Bill Text: FL S1592 | 2019 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Assisted Living Facilities
Spectrum: Bipartisan Bill
Status: (Failed) 2019-05-03 - Died in Appropriations, companion bill(s) passed, see CS/SB 184 (Ch. 2019-11) [S1592 Detail]
Download: Florida-2019-S1592-Introduced.html
Bill Title: Assisted Living Facilities
Spectrum: Bipartisan Bill
Status: (Failed) 2019-05-03 - Died in Appropriations, companion bill(s) passed, see CS/SB 184 (Ch. 2019-11) [S1592 Detail]
Download: Florida-2019-S1592-Introduced.html
Florida Senate - 2019 SB 1592 By Senator Harrell 25-01786-19 20191592__ 1 A bill to be entitled 2 An act relating to assisted living facilities; 3 amending s. 429.11, F.S.; updating obsolete language; 4 amending s. 429.19, F.S.; clarifying that specified 5 provisions of law do not apply to assisted living 6 facilities and prohibiting the Agency for Health Care 7 Administration from citing facilities or imposing 8 fines on such facilities under those provisions; 9 amending s. 429.23, F.S.; encouraging facilities to 10 take certain measures to provide for the general 11 security of residents, staff, and the facility; 12 amending s. 429.255, F.S.; clarifying that a resident 13 and specified persons may contract with a third party 14 for services under certain circumstances; amending s. 15 429.26, F.S.; requiring an owner’s or administrator’s 16 determination of an individual’s appropriateness of 17 admission to include a medical examination and to 18 follow specified guidelines; defining the term 19 “bedridden”; authorizing an advanced practice 20 registered nurse to provide an initial examination of 21 such individuals; requiring information from the 22 medical examination to be signed and recorded on a 23 certain form; requiring a medical examination form 24 including specified information to be provided by the 25 agency; removing provisions related to the placement 26 of an individual by the Department of Elderly Affairs; 27 requiring a facility to notify the resident’s 28 representative or designee when a resident exhibits 29 signs of dementia or cognitive impairment and an 30 underlying condition is determined to exist which 31 requires treatment; removing the requirement that a 32 facility arrange for the provision of health care 33 services to treat such a condition; removing a 34 provision relating to the continued residency of 35 terminally ill patients and residents who require 24 36 hour nursing services; amending s. 429.28, F.S.; 37 expanding the residents’ bill of rights to include 38 compliance with certain firesafety standards, 39 environmental health and safety practices, and 40 security procedures; amending s. 429.41, F.S.; 41 revising legislative intent; removing the requirement 42 that the Department of Elderly Affairs, in 43 consultation with the agency, the Department of 44 Children and Families, and the Department of Health 45 adopt certain rules; authorizing the Department of 46 Elderly Affairs, in consultation with the agency, the 47 Department of Children and Families, and the 48 Department of Health to adopt certain rules that 49 include specified standards; removing provisions 50 relating to firesafety standards and inspections which 51 are relocated to s. 429.435, F.S.; removing a 52 provision requiring the Department of Elderly Affairs 53 to submit a copy of proposed rules to the Legislature; 54 requiring rather than authorizing the agency to use a 55 biennial standard licensure inspection; creating s. 56 429.435, F.S.; relocating existing provisions relating 57 to firesafety standards and inspections; amending s. 58 429.52, F.S.; requiring the Department of Elderly 59 Affairs to establish core training requirements for 60 facility administrators; revising continuing education 61 and training requirements for certain facility staff; 62 removing the authority of the Department of Elderly 63 Affairs to require, provide, or cause to be provided, 64 training for staff in a facility; providing an 65 effective date. 66 67 Be It Enacted by the Legislature of the State of Florida: 68 69 Section 1. Subsection (7) of section 429.11, Florida 70 Statutes, is amended to read: 71 429.11 Initial application for license; provisional 72 license.— 73 (7) A county or municipality may not issue a business tax 74 receiptan occupational licensethat is being obtained for the 75 purpose of operating a facility regulated under this part 76 without first ascertaining that the applicant has been licensed 77 to operate such facility at the specified location or locations 78 by the agency. The agency shall furnish to local agencies 79 responsible for issuing business tax receiptsoccupational80licensessufficient instruction for making such determinations. 81 Section 2. Subsection (1) of section 429.19, Florida 82 Statutes, is amended to read: 83 429.19 Violations; imposition of administrative fines; 84 grounds.— 85 (1) In addition to the requirements of part II of chapter 86 408, the agency shall impose an administrative fine in the 87 manner provided in chapter 120 for the violation of any 88 provision of this part, part II of chapter 408, and applicable 89 rules by an assisted living facility, for the actions of any 90 person subject to level 2 background screening under s. 408.809, 91 for the actions of any facility employee, or for an intentional 92 or negligent act seriously affecting the health, safety, or 93 welfare of a resident of the facility. Parts II, III, and IV of 94 chapter 400 are not applicable to assisted living facilities, 95 and the agency may not cite a facility for a violation of those 96 parts or impose a fine for any such violation. 97 Section 3. Present subsection (10) of section 429.23, 98 Florida Statutes, is redesignated as subsection (11), and a new 99 subsection (10) is added to that section, to read: 100 429.23 Internal risk management and quality assurance 101 program; adverse incidents and reporting requirements.— 102 (10) Facilities are encouraged to use safety devices, 103 equipment, security measures, wander management, care sensing, 104 and staff risk management to provide for the general security of 105 residents, staff, and the facility. 106 Section 4. Paragraph (a) of subsection (1) of section 107 429.255, Florida Statutes, is amended to read: 108 429.255 Use of personnel; emergency care.— 109 (1)(a) Persons under contract to the facility, facility 110 staff, or volunteers, who are licensed underaccording topart I 111 of chapter 464, or those persons exempt under s. 464.022(1), and 112 others as defined by rule, may administer medications to 113 residents, take residents’ vital signs, manage individual weekly 114 pill organizers for residents who self-administer medication, 115 give prepackaged enemas ordered by a physician, observe 116 residents, document observations on the appropriate resident’s 117 record, and report observations to the resident’s physician, and118contract or allow residents. A resident or a resident’s 119 representative, designee, surrogate, guardian, or attorney in 120 fact maytocontract with a third party for services, provided 121 that the resident meetsresidents meetthe criteria for 122 appropriate placement as defined in s. 429.26. Nursing 123 assistants certified pursuant to part II of chapter 464 may take 124 residents’ vital signs as directed by a licensed nurse or 125 physician. 126 Section 5. Section 429.26, Florida Statutes, is amended to 127 read: 128 429.26 Appropriateness of placements; examinations of 129 residents.— 130 (1) The owner or administrator of a facility is responsible 131 for determining the appropriateness of admission of an 132 individual to the facility and for determining the continued 133 appropriateness of residence of an individual in the facility. A 134 determination mustshallbe based upon the owner’s or 135 administrator’s evaluationan assessmentof the strengths, 136 needs, and preferences of the resident; a medical examination;,137 the care and services offered or arranged for by the facility in 138 accordance with facility policy;,and any limitations in law or 139 rule related to admission criteria or continued residency for 140 the type of license held by the facility under this part. All of 141 the following guidelines apply to the determination of 142 appropriateness for residency and continued residency of an 143 individual in a facility: 144 (a) A facility may admit or retain a resident who receives 145 a health care service or treatment that is designed to be 146 provided within a private residential setting if all 147 requirements for providing that service or treatment are met by 148 the facility or a third party. 149 (b) A facility may admit or retain a resident who requires 150 the use of safety and assistive devices for performing the 151 activities of daily living; for transfer, such as sit-to-stand 152 lifts; for preventing and addressing falls; and for addressing 153 elopement. 154 (c) A facility may not admit or retain a resident who 155 requires 24-hour nursing supervision except for a resident who 156 is enrolled in hospice services pursuant to part IV of chapter 157 400. An individual receiving hospice services may be admitted or 158 retained in a facility if the arrangement is agreed to by the 159 facility and the resident, additional care is provided by a 160 licensed hospice, and the resident is under the care of a 161 physician who agrees that the physical needs of the resident can 162 be met at the facility. 163 (d) A facility may not admit or retain a resident who is 164 bedridden. For purposes of this section, the term “bedridden” 165 means that the resident is confined to bed because of the 166 inability to ambulate; the inability to transfer to a wheelchair 167 without assistance; or the inability to sit safely in a chair or 168 wheelchair without personal assistance or the assistance of a 169 physical restraint. 170 1. A resident may be retained in a facility if, during 171 residency, the resident is bedridden for no more than 7 172 consecutive days. 173 2. If a facility is licensed to provide extended congregate 174 care, the resident may be retained in a facility if, during 175 residency, the resident is bedridden for not more than 14 176 consecutive days. 177 3. A resident may be admitted or retained in a facility if 178 the resident meets the guidelines in paragraph (b) and is 179 enrolled in hospice services. 180 181 A resident may not be moved from one facility to another without 182 consultation with and agreement from the resident or, if 183 applicable, the resident’s representative or designee or the 184 resident’s family, guardian, surrogate, or attorney in fact. In 185 the case of a resident who has been placed by thedepartment or186theDepartment of Children and Families, the administrator must 187 notify the appropriate contact person in theapplicable188 department. 189 (2) A physician, physician assistant, or advanced practice 190 registered nursepractitionerwho is employed by an assisted 191 living facility to provide an initial examination for admission 192 purposes may not have financial interest in the facility. 193 (3) Persons licensed under part I of chapter 464 who are 194 employed by or under contract with a facility shall, on a 195 routine basis or at least monthly, perform a nursing assessment 196 of the residents for whom they are providing nursing services 197 ordered by a physician, except administration of medication, and 198 shall document such assessment, including any substantial 199 changes in a resident’s status which may necessitate relocation 200 to a nursing home, hospital, or specialized health care 201 facility. Such records shall be maintained in the facility for 202 inspection by the agency and shall be forwarded to the 203 resident’s case manager, if applicable. 204 (4)If possible,Each resident mustshallhave been 205 examined by a licensed physician, a licensed physician 206 assistant, or a licensed advanced practice registered nurse 207practitionerwithin 60 days before admission to the facility or 208 within 30 days after admission to the facility, except as 209 provided in s. 429.07. The information from the medical 210 examination may be recorded on the practitioner’s form or on a 211 form provided by the agency. Thesigned andcompleted medical 212 examination form, signed by the practitioner, mustreportshall213 be submitted to the owner or administrator of the facility, who 214 shall use the information contained therein to assist in the 215 determination of the appropriateness of the resident’s admission 216 and continued stay in the facility. The medical examination form 217 becomesreportshall becomea permanent part of the record of 218 the resident at the facility and shall be made available to the 219 agency during inspection or upon request. An assessment that has 220 been completed through the Comprehensive Assessment and Review 221 for Long-Term Care Services (CARES) Program fulfills the 222 requirements for a medical examination under this subsection and 223 s. 429.07(3)(b)6. 224 (5) The medical examination form provided by the agency 225 must include all of the following information relating to the 226 resident: 227 (a) Height, weight, and known allergies. 228 (b) Significant medical history and diagnoses. 229 (c) Physical or sensory limitations. 230 (d) Cognitive or behavioral status. 231 (e) Nursing, treatment, or therapy service requirements. 232 (f) Whether assistance or total care is needed for the 233 activities of ambulating, eating, or transferring. 234 (g) Special dietary instructions. 235 (h) The existence of communicable diseases. 236 (i) Bedridden and pressure sore status. 237 (j) Whether the resident needs 24-hour nursing or 238 psychiatric care. 239 (k) A list of current prescribed medications, including, 240 for each such medication, the medication name; dosage; 241 directions for use; route; prescription quantity; and whether 242 the resident may self-administer medications, needs assistance, 243 or needs medication administrationExcept as provided in s.244429.07, if a medical examination has not been completed within24560 days before the admission of the resident to the facility, a246licensed physician, licensed physician assistant, or licensed247nurse practitioner shall examine the resident and complete a248medical examination form provided by the agency within 30 days249following the admission to the facility to enable the facility250owner or administrator to determine the appropriateness of the251admission. The medical examination form shall become a permanent252part of the record of the resident at the facility and shall be253made available to the agency during inspection by the agency or254upon request. 255 (6) Any resident accepted in a facility and placed bythe256department orthe Department of Children and Families shall have 257 been examined by medical personnel within 30 days before 258 placement in the facility. The examination shall include an 259 assessment of the appropriateness of placement in a facility. 260 The findings of this examination shall be recorded on the 261 examination form provided by the agency. The completed form 262 shall accompany the resident and shall be submitted to the 263 facility owner or administrator. Additionally, in the case of a 264 mental health resident, the Department of Children and Families 265 must provide documentation that the individual has been assessed 266 by a psychiatrist, clinical psychologist, clinical social 267 worker, or psychiatric nurse, or an individual who is supervised 268 by one of these professionals, and determined to be appropriate 269 to reside in an assisted living facility. The documentation must 270 be in the facility within 30 days after the mental health 271 resident has been admitted to the facility. An evaluation 272 completed upon discharge from a state mental hospital meets the 273 requirements of this subsection related to appropriateness for 274 placement as a mental health resident providing it was completed 275 within 90 days prior to admission to the facility. The 276applicableDepartment of Children and Families shall provide to 277 the facility administrator any information about the resident 278 that would help the administrator meet his or her 279 responsibilities under subsection (1). Further, Department of 280 Children and Families personnel shall explain to the facility 281 operator any special needs of the resident and advise the 282 operator whom to call should problems arise. Theapplicable283 Department of Children and Families shall advise and assist the 284 facility administrator where the special needs of residents who 285 are recipients of optional state supplementation require such 286 assistance. 287 (7) The facility must notify a licensed physician when a 288 resident exhibits signs of dementia or cognitive impairment or 289 has a change of condition in order to rule out the presence of 290 an underlying physiological condition that may be contributing 291 to such dementia or impairment. The notification must occur 292 within 30 days after the acknowledgment of such signs by 293 facility staff. If an underlying condition is determined to 294 exist, the facility shall notify the resident’s representative 295 or designee of the need for health carearrange, with the296appropriate health care provider, the necessary care and297 services to treat the condition. 298 (8) The Department of Children and Families may require an 299 examination for supplemental security income and optional state 300 supplementation recipients residing in facilities at any time 301 and shall provide the examination whenever a resident’s 302 condition requires it. Any facility administrator; personnel of 303 the agency, the department, or the Department of Children and 304 Families; or a representative of the State Long-Term Care 305 Ombudsman Program who believes a resident needs to be evaluated 306 shall notify the resident’s case manager, who shall take 307 appropriate action. A report of the examination findings shall 308 be provided to the resident’s case manager and the facility 309 administrator to help the administrator meet his or her 310 responsibilities under subsection (1). 311(9) A terminally ill resident who no longer meets the312criteria for continued residency may remain in the facility if313the arrangement is mutually agreeable to the resident and the314facility; additional care is rendered through a licensed315hospice, and the resident is under the care of a physician who316agrees that the physical needs of the resident are being met.317 (9)(10)Facilities licensed to provide extended congregate 318 care services shall promote aging in place by determining 319 appropriateness of continued residency based on a comprehensive 320 review of the resident’s physical and functional status; the 321 ability of the facility, family members, friends, or any other 322 pertinent individuals or agencies to provide the care and 323 services required; and documentation that a written service plan 324 consistent with facility policy has been developed and 325 implemented to ensure that the resident’s needs and preferences 326 are addressed. 327(11) No resident who requires 24-hour nursing supervision,328except for a resident who is an enrolled hospice patient329pursuant to part IV of chapter 400, shall be retained in a330facility licensed under this part.331 Section 6. Paragraphs (a) and (d) of subsection (1) of 332 section 429.28, Florida Statutes, are amended to read: 333 429.28 Resident bill of rights.— 334 (1) No resident of a facility shall be deprived of any 335 civil or legal rights, benefits, or privileges guaranteed by 336 law, the Constitution of the State of Florida, or the 337 Constitution of the United States as a resident of a facility. 338 Every resident of a facility shall have the right to: 339 (a) Live in a safe and decent living environment that meets 340 the requirements of the uniform firesafety standards established 341 under s. 633.206 and the environmental health and safety 342 practices established under ss. 381.006, 381.0072, and 381.0098, 343 and be free from abuse,andneglect, or exploitation as defined 344 in s. 415.102. 345 (d) Unrestricted private communication, including receiving 346 and sending unopened correspondence, access to a telephone, and 347 visiting with any person of his or her choice, at any time 348 between the hours of 9 a.m. and 9 p.m. at a minimum. Visitors 349 must comply with the facility’s security procedures and may not 350 pose a health or safety risk to any residents or staff. Upon 351 request, the facility shall make provisions to extend visiting 352 hours for caregivers and out-of-town guests, and in other 353 similar situations. 354 Section 7. Section 429.41, Florida Statutes, is amended to 355 read: 356 429.41 Rules establishing standards.— 357 (1) It is the intent of the Legislature that rules 358 published and enforced pursuant to this sectionshallinclude 359 criteria by which a reasonable and consistent quality of 360 resident care and quality of life may be promotedensured and361the results of such resident care may be demonstrated. Such 362 rulesshallalso must promoteensurea safe and sanitary 363 environment that is residential and noninstitutional in design 364 or nature and that allows for technological advances in the 365 provision of care, safety, and security. It is further intended 366 that reasonable efforts be made to accommodate the needs and 367 preferences of residents to enhance the quality of life in a 368 facility.Uniform firesafety standards for assisted living369facilities shall be established by the State Fire Marshal370pursuant to s. 633.206.The agency, in consultation with the 371 department, may adopt rules to administer the requirements of 372 part II of chapter 408.In order to provide safe and sanitary373facilities and the highest quality of resident care374accommodating the needs and preferences of residents,The 375 department, in consultation with the agency, the Department of 376 Children and Families, and the Department of Health, mayshall377 adopt rules, policies, and proceduresto administer this part, 378 which must include reasonable and fair minimum standards in 379 relation to: 380 (a) The requirements forandmaintenance and the sanitary 381 condition of facilities, not in conflict with, or duplicative 382 of, the requirements in chapter 381 or chapter 553 and the rules 383 adopted thereunder, relating to furnishings for residents’ 384 bedrooms or sleeping areas, locking devices, linens, laundry 385 servicesplumbing, heating, cooling, lighting, ventilation,386living space, and similar physical plant standardsother housing387conditions, which will reasonably promoteensurethe health, 388 safety, and welfarecomfortof residents suitable to the size of 389 the structure. The rules must clearly delineate the 390 responsibilities of the agency’s licensure and survey staff and 391 the county health departments and ensure that inspections are 392 not duplicative. The agency may collect fees for food service 393 inspections conducted by the county health departments and shall 394 transfer such fees to the Department of Health. 3951. Firesafety evacuation capability determination.—An396evacuation capability evaluation for initial licensure shall be397conducted within 6 months after the date of licensure.3982. Firesafety requirements.—399a. The National Fire Protection Association, Life Safety400Code, NFPA 101 and 101A, current editions, shall be used in401determining the uniform firesafety code adopted by the State402Fire Marshal for assisted living facilities, pursuant to s.403633.206.404b. A local government or a utility may charge fees only in405an amount not to exceed the actual expenses incurred by the406local government or the utility relating to the installation and407maintenance of an automatic fire sprinkler system in a licensed408assisted living facility structure.409c. All licensed facilities must have an annual fire410inspection conducted by the local fire marshal or authority411having jurisdiction.412d. An assisted living facility that is issued a building413permit or certificate of occupancy before July 1, 2016, may at414its option and after notifying the authority having415jurisdiction, remain under the provisions of the 1994 and 1995416editions of the National Fire Protection Association, Life417Safety Code, NFPA 101, and NFPA 101A. The facility opting to418remain under such provisions may make repairs, modernizations,419renovations, or additions to, or rehabilitate, the facility in420compliance with NFPA 101, 1994 edition, and may utilize the421alternative approaches to life safety in compliance with NFPA422101A, 1995 edition. However, a facility for which a building423permit or certificate of occupancy is issued before July 1,4242016, that undergoes Level III building alteration or425rehabilitation, as defined in the Florida Building Code, or426seeks to utilize features not authorized under the 1994 or 1995427editions of the Life Safety Code must thereafter comply with all428aspects of the uniform firesafety standards established under s.429633.206, and the Florida Fire Prevention Code, in effect for430assisted living facilities as adopted by the State Fire Marshal.4313. Resident elopement requirements.—Facilities are required432to conduct a minimum of two resident elopement prevention and433response drills per year. All administrators and direct care434staff must participate in the drills which shall include a435review of procedures to address resident elopement. Facilities436must document the implementation of the drills and ensure that437the drills are conducted in a manner consistent with the438facility’s resident elopement policies and procedures.439 (b) The preparation and annual update of a comprehensive 440 emergency management plan. Such standards must be included in 441 the rules adopted by the department after consultation with the 442 Division of Emergency Management. At a minimum, the rules must 443 provide for plan components that address emergency evacuation 444 transportation; adequate sheltering arrangements; postdisaster 445 activities, including provision of emergency power, food, and 446 water; postdisaster transportation; supplies; staffing; 447 emergency equipment; individual identification of residents and 448 transfer of records; communication with families; and responses 449 to family inquiries. The comprehensive emergency management plan 450 is subject to review and approval by the local emergency 451 management agency. During its review, the local emergency 452 management agency shall ensure that the following agencies, at a 453 minimum, are given the opportunity to review the plan: the 454 Department of Elderly Affairs, the Department of Health, the 455 Agency for Health Care Administration, and the Division of 456 Emergency Management. Also, appropriate volunteer organizations 457 must be given the opportunity to review the plan. The local 458 emergency management agency shall complete its review within 60 459 days and either approve the plan or advise the facility of 460 necessary revisions. 461 (c) The number, training, and qualifications of all 462 personnel having responsibility for the care of residents. The 463 rules must require adequate staff to provide for the safety of 464 all residents. Facilities licensed for 17 or more residents are 465 required to maintain an alert staff for 24 hours per day. 466(d) All sanitary conditions within the facility and its467surroundings which will ensure the health and comfort of468residents. The rules must clearly delineate the responsibilities469of the agency’s licensure and survey staff, the county health470departments, and the local authority having jurisdiction over471firesafety and ensure that inspections are not duplicative. The472agency may collect fees for food service inspections conducted473by the county health departments and transfer such fees to the474Department of Health.475 (d)(e)Licensure requirements not in conflict with part II 476 of chapter 408License application and license renewal, transfer 477 of ownership, proper management of resident funds and personal 478 property, surety bonds, resident contracts, refund policies, 479 financial ability to operate, and facility and staff records. 480 (e)(f)Inspections, complaint investigations,moratoriums,481classification of deficiencies, levyingand enforcement of 482 penalties, and use of income from fees and fines. 483 (f)(g)The enforcement of the resident bill of rights 484 specified in s. 429.28. 485 (g)(h)The careand maintenanceof residents, which must 486 allow for technological advances in the provision of care, 487 safety, and security, includinginclude, but is not limited to: 488 1. The supervision of residents; 489 2. The provision of personal services; 490 3. The provision of, or arrangement for, social and leisure 491 activities; 492 4. The provision of assistance in making arrangements 493arrangementfor appointments and transportation to appropriate 494 medical, dental, nursing, or mental health services, as needed 495 by residents; 496 5. The management of medication stored within the facility 497 and as needed by residents; 498 6. The dietarynutritionalneeds of residents; 499 7. Resident records, including services provided by the 500 facility; and 501 8. Internal risk management and quality assurance. 502 (h)(i)Facilities holding a limited nursing, extended 503 congregate care, or limited mental health license. 504 (i)(j)The establishment of specific criteria to define 505 appropriateness of resident admission and continued residency in 506 a facility holding a standard, limited nursing, extended 507 congregate care, and limited mental health license. 508 (j)(k)The use of physical or chemical restraints. The use 509 of physical restraints is limited to half-bed rails and other 510 measures as prescribed and documented by the resident’s 511 physician with the consent of the resident or, if applicable, 512 the resident’s representative or designee or the resident’s 513 surrogate, guardian, or attorney in fact. The use of chemical 514 restraints is limited to prescribed dosages of medications 515 authorized by the resident’s physician and must be consistent 516 with the resident’s diagnosis. Residents who are receiving 517 medications that can serve as chemical restraints must be 518 evaluated by their physician at least annually to assess: 519 1. The continued need for the medication. 520 2. The level of the medication in the resident’s blood. 521 3. The need for adjustments in the prescription. 522 (k)(l)Resident elopement drill requirementsThe523establishment of specific policies and procedures on resident524elopement. Facilities shall conduct a minimum of two resident 525 elopement drills each year. All administrators and direct care 526 staff shall participate in the drills, which must include a 527 review of the facility’s procedures to address resident 528 elopement. Facilities shall document the drills. 529 (2) In adopting any rules pursuant to this part, the 530 department, in conjunction with the agency, shall make distinct 531 standards for facilities based upon facility size; the types of 532 care provided; the physical and mental capabilities and needs of 533 residents; the type, frequency, and amount of services and care 534 offered; and the staffing characteristics of the facility. Rules 535 developed pursuant to this section may not restrict the use of 536 shared staffing and shared programming in facilities that are 537 part of retirement communities that provide multiple levels of 538 care and otherwise meet the requirements of law and rule. If a 539 continuing care facility licensed under chapter 651 or a 540 retirement community offering multiple levels of care licenses a 541 building or part of a building designated for independent living 542 for assisted living, staffing requirements established in rule 543 apply only to residents who receive personal, limited nursing, 544 or extended congregate care services under this part. Such 545 facilities shall retain a log listing the names and unit number 546 for residents receiving these services. The log must be 547 available to surveyors upon request.Except for uniform548firesafety standards,The department shall adopt by rule 549 separate and distinct standards for facilities with 16 or fewer 550 beds and for facilities with 17 or more beds. The standards for 551 facilities with 16 or fewer beds must be appropriate for a 552 noninstitutional residential environment; however, the structure 553 may not be more than two stories in height and all persons who 554 cannot exit the facility unassisted in an emergency must reside 555 on the first floor. The department, in conjunction with the 556 agency, may make other distinctions among types of facilities as 557 necessary to enforce this part. Where appropriate, the agency 558 shall offer alternate solutions for complying with established 559 standards, based on distinctions made by the department and the 560 agency relative to the physical characteristics of facilities 561 and the types of care offered. 562 (3)The department shall submit a copy of proposed rules to563the Speaker of the House of Representatives, the President of564the Senate, and appropriate committees of substance for review565and comment prior to the promulgation thereof.Rules adopted 566promulgatedby the department shall encourage the development of 567 homelike facilities which promote the dignity, individuality, 568 personal strengths, and decisionmaking ability of residents. 569 (4) The agency, in consultation with the department, may 570 waive rules promulgated pursuant to this part in order to 571 demonstrate and evaluate innovative or cost-effective congregate 572 care alternatives which enable individuals to age in place. Such 573 waivers may be granted only in instances where there is 574 reasonable assurance that the health, safety, or welfare of 575 residents will not be endangered. To apply for a waiver, the 576 licensee shall submit to the agency a written description of the 577 concept to be demonstrated, including goals, objectives, and 578 anticipated benefits; the number and types of residents who will 579 be affected, if applicable; a brief description of how the 580 demonstration will be evaluated; and any other information 581 deemed appropriate by the agency. Any facility granted a waiver 582 shall submit a report of findings to the agency and the 583 department within 12 months. At such time, the agency may renew 584 or revoke the waiver or pursue any regulatory or statutory 585 changes necessary to allow other facilities to adopt the same 586 practices. The department may by rule clarify terms and 587 establish waiver application procedures, criteria for reviewing 588 waiver proposals, and procedures for reporting findings, as 589 necessary to implement this subsection. 590 (5) The agency shallmayuse an abbreviated biennial 591 standard licensure inspection that consists of a review of key 592 quality-of-care standards in lieu of a full inspection in a 593 facility that has a good record of past performance. However, a 594 full inspection must be conducted in a facility that has a 595 history of class I or class II violations, uncorrected class III 596 violations, a long-term care ombudsman complaint referred to a 597 regulatory agency for further actionconfirmed ombudsman council598complaints, or confirmed licensure complaints, within the 599 previous licensure period immediately preceding the inspection 600 or if a potentially serious problem is identified during the 601 abbreviated inspection. The agency, in consultation with the602department,shall develop the key quality-of-care standardswith603input from the State Long-Term Care Ombudsman Council and604representatives of provider groupsfor incorporation into its 605 rules. 606 Section 8. Section 429.435, Florida Statutes, is created to 607 read: 608 429.435 Uniform firesafety standards.-Pursuant to s. 609 633.206, the State Fire Marshal shall establish uniform 610 firesafety standards for assisted living facilities. 611 (1) CAPABILITY DETERMINATION.—A firesafety evacuation 612 capability determination shall be made within 6 months after the 613 date of a facility’s initial licensure. 614 (2) FIRESAFETY REQUIREMENTS.— 615 (a) The National Fire Protection Association, Life Safety 616 Code, NFPA 101 and 101A, current editions, must be used in 617 determining the uniform firesafety code adopted by the State 618 Fire Marshal for assisted living facilities. 619 (b) A local government or a utility may charge fees only in 620 an amount not to exceed the actual expenses incurred by the 621 local government or the utility relating to the installation and 622 maintenance of an automatic fire sprinkler system in a licensed 623 assisted living facility structure. 624 (c) All licensed facilities must be annually inspected by 625 the local fire marshal or authority having jurisdiction for 626 compliance with this section. 627 (d) An assisted living facility that was issued a building 628 permit or certificate of occupancy before July 1, 2016, at its 629 option and after notifying the authority having jurisdiction, 630 may remain under the provisions of the 1994 and 1995 editions of 631 the National Fire Protection Association, Life Safety Code, NFPA 632 101, and NFPA 101A. The facility opting to remain under those 633 provisions may make repairs, modernizations, renovations, or 634 additions to, or may rehabilitate, the facility in compliance 635 with NFPA 101, 1994 edition, and may utilize the alternative 636 approaches to life safety in compliance with NFPA 101A, 1995 637 edition. However, a facility for which a building permit or 638 certificate of occupancy is issued before July 1, 2016, which 639 undergoes Level III building alteration or rehabilitation, as 640 defined in the Florida Building Code, or seeks to utilize 641 features not authorized under the 1994 or 1995 editions of the 642 Life Safety Code must thereafter comply with all aspects of the 643 uniform firesafety standards established under s. 633.206, and 644 the Florida Fire Prevention Code, in effect for assisted living 645 facilities as adopted by the State Fire Marshal. 646 Section 9. Section 429.52, Florida Statutes, is amended to 647 read: 648 429.52 Staff trainingand educational programs; core 649 educational requirement.— 650 (1)Effective October 1, 2015,Each new assisted living 651 facility employee who has not previously completed core training 652 must attend a preservice orientation provided by the facility 653 before interacting with residents. The preservice orientation 654 must be at least 2 hours in duration and cover topics that help 655 the employee provide responsible care and respond to the needs 656 of facility residents. Upon completion, the employee and the 657 administrator of the facility must sign a statement that the 658 employee completed the required preservice orientation. The 659 facility must keep the signed statement in the employee’s 660 personnel record. 661 (2) Administrators and other assisted living facility staff 662 must meet minimum trainingand educationrequirements 663 established by the Department of Elderly Affairs by rule. This 664 trainingand educationis intended to assist facilities to 665 appropriately respond to the needs of residents, to maintain 666 resident care and facility standards, and to meet licensure 667 requirements. 668 (3) The department shall establish core training 669 requirements for administrators which consist of minimum core 670 training and a competency test. Theand aminimum required score 671 for passageto indicate successfulcompletionof the core 672 competency test is 75 percenttraining and educational673requirements. The competency test must be developed by the 674 department in conjunction with the agency and providers. The 675 required competency testtraining and educationmust cover at 676 least the following topics: 677 (a) State law and rules relating to assisted living 678 facilities. 679 (b) Resident rights and identifying and reporting abuse, 680 neglect, and exploitation. 681 (c) Special needs of elderly persons, persons with mental 682 illness, and persons with developmental disabilities and how to 683 meet those needs. 684 (d) Nutrition and food service, including acceptable 685 sanitation practices for preparing, storing, and serving food. 686 (e) Medication management, recordkeeping, and proper 687 techniques for assisting residents with self-administered 688 medication. 689 (f) Firesafety requirements, including fire evacuation 690 drill procedures and other emergency procedures. 691 (g) Care of persons with Alzheimer’s disease and related 692 disorders. 693 (4) Anewfacility administrator must complete the required 694 core trainingand education, including the competency test, 695 within 90 days after the date of employment as an administrator. 696 Failure to do so is a violation of this part and subjects the 697 violator to an administrative fine as prescribed in s. 429.19. 698 Administrators licensed in accordance with part II of chapter 699 468 are exempt from this requirement. Other licensed 700 professionals may be exempted, as determined by the department 701 by rule. 702 (5) Administrators are required to participate in 703 continuing education for a minimum of 12 contact hours every 2 704 years. 705 (6) BeforeStaff involved with the management of706medications andassisting with the self-administration of 707 medications under s. 429.256, staff must complete a minimum of 6 708additionalhours of training provided by a registered nurse or 709 a,licensed pharmacist, or department staff. Two hours of 710 continuing education is required annually thereafter. The 711 department shall establish by rule the minimum requirements of 712 thisadditionaltraining. 713 (7) Other facility staff shall participate in in-service 714 training relevant to their job duties as specified by rule of 715 the department. Topics covered during the preservice orientation 716 are not required to be repeated during in-service training. A 717 single certificate of completion that covers all required in 718 service training topics may be issued to a participating staff 719 member if the training is provided in a single training session. 720 (8) If thedepartment or theagency determines that there 721 are problems in a facility whichthatcould be reduced through 722 specific staff trainingor educationbeyond that already 723 required under this section, thedepartment or theagency may 724 require, and provide, or cause to be provided, the trainingor725educationof any personal care staff in the facility. 726 (9) The department shall adopt rules related to these 727 training requirements, the competency test, necessary 728 procedures, and competency test fees and shall adopt or contract 729 with another entity to develop and administer the competency 730 test. The department must also adopt a curriculum outline to be 731 used by core trainers, which shall be usedas the minimum core 732 training contentrequirements. The department shall consult with 733 representatives of stakeholder associations and agencies in the 734 development of the curriculum outline. 735 (10) The core training required by this sectionother than736the preservice orientationmust be conducted by persons 737 registered with the department as having the requisite 738 experience and credentials to conduct the training. A person 739 seeking to register as a core trainer must provide the 740 department with proof of completion of theminimumcore training 741educationrequirements, successful passage of the competency 742 test established under this section, and proof of compliance 743 with the continuing education requirement in subsection (5). 744 (11) A person seeking to register as a core trainer must 745 also: 746 (a) Provide proof of completion of a 4-year degree from an 747 accredited college or university and must have worked in a 748 management position in an assisted living facility for 3 years 749 after being core certified; 750 (b) Have worked in a management position in an assisted 751 living facility for 5 years after being core certified and have 752 1 year of teaching experience as an educator or staff trainer 753 for persons who work in assisted living facilities or other 754 long-term care settings; 755 (c) Have been previously employed as a core trainer for the 756 department; or 757 (d) Meet other qualification criteria as defined in rule, 758 which the department is authorized to adopt. 759 (12) The department shall adopt rules to establish trainer 760 registration requirements. 761 Section 10. This act shall take effect July 1, 2019.