Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 1592
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Children, Families, and Elder Affairs (Harrell)
       recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Present subsections (6) through (27) of section
    6  429.02, Florida Statutes, are redesignated as subsections (7)
    7  through (28), respectively, present subsections (13), (18), and
    8  (27) of that section are amended, and a new subsection (6) is
    9  added to that section, to read:
   10         429.02 Definitions.—When used in this part, the term:
   11         (6) “Assistive device” means any device designed or adapted
   12  to help a resident perform an action, a task, an activity of
   13  daily living, or a transfer; prevent a fall; or recover from a
   14  fall. The term does not include a total body lift or a motorized
   15  sit-to-stand lift, with the exception of a chair lift or
   16  recliner lift that a resident is able to operate independently.
   17         (14)(13) “Limited nursing services” means acts that may be
   18  performed by a person licensed under part I of chapter 464.
   19  Limited nursing services shall be for persons who meet the
   20  admission criteria established by the department for assisted
   21  living facilities and shall not be complex enough to require 24
   22  hour nursing supervision and may include such services as the
   23  application and care of routine dressings, and care of casts,
   24  braces, and splints.
   25         (19)(18) “Physical restraint” means a device that which
   26  physically limits, restricts, or deprives an individual of
   27  movement or mobility, including, but not limited to, a half-bed
   28  rail, a full-bed rail, a geriatric chair, and a posey restraint.
   29  The term “physical restraint” shall also include any device that
   30  is which was not specifically manufactured as a restraint but is
   31  which has been altered, arranged, or otherwise used for that
   32  this purpose. The term does shall not include any device that
   33  the resident chooses to use and is able to remove or avoid
   34  independently, or any bandage material used for the purpose of
   35  binding a wound or injury.
   36         (27) “Twenty-four-hour nursing supervision” means services
   37  that are ordered by a physician for a resident whose condition
   38  requires the supervision of a physician and continued monitoring
   39  of vital signs and physical status. Such services shall be:
   40  medically complex enough to require constant supervision,
   41  assessment, planning, or intervention by a nurse; required to be
   42  performed by or under the direct supervision of licensed nursing
   43  personnel or other professional personnel for safe and effective
   44  performance; required on a daily basis; and consistent with the
   45  nature and severity of the resident’s condition or the disease
   46  state or stage.
   47         Section 2. Subsection (7) of section 429.11, Florida
   48  Statutes, is amended to read:
   49         429.11 Initial application for license; provisional
   50  license.—
   51         (7) A county or municipality may not issue a business tax
   52  receipt an occupational license that is being obtained for the
   53  purpose of operating a facility regulated under this part
   54  without first ascertaining that the applicant has been licensed
   55  to operate such facility at the specified location or locations
   56  by the agency. The agency shall furnish to local agencies
   57  responsible for issuing business tax receipts occupational
   58  licenses sufficient instruction for making such determinations.
   59         Section 3. Section 429.176, Florida Statutes, is amended to
   60  read:
   61         429.176 Notice of change of administrator.—If, during the
   62  period for which a license is issued, the owner changes
   63  administrators, the owner must notify the agency of the change
   64  within 10 days and provide documentation within 90 days that the
   65  new administrator meets educational requirements and has
   66  completed the applicable core educational and core competency
   67  test requirements under s. 429.52. A facility may not be
   68  operated for more than 120 consecutive days without an
   69  administrator who has completed the core training and core
   70  competency test educational requirements.
   71         Section 4. Subsections (3) through (9) of section 429.23,
   72  Florida Statutes, are amended to read:
   73         429.23 Internal risk management and quality assurance
   74  program; adverse incidents and reporting requirements.—
   75         (3) Licensed facilities shall initiate an investigation
   76  provide within 24 hours after 1 business day after the
   77  occurrence of an adverse incident, by electronic mail,
   78  facsimile, or United States mail, a preliminary report to the
   79  agency on all adverse incidents specified under this section.
   80  The facility must complete the investigation and submit a report
   81  to the agency within 15 days after the occurrence of the adverse
   82  incident. The report must include information regarding the
   83  identity of the affected resident, the type of adverse incident,
   84  and the result status of the facility’s investigation of the
   85  incident.
   86         (4)Licensed facilities shall provide within 15 days, by
   87  electronic mail, facsimile, or United States mail, a full report
   88  to the agency on all adverse incidents specified in this
   89  section. The report must include the results of the facility’s
   90  investigation into the adverse incident.
   91         (5)Each facility shall report monthly to the agency any
   92  liability claim filed against it. The report must include the
   93  name of the resident, the dates of the incident leading to the
   94  claim, if applicable, and the type of injury or violation of
   95  rights alleged to have occurred. This report is not discoverable
   96  in any civil or administrative action, except in such actions
   97  brought by the agency to enforce the provisions of this part.
   98         (4)(6) Abuse, neglect, or exploitation must be reported to
   99  the Department of Children and Families as required under
  100  chapter 415.
  101         (5)(7) The information reported to the agency pursuant to
  102  subsection (3) which relates to persons licensed under chapter
  103  458, chapter 459, chapter 461, chapter 464, or chapter 465 shall
  104  be reviewed by the agency. The agency shall determine whether
  105  any of the incidents potentially involved conduct by a health
  106  care professional who is subject to disciplinary action, in
  107  which case the provisions of s. 456.073 apply. The agency may
  108  investigate, as it deems appropriate, any such incident and
  109  prescribe measures that must or may be taken in response to the
  110  incident. The agency shall review each incident and determine
  111  whether it potentially involved conduct by a health care
  112  professional who is subject to disciplinary action, in which
  113  case the provisions of s. 456.073 apply.
  114         (6)(8) If the agency, through its receipt of the adverse
  115  incident report reports prescribed in this part or through any
  116  investigation, has reasonable belief that conduct by a staff
  117  member or employee of a licensed facility is grounds for
  118  disciplinary action by the appropriate board, the agency shall
  119  report this fact to such regulatory board.
  120         (7)(9) The adverse incident report reports and preliminary
  121  adverse incident reports required under this section is are
  122  confidential as provided by law and are not discoverable or
  123  admissible in any civil or administrative action, except in
  124  disciplinary proceedings by the agency or appropriate regulatory
  125  board.
  126         Section 5. Paragraphs (a) and (b) of subsection (1) of
  127  section 429.255, Florida Statutes, are amended, and paragraph
  128  (d) is added to that subsection, to read:
  129         429.255 Use of personnel; emergency care.—
  130         (1)(a) Persons under contract to the facility, facility
  131  staff, or volunteers, who are licensed according to part I of
  132  chapter 464, or those persons exempt under s. 464.022(1), and
  133  others as defined by rule, may administer medications to
  134  residents, take residents’ vital signs, manage individual weekly
  135  pill organizers for residents who self-administer medication,
  136  give prepackaged enemas ordered by a physician, observe
  137  residents, document observations on the appropriate resident’s
  138  record, and report observations to the resident’s physician, and
  139  contract or allow residents or a resident’s representative,
  140  designee, surrogate, guardian, or attorney in fact to contract
  141  with a third party, provided residents meet the criteria for
  142  appropriate placement as defined in s. 429.26. Nursing
  143  assistants certified pursuant to part II of chapter 464 may take
  144  residents’ vital signs as directed by a licensed nurse or
  145  physician.
  146         (b) All staff of in facilities licensed under this part
  147  shall exercise their professional responsibility to observe
  148  residents, to document observations on the appropriate
  149  resident’s record, and to report the observations to the
  150  resident’s physician. However, the owner or administrator of the
  151  facility shall be responsible for determining that the resident
  152  receiving services is appropriate for residence in the facility.
  153         (d) A resident or a resident’s representative, designee,
  154  surrogate, guardian, or attorney in fact may contract for
  155  services with a third party, provided the resident meets the
  156  criteria for continued residency as provided in s. 429.26. The
  157  third party must communicate with the facility regarding the
  158  resident’s condition and the services being provided. The
  159  facility must document that it received such communication.
  160         Section 6. Subsection (2), paragraph (b) of subsection (3),
  161  and paragraphs (e), (f), and (g) of subsection (4) of section
  162  429.256, Florida Statutes, are amended to read:
  163         429.256 Assistance with self-administration of medication.—
  164         (2) Residents who are capable of self-administering their
  165  own medications without assistance shall be encouraged and
  166  allowed to do so. However, an unlicensed person may, consistent
  167  with a dispensed prescription’s label or the package directions
  168  of an over-the-counter medication, assist a resident whose
  169  condition is medically stable with the self-administration of
  170  routine, regularly scheduled medications that are intended to be
  171  self-administered. Assistance with self-medication by an
  172  unlicensed person may occur only upon a documented request by,
  173  and the written informed consent of, a resident or the
  174  resident’s surrogate, guardian, or attorney in fact. For the
  175  purposes of this section, self-administered medications include
  176  both legend and over-the-counter oral dosage forms, topical
  177  dosage forms and topical skin, ophthalmic, otic, and nasal
  178  dosage forms, including patches, solutions, suspensions, sprays,
  179  and inhalers.
  180         (3) Assistance with self-administration of medication
  181  includes:
  182         (b) In the presence of the resident, confirming that the
  183  medication is intended for that resident, orally advising the
  184  resident of the medication name and purpose reading the label,
  185  opening the container, removing a prescribed amount of
  186  medication from the container, and closing the container.
  187         (4) Assistance with self-administration does not include:
  188         (e) The use of irrigations or debriding agents used in the
  189  treatment of a skin condition.
  190         (f) Assisting with rectal, urethral, or vaginal
  191  preparations.
  192         (g) Assisting with medications ordered by the physician or
  193  health care professional with prescriptive authority to be given
  194  “as needed,” unless the order is written with specific
  195  parameters that preclude independent judgment on the part of the
  196  unlicensed person, and the at the request of a competent
  197  resident requesting the medication is aware of his or her need
  198  for the medication and understands the purpose of taking the
  199  medication.
  200         Section 7. Section 429.26, Florida Statutes, is amended to
  201  read:
  202         429.26 Appropriateness of placements; examinations of
  203  residents.—
  204         (1) The owner or administrator of a facility is responsible
  205  for determining the appropriateness of admission of an
  206  individual to the facility and for determining the continued
  207  appropriateness of residence of an individual in the facility. A
  208  determination must shall be based upon an evaluation assessment
  209  of the strengths, needs, and preferences of the resident, a
  210  medical examination, the care and services offered or arranged
  211  for by the facility in accordance with facility policy, and any
  212  limitations in law or rule related to admission criteria or
  213  continued residency for the type of license held by the facility
  214  under this part. The following criteria apply to the
  215  determination of appropriateness for residency and continued
  216  residency of an individual in a facility:
  217         (a) A facility may admit or retain a resident who receives
  218  a health care service or treatment that is designed to be
  219  provided within a private residential setting if all
  220  requirements for providing that service or treatment are met by
  221  the facility or a third party.
  222         (b) A facility may admit or retain a resident who requires
  223  the use of assistive devices.
  224         (c) A facility may admit or retain an individual receiving
  225  hospice services if the arrangement is agreed to by the facility
  226  and the resident, additional care is provided by a licensed
  227  hospice, and the resident is under the care of a physician who
  228  agrees that the physical needs of the resident can be met at the
  229  facility. A facility may not retain a resident who requires 24
  230  hour nursing supervision, except for a resident who is enrolled
  231  in hospice services pursuant to part IV of chapter 400. The
  232  resident must have a plan of care that delineates how the
  233  facility and the hospice will meet the scheduled and unscheduled
  234  needs of the resident.
  235         (d)1. Except as provided in paragraph (c), a facility may
  236  not admit or retain a resident who is bedridden. For purposes of
  237  this paragraph, the term “bedridden” means that a resident is
  238  confined to bed because of the inability to:
  239         a.Move, turn, or reposition without total physical
  240  assistance;
  241         b.Transfer to a chair or wheelchair without total physical
  242  assistance;
  243         c.Sit safely in a chair or wheelchair without personal
  244  assistance or a physical restraint.
  245         2.A resident may continue to reside in a facility if,
  246  during residency, he or she is bedridden for no more than 7
  247  consecutive days.
  248         3.If a facility is licensed to provide extended congregate
  249  care, a resident may continue to reside in a facility if, during
  250  residency, he or she is bedridden for no more than 14
  251  consecutive days.
  252         (2) A resident may not be moved from one facility to
  253  another without consultation with and agreement from the
  254  resident or, if applicable, the resident’s representative or
  255  designee or the resident’s family, guardian, surrogate, or
  256  attorney in fact. In the case of a resident who has been placed
  257  by the department or the Department of Children and Families,
  258  the administrator must notify the appropriate contact person in
  259  the applicable department.
  260         (3)(2) A physician, physician assistant, or advanced
  261  practice registered nurse practitioner who is employed by an
  262  assisted living facility to provide an initial examination for
  263  admission purposes may not have financial interest in the
  264  facility.
  265         (4)(3) Persons licensed under part I of chapter 464 who are
  266  employed by or under contract with a facility shall, on a
  267  routine basis or at least monthly, perform a nursing assessment
  268  of the residents for whom they are providing nursing services
  269  ordered by a physician, except administration of medication, and
  270  shall document such assessment, including any substantial
  271  changes in a resident’s status which may necessitate relocation
  272  to a nursing home, hospital, or specialized health care
  273  facility. Such records shall be maintained in the facility for
  274  inspection by the agency and shall be forwarded to the
  275  resident’s case manager, if applicable.
  276         (5)(4)If possible, Each resident must shall have been
  277  examined by a licensed physician, a licensed physician
  278  assistant, or a licensed advanced practice registered nurse
  279  practitioner within 60 days before admission to the facility or
  280  within 30 days after admission to the facility, except as
  281  provided in s. 429.07. The information from the medical
  282  examination must be recorded on the practitioner’s form or on a
  283  form adopted by agency rule. The signed and completed medical
  284  examination form, signed by the practitioner, must report shall
  285  be submitted to the owner or administrator of the facility, who
  286  shall use the information contained therein to assist in the
  287  determination of the appropriateness of the resident’s admission
  288  to or and continued stay in the facility. The medical
  289  examination form becomes report shall become a permanent part of
  290  the facility’s record of the resident at the facility and must
  291  shall be made available to the agency during inspection or upon
  292  request. An assessment that has been completed through the
  293  Comprehensive Assessment and Review for Long-Term Care Services
  294  (CARES) Program fulfills the requirements for a medical
  295  examination under this subsection and s. 429.07(3)(b)6.
  296         (6)The medical examination form submitted under subsection
  297  (5) must include the following information relating to the
  298  resident:
  299         (a)Height, weight, and known allergies.
  300         (b)Significant medical history and diagnoses.
  301         (c)Physical or sensory limitations, including the need for
  302  fall precautions or recommended use of assistive devices.
  303         (d)Cognitive or behavioral status and a brief description
  304  of any behavioral issues known or ascertained by the examining
  305  practitioner, including any known history of wandering or
  306  elopement.
  307         (e)Nursing, treatment, or therapy service requirements.
  308         (f)Whether assistance is needed for ambulating, eating,
  309  and transferring.
  310         (g)Special dietary instructions.
  311         (h)Whether he or she has any communicable diseases,
  312  including necessary precautions.
  313         (i)Whether he or she is bedridden and the status of any
  314  pressure sores that he or she has.
  315         (j)Whether the resident needs 24-hour nursing or
  316  psychiatric care.
  317         (k)A list of current prescribed medications as known or
  318  ascertained by the examining practitioner and whether the
  319  resident can self-administer medications, needs assistance, or
  320  needs medication administration.
  321         (5)Except as provided in s. 429.07, if a medical
  322  examination has not been completed within 60 days before the
  323  admission of the resident to the facility, a licensed physician,
  324  licensed physician assistant, or licensed nurse practitioner
  325  shall examine the resident and complete a medical examination
  326  form provided by the agency within 30 days following the
  327  admission to the facility to enable the facility owner or
  328  administrator to determine the appropriateness of the admission.
  329  The medical examination form shall become a permanent part of
  330  the record of the resident at the facility and shall be made
  331  available to the agency during inspection by the agency or upon
  332  request.
  333         (7)(6) Any resident accepted in a facility and placed by
  334  the department or the Department of Children and Families must
  335  shall have been examined by medical personnel within 30 days
  336  before placement in the facility. The examination must shall
  337  include an assessment of the appropriateness of placement in a
  338  facility. The findings of this examination must shall be
  339  recorded on the examination form provided by the agency. The
  340  completed form must shall accompany the resident and shall be
  341  submitted to the facility owner or administrator. Additionally,
  342  in the case of a mental health resident, the Department of
  343  Children and Families must provide documentation that the
  344  individual has been assessed by a psychiatrist, clinical
  345  psychologist, clinical social worker, or psychiatric nurse, or
  346  an individual who is supervised by one of these professionals,
  347  and determined to be appropriate to reside in an assisted living
  348  facility. The documentation must be in the facility within 30
  349  days after the mental health resident has been admitted to the
  350  facility. An evaluation completed upon discharge from a state
  351  mental hospital meets the requirements of this subsection
  352  related to appropriateness for placement as a mental health
  353  resident providing it was completed within 90 days prior to
  354  admission to the facility. The applicable Department of Children
  355  and Families shall provide to the facility administrator any
  356  information about the resident which that would help the
  357  administrator meet his or her responsibilities under subsection
  358  (1). Further, Department of Children and Families personnel
  359  shall explain to the facility operator any special needs of the
  360  resident and advise the operator whom to call should problems
  361  arise. The applicable Department of Children and Families shall
  362  advise and assist the facility administrator when where the
  363  special needs of residents who are recipients of optional state
  364  supplementation require such assistance.
  365         (8)(7) The facility shall must notify a licensed physician
  366  in writing when a resident exhibits signs of dementia or
  367  cognitive impairment or has a change of condition in order to
  368  rule out the presence of an underlying physiological condition
  369  that may be contributing to such dementia or impairment. The
  370  notification must occur within 30 days after the acknowledgment
  371  of such signs by facility staff. If an underlying condition is
  372  determined to exist, the facility must notify the resident’s
  373  representative or designee in writing of the need for health
  374  care services and may assist in making appointments for shall
  375  arrange, with the appropriate health care provider, the
  376  necessary care and services to treat the condition.
  377         (9)(8) The Department of Children and Families may require
  378  an examination for supplemental security income and optional
  379  state supplementation recipients residing in facilities at any
  380  time and shall provide the examination whenever a resident’s
  381  condition requires it. Any facility administrator; personnel of
  382  the agency, the department, or the Department of Children and
  383  Families; or a representative of the State Long-Term Care
  384  Ombudsman Program who believes a resident needs to be evaluated
  385  shall notify the resident’s case manager, who shall take
  386  appropriate action. A report of the examination findings must
  387  shall be provided to the resident’s case manager and the
  388  facility administrator to help the administrator meet his or her
  389  responsibilities under subsection (1).
  390         (9)A terminally ill resident who no longer meets the
  391  criteria for continued residency may remain in the facility if
  392  the arrangement is mutually agreeable to the resident and the
  393  facility; additional care is rendered through a licensed
  394  hospice, and the resident is under the care of a physician who
  395  agrees that the physical needs of the resident are being met.
  396         (10) Facilities licensed to provide extended congregate
  397  care services shall promote aging in place by determining
  398  appropriateness of continued residency based on a comprehensive
  399  review of the resident’s physical and functional status; the
  400  ability of the facility, family members, friends, or any other
  401  pertinent individuals or agencies to provide the care and
  402  services required; and documentation that a written service plan
  403  consistent with facility policy has been developed and
  404  implemented to ensure that the resident’s needs and preferences
  405  are addressed.
  406         (11)No resident who requires 24-hour nursing supervision,
  407  except for a resident who is an enrolled hospice patient
  408  pursuant to part IV of chapter 400, shall be retained in a
  409  facility licensed under this part.
  410         Section 8. Paragraphs (a) and (k) of subsection (1) and
  411  subsection (3) of section 429.28, Florida Statutes, are amended
  412  to read:
  413         429.28 Resident bill of rights.—
  414         (1) No resident of a facility shall be deprived of any
  415  civil or legal rights, benefits, or privileges guaranteed by
  416  law, the Constitution of the State of Florida, or the
  417  Constitution of the United States as a resident of a facility.
  418  Every resident of a facility shall have the right to:
  419         (a) Live in a safe and decent living environment, free from
  420  abuse, exploitation, and neglect.
  421         (k) At least 45 days’ notice of relocation or termination
  422  of residency from the facility unless, for medical reasons, the
  423  resident is certified by a physician to require an emergency
  424  relocation to a facility providing a more skilled level of care
  425  or the resident engages in a pattern of conduct that is harmful
  426  or offensive to other residents. In the case of a resident who
  427  has been adjudicated mentally incapacitated, the guardian shall
  428  be given at least 45 days’ notice of a nonemergency relocation
  429  or residency termination. Reasons for relocation must shall be
  430  set forth in writing and provided to the resident or the
  431  resident’s legal representative. The written notice must contain
  432  the following disclosure in 12-point uppercase type:
  437         0404 OR VIA E-MAIL AT LTCOPInformer@elderaffairs.org.
  438  In order for a facility to terminate the residency of an
  439  individual without notice as provided herein, the facility shall
  440  show good cause in a court of competent jurisdiction.
  441         (3)(a) The agency shall conduct a survey to determine
  442  general compliance with facility standards and compliance with
  443  residents’ rights as a prerequisite to initial licensure or
  444  licensure renewal. The agency shall adopt rules for uniform
  445  standards and criteria that will be used to determine compliance
  446  with facility standards and compliance with residents’ rights.
  447         (b) In order to determine whether the facility is
  448  adequately protecting residents’ rights, the licensure renewal
  449  biennial survey must shall include private informal
  450  conversations with a sample of residents and consultation with
  451  the ombudsman council in the district in which the facility is
  452  located to discuss residents’ experiences within the facility.
  453         Section 9. Section 429.41, Florida Statutes, is amended to
  454  read:
  455         429.41 Rules establishing standards.—
  456         (1) It is the intent of the Legislature that rules
  457  published and enforced pursuant to this section shall include
  458  criteria by which a reasonable and consistent quality of
  459  resident care and quality of life may be ensured and the results
  460  of such resident care may be demonstrated. Such rules shall also
  461  promote ensure a safe and sanitary environment that is
  462  residential and noninstitutional in design or nature and may
  463  allow for technological advances in the provision of care,
  464  safety, and security, including the use of devices, equipment
  465  and other security measures related to wander management,
  466  emergency response, staff risk management, and the general
  467  safety and security of residents, staff, and the facility. It is
  468  further intended that reasonable efforts be made to accommodate
  469  the needs and preferences of residents to enhance the quality of
  470  life in a facility. Uniform firesafety standards for assisted
  471  living facilities shall be established by the State Fire Marshal
  472  pursuant to s. 633.206. The agency, in consultation with the
  473  department, may adopt rules to administer the requirements of
  474  part II of chapter 408. In order to provide safe and sanitary
  475  facilities and the highest quality of resident care
  476  accommodating the needs and preferences of residents, The
  477  department, in consultation with the agency, the Department of
  478  Children and Families, and the Department of Health, shall adopt
  479  rules, policies, and procedures to administer this part, which
  480  must include reasonable and fair minimum standards in relation
  481  to:
  482         (a) The requirements for and maintenance and the sanitary
  483  condition of facilities, not in conflict with, or duplicative
  484  of, the requirements in chapter 553 or chapter 381, relating to
  485  furnishings for resident bedrooms or sleeping areas, locking
  486  devices, linens, laundry services plumbing, heating, cooling,
  487  lighting, ventilation, living space, and similar physical plant
  488  standards other housing conditions, which will promote ensure
  489  the health, safety, and welfare comfort of residents suitable to
  490  the size of the structure. The rules must clearly delineate the
  491  respective responsibilities of the agency’s licensure and survey
  492  staff and the county health departments and ensure that
  493  inspections are not duplicative. The agency may collect fees for
  494  food service inspections conducted by county health departments
  495  and may transfer such fees to the Department of Health.
  496         1.Firesafety evacuation capability determination.—An
  497  evacuation capability evaluation for initial licensure shall be
  498  conducted within 6 months after the date of licensure.
  499         2.Firesafety requirements.—
  500         a.The National Fire Protection Association, Life Safety
  501  Code, NFPA 101 and 101A, current editions, shall be used in
  502  determining the uniform firesafety code adopted by the State
  503  Fire Marshal for assisted living facilities, pursuant to s.
  504  633.206.
  505         b.A local government or a utility may charge fees only in
  506  an amount not to exceed the actual expenses incurred by the
  507  local government or the utility relating to the installation and
  508  maintenance of an automatic fire sprinkler system in a licensed
  509  assisted living facility structure.
  510         c.All licensed facilities must have an annual fire
  511  inspection conducted by the local fire marshal or authority
  512  having jurisdiction.
  513         d.An assisted living facility that is issued a building
  514  permit or certificate of occupancy before July 1, 2016, may at
  515  its option and after notifying the authority having
  516  jurisdiction, remain under the provisions of the 1994 and 1995
  517  editions of the National Fire Protection Association, Life
  518  Safety Code, NFPA 101, and NFPA 101A. The facility opting to
  519  remain under such provisions may make repairs, modernizations,
  520  renovations, or additions to, or rehabilitate, the facility in
  521  compliance with NFPA 101, 1994 edition, and may utilize the
  522  alternative approaches to life safety in compliance with NFPA
  523  101A, 1995 edition. However, a facility for which a building
  524  permit or certificate of occupancy is issued before July 1,
  525  2016, that undergoes Level III building alteration or
  526  rehabilitation, as defined in the Florida Building Code, or
  527  seeks to utilize features not authorized under the 1994 or 1995
  528  editions of the Life Safety Code must thereafter comply with all
  529  aspects of the uniform firesafety standards established under s.
  530  633.206, and the Florida Fire Prevention Code, in effect for
  531  assisted living facilities as adopted by the State Fire Marshal.
  532         3.Resident elopement requirements.—Facilities are required
  533  to conduct a minimum of two resident elopement prevention and
  534  response drills per year. All administrators and direct care
  535  staff must participate in the drills which shall include a
  536  review of procedures to address resident elopement. Facilities
  537  must document the implementation of the drills and ensure that
  538  the drills are conducted in a manner consistent with the
  539  facility’s resident elopement policies and procedures.
  540         (b) The preparation and annual update of a comprehensive
  541  emergency management plan. Such standards must be included in
  542  the rules adopted by the department after consultation with the
  543  Division of Emergency Management. At a minimum, the rules must
  544  provide for plan components that address emergency evacuation
  545  transportation; adequate sheltering arrangements; postdisaster
  546  activities, including provision of emergency power, food, and
  547  water; postdisaster transportation; supplies; staffing;
  548  emergency equipment; individual identification of residents and
  549  transfer of records; communication with families; and responses
  550  to family inquiries. The comprehensive emergency management plan
  551  is subject to review and approval by the local emergency
  552  management agency. During its review, the local emergency
  553  management agency shall ensure that the following agencies, at a
  554  minimum, are given the opportunity to review the plan: the
  555  Department of Elderly Affairs, the Department of Health, the
  556  Agency for Health Care Administration, and the Division of
  557  Emergency Management. Also, appropriate volunteer organizations
  558  must be given the opportunity to review the plan. The local
  559  emergency management agency shall complete its review within 60
  560  days and either approve the plan or advise the facility of
  561  necessary revisions.
  562         (c) The number, training, and qualifications of all
  563  personnel having responsibility for the care of residents. The
  564  rules must require adequate staff to provide for the safety of
  565  all residents. Facilities licensed for 17 or more residents are
  566  required to maintain an alert staff for 24 hours per day.
  567         (d)All sanitary conditions within the facility and its
  568  surroundings which will ensure the health and comfort of
  569  residents. The rules must clearly delineate the responsibilities
  570  of the agency’s licensure and survey staff, the county health
  571  departments, and the local authority having jurisdiction over
  572  firesafety and ensure that inspections are not duplicative. The
  573  agency may collect fees for food service inspections conducted
  574  by the county health departments and transfer such fees to the
  575  Department of Health.
  576         (d)(e) License application and license renewal, transfer of
  577  ownership, proper management of resident funds and personal
  578  property, surety bonds, resident contracts, refund policies,
  579  financial ability to operate, and facility and staff records.
  580         (e)(f) Inspections, complaint investigations, moratoriums,
  581  classification of deficiencies, levying and enforcement of
  582  penalties, and use of income from fees and fines.
  583         (f)(g) The enforcement of the resident bill of rights
  584  specified in s. 429.28.
  585         (g)(h) The care and maintenance of residents provided by
  586  the facility, which must include, but is not limited to:
  587         1. The supervision of residents;
  588         2. The provision of personal services;
  589         3. The provision of, or arrangement for, social and leisure
  590  activities;
  591         4. The assistance in making arrangements arrangement for
  592  appointments and transportation to appropriate medical, dental,
  593  nursing, or mental health services, as needed by residents;
  594         5. The management of medication stored within the facility
  595  and as needed by residents;
  596         6. The dietary nutritional needs of residents;
  597         7. Resident records; and
  598         8. Internal risk management and quality assurance; and
  599         9. The requirements for using medical diagnostic testing
  600  equipment that is designed for a residential setting and is used
  601  at the point of care delivery, including equipment to test
  602  cholesterol, blood glucose level, and blood pressure.
  603         (h)(i) Facilities holding a limited nursing, extended
  604  congregate care, or limited mental health license.
  605         (i)(j) The establishment of specific criteria to define
  606  appropriateness of resident admission and continued residency in
  607  a facility holding a standard, limited nursing, extended
  608  congregate care, and limited mental health license.
  609         (j)(k) The use of physical or chemical restraints. The use
  610  of geriatric chairs or posey restraints is prohibited. Other
  611  physical restraints may be used in accordance with agency rules
  612  when ordered is limited to half-bed rails as prescribed and
  613  documented by the resident’s physician and consented to by with
  614  the consent of the resident or, if applicable, the resident’s
  615  representative or designee or the resident’s surrogate,
  616  guardian, or attorney in fact. Such rules must specify
  617  requirements for care planning, staff monitoring, and periodic
  618  review. The use of chemical restraints is limited to prescribed
  619  dosages of medications authorized by the resident’s physician
  620  and must be consistent with the resident’s diagnosis. Residents
  621  who are receiving medications that can serve as chemical
  622  restraints must be evaluated by their physician at least
  623  annually to assess:
  624         1. The continued need for the medication.
  625         2. The level of the medication in the resident’s blood.
  626         3. The need for adjustments in the prescription.
  627         (k)(l) The establishment of specific resident elopement
  628  drill requirements policies and procedures on resident
  629  elopement. Facilities shall conduct a minimum of two resident
  630  elopement drills each year. All administrators and direct care
  631  staff shall participate in the drills, which must include a
  632  review of the facility’s procedures to address resident
  633  elopement. Facilities shall document participation in the
  634  drills.
  635         (2) In adopting any rules pursuant to this part, the
  636  department, in conjunction with the agency, shall make distinct
  637  standards for facilities based upon facility size; the types of
  638  care provided; the physical and mental capabilities and needs of
  639  residents; the type, frequency, and amount of services and care
  640  offered; and the staffing characteristics of the facility. Rules
  641  developed pursuant to this section may not restrict the use of
  642  shared staffing and shared programming in facilities that are
  643  part of retirement communities that provide multiple levels of
  644  care and otherwise meet the requirements of law and rule. If a
  645  continuing care facility licensed under chapter 651 or a
  646  retirement community offering multiple levels of care licenses a
  647  building or part of a building designated for independent living
  648  for assisted living, staffing requirements established in rule
  649  apply only to residents who receive personal, limited nursing,
  650  or extended congregate care services under this part. Such
  651  facilities shall retain a log listing the names and unit number
  652  for residents receiving these services. The log must be
  653  available to surveyors upon request. Except for uniform
  654  firesafety standards, The department shall adopt by rule
  655  separate and distinct standards for facilities with 16 or fewer
  656  beds and for facilities with 17 or more beds. The standards for
  657  facilities with 16 or fewer beds must be appropriate for a
  658  noninstitutional residential environment; however, the structure
  659  may not be more than two stories in height and all persons who
  660  cannot exit the facility unassisted in an emergency must reside
  661  on the first floor. The department, in conjunction with the
  662  agency, may make other distinctions among types of facilities as
  663  necessary to enforce this part. Where appropriate, the agency
  664  shall offer alternate solutions for complying with established
  665  standards, based on distinctions made by the department and the
  666  agency relative to the physical characteristics of facilities
  667  and the types of care offered.
  668         (3) The department shall submit a copy of proposed rules to
  669  the Speaker of the House of Representatives, the President of
  670  the Senate, and appropriate committees of substance for review
  671  and comment prior to the promulgation thereof. Rules promulgated
  672  by the department must shall encourage the development of
  673  homelike facilities which promote the dignity, individuality,
  674  personal strengths, and decisionmaking ability of residents.
  675         (4) The agency, in consultation with the department, may
  676  waive rules promulgated pursuant to this part in order to
  677  demonstrate and evaluate innovative or cost-effective congregate
  678  care alternatives which enable individuals to age in place. Such
  679  waivers may be granted only in instances where there is
  680  reasonable assurance that the health, safety, or welfare of
  681  residents will not be endangered. To apply for a waiver, the
  682  licensee shall submit to the agency a written description of the
  683  concept to be demonstrated, including goals, objectives, and
  684  anticipated benefits; the number and types of residents who will
  685  be affected, if applicable; a brief description of how the
  686  demonstration will be evaluated; and any other information
  687  deemed appropriate by the agency. Any facility granted a waiver
  688  shall submit a report of findings to the agency and the
  689  department within 12 months. At such time, the agency may renew
  690  or revoke the waiver or pursue any regulatory or statutory
  691  changes necessary to allow other facilities to adopt the same
  692  practices. The department may by rule clarify terms and
  693  establish waiver application procedures, criteria for reviewing
  694  waiver proposals, and procedures for reporting findings, as
  695  necessary to implement this subsection.
  696         (5) The agency may use an abbreviated biennial standard
  697  licensure inspection that consists of a review of key quality
  698  of-care standards in lieu of a full inspection in a facility
  699  that has a good record of past performance. However, a full
  700  inspection must be conducted in a facility that has a history of
  701  class I or class II violations, uncorrected class III
  702  violations, or a violation resulting from a complaint referred
  703  by the State Long-Term Care Ombudsman Program to a regulatory
  704  agency confirmed ombudsman council complaints, or confirmed
  705  licensure complaints, within the previous licensure period
  706  immediately preceding the inspection or if a potentially serious
  707  problem is identified during the abbreviated inspection. The
  708  agency, in consultation with the department, shall adopt by rule
  709  develop the key quality-of-care standards with input from the
  710  State Long-Term Care Ombudsman Council and representatives of
  711  provider groups for incorporation into its rules.
  712         Section 10. Section 429.435, Florida Statutes, is created
  713  to read:
  714         429.435 Uniform firesafety standards.-Uniform firesafety
  715  standards for assisted living facilities and a residential board
  716  and care occupancy shall be established by the State Fire
  717  Marshal pursuant to s. 633.206.
  718         (1)EVACUATION CAPABILITY.—A firesafety evacuation
  719  capability determination shall be conducted within 6 months
  720  after the date of initial licensure, if required.
  722         (a)The National Fire Protection Association, Life Safety
  723  Code, NFPA 101 and 101A, current editions, must be used in
  724  determining the uniform firesafety code adopted by the State
  725  Fire Marshal for assisted living facilities, pursuant to s.
  726  633.206.
  727         (b)A local government or a utility may charge fees that do
  728  not exceed the actual costs incurred by the local government or
  729  the utility for the installation and maintenance of an automatic
  730  fire sprinkler system in a licensed assisted living facility
  731  structure.
  732         (c)All licensed facilities must have an annual fire
  733  inspection conducted by the local fire marshal or authority
  734  having jurisdiction.
  735         (d)An assisted living facility that was issued a building
  736  permit or certificate of occupancy before July 1, 2016, at its
  737  option and after notifying the authority having jurisdiction,
  738  may remain under the provisions of the 1994 and 1995 editions of
  739  the National Fire Protection Association, Life Safety Code, NFPA
  740  101 and 101A. A facility opting to remain under such provisions
  741  may make repairs, modernizations, renovations, or additions to,
  742  or rehabilitate, the facility in compliance with NFPA 101, 1994
  743  edition, and may utilize the alternative approaches to life
  744  safety in compliance with NFPA 101A, 1995 edition. However, a
  745  facility for which a building permit or certificate of occupancy
  746  was issued before July 1, 2016, which undergoes Level III
  747  building alteration or rehabilitation, as defined in the Florida
  748  Building Code, or which seeks to utilize features not authorized
  749  under the 1994 or 1995 editions of the Life Safety Code shall
  750  thereafter comply with all aspects of the uniform firesafety
  751  standards established under s. 633.206, and the Florida Fire
  752  Prevention Code, in effect for assisted living facilities as
  753  adopted by the State Fire Marshal.
  754         Section 11. Section 429.52, Florida Statutes, is amended to
  755  read:
  756         429.52 Staff training and educational requirements
  757  programs; core educational requirement.—
  758         (1) Effective October 1, 2015, Each new assisted living
  759  facility employee who has not previously completed core training
  760  must attend a preservice orientation provided by the facility
  761  before interacting with residents. The preservice orientation
  762  must be at least 2 hours in duration and cover topics that help
  763  the employee provide responsible care and respond to the needs
  764  of facility residents. Upon completion, the employee and the
  765  administrator of the facility must sign a statement that the
  766  employee completed the required preservice orientation. The
  767  facility must keep the signed statement in the employee’s
  768  personnel record.
  769         (2) Administrators and other assisted living facility staff
  770  must meet minimum training and education requirements
  771  established by the Department of Elderly Affairs by rule. This
  772  training and education is intended to assist facilities to
  773  appropriately respond to the needs of residents, to maintain
  774  resident care and facility standards, and to meet licensure
  775  requirements.
  776         (3) The department shall establish core training
  777  requirements for administrators consisting of core training
  778  learning objectives, a competency test, and a minimum required
  779  score to indicate successful passage completion of the core
  780  competency test training and educational requirements. The
  781  competency test must be developed by the department in
  782  conjunction with the agency and providers. The required core
  783  competency test training and education must cover at least the
  784  following topics:
  785         (a) State law and rules relating to assisted living
  786  facilities.
  787         (b) Resident rights and identifying and reporting abuse,
  788  neglect, and exploitation.
  789         (c) Special needs of elderly persons, persons with mental
  790  illness, and persons with developmental disabilities and how to
  791  meet those needs.
  792         (d) Nutrition and food service, including acceptable
  793  sanitation practices for preparing, storing, and serving food.
  794         (e) Medication management, recordkeeping, and proper
  795  techniques for assisting residents with self-administered
  796  medication.
  797         (f) Firesafety requirements, including fire evacuation
  798  drill procedures and other emergency procedures.
  799         (g) Care of persons with Alzheimer’s disease and related
  800  disorders.
  801         (4) A new facility administrator must complete the required
  802  core training and education, including the competency test,
  803  within 90 days after the date of employment as an administrator.
  804  Failure to do so is a violation of this part and subjects the
  805  violator to an administrative fine as prescribed in s. 429.19.
  806  Administrators licensed in accordance with part II of chapter
  807  468 are exempt from this requirement. Other licensed
  808  professionals may be exempted, as determined by the department
  809  by rule.
  810         (5) Administrators are required to participate in
  811  continuing education for a minimum of 12 contact hours every 2
  812  years.
  813         (6) Staff involved with the management of medications and
  814  assisting with the self-administration of medications under s.
  815  429.256 must complete a minimum of 6 additional hours of
  816  training provided by a registered nurse, or a licensed
  817  pharmacist, before providing assistance or department staff. Two
  818  hours of continuing education is required annually thereafter.
  819  The department shall establish by rule the minimum requirements
  820  of this additional training.
  821         (7) Other Facility staff shall participate in in-service
  822  training relevant to their job duties as specified by department
  823  rule of the department. Topics covered during the preservice
  824  orientation are not required to be repeated during in-service
  825  training. A single certificate of completion that covers all
  826  required in-service training topics may be issued to a
  827  participating staff member if the training is provided in a
  828  single training course.
  829         (8) If the department or the agency determines that there
  830  are problems in a facility that could be reduced through
  831  specific staff training or education beyond that already
  832  required under this section, the department or the agency may
  833  require, and provide, or cause to be provided, the training or
  834  education of any personal care staff in the facility.
  835         (9) The department shall adopt rules related to these
  836  training and education requirements, the competency test,
  837  necessary procedures, and competency test fees and shall adopt
  838  or contract with another entity to develop and administer the
  839  competency test. The department shall adopt a curriculum outline
  840  with learning objectives to be used by core trainers, which
  841  shall be used as the minimum core training content requirements.
  842  The department shall consult with representatives of stakeholder
  843  associations and agencies in the development of the curriculum
  844  outline.
  845         (10) The core training required by this section other than
  846  the preservice orientation must be conducted by persons
  847  registered with the department as having the requisite
  848  experience and credentials to conduct the training. A person
  849  seeking to register as a core trainer must provide the
  850  department with proof of completion of the minimum core training
  851  education requirements, successful passage of the competency
  852  test established under this section, and proof of compliance
  853  with the continuing education requirement in subsection (5).
  854         (11) A person seeking to register as a core trainer also
  855  must also:
  856         (a) Provide proof of completion of a 4-year degree from an
  857  accredited college or university and must have worked in a
  858  management position in an assisted living facility for 3 years
  859  after being core certified;
  860         (b) Have worked in a management position in an assisted
  861  living facility for 5 years after being core certified and have
  862  1 year of teaching experience as an educator or staff trainer
  863  for persons who work in assisted living facilities or other
  864  long-term care settings;
  865         (c) Have been previously employed as a core trainer for the
  866  department; or
  867         (d) Meet other qualification criteria as defined in rule,
  868  which the department is authorized to adopt.
  869         (12) The department shall adopt rules to establish core
  870  trainer registration and removal requirements.
  871         Section 12. Paragraph (b) of subsection (3) of section
  872  429.07, Florida Statutes, is amended to read
  873         429.07 License required; fee.—
  874         (3) In addition to the requirements of s. 408.806, each
  875  license granted by the agency must state the type of care for
  876  which the license is granted. Licenses shall be issued for one
  877  or more of the following categories of care: standard, extended
  878  congregate care, limited nursing services, or limited mental
  879  health.
  880         (b) An extended congregate care license shall be issued to
  881  each facility that has been licensed as an assisted living
  882  facility for 2 or more years and that provides services,
  883  directly or through contract, beyond those authorized in
  884  paragraph (a), including services performed by persons licensed
  885  under part I of chapter 464 and supportive services, as defined
  886  by rule, to persons who would otherwise be disqualified from
  887  continued residence in a facility licensed under this part. An
  888  extended congregate care license may be issued to a facility
  889  that has a provisional extended congregate care license and
  890  meets the requirements for licensure under subparagraph 2. The
  891  primary purpose of extended congregate care services is to allow
  892  residents the option of remaining in a familiar setting from
  893  which they would otherwise be disqualified for continued
  894  residency as they become more impaired. A facility licensed to
  895  provide extended congregate care services may also admit an
  896  individual who exceeds the admission criteria for a facility
  897  with a standard license, if he or she is determined appropriate
  898  for admission to the extended congregate care facility.
  899         1. In order for extended congregate care services to be
  900  provided, the agency must first determine that all requirements
  901  established in law and rule are met and must specifically
  902  designate, on the facility’s license, that such services may be
  903  provided and whether the designation applies to all or part of
  904  the facility. This designation may be made at the time of
  905  initial licensure or relicensure, or upon request in writing by
  906  a licensee under this part and part II of chapter 408. The
  907  notification of approval or the denial of the request shall be
  908  made in accordance with part II of chapter 408. Each existing
  909  facility that qualifies to provide extended congregate care
  910  services must have maintained a standard license and may not
  911  have been subject to administrative sanctions during the
  912  previous 2 years, or since initial licensure if the facility has
  913  been licensed for less than 2 years, for any of the following
  914  reasons:
  915         a. A class I or class II violation;
  916         b. Three or more repeat or recurring class III violations
  917  of identical or similar resident care standards from which a
  918  pattern of noncompliance is found by the agency;
  919         c. Three or more class III violations that were not
  920  corrected in accordance with the corrective action plan approved
  921  by the agency;
  922         d. Violation of resident care standards which results in
  923  requiring the facility to employ the services of a consultant
  924  pharmacist or consultant dietitian;
  925         e. Denial, suspension, or revocation of a license for
  926  another facility licensed under this part in which the applicant
  927  for an extended congregate care license has at least 25 percent
  928  ownership interest; or
  929         f. Imposition of a moratorium pursuant to this part or part
  930  II of chapter 408 or initiation of injunctive proceedings.
  932  The agency may deny or revoke a facility’s extended congregate
  933  care license for not meeting the criteria for an extended
  934  congregate care license as provided in this subparagraph.
  935         2. If an assisted living facility has been licensed for
  936  less than 2 years, the initial extended congregate care license
  937  must be provisional and may not exceed 6 months. The licensee
  938  shall notify the agency, in writing, when it has admitted at
  939  least one extended congregate care resident, after which an
  940  unannounced inspection shall be made to determine compliance
  941  with the requirements of an extended congregate care license. A
  942  licensee with a provisional extended congregate care license
  943  that demonstrates compliance with all the requirements of an
  944  extended congregate care license during the inspection shall be
  945  issued an extended congregate care license. In addition to
  946  sanctions authorized under this part, if violations are found
  947  during the inspection and the licensee fails to demonstrate
  948  compliance with all assisted living facility requirements during
  949  a followup inspection, the licensee shall immediately suspend
  950  extended congregate care services, and the provisional extended
  951  congregate care license expires. The agency may extend the
  952  provisional license for not more than 1 month in order to
  953  complete a followup visit.
  954         3. A facility that is licensed to provide extended
  955  congregate care services shall maintain a written progress
  956  report on each person who receives services which describes the
  957  type, amount, duration, scope, and outcome of services that are
  958  rendered and the general status of the resident’s health. A
  959  registered nurse, or appropriate designee, representing the
  960  agency shall visit the facility at least twice a year to monitor
  961  residents who are receiving extended congregate care services
  962  and to determine if the facility is in compliance with this
  963  part, part II of chapter 408, and relevant rules. One of the
  964  visits may be in conjunction with the regular survey. The
  965  monitoring visits may be provided through contractual
  966  arrangements with appropriate community agencies. A registered
  967  nurse shall serve as part of the team that inspects the
  968  facility. The agency may waive one of the required yearly
  969  monitoring visits for a facility that has:
  970         a. Held an extended congregate care license for at least 24
  971  months;
  972         b. No class I or class II violations and no uncorrected
  973  class III violations; and
  974         c. No ombudsman council complaints that resulted in a
  975  citation for licensure.
  976         4. A facility that is licensed to provide extended
  977  congregate care services must:
  978         a. Demonstrate the capability to meet unanticipated
  979  resident service needs.
  980         b. Offer a physical environment that promotes a homelike
  981  setting, provides for resident privacy, promotes resident
  982  independence, and allows sufficient congregate space as defined
  983  by rule.
  984         c. Have sufficient staff available, taking into account the
  985  physical plant and firesafety features of the building, to
  986  assist with the evacuation of residents in an emergency.
  987         d. Adopt and follow policies and procedures that maximize
  988  resident independence, dignity, choice, and decisionmaking to
  989  permit residents to age in place, so that moves due to changes
  990  in functional status are minimized or avoided.
  991         e. Allow residents or, if applicable, a resident’s
  992  representative, designee, surrogate, guardian, or attorney in
  993  fact to make a variety of personal choices, participate in
  994  developing service plans, and share responsibility in
  995  decisionmaking.
  996         f. Implement the concept of managed risk.
  997         g. Provide, directly or through contract, the services of a
  998  person licensed under part I of chapter 464.
  999         h. In addition to the training mandated in s. 429.52,
 1000  provide specialized training as defined by rule for facility
 1001  staff.
 1002         5. A facility that is licensed to provide extended
 1003  congregate care services is exempt from the criteria for
 1004  continued residency set forth in rules adopted under s. 429.41.
 1005  A licensed facility must adopt its own requirements within
 1006  guidelines for continued residency set forth by rule. However,
 1007  the facility may not serve residents who require 24-hour nursing
 1008  supervision. A licensed facility that provides extended
 1009  congregate care services must also provide each resident with a
 1010  written copy of facility policies governing admission and
 1011  retention.
 1012         6. Before the admission of an individual to a facility
 1013  licensed to provide extended congregate care services, the
 1014  individual must undergo a medical examination as provided in s.
 1015  429.26(5) s. 429.26(4) and the facility must develop a
 1016  preliminary service plan for the individual.
 1017         7. If a facility can no longer provide or arrange for
 1018  services in accordance with the resident’s service plan and
 1019  needs and the facility’s policy, the facility must make
 1020  arrangements for relocating the person in accordance with s.
 1021  429.28(1)(k).
 1022         Section 13. This act shall take effect July 1, 2019.
 1024  ================= T I T L E  A M E N D M E N T ================
 1025  And the title is amended as follows:
 1026         Delete everything before the enacting clause
 1027  and insert:
 1028                        A bill to be entitled                      
 1029         An act relating to assisted living facilities;
 1030         amending s. 429.02, F.S.; defining and redefining
 1031         terms; amending s. 429.11, F.S.; prohibiting a county
 1032         or municipality from issuing a business tax receipt,
 1033         rather than an occupational license, to an assisted
 1034         living facility under certain circumstances; amending
 1035         s. 429.176, F.S.; amending educational requirements
 1036         for an administrator who is replacing another
 1037         administrator; amending s. 429.23, F.S.; requiring a
 1038         facility to initiate an investigation of an adverse
 1039         incident within 24 hours and provide a report of such
 1040         investigation to the Agency for Health Care
 1041         Administration within 15 days; amending s. 429.255,
 1042         F.S.; authorizing a facility resident or his or her
 1043         representative to contract with a third party under
 1044         certain circumstances; amending s. 429.256, F.S.;
 1045         requiring a person assisting with a resident’s self
 1046         administration of medication to confirm that the
 1047         medication is intended for that resident and to orally
 1048         advise the resident of the medication name and
 1049         purpose; amending s. 429.26, F.S.; including medical
 1050         examinations within criteria used for admission to an
 1051         assisted living facility; providing specified criteria
 1052         for determinations of appropriateness for admission
 1053         and continued residency at an assisted living
 1054         facility; defining the term “bedridden”; requiring
 1055         that a resident receive a medical examination within a
 1056         specified timeframe after admission to a facility;
 1057         requiring that such examination be recorded on a
 1058         specified form; providing minimum requirements for
 1059         such form; revising provisions relating to the
 1060         placement of residents by the Department of Elderly
 1061         Affairs or the Department of Children and Families;
 1062         requiring a facility to notify a resident’s
 1063         representative or designee of the need for health care
 1064         services and authorizing the facility to assist in
 1065         making appointments for such care and services under
 1066         certain circumstances; removing provisions relating to
 1067         the retention of certain residents in a facility;
 1068         amending s. 429.28, F.S.; revising residents’ rights
 1069         relating to a safe and secure living environment;
 1070         amending s. 429.41, F.S.; removing provisions relating
 1071         to firesafety requirements; removing an obsolete
 1072         provision; requiring, rather than authorizing, the
 1073         Agency for Health Care Administration to use an
 1074         abbreviated biennial standard licensure inspection;
 1075         revising the criteria under which a facility must be
 1076         fully inspected; revising provisions requiring the
 1077         agency to develop key quality-of-care standards;
 1078         creating s. 429.435, F.S.; revising uniform firesafety
 1079         standards for assisted living facilities, which are
 1080         relocated to this section; amending s. 429.52, F.S.;
 1081         revising provisions relating to facility staff
 1082         training requirements; requiring the Department of
 1083         Elderly Affairs to establish core training
 1084         requirements for facility administrators; revising the
 1085         training and continuing education requirements for
 1086         facility staff who assist residents with the self
 1087         administration of medications; revising provisions
 1088         relating to the training responsibilities of the
 1089         Department of Elderly Affairs and the Agency for
 1090         Health Care Administration; requiring the Department
 1091         of Elderly Affairs to contract with another entity to
 1092         administer the competency test; requiring the
 1093         department to adopt a curriculum outline to be used by
 1094         core trainers; amending s. 429.07, F.S.; conforming a
 1095         cross-reference; providing an effective date.