Florida Senate - 2019 CS for SB 1592
By the Committee on Children, Families, and Elder Affairs; and
Senator Harrell
586-04036A-19 20191592c1
1 A bill to be entitled
2 An act relating to assisted living facilities;
3 amending s. 429.02, F.S.; defining and redefining
4 terms; amending s. 429.11, F.S.; prohibiting a county
5 or municipality from issuing a business tax receipt,
6 rather than an occupational license, to an assisted
7 living facility under certain circumstances; amending
8 s. 429.176, F.S.; amending educational requirements
9 for an administrator who is replacing another
10 administrator; amending s. 429.23, F.S.; requiring a
11 facility to initiate an investigation of an adverse
12 incident within 24 hours and provide a report of such
13 investigation to the Agency for Health Care
14 Administration within 15 days; amending s. 429.255,
15 F.S.; authorizing a facility resident or his or her
16 representative to contract with a third party under
17 certain circumstances; amending s. 429.256, F.S.;
18 requiring a person assisting with a resident’s self
19 administration of medication to confirm that the
20 medication is intended for that resident and to orally
21 advise the resident of the medication name and
22 purpose; amending s. 429.26, F.S.; including medical
23 examinations within criteria used for admission to an
24 assisted living facility; providing specified criteria
25 for determinations of appropriateness for admission
26 and continued residency at an assisted living
27 facility; defining the term “bedridden”; requiring
28 that a resident receive a medical examination within a
29 specified timeframe after admission to a facility;
30 requiring that such examination be recorded on a
31 specified form; providing minimum requirements for
32 such form; revising provisions relating to the
33 placement of residents by the Department of Elderly
34 Affairs or the Department of Children and Families;
35 requiring a facility to notify a resident’s
36 representative or designee of the need for health care
37 services and to assist in making appointments for such
38 care and services under certain circumstances;
39 removing provisions relating to the retention of
40 certain residents in a facility; amending s. 429.28,
41 F.S.; revising residents’ rights relating to a safe
42 and secure living environment; amending s. 429.41,
43 F.S.; removing provisions relating to firesafety
44 requirements; removing an obsolete provision;
45 requiring, rather than authorizing, the Agency for
46 Health Care Administration to use an abbreviated
47 biennial standard licensure inspection; revising the
48 criteria under which a facility must be fully
49 inspected; revising provisions requiring the agency to
50 develop key quality-of-care standards; creating s.
51 429.435, F.S.; revising uniform firesafety standards
52 for assisted living facilities, which are relocated to
53 this section; amending s. 429.52, F.S.; revising
54 provisions relating to facility staff training
55 requirements; requiring the Department of Elderly
56 Affairs to establish core training requirements for
57 facility administrators; revising the training and
58 continuing education requirements for facility staff
59 who assist residents with the self-administration of
60 medications; revising provisions relating to the
61 training responsibilities of the Department of Elderly
62 Affairs and the Agency for Health Care Administration;
63 requiring the Department of Elderly Affairs to
64 contract with another entity to administer the
65 competency test; requiring the department to adopt a
66 curriculum outline to be used by core trainers;
67 amending s. 429.07, F.S.; conforming a cross
68 reference; providing an effective date.
69
70 Be It Enacted by the Legislature of the State of Florida:
71
72 Section 1. Present subsections (6) through (27) of section
73 429.02, Florida Statutes, are redesignated as subsections (7)
74 through (28), respectively, present subsections (13), (18), and
75 (27) of that section are amended, and a new subsection (6) is
76 added to that section, to read:
77 429.02 Definitions.—When used in this part, the term:
78 (6) “Assistive device” means any device designed or adapted
79 to help a resident perform an action, a task, an activity of
80 daily living, or a transfer; prevent a fall; or recover from a
81 fall. The term does not include a total body lift or a motorized
82 sit-to-stand lift, with the exception of a chair lift or
83 recliner lift that a resident is able to operate independently.
84 (14)(13) “Limited nursing services” means acts that may be
85 performed by a person licensed under part I of chapter 464.
86 Limited nursing services shall be for persons who meet the
87 admission criteria established by the department for assisted
88 living facilities and shall not be complex enough to require 24
89 hour nursing supervision and may include such services as the
90 application and care of routine dressings, and care of casts,
91 braces, and splints.
92 (19)(18) “Physical restraint” means a device that which
93 physically limits, restricts, or deprives an individual of
94 movement or mobility, including, but not limited to, a half-bed
95 rail, a full-bed rail, a geriatric chair, and a posey restraint.
96 The term “physical restraint” shall also include any device that
97 is which was not specifically manufactured as a restraint but is
98 which has been altered, arranged, or otherwise used for that
99 this purpose. The term does shall not include any device that
100 the resident chooses to use and is able to remove or avoid
101 independently, or any bandage material used for the purpose of
102 binding a wound or injury.
103 (27) “Twenty-four-hour nursing supervision” means services
104 that are ordered by a physician for a resident whose condition
105 requires the supervision of a physician and continued monitoring
106 of vital signs and physical status. Such services shall be:
107 medically complex enough to require constant supervision,
108 assessment, planning, or intervention by a nurse; required to be
109 performed by or under the direct supervision of licensed nursing
110 personnel or other professional personnel for safe and effective
111 performance; required on a daily basis; and consistent with the
112 nature and severity of the resident’s condition or the disease
113 state or stage.
114 Section 2. Subsection (7) of section 429.11, Florida
115 Statutes, is amended to read:
116 429.11 Initial application for license; provisional
117 license.—
118 (7) A county or municipality may not issue a business tax
119 receipt an occupational license that is being obtained for the
120 purpose of operating a facility regulated under this part
121 without first ascertaining that the applicant has been licensed
122 to operate such facility at the specified location or locations
123 by the agency. The agency shall furnish to local agencies
124 responsible for issuing business tax receipts occupational
125 licenses sufficient instruction for making such determinations.
126 Section 3. Section 429.176, Florida Statutes, is amended to
127 read:
128 429.176 Notice of change of administrator.—If, during the
129 period for which a license is issued, the owner changes
130 administrators, the owner must notify the agency of the change
131 within 10 days and provide documentation within 90 days that the
132 new administrator meets educational requirements and has
133 completed the applicable core educational and core competency
134 test requirements under s. 429.52. A facility may not be
135 operated for more than 120 consecutive days without an
136 administrator who has completed the core training and core
137 competency test educational requirements.
138 Section 4. Subsections (3) through (9) of section 429.23,
139 Florida Statutes, are amended to read:
140 429.23 Internal risk management and quality assurance
141 program; adverse incidents and reporting requirements.—
142 (3) Licensed facilities shall initiate an investigation
143 provide within 24 hours after 1 business day after the
144 occurrence of an adverse incident, by electronic mail,
145 facsimile, or United States mail, a preliminary report to the
146 agency on all adverse incidents specified under this section.
147 The facility must complete the investigation and submit a report
148 to the agency within 15 days after the occurrence of the adverse
149 incident. The report must include information regarding the
150 identity of the affected resident, the type of adverse incident,
151 and the result status of the facility’s investigation of the
152 incident.
153 (4) Licensed facilities shall provide within 15 days, by
154 electronic mail, facsimile, or United States mail, a full report
155 to the agency on all adverse incidents specified in this
156 section. The report must include the results of the facility’s
157 investigation into the adverse incident.
158 (5) Each facility shall report monthly to the agency any
159 liability claim filed against it. The report must include the
160 name of the resident, the dates of the incident leading to the
161 claim, if applicable, and the type of injury or violation of
162 rights alleged to have occurred. This report is not discoverable
163 in any civil or administrative action, except in such actions
164 brought by the agency to enforce the provisions of this part.
165 (4)(6) Abuse, neglect, or exploitation must be reported to
166 the Department of Children and Families as required under
167 chapter 415.
168 (5)(7) The information reported to the agency pursuant to
169 subsection (3) which relates to persons licensed under chapter
170 458, chapter 459, chapter 461, chapter 464, or chapter 465 shall
171 be reviewed by the agency. The agency shall determine whether
172 any of the incidents potentially involved conduct by a health
173 care professional who is subject to disciplinary action, in
174 which case the provisions of s. 456.073 apply. The agency may
175 investigate, as it deems appropriate, any such incident and
176 prescribe measures that must or may be taken in response to the
177 incident. The agency shall review each incident and determine
178 whether it potentially involved conduct by a health care
179 professional who is subject to disciplinary action, in which
180 case the provisions of s. 456.073 apply.
181 (6)(8) If the agency, through its receipt of the adverse
182 incident report reports prescribed in this part or through any
183 investigation, has reasonable belief that conduct by a staff
184 member or employee of a licensed facility is grounds for
185 disciplinary action by the appropriate board, the agency shall
186 report this fact to such regulatory board.
187 (7)(9) The adverse incident report reports and preliminary
188 adverse incident reports required under this section is are
189 confidential as provided by law and are not discoverable or
190 admissible in any civil or administrative action, except in
191 disciplinary proceedings by the agency or appropriate regulatory
192 board.
193 Section 5. Paragraphs (a) and (b) of subsection (1) of
194 section 429.255, Florida Statutes, are amended, and paragraph
195 (d) is added to that subsection, to read:
196 429.255 Use of personnel; emergency care.—
197 (1)(a) Persons under contract to the facility, facility
198 staff, or volunteers, who are licensed according to part I of
199 chapter 464, or those persons exempt under s. 464.022(1), and
200 others as defined by rule, may administer medications to
201 residents, take residents’ vital signs, manage individual weekly
202 pill organizers for residents who self-administer medication,
203 give prepackaged enemas ordered by a physician, observe
204 residents, document observations on the appropriate resident’s
205 record, and report observations to the resident’s physician, and
206 contract or allow residents or a resident’s representative,
207 designee, surrogate, guardian, or attorney in fact to contract
208 with a third party, provided residents meet the criteria for
209 appropriate placement as defined in s. 429.26. Nursing
210 assistants certified pursuant to part II of chapter 464 may take
211 residents’ vital signs as directed by a licensed nurse or
212 physician.
213 (b) All staff of in facilities licensed under this part
214 shall exercise their professional responsibility to observe
215 residents, to document observations on the appropriate
216 resident’s record, and to report the observations to the
217 resident’s physician. However, the owner or administrator of the
218 facility shall be responsible for determining that the resident
219 receiving services is appropriate for residence in the facility.
220 (d) A resident or a resident’s representative, designee,
221 surrogate, guardian, or attorney in fact may contract for
222 services with a third party, provided the resident meets the
223 criteria for continued residency as provided in s. 429.26. The
224 third party must communicate with the facility regarding the
225 resident’s condition and the services being provided. The
226 facility must document that it received such communication.
227 Section 6. Subsection (2), paragraph (b) of subsection (3),
228 and paragraphs (e), (f), and (g) of subsection (4) of section
229 429.256, Florida Statutes, are amended to read:
230 429.256 Assistance with self-administration of medication.—
231 (2) Residents who are capable of self-administering their
232 own medications without assistance shall be encouraged and
233 allowed to do so. However, an unlicensed person may, consistent
234 with a dispensed prescription’s label or the package directions
235 of an over-the-counter medication, assist a resident whose
236 condition is medically stable with the self-administration of
237 routine, regularly scheduled medications that are intended to be
238 self-administered. Assistance with self-medication by an
239 unlicensed person may occur only upon a documented request by,
240 and the written informed consent of, a resident or the
241 resident’s surrogate, guardian, or attorney in fact. For the
242 purposes of this section, self-administered medications include
243 both legend and over-the-counter oral dosage forms, topical
244 dosage forms and topical skin, ophthalmic, otic, and nasal
245 dosage forms, including patches, solutions, suspensions, sprays,
246 and inhalers.
247 (3) Assistance with self-administration of medication
248 includes:
249 (b) In the presence of the resident, confirming that the
250 medication is intended for that resident, orally advising the
251 resident of the medication name and purpose reading the label,
252 opening the container, removing a prescribed amount of
253 medication from the container, and closing the container.
254 (4) Assistance with self-administration does not include:
255 (e) The use of irrigations or debriding agents used in the
256 treatment of a skin condition.
257 (f) Assisting with rectal, urethral, or vaginal
258 preparations.
259 (g) Assisting with medications ordered by the physician or
260 health care professional with prescriptive authority to be given
261 “as needed,” unless the order is written with specific
262 parameters that preclude independent judgment on the part of the
263 unlicensed person, and the at the request of a competent
264 resident requesting the medication is aware of his or her need
265 for the medication and understands the purpose of taking the
266 medication.
267 Section 7. Section 429.26, Florida Statutes, is amended to
268 read:
269 429.26 Appropriateness of placements; examinations of
270 residents.—
271 (1) The owner or administrator of a facility is responsible
272 for determining the appropriateness of admission of an
273 individual to the facility and for determining the continued
274 appropriateness of residence of an individual in the facility. A
275 determination must shall be based upon an evaluation assessment
276 of the strengths, needs, and preferences of the resident, a
277 medical examination, the care and services offered or arranged
278 for by the facility in accordance with facility policy, and any
279 limitations in law or rule related to admission criteria or
280 continued residency for the type of license held by the facility
281 under this part. The following criteria apply to the
282 determination of appropriateness for residency and continued
283 residency of an individual in a facility:
284 (a) A facility may admit or retain a resident who receives
285 a health care service or treatment that is designed to be
286 provided within a private residential setting if all
287 requirements for providing that service or treatment are met by
288 the facility or a third party.
289 (b) A facility may admit or retain a resident who requires
290 the use of assistive devices.
291 (c) A facility may admit or retain an individual receiving
292 hospice services if the arrangement is agreed to by the facility
293 and the resident, additional care is provided by a licensed
294 hospice, and the resident is under the care of a physician who
295 agrees that the physical needs of the resident can be met at the
296 facility. A facility may not retain a resident who requires 24
297 hour nursing supervision, except for a resident who is enrolled
298 in hospice services pursuant to part IV of chapter 400. The
299 resident must have a plan of care that delineates how the
300 facility and the hospice will meet the scheduled and unscheduled
301 needs of the resident.
302 (d)1. Except as provided in paragraph (c), a facility may
303 not admit or retain a resident who is bedridden. For purposes of
304 this paragraph, the term “bedridden” means that a resident is
305 confined to bed because of the inability to:
306 a. Move, turn, or reposition without total physical
307 assistance;
308 b. Transfer to a chair or wheelchair without total physical
309 assistance;
310 c. Sit safely in a chair or wheelchair without personal
311 assistance or a physical restraint.
312 2. A resident may continue to reside in a facility if,
313 during residency, he or she is bedridden for no more than 7
314 consecutive days.
315 3. If a facility is licensed to provide extended congregate
316 care, a resident may continue to reside in a facility if, during
317 residency, he or she is bedridden for no more than 14
318 consecutive days.
319 (2) A resident may not be moved from one facility to
320 another without consultation with and agreement from the
321 resident or, if applicable, the resident’s representative or
322 designee or the resident’s family, guardian, surrogate, or
323 attorney in fact. In the case of a resident who has been placed
324 by the department or the Department of Children and Families,
325 the administrator must notify the appropriate contact person in
326 the applicable department.
327 (3)(2) A physician, physician assistant, or advanced
328 practice registered nurse practitioner who is employed by an
329 assisted living facility to provide an initial examination for
330 admission purposes may not have financial interest in the
331 facility.
332 (4)(3) Persons licensed under part I of chapter 464 who are
333 employed by or under contract with a facility shall, on a
334 routine basis or at least monthly, perform a nursing assessment
335 of the residents for whom they are providing nursing services
336 ordered by a physician, except administration of medication, and
337 shall document such assessment, including any substantial
338 changes in a resident’s status which may necessitate relocation
339 to a nursing home, hospital, or specialized health care
340 facility. Such records shall be maintained in the facility for
341 inspection by the agency and shall be forwarded to the
342 resident’s case manager, if applicable.
343 (5)(4) If possible, Each resident must shall have been
344 examined by a licensed physician, a licensed physician
345 assistant, or a licensed advanced practice registered nurse
346 practitioner within 60 days before admission to the facility or
347 within 30 days after admission to the facility, except as
348 provided in s. 429.07. The information from the medical
349 examination must be recorded on the practitioner’s form or on a
350 form adopted by agency rule. The signed and completed medical
351 examination form, signed by the practitioner, must report shall
352 be submitted to the owner or administrator of the facility, who
353 shall use the information contained therein to assist in the
354 determination of the appropriateness of the resident’s admission
355 to or and continued stay in the facility. The medical
356 examination form becomes report shall become a permanent part of
357 the facility’s record of the resident at the facility and must
358 shall be made available to the agency during inspection or upon
359 request. An assessment that has been completed through the
360 Comprehensive Assessment and Review for Long-Term Care Services
361 (CARES) Program fulfills the requirements for a medical
362 examination under this subsection and s. 429.07(3)(b)6.
363 (6) The medical examination form submitted under subsection
364 (5) must include the following information relating to the
365 resident:
366 (a) Height, weight, and known allergies.
367 (b) Significant medical history and diagnoses.
368 (c) Physical or sensory limitations, including the need for
369 fall precautions or recommended use of assistive devices.
370 (d) Cognitive or behavioral status and a brief description
371 of any behavioral issues known or ascertained by the examining
372 practitioner, including any known history of wandering or
373 elopement.
374 (e) Nursing, treatment, or therapy service requirements.
375 (f) Whether assistance is needed for ambulating, eating,
376 and transferring.
377 (g) Special dietary instructions.
378 (h) Whether he or she has any communicable diseases,
379 including necessary precautions.
380 (i) Whether he or she is bedridden and the status of any
381 pressure sores that he or she has.
382 (j) Whether the resident needs 24-hour nursing or
383 psychiatric care.
384 (k) A list of current prescribed medications as known or
385 ascertained by the examining practitioner and whether the
386 resident can self-administer medications, needs assistance, or
387 needs medication administration.
388 (5) Except as provided in s. 429.07, if a medical
389 examination has not been completed within 60 days before the
390 admission of the resident to the facility, a licensed physician,
391 licensed physician assistant, or licensed nurse practitioner
392 shall examine the resident and complete a medical examination
393 form provided by the agency within 30 days following the
394 admission to the facility to enable the facility owner or
395 administrator to determine the appropriateness of the admission.
396 The medical examination form shall become a permanent part of
397 the record of the resident at the facility and shall be made
398 available to the agency during inspection by the agency or upon
399 request.
400 (7)(6) Any resident accepted in a facility and placed by
401 the department or the Department of Children and Families must
402 shall have been examined by medical personnel within 30 days
403 before placement in the facility. The examination must shall
404 include an assessment of the appropriateness of placement in a
405 facility. The findings of this examination must shall be
406 recorded on the examination form provided by the agency. The
407 completed form must shall accompany the resident and shall be
408 submitted to the facility owner or administrator. Additionally,
409 in the case of a mental health resident, the Department of
410 Children and Families must provide documentation that the
411 individual has been assessed by a psychiatrist, clinical
412 psychologist, clinical social worker, or psychiatric nurse, or
413 an individual who is supervised by one of these professionals,
414 and determined to be appropriate to reside in an assisted living
415 facility. The documentation must be in the facility within 30
416 days after the mental health resident has been admitted to the
417 facility. An evaluation completed upon discharge from a state
418 mental hospital meets the requirements of this subsection
419 related to appropriateness for placement as a mental health
420 resident providing it was completed within 90 days prior to
421 admission to the facility. The applicable Department of Children
422 and Families shall provide to the facility administrator any
423 information about the resident which that would help the
424 administrator meet his or her responsibilities under subsection
425 (1). Further, Department of Children and Families personnel
426 shall explain to the facility operator any special needs of the
427 resident and advise the operator whom to call should problems
428 arise. The applicable Department of Children and Families shall
429 advise and assist the facility administrator when where the
430 special needs of residents who are recipients of optional state
431 supplementation require such assistance.
432 (8)(7) The facility shall must notify a licensed physician
433 in writing when a resident exhibits signs of dementia or
434 cognitive impairment or has a change of condition in order to
435 rule out the presence of an underlying physiological condition
436 that may be contributing to such dementia or impairment. The
437 notification must occur within 30 days after the acknowledgment
438 of such signs by facility staff. If an underlying condition is
439 determined to exist, the facility must notify the resident’s
440 representative or designee in writing of the need for health
441 care services and must assist in making appointments for shall
442 arrange, with the appropriate health care provider, the
443 necessary care and services to treat the condition.
444 (9)(8) The Department of Children and Families may require
445 an examination for supplemental security income and optional
446 state supplementation recipients residing in facilities at any
447 time and shall provide the examination whenever a resident’s
448 condition requires it. Any facility administrator; personnel of
449 the agency, the department, or the Department of Children and
450 Families; or a representative of the State Long-Term Care
451 Ombudsman Program who believes a resident needs to be evaluated
452 shall notify the resident’s case manager, who shall take
453 appropriate action. A report of the examination findings must
454 shall be provided to the resident’s case manager and the
455 facility administrator to help the administrator meet his or her
456 responsibilities under subsection (1).
457 (9) A terminally ill resident who no longer meets the
458 criteria for continued residency may remain in the facility if
459 the arrangement is mutually agreeable to the resident and the
460 facility; additional care is rendered through a licensed
461 hospice, and the resident is under the care of a physician who
462 agrees that the physical needs of the resident are being met.
463 (10) Facilities licensed to provide extended congregate
464 care services shall promote aging in place by determining
465 appropriateness of continued residency based on a comprehensive
466 review of the resident’s physical and functional status; the
467 ability of the facility, family members, friends, or any other
468 pertinent individuals or agencies to provide the care and
469 services required; and documentation that a written service plan
470 consistent with facility policy has been developed and
471 implemented to ensure that the resident’s needs and preferences
472 are addressed.
473 (11) No resident who requires 24-hour nursing supervision,
474 except for a resident who is an enrolled hospice patient
475 pursuant to part IV of chapter 400, shall be retained in a
476 facility licensed under this part.
477 Section 8. Paragraphs (a) and (k) of subsection (1) and
478 subsection (3) of section 429.28, Florida Statutes, are amended
479 to read:
480 429.28 Resident bill of rights.—
481 (1) No resident of a facility shall be deprived of any
482 civil or legal rights, benefits, or privileges guaranteed by
483 law, the Constitution of the State of Florida, or the
484 Constitution of the United States as a resident of a facility.
485 Every resident of a facility shall have the right to:
486 (a) Live in a safe and decent living environment, free from
487 abuse, exploitation, and neglect.
488 (k) At least 45 days’ notice of relocation or termination
489 of residency from the facility unless, for medical reasons, the
490 resident is certified by a physician to require an emergency
491 relocation to a facility providing a more skilled level of care
492 or the resident engages in a pattern of conduct that is harmful
493 or offensive to other residents. In the case of a resident who
494 has been adjudicated mentally incapacitated, the guardian shall
495 be given at least 45 days’ notice of a nonemergency relocation
496 or residency termination. Reasons for relocation must shall be
497 set forth in writing and provided to the resident or the
498 resident’s legal representative. The written notice must contain
499 the following disclosure in 12-point uppercase type:
500 THE STATE LONG-TERM CARE OMBUDSMAN PROGRAM PROVIDES
501 SERVICES THAT ASSIST IN PROTECTING THE HEALTH, SAFETY,
502 WELFARE, AND RIGHTS OF RESIDENTS. FOR ASSISTANCE,
503 CONTACT THE OMBUDSMAN PROGRAM TOLL-FREE AT 1-888-831
504 0404 OR VIA E-MAIL AT LTCOPInformer@elderaffairs.org.
505 In order for a facility to terminate the residency of an
506 individual without notice as provided herein, the facility shall
507 show good cause in a court of competent jurisdiction.
508 (3)(a) The agency shall conduct a survey to determine
509 general compliance with facility standards and compliance with
510 residents’ rights as a prerequisite to initial licensure or
511 licensure renewal. The agency shall adopt rules for uniform
512 standards and criteria that will be used to determine compliance
513 with facility standards and compliance with residents’ rights.
514 (b) In order to determine whether the facility is
515 adequately protecting residents’ rights, the licensure renewal
516 biennial survey must shall include private informal
517 conversations with a sample of residents and consultation with
518 the ombudsman council in the district in which the facility is
519 located to discuss residents’ experiences within the facility.
520 Section 9. Section 429.41, Florida Statutes, is amended to
521 read:
522 429.41 Rules establishing standards.—
523 (1) It is the intent of the Legislature that rules
524 published and enforced pursuant to this section shall include
525 criteria by which a reasonable and consistent quality of
526 resident care and quality of life may be ensured and the results
527 of such resident care may be demonstrated. Such rules shall also
528 promote ensure a safe and sanitary environment that is
529 residential and noninstitutional in design or nature and may
530 allow for technological advances in the provision of care,
531 safety, and security, including the use of devices, equipment
532 and other security measures related to wander management,
533 emergency response, staff risk management, and the general
534 safety and security of residents, staff, and the facility. It is
535 further intended that reasonable efforts be made to accommodate
536 the needs and preferences of residents to enhance the quality of
537 life in a facility. Uniform firesafety standards for assisted
538 living facilities shall be established by the State Fire Marshal
539 pursuant to s. 633.206. The agency, in consultation with the
540 department, may adopt rules to administer the requirements of
541 part II of chapter 408. In order to provide safe and sanitary
542 facilities and the highest quality of resident care
543 accommodating the needs and preferences of residents, The
544 department, in consultation with the agency, the Department of
545 Children and Families, and the Department of Health, shall adopt
546 rules, policies, and procedures to administer this part, which
547 must include reasonable and fair minimum standards in relation
548 to:
549 (a) The requirements for and maintenance and the sanitary
550 condition of facilities, not in conflict with, or duplicative
551 of, the requirements in chapter 553 or chapter 381, relating to
552 furnishings for resident bedrooms or sleeping areas, locking
553 devices, linens, laundry services plumbing, heating, cooling,
554 lighting, ventilation, living space, and similar physical plant
555 standards other housing conditions, which will promote ensure
556 the health, safety, and welfare comfort of residents suitable to
557 the size of the structure. The rules must clearly delineate the
558 respective responsibilities of the agency’s licensure and survey
559 staff and the county health departments and ensure that
560 inspections are not duplicative. The agency may collect fees for
561 food service inspections conducted by county health departments
562 and may transfer such fees to the Department of Health.
563 1. Firesafety evacuation capability determination.—An
564 evacuation capability evaluation for initial licensure shall be
565 conducted within 6 months after the date of licensure.
566 2. Firesafety requirements.—
567 a. The National Fire Protection Association, Life Safety
568 Code, NFPA 101 and 101A, current editions, shall be used in
569 determining the uniform firesafety code adopted by the State
570 Fire Marshal for assisted living facilities, pursuant to s.
571 633.206.
572 b. A local government or a utility may charge fees only in
573 an amount not to exceed the actual expenses incurred by the
574 local government or the utility relating to the installation and
575 maintenance of an automatic fire sprinkler system in a licensed
576 assisted living facility structure.
577 c. All licensed facilities must have an annual fire
578 inspection conducted by the local fire marshal or authority
579 having jurisdiction.
580 d. An assisted living facility that is issued a building
581 permit or certificate of occupancy before July 1, 2016, may at
582 its option and after notifying the authority having
583 jurisdiction, remain under the provisions of the 1994 and 1995
584 editions of the National Fire Protection Association, Life
585 Safety Code, NFPA 101, and NFPA 101A. The facility opting to
586 remain under such provisions may make repairs, modernizations,
587 renovations, or additions to, or rehabilitate, the facility in
588 compliance with NFPA 101, 1994 edition, and may utilize the
589 alternative approaches to life safety in compliance with NFPA
590 101A, 1995 edition. However, a facility for which a building
591 permit or certificate of occupancy is issued before July 1,
592 2016, that undergoes Level III building alteration or
593 rehabilitation, as defined in the Florida Building Code, or
594 seeks to utilize features not authorized under the 1994 or 1995
595 editions of the Life Safety Code must thereafter comply with all
596 aspects of the uniform firesafety standards established under s.
597 633.206, and the Florida Fire Prevention Code, in effect for
598 assisted living facilities as adopted by the State Fire Marshal.
599 3. Resident elopement requirements.—Facilities are required
600 to conduct a minimum of two resident elopement prevention and
601 response drills per year. All administrators and direct care
602 staff must participate in the drills which shall include a
603 review of procedures to address resident elopement. Facilities
604 must document the implementation of the drills and ensure that
605 the drills are conducted in a manner consistent with the
606 facility’s resident elopement policies and procedures.
607 (b) The preparation and annual update of a comprehensive
608 emergency management plan. Such standards must be included in
609 the rules adopted by the department after consultation with the
610 Division of Emergency Management. At a minimum, the rules must
611 provide for plan components that address emergency evacuation
612 transportation; adequate sheltering arrangements; postdisaster
613 activities, including provision of emergency power, food, and
614 water; postdisaster transportation; supplies; staffing;
615 emergency equipment; individual identification of residents and
616 transfer of records; communication with families; and responses
617 to family inquiries. The comprehensive emergency management plan
618 is subject to review and approval by the local emergency
619 management agency. During its review, the local emergency
620 management agency shall ensure that the following agencies, at a
621 minimum, are given the opportunity to review the plan: the
622 Department of Elderly Affairs, the Department of Health, the
623 Agency for Health Care Administration, and the Division of
624 Emergency Management. Also, appropriate volunteer organizations
625 must be given the opportunity to review the plan. The local
626 emergency management agency shall complete its review within 60
627 days and either approve the plan or advise the facility of
628 necessary revisions.
629 (c) The number, training, and qualifications of all
630 personnel having responsibility for the care of residents. The
631 rules must require adequate staff to provide for the safety of
632 all residents. Facilities licensed for 17 or more residents are
633 required to maintain an alert staff for 24 hours per day.
634 (d) All sanitary conditions within the facility and its
635 surroundings which will ensure the health and comfort of
636 residents. The rules must clearly delineate the responsibilities
637 of the agency’s licensure and survey staff, the county health
638 departments, and the local authority having jurisdiction over
639 firesafety and ensure that inspections are not duplicative. The
640 agency may collect fees for food service inspections conducted
641 by the county health departments and transfer such fees to the
642 Department of Health.
643 (d)(e) License application and license renewal, transfer of
644 ownership, proper management of resident funds and personal
645 property, surety bonds, resident contracts, refund policies,
646 financial ability to operate, and facility and staff records.
647 (e)(f) Inspections, complaint investigations, moratoriums,
648 classification of deficiencies, levying and enforcement of
649 penalties, and use of income from fees and fines.
650 (f)(g) The enforcement of the resident bill of rights
651 specified in s. 429.28.
652 (g)(h) The care and maintenance of residents provided by
653 the facility, which must include, but is not limited to:
654 1. The supervision of residents;
655 2. The provision of personal services;
656 3. The provision of, or arrangement for, social and leisure
657 activities;
658 4. The assistance in making arrangements arrangement for
659 appointments and transportation to appropriate medical, dental,
660 nursing, or mental health services, as needed by residents;
661 5. The management of medication stored within the facility
662 and as needed by residents;
663 6. The dietary nutritional needs of residents;
664 7. Resident records; and
665 8. Internal risk management and quality assurance; and
666 9. The requirements for using medical diagnostic testing
667 equipment that is designed for a residential setting and is used
668 at the point of care delivery, including equipment to test
669 cholesterol, blood glucose level, and blood pressure.
670 (h)(i) Facilities holding a limited nursing, extended
671 congregate care, or limited mental health license.
672 (i)(j) The establishment of specific criteria to define
673 appropriateness of resident admission and continued residency in
674 a facility holding a standard, limited nursing, extended
675 congregate care, and limited mental health license.
676 (j)(k) The use of physical or chemical restraints. The use
677 of geriatric chairs or posey restraints is prohibited. Other
678 physical restraints may be used in accordance with agency rules
679 when ordered is limited to half-bed rails as prescribed and
680 documented by the resident’s physician and consented to by with
681 the consent of the resident or, if applicable, the resident’s
682 representative or designee or the resident’s surrogate,
683 guardian, or attorney in fact. Such rules must specify
684 requirements for care planning, staff monitoring, and periodic
685 review. The use of chemical restraints is limited to prescribed
686 dosages of medications authorized by the resident’s physician
687 and must be consistent with the resident’s diagnosis. Residents
688 who are receiving medications that can serve as chemical
689 restraints must be evaluated by their physician at least
690 annually to assess:
691 1. The continued need for the medication.
692 2. The level of the medication in the resident’s blood.
693 3. The need for adjustments in the prescription.
694 (k)(l) The establishment of specific resident elopement
695 drill requirements policies and procedures on resident
696 elopement. Facilities shall conduct a minimum of two resident
697 elopement drills each year. All administrators and direct care
698 staff shall participate in the drills, which must include a
699 review of the facility’s procedures to address resident
700 elopement. Facilities shall document participation in the
701 drills.
702 (2) In adopting any rules pursuant to this part, the
703 department, in conjunction with the agency, shall make distinct
704 standards for facilities based upon facility size; the types of
705 care provided; the physical and mental capabilities and needs of
706 residents; the type, frequency, and amount of services and care
707 offered; and the staffing characteristics of the facility. Rules
708 developed pursuant to this section may not restrict the use of
709 shared staffing and shared programming in facilities that are
710 part of retirement communities that provide multiple levels of
711 care and otherwise meet the requirements of law and rule. If a
712 continuing care facility licensed under chapter 651 or a
713 retirement community offering multiple levels of care licenses a
714 building or part of a building designated for independent living
715 for assisted living, staffing requirements established in rule
716 apply only to residents who receive personal, limited nursing,
717 or extended congregate care services under this part. Such
718 facilities shall retain a log listing the names and unit number
719 for residents receiving these services. The log must be
720 available to surveyors upon request. Except for uniform
721 firesafety standards, The department shall adopt by rule
722 separate and distinct standards for facilities with 16 or fewer
723 beds and for facilities with 17 or more beds. The standards for
724 facilities with 16 or fewer beds must be appropriate for a
725 noninstitutional residential environment; however, the structure
726 may not be more than two stories in height and all persons who
727 cannot exit the facility unassisted in an emergency must reside
728 on the first floor. The department, in conjunction with the
729 agency, may make other distinctions among types of facilities as
730 necessary to enforce this part. Where appropriate, the agency
731 shall offer alternate solutions for complying with established
732 standards, based on distinctions made by the department and the
733 agency relative to the physical characteristics of facilities
734 and the types of care offered.
735 (3) The department shall submit a copy of proposed rules to
736 the Speaker of the House of Representatives, the President of
737 the Senate, and appropriate committees of substance for review
738 and comment prior to the promulgation thereof. Rules promulgated
739 by the department must shall encourage the development of
740 homelike facilities which promote the dignity, individuality,
741 personal strengths, and decisionmaking ability of residents.
742 (4) The agency, in consultation with the department, may
743 waive rules promulgated pursuant to this part in order to
744 demonstrate and evaluate innovative or cost-effective congregate
745 care alternatives which enable individuals to age in place. Such
746 waivers may be granted only in instances where there is
747 reasonable assurance that the health, safety, or welfare of
748 residents will not be endangered. To apply for a waiver, the
749 licensee shall submit to the agency a written description of the
750 concept to be demonstrated, including goals, objectives, and
751 anticipated benefits; the number and types of residents who will
752 be affected, if applicable; a brief description of how the
753 demonstration will be evaluated; and any other information
754 deemed appropriate by the agency. Any facility granted a waiver
755 shall submit a report of findings to the agency and the
756 department within 12 months. At such time, the agency may renew
757 or revoke the waiver or pursue any regulatory or statutory
758 changes necessary to allow other facilities to adopt the same
759 practices. The department may by rule clarify terms and
760 establish waiver application procedures, criteria for reviewing
761 waiver proposals, and procedures for reporting findings, as
762 necessary to implement this subsection.
763 (5) The agency may use an abbreviated biennial standard
764 licensure inspection that consists of a review of key quality
765 of-care standards in lieu of a full inspection in a facility
766 that has a good record of past performance. However, a full
767 inspection must be conducted in a facility that has a history of
768 class I or class II violations, uncorrected class III
769 violations, or a violation resulting from a complaint referred
770 by the State Long-Term Care Ombudsman Program to a regulatory
771 agency confirmed ombudsman council complaints, or confirmed
772 licensure complaints, within the previous licensure period
773 immediately preceding the inspection or if a potentially serious
774 problem is identified during the abbreviated inspection. The
775 agency, in consultation with the department, shall adopt by rule
776 develop the key quality-of-care standards with input from the
777 State Long-Term Care Ombudsman Council and representatives of
778 provider groups for incorporation into its rules.
779 Section 10. Section 429.435, Florida Statutes, is created
780 to read:
781 429.435 Uniform firesafety standards.-Uniform firesafety
782 standards for assisted living facilities and a residential board
783 and care occupancy shall be established by the State Fire
784 Marshal pursuant to s. 633.206.
785 (1) EVACUATION CAPABILITY.—A firesafety evacuation
786 capability determination shall be conducted within 6 months
787 after the date of initial licensure, if required.
788 (2) FIRESAFETY REQUIREMENTS.—
789 (a) The National Fire Protection Association, Life Safety
790 Code, NFPA 101 and 101A, current editions, must be used in
791 determining the uniform firesafety code adopted by the State
792 Fire Marshal for assisted living facilities, pursuant to s.
793 633.206.
794 (b) A local government or a utility may charge fees that do
795 not exceed the actual costs incurred by the local government or
796 the utility for the installation and maintenance of an automatic
797 fire sprinkler system in a licensed assisted living facility
798 structure.
799 (c) All licensed facilities must have an annual fire
800 inspection conducted by the local fire marshal or authority
801 having jurisdiction.
802 (d) An assisted living facility that was issued a building
803 permit or certificate of occupancy before July 1, 2016, at its
804 option and after notifying the authority having jurisdiction,
805 may remain under the provisions of the 1994 and 1995 editions of
806 the National Fire Protection Association, Life Safety Code, NFPA
807 101 and 101A. A facility opting to remain under such provisions
808 may make repairs, modernizations, renovations, or additions to,
809 or rehabilitate, the facility in compliance with NFPA 101, 1994
810 edition, and may utilize the alternative approaches to life
811 safety in compliance with NFPA 101A, 1995 edition. However, a
812 facility for which a building permit or certificate of occupancy
813 was issued before July 1, 2016, which undergoes Level III
814 building alteration or rehabilitation, as defined in the Florida
815 Building Code, or which seeks to utilize features not authorized
816 under the 1994 or 1995 editions of the Life Safety Code shall
817 thereafter comply with all aspects of the uniform firesafety
818 standards established under s. 633.206, and the Florida Fire
819 Prevention Code, in effect for assisted living facilities as
820 adopted by the State Fire Marshal.
821 Section 11. Section 429.52, Florida Statutes, is amended to
822 read:
823 429.52 Staff training and educational requirements
824 programs; core educational requirement.—
825 (1) Effective October 1, 2015, Each new assisted living
826 facility employee who has not previously completed core training
827 must attend a preservice orientation provided by the facility
828 before interacting with residents. The preservice orientation
829 must be at least 2 hours in duration and cover topics that help
830 the employee provide responsible care and respond to the needs
831 of facility residents. Upon completion, the employee and the
832 administrator of the facility must sign a statement that the
833 employee completed the required preservice orientation. The
834 facility must keep the signed statement in the employee’s
835 personnel record.
836 (2) Administrators and other assisted living facility staff
837 must meet minimum training and education requirements
838 established by the Department of Elderly Affairs by rule. This
839 training and education is intended to assist facilities to
840 appropriately respond to the needs of residents, to maintain
841 resident care and facility standards, and to meet licensure
842 requirements.
843 (3) The department shall establish core training
844 requirements for administrators consisting of core training
845 learning objectives, a competency test, and a minimum required
846 score to indicate successful passage completion of the core
847 competency test training and educational requirements. The
848 competency test must be developed by the department in
849 conjunction with the agency and providers. The required core
850 competency test training and education must cover at least the
851 following topics:
852 (a) State law and rules relating to assisted living
853 facilities.
854 (b) Resident rights and identifying and reporting abuse,
855 neglect, and exploitation.
856 (c) Special needs of elderly persons, persons with mental
857 illness, and persons with developmental disabilities and how to
858 meet those needs.
859 (d) Nutrition and food service, including acceptable
860 sanitation practices for preparing, storing, and serving food.
861 (e) Medication management, recordkeeping, and proper
862 techniques for assisting residents with self-administered
863 medication.
864 (f) Firesafety requirements, including fire evacuation
865 drill procedures and other emergency procedures.
866 (g) Care of persons with Alzheimer’s disease and related
867 disorders.
868 (4) A new facility administrator must complete the required
869 core training and education, including the competency test,
870 within 90 days after the date of employment as an administrator.
871 Failure to do so is a violation of this part and subjects the
872 violator to an administrative fine as prescribed in s. 429.19.
873 Administrators licensed in accordance with part II of chapter
874 468 are exempt from this requirement. Other licensed
875 professionals may be exempted, as determined by the department
876 by rule.
877 (5) Administrators are required to participate in
878 continuing education for a minimum of 12 contact hours every 2
879 years.
880 (6) Staff involved with the management of medications and
881 assisting with the self-administration of medications under s.
882 429.256 must complete a minimum of 6 additional hours of
883 training provided by a registered nurse, or a licensed
884 pharmacist, before providing assistance or department staff. Two
885 hours of continuing education is required annually thereafter.
886 The department shall establish by rule the minimum requirements
887 of this additional training.
888 (7) Other Facility staff shall participate in in-service
889 training relevant to their job duties as specified by department
890 rule of the department. Topics covered during the preservice
891 orientation are not required to be repeated during in-service
892 training. A single certificate of completion that covers all
893 required in-service training topics may be issued to a
894 participating staff member if the training is provided in a
895 single training course.
896 (8) If the department or the agency determines that there
897 are problems in a facility that could be reduced through
898 specific staff training or education beyond that already
899 required under this section, the department or the agency may
900 require, and provide, or cause to be provided, the training or
901 education of any personal care staff in the facility.
902 (9) The department shall adopt rules related to these
903 training and education requirements, the competency test,
904 necessary procedures, and competency test fees and shall adopt
905 or contract with another entity to develop and administer the
906 competency test. The department shall adopt a curriculum outline
907 with learning objectives to be used by core trainers, which
908 shall be used as the minimum core training content requirements.
909 The department shall consult with representatives of stakeholder
910 associations and agencies in the development of the curriculum
911 outline.
912 (10) The core training required by this section other than
913 the preservice orientation must be conducted by persons
914 registered with the department as having the requisite
915 experience and credentials to conduct the training. A person
916 seeking to register as a core trainer must provide the
917 department with proof of completion of the minimum core training
918 education requirements, successful passage of the competency
919 test established under this section, and proof of compliance
920 with the continuing education requirement in subsection (5).
921 (11) A person seeking to register as a core trainer also
922 must also:
923 (a) Provide proof of completion of a 4-year degree from an
924 accredited college or university and must have worked in a
925 management position in an assisted living facility for 3 years
926 after being core certified;
927 (b) Have worked in a management position in an assisted
928 living facility for 5 years after being core certified and have
929 1 year of teaching experience as an educator or staff trainer
930 for persons who work in assisted living facilities or other
931 long-term care settings;
932 (c) Have been previously employed as a core trainer for the
933 department; or
934 (d) Meet other qualification criteria as defined in rule,
935 which the department is authorized to adopt.
936 (12) The department shall adopt rules to establish core
937 trainer registration and removal requirements.
938 Section 12. Paragraph (b) of subsection (3) of section
939 429.07, Florida Statutes, is amended to read
940 429.07 License required; fee.—
941 (3) In addition to the requirements of s. 408.806, each
942 license granted by the agency must state the type of care for
943 which the license is granted. Licenses shall be issued for one
944 or more of the following categories of care: standard, extended
945 congregate care, limited nursing services, or limited mental
946 health.
947 (b) An extended congregate care license shall be issued to
948 each facility that has been licensed as an assisted living
949 facility for 2 or more years and that provides services,
950 directly or through contract, beyond those authorized in
951 paragraph (a), including services performed by persons licensed
952 under part I of chapter 464 and supportive services, as defined
953 by rule, to persons who would otherwise be disqualified from
954 continued residence in a facility licensed under this part. An
955 extended congregate care license may be issued to a facility
956 that has a provisional extended congregate care license and
957 meets the requirements for licensure under subparagraph 2. The
958 primary purpose of extended congregate care services is to allow
959 residents the option of remaining in a familiar setting from
960 which they would otherwise be disqualified for continued
961 residency as they become more impaired. A facility licensed to
962 provide extended congregate care services may also admit an
963 individual who exceeds the admission criteria for a facility
964 with a standard license, if he or she is determined appropriate
965 for admission to the extended congregate care facility.
966 1. In order for extended congregate care services to be
967 provided, the agency must first determine that all requirements
968 established in law and rule are met and must specifically
969 designate, on the facility’s license, that such services may be
970 provided and whether the designation applies to all or part of
971 the facility. This designation may be made at the time of
972 initial licensure or relicensure, or upon request in writing by
973 a licensee under this part and part II of chapter 408. The
974 notification of approval or the denial of the request shall be
975 made in accordance with part II of chapter 408. Each existing
976 facility that qualifies to provide extended congregate care
977 services must have maintained a standard license and may not
978 have been subject to administrative sanctions during the
979 previous 2 years, or since initial licensure if the facility has
980 been licensed for less than 2 years, for any of the following
981 reasons:
982 a. A class I or class II violation;
983 b. Three or more repeat or recurring class III violations
984 of identical or similar resident care standards from which a
985 pattern of noncompliance is found by the agency;
986 c. Three or more class III violations that were not
987 corrected in accordance with the corrective action plan approved
988 by the agency;
989 d. Violation of resident care standards which results in
990 requiring the facility to employ the services of a consultant
991 pharmacist or consultant dietitian;
992 e. Denial, suspension, or revocation of a license for
993 another facility licensed under this part in which the applicant
994 for an extended congregate care license has at least 25 percent
995 ownership interest; or
996 f. Imposition of a moratorium pursuant to this part or part
997 II of chapter 408 or initiation of injunctive proceedings.
998
999 The agency may deny or revoke a facility’s extended congregate
1000 care license for not meeting the criteria for an extended
1001 congregate care license as provided in this subparagraph.
1002 2. If an assisted living facility has been licensed for
1003 less than 2 years, the initial extended congregate care license
1004 must be provisional and may not exceed 6 months. The licensee
1005 shall notify the agency, in writing, when it has admitted at
1006 least one extended congregate care resident, after which an
1007 unannounced inspection shall be made to determine compliance
1008 with the requirements of an extended congregate care license. A
1009 licensee with a provisional extended congregate care license
1010 that demonstrates compliance with all the requirements of an
1011 extended congregate care license during the inspection shall be
1012 issued an extended congregate care license. In addition to
1013 sanctions authorized under this part, if violations are found
1014 during the inspection and the licensee fails to demonstrate
1015 compliance with all assisted living facility requirements during
1016 a followup inspection, the licensee shall immediately suspend
1017 extended congregate care services, and the provisional extended
1018 congregate care license expires. The agency may extend the
1019 provisional license for not more than 1 month in order to
1020 complete a followup visit.
1021 3. A facility that is licensed to provide extended
1022 congregate care services shall maintain a written progress
1023 report on each person who receives services which describes the
1024 type, amount, duration, scope, and outcome of services that are
1025 rendered and the general status of the resident’s health. A
1026 registered nurse, or appropriate designee, representing the
1027 agency shall visit the facility at least twice a year to monitor
1028 residents who are receiving extended congregate care services
1029 and to determine if the facility is in compliance with this
1030 part, part II of chapter 408, and relevant rules. One of the
1031 visits may be in conjunction with the regular survey. The
1032 monitoring visits may be provided through contractual
1033 arrangements with appropriate community agencies. A registered
1034 nurse shall serve as part of the team that inspects the
1035 facility. The agency may waive one of the required yearly
1036 monitoring visits for a facility that has:
1037 a. Held an extended congregate care license for at least 24
1038 months;
1039 b. No class I or class II violations and no uncorrected
1040 class III violations; and
1041 c. No ombudsman council complaints that resulted in a
1042 citation for licensure.
1043 4. A facility that is licensed to provide extended
1044 congregate care services must:
1045 a. Demonstrate the capability to meet unanticipated
1046 resident service needs.
1047 b. Offer a physical environment that promotes a homelike
1048 setting, provides for resident privacy, promotes resident
1049 independence, and allows sufficient congregate space as defined
1050 by rule.
1051 c. Have sufficient staff available, taking into account the
1052 physical plant and firesafety features of the building, to
1053 assist with the evacuation of residents in an emergency.
1054 d. Adopt and follow policies and procedures that maximize
1055 resident independence, dignity, choice, and decisionmaking to
1056 permit residents to age in place, so that moves due to changes
1057 in functional status are minimized or avoided.
1058 e. Allow residents or, if applicable, a resident’s
1059 representative, designee, surrogate, guardian, or attorney in
1060 fact to make a variety of personal choices, participate in
1061 developing service plans, and share responsibility in
1062 decisionmaking.
1063 f. Implement the concept of managed risk.
1064 g. Provide, directly or through contract, the services of a
1065 person licensed under part I of chapter 464.
1066 h. In addition to the training mandated in s. 429.52,
1067 provide specialized training as defined by rule for facility
1068 staff.
1069 5. A facility that is licensed to provide extended
1070 congregate care services is exempt from the criteria for
1071 continued residency set forth in rules adopted under s. 429.41.
1072 A licensed facility must adopt its own requirements within
1073 guidelines for continued residency set forth by rule. However,
1074 the facility may not serve residents who require 24-hour nursing
1075 supervision. A licensed facility that provides extended
1076 congregate care services must also provide each resident with a
1077 written copy of facility policies governing admission and
1078 retention.
1079 6. Before the admission of an individual to a facility
1080 licensed to provide extended congregate care services, the
1081 individual must undergo a medical examination as provided in s.
1082 429.26(5) s. 429.26(4) and the facility must develop a
1083 preliminary service plan for the individual.
1084 7. If a facility can no longer provide or arrange for
1085 services in accordance with the resident’s service plan and
1086 needs and the facility’s policy, the facility must make
1087 arrangements for relocating the person in accordance with s.
1088 429.28(1)(k).
1089 Section 13. This act shall take effect July 1, 2019.