Florida Senate - 2020                              CS for SB 402
       By the Committee on Health Policy; and Senator Harrell
       588-01170-20                                           2020402c1
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 429.02, F.S.; defining and redefining
    4         terms; amending s. 429.07, F.S.; clarifying that an
    5         assisted living facility licensed to provide extended
    6         congregate care services or limited nursing services
    7         must maintain a written progress report on each person
    8         receiving services from the facility’s staff;
    9         conforming a cross-reference; amending s. 429.11,
   10         F.S.; prohibiting a county or municipality from
   11         issuing a business tax receipt, rather than an
   12         occupational license, to a facility under certain
   13         circumstances; amending s. 429.176, F.S.; amending
   14         educational requirements for an administrator who is
   15         replacing another administrator; amending s. 429.23,
   16         F.S.; removing restrictions on the method by which a
   17         facility may send a report to the Agency for Health
   18         Care Administration; requiring the agency to send a
   19         reminder to the facility 3 business days prior to the
   20         deadline for submission of the full report; removing a
   21         requirement that each facility file reports of
   22         liability claims; amending s. 429.255, F.S.;
   23         clarifying that the absence of an order not to
   24         resuscitate does not preclude a physician from
   25         withholding or withdrawing cardiopulmonary
   26         resuscitation or use of an automated external
   27         defibrillator; amending s. 429.256, F.S.; requiring a
   28         person assisting with a resident’s self-administration
   29         of medication to confirm that the medication is
   30         intended for that resident and to orally advise the
   31         resident of the medication name and purpose; amending
   32         s. 429.26, F.S.; including medical examinations within
   33         criteria used for admission to an assisted living
   34         facility; providing specified criteria for
   35         determination of appropriateness for admission and
   36         continued residency at an assisted living facility;
   37         defining the term “bedridden”; requiring that a
   38         resident receive a medical examination within a
   39         specified timeframe after admission to a facility;
   40         requiring that such examination be recorded on a
   41         specified form; providing limitations on the use of
   42         such form; providing minimum requirements for such
   43         form; conforming a provision to changes made by the
   44         act; eliminating the role of the Department of Elderly
   45         Affairs in certain provisions relating to the
   46         placement of residents in assisted living facilities;
   47         requiring a facility to notify a resident’s
   48         representative or designee of the need for health care
   49         services and to assist in making appointments for such
   50         care and services under certain circumstances;
   51         requiring the facility to arrange for necessary care
   52         and services if no resident representative or designee
   53         is available or responsive; removing provisions
   54         relating to the retention of certain residents in a
   55         facility; amending s. 429.28, F.S.; revising
   56         residents’ rights relating to a safe and secure living
   57         environment; amending s. 429.41, F.S.; revising
   58         legislative intent; removing a provision to conform to
   59         changes made by the act; removing a redundant
   60         provision authorizing the Agency for Health Care
   61         Administration to adopt certain rules; removing
   62         provisions relating to firesafety requirements, which
   63         are relocated to another section; requiring county
   64         emergency management agencies, rather than local
   65         emergency management agencies, to review and approve
   66         or disapprove of a facility’s comprehensive emergency
   67         management plan; requiring a facility to submit a
   68         comprehensive emergency management plan to the county
   69         emergency management agency within a specified
   70         timeframe after its licensure; revising the criteria
   71         under which a facility must be fully inspected;
   72         revising standards for the care of residents provided
   73         by a facility; prohibiting the use of geriatric chairs
   74         and Posey restraints in facilities; authorizing other
   75         physical restraints to be used under certain
   76         conditions and in accordance with certain rules;
   77         requiring the agency to establish resident elopement
   78         drill requirements; requiring that elopement drills
   79         include a review of a facility’s procedures to address
   80         elopement; revising the criteria under which a
   81         facility must be fully inspected; revising provisions
   82         requiring the agency to adopt by rule key quality-of
   83         care standards; creating s. 429.435, F.S.; revising
   84         uniform firesafety standards for assisted living
   85         facilities, which are relocated to this section;
   86         amending s. 429.52, F.S.; revising provisions relating
   87         to facility staff training and educational
   88         requirements; requiring the agency, in conjunction
   89         with providers, to establish core training
   90         requirements for facility administrators; revising
   91         continuing education requirements for facility staff
   92         who assist residents with the self-administration of
   93         medications; revising the training requirements for
   94         facility staff; revising provisions relating to the
   95         training responsibilities of the agency; requiring the
   96         agency to contract with another entity to administer a
   97         certain competency test; requiring the department to
   98         adopt a curriculum outline to be used by core
   99         trainers; providing an effective date.
  101  Be It Enacted by the Legislature of the State of Florida:
  103         Section 1. Present subsections (1) through (5), (6) through
  104  (10), (11) through (15), and (16) through (27) of section
  105  429.02, Florida Statutes, are redesignated as subsections (2)
  106  through (6), (8) through (12), (14) through (18), and (20)
  107  through (31), respectively, new subsections (1), (7), (13), and
  108  (19) are added, and present subsections (11) and (18) of that
  109  section are amended, to read:
  110         429.02 Definitions.—When used in this part, the term:
  111         (1) “Abuse” has the same meaning as in s. 415.102.
  112         (7) “Assistive device” means any device designed or adapted
  113  to help a resident perform an action, a task, an activity of
  114  daily living, or a transfer; prevent a fall; or recover from a
  115  fall. The term does not include a total body lift or a motorized
  116  sit-to-stand lift, with the exception of a chair lift or
  117  recliner lift that a resident is able to operate independently.
  118         (13) “Exploitation” has the same meaning as in s. 415.102.
  119         (14)(11) “Extended congregate care” means acts beyond those
  120  authorized in subsection (21) which (17) that may be performed
  121  pursuant to part I of chapter 464 by persons licensed thereunder
  122  while carrying out their professional duties, and other
  123  supportive services that which may be specified by rule. The
  124  purpose of such services is to enable residents to age in place
  125  in a residential environment despite mental or physical
  126  limitations that might otherwise disqualify them from residency
  127  in a facility licensed under this part.
  128         (19)“Neglect” has the same meaning as in s. 415.102. For
  129  purposes other than reporting requirements within this part,
  130  “neglect” may also include the failure to prevent sexual abuse
  131  as defined in s. 415.102.
  132         (22)(18) “Physical restraint” means a device that which
  133  physically limits, restricts, or deprives an individual of
  134  movement or mobility, including, but not limited to, a half-bed
  135  rail, a full-bed rail, a geriatric chair, and a posey restraint.
  136  The term “physical restraint” shall also include any device that
  137  is which was not specifically manufactured as a restraint but is
  138  which has been altered, arranged, or otherwise used for that
  139  this purpose. The term does shall not include any device that
  140  the resident chooses to use and is able to remove or avoid
  141  independently, or any bandage material used for the purpose of
  142  binding a wound or injury.
  143         Section 2. Paragraphs (b) and (c) of subsection (3) of
  144  section 429.07, Florida Statutes, are amended to read:
  145         429.07 License required; fee.—
  146         (3) In addition to the requirements of s. 408.806, each
  147  license granted by the agency must state the type of care for
  148  which the license is granted. Licenses shall be issued for one
  149  or more of the following categories of care: standard, extended
  150  congregate care, limited nursing services, or limited mental
  151  health.
  152         (b) An extended congregate care license shall be issued to
  153  each facility that has been licensed as an assisted living
  154  facility for 2 or more years and that provides services,
  155  directly or through contract, beyond those authorized in
  156  paragraph (a), including services performed by persons licensed
  157  under part I of chapter 464 and supportive services, as defined
  158  by rule, to persons who would otherwise be disqualified from
  159  continued residence in a facility licensed under this part. An
  160  extended congregate care license may be issued to a facility
  161  that has a provisional extended congregate care license and
  162  meets the requirements for licensure under subparagraph 2. The
  163  primary purpose of extended congregate care services is to allow
  164  residents the option of remaining in a familiar setting from
  165  which they would otherwise be disqualified for continued
  166  residency as they become more impaired. A facility licensed to
  167  provide extended congregate care services may also admit an
  168  individual who exceeds the admission criteria for a facility
  169  with a standard license, if he or she is determined appropriate
  170  for admission to the extended congregate care facility.
  171         1. In order for extended congregate care services to be
  172  provided, the agency must first determine that all requirements
  173  established in law and rule are met and must specifically
  174  designate, on the facility’s license, that such services may be
  175  provided and whether the designation applies to all or part of
  176  the facility. This designation may be made at the time of
  177  initial licensure or relicensure, or upon request in writing by
  178  a licensee under this part and part II of chapter 408. The
  179  notification of approval or the denial of the request shall be
  180  made in accordance with part II of chapter 408. Each existing
  181  facility that qualifies to provide extended congregate care
  182  services must have maintained a standard license and may not
  183  have been subject to administrative sanctions during the
  184  previous 2 years, or since initial licensure if the facility has
  185  been licensed for less than 2 years, for any of the following
  186  reasons:
  187         a. A class I or class II violation;
  188         b. Three or more repeat or recurring class III violations
  189  of identical or similar resident care standards from which a
  190  pattern of noncompliance is found by the agency;
  191         c. Three or more class III violations that were not
  192  corrected in accordance with the corrective action plan approved
  193  by the agency;
  194         d. Violation of resident care standards which results in
  195  requiring the facility to employ the services of a consultant
  196  pharmacist or consultant dietitian;
  197         e. Denial, suspension, or revocation of a license for
  198  another facility licensed under this part in which the applicant
  199  for an extended congregate care license has at least 25 percent
  200  ownership interest; or
  201         f. Imposition of a moratorium pursuant to this part or part
  202  II of chapter 408 or initiation of injunctive proceedings.
  204  The agency may deny or revoke a facility’s extended congregate
  205  care license for not meeting the criteria for an extended
  206  congregate care license as provided in this subparagraph.
  207         2. If an assisted living facility has been licensed for
  208  less than 2 years, the initial extended congregate care license
  209  must be provisional and may not exceed 6 months. The licensee
  210  shall notify the agency, in writing, when it has admitted at
  211  least one extended congregate care resident, after which an
  212  unannounced inspection shall be made to determine compliance
  213  with the requirements of an extended congregate care license. A
  214  licensee with a provisional extended congregate care license
  215  which that demonstrates compliance with all the requirements of
  216  an extended congregate care license during the inspection shall
  217  be issued an extended congregate care license. In addition to
  218  sanctions authorized under this part, if violations are found
  219  during the inspection and the licensee fails to demonstrate
  220  compliance with all assisted living facility requirements during
  221  a followup inspection, the licensee shall immediately suspend
  222  extended congregate care services, and the provisional extended
  223  congregate care license expires. The agency may extend the
  224  provisional license for not more than 1 month in order to
  225  complete a followup visit.
  226         3. A facility that is licensed to provide extended
  227  congregate care services shall maintain a written progress
  228  report on each person who receives services from the facility’s
  229  staff which describes the type, amount, duration, scope, and
  230  outcome of services that are rendered and the general status of
  231  the resident’s health. A registered nurse, or appropriate
  232  designee, representing the agency shall visit the facility at
  233  least twice a year to monitor residents who are receiving
  234  extended congregate care services and to determine if the
  235  facility is in compliance with this part, part II of chapter
  236  408, and relevant rules. One of the visits may be in conjunction
  237  with the regular survey. The monitoring visits may be provided
  238  through contractual arrangements with appropriate community
  239  agencies. A registered nurse shall serve as part of the team
  240  that inspects the facility. The agency may waive one of the
  241  required yearly monitoring visits for a facility that has:
  242         a. Held an extended congregate care license for at least 24
  243  months;
  244         b. No class I or class II violations and no uncorrected
  245  class III violations; and
  246         c. No ombudsman council complaints that resulted in a
  247  citation for licensure.
  248         4. A facility that is licensed to provide extended
  249  congregate care services must:
  250         a. Demonstrate the capability to meet unanticipated
  251  resident service needs.
  252         b. Offer a physical environment that promotes a homelike
  253  setting, provides for resident privacy, promotes resident
  254  independence, and allows sufficient congregate space as defined
  255  by rule.
  256         c. Have sufficient staff available, taking into account the
  257  physical plant and firesafety features of the building, to
  258  assist with the evacuation of residents in an emergency.
  259         d. Adopt and follow policies and procedures that maximize
  260  resident independence, dignity, choice, and decisionmaking to
  261  permit residents to age in place, so that moves due to changes
  262  in functional status are minimized or avoided.
  263         e. Allow residents or, if applicable, a resident’s
  264  representative, designee, surrogate, guardian, or attorney in
  265  fact to make a variety of personal choices, participate in
  266  developing service plans, and share responsibility in
  267  decisionmaking.
  268         f. Implement the concept of managed risk.
  269         g. Provide, directly or through contract, the services of a
  270  person licensed under part I of chapter 464.
  271         h. In addition to the training mandated in s. 429.52,
  272  provide specialized training as defined by rule for facility
  273  staff.
  274         5. A facility that is licensed to provide extended
  275  congregate care services is exempt from the criteria for
  276  continued residency set forth in rules adopted under s. 429.41.
  277  A licensed facility must adopt its own requirements within
  278  guidelines for continued residency set forth by rule. However,
  279  the facility may not serve residents who require 24-hour nursing
  280  supervision. A licensed facility that provides extended
  281  congregate care services must also provide each resident with a
  282  written copy of facility policies governing admission and
  283  retention.
  284         6. Before the admission of an individual to a facility
  285  licensed to provide extended congregate care services, the
  286  individual must undergo a medical examination as provided in s.
  287  429.26(5) s. 429.26(4) and the facility must develop a
  288  preliminary service plan for the individual.
  289         7. If a facility can no longer provide or arrange for
  290  services in accordance with the resident’s service plan and
  291  needs and the facility’s policy, the facility must make
  292  arrangements for relocating the person in accordance with s.
  293  429.28(1)(k).
  294         (c) A limited nursing services license shall be issued to a
  295  facility that provides services beyond those authorized in
  296  paragraph (a) and as specified in this paragraph.
  297         1. In order for limited nursing services to be provided in
  298  a facility licensed under this part, the agency must first
  299  determine that all requirements established in law and rule are
  300  met and must specifically designate, on the facility’s license,
  301  that such services may be provided. This designation may be made
  302  at the time of initial licensure or licensure renewal, or upon
  303  request in writing by a licensee under this part and part II of
  304  chapter 408. Notification of approval or denial of such request
  305  shall be made in accordance with part II of chapter 408. An
  306  existing facility that qualifies to provide limited nursing
  307  services must have maintained a standard license and may not
  308  have been subject to administrative sanctions that affect the
  309  health, safety, and welfare of residents for the previous 2
  310  years or since initial licensure if the facility has been
  311  licensed for less than 2 years.
  312         2. A facility that is licensed to provide limited nursing
  313  services shall maintain a written progress report on each person
  314  who receives such nursing services from the facility’s staff.
  315  The report must describe the type, amount, duration, scope, and
  316  outcome of services that are rendered and the general status of
  317  the resident’s health. A registered nurse representing the
  318  agency shall visit the facility at least annually to monitor
  319  residents who are receiving limited nursing services and to
  320  determine if the facility is in compliance with applicable
  321  provisions of this part, part II of chapter 408, and related
  322  rules. The monitoring visits may be provided through contractual
  323  arrangements with appropriate community agencies. A registered
  324  nurse shall also serve as part of the team that inspects such
  325  facility. Visits may be in conjunction with other agency
  326  inspections. The agency may waive the required yearly monitoring
  327  visit for a facility that has:
  328         a. Had a limited nursing services license for at least 24
  329  months;
  330         b. No class I or class II violations and no uncorrected
  331  class III violations; and
  332         c. No ombudsman council complaints that resulted in a
  333  citation for licensure.
  334         3. A person who receives limited nursing services under
  335  this part must meet the admission criteria established by the
  336  agency for assisted living facilities. When a resident no longer
  337  meets the admission criteria for a facility licensed under this
  338  part, arrangements for relocating the person shall be made in
  339  accordance with s. 429.28(1)(k), unless the facility is licensed
  340  to provide extended congregate care services.
  341         Section 3. Subsection (7) of section 429.11, Florida
  342  Statutes, is amended to read:
  343         429.11 Initial application for license; provisional
  344  license.—
  345         (7) A county or municipality may not issue a business tax
  346  receipt an occupational license that is being obtained for the
  347  purpose of operating a facility regulated under this part
  348  without first ascertaining that the applicant has been licensed
  349  to operate such facility at the specified location or locations
  350  by the agency. The agency shall furnish to local agencies
  351  responsible for issuing business tax receipts occupational
  352  licenses sufficient instruction for making such determinations.
  353         Section 4. Section 429.176, Florida Statutes, is amended to
  354  read:
  355         429.176 Notice of change of administrator.—If, during the
  356  period for which a license is issued, the owner changes
  357  administrators, the owner must notify the agency of the change
  358  within 10 days and provide documentation within 90 days that the
  359  new administrator meets educational requirements and has
  360  completed the applicable core educational requirements under s.
  361  429.52. A facility may not be operated for more than 120
  362  consecutive days without an administrator who has completed the
  363  core educational requirements.
  364         Section 5. Subsections (2) through (5) of section 429.23,
  365  Florida Statutes, are amended to read:
  366         429.23 Internal risk management and quality assurance
  367  program; adverse incidents and reporting requirements.—
  368         (2) Every facility licensed under this part is required to
  369  maintain adverse incident reports. For purposes of this section,
  370  the term, “adverse incident” means:
  371         (a) An event over which facility personnel could exercise
  372  control which is associated with the facility’s intervention,
  373  rather than as a result of the resident’s underlying disease or
  374  condition, and the injury results in:
  375         1. Death;
  376         2. Brain or spinal damage;
  377         3. Permanent disfigurement;
  378         4. Fracture or dislocation of bones or joints;
  379         5. Any condition that required medical attention to which
  380  the resident has not given his or her consent, including failure
  381  to honor advanced directives;
  382         6. Any condition that requires the transfer of the resident
  383  from the facility to a unit providing more acute care due to the
  384  incident rather than the resident’s condition before the
  385  incident; or
  386         7. A report made An event that is reported to law
  387  enforcement or its personnel for investigation; or
  388         (b) Resident elopement, if the elopement places the
  389  resident at risk of harm or injury.
  390         (3) Licensed facilities shall provide within 1 business day
  391  after the occurrence of an adverse incident, by electronic mail,
  392  facsimile, or United States mail, a preliminary report to the
  393  agency on all adverse incidents specified under this section.
  394  The report must include information regarding the identity of
  395  the affected resident, the type of adverse incident, and the
  396  result status of the facility’s investigation of the incident.
  397         (4) Licensed facilities shall provide within 15 days, by
  398  electronic mail, facsimile, or United States mail, a full report
  399  to the agency on all adverse incidents specified in this
  400  section. The report must include the results of the facility’s
  401  investigation into the adverse incident.
  402         (5) The agency shall send, by electronic mail, reminders to
  403  the facility’s administrator and other specified facility
  404  contacts 3 business days before the deadline for the submission
  405  of the full report. If the facility determines that the event is
  406  not an adverse incident, the facility must withdraw the
  407  preliminary report. Until 3 business days after the agency
  408  provides the reminder, facilities shall not be subject to any
  409  administrative or other action for failing to file a full report
  410  if the facility determined that the event was not an adverse
  411  incident after filing the preliminary report. Each facility
  412  shall report monthly to the agency any liability claim filed
  413  against it. The report must include the name of the resident,
  414  the dates of the incident leading to the claim, if applicable,
  415  and the type of injury or violation of rights alleged to have
  416  occurred. This report is not discoverable in any civil or
  417  administrative action, except in such actions brought by the
  418  agency to enforce the provisions of this part.
  419         Section 6. Subsection (4) of section 429.255, Florida
  420  Statutes, is amended to read:
  421         429.255 Use of personnel; emergency care.—
  422         (4) Facility staff may withhold or withdraw cardiopulmonary
  423  resuscitation or the use of an automated external defibrillator
  424  if presented with an order not to resuscitate executed pursuant
  425  to s. 401.45. The agency shall adopt rules providing for the
  426  implementation of such orders. Facility staff and facilities may
  427  not be subject to criminal prosecution or civil liability, nor
  428  be considered to have engaged in negligent or unprofessional
  429  conduct, for withholding or withdrawing cardiopulmonary
  430  resuscitation or use of an automated external defibrillator
  431  pursuant to such an order and rules adopted by the agency. The
  432  absence of an order not to resuscitate executed pursuant to s.
  433  401.45 does not preclude a physician from withholding or
  434  withdrawing cardiopulmonary resuscitation or use of an automated
  435  external defibrillator as otherwise permitted by law.
  436         Section 7. Subsection (2), paragraph (b) of subsection (3),
  437  and paragraphs (e), (f), and (g) of subsection (4) of section
  438  429.256, Florida Statutes, are amended to read:
  439         429.256 Assistance with self-administration of medication.—
  440         (2) Residents who are capable of self-administering their
  441  own medications without assistance shall be encouraged and
  442  allowed to do so. However, an unlicensed person may, consistent
  443  with a dispensed prescription’s label or the package directions
  444  of an over-the-counter medication, assist a resident whose
  445  condition is medically stable with the self-administration of
  446  routine, regularly scheduled medications that are intended to be
  447  self-administered. Assistance with self-medication by an
  448  unlicensed person may occur only upon a documented request by,
  449  and the written informed consent of, a resident or the
  450  resident’s surrogate, guardian, or attorney in fact. For the
  451  purposes of this section, self-administered medications include
  452  both legend and over-the-counter oral dosage forms, topical
  453  dosage forms, transdermal patches, and topical ophthalmic, otic,
  454  and nasal dosage forms including solutions, suspensions, sprays,
  455  and inhalers.
  456         (3) Assistance with self-administration of medication
  457  includes:
  458         (b) In the presence of the resident, confirming that the
  459  medication is intended for that resident, orally advising the
  460  resident of the medication name and purpose reading the label,
  461  opening the container, removing a prescribed amount of
  462  medication from the container, and closing the container.
  463         (4) Assistance with self-administration does not include:
  464         (e) The use of irrigations or debriding agents used in the
  465  treatment of a skin condition.
  466         (f) Assisting with rectal, urethral, or vaginal
  467  preparations.
  468         (g) Assisting with medications ordered by the physician or
  469  health care professional with prescriptive authority to be given
  470  “as needed,” unless the order is written with specific
  471  parameters that preclude independent judgment on the part of the
  472  unlicensed person, and at the request of a competent resident
  473  requesting the medication is aware of his or her need for the
  474  medication and understands the purpose for taking the
  475  medication.
  476         Section 8. Section 429.26, Florida Statutes, is amended to
  477  read:
  478         429.26 Appropriateness of placements; examinations of
  479  residents.—
  480         (1) The owner or administrator of a facility is responsible
  481  for determining the appropriateness of admission of an
  482  individual to the facility and for determining the continued
  483  appropriateness of residence of an individual in the facility. A
  484  determination must shall be based upon an evaluation assessment
  485  of the strengths, needs, and preferences of the resident, a
  486  medical examination, the care and services offered or arranged
  487  for by the facility in accordance with facility policy, and any
  488  limitations in law or rule related to admission criteria or
  489  continued residency for the type of license held by the facility
  490  under this part. The following criteria apply to the
  491  determination of appropriateness for admission and continued
  492  residency of an individual in a facility:
  493         (a) A facility may admit or retain a resident who receives
  494  a health care service or treatment that is designed to be
  495  provided within a private residential setting if all
  496  requirements for providing that service or treatment are met by
  497  the facility or a third party.
  498         (b) A facility may admit or retain a resident who requires
  499  the use of assistive devices.
  500         (c) A facility may admit or retain an individual receiving
  501  hospice services if the arrangement is agreed to by the facility
  502  and the resident, additional care is provided by a licensed
  503  hospice, and the resident is under the care of a physician who
  504  agrees that the physical needs of the resident can be met at the
  505  facility. The resident must have a plan of care which delineates
  506  how the facility and the hospice will meet the scheduled and
  507  unscheduled needs of the resident.
  508         (d)1. Except for a resident who is receiving hospice
  509  services as provided in paragraph (c), a facility may not admit
  510  or retain a resident who is bedridden or who requires 24-hour
  511  nursing supervision. For purposes of this paragraph, the term
  512  “bedridden” means that a resident is confined to a bed because
  513  of the inability to:
  514         a.Move, turn, or reposition without total physical
  515  assistance;
  516         b.Transfer to a chair or wheelchair without total physical
  517  assistance; or
  518         c.Sit safely in a chair or wheelchair without personal
  519  assistance or a physical restraint.
  520         2.A resident may continue to reside in a facility if,
  521  during residency, he or she is bedridden for no more than 7
  522  consecutive days.
  523         3.If a facility is licensed to provide extended congregate
  524  care, a resident may continue to reside in a facility if, during
  525  residency, he or she is bedridden for no more than 14
  526  consecutive days.
  527         (2) A resident may not be moved from one facility to
  528  another without consultation with and agreement from the
  529  resident or, if applicable, the resident’s representative or
  530  designee or the resident’s family, guardian, surrogate, or
  531  attorney in fact. In the case of a resident who has been placed
  532  by the department or the Department of Children and Families,
  533  the administrator must notify the appropriate contact person in
  534  the applicable department.
  535         (3)(2) A physician, physician assistant, or advanced
  536  practice registered nurse practitioner who is employed by an
  537  assisted living facility to provide an initial examination for
  538  admission purposes may not have financial interests interest in
  539  the facility.
  540         (4)(3) Persons licensed under part I of chapter 464 who are
  541  employed by or under contract with a facility shall, on a
  542  routine basis or at least monthly, perform a nursing assessment
  543  of the residents for whom they are providing nursing services
  544  ordered by a physician, except administration of medication, and
  545  shall document such assessment, including any substantial
  546  changes in a resident’s status which may necessitate relocation
  547  to a nursing home, hospital, or specialized health care
  548  facility. Such records shall be maintained in the facility for
  549  inspection by the agency and shall be forwarded to the
  550  resident’s case manager, if applicable.
  551         (5)(4)If possible, Each resident must shall have been
  552  examined by a licensed physician, a licensed physician
  553  assistant, or a licensed advanced practice registered nurse
  554  practitioner within 60 days before admission to the facility or
  555  within 30 days after admission to the facility, except as
  556  provided in s. 429.07. The information from the medical
  557  examination must be recorded on the practitioner’s form or on a
  558  form adopted by agency rule. The signed and completed medical
  559  examination form, signed by the practitioner, must report shall
  560  be submitted to the owner or administrator of the facility, who
  561  shall use the information contained therein to assist in the
  562  determination of the appropriateness of the resident’s admission
  563  to or and continued residency stay in the facility. The medical
  564  examination form may be used only to record the health care
  565  provider’s direct observation of the patient at the time of
  566  examination and must include any known medical history. The
  567  medical examination form is not a guarantee of admission,
  568  continued residency, or the delivery of services and may be used
  569  only as an informative tool to assist in the determination of
  570  the appropriateness of the resident’s admission to or continued
  571  residency in the facility. The medical examination form,
  572  reflecting the resident’s condition on the date the examination
  573  is performed, becomes report shall become a permanent part of
  574  the facility’s record of the resident at the facility and must
  575  shall be made available to the agency during inspection or upon
  576  request. An assessment that has been completed through the
  577  Comprehensive Assessment and Review for Long-Term Care Services
  578  (CARES) Program fulfills the requirements for a medical
  579  examination under this subsection and s. 429.07(3)(b)6.
  580         (6)The medical examination form submitted under subsection
  581  (5) must include the following information relating to the
  582  resident:
  583         (a)Height, weight, and known allergies.
  584         (b)Significant medical history and diagnoses.
  585         (c)Physical or sensory limitations, including the need for
  586  fall precautions or recommended use of assistive devices.
  587         (d)Cognitive or behavioral status and a brief description
  588  of any behavioral issues known or ascertained by the examining
  589  practitioner, including any known history of wandering or
  590  elopement.
  591         (e)Nursing, treatment, or therapy service requirements.
  592         (f)Whether assistance is needed for ambulating, eating, or
  593  transferring.
  594         (g)Special dietary instructions.
  595         (h)Whether he or she has any communicable diseases,
  596  including necessary precautions.
  597         (i)Whether he or she is bedridden and the status of any
  598  pressure sores that he or she has.
  599         (j)Whether the resident needs 24-hour nursing supervision
  600  or psychiatric care.
  601         (k)A list of current prescribed medications as known or
  602  ascertained by the examining practitioner and whether the
  603  resident can self-administer medications, needs assistance, or
  604  needs medication administration.
  605         (5)Except as provided in s. 429.07, if a medical
  606  examination has not been completed within 60 days before the
  607  admission of the resident to the facility, a licensed physician,
  608  licensed physician assistant, or licensed nurse practitioner
  609  shall examine the resident and complete a medical examination
  610  form provided by the agency within 30 days following the
  611  admission to the facility to enable the facility owner or
  612  administrator to determine the appropriateness of the admission.
  613  The medical examination form shall become a permanent part of
  614  the record of the resident at the facility and shall be made
  615  available to the agency during inspection by the agency or upon
  616  request.
  617         (7)(6) Any resident accepted in a facility and placed by
  618  the department or the Department of Children and Families must
  619  shall have been examined by medical personnel within 30 days
  620  before placement in the facility. The examination must shall
  621  include an assessment of the appropriateness of placement in a
  622  facility. The findings of this examination must shall be
  623  recorded on the examination form provided by the agency. The
  624  completed form must shall accompany the resident and shall be
  625  submitted to the facility owner or administrator. Additionally,
  626  in the case of a mental health resident, the Department of
  627  Children and Families must provide documentation that the
  628  individual has been assessed by a psychiatrist, clinical
  629  psychologist, clinical social worker, or psychiatric nurse, or
  630  an individual who is supervised by one of these professionals,
  631  and determined to be appropriate to reside in an assisted living
  632  facility. The documentation must be in the facility within 30
  633  days after the mental health resident has been admitted to the
  634  facility. An evaluation completed upon discharge from a state
  635  mental hospital meets the requirements of this subsection
  636  related to appropriateness for placement as a mental health
  637  resident provided that providing it was completed within 90 days
  638  prior to admission to the facility. The applicable Department of
  639  Children and Families shall provide to the facility
  640  administrator any information about the resident which that
  641  would help the administrator meet his or her responsibilities
  642  under subsection (1). Further, Department of Children and
  643  Families personnel shall explain to the facility operator any
  644  special needs of the resident and advise the operator whom to
  645  call should problems arise. The applicable Department of
  646  Children and Families shall advise and assist the facility
  647  administrator when where the special needs of residents who are
  648  recipients of optional state supplementation require such
  649  assistance.
  650         (8)(7) The facility shall must notify a licensed physician
  651  when a resident exhibits signs of dementia or cognitive
  652  impairment or has a change of condition in order to rule out the
  653  presence of an underlying physiological condition that may be
  654  contributing to such dementia or impairment. The notification
  655  must occur within 30 days after the acknowledgment of such signs
  656  by facility staff. If an underlying condition is determined to
  657  exist, the facility must notify the resident’s representative or
  658  designee of the need for health care services and must assist in
  659  making appointments for shall arrange, with the appropriate
  660  health care provider, the necessary care and services to treat
  661  the condition. If the resident does not have a representative or
  662  designee or if the resident’s representative or designee cannot
  663  be located or is unresponsive, the facility shall arrange, with
  664  the appropriate health care provider, the necessary care and
  665  services to treat the condition.
  666         (9)(8) The Department of Children and Families may require
  667  an examination for supplemental security income and optional
  668  state supplementation recipients residing in facilities at any
  669  time and shall provide the examination whenever a resident’s
  670  condition requires it. Any facility administrator; personnel of
  671  the agency, the department, or the Department of Children and
  672  Families; or a representative of the State Long-Term Care
  673  Ombudsman Program who believes a resident needs to be evaluated
  674  shall notify the resident’s case manager, who shall take
  675  appropriate action. A report of the examination findings must
  676  shall be provided to the resident’s case manager and the
  677  facility administrator to help the administrator meet his or her
  678  responsibilities under subsection (1).
  679         (9)A terminally ill resident who no longer meets the
  680  criteria for continued residency may remain in the facility if
  681  the arrangement is mutually agreeable to the resident and the
  682  facility; additional care is rendered through a licensed
  683  hospice, and the resident is under the care of a physician who
  684  agrees that the physical needs of the resident are being met.
  685         (10) Facilities licensed to provide extended congregate
  686  care services shall promote aging in place by determining
  687  appropriateness of continued residency based on a comprehensive
  688  review of the resident’s physical and functional status; the
  689  ability of the facility, family members, friends, or any other
  690  pertinent individuals or agencies to provide the care and
  691  services required; and documentation that a written service plan
  692  consistent with facility policy has been developed and
  693  implemented to ensure that the resident’s needs and preferences
  694  are addressed.
  695         (11)No resident who requires 24-hour nursing supervision,
  696  except for a resident who is an enrolled hospice patient
  697  pursuant to part IV of chapter 400, shall be retained in a
  698  facility licensed under this part.
  699         Section 9. Paragraphs (a) and (k) of subsection (1) and
  700  subsection (3) of section 429.28, Florida Statutes, are amended
  701  to read:
  702         429.28 Resident bill of rights.—
  703         (1) No resident of a facility shall be deprived of any
  704  civil or legal rights, benefits, or privileges guaranteed by
  705  law, the Constitution of the State of Florida, or the
  706  Constitution of the United States as a resident of a facility.
  707  Every resident of a facility shall have the right to:
  708         (a) Live in a safe and decent living environment, free from
  709  abuse, and neglect, and exploitation.
  710         (k) At least 45 days’ notice of relocation or termination
  711  of residency from the facility unless, for medical reasons, the
  712  resident is certified by a physician to require an emergency
  713  relocation to a facility providing a more skilled level of care
  714  or the resident engages in a pattern of conduct that is harmful
  715  or offensive to other residents. In the case of a resident who
  716  has been adjudicated mentally incapacitated, the guardian shall
  717  be given at least 45 days’ notice of a nonemergency relocation
  718  or residency termination. Reasons for relocation must shall be
  719  set forth in writing and provided to the resident or the
  720  resident’s legal representative. In order for a facility to
  721  terminate the residency of an individual without notice as
  722  provided herein, the facility shall show good cause in a court
  723  of competent jurisdiction.
  724         (3)(a) The agency shall conduct a survey to determine
  725  whether the facility is complying with this section general
  726  compliance with facility standards and compliance with
  727  residents’ rights as a prerequisite to initial licensure or
  728  licensure renewal. The agency shall adopt rules for uniform
  729  standards and criteria that will be used to determine compliance
  730  with facility standards and compliance with residents’ rights.
  731         (b) In order to determine whether the facility is
  732  adequately protecting residents’ rights, the licensure renewal
  733  biennial survey must shall include private informal
  734  conversations with a sample of residents and consultation with
  735  the ombudsman council in the district in which the facility is
  736  located to discuss residents’ experiences within the facility.
  737         Section 10. Section 429.41, Florida Statutes, is amended to
  738  read:
  739         429.41 Rules establishing standards.—
  740         (1) It is the intent of the Legislature that rules
  741  published and enforced pursuant to this section shall include
  742  criteria by which a reasonable and consistent quality of
  743  resident care and quality of life may be ensured and the results
  744  of such resident care may be demonstrated. Such rules shall also
  745  promote ensure a safe and sanitary environment that is
  746  residential and noninstitutional in design or nature and may
  747  allow for technological advances in the provision of care,
  748  safety, and security, including the use of devices, equipment,
  749  and other security measures related to wander management,
  750  emergency response, staff risk management, and the general
  751  safety and security of residents, staff, and the facility. It is
  752  further intended that reasonable efforts be made to accommodate
  753  the needs and preferences of residents to enhance the quality of
  754  life in a facility. Uniform firesafety standards for assisted
  755  living facilities shall be established by the State Fire Marshal
  756  pursuant to s. 633.206. The agency may adopt rules to administer
  757  part II of chapter 408. In order to provide safe and sanitary
  758  facilities and the highest quality of resident care
  759  accommodating the needs and preferences of residents, The
  760  agency, in consultation with the Department of Children and
  761  Families and the Department of Health, shall adopt rules,
  762  policies, and procedures to administer this part, which must
  763  include reasonable and fair minimum standards in relation to:
  764         (a) The requirements for and maintenance and the sanitary
  765  condition of facilities, not in conflict with, or duplicative
  766  of, rules adopted pursuant to s. 381.006(16) and s. 381.0072 and
  767  standards established under chapter 553 and s. 633.206, relating
  768  to a safe and decent living environment, including furnishings
  769  for resident bedrooms or sleeping areas, locking devices, linens
  770  plumbing, heating, cooling, lighting, ventilation, living space,
  771  and other housing conditions relating to hazards, which will
  772  promote ensure the health, safety, and welfare comfort of
  773  residents suitable to the size of the structure. The rules must
  774  clearly delineate the respective responsibilities of the
  775  agency’s licensure and survey staff and the county health
  776  departments and ensure that inspections are not duplicative. The
  777  agency may collect fees for food service inspections conducted
  778  by county health departments and may transfer such fees to the
  779  Department of Health.
  780         1.Firesafety evacuation capability determination.—An
  781  evacuation capability evaluation for initial licensure shall be
  782  conducted within 6 months after the date of licensure.
  783         2.Firesafety requirements.—
  784         a.The National Fire Protection Association, Life Safety
  785  Code, NFPA 101 and 101A, current editions, shall be used in
  786  determining the uniform firesafety code adopted by the State
  787  Fire Marshal for assisted living facilities, pursuant to s.
  788  633.206.
  789         b.A local government or a utility may charge fees only in
  790  an amount not to exceed the actual expenses incurred by the
  791  local government or the utility relating to the installation and
  792  maintenance of an automatic fire sprinkler system in a licensed
  793  assisted living facility structure.
  794         c.All licensed facilities must have an annual fire
  795  inspection conducted by the local fire marshal or authority
  796  having jurisdiction.
  797         d.An assisted living facility that is issued a building
  798  permit or certificate of occupancy before July 1, 2016, may at
  799  its option and after notifying the authority having
  800  jurisdiction, remain under the provisions of the 1994 and 1995
  801  editions of the National Fire Protection Association, Life
  802  Safety Code, NFPA 101, and NFPA 101A. The facility opting to
  803  remain under such provisions may make repairs, modernizations,
  804  renovations, or additions to, or rehabilitate, the facility in
  805  compliance with NFPA 101, 1994 edition, and may utilize the
  806  alternative approaches to life safety in compliance with NFPA
  807  101A, 1995 edition. However, a facility for which a building
  808  permit or certificate of occupancy is issued before July 1,
  809  2016, that undergoes Level III building alteration or
  810  rehabilitation, as defined in the Florida Building Code, or
  811  seeks to utilize features not authorized under the 1994 or 1995
  812  editions of the Life Safety Code must thereafter comply with all
  813  aspects of the uniform firesafety standards established under s.
  814  633.206, and the Florida Fire Prevention Code, in effect for
  815  assisted living facilities as adopted by the State Fire Marshal.
  816         3.Resident elopement requirements.—Facilities are required
  817  to conduct a minimum of two resident elopement prevention and
  818  response drills per year. All administrators and direct care
  819  staff must participate in the drills, which shall include a
  820  review of procedures to address resident elopement. Facilities
  821  must document the implementation of the drills and ensure that
  822  the drills are conducted in a manner consistent with the
  823  facility’s resident elopement policies and procedures.
  824         (b) The preparation and annual update of a comprehensive
  825  emergency management plan. Such standards must be included in
  826  the rules adopted by the agency after consultation with the
  827  Division of Emergency Management. At a minimum, the rules must
  828  provide for plan components that address emergency evacuation
  829  transportation; adequate sheltering arrangements; postdisaster
  830  activities, including provision of emergency power, food, and
  831  water; postdisaster transportation; supplies; staffing;
  832  emergency equipment; individual identification of residents and
  833  transfer of records; communication with families; and responses
  834  to family inquiries. The comprehensive emergency management plan
  835  is subject to review and approval by the county local emergency
  836  management agency. During its review, the county local emergency
  837  management agency shall ensure that the following agencies, at a
  838  minimum, are given the opportunity to review the plan: the
  839  Department of Health, the Agency for Health Care Administration,
  840  and the Division of Emergency Management. Also, appropriate
  841  volunteer organizations must be given the opportunity to review
  842  the plan. The county local emergency management agency shall
  843  complete its review within 60 days and either approve the plan
  844  or advise the facility of necessary revisions. A facility must
  845  submit a comprehensive emergency management plan to the county
  846  emergency management agency within 30 days after issuance of a
  847  license.
  848         (c) The number, training, and qualifications of all
  849  personnel having responsibility for the care of residents. The
  850  rules must require adequate staff to provide for the safety of
  851  all residents. Facilities licensed for 17 or more residents are
  852  required to maintain an alert staff for 24 hours per day.
  853         (d)All sanitary conditions within the facility and its
  854  surroundings which will ensure the health and comfort of
  855  residents. The rules must clearly delineate the responsibilities
  856  of the agency’s licensure and survey staff, the county health
  857  departments, and the local authority having jurisdiction over
  858  firesafety and ensure that inspections are not duplicative. The
  859  agency may collect fees for food service inspections conducted
  860  by the county health departments and transfer such fees to the
  861  Department of Health.
  862         (d)(e) License application and license renewal, transfer of
  863  ownership, proper management of resident funds and personal
  864  property, surety bonds, resident contracts, refund policies,
  865  financial ability to operate, and facility and staff records.
  866         (e)(f) Inspections, complaint investigations, moratoriums,
  867  classification of deficiencies, levying and enforcement of
  868  penalties, and use of income from fees and fines.
  869         (f)(g) The enforcement of the resident bill of rights
  870  specified in s. 429.28.
  871         (g)(h) The care and maintenance of residents provided by
  872  the facility, which must include, but is not limited to:
  873         1. The supervision of residents;
  874         2. The provision of personal services;
  875         3. The provision of, or arrangement for, social and leisure
  876  activities;
  877         4. The assistance in making arrangements arrangement for
  878  appointments and transportation to appropriate medical, dental,
  879  nursing, or mental health services, as needed by residents;
  880         5. The management of medication stored within the facility
  881  and as needed by residents;
  882         6. The dietary nutritional needs of residents;
  883         7. Resident records; and
  884         8. Internal risk management and quality assurance.
  885         (h)(i) Facilities holding a limited nursing, extended
  886  congregate care, or limited mental health license.
  887         (i)(j) The establishment of specific criteria to define
  888  appropriateness of resident admission and continued residency in
  889  a facility holding a standard, limited nursing, extended
  890  congregate care, and limited mental health license.
  891         (j)(k) The use of physical or chemical restraints. The use
  892  of geriatric chairs or Posey restraints is prohibited. Other
  893  physical restraints may be used in accordance with agency rules
  894  when ordered is limited to half-bed rails as prescribed and
  895  documented by the resident’s physician and consented to by with
  896  the consent of the resident or, if applicable, the resident’s
  897  representative or designee or the resident’s surrogate,
  898  guardian, or attorney in fact. Such rules must specify
  899  requirements for care planning, staff monitoring, and periodic
  900  review by a physician. The use of chemical restraints is limited
  901  to prescribed dosages of medications authorized by the
  902  resident’s physician and must be consistent with the resident’s
  903  diagnosis. Residents who are receiving medications that can
  904  serve as chemical restraints must be evaluated by their
  905  physician at least annually to assess:
  906         1. The continued need for the medication.
  907         2. The level of the medication in the resident’s blood.
  908         3. The need for adjustments in the prescription.
  909         (k)(l) The establishment of specific resident elopement
  910  drill requirements, policies, and procedures on resident
  911  elopement. Facilities shall conduct a minimum of two resident
  912  elopement drills each year. All administrators and direct care
  913  staff shall participate in the drills, which must include a
  914  review of the facility’s procedures to address resident
  915  elopement. Facilities shall document participation in the
  916  drills.
  917         (2) In adopting any rules pursuant to this part, the agency
  918  shall make distinct standards for facilities based upon facility
  919  size; the types of care provided; the physical and mental
  920  capabilities and needs of residents; the type, frequency, and
  921  amount of services and care offered; and the staffing
  922  characteristics of the facility. Rules developed pursuant to
  923  this section may not restrict the use of shared staffing and
  924  shared programming in facilities that are part of retirement
  925  communities that provide multiple levels of care and otherwise
  926  meet the requirements of law and rule. If a continuing care
  927  facility licensed under chapter 651 or a retirement community
  928  offering multiple levels of care licenses a building or part of
  929  a building designated for independent living for assisted
  930  living, staffing requirements established in rule apply only to
  931  residents who receive personal, limited nursing, or extended
  932  congregate care services under this part. Such facilities shall
  933  retain a log listing the names and unit number for residents
  934  receiving these services. The log must be available to surveyors
  935  upon request. Except for uniform firesafety standards, The
  936  agency shall adopt by rule separate and distinct standards for
  937  facilities with 16 or fewer beds and for facilities with 17 or
  938  more beds. The standards for facilities with 16 or fewer beds
  939  must be appropriate for a noninstitutional residential
  940  environment; however, the structure may not be more than two
  941  stories in height and all persons who cannot exit the facility
  942  unassisted in an emergency must reside on the first floor. The
  943  agency may make other distinctions among types of facilities as
  944  necessary to enforce this part. Where appropriate, the agency
  945  shall offer alternate solutions for complying with established
  946  standards, based on distinctions made by the agency relative to
  947  the physical characteristics of facilities and the types of care
  948  offered.
  949         (3) Rules adopted by the agency shall encourage the
  950  development of homelike facilities that promote the dignity,
  951  individuality, personal strengths, and decisionmaking ability of
  952  residents.
  953         (4) The agency may waive rules adopted under this part to
  954  demonstrate and evaluate innovative or cost-effective congregate
  955  care alternatives that enable individuals to age in place. Such
  956  waivers may be granted only in instances where there is
  957  reasonable assurance that the health, safety, or welfare of
  958  residents will not be endangered. To apply for a waiver, the
  959  licensee shall submit to the agency a written description of the
  960  concept to be demonstrated, including goals, objectives, and
  961  anticipated benefits; the number and types of residents who will
  962  be affected, if applicable; a brief description of how the
  963  demonstration will be evaluated; and any other information
  964  deemed appropriate by the agency. Any facility granted a waiver
  965  shall submit a report of findings to the agency within 12
  966  months. At such time, the agency may renew or revoke the waiver
  967  or pursue any regulatory or statutory changes necessary to allow
  968  other facilities to adopt the same practices. The agency may by
  969  rule clarify terms and establish waiver application procedures,
  970  criteria for reviewing waiver proposals, and procedures for
  971  reporting findings, as necessary to implement this subsection.
  972         (5) The agency may use an abbreviated biennial standard
  973  licensure inspection that consists of a review of key quality
  974  of-care standards in lieu of a full inspection in a facility
  975  that has a good record of past performance. However, a full
  976  inspection must be conducted in a facility that has a history of
  977  class I or class II violations;, uncorrected class III
  978  violations; or a class I, class II, or uncorrected class III
  979  violation resulting from a complaint referred by the State Long
  980  Term Care Ombudsman Program, confirmed ombudsman council
  981  complaints, or confirmed licensure complaints within the
  982  previous licensure period immediately preceding the inspection
  983  or if a potentially serious problem is identified during the
  984  abbreviated inspection. The agency shall adopt by rule develop
  985  the key quality-of-care standards with input from the State
  986  Long-Term Care Ombudsman Council and representatives of provider
  987  groups for incorporation into its rules.
  988         Section 11. Section 429.435, Florida Statutes, is created
  989  to read:
  990         429.435 Uniform firesafety standards.—Uniform firesafety
  991  standards for assisted living facilities, which are residential
  992  board and care occupancies, shall be established by the State
  993  Fire Marshal pursuant to s. 633.206.
  994         (1)EVACUATION CAPABILITY.—A firesafety evacuation
  995  capability determination shall be conducted within 6 months
  996  after the date of initial licensure of an assisted living
  997  facility, if required.
  999         (a)The National Fire Protection Association, Life Safety
 1000  Code, NFPA 101 and 101A, current editions, must be used in
 1001  determining the uniform firesafety code adopted by the State
 1002  Fire Marshal for assisted living facilities, pursuant to s.
 1003  633.206.
 1004         (b)A local government or a utility may charge fees that do
 1005  not exceed the actual costs incurred by the local government or
 1006  the utility for the installation and maintenance of an automatic
 1007  fire sprinkler system in a licensed assisted living facility
 1008  structure.
 1009         (c)All licensed facilities must have an annual fire
 1010  inspection conducted by the local fire marshal or authority
 1011  having jurisdiction.
 1012         (d)An assisted living facility that was issued a building
 1013  permit or certificate of occupancy before July 1, 2016, at its
 1014  option and after notifying the authority having jurisdiction,
 1015  may remain under the provisions of the 1994 and 1995 editions of
 1016  the National Fire Protection Association, Life Safety Code, NFPA
 1017  101 and 101A. A facility opting to remain under such provisions
 1018  may make repairs, modernizations, renovations, or additions to,
 1019  or rehabilitate, the facility in compliance with NFPA 101, 1994
 1020  edition, and may utilize the alternative approaches to life
 1021  safety in compliance with NFPA 101A, 1995 edition. However, a
 1022  facility for which a building permit or certificate of occupancy
 1023  was issued before July 1, 2016, which undergoes Level III
 1024  building alteration or rehabilitation, as defined in the Florida
 1025  Building Code, or which seeks to utilize features not authorized
 1026  under the 1994 or 1995 editions of the Life Safety Code, shall
 1027  thereafter comply with all aspects of the uniform firesafety
 1028  standards established under s. 633.206 and the Florida Fire
 1029  Prevention Code in effect for assisted living facilities as
 1030  adopted by the State Fire Marshal.
 1031         Section 12. Section 429.52, Florida Statutes, is amended to
 1032  read:
 1033         429.52 Staff training and educational requirements
 1034  programs; core educational requirement.—
 1035         (1) Effective October 1, 2015, Each new assisted living
 1036  facility employee who has not previously completed core training
 1037  must attend a preservice orientation provided by the facility
 1038  before interacting with residents. The preservice orientation
 1039  must be at least 2 hours in duration and cover topics that help
 1040  the employee provide responsible care and respond to the needs
 1041  of facility residents. Upon completion, the employee and the
 1042  administrator of the facility must sign a statement that the
 1043  employee completed the required preservice orientation. The
 1044  facility must keep the signed statement in the employee’s
 1045  personnel record.
 1046         (2) Administrators and other assisted living facility staff
 1047  must meet minimum training and education requirements
 1048  established by the agency by rule. This training and education
 1049  is intended to assist facilities to appropriately respond to the
 1050  needs of residents, to maintain resident care and facility
 1051  standards, and to meet licensure requirements.
 1052         (3) The agency, in conjunction with providers, shall
 1053  develop core training requirements for administrators consisting
 1054  of core training learning objectives, a competency test, and a
 1055  minimum required score to indicate successful passage completion
 1056  of the core competency test training and educational
 1057  requirements. The required core competency test training and
 1058  education must cover at least the following topics:
 1059         (a) State law and rules relating to assisted living
 1060  facilities.
 1061         (b) Resident rights and identifying and reporting abuse,
 1062  neglect, and exploitation.
 1063         (c) Special needs of elderly persons, persons with mental
 1064  illness, and persons with developmental disabilities and how to
 1065  meet those needs.
 1066         (d) Nutrition and food service, including acceptable
 1067  sanitation practices for preparing, storing, and serving food.
 1068         (e) Medication management, recordkeeping, and proper
 1069  techniques for assisting residents with self-administered
 1070  medication.
 1071         (f) Firesafety requirements, including fire evacuation
 1072  drill procedures and other emergency procedures.
 1073         (g) Care of persons with Alzheimer’s disease and related
 1074  disorders.
 1075         (4) A new facility administrator must complete the required
 1076  core training and education, including the competency test,
 1077  within 90 days after the date of employment as an administrator.
 1078  Failure to do so is a violation of this part and subjects the
 1079  violator to an administrative fine as prescribed in s. 429.19.
 1080  Administrators licensed in accordance with part II of chapter
 1081  468 are exempt from this requirement. Other licensed
 1082  professionals may be exempted, as determined by the agency by
 1083  rule.
 1084         (5) Administrators are required to participate in
 1085  continuing education for a minimum of 12 contact hours every 2
 1086  years.
 1087         (6) Staff involved with the management of medications and
 1088  assisting with the self-administration of medications under s.
 1089  429.256 must complete a minimum of 6 additional hours of
 1090  training provided by a registered nurse or, a licensed
 1091  pharmacist before providing assistance, or agency staff. Two
 1092  hours of continuing education are required annually thereafter.
 1093  The agency shall establish by rule the minimum requirements of
 1094  this additional training.
 1095         (7) Other Facility staff shall participate in in-service
 1096  training relevant to their job duties as specified by agency
 1097  rule of the agency. Topics covered during the preservice
 1098  orientation are not required to be repeated during in-service
 1099  training. A single certificate of completion that covers all
 1100  required in-service training topics may be issued to a
 1101  participating staff member if the training is provided in a
 1102  single training course.
 1103         (8) If the agency determines that there are problems in a
 1104  facility which could be reduced through specific staff training
 1105  or education beyond that already required under this section,
 1106  the agency may require, and provide, or cause to be provided,
 1107  the training or education of any personal care staff in the
 1108  facility.
 1109         (9) The agency shall adopt rules related to these training
 1110  and education requirements, the competency test, necessary
 1111  procedures, and competency test fees and shall adopt or contract
 1112  with another entity to develop and administer the competency
 1113  test. The agency shall adopt a curriculum outline with learning
 1114  objectives to be used by core trainers, which shall be used as
 1115  the minimum core training content requirements. The agency shall
 1116  consult with representatives of stakeholder associations and
 1117  agencies in the development of the curriculum outline.
 1118         (10) The core training required by this section other than
 1119  the preservice orientation must be conducted by persons
 1120  registered with the agency as having the requisite experience
 1121  and credentials to conduct the training. A person seeking to
 1122  register as a core trainer must provide the agency with proof of
 1123  completion of the minimum core training education requirements,
 1124  successful passage of the competency test established under this
 1125  section, and proof of compliance with the continuing education
 1126  requirement in subsection (5).
 1127         (11) A person seeking to register as a core trainer also
 1128  must also:
 1129         (a) Provide proof of completion of a 4-year degree from an
 1130  accredited college or university and must have worked in a
 1131  management position in an assisted living facility for 3 years
 1132  after being core certified;
 1133         (b) Have worked in a management position in an assisted
 1134  living facility for 5 years after being core certified and have
 1135  1 year of teaching experience as an educator or staff trainer
 1136  for persons who work in assisted living facilities or other
 1137  long-term care settings;
 1138         (c) Have been previously employed as a core trainer for the
 1139  agency or department; or
 1140         (d) Meet other qualification criteria as defined in rule,
 1141  which the agency is authorized to adopt.
 1142         (12) The agency shall adopt rules to establish core trainer
 1143  registration and removal requirements.
 1144         Section 13. This act shall take effect July 1, 2020.