Florida Senate - 2008 COMMITTEE AMENDMENT

Bill No. CS for SB 2216

754484

CHAMBER ACTION

Senate

Comm: RCS

3/19/2008

House

The Committee on Health Regulation (Alexander) recommended the

following amendment:

Senate Amendment (with title amendment)

Delete everything after the enacting clause

and insert:

Section 1. Subsection (4) of section 322.142, Florida

Statutes, is amended to read:

322.142 Color photographic or digital imaged licenses.--

(4) The department may maintain a film negative or print

file. The department shall maintain a record of the digital

image and signature of the licensees, together with other data

required by the department for identification and retrieval.

Reproductions from the file or digital record are exempt from

the provisions of s. 119.07(1) and shall be made and issued only

for departmental administrative purposes; for the issuance of

duplicate licenses; in response to law enforcement agency

requests; to the Department of State pursuant to an interagency

agreement to facilitate determinations of eligibility of voter

registration applicants and registered voters in accordance with

ss. 98.045 and 98.075; to the Department of Revenue pursuant to

an interagency agreement for use in establishing paternity and

establishing, modifying, or enforcing support obligations in

Title IV-D cases; to the Department of Children and Family

Services pursuant to an interagency agreement to conduct

protective investigations under chapter 415; or to the

Department of Financial Services pursuant to an interagency

agreement to facilitate the location of owners of unclaimed

property, the validation of unclaimed property claims, and the

identification of fraudulent or false claims, and are exempt

from the provisions of s. 119.07(1).

Section 2. Subsection (25) is added to section 400.141,

Florida Statutes, to read:

400.141 Administration and management of nursing home

facilities.--Every licensed facility shall comply with all

applicable standards and rules of the agency and shall:

(25) Conduct a level 1 background screening as defined in

chapter 435, of a prospective resident before admission or

immediately after admission at the resident's expense. The

information obtained may be used by the facility to assess the

needs of the resident and to provide adequate and appropriate

health care and protective and support services in accordance

with this part. The Agency's employee background screening

database may not be used for resident screening. If a resident

transfers between facilities, the resident's background

screening results shall be transferred with the resident.

Facilities that have been awarded a Gold Seal under the program

established in s. 400.235 may develop a plan to provide

certified nursing assistant training as prescribed by federal

regulations and state rules and may apply to the agency for

approval of their program.

Section 3. Subsection (3) of section 400.19, Florida

Statutes, is amended to read:

400.19 Right of entry and inspection.--

(3) The agency shall every 15 months conduct at least one

unannounced inspection to determine compliance by the licensee

with statutes, and related with rules promulgated under the

provisions of those statutes, governing minimum standards of

construction, quality and adequacy of care, and rights of

residents. The survey shall be conducted every 6 months for the

next 2-year period if the facility has been cited for a class I

deficiency, has been cited for two or more class II deficiencies

arising from separate surveys or investigations within a 60-day

period, or has had three or more substantiated complaints within

a 6-month period, each resulting in at least one class I or

class II deficiency. In addition to any other fees or fines in

this part, the agency shall assess a fine for each facility that

is subject to the 6-month survey cycle. The fine for the 2-year

period shall be $6,000, one-half to be paid at the completion of

each survey. The agency may adjust this fine by the change in

the Consumer Price Index, based on the 12 months immediately

preceding the change increase, to cover the cost of the

additional surveys. The agency shall verify through subsequent

inspection that any deficiency identified during inspection is

corrected. However, the agency may verify the correction of a

class III or class IV deficiency unrelated to resident rights or

resident care without reinspecting the facility if adequate

written documentation has been received from the facility, which

provides assurance that the deficiency has been corrected. The

giving or causing to be given of advance notice of such

unannounced inspections by an employee of the agency to any

unauthorized person shall constitute cause for suspension of not

fewer than 5 working days according to the provisions of chapter

110.

Section 4. Section 400.215, Florida Statutes, is amended

to read:

400.215 Background Personnel screening requirement.--

(1) The agency shall require Background screening as

provided in chapter 435 is required for all nursing home

facility employees and contracted workers or prospective

employees of facilities licensed under this part who are

expected to, or whose responsibilities may require them to:

(a) Provide personal care or services to residents;

(b) Have access to resident living areas; or

property.

(2) Employers, and employees, contractors, and contracted

workers shall comply with the requirements of s. 435.05.

100

(a) Notwithstanding the provisions of s. 435.05(1),

101

facilities must have in their possession evidence that level 1

102

screening under s. 435.03 has been completed before allowing an

103

employee or contracted worker to begin employment in the

104

facility working with patients as provided in subsection (1).

105

All information necessary for conducting level 1 background

106

screening using level 1 standards as specified in s. 435.03

107

shall be submitted by the nursing facility to the agency.

108

Results of the background screening shall be provided by the

109

agency to the requesting nursing facility.

110

(b) Employees and contracted workers qualified under the

111

provisions of paragraph (a) who have not maintained continuous

112

residency within the state for the 5 years immediately preceding

113

the date of request for background screening must complete level

114

2 screening, as provided in s. 435.04 chapter 435. Such

115

Employees may work in a conditional status for up to 180 days

116

pending the receipt of written findings evidencing the

117

completion of level 2 screening. Contracted workers who are

118

awaiting the completion of level 2 screening may work only under

119

the direct and visual supervision of persons who have met the

120

screening requirements of this section. Level 2 screening is

121

shall not be required for of employees, or prospective

122

employees, or contracted workers who attest in writing under

123

penalty of perjury that they meet the residency requirement. To

124

complete Completion of level 2 screening: shall require

125

1. The employee or contracted worker shall prospective

126

employee to furnish to the nursing facility a full set of

127

fingerprints for conducting a federal criminal records check to

128

enable a criminal background investigation to be conducted.

129

2. The nursing facility shall submit the completed

130

fingerprint card to the agency.

131

3. The agency shall establish a record of the request in

132

the database provided for in paragraph (c) and forward the

133

request to the Department of Law Enforcement, which is

134

authorized to submit the fingerprints to the Federal Bureau of

135

Investigation for a national criminal history records check.

136

4. The results of the national criminal history records

137

check shall be returned to the agency, which shall maintain the

138

results in the database provided for in paragraph (c).

139

5. The agency shall notify the administrator of the

140

requesting nursing facility or the administrator of any other

141

requesting facility licensed under chapter 393, chapter 394,

142

chapter 395, chapter 397, chapter 429, or this chapter, as

143

requested by such facility, as to whether or not the employee

144

has qualified under level 1 or level 2 screening.

145

146

An employee or contracted worker prospective employee who has

147

qualified under level 2 screening and has maintained such

148

continuous residency within the state is shall not be required

149

to complete a subsequent level 2 screening as a condition of

150

employment at another facility.

151

152

A contract worker who is retained on an emergency basis or for a

153

task involving repair or maintenance that will require the

154

contract worker to be on the premises for less than one day,

155

shall not be required to have a background screen under this

156

section, but must be required to sign in upon entering the

157

building, wear an identification badge, and sign out before

158

leaving the building. The facility shall maintain a log with the

159

information collected.

160

161

162

that includes of background screening information which shall

163

include the results of all both level 1 and level 2 screening.

164

The Department of Law Enforcement shall timely provide to the

165

agency, electronically, the results of each statewide screening

166

for incorporation into the database. The agency shall, upon

167

request from any facility, agency, or program required by or

168

authorized by law to screen its employees or contracted workers

169

applicants, notify the administrator of the facility, agency, or

170

program of the qualifying or disqualifying status of the person

171

employee or applicant named in the request.

172

(d) Applicants and Employees, prospective employees, and

173

contracted workers shall be excluded from employment pursuant to

174

s. 435.06, and may not be employed or resume employment until

175

exempted or all appeals have been resolved in favor of the

176

person screened.

177

(3) The person being screened applicant is responsible for

178

paying the fees associated with obtaining the required

179

screening. Payment for the screening shall be submitted to the

180

agency. The agency shall establish a schedule of fees to cover

181

the costs of level 1 and level 2 screening. Facilities may pay

182

reimburse employees for these costs. The Department of Law

183

Enforcement shall charge the agency for a level 1 or level 2

184

screening a rate sufficient to cover the costs of such screening

185

pursuant to s. 943.053(3). The agency shall, as allowable,

186

reimburse nursing facilities for the cost of conducting

187

background screening as required by this section. This

188

reimbursement is will not be subject to any rate ceilings or

189

payment targets in the Medicaid Reimbursement plan.

190

(4)(a) As provided in s. 435.07:,

191

(a) The agency may grant an exemption from

192

disqualification to an employee, or prospective employee, or

193

contracted worker who is subject to this section and who has not

194

received a professional license or certification from the

195

Department of Health.

196

(b) As provided in s. 435.07, The appropriate regulatory

197

board within the Department of Health, or that department itself

198

when there is no board, may grant an exemption from

199

disqualification to an employee, or prospective employee, or

200

contracted worker who is subject to this section and who has

201

received a professional license or certification from the

202

Department of Health or a regulatory board within that

203

department.

204

(5) Any provision of law to the contrary notwithstanding,

205

Persons who have been screened and qualified as required by this

206

section, and who have not been unemployed for more than 180 days

207

thereafter, and who, under penalty of perjury, attest to not

208

having been convicted of a disqualifying offense since the

209

completion of such screening are, shall not be required to be

210

rescreened. An employer may obtain, pursuant to s. 435.10,

211

written verification of qualifying screening results from the

212

previous employer, contractor, or other entity that which caused

213

the such screening to be performed.

214

(6) The agency and the Department of Health may shall have

215

authority to adopt rules to administer pursuant to the

216

Administrative Procedure Act to implement this section.

217

(7) All employees shall comply with the requirements of

218

this section by October 1, 1998. No current employee of a

219

nursing facility as of the effective date of this act shall be

220

required to submit to rescreening if the nursing facility has in

221

its possession written evidence that the person has been

222

screened and qualified according to level 1 standards as

223

specified in s. 435.03(1). Any current employee who meets the

224

level 1 requirement but does not meet the 5-year residency

225

requirement as specified in this section must provide to the

226

employing nursing facility written attestation under penalty of

227

perjury that the employee has not been convicted of a

228

disqualifying offense in another state or jurisdiction. All

229

applicants hired on or after October 1, 1998, shall comply with

230

the requirements of this section.

231

(7)(8) There is no monetary or unemployment liability on

232

the part of, and a no cause of action for damages does not arise

233

arising against, an employer that, upon notice of a

234

disqualifying offense listed under chapter 435 or an act of

235

domestic violence, terminates the employee against whom the

236

report was issued, whether or not the employee has filed for an

237

exemption with the Department of Health or the agency for Health

238

Care Administration.

239

Section 5. Subsection (6) of section 408.809, Florida

240

Statutes, is created to read:

241

(6) The agency shall establish a schedule of fees to cover

242

the costs of any Level 1 or Level 2 screening required pursuant

243

to this part or other authorizing statutes and may adopt rules

244

to carryout these screenings and for the schedule of fees.

245

Section 6. Subsection (5) of section 408.810, Florida

246

Statutes, is amended to read:

247

408.810 Minimum licensure requirements.--In addition to

248

the licensure requirements specified in this part, authorizing

249

statutes, and applicable rules, each applicant and licensee must

250

comply with the requirements of this section in order to obtain

251

and maintain a license.

252

(5) Each licensee must:

253

(a) On or before the first day services are provided to a

254

client, a licensee must inform the client and his or her

255

immediate family or representative, if appropriate, of the right

256

to report:

257

1. Complaints. The statewide toll-free telephone number

258

for reporting complaints to the agency must be provided to

259

clients in a manner that is clearly legible and must include the

260

words: "To report a complaint regarding the services you

261

receive, please call toll-free (phone number)."

262

2. Abusive, neglectful, or exploitative practices. The

263

statewide toll-free telephone number for the central abuse

264

hotline must be provided to clients in a manner that is clearly

265

legible and must include the words: "To report abuse, neglect,

266

or exploitation, please call toll-free (phone number)." The

267

agency shall publish a minimum of a 90-day advance notice of a

268

change in the toll-free telephone numbers.

269

(b) Each licensee shall Establish appropriate policies and

270

procedures for providing such notice to clients.

271

272

containing the names, addresses, and telephone numbers for the

273

state's central abuse hotline, the State Long-Term Care

274

Ombudsman, the agency's consumer hotline, the Advocacy Center

275

for Persons with Disabilities, the Florida Statewide Advocacy

276

Council, the Medicaid Fraud Control Unit, and the Statewide

277

Public Guardianship Office, along with a clear description of

278

the assistance to be expected from each. The agency may charge a

279

fee for the cost of production and distribution of the poster.

280

Section 7. Paragraph (a) is amended and paragraphs (c) and

281

(d) are created in subsection (1) and paragraph (c) is created

282

in subsection (4) of section 408.811, Florida Statutes, to read:

283

408.811 Right of inspection; copies; inspection reports.--

284

(1) An authorized officer or employee of the agency may

285

make or cause to be made any inspection or investigation deemed

286

necessary by the agency to determine the state of compliance

287

with this part, authorizing statutes, and applicable rules. The

288

right of inspection extends to any business that the agency has

289

reason to believe is being operated as a provider without a

290

license, but inspection of any business suspected of being

291

operated without the appropriate license may not be made without

292

the permission of the owner or person in charge unless a warrant

293

is first obtained from a circuit court. Any application for a

294

license issued under this part, authorizing statutes, or

295

applicable rules constitutes permission for an appropriate

296

inspection to verify the information submitted on or in

297

connection with the application.

298

(a) All inspections shall be unannounced, except as

299

specified in s. 408.806. The giving or causing to be given of

300

advance notice of the unannounced inspection by an agency

301

employee to any unauthorized person shall, in accordance with

302

chapter 110, constitute cause for suspension of the employee for

303

at least 5 working days.

304

(b) Inspections for relicensure shall be conducted

305

biennially unless otherwise specified by authorizing statutes or

306

applicable rules.

307

308

investigation must be corrected within 30 days unless an

309

alternative timeframe is required or approved by the agency.

310

(d) The agency may require an applicant or licensee to

311

submit a plan of correction for deficiencies. If required, the

312

plan of correction must be filed with the agency within ten days

313

unless an alternative timeframe is required.

314

(2) Inspections conducted in conjunction with

315

certification may be accepted in lieu of a complete licensure

316

inspection. However, a licensure inspection may also be

317

conducted to review any licensure requirements that are not also

318

requirements for certification.

319

(3) The agency shall have access to and the licensee shall

320

provide copies of all provider records required during an

321

inspection at no cost to the agency.

322

(4)(a) Each licensee shall maintain as public information,

323

available upon request, records of all inspection reports

324

pertaining to that provider that have been filed by the agency

325

unless those reports are exempt from or contain information that

326

is exempt from s. 119.07(1) and s. 24(a), Art. I of the State

327

Constitution or is otherwise made confidential by law. Effective

328

October 1, 2006, copies of such reports shall be retained in the

329

records of the provider for at least 3 years following the date

330

the reports are filed and issued, regardless of a change of

331

ownership.

332

(b) A licensee shall, upon the request of any person who

333

has completed a written application with intent to be admitted

334

by such provider, any person who is a client of such provider,

335

or any relative, spouse, or guardian of any such person, furnish

336

to the requester a copy of the last inspection report pertaining

337

to the licensed provider that was issued by the agency or by an

338

accrediting organization if such report is used in lieu of a

339

licensure inspection.

340

341

part or authorizing statutes, the agency may provide electronic

342

access to information or documents.

343

Section 8. Subsection (2) of section 415.103, Florida

344

Statutes, is amended to read:

345

415.103 Central abuse hotline.--

346

(2) Upon receiving an oral or written report of known or

347

suspected abuse, neglect, or exploitation of a vulnerable adult,

348

the central abuse hotline shall must determine if the report

349

requires an immediate onsite protective investigation.

350

(a) For reports requiring an immediate onsite protective

351

investigation, the central abuse hotline must immediately notify

352

the department's designated protective investigative district

353

staff responsible for protective investigations to ensure prompt

354

initiation of an onsite investigation.

355

(b) For reports not requiring an immediate onsite

356

protective investigation, the central abuse hotline must notify

357

the department's designated protective investigative district

358

staff responsible for protective investigations in sufficient

359

time to allow for an investigation to be commenced within 24

360

hours. At the time of notification of district staff with

361

respect to the report, the central abuse hotline must also

362

provide any known information on any previous reports report

363

concerning the a subject of the present report or any pertinent

364

information relative to the present report or any noted earlier

365

reports.

366

367

vulnerable adult by someone other than a relative, caregiver, or

368

household member, the call shall be immediately transferred to

369

the appropriate county sheriff's office.

370

Section 9. Paragraph (e) of subsection (1) and paragraph

371

(g) of subsection (2) of section 415.1051, Florida Statutes, are

372

amended to read:

373

415.1051 Protective services interventions when capacity

374

to consent is lacking; nonemergencies; emergencies; orders;

375

limitations.--

376

(1) NONEMERGENCY PROTECTIVE SERVICES INTERVENTIONS.--If

377

the department has reasonable cause to believe that a vulnerable

378

adult or a vulnerable adult in need of services is being abused,

379

neglected, or exploited and is in need of protective services

380

but lacks the capacity to consent to protective services, the

381

department shall petition the court for an order authorizing the

382

provision of protective services.

383

(e) Continued protective services.--

384

1. Within No more than 60 days after the date of the order

385

authorizing the provision of protective services, the department

386

shall petition the court to determine whether:

387

a. Protective services are to will be continued with the

388

consent of the vulnerable adult pursuant to this subsection;

389

b. Protective services are to will be continued for the

390

vulnerable adult who lacks capacity;

391

c. Protective services are to will be discontinued; or

392

d. A petition for guardianship shall should be filed

393

pursuant to chapter 744.

394

2. If the court determines that a petition for

395

guardianship shall should be filed pursuant to chapter 744, the

396

court, for good cause shown, may order continued protective

397

services until it makes a determination regarding capacity.

398

3. If the department has a good faith belief that the

399

vulnerable adult lacks capacity, the petition to determine

400

incapacity under s. 744.3201 may be filed by the department.

401

Once the petition is filed, the department may not be appointed

402

guardian and may not provide legal counsel for the guardian.

403

(2) EMERGENCY PROTECTIVE SERVICES INTERVENTION.--If the

404

department has reasonable cause to believe that a vulnerable

405

adult is suffering from abuse or neglect that presents a risk of

406

death or serious physical injury to the vulnerable adult and

407

that the vulnerable adult lacks the capacity to consent to

408

emergency protective services, the department may take action

409

under this subsection. If the vulnerable adult has the capacity

410

to consent and refuses consent to emergency protective services,

411

emergency protective services may not be provided.

412

(g) Continued emergency protective services.--

413

1. Within Not more than 60 days after the date of the

414

order authorizing the provision of emergency protective

415

services, the department shall petition the court to determine

416

whether:

417

a. Emergency protective services are to will be continued

418

with the consent of the vulnerable adult;

419

b. Emergency protective services are to will be continued

420

for the vulnerable adult who lacks capacity;

421

c. Emergency protective services are to will be

422

discontinued; or

423

d. A petition shall should be filed under chapter 744.

424

2. If it is decided to file a petition under chapter 744,

425

for good cause shown, the court may order continued emergency

426

protective services until a determination is made by the court.

427

3. If the department has a good faith belief that the

428

vulnerable adult lacks capacity, the petition to determine

429

incapacity under s. 744.3201 may be filed by the department.

430

Once the petition is filed, the department may not be appointed

431

guardian and may not provide legal counsel for the guardian.

432

Section 10. Section 415.112, Florida Statutes, is amended

433

to read:

434

415.112 Rules for implementation of ss. 415.101-

435

415.113.--The department shall adopt promulgate rules to

436

administer this chapter including, but not limited to: for the

437

implementation of ss. 415.101-415.113.

438

(1) Background screening of department employees and

439

employee applicants which includes a criminal records check and

440

drug testing of adult protective investigators and adult

441

protective investigator supervisors.

442

(2) The reporting of adult abuse, neglect, exploitation, a

443

vulnerable adult in need of services, false reporting, and adult

444

protective investigations.

445

(3) Confidentiality and retention of department records,

446

access to records, and record requests.

447

(4) Injunctions and other protective orders.

448

(5) The provision of emergency and nonemergency protective

449

services intervention.

450

(6) Agreements with law enforcement and other state

451

agencies.

452

(7) Legal and casework procedures, including, but not

453

limited to, diligent search, petitions, emergency removals,

454

capacity to consent, and adult protection teams.

455

(8) The legal and casework management of cases involving

456

protective supervision, protective orders, judicial reviews,

457

administrative reviews, case plans, and documentation

458

requirements.

459

Section 11. Subsection (21) of section 429.02, Florida

460

Statutes, is amended to read:

461

429.02 Definitions.--When used in this part, the term:

462

(21) "Service plan" means a written plan, developed and

463

agreed upon by the resident and, if applicable, the resident's

464

representative or designee or the resident's surrogate,

465

guardian, or attorney in fact, if any, and the administrator or

466

designee representing the facility, which addresses the unique

467

physical and psychosocial needs, abilities, and personal

468

preferences of each resident receiving extended congregate care

469

services. The plan must shall include a brief written

470

description, in easily understood language, of what services

471

shall be provided, who shall provide the services, when the

472

services shall be rendered, and the purposes and benefits of the

473

services. The agency shall develop a service plan form for use

474

by providers.

475

Section 12. Paragraphs (b) and (c) of subsection (3) of

476

section 429.07, Florida Statutes, are amended to read:

477

429.07 License required; fee.--

478

(3) In addition to the requirements of s. 408.806, each

479

license granted by the agency must state the type of care for

480

which the license is granted. Licenses shall be issued for one

481

or more of the following categories of care: standard, extended

482

congregate care, limited nursing services, or limited mental

483

health.

484

(b) An extended congregate care license shall be issued to

485

facilities providing, directly or through contract, services

486

beyond those authorized in paragraph (a), including services

487

performed by persons licensed under acts performed pursuant to

488

part I of chapter 464 by persons licensed thereunder, and

489

supportive services, as defined by rule, to persons who would

490

otherwise would be disqualified from continued residence in a

491

facility licensed under this part.

492

1. To obtain an In order for extended congregate care

493

license services to be provided in a facility licensed under

494

this part, the agency must first determine that all requirements

495

established in law and rule are met and must specifically

496

designate, on the facility's license, that such services may be

497

provided and whether the designation applies to all or part of

498

the a facility. Such designation may be made at the time of

499

initial licensure or relicensure, or upon request in writing by

500

a licensee under this part and part II of chapter 408.

501

Notification of approval or denial of the such request shall be

502

made in accordance with part II of chapter 408. Existing

503

2. Facilities applying for, and facilities currently

504

licensed qualifying to provide, extended congregate care

505

services must have maintained a standard license and may not

506

have been subject to administrative sanctions during the

507

previous 2 years, or since initial licensure if the facility has

508

been licensed for less than 2 years, for any of the following

509

reasons:

510

a. A class I or class II violation;

511

b. Three or more repeat or recurring class III violations

512

of identical or similar resident care standards as specified in

513

rule from which a pattern of noncompliance is found by the

514

agency;

515

c. Three or more class III violations that were not

516

corrected in accordance with the corrective action plan approved

517

by the agency;

518

d. Violation of resident care standards which result in

519

requiring the facility resulting in a requirement to employ the

520

services of a consultant pharmacist or consultant dietitian;

521

e. Denial, suspension, or revocation of a license for

522

another facility licensed under this part in which the applicant

523

for an extended congregate care license has at least 25 percent

524

ownership interest; or

525

f. Imposition of a moratorium pursuant to this part or

526

part II of chapter 408 or initiation of injunctive proceedings.

527

3.2. A facility that is Facilities that are licensed to

528

provide extended congregate care services must shall maintain a

529

written progress report on each person who receives such

530

services, which report describes the type, amount, duration,

531

scope, and outcome of services that are rendered and the general

532

status of the resident's health. A registered nurse, or

533

appropriate designee, representing the agency shall visit the

534

facility such facilities at least quarterly to monitor residents

535

who are receiving extended congregate care services and to

536

determine if the facility is in compliance with this part, part

537

II of chapter 408, and rules that relate to extended congregate

538

care. One of these visits may be in conjunction with the regular

539

survey. The monitoring visits may be provided through

540

contractual arrangements with appropriate community agencies. A

541

registered nurse shall serve as part of the team that inspects

542

the such facility. The agency may waive one of the required

543

yearly monitoring visits for a facility that has been licensed

544

for at least 24 months to provide extended congregate care

545

services, if, during the inspection, the registered nurse

546

determines that extended congregate care services are being

547

provided appropriately, and if the facility has no class I or

548

class II violations and no uncorrected class III violations.

549

Before such decision is made, The agency must first shall

550

consult with the long-term care ombudsman council for the area

551

in which the facility is located to determine if any complaints

552

have been made and substantiated about the quality of services

553

or care. The agency may not waive one of the required yearly

554

monitoring visits if complaints have been made and

555

substantiated.

556

4.3. Facilities that are licensed to provide extended

557

congregate care services must shall:

558

a. Demonstrate the capability to meet unanticipated

559

resident service needs.

560

b. Offer a physical environment that promotes a homelike

561

setting, provides for resident privacy, promotes resident

562

independence, and allows sufficient congregate space as defined

563

by rule.

564

c. Have sufficient staff available, taking into account

565

the physical plant and firesafety features of the building, to

566

assist with the evacuation of residents in an emergency, as

567

necessary.

568

d. Adopt and follow policies and procedures that maximize

569

resident independence, dignity, choice, and decisionmaking to

570

permit residents to age in place to the extent possible, so that

571

moves due to changes in functional status are minimized or

572

avoided.

573

e. Allow residents or, if applicable, a resident's

574

representative, designee, surrogate, guardian, or attorney in

575

fact to make a variety of personal choices, participate in

576

developing service plans, and share responsibility in

577

decisionmaking.

578

f. Implement the concept of managed risk.

579

g. Provide, either directly or through contract, the

580

services of a person licensed pursuant to part I of chapter 464.

581

h. In addition to the training mandated in s. 429.52,

582

provide specialized training as defined by rule for facility

583

staff.

584

5.4. Facilities licensed to provide extended congregate

585

care services are exempt from the criteria for continued

586

residency as set forth in rules adopted under s. 429.41.

587

Facilities so licensed must shall adopt their own requirements

588

within guidelines for continued residency set forth by rule.

589

However, such facilities may not serve residents who require 24-

590

hour nursing supervision. Facilities licensed to provide

591

extended congregate care services must shall provide each

592

resident with a written copy of facility policies governing

593

admission and retention.

594

6.5. The primary purpose of extended congregate care

595

services is to allow residents, as they become more impaired,

596

the option of remaining in a familiar setting from which they

597

would otherwise be disqualified for continued residency. A

598

facility licensed to provide extended congregate care services

599

may also admit an individual who exceeds the admission criteria

600

for a facility with a standard license, if the individual is

601

determined appropriate for admission to the extended congregate

602

care facility.

603

7.6. Before admission of an individual to a facility

604

licensed to provide extended congregate care services, the

605

individual must undergo a medical examination as provided in s.

606

429.26(4) and the facility must develop a preliminary service

607

plan for the individual as provided in s. 429.26.

608

8.7. When a facility can no longer provide or arrange for

609

services in accordance with the resident's service plan and

610

needs and the facility's policy, the facility shall make

611

arrangements for relocating the person in accordance with s.

612

429.28(1)(k).

613

9.8. Failure to provide extended congregate care services

614

may result in denial of extended congregate care license

615

renewal.

616

9. No later than January 1 of each year, the department,

617

in consultation with the agency, shall prepare and submit to the

618

Governor, the President of the Senate, the Speaker of the House

619

of Representatives, and the chairs of appropriate legislative

620

committees, a report on the status of, and recommendations

621

related to, extended congregate care services. The status report

622

must include, but need not be limited to, the following

623

information:

624

a. A description of the facilities licensed to provide

625

such services, including total number of beds licensed under

626

this part.

627

b. The number and characteristics of residents receiving

628

such services.

629

c. The types of services rendered that could not be

630

provided through a standard license.

631

d. An analysis of deficiencies cited during licensure

632

inspections.

633

e. The number of residents who required extended

634

congregate care services at admission and the source of

635

admission.

636

f. Recommendations for statutory or regulatory changes.

637

g. The availability of extended congregate care to state

638

clients residing in facilities licensed under this part and in

639

need of additional services, and recommendations for

640

appropriations to subsidize extended congregate care services

641

for such persons.

642

h. Such other information as the department considers

643

appropriate.

644

645

a facility that provides services beyond those authorized in

646

paragraph (a) and as specified in this paragraph.

647

1. To obtain a In order for limited nursing services

648

license to be provided in a facility licensed under this part,

649

the agency must first determine that all requirements

650

established in law and rule are met and must specifically

651

designate, on the facility's license, that such services may be

652

provided. Such designation may be made at the time of initial

653

licensure or relicensure, or upon request in writing by a

654

licensee under this part and part II of chapter 408.

655

Notification of approval or denial of such request shall be made

656

in accordance with part II of chapter 408. Existing

657

2. Facilities applying for, and facilities currently

658

licensed qualifying to provide, limited nursing services must

659

shall have maintained a standard license and may not have been

660

subject to administrative sanctions that affect the health,

661

safety, and welfare of residents for the previous 2 years or

662

since initial licensure if the facility has been licensed for

663

less than 2 years.

664

3.2. Facilities that are licensed to provide limited

665

nursing services shall maintain a written progress report on

666

each person who receives such nursing services, which report

667

describes the type, amount, duration, scope, and outcome of

668

services that are rendered and the general status of the

669

resident's health. A registered nurse representing the agency

670

shall visit such facilities at least twice a year to monitor

671

residents who are receiving limited nursing services and to

672

determine if the facility is in compliance with applicable

673

provisions of this part, part II of chapter 408, and related

674

rules. The monitoring visits may be provided through contractual

675

arrangements with appropriate community agencies. A registered

676

nurse shall also serve as part of the team that inspects the

677

such facility.

678

4.3. A person who receives limited nursing services under

679

this part must meet the admission criteria established by the

680

agency for assisted living facilities. If When a resident no

681

longer meets the admission criteria for a facility licensed

682

under this part, arrangements for relocating the person shall be

683

made in accordance with s. 429.28(1)(k), unless the facility is

684

also licensed to provide extended congregate care services.

685

Section 13. Section 429.174, Florida Statutes, is amended

686

to read:

687

429.174 Background screening; exemptions.--The owner or

688

administrator of an assisted living facility must conduct level

689

1 background screening, as set forth in chapter 435, on all

690

employees and contracted workers hired on or after October 1,

691

1998, who perform personal services or who have access to

692

resident living areas as defined in s. 429.02(16). The agency

693

may exempt an individual from employment disqualification as set

694

forth in s. 435.07 chapter 435. However, such person may not be

695

employed or resume employment pending the granting of an

696

exemption or until all appeals have been resolved in favor of

697

the person screened. Employees and contracted workers Such

698

persons shall be considered as having met the screening

699

requirements this requirement if:

700

(1) Proof of compliance with level 1 screening

701

requirements obtained to meet any professional license

702

requirements in this state is provided and accompanied, under

703

penalty of perjury, by a copy of the person's current

704

professional license and an affidavit of current compliance with

705

the background screening requirements.

706

(2) The person required to be screened has been

707

continuously employed in the same type of occupation for which

708

the person is seeking employment without a breach in service

709

which exceeds 180 days, and proof of compliance with the level 1

710

screening requirement which is no more than 2 years old is

711

provided. Proof of compliance shall be provided directly from

712

one employer or contractor to another, and not from the person

713

screened. Upon request, a copy of screening results shall be

714

provided by the employer or contractor retaining documentation

715

of the screening to the person screened.

716

(3) The person required to be screened is employed by or

717

contracts with a corporation or business entity or related

718

corporation or business entity that owns, operates, or manages

719

more than one facility or agency licensed under this chapter,

720

and for whom a level 1 screening was conducted by the

721

corporation or business entity as a condition of initial or

722

continued employment.

723

(4) The person being screened is responsible for paying

724

the fees associated with obtaining the required screening.

725

Payment for the screening shall be submitted to the agency. The

726

agency shall establish a schedule of fees to cover the costs of

727

level 1 and level 2 screening. Facilities may pay for these

728

costs. The Department of Law Enforcement shall charge the agency

729

for a level 1 or level 2 screening a rate sufficient to cover

730

the costs of screening pursuant to s. 943.053(3).

731

732

A contract worker who is retained on an emergency basis or for a

733

task involving repair or maintenance that will require the

734

contract worker to be on the premises for less than one day,

735

shall not be required to have a background screen under this

736

section, but must be required to sign in upon entering the

737

building, wear an identification badge, and sign out before

738

leaving the building. The facility shall maintain a log with the

739

information collected.

740

Section 14. Subsection (1) of section 429.255, Florida

741

Statutes, is amended to read:

742

429.255 Use of personnel; emergency care.--

743

(1)(a) Facility staff, including persons under contract to

744

the facility, facility employees staff, or volunteers, who are

745

licensed according to part I of chapter 464, or those persons

746

exempt under s. 464.022(1), and others as defined by rule, may

747

administer medications to residents, take residents' vital

748

signs, manage individual weekly pill organizers for residents

749

who self-administer medication, give prepackaged enemas ordered

750

by a physician, observe residents, document observations on the

751

appropriate resident's record, report observations to the

752

resident's physician, and contract or allow residents or a

753

resident's representative, designee, surrogate, guardian, or

754

attorney in fact to contract with a third party, provided

755

residents meet the criteria for appropriate placement as defined

756

in s. 429.26. Nursing assistants certified pursuant to part II

757

of chapter 464 may take residents' vital signs as directed by a

758

licensed nurse or physician.

759

(b) Facility All staff, including persons under contract

760

to the facility and facility employees in facilities licensed

761

under this part shall exercise their professional responsibility

762

to observe residents, to document observations on the

763

appropriate resident's record, and to report the observations to

764

the resident's physician, and to provide needed services

765

competently. Volunteers shall have the same obligations but

766

shall report to a facility employee who will make the

767

appropriate notation in the resident's records. However, the

768

owner or administrator of the facility is shall be responsible

769

for determining that the resident receiving services is

770

appropriate for residence in the facility and for the provision

771

of and quality of care and services provided to the resident.

772

773

carry out their professional duties pursuant to part I of

774

chapter 464 until emergency medical personnel assume

775

responsibility for care.

776

Section 15. Present subsections (8) through (12) of

777

section 429.26, Florida Statutes, are renumbered as sections (6)

778

through (10), respectively, and present subsections (1) through

779

(7) of that section, are amended to read:

780

429.26 Appropriateness of placements; examinations of

781

residents.--

782

(1) The owner or administrator of a facility is

783

responsible for determining the appropriateness of admission of

784

an individual to the facility and for determining the continued

785

appropriateness of residence of an individual in the facility. A

786

determination shall be based upon an assessment of the

787

strengths, needs, and preferences of the resident, the care and

788

services offered or arranged for by the facility in accordance

789

with facility policy, and any limitations in law or rule related

790

to admission criteria or continued residency for the type of

791

license held by the facility under this part. Except as provided

792

in s. 429.28(1)(k), a resident may not be moved from one

793

facility to another without consultation with and agreement from

794

the resident or, if applicable, the resident's representative or

795

designee or the resident's family, guardian, surrogate, or

796

attorney in fact. If In the case of a resident who has been

797

placed by the department or the Department of Children and

798

Family Services, the administrator must notify the appropriate

799

contact person in the applicable department.

800

(2) A physician, physician assistant, or nurse

801

practitioner who is employed by an assisted living facility to

802

provide an initial examination for admission purposes may not

803

have financial interest in the facility.

804

(3) Persons licensed under part I of chapter 464 who are

805

employed by or under contract with a facility shall, on a

806

routine basis or at least monthly, perform a nursing assessment

807

of the residents for whom they are providing nursing services

808

ordered by a physician, except administration of medication, and

809

shall document such assessment, including any substantial

810

changes in a resident's status which may necessitate relocation

811

to a nursing home, hospital, or specialized health care

812

facility. Such records shall be maintained in the facility for

813

inspection by the agency and shall be forwarded to the

814

resident's case manager, if applicable.

815

(2)(4) If possible, each resident shall have been examined

816

by a licensed physician, a licensed physician assistant, or a

817

licensed nurse practitioner within 60 days before admission to

818

the facility. The person conducting an examination under this

819

subsection may not have financial interest in the facility. The

820

signed and completed medical examination report shall be

821

submitted to the owner or administrator of the facility who

822

shall use the information contained in the report therein to

823

assist in determining the determination of the appropriateness

824

of the resident's admission and continued stay in the facility

825

and to develop a service plan for the resident. The medical

826

examination report and service plan shall become a permanent

827

part of the record of the resident at the facility and shall be

828

made available to the agency during inspection or upon request.

829

An assessment that has been completed through the Comprehensive

830

Assessment and Review for Long-Term Care Services (CARES)

831

Program fulfills the requirements for a medical examination

832

under this subsection and s. 429.07(3)(b)6.

833

(a)(5) Except as provided in s. 429.07, if a medical

834

examination has not been completed within 60 days before the

835

admission of the resident to the facility, medical personnel a

836

licensed physician, licensed physician assistant, or licensed

837

nurse practitioner shall examine the resident and complete a

838

medical examination form provided by the agency within 30 days

839

following the admission to the facility to enable the facility

840

owner or administrator to determine the appropriateness of the

841

admission. The medical examination form shall become a permanent

842

part of the record of the resident at the facility and shall be

843

made available to the agency during inspection by the agency or

844

upon request.

845

(b)(6) Any resident accepted in a facility and placed by

846

the department or the Department of Children and Family Services

847

must be shall have been examined by medical personnel within 30

848

days before placement in the facility and recorded on a medical

849

examination form provided by the agency. The examination shall

850

include an assessment of the appropriateness of placement in a

851

facility. The findings of this examination shall be recorded on

852

the examination form provided by the agency. The completed form

853

shall accompany the resident and shall be submitted to the

854

facility owner or administrator. For Additionally, in the case

855

of a mental health resident, the Department of Children and

856

Family Services must provide documentation that the individual

857

has been assessed by a psychiatrist, clinical psychologist,

858

clinical social worker, or psychiatric nurse, or an individual

859

who is supervised by one of these professionals, and determined

860

to be appropriate to reside in an assisted living facility. The

861

documentation must be in the facility within 30 days after the

862

mental health resident has been admitted to the facility. An

863

evaluation completed upon discharge from a state mental hospital

864

meets the requirements of this subsection related to

865

appropriateness for placement as a mental health resident

866

providing it was completed within 90 days prior to admission to

867

the facility. The applicable department shall provide to the

868

facility administrator any information about the resident that

869

would help the administrator meet his or her responsibilities

870

under this section subsection (1). Further, department personnel

871

shall explain to the facility operator any special needs of the

872

resident and advise the operator whom to call should problems

873

arise. The applicable department shall advise and assist the

874

facility administrator where the special needs of residents who

875

are recipients of optional state supplementation require such

876

assistance.

877

(3) A level 1 criminal background screening as defined in

878

chapter 435 of a prospective resident must be conducted by the

879

facility before admission or immediately after admission at the

880

resident's expense. The information obtained may be used by the

881

facility to assess the needs of the resident and the care and

882

services offered or arranged by the facility in accordance with

883

this section. The Agency's employee background screening

884

database may not be used for resident screening. If a resident

885

transfers between facilities, the resident's background

886

screening results shall be transferred with the resident.

887

(4) Persons licensed under part I of chapter 464 who are

888

employed by or under contract with a facility shall at least

889

monthly, perform a nursing assessment of residents for whom they

890

are providing nursing services ordered by a physician, except

891

administration of medication, and shall document such

892

assessment, including any substantial change in a resident's

893

status which may necessitate relocation to a nursing home,

894

hospital, or specialized health care facility. The records must

895

be maintained in the facility for inspection by the agency and

896

shall be forwarded to the resident's case manager, if

897

applicable.

898

(5)(7) Residents shall be periodically assessed to

899

determine if the resident is competent to handle his or her

900

personal and financial affairs, and, if not, whether a

901

responsible person such as a resident representative or

902

designee, guardian, surrogate, or attorney in fact is available

903

to make decisions on behalf of the resident. If a resident is

904

having difficulty handling his or her personal or financial

905

affairs, because of a decline in health or cognitive abilities,

906

the owner or administrator shall contact the resident's

907

representative or designee, guardian, surrogate or attorney-in-

908

fact. If a resident does not have family or a legal

909

representative to make decisions on his or her behalf, the owner

910

or administrator must contact the Florida Abuse Hotline. The

911

facility must notify a licensed physician when a resident

912

exhibits signs of dementia or cognitive impairment or has a

913

change of condition in order to rule out the presence of an

914

underlying physiological condition that may be contributing to

915

such dementia or impairment. The notification must occur within

916

30 days after the acknowledgment of such signs by facility

917

staff. If an underlying condition is determined to exist, the

918

facility shall arrange, with the appropriate health care

919

provider, the necessary care and services to treat the

920

condition.

921

Section 16. Subsections (3) through (8) of section 429.27,

922

Florida Statutes, are renumbered as subsections (6) through

923

(11), respectively, and subsections (1) and (2) of that section,

924

are amended to read:

925

429.27 Property and personal affairs of residents.--

926

(1)(a) A resident shall be given the option of using his

927

or her own belongings, as space permits; choosing his or her

928

roommate; and, whenever possible, unless the resident is

929

adjudicated incompetent or incapacitated under state law,

930

managing his or her own affairs.

931

(2)(b) The admission of a resident to a facility does and

932

his or her presence therein shall not confer on the facility or

933

its owner, administrator, staff employees, or representatives

934

any authority to manage, use, or dispose of any property of the

935

resident or to make financial or health care decisions on behalf

936

of the resident; nor shall such admission or presence confer on

937

any of such persons any authority or responsibility for the

938

personal affairs of the resident, except if that which may be

939

necessary for the safe management of the facility or for the

940

safety of the resident.

941

(3)(2) A facility, or an owner, administrator, staff

942

employee, or representative thereof, may not act as the

943

resident's representative or designee, guardian, health care

944

surrogate, trustee, or conservator for a any resident of the

945

assisted living facility or any of the such resident's property

946

unless the person is a relative of the resident.

947

(4) A facility An owner, administrator, or staff member,

948

or representative thereof, may not act as a competent resident's

949

payee for social security, veteran's, or railroad benefits

950

without the consent of the resident. Any facility whose owner,

951

administrator, or staff, or representative thereof who, serves

952

as representative payee for a any resident must of the facility

953

shall file a surety bond with the agency in an amount equal to

954

twice the average monthly aggregate income or personal funds due

955

to residents, or expendable for his or her their account, which

956

are received by a facility.

957

(5) Any facility whose owner, administrator, or staff, or

958

a representative thereof who, is granted power of attorney for a

959

any resident must of the facility shall file a surety bond with

960

the agency for each resident for whom such power of attorney is

961

granted. The surety bond must shall be in an amount equal to

962

twice the average monthly income of the resident, plus the value

963

of any resident's property under the control of the attorney in

964

fact. The bond must shall be executed by the facility as

965

principal and a licensed surety company. The bond shall be

966

conditioned upon the faithful compliance of the facility with

967

this section and shall run to the agency for the benefit of any

968

resident who suffers a financial loss as a result of the misuse

969

or misappropriation by a facility of funds held pursuant to this

970

subsection. Any surety company that cancels or does not renew

971

the bond of any licensee shall notify the agency in writing not

972

less than 30 days in advance of such action, giving the reason

973

for the cancellation or nonrenewal. Any facility owner,

974

administrator, or staff, or representative thereof, who is

975

granted power of attorney for a any resident of the facility

976

shall, on a monthly basis, be required to provide the resident

977

with a written statement of any transaction made on behalf of

978

the resident pursuant to this subsection, and a copy of such

979

statement given to the resident shall be retained in each

980

resident's file and available for agency inspection.

981

Section 17. Paragraphs (k) and (l) of subsection (1) and

982

subsection (3) of section 429.28, Florida Statutes, are amended

983

to read:

984

429.28 Resident bill of rights.--

985

(1) No resident of a facility shall be deprived of any

986

civil or legal rights, benefits, or privileges guaranteed by

987

law, the Constitution of the State of Florida, or the

988

Constitution of the United States as a resident of a facility.

989

Every resident of a facility shall have the right to:

990

(k) At least 45 days' written notice of relocation or

991

termination of residency from the facility unless, for medical

992

reasons, the resident is certified by a physician to require an

993

emergency relocation to a facility providing a more skilled

994

level of care or the resident engages in a pattern of conduct

995

that is harmful or offensive to other residents. The notice must

996

specify the reasons for the relocation or termination and a copy

997

of the notice must be sent by registered mail to the resident's

998

representative or designee, guardian, surrogate, attorney in

999

fact, the local ombudsman council, and the agency at the same

1000

time the notice is delivered to the resident. The agency shall

1001

compile an annual report summarizing the information received in

1002

the notice, including the number and reasons for relocation or

1003

termination of facility residents, type and size of facilities,

1004

and other information that the agency considers relevant, which

1005

shall be submitted to the Governor, the President of the Senate,

1006

and the Speaker of the House of Representatives. In the case of

1007

a resident who has been adjudicated mentally incapacitated, the

1008

guardian shall be given at least 45 days' notice of a

1009

nonemergency relocation or residency termination. Reasons for

1010

relocation shall be set forth in writing. In order for a

1011

facility to terminate the residency of an individual without

1012

notice as provided in this paragraph herein, the facility must

1013

shall show good cause in a court of competent jurisdiction.

1014

(l) Present grievances and recommend changes in policies,

1015

procedures, and services to the staff of the facility, governing

1016

officials, or any other person without restraint, interference,

1017

coercion, discrimination, or reprisal. Each facility shall

1018

establish a written grievance procedure to facilitate the

1019

residents' exercise of this right which must include, at a

1020

minimum, maintaining a written record of each grievance, the

1021

stated reason for the grievance, actions taken by the facility,

1022

and reporting each grievance within 3 business days after

1023

receiving the grievance to the local ombudsman council. Each

1024

facility must accept grievances orally and may accept grievances

1025

in writing. The local ombudsman council shall maintain a record

1026

of all grievances received from each facility in the local area

1027

which shall be submitted by the local council to the Office of

1028

the State Long-Term Care Ombudsman pursuant to s. 400.0089. This

1029

right also includes access to ombudsman volunteers and advocates

1030

and the right to be a member of, to be active in, and to

1031

associate with advocacy or special interest groups.

1032

(3)(a) The agency shall conduct a survey to determine

1033

general compliance with facility standards and compliance with

1034

residents' rights as a prerequisite to initial licensure or

1035

licensure renewal.

1036

(b) In order to determine whether the facility is

1037

adequately protecting residents' rights, the agency's biennial

1038

survey shall include private informal conversations with a

1039

sample of residents and consultation with the ombudsman council

1040

in the planning and service area in which the facility is

1041

located to discuss residents' experiences within the facility.

1042

1043

conducted, the agency shall conduct at least one monitoring

1044

visit of each facility cited in the previous year for a class I

1045

or class II violation, or more than three uncorrected class III

1046

violations.

1047

(d) The agency may conduct periodic followup inspections

1048

as necessary to monitor the compliance of facilities with a

1049

history of any class I, class II, or class III violations that

1050

threaten the health, safety, or security of residents.

1051

(e) The agency may conduct complaint investigations as

1052

warranted to investigate any allegations of noncompliance with

1053

requirements required under this part or rules adopted under

1054

this part.

1055

Section 18. Subsection (1) of section 429.294, Florida

1056

Statutes, is amended to read:

1057

429.294 Availability of facility records for investigation

1058

of resident's rights violations and defenses; penalty.--

1059

(1) Failure to provide complete copies of a resident's

1060

records, including, but not limited to, all medical records and

1061

the resident's chart, within the control or possession of the

1062

facility within 10 days, in accordance with the provisions of s.

1063

400.145, shall constitute evidence of failure of that party to

1064

comply with good faith discovery requirements and shall waive

1065

the good faith certificate and presuit notice requirements under

1066

this part by the requesting party.

1067

Section 19. Section 429.34, Florida Statutes, is amended

1068

to read:

1069

429.34 Right of entry and inspection.--In addition to the

1070

requirements of s. 408.811:,

1071

(1) Any duly designated officer or employee of the

1072

department, the Department of Children and Family Services, the

1073

Medicaid Fraud Control Unit of the Office of the Attorney

1074

General, the state or local fire marshal, or a member of the

1075

state or local long-term care ombudsman council shall have the

1076

right to enter unannounced upon and into the premises of any

1077

facility licensed pursuant to this part in order to determine

1078

the state of compliance with the provisions of this part, part

1079

II of chapter 408, and applicable rules. Data collected by the

1080

state or local long-term care ombudsman councils or the state or

1081

local advocacy councils may be used by the agency in

1082

investigations involving violations of regulatory standards.

1083

(2) Every 15 months the agency shall conduct at least one

1084

unannounced inspection to determine compliance with this chapter

1085

and related rules including minimum standards of quality and

1086

adequacy of care, and the rights of residents. Two additional

1087

surveys shall be conducted every 6 months for the next year if

1088

the facility has been cited for a class I deficiency or two or

1089

more class II deficiencies arising from separate surveys or

1090

investigations within a 60-day period. In addition to any fines

1091

imposed on a facility under s. 429.19, the agency shall assess a

1092

fine of $160 per bed for each of the additional two surveys. The

1093

agency shall adjust this fine by the change in the Consumer

1094

Price Index, based on the 12 months immediately preceding the

1095

change, to cover the cost of the additional two surveys. The

1096

agency shall verify through subsequent inspections that any

1097

deficiency identified during an inspection is corrected.

1098

However, the agency may verify the correction of a class III or

1099

class IV deficiency unrelated to resident rights or resident

1100

care without reinspecting the facility if adequate written

1101

documentation has been received from the facility which provides

1102

assurance that the deficiency has been corrected.

1103

Section 20. Paragraphs (k) and (l) of subsection (1) of

1104

section 429.41, Florida Statutes, are redesignated as paragraphs

1105

(l) and (m), respectively, and a new paragraph (k) is added to

1106

that subsection, to read:

1107

(1) It is the intent of the Legislature that rules

1108

published and enforced pursuant to this section shall include

1109

criteria by which a reasonable and consistent quality of

1110

resident care and quality of life may be ensured and the results

1111

of such resident care may be demonstrated. Such rules shall also

1112

ensure a safe and sanitary environment that is residential and

1113

noninstitutional in design or nature. It is further intended

1114

that reasonable efforts be made to accommodate the needs and

1115

preferences of residents to enhance the quality of life in a

1116

facility. The agency, in consultation with the department, may

1117

adopt rules to administer the requirements of part II of chapter

1118

408. In order to provide safe and sanitary facilities and the

1119

highest quality of resident care accommodating the needs and

1120

preferences of residents, the department, in consultation with

1121

the agency, the Department of Children and Family Services, and

1122

the Department of Health, shall adopt rules, policies, and

1123

procedures to administer this part, which must include

1124

reasonable and fair minimum standards in relation to:

1125

(k) The requirement that all residents have service plans.

1126

The service plan must be reviewed and updated annually; however,

1127

for a resident receiving nursing services ordered by a

1128

physician, except administration of medication, the plan must be

1129

reviewed and updated quarterly and whenever a resident

1130

experiences a significant change in condition.

1131

Section 21. Subsection (14) of section 429.65, Florida

1132

Statutes, is created to read:

1133

(14) "Reside" means the licensee or applicant lives in the

1134

adult family care home as a primary residence. For the purposes

1135

of this part, any two of the following documents which include

1136

the adult family care home address and the name of the licensee

1137

or applicant may be accepted by the agency as proof that the

1138

licensee or applicant resides in the adult family care home:

1139

(a) Homestead exemption documentation;

1140

(b) Lease or rental agreement accompanied by a

1141

corresponding utility bill;

1142

1143

agency.

1144

(14)(15) "Resident" means a person receiving room, board,

1145

and personal care in an adult family-care home.

1146

Section 22. Subsection (4) of section 429.67, Florida

1147

Statutes, is amended to read:

1148

429.67 Licensure.--

1149

(4) Upon receipt of a completed license application or

1150

license renewal, and the fee, the agency shall initiate a level

1151

1 background screening as provided under chapter 435 on the

1152

adult family-care home provider, the designated relief person,

1153

all adult household members, and all staff members, and any

1154

other person who provides personal services to residents or who

1155

have routine access to the adult family-care home.

1156

(a) Proof of compliance with level 1 screening standards

1157

which has been submitted within the previous 5 years to meet any

1158

facility or professional licensure requirements of the agency or

1159

the Department of Health satisfies the requirements of this

1160

subsection. Such proof must be accompanied, under penalty of

1161

perjury, by a copy of the person's current professional license

1162

and an affidavit of current compliance with the background

1163

screening requirements.

1164

(b) The person required to be screened must have been

1165

continuously employed in the same type of occupation for which

1166

the person is seeking employment without a breach in service

1167

that exceeds 180 days, and proof of compliance with the level 1

1168

screening requirement which is no more than 2 years old must be

1169

provided. Proof of compliance shall be provided directly from

1170

one employer or contractor to another, and not from the person

1171

screened. Upon request, a copy of screening results shall be

1172

provided to the person screened by the employer retaining

1173

documentation of the screening.

1174

Section 23. Subsection (3) is added to section 429.69,

1175

Florida Statutes, to read:

1176

429.69 Denial, revocation, and suspension of a

1177

license.--In addition to the requirements of part II of chapter

1178

408, the agency may deny, suspend, and revoke a license for any

1179

of the following reasons:

1180

(3) Failure of the adult family-care home provider who

1181

owns or rents the home to live in the home.

1182

Section 24. Paragraph (b) of subsection (1) of section

1183

429.73, Florida Statutes, is amended to read:

1184

429.73 Rules and standards relating to adult family-care

1185

homes.--

1186

(1) The agency, in consultation with the department, may

1187

adopt rules to administer the requirements of part II of chapter

1188

408. The department, in consultation with the Department of

1189

Health, the Department of Children and Family Services, and the

1190

agency shall, by rule, establish minimum standards to ensure the

1191

health, safety, and well-being of each resident in the adult

1192

family-care home pursuant to this part. The rules must address:

1193

(b) Services that must be provided to all residents of an

1194

adult family-care home and standards for such services, which

1195

must include, but need not be limited to:

1196

1. Room and board.

1197

2. Assistance necessary to perform the activities of daily

1198

living.

1199

3. Assistance necessary to administer medication.

1200

4. Supervision of residents.

1201

5. Health monitoring, including periodic assessments to

1202

determine if the resident is competent to handle his or her

1203

personal and financial affairs, and, if not, whether a

1204

responsible person such as a guardian, surrogate, or attorney in

1205

fact is available to make decisions on behalf of the resident.

1206

6. Social and leisure activities.

1207

Section 25. Subsections (2) and (3) of section 435.03,

1208

Florida Statutes, are amended to read:

1209

435.03 Level 1 screening standards.--

1210

(2) Any person for whom employment screening is required

1211

by statute must not have been convicted of found guilty of,

1212

regardless of adjudication, or entered a plea of guilty or nolo

1213

contendere or guilty to, regardless of adjudication, to any

1214

offense prohibited under any of the following provisions of the

1215

Florida statutes or under any similar statute of another

1216

jurisdiction:

1217

(a) Section 393.135, relating to sexual misconduct with

1218

certain developmentally disabled clients and reporting of such

1219

sexual misconduct.

1220

(b) Section 394.4593, relating to sexual misconduct with

1221

certain mental health patients and reporting of such sexual

1222

misconduct.

1223

1224

exploitation of a vulnerable adult.

1225

(d) Section 782.04, relating to murder.

1226

(e) Section 782.07, relating to manslaughter, aggravated

1227

manslaughter of an elderly person or disabled adult, or

1228

aggravated manslaughter of a child.

1229

(f) Section 782.071, relating to vehicular homicide.

1230

(g) Section 782.09, relating to killing of an unborn quick

1231

child by injury to the mother.

1232

(h) Section 784.011, relating to assault, if the victim of

1233

the offense was a minor.

1234

(i) Section 784.021, relating to aggravated assault.

1235

(j) Section 784.03, relating to battery, if the victim of

1236

the offense was a minor.

1237

(k) Section 784.045, relating to aggravated battery.

1238

(l) Section 787.01, relating to kidnapping.

1239

(m) Section 787.02, relating to false imprisonment.

1240

(n) Section 794.011, relating to sexual battery.

1241

(o) Former s. 794.041, relating to prohibited acts of

1242

persons in familial or custodial authority.

1243

(p) Chapter 796, relating to prostitution.

1244

(q) Section 798.02, relating to lewd and lascivious

1245

behavior.

1246

(r) Chapter 800, relating to lewdness and indecent

1247

exposure.

1248

(s) Section 806.01, relating to arson.

1249

(t) Chapter 812, relating to theft, robbery, and related

1250

crimes, if the offense was a felony.

1251

(u) Section 817.563, relating to fraudulent sale of

1252

controlled substances, only if the offense was a felony.

1253

(v) Section 825.102, relating to abuse, aggravated abuse,

1254

or neglect of an elderly person or disabled adult.

1255

(w) Section 825.1025, relating to lewd or lascivious

1256

offenses committed upon or in the presence of an elderly person

1257

or disabled adult.

1258

(x) Section 825.103, relating to exploitation of an

1259

elderly person or disabled adult, if the offense was a felony.

1260

(y) Section 826.04, relating to incest.

1261

(z) Section 827.03, relating to child abuse, aggravated

1262

child abuse, or neglect of a child.

1263

(aa) Section 827.04, relating to contributing to the

1264

delinquency or dependency of a child.

1265

(bb) Former s. 827.05, relating to negligent treatment of

1266

children.

1267

(cc) Section 827.071, relating to sexual performance by a

1268

child.

1269

(dd) Chapter 847, relating to obscene literature.

1270

(ee) Chapter 893, relating to drug abuse prevention and

1271

control, only if the offense was a felony or if any other person

1272

involved in the offense was a minor.

1273

(ff) Section 916.1075, relating to sexual misconduct with

1274

certain forensic clients and reporting of such sexual

1275

misconduct.

1276

(3) Standards must also ensure that the person:

1277

(a) For employees and employers licensed or registered

1278

pursuant to chapter 408, part II400 or chapter 429, and for

1279

employees and employers of developmental disabilities

1280

institutions as defined in s. 393.063, intermediate care

1281

facilities for the developmentally disabled as defined in s.

1282

400.960, and mental health treatment facilities as defined in s.

1283

394.455, has not been convicted of, or entered a plea of guilty

1284

or nolo contendere, regardless of adjudication, to offenses

1285

prohibited under any of the following statutes or under any

1286

similar statute of another jurisdiction: meets the requirements

1287

of this chapter.

1288

1. Sections 409.920 and 409.9201, relating to Medicaid

1289

fraud.

1290

2. Chapter 429, relating to assisted care communities.

1291

3. Chapter 784, relating to assault, battery, and culpable

1292

negligence, if the offense is a felony.

1293

4. Section 810.02, relating to burglary, if the offense is

1294

a felony.

1295

5. Section 817.034, relating to communications fraud.

1296

6. Section 817.234, relating to fraudulent insurance

1297

claims.

1298

7. Section 817.505, relating to patient brokering.

1299

8. Section 817.568, relating to identification theft.

1300

9. Sections 817.60 and 817.61, relating to credit cards,

1301

if the offense is a felony.

1302

10. Sections 831.01, 831.02, 831.07, 831.09, 831.30, and

1303

831.31 relating to forgery, uttering, and counterfeiting.

1304

(b) Has not committed an act that constitutes domestic

1305

violence as defined in s. 741.28.

1306

Section 26. Subsections (2) and (4) of section 435.04,

1307

Florida Statutes, are amended to read:

1308

435.04 Level 2 screening standards.--

1309

(2) The security background investigations under this

1310

section must ensure that no persons subject to the provisions of

1311

this section have been convicted found guilty of, regardless of

1312

adjudication, or entered a plea of guilty or nolo contendere or

1313

guilty to, regardless of adjudication, to any offense prohibited

1314

under any of the following provisions of the Florida statutes or

1315

under any similar statute of another jurisdiction:

1316

(a) Section 393.135, relating to sexual misconduct with

1317

certain developmentally disabled clients and reporting of such

1318

sexual misconduct.

1319

(b) Section 394.4593, relating to sexual misconduct with

1320

certain mental health patients and reporting of such sexual

1321

misconduct.

1322

1323

exploitation of aged persons or disabled adults.

1324

(d) Section 782.04, relating to murder.

1325

(e) Section 782.07, relating to manslaughter, aggravated

1326

manslaughter of an elderly person or disabled adult, or

1327

aggravated manslaughter of a child.

1328

(f) Section 782.071, relating to vehicular homicide.

1329

(g) Section 782.09, relating to killing of an unborn quick

1330

child by injury to the mother.

1331

(h) Section 784.011, relating to assault, if the victim of

1332

the offense was a minor.

1333

(i) Section 784.021, relating to aggravated assault.

1334

(j) Section 784.03, relating to battery, if the victim of

1335

the offense was a minor.

1336

(k) Section 784.045, relating to aggravated battery.

1337

(l) Section 784.075, relating to battery on a detention or

1338

commitment facility staff.

1339

(m) Section 787.01, relating to kidnapping.

1340

(n) Section 787.02, relating to false imprisonment.

1341

(o) Section 787.04(2), relating to taking, enticing, or

1342

removing a child beyond the state limits with criminal intent

1343

pending custody proceedings.

1344

(p) Section 787.04(3), relating to carrying a child beyond

1345

the state lines with criminal intent to avoid producing a child

1346

at a custody hearing or delivering the child to the designated

1347

person.

1348

(q) Section 790.115(1), relating to exhibiting firearms or

1349

weapons within 1,000 feet of a school.

1350

(r) Section 790.115(2)(b), relating to possessing an

1351

electric weapon or device, destructive device, or other weapon

1352

on school property.

1353

(s) Section 794.011, relating to sexual battery.

1354

(t) Former s. 794.041, relating to prohibited acts of

1355

persons in familial or custodial authority.

1356

(u) Chapter 796, relating to prostitution.

1357

(v) Section 798.02, relating to lewd and lascivious

1358

behavior.

1359

(w) Chapter 800, relating to lewdness and indecent

1360

exposure.

1361

(x) Section 806.01, relating to arson.

1362

(y) Chapter 812, relating to theft, robbery, and related

1363

crimes, if the offense is a felony.

1364

(z) Section 817.563, relating to fraudulent sale of

1365

controlled substances, only if the offense was a felony.

1366

(aa) Section 825.102, relating to abuse, aggravated abuse,

1367

or neglect of an elderly person or disabled adult.

1368

(bb) Section 825.1025, relating to lewd or lascivious

1369

offenses committed upon or in the presence of an elderly person

1370

or disabled adult.

1371

(cc) Section 825.103, relating to exploitation of an

1372

elderly person or disabled adult, if the offense was a felony.

1373

(dd) Section 826.04, relating to incest.

1374

(ee) Section 827.03, relating to child abuse, aggravated

1375

child abuse, or neglect of a child.

1376

(ff) Section 827.04, relating to contributing to the

1377

delinquency or dependency of a child.

1378

(gg) Former s. 827.05, relating to negligent treatment of

1379

children.

1380

(hh) Section 827.071, relating to sexual performance by a

1381

child.

1382

(ii) Section 843.01, relating to resisting arrest with

1383

violence.

1384

(jj) Section 843.025, relating to depriving a law

1385

enforcement, correctional, or correctional probation officer

1386

means of protection or communication.

1387

(kk) Section 843.12, relating to aiding in an escape.

1388

(ll) Section 843.13, relating to aiding in the escape of

1389

juvenile inmates in correctional institutions.

1390

(mm) Chapter 847, relating to obscene literature.

1391

(nn) Section 874.05(1), relating to encouraging or

1392

recruiting another to join a criminal gang.

1393

(oo) Chapter 893, relating to drug abuse prevention and

1394

control, only if the offense was a felony or if any other person

1395

involved in the offense was a minor.

1396

(pp) Section 916.1075, relating to sexual misconduct with

1397

certain forensic clients and reporting of such sexual

1398

misconduct.

1399

(qq) Section 944.35(3), relating to inflicting cruel or

1400

inhuman treatment on an inmate resulting in great bodily harm.

1401

(rr) Section 944.46, relating to harboring, concealing, or

1402

aiding an escaped prisoner.

1403

(ss) Section 944.47, relating to introduction of

1404

contraband into a correctional facility.

1405

(tt) Section 985.701, relating to sexual misconduct in

1406

juvenile justice programs.

1407

(uu) Section 985.711, relating to contraband introduced

1408

into detention facilities.

1409

(4) Standards must also ensure that the person:

1410

(a) For employees or employers licensed or registered

1411

pursuant to chapter 408, part II 400 or chapter 429, and for

1412

employees and employers of developmental disabilities

1413

institutions as defined in s. 393.063, and mental health

1414

treatment facilities as defined in s. 394.455, has not been

1415

convicted of, or entered a plea of guilty or nolo contendere,

1416

regardless of adjudication, to offenses prohibited under any of

1417

the following statutes or under similar statutes of another

1418

jurisdiction: does not have a confirmed report of abuse,

1419

neglect, or exploitation as defined in s. 415.102(6), which has

1420

been uncontested or upheld under s. 415.103.

1421

1. Sections 409.920 and 409.9201, relating to Medicaid

1422

fraud.

1423

2. Chapter 429, relating to assisted care communities.

1424

3. Chapter 784, relating to assault, battery, and culpable

1425

negligence, if the offense is a felony.

1426

4. Section 810.02, relating to burglary, if the offense is

1427

a felony.

1428

5. Section 817.034, relating to communications fraud.

1429

6. Section 817.234, relating to fraudulent insurance

1430

claims.

1431

7. Section 817.505, relating to patient brokering.

1432

8. Section 817.568, relating to identification theft.

1433

9. Sections 817.60 and 817.61, relating to credit cards,

1434

if the offense is a felony.

1435

10. Sections 831.01, 831.02, 831.07, 831.09, 831.30, and

1436

831.31 relating to forgery, uttering, and counterfeiting.

1437

(b) Has not committed an act that constitutes domestic

1438

violence as defined in s. 741.28 s. 741.30.

1439

Section 27. Subsection (13) of section 400.141, subsection

1440

(3)of section 408.809, subsection (2) of section 429.08, and

1441

subsection (5) of section 429.41, Florida Statutes, are

1442

repealed.

1443

Section 28. Paragraph (h) of subsection (3) of section

1444

430.80, Florida Statutes, is amended to read:

1445

430.80 Implementation of a teaching nursing home pilot

1446

project.--

1447

(3) To be designated as a teaching nursing home, a nursing

1448

home licensee must, at a minimum:

1449

(h) Maintain insurance coverage pursuant to s. 400.141(19)

1450

s. 400.141(20) or proof of financial responsibility in a minimum

1451

amount of $750,000. Such Proof of financial responsibility may

1452

include:

1453

1. Maintaining an escrow account consisting of cash or

1454

assets eligible for deposit in accordance with s. 625.52; or

1455

2. Obtaining and maintaining, pursuant to chapter 675, an

1456

unexpired, irrevocable, nontransferable and nonassignable letter

1457

of credit issued by a any bank or savings association organized

1458

and existing under the laws of this state or a any bank or

1459

savings association organized under the laws of the United

1460

States that has its principal place of business in this state or

1461

has a branch office which is authorized to receive deposits in

1462

this state. The letter of credit shall be used to satisfy the

1463

obligation of the facility to the claimant upon presentment of a

1464

final judgment indicating liability and awarding damages to be

1465

paid by the facility or upon presentment of a settlement

1466

agreement signed by all parties if the to the agreement when

1467

such final judgment or settlement is a result of a liability

1468

claim against the facility.

1469

Section 29. Subsection (13) of section 651.118, Florida

1470

Statutes, is amended to read:

1471

651.118 Agency for Health Care Administration;

1472

certificates of need; sheltered beds; community beds.--

1473

(13) Residents, as defined in this chapter, are not

1474

considered new admissions for the purpose of s. 400.141(14)(d)

1475

s. 400.141(15)(d).

1476

Section 30. This act shall take effect October 1, 2008.

1477

1478

1479

================ T I T L E A M E N D M E N T ================

1480

And the title is amended as follows:

1481

Delete everything before the enacting clause

1482

and insert:

1483

A bill to be entitled

1484

An act relating to adult protection and care; amending s.

1485

322.142, F.S.; authorizing the Department of Children and

1486

Family Services to obtain copies of driver's license files

1487

maintained by the Department of Highway Safety and Motor

1488

Vehicles for the purpose of conducting protective

1489

investigations; amending s. 400.141, F.S.; requiring a

1490

check of the Florida Department of Law Enforcement sexual

1491

offender database to be conducted on all nursing home

1492

residents; amending s. 400.19, F.S.; revising provisions

1493

relating to unannounced inspections; amending s. 400.215,

1494

F.S.; requiring contracted workers employed in a nursing

1495

home to submit to background screening; prohibiting

1496

employees and contracted workers who do not meet

1497

background screening requirements from being employed in a

1498

nursing home; providing certain exceptions; deleting an

1499

obsolete provision; amending s. 408.809, F.S.; requiring

1500

the agency to establish a fee schedule to cover the cost

1501

of a level 1 or level 2 screening and giving the agency

1502

rule making authority; amending s. 408.810, F.S.;

1503

requiring health care facilities regulated by the Agency

1504

for Health Care Administration to post certain information

1505

in the facility and allowing the agency to charge a fee to

1506

cover production and distribution; amending s. 408.811,

1507

F.S.; providing that agency employees who provide advance

1508

notice of unannounced agency inspections are subject to

1509

suspension, providing a timeline and process for

1510

correction of deficiencies, and providing that the agency

1511

may provide electronic access to documents; amending s.

1512

415.103, F.S.; requiring certain reports to the central

1513

abuse hotline relating to vulnerable adults to be

1514

immediately transferred to the county sheriff's office;

1515

amending s. 415.1051, F.S.; authorizing the Department of

1516

Children and Family Services to file the petition to

1517

determine incapacity in adult protection proceedings;

1518

prohibiting the department from serving as the guardian or

1519

providing legal counsel to the guardian; amending s.

1520

415.112, F.S.; specifying rules to be adopted by the

1521

Department of Children and Family Services relating to

1522

adult protective services under ch. 415, F.S.; amending s.

1523

429.02, F.S.; revising the definition of "service plan" to

1524

remove the limitation that plans are required only in

1525

assisted living facilities that have an extended

1526

congregate care license and providing that the agency

1527

develop a service plan form; amending s. 429.07, F.S.;

1528

providing that license requirements for specialty licenses

1529

apply to current licensees as well as applicants for an

1530

extended congregate care and limited nursing license;

1531

conforming a cross-reference; amending s. 429.174, F.S.;

1532

requiring certain employees and contracted workers in

1533

assisted living facilities to submit to background

1534

screening; prohibiting employees and contracted workers

1535

who do not meet background screening requirements from

1536

being employed in an assisted living facility; providing

1537

certain exceptions; requiring the person being screened to

1538

pay for the cost of screening; amending s. 429.255, F.S.;

1539

providing that the owner or administrator of an assisted

1540

living facility is responsible for the services provided

1541

in the facility; amending s. 429.26, F.S.; clarifying a

1542

prohibition on moving a resident; providing for the

1543

development of a service plan for all residents; requiring

1544

a criminal records check to be conducted on all residents

1545

of an assisted living facility; requiring residents to be

1546

periodically assessed for competency to handle personal

1547

affairs; amending s. 429.27, F.S.; prohibiting assisted

1548

living facility personnel from making certain decisions

1549

for a resident or act as the resident's representative or

1550

surrogate; amending s. 429.28, F.S.; requiring that notice

1551

of a resident's relocation or termination of residency be

1552

in writing and a copy sent to specified persons; requiring

1553

the State Long-Term Ombudsman Program include information

1554

within their annual report to the Governor and the

1555

Legislature; requiring facilities to have a written

1556

grievance procedure that includes certain information;

1557

requiring that grievances reported to the local ombudsman

1558

council be included in a statewide reporting system;

1559

revising provisions relating to agency surveys to

1560

determine compliance with resident rights in assisted

1561

living facilities; amending s. 429.294, F.S.; deleting a

1562

cross-reference; amending s. 429.34, F.S.; providing for

1563

unannounced inspections; providing for additional 6-month

1564

inspections for certain violations; providing for an

1565

additional fine for 6-month inspections; amending s.

1566

429.41, F.S.; requiring all residents of assisted living

1567

facilities to have a service plan; amending s. 429.65,

1568

F.S.; providing a definition of the term "Reside";

1569

amending s. 429.67, F.S.; expanding the list of persons

1570

who must have a background screening in adult family-care

1571

homes; amending s. 429.69, F.S.; providing that the

1572

failure of a adult family-care home provider to live in

1573

the home is grounds for the denial, revocation, or

1574

suspension of a license; amending s. 429.73, F.S.;

1575

requiring adult family-care home residents to be

1576

periodically assessed for competency to handle personal

1577

affairs; amending ss. 435.03 and 435.04, F.S.; providing

1578

additional criminal offenses for screening certain health

1579

care facility personnel; repealing s. 400.141(13), F.S.,

1580

relating to a requirement to post certain information in

1581

nursing homes; repealing s. 408.809(3), F.S., relating to

1582

the granting of a provisional license while awaiting the

1583

results of a background screening; repealing s. 429.08(2),

1584

F.S., deleting a provision relating to local workgroups of

1585

field offices of the Agency for Health Care

1586

Administration; repealing s. 429.41(5), F.S., relating to

1587

agency inspections; amending ss. 430.80 and 651.118, F.S.;

1588

conforming cross-references; providing an effective date.

3/18/2008 9:00:00 AM CF.HR.05190

CODING: Words stricken are deletions; words underlined are additions.