The purpose of the proposed rule is to implement portions of recommendations proposed by the Governor’s Assisted Living Facility Workgroup, recommendations from members of the public received in rule workshops, as well as rule recommendations ...

 

DEPARTMENT OF ELDER AFFAIRS

Federal Aging Programs

RULE NOS.:RULE TITLES:

58A-5.0131Definitions

58A-5.014License Application, Change of Ownership, and Provisional Licenses

58A-5.015License Renewal and Conditional Licenses

58A-5.016License Requirements

58A-5.0161Inspection Responsibilities

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

58A-5.0182Resident Care Standards

58A-5.0185Medication Practices

58A-5.0186Do Not Resuscitate Orders (DNROs)

58A-5.019Staffing Standards

58A-5.0191Staff Training Requirements and Competency Test

58A-5.0194Alzheimer’s Disease or Related Disorders Training Provider and Curriculum Approval

58A-5.020Food Service Standards

58A-5.021Fiscal Standards

58A-5.023Physical Plant Standards

58A-5.024Records

58A-5.0241Adverse Incident Report

58A-5.0242Liability Claim Report

58A-5.025Resident Contracts

58A-5.026Emergency Management

58A-5.029Limited Mental Health

58A-5.030 Extended Congregate Care Services

58A-5.031Limited Nursing Services

58A-5.033Administrative Enforcement

58A-5.035Waivers

PURPOSE AND EFFECT: The purpose of the proposed rule is to implement portions of recommendations proposed by the Governor’s Assisted Living Facility Workgroup, recommendations from members of the public received in rule workshops, as well as rule recommendations developed by the Assisted Living Facility Negotiated Rulemaking Committee. Such negotiated committee recommendations were the consensus product of the individuals designated to represent the interests of entities and persons affected by the rule. In addition to implementing these recommendations, the proposed rules were developed to address statutory changes enacted in Part II, Chapter 408 and Part I, Chapter 429, Florida Statutes, regarding the regulation of assisted living facilities.

SUMMARY: The proposed rule eliminates regulatory conflicts between Chapters 408 and 429; Florida Statutes, streamlines, clarifies, and reduces burdensome reporting requirements; and addresses necessary safeguards to ensure the health, safety, and welfare of individuals residing in Florida’s assisted living facilities. Specifically, the proposed rule addresses facility licensing requirements; admission procedures, appropriateness of resident placement and continued residency requirements; aging in place initiatives; medication practices; staffing standards, including training requirements and imposition of competency testing; facility food service standards; resident contracts and certain financials standards; emergency management within facilities; resident and facility record requirements; and the scope of health services provided by third parties.

SUMMARY OF STATEMENT OF REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The agency has determined that this rule will have an adverse impact on small business or likely will directly or indirectly increase regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. Phase I recommendations of the Governor’s Assisted Living Facility Workgroup incorporated within the proposed rule an increase in core training and continuing education requirements for administrators and managers of assisted living facilities. The core training curriculum to be completed by prospective administrators or managers will be increased from 26 to 40 hours, while the biennial continuing education requirements for existing administrators and managers will be increased from 12 to 18 hours. While the proposed rule is anticipated to have a fiscal impact on the state’s private sector, it is not expected to require the expenditure of state funds, will not negatively impact the delivery of services by state agencies, and will not otherwise divert state resources. A Statement of Regulatory Costs (“SERC”) is being prepared by the department.

The Department has determined that the proposed rule is expected to require legislative ratification because the rule is likely to increase regulatory costs in excess of $1 million in the aggregate within 5 years after the implementation of the rule.

Any person who wishes to provide information regarding the statement of estimated regulatory costs or to provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days after publication of this notice.

RULEMAKING AUTHORITY: 429.07, 429.17, 429.178, 429.23, 429.24, 429.255, 429.256, 429.27, 429.275, 429.41, 429.42, 429.52 FS.

LAW IMPLEMENTED: 429.04, 429.07, 429.075, 429.08, 429.11, 429.12, 429.14, 429.17, 429.174, 429.178, 429.19, 429.20, 429.23, 429.24, 429.255, 429.256, 429.26, 429.27, 429.275, 429.28, 429.34, 429.35, 429.41, 429.42, 429.44, 429.445, 429.47, 429.52 FS.

A PUBLIC HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: December 19, 2013, 9:30 a.m. – 12:30 p.m.

PLACE: Florida Department of Elder Affairs, 4040 Esplanade Way, Room 225F, Tallahassee, Florida 32399. To participate by webinar, please register at https://www2.gotomeeting.com/register/257760858 at least 5 days prior to the hearing. Access to a computer with an internet connection is required for participation by webinar.  If you do not have internet access and are unable to attend in person, you may request assistance with registration to participate by telephone by contacting Ms. Anita Bushnyakova, Department of Elder Affairs, Office of General Counsel, 4040 Esplanade Way, Tallahassee, FL 32399, email: [e-mail], telephone: [phone]. You may also choose to send written comments in advance to Ms. Amanda Samerson, Department of Elder Affairs, Office of General Counsel, 4040 Esplanade Way, Tallahassee, FL 32399, email: [e-mail].

The Notice of Rule Development for this rule was published in the Florida Administrative Register, Volume 39, Issue 82 on September 18, 2013.

This hearing is developed in compliance with Title VI of the Civil Rights Act of 1964 and related statutes. Public participation is solicited without regard to race, color, national origin, age, sex, religion, disability or family status. Any person requiring special accommodations to participate in the hearing is asked to advise the agency at least 5 days in advance by contacting Ms. Bushnyakova at the above address.

People who are hearing or speech impaired should contact DOEA using the Florida Relay Service, 1(800)955-8771 (TTY) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Ms. Amanda Samerson, Department of Elder Affairs, Office of General Counsel, 4040 Esplanade Way, Tallahassee, FL 32399, email: [e-mail], telephone: [phone]

 

THE FULL TEXT OF THE PROPOSED RULE 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) “Advertise” means any written, printed, oral, visual, or electronic promotion, statement of availability, qualifications, services offered, or other similar communication appearing in or on television, radio, the Internet, billboards, newspapers, magazines, business cards, flyers, brochures or other medium for the purpose of attracting potential residents to an assisted living facility. A complimentary listing of a licensed facility’s name, address, and telephone number in the telephone directory is shall not be considered advertising.

(2) “Agency Central Office or AHCA Central Office” means the Agency for Health Care Administration (also referred to as “Agency”), Assisted Living Unit (ALU), located at 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL 32308-5403. The ALU telephone number and website address is [phone], and http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/index.shtml#al [phone].

(3) “Agency Field Office” means the Agency for Health Care Administration’s Office in a particular geographic area. Information regarding local offices is available online at: http://ahca.myflorida.com/mchq/index.shtml#six.

(4)(3) “Apartment” means a self-contained dwelling unit with a bathroom, kitchen area, and living and sleeping space that is contracted for use as a residence by one or more persons who maintain a common household.

(5)(4) “Assistance with Aactivities of Ddaily Lliving” means individual assistance with the following:

(a) Ambulation – Providing physical support to enable the resident to move about within or outside the facility. Physical support includes supporting or holding the resident’s hand, elbow, or arm; holding on to a support belt worn by the resident to assist in providing stability or direction while the resident ambulates; or pushing the resident’s wheelchair. The term does not include assistance with transfer.

(b) Bathing – Assembling towels, soaps, and other necessary supplies, helping the resident in and out of the bathtub or shower, turning the water on and off, adjusting water temperatures, washing and drying portions of the body that which are difficult for the resident to reach, or being available while the resident is bathing.

(c) Dressing – Helping the resident to choose, and to put on and remove clothing.

(d) Eating – Helping with cutting food, pouring beverages, and feeding residents who are unable to feed themselves.

(e) Grooming – Helping the resident with shaving, with oral care, with care of the hair, and with nail care.

(f) Toileting – Assisting the resident to the bathroom, helping to undress, positioning on the commode, and helping with related personal hygiene, including assistance with changing an adult brief. Assistance with toileting includes assistance with the routine emptying of a catheter or ostomy bag.

(6)(5) “Assistance Wwith Ttransfer” means providing verbal and physical cuing or physical assistance or both while the resident moves between bed and a standing position or between bed and chair or wheelchair.

(7)(6) “Bedridden” means confined to bed because of inability to ambulate or transfer to a wheelchair even with assistance, or to sit safely in a chair or wheelchair without personal assistance or physical mechanical restraint.

(8)(7) “Capacity” means the number of residents for which a facility has been licensed to provide residential care.

(9)(8) “Case Mmanager” means an individual employed by or under contract with any agency or organization, public, or private, who has the responsibility for assessing resident needs; planning services; coordinating and assisting residents to gain access to needed medical, mental health, social, housing, educational or other services; monitoring service delivery; and evaluating the effects of service delivery.

(10)(9) “Certified Nnursing Aassistant (CNA)” means a person certified under Part II, XV of Chapter 464 468, F.S.

(11)(10) “Deficiency” means an instance of non-compliance with the requirements of Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., Part III, Chapter 400, F.S., and this rule chapter.

(12)(11) “Direct Ccare Sstaff” means staff providing personal or nursing services to residents, including administrators and managers or supervising staff providing such services.

(13)(12) “Distinct Ppart” means designated bedrooms or apartments, bathrooms and a living area; or a separately identified wing, floor, or building that which includes bedrooms or apartments, bathrooms and a living area. The distinct part may include a separate dining area, or meals may be served in another part of the facility.

(14)(13) “Elopement” means an occurrence in which a resident leaves a facility without following facility policy and procedures.

(15)(14) “Food Sservice” means the storage, preparation, serving, and cleaning up of food intended for consumption in a facility or a formal agreement that meals will be regularly catered by a third party.

(16)(15) “Health Ccare Pprovider” means a physician or physician’s assistant licensed under Chapter 458 or 459, F.S., or advanced registered nurse practitioner licensed under Chapter 464, F.S.

(16) “Hold itself out” means making any personal, verbal, telephone, mail contact, or other communication to a person or any announcement, solicitation, display, or advertisement to inform the general public of the services provided by the facility.

(17) “Licensed Ddietitian/or Nnutritionist” means a dietitian or nutritionist licensed in accordance with Section 468.509, F.S.

(18) “Long-term Ccare Oombudsman Program (LTCOP) council (LTCOC)” means the State Long-term Care Ombudsman Council or the district long-term care ombudsman program councils established under Part I, Chapter 400, F.S.

(19) “Manager” means an individual who is authorized to perform the same functions of the administrator, and is responsible for the operation and maintenance of an assisted living facility while under the supervision of the administrator of that facility. For the purpose of this definition, a manager does not include staff authorized to perform limited administrative functions during an administrator’s temporary absence “Major incident” means:

(a) Death of a resident from other than natural causes;

(b) Determining that a resident is missing;

(c) An assault on a resident resulting in injury;

(d) An injury to a resident which requires assessment and treatment by a health care provider; or

(e) Any event, such as a fire, natural disaster, or other occurrence that results in the disruption of the facility’s normal activities.

(20) “Mental Ddisorder,” for the purposes of identifying a mental health resident, means schizophrenia schizophrenic and other psychotic disorders; affective disorders; anxiety related disorders; and personality and dissociative disorders. However, mental disorder does not include residents with a primary diagnosis of Alzheimer’s disease, other dementias, or mental retardation.

(21) “Mental Hhealth Ccare Pprovider” means an individual, agency, or organization providing mental health services to clients of the Department of Children and Families; an individual licensed by the state to provide mental health services; or an entity employing or contracting with individuals licensed by the state to provide mental health services means:

(a) An individual, agency, or organization under contract to the Department of Children and Family Services’ district Substance Abuse and Mental Health program office to provide mental health services to clients of the department;

(b) An individual licensed by the state to provide mental health services; or

(c) An agency or organization employing or contracting with individuals licensed by the state to provide mental health services.

(22) “Mental Hhealth Ccase Mmanager” means a case manager employed by or under contract to a mental health care provider to assist mental health residents residing in a facility holding a limited mental health license. A private mental health care provider may serve as a resident’s mental health case manager.

(23) “Newly licensed” means a new facility which is licensed for the first time. The term does not apply to an existing facility that has undergone a change of ownership.

(23)(24) “Nurse” means a licensed practical nurse (LPN), registered nurse (RN), or advanced registered nurse practitioner (ARNP) licensed under Chapter 464, F.S.

(24)(25) “Nursing Aassessment” means a written review of information collected from observation of and interaction with a resident, the resident’s record, and any other relevant sources; the analysis of the information; and recommendations for modification of the resident’s care, if warranted.

(25)(26) “Nursing Pprogress Nnotes” or “Pprogress Rreport” means a written record of nursing services, other than medication administration or the taking of vital signs, provided to each resident who receives such services pursuant to a limited nursing or extended congregate care license. The progress notes must shall be completed by the nurse who delivered the service and must shall describe the date, type, scope, amount, duration, and outcome of services that are rendered; the general status of the resident’s health; any deviations; any contact with the resident’s physician; and must shall contain the signature and credential initials of the person rendering the service.

(26)(27) “Optional Sstate Ssupplementation (OSS)” means the state program providing monthly payments to eligible residents pursuant to Section 409.212, F.S., and Rule Chapter 65A-2, F.A.C.

(27)(28) “Owner” means the person, partnership, association, limited liability company, or corporation, which owns or leases the facility, and is licensed by the aAgency. The term does not include a person, partnership, association, limited liability company, or corporation that which contracts only to manage or operate the facility.

(28)(29) “Physician” means an individual licensed under Chapter 458 or 459, F.S.

(29)(30) “Registered Ddietitian” means an individual registered with the Commission on Dietetic Registration, the accrediting body of the Academy of Nutrition and Dietetics American Dietetic Association.

(30)(31) “Renovation” means additions, repairs, restorations, or other improvements to the physical plant of the facility within a 5 year period that costs in excess of 50 percent of the value of the building as reported on the tax rolls, excluding land, before the renovation.

(31)(32) “Respite Ccare” means facility-based supervision of an impaired adult for the purpose of relieving the primary caregiver.

(32)(33) “Significant Cchange” means a sudden or major shift in behavior or mood inconsistent with the resident’s diagnosis, or a deterioration in health status such as unplanned weight change, stroke, heart condition, enrollment in hospice, or stage 2, 3, or 4 pressure sore. Ordinary day-to-day fluctuations in functioning and behavior, a short-term illness such as a cold, or the gradual deterioration in the ability to carry out the activities of daily living that accompanies the aging process are not considered significant changes.

(33)(34) “Staff” means any individual person employed by a facility; or contracting with a facility to provide direct or indirect services to residents; or employees of firms under contract to the facility to provide direct or indirect services to residents when present in the facility. The term includes volunteers performing any service that which counts toward meeting any staffing requirement of this rule chapter.

(34) “Staff in Regular Contact” means all staff who do not provide direct care to residents, but whose duties may require them to interact with residents on a daily basis.

(35) “Third Party” means any individual person or business entity providing services to residents who is not staff of the facility.

(36) “Universal Precautions” are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all residents are considered potentially infectious for HIV, HBV, and other bloodborne pathogens.

(37)(36) “Unscheduled Sservice Nneed” means a need for a personal service, nursing service, or mental health intervention that which generally cannot be predicted in advance of the need for service, and that which must be met promptly within a time frame that which provides reasonable assurance that the resident’s health, safety, and welfare and that of other residents is shall be preserved.

Rulemaking 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, 4-15-10,_________.

 

58A-5.014 Licensing and License Application, Change of Ownership, and Provisional Licenses.

(1) LICENSE APPLICATION. An applicant for a standard assisted living facility (ALF) license, or a limited mental health (LMH), extended congregate care (ECC), or limited nursing services (LNS) license, may apply for licensure pursuant to the requirements of Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., and Rule Chapter 59A-35, F.A.C. obtain a license application package from the Agency Central Office.

(a) The completed application shall be signed, under oath, by an owner (or corporate officer if the owner is a corporation), the administrator, or an individual designated in writing by an owner or corporate officer, who is at least 18 years old. The application shall include the following:

1. The Assisted Living Facilities (ALF) License Application, AHCA Form 3110-1008, January 2006, and the Assisted Living Facility Licensure Application Addendum, AHCA Form, 3110-1016, January 2006, which are incorporated by reference and can be obtained from the Agency Central Office, with all requested information provided as specified in Section 429.11(3), F.S.

2. An assets and liabilities statement, or AHCA Form 3180-1003, January 1998, which is incorporated by reference. The assets and liabilities statement shall include information about the assets available to cover claims against the owner and administrator and to demonstrate that the applicant has the financial ability to operate.

3. A statement of operations, or AHCA Form 3180-1002, July 1995, which is incorporated by reference. The statement of operations shall include projected revenues, expenses, taxes, extraordinary items, and other credits or charges for the first 12 months of operation.

4. If the proposed facility will be part of a continuing care retirement community, a copy of the Certificate of Authority to offer continuing care agreements issued pursuant to Chapter 651, F.S. The certificate may be used in lieu of fiscal documentation specified in subparagraphs 2. and 3.

5. Proof of liability insurance as required by Rule 58A-5.021, F.A.C.

6. For applicants anticipating a licensed capacity of 14 or fewer residents and located in an area zoned single-family or multi-family, documentation of compliance with the community residential home requirements specified in Chapter 419, F.S., obtained from the Department of Children and Family Services’ district community residential home coordinator. If not located in an area zoned single-family or multi-family, Local Zoning Form, AHCA Form 3180-1021, September 1996, which is incorporated by reference, or a letter from the local zoning authority, signed by the county zoning official, which states that the applicant is in compliance with local zoning ordinances.

7. Proof of legal right to occupy the property which may include copies of recorded deeds, or copies of lease or rental agreements, contracts for deeds, quitclaim deeds, or other such documentation.

8. Documentation of a satisfactory fire safety inspection conducted by the local authority having jurisdiction over fire safety or by the State Fire Marshal.

9. Documentation of a satisfactory sanitation inspection by the county health department.

10. For each person specified in Section 429.174(1), F.S.:

a. A set of fingerprints obtained from the nearest available local law enforcement agency on the fingerprint card provided by the Agency; and

b. A check or money order to cover the cost of screening.

11. In lieu of the requirements of subparagraph 10., the following may be substituted: proof of compliance with the Level 2 background screening requirements of Section 435.04, F.S., conducted within the last five (5) years pursuant to a facility or professional license requirement of the Agency or the Department of Health, a copy of the professional or facility license, and an affidavit of current compliance with Level 2 background screening standards. For owners, administrators, and financial officers of continuing care retirement communities, proof of compliance with the background screening requirements of Rule 69O-193.060, F.A.C., conducted within the last five (5) years, may be substituted.

12. A copy of any surety bond required pursuant to Rule 58A-5.021, F.A.C.

13. A copy of the proposed facility’s floor plan indicating those areas to be licensed as an assisted living facility and, if applicable, the distinct part to be licensed as an extended congregate care facility if the entire assisted living facility is not to be so licensed.

14. Certificates of Occupancy shall be required from authorities charged with seeing that new buildings or renovations to existing buildings comply with state and local building codes. This must be provided at the time of the agency survey.

(b) If the Agency Central Office delivers a letter notifying the applicant of apparent errors or omissions in the application, then the applicant must respond with the required information no later than twenty-one (21) days from the date of the Agency’s one omission letter. If the required information is not received by the Agency within the twenty-one (21) day timeframe, the Agency shall deem the application incomplete and shall issue a notice of intent to deny the application.

(c) An applicant for a limited mental health, extended congregate care, or limited nursing services license must concurrently apply for, or hold, a standard license and comply, in addition, with the applicable requirements of Rules 58A-5.029, 58A-5.030, and 58A-5.031, F.A.C., respectively. These specialty licenses shall only be issued to a facility holding a standard license.

(d) The application shall be submitted to the Agency Central Office and be accompanied by a license fee in the form of a check or money order payable to the State of Florida. The license fee shall be in accordance with Section 429.07, F.S.

1. The fee for any special license shall be in addition to the standard license fee required by statute. When a special license is requested during a facility’s standard license period, the fee will be prorated so that the special license will expire at the same time as the facility’s standard license.

2. One check or money order can be submitted to cover all license fees and background screening costs.

3. For checks returned from the applicant’s bank for whatever reason, the agency shall add to the amount due a service fee of $20 or 5 percent of the face amount of the check, whichever is greater, up to a maximum charge of $200.

(e) Upon submission of all documentation required under this subsection and fees, and notification to the Agency Field Office that the applicant is ready for survey, the Field Office shall conduct a survey of the facility in accordance with Section 429.28(3), F.S.

(2) CHANGE OF OWNERSHIP (CHOW). In addition to the requirements for a change of ownership contained in Part II, Chapter 408, F.S., Section 429.12, F.S., and Rule Chapter 59A-35, F.A.C., the following provisions relating to resident funds apply pursuant to Section 429.27, F.S.:

(a) Pursuant to Section 429.12, F.S., the transferor shall notify the agency in writing, at least 60 days prior to the date of transfer of ownership.

(b) Completed applications shall be filed with the Agency by the transferee at least 60 days before the date of transfer of ownership as required by Section 429.12, F.S., and must include the information and fees required under subsection (1) of this rule. An application package for a change of ownership of a currently licensed facility is available from the Agency Central Office.

(a)(c) At the time of transfer of ownership, all resident funds on deposit, advance payments of resident rents, resident security deposits, and resident trust funds held by the current licensee must shall be transferred to the applicant. Proof of such transfer must shall be provided to the agency at the time of the agency survey and before prior to the issuance of a standard license. This provision does not apply to entrance fees paid to a continuing care facility subject to the acquisition provisions in Section 651.024, F.S.

(b)1. The transferor must shall provide to each resident a statement detailing the amount and type of funds credited to the resident for whom funds are held by the facility.

(c)2. The transferee must shall notify each resident in writing of the manner in which the transferee is holding the resident’s funds and state the name and address of the depository where the funds are being held, the amount held, and type of funds credited.

(d) The current resident contract on file with the facility shall be considered valid until such time as the transferee is licensed and negotiates a new contract with the resident.

(e) Failure to apply for a change of ownership of a licensed facility as required by Section 429.12, F.S., shall result in a fine levied by the Agency pursuant to Section 429.19, F.S.

(f) During a change of ownership, the owner of record is responsible for ensuring that the needs of all residents are met at all times in accordance with Part III of Chapter 400, F.S., and this rule chapter.

(g) If applicable, the transferor shall comply with Section 408.831(2), F.S., prior to Agency approval of the change of ownership application.

(3) CONDITIONAL PROVISIONAL LICENSE. Except as provided in Section 429.14, F.S., the agency may issue a conditional license to a facility if, at the time of license renewal the facility is found to have uncorrected violations that the facility has had an opportunity to correct. The issuance of a conditional license does not change the biennial license expiration date.

(a) The agency shall issue a provisional license to an applicant making an initial application for a standard license or who has filed a completed application for a change of ownership, if the applicant has met all other licensing requirements and is:

1. Waiting for the receipt of Federal Bureau of Investigation background screening results; or

2. Waiting for a response to a request for an exemption from the background screening standards listed in Section 435.03 or 435.05, F.S., as applicable, provided that the exemption from disqualification request is for: felonies committed more than 10 years ago; misdemeanors, including offenses that were felonies when committed but are now misdemeanors; findings of delinquency; and acts of domestic violence committed more than 5 years ago.

(b) A provisional license issued pursuant to an initial application for license shall not be considered equivalent to a standard license for the purposes of issuing a limited mental health, extended congregate care, or limited nursing services license.

(c) A provisional license issued pursuant to a change of ownership application shall be considered equivalent to a standard license for the purpose of issuing a limited mental health, extended congregate care, or limited nursing services license.

(d) A provisional license shall be issued for a specific period of time as determined by the agency provided such time is not less than 1 month nor for more than 6 months.

(4) OSS RESIDENT DETERMINATION LICENSE DENIAL. With respect to the fee per bed required for a standard license, the number of OSS recipients claimed shall be the average number per month residing in the facility during the previous license period. An additional per bed charge shall be added to the bed fee for facilities whose average number of OSS residents per month was less than the number of beds designated for OSS recipients during the previous license period.

Owners denied a license shall be notified by the agency of their right to appeal the denial, the remedies available, and the time limit for requesting such remedies as provided under Part II of Rule Chapter 59-1, F.A.C. and Chapter 120, F.S.

Rulemaking Authority 429.07, 429.17, 429.27, 429.275, 429.41 FS. Law Implemented 429.02, 429.04, 429.07, 429.075, 429.08, 429.11, 429.12, 429.17, 429.176, 429.174, 429.27, 429.275, 429.41, 429.44, 429.445, 429.47 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.14, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.014, Amended 10-30-95, 4-20-98, 10-17-99, 7-30-06,_________.

 

58A-5.015 License Renewal and Conditional Licenses.

(1) LICENSE RENEWAL. Every two years, the Agency Central Office shall provide applications for license renewal, either electronically or by mail, to licensees no less than 120 days prior to the expiration of the current license. Applications shall be postmarked or hand delivered to the Agency a minimum of 90 days prior to the expiration date appearing on the currently held license. Failure to file a timely application shall result in a late fee charged to the facility as described in Section 429.17, F.S.

(a) All applicants for renewal of a license shall submit the following:

1. An Assisted Living Facilities (ALF) License Application, AHCA Form 3110‑1008, January 2006 and the Assisted Living Facility Licensure Application Addendum, AHCA Form 3110-1016, January 2006, completed as required under Rule 58A-5.014, F.A.C.

2. Proof of liability insurance as required by Rule 58A-5.021, F.A.C.

3. A copy of the annual fire safety inspection conducted by the local authority having jurisdiction over fire safety or the State Fire Marshal. Documentation of a satisfactory fire safety inspection shall be provided at the time of the agency’s biennial survey.

4. A copy of the annual sanitation inspection by the county health department. Documentation of a satisfactory sanitation inspection shall be provided at the time of the agency’s biennial survey.

5. An affidavit of current compliance with level 1 and 2 background screening conducted pursuant to Section 429.174, F.S.

6. A copy of any surety bond or continuation bond required by Rule 58A-5.021, F.A.C.

7. A copy of the facility’s floor plan if different from the previous application.

(b) If the Agency Central Office delivers a letter notifying the applicant of apparent errors or omissions in the application, then the applicant must respond with the required information no later than twenty-one (21) days from the date of the Agency’s one omission letter. If the required information is not received by the Agency within the twenty-one (21) day time frame, the Agency shall deem the application incomplete and shall issue a notice of intent to deny the application.

(c) Applicants for renewal of a license shall not be required to provide proof of financial ability to operate unless the facility or any other facility owned or operated in whole or part by the same owner or business entity has demonstrated financial instability as described in Rule 58A-5.021, F.A.C.

(d) Applicants for renewal of licenses shall remit license fees as required by Section 429.07, F.S., and Rule 58A-5.014, F.A.C. With respect to the fee per bed required for a standard license, the number of OSS recipients claimed shall be the average number per month residing in the facility during the previous license period. An additional per bed charge shall be added to the bed fee for facilities whose average number of OSS residents per month was less than the number of beds designated for OSS recipients during the previous license period.

(2) CONDITIONAL LICENSE. Except as provided under Section 429.14, F.S., the agency shall issue a conditional license to a facility if, at the time of license renewal the facility is found to have uncorrected violations which the facility has had an opportunity to correct.

(a) The issuance of a conditional license shall be contingent upon agency approval of a written plan of correction which includes corrective steps that will be taken to eliminate the deficiencies and a timetable for correction of the deficiencies by the expiration date of the conditional license.

(b) A conditional license shall be issued by the agency only for that time period necessary to comply with applicable licensing standards and complete license renewal procedures, but not to exceed 6 months.

(c) A conditional license shall be revoked if subsequent follow-up surveys by the agency indicate that necessary progress has not been made toward compliance with applicable licensing standards.

(d) The issuance of a conditional license does not change the biennial license expiration date.

(3) LICENSE DENIAL.

(a) Applicants denied a license shall be notified by the agency of their right to appeal the denial, the remedies available, and the time limit for requesting such remedies as provided under Part II of Rule Chapter 59-1, F.A.C. and Chapter 120, F.S.

(b) Pursuant to Section 429.14, F.S., agency notice of license denial following a renewal application shall be posted and visible to the public at the facility.

Rulemaking Authority 429.41 FS. Law Implemented 429.02, 429.04, 429.07, 429.11, 429.14, 429.17, 429.174, 429.27, 429.275, 429.41, 429.47 FS. History-New 10-17-99, Amended 7-30-06, Repealed_________.

 

58A-5.016 License Requirements.

(1) SERVICE PROHIBITION. An assisted living facility ALF may not represent that it provides hold itself out to the public as providing any service other than a service for which it is licensed to provide.

(2) LICENSE TRANSFER PROHIBITION. Licenses are not transferable. Whenever a facility is sold or ownership is transferred, including leasing, the transferor and transferee must comply with the provisions of Section 429.41, F.S., and the transferee must submit a change of ownership license application pursuant to Rule 58A-5.014, F.A.C.

(2)(3) CHANGE IN USE OF SPACE REQUIRING AGENCY CENTRAL OFFICE APPROVAL. A change in the use of space that increases or decreases a facility’s capacity must shall not be made without prior approval from the Agency Central Office. Approval must shall be based on the compliance with the physical plant standards provided in Rule 58A-5.023, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation inspection requirements as referenced in Rule 58A-5.0161, F.A.C.

(3)(4) CHANGE IN USE OF SPACE REQUIRING AGENCY FIELD OFFICE APPROVAL. A change in the use of space that involves converting an area to resident use, which has not previously been inspected for such use, must shall not be made without prior approval from the Agency Field Office. Approval must shall be based on the compliance with the physical plant standards provided in Rule 58A-5.023, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation inspection standards as referenced in Rule 58A-5.0161, F.A.C.

(4)(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 II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter.

(5)(6) PROOF OF INSPECTIONS. A copy of the annual fire safety and sanitation inspections described in Rule 58A-5.0161, F.A.C., must shall be submitted annually to the Agency Central Office. The annual inspections must shall be submitted no later than 30 calendar days after the inspections. Failure to comply with this requirement may result in administrative action pursuant to Part II, Chapter 408, F.S., Section 429.14, F.S., and Rule Chapter 59A-35 Rule 58A-5.033, F.A.C.

(6)(7) MEDICAID WAIVER RESIDENTS RECEIVING STATE-FUNDED SERVICES. Upon request, the facility administrator or designee must identify Medicaid waiver residents receiving state-funded services 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 action to assist 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, the facility administrator or designee, when requested by residents or representatives, must take action to assist 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 this 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 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, 4-15-10, _________.

 

58A-5.0161 Inspection Responsibilities.

(1) County health departments are shall be responsible for inspecting all license applicants and licensed facilities in matters regulated by:

(a) Rule 64E-12.004, F.A.C., and Rule Chapter 64E-11, F.A.C., relating to food hygiene.

(b) Chapter 64E-12, F.A.C., relating to sanitary practices in community-based residential facilities.

(c) Chapter 64E-16, F.A.C., relating to biomedical waste.

(2) The local authority having jurisdiction over fire safety or State Fire Marshal is Marshall shall be responsible for inspecting all license applicants and licensed facilities in matters regulated by Section 429.41, F.S., relating to uniform fire safety standards and Chapter 69A-40, F.A.C., Uniform Fire Safety Standards for Assisted Living Facilities.

(3) The agency is shall be responsible for inspecting all license applicants and licensed facilities in all other matters regulated by this rule chapter.

Rulemaking Authority 429.41 FS. Law Implemented 429.41 FS. History–New 8-15-90, Formerly 10A-5.0161, Amended 10-30-95, 10-17-99,_________.

 

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

(1) ADMISSION CRITERIA.

(a) An individual must meet the following minimum criteria in order to be admitted to a facility holding a standard, limited nursing, or limited mental health license:

1.(a) Be at least 18 years of age.

2.(b) Be free from signs and symptoms of any communicable disease that which is likely to be transmitted to other residents or staff; however, an individual a person who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that the individual would otherwise be eligible for admission according to this rule.

3.(c) Be able to perform the activities of daily living, with supervision or assistance if necessary.

4.(d) Be able to transfer, with assistance if necessary. The assistance of more than one person is permitted.

5.(e) Be capable of taking his/her own medication, by either self-administration, with assistance with self-administration, or by administration of medication from staff if necessary.

a.1. If the resident individual needs assistance with self-administration, the facility must inform the resident of the professional qualifications of facility staff who will be providing this assistance. , and Iif unlicensed staff will be providing such assistance with self-administration of medication, the facility must obtain written informed consent from the resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s written informed consent to provide such assistance as required under Section 429.256, F.S.

b.2. The facility may accept a resident who requires the administration of medication, if the facility has a nurse to provide this service, or the resident or the resident’s legal representative, designee, surrogate, guardian, or attorney-in-fact contracts with a licensed third party to provide this service to the resident.

6.(f) Not have aAny special dietary needs that cannot be met by the facility.

7.(g) Not be a danger to self or others as determined by a physician, or mental health practitioner licensed under Chapters 490 or 491, F.S.

8.(h) Not require 24-hour licensed professional mental health treatment on a 24‑hour a day basis.

9.(i) Not be bedridden.

10.(j) Not have any stage 3 or 4 pressure sores. A resident requiring care of a stage 2 pressure sore may be admitted provided that:

a. Such resident either:

(I) Resides in a standard licensed facility and contracts directly with a licensed home health agency or a nurse to provide care, or

(II) Resides in a limited nursing services licensed facility and services are provided pursuant to a plan of care issued by a health care provider, or the resident contracts directly with a licensed home health agency or a nurse to provide care;

1. The facility has a LNS license and services are provided pursuant to a plan of care issued by a physician, or the resident contracts directly with a licensed home health agency or a nurse to provide care;

b.2. The condition is documented in the resident’s record and admission and discharge log; and

c.3. If the resident’s condition fails to improve within 30 days, as documented by a health care provider licensed nurse or physician, the resident must shall be discharged from the facility.

11.(k) Not require any of the following nursing services:

a.1. Oral, nasopharyngeal, or tracheotomy suctioning;

b.2. Assistance with tube feeding;

c.3. Monitoring of blood gases;

d.4. Intermittent positive pressure breathing therapy; or

e.5. Treatment of surgical incisions or wounds, unless the surgical incision or wound and the condition that which caused it, has have been stabilized and a plan of care developed.

12.(l) Not require 24-hour nursing supervision.

13.(m) Not require skilled rehabilitative services as described in Rule 59G-4.290, F.A.C.

14.(n) Have been determined by the facility administrator to be appropriate for admission to the facility. The administrator must shall base the decision on:

a.1. An assessment of the strengths, needs, and preferences of the individual, and the medical examination report required by Section 429.26, F.S., and subsection (2) of this rule;

b.2. The facility’s admission policy, and the services the facility is prepared to provide or arrange in order for to meet resident needs. Such services may not exceed the scope of the facility’s license unless specified elsewhere in this rule; and

c.3. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in under Section 429.41, F.S., and Rule Chapter 69A-40, F.A.C.

(o) Resident admission criteria for facilities holding an extended congregate care license are described in Rule 58A-5.030, F.A.C.

(b) A resident who otherwise meets the admission criteria for residency in a standard licensed facility, but who requires assistance with the administration and regulation of portable oxygen, assistance with routine colostomy care, or assistance and monitoring of the application of anti-embolism stockings or hosiery as prescribed by a health care provider in accordance with manufacturer’s guidelines, may be admitted to a facility with a standard license as long as the following conditions are met:

1. The facility must have a nurse on staff or under contract to provide the assistance or to provide training to the resident to perform these functions.

2. Nursing staff may not provide training to unlicensed persons to perform skilled nursing services, and may not delegate the nursing services described in this section to certified nursing assistants or unlicensed persons as defined in Section 429.256(1)(b), F.S. Certified nursing assistants may not be delegated the nursing services described in this section, but may apply anti-embolism stockings or hosiery under the supervision of a nurse in accordance with paragraph 64B9-15.002(1)(e), F.A.C. This provision does not restrict a resident or a resident’s representative from contracting with a licensed third party to provide the assistance if the facility is agreeable to such an arrangement and the resident otherwise meets the criteria for admission and continued residency in a facility with a standard license.

(c) An individual enrolled in and receiving hospice services may be admitted to an assisted living facility as long as the individual otherwise meets resident admission criteria.

(d) Resident admission criteria for facilities holding an extended congregate care license are described in Rule 58A-5.030, F.A.C.

(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 medical examination completed within 60 calendar days before prior to the individual’s admission to a facility pursuant to Section 429.26(4), F.S. The examination must address the following:

1. The physical and mental status of the resident, including the identification of any health-related problems and functional limitations;

2. An evaluation of whether the individual will require supervision or assistance with the activities of daily living;

3. Any nursing or therapy services required by the individual;

4. Any special diet required by the individual;

5. A list of current medications prescribed, and whether the individual will require any assistance with the administration of medication;

6. Whether the individual has signs or symptoms of Tuberculosis, Methicillin Resistant Staphylococcus Aureus, Scabies or any other communicable disease, signs or symptoms of a communicable disease which are is likely to be transmitted to other residents or staff;

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

8. The date of the examination, and the name, signature, address, telephone phone number, and license number of the examining licensed health care provider. The medical examination may be conducted by a currently licensed health care provider licensed under Chapter 458, 459 or 464, F.S. from another state.

(b) A medical examination completed after the resident’s admission to the facility within 30 calendar days of the admission date. The examination must be recorded on AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, October 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 http://www.fdhc.state.fl.us/Executive/Inspector_General/docs/ALF/AHCA_Form_1823.pdf www.fdhc.state.fl.us/MCHQ/Long_Term_Care/Assisted_living/pdf/AHCA_Form_1823%.pdf. Faxed or electronic copies of the completed form are acceptable. The form must be completed as instructed. 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.

a. Items on the form that may have been omitted by the licensed health care provider during the examination do not necessarily require an additional face-to-face examination for completion.

b. The facility may obtain the omitted information either orally verbally or in writing from the licensed health care provider.

2.c. Omitted information received verbally must be documented in the resident’s record., Information received orally must include including the name of the licensed health care provider, the name of the facility staff recording the information, and the date the information was provided.

3. Electronic documentation may be used in place of completing the section on AHCA Form 1823 referencing Services Offered or Arranged by the Facility for the Resident. The electronic documentation must include all of the elements described in this section of AHCA Form 1823.

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 for residents receiving:

a. Extended congregate care (ECC) services in facilities holding an ECC license;

b. Services under community living support plans in facilities holding limited mental health licenses;

c. Medicaid assistive care services; and

d. Medicaid waiver services.

(c) Any information required by paragraph (a) that is not contained in the medical examination report conducted before prior to the individual’s admission to the facility must be obtained by the administrator using AHCA Form 1823 within 30 days after admission using AHCA Form 1823.

(d) Medical examinations of residents placed by the department, by the Department of Children and Families Family Services, or by an agency under contract with either department must be conducted within 30 days before placement in the facility and recorded on AHCA Form 1823 described in paragraph (b).

(e) An assessment that has been conducted through the Comprehensive, Assessment, Review and Evaluation for Long-Term Care Services (CARES) program may be substituted for the medical examination requirements of Section 429.26 429.426, F.S., and this rule.

(f) Any orders for medications, nursing, therapeutic diets, or other services to be provided or supervised by the facility issued by the licensed health care provider conducting the medical examination may be attached to the health assessment. A licensed health care provider may attach a DH Form 1896, Florida Do Not Resuscitate Order Form, do-not-resuscitate order for residents who do not wish cardiopulmonary resuscitation to be administered in the case of cardiac or respiratory arrest.

(g) A resident placed on a temporary emergency basis by the Department of Children and Families Family Services pursuant to Section 415.105 or 415.1051, F.S., is shall be exempt from the examination requirements of this subsection for up to 30 days. However, a resident accepted for temporary emergency placement must shall be entered on the facility’s admission and discharge log and counted in the facility census; a facility may not exceed its licensed capacity in order to accept a such a resident. A medical examination must be conducted on any temporary emergency placement resident accepted for regular admission.

(3) ADMISSION PACKAGE.

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

1. The facility’s admission and continued residency criteria;

2. The daily, weekly or monthly charge to reside in the facility and the services, supplies, and accommodations provided provide by the facility for that rate;

3. Personal care services that the facility is prepared to provide to residents and additional costs to the resident, if any;

4. Nursing services that the facility is prepared to provide to residents and additional costs to the resident, if any;

5. Food service and the ability of the facility to accommodate special diets;

6. The availability of transportation and additional costs to the resident, if any;

7. Any other special services that are provided by the facility and additional cost if any;

8. Social and leisure activities generally offered by the facility;

9. Any services that the facility does not provide but will arrange for the resident and additional cost, if any;

10. The A statement of facility rules and regulations that residents must follow as described in Rule 58A-5.0182, F.A.C.;

11. A statement of Tthe facility policy concerning Do Not Resuscitate Orders pursuant to Section 429.255, F.S. and Rule 58A-5.0186, F.A.C., and Advance Directives pursuant to Chapter 765, F.S.

12. The facility’s residency criteria for residents receiving extended congregate care services iIf the facility also has an extended congregate care license program, the ECC program’s residency criteria; and a description of the additional personal, supportive, and nursing services provided by the facility program; additional costs; and any limitations, if any, on where extended congregate care ECC residents must reside based on the policies and procedures described in Rule 58A-5.030, F.A.C.;

13. If the facility advertises that it provides special care for individuals persons with Alzheimer’s disease and related disorders, a written description of those special services as required in under Section 429.177, F.S.; and

14. A copy of Tthe facility’s resident elopement response policies and procedures.

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

1. A copy of the resident’s contract that which meets the requirements of Rule 58A-5.025, F.A.C.;

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

3. A copy of the resident’s bill of rights as required by Rule 58A-5.0182, F.A.C.; and

4. A Long-Term Care Ombudsman Program Council brochure that which includes the telephone number and address of the district office council.

(c) Documents required by this subsection must shall be in English. If the resident is not able to read, or does not understand English and translated documents are not available, the facility must explain its policies to a family member or friend of the resident or another individual who can communicate the information to the resident.

(4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (e) of this subsection, criteria for continued residency in any licensed facility must 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 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 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) The resident may be bedridden for up to 7 consecutive days.

(b) A resident requiring care of a stage 2 pressure sore may be retained provided that:

1. The resident contracts directly with a licensed home health agency or a nurse to provide care, or the facility has a limited nursing services LNS license and services are provided pursuant to a plan of care issued by a licensed health care provider, or the resident contracts directly with a licensed home health agency or a nurse to provide care;

2. The condition is documented in the resident’s record; and

3. If the resident’s condition fails to improve within 30 days, as documented by a licensed health care provider, the resident must shall be discharged from the facility.

(c) A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the following conditions are met:

1. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice that which coordinates and ensures the provision of any additional care and services that may be needed;

2. Continued residency is agreeable to the resident and the facility;

3. An interdisciplinary care plan, which specifies the services being provided by hospice and those being provided by the facility, is developed and implemented by a licensed hospice in consultation with the facility. Facility staff may provide any nursing service permitted under the facility’s license and total help with the activities of daily living; and

4. Documentation of the requirements of this paragraph is maintained in the resident’s file.

(d) The administrator is responsible for monitoring the continued appropriateness of placement of a resident in the facility at all times.

(e) A hospice resident that meets the qualifications of continued residency pursuant to this subsection may only receive services from the assisted living facility’s staff within the scope of the facility’s license. Continued residency criteria for facilities holding an extended congregate care license are described in Rule 58A-5.030, F.A.C.

(f) Assisted living facility staff may provide any nursing service permitted under the facility’s license and total help with the activities of daily living for residents admitted to hospice; however, staff may not exceed the scope of their professional licensure or training.

(g) Continued residency criteria for facilities holding an extended congregate care license are described in Rule 58A-5.030, F.A.C.

(5) DISCHARGE. If the resident no longer meets the criteria for continued residency, or the facility is unable to meet the resident’s needs, as determined by the facility administrator or licensed health care provider, the resident must shall be discharged in accordance with Section 429.28 429.28(1), F.S.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.28, 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, 4-15-10, 10-14-10,_________.

 

58A-5.0182 Resident Care Standards.

An assisted living facility must shall provide care and services appropriate to the needs of residents accepted for admission to the facility.

(1) SUPERVISION. Facilities must shall offer personal supervision, as appropriate for each resident, including the following:

(a) Monitoring of Monitor the quantity and quality of resident diets in accordance with Rule 58A-5.020, F.A.C.

(b) Daily observation by designated staff of the activities of the resident while on the premises, and awareness of the general health, safety, and physical and emotional well-being of the resident individual.

(c) Maintaining a gGeneral awareness of the resident’s whereabouts. The resident may travel independently in the community.

(d) Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out.

(e) Maintaining aA written record, updated as needed, of any significant changes as defined in subsection 58A-5.0131(33), F.A.C., any illnesses that which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes that which resulted in the provision of additional services.

(2) SOCIAL AND LEISURE ACTIVITIES. Residents shall be encouraged to participate in social, recreational, educational and other activities within the facility and the community.

(a) The facility must shall provide an ongoing activities program. The program must shall provide diversified individual and group activities in keeping with each resident’s needs, abilities, and interests.

(b) The facility must shall consult with the residents in selecting, planning, and scheduling activities. The facility must shall demonstrate residents’ participation through one or more of the following methods: resident meetings, committees, a resident council, suggestion box, group discussions, questionnaires, or any other form of communication appropriate to the size of the facility.

(c) Scheduled activities must shall be available at least 6 six (6) days a week for a total of not less than 12 twelve (12) hours per week. Watching television is shall not be considered an activity for the purpose of meeting the 12 twelve (12) hours per week of scheduled activities unless the television program is a special one-time event of special interest to residents of the facility. A facility whose residents choose to attend day programs conducted at adult day care centers, senior centers, mental health centers, or other day programs may count those attendance hours towards the required 12 twelve (12) hours per week of scheduled activities. An activities calendar must shall be posted in common areas where residents normally congregate.

(d) If residents assist in planning a special activity such as an outing, seasonal festivity, or an excursion, up to 3 three (3) hours may be counted toward the required activity time.

(3) ARRANGEMENT FOR HEALTH CARE. In order to facilitate resident access to needed health care as needed, the facility must shall, as needed by each resident:

(a) Assist residents in making appointments and remind residents about scheduled appointments for medical, dental, nursing, or mental health services.

(b) Provide transportation to needed medical, dental, nursing, or mental health services, or arrange for transportation through family and friends, volunteers, taxi cabs, public buses, and agencies providing transportation for persons with disabilities.

(c) The facility may not require residents to receive services from see a particular health care provider.

(4) ACTIVITIES OF DAILY LIVING. Facilities must shall offer supervision of or assistance with activities of daily living as needed by each resident. Residents should shall be encouraged to be as independent as possible in performing activities of daily living ADLs.

(5) NURSING SERVICES.

(a) Pursuant to Section 429.255, F.S., the facility may employ or contract with a nurse to:

1. Take or supervise the taking of vital signs;

2. Manage pill-organizers and administer medications as described in under Rule 58A-5.0185, F.A.C.;

3. Give prepackaged enemas pursuant to a physician’s order; and

4. Maintain nursing progress notes.

(b) Pursuant to Section 464.022, F.S., the nursing services listed in paragraph (a) may also be delivered in the facility by family members or friends of the resident provided the family member or friend does not receive compensation for such services.

(6) RESIDENT RIGHTS AND FACILITY PROCEDURES.

(a) A copy of the Resident Bill of Rights as described in Section 429.28, F.S., or a summary provided by the Long-Term Care Ombudsman Program must Council shall be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to Rule 58A-5.0181, F.A.C.

(b) In accordance with Section 429.28, F.S., the facility must shall have a written grievance procedure for receiving and responding to resident complaints, and for residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint.

(c) The address and telephone number for lodging complaints against a facility or facility staff must shall be posted in full view in a common area accessible to all residents. The addresses and telephone numbers are: the District Long-Term Care Ombudsman Program Council, 1(888)831-0404; Disability Rights Florida, the Advocacy Center for Persons with Disabilities, 1(800)342-0823; the Florida Local Advocacy Council, 1(800)342-0825; and the Agency Consumer Hotline [phone],. and the statewide toll-free telephone number of the Florida Abuse Hotline, 1(800)96-ABUSE or 1(800)962-2873. The telephone numbers must be posted in close proximity to a telephone accessible by residents and must be a minimum of 14-point font.

(d) The statewide toll-free telephone number of the Florida Abuse Hotline “1(800)96-ABUSE or 1(800)962-2873” shall be posted in full view in a common area accessible to all residents.

(d)(e) The facility must shall have a written statement of its house rules and procedures that which must shall be included in the admission package provided pursuant to Rule 58A-5.0181, F.A.C. The rules and procedures must at a minimum shall address the facility’s policies regarding: with respect to such issues, for example, as

1. Rresident responsibilities;, the facility’s

2. Aalcohol and tobacco; policy,

3. Mmedication storage;, the delivery of services to residents by third party providers,

4. Rresident elopement;, and other

5. Reporting resident abuse, neglect, and exploitation;

6. Aadministrative and housekeeping practices, schedules, and requirements;,

7. Infection control, sanitation, and universal precautions; and

8.The requirements for coordinating the delivery of services to residents by third party providers.

(e)(f) Residents may not be required to perform any work in the facility without compensation, unless the except that facility rules or the facility contract may includes a requirement that residents be responsible for cleaning their own sleeping areas or apartments. If a resident is employed by the facility, the resident must shall be compensated in compliance, at a minimum, at an hourly wage consistent with state and the federal minimum wage laws law.

(f)(g) The facility must shall provide residents with convenient access to a telephone to facilitate the resident’s right to unrestricted and private communication, pursuant to Section 429.28(1)(d), F.S. The facility must shall not prohibit unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there must shall be, at a minimum, a readily-an accessible telephone on each floor of each building where residents reside.

(g)(h) In addition to the requirements of Pursuant to Section 429.41(1)(k) 429.41, F.S., the use of physical restraints by a facility must be reviewed by the resident’s physician annually the use of physical restraints shall be limited to half-bed rails, which shall and only upon the written order of the resident’s physician, who shall review the order biannually, and the consent of the resident or the resident’s representative. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is shall not be considered a physical restraint.

(7) THIRD PARTY SERVICES.

(a) 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 admission and 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 58A-5.016(8), 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.

(b) When residents require or arrange for services from a third party provider, the facility administrator or designee must allow for the receipt of those services, provided that the resident meets the criteria for admission and continued residency. The facility, when requested by residents or representatives, must coordinate with the provider to facilitate the receipt of care and services provided to meet the particular resident’s needs.

(c) If residents accept the assistance from the facility to arrange and coordinate third party services, the facility’s assistance does not represent a guarantee that third party services will be received. If the facility’s efforts to make arrangements for third party services are unsuccessful or declined by residents, the facility must include this documentation in the residents’ record explaining why its efforts were unsuccessful. This documentation will serve to demonstrate its compliance with this subsection.

(8) ELOPEMENT STANDARDS.

(a) Residents Assessed at Risk for Elopement. All residents assessed at risk for elopement or with any history of elopement must shall be identified so staff can be alerted to their needs for support and supervision.

1. As part of its resident elopement response policies and procedures, the facility must shall make, at a minimum, a daily effort to determine that at-risk residents have identification on their persons that includes their name and the facility’s name, address, and telephone number. Staff attention must shall be directed towards residents assessed at high risk for elopement, with special attention given to those with Alzheimer’s disease or and related disorders assessed at high risk.

2. At a minimum, the facility must shall have a photo identification of at risk residents on file that is accessible to all facility staff and law enforcement as necessary. The facility’s file must contain the resident’s photo identification shall be made available for the file within 10 calendar days of admission or within 10 days of being. In the event a resident is assessed at risk for elopement subsequent to admission, the photo identification shall be made available for the file within 10 calendar days after a determination is made that the resident is at risk for elopement. The photo identification may be provided taken by the facility, or provided by the resident, or the resident’s representative family/caregiver.

(b) Facility Resident Elopement Response Policies and Procedures. The facility must shall develop detailed written policies and procedures for responding to a resident elopement. At a minimum, the policies and procedures must provide for shall include:

1. An immediate staff search of the facility and premises;

2. The identification of staff responsible for implementing each part of the elopement response policies and procedures, including specific duties and responsibilities;

3. The identification of staff responsible for contacting law enforcement, the resident’s family, guardian, health care surrogate, and case manager if the resident is not located pursuant to subparagraph (8)(b)1.; and

4. The continued care of all residents within the facility in the event of an elopement.

(c) Facility Resident Elopement Drills. The facility must shall conduct and document resident elopement drills pursuant to Sections 429.41(1)(a)3. and 429.41(1)(l), F.S.

(9) OTHER STANDARDS. Additional care standards for residents residing in a facility holding a limited mental health, extended congregate care or limited nursing services license are provided in Rules 58A-5.029, 58A-5.030 and 58A-5.031, F.A.C., respectively.

Rulemaking 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, 4-15-10,__________.

 

58A-5.0185 Medication Practices.

Pursuant to Sections 429.255 and 429.256, F.S., and this rule, licensed facilities 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) SELF ADMINISTERED MEDICATIONS.

(a) Residents who are capable of self-administering their medications without assistance must shall be encouraged and allowed to do so.

(b) If facility staff observes health changes that note deviations which could reasonably be attributed to the improper self-administration of medication, staff must shall consult with the resident concerning any problems the resident may be experiencing in self-administering with the medications.;  The consultation should describe the services offered by need to permit the facility that to aid the resident with medication administration through the use of a pill organizer, through providing provide assistance with self-administration of medications, or through administering administer medications if such services are offered by the facility. The facility must shall contact the resident’s health care provider when observable health care changes occur that may be attributed to the resident’s medications. The facility must shall document such contacts in the resident’s records.

(2) PILL ORGANIZERS.

(a) A “pill organizer” means a container that which is designed to hold solid doses of medication and is divided according to day and time increments.

(b) A resident who self-administers medications may use a pill organizer.

(c) A nurse may manage a pill organizer to be used only by residents who self-administer medications. The nurse is responsible for instructing the resident in the proper use of the pill organizer. The nurse must shall manage the pill organizer in the following manner:

1. Obtain the labeled medication container from the storage area or the resident;

2. Transfer the medication from the original container into a pill organizer, labeled with the resident’s name, according to the day and time increments as prescribed;

3. Return the medication container to the storage area or resident; and

4. Document the date and time the pill organizer was filled in the resident’s record.

(d) If there is a determination that the resident is not taking medications as prescribed after the medicinal benefits are explained, it must shall be noted in the resident’s record and the facility must shall consult with the resident concerning providing assistance with self-administration or the administration of medications if such services are offered by the facility. The facility must shall contact the resident’s health care provider regarding questions, concerns, or observations relating to the resident’s medications. Such communication must shall be documented in the resident’s record.

(3) ASSISTANCE WITH SELF-ADMINISTRATION.

(a) Any unlicensed person providing assistance with self administration of medication must be 18 years of age or older, trained to assist with self administered medication pursuant to the training requirements of Rule 58A-5.0191, F.A.C., and For facilities which provide assistance with self-administered medication, either: a nurse; or an unlicensed staff member, who is at least 18 years old, trained to assist with self-administered medication in accordance with Rule 58A-5.0191, F.A.C., and able to demonstrate to the administrator the ability to accurately read and interpret a prescription label, must be available to assist residents with self-administered medications in accordance with procedures described in Section 429.256, F.S., and this rule.

(b) In addition to the specifications of Section 429.256(3), F.S., aAssistance with self-administration of medication includes verbally prompting a resident to take medications as prescribed, retrieving and opening a properly labeled medication container, and providing assistance as specified in Section 429.256(3), F.S.

(c) In order to facilitate assistance with self-administration, trained staff may prepare and make available such items as water, juice, cups, and spoons. Trained sStaff may also return unused doses to the medication container. Medication, which appears to have been contaminated, must shall not be returned to the container.

(d)(c) Trained sStaff must shall observe the resident take the medication. Any concerns about the resident’s reaction to the medication or suspected noncompliance must shall be reported to the resident’s health care provider and documented in the resident’s record.

(e)(d) When a resident who receives assistance with medication is away from the facility and from facility staff, the following options are available to enable the resident to take medication as prescribed:

1. The health care provider may prescribe a medication schedule that which coincides with the resident’s presence in the facility;

2. The medication container may be given to the resident, or a friend, or family member upon leaving the facility, with this fact noted in the resident’s medication record;

3. The medication may be transferred to a pill organizer pursuant to the requirements of subsection (2), and given to the resident, a friend, or family member upon leaving the facility, with this fact noted in the resident’s medication record; or

4. Medications may be separately prescribed and dispensed in an easier to use form, such as unit dose packaging;

(f) Assistance with self-administration of medication does not include the activities detailed in Section 429.256(4), F.S.

1. As used in Section 429.256(4)(h), F.S., the term “competent resident” means that the resident is cognizant of when a medication is required and understands the purpose for taking the medication.

2. As used in Section 429.256(4)(i), F.S., the terms “judgment” and “discretion” mean interpreting vital signs and evaluating or assessing a resident’s condition.

(e) Pursuant to Section 429.256(4)(h), F.S., the term “competent resident” means that the resident is cognizant of when a medication is required and understands the purpose for taking the medication.

(f) Pursuant to Section 429.256(4)(i), F.S., the terms “judgment” and “discretion” mean interpreting vital signs and evaluating or assessing a resident’s condition.

(4) MEDICATION ADMINISTRATION.

(a) For facilities that which provide medication administration, a staff member, who is licensed to administer medications, must be available to administer medications in accordance with a health care provider’s order or prescription label.

(b) Unusual reactions or a significant change in the resident’s health or behavior must shall be documented in the resident’s record and reported immediately to the resident’s health care provider. The contact with the health care provider must shall also be documented in the resident’s record.

(c) Medication administration includes the conducting of any examination or testing, such as blood glucose testing, or other procedure necessary for the proper administration of medication that the resident cannot conduct  personally himself and that can be performed by licensed staff.

(d) A facility that which performs clinical laboratory tests for residents, including blood glucose testing, must be in compliance with the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) and Part I of Chapter 483, F.S. A valid copy of the State Clinical Laboratory License, if required, and the federal CLIA Certificate must be maintained in the facility. A state license or federal CLIA certificate is not required if residents perform the test themselves or if a third party assists residents in performing the test. The facility is not required to maintain a State Clinical Laboratory License or a federal CLIA Certificate if facility staff assist residents in performing clinical laboratory testing with the residents’ own equipment. Information about the State Clinical Laboratory License and federal CLIA Certificate is available from the Laboratory Clinical Laboratory Licensure Unit, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 32, Tallahassee, FL 32308; telephone [phone] [phone].

(5) MEDICATION RECORDS.

(a) For residents who use a pill organizer managed in under subsection (2), the facility must shall keep either the original labeled medication container; or a medication listing with the prescription number, the name and address of the issuing pharmacy, the health care provider’s name, the resident’s name, the date dispensed, the name and strength of the drug, and the directions for use.

(b) The facility must shall maintain a daily medication observation record (MOR) for each resident who receives assistance with self-administration of medications or medication administration. A medication observation record MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider’s telephone number; the name, strength, and directions for use of each medication; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The medication observation record MOR must be immediately updated each time the medication is offered or administered.

(c) For medications that which serve as chemical restraints, the facility must shall, pursuant to Section 429.41, F.S., maintain a record of the prescribing physician’s annual evaluation of the use of the medication.

(6) MEDICATION STORAGE AND DISPOSAL.

(a) In order to accommodate the needs and preferences of residents and to encourage residents to remain as independent as possible, residents may keep their medications, both prescription and over-the-counter, in their possession both on or off the facility premises; or in their rooms or apartments, which must be kept locked when residents are absent, unless the medication is in a secure place within the rooms or apartments or in some other secure place that which is out of sight of other residents. However, both prescription and over-the-counter medications for residents must shall be centrally stored if:

1. The facility administers the medication;

2. The resident requests central storage. The facility must shall maintain a list of all medications being stored pursuant to such a request;

3. The medication is determined and documented by the health care provider to be hazardous if kept in the personal possession of the person for whom it is prescribed;

4. The resident fails to maintain the medication in a safe manner as described in this paragraph;

5. The facility determines that because of physical arrangements and the conditions or habits of residents, the personal possession of medication by a resident poses a safety hazard to other residents; or

6. The facility’s rules and regulations require central storage of medication and that policy has been provided to the resident before prior to admission as required in under Rule 58A-5.0181, F.A.C.

(b) Centrally stored medications must be:

1. Kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times;

2. Located in an area free of dampness and abnormal temperature, except that a medication requiring refrigeration must shall be refrigerated. Refrigerated medications must shall be secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which refrigerator is located locked;

3. Accessible to staff responsible for filling pill-organizers, assisting with self-administration, or administering medication. Such staff must have ready access to keys or codes to the medication storage areas at all times; and

4. Kept separately from the medications of other residents and properly closed or sealed.

(c) Medication that which has been discontinued but which has not expired must shall be returned to the resident or the resident’s representative, as appropriate, or may be centrally stored by the facility for future resident use by the resident at the resident’s request. If centrally stored by the facility, the discontinued medication must it shall be stored separately from medication in current use, and the area in which it is stored must shall be marked “discontinued medication.” Such medication may be reused if re-prescribed by the resident’s health care provider.

(d) When a resident’s stay in the facility has ended, the administrator must shall return all medications to the resident, the resident’s family, or the resident’s guardian unless otherwise prohibited by law. If, after notification and waiting at least 15 days, the resident’s medications are still at the facility, the medications are shall be considered abandoned and may disposed of in accordance with paragraph (e).

(e) Medications that which have been abandoned or which have expired must be disposed of within 30 days of being determined abandoned or expired and the disposal must disposition shall be documented in the resident’s record. The medication may be taken to a pharmacist for disposal or may be destroyed by the administrator or designee with one witness.

(f) Facilities that hold a Special-ALF permit issued by the Board of Pharmacy may return dispensed medicinal drugs to the dispensing pharmacy pursuant to Rule 64B16-28.870, F.A.C.

(7) MEDICATION LABELING AND ORDERS.

(a) The facility may not store prescription drugs for self-administration, assistance with self-administration, or administration No prescription drug shall be kept or administered by the facility, including assistance with self-administration of medication, unless it is properly labeled and dispensed in accordance with Chapters 465 and 499, F.S., and Rule 64B16-28.108, F.A.C. If a customized patient medication package is prepared for a resident, and separated into individual medicinal drug containers, then the following information must be recorded on each individual container:

1. The resident’s name; and

2. Identification of each medicinal drug product in the container.

(b) Except with respect to the use of pill organizers as described in subsection (2), no individual person other than a pharmacist may transfer medications from one storage container to another.

(c) If the directions for use are “as needed” or “as directed,” the health care provider must shall be contacted and requested to provide revised instructions. For an “as needed” prescription, the circumstances under which it would be appropriate for the resident to request the medication and any limitations must shall be specified; for example, “as needed for pain, not to exceed 4 tablets per day.” The revised instructions, including the date they were obtained from the health care provider and the signature of the staff who obtained them, must shall be noted in the medication record, or a revised label must shall be obtained from the pharmacist.

(d) Any change in directions for use of a medication for which the facility is providing assistance with self-administration or administering medication must be accompanied by a written medication order issued and signed by the resident’s health care provider, or a faxed or electronic copy of such order. The new directions must shall promptly be recorded in the resident’s medication observation record. The facility may then place an “alert” label on the medication container that which directs staff to examine the revised directions for use in the medication observation record MOR, or obtain a revised label from the pharmacist.

(e) A nurse may take a medication order by telephone. Such order must be promptly documented in the resident’s medication observation record. The facility must obtain a written medication order from the health care provider within 10 working days. A faxed or electronic copy of a signed order is acceptable.

(f) The facility must shall make every reasonable effort to ensure that prescriptions for residents who receive assistance with self-administration of medication or medication administration are filled or refilled in a timely manner.

(g) Pursuant to Section 465.0276(5), F.S., and Rule 61N-1.006, F.A.C. Rule 64F-12.006, F.A.C., sample or complimentary prescription drugs that are dispensed by a health care provider, must be kept in their original manufacturer’s packaging, which must shall also include the practitioner’s name, the resident’s name for whom they were dispensed, and the date they were dispensed. If the sample or complimentary prescription drugs are not dispensed in the manufacturer’s labeled package, they must shall be kept in a container that bears a label containing the following:

1. Practitioner’s name;

2. Resident’s name;

3. Date dispensed;

4. Name and strength of the drug;

5. Directions for use; and

6. Expiration date.

(h) Pursuant to Section 465.0276(2)(c), F.S., before dispensing any sample or complimentary prescription drug, the resident’s health care provider must shall provide the resident with a written prescription, or a faxed or electronic fax copy of such order.

(8) OVER THE COUNTER (OTC) PRODUCTS. For purposes of this subsection, the term over the counter OTC includes, but is not limited to, over the counter OTC medications, vitamins, nutritional supplements and nutraceuticals, hereafter referred to as OTC products, that which can be sold without a prescription.

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

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

(c) Residents or their representatives may purchase OTC products from an establishment of their choice.

(d) A health care provider’s order is required when a nurse provides assistance with self-administration or administration of OTC products. When an order for an OTC product exists, the order must meet the requirements of paragraphs (b) and (c) of this subsection. A health care provider’s order for OTC products is not required A facility cannot require a licensed health care provider’s order for all OTC products when a resident self-administers his or her own medications, or when unlicensed staff provides assistance with self-administration of medications pursuant to Section 429.256, F.S. A licensed health care provider’s order is required when a licensed nurse provides assistance with self-administration or administration of medications, which includes OTC products. When such an order for an OTC product exists, only the requirements of paragraphs (b) and (c) of this subsection are required.

Rulemaking Authority 429.256, 429.41 FS. Law Implemented 429.255, 429.256, 429.41 FS. History–New 10-17-99, Amended 7-30-06, 4-15-10, 10-14-10,________.

 

58A-5.0186 Do Not Resuscitate Orders (DNROs).

(1) POLICIES AND PROCEDURES.

(a) Each assisted living facility (ALF) must have written policies and procedures that, which explain its implementation of delineate its position with respect to state laws and rules relative to Do Not Resuscitate Orders (DNROs) DNROs. An assisted living facility may not require execution of a DNRO as a condition of admission or treatment The policies and procedures shall not condition treatment or admission upon whether or not the individual has executed or waived a DNRO. The assisted living facility 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,” 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 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. DH Form 1896, Florida Do Not Resuscitate Order Form, December, 2004, which is hereby incorporated by reference. This form may be obtained by calling the Department of Health’s toll free number [phone], extension2780 or online at: http://www.floridahealth.gov/public-health-in-your-life/patient-rights-and-safety/do-not-resuscitate/. 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 64J-2.018, F.A.C.

(b) There must be documentation in the resident’s record indicating whether or not he or she has executed a DH Form 1896 has been executed DNRO. If a DH Form 1896 DNRO has been executed, a yellow copy of that document must be made a part of the resident’s record. If the assisted living facility ALF does not receive a copy of a resident’s executed DH Form 1896 DNRO, the assisted living facility ALF must document in the resident’s record that it has requested a copy.

(c) The executed DH Form 1896 must be readily available to medical staff in the event of an emergency.

(2) LICENSE REVOCATION. An assisted living facility’s license is ALF shall be subject to revocation of its license pursuant to Section 408.815, F.S., if, as a condition of treatment or admission, the facility it requires an individual to execute or waive DH Form 1896 a DNRO.

(3) DNRO PROCEDURES. Pursuant to Section 429.255, F.S., an assisted living facility ALF must honor a properly executed DH Form 1896 DNRO as follows:

(a) In the event a resident experiences cardiac or pulmonary cardiopulmonary arrest, staff trained in cardiopulmonary resuscitation (CPR), or a licensed health care provider present in the facility, may withhold cardiopulmonary resuscitation (artificial ventilation, cardiac compression, endotracheal intubation and defibrillation).

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

(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.

Rulemaking Authority 429.255 FS. Law Implemented 429.255 FS. History–New 4-15-10, Amended_________.

 

58A-5.019 Staffing Standards.

(1) ADMINISTRATORS. Every facility must shall be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff and the provision of appropriate adequate care to all residents as required by Part II, Chapter 408, F.S., Part I, of Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter.

(a) An administrator must The administrators shall:

1. Be at least 21 years of age;

2. If employed on or after August 15, 1990, have a high school diploma or general equivalency diploma (G.E.D.), or have been an operator or administrator of a licensed assisted living facility in the State of Florida for at least one of the past 3 years in which the facility has met minimum standards. Administrators employed on or after October 30, 1995, must have, at a minimum, a high school diploma or G.E.D.;

3. Be in compliance with Level 2 background screening requirements standards pursuant to Sections 408.809 and 429.174, F.S.; and

4. Complete the core training and core competency test requirements requirement pursuant to Rule 58A-5.0191, F.A.C., no later than 90 days after becoming employed as a facility administrator. Individuals who have successfully completed these requirements before December 1, 2014, are not required to take either the 40 hour core training or test unless specified elsewhere in this rule. Administrators who attended core training prior to July 1, 1997, are not required to take the competency test unless specified elsewhere in this rule.

5. Satisfy the continuing education requirements pursuant to Rule 58A-5.0191, F.A.C. Administrators who are not in compliance with these requirements must retake the core training and core competency test requirements in effect on the date the non-compliance is discovered by the agency or the department.

(b) In the event of extenuating circumstances, such as the death of a facility administrator, the agency may permit an individual who otherwise has not satisfied the training requirements of subparagraphs (1)(a)4. of this rule to temporarily serve as the facility administrator for a period not to exceed 90 days. During the 90 day period, the individual temporarily serving as facility administrator must:

1. Complete the core training and core competency test requirements pursuant to Rule 58A-5.0191, F.A.C.; and

2. Complete all additional training requirements if the facility maintains licensure as an extended congregate care or limited mental health facility.

(c)(b) Administrators may supervise a maximum of either three assisted living facilities or a group of facilities on a single campus providing combination of housing and health care facilities or agencies on a single campus. Administrators who supervise more than one facility must appoint in writing a separate manager for each facility. However, an administrator supervising a maximum of three assisted living facilities, each licensed for 16 or fewer beds and all within a 15 mile radius of each other, is only required to appoint two managers to assist in the operation and maintenance of those facilities.

However, administrators who supervise more than one facility shall appoint in writing a separate “manager” for each facility who must:

1. Be at least 21 years old;

2. Complete the core training requirement pursuant to Rule 58A-5.0191, F.A.C.

(d) An individual serving as a manager must satisfy the same qualifications, background screening, core training and competency test requirements, and continuing education requirements of an administrator pursuant to paragraph (1)(a) of this rule. Managers who attended the core training program prior to April 20, 1998, are not required to take the competency test unless specified elsewhere in this rule. In addition, a manager may not serve as a manager of more than a single facility, except as provided in paragraph (1)(c) of this rule, and may not simultaneously serve as an administrator of any other facility.

(e)(c) Pursuant to Section 429.176, F.S., facility owners must shall notify both the Agency Field Office and Agency Central Office within 10 ten (10) days of a change in a facility administrator on the Notification of Change of Administrator form, AHCA Form 3180-1006, May 2013 January 2006, which is incorporated by reference and available online at: http://ahca.myflorida.com/mchq/corebill/AssistedLivingFacility/ FORM_ALF_Notification_of_change_of_administrator.doc may be obtained from the Agency Central Office. The Agency Central Office shall conduct a background screening on the new administrator in accordance with Section 429.174, F.S., and Rule 58A-5.014, F.A.C.

(2) STAFF.

(a) Within 30 days after beginning employment, newly hired staff must submit a written statement from a health care provider documenting that the individual does not have any signs or symptoms of Tuberculosis, Methicillin Resistant Staphylococcus Aureus, Scabies or any other communicable disease. The examination performed by the health care provider must have been conducted no earlier than 6 months before submission of the statement. Newly hired staff shall have 30 days to submit a statement from a health care provider, based on a examination conducted within the last six months, that the person does not have any signs or symptoms of a communicable disease including tuberculosis. Newly hired staff does not include an employee transferring without a break in service from one facility to another when the facility is under the same management or ownership. 

1. Evidence of a negative Freedom from tuberculosis examination must be documented on an annual basis. Signed documentation provided by the Florida Department of Health or a licensed health care provider that a test is not required, shall satisfy the tuberculosis requirement. An individual A person with a positive tuberculosis test must submit a health care provider’s statement that the individual person does not constitute a risk of communicating tuberculosis. Newly hired staff does not include an employee transferring from one facility to another that is under the same management or ownership, without a break in service.

2. If any staff member has is later found to have, or is suspected of having, a communicable disease, such individual must he/she shall be immediately removed from duties until a written statement is submitted from a health care provider indicating that the individual does not constitute a risk of transmitting a communicable disease the administrator determines that such condition no longer exists.

(b) All Sstaff must shall be qualified to perform their assigned duties consistent with their his/her level of education, training, preparation, and experience. Staff providing services requiring licensing or certification must be appropriately licensed or certified. All staff must shall exercise their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident’s record, and to report the observations to the resident’s health care provider in accordance with this rule chapter.

(c) All staff must comply with the training requirements of Rule 58A-5.0191, F.A.C.

(d) An assisted living facility contracting to provide services to residents must ensure that individuals providing services are qualified to perform their assigned duties Staff provided by a staffing agency or employed by a business entity contracting to provide direct or indirect services to residents must be qualified for the position in accordance with this rule chapter. The contract between the facility and the staffing agency or contractor must shall specifically describe the services the staffing agency or contractor will provide be providing to residents.

(e) For facilities with a licensed capacity of 17 or more residents, the facility must shall:

1. Develop a written job description for each staff position and provide a copy of the job description to each staff member; and

2. Maintain time sheets for all staff.

(f) Level 2 background screening must be conducted for staff, including staff contracted by the facility to provide services to residents, pursuant to Sections 408.809 and 429.174, F.S.

(3) BACKGROUND SCREENING.

(a) All staff, who are hired on or after October 1, 1998, to provide personal services to residents, must be screened in accordance with Section 429.174, F.S., and meet the screening standards of Section 435.03, F.S. A packet containing background screening forms and instructions may be obtained from the Agency Background Screening Unit, 2727 Mahan Drive, Tallahassee, FL 32308; telephone [phone]. Within ten (10) days of an individual’s employment, the facility shall submit the following to the Agency Background Screening Unit:

1. A completed Level 1 Criminal History Request, AHCA Form 3110-0002, July 2005, which is incorporated by reference and may be obtained in the screening packet referenced in paragraph (3)(a) of this rule; and

2. A check to cover the cost of screening.

(b) The results of employee screening conducted by the agency shall be maintained in the employee’s personnel file.

(c) Staff with the following documentation in their personnel records shall be considered to have met the required screening requirement:

1. A copy of their current professional license, proof that a criminal history screening has been conducted, and an affidavit of current compliance with Section 435.03, F.S.;

2. Proof of continuous employment in an occupation which requires Level 1 screening without a break in employment that exceeds 180 days, and proof that a criminal history screening has been conducted within the previous two (2) years; or

3. Proof of employment with a corporation or business entity or related entity that owns, operates, or manages more than one facility or agency licensed under Chapter 400, F.S., that conducted Level 1 screening as a condition of initial or continued employment

(3)(4) STAFFING STANDARDS.

(a) Minimum staffing:

1. Facilities must shall maintain the following minimum staff hours per week:

Number of ResidentsStaff Hours/Week

0-5168

6-15212

16-25253

26-35294

36-45335

46-55375

56-65416

66-75457

76-85498

86-95539

For every 20 residents over 95 add 42 staff hours per week.

2. Independent living residents as referenced in subsection 58A-5.024(3), F.A.C., who occupy beds included within the licensed capacity of an assisted living facility and who receive no personal, limited nursing, or extended congregate care services, are not counted as a resident for purposes of computing minimum staff hours.

3.2. At least one staff member who has access to facility and resident records in case of an emergency must shall be in within the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be left solely in charge of other residents while the facility administrator, manager or other staff are absent from the facility.

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

5.4. A staff member who has completed courses in First Aid and Cardiopulmonary Resuscitation (CPR) and holds a currently valid card documenting completion of such courses must be in the facility at all times At least one staff member who is trained in First Aid and CPR, as provided under Rule 58A-5.0191, F.A.C., shall be within the facility at all times when residents are in the facility.

a. Documentation of attendance at First Aid or CPR courses offered by an accredited college, university or vocational school; a licensed hospital; the American Red Cross, American Heart Association, or National Safety Council; or a provider approved by the Department of Health, satisfies this requirement.

b. A nurse is considered as having met the course requirements for both First Aid and CPR. In addition, an emergency medical technician or paramedic currently certified under Part III, Chapter 401, F.S., is considered as having met the course requirements for both First Aid and CPR.

6.5. During periods of temporary absence of the administrator or manager of more than 48 hours when residents are on the premises, a staff member who is at least 21 18 years of age, must be physically present and designated in writing to be in charge of the facility. No staff member shall be in charge of a facility for a consecutive period of 21 days or more, or for a total of 60 days within a calendar year, without being an administrator or manager.

7.6. Staff whose duties are exclusively building or grounds maintenance, clerical, or food preparation do shall not count towards be counted toward meeting the minimum staffing hours requirement.

8.7. The administrator or manager’s time may be counted for the purpose of meeting the required staffing hours, provided the administrator or manager is actively involved in the day-to-day operation of the facility, including making decisions and providing supervision for all aspects of resident care, and is listed on the facility’s staffing schedule.

9.8. Only on-the-job staff may be counted in meeting the minimum staffing hours. Vacant positions or absent staff may not be counted.

(b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities, including those composed of apartments, must shall have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents’ scheduled and unscheduled service needs, resident contracts, and resident care standards as described in Rule 58A-5.0182, F.A.C.

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

(d) The facility must shall be required to provide staff immediately when the aAgency determines that the requirements of paragraph (a) are not met. The facility must shall also be required to immediately increase staff above the minimum levels established in paragraph (a) if the aAgency determines that adequate supervision and care are not being provided to residents, resident care standards described in Rule 58A-5.0182, F.A.C., are not being met, or that the facility is failing to meet the terms of residents’ contracts. The aAgency will shall consult with the facility administrator and residents regarding any determination that additional staff is required. Based on the recommendations of the local fire safety authority, the agency may require additional staff when the facility fails to meet the fire safety standards described in Section 429.41(1)(a), F.S., and Rule Chapter 69A-40, F.A.C., until such time as the local fire safety authority informs the agency that fire safety requirements are being met.

1. When additional staff is required above the minimum, the agency will shall require the submission, within the time specified in the notification, of a corrective action plan within the time specified in the notification indicating how the increased staffing is to be achieved to meet and resident service needs will be met. The plan will shall be reviewed by the agency to determine if the plan increases will increase the staff to needed levels to and meet resident needs.

2. When the facility can demonstrate to the agency that resident needs are being met, or that resident needs can be met without increased staffing, modifications may be made in staffing requirements for the facility and the facility will shall no longer be required to maintain a plan with the agency.

3. Based on the recommendations of the local fire safety authority, the Agency may require additional staff when the facility fails to meet the fire safety standards described in Section 429.41, F.S., and Rule Chapter 69A-40, F.A.C., until such time as the local fire safety authority informs the Agency that fire safety requirements are being met.

(e) Facilities that are co-located with a nursing home may use shared staffing provided that staff hours are only counted once for the purpose of meeting either assisted living facility or nursing home minimum staffing ratios.

(f) Facilities holding a limited mental health, extended congregate care, or limited nursing services license must also comply with the staffing requirements of Rule 58A-5.029, 58A-5.030, or 58A-5.031, F.A.C., respectively.

Rulemaking Authority 429.275, 429.41, 429.52, 429.275 FS. Law Implemented 429.02, 429.174, 429.176, 429.24, 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, 4-15-10,_________.

 

(Substantial rewording of Rule 58A-5.0191 follows. See Florida Administrative Code for present text.)

 

58A-5.0191 Administrator, Manager, and Staff Training Requirements and Competency Test.

Administrators, managers, and staff must satisfy the minimum training, testing, continuing education, and documentation requirements as specified in this rule.

(1) ADMINISTRATORS AND MANAGERS. Administrators and managers must satisfy the training requirements as stated below.

(a) Core Training. Completion of the department approved assisted living facility core training curriculum consisting of a minimum of 40 hours of training.  The core training curriculum must be conducted by a department approved core training provider using the curriculum outlined in DOEA Form ALFCT-003, Assisted Living Facility Minimum 40 Hour Core Training Curriculum, November 2013, which is incorporated by reference. The curriculum is available from the Department of Elder Affairs, Elder Housing Unit, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 or the department’s website at: http://elderaffairs.state.fl.us/doea/ruleforms/ALFCT_003.pdf. A listing of approved training providers may be obtained from http://elderaffairs.state.fl.us/doea/alf.php or http://www.alf.usf.edu.

(b) Core Competency Test. Successful passage of the core competency test within 24 months of completing the core training curriculum but no later than 90 days after beginning employment as an administrator or manager. Completion of the approved core training curriculum is required before registering for the core competency test. The overall passing score for the competency test is 75%. Registration information for the core competency test may be obtained from the ALF Core Competency Testing Office at http://www.alf.usf.edu, or by calling [phone].

1. Administrators and managers who fail to pass the core competency test after three attempts must retake the core training curriculum before retaking the core competency test.

2. The fee for the core competency test is $200. The payment for the competency test fee must be remitted to the entity administering the test. A new fee is due each time the test is taken.

3. Before December 1, 2014, any individual registering to take the core competency test must have completed the approved 26 hour core training curriculum conducted by a department approved core training provider using the curriculum outlined in DOEA Form ALFCT-001, Assisted Living Facility Minimum 26 Hour Core Training Curriculum, June 2009, which is incorporated by reference. The curriculum is available from the Department of Elder Affairs, Elder Housing Unit, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 or the department’s website at: http://elderaffairs.state.fl.us/doea/ruleforms/ALFCT_001.pdf. On or after December 1, 2014, any individual registering to take the core competency test must have completed the approved 40 hour core training curriculum as provided above.

(c) Initial Specialty License Training. Administrators and managers of facilities holding the following specialty licenses must satisfy the specific training identified below:

1. Extended Congregate Care. Completion of 4 hours of initial training in extended congregate care prior to the facility’s receipt of its initial extended congregate care license, or within 90 days of beginning employment in a facility with an existing extended congregate care license. The training must address topics relating to the medical, physical, psychological, or social needs of frail elderly and disabled persons, including statutory and rule requirements, and delivery of personal care and supportive services in an extended congregate care facility. Training must be received from the approved providers as set forth in subparagraphs (5)(d)1. through 5. of this rule.

2. Limited Mental Health. Completion of a minimum of 6 hours of training in working with individuals with mental health diagnoses within 6 months of the facility’s receiving an initial limited mental health license, or within 90 days of beginning employment in a facility with an existing limited mental health license. Training must be received from the approved providers as set forth in subparagraph (5)(d)8. of this rule.

(2) ALL FACILITY STAFF. All facility staff, including administrators and managers, regardless of responsibilities or duties, must satisfy the following requirements within 90 days of beginning employment:

(a) Completion of a one-time education training course on HIV and AIDS, which includes the topics prescribed in Section 381.0035, F.S. Staff subject to the requirements of Section 456.033, F.S., or who have documentation of prior completion of this training course, are exempt from this requirement.

(b) Completion of in-service training regarding the facility’s resident elopement response policies and procedures.

(c) Completion of in-service training relating to the facility’s policies and procedures regarding Do Not Resuscitate Orders (DNROs).

(3) STAFF INTERACTING WITH RESIDENTS. Direct care staff, other than administrators and managers who have satisfied the training requirements of subsection (1) of this rule, must satisfy the training requirements as stated below. Additionally, staff in a facility with a limited mental health license who have regular contact with residents must satisfy the training specified in subparagraph (3)(c)2. below.

(a) Pre-Service Training. Facility administrators or managers must provide or arrange for a minimum of 1 hour of training for direct care staff relating to infection control, universal precautions, and facility sanitation procedures.

1. Pre-service training must be completed before direct care staff may provide personal care to residents.

2. Documentation of compliance with the staff training requirements of 29 CFR 1910.1030, relating to blood borne pathogens, July 2012, which is hereby incorporated by reference and available at: http://www.gpo.gov/fdsys/pkg/CFR-2010-title29-vol6/pdf/CFR-2010-title29-vol6-sec1910-1030.pdf, may be used to meet this requirement.

3. Nurses, certified nursing assistants, and home health aides, as defined in Section 400.462(15), F.S., trained in accordance with Rule 59A-8.0095, F.A.C., are exempt from the pre-service training requirements.

(b) In-Service Training. Facility administrators or managers must provide or arrange for the following in-service training within 30 days of direct care staff beginning employment:

1. 1 hour of training covering the reporting of adverse incidents and facility emergency procedures, including chain-of-command and staff roles relating to emergency evacuation;

2. 1 hour of training covering resident rights in an assisted living facility and recognizing and reporting resident abuse, neglect, and exploitation; and

3. 3 hours of training covering resident behavior and needs and providing assistance with the activities of daily living. Nurses, certified nursing assistants, and home health aides trained in accordance with Rule 59A-8.0095, F.A.C., are exempt from this 3 hour in-service training requirement.

(c) Specialty License Training.

1. Extended Congregate Care. All direct care staff providing care to residents receiving extended congregate care services must complete a minimum of 2 hours of in-service training within 30 days of beginning employment in the facility.  The training must be provided by the facility administrator or manager or arranged through approved providers as set forth in subparagraphs (5)(d)1. through 5. of this rule, The training must address topics relating to the medical, physical, psychological, or social needs of frail elderly and disabled persons, including statutory and rule requirements, and delivery of personal care and supportive services in an extended congregate care facility.

2. Limited Mental Health. Direct care staff and staff in regular contact with mental health residents must complete a minimum of 6 hours of training in working with individuals with mental health diagnoses within 6 months of the facility’s receiving an initial limited mental health license, or within 90 days of beginning employment in a facility with an existing limited mental health license. The training must be received from providers as set forth in subparagraph (5)(d)8. of this rule.

(4) ADDITIONAL TRAINING REQUIREMENTS FOR ADMINISTRATORS, MANAGERS AND STAFF. Additional training requirements for administrators, managers, and staff are specified below.

(a) Alzheimer’s Disease or Related Disorders (“ADRD”) Training. Facilities providing special care for persons with ADRD, or that maintain secured areas as described in Chapter 4, Section 434.4.6 of the Florida Building Code as adopted in Rule 61G20-1.001, F.A.C., must ensure that facility staff receives the following training.

1. Individuals other than direct care staff or staff in regular contact with residents with ADRD must receive general written information provided by the facility on interacting with such residents within 3 months of beginning employment.

2. Direct care staff and staff in regular contact with residents with ADRD must obtain 4 hours of initial training within 3 months of beginning employment. The following individuals will be considered as having met this initial training requirement:

a. Administrators and managers who have successfully completed the training requirements of subsection (1) of this rule;

b. Facility staff who meet the requirements of an ADRD training provider pursuant to Rule 58A-5.0194, F.A.C.; and

c. Staff who have received both the initial one hour and continuing three hours of ADRD training pursuant to Sections 400.1755, 400.6045(1), and 429.917, F.S.

3. The initial training, entitled “Alzheimer’s Disease or Related Disorders Level I Training,” must address the following subject areas:

a. Understanding Alzheimer’s disease or related disorders;

b. Characteristics of Alzheimer’s disease or related disorders;

c. Communicating with residents with Alzheimer’s disease or related disorders;

d. Family issues;

e. Resident environment; and

f. Ethics.

4. Direct care staff must obtain an additional 4 hours of training within 9 months of beginning employment. Facility staff who meet the requirements of an ADRD training provider pursuant to Rule 58A-5.0194, F.A.C., will be considered as having met this requirement.

5. The additional training, entitled “Alzheimer’s Disease or Related Disorders Level II Training,” must address the following subject areas:

a. Behavior management;

b. Assistance with activities of daily living;

c. Activities for residents;

d. Stress management for the caregiver; and

e. Medical information.

(b) Assistance With Self-Administered Medication Training. Unlicensed persons as defined in Section 429.256(1)(b), F.S., who provide assistance with self-administered medications as described in Rule 58A-5.0185, F.A.C., must complete a minimum of 6 hours of training provided by a registered nurse, licensed pharmacist, or department staff before assuming this responsibility. Training must include demonstrations of proper techniques and provide opportunities for hands-on learning through practice exercises. Unlicensed persons who have received a training certificate demonstrating successful completion of a 4 hour course before July 1, 2014 are not required to take the 6 hour training.

1. Training provided in fulfillment of this requirement must address the following subject areas:

a. State law and rule requirements with respect to recognizing the differences between providing assistance with the self-administration of medications and the supervision, administration, and management of medications in assisted living facilities;

b. Procedures and techniques for assisting the resident with self-administration of medication including how to read a prescription label;

c. Providing the right medications to the right resident;

d. Common medications;

e. The importance of taking medications as prescribed;

f. Recognition of side effects, adverse reactions, and procedures to follow when residents appear to be experiencing side effects and adverse reactions;

g. Documentation and record keeping;

h. Medication storage and disposal; and

i. Procedures and techniques for hand washing and infection control when assisting the resident with self-administration of medication.

2. A training certificate will be issued to a trainee after successfully demonstrating the ability to provide assistance with self-administration, including the ability to:

a. Read and understand a prescription label; 

b. Assist with forms of oral; topical; and topical ophthalmic, otic, and nasal dosages, including solutions, suspensions, sprays, and inhalers;

c. Measure liquid medications, break scored tablets, and crush tablets in accordance with prescription directions;

d. Recognize the need to obtain clarification of an “as needed” prescription order;

e. Recognize a medication order that requires judgment or discretion, and to advise the resident, resident’s health care provider, or facility administrator or manager of the unlicensed individual’s inability to assist in the administration of such orders;

f. Complete a medication observation record;

g. Retrieve and store medication; and

h. Recognize the general signs of adverse reactions to medications and report such reactions.

(c) Food Services. Staff who prepare or serve food, who have not taken the assisted living facility core training must receive a minimum of 1 hour in-service training in safe food handling practices within 30 days of beginning employment.

(5) CONTINUING EDUCATION REQUIREMENTS, Administrators, managers and staff must satisfy the continuing education requirements as stated below from the training providers listed.

(a) Administrators and Managers. To maintain the status as an administrator or manager, documentation of compliance with the continuing education requirement must be kept in staff records.

1. All Licensed Facilities. Completion of 18 hours of continuing education every 2 years in topics related to the core training curriculum as specified on DOEA Form ALFCT-003, Assisted Living Facility Minimum 40 Hour Core Training Curriculum, November 2013, or other topics relating to the care of residents and the operation and maintenance of an assisted living facility.

2. Extended Congregate Care Licensed Facilities. Completion of a minimum of 4 hours, every 2 years, in topics relating to the medical, physical, psychological, or social needs of frail elderly and disabled persons. The initial and continuing education in extended congregate care training may count for 4 of the required 18 hours of continuing education.

3. Limited Mental Health Licensed Facilities. Completion of a minimum of 3 of the required 18 hours of continuing education in the following topics:

a. Mental health diagnoses; and

b. Mental health treatment such as mental health needs, services, behaviors and appropriate interventions; resident progress in achieving treatment goals; how to recognize changes in the resident’s status or condition that may affect other services received or may require intervention; and crisis services and Baker Act procedures.

The initial training received under subparagraph (1)(c)2. may count once for 6 of the required 18 hours of continuing education. The limited mental health continuing education training may count for 3 of the required 18 hours of continuing education.

4. Alzheimer’s Disease and Related Disorders (ADRD). Administrators and managers who are also direct care staff must complete 4 hours of continuing education annually in topics related to Alzheimer’s Disease or Related Disorders Level I and II Training. A total of 4 hours of ADRD continuing education training may count towards the 18 hours of continuing education.

5. Assistance With Self-Administered Medication. Administrators and managers who are unlicensed and provide assistance with self-administered medications must obtain annually a minimum of 2 hours of continuing education in topics relating to providing assistance with self-administered medications and safe medication practices in an assisted living facility. The continuing education may only be provided by a registered nurse, licensed pharmacist, or department staff. A total of 2 hours of assistance with self-administered medication continuing education training may count towards the 18 hours of continuing education.

6. Food Services. If the administrator or manager is responsible for total food services and the day-to-day supervision of food services staff, the administrator or manager must obtain a minimum of 2 hours of continuing education annually in topics related to nutrition or food services in an assisted living facility. A total of 2 hours of food services continuing education training may count towards the 18 hours of continuing education.

(b) Staff Interacting With Residents.

1. Limited Mental Health Licensed Facilities Direct care staff and staff in regular contact with mental health residents must complete a minimum of 3 hours of continuing education every 2 years in the following topics:

a. Mental health diagnoses; and

b. Mental health treatment such as mental health needs, services, behaviors and appropriate interventions; resident progress in achieving treatment goals; how to recognize changes in the resident’s status or condition that may affect other services received or may require intervention; and crisis services and Baker Act procedures.

2.  Alzheimer’s Disease and Related Disorders (ADRD). Direct care staff must obtain 4 hours of continuing education annually in topics related to Alzheimer’s Disease or Related Disorders Level I and II Training.

3. Assistance With Self-Administered Medication. Unlicensed persons who provide assistance with self-administered medications must obtain annually a minimum of 2 hours of continuing education in topics relating to providing assistance with self-administered medications and safe medication practices in an assisted living facility. The continuing education may only be provided by a registered nurse, licensed pharmacist, or department staff.

(c) Food Services. An individual designated by an administrator or manager to be responsible for total food services and the day-to-day supervision of food services staff must obtain annually a minimum of 2 hours of continuing education in topics related to nutrition or food services in an assisted living facility.

(d) Continuing Education Providers. Continuing education may be obtained either online or in person and must be obtained from courses or workshops offered by providers as specified below.

1. Core trainers registered with the department;

2. Providers offering courses through a trade association, accredited college, university, or private post-secondary institution;

3. Providers and courses registered within the continuing education tracking databases maintained by the department, the agency, or the Department of Health;

4. Courses and workshops offered by or in conjunction with the department, the agency, the Department of Health, or the Department of Children and Families that offer a certificate of completion in compliance with paragraph (6) of this rule;

5. Courses and workshops approved by the National Accreditation Board;

6. For training related to food services, training may be obtained from a certified food manager, certified dietary manager, registered or licensed dietitian, dietetic registered technician, or health department sanitarian; or

7. For training related to nutrition, training may be obtained from a certified food manager, certified dietary manager, registered or licensed dietitian, or dietetic registered technician.

8.  For training related to limited mental health, training must be provided by a trainer approved by the Department of Children and Families, or its designee.

(6) TRAINING DOCUMENTATION AND MONITORING.

(a) Certificates, or copies of certificates, issued by a training provider for completion of any training required by this rule must be documented in the facility’s personnel files for a period of 3 years. The documentation must include the following:

1. The title of the training program;

2. The subject matter of the training program;

3. The training program agenda;

4. The number of hours of the training program;

5. The trainee’s name, dates of participation, and location of the training program; and

6. The training provider’s name, dated signature, credentials, and professional license number, if applicable.

(b) Administrators, managers, and staff do not have to repeat the initial or one-time training specified in this rule upon a change or lapse of employment if a copy of the training certificate is provided to the new employer for retention in the facility’s personnel files. Administrators, managers, and staff must also ensure that copies of the continuing education training certificates are provided to the facility for retention in the facility’s personnel files.

(c) Upon request, the facility must provide training documentation to the department or agency for review.

(d) The department and agency reserve the right to attend and monitor any training that is intended to meet regulatory requirements in this rule.

Rulemaking Authority 429.178, 429.41, 429.52 FS. Law Implemented 429.07, 429.075, 429.178, 429.256, 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, 4-15-10,_________.

 

58A-5.0194 Alzheimer’s Disease or Related Disorders Training Provider and Curriculum Approval.

(1) The Alzheimer’s Disease or Related Disorders (“ADRD”) training provider and curriculum must be approved by the department or its designee before commencing training activities. The department or its designee will maintain a list of approved ADRD training providers and curricula, which may be obtained from http://usfweb3.usf.edu/trainingonAging/default.aspx.

(a) ADRD Training Providers.

1. Individuals who seek to become an ADRD training provider must provide the department or its designee with the documentation of the following educational, teaching, or practical experience:

a. A Master’s degree from an accredited college or university in a health care, human service, or gerontology related field; or

b. A Bachelor’s degree from an accredited college or university, or licensure as a registered nurse, and:

(I) Proof of 1 year of teaching experience as an educator of caregivers for individuals with Alzheimer’s disease or related disorders; or

(II) Proof of completion of a specialized training program specifically relating to Alzheimer’s disease or related disorders, and a minimum of 2 years of practical experience in a program providing direct care to individuals with Alzheimer’s disease or related disorders; or

(III) Proof of 3 years of practical experience in a program providing direct care to persons with Alzheimer’s disease or related disorders.

c. Teaching experience pertaining to Alzheimer’s disease or related disorders may substitute on a year-by-year basis for the required Bachelor’s degree.

2. Applicants seeking approval as ADRD training providers must complete DOEA form ALF/ADRD-001, Application for Alzheimer’s Disease or Related Disorders Training Provider Certification, dated November 2013, which is incorporated by reference and available at the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 and online at http://usfweb3.usf.edu/trainingonAging/ApplicationForm.aspx.

(b) ADRD Training Curricula. Applicants seeking approval of ADRD curricula must complete DOEA form ALF/ADRD-002, Application for Alzheimer’s Disease or Related Disorders Training Three-Year Curriculum Certification, dated November 2013, which is incorporated by reference and available at the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 and online at http://trainingonaging.cbcs.usf.edu/data/doea_alf_curriculum.pdf. Approval of the curriculum will be granted for 3 years. After 3 years the curriculum must be resubmitted to the department or its designee for approval.

(2) Approved ADRD training providers must maintain records of each course taught for a period of 3 years following each training presentation. Course records must include the title of the approved ADRD training curriculum, the curriculum approval number, the number of hours of training, the training provider’s name and approval number, the date and location of the course, and a roster of trainees.

(3) Upon successful completion of training, the trainee must be issued a certificate by the approved training provider. The certificate must include the trainee’s name, the title of the approved ADRD training, the curriculum approval number, the number of hours of training received, the date and location of the course, the training provider’s name and approval number, and dated signature.

(4) The department or its designee reserves the right to attend and monitor ADRD training courses, review records and course materials approved pursuant to this rule, and revoke approval for the following reasons: non-adherence to approved curriculum, failing to maintain required training credentials, or knowingly disseminating any false or misleading information.

(5) ADRD training providers satisfying the requirements of Sections 400.1755, F.S., relating to nursing homes, and 400.6045, F.S., relating to hospices, will satisfy the Level 1 and Level 2 training provider requirements of this rule. ADRD training curricula satisfying the requirements of Section 400.1755, F.S., relating to nursing homes, and 400.6045, F.S., relating to hospices, will satisfy the Level 1 curriculum requirements of this rule.

Rulemaking Authority 429.178 FS. Law Implemented 429.178 FS. History–New_________.

 

58A-5.020 Food Service Standards.

(1) GENERAL RESPONSIBILITIES. When food service is provided by the facility, the administrator, or an individual a person designated in writing by the administrator, must be responsible for total food services and the day-to-day supervision of food services staff. In addition, the following requirements apply shall:

(a) Be responsible for total food services and the day‑to‑day supervision of food services staff. If the designee is an individual who has not completed an approved assisted living facility core training course, such individual must complete the food and nutrition services module of the core training course before assuming responsibility for the facility’s food service. The designee is not subject to the 1 hour in-service training in safe food handling practices.

(b) If the designee is a certified food manager, certified dietary manager, registered or licensed dietitian, dietetic registered technician, or health department sanitarian, the designee is exempt from the requirement to complete the food and nutrition services module of the core training course before assuming responsibility for the facility’s food service as required in subsection (1)(a) of this rule.

(c)(b) An administrator or designee must pPerform his or her his/her duties in a safe and sanitary manner.

(d)(c) An administrator or designee must pProvide regular meals that which meet the nutritional needs of residents, and therapeutic diets as ordered by the resident’s health care provider for residents resident’s who require special diets.

(e)(d) An administrator or designee must comply with Maintain the food service in-service and continuing education requirements specified in Rule 58A-5.0191, F.A.C.

(2) DIETARY STANDARDS.

(a) The meals provided by the assisted living facility must be planned based on the current USDA Dietary Guidelines for Americans, 2010, which are incorporated by reference and available for review at: http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf, and the current summary of Dietary Reference Intakes established by the Food and Nutrition Board of the Institute of Medicine of the National Academies, 2010, which are incorporated by reference and available for review at: http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/New%20Material/5DRI%20Values%20SummaryTables%2014.pdf. The Tenth Edition Recommended Dietary Allowances established by the Food and Nutrition Board – National Research Council, adjusted for age, sex and activity, shall be the nutritional standard used to evaluate meals. A summary of the Tenth Edition Recommended Dietary Allowances, interpreted by a daily food guide, is available from the DOEA Assisted Living Program. Therapeutic diets must shall meet these nutritional standards to the extent possible.

(b) The residents’ nutritional needs must recommended dietary allowances shall be met by offering a variety of meals foods adapted to the food habits, preferences, and physical abilities of the residents, and must be prepared through by the use of standardized recipes. For facilities with a licensed capacity of 16 or fewer residents, standardized recipes are not required. Unless a resident chooses to eat less, the facility must serve the standard minimum portions of food according to the Dietary Reference Intakes. recommended dietary allowances to be made available to each resident daily by the facility are as follows:

1. Protein: 6 ounces or 2 or more servings;

2. Vegetables: 3-5 servings;

3. Fruit: 2-4 or more servings;

4. Bread and starches: 6-11 or more servings;

5. Milk or milk equivalent: 2 servings;

6. Fats, oils, and sweets: use sparingly; and

7. Water.

(c) All regular and therapeutic menus to be used by the facility must shall be reviewed annually by a licensed or registered dietitian, a licensed nutritionist dietitian/nutritionist, or by a registered dietetic technician supervised by a licensed or registered dietitian, or a licensed nutritionist dietitian/nutritionist, to ensure the meals meet are commensurate with the nutritional standards established in this rule. The annual review must be documented in the facility files and include the original signature of the reviewer, registration or license number, and date reviewed. Portion sizes must shall be indicated on the menus or on a separate sheet.

1. Daily food servings may be divided among three or more meals per day, including snacks, as necessary to accommodate resident needs and preferences. This review shall be documented in the facility files and include the signature of the reviewer, registration or license number, and date reviewed.

2. Menu items may be substituted with items of comparable nutritional value based on the seasonal availability of fresh produce or the preferences of the residents.

(d) Menus must to be served shall be dated and planned at least 1 one week in advance for both regular and therapeutic diets. Residents must shall be encouraged to participate in menu planning. Planned menus must shall be conspicuously posted or easily available to residents. Regular and therapeutic menus as served, with substitutions noted before or when the meal is served, must shall be kept on file in the facility for 6 months.

(e) Therapeutic diets must shall be prepared and served as ordered by the health care provider.

1. Facilities that offer residents a variety of food choices through a select menu, buffet style dining, or family style dining are not required to document what is eaten unless a health care provider’s order indicates that such monitoring is necessary. However, the food items that which enable residents to comply with the therapeutic diet must shall be identified on the menus developed for use in the facility.

2. The facility must shall document a resident’s refusal to comply with a therapeutic diet and provide notification to the resident’s health care provider of such refusal. If a resident refuses to follow a therapeutic diet after the benefits are explained, a signed statement from the resident or the resident’s responsible party refusing the diet is acceptable documentation of a resident’s preferences. In such instances daily documentation is not necessary.

(f) For facilities serving three or more meals a day, no more than 14 hours must shall elapse between the end of an evening meal containing a protein food and the beginning of a morning meal. Intervals between meals must shall be evenly distributed throughout the day with not less than 2 two hours nor more than 6 six hours between the end of one meal and the beginning of the next. For residents without access to kitchen facilities, snacks must shall be offered at least once per day. Snacks are not considered to be meals for the purposes of calculating the time between meals.

(g) Food must shall be served attractively at safe and palatable temperatures. All residents must shall be encouraged to eat at tables in the dining areas. A supply of eating ware sufficient for all residents, including adaptive equipment if needed by any resident, must shall be on hand.

(h) A 3-day supply of nonperishable non-perishable food, based on the number of weekly meals the facility has contracted with residents to serve, must and shall be on hand at all times. The quantity must shall be based on the resident census and not on licensed capacity. The supply must shall consist of dry or canned foods that can be stored safely without do not require refrigeration and shall be kept in sealed containers which are labeled and dated. The food shall be rotated in accordance with shelf life to ensure safety and palatability. Water sufficient for drinking and food preparation must shall also be stored, or the facility must shall have a plan for obtaining water in an emergency, with the plan coordinated with and reviewed by the local disaster preparedness authority.

(3) FOOD HYGIENE. Copies of inspection reports issued by the county health department for the last 2 years pursuant to Rule 64E-12.004 or Chapter 64E-11, F.A.C., as applicable, depending on the licensed capacity of the assisted living facility ALF, must shall be on file in the facility.

(4) CONTRACTED CATERED FOOD SERVICE. When food service is contracted by the facility, catered the facility must shall ensure that the contracted catered food service meets all dietary standards imposed by this rule and is adequately protected upon delivery to the facility pursuant to subsection 64E-12.004(4), F.A.C. The facility must shall maintain:

(a) A copy of the current contract between the facility and the food service contractor establishment agreeing to provide food service in the facility which includes the terms of the agreement.

(b) A copy of the annually issued certificate or license authorizing the operation of the food service contractor establishment issued by the applicable regulating agency. The license or certificate must shall provide documentation of the food service contractor’s establishment’s compliance with food service regulatory requirements.

Rulemaking Authority 429.41 FS. Law Implemented 429.41, 429.52 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.20, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.020, Amended 10-30-95, 6-2-96, 10-17-99,__________.

 

58A-5.021 Fiscal Standards.

(1) FINANCIAL STABILITY. The facility must shall be administered on a sound financial basis in order to ensure adequate resources to meet resident needs pursuant to the requirements of Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter. For the purposes of Section 429.47, F.S., evidence of financial instability includes filed bankruptcy by any owner; issuance of checks returned for insufficient funds; delinquent accounts; nonpayment of local, state, or federal taxes or fees; unpaid utility bills; tax or judgment liens against facility or owners property; failure to meet employee payroll; confirmed complaints to the agency or district long-term care ombudsman council regarding withholding of refunds or funds due residents; failure to maintain liability insurance due to non‑payment of premiums; non‑payment of rent or mortgage; non‑payment for essential services; or adverse court action which could result in the closure or change in ownership or management of the ALF. When there is evidence of financial instability, the agency shall require the facility to submit the following documentation:

(a) Facilities with a capacity of 25 or less:

1. Payment of local, state or federal taxes;

2. Delinquent accounts, if any;

3. Number of checks returned for insufficient funds during the previous 24 months, if any;

4. Receipt of resident rent payment;

5. Amount of cash assets deposited in the facility bank account;

6. Capability of obtaining additional financing, if needed; and

7. A statement of operations or AHCA Form 3180-1002, July 1995, projecting revenues, expenses, taxes, extraordinary items, and other credits and charges for the next 12 months.

(b) Facilities with a capacity of 26 or more, shall provide the documentation described in paragraph (a) above, or submit a current asset and liabilities statement or AHCA Form 3180-1003, January 1998.

(2) ACCOUNTING PROCEDURES. The facility shall maintain written business records using generally accepted accounting principles as defined in Rule 61H1-20.007, F.A.C., which accurately reflect the facility’s assets and liabilities and income and expenses. Income from residents shall be identified by resident name in supporting documents, and income and expenses from other sources, such as from day care or interest on facility funds, shall be separately identified.

(3) PERSONAL EFFECTS.

(a) The facility, upon resident request, may provide for the safekeeping in the facility of up to $200 in personal funds, and $500 in personal property. If the resident is expected to be absent from the facility for more than 24 hours, the facility may provide for the safekeeping of more than $500 in personal property.

(b) Any personal funds shall be kept separately from facility funds and shall be used by residents as they choose.

(c) Any personal property held by the facility, including property held for safekeeping, shall be itemized.

(2)(4) RESIDENT TRUST FUNDS AND ADVANCED PAYMENTS. Funds or other property received by the facility belonging to or due a resident, including personal funds, must be held as trust funds and expended only for the resident’s account. Resident funds or property may be held in one bank account if a separate written accounting for each resident is maintained. A separate bank account is required for facility funds; co-mingling resident funds with facility funds is prohibited. Written accounting procedures for resident trust funds must include income and expense records of the trust fund, including the source and disposition of the funds.

(a) Funds or other property received by the facility belonging to or due a resident, including the personal funds described in subsection (3), shall be held as trust funds and expended only for the resident’s account. Resident funds or property may be held in one bank account if a separate written accounting for each resident is maintained. A separate bank account is required for facility funds; co-mingling resident funds with facility funds is prohibited. Written accounting procedures for resident trust funds shall include income and expense records of the trust fund, including the source and disposition of the funds.

(b) Money deposited or advanced as security for performance of the contract agreement or as advance rent for other than the next immediate rental period shall be kept separate from the funds and property of the facility, and shall be used, or otherwise expended, only for the account of the resident. On facility financial statements, such funds shall be indicated as restricted assets and there shall be a corresponding liability shown.

(5) BANK ACCOUNTS. Resident funds and property in excess of the amount stated in subsection (3), and money deposited or advanced as security for performance of the contract agreement or as advance rent for other than the next immediate rental period shall be held in a Florida banking institution, located if possible in the same community in which the facility is located. The facility shall notify the resident of the name and address of the depository where all funds are being held.

(3)(6) SURETY BONDS. In addition Pursuant to the requirements of Section 429.27(2), F.S.:

(a) A facility whose owner, administrator, or staff, or representative thereof, serves as the representative payee or attorney-in-fact for facility residents, must maintain a surety bond, a copy of which shall be filed with the agency. For entities corporations that which own more than one facility in the state, one surety bond may be purchased to cover the needs of all residents served by the entities corporation.

1. If serving as representative payee:

a. The minimum bond proceeds must equal twice the average monthly aggregate income or personal funds due to residents, or expendable for their account which are held by the facility; or

b. For residents who receive OSS, the minimum bond proceeds shall equal twice the supplemental security income or social security disability income plus the OSS payments including the personal needs allowance.

2. If holding a power of attorney:

a. The minimum bond proceeds shall equal twice the average monthly income of the resident, plus the value of any resident property under the control of the attorney in fact; or

b. For residents who receive OSS, the minimum bond proceeds shall equal twice the supplemental security income or social security disability income and the OSS payments including the personal allowance, plus the value of any resident property held at the facility.

(b) The following additional bonding requirements apply to facilities serving residents receiving OSS:

1. If serving as representative payee for a resident receiving OSS, the minimum bond proceeds must equal twice the value of supplemental security income or social security disability income plus the OSS payments, including the personal needs allowance.

2. If holding a power of attorney for a resident receiving OSS, the minimum bond proceeds must equal twice the value of supplemental security income or social security disability income; the OSS payments, including the personal allowance; plus the value of any property belonging to a resident held at the facility.

(c)(b) Upon the annual issuance of a new bond or continuation bond, the facility must shall file a copy of the bond with the Agency Central Office AHCA central office.

(7) RESIDENT ACCOUNTING.

(a) If the facility provides safekeeping for money or property; holds resident money or property in a trust fund; or if the facility owner, administrator, or staff, or representative thereof, acts as a representative payee; the resident or the resident’s legal representative shall be provided with a quarterly statement detailing the income and expense records required under subsection (4), and a list of any property held for safekeeping with copies maintained in the resident’s file. The facility shall also provide such statement upon the discharge of the resident, and if there is a change in ownership of the facility as provided under Rule 58A-5.014, F.A.C.

(b) If the facility owner, administrator, or staff, or representative thereof, serves as a resident’s attorney-in-fact, the resident shall be given, on a monthly basis, a written statement of any transaction made on behalf of the resident.

(c) Within 30 days of receipt of an advance rent or security deposit, the facility shall notify the resident in writing of the manner in which the licensee is holding the advance rent or security deposit.

(4)(8) LIABILITY INSURANCE. Pursuant to Section 429.275, F.S., facilities must shall maintain liability insurance coverage, as defined in Section 624.605, F.S., that remains in force at all times. On the renewal date of the facility’s policy or whenever a facility changes policies, the facility must shall file documentation of continued coverage with the Agency Central Office AHCA central office. Such documentation must shall be issued by the insurance company and must shall include the name and street address of the facility, a reference the street address of the facility, that the facility it is an assisted living facility, the facility’s its licensed capacity, and the dates of coverage.

Rulemaking Authority 429.24, 429.27, 429.275, 429.41 FS. Law Implemented 429.11, 429.24, 429.27, 429.275 FS. History–New 5-14-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.21, Amended 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.021, Amended 10-30-95, 6-2-96, 10-17-99,_________.

 

58A-5.023 Physical Plant Standards.

(1) NEW FACILITIES. Newly constructed facilities to be licensed as assisted living facilities, and existing structures, not previously licensed as assisted living facilities, to be converted to assisted living facilities, as well as any subsequent additions, modifications, alterations, renovations or refurbishing of such facilities, must adhere to the following standards:

(a) Chapter 4, Section 434, of the Florida Building Code as adopted in Rule 61G20-1.001, F.A.C.;

(b) 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; and

(c) The National Fire Protection Association codes described in Section 429.41, F.S.

(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 the following standards:

1. Chapter 4, Section 434, of the Florida Building Code, as adopted in Rule 9N-1.001, F.A.C., Florida Building Code Adopted; and

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 the following standards:

1. Chapter 4, Section 434, of the Building Code, as adopted in Rule 9N-1.001, F.A.C., Florida Building Code Adopted; and

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, as well as the rule or building code in effect at the time of any except that any part of the facility included in additions, modifications, alterations, refurbishment refurbishing, renovations or reconstruction must comply with the 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) A facility undergoing change of ownership is shall be considered an existing facility for purposes of this rule.

(3) OTHER REQUIREMENTS.

(a) All facilities must:

1. Provide a safe living environment pursuant to Section 429.28(1)(a), F.S.; and

2. Must Bbe maintained free of hazards; and

3. Must Eensure that all existing architectural, mechanical, electrical and structural systems, and appurtenances are maintained in good working order.

(b) Pursuant to Section 429.27, F.S., residents must shall be given the option of using their own belongings as space permits. When the facility supplies the furnishings, each resident bedroom or sleeping area must have at least the following furnishings:

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

2. A closet or wardrobe space for hanging clothes;

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

4. A table or nightstand, bedside lamp or floor lamp, and waste basket; and

5. A comfortable chair, if requested.

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

(d) Residents who use portable bedside commodes must be provided with privacy during use.

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

(4) FACILITIES WITH 16 OR FEWER RESIDENTS: Pursuant to Section 429.41, F.S., facilities with 16 or fewer residents are not 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 Rules 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 Authority 429.41 FS. Law Implemented 429.27, 429.28, 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, 4-15-10,_________.

 

58A-5.024 Records.

The facility must shall maintain required the following written records in a manner that makes such records readily available at the licensee’s physical address for review by a legally authorized entity. in a form, place and system ordinarily employed in good business practice and accessible to Department of Elder Affairs and Agency staff. If records are maintained in an electronic format, facility staff must be readily available to access the data and produce the requested information. For purposes of this section, “readily available” means the ability to immediately produce documents, records, or other such data, either in electronic or paper format, upon request.

(1) FACILITY RECORDS. Facility records must shall include:

(a) The facility’s license which shall be displayed in a conspicuous and public place within the facility.

(b) An up-to-date admission and discharge log listing the names of all residents and each resident’s:

1. Date of admission, the facility or place from which the resident was admitted, and if applicable, a notation indicating that the resident was admitted with a stage 2 pressure sore; and

2. Date of discharge, the reason for discharge, and the identification of the facility or home address to which the resident was is discharged or home address, or if the person is deceased, the date of death. Readmission of a resident to the facility after discharge requires a new entry in the log. Discharge of a resident is not required if the facility is holding a bed for a resident who is out of the facility but intending intends to return pursuant to Rule 58A-5.025, F.A.C. If the resident dies while in the care of the facility, the log must indicate the date of death.

(c) A log listing the names of all temporary emergency placement and respite care residents if not included in on the log described in paragraph (b).

(d) An up-to-date record of major incidents occurring within the last 2 years. Such record shall contain a clear description of each incident; the time, place, names of individuals involved; witnesses; nature of injuries; cause if known; action taken; a description of medical or other services provided; by whom such services were provided; and any steps taken to prevent recurrence. These reports shall be made by the individuals having first hand knowledge of the incidents, including paid staff, volunteer staff, emergency and temporary staff, and student interns.

(d)(e) The facility’s emergency management plan, with documentation of review and approval by the county emergency management agency, as described in under Rule 58A-5.026, F.A.C., that must which shall be readily available located where immediate access by facility staff is assured.

(f) Documentation of radon testing conducted pursuant to Rule 58A-5.023, F.A.C.;

(e)(g) The facility’s liability insurance policy required in under Rule 58A-5.021, F.A.C.;

(f)(h) For facilities that which have a surety bond, a copy of the surety bond currently in effect as required by Rule 58A-5.021, F.A.C.

(g)(i) The admission package presented to new or prospective residents (less the resident’s contract) described in Rule 58A-5.0181 58A-5.0182, F.A.C.

(h)(j) If the facility advertises that it provides special care for persons with Alzheimer’s disease or related disorders, a copy of all such facility advertisements as required by Section 429.177, F.S.

(i)(k) A grievance procedure for receiving and responding to resident complaints and recommendations as described in Rule 58A-5.0182, F.A.C.

(j)(l) All food service records required in under Rule 58A-5.020, F.A.C., including menus planned and served; and county health department inspection reports.; and for Ffacilities that which contract for catered food services, must include a copy of the contract for food catered services and the food service contractor’s caterer’s license or certificate to operate.

(k)(m) All fire safety inspection reports issued by the local authority or the State Fire Marshal pursuant to Section 429.41, F.S., and Rule Chapter 69A-40, F.A.C., issued within the last 2 two (2) years.

(l)(n) All sanitation inspection reports issued by the county health department pursuant to Section 381.031, F.S., and Chapter 64E-12, F.A.C., issued within the last 2 years.

(m)(o) Pursuant to Section 429.35, F.S., all completed survey, inspection and complaint investigation reports, and notices of sanctions and moratoriums issued by the agency within the last 5 years.

(p) Additional facility records requirements for facilities holding a limited mental health, extended congregate care, or limited nursing services license are provided in Rules 58A-5.029, 58A-5.030 and 58A-5.031, F.A.C., respectively.

(n)(q) The facility’s resident elopement response policies and procedures.

(o)(r) The facility’s documented resident elopement response drills.

(p) For facilities licensed as limited mental health, extended congregate care, or limited nursing services, records required as stated in Rules 58A-5.029, 58A-5.030 and 58A-5.031, F.A.C., respectively.

(2) STAFF RECORDS.

(a) Personnel records for each staff member must shall contain, at a minimum, a copy of the original employment application, with references furnished, and documentation verifying verification of freedom from signs or symptoms of Tuberculosis, Methicillin Resistant Staphylococcus Aureus, Scabies or any other communicable disease communicable disease including tuberculosis. In addition, records must shall contain the following, as applicable:

1. Documentation of compliance with all staff training and continuing education required by Rule 58A-5.0191, F.A.C.;

2. Copies of all licenses or certifications for all staff providing services that which require licensing or certification;

3. Documentation of compliance with level 2 1 background screening for all staff subject to screening requirements as specified in Section 429.174, F.S., and required under Rule 58A-5.019, F.A.C.;

4. For facilities with a licensed capacity of 17 or more residents, aA copy of the job description given to each staff member pursuant to Rule 58A-5.019, F.A.C., for facilities with a licensed capacity of seventeen (17) or more residents; and

5. Documentation verifying of facility direct care staff and administrator participation in resident elopement drills pursuant to paragraph 58A-5.0182(8)(c), F.A.C.

(b) The facility is shall not be required to maintain personnel records for staff provided by a licensed staffing agency or staff employed by an a business entity contracting to provide direct or indirect services to residents and the facility. However, the facility must maintain a copy of the contract between the facility and the staffing agency or contractor as described in Rule 58A-5.019, F.A.C.

(c) The facility must shall maintain the facility’s written work schedules and staff time sheets as required under Rule 58A-5.019, F.A.C., for the most current last 6 months as required by Rule 58A-5.019, F.A.C.

(3) RESIDENT RECORDS. Resident records must shall be maintained on the premises and include:

(a) Resident demographic data as follows:

1. Name;

2. Sex;

3. Race;

4. Date of birth;

5. Place of birth, if known;

6. Social security number;

7. Medicaid and/or Medicare number, or name of other health insurance carrier;

8. Name, address, and telephone number of next of kin, legal representative, responsible party, or individual designated by other person the resident for notification would like to have notified in case of an emergency, and relationship to resident; and

9. Name, address, and telephone phone number of the health care provider, and case manager, if applicable.

(b) A copy of the Resident Health Assessment form, AHCA Form 1823 medical examination described in Rule 58A-5.0181, F.A.C.

(c) Any health care provider’s orders for medications, nursing services, therapeutic diets, do not resuscitate orders, or other services to be provided,. supervised, or implemented by the facility that require a health care provider’s order.

(d) Documentation of a resident’s refusal of A signed statement from a resident refusing a therapeutic diet pursuant to Rule 58A-5.020, F.A.C., if applicable.

(e) The resident care record described in paragraph 58A-5.0182(1)(e), F.A.C.

(f) A weight record that which is initiated on admission. Information may be taken from AHCA Form 1823 or the resident’s health assessment. Residents receiving assistance with the activities of daily living must shall have their weight recorded semi-annually.

(g) For facilities that which will have unlicensed staff assisting the resident with the self-administration of medication, a copy of the written informed consent described in Rule 58A-5.0181, F.A.C., if such consent is not included in the resident’s contract.

(h) For facilities that which manage a pill organizer, assist with self-administration of medications, or administer medications for a resident, copies of the required medication records maintained pursuant to Rule 58A-5.0185, F.A.C.

(i) A copy of the resident’s contract with the facility, including any addendums to the contract, as described in Rule 58A-5.025, F.A.C.

(j) For a facility whose owner, administrator, or staff, or representative thereof, serves as an attorney in fact for a resident, a copy of the monthly written statement of any transaction made on behalf of the resident as required in under Section 429.27, F.S.

(k) For any facility that which maintains a separate trust fund to receive funds or other property belonging to or due a resident, a copy of the quarterly written statement of funds or other property disbursed as required in under Section 429.27, F.S.

(l) If the resident is an OSS recipient, aA copy of the Department of Children and Families form Alternate Care Certification for Optional State Supplementation (OSS) Form, CF-ES 1006, October 2005 March 1998, which is hereby incorporated by reference and available for review at: http://www.dcf.state.fl.us/DCFForms/Search/OpenDCFForm.aspx?FormId=72 if the resident is an OSS recipient. The absence of this form will shall not be the basis for administrative action against a facility considered a deficiency if the facility can demonstrate that it has made a good faith effort to obtain the required documentation from the Department of Children and Families Family Services.

(m) Documentation of the appointment of a health care surrogate, health care proxy, guardian, or the existence of a power of attorney, where applicable.

(n) For hospice patients, the interdisciplinary care plan and other documentation that the resident is a hospice patient as required in under Rule 58A-5.0181, F.A.C.

(o) The resident’s Do Not Resuscitate Order, DH Form 1896, if applicable.

(p)(o) For independent living residents who receive meals and occupy beds included within the licensed capacity of an assisted living facility, but who are not receiving any personal, limited nursing, or extended congregate care services, record keeping may apartments, duplexes, quadruplexes, or single family homes that are designated for independent living but which are licensed as assisted living facilities solely for the purpose of delivering personal services to residents in their homes, when and if such services are needed, record keeping on residents who may receive meals but who do not receive any personal, limited nursing, or extended congregate care service shall be limited to the following at the discretion of the facility:

1. A log listing the names of residents participating in this arrangement;

2. The resident demographic data required in under this paragraph subsection;

3. The health assessment medical examination described in Rule 58A-5.0181, F.A.C.;

4. The resident’s contract described in Rule 58A-5.025, F.A.C.; and

5. A health care provider’s order for a therapeutic diet if such diet is prescribed and the resident participates in the meal plan offered by the facility.

(q)(p) Except for resident contracts, which must be retained for 5 years, all resident records must shall be retained for 2 years following the departure of a resident from the facility unless it is required by contract to retain the records for a longer period of time. Upon request, residents must shall be provided with a copy of their resident records upon departure from the facility.

(r)(q) Additional resident records requirements for facilities holding a limited mental health, extended congregate care, or limited nursing services license are provided in Rules 58A-5.029, 58A-5.030 and 58A-5.031, F.A.C., respectively.

(4) RECORD INSPECTION.

(a) All records required by this rule chapter shall be available for inspection at all times by staff of the agency, the department, the district long-term care ombudsman council, and the advocacy center for persons with disabilities.

(a)(b) The resident’s records must shall be available to the resident;, and the resident’s legal representative, designee, surrogate, guardian, or attorney in fact, or case manager;, or the resident’s estate, and such additional parties as authorized in writing or by law.

(b)(c) Pursuant to Section 429.35, F.S., agency reports that which pertain to any agency survey, inspection, or monitoring visit must, or complaint investigation shall be available to the residents and the public.

1. Requestors shall be required to provide identification prior to review of records.

2. In facilities that are co-located with a licensed nursing home, the inspection of record for all common areas is shall be the nursing home inspection report.

(d) The facility shall ensure the availability of records for inspection.

Rulemaking Authority 429.275, 429.41, 429.275 FS. Law Implemented 429.07, 429.075, 429.24, 429.255, 429.256, 429.26, 429.27, 429.275, 429.28, 429.35, 429.41, 429.52 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.24, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.024, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 10-9-06,_________.

 

58A-5.0241 Adverse Incident Report.

(1) INITIAL ADVERSE INCIDENT REPORT. The preliminary adverse incident report required by Section 429.23(3), F.S., must be submitted within 1 one (1) business day after the incident pursuant to Rule 59A-35.110, F.A.C., which requires online reporting on AHCA Form 3180-1024, Assisted Living Facility Initial Adverse Incident Report–1 Day, January 2006, and incorporated by reference. The form shall be submitted via electronic mail to [e-mail]; on-line at http://ahca.myflorida.com/reporting/index.shtml; by facsimile to [phone]; or by U.S. Mail to AHCA, Florida Center for Health Information and Policy Analysis, 2727 Mahan Drive, Mail Stop 16, Tallahassee, Florida 32308-5403, telephone [phone]. AHCA Form 3180-1024 is available from the Florida Center for Health Information and Policy Analysis at the address stated above. The Initial Adverse Incident Report is in addition to, and does not replace, other reporting requirements specified in Florida Statutes.

(2) FULL ADVERSE INCIDENT REPORT. For each adverse incident reported in under subsection (1) above, the facility must shall submit a full report within 15 fifteen (15) days of the incident. The full report must shall be submitted pursuant to Rule 59A-35.110, F.A.C., which requires online reporting on AHCA Form 3180-1025, Assisted Living Facility Full Adverse Incident Report–15 Day, dated January 2006, and incorporated by reference. The methods for obtaining and submitting the form are set forth in subsection (1) of this rule.

Rulemaking Authority 429.23 FS. Law Implemented 429.23 FS. History–New 1-9-02, Amended 7-30-06,_________.

 

58A-5.0242 Liability Claim Report.

(1) MONTHLY LIABILITY CLAIM REPORT. Each assisted living facility must licensed under Part I of Chapter 429, F.S., shall report monthly any liability claim filed against the facility pursuant to Rule 59A-35.110, F.A.C., which requires online reporting by completing an Assisted Living Facility Monthly Liability Claim Information, DOEA Form 3180-1026, dated July 2006, which is incorporated by reference and available from the Agency for Health Care Administration at 2727 Mahan Drive, Mail Stop 27, Tallahassee, Florida 32308, or the agency Web site at http://ahca.myflorida.com/MCHQ/Long_Term_Care/Assisting_ living/monthly_liability_claim.pdf. Each facility must comply with the reporting report time frames frame and transmission requirements specified in Section 429.23(5), F.S.

(2) If a liability claim has not been filed against the facility in a given month, no report is required.

Rulemaking Authority 429.23 FS. Law Implemented 429.23 FS. History–New 1-9-02, Amended________.

 

58A-5.025 Resident Contracts.

(1) Pursuant to Section 429.24, F.S., the facility must offer a contract for execution by the resident or the resident’s legal representative before prior to or at the time of admission. The contract must contain, each resident or legal representative shall execute a contract with the facility which contains the following provisions:

(a) A list of the specific services, supplies, and accommodations to be provided by the facility to the resident, including limited nursing and extended congregate care services that the resident elects to receive if the facility is licensed to provide such services;.

(b) The daily, weekly, or monthly rate;.

(c) A list of any additional services and charges to be provided that are not included in the daily, weekly, or monthly rates, or a reference to a separate fee schedule that must which shall be attached to the contract;.

(d) A provision stating that giving at least 30 days written notice will be given before prior to any rate increase;.

(e) Any rights, duties, or obligations of residents, other than those specified in Section 429.28, F.S.;

(f) The purpose of any advance payments or deposit payments, and the refund policy for such advance or deposit payments;.

(g) A refund policy that must which shall conform to Section 429.24(3), F.S.;

(h) A written bed hold policy and provisions for terminating a bed hold agreement if a facility agrees in writing to reserve a bed for a resident who is admitted to a nursing home, health care facility, or psychiatric facility. The resident or responsible party must shall notify the facility in writing of any change in status that would prevent the resident from returning to the facility. Until such written notice is received, the agreed upon daily, weekly, or monthly rate may be charged by the facility unless the resident’s medical condition, such as the resident’s being comatose, prevents the resident from giving written notification, such as when a resident is comatose, and the resident does not have a responsible party to act on in the resident’s behalf;.

(i) A provision stating whether the facility organization is affiliated with any religious organization, and, if so, which organization and its relationship to the facility;.

(j) A provision that, upon determination by the administrator or health care provider that the resident needs services beyond those that the facility is licensed to provide, the resident or the resident’s representative, or agency acting on the resident’s behalf, must shall be notified in writing that the resident must make arrangements for transfer to a care setting that is able to provide has services needed by the resident. In the event the resident has no one person to represent him or her, the facility must shall refer the resident to the social service agency for placement. If there is disagreement regarding the appropriateness of placement, provisions as outlined in Section 429.26(8), F.S., will shall take effect;.

(k) A provision that residents must be assessed upon admission pursuant to subsection 58A-5.0181(2), F.A.C., and every 3 years thereafter, or after a significant change, 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 provisions regarding over-the-counter (OTC) products pursuant to subsection (8) of that rule; and.

(m) The facility’s policies and procedures related to a properly executed DH Form 1896, Do Not Resuscitate Order.

(2) The resident, or the resident’s representative, must shall be provided with a copy of the executed contract.

(3) The facility may not levy an additional charge for any supplies, services, or accommodations that the facility has agreed by contract to provide as part of the standard daily, weekly, or monthly rate. The resident or resident’s representative must shall be furnished in advance with an itemized written statement setting forth additional charges for any services, supplies, or accommodations available to residents not covered under the contract. An addendum must shall be added to the resident contract to reflect the additional services, supplies, or accommodations not provided under the original agreement. Such addendum must be dated and signed by the facility and the resident or the resident’s legal representative and a copy given to the resident or the resident’s representative.

Rulemaking Authority 429.24, 429.41 FS. Law Implemented 429.24, 429.41 FS. History–New 10-17-99, Amended 7-30-06, 4-15-10,________.

 

58A-5.026 Emergency Management.

(1) EMERGENCY PLAN COMPONENTS. Pursuant to Section 429.41, F.S., each facility must shall prepare a written comprehensive emergency management plan in accordance with the “Emergency Management Criteria for Assisted Living Facilities,” dated October 1995, which is incorporated by reference. This document is available from the local emergency management agency. The emergency management plan must, at a minimum, address the following:

(a) Provision for all hazards;.

(b) Provision for the care of residents remaining in the facility during an emergency, including pre-disaster or emergency preparation; protecting the facility; supplies; emergency power; food and water; staffing; and emergency equipment;.

(c) Provision for the care of residents who must be evacuated from the facility during an emergency including identification of such residents and transfer of resident records; evacuation transportation; sheltering arrangements; supplies; staffing; emergency equipment; and medications;.

(d) Provision for the care of additional residents who may be evacuated to the facility during an emergency including the identification of such residents, staffing, and supplies;.

(e) Identification of residents with Alzheimer’s disease or and related disorders dementias, and residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation;.

(f) Identification of and coordination with the local emergency management agency;.

(g) Arrangement for post-disaster activities, including responding to family inquiries, obtaining medical intervention for residents,; transportation,; and reporting to the local county office of emergency management agency the number of residents who have been relocated, and the place of relocation; and.

(h) The identification of staff responsible for implementing each part of the plan.

(2) EMERGENCY PLAN APPROVAL. The plan must shall be submitted for review and approval to the local county emergency management agency.

(a) If the local The county emergency management agency requires revisions to the emergency management plan, such has 60 days in which to review and approve the plan or advise the facility of necessary revisions. Any revisions must be made and the plan resubmitted to the local county office of emergency management within 30 days of receiving notification from the county agency that the plan must be revised.

(b) A new Newly-licensed facility as described in Rule 58A-5.023, F.A.C., and facilities whose ownership has been transferred, must submit an emergency management plan within 30 days after obtaining a license.

(c) The facility must shall review its emergency management plan on an annual basis. Any substantive changes must be submitted to the local county emergency agency for review and approval.

1. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered substantive revisions for the purposes of this rule.

2. Changes in the identification of specific staff must be submitted to the local county emergency management agency annually as a signed and dated addendum that is not subject to review and approval.

(d) The local county emergency management agency is shall be the final administrative authority for emergency management plans prepared by assisted living facilities.

(e) Any plan approved by the local county emergency management agency is shall be considered to have met all the criteria and conditions established in this rule.

(3) PLAN IMPLEMENTATION. In the event of an internal or external disaster, the facility must shall implement the facility’s emergency management plan in accordance with Part I, Chapter 252, F.S.

(a) All staff must be trained in their duties and are responsible for implementing the emergency management plan.

(b) If telephone service is not available during an emergency, the facility must shall request assistance from local law enforcement or emergency management personnel in maintaining communication.

(4) FACILITY EVACUATION. The facility must evacuate the premises during or after an emergency if so directed by the local emergency management agency.

(a) The facility must shall report the evacuation to the local office of emergency management or designee and to the agency within 6 hours of the evacuation order. If the evacuation takes more than 6 hours, the facility must report and when the evacuation is completed complete if the evacuation is not completed within the 6 hour period.

(b) The facility must shall not be re-occupied until the area is cleared for reentry by the local emergency management agency or its designee and the facility can meet the immediate needs of the residents.

(c) A facility with significant structural damage must relocate residents until the facility can be safely re-occupied.

(d) The facility is responsible for knowing the location of all residents until the residents have the resident has been relocated to another from the facility.

(e) The facility must shall provide the agency with the name of a contact person who must shall be available by telephone 24 hours a day, seven days a week, until the facility is re-occupied.

(f) The facility must shall assist in the relocation of residents, and must shall cooperate with outreach teams established by the Department of Health or emergency management agency to assist in relocation efforts. Resident needs and preferences must shall be considered to the extent possible in any relocation decision.

(5) EMERGENCY SHELTER. In the event a state of emergency has been declared and the facility is not required to evacuate the premises, the facility may provide emergency shelter above the facility’s licensed capacity provided the following conditions are met:

(a) Life safety will not be jeopardized for any individual;.

(b) The immediate needs of residents and other individuals sheltered at the facility can be met by the facility;.

(c) The facility reports the number of individuals over its licensed capacity and the conditions causing it to the Agency Field Office within 48 forty-eight (48) hours or as soon as practical. As an alternative, the facility may report to the Agency Central Office at [phone] [phone]. If the facility will continue to be over capacity after the declared emergency ends, the aAgency will shall review requests for excess capacity on a case-by-case basis; and.

(d) The facility maintains a log of the additional individuals persons being housed in the facility. The log must shall include the individual’s name, usual address, and the dates of arrival and departure. The log must shall be available for review by representatives of the agency, the department, the local emergency management agency or its designee. The admissions and discharge log maintained by the facility may be used for this purpose provided the information is maintained in a manner that is easily accessible.

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

 

58A-5.029 Limited Mental Health.

(1) LICENSE APPLICATION.

(a) Any facility intending to admit three or more mental health residents must obtain a limited mental health license from the aAgency before in accordance with Rule 58A-5.014, F.A.C., and Section 429.075, F.S., prior to accepting the third mental health resident.

(b) Facilities applying for a limited mental health license that which have uncorrected deficiencies or violations found during the facility’s last survey, complaint investigation, or monitoring visit will be surveyed before prior to the issuance of a limited mental health license to determine if such deficiencies or violations have been corrected.

(2) RECORDS.

(a) A facility with a limited mental health license must shall maintain an up-to-date admission and discharge log containing the names and dates of admission and discharge for all mental health residents. The admission and discharge log required in under Rule 58A-5.024, F.A.C., satisfies this condition shall be sufficient provided that all mental health residents are clearly identified.

(b) Staff records must shall contain documentation that designated staff have completed limited mental health training as required by Rule 58A-5.0191, F.A.C.

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

1. Documentation, provided by a mental health care provider the Department of Children and Family Services within 30 days of the resident’s admission to the facility, that the resident is a mental health resident as defined in Section 394.4574, F.S., and Documentation that the resident is receiving social security disability or supplemental security income, and optional state supplementation, as follows: and any of the following shall meet this requirement.

a. An affirmative statement on the Alternate Care Certification for Optional State Supplementation (OSS) form Form, CF-ES 1006, October 2005 March 1998, which is hereby incorporated by reference and available for review at: http://www.dcf.state.fl.us/DCFForms/Search/OpenDCFForm.aspx?FormId=72, that the resident is receiving SSI or SSDI SSI/SSDI due to a psychiatric disorder;.

b. Written verification provided by the Social Security Administration that the resident is receiving SSI or SSDI for a mental disorder. Such verification may be acquired from the Social Security Administration upon obtaining a release from the resident permitting the Social Security Administration to provide such information to the Department of Children and Family Services; or.

c. A written statement from the resident’s case manager or other mental health care provider that the resident is an adult with severe and persistent mental disorder illness. The case manager or other mental health care provider must shall consider the following minimum criteria in making that determination:.

(I) The resident is eligible for, is receiving, or has received mental health services state funded services from the Department of Children and Family Services’ Substance Abuse and Mental Health program office within the last 5 years; or

(II) The resident has been diagnosed as having a severe and persistent mental disorder.

2. An appropriate placement assessment provided by the resident’s mental health care provider within 30 days of admission to the facility that the resident has been assessed and found appropriate for residence in an assisted living facility. Such assessment must shall be conducted by a psychiatrist, clinical psychologist, clinical social worker, or psychiatric nurse, or an individual person supervised by one of these professionals.

a. Any of the following documentation that which contains the name of the resident and the name, signature, date, and license number, if applicable, of the person making the assessment, meets shall meet this requirement:

(I) Completed Alternate Care Certification for Optional State Supplementation (OSS) form Form, CF-ES Form 1006, March 1998;

(II) Discharge Statement from a state mental hospital completed no more than within 90 days before prior to admission to the assisted living facility ALF provided it contains a statement that the individual is appropriate to live in an assisted living facility; or

(III) Other signed statement that the resident has been assessed and found appropriate for residency in an assisted living facility.

b. A mental health resident returning to a facility from treatment in a hopsital or crisis stabilization unit (CSU) will not be considered a new admission and will not require a new assessment. However, a break in a resident’s continued residency that which requires the facility to execute a new resident contract or admission agreement will be considered a new admission and the resident’s mental health care provider must provide a new assessment.

3. A Community Living Support Plan.

a. Each mental health resident and the resident’s mental health case manager must 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 in under paragraph (2)(c), whichever is later, that which:

(I) Includes the specific needs of the resident that 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 that 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 assisted living facility 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 must 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 (2)(c)4. If included, the mental health care provider must also sign the plan; and

(X) Must be available for inspection to those who have legal authority to review 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., that which address all the elements listed in sub-subparagraph (2)(c)3.a. above may be substituted.

4. Cooperative Agreement. The mental health care provider for each mental health resident and the facility administrator or designee must prepare a written statement shall, within 30 days of the resident’s admission to the facility or receipt of the resident’s appropriate placement assessment, whichever is later.,  The 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 in under Section 409.912, F.S.;

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

d. May be included in the Community Living Support Plan described in subparagraph (2)(c)3.

Missing documentation will shall not be the basis for administrative action against a facility considered a deficiency if the facility can demonstrate that it has made a good faith effort to obtain the required documentation from the Department of Children and Families Family Services, or the mental health care provider under contract to provide mental health services to clients of the department.

(3) RESPONSIBILITIES OF FACILITY. In addition to the staffing and care standards of this rule chapter to provide for the welfare of residents in an assisted living facility, a facility holding a limited mental health license must:

(a) Meet the facility’s obligation to assist the resident in carrying out the activities identified in the Community Living Support Plan;.

(b) Provide an opportunity for private face-to-face contact between the mental health resident and the resident’s mental health case manager or other treatment personnel of the resident’s mental health care provider;.

(c) Observe resident behavior and functioning in the facility, and record and communicate observations to the resident’s mental health case manager or mental health care provider regarding any significant behavioral or situational changes that which may signify the need for a change in the resident’s professional mental health services, supports, and services described in the community living support plan, or that the resident is no longer appropriate for residency in the facility;.

(d) If the facility initiates an involuntary mental health examination pursuant to Section 394.463, F.S., the facility must document the circumstances leading to the initiation of the examination;

(e)(d) Ensure that designated staff have completed limited mental health training as required by Rule 58A-5.0191, F.A.C.; and

(f)(e) Maintain facility, staff, and resident records in accordance with the requirements of this rule chapter.

Rulemaking 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-5.030 Extended Congregate Care Services.

(1) LICENSING.

(a) Any facility intending to establish an extended congregate care services program must meet the license requirements specified in Section 429.07, F.S., and obtain a license from the agency before accepting residents needing extended congregate care services in accordance with Rule 58A-5.014, F.A.C.

(b) Only the that portion of a facility that which meets the physical requirements of subsection (3) and which is staffed in accordance with subsection (4) is shall be considered licensed to provide extended congregate care ECC services to residents who which meet the admission and continued residency requirements of this rule.

(2) EXTENDED CONGREGATE CARE POLICIES. Policies and procedures established through an extended congregate care services program must promote resident independence, dignity, choice, and decision-making. The facility must program shall develop and implement specific written policies and procedures that which address:

(a) Aging in place;.

(b) The facility’s residency criteria developed in accordance with the admission and discharge requirements described in subsection (5) and extended congregate care ECC services listed in subsection (8);.

(c) The personal and supportive services the facility intends to provide, how the services will be provided, and the identification of staff positions to provide the services including their relationship to the facility;.

(d) The nursing services the facility intends to provide, identification of staff positions to provide nursing services, and the license status, duties, general working hours, and supervision of such staff;.

(e) Identifying potential unscheduled resident service needs and mechanisms mechanism for meeting those needs including the identification of resources to meet those needs;.

(f) A process for mediating conflicts among residents regarding choice of room or apartment and roommate; and.

(g) How to involve residents in decisions concerning the resident. The services must program shall provide opportunities and encouragement for the resident to make personal choices and decisions. If a resident needs assistance to make choices or decisions, a family member or other resident representative must shall be consulted. Choices must shall include at a minimum whether:

1. To participate in the process of developing, implementing, reviewing, and revising the resident’s service plan;

2. To remain in the same room in the facility, except that a current resident transferring into extended congregate care services an ECC program may be required to move to the part of the facility licensed for extended congregate care, if only part of the facility is so licensed;

3. To select among social and leisure activities;

4. To participate in activities in the community. At a minimum the facility must shall arrange transportation to such activities if requested by the resident; and

5. To provide input with respect to the adoption and amendment of facility policies and procedures.

(3) PHYSICAL SITE REQUIREMENTS. Each extended congregate care facility must shall provide a homelike physical environment that which promotes resident privacy and independence including:

(a) A private room or apartment, or a semi‑private room or apartment, shared with a roommate of the resident’s choice. The entry door to the room or apartment must shall have a lock that which is operable from the inside by the resident with no key needed. The resident must shall be provided with a key to the entry door on request. The resident’s service plan may allow for a non-locking entry door if the resident’s safety would otherwise be jeopardized; and.

(b) A bathroom, with a toilet, sink, and bathtub or shower, that which is shared by a maximum of 4 four (4) residents for a maximum ratio of 4 four (4) residents to 1 one (1) bathroom.

1. A centrally located hydro-massage bathtub may substitute for a bathtub or shower and be considered equivalent to two bathrooms, increasing the resident to bathroom ratio from four-to-one to eight-to-one four (4) to one (1) to eight (8) to one (1). The substitution of a centrally located hydro-massage bathtub for a bathtub or shower that increases the resident to bathroom ratio above four-to-one four (4) to one (1) may occur only once in a facility. The one time substitution of a centrally located hydro-massage bathtub does not preclude the installation of multiple hydro-massage bathtubs in the facility. The limitation applies only to the one-time reduction in the total number of bathrooms in the facility.

2. The entry door to the bathroom must shall have a lock that the resident can operate from the inside with no key needed. The resident’s service plan may allow for a non-locking bathroom door if the resident’s safety would otherwise be jeopardized.

(4) STAFFING REQUIREMENTS. The following staffing requirements apply for Each extended congregate care services program shall:

(a) Specify a staff member to serve as the extended congregate care supervisor if the administrator does not perform this function. If the administrator supervises more than one facility, he/she shall appoint a separate ECC supervisor for each facility holding an extended congregate care license.

1. The extended congregate care supervisor shall be responsible for the general supervision of the day-to-day management of an ECC program and ECC resident service planning.

(a)2. Supervision by an administrator who has The administrator of a facility with an extended congregate care license and the ECC supervisor, if separate from the administrator, must have a minimum of two years of managerial, nursing, social work, therapeutic recreation, or counseling experience in a residential, long-term care, or acute care setting or agency serving elderly or disabled persons. If an administrator appoints a manager as the supervisor of an extended congregate care facility, both the administrator and manager must satisfy the requirements of subsection 58A-5.019(1), F.A.C.

1. A baccalaureate degree may be substituted for one year of the required experience.

2. A nursing home administrator licensed under Chapter 468, F.S., is exempt from the educational requirements referenced in paragraph (4)(a) shall be considered qualified under this paragraph.

(b) Provide, as staff or by contract, the services of a nurse who must shall be available to provide nursing services as needed by extended congregate care ECC residents, participate in the development of resident service plans, and perform monthly nursing assessments for extended congregate care residents.

(c) Provide enough qualified staff to meet the needs of extended congregate care ECC residents in accordance with Rule 58A-5.019, F.A.C., and to provide the amount and type of services established in each resident’s service plan.

(d) Ensure that adequate staff is awake during all hours Regardless of the number of ECC residents, awake staff shall be provided to meet the resident scheduled and unscheduled night needs of residents.

(e) In accordance with agency procedures established in Rule 58A-5.019, F.A.C., the agency shall require facilities to Iimmediately provide additional or appropriately more qualified staff, when the agency determines that service plans are not being followed or that residents’ needs are not being met because of insufficient staffing, in accordance with the staffing standards established in Rule 58A-5.019, F.A.C the lack of sufficient or adequately trained staff.

(f) Ensure and document that staff receive extended congregate care training as required in under Rule 58A-5.0191, F.A.C.

(5) ADMISSION AND CONTINUED RESIDENCY.

(a) An individual must meet the following minimum criteria in order to receive be admitted to an extended congregate care services program.

1. Be at least 18 years of age;.

2. Be free from signs and symptoms of a communicable disease that which is likely to be transmitted to other residents or staff; however, an individual a person who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that he or she would otherwise be eligible for admission according to this rule;.

3. Be able to transfer, with assistance if necessary. The assistance of more than one individual person is permitted;.

4. Not be a danger to self or others as determined by a health care provider, or mental health practitioner licensed under Chapters 490 or 491, F.S.;

5. Not be bedridden;.

6. Not have any stage 3 or 4 pressure sores;.

7. Not require any of the following nursing services:

a. Oral or nasopharyngeal suctioning;

b. Nasogastric tube feeding;

c. Monitoring of blood gases;

d. Intermittent positive pressure breathing therapy;

e. Skilled rehabilitative services as described in Rule 59G-4.290, F.A.C.; or

f. Treatment of a surgical incision, unless the surgical incision and the condition that which caused it have been stabilized and a plan of care developed;.

8. Not require 24-hour nursing supervision; and.

9. Have been determined to be appropriate for admission to the facility by the facility administrator or manager. The administrator or manager must shall base his or her his/her decision on:

a. An assessment of the strengths, needs, and preferences of the individual, the health assessment required by subsection (6) of this rule, and the preliminary service plan developed in under subsection (7);

b. The facility’s residency criteria, and services offered or arranged for by the facility to meet resident needs; and

c. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in under Section 429.41, F.S., and Rule Chapter 69A-40, F.A.C.

(b) Criteria for continued residency in extended congregate care services must an ECC program shall be the same as the criteria for admission, except as specified below. follows:

1. A resident may be bedridden for up to 14 consecutive days.

2. A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the following conditions are met:

a. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice that which coordinates and ensures the provision of any additional care and services that may be needed;

b. Continued residency is agreeable to the resident and the facility;

c. An interdisciplinary care plan, which specifies the services being provided by hospice and those being provided by the facility, is developed and implemented by a licensed hospice in consultation with the facility;. Facility staff may provide any nursing service within the scope of their license including 24-hour nursing supervision, and total help with the activities of daily living; and

d. Documentation of the requirements of this subparagraph (5)(b)2. is maintained in the resident’s file.

3. The extended congregate care administrator or manager is responsible for monitoring the appropriateness of continued residency of a resident in extended congregate care services at all times.

4. A hospice resident that meets the qualifications of continued residency pursuant to this rule may only receive services from the assisted living facility’s staff within the scope of the facility’s license.

5. Staff may provide any nursing service permitted under the facility’s license and total help with the activities of daily living for residents admitted to hospice. Staff may not exceed the scope of their professional licensure or training in any licensed assisted living facility.

(6) HEALTH ASSESSMENT. Before receiving extended congregate care services Prior to admission to an ECC program, all persons, including residents transferring within the same facility to that portion of the facility licensed to provide extended congregate care services, must be examined by a health care provider physician or advanced registered nurse practitioner pursuant to Rule 58A-5.0181, F.A.C. A health assessment conducted no more than within 60 days before receiving extended congregate care services meets prior to admission to the ECC program shall meet this requirement. Once receiving services admitted, a new health assessment must be obtained at least annually.

(7) SERVICE PLANS.

(a) Before receiving services, Prior to admission the extended congregate care administrator or manager must supervisor shall develop a preliminary service plan that which includes an assessment of whether the resident meets the facility’s residency criteria, an appraisal of the resident’s unique physical, psychological and psycho social needs and preferences, and an evaluation of the facility’s ability to meet the resident’s needs.

(b) Within 14 days of receiving services, admission the extended congregate care administrator or manager must supervisor shall coordinate the development of a written service plan that which takes into account the resident’s health assessment obtained pursuant to subsection (6); the resident’s unique physical, psychological and psycho social needs and preferences; and how the facility will meet the resident’s needs including the following if required:

1. Health monitoring;

2. Assistance with personal care services;

3. Nursing services;

4. Supervision;

5. Special diets;

6. Ancillary services;

7. The provision of other services such as transportation and supportive services; and

8. The manner of service provision, and identification of service providers, including family and friends, in keeping with resident preferences.

(c) Pursuant to the definitions of “shared responsibility” and “managed risk” as provided in Section 429.02, F.S., the service plan must shall be developed and agreed upon by the resident or the resident’s representative or designee, surrogate, guardian, or attorney-in-fact, the facility designee, and must shall reflect the responsibility and right of the resident to consider options and assume risks when making choices pertaining to the resident’s service needs and preferences.

(d) The service plan must shall be reviewed and updated quarterly to reflect any changes in the manner of service provision, accommodate any changes in the resident’s physical or mental status, or pursuant to recommendations for modifications in the resident’s care as documented in the nursing assessment.

(8) EXTENDED CONGREGATE CARE SERVICES. All services must shall be provided in the least restrictive environment, and in a manner that which respects the resident’s independence, privacy, and dignity.

(a) A facility providing An extended congregate care services program may provide supportive services including social service needs, counseling, emotional support, networking, assistance with securing social and leisure services, shopping service, escort service, companionship, family support, information and referral, assistance in developing and implementing self‑directed activities, and volunteer services. Family or friends must shall be encouraged to provide supportive services for residents. The facility must shall provide training for family or friends to enable them to provide supportive services in accordance with the resident’s service plan.

(b) A facility providing An extended congregate care services must program shall make available the following additional services if required by the resident’s service plan:

1. Total help with bathing, dressing, grooming and toileting;

2. Nursing assessments conducted more frequently than monthly;

3. Measurement and recording of basic vital functions and weight;

4. Dietary management including provision of special diets, monitoring nutrition, and observing the resident’s food and fluid intake and output;

5. Assistance with self-administered medications, or the administration of medications and treatments pursuant to a health care provider’s order. If the individual needs assistance with self-administration, the facility must inform the resident of the qualifications of staff who will be providing this assistance, and if unlicensed persons staff will be providing such assistance, obtain the resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s informed written consent to provide such assistance as required in under Section 429.256, F.S.;

6. Supervision of residents with dementia and cognitive impairments;

7. Health education and counseling and the implementation of health-promoting programs and preventive regimes;

8. Provision or arrangement for rehabilitative services; and

9. Provision of escort services to health-related appointments.

(c) Licensed Nnursing staff providing in an extended congregate care services program may provide any nursing service permitted within the scope of their license consistent with the residency requirements of this rule and the facility’s written policies and procedures, provided and the nursing services are:

1. Authorized by a health care provider’s order and pursuant to a plan of care;

2. Medically necessary and appropriate for treatment of the resident’s condition;

3. In accordance with the prevailing standard of practice in the nursing community;

4. A service that can be safely, effectively, and efficiently provided in the facility;

5. Recorded in nursing progress notes; and

6. In accordance with the resident’s service plan.

(d) At least monthly, or more frequently if required by the resident’s service plan, a nursing assessment of the resident must shall be conducted.

(9) RECORDS. In addition to the records required in Rule 58A-5.024, F.A.C., a facility providing extended congregate care services must maintain the following:

(a) In addition to the records required under Rule 58A-5.024, F.A.C., an extended congregate care program shall maintain the following:

1. The service plans for each resident receiving extended congregate care services;

(b)2. The nursing progress notes for each resident receiving nursing services;

(c)3. Nursing assessments; and

(d)4. The facility’s extended congregate care ECC policies and procedures.

(b) Upon request, a facility shall report to the department such information as necessary to meet the requirements of Section 429.07(3)(b)9., F.S.

(10) DISCHARGE. If the facility and the resident are unable to agree on a service plan, or if the facility is unable to meet the resident’s needs as identified in the service plan, or if the resident no longer meets the criteria for continued residency, the resident must shall be discharged or relocated in accordance with Sections 429.26 429.26(8) and 429.28 429.28(1), F.S.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.02, 429.07, 429.255, 429.26, 429.28, 429.41 FS. History–New 9-30-92, Formerly 10A-5.030, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-30-06,_________.

 

58A-5.031 Limited Nursing Services.

Any facility intending to provide limited nursing services as described in subsection (1) must meet the license requirements specified in Section 429.07, F.S., and obtain a license from the aAgency in accordance with Rule 58A-5.014, F.A.C.

(1) NURSING SERVICES. A facility with a limited nursing services license may provide the following nursing services in addition to any nursing service permitted under a standard license pursuant to Section 429.255, F.S.

(a) Conducting passive range of motion exercises.

(b) Applying ice caps or collars.

(c) Applying heat, including dry heat, hot water bottle, heating pad, aquathermia, moist heat, hot compresses, sitz bath and hot soaks.

(d) Cutting the toenails of diabetic residents or residents with a documented circulatory problem if the written approval of the resident’s health care provider has been obtained.

(e) Performing ear and eye irrigations.

(f) Conducting a urine dipstick test.

(g) Replacing Replacement of an established self-maintained indwelling urinary catheter, or inserting performance of an intermittent urinary catheter catheterizations.

(h) Performing digital stool removal therapies.

(i) Applying and changing routine dressings that do not require packing or irrigation, but are for abrasions, skin tears and closed surgical wounds.

(j) Caring Care for stage 2 pressure sores. Caring Care for stage 3 or 4 pressure sores is are not permitted by a facility with a limited nursing services license under this rule.

(k) Caring for casts, braces and splints. Caring Care for head braces, such as a halo is not permitted by a facility with a limited nursing services license under this rule.

(l) Conducting Conduct nursing assessments if conducted by a registered nurse or under the direct supervision of a registered nurse.

(m) For hospice patients, Pproviding any nursing service permitted under the facility’s license and total help with the activities of daily living for residents admitted to hospice as described in subsection 58A-5.0181(4), F.A.C.; however, staff may not exceed the scope of their professional licensure within the scope of the nurse’s license including 24-hour nursing supervision.

(n) Assisting, applying, caring for and monitoring the application of anti-embolism stockings or hosiery as prescribed by the health care provider and in accordance with the manufacturers’ guidelines.

(o) Administration and regulation of portable oxygen.

(p) Applying, caring for, and monitoring a transcutaneous electric nerve stimulator (TENS).

(q) Catheter, colostomy, ileostomy care and maintenance.

(2) RESIDENT CARE STANDARDS.

(a) A resident receiving limited nursing services in a facility holding only a standard and limited nursing services license must meet the admission and continued residency criteria specified in Rule 58A-5.0181, F.A.C.

(b) In accordance with Rule 58A-5.019, F.A.C., the facility must employ sufficient and qualified staff to meet the needs of residents requiring limited nursing services based on the number of such residents and the type of nursing service to be provided.

(c) Limited nursing services may only be provided as authorized by a health care provider’s order, a copy of which must shall be maintained in the resident’s file.

(d) Facilities licensed to provide limited nursing services must employ or contract with a nurse(s) who must shall be available to provide such services as needed by residents. The facility must shall maintain documentation of the qualifications of nurses providing limited nursing services in the facility’s personnel files.

(e) The facility must ensure that nursing services are conducted and supervised in accordance with Chapter 464, F.S., and the prevailing standard of practice in the nursing community.

(3) RECORDS.

(a) A record of all residents receiving limited nursing services under this license and the type of services service provided, must shall be maintained.

(b) Nursing progress notes must shall be maintained for each resident who receives limited nursing services.

(c) A nursing assessment conducted at least monthly must shall be maintained on each resident who receives a limited nursing service.

Rulemaking Authority 429.02, 429.41 FS. Law Implemented 429.02, 429.07, 429.255, 429.26, 429.41 FS. History–New 9-30-92, Formerly 10A-5.031, Amended 10-30-95, 10-17-99, 7-30-06,_________.

 

58A-5.033 Administrative Enforcement.

Facility staff must shall cooperate with aAgency 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 II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., Part I of Chapter 429, F.S., and this rule chapter.

(1) INSPECTIONS.

(a) Pursuant to Section 429.34, F.S., the agency shall conduct a survey, investigation, or appraisal of a facility:

1. Prior to issuance of a license;

2. Prior to biennial renewal of a license;

3. When there is a change of ownership;

4. To monitor facilities licensed to provide limited nursing or extended congregate care services, or who were cited in the previous year for a Class I or Class II, or 4 or more uncorrected Class III violations;

5. Upon receipt of an oral or written complaint of practices that threaten the health, safety, or welfare of residents;

6. If the agency has reason to believe a facility is violating a provision of Part I III of Chapter 429, F.S., or this rule chapter;

7. To determine if cited deficiencies have been corrected; and

8. To determine if a facility is operating without a license.

(b) The inspection shall consist of full access to and examination of the facility’s physical premises and facility records and accounts, and staff and resident records.

(c) Agency personnel shall interview facility staff and residents in order to determine whether the facility is respecting resident rights and to determine compliance with resident care standards. Interviews shall be conducted privately.

(d) Agency personnel shall respect the private possessions of residents and staff while conducting facility inspections.

(1)(2) ABBREVIATED SURVEY.

(a) An applicant for license renewal who does not have any class I or class II violations or uncorrected class III violations, confirmed long-term care ombudsman program council complaints reported to the agency by the LTCOC, or confirmed licensing complaints within the two licensing periods immediately preceding the current renewal date, is shall be eligible for an abbreviated biennial survey by the agency. For the purpose of this rule, a confirmed long-term care ombudsman program complaint is a complaint that is verified and referred to a regulatory agency for further action. Facilities that do not have two survey reports on file with the agency under current ownership are not eligible for an abbreviated inspection. Upon arrival at the facility, the agency must shall inform the facility that it is eligible for an abbreviated survey, and that an abbreviated survey will be conducted.

(b) Compliance with key quality of care standards described in the following statutes and rules will be used by the agency during its abbreviated survey of eligible facilities:

1. Section 429.26, F.S., and Rule 58A-5.0181, F.A.C., relating to residency criteria;

2. Section 429.27, F.S., and Rule 58A-5.021, F.A.C., relating to proper management of resident funds and property;

3. Section 429.28, F.S., and Rule 58A-5.0182, F.A.C., relating to respect for resident rights;

4. Section 429.41, F.S., and Rule 58A-5.0182, F.A.C., relating to the provision of supervision, assistance with the activities of daily living ADLs, and arrangement for appointments and transportation to appointments;

5. Section 429.256, F.S., and Rule 58A-5.0185, F.A.C., relating to assistance with or administration of medications;

6. Section 429.41, F.S., and Rule 58A-5.019, F.A.C., relating to the provision of sufficient staffing to meet resident needs;

7. Section 429.41, F.S., and Rule 58A-5.020 58A-5.0191, F.A.C., relating to minimum dietary requirements and proper food hygiene;

8. Section 429.075, F.S., and Rule 58A-5.029, F.A.C., relating to mental health residents’ community support living plan;

9. Section 429.07, F.S., and Rule 58A-5.030, F.A.C., relating to meeting the environmental standards and residency criteria in a facility with an extended congregate care license; and

10. Section 429.07, F.S., and Rule 58A-5.031, F.A.C., relating to the provision of care and staffing in a facility with a limited nursing services license.

(c) The agency will expand the abbreviated survey or conduct a full survey if violations that which threaten or potentially threaten the health, safety, or welfare security of residents are identified during the abbreviated survey. The facility must shall be informed when that a full survey will be conducted. If one or more of the following serious problems are identified during an abbreviated survey, a full biennial survey will be immediately conducted:

1. Violations of Rule Chapter 69A-40, F.A.C., relating to firesafety, that threaten the life or safety of a resident;

2. Violations relating to staffing standards or resident care standards that adversely affect the health, or safety, or welfare of a resident;

3. Violations relating to facility staff rendering services for which the facility is not licensed; or

4. Violations relating to facility medication practices that are a threat to the health, or safety, or welfare of a resident.

(2)(3) SURVEY DEFICIENCY.

(a) Before Prior to or in conjunction with a notice of violation issued pursuant to Part II, Chapter 408, F.S., and Section 429.19, F.S. and Chapter 120, F.S., the agency must shall issue a statement of deficiency for cClass I, II, III, and IV violations that which are observed by aAgency personnel during any inspection of the facility. The deficiency statement must shall be issued within 10 ten (10) working days of the aAgency’s inspection and must shall include:

1. A description of the deficiency;

2. A citation to the statute or rule violated; and

3. A time frame for the correction of the deficiency.;

4. A request for a plan of correction which shall include time frame for correction of the deficiency; and

5. A description of the administrative sanction that may be imposed if the facility fails to correct the deficiency within the established time frame.

(b) Additional time may be granted to correct specific deficiencies if a written request is received by the agency before the expiration of prior to the time frame included in the agency’s statement.

(c) The facility’s plan of correction must be received by the agency within 10 working days of receipt of the deficiency statement and is subject to approval by the agency.

(3)(4) EMPLOYMENT OF A CONSULTANT.

(a) Medication Deficiencies.

1. If a cClass I, cClass II, or uncorrected cClass III deficiency directly relating to facility medication practices as established in Rule 58A-5.0185, F.A.C., is documented by the agency personnel pursuant to an inspection of the facility, the agency must shall notify the facility in writing that the facility must employ, on staff or by contract, the services of a pharmacist licensed pursuant to Section 465.0125, F.S., or registered nurse, as determined by the agency.

2. After developing and implementing a corrective action plan in compliance with Section 429.42(2), F.S., tThe initial on-site consultant visit must shall take place within 7 working days of the notice identification of the a cClass I or Class II deficiency and within 14 working days of the notice identification of an uncorrected cClass III deficiency. The facility must shall have available for review by the agency a copy of the license of the consultant pharmacist or registered nurse pharmacist’s or registered nurse’s license and the consultant’s a signed and dated review of the recommended corrective action plan no later than 10 working days subsequent to the initial on‑site consultant visit.

3. The facility must shall provide the agency with, at a minimum, quarterly on-site corrective action plan updates until the agency determines after written notification by the consultant and facility administrator that deficiencies are corrected and staff has been trained to ensure that proper medication standards are followed and that such consultant services are no longer required. The agency must shall provide the facility with written notification of such determination.

(b) Dietary Deficiencies.

1. If a cClass I, Class II, or uncorrected cClass III deficiency directly related to dietary standards as established in Rule 58A-5.020, F.A.C., is documented by the agency personnel pursuant to an inspection of the facility, the agency must shall notify the facility in writing that the facility must employ, on staff or by contract, the services of a registered or licensed dietitian, or a licensed nutritionist dietitian/nutritionist.

2. The initial on-site consultant visit must shall take place within 7 working days of the notice identification of a cClass I or Class II deficiency or and within 14 working days of the notice identification of an uncorrected cClass III deficiency. The facility must shall have available for review by the agency a copy of the license or registration of the consultant dietitian or nutritionist dietitian’s license or registration card and the consultant’s a signed and dated review of the facility’s dietary consultant’s recommended corrective action plan, if a plan is required by the agency, no later than 10 working days after subsequent to the initial on-site consultant visit.

3. If a corrective action plan is required, tThe facility must shall provide the agency with, at a minimum, quarterly on-site corrective action plan updates until the agency determines, after written notification by the dietary consultant and facility administrator, that deficiencies are corrected and staff has been trained to ensure that proper dietary standards are followed and that such consultant services are no longer required. The agency must shall provide the facility with written notification of such determination.

(5) ADMINISTRATIVE SANCTIONS. Administrative fines shall be imposed for Class I and Class II violations, or Class III or IV violations which are not corrected within the time frame set by the Agency, and for repeat Class III violations, as set forth in Section 429.19, F.S.

(a) The Agency shall notify facilities of the imposition of sanctions, their right to appeal the sanctions, the remedies available, and the time limit for requesting such remedies as provided under Chapter 120, F.S., and Part II of Chapter 59-1, F.A.C.

(b) When an administrative fine payment is returned from the applicant’s bank for whatever reason, the agency shall add to the amount due a service fee of $20 or 5 percent of the face amount of the check, whichever is greater, up to a maximum charge of $200. Proceeds from this fee shall be deposited in the same agency account as the fine.

Rulemaking Authority 429.41, 429.42 FS. Law Implemented 429.07, 429.08, 429.11, 429.12, 429.14, 429.17, 429.19, 429.256, 429.26, 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, 4-15-10,________.

 

58A-5.035 Waivers.

The agency, in consultation with the department, may waive rules promulgated pursuant to Part I, Chapter 429, F.S., if the waiver request meets the conditions set forth in Section 429.41(4), F.S., and demonstrates and evaluates innovative or cost-effective congregate care alternatives which will enable individuals to age in place.

(1) Application Process.

(a) Licensed assisted living facilities proposing a waiver under this statute must submit the request in writing. All requests must include the facility name and address, license number, administrator’s name and contact information for the requestor, or its attorney. Petitions for waiver of rules will only be considered other than for the objectives detailed in Section 429.41(4), F.S., including emergency waivers, will not be considered under this section but should follow the petition for waiver provisions of Section 120.542, F.S., and Rule Chapter 28-104, Variance or Waiver, F.A.C.

(b) The written request must address the elements required in Section 429.41(4), F.S. In addition, the following information must be included in order to demonstrate how a waiver of the stated rule will permit development of a concept that will achieve the purpose of the underlying statute:

1. The rule or rules for which the waiver is requested;.

2. The licensee’s anticipated date or dates for implementation of the concept;.

3. If applying based on cost-effectiveness or cost-savings, a cost-benefit analysis of the proposed alternative to both residents or potential residents as well as facility operations;.

4. An analysis of the impact the alternative will have on the relevant local community, including any barriers such as zoning or use issues, that which may need resolution before prior to implementation;.

5. Specific performance measures with an annual projection of objectives and goals to be achieved broken into quarterly increments or an annual projection of outcome measures, if the concept will be implemented in less than 90 days; and.

6. If applying based on cost-effectiveness or cost-savings, an annual budget projection for the proposed alternative broken into quarterly increments.

(c) A waiver can be requested at the time of the initial license application, relicensure, or any time during the licensure period.

(d) Waiver requests must be submitted to the Agency for Health Care Administration, Assisted Living Unit, 2727 Mahan Drive, Mail Stop 30, Tallahassee, Florida 32308-5403.

(2) In accordance with Section 120.542(6), F.S., the agency must shall post notice of the request within 15 fifteen (15) days of receipt of the request. The agency must shall make any requests for additional information within 30 days of receipt of the request. If additional information is provided, the agency may request clarification of only that information no later than 30 days following receipt of the information. The agency must shall process the waiver request pursuant to the time frame referenced in Section 120.542(8), F.S.

(3) The agency, in consultation with the department, will evaluate all requests in light of the likelihood the concept, as described in detail, will achieve the underlying statutory objectives of innovative or cost effective congregate care alternatives to enable individuals to age in place, as provided in Section 429.41(4), F.S. Waivers may be granted only so long as there is reasonable assurance that the health, safety, and or welfare of residents will not be endangered by the waiver.

(4) The agency must shall grant or deny the request for waiver and enter an order summarizing the facts it relied on, and reasons supporting its decision. The agency must provide notice of its order as described in Section 120.542(8), F.S. The requestor must shall be advised that a denial of the request may be reviewed as provided in subsection (5) of this rule.

(5) Report of Findings. A facility that has been granted a waiver must submit an annual report within 12 months of the order granting the waiver as specified in Section 429.41(4), F.S. If the report is not submitted as required, the agency may revoke the waiver.

(a) The agency will review the report of findings to determine whether the waiver will shall be renewed or revoked. The agency must shall make the determination based on whether the facility has met the requirements outlined in paragraph subparagraph (1)(b) of this rule. The agency must shall enter an order providing the general basis for making its decision and notify the licensee of its opportunity to seek review of a revocation in accordance with Sections 120.569 and 120.57, F.S. and Rule 28-106.111, F.A.C.

(b) The agency may also consider other material that which is available relative to this review.

(c) A waiver is effective unless revoked by the agency or superseded by statutory or regulatory change.

(d) In reviewing the report of findings, the agency, in consultation with the department, must shall assess whether statutory or regulatory changes should be pursued to enable other facilities to adopt the same practices.

Rulemaking Authority 429.41 FS. Law Implemented 120.542, 429.41 FS. History–New 9-30-92, Formerly 10A-5.035, Amended 10-30-95, 7-1-08,________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jason Nelson

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Charles Corley

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 26, 2013

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 18, 2013