Florida Senate - 2019                             CS for SB 1592
       By the Committee on Children, Families, and Elder Affairs; and
       Senator Harrell
       586-04036A-19                                         20191592c1
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 429.02, F.S.; defining and redefining
    4         terms; amending s. 429.11, F.S.; prohibiting a county
    5         or municipality from issuing a business tax receipt,
    6         rather than an occupational license, to an assisted
    7         living facility under certain circumstances; amending
    8         s. 429.176, F.S.; amending educational requirements
    9         for an administrator who is replacing another
   10         administrator; amending s. 429.23, F.S.; requiring a
   11         facility to initiate an investigation of an adverse
   12         incident within 24 hours and provide a report of such
   13         investigation to the Agency for Health Care
   14         Administration within 15 days; amending s. 429.255,
   15         F.S.; authorizing a facility resident or his or her
   16         representative to contract with a third party under
   17         certain circumstances; amending s. 429.256, F.S.;
   18         requiring a person assisting with a resident’s self
   19         administration of medication to confirm that the
   20         medication is intended for that resident and to orally
   21         advise the resident of the medication name and
   22         purpose; amending s. 429.26, F.S.; including medical
   23         examinations within criteria used for admission to an
   24         assisted living facility; providing specified criteria
   25         for determinations of appropriateness for admission
   26         and continued residency at an assisted living
   27         facility; defining the term “bedridden”; requiring
   28         that a resident receive a medical examination within a
   29         specified timeframe after admission to a facility;
   30         requiring that such examination be recorded on a
   31         specified form; providing minimum requirements for
   32         such form; revising provisions relating to the
   33         placement of residents by the Department of Elderly
   34         Affairs or the Department of Children and Families;
   35         requiring a facility to notify a resident’s
   36         representative or designee of the need for health care
   37         services and to assist in making appointments for such
   38         care and services under certain circumstances;
   39         removing provisions relating to the retention of
   40         certain residents in a facility; amending s. 429.28,
   41         F.S.; revising residents’ rights relating to a safe
   42         and secure living environment; amending s. 429.41,
   43         F.S.; removing provisions relating to firesafety
   44         requirements; removing an obsolete provision;
   45         requiring, rather than authorizing, the Agency for
   46         Health Care Administration to use an abbreviated
   47         biennial standard licensure inspection; revising the
   48         criteria under which a facility must be fully
   49         inspected; revising provisions requiring the agency to
   50         develop key quality-of-care standards; creating s.
   51         429.435, F.S.; revising uniform firesafety standards
   52         for assisted living facilities, which are relocated to
   53         this section; amending s. 429.52, F.S.; revising
   54         provisions relating to facility staff training
   55         requirements; requiring the Department of Elderly
   56         Affairs to establish core training requirements for
   57         facility administrators; revising the training and
   58         continuing education requirements for facility staff
   59         who assist residents with the self-administration of
   60         medications; revising provisions relating to the
   61         training responsibilities of the Department of Elderly
   62         Affairs and the Agency for Health Care Administration;
   63         requiring the Department of Elderly Affairs to
   64         contract with another entity to administer the
   65         competency test; requiring the department to adopt a
   66         curriculum outline to be used by core trainers;
   67         amending s. 429.07, F.S.; conforming a cross
   68         reference; providing an effective date.
   70  Be It Enacted by the Legislature of the State of Florida:
   72         Section 1. Present subsections (6) through (27) of section
   73  429.02, Florida Statutes, are redesignated as subsections (7)
   74  through (28), respectively, present subsections (13), (18), and
   75  (27) of that section are amended, and a new subsection (6) is
   76  added to that section, to read:
   77         429.02 Definitions.—When used in this part, the term:
   78         (6) “Assistive device” means any device designed or adapted
   79  to help a resident perform an action, a task, an activity of
   80  daily living, or a transfer; prevent a fall; or recover from a
   81  fall. The term does not include a total body lift or a motorized
   82  sit-to-stand lift, with the exception of a chair lift or
   83  recliner lift that a resident is able to operate independently.
   84         (14)(13) “Limited nursing services” means acts that may be
   85  performed by a person licensed under part I of chapter 464.
   86  Limited nursing services shall be for persons who meet the
   87  admission criteria established by the department for assisted
   88  living facilities and shall not be complex enough to require 24
   89  hour nursing supervision and may include such services as the
   90  application and care of routine dressings, and care of casts,
   91  braces, and splints.
   92         (19)(18) “Physical restraint” means a device that which
   93  physically limits, restricts, or deprives an individual of
   94  movement or mobility, including, but not limited to, a half-bed
   95  rail, a full-bed rail, a geriatric chair, and a posey restraint.
   96  The term “physical restraint” shall also include any device that
   97  is which was not specifically manufactured as a restraint but is
   98  which has been altered, arranged, or otherwise used for that
   99  this purpose. The term does shall not include any device that
  100  the resident chooses to use and is able to remove or avoid
  101  independently, or any bandage material used for the purpose of
  102  binding a wound or injury.
  103         (27) “Twenty-four-hour nursing supervision” means services
  104  that are ordered by a physician for a resident whose condition
  105  requires the supervision of a physician and continued monitoring
  106  of vital signs and physical status. Such services shall be:
  107  medically complex enough to require constant supervision,
  108  assessment, planning, or intervention by a nurse; required to be
  109  performed by or under the direct supervision of licensed nursing
  110  personnel or other professional personnel for safe and effective
  111  performance; required on a daily basis; and consistent with the
  112  nature and severity of the resident’s condition or the disease
  113  state or stage.
  114         Section 2. Subsection (7) of section 429.11, Florida
  115  Statutes, is amended to read:
  116         429.11 Initial application for license; provisional
  117  license.—
  118         (7) A county or municipality may not issue a business tax
  119  receipt an occupational license that is being obtained for the
  120  purpose of operating a facility regulated under this part
  121  without first ascertaining that the applicant has been licensed
  122  to operate such facility at the specified location or locations
  123  by the agency. The agency shall furnish to local agencies
  124  responsible for issuing business tax receipts occupational
  125  licenses sufficient instruction for making such determinations.
  126         Section 3. Section 429.176, Florida Statutes, is amended to
  127  read:
  128         429.176 Notice of change of administrator.—If, during the
  129  period for which a license is issued, the owner changes
  130  administrators, the owner must notify the agency of the change
  131  within 10 days and provide documentation within 90 days that the
  132  new administrator meets educational requirements and has
  133  completed the applicable core educational and core competency
  134  test requirements under s. 429.52. A facility may not be
  135  operated for more than 120 consecutive days without an
  136  administrator who has completed the core training and core
  137  competency test educational requirements.
  138         Section 4. Subsections (3) through (9) of section 429.23,
  139  Florida Statutes, are amended to read:
  140         429.23 Internal risk management and quality assurance
  141  program; adverse incidents and reporting requirements.—
  142         (3) Licensed facilities shall initiate an investigation
  143  provide within 24 hours after 1 business day after the
  144  occurrence of an adverse incident, by electronic mail,
  145  facsimile, or United States mail, a preliminary report to the
  146  agency on all adverse incidents specified under this section.
  147  The facility must complete the investigation and submit a report
  148  to the agency within 15 days after the occurrence of the adverse
  149  incident. The report must include information regarding the
  150  identity of the affected resident, the type of adverse incident,
  151  and the result status of the facility’s investigation of the
  152  incident.
  153         (4)Licensed facilities shall provide within 15 days, by
  154  electronic mail, facsimile, or United States mail, a full report
  155  to the agency on all adverse incidents specified in this
  156  section. The report must include the results of the facility’s
  157  investigation into the adverse incident.
  158         (5)Each facility shall report monthly to the agency any
  159  liability claim filed against it. The report must include the
  160  name of the resident, the dates of the incident leading to the
  161  claim, if applicable, and the type of injury or violation of
  162  rights alleged to have occurred. This report is not discoverable
  163  in any civil or administrative action, except in such actions
  164  brought by the agency to enforce the provisions of this part.
  165         (4)(6) Abuse, neglect, or exploitation must be reported to
  166  the Department of Children and Families as required under
  167  chapter 415.
  168         (5)(7) The information reported to the agency pursuant to
  169  subsection (3) which relates to persons licensed under chapter
  170  458, chapter 459, chapter 461, chapter 464, or chapter 465 shall
  171  be reviewed by the agency. The agency shall determine whether
  172  any of the incidents potentially involved conduct by a health
  173  care professional who is subject to disciplinary action, in
  174  which case the provisions of s. 456.073 apply. The agency may
  175  investigate, as it deems appropriate, any such incident and
  176  prescribe measures that must or may be taken in response to the
  177  incident. The agency shall review each incident and determine
  178  whether it potentially involved conduct by a health care
  179  professional who is subject to disciplinary action, in which
  180  case the provisions of s. 456.073 apply.
  181         (6)(8) If the agency, through its receipt of the adverse
  182  incident report reports prescribed in this part or through any
  183  investigation, has reasonable belief that conduct by a staff
  184  member or employee of a licensed facility is grounds for
  185  disciplinary action by the appropriate board, the agency shall
  186  report this fact to such regulatory board.
  187         (7)(9) The adverse incident report reports and preliminary
  188  adverse incident reports required under this section is are
  189  confidential as provided by law and are not discoverable or
  190  admissible in any civil or administrative action, except in
  191  disciplinary proceedings by the agency or appropriate regulatory
  192  board.
  193         Section 5. Paragraphs (a) and (b) of subsection (1) of
  194  section 429.255, Florida Statutes, are amended, and paragraph
  195  (d) is added to that subsection, to read:
  196         429.255 Use of personnel; emergency care.—
  197         (1)(a) Persons under contract to the facility, facility
  198  staff, or volunteers, who are licensed according to part I of
  199  chapter 464, or those persons exempt under s. 464.022(1), and
  200  others as defined by rule, may administer medications to
  201  residents, take residents’ vital signs, manage individual weekly
  202  pill organizers for residents who self-administer medication,
  203  give prepackaged enemas ordered by a physician, observe
  204  residents, document observations on the appropriate resident’s
  205  record, and report observations to the resident’s physician, and
  206  contract or allow residents or a resident’s representative,
  207  designee, surrogate, guardian, or attorney in fact to contract
  208  with a third party, provided residents meet the criteria for
  209  appropriate placement as defined in s. 429.26. Nursing
  210  assistants certified pursuant to part II of chapter 464 may take
  211  residents’ vital signs as directed by a licensed nurse or
  212  physician.
  213         (b) All staff of in facilities licensed under this part
  214  shall exercise their professional responsibility to observe
  215  residents, to document observations on the appropriate
  216  resident’s record, and to report the observations to the
  217  resident’s physician. However, the owner or administrator of the
  218  facility shall be responsible for determining that the resident
  219  receiving services is appropriate for residence in the facility.
  220         (d) A resident or a resident’s representative, designee,
  221  surrogate, guardian, or attorney in fact may contract for
  222  services with a third party, provided the resident meets the
  223  criteria for continued residency as provided in s. 429.26. The
  224  third party must communicate with the facility regarding the
  225  resident’s condition and the services being provided. The
  226  facility must document that it received such communication.
  227         Section 6. Subsection (2), paragraph (b) of subsection (3),
  228  and paragraphs (e), (f), and (g) of subsection (4) of section
  229  429.256, Florida Statutes, are amended to read:
  230         429.256 Assistance with self-administration of medication.—
  231         (2) Residents who are capable of self-administering their
  232  own medications without assistance shall be encouraged and
  233  allowed to do so. However, an unlicensed person may, consistent
  234  with a dispensed prescription’s label or the package directions
  235  of an over-the-counter medication, assist a resident whose
  236  condition is medically stable with the self-administration of
  237  routine, regularly scheduled medications that are intended to be
  238  self-administered. Assistance with self-medication by an
  239  unlicensed person may occur only upon a documented request by,
  240  and the written informed consent of, a resident or the
  241  resident’s surrogate, guardian, or attorney in fact. For the
  242  purposes of this section, self-administered medications include
  243  both legend and over-the-counter oral dosage forms, topical
  244  dosage forms and topical skin, ophthalmic, otic, and nasal
  245  dosage forms, including patches, solutions, suspensions, sprays,
  246  and inhalers.
  247         (3) Assistance with self-administration of medication
  248  includes:
  249         (b) In the presence of the resident, confirming that the
  250  medication is intended for that resident, orally advising the
  251  resident of the medication name and purpose reading the label,
  252  opening the container, removing a prescribed amount of
  253  medication from the container, and closing the container.
  254         (4) Assistance with self-administration does not include:
  255         (e) The use of irrigations or debriding agents used in the
  256  treatment of a skin condition.
  257         (f) Assisting with rectal, urethral, or vaginal
  258  preparations.
  259         (g) Assisting with medications ordered by the physician or
  260  health care professional with prescriptive authority to be given
  261  “as needed,” unless the order is written with specific
  262  parameters that preclude independent judgment on the part of the
  263  unlicensed person, and the at the request of a competent
  264  resident requesting the medication is aware of his or her need
  265  for the medication and understands the purpose of taking the
  266  medication.
  267         Section 7. Section 429.26, Florida Statutes, is amended to
  268  read:
  269         429.26 Appropriateness of placements; examinations of
  270  residents.—
  271         (1) The owner or administrator of a facility is responsible
  272  for determining the appropriateness of admission of an
  273  individual to the facility and for determining the continued
  274  appropriateness of residence of an individual in the facility. A
  275  determination must shall be based upon an evaluation assessment
  276  of the strengths, needs, and preferences of the resident, a
  277  medical examination, the care and services offered or arranged
  278  for by the facility in accordance with facility policy, and any
  279  limitations in law or rule related to admission criteria or
  280  continued residency for the type of license held by the facility
  281  under this part. The following criteria apply to the
  282  determination of appropriateness for residency and continued
  283  residency of an individual in a facility:
  284         (a) A facility may admit or retain a resident who receives
  285  a health care service or treatment that is designed to be
  286  provided within a private residential setting if all
  287  requirements for providing that service or treatment are met by
  288  the facility or a third party.
  289         (b) A facility may admit or retain a resident who requires
  290  the use of assistive devices.
  291         (c) A facility may admit or retain an individual receiving
  292  hospice services if the arrangement is agreed to by the facility
  293  and the resident, additional care is provided by a licensed
  294  hospice, and the resident is under the care of a physician who
  295  agrees that the physical needs of the resident can be met at the
  296  facility. A facility may not retain a resident who requires 24
  297  hour nursing supervision, except for a resident who is enrolled
  298  in hospice services pursuant to part IV of chapter 400. The
  299  resident must have a plan of care that delineates how the
  300  facility and the hospice will meet the scheduled and unscheduled
  301  needs of the resident.
  302         (d)1. Except as provided in paragraph (c), a facility may
  303  not admit or retain a resident who is bedridden. For purposes of
  304  this paragraph, the term “bedridden” means that a resident is
  305  confined to bed because of the inability to:
  306         a.Move, turn, or reposition without total physical
  307  assistance;
  308         b.Transfer to a chair or wheelchair without total physical
  309  assistance;
  310         c.Sit safely in a chair or wheelchair without personal
  311  assistance or a physical restraint.
  312         2.A resident may continue to reside in a facility if,
  313  during residency, he or she is bedridden for no more than 7
  314  consecutive days.
  315         3.If a facility is licensed to provide extended congregate
  316  care, a resident may continue to reside in a facility if, during
  317  residency, he or she is bedridden for no more than 14
  318  consecutive days.
  319         (2) A resident may not be moved from one facility to
  320  another without consultation with and agreement from the
  321  resident or, if applicable, the resident’s representative or
  322  designee or the resident’s family, guardian, surrogate, or
  323  attorney in fact. In the case of a resident who has been placed
  324  by the department or the Department of Children and Families,
  325  the administrator must notify the appropriate contact person in
  326  the applicable department.
  327         (3)(2) A physician, physician assistant, or advanced
  328  practice registered nurse practitioner who is employed by an
  329  assisted living facility to provide an initial examination for
  330  admission purposes may not have financial interest in the
  331  facility.
  332         (4)(3) Persons licensed under part I of chapter 464 who are
  333  employed by or under contract with a facility shall, on a
  334  routine basis or at least monthly, perform a nursing assessment
  335  of the residents for whom they are providing nursing services
  336  ordered by a physician, except administration of medication, and
  337  shall document such assessment, including any substantial
  338  changes in a resident’s status which may necessitate relocation
  339  to a nursing home, hospital, or specialized health care
  340  facility. Such records shall be maintained in the facility for
  341  inspection by the agency and shall be forwarded to the
  342  resident’s case manager, if applicable.
  343         (5)(4)If possible, Each resident must shall have been
  344  examined by a licensed physician, a licensed physician
  345  assistant, or a licensed advanced practice registered nurse
  346  practitioner within 60 days before admission to the facility or
  347  within 30 days after admission to the facility, except as
  348  provided in s. 429.07. The information from the medical
  349  examination must be recorded on the practitioner’s form or on a
  350  form adopted by agency rule. The signed and completed medical
  351  examination form, signed by the practitioner, must report shall
  352  be submitted to the owner or administrator of the facility, who
  353  shall use the information contained therein to assist in the
  354  determination of the appropriateness of the resident’s admission
  355  to or and continued stay in the facility. The medical
  356  examination form becomes report shall become a permanent part of
  357  the facility’s record of the resident at the facility and must
  358  shall be made available to the agency during inspection or upon
  359  request. An assessment that has been completed through the
  360  Comprehensive Assessment and Review for Long-Term Care Services
  361  (CARES) Program fulfills the requirements for a medical
  362  examination under this subsection and s. 429.07(3)(b)6.
  363         (6)The medical examination form submitted under subsection
  364  (5) must include the following information relating to the
  365  resident:
  366         (a)Height, weight, and known allergies.
  367         (b)Significant medical history and diagnoses.
  368         (c)Physical or sensory limitations, including the need for
  369  fall precautions or recommended use of assistive devices.
  370         (d)Cognitive or behavioral status and a brief description
  371  of any behavioral issues known or ascertained by the examining
  372  practitioner, including any known history of wandering or
  373  elopement.
  374         (e)Nursing, treatment, or therapy service requirements.
  375         (f)Whether assistance is needed for ambulating, eating,
  376  and transferring.
  377         (g)Special dietary instructions.
  378         (h)Whether he or she has any communicable diseases,
  379  including necessary precautions.
  380         (i)Whether he or she is bedridden and the status of any
  381  pressure sores that he or she has.
  382         (j)Whether the resident needs 24-hour nursing or
  383  psychiatric care.
  384         (k)A list of current prescribed medications as known or
  385  ascertained by the examining practitioner and whether the
  386  resident can self-administer medications, needs assistance, or
  387  needs medication administration.
  388         (5)Except as provided in s. 429.07, if a medical
  389  examination has not been completed within 60 days before the
  390  admission of the resident to the facility, a licensed physician,
  391  licensed physician assistant, or licensed nurse practitioner
  392  shall examine the resident and complete a medical examination
  393  form provided by the agency within 30 days following the
  394  admission to the facility to enable the facility owner or
  395  administrator to determine the appropriateness of the admission.
  396  The medical examination form shall become a permanent part of
  397  the record of the resident at the facility and shall be made
  398  available to the agency during inspection by the agency or upon
  399  request.
  400         (7)(6) Any resident accepted in a facility and placed by
  401  the department or the Department of Children and Families must
  402  shall have been examined by medical personnel within 30 days
  403  before placement in the facility. The examination must shall
  404  include an assessment of the appropriateness of placement in a
  405  facility. The findings of this examination must shall be
  406  recorded on the examination form provided by the agency. The
  407  completed form must shall accompany the resident and shall be
  408  submitted to the facility owner or administrator. Additionally,
  409  in the case of a mental health resident, the Department of
  410  Children and Families must provide documentation that the
  411  individual has been assessed by a psychiatrist, clinical
  412  psychologist, clinical social worker, or psychiatric nurse, or
  413  an individual who is supervised by one of these professionals,
  414  and determined to be appropriate to reside in an assisted living
  415  facility. The documentation must be in the facility within 30
  416  days after the mental health resident has been admitted to the
  417  facility. An evaluation completed upon discharge from a state
  418  mental hospital meets the requirements of this subsection
  419  related to appropriateness for placement as a mental health
  420  resident providing it was completed within 90 days prior to
  421  admission to the facility. The applicable Department of Children
  422  and Families shall provide to the facility administrator any
  423  information about the resident which that would help the
  424  administrator meet his or her responsibilities under subsection
  425  (1). Further, Department of Children and Families personnel
  426  shall explain to the facility operator any special needs of the
  427  resident and advise the operator whom to call should problems
  428  arise. The applicable Department of Children and Families shall
  429  advise and assist the facility administrator when where the
  430  special needs of residents who are recipients of optional state
  431  supplementation require such assistance.
  432         (8)(7) The facility shall must notify a licensed physician
  433  in writing when a resident exhibits signs of dementia or
  434  cognitive impairment or has a change of condition in order to
  435  rule out the presence of an underlying physiological condition
  436  that may be contributing to such dementia or impairment. The
  437  notification must occur within 30 days after the acknowledgment
  438  of such signs by facility staff. If an underlying condition is
  439  determined to exist, the facility must notify the resident’s
  440  representative or designee in writing of the need for health
  441  care services and must assist in making appointments for shall
  442  arrange, with the appropriate health care provider, the
  443  necessary care and services to treat the condition.
  444         (9)(8) The Department of Children and Families may require
  445  an examination for supplemental security income and optional
  446  state supplementation recipients residing in facilities at any
  447  time and shall provide the examination whenever a resident’s
  448  condition requires it. Any facility administrator; personnel of
  449  the agency, the department, or the Department of Children and
  450  Families; or a representative of the State Long-Term Care
  451  Ombudsman Program who believes a resident needs to be evaluated
  452  shall notify the resident’s case manager, who shall take
  453  appropriate action. A report of the examination findings must
  454  shall be provided to the resident’s case manager and the
  455  facility administrator to help the administrator meet his or her
  456  responsibilities under subsection (1).
  457         (9)A terminally ill resident who no longer meets the
  458  criteria for continued residency may remain in the facility if
  459  the arrangement is mutually agreeable to the resident and the
  460  facility; additional care is rendered through a licensed
  461  hospice, and the resident is under the care of a physician who
  462  agrees that the physical needs of the resident are being met.
  463         (10) Facilities licensed to provide extended congregate
  464  care services shall promote aging in place by determining
  465  appropriateness of continued residency based on a comprehensive
  466  review of the resident’s physical and functional status; the
  467  ability of the facility, family members, friends, or any other
  468  pertinent individuals or agencies to provide the care and
  469  services required; and documentation that a written service plan
  470  consistent with facility policy has been developed and
  471  implemented to ensure that the resident’s needs and preferences
  472  are addressed.
  473         (11)No resident who requires 24-hour nursing supervision,
  474  except for a resident who is an enrolled hospice patient
  475  pursuant to part IV of chapter 400, shall be retained in a
  476  facility licensed under this part.
  477         Section 8. Paragraphs (a) and (k) of subsection (1) and
  478  subsection (3) of section 429.28, Florida Statutes, are amended
  479  to read:
  480         429.28 Resident bill of rights.—
  481         (1) No resident of a facility shall be deprived of any
  482  civil or legal rights, benefits, or privileges guaranteed by
  483  law, the Constitution of the State of Florida, or the
  484  Constitution of the United States as a resident of a facility.
  485  Every resident of a facility shall have the right to:
  486         (a) Live in a safe and decent living environment, free from
  487  abuse, exploitation, and neglect.
  488         (k) At least 45 days’ notice of relocation or termination
  489  of residency from the facility unless, for medical reasons, the
  490  resident is certified by a physician to require an emergency
  491  relocation to a facility providing a more skilled level of care
  492  or the resident engages in a pattern of conduct that is harmful
  493  or offensive to other residents. In the case of a resident who
  494  has been adjudicated mentally incapacitated, the guardian shall
  495  be given at least 45 days’ notice of a nonemergency relocation
  496  or residency termination. Reasons for relocation must shall be
  497  set forth in writing and provided to the resident or the
  498  resident’s legal representative. The written notice must contain
  499  the following disclosure in 12-point uppercase type:
  504         0404 OR VIA E-MAIL AT LTCOPInformer@elderaffairs.org.
  505  In order for a facility to terminate the residency of an
  506  individual without notice as provided herein, the facility shall
  507  show good cause in a court of competent jurisdiction.
  508         (3)(a) The agency shall conduct a survey to determine
  509  general compliance with facility standards and compliance with
  510  residents’ rights as a prerequisite to initial licensure or
  511  licensure renewal. The agency shall adopt rules for uniform
  512  standards and criteria that will be used to determine compliance
  513  with facility standards and compliance with residents’ rights.
  514         (b) In order to determine whether the facility is
  515  adequately protecting residents’ rights, the licensure renewal
  516  biennial survey must shall include private informal
  517  conversations with a sample of residents and consultation with
  518  the ombudsman council in the district in which the facility is
  519  located to discuss residents’ experiences within the facility.
  520         Section 9. Section 429.41, Florida Statutes, is amended to
  521  read:
  522         429.41 Rules establishing standards.—
  523         (1) It is the intent of the Legislature that rules
  524  published and enforced pursuant to this section shall include
  525  criteria by which a reasonable and consistent quality of
  526  resident care and quality of life may be ensured and the results
  527  of such resident care may be demonstrated. Such rules shall also
  528  promote ensure a safe and sanitary environment that is
  529  residential and noninstitutional in design or nature and may
  530  allow for technological advances in the provision of care,
  531  safety, and security, including the use of devices, equipment
  532  and other security measures related to wander management,
  533  emergency response, staff risk management, and the general
  534  safety and security of residents, staff, and the facility. It is
  535  further intended that reasonable efforts be made to accommodate
  536  the needs and preferences of residents to enhance the quality of
  537  life in a facility. Uniform firesafety standards for assisted
  538  living facilities shall be established by the State Fire Marshal
  539  pursuant to s. 633.206. The agency, in consultation with the
  540  department, may adopt rules to administer the requirements of
  541  part II of chapter 408. In order to provide safe and sanitary
  542  facilities and the highest quality of resident care
  543  accommodating the needs and preferences of residents, The
  544  department, in consultation with the agency, the Department of
  545  Children and Families, and the Department of Health, shall adopt
  546  rules, policies, and procedures to administer this part, which
  547  must include reasonable and fair minimum standards in relation
  548  to:
  549         (a) The requirements for and maintenance and the sanitary
  550  condition of facilities, not in conflict with, or duplicative
  551  of, the requirements in chapter 553 or chapter 381, relating to
  552  furnishings for resident bedrooms or sleeping areas, locking
  553  devices, linens, laundry services plumbing, heating, cooling,
  554  lighting, ventilation, living space, and similar physical plant
  555  standards other housing conditions, which will promote ensure
  556  the health, safety, and welfare comfort of residents suitable to
  557  the size of the structure. The rules must clearly delineate the
  558  respective responsibilities of the agency’s licensure and survey
  559  staff and the county health departments and ensure that
  560  inspections are not duplicative. The agency may collect fees for
  561  food service inspections conducted by county health departments
  562  and may transfer such fees to the Department of Health.
  563         1.Firesafety evacuation capability determination.—An
  564  evacuation capability evaluation for initial licensure shall be
  565  conducted within 6 months after the date of licensure.
  566         2.Firesafety requirements.—
  567         a.The National Fire Protection Association, Life Safety
  568  Code, NFPA 101 and 101A, current editions, shall be used in
  569  determining the uniform firesafety code adopted by the State
  570  Fire Marshal for assisted living facilities, pursuant to s.
  571  633.206.
  572         b.A local government or a utility may charge fees only in
  573  an amount not to exceed the actual expenses incurred by the
  574  local government or the utility relating to the installation and
  575  maintenance of an automatic fire sprinkler system in a licensed
  576  assisted living facility structure.
  577         c.All licensed facilities must have an annual fire
  578  inspection conducted by the local fire marshal or authority
  579  having jurisdiction.
  580         d.An assisted living facility that is issued a building
  581  permit or certificate of occupancy before July 1, 2016, may at
  582  its option and after notifying the authority having
  583  jurisdiction, remain under the provisions of the 1994 and 1995
  584  editions of the National Fire Protection Association, Life
  585  Safety Code, NFPA 101, and NFPA 101A. The facility opting to
  586  remain under such provisions may make repairs, modernizations,
  587  renovations, or additions to, or rehabilitate, the facility in
  588  compliance with NFPA 101, 1994 edition, and may utilize the
  589  alternative approaches to life safety in compliance with NFPA
  590  101A, 1995 edition. However, a facility for which a building
  591  permit or certificate of occupancy is issued before July 1,
  592  2016, that undergoes Level III building alteration or
  593  rehabilitation, as defined in the Florida Building Code, or
  594  seeks to utilize features not authorized under the 1994 or 1995
  595  editions of the Life Safety Code must thereafter comply with all
  596  aspects of the uniform firesafety standards established under s.
  597  633.206, and the Florida Fire Prevention Code, in effect for
  598  assisted living facilities as adopted by the State Fire Marshal.
  599         3.Resident elopement requirements.—Facilities are required
  600  to conduct a minimum of two resident elopement prevention and
  601  response drills per year. All administrators and direct care
  602  staff must participate in the drills which shall include a
  603  review of procedures to address resident elopement. Facilities
  604  must document the implementation of the drills and ensure that
  605  the drills are conducted in a manner consistent with the
  606  facility’s resident elopement policies and procedures.
  607         (b) The preparation and annual update of a comprehensive
  608  emergency management plan. Such standards must be included in
  609  the rules adopted by the department after consultation with the
  610  Division of Emergency Management. At a minimum, the rules must
  611  provide for plan components that address emergency evacuation
  612  transportation; adequate sheltering arrangements; postdisaster
  613  activities, including provision of emergency power, food, and
  614  water; postdisaster transportation; supplies; staffing;
  615  emergency equipment; individual identification of residents and
  616  transfer of records; communication with families; and responses
  617  to family inquiries. The comprehensive emergency management plan
  618  is subject to review and approval by the local emergency
  619  management agency. During its review, the local emergency
  620  management agency shall ensure that the following agencies, at a
  621  minimum, are given the opportunity to review the plan: the
  622  Department of Elderly Affairs, the Department of Health, the
  623  Agency for Health Care Administration, and the Division of
  624  Emergency Management. Also, appropriate volunteer organizations
  625  must be given the opportunity to review the plan. The local
  626  emergency management agency shall complete its review within 60
  627  days and either approve the plan or advise the facility of
  628  necessary revisions.
  629         (c) The number, training, and qualifications of all
  630  personnel having responsibility for the care of residents. The
  631  rules must require adequate staff to provide for the safety of
  632  all residents. Facilities licensed for 17 or more residents are
  633  required to maintain an alert staff for 24 hours per day.
  634         (d)All sanitary conditions within the facility and its
  635  surroundings which will ensure the health and comfort of
  636  residents. The rules must clearly delineate the responsibilities
  637  of the agency’s licensure and survey staff, the county health
  638  departments, and the local authority having jurisdiction over
  639  firesafety and ensure that inspections are not duplicative. The
  640  agency may collect fees for food service inspections conducted
  641  by the county health departments and transfer such fees to the
  642  Department of Health.
  643         (d)(e) License application and license renewal, transfer of
  644  ownership, proper management of resident funds and personal
  645  property, surety bonds, resident contracts, refund policies,
  646  financial ability to operate, and facility and staff records.
  647         (e)(f) Inspections, complaint investigations, moratoriums,
  648  classification of deficiencies, levying and enforcement of
  649  penalties, and use of income from fees and fines.
  650         (f)(g) The enforcement of the resident bill of rights
  651  specified in s. 429.28.
  652         (g)(h) The care and maintenance of residents provided by
  653  the facility, which must include, but is not limited to:
  654         1. The supervision of residents;
  655         2. The provision of personal services;
  656         3. The provision of, or arrangement for, social and leisure
  657  activities;
  658         4. The assistance in making arrangements arrangement for
  659  appointments and transportation to appropriate medical, dental,
  660  nursing, or mental health services, as needed by residents;
  661         5. The management of medication stored within the facility
  662  and as needed by residents;
  663         6. The dietary nutritional needs of residents;
  664         7. Resident records; and
  665         8. Internal risk management and quality assurance; and
  666         9. The requirements for using medical diagnostic testing
  667  equipment that is designed for a residential setting and is used
  668  at the point of care delivery, including equipment to test
  669  cholesterol, blood glucose level, and blood pressure.
  670         (h)(i) Facilities holding a limited nursing, extended
  671  congregate care, or limited mental health license.
  672         (i)(j) The establishment of specific criteria to define
  673  appropriateness of resident admission and continued residency in
  674  a facility holding a standard, limited nursing, extended
  675  congregate care, and limited mental health license.
  676         (j)(k) The use of physical or chemical restraints. The use
  677  of geriatric chairs or posey restraints is prohibited. Other
  678  physical restraints may be used in accordance with agency rules
  679  when ordered is limited to half-bed rails as prescribed and
  680  documented by the resident’s physician and consented to by with
  681  the consent of the resident or, if applicable, the resident’s
  682  representative or designee or the resident’s surrogate,
  683  guardian, or attorney in fact. Such rules must specify
  684  requirements for care planning, staff monitoring, and periodic
  685  review. The use of chemical restraints is limited to prescribed
  686  dosages of medications authorized by the resident’s physician
  687  and must be consistent with the resident’s diagnosis. Residents
  688  who are receiving medications that can serve as chemical
  689  restraints must be evaluated by their physician at least
  690  annually to assess:
  691         1. The continued need for the medication.
  692         2. The level of the medication in the resident’s blood.
  693         3. The need for adjustments in the prescription.
  694         (k)(l) The establishment of specific resident elopement
  695  drill requirements policies and procedures on resident
  696  elopement. Facilities shall conduct a minimum of two resident
  697  elopement drills each year. All administrators and direct care
  698  staff shall participate in the drills, which must include a
  699  review of the facility’s procedures to address resident
  700  elopement. Facilities shall document participation in the
  701  drills.
  702         (2) In adopting any rules pursuant to this part, the
  703  department, in conjunction with the agency, shall make distinct
  704  standards for facilities based upon facility size; the types of
  705  care provided; the physical and mental capabilities and needs of
  706  residents; the type, frequency, and amount of services and care
  707  offered; and the staffing characteristics of the facility. Rules
  708  developed pursuant to this section may not restrict the use of
  709  shared staffing and shared programming in facilities that are
  710  part of retirement communities that provide multiple levels of
  711  care and otherwise meet the requirements of law and rule. If a
  712  continuing care facility licensed under chapter 651 or a
  713  retirement community offering multiple levels of care licenses a
  714  building or part of a building designated for independent living
  715  for assisted living, staffing requirements established in rule
  716  apply only to residents who receive personal, limited nursing,
  717  or extended congregate care services under this part. Such
  718  facilities shall retain a log listing the names and unit number
  719  for residents receiving these services. The log must be
  720  available to surveyors upon request. Except for uniform
  721  firesafety standards, The department shall adopt by rule
  722  separate and distinct standards for facilities with 16 or fewer
  723  beds and for facilities with 17 or more beds. The standards for
  724  facilities with 16 or fewer beds must be appropriate for a
  725  noninstitutional residential environment; however, the structure
  726  may not be more than two stories in height and all persons who
  727  cannot exit the facility unassisted in an emergency must reside
  728  on the first floor. The department, in conjunction with the
  729  agency, may make other distinctions among types of facilities as
  730  necessary to enforce this part. Where appropriate, the agency
  731  shall offer alternate solutions for complying with established
  732  standards, based on distinctions made by the department and the
  733  agency relative to the physical characteristics of facilities
  734  and the types of care offered.
  735         (3) The department shall submit a copy of proposed rules to
  736  the Speaker of the House of Representatives, the President of
  737  the Senate, and appropriate committees of substance for review
  738  and comment prior to the promulgation thereof. Rules promulgated
  739  by the department must shall encourage the development of
  740  homelike facilities which promote the dignity, individuality,
  741  personal strengths, and decisionmaking ability of residents.
  742         (4) The agency, in consultation with the department, may
  743  waive rules promulgated pursuant to this part in order to
  744  demonstrate and evaluate innovative or cost-effective congregate
  745  care alternatives which enable individuals to age in place. Such
  746  waivers may be granted only in instances where there is
  747  reasonable assurance that the health, safety, or welfare of
  748  residents will not be endangered. To apply for a waiver, the
  749  licensee shall submit to the agency a written description of the
  750  concept to be demonstrated, including goals, objectives, and
  751  anticipated benefits; the number and types of residents who will
  752  be affected, if applicable; a brief description of how the
  753  demonstration will be evaluated; and any other information
  754  deemed appropriate by the agency. Any facility granted a waiver
  755  shall submit a report of findings to the agency and the
  756  department within 12 months. At such time, the agency may renew
  757  or revoke the waiver or pursue any regulatory or statutory
  758  changes necessary to allow other facilities to adopt the same
  759  practices. The department may by rule clarify terms and
  760  establish waiver application procedures, criteria for reviewing
  761  waiver proposals, and procedures for reporting findings, as
  762  necessary to implement this subsection.
  763         (5) The agency may use an abbreviated biennial standard
  764  licensure inspection that consists of a review of key quality
  765  of-care standards in lieu of a full inspection in a facility
  766  that has a good record of past performance. However, a full
  767  inspection must be conducted in a facility that has a history of
  768  class I or class II violations, uncorrected class III
  769  violations, or a violation resulting from a complaint referred
  770  by the State Long-Term Care Ombudsman Program to a regulatory
  771  agency confirmed ombudsman council complaints, or confirmed
  772  licensure complaints, within the previous licensure period
  773  immediately preceding the inspection or if a potentially serious
  774  problem is identified during the abbreviated inspection. The
  775  agency, in consultation with the department, shall adopt by rule
  776  develop the key quality-of-care standards with input from the
  777  State Long-Term Care Ombudsman Council and representatives of
  778  provider groups for incorporation into its rules.
  779         Section 10. Section 429.435, Florida Statutes, is created
  780  to read:
  781         429.435 Uniform firesafety standards.-Uniform firesafety
  782  standards for assisted living facilities and a residential board
  783  and care occupancy shall be established by the State Fire
  784  Marshal pursuant to s. 633.206.
  785         (1)EVACUATION CAPABILITY.—A firesafety evacuation
  786  capability determination shall be conducted within 6 months
  787  after the date of initial licensure, if required.
  789         (a)The National Fire Protection Association, Life Safety
  790  Code, NFPA 101 and 101A, current editions, must be used in
  791  determining the uniform firesafety code adopted by the State
  792  Fire Marshal for assisted living facilities, pursuant to s.
  793  633.206.
  794         (b)A local government or a utility may charge fees that do
  795  not exceed the actual costs incurred by the local government or
  796  the utility for the installation and maintenance of an automatic
  797  fire sprinkler system in a licensed assisted living facility
  798  structure.
  799         (c)All licensed facilities must have an annual fire
  800  inspection conducted by the local fire marshal or authority
  801  having jurisdiction.
  802         (d)An assisted living facility that was issued a building
  803  permit or certificate of occupancy before July 1, 2016, at its
  804  option and after notifying the authority having jurisdiction,
  805  may remain under the provisions of the 1994 and 1995 editions of
  806  the National Fire Protection Association, Life Safety Code, NFPA
  807  101 and 101A. A facility opting to remain under such provisions
  808  may make repairs, modernizations, renovations, or additions to,
  809  or rehabilitate, the facility in compliance with NFPA 101, 1994
  810  edition, and may utilize the alternative approaches to life
  811  safety in compliance with NFPA 101A, 1995 edition. However, a
  812  facility for which a building permit or certificate of occupancy
  813  was issued before July 1, 2016, which undergoes Level III
  814  building alteration or rehabilitation, as defined in the Florida
  815  Building Code, or which seeks to utilize features not authorized
  816  under the 1994 or 1995 editions of the Life Safety Code shall
  817  thereafter comply with all aspects of the uniform firesafety
  818  standards established under s. 633.206, and the Florida Fire
  819  Prevention Code, in effect for assisted living facilities as
  820  adopted by the State Fire Marshal.
  821         Section 11. Section 429.52, Florida Statutes, is amended to
  822  read:
  823         429.52 Staff training and educational requirements
  824  programs; core educational requirement.—
  825         (1) Effective October 1, 2015, Each new assisted living
  826  facility employee who has not previously completed core training
  827  must attend a preservice orientation provided by the facility
  828  before interacting with residents. The preservice orientation
  829  must be at least 2 hours in duration and cover topics that help
  830  the employee provide responsible care and respond to the needs
  831  of facility residents. Upon completion, the employee and the
  832  administrator of the facility must sign a statement that the
  833  employee completed the required preservice orientation. The
  834  facility must keep the signed statement in the employee’s
  835  personnel record.
  836         (2) Administrators and other assisted living facility staff
  837  must meet minimum training and education requirements
  838  established by the Department of Elderly Affairs by rule. This
  839  training and education is intended to assist facilities to
  840  appropriately respond to the needs of residents, to maintain
  841  resident care and facility standards, and to meet licensure
  842  requirements.
  843         (3) The department shall establish core training
  844  requirements for administrators consisting of core training
  845  learning objectives, a competency test, and a minimum required
  846  score to indicate successful passage completion of the core
  847  competency test training and educational requirements. The
  848  competency test must be developed by the department in
  849  conjunction with the agency and providers. The required core
  850  competency test training and education must cover at least the
  851  following topics:
  852         (a) State law and rules relating to assisted living
  853  facilities.
  854         (b) Resident rights and identifying and reporting abuse,
  855  neglect, and exploitation.
  856         (c) Special needs of elderly persons, persons with mental
  857  illness, and persons with developmental disabilities and how to
  858  meet those needs.
  859         (d) Nutrition and food service, including acceptable
  860  sanitation practices for preparing, storing, and serving food.
  861         (e) Medication management, recordkeeping, and proper
  862  techniques for assisting residents with self-administered
  863  medication.
  864         (f) Firesafety requirements, including fire evacuation
  865  drill procedures and other emergency procedures.
  866         (g) Care of persons with Alzheimer’s disease and related
  867  disorders.
  868         (4) A new facility administrator must complete the required
  869  core training and education, including the competency test,
  870  within 90 days after the date of employment as an administrator.
  871  Failure to do so is a violation of this part and subjects the
  872  violator to an administrative fine as prescribed in s. 429.19.
  873  Administrators licensed in accordance with part II of chapter
  874  468 are exempt from this requirement. Other licensed
  875  professionals may be exempted, as determined by the department
  876  by rule.
  877         (5) Administrators are required to participate in
  878  continuing education for a minimum of 12 contact hours every 2
  879  years.
  880         (6) Staff involved with the management of medications and
  881  assisting with the self-administration of medications under s.
  882  429.256 must complete a minimum of 6 additional hours of
  883  training provided by a registered nurse, or a licensed
  884  pharmacist, before providing assistance or department staff. Two
  885  hours of continuing education is required annually thereafter.
  886  The department shall establish by rule the minimum requirements
  887  of this additional training.
  888         (7) Other Facility staff shall participate in in-service
  889  training relevant to their job duties as specified by department
  890  rule of the department. Topics covered during the preservice
  891  orientation are not required to be repeated during in-service
  892  training. A single certificate of completion that covers all
  893  required in-service training topics may be issued to a
  894  participating staff member if the training is provided in a
  895  single training course.
  896         (8) If the department or the agency determines that there
  897  are problems in a facility that could be reduced through
  898  specific staff training or education beyond that already
  899  required under this section, the department or the agency may
  900  require, and provide, or cause to be provided, the training or
  901  education of any personal care staff in the facility.
  902         (9) The department shall adopt rules related to these
  903  training and education requirements, the competency test,
  904  necessary procedures, and competency test fees and shall adopt
  905  or contract with another entity to develop and administer the
  906  competency test. The department shall adopt a curriculum outline
  907  with learning objectives to be used by core trainers, which
  908  shall be used as the minimum core training content requirements.
  909  The department shall consult with representatives of stakeholder
  910  associations and agencies in the development of the curriculum
  911  outline.
  912         (10) The core training required by this section other than
  913  the preservice orientation must be conducted by persons
  914  registered with the department as having the requisite
  915  experience and credentials to conduct the training. A person
  916  seeking to register as a core trainer must provide the
  917  department with proof of completion of the minimum core training
  918  education requirements, successful passage of the competency
  919  test established under this section, and proof of compliance
  920  with the continuing education requirement in subsection (5).
  921         (11) A person seeking to register as a core trainer also
  922  must also:
  923         (a) Provide proof of completion of a 4-year degree from an
  924  accredited college or university and must have worked in a
  925  management position in an assisted living facility for 3 years
  926  after being core certified;
  927         (b) Have worked in a management position in an assisted
  928  living facility for 5 years after being core certified and have
  929  1 year of teaching experience as an educator or staff trainer
  930  for persons who work in assisted living facilities or other
  931  long-term care settings;
  932         (c) Have been previously employed as a core trainer for the
  933  department; or
  934         (d) Meet other qualification criteria as defined in rule,
  935  which the department is authorized to adopt.
  936         (12) The department shall adopt rules to establish core
  937  trainer registration and removal requirements.
  938         Section 12. Paragraph (b) of subsection (3) of section
  939  429.07, Florida Statutes, is amended to read
  940         429.07 License required; fee.—
  941         (3) In addition to the requirements of s. 408.806, each
  942  license granted by the agency must state the type of care for
  943  which the license is granted. Licenses shall be issued for one
  944  or more of the following categories of care: standard, extended
  945  congregate care, limited nursing services, or limited mental
  946  health.
  947         (b) An extended congregate care license shall be issued to
  948  each facility that has been licensed as an assisted living
  949  facility for 2 or more years and that provides services,
  950  directly or through contract, beyond those authorized in
  951  paragraph (a), including services performed by persons licensed
  952  under part I of chapter 464 and supportive services, as defined
  953  by rule, to persons who would otherwise be disqualified from
  954  continued residence in a facility licensed under this part. An
  955  extended congregate care license may be issued to a facility
  956  that has a provisional extended congregate care license and
  957  meets the requirements for licensure under subparagraph 2. The
  958  primary purpose of extended congregate care services is to allow
  959  residents the option of remaining in a familiar setting from
  960  which they would otherwise be disqualified for continued
  961  residency as they become more impaired. A facility licensed to
  962  provide extended congregate care services may also admit an
  963  individual who exceeds the admission criteria for a facility
  964  with a standard license, if he or she is determined appropriate
  965  for admission to the extended congregate care facility.
  966         1. In order for extended congregate care services to be
  967  provided, the agency must first determine that all requirements
  968  established in law and rule are met and must specifically
  969  designate, on the facility’s license, that such services may be
  970  provided and whether the designation applies to all or part of
  971  the facility. This designation may be made at the time of
  972  initial licensure or relicensure, or upon request in writing by
  973  a licensee under this part and part II of chapter 408. The
  974  notification of approval or the denial of the request shall be
  975  made in accordance with part II of chapter 408. Each existing
  976  facility that qualifies to provide extended congregate care
  977  services must have maintained a standard license and may not
  978  have been subject to administrative sanctions during the
  979  previous 2 years, or since initial licensure if the facility has
  980  been licensed for less than 2 years, for any of the following
  981  reasons:
  982         a. A class I or class II violation;
  983         b. Three or more repeat or recurring class III violations
  984  of identical or similar resident care standards from which a
  985  pattern of noncompliance is found by the agency;
  986         c. Three or more class III violations that were not
  987  corrected in accordance with the corrective action plan approved
  988  by the agency;
  989         d. Violation of resident care standards which results in
  990  requiring the facility to employ the services of a consultant
  991  pharmacist or consultant dietitian;
  992         e. Denial, suspension, or revocation of a license for
  993  another facility licensed under this part in which the applicant
  994  for an extended congregate care license has at least 25 percent
  995  ownership interest; or
  996         f. Imposition of a moratorium pursuant to this part or part
  997  II of chapter 408 or initiation of injunctive proceedings.
  999  The agency may deny or revoke a facility’s extended congregate
 1000  care license for not meeting the criteria for an extended
 1001  congregate care license as provided in this subparagraph.
 1002         2. If an assisted living facility has been licensed for
 1003  less than 2 years, the initial extended congregate care license
 1004  must be provisional and may not exceed 6 months. The licensee
 1005  shall notify the agency, in writing, when it has admitted at
 1006  least one extended congregate care resident, after which an
 1007  unannounced inspection shall be made to determine compliance
 1008  with the requirements of an extended congregate care license. A
 1009  licensee with a provisional extended congregate care license
 1010  that demonstrates compliance with all the requirements of an
 1011  extended congregate care license during the inspection shall be
 1012  issued an extended congregate care license. In addition to
 1013  sanctions authorized under this part, if violations are found
 1014  during the inspection and the licensee fails to demonstrate
 1015  compliance with all assisted living facility requirements during
 1016  a followup inspection, the licensee shall immediately suspend
 1017  extended congregate care services, and the provisional extended
 1018  congregate care license expires. The agency may extend the
 1019  provisional license for not more than 1 month in order to
 1020  complete a followup visit.
 1021         3. A facility that is licensed to provide extended
 1022  congregate care services shall maintain a written progress
 1023  report on each person who receives services which describes the
 1024  type, amount, duration, scope, and outcome of services that are
 1025  rendered and the general status of the resident’s health. A
 1026  registered nurse, or appropriate designee, representing the
 1027  agency shall visit the facility at least twice a year to monitor
 1028  residents who are receiving extended congregate care services
 1029  and to determine if the facility is in compliance with this
 1030  part, part II of chapter 408, and relevant rules. One of the
 1031  visits may be in conjunction with the regular survey. The
 1032  monitoring visits may be provided through contractual
 1033  arrangements with appropriate community agencies. A registered
 1034  nurse shall serve as part of the team that inspects the
 1035  facility. The agency may waive one of the required yearly
 1036  monitoring visits for a facility that has:
 1037         a. Held an extended congregate care license for at least 24
 1038  months;
 1039         b. No class I or class II violations and no uncorrected
 1040  class III violations; and
 1041         c. No ombudsman council complaints that resulted in a
 1042  citation for licensure.
 1043         4. A facility that is licensed to provide extended
 1044  congregate care services must:
 1045         a. Demonstrate the capability to meet unanticipated
 1046  resident service needs.
 1047         b. Offer a physical environment that promotes a homelike
 1048  setting, provides for resident privacy, promotes resident
 1049  independence, and allows sufficient congregate space as defined
 1050  by rule.
 1051         c. Have sufficient staff available, taking into account the
 1052  physical plant and firesafety features of the building, to
 1053  assist with the evacuation of residents in an emergency.
 1054         d. Adopt and follow policies and procedures that maximize
 1055  resident independence, dignity, choice, and decisionmaking to
 1056  permit residents to age in place, so that moves due to changes
 1057  in functional status are minimized or avoided.
 1058         e. Allow residents or, if applicable, a resident’s
 1059  representative, designee, surrogate, guardian, or attorney in
 1060  fact to make a variety of personal choices, participate in
 1061  developing service plans, and share responsibility in
 1062  decisionmaking.
 1063         f. Implement the concept of managed risk.
 1064         g. Provide, directly or through contract, the services of a
 1065  person licensed under part I of chapter 464.
 1066         h. In addition to the training mandated in s. 429.52,
 1067  provide specialized training as defined by rule for facility
 1068  staff.
 1069         5. A facility that is licensed to provide extended
 1070  congregate care services is exempt from the criteria for
 1071  continued residency set forth in rules adopted under s. 429.41.
 1072  A licensed facility must adopt its own requirements within
 1073  guidelines for continued residency set forth by rule. However,
 1074  the facility may not serve residents who require 24-hour nursing
 1075  supervision. A licensed facility that provides extended
 1076  congregate care services must also provide each resident with a
 1077  written copy of facility policies governing admission and
 1078  retention.
 1079         6. Before the admission of an individual to a facility
 1080  licensed to provide extended congregate care services, the
 1081  individual must undergo a medical examination as provided in s.
 1082  429.26(5) s. 429.26(4) and the facility must develop a
 1083  preliminary service plan for the individual.
 1084         7. If a facility can no longer provide or arrange for
 1085  services in accordance with the resident’s service plan and
 1086  needs and the facility’s policy, the facility must make
 1087  arrangements for relocating the person in accordance with s.
 1088  429.28(1)(k).
 1089         Section 13. This act shall take effect July 1, 2019.