Florida Senate - 2013                             CS for SB 1724
       By the Committee on Children, Families, and Elder Affairs; and
       Senator Garcia
       586-03371-13                                          20131724c1
    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 a comprehensive treatment
   14         plan 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 licensee and
   43         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.; authorizing the agency to
   50         adopt and enforce certain rules; creating s. 400.9982,
   51         F.S.; providing procedures relating to violations and
   52         penalties; providing administrative fines for
   53         specified classes of violations; creating s. 400.9983,
   54         F.S.; authorizing the agency to apply certain
   55         provisions with regard to receivership proceedings;
   56         creating s. 400.9984, F.S.; requiring the Agency for
   57         Health Care Administration, the Department of Health,
   58         the Agency for Persons with Disabilities, and the
   59         Department of Children and Families to develop
   60         electronic systems for certain purposes; repealing s.
   61         400.805, F.S., relating to transitional living
   62         facilities; providing that every transitional living
   63         facilities licensed under s. 400.805, F.S., on or
   64         before a specified date is licensed under the
   65         provisions of the act; amending s. 381.745, F.S.;
   66         revising a definition; amending s. 381.75, F.S.;
   67         revising the duties of the Department of Health as
   68         they relate to transitional living facilities;
   69         amending s. 381.78, F.S.; conforming provisions to
   70         changes made by the act; providing an effective date.
   72  Be It Enacted by the Legislature of the State of Florida:
   74         Section 1. Sections 400.9970 through 400.9984, Florida
   75  Statutes, are designated as part XI of chapter 400, Florida
   76  Statutes, entitled “Transitional Living Facilities.”
   77         Section 2. Section 400.9970, Florida Statutes, is created
   78  to read:
   79         400.9970 Legislative intent.—It is the intent of the
   80  Legislature to provide for the licensure of transitional living
   81  facilities and require the development, establishment, and
   82  enforcement of basic standards by the Agency for Health Care
   83  Administration to ensure quality of care and services to clients
   84  in transitional living facilities. It is the policy of the state
   85  that the least restrictive appropriate available treatment be
   86  used based on the individual needs and best interest of the
   87  client and consistent with optimum improvement of the client’s
   88  condition. The goal of a transitional living program for
   89  individuals who have brain or spinal cord injuries is to assist
   90  each individual who has such an injury to achieve a higher level
   91  of independent functioning and to enable that individual to
   92  reenter the community.
   93         Section 3. Section 400.9971, Florida Statutes, is created
   94  to read:
   95         400.9971 Definitions.—As used in this part, the term:
   96         (1) “Agency” means the Agency for Health Care
   97  Administration.
   98         (2) “Chemical restraint” means a pharmacologic drug that
   99  physically limits, restricts, or deprives an individual of
  100  movement or mobility, is used for client protection or safety,
  101  and is not required for the treatment of medical conditions or
  102  symptoms.
  103         (3) “Client’s representative” means the parent of a child
  104  client or the client’s guardian, designated representative or
  105  designee, surrogate, or attorney in fact.
  106         (4) “Department” means the Department of Health.
  107         (5) “Licensee” means an individual issued a license by the
  108  agency.
  109         (6) “Physical restraint” means any manual method to
  110  restrict freedom of movement of or normal access to an
  111  individual’s body or a physical or mechanical device, material,
  112  or equipment attached or adjacent to the individual’s body so
  113  that he or she cannot easily remove the restraint and which
  114  restricts freedom of movement of or normal access to one’s body,
  115  including, but not limited to, a half-bed rail, a full-bed rail,
  116  a geriatric chair, and a posey restraint. The term includes any
  117  device that was not specifically manufactured as a restraint but
  118  which has been altered, arranged, or otherwise used for this
  119  purpose. The term does not include bandage material used for the
  120  purpose of binding a wound or injury.
  121         (7) “Transitional living facility” means a site where
  122  specialized health care services are provided, including, but
  123  not limited to, rehabilitative services, behavior modification,
  124  community reentry training, aids for independent living, and
  125  counseling to individuals who have brain injuries or spinal cord
  126  injuries. The term does not require a provider that is licensed
  127  by the agency to obtain a separate transitional living facility
  128  license to serve persons who have brain injuries or spinal cord
  129  injuries as long as the services provided are within the scope
  130  of the provider’s license.
  131         Section 4. Section 400.9972, Florida Statutes, is created
  132  to read:
  133         400.9972 License required; fee; application.—
  134         (1) The requirements of part II of chapter 408 apply to the
  135  provision of services that require licensure pursuant to this
  136  part and part II of chapter 408 and to entities licensed by or
  137  applying for such licensure from the agency pursuant to this
  138  part. A license issued by the agency is required for the
  139  operation of a transitional living facility in this state.
  140         (2) In accordance with this part, an applicant or a
  141  licensee shall pay a fee for each license application submitted
  142  under this part. The license fee shall consist of a $4,588
  143  license fee and a $90 per-bed fee per biennium and shall conform
  144  to the annual adjustment authorized in s. 408.805.
  145         (3) Each applicant for licensure must provide the
  146  following:
  147         (a) The location of the facility for which a license is
  148  sought and documentation, signed by the appropriate local
  149  government official, which states that the applicant has met
  150  local zoning requirements.
  151         (b) Proof of liability insurance as provided in s. 624.605.
  152         (c) Proof of compliance with local zoning requirements,
  153  including compliance with the requirements of chapter 419 if the
  154  proposed facility is a community residential home.
  155         (d) Proof that the facility has received a satisfactory
  156  firesafety inspection.
  157         (e) Documentation of a satisfactory sanitation inspection
  158  of the facility by the county health department.
  160  The applicant’s proposed facility must attain and continuously
  161  maintain accreditation by an accrediting organization
  162  specializing in evaluating rehabilitation facilities whose
  163  standards incorporate comparable licensure regulations required
  164  by the state. An applicant for licensure as a transitional
  165  living facility must acquire accreditation within 12 months
  166  after the issuance of an initial license. The agency shall
  167  accept the accreditation survey report of the accrediting
  168  organization in lieu of conducting a licensure inspection if the
  169  standards included in the survey report are determined by the
  170  agency to document that the facility is in substantial
  171  compliance with state licensure requirements. The applicant
  172  shall submit to the agency within 10 days after receipt a copy
  173  of any accreditation survey report and evidence of the
  174  accreditation decision subsequent to a survey by the accrediting
  175  organization on the facility. This part does not preclude the
  176  agency from conducting periodic inspections of a transitional
  177  living facility to ensure compliance with all licensure
  178  requirements, and as it deems necessary to carry out the
  179  functions of the agency. An inspection may be conducted to
  180  ensure compliance with licensure requirements of this part, to
  181  validate the inspection process of accrediting organizations, to
  182  respond to licensure complaints, or to protect the public health
  183  and safety.
  184         Section 5. Section 400.9973, Florida Statutes, is created
  185  to read:
  186         400.9973 Client admission, transfer, and discharge.—
  187         (1) Each transitional living facility must have written
  188  policies and procedures governing the admission, transfer, and
  189  discharge of clients.
  190         (2) The admission of each client to a transitional living
  191  facility must be in accordance with the licensee’s policies and
  192  procedures.
  193         (3) A client admitted to a transitional living facility
  194  must have a brain or spinal cord injury, such as a lesion to the
  195  spinal cord or cauda equina syndrome, with evidence of
  196  significant involvement of two of the following deficits or
  197  dysfunctions:
  198         (a) A motor deficit.
  199         (b) A sensory deficit.
  200         (c) Bowel and bladder dysfunction.
  201         (d) An acquired internal or external injury to the skull,
  202  the brain, or the brain’s covering, whether caused by a
  203  traumatic or nontraumatic event, which produces an altered state
  204  of consciousness or an anatomic motor, sensory, cognitive, or
  205  behavioral deficit.
  206         (4) A client whose medical diagnosis does not positively
  207  identify a cause of the client’s condition, whose symptoms are
  208  inconsistent with the known cause of injury, or whose recovery
  209  is inconsistent with the known medical condition may be admitted
  210  to a transitional living facility for evaluation for a period
  211  not to exceed 90 days.
  212         (5) A client admitted to a transitional living facility
  213  must be admitted upon prescription by a licensed physician and
  214  must remain under the care of a licensed physician for the
  215  duration of the client’s stay in the facility.
  216         (6) A transitional living facility may not admit a client
  217  whose primary admitting diagnosis is mental illness or an
  218  intellectual or a developmental disability.
  219         (7) An individual may not be admitted to a transitional
  220  living facility if the individual:
  221         (a) Presents significant risk of infection to other clients
  222  or personnel. A health care practitioner must provide
  223  documentation that the individual is free of apparent signs and
  224  symptoms of communicable disease;
  225         (b) Is a danger to self or others as determined by a
  226  physician or mental health practitioner licensed under chapter
  227  490 or chapter 491, unless the facility provides adequate
  228  staffing and support to ensure patient safety;
  229         (c) Is bedridden; or
  230         (d) Requires 24-hour nursing supervision.
  231         (8) If the client meets the admission criteria, the medical
  232  or nursing director of the facility must complete an initial
  233  evaluation of the client’s functional skills, behavioral status,
  234  cognitive status, educational or vocational potential, medical
  235  status, psychosocial status, sensorimotor capacity, and other
  236  related skills and abilities within the first 72 hours after the
  237  client’s admission to the facility. An initial comprehensive
  238  treatment plan that delineates services to be provided and
  239  appropriate sources for such services must be implemented within
  240  the first 4 days after admission.
  241         (9) Each transitional living facility shall develop a
  242  discharge plan for each client before or upon admission to the
  243  facility. The discharge plan must identify the intended
  244  discharge site and possible alternative discharge sites. For
  245  each discharge site identified, the discharge plan must identify
  246  the skills, behaviors, and other conditions that the client must
  247  achieve to be appropriate for discharge. Discharge plans must be
  248  reviewed and updated as necessary, but no less often than once
  249  monthly.
  250         (10) As soon as practicable, a transitional living facility
  251  shall discharge a client when he or she no longer requires any
  252  of the specialized services described in s. 400.9971(7) or is
  253  not making measurable progress in accordance with his or her
  254  comprehensive treatment plan, or if the transitional living
  255  facility is no longer the most appropriate, least restrictive
  256  treatment option.
  257         (11) Each transitional living facility shall provide at
  258  least 30 days’ notice to clients of transfer or discharge plans,
  259  including the location of an acceptable transfer location if the
  260  client is unable to live independently. This requirement does
  261  not apply if a client voluntarily terminates residency.
  262         Section 6. Section 400.9974, Florida Statutes, is created
  263  to read:
  264         400.9974 Client comprehensive treatment plans; client
  265  services.—
  266         (1) Each transitional living facility shall develop a
  267  comprehensive treatment plan for each client as soon as
  268  possible, but no later than 30 days following development of the
  269  initial comprehensive treatment plan. Comprehensive treatment
  270  plans must be reviewed and updated if the client fails to meet
  271  projected improvements in the plan or if a significant change in
  272  the client’s condition occurs. Comprehensive treatment plans
  273  must be reviewed and updated at least once monthly.
  274  Comprehensive treatment plans must be developed by an
  275  interdisciplinary team consisting of the case manager, the
  276  program director, the nurse, and appropriate therapists. The
  277  client or, if appropriate, the client’s representative must be
  278  included in developing the comprehensive treatment plan.
  279         (2) The comprehensive treatment plan must include the
  280  following:
  281         (a) The physician’s orders and the client’s diagnosis,
  282  medical history, physical examination, and rehabilitative or
  283  restorative needs.
  284         (b) A preliminary nursing evaluation with physician’s
  285  orders for immediate care, completed on admission.
  286         (c) A comprehensive, accurate, reproducible, and
  287  standardized assessment of the client’s functional capability;
  288  the treatments designed to achieve skills, behaviors, and other
  289  conditions necessary to return to the community; and specific
  290  measurable goals.
  291         (d) Steps necessary for the client to achieve transition to
  292  the community and estimated length of time to achieve the goals.
  293         (3) The client or, if appropriate, the client’s
  294  representative shall consent to the continued treatment at the
  295  transitional living facility. If such consent is not given, the
  296  transitional living facility shall discharge the client as soon
  297  as practicable.
  298         (4) Each client must receive the professional program
  299  services needed to implement the client’s comprehensive
  300  treatment plan.
  301         (5) The licensee must employ qualified professional staff
  302  to carry out and monitor the various professional interventions
  303  in accordance with the stated goals and objectives of every
  304  client’s comprehensive treatment plan.
  305         (6) Each client must receive a continuous treatment program
  306  that includes appropriate, consistent implementation of a
  307  program of specialized and general training, treatment, health
  308  services, and related services which is directed toward:
  309         (a) The acquisition of the behaviors and skills necessary
  310  for the client to function with as much self-determination and
  311  independence as possible;
  312         (b) The prevention or deceleration of regression or loss of
  313  current optimal functional status; and
  314         (c) The management of behavioral issues that preclude
  315  independent functioning in the community.
  316         Section 7. Section 400.9975, Florida Statutes, is created
  317  to read:
  318         400.9975 Licensee responsibilities.—
  319         (1) The licensee shall ensure that each client:
  320         (a) Lives in a safe environment free from abuse, neglect,
  321  and exploitation.
  322         (b) Is treated with consideration and respect and with due
  323  recognition of personal dignity, individuality, and the need for
  324  privacy.
  325         (c) Retains and uses his or her own clothes and other
  326  personal property in his or her immediate living quarters, so as
  327  to maintain individuality and personal dignity, except when the
  328  licensee can demonstrate that such retention and use would be
  329  unsafe, impractical, or an infringement upon the rights of other
  330  clients.
  331         (d) Has unrestricted private communication, including
  332  receiving and sending unopened correspondence, access to a
  333  telephone, and visiting with any person of his or her choice.
  334  Upon request, the licensee shall make provisions to modify
  335  visiting hours for caregivers and guests. The facility shall
  336  restrict communication in accordance with any court order or
  337  written instruction of a client’s representative. Any
  338  restriction on a client’s communication for therapeutic reasons
  339  shall be documented and reviewed at least weekly and shall be
  340  removed as soon as it is no longer clinically indicated. The
  341  basis for the restriction shall be explained to the client and,
  342  if applicable, the client’s representative. The client shall
  343  nonetheless retain the right to call the abuse hotline, the
  344  agency, and Disability Rights Florida at any and all times.
  345         (e) Participates in and benefits from community services
  346  and activities to achieve the highest possible level of
  347  independence, autonomy, and interaction within the community.
  348         (f) Manages his or her financial affairs unless the client
  349  or, if applicable, the client’s representative authorizes the
  350  administrator of the facility to provide safekeeping for funds
  351  as provided in this part.
  352         (g) Has reasonable opportunity for regular exercise several
  353  times a week and to be outdoors at regular and frequent
  354  intervals except when prevented by inclement weather.
  355         (h) Exercises civil and religious liberties, including the
  356  right to independent personal decisions. No religious belief or
  357  practice, including attendance at religious services, shall be
  358  imposed upon any client.
  359         (i) Has access to adequate and appropriate health care
  360  consistent with established and recognized standards within the
  361  community.
  362         (j) Has the ability to present grievances and recommend
  363  changes in policies, procedures, and services to the staff of
  364  the licensee, governing officials, or any other person without
  365  restraint, interference, coercion, discrimination, or reprisal.
  366  Each licensee shall establish a grievance procedure to
  367  facilitate a client’s ability to present grievances, including a
  368  system for investigating, tracking, managing, and responding to
  369  complaints by persons receiving services or individuals acting
  370  on their behalf, and an appeals process. This process must
  371  include access to Disability Rights Florida and other advocates
  372  and the right to be a member of, be active in, and associate
  373  with advocacy or special interest groups.
  374         (2) The licensee shall:
  375         (a) Promote participation of each client’s representative
  376  in the process of providing treatment to the client unless the
  377  representative’s participation is unobtainable or inappropriate.
  378         (b) Answer communications from each client’s family,
  379  guardians, and friends promptly and appropriately.
  380         (c) Promote visits by individuals with a relationship to
  381  the client at any reasonable hour, without requiring prior
  382  notice, or in any area of the facility which provides direct
  383  client care services to the client, consistent with the client’s
  384  and other clients’ privacy, unless the interdisciplinary team
  385  determines that such a visit would not be appropriate.
  386         (d) Promote leave from the facility for visits, trips, or
  387  vacations.
  388         (e) Promptly notify the client’s representative of any
  389  significant incidents or changes in the client’s condition,
  390  including, but not limited to, serious illness, accident, abuse,
  391  unauthorized absence, or death.
  392         (3) The administrator of a facility shall ensure that a
  393  written notice of licensee responsibilities is posted in a
  394  prominent place in each building where clients reside and read
  395  or explained to clients who cannot read. This notice shall
  396  include the statewide toll-free telephone number for reporting
  397  complaints to the agency, must be provided to clients in a
  398  manner that is clearly legible, and must include the words: “To
  399  report a complaint regarding the services you receive, please
  400  call toll-free ...[telephone number]... or Disability Rights
  401  Florida ...[telephone number]...”; and the statewide toll-free
  402  telephone number for the central abuse hotline must be provided
  403  to clients in a manner that is clearly legible and must include
  404  the words: “To report abuse, neglect or exploitation, please
  405  call toll-free ...[telephone number where complaints may be
  406  lodged]....” The licensee must ensure a client’s access to a
  407  telephone, where telephone numbers required in this subsection
  408  are readily available, to call the agency, central abuse
  409  hotline, or Disability Rights Florida.
  410         (4) A licensee or employee of a facility may not serve
  411  notice upon a client to leave the premises or take any other
  412  retaliatory action against any person solely due to the
  413  following:
  414         (a) The client or other person files an internal or
  415  external complaint or grievance regarding the facility.
  416         (b) The client or other person appears as a witness in any
  417  hearing inside or outside the facility.
  418         (5) Before or at the time of admission, the client and the
  419  client’s representative shall be provided with a copy of the
  420  licensee’s responsibilities as provided in this section,
  421  including grievance procedures and the telephone numbers
  422  provided in this section.
  423         (6) The licensee must develop and implement policies and
  424  procedures governing the release of any client information,
  425  including consent necessary from the client or the client’s
  426  representative.
  427         Section 8. Section 400.9976, Florida Statutes, is created
  428  to read:
  429         400.9976 Medication practices.—
  430         (1) An individual medication administration record must be
  431  maintained for each client. Each dose of medication, including a
  432  self-administered dose, shall be properly recorded in the
  433  client’s record. Each client who self-administers medication
  434  shall be given a pill organizer. Medication must be placed in
  435  the pill organizer by a nurse. A nurse shall document the date
  436  and time medication is placed into each client’s pill organizer.
  437  All medications must be administered in compliance with the
  438  physician’s orders.
  439         (2) If the interdisciplinary team determines that self
  440  administration of medications is an appropriate objective, and
  441  if the physician does not specify otherwise, a client must be
  442  taught to self-administer his or her medication without a staff
  443  person. This includes all forms of administration, including
  444  orally, via injection, and via suppository. The client’s
  445  physician must be informed of the interdisciplinary team’s
  446  decision that self-administration of medications is an objective
  447  for the client. A client may not self-administer medication
  448  until he or she demonstrates the competency to take the correct
  449  medication in the correct dosage at the correct time, to respond
  450  to missed doses, and to contact an appropriate person with
  451  questions.
  452         (3) Medication administration discrepancies and adverse
  453  drug reactions must be recorded and reported immediately to a
  454  physician.
  455         Section 9. Section 400.9977, Florida Statutes, is created
  456  to read:
  457         400.9977 Protection from abuse, neglect, mistreatment, and
  458  exploitation.—The licensee must develop and implement policies
  459  and procedures for the screening and training of employees, the
  460  protection of clients, and the prevention, identification,
  461  investigation, and reporting of abuse, neglect, and
  462  exploitation. This includes the licensee’s identification of
  463  clients whose personal histories render them at risk for abusing
  464  other clients, development of intervention strategies to prevent
  465  occurrences, monitoring for changes that would trigger abusive
  466  behavior, and reassessment of the interventions on a regular
  467  basis. A licensee shall implement procedures to:
  468         (1) Screen potential employees for a history of abuse,
  469  neglect, or mistreatment of clients. The screening shall include
  470  an attempt to obtain information from previous employers and
  471  current employers and verification with the appropriate
  472  licensing boards and registries.
  473         (2) Train employees, through orientation and ongoing
  474  sessions, on issues related to abuse prohibition practices,
  475  including identification of abuse, neglect, mistreatment, and
  476  exploitation, appropriate interventions to deal with aggressive
  477  or catastrophic reactions of clients, the process to report
  478  allegations without fear of reprisal, and recognition of signs
  479  of frustration and stress that may lead to abuse.
  480         (3) Provide clients, families, and staff with information
  481  on how and to whom they may report concerns, incidents, and
  482  grievances without the fear of retribution and provide feedback
  483  regarding the concerns that have been expressed. A licensee must
  484  identify, correct, and intervene in situations in which abuse,
  485  neglect, mistreatment, or exploitation is likely to occur,
  486  including:
  487         (a) Evaluating the physical environment of the facility to
  488  identify characteristics that may make abuse or neglect more
  489  likely to occur, such as secluded areas.
  490         (b) Providing sufficient staff on each shift to meet the
  491  needs of the clients, and ensuring that the staff assigned have
  492  knowledge of the individual clients’ care needs. The licensee
  493  shall identify inappropriate behaviors of its staff, such as
  494  using derogatory language, rough handling, ignoring clients
  495  while giving care, and directing clients who need toileting
  496  assistance to urinate or defecate in their beds.
  497         (c) Assessing, planning care for, and monitoring clients
  498  with needs and behaviors that might lead to conflict or neglect,
  499  such as clients with a history of aggressive behaviors, clients
  500  who have behaviors such as entering other clients’ rooms,
  501  clients with self-injurious behaviors, clients with
  502  communication disorders, and clients who require heavy nursing
  503  care or are totally dependent on staff.
  504         (4) Identify events, such as suspicious bruising of
  505  clients, occurrences, patterns, and trends that may constitute
  506  abuse and determine the direction of the investigation.
  507         (5) Investigate different types of incidents, identify the
  508  staff member responsible for the initial reporting, investigate
  509  alleged violations, and report results to the proper
  510  authorities. The licensee must analyze the occurrences to
  511  determine what changes are needed, if any, to policies and
  512  procedures to prevent further occurrences and to take all
  513  necessary corrective action depending on the results of the
  514  investigation.
  515         (6) Protect clients from harm during an investigation.
  516         (7) Report all alleged violations and all substantiated
  517  incidents, as required under chapters 39 and 415, to the
  518  licensing authorities and all other agencies as required and to
  519  report any knowledge it has of any actions by a court of law
  520  that would indicate an employee is unfit for service.
  521         Section 10. Section 400.9978, Florida Statutes, is created
  522  to read:
  523         400.9978 Restraints and seclusion; client safety.—
  524         (1) The use of physical restraints must be ordered and
  525  documented by a physician and must be consistent with policies
  526  and procedures adopted by the facility. The client or, if
  527  applicable, the client’s representative must be informed of the
  528  facility’s physical restraint policies and procedures at the
  529  time of the client’s admission.
  530         (2) The use of chemical restraints is limited to prescribed
  531  dosages of medications as ordered by a physician and must be
  532  consistent with the client’s diagnosis and the policies and
  533  procedures adopted by the facility. The client or, if
  534  applicable, the client’s representative must be informed of the
  535  facility’s chemical restraint policies and procedures at the
  536  time of the client’s admission.
  537         (3) Based on a physician’s assessment, if a client exhibits
  538  symptoms that present an immediate risk of injury or death to
  539  self or others, a physician may issue an emergency treatment
  540  order to immediately administer rapid response psychotropic
  541  medications or other chemical restraints. Each emergency
  542  treatment order must be documented and maintained in the
  543  client’s record.
  544         (a) An emergency treatment order is effective for no more
  545  than 24 hours.
  546         (b) Whenever a client is medicated in accordance with this
  547  subsection, the client’s representative or responsible party and
  548  the client’s physician must be notified as soon as practicable.
  549         (4) A client who is prescribed and receiving a medication
  550  that can serve as a chemical restraint for a purpose other than
  551  an emergency treatment order must be evaluated by his or her
  552  physician at least monthly to assess the following:
  553         (a) The continued need for the medication.
  554         (b) The level of the medication in the client’s blood, as
  555  appropriate.
  556         (c) The need for adjustments in the prescription.
  557         (5) The licensee shall ensure that clients are free from
  558  unnecessary drugs and physical restraints and are provided
  559  treatment to reduce dependency on drugs and physical restraints.
  560         (6) The licensee may use physical restraints only as an
  561  integral part of a client’s comprehensive treatment plan which
  562  is intended to lead to less restrictive means of managing and
  563  eliminating the behavior for which the restraint is applied.
  564         (7) Interventions to manage inappropriate client behavior
  565  must be employed with sufficient safeguards and supervision to
  566  ensure that the safety, welfare, and civil and human rights of
  567  each client are adequately protected.
  568         Section 11. Section 400.9979, Florida Statutes, is created
  569  to read:
  570         400.9979 Background screening; administration and
  571  management.—
  572         (1) The agency shall require level 2 background screening
  573  for personnel as required in s. 408.809(1)(e) pursuant to
  574  chapter 435 and s. 408.809.
  575         (2) The licensee shall maintain personnel records for each
  576  staff member which contain, at a minimum, documentation of
  577  background screening, if applicable, a job description,
  578  documentation of compliance with all training requirements of
  579  this part or applicable rule, the employment application,
  580  references, a copy of all job performance evaluations, and, for
  581  each staff member who performs services for which licensure or
  582  certification is required, a copy of all licenses or
  583  certification held by the staff member.
  584         (3) The licensee must:
  585         (a) Develop and implement infection control policies and
  586  procedures and include such policies and procedures in the
  587  licensee’s policy manual.
  588         (b) Maintain liability insurance as defined in s. 624.605.
  589         (c) Designate one person as an administrator who is
  590  responsible and accountable for the overall management of the
  591  facility.
  592         (d) Designate a person in writing to be responsible for the
  593  facility when the administrator is absent from the facility for
  594  more than 24 hours.
  595         (e) Designate in writing a program director who is
  596  responsible for supervising the therapeutic and behavioral
  597  staff, determining the levels of supervision, and determining
  598  room placement for each client.
  599         (f) Designate in writing a person to be responsible when
  600  the program director is absent from the facility for more than
  601  24 hours.
  602         (g) Obtain approval of the comprehensive emergency
  603  management plan, pursuant to s. 400.9981(2)(e), from the local
  604  emergency management agency. Pending the approval of the plan,
  605  the local emergency management agency shall ensure that the
  606  following agencies, at a minimum, are given the opportunity to
  607  review the plan: the Department of Health, the Agency for Health
  608  Care Administration, and the Division of Emergency Management.
  609  Appropriate volunteer organizations must also be given the
  610  opportunity to review the plan. The local emergency management
  611  agency shall complete its review within 60 days and either
  612  approve the plan or advise the licensee of necessary revisions.
  613         (h) Maintain written records in a form and system that
  614  comply with medical and business practices and make such records
  615  available in the facility for review or submission to the agency
  616  upon request. The records shall include:
  617         1. A daily census record that indicates the number of
  618  clients currently receiving services in the facility, including
  619  information regarding any public funding of such clients.
  620         2. A record of all accidents or unusual incidents involving
  621  any client or staff member that caused, or had the potential to
  622  cause, injury or harm to any person or property within the
  623  facility. Such records must contain a clear description of each
  624  accident or incident, the names of the persons involved, a
  625  description of all medical or other services provided to these
  626  persons specifying who provided such services, and the steps
  627  taken to prevent recurrence of such accidents or incidents.
  628         3. A copy of current agreements with third-party providers.
  629         4. A copy of current agreements with each consultant
  630  employed by the licensee and documentation of each consultant’s
  631  visits and required written, dated reports.
  632         Section 12. Section 400.9980, Florida Statutes, is created
  633  to read:
  634         400.9980 Property and personal affairs of clients.—
  635         (1) A client shall be given the option of using his or her
  636  own belongings, as space permits; choosing his or her roommate
  637  if practical and not clinically contraindicated; and, whenever
  638  possible, unless the client is adjudicated incompetent or
  639  incapacitated under state law, managing his or her own affairs.
  640         (2) The admission of a client to a facility and his or her
  641  presence therein shall not confer on a licensee, administrator,
  642  employee, or representative thereof any authority to manage,
  643  use, or dispose of any property of the client, nor shall such
  644  admission or presence confer on any of such persons any
  645  authority or responsibility for the personal affairs of the
  646  client except that which may be necessary for the safe
  647  management of the facility or for the safety of the client.
  648         (3) A licensee, administrator, employee, or representative
  649  thereof may:
  650         (a) Not act as the guardian, trustee, or conservator for
  651  any client or any of such client’s property.
  652         (b) Act as a competent client’s payee for social security,
  653  veteran’s, or railroad benefits if the client provides consent
  654  and the licensee files a surety bond with the agency in an
  655  amount equal to twice the average monthly aggregate income or
  656  personal funds due to the client, or expendable for the client’s
  657  account, that are received by a licensee.
  658         (c) Act as the power of attorney for a client if the
  659  licensee has filed a surety bond with the agency in an amount
  660  equal to twice the average monthly income of the client, plus
  661  the value of any client’s property under the control of the
  662  attorney in fact.
  664  The bond under paragraph (b) or paragraph (c) shall be executed
  665  by the licensee as principal and a licensed surety company. The
  666  bond shall be conditioned upon the faithful compliance of the
  667  licensee with the requirements of licensure and shall be payable
  668  to the agency for the benefit of any client who suffers a
  669  financial loss as a result of the misuse or misappropriation of
  670  funds held pursuant to this subsection. Any surety company that
  671  cancels or does not renew the bond of any licensee shall notify
  672  the agency in writing not less than 30 days in advance of such
  673  action, giving the reason for the cancellation or nonrenewal.
  674  Any licensee, administrator, employee, or representative thereof
  675  who is granted power of attorney for any client of the facility
  676  shall, on a monthly basis, notify the client in writing of any
  677  transaction made on behalf of the client pursuant to this
  678  subsection, and a copy of such notification given to the client
  679  shall be retained in each client’s file and available for agency
  680  inspection.
  681         (4) A licensee, upon mutual consent with the client, shall
  682  provide for the safekeeping in the facility of the client’s
  683  personal effects of a value not in excess of $1,000 and the
  684  client’s funds not in excess of $500 cash and shall keep
  685  complete and accurate records of all such funds and personal
  686  effects received. If a client is absent from a facility for 24
  687  hours or more, the licensee may provide for the safekeeping of
  688  the client’s personal effects of a value in excess of $1,000.
  689         (5) Any funds or other property belonging to or due to a
  690  client or expendable for his or her account that is received by
  691  licensee shall be trust funds and shall be kept separate from
  692  the funds and property of the licensee and other clients or
  693  shall be specifically credited to such client. Such trust funds
  694  shall be used or otherwise expended only for the account of the
  695  client. At least once every month, unless upon order of a court
  696  of competent jurisdiction, the licensee shall furnish the client
  697  and the client’s representative a complete and verified
  698  statement of all funds and other property to which this
  699  subsection applies, detailing the amount and items received,
  700  together with their sources and disposition. In any event, the
  701  licensee shall furnish such statement annually and upon the
  702  discharge or transfer of a client. Any governmental agency or
  703  private charitable agency contributing funds or other property
  704  to the account of a client shall also be entitled to receive
  705  such statement monthly and upon the discharge or transfer of the
  706  client.
  707         (6)(a) In addition to any damages or civil penalties to
  708  which a person is subject, any person who:
  709         1. Intentionally withholds a client’s personal funds,
  710  personal property, or personal needs allowance, or who demands,
  711  beneficially receives, or contracts for payment of all or any
  712  part of a client’s personal property or personal needs allowance
  713  in satisfaction of the facility rate for supplies and services;
  714  or
  715         2. Borrows from or pledges any personal funds of a client,
  716  other than the amount agreed to by written contract under s.
  717  429.24,
  719  commits a misdemeanor of the first degree, punishable as
  720  provided in s. 775.082 or s. 775.083.
  721         (b) Any licensee, administrator, employee, or
  722  representative thereof who is granted power of attorney for any
  723  client of the facility and who misuses or misappropriates funds
  724  obtained through this power commits a felony of the third
  725  degree, punishable as provided in s. 775.082, s. 775.083, or s.
  726  775.084.
  727         (7) In the event of the death of a client, a licensee shall
  728  return all refunds, funds, and property held in trust to the
  729  client’s personal representative, if one has been appointed at
  730  the time the licensee disburses such funds, or, if not, to the
  731  client’s spouse or adult next of kin named in a beneficiary
  732  designation form provided by the licensee to the client. If the
  733  client has no spouse or adult next of kin or such person cannot
  734  be located, funds due the client shall be placed in an interest
  735  bearing account and all property held in trust by the licensee
  736  shall be safeguarded until such time as the funds and property
  737  are disbursed pursuant to the Florida Probate Code. Such funds
  738  shall be kept separate from the funds and property of the
  739  licensee and other clients of the facility. If the funds of the
  740  deceased client are not disbursed pursuant to the Florida
  741  Probate Code within 2 years after the client’s death, the funds
  742  shall be deposited in the Health Care Trust Fund administered by
  743  the agency.
  744         (8) The agency, by rule, may clarify terms and specify
  745  procedures and documentation necessary to administer the
  746  provisions of this section relating to the proper management of
  747  clients’ funds and personal property and the execution of surety
  748  bonds.
  749         Section 13. Section 400.9981, Florida Statutes, is created
  750  to read:
  751         400.9981 Rules establishing standards.—
  752         (1) It is the intent of the Legislature that rules
  753  published and enforced pursuant to this part and part II of
  754  chapter 408 include criteria to ensure reasonable and consistent
  755  quality of care and client safety. Rules should make reasonable
  756  efforts to accommodate the needs and preferences of clients to
  757  enhance the quality of life in transitional living facilities.
  758         (2) The agency may adopt and enforce rules to implement
  759  this part and part II of chapter 408, which shall include
  760  reasonable and fair criteria in relation to the following:
  761         (a) The location of transitional living facilities.
  762         (b) The number of qualifications of all personnel,
  763  including management, medical, nursing, and other professional
  764  personnel and nursing assistants and support personnel having
  765  responsibility for any part of the care given to clients. The
  766  licensee must have enough qualified professional staff available
  767  to carry out and monitor the various professional interventions
  768  in accordance with the stated goals and objectives of each
  769  comprehensive treatment plan.
  770         (c) Requirements for personnel procedures, insurance
  771  coverage, reporting procedures, and documentation necessary to
  772  implement this part.
  773         (d) Services provided to clients of transitional living
  774  facilities.
  775         (e) The preparation and annual update of a comprehensive
  776  emergency management plan in consultation with the Division of
  777  Emergency Management. At a minimum, the rules must provide for
  778  plan components that address emergency evacuation
  779  transportation; adequate sheltering arrangements; postdisaster
  780  activities, including provision of emergency power, food, and
  781  water; postdisaster transportation; supplies; staffing;
  782  emergency equipment; individual identification of clients and
  783  transfer of records; communication with families; and responses
  784  to family inquiries.
  785         Section 14. Section 400.9982, Florida Statutes, is created
  786  to read:
  787         400.9982 Violations; penalties.—
  788         (1) Each violation of this part and rules adopted pursuant
  789  thereto shall be classified according to the nature of the
  790  violation and the gravity of its probable effect on facility
  791  clients. The agency shall indicate the classification on the
  792  written notice of the violation as follows:
  793         (a) Class “I” violations are defined in s. 408.813. The
  794  agency shall issue a citation regardless of correction and
  795  impose an administrative fine of $5,000 for an isolated
  796  violation, $7,500 for a patterned violation, and $10,000 for a
  797  widespread violation. Violations may be identified and a fine
  798  must be levied notwithstanding the correction of the deficiency
  799  giving rise to the violation.
  800         (b) Class “II” violations are defined in s. 408.813. The
  801  agency shall impose an administrative fine of $1,000 for an
  802  isolated violation, $2,500 for a patterned violation, and $5,000
  803  for a widespread violation. A fine must be levied
  804  notwithstanding the correction of the deficiency giving rise to
  805  the violation.
  806         (c) Class “III” violations are defined in s. 408.813. The
  807  agency shall impose an administrative fine of $500 for an
  808  isolated violation, $750 for a patterned violation, and $1,000
  809  for a widespread violation. If a deficiency giving rise to a
  810  class “III” violation is corrected within the time specified by
  811  the agency, a fine may not be imposed.
  812         (d) Class “IV” violations are defined in s. 408.813. The
  813  agency shall impose an administrative fine for a cited class IV
  814  violation in an amount not less than $100 and not exceeding $200
  815  for each violation.
  816         Section 15. Section 400.9983, Florida Statutes, is created
  817  to read:
  818         400.9983 Receivership proceedings.—The agency may apply s.
  819  429.22 with regard to receivership proceedings for transitional
  820  living facilities.
  821         Section 16. Section 400.9984, Florida Statutes, is created
  822  to read:
  823         400.9984 Interagency communication.—The agency, the
  824  department, the Agency for Persons with Disabilities, and the
  825  Department of Children and Families shall develop electronic
  826  systems to ensure that relevant information pertaining to the
  827  regulation of transitional living facilities and clients is
  828  timely and effectively communicated among agencies in order to
  829  facilitate the protection of clients. Electronic sharing of
  830  information shall include, at a minimum, a brain and spinal cord
  831  injury registry and a client abuse registry.
  832         Section 17. Section 400.805, Florida Statutes, is repealed.
  833  Every transitional living facility licensed under s. 400.805 on
  834  or before July 1, 2013, shall be licensed under the provisions
  835  of this act.
  836         Section 18. Subsection (9) of section 381.745, Florida
  837  Statutes, is amended to read:
  838         381.745 Definitions; ss. 381.739-381.79.—As used in ss.
  839  381.739-381.79, the term:
  840         (9) “Transitional living facility” means a state-approved
  841  facility, as defined and licensed under chapter 400 or chapter
  842  429, or a facility approved by the brain and spinal cord injury
  843  program in accordance with this chapter.
  844         Section 19. Section 381.75, Florida Statutes, is amended to
  845  read:
  846         381.75 Duties and responsibilities of the department, of
  847  transitional living facilities, and of residents.—Consistent
  848  with the mandate of s. 381.7395, the department shall develop
  849  and administer a multilevel treatment program for individuals
  850  who sustain brain or spinal cord injuries and who are referred
  851  to the brain and spinal cord injury program.
  852         (1) Within 15 days after any report of an individual who
  853  has sustained a brain or spinal cord injury, the department
  854  shall notify the individual or the most immediate available
  855  family members of their right to assistance from the state, the
  856  services available, and the eligibility requirements.
  857         (2) The department shall refer individuals who have brain
  858  or spinal cord injuries to other state agencies to assure that
  859  rehabilitative services, if desired, are obtained by that
  860  individual.
  861         (3) The department, in consultation with emergency medical
  862  service, shall develop standards for an emergency medical
  863  evacuation system that will ensure that all individuals who
  864  sustain traumatic brain or spinal cord injuries are transported
  865  to a department-approved trauma center that meets the standards
  866  and criteria established by the emergency medical service and
  867  the acute-care standards of the brain and spinal cord injury
  868  program.
  869         (4) The department shall develop standards for designation
  870  of rehabilitation centers to provide rehabilitation services for
  871  individuals who have brain or spinal cord injuries.
  872         (5) The department shall determine the appropriate number
  873  of designated acute-care facilities, inpatient rehabilitation
  874  centers, and outpatient rehabilitation centers, needed based on
  875  incidence, volume of admissions, and other appropriate criteria.
  876         (6) The department shall develop standards for designation
  877  of transitional living facilities to provide transitional living
  878  services for individuals who participate in the brain and spinal
  879  cord injury program the opportunity to adjust to their
  880  disabilities and to develop physical and functional skills in a
  881  supported living environment.
  882         (a) The Agency for Health Care Administration, in
  883  consultation with the department, shall develop rules for the
  884  licensure of transitional living facilities for individuals who
  885  have brain or spinal cord injuries.
  886         (b) The goal of a transitional living program for
  887  individuals who have brain or spinal cord injuries is to assist
  888  each individual who has such a disability to achieve a higher
  889  level of independent functioning and to enable that person to
  890  reenter the community. The program shall be focused on preparing
  891  participants to return to community living.
  892         (c) A transitional living facility for an individual who
  893  has a brain or spinal cord injury shall provide to such
  894  individual, in a residential setting, a goal-oriented treatment
  895  program designed to improve the individual’s physical,
  896  cognitive, communicative, behavioral, psychological, and social
  897  functioning, as well as to provide necessary support and
  898  supervision. A transitional living facility shall offer at least
  899  the following therapies: physical, occupational, speech,
  900  neuropsychology, independent living skills training, behavior
  901  analysis for programs serving brain-injured individuals, health
  902  education, and recreation.
  903         (d) All residents shall use the transitional living
  904  facility as a temporary measure and not as a permanent home or
  905  domicile. The transitional living facility shall develop an
  906  initial treatment plan for each resident within 3 days after the
  907  resident’s admission. The transitional living facility shall
  908  develop a comprehensive plan of treatment and a discharge plan
  909  for each resident as soon as practical, but no later than 30
  910  days after the resident’s admission. Each comprehensive
  911  treatment plan and discharge plan must be reviewed and updated
  912  as necessary, but no less often than quarterly. This subsection
  913  does not require the discharge of an individual who continues to
  914  require any of the specialized services described in paragraph
  915  (c) or who is making measurable progress in accordance with that
  916  individual’s comprehensive treatment plan. The transitional
  917  living facility shall discharge any individual who has an
  918  appropriate discharge site and who has achieved the goals of his
  919  or her discharge plan or who is no longer making progress toward
  920  the goals established in the comprehensive treatment plan and
  921  the discharge plan. The discharge location must be the least
  922  restrictive environment in which an individual’s health, well
  923  being, and safety is preserved.
  924         (7) Recipients of services, under this section, from any of
  925  the facilities referred to in this section shall pay a fee based
  926  on ability to pay.
  927         Section 20. Subsection (4) of section 381.78, Florida
  928  Statutes, is amended to read:
  929         381.78 Advisory council on brain and spinal cord injuries.—
  930         (4) The council shall:
  931         (a) provide advice and expertise to the department in the
  932  preparation, implementation, and periodic review of the brain
  933  and spinal cord injury program.
  934         (b) Annually appoint a five-member committee composed of
  935  one individual who has a brain injury or has a family member
  936  with a brain injury, one individual who has a spinal cord injury
  937  or has a family member with a spinal cord injury, and three
  938  members who shall be chosen from among these representative
  939  groups: physicians, other allied health professionals,
  940  administrators of brain and spinal cord injury programs, and
  941  representatives from support groups with expertise in areas
  942  related to the rehabilitation of individuals who have brain or
  943  spinal cord injuries, except that one and only one member of the
  944  committee shall be an administrator of a transitional living
  945  facility. Membership on the council is not a prerequisite for
  946  membership on this committee.
  947         1. The committee shall perform onsite visits to those
  948  transitional living facilities identified by the Agency for
  949  Health Care Administration as being in possible violation of the
  950  statutes and rules regulating such facilities. The committee
  951  members have the same rights of entry and inspection granted
  952  under s. 400.805(4) to designated representatives of the agency.
  953         2. Factual findings of the committee resulting from an
  954  onsite investigation of a facility pursuant to subparagraph 1.
  955  shall be adopted by the agency in developing its administrative
  956  response regarding enforcement of statutes and rules regulating
  957  the operation of the facility.
  958         3. Onsite investigations by the committee shall be funded
  959  by the Health Care Trust Fund.
  960         4. Travel expenses for committee members shall be
  961  reimbursed in accordance with s. 112.061.
  962         5. Members of the committee shall recuse themselves from
  963  participating in any investigation that would create a conflict
  964  of interest under state law, and the council shall replace the
  965  member, either temporarily or permanently.
  966         Section 21. This act shall take effect July 1, 2013.