The Agency proposes to revise rules 59A-36.007, 36.008 and 36.028, F.A.C., pursuant to HB 767 (2020) which amended sections 429.41, 426.256, and 429.52, F.S., respectively, to provide for the use of physical restraints, ....

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NOS.:RULE TITLES:

59A-36.007Resident Care Standards

59A-36.008Medication Practices

59A-36.028ALF Minimum Core Training Curriculum Requirements

PURPOSE AND EFFECT: The Agency proposes to revise rules 59A-36.007, 36.008 and 36.028, F.A.C., pursuant to HB 767 (2020) which amended sections 429.41, 426.256, and 429.52, F.S., respectively, to provide for the use of physical restraints, the option for a resident to waive being orally advised of medication names and dosages, and the establishment of requirements by rule for core trainer registration and removal.

SUMMARY: The Agency proposes to revise rules 59A-36.007, 36.008 and 36.028, F.A.C., to include specifications for a care plan, staff monitoring, and periodic review by a physician pertaining to use of physical restraints, the option for a resident to waive being orally advised of medication names and dosages, clarification for coordination of third party services, infection control procedures, and requirements for core trainer registration and removal.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A SERC has not been prepared by the agency. For rules listed where no SERC was prepared, the Agency prepared a checklist for each rule to determine the necessity for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

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

RULEMAKING AUTHORITY: 429.41, 429.41, 429.52, FS.

LAW IMPLEMENTED: 429.255, 429.26, 429.28, 429.41, 429.52, FS.

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

DATE AND TIME: May 25, 2021, 2:30 p.m. to 3:30 p.m.

PLACE: No public face-to-face meeting. This hearing will be conducted via teleconference. Participate by dialing the Open Voice conference line, 1(888)585-9008, then enter the conference room number followed by the pound sign, 476-211-242#. The agenda and related materials can also be found on the web at: https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Rulemaking.shtml.

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 days before the workshop/meeting by contacting: [e-mail], Bureau of Health Facility Regulation, 2727 Mahan Drive, MS 28A, Tallahassee, Florida, 32308 at [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Keisha Woods, [phone] or email at [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59A-36.007 Resident Care Standards.

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

(1) through (5) No change.

(6) RESIDENT RIGHTS AND FACILITY PROCEDURES.

(a) through (c) No change.

(d) The facility must have a written statement of its house rules and procedures that must be included in the admission package provided pursuant to rule 59A-36.006, F.A.C. The rules and procedures must at a minimum address the facility’s policies regarding:

1. Resident responsibilities;

2. Alcohol and tobacco use;

3. Medication storage;

4. Resident elopement;

5. Reporting resident abuse, neglect, and exploitation;

6. Administrative and housekeeping 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;

9. Assistive devices; and

10. Physical restraints.

(e) through (g) No change

(7) THIRD PARTY SERVICES.

(a) through (b) No change.

(c) The administrator or designee must ensure that:

1. Care coordination includes documented communications about the resident’s condition and response to treatment or services ordered by the physician which may impact the resident’s appropriateness for continued residency in the facility;

2. Communications occur at least once every 30 days and whenever there is a significant change in the resident’s condition; and

3. If physician ordered treatments or services occur less often than once a month, communications must be conducted according to the ordered treatment or service schedule and whenever there is a significant change in the resident’s condition.

(d)(c) If residents accept assistance from the facility in arranging and coordinating 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 documentation in the residents’ record explaining why its efforts were unsuccessful. This documentation will serve to demonstrate its compliance with this subsection.

(8) No change.

(9) PHYSICAL RESTRAINTS. Residents for whom a physician has prescribed a physical restraint must have a written care plan for the use of the physical restraint. The care plan must be developed within 14 days of the device being prescribed, and prior to use on the resident.

(a) The care plan must specify:

1. The device prescribed for use,

2. The maximum amount of time the resident is to have the restraint applied each day, and,

3. In what manner and frequency staff will monitor, observe, and report to the physician any injuries, increase in agitation, signs and symptoms of depression, or decline in mobility or function related to the use of the prescribed restraint.

(b) Facility staff must ensure that the device is applied appropriately and safely.

(c) The resident’s physician must review the appropriateness of the continued use of the physical restraint annually, and documentation of this review must be maintained in the resident’s record. If the resident’s ability to independently remove or avoid the device fluctuates, the device must be considered a physical restraint and all requirements of this subsection apply.

(10) ASSISTIVE DEVICES. Facilities are responsible for ensuring the safe usage of a resident’s assistive devices.

(a) The facility must have policies and procedures that include the requirements and methods for assessing the physical condition of assistive devices that may injure the resident and procedures for recommending repair or replacement for the continuing safety of a resident’s assistive device.

(b) Documentation of each assistive device a resident uses must be included in the resident’s record.

(c) Direct care staff using assistive devices while rendering personal services to residents must know how to operate and utilize the equipment.

(d) All assistive devices must be clean, in good repair, and free of hazards.

(e) The facility must encourage and allow the resident to function with independence when using the assistive device.

(11) INFECTION CONTROL PROCEDURES. Facilities must provide services in a manner that reduces the risk of transmission of infectious diseases. 

(a) The facility must implement a hand hygiene program before and after the provision of personal services to residents whenever there is an expectation of possible exposure to infectious materials or bodily fluids. Hand hygiene may include the use of alcohol-based rubs, antiseptic handwash, or handwashing with soap and water.

(b) Standard precautions must be used when there is an anticipated exposure to transmissible infectious agents in blood, body fluids, secretions, excretions, nonintact skin, and mucuous membranes during the provision of personal services. Standard precautions include: hand hygiene, and dependent upon the exposure, use of gloves, gown, mask, eye protection, or a face shield.

(c) The facility must clean and disinfect reusable medical equipment and communal assistive devices that have been designed for use by multiple residents before and after each use according to the manufacturer’s recommendations. 

(12)(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 59A-36.020, 59A-36.021 and 59A-36.022, F.A.C., respectively.

(13) This rule is in effect for five years from its effective date.

Rulemaking Authority 429.41 FS. Law Implemented 429.255, 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, 4-17-14, 5-10-18, Formerly 58A-5.0182, 7-1-19, Amended _______.

 

59A-36.008 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) through (2) No change.

(3) ASSISTANCE WITH SELF-ADMINISTRATION.

(a) No change.

(b) In addition to the specifications of section 429.256(3), F.S., assistance with self-administration of medication includes, orally advising the resident of the name and dosage of the medication in the presence of the resident, reading the medication label aloud and verbally prompting a resident to take medications as prescribed.

(c) through (g) No change

(4) MEDICATION ADMINISTRATION.

(a) through (c) No change.

(d) A facility that 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 chapter 483, part I, 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’ equipment. Information about the State Clinical Laboratory License and federal CLIA Certificate is available from the Laboratory and In-Home Services Unit Laboratory Unit, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 32, Tallahassee, FL 32308; telephone [phone].

(5) through (8) No change.

(9) This rule is in effect for five years from its effective date.

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, 3-13-14, 5-10-18, Formerly 58A-5.0185, 7-1-19, Amended___________.

 

59A-36.028 ALF Minimum Core Training Curriculum Requirements.

(1) No change.

(2) MONITORING. The Agency reserves the right to do the following:

(a) Require submission of the core training schedule from a core trainer;

(b)(a) Attend and monitor core training courses;

(c)(b) Review provider records and course materials pursuant to this rule; and,

(d)(c) Conduct on-site or virtual monitoring, follow-up monitoring, and require implementation of a corrective action plan if the provider does not adhere to the approved curriculum.

(3) CANCELLATION OF CORE REGISTRATION. The Agency may cancel the core registration and remove any ALF core training provider from the approved list who fails to:

(a) Comply with submission of core training schedule within 10 business days of the request;

(b) Comply with corrective action plan issued by the Agency;

(c) Have a student passage rate at or above 55% as determined by the Agency’s contracted vendor in the preceding calendar year;

(d) Conduct an ALF core training session for twelve consecutive months; or

(e) Submit at least 10 examinees’ names to the Agency’s contracted ALF core training testing vendor in the preceding calendar year.

(9) This rule is in effect for five years from its effective date.

Rulemaking Authority 429.52 FS. Law Implemented 429.52 FS. History–New 6-15-09, Formerly 58T-1.205, 7-1-19. Amended _______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Keisha Woods

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Simone Marstiller

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 3/26/2021

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 12/01/2020