65G-2.009. Resident Care and Supervision Standards

(1) MINIMUM STANDARDS. Residential facility services shall ensure the health and safety of the residents and shall also address the provision of appropriate physical care and supervision.

(a) Each facility shall:

1. Facilitate the implementation of client support plans, behavior plans, and any other directions from medical or health care professionals as applicable;

2. Contact the client’s support coordinator, as necessary, to ensure the timely provision of needed medical and dental care; and

3. Participate in staff training and meetings as required by the Agency.

(b) The facility must employ sufficient staff so that it is not dependent upon the use of volunteers or residents. However, residents shall be encouraged to perform age and ability appropriate personal housekeeping chores such as maintaining his or her own quarters. A resident may also be expected to participate in an independent daily living skills program which may include the sharing of, or responsibility for, ordinary household tasks such as meal preparation, grocery shopping, dishwashing, laundering, and cleaning of common areas of the residence, lawn care, gardening and other tasks generally performed by a typical family.

(c) The treatment and care of residents shall be individualized and appropriate to differences in personal goals, abilities, sex, age, and special needs.

(d) The facility shall adhere to and protect resident rights and freedoms in accordance with the Bill of Rights of Persons with Developmental Disabilities, as provided in Section 393.13, F.S. Violations of Section 393.13(3)(a), F.S. relating to humane care, abuse, sexual abuse, neglect, or exploitation and all violations of Section 393.13(3)(g), F.S., shall constitute a Class I violation. All other violations of Section 393.13(3), F.S., shall constitute Class III violations. All violations of Sections 393.13(4)(c)1. and 2., (f), and (g), F.S., shall constitute Class I violations. All violations of Section 393.13(4)(h), F.S. shall constitute Class II violations. All other violations of Section 393.13(4), F.S., shall constitute Class III violations.

(e) The placement of a resident within a facility shall not be construed as a termination or restriction of the rights and responsibilities of the parents or guardians. Although not required, it is recommended that parents, guardians, and other responsible persons organize as volunteers for the purpose of promoting the welfare of the residents.

(f)1. Within the scope of the licensee’s responsibility for care and supervision of residents, the licensee shall ensure that there is appropriate action taken for a resident’s essential care following a resident’s medical, dental, therapy or other health care-related appointments to include scheduling additional appointments for residents, or assisting residents in scheduling their own appointments, as well as appropriate training of staff on changes in medication or dietary regimens, positioning of residents, utilization of specialized equipment, or any other area which has changed subsequent to any such appointments that would be within the purview and authority of the licensee to accomplish. As used in this paragraph “essential care” refers to care and follow-up measures that are medically necessary or directed by a treating physician or health care practitioner for the purpose of continuing an ongoing course of treatment of, or therapy for, a resident’s illness, injury, medical condition or diagnosis until such time as such care and follow-up measures are no longer directed or recommended by the physician or health care practitioner. A violation of this paragraph shall constitute a Class I violation.

2. Within the scope of the licensee’s responsibility for care and supervision of residents, the licensee shall ensure that there is appropriate action taken for a resident’s routine or preventive care following a resident’s medical, dental, therapy or other health care-related appointments to include scheduling additional appointments for residents, or assisting residents in scheduling their own appointments. As used in this paragraph “routine or preventive” means care other than essential care such as routine examinations, annual check-ups, or preventive screenings and dental care and cleanings. A violation of this paragraph shall constitute a Class II violation.

(g) Except as otherwise provided a violation of this subsection shall constitute a Class III violation.

(2) COMMUNITY RELATIONSHIP AND RECREATIONAL ACTIVITIES. Facilities shall provide opportunities for residents to participate in community activities. A violation of this subsection shall constitute a Class III violation.

(3) TRANSFER AND PLACEMENT OF CLIENTS.

(a) The licensee shall have written criteria and procedures in place for the admission or termination of residential services for clients; termination procedures must be consistent with Chapter 65G-3, F.A.C.

(b) The facility shall not serve residents unless it can meet their specific programmatic and physical accessibility needs. The facility must be capable of effectively and safely meeting the needs of all facility residents accepted for placement. The licensee shall ensure that the placement of new residents within the facility does not adversely affect the health, safety, or welfare of existing facility residents. The licensee must obtain the Agency’s approval prior to any proposed placement that would deviate from the criteria specified on the facility's application for licensure. The licensee shall notify the Agency and provide descriptive information on the prospective resident if the proposed placement involves an individual who is not a client of the Agency.

(c) Prior to a proposed transfer of a client from one licensed facility to another, the licensee shall discuss the transfer and reasons for transfer with the client, the client’s authorized representative (if one has been appointed), support coordinator, the Agency, and other involved service providers, as appropriate.

(d) A licensee who operates, administers, or manages more than one foster care facility, group home facility or residential habilitation center facility must receive approval from the Agency prior to transferring a client from one of its licensed facilities to another of its licensed facilities. Prior approval shall not be required in the event of an emergency in which there is a substantial probability that the health or safety of the client would be jeopardized in the absence of immediate relocation. Agency approval or notification is not required when a client is transferred within a single comprehensive transitional education program (CTEP).

(e) When a client is moved to a new residential setting, the licensee shall provide any personal belongings of the client to the client or the client’s authorized representative. The property inventory list completed in accordance with paragraph (g) below shall be referenced in order to account for all items.

(f) Prior to placement, and to ensure the smooth, safe and most effective transition of a new client to the licensee’s facility, the licensee shall:

1. Provide an opportunity for the referred client and the client’s authorized representative to visit the facility;

2. Cooperate and assist the Agency, the client’s support coordinator, and the client’s authorized representative with the new client’s discharge from the former residential setting; and

3. Make needed preparations for the new client, including ensuring that all staff are made aware of the client’s needs, and are properly trained and equipped to meet those needs.

(g) Upon placement, an itemized property inventory list accounting for the client’s records, personal funds, serviceable clothing, and any other personal belongings shall be completed and signed by the licensee and the client or the client’s authorized representative. This inventory record shall be updated within 30 days to reflect the acquisition of new items and reflect items that have been discarded, except that new and discarded articles of clothing are not required to be continually inventoried.

(h) Facilities that plan to use facility staff to take clients of the Agency out of Florida overnight shall provide prior notification to the Agency.

(i) The licensee shall cooperate and assist the Agency, the client’s support coordinator, and the client’s authorized representative in ensuring a smooth discharge of clients to other facilities or residential settings. Within 30 days, unless otherwise approved by the Agency, the licensee shall transfer all personal funds, medications, records, and possessions of the resident in the providers possession to the Agency, the client’s support coordinator, the client’s authorized representative, or the receiving facility, as applicable.

(j) A violation of this subsection shall constitute a Class III violation.

(4) RESIDENT FUNDS. Neither the licensee nor staff employed by the licensee may receive any financial benefit by charging a fee against, borrowing, or otherwise using the personal funds of a client for their personal benefit.

(a) The licensee shall maintain written receipts for purchases made with clients funds, valued at $25.00 or more for at least one year following the date of purchase.

(b) A record of income and expenditures from each client’s personal funds shall be maintained in accordance with generally accepted accounting principles.

(c) The available amount of each client’s personal funds must reconcile with the most recent ending balance which is recorded within the licensee’s record of client income and expenditures.

(d) The licensee shall maintain a checking or savings account for the personal funds of clients. If a single account is maintained for multiple clients, a separate accounting must be maintained for each individual client that reconciles monthly to the account’s total, as noted on the bank statement, and shall be retained by the provider for review by the Agency. With the exception of the facility’s other residents, the personal funds of clients must not be co-mingled with the funds of any other person or entity, including those of the licensee or staff.

(e) Each client’s individual accounting must include:

1. The group home facility’s name and address;

2. The client’s name;

3. The client’s ending balance for the previous month;

4. The month and year for the accounting form;

5. The date and amount of all deposits and withdrawals;

6. The account balance following each deposit or withdrawal;

7. A brief statement of the purpose or reason for each deposit and withdrawal;

8. The name and signature of the staff member that completed each deposit or withdrawal;

9. The client’s signature, in any instance where money has been withdrawn for the client to use at his or her own discretion; and

10. The ending balance for the month.

(f) Each licensee must maintain this client accounting information on Agency form APD 2014-09 (effective April 1, 2014) which is incorporated herein by reference, or in an alternative format that includes all required information contained in the form and tracks all of the information required in paragraph 65G-2.009(4)(e), F.A.C. A copy of this form may be obtained from the Regional Office. The client accounting records shall be kept on the premises or maintained electronically and in a central location. Relevant current financial information, such as the account balance and a supply of funds, shall be maintained and secured in each facility to allow for purchases and other client or guardian-authorized uses of resident funds. All records shall be made available, as requested by Agency staff for inspection and monitoring purposes.

(g) A violation of this subsection shall constitute a Class II violation.

(5) CLIENT RECORDS. The facility shall establish and maintain an individual record for each client on the premises. The record shall contain information pertinent to the resident’s health, supervision, and care. The records may be maintained electronically.

(a) The record shall be the property of the client and shall remain with the client in the event the client moves to a different facility or the facility has a change in providers. However, in accordance with HIPAA, the licensee shall retain a copy of the records for six years, which shall be made available to the Agency for surveying, monitoring and inspection purposes. The licensee is solely responsible for the costs of reproduction of client records for the purposes of this subsection.

(b) At a minimum, the client records shall include:

1. The client’s name and date of birth;

2. The name, addresses and telephone number of the client’s physician and dentist;

3. Contact information for the client’s authorized representative and support coordinator;

4. Client or authorized representative authorization for routine medical or dental care;

5. Medical and dental reports, including any examination results and laboratory findings, if received by the facility, and the client’s medication history and any special instructions for carrying, lifting, positioning, bathing, assisting with meals or other aspects of personal care;

6. The resident’s legal competency, guardianship status, and the identification of any authorized representatives;

7. If applicable, a copy of the client’s current support plan, as supplied by the client’s support coordinator, and any other applicable plans such as an implementation plan; or behavior plan.

8. Property inventory list;

9. Incident reports directly involving the client; and

10. A color photograph of the client taken within the past five years.

(c) The records shall be current to the greatest extent possible and updated at least 30 days following receipt of new information. If any of the required information is not available, the licensee shall include written documentation in the record that a diligent effort was made to obtain the missing information.

(d) Client records shall be kept confidential in accordance with Section 393.13, F.S.

(e) A violation of this subsection shall constitute a Class III violation.

(6) RESIDENT SUPERVISION.

(a) Each facility must provide the level of supervision necessary to ensure that residents are protected from harm and that a safe and healthy living environment is created and maintained. Direct service providers must be given specific information and strategies to provide such an environment for all of residents of the facility. To the maximum extent possible, however, the facility shall respect the rights of residents to privacy and self-determination.

(b) At least one staff person must be present at all times while clients are in the facility. The only exception would be if the licensee prepares a written plan proposing that a specified client be left alone for limited periods of time during the day or night. Such plans must be approved by the Regional Office prior to implementation. In granting plan approval, the Agency shall consider the needs, characteristics, and abilities of the resident and the proposed circumstances under which the resident will be left alone. Non-compliance with the approved plans may result in the imposition of administrative fines, the suspension or revocation of such plans, or other administrative actions as appropriate.

(c) A violation of this subsection shall constitute a Class I violation.

(7) VIDEO MONITORING.

(a) The use of video cameras for the purposes of visually monitoring residents is permitted when necessary to assist in the behavioral or medical monitoring, diagnosis, intervention or treatment of residents who require ongoing and continuous supervision due to intensive medical and/or behavioral programmatic issues or if the licensee intends to use the monitoring as a means by which to prevent or detect abuse, neglect, exploitation, or sexual misconduct. Any providers that utilize a video monitoring system shall develop written criteria for determining which residents will be monitored by video camera, and protocols for implementing video monitoring.

(b) Monitoring shall be permitted only with the written consent of the resident, if competent, or the resident’s authorized representative. The facility must explain when and where monitoring will occur and the purposes of the monitoring system.

(c) The titles and positions of all persons authorized to access video feeds at off-site locations must be disclosed to the Agency. Such remote access must be accompanied by safeguards, such as firewalls and other security measures, sufficient to ensure resident privacy.

(d) The use of remote interactive video monitoring shall be limited to vocational and educational settings, medical and special treatment spaces, administrative offices, or common areas. Remote interactive video monitoring may not be used in bedrooms or bathrooms.

(e) The Agency reserves the right to preclude, restrict, or suspend a facility’s authority to conduct video monitoring pursuant to this subsection at any time if the Agency determines that any of the provisions of this subsection or of Section 393.13, F.S., have been violated.

(f) A violation of this subsection shall constitute a Class II violation.

(8) BEHAVIORAL INTERVENTIONS AND RESPONSES TO BEHAVIORAL ISSUES INVOLVING RESIDENTS.

(a) The facility shall have a written statement of policies and procedures governing actions that may be taken by direct service providers to help prevent or respond to problematic behaviors exhibited by residents. Such policies and procedures, as well as any actions taken by direct service providers involving residents of the facility, shall include emergency procedures, reporting requirements, and be consistent with the provisions of Section 393.13, F.S., as well as Chapters 65G-4 and 65G-8, F.A.C. A violation of this paragraph shall constitute a Class II violation.

(b) Direct service providers shall be trained in responding to serious and spontaneous behavioral incidents requiring emergency intervention procedures. A violation of this paragraph shall constitute a Class II violation.

(c) Emergency intervention procedures that use restraint or seclusion, or cause physical discomfort require approval from the Local Review Committee prior to implementation. A violation of this paragraph shall constitute a Class II violation.

(d) The following responses are strictly forbidden:

1. Physical or corporal punishment that includes but is not limited to hitting, slapping, smacking, pinching, paddling, pulling hair, pushing or shoving residents;

2. The use of noxious substances, which include painful or aversive stimuli used to control behavior such as pepper on tongue, squirt of lemon juice, ammonia inhalants, or electric shock;

3. Verbal abuse such as cursing at residents, using slurs or derogatory names, or screaming; or

4. Humiliation, such as keeping a resident in wet or soiled clothing or diapers, making the resident stand in front of others to be ridiculed, or making the resident wear a sign or dunce cap, placing residents in dark or locked time-out rooms.

A violation of this paragraph shall constitute a Class I violation.

(9) SEXUAL ACTIVITY.

(a) The licensee shall develop and enforce a written policy regarding sexual activity involving residents of the facility. Such policy must explicitly prohibit sexual activity between a resident and a covered person and any sexual activity that involves residents who are under the age of eighteen. Such policy shall not in any way abridge nor restrict the civil and legal rights of persons with developmental disabilities, including those specified within Section 393.13, F.S.

(b) The licensee shall provide direct service providers with training regarding the licensee’s policy regarding sexual activity involving residents of the facility. The policy shall address appropriate physical boundaries and standards among direct service providers and residents and must include the following elements:

1. Physical affection between direct service providers and residents should be brief, age appropriate, and should avoid bodily contact, such as lying together or sitting on laps, unless such affection is appropriate and clinically indicated based upon the context, such as consoling a grieving resident upon the death of a loved one, nurturing a young child recently separated from their family, or comforting a resident recovering from surgery;

2. A dress code, for both residents and direct service providers, shall be established which outlines the type of clothing that is acceptable, and where and under what circumstances it is acceptable;

3. Direct service providers and residents must respect personal space, such as knocking before entering a bedroom except as may be necessary for residents who require visual supervision due to documented behavioral or medical issues. A violation of this subparagraph constitutes a Class III violation;

4. The licensee shall limit access to bedrooms by establishing and enforcing house rules on who is allowed to visit whose bedroom and under what conditions;

5. All residents and direct service providers shall sleep in separate beds;

6. A provision which permits direct service providers to assist or supervise residents while the resident bathes, showers, or toilets, if the resident requires assistance or supervision, and which prohibits staff from bathing, showering, or toileting  simultaneously with the resident under any circumstances;

7. Guidelines concerning the level and type of supervision required for residents and all direct service providers shall be familiar with such guidelines;

8. Open communication among residents and direct service providers about events occurring in the facility in order to encourage reporting of incidents of inappropriate sexual behavior.

(c) The following safeguards shall be implemented in any facility which serves one or more sexually aggressive residents:

1. All direct service providers shall review all available written, detailed and complete information related to sexually aggressive residents in order to prevent the occurrence of sexual abuse incidents. When available to the licensee, such information provided to staff must include, but is not limited to, the date of the sexual abuse incident, type of abuse, brief narrative outlining the event, type of treatment the resident received and the outcome of the treatment. If the resident is currently in treatment, the licensee shall maintain contact information for the treatment provider;

2. Newly placed sexually aggressive residents shall be provided visual supervision at all times the resident is awake during the resident’s first twenty-four (24) hours in the facility;

3. A sexually aggressive resident must not be allowed to share a bedroom with another resident without Agency approval. Such approvals shall take into consideration the licensee’s plan to assure supervision sufficient to ensure the safety of residents;

4. Known sexually aggressive residents who are minors shall never be left alone with other residents in a bedroom or bathroom behind closed doors. Only one resident may use the bathroom at any time that the bathroom door is closed; and

5. Residents who are minors are not permitted to possess obscene materials as defined in Section 847.001, F.S., on the premises.

(d) Except as otherwise provided, a violation of this subsection shall constitute a Class I violation.

(10) SOLICITATION ACTIVITIES. The licensee must have the written permission of the client, if competent, or the client’s authorized representative prior to using the client, the client’s name, picture, or disability for the purpose of securing donations. A violation of this subsection shall constitute a Class III violation.

(11) FIRST AID. The facility shall have on the premises an American Red Cross-approved first aid kit. The first aid kit shall be maintained in places known to and readily available to all direct service providers. Potentially toxic materials contained within first aid kits should be stored in a manner which does not pose a risk to residents. A violation of this subsection shall constitute a Class III violation.

(12) MEDICATION.

(a) Medication shall be administered to clients in accordance with the written order or prescription issued by an individual’s health care practitioner. Ongoing staff re-training and competency based verification of skills shall be provided when there is evidence of medication errors to correct staff practices and prevent future occurrences. A violation of this paragraph resulting in a direct, negative impact to the health and safety of the individual, or presenting an imminent danger to the individual shall constitute a Class I violation.

(b) All prescription medication shall be kept in its original container bearing the original dated label with legible information stating the prescription number, direction for use, client’s name, physician’s name, and address of the issuing pharmacy.

(c) Medication shall be kept in a locked enclosure.

(d) A client, whom the physician has deemed capable of handling his/her own medications, should be encouraged to do so. Staff shall assist the client by making the medication available and reminding the client to take medication at appropriate times.

(e) The licensee must maintain an up-to-date and accurate daily record of prescription and/or nonprescription medication administered to clients in accordance with the provisions of Chapter 65G-7, F.A.C.

(f) The administration of medication to residents, as well as the documentation of administration of such medication, medication storage, and error reporting shall be performed in accordance with Sections 393.13 and 393.506, F.S., Chapter 65G-7, F.A.C., and this rule chapter.

(g) If the licensee or a direct service provider observes or receives reports from other individuals that a client may have experienced an adverse reaction to an administered medication, such information must be conveyed immediately to either the prescribing physician or the licensed medical professional employed by the licensee who has been charged with the responsibility of securing appropriate medical treatment for residents with health-related issues or concerns. If either the prescribing physician or medical professional employed by the licensee is unable to be reached, facility staff shall immediately seek medical attention for the resident. A violation of this paragraph shall constitute a Class I violation.

(h) With the exception of paragraphs (a) and (g), a violation of this subsection shall constitute a Class II violation.

(13) SPECIALIZED EQUIPMENT. The licensee shall ensure that all direct service providers have been trained and are competent in the proper application, monitoring, and removal of specialized equipment worn by residents, including but not limited to Ankle-Foot Orthoses (AFOs), leg braces, arm splints, neck collars, helmets, and safety belts. In addition, direct service providers shall be knowledgeable in the proper operation of other specialized equipment required by residents such as wheelchairs, lifts, and positioning devices. The licensee shall contact the appropriate support coordinator(s) as soon as significant signs of wear and tear are noticed on specialized equipment used by the residents. A violation of this subsection shall constitute a Class III violation.

(14) TRANSPORTATION.

(a) The facility shall provide or arrange for the incidental transportation of residents within the community as a typical household would provide for its members. This shall include, but is not limited to, trips to malls, grocery stores, religious worship services, medical or dental appointments, and recreational outings within the surrounding community. These trips shall be provided by the facility at no cost to the residents unless such trips involve destinations which are more than 25 miles from the facility.

(b) Any vehicle operated by the facility in which residents are transported shall have a current license plate, carry at least the minimum insurance coverage required by state law, contain a working and tagged fire extinguisher, be operated by a driver holding an appropriate valid driver’s license, have working seatbelts and wheelchair tie-downs when applicable, have working heat and air conditioning, and be maintained in a manner to ensure safe transport.

(c) The number of transported residents not seated in wheelchairs during the trip shall not exceed the number of available seats in the vehicle.

(d) Residents shall be encouraged to use public transportation in areas where it is available and appropriate to the residents’ ability.

(e) Residents may not be left unattended in any vehicle operated by the facility. A violation of this paragraph shall constitute a Class I violation.

(f) With the exception of paragraph (e), a violation of this subsection shall constitute a Class II violation.

(15) COMMUNICATION AMONG STAFF. A facility shall have a system in place to communicate recent incidents and client information to staff working on subsequent shifts.

(a) The system shall include a mechanism for documenting in writing, any and all information, such as medical or behavioral incidents or physician or therapist orders or recommendations, of which staff should be made aware and which could potentially affect the residents’ health or safety if staff were unaware of such information.

(b) The system established shall include a procedure or mechanism to assure that the information described in this subsection is reviewed across all shifts.

(c) Such communication-related documentation shall be maintained within the facility for a least one year following each entry and may be maintained electronically. The information shall be made available to the Agency during inspections.

(d) A violation of this subsection shall constitute a Class III violation.

Rulemaking Authority 393.501(1), 393.067, 393.506 FS. Law Implemented 393.067, 393.13, 393.135, 393.506 FS. History‒New 7-1-14.