Assisted Living Facility Resource Manual

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1 Assisted Living Facility Resource Manual August 2015

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3 Assisted Living Facility Resource Manual August 2015 Table of Contents Survey Process... 1 ALF Resident Centered Survey Process... 1 LNS & ECC Monitoring ALF Survey Task Tool Forms Naming Conventions Dining & Food Service Review, , Rev Oct Employee Review, , Rev Oct Facility & Financial Record Review, , Rev Oct Family Interview, , Rev Oct Medication Review, , Rev Oct Resident Interview, , Rev Oct Resident Review, , Rev Oct Resident Sample Matrix, , Rev Oct Staff Interview, , Rev Oct Specialty License Review for ECC, , Rev Oct Specialty License Review for LMH, , Rev Oct Specialty License Review for LNS, , Rev Oct Surveyor Notes, , Rev Oct

4 Regulations Tag Summary ASPEN Regulation Set, version A State Classification Matrix Using Aspen Scope/Severity Grid, rev. May Section , Florida Statutes Complaint Manual Immediate Jeopardy and Appendix Q Tool Immediate Jeopardy Supplemental Protocol Appendix Q Tool Protocols Initial Comments Protocol QA Audit Protocol Attachment A QA Audit Tool Attachment B Complaint Review Tool Attachment C Survey Corrective Action Plan Directed Plan of Correction Protocol Photographic Evidence Protocol (with CamScanner Instructions) Tools Bed Bugs Best Management Practices (Florida Bed Bug Work Group June 2013)

5 Survey Process 1

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7 Assisted Living Facility Resident Centered Survey Process ASSISTED LIVING SURVEY PROCESS I. OVERVIEW The Agency s mission of better health care for all Floridians includes and recognizes the need for all stakeholders of assisted living to collaborate toward a common goal of ensuring quality services to residents who live in licensed assisted living facilities in Florida. While each facility must comply with all regulatory requirements, the survey will focus on identified core requirements that produce outcomes for residents served in assisted living facilities. An outcome survey focuses on the quality of life and care provided by assisted living facilities. The survey process promotes input from residents, family members/representatives, and staff to evaluate outcomes. Core areas of the regulations are identified based on their potential to affect resident outcomes. Key regulations from each core area have been identified for each provider type. These are regulations that have the highest potential to affect outcomes related to quality of life and quality of care. Core Areas RESIDENT RIGHTS RESIDENT CARE & SERVICES NUTRITION AND FOOD SERVICE PHYSICAL ENVIRONMENT AND SAFETY STAFF TRAINING MEDICATION MANAGEMENT The goal of the survey process is to ensure the health, safety, and welfare of persons receiving services in assisted living facilities. The intent of the survey process is to effectively and efficiently identify deficient practices that result in potential or actual negative resident outcomes, without review of every code. However, the process allows flexibility to expand the survey when needed. The survey process was developed to focus the surveyor s attention on outcomes. As part of this process, an abbreviated survey was created for providers demonstrating a history of substantial compliance as defined by Section (5), FS. Whenever a facility qualifies, the abbreviated survey will be used by surveyors to determine compliance with the regulations. Revised July 31, 2015 Page 1 AHCA ALF Resource Manual Aug

8 The assisted living survey process includes five types of surveys; each designed to review providers compliance with relevant codes. The five types of surveys are initial, standard, abbreviated, complaint and follow-up. Except for initial surveys, all surveys are unannounced. Providers who do not meet the criteria for an abbreviated or initial survey will have a standard survey. If the surveyor identifies a concern in any regulatory area, the survey process may be expanded. Additional information will be gathered to clarify concerns and to determine if the facility is in compliance. II. PRINCIPLE FOCUS OF THE ASSISTED LIVING SURVEY PROCESS The principle focus of any survey is the resident s quality of life and care outcomes. Review of the core areas determines if: residents rights are protected; care and services are provided to residents in accordance with their needs and preferences; residents are appropriately placed for ALF services residents nutritional needs and preferences are met; a safe and homelike environment is maintained; staff have the capacity and training to perform their assigned job duties; and an effective medication system in compliance with the regulation exists. The primary methods of information gathering are observation and interview. Record reviews may occur after completion of observations and interviews to confirm or resolve specific compliance issues or concerns. III. ASSISTED LIVING SURVEY PROCESS TYPES A. INITIAL SURVEY PROCESS An initial survey is used for the issuance of a new license with a strong emphasis on the provision of technical assistance to the new provider. The prospective ALF provider must submit an application to the licensure unit to begin the process. Once the application is reviewed and the provider is ready for survey, the Assisted Living Unit will notify the field office to schedule a survey. The field office will contact the provider directly and schedule the survey. Minimal staff will be available for an initial survey since no residents will have been admitted to the facility prior to licensure. At a minimum, the facility must have at least one staff on site at all times with at least CPR and first aid training, and medication assistance/safe medication practices training if this assistance will be provided in the facility, pending completion of all required training within the time allowed. However, an unlicensed facility that is obtaining initial licensure may have up to two residents if the ALF is located in the provider s home. The Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 2 2

9 facility must demonstrate readiness for operation at the time of survey. The survey, while serving a regulatory function, also provides an opportunity for the surveyor to provide technical assistance in the core areas of: assessments (pre-admission and change of condition) medication system service planning process caregiver law requirements (except ADCs) investigation and reporting requirements training requirements admission/discharge policies grievance procedures personnel records resident records environmental and physical plant requirements nutrition and food service activity planning Occasionally, there will be instances where an existing facility (such as an Adult Family Care Home) will seek licensure as an Assisted Living Facility. In this case, current resident status and care will be generally assessed during the initial survey. In addition, as part of the Initial Survey process, surveyors are directed to assess for basic operational requirements and provide technical assistance. In recognition that the ALF applicant will not have any residents, the following clarification has been added to ensure consistent application of the Initial Survey process. In addition to the previously described Initial Survey process the following will be evaluated for compliance. Service Planning process- Extended Congregate Care as defined in 58A5.030(7), F.A.C. (AE 206). The surveyor should interview the applicant and determine how the facility plans to accomplish Service Planning. Limited Mental Health- Community Supported Living Plan as defined in 58A-5.029(2), F.A.C. (AL 241). The surveyor should interview the applicant and determine what will be the process by which the facility will consult with the resident s mental health case manager in order to assist in the planning process. Training Requirements- Direct Care staff must have a minimum of 1 hour training in Infection Control, Universal Precautions, and Facility Sanitation Procedures prior to providing personal care as defined in 58A-5.019(2)(a), F.A.C. (A 81). The survey should evaluate if staff have received this basic Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 3 3

10 training component to ensure safe practices. B. Elopement Policies and Procedures- As defined in 58A (8), F.A.C. (A 32). The surveyor should request and review the applicant s Elopement policies and procedures to ensure core elements are in place that prompts safe practices. Nutrition and Food Services- The provider will not be required to have food items in the facility at the time of the survey, but the surveyor should interview the applicant to determine what plan is in place for the acquisition of menus, food, and supplies once the license has been granted and prior to resident admissions. In recognition that the ALF applicant will not have any residents, surveyors will not have an executed contract available for review. However, the applicant should be interviewed to determine the process followed by that facility for development of the resident contracts including the general items that will be included in the contracts and ensure the provider is aware of the requirements of 58A-5.025, FAC. The applicant should have a contract template available for review. Since contracts may vary according to the services offered, the applicant interview is the critical element for evaluation of this requirement. The surveyors are not to obtain square footage measurements, but report any concerns to their Field Office manager for referral to the appropriate entity with jurisdiction. ABBREVIATED SURVEY PROCESS The abbreviated survey process will be used for facilities with good compliance history that meet criteria outlined in (5), FS, and 58A-5.033(2), FAC. The abbreviated survey process focuses on observations and interviews. Observations and interviews are used to evaluate how the individual needs and preferences of residents are met. If concerns are identified, the surveyor will continue to gather information and will investigate further. The survey will be expanded to clarify concerns and to determine if the facility is in compliance. A full, standard survey will be completed if during the abbreviated survey the following serious problems are identified: 1. Fire safety violations that threaten the life or safety of a resident and which are confirmed as serious by the local fire authority having jurisdiction; 2. Violations that are classified as a class 1 or 2 violation; or 3. Violations relating to facility staff rendering services for which the facility is not licensed. Tasks The following are the tasks for an abbreviated survey: Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 4 4

11 Off-site review Entrance conference with staff in charge Tour of the facility Sample Selection Observations Interviews with residents, family members/representatives and staff Record reviews if triggered by concerns raised during observation or interviews 8. Exit conference with staff in charge 9. Specialty License review as appropriate 1. OFF-SITE REVIEW This task establishes the type of survey to be conducted and identifies areas of concern. At a minimum, the ALF Supervisor and surveyor should review the compliance history of the facility for the last two licensure periods. Pertinent information to review includes: Current application Population served Notice(s) Statement(s) of deficiency (SOD) Enforcement Correspondence Miscellaneous information Conditions on license Floor plans Appeal status Facility self-reports Complaints Other agency information (e.g., ombudsman, DCF, Medicaid) The facility meets the criteria for an abbreviated survey if the facility has had no class I, class II, or any uncorrected class III deficiencies, confirmed Ombudsman council complaints or confirmed licensure complaints and has not had a change of ownership within two licensure periods (four years) immediately preceding the survey. 2. ENTRANCE CONFERENCE WITH STAFF IN CHARGE The purpose of this task is to meet the administrator or designee in order to make introductions, explain the abbreviated survey process and request needed materials. This is a brief task that provides the surveyor an overview of the consumer population and the services the facility provides. Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 5 5

12 3. TOUR Tour the facility with staff, if available. During the tour, talk briefly with staff and residents in order to gather a general understanding of the level of services provided by the facility and the resident s perception of the facility and the services received. During the tour, make general observations to determine: Whether the environment is clean, comfortable, home-like, and accessible. How food is stored, and what quantities of food are available. How medications are stored and secured. Whether there are any safety hazards. What activities are available for residents. How residents interact with one another. Whether adaptive equipment is clean and well maintained. Whether restraints are being used. The overall appearance of residents. How staff members interact with residents. The number of residents in the facility in relation to the facility s licensed capacity. Document tour findings on the Assisted Living Surveyor Worksheet. 4. SAMPLE SELECTION-RESIDENT INTERVIEWS The resident sample selection is a minimum of 6. The Field Office Manager, or designee, and surveyor will determine if the sample selection needs to be increased based on the survey history, observations, or other concerns such as Ombudsman referrals. Family or representative interviews may be utilized if the resident is not able to participate or refuses the interview process For facilities with a specialty license (limited mental health, limited nursing service or extended congregate care), the sample must include residents currently residing in the facility who are receiving those services. Using information from the off-site preparation, tour, and introductory interviews, select specific residents with varying care needs to be in the sample. Some considerations may include: Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Residents who appear to have unmet care or service needs Residents who use, or may need, adaptive equipment Hospice patients Residents with restricted communication Residents within varying wings/floors in large facilities Page 6 6

13 Skin integrity of residents including pressure sores Treatments received by residents Residents who receive special diets Continuous care needs of residents Residents who use English as a second language Residents who receive psychotropic medications Residents who are without representation Residents with sensory impairments Record the names of the selected sample consumers on the Assisted Living Resident Roster Surveyor Worksheet. 5. OBSERVATIONS This task builds on the general observations and brief interviews made during the tour. Observations focus on residents during varying times and settings. These observations evaluate if the facility promotes and protects rights and dignity, and evaluates how the residents needs and preferences are met. Observations of the following may be included: resident rights, activities, resident behavior and demeanor, staff interaction, homelike environment and safety, resident appearance, staff ability to perform job duties, restraint use, resident use of adaptive equipment, and positioning/transferring. Observations are documented on the Assisted Living Surveyor Worksheet. 6. INTERVIEWS: RESIDENT, FAMILY MEMBERS/REPRESENTATIVES AND STAFF Interviews are conducted to determine how the resident, family members/representatives, and staff perceive the services delivered by the facility and to clarify information gathered during observations. Interviews are informal and conducted in a private location. Document the interviews on the Assisted Living Interview Worksheet. In the abbreviated survey process, a minimum of 6 interviews will be conducted with residents or family members/representatives and at least one staff interview will be conducted. The surveyor should build on the general information gathered during the tour by speaking with residents, Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 7 7

14 family members/representatives and staff until adequate information is gathered to determine the quality of life and care in the facility. The interview process provides residents, family members/representatives and staff an opportunity to verbalize feelings about care, treatment and services provided. The surveyor will investigate any concerns conveyed during the process and will expand the survey to clarify concerns and to determine if the facility is in compliance. For facilities with a specialty license (limited mental health, limited nursing service or extended congregate care), the sample must include at least one resident currently residing in the facility who is receiving those services. 7. RECORD REVIEW a) Resident If observations of residents and interviews with residents and family members/representatives do not raise concerns, review of the resident record is not required except for specialty license review requirements, see Task 9 of this section. If problems with care and services are identified, the content of the record will be evaluated to confirm or obtain needed information to determine compliance. b) Staff A review of one staff record per shift is required to determine compliance in the areas of: Health screening, Training, Background information checks, and Job responsibilities. If concerns are identified, additional records will be reviewed to obtain additional information in order to establish the extent of the deficient practice. 8. EXIT CONFERENCE WITH STAFF IN CHARGE The purpose of this task is to meet briefly with the administrator or designee in order to share the preliminary results of the survey. Surveyors will identify areas of non-compliance and give examples as appropriate. The facility will also be informed that the results will have a supervisory review which could result in changes to the statement of deficiencies. The timeframes for receiving survey results and for correction will also be reviewed at the exit conference. Give the provider a listing of sampled residents and/or staff if they will be subsequently referenced in the survey report. Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 8 8

15 9. SPECIALTY LICENSES In addition to the core areas identified above and through resident, family or staff interviews and record reviews, the following will be documented on the appropriate Assisted Living Facility Specialty License Review Worksheet: Limited Mental Health: Compliance with Section , FS and 58A5.029, FAC, relating to community living support plans for limited mental health residents. Extended Congregate Care: Compliance with Section , FS and 58A-5.030, FAC, relating to environment standards and residency criteria for residents receiving those services. Limited Nursing Services: Compliance with Section , FS and Rule 58A-5.031, FAC, relating to the provision of care and staffing in a facility for residents receiving those services. B. STANDARD SURVEY PROCESS A standard survey process is used in facilities that do not meet the criteria for an abbreviated or initial survey. Observation and interview will be used to gather data during the survey. Review of the residents records and facility records will be conducted to further investigate concerns identified by observations and interviews, and to determine compliance with process requirements. Tasks The following are the tasks for a standard survey: 1. Off-site review 2. Entrance conference with staff in charge 3. Tour of the facility 4. Sample selection 5. Observations including medication storage and medication pass 6. Interviews with resident, family members/representatives and staff 7. Record review 8. Exit conference with staff in charge 9. Specialty license review as appropriate 1. OFF-SITE REVIEW This task establishes the type of survey to be conducted and identifies areas of concern. At a minimum, the ALF Supervisor and surveyor should review the compliance history of the facility for the last two licensure periods. Pertinent information to review includes: Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Current application Population served Notice(s) Page 9 9

16 Statement(s) of deficiency (SOD) Enforcement Correspondence Miscellaneous information Floor plans Appeal status Facility self-reports Complaints Other agency information (i.e., Ombudsman, Medicaid, Department of Children and Families, etc.) This review is documented on the Assisted Living Surveyor Worksheet. 2. ENTRANCE CONFERENCE WITH STAFF IN CHARGE The purpose of this task is to meet the administrator or designee in order to make introductions, explain the survey process and request needed materials. This is a brief task that provides the surveyor an overview of the resident population and the services the facility provides. Any questions by the provider relative to the license application would be referred to the licensure unit. 3. TOUR The surveyor tours the facility with staff, if available, and meets as many residents and staff as possible. During the tour, the surveyor s attention focuses on resident rights, dignity and privacy, the environment, and safety. Observations will be used to identify residents to include in the survey sample. Document tour observations on the Assisted Living Surveyor Worksheet. Examples of observations during a tour include: Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Is the environment clean, comfortable, home-like and accessible. How is food stored and what quantities of food are available. How are medications stored and secured. Are there any safety hazards. What activities are available to residents. How do residents interact with one another. Is adaptive equipment clean and well maintained. Are restraints being used. The overall appearance of residents. How staff interact with residents. The number of residents in the facility in relation to the facility s licensed capacity. Page 10 10

17 4. SAMPLE SELECTION-RESIDENT INTERVIEWS The resident interview sample will be based on the size of the facility and will include a minimum of 6 and a maximum of 10 residents. The Field Office Manager, or designee, and surveyor will determine if the sample selection needs to be increased based on the survey history, observations, or other concerns such as Ombudsman referrals. Family or representative interviews may be utilized if the resident is not able to participate or refuses to be interviewed. In addition, at least one family interview must be completed as part of the standard survey. For facilities with a specialty license (limited mental health, limited nursing service or extended congregate care), the sample must include residents currently residing in the facility who are receiving those services. Using information from the off-site preparation, tour, and introductory interviews, select specific residents with varying care needs to be in the sample. Some considerations may include: Residents who appear to have unmet care or service needs Residents who use, or may need, adaptive equipment Hospice patients Residents with restricted communication Residents within varying wings/floors in large facilities Skin integrity of residents including pressure sores Treatments received by residents Residents who receive special diets Continuous care needs of residents Residents who use English as a second language Residents who receive psychotropic medications Residents who are without representation Residents with sensory impairments Record the names of the selected sample consumers on the Assisted Living Resident Roster Surveyor Worksheet. 5. OBSERVATIONS This task builds on the general observations made during the tour. Observations focus on the sampled residents during varying times and settings. These observations evaluate if the facility promotes and protects resident rights and dignity, and how the residents needs and preferences are met. Observations may include: residents rights meals Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 11 11

18 activities medication administration and treatments resident behavior and demeanor staff interaction homelike environment and safety resident appearance staff ability to perform job duties restraint use resident use of adaptive equipment staff use of equipment activities of daily living positioning/transferring skin integrity In addition, if, in the previous 12 months prior to the survey, the facility has had: 1. Substantiated allegations of abuse, neglect or exploitation; 2. Multiple elopements of one resident or an elopement resulting in death; or 3. Substantiated allegations of inappropriate residents living in the facility; or 4. Surveyors note indicators of inappropriate residents during the survey. The surveyor will observe 100% of the residents currently physically in the facility and use data obtained from those observations to supplement the sample for the current survey as appropriate. Observations are documented on the Assisted Living Surveyor Worksheet. Medication system observations are documented on the Medication Review Worksheet. 6. INTERVIEWS: RESIDENT, FAMILY MEMBERS/REPRESENTATIVES, STAFF Interviews are conducted to determine how the resident, family members/representatives and staff perceive the services delivered by the facility, and to clarify information gathered during observations. Interviews are informal and conducted in a private location. Document the interviews on the appropriate Assisted Living Interview Worksheets. a) Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Residents: Attempt to interview all residents identified in the sample about the care and services they receive. If residents are away from the facility at a day programming site and the surveyor is unable to sufficiently complete all of interviews at the facility, the surveyor should visit the day programming site to complete the task. Page 12 12

19 Resident interviews focus on the quality of life and care in the facility. This interview gives the resident an opportunity to verbalize feelings about care, treatment, and services being provided. The surveyor will investigate any concerns conveyed during the interview. If the resident refuses the interview or the resident s cognitive status prevents the resident from participating in the interview, the surveyors shall document the attempt and the reason on the interview worksheet and the resident sample supplemented with additional residents to complete the task with a sufficient number of interviews. b) Family Members/Representatives: In addition to the prescribed resident interviews, include at least one interview of a resident s designated family member or representative. For residents who are unable to be interviewed, complete the required number of interviews from this category if possible. This will give the family members/representatives an opportunity to describe the quality of services provided to the resident. These interviews may be conducted via telephone if the family members are not present in the facility. c) Staff: The interview process includes interviews with caregivers and the administrator or designated representative. The interviews will obtain information to: 7. verify information obtained from other sources; obtain information about staff knowledge of a resident s need for services and supervision; identify the type and frequency of services provided; gain information about specific safety procedures, and validate training. RECORD REVIEW a) Resident The primary intent of reviewing the record is to confirm or obtain needed information to make compliance decisions. If observations and interviews of sampled residents do not raise concerns, review of the sampled resident s record is not required. However, a minimum of two records must be reviewed to evaluate process requirements. If no concerns are identified, no additional records will be reviewed. A focused review of two records is completed to verify compliance with the following requirements: Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Completion of the AHCA Health Assessment form #1823 Contract provisions Page 13 13

20 Change of condition reports Legal status Medication administration requirements or other needed services If concerns with care and services are identified, the content of the record will be evaluated more extensively. Closed records may be reviewed if an issue regarding a discharged resident occurs. The surveyor may review one or more closed records for adequacy of care related to services provided if a concern is identified. Document the record review on the Assisted Living Surveyor Worksheet. b) Staff The primary intent of the staff record review is to confirm or obtain needed information regarding compliance in the areas of: Health screening Training Background information checks, and Job responsibilities A review of a minimum of one staff record per shift is required. If no concerns are identified, no additional staff records will be reviewed. The number of staff records reviewed should be proportionate to the facility size and complexity. If problems are identified, additional records will be reviewed to confirm or obtain needed information to establish the extent of the deficient practice. 8. EXIT CONFERENCE Throughout the entire survey process, the surveyor will inform staff of identified issues and seek additional information about the issue. At the completion of the survey, the surveyor conducts an exit conference with the administrator or designated representative. The general objective of this meeting is to explain the preliminary findings and areas of concern, if any. Give the provider a listing of sampled residents and/or staff if they will be subsequently referenced in the survey report. 9. SPECIALTY LICENSES In addition to the core areas identified above and through resident, family or staff interviews and record reviews, the following will be documented on the appropriate Assisted Living Facility Specialty License Review Worksheet: Limited Mental Health: Compliance with Section , FS and 58A5.029, FAC, relating to community living support plans for limited mental health residents. Revised July 31, 2015 AHCA ALF Resource Manual Aug 2014 Page 14 14

21 Extended Congregate Care: Compliance with Section , FS and 58A-5.030, FAC, relating to environment standards and residency criteria for residents receiving those services. Limited Nursing Services: Compliance with Section , FS and Rule 58A-5.031, FAC, relating to the provision of care and staffing in a facility for residents receiving those services. 10. DECISION MAKING The surveyor will review survey findings in each of the core areas, focusing on key codes to identify the deficient practice(s). Survey results will be documented on state form AHCA Deficiencies are classified according to class I, II, III and IV as defined in Chapter FS. All statements of deficiencies will be provided to the facility representative within ten working days of survey exit. The facility is not required to provide the office with a written plan of correction. Follow-up surveys (revisits) will be conducted within 45 days of the survey exit to verify correction of the deficiencies. However, desk reviews may be conducted in lieu of on-site revisits when the facility voluntarily submits supporting documentation of corrective action. C. REVIST SURVEYS The purpose of a revisit survey is to determine if the identified areas of noncompliance have been corrected. Observation and interview will be used to gather data during the survey. Review of the residents records and facility records will be conducted to further investigate corrective actions and current compliance. 1. OFF SITE PREPARATION Review previous survey and plan how to proceed with avenues of investigations based on the identified areas of non-compliance. Example: A 25 Supervision was cited related to the facility s failure to ensure the safety 2 of 5 sampled residents that engaged in a physical altercation resulting in 1 resident suffering a broken nose. The surveyor would plan on speaking to the sampled residents, other residents, and staff regarding the level of supervision and monitoring of resident needs or aggressive behaviors. The surveyor would plan on touring the ALF and observing how residents are monitored and supervised. The surveyor would plan on reviewing any facility documents relevant to the non-compliance such as training or new facility policies. Revised July 31, 2015 Page 15 AHCA ALF Resource Manual Aug

22 2. ENTRANCE CONFERENCE WITH STAFF IN CHARGE The purpose of this task is to meet the administrator or designee in order to make introductions, explain the survey process and request needed materials. 3. TOUR Tour the facility with a specific focus relevant to the identified noncompliance. This is an opportunity to assess if corrective actions have been taken by the provider. The surveyor should make observations of care and services and document those observations on the Assisted Living Surveyor Notes Worksheet. 4. SAMPLE SELECTION The surveyor should sample residents referenced in the original survey and additional residents that may have been impacted by the provider s non-compliance. If areas of non-compliance were identified related to staff, the surveyor would ensure to sample the staff referenced in the original survey and additional staff that may have been impacted by the provider s noncompliance. Documentation should be made utilizing: Assisted Living Resident Roster Surveyor Worksheet, Assisted Living Surveyor Notes Worksheet, and/or Employee Review Worksheet. 5. SURVEY The surveyor would utilize standard survey methods of observation, interview, and record/document reviews to determine if correction of noncompliance has been achieved. The surveyor should document on the applicable Assisted Living Worksheets. 6. EXIT CONFERENCE WITH STAFF IN CHARGE The purpose of this task is to meet briefly with the administrator or designee in order to share the preliminary results of the survey. The facility will also be informed that the results will have a supervisory review which could result in changes to the statement of deficiencies. The timeframes for receiving survey results and for correction will also be reviewed at the exit conference. Give the provider a listing of sampled residents and/or staff if they will be subsequently referenced in the survey report. 7. DECISION MAKING Survey results will be documented on state form AHCA Deficiencies are classified according to class I, II, III and IV as defined in Chapter FS. All statements of deficiencies will be provided to the facility representative within ten working days of survey exit. Revised July 31, 2015 Page 16 AHCA ALF Resource Manual Aug

23 LIMITED NURSING SERVICES AND EXTENDED CONGREGATE CARE MONITORING PROCESS The ECC/LNS monitoring process uses observations and interviews to evaluate how the individual needs and preferences of residents receiving those services are met. Specifically, services provided for Extended Congregate Care are evaluated to determine compliance with Section , FS and 58A-5.030, FAC, relating to environment standards and residency criteria for residents receiving those services. And, services provided for Limited Nursing Services are evaluated to determine compliance with Section , FS and Rule 58A-5.031, FAC, relating to the provision of care and staffing in a facility for residents receiving those services. Tasks The following are the tasks for the ECC/LNS monitoring visit: Off-site review Entrance conference with staff in charge Tour of the facility Observations Interviews with residents, and staff and family members/representatives if appropriate 6. Record reviews if triggered by concerns raised during observation or interviews 7. Exit conference with staff in charge 1. OFF-SITE REVIEW This task establishes the type of survey to be conducted and identifies areas of concern. The ALF Supervisor and surveyor review the compliance history of the facility. Pertinent information to review includes: Current application Population served Statement(s) of deficiency (SOD) Enforcement Correspondence Miscellaneous information Facility self-reports Complaints Other agency information (e.g., ombudsman, DCF, Medicaid) Revised March 17, 2015 AHCA ALF Resource Manual Aug

24 2. ENTRANCE CONFERENCE WITH STAFF IN CHARGE The purpose of this task is to meet the administrator or designee in order to make introductions, explain the monitoring process and request needed materials. This is a brief task that provides the surveyor an overview of the consumer population and the services the facility provides. During the entrance conference: Request a list of residents receiving Limited Nursing Services and/or Extended Congregate Care Services as applicable depending on the specific license issued to the facility Ask if any residents are receiving home health services and if so, obtain the contact information on the home health agency If the facility indicates that there are in fact no residents receiving those services, note the response on the Assisted Living Survey Worksheet; however, continue the monitoring visit to include a tour and observe residents to determine that there are no residents who actually appear to be receiving the service(s) in question. If residents are identified, surveyors will utilize the appropriate Assisted Living Facility Specialty License Review Worksheet. 3. TOUR Tour the facility with staff, if available. During the tour, talk briefly with staff and residents in order to gather a general understanding of the level of services provided by the facility and the resident s perception of the facility and the services received. During the tour, make general observations to determine: Whether the environment is clean, comfortable, home-like, and accessible. How medications are stored and secured. Whether there are any safety hazards. The overall appearance of residents; note any special needs of residents What services residents are receiving and if any of the services are consistent with LNS/ECC services Tour findings are documented on the Assisted Living Surveyor Worksheet. 4. OBSERVATIONS This task builds on the general observations and brief interviews made during the tour. Observations focus on residents during varying times and settings. These observations evaluate if the facility promotes and protects rights and dignity, and evaluates how the residents care needs are met. Observations of the following may be included: resident behavior and demeanor, restraint use, resident use of adaptive equipment, positioning/transferring Observations are documented on the Assisted Living Surveyor Worksheet. Revised March 17, 2015 AHCA ALF Resource Manual Aug

25 5. INTERVIEWS: RESIDENT, FAMILY MEMBERS/REPRESENTATIVES AND STAFF Interviews are conducted to determine how the resident, family members/representatives (as appropriate) and staff perceive the services delivered by the facility and to clarify information gathered during observations. Interviews are informal and conducted in a private location. Document the interviews on the Assisted Living Interview Worksheet. In the LNS/ECC monitoring survey process, a minimum of two interviews will be conducted with residents or family members/representatives receiving LNS and/or ECC services and at least one staff interview will be conducted. The surveyor should build on the general information gathered during the tour by speaking with residents, family members/representatives and staff until adequate information is gathered to determine the quality of care provided in the facility. The surveyor will investigate any concerns conveyed during the process and will expand the visit to clarify concerns and to determine if the facility is in compliance. 6. RECORD REVIEW a. Resident If observations of residents and interviews with residents and family members/representatives do not raise concerns, review of the resident record is not required. If problems with care and services are identified, the content of the record will be evaluated in order to confirm or obtain needed information to determine compliance. b. Staff A review of one staff record per shift is required to determine compliance in the areas of: Training to provide the specialized ECC and/or LNS services Background information checks, and Job responsibilities. If concerns are identified, additional records will be reviewed to obtain additional information in order to establish the extent of the deficient practice. 7. EXIT CONFERENCE WITH STAFF IN CHARGE The purpose of this task is to meet briefly with the administrator or designee in order to share the preliminary results of the survey. Surveyors will identify areas of noncompliance and give examples as appropriate. The facility will also be informed that the results will have a supervisory review which could result in changes to the statement of deficiencies. The timeframes for receiving survey results and for correction will also be reviewed at the exit conference. Revised March 17, 2015 AHCA ALF Resource Manual Aug

26 ALF Survey Task Tool Abbreviated Standard Abbre. LNS/ECC/LMH STD LN ECC LMH ECC/LNS Monitoring Tour Yes Yes Yes Yes Yes Resident Interview 6 minimum Min= 6 Max = 10 Minimum = 6, maximum = Min=6 Max=10 and include minimum of 2 10 and include 1 resident per 1 resident for each specialty specialty license. license Family Interview Staff Interview Resident record review Staff Record Review If unable to obtain resident interview One staff per number of shifts 0 if no issue. If issues are noted, review pertinent record for issue only 1 Per Shift for health screening, training, background screen and job responsibility. If concerns noted, additional records will be reviewed to to establish the extent of the deficient practice 1 family member as needed if residents are unable or unavailable to be interviewed One staff per number of shifts 2 for Complete 1823, Contract Provisions, Change of Condition reports, legal status, med administration 1 Per Shift for health screening, training, background screen and job responsibility. If concerns noted, additional records will be reviewed to establish the extent of the deficient practice One staff per number of shifts 1 receiving for each of the specialty services, for Community Living Support Plans, Service Plans, Nursing Assessments and Notes 1 Per Shift for health screening, training, background screen and job responsibility. If concerns noted, additional records will be reviewed to to establish the extent of the deficient practice 1 family member Include if you can't get a resident interview One staff per number of shifts 2 for Complete 1823 Contract Provisions Change of Condition reports, legal status, med administration requirements 1 Per Shift for health screening, training, background screen and job responsibility. If concerns noted, additional records will be reviewed to to establish the extent of the deficient practice One staff per number of shifts As needed to verify specialized services or if there is a problem 1 per shift for training to provide the specialized ECC and/or LNS services, background screen and job responsibilities. Observations Possibilities Residents observed during tour, medication pass, dining and activities. Residents observed during tour, medication pass, dining and activities. Survey Sample 6 minimum minimum of 6 and maximum of 10 Residents observed during tour, medication pass, dining and activities. 6 including one from each specialty license Residents observed during tour, medication pass, dining and activities including one from each specialty license Residents observed during tour, medication pass, dining and activities. 2 receiving services under specialty license AHCA ALF Resource Manual Aug

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29 ALF/AFCH/ADC Electronic Survey Form Naming Convention NAMING CONVENTION: Form Number or Form Abbreviation_(underscore)Surveyor ID(underscore)_ASPEN Event ID(underscore)_Exit Date(underscore)_Resident ID (if applicable) Examples: AFRR_12345_TUOJ11_ GTN_12345_TUOJ11_ AFRR ER Proorams Adm inistrative & Financial Record Review Programs Employee Review FSDR GTN MR RI RR RS SN Fl SI ECG LNS LMH Programs Food Service & Dining Review Proorams General Tour Notes Program Med Review Proqrams Resident Interview Programs Resident Review Proqrams Resident Sample Programs Surveyor Notes Proqrams Family Interview Programs Staff Interview ECG Worksheet LNS Worksheet LMH Worksheet Updated August, 2011 AHCA ALF Resource Manual Aug

30 AGEHCYFOA HEALTHCARE ADMINISTAATION ALF/AFCH DINING & FOOD SERVICE REVIEW Facility Name: Facility Type: Event ID: r ALF r AFCH Spell Check Surveyor: Date: Requirement: Notes: I Meal Observed: Time: Dining Obversations Meal observation instructions. Observe a meal during the survey to determine compliance with the Food Service Standards and DESCRIBE YOUR OBSERVATIONS. ALFs Refer to tags A092 to A095 Foodservice Standards Food served is nutritionally adequate. Menus are followed, including serving size & MD orders. Substitutions are of equal nutritive value and noted before or when meal served. Appropriate eating ware is available. Residents are encouraged to eat at tables. Food is attractive & served at safe/ palatable tern perature. -- Eating ware and adaptive equipment as needed Residents encouraged in menu planning Admin/designee performs in safe/sanitary manner Menus are nutritionally adequate. (also AFCH) Menus are annually signed by a licensed and/or registered dietitian or dietetic technician. Menus are posted. AHCA FORM , Rev. Oct HQA Field AHCA ALF Resource Manual Aug 2014 \\hg3fsvip02\protocols\protocols.htm Page 1 22

31 ALF/AFCH DINING & FOOD SERVICE REVIEW Facility Name: Facility Type: Event ID: r ALF r AFCH Spell Check Surveyor: Date: Requirement: Notes: I Meal Observed: Time: Menus are dated & planned at least one week in advance. Portion sizes are noted on menus. Substitutions are maintained on file for 6 months. Regular and therapeutic menus are kept on file in the facility for 6 months Meals are served at appropriate times/ intervals. Therapeutic menus provided as ordered (also AFCH) Snacks are offered at least daily for residents without kitchen access Intervals between meals meet requirements Three day emergency supply of food is available If food is catered, contract is on file. Is catered food protected upon delivery Note: If you know of concerns with the dining room environment, refer to A030 Bill of Rights. ADFC Refer to tags F1000 to A1008 Food Service Standards Resident special dietary needs must be met by the provider. Meals are prepared by methods which conserve nutritional value. AHCA FORM , Rev. Oct HQA Field AHCA ALF Resource Manual Aug 2014 \\hg3fsvip02\protocols\protocols.htm Page 2 23

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75 ALF TAG SUMMARY REG ID TAG TITLE REGULATORY REFERENCE ACTION A 0000 Initial Comments A 0001 Definitions ; , 58A Revised A 0002 Licensure - Unlicensed Facilities FS A 0003 Licensure - Change of Ownership (CHOW) 58A FAC A 0004 Licensure - Requirements 58A FAC A 0005 Licensure - Inspection Responsibilities 58A FAC Deleted A 0006 Licensure - Rebates Prohibited; Penalties FS A 0007 Admissions - Criteria (11) FS; 58A (1) FAC Revised A 0008 Admissions - Health Assessment (4-6) FS; 58A (2) FAC Revised A 0009 Admissions - Admission Package 58A (3) FAC; (2) A 0010 Admissions - Continued Residency (1&9) FS; 58A (4) FAC Revised A 0011 Admissions - Discharge 58A (5) FAC A 0025 Resident Care - Supervision (7) FS; 58A (1) FAC Revised A 0026 Resident Care - Social & Leisure Activities 58A (2) FAC A 0027 Resident Care - Arrangement for Health Care 58A (3) FAC A 0028 Resident Care - Activities of Daily Living 58A (4) FAC A 0029 Resident Care - Nursing Services 58A (5) FAC A 0030 Resident Care - Rights & Facility Procedures 58A (6) FAC; (1-2) FS A 0031 Resident Care - Third Party Services 58A (7) FAC A 0032 Resident Care - Elopement Standards 58A (8) FAC A 0050 Medication - Self Administered Medications (2) FS;58A (1) FAC Revised A 0051 Medication - Pill Organizers 58A (2) FAC A 0052 Medication - Assistance with Self-Admin 58A (3) A 0053 Medication - Administration 58A (4) FAC A 0054 Medication - Records 58A (5) FAC A 0055 Medication - Storage and Disposal 58A (6) FAC A 0056 Medication - Labeling and Orders 58A (7) FAC A 0057 Medication - Over The Counter (OTC) Products 58A (8) FAC A 0058 Pharmacy & Dietary; Uncorrected Deficiencies (1-2) FS; 58A-5.033(3)(a) FAC A 0075 Use of Personnel; Emergency Care (AED) (3-5) FS A 0076 Do Not Resuscitate Orders (DNROs) 58A FAC A 0077 Staffing Standards - Administrators FS; 58A-5.019(1) FAC Revised A 0078 Staffing Standards - Staff 58A-5.019(2) FAC A 0079 Staffing Standards - Levels 58A-5.019(3) FAC A 0080 Training - Core & Competency Test (1-2) FS; 58A (1) FAC Revised A 0081 Training - Staff In-Service 58A (2) FAC A 0082 Training - HIV/AIDS 58A (3) FAC A 0083 Training - First Aid and CPR 58A (4) FAC A 0084 Training - Assis Self-Admin Meds & Med Mgmt 58A (5) FAC A 0085 Training - Nutrition & Food Service 58A (6) FAC A 0086 Training - ADRD 58A (9) FAC A 0087 Alzheimer's Training - Prov & Curriculum Appr 58A FAC Revised A 0088 Alzheimer's/Other Disorders - Disclosures FS A 0089 Alzheimer's/Other Disorders - Special Care FS A 0090 Training - Do Not Resuscitate Orders 58A (11) FAC A 0091 Training - Documentation & Monitoring 58A (12) FAC A 0092 Food Service - General Responsibilities 58A-5.020(1) FAC A 0093 Food Service - Dietary Standards 58A-5.020(2) FAC Page 1 of 3 AHCA ALF Resource Manual Aug

76 ALF TAG SUMMARY REG ID TAG TITLE REGULATORY REFERENCE ACTION A 0094 Food Service - Food Hygiene 58A-5.020(3) FAC A 0095 Food Service - Contracted Food Service 58A-5.020(4) FAC A 0120 Fiscal - Financial Stability (3) FS: (1)58A-5.021(1) FAC Revised A 0123 Fiscal - Resident Trust Funds (3-4) FS; 58A-5.021(2) FAC Revised A 0125 Fiscal - Surety Bonds (2) FS; 58A-5.021(3) FAC Revised A 0127 Fiscal - Liability Insurance (3) FS; 58A-5.021(4) FAC Revised A 0150 Physical Plant - New Facilities 58A-5.023(1) FAC A 0151 Physical Plant - Existing Facilities 58A-5.023(2) FAC A 0152 Physical Plant - Safe Living Environ/Other 58A-5.023(3) FAC A 0160 Records - Facility 58A-5.024(1) FAC A 0161 Records - Staff (2) FS; 58A-5.024(2) FAC Revised A 0162 Records - Resident 58A-5.024(3) FAC A 0163 Records - Resident, Penalties for Alteration FS A 0164 Records - Inspection Availability 58A-5.024(4) FAC Revised A 0165 Risk Mgmt & QA; Adverse Incident Report (1-4 & 6-10) FS; 58A FAC A 0166 Risk Mgmt & QA; Liability Claim Report (5) FS; 58A FAC A 0167 Resident Contracts 58A FAC A 0180 Emergency Management 58A-5.026(1) FAC A 0181 Emergency Plan Approval 58A-5.026(2) FAC A 0182 Emergency Mgmt - Plan Implementation 58A-5.026(3) FAC A 0183 Emergency Mgmt - Facility Evacuation 58A-5.026(4) FAC A 0184 Emergency Mgmt - Emergency Shelter 58A-5.026(5) FAC A 0189 ADCCs in ALF FS (2); 58A (2-3) FAC New A 0190 Administrative Enforcement 58A-5.033(1-2) & (3)(b) FAC; (6) A E200 ECC - Licensing 58A-5.030(1) FAC A E201 ECC - Policies 58A-5.030(2) FAC A E202 ECC - Physical Site Requirements 58A-5.030(3) FAC A E203 ECC - Staffing Requirements 58A-5.030(4) FAC Revised A E204 ECC - Admissions & Continued Residency (10); (3)b ; 58A-5.030(5) Revised A E205 ECC - Health Assessment 58A-5.030(6) FAC A E206 ECC - Service Plans 58A-5.030(7) FAC Revised A E207 ECC - Services 58A-5.030(8) FAC A E208 ECC - Records 58A-5.030(9) FAC A E209 ECC - Discharge 58A-5.030(10) FAC A E210 ECC - Training 58A (7) FAC A L240 LMH - Licensing A L241 LMH - Records (3-4); 58A-5.029(2) FAC Revised A L242 LMH - Responsibilities of Facility (2) FS; 58A-5.029(3) FAC Revised A L243 LMH - Training (1) FS; 58A (8) FAC Revised A N275 LNS - Licensing 58A FAC A N276 LNS - Nursing Services 58A-5.031(1) FAC Revised A N277 LNS - Resident Care Standards 58A-5.031(2) FAC A N278 LNS - Records 58A-5.031(3) FAC A Z800 Applicability; Definitions , 59A , 59A (1) Revised A Z802 License or Application Denial; Revocation FS Revised A Z803 License Required; Display , F.S. Revised A Z806 Change of Address 59A (2-5), FAC Revised A Z809 Proof of Financial Ability to Operate 59A (3)(e)&(7), (7), Revised Page 2 of 3 AHCA ALF Resource Manual Aug

77 ALF TAG SUMMARY REG ID TAG TITLE REGULATORY REFERENCE ACTION A Z812 Change of Ownership (5), FS, , FS Revised A Z813 Results of Screening & Notification in File 59A (3)(c), FAC New A Z814 Background Screening Clearinghouse (2)(b-d), FS New A Z815 Background Screening; Prohibited Offenses , (2), Revised A Z816 Background Screening-Compliance Attestation (2)(a-c) FS Revised A Z817 Minimum Licensure Requirement - Inform AHCA (3-4) FS; 59A FAC Revised A Z818 Minimum Licensure Requirement - Client Notice (5) FS Revised A Z819 Minimum Licensure Req - Financial Viability (9) FS Revised A Z821 Reporting Requirements; Electronic Submission 59A , FAC Revised A Z824 Right of Inspection; inspection reports FS, 59A FAC Revised A Z827 Unlicensed Activity , FS Revised A Z829 Moratorium; Emergency Suspension , FS Revised A Z830 Emergency Management Planning FS Revised Page 3 of 3 AHCA ALF Resource Manual Aug

78 Agency for Health Care Administration ASPEN: Regulation Set (RS) Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0000 Initial Comments Title Initial Comments Statute or Rule Tag_Type M Regulation Definition Interpretive Guidance These guidelines are meant solely to provide guidance to surveyors in the survey process. ST 0001 Definitions Title Definitions Statute or Rule ; , 58A Tag_Type L Regulation Definition (4) " Aging in place " or " age in place " means the process of providing increased or adjusted services to a person to compensate for the physical or mental decline that may occur with the aging process, in order to maximize the person ' s dignity and independence and permit them to remain in a familiar, noninstitutional, residential environment for as long as possible. Such services may be provided by facility staff, volunteers, family, or friends, or through contractual arrangements with a third party. (5) " Assisted living facility " means any building or buildings, section or distinct part of a building, private home, boarding home, home for the aged, or other residential facility, whether operated for profit or not, which undertakes through its ownership or management to provide housing, meals, and one or more personal services for a period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator. (6) "Chemical restraint" means a pharmacologic drug that physically limits, restricts, or deprives an individual of movement or mobility, and is used for discipline or convenience and not required for the treatment of medical symptoms. (10) "Emergency" means a situation, physical condition, or method of operation which presents imminent danger of death or serious physical or mental harm to facility residents. Interpretive Guidance The Assisted Living Unit (ALU) telephone number located in paragraph (2) was changed to when AHCA transitioned to the Voice Over IP (VOIP) telephone system. Activities of daily living includes other similar tasks according to FS AHCA ALF Resource Manual Aug

79 Aspen State Regulation Set: A 4.01 Assisted Living Facility (13) "Limited nursing services" means acts that may be performed by a person licensed under part I of Chapter 464. Limited nursing services shall be for persons who meet the admission criteria established by the department for assisted living facilities and shall not be complex enough to require 24-hour nursing supervision and many include such services as the application and care of routine dressings, and care of casts, braces, and splints. (14) "Managed risk" means the process by which the facility staff discuss the service plan and the needs of the resident with the resident and, if applicable, the resident's representative or designee or the resident's surrogate, guardian, or attorney in fact, in such a way that the consequences of a decision, including any inherent risk, are explained to all parties and reviewed periodically in conjunction with the service plan, taking into account changes in the resident's status and the ability of the facility to respond accordingly. (15) "Mental health resident" means an individual who receives social security disability income due to a mental disorder as determined by the Social Security Administration or receives supplemental security income due to a mental disorder as determined by the Social Security Administration and receives optional state supplementation. (16) "Personal services" means direct physical assistance with or supervision of the activities of daily living and the self-administration of medication and other similar services which the department may define by rule. "Personal services" shall not be construed to mean the provision of medical, nursing, dental, or mental health services. (17) "Physical restraint" means a device which physically limits, restricts, or deprives an individual of movement or mobility, including, but not limited to, a half-bed rail, a full-bed rail, a geriatric chair, and a posey restraint. The term "physical restraint" shall also include any device which was not specifically manufactured as a restraint but which has been altered, arranged, or otherwise used for this purpose. The term shall not include bandage material used for the purpose of binding a wound or injury. (18) "Relative" means an individual who is the father, mother, stepfather, stepmother, son, daughter, brother, sister, grandmother, grandfather, great-grandmother, greatgrandfather, grandson, granddaughter, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sisterin-law, stepson, stepdaughter, stepbrother, stepsister, half brother, or half sister of an owner or administrator. (22) "Shared responsibility" means exploring the options available to a resident within a facility and the risks involved with each option when making decisions pertaining to the resident ' s abilities, preferences, and service needs, thereby enabling the resident and, if applicable, the resident's representative or designee, or the resident's surrogate, guardian, or attorney in fact, and the facility to develop a service plan which best meets the resident's needs and seeks to improve the resident's quality of life , F.S. Definitions: (a) "Informed consent" means advising the resident, or the resident's surrogate, guardian, or attorney in fact, that an assisted living facility is not required to have a licensed nurse on staff, that the resident may be receiving assistance with selfadministration of medication from an unlicensed person, and that such assistance, if provided by an unlicensed person, will or will not be overseen by a licensed nurse. (b) "Unlicensed person" means an individual not currently licensed to practice nursing or medicine who is employed by or under contract to an assisted living facility and who has received training with respect to assisting with the self-administration of medication in an assisted living facility as provided under s prior to providing such assistance as described in this section. AHCA ALF Resource Manual Aug

80 Aspen State Regulation Set: A 4.01 Assisted Living Facility 58A , FAC In addition to the terms defined in Section , F.S., the following definitions are applicable in this rule chapter: (1) " Advertise " means any written, printed, oral, visual, or electronic promotion, statement of availability, qualifications, services offered, or other similar communication appearing in or on television, radio, the Internet, billboards, newspapers, magazines, business cards, flyers, brochures or other medium for the purpose of attracting potential residents to an assisted living facility. A complimentary listing of a licensed facility ' s name, address, and telephone number in the telephone directory is not considered advertising. (2) " Agency Central Office " means the Agency for Health Care Administration Assisted Living Unit (ALU), located at 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL The ALU telephone number and website address is (850) , and (3) " Agency Field Office " means the Agency for Health Care Administration ' s Office in a particular geographic area. Information regarding local offices is available online at: (4) " Apartment " means a self-contained dwelling unit with a bathroom, kitchen area, and living and sleeping space that is contracted for use as a residence by one or more persons who maintain a common household. (5) " Assistance with Activities of Daily Living " means individual assistance with the following: (a) Ambulation - Providing physical support to enable the resident to move about within or outside the facility. Physical support includes supporting or holding the resident ' s hand, elbow, or arm; holding on to a support belt worn by the resident to assist in providing stability or direction while the resident ambulates; or pushing the resident ' s wheelchair. The term does not include assistance with transfer. (b) Bathing - Assembling towels, soaps, and other necessary supplies, helping the resident in and out of the bathtub or shower, turning the water on and off, adjusting water temperatures, washing and drying portions of the body that are difficult for the resident to reach, or being available while the resident is bathing. (c) Dressing - Helping the resident to choose, and to put on and remove clothing. (d) Eating - Helping with cutting food, pouring beverages, and feeding residents who are unable to feed themselves. (e) Grooming - Helping the resident with shaving, with oral care, with care of the hair, and with nail care. (f) Toileting - Assisting the resident to the bathroom, helping to undress, positioning on the commode, and helping with related personal hygiene, including assistance with changing an adult brief. Assistance with toileting includes assistance with the routine emptying of a catheter or ostomy bag. (6) " Assistance With Transfer " means providing verbal and physical cuing or physical assistance or both while the resident moves between bed and a standing position or between bed and chair or wheelchair. (7) " Bedridden " means confined to bed because of inability to ambulate or transfer to a wheelchair even with assistance, or to sit safely in a chair or wheelchair without personal assistance or physical restraint. AHCA ALF Resource Manual Aug

81 Aspen State Regulation Set: A 4.01 Assisted Living Facility (8) " Capacity " means the number of residents for which a facility has been licensed to provide residential care. (9) " Case Manager " means an individual employed by or under contract with any agency or organization, public, or private, who has the responsibility for assessing resident needs; planning services; coordinating and assisting residents to gain access to needed medical, mental health, social, housing, educational or other services; monitoring service delivery; and evaluating the effects of service delivery. (10) " Certified Nursing Assistant (CNA) " means a person certified under Part II, Chapter 464, F.S. (11) " Deficiency " means an instance of non-compliance with the requirements of Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter. (12) " Direct Care Staff " means Staff in Regular Contact or Staff in Direct Contact with residents that provide personal or nursing services to residents, including administrators and managers providing such services. (13) " Distinct Part " means designated bedrooms or apartments, bathrooms and a living area; or a separately identified wing, floor, or building that includes bedrooms or apartments, bathrooms and a living area. The distinct part may include a separate dining area, or meals may be served in another part of the facility. (14) " Elopement " means an occurrence in which a resident leaves a facility without following facility policy and procedures. (15) " Food Service " means the storage, preparation, serving, and cleaning up of food intended for consumption in a facility or a formal agreement that meals will be regularly catered by a third party. (16) " Health Care Provider " means a physician or physician ' s assistant licensed under Chapter 458 or 459, F.S., or advanced registered nurse practitioner licensed under Chapter 464, F.S. (17) " Licensed Dietitian or Nutritionist " means a dietitian or nutritionist licensed in accordance with Section , F.S. (18) " Long-term Care Ombudsman Program (LTCOP) " means the long-term care ombudsman program established under Part I, Chapter 400, F.S. (19) " Manager " means an individual who is authorized to perform the same functions of the administrator, and is responsible for the operation and maintenance of an assisted living facility while under the supervision of the administrator of that facility. For the purpose of this definition, a manager does not include staff authorized to perform limited administrative functions during an administrator ' s temporary absence. (20) " Mental Disorder " for the purposes of identifying a mental health resident, means schizophrenia and other psychotic disorders; affective disorders; anxiety related disorders; and personality and dissociative disorders. However, mental disorder does not include residents with a primary diagnosis of Alzheimer ' s disease, other dementias, or mental retardation. (21) " Mental Health Care Provider " means an individual, agency, or organization providing mental health services to clients of the Department of Children and Families; an individual licensed by the state to provide mental health services; or an entity employing or contracting with individuals licensed by the state to provide mental health services. (22) " Mental Health Case Manager " means a case manager employed by or under contract to a mental health care provider to assist mental health residents residing in a facility holding a limited mental health license. AHCA ALF Resource Manual Aug

82 Aspen State Regulation Set: A 4.01 Assisted Living Facility (23) " Nurse " means a licensed practical nurse (LPN), registered nurse (RN), or advanced registered nurse practitioner (ARNP) licensed under Chapter 464, F.S. (24) " Nursing Assessment " means a written review of information collected from observation of and interaction with a resident, the resident ' s record, and any other relevant sources; the analysis of the information; and recommendations for modification of the resident ' s care, if warranted. (25) " Nursing Progress Notes " or " Progress Report " means a written record of nursing services, other than medication administration or the taking of vital signs, provided to each resident who receives such services pursuant to a limited nursing or extended congregate care license. The progress notes must be completed by the nurse who delivered the service and must describe the date, type, scope, amount, duration, and outcome of services that are rendered; the general status of the resident ' s health; any deviations; any contact with the resident ' s physician; and must contain the signature and credential initials of the person rendering the service. (26) " Optional State Supplementation (OSS) " means the state program providing monthly payments to eligible residents pursuant to Section , F.S., and Rule Chapter 65A-2, F.A.C. (27) " Owner " means the person, partnership, association, limited liability company, or corporation, which owns or leases the facility, and is licensed by the agency. The term does not include a person, partnership, association, limited liability company, or corporation that contracts only to manage or operate the facility. (28) " Physician " means an individual licensed under Chapter 458 or 459, F.S. (29) " Registered Dietitian " means an individual registered with the Commission on Dietetic Registration, the accrediting body of the Academy of Nutrition and Dietetics. (30) " Renovation " means additions, repairs, restorations, or other improvements to the physical plant of the facility within a 5 year period that costs in excess of 50 percent of the value of the building as reported on the tax rolls, excluding land, before the renovation. (31) " Respite Care " means facility-based supervision of an impaired adult for the purpose of relieving the primary caregiver. (32) " Significant Change " means a sudden or major shift in behavior or mood inconsistent with the resident ' s diagnosis, or a deterioration in health status such as unplanned weight change, stroke, heart condition, enrollment in hospice, or stage 2, 3, or 4 pressure sore. Ordinary day-to-day fluctuations in functioning and behavior, a shortterm illness such as a cold, or the gradual deterioration in the ability to carry out the activities of daily living that accompanies the aging process are not considered significant changes. (33) " Staff " means any individual employed by a facility; or contracting with a facility to provide direct or indirect services to residents; or employees of firms under contract to the facility to provide direct or indirect services to residents when present in the facility. The term includes volunteers performing any service that counts toward meeting any staffing requirement of this rule chapter. (34) " Staff in Regular Contact " or " Staff in Direct Contact " mean all staff whose duties may require them to interact with residents on a daily basis. (35) " Third Party " means any individual or business entity providing services to residents who is not staff of the facility. (36) " Universal Precautions " are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all residents are considered potentially infectious for HIV, HBV, and other bloodborne pathogens. (37) " Unscheduled Service Need " means a need for a personal service, nursing service, or mental health intervention that generally cannot be predicted in advance of the need for service, and that must be met promptly within a time frame that provides reasonable assurance that the health, safety, and welfare of residents is preserved. AHCA ALF Resource Manual Aug

83 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0002 Licensure Unlicensed Facilities Title Licensure - Unlicensed Facilities Statute or Rule FS Tag_Type L Regulation Definition (1)(a) This section applies to the unlicensed operation of an assisted living facility in addition to the requirements of part II of chapter 408. (b) Except as provided under paragraph (d), any person who owns, operates, or maintains an unlicensed assisted living facility commits a felony of the third degree, punishable as provided in s , s , or s Each day of continued operation is a separate offense. (c) Any person found guilty of violating paragraph (a) a second or subsequent time commits a felony of the second degree, punishable as provided under s , s , or s Each day of continued operation is a separate offense. (d) Any person who owns, operates, or maintains an unlicensed assisted living facility due to a change in this part or a modification in rule within 6 months after the effective date of such change and who, within 10 working days after receiving notification from the agency, fails to cease operation or apply for a license under this part commits a felony of the third degree, punishable as provided in s , s , or s Each day of continued operation is a separate offense. (e) The agency shall publish a list, by county, of licensed assisted living facilities. This information may be provided electronically or through the agency ' s Internet site. (2) It is unlawful to knowingly refer a person for residency to an unlicensed assisted living facility; to an assisted living facility the license of which is under denial or has been suspended or revoked; or to an assisted living facility that has a moratorium pursuant to part II of chapter 408. (a) Any health care practitioner, as defined in s , who is aware of the operation of an unlicensed facility shall report that facility to the agency. Failure to report a facility that the practitioner knows or has reasonable cause to suspect is unlicensed shall be reported to the practitioner ' s licensing board. (b) Any provider as defined in s which knowingly discharges a patient or client to an unlicensed facility is subject to sanction by the agency. (c) Any employee of the agency or department, or the Department of Children and Families, who knowingly refers a person for residency to an unlicensed facility; to a facility the license of which is under denial or has been suspended or revoked; or to a facility that has a moratorium pursuant to part II of chapter 408 is subject to disciplinary action by the agency or department, or the Department of Children and Families. (d) The employer of any person who is under contract with the agency or department, or the Department of Children and Families, and who knowingly refers a person for residency to an unlicensed facility; to a facility the license of which is under denial or has been suspended or revoked; or to a facility that has a moratorium pursuant to part II of chapter 408 shall be fined and required to prepare a corrective action plan designed to prevent such referrals. Interpretive Guidance Surveyor Probe: Review for current license. Ensure that residents that have been referred to another facility were transferred to a licensed facility. AHCA ALF Resource Manual Aug

84 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0003 Licensure Change of Ownership (CHOW) Title Licensure - Change of Ownership (CHOW) Statute or Rule 58A FAC Tag_Type L Regulation Definition (2) CHANGE OF OWNERSHIP. In addition to the requirements for a change of ownership contained in Part II, Chapter 408, F.S., Section , F.S., and Rule Chapter 59A-35, F.A.C., the following provisions relating to resident funds apply pursuant to Section , F.S.: (a) At the time of transfer of ownership, all resident funds on deposit, advance payments of resident rents, resident security deposits, and resident trust funds held by the current licensee must be transferred to the applicant. Proof of such transfer must be provided to the agency at the time of the agency survey and before the issuance of a standard license. This provision does not apply to entrance fees paid to a continuing care facility subject to the acquisition provisions in Section , F.S. (b) The transferor must provide to each resident a statement detailing the amount and type of funds credited to the resident for whom funds are held by the facility. (c) The transferee must notify each resident in writing of the manner in which the transferee is holding the resident ' s funds and state the name and address of the depository where the funds are being held, the amount held, and type of funds credited. Interpretive Guidance Surveyor Probe: Review if there has been a change in ownership. AHCA ALF Resource Manual Aug

85 ST 0004 Licensure Requirements Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Licensure - Requirements Statute or Rule 58A FAC Tag_Type L Regulation Definition (1) SERVICE PROHIBITION. An assisted living facility may not represent that it provides any service other than a service for which it is licensed to provide. (2) CHANGE IN USE OF SPACE REQUIRING AGENCY CENTRAL OFFICE APPROVAL. A change in the use of space that increases or decreases a facility ' s capacity must not be made without prior approval from the Agency Central Office. Approval must be based on the compliance with the physical plant standards provided in Rule 58A-5.023, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation inspection requirements referenced in Rule 58A , F.A.C. (3) CHANGE IN USE OF SPACE REQUIRING AGENCY FIELD OFFICE APPROVAL. A change in the use of space that involves converting an area to resident use, which has not previously been inspected for such use, must not be made without prior approval from the Agency Field Office. Approval must be based on compliance with the physical plant standards provided in Rule 58A-5.023, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation inspection standards referenced in Rule 58A , F.A.C. (4) CONTIGUOUS PROPERTY. If a facility consists of more than one building, all buildings included under a single license must be on contiguous property. " Contiguous property " means property under the same ownership separated by no more than a twolane street that traverses the property. A licensed location may be expanded to include additional contiguous property with the approval of the agency to ensure continued compliance with the requirements and standards of Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter. (5) PROOF OF INSPECTIONS. A copy of the annual fire safety and sanitation inspections described in Rule 58A , F.A.C., must be submitted annually to the Agency Central Office. The annual inspections must be submitted no later than 30 calendar days after the inspections. Failure to comply with this requirement may result in administrative action pursuant to Part II, Chapter 408, F.S., Section , F.S., and Rule Chapter 59A-35, F.A.C. (6) RESIDENTS RECEIVING STATE-FUNDED SERVICES. Upon request, the facility administrator or designee must identify residents receiving state-funded services to the agency and the department for monitoring purposes authorized by state and federal laws. Interpretive Guidance Surveyor Probe: Review that the services being provided are those that have been licensed. AHCA ALF Resource Manual Aug

86 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0006 Licensure Rebates Prohibited; Penalties Title Licensure - Rebates Prohibited; Penalties Statute or Rule FS Tag_Type L Regulation Definition Rebates prohibited; penalties.- (1) An assisted living facility licensed under this part may not contract or promise to pay or receive any commission, bonus, kickback, or rebate or engage in any split-fee arrangement in any form whatsoever with any person, health care provider, or health care facility as provided under s (2) This section does not apply to: (a) An individual employed by the assisted living facility, or with whom the facility contracts to provide marketing services for the facility, if the individual clearly indicates that he or she works with or for the facility. (b) Payments by an assisted living facility to a referral service that provides information, consultation, or referrals to consumers to assist them in finding appropriate care or housing options for seniors or disabled adults if the referred consumers are not Medicaid recipients. (c) A resident of an assisted living facility who refers a friend, family members, or other individuals with whom the resident has a personal relationship to the assisted living facility, in which case the assisted living facility may provide a monetary reward to the resident for making such referral. (3) A violation of this section is patient brokering and is punishable as provided in s Interpretive Guidance Surveyor Probes: Review contracted arrangement if kickbacks are suspected. AHCA ALF Resource Manual Aug

87 ST 0007 Admissions Criteria Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Admissions - Criteria Statute or Rule (11) FS; 58A (1) FAC Tag_Type L Regulation Definition (11) No resident who requires 24-hour nursing supervision, except for a resident who is an enrolled hospice patient pursuant to part IV of chapter 400, shall be retained in a facility licensed under this part. 58A (1) ADMISSION CRITERIA. (a) An individual must meet the following minimum criteria in order to be admitted to a facility holding a standard, limited nursing or limited mental health license: 1. Be at least 18 years of age. 2. Be free from signs and symptoms of any communicable disease that is likely to be transmitted to other residents or staff; however, an individual who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that the individual would otherwise be eligible for admission according to this rule. 3. Be able to perform the activities of daily living, with supervision or assistance if necessary. 4. Be able to transfer, with assistance if necessary. The assistance of more than one person is permitted. 5. Be capable of taking medication, by either self-administration, assistance with selfadministration, or by administration of medication. a. If the resident needs assistance with self-administration, the facility must inform the resident of the professional qualifications of facility staff who will be providing this assistance. If unlicensed staff will be providing assistance with self-administration of medication, the facility must obtain written informed consent from the resident or the resident ' s surrogate, guardian, or attorney-in-fact. b. The facility may accept a resident who requires the administration of medication, if the facility has a nurse to provide this service, or the resident or the resident ' s legal representative, designee, surrogate, guardian, or attorney-in-fact contracts with a licensed third party to provide this service to the resident. 6. Not have any special dietary needs that cannot be met by the facility. 7. Not be a danger to self or others as determined by a physician, or mental health practitioner licensed under Chapters 490 or 491, F.S. 8. Not require 24-hour licensed professional mental health treatment. 9. Not be bedridden. 10. Not have any stage 3 or 4 pressure sores. A resident requiring care of a stage 2 pressure sore may be admitted provided that: a. Such resident either: (I) Resides in a standard licensed facility and contracts directly with a licensed home health agency or a nurse to provide care, or (II) Resides in a limited nursing services licensed facility and services are provided pursuant to a plan of care issued by a health care provider, or the resident contracts directly with a licensed home health agency or a nurse to provide care; b. The condition is documented in the resident ' s record and admission and discharge log; and c. If the resident ' s condition fails to improve within 30 days as documented by a health care provider, the resident must be discharged from the facility. 11. Not require any of the following nursing services: a. Oral, nasopharyngeal, or tracheotomy suctioning; b. Assistance with tube feeding; c. Monitoring of blood gases; Interpretive Guidance Surveyor Probe: Make observations of residents and conduct interviews with residents and/or family members to confirm appropriateness of admission. Review a sample of resident for compliance as necessary to validate concerns. AHCA ALF Resource Manual Aug

88 Aspen State Regulation Set: A 4.01 Assisted Living Facility d. Intermittent positive pressure breathing therapy; or e. Treatment of surgical incisions or wounds, unless the surgical incision or wound and the condition that caused it, has been stabilized and a plan of care developed. 12. Not require 24-hour nursing supervision. 13. Not require skilled rehabilitative services as described in Rule 59G-4.290, F.A.C. 14. Have been determined by the facility administrator to be appropriate for admission to the facility. The administrator must base the decision on: a. An assessment of the strengths, needs, and preferences of the individual, and the medical examination report required by Section , F.S., and subsection (2) of this rule; b. The facility ' s admission policy and the services the facility is prepared to provide or arrange in order to meet resident needs. Such services may not exceed the scope of the facility ' s license unless specified elsewhere in this rule; and c. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in Section , F.S., and Rule Chapter 69A-40, F.A.C. (b) A resident who otherwise meets the admission criteria for residency in a standard licensed facility, but who requires assistance with the administration and regulation of portable oxygen, assistance with routine colostomy care, or assistance and monitoring of the application of anti-embolism stockings or hosiery as prescribed by a health care provider in accordance with manufacturer ' s guidelines, may be admitted to a facility with a standard license as long as the following conditions are met: 1. The facility must have a nurse on staff or under contract to provide the assistance or to provide training to the resident to perform these functions. 2. Nursing staff may not provide training to unlicensed persons to perform skilled nursing services, and may not delegate the nursing services described in this section to certified nursing assistants or unlicensed persons as defined in Section (1)(b), F.S. Certified nursing assistants may not be delegated the nursing services described in this section, but may apply anti-embolism stockings or hosiery under the supervision of a nurse in accordance with paragraph 64B (1)(e), F.A.C. This provision does not restrict a resident or a resident ' s representative from contracting with a licensed third party to provide the assistance if the facility is agreeable to such an arrangement and the resident otherwise meets the criteria for admission and continued residency in a facility with a standard license. (c) An individual enrolled in and receiving hospice services may be admitted to an assisted living facility as long as the individual otherwise meets resident admission criteria. (d) Resident admission criteria for facilities holding an extended congregate care license are described in Rule 58A-5.030, F.A.C AHCA ALF Resource Manual Aug

89 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0008 Admissions Health Assessment Title Admissions - Health Assessment Statute or Rule (4-6) FS; 58A (2) FAC Tag_Type L Regulation Definition (4) If possible, each resident shall have been examined by a licensed physician, a licensed physician assistant, or a licensed nurse practitioner within 60 days before admission to the facility. The signed and completed medical examination report shall be submitted to the owner or administrator of the facility who shall use the information contained therein to assist in the determination of the appropriateness of the resident ' s admission and continued stay in the facility. The medical examination report shall become a permanent part of the record of the resident at the facility and shall be made available to the agency during inspection or upon request. An assessment that has been completed through the Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program fulfills the requirements for a medical examination under this subsection and s (3)(b)6. (5) Except as provided in s , if a medical examination has not been completed within 60 days before the admission of the resident to the facility, a licensed physician, licensed physician assistant, or licensed nurse practitioner shall examine the resident and complete a medical examination form provided by the agency within 30 days following the admission to the facility to enable the facility owner or administrator to determine the appropriateness of the admission. The medical examination form shall become a permanent part of the record of the resident at the facility and shall be made available to the agency during inspection by the agency or upon request. (6) Any resident accepted in a facility and placed by the department or the Department of Children and Families shall have been examined by medical personnel within 30 days before placement in the facility. The examination shall include an assessment of the appropriateness of placement in a facility. The findings of this examination shall be recorded on the examination form provided by the agency. The completed form shall accompany the resident and shall be submitted to the facility owner or administrator. Additionally, in the case of a mental health resident, the Department of Children and Families must provide documentation that the individual has been assessed by a psychiatrist, clinical psychologist, clinical social worker, or psychiatric nurse, or an individual who is supervised by one of these professionals, and determined to be appropriate to reside in an assisted living facility. The documentation must be in the facility within 30 days after the mental health resident has been admitted to the facility. An evaluation completed upon discharge from a state mental hospital meets the requirements of this subsection related to appropriateness for placement as a mental health resident providing it was completed within 90 days prior to admission to the facility. The applicable department shall provide to the facility administrator any information about the resident that would help the administrator meet his or her responsibilities under subsection (1). Further, department personnel shall explain to the facility operator any special needs of the resident and advise the operator whom to call should problems arise. The applicable department shall advise and assist the facility administrator where the special needs of residents who are recipients of optional state supplementation require such assistance. 58A (2) HEALTH ASSESSMENT. As part of the admission criteria, an individual must undergo a face-to-face medical examination completed by a health care provider as specified in either paragraph (a) or (b) of this subsection. (a) A medical examination completed within 60 calendar days before to the individual ' s admission to a facility pursuant to Section (4), F.S. The examination must address the following: 1. The physical and mental status of the resident, including the identification of any health-related problems and functional limitations; Interpretive Guidance Surveyor Probes: Make observations of residents and conduct interviews with residents and/or family members to confirm appropriateness of assessment. Review a sample of resident for compliance as necessary to validate concerns. AHCA ALF Resource Manual Aug

90 Aspen State Regulation Set: A 4.01 Assisted Living Facility 2. An evaluation of whether the individual will require supervision or assistance with the activities of daily living; 3. Any nursing or therapy services required by the individual; 4. Any special diet required by the individual; 5. A list of current medications prescribed, and whether the individual will require any assistance with the administration of medication; 6. Whether the individual has signs or symptoms of Tuberculosis, Methicillin Resistant Staphylococcus Aureus, Scabies or any other communicable disease, which are likely to be transmitted to other residents or staff; 7. A statement on the day of the examination that, in the opinion of the examining health care provider, the individual ' s needs can be met in an assisted living facility; and 8. The date of the examination, and the name, signature, address, telephone number, and license number of the examining health care provider. The medical examination may be conducted by a health care provider licensed under Chapter 458, 459 or 464, F.S. (b) A medical examination completed after the resident ' s admission to the facility within 30 calendar days of the admission date. The examination must be recorded on AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, October The form is hereby incorporated by reference. AHCA Form 1823 may be obtained Faxed or electronic copies of the completed form are acceptable. The form must be completed as instructed. 1. Items on the form that may have been omitted by the health care provider during the examination do not necessarily require an additional face-to-face examination for completion. The facility may obtain the omitted information either orally or in writing from the health care provider. 2. Omitted information must be documented in the resident ' s record. Information received orally must include the name of the health care provider, the name of the facility staff recording the information, and the date the information was provided. 3. Electronic documentation may be used in place of completing the section on AHCA Form 1823 referencing Services Offered or Arranged by the Facility for the Resident. The electronic documentation must include all of the elements described in this section of AHCA Form (c) Any information required by paragraph (a) that is not contained in the medical examination report conducted before the individual ' s admission to the facility must be obtained by the administrator using AHCA Form 1823 within 30 days after admission. (d) Medical examinations of residents placed by the department, by the Department of Children and Families, or by an agency under contract with either department must be conducted within 30 days before placement in the facility and recorded on AHCA Form 1823 described in paragraph (b). (e) An assessment that has been conducted through the Comprehensive, Assessment, Review and Evaluation for Long-Term Care Services (CARES) program may be substituted for the medical examination requirements of Section , F.S., and this rule. (f) Any orders for medications, nursing, therapeutic diets, or other services to be provided or supervised by the facility issued by the health care provider conducting the medical examination may be attached to the health assessment. A health care provider may attach a DH Form 1896, Florida Do Not Resuscitate Order Form, for residents who do not wish cardiopulmonary resuscitation to be administered in the case of cardiac or respiratory arrest. (g) A resident placed on a temporary emergency basis by the Department of Children and Families pursuant to Section or , F.S., is exempt from the examination requirements of this subsection for up to 30 days. However, a resident accepted for temporary emergency placement must be entered on the facility ' s admission and discharge log and counted in the facility census; a facility may not exceed its licensed capacity in order to accept such a resident. A medical examination must be conducted on any temporary emergency placement resident accepted for regular admission AHCA ALF Resource Manual Aug

91 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0009 Admissions Admission Package Title Admissions - Admission Package Statute or Rule 58A (3) FAC; (2) Tag_Type L Regulation Definition (3) ADMISSION PACKAGE. (a) The facility must make available to potential residents a written statement(s) that includes the following information listed below. A copy of the facility resident contract or facility brochure containing all the required information must meet this requirement. 1. The facility ' s admission and continued residency criteria; 2. The daily, weekly or monthly charge to reside in the facility and the services, supplies, and accommodations provided by the facility for that rate; 3. Personal care services that the facility is prepared to provide to residents and additional costs to the resident, if any; 4. Nursing services that the facility is prepared to provide to residents and additional costs to the resident, if any; 5. Food service and the ability of the facility to accommodate special diets; 6. The availability of transportation and additional costs to the resident, if any; 7. Any other special services that are provided by the facility and additional cost if any; 8. Social and leisure activities generally offered by the facility; 9. Any services that the facility does not provide but will arrange for the resident and additional cost, if any; 10. The facility rules and regulations that residents must follow as described in Rule 58A , F.A.C.; 11. The facility policy concerning Do Not Resuscitate Orders pursuant to Section , F.S. and Rule 58A , F.A.C., and Advance Directives pursuant to Chapter 765, F.S. 12. The facility ' s residency criteria for residents receiving extended congregate care services if the facility also has an extended congregate care license; and a description of the additional personal, supportive, and nursing services provided by the facility; additional costs; and any limitations, if any, on where extended congregate care residents must reside based on the policies and procedures described in Rule 58A-5.030, F.A.C.; 13. If the facility advertises that it provides special care for individuals with Alzheimer ' s disease and related disorders, a written description of those special services as required in Section , F.S.; and 14. The facility ' s resident elopement response policies and procedures. (b) Before or at the time of admission, the resident, responsible party, guardian, or attorney-in-fact, if applicable, must be provided with the following: 1. A copy of the resident ' s contract that meets the requirements of Rule 58A-5.025, F.A.C.; 2. A copy of the facility statement described in paragraph (a) of this subsection if one has not already been provided; 3. A copy of the resident ' s bill of rights as required by Rule 58A , F.A.C.; and 4. A Long-Term Care Ombudsman Program brochure that includes the telephone number and address of the district office. (c) Documents required by this subsection must be in English. If the resident is not able to read, or does not understand English and translated documents are not available, the facility must explain its policies to a family member or friend of the resident or another individual who can communicate the information to the resident. Interpretive Guidance Surveyor Probe: Review an admission package as necessary for compliance determination (2) Upon admission to a long-term care facility, each resident or representative of a resident must recieve information regarding the purpose of the State Long-Term Care Ombudsman Program, the statewide toll-free telephone number for receiving complaints, information that retaliatory action cannot be taken against a resident for AHCA ALF Resource Manual Aug

92 Aspen State Regulation Set: A 4.01 Assisted Living Facility presenting grievances or for exercising any other resident right, and other relevant information regarding how to contact the program. Each resident or his or her representative must be furnished additional copies of this information upon request. ST 0010 Admissions Continued Residency Title Statute or Rule Tag_Type L Admissions - Continued Residency (1&9) FS; 58A (4) FAC Regulation Definition (1) The owner or administrator of a facility is responsible for determining the appropriateness of admission of an individual to the facility and for determining the continued appropriateness of residence of an individual in the facility. A determination shall be based upon an assessment of the strengths, needs, and preferences of the resident, the care and services offered or arranged for by the facility in accordance with facility policy, and any limitations in law or rule related to admission criteria or continued residency for the type of license held by the facility under this part. A resident may not be moved from one facility to another without consultation with and agreement from the resident or, if applicable, the resident ' s representative or designee or the resident ' s family, guardian, surrogate, or attorney in fact. In the case of a resident who has been placed by the department or the Department of Children and Families, the administrator must notify the appropriate contact person in the applicable department. (9) A terminally ill resident who no longer meets the criteria for continued residency may remain in the facility if the arrangement is mutually agreeable to the resident and the facility; additional care is rendered through a licensed hospice, and the resident is under the care of a physician who agrees that the physical needs of the resident are being met. 58A (4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (e) of this subsection, criteria for continued residency in any licensed facility must be the same as the criteria for admission. As part of the continued residency criteria, a resident must have a face-to-face medical examination by a health care provider at least every 3 years after the initial assessment, or after a significant change, whichever comes first. A significant change is defined in Rule 58A , F.A.C. The results of the examination must be recorded on AHCA Form 1823, which is incorporated by reference in paragraph (2)(b) of this rule. The form must be completed in accordance with that paragraph. (a) The resident may be bedridden for up to 7 consecutive days. (b) A resident requiring care of a stage 2 pressure sore may be retained provided that: 1. The resident contracts directly with a licensed home health agency or a nurse to provide care, or the facility has a limited nursing services license and services are provided pursuant to a plan of care issued by a health care provider; 2. The condition is documented in the resident ' s record; and 3. If the resident ' s condition fails to improve within 30 days, as documented by a health care provider, the resident must be discharged from the facility. (c) A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the following conditions are met: Interpretive Guidance Surveyor Probe: Make observations of residents on tour, interview residents and/or family members for information as to the appropriateness of continued residency. If necessary, review documentation of the face-to-face medical examination. AHCA ALF Resource Manual Aug

93 Aspen State Regulation Set: A 4.01 Assisted Living Facility 1. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice that coordinates and ensures the provision of any additional care and services that may be needed; 2. Continued residency is agreeable to the resident and the facility; 3. An interdisciplinary care plan, which specifies the services being provided by hospice and those being provided by the facility, is developed and implemented by a licensed hospice in consultation with the facility; and 4. Documentation of the requirements of this paragraph is maintained in the resident ' s file. (d) The administrator is responsible for monitoring the continued appropriateness of placement of a resident in the facility at all times. (e) A hospice resident that meets the qualifications of continued residency pursuant to this subsection may only receive services from the assisted living facility ' s staff within the scope of the facility ' s license. (f) Assisted living facility staff may provide any nursing service permitted under the facility ' s license and total help with the activities of daily living for residents admitted to hospice; however, staff may not exceed the scope of their professional licensure or training. (g) Continued residency criteria for facilities holding an extended congregate care license are described in Rule 58A-5.030, F.A.C. ST 0011 Admissions Discharge Title Admissions - Discharge Statute or Rule 58A (5) FAC Tag_Type L Regulation Definition (5) DISCHARGE. If the resident no longer meets the criteria for continued residency, or the facility is unable to meet the resident ' s needs, as determined by the facility administrator or health care provider, the resident must be discharged in accordance with Section , F.S Interpretive Guidance AHCA ALF Resource Manual Aug

94 ST 0025 Resident Care Supervision Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Resident Care - Supervision Statute or Rule (7) FS; 58A (1) FAC Tag_Type L Regulation Definition (7) The facility must notify a licensed physician when a resident exhibits signs of dementia or cognitive impairment or has a change of condition in order to rule out the presence of an underlying physiological condition that may be contributing to such dementia or impairment. The notification must occur within 30 days after the acknowledgment of such signs by facility staff. If an underlying condition is determined to exist, the facility shall arrange, with the appropriate health care provider, the necessary care and services to treat the condition. Interpretive Guidance Surveyor Probe: Observe residents ' care and services, interview residents and/or family members to confirm their satisfaction with their care. Review a sample of records as necessary to confirm compliance concerns. 58A (1) An assisted living facility must provide care and services appropriate to the needs of residents accepted for admission to the facility. (1) SUPERVISION. Facilities must offer personal supervision as appropriate for each resident, including the following: (a) Monitoring of the quantity and quality of resident diets in accordance with Rule 58A , F.A.C. (b) Daily observation by designated staff of the activities of the resident while on the premises, and awareness of the general health, safety, and physical and emotional wellbeing of the resident. (c) Maintaining a general awareness of the resident ' s whereabouts. The resident may travel independently in the community. (d) Contacting the resident ' s health care provider and other appropriate party such as the resident ' s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change; contacting the resident ' s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out. (e) Maintaining a written record, updated as needed, of any significant changes, any illnesses that resulted in medical attention, changes in the method of medication administration, or other changes that resulted in the provision of additional services. AHCA ALF Resource Manual Aug

95 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0026 Resident Care Social & Leisure Activities Title Resident Care - Social & Leisure Activities Statute or Rule 58A (2) FAC Tag_Type L Regulation Definition (2) SOCIAL AND LEISURE ACTIVITIES. Residents shall be encouraged to participate in social, recreational, educational and other activities within the facility and the community. (a) The facility must provide an ongoing activities program. The program must provide diversified individual and group activities in keeping with each resident ' s needs, abilities, and interests. (b) The facility must consult with the residents in selecting, planning, and scheduling activities. The facility must demonstrate residents ' participation through one or more of the following methods: resident meetings, committees, a resident council, suggestion box, group discussions, questionnaires, or any other form of communication appropriate to the size of the facility. (c) Scheduled activities must be available at least 6 days a week for a total of not less than 12 hours per week. Watching television is not an activity for the purpose of meeting the 12 hours per week of scheduled activities unless the television program is a special one-time event of special interest to residents of the facility. A facility whose residents choose to attend day programs conducted at adult day care centers, senior centers, mental health centers, or other day programs may count those attendance hours towards the required 12 hours per week of scheduled activities. An activities calendar must be posted in common areas where residents normally congregate. (d) If residents assist in planning a special activity such as an outing, seasonal festivity, or an excursion, up to 3 hours may be counted toward the required activity time. Interpretive Guidance Surveyor Probe: Make observations of residents. Interview residents and/or family members to confirm that their interests are being considered. ST 0027 Resident Care Arrangement for Health Care Title Resident Care - Arrangement for Health Care Statute or Rule 58A (3) FAC Tag_Type L Regulation Definition (3) ARRANGEMENT FOR HEALTH CARE. In order to facilitate resident access to health care as needed, the facility must: (a) Assist residents in making appointments and remind residents about scheduled appointments for medical, dental, nursing, or mental health services. (b) Provide transportation to needed medical, dental, nursing or mental health services, or arrange for transportation through family and friends, volunteers, taxi cabs, public buses, and agencies providing transportation. (c) The facility may not require residents to receive services from a particular health care provider. Interpretive Guidance Surveyor Probe: Interview residents and family members regarding the assistance that the facility has provided for medical appointments. AHCA ALF Resource Manual Aug

96 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0028 Resident Care Activities of Daily Living Title Resident Care - Activities of Daily Living Statute or Rule 58A (4) FAC Tag_Type L Regulation Definition (4) ACTIVITIES OF DAILY LIVING. Facilities must offer supervision of or assistance with activities of daily living as needed by each resident. Residents should be encouraged to be as independent as possible in performing activities of daily living. Interpretive Guidance Surveyor Probe: Observe and interview residents and/or family members regarding ADL assistance. Also interview staff members related to the level of assistance required by the residents. ST 0029 Resident Care Nursing Services Title Resident Care - Nursing Services Statute or Rule 58A (5) FAC Tag_Type L Regulation Definition (5) NURSING SERVICES. (a) Pursuant to Section , F.S., the facility may employ or contract with a nurse to: 1. Take or supervise the taking of vital signs; 2. Manage pill-organizers and administer medications as described in Rule 58A , F.A.C.; 3. Give prepackaged enemas pursuant to a physician ' s order; and 4. Maintain nursing progress notes. (b) Pursuant to Section (2), F.S., the nursing services listed in paragraph (a) may also be delivered in the facility by family members or friends of the resident provided the family member or friend does not receive compensation for such services. Interpretive Guidance Surveyor Probe: Review personnel records for that appropriate employed or contracted nurse. AHCA ALF Resource Manual Aug

97 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0030 Resident Care Rights & Facility Procedures Title Resident Care - Rights & Facility Procedures Statute or Rule 58A (6) FAC; (1-2) FS Tag_Type L Regulation Definition 58A (6) RESIDENT RIGHTS AND FACILITY PROCEDURES. (a) A copy of the Resident Bill of Rights as described in Section , F.S., or a summary provided by the Long-Term Care Ombudsman Program must be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to Rule 58A , F.A.C. (b) In accordance with Section , F.S., the facility must have a written grievance procedure for receiving and responding to resident complaints, and for residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint. (c) The telephone number for lodging complaints against a facility or facility staff must be posted in full view in a common area accessible to all residents. The telephone numbers are: the Long-Term Care Ombudsman Program, 1(888) ; Disability Rights Florida, 1(800) ; the Agency Consumer Hotline 1(888) , and the statewide toll-free telephone number of the Florida Abuse Hotline, 1(800)96- ABUSE or 1(800) The telephone numbers must be posted in close proximity to a telephone accessible by residents and must be a minimum of 14-point font. (d) The facility must have a written statement of its house rules and procedures that must be included in the admission package provided pursuant to Rule 58A , F.A.C. The rules and procedures must at a minimum address the facility ' s policies regarding: 1. Resident responsibilities; 2. Alcohol and tobacco; 3. Medication storage; 4. Resident elopement; 5. Reporting resident abuse, neglect, and exploitation; 6. Administrative and housekeeping schedules and requirements; 7. Infection control, sanitation, and universal precautions; and 8. The requirements for coordinating the delivery of services to residents by third party providers. (e) Residents may not be required to perform any work in the facility without compensation, unless the facility rules or the facility contract includes a requirement that residents be responsible for cleaning their own sleeping areas or apartments. If a resident is employed by the facility, the resident must be compensated in compliance with state and federal wage laws. (f) The facility must provide residents with convenient access to a telephone to facilitate the resident ' s right to unrestricted and private communication, pursuant to Section (1)(d), F.S. The facility must not prohibit unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there must be, at a minimum, a readily accessible telephone on each floor of each building where residents reside. (g) In addition to the requirements of Section (1)(k), F.S., the use of physical restraints by a facility must be reviewed by the resident ' s physician annually. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint. Interpretive Guidance Resident bill of rights.- (1) No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to: (a) Live in a safe and decent living environment, free from abuse and neglect. AHCA ALF Resource Manual Aug

98 Aspen State Regulation Set: A 4.01 Assisted Living Facility (b) Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy. (c) Retain and use his or her own clothes and other personal property in his or her immediate living quarters, so as to maintain individuality and personal dignity, except when the facility can demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other residents. (d) Unrestricted private communication, including receiving and sending unopened correspondence, access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar situations. (e) Freedom to participate in and benefit from community services and activities and to achieve the highest possible level of independence, autonomy, and interaction within the community. (f) Manage his or her financial affairs unless the resident or, if applicable, the resident's representative, designee, surrogate, guardian, or attorney in fact authorizes the administrator of the facility to provide safekeeping for funds as provided in s (g) Share a room with his or her spouse if both are residents of the facility. (h) Reasonable opportunity for regular exercise several times a week and to be outdoors at regular and frequent intervals except when prevented by inclement weather. (i) Exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, nor any attendance at religious services, shall be imposed upon any resident. (j) Access to adequate and appropriate health care consistent with established and recognized standards within the community. (k) At least 45 days' notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a physician to require an emergency relocation to a facility providing a more skilled level of care or the resident engages in a pattern of conduct that is harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days' notice of a nonemergency relocation or residency termination. Reasons for relocation shall be set forth in writing. In order for a facility to terminate the residency of an individual without notice as provided herein, the facility shall show good cause in a court of competent jurisdiction. (l) Present grievances and recommend changes in policies, procedures, and services to the staff of the facility, governing officials, or any other person without restraint, interference, coercion, discrimination, or reprisal. Each facility shall establish a grievance procedure to facilitate the residents' exercise of this right. This right includes access to ombudsman volunteers and advocates and the right to be a member of, to be active in, and to associate with advocacy or special interest groups. (2) The administrator of a facility shall ensure that a written notice of the rights, obligations, and prohibitions set forth in this part is posted in a prominent place in each facility and read or explained to residents who cannot read.... The notice must state that a complaint made to the Office of State Long-Term Ombudsman or a local long-term care ombudsman council, the names and identity of complainants are kept confidential pursuant to s and that retaliatory action cannot be taken against a resident for presenting grievances or for exercising any other resident right. The facility must ensure a resident's access to a telephone to call the local ombudsman council, central abuse hotmail, and Disability Rights Florida. AHCA ALF Resource Manual Aug

99 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0031 Resident Care Third Party Services Title Resident Care - Third Party Services Statute or Rule 58A (7) FAC Tag_Type L Regulation Definition (7) THIRD PARTY SERVICES. (a) Nothing in this rule chapter is intended to prohibit a resident or the resident ' s representative from independently arranging, contracting, and paying for services provided by a third party of the resident ' s choice, including a licensed home health agency or private nurse, or receiving services through an out-patient clinic, provided the resident meets the criteria for admission and continued residency and the resident complies with the facility ' s policy relating to the delivery of services in the facility by third parties. The facility ' s policies must require the third party to coordinate with the facility regarding the resident ' s condition and the services being provided. (b) When residents require or arrange for services from a third party provider, the facility administrator or designee must allow for the receipt of those services, provided that the resident meets the criteria for admission and continued residency. The facility, when requested by residents or representatives, must coordinate with the provider to facilitate the receipt of care and services provided to meet the particular resident ' s needs. (c) If residents accept the assistance from the facility to arrange and coordinate third party services, the facility ' s assistance does not represent a guarantee that third party services will be received. If the facility ' s efforts to make arrangements for third party services are unsuccessful or declined by residents, the facility must include this documentation in the residents ' record explaining why its efforts were unsuccessful. This documentation will serve to demonstrate its compliance with this subsection. Interpretive Guidance Surveyor Probe: Review as necessary for compliance determination. AHCA ALF Resource Manual Aug

100 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0032 Resident Care Elopement Standards Title Resident Care - Elopement Standards Statute or Rule 58A (8) FAC Tag_Type L Regulation Definition (8) ELOPEMENT STANDARDS. (a) Residents Assessed at Risk for Elopement. All residents assessed at risk for elopement or with any history of elopement must be identified so staff can be alerted to their needs for support and supervision. 1. As part of its resident elopement response policies and procedures, the facility must make, at a minimum, a daily effort to determine that at risk residents have identification on their persons that includes their name and the facility ' s name, address, and telephone number. Staff attention must be directed towards residents assessed at high risk for elopement, with special attention given to those with Alzheimer ' s disease or related disorders assessed at high risk. 2. At a minimum, the facility must have a photo identification of at risk residents on file that is accessible to all facility staff and law enforcement as necessary. The facility ' s file must contain the resident ' s photo identification within 10 days of admission or within 10 days of being assessed at risk for elopement subsequent to admission. The photo identification may be provided by the facility, the resident, or the resident ' s representative. (b) Facility Resident Elopement Response Policies and Procedures. The facility must develop detailed written policies and procedures for responding to a resident elopement. At a minimum, the policies and procedures must provide for: 1. An immediate search of the facility and premises; 2. The identification of staff responsible for implementing each part of the elopement response policies and procedures, including specific duties and responsibilities; 3. The identification of staff responsible for contacting law enforcement, the resident ' s family, guardian, health care surrogate, and case manager if the resident is not located pursuant to subparagraph (8)(b)1.; and 4. The continued care of all residents within the facility in the event of an elopement. (c) Facility Resident Elopement Drills. The facility must conduct and document resident elopement drills pursuant to Sections (1)(a)3. and (1)(l), F.S. Interpretive Guidance Surveyor Probe: Review a sample of residents as necessary for compliance determination. AHCA ALF Resource Manual Aug

101 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0050 Medication Self Administered Medications Title Medication - Self Administered Medications Statute or Rule (2) FS;58A (1) FAC Tag_Type L Regulation Definition (2) Residents who are capable of self-administering their own medications without assistance shall be encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed prescription ' s label or the package directions of an over-the-counter medication, assist a resident whose condition is medically stable with the self-administration of routine, regularly scheduled medications that are intended to be self-administered. Assistance with self-medication by an unlicensed person may occur only upon a documented request by, and the written informed consent of, a resident or the resident ' s surrogate, guardian, or attorney in fact. For the purposes of this section, self-administered medications include both legend and over-the-counter oral dosage forms, topical dosage forms and topical ophthalmic, otic, and nasal dosage forms including solutions, suspensions, sprays, and inhalers. Interpretive Guidance Surveyor Probes: Review a sample of residents as necessary for compliance determination. 58A (1) Pursuant to Sections and , F.S., and this rule, licensed facilities may assist with the self-administration or administration of medications to residents in a facility. A resident may not be compelled to take medications but may be counseled in accordance with this rule. (1) SELF ADMINISTERED MEDICATIONS. (a) Residents who are capable of self-administering their medications without assistance must be encouraged and allowed to do so. (b) If facility staff observes health changes that could reasonably be attributed to the improper self-administration of medication, staff must consult with the resident concerning any problems the resident may be experiencing in self-administering the medications. The consultation should describe the services offered by the facility that aid the resident with medication administration through the use of a pill organizer, through providing assistance with self-administration of medications, or through administering medications. The facility must contact the resident ' s health care provider when observable health changes occur that may be attributed to the resident ' s medications. The facility must document such contacts in the resident ' s records. AHCA ALF Resource Manual Aug

102 ST 0051 Medication Pill Organizers Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Medication - Pill Organizers Statute or Rule 58A (2) FAC Tag_Type L Regulation Definition (2) PILL ORGANIZERS. (a) A " pill organizer " means a container that is designed to hold solid doses of medication and is divided according to day and time increments. (b) A resident who self-administers medications may use a pill organizer. (c) A nurse may manage a pill organizer to be used only by residents who selfadminister medications. The nurse is responsible for instructing the resident in the proper use of the pill organizer. The nurse must manage the pill organizer in the following manner: 1. Obtain the labeled medication container from the storage area or the resident; 2. Transfer the medication from the original container into a pill organizer, labeled with the resident ' s name, according to the day and time increments as prescribed; 3. Return the medication container to the storage area or resident; and 4. Document the date and time the pill organizer was filled in the resident ' s record. (d) If there is a determination that the resident is not taking medications as prescribed after the medicinal benefits are explained, it must be noted in the resident ' s record and the facility must consult with the resident concerning providing assistance with selfadministration or the administration of medications if such services are offered by the facility. The facility must contact the resident ' s health care provider regarding questions, concerns, or observations relating to the resident ' s medications. Such communication must be documented in the resident ' s record Interpretive Guidance Nurse means a licensed practical nurse (LPN), registered nurse (RN), or advanced registered nurse practitioner (ARNP). Surveyor Probes: Ask for names of residents using pill organizers. Review the resident's health assessment, facility's assessment of resident's medication management, and progress notes of those residents to determine they do not need help with their medications. Interview staff to determine if proper steps are followed. If possible, observe a nurse filling a pill organizer. Interview residents regarding use of the pill organizer. If staff have identified a resident who is unable to use their pill organizer properly, what steps are taken? If the pill organizer is spilled, what procedure or steps are followed? When a prescription is changed or a medication discontinued, does nursing staff reload the pill organizer correctly? Are the original prescription bottles or containers retained by the facility or a list kept providing the required information? Does the resident's record note the resident is not taking their medications and the facility consultation with the resident? Does the resident's record document communication with the resident's health care provider, family, guardian or health care surrogate? Is there a pattern to the medications the resident was not taking properly? AHCA ALF Resource Manual Aug

103 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0052 Medication Assistance with Self Admin Title Medication - Assistance with Self-Admin Statute or Rule 58A (3) Tag_Type L Regulation Definition (3) ASSISTANCE WITH SELF-ADMINISTRATION. (a) Any unlicensed person providing assistance with self administration of medication must be 18 years of age or older, trained to assist with self administered medication pursuant to the training requirements of Rule 58A , F.A.C., and must be available to assist residents with self-administered medications in accordance with procedures described in Section , F.S. and this rule. (b) In addition to the specifications of Section (3), F.S., assistance with selfadministration of medication includes verbally prompting a resident to take medications as prescribed. (c) In order to facilitate assistance with self-administration, trained staff may prepare and make available such items as water, juice, cups, and spoons. Trained staff may also return unused doses to the medication container. Medication, which appears to have been contaminated, must not be returned to the container. (d) Trained staff must observe the resident take the medication. Any concerns about the resident ' s reaction to the medication or suspected noncompliance must be reported to the resident ' s health care provider and documented in the resident ' s record. (e) When a resident who receives assistance with medication is away from the facility and from facility staff, the following options are available to enable the resident to take medication as prescribed: 1. The health care provider may prescribe a medication schedule that coincides with the resident ' s presence in the facility; 2. The medication container may be given to the resident, a friend, or family member upon leaving the facility, with this fact noted in the resident ' s medication record; 3. The medication may be transferred to a pill organizer pursuant to the requirements of subsection (2), and given to the resident, a friend, or family member upon leaving the facility, with this fact noted in the resident ' s medication record; or 4. Medications may be separately prescribed and dispensed in an easier to use form, such as unit dose packaging; (f) Assistance with self-administration of medication does not include the activities detailed in Section (4), F.S. 1. As used in Section (4)(h), F.S., the term " competent resident " means that the resident is cognizant of when a medication is required and understands the purpose for taking the medication. 2. As used in Section (4)(i), F.S., the terms " judgment " and " discretion " mean interpreting vital signs and evaluating or assessing a resident ' s condition. Interpretive Guidance AHCA ALF Resource Manual Aug

104 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0053 Medication Administration Title Medication - Administration Statute or Rule 58A (4) FAC Tag_Type L Regulation Definition (4) MEDICATION ADMINISTRATION. (a) For facilities that provide medication administration, a staff member licensed to administer medications must be available to administer medications in accordance with a health care provider ' s order or prescription label. (b) Unusual reactions or a significant change in the resident ' s health or behavior must be documented in the resident ' s record and reported immediately to the resident ' s health care provider. The contact with the health care provider must also be documented in the resident ' s record. (c) Medication administration includes conducting any examination or testing, such as blood glucose testing, or other procedure necessary for the proper administration of medication that the resident cannot conduct personally and that can be performed by licensed staff. (d) A facility that performs clinical laboratory tests for residents, including blood glucose testing, must be in compliance with the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) and Part I of Chapter 483, F.S. A valid copy of the State Clinical Laboratory License, if required, and the federal CLIA Certificate must be maintained in the facility. A state license or federal CLIA certificate is not required if residents perform the test themselves or if a third party assists residents in performing the test. The facility is not required to maintain a State Clinical Laboratory License or a federal CLIA Certificate if facility staff assist residents in performing clinical laboratory testing with the residents ' equipment. Information about the State Clinical Laboratory License and federal CLIA Certificate is available from the Laboratory Unit, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 32, Tallahassee, FL 32308; telephone (850) Interpretive Guidance Surveyor Probe: Medication administration includes conducting any examination or testing such as blood glucose testing or other procedure necessary for the proper administration of medication the resident cannot personally conduct and can only be performed by licensed staff. The Clinical Laboratory Licensure Unit telephone number located in paragraph (d) was changed to when AHCA transitioned to the Voice Over IP (VOIP) telephone system. AHCA ALF Resource Manual Aug

105 ST 0054 Medication Records Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Medication - Records Statute or Rule 58A (5) FAC Tag_Type L Regulation Definition (5) MEDICATION RECORDS. (a) For residents who use a pill organizer managed in subsection (2), the facility must keep either the original labeled medication container; or a medication listing with the prescription number, the name and address of the issuing pharmacy, the health care provider ' s name, the resident ' s name, the date dispensed, the name and strength of the drug, and the directions for use. (b) The facility must maintain a daily medication observation record (MOR) for each resident who receives assistance with self-administration of medications or medication administration. A medication observation record must include the name of the resident and any known allergies the resident may have; the name of the resident ' s health care provider, the health care provider ' s telephone number; the name, strength, and directions for use of each medication; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The medication observation record must be immediately updated each time the medication is offered or administered. (c) For medications that serve as chemical restraints, the facility must, pursuant to Section , F.S., maintain a record of the prescribing physician ' s annual evaluation of the use of the medication. Interpretive Guidance Surveyor Probe: Review the resident's record as necessary to determine compliance. All MORs must be accurate and upto-date. Surveyor Probes: Study the MOR for any omissions, delays, pre-dating of medications. MOR documents reasons for omission of delay. MOR must be signed at time medication is given. Look for medications that are presigned by staff. "Chemical restraint" means a pharmacologic drug that physically limits, restricts, or deprives an individual of movement or mobility, and is used for discipline or convenience and not required for the treatment of medical symptoms. The use of chemical restraints is limited to prescribed dosages of medications authorized by the resident's physician and must be consistent with the resident's diagnosis. Residents who are receiving medications that can serve as chemical restraints must be evaluated by their physician at least annually to assess: 1. The continued need for the medication. 2. The level of the medication in the resident's blood. 3. The need for adjustments in the prescription. See documentation from physician that resident's use of the medication has been assessed or the resident has been seen by a psychiatrist for medication review. AHCA ALF Resource Manual Aug

106 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0055 Medication Storage and Disposal Title Medication - Storage and Disposal Statute or Rule 58A (6) FAC Tag_Type L Regulation Definition (6) MEDICATION STORAGE AND DISPOSAL. (a) In order to accommodate the needs and preferences of residents and to encourage residents to remain as independent as possible, residents may keep their medications, both prescription and over-the-counter, in their possession both on or off the facility premises; or in their rooms or apartments, which must be kept locked when residents are absent, unless the medication is in a secure place within the rooms or apartments or in some other secure place that is out of sight of other residents. However, both prescription and over-the-counter medications for residents must be centrally stored if: 1. The facility administers the medication; 2. The resident requests central storage. The facility must maintain a list of all medications being stored pursuant to such a request; 3. The medication is determined and documented by the health care provider to be hazardous if kept in the personal possession of the person for whom it is prescribed; 4. The resident fails to maintain the medication in a safe manner as described in this paragraph; 5. The facility determines that because of physical arrangements and the conditions or habits of residents, the personal possession of medication by a resident poses a safety hazard to other residents; or 6. The facility ' s rules and regulations require central storage of medication and that policy has been provided to the resident before admission as required in Rule 58A , F.A.C. (b) Centrally stored medications must be: 1. Kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times; 2. Located in an area free of dampness and abnormal temperature, except that a medication requiring refrigeration must be refrigerated. Refrigerated medications must be secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which refrigerator is located locked; 3. Accessible to staff responsible for filling pill-organizers, assisting with self administration, or administering medication. Such staff must have ready access to keys or codes to the medication storage areas at all times; and 4. Kept separately from the medications of other residents and properly closed or sealed. (c) Medication that has been discontinued but has not expired must be returned to the resident or the resident ' s representative, as appropriate, or may be centrally stored by the facility for future use by the resident at the resident ' s request. If centrally stored by the facility, the discontinued medication must be stored separately from medication in current use, and the area in which it is stored must be marked " discontinued medication. " Such medication may be reused if prescribed by the resident ' s health care provider. (d) When a resident ' s stay in the facility has ended, the administrator must return all medications to the resident, the resident ' s family, or the resident ' s guardian unless otherwise prohibited by law. If, after notification and waiting at least 15 days, the resident ' s medications are still at the facility, the medications are considered abandoned and may disposed of in accordance with paragraph (e). (e) Medications that have been abandoned or have expired must be disposed of within 30 days of being determined abandoned or expired and the disposal must be documented in the resident ' s record. The medication may be taken to a pharmacist for disposal or may be destroyed by the administrator or designee with one witness. (f) Facilities that hold a Special-ALF permit issued by the Board of Pharmacy may return dispensed medicinal drugs to the dispensing pharmacy pursuant to Rule 64B , F.A.C. Interpretive Guidance (OTC) products. The term OTC includes, but is not limited to, OTC medications, vitamins, nutritional supplements and nutraceuticals, hereafter referred to as OTC products, which can be sold without a prescription. Surveyor must observe where drugs are stored and note whether the medication cabinet, room, medication cart or other area is locked and the key is out of sight. During the facility tour, observe whether there are drugs visible on counter tops, dressers, night stands, etc. If medications are observed during the tour, this needs to be further explored. Observe whether the resident appears able to be responsible for his/her medication. If not, this should be brought to the attention of the administrator. If not kept secured in resident room or apartment and the resident requests facility courtesy storage, their medications must be centrally stored. Review records of residents who have been discharged for notation of drug disposition in their files. Examine medication cabinets for drugs prescribed for residents who have been discharged or discontinued or for which the medication has expired. AHCA ALF Resource Manual Aug

107 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0056 Medication Labeling and Orders Title Medication - Labeling and Orders Statute or Rule 58A (7) FAC Tag_Type L Regulation Definition (7) MEDICATION LABELING AND ORDERS. (a) The facility may not store prescription drugs for self-administration, assistance with self-administration, or administration unless it is properly labeled and dispensed in accordance with Chapters 465 and 499, F.S., and Rule 64B , F.A.C. If a customized patient medication package is prepared for a resident, and separated into individual medicinal drug containers, then the following information must be recorded on each individual container: 1. The resident ' s name; and 2. Identification of each medicinal drug in the container. (b) Except with respect to the use of pill organizers as described in subsection (2), no individual other than a pharmacist may transfer medications from one storage container to another. (c) If the directions for use are " as needed " or " as directed, " the health care provider must be contacted and requested to provide revised instructions. For an " as needed " prescription, the circumstances under which it would be appropriate for the resident to request the medication and any limitations must be specified; for example, " as needed for pain, not to exceed 4 tablets per day. " The revised instructions, including the date they were obtained from the health care provider and the signature of the staff who obtained them, must be noted in the medication record, or a revised label must be obtained from the pharmacist. (d) Any change in directions for use of a medication for which the facility is providing assistance with self-administration or administering medication must be accompanied by a written medication order issued and signed by the resident ' s health care provider, or a faxed or electronic copy of such order. The new directions must promptly be recorded in the resident ' s medication observation record. The facility may then place an " alert " label on the medication container that directs staff to examine the revised directions for use in the medication observation record, or obtain a revised label from the pharmacist. (e) A nurse may take a medication order by telephone. Such order must be promptly documented in the resident ' s medication observation record. The facility must obtain a written medication order from the health care provider within 10 working days. A faxed or electronic copy of a signed order is acceptable. (f) The facility must make every reasonable effort to ensure that prescriptions for residents who receive assistance with self-administration of medication or medication administration are filled or refilled in a timely manner. (g) Pursuant to Section (5), F.S., and Rule 61N-1.006, F.A.C., sample or complimentary prescription drugs that are dispensed by a health care provider, must be kept in their original manufacturer ' s packaging, which must include the practitioner ' s name, the resident ' s name for whom they were dispensed, and the date they were dispensed. If the sample or complimentary prescription drugs are not dispensed in the manufacturer ' s labeled package, they must be kept in a container that bears a label containing the following: 1. Practitioner ' s name; 2. Resident ' s name; 3. Date dispensed; 4. Name and strength of the drug; 5. Directions for use; and 6. Expiration date. (h) Pursuant to Section (2)(c), F.S., before dispensing any sample or complimentary prescription drug, the resident ' s health care provider must provide the resident with a written prescription, or a faxed or electronic copy of such order. Interpretive Guidance Surveyor Probes: Examine all prescription drugs stored and controlled by the facility to determine they have been ordered by the health care provider and labeled by a licensed pharmacist. Check for out-dated centrally stored prescription medications. Interview staff about unlabeled drugs. Only a nurse may transfer medication into a pill organizer for the management of medications for residents who self-administer. The term "timely manner" can be addressed by the facility in their rules and regulations. When reviewing medications, determine if any need to be refilled. Ask both staff and residents what the facility's procedure is to ensure that dosages are not missed. Do medication records reflect missed dosages? If so, what explanation is provided by staff and/or residents? If family members have the responsibility for ensuring timely refilling of resident prescriptions, did the facility give the resident family member(s) ample notice of need to refill? AHCA ALF Resource Manual Aug

108 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0057 Medication Over The Counter (OTC) Products Title Medication - Over The Counter (OTC) Products Statute or Rule 58A (8) FAC Tag_Type L Regulation Definition (8) OVER THE COUNTER (OTC) PRODUCTS. For purposes of this subsection, the term over the counter includes, but is not limited to, over the counter medications, vitamins, nutritional supplements and nutraceuticals, hereafter referred to as OTC products, that can be sold without a prescription. (a) A stock supply of OTC products for multiple resident use is not permitted in any facility. (b) OTC products, including those prescribed by a health care provider, must be labeled with the resident ' s name and the manufacturer ' s label with directions for use, or the health care provider ' s directions for use. No other labeling requirements are required. (c) Residents or their representatives may purchase OTC products from an establishment of their choice. (d) A health care provider ' s order is required when a nurse provides assistance with self-administration or administration of OTC products. When an order for an OTC product exists, the order must meet the requirements of paragraphs (b) and (c) of this subsection. A health care provider ' s order for OTC products is not required when a resident self-administers his or her medications, or when unlicensed staff provides assistance with self-administration of medications Interpretive Guidance A stock supply of OTC's products for multiple resident use is not permitted because ALFs do not have institutional pharmacy permits. Look for OTC products and determine if a residents name appears or ask reason for the OTC use. When an OTC product is prescribed by a physician, the medication becomes a prescription and must be properly labeled by a pharmacist or physician AHCA ALF Resource Manual Aug

109 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0058 Pharmacy & Dietary; Uncorrected Deficiencies Title Pharmacy & Dietary; Uncorrected Deficiencies Statute or Rule (1-2) FS; 58A-5.033(3)(a) FAC Tag_Type L Regulation Definition Pharmacy and dietary services.- (1) Any assisted living facility in which the agency has documented a class I or class II deficiency or uncorrected class III deficiencies regarding medicinal drugs or over-thecounter preparations, including their storage, use, delivery, or administration, or dietary services, or both, during a biennial survey or a monitoring visit or an investigation in response to a complaint, shall, in addition to or as an alternative to any penalties imposed under s , be required to employ the consultant services of a licensed pharmacist, a licensed registered nurse, or a registered or licensed dietitian, as applicable. The consultant shall, at a minimum, provide onsite quarterly consultation until the inspection team from the agency determines that such consultation services are no longer required. (2) A corrective action plan for deficiencies related to assistance with the selfadministration of medication or the administration of medication must be developed and implemented by the facility within 48 hours after notification of such deficiency, or sooner if the deficiency is determined by the agency to be life-threatening. Interpretive Guidance Surveyor Probe: Verify the presence of the consultant services of a licensed pharmacist, or a licensed registered nurse. 59A-5.033(3) (3) EMPLOYMENT OF A CONSULTANT. (a) Medication Deficiencies. 1. If a class I, class II, or uncorrected class III deficiency directly relating to facility medication practices as established in Rule 58A , F.A.C., is documented by the agency pursuant to an inspection of the facility, the agency must notify the facility in writing that the facility must employ or contract the services of a pharmacist licensed pursuant to Section , F.S., or registered nurse as determined by the agency. 2. After developing and implementing a corrective action plan in compliance with Section (2), F.S., the initial on-site consultant visit must take place within 7 working days of the notice of the class I or II deficiency and within 14 working days of the notice of an uncorrected class III deficiency. The facility must have available for review by the agency a copy of the license of the consultant pharmacist or registered nurse and the consultant ' s signed and dated review of the corrective action plan no later than 10 working days subsequent to the initial on-site consultant visit. 3. The facility must provide the agency with, at a minimum, quarterly on-site corrective action plan updates until the agency determines after written notification by the consultant and facility administrator that deficiencies are corrected and staff has been trained to ensure that proper medication standards are followed and that such consultant services are no longer required. The agency must provide the facility with written notification of such determination. AHCA ALF Resource Manual Aug

110 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0075 Use of Personnel; Emergency Care (AED) Title Use of Personnel; Emergency Care (AED) Statute or Rule (3-5) FS Tag_Type L Regulation Definition (3)(a) An assisted living facility licensed under this part with 17 or more beds shall have on the premises at all times a functioning automated external defibrillator as defined in s (2)(b). (b) The facility is encouraged to register the location of each automated external defibrillator with a local emergency medical services medical director. (c) The provisions of ss and apply to automated external defibrillators within the facility. (4) Facility staff may withhold or withdraw cardiopulmonary resuscitation or the use of an automated external defibrillator if presented with an order not to resuscitate executed pursuant to s The department shall adopt rules providing for the implementation of such orders. Facility staff and facilities shall not be subject to criminal prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct, for withholding or withdrawing cardiopulmonary resuscitation or use of an automated external defibrillator pursuant to such an order and rules adopted by the department. The absence of an order to resuscitate executed pursuant to s does not preclude a physician from withholding or withdrawing cardiopulmonary resuscitation or use of an automated external defibrillator as otherwise permitted by law. (5) The Department of Elderly Affairs may adopt rules to implement the provisions of this section relating to use of an automated external defibrillator. Interpretive Guidance AHCA ALF Resource Manual Aug

111 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0076 Do Not Resuscitate Orders (DNROs) Title Do Not Resuscitate Orders (DNROs) Statute or Rule 58A FAC Tag_Type L Regulation Definition (1) POLICIES AND PROCEDURES. (a) Each assisted living facility must have written policies and procedures that explain its implementation of state laws and rules relative to Do Not Resuscitate Orders (DNROs). An assisted living facility may not require execution of a DNRO as a condition of admission or treatment. The assisted living facility must provide the following to each resident, or resident ' s representative, at the time of admission: 1. Form SCHS , " Health Care Advance Directives - The Patient ' s Right to Decide, " April 2006, or with a copy of some other substantially similar document, which incorporates information regarding advance directives included in Chapter 765, F.S. Form SCHS is available from the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 34, Tallahassee, FL 32308, or the agency ' s Web site at: docs/adv_dir.pdf; and 2. DH Form 1896, Florida Do Not Resuscitate Order Form, December, 2004, which is hereby incorporated by reference. This form may be obtained by calling the Department of Health ' s toll free number (800) , extension 2780 or online at: (b) There must be documentation in the resident ' s record indicating whether a DH Form 1896 has been executed. If a DH Form 1896 has been executed, a yellow copy of that document must be made a part of the resident ' s record. If the assisted living facility does not receive a copy of a resident ' s executed DH Form 1896, the assisted living facility must document in the resident ' s record that it has requested a copy. (c) The executed DH Form 1896 must be readily available to medical staff in the event of an emergency. (2) LICENSE REVOCATION. An assisted living facility ' s license is subject to revocation pursuant to Section , F.S., if, as a condition of treatment or admission, the facility requires an individual to execute or waive DH Form (3) DNRO PROCEDURES. Pursuant to Section , F.S., an assisted living facility must honor a properly executed DH Form 1896 as follows: (a) In the event a resident experiences cardiac or pulmonary arrest, staff trained in cardiopulmonary resuscitation (CPR) or a health care provider present in the facility, may withhold cardiopulmonary resuscitation (artificial ventilation, cardiac compression, endotracheal intubation and defibrillation). (b) In the event a resident is receiving hospice services and experiences cardiac or pulmonary arrest, facility staff must immediately contact hospice staff. The hospice procedures take precedence over those of the assisted living facility. Interpretive Guidance Surveyor Probe: Review policies and procedures for DNROs as necessary for compliance determination. AHCA ALF Resource Manual Aug

112 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0077 Staffing Standards Administrators Title Staffing Standards - Administrators Statute or Rule FS; 58A-5.019(1) FAC Tag_Type L Regulation Definition Notice of change of administrator.-if, during the period for which a license is issued, the owner changes administrators, the owner must notify the agency of the change within 10 days and provide documentation within 90 days that the new administrator has completed the applicable core educational requirements under s Interpretive Guidance Surveyor Probe: Review personnel record as necessary for compliance determination. 58A Staffing Standards. (1) ADMINISTRATORS. Every facility must be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff and the provision of appropriate care to all residents as required by Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter. (a) An administrator must: 1. Be at least 21 years of age; 2. If employed on or after October 30, 1995, have, at a minimum, a high school diploma or G.E.D.; 3. Be in compliance with Level 2 background screening requirements pursuant to Sections and , F.S.; and 4. Complete the core training and core competency test requirements pursuant to Rule 58A , F.A.C., no later than 90 days after becoming employed as a facility administrator. Individuals who have successfully completed these requirements before December 1, 2014, are not required to take either the 40 hour core training or test unless specified elsewhere in this rule. Administrators who attended core training prior to July 1, 1997, are not required to take the competency test unless specified elsewhere in this rule. 5. Satisfy the continuing education requirements pursuant to Rule 58A , F.A.C. Administrators who are not in compliance with these requirements must retake the core training and core competency test requirements in effect on the date the non-compliance is discovered by the agency or the department. (b) In the event of extenuating circumstances, such as the death of a facility administrator, the agency may permit an individual who otherwise has not satisfied the training requirements of subparagraphs (1)(a)4. of this rule to temporarily serve as the facility administrator for a period not to exceed 90 days. During the 90 day period, the individual temporarily serving as facility administrator must: 1. Complete the core training and core competency test requirements pursuant to Rule 58A , F.A.C.; and 2. Complete all additional training requirements if the facility maintains licensure as an extended congregate care or limited mental health facility. (c) Administrators may supervise a maximum of either three assisted living facilities or a group of facilities on a single campus providing housing and health care Administrators who supervise more than one facility must appoint in writing a separate manager for each facility. However, an administrator supervising a maximum of three assisted living facilities, each licensed for 16 or fewer beds and all within a 15 mile radius of each other, is only required to appoint two managers to assist in the operation and maintenance of those facilities. (d) An individual serving as a manager must satisfy the same qualifications, background screening, core training and competency test requirements, and continuing education requirements of an administrator pursuant to paragraph (1)(a) of this rule. Managers who attended the core training program prior to July 1, 1997, are not required to take the competency test unless specified elsewhere in this rule. In addition, a manager may AHCA ALF Resource Manual Aug

113 Aspen State Regulation Set: A 4.01 Assisted Living Facility not serve as a manager of more than a single facility, except as provided in paragraph (1)(c) of this rule, and may not simultaneously serve as an administrator of any other facility. (e) Pursuant to Section , F.S., facility owners must notify the Agency Central Office within 10 days of a change in facility administrator on the Notification of Change of Administrator form, AHCA Form , May 2013, which is incorporated by reference and available online at: ST 0078 Staffing Standards Staff Title Staffing Standards - Staff Statute or Rule 58A-5.019(2) FAC Tag_Type L Regulation Definition (2) STAFF. (a) Within 30 days after beginning employment, newly hired staff must submit a written statement from a health care provider documenting that the individual does not have any signs or symptoms of communicable disease. The examination performed by the health care provider must have been conducted no earlier than 6 months before submission of the statement. Newly hired staff does not include an employee transferring without a break in service from one facility to another when the facility is under the same management or ownership. 1. Evidence of a negative tuberculosis examination must be documented on an annual basis. Documentation provided by the Florida Department of Health or a licensed health care provider certifying that there is a shortage of tuberculosis testing materials, shall satisfy the annual tuberculosis examination requirement. An individual with a positive tuberculosis test must submit a health care provider ' s statement that the individual does not constitute a risk of communicating tuberculosis. 2. If any staff member has, or is suspected of having, a communicable disease, such individual must be immediately removed from duties until a written statement is submitted from a health care provider indicating that the individual does not constitute a risk of transmitting a communicable disease. (b) Staff must be qualified to perform their assigned duties consistent with their level of education, training, preparation, and experience. Staff providing services requiring licensing or certification must be appropriately licensed or certified. All staff must exercise their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident ' s record, and to report the observations to the resident ' s health care provider in accordance with this rule chapter. (c) All staff must comply with the training requirements of Rule 58A , F.A.C. (d) An assisted living facility contracting to provide services to residents must ensure that individuals providing services are qualified to perform their assigned duties in accordance with this rule chapter. The contract between the facility and the staffing agency or contractor must specifically describe the services the staffing agency or contractor will provide to residents. (e) For facilities with a licensed capacity of 17 or more residents, the facility must: 1. Develop a written job description for each staff position and provide a copy of the job description to each staff member; and 2. Maintain time sheets for all staff. (f) Level 2 background screening must be conducted for staff, including staff contracted by the facility to provide services to residents, pursuant to Sections and , F.S. Interpretive Guidance Surveyor Probes: Review a sample of personnel records as necessary for compliance determination. AHCA ALF Resource Manual Aug

114 ST 0079 Staffing Standards Levels Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Staffing Standards - Levels Statute or Rule 58A-5.019(3) FAC Tag_Type L Regulation Definition (3) STAFFING STANDARDS. (a) Minimum staffing: 1. Facilities must maintain the following minimum staff hours per week: Number of ResidentsStaff Hours/Week For every 20 residents over 95 add 42 staff hours per week. 2. Independent living residents as referenced in subsection 58A-5.024(3), F.A.C., who occupy beds included within the licensed capacity of an assisted living facility and who receive no personal, limited nursing, or extended congregate care services, are not counted as a resident for purposes of computing minimum staff hours. 3. At least one staff member who has access to facility and resident records in case of an emergency must be in the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be left solely in charge of other residents while the facility administrator, manager or other staff are absent from the facility. 4. In facilities with 17 or more residents, there must be at least one staff member awake at all hours of the day and night. 5. A staff member who has completed courses in First Aid and Cardiopulmonary Resuscitation (CPR) and holds a currently valid card documenting completion of such courses must be in the facility at all times. a. Documentation of attendance at First Aid or CPR courses offered by an accredited college, university or vocational school; a licensed hospital; the American Red Cross, American Heart Association, or National Safety Council; or a provider approved by the Department of Health, satisfies this requirement. b. A nurse is considered as having met the course requirements for both First Aid and CPR. In addition, an emergency medical technician or paramedic currently certified under Part III, Chapter 401, F.S., is considered as having met the course requirements for both First Aid and CPR. 6. During periods of temporary absence of the administrator or manager of more than 48 hours when residents are on the premises, a staff member who is at least 21 years of age must be physically present and designated in writing to be in charge of the facility. No staff member shall be in charge of a facility for a consecutive period of 21 days or more, or for a total of 60 days within a calendar year, without being an administrator or manager. 7. Staff whose duties are exclusively building or grounds maintenance, clerical, or food preparation do not count towards meeting the minimum staffing hours requirement. Interpretive Guidance Surveyor Probes: Interview staff as necessary to verify staff schedules. Interview residents and/or families regarding staffing. Review schedules as necessary for required elements. AHCA ALF Resource Manual Aug

115 Aspen State Regulation Set: A 4.01 Assisted Living Facility 8. The administrator or manager ' s time may be counted for the purpose of meeting the required staffing hours, provided the administrator or manager is actively involved in the day-to-day operation of the facility, including making decisions and providing supervision for all aspects of resident care, and is listed on the facility ' s staffing schedule. 9. Only on-the-job staff may be counted in meeting the minimum staffing hours. Vacant positions or absent staff may not be counted. (b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities, including those composed of apartments, must have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents ' scheduled and unscheduled service needs, resident contracts, and resident care standards as described in Rule 58A , F.A.C. (c) The facility must maintain a written work schedule that reflects its 24-hour staffing pattern for a given time period. Upon request, the facility must make the daily work schedules of direct care staff available to residents or representatives, for that resident ' s care. (d) The facility must provide staff immediately when the agency determines that the requirements of paragraph (a) are not met. The facility must immediately increase staff above the minimum levels established in paragraph (a) if the agency determines that adequate supervision and care are not being provided to residents, resident care standards described in Rule 58A , F.A.C., are not being met, or that the facility is failing to meet the terms of residents ' contracts. The agency will consult with the facility administrator and residents regarding any determination that additional staff is required. Based on the recommendations of the local fire safety authority, the agency may require additional staff when the facility fails to meet the fire safety standards described in Section (1)(a), F.S., and Rule Chapter 69A-40, F.A.C., until such time as the local fire safety authority informs the agency that fire safety requirements are being met. 1. When additional staff is required above the minimum, the agency will require the submission of a corrective action plan within the time specified in the notification indicating how the increased staffing is to be achieved to meet resident service needs. The plan will be reviewed by the agency to determine if the plan increases the staff to needed levels to meet resident needs. 2. When the facility can demonstrate to the agency that resident needs are being met, or that resident needs can be met without increased staffing, modifications may be made in staffing requirements for the facility and the facility will no longer be required to maintain a plan with the agency. (e) Facilities that are co-located with a nursing home may use shared staffing provided that staff hours are only counted once for the purpose of meeting either assisted living facility or nursing home minimum staffing ratios. (f) Facilities holding a limited mental health, extended congregate care, or limited nursing services license must also comply with the staffing requirements of Rule 58A , 58A-5.030, or 58A-5.031, F.A.C., respectively. AHCA ALF Resource Manual Aug

116 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0080 Training Core & Competency Test Title Training - Core & Competency Test Statute or Rule (1-2) FS; 58A (1) FAC Tag_Type L Regulation Definition (1) Administrators and other assisted living facility staff must meet minimum training and education requirements established by the Department of Elderly Affairs by rule. This training and education is intended to assist facilities to appropriately respond to the needs of residents, to maintain resident care and facility standards, and to meet licensure requirements. (2) The department shall establish a competency test and a minimum required score to indicate successful completion of the training and educational requirements. The competency test must be developed by the department in conjunction with the agency and providers. The required training and education must cover at least the following topics: (a) State law and rules relating to assisted living facilities. (b) Resident rights and identifying and reporting abuse, neglect, and exploitation. (c) Special needs of elderly persons, persons with mental illness, and persons with developmental disabilities and how to meet those needs. (d) Nutrition and food service, including acceptable sanitation practices for preparing, storing, and serving food. (e) Medication management, recordkeeping, and proper techniques for assisting residents with self-administered medication. (f) Firesafety requirements, including fire evacuation drill procedures and other emergency procedures. (g) Care of persons with Alzheimer ' s disease and related disorders. 58A Staff Training Requirements and Competency Test. (1) ASSISTED LIVING FACILITY CORE TRAINING REQUIREMENTS AND COMPETENCY TEST. (a) The assisted living facility core training requirements established by the department pursuant to Section , F.S., shall consist of a minimum of 26 hours of training plus a competency test. (b) Administrators and managers must successfully complete the assisted living facility core training requirements within 3 months from the date of becoming a facility administrator or manager. Successful completion of the core training requirements includes passing the competency test. The minimum passing score for the competency test is 75%. Administrators who have attended core training prior to July 1, 1997, and managers who attended the core training program prior to April 20, 1998, shall not be required to take the competency test. Administrators licensed as nursing home administrators in accordance with Part II of Chapter 468, F.S., are exempt from this requirement. (c) Administrators and managers shall participate in 12 hours of continuing education in topics related to assisted living every 2 years as provided under Section , F.S. (d) A newly hired administrator or manager who has successfully completed the assisted living facility core training and continuing education requirements, shall not be required to retake the core training. An administrator or manager who has successfully completed the core training but has not maintained the continuing education requirements will be considered a new administrator or manager for the purposes of the core training requirements and must: Interpretive Guidance Surveyor Probe: Review personnel records as necessary for compliance determination. AHCA ALF Resource Manual Aug

117 Aspen State Regulation Set: A 4.01 Assisted Living Facility 1. Retake the assisted living facility core training; and 2. Retake and pass the competency test. (e) The fees for the competency test shall not exceed $200. The payment for the competency test fee shall be remitted to the entity administering the test. A new fee is due each time the test is taken ST 0081 Training Staff In Service Title Training - Staff In-Service Statute or Rule 58A (2) FAC Tag_Type L Regulation Definition (2) STAFF IN-SERVICE TRAINING. Facility administrators or managers shall provide or arrange for the following in-service training to facility staff: (a) Staff who provide direct care to residents, other than nurses, certified nursing assistants, or home health aides trained in accordance with Rule 59A , F.A.C., must receive a minimum of 1 hour in-service training in infection control, including universal precautions, and facility sanitation procedures before providing personal care to residents. Documentation of compliance with the staff training requirements of 29 CFR , relating to blood borne pathogens, may be used to meet this requirement. (b) Staff who provide direct care to residents must receive a minimum of 1 hour inservice training within 30 days of employment that covers the following subjects: 1. Reporting major incidents. 2. Reporting adverse incidents. 3. Facility emergency procedures including chain-of-command and staff roles relating to emergency evacuation. (c) Staff who provide direct care to residents, who have not taken the core training program, shall receive a minimum of 1 hour in-service training within 30 days of employment that covers the following subjects: 1. Resident rights in an assisted living facility. 2. Recognizing and reporting resident abuse, neglect, and exploitation. (d) Staff who provide direct care to residents, other than nurses, CNAs, or home health aides trained in accordance with Rule 59A , F.A.C., must receive 3 hours of inservice training within 30 days of employment that covers the following subjects: 1. Resident behavior and needs. 2. Providing assistance with the activities of daily living. (e) Staff who prepare or serve food, who have not taken the assisted living facility core training must receive a minimum of 1-hour-in-service training within 30 days of employment in safe food handling practices. (f) All facility staff shall receive in-service training regarding the facility ' s resident elopement response policies and procedures within thirty (30) days of employment. 1. All facility staff shall be provided with a copy of the facility ' s resident elopement response policies and procedures. 2. All facility staff shall demonstrate an understanding and competency in the implementation of the elopement response policies and procedures. Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination. AHCA ALF Resource Manual Aug

118 ST 0082 Training HIV/AIDS Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Training - HIV/AIDS Statute or Rule 58A (3) FAC Tag_Type L Regulation Definition (3) HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNE DEFICIENCY SYNDROME (HIV/AIDS). Pursuant to Section , F.S., all facility employees, with the exception of employees subject to the requirements of Section , F.S., must complete a one-time education course on HIV and AIDS, including the topics prescribed in the Section , F.S. New facility staff must obtain the training within 30 days of employment. Documentation of compliance must be maintained in accordance with subsection (12) of this rule. Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination. ST 0083 Training First Aid and CPR Title Training - First Aid and CPR Statute or Rule 58A (4) FAC Tag_Type L Regulation Definition (4) FIRST AID AND CARDIOPULMONARY RESUSCITATION (CPR). A staff member who has completed courses in First Aid and CPR and holds a currently valid card documenting completion of such courses must be in the facility at all times. (a) Documentation of attendance at First Aid or CPR course offered by an accredited college, university or vocational school; a licensed hospital; the American Red Cross, American Heart Association, or National Safety Council; or a provider approved by the Department of Health, shall satisfy this requirement. (b) A nurse shall be considered as having met the training requirement for First Aid. An emergency medical technician or paramedic currently certified under Part III of Chapter 401, F.S., shall be considered as having met the training requirements for both First Aid and CPR. Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination AHCA ALF Resource Manual Aug

119 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0084 Training Assis Self Admin Meds & Med Mgmt Title Training - Assis Self-Admin Meds & Med Mgmt Statute or Rule 58A (5) FAC Tag_Type L Regulation Definition (5) ASSISTANCE WITH SELF-ADMINISTERED MEDICATION AND MEDICATION MANAGEMENT. Unlicensed persons who will be providing assistance with self-administered medications as described in Rule 58A , F.A.C., must meet the training requirements pursuant to Section (5), F.S., prior to assuming this responsibility. Courses provided in fulfilment of this requirement must meet the following criteria: (a) Training must cover state law and rule requirements with respect to the supervision, assistance, administration, and management of medications in assisted living facilities; procedures and techniques for assisting the resident with self-administration of medication including how to read a prescription label; providing the right medications to the right resident; common medications; the importance of taking medications as prescribed; recognition of side effects and adverse reactions and procedures to follow when residents appear to be experiencing side effects and adverse reactions; documentation and record keeping; and medication storage and disposal. Training shall include demonstrations of proper techniques and provide opportunities for hands-on learning through practice exercises. (b) The training must be provided by a registered nurse or licensed pharmacist who shall issue a training certificate to a trainee who demonstrates an ability to: 1. Read and understand a prescription label; 2. Provide assistance with self-administration in accordance with Section , F.S., and Rule 58A , F.A.C., including: a. Assist with oral dosage forms, topical dosage forms, and topical ophthalmic, otic and nasal dosage forms; b. Measure liquid medications, break scored tablets, and crush tablets in accordance with prescription directions; c. Recognize the need to obtain clarification of an " as needed " prescription order; d. Recognize a medication order which requires judgment or discretion, and to advise the resident, resident ' s health care provider or facility employer of inability to assist in the administration of such orders; e. Complete a medication observation record; f. Retrieve and store medication; and g. Recognize the general signs of adverse reactions to medications and report such reactions. (c) Unlicensed persons, as defined in Section (1)(b), F.S., who provide assistance with self-administered medications and have successfully completed the initial 4 hour training, must obtain, annually, a minimum of 2 hours of continuing education training on providing assistance with self-administered medications and safe medication practices in an assisted living facility. The 2 hours of continuing education training shall only be provided by a licensed registered nurse, or a licensed pharmacist. Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination AHCA ALF Resource Manual Aug

120 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0085 Training Nutrition & Food Service Title Training - Nutrition & Food Service Statute or Rule 58A (6) FAC Tag_Type L Regulation Definition (6) NUTRITION AND FOOD SERVICE. The administrator or person designated by the administrator as responsible for the facility ' s food service and the day-to-day supervision of food service staff must obtain, annually, a minimum of 2 hours continuing education in topics pertinent to nutrition and food service in an assisted living facility. A certified food manager, licensed dietician, registered dietary technician or health department sanitarians are qualified to train assisted living facility staff in nutrition and food service. Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination ST 0086 Training ADRD Title Training - ADRD Statute or Rule 58A (9) FAC Tag_Type L Regulation Definition (9) ALZHEIMER ' S DISEASE AND RELATED DISORDERS ( " ADRD " ) TRAINING REQUIREMENTS. Facilities which advertise that they provide special care for persons with ADRD, or who maintain secured areas as described in Chapter 4, Section of the Florida Building Code, as adopted in Rule 9N-1.001, F.A.C., Florida Building Code Adopted, must ensure that facility staff receive the following training. (a) Facility staff who have regular contact with or provide direct care to residents with ADRD, shall obtain 4 hours of initial training within 3 months of employment. Completion of the core training program between April 20, 1998 and July 1, 2003 shall satisfy this requirement. Facility staff who meet the requirements for ADRD training providers under paragraph (g) of this subsection will be considered as having met this requirement. " Staff who have regular contact " means staff who interact on a daily basis with residents but do not provide direct care to residents. Initial training, entitled " Alzheimer ' s Disease and Related Disorders Level I Training, " must address the following subject areas: 1. Understanding Alzheimer ' s disease and related disorders; 2. Characteristics of Alzheimer ' s disease; 3. Communicating with residents with Alzheimer ' s disease; 4. Family issues; 5. Resident environment; and 6. Ethical issues. (b) Staff who have received both the initial one hour and continuing three hours of ADRD training pursuant to Sections , , and (1), F.S., shall be considered to have met the initial assisted living facility Alzheimer ' s Disease and Related Disorders Level I Training. (c) Facility staff who provide direct care to residents with ADRD must obtain an additional 4 hours of training, entitled " Alzheimer ' s Disease and Related Disorders Level II Training, " within 9 months of employment. Facility staff who meet the requirements for ADRD training providers under paragraph (g) of this subsection will be considered as having met this requirement. Alzheimer ' s Disease and Related Disorders Level II Training must address the following subject areas as they apply to these disorders: Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination AHCA ALF Resource Manual Aug

121 Aspen State Regulation Set: A 4.01 Assisted Living Facility 1. Behavior management; 2. Assistance with ADLs; 3. Activities for residents; 4. Stress management for the care giver; and 5. Medical information. (d) A detailed description of the subject areas that must be included in an ADRD curriculum which meets the requirements of paragraphs (a) and (b) of this subsection can be found in the document " Training Guidelines for the Special Care of Persons with Alzheimer ' s Disease and Related Disorders, " dated March 1999, incorporated by reference, available from the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida (e) Direct care staff shall participate in 4 hours of continuing education annually as required under Section , F.S. Continuing education received under this paragraph may be used to meet 3 of the 12 hours of continuing education required by Section , F.S., and subsection (1) of this rule, or 3 of the 6 hours of continuing education for extended congregate care required by subsection (7) of this rule. (f) Facility staff who have only incidental contact with residents with ADRD must receive general written information provided by the facility on interacting with such residents, as required under Section , F.S., within three (3) months of employment. " Incidental contact " means all staff who neither provide direct care nor are in regular contact with such residents. (g) Persons who seek to provide ADRD training in accordance with this subsection must provide the department or its designee with documentation that they hold a Bachelor ' s degree from an accredited college or university or hold a license as a registered nurse, and: 1. Have 1 year teaching experience as an educator of caregivers for persons with Alzheimer ' s disease or related disorders; or 2. Three years of practical experience in a program providing care to persons with Alzheimer ' s disease or related disorders; or 3. Completed a specialized training program in the subject matter of this program and have a minimum of two years of practical experience in a program providing care to persons with Alzheimer ' s disease or related disorders. (h) With reference to requirements in paragraph (g), a Master ' s degree from an accredited college or university in a subject related to the content of this training program can substitute for the teaching experience. Years of teaching experience related to the subject matter of this training program may substitute on a year-by-year basis for the required Bachelor ' s degree referenced in paragraph (g). AHCA ALF Resource Manual Aug

122 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0087 Alzheimer's Training Prov & Curriculum Appr Title Alzheimer's Training - Prov & Curriculum Appr Statute or Rule 58A FAC Tag_Type L Regulation Definition (1) The Alzheimer ' s Disease or Related Disorders ( " ADRD " ) training provider and curriculum must be approved by the department or its designee before commencing training activities. The department or its designee will maintain a list of approved ADRD training providers and curricula, which may be obtained from (a) ADRD Training Providers. 1. Individuals who seek to become an ADRD training provider must provide the department or its designee with the documentation of the following educational, teaching, or practical experience: a. A Master ' s degree from an accredited college or university in a health care, human service, or gerontology related field; or b. A Bachelor ' s degree from an accredited college or university, or licensure as a registered nurse, and: (I) Proof of 1 year of teaching experience as an educator of caregivers for individuals with Alzheimer ' s disease or related disorders; or (II) Proof of completion of a specialized training program specifically relating to Alzheimer ' s disease or related disorders, and a minimum of 2 years of practical experience in a program providing direct care to individuals with Alzheimer ' s disease or related disorders; or (III) Proof of 3 years of practical experience in a program providing direct care to persons with Alzheimer ' s disease or related disorders. c. Teaching experience pertaining to Alzheimer ' s disease or related disorders may substitute on a year-by-year basis for the required Bachelor ' s degree. 2. Applicants seeking approval as ADRD training providers must complete DOEA form ALF/ADRD-001, Application for Alzheimer ' s Disease or Related Disorders Training Provider Certification, dated November 2013, which is incorporated by reference and available at the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida and online at: (b) ADRD Training Curricula. Applicants seeking approval of ADRD curricula must complete DOEA form ALF/ADRD-002, Application for Alzheimer ' s Disease or Related Disorders Training Three-Year Curriculum Certification, dated November 2013, which is incorporated by reference and available at the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida and online at Approval of the curriculum will be granted based on how well the curriculum addresses the subject areas referenced in subparagraphs 58A (4)(a)2. and 58A (4)(a)5., F.A.C. Curriculum approval will be granted for 3 years. After 3 years the curriculum must be resubmitted to the department or its designee for approval. (2) Approved ADRD training providers must maintain records of each course taught for a period of 3 years following each training presentation. Course records must include the title of the approved ADRD training curriculum, the curriculum approval number, the number of hours of training, the training provider ' s name and approval number, the date and location of the course, and a roster of trainees. (3) Upon successful completion of training, the trainee must be issued a certificate by the approved training provider. The certificate must include the trainee ' s name, the title of the approved ADRD training, the curriculum approval number, the number of hours of training received, the date and location of the course, the training provider ' s name and approval number, and dated signature. (4) The department or its designee reserves the right to attend and monitor ADRD training courses, review records and course materials approved pursuant to this rule, and Interpretive Guidance AHCA ALF Resource Manual Aug

123 Aspen State Regulation Set: A 4.01 Assisted Living Facility revoke approval for the following reasons: non-adherence to approved curriculum, failing to maintain required training credentials, or knowingly disseminating any false or misleading information. (5) ADRD training providers satisfying the requirements of Section , F.S., relating to nursing homes, and Section , F.S., relating to hospices, will satisfy the Level 1 and Level 2 training provider requirements of subparagraph 58A (4)(a)3. and paragraph 58A (4)(a), subsection (5), F.A.C. ADRD training curricula satisfying the requirements of Section , F.S., relating to nursing homes, and Section , F.S., relating to hospices, will satisfy the Level 1 curriculum requirements of subparagraph 58A (4)(a)3., F.A.C. ST 0088 Alzheimer's/Other Disorders Disclosures Title Alzheimer's/Other Disorders - Disclosures Statute or Rule FS Tag_Type L Regulation Definition Patients with Alzheimer ' s disease or other related disorders; certain disclosures.-a facility licensed under this part which claims that it provides special care for persons who have Alzheimer ' s disease or other related disorders must disclose in its advertisements or in a separate document those services that distinguish the care as being especially applicable to, or suitable for, such persons. The facility must give a copy of all such advertisements or a copy of the document to each person who requests information about programs and services for persons with Alzheimer ' s disease or other related disorders offered by the facility and must maintain a copy of all such advertisements and documents in its records. The agency shall examine all such advertisements and documents in the facility ' s records as part of the license renewal procedure. Interpretive Guidance Surveyor Probes: Review advertisements (yellow pages) and brochures as necessary for compliance determination. AHCA ALF Resource Manual Aug

124 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0089 Alzheimer's/Other Disorders Special Care Title Alzheimer's/Other Disorders - Special Care Statute or Rule FS Tag_Type L Regulation Definition Special care for persons with Alzheimer ' s disease or other related disorders.- (1) A facility which advertises that it provides special care for persons with Alzheimer ' s disease or other related disorders must meet the following standards of operation: (a)1. If the facility has 17 or more residents, have an awake staff member on duty at all hours of the day and night; or 2. If the facility has fewer than 17 residents, have an awake staff member on duty at all hours of the day and night or have mechanisms in place to monitor and ensure the safety of the facility ' s residents. (b) Offer activities specifically designed for persons who are cognitively impaired. (c) Have a physical environment that provides for the safety and welfare of the facility ' s residents. (d) Employ staff who have completed the training and continuing education required in subsection (2). (2)(a) An individual who is employed by a facility that provides special care for residents with Alzheimer ' s disease or other related disorders, and who has regular contact with such residents, must complete up to 4 hours of initial dementia-specific training developed or approved by the department. The training shall be completed within 3 months after beginning employment and shall satisfy the core training requirements of s (2)(g). (b) A direct caregiver who is employed by a facility that provides special care for residents with Alzheimer ' s disease or other related disorders, and who provides direct care to such residents, must complete the required initial training and 4 additional hours of training developed or approved by the department. The training shall be completed within 9 months after beginning employment and shall satisfy the core training requirements of s (2)(g). (c) An individual who is employed by a facility that provides special care for residents with Alzheimer ' s disease or other related disorders, but who only has incidental contact with such residents, must be given, at a minimum, general information on interacting with individuals with Alzheimer ' s disease or other related disorders, within 3 months after beginning employment. (3) In addition to the training required under subsection (2), a direct caregiver must participate in a minimum of 4 contact hours of continuing education each calendar year. The continuing education must include one or more topics included in the dementiaspecific training developed or approved by the department, in which the caregiver has not received previous training. (4) Upon completing any training listed in subsection (2), the employee or direct caregiver shall be issued a certificate that includes the name of the training provider, the topic covered, and the date and signature of the training provider. The certificate is evidence of completion of training in the identified topic, and the employee or direct caregiver is not required to repeat training in that topic if the employee or direct caregiver changes employment to a different facility. The employee or direct caregiver must comply with other applicable continuing education requirements. (5) The department, or its designee, shall approve the initial and continuing education courses and providers. (6) The department shall keep a current list of providers who are approved to provide initial and continuing education for staff of facilities that provide special care for persons with Alzheimer ' s disease or other related disorders. (7) Any facility more than 90 percent of whose residents receive monthly optional supplementation payments is not required to pay for the training and education programs required under this section. A facility that has one or more such residents shall pay a reduced fee that is proportional to the percentage of such residents in the facility. Interpretive Guidance Surveyor Probes: Observe residents and staff for special care activities. Interview staff, residents and/or families as necessary for compliance determination. AHCA ALF Resource Manual Aug

125 Aspen State Regulation Set: A 4.01 Assisted Living Facility A facility that does not have any residents who receive monthly optional supplementation payments must pay a reasonable fee, as established by the department, for such training and education programs. (8) The department shall adopt rules to establish standards for trainers and training and to implement this section. ST 0090 Training Do Not Resuscitate Orders Title Training - Do Not Resuscitate Orders Statute or Rule 58A (11) FAC Tag_Type L Regulation Definition (11) DO NOT RESUSCITATE ORDERS TRAINING. (a) Currently employed facility administrators, managers, direct care staff and staff involved in resident admissions must receive at least one hour of training in the facility ' s policies and procedures regarding DNROs within 60 days after the effective date of this rule. (b) Newly hired facility administrators, managers, direct care staff and staff involved in resident admissions must receive at least one hour of training in the facility ' s policy and procedures regarding DNROs within 30 days after employment. (c) Training shall consist of the information included in Rule 58A , F.A.C. Interpretive Guidance Surveyor Probe: Review as necessary for compliance determination. ST 0091 Training Documentation & Monitoring Title Training - Documentation & Monitoring Statute or Rule 58A (12) FAC Tag_Type L Regulation Definition (12) TRAINING DOCUMENTATION AND MONITORING. (a) Except as otherwise noted, certificates, or copies of certificates, of any training required by this rule must be documented in the facility ' s personnel files. The documentation must include the following: 1. The title of the training program; 2. The subject matter of the training program; 3. The training program agenda; 4. The number of hours of the training program; 5. The trainee ' s name, dates of participation, and location of the training program; 6. The training provider ' s name, dated signature and credentials, and professional license number, if applicable. (b) Upon successful completion of training pursuant to this rule, the training provider must issue a certificate to the trainee as specified in this rule. (c) The facility must provide the Department of Elder Affairs and the Agency for Health Care Administration with training documentation and training certificates for review, as requested. The department and agency reserve the right to attend and monitor all facility in-service training, which is intended to meet regulatory requirements. Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination AHCA ALF Resource Manual Aug

126 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0092 Food Service General Responsibilities Title Food Service - General Responsibilities Statute or Rule 58A-5.020(1) FAC Tag_Type L Regulation Definition (1) GENERAL RESPONSIBILITIES. When food service is provided by the facility, the administrator, or an individual designated in writing by the administrator, must be responsible for total food services and the day-to-day supervision of food services staff. In addition, the following requirements apply: (a) If the designee is an individual who has not completed an approved assisted living facility core training course, such individual must complete the food and nutrition services module of the core training course before assuming responsibility for the facility ' s food service. The designee is not subject to the 1 hour in-service training in safe food handling practices. (b) If the designee is a certified food manager, certified dietary manager, registered or licensed dietitian, dietetic registered technician, or health department sanitarian, the designee is exempt from the requirement to complete the food and nutrition services module of the core training course before assuming responsibility for the facility ' s food service as required in paragraph (1)(a) of this rule. (c) An administrator or designee must perform his or her duties in a safe and sanitary manner. (d) An administrator or designee must provide regular meals that meet the nutritional needs of residents, and therapeutic diets as ordered by the resident ' s health care provider for residents who require special diets. (e) An administrator or designee must comply with the food service continuing education requirements specified in Rule 58A , F.A.C. Interpretive Guidance Surveyor Probe: Review a personnel record as necessary for compliance determination AHCA ALF Resource Manual Aug

127 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0093 Food Service Dietary Standards Title Food Service - Dietary Standards Statute or Rule 58A-5.020(2) FAC Tag_Type L Regulation Definition (2) DIETARY STANDARDS. (a) The meals provided by the assisted living facility must be planned based on the current USDA Dietary Guidelines for Americans, 2010, which are incorporated by reference and available for review at: and the current summary of Dietary Reference Intakes established by the Food and Nutrition Board of the Institute of Medicine of the National Academies, 2010, which are incorporated by reference and available for review at: ion/dris/ New%20Material/5DRI%20Values%20SummaryTables%2014.pdf. Therapeutic diets must meet these nutritional standards to the extent possible. (b) The residents ' nutritional needs must be met by offering a variety of meals adapted to the food habits, preferences, and physical abilities of the residents, and must be prepared through the use of standardized recipes. For facilities with a licensed capacity of 16 or fewer residents, standardized recipes are not required. Unless a resident chooses to eat less, the facility must serve the standard minimum portions of food according to the Dietary Reference Intakes. (c) All regular and therapeutic menus to be used by the facility must be reviewed annually by a licensed or registered dietitian, a licensed nutritionist, or a registered dietetic technician supervised by a licensed or registered dietitian, or a licensed nutritionist to ensure the meals meet the nutritional standards established in this rule. The annual review must be documented in the facility files and include the original signature of the reviewer, registration or license number, and date reviewed. Portion sizes must be indicated on the menus or on a separate sheet. 1. Daily food servings may be divided among three or more meals per day, including snacks, as necessary to accommodate resident needs and preferences. 2. Menu items may be substituted with items of comparable nutritional value based on the seasonal availability of fresh produce or the preferences of the residents. (d) Menus must be dated and planned at least 1 week in advance for both regular and therapeutic diets. Residents must be encouraged to participate in menu planning. Planned menus must be conspicuously posted or easily available to residents. Regular and therapeutic menus as served, with substitutions noted before or when the meal is served, must be kept on file in the facility for 6 months. (e) Therapeutic diets must be prepared and served as ordered by the health care provider. 1. Facilities that offer residents a variety of food choices through a select menu, buffet style dining, or family style dining are not required to document what is eaten unless a health care provider ' s order indicates that such monitoring is necessary. However, the food items that enable residents to comply with the therapeutic diet must be identified on the menus developed for use in the facility. 2. The facility must document a resident ' s refusal to comply with a therapeutic diet and provide notification to the resident ' s health care provider of such refusal. (f) For facilities serving three or more meals a day, no more than 14 hours must elapse between the end of an evening meal containing a protein food and the beginning of a morning meal. Intervals between meals must be evenly distributed throughout the day with not less than 2 hours nor more than 6 hours between the end of one meal and the beginning of the next. For residents without access to kitchen facilities, snacks must be offered at least once per day. Snacks are not considered to be meals for the purposes of calculating the time between meals. (g) Food must be served attractively at safe and palatable temperatures. All residents must be encouraged to eat at tables in the dining areas. A supply of eating ware sufficient for all residents, including adaptive equipment if needed by any resident, must Interpretive Guidance Surveyor Probe: Review menus as necessary for compliance determination. AHCA ALF Resource Manual Aug

128 Aspen State Regulation Set: A 4.01 Assisted Living Facility be on hand. (h) A 3-day supply of nonperishable food, based on the number of weekly meals the facility has contracted with residents to serve, must be on hand at all times. The quantity must be based on the resident census and not on licensed capacity. The supply must consist of foods that can be stored safely without refrigeration. Water sufficient for drinking and food preparation must also be stored, or the facility must have a plan for obtaining water in an emergency, with the plan coordinated with and reviewed by the local disaster preparedness authority ST 0094 Food Service Food Hygiene Title Food Service - Food Hygiene Statute or Rule 58A-5.020(3) FAC Tag_Type L Regulation Definition (3) FOOD HYGIENE. Copies of inspection reports issued by the county health department for the last 2 years pursuant to Rule 64E or Chapter 64E-11, F.A.C., as applicable, depending on the licensed capacity of the assisted living facility, must be on file in the facility. Interpretive Guidance Surveyor Probes: Review reports as necessary for compliance determination. ST 0095 Food Service Contracted Food Service Title Food Service - Contracted Food Service Statute or Rule 58A-5.020(4) FAC Tag_Type L Regulation Definition (4) CANTRACTED FOOD SERVICE. When food service is contracted by the facility, the facility must ensure that the contracted food service meets all dietary standards imposed by this rule and is adequately protected upon delivery to the facility pursuant to subsection 64E (4), F.A.C. The facility must maintain: (a) A copy of the current contract between the facility and the food service contractor. (b) A copy of the annually issued certificate or license authorizing the operation of the food service contractor issued by the applicable regulating agency. The license or certificate must provide documentation of the food service contractor ' s compliance with food service regulatory requirements Interpretive Guidance Surveyor Probes: Review contracts as necessary for compliance determination. AHCA ALF Resource Manual Aug

129 ST 0120 Fiscal Financial Stability Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Fiscal - Financial Stability Statute or Rule (3) FS: (1)58A-5.021(1) FAC Tag_Type L Regulation Definition (3) In addition to the requirements of part II of chapter 408, each facility must report to the agency any adverse court action concerning the facility ' s financial viability, within 7 days after its occurrence. The agency shall have access to books, records, and any other financial documents maintained by the facility to the extent necessary to determine the facility ' s financial stability (1) The administrator or owner of a facility shall maintain accurate business records that identify, summarize, and classify funds received and expenses disbursed and shall use written accounting procedures and a recognized accounting system. 58A (1) FINANCIAL STABILITY. The facility must be administered on a sound financial basis in order to ensure adequate resources to meet resident needs pursuant to the requirements of Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A- 35, F.A.C., and this rule chapter. Interpretive Guidance ST 0123 Fiscal Resident Trust Funds Title Fiscal - Resident Trust Funds Statute or Rule (3-4) FS; 58A-5.021(2) FAC Tag_Type L Regulation Definition (3) A facility, upon mutual consent with the resident, shall provide for the safekeeping in the facility of personal effects not in excess of $500 and funds of the resident not in excess of $500 cash, and shall keep complete and accurate records of all such funds and personal effects received. If a resident is absent from a facility for 24 hours or more, the facility may provide for the safekeeping of the resident ' s personal effects in excess of $500. (4) Any funds or other property belonging to or due to a resident, or expendable for his or her account, which is received by a facility shall be trust funds which shall be kept separate from the funds and property of the facility and other residents or shall be specifically credited to such resident. Such trust funds shall be used or otherwise expended only for the account of the resident. At least once every 3 months, unless upon order of a court of competent jurisdiction, the facility shall furnish the resident and his or her guardian, trustee, or conservator, if any, a complete and verified statement of all funds and other property to which this subsection applies, detailing the amount and items received, together with their sources and disposition. In any event, the facility shall furnish such statement annually and upon the discharge or transfer of a resident. Any governmental agency or private charitable agency contributing funds or other property to the account of a resident shall also be entitled to receive such statement annually and upon the discharge or transfer of the resident. Interpretive Guidance Surveyor Probe: Request accounting of funds as necessary for compliance determination. AHCA ALF Resource Manual Aug

130 Aspen State Regulation Set: A 4.01 Assisted Living Facility 58A (2) RESIDENT TRUST FUNDS. Funds or other property received by the facility belonging to or due a resident, including personal funds, must be held as trust funds and expended only for the resident ' s account. Resident funds or property may be held in one bank account if a separate written accounting for each resident is maintained. A separate bank account is required for facility funds; co-mingling resident funds with facility funds is prohibited. Written accounting procedures for resident trust funds must include income and expense records of the trust fund, including the source and disposition of the funds. ST 0125 Fiscal Surety Bonds Title Fiscal - Surety Bonds Statute or Rule (2) FS; 58A-5.021(3) FAC Tag_Type L Regulation Definition (2) A facility, or an owner, administrator, employee, or representative thereof, may not act as the guardian, trustee, or conservator for any resident of the assisted living facility or any of such resident ' s property. An owner, administrator, or staff member, or representative thereof, may not act as a competent resident ' s payee for social security, veteran ' s, or railroad benefits without the consent of the resident. Any facility whose owner, administrator, or staff, or representative thereof, serves as representative payee for any resident of the facility shall file a surety bond with the agency in an amount equal to twice the average monthly aggregate income or personal funds due to residents, or expendable for their account, which are received by a facility. Any facility whose owner, administrator, or staff, or a representative thereof, is granted power of attorney for any resident of the facility shall file a surety bond with the agency for each resident for whom such power of attorney is granted. The surety bond shall be in an amount equal to twice the average monthly income of the resident, plus the value of any resident ' s property under the control of the attorney in fact. The bond shall be executed by the facility as principal and a licensed surety company. The bond shall be conditioned upon the faithful compliance of the facility with this section and shall run to the agency for the benefit of any resident who suffers a financial loss as a result of the misuse or misappropriation by a facility of funds held pursuant to this subsection. Any surety company that cancels or does not renew the bond of any licensee shall notify the agency in writing not less than 30 days in advance of such action, giving the reason for the cancellation or nonrenewal. Any facility owner, administrator, or staff, or representative thereof, who is granted power of attorney for any resident of the facility shall, on a monthly basis, be required to provide the resident a written statement of any transaction made on behalf of the resident pursuant to this subsection, and a copy of such statement given to the resident shall be retained in each resident ' s file and available for agency inspection. 58A (3) SURETY BONDS. Pursuant to the requirements of Section (2), F.S.: (a) For entities that own more than one facility in the state, one surety bond may be purchased to cover the needs of all residents served by the entities. (b) The following additional bonding requirements apply to facilities serving residents receiving OSS: 1. If serving as representative payee for a resident receiving OSS, the minimum bond proceeds must equal twice the value of the resident ' s monthly aggregate income, which must include any supplemental security income or social security disability income plus the OSS payments, including the personal needs allowance. Interpretive Guidance Surveyor Probe: Review surety bond as necessary for compliance determination. AHCA ALF Resource Manual Aug

131 Aspen State Regulation Set: A 4.01 Assisted Living Facility 2. If holding a power of attorney for a resident receiving OSS, the minimum bond proceeds must equal twice the value of the resident ' s monthly aggregate income, which must include any supplemental security income or social security disability income; the OSS payments, including the personal allowance; plus the value of any property belonging to a resident held at the facility. (c) Upon the annual issuance of a new bond or continuation bond, the facility must file a copy of the bond with the Agency Central Office. ST 0127 Fiscal Liability Insurance Title Fiscal - Liability Insurance Statute or Rule (3) FS; 58A-5.021(4) FAC Tag_Type L Regulation Definition (3) The administrator or owner of a facility shall maintain liability insurance coverage that is in force at all times. 58A (4) LIABILITY INSURANCE. Pursuant to Section , F.S., facilities must maintain liability insurance coverage, as defined in Section , F.S., that remains in force at all times. On the renewal date of the facility ' s policy or whenever a facility changes policies, the facility must file documentation of continued coverage with the Agency Central Office. Such documentation must be issued by the insurance company and must include the name and street address of the facility, a reference that the facility is an assisted living facility, the facility ' s licensed capacity, and the dates of coverage. Interpretive Guidance Surveyor Probe: Review insurance coverage as necessary for compliance determination. ST 0150 Physical Plant New Facilities Title Physical Plant - New Facilities Statute or Rule 58A-5.023(1) FAC Tag_Type L Regulation Definition (1) NEW FACILITIES. Newly constructed facilities to be licensed as assisted living facilities, and existing structures, not previously licensed as assisted living facilities, to be converted to assisted living facilities, as well as any subsequent additions, modifications, alterations, renovations or refurbishing of such facilities, are required by governmental entities other than the Department of Elder Affairs to adhere to certain building code and fire safety standards. Such standards may be found in: (a) Chapter 4, Section 434, of the Florida Building Code as adopted in Rule 61G , F.A.C.; (b) Section , F.S., Uniform Firesafety Standards, and Rule Chapter 69A-40, F.A.C., The Uniform Fire Safety Standards for Assisted Living Facilities; and (c) The National Fire Protection Association codes described in Section , F.S. Interpretive Guidance Surveyor Probe: Observe as necessary for compliance determination, and refer to the Florida Building Code etc. AHCA ALF Resource Manual Aug

132 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0151 Physical Plant Existing Facilities Title Physical Plant - Existing Facilities Statute or Rule 58A-5.023(2) FAC Tag_Type L Regulation Definition (2) EXISTING FACILITIES. (a) An assisted living facility must comply with the rule or building code in effect at the time of initial licensure, as well as the rule or building code in effect at the time of any additions, modifications, alterations, refurbishment, renovations or reconstruction. Determination of the installation of a fire sprinkler system in an existing facility must comply with the requirements described in Section , F.S. (b) A facility undergoing change of ownership is considered an existing facility for purposes of this rule. Interpretive Guidance Surveyor Probe: Observe as necessary for compliance determination, and refer to the Florida Building Code etc. ST 0152 Physical Plant Safe Living Environ/Other Title Physical Plant - Safe Living Environ/Other Statute or Rule 58A-5.023(3) FAC Tag_Type L Regulation Definition (3) OTHER REQUIREMENTS. (a) All facilities must: 1. Provide a safe living environment pursuant to Section (1)(a), F.S.; 2. Be maintained free of hazards; and 3. Ensure that all existing architectural, mechanical, electrical and structural systems, and appurtenances are maintained in good working order. (b) Pursuant to Section , F.S., residents must be given the option of using their own belongings as space permits. When the facility supplies the furnishings, each resident bedroom or sleeping area must have at least the following furnishings: 1. A clean, comfortable bed with a mattress no less than 36 inches wide and 72 inches long, with the top surface of the mattress at a comfortable height to ensure easy access by the resident; 2. A closet or wardrobe space for hanging clothes; 3. A dresser, chest or other furniture designed for storage of clothing or personal effects; 4. A table or nightstand, bedside lamp or floor lamp, and waste basket; and 5. A comfortable chair, if requested. (c) The facility must maintain master or duplicate keys to resident bedrooms to be used in the event of an emergency. (d) Residents who use portable bedside commodes must be provided with privacy during use. (e) Facilities must make available linens and personal laundry services for residents who require such services. Linens provided by a facility must be free of tears, stains and must not be threadbare. Interpretive Guidance Surveyor Probe: Observe and interview resident and staff as necessary for compliance determination. AHCA ALF Resource Manual Aug

133 ST 0160 Records Facility Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Records - Facility Statute or Rule 58A-5.024(1) FAC Tag_Type L Regulation Definition The facility must maintain required records in a manner that makes such records readily available at the licensee ' s physical address for review by a legally authorized entity. If records are maintained in an electronic format, facility staff must be readily available to access the data and produce the requested information. For purposes of this section, " readily available " means the ability to immediately produce documents, records, or other such data, either in electronic or paper format, upon request. (1) FACILITY RECORDS. Facility records must include: (a) The facility ' s license displayed in a conspicuous and public place within the facility. (b) An up-to-date admission and discharge log listing the names of all residents and each resident ' s: 1. Date of admission, the facility or place from which the resident was admitted, and if applicable, a notation indicating that the resident was admitted with a stage 2 pressure sore; and 2. Date of discharge, reason for discharge, and identification of the facility or home address to which the resident was discharged. Readmission of a resident to the facility after discharge requires a new entry in the log. Discharge of a resident is not required if the facility is holding a bed for a resident who is out of the facility but intending to return pursuant to Rule 58A-5.025, F.A.C. If the resident dies while in the care of the facility, the log must indicate the date of death. (c) A log listing the names of all temporary emergency placement and respite care residents if not included on the log described in paragraph (b). (d) The facility ' s emergency management plan, with documentation of review and approval by the county emergency management agency, as described in Rule 58A , F.A.C., that must be readily available by facility staff. (e) The facility ' s liability insurance policy required in Rule 58A-5.021, F.A.C.; (f) For facilities that have a surety bond, a copy of the surety bond currently in effect as required by Rule 58A-5.021, F.A.C. (g) The admission package presented to new or prospective residents (less the resident ' s contract) described in Rule 58A , F.A.C. (h) If the facility advertises that it provides special care for persons with Alzheimer ' s disease or related disorders, a copy of all such facility advertisements as required by Section , F.S. (i) A grievance procedure for receiving and responding to resident complaints and recommendations as described in Rule 58A , F.A.C. (j) All food service records required in Rule 58A-5.020, F.A.C., including menus planned and served and county health department inspection reports. Facilities that contract for food services, must include a copy of the contract for food services and the food service contractor ' s license or certificate to operate. (k) All fire safety inspection reports issued by the local authority or the State Fire Marshal pursuant to Section , F.S., and Rule Chapter 69A-40, F.A.C., issued within the last 2 years. (l) All sanitation inspection reports issued by the county health department pursuant to Section , F.S., and Chapter 64E-12, F.A.C., issued within the last 2 years. (m) Pursuant to Section , F.S., all completed survey, inspection and complaint investigation reports, and notices of sanctions and moratoriums issued by the agency within the last 5 years. (n) The facility ' s resident elopement response policies and procedures. (o) The facility ' s documented resident elopement response drills. (p) For facilities licensed as limited mental health, extended congregate care, or limited nursing services, records required as stated in Rules 58A-5.029, 58A and 58A , F.A.C., respectively. Interpretive Guidance Surveyor Probe: Review a sample of records as necessary for compliance determination. AHCA ALF Resource Manual Aug

134 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0161 Records Staff Title Records - Staff Statute or Rule (2) FS; 58A-5.024(2) FAC Tag_Type L Regulation Definition (2) The administrator or owner of a facility shall maintain personnel records for each staff member which contain, at a minimum, documentation of background screening, if applicable, documentation of compliance with all training requirements of this part or applicable rule, and a copy of all licenses or certification held by each staff who performs services for which licensure or certification is required under this part or rule. Interpretive Guidance Surveyor Probe: Review a sample of personnel records as necessary for compliance determination. 58A (2) STAFF RECORDS. (a) Personnel records for each staff member must contain, at a minimum, a copy of the employment application, with references furnished, and documentation verifying freedom from signs or symptoms of communicable disease. In addition, records must contain the following, as applicable: 1. Documentation of compliance with all staff training and continuing education required by Rule 58A , F.A.C.; 2. Copies of all licenses or certifications for all staff providing services that require licensing or certification; 3. Documentation of compliance with level 2 background screening for all staff subject to screening requirements as specified in Section , F.S., and Rule 58A-5.019, F.A.C.; 4. For facilities with a licensed capacity of 17 or more residents, a copy of the job description given to each staff member pursuant to Rule 58A-5.019, F.A.C.; 5. Documentation verifying direct care staff and administrator participation in resident elopement drills pursuant to paragraph 58A (8)(c), F.A.C. (b) The facility is not required to maintain personnel records for staff provided by a licensed staffing agency or staff employed by an entity contracting to provide direct or indirect services to residents and the facility. However, the facility must maintain a copy of the contract between the facility and the staffing agency or contractor as described in Rule 58A-5.019, F.A.C. (c) The facility must maintain the written work schedules and staff time sheets for the most current 6 months as required by Rule 58A-5.019, F.A.C. AHCA ALF Resource Manual Aug

135 ST 0162 Records Resident Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Records - Resident Statute or Rule 58A-5.024(3) FAC Tag_Type L Regulation Definition (3) RESIDENT RECORDS. Resident records must be maintained on the premises and include: (a) Resident demographic data as follows: 1. Name; 2. Sex; 3. Race; 4. Date of birth; 5. Place of birth, if known; 6. Social security number; 7. Medicaid and/or Medicare number, or name of other health insurance carrier; 8. Name, address, and telephone number of next of kin, legal representative, or individual designated by the resident for notification in case of an emergency; and 9. Name, address, and telephone number of the health care provider and case manager, if applicable. (b) A copy of the Resident Health Assessment form, AHCA Form 1823 described in Rule 58A , F.A.C. (c) Any orders for medications, nursing services, therapeutic diets, do not resuscitate orders, or other services to be provided, supervised, or implemented by the facility that require a health care provider ' s order. (d) Documentation of a resident ' s refusal of a therapeutic diet pursuant to Rule 58A , F.A.C., if applicable. (e) The resident care record described in paragraph 58A (1)(e), F.A.C. (f) A weight record that is initiated on admission. Information may be taken from AHCA Form 1823 or the resident ' s health assessment. Residents receiving assistance with the activities of daily living must have their weight recorded semi-annually. (g) For facilities that will have unlicensed staff assisting the resident with the selfadministration of medication, a copy of the written informed consent described in Rule 58A , F.A.C., if such consent is not included in the resident ' s contract. (h) For facilities that manage a pill organizer, assist with self-administration of medications or administer medications for a resident, copies of the required medication records maintained pursuant to Rule 58A , F.A.C. (i) A copy of the resident ' s contract with the facility, including any addendums to the contract as described in Rule 58A-5.025, F.A.C. (j) For a facility whose owner, administrator, staff, or representative thereof, serves as an attorney in fact for a resident, a copy of the monthly written statement of any transaction made on behalf of the resident as required in Section , F.S. (k) For any facility that maintains a separate trust fund to receive funds or other property belonging to or due a resident, a copy of the quarterly written statement of funds or other property disbursed as required in Section , F.S. (l) If the resident is an OSS recipient, a copy of the Department of Children and Families form Alternate Care Certification for Optional State Supplementation (OSS), CF-ES 1006, October 2005, which is hereby incorporated by reference and available for review at: The absence of this form will not be the basis for administrative action against a facility if the facility can demonstrate that it has made a good faith effort to obtain the required documentation from the Department of Children and Families. (m) Documentation of the appointment of a health care surrogate, health care proxy, guardian, or the existence of a power of attorney, where applicable. (n) For hospice patients, the interdisciplinary care plan and other documentation that the resident is a hospice patient as required in Rule 58A , F.A.C. (o) The resident ' s Do Not Resuscitate Order, DH Form 1896, if applicable. Interpretive Guidance Surveyor Probe: Review a sample of records as necessary for compliance determination. AHCA ALF Resource Manual Aug

136 Aspen State Regulation Set: A 4.01 Assisted Living Facility (p) For independent living residents who receive meals and occupy beds included within the licensed capacity of an assisted living facility, but who are not receiving any personal, limited nursing, or extended congregate care services, record keeping may be limited to the following at the discretion of the facility: 1. A log listing the names of residents participating in this arrangement; 2. The resident demographic data required in this paragraph; 3. The health assessment described in Rule 58A , F.A.C.; 4. The resident ' s contract described in Rule 58A-5.025, F.A.C.; and 5. A health care provider ' s order for a therapeutic diet if such diet is prescribed and the resident participates in the meal plan offered by the facility. (q) Except for resident contracts, which must be retained for 5 years, all resident records must be retained for 2 years following the departure of a resident from the facility unless it is required by contract to retain the records for a longer period of time. Upon request, residents must be provided with a copy of their records upon departure from the facility. (r) Additional resident records requirements for facilities holding a limited mental health, extended congregate care, or limited nursing services license are provided in Rules 58A-5.029, 58A and 58A-5.031, F.A.C., respectively. ST 0163 Records Resident, Penalties for Alteration Title Records - Resident, Penalties for Alteration Statute or Rule FS Tag_Type L Regulation Definition Resident records; penalties for alteration.- (1) Any person who fraudulently alters, defaces, or falsifies any medical or other record of an assisted living facility, or causes or procures any such offense to be committed, commits a misdemeanor of the second degree, punishable as provided in s or s (2) A conviction under subsection (1) is also grounds for restriction, suspension, or termination of license privileges. Interpretive Guidance Surveyor Probe: Review a sample of records as necessary for compliance determination. AHCA ALF Resource Manual Aug

137 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0164 Records Inspection Availability Title Records - Inspection Availability Statute or Rule 58A-5.024(4) FAC Tag_Type L Regulation Definition (4) RECORD INSPECTION. (a) The resident ' s records must be available to the resident; the resident ' s legal representative, designee, surrogate, guardian, attorney in fact, or case manager; or the resident ' s estate, and such additional parties as authorized in writing or by law. (b) Pursuant to Section , F.S., agency reports that pertain to any agency survey, inspection, or monitoring visit must be available to the residents and the public. In facilities that are co-located with a licensed nursing home, the inspection of record for all common areas is the nursing home inspection report. Interpretive Guidance Maintenance of records; reports.- (1) Every facility shall maintain, as public information available for public inspection under such conditions as the agency shall prescribe, records containing copies of all inspection reports pertaining to the facility that have been issued by the agency to the facility. Copies of inspection reports shall be retained in the records for 5 years from the date the reports are filed or issued. (2) Within 60 days after the date of the biennial inspection visit required under s or within 30 days after the date of any interim visit, the agency shall forward the results of the inspection to the local ombudsman council in whose planning and service area, as defined in part II of chapter 400, the facility is located; to at least one public library or, in the absence of a public library, the county seat in the county in which the inspected assisted living facility is located; and, when appropriate, to the district Adult Services and Mental Health Program Offices. (3) Every facility shall post a copy of the last inspection report of the agency for that facility in a prominent location within the facility so as to be accessible to all residents and to the public. Upon request, the facility shall also provide a copy of the report to any resident of the facility or to an applicant for admission to the facility. Surveyor Probe: Review a sample of records as necessary for compliance determination. AHCA ALF Resource Manual Aug

138 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0165 Risk Mgmt & QA; Adverse Incident Report Title Risk Mgmt & QA; Adverse Incident Report Statute or Rule (1-4 & 6-10) FS; 58A FAC Tag_Type L Regulation Definition Internal risk management and quality assurance program; adverse incidents and reporting requirements.- (1) Every facility licensed under this part may, as part of its administrative functions, voluntarily establish a risk management and quality assurance program, the purpose of which is to assess resident care practices, facility incident reports, deficiencies cited by the agency, adverse incident reports, and resident grievances and develop plans of action to correct and respond quickly to identify quality differences. (2) Every facility licensed under this part is required to maintain adverse incident reports. For purposes of this section, the term, " adverse incident " means: (a) An event over which facility personnel could exercise control rather than as a result of the resident ' s condition and results in: 1. Death; 2. Brain or spinal damage; 3. Permanent disfigurement; 4. Fracture or dislocation of bones or joints; 5. Any condition that required medical attention to which the resident has not given his or her consent, including failure to honor advanced directives; 6. Any condition that requires the transfer of the resident from the facility to a unit providing more acute care due to the incident rather than the resident ' s condition before the incident; or 7. An event that is reported to law enforcement or its personnel for investigation; or (b) Resident elopement, if the elopement places the resident at risk of harm or injury. (3) Licensed facilities shall provide within 1 business day after the occurrence of an adverse incident, by electronic mail, facsimile, or United States mail, a preliminary report to the agency on all adverse incidents specified under this section. The report must include information regarding the identity of the affected resident, the type of adverse incident, and the status of the facility ' s investigation of the incident. (4) Licensed facilities shall provide within 15 days, by electronic mail, facsimile, or United States mail, a full report to the agency on all adverse incidents specified in this section. The report must include the results of the facility ' s investigation into the adverse incident. (6) Abuse, neglect, or exploitation must be reported to the Department of Children and Families as required under chapter 415. (7) The information reported to the agency pursuant to subsection (3) which relates to persons licensed under chapter 458, chapter 459, chapter 461, chapter 464, or chapter 465 shall be reviewed by the agency. The agency shall determine whether any of the incidents potentially involved conduct by a health care professional who is subject to disciplinary action, in which case the provisions of s apply. The agency may investigate, as it deems appropriate, any such incident and prescribe measures that must or may be taken in response to the incident. The agency shall review each incident and determine whether it potentially involved conduct by a health care professional who is subject to disciplinary action, in which case the provisions of s apply. (8) If the agency, through its receipt of the adverse incident reports prescribed in this part or through any investigation, has reasonable belief that conduct by a staff member or employee of a licensed facility is grounds for disciplinary action by the appropriate board, the agency shall report this fact to such regulatory board. (9) The adverse incident reports and preliminary adverse incident reports required under this section are confidential as provided by law and are not discoverable or admissible in any civil or administrative action, except in disciplinary proceedings by the agency or appropriate regulatory board. (10) The Department of Elderly Affairs may adopt rules necessary to administer this Interpretive Guidance Surveyor Probe: Review a sample of records as necessary for compliance determination. AHCA ALF Resource Manual Aug

139 section. Aspen State Regulation Set: A 4.01 Assisted Living Facility 58A Adverse Incident Report. (1) INITIAL ADVERSE INCIDENT REPORT. The preliminary adverse incident report required by Section (3), F.S., must be submitted within 1 business day after the incident pursuant to Rule 59A , F.A.C., which requires online reporting. (2) FULL ADVERSE INCIDENT REPORT. For each adverse incident reported in subsection (1) above, the facility must submit a full report within 15 days of the incident. The full report must be submitted pursuant to Rule 59A , F.A.C., which requires online reporting. ST 0166 Risk Mgmt & QA; Liability Claim Report Title Risk Mgmt & QA; Liability Claim Report Statute or Rule (5) FS; 58A FAC Tag_Type L Regulation Definition , FS Internal risk management and quality assurance program; adverse incidents and reporting requirements.- (5) Each facility shall report monthly to the agency any liability claim filed against it. The report must include the name of the resident, the dates of the incident leading to the claim, if applicable, and the type of injury or violation of rights alleged to have occurred. This report is not discoverable in any civil or administrative action, except in such actions brought by the agency to enforce the provisions of this part. Interpretive Guidance Surveyor Probe: Review liability claim report as necessary for compliance determination. 58A Liability Claim Report. (1) MONTHLY LIABILITY CLAIM REPORT. Each assisted living facility must report monthly any liability claim filed against the facility pursuant to Rule 59A , F.A.C., which requires online reporting. Each facility must comply with the reporting time frames and transmission requirements specified in Section (5), F.S. (2) If a liability claim has not been filed against the facility in a given month, no report is required. AHCA ALF Resource Manual Aug

140 ST 0167 Resident Contracts Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Resident Contracts Statute or Rule 58A FAC Tag_Type L Regulation Definition (1) Pursuant to Section , F.S., the facility must offer a contract for execution by the resident or the resident ' s legal representative before or at the time of admission. The contract must contain the following provisions: (a) A list of the specific services, supplies and accommodations to be provided by the facility to the resident, including limited nursing and extended congregate care services that the resident elects to receive; (b) The daily, weekly, or monthly rate; (c) A list of any additional services and charges to be provided that are not included in the daily, weekly, or monthly rates, or a reference to a separate fee schedule that must be attached to the contract; (d) A provision stating that at least 30 days written notice will be given before any rate increase; (e) Any rights, duties, or obligations of residents, other than those specified in Section , F.S.; (f) The purpose of any advance payments or deposit payments, and the refund policy for such advance or deposit payments; (g) A refund policy that must conform to Section (3), F.S.; (h) A written bed hold policy and provisions for terminating a bed hold agreement if a facility agrees in writing to reserve a bed for a resident who is admitted to a nursing home, health care facility, or psychiatric facility. The resident or responsible party must notify the facility in writing of any change in status that would prevent the resident from returning to the facility. Until such written notice is received, the agreed upon daily, weekly, or monthly rate may be charged by the facility unless the resident ' s medical condition prevents the resident from giving written notification, such as when a resident is comatose, and the resident does not have a responsible party to act on the resident ' s behalf; (i) A provision stating whether the facility is affiliated with any religious organization and, if so, which organization and its relationship to the facility; (j) A provision that, upon determination by the administrator or health care provider that the resident needs services beyond those that the facility is licensed to provide, the resident or the resident ' s representative, or agency acting on the resident ' s behalf, must be notified in writing that the resident must make arrangements for transfer to a care setting that is able to provide services needed by the resident. In the event the resident has no one to represent him or her, the facility must refer the resident to the social service agency for placement. If there is disagreement regarding the appropriateness of placement, provisions outlined in Section (8), F.S., will take effect; (k) A provision that residents must be assessed upon admission pursuant to subsection 58A (2), F.A.C., and every 3 years thereafter, or after a significant change, pursuant to subsection (4) of that rule; (l) The facility ' s policies and procedures for self-administration, assistance with selfadministration, and administration of medications, if applicable, pursuant to Rule 58A , F.A.C. This also includes provisions regarding over-the-counter (OTC) products pursuant to subsection (8) of that rule; and (m) The facility ' s policies and procedures related to a properly executed DH Form 1896, Do Not Resuscitate Order. (2) The resident, or the resident ' s representative, must be provided with a copy of the executed contract. (3) The facility may not levy an additional charge for any supplies, services, or accommodations that the facility has agreed by contract to provide as part of the standard daily, weekly, or monthly rate. The resident or resident ' s representative must Interpretive Guidance Surveyor Probe: Review a sample of records as necessary for compliance determination. AHCA ALF Resource Manual Aug

141 Aspen State Regulation Set: A 4.01 Assisted Living Facility be furnished in advance with an itemized written statement setting forth additional charges for any services, supplies, or accommodations available to residents not covered under the contract. An addendum must be added to the resident contract to reflect the additional services, supplies, or accommodations not provided under the original agreement. Such addendum must be dated and signed by the facility and the resident or resident ' s legal representative and a copy given to the resident or resident ' s representative. ST 0180 Emergency Management Title Emergency Management Statute or Rule 58A-5.026(1) FAC Tag_Type L Regulation Definition Emergency Management. (1) EMERGENCY PLAN COMPONENTS. Pursuant to Section , F.S., each facility must prepare a written comprehensive emergency management plan in accordance with the " Emergency Management Criteria for Assisted Living Facilities, " dated October 1995, which is incorporated by reference and available at This document is available from the local emergency management agency. The emergency management plan must, at a minimum, address the following: (a) Provision for all hazards; (b) Provision for the care of residents remaining in the facility during an emergency, including pre-disaster or emergency preparation; protecting the facility; supplies; emergency power; food and water; staffing; and emergency equipment; (c) Provision for the care of residents who must be evacuated from the facility during an emergency including identification of such residents and transfer of resident records; evacuation transportation; sheltering arrangements; supplies; staffing; emergency equipment; and medications; (d) Provision for the care of additional residents who may be evacuated to the facility during an emergency including the identification of such residents, staffing, and supplies; (e) Identification of residents with Alzheimer ' s disease or related disorders, and residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation; (f) Identification of and coordination with the local emergency management agency; (g) Arrangement for post-disaster activities including responding to family inquiries, obtaining medical intervention for residents, transportation, and reporting to the local emergency management agency the number of residents who have been relocated, and the place of relocation; and (h) The identification of staff responsible for implementing each part of the plan. Interpretive Guidance Surveyor Probe: Review the emergency plan as necessary for compliance determination. AHCA ALF Resource Manual Aug

142 ST 0181 Emergency Plan Approval Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Emergency Plan Approval Statute or Rule 58A-5.026(2) FAC Tag_Type L Regulation Definition (2) EMERGENCY PLAN APPROVAL. The plan must be submitted for review and approval to the local emergency management agency. (a) If the local emergency management agency requires revisions to the emergency management plan, such revisions must be made and the plan resubmitted to the local office within 30 days of receiving notification that the plan must be revised. (b) A new facility as described in Rule 58A-5.023, F.A.C., and facilities whose ownership has been transferred, must submit an emergency management plan within 30 days after obtaining a license. (c) The facility must review its emergency management plan on an annual basis. Any substantive changes must be submitted to the local emergency agency for review and approval. 1. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered substantive revisions for the purposes of this rule. 2. Changes in the identification of specific staff must be submitted to the local emergency management agency annually as a signed and dated addendum that is not subject to review and approval. (d) The local emergency management agency is the final administrative authority for emergency management plans prepared by assisted living facilities. (e) Any plan approved by the local emergency management agency is considered to have met all the criteria and conditions established in this rule. Interpretive Guidance Surveyor Probe: Review the plan for approval as necessary for compliance determination. ST 0182 Emergency Mgmt Plan Implementation Title Emergency Mgmt - Plan Implementation Statute or Rule 58A-5.026(3) FAC Tag_Type L Regulation Definition (3) PLAN IMPLEMENTATION. (a) All staff must be trained in their duties and are responsible for implementing the emergency management plan. (b) If telephone service is not available during an emergency, the facility must request assistance from local law enforcement or emergency management personnel in maintaining communication. Interpretive Guidance Surveyor Probe: Interview staff for knowledge as necessary for compliance determination. AHCA ALF Resource Manual Aug

143 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0183 Emergency Mgmt Facility Evacuation Title Emergency Mgmt - Facility Evacuation Statute or Rule 58A-5.026(4) FAC Tag_Type L Regulation Definition (4) FACILITY EVACUATION. The facility must evacuate the premises during or after an emergency if so directed by the local emergency management agency. (a) The facility must report the evacuation to the local office of emergency management or designee and to the agency within 6 hours of the evacuation order. If the evacuation takes more than 6 hours, the facility must report when the evacuation is completed. (b) The facility must not be re-occupied until the area is cleared for reentry by the local emergency management agency or its designee and the facility can meet the immediate needs of the residents. (c) A facility with significant structural damage must relocate residents until the facility can be safely re-occupied. (d) The facility is responsible for knowing the location of all residents until the residents have been relocated to another facility. (e) The facility must provide the agency with the name of a contact person who must be available by telephone 24 hours a day, seven days a week, until the facility is reoccupied. (f) The facility must assist in the relocation of residents, and must cooperate with outreach teams established by the Department of Health or emergency management agency to assist in relocation efforts. Resident needs and preferences must be considered to the extent possible in any relocation decision. Interpretive Guidance Surveyor Probe: Inquire if there has been an evacuation and review as necessary for compliance determination. ST 0184 Emergency Mgmt Emergency Shelter Title Emergency Mgmt - Emergency Shelter Statute or Rule 58A-5.026(5) FAC Tag_Type L Regulation Definition (5) EMERGENCY SHELTER. In the event a state of emergency has been declared and the facility is not required to evacuate the premises, the facility may provide emergency shelter above the facility ' s licensed capacity provided the following conditions are met: (a) Life safety will not be jeopardized for any individual; (b) The immediate needs of residents and other individuals sheltered at the facility can be met by the facility; (c) The facility reports the number of individuals over its licensed capacity and the conditions causing it to the Agency Field Office within 48 hours or as soon as practical. As an alternative, the facility may report to the Agency Central Office at (850) If the facility will continue to be over capacity after the declared emergency ends, the agency will review requests for excess capacity on a case-by-case basis; and (d) The facility maintains a log of the additional individuals being housed in the facility. The log must include the individual ' s name, usual address, and the dates of arrival and departure. The log must be available for review by representatives of the agency, the department, the local emergency management agency or its designee. The admissions and discharge log maintained by the facility may be used for this purpose provided the information is maintained in a manner that is easily accessible. Interpretive Guidance Surveyor Probe: Inquire if there has been an evacuation to an emergency shelter and review as necessary for compliance determination. The Assisted Living Unit (ALU) telephone number located in paragraph (c) was changed to when AHCA transitioned to the Voice Over IP (VOIP) telephone system. AHCA ALF Resource Manual Aug

144 ST 0189 ADCCs in ALF Aspen State Regulation Set: A 4.01 Assisted Living Facility Title ADCCs in ALF Statute or Rule FS (2); 58A (2-3) FAC Tag_Type L Regulation Definition (2) A licensed assisted living facility, a licensed hospital, or a licensed nursing home facility may provide services during the day which include, but are not limited to, social, health, therapeutic, recreational, nutritional, and respite services, to adults who are not residents. Such a facility need not be licensed as an adult day care center; however, the agency must monitor the facility during the regular inspection and at least biennially to ensure adequate space and sufficient staff. If an assisted living facility, a hospital, or a nursing home holds itself out to the public as an adult day care center, it must be licensed as such and meet all standards prescribed by statute and rule. For the purpose of this subsection, the term " day " means any portion of a 24-hour day. The participant capacity shall be determined by the total amount of net floor space available for all of the participants. Centers licensed prior to the effective date of this rule shall provide 30 square feet of net floor area per participant. For centers initially licensed after November 9, 1995, there shall be not less than 45 square feet of net floor area per participant. Centers shall be required to provide additional floor space for special target populations to accommodate activities required by participant care plans. Interpretive Guidance Make observations of participants and what services are being provided, including assistance with medication. Review participant records, including medication observation records. Conduct interviews with participants and/or family members to confirm how much time participants spend at the facility and how participants and/or family members learned of daycare services. Assess the amount of available congregate space in proportion to the number of facility residents and daycare participants. Facilities exempt pursuant to Section , F.S., shall utilize separate space over and above the minimum requirement needed to meet their own licensure certification approval requirements. Only congregate space shall be included in determining minimum space. For purposes of this rule, congregate space shall mean climatically controlled living room, dining room, specialized activity rooms, or other rooms to be commonly used by all participants. 58A (k) AHCA ALF Resource Manual Aug

145 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST 0190 Administrative Enforcement Title Administrative Enforcement Statute or Rule 58A-5.033(1-2) & (3)(b) FAC; (6) Tag_Type L Regulation Definition 58A-5.033(1-2) & (3)(b) FAC Facility staff must cooperate with agency personnel during surveys, complaint investigations, monitoring visits, license application and renewal procedures and other activities necessary to ensure compliance with Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter. (1) ABBREVIATED SURVEY. (a) An applicant for license renewal who does not have any class I or class II violations or uncorrected class III violations, confirmed long-term care ombudsman program complaints, or confirmed licensing complaints within the two licensing periods immediately preceding the current renewal date, is eligible for an abbreviated biennial survey by the agency. For the purpose of this rule, a confirmed long-term care ombudsman program complaint is a complaint that is verified and referred to a regulatory agency for further action. Facilities that do not have two survey reports on file with the agency under current ownership are not eligible for an abbreviated inspection. Upon arrival at the facility, the agency must inform the facility that it is eligible for an abbreviated survey, and that an abbreviated survey will be conducted. (b) Compliance with key quality of care standards described in the following statutes and rules will be used by the agency during its abbreviated survey of eligible facilities: 1. Section , F.S., and Rule 58A , F.A.C., relating to residency criteria; 2. Section , F.S., and Rule 58A-5.021, F.A.C., relating to proper management of resident funds and property; 3. Section , F.S., and Rule 58A , F.A.C., relating to respect for resident rights; 4. Section , F.S., and Rule 58A , F.A.C., relating to the provision of supervision, assistance with the activities of daily living, and arrangement for appointments and transportation to appointments; 5. Section , F.S., and Rule 58A , F.A.C., relating to assistance with or administration of medications; 6. Section , F.S., and Rule 58A-5.019, F.A.C., relating to the provision of sufficient staffing to meet resident needs; 7. Section , F.S., and Rule 58A-5.020, F.A.C., relating to minimum dietary requirements and proper food hygiene; 8. Section , F.S., and Rule 58A-5.029, F.A.C., relating to mental health residents ' community support living plan; 9. Section , F.S., and Rule 58A-5.030, F.A.C., relating to meeting the environmental standards and residency criteria in a facility with an extended congregate care license; and 10. Section , F.S., and Rule 58A-5.031, F.A.C., relating to the provision of care and staffing in a facility with a limited nursing services license. (c) The agency will expand the abbreviated survey or conduct a full survey if violations that threaten or potentially threaten the health, safety, or welfare of residents are identified during the abbreviated survey. The facility must be informed when a full survey will be conducted. If one or more of the following serious problems are identified during an abbreviated survey, a full biennial survey will be immediately conducted: 1. Violations of Rule Chapter 69A-40, F.A.C., relating to firesafety, that threaten the life or safety of a resident; 2. Violations relating to staffing standards or resident care standards that adversely affect the health, safety, or welfare of a resident; 3. Violations relating to facility staff rendering services for which the facility is not licensed; or Interpretive Guidance SURVEYOR PROBE: - Is the ALF cooperative during the survey? Contact your Field Office for any provider that refuses access to the licensed facility, resident records, resident contact, or any other data necessary to determine compliance. - Verify the presence of the consultant registered dietician or licensed dietitian/nutritionist. AHCA ALF Resource Manual Aug

146 Aspen State Regulation Set: A 4.01 Assisted Living Facility 4. Violations relating to facility medication practices that are a threat to the health, safety, or welfare of a resident. (2) SURVEY DEFICIENCY. (a) Before or in conjunction with a notice of violation issued pursuant to Part II, Chapter 408, F.S., and Section , F.S., the agency must issue a statement of deficiency for class I, II, III, and IV violations that are observed by agency personnel during any inspection of the facility. The deficiency statement must be issued within 10 working days of the agency ' s inspection and must include: 1. A description of the deficiency; 2. A citation to the statute or rule violated; and 3. A time frame for the correction of the deficiency. (b) Additional time may be granted to correct specific deficiencies if a written request is received by the agency before the expiration of the time frame included in the agency ' s statement. (3)(b) Dietary Deficiencies. 1. If a class I, II, or uncorrected class III deficiency directly related to dietary standards as established in Rule 58A-5.020, F.A.C., is documented by the agency pursuant to an inspection of the facility, the agency must notify the facility in writing that the facility must employ or contract the services of a registered or licensed dietitian, or a licensed nutritionist. 2. The initial on-site consultant visit must take place within 7 working days of the notice of a class I or II deficiency or within 14 working days of the notice of an uncorrected class III deficiency. The facility must have available for review by the agency a copy of the license or registration of the consultant dietitian or nutritionist and the consultant ' s signed and dated review of the facility ' s corrective action plan, if a plan is required by the agency, no later than 10 working days after the initial on-site consultant visit. 3. If a corrective action plan is required, the facility must provide the agency with, at a minimum, quarterly on-site corrective action plan updates until the agency determines after written notification by the dietary consultant and facility administrator, that deficiencies are corrected and staff has been trained to ensure that proper dietary standards are followed and consultant services are no longer required. The agency must provide the facility with written notification of such determination (6) As provided under s , the agency shall impose an immediate moratorium on an assisted living facility that fails to provide the agency with access to the facility or prohibits the agency from conducting a regulatory inspection. The licensee may not restrict agency staff from accessing and copying records at the agency's expense or from conducting confidential interviews with facility staff or any individual who receives services from the facility AHCA ALF Resource Manual Aug

147 ST E200 ECC Licensing Aspen State Regulation Set: A 4.01 Assisted Living Facility Title ECC - Licensing Statute or Rule 58A-5.030(1) FAC Tag_Type L Regulation Definition (1) LICENSING. (a) Any facility intending to establish extended congregate care services must obtain a license from the agency before accepting residents needing extended congregate care services. (b) Only the portion of a facility that meets the physical requirements of subsection (3) and is staffed in accordance with subsection (4) is considered licensed to provide extended congregate care services to residents who meet the admission and continued residency requirements of this rule. Interpretive Guidance SURVEYOR PROBE: In order for ECC services to be provided in a facility, the agency must first determine that all requirements in law and rule are met. TOUR THE ALF: Does the ECC facility shall provide a homelike physical environment which promotes resident privacy and independence? ST E201 ECC Policies Title ECC - Policies Statute or Rule 58A-5.030(2) FAC Tag_Type L Regulation Definition (2) EXTENDED CONGREGATE CARE POLICIES. Policies and procedures established through extended congregate care services must promote resident independence, dignity, choice, and decision-making. The facility must develop and implement specific written policies and procedures that address: (a) Aging in place; (b) The facility ' s residency criteria developed in accordance with the admission and discharge requirements described in subsection (5) and extended congregate care services listed in subsection (8); (c) The personal and supportive services the facility intends to provide, how the services will be provided, and the identification of staff positions to provide the services including their relationship to the facility; (d) The nursing services the facility intends to provide, identification of staff positions to provide nursing services, and the license status, duties, general working hours, and supervision of such staff; (e) Identifying potential unscheduled resident service needs and mechanisms for meeting those needs including the identification of resources to meet those needs; (f) A process for mediating conflicts among residents regarding choice of room or apartment and roommate; and (g) How to involve residents in decisions concerning the resident. The services must provide opportunities and encouragement for the resident to make personal choices and decisions. If a resident needs assistance to make choices or decisions, a family member or other resident representative must be consulted. Choices must include at a minimum whether: 1. To participate in the process of developing, implementing, reviewing, and revising the resident ' s service plan; 2. To remain in the same room in the facility, except that a current resident transferring into an extended congregate care services may be required to move to the part of the facility licensed for extended congregate care, if only part of the facility is so licensed; 3. To select among social and leisure activities; Interpretive Guidance SURVEYOR PROBE: Aging in Place means the process of providing increased or adjusted services to a person to compensate for the physical or mental decline that may occur with the aging process, in order to maximize the person ' s dignity and independence and permit them to remain in a familiar non-institutional, residential environment for as long as possible. Such services may be provided by facility staff, or friends, or through contractual arrangements with a third party. AHCA ALF Resource Manual Aug

148 Aspen State Regulation Set: A 4.01 Assisted Living Facility 4. To participate in activities in the community. At a minimum the facility must arrange transportation to such activities if requested by the resident; and 5. To provide input with respect to the adoption and amendment of facility policies and procedures. ST E202 ECC Physical Site Requirements Title ECC - Physical Site Requirements Statute or Rule 58A-5.030(3) FAC Tag_Type L Regulation Definition (3) PHYSICAL SITE REQUIREMENTS. Each extended congregate care facility must provide a homelike physical environment that promotes resident privacy and independence including: (a) A private room or apartment, or a semi private room or apartment, shared with a roommate of the resident ' s choice. The entry door to the room or apartment must have a lock that is operable from the inside by the resident with no key needed. The resident must be provided with a key to the entry door on request. The resident ' s service plan may allow for a non locking entry door if the resident ' s safety would otherwise be jeopardized; and (b) A bathroom, with a toilet, sink, and bathtub or shower, that is shared by a maximum of 4 residents for a maximum ratio of 4 residents to 1 bathroom. 1. A centrally located hydro-massage bathtub may substitute for a bathtub or shower and be considered equivalent to two bathrooms, increasing the resident to bathroom ratio from four-to-one to eight-to-one. The substitution of a centrally located hydromassage bathtub for a bathtub or shower that increases the resident to bathroom ratio above four-to-one may occur only once in a facility. The one time substitution of a centrally located hydro-massage bathtub does not preclude the installation of multiple hydro-massage bathtubs in the facility. The limitation applies only to the one-time reduction in the total number of bathrooms in the facility. 2. Th entry door to the bathroom must have a lock that the resident can operate from the inside with no key needed. The resident ' s service plan may allow for a non-locking bathroom door if the resident ' s safety would otherwise be jeopardized. Interpretive Guidance SURVEYOR PROBE: Tour the ALF (including resident rooms with their permission) and observe for a homelike environment. Interview the residents regarding their satisfaction with the physical environment. Do the residents feel the ALF environment promotes privacy and independence? AHCA ALF Resource Manual Aug

149 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST E203 ECC Staffing Requirements Title ECC - Staffing Requirements Statute or Rule 58A-5.030(4) FAC Tag_Type L Regulation Definition (4) STAFFING REQUIREMENTS. The following staffing requirements apply for extended congregate care services: (a) Supervision by an administrator who has a minimum of two years of managerial, nursing, social work, therapeutic recreation, or counseling experience in a residential, long-term care, or acute care setting or agency serving elderly or disabled persons. If an administrator appoints a manager as the supervisor of an extended congregate care facility, both the administrator and manager must satisfy the requirements of subsection 58A-5.019(1), F.A.C. 1. A baccalaureate degree may be substituted for one year of the required experience. 2. A nursing home administrator licensed under Chapter 468, F.S., is qualified under this paragraph. (b) Provide staff or contract the services of a nurse who must be available to provide nursing services, participate in the development of resident service plans, and perform monthly nursing assessments for extended congregate care residents. (c) Provide enough qualified staff to meet the needs of extended congregate care residents in accordance with Rule 58A-5.019, F.A.C., and to provide the services established in each resident ' s service plan. (d) Ensure that adequate staff is awake during all hours to meet the scheduled and unscheduled needs of residents. (e) Immediately provide additional or appropriately qualified staff, when the agency determines that service plans are not being followed or that residents ' needs are not being met because insufficient staffing, in accordance with the staffing standards established in Rule 58A-5.019, F.A.C. (f) Ensure and document that staff receive extended congregate care training as required in Rule 58A , F.A.C. Interpretive Guidance SURVEYOR PROBES: Interview the ECC supervisor and determine the scope of their responsibility. Review personnel records to establish that the administrator and ECC supervisor meet the minimum education/experience requirement. Verify Nursing Services where provided by a licensed nurse. Review the resident's service plans and observe resident care/services to determine if the ALF has sufficient qualified staff to carry out the plan. Interview the ECC residents/families regarding the availability of staff to ensure the service plans are implemented. AHCA ALF Resource Manual Aug

150 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST E204 ECC Admissions & Continued Residency Title ECC - Admissions & Continued Residency Statute or Rule (10); (3)b ; 58A-5.030(5) Tag_Type L Regulation Definition (10) Facilities licensed to provide extended congregate care services shall promote aging in place by determining appropriateness of continued residency based on a comprehensive review of the resident ' s physical and functional status; the ability of the facility, family members, friends, or any other pertinent individuals or agencies to provide the care and services required; and documentation that a written service plan consistent with facility policy has been developed and implemented to ensure that the resident ' s needs and preferences are addressed. Interpretive Guidance SURVEYOR PROBE: - OBSERVE ECC RESIDENTS and determine if they meet the admission and continued residency requirements. for ECC - Interview ECC residents and verify what services the ALF is providing (3)b... The primary purpose of extended congregate care services is to allow residents the option of remaining in a familiar setting from which they would otherwise be disqualified for continued residency as they become more impaired. A facility licensed to provide extended congregate care services may also admit an individual who exceeds the admission criteria for a facility with a standard license, if he or she is determined appropriate for admission to the extended congregate care facility. 58A (5) ADMISSION AND CONTINUED RESIDENCY. (a) An individual must meet the following minimum criteria in order to receive extended congregate care services. 1. Be at least 18 years of age; 2. Be free from signs and symptoms of a communicable disease that is likely to be transmitted to other residents or staff; however, an individual who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that he or she would otherwise be eligible for admission according to this rule; 3. Be able to transfer, with assistance if necessary. The assistance of more than one individual is permitted; 4. Not be a danger to self or others as determined by a health care provider or mental health practitioner licensed under Chapters 490 or 491, F.S.; 5. Not be bedridden; 6. Not have any stage 3 or 4 pressure sores; 7. Not require any of the following nursing services: a. Oral or nasopharyngeal suctioning; b. Nasogastric tube feeding; c. Monitoring of blood gases; d. Intermittent positive pressure breathing therapy; e. Skilled rehabilitative services as described in Rule 59G-4.290, F.A.C.; or f. Treatment of a surgical incision, unless the surgical incision and the condition that caused it have been stabilized and a plan of care developed; 8. Not require 24-hour nursing supervision; and 9. Have been determined to be appropriate for admission to the facility by the facility administrator or manager. The administrator or manager must base his or her decision on: a. An assessment of the strengths, needs, and preferences of the individual, the health assessment required by subsection (6) of this rule, and the preliminary service plan developed in subsection (7); b. The facility ' s residency criteria, and services offered or arranged for by the facility to meet resident needs; and AHCA ALF Resource Manual Aug

151 Aspen State Regulation Set: A 4.01 Assisted Living Facility c. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in Section , F.S., and Rule Chapter 69A-40, F.A.C. (b) Criteria for continued residency in an extended congregate care services must be the same as the criteria for admission, except as specified below. 1. A resident may be bedridden for up to 14 consecutive days. 2. A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the following conditions are met: a. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice that coordinates and ensures the provision of any additional care and services that may be needed; b. Continued residency is agreeable to the resident and the facility; c. An interdisciplinary care plan, which specifies the services being provided by hospice and those being provided by the facility, is developed and implemented by a licensed hospice in consultation with the facility; and d. Documentation of the requirements of subparagraph (5)(b)2. is maintained in the resident ' s file. 3. The extended congregate care administrator or manager is responsible for monitoring the appropriateness of continued residency of a resident in extended congregate care services at all times. 4. A hospice resident that meets the qualifications of continued residency pursuant to this rule may only receive services from the assisted living facility ' s staff within the scope of the facility ' s license. 5. Staff may provide any nursing service permitted under the facility ' s license and total help with the activities of daily living for residents admitted to hospice. Staff may not exceed the scope of their professional licensure or training in any licensed assisted living facility. ST E205 ECC Health Assessment Title ECC - Health Assessment Statute or Rule 58A-5.030(6) FAC Tag_Type L Regulation Definition (6) HEALTH ASSESSMENT. Before receiving extended congregate care services, all persons. including residents transferring within the same facility to that portion of the facility licensed to provide extended congregate care services, must be examined by a health care provider pursuant to Rule 58A , F.A.C. A health assessment conducted no more than 60 days before receiving extended congregate care services meets this requirement. Once receiving services, a new health assessment must be obtained at least annually. Interpretive Guidance SURVEYOR PROBE: Review the Health Assessments and determine if they reflect an examination by a physician or advanced registered nurse practitioner. (see AHCA 1823 effective October 2010) AHCA ALF Resource Manual Aug

152 ST E206 ECC Service Plans Aspen State Regulation Set: A 4.01 Assisted Living Facility Title ECC - Service Plans Statute or Rule 58A-5.030(7) FAC Tag_Type L Regulation Definition (7) SERVICE PLANS. (a) Before receiving services, the extended congregate care administrator or manager must develop a preliminary service plan that includes an assessment of whether the resident meets the facility ' s residency criteria, an appraisal of the resident ' s unique physical, psychological and social needs and preferences, and an evaluation of the facility ' s ability to meet the resident ' s needs. (b) Within 14 days of receiving services, the extended congregate care administrator or manager must coordinate the development of a written service plan that takes into account the resident ' s health assessment obtained pursuant to subsection (6); the resident ' s unique physical, psychological and social needs and preferences; and how the facility will meet the resident ' s needs including the following if required: 1. Health monitoring; 2. Assistance with personal care services; 3. Nursing services; 4. Supervision; 5. Special diets; 6. Ancillary services; 7. The provision of other services such as transportation and supportive services; and 8. The manner of service provision, and identification of service providers, including family and friends, in keeping with resident preferences. (c) Pursuant to the definitions of " shared responsibility " and " managed risk " as provided in Section , F.S., the service plan must be developed and agreed upon by the resident or the resident ' s representative or designee, surrogate, guardian, or attorney-in-fact, and must reflect the responsibility and right of the resident to consider options and assume risks when making choices pertaining to the resident ' s service needs and preferences. (d) The service plan must be reviewed and updated quarterly to reflect any changes in the manner of service provision, accommodate any changes in the resident ' s physical or mental status, or pursuant to recommendations for modifications in the resident ' s care as documented in the nursing assessment. Interpretive Guidance SURVEYOR PROBE: Review resident service plans for evidence of the required elements. OBSERVE RESIDENT CARE AND SERVICES PROVIDED. Interview the resident or their representatives to determine if they participated in the development of the plan. (Shared Responsibility) Is there evidence the service plans were reviewed and updated quarterly? Do they reflect the resident ' s current needs? AHCA ALF Resource Manual Aug

153 ST E207 ECC Services Aspen State Regulation Set: A 4.01 Assisted Living Facility Title ECC - Services Statute or Rule 58A-5.030(8) FAC Tag_Type L Regulation Definition (8) EXTENDED CONGREGATE CARE SERVICES. All services must be provided in the least restrictive environment, and in a manner that respects the resident ' s independence, privacy, and dignity. (a) A facility providing extended congregate care services may provide supportive services including social service needs, counseling, emotional support, networking, assistance with securing social and leisure services, shopping service, escort service, companionship, family support, information and referral, assistance in developing and implementing self-directed activities, and volunteer services. Family or friends must be encouraged to provide supportive services for residents. The facility must provide training for family or friends to enable them to provide supportive services in accordance with the resident ' s service plan. (b) A facility providing extended congregate care services must make available the following additional services if required by the resident ' s service plan: 1. Total help with bathing, dressing, grooming and toileting; 2. Nursing assessments conducted more frequently than monthly; 3. Measurement and recording of basic vital functions and weight; 4. Dietary management including provision of special diets, monitoring nutrition, and observing the resident ' s food and fluid intake and output; 5. Assistance with self-administered medications, or the administration of medications and treatments pursuant to a health care provider ' s order. If the individual needs assistance with self-administration the facility must inform the resident of the qualifications of staff who will be providing this assistance, and if unlicensed persons will be providing such assistance, obtain the resident ' s or the resident ' s surrogate, guardian, or attorney-in-fact ' s informed written consent to provide such assistance as required in Section , F.S.; 6. Supervision of residents with dementia and cognitive impairments; 7. Health education and counseling and the implementation of health-promoting programs and preventive regimes; 8. Provision or arrangement for rehabilitative services; and 9. Provision of escort services to health-related appointments. (c) Nursing staff providing extended congregate care services may provide any nursing service permitted within the scope of their license consistent with the residency requirements of this rule and the facility ' s written policies and procedures, provided the nursing services are: 1. Authorized by a health care provider ' s order and pursuant to a plan of care; 2. Medically necessary and appropriate for treatment of the resident ' s condition; 3. In accordance with the prevailing standard of practice in the nursing community; 4. A service that can be safely, effectively, and efficiently provided in the facility; 5. Recorded in nursing progress notes; and 6. In accordance with the resident ' s service plan. (d) At least monthly, or more frequently if required by the resident ' s service plan, a nursing assessment of the resident must be conducted. Interpretive Guidance SURVEYOR PROBE: OBSERVE RESIDENT CARE AND SERVICES. Interview residents or their representatives. Does the ECC program meet the resident ' s needs? Verify nursing services were provided by a licensed nurse as defined under Chapter 464, F.S. Is there evidence of nursing assessments? AHCA ALF Resource Manual Aug

154 ST E208 ECC Records Aspen State Regulation Set: A 4.01 Assisted Living Facility Title ECC - Records Statute or Rule 58A-5.030(9) FAC Tag_Type L Regulation Definition (9) RECORDS. In addition to the records required in Rule 58A-5.024, F.A.C., a facility providing extended congregate care services must maintain the following: (a) The service plans for each resident receiving extended congregate care services; (b) The nursing progress notes for each resident receiving nursing services; (c) Nursing assessments; and (d) The facility ' s extended congregate care policies and procedures. Interpretive Guidance SURVYOR PROBE: Does the service plan include the required elements? ST E209 ECC Discharge Title ECC - Discharge Statute or Rule 58A-5.030(10) FAC Tag_Type L Regulation Definition (10) DISCHARGE. If the facility and the resident are unable to agree on a service plan, the facility is unable to meet the resident ' s needs as identified in the service plan, or the resident no longer meets the criteria for continued residency, the resident must be discharged or relocated in accordance with Sections and , F.S. Interpretive Guidance SURVEYOR PROBE: At least 45 days ' notice of relocation or termination of residency. (refer to Resident Bill of Rights) ST E210 ECC Training Title ECC - Training Statute or Rule 58A (7) FAC Tag_Type L Regulation Definition (7) EXTENDED CONGREGATE CARE TRAINING. (a) The administrator and extended congregate care supervisor, if different from the administrator, must complete core training and 4 hours of initial training in extended congregate care prior to the facility ' s receiving its extended congregate care license or within 3 months of beginning employment in the facility as an administrator or ECC supervisor. Successful completion of the assisted living facility core training shall be a prerequisite for this training. ECC supervisors who attended the assisted living facility core training prior to April 20, 1998, shall not be required to take the assisted living facility core training competency test. (b) The administrator and the extended congregate care supervisor, if different from the administrator, must complete a minimum of 4 hours of continuing education every two years in topics relating to the physical, psychological, or social needs of frail elderly and disabled persons, or persons with Alzheimer ' s disease or related disorders. (c) All direct care staff providing care to residents in an extended congregate care program must complete at least 2 hours of in-service training, provided by the facility administrator or ECC supervisor, within 6 months of beginning employment in the facility. The training must address extended congregate care concepts and requirements, including statutory and rule requirements, and delivery of personal care and supportive services in an extended congregate care facility. Interpretive Guidance SURVEYOR PROBE: Review the ALF training records for the administrator, ECC supervisor and direct care staff for required training. AHCA ALF Resource Manual Aug

155 ST L240 LMH Licensing Aspen State Regulation Set: A 4.01 Assisted Living Facility Title LMH - Licensing Statute or Rule Tag_Type L Regulation Definition Limited mental health license.-an assisted living facility that serves one or more mental health residents must obtain a limited mental health license. Interpretive Guidance Surveyor Probe: Review ALF license to validate LMH service capability. Interview the administrator and residents and review resident records to identify which residents are mental health residents. ST L241 LMH Records Title LMH - Records Statute or Rule (3-4); 58A-5.029(2) FAC Tag_Type L Regulation Definition (3) A facility that has a limited mental health license must: (a) Have a copy of each mental health resident's community living support plan and the cooperative agreement with the mental health care services provider or provide written evidence that a request for the community living support plan and the cooperative agreement was sent to the Medicaid managed care plan or managing entity under contract with the Department of Children and Families within 72 hours after admission. The support plan and the agreement may be combined. (b) Have documentation provided by the department that each mental health resident has been assessed and determined to be able to live in the community in an assisted living facility that has with a limited mental health license or provide written evidence that a request for documentation was sent to the department within 72 hours after admission. (c) Make the community living support plan available for inspection by the resident, the resident's legal guardian or, the resident's health care surrogate, and other individuals who have a lawful basis for reviewing this document. (d) Assist the mental health resident in carrying out the activities identified in the resident's community living support plan. (4) A facility that has with a limited mental health license may enter into a cooperative agreement with a private mental health provider. For purposes of the limited mental health license, the private mental health provider may act as the case manager. 58A (2) RECORDS. (a) A facility with a limited mental health license must maintain an up-to-date admission and discharge log containing the names and dates of admission and discharge for all mental health residents. The admission and discharge log required in Rule 58A-5.024, F.A.C., satisfies this condition provided that all mental health residents are clearly identified. (b) Staff records must contain documentation that designated staff have completed limited mental health training as required by Rule 58A , F.A.C. (c) Resident records must include: Interpretive Guidance SURVEYOR PROBES: Review the admission and discharge log to verify Limited Mental Health residents Review supportive documentation provided by the Department of Children and Family Services that the support the resident meets the criteria for Limited Mental Health. Review the Community Living Support Plan for scope of services the Limited Mental Health Resident is to receive. Interview the Limited Mental Health resident to assess their knowledge of their Community Living Support Plan. NOTE: the Community Living Support Plan is primarily the responsibility of the resident ' s mental health case manager. AHCA ALF Resource Manual Aug

156 Aspen State Regulation Set: A 4.01 Assisted Living Facility 1. Documentation, provided by a mental health care provider within 30 days of the resident ' s admission to the facility, that the resident is a mental health resident as defined in Section , F.S., and that the resident is receiving social security disability or supplemental security income and optional state supplementation as follows: a. An affirmative statement on the Alternate Care Certification for Optional State Supplementation (OSS) form, CF-ES 1006, October 2005, which is hereby incorporated by reference and available for review at: that the resident is receiving SSI or SSDI due to a psychiatric disorder; b. Written verification provided by the Social Security Administration that the resident is receiving SSI or SSDI for a mental disorder. Such verification may be acquired from the Social Security Administration upon obtaining a release from the resident permitting the Social Security Administration to provide such information ; or c. A written statement from the resident ' s case manager or other mental health care provider that the resident is an adult with severe and persistent mental disorder. The case manager or other mental health care provider must consider the following minimum criteria in making that determination: (I) The resident is eligible for, is receiving, or has received mental health services within the last 5 years; or (II) The resident has been diagnosed as having a severe or persistent mental disorder. 2. An appropriate placement assessment provided by the resident ' s mental health care provider within 30 days of admission to the facility that the resident has been assessed and found appropriate for residence in an assisted living facility. Such assessment must be conducted by a psychiatrist, clinical psychologist, clinical social worker, psychiatric nurse, or an individual supervised by one of these professionals. a. Any of the following documentation that contains the name of the resident and the name, signature, date, and license number, if applicable, of the person making the assessment, meets this requirement: (I) Completed Alternate Care Certification for Optional State Supplementation (OSS) form, CF-ES Form 1006; (II) Discharge Statement from a state mental hospital completed no more than 90 days before admission to the assisted living facility provided it contains a statement that the individual is appropriate to live in an assisted living facility; or (III) Other signed statement that the resident has been assessed and found appropriate for residency in an assisted living facility. b. A mental health resident returning to a facility from treatment in a hopsital or crisis stabilization unit will not be considered a new admission and will not require a new assessment. However, a break in a resident ' s residency that requires the facility to execute a new resident contract or admission agreement will be considered a new admission and the resident ' s mental health care provider must provide a new assessment. AHCA ALF Resource Manual Aug

157 Aspen State Regulation Set: A 4.01 Assisted Living Facility 3. A Community Living Support Plan. a. Each mental health resident and the resident ' s mental health case manager must, in consultation with the facility administrator, prepare a plan within 30 days of the resident ' s admission to the facility or within 30 days after receiving the appropriate placement assessment in paragraph (2)(c), whichever is later, that: (I) Includes the specific needs of the resident that must be met in order to enable the resident to live in the assisted living facility and the community; (II) Includes the clinical mental health services to be provided by the mental health care provider to help meet the resident ' s needs, and the frequency and duration of such services; (III) Includes any other services and activities to be provided by or arranged for by the mental health care provider or mental health case manager to meet the resident ' s needs, and the frequency and duration of such services and activities; (IV) Includes the obligations of the facility to facilitate and assist the resident in attending appointments and arranging transportation to appointments for the services and activities identified in the plan that have been provided or arranged for by the resident ' s mental health care provider or case manager; (V) Includes a description of other services to be provided or arranged by the facility; (VI) Includes a list of factors pertinent to the care, safety, and welfare of the mental health resident and a description of the signs and symptoms particular to the resident that indicate the immediate need for professional mental health services; (VII) Is in writing and signed by the mental health resident, the resident ' s mental health case manager, and the assisted living facility administrator or manager and a copy placed in the resident ' s file. If the resident refuses to sign the plan, the resident ' s mental health case manager must add a statement that the resident was asked but refused to sign the plan; (VIII) Is updated at least annually; (IX) May include the Cooperative Agreement described in subparagraph (2)(c)4. If included, the mental health care provider must also sign the plan; and (X) Must be available for inspection to those who have legal authority to review the document. b. Those portions of a service or treatment plan prepared pursuant to Rule 65E-4.014, F.A.C., that address all the elements listed in sub-subparagraph (2)(c)3.a. above may be substituted. 4. Cooperative Agreement. The mental health care provider for each mental health resident and the facility administrator or designee must prepare a written statement, within 30 days of the resident ' s admission to the facility or receipt of the resident ' s appropriate placement assessment, whichever is later. The statement: a. Provides procedures and directions for accessing emergency and after-hours care for the mental health resident. The provider must furnish the resident and the facility with the provider ' s 24-hour emergency crisis telephone number; b. Must be signed by the administrator or designee and the mental health care provider, or by a designated representative of a Medicaid prepaid health plan if the resident is on a plan and the plan provides behavioral health services in Section , F.S.; c. May cover all mental health residents of the facility who are clients of the same provider; and d. May be included in the Community Living Support Plan described in subparagraph (2)(c)3. Missing documentation will not be the basis for administrative action against a facility if the facility can demonstrate that it has made a good faith effort to obtain the required documentation from the Department of Children and Families, or the mental health care provider. AHCA ALF Resource Manual Aug

158 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST L242 LMH Responsibilities of Facility Title LMH - Responsibilities of Facility Statute or Rule (2) FS; 58A-5.029(3) FAC Tag_Type L Regulation Definition (2) Facilities licensed to provide services to mental health residents shall provide appropriate supervision and staffing to provide for the health, safety, and welfare of such residents. (3d) Assist the mental health resident in carrying out the activities identified in the individual ' s community living support plan (3) RESPONSIBILITIES OF FACILITY. In addition to the staffing and care standards of this rule chapter to provide for the welfare of residents in an assisted living facility, a facility holding a limited mental health license must: (a) Meet the facility ' s obligation to assist the resident in carrying out the activities identified in the Community Living Support Plan; (b) Provide an opportunity for private face-to-face contact between the mental health resident and the resident ' s mental health case manager or other treatment personnel of the resident ' s mental health care provider; (c) Observe resident behavior and functioning in the facility, and record and communicate observations to the resident ' s mental health case manager or mental health care provider regarding any significant behavioral or situational changes that may signify the need for a change in the resident ' s professional mental health services, supports, and services described in the community living support plan, or that the resident is no longer appropriate for residency in the facility; (d) If the facility initiates an involuntary mental health examination pursuant to Section , F.S., the facility must document the circumstances leading to the initiation of the examination; (e) Ensure that designated staff have completed limited mental health training as required by Rule 58A , F.A.C.; and (e) Maintain facility, staff, and resident records in accordance with the requirements of this rule chapter. Interpretive Guidance SURVEYOR PROBE: Is the ALF assisting the resident in carrying out the activities identified in the Community Living Support Plan? Does the ALF ensure privacy for the resident and their mental health case manager? AHCA ALF Resource Manual Aug

159 ST L243 LMH Training Aspen State Regulation Set: A 4.01 Assisted Living Facility Title LMH - Training Statute or Rule (1) FS; 58A (8) FAC Tag_Type L Regulation Definition (1) To obtain a limited mental health license, a facility must hold a standard license as an assisted living facility, must not have any current uncorrected deficiencies or violations, and must ensure that, within 6 months after receiving a limited mental health license, the facility administrator and the staff of the facility who are in direct contact with mental health residents must complete training of no less than 6 hours related to their duties. Such designation may be made at the time of initial licensure or relicensure or upon request in writing by a licensee under this part and part II of chapter 408. Notification of approval or denial of such request shall be made in accordance with this part, part II of chapter 408, and applicable rules. This training will be provided by or approved by the Department of Children and Families. Interpretive Guidance SURVEYOR PROBE: Review personnel files to determine compliance with the required training. Is the training provided or approved by the Department of Children and Families? 58A (8) LIMITED MENTAL HEALTH TRAINING. (a) Pursuant to Section , F.S., the administrator, managers and staff, who have direct contact with mental health residents in a licensed limited mental health facility, must receive the following training: 1. A minimum of 6 hours of specialized training in working with individuals with mental health diagnoses. a. The training must be provided or approved by the Department of Children and Families and must be taken within 6 months of the facility ' s receiving a limited mental health license or within 6 months of employment in a limited mental health facility. b. Staff in " direct contact " means direct care staff and staff whose duties take them into resident living areas and require them to interact with mental health residents on a daily basis. The term does not include maintenance, food service or administrative staff, if such staff have only incidental contact with mental health residents. c. Training received under this subparagraph may count once for 6 of the 12 hours of continuing education required for administrators and managers pursuant to Section (4), F.S., and subsection (1) of this rule. 2. A minimum of 3 hours of continuing education, which may be provided by the ALF administrator or through distance learning, biennially thereafter in subjects dealing with one or more of the following topics: a. Mental health diagnoses; and b. Mental health treatment such as mental health needs, services, behaviors and appropriate interventions; resident progress in achieving treatment goals; how to recognize changes in the resident ' s status or condition that may affect other services received or may require intervention; and crisis services and the Baker Act procedures. 3. For administrators and managers, the continuing education requirement under this subsection will satisfy 3 of the 12 hours of continuing education required biennially pursuant to Section (4), F.S., and subsection (1) of this rule. 4. Administrators, managers and direct contact staff affected by the continuing education requirement under this subsection shall have up to 6 months after the effective date of this rule to meet the training requirement. (b) Administrators, managers and staff do not have to repeat the initial training should they change employers provided they present a copy of their training certificate to the current employer for retention in the facility ' s personnel files. They must also ensure that copies of the continuing education training certificates, pursuant to subparagraph (a)2. of this subsection, are retained in their personnel files. AHCA ALF Resource Manual Aug

160 ST N275 LNS Licensing Aspen State Regulation Set: A 4.01 Assisted Living Facility Title LNS - Licensing Statute or Rule 58A FAC Tag_Type L Regulation Definition Limited Nursing Services. Any facility intending to provide limited nursing services obtain a license from the agency. Interpretive Guidance Surveyor Probe: Review the posted license in the facility to ensure LNS designation. ST N276 LNS Nursing Services Title LNS - Nursing Services Statute or Rule 58A-5.031(1) FAC Tag_Type L Regulation Definition Any facility intending to provide limited nursing services obtain a license from the agency. (1) NURSING SERVICES. A facility with a limited nursing services license may provide the following nursing services in addition to any nursing service permitted under a standard license pursuant to Section , F.S. (a) Conducting passive range of motion exercises. (b) Applying ice caps or collars. (c) Applying heat, including dry heat, hot water bottle, heating pad, aquathermia, moist heat, hot compresses, sitz bath and hot soaks. (d) Cutting the toenails of diabetic residents or residents with a documented circulatory problem if the written approval of the resident ' s health care provider has been obtained. (e) Performing ear and eye irrigations. (f) Conducting a urine dipstick test. (g) Replacing of an established self-maintained indwelling urinary catheter, or inserting an intermittent urinary catheter. (h) Performing digital stool removal therapies. (i) Applying and changing routine dressings that do not require packing or irrigation, but are for abrasions, skin tears and closed surgical wounds. (j) Caring for stage 2 pressure sores. Caring for stage 3 or 4 pressure sores is not permitted by a facility with a limited nursing services license. (k) Caring for casts, braces and splints. Caring for head braces, such as a halo is not permitted by a facility with a limited nursing services license. (l) Conducting nursing assessments if conducted by a registered nurse or under the direct supervision of a registered nurse. (m) Providing any nursing service permitted under the facility ' s license and total help with the activities of daily living for residents admitted to hospice as described in subsection 58A (4), F.A.C.; however, staff may not exceed the scope of their professional licensure. (n) Assisting, applying, caring for and monitoring the application of anti-embolism stockings or hosiery as prescribed by the health care provider and in accordance with the manufacturers ' guidelines. (o) Administration and regulation of portable oxygen. (p) Applying, caring for and monitoring a transcutaneous electric nerve stimulator (TENS). (q) Catheter, colostomy, ileostomy care and maintenance. Interpretive Guidance Surveyor Probe: Observe resident care and services. Interview residents or their representatives regarding the nursing services provided. AHCA ALF Resource Manual Aug

161 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST N277 LNS Resident Care Standards Title LNS - Resident Care Standards Statute or Rule 58A-5.031(2) FAC Tag_Type L Regulation Definition (2) RESIDENT CARE STANDARDS. (a) A resident receiving limited nursing services in a facility holding only a standard and limited nursing services license must meet the admission and continued residency criteria specified in Rule 58A , F.A.C. (b) In accordance with Rule 58A-5.019, F.A.C., the facility must employ sufficient and qualified staff to meet the needs of residents requiring limited nursing services based on the number of such residents and the type of nursing service to be provided. (c) Limited nursing services may only be provided as authorized by a health care provider ' s order, a copy of which must be maintained in the resident ' s file. (d) Facilities licensed to provide limited nursing services must employ or contract with a nurse(s) who must be available to provide such services as needed by residents. The facility must maintain documentation of the qualifications of nurses providing limited nursing services in the facility ' s personnel files. (e) The facility must ensure that nursing services are conducted and supervised in accordance with Chapter 464, F.S., and the prevailing standard of practice in the nursing community. Interpretive Guidance Surveyor Probe: Observe resident care and services. Verify nursing services are provided based on authorization from a health care provider (MD/PA/ARNP). If concerns, contact the health care provider for clarification of orders. Is there a qualified nurse to ensure the provision of the ordered services? ST N278 LNS Records Title LNS - Records Statute or Rule 58A-5.031(3) FAC Tag_Type L Regulation Definition (3) RECORDS. (a) A record of all residents receiving limited nursing services and the type of services provided must be maintained. (b) Nursing progress notes must be maintained for each resident who receives limited nursing services. (c) A nursing assessment conducted at least monthly must be maintained on each resident who receives a limited nursing service. Interpretive Guidance AHCA ALF Resource Manual Aug

162 ST Z800 Applicability; Definitions Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Applicability; Definitions Statute or Rule , 59A , 59A (1) Tag_Type L Regulation Definition Applicability.- The provisions of this part apply to the provision of services that require licensure as defined in this part and to the following entities licensed, registered, or certified by the agency, as described in chapters 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765: Interpretive Guidance (1) Laboratories authorized to perform testing under the Drug-Free Workplace Act, as provided under ss and (2) Birth centers, as provided under chapter 383. (3) Abortion clinics, as provided under chapter 390. (4) Crisis stabilization units, as provided under parts I and IV of chapter 394. (5) Short-term residential treatment facilities, as provided under parts I and IV of chapter 394. (6) Residential treatment facilities, as provided under part IV of chapter 394. (7) Residential treatment centers for children and adolescents, as provided under part IV of chapter 394. (8) Hospitals, as provided under part I of chapter 395. (9) Ambulatory surgical centers, as provided under part I of chapter 395. (10) Mobile surgical facilities, as provided under part I of chapter 395. (11) Health care risk managers, as provided under part I of chapter 395. (12) Nursing homes, as provided under part II of chapter 400. (13) Assisted living facilities, as provided under part I of chapter 429. (14) Home health agencies, as provided under part III of chapter 400. (15) Nurse registries, as provided under part III of chapter 400. (16) Companion services or homemaker services providers, as provided under part III of chapter 400. (17) Adult day care centers, as provided under part III of chapter 429. (18) Hospices, as provided under part IV of chapter 400. (19) Adult family-care homes, as provided under part II of chapter 429. (20) Homes for special services, as provided under part V of chapter 400. (21) Transitional living facilities, as provided under part V of chapter 400. (22) Prescribed pediatric extended care centers, as provided under part VI of chapter 400. (23) Home medical equipment providers, as provided under part VII of chapter 400. (24) Intermediate care facilities for persons with developmental disabilities, as provided under part VIII of chapter 400. (25) Health care services pools, as provided under part IX of chapter 400. (26) Health care clinics, as provided under part X of chapter 400. (27) Clinical laboratories, as provided under part I of chapter 483. (28) Multiphasic health testing centers, as provided under part II of chapter 483. (29) Organ, tissue, and eye procurement organizations, as provided under part V of chapter Definitions.-As used in this part, the term: (1) "Agency" means the Agency for Health Care Administration, which is the licensing agency under this part. (2) "Applicant" means an individual, corporation, partnership, firm, association, or governmental entity that submits an application for a license to the agency. (3) "Authorizing statute" means the statute authorizing the licensed operation of a provider listed in s and includes chapters 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765. AHCA ALF Resource Manual Aug

163 Aspen State Regulation Set: A 4.01 Assisted Living Facility (4) "Certification" means certification as a Medicare or Medicaid provider of the services that require licensure, or certification pursuant to the federal Clinical Laboratory Improvement Amendment (CLIA). (5) "Change of ownership" means: (a) An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or (b) An event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned. This paragraph does not apply to a licensee that is publicly traded on a recognized stock exchange. A change solely in the management company or board of directors is not a change of ownership. (6) "Client" means any person receiving services from a provider listed in s (7) "Controlling interest" means: (a) The applicant or licensee; (b) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater ownership interest in the applicant or licensee; or (c) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater ownership interest in the management company or other entity, related or unrelated, with which the applicant or licensee contracts to manage the provider. The term does not include a voluntary board member. (8) "License" means any permit, registration, certificate, or license issued by the agency. (9) "Licensee" means an individual, corporation, partnership, firm, association, governmental entity, or other entity that is issued a permit, registration, certificate, or license by the agency. The licensee is legally responsible for all aspects of the provider operation. (10) "Moratorium" means a prohibition on the acceptance of new clients. (11) "Provider" means any activity, service, agency, or facility regulated by the agency and listed in s (12) "Services that require licensure" means those services, including residential services, that require a valid license before those services may be provided in accordance with authorizing statutes and agency rules. (13) "Voluntary board member" means a board member or officer of a not-for-profit corporation or organization who serves solely in a voluntary capacity, does not receive any remuneration for his or her services on the board of directors, and has no financial interest in the corporation or organization. 59A Definitions. (1) "Address of record" means the location that is printed on the license and is the address at which the provider is licensed to operate. In the event a license displays multiple locations including branch offices, satellite offices, or off-site locations, the address of record is the main or principle office address. (2) "Agency notification" or "Agency request" means the Agency sends notification by: (a) Mail or personal delivery to the address of record for a licensee or applicant, (b) Mail to an alternative mailing address if requested by the licensee or applicant, or (c) Electronic mail if an electronic mail address has been provided. (3) "Days" means calendar days. (4) "Management company" means an entity retained by a licensee to administer or direct the operation of a provider. This does not include an entity that serves solely as a lender or lien holder. 59A Background Screening. (1) Definitions: (a) "Arrest Report" means the detailed narrative written by the arresting law enforcement officer explaining the circumstances of the arrest. AHCA ALF Resource Manual Aug

164 Aspen State Regulation Set: A 4.01 Assisted Living Facility (b) "Disposition" means the sentencing or other final settlement of a criminal case which shall include, regardless of adjudication, a plea of nolo contendere or guilty, or a conviction by a judge or jury. (c) "Disqualifying Offense" means any criminal offense prohibited in Section or (5), F.S. (d) "Exemption from Disqualification" means an exemption granted by the Agency following a review of the Application for Exemption, AHCA Form , September 2013, hereby incorporated by reference, and an informal hearing, if appropriate, during which the individual must present clear and convincing evidence to support a reasonable belief that he or she has been rehabilitated and does not present a danger to the health, safety, and welfare of the patient or individual as described in Section , F.S. (e) "FBI" means the Federal Bureau of Investigation. (f) "FDLE" means the Florida Department of Law Enforcement. (g) "Level 2 Screening" means an assessment of the criminal history record obtained through a fingerprint search through the FDLE and FBI to determine whether screened individuals have any disqualifying offenses pursuant to Section or (5), F.S. An analysis and review of court dispositions and arrest reports may be required to make a final determination. (h) "Livescan Service Provider" means an entity that scans fingerprints electronically and submits them to FDLE. ST Z802 License or Application Denial; Revocation Title License or Application Denial; Revocation Statute or Rule FS Tag_Type L Regulation Definition License or application denial; revocation.- (1) In addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest: (a) False representation of a material fact in the license application or omission of any material fact from the application. (b) An intentional or negligent act materially affecting the health or safety of a client of the provider. (c) A violation of this part, authorizing statutes, or applicable rules. (d) A demonstrated pattern of deficient performance. (e) The applicant, licensee, or controlling interest has been or is currently excluded, suspended, or terminated from participation in the state Medicaid program, the Medicaid program of any other state, or the Medicare program. (2) If a licensee lawfully continues to operate while a denial or revocation is pending in litigation, the licensee must continue to meet all other requirements of this part, authorizing statutes, and applicable rules and file subsequent renewal applications for licensure and pay all licensure fees. The provisions of ss (1) and (3)(c) do not apply to renewal applications filed during the time period in which the litigation of the denial or revocation is pending until that litigation is final. (3) An action under s or denial of the license of the transferor may be grounds for denial of a change of ownership application of the transferee. (4) Unless an applicant is determined by the agency to satisfy the provisions of subsection Interpretive Guidance AHCA ALF Resource Manual Aug

165 Aspen State Regulation Set: A 4.01 Assisted Living Facility (5) for the action in question, the agency shall deny an application for a license or license renewal based upon any of the following actions of an applicant, a controlling interest of the applicant, or any entity in which a controlling interest of the applicant was an owner or officer when the following actions occurred: (a) A conviction or a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, chapter 893, 21 U.S.C. ss , or 42 U.S.C. ss , Medicaid fraud, Medicare fraud, or insurance fraud, unless the sentence and any subsequent period of probation for such convictions or plea ended more than 15 years before the daate of the application; or (b) Termination for cause from the Medicare program or a state Medicaid program, unless the applicant has been in good standing with the Medicare program or a state Medicaid program for the most recent 5 years and the termination occurred at least 20 years before the date of the application. ST Z803 License Required; Display Title License Required; Display Statute or Rule , F.S. Tag_Type L Regulation Definition License required; display.- (1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider. (2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued. (3) Any person who knowingly alters, defaces, or falsifies a license certificate issued by the agency, or causes or procures any person to commit such an offense, commits a misdemeanor of the second degree, punishable as provided in s or s Any licensee or provider who displays an altered, defaced, or falsified license certificate is subject to the penalties set forth in s and an administrative fine of $1,000 for each day of illegal display. Interpretive Guidance - Check to see that the license is for the facility and location where it is displayed. Contact the appropriate licensure unit if there are questions about the license. - If applicable, check to make sure the category of testing being done is reflected on the license, the ownership given on the face of the license is accurate, that the location of the facility is the address printed on the license, and that the license is properly displayed. Look at Z0827 Unlicensed Activity , F.S. as unlicensed activity should be cited if there has been a change of ownership, or for clinical laboratories, testing outside of the specialty/subspecialties printed on the license are being performed. - Regarding Nursing Homes, refer to (2) which states: Separate licenses shall be required for facilities maintained in separate premises, even though operated under the same management. However, a separate license shall not be required for separate buildings on the same grounds. - Regarding Labs, refer to 59A (3) which states: AHCA ALF Resource Manual Aug

166 Aspen State Regulation Set: A 4.01 Assisted Living Facility Separate licensure shall be required for all laboratories maintained on separate premises, as defined under subsection 59A-7.020(27), F.A.C., including mobile laboratory units, even though operated under the same management. Separate licensure shall not be required for separate buildings on the same or adjoining grounds. ST Z806 Change of Address Title Change of Address Statute or Rule 59A (2-5), FAC Tag_Type L Regulation Definition (2) Any request to amend a license must be received by the Agency in advance of the requested effective date as detailed below. Requests to amend a license are not authorized until the license is issued. (a) Requests to change the address of record must be received by the Agency 60 to 120 days in advance of the requested effective date for the following provider types: 1. Birth Centers, as provided under Chapter 383, F.S.; 2. Abortion Clinics, as provided under Chapter 390, F.S.; 3. Crisis Stabilization Units, as provided under Parts I and IV of Chapter 394, F.S.; 4. Short Term Residential Treatment Units, as provided under Parts I and IV of Chapter 394, F.S. 5. Residential Treatment Facilities, as provided under Part IV of Chapter 394, F.S.; 6. Residential Treatment Centers for Children and Adolescents, as provided under Part IV of Chapter 394, F.S.; 7. Hospitals, as provided under Part I of Chapter 395, F.S.; 8. Ambulatory Surgical Centers, as provided under Part I of Chapter 395, F.S.; 9. Nursing Homes, as provided under Part II of Chapter 400, F.S.; 10. Hospices, as provided under Part IV of Chapter 400, F.S.; 11. Homes for Special Services as provided under Part V of Chapter 400, F.S.; 12. Transitional Living Facilities, as provided under Part V of Chapter 400, F.S.; 13. Prescribed Pediatric Extended Care Centers, as provided under Part VI of Chapter 400, F.S.; 14. Intermediate Care Facilities for the Developmentally Disabled, as provided under Part VIII of Chapter 400, F.S.; 15. Assisted Living Facilities, as provided under Part I of Chapter 429, F.S.; 16. Adult Family-Care Homes, as provided under Part II of Chapter 429, F.S.; 17. Adult Day Care Centers, as provided under Part III of Chapter 429, F.S. (b) Requests to change the address of record must be received by the Agency 21 to 120 days in advance of the requested effective date for the following provider types: 1. Drug Free Workplace Laboratories as provided under Sections and , F.S.; 2. Mobile Surgical Facilities, as provided under Part I of Chapter 395, F.S.; 3. Health Care Risk Managers, as provided under Part I of Chapter 395, F.S.; 4. Home Health Agencies, as provided under Part III of Chapter 400, F.S.; 5. Nurse Registries, as provided under Part III of Chapter 400, F.S.; Interpretive Guidance - The licensure unit handles change of address, but surveyors may find that the provider has moved and therefore could cite this. AHCA ALF Resource Manual Aug

167 Aspen State Regulation Set: A 4.01 Assisted Living Facility 6. Companion Services or Homemaker Services Providers, as provided under Part III of Chapter 400, F.S.; 7. Home Medical Equipment Providers, as provided under Part VII of Chapter 400, F.S.; 8. Health Care Services Pools, as provided under Part IX of Chapter 400, F.S.; 9. Health Care Clinics, as provided under Part X of Chapter 400, F.S., including certificate of exemption; 10. Clinical Laboratories, as provided under Part I of Chapter 483, F.S.; 11. Multiphasic Health Testing Centers, as provided under Part II of Chapter 483, F.S.; 12. Organ and Tissue Procurement Agencies, as provided under Chapter 381, F.S. (c) All other requests to amend a license including but not limited to services, licensed capacity, and other specifications which are required to be displayed on the license by authorizing statutes or applicable rules must be received by the Agency 60 to 120 days in advance of the requested effective date. This deadline does not apply to a request to amend hospital emergency services defined in Section (2), F.S. (3) Failure to submit a timely request shall result in a $500 fine. (4) A licensee is not authorized to operate in a new location until a license is obtained which specifies the new location. Failure to amend a license prior to a change of the address of record constitutes unlicensed activity. (5) The licensee shall return the license certificate to the Agency upon the rendition of a final order revoking, cancelling or denying a license, and upon the voluntary discontinuance of operation. AHCA ALF Resource Manual Aug

168 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z809 Proof of Financial Ability to Operate Title Proof of Financial Ability to Operate Statute or Rule 59A (3)(e)&(7), (7), Tag_Type L Regulation Definition 59A (3)(e) FAC Proof of Financial Ability to Operate. "Financial instability" means the provider cannot meet its financial obligations. Evidence such as the issuance of bad checks, an accumulation of delinquent bills, or inability to meet current payroll needs shall constitute prima facie evidence that the ownership of the provider lacks the financial ability to operate. Evidence shall also include the Medicare or Medicaid program's indications or determination of financial instability or fraudulent handling of government funds by the provider (7) FS Definitions. "Controlling interest" means: (a) The applicant or licensee; (b) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater ownership interest in the applicant or licensee; or (c) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater ownership interest in the management company or other entity, related or unrelated, with which the applicant or licensee contracts to manage the provider. The term does not include a voluntary board member FS (8) Upon application for initial licensure or change of ownership licensure, the applicant shall furnish satisfactory proof of the applicant's financial ability to operate in accordance with the requirements of this part, authorizing statutes, and applicable rules. The agency shall establish standards for this purpose, including information concerning the applicant's controlling interests. The agency shall also establish documentation requirements, to be completed by each applicant, that show anticipated provider revenues and expenditures, the basis for financing the anticipated cash-flow requirements of the provider, and an applicant's access to contingency financing. A current certificate of authority, pursuant to chapter 651, may be provided as proof of financial ability to operate. The agency may require a licensee to provide proof of financial ability to operate at any time if there is evidence of financial instability, including, but not limited to, unpaid expenses necessary for the basic operations of the provider. 59A FS (7) An applicant for renewal of a license shall not be required to provide proof of financial ability to operate, unless the licensee or applicant has demonstrated financial instability. If an applicant or licensee has shown signs of financial instability, as provided in Section (9), F.S., at any time, the Agency may require the applicant or licensee to provide proof of financial ability to operate by submission of: (a) AHCA Form , July 2009, Proof of Financial Ability Form, that includes a balance sheet and income and expense statement for the next 2 years of operation which provide evidence of having sufficient assets, credit, and projected revenues to cover liabilities and expenses, and (b) Documentation of correction of the financial instability, including but not limited to, evidence of the payment of any bad checks, delinquent bills or liens. If complete payment cannot be made, evidence must be submitted of partial payment along with a plan for payment of any liens or delinquent bills. If the lien is with a government agency or repayment is ordered by a federal or state court, an accepted plan of repayment must be provided. Interpretive Guidance - This standard would be used by surveyors if evidence of financial instability is found and the licensee or any controlling interest in the licensee withholds information from the surveyor. - The financial schedules and documentation of correction of the financial instability are submitted to the AHCA Home Care Unit in the state office and reviewed by AHCA state office financial reviewers in the Financial Analysis Unit. Further administrative action may be taken by the state office. - This standard applies to the following provider types: Nursing Home Facilities, as specified in Part II, Chapter 400, F.S.; Assisted Living Facilities, as specified in Part I, Chapter 429, F.S.; Home Health Agencies, as specified in Part III, Chapter 400, F.S.; Hospices, as specified in Part IV, Chapter 400, F.S.; Adult Day Care Centers, as specified in Part III, Chapter 429, F.S.; Prescribed Pediatric Extended Care Centers, as specified in Part VI, Chapter 400, F.S.; Home Medical Equipment Providers, as specified in Part VII, Chapter 400, F.S.; Intermediate Care Facilities for the Developmentally Disabled, as specified in Part VIII, Chapter 400, F.S.; Health Care Clinics, as specified in Part X, Chapter 400, F.S.; - The standard applies to Nurse Registries as specified in 59A (7) which states: - An application for renewal of a license shall not be required to provide proof of financial ability to operate, unless the applicant has demonstrated financial instability at any time, pursuant to Section AHCA ALF Resource Manual Aug

169 Aspen State Regulation Set: A 4.01 Assisted Living Facility , F.S., in which case AHCA shall require the applicant for renewal to provide proof of financial ability to operate by submitting information as described in 59A (7)(b), F.A.C. and documentation of correction of the financial instability, to include evidence of the payment in full of any bad checks, delinquent bills or liens and all associated fees, costs, and changes related to the instability. If complete payment cannot be made, evidence must be submitted of partial payment along with a plan for payment of any liens or delinquent bills. If the lien is with a government agency or repayment is ordered by a federal, state, or district court, an accepted plan of repayment must be provided. If the licensed nurse registry has demonstrated financial instability as outlined above at any time the AHCA will request proof of financial ability to operate. - None of the Hospital Unit Programs nor the Lab Unit Programs would have this requirement. AHCA ALF Resource Manual Aug

170 ST Z812 Change of Ownership Aspen State Regulation Set: A 4.01 Assisted Living Facility Title Change of Ownership Statute or Rule (5), FS, , FS Tag_Type L Regulation Definition (5) FS "Change of ownership" means: (a) An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or (b) An event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned. This paragraph does not apply to a licensee that is publicly traded on a recognized stock exchange. A change solely in the management company or board of directors is not a change of ownership. Interpretive Guidance This tag may be cited for unreported changes of ownership Change of ownership.-whenever a change of ownership occurs: (1) The transferor shall notify the agency in writing at least 60 days before the anticipated date of the change of ownership. (2) The transferee shall make application to the agency for a license within the timeframes required in s (3) The transferor shall be responsible and liable for: (a) The lawful operation of the provider and the welfare of the clients served until the date the transferee is licensed by the agency. (b) Any and all penalties imposed against the transferor for violations occurring before the date of change of ownership. (4) Any restriction on licensure, including a conditional license existing at the time of a change of ownership, shall remain in effect until the agency determines that the grounds for the restriction are corrected. (5) The transferee shall maintain records of the transferor as required in this part, authorizing statutes, and applicable rules, including: (a) All client records. (b) Inspection reports. (c) All records required to be maintained pursuant to s , if applicable. ST Z813 Results of Screening & Notification in File Title Results of Screening & Notification in File Statute or Rule 59A (3)(c), FAC Tag_Type L Regulation Definition 59A (3) Results of Screening and Notification. (c) The eligibility results of employee screening and the signed Attestation referenced in subsection 59A (2), F.A.C., must be in the employee's personnel file, maintained by the provider. Interpretive Guidance AHCA ALF Resource Manual Aug

171 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z814 Background Screening Clearinghouse Title Background Screening Clearinghouse Statute or Rule (2)(b-d), FS Tag_Type L Regulation Definition (2) Care Provider Background Screening Clearinghouse.- (b) Until such time as the fingerprints are enrolled in the national retained print arrest notification program at the Federal Bureau of Investigation, an employee with a break in service of more than 90 days from a position that requires screening by a specified agency must submit to a national screening if the person returns to a position that requires screening by a specified agency. (c) An employer of persons subject to screening by a specified agency must register with the clearinghouse and maintain the employment status of all employees within the clearinghouse. Initial employment status and any changes in status must be reported within 10 business days. (d) An employer must register with and initiate all criminal history checks through the clearinghouse before referring an employee or potential employee for electronic fingerprint submission to the Department of Law Enforcement. The registration must include the employee's full first name, middle initial, and last name; social security number; date of birth; mailing address; sex; and race. Individuals, persons, applicants, and controlling interests that cannot legally obtain a social security number must provide an individual taxpayer identification number. Interpretive Guidance Review employee files for verification that any break in service was less than 90 days or a new screening was completed. Verify that the facility has an updated employee roster listed in the clearinghouse. AHCA ALF Resource Manual Aug

172 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z815 Background Screening; Prohibited Offenses Title Background Screening; Prohibited Offenses Statute or Rule , (2), Tag_Type L Regulation Definition Background screening; prohibited offenses.- (1) Level 2 background screening pursuant to chapter 435 must be conducted through the agency on each of the following persons, who are considered employees for the purposes of conducting screening under chapter 435: (a) The licensee, if an individual. (b) The administrator or a similarly titled person who is responsible for the day-to-day operation of the provider. (c) The financial officer or similarly titled individual who is responsible for the financial operation of the licensee or provider. (d) Any person who is a controlling interest if the agency has reason to believe that such person has been convicted of any offense prohibited by s For each controlling interest who has been convicted of any such offense, the licensee shall submit to the agency a description and explanation of the conviction at the time of license application. (e) Any person, as required by authorizing statutes, seeking employment with a licensee or provider who is expected to, or whose responsibilities may require him or her to, provide personal care or services directly to clients or have access to client funds, personal property, or living areas; and any person, as required by authorizing statutes, contracting with a licensee or provider whose responsibilities require him or her to provide personal care or personal services directly to clients. Evidence of contractor screening may be retained by the contractor's employer or the licensee. (3) All fingerprints must be provided in electronic format. Screening results shall be reviewed by the agency with respect to the offenses specified in s and this section, and the qualifying or disqualifying status of the person named in the request shall be maintained in a database. The qualifying or disqualifying status of the person named in the request shall be posted on a secure website for retrieval by the licensee or designated agent on the licensee's behalf. (4) In addition to the offenses listed in s , all persons required to undergo background screening pursuant to this part or authorizing statutes must not have an arrest awaiting final disposition for, must not have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, and must not have been adjudicated delinquent and the record not have been sealed or expunged for any of the following offenses or any similar offense of another jurisdiction: (a) Any authorizing statutes, if the offense was a felony. (b) This chapter, if the offense was a felony. (c) Section , relating to Medicaid provider fraud. (d) Section , relating to Medicaid fraud. (e) Section , relating to domestic violence. (f) Section , relating to attempts, solicitation, and conspiracy to commit an offense listed in this subsection. (g) Section , relating to fraudulent acts through mail, wire, radio, electromagnetic, photoelectronic, or photooptical systems. (h) Section , relating to false and fraudulent insurance claims. (i) Section , relating to obtaining goods by using a false or expired credit card or other credit device, if the offense was a felony. (j) Section , relating to fraudulently obtaining goods or services from a health care provider. (k) Section , relating to patient brokering. (l) Section , relating to criminal use of personal identification information. (m) Section , relating to obtaining a credit card through fraudulent means. (n) Section , relating to fraudulent use of credit cards, if the offense was a felony. Interpretive Guidance - Employees and independent contractors hired or contracted before August 1, 2010, must be screened according to the schedule in (5), F.S. included in this standard. - Persons already hired or under contract before August 1, 2010 would have received level 1 screening. - Employees and contractors who do not meet the background screening requirements cannot be retained in a direct care capacity, unless an exemption from disqualification has been approved by AHCA or the Department of Health (when a licensed or certified health care professional or certified nursing assistant). - The employee or contractor with a disqualifying offense must have a copy of an exemption [granted by either DOH or AHCA] in their personnel file before the employee or contractor can be hired. - There is a new staggered schedule: (a) Individuals for whom the last screening was conducted on or before December 31, 2004, must be rescreened by July 31, (b) Individuals for whom the last screening conducted was between January 1, 2005, and December 31, 2008, must be rescreened by July 31, (c) Individuals for whom the last screening conducted was between January 1, 2009, through July 31, 2011, must be rescreened by July 31, An employer may hire an employee to a position that requires background screening before the employee completes the screening process for training and orientation purposes. However, the employee may not have direct contact with vulnerable persons until the screening process is completed and the employee demonstrates that he AHCA ALF Resource Manual Aug

173 Aspen State Regulation Set: A 4.01 Assisted Living Facility (o) Section , relating to forgery. (p) Section , relating to uttering forged instruments. (q) Section , relating to forging bank bills, checks, drafts, or promissory notes. (r) Section , relating to uttering forged bank bills, checks, drafts, or promissory notes. (s) Section , relating to fraud in obtaining medicinal drugs. (t) Section , relating to the sale, manufacture, delivery, or possession with the intent to sell, manufacture, or deliver any counterfeit controlled substance, if the offense was a felony. (u) Section , relating to racketeering and collection of unlawful debts. (v) Section , relating to the Florida Money Laundering Act. If, upon rescreening, a person who is currently employed or contracted with a licensee as of June 30, 2014, and was screened and qualified under ss and , has a disqualifying offense that was not a disqualifying offense at the time of the last screening, but is a current disqualifying offense and was committed before the last screening, he or she may apply for an exemption from the appropriate licensing agency and, if agreed to by the employer, may continue to perform his or her duties until the licensing agency renders a decision on the application for exemption if the person is eligible to apply for an exemption and the exemption request is received by the agency no later than 30 days after receipt of the rescreening results by the person. (5) A person who serves as a controlling interest of, is employed by, or contracts with a licensee on July 31, 2010, who has been screened and qualified according to standards specified in s or s must be rescreened by July 31, 2015, in compliance with the following schedule. If, upon rescreening, such person has a disqualifying offense that was not a disqualifying offense at the time of the last screening, but is a current disqualifying offense and was committed before the last screening, he or she may apply for an exemption from the appropriate licensing agency and, if agreed to by the employer, may continue to perform his or her duties until the licensing agency renders a decision on the application for exemption if the person is eligible to apply for an exemption and the exemption request is received by the agency within 30 days after receipt of the rescreening results by the person. The rescreening schedule shall be: (a) Individuals for whom the last screening was conducted on or before December 31, 2004, must be rescreened by July 31, (b) Individuals for whom the last screening conducted was between January 1, 2005, and December 31, 2008, must be rescreened by July 31, (c) Individuals for whom the last screening conducted was between January 1, 2009, through July 31, 2011, must be rescreened by July 31, (6) The costs associated with obtaining the required screening must be borne by the licensee or the person subject to screening. Licensees may reimburse persons for these costs. The Department of Law Enforcement shall charge the agency for screening pursuant to s (3). The agency shall establish a schedule of fees to cover the costs of screening. (7)(a) As provided in chapter 435, the agency may grant an exemption from disqualification to a person who is subject to this section and who: 1. Does not have an active professional license or certification from the Department of Health; or 2. Has an active professional license or certification from the Department of Health but is not providing a service within the scope of that license or certification. (b) As provided in chapter 435, the appropriate regulatory board within the Department of Health, or the department itself if there is no board, may grant an exemption from disqualification to a person who is subject to this section and who has received a professional license or certification from the Department of Health or a regulatory board within that department and that person is providing a service within the scope of his or her licensed or certified practice. (8) The agency and the Department of Health may adopt rules pursuant to ss (1) and to implement this section, chapter 435, and authorizing statutes requiring background screening and to implement and adopt criteria relating to retaining fingerprints pursuant to s (2). or she exhibits no behaviors that warrant the denial or termination of employment. - Individuals may be provisionally employed in positions requiring background screening. They may be in training or orientation, but may NOT have access to residents/patients until the background screening process is completed. - An employer of persons subject to screening by a specified agency must register with the clearinghouse and maintain the employment status of all employees within the clearinghouse. Initial employment status and any changes in status must be reported within 10 business days. - If an individual is in the Clearinghouse and are working then they must be on that provider's employee roster within 10 days of their hire date. The same for once a person is no longer working for that provider. If they are in the Clearinghouse then their status in the employee roster must be updated within 10 days of a change. Surveyor Probes: - Level 2 includes FDLE and FBI screening. - Staff who do not have access to client property, funds, or living areas or who do not have contact with clients are not required to be screened. - If an employee or contractor's responsibility requires him or her to have contact with clients, a Level 2 background screening is required. - Was the employee or contractor hired on or after August 1, 2010? - Does the licensee have evidence of contractor and employee screening? AHCA ALF Resource Manual Aug

174 Aspen State Regulation Set: A 4.01 Assisted Living Facility (9) There is no reemployment assistance or other monetary liability on the part of, and no cause of action for damages arising against, an employer that, upon notice of a disqualifying offense listed under chapter 435 or this section, terminates the person against whom the report was issued, whether or not that person has filed for an exemption with the Department of Health or the agency Exclusion from employment.- (1) If an employer or agency has reasonable cause to believe that grounds exist for the denial or termination of employment of any employee as a result of background screening, it shall notify the employee in writing, stating the specific record that indicates noncompliance with the standards in this chapter. It is the responsibility of the affected employee to contest his or her disqualification or to request exemption from disqualification. The only basis for contesting the disqualification is proof of mistaken identity. (2)(a) An employer may not hire, select, or otherwise allow an employee to have contact with any vulnerable person that would place the employee in a role that requires background screening until the screening process is completed and demonstrates the absence of any grounds for the denial or termination of employment. If the screening process shows any grounds for the denial or termination of employment, the employer may not hire, select, or otherwise allow the employee to have contact with any vulnerable person that would place the employee in a role that requires background screening unless the employee is granted an exemption for the disqualification by the agency as provided under s (b) If an employer becomes aware that an employee has been arrested for a disqualifying offense, the employer must remove the employee from contact with any vulnerable person that places the employee in a role that requires background screening until the arrest is resolved in a way that the employer determines that the employee is still eligible for employment under this chapter. (c) The employer must terminate the employment of any of its personnel found to be in noncompliance with the minimum standards of this chapter or place the employee in a position for which background screening is not required unless the employee is granted an exemption from disqualification pursuant to s (d) An employer may hire an employee to a position that requires background screening before the employee completes the screening process for training and orientation purposes. However, the employee may not have direct contact with vulnerable persons until the screening process is completed and the employee demonstrates that he or she exhibits no behaviors that warrant the denial or termination of employment. (3) Any employee who refuses to cooperate in such screening or refuses to timely submit the information necessary to complete the screening, including fingerprints if required, must be disqualified for employment in such position or, if employed, must be dismissed. (4) There is no reemployment assistance or other monetary liability on the part of, and no cause of action for damages against, an employer that, upon notice of a conviction or arrest for a disqualifying offense listed under this chapter, terminates the person against whom the report was issued or who was arrested, regardless of whether or not that person has filed for an exemption pursuant to this chapter Definitions.-For the purposes of this chapter, the term: (2) "Employee" means any person required by law to be screened pursuant to this chapter, including, but not limited to, persons who are contractors, licensees, or volunteers. AHCA ALF Resource Manual Aug

175 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z816 Background Screening Compliance Attestation Title Background Screening-Compliance Attestation Statute or Rule (2)(a-c) FS Tag_Type L Regulation Definition (2) Every 5 years following his or her licensure, employment, or entry into a contract in a capacity that under subsection (1) would require level 2 background screening under chapter 435, each such person must submit to level 2 background rescreening as a condition of retaining such license or continuing in such employment or contractual status. For any such rescreening, the agency shall request the Department of Law Enforcement to forward the person's fingerprints to the Federal Bureau of Investigation for a national criminal history record check unless the person's fingerprints are enrolled in the Federal Bureau of Investigation ' s national retained print arrest notification program. If the fingerprints of such a person are not retained by the Department of Law Enforcement under s (2)(g) and (h), the person must submit fingerprints electronically to the Department of Law Enforcement for state processing, and the Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history record check. The fingerprints shall be retained by the Department of Law Enforcement under s (2)(g) and (h) and enrolled in the national retained print arrest notification program when the Department of Law Enforcement begins participation in the program. The cost of the state and national criminal history records checks required by level 2 screening may be borne by the licensee or the person fingerprinted. Until a specified agency is fully implemented in the clearinghouse created under s , the agency may accept as satisfying the requirements of this section proof of compliance with level 2 screening standards submitted within the previous 5 years to meet any provider or professional licensure requirements of the agency, the Department of Health, the Department of Elderly Affairs, the Agency for Persons with Disabilities, the Department of Children and Families, or the Department of Financial Services for an applicant for a certificate of authority or provisional certificate of authority to operate a continuing care retirement community under chapter 651, provided that: (a) The screening standards and disqualifying offenses for the prior screening are equivalent to those specified in s and this section; (b) The person subject to screening has not had a break in service from a position that requires level 2 screening for more than 90 days; and (c) Such proof is accompanied, under penalty of perjury, by an attestation of compliance with chapter 435 and this section using forms provided by the agency. Interpretive Guidance - Is AHCA Recommended Form , September 2013, Affidavit of Compliance with Background Screening Requirements, in the employee's personnel file? - Or, does the employee have a similar document attesting under penalty of perjury that they are in compliance with Chapter 435, F.S. AHCA ALF Resource Manual Aug

176 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z817 Minimum Licensure Requirement Inform AHCA Title Minimum Licensure Requirement - Inform AHCA Statute or Rule (3-4) FS; 59A FAC Tag_Type L Regulation Definition Minimum licensure requirements.-in addition to the licensure requirements specified in this part, authorizing statutes, and applicable rules, each applicant and licensee must comply with the requirements of this section in order to obtain and maintain a license. (3) Unless otherwise specified in this part, authorizing statutes, or applicable rules, any information required to be reported to the agency must be submitted within 21 calendar days after the report period or effective date of the information, whichever is earlier, including, but not limited to, any change of: (a) Information contained in the most recent application for licensure. (b) Required insurance or bonds. (4) Whenever a licensee discontinues operation of a provider: (a) The licensee must inform the agency not less than 30 days prior to the discontinuance of operation and inform clients of such discontinuance as required by authorizing statutes. Immediately upon discontinuance of operation by a provider, the licensee shall surrender the license to the agency and the license shall be canceled. (b) The licensee shall remain responsible for retaining and appropriately distributing all records within the timeframes prescribed in authorizing statutes and applicable rules. In addition, the licensee or, in the event of death or dissolution of a licensee, the estate or agent of the licensee shall: 1. Make arrangements to forward records for each client to one of the following, based upon the client's choice: the client or the client's legal representative, the client's attending physician, or the health care provider where the client currently receives services; or 2. Cause a notice to be published in the newspaper of greatest general circulation in the county in which the provider was located that advises clients of the discontinuance of the provider operation. The notice must inform clients that they may obtain copies of their records and specify the name, address, and telephone number of the person from whom the copies of records may be obtained. The notice must appear at least once a week for 4 consecutive weeks. 59A Minimum Licensure Requirements. Provider location. A licensee must maintain proper authority for operation of the provider at the address of record. If such authority is denied, revoked or otherwise terminated by the local zoning or code enforcement authority, the Agency may deny or revoke an application or license, or impose sanctions. Interpretive Guidance - Refer to s , F.S. regarding the Exemptions for this regulation. - Regarding Nursing Homes, note that the closing of a nursing facility ( (4)(a)) must comply with (1), F.S. instead which states: (1) Whenever a licensee voluntarily discontinues operation, and during the period when it is preparing for such discontinuance, it shall inform the agency not less than 90 days prior to the discontinuance of operation. The licensee also shall inform the resident or the next of kin, legal representative, or agency acting on behalf of the resident of the fact, and the proposed time, of such discontinuance and give at least 90 days' notice so that suitable arrangements may be made for the transfer and care of the resident. In the event any resident has no such person to represent him or her, the licensee shall be responsible for securing a suitable transfer of the resident before the discontinuance of operation. The agency shall be responsible for arranging for the transfer of those residents requiring transfer who are receiving assistance under the Medicaid program. AHCA ALF Resource Manual Aug

177 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z818 Minimum Licensure Requirement Client Notice Title Minimum Licensure Requirement - Client Notice Statute or Rule (5) FS Tag_Type L Regulation Definition Minimum licensure requirements. In addition to the licensure requirements specified in this part, authorizing statutes, and applicable rules, each applicant and licensee must comply with the requirements of this section in order to obtain and maintain a license. Interpretive Guidance Refer to s , F.S. regarding the Exemptions for this regulation. (5)(a) On or before the first day services are provided to a client, a licensee must inform the client and his or her immediate family or representative, if appropriate, of the right to report: 1. Complaints. The statewide toll-free telephone number for reporting complaints to the agency must be provided to clients in a manner that is clearly legible and must include the words: "To report a complaint regarding the services you receive, please call tollfree (phone number)." 2. Abusive, neglectful, or exploitative practices. The statewide toll-free telephone number for the central abuse hotline must be provided to clients in a manner that is clearly legible and must include the words: "To report abuse, neglect, or exploitation, please call toll-free (phone number)." 3. Medicaid fraud. An agency-written description of Medicaid fraud and the statewide toll-free telephone number for the central Medicaid fraud hotline must be provided to clients in a manner that is clearly legible and must include the words: "To report suspected Medicaid fraud, please call toll-free (phone number)." The agency shall publish a minimum of a 90-day advance notice of a change in the tollfree telephone numbers. (b) Each licensee shall establish appropriate policies and procedures for providing such notice to clients. ST Z819 Minimum Licensure Req Financial Viability Title Minimum Licensure Req - Financial Viability Statute or Rule (9) FS Tag_Type L Regulation Definition FS (9) A controlling interest may not withhold from the agency any evidence of financial instability, including, but not limited to, checks returned due to insufficient funds, delinquent accounts, nonpayment of withholding taxes, unpaid utility expenses, nonpayment for essential services, or adverse court action concerning the financial viability of the provider or any other provider licensed under this part that is under the control of the controlling interest. A controlling interest shall notify the agency within 10 days after a court action to initiate bankruptcy, foreclosure, or eviction proceedings concerning the provider in which the controlling interest is a petitioner or defendant. Any person who violates this subsection commits a misdemeanor of the second degree, punishable as provided in s or s Each day of continuing violation is a separate offense. Interpretive Guidance Refer to s , F.S. regarding the Exemptions for this regulation. AHCA ALF Resource Manual Aug

178 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z821 Reporting Requirements; Electronic Submission Title Reporting Requirements; Electronic Submission Statute or Rule 59A , FAC Tag_Type L Regulation Definition 59A Reporting Requirements; Electronic Submission. (1) During the two year licensure period, any change or expiration of any information that is required to be reported under Chapter 408, Part II, F.S., or authorizing statutes for the provider type as specified in Section (3), F.S., during the license application process must be reported to the Agency within 21 days of occurrence of the change, including: (a) Insurance coverage renewal, (b) Bond renewal, (c) Change of administrator or the similarly titled person who is responsible for the dayto-day operation of the provider, (d) Annual sanitation inspections, (e) Fire inspections, (f) Approval of revisions to emergency management plans. (2) Electronic submission of information. (a) The following required information must be reported through the Agency's Internet site at 1. Nursing homes: a. Semi-annual staffing ratios required pursuant to Section (1)(o), F.S. and Rule 59A-4.103, F.A.C. b. Adverse incident reports required pursuant to Sections (7) and (8), F.S. and Rule 59A-4.123, F.A.C. c. Liability claim reports required pursuant to Section (10), F.S. and Rule 59A , F.A.C. 2. Assisted living facilities: a. Adverse incident reports required pursuant to Sections (3) and (4), F.S. and Rule 58A , F.A.C. b. Liability claim reports required pursuant to Section (5), F.S. and Rule 58A , F.A.C. (b) The licensee must retain the receipt issued from the Internet site indicating that their transaction was accepted. (c) If the Agency's Internet site is temporarily out of service, the required reports may be submitted by mail or facsimile as follows: 1. Semi-annual staffing ratios and liability claim reports are sent to the Agency for Health Care Administration, Central Systems Management Unit, 2727 Mahan Drive, MS #47, Tallahassee, FL or facsimile to (850) Adverse incident reports are sent to the Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, 2727 Mahan Drive, MS #16, Tallahassee, FL or facsimile to (850) Interpretive Guidance Regarding 59A (1)(f), this does not apply to Home Care Unit programs since there is a different process through the Department of Health in chapter 400 Part III & IV, F.S. Regarding 59A (2), this only applies to nursing homes and assisted living facilities. AHCA ALF Resource Manual Aug

179 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z824 Right of Inspection; inspection reports Title Right of Inspection; inspection reports Statute or Rule FS, 59A FAC Tag_Type L Regulation Definition Right of inspection; copies; inspection reports; plan for correction of deficiencies.- (1) An authorized officer or employee of the agency may make or cause to be made any inspection or investigation deemed necessary by the agency to determine the state of compliance with this part, authorizing statutes, and applicable rules. The right of inspection extends to any business that the agency has reason to believe is being operated as a provider without a license, but inspection of any business suspected of being operated without the appropriate license may not be made without the permission of the owner or person in charge unless a warrant is first obtained from a circuit court. Any application for a license issued under this part, authorizing statutes, or applicable rules constitutes permission for an appropriate inspection to verify the information submitted on or in connection with the application. (a) All inspections shall be unannounced, except as specified in s (b) Inspections for relicensure shall be conducted biennially unless otherwise specified by authorizing statutes or applicable rules. (2) Inspections conducted in conjunction with certification, comparable licensure requirements, or a recognized or approved accreditation organization may be accepted in lieu of a complete licensure inspection. However, a licensure inspection may also be conducted to review any licensure requirements that are not also requirements for certification. (3) The agency shall have access to and the licensee shall provide, or if requested send, copies of all provider records required during an inspection or other review at no cost to the agency, including records requested during an offsite review. (4) A deficiency must be corrected within 30 calendar days after the provider is notified of inspection results unless an alternative timeframe is required or approved by the agency. (5) The agency may require an applicant or licensee to submit a plan of correction for deficiencies. If required, the plan of correction must be filed with the agency within 10 calendar days after notification unless an alternative timeframe is required. (6)(a) Each licensee shall maintain as public information, available upon request, records of all inspection reports pertaining to that provider that have been filed by the agency unless those reports are exempt from or contain information that is exempt from s (1) and s. 24(a), Art. I of the State Constitution or is otherwise made confidential by law. Effective October 1, 2006, copies of such reports shall be retained in the records of the provider for at least 3 years following the date the reports are filed and issued, regardless of a change of ownership. (b) A licensee shall, upon the request of any person who has completed a written application with intent to be admitted by such provider, any person who is a client of such provider, or any relative, spouse, or guardian of any such person, furnish to the requester a copy of the last inspection report pertaining to the licensed provider that was issued by the agency or by an accrediting organization if such report is used in lieu of a licensure inspection. Interpretive Guidance 59A Inspections. (1) When regulatory violations are identified by the Agency: (a) Deficiencies must be corrected within 30 days of the date the Agency sends the deficiency notice to the provider, unless an alternative timeframe is required or approved by the Agency. (b) The Agency may conduct an unannounced follow-up inspection or off-site review to verify correction of deficiencies at any time. (2) If an inspection is completed through off-site record review, any records requested AHCA ALF Resource Manual Aug

180 Aspen State Regulation Set: A 4.01 Assisted Living Facility by the Agency in conjunction with the review, must be received within 7 days of request and provided at no cost to the Agency. Each licensee shall maintain the records including medical and treatment records of a client and provide access to the Agency. (3) Providers that are exempt from Agency inspections due to accreditation oversight as prescribed in authorizing statutes must provide: (a) Documentation from the accrediting agency including the name of the accrediting agency, the beginning and expiration dates of the provider's accreditation, accreditation status and type must be submitted at the time of license application, or within 21 days of accreditation. (b) Documentation of each accreditation inspection including the accreditation organization's report of findings, the provider's response and the final determination must be submitted within 21 days of final determination or the provider is no longer exempt from Agency inspection. ST Z827 Unlicensed Activity Title Unlicensed Activity Statute or Rule , FS Tag_Type L Regulation Definition Unlicensed activity.- (1) A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation. (6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency. Interpretive Guidance This tag can be cited in conjunction with Z0803 License Required; Display, F.S. License required when the provider is offering services not authorized and printed on the face of the license, when the licensed owner is not operating and it is being operated by another entity that is not licensed to operate. It may also be cited if the licensure unit has notified the person or entity operating the unlicensed facility failing to cease operation and apply for a license. AHCA ALF Resource Manual Aug

181 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z829 Moratorium; Emergency Suspension Title Moratorium; Emergency Suspension Statute or Rule , FS Tag_Type L Regulation Definition Moratorium; emergency suspension.- (1) The agency may impose an immediate moratorium or emergency suspension as defined in s on any provider if the agency determines that any condition related to the provider or licensee presents a threat to the health, safety, or welfare of a client. (2) A provider or licensee, the license of which is denied or revoked, may be subject to immediate imposition of a moratorium or emergency suspension to run concurrently with licensure denial, revocation, or injunction. (3) A moratorium or emergency suspension remains in effect after a change of ownership, unless the agency has determined that the conditions that created the moratorium, emergency suspension, or denial of licensure have been corrected. (4) When a moratorium or emergency suspension is placed on a provider or licensee, notice of the action shall be posted and visible to the public at the location of the provider until the action is lifted. Interpretive Guidance AHCA ALF Resource Manual Aug

182 Aspen State Regulation Set: A 4.01 Assisted Living Facility ST Z830 Emergency Management Planning Title Emergency Management Planning Statute or Rule FS Tag_Type L Regulation Definition Emergency management planning; emergency operations; inactive license.- (1) A licensee required by authorizing statutes to have an emergency operations plan must designate a safety liaison to serve as the primary contact for emergency operations. (2) An entity subject to this part may temporarily exceed its licensed capacity to act as a receiving provider in accordance with an approved emergency operations plan for up to 15 days. While in an overcapacity status, each provider must furnish or arrange for appropriate care and services to all clients. In addition, the agency may approve requests for overcapacity in excess of 15 days, which approvals may be based upon satisfactory justification and need as provided by the receiving and sending providers. (3)(a) An inactive license may be issued to a licensee subject to this section when the provider is located in a geographic area in which a state of emergency was declared by the Governor if the provider: 1. Suffered damage to its operation during the state of emergency. 2. Is currently licensed. 3. Does not have a provisional license. 4. Will be temporarily unable to provide services but is reasonably expected to resume services within 12 months. (b) An inactive license may be issued for a period not to exceed 12 months but may be renewed by the agency for up to 12 additional months upon demonstration to the agency of progress toward reopening. A request by a licensee for an inactive license or to extend the previously approved inactive period must be submitted in writing to the agency, accompanied by written justification for the inactive license, which states the beginning and ending dates of inactivity and includes a plan for the transfer of any clients to other providers and appropriate licensure fees. Upon agency approval, the licensee shall notify clients of any necessary discharge or transfer as required by authorizing statutes or applicable rules. The beginning of the inactive licensure period shall be the date the provider ceases operations. The end of the inactive period shall become the license expiration date, and all licensure fees must be current, must be paid in full, and may be prorated. Reactivation of an inactive license requires the prior approval by the agency of a renewal application, including payment of licensure fees and agency inspections indicating compliance with all requirements of this part and applicable rules and statutes. (4) The agency may adopt rules relating to emergency management planning, communications, and operations. Licensees providing residential or inpatient services must utilize an online database approved by the agency to report information to the agency regarding the provider's emergency status, planning, or operations. Interpretive Guidance Four of the Home Care programs have major state laws that have extensive emergency management requirements - home health agencies, hospices, nurse registries and home medical equipment providers - and their associated regulation sets have specific standards. AHCA ALF Resource Manual Aug

183 Florida Statutes and Florida Administrative Codes Applicable to Classifying Deficiencies State Class ASPEN Code Assisted Living Facility Home Health Agency Nurse Registry Adult Family Care Home Adult Day Care Center Home Medical Equipment Intermediate Care Facilities , FS (2), FS , FS , FAC and , FS , FS 59A (3), FAC (3) FS Client Client Client Client Client Client Client Code=11 Code=19 Code=42 Code=52 Code=12 Code=56 Code=25 1 J MAJOR G D MINOR B Unclassified C Unclassified Unclassified Unclassified Unclassified Unclassified Unclassified Unclassified Write 1 Tags A G154, G171, G173, G180, G190, G191, G200, G225, G277, G278 1 Write = Write in opening remarks to inform Nurse Registry, but don t cite deficiency when first found; only cite if not corrected on revisit. Section Update July 2015 AHCA ALF Resource Manual Aug

184 The 2014 Florida Statutes Title XXIX PUBLIC HEALTH Chapter 408 HEALTH CARE ADMINISTRATION View Entire Chapter Administrative fines; violations. As a penalty for any violation of this part, authorizing statutes, or applicable rules, the agency may impose an administrative fine. (1) Unless the amount or aggregate limitation of the fine is prescribed by authorizing statutes or applicable rules, the agency may establish criteria by rule for the amount or aggregate limitation of administrative fines applicable to this part, authorizing statutes, and applicable rules. Each day of violation constitutes a separate violation and is subject to a separate fine. For fines imposed by final order of the agency and not subject to further appeal, the violator shall pay the fine plus interest at the rate specified in s for each day beyond the date set by the agency for payment of the fine. (2) Violations of this part, authorizing statutes, or applicable rules shall be classified according to the nature of the violation and the gravity of its probable effect on clients. The scope of a violation may be cited as an isolated, patterned, or widespread deficiency. An isolated deficiency is a deficiency affecting one or a very limited number of clients, or involving one or a very limited number of staff, or a situation that occurred only occasionally or in a very limited number of locations. A patterned deficiency is a deficiency in which more than a very limited number of clients are affected, or more than a very limited number of staff are involved, or the situation has occurred in several locations, or the same client or clients have been affected by repeated occurrences of the same deficient practice but the effect of the deficient practice is not found to be pervasive throughout the provider. A widespread deficiency is a deficiency in which the problems causing the deficiency are pervasive in the provider or represent systemic failure that has affected or has the potential to affect a large portion of the provider s clients. This subsection does not affect the legislative determination of the amount of a fine imposed under authorizing statutes. Violations shall be classified on the written notice as follows: (a) Class I violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines present an imminent danger to the clients of the provider or a substantial probability that death or serious physical or emotional harm would result therefrom. The condition or practice constituting a class I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by the agency, is required for correction. The agency shall impose an administrative fine as provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation. (b) Class II violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. The agency shall impose an administrative fine as provided by law for a cited class II violation. A fine shall be levied notwithstanding the correction of the violation. (c) Class III violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of clients, other than class I or class II violations. The agency shall impose an administrative fine as provided in this section for a cited class III violation. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, a fine may not be imposed. (d) Class IV violations are those conditions or occurrences related to the operation and maintenance of a provider or to required reports, forms, or documents that do not have the potential of negatively affecting clients. These violations are of a type that the agency determines do not threaten the health, safety, or security of clients. The agency shall impose an administrative fine as provided in this section for a cited class IV violation. A citation for a class IV violation must specify the time within which the violation is required to be corrected. If a class IV violation is corrected within the time specified, a fine may not be imposed. (3) The agency may impose an administrative fine for a violation that is not designated as a class I, class II, class III, or class IV violation. Unless otherwise specified by law, the amount of the fine may not exceed $500 for each violation. Unclassified violations include: (a) Violating any term or condition of a license. (b) Violating any provision of this part, authorizing statutes, or applicable rules. (c) Exceeding licensed capacity. (d) Providing services beyond the scope of the license. (e) Violating a moratorium imposed pursuant to s History. s. 5, ch ; s. 52, ch ; s. 28, ch Copyright The Florida Legislature Privacy Statement Contact Us ng= &url= /0408/sections/ html AHCA ALF Resource Manual Aug

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187 Complaint Management Manual Chapter 3 -- January 2015 Rev. 1 CHAPTER 3 THE SURVEY This chapter is a resource only for the complaint survey and is not intended to be absolute or all inclusive of the complaint survey process. Please refer to protocols, procedures & training guidelines, resources and training materials. Introduction to the Complaint Investigation Process The purpose of this introduction is to outline the scope of the complaint investigation process and how that process correlates with other oversight agencies. A Complaint is an allegation that a facility or provider under the regulatory authority of the Agency for Health Care Administration ( AHCA or Agency ) failed or is failing to comply with Federal or State laws that AHCA has been duly authorized to regulate. The purpose of a Complaint Survey is to gather information through a survey of the licensed facility to determine, where possible, whether the alleged incident in fact occurred, and if so whether the incident was appropriately addressed by the facility at the time it occurred and thereafter in accordance with the federal and state laws AHCA is authorized to enforce. An ancillary purpose of the survey is to allow for timely and appropriate referrals by AHCA to other state and federal regulatory and law enforcement agencies for review of incidents that fall outside the scope of AHCA s regulatory authority but which appear to fall within the authority of other agencies. While it may be necessary for AHCA to assess the accuracy of the allegations giving rise to the Complaint as part of its Complaint Survey, that is not the purpose of the Complaint Survey. Thus, factual findings made by AHCA pursuant to the survey should not be relied upon by thirdparties for purposes beyond the Complaint Survey itself. Rather, the Complaint Survey process is intended to determine whether the entity under investigation is in substantial compliance with the federal and state regulations within AHCA s remit at the time of the investigation using the allegations as one source of information to assist AHCA in making that determination. Further, AHCA s purpose in conducting the Complaint Survey is (with one exception, noted below) not to determine whether sanctions should be imposed for past violations of law as that is beyond AHCA s regulatory authority. Instead, AHCA s regulatory authority generally empowers it to consider current non-compliance only. Thus, the allegations giving rise to the complaint are only used to identify a point in time in the past where it is alleged that regulatory compliance was breached by a particular facility so that AHCA may use that allegation to determine whether the facility is currently in compliance with licensure standards. The exception to this general rule as to prospective focus of Complaint Surveys is in the context of nursing home surveys. AHCA s authority to regulate nursing homes permits it to sanction nursing homes for past noncompliance with regulations within AHCA regulatory authority. The survey process includes observations, record review, and interviews to gather evidence to make the overall determination of regulatory compliance. The survey responsibilities end once the determination of compliance with the pertinent regulations is determined. There are multiple activities associated with the management of complaints. Responsibilities often cut across organizational lines. Therefore, the Agency will evaluate regulatory compliance AHCA ALF Resource Manual Aug

188 specific to the authority provided to AHCA by law. These requirements are often general in nature and designed to ensure that each facility has a system of care that provides accountability in the provision of care and services to individuals receiving care. As noted above, when a review of the allegations or the Complaint Surveys themselves reveal facts which, if true, potentially implicate violations of law outside of AHCA s regulatory authority, AHCA will take appropriate action to inform the complaining party of the regulatory or law enforcement agenc(y/ies) which have authority over that issue. When required by law, or if not required by law when appropriate, AHCA will also bring such allegations directly to the attention of the proper agenc(y/ies) before the Complaint Survey is conducted and, when applicable, once it has been completed. A few of these non-ahca regulatory or law enforcement agencies are described below: Licensed health care practitioners are regulated by the appropriate licensing board at the Department of Health. The staff from the Department of Health will conduct investigations of specific allegations of professional practice. The Office of the Attorney General investigates and prosecutes fraud involving providers that intentionally defraud the state s Medicaid program. Staff from the Florida Medicaid Fraud Control Unit may participate in complaint investigations involving unlicensed activity for residential providers where abuse or neglect is suspected. Other law enforcement agencies may also become involved when allegations reflect that a crime has been committed. Additionally, some facilities, such as hospitals, are accredited by an organization that has been deemed to have participation requirements that are consistent with the Federal Certification and State Licensure requirements. Those accrediting organizations are tasked with oversight of participating facilities. The United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, contracts with Quality Improvement Organizations that provide peer review oversight for physician practices, health plans, home health agencies, nursing homes, rehabilitation facilities and hospitals for each state. In Florida, the peer review organization is the Florida Medical Quality Assurance, Inc. These organizations assist providers in transforming the way health care is delivered by collaborating with them to implement best practices of care. These best practices go beyond the basic regulatory requirements and extend improvements in the care delivery system. While these investigative activities will coincide to some degree, each has a separate purpose to provide oversight at different levels of the care delivery system within the scope of each investigating agency. Purpose of the Survey As stated above, the purpose of a complaint survey is to gather information about the complaint to determine if: The complaint situation occurred or is likely to have occurred: Complaint Management Manual Chapter 3 -- January 2015 Rev. 2 AHCA ALF Resource Manual Aug

189 A deficient practice is or was present; There is a state or federal requirement that is not met; The complaint information is serious enough to warrant correction but does not fall under state or federal requirements; The complaint situation has been resolved or corrected. State Licensure Only Surveys Protocol See also the specific survey guidance for ALF, AFCH, ADCC on the website at \\hq3fsvip02\protocols\protocols.htm. The complaint survey will focus on the specific allegations under review. Pull a sample of three (3) (or more if needed) from the facility to protect the identity of the complainant/resident/patient in question and to establish if deficient practice exists. This would include interview, observation, and record review. State Agency staff will interview or observe up to three residents during the facility observation or tour, which will include the individual referenced in the allegation if such identification is made. Areas of non-compliance will be cited according to the provisions for the particular program/provider/supplier under review. The surveyors may need to copy any records reviewed in the facility that support the findings of non-compliance. If deficiencies are identified that present an imminent danger to the residents of the facility, the surveyor will notify the field office manager or designee immediately. The surveyor will conduct a comprehensive survey of the underlying problems impacting the deficiency(ies). The field office manager will provide additional survey staff to assist as necessary. The complaint report will be limited to the Complaint Investigation Form (CIF), letters as appropriate, and the Statement of Deficiencies. The Complaint Investigation Form is in electronic format and is generally required for all complaint surveys as part of the complaint kit. (In some cases wherein the complaint is done with a routine recertification or licensure survey, the field office management may have opted to not have this form completed.) It is important that staff fully utilize the notes section of the report to summarize and document pertinent portions of the survey process. The details of what was found, who was contacted, what was observed, who was interviewed and any other pertinent aspects of the survey should be documented on this form to show that a complete survey was conducted to survey thoroughly all allegations of the complaint. Each report should always document instances where the complainant could not be contacted prior to the completion of the survey, if an attempt was made. Complaint Management Manual Chapter 3 -- January 2015 Rev. 3 AHCA ALF Resource Manual Aug

190 Field Office Responsibilities The geographic location of the provider determines which field office is responsible for investigating the complaint. The field office manager or designee will assign the complaint to a surveyor who is skilled in the areas pertinent to the allegations contained in the complaint. The field office will schedule a date for a site visit to the provider involved. Complaint surveys are unannounced. The surveyor conducting the investigation should be provided all pertinent documents (including the Recap, the CIF, ASPEN shell, Adverse Incident report, DCF FSFN report, and any other documents available and/or provided to the FO by CAU). The easiest way to accomplish this is to attach the documents as part of the survey appointment. If the documentation is too large, other arrangements may need to be made; but, regardless, it is expected that the surveyor has the information as pre-survey activity. The field office must review all complaint allegations and conduct a standard or an abbreviated standard survey (See Appendix P for LTC facilities) to survey complaints of violations of requirements if its review of the allegation concludes that: A deficiency in one or more of the requirements may have occurred; Only a survey can determine whether a deficiency or deficiencies exist; and The complaint is general or specific and may involve staff, residents, volunteers, the physical environment or administration. Complaint surveys follow, as appropriate, the pertinent survey tasks or tags, and information gathered is recorded on the appropriate survey worksheets. Deficiencies are cited on the CMS or State Form (Statement of Deficiencies) as appropriate. For long term care complaints not completed in conjunction with a recertification survey, related exhibits / surveyor worksheets should be used to ensure appropriate review of identified concerns. Record deficiencies on the CMS-2567 or the Notice of Isolated Deficiencies (2567A), or both as applicable. The timing, scope, duration and conduct of a complaint survey are at the discretion of the field office manager/designee. The team should conduct the necessary survey to resolve the complaint. If the complaint concerns conditions on a certain day or shift, the field office should make an attempt to survey it at the time relevant to the complaint. Baker Act Complaints (added October 2014) The field office should coordinate joint visits with the local SAMH Contact for complaints with Baker Act allegations against Baker Act receiving facilities. There should be time allowed to coordinate, since these investigations are state only-priority 4, 90-days. At times, the joint visit may not work out, but there should still be communication with the local SAMH office to make them aware of the issue. Many times, they may be looking at the same complaint we have received. Discharge Hearing Complaints (Amended September 2011) Upon facility entrance, the survey team will request a list of all facility discharge notices for the past three to six months, as well as residents with pending discharge notices. 1. A sample of at least three of these discharge notices (if available), including the subject of the hearing request will be reviewed. Complaint Management Manual Chapter 3 -- January 2015 Rev. 4 AHCA ALF Resource Manual Aug

191 2. If the transfer/discharge is related to non-payment and the resident is a Medicaid beneficiary and/or they are applying for Medicaid, survey staff should coordinate with the local Medicaid field office to verify eligibility status. 3. The surveyor will review facility compliance with Florida Statutes and Federal Code of Regulations , related to discharge requirements. This review shall include determination of whether the notice was provided to the correct party, within required timeframes and with appropriate cause, as outlined in the federal and state requirements. Furthermore, the surveyors should assess whether the facility has provided required discharge planning and orientation for transfer. The location of transfer must be viable at the time the notice is provided. Verify with the receiving facility that they are ready for the resident. The facility record must show documentation of the steps taken during the transfer/discharge process. The survey may also include components of interviewing residents and/or family members to determine facility compliance with these requirements. 4. Review of the resident discharge may also lead to a review of associated care requirements, such as residents rights and social services. The surveyor must determine if the facility has provided interventions to meet resident care needs prior to making a determination that resident needs cannot be met within the facility. This would include review of whether appropriate assessments, care planning and provision of care had been provided to the resident before providing discharge notice. 5. Since the D/C hearing complaint is a federal process, documentation of the survey should be on approved CMS forms. The surveyor must also incorporate use of the appropriate Critical Element pathway, which is an exhibit in Appendix P/PP. 6. Within ten business days of the completion of the survey, the field office will notify the hearing officer (complainant) via letter/ of the results of the survey, which should include the Closure Letter and Statement of Deficiencies (if applicable). Do not send the Complaint Investigation Form. Unlicensed Activity Complaints (Amended January 2015) Refer to the current Unlicensed Activity Survey Protocol for instructions regarding this type of activity. Unlicensed activity must also be referred to appropriate agencies in accordance with the current Referral Matrix. Unlicensed Assisted Living Facility (ALF) To be sufficient for onsite survey, an intake alleging unlicensed ALF activity must include: A verifiable address (via USPS.com) A description of the known/suspected services provided in the facility Current information (residents known to be receiving these services within the past 30 days) The owner/provider lives in the home, and the number of residents receiving services who are unrelated to that owner is greater than two. The owner/provider does not live in the home, but sets up housing and provides services for any number of residents. Any number of residents are receiving OSS funds. NOTE: Call Center staff will ask for owner to resident relationship and OSS info at intake. If the complaint did not come through the call center and we have complainant contact info, CAU will attempt to obtain that information. If the complainant is anonymous, or we are otherwise unable to obtain the relationship/oss info, there must be two or more residents to be considered for survey. Complaint Management Manual Chapter 3 -- January 2015 Rev. 5 AHCA ALF Resource Manual Aug

192 Unlicensed Health Care Clinics (HCC) may require additional coordination with staff of the Department of Health. Upon receipt of the complaint of unlicensed HCC activity the following must occur: Staff of CAU shall contact the HCC Unit to determine if the organization has a pending application for licensure, per the current Unlicensed Activity Survey Protocol. If there is no pending application, staff of CAU shall review the facility information at to attempt to determine ownership status. If the owner can be determined, CAU staff shall check the Florida Department of Health licensee website ( to determine if the facility principle owner is an MD or DO (thus excluding the clinic from AHCA licensure law). If CAU staff cannot determine the facility is excluded from AHCA licensure requirements, they shall set up a complaint. Field office staff shall coordinate on-site activity with Department of Health (DOH) staff for unlicensed pain clinics. Whenever feasible, a joint survey between AHCA & DOH staff should occur. Referrals to DOH should always be noted in Versa, in accordance with current protocol. Off-site Survey Preparation Obtain as much additional information as you can about the complaint before you begin to plan your survey. Contact the complainant, as appropriate. Refer to the Script for Contacting the Complainant for guidance, located at the end of this chapter, and on the protocols page at \\hq3fsvip02\protocols\protocols.htm. Review facility files for recent changes in staffing or ownership, APS reports and basic licensure data. Obtain reports of historical survey data and prior complaints. You may wish to contact APS or the ombudsman to discuss the nature of the complaint and whether there have been any similar complaints reported and substantiated by them. Review the related regulatory requirements or standards that pertain to the complaint. Plan the survey. Before you go to the facility, plan what information you need to obtain during the complaint survey based on the information you have already acquired. Consider practical methods to obtain that information. Plan interviews, observations and record reviews that may need to be conducted. Plan what questions to ask during interviews. Plan steps to protect the identity and confidentiality of persons involved in the complaint. Entrance Conference/Onsite Preparatory Activities Onsite complaint surveys should always be unannounced. Upon entrance, advise the provider s administrator, owner or medical director of the general purpose of the visit. It is important to let the facility know why you are there. However, the identity of the complainant and any patient or resident in the facility involved in the complaint must always remain confidential and cannot be discussed with the provider. Do not release information that will cause you to lose opportunities for pertinent observations, interviews, and record reviews required for a thorough survey. Complaint Management Manual Chapter 3 -- January 2015 Rev. 6 AHCA ALF Resource Manual Aug

193 If the provider denies access to the facility, or refuses to provide information necessary to conduct the survey, the surveyor should stop the survey and immediately contact the field office manager for advice and guidance. If determined necessary by the field office manager/designee, an Enforcement Call should be set up to include a representative from general counsel, the field office staff, the Survey Certification & Support Branch designee and the Chief of Field Operations. For certified facilities, denial of access or information is a basis for termination by CMS as defined in 42CFR In the case of a hospital, the first action taken by CMS is that the hospital will no longer be deemed to meet the Medicare Conditions of Participation (COP) and will be subject to full review by the state agency in accordance with 42CFR Continued refusal may result in termination of the Medicare Provider Agreement. In addition, if the provider refuses surveyors access, a referral should be made to Medicaid Program Integrity and the AHCA attorneys (copying the Chief of Field Operations or designee) for possible sanctions under Florida Statute 409, for failure to provide access to records for Medicaid beneficiaries (when Medicaid beneficiary records are involved). Information Gathering It may be necessary to go to more than one facility to gather information. The survey team should discuss this with the field office manager, supervisor or designee before conducting the survey. The order and manner in which you gather information will depend on the type of complaint you are surveying. Conduct comprehensive, focused, and/or closed record reviews as appropriate for the type of complaint. It is very important to remember that the determination of whether the complaint happened is not enough. The surveyor needs to determine noncompliant facility practices related to the complaint situation and which, if any, requirements are not met by the facility. It is also important to determine if other residents/patients are involved. Do your information gathering in order of priorities. Obtain the most critical information first. Based on this critical information about the incident, determine what other information to obtain in the survey. Observations, record review and interviews can be done in any order necessary. As you obtain information, use what you have learned to determine what needs to be clarified or verified as you continue the survey. 1. Observe Observe the physical environment, situations, procedures, patterns of care, delivery of services to residents/patients, and interactions related to the area of the complaint. Also, if necessary, observe other residents/patients with the same care need. After determining what occurred, i.e., what happened to the resident/patient and the outcome, determine what facility practice(s) or procedures caused the incident. Laboratory complaints may involve observing testing personnel or practices; instrument operation; pre-analytical, analytical, and post-analytical test processes. Observations may be limited to units or departments where the complaint incident occurred. For a home health agency, observations may include a home visit. *For allegations of abuse and elopement in ALFs, all residents must be observed. Include documentation of resident well-being. Complaint Management Manual Chapter 3 -- January 2015 Rev. 7 AHCA ALF Resource Manual Aug

194 Examples: 1. The complaint is that no controls are being run in the laboratory. You could observe whether: quality control material is present; appropriate control materials are used properly (i.e., according to manufacturer s instruction, at required frequency, and using the required number of levels); and appropriate and complete documentation of control results is maintained. 2. The complaint is that a resident developed a pressure ulcer in the facility which progressed to a Stage IV, became infected, and resulted in the resident s hospitalization for aggressive antibiotic therapy. The resident is still in the hospital. Procedures you might observe are: dressing changes, especially for any other residents with Stage III or IV pressure ulcers; other infection control techniques, such as hand washing and linen handling; how residents with infections are cared for to prevent decline; and care given to prevent development of pressure ulcers. (ie., are residents turned as scheduled, is specialized bedding used when appropriate, are treatments done when ordered, and are the residents with pressure ulcers receiving adequate nutritional support for wound healing). Is the pressure ulcer care planned? 3. For a complaint of verbal and physical abuse, review the record to determine the resident s mood and demeanor before and after the alleged abuse. Determine if there are any other reasons for the change in the resident s demeanor and behavior. Determine whether an assessment has been done to determine the reason for the change in mood and behavior. Does the record document any unexplained bruises and/or complaints of pain, and whether they occurred in relation to the alleged incident? 2. Sample/Observe/Interview/Record Review Conduct the survey in a manner that allows for the greatest degree of confidentiality for residents, particularly regarding the information gathered during the in-depth interviews. Use the resident identifier (e.g., a code number assigned to each resident.) For laboratory complaints, the sample may not always involve a patient (e.g. quality control/calibration). Please refer to CLIA protocol. The surveyor should observe procedures and practices of the provider, as these relate to the complaint. Patient/resident and staff interviews focusing on the facts of the allegations should also be conducted. Interview the person who made the complaint, if appropriate. Interview the person the complaint is about, if possible. Then interview any other witnesses or staff involved. You must conduct the survey in a manner designed to preserve anonymity by choosing a sample of records that includes but is not limited to the patient or resident. You may not want to interview the person who made the complaint first, as that may identify the person to the facility as the complainant. Interview residents with similar care needs. For example: Allegation: Mrs. Jones daughter states that her mother, Mrs. Jones, in the XYZ Convalescent Center, had her clothing and other personal belongings stolen on a number of occasions. Process: The surveyor should randomly question a sampling, of residents about the loss of their personal belongings. Mrs. Jones should be included in the larger sample of residents so as not to identify her as the resident involved in the complaint. Complaint Management Manual Chapter 3 -- January 2015 Rev. 8 AHCA ALF Resource Manual Aug

195 Questions like, "Your daughter informs me that you have been losing clothing here, is that true?" are not appropriate. Such questions clearly identify the resident's daughter as the complainant and may expose her and the resident to retaliation. Initially, the surveyor should confine the scope of the survey to examining the facts relevant to the allegations. Confirmation of one incident is enough to affirm the allegations. If other deficiencies are identified during the survey, it may be necessary to expand the scope of the survey. Request direction from your field office manager. Document and Analyze As interviews proceed, prepare outlines needed for other identified witnesses. Revise the outlines as new information is obtained. Inform the interviewees that you will document information during the interview. A telephone or in-person interview with the complainant may be desired. As applicable, interview the resident advocate or ombudsman. Before beginning the decision making process, review all information. Do you need additional information? Identify any inconsistencies/contradictions between interviews, observations, and record reviews. If you find inconsistencies or contradictions, collect additional data until you can resolve them. Copy any pertinent pages of patient records as needed to sufficiently document and support your decisions. Decide (Amended March 2011) Based on the information you have obtained in your complaint survey, decide the following: Is the complaint substantiated? According to the CMS State Operations Manual, Chapter 5, section 5500, A substantiated complaint is one resulting in a finding of noncompliance at the time of the investigation (substantiated with deficiencies), or a finding that noncompliance was proven to exist, but was corrected prior to the investigation (substantiated without deficiencies-the facility implemented corrective measures to remove the non-compliance). An unsubstantiated complaint is an allegation where sufficient evidence could not be found to conclude that noncompliance with requirements existed during the investigation or at the time of the alleged violation. Did the situation actually occur at some time? Is the provider out of compliance with the regulation that pertains to the complaint? For a long-term care facility, does your survey provide information indicating that a requirement is not met? Is this an isolated situation or a facility/agency problem? For a psychiatric hospital, is either of the two special COPs not met? For an HHA or ICF/MR, what is the standard or COP not met? For a laboratory, is a condition or standard level requirement not met? Has the providers practice or procedure that contributed to the incident causing the complaint been changed to achieve and/or maintain compliance? 3. Exit Conference & Report Complaint Management Manual Chapter 3 -- January 2015 Rev. 9 AHCA ALF Resource Manual Aug

196 Advise the administrator, owner or medical director of the complaint survey findings and any deficiencies. Do not inform him/her of confidential information unless the individual who provided you with the information specifically authorizes you to do so. If the deficiencies cited expose patients/residents to an immediate and serious threat, the surveyor should notify the field office manager/designee as soon as this condition is identified (prior to exit). Upon completion of the survey, the surveyor should conduct an exit interview with the provider's administrator. The surveyor should advise the administrator about whether the allegations were confirmed and whether deficiencies will be cited. If deficiencies are present, follow the usual procedures for providing the facility with the CMS-2567/state form and requesting a plan of correction (as indicated). Upon completion of the survey kit, the field office will submit the kit within required timeframes, following standard procedures. Refer to AHCA protocols for reporting timeframes and requirements. A CMS-562 must be completed for all certified facility complaints that are surveyed by an onsite visit to the facility. Refer to current protocols for report writing, kit completion, timeframes, and data entry. If a complaint is substantiated and a deficiency is present, follow procedures in the SOM (both general and provider-specific) for follow-up on the facility s PoC and any necessary enforcement actions. If the complaint is unsubstantiated (the surveyor/s cannot determine that it occurred) and there is not any indication of deficient practice, notify the facility and complainant of this decision. Whether the complaint is substantiated or not, respond to and address the concerns of the complainant. The field office should inform the complainant in writing that the office has surveyed the complaint and should report the findings and conclusion of the complaint survey. An activity should be entered in Versa the date the letter is sent to the complainant. Any enforcement procedures or planned state agency follow-up should also be communicated. Additional communication with the complainant may be necessary to explain findings and answer any questions and concerns. This can be done by telephone or in writing. If done by telephone, note the date and time of the call in the file. If the complaint was filed via , you may report the findings to the complainant by , adhering to AHCA guidelines for protecting Protected Health Information. The CMS Complaint Manual (SOM Chapter 5) gives guidance on communication with the complainant. This guidance should be followed. On occasion, findings of complaint surveys may need to be sent out for physician review to determine non-compliance. The field office manager should follow the guidance in the bureau s Quality Assurance Review Protocol to request these reviews through the FMQAI (Florida Medical Quality Assurance, Inc). Where necessary, refer complaint situations to another appropriate agency for further survey. Referrals to other agencies responsible for complaint surveys can occur as soon as it is apparent that the complaint falls into a jurisdiction other than that of the Agency. An activity should be entered in Versa on the date of this occurrence showing where the complaint was referred. For example: Complaint Management Manual Chapter 3 -- January 2015 Rev. 10 AHCA ALF Resource Manual Aug

197 The survey reveals that the facility is not following guidelines for control of the transmission of blood borne pathogens as put forth by the OSHA. This information must then be referred to OSHA. Abuse, neglect or exploitation as defined in Chapter 415 is identified; refer as appropriate to the Abuse Registry. The complaint survey indicates that a physician at a psychiatric hospital has a history of inappropriate admissions and prescriptions of inappropriate medications for his patients. In addition to your survey of the facility s practice and adherence to federal requirements, this complaint must be referred to the Department of Health, Medical Quality Assurance (MQA), Consumer Services, using current protocols. Complaint Management Manual Chapter 3 -- January 2015 Rev. 11 AHCA ALF Resource Manual Aug

198 Script for Contacting the Complainant (Final December 16, 2014) When speaking to the complainant via telephone contact for a complaint investigation, use the following script. My name is and I am calling from the Agency for Health Care Administration. I would like to speak with (complainant s name). The purpose of this call is to inform you the complaint that you filed regarding (Name of Facility) has been assigned to me to be investigated. Offer condolences or sympathy to complainant based on events listed in allegation. i.e.: I m sorry for your loss. I m sorry you did not receive services as you expected. I d like to read to you, if I may, the information given to me to ensure that what I have is accurate. READ THE COMPLAINT SUMMARY. The surveyor will then ask if the complainant has any clarifications, questions, or additions to the allegations. Ask if the complainant discussed the concerns with administration and if so, what happened. It is important to listen to the complainant and let them speak without interruption. READ THE FOLLOWING INFORMATION TO THE COMPLAINANT: The way that we investigate complaints is governed by mandated Florida Statutes and/or Federal regulations. We will gather information by observation, interview and record reviews to determine if deficient practice is or was present, and if there are any State or Federal requirements not met at the time of the investigation. AHCA s regulatory authority generally empowers us to consider current non-compliance only. During this process, we select several residents/patients/clients with similar care needs to evaluate whether they were affected by the same concerns. You will receive a letter informing you of the results of the investigation. To ensure the letter will get to you, I d like to verify that the address that we have for you is correct. (Verify the complainant s address and correct spelling of their name). If the letter you receive indicates we found no evidence that rules or laws were violated, it does not mean what you have reported did not happen, it just means at the time of the survey we could not find evidence to support current deficient practice according to the regulations. The letter will also include a website to access the inspection results. They are generally available in approximately 45 days after you receive the letter. We value your information to help us ensure facility compliance. Thank you for bringing your concerns to our attention. Complaint Management Manual Chapter 3 -- January 2015 Rev. AHCA ALF Resource Manual Aug

199 If the call to complainant results in voice mail, it is acceptable to leave your name and cell phone number, but do not leave a message with details about the complaint. If a complaint is received with an address only, respond back with your name and phone number and request the complainant to call back. *Do not use the resident/patient name or other PHI unless the message is encrypted.* Use the following script in the body. Good morning (name of complainant), My name is (name of surveyor). I am from the Agency for Health Care Administration. I am investigating your concerns regarding (name of facility). If you have anything else you would like to add, please don't hesitate to let us know. Thank you for putting your trust in the Agency to investigate your concerns. Surveyor Name Field Office (Please include the location of your field office, such as Tallahassee, Alachua, Jacksonville, St. Petersburg, Orlando, Ft. Myers, Delray Beach or Miami). Phone Number *Note: if the complainant sent an to the Agency that contains PHI, reply in a separate message with the above script. Remember, that you must follow the Agency s encryption policy. Complaint Management Manual Chapter 3 -- January 2015 Rev. 13 AHCA ALF Resource Manual Aug

200 SUGGESTIONS FOR SURVEY PROTOCOLS (FOR NURSING HOME SURVEYS, USE THE APPRROPRIATE GUIDANCE PROVIDED IN APPENDIX P & PP OF THE SOM) Concern: Observation: Physical Abuse Short tour to make observations for: Evidence of bruises Skin tears Physical injuries Sample selection from observations Determine cause of injury via interviews resident/family/roommate) and record review. Interviews: Observations: What happened? How did this injury happen? When did it happen? Who was involved? Whom did you talk to about this? Have you been injured before? Tell me about it (how, when, who). Staff/resident interactions Resident/resident interactions pertinent to data obtained from interviews and at various times during the visit Record Review/Staff Interview: Review the facility s documentation concerning the injury, the facility s response, and the method of preventing recurrence. Personnel file of identified staff - Criminal history check before hire - Performance evaluations - Disciplinary actions Complaint Management Manual Chapter 3 -- January 2015 Rev. 14 AHCA ALF Resource Manual Aug

201 Concern: Verbal or Mental Abuse Observation: Tour to observe staff /resident interactions Fear Anger Behavioral symptoms: calling out, demanding, crying Sample Selection: Residents identified from observations and interview responses Resident/Family, Roommate Tell me how staff talk to you. Use appropriate council probes, as needed, related to abuse and dignity. Is there a particular person who is involved? When did it happen? Who was involved? Whom did you talk to about this? Has it happened before? Further observations pertinent to data obtained Staff Have you heard complaints from residents about staff? Have you observed or heard about any residents being yelled at, threatened, or poorly treated? Who, when, where? Did you report it? To whom? What happened? Alleged perpetrator A report was received regarding an incident that occurred between you and the resident on (dates). What can you tell me about it? (physical and mental abuse protocols) Supervisory staff Are you aware of any problems with staff treatment of residents? What did you do about it? What is your procedure to prevent recurrence? Record Review: Personnel file of identified staff Criminal history check Performance evaluations Disciplinary actions Complaint Management Manual Chapter 3 -- January 2015 Rev. 15 AHCA ALF Resource Manual Aug

202 Concern: Lack of Activities Observations: Is the activity calendar available? Who is invited to activities? How does facility staff assist residents to activities? What activities are offered to confused residents? Do activities address the needs of the population? Is sufficient storage space available for activity material so that it doesn t interfere with other items? How many residents attending the activity are participating? What are residents who are not at an activity doing? What are residents who are bedfast or room bound doing? What do one-on-one activities consist of? To what extent are volunteers used in the activity program? Interviews: Staff How do you coordinate and provide out-of-facility activities for your residents? How do you encourage and assist clients to attend activities? What activities are offered at night and on weekends? What are the special activities for residents with dementia? What activities do you have for residents who are confined to their rooms? How are activities planned or developed? How many residents are provided one-on-one activities? Obtain list. What are the qualifications of the activity director? What is the role of volunteers in the activity program? By what process do you ensure that all residents know the activity schedule? Resident/Family What activities do you attend? What kinds of things interest you most, and are you able to do them? How are you informed of the activity schedule? Does someone assist you to the activities you choose to attend? Have you been able to attend any out-of-facility activities? If no, why not? Is there sufficient transportation for out-of-facility activities? What activities are available on weekends? What activities are offered to you if you are confined to your room? How does staff assist you with independent activities? How does the facility assist you to maintain access to community events/activities? Do the activities occur the way they are posted on the calendar? What activities would you like that are not offered here? Which activities were you offered and refused? Why? Record Review: Do activities reflect individual resident history indicated by the Complaint Management Manual Chapter 3 -- January 2015 Rev. 16 AHCA ALF Resource Manual Aug

203 comprehensive assessment? Do care plans address activities that are appropriate and individual to each resident based on the comprehensive assessment? Activity Calendar: Are activities occurring as planned? Are responses to activity interventions identified in progress notes of each resident? Does the calendar reflect interests identified by assessment? Does the calendar offer activities at hours convenient to the residents (a.m., p.m., evenings, weekends)? Does the calendar reflect cultural and religious interests of residents? Do activities appeal to both men and women of all age groups? Do activities take place in a variety of places? Does the calendar include seasonal and special events? Activity attendance records Complaint Management Manual Chapter 3 -- January 2015 Rev. 17 AHCA ALF Resource Manual Aug

204 Concern: Dietary/Cold Food Observations: What is the process for delivering and serving food to: Dining room? Resident s room? Assisted dining room? First seating? Second seating? Task: Check temperatures of food. Is there adequate staff to prepare and serve food? Is there prompt assistance with feeding? Interviews: Residents/Family Do you like the temperature of the food served to you? If not, do you send it back for hot food? Do you need assistance with eating before your food gets cold? Is it a particular meal? Type of food, weekends, what groups of residents affected? Staff Describe the process for delivering and serving food. Do residents complain of cold food? How long does it take to serve food? Are room trays served before or after the dining room is served? Is there enough staff to feed residents before their food is cold? Record Review: Review recorded food temperatures for the last 30 days. Food intake Resident council minutes (grievance file) Staffing records Other Potential Concerns: Nutrition Pressure sores Complaint Management Manual Chapter 3 -- January 2015 Rev. 18 AHCA ALF Resource Manual Aug

205 Concern: Dietary/Food Is Inadequate/Tastes Poor Observations: Are residents receiving food of acceptable nutritional value in the amount, type, consistency, and frequency required? If a food group is missing from diet, what process does the facility have to offer an alternative means of satisfying residents nutritional needs? How is food prepared to ensure conservation of nutritive value? Does food have appetizing appearance and aroma? Is food prepared in a form designed to meet individual needs? Is a substitute offered, of similar nutritive value, to residents who refuse food served? Are therapeutic diets served? Are meals consistent with the planned menu? Are meals served according to schedule? How much food is left on an individual s plate? Are pureed diets prepared according to the menu/recipe? Are nourishing snacks offered appropriate to the needs of the individual? What is the facility s system to ensure outdated foods are not served? How much of specific food items are left on individuals plates? Observe for additional food kept by residents in their rooms. Why? How are food supplements served? How much of the food supplement or snack is consumed by individuals? Observe food served in all dining areas, including residents rooms, to assess appearance and palatability. How long are trays served before residents arrive in the dining area? Interviews: Resident/Family Do you like the food? If not, why? How does staff react when you ask for substitutes or second portions? What happens when you ask for a second portion? Are you on a special diet? Are you getting enough to eat? What kinds of snacks do you receive? What happens when you don t like the food? Do they serve what is posted on the menus? Do you get assistance with eating when you need it? How long do you have to wait in the dining room to be served? Does the food look appetizing? How well do you like the way food is seasoned? How often is the food overcooked or undercooked? How much input do you have in menu planning? Staff Can you tell any difference between regular diets and therapeutic diets? When do you serve second portions? Are menus followed When are snacks served? What snacks are served? How do you ensure that meals are varied throughout the week or month? Complaint Management Manual Chapter 3 -- January 2015 Rev. 19 AHCA ALF Resource Manual Aug

206 How do you ensure that menus reflect the recommended dietary allowances? How are individual food preferences identified? Which residents receive dietary supplements and what are they? What is your procedure for offering substitutes? Record Review: Does review of the medical record indicate that weight losses have occurred, and why? Do menus reflect recommended dietary allowances? Are diets accurate, adequate, and based on individual need? To what extent does the dietician participate in interdisciplinary care planning? Is the food being served according to the menu? Is the therapeutic diet prescribed by the physician? Are dietary concerns addressed on the MDS and the comprehensive care plan? If a significant change is identified (i.e., weight loss, decline in eating ability), is there an assessment as to the cause and progress notes to show how the resident is responding to the treatment plan? If not responding, can you see evidence of what changes were made in the approaches based on the assessment? Are menus varied and prepared in advance? Review dietary intake records. Review Resident Council minutes or recommendations from family groups related to food complaints. Complaint Management Manual Chapter 3 -- January 2015 Rev. 20 AHCA ALF Resource Manual Aug

207 CONCERN: Dietary Sanitation Observations: Observe how food is stored and protected from contamination. At what temperature are foods stored? How do staff handle and cook potentially hazardous food? How is food transported in a way that protects against contamination (covered, wrapped, etc.)? Pest free? Is hot water or chemical washing in the dish machine sufficient to sanitize? How are the dishes/pans which do not go through the dishwasher sanitized? How is food preparation equipment sanitized? Are hand washing facilities convenient and properly equipped for dietary staff use and being used? How are toxic items (insecticides, detergent, and polishes) sorted, labeled, and used? Are garbage containers in good condition, and is waste properly contained with lids or otherwise covered? Observe for good infection control practices. Observe standard meal preparation/cleanup (i.e. storage). Observe equipment and utensil/dish storage areas. What procedures does the facility use to thaw and cool foods? How are food preparation areas and equipment sanitized? What procedure is used to store, date, and identify food items? Interviews: Resident/Family Have the dishes/glasses/silverware you use ever been unclean? Have you noticed any problems regarding cleanliness in the dietary area? Are you aware of anyone who has gotten ill from eating the food? Do kitchen staff look clean? Staff How do you store foods? Have you seen mice in the dietary area? Have you seen flies or cockroaches in the dietary area? What do you do if pests are present? Where do you store chemicals or pesticides? Are garbage containers always covered? What is your cleaning schedule? When was your last training session on infection control or food-borne illness? How far in advance is food prepared? What is facility policy and practice when staff are ill? How do you sanitize food preparation areas and kitchen equipment? Complaint Management Manual Chapter 3 -- January 2015 Rev. 21 AHCA ALF Resource Manual Aug

208 Record Review: Kitchen equipment maintenance Pest control records Schedule for cleaning kitchen equipment Staff training records - infection control, food-borne illness LSC requirements Infection control policies Complaint Management Manual Chapter 3 -- January 2015 Rev. 22 AHCA ALF Resource Manual Aug

209 Concern: Matrix: Infection Control Infections/antibiotics, catheters, tube feeding, pressure ulcers Observations: Proper hand washing and glove usage? How does facility dispose of trash and infectious waste? What types of infection control practices are staff using? Are there symptoms of infections in staff or visitors to the facility? Proper linen processing, transportation, storage, and handling? Appropriate clean or sterile techniques are used with treatments and wherever appropriate? For residents who are isolated, do all staff/visitors follow appropriate precautions? Interviews: Resident/Family Have you ever noticed staff to be ill when they cared for you? Do staff wash their hands when caring for you? Does staff wear gloves to do your care? How do they handle your soiled linens, your dressing, your trash, any used needles? Have you had an infection or severe nausea or diarrhea? Was anyone else in the facility sick also? What does staff do when you tell them you re sick? When did you last have a flu shot? Pneumonia vaccine? TB testing? Staff What kind of training have you had to prevent and manage infections? (Ask different departments, different shifts.) When was your last flu shot, pneumonia vaccination, hepatitis vaccination, TB skin testing? Do you know which residents are at high risk for infections? What do you do to reduce the risk for them? What do you do if you have a communicable disease or infected skin problem? Have you had enough training to feel comfortable caring for residents with infections? Management staff (If a problem is noted after staff questions, ask management.) How do you monitor staff infection control practices? Whom do you consult for infection control problems? How do you communicate/collaborate? Whom do you notify for facility-wide infections that are difficult to control? What do they do? How do you decide when to do cultures/other lab tests? Are results timely? Are they used effectively to manage infections? How do you manage colonization? How do you monitor the infection rate? If you need to isolate someone, how do you determine that and what isolation procedures to follow? How do you monitor antibiotic usage in the facility? Complaint Management Manual Chapter 3 -- January 2015 Rev. 23 AHCA ALF Resource Manual Aug

210 How do you identify and monitor infections in the facility? Anyone currently on antibiotics? Any recent outbreaks (flu, diarrhea, scabies, MRSA, shingles, VRE, etc.)? Record Review: Is there documented evidence of an effective system to monitor and determine causes of infection and prevention of spread? Are physicians/family notified appropriately? Does infection report contain: - Name of the resident/location in the facility? - - Date of infection/causative agent/how determined? - Origin/site of infection? - Treatment/results? - Cautionary measures to prevent spread? Is there evidence that outbreaks are reported to appropriate authorities? Is there evidence of adequate infection control policies/procedures for HIV, hepatitis, TB, flu, pneumonia, etc.? Is there evidence the facility consistently follows their policies/procedures for both residents and staff? Is there evidence of appropriateness and monitoring of antibiotic usage? Complaint Management Manual Chapter 3 -- January 2015 Rev. 24 AHCA ALF Resource Manual Aug

211 Concern: Loss of Mobility/Range of Motion Observations: Short tour; select sample of residents with this problem. Position, devices, and contractures; absence of devices; condition of devices. If staff are working with the resident, what are they doing? Resident response. Does resident ambulate? Mobility/movement observed Interview: Residents/Family/Roommate Are you comfortable? What is that device? What happened to your (contracted limb)? Do you know what exercises are provided to the residents? What do staff do with your roommate? (if resident is not interviewable) Staff Direct care staff involved with this issue: - Nurses, PT/OT, aides - What interventions/services, if any, do they do? - What are you doing with this resident s (contracted limb)? - What are your procedures to prevent decline in mobility and use of extremities? - How do you measure? Record Review: If resident is bedfast-- Assessments: MDS, initial nursing, progress reports, history and physical; closed record if readmit documents do not reflect the decline; diagnosis and prognosis Care plan interventions; physician s orders and notes Analysis: Analyze data and determine if decline was avoidable or unavoidable-- Is there evidence that there has been a decline in the client s range of motion or muscle atrophy? What? When? Was the resident at risk for declines in range of motion? - Did the assessment accurately reflect this problem? Was it care planned? Was the care plan appropriate? - What care did the facility provide, including preventive measures that addressed the client s unique risk factors? - Was this care provided consistently? What was the resident s response to the care provided? Is there evidence that care planning is changed as needed? Complaint Management Manual Chapter 3 -- January 2015 Rev. 25 AHCA ALF Resource Manual Aug

212 Concern: Misappropriation of Property Observations: Physical security of building (i.e., locks, alarms, exit doors, storage/closet areas have doors) Who has access to the facility or residents rooms? Observe how personal items are secured. How are personal items identified? How do staff intervene with residents who wander into others rooms? Who has access to secured units? Interviews: Staff What is your procedure when a theft is reported? What is your system to prevent theft? Who has keys to residents locked boxes or areas? What is your system to ensure laundered items are returned to individuals? What is your system to ensure the identification of individuals personal possessions? How do you manage residents who wander into other residents rooms? Has theft from the facility been a problem? When and to whom do you report theft? When do you involve your social services worker in assisting the resident with coping with the loss? How do you identify and assist residents who cannot protect their possessions or report theft to ensure their possessions are secured? Resident/Family Have you ever lost or missed anything? Do staff ever borrow things from you? Do staff ever use your things without permission? To whom do you report missing property? What does the facility do when you report things missing? Who else knew of your missing items? How was the situation resolved? What did the facility tell you about it? Record Review: Policy regarding the theft/safeguarding of personal property Policy regarding system to report and investigate theft Facility records regarding previous thefts, complaints, survey, resolutions, corrective actions, and steps taken to prevent reoccurrence Facility records of personal property inventory Resident Council meeting minutes concerning complaints Court or law enforcement reports Grievance file Employee personnel files Complaint Management Manual Chapter 3 -- January 2015 Rev. 26 AHCA ALF Resource Manual Aug

213 Concern: Restraints Tour to observe restraint use. Select sample of residents using restraints (those who cannot self-release). Observations: Different settings and times Type of restraint and resident response to restraint Single or multiple Staff interactions with resident and care observed Interviews: Resident (if interviewable) What is this? What is it for? Do you want it? Resident/Family When do you use it? How long have you had it? Why? Did something happen? Did the facility discuss it with you? Was it okay with you? Did they discuss other options? Did they tell you the advantages? Did they tell you the disadvantages? How long will you be using it? Record Review/Staff Interview Did the resident come in with the restraint? Assessment: RAPs, interdisciplinary team evaluation of the RAP Symptoms that lead to the restraint use What other alternatives were reviewed and tried prior to restraint use? If none, restraint use is improper. If alternatives were reviewed and tried: - Review the care plan. - Least restrictive device? - Least amount of time per day? - Plan to reduce/remove? - Is care plan implemented as written? - Did facility re-evaluate the need for the restraint? Analysis: Determine if additional observations are needed to decide severity/ scope Review probes in SOM for additional focus needed. Determine prevalence of restraint use in the facility. Complaint Management Manual Chapter 3 -- January 2015 Rev. 27 AHCA ALF Resource Manual Aug

214 Concern: Staffing Shortage Off-Site Prep: Determine the outcome-related issue to be surveyed prior to entering the facility. Tour the facility within the time period referenced in the complaint, e.g., the p.m. shift, the weekend, as appropriate. Observations: Presence/absence of care provided specific to complaint issue Quality of interactions between staff and residents during care Interviews: Resident/Family/Roommate (as appropriate) Sample of residents with similar care issues Are you getting the (blank) care you need in a timely manner? How are you treated by staff? How long has this been happening? Is it different on other shifts? On other days of the week? What is the impact to the patient as a result of a missed home health visit? Direct care staff Tell me about how you provide care. Are you able to complete the care in a timely manner according to your assignment? If you can t complete your assignments, what happens? Supervisory staff What is your system to ensure that residents are given (blank) care as planned? Share findings and ask for a response. Analysis: Analyze data to determine if there is a quality of care/quality of life deficiency. If yes, gather support information regarding staff numbers and the staff schedule/support documents as needed. Complaint Management Manual Chapter 3 -- January 2015 Rev. 28 AHCA ALF Resource Manual Aug

215 Concern: Pressure Ulcers Observations: Tour observations - focus on: Dependent residents Restraints Positioning Signs of malnutrition or dehydration Staff availability Call lights Treatment observations Appropriate facility assessment Pain Management Infection Control Treatment appropriate to current standards of practice Ongoing observation: Positioning Use of pressure-reducing devices (special bed, mattress, cushion ) Appropriately restrained/effective release of restraints Hydration needs Nutritional interventions Interview: Resident/Family Do you have any open areas/sores/skin problems? Do you have any pain (wherever pressure sores are a problem)? How is the facility staff caring for your skin problem/sore? How often do they provide the care? Is the care helping? Is the area getting better? Do you have any concerns about treatment/care? Staff How do you manage pressure sores? Tell me how you identify pressure sores on admission. How do you identify pressure sores on an ongoing basis? (Ask various facility staff levels.) What is the process of assessing pressure sores? Do you have any problems with getting treatment supplies? Are there any problems with providing treatments being done as planned? Tell me about nutritional supplements. Is anyone other than nursing (hospice, physical therapy, dietary, infection control consultants) involved in wound care? If so, how do they communicate and collaborate? Complaint Management Manual Chapter 3 -- January 2015 Rev. 29 AHCA ALF Resource Manual Aug

216 Record Review: When did the facility identify the pressure sore? How was it assessed? How was it care planned? Was treatment provided according to plan? How was the physician notified? If healing is not occurring, has the physician been called to change the treatment regimen? Does the resident have any medical diagnoses that substantially contribute to this problem? Is there proper documentation, assessment, and care planning of contributing factors (nutrition, hydration, incontinence, restraints, contracture)? Is there documentation that shows other disciplines (dietary, physical therapy, hospice, infection control) were involved as necessary? Complaint Management Manual Chapter 3 -- January 2015 Rev. 30 AHCA ALF Resource Manual Aug

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221 Attachment A Appendix Q Tool Immediate Jeopardy and Class I Documentation Facility Name: Facility ID: Surveyor Name/ID: Regulatory Non- Compliance: Identify Potential IJ/Class I Tags and Scope: Please remember to refer back to Appendix Q during your investigation. Include: Date, Time, Source and Documentation WHO: Who was involved in the Immediate Jeopardy/Class I situation: staff, individuals receiving care and services, and others? Does the individual(s) at risk have special needs? Has this happened to other individuals? If yes, how many? Are there others to whom this is likely to occur? If so, how many and who? Which facility staff knew or should have known about the situation? WHAT: What harm has occurred, is occurring, or most likely will occur? How serious is the potential/actual harm? As the result of the incident/practice, has any individual, Died? Had serious harm (almost life threatening)? Had serious impairment (loss of physical/mental functioning or sensory functioning)? Had serious illness (resulting in hospitalization or higher level of care)? Or will likely have any of the above in the immediate future without intervention? How did the situation occur? Final June 13, 2012 AHCA ALF Resource Manual Aug

222 Include: Date, Time, Source and Documentation What was the sequence of events? (What is the timeline of events from start to present time?) What attempts did the facility make to assess, plan, correct, and reevaluate regarding the potential/actual harm? What did the facility do to prevent any further occurrences of the same nature? WHEN: When did the current situation first occur? How long has the situation existed? Has a similar occurrence happened before? Has the facility had an opportunity to correct the situation? Did the facility thoroughly investigate the event? Did you agree with the facility s conclusion after their investigation? Did the entity implement corrective measures to prevent any further similar situations? Did they follow up and evaluate the effectiveness of their measures? (Was this incident addressed in any quality improvement process, if included in this entity s regulations?) WHERE: Where did the potential/actual harm occur? Is this an isolated incident or an entity-wide problem? WHY: Why did the potential/actual harm occur? Final June 13, AHCA ALF Resource Manual Aug

223 Include: Date, Time, Source and Documentation Was the Immediate Jeopardy/Class I preventable? Is there a system in place to prevent further occurrences? Is this a repeat deficient practice? Is there a pattern of similar deficient practices? Is a moratorium on admissions necessary? Was the Referrals Matrix reviewed and contacts made to outside agencies/departments? Do individuals need to be relocated from the facility? Do staff need to be removed from resident/patient care if the facility hasn t done so? Final June 13, AHCA ALF Resource Manual Aug

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233 ASSISTED LIVING FACILITY SURVEY QUALITY ASSURANCE AUDIT TOOL (Attachment A) Purpose: Use this tool to audit Assisted Living Facility Surveys for compliance with the Revised Survey Process effective October 1, 2012 Facility Name: F/O: Date of Survey: Census: ASPEN Event ID: Reviewer: Date of Review: Survey Team: 1. Abbreviated survey tasks Minimum of 6 resident interviews 1 staff interview Resident record reviews (there should be none unless concerns) Staff record reviews 1 per shift Dining observations Medication Pass observations Other observations notes Yes No N/A Comments Abbreviated: Yes or No: If Yes, was local Ombudsman contacted prior to going onsite? Specialty License Worksheet (ECC/LNS/LMH) 2. Standard survey tasks Resident interviews (25% of census min of 6 and max of 10) Family interview at least 1 Record reviews 2 Staff record reviews 1 per shift Staff Interview 1 per shift Dining observations Medication pass observations Other observation notes Specialty License Worksheet (ECC/LNS/LMH) 3. Surveyor Worksheets utilized and completed accurately? 4. Based upon findings of the survey, were deficiencies cited as appropriate? Was appropriate Class assigned? AHCA ALF Resource Manual Aug

234 5. Recommendations/Corrective Measures (Include dates of implementation and measures for tracking compliance.) Reviewed with Surveyor Date AHCA ALF Resource Manual Aug

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236 AHCA ALF Resource Manual Aug Survey Corrective Action Plan (Attachment C) Facility Name: F/O: Date of Survey: Type of Survey: Reviewer: Date of Review: Surveyor (s) identified needing corrective action plan, include date of hire and date successfully completed program orientation: Identification of Training Needs Plan of Re-Training Plan for One-to Onementoring of the surveyor or surveyors Plan for Re-Evaluation of surveyor Anticipated Compliance Date

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247 DIVISION OF INFORMATION TECHNOLOGY Helpdesk: Technical Training: TRAINING To request training, call the AHCA IT or send to: MISTrain@ahca.myflorida.com DISCLAIMER The contents of this document were compiled from the expertise and experience of the Agency s Information Technology Technical Trainer, and from instructions obtained from various sources. IMPORTANT Instructions covered in this manual may or may not be applicable to the computer configuration, usage, or network infrastructure of other organizations using iphone 4s smart phone. DEVELOPED BY Bureau of Customer Service Business and Technical Training Ft. Knox Office Park 2727 Mahan Drive, Bldg. #3, Suite Tallahassee, Florida Revision 4/16/2014 BGavin INSTRUCTIONAL GUIDE HOW TO IMAGE AS PDF FILE Division of Health Quality Assurance Photographic Evidence Protocol AHCA ALF Resource Manual Aug

248 HOW TO PRINT THIS GUIDE This guide is designed to be printed as a half fold booklet in landscape orientation. To print from Word 2007/2010, choose the following print settings if supported by your printer. Print All Pages Print on both sides/flip pages on short edge. Landscape Orientation Page 8 NOTES AHCA ALF Resource Manual Aug

249 Page 7 NOTES TABLE OF CONTENTS TRANSFER PHOTOGRAPHIC IMAGES... 1 HOW TO SCAN DOCUMENTS... 1 Single Mode Scan One Page... 1 Batch Mode Scan Multiple Pages... 1 ADJUST IMAGE QUALITY... 2 ENTER NOTES... 2 NAME THE FOLDER PDF FILE... 3 EDIT NOTES IN THE ADOBE PDF FILE... 4 DELETE IMAGES FROM CAMSCANNER... 4 SCAN IN BATCH MODE... 5 OTHER NEW FEATURES... 6 ADD ADDITIONAL PAGES... 6 ANNOTATION... 6 ADD NOTES... 6 i AHCA ALF Resource Manual Aug

250 TRANSFER PHOTOGRAPHIC IMAGES The following process outlines steps on how to send photographic images and scanned documents to your from the CamScanner app. This method is beneficial in that when pictures are taken, or documents are scanned, the image can be named and notes can be added to provide additional details. When ed, the name and any notes will remain with the image. Please use this process exclusively. HOW TO SCAN DOCUMENTS 1. From the Home screen, tap CamScanner Pro app. 2. Tap Single Mode icon or Batch Mode icon. (See image below) Single Mode Scan One Page To scan a single document, tap the Single Mode icon. Batch Mode Scan Multiple Pages To scan multiple documents tap Batch Mode icon. Batch Mode scans multiple pages and saves scanned pages as one file. After all pages are scanned, the number of scanned images will appear to the right of the camera icon. See Scan in Batch Mode on page Focus on the document or image then tap Camera icon to begin scanning. Page 1 7. Use the crop tools if desired, then tap the check mark when editing is completed. 8. To improve image quality, tap picture enhancement tool (like Magic Color), then tap Check Mark again to save changes. 9. Tap Back to move to the next image and repeat steps Complete the process by following steps on page 2, starting with ADJUST IMAGE QUALITY. OTHER NEW FEATURES ADD ADDITIONAL PAGES ANNOTATION ADD NOTES Add additional images to an existing file before the file is ed. Mark: Use to add annotations to the scanned image. Recognize: Prepare file for character recognition such that the image text is searchable. Note: add Notes in reference to the scanned document. Enter notes to the scanned document or image. Notes are editable in Adobe and while saved in the iphone. Page 6 AHCA ALF Resource Manual Aug

251 IMPORTANT Please do not delete images from CamScanner until you are certain the image(s) have been successfully ed and stored in the required location. SCAN IN BATCH MODE Batch Mode allow you to scan multiple document pages or capture multiple images then save as one file. For example, if you need to scan multiple pages of a file, scan the pages in batch mode and save all pages as one file. 1. From the Home screen, tap CamScanner Pro icon. 2. Tap Batch Mode icon. 3. Focus on the document or image then tap Camera icon to begin scanning. The # Scanned Pages will appear to the right of the screen. 4. Tap Finished(#) after all pages or scanned. The number of scanned pages will appear in sequence. 5. Images are processed for storing in a single file and once completed, a list of images will appear. 6. To edit a single page, tap the page then tap Re edit. Page 5 ADJUST IMAGE QUALITY 4. Tap Crop icon to surround entire image or drag the round handles to crop Image. Tap Check Mark to save changes. 5. To improve image quality, tap picture enhancement tool (like Magic Color), then tap Check Mark again to save changes. ENTER NOTES 6. Tap image, tap Note icon, then tap on Start to add some notes!. Use the keyboard to enter notes, and when finished, tap Save, tap Close, tap Back. NAME THE FOLDER 7. Tap on the name (new doc 1), then type the name when the Rename window appears. Tap OK. Another method is to tap More and from Actions screen, tap Attribute, enter a folder name, tap Done, tap Back. Page 2 AHCA ALF Resource Manual Aug

252 8. To add images to an existing folder, tap to open image, then tap Add icon. NOTE: To store pictures in a new folder, tap Back button until you return to the window that shows all images, then tap Camera icon. Repeat steps PDF FILE 9. While image is in view, tap More and from the Actions screen, tap then tap PDF File. 10. Address the message, then tap Send. Note that the name entered in the Rename box becomes the name of the PDF file. 11. Tap Back. 12. Tap Back. 13. Tap Back then press Home button to exit CamScanner and return to the Home screen. IMPORTANT *Maximum Size: 6 MB to send outside the agency, and 10 MB to send within the agency. If the size exceeds the maximum size, then use your cable to download images to the computer. Page 3 EDIT NOTES IN THE ADOBE PDF FILE 1. Open message, then open the PDF file. 2. While the PDF file is opened in Adobe, click the Notes icon to view or edit notes. 3. Click the Save or Save As command to save the PDF file to the proper location. DELETE IMAGES FROM CAMSCANNER At some point, images should be deleted from the CamScanner application. To do so: 1. From the Home screen, tap the CamScanner icon. A screen of All images appears. 2. Tap on the Folder or image you want to delete. The image or folder containing multiple images opens showing the images in numbered order. 3. Tap Select, then tap the circle next to the numbered photo you wish to delete. A check mark will appear in the circle left of the image to indicate the image is selected. 4. Tap the Delete icon to delete the selected image(s) then tap OK to confirm deletion. 5. When CamScanner returns to the previous screen, press the Home button to return to Home screen. Page 4 AHCA ALF Resource Manual Aug

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Oversight of Assisted Living Facilities, Innovations and Lessons Learned October 1, 2012

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