSECTION TITLE ADDED. NO CHANGE TO LANGUAGE)

(4) CHANGE IN USE OF SPACE REQUIRING FIELD OFFICE APPROVAL.

(SUBSECTION TITLE ADDED. NO CHANGE TO LANGUAGE)

(5) CONTIGUOUS PROPERTY.

(SUBSECTION TITLE ADDED. NO CHANGE TO LANGUAGE)

(6) PROOF OF INSPECTIONS.

(SUBSECTION TITLE ADDED. NO CHANGE TO LANGUAGE)

(7) MEDICAID WAIVER RESIDENTS.

Upon request, the facility administrator or designee must identify Medicaid waiver residents to the agency and the department for monitoring purposes authorized by state and federal laws.

(8) THIRD PARTY SERVICES.

(a) In instances when residents require services from a third party provider, the facility administrator or designee must take appropriate 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. These are services as described in the following documents:

1. AHCA Form 1823, Section 3, incorporated by reference in paragraph 58A-5.0181(2)(b), F.A.C.; or

2. Service plan for a resident in a facility holding an extended congregate care license pursuant to Rule 58A-5.030, F.A.C.; or

3. Community living support plan for a mental health resident receiving services in a facility holding a limited mental health license pursuant to Rule 58A-5.029, F.A.C.

(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 notified by residents or representatives, must take appropriate 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.

Rulemaking Specific Authority 429.41 FS. Law Implemented 429.07, 429.11, 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 Residency Criteria and Admission Procedures, Appropriateness of Placement and Continued Residency Criteria.

(1) No change.

(2) HEALTH ASSESSMENT.

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

1. through 6. No change.

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

8. The date of the examination and the name, signature, address, phone number and license number of the examining health care provider physician or ARNP. The medical examination may be conducted by a currently licensed health care provider physician or ARNP from another state.

(b) Medical examinations completed after the resident’s admission of the resident to the facility must be completed within 30 days of the admission date of admission and must be recorded on AHCA Form 1823, the Resident Health Assessment For Assisted Living Facilities and Adult Family-Care Homes, AHCA Form 1823,_______2009. The form January 2006, which 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%_Jan_2006_.pdf. (New form date [_____2009]) The form must be completed as follows: Previous versions of this form completed up to six (6) months after 7-30-06 are acceptable.

1. The information in Section 1, Health Assessment, must be completed by the resident’s licensed health care provider and must be based on a face-to-face examination.

2. The facility administrator, or designee, must complete Section 2 of the form, Self-Care and General Oversight Assessment.

3. The facility administrator, or designee, must complete Section 3 of the form entitled Services Offered or Arranged by the Facility, except for the following:

a. Facilities holding an extended congregate care license; or

b. Mental health residents receiving services under community living support plans in facilities holding limited mental health licenses.

(c) through (g) No change.

(3) ADMISSION PACKAGE.

(a) The facility shall make available to potential residents a written statement(s), which includes the following information listed below. A copy of the facility resident contract or facility brochure containing all the required information shall meet this requirement:

1. through 10. No change.

11. A statement of the facility policy concerning Do Not Resuscitate Orders pursuant to Section 429.255, F.S., and Advance Directives pursuant to Chapter 765, F.S., and Rule 58A-5.0183, F.A.C.

12. through 14. No change.

(b) Prior to or at the time of admission, the resident, responsible party, guardian, or attorney in fact, if applicable, shall be provided with the following:

1. No change.

2. A copy of the facility statement described in paragraph (a) of this subsection if one has not already been provided;

3. through 4. No change.

(c) No change.

(4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (e) of this subsection, cCriteria for continued residency in a facility holding a standard, limited nursing services, or limited mental health license shall be the same as the criteria for admission. A determination of the appropriateness of an individual’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 facility must make the determination 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. except as follows:

(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 must may 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 429.02, 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. Pursuant to Section 765.110, F.S., these policies and procedures shall not condition treatment or admission upon whether or not the individual has executed or waived a DNRO. The ALF must provide the following to each resident, or resident’s representative, at the time of admission:

1. A copy of Form SCHS-4-2006, “Health Care Advance Directives – The Patient’s Right to Decide,” effective April 2006, or with a copy of some other substantially similar document which incorporates information regarding advance directives included in Chapter 765, F.S. Form SCHS-4-2006 is hereby incorporated by reference and is available from the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 34, Tallahassee, FL 32308, or the agency’s Web site at: http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/HC_Advance_Directives/docs/adv_dir.pdf; and

2. Written information concerning the ALF’s policies regarding DNROs; and

3. Information about how to obtain DH Form 1896, Florida Do Not Resuscitate Order Form, incorporated by reference in Rule 64E-2.031, F.A.C.

(b) Documentation must be contained in the resident’s record indicating whether or not the resident has executed a DNRO. If a DNRO has been executed, a copy of that document must be made a part of the resident’s record. If the ALF does not receive a copy of a resident’s executed DNRO, the ALF must document in the resident’s record that it has requested a copy.

(2) LICENSE REVOCATION.

Pursuant to Section 765.110, F.S., an ALF shall be subject to revocation of its license pursuant to Section 408.815, F.S., if, as a condition of treatment or admission, it requires an individual to execute or waive a DNRO.

(3) DNRO PROCEDURES.

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

(a) In instances when a licensed health care provider is present at the facility and a resident experiences cardiopulmonary distress, the licensed health care provider may withhold cardiopulmonary resuscitation.

(b) In instances when a resident is receiving hospice services, facility staff must immediately contact the hospice. The hospice procedures shall take precedence over those of the assisted living facility.

(c) When conditions in paragraphs (a) and (b) of this subsection are not met, the following procedure shall apply:

1. Staff must immediately contact “911;”

2. A staff member trained in first aid must administer first aid; and

3. Once emergency services arrive, cardiopulmonary resuscitation may be withheld or withdrawn by an individual pursuant to Section 401.45, F.S.

(4) LIABILITY.

Pursuant to Section 429.255, F.S., ALF providers shall not be subject to criminal prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct, for following the procedures set forth in subsection (3) of this rule, which involves withholding or withdrawing cardiopulmonary resuscitation pursuant to a Do Not Resuscitate Order and rules adopted by the department. Any ALF provider, who, in good faith, obeys the directives of an existing DNRO, executed pursuant to Section 401.45, F.S., will not be subject to prosecution or civil liability for his or her performance regarding patient care.

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, 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) MEDICATIONS.

For purposes of this subsection, the term OTC includes, but is not limited to, OTC medications, vitamins, nutritional supplements and nutraceuticals.

(a) No change.

(b) When centrally stored, OTC medications Non‑prescription over‑the‑counter drugs, including those prescribed by a health care provider when centrally stored, must shall be labeled with the resident’s name. In addition, and the manufacturer’s label with directions for use, or the health care provider’s order with directions for use, must shall be kept with the medication. No other labeling requirements are necessary.

(c) Residents or their representatives may purchase OTC medications from an establishment of their choice. When an over‑the‑counter medication is prescribed by a health care provider, the medication becomes a prescription medication and shall be managed in accordance with prescription medication under this rule.

(d) As part of its policies and procedures, a facility cannot require a health care provider’s order for all OTC medications when a resident self-administers, or when staff provides assistance with self-administration or administration of medications. However, in the event that staff becomes concerned for 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, and the resident’s health care provider. The resident’s health care provider shall make the determination as to whether the OTC medication is:

a. Contraindicated and should be discontinued; or

b. Safe when taken as directed; or

c. Safe but provides 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) Minimum staffing:

1. through 2. No change.

3. In facilities with 17 or more residents, there shall be at least one staff member awake at all hours of the day and night.

4. through 8. No change.

(b) No change.

(c) The facility must shall maintain a written work schedule which reflects its the facility’s 24-hour staffing pattern for a given time period. The facility must make the work schedules for direct care staff available to residents or representatives, and make them aware of how to obtain it.

(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) ASSISTED LIVING FACILITY CORE TRAINING REQUIREMENTS AND COMPETENCY TEST.

(a) No change.

(b) Administrators and managers must successfully complete the assisted living facility core training requirements within 3 months from the date of becoming a facility administrator or manager. Successful completion of the core training requirements includes passing the competency test. The minimum passing score for the competency test is 75%. Administrators who have attended core training prior to July 1, 1997, and managers who attended the core training program prior to April 20, 1998, shall not be required to take the competency test. Administrators licensed as nursing home administrators in accordance with Part II of Chapter 468, F.S., are exempt from this requirement.

(c) through (e) No change.

(2) No change.

(3) HUMAN IMMUNODEFICIENCY VIRUS/ ACQUIRED IMMUNE DEFICIENCY SYNDROME (HIV/AIDS). Pursuant to Section 381.0035, F.S., all facility employees, with the exception of employees subject to the requirements of Section 456.033, F.S., must complete biennially, a one-time continuing education course on HIV and AIDS, including the topics prescribed in the Section 381.0035, F.S. New facility staff must obtain the an initial training on HIV/AIDS within 30 days of employment, unless the new staff person previously completed the initial training and has maintained the biennial continuing education requirement. Documentation of compliance must be maintained in accordance with subsection (11) of this rule.

(4) No change.

(5) DNROs.

(a) Currently employed facility administrators, managers, direct care staff and staff involved in resident admissions must attend training in the facility’s policies and procedures regarding DNROs within 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 attend training in the facility’s policy and procedures regarding DNROs within 30 days after employment.

(c) Training shall consist of the information included in Rule 58A-5.0183, F.A.C.

(5) through (7) renumbered (6) through (8) No change.

(9)(8) LIMITED MENTAL HEALTH TRAINING. Pursuant to Section 429.075, F.S., the administrator, manager, and staff in direct contact with mental health residents in a facility with a limited mental health license must receive a minimum of 6 hours training provided or approved by the Department of Children and Family Services within 6 months of the facility’s receiving a limited mental health license or within 6 months of employment in a facility holding a limited mental health license. Staff in “direct contact” means direct care staff and staff whose duties take them into resident living areas and require them to interact with mental health residents on a daily basis. The term does not include maintenance, food service, or administrative staff if such staff have only incidental contact with mental health residents.

(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. A minimum of 6 hours of specialized training in working with individuals with mental health diagnoses.

a. The training must be provided or approved by the Department of Children and Families and must be taken within 6 months of the facility’s receiving a limited mental health license or within 6 months of employment in a limited mental health facility.

b. Staff in “direct contact” means direct care staff and staff whose duties take them into resident living areas and require them to interact with mental health residents on a daily basis. The term does not include maintenance, food service or administrative staff, if such staff have only incidental contact with mental health residents.

c. Training received under this subparagraph may count once for 6 of the 12 hours of continuing education required for administrators and managers pursuant to Section 429.52(4), F.S., and subsection (1) of this rule.

2. A minimum of 3 hours of continuing education annually thereafter in subjects dealing with mental health diagnoses and issues. The training may be provided by, or approved by, the Department of Children and Families or a mental health provider, as defined under Chapters 458, 490 and 491, F.S. Online training is acceptable.

a. For administrators and managers, this annual requirement will satisfy 6 of the 12 hours of continuing education required biennially pursuant to Section 429.52(4), F.S., and subsection (1) of this rule.

b. Administrators, managers and direct contact staff affected by this requirement shall have up to 6 months after the effective date of this rule to meet the continuing education requirement.

(b)(a) Administrators, managers and staff receiving this training do not have to repeat the initial this training should they change employers provided they present the employee provides a copy of their the employee’s training certificate to the employee’s current employer for retention in the facility’s personnel files. They must ensure that copies of the continuing education training certificates are retained in their personnel files.

(b) Training received under this subsection may count once for 6 of the 12 hours of continuing education required for administrators and managers under subsection (1) of this rule.

(9) through (11) renumbered (10) through (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) GENERAL REQUIREMENTS.

(a) The ALF must shall be located, designed, equipped, and maintained to promote a residential, non-medical environment, and provide for the safe care and supervision of all residents.

(b) The ALF is required to meet all applicable requirements pursuant to Section 434 of the Florida Building Code, 2007 Edition; Chapter 633, F.S., Fire Prevention and Control; and Rule Chapter 69A-40, F.A.C., The Uniform Fire Safety Standards for Assisted Living Facilities. The facility’s physical structure, including the interior and exterior walls, floors, roof and ceilings shall be structurally sound and in good repair. Peeling paint or wallpaper, missing ceiling or floor tiles, or torn carpeting shall be repaired or replaced. Windows, doors, plumbing, and appliances shall be functional and in good working order. All furniture and furnishings shall be clean, functional, free-of-odors, and in good repair. Appliances may be disabled for safety reasons provided they are functionally available when needed.

(c) In order to ensure a safe and sanitary environment, the ALF shall be subject to annual inspection by the county health department pursuant to Chapter 64E-12, F.A.C.

(d) Indoor radon testing as mandated by Section 404.056(5), F.S., shall be completed by all facilities.

(2) HEATING AND COOLING.

(a) When outside temperatures are 65 degrees Fahrenheit or below, an indoor temperature of at least 72 degrees Fahrenheit shall be maintained in all areas used by residents during hours when residents are normally awake. During night hours when residents are asleep, an indoor temperature of at least 68 degrees Fahrenheit shall be maintained.

(b) During hours when residents are normally awake, mechanical cooling devices, such as electric fans, must be used in those areas of buildings used by residents when inside temperatures exceed 85 degrees Fahrenheit provided outside temperatures remain below 90 degrees Fahrenheit. No residents shall be in any inside area that exceeds 90 degrees Fahrenheit. However, during daytime hours when outside temperatures exceed 90 degrees, and at night, an indoor temperature of no more than 81 degrees Fahrenheit must be maintained in all areas used by residents.

(c) Residents who have individually controlled thermostats in their bedrooms or apartments shall be permitted to control temperatures in those areas.

(3) COMMON AREAS.

(a) A minimum of 35 square feet of living and dining space per resident, live‑in staff, and live‑in family member shall be provided except in facilities comprised of apartments. This space shall include living, dining, recreational, or other space designated accessible to all residents, and shall not include bathrooms, corridors, storage space, or screened porches which cannot be adapted for year round use. Facilities with apartments may count the apartment’s living space square footage as part of the 35 square footage living and dining space requirement.

1. Those facilities which were licensed as of May 14, 1981, which demonstrate compliance with all other applicable rules shall be granted a 10 percent waiver in the square footage requirement upon request.

2. Those facilities also serving as adult day care centers must provide an additional 35 square feet of living and dining space per adult day care client. Excess floor space in residents’ bedrooms or apartments cannot be counted toward meeting the requirement of 35 square feet of living and dining space requirements for adult day care participants. Day care participants may not use residents’ bedrooms for resting unless the room is currently vacant.

(b) A room, separate from resident bedrooms, shall be provided where residents may read, engage in socialization or other leisure time activities. Comfortable chairs or sofas shall be provided in this communal area.

(c) The dining area shall be furnished to accommodate communal dining.

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

(a) Resident bedrooms designated for single occupancy shall provide a minimum inside measurement of 80 square feet of usable floor space. Usable floor space does not include closet space or bathrooms.

(b) Resident bedrooms designated for multiple occupancy shall provide a minimum inside measurement of 60 square feet of usable floor space per room occupant.

(c) Resident bedrooms designated for multiple occupancy in facilities newly licensed or renovated 6 months after 10-17-99, shall have a maximum occupancy of two persons. Resident bedrooms designated for multiple occupancy in facilities licensed prior to 10-17-99, shall have a maximum occupancy of four persons.

(d) All resident bedrooms shall open directly into a corridor, common use area or to the outside. A resident must be able to exit his bedroom without having to pass through another bedroom unless the 2 rooms have been licensed as one bedroom.

(2)(e) BEDROOMS. Pursuant to Section 429.27, F.S., residents shall be given the option of using their his/her own belongings as space permits. When the facility supplies the furnishings, eEach resident bedroom or sleeping area must have at least, where furnishings are supplied by the facility shall, at a minimum, be furnished with the following furnishings:

1. A clean, comfortable bed with a mattress no less than 36 inches wide in width and 72 inches long, in length with the top surface of the mattress a comfortable height to ensure assure easy access by the resident;

2. A closet or wardrobe space for the hanging of clothes;

3. A dresser, chest, or other furniture designed for the storage of personal effects; and

4. A table, bedside lamp or floor lamp, and waste basket; and, and comfortable chair shall be provided, if requested.

5. A comfortable chair, if requested.

(f) All resident bedrooms shall be for the exclusive use of residents. Live-in staff and their family members shall be provided with sleeping space separate from the sleeping and congregate space required for residents.

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

(5) BATHROOMS.

(a) There shall be at least one bathroom with one toilet and sink per six persons, and one bathtub or shower per eight persons. All residents, all live-in staff and family members, and respite care participants must be included when calculating the required number of toilets, sinks, bathtubs and showers. All adult day care participants shall be included when calculating the required number of toilets and sinks.

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

(c) There shall be non‑slip safety devices such as bath mats or peel off stickers in the showers and bathtubs of all facilities. Showers and bathtubs with a non‑skid surface require a separate non‑skid device only if the surface is worn. Grab bars shall be required in showers and bathtubs. Grab bars, whether portable or permanent, must be securely affixed to the floor or adjoining walls. Facilities newly licensed or renovated 6 months after (10-17-99) must have grab bars next to the commode.

(d) Sole access to a toilet or bathtub or shower shall not be through another resident’s bedroom, except in apartments within a facility.

(4)(e) PRIVACY. Residents who use portable bedside commodes must shall be provided with privacy during in their use.

(5)(6) LINENS AND LAUNDRY. Facilities must shall make available linens and personal laundry services for residents who require such services. Linens provided by a facility shall be free of tears, stains, and not be threadbare.

(7) SECURITY. External boundaries of a facility or a distinct part of a facility, including outside areas, may be secured using egress control or perimeter control devices if the following conditions are met.

(a) The use of the device complies with all life-safety requirements.

(b) Residents residing within a secured area are able to move freely throughout the area, including the resident’s bedroom or apartment, bathrooms and all common areas, and have access to outdoor areas on a regular basis and as requested by each resident.

(c) Residents capable of entering and exiting without supervision have keys, codes, or other mechanisms to exit the secured area without requiring staff assistance.

(d) Staff who provide direct care or who have regular contact with residents residing in secured areas complete Level 1 Alzheimer’s training as described in Rule 58A-5.0191, F.A.C.

(6)(8) Pursuant to Section 429.41, F.S., facilities with 16 or fewer residents are shall not be required to maintain an accessible telephone in each building where residents reside, maintain written staff job descriptions, have awake night staff, or maintain standardized recipes as provided in paragraphs 58A-5.0182(6)(g), 58A-5.019(2)(e), 58A-5.019(4)(a), and 58A-5.020(2)(b), F.A.C., respectively.

Rulemaking Specific Authority 429.41 FS. Law Implemented 404.056, 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 the residents legal representative, shall, prior to or at the time of admission, 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 periodically thereafter pursuant to subsection (4) of that rule.

(l) 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 requirements for over-the-counter medications pursuant to subsection (8) of that rule.

(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-5.029 Limited Mental Health.

(1) No change.

(2) RECORDS.

(a) through (b) No change.

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

1. through 2. No change.

3. A cCommunity lLiving sSupport pPlan prepared by the resident’s case manager in consultation with the administrator.

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

(i) Includes the specific needs of the resident which must be met in order to enable the resident to live in the assisted living facility and the community;

(ii) Includes the clinical mental health services to be provided by the mental health care provider to help meet the resident’s needs, and the frequency and duration of such services;

(iii) Includes any other services and activities to be provided by or arranged for by the mental health care provider or mental health case manager to meet the resident’s needs, and the frequency and duration of such services and activities;

(iv) Includes the obligations of the facility to facilitate and assist the resident in attending appointments and arranging transportation to appointments for the services and activities identified in the plan which have been provided or arranged for by the resident’s mental health care provider or case manager;

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

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

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

(viii) Is updated at least annually;

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

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

b. Those portions of a service or treatment plan prepared pursuant to Rule 65E-4.014, F.A.C., which address all the elements listed in sub-subparagraph a. above may be substituted.

4. Cooperative Agreement which provides procedures and directions for accessing emergency and after-hours care for mental health residents. The mental health care provider for each mental health resident and the facility administrator or designee shall, within 30 days of the resident’s admission to facility or receipt of the resident’s appropriate placement assessment, whichever is later, prepare a written statement which:

a. Provides procedures and directions for accessing emergency and after-hours care for the mental health resident. The provider must furnish the resident and the facility with the provider’s 24-hour emergency crisis telephone number.

b. Must be signed by the administrator or designee and the mental health care provider, or by a designated representative of a Medicaid prepaid health plan if the resident is on a plan and the plan provides behavioral health services under Section 409.912, F.S.

c. May cover all mental health residents of the facility who are clients of the same provider.

d. May be included in the Community Living Support Plan described in subparagraph 3.

(d) Missing documentation required in subparagraphs (c)3. and 4. of this subsection shall not be considered a deficiency for agency survey purposes if the facility can demonstrate that it has made a good faith effort to obtain the required documentation from the Department of Children and Family Services (DCFS), or the mental health care provider under contract to provide mental health services to clients of DCFS the department.

(3) No change.

Rulemaking Specific Authority 429.41 FS. Law Implemented 394.4574, 429.02, 429.075, 429.26, 429.41, 409.912 FS. History– New 8-15-90, Amended 9-30-92, Formerly 10A-5.029, Repromulgated 10-30-95, Amended 6-2-96, 11-2-98, 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 (6) No change.

(7) TEMPORARY LICENSE. Temporary licenses as defined in subsection 58A-5.0131(37), F.A.C., may be issued by the Agency upon the initiation of any proceeding pursuant to Section 429.14(8), F.S.

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, 429.12, 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,________.