Florida Senate - 2013                                    SB 1724
       By Senator Garcia
       38-00939A-13                                          20131724__
    1                        A bill to be entitled                      
    2         An act relating to transitional living facilities;
    3         creating part XI of ch. 400, F.S., entitled
    4         “Transitional Living Facilities”; creating s.
    5         400.9970, F.S.; providing legislative intent; creating
    6         s. 400.9971, F.S.; providing definitions; creating s.
    7         400.9972, F.S.; requiring the licensure of
    8         transitional living facilities; providing fees;
    9         providing license application requirements; creating
   10         s. 400.9973, F.S.; providing requirements for
   11         transitional living facilities relating to client
   12         admission, transfer, and discharge; creating s.
   13         400.9974, F.S.; requiring an individual treatment plan
   14         to be developed for each client; providing plan
   15         requirements; creating s. 400.9975, F.S.; providing
   16         licensee responsibilities; providing notice
   17         requirements; prohibiting a licensee or employee of a
   18         facility from serving notice upon a client to leave
   19         the premises or take other retaliatory action;
   20         requiring the client and client’s representative to be
   21         provided with certain information; requiring the
   22         licensee to develop and implement certain policies and
   23         procedures; creating s. 400.9976, F.S.; providing
   24         licensee requirements relating to medication
   25         practices; creating s. 400.9977, F.S.; providing
   26         requirements for the screening of potential employees
   27         and monitoring of employees for the protection of
   28         clients; requiring licensees to implement certain
   29         procedures; creating s. 400.9978, F.S.; providing
   30         requirements for the use of physical restraints and
   31         chemical restraint medication on clients; creating s.
   32         400.9979, F.S.; providing background screening
   33         requirements; requiring the licensee to maintain
   34         certain personnel records; providing administrative
   35         responsibilities for licensees; providing
   36         recordkeeping requirements; creating s. 400.9980,
   37         F.S.; providing requirements relating to property and
   38         personal affairs of clients; providing requirements
   39         for a licensee with respect to obtaining surety bonds;
   40         providing recordkeeping requirements relating to the
   41         safekeeping of personal effects; providing
   42         requirements for trust funds received by a licensee
   43         and credited to the client; providing a penalty for
   44         certain misuse of a resident’s personal needs
   45         allowance; providing criminal penalties for
   46         violations; providing for the disposition of property
   47         in the event of the death of a client; authorizing the
   48         Agency for Health Care Administration to adopt rules;
   49         creating s. 400.9981, F.S.; requiring the agency, in
   50         consultation with the Department of Health, to adopt
   51         and enforce certain rules; creating s. 400.9982, F.S.;
   52         providing procedures relating to violations and
   53         penalties; providing administrative fines for
   54         specified classes of violations; creating s. 400.9983,
   55         F.S.; authorizing the agency to access the provisions
   56         of s. 429.22, F.S., regarding receivership
   57         proceedings; creating s. 400.9984, F.S.; requiring the
   58         Agency for Health Care Administration, the Department
   59         of Health, the Agency for Persons with Disabilities,
   60         and the Department of Children and Families to develop
   61         an electronic database for certain purposes; repealing
   62         s. 400.805, F.S., relating to transitional living
   63         facilities; amending s. 381.78, F.S.; conforming
   64         provisions to changes made by the act; providing an
   65         effective date.
   67  Be It Enacted by the Legislature of the State of Florida:
   69         Section 1. Sections 400.9970 through 400.9984, Florida
   70  Statutes, are designated as part XI of chapter 400, Florida
   71  Statutes, entitled “Transitional Living Facilities.”
   72         Section 2. Section 400.9970, Florida Statutes, is created
   73  to read:
   74         400.9970 Legislative intent.—It is the intent of the
   75  Legislature to provide for the licensure of transitional living
   76  facilities and require the development, establishment, and
   77  enforcement of basic standards by the department to ensure
   78  quality of care and services to clients in transitional living
   79  facilities. It is the policy of the state that the least
   80  restrictive appropriate available treatment be used based on the
   81  individual needs and best interests of the client and consistent
   82  with optimum improvement of the client’s condition. The goal of
   83  a transitional living program for individuals who have brain or
   84  spinal cord injuries is to assist each individual who has such a
   85  disability to achieve a higher level of independent functioning
   86  and to enable that person to reenter the community.
   87         Section 3. Section 400.9971, Florida Statutes, is created
   88  to read:
   89         400.9971 Definitions.—As used in this part, the term:
   90         (1) “Agency” means the Agency for Health Care
   91  Administration.
   92         (2) “Chemical restraint” means a pharmacologic drug that
   93  physically limits, restricts, or deprives an individual of
   94  movement or mobility and is used for client protection or safety
   95  and is not required for the treatment of medical conditions or
   96  symptoms.
   97         (3) “Client’s representative” means the parent of a child
   98  client, or the client’s guardian, designated representative or
   99  designee, surrogate, or attorney in fact.
  100         (4) “Department” means the Department of Health.
  101         (5) “Licensee” means an individual issued a license by the
  102  agency.
  103         (6) “Physical restraint” means any manual method or
  104  physical or mechanical device, material, or equipment attached
  105  or adjacent to the individual’s body so that he or she cannot
  106  easily remove the restraint and which restricts freedom of
  107  movement or normal access to one’s body, including, but not
  108  limited to, a half-bed rail, a full-bed rail, a geriatric chair,
  109  and a posey restraint. The term includes any device that was not
  110  specifically manufactured as a restraint but that has been
  111  altered, arranged, or otherwise used for this purpose. The term
  112  does not include bandage material used for the purpose of
  113  binding a wound or injury.
  114         (7) “Transitional living facility” means a site where
  115  specialized health care services are provided, including, but
  116  not limited to, rehabilitative services, community reentry
  117  training, aids for independent living, and counseling to brain
  118  injured persons and spinal-cord-injured persons. The term does
  119  not include a hospital licensed under chapter 395 or any
  120  federally operated hospital or facility.
  121         Section 4. Section 400.9972, Florida Statutes, is created
  122  to read:
  123         400.9972 License required; fee; application.—
  124         (1) The requirements of part II of chapter 408 apply to the
  125  provision of services that require licensure pursuant to this
  126  part and part II of chapter 408 and to entities licensed by or
  127  applying for such licensure from the agency pursuant to this
  128  part. A license issued by the agency is required for the
  129  operation of a transitional living facility in this state.
  130         (2) In accordance with this part, an applicant or a
  131  licensee shall pay a fee for each license application submitted
  132  under this part. The license fee shall consist of a $4,000
  133  license fee and a $90 per-bed fee per biennium and shall conform
  134  to the annual adjustment authorized in s. 408.805.
  135         (3) Each applicant for licensure must provide:
  136         (a) The location of the facility for which a license is
  137  sought and documentation, signed by the appropriate local
  138  government official, that states that the applicant has met
  139  local zoning requirements.
  140         (b) Proof of liability insurance as defined in s. 624.605.
  141         (c) Proof of compliance with local zoning requirements,
  142  including compliance with the requirements of chapter 419 if the
  143  proposed facility is a community residential home.
  144         (d) Proof that the facility has received a satisfactory
  145  firesafety inspection.
  146         (e) Documentation of a satisfactory sanitation inspection
  147  of the facility by the county health department.
  148         Section 5. Section 400.9973, Florida Statutes, is created
  149  to read:
  150         400.9973 Client admission, transfer, and discharge.—
  151         (1) Each transitional living facility must have written
  152  policies and procedures governing the admission, transfer, and
  153  discharge of clients.
  154         (2) The admission of each client to a transitional living
  155  facility must be in accordance with the licensee’s policies and
  156  procedures.
  157         (3) A client admitted to a transitional living facility
  158  must have a brain or spinal cord injury, such as a lesion to the
  159  spinal cord or cauda equina syndrome, with evidence of
  160  significant involvement of two of the following deficits or
  161  dysfunctions:
  162         (a) Motor deficit.
  163         (b) Sensory deficit.
  164         (c) Bowel and bladder dysfunction.
  165         (d)An injury to the skull, brain, or its covering that
  166  produces an altered state of consciousness or anatomic motor,
  167  sensory, cognitive, or behavioral deficits.
  168         (4) A client admitted to a transitional living facility
  169  must be admitted upon prescription by a licensed physician and
  170  must remain under the care of a licensed physician for the
  171  duration of the client’s stay in the facility.
  172         (5) A transitional living facility may not admit a client
  173  whose primary admitting diagnosis is mental illness.
  174         (6) A person may not be admitted to a transitional living
  175  facility if the person:
  176         (a) Presents significant risk of infection to other client
  177  or personnel. A health care practitioner must provide
  178  documentation that the person is free of apparent signs and
  179  symptoms of communicable disease;
  180         (b) Is a danger to self or others as determined by a
  181  physician, or mental health practitioner licensed under chapter
  182  490 or chapter 491, unless the facility provides adequate
  183  staffing and support to ensure patient safety;
  184         (c) Is bedridden; or
  185         (d) Requires 24-hour nursing supervision.
  186         (7) If the client meets the admission criteria, the medical
  187  or nursing director of the facility must implement a
  188  preadmission treatment plan that delineates services to be
  189  provided and appropriate sources for such services.
  190         (8) Each comprehensive treatment plan and discharge plan
  191  must be reviewed and updated as necessary, but at least monthly.
  192  A transitional living facility shall discharge as quickly as
  193  possible a resident who no longer requires any of the
  194  specialized services described in s. 400.9971(6) or is not
  195  making measurable progress in accordance with that individual’s
  196  comprehensive treatment plan.
  197         (9) Each transitional living facility shall provide at
  198  least 30 days’ notice to clients of transfer or discharge plans,
  199  including the location of an acceptable transfer location if the
  200  client is unable to live independently. This requirement does
  201  not apply if a client voluntarily terminates residency.
  202         (10) Each transitional living facility shall create a
  203  discharge plan for each client within 15 days after admission.
  204  The discharge plan must identify the intended discharge site and
  205  possible alternative discharge sites. For each discharge site,
  206  the discharge plan must identify the skills, behaviors, and
  207  other conditions that the client must achieve to be appropriate
  208  for discharge. A transitional living facility shall discharge a
  209  client as soon as practicable if the transitional living
  210  facility is no longer the most appropriate, least restrictive
  211  treatment option.
  212         (11) A client may not reside in a transitional living
  213  facility for a period of more than 2 years. An exception may be
  214  made if a referral is made to Disability Rights Florida at least
  215  21 months after admission and the client or, if appropriate, the
  216  client’s guardian requests that the client continue to receive
  217  treatment at the transitional living facility. However, the
  218  extension may not exceed a 1 year.
  219         Section 6. Section 400.9974, Florida Statutes, is created
  220  to read:
  221         400.9974 Individual treatment plans; client services.—
  222         (1) An interdisciplinary team, consisting of the case
  223  manager, program director, nurse, behavior specialist, and
  224  appropriate therapists, must develop an individual treatment
  225  plan for each client. The client and his or her representative
  226  must also be included in developing the treatment plan.
  227         (2) The individual treatment plan must include:
  228         (a) The physician’s orders and the client’s diagnosis,
  229  medical history, physical examination, and rehabilitative or
  230  restorative needs.
  231         (b) A preliminary nursing evaluation with physician’s
  232  orders for immediate care, completed on admission.
  233         (c) A comprehensive, accurate, reproducible, and
  234  standardized assessment of the client’s functional capability
  235  and the treatments designed to achieve skills, behaviors, and
  236  other conditions to return to the community, and shall specify
  237  measurable goals.
  238         (d) Steps necessary for the client to achieve transition to
  239  the community and estimated length of time to achieve the goals.
  240         (3) The individual treatment plan must be completed before
  241  admission to the facility and be reevaluated and updated at
  242  least every 90 days thereafter. A reevaluation of the plan must
  243  also occur if the client fails to meet projected improvements in
  244  the plan or a significant change in the client’s condition
  245  occurs. The client, the client’s guardian or responsible party,
  246  and any other person approved by the client, and members of the
  247  comprehensive treatment team are allowed to attend and
  248  participate in formulating updates to the discharge and
  249  treatment plans. At each quarterly meeting, the client or, if
  250  appropriate, the client’s guardian, shall consent to the
  251  continued treatment at the transitional living facility. If such
  252  consent is not given, the transitional living facility shall
  253  discharge the client as soon as practicable.
  254         (4) Each client must receive the professional program
  255  services needed to implement the client’s individual program
  256  plan.
  257         (5) The licensee must employ available qualified
  258  professional staff to carry out and monitor the various
  259  professional interventions in accordance with the stated goals
  260  and objectives of every individual program plan.
  261         (6) Each client must receive a continuous treatment program
  262  that includes appropriate, consistent implementation of a
  263  program of specialized and general training, treatment, health
  264  services, and related services that is directed toward:
  265         (a) The acquisition of the behaviors necessary for the
  266  client to function with as much self-determination and
  267  independence as possible;
  268         (b) The prevention or deceleration of regression or loss of
  269  current optimal functional status; and
  270         (c) An appropriate plan to address behavioral issues that
  271  preclude independent functioning in the community.
  272         Section 7. Section 400.9975, Florida Statutes, is created
  273  to read:
  274         400.9975 Licensee responsibilities.—
  275         (1) The licensee shall ensure that each client:
  276         (a) Lives in a safe environment free from abuse, neglect,
  277  and exploitation.
  278         (b) Is treated with consideration and respect and with due
  279  recognition of personal dignity, individuality, and the need for
  280  privacy.
  281         (c) Retains and uses his or her own clothes and other
  282  personal property in his or her immediate living quarters, so as
  283  to maintain individuality and personal dignity, except when the
  284  licensee can demonstrate that such retention and use would be
  285  unsafe, impractical, or an infringement upon the rights of other
  286  clients.
  287         (d) Has unrestricted private communication, including
  288  receiving and sending unopened correspondence, access to a
  289  telephone, and visiting with any person of his or her choice.
  290  Upon request, the licensee shall make provisions to modify
  291  visiting hours for caregivers and guests. The facility shall
  292  restrict communication in accordance with any court order or
  293  written instruction of a guardian. Any restriction on a client’s
  294  communication for therapeutic reasons shall be reviewed no less
  295  often than weekly and the restrictions shall be removed as soon
  296  as it is no longer clinically indicated. The basis for the
  297  restrictions shall be explained to the client and, if
  298  applicable, the client’s representative. The client shall
  299  nonetheless retain the right to call the abuse hotline, the
  300  agency, and Disability Rights Florida at any and all times.
  301         (e) Participates in and benefits from community services
  302  and activities to achieve the highest possible level of
  303  independence, autonomy, and interaction within the community.
  304         (f) Manages his or her financial affairs unless the client
  305  or, if applicable, the client’s representative authorizes the
  306  administrator of the facility to provide safekeeping for funds
  307  as provided in this part.
  308         (g) Has reasonable opportunity for regular exercise several
  309  times a week and to be outdoors at regular and frequent
  310  intervals except when prevented by inclement weather.
  311         (h) Exercises civil and religious liberties, including the
  312  right to independent personal decisions. No religious belief or
  313  practice, including attendance at religious services, shall be
  314  imposed upon any client.
  315         (i) Has access to adequate and appropriate health care as
  316  appropriate for the client and consistent with established and
  317  recognized standards within the community.
  318         (j) Has the ability to present grievances and recommend
  319  changes in policies, procedures, and services to the staff of
  320  the licensee, governing officials, or any other person without
  321  restraint, interference, coercion, discrimination, or reprisal.
  322  Each licensee shall establish a grievance procedure to
  323  facilitate a client’s exercise of this right. This right
  324  includes access to Disability Rights Florida and other advocates
  325  and the right to be a member of, be active in, and associate
  326  with advocacy or special interest groups.
  327         (2) The licensee shall:
  328         (a) Promote participation of each client’s representative
  329  in the process of providing treatment to the client unless the
  330  representative’s participation is unobtainable or inappropriate.
  331         (b) Answer communications from each client’s family and
  332  friends promptly and appropriately.
  333         (c) Promote visits by individuals with a relationship to
  334  the client at any reasonable hour, without requiring prior
  335  notice, or in any area of the facility that provides direct
  336  client care services to the client, consistent with the client’s
  337  and other clients’ privacy, unless the interdisciplinary team
  338  determines that such a visit would not be appropriate.
  339         (d) Promote leave from the facility for visits, trips, or
  340  vacations.
  341         (e) Promptly notify the client’s representative of any
  342  significant incidents or changes in the client’s condition,
  343  including, but not limited to, serious illness, accident, abuse,
  344  unauthorized absence, or death.
  345         (3) The administrator of a facility shall ensure that a
  346  written notice of licensee responsibilities is posted in a
  347  prominent place in each building where clients reside and read
  348  or explained to clients who cannot read. This notice shall
  349  include the statewide toll-free telephone number for reporting
  350  complaints to the agency, must be provided to clients in a
  351  manner that is clearly legible, and must include the words: “To
  352  report a complaint regarding the services you receive, please
  353  call toll-free ...[telephone number]...; the Disability Rights
  354  Florida (telephone number); and the statewide toll-free
  355  telephone number for the central abuse hotline must be provided
  356  to clients in a manner that is clearly legible and must include
  357  the words: “To report abuse, neglect or exploitation, please
  358  call toll-free ...[telephone number]...” where complaints may be
  359  lodged. The licensee must ensure a client’s access to a
  360  telephone to call the agency, central abuse hotline, Disability
  361  Rights Florida.
  362         (4) No licensee or employee of a facility may serve notice
  363  upon a client to leave the premises or take any other
  364  retaliatory action against any person who:
  365         (a) Files an internal or external complaint or grievance
  366  regarding the facility.
  367         (b) Appears as a witness in any hearing inside or outside
  368  the facility.
  369         (5) Before or at the time of admission, the client and the
  370  client’s representative shall be provided with a copy of the
  371  client’s contract and a copy of the licensee’s responsibilities
  372  as provided in subsection (1).
  373         (6) The licensee must develop and implement policies and
  374  procedures governing the release of any client information,
  375  including consent necessary from the client or the client’s
  376  representative.
  377         Section 8. Section 400.9976, Florida Statutes, is created
  378  to read:
  379         400.9976 Medication practices.—
  380         (1) An individual medication administration record must be
  381  maintained for each client. Each dose of medication, including a
  382  self administered dose, shall be properly recorded in the
  383  client’s record. Each patient who is self administering
  384  medication shall be given a pill organizer. Medication must be
  385  placed in the pill organizer by a nurse. A nurse shall document
  386  the date and time medication is placed into each patient’s pill
  387  organizer. All medications must be administered in compliance
  388  with the physician’s orders.
  389         (2) If the interdisciplinary team determines that self
  390  administration of medications is an appropriate objective, and
  391  if the physician does not specify otherwise, a client must be
  392  taught to self administer his or her medication without a staff
  393  person. This includes all forms of administration, including
  394  orally, via injection, and via suppository. The client’s
  395  physician must be informed of the interdisciplinary team’s
  396  decision that self administration of medications is an objective
  397  for the client. A client may not self administer medication
  398  until he or she demonstrates the competency to take the correct
  399  medication in the correct dosage at the correct time, knows how
  400  to respond to missed doses, and knows who to contact with
  401  questions.
  402         (3) Medication administration discrepancies and adverse
  403  drug reactions must be recorded and reported immediately to a
  404  physician.
  405         Section 9. Section 400.9977, Florida Statutes, is created
  406  to read:
  407         400.9977 Protection from abuse, neglect, mistreatment, and
  408  exploitation.—The licensee must develop and implement policies
  409  and procedures for the screening and training of employees, the
  410  protection of clients, and the prevention, identification,
  411  investigation, and reporting of abuse, neglect, and
  412  exploitation. This includes the licensee’s identification of
  413  clients whose personal histories render them at risk for abusing
  414  other clients, development of intervention strategies to prevent
  415  occurrences, monitoring for changes that would trigger abusive
  416  behavior, and reassessment of the interventions on a regular
  417  basis. A licensee shall implement procedures to:
  418         (1) Screen potential employees for a history of abuse,
  419  neglect, or mistreatment of clients. The screening shall include
  420  an attempt to obtain information from previous employers and
  421  current employers and verification with the appropriate
  422  licensing boards and registries.
  423         (2) Train employees, through orientation and ongoing
  424  sessions, on issues related to abuse prohibition practices,
  425  including identification of abuse, neglect, mistreatment, and
  426  exploitation, appropriate interventions to deal with aggressive
  427  or catastrophic reactions of clients, the process to report
  428  allegations without fear of reprisal, and recognition of signs
  429  of frustration and stress that may lead to abuse.
  430         (3) Provide clients, families, and staff with information
  431  on how and to whom they may report concerns, incidents, and
  432  grievances without the fear of retribution and provide feedback
  433  regarding the concerns that have been expressed. A licensee must
  434  identify, correct, and intervene in situations in which abuse,
  435  neglect, mistreatment, or exploitation is likely to occur,
  436  including:
  437         (a) Evaluating the physical environment of the facility to
  438  identify characteristics that may make abuse or neglect more
  439  likely to occur, such as secluded areas.
  440         (b) Providing sufficient staff on each shift to meet the
  441  needs of the clients, and ensuring that the staff assigned have
  442  knowledge of the individual clients’ care needs. The licensee
  443  shall identify inappropriate behaviors of its staff, such as
  444  using derogatory language, rough handling, ignoring clients
  445  while giving care, and directing clients who need toileting
  446  assistance to urinate or defecate in their beds.
  447         (c) Assessing, planning care for, and monitoring clients
  448  with needs and behaviors that might lead to conflict or neglect,
  449  such as clients with a history of aggressive behaviors, clients
  450  who have behaviors such as entering other clients’ rooms,
  451  clients with self-injurious behaviors, clients with
  452  communication disorders, and clients who require heavy nursing
  453  care or are totally dependent on staff.
  454         (4) Identify events, such as suspicious bruising of
  455  clients, occurrences, patterns, and trends that may constitute
  456  abuse and determine the direction of the investigation.
  457         (5) Investigate different types of incidents, identify the
  458  staff member responsible for the initial reporting, investigate
  459  alleged violations, and report results to the proper
  460  authorities. The licensee must analyze the occurrences to
  461  determine what changes are needed, if any, to policies and
  462  procedures to prevent further occurrences and to take all
  463  necessary corrective actions depending on the results of the
  464  investigation.
  465         (6) Protect clients from harm during an investigation.
  466         (7) Report all alleged violations and all substantiated
  467  incidents, as required under chapters 39 and 415, to the
  468  licensing authorities and to all other agencies as required, and
  469  to report any knowledge it has of any actions by a court of law
  470  that would indicate an employee is unfit for service.
  471         Section 10. Section 400.9978, Florida Statutes, is created
  472  to read:
  473         400.9978 Restraints and seclusion; client safety.—
  474         (1) The use of physical restraints must be ordered and
  475  documented by the a physician and must be consistent with
  476  policies and procedures adopted by the facility. The client or,
  477  if applicable, the client’s representative must be informed of
  478  the facility’s physical restraint policies and procedures at the
  479  time of admission.
  480         (2) The use of chemical restraints is limited to prescribed
  481  dosages of medications as ordered by a physician, must be
  482  consistent with the client’s diagnosis and the policies and
  483  procedures adopted by the facility. The client or, if
  484  applicable, the client’s representative, must be informed of the
  485  facility’s chemical restraint policies and procedures at the
  486  time of admission.
  487         (3)Based on a physician’s assessment, when a patient
  488  exhibits symptoms that present an immediate risk of injury or
  489  death to self or others, a physician may issue an emergency
  490  treatment order to immediately administer rapid response
  491  psychotropic medications or other chemical restraints. Each
  492  emergency treatment order must be documented and maintained in
  493  the patient’s record.
  494         (a) An emergency treatment order is effective for no more
  495  than 24 hours.
  496         (b) Whenever a client is medicated in accordance with this
  497  section, the client’s representative or responsible party and
  498  the client’s physician must be notified as soon as practicable.
  499         (4) A client who is prescribed and receiving a medication
  500  that can serve as a chemical restraint, but not on an emergency
  501  basis, must be evaluated by his or her physician at least
  502  monthly to assess:
  503         (a) The continued need for the medication.
  504         (b) The level of the medication in the client’s blood as
  505  appropriate.
  506         (c) The need for adjustments in the prescription.
  507         (5) The licensee shall ensure that clients are free from
  508  unnecessary drugs and physical restraints and are provided
  509  treatment to reduce dependency on drugs and physical restraints.
  510         (6) The licensee may use physical restraints only as an
  511  integral part of an individual program plan that is intended to
  512  lead to less restrictive means of managing and eliminating the
  513  behavior for which the restraint is applied.
  514         (7) Interventions to manage inappropriate client behavior
  515  must be employed with sufficient safeguards and supervision to
  516  ensure that the safety, welfare, and civil and human rights of
  517  each client are adequately protected.
  518         Section 11. Section 400.9979, Florida Statutes, is created
  519  to read:
  520         400.9979 Background screening; administration and
  521  management.—
  522         (1) The agency shall require level 2 background screening
  523  for personnel as required in s. 408.809(1)(e) pursuant to
  524  chapter 435 and s. 408.809.
  525         (2) The licensee shall maintain personnel records for each
  526  staff member that contain, at a minimum, documentation of
  527  background screening, if applicable, a job description,
  528  documentation of compliance with all training requirements of
  529  this part or applicable rule, the employment application,
  530  references, a copy of all job performance evaluations, and, for
  531  each staff member who performs services for which licensure or
  532  certification is required, a copy of all licenses or
  533  certification held by the staff member.
  534         (3) The licensee must:
  535         (a) Develop and implement infection control policies and
  536  procedures and include such policies and procedures in the
  537  licensee’s policy manual.
  538         (b) Maintain liability insurance as defined in s. 624.605.
  539         (c) Designate one person as an administrator who is
  540  responsible and accountable for the overall management of the
  541  facility.
  542         (d) Designate a person in writing to be responsible for the
  543  facility when the administrator is absent from the facility for
  544  more than 24 hours.
  545         (e) Designate in writing a program director who is
  546  responsible for supervising the therapeutic and behavioral
  547  staff, determining the levels of supervision, and room placement
  548  for each client.
  549         (f) Designate in writing a person to be responsible when
  550  the program director is absent from the facility for more than
  551  24 hours.
  552         (g) Obtain approval of the comprehensive emergency
  553  management plan, pursuant to s. 400.9981(2)(e), from the local
  554  emergency management agency. Pending the approval of the plan,
  555  the local emergency management agency shall ensure that the
  556  following agencies, at a minimum, are given the opportunity to
  557  review the plan: the Department of Health, the Agency for Health
  558  Care Administration, and the Division of Emergency Management.
  559  Appropriate volunteer organizations must also be given the
  560  opportunity to review the plan. The local emergency management
  561  agency shall complete its review within 60 days and either
  562  approve the plan or advise the licensee of necessary revisions.
  563         (h) Maintain written records in a form and system that
  564  comply with medical and business practices and make such records
  565  available in the facility for review or submission to the agency
  566  upon request. The records shall include:
  567         1. A daily census record that indicates the number of
  568  clients currently receiving services in the facility, including
  569  information regarding any public funding of such clients.
  570         2. A record of all accidents or unusual incidents involving
  571  any client or staff member that caused, or had the potential to
  572  cause, injury or harm to any person or property within the
  573  facility. Such records must contain a clear description of each
  574  accident or incident, the names of the persons involved, a
  575  description of all medical or other services provided to these
  576  persons specifying who provided such services, and the steps
  577  taken to prevent recurrence of such accidents or incidents.
  578         3. A copy of current agreements with third-party providers.
  579         4. A copy of current agreements with each consultant
  580  employed by the licensee and documentation of each consultant’s
  581  visits and required written, dated reports.
  582         Section 12. Section 400.9980, Florida Statutes, is created
  583  to read:
  584         400.9980 Property and personal affairs of clients.—
  585         (1) A client shall be given the option of using his or her
  586  own belongings, as space permits; choosing his or her roommate
  587  if practical and not clinically contraindicated; and, whenever
  588  possible, unless the client is adjudicated incompetent or
  589  incapacitated under state law, managing his or her own affairs.
  590         (2) The admission of a client to a facility and his or her
  591  presence therein shall not confer on a licensee, administrator,
  592  employee, or representative thereof any authority to manage,
  593  use, or dispose of any property of the client, nor shall such
  594  admission or presence confer on any of such persons any
  595  authority or responsibility for the personal affairs of the
  596  client except that which may be necessary for the safe
  597  management of the facility or for the safety of the client.
  598         (3) A licensee, administrator, employee, or representative
  599  thereof may:
  600         (a) Not act as the guardian, trustee, or conservator for
  601  any client or any of such client’s property.
  602         (b) Act as a competent client’s payee for social security,
  603  veteran’s, or railroad benefits if the client provides consent
  604  and the licensee files a surety bond with the agency in an
  605  amount equal to twice the average monthly aggregate income or
  606  personal funds due to the client, or expendable for the client’s
  607  account, that are received by a licensee.
  608         (c) Act as the power of attorney for a client if the
  609  licensee has filed a surety bond with the agency in an amount
  610  equal to twice the average monthly income of the client, plus
  611  the value of any client’s property under the control of the
  612  attorney in fact.
  614  The bond under paragraph (b) or paragraph (c) shall be executed
  615  by the licensee as principal and a licensed surety company. The
  616  bond shall be conditioned upon the faithful compliance of the
  617  licensee with the requirements of licensure and shall be payable
  618  to the agency for the benefit of any client who suffers a
  619  financial loss as a result of the misuse or misappropriation of
  620  funds held pursuant to this subsection. Any surety company that
  621  cancels or does not renew the bond of any licensee shall notify
  622  the agency in writing not less than 30 days in advance of such
  623  action, giving the reason for the cancellation or nonrenewal.
  624  Any licensee, administrator, employee, or representative thereof
  625  who is granted power of attorney for any client of the facility
  626  shall, on a monthly basis, notify the client in writing of any
  627  transaction made on behalf of the client pursuant to this
  628  subsection, and a copy of such notification given to the client
  629  shall be retained in each client’s file and available for agency
  630  inspection.
  631         (4) A licensee, upon mutual consent with the client, shall
  632  provide for the safekeeping in the facility of the client’s
  633  personal effects of a value not in excess of $1,000 and the
  634  client’s funds not in excess of $500 cash and shall keep
  635  complete and accurate records of all such funds and personal
  636  effects received. If a client is absent from a facility for 24
  637  hours or more, the licensee may provide for the safekeeping of
  638  the client’s personal effects of a value in excess of $1,000.
  639         (5) Any funds or other property belonging to or due to a
  640  client or expendable for his or her account that is received by
  641  licensee shall be trust funds and shall be kept separate from
  642  the funds and property of the licensee and other clients or
  643  shall be specifically credited to such client. Such trust funds
  644  shall be used or otherwise expended only for the account of the
  645  client. At least once every month, unless upon order of a court
  646  of competent jurisdiction, the licensee shall furnish the client
  647  and the client’s representative a complete and verified
  648  statement of all funds and other property to which this
  649  subsection applies, detailing the amount and items received,
  650  together with their sources and disposition. In any event, the
  651  licensee shall furnish such statement annually and upon the
  652  discharge or transfer of a client. Any governmental agency or
  653  private charitable agency contributing funds or other property
  654  to the account of a client shall also be entitled to receive
  655  such statement monthly and upon the discharge or transfer of the
  656  client.
  657         (6)(a) In addition to any damages or civil penalties to
  658  which a person is subject, any person who:
  659         1. Intentionally withholds a client’s personal funds,
  660  personal property, or personal needs allowance, or who demands,
  661  beneficially receives, or contracts for payment of all or any
  662  part of a client’s personal property or personal needs allowance
  663  in satisfaction of the facility rate for supplies and services;
  664  or
  665         2. Borrows from or pledges any personal funds of a client,
  666  other than the amount agreed to by written contract under s.
  667  429.24,
  669  commits a misdemeanor of the first degree, punishable as
  670  provided in s. 775.082 or s. 775.083.
  671         (b) Any licensee, administrator, employee, or
  672  representative thereof who is granted power of attorney for any
  673  client of the facility and who misuses or misappropriates funds
  674  obtained through this power commits a felony of the third
  675  degree, punishable as provided in s. 775.082, s. 775.083, or s.
  676  775.084.
  677         (7) In the event of the death of a client, a licensee shall
  678  return all refunds, funds, and property held in trust to the
  679  client’s personal representative, if one has been appointed at
  680  the time the licensee disburses such funds, or, if not, to the
  681  client’s spouse or adult next of kin named in a beneficiary
  682  designation form provided by the licensee to the client. If the
  683  client has no spouse or adult next of kin or such person cannot
  684  be located, funds due the client shall be placed in an interest
  685  bearing account and all property held in trust by the licensee
  686  shall be safeguarded until such time as the funds and property
  687  are disbursed pursuant to the Florida Probate Code. Such funds
  688  shall be kept separate from the funds and property of the
  689  licensee and other clients of the facility. If the funds of the
  690  deceased client are not disbursed pursuant to the Florida
  691  Probate Code within 2 years after the client’s death, the funds
  692  shall be deposited in the Health Care Trust Fund administered by
  693  the agency.
  694         (8) The agency may by rule clarify terms and specify
  695  procedures and documentation necessary to administer the
  696  provisions of this section relating to the proper management of
  697  clients’ funds and personal property and the execution of surety
  698  bonds.
  699         Section 13. Section 400.9981, Florida Statutes, is created
  700  to read:
  701         400.9981 Rules establishing standards.—
  702         (1) It is the intent of the Legislature that rules
  703  published and enforced pursuant to this part and part II of
  704  chapter 408 include criteria to ensure reasonable and consistent
  705  quality of care and client safety. Rules should make reasonable
  706  efforts to accommodate the needs and preferences of clients to
  707  enhance the quality of life in transitional living facilities.
  708         (2) The agency, in consultation with the Department of
  709  Health, may adopt and enforce rules to implement this part and
  710  part II of chapter 408, which shall include reasonable and fair
  711  criteria in relation to:
  712         (a) The location of transitional living facilities.
  713         (b) The number of qualifications of all personnel,
  714  including management, medical, nursing, and other professional
  715  personnel and nursing assistants and support personnel having
  716  responsibility for any part of the care given to clients. The
  717  licensee must have enough qualified professional staff available
  718  to carry out and monitor the various professional interventions
  719  in accordance with the stated goals and objectives of each
  720  individual program plan.
  721         (c) Requirements for personnel procedures, insurance
  722  coverage, reporting procedures, and documentation necessary to
  723  implement this part.
  724         (d) Services provided to clients of transitional living
  725  facilities.
  726         (e) The preparation and annual update of a comprehensive
  727  emergency management plan in consultation with the Division of
  728  Emergency Management. At a minimum, the rules must provide for
  729  plan components that address emergency evacuation
  730  transportation; adequate sheltering arrangements; postdisaster
  731  activities, including provision of emergency power, food, and
  732  water; postdisaster transportation; supplies; staffing;
  733  emergency equipment; individual identification of clients and
  734  transfer of records; communication with families; and responses
  735  to family inquiries.
  736         Section 14. Section 400.9982, Florida Statutes, is created
  737  to read:
  738         400.9982 Violations; penalties.—
  739         (1) Each violation of this part and rules adopted pursuant
  740  thereto shall be classified according to the nature of the
  741  violation and the gravity of its probable effect on facility
  742  clients. The agency shall indicate the classification on the
  743  written notice of the violation as follows:
  744         (a) Class “I” violations are defined in s. 408.813. The
  745  agency shall issue a citation regardless of correction and
  746  impose an administrative fine of $5,000 for an isolated
  747  violation, $7,500 for a patterned violation, and $10,000 for a
  748  widespread violation. Violations may be identified and a fine
  749  must be levied notwithstanding the correction of the deficiency
  750  giving rise to the violation.
  751         (b) Class “II” violations are defined in s. 408.813. The
  752  agency shall impose an administrative fine of $1,000 for an
  753  isolated violation, $2,500 for a patterned violation, and $5,000
  754  for a widespread violation. A fine must be levied
  755  notwithstanding the correction of the deficiency giving rise to
  756  the violation.
  757         (c) Class “III” violations are defined in s. 408.813. The
  758  agency shall impose an administrative fine of $500 for an
  759  isolated violation, $750 for a patterned violation, and $1,000
  760  for a widespread violation. If a deficiency giving rise to a
  761  class “III” violation is corrected within the time specified by
  762  the agency, a fine may not be imposed.
  763         (d) Class “IV” violations are defined in s. 408.813. The
  764  agency shall impose an administrative fine for a cited class IV
  765  violation in an amount not less than $100 and not exceeding $200
  766  for each violation.
  767         Section 15. Section 400.9983, Florida Statutes, is created
  768  to read:
  769         400.9983 Receivership proceedings.—The agency may access
  770  the provisions of s. 429.22 regarding receivership proceedings
  771  for transitional living facilities.
  772         Section 16. Section 400.9984, Florida Statutes, is created
  773  to read:
  774         400.9984 Interagency communication.—The agency, the
  775  department, the Agency for Persons with Disabilities, and the
  776  Department of Children and Families shall develop an electronic
  777  database to ensure that relevant information pertaining to the
  778  regulation of transitional living facilities and clients is
  779  timely and effectively communicated among agencies in order to
  780  facilitate the protection of clients. Electronic sharing of
  781  information shall include, at a minimum, a brain and spinal cord
  782  injury registry and a client abuse registry.
  783         Section 17. Section 400.805, Florida Statutes, is repealed.
  784         Section 18. Paragraph (b) of subsection (4) of section
  785  381.78, Florida Statutes, is amended to read:
  786         381.78 Advisory council on brain and spinal cord injuries.—
  787         (4) The council shall:
  788         (b) Annually appoint a five-member committee composed of
  789  one individual who has a brain injury or has a family member
  790  with a brain injury, one individual who has a spinal cord injury
  791  or has a family member with a spinal cord injury, and three
  792  members who shall be chosen from among these representative
  793  groups: physicians, other allied health professionals,
  794  administrators of brain and spinal cord injury programs, and
  795  representatives from support groups with expertise in areas
  796  related to the rehabilitation of individuals who have brain or
  797  spinal cord injuries, except that one and only one member of the
  798  committee shall be an administrator of a transitional living
  799  facility. Membership on the council is not a prerequisite for
  800  membership on this committee.
  801         1. The committee shall perform onsite visits to those
  802  transitional living facilities identified by the Agency for
  803  Health Care Administration as being in possible violation of the
  804  statutes and rules regulating such facilities. The committee
  805  members have the same rights of entry and inspection granted
  806  under s. 400.805(4) to designated representatives of the agency.
  807         2. Factual findings of the committee resulting from an
  808  onsite investigation of a facility pursuant to subparagraph 1.
  809  shall be adopted by the agency in developing its administrative
  810  response regarding enforcement of statutes and rules regulating
  811  the operation of the facility.
  812         3. Onsite investigations by the committee shall be funded
  813  by the Health Care Trust Fund.
  814         4. Travel expenses for committee members shall be
  815  reimbursed in accordance with s. 112.061.
  816         5. Members of the committee shall recuse themselves from
  817  participating in any investigation that would create a conflict
  818  of interest under state law, and the council shall replace the
  819  member, either temporarily or permanently.
  820         Section 19. This act shall take effect July 1, 2013.