58A-5.0131: Definitions
58A-5.016: License
58A-5.0181: Residency Criteria and Admission Procedures
58A-5.0182: Resident Care Standards
58A-5.0183: Advance Directives and Do Not Resuscitate Orders (DNRO)
58A-5.0185: Medication Practices
58A-5.019: Staffing Standards
58A-5.0191: Staff Training Requirements and Competency Test
58A-5.023: Physical Plant Standards
58A-5.025: Resident Contracts
58A-5.033: Administrative Enforcement
PURPOSE AND EFFECT: The purpose and effect of the proposed rule amendments is to: include an additional requirement for determining continued residency resulting in amendments to AHCA Form 1823, which is incorporated by reference; include changes to resident care standards as it pertains to third party services; provide work schedules for direct care staff upon request by residents and their representatives; amend medication practices, specifically in regards to over the counter medications; include changes to staff training requirements, specifically in regards to HIV/AIDS, pursuant to statutory changes to Section 381.0035, F.S., additional training for direct care staff in facilities holding a limited mental health license, and establishing the minimum score for successful completion of the core training competency exam; amend the physical plant standards to coincide with the Florida Building Code, 2007 Edition; and Chapter 633, F.S., Fire Prevention and Control; include changes to the resident contract, specifically notification that the resident must be assessed for admission as well as for continued residency, and statements regarding self-administration, assistance with self-administration and administration of medications, including over-the-counter medications, in resident contracts or written statement of house rules; amend language to stress that facilities must take appropriate action to assist, if necessary, in facilitating the provision of services for residents in facilities holding standard, extended congregate care, limited nursing services and limited mental health licenses; and deletion of the use of a temporary license under administrative enforcement. The purpose and effect of a new rule is to address procedures for do not resuscitate orders.
SUMMARY: Additional requirement for determining continued residency; changes to AHCA Form 1823, which is incorporated by reference; changes to resident care standards as in pertains to third party services; provision of the work schedule for direct care staff for residents or representatives; amendments to medication practices, specifically in regards to over-the-counter medications; changes to staff training requirements, specifically HIV/AIDS, additional training for direct care staff in facilities holding a limited mental health license and establishing a minimum score for the core training examination; amendments to the physical plant standards to coincide with the Florida Building Code, 2007 Edition, and Chapter 633, F.S., Fire Prevention and Control; notification that the resident must be assessed for admission as well as for continued residency, requiring use of AHCA Form 1823 for the latter determination; requirement regarding the facility’s policies and procedures for self-administration, assistance with self-administration and administration of medications, including over-the-counter medications, to be included in resident contracts; amendment to stress that facilities must take appropriate action to assist, if necessary, in facilitating the provision of services for residents in facilities holding standard, extended congregate care, limited nursing services and limited mental health licenses; deletion of the use of a temporary license; and procedures for do not resuscitate orders.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: Amendments to proposed subsections 58A-5.0181(4) and 58A-5.0191(9), F.A.C., will have an impact on small business as defined in Section 288.703, F.S. Pursuant to Section 120.54(3)(a)1., F.S., the department’s statement of estimated regulatory costs is provided. Under subsection 58A-5.0181(4), F.A.C., the amount is determined to be an approximate cost of $50.00 for a reassessment of a resident’s continued residency in a facility, including a physical examination, every three years or after a significant change. Under subsection 58A-5.0191(9), F.A.C., the estimated cost is an biennial expense of $100.00 for continuing education training in mental health diagnoses and treatments, or a minimal cost if in-service training is provided, for all direct care staff employed in facilities holding a limited mental health license.
The amendments to the proposed rules will not have an impact on small cities or counties as defined in Section 120.52, F.S. Therefore, a statement of estimated regulatory costs has not been prepared in regards to small cities or counties.
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.
SPECIFIC AUTHORITY: 429.15, 429.178, 429.23, 429.24, 429.255, 429.26, 429.275, 429.41, 429.42, 429.52 FS.
LAW IMPLEMENTED: 429.02, 429.04, 429.075, 429.12, 429.14, 429.15, 429.17, 429.176, 429.178, 429.19, 429.24, 429.255, 429.256, 429.23, 429.26, 429.27, 429.275, 429.28, 429.34, 429.41, 429.42, 429.44, 429.445, 429.47, 429.52 FS.
A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: January 7, 2010, 9:30 a.m. – 12:00 Noon EST
PLACE: Department of Elder Affairs, 4040 Esplanade Way, Conference Room 225F, Tallahassee, Florida 32399-7000
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, FL 32399-7000; telephone (859)414-2113; Email address: crochethj@elderaffairs.org. 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: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, FL 32399-7000; telephone (859)414-2113; Email address: crochethj@elderaffairs.org
THE TEXT OF THE PROPOSED RULE AND AHCA FORM 1823, INCORPORATED BY REFERENCE, CAN BE FOUND ON THE WEBSITE BELOW UNDER THE HEADING ENTITLED “ASSISTED LIVING FACILITIES, RULE CHAPTER 58A-5, F.A.C.” http://elderaffairs.state.fl.us/english/rulemaking.php
THE 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) through (34) No change.
(35) “Temporary license” means a license issued by Agency for Health Care Administration to an assisted living facility that supersedes and temporarily replaces the current license and remains in place pending the final disposition of a proceeding involving the suspension or revocation of an assisted living facility license.
(36) through (37) renumbered (35) through (36) No change.
Rulemaking Specific Authority 429.23, 429.41 FS. Law Implemented 429.02, 429.07, 429.075, 429.11, 429.14, 429.178, 429.19, 429.255, 429.23, 429.28, 429.41, 429.47, 429.52 FS. History–New 9‑30‑92, Formerly 10A‑5.0131, Amended 10‑30‑95, 6‑2‑96, 4‑20‑98, 10-17-99, 1-9-02, 7-30-06,________.
58A‑5.016 License Requirements.
(1) SERVICE PROHIBITION. An ALF may not 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.
(3) CHANGE IN USE OF SPACE REQUIRING CENTRAL OFFICE APPROVAL. A change in the use of space that increases or decreases a facility’s capacity shall not be made without prior approval from the Agency Central Office. Approval 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 requirements as referenced in Rule 58A-5.0161, F.A.C.
(4) CHANGE IN USE OF SPACE REQUIRING 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, shall not be made without prior approval from the Agency Field Office. Approval 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 standards as referenced in Rule 58A-5.0161, F.A.C.
(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 III, Chapter 400, F.S., and this rule chapter.
(6) PROOF OF INSPECTIONS. A copy of the annual fire safety and sanitation inspections described in Rule 58A-5.0161, F.A.C., shall be submitted annually to the Agency Central Office. The annual inspections 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 Section 429.14, F.S., and Rule 58A-5.033, F.A.C.
(7) MEDICAID WAIVER RESIDENTS. Upon request, the facility administrator or designee must identify Medicaid waiver residents to the agency and the department for monitoring purposes authorized by state and federal laws.
(8) THIRD PARTY SERVICES.
(a) In instances when residents require services from a third party provider, the facility administrator or designee must take action to assist, if necessary, in facilitating the provision of those services and coordinate with the provider to meet the specific service goals. These actions must be documented in the resident’s record.
(b) In instances when residents or their representatives arrange for third party services that are not included in the documents listed in paragraph (a) of this subsection, the facility administrator or designee, when requested by residents or representatives, must take action to assist, if necessary, in facilitating the provision of those services and coordinate with the provider to meet the specific service goals. These actions must be documented in the resident’s record.
Rulemaking Specific Authority 429.41 FS. Law Implemented 429.07, 429.11, 429.12, 429.41, 429.44, 429.445 FS. History–New 5‑15‑81, Amended 1‑6‑82, 9‑17‑84, Formerly 10A‑5.16, Amended 6‑21‑88, 9‑30‑92, Formerly 10A‑5.016, Amended 10‑30‑95, 10-17-99, 7-30-06,________.
58A-5.0181 Residency Criteria and Admission Procedures, Appropriateness of Placement and Continued Residency Criteria.
(1) No change.
(2) HEALTH ASSESSMENT.
(a) The medical examination report must be completed within 60 calendar days prior to the individual’s admission to a facility pursuant to Section 429.26(4), F.S. The report must be based on a face-to-face examination and must shall address the following:
1. through 6. No change.
7. A statement on the day of the examination by that, in the opinion of the licensed health care provider examining physician or ARNP, on the day the examination is conducted, that the individual’s needs can be met in an assisted living facility; and
8. The date of the examination and the name, signature, address, phone number and license number of the examining licensed health care provider physician or ARNP. The medical examination may be conducted by a currently licensed health care provider physician or ARNP from another state.
(b) Medical examinations completed after the resident’s admission of the resident to the facility must be completed within 30 calendar days of the admission date of admission and must be recorded on AHCA Form 1823, the Resident Health Assessment For Assisted Living Facilities and Adult Family-Care Homes, AHCA Form 1823,_______2010. The form January 2006, which is hereby incorporated by reference. A faxed copy of the completed form is acceptable. A copy of AHCA Form 1823 may be obtained from the Agency Central Office or its website at: www.fdhc.state.fl.us/MCHQ/Long_Term_Care/Assisted_living/pdf/AHCA_Form_1823%_Jan_2006_.pdf. The form must be completed as follows: Previous versions of this form completed up to six (6) months after 7-30-06 are acceptable.
1. The 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, based on a face-to-face examination.
a. Items on the form that may have been omitted by the licensed health care provider during the face-to-face examination do not necessarily require an additional face-to-face examination for completion.
b. The facility may obtain the omitted information either verbally or in writing form the licensed health care provider.
c. Omitted information received verbally must be documented in the resident’s record, 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.
2. The facility administrator, or designee, must complete Section 3 of the form, Services Offered or Arranged by the Facility, except 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) through (g) No change.
(3) ADMISSION PACKAGE.
(a) The facility shall make available to potential residents a written statement(s), which includes the following information listed below. A copy of the facility resident contract or facility brochure containing all the required information shall meet this requirement.:
1. through 10. No change.
11. A statement of the facility policy concerning Do Not Resuscitate Orders pursuant to Section 429.255, F.S., and Rule 58A-5.0183, F.A.C., and Advance Directives pursuant to Chapter 765, F.S.
12. through 14. No change.
(b) Prior to or at the time of admission, the resident, responsible party, guardian, or attorney in fact, if applicable, shall be provided with the following:
1. No change.
2. A copy of the facility statement described in paragraph (a) of this subsection if one has not already been provided;
3. through 4. No change.
(c) No change.
(4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (e) of this subsection, cCriteria for continued residency in a facility holding a standard, limited nursing services, or limited mental health license shall be the same as the criteria for admission.,except as follows: A determination of the appropriateness of a resident’s continued residency must be completed at least every 3 years after the initial assessment, or after a significant change, whichever comes first. A significant change is defined in Rule 58A-5.0131, F.A.C. The facility must make the determination of continued residency using AHCA Form 1823, which is incorporated by reference in paragraph (2)(b) of this rule. The form must be completed in accordance with that paragraph. After the effective date of this rule, providers shall have up to 12 months to comply with this requirement. except as follows:
(a) through (e) No change.
(5) No change.
Rulemaking Specific Authority 429.07, 429.26, 429.41 FS. Law Implemented 429.02, 429.07, 429.075, 429.26, 429.41 FS. History– New 9‑17‑84, Formerly 10A‑5.181, Amended 10‑20‑86, 6‑21‑88, 8‑15‑90, 9‑30‑92, Formerly 10A‑5.0181, Amended 10‑30‑95, 6‑2‑96, 10-17-99, 7-30-06, 10-9-06,________.
58A-5.0182 Resident Care Standards.
An assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility.
(1) through (6) No change.
(7) THIRD PARTY SERVICES. Nothing in this rule chapter is intended to prohibit a resident or the resident’s representative from independently arranging, contracting, and paying for services provided by a third party of the resident’s choice, including a licensed home health agency or private nurse, or receiving services through an out‑patient clinic, provided the resident meets the criteria for continued residency and the resident complies with the facility’s policy relating to the delivery of services in the facility by third parties. The facility’s policies must may require the third party to coordinate with the facility regarding the resident’s condition and the services being provided pursuant to subsection (8) of Rule 58A-5.016, F.A.C. Pursuant to subsection (6) of this rule, the facility shall provide the resident with the facility’s policy regarding the provision of services to residents by non-facility staff.
(8) through (9) No change.
Rulemaking Specific Authority 429.02, 429.41 FS. Law Implemented 429.02, 429.255, 429.256, 429.26, 429.28, 429.41 FS. History–New 9‑17‑84, Formerly 10A‑5.182, Amended 10‑20‑86, 6‑21‑88, 8‑15‑90, 9‑30‑92, Formerly 10A‑5.0182, Amended 10‑30‑95, 4‑20‑98, 11-2-98, 10-17-99, 7-30-06, 10-9-06,________.
58A-5.0183 Do Not Resuscitate Orders (DNROs).
(1) POLICIES AND PROCEDURES.
(a) Each assisted living facility (ALF) must have written policies and procedures, which delineate its position with respect to state laws and rules relative to DNROs. The policies and procedures shall not condition treatment or admission upon whether or not the individual has executed or waived a DNRO. The ALF must provide the following to each resident, or resident’s representative, at the time of admission:
1. A copy of Form SCHS-4-2006, “Health Care Advance Directives – The Patient’s Right to Decide,” 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. 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 DNRO. If a DNRO has been executed, a copy of that document must be made a part of the resident’s record. If the ALF does not receive a copy of a resident’s executed DNRO, the ALF must document in the resident’s record that it has requested a copy.
(2) LICENSE REVOCATION. An ALF shall be subject to revocation of its license pursuant to Section 408.815, F.S., if, as a condition of treatment or admission, it requires an individual to execute or waive a DNRO.
(3) DNRO PROCEDURES. Pursuant to Section 429.255, F.S., an ALF must honor a properly executed DNRO as follows:
(a) In the event a resident experiences cardiopulmonary distress, staff trained in cardiopulmonary resuscitation (CPR), or a licensed health care provider present in the facility, may withhold cardiopulmonary resuscitation.
(b) In the event a resident is receiving hospice services and experiences cardiopulmonary distress, facility staff must immediately contact the hospice. The hospice procedures shall take precedence over those of the assisted living facility.
(c) If a facility has a written policy not to honor a properly executed DNRO, the facility must make this fact clearly known in writing to the resident, or legal representative, at the time of admission and in its contract with the resident. The facility must also inform the resident, or legal representative, in writing at the time of admission and in its contract with such resident that the facility will administer CPR until the “911” contact person arrives. This must be documented in the resident’s record. In such a facility, when a resident, who has a properly executed DNRO, experiences cardiopulmonary distress, staff must immediately contact “911.”
1. A trained staff member must administer CPR until emergency services arrive.
2. Once emergency services arrive, the facility must present the properly executed DNRO to the “911” contact person.
3. Cardiopulmonary resuscitation may then be withheld or withdrawn by the “911” contact person pursuant to Section 401.45, F.S.
(4) LIABILITY. Pursuant to Section 429.255, F.S., ALF providers shall not be subject to criminal prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct, for following the procedures set forth in subsection (3) of this rule, which involves withholding or withdrawing cardiopulmonary resuscitation pursuant to a Do Not Resuscitate Order and rules adopted by the department.
Rulemaking Authority 429.255 FS. Law Implemented 429.255 FS. History–New________.
58A-5.0185 Medication Practices.
Pursuant to Sections 429.255 and 429.256, F.S., and this rule, facilities holding a standard, limited mental health, extended congregate care, or limited nursing services license may assist with the self-administration or administration of medications to residents in a facility. A resident may not be compelled to take medications but may be counseled in accordance with this rule.
(1) through (7) No change.
(8) OVER THE COUNTER (OTC) MEDICATIONS. For purposes of this subsection, the term OTC includes, but is not limited to, OTC medications, vitamins, nutritional supplements and nutraceuticals.
(a) No change.
(b) When centrally stored, OTC medications Non‑prescription over‑the‑counter drugs, including those prescribed by a licensed health care provider when centrally stored, must shall be labeled with the resident’s name. In addition, and the manufacturer’s label with directions for use, or the licensed health care provider’s order with directions for use, must shall be kept with the medication. No other labeling requirements are necessary nor should be required.
(c) Residents or their representatives may purchase OTC medications from an establishment of their choice. When an over‑the‑counter medication is prescribed by a health care provider, the medication becomes a prescription medication and shall be managed in accordance with prescription medication under this rule.
(d) A facility cannot require a licensed health care provider’s order for all OTC medications as part of its policies and procedures when a resident self-administers his or her own medications, or when staff provides assistance with self-administration or administration of medications. However, in the event staff becomes concerned over a resident’s health, safety and welfare regarding OTC medications that may be contraindicated when taken with one another or in combination with prescribed medications, the following shall apply:
1. Staff must bring the issue to the attention of the resident, or representative, the resident’s licensed health care provider and the administrator. This action must be documented in the resident’s record. The resident’s licensed health care provider shall make the determination as to whether the OTC medication is:
a. Contraindicated and should be discontinued; or
b. Can be taken as directed; or
c. Can be taken with other directions for use.
2. The facility must document the health care provider’s directives and keep a copy of the health care provider’s written order, if applicable, in the resident’s record.
(e) The facility must include the provisions in this subsection in resident contracts or house rules pursuant to Rule 58A-5.025, F.A.C.
Rulemaking Specific Authority 429.256, 429.41 FS. Law Implemented 429.255, 429.256, 429.41 FS. History–New 10-17-99, Amended 7-30-06,________.
58A‑5.019 Staffing Standards.
(1) through (3) No change.
(4) STAFFING STANDARDS.
(a) Minimum staffing:
1. through 2. No change.
3. In facilities with 17 or more residents, there shall be at least one staff member awake at all hours of the day and night.
4. through 8. No change.
(b) No change.
(c) The facility must shall maintain a written work schedule which reflects its the facility’s 24-hour staffing pattern for a given time period. Upon request, the facility must make the work schedules for direct care staff available to residents or representatives.
(d) through (f) No change.
Rulemaking Specific Authority 429.41, 429.52, 429.275 FS. Law Implemented 429.02, 429.04, 429.174, 429.176, 429.19, 429.24, 429.255, 429.26, 429.275, 429.41, 429.52 FS. History–New 5‑14‑81, Amended 1‑6‑82, 9‑17‑84, Formerly 10A‑5.19, Amended 10‑20‑86, 6‑21‑88, 8‑15‑90, 9‑30‑92, Formerly 10A‑5.019, Amended 10‑30‑95, 4‑20‑98, 11-2-98, 10-17-99, 7-30-06,________.
58A-5.0191 Staff Training Requirements and Competency Test.
(1) ASSISTED LIVING FACILITY CORE TRAINING REQUIREMENTS AND COMPETENCY TEST.
(a) No change.
(b) Administrators and managers must successfully complete the assisted living facility core training requirements within 3 months from the date of becoming a facility administrator or manager. Successful completion of the core training requirements includes passing the competency test. The minimum passing score for the competency test is 75%. Administrators who have attended core training prior to July 1, 1997, and managers who attended the core training program prior to April 20, 1998, shall not be required to take the competency test. Administrators licensed as nursing home administrators in accordance with Part II of Chapter 468, F.S., are exempt from this requirement.
(c) through (e) No change.
(2) No change.
(3) HUMAN IMMUNODEFICIENCY VIRUS/ ACQUIRED IMMUNE DEFICIENCY SYNDROME (HIV/AIDS). Pursuant to Section 381.0035, F.S., all facility employees, with the exception of employees subject to the requirements of Section 456.033, F.S., must complete biennially, a one-time continuing education course on HIV and AIDS, including the topics prescribed in the Section 381.0035, F.S. New facility staff must obtain the an initial training on HIV/AIDS within 30 days of employment, unless the new staff person previously completed the initial training and has maintained the biennial continuing education requirement. Documentation of compliance must be maintained in accordance with subsection (12)(11) of this rule.
(4) through (7) No change.
(8) LIMITED MENTAL HEALTH TRAINING. Pursuant to Section 429.075, F.S., the administrator, manager, and staff in direct contact with mental health residents in a facility with a limited mental health license must receive a minimum of 6 hours training provided or approved by the Department of Children and Family Services within 6 months of the facility’s receiving a limited mental health license or within 6 months of employment in a facility holding a limited mental health license. Staff in “direct contact” means direct care staff and staff whose duties take them into resident living areas and require them to interact with mental health residents on a daily basis. The term does not include maintenance, food service, or administrative staff if such staff have only incidental contact with mental health residents.
(a) Pursuant to Section 429.075, F.S., the administrator, managers and staff, who have direct contact with mental health residents in a licensed limited mental health facility, must receive the following training:
1. A minimum of 6 hours of specialized training in working with individuals with mental health diagnoses.
a. The training must be provided or approved by the Department of Children and Families and must be taken within 6 months of the facility’s receiving a limited mental health license or within 6 months of employment in a limited mental health facility.
b. Staff in “direct contact” means direct care staff and staff whose duties take them into resident living areas and require them to interact with mental health residents on a daily basis. The term does not include maintenance, food service or administrative staff, if such staff have only incidental contact with mental health residents.
c. Training received under this subparagraph may count once for 6 of the 12 hours of continuing education required for administrators and managers pursuant to Section 429.52(4), F.S., and subsection (1) of this rule.
2. A minimum of 3 hours of continuing education or in-service training biennially thereafter in subjects dealing with one or more of 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 the Baker Act procedures.
c. For administrators and managers, this requirement will satisfy 3 of the 12 hours of continuing education required biennially pursuant to Section 429.52(4), F.S., and subsection (1) of this rule.
d. Administrators, managers and direct contact staff affected by this requirement shall have up to 6 months after the effective date of this rule to meet the continuing education or in-service training requirement.
(b)(a) Administrators, managers and staff receiving this training do not have to repeat the initial this training should they change employers provided they present the employee provides a copy of their the employee’s training certificate to the employee’s current employer for retention in the facility’s personnel files. They must also ensure that copies of the continuing education training certificates, pursuant to subparagraph 2. of this subsection, are retained in their personnel files.
(b) Training received under this subsection may count once for 6 of the 12 hours of continuing education required for administrators and managers under subsection (1) of this rule.
(9) ALZHEIMER’S DISEASE AND RELATED DISORDERS (“ADRD”) TRAINING REQUIREMENTS. Facilities which advertise that they provide special care for persons with ADRD, or who maintain secured areas as described in Chapter 4, Section 434.4.6 of the Florida Building Code, as adopted in Rule 9B-3.047, F.A.C., Florida Building Code Adopted Rule 58A-5.023, F.A.C., must ensure that facility staff receive the following training.
(a) through (h) No change.
(10) No change.
(11) DO NOT RESUSITATE ORDERS TRAINING REQUIREMENT.
(a) Currently employed facility administrators, managers, direct care staff and staff involved in resident admissions must attend training in the facility’s policies and procedures regarding DNROs within 30 days after the effective date of this rule.
(b) Newly hired facility administrators, managers, direct care staff and staff involved in resident admissions must attend training in the facility’s policy and procedures regarding DNROs within 30 days after employment.
(c) Training shall consist of the information included in Rule 58A-5.0183, F.A.C.
(12)(11) No change.
Rulemaking Specific Authority 429.178, 429.41, 429.52 FS. Law Implemented 429.07, 429.075, 429.178, 429.41, 429.52 FS. History– New 9-30-92, Formerly 10A-5.0191, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-5-05, 7-30-06, 10-9-06, 7-1-08, ________.
(Substantial rewording of Rule 58A-5.023 follows. See Florida Administrative Code for present text.)
58A‑5.023 Physical Plant Standards.
(1) NEW FACILITIES.
(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 must comply with the following standards:
1. Chapter 4, Section 434, of the Florida Building Code, as adopted in Rule 9B-3.047, 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.
(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 must comply with the following standards:
1. Chapter 4, Section 434, of the Building Code, as adopted in Rule 9B-3.047, 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.
(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, except that any part of the facility included in additions, modifications, alterations, refurbishing, renovations or reconstruction must comply with the currently adopted codes and standards referenced in subsection (1) of this rule.
(b) A facility undergoing change of ownership shall be considered an existing facility for purposes of this rule.
(4) OTHER REQUIREMENTS.
(a) All facilities must:
1. Provide a safe living environment pursuant to Section 429.28(1)(a), F.S.; and
2. Must be maintained free of hazards; and
3. Must ensure 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 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 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 personal effects;
4. A table, bedside lamp or floor lamp, and waste basket; and
5. A comfortable chair, if requested.
(b) The facility must maintain master or duplicate keys to resident bedrooms to be used in the event of an emergency.
(c) Residents who use portable bedside commodes must be provided with privacy during use.
(d) Facilities must make available linens and personal laundry services for residents who require such services. Linens provided by a facility shall be free of tears, stains and not be threadbare.
(5) 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 paragraphs 58A-5.0182(6)(g), 58A-5.019(2)(e), 58A-5.019(4)(a), and 58A-5.020(2)(b), F.A.C., respectively.
Rulemaking Specific Authority 429.41 FS. Law Implemented 404.056, 429.27, 429.41 FS. History–New 5‑14‑81, Amended 1‑6‑82, 5‑19‑83, 9‑17‑84, Formerly 10A‑5.23, Amended 10‑20‑86, 6‑21‑88, 8‑15‑90, 9‑30‑92, Formerly 10A‑5.023, Amended 10‑30‑95, 6‑2‑96, 10- 17-99, 7-30-06,________.
58A-5.025 Resident Contracts.
(1) Pursuant to Section 429.24, F.S., prior to or at the time of admission, each resident or the residents legal representative, shall, prior to or at the time of admission, execute a contract with the facility, which contains the following provisions:
(a) through (j) No change.
(k) A provision that residents must be assessed upon admission pursuant to subsection (2) of Rule 58A-5.0181, F.A.C., and periodically thereafter pursuant to subsection (4) of that rule.
(l) The facility’s policies and procedures for self-administration, assistance with self-administration and administration of medications, if applicable, pursuant to Rule 58A-5.0185, F.A.C. This also includes requirements for over-the-counter medications pursuant to subsection (8) of that rule.
(m) If a facility has a policy not to honor a properly executed DNRO, the facility must inform the resident, or legal representative, in writing of the policy pursuant to paragraph (3)(c) of Rule 58A-5.0183, F.A.C.
(2) through (3) No change.
Rulemaking Specific Authority 429.24, 429.41 FS. Law Implemented 429.24, 429.41 FS. History–New 10-17-99, Amended 7-30-06,________.
58A-5.033 Administrative Enforcement.
Facility staff shall cooperate with Agency personnel during surveys, complaint investigations, monitoring visits, implementation of correction plans, license application and renewal procedures and other activities necessary to ensure compliance with Part I of Chapter 429, F.S., and this rule chapter.
(1) through (6) No change.
(7) TEMPORARY LICENSE. Temporary licenses as defined in subsection 58A-5.0131(37), F.A.C., may be issued by the Agency upon the initiation of any proceeding pursuant to Section 429.14(8), F.S.
Rulemaking Specific Authority 429.15, 429.23, 429.41, 429.42 FS. Law Implemented 429.07, 429.08, 429.11, 429.12, 429.14, 429.15, 429.17, 429.19, 429.12, 429.23, 429.27, 429.28, 429.34, 429.41, 429.42 FS. History–New 9‑30‑92, Formerly 10A‑5.033, Amended 10‑30‑95, 10-17-99, 1-9-02, 7-30-06,________.