SB 402 — Assisted Living Facilities

prohibitingrequiring a facility to submit a comprehensive emergency management plan to the usecounty ofemergency Poseymanagement restraints;agency within a specified timeframe after its licensure;

authorizing the use of other restraints under certain circumstances;

revising resident elopement drill requirements for facilities;

requiringrevising thestandards agencyfor tothe adoptcare byof rule,residents ratherprovided thanby develop,a keyfacility; quality-of-care standards;

prohibiting the use of geriatric chairs and Posey restraints in facilities;

authorizing other physical restraints to be used under certain conditions and in accordance with certain rules;

requiring the agency to establish resident elopement drill requirements;

requiring that elopement drills include a review of a facility’s procedures to address elopement;

revising the criteria under which a facility must be fully inspected;

revising provisions requiring the agency to adopt by rule key quality-of care standards;

requiringrevising the State Fire Marshall to establish uniform firesafety standards for certain assisted living facilities;facilities, which are relocated to this section;

providing for a firesafety evacuation capability determination within a specified timeframe under certain circumstances;

requiring the State Fire Marshall to use certain standards from a specified national association to determine the uniform firesafety standards to be adopted;

authorizing local governments and utilities to charge certain fees relating to fire sprinkler systems;

requiring licensed facilities to have an annual fire inspection;

specifying certain code requirements for facilities that undergo a specific alteration or rehabilitation;

revising certain provisions relating to facility staff training and educational requirements;

revising the training and continuing education requirements for facility staff who assist residents with the self-administration of medications;

revising the training requirements for facility staff;

requiring the agencydepartment to adopt a curriculum outline with learning objectives to be used by core trainers;

conforming provisions to changes made by the act;

131101 Be It Enacted by the Legislature of the State of Florida:

133103 Section 1. Present subsections (1) through (5), (6) through (10), (11) through (15), and (16) through (27) of section 429.02, Florida Statutes, are redesignated as subsections (7)(2) through (28),(6), respectively,(8) athrough (12), (14) through (18), and (20) through (31), respectively, new subsectionsubsections (6)(1), is(7), added(13), toand that(19) section,are added, and present subsections (11) and (18) of that section are amended, to read:

(6) “Assistive(1) “Abuse” device”has meansthe anysame devicemeaning designedas orin adapteds. to help a resident perform an action, a task, an activity of daily living, or a transfer;

415.102.

(7) “Assistive device” means any device designed or adapted to help a resident perform an action, a task, an activity of daily living, or a transfer;

(12)(11) “Extended(13) “Exploitation” congregatehas care”the meanssame actsmeaning beyondas those authorized in subsections. (18) which (17) that may be performed pursuant to part I of chapter 464 by persons licensed thereunder while carrying out their professional duties, and other supportive services that which may be specified by rule.

415.102.

(14)(11) “Extended congregate care” means acts beyond those authorized in subsection (21) which (17) that may be performed pursuant to part I of chapter 464 by persons licensed thereunder while carrying out their professional duties, and other supportive services that which may be specified by rule.

(19)(18) “Physical(19) “Neglect” restraint”has meansthe asame devicemeaning thatas whichin physicallys. limits, restricts, or deprives an individual of movement or mobility, including, but not limited to, a half-bed rail, a full-bed rail, a geriatric chair, and a posey restraint.

415.102.

For purposes other than reporting requirements within this part, “neglect” may also include the failure to prevent sexual abuse as defined in s.

415.102.

(22)(18) “Physical restraint” means a device that which physically limits, restricts, or deprives an individual of movement or mobility, including, but not limited to, a half-bed rail, a full-bed rail, a geriatric chair, and a posey restraint.

226204 The agency may deny or revoke a facility’s extended congregate care license for not meeting the criteria for an extended congregate care license as provided in this subparagraph.

3. A facility that is licensed to provide extended congregate care services shall maintain a written progress report on each person who receives nursing services from the facility’s staff which describes the type, amount, duration, scope, and outcome of services that are rendered and the general status of the resident’s health.

Section 5. Subsections (3),(2) (4),through and (5) of section 429.23, Florida Statutes, are amended to read:

adverse incidents and reporting requirements.— (3) Licensed(2) Every facilitiesfacility shalllicensed provideunder withinthis 1part business day after the occurrence of an adverse incident, through the agency’s online portal or, if the portal is offline,required by electronic mail, facsimile, or United States mail, a preliminary report to themaintain agency on all adverse incidentsincident specifiedreports. under this section.

TheFor reportpurposes must include information regarding the identity of thethis affectedsection, resident, the typeterm, of“adverse adverseincident” incident,means: and the status of the facility’s investigation of the incident.

(4) Licensed(a) An facilitiesevent shallover providewhich withinfacility 15personnel days,could throughexercise thecontrol agency’swhich onlineis portalassociated or,with if the portalfacility’s isintervention, offline,rather bythan electronicas mail, facsimile, or United States mail, a fullresult reportof to the agencyresident’s onunderlying alldisease adverseor incidentscondition, specifiedand inthe thisinjury section.results in:

1. Death;

2. Brain or spinal damage;

3. Permanent disfigurement;

4. Fracture or dislocation of bones or joints;

5. Any condition that required medical attention to which the resident has not given his or her consent, including failure to honor advanced directives;

6. Any condition that requires the transfer of the resident from the facility to a unit providing more acute care due to the incident rather than the resident’s condition before the incident;

or 7. A report made An event that is reported to law enforcement or its personnel for investigation;

or (b) Resident elopement, if the elopement places the resident at risk of harm or injury.

(3) Licensed facilities shall provide within 1 business day after the occurrence of an adverse incident, by electronic mail, facsimile, or United States mail, a preliminary report to the agency on all adverse incidents specified under this section.

The report must include information regarding the identity of the affected resident, the type of adverse incident, and the result status of the facility’s investigation of the incident.

(4) Licensed facilities shall provide within 15 days, by electronic mail, facsimile, or United States mail, a full report to the agency on all adverse incidents specified in this section.

(5) Three(5) The businessagency daysshall beforesend, theby deadlineelectronic formail, thereminders submissionto of the fullfacility’s reportadministrator requiredand underother subsectionspecified (4),facility thecontacts agency3 shallbusiness senddays bybefore electronicthe maildeadline afor reminder to the facility’ssubmission administratorof andthe otherfull specifiedreport. facility contacts.

WithinIf 3 business days after the agency sends the reminder, a facility isdetermines notthat subject to any administrative or other agency action for failing to withdraw the preliminary report if the facility determines the event wasis not an adverse incidentincident, or for failing to file a full report if the facility determinesmust thewithdraw event was an adverse incident Each facility shall report monthly to the agencypreliminary anyreport. liability claim filed against it.

Until 3 business days after the agency provides the reminder, facilities shall not be subject to any administrative or other action for failing to file a full report if the facility determined that the event was not an adverse incident after filing the preliminary report.

Each facility shall report monthly to the agency any liability claim filed against it.

Section 6. Paragraphs6. Subsection (a)(4) and (b) of subsection (1) of section 429.255, Florida Statutes, are amended, paragraph (d) is addedamended to that subsection, and subsection (4) of that section is amended, to read:

emergency care.— (1)(a) Persons(4) Facility understaff contractmay towithhold theor facility,withdraw facilitycardiopulmonary staff,resuscitation or volunteers,the whouse areof licensedan accordingautomated toexternal partdefibrillator Iif ofpresented chapterwith 464,an ororder thosenot personsto exemptresuscitate underexecuted pursuant to s.

464.022(1), and others as defined by rule, may administer medications to residents, take residents’ vital signs, change residents’ bandages for minor cuts and abrasions, manage individual weekly pill organizers for residents who self-administer medication, give prepackaged enemas ordered by a physician, observe residents, document observations on the appropriate resident’s record, and report observations to the resident’s physician, and contract or allow residents or a resident’s representative, designee, surrogate, guardian, or attorney in fact to contract with a third party, provided residents meet the criteria for appropriate placement as defined in s.

429.26.

Nursing assistants certified pursuant to part II of chapter 464 may take residents’ vital signs as directed by a licensed nurse or physician.

(b) All staff of in facilities licensed under this part shall exercise their professional responsibility to observe residents, to document observations on the appropriate resident’s record, and to report the observations to the resident’s physician.

However, the owner or administrator of the facility shall be responsible for determining that the resident receiving services is appropriate for residence in the facility.

(d) A resident or his or her representative, designee, surrogate, guardian, or attorney in fact, as applicable, may contract for services with a third party, provided the resident meets the criteria for residency and continued residency as defined in s.

429.26.

The third party must communicate with the facility regarding the resident’s condition and the services being provided in accordance with the facility’s policies.

The facility must document that it received such communication.

(4) Facility staff may withhold or withdraw cardiopulmonary resuscitation or the use of an automated external defibrillator if presented with an order not to resuscitate executed pursuant to s.

(b) In the presence of the resident, confirming that the medication is intended for that resident, orally advising the resident of the medication name and dosagepurpose reading the label, opening the container, removing a prescribed amount of medication from the container, and closing the container.

The resident may sign a written waiver to opt out of being orally advised of the medication name and dosage.

The waiver must identify all of the medications intended for the resident, including names and dosages of such medications, and must immediately be updated each time the resident’s medications or dosages change.

The resident must have a plan of care which delineates how the facility and the hospice will meet the scheduled and unscheduled needs of the resident,resident. including, if applicable, staffing for nursing care.

(5)(a)(4) If(5)(4) If possible, Each resident must shall have been examined by a licensed physician, a licensed physician assistant, or a licensed advanced practice registered nurse practitioner within 60 days before admission to the facility or within 30 days after admission to the facility, except as provided in s.

429.07(3)(b)6.429.07.

The signed and completed medical examination form, signed only by the practitioner, must report shall be submitted to the owner or administrator of the facility, who shall use the information contained therein to assist in the determination of the appropriateness of the resident’s admission to or and continued residency stay in the facility.

(b) TheThe medical examination form may be used only to record the practitioner’shealth care provider’s direct observation of the patient at the time of examination and must include theany patient’sknown medical history.

SuchThe medical examination form doesis not a guarantee admissionof to,admission, continued residencyresidency, in, or the delivery of services at the facility and mustmay be used only as an informative tool to assist in the determination of the appropriateness of the resident’s admission to or continued residency in the facility.

(c) The(6) The medical examination form mustsubmitted includeunder allsubsection of(5) must include the following information aboutrelating to the resident:

1. Height,(a) Height, weight, and known allergies.

2. Significant(b) Significant medical history and diagnoses.

3. Physical(c) Physical or sensory limitations, including the need for fall precautions or recommended use of assistive devices.

4. Cognitive(d) Cognitive or behavioral status and a brief description of any behavioral issues known or ascertained by the examining practitioner, including any known history of wandering or elopement.

5. Nursing,(e) Nursing, treatment, or therapy service requirements.

6. Whether(f) Whether theassistance residentis needsneeded assistance for ambulating, eating, or transferring.

7. Special(g) Special dietary instructions.

8. Whether(h) Whether thehe residentor she has any communicable diseases, including precautions that are necessary dueprecautions. to such diseases.

9. Whether(i) Whether thehe residentor she is bedridden and the presencestatus of any pressure sores.sores that he or she has.

10. Whether(j) Whether the resident needs 24-hour nursing supervision or psychiatric care.

11. A(k) A list of current prescribed medications as known or ascertained by the examining practitioner and whether the resident can self-administer medications, needs assistanceassistance, with medications, or needs medication administration.

(6) Any(7)(6) Any resident accepted in a facility and placed by the department or the Department of Children and Families must shall have been examined by medical personnel within 30 days before placement in the facility.

An evaluation completed upon discharge from a state mental hospital meets the requirements of this subsection related to appropriateness for placement as a mental health resident,resident provided that providing it was completed within 90 days before prior to admission to the facility.

(7) The(8)(7) The facility shall must notify a licensed physician when a resident exhibits signs of dementia or cognitive impairment or has a change of condition in order to rule out the presence of an underlying physiological condition that may be contributing to such dementia or impairment.

If the resident does not have a representative or designee or if the resident’s representative or designee cannot be located or is nonresponsive,unresponsive, the facility shall arrangearrange, with anthe appropriate health care providerprovider, for the necessary care and services to treat the condition.

(8) The(9)(8) The Department of Children and Families may require an examination for supplemental security income and optional state supplementation recipients residing in facilities at any time and shall provide the examination whenever a resident’s condition requires it.

(9)(10) Facilities(10) Facilities licensed to provide extended congregate care services shall promote aging in place by determining appropriateness of continued residency based on a comprehensive review of the resident’s physical and functional status;

Section 9. Paragraph9. Paragraphs (a) and (k) of subsection (1) and subsection (3) of section 429.28, Florida Statutes, are amended to read:

(a) Live in a safe and decent living environment, free from abuse, and neglect, and exploitation.

(3)(a) The agency shall conduct a survey to determine whether the facility is complying with this partsection general compliance with facility standards and compliance with residents’ rights as a prerequisite to initial licensure or licensure renewal.

Section 10. Subsections10. Section (1)429.41, and (2) of section 429.31, Florida Statutes, areis amended to read:

429.31 Closing of facility;

notice;

penalty.— (1) In addition to the requirements of part II of chapter 408, the facility shall inform, in writing, the agency and each resident or the next of kin, legal representative, or agency acting on each resident’s behalf, of the fact and the proposed time of discontinuance of operation, following the notification requirements provided in s.

429.28(1)(k).

In the event a resident has no person to represent him or her, the facility shall be responsible for referral to an appropriate social service agency for placement.

(2) Immediately upon the notice by the agency of the voluntary or involuntary termination of such operation, the agency shall inform the State Long-Term Care Ombudsman Program and monitor the transfer of residents to other facilities and ensure that residents’ rights are being protected.

The agency, in consultation with the Department of Children and Families, shall specify procedures for ensuring that all residents who receive services are appropriately relocated.

Section 11. Subsections (1), (2), and (5) of section 429.41, Florida Statutes, are amended to read:

(a) The requirements for and maintenance and the sanitary condition of facilities, not in conflict with, or duplicative of, therules requirementsadopted inpursuant to s.

381.006,381.006(16) and s.

381.0072,381.0072 and standards established under chapter 553,553 orand s.

The use of geriatric chairs or Posey restraints is prohibited.

(k)(l) The establishment of specific resident elopement drill requirementsrequirements, andpolicies, policies and procedures on resident elopement.

(3) Rules adopted by the agency shall encourage the development of homelike facilities that promote the dignity, individuality, personal strengths, and decisionmaking ability of residents.

(4) The agency may waive rules adopted under this part to demonstrate and evaluate innovative or cost-effective congregate care alternatives that enable individuals to age in place.

Such waivers may be granted only in instances where there is reasonable assurance that the health, safety, or welfare of residents will not be endangered.

To apply for a waiver, the licensee shall submit to the agency a written description of the concept to be demonstrated, including goals, objectives, and anticipated benefits;

the number and types of residents who will be affected, if applicable;

a brief description of how the demonstration will be evaluated;

and any other information deemed appropriate by the agency.

Any facility granted a waiver shall submit a report of findings to the agency within 12 months.

At such time, the agency may renew or revoke the waiver or pursue any regulatory or statutory changes necessary to allow other facilities to adopt the same practices.

The agency may by rule clarify terms and establish waiver application procedures, criteria for reviewing waiver proposals, and procedures for reporting findings, as necessary to implement this subsection.

Section 12. Section11. Section 429.435, Florida Statutes, is created to read:

429.435 Uniform firesafety standards.—Uniform firesafety standards for assisted living facilitiesfacilities, thatwhich are residential board and care occupanciesoccupancies, shall be established by the State Fire Marshal pursuant to s.

A facility opting to remain under such provisions may make repairs, modernizations, renovations, or additions toto, or rehabilitaterehabilitate, the facility in compliance with NFPA 101, 1994 edition, and may useutilize the alternative approaches to life safety in compliance with NFPA 101A, 1995 edition.

However, a facility for which a building permit or certificate of occupancy was issued before July 1, 2016, which undergoes Level III building alteration or rehabilitation, as defined in the Florida Building Code, or which seeks to useutilize features not authorized under the 1994 or 1995 editions of the Life Safety Code, shall thereafter comply with all aspects of the uniform firesafety standards established under s.

Section 13. Section12. Section 429.52, Florida Statutes, is amended to read:

(7) Other Facility staff shall participate in inservicein-service training relevant to their job duties as specified by agency rule of the agency.

Topics covered during the preservice orientation are not required to be repeated during inservicein-service training.

A single certificate of completion whichthat covers all required inservicein-service training topics may be issued to a participating staff member if the training is provided in a single training course.

Section 14. This13. This act shall take effect July 1, 2020.