Florida Senate - 2012         (Proposed Committee Bill) SPB 7174
       
       
       
       FOR CONSIDERATION By the Committee on Health Regulation
       
       
       
       
       588-01897A-12                                         20127174__
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 394.4574, F.S.; revising the duties of the
    4         case manager for, and the community living support
    5         plan of, a mental health resident of an assisted
    6         living facility; amending s. 400.0078, F.S.; requiring
    7         residents of long-term care facilities to be informed
    8         about the confidentiality of the subject matter and
    9         identify of the complainant of a complaint received by
   10         the State Long-Term Care Ombudsman Program; amending
   11         s. 415.1034, F.S.; adding certain employees or agents
   12         of a state or local agency to the list of persons who
   13         must report the known or suspected abuse of a
   14         vulnerable adult to the abuse hotline; amending s.
   15         429.02, F.S.; providing definitions for “board” and
   16         “mental health professional”; amending s. 429.07,
   17         F.S.; conforming a cross-reference; increasing the
   18         biennial license fee required for a facility that has
   19         certain violations within the 2 years preceding
   20         license renewal; amending s. 429.075, F.S.; revising
   21         the criteria preventing a licensed facility from
   22         receiving a limited mental health license; providing
   23         training requirements for administrators and staff
   24         members of facilities that hold a limited mental
   25         health license; requiring that a mental health
   26         professional be part of the team inspecting a facility
   27         that holds a limited mental health license; requiring
   28         quarterly monitoring of the facility; providing for an
   29         exception from quarterly monitoring; amending s.
   30         429.14, F.S.; requiring the revocation of a facility
   31         license for certain violations that result in the
   32         death of a resident; amending s. 429.17, F.S.;
   33         providing that a facility that has been cited for
   34         certain violations may not be issued a conditional
   35         license; amending s. 429.176, F.S.; requiring the
   36         licensure of facility administrators; providing
   37         administrator education, training, and examination
   38         requirements; providing exceptions; providing for
   39         inactive and provisional licenses; amending s.
   40         429.178, F.S.; revising training requirements for
   41         staff who provide care for persons with Alzheimer’s
   42         disease and related disorders; amending s. 429.19,
   43         F.S.; conforming provisions to changes made by the
   44         act; authorizing the Agency for Health Care
   45         Administration to impose an increased fine for certain
   46         violations that result in the death of a resident;
   47         amending s. 429.23, F.S.; requiring a facility to
   48         establish a risk management and quality assurance
   49         program; amending s. 429.256, F.S.; conforming a
   50         cross-reference; amending s. 429.28, F.S.; requiring
   51         residents of facilities to be informed about the
   52         confidentiality of the subject matter and identify of
   53         the resident and complainant of a complaint made to
   54         the State Long-Term Care Ombudsman Program; requiring
   55         the agency to conduct followup inspections of
   56         facilities that have a history of certain violations;
   57         providing that facility that terminates an
   58         individual’s residency will be fined if good cause is
   59         not shown in court; amending s. 429.34, F.S.;
   60         providing that the agency is designated as the central
   61         agency for receiving and tracking facility complaints;
   62         requiring the agency to have lead surveyors who
   63         specialize in assessing facilities; amending s.
   64         429.41, F.S.; requiring the agency to anonymously
   65         observe the elopement drills of a randomly selected
   66         group of facilities; authorizing the agency to require
   67         additional staffing for facilities that hold a
   68         specialty license; requiring the agency to conduct an
   69         abbreviated biennial licensure inspection; amending s.
   70         429.49, F.S.; increasing the criminal penalty for
   71         altering facility records; creating s. 429.515, F.S.;
   72         requiring new facility employees to attend a
   73         preservice orientation; providing requirements for
   74         such orientation; amending s. 429.52, F.S.; revising
   75         training and continuing education requirements for
   76         facility staff other than administrators; providing
   77         for the use of interactive online tutorials; creating
   78         s. 429.521, F.S.; providing training requirements for
   79         certain staff of facilities that hold an extended
   80         congregate care, limited nursing, and limited mental
   81         health license; providing for examinations;
   82         authorizing the Board of Assisted Living Facility
   83         Administration to adopt rules; creating s. 429.522,
   84         F.S.; requiring training providers to be certified by
   85         the board and provide trainer oversight; providing
   86         trainer requirements; requiring the board to maintain
   87         an electronic database of certified providers and
   88         persons who complete training if funding is available;
   89         creating s. 429.523, F.S.; providing for board
   90         approval of training and testing centers; providing
   91         approval criteria; amending s. 429.54, F.S.; requiring
   92         specified state agencies to have an electronic system
   93         of communication pertaining to the regulation of
   94         facilities; requiring facilities to submit certain
   95         facility and resident information electronically to
   96         the agency twice yearly; providing for the maintenance
   97         and use of such information; providing for expiration
   98         of this requirement; creating s. 429.55, F.S.;
   99         establishing the Board of Assisted Living Facility
  100         Administration in the agency; providing for
  101         membership; providing board duties including duties
  102         relating to administrator licensing and to
  103         administrator and facility staff training; providing
  104         board oversight over administrators including grounds
  105         for disciplinary action; authorizing the board to
  106         adopt certain rules; creating s. 429.56, F.S.;
  107         directing the agency to establish an online, user
  108         friendly facility rating system that may be accessed
  109         by the public; requiring the agency to create a task
  110         force to determine whether state agencies have
  111         overlapping regulatory jurisdiction over facilities
  112         and to submit findings and recommendations to the
  113         Governor and Legislature by a certain date; providing
  114         for termination; requiring the Office of the State
  115         Long-Term Care Ombudsman to create a task force to
  116         review the agency’s facility inspection forms and to
  117         submit its recommendations to the agency by a certain
  118         date; providing for termination; providing an
  119         effective date.
  120  
  121  Be It Enacted by the Legislature of the State of Florida:
  122  
  123         Section 1. Paragraph (e) of subsection (2) of section
  124  394.4574, Florida Statutes, is amended, and paragraph (f) is
  125  added to that subsection, to read:
  126         394.4574 Department responsibilities for a mental health
  127  resident who resides in an assisted living facility that holds a
  128  limited mental health license.—
  129         (2) The department must ensure that:
  130         (e) The mental health services provider assigns a case
  131  manager to each mental health resident who lives in an assisted
  132  living facility with a limited mental health license. The case
  133  manager is responsible for coordinating the development of and
  134  implementation of the community living support plan defined in
  135  s. 429.02. The plan must be updated as needed, but at least
  136  annually, to ensure that the ongoing needs of the resident are
  137  being addressed. Case managers must keep a record of the date
  138  and time of any face-to-face interaction with the mental health
  139  resident and make the record available to the department for
  140  inspection. The record must be retained for 2 years after the
  141  date of the last interaction.
  142         (f) There is adequate and consistent monitoring and
  143  enforcement of community living support plans and cooperative
  144  agreements by the department.
  145         Section 2. Subsection (2) of section 400.0078, Florida
  146  Statutes, is amended to read:
  147         400.0078 Citizen access to State Long-Term Care Ombudsman
  148  Program services.—
  149         (2) Every resident or representative of a resident shall
  150  receive, Upon admission to a long-term care facility, each
  151  resident or representative of a resident must receive
  152  information regarding the purpose of the State Long-Term Care
  153  Ombudsman Program, the statewide toll-free telephone number for
  154  receiving complaints, the confidentiality of the subject matter
  155  of a complaint and the complainant’s name and identity, and
  156  other relevant information regarding how to contact the program.
  157  Residents or their representatives must be furnished additional
  158  copies of this information upon request.
  159         Section 3. Paragraph (a) of subsection (1) of section
  160  415.1034, Florida Statutes, is amended to read:
  161         415.1034 Mandatory reporting of abuse, neglect, or
  162  exploitation of vulnerable adults; mandatory reports of death.—
  163         (1) MANDATORY REPORTING.—
  164         (a) Any person, including, but not limited to, any:
  165         1. A physician, osteopathic physician, medical examiner,
  166  chiropractic physician, nurse, paramedic, emergency medical
  167  technician, or hospital personnel engaged in the admission,
  168  examination, care, or treatment of vulnerable adults;
  169         2. A health professional or mental health professional
  170  other than one listed in subparagraph 1.;
  171         3. A practitioner who relies solely on spiritual means for
  172  healing;
  173         4. Nursing home staff; assisted living facility staff;
  174  adult day care center staff; adult family-care home staff;
  175  social worker; or other professional adult care, residential, or
  176  institutional staff;
  177         5. A state, county, or municipal criminal justice employee
  178  or law enforcement officer;
  179         6. An employee of the Department of Business and
  180  Professional Regulation conducting inspections of public lodging
  181  establishments under s. 509.032;
  182         7. A Florida advocacy council member or long-term care
  183  ombudsman council member; or
  184         8. A bank, savings and loan, or credit union officer,
  185  trustee, or employee; or
  186         9. An employee or agent of a state or local agency who has
  187  regulatory responsibilities over, or who provides services to,
  188  persons residing in a state-licensed facility,
  189  
  190  who knows, or has reasonable cause to suspect, that a vulnerable
  191  adult has been or is being abused, neglected, or exploited must
  192  shall immediately report such knowledge or suspicion to the
  193  central abuse hotline.
  194         Section 4. Subsections (5) and (11) of section 429.02,
  195  Florida Statutes, are amended, present subsections (6) through
  196  (14) of that section are redesignated as subsections (7) through
  197  (15), respectively, present subsections (15) through (26) of
  198  that section are redesignated as subsections (17) through (28),
  199  respectively, and new subsections (6) and (16) are added to that
  200  section, to read:
  201         429.02 Definitions.—When used in this part, the term:
  202         (5) “Assisted living facility” or “facility” means any
  203  building or buildings, section or distinct part of a building,
  204  private home, boarding home, home for the aged, or other
  205  residential facility, whether operated for profit or not, which
  206  undertakes through its ownership or management to provide
  207  housing, meals, and one or more personal services for a period
  208  exceeding 24 hours to one or more adults who are not relatives
  209  of the owner or administrator.
  210         (6) “Board” means the Board of Assisted Living Facility
  211  Administration established under s. 429.55.
  212         (12)(11) “Extended congregate care” means acts beyond those
  213  authorized in subsection (18) which (16) that may be performed
  214  pursuant to part I of chapter 464 by persons licensed thereunder
  215  while carrying out their professional duties, and other
  216  supportive services which may be specified by rule. The purpose
  217  of such services is to enable residents to age in place in a
  218  residential environment despite mental or physical limitations
  219  that might otherwise disqualify them from residency in a
  220  facility licensed under this part.
  221         (16) “Mental health professional” means a person licensed
  222  under chapter 458, chapter 459, chapter 464, chapter 490, or
  223  chapter 491 who provides mental health services as defined in s.
  224  394.67, or an individual who has at least 5 years of experience
  225  providing services that improve an individual’s mental health or
  226  that treat mental illness.
  227         Section 5. Section 429.07, Florida Statutes, is amended to
  228  read:
  229         429.07 Facility license required; fee.—
  230         (1) The requirements of part II of chapter 408 apply to the
  231  provision of services that require licensure pursuant to this
  232  part and part II of chapter 408 and to entities licensed by or
  233  applying for such licensure from the agency pursuant to this
  234  part. A license issued by the agency is required in order to
  235  operate an assisted living facility in this state.
  236         (2) Separate licenses are shall be required for facilities
  237  maintained in separate premises, even though operated under the
  238  same management. A separate license is shall not be required for
  239  separate buildings on the same grounds.
  240         (3) In addition to the requirements of s. 408.806, each
  241  license granted by the agency must state the type of care for
  242  which the license is granted. Licenses shall be issued for one
  243  or more of the following categories of care: standard, extended
  244  congregate care, limited nursing services, or limited mental
  245  health.
  246         (a) A standard license shall be issued to facilities
  247  providing one or more of the personal services identified in s.
  248  429.02. Such facilities may also employ or contract with a
  249  person licensed under part I of chapter 464 to administer
  250  medications and perform other tasks as specified in s. 429.255.
  251         (b) An extended congregate care license shall be issued to
  252  facilities providing, directly or through contract, services
  253  beyond those authorized in paragraph (a), including services
  254  performed by persons licensed under part I of chapter 464 and
  255  supportive services, as defined by rule, to persons who would
  256  otherwise be disqualified from continued residence in a facility
  257  licensed under this part.
  258         1. In order for extended congregate care services to be
  259  provided, the agency must first determine that all requirements
  260  established in law and rule are met and must specifically
  261  designate, on the facility’s license, that such services may be
  262  provided and whether the designation applies to all or part of
  263  the facility. Such designation may be made at the time of
  264  initial licensure or relicensure, or upon request in writing by
  265  a licensee under this part and part II of chapter 408. The
  266  notification of approval or the denial of the request shall be
  267  made in accordance with part II of chapter 408. Existing
  268  facilities qualifying to provide extended congregate care
  269  services must have maintained a standard license and may not
  270  have been subject to administrative sanctions during the
  271  previous 2 years, or since initial licensure if the facility has
  272  been licensed for less than 2 years, for any of the following
  273  reasons:
  274         a. A class I or class II violation;
  275         b. Three or more repeat or recurring class III violations
  276  of identical or similar resident care standards from which a
  277  pattern of noncompliance is found by the agency;
  278         c. Three or more class III violations that were not
  279  corrected in accordance with the corrective action plan approved
  280  by the agency;
  281         d. Violation of resident care standards which results in
  282  requiring the facility to employ the services of a consultant
  283  pharmacist or consultant dietitian;
  284         e. Denial, suspension, or revocation of a license for
  285  another facility licensed under this part in which the applicant
  286  for an extended congregate care license has at least 25 percent
  287  ownership interest; or
  288         f. Imposition of a moratorium pursuant to this part or part
  289  II of chapter 408 or initiation of injunctive proceedings.
  290         2. A facility that is licensed to provide extended
  291  congregate care services must shall maintain a written progress
  292  report on each person who receives services which describes the
  293  type, amount, duration, scope, and outcome of services that are
  294  rendered and the general status of the resident’s health. A
  295  registered nurse, or appropriate designee, representing the
  296  agency shall visit the facility at least quarterly to monitor
  297  residents who are receiving extended congregate care services
  298  and to determine if the facility is in compliance with this
  299  part, part II of chapter 408, and relevant rules. One of the
  300  visits may be in conjunction with the regular survey. The
  301  monitoring visits may be provided through contractual
  302  arrangements with appropriate community agencies. A registered
  303  nurse shall serve as part of the team that inspects the
  304  facility. The agency may waive one of the required yearly
  305  monitoring visits for a facility that has been licensed for at
  306  least 24 months to provide extended congregate care services,
  307  if, during the inspection, the registered nurse determines that
  308  extended congregate care services are being provided
  309  appropriately, and if the facility has no class I or class II
  310  violations and no uncorrected class III violations. The agency
  311  must first consult with the long-term care ombudsman council for
  312  the area in which the facility is located to determine if any
  313  complaints have been made and substantiated about the quality of
  314  services or care. The agency may not waive one of the required
  315  yearly monitoring visits if complaints have been made and
  316  substantiated.
  317         3. A facility that is licensed to provide extended
  318  congregate care services must:
  319         a. Demonstrate the capability to meet unanticipated
  320  resident service needs.
  321         b. Offer a physical environment that promotes a homelike
  322  setting, provides for resident privacy, promotes resident
  323  independence, and allows sufficient congregate space as defined
  324  by rule.
  325         c. Have sufficient staff available, taking into account the
  326  physical plant and firesafety features of the building, to
  327  assist with the evacuation of residents in an emergency.
  328         d. Adopt and follow policies and procedures that maximize
  329  resident independence, dignity, choice, and decisionmaking in
  330  order to permit residents to age in place, so that moves due to
  331  changes in functional status are minimized or avoided.
  332         e. Allow residents or, if applicable, a resident’s
  333  representative, designee, surrogate, guardian, or attorney in
  334  fact to make a variety of personal choices, participate in
  335  developing service plans, and share responsibility in
  336  decisionmaking.
  337         f. Implement the concept of managed risk.
  338         g. Provide, directly or through contract, the services of a
  339  person licensed under part I of chapter 464.
  340         h. In addition to the training mandated under s. 429.55 in
  341  s. 429.52, provide specialized training as defined by rule for
  342  facility staff.
  343         4. A facility that is licensed to provide extended
  344  congregate care services is exempt from the criteria for
  345  continued residency set forth in rules adopted under s. 429.41.
  346  A licensed facility must adopt its own requirements within
  347  guidelines for continued residency set forth by rule. However,
  348  the facility may not serve residents who require 24-hour nursing
  349  supervision. A licensed facility that provides extended
  350  congregate care services must also provide each resident with a
  351  written copy of facility policies governing admission and
  352  retention.
  353         5. The primary purpose of extended congregate care services
  354  is to allow residents, as they become more impaired, the option
  355  of remaining in a familiar setting from which they would
  356  otherwise be disqualified for continued residency. A facility
  357  licensed to provide extended congregate care services may also
  358  admit an individual who exceeds the admission criteria for a
  359  facility with a standard license, if the individual is
  360  determined appropriate for admission to the extended congregate
  361  care facility.
  362         6. Before the admission of an individual to a facility
  363  licensed to provide extended congregate care services, the
  364  individual must undergo a medical examination as provided in s.
  365  429.26(4) and the facility must develop a preliminary service
  366  plan for the individual.
  367         7. If When a facility can no longer provide or arrange for
  368  services in accordance with the resident’s service plan and
  369  needs and the facility’s policy, the facility must shall make
  370  arrangements for relocating the person in accordance with s.
  371  429.28(1)(k).
  372         8. Failure to provide extended congregate care services may
  373  result in denial of extended congregate care license renewal.
  374         (c) A limited nursing services license shall be issued to a
  375  facility that provides services beyond those authorized in
  376  paragraph (a) and as specified in this paragraph.
  377         1. In order for limited nursing services to be provided in
  378  a facility licensed under this part, the agency must first
  379  determine that all requirements established in law and rule are
  380  met and must specifically designate, on the facility’s license,
  381  that such services may be provided. Such designation may be made
  382  at the time of initial licensure or relicensure, or upon request
  383  in writing by a licensee under this part and part II of chapter
  384  408. Notification of approval or denial of such request shall be
  385  made in accordance with part II of chapter 408. Existing
  386  facilities qualifying to provide limited nursing services shall
  387  have maintained a standard license and may not have been subject
  388  to administrative sanctions that affect the health, safety, and
  389  welfare of residents for the previous 2 years or since initial
  390  licensure if the facility has been licensed for less than 2
  391  years.
  392         2. Facilities that are licensed to provide limited nursing
  393  services shall maintain a written progress report on each person
  394  who receives such nursing services, which report describes the
  395  type, amount, duration, scope, and outcome of services that are
  396  rendered and the general status of the resident’s health. A
  397  registered nurse representing the agency shall visit such
  398  facilities at least twice a year to monitor residents who are
  399  receiving limited nursing services and to determine if the
  400  facility is in compliance with applicable provisions of this
  401  part, part II of chapter 408, and related rules. The monitoring
  402  visits may be provided through contractual arrangements with
  403  appropriate community agencies. A registered nurse shall also
  404  serve as part of the team that inspects such facility.
  405         3. A person who receives limited nursing services under
  406  this part must meet the admission criteria established by the
  407  agency for assisted living facilities. When a resident no longer
  408  meets the admission criteria for a facility licensed under this
  409  part, arrangements for relocating the person shall be made in
  410  accordance with s. 429.28(1)(k), unless the facility is licensed
  411  to provide extended congregate care services.
  412         (4) In accordance with s. 408.805, an applicant or licensee
  413  shall pay a fee for each license application submitted under
  414  this part, part II of chapter 408, and applicable rules. The
  415  amount of the fee shall be established by rule.
  416         (a) The biennial license fee required of a facility is $300
  417  per license, plus with an additional fee of $50 per resident
  418  based on the total licensed resident capacity of the facility,
  419  except that an no additional fee may not will be assessed for
  420  beds designated for recipients of optional state supplementation
  421  payments provided under for in s. 409.212. The total fee may not
  422  exceed $10,000. However, the biennial license fee for a licensed
  423  facility that has one or more class I or class II violations
  424  within the 2 years before licensure renewal is $500 per license,
  425  plus an additional fee of $55 per resident based on the total
  426  licensed resident capacity of the facility. The total fee for
  427  such facilities may not exceed $15,000.
  428         (b) In addition to the total fee assessed under paragraph
  429  (a), the agency shall require facilities that are licensed to
  430  provide extended congregate care services under this part to pay
  431  an additional fee per licensed facility. The amount of the
  432  biennial fee shall be $400 per license, with an additional fee
  433  of $10 per resident based on the total licensed resident
  434  capacity of the facility.
  435         (c) In addition to the total fee assessed under paragraph
  436  (a), the agency shall require facilities that are licensed to
  437  provide limited nursing services under this part to pay an
  438  additional fee per licensed facility. The amount of the biennial
  439  fee shall be $250 per license, with an additional fee of $10 per
  440  resident based on the total licensed resident capacity of the
  441  facility.
  442         (5) Counties or municipalities applying for licenses under
  443  this part are exempt from the payment of license fees.
  444         Section 6. Section 429.075, Florida Statutes, is amended to
  445  read:
  446         429.075 Limited mental health license.—An assisted living
  447  facility that serves a three or more mental health resident
  448  residents must obtain a limited mental health license.
  449         (1) To obtain a limited mental health license, a facility
  450  must hold a standard license as an assisted living facility and,
  451  must not have been subject to administrative sanctions during
  452  the previous 2 years, or since initial licensure if the facility
  453  has been licensed for less than 2 years, for any of the
  454  following reasons:
  455         (a) Two or more class I or class II violations;
  456         (b) Three or more repeat or recurring class III violations
  457  of identical or similar resident care standards from which a
  458  pattern of noncompliance is found by the agency;
  459         (c) Three or more class III violations that were not
  460  corrected in accordance with the facility’s corrective action
  461  plan approved by the agency;
  462         (d) A violation of resident care standards which resulted
  463  in requiring the facility to employ the consultant services of a
  464  licensed pharmacist or a registered or licensed dietitian under
  465  s. 429.42;
  466         (e) Denial, suspension, or revocation of a license for
  467  another facility licensed under this part in which the license
  468  applicant has at least a 25 percent ownership interest; or
  469         (f) Imposition of a moratorium pursuant to this part or
  470  part II of chapter 408 or initiation of injunctive proceedings
  471  any current uncorrected deficiencies or violations, and must
  472  ensure that, within 6 months after receiving a limited mental
  473  health license, the facility administrator and the staff of the
  474  facility who are in direct contact with mental health residents
  475  must complete training of no less than 6 hours related to their
  476  duties. Such designation
  477         (2) Licensure to provide services to mental health
  478  residents may be made at the time of initial licensure or
  479  relicensure or upon request in writing by a licensee under this
  480  part and part II of chapter 408. Notification of agency approval
  481  or denial of such request must shall be made in accordance with
  482  this part, part II of chapter 408, and applicable rules. This
  483  training will be provided by or approved by the Department of
  484  Children and Family Services.
  485         (3)(2) Facilities licensed to provide services to mental
  486  health residents shall provide appropriate supervision and
  487  staffing to provide for the health, safety, and welfare of such
  488  residents.
  489         (a) In addition to any other training or education
  490  requirements for employees of an assisted living facility, each
  491  administrator and staff member of the facility must meet the
  492  limited mental health training requirements set forth in s.
  493  429.521.
  494         (b) Effective July 1, 2012, an administrator of a facility
  495  that has a limited mental health licensee must, in addition to
  496  the educational requirements under s. 429.56, also have
  497  completed at least 6 semester credit hours of college-level
  498  coursework relating to mental health.
  499         (4)(3) A facility that holds has a limited mental health
  500  license must:
  501         (a) Have a copy of each mental health resident’s community
  502  living support plan and the cooperative agreement with the
  503  mental health care services provider. The support plan and the
  504  agreement may be combined.
  505         (b) Have documentation that is provided by the Department
  506  of Children and Family Services that each mental health resident
  507  has been assessed and determined to be able to live in the
  508  community in an assisted living facility with a limited mental
  509  health license.
  510         (c) Make the community living support plan available for
  511  inspection by the resident, the resident’s legal guardian, the
  512  resident’s health care surrogate, and other individuals who have
  513  a lawful basis for reviewing this document.
  514         (d) Assist the mental health resident in carrying out the
  515  activities identified in the individual’s community living
  516  support plan.
  517         (5)(4) A facility that holds with a limited mental health
  518  license may enter into a cooperative agreement with a private
  519  mental health provider. For purposes of the limited mental
  520  health license, the private mental health provider may act as
  521  the case manager.
  522         (6)A mental health professional shall serve as part of the
  523  team that inspects a facility that holds a mental health
  524  license. A mental health professional representing the agency
  525  shall visit the facility at least quarterly to monitor residents
  526  who are receiving limited mental health services and to
  527  determine if the facility is in compliance with this part, part
  528  II of chapter 408, and relevant rules. One of those visits may
  529  be in conjunction with the agency’s regular survey. The
  530  monitoring visits may be provided through a contractual
  531  arrangement with an appropriate community agency. The agency may
  532  waive one of the quarterly monitoring visits of a facility that
  533  has had a mental health license for at least 2 years if, during
  534  the inspection, the mental health professional determines that
  535  mental health services are being provided appropriately and the
  536  facility has had no class I or class II violation and no
  537  uncorrected class III violation. Before waiving a monitoring
  538  visit, the agency must first consult with a representative of
  539  the local long-term care ombudsman council for the area in which
  540  the facility is located to determine if any complaint has been
  541  made and substantiated regarding the quality of services or care
  542  provided at that facility. The agency may not waive one of the
  543  required monitoring visits if a complaint has been made and
  544  substantiated.
  545         Section 7. Subsection (4) of section 429.14, Florida
  546  Statutes, is amended to read:
  547         429.14 Administrative penalties.—
  548         (4) The agency shall deny or revoke the license of an
  549  assisted living facility that:
  550         (a) Has two or more class I or class II violations that are
  551  similar or identical to violations identified by the agency
  552  during a survey, inspection, monitoring visit, or complaint
  553  investigation occurring within the previous 2 years; or.
  554         (b) Committed a class I violation or any intentional or
  555  negligent act that caused the death of a resident.
  556         Section 8. Subsection (4) of section 429.17, Florida
  557  Statutes, is amended to read:
  558         429.17 Expiration of license; renewal; conditional
  559  license.—
  560         (4) In addition to the license categories available in s.
  561  408.808, a conditional license may be issued to an applicant for
  562  license renewal if the applicant fails to meet all standards and
  563  requirements for licensure. A conditional license must issued
  564  under this subsection shall be limited in duration to a specific
  565  period of time not to exceed 6 months, as determined by the
  566  agency, and shall be accompanied by an agency-approved plan of
  567  correction. An assisted living facility that has been cited for
  568  two or more class I violations within the previous 2 years may
  569  not be issued a conditional license.
  570         Section 9. Section 429.176, Florida Statutes, is amended to
  571  read:
  572         429.176 Notice of change of Administrator license.—
  573         (1) Effective July 1, 2013, an assisted living facility in
  574  the state may not operate unless it is under the management of
  575  an administrator who holds a currently valid license or
  576  provisional license as an assisted living facility
  577  administrator.
  578         (2) In order to be licensed as an assisted living facility
  579  administrator, an applicant must:
  580         (a) Be at least 21 years old;
  581         (b) Meet the educational requirements under this section;
  582         (c) Complete the core training and supplemental training
  583  developed by the board pursuant to s. 429.55(3)(b)7.-8.;
  584         (d) Pass a licensure examination with a minimum score of
  585  80;
  586         (e) Complete background screening pursuant to s. 429.174;
  587  and
  588         (f) Otherwise meet the requirements of this part.
  589         (3) Before licensure, the applicant must submit to the
  590  board proof that he or she is at least 21 years old and has a 4
  591  year baccalaureate degree that includes some coursework in
  592  health care, gerontology, or geriatrics; a 4-year baccalaureate
  593  degree and at least 2 years of experience in direct patient care
  594  in an assisted living facility or nursing home; or a 2-year
  595  associate degree that includes coursework in health care,
  596  gerontology, or geriatrics and at least 2 years of experience in
  597  direct patient care in an assisted living facility or nursing
  598  home. The applicant must also submit a licensure fee established
  599  by the board by rule. The fee may not exceed $250 for the
  600  initial licensure or $250 for each biennial license renewal.
  601         (4) An assisted living facility administrator who is
  602  continuously employed as facility administrator for at least the
  603  2 years before July 1, 2012, is eligible for licensure without
  604  meeting the educational requirements of this section or taking
  605  the licensure examination if proof of compliance with the core
  606  training and educational requirements under this part is
  607  submitted to the board and the applicant was not the
  608  administrator of a facility that was cited for a class I or
  609  class II violation within the prior 2 years.
  610         (5) An administrator licensed in accordance with part II of
  611  chapter 468 is exempt from the core training requirements
  612  developed under s. 429.55(3)(b)7. Other licensed professionals
  613  may be exempted from some or all of the training requirements of
  614  this section, as determined by the board by rule.
  615         (6) If an applicant fails the licensure examination, the
  616  applicant must wait 10 days before retaking it. If an applicant
  617  fails the licensure examination three times, the applicant must
  618  retake the initial core and supplemental training before
  619  retaking the examination.
  620         (7) An administrator may not be an administrator of a
  621  facility that holds a limited mental health license unless the
  622  administrator meets the educational requirement under s.
  623  429.075(3).
  624         (8) A licensed administrator must complete a minimum of 18
  625  hours of continuing education every 2 years and pass a short
  626  test with a minimum score of 80 in order to document receipt and
  627  comprehension of the training. A passing score must be achieved
  628  before license renewal. The examination may be offered online.
  629  Any fees associated with the online service shall be borne by
  630  the participant.
  631         (9) An administrator may apply for inactive licensure
  632  status. An administrator’s license also becomes inactive if the
  633  administrator does not complete continuing education courses
  634  within the requisite time or if the administrator does not pay
  635  licensure renewal fees on time. The board may not reactivate a
  636  license unless the inactive or delinquent licensee has paid any
  637  applicable biennial renewal or delinquency fee, or both, and a
  638  reactivation fee.
  639         (a) The board shall adopt rules relating to application
  640  procedures for inactive status, for the renewal of inactive
  641  licenses, and for the reactivation of licenses.
  642         (b) The board shall prescribe by rule an application fee
  643  for inactive status, a renewal fee for inactive status, a
  644  delinquency fee, and a fee for the reactivation of a license.
  645  Such fees may not exceed the biennial renewal fee established by
  646  the board for an active license.
  647         (10) The board may establish requirements by rule for
  648  issuing a provisional assisted living facility administrator
  649  license. A provisional license shall be issued only to fill a
  650  position of an assisted living facility administrator which
  651  unexpectedly becomes vacant and shall be issued for only one
  652  single period as provided by rule, not to exceed 6 months. The
  653  board may not issue a provisional license to an applicant who is
  654  under investigation for, or has committed, an act in this state
  655  or another jurisdiction which would constitute a violation of s.
  656  429.55(4)(a). The provisional license may be issued to a person
  657  who does not meet all of the licensing requirements established
  658  by this part, but does meet minimal requirements established by
  659  board rule, to ensure protection of the public health, safety,
  660  and welfare. The provisional license shall be issued to the
  661  person who is designated as the responsible person next in
  662  command in the event of the administrator’s departure. The board
  663  may set an application fee not to exceed $500 for a provisional
  664  license.
  665         (11) If, during the period for which a standard license is
  666  issued, the facility owner changes administrators, the owner
  667  must notify the agency of the change within 10 days and provide
  668  documentation that the administrator is licensed or has been
  669  granted a provisional license within 90 days that the new
  670  administrator has completed the applicable core educational
  671  requirements under s. 429.52.
  672         Section 10. Paragraphs (a) and (b) of subsection (2) of
  673  section 429.178, Florida Statutes, are amended to read:
  674         429.178 Special care for persons with Alzheimer’s disease
  675  or other related disorders.—
  676         (2)(a) Staff members, including administrators, An
  677  individual who are is employed by a facility that provides
  678  special care for residents with Alzheimer’s disease or other
  679  related disorders, and who provide has regular or direct care to
  680  contact with such residents, must complete up to 4 hours of
  681  initial dementia-specific training developed or approved by the
  682  department. The training must shall be completed within 3 months
  683  after beginning employment and shall satisfy the core training
  684  requirements of s. 429.52(2)(g).
  685         (b) A direct caregiver who is employed by a facility that
  686  provides special care for residents with Alzheimer’s disease or
  687  other related disorders, and who provides direct care to such
  688  residents, must complete the required initial training and 4
  689  additional hours of training developed or approved by the
  690  department. The training must shall be completed within 6 months
  691  9 months after beginning employment and shall satisfy the core
  692  training requirements of s. 429.52(2)(g).
  693         Section 11. Subsections (1) and (2) of section 429.19,
  694  Florida Statutes, are amended to read:
  695         429.19 Violations; imposition of administrative fines;
  696  grounds.—
  697         (1) In addition to the requirements of part II of chapter
  698  408 and s. 429.28(6), the agency shall impose an administrative
  699  fine in the manner provided under in chapter 120 for the
  700  violation of any provision of this part, part II of chapter 408,
  701  and applicable rules by an assisted living facility;, for the
  702  actions of any person subject to level 2 background screening
  703  under s. 408.809;, for the actions of any facility employee;, or
  704  for an intentional or negligent act seriously affecting the
  705  health, safety, or welfare of a resident of the facility.
  706         (2) Each violation of this part and adopted rules shall be
  707  classified according to the nature of the violation and the
  708  gravity of its probable effect on facility residents as provided
  709  in s. 408.813.
  710         (a) The agency shall indicate the classification on the
  711  written notice of the violation as follows:
  712         1.(a)For class “I” violations, are defined in s. 408.813.
  713  the agency shall impose an administrative fine for a cited class
  714  I violation in an amount not less than $5,000 and not exceeding
  715  $10,000 for each violation.
  716         2.(b)For class “II” violations, are defined in s. 408.813.
  717  the agency shall impose an administrative fine for a cited class
  718  II violation in an amount not less than $1,000 and not exceeding
  719  $5,000 for each violation.
  720         3.(c)For class “III” violations, are defined in s.
  721  408.813. the agency shall impose an administrative fine for a
  722  cited class III violation in an amount not less than $500 and
  723  not exceeding $1,000 for each violation.
  724         4.(d)For class “IV” violations, are defined in s. 408.813.
  725  the agency shall impose an administrative fine for a cited class
  726  IV violation in an amount not less than $100 and not exceeding
  727  $200 for each violation.
  728         (b) The agency shall impose the maximum penalty for the
  729  class of violation which results in the death of a resident. If
  730  the facility is cited for a second or subsequent violation that
  731  is in the same class as a prior violation that the facility has
  732  been cited for at, or since, the last inspection, the agency
  733  shall double the fine for the second or subsequent violation
  734  even if the fine exceeds the maximum amount authorized.
  735  Notwithstanding s. 408.813(c) and (d), the agency shall impose a
  736  fine for a class III or class IV violation.
  737         Section 12. Subsection (1) of section 429.23, Florida
  738  Statutes, is amended to read:
  739         429.23 Internal risk management and quality assurance
  740  program; adverse incidents and reporting requirements.—
  741         (1) As part of its administrative functions, an assisted
  742  living Every facility licensed under this part shall may, as
  743  part of its administrative functions, voluntarily establish a
  744  risk management and quality assurance program, the purpose of
  745  which is to assess resident care practices, facility incident
  746  reports, deficiencies cited by the agency, adverse incident
  747  reports, and resident grievances and develop plans of action to
  748  correct and respond quickly to identify quality differences.
  749         Section 13. Paragraph (b) of subsection (1) of section
  750  429.256, Florida Statutes, is amended to read:
  751         429.256 Assistance with self-administration of medication.—
  752         (1) For the purposes of this section, the term:
  753         (b) “Unlicensed person” means an individual not currently
  754  licensed to practice nursing or medicine who is employed by or
  755  under contract to an assisted living facility and who has
  756  received training with respect to assisting with the self
  757  administration of medication in an assisted living facility, as
  758  provided under s. 429.521, before 429.52 prior to providing such
  759  assistance as described in this section.
  760         Section 14. Subsection (2), paragraph (d) of subsection
  761  (3), and subsection (6) of section 429.28, Florida Statutes, are
  762  amended to read:
  763         429.28 Resident bill of rights.—
  764         (2) The administrator of a facility shall ensure that a
  765  written notice of the rights, obligations, and prohibitions set
  766  forth in this part is posted in a prominent place in each
  767  facility and read or explained to residents who cannot read. The
  768  This notice must shall include the name, address, and telephone
  769  numbers of the local ombudsman council and central abuse hotline
  770  and, if when applicable, the Advocacy Center for Persons with
  771  Disabilities, Inc., and the Florida local advocacy council,
  772  where complaints may be lodged. The notice must state that the
  773  subject matter of a complaint made to the Office of State Long
  774  Term Care Ombudsman or a local long-term care ombudsman council
  775  and the names and identities of the residents involved in the
  776  complaint and the complainants are confidential pursuant to s.
  777  400.0077. The facility must ensure a resident’s access to a
  778  telephone to call the local ombudsman council, central abuse
  779  hotline, Advocacy Center for Persons with Disabilities, Inc.,
  780  and the Florida local advocacy council.
  781         (3)
  782         (d) The agency shall conduct periodic followup inspections
  783  to monitor the compliance of facilities having a history of
  784  class I violations that threaten the health, safety, or security
  785  of residents and may conduct periodic followup inspections as
  786  necessary to monitor the compliance of facilities having with a
  787  history of any class I, class II, or class III violations that
  788  threaten the health, safety, or security of residents.
  789         (6) A Any facility that which terminates the residency of
  790  an individual who participated in activities specified in
  791  subsection (5) must shall show good cause in a court of
  792  competent jurisdiction. If good cause is not shown, the agency
  793  shall impose a fine of $2,500 in addition to any other penalty
  794  assessed against the facility.
  795         Section 15. Section 429.34, Florida Statutes, is amended to
  796  read:
  797         429.34 Right of entry and inspection.—
  798         (1) In addition to the requirements of s. 408.811, a any
  799  duly designated officer or employee of the department, the
  800  Department of Children and Family Services, the Medicaid Fraud
  801  Control Unit of the Office of the Attorney General, the state or
  802  local fire marshal, or a member of the state or local long-term
  803  care ombudsman council may shall have the right to enter
  804  unannounced upon and into the premises of any facility licensed
  805  pursuant to this part in order to determine the state of
  806  compliance with the provisions of this part, part II of chapter
  807  408, and applicable rules. Data collected by the state or local
  808  long-term care ombudsman councils or the state or local advocacy
  809  councils may be used by the agency in investigations involving
  810  violations of regulatory standards.
  811         (2) The agency is designated the central agency for
  812  receiving and tracking complaints to ensure that allegations
  813  regarding facilities are timely responded to and that licensure
  814  enforcement action is initiated if warranted. Any other state
  815  agency regulating, or providing services to residents of,
  816  assisted living facilities must report any allegations or
  817  complaints that have been substantiated or are likely to have
  818  occurred to the agency as soon as reasonably possible.
  819         (3) The agency shall have lead surveyors in each field
  820  office who specialize in assessing assisted living facilities.
  821  The lead surveyors shall provide initial and ongoing training to
  822  surveyors who will be inspecting and monitoring facilities. The
  823  lead surveyors shall ensure that consistent inspection and
  824  monitoring assessments are conducted.
  825         (4) The agency shall have one statewide lead surveyor who
  826  specializes in assisted living facility inspections. The lead
  827  surveyor shall coordinate communication between lead surveyors
  828  of assisted living facilities throughout the state and ensure
  829  statewide consistency in applying facility inspection laws and
  830  rules.
  831         Section 16. Paragraph (l) of subsection (1) subsections (2)
  832  and (5) of section 429.41, Florida Statutes, are amended to
  833  read:
  834         429.41 Rules establishing standards.—
  835         (1) It is the intent of the Legislature that rules
  836  published and enforced pursuant to this section shall include
  837  criteria by which a reasonable and consistent quality of
  838  resident care and quality of life may be ensured and the results
  839  of such resident care may be demonstrated. Such rules shall also
  840  ensure a safe and sanitary environment that is residential and
  841  noninstitutional in design or nature. It is further intended
  842  that reasonable efforts be made to accommodate the needs and
  843  preferences of residents to enhance the quality of life in a
  844  facility. The agency, in consultation with the department, may
  845  adopt rules to administer the requirements of part II of chapter
  846  408. In order to provide safe and sanitary facilities and the
  847  highest quality of resident care accommodating the needs and
  848  preferences of residents, the department, in consultation with
  849  the agency, the Department of Children and Family Services, and
  850  the Department of Health, shall adopt rules, policies, and
  851  procedures to administer this part, which must include
  852  reasonable and fair minimum standards in relation to:
  853         (l) The establishment of specific policies and procedures
  854  on resident elopement. Facilities shall conduct a minimum of two
  855  resident elopement drills each year. All administrators and
  856  direct care staff shall participate in the drills. Facilities
  857  shall document the drills. Facilities shall notify the agency at
  858  least 15 calendar days before conducting the two drills. Each
  859  calendar year, the agency shall randomly select 10 percent of
  860  the licensed facilities and have an agency employee attend and
  861  observe a resident elopement drill at each of the selected
  862  facilities. Such attendance must be unannounced. If the employee
  863  observes an elopement drill that does not meet standards
  864  established by rule, the agency shall provide notice of the
  865  deficiencies to the facility within 15 calendar days after the
  866  drill. The facility shall submit a corrective action plan to the
  867  agency within 30 calendar days after receiving such notice.
  868         (2) In adopting any rules pursuant to this part, the
  869  department, in conjunction with the agency, shall make distinct
  870  standards for facilities based upon facility size; the types of
  871  care provided; the physical and mental capabilities and needs of
  872  residents; the type, frequency, and amount of services and care
  873  offered; and the staffing characteristics of the facility. Rules
  874  developed pursuant to this section may shall not restrict the
  875  use of shared staffing and shared programming in facilities that
  876  are part of retirement communities that provide multiple levels
  877  of care and otherwise meet the requirements of law and rule. The
  878  department may require additional staffing for facilities that
  879  have specialty licenses, but the additional staffing must
  880  correlate with the number of residents receiving special care
  881  and the type of special care required. Except for uniform
  882  firesafety standards, the department shall adopt by rule
  883  separate and distinct standards for facilities with 16 or fewer
  884  beds and for facilities with 17 or more beds. The standards for
  885  facilities with 16 or fewer beds must shall be appropriate for a
  886  noninstitutional residential environment if, provided that the
  887  structure is no more than two stories in height and all persons
  888  who cannot exit the facility unassisted in an emergency reside
  889  on the first floor. The department, in conjunction with the
  890  agency, may make other distinctions among types of facilities as
  891  necessary to enforce the provisions of this part. If Where
  892  appropriate, the agency shall offer alternate solutions for
  893  complying with established standards, based on distinctions made
  894  by the department and the agency relative to the physical
  895  characteristics of facilities and the types of care offered
  896  therein.
  897         (5) In order to allocate resources efficiently, the agency
  898  shall conduct may use an abbreviated biennial standard licensure
  899  inspection that consists of a review of key quality-of-care
  900  standards in lieu of a full inspection in a facility that has a
  901  good record of past performance. However, a full inspection must
  902  be conducted in a facility that has a history of class I or
  903  class II violations, uncorrected class III violations, confirmed
  904  ombudsman council complaints, or confirmed licensure complaints,
  905  within the previous licensure period immediately preceding the
  906  inspection or if a potentially serious problem is identified
  907  during the abbreviated inspection. The agency, in consultation
  908  with the department, shall develop the key quality-of-care
  909  standards with input from the State Long-Term Care Ombudsman
  910  Council and representatives of provider groups for incorporation
  911  into its rules.
  912         Section 17. Subsection (1) of section 429.49, Florida
  913  Statutes, is amended to read:
  914         429.49 Resident records; penalties for alteration.—
  915         (1) Any person who fraudulently alters, defaces, or
  916  falsifies any medical or other record of an assisted living
  917  facility, or causes or procures any such offense to be
  918  committed, commits a misdemeanor of the first second degree,
  919  punishable as provided in s. 775.082 or s. 775.083.
  920         Section 18. Section 429.515, Florida Statutes, is created
  921  to read:
  922         429.515Preservice orientation.—
  923         (1) Effective July 1, 2012, a new employee, including an
  924  administrator, of an assisted living facility must attend a
  925  preservice orientation provided by the facility which covers
  926  topics that will enable the employee to relate and respond to
  927  the residents of that facility. The orientation must be for at
  928  least 2 hours and, at a minimum, cover the following topics:
  929         (a) Care of persons who have Alzheimer’s disease or other
  930  related disorders.
  931         (b) Deescalation techniques.
  932         (c) Aggression control.
  933         (d) Elopement prevention.
  934         (e) Behavior management.
  935         (2)Upon completion of the preservice orientation, the
  936  employee must sign an affidavit, under penalty of perjury,
  937  stating that the employee completed the orientation. The
  938  administrator of the facility must maintain the signed affidavit
  939  in the employee’s work file.
  940         Section 19. Section 429.52, Florida Statutes, is amended to
  941  read:
  942         (Substantial rewording of section. See
  943         s. 429.52, F.S., for present text.)
  944         429.52Staff member training; tutorial; continuing
  945  education.—
  946         (1) Staff members, other than administrators, providing
  947  regular or direct care to residents must complete a staff
  948  training curriculum, developed by the board under s.
  949  429.55(3)(e). The training must be completed within 30 days
  950  after employment and is in addition to the preservice
  951  orientation required under s. 429.515. Any cost or fee
  952  associated with the training shall be borne by the participant.
  953         (2) Staff members, other than administrators, providing
  954  regular or direct care to residents must complete an interactive
  955  online tutorial that demonstrates an understanding of the
  956  training received under subsection (1). Staff members shall
  957  receive a certificate of completion upon completing the
  958  tutorial. The certificate must be maintained in the employee’s
  959  work file.
  960         (3) Staff members, other than administrators, providing
  961  regular or direct care to residents must participate in a
  962  minimum of 8 hours of continuing education every 2 years. The
  963  continuing education may be offered through online courses and
  964  any fee associated with the online service shall be borne by the
  965  participant.
  966         Section 20. Section 429.521, Florida Statutes, is created
  967  to read:
  968         429.521Specialty training and education; examinations.—
  969         (1) Administrators and staff members who provide regular or
  970  direct care to residents of a facility that holds an extended
  971  congregate care license must complete a minimum of 6 hours of
  972  board-approved extended congregate care training within 30 days
  973  after beginning employment.
  974         (2) Administrators employed by a facility that holds a
  975  limited nursing services license must complete a minimum of 4
  976  hours of board-approved courses that train and educate
  977  administrators on the special needs and care of those requiring
  978  limited nursing services. The training must be completed within
  979  30 days after employment.
  980         (3) Staff, including administrators, who prepare or serve
  981  food must receive a minimum of 1 hour of inservice training in
  982  safe food handling practices within 30 days after beginning
  983  employment.
  984         (4) Staff members, including administrators, must receive
  985  at least 1 hour of inservice training on the facility’s resident
  986  elopement response policies and procedures within 30 days after
  987  beginning employment.
  988         (a) A copy of the facility’s resident elopement response
  989  policies and procedures must be provided to staff members and
  990  the administrator.
  991         (b) Staff members and the administrator must demonstrate
  992  understanding and competency in the implementation of the
  993  elopement response policies and procedures.
  994         (5) Staff members who provide regular or direct care to
  995  mental health residents and administrators who are employed by
  996  facility that holds a limited mental health license must
  997  complete a minimum of 8 hours of board-approved mental health
  998  training within 30 days after beginning employment. Within 30
  999  days after completing such training, a staff member must
 1000  complete an online interactive tutorial related to the training
 1001  in order to demonstrate an understanding of the training
 1002  received. An administrator must pass an examination related to
 1003  the administrator’s training with a minimum score of 80. The
 1004  participant shall pay any fee associated with taking the
 1005  tutorial or examination.
 1006         (a) A staff member who cannot demonstrate an understanding
 1007  of the training received or an administrator who fails the
 1008  examination may not provide regular or direct care to residents
 1009  until he or she successfully completes the tutorial or passes
 1010  the examination.
 1011         (b) An administrator who does not pass the examination
 1012  within 6 months after completing the mental health training may
 1013  not be an administrator of a facility that holds a limited
 1014  mental health license until the administrator achieves a passing
 1015  score.
 1016         (6) Staff members, including the administrator, involved
 1017  with the management of medications and the assistance with self
 1018  administration of medications under s. 429.256 must complete a
 1019  minimum of 4 additional hours of training provided by a
 1020  registered nurse, licensed pharmacist, or department staff
 1021  member. The board shall establish by rule the minimum
 1022  requirements of this training, including continuing education
 1023  requirements.
 1024         (7)Other facility staff members shall participate in
 1025  training relevant to their job duties as specified by board
 1026  rule.
 1027         Section 21. Section 429.522, Florida Statutes, is created
 1028  to read:
 1029         429.522Core training providers; certification.—
 1030         (1) Effective January 1, 2013, an individual seeking to
 1031  provide core training in this state must be certified by the
 1032  board. The applicant must provide the board with proof of
 1033  completion of the minimum core training education requirements,
 1034  successful passage of the assisted living facility administrator
 1035  licensure examination, and proof of compliance with any
 1036  continuing education requirements.
 1037         (2) A person seeking to be certified as a trainer must
 1038  also:
 1039         (a) Provide proof of completion of a 4-year baccalaureate
 1040  degree from an accredited college or university and have worked
 1041  in a management position in an assisted living facility for 3
 1042  years after obtaining certification in core training courses;
 1043         (b) Have worked in a management position in an assisted
 1044  living facility for 5 years after obtaining certification in the
 1045  core training courses and have 1 year of teaching experience as
 1046  an educator or staff trainer for persons who work in an assisted
 1047  living facility or another long-term care setting;
 1048         (c) Have been previously employed as a trainer of core
 1049  training courses for the department;
 1050         (d) Have at least 5 years of employment with the agency as
 1051  a surveyor of assisted living facilities;
 1052         (e) Have at least 5 years of employment in a professional
 1053  position in the agency’s assisted living unit;
 1054         (f) Have at least 5 years of employment as an educator or
 1055  staff trainer for persons working in an assisted living facility
 1056  or another long-term care setting;
 1057         (g) Have at least 5 years of employment as a trainer of
 1058  core assisted living facility courses not directly associated
 1059  with the department;
 1060         (h) Have a 4-year baccalaureate degree from an accredited
 1061  college or university in the areas of health care, gerontology,
 1062  social work, education, or human services and at least 4 years
 1063  of experience as an educator or staff trainer for persons
 1064  working in an assisted living facility or another long-term care
 1065  setting after receiving certification in core courses; or
 1066         (i) Meet other qualification criteria as defined by rule of
 1067  the board.
 1068         (3)The board shall provide oversight of the core training
 1069  providers. The board shall adopt rules to establish requirements
 1070  for trainer certification, disciplinary action that may be taken
 1071  against a trainer, and a trainer decertification process.
 1072         (4) If funding is available, by January 1, 2013, the board
 1073  shall develop and maintain an electronic database, accessible to
 1074  the public, which lists all persons holding certification as a
 1075  core trainer, including any history of violations. Core trainers
 1076  shall keep a record of individuals who complete training and
 1077  shall submit the record to the board within 24 hours after the
 1078  completion of a course in order for the board to include the
 1079  information in the database.
 1080         Section 22. Section 429.523, Florida Statutes, is created
 1081  to read:
 1082         429.523Training and testing centers.—In addition to
 1083  certified trainers under s. 429.522, training and testing
 1084  centers approved by the board may conduct training and
 1085  examinations under this part.
 1086         (1) The board shall consider the following when reviewing a
 1087  center applicant:
 1088         (a)Whether the center will provide sufficient space for
 1089  training.
 1090         (b)The location of the center and whether another center
 1091  already provides core training or testing in the approximate
 1092  area.
 1093         (c)The fee to be charged by the center for providing such
 1094  services.
 1095         (d) Whether the center has sufficient staff who meet the
 1096  qualifications for core training providers under s. 429.522.
 1097         (e) Any other consideration that the board deems necessary
 1098  to approve a center.
 1099         (2) The board shall provide a certificate of approval to an
 1100  applicant that meets with the board’s approval. The training and
 1101  examination center shall keep the certificate on file as long as
 1102  it provides training and examination services.
 1103         (3) The board or the agency may inspect a center to
 1104  determine whether the training and examination center meets law
 1105  and rule requirements and may decertify a training and
 1106  examination center that does not continue to meet such
 1107  requirements.
 1108         Section 23. Section 429.54, Florida Statutes, is amended to
 1109  read:
 1110         429.54 Collection of information; local subsidy;
 1111  interagency communication; facility reporting.—
 1112         (1) To enable the department to collect the information
 1113  requested by the Legislature regarding the actual cost of
 1114  providing room, board, and personal care in assisted living
 1115  facilities, the department may is authorized to conduct field
 1116  visits and audits of facilities as may be necessary. The owners
 1117  of randomly sampled facilities shall submit such reports,
 1118  audits, and accountings of cost as the department may require by
 1119  rule; however, provided that such reports, audits, and
 1120  accountings may not be more than shall be the minimum necessary
 1121  to implement the provisions of this subsection section. Any
 1122  facility selected to participate in the study shall cooperate
 1123  with the department by providing cost of operation information
 1124  to interviewers.
 1125         (2) Local governments or organizations may contribute to
 1126  the cost of care of local facility residents by further
 1127  subsidizing the rate of state-authorized payment to such
 1128  facilities. Implementation of local subsidy shall require
 1129  departmental approval and may shall not result in reductions in
 1130  the state supplement.
 1131         (3) Subject to the availability of funds, the agency, the
 1132  department, the Department of Children and Family Services, and
 1133  the Agency for Persons with Disabilities shall develop or modify
 1134  electronic systems of communication among state-supported
 1135  automated systems to ensure that relevant information pertaining
 1136  to the regulation of assisted living facilities and facility
 1137  staff is timely and effectively communicated among agencies in
 1138  order to facilitate the protection of residents.
 1139         (4) All assisted living facilities shall submit twice a
 1140  year electronic reports to the agency.
 1141         (a) The reports must include the following information and
 1142  must be submitted in accordance with a reporting cycle
 1143  established by the agency by rule:
 1144         1. The number of beds in the facility;
 1145         2. The number of beds being occupied;
 1146         3. The number of residents who are younger than 65 years of
 1147  age, from 65 to 74 years of age, from 75 to 84 years of age, and
 1148  85 years of age or older;
 1149         4. The number of residents who are mental health residents,
 1150  who are receiving extended congregate care, who are receiving
 1151  limited nursing services, and who are receiving hospice care;
 1152         5. If there is a facility waiting list, the number of
 1153  individuals on the waiting list and the type of services or care
 1154  that they require, if known;
 1155         6. The number of residents receiving optional state
 1156  supplementation; and
 1157         7. The number of residents who are Medicaid recipients and
 1158  the type of waiver used to fund each such resident’s care.
 1159         (b) The agency may authorize a facility to submit a written
 1160  report in lieu of an electronic report if the facility provides
 1161  written notice at least 30 days before the date the report is
 1162  due that it cannot provide the report electronically. The notice
 1163  must provide the reason for noncompliance.
 1164         (c) The agency must maintain electronically the information
 1165  it receives and, at a minimum, use such information to track
 1166  trends in resident populations and needs.
 1167         (d) This subsection expires July 1, 2017.
 1168         Section 24. Section 429.55, Florida Statutes, is created to
 1169  read:
 1170         429.55Board of Assisted Living Facility Administration.—
 1171         (1) CREATION.—The Board of Assisted Living Facility
 1172  Administration is established within the agency, consisting of
 1173  nine members to be appointed by the Governor and confirmed by
 1174  the Senate for a term of 4 years or for the remainder of an
 1175  unexpired term following a vacancy.
 1176         (2) BOARD MEMBERSHIP.—
 1177         (a) Membership of the board shall include:
 1178         1. A representative from the Agency for Health Care
 1179  Administration.
 1180         2. A representative from the Department of Elderly Affairs.
 1181         3. A representative from the Department of Children and
 1182  Family Services.
 1183         4. A representative from the Agency for Persons with
 1184  Disabilities.
 1185         5. A representative from the Department of Health.
 1186         6. A representative from the Office of State Long-Term Care
 1187  Ombudsman.
 1188         7. A licensed assisted living facility administrator.
 1189         8. Two residents or family members of a resident.
 1190         (b) A person may not be appointed as a member of the board
 1191  if a conflict of interest exists, except that an assisted living
 1192  facility administrator who is appointed to the board may retain
 1193  a financial interest in the facility he or she administers at
 1194  the time of appointment.
 1195         (c) The board shall maintain its official headquarters in
 1196  Tallahassee.
 1197         (3) DUTIES.—The functions and duties of the board include:
 1198         (a) Adopting rules to administer the provisions of this
 1199  section which confer duties on the board.
 1200         (b) With regard to assisted living facility administrator
 1201  licensure:
 1202         1. Developing, imposing, and enforcing specific standards
 1203  that are designed to ensure that administrators are individuals
 1204  of good character and otherwise suitable and qualified to serve
 1205  as administrators by virtue of training or experience in the
 1206  field of health care facility administration.
 1207         2. Developing by appropriate techniques, including
 1208  investigations and examination, a method for determining whether
 1209  an applicant meets such standards.
 1210         3. Issuing licenses, including provisional licenses, to
 1211  qualified applicants meeting board standards and revoking or
 1212  suspending licenses previously issued by the board if the
 1213  licensee fails to substantially conform to the requirements of
 1214  such standards.
 1215         4. Establishing and carrying out procedures, adopted by
 1216  rule, which are designed to ensure that administrators comply
 1217  with and maintain standards adopted by the board.
 1218         5. Receiving, investigating, and taking appropriate action
 1219  with respect to any charge or complaint filed with the agency
 1220  alleging that an administrator failed to comply with the
 1221  requirements or standards adopted by the board.
 1222         6. Continually seeking to improve the standards imposed for
 1223  the licensure of administrators and the procedures and methods
 1224  for enforcing such standards.
 1225         7. Developing a core training curriculum, in consultation
 1226  with the agency, the department, and the Department of Children
 1227  and Family Services, to be completed by an applicant for
 1228  administrator licensure. The curriculum examination must include
 1229  at least 40 hours of training, be offered in English and
 1230  Spanish, be reviewed at least annually by the board, and be
 1231  updated as needed to reflect changes in the law, rules, and best
 1232  practices, and must, at a minimum, cover the following topics:
 1233         a. State law and rules relating to assisted living
 1234  facilities.
 1235         b. Resident rights and the identification and reporting of
 1236  abuse, neglect, and exploitation.
 1237         c. Special needs of elderly persons, persons who have
 1238  mental illness, and persons who have developmental disabilities
 1239  and how to meet those needs.
 1240         d. Nutrition and food service, including acceptable
 1241  sanitation practices for preparing, storing, and serving food.
 1242         e. Medication management, recordkeeping, and proper
 1243  techniques for assisting residents who self-administer
 1244  medication.
 1245         f. Firesafety requirements, including procedures for fire
 1246  evacuation drills and other emergency procedures.
 1247         g. Care of persons who have Alzheimer’s disease and related
 1248  disorders.
 1249         h. Elopement prevention.
 1250         i. Aggression and behavior management, deescalation
 1251  techniques, and proper protocols and procedures relating to the
 1252  Baker Act as provided in part I of chapter 394.
 1253         j. Do-not-resuscitate orders.
 1254         k. Infection control.
 1255         l. Admission and continued residency.
 1256         m. Phases of care and interacting with residents.
 1257         n. Best practices in the industry.
 1258         8. Developing a supplemental course consisting of at least
 1259  10 hours of training related to extended congregate care,
 1260  limited mental health, best practices, and business operations,
 1261  including, but not limited to, human resources, financial
 1262  management, and supervision of staff, to be completed by an
 1263  applicant for assisted living facility administrator licensure.
 1264         9. Developing an assisted living facility administrator
 1265  licensure examination in consultation with the agency, the
 1266  department, and the Department of Children and Family Services
 1267  which tests the applicant’s knowledge and training of the core
 1268  and supplemental topics listed in subparagraphs 7. and 8. The
 1269  examination must be offered in English and Spanish, reviewed at
 1270  least annually by the board, and updated as needed to reflect
 1271  changes in the law, rules, and best practices. A minimum score
 1272  of 80 is required to show successful completion of the training
 1273  requirements.
 1274         (c) Developing a limited mental health curriculum and
 1275  examination, in consultation with a panel of at least three
 1276  mental health professionals, which must be completed by an
 1277  administrator within 30 days after being employed by a limited
 1278  mental health licensee. The board must ensure that the
 1279  examination is available online, offer the examination in
 1280  English and Spanish, and update the examination as needed, but
 1281  at least annually. The board may establish a examination fee or
 1282  a fee may be charged by a testing service. The examination fee
 1283  may not exceed the cost of administering the examination.
 1284         (d) Developing a continuing education curriculum, in
 1285  consultation with the agency, the department, and the Department
 1286  of Children and Family Services, for administrators and for
 1287  staff members who provide regular and direct care to residents.
 1288  The board shall require additional credit hours for
 1289  administrators who are employed by extended congregate care,
 1290  limited nursing services, or limited mental health licensees.
 1291  The board must also develop a short test for administrators to
 1292  take upon completing the continuing education curriculum. The
 1293  board must review the continuing education curriculum and test
 1294  at least annually, and update the curriculum and examination as
 1295  needed to reflect changes in the law, rules, and best practices.
 1296  Continuing education must include topics similar to those of the
 1297  core training and inservice training in paragraph (e), and may
 1298  include additional subject matter that enhances the knowledge,
 1299  skills, and abilities of administrators and staff members, as
 1300  adopted by rule.
 1301         (e) Developing, in consultation with stakeholders, a
 1302  standardized staff training curriculum for staff members of an
 1303  assisted living facility, other than an administrator, who
 1304  provide regular or direct care to residents. Only staff members
 1305  hired on or after July 1, 2012, are subject to this training
 1306  requirement. The board may exempt from this training requirement
 1307  nurses, certified nursing assistants, and home health aides who
 1308  can demonstrate that they have already completed such training
 1309  or substantially similar training. The curriculum must include
 1310  at least 20 hours of inservice training, with at least 1 hour of
 1311  training per topic, covering at least the following topics:
 1312         1. Reporting major incidents.
 1313         2. Reporting adverse incidents.
 1314         3. Facility emergency procedures, including chain-of
 1315  command and staff member roles relating to emergency evacuation.
 1316         4.Resident rights in an assisted living facility.
 1317         5. Recognizing and reporting resident abuse, neglect, and
 1318  exploitation.
 1319         6. Resident behavior and needs.
 1320         7. Providing assistance with the activities of daily
 1321  living.
 1322         8. Infection control.
 1323         9. Aggression and behavior management and deescalation
 1324  techniques.
 1325         (f) Developing an interactive online tutorial, in
 1326  consultation with the agency, the department, the Department of
 1327  Children and Family Services, and stakeholders, which must be
 1328  completed by facility staff members who provide regular or
 1329  direct care to assisted living facility residents. The tutorial
 1330  must be based on the training required under paragraph (c). The
 1331  board must offer the tutorial in English and Spanish and update
 1332  the tutorial as needed, but at least annually. The board shall
 1333  provide a certificate to each staff member who completes the
 1334  tutorial.
 1335         (g) Requiring and providing, or causing to be provided, the
 1336  training or education of staff members of a facility beyond that
 1337  which is required under this part if the board or agency
 1338  determines that there are problems in a facility which could be
 1339  reduced through specific staff training or education.
 1340         (h) Approving testing and training centers.
 1341         (i) Certifying core training providers who meet the
 1342  qualifications under s. 429.522.
 1343         (4) DISCIPLINARY AUTHORITY OVER ADMINISTRATORS.—
 1344         (a) The board may deny licensure or license renewal and may
 1345  suspend or revoke the license of an administrator who is under
 1346  investigation for, or who has committed, in this state or
 1347  another jurisdiction, any of the following:
 1348         1. Practicing assisted living facility administration with
 1349  a revoked, suspended, inactive, or delinquent license.
 1350         2. Using the name or title “assisted living facility
 1351  administrator” if the person has not been licensed pursuant to
 1352  this part.
 1353         3. Presenting as his or her own the license of another.
 1354         4.Giving false or forged evidence to the board or a member
 1355  thereof for the purpose of obtaining a license.
 1356         5.Using or attempting to use an administrator’s license
 1357  that has been suspended or revoked.
 1358         6.Knowingly employing unlicensed persons in the practice
 1359  of assisted living facility administration.
 1360         7.Knowingly concealing information relative to violations
 1361  of this part.
 1362         8. Attempting to procure a license to practice assisted
 1363  living facility administration by bribery, fraudulent
 1364  misrepresentation, or through an error of the agency or the
 1365  board.
 1366         9.Having an license to practice assisted living facility
 1367  administration revoked, suspended, or otherwise acted against,
 1368  including the denial of licensure by the licensing authority of
 1369  another state, territory, or country.
 1370         10.Being convicted or found guilty of, or entered a plea
 1371  of nolo contendre, regardless of adjudication, to a crime in any
 1372  jurisdiction which relates to the practice of assisted living
 1373  facility administration.
 1374         11.Making or filing a report or record that the licensee
 1375  knows to be false, intentionally failing to file a report or
 1376  record required by state or federal law, willfully impeding or
 1377  obstructing such filing, or inducing another person to impede or
 1378  obstruct such filing. Such reports or records include only those
 1379  which are signed in the capacity of a licensed assisted living
 1380  facility administrator.
 1381         12.Advertising goods or services in a manner that is
 1382  fraudulent, false, deceptive, or misleading in form or content.
 1383         13.Committing fraud or deceit or exhibiting negligence,
 1384  incompetence, or misconduct in the practice of assisted living
 1385  facility administration.
 1386         14.Violating a lawful order of the board or agency
 1387  previously entered in a disciplinary hearing or failing to
 1388  comply with a lawfully issued subpoena of the board or agency.
 1389         15.Repeatedly acting in a manner that is inconsistent with
 1390  the health, safety, or welfare of the residents of the facility
 1391  in which he or she is the administrator.
 1392         16.Being unable to practice assisted living facility
 1393  administration with reasonable skill and safety to residents by
 1394  reason of illness, drunkenness, use of drugs, narcotics,
 1395  chemicals, or any other material or substance or as a result of
 1396  any mental or physical condition. To enforce this subparagraph,
 1397  upon a finding of the Secretary of Health Care Administration or
 1398  his or her designee that probable cause exists to believe that
 1399  the licensee is unable to serve as an assisted living facility
 1400  administrator due to the reasons stated in this subparagraph,
 1401  the agency may issue an order to compel the licensee to submit
 1402  to a mental or physical examination by a physician designated by
 1403  the agency. If the licensee refuses to comply with such order,
 1404  the order may be enforced by filing a petition for enforcement
 1405  in the circuit court where the licensee resides or serves as a
 1406  facility administrator. The licensee against whom the petition
 1407  is filed may not be named or identified by initials in any
 1408  public court records or documents and the proceedings shall be
 1409  closed to the public. The agency is entitled to the summary
 1410  procedure pursuant to s. 51.011. At reasonable intervals, the
 1411  licensee affected must be provided an opportunity to demonstrate
 1412  that he or she can resume the competent practice of assisted
 1413  living facility administration with reasonable skill and safety
 1414  to residents.
 1415         17.Paying, giving, causing to be paid or given, or
 1416  offering to pay or to give to any person a commission or other
 1417  valuable consideration for the solicitation or procurement,
 1418  directly or indirectly, of assisted living facility usage.
 1419         18.Willfully permitting unauthorized disclosure of
 1420  information relating to a resident or his or her records.
 1421         19. Discriminating with respect to residents, employees, or
 1422  staff members on account of race, religion, sex, or national
 1423  origin.
 1424         20. Violating any provision of this part, part II of
 1425  chapter 408, or rules adopted pursuant to this part.
 1426         (b) The board shall revoke the license of an administrator
 1427  who knowingly participates in intentional misconduct, or engages
 1428  in conduct that constitutes gross negligence, and contributes to
 1429  the death of a resident.
 1430         (5) RULEMAKING AND OTHER AUTHORITY.—
 1431         (a) The board may adopt rules related to education
 1432  requirements, training curricula, testing requirements, and
 1433  necessary procedures, forms, and fees.
 1434         (b) The board may consult with or contract with a service
 1435  provider to develop training and to provide online training,
 1436  testing, or tutorial services.
 1437         Section 25. Section 429.56, Florida Statutes, is created to
 1438  read:
 1439         429.56Assisted living facility rating system.—
 1440         (1) The agency, in consultation with the department, the
 1441  Department of Children and Family Services, and the Office of
 1442  State Long-Term Care Ombudsman, shall develop and adopt by rule
 1443  a user-friendly assisted living facility rating system.
 1444         (2) The rating system must be publicly available on the
 1445  Internet in order to assist consumers in evaluating assisted
 1446  living facilities and the services provided by such facilities.
 1447         (3) The rating system must be based on resident
 1448  satisfaction, the number and class of deficiencies for which the
 1449  facility has been cited, agency inspection reports, the
 1450  inspection reports of any other regulatory agency, assessments
 1451  conducted by the ombudsman program pursuant to part of chapter
 1452  400, and other criteria as determined by the agency.
 1453         (4) The Internet home page for the rating system must
 1454  include a link that allows consumers to complete a voluntary
 1455  survey that provides feedback on whether the rating system is
 1456  helpful and suggestions for improvement.
 1457         (5) The agency may adopt rules as necessary to administer
 1458  this section.
 1459         Section 26. Assisted living facility streamlining task
 1460  force.—
 1461         (1) The Agency for Health Care Administration shall create
 1462  a task force consisting of at least one representative from the
 1463  agency, the Department of Elderly Affairs, the Department of
 1464  Children and Family Services, the Department of Health, and the
 1465  Office of State Long-Term Care Ombudsman.
 1466         (2) The purpose of the task force is to determine whether
 1467  agencies currently have overlapping regulatory responsibilities
 1468  over assisted living facilities and whether increased efficiency
 1469  and effectiveness may be realized by transferring,
 1470  consolidating, eliminating, or modifying such oversight between
 1471  agencies.
 1472         (3) The task force shall meet at least three times and
 1473  submit a report to the Governor, the President of the Senate,
 1474  and the Speaker of the House of Representatives by January 1,
 1475  2013, which includes the task force’s findings and
 1476  recommendations pertaining to streamlining agency oversight and
 1477  improving the effectiveness of regulatory functions.
 1478         (4) The task force is terminated effective March 1, 2013.
 1479         Section 27. By January 1, 2013, the Agency for Health Care
 1480  Administration shall submit a copies of all of its inspection
 1481  forms used to inspect assisted living facilities to the Office
 1482  of State Long-Term Care Ombudsman. The office shall create and
 1483  act as the chair of a task force of up to 11 members, consisting
 1484  of an ombudsman, one representative of a nonprofit assisted
 1485  living facility, one representative of a for-profit assisted
 1486  living facility, at least one resident or family member of a
 1487  resident, other stakeholders, and one representative of the
 1488  agency, the Department of Elderly Affairs, the Department of
 1489  Children and Family Services, and the Department of Health, to
 1490  review the inspection forms. The task force shall provide
 1491  recommendations, if any, to modify the forms in order to ensure
 1492  that inspections adequately assess whether the assisted living
 1493  facilities are in compliance with the law, meet the needs of
 1494  residents, and ensure resident safety. The task force must
 1495  provide its recommendations, including explanations of its
 1496  recommendations, to the agency within 90 days after receiving
 1497  the inspection forms. The task force is terminated July 1, 2013.
 1498         Section 28. This act shall take effect July 1, 2012.