Florida Senate - 2013 SB 646
By the Committee on Children, Families, and Elder Affairs
586-01561-13 2013646__
1 A bill to be entitled
2 An act relating to assisted living facilities;
3 amending s. 394.4574, F.S.; providing that Medicaid
4 prepaid behavioral health plans are responsible for
5 enrolled mental health residents; providing that
6 managing entities under contract with the Department
7 of Children and Families are responsible for mental
8 health residents who are not enrolled with a Medicaid
9 prepaid behavioral health plan; deleting a provision
10 to conform to changes made by the act; requiring the
11 community living support plan to be updated when there
12 is a significant change to the mental health
13 resident’s behavioral health; requiring the case
14 manager assigned to a mental health resident of an
15 assisted living facility that holds a limited mental
16 health license to keep a record of the date and time
17 of face-to-face interactions with the resident and to
18 make the record available to the responsible entity
19 for inspection; requiring that the record be
20 maintained for a specified time; requiring the
21 responsible entity to ensure that there is adequate
22 and consistent monitoring and enforcement of community
23 living support plans and cooperative agreements and
24 that concerns are reported to the appropriate
25 regulatory oversight organization under certain
26 circumstances; amending s. 400.0074, F.S.; providing
27 that an administrative assessment conducted by a local
28 council be comprehensive in nature and focus on
29 factors affecting the rights, health, safety, and
30 welfare of the residents of a nursing home; requiring
31 a local council to conduct an exit consultation with
32 the facility administrator or administrator designee
33 to discuss issues and concerns and make
34 recommendations for improvement; amending s. 400.0078,
35 F.S.; requiring that residents of long-term care
36 facilities be informed about the confidentiality of
37 the subject matter and identity of the complainant of
38 a complaint received by the State Long-Term Care
39 Ombudsman Program; amending s. 429.07, F.S.; providing
40 that an extended congregate care license is issued to
41 certain facilities that have been licensed as assisted
42 living facilities under certain circumstances;
43 providing the purpose of an extended congregate care
44 license; providing that the initial extended
45 congregate care license of an assisted living facility
46 is provisional under certain circumstances; requiring
47 the licensee to notify the Agency for Health Care
48 Administration whenever it accepts a resident who
49 qualifies for extended congregate care services;
50 requiring the agency to inspect the facility for
51 compliance with the requirements of an extended
52 congregate care license; authorizing the agency to
53 waive one of the required yearly monitoring visits
54 under certain circumstances; authorizing the agency to
55 deny or revoke a facility’s extended congregate care
56 license for certain reasons or on certain grounds;
57 requiring a registered nurse representing the agency
58 to visit the facility at least annually, rather than
59 twice a year, to monitor residents who are receiving
60 limited nursing services; providing that the agency’s
61 monitoring visits may be in conjunction with other
62 agency inspections; authorizing the agency to waive
63 one of the required yearly monitoring visits for
64 certain facilities; amending s. 429.075, F.S.;
65 requiring an assisted living facility that serves one
66 or more mental health residents to obtain a limited
67 mental health license; amending s. 429.14, F.S.;
68 authorizing the agency to deny, revoke, or suspend a
69 license of an assisted living facility for a negligent
70 act of any facility staff which seriously affects the
71 health, safety, or welfare of a resident; requiring
72 the agency to deny or revoke the license of an
73 assisted living facility under certain circumstances;
74 requiring the agency to impose an immediate moratorium
75 on the license of an assisted living facility under
76 certain circumstances; deleting a provision requiring
77 the agency to provide a list of facilities with
78 denied, suspended, or revoked licenses to the
79 Department of Business and Professional Regulation;
80 amending s. 429.178, F.S.; conforming cross
81 references; amending s. 429.19, F.S.; revising the
82 amounts and uses of administrative fines; requiring
83 the agency to levy a fine for violations that are
84 corrected before an inspection if noncompliance
85 occurred within a specified period of time; deleting
86 factors that the agency is required to consider to
87 determine penalties and fines; amending s. 429.28,
88 F.S.; requiring residents of facilities to be informed
89 about the confidentiality of the subject matter and
90 identity of the resident and complainant of a
91 complaint made to the State Long-Term Care Ombudsman
92 Program; providing that a facility that terminates an
93 individual’s residency is fined if good cause is not
94 shown in court; amending s. 429.34, F.S.; requiring
95 certain persons to report elder abuse in assisted
96 living facilities; requiring the agency to regularly
97 inspect every licensed assisted living facility;
98 requiring the agency to conduct more frequent
99 inspections under certain circumstances; requiring the
100 licensee to pay a fee for the cost of additional
101 inspections; requiring the agency to adjust the fee;
102 amending s. 429.52, F.S.; requiring each newly hired
103 employee of an assisted living facility to attend a
104 preservice orientation provided by the assisted living
105 facility; requiring the employee and administrator to
106 sign an affidavit upon completion of the preservice
107 orientation; requiring the assisted living facility to
108 maintain the signed affidavit in each employee’s work
109 file; conforming a cross-reference; requiring the
110 Agency for Health Care Administration to study the
111 reliability of facility surveys and submit to the
112 Governor and the Legislature its findings and
113 recommendations; requiring the agency to propose a
114 rating system of assisted living facilities for
115 consumers and create content for the agency’s website
116 that makes available to consumers information
117 regarding assisted living facilities; providing
118 criteria for the content; providing an effective date.
119
120 Be It Enacted by the Legislature of the State of Florida:
121
122 Section 1. Section 394.4574, Florida Statutes, is amended
123 to read:
124 394.4574 Department Responsibilities for coordination of
125 services for a mental health resident who resides in an assisted
126 living facility that holds a limited mental health license.—
127 (1) As used in this section, the term “mental health
128 resident” “mental health resident,” for purposes of this
129 section, means an individual who receives social security
130 disability income due to a mental disorder as determined by the
131 Social Security Administration or receives supplemental security
132 income due to a mental disorder as determined by the Social
133 Security Administration and receives optional state
134 supplementation.
135 (2) Medicaid prepaid behavioral health plans are
136 responsible for enrolled mental health residents, and managing
137 entities under contract with the department are responsible for
138 mental health residents who are not enrolled with a Medicaid
139 prepaid behavioral health plan. Each responsible entity shall
140 The department must ensure that:
141 (a) A mental health resident has been assessed by a
142 psychiatrist, clinical psychologist, clinical social worker, or
143 psychiatric nurse, or an individual who is supervised by one of
144 these professionals, and determined to be appropriate to reside
145 in an assisted living facility. The documentation must be
146 provided to the administrator of the facility within 30 days
147 after the mental health resident has been admitted to the
148 facility. An evaluation completed upon discharge from a state
149 mental hospital meets the requirements of this subsection
150 related to appropriateness for placement as a mental health
151 resident if it was completed within 90 days before prior to
152 admission to the facility.
153 (b) A cooperative agreement, as required in s. 429.075, is
154 developed between the mental health care services provider that
155 serves a mental health resident and the administrator of the
156 assisted living facility with a limited mental health license in
157 which the mental health resident is living. Any entity that
158 provides Medicaid prepaid health plan services shall ensure the
159 appropriate coordination of health care services with an
160 assisted living facility in cases where a Medicaid recipient is
161 both a member of the entity’s prepaid health plan and a resident
162 of the assisted living facility. If the entity is at risk for
163 Medicaid targeted case management and behavioral health
164 services, the entity shall inform the assisted living facility
165 of the procedures to follow should an emergent condition arise.
166 (c) The community living support plan, as defined in s.
167 429.02, has been prepared by a mental health resident and a
168 mental health case manager of that resident in consultation with
169 the administrator of the facility or the administrator’s
170 designee. The plan must be provided to the administrator of the
171 assisted living facility with a limited mental health license in
172 which the mental health resident lives. The support plan and the
173 agreement may be in one document.
174 (d) The assisted living facility with a limited mental
175 health license is provided with documentation that the
176 individual meets the definition of a mental health resident.
177 (e) The mental health services provider assigns a case
178 manager to each mental health resident for whom the entity is
179 responsible who lives in an assisted living facility with a
180 limited mental health license. The case manager is responsible
181 for coordinating the development of and implementation of the
182 community living support plan defined in s. 429.02. The plan
183 must be updated at least annually, or when there is a
184 significant change to the resident’s behavioral health status,
185 such as an inpatient admission or a change in behavioral status,
186 medications, level of service, or residence. Each case manager
187 shall keep a record of the date and time of any face-to-face
188 interaction with the resident and make the record available to
189 the responsible entity for inspection. The record must be
190 retained for at least 2 years after the date of the most recent
191 interaction.
192 (f) Adequate and consistent monitoring and enforcement of
193 community living support plans and cooperative agreements are
194 conducted by the resident’s case manager.
195 (g) Concerns are reported to the appropriate regulatory
196 oversight organization if a regulated provider fails to deliver
197 appropriate services or otherwise acts in a manner that has the
198 potential to result in harm to the resident.
199 (3) The Secretary of Children and Family Services, in
200 consultation with the Agency for Health Care Administration,
201 shall annually require each district administrator to develop,
202 with community input, a detailed annual plan that demonstrates
203 detailed plans that demonstrate how the district will ensure the
204 provision of state-funded mental health and substance abuse
205 treatment services to residents of assisted living facilities
206 that hold a limited mental health license. These plans must be
207 consistent with the substance abuse and mental health district
208 plan developed pursuant to s. 394.75 and must address case
209 management services; access to consumer-operated drop-in
210 centers; access to services during evenings, weekends, and
211 holidays; supervision of the clinical needs of the residents;
212 and access to emergency psychiatric care.
213 Section 2. Subsection (1) of section 400.0074, Florida
214 Statutes, is amended, and paragraph (h) is added to subsection
215 (2) of that section, to read:
216 400.0074 Local ombudsman council onsite administrative
217 assessments.—
218 (1) In addition to any specific investigation conducted
219 pursuant to a complaint, the local council shall conduct, at
220 least annually, an onsite administrative assessment of each
221 nursing home, assisted living facility, and adult family-care
222 home within its jurisdiction. This administrative assessment
223 must be comprehensive in nature and must shall focus on factors
224 affecting the rights, health, safety, and welfare of the
225 residents. Each local council is encouraged to conduct a similar
226 onsite administrative assessment of each additional long-term
227 care facility within its jurisdiction.
228 (2) An onsite administrative assessment conducted by a
229 local council shall be subject to the following conditions:
230 (h) The local council shall conduct an exit consultation
231 with the facility administrator or administrator designee to
232 discuss issues and concerns and make recommendations for
233 improvement, if any.
234 Section 3. Subsection (2) of section 400.0078, Florida
235 Statutes, is amended to read:
236 400.0078 Citizen access to State Long-Term Care Ombudsman
237 Program services.—
238 (2) Every resident or representative of a resident shall
239 receive, Upon admission to a long-term care facility, each
240 resident or representative of a resident must receive
241 information regarding the purpose of the State Long-Term Care
242 Ombudsman Program, the statewide toll-free telephone number for
243 receiving complaints, the confidentiality of the subject matter
244 of a complaint and the complainant’s name and identity, and
245 other relevant information regarding how to contact the program.
246 Residents or their representatives must be furnished additional
247 copies of this information upon request.
248 Section 4. Paragraphs (b) and (c) of subsection (3) of
249 section 429.07, Florida Statutes, are amended to read:
250 429.07 License required; fee.—
251 (3) In addition to the requirements of s. 408.806, each
252 license granted by the agency must state the type of care for
253 which the license is granted. Licenses shall be issued for one
254 or more of the following categories of care: standard, extended
255 congregate care, limited nursing services, or limited mental
256 health.
257 (b) An extended congregate care license shall be issued to
258 facilities that have been licensed as assisted living facilities
259 for 2 or more years and that provide providing, directly or
260 through contract, services beyond those authorized in paragraph
261 (a), including services performed by persons licensed under part
262 I of chapter 464 and supportive services, as defined by rule, to
263 persons who would otherwise be disqualified from continued
264 residence in a facility licensed under this part. The primary
265 purpose of extended congregate care services is to allow
266 residents, as they become more impaired, the option of remaining
267 in a familiar setting from which they would otherwise be
268 disqualified for continued residency. A facility licensed to
269 provide extended congregate care services may also admit an
270 individual who exceeds the admission criteria for a facility
271 with a standard license, if the individual is determined
272 appropriate for admission to the extended congregate care
273 facility.
274 1. In order for extended congregate care services to be
275 provided, the agency must first determine that all requirements
276 established in law and rule are met and must specifically
277 designate, on the facility’s license, that such services may be
278 provided and whether the designation applies to all or part of
279 the facility. Such designation may be made at the time of
280 initial licensure or relicensure, or upon request in writing by
281 a licensee under this part and part II of chapter 408. The
282 notification of approval or the denial of the request shall be
283 made in accordance with part II of chapter 408. Existing
284 facilities qualifying to provide extended congregate care
285 services must have maintained a standard license and may not
286 have been subject to administrative sanctions during the
287 previous 2 years, or since initial licensure if the facility has
288 been licensed for less than 2 years, for any of the following
289 reasons:
290 a. A class I or class II violation;
291 b. Three or more repeat or recurring class III violations
292 of identical or similar resident care standards from which a
293 pattern of noncompliance is found by the agency;
294 c. Three or more class III violations that were not
295 corrected in accordance with the corrective action plan approved
296 by the agency;
297 d. Violation of resident care standards which results in
298 requiring the facility to employ the services of a consultant
299 pharmacist or consultant dietitian;
300 e. Denial, suspension, or revocation of a license for
301 another facility licensed under this part in which the applicant
302 for an extended congregate care license has at least 25 percent
303 ownership interest; or
304 f. Imposition of a moratorium pursuant to this part or part
305 II of chapter 408 or initiation of injunctive proceedings.
306 2. If an assisted living facility has been licensed for
307 less than 2 years, the initial extended congregate care license
308 must be provisional and may not exceed 6 months. Within the
309 first 3 months after the provisional license is issued, the
310 licensee shall notify the agency when it has admitted an
311 extended congregate care resident, after which an unannounced
312 inspection shall be made to determine compliance with
313 requirements of an extended congregate care license. If the
314 licensee demonstrates compliance with all of the requirements of
315 an extended congregate care license during the inspection, the
316 licensee shall be issued an extended congregate care license. In
317 addition to sanctions authorized under this part, if violations
318 are found during the inspection and the licensee fails to
319 demonstrate compliance with all assisted living requirements
320 during a followup inspection, the licensee shall immediately
321 suspend extended congregate care services, and the provisional
322 extended congregate care license expires.
323 3.2. A facility that is licensed to provide extended
324 congregate care services shall maintain a written progress
325 report on each person who receives services which describes the
326 type, amount, duration, scope, and outcome of services that are
327 rendered and the general status of the resident’s health. A
328 registered nurse, or appropriate designee, representing the
329 agency shall visit the facility at least twice a year quarterly
330 to monitor residents who are receiving extended congregate care
331 services and to determine if the facility is in compliance with
332 this part, part II of chapter 408, and relevant rules. One of
333 the visits may be in conjunction with the regular survey. The
334 monitoring visits may be provided through contractual
335 arrangements with appropriate community agencies. A registered
336 nurse shall serve as part of the team that inspects the
337 facility. The agency may waive one of the required yearly
338 monitoring visits for a facility that has been licensed for at
339 least 24 months to provide extended congregate care services,
340 if, during the inspection, the registered nurse determines that
341 extended congregate care services are being provided
342 appropriately, and if the facility has held an extended
343 congregate care license during the last 24 months, has had no
344 class I or class II violations, has had and no uncorrected class
345 III violations, and has had no confirmed ombudsman council
346 complaints that resulted in a citation for licensure. The agency
347 must first consult with the long-term care ombudsman council for
348 the area in which the facility is located to determine if any
349 complaints have been made and substantiated about the quality of
350 services or care. The agency may not waive one of the required
351 yearly monitoring visits if complaints have been made and
352 substantiated.
353 4.3. A facility that is licensed to provide extended
354 congregate care services must:
355 a. Demonstrate the capability to meet unanticipated
356 resident service needs.
357 b. Offer a physical environment that promotes a homelike
358 setting, provides for resident privacy, promotes resident
359 independence, and allows sufficient congregate space as defined
360 by rule.
361 c. Have sufficient staff available, taking into account the
362 physical plant and firesafety features of the building, to
363 assist with the evacuation of residents in an emergency.
364 d. Adopt and follow policies and procedures that maximize
365 resident independence, dignity, choice, and decisionmaking to
366 permit residents to age in place, so that moves due to changes
367 in functional status are minimized or avoided.
368 e. Allow residents or, if applicable, a resident’s
369 representative, designee, surrogate, guardian, or attorney in
370 fact to make a variety of personal choices, participate in
371 developing service plans, and share responsibility in
372 decisionmaking.
373 f. Implement the concept of managed risk.
374 g. Provide, directly or through contract, the services of a
375 person licensed under part I of chapter 464.
376 h. In addition to the training mandated in s. 429.52,
377 provide specialized training as defined by rule for facility
378 staff.
379 5.4. A facility that is licensed to provide extended
380 congregate care services is exempt from the criteria for
381 continued residency set forth in rules adopted under s. 429.41.
382 A licensed facility must adopt its own requirements within
383 guidelines for continued residency set forth by rule. However,
384 the facility may not serve residents who require 24-hour nursing
385 supervision. A licensed facility that provides extended
386 congregate care services must also provide each resident with a
387 written copy of facility policies governing admission and
388 retention.
389 5. The primary purpose of extended congregate care services
390 is to allow residents, as they become more impaired, the option
391 of remaining in a familiar setting from which they would
392 otherwise be disqualified for continued residency. A facility
393 licensed to provide extended congregate care services may also
394 admit an individual who exceeds the admission criteria for a
395 facility with a standard license, if the individual is
396 determined appropriate for admission to the extended congregate
397 care facility.
398 6. Before the admission of an individual to a facility
399 licensed to provide extended congregate care services, the
400 individual must undergo a medical examination as provided in s.
401 429.26(4) and the facility must develop a preliminary service
402 plan for the individual.
403 7. If When a facility can no longer provide or arrange for
404 services in accordance with the resident’s service plan and
405 needs and the facility’s policy, the facility must shall make
406 arrangements for relocating the person in accordance with s.
407 429.28(1)(k).
408 8. Failure to provide extended congregate care services may
409 result in denial of extended congregate care license renewal.
410
411 The agency may deny or revoke a facility’s extended congregate
412 care license for not meeting the standards of an extended
413 congregate care license or for any of the grounds listed in this
414 subsection.
415 (c) A limited nursing services license shall be issued to a
416 facility that provides services beyond those authorized in
417 paragraph (a) and as specified in this paragraph.
418 1. In order for limited nursing services to be provided in
419 a facility licensed under this part, the agency must first
420 determine that all requirements established in law and rule are
421 met and must specifically designate, on the facility’s license,
422 that such services may be provided. Such designation may be made
423 at the time of initial licensure or licensure renewal
424 relicensure, or upon request in writing by a licensee under this
425 part and part II of chapter 408. Notification of approval or
426 denial of such request shall be made in accordance with part II
427 of chapter 408. An existing facility that qualifies facilities
428 qualifying to provide limited nursing services must shall have
429 maintained a standard license and may not have been subject to
430 administrative sanctions that affect the health, safety, and
431 welfare of residents for the previous 2 years or since initial
432 licensure if the facility has been licensed for less than 2
433 years.
434 2. A facility Facilities that is are licensed to provide
435 limited nursing services shall maintain a written progress
436 report on each person who receives such nursing services. The,
437 which report must describe describes the type, amount, duration,
438 scope, and outcome of services that are rendered and the general
439 status of the resident’s health. A registered nurse representing
440 the agency shall visit the facility such facilities at least
441 annually twice a year to monitor residents who are receiving
442 limited nursing services and to determine if the facility is in
443 compliance with applicable provisions of this part, part II of
444 chapter 408, and related rules. The monitoring visits may be
445 provided through contractual arrangements with appropriate
446 community agencies. A registered nurse shall also serve as part
447 of the team that inspects such facility. Visits may be in
448 conjunction with other agency inspections. The agency may waive
449 one of the required yearly monitoring visits for a facility that
450 has:
451 a. A limited nursing services license for at least 24
452 months;
453 b. No class I or class II violations and no uncorrected
454 class III violations; and
455 c. No confirmed ombudsman council complaints that resulted
456 in a citation for licensure.
457 3. A person who receives limited nursing services under
458 this part must meet the admission criteria established by the
459 agency for assisted living facilities. When a resident no longer
460 meets the admission criteria for a facility licensed under this
461 part, arrangements for relocating the person shall be made in
462 accordance with s. 429.28(1)(k), unless the facility is licensed
463 to provide extended congregate care services.
464 Section 5. Section 429.075, Florida Statutes, is amended to
465 read:
466 429.075 Limited mental health license.—An assisted living
467 facility that serves one three or more mental health residents
468 must obtain a limited mental health license.
469 (1) To obtain a limited mental health license, a facility
470 must hold a standard license as an assisted living facility,
471 must not have any current uncorrected deficiencies or
472 violations, and must ensure that, within 6 months after
473 receiving a limited mental health license, the facility
474 administrator and the staff of the facility who are in direct
475 contact with mental health residents must complete training of
476 no less than 6 hours related to their duties. Such designation
477 may be made at the time of initial licensure or relicensure or
478 upon request in writing by a licensee under this part and part
479 II of chapter 408. Notification of approval or denial of such
480 request shall be made in accordance with this part, part II of
481 chapter 408, and applicable rules. This training must will be
482 provided by or approved by the Department of Children and Family
483 Services.
484 (2) A facility that is Facilities licensed to provide
485 services to mental health residents must shall provide
486 appropriate supervision and staffing to provide for the health,
487 safety, and welfare of such residents.
488 (3) A facility that has a limited mental health license
489 must:
490 (a) Have a copy of each mental health resident’s community
491 living support plan and the cooperative agreement with the
492 mental health care services provider. The support plan and the
493 agreement may be combined.
494 (b) Have documentation that is provided by the Department
495 of Children and Family Services that each mental health resident
496 has been assessed and determined to be able to live in the
497 community in an assisted living facility that has with a limited
498 mental health license.
499 (c) Make the community living support plan available for
500 inspection by the resident, the resident’s legal guardian, the
501 resident’s health care surrogate, and other individuals who have
502 a lawful basis for reviewing this document.
503 (d) Assist the mental health resident in carrying out the
504 activities identified in the individual’s community living
505 support plan.
506 (4) A facility that has with a limited mental health
507 license may enter into a cooperative agreement with a private
508 mental health provider. For purposes of the limited mental
509 health license, the private mental health provider may act as
510 the case manager.
511 Section 6. Section 429.14, Florida Statutes, is amended to
512 read:
513 429.14 Administrative penalties.—
514 (1) In addition to the requirements of part II of chapter
515 408, the agency may deny, revoke, and suspend any license issued
516 under this part and impose an administrative fine in the manner
517 provided in chapter 120 against a licensee for a violation of
518 any provision of this part, part II of chapter 408, or
519 applicable rules, or for any of the following actions by a
520 licensee, for the actions of any person subject to level 2
521 background screening under s. 408.809, or for the actions of any
522 facility staff employee:
523 (a) A An intentional or negligent act seriously affecting
524 the health, safety, or welfare of a resident of the facility.
525 (b) A The determination by the agency that the owner lacks
526 the financial ability to provide continuing adequate care to
527 residents.
528 (c) Misappropriation or conversion of the property of a
529 resident of the facility.
530 (d) Failure to follow the criteria and procedures provided
531 under part I of chapter 394 relating to the transportation,
532 voluntary admission, and involuntary examination of a facility
533 resident.
534 (e) A citation of any of the following deficiencies as
535 specified in s. 429.19:
536 1. One or more cited class I deficiencies.
537 2. Three or more cited class II deficiencies.
538 3. Five or more cited class III deficiencies that have been
539 cited on a single survey and have not been corrected within the
540 times specified.
541 (f) Failure to comply with the background screening
542 standards of this part, s. 408.809(1), or chapter 435.
543 (g) Violation of a moratorium.
544 (h) Failure of the license applicant, the licensee during
545 relicensure, or a licensee that holds a provisional license to
546 meet the minimum license requirements of this part, or related
547 rules, at the time of license application or renewal.
548 (i) An intentional or negligent life-threatening act in
549 violation of the uniform firesafety standards for assisted
550 living facilities or other firesafety standards which that
551 threatens the health, safety, or welfare of a resident of a
552 facility, as communicated to the agency by the local authority
553 having jurisdiction or the State Fire Marshal.
554 (j) Knowingly operating any unlicensed facility or
555 providing without a license any service that must be licensed
556 under this chapter or chapter 400.
557 (k) Any act constituting a ground upon which application
558 for a license may be denied.
559 (2) Upon notification by the local authority having
560 jurisdiction or by the State Fire Marshal, the agency may deny
561 or revoke the license of an assisted living facility that fails
562 to correct cited fire code violations that affect or threaten
563 the health, safety, or welfare of a resident of a facility.
564 (3) The agency may deny or revoke a license of an to any
565 applicant or controlling interest as defined in part II of
566 chapter 408 which has or had a 25-percent or greater financial
567 or ownership interest in any other facility that is licensed
568 under this part, or in any entity licensed by this state or
569 another state to provide health or residential care, if that
570 which facility or entity during the 5 years prior to the
571 application for a license closed due to financial inability to
572 operate; had a receiver appointed or a license denied,
573 suspended, or revoked; was subject to a moratorium; or had an
574 injunctive proceeding initiated against it.
575 (4) The agency shall deny or revoke the license of an
576 assisted living facility if:
577 (a) A resident’s health, safety, or welfare has been
578 seriously affected by an intentional act of facility staff;
579 (b) There are two moratoria issued pursuant to this part,
580 or part II of chapter 408, which are imposed by final order
581 within a 2-year period;
582 (c) The facility is conditionally licensed for 180 or more
583 consecutive days;
584 (d) The facility is cited for two or more class I
585 violations arising from unrelated circumstances during the same
586 survey or investigation; or
587 (e) The facility is cited for two or more class I
588 violations arising from separate surveys or investigations
589 within a 2-year period that has two or more class I violations
590 that are similar or identical to violations identified by the
591 agency during a survey, inspection, monitoring visit, or
592 complaint investigation occurring within the previous 2 years.
593 (5) An action taken by the agency to suspend, deny, or
594 revoke a facility’s license under this part or part II of
595 chapter 408, in which the agency claims that the facility owner
596 or an employee of the facility has threatened the health,
597 safety, or welfare of a resident of the facility must be heard
598 by the Division of Administrative Hearings of the Department of
599 Management Services within 120 days after receipt of the
600 facility’s request for a hearing, unless that time limitation is
601 waived by both parties. The administrative law judge shall must
602 render a decision within 30 days after receipt of a proposed
603 recommended order.
604 (6) The agency shall impose an immediate moratorium, as
605 provided under s. 408.814, on an assisted living facility that
606 fails to provide the agency access to the facility or prohibits
607 the agency from conducting a regulatory inspection. The licensee
608 may not restrict agency staff in accessing and copying records
609 or in conducting confidential interviews with facility staff or
610 any individual who receives services from the facility provide
611 to the Division of Hotels and Restaurants of the Department of
612 Business and Professional Regulation, on a monthly basis, a list
613 of those assisted living facilities that have had their licenses
614 denied, suspended, or revoked or that are involved in an
615 appellate proceeding pursuant to s. 120.60 related to the
616 denial, suspension, or revocation of a license.
617 (7) Agency notification of a license suspension or
618 revocation, or denial of a license renewal, shall be posted and
619 visible to the public at the facility.
620 Section 7. Paragraphs (a) and (b) of subsection (2) of
621 section 429.178, Florida Statutes, are amended to read:
622 429.178 Special care for persons with Alzheimer’s disease
623 or other related disorders.—
624 (2)(a) An individual who is employed by a facility that
625 provides special care for residents with Alzheimer’s disease or
626 other related disorders, and who has regular contact with such
627 residents, must complete up to 4 hours of initial dementia
628 specific training developed or approved by the department. The
629 training must shall be completed within 3 months after beginning
630 employment and satisfy shall satisfy the core training
631 requirements of s. 429.52(3)(g) s. 429.52(2)(g).
632 (b) A direct caregiver who is employed by a facility that
633 provides special care for residents with Alzheimer’s disease or
634 other related disorders, and who provides direct care to such
635 residents, must complete the required initial training and 4
636 additional hours of training developed or approved by the
637 department. The training must shall be completed within 9 months
638 after beginning employment and satisfy shall satisfy the core
639 training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
640 Section 8. Section 429.19, Florida Statutes, is amended to
641 read:
642 429.19 Violations; imposition of administrative fines;
643 grounds.—
644 (1) In addition to the requirements of part II of chapter
645 408, the agency shall impose an administrative fine in the
646 manner provided in chapter 120 for the violation of any
647 provision of this part, part II of chapter 408, and applicable
648 rules by an assisted living facility, for the actions of any
649 person subject to level 2 background screening under s. 408.809,
650 for the actions of any facility employee, or for an intentional
651 or negligent act seriously affecting the health, safety, or
652 welfare of a resident of the facility.
653 (2) Each violation of this part and adopted rules must
654 shall be classified according to the nature of the violation and
655 the gravity of its probable effect on facility residents. The
656 agency shall indicate the classification on the written notice
657 of the violation as follows:
658 (a) Class “I” violations are defined in s. 408.813. The
659 agency shall impose an administrative fine of $7,500 for each a
660 cited class I violation in a facility that is licensed for fewer
661 than 100 beds at the time of the violation in an amount not less
662 than $5,000 and not exceeding $10,000 for each violation. The
663 agency shall impose an administrative fine of $11,250 for each
664 cited class I violation in a facility that is licensed for 100
665 or more beds at the time of the violation. If the noncompliance
666 occurs within the prior 12 months, the fine must be levied for
667 violations that are corrected before an inspection.
668 (b) Class “II” violations are defined in s. 408.813. The
669 agency shall impose an administrative fine of $3,000 for each a
670 cited class II violation in a facility that is licensed for
671 fewer than 100 beds at the time of the violation in an amount
672 not less than $1,000 and not exceeding $5,000 for each
673 violation. The agency shall impose an administrative fine of
674 $4,500 for each cited class II violation in a facility that is
675 licensed for 100 or more beds at the time of the violation.
676 (c) Class “III” violations are defined in s. 408.813. The
677 agency shall impose an administrative fine of $750 for each a
678 cited class III violation in a facility that is licensed for
679 fewer than 100 beds at the time of the violation in an amount
680 not less than $500 and not exceeding $1,000 for each violation.
681 The agency shall impose an administrative fine of $1,125 for
682 each cited class III violation in a facility that is licensed
683 for 100 or more beds at the time of the violation.
684 (d) Class “IV” violations are defined in s. 408.813. The
685 agency shall impose an administrative fine of $150 for each a
686 cited class IV violation in a facility that is licensed for
687 fewer than 100 beds at the time of the violation in an amount
688 not less than $100 and not exceeding $200 for each violation.
689 The agency shall impose an administrative fine of $225 for each
690 cited class IV violation in a facility that is licensed for 100
691 or more beds at the time of the violation.
692 (e) Any fine imposed for class I and class II violations
693 must be doubled if a facility was previously cited for one or
694 more class I or class II violations during the agency’s last
695 licensure inspection or any inspection or complaint
696 investigation since the last licensure inspection.
697 (f) Notwithstanding any other provision of law, a fine must
698 be imposed for each class III and class IV violation, regardless
699 of correction, if a facility was previously cited for one or
700 more class III or class IV violations during the agency’s last
701 licensure inspection or any inspection or complaint
702 investigation since the last licensure inspection, for the same
703 regulatory violation. A fine imposed for class III or class IV
704 violations must be doubled if a facility was previously cited
705 for one or more class III or class IV violations during the
706 agency’s last two licensure inspections for the same regulatory
707 violation.
708 (g) In addition to the fines listed in paragraphs (a)-(d),
709 the agency shall impose an administrative fine of $500 if a
710 facility is found not to be in compliance with the background
711 screening requirements as provided in s. 408.809.
712 (3) For purposes of this section, in determining if a
713 penalty is to be imposed and in fixing the amount of the fine,
714 the agency shall consider the following factors:
715 (a) The gravity of the violation, including the probability
716 that death or serious physical or emotional harm to a resident
717 will result or has resulted, the severity of the action or
718 potential harm, and the extent to which the provisions of the
719 applicable laws or rules were violated.
720 (b) Actions taken by the owner or administrator to correct
721 violations.
722 (c) Any previous violations.
723 (d) The financial benefit to the facility of committing or
724 continuing the violation.
725 (e) The licensed capacity of the facility.
726 (3)(4) Each day of continuing violation after the date
727 established by the agency fixed for correction termination of
728 the violation, as ordered by the agency, constitutes an
729 additional, separate, and distinct violation.
730 (4)(5) An Any action taken to correct a violation shall be
731 documented in writing by the owner or administrator of the
732 facility and verified through followup visits by agency
733 personnel. The agency may impose a fine and, in the case of an
734 owner-operated facility, revoke or deny a facility’s license
735 when a facility administrator fraudulently misrepresents action
736 taken to correct a violation.
737 (5)(6) A Any facility whose owner fails to apply for a
738 change-of-ownership license in accordance with part II of
739 chapter 408 and operates the facility under the new ownership is
740 subject to a fine of $5,000.
741 (6)(7) In addition to any administrative fines imposed, the
742 agency may assess a survey fee, equal to the lesser of one half
743 of the facility’s biennial license and bed fee or $500, to cover
744 the cost of conducting initial complaint investigations that
745 result in the finding of a violation that was the subject of the
746 complaint or monitoring visits conducted under s. 429.28(3)(c)
747 to verify the correction of the violations.
748 (7)(8) During an inspection, the agency shall make a
749 reasonable attempt to discuss each violation with the owner or
750 administrator of the facility, prior to written notification.
751 (8)(9) The agency shall develop and disseminate an annual
752 list of all facilities sanctioned or fined for violations of
753 state standards, the number and class of violations involved,
754 the penalties imposed, and the current status of cases. The list
755 shall be disseminated, at no charge, to the Department of
756 Elderly Affairs, the Department of Health, the Department of
757 Children and Family Services, the Agency for Persons with
758 Disabilities, the area agencies on aging, the Florida Statewide
759 Advocacy Council, and the state and local ombudsman councils.
760 The Department of Children and Family Services shall disseminate
761 the list to service providers under contract to the department
762 who are responsible for referring persons to a facility for
763 residency. The agency may charge a fee commensurate with the
764 cost of printing and postage to other interested parties
765 requesting a copy of this list. This information may be provided
766 electronically or through the agency’s Internet site.
767 Section 9. Subsections (2) and (6) of section 429.28,
768 Florida Statutes, are amended to read:
769 429.28 Resident bill of rights.—
770 (2) The administrator of a facility shall ensure that a
771 written notice of the rights, obligations, and prohibitions set
772 forth in this part is posted in a prominent place in each
773 facility and read or explained to residents who cannot read. The
774 This notice must shall include the name, address, and telephone
775 numbers of the local ombudsman council and central abuse hotline
776 and, if when applicable, the Advocacy Center for Persons with
777 Disabilities, Inc., and the Florida local advocacy council,
778 where complaints may be lodged. The notice must state that the
779 subject matter of a complaint made to the Office of State Long
780 Term Care Ombudsman or a local long-term care ombudsman council
781 and the names and identities of the residents involved in the
782 complaint and the complainants are kept confidential pursuant to
783 s. 400.0077. The facility must ensure a resident’s access to a
784 telephone to call the local ombudsman council, central abuse
785 hotline, Advocacy Center for Persons with Disabilities, Inc.,
786 and the Florida local advocacy council.
787 (6) A Any facility that which terminates the residency of
788 an individual who participated in activities specified in
789 subsection (5) must shall show good cause in a court of
790 competent jurisdiction. If good cause is not shown, the agency
791 shall impose a fine of $2,500 in addition to any other penalty
792 assessed against the facility.
793 Section 10. Section 429.34, Florida Statutes, is amended to
794 read:
795 429.34 Right of entry and inspection.—
796 (1) In addition to the requirements of s. 408.811, any duly
797 designated officer or employee of the department, the Department
798 of Children and Family Services, the Medicaid Fraud Control Unit
799 of the Office of the Attorney General, the state or local fire
800 marshal, or a member of the state or local long-term care
801 ombudsman council has shall have the right to enter unannounced
802 upon and into the premises of any facility licensed pursuant to
803 this part in order to determine the state of compliance with the
804 provisions of this part, part II of chapter 408, and applicable
805 rules. Data collected by the state or local long-term care
806 ombudsman councils or the state or local advocacy councils may
807 be used by the agency in investigations involving violations of
808 regulatory standards. A person specified in this section who
809 knows or has reasonable cause to suspect that a vulnerable adult
810 has been or is being abused, neglected, or exploited shall
811 immediately report such knowledge or suspicion to the central
812 abuse hotline pursuant to chapter 415.
813 (2) Each licensed assisted living facility must be
814 inspected by the agency at least once every 24 months to
815 determine compliance with this chapter and related rules. If an
816 assisted living facility is cited for one or more class I
817 violations or two or more class II violations arising from
818 separate surveys within a 60-day period or due to unrelated
819 circumstances during the same survey, the agency must conduct an
820 additional licensure inspection within 6 months. In addition to
821 any fines imposed on the facility under s. 429.19, the licensee
822 must pay a fee for the cost of the additional inspection
823 equivalent to the standard assisted living facility license and
824 per-bed fees, without exception for beds designated for
825 recipients of optional state supplementation. The agency shall
826 adjust the fee in accordance with s. 408.805.
827 Section 11. Present subsections (1) through (11) of section
828 429.52, Florida Statutes, are redesignated as subsections (2)
829 through (12), respectively, a new subsection (1) is added to
830 that section, and present subsection (9) of that section is
831 amended, to read:
832 429.52 Staff training and educational programs; core
833 educational requirement.—
834 (1) Effective October 1, 2013, each new assisted living
835 facility employee who has not previously completed core training
836 must attend a preservice orientation provided by the facility
837 before interacting with residents. The preservice orientation
838 must be at least 2 hours in duration and cover topics that help
839 the employee provide responsible care and respond to the needs
840 of residents of the facility. Upon completion, the employee and
841 the administrator of the facility must sign an affidavit stating
842 that the employee completed the required preservice orientation.
843 The facility must keep the affidavit in the employee’s work
844 file.
845 (10)(9) The training required by this section must shall be
846 conducted by persons registered with the department as having
847 the requisite experience and credentials to conduct the
848 training. A person seeking to register as a trainer must provide
849 the department with proof of completion of the minimum core
850 training education requirements, successful passage of the
851 competency test established under this section, and proof of
852 compliance with the continuing education requirement in
853 subsection (5)(4).
854 Section 12. The Legislature finds that consistent
855 regulation of assisted living facilities benefits residents and
856 operators of such facilities. To determine whether surveys are
857 consistent between surveys and surveyors, the Agency for Health
858 Care Administration shall conduct a study of intersurveyor
859 reliability for assisted living facilities. By November 1, 2013,
860 the agency shall report to the Governor, the President of the
861 Senate, and the Speaker of the House of Representatives its
862 findings and make any recommendations to improve intersurveyor
863 reliability.
864 Section 13. The Legislature finds that consumers need
865 additional information on the quality of care and service in
866 assisted living facilities in order to select the best facility
867 for themselves or their loved ones. Therefore, the Agency for
868 Health Care Administration shall:
869 (1) Propose a rating system for assisted living facilities
870 similar to that used for nursing homes. The proposal must
871 include, but is not limited to, the data elements to be used,
872 the method of collecting the data, the method of determining the
873 rating, an estimate of the initial and ongoing costs of a rating
874 system to both the agency and assisted living facilities, and a
875 timetable for the implementation of the rating system for
876 assisted living facilities. The agency shall submit its proposal
877 to the Governor, the President of the Senate, and the Speaker of
878 the House of Representatives by November 1, 2013.
879 (2) By January 1, 2014, create a content that is easily
880 accessible through the front page of the agency’s website. At a
881 minimum, the content must include:
882 (a) Information on each licensed assisted living facility,
883 including, but not limited to:
884 1. The name and address of the facility.
885 2. The number and type of licensed beds in the facility.
886 3. The types of licenses held by the facility.
887 4. The facility’s license expiration date and status.
888 5. Other relevant information that the agency currently
889 collects.
890 (b) A list of the facility’s cited violations and a summary
891 of each violation which is presented in an understandable manner
892 to the general public.
893 (c) Links to inspection reports that the agency has on
894 file.
895 (d) A monitored comment page, maintained by the agency,
896 which allows citizens to anonymously comment on assisted living
897 facilities that are licensed to operate in the state. This
898 comment page must, at a minimum, allow members of the public to
899 post comments on their experiences with, or observations of, an
900 assisted living facility and to review other people’s comments.
901 Comments posted to the agency’s comment page may not contain
902 profanity and are intended to provide meaningful feedback about
903 the assisted living facility. The agency shall provide for a
904 webpage moderator to review comments for profane content before
905 the comments are posted to the page. An employee, owner, or
906 controlling interest in an assisted living facility is
907 prohibited from posting comments on the page.
908 Section 14. This act shall take effect July 1, 2013.