Assisted Living Facility Core

Competency Guide
Table of Contents
Introduction
Meet your core trainer

Module 1 - Assisted Living

Overview and Definitions
Regulatory Agencies
Assisted Living Licensing

Module 2 - Physical Plan Standards

Florida Building Code
59A-36.014 F.A.C
Fire Safety Standards

Module 3 - Resident Criteria

Admission Resident Criteria
Continued Resident Criteria

Module 4 - Resident Care

Resident Care
Resident Care Standards - Supervision
Social and Leisure Activities
Health Care and Personal Care
Third Party Services
Elopement Standards
Physical and Chemical Restraints
Assistive Devices
Infection Control
Clean Hands
Nursing Services
Best Practice - Leadership

Module 5 - Your Own Training

Module 6 - Admission Procedures

Advertising
Patient Brokering
Paying for Assisted Living
Medical Examination Requirements
 Resident Contracts
Admission Procedures
Best Practice - Sale Process
Managing the Moving Process

Module 7 - Fiscal Standards

Fiscal Standards
Property and Personal Affairs of Residents
Business Practices

Module 8 - Medication Management

Medication Management Overview
Medication Ordering
Medication Packaging
Health Care Provider and Pharmacy Communication
Assistance with Oral and Liquid Medications
Best Practice Assisting Residents
Assisting with Topical Medications
Vital Signs
Anti-embolism stockings, oxygen, nebulizers
Colostomy Care

Food Services
Food Services Introduction
Ch. 64E-11 and the Food Code
Pest Control
Food Services
Food Handling Practices
Foodborne Illnesses and Common Causes
Handwashing
Food Services Requirements - Ch 59A-36
Best Practice
Menus and Resident’s Input
Best Practices on Dining Experience
Emergency Supplies
Common Deficiencies in Food Services

Ch 64E-12, F.A.C.
Ch 64E-12,F.A.C.

Staffing Standards
Staffing Standards Overview
Important Definitions
Administrator and Management Requirements
 Best Practice - Administrators
Staffing Standard Requirements
Background Screenings
Staff Training Part I
Staff Training Part II
Staff Training Part III
Best Practices - Support and Retention
Staff Records
Best Practices - Time Management

Resident and Facility Records

Resident and Facility REcords Intro
Resident Records
Facility Records
Adverse Incident Reporting

Resident Rights
Resident Rights Into
Resident Bill of Rights
Resident Rights
Advance Directives
Long Term Care Ombudsman Program
Ombudsman Video
Abuse, Neglect and Exploitation
Baker Act

Specialty License and Services

Specialty License and Services
Limited Mental Health
Mental Health Video
Limited Nursing Services
Extended Congregate Care Intro
ECC Resident Criteria
ECC Services
Best Practice ECC Video
Alzheirmer’s Disease Requirements
Alzheirmer’s Video
Lewy Body Dementia
Facilities Licensed for 17 or More Residents

Emergency Management
Emergency Management
Comprehensive Emergency Management Plan (CEMP)
Emergency Environmental Control Plan (EECP)
 Fire Safety Plans
Covid Response Video

Licensing
Licensing Procedures
Licensing Process
Change of Ownership

Enforcement
Administrative Enforcement
Survey Process
Enforcement and Penalties

Review
Review Quiz

Wrap Up
Wrap Up
Online Core Training Evaluation
Reminder - Course Completion
Introduction
Meet your Core Trainer

Welcome to the core training course my name is Pascal Bergeron and I will be your instructor
for the Core Training course. This class is required by the state of Florida in order to receive
your assisted living administrator’s license. Once you pass this course, you are required to take
a state final exam in order to get certified.

A little bit about me, I have been administrator for over 30 years and continue to own and
operate a 114-bed facility. My course will contain a lot of real life examples that relate to the
regulations that you will be learning.

With this course you will learn about the state of Florida's assisted Living regulations more
specifically Florida statute Chapter 59A-36 See attached or display.

Course Overview
Included with this course is a guide to cover the minimum core training curriculum on Assisted
Living making it easy for you to follow along with the videos. The course is based on
regulations, laws and rules pertaining to Assisted Living. The guide is an amazing tool that will
make studying and understanding a bit easier to comprehend.

You must complete the training in its entirety to receive your certificate of completion within a
60-day period. Once the course is completed, we notified the MacDonald Research institute
who is the one that administers the ALF Administrator Competency Exam.

It is your responsibility to register in advance and plan when to take the exam. Once ready, you
may contact them and they will have your information. For additional information please visit
their website alfmacdonald-research.com. (Plan ahead tips at the end of the course should
be added)

It is recommended that you watch all the videos, study and review each section of this guide. As
a reminder, it is crucial that you dedicate a time to study each day consistently in a nice quiet
location with no distractions. Watch and read each module at a time, then stop and take 30
minutes to review it carefully. This will greatly improve your retention of all the information
provided. Mastering the information on this guide for all sections will increase your chances of
passing the exam.

For those coming from different states, it is important to be aware that there will be differences
on how each state regulates Assisting Living (AL). In Florida, AL is regulated by the state. One
of the differences is that nurses are not required on a Standard Licensed ALF.

Key sections: As an administrator, you should be aware of Food hygiene requirements

addressed on Chapter 4E11, 2013 Food code, 429, Florida Statutes, and 59A-36 Florida
Administrative Code are some of the main laws and rules governing assisted living.

Important Tips:
● Watch and pay close attention to all the videos.
● Read ALL sections and highlight important information such as definitions.
● Take good notes and if there’s anything you do not understand, go back and rewatch the
video or section.
● Flashcards may come handy to review key points.
● Time frames for better tracking on specific regulations.
Module 1- Assisted Living
Overview and Definitions
Chapter 429 of the Florida Statutes pertaining to Assisted Care Communities, more specifically
Assisted Living Facilities on Part 1 sections 429.01-429.55. The video for this section will cover
the main aspects of assisted living but we highly recommend that you read the following
sections in its entirety. (See attachments at the end of this guide)

429.01 Assisting Living Facilities Act

429.02 Definitions
429.04 Facilities to be licensed; exemptions
429.07 License required; fee.
429.075 Limited Mental Health License
429.08 Unlicensed facilities; referral of person for residency to unlicensed facility; penalties.
429.34 Right of entry and inspection

Definitions
Agency: is used in Ch 429 referring to the Agency Health Care Administration (AHCA).
Aging in place: means that there’s process where we are able to increase or adjust services
for residents as their needs increase or as they experience some type of physical or mental
decline so that they may remain living in their home or in their our facility these services are
intended to maximize the persons’ independence and their dignity. These services may be
provided by a facility, volunteers, family members or third party provider.
Assisted living facility: is a place to provide personal care services in the least restrictive and
most home-like environment.
Department: Department of Elder Affairs
Extended Congregate Care: It is an assisted living facility that provides services beyond those
authorized for a standard ALF, meaning that they may provide additional nursing services and
total assistance with personal care services.
Limited Nursing Services: an ALF that provides nursing services that are beyond what a
standard ALF is licensed to provide.
Mental Health Resident: is an individual who receives social security disability income due to a
mental disorder as determined by the Social Security Administration or receives supplemental
security income due to a mental disorder as determined by the Social Security Administration
and receives optional state supplementation.
Personal Services: services that are provided to residents of an ALF are services such as
physical assistance with, or supervision of, the activities of daily living and the self-
administration of medication.
Resident: it means a person 18 years of age or older, residing in and receiving care from a
facility.
Resident’s Representative or designee: a person other than the owner, or an agent or
employee of the facility, designated in writing by the resident, if legally competent, to receive
notice of changes in the contract executed pursuant to s. 429.24; to receive notice of and to
participate in meetings between the resident and the facility owner, administrator, or staff
concerning the rights of the resident; to assist the resident in contacting the State Long-Term
Care Ombudsman Program or local ombudsman council if the resident has a complaint against
the facility; or to bring legal action on behalf of the resident pursuant to s. 429.29.

Regulatory Agencies
This section will cover the primary state and regulatory agencies we normally interact with and
their responsibilities.

Agency for Health Care Administration (AHCA) The primary regulatory agency is AHCA, who
is responsible for licensure and regulation of Florida’s health facilities and for providing
information to Floridians about the quality of care they receive. They handle the licensing and
monitoring of all ALFs. AHCA also administers the Medicaid Program and any medicaid fraud
investigations through the Medicaid Fraud Control Unit of the Office of Attorney General.

The Department of Health (DOH) and Local Health Departments are responsible for
monitoring our food handling, sanitation and kitchen inspections. DOH promulgates many rules
to assisted living as stated in the Florida Administrative Code (F.A.C) but here are some of them
Chapter 64E-11 Food Hygiene
64E-12 Entitled Community Residential Homes
64E-16 Biohazards
Local Health Department conducts sanitization inspections at least annually and for larger
facilities they may inspect quarterly as well training review to ensure all food handler certification
is current.

County Local Agencies:

Local Fire Safety Authority: They are responsible for completing the Fire Safety Inspections
and also approving the Fire Safety Plan. It is important to note this needs to be approved
annually because they are to be submitted every year for the Comprehensive Emergency
Management Plan (CEMP).
In some cases, they may also help with generators to ensure they are properly installed and
functioning.
The County Emergency Management Agency is responsible for reviewing and approving the
CEMP and Emergency Environmental Plan (EEP) annually. They both address the minimum
temperature should you lose power and/or an alternate power source.
Department of Children and Families (DCF): They are responsible for approving and/or
providing training for Limited Mental Health Licensees & Baker Act Training. They would likely
come to a facility to investigate any allegations of abuse, neglect and exploitation. The division
of DCF investigating this type of cases is the Adult Protective Services (APS).

Florida Ombudsman Program is an advocate of Resident Rights and the quality of long-term
care communities. Skilled nursing, ALFs and adult family care homes. The program is
authorized at a federal level by the Older Americans Act of 1965 and the states receive funding
for that. The program in Florida is made up primarily of volunteers that have been trained. They
conduct annual inspections and may come in response to complaints or visits to ensure the
welfare and safety of residents. They may report any findings that are not in compliance with
standards to AHCA.
Florida Department of Elder Affairs (DOEA) administers programs and services that can help
elders, their families, and caregivers better understand and access federal, state and local
benefits available to them. The Department of Elder Affairs is responsible for the federal
program CARES. CARES is responsible for performing a comprehensive assessment of all
Medicaid long-term care applicants to determine if individuals meet the State’s medical level of
care eligibility requirements and financial criteria. The DOEA also oversees the Florida
Ombudsman Program previously explained.

Now that we have covered the responsibilities of each entity or agency, it is important to
remember that they each have a right of entry to any license assisted living facilities for
inspection. They may come unannounced to inspect in order to ensure compliance with
standards, laws and regulations governing assisted living. This leads us to emphasize the
importance of staff training when handling these visits to let them in. You may ask for
identification but you must not restrict access into the building. If you were to restrict or fail to
provide access, AHCA shall impose an immediate moratorium. An immediate moratorium
means you may not admit residents and it is an administrative penalty that will be further
discussed later in the course.

Assisted Living Licensing

Assisted living facilities are each licensed by the state. Therefore, regulations are different for
each state unlike skilled nursing facilities which are governed by the federal government and the
state. Some states have developed very specific regulations for facilities over the years but that
is not the case for Florida. Some regulations may not seem as modern and may be confusing
at times; however, we’ll address the main points of licensure in this section to better help
understand it.
The Assisted Living Facilities Act was enacted by the legislature as stated in chapter 429.01
of Florida Statutes where we can emphasize three keys aspects of it:

● The purpose of this act is to promote the availability of appropriate services for elderly
persons and adults with disabilities in the least restrictive and most homelike
environment,
● To encourage the development of facilities that promote the dignity, individuality, privacy,
and decision-making ability of such persons,
● To provide for the health, safety, and welfare of residents of assisted living facilities in
the state
The Legislature recognizes that assisted living facilities are an important part of the continuum
of long-term care in the state. In support of the goal of aging in place, the Legislature further
recognizes that assisted living facilities should be operated and regulated as residential
environments with supportive services and not as medical or nursing facilities. The services
available in these facilities, either directly or through contract or agreement, are intended to help
residents remain as independent as possible. Regulations governing these facilities must be
sufficiently flexible to allow facilities to adopt policies that enable residents to age in place when
resources are available to meet their needs and accommodate their preferences.

Let's take a look at Florida's definition of Assisted Living Facility:

“Assisted living facility” means any building or buildings, section or distinct part of a building,
private home, boarding home, home for the aged, or other residential facilities, regardless of
whether operated for profit, which through its ownership or management provides housing,
meals, and one or more personal services for a period exceeding 24 hours to one or more
adults who are not relatives of the owner or administrator.

If you meet the definition of an assisted living facility, then you are required to be licensed in
Florida by the Department of Health Care Administration (AHCA). A license must be issued prior
to admitting any residents unless you meet one of the exemptions listed on F.S Chapter 429.04:
● You may provide care for up to 2 adults who are not related in your own home not
receiving optional state supplementation. It must be in your primary residence. (Provide
specific example here) Not applicable to any person or entity that previously held an
ALF license that was revoked or surrendered.
● If you hold an adult family care home license: if you want to operate a facility based on a
foster home model, you live in your primary home all the time and could be licensed to
provide services for up to 5 residents.
● Other exempt facilities: Veterans administration as Residential homes serving 3 or fewer
veterans, facilities by fed gov, facilities licensed by the agency for persons with
disabilities and fac licensed as mental health fac nursing homes intermediate care or
transitional living facilities. More details on Chapter 429.04 F.S to reference each of
them more specifically.
● Communities licensed under Ch 651 or retirement communities that may provide services
to residents that live in single facility homes or duplexes without obtaining a ALF license,
as long as the residents do not require supervision during times other than services are
being delivered and the owner has a license for home health agency.

Chapter 429.07 - If you do not meet any of the above exemptions then you are required to have
an assisted living facility license. There are two types of required licenses.

A Standard license is a basic license that allows a facility to operate and provide physical and
or supervision with residents activities of daily living as well as medications. This license is
designed to care for residents that do not require the facility to directly provide nursing services.
The resident level of care criteria is minimal with a standard license. ALFs may not have
residents who require 24 hour nursing supervision.
A limited mental health license must be obtained if an assisted living facility serves one or
more mental health residents. Mental health resident is an individual who receives social
security disability income due to a mental disorder as determined by the Social Security
Administration or receives supplemental security income due to a mental disorder as
determined by the Social Security Administration and receives optional state supplementation.

There are two optional licenses as well.

Limited Nursing Services (LNS) license: An assisted living facility with an LNS license
provides the basic services of an assisted living facility as well as nursing services provided by
licensed nurses within the scope of their nursing practice.
Extended Congregate Care License (ECC): As the word refers, a facility with an extended
congregate care license can provide extended care services to residents such as total help with
bathing, dressing, grooming and toileting, limited nursing services and assessments. The
primary purpose of ECC services is to allow residents the option of remaining in a familiar
setting from which they would otherwise be disqualified for continued residency as they become
more impaired. ECC facilities have a requirement for an ECC supervisor in addition to the ALF
Administrator; additional training requirements for the supervisor as well as for the staff, and
additional documentation requirements including specific policies and procedures, residency
criteria and services plans.
In order to get an ECC license you must have a good compliance history if an existing facility.
You may not have been subject to any administrative sanctions in the last 24 months or since
initial licensure. You may not have class 1, class 2 violations, or 3 or more repeat class 3
violations related to resident care standards.
(Include a snapshot on the presentation of the number of facilities in Fl by license type.
screenshot to be added and do short video elaborating more about it. Also add snapshot of
license type by main counties. )

A facility license is valid for 2 years. You must submit a renewal application with AHCA who will
inspect the facility and you must have zero outstanding deficiencies prior to a renewal license to
be granted. You may apply for a LNS license at your initial, renewal or at any time of your
license. If you have a LNS license, AHCA will come and monitor you annually instead of bi-
annually. However, they may waive the required visit when you have a good compliance history
in the last 24 months; meaning no class 1 class 2 or uncorrected class 3 violations and no
conformed complaints referred by the Long-term care Ombudsman.

A license must be displayed in a conspicuous place readily visible to clients who enter at the
address that appears on the license and is valid only in the hands of the licensee to whom it is
issued and may not be sold, assigned or otherwise transferred. The License is valid only for the
licensee, provider and location for which it is issued.

In close, if you own, rent or operate an unlicensed assisted living facility it is a 3rd degree
felony. Additionally, health care practitioners are required to report suspicious unlicensed
activity and can be sanctioned for knowling referring to or discharging to an unlicensed facility or
to a facility whose license has been denied, revoked or suspended or with a moratorium in
place.

AHCA website is a great resource for license verification to ensure that a facility has a license in
place.

Module 2 - Physical Plant Standards

Objectives covered 2.8, 2.9 and 2.11

The video for this section will cover the main aspects of Physical Plan Standards but we highly
recommend that you read the following sections in its entirety. (See attachments at the end of
this guide)
Florida Building Code Section 464
59A-36.014, F.A.C.
429.435 F.S.
69A-40 F.A.C.

Physical Plant Standards - Florida Building Code

Section 464.3 - Codes and Standards for the design and construction of Assisted Living
Facilities
The Florida Building Code, section 464 covers the codes and standards for the design and
construction of assisted living facilities; except as modified by 59A-36, F.A.C. and Chapter 429
F.S.

Additionally, Assisted Living Facilities licensed for more than 16 beds must also comply with
The Guidelines for the Design and Construction of Residential Health Care and Support
Facilities (The Guidelines) Part 1 General, and Chapter 4.1 Special Requirements for Assisted
Living Facilities are referenced in Chapter 35, Florida Building Code.

If you are building a new facility, it is important that you have a construction team and building
professionals to meet all requirements for your community.
Radon testing is required for state regulated entities including ALFs that are located in a county
designated within the Department of Business and Professional Regulation’s Florida Radon
Protection Map Categories as intermediate or Elevated Radon Potential. Please refer to
statute 404.056 (5) F.S. for additional details.

If your facility is located where required to test, all buildings in a facility used by residents must
be tested twice, five years apart. Once tested twice, testing is no longer required unless one
other triggering events occurs:
● A building is subject to significant structural renovation or a change in facility operation
equivalent to a building structural change, or
● The facility legally becomes a new facility; a change of ownership or operator for
instance. If a facility operator failed to complete the required testing in any buildings by
the time it was due, the testing should be completed as soon as practical.

Additional information may be available on the Florida Department of Health’s website on how
to complete radon testing.

Heating and Cooling Requirements

Facilities are required to maintain dry-bulb temperatures between 70 degrees and 81 degrees in
areas occupied by residents. Dry-bulb temperatures referred to can be the air temperature
measured by a regular thermometer but shielded from radiation and moisture.

Residents may individually control thermostat temperature in their bedrooms or apartments if we

have thermostats in the building. Staff has to ensure temperature is adequate for the residents
so it’s not too hot or too cold.

We are also required to have an alternate power source such as a generator if we were to lose
power or electricity to our community. Section 464 states a facility is to have a permanent on-
site or permanently installed pre-designed electrical service entry for a quick connection and it
shall be installed in a permanent metal enclosure. Generators must also comply with NFPA 70
and gasoline is not permitted as a fuel source. You may contact your local buildings and local
fire department and they can guide you to meet the required standards for your building in order
to maintain safe indoor temperatures and keep it fully operational.

Common Areas
Minimum square footage is required of a minimum of 35 square feet living and dining space per
resident, live-in staff, and live-in family members as well as each adult day care client. This
includes our common areas such as living, dining, recreational or other space designated
accessible to all residents. It cannot include bathrooms, corridors, screened porches, which
cannot be adapted for year-round use. Additionally, if you have an apartment, you may count an
apartment’s living and dining space towards the minimum square footage as part of the 35 S.F.
living and dining space.
Living staff is a common language to hear because a lot of ALFs were developed in individual’s
homes.
Bedrooms
Resident bedrooms are limited to no more than 2 persons with a 120 square feet occupancy.
Some exceptions are those facilities grandfathered in from back in the 1990s. Now bedrooms
have to meet specific guidelines of usable square feet:
● Single Occupancy bedrooms must have at least 80 square feet
● Multiple Occupancy bedrooms must be at least 60 square feet of usable floor space per
occupant.

All resident bedrooms shall open directly into a corridor, common use area or to the outside. A
resident must be able to exit his bedroom without having to pass through another bedroom
unless the two rooms have been licensed as one bedroom.

Bathrooms
Minimum standards:
● We must have one toilet and sink for every 6 persons.
● We must have 1 bathtub or shower for every 8 persons.

This includes any residents, living staff, and family members. Day care participants are only
included in the toilet and sink ratio 1:6 mentioned above.

Bathrooms should have doors in working order with locks on the inside to assure privacy. Non-
Slip safety devices in the shoes and tubs. Grab bars in showers and tubs and around the
commode.

A room separate from residents’ bedrooms shall be provided where residents may read, engage
in socialization or other leisure time activities. Comfortable chairs or sofas shall be provided in
this communal area.

Common areas should be furnished to accommodate communal dining. Meaning that you may
have multiple seatings to allow residents to dine together.

We can secure part of facilities with egress control or perimeter control if we have mental health
residents but they must meet life safety guidelines. Residents must be able to move freely within
the areas and with access to the secured areas without staff assistance. Staff who provide
direct care or who have regular contact with residents residing in secured areas must complete
Level 1 Alzheimer’s training.

Physical Plan Standards - 59A-36.014 F.A.C

We’re responsible for providing a safe living environment. There should not be any hazards
such as water on the floor, lifted tile that could be of risk. A facility must have all electrical,
water, mechanical systems in working conditions; and maintain master keys to residents' rooms
or apartments. We are responsible for providing proper linen when residents require these
services. You are not prevented from charging for this service but you have to make sure this is
fully disclosed prior to moving in.

Residents must be given the option to bring their own belongings when moving in. However,
when the alf supplies the furnishings, residents bedrooms must have at a minimum:
● A clean and comfortable bed, at least 36 inches wide by 72 inches long.
● A closet or a wardrobe for hanging clothes
● A dresser, chest or other furniture for storing clothing and personal effects.
● A table or nightstand, a lamp and a wastebasket.
● A comfortable chair, if requested.

Bedbugs policy should be in place when residents are bringing their belongings. You may assist
the check their furniture to ensure measurements are adequate and this gives you an
opportunity to check for bedbugs and things like that.

Florida Building Code addresses a couple of requirements for Extended Congregate Care
Facilities.
ECC Physical Plant Requirements:
● Private or semi-private room or apartment.
● Entry door has to have a lock.
● Bathroom with a toilet, sink, bathtub or shower shared by a maximum of 4 residents.
● Hydromassage bathtub may substitute for a bathtub or shower in two of the bathrooms.

Fire Safety Standards

We have fire safety requirements for our assisted living facilities which is an important part of
our Emergency Planning Procedures. I encourage you to be in communication with your local
fire department, fire marshall in terms of new construction, permitting, or renovating. Ch 429.435
shows major changes on July 1st, 2016. The National Fire Protection Association life safety
code NFPA 101 and NFPA 101A current editions apply.

The facilities that had their certificates of occupancy issued prior to July 1st, 2016, have the
option of complying with 1994 and 1995 editions of NFPA 101 and NFPA 101A. You would
need to make this request through the fire marshall. These facilities were grandfathered in since
It would be too expensive for these older facilities to bring them up to current safety code with all
the technology. However, if the facility is making major renovations where the work area
exceeds 50% of the aggregate area of the building, you would have to bring all of the safety
code to current edition NFPA 101 and NFPA 101A. New facilities can take advantage of all the
technology we have now available.

There is a statement in the law that a fire safety evacuation capability determination must be
made within 6 months after initial licensure. You may reach out to your local fire department to
learn more about the rules that apply to your community in terms of evacuation capability and
points of safety. This is dependent on the requirements on fire sprinklers and what your building
features are and each municipality has its own requirements.

You may find rules regarding the Uniform Fire Safety Standards for assisting living facilities on
the F.A.C 69A-40. This includes the revised edition in 2019 to reflect the 2016 legislative
changes and some definitions to review are the following:

Authority having jurisdiction (AHJ) means the governmental entity, organization, office, or
individual responsible by law or ordinance to conduct and enforce uniform firesafety
requirements.

Final administrative interpreting Authority shall mean the State Fire Marshal.

Legacy Facility shall mean any ALF that has elected to comply with the option afforded in
Section 429.41(1)(a)2.d., F.S from 1994 and 1995 code.

Chapter 69A-40 addresses Evacuation Capability Determination

Legacy Facilities that do not have fire sprinklers must conduct an evacuation capability
determination using forms and procedures addressed in chapter 5 NFPA 101A guide on
alternative approaches to life safety 1995 edition. The authority must validate this by reviewing
to ensure completeness.
A facility with fire sprinklers is not required to complete an evacuation capability determination.
However, the state fire marshal office recommends an evacuation capability determination using
a method that is acceptable to the local authority having jurisdiction over fire safety. This is why
it is important to contact your local authority and review their requirements and what they want
for your fire safety plan.

Cooking operations in Legacy Facilities

Small Facilities (16 beds or less): are not required to comply with the standards for ventilation
control and fire protect for com cooking operations

Large Facilities (17 beds or more): must comply with NFPA 96 1994 edition regarding the
requirements for ventilation control and fire protection.

Fire Drills

We are required to conduct fire drills. 16A-40 again addresses assisted living facilities and
Emergency Egress and Relocation Drills in Legacy Facilities
Unsprinklered Legacy Facilities shall conduct emergency egress and relocation drills monthly
and at least twelve drills shall have been conducted during the previous year (four times per
year on each new shift).
Legacy Facilities with Sprinklers shall conduct at least six emergency egress and relocation
drills per year, one every two months, with a minimum of two drills conducted during the night
when residents are sleeping.
Legacy facilities with Sprinklers and in Compliance with other firesafety standards as
determined by the AHJ are not required to conduct more than one of the two required nighttime
emergency egress and relocation drills between the hours of 11:00 p.m. and 7:00 a.m. per year.

If you are a non Legacy Facility, you must comply with emergency egress and relocation drill
requirements of the occupancy classification as designated by the local authority having
jurisdiction and mandated in NFPA 101 and NFPA 101A.

Keep records of fire drills and your local authority having jurisdiction may have some specific
requirements for this. Record keeping and fire drills procedures are often addressed as part of
the fire safety plan that they approve.

Code Conflict Resolution

The local government agency and city and/or county board shall resolve conflicts with code
issues cited by the local government.

Issues cited by AHCA shall be resolved by AHCA and the authority having jurisdiction.

The State Fire Marshal is the Final Administrative Interpreting Authority and they rendered
interpretation and explanation of the life safety codes.

The local fire safety authority is responsible for completing your annual fire safety inspections
and approving your fire safety plan. This is done annually because it must be submitted with the
Comprehensive Emergency Management Plan to the Emergency Management Team and they
will require a currently approved fire safety plan with that submission.

Module 3 - Resident Criteria

We highly recommend that you read the following sections in its entirety.
429.26 1,2,3,4 F.S
59A-36.006 1,4 F.A.C

Individuals moving into an assisted living facility must meet certain criteria at the time of
admission and residents must continue to meet resident criteria throughout their stay in our
communities. It is very important to administrators to understand what the parameters are and
the laws and the rules regarding residency criteria. Each community should have its own
residency criteria that addresses our own residency criteria and continuing criteria but that has
to be developed within the scope of the law and rule. It is always the administrator’s
responsibility to determine the appropriateness of admission of an individual resident to the
community as well as the continued residency.
Admission is based on an evaluation of the resident’s strengths, needs and preferences; a
medical examination completed by a healthcare provider; and the care and services offered or
arranged by the community or arranged by the community that is in accordance with the
community’s policy and any limitations in law or rule related to admissions or continued
residency criteria for the license held by the community.

Admission Residency Criteria

You may find Residency Criteria Requirements on sections 429.26 F.S and 59A-36.006 1 and 4
F.A.C.
Residency criteria applies to facilities holding a standard license, limited nursing services, or
limited mental health license. Some specific requirements apply to them and it is important to
know the difference. In this module, we will also cover the difference of admission criteria and
continued residency criteria.

Admission criteria applies at the time of admission and a resident needs to meet this criteria.

An individual must meet the following minimum criteria in order to be admitted to a facility
holding a standard, limited nursing services, or limited mental health license:

1. Be at least 18 years of age. We do not serve children in assisted living in Florida.

2. Be free from signs and symptoms of any communicable disease that is likely to be
transmitted to other residents or staff. An individual who has human immunodeficiency virus
(HIV) infection may be admitted to a facility, provided that the individual would otherwise be
eligible for admission according to this rule.

3. Be able to perform the activities of daily living, with supervision or assistance if necessary.
Assistance with the activities of daily living as stated on 59A-36.002 means assistance with:

➢ Ambulation includes providing physical support to the resident. We can hold their hands
or elbows, using a support belt to assist in ambulation and we can also assist by pushing
a resident’s wheelchair. It does not include assistance with transfer which we’ll define
later on.
➢ Bathing means preparing all the supplies the resident needs while bathing, helping the
resident in and out of the tub, adjusting the temperature, or washing or drying parts of
the body the resident has difficulty reaching. We want the residents to be as
independent as possible and only provide as much assistance as they need.
➢ Dressing includes helping the resident choose, put on and remove clothing.
 ➢ Eating includes helping the residents by cutting their food, pouring beverages and
feeding residents who are unable to feed themselves.
➢ Grooming includes helping the residents with shaving, oral care, hair care and nail care.
➢ Toileting includes assisting the resident to the bathroom, helping to undress, position to
the commode, helping with personal hygiene and also assistance with the routine
emptying of a catheter or ostomy bag.

4. Be able to transfer, with assistance if necessary. The assistance of more than one person is
permitted.

Assistance With Transfer means providing verbal and physical cuing or physical assistance or
both while the resident moves between bed and a standing position or between bed and chair or
wheelchair. The term does not include total physical assistance with transfer provided by staff to
residents.

Bedridden can be found on chapter 429.26 F.S. Bedridden means that a resident is confined to
a bed because of the inability to:
a. Move, turn, or reposition without total physical assistance;
b. Transfer to a chair or wheelchair without total physical assistance; or
c. Sit safely in a chair or wheelchair without personal assistance or a physical restraint.

5. Be capable of taking medication, by either self-administration, assistance with self-

administration, or administration of medication

Medication
We need to understand what the resident’s needs are for medication assistance and to have the
appropriate trained or licensed staff for it. Remember Florida does not require nurses for
assisted living. Some facilities may have nurses but they may not be available 24/7 or they may
not be available at the time a resident needs assistance with medication. In terms of medication,
if the resident is able to self administer medication is great; if assistance is needed to self
administer medication and we have the appropriate trained staff then we can admit them; or if
the resident needs their medication administered and we have licensed staff at the time they
need their medication administered then we can admit those residents as well.

The resident may also contract a third party provider to administer their medication. It is not
common, but you may see some cases such as administering insulin shots by a third party.
What’s important here is that you need to understand the residents' needs and assistance they
need with medication and if we have the appropriate staff for their assistance. If they are not
appropriately

6. Not have any special dietary needs that cannot be met by the facility.

Dietary Needs
We need to be able to meet the residents’ dietary needs. If a resident has been prescribed a
special diet by a health care provider, we can only admit them if we can meet their needs. A
common dietary need is a low sodium diet and a lot of facilities are able to meet it. However,
some residents may require a diet and not all facilities are able to meet this so you have to
make sure you are aware of their dietary needs prior to admission.
7. Residents may not be a danger to themselves or others as determined by a physician or a
mental health practitioner licensed under chapter 490 or 491, F.S.
8. They also may not require 24-hour licensed professional mental health treatment.
9. Not be bedridden. We may not admit residents who are bedridden unless the resident is
receiving licensed hospice services exception pursuant to Section 429.26(1)(c), F.S.;In this
case, the law supersedes the rule because there is a conflict within the law and the rule.

10. Not have any stage 3 or 4 pressure sores. A resident requiring care of a stage 2 pressure
sore may be admitted provided that:

a. The resident either:

(I) Resides in a standard or limited nursing services licensed facility and contracts directly with a
licensed home health agency or a nurse to provide care; or

(II) Resides in a limited nursing services licensed facility and care is provided by the facility
pursuant to a plan of care issued by a health care practitioner;

b. The condition is documented in the resident’s record and admission and discharge logs; and,

c. If the resident’s condition fails to improve within 30 days as documented by a health care
practitioner, the resident must be discharged from the facility. A move out notice must be
provided.

11. Residents admitted to standard, limited nursing services, or limited mental health licensed
facilities may not require any of the following nursing services:

a. Artificial airway management of any kind, except that of continuous positive airway pressure
may be provided through the use of a CPAP or bipap machine;

b. Assistance with tube feeding,

c. Monitoring of blood gases,

d. Management of post-surgical drainage tubes and wound vacuum devices;

e. The administration of blood products in the facility; or

f. Treatment of surgical incisions or wounds, unless the surgical incision or wound and the
underlying condition have been stabilized and a plan of care has been developed. The plan of
care must be maintained in the resident’s record.
12. In addition to the nursing services listed above, residents admitted to facilities holding only
standard and/or limited mental health licenses may not require any of the following nursing
services:

a. Hemodialysis and peritoneal dialysis performed in the facility;

b. Intravenous therapy performed in the facility.

13. Not require 24-hour nursing supervision, unless the resident is receiving licensed hospice
services pursuant to Section 429.26(1)(c), F.S.;

14. Not require skilled rehabilitative services as described in Rule 59G-4.290, F.A.C.

15. Be appropriate for admission to the facility as determined by the facility administrator. The
administrator must base the determination on:

a. An assessment of the strengths, needs, and preferences of the individual;

b. The medical examination report required by Section 429.26, F.S.;

c. The facility’s admission policy and the services the facility is prepared to provide or arrange in
order to meet resident needs. Such services may not exceed the scope of the facility’s license
unless specified elsewhere in this rule; and,

d. The ability of the facility to meet the uniform fire safety standards for assisted living facilities
established in rule Chapter 69A-40, F.A.C.

(b) A resident who otherwise meets the admission criteria for residency in a standard licensed
facility, but who requires assistance with the administration and regulation of portable oxygen or
assistance with routine colostomy care of stoma site flange placement, may be admitted to a
facility with a standard license as long as the facility has a nurse on staff or under contract to
provide the assistance or to provide training to the resident on how to perform these functions
themselves.

(c) Nursing staff may not provide training to unlicensed persons, as defined in Section
429.256(1)(b), F.S., to perform skilled nursing services, and may not delegate the nursing
services described in this section to certified nursing assistants or unlicensed persons. This
provision does not restrict a resident or a resident’s representative from contracting with a
licensed third party to provide the assistance if the facility is agreeable to such an arrangement
and the resident otherwise meets the criteria for admission and continued residency in a facility
with a standard license.

(d) Not withstanding any other provisions of this rule, an individual enrolled in and receiving
licensed hospice services may be admitted to an assisted living facility pursuant to Section
429.26(1)(d), F.S.
(e) Resident admission criteria for facilities holding an extended congregate care license are
described in Rule 59A-36.021, F.A.C.

It is ultimately the administrator’s responsibility to ensure that we are admitting and retaining
residents that are appropriate. We make this determination by looking at the residents
strengths, their needs, preferences, medical examination report from a health care provider, the
facility’s admission policy and services that we provide or arrange, and the ability of the facility
to continue to meet uniform firesafety standards.

Continued Residency Criteria 59A-36.006 (4)

This applies to residents already living in the facility. As part of the continued resident criteria, a
resident must undergo a face-to-face medical examination at least every 3 years after the initial
assessment and whenever there is significant change. This applies to standard license facilities,
limited skilled nursing and limited mental health facilities. Many of our communities require a
medical examination at least every year as a best practice but the rule is at least every 3 years
after initial assessment or after a significant change, whichever comes first. A significant change
is defined on section 59A-36.002 (36), F.A.C. The results of the examination must be recorded
on the practitioner’s form or on AHCA Form 1823, which is incorporated by reference in
paragraph (2)(b) of this rule and must be completed in accordance with that paragraph.

“Significant Change” means either a sudden or major shift in the behavior or mood of a
resident that is inconsistent with the resident’s diagnosis, or a deterioration in the resident’s
health status such as unplanned weight change, stroke, heart condition, enrollment in hospice,
or stage 2, 3 or 4 pressure sore. Ordinary day-to-day fluctuations in a resident’s functioning and
behavior, short-term illnesses such as colds, or the gradual deterioration in the resident’s ability
to carry out the activities of daily living that accompanies the aging process are not considered
significant changes.

Continued Residency Criteria is the same as the admission criteria with just a couple of
exceptions. Exceptions to the requirement to meet the criteria for continued residency are:

(a) The resident may be bedridden for no more than 7 consecutive days, unless the resident is
receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S.

(b) A resident requiring care of a stage 2 pressure sore may be retained provided that:

1. The resident contracts directly with a licensed home health agency or a nurse to provide care,
or the facility has a limited nursing services license and services are provided pursuant to a plan
of care issued by a health care practitioner,

2. The condition is documented in the resident’s record; and,

3. If the resident’s condition fails to improve within 30 days, as documented by a health care
practitioner, the resident must be discharged from the facility.

(c) A terminally ill resident who no longer meets the criteria for continued residency may
continue to reside in the facility if the following conditions are met:

1. The resident qualifies for, is admitted to, and consents to receive services from a licensed
hospice that coordinates and ensures the provision of any additional care and services that the
resident may need;

2. Both the resident, or the resident’s legal representative if applicable, and the facility agree to
continued residency;

3. A licensed hospice, in consultation with the facility, develops and implements an

interdisciplinary care plan that specifies the services being provided by hospice and those being
provided by the facility; and,

4. Documentation of the requirements of this paragraph is maintained in the resident’s file.

(d) The facility administrator is responsible for monitoring the continued appropriateness of
placement of a resident in the facility at all times.

(e) A hospice resident that meets the qualifications of continued residency pursuant to this
subsection may only receive services from the assisted living facility’s staff which are within the
scope of the facility’s license.

(f) Assisted living facility staff may provide any nursing service permitted under the facility’s
license and total help with the activities of daily living for residents admitted to hospice;
however, staff may not exceed the scope of their professional licensure or training.

(g) Continued residency criteria for facilities holding an extended congregate care license are
described in Rule 59A-36.021, F.A.C. It allows residents to age in place. However, if the
residents exceed the residency criteria and do not meet one of the exceptions for ECC then we
have to provide a move out notice. A move out notice is a 45-day written notice unless for
emergency reasons the resident needs a higher level of care. It is up to the administrator and/or
the healthcare provider to determine when a resident exceeds the residency criteria or the
facility cannot meet the residents’ needs. Even if the resident is in hospice and the facility
cannot meet the resident’s needs, then they’ll need to be provided with a move out notice.

(5) DISCHARGE. If the resident no longer meets the criteria for continued residency, or the
facility is unable to meet the resident’s needs, as determined by the facility administrator or
health care practitioner, the resident must be discharged in accordance with Section 429.28,
F.S.

(6) This rule is in effect for five years from its effective date.
Module 4 - Resident Care
On this module we will be covering resident care standards. We highly recommend that you
read the following sections in its entirety.
429..02 F.S.
Chemical Restraint
Physical Restraint
429.255 F.S.
429.26 (7) F.S.
429.41 (1) (j)
59A-36.007 F.A.C

We are responsible for ensuring that we provide care and services appropriate for each
resident’s needs. This section will cover some specifics about resident care standards
pertaining to all types of facilities because this applies to a standard license facility. However,
there are some additional requirements if you hold a specialty licensed facility which will be
discussed later on.
An assisted living facility must provide care and services appropriate to the needs of residents
accepted for admission to the supervision. Supervision under resident care standards 59A-
36.007 (1) is one of the most important sections as an administrator in this training. It
summarizes our responsibilities in terms of resident supervision and services as well as
documentation. Visiting the dining room every day gives you a great opportunity to quickly scan
the room and observe all residents and their behavior.

SUPERVISION
Facilities must offer personal supervision as appropriate for each resident, including the
following:
(a) Monitoring of the quantity and quality of resident diets in accordance with Rule 59A-36.012,
F.A.C.
(b) Daily observation by designated staff of the activities of the resident while on the premises,
and awareness of the general health, safety, and physical and emotional well-being of the
resident.
(c) Maintaining a general awareness of the resident’s whereabouts. The resident may travel
independently in the community.
(d) Contacting the resident’s health care provider and other appropriate party such as the
resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a
significant change. It has to be documented as well as getting the health assessment
completed, form 1823, by the resident’s health care provider.
(e) Contacting the resident’s family, guardian, health care surrogate, or case manager if the
resident is discharged or moves out.
(f) Maintaining a written record, updated as needed, of any significant changes, any illnesses
that resulted in medical attention, changes in the method of medication administration, or other
changes that resulted in the provision of additional services.
SOCIAL AND LEISURE ACTIVITIES.
Residents shall be encouraged to participate in social, recreational, educational and other
activities within the facility and the community.
(a) The facility must provide an ongoing activities program. The program must provide
diversified individual and group activities in keeping with each resident’s needs, abilities, and
interests.
(b) The facility must consult with the residents in selecting, planning, and scheduling activities.
The facility must demonstrate residents’ participation through one or more of the following
methods: resident meetings, committees, a resident council, a monitored suggestion box, group
discussions, questionnaires, or any other form of communication appropriate to the size of the
facility.
(c) Scheduled activities must be available at least 6 days a week for a total of not less than 12
hours per week. Watching television is not an activity for the purpose of meeting the 12 hours
per week of scheduled activities unless the television program is a special one-time event of
special interest to residents of the facility. A facility whose residents choose to attend day
programs conducted at adult day care centers, senior centers, mental health centers, or other
day programs may count those attendance hours towards the required 12 hours per week of
scheduled activities. An activities calendar must be posted in common areas where residents
normally congregate.
(d) If residents assist in planning a special activity such as an outing, seasonal festivity, or an
excursion, up to 3 hours may be counted toward the required activity time.
Please note residents are not required to attend the activities. The average participation rate on
some facilities is about 35%, so it may be challenging for smaller facilities to get everyone
involved. In those cases, it is important to offer more individualized activities for residents. The
main idea is to understand that activities are very important and there is so much that you can
do that doesnt cost much.Make it fun and see your residents engage in their favorite activities.

ARRANGEMENT FOR HEALTH CARE.

In order to facilitate resident access to health care as needed, the facility must:
(a) Assist residents in making appointments and remind residents about scheduled
appointments for medical, dental, nursing, or mental health services.
(b) Provide transportation to needed medical, dental, nursing or mental health services, or
arrange for transportation through family and friends, volunteers, taxi cabs, public buses, and
agencies providing transportation.
(c) The facility may not require residents to receive services from a particular health care
provider.
When a resident exhibits signs of dementia or cognitive impairments:
➢ We must notify the resident’s representative of the need for health care services and
assist in making appointments
➢ If the resident does not have a representative or designee, the facility shall arrange with
the appropriate health care provider for the necessary care and services to treat the
condition.
ACTIVITIES OF DAILY LIVING.
Facilities must offer supervision of or assistance with activities of daily living as needed by each
resident. Residents should be encouraged to be as independent as possible in performing
activities of daily living.
(5) RESIDENT RIGHTS AND FACILITY PROCEDURES.
(a) A copy of the Resident Bill of Rights as described in Section 429.28, F.S., or a summary
provided by the Long-Term Care Ombudsman Program must be posted in full view in a freely
accessible resident area, and included in the admission package provided pursuant to Rule
59A-36.006, F.A.C.
(b) In accordance with Section 429.28, F.S., the facility must have a written grievance procedure
for receiving and responding to resident complaints and a written procedure to allow residents to
recommend changes to facility policies and procedures. The facility must be able to
demonstrate that such procedure is implemented upon receipt of a complaint.
(c) The telephone number for lodging complaints against a facility or facility staff must be posted
in full view in a common area accessible to all residents. The telephone numbers are: the Long-
Term Care Ombudsman Program, 1(888)831-0404; Disability Rights Florida, 1(800)342-0823;
the Agency Consumer Hotline 1(888)419-3456, and the statewide toll-free telephone number of
the Florida Abuse Hotline, 1(800)96-ABUSE or 1(800)962-2873. The telephone numbers must
be posted in close proximity to a telephone accessible by residents and the text must be a
minimum of 14-point font.
(d) The facility must have a written statement of its house rules and procedures that must be
included in the admission package provided pursuant to Rule 59A-36.006, F.A.C. The rules and
procedures must at a minimum address the facility’s policies regarding:
1. Resident responsibilities;
2. Alcohol and tobacco use;
3. Medication storage;
4. Resident elopement;
5. Reporting resident abuse, neglect, and exploitation;
6. Administrative and housekeeping schedules and requirements;
7. Infection control, sanitation, and standard precautions;
8. The requirements for coordinating the delivery of services to residents by third party
providers;
9. Assistive devices; and
10. Physical restraints.
(e) Residents may not be required to perform any work in the facility without compensation.
Residents may be required to clean their own sleeping areas or apartments if the facility rules or
the facility contract includes such a requirement. If a resident is employed by the facility, the
resident must be compensated in compliance with state and federal wage laws.
(f) The facility must provide residents with convenient access to a telephone to facilitate the
resident’s right to unrestricted and private communication, pursuant to Section 429.28(1)(d),
F.S. The facility must allow unidentified telephone calls to residents. For facilities with a licensed
capacity of 17 or more residents in which residents do not have private telephones, there must
be, at a minimum, a readily accessible telephone on each floor of each building where residents
reside.
THIRD PARTY SERVICES.
Third Party is defined as any individual or business entity providing services to residents in a
facility that is not staff of the facility.
(a) Nothing in this rule chapter is intended to prohibit a resident or the resident’s representative
from independently arranging, contracting, and paying for services provided by a third party of
the resident’s choice, including a licensed home health agency or private nurse, or receiving
services through an out-patient clinic, provided the resident meets the criteria for admission and
continued residency and the resident complies with the facility’s policy relating to the delivery of
services in the facility by third parties. The facility’s policies must require the third party to
coordinate with the facility regarding the resident’s condition and the services being provided.

(b) When residents require or arrange for services from a third party provider, the facility
administrator or designee must allow for the receipt of those services, provided that the resident
meets the criteria for admission and continued residency. The facility, when requested by
residents or representatives, must coordinate with the provider to facilitate the receipt of care
and services provided to meet the particular resident’s needs.
(c) The administrator or designee must ensure that:
1. Care coordination includes documented communications about the resident’s condition and
response to treatment or services ordered by the physician which may impact the resident’s
appropriateness for continued residency in the facility;
2. Communications occur at least once every 30 days and whenever there is a significant
change in the resident’s condition; and
3. If physician ordered treatments or services occur less often than once a month,
communications must be conducted according to the ordered treatment or service schedule and
whenever there is a significant change in the resident’s condition.
4. When communication with the third party provider is unsuccessful, at least two attempts at
communication on two separate days must be documented. Documentation must include the
name of the person from the third party provider with whom contact was attempted, the method
of communication, and the date and time of the attempts. This documentation must be included
in the resident’s record in accordance with the timeframes in subparagraphs 59A-36.007(6)(c)2.
and 3.
(d) If residents accept assistance from the facility in arranging and coordinating third party
services, the facility’s assistance does not represent a guarantee that third party services will be
received. If the facility’s efforts to make arrangements for third party services are unsuccessful
or declined by residents, the facility must include documentation in the residents’ record
explaining why its efforts were unsuccessful. This documentation will serve to demonstrate its
compliance with this subsection.

ELOPEMENT STANDARDS.
We have requirements for elopement policies and procedures and training.
(a) Residents Assessed at Risk for Elopement. All residents assessed at risk for elopement
or with any history of elopement must be identified so staff can be alerted to their needs for
support and supervision. All residents must be assessed for risk of elopement by a health care
provider or a mental health care provider within 30 calendar days of being admitted to a facility.
If the resident has had a health assessment performed prior to admission pursuant to paragraph
59A-36.006(2)(a), F.A.C., this requirement is satisfied. A resident placed in a facility on a
temporary emergency basis by the Department of Children and Families pursuant to Section
415.105 or 415.1051, F.S., is exempt from this requirement for up to 30 days.
1. As part of its resident elopement response policies and procedures, the facility must make, at
a minimum, a daily effort to determine that at risk residents have identification on their persons
that includes their name and the facility’s name, address, and telephone number. Staff trained
pursuant to paragraph 59A-36.011(10)(a) or (c), F.A.C., must be generally aware of the location
of all residents assessed at high risk for elopement at all times.
2. The facility must have a photo identification of at risk residents on file that is accessible to all
facility staff and law enforcement as necessary. The facility’s file must contain the resident’s
photo identification upon admission or upon being assessed at risk for elopement subsequent to
admission. The photo identification may be provided by the facility, the resident, or the
resident’s representative.
(b) Facility Resident Elopement Response Policies and Procedures. The facility must
develop detailed written policies and procedures for responding to a resident elopement. At a
minimum, the policies and procedures must provide for:
1. An immediate search of the facility and premises,
2. The identification of staff responsible for implementing each part of the elopement response
policies and procedures, including specific duties and responsibilities,
3. The identification of staff responsible for contacting law enforcement, the resident’s family,
guardian, health care surrogate, and case manager if the resident is not located pursuant to
subparagraph (8)(b)1.; and,
4. The continued care of all residents within the facility in the event of an elopement.
(c) Facility Resident Elopement Drills. The facility must conduct and document resident
elopement drills pursuant to Section 429.41(1)(k), F.S.

Administrators and direct care staff must participate in at least 2 elopement drills per year.
When we are conducting our resident elopement drills we must include our review of the
facility’s procedures to address resident elopements. We also need to document participation in
the drill. In some cases, you may need to do 6,8,12 drills to be able to capture all staff’s
participation in the year to make sure you get that documentation. It is important to understand
elopement risk and how we respond to it because it may be different based on the size of the
facility.

There is a risk assessment elopement decision tree that you may use as a guide if you do not
have one already. GET THE FORM
If you have a resident that elopes this is considered to be an adverse incident and it must be
reported to AHCA within 1 day.
PHYSICAL RESTRAINTS.
Physical restraint is defined in chapter 429 F.S.. It is a device that physically limits, restricts or
deprives an individual of movement or mobility, including:
● Devices not specifically manufactured as a restraint.
● Does not include any device a resident is able to remove or avoid independently or
bandages for wounds or injuries.
Posey restraints are prohibited but there are other restraints that may be used. Residents for
whom a physician has prescribed a physical restraint must have a written care plan for the use
of the physical restraint. It must be consented to by the resident, the resident’s guardian or
attorney in fact. The care plan must be developed within 14 days of the device being
prescribed, and prior to use on the resident.
(a) The care plan must specify:
1. The device prescribed for use;
2. The maximum amount of time the resident is to have the restraint applied each day; and,
3. In what manner and frequency staff will monitor, observe, and report to the physician any
injuries, increase in agitation, signs and symptoms of depression, or decline in mobility or
function related to the use of the prescribed restraint.
(b) Facility staff must ensure that the device is applied appropriately and safely.
(c) The resident’s physician must review the appropriateness of the continued use of the
physical restraint annually, and documentation of this review must be maintained in the
resident’s record. If the resident’s ability to independently remove or avoid the device fluctuates,
the device must be considered a physical restraint and all requirements of this subsection apply.

CHEMICAL RESTRAINT
Chemical Restraint is defined as a pharmacological drug that physically limits, restricts or
deprives an individual of movement or mobility, and is used for discipline or convenience and
not required for treatment of medical symptoms.
Any prescribed medication consistent with the resident’s diagnosis that could serve as a
chemical restraint must be evaluated annually by the physician. We have to maintain
documentation of this in the resident’s record. The law also states that any resident’s medication
that could serve as a chemical restraint, must be evaluated annually by the resident’s physician
to assess the continued need for medication, level of medication in the resident’s blood, and any
need for adjustment to the medication regimen. If you are using any physical or chemical
restraints you must ensure that they are medically necessary and not being used for the
convenience of the community or community staff.

ASSISTIVE DEVICES.
Facilities are responsible for ensuring the safe usage of a resident’s assistive devices. Facilities
are also required to document the use of any assistive devices as of August 2021.
Assistive devices is defined as any device designed or adapted to help a resident perform an
action, task, an activity of daily living, or transfer; prevent a fall; or recover from a fall.
The term does not include a total body lift or motorized sit-to-stand lift, with the exception of a
chair lift or a recliner lift that a resident is able to operate independently.

(a) The facility must have policies and procedures that include the requirements and methods
for assessing the physical condition of assistive devices that may injure the resident and
procedures for recommending repair or replacement for the continuing safety of a resident’s
assistive device.
(b) Documentation of each assistive device a resident uses must be included in the resident’s
record.
(c) Direct care staff using assistive devices while rendering personal services to residents must
know how to operate and utilize the equipment.
(d) All assistive devices must be clean, in good repair, and free of hazards.
(e) The facility must encourage and allow the resident to function with independence when
using the assistive device.

INFECTION CONTROL PROCEDURES.

Facilities must provide services in a manner that reduces the risk of transmission of infectious
diseases.
(a) The facility must implement a hand hygiene program before and after the provision of
personal services to residents whenever there is an expectation of possible exposure to
infectious materials or bodily fluids. Hand hygiene may include the use of alcohol-based rubs,
antiseptic handwash, or handwashing with soap and water.
(b) Standard precautions must be used when there is an anticipated exposure to transmissible
infectious agents in blood, body fluids, secretions, excretions, non intact skin, and mucous
membranes during the provision of personal services. Standard precautions include: hand
hygiene, PPE, and depending upon the exposure, use of gloves, gown, mask, eye protection, or
a face shield. It is best to follow CDC Guidance for the use of when personal protective
equipment (PPE) is recommended. They have important handouts, training videos and
information on how to properly put on and take off PPE. If you are not familiar with standard
precautions this is the time to learn about it as much as you can and how to train staff to ensure
everyone is practicing proper infection control procedures.
(c) The facility must clean and disinfect reusable medical equipment and communal assistive
devices that have been designed for use by multiple residents before and after each use
according to the manufacturer’s recommendations.

INSERT COVID 19 CLEAN HANDS: PROTECT RESIDENTS YOU TUBE VIDEO HERE
https://www.youtube.com/watch?v=xmYMUly7qiE
OTHER STANDARDS. Additional care standards for residents residing in a facility holding a
limited mental health, extended congregate care or limited nursing services license are provided
in Rules 59A-36.020, 59A-36.021 and 59A-36.022, F.A.C., respectively.

NURSING SERVICES

Nurses are limited to a number of services they can provide based on their setting; standard,
LNS, ECC.
In a standard license facility, nurses may:
➢ Administer medications
➢ Manage weekly pill organizers for residents who self-administer medications
➢ Take resident’s vital signs
➢ Change bandages for minor cuts and abrasions
➢ Give pre-packaged enemas ordered by a physician
➢ Observe residents and document observations
➢ Administer and regulate portable oxygen
➢ Routine colostomy care of a stoma site flange

In a limited nursing skilled community or extended congregate care, nurses may:

➢ Provide any service under the scope of the nurse’s license; such as LPN, RN, APRN.
➢ Residency criteria limits the nursing services by restricting residency when a resident
has certain nursing needs; for example: use of wound vacuum device or management of
post-surgical drainage tubes.

In ECC programs, CNAs may perform any service under the scope of their certification.

Best Practices shared by by Senior Living Professionals

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Module 5 - Person and Family Centered Service

Delivery (Your own training)
The Thin Edge of Dignity by Dick Weinman | Assisted Living Documentary

I suggest adding the mental and self care training you already have videos of.
Creating a positive practice environment. Creating a person and family-centered service
delivery environment. This is part of our mission as ALF providers that
Pressure and competition gets us away from that environment. Working with an individual,
seeing that person as a whole and providing care with dignity and respect.

Person-centered care is an orientation to the delivery of care and supportive services that
address the individual’s needs, goals, preferences, cultural traditions, family situations and
values.

There is a focus of quality of life on how services are delivered from a perspective of the older
adult and family.
Support of caregivers is important because they are often critical sources of support for older
adults with disabling conditions.

Person-centered focuses on the individual rather than the condition, and on the person’s
abilities and strengths. It focuses on the whole person and the family when appropriate, it allows
choices, it supports relationship development and individualizes care and services.

Some of the barriers are attitudinal. We can have a fear that the person or family will be asking
for unreasonable things. We already believe in our minds that this would be a problem. Another
barrier is that we believe that the level of customer service in the facility is sufficient. I=Many
times activities of daily living (ADLs) are mistakenly confused as enough activities the residents
will enjoy. The question is are we really meeting the residents’ needs with these activities.
Examples like this set up apart from person-centered focus.
Professional barriers: we know what’s best for residents
Management barriers
Cultural barriers:
Limited financial resources
Regulatory barriers : zero tolerance for risk
Lack of understanding of all shareholder or stakeholders

Ask yourself about any barriers you may be facing and how to overcome them. From a
leadership perspective, what can be done to focus on quality of life and person-centered
environment? Have a system in place to support this vision with effective communication and
commitment that drives a learning culture with beliefs and teamwork towards a person and
family centered culture.

Quality of life for all stakeholders is crucial to establish relationship opportunities. Every team
member coming to work should have security, belonging, continuity, purpose, achievement and
significance.
Organizational Strategies that we can implement to create a shared vision for all stakeholders:
● Service planning
● Knowledgeable staff with the right tools and resources on hand to succeed.
● Establish an environment of openness and support.
 ● Emphasize collaboration from all stakeholders
● Establish a committed learning culture in an ongoing dynamic aspect. Evaluate results
for effectiveness.
● Communication is key.
● Celebrate success.
● Strong HR system and expectations
● Listen to resident and family members input for decision making.

In terms of Alzheimer's disease and related disorders, person-centered care focuses on

individuals being valued for who they have been and who they are at this point in their lives. The
service delivery we should be providing is keeping with the person’s life - long values,
preferences and interests. Provide support for family members and solicit life histories of their
loved-ones. Give residents their sense of belonging.

LEADERSHIP - Get best practices from alf owners and operators - video format

Module 6 - Admission Procedures

We highly recommend that you read the following sections in its entirety.
429.47 F.S.
59A-36.002 (1) F.A.C.
429.195 F.S.
429.20 F.S.
429.26 F.S.
59A-36.007 (2) F.A.C
429.24 F.S.
59A-36.018 F.A.C
59A-36.007 (3) F.A.C.

Advertising
A facility under construction is able to advertise to the public prior to obtaining a license if we are
certified under chapter 651 then we must comply with advertisement standards and provisions
stated on F.S. chapter 651.095. A free standing facility shall not imply that it is part of a nursing
home. A free standing facility is a facility not operating in conjunction with a nursing home. Any
facility affiliated with any religious organization or that has a name implying religious affiliation
must include in all advertisements whether or not you are affiliated with any religious
organization and if so which organization.
When we advertise we must include the facility license number in all advertisement.
If you own multiple facilities you must include at least one license number per advertisement. All
advertisements must include the term Assisted Living Facility (No abbreviations) before the
license number.
Some forms of advertising are:
➢ Any printed, written, oral, visual or electronic promotion
➢ Statement of availability or qualifications
➢ Services offered on television, radio, internet, magazine, billboard, newspaper, business
cards, flyers, brochures or media used for the purpose of attracting potential residents to
an assisted living facility.

A complementary listing on telephone directories is not considered advertising. When we

advertise special services for persons with memory impairment we must keep copies in records
of those advertisements for 2 years and available to anyone that requests information on them.

Patient Brokering
Assisted living facilities are not allowed to participate in patient brokering activities. Rebates are
prohibited. We may not contract or promise to pay, or receive a commision or kickback or
engage in split fee arrangements with any person or healthcare provider or healthcare facility.
We are allowed to employ or contract someone to market our community as long as that person
clearly discloses that they are working with or on behalf of our assisted living community. We
are also able to use a referral service that provides information consultation or referral to
consumers to assist to find appropriate housing and care for senior or older adults or disabled
adults. However, we are not allowed to pay to referrals that are medicaid recipients. These
referral agencies if we choose to, may pay them for referrals except when a person is receiving
medicaid.
One of the best sources of referrals are our residents. The law allows us to compensate our
residents when they refer a friend or family member. We may give them rebates, provide
monetary compensation for referral, gift cards etc.
Statute 817.505 F.S. provides for different classifications of felonies when we violate the patient
brokering act. The most important is that we are not allowed to participate in patient brokering
activities.

Paying for Assisted Living

Individuals may not falsely represent any solicitation of contribution either by or on behalf of an
assisted living facility. We cannot lead people to believe that such funds will be used for
charitable purposes if that is not the case. We are not allowed to participate in any threatening
or coercive type solicitation of contributions. If this is the case, this is grounds for deniable,
suspension, or revocation of the assisted living facility license.
We are not allowed to condition admission of someone who is receiving Optional State
Supplementation (OSS) on an additional contribution or donation from another person.
However, we are allowed to accept supplemental money from a third party on behalf of the
resident who is receiving optional state supplementation as long as it is entirely voluntary, and
they are not a condition of providing proper care to the resident and the additional
supplementation may not exceed 4 times the provider rate recognized under the optional state
supplementation program.
Eligibility standards and additional information regarding OSS can be found on the Department
of Children and Families website. This includes income levels criteria for eligibility for OSS and
the amount of personal needs allowance and the maximum OSS payment.

Assisted living residents mostly pay privately. persons who meet financial and functional
eligibility may qualify to receive assistance to pay for long term care services through the
Statewide Medicaid Managed Care Long Term Care Program. Medicaid helps lower income
individuals when they meet both functional and financial criteria for long term care coverage. It
covers home and community services as well nursing home care. Assisted living is part of the
home and community services. The purpose of the long term care program is to try to reduce
the number of individuals residing in nursing homes so that residents may be cared for in a less
restrictive environment while also creating cost savings for the state. These services are
delivered by enrollment in managed care plans.

As an assisted living provider, if you decide to accept this type of payment you would need to
contract with one or more of the managed care providers in your area and you would need to
obtain a medicaid billing number. This covers care services that we provide; room and board
are separate and covered by the resident.

In some parts of the state, they have a program called Program of All-Inclusive Care for the
Elderly (PACE). PACE provides comprehensive medical and social services to certain frail,
elderly people (participants) still living in the community. Most of the participants who are in
PACE are dually eligible for both Medicare and Medicaid. It targets individuals that qualify for
medicaid nursing home placement and tries to provide comprehensive care at a lower cost;
individuals that choose to be part of PACE, have all their medical and long term care needs
managed by a single provider.

Veterans may be eligible for additional assistance to pay for assisted living facility services
when they have the need for assistance with the activities of daily living and some other
functions. This benefit is referred to as the Aid & Attendance Benefit. Veterans may apply for
these benefits through their veteran administration.

Medical Examination Requirement

As part of the admission criteria discussed on section 429.26 (5), residents are required to
undergo a face-to-face medical examination completed by a medical health care provider. A
health care provider is a physician, physician assistant, advanced practice registered nurse or
individual, entity or organization licensed by the State to provide health care services. This
examination must take place at least 60 days prior to admission or within 30 days following
admission.
The results of the medical examination must be recorded on the health care provider’s form or
AHCA Form 1823. It is used to record the practitioner’s direct observation of the patient at the
time of examination and it reflects the person’s condition on the date the examination was
performed.

It must include the person’s medical history and address:

● The physical and mental status of the resident including health related problems and
functional limitations.
● The person’s needs for assistance with the activities of daily living.
● Any nursing or therapy services the person requires.
● Any special diet required
● A list of the current medications prescribed and whether or not the person requires
assistance with medications or administration of medications.
● Whether or not the person has signs and symptoms of communicable disease.
● A statement that on the day of the examination, the person’s needs can be met at the
ALF.
● Date of the examination, name, signature, address and telephone number and license
number of the examining health care practitioner.

There is an important step whenever you get an incomplete AHCA form 1823 incompleted or
with omitted information. Any missing information on either the provider’s form or AHCA form
1823 may be obtained either orally or in writing from the provider within 30 days after admission.
You need to record the name of the health care provider, and the name and signature of the
person in the community recording the information as well as the date the information was
provided as well as the information that was omitted.

There are some exceptions to this under 59A-36.006 (2):

● Residents who are placed by the department of children and families which is not as
common anymore or an agency under contract with them. Medical examination must
have been conducted within 30 prior to admission and it must be recorded on AHCA
form 1823.
● Residents placed by Adult Protective Services. Residents who have been placed by the
department of children and families on an emergency basis are exempt from having the
health assessment completed for up to 30 after admission. You must enter the
placement on the ALF’s admission/discharge log.
● The CARES Assessment may be accepted in lieu of the AHCA form 1823.

Insert AHCA form 1823 on video and cover things you should be looking for when reviewing this
form.

Let’s get familiar with AHCA form 1823 so you may properly review it whenever you receive one
from a healthcare provider.
➢ The top section is completed by the facility and it includes the resident’s information if
you are handing this to a family member for the health care provider.
➢ The next section is the actual health assessment. Any allergies should be listed as well
as their height and weight; any medical history and diagnosis; physical or sensory
 limitations; cognitive or behavioral status; nursing/treatment/therapy service
requirements; special precautions and elopement risk.
➢ On page 2 of the health assessment is where the health care provider evaluates if a
resident needs assistance with activities of daily living, the level and type of assistance.
➢ The special diet instructions must be included by checking the box indicating the one
that applies or other with specific instructions.
➢ Section C is key to decide if a resident meets admission criteria standards. This section
covers conditions and requirements needed for the level of care; such as communicable
disease, bedridden, any stage pressure sores, 24-hour nursing requirements. Any
indication that the resident does need some of these conditions would mean that the
resident does not meet admission criteria to assisted living if marked yes. Keep in mind
the exception applies to hospice residents.
➢ The professional must indicate by yes or no if the resident’s needs can be met in an
assisted living facility.
➢ Section 2 is the self-care and general oversight assessment - medications. The provider
must list all current medications including dosage, directions for use, and route and the
level of assistance the resident needs for it.
The provider’s information must be fully completed. It must include the name of the
examiner, license number, title, telephone number, address, signature and date of
examination. Any missing information is grounds for citations on inspections.

Resident Contracts
We must review the law chapter 429.24 F.S and the rule chapter 59A-36.018 F.A.C. in order to
understand resident contracts or agreements. We must execute a contract with a resident prior
to or at the time of admission to our facility. We need to ensure that both the resident and the
community have a duplicate original of the contract. We are required to keep copies of the
contract for at least 5 years after they expire.
Residents contracts must include express provisions specifically setting forth:
➢ Services and Accommodations to be provided
➢ The rate of charges for those services
➢ Provision for at least 30 days written notice of a rate increase. A new service or
accommodation added to, or implemented in, a resident’s contract for which the resident
was not previously charged does not require a 30-day written notice of a rate increase.
➢ The rights, duties, and obligations of the residents
➢ Disclose all services provided by the facility and fees as a reference for future need.
➢ Disclosure: We may not levy any additional charges for supplies, services or
accommodations that we already agreed to provide as part of our standard
daily/weekly/monthly rate.
➢ An other matters that the parties deem appropriate
➢ Addendum to reflect any additional services not included on our daily/weekly/monthly
rates. It must be signed by the resident or representative and the community. Provide a
copy and keep a copy for records.
➢ Whenever money is deposited or advanced by a resident in a contract as security for
performance of the contract agreement or as advance rent for other than the next
immediate rental period:
○ Such funds shall be deposited in a banking institution in this state that is located,
if possible, in the same community in which the facility is located; shall be kept
separate from the funds and property of the facility; may not be represented as
part of the assets of the facility on financial statements; and shall be used, or
otherwise expended, only for the account of the resident.
○ The licensee shall, within 30 days of receipt of advance rent or a security deposit,
notify the resident or residents in writing of the manner in which the licensee is
holding the advance rent or security deposit and state the name and address of
the depository where the moneys are being held. The licensee shall notify
residents of the facility’s policy on advance deposits.
➢ Refund Policy to be implemented at the time of a resident’s transfer, discharge, or death.
The refund policy shall provide that the resident or responsible party is entitled to a
prorated refund based on the daily rate for any unused portion of payment beyond the
termination date after all charges, including the cost of damages to the residential unit
resulting from circumstances other than normal use, have been paid to the licensee.The
contract shall also specify any other conditions under which claims will be made against
the refund due the resident.
○ Move out notice: a resident may not be required to provide the licensee with
more than 30 days’ notice of termination.
○ Termination date: If the amount of belongings does not preclude renting the unit,
the facility may clear the unit and charge the resident or his or her estate for
moving and storing the items at a rate equal to the actual cost to the facility, not
to exceed 20 percent of the regular rate for the unit, provided that 14 days’
advance written notification is given.
■ The facility shall provide a refund to the resident or responsible party
within 45 days after the transfer, discharge, or death of the resident. The
agency shall impose a fine upon a facility that fails to comply with the
refund provisions of the paragraph, which fine shall be equal to three
times the amount due to the resident.
■ If the resident’s possessions are not claimed within 45 days after
notification, the facility may dispose of them.
■ If after a contract is terminated, the facility intends to make a claim
against a refund due the resident, the facility shall notify the resident or
responsible party in writing of the claim and shall provide said party with a
reasonable time period of no less than 14 calendar days to respond.
■ If a licensee agrees to reserve a bed for a resident who is admitted to a
medical facility, including, but not limited to, a nursing home, health care
facility, or psychiatric facility, the resident or his or her responsible party
 shall notify the licensee of any change in status that would prevent the
resident from returning to the facility. Until such notice is received, the
agreed-upon daily rate may be charged by the licensee.

➢ The purpose of any advance payment and a refund policy for such payment, including
any advance payment for housing, meals, or personal services, shall be covered in the
contract.
➢ The contract shall state whether or not the facility is affiliated with any religious
organization and, if so, which organization and its general responsibility to the facility.
➢ Neither the contract nor any provision thereof relieves any licensee of any requirement
or obligation imposed upon it by this part or rules adopted under this part.
➢ Provision: Residents must be assessed upon admission and at least every 3 years
thereafter or after any significant change.
➢ In lieu of the provisions of this section, facilities certified under chapter 651 shall comply
with the requirements of s.651.055.
➢ (7) Notwithstanding the provisions of this section, facilities which consist of 60 or more
apartments may require refund policies and termination notices in accordance with the
provisions of part II of chapter 83, provided that the lease is terminated automatically
without financial penalty in the event of a resident’s death or relocation due to psychiatric
hospitalization or to medical reasons which necessitate services or care beyond which
the facility is licensed to provide. The date of termination in such instances shall be the
date the unit is fully vacated. A lease may be substituted for the contract if it meets the
disclosure requirements of this section. For the purpose of this section, the term
“apartment” means a room or set of rooms with a kitchen or kitchenette and lavatory
located within one or more buildings containing other similar or like residential units.
➢ The agency may by rule clarify terms, establish procedures, clarify refund policies and
contract provisions, and specify documentation as necessary to administer this section.

Admission Procedures
When we are talking with prospective residents and their family members about our services in
the facility. We need to provide them with sufficient information that is required under the law
and regulations. All information should be helpful to understand our services and fees.

Regulation 59A-36.006(3) talks about Admission Package and what needs to be included in
that.
We must make available to potential residents and their responsible parties a written statement
which includes the following information:
● If your contract and/or facility brochure discloses all information about the facility’s
admission criteria that would meet this requirement. Services and accommodations, the
rate or charges, provisions for at least 30 days written notice of a rate increase, the
rights, duties, and obligations of the residents, and other matters that the parties deem
appropriate.
 ● ALF’s admission and continued resident criteria based on the scope of the regulation
and the scope of the license we hold.
● Residency agreement (contract) and any supplemental service and fee schedule.
Daily/weekly/monthly rates and what it includes.
● DNRO and advance directives policies.
● Alzheimer’s disease or memory care written disclosures and fees.
● Elopement response policies and procedures.
● Resident Bill of Rights
● Long Term Care Ombudsman program brochure
● Personal care services we are prepared to provide services; level of care, medication
management and fees; additional nursing services and cost; food services and special
diets we are prepared to accommodate. Transportation available and additional cost
associated with that; any special services provided by the facility and additional cost.
● Information on social and leisure programs, such as copies of monthly activity calendars.
● Information on services we do not provide that we would arrange for the resident such
as additional transportation.

Facility rules and regulations often referred to as household rules or resident handbooks. These
must be very specific and detailed.
● Resident responsibilities
● Alcohol and tobacco policies
● Medication storage requirements
● Resident Elopement
● Reporting resident abuse, neglect and exploitation
● Administrative and housekeeping requirements
● Infection control, sanitation and standard precautions
● The requirements for coordinating the delivery of services to residents by third party
providers.
● Assistive devices
● Physical restraints
● ECC facilities are required to disclose in writing what their additional services are and
fees associated with care.

Documents must be provided prior to or at the time of admission to the resident or responsible
party. There may be other things you may want to include such as pet policies, name tags for
visitors or third party providers, or dress code, or anything to consider as part of the house rules.

Best Practice - Sale Process

Video from administrator on the sale process and best practices, planning and
knowledge staff and administrator to be involved.
Managing the Moving Process
Many communities have the moving process in place with an effective ongoing system.
However, other facilities struggle with the moving process specially new ALFs as they are not
familiar with some of this information.
Moving can be difficult for anyone, especially for an elder adult moving into a facility for some
urgent need. Having to leave their beloved home and memories can be emotional and
overwhelming. Managing the moving process effectively for residents is one of the key
processes we need to do well so that we can help residents get familiar with their surroundings
and ensure their needed services are in place on day one.
Aspects to address the moving process are based on facility size. However, no matter what
environment, the important thing is that the resident receives the right support and a warm
welcome.
● A systematic pre admitted process. Having the residents medical and physical history
and medications, special diets or therapy to ensure a smooth moving process.
● Prior to admission or at least at the time of admission, an admission package needs to
be provided to the resident as well as a copy of the executed contract. In addition, you
may provide helpful information such as a change of mailing address or telephone
service, measuring their furniture for easier moving.
● Before the resident moves in, ensure that everything in their unit is in working order and
that all the appliances are working properly, adjust the room’s temperature, prepare a
welcome letter, basket, banner or team.
● Ensure that physician’s orders have been reviewed, a pharmacy has been notified,
medications are in order and supplies are available for the resident.
● Communication is crucial and letting residents know procedures they can expect from
the staff.
● You may want to get the resident's preferences and share that information to the
caregiving staff.
● Elopement process in place to alert staff of the risk
● Helping family members manage the moving process is a big piece of the puzzle
because the process itself may be as traumatic to them as to the resident. This can
establish a better relationship with them and the residents.

Having the right support and information available will make the process a lot easier for all
parties involved and it will allow a smooth transition.

Module 7- Fiscal Standards

We highly recommend that you read the following sections in its entirety.
429.27 F.S.
59A-36.013 F.A.C.
429.275 F.S.
408.810 (9) F.S.
59A-35.062 F.A.C

Fiscal Standards
This section will cover handling resident’s property and funds as part of chapter 429.27 F.S.
1. A resident shall be given the option of using his or her own belongings, as space permits; choosing his
or her roommate; and, whenever possible, unless the resident is adjudicated incompetent or
incapacitated under state law, managing his or her own affairs.
2. (b) The admission of a resident to a facility and his or her presence therein shall not confer on the
facility or its owner, administrator, employees, or representatives any authority to manage, use, or
dispose of any property of the resident; nor shall such admission or presence confer on any of such
persons any authority or responsibility for the personal affairs of the resident, except that which may
be necessary for the safe management of the facility or for the safety of the resident.
3. (2) A facility, or an owner, administrator, employee, or representative thereof, may not act as the
guardian, trustee, or conservator for any resident of the assisted living facility or any of such resident’s
property. An owner, administrator, or staff member, or representative thereof, may not act as a
competent resident’s payee for social security, veteran’s, or railroad benefits without the consent of the
resident. Any facility whose owner, administrator, or staff, or representative thereof, serves as
representative payee for any resident of the facility shall file a surety bond with the agency in an
amount equal to twice the average monthly aggregate income or personal funds due to residents, or
expendable for their account, which are received by a facility. Any facility whose owner, administrator,
or staff, or a representative thereof, is granted power of attorney for any resident of the facility shall file
a surety bond with the agency for each resident for whom such power of attorney is granted. The
surety bond shall be in an amount equal to twice the average monthly income of the resident, plus the
value of any resident’s property under the control of the attorney in fact. The bond shall be executed
by the facility as principal and a licensed surety company. The bond shall be conditioned upon the
faithful compliance of the facility with this section and shall run to the agency for the benefit of any
resident who suffers a financial loss as a result of the misuse or misappropriation by a facility of funds
held pursuant to this subsection. Any surety company that cancels or does not renew the bond of any
licensee shall notify the agency in writing not less than 30 days in advance of such action, giving the
reason for the cancellation or nonrenewal. Any facility owner, administrator, or staff, or representative
thereof, who is granted power of attorney for any resident of the facility shall, on a monthly basis, be
required to provide the resident a written statement of any transaction made on behalf of the resident
pursuant to this subsection, and a copy of such statement given to the resident shall be retained in
each resident’s file and available for agency inspection.
4. (3) A facility, upon mutual consent with the resident, shall provide for the safekeeping in the facility of
personal effects not in excess of $500 and funds of the resident not in excess of $500 cash, and shall
keep complete and accurate records of all such funds and personal effects received. If a resident is
absent from a facility for 24 hours or more, the facility may provide for the safekeeping of the resident’s
personal effects in excess of $500.
5. (4) Any funds or other property belonging to or due to a resident, or expendable for his or her
account, which is received by a facility shall be trust funds which shall be kept separate from the funds
and property of the facility and other residents or shall be specifically credited to such resident. Such
trust funds shall be used or otherwise expended only for the account of the resident. At least once
every 3 months, unless upon order of a court of competent jurisdiction, the facility shall furnish the
resident and his or her guardian, trustee, or conservator, if any, a complete and verified statement of
all funds and other property to which this subsection applies, detailing the amount and items received,
together with their sources and disposition. In any event, the facility shall furnish such statement
annually and upon the discharge or transfer of a resident. Any governmental agency or private
 charitable agency contributing funds or other property to the account of a resident shall also be entitled
to receive such statement annually and upon the discharge or transfer of the resident.
6. (5) Any personal funds available to facility residents may be used by residents as they choose to
obtain clothing, personal items, leisure activities, and other supplies and services for their personal
use. A facility may not demand, require, or contract for payment of all or any part of the personal funds
in satisfaction of the facility rate for supplies and services beyond that amount agreed to in writing and
may not levy an additional charge to the individual or the account for any supplies or services that the
facility has agreed by contract to provide as part of the standard monthly rate. Any service or supplies
provided by the facility which are charged separately to the individual or the account may be provided
only with the specific written consent of the individual, who shall be furnished in advance of the
provision of the services or supplies with an itemized written statement to be attached to the contract
setting forth the charges for the services or supplies.
7. (6)(a) In addition to any damages or civil penalties to which a person is subject, any person who:
8. 1. Intentionally withholds a resident’s personal funds, personal property, or personal needs
allowance, or who demands, beneficially receives, or contracts for payment of all or any part of a
resident’s personal property or personal needs allowance in satisfaction of the facility rate for supplies
and services; or
9. 2. Borrows from or pledges any personal funds of a resident, other than the amount agreed to by
written contract under s. 429.24,
10. commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.
11. (b) Any facility owner, administrator, or staff, or representative thereof, who is granted power of
attorney for any resident of the facility and who misuses or misappropriated funds obtained through
this power commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s.
775.084.
12. (7) In the event of the death of a resident, a licensee shall return all refunds, funds, and property held
in trust to the resident’s personal representative, if one has been appointed at the time the facility
disburses such funds, and, if not, to the resident’s spouse or adult next of kin named in a beneficiary
designation form provided by the facility to the resident. If the resident has no spouse or adult next of
kin or such person cannot be located, funds due the resident shall be placed in an interest-bearing
account, and all property held in trust by the facility shall be safeguarded until such time as the funds
and property are disbursed pursuant to the Florida Probate Code. Such funds shall be kept separate
from the funds and property of the facility and other residents of the facility. If the funds of the
deceased resident are not disbursed pursuant to the Florida Probate Code within 2 years after the
resident’s death, the funds shall be deposited in the Health Care Trust Fund administered by the
agency.
13. (8) The agency may by rule clarify terms and specify procedures and documentation necessary to
administer the provisions of this section relating to the proper management of residents’ funds and
personal property and the execution of surety bonds.

Business Practices
We are required to operate on a sound financial basis and to keep accurate business records
that at a minimum identify, summarize and classify the funds that we receive and the expenses
disbursed. A sound financial basis means having enough money to operate, pay staff, to buy
food, make repairs and more. We are also required to use a recognized accounting system and
to have written accounting procedures.
If you are planning to open your own ALF, you may want to consider getting an accountant to
establish a procedure to keep good records and identify the funds you receive from your
residents because you’ll need to provide refunds according to the law.

At the time of initial license application is when we must provide financial ability to operate.
Thereafter, you are not required to provide it unless there is enough evidence of financial
instability such as returned checks, unpaid taxes, etc. In this instance, AHCA may require to
submit a proof of financial stability including an income and expenses statement, evidence of
sufficient funds, settled delinquent accounts or taxes. This is done in order to ensure the safety
and well being of residents living in assisted living. Notification within 10 days is required to
AHCA whenever there is court order to initiate a bankruptcy foreclosure or eviction proceedings
when our controlling interest is involved. If you fail to do this, it is considered a misdemeanor of
a second degree.

Module 8 - Medication Management

We highly recommend that you read the following sections in its entirety.
429.256 F.S.
59A-36.008 F.A.C. (Medication practices)
59A-36.011(6) F.A.C (Medication requirements)

Medication Overview
This section is crucial to learn all the details about medication so you can properly train
unlicensed staff and for them to safely care for residents. For this you need to attend a class
about self-administration of medication instructed by a registered nurse or a licensed
pharmacist. The instructor will need to cover the law and the rule. It is important to remind your
staff that the law may say things that they are allowed but if your policies and procedures say
staff is not allowed, then they are not allowed. The party that is more strict is the one to follow.

Nurses come from different settings, some may come from skilled nursing, others from acute
nursing or nursing individuals with disabilities. They must know they have knowledge, skiles and
certifications but they must follow assisted living regulations. The training consists of a 6-HR
Medication initial training.
Some of the things covered in the training are:
Residents may be allowed a pill organizer for self medication. This may only be filled by the
residents themselves, a family member, or a nurse for up to 7 days.

Medication Storage Policy: Residents must lock the room when they leave or they have a
locked cabinet or drawer. Facilities must have a written policy regarding the central storage of
medications and must provide this information to residents upon admission to the community.
Medication Management
This section will cover the responsibilities of an administrator. It is your responsibility to oversee
nurses assisting with medication and monitor self-administered medication on independent
residents. As of 2018, additional skills were added for the medication course and that is why
the initial Medication training is now 6 hours. This training must be instructed by an RN or a
licensed pharmacist who gives you a certificate to be included in the employee’s file. This
certificate has to include the name and license number of the trainer, the date and the agenda
of the program shown on the back or page 2 of the certificate. Make sure the trainer is requiring
them to do a return demonstration so they know how to do it safely.

As an administrator, it is your responsibility to ensure that residents do not skip their

medications and that they take them according to their health care provider’s recommendation.
The important thing is to know the difference between responsibilities between licensed and
unlicensed staff and what they can or cannot handle on medication management.

On average residents take 9-16 medications a day which is a lot of chemicals to intake at once.
This goes back to the facility being able to meet resident’s needs from the admission criteria
under the scope of the facility’s license. Are we making sure we can meet residents’ medication
options such as:
● Resident may self-administer
● Resident may require assistance
● A nurse may administer

Also keep in mind the continuing criteria because:

➢ A resident’s health or cognitive ability can change.
➢ Unsafe self administration or refusal to take medications should be reported to the health
care provider.
➢ Independent residents frequently become residents needing assistance.

Observing staff during assisting on medication administration is key to ensure they are properly
handling their tasks and hygiene standards. During this observations, you may ask yourself:
● Are they following hand-washing procedures?
● Are they wearing gloves when needed?
● Are they giving privacy and treating residents with dignity and respect?
● Are they administering medications on time on a regular basis?

The state of Florida requires in regards to medication that if independent residents are in a room
by themselves, they must lock the door when they leave the room. If they share a room, if they
are independent with their medicine, each person has to have a separate locked cabinet or
drawer. Or you may have a separate room or drawer for central storing so they do not keep it in
their room.
Front line staff is the best source to tell you when a resident's abilities change or signs that
assistance is needed. This information must be disclosed on form 1823 along with any rules and
standards required by the state and the facility.

Remember ALFs with standard licenses are not required to have nurses. However, you may
decide to have trained unlicensed staff, a nurse, or both trained unlicensed overseeing by a
nurse. The resident or responsible party must be notified in writing that trained unlicensed care
givers will be assisting with medication. Residents must sign a consent allowing trained
unlicensed care givers to assist which is discussed and occurs prior or at the time of admission
to the facility.

You may also have a nurse fully administer medication if allowed under the facility license and
resident criteria. This is not allowed by trained unlicensed staff. The focus in that case is to
ensure that residents are participating in taking their medications.

Staff Requirements and Objectives:

● Read and understand the label of medications when assisting residents.
● Understand what the medication is for and how it is taken; orally by mouth, or applied
topically like creams and ointments, drops like eye drops or ear drops, etc.
● Demonstrate accurate documentation on Medication Observation Record (MOR).
● Demonstrate the correct way of assisting a resident with medication.
● Understand how to manage over the counter medications.
● Be able to recognize incomplete orders, orders that require judgment.
● Know when to ask for help with medication assistance.

In the scenario where a resident is not at the facility, it is important to ask the pharmacys or
health care provider if it is ok to give them the medication. You do not want to overdose or
underdose any resident. The right dose is just as important as the right drug.

Remember the 6 rights:

➔ Right Resident
➔ Right Medication
➔ Right Dosage
➔ Right Time
➔ Right Route
➔ Right Documentation
Dangerous practices to avoid are:
➢ Preparing medication in advance. Some people would put a name or room number in
paper or plastic cups which are not safe. We are required to prepare the medicine in
front of the residents. This breaks the safety steps and compliance previously
mentioned. The important thing is to follow compliance at all times in a safe manner.

➢ Someone preparing the medication in advance and then having a coworker to go give
them. There is a high risk and lack of compliance in this scenario. You may end up
 giving medication to the wrong resident and the responsible person would be the one
giving the medication not the one pre-pouring it. That is why it is very important all team
members understand the implications of errors like this and the responsibility they have
with residents.

➢ Another scenario is when the family wants to bring medications to the resident. This is
considered the least responsible, accountable way to give medication in a facility. The
best practice would be to use a preferred pharmacy provider to better manage
medication refills and records.

As an administrator, we want to ensure these types of practices are not happening in our facility.
It is our responsibility to ensure refills are ordered and received in a timely manner.

Know where the medication comes from:

● Facility’s pharmacy providers
● VA
● Mail-order
● Family pick up

The key information to remember here is that even if the family is supplying the medications, the
surveyor will hold you and the facility accountable if the resident does not have medications
available.

Medication Ordering
Medication ordering may be challenging and that is why it is important to have a good
relationship with preferred pharmacy as a best practice. You may have residents whose
insurance requires mail-orders or a different pharmacy. Your staff success rate on having
medication on hand will be increased by having the least number of pharmacies having to deal
with.
Medications may be re-order through an electronic system (EMAR), re-order by or by phone. If
for any reason a pharmacy cannot fill a prescription we need to find out why. In some instances,
it may be due not having refills available, medication is a narcotic which requires a new hard
script, C2 which is a type of narcotic requires new prescriptions every 30 days. In an instance
where a resident needs immediate medication, you may call the pharmacy directly and request
a 3-day emergency supply so you may have the time to request a hard copy from the health
care provider.
In the event of a hurricane, you may work with third party providers including the pharmacy to
receive a week to 10 days of medications in case of evacuation. This way you may continue to
provide the best care possible.
Form 1823 shows the list of orders from the health care provider as well as a list of meds,
dosage and frequency. This is not a prescription as it does not list the quantity of meds needed.
This may be submitted to the pharmacy and they’ll get the correct with the health care provider
directly. However, if it is a narcotic C2, 3,4, or 5, they’ll need a hard copy from the healthcare
provider and you may want to ask the physician to speak to the pharmacy for this.

Mail-order meds need to be ordered 10-21 days in advance. In some cases, they may put them
in auto fills, meaning they’ll come every 2 and a half months or so but this would not include
controlled substances on auto fill. You would still need to continue ordering those.

On demand ordering is another type. This means you may order 7-10 days supply to take when
needed. Another type is called cycle-filled, which are routine meds filled every 28-30 days but
does not include controlled substances, creams, ointments, patches, eyedrops, etc.

The goal is to have an effective system in place to ensure medication is on hand when needed.

Medication Packaging and Labels

Medication packaging includes a great variety that you can find such as: blister cards, multi-
dose, boxes, and bottles.

Blister cards are common and easy to use and to keep count of them which is good for control
substances. If controlled substances are kept in a bottle, they must be counted at the end of
every shift to ensure any used med is accounted for and signed. Ensuring this process takes
place as stated will avoid a bigger problem if they are not counted and control drugs are
missing. If anything is missing you must notify your supervisor. Narcotics should be kept under a
double locked storage place, some facilities have mediation carts and they have a second
locked drawer for narcotics. Other facilities use a multi-dose packaging but this may not be ideal
as this packaging does not really tell us if the staff is reading the medication to residents and it
is also challenging when medication dosage changes.

Medication Labeling All packaging is required to have specific prescription information such
as: resident’s name, date dispensed, the name, address and phone number of the pharmacy,
doctor’s name, drug name, dose, strength, expiration date, refills, auxiliary labels, special
instructions and an Rx or prescription number which tracks everyone handling that prescription.

Always check for expiration dates, prescription meds would have on the front or back; over the
counter meds would display a lot number and expiration date on the side which is important in
the event of recalls. Most pharmacies will try to brand and generic name on the prescription
label. In some cases health care providers may require getting the brand name.

Auxiliary labels are smaller than regular labels and provide additional instructions. These labels
are often bright colors to help get your attention.

Facilities are required to notify health care providers when residents do not get their medication.
In some scenarios, residents refuse taking medications which put them at risk for complications
that may send them to the hospital. At the hospital, a provider must be aware of their recent
meds dosage so they can get the right treatment; you may provide a copy of the physician's
order sheet.
Always notify the health care provider when a resident refuses to take the medication; a side
effect occurs, side effects such as vomiting, nausea, dizziness or alteration in level of
consciousness.

For medication orders it is important to have a double check system regardless of you entering
the order or the pharmacy. This way you always ensure that the resident is getting exactly what
they health care provider listed and this system will eliminate errors. There are also legal
processes where staff is required to have their own sign on login for electronic systems and
tracking changes of medication records.

Oral and Liquid Medications

When assisting residents with medication, staff must come in contact with the medication; you
must wear gloves if contact is required. If a medication touches any surface is considered
contaminated and must be disposed of. Once medication is prepared, you may place it in their
hands or hand a cup to residents but some may struggle to hold it. You may help them in
holding the cup and lifting the medication to the mouth by placing a hand under the resident’s
hand and guiding toward the mouth. However, unlicensed staff are not allowed to fully
administer meds in the resident’s mouth.
Some medications need to be half and meds may have a line for easier breaking; remember to
wear gloves so the med is safely handled. Many times the drug may not have the line and in this
situation is best to contact the pharmacy and get the correct dosage dispensed. Unlicensed staff
may break tablets in half. Another scenario is crushing meds. We have to have a health care
provider’s order and it has to be a medication that may be crushed.

These are the proper steps on how to assist residents with medications:
● You may only assist on resident at a time
● Obtain the Medication Observation Record (MOR)
● Verify the medication label with the MOR
● The resident must be present when you open the container and prepare to assist them,
eye contact.
● After observing the resident administer the medication, sign the MOR immediately to
avoid omissions and errors.
Liquid medications are either a suspension or a liquid solution. Liquid meds are poured out the
back; suspension meds must be shaken before pouring. Measure cups are used to measure to
correct dosage and as best practice measure the liquid at eye level to provide right dosage.

Topical Medications
Unlicensed or trained staff may apply and assist with topical medications with resident’s
participation. These may include: ointments, creams and lotions, patches, eye drops and
ointments, ear drops, nose sprays and inhalers.
You must wear gloves to apply ear drops and the ear area should be clean. This should be
done in private and the resident needs to be in a comfortable position to allow the drops to stay
in place. Do not allow staff to use Q tips on resident’s ears.

Nose sprays are mostly aerosol which means they are inhaled quickly. If a resident is able to
apply it, provide privacy and dignity and ensure they are in a comfortable position to insert and
administer the spray and wear gloves. Nose drops may be applied at bedtime as the resident
will need to hold recline their head to allow absorption for at least 5 minutes. Residents should
blow their nose first and you may provide a tissue.

Eye drops should have a date opened label because they may build bacteria and they are
normally good for 30 days. Staff will need to wear gloves and if a resident is able to handle the
drops you may hand a tissue. If you need to apply the drops, residents must participate in ways
they can; otherwise, you'd be administering the medication which is not allowed.

Eye ointments have to be carefully applied and you must ensure the resident is not at risk of
falling due to distorted vision. Bedtime may be ideal if not you may ask the resident to lay down
for it. Wear gloves; if eye drops and eye ointment are prescribed then eye drops go in first and
applied in the eye area close to the nose. Eye ointment should be applied in the eye close to the
nose and out ensuring the bottle or packaging does not touch the eye. Encourage staff to wash
their hands before and after assisting handling topical medications.

Inhale medications are great for allergies, some are used as needed or on a regular basis.
Some packaging may show doses left and may require additional packaging due to the
chemicals used. These are used to help you breathe better.

Transdermal patches look like a band-aid and is a medication used to help relieve severe
ongoing pain. They are applied for 12 hours and give the body a 12 hour break after removing it.
When applying a patch, we should put the date the patch was applied and the staff member’s
initials. Residents may wear some patches for other medical conditions for a longer period of
time.

Vital Signs
Under the new administrative code published May 10th, 2018, unlicensed staff must have an in-
person 6-hour training in how to assist residents with the self-administration of medications and
must demonstrate the ability to perform the skills. They may check vitals signs, assist with
nebulizers, anti-embolism stockings, assist with insulin pens and check blood glucose. A 2-hour
of continuing education is required annually of law and rule, safety practices which can be done
online.

Staff who were trained to assist residents with the self-administration of medication prior to May
10 2018 only need to take the additional 2 hours of training on the new skills prior to providing
assistance with the new skills. This training must be completed in person and provided by a
licensed pharmacist or a registered nurse.
Nebulizers, Oxygen and Anti-embolism stockings
Anti-embolism stockings help return blood to the heart, improving circulation in the leg veins by
applying graduated compression. They are measured at the thighs at the widest place of your
thigh. If they are knee high you measure the calf or widest part of the leg. The best time to put
them on is in the morning. They should not be wrinkled once you put them on, feet must be dry
and check for wounds. They need to be washed.

Nebulizers are mist-producing machines to deliver medication to the lungs. Be sure to follow
manufacturer guidelines and the facilities' policies and procedures.
● Unlicensed, trained staff may pour a prescribed pre measured dose of medication into
the dispensing cup of the nebulizer.
● Be sure all tubing is secured and attach the mouthpiece or face mask to the nebulizer.
● Turn the air compressor on and confirm the misting
● Hand the mouthpiece and assist the resident with properly placing it upright.
● Advise the resident to breathe normally and the drug administration takes about 5
minutes or so. You’ll hear an onset of sputtering sound or inconsistent nebulization.
● Record assistance with self-administration on MOR.
● Remove gloves and wash hands thoroughly.

Oxygen
Oxygen delivery by nasal cannula must be administered at the rate and percentage prescribed.
Regulate flow meter as prescribed and observe the flow of oxygen. If they have oxygen tanks,
you’ll need to display a sign on their door and ask the oxygen provider for a crate to keep them
secure.

CPAP
Continuous positive airway pressure (CPAP) devices are some of the most effective methods
for treating obstructive sleep apnea. The CPAP treatment will blow air into the resident’s nose to
keep the airway from collapsing while they are sleeping. The pressurized air acts as a splint
keeping the throat open.

AHCA has stated the staff may assist with a pre-filled insulin pen by dialing the prescribed
amount.
➢ Assist residents with pens by dialing the prescribed amount to be injected and handing
the pend to the resident for self-injection.
➢ Only insulin syringes that are prefilled with the proper dosage by a pharmacist or
manufacturer may be used.
➢ Use a glucometer to perform blood glucose testing.

Colostomy Care
Unlicensed trained staff may place and remove colostomy bags, excluding the removal of the
flange. A colostomy is an operation that creates an opening for the colon, or large intestine,
through the abdomen. A colostomy may be temporary or permanent. It is usually done after
bowel surgery or injury. Most permanent colostomies are end colostomies while many
temporary colostomies bring the side of the colon up to an opening in the abdomen.

Only a nurse or resident may change what is attached to the skin. When you change a 1 piece
bag, you change the wafer which is attached to the skin. When you change a 2 piece,
unlicensed staff may attach the bag to the wafer and only a nurse or resident may change the
wafer.

Medication Management Review

Ensure safe and appropriate medication management.
Proper Documentation
MOR
Prescription Label
Health Care Providers Orders
Coordination with resident, health care provider, pharmacy.
Proper storage and disposal of medications
Policies and procedures for handling OTC meds and central storing requirements.
Training of unlicensed staff to assist with self-administration of meds
Infection control

Be sure staff members are following policies and procedures in regards to infection control at all
times when assisting residents with their medications.

There are 3 methods of medication management:

➔ Self-administration
➔ Assistance with the self-administration of medication
➔ Administration of medication by a licensed nurse

Residents have the right to refuse their medications. We would need to alert their health care
provider.
Both the rule and the law states we must encourage residents and be allowed to do so of self-
administration of medication. We still need to observe and assist when a resident appears to be
having problems. A resident may use a pill organizer as long as it has been determined that the
resident is capable of self-administration. Only a resident, a nurse or family member may fill the
pill organizer. If a nurse obtains the medication, fills the pill organizer, returns medication to
storage and documents the day and time organizer was filled. Contact the health care provider if
the resident appears to be having problems. Consult the resident and let them know what other
assistance may be provided. Remember, unlicensed staff may not assist with the contents of
the pill organizer. As a best practice, you may use an assessment to evaluate and observe the
resident on self-medication. This may provide good insight to determine changes on some
residents' caring needs.

Unlicensed staff may assist with self administration of medication with a written consent from
the resident and the resident’s representative.
Training requirements for assistance with the self-administration of medication:
● 6 hours initial training provided by a registered nurse or a licensed pharmacist. This must
be in person and skills demonstration.
● 2 hours continuing education annually provided by a RN or a licensed pharmacist. The
class may be online.

Definitions
Informed consent means that we are obtaining consent from the resident and acknowledging
that we have advised them that the resident may need assistance with medication and whether
this assistance would be provided by a licensed nurse.
Unlicensed person is someone who is not licensed to practice nursing or medicine but who is
employed and under contract with the facility, and who has received training on how to assist
residents with self administration of medication prior to providing such assistance. Unlicensed
staff are not allowed to put the medication in the resident’s mouth.

Residents may opt-out of being orally advised of the medication name and dosage. The written
waiver must identify all the medications intended for the resident. Names and dosage of
medication. It must be immediately updated each time the resident’s medications or dosages
change.

Staff must observe the resident take the medication. Any concerns about the resident’s reaction
to the medication or suspected noncompliance must be reported to the resident’s health care
provider and documented in the resident’s record.

Unlicensed, trained staff may break scored tablets; crush medications according to the
provider’s order; and measure a prescribed amount of a liquid dosage.

Unlicensed staff may not assist with medications for which the time of administration, the
amount, the strength of dosage, the method of administration, or the reason for administration
requires judgment or discretion on the part of the unlicensed person. The term judgment and
discretion mean interpreting vital signs and evaluating or assessing a resident’s condition.
Directions must be clear.

Medications ordered to be given as needed, must be written with specific parameters that
preclude independent judgment on the part of the unlicensed person. For an as needed
prescription the circumstances under which it would be appropriate for the resident to request
the medication and any limitations must be specified; for example, “as needed for pain, not to
exceed 4 tablets per day”.
Provided at the request of a resident. The resident is aware of his or her need for medication
and the purpose of taking it.
After assisting the resident with medication, return the medication container to the proper
storage. Record the medication taken, any missed dosages, or refusals to the medication as
prescribed.

Assistance does not include:

Mixing or compounding medications
Preparing syringes or giving injections
Tube Feeding
Infusions
Irrigations
Rectal, urethral or vaginal preparations
Unclear orders
Use of judgment or discretion

Administration of medication by a licensed nurse. We must ensure nurse’s availability in the

community for medication administration. Report any unusual reactions to the health care
provider.

Over the counter medications include any vitamins, nutritional supplements, or medicated
ointments that can be sold at any store without prescription. They must be labeled with the
resident’s name and manufacturer’s instructions for use or the health care provider’s
instructions for use.
Health care provider’s orders are required when a nurse provides assistance or administers
over the counter medications.

A facility may keep a stock supply of OTC medications for multiple resident use. Stock supply
must be centrally stored and labeled with the medication name, the date of purchase and a
notice that the medication is part of the facility’s stock supply.

When the resident is away from the ALF, provide a medication schedule, and the medication to
the resident, a family member or friend. Use of a pill organizer, or you may provide a unit dose
packaging to take with them.

Medication records, we must have a medication observation record (MOR), annual review by
the health care provider of any medication that might serve as a chemical restraint. Chemical
restraints means a pharmacologic drug that physically limits, restricts, or deprives an individual
of movement or mobility, and is used for discipline or convenience and not required for the
treatment of medical symptoms.

Medication storage:
● The facility administers the medication
● The resident request central storage
● The health care provider determines it to be hazardous if kept in the personal
possession of the resident.
 ● The resident fails to maintain the medication in a safe manner
● The facility determines that, because of physical arrangements and the conditions or
habits of residents, the possession of medication by a resident poses a safety hazard to
their residents.
● The facility’s rules and regulations require central storage of medication.

Discontinued medications must be kept separate from current medications; must be marked
discontinued; and disposed of within 30 days of expiration.

Medication disposal must be followed within 30 days of being abandoned or expired. You may
return to the pharmacy, dispose of in community with a witness and document disposal.

All medications must be properly labeled and dispensed. Customized packaging must display
the resident's name and identification of each drug in the container.

Change order must have a copy of a written or electronic order signed by the health care
provider. Make changes on the MOR and use bright alert labels. Nurses may take phone
orders; must be signed by the health care provider within 10 days; unlicensed staff are not
allowed to take phone orders and must receive the orders in writing.

Food Services - F.A.C. 64E-11

F.A.C 64E-11 Food Hygiene code applies to all facilities licensed for 11 beds or more. The
Florida Administrative Code Chapter 64E-11 falls under the review of the Department of Health.
DOH will inspect facilities on a regular basis, at least every quarter or depending on their
schedule. AHCA will conduct surveys that happen every 2 years. Facilities with 10 or fewer
residents must follow 64E-12 for specific guidelines to your department operation.

Food code is a reference document that is supported by FDA, CDC, US department of health
and human services and food safety and inspection services of the US department of
Agriculture. The food code discusses safe food handling practices to prevent foodborne
illnesses in food service operations. The goal of the food code and chapter 64E-11 is to protect
our food supply and the food service.

Time Temperature Control for Safety (TCS Foods)

TCS foods are foods that require temperature control for safety to limit pathogenic,
microorganism growth or toxic formation. This includes our protein source foods such as eggs,
cheese, dairy and milk products, meats, chicken and fish. The food code 2013 also includes
foods as raw seed sprouts, cut melons, cut leafy greens, but not such items as herbs such as
parsley. It also includes cut tomatoes or mixtures of cut tomatoes that are not modified, or
garlic-in-oil mixtures that are not modified; foods that need specific water percent requirements
and pH level would also fall under this category.
64E-11 still defines a highly susceptible population to be immune compromised institutionalized
older adults. Many of our residents are meeting this category in the AL environment. We need to
consider the regulation in regards to this. The food code has specific guidelines applying to
certain foods such as eggs for highly susceptible populations.
64E-11 defines hot water as a minimum temperature of 100 degrees Fahrenheit or above. The
safe temperature for hot food is now 135 degrees fahrenheit or higher, previous guidelines was
140 degrees fahrenheit. Cold food remains the same at 41 degrees fahrenheit or lower. Any
foods that are reheated need to be at 165 degrees fahrenheit for a minimum of 15 seconds.
Mechanically processed TCS foods also need to meet this requirement.

Food Standards and Guidelines

Standards for food supply are governed in the food code in the chapter 3 section. Food is to be
obtained from approved food sources that comply with law. Food needs to be in a safe
condition, unadulterated, and honestly presented.
Food must be prepared, processed, handled, packaged, transported and stored in a sanitary
manner to protect it from contamination and spoilage. No food served is to be provided from a
private home. While handling food, we need to handle, service and transport in a way that is
protected from contamination. This means when transporting food from one location to another,
it needs to be covered. If food is out in a salad bar or public serving area, you will need to
protect it from sneezes and coughs, from rodents and insects, from leakage and sewage.

Department Manager requirements are also listed in the Food code. The name of the
designated person in charge of the department must be in writing along with the responsibilities
listed. Facilities larger than 10 beds, you must be a certified food protection manager or receive
certification within 30 days of hire. The certification requirement means you have mandatory
training in regards to safe food handling. This could be the ServeSafe Food Handling Training or
Certified Food Protection Professional credential. This training is appropriate for those in large
communities or greater than 10 beds. 10 or fewer bed facilities may participate in a core training
or the food portion of the core training. Once you complete the core training, your department
manager will need to receive 2 hours of in-service education to maintain their currency. They
must also utilize a credential person to provide the training such as a Certified Food Manager.

The CFPP training or Servsafe training is valid for 5 years after successful completion of the
certification exam. This training requirement must be met by at least 1 person of the department
during all hours of operation where food is being handled in any way. The recommendation is
that in a larger property you would want to have at least the Manager, your cooks and possibly
your administrator all trained so that all hours in all shifts are being covered. Smaller properties
of 10 or fewer beds, maybe the administrator who is also the director of the department can
meet this requirement. Additional staff requirement applies to facilities licensed for 11 beds or
more. This training will cover topics related to food handling, food service, department
operations.
The manager is responsible to ensure that the staff is to receive this training in the time
specified. All food service staff must go through this training which needs to be completed on an
annual basis by March 31st. The training can be done by the certified manager; if you are hired
after March 31st, then you also must receive this training within 30 calendar days; which will
cover food handling practices, preparation and service practices as stated in chapter 64E-11
code and reflected in food code 2013 in regards to thawing, cooking, cooling, handling, holding
and serving foods. You must also demonstrate knowledge of safe methods of food service for
those serving food to residents. For staff performing cleaning duties, they need training in
equipment and work areas and proper cleaning and sanitation procedures. The maintenance
staff needs to have knowledge on insect and vermin control. All staff need training on topics
related to personal hygiene, clothing, hair covering and jewelry, as well as causes of most
common foodborne illnesses.
Records are to be kept by the manager for each person trained and a training curriculum for
each person receiving training on file for a minimum of 3 years. If the certified manager resigns,
then the facility has 90 days to come back into compliance.

Personnel Requirements
A food employee or conditional employee shall report the information in a manner that allows
the person in charge to reduce the risk of foodborne disease transmission, including providing
necessary additional information, such as date of onset of symptoms and an illness, or of a
diagnosis without symptoms. These are some reportable symptoms: vomiting, diarrhea,
jaundice, sore throat with fever or a lesion containing pus such as a boil or infected wound that
is open and draining on the hands or wrists, exposed portions of the arms; or other parts of the
body, unless the lesion is covered by a dry, durable, tight-fitting bandage.
Other reportable diagnoses are illnesses diagnosed by a health care practitioner due to:
Norovirus, hepatitis A virus, Shingella spp, Shiga toxin-producing escherichia coli, salmonella
typhi or nontyphoidal salmonella.

No person with a communicable disease or being a carrier of such disease as a respiratory

virus, stomach virus or infected wound that can be covered, cannot be working in the food
serving environment. They are to return to work when they are symptom free or with doctors
approval to return to work. No children are allowed to be working in the department.

Food Service Equipment, Utensils, and Linens

Materials
Materials that used in the construction of utensils and food contact surfaces of equipment may
not allow the migration of deleterious materials or impart colors, odors, or tastes to the food and
under normal use conditions shall be: safe, durable, corrosion resistant and non-absorbent,
sufficient weight and thickness of withstand repeated warewashing, should have a smooth and
easily cleanable surface.
Galvanized metal may not be used for utensil or food contact surfaces of equipment that are
used in contact with acidic food.

Sponges may not be used in contact with cleaned and sanitized or in use food contact surfaces.

Wood and wood wicker may not be used as a food contact surface. Hard maple or an
equivalently hard, close-grained wood may be used for:
● Cutting boards: cutting blocks, bakers’ tablets, and utensils such as rolling pins,
doughnut dowels, salad bowls and chopsticks,

Use separate cutting boards for fresh produce and for raw meat, poultry, fruits, vegetables and
cooked foods.

Nonstick coatings: Multiuse kitchenware such as frying pans, griddles, sauce pans, cookie
sheets, and waffle bakers that have a perfluorocarbon resin coating shall be used with non
scoring or non scratching utensils and cleaning aids. You need to replace utensils when they
become scratched or scored.

Can openers: cutting or piercing parts of cans openers shall be readily removable for cleaning
and for replacement. You want to replace dull blades and when there is an accumulation of
metal shaving on the gear.

Nonfood contact surfaces of equipment that are exposed to splash, spillage, or other food
soiling or that require frequent cleaning shall be constructed of a corrosion resistant,
nonabsorbent and smooth material.

Equipment that requires specific temperature parameters to be met, must be maintained in

working condition such as refrigerators, freezers and dish machine units, also food hot food
boxes. A working temperature must be placed where the temperature is the most warm in the
unit.

Food temperature measuring devices are to be scaled only in Fahrenheit and shall be accurate
to +-2 degrees F in the intended range of use.

Ambient air and water temperature measuring devices are scaled in fahrenheit shall be accurate
to +-3 degrees F in the intended range of use. Staff need to be able to demonstrate how to
calibrate a thermometer. The desired method is to fill a wide rim glass with ice , fill it with water,
plunge the thermometer in so that the center probe is covered by the water. The thermometer
must be calibrated to be accurate within 3 degrees of the desired temperature of 32 degrees.

Specific regulations apply to warewashing machines. A warewashing machine shall be provided

with an easily accessible and readable date place affixed to the machine by the manufacturer
that indicates the machine’s design and operation specifications including the temperatures
required for washing, rinsing, and sanitizing; pressure required for the fresh water sanitizing
rinse; and conveyor speed for conveyor machines or cycle time for stationary rack machines.
The food code specifies the minimum temperature required for warewashing machines but the
final ruling is the manufacturer’s specifications. It is highly recommended to keep a temperature
log for all required monitoring temperature situations including for refrigeration, warewashing
units, hot food boxes, etc.

Rinsing procedures: Washed utensils are equipment shall be rinsed so that abrasives are
removed and cleaning chemicals are removed or diluted through the use of water or a
detergent-sanitizer by using one a 3-compartment sink. This must meet the manufacturer’s
guidelines for water temperature and sanitizing concentration.

Chemical Sanitization: a chemical sanitizer used in a sanitizing solution fo a manual or

mechanical operation at contact times specified by the manufacturer. Chlorine solution shall
have a minimum temperature based on the concentration and pH of the solution as listed by
manufacturer guidelines. Iodine solution shall have a minimum temperature of 68 degrees F and
concentration between 12.5 and 25 MG/L. A quaternary ammonium compound solution shall
have a minimum temperature of 75 degrees F and a concentration as listed by the
manufacturer. Equipment and utensils washed in a three compartment sink or a dish machine
must be air dried.

Handle your clean utensils by the handle non service area. Wet clothes must be kept in their
appropriate solutions. Once used you may discard if disposable or you may launder them if
reusable.
Routine testing of the sanitizing solutions is recommended to measure the effectiveness of
these solutions. This testing may be as frequent as 2 hours or at a minimum of 3 times a day
with a fresh clean solution for every use.
Soiled linens: shall be kept in clean, nonabsorbent receptacles or clean, washable laundry bags
and stored and transported to prevent contamination of food, clean equipment, clean utensils,
and single service and single service articles.

Sufficient equipment is required to ensure hot food is kept hot, and cold food is kept cold.

Fixed equipment: equipment that is fixed because it is not easily movable shall be installed so
that it is: spaced to allow access for cleaning along the sides, behind, and above the equipment;
spaced from adjoining equipment, walls and ceiling. Floor mounted equipment that is not easily
movable shall be sealed to the floor or elevated on legs that provide at least 6 inch clearance
between the floor and the equipment. Counter mounted equipment shall be elevated on legs
that provide at least 4 inches clearance between the table and the equipment. All equipment
must be clean before use and as needed with a minimum of once daily.

Ice machines: the water needs to come from an approve source. You must handle the ice in a
sanitary manner; the ice scoop is to not come in contact with ice storing use or during storage.
The drain in the ice machine must drain directly into a floor drain.
Design and construction
Equipment and utensils shall be designed and constructed to be durable and to retain their
characteristic qualities under normal use conditions.

Food temperature measuring devices may not have sensors or stems constructed of glass,
except that thermometers with glass sensors or stems that are encased in a shatterproof
coating such as candy thermometers may be used.

Food contact surfaces shall be: smooth, free of breaks, open seams, cracks, chips, inclusions,
pins, and similar imperfections. Free of sharp internal angles, and have smooth welds and
joints.

● Food equipment must be built to be maintained in the same operating condition and
easily cleaned.
● A water supply needs to come from a safe and sanitary source for consumption and use.
● Plumbing and sewage need to be designed, installed, and maintained in such a way that
is in compliance with applicable laws and regulations and so it is not to contaminate any
food or equipment.
● An indirect water connection is required between the sewage system and any drains
originating from equipment in which food or portable equipment are being placed.
Hand washing areas must be located in or immediately adjacent toilet rooms or
restrooms. At least 1 employee hand washing facility must be located within 20 feet of
the duty station, visible and easily accessible through an unobstructed area with signage
at each hand washing station indicating that all employees are to wash their hands
before returning to work.
● A hand washing sink is to be at least 100 degrees fahrenheit. This is only to be used for
hand washing with a trash can available if disposable towels are being used.

The food code 2013 describes the hand washing process that needs to last at least 20 second.
We need to use a cleaning compound, and have your hands wet over the hand washing sink;
you want to wash your hands under clean running warm water, apply the cleaning compound
following the manufacturers instructions; rub your hands together vigorously for at least 10-20
seconds paying close attention to the areas under the fingernails, creating friction on the surface
of your hands, and exposed arms, wrist and fingers so that the rubbing water would thoroughly
rinse away any residue. After washing your hands under warm water you are to immediately dry
your hands. If using a disposable paper towel, you may also use the same paper towel to turn
off the faucet and open the restroom door and dispose of the paper towel in a garbage can.

As a food service staff, you must wash their hands at the start of your shift; you must wash your
hands after using the restroom, after touching your body, after handling soil equipment and
utensils, after coughing or sneezing, after you use any tobacco products or you eat or drink
something, during the food preparation process as needed, before changing from one task to
another to prevent cross contamination, when switching between handling raw food and ready
to eat foods, you’d wash your hands before donning gloves to handle foods, and after removing
gloves. Wash your hands when handling soiled dishes and clean dishes and after any activity
that might contaminate your hands.

Glove use
Gloves need to be clean and intact with no holes, glove use is designed for short term specific
function use. You must change gloves when they become soiled or when changing to a different
task. Please note it is not required to change gloves when you are at the same station and
doing the same task. Gloves would be disposed of if the task is interrupted and you must wash
your hands and start with a new pair of gloves. You must also use gloves if no further cooking of
food items will occur. Use a utensil prior to utilizing your gloves, such as tongs to handle food.
Hand washing is only to occur in a hand washing sink.

Fingernails are specifically addressed in the food code 2013. Fingernails are to be trimmed,
clean, filed, and maintained to be clean with no rough edges; no nail polish or artificial nails are
to be used unless you have an intact glove and in good repair when working with exposed food.
Many facilities have specific policies that will not allow artificial nails or nail polish; you must
adhere to the facility’s policy in regard to this. Some surveyors are very strict on this matter as
well and they will not accept them.
Jewelry: the only jewelry allowed is a simple ring such as a plain wedding band.

Clothing: clothing must be clean and you are to follow the uniform guidelines as established by
the facility. Personal cleanliness is essential.

Hair restraints: all facial and head hair must be properly covered or restrained. A clean cap, hair
or beard net must be worn as long as it fully covers the hair. This does not apply to wait staff
who have minimum contact with the food, such as delivery of a food item to the table as they
are not involved in the preparation of the food.

Eating, drinking and using tobacco products are prohibited. You may have a beverage in a
covered container and is handled in a way to prevent contamination. It is to be kept away from
food preparation areas. It must not be attractive to insects or vermin.

Physical kitchen area requirements:

Walls and floors must be smooth and easily cleanable.
Light bulbs are to be shielded, covered or shatter resistant in the food handling areas.
Lighting requirements are specific to working areas; 10 feet candles for 30 inches above the
floor if you are working in a walking or dry food storage area, 20 foot candles for salad bars and
undercounter refrigerators that are 30 inches above the floor. This also applies to washing
areas, utensils and equipment storage and restrooms. 50 feet candles when working with foods
and equipment such as knives, slicer or grinders due to a safety factor. The main idea is that
you need to have adequate lighting to see what you are doing in a safe and sanitary manner.
Ventilation hood systems: Air vents are to be clean and not cause any contamination of food or
equipment. Pay close attention to where ceiling vents are placed so that any condensation does
not contaminate the food. This includes components such as hoods, fans, guards, and ducting
that shall be designed to prevent grease or condensation from draining or dripping onto food.
Venting systems must comply with all applicable fire prevention requirements. For ventilation
hood systems, filters and other grease extracting equipment shall be designed to be readily
removable for cleaning and replacement if not designed to be cleaned in place.

Insect control devices are not to be over food preparation areas. They must catch the dead
insect.

Any doors to the exterior must be closed, they must have a tight fit or seal. If the door is to
remain open for a short period of time such as supply delivery, then you must have a mesh or
air curtain to protect from insects entering the department while the door is open. Any holes
need to be filled or closed off on floors, walls or ceilings.
Garbage control: indoors garbage cans need to be covered unless in continuing use. Outdoor
cans need to have a tight fitting lid so that rodents or insects cannot access it.
Dumpster areas and items that are recycled need to be in a nonabsorbent material such as
asphalt,

Pest control
You need to inspect any incoming shipments to your department for food and supplies and
check for pests. You also want to do a routine inspection of the premises looking for evidence of
pests. Then you want to make sure that you have a pest control program in place, to eliminate
the risk of pests such as eliminating cardboard immediately.
Poisonous and toxic agents: chemicals must be legibly and clearly marked. The manufacturer
provided label must be utilized when you remove product from the original container and place it
into a smaller container. Any chemicals must be stored away from food, utensils or linen. The
only exception is the chemicals used for the dish machine or the 3 compartment sink. These
chemicals must be stored away to prevent contamination. Only chemicals safe to use are to be
kept in the department and you must follow manufacturer guidelines for use of those chemicals.

Mop use: you need at least 1 service sink or mop sink equipped with a floor drain. Mop is to be
washed and placed in a position to air dry.

Sanitization of Equipment and Utensils

Equipment food-contact surfaces and utensils shall be sanitized before use after cleaning. After
being cleaned, equipment, food contact surfaces and utensils shall be sanitized in: hot water
manual operations by inmersion for at least 30 second. Chemical manual or mechanical
operations , including the application of sanitizing chemicals by immersion, manual, swabbing,
brushing, or pressure spraying methinds, using a solution as specified by manufacturer.

Food Handling Practices

The purpose of food handling and storage practices is to protect from any potential
contaminants. It is very important at any point of food handling.

Temperature
Refrigerated, Time-Temperature Control Foods (TCS Foods) shall be at a temperature of 41o F
or below when received.
Raw eggs shall be received in refrigerated equipment that maintains an ambient air temperature
of 45o F or less.
Upon receipt, Time TCS Food shall be free of evidence of previous temperature abuse.
A) Egg products shall be obtained pasteurized.
(B) Fluid and dry milk and milk products shall:
(1) Be obtained pasteurized;and
(2) Comply with Grade A Standards as specified in law.
(C) Frozen milk products, such as ice cream, shall be obtained pasteurized as specified
in 21 CFR 135 - Frozen desserts.

Food packages shall be in good condition and protect the integrity of the contents so that the
food is not exposed to Adulteration or potential contaminants.

Ice for use as a food or a cooling medium such as chicken in ice; ice must be discarded.

A food that is labeled frozen and shipped frozen by a food processing plant shall be received
frozen. Items that are labeled and frozen must remain frozen.

TCS Foods that are cooked to a temperature and for a time specified under §§ 3-401.11 3-
401.13 and received hot shall be at a temperature of 135o F or above.

Pre-packaged juice shall:

(A) Be obtained from a processor with a HACCP system as specified in 21 CFR Part 120
Hazard Analysis and Critical Control (HACCP) Systems; and
(B) Be obtained pasteurized or otherwise treated to attain a 5-log reduction of the most resistant
microorganism of public health significance as specified in 21 CFR Part 120.24 Process
Controls.

Storage practices are such that you separate raw food from cooked TCS Food.
The food store room must be in a clean and dry location. Shelving must be 6 inches from the
floor.
Any food items moved from their original packaging need to be labeled and dated. This includes
food in storage bins such as flour and sugar. The scoops for the bins need to be stored in a way
to protect from contamination. Bins must be clean before you refill them.
No food is to be stored in locker rooms, restrooms, or mechanical equipment rooms.
No food is to be stored under a leaking water line or an unprotected sewer line.
Fruits and vegetables must be washed to remove any physical debri before preparation and
handling and service.

Thawing Practices for TCS Foods

Freezing prevents microbial growth in foods, but usually does not destroy all microorganisms.
Improper thawing provides an opportunity for surviving bacteria to grow to harmful numbers
and/or produce toxins. If the food is then refrozen, significant numbers of bacteria and/or all
preformed toxins are preserved.
Thawing must be monitored and controlled to ensure thoroughness and to prevent temperature
abuse. Improperly thawed meat could cause insufficient cure penetration. Temperature abuse
can cause spoilage or growth of pathogens. The ideal thawing method is thawing under
refrigeration that maintains food temperature at 41 degrees F or less.
You may also thaw food by completely submerging under running water at a temperature of 70
F or below; with sufficient water velocity to agitate and float off loose particles in an overflow;
and for a period of time that does not allow thawed portions of a raw animal food requiring
cooking as specified to be above 41 degrees F for more than 4 hours.
Thawed in a microwave oven and immediately transferred to conventional cooking equipment,
with no interruption in the process. However, this is not the ideal process.
Using any procedure if a portion of frozen ready to eat food is thawed and prepared for
immediate service in response to an individual consumer’s order such as french fries.

TCS must be cooked to reach temperatures at least 145 degrees F for 15 seconds. The
exception for this is cooked fruits and vegetables need to reach 135 degrees F; any
mechanicalized meat or ground meat product needs to reach 155 degrees F for 15 seconds;
poultry and stuffing needs to reach 165 degrees F for 15 seconds; and leftovers need to reach
165 for 15 seconds. Leftovers are a one time reheating use, if they are not consumed, they
must be discarded. Also, you never want to mix leftovers in a pan with a fresh product such as
on a buffet line. Leftovers are to be rapidly reheated. The time frame is not to exceed 2 hours for
it.

There are specific guidelines for handling eggs:

Pasteurized eggs will have stamped on each egg. These eggs are treated to destroy any
salmonella in a precision warm water bath. Pasteurized eggs are then safe for anyone to
consume. You want to utilize pasteurized eggs if you are not hard cooking or hard frying the egg
which is a specific requirement for a highly susceptible population. Pasteurized eggs do not
need to meet the 145 degrees F if cooked requirement when they are being served immediately
such as preparing table sides, sunny side up or pouched egg. Pasteurized eggs and
pasteurized products would be used to prepare caesar salads, sauces, eggnog, ice creams or
non cooked beverages.
Non pasteurized eggs can be used when they’ll be fully cooked in baked goods such as a cake.
There are specific guidelines for pulling eggs, when you are pulling 4 or more eggs together,
they must be prepared and served immediately.
Raw eggs must be cooked within 30 minutes after breaking unless used in a batter such as in a
quiche or buffet line scramble eggs. This does not apply to liquid pasteurized egg juice.

As a reminder of food code 2013, temperature requirements for TCS Foods. Once TCS foods
are cooked, the holding temp requirement is 135 degrees F or greater. Cold TCS are to be held
at 41 degrees F or less. Cooling TCS has specific requirements: within 2 hours you must get
from 135 F to 70 F and you have a total of 6 hours to get from 135F to 41F. Surveyors may ask
for a temperature log to reflect the time temperature practices for hot and cold TCS foods that
are prepared in house. The exception to this time requirement is if you are working with room
temperature ingredients such as cans, tuna, etc, you have 4 hours total to achieve the 41F. The
best practice is to start with chilled ingredients, equipment and utensils to keep the
temperatures out of the danger zone for the minimum amount of time. There are a number of
cooling methods that will help achieve the proper cooling time frames for TCS Foods. This
includes such practices as placing the food in shallow pans; you can even place it in pans that
have been in the freezer to bring temperature down. You can separate foods into smaller or
thinner portions. You may use rapid cooling methods, or ice water baths or use containers that
will facilitate heat transfer. The code identifies you can use any other effective method to
accomplish this. Once you achieve the desired temperature of 41F you must properly place the
item and label it as such.
Labeling Practices: Labels need to be able to identify the food as well as the date of
preparation and/or discarding practices. The best practice is to date food items upon the
delivery receipt, because this will help ensure First In/First Out practices are followed. TCS
foods that are prepared on site such as tuna salad, when it is held for greater than 24 hours,
must be marked with date of preparation or discarded. THis products are to be held at 41F or
less and they must be discarded at a maximum of 7 days. The date of preparation will count as
day 1. Commercially prepared food such as store bought tuna salad, will be marked with an
open date if held for greater than 24 hours, they will be marked with discard date not to exceed
the manufacturer discard date. The best practice is to maintain a uniform labeling practice so it
is easy to follow and adhere by all staff members. It should be easily readable as well as easily
removable. Plan to utilize leftovers within 48 to 72 hours. TCS foods that are held at a
temperature greater than 41F and less than 135F (Danger Zone) for more than 4 hours, must
be discarded.

All equipment is to be maintained in proper order; it is important that you have a preventive
maintenance inspection and surface program to ensure all equipment remains in working order.
Some wood materials are allowed such as cutting boards but they must be free of scratching. It
is allowed to resurface scratched boards but if not possible then you must replace it with a new
one.
Always start with clean equipment and utensils meaning that is clean to the sight and to touch.
Easily cleanable and smooth surfaces are desired. Equipment should be made of nonabsorbent
and durable materials.

The 6 most common causes of foodborne illnesses

Foodborne illness is any illness resulting from food spoilage, food contamination or pathogenic
bacteria, viruses or parasites that contaminate the foods as well as toxins such as certain
mushrooms or various species of bean that have not been boiled for at least 10 minutes.
Symptoms occur after ingestion of the contaminated foods. Typically they are gastrointestinal
(GI) related and may include nausea, vomiting, abdominal pain and/or diarrhea. Prompt medical
attention may be necessary for residents. THe primary focus is to protect residents from
foodborne illnesses and addressed when we store, prepare, handle, thaw, cook and serve foods
in a safe and sanitary way as described in the food code 2013 and as found on chapter 64E-11
Food hygiene code.
Most foodborne illnesses involve staff when food has not been handled properly or poor
personal hygiene practices have occurred. The first line of defense is proper hand washing
which was previously addressed in the training.
There cannot be too much emphasis on this practice. Proper and frequent hand washing is the
number one priority to prevent foodborne illnesses.
The 6 most common causes foodborne illness as identified by the Food and Drug
Administration as follows:
E coli
Hepatitis A
Nontyphoidal Salmonella
Norovirus
Shigella
Salmonella Typhi

E coli is typically spread by eating contaminated food such as raw foods, raw vegetables,
unpasteurized dairy products and undercooked meats specially ground beef; poor personal
hygiene practices lead to contamination for touching fecal material from an infected person.

How to protect against E coli poisoning? Proper washing of foods and vegetables, using
pasteurized dairy products and properly cooking meats. Remember ground beef is to reach
155F for a minimum of 15 seconds.

Hepatitis A is spread through the fecal oral route either person to person, or by ingesting
contaminated food or water. The best way to prevent it is by vaccination.

Nontyphoidal Salmonella is spread by eating contaminated foods of animal origin such as

eggs, meat, poultry or milk; raw vegetables may be contaminated if they come in contact with
animal feces; the last way to get this is by person to person transmission which may occur from
the fecal oral route. It can be prevented by proper hand washing, and proper handling and
cooking of TCS foods.

Norovirus is likely the most familiar one due to its occurrence on cruises making it the news
when outbreaks occur. When you are in close contact with poor hygiene practices and
compromised food handling practices. It is highly contagious and spread through contact with
an infected person or by touching an infected surface or by ingestion of contaminated food or
water. The prevention of it is proper hand washing, proper cleaning practices of food and
contact surfaces, equipment and utensils, and proper food handling in preparation techniques.

Shigella is typically spread person to person contact though the fecal oral route and is more
common in young children. Its prevention is proper hand washing and hygiene practices, which
is especially important for people with children who then come to work in the food service
environment.

Salmonella Typhi is spread from person to person through the fecal oral route and from
infected drinking water. The prevention of it is to proper hand washing and hygiene practices
and ensuring the water is obtained from a safe water source.

Proper handwashing
Remember, proper hand washing is key to prevent foodborne illnesses.
Handwashing: Reduce the Spread of Viruses - NFSM 2016

10 most common causes of foodborne illnesses

The CDC has identify the top 10 most common causes of foodborne illnesses in the food
service environment:
1. Improper cooling techniques. We must cool TCS food from 135F to 70F within 2 hours
and 135F to 41F within 6 hours.
2. 12 or more hours between the preparation and consumption of the food item. This
occurs when we take frequent breaks on food preparation or our task if being interrupted
and TCS foods are not being refrigerated until you return to complete the task
3. Infected people handling food: when you are sick and contagious you need to stay
home.
4. Inadequate reheating practices: it is recommended that you 165F for 15 seconds for
reheating of any leftovers. Leftovers are to be reheated only once. Never mix leftovers
with a fresh food item.
5. Improper hot holding temperatures: the food code 2013 identifies hot holding
temperatures at 135F or higher. You need to check at least every 2 hours to ensure this
temperature is maintained during hot holding times. Also cold TCS foods need to be held
at 41F or less.
6. Contaminated ingredients: we need to protect our food products from contamination.
Reject delivery of food items with obvious damage or temperature abuse.
7. Food from unsafe sources: only purchase from approved food vendors. There is a
guideline that you can grow in your community garden but you must assure all practices
are followed for proper hygiene and safe food handling techniques.
8. Improper cleaning procedures: proper cleaning procedures must be established for all
equipment in the department. The cleaning cycle must be at a minimum daily and as
needed. Use hot water, chemical cleaner and sanitize properly.
9. Cross contamination: need to always assure a separation of raw to cooked food items;
never store raw above cooked items in the refrigerator and always practice proper hand
washing techniques. Use separate cutting boards for separation of raw food items
versus cooked items, different types of raw meats, separation of fruits and vegetables
and other food products
 10. Inaquetes cooking techniques: thoroughly cooking of foods will destroy the harm or
illnesses. This is achieved when the desired temperatures are met. Remember it is a
minimum of 145F for 15 seconds for cooking of TCS foods.

Food Service Requirements on CH 59A-36.012 F.A.C.

You are encouraged to access CH 59A-36.012 F.A.C to ensure you get the most recent
standards in the food service. This code includes a section on food standards as dietician
services and many requirements. This establishes that a person is designated in writing to be
responsible for the day to day operations of the food service department and they will supervise
any employees in that department. The food service supervisor must complete the certified food
manager training or complete the food service training portion of the ALF core training
depending on the size of your facility.

Any food service personnel working in the department will be required to have a 1-hour training
on topics related to food handling and sanitation practices and must be completed within 30
days of hire.
Menus that will be utilized in the assisted living environment have specific requirements that
must be followed. THe menus will be dated and planned in advance at least 1 week. The menus
will need to meet the nutritional needs of the residents in the facility. There are established
guidelines that are available to cover these regulations. Over the course of the day, the menu
must provide for a minimum of 6oz or 2 or more servings of protein; 6-11 or more servings of
breads and starches; 3-5 servings of vegetables; 2-4 servings of fruits; 2 or more servings of
milk or milk equivalent products as well as fats, oils, sweets and water.

Therapeutic diets will also meet these nutritional standards to the extent possible. Regular and
therapeutic menus must be reviewed annually by a registered dietician, or a licensed dietitian,
or nutritionist.
Portion sizes will be available either posted on the menu or on a separate sheet that is
accessible to the food service area.
Residents shall be encouraged to participate in the meal planning process. Planned menus
shall be available for the residents to review; either posted in a conspicuous location or
available in a location that the resident can easily access it. This posting will include both
regular and therapeutic menus as well as snacks and meal times. Menus must be legible and
must be accessible to residents that utilize a wheelchair or another motorized device for
mobility.
Menus substitution must be documented prior to or at the time the meal is served.
Menus must be kept on file for 6 months.
Therapeutic diets must be prepared and served as ordered by the health care provider. These
diets require a doctor’s order for that diet. The staff also needs a way to identify the resident to
the diet to any food allergies and any non-food preferences.
Standardized recipes must be utilized when the facility has more than 16 residents. A best
practice is to use a liberalized diet approach to maximize meal intake and resident satisfaction
while dining in a home like environment.
Typical menus encompass a 3-6 week rotating menu cycle. This is so that the menus are not
too repetitive and as a way to avoid serving the same menu items on the same day. THe menus
will cover several different common diet types; the most common is the regular diets and it
serves as the basis for all other diets. The regular diet basically allows all food to be served to
the residents. From this diet they may allow for a mechanical change to the diet such as a
mechanical soft texture or puree textured; or therapeutic components to the diet such as no
added salt, limited salt, or a low concentrated sweet, no concentrated sweet, or consistent
carbohydrate diet. This will address issues for residents with hypertension or diabetes concerns.
The most difficult diet to serve in this setting is the renal diet or a diet for those who have renal
difficulties or required dialysis. Residents with this therapeutic diet, you will need to work with
your dietitian, or licensed nutritionist to make sure the diet is served in a proper way to the
resident. If unable to meet the resident’s need, then the resident is not an appropriate candidate
for the facility.

Dietician services provided in the assisted living environment. The regulation states that you will
receive support from a registered dietitian or licensed dietitian nutritionist. This person needs the
licensing or registration requirements either at the national or state level. At the national level is
the registration requirement for a registered dietitian; this is certification that is met by the
credentialing established by the Commission on Dietetic Registration which is the accrediting
community for the academy of nutrition and dietetics. In the state of Florida there is also
licensure. This licensure component is covered under Ch 468; a licensed dietitian is a dietitian
who meets this requirement and provides consultation to more than one facility. The main
services that a dietitian is going to provide to the ALF first deal with the menu requirements.
Menus are required to be signed off annually by a registered or licensed dietitian nutritionist.
With this signature, there will also be included the date of approval as well as the registration or
license number of that licensed or registered dietitian. When we registered signs these menus, it
shows the menus have been reviewed for the appropriate choices and appropriate variety,
palatability of choices and that the nutritional standards have been met from these menu
components.
The registered dietitian will also ensure that any therapeutic diets are addressed properly. The
registered dietitian or licensed dietitian nutritionist can also assist when a resident refuses to
follow a therapeutic diet. They can provide counseling to the residents as well written
documentation that a counseling has taken place.
Another area that they may assist in is by providing the 2-hour training that is annually required
for the director in areas concerning nutrition, and food handling and sanitation practices.
The last area that a registered dietitian may assist with is in addressing any written deficiencies
of a Class I, Class II or Class III level. If there are any class I or II level deficiencies, the licensed
dietitian will provide an onsite visit within 7 seven days of the original citation. If it is an
uncorrected class III deficiency, the licensed dietitian will provide an onsite visit within 14 days
of the deficiency. At this visit, they will generate a written plan of corrective action that is
submitted within 10 working days of the original citation. The licensed dietitian will provide
subsequent visits to the facility at least on a quarterly basis until those deficiencies have been
cleared. Your licensed dietitian or registered dietitian is a great source of information with menu
planning, menu approval, any questions regarding regulations and to also help with any training
and any deficiencies citation.

Meal times are established so that no greater than 14 hours must elapse between the end of an
evening meal containing a protein food and the beginning of a morning meal. Intervals between
meals must be evenly distributed throughout the day with not less than 2 hours nor more than 6
hours between the end of one meal and the beginning of the next. For residents without access
to kitchen facilities, snacks must be offered at least once per day. Snacks are not considered to
be meals for the purposes of calculating the time between meals.

Residents must be encouraged to eat at tables in the dining areas. Food must be served
attractively at safe and palatable temperatures. A supply of eating utensils sufficient for all
residents, including adaptive equipment if needed by any resident, must be on hand.

A 3-day supply of nonperishable food, based on the number of weekly meals the facility has
contracted with residents to serve, must be on hand at all times. The quantity must be based on
the resident census and not on licensed capacity. The supply must consist of food that can be
stored safely without refrigeration; such as dry or canned foods. They must be kept in a sealed
container, labeled and dated; and rotated to establish shelf life parameters; they will not include
any frozen or refrigerated foods; any condensed foods such as dry beans or dehydrated
mashed potatoes require that adequate bottled water be maintained on hand to reconstitute
them. Water sufficient for drinking and food preparation must be stored, or the facility must have
a plan for obtaining water in an emergency, with the plan coordinated with and reviewed by the
local disaster preparedness authority.

Menus and Dining

The success of menus and dining starts with the appropriate equipment for food preparation.
You have to consider the manpower and skills of staff; the training and desire to participate in
the program; the type of diet you serve. It is a best practice to serve a liberal approach diet
because it’s more appealing and more appetizing on the choices that are available.
Regular diet means there are no restrictions; however some residents do have chronic
conditions such as hypertension, diabetes, cardiac conditions, kidney conditions and we must
ensure we do some diet modifications to meet residents’ dietary needs. The American diet
includes 9 grams of salt but we may cut it to 3-4 grams to adapt to dietary needs for those with
chronic conditions while still appealing to eat.
Diabetic diet or calorie controlled diet, also known as low concentrated sweet, no concentrator
sweets or restricted concentrated sweets which they all imply limiting the sugary high sugar that
have minimal nutritional value while balancing their choices of starches, protein and fats that
they are consuming. By offering a variety of food and balancing those food, we can offer more
choices and increase their meal satisfaction.
Renal issues are more complicated, when you have impaired kidney function, your body cannot
utilize certain nutrients. The major nutrients the body has problems with are protein, sodium,
potassium. What we do with the diet is coordinate with the doctor or dialysis center to liberalize
their diet as much as possible so that the residents can have as many food choices as possible.

Residents' preferences and food habits must be considered on menu choices. However, with
growing dementia residents you may deal with texture changes to the diets versus therapeutic
alterations. The most common textured changes we have to utilize are mechanical soft or
chopped diets but sometimes all you may do is cut up their food. However, many residents may
need further textured alterations such as a puree texture.
Plates and utensils play a part in how residents eat. They should not be too heavy or delicate for
residents to handle. Plate size impacts food appearance and the perception on the plate. Using
a 10.5” plae allows for better presentation and allows for sauce or gravy on that plate. Garnish
may be used and you want it to be edible.
A good practice is to use a demonstration plate or photo of the prepared plate so that staff can
see how to serve. The color of the plate has a great impact. Research has shown that red plates
increase the appetite, a green plate makes the food more appealing. When you plate the food
you must consider the food, the texture and taste of the food which goes in hand with menu
planning.
The dining environment is very important as it is the decoration of the dining area. It will impact
residents’ appetite; you want to plan for activities and social functions that involve meals. You
want to solicit resident’s input for menu choices because they want food they are comfortable
with. Once you incorporate that in the menu, they feel involved and want to eat in your dining
rooms. Make them feel important and always offer a variety of foods. Consider different ways to
serve the meal and the environment you have available. Make it fun and be creative so
residents feel motivated to join the dining experience. Your staff is very important in selling the
menu, their training and attitude will go a long way to getting residents to accept the menu.
Remember residents are to be treated with dignity and respect including the dining process.
They should not be isolated, if so, you must intervene and try to get residents with similar
interests so they do not feel alone.

Emergency and Disaster Preparedness

In an event of an emergency, you must be prepared with a 3 day supply of non-perishable food,
water supply and paper goods for serving those items. However, AHCA is recommending a 7
day supply if a potential disaster occurs.
A planned disaster would be a hurricane coming. An unplanned disaster would be a water line
breaking on a late friday afternoon. These are handled differently, if the water main breaks you
need to use your emergency water supply if the supplier would not be able to supply over the
weekend. For a disaster you can plan for. For a hurricane, you may have additional staff or
family staying and you need to make room for them; preparing certain items before the disaster
occurs such as bread type products to keep them available to serve; coffee needs to be on
hand and you need to have a way to prepare it.
A 3-day food supply are non-perishable items and they should be dated and rotated annually
before hurricane season. You may plan to utilize items that you can use over the course of the
year such as tuna and incorporate it in the menu.
If you have to evacuate your property, you would go to a receiving facility and you must bring
your food supply and paper good supply if the receiving facility requests it as well as the
Identification of all residents such as diets orders and food allergies and food preferences.
It is important to know what equipment you have that would operate during an emergency. It is
important to have several can openers on hand as well as puree items for residents needing
texture altered diets.

Common Deficiencies Areas

Some of the most common deficiencies areas related to food services in Florida include
following food menus.
There are any number of ways this can turn into a citation:
● The most obvious one is the menu not being followed; if you make a change to the
menu, you must document it on the menu prior to the meal service. A surveyor may
come during meal serving and observe the meal serving and then compare the menu to
ensure it is followed. Remember any substitutions should be like items to replace it with.
If you eliminate vitamin A sources for the menu, you want to make sure you have other
items with vitamin A sources during the course of the week; a minimum of at least 3
vitamins A menus for each week.
● The next citation might occur in what you do not have portioning listed for the menu item
on the menu or separate paper that is in the food serving area.
● Menus that have not been signed off by a licensed or registered dietitian. Remember
they are good for 365 days and they should be reviewed before they expire.
● The facility is unable to meet specific needs of the resident. THis needs to be reviewed
and address with administration
● A resident refusing a therapeutic diet for which there’s a process to follow. Counseling
with the resident or their power of attorney to determine whether the diet is appropriate
or if it needs to be continued or whether they are accepting alternative options and then
addressing with the physician and coming to an agreement as to how to proceed in the
future. This must be documented very clearly in the medical record and it can be shown
to a surveyor in this instance.
● Food service: the food is not being served in a safe and sanitary way. This relates to
maintaining TCS food temperatures. A surveyor may test the food during the process
and determine the facility is out of compliance. It is our responsibility to maintain all
equipment in working order, prepare the food to the proper temperature and serve it at
the proper temperatures. We are required to maintain a temperature log so that we can
show these temperature records if they were to ask.
● Infection control practices: when a staff member would clear dirty dishes away from the
table and then without properly washing or sanitizing their hands would bring another
food item.
● Emergency food supplies: regulation requires a 3 day non perishable food supply; food
that can be opened and served without further processing. The number of food items to
 have on hand is based on overage coverage of any staff or family members at the facility
during an emergency situation.

CH 64E-12, F.A.C.
Chapter 64E-12 F.A.C. addressed the sanitary practices related to construction, operation and
maintenance of the community based residential facilities. If a requirement in this rule chapter
conflicts with a specific requirement in any other Florida state licensing
agency’s rule, then that agency’s standards shall prevail and will be addressed by that agency’s
officials.This chapter covers the food service standards for small facilities licensed for 10 beds
or less.
There are 3 tiers of food service, each with different minimal requirements based on facility type
and number of residents.
1. Facilities licensed for 11 or more residents must comply with the rule Ch 64E-11 as well
as the Food code 2013.
2. Tier 1 community based residential facilities as outlined in Chapter 64E-12 having a
capacity of 5 or fewer are not required to complete a food service plan review. Adult
Family Care Homes, regardless of size, are considered tier I facilities.
a. Food must be clean and free from spoilage and sage for human consumption.
b. Food must be from approved sources
c. Equipment and utensils must be clean
d. Safe temperatures must be maintained for TCS Foods
e. Food must be protected from any type of contamination.
3. Facilities licensed for 6-10 residents, must comply with Ch 64E-12 and they must have a
designated hand washing sink.

A safe and sanitized environment must be maintained at all times. Windows, doors must be in
working condition. Floors must be non-slip surfaces and that there are no slip hazards; no
broken baseboards, no water damage.

All furnishing needs to be in due repair and clean.A facility must be well lighted with lighting
fixtures that provide at least 20 foot candles of illumination in all areas of the room measured at
a distance of 30 inches from the floor.

Pest control must be in place to ensure you do not have roaches, flies or bed bugs. Mattresses
and pillows must have cleanable covers and they must be clean between residents. Sheets and
towels and personal clothing for residents must be washed at least weekly. Any blankets need
to be washed or dry clean as necessary and in between uses by different residents. No
common towels are not allowed; disposable towels are recommended so they can be discarded
after each use.
Recreational areas must be clean and free of hazard conditions.
Staffing Standards
We highly recommend that you read the following sections in its entirety.
429.52 F.S.
59A-36.010, F.A.C.
59A-36.011, F.A.C.
408.809, F.S.
59A-35.090, F.A.C.
435, F.S
59A-36.015 (2), F.A.C

Staffing Standards Definitions

CH 59A-36 F.A.C. includes very important definitions and to understand them throughout the
rule.
CNA: a certified nursing assistant is an individual certified under ch 464 (2) F.S.
Direct Care Staff: means staff in regular or direct contact with residents who provide personal
or nursing services to residents. It could include administrators and managers providing those
services.
Manager: someone who is authorized to perform the same functions as an administrator and is
also responsible for the operational maintenance of the facility while under the supervision of
the administrator. This does not include staff in place during the absence of an administrator.
Staff: individuals employed by a facility or contracting with a facility to provide direct or indirect
services to residents; or individuals who are employed by a firm under contract with a facility to
provide direct or indirect services to a facility. The term includes volunteers performing any
service that counts toward meeting any staffing requirement of this rule chapter.
Staff in regular or direct contact: staff whose duties may require to interact with residents on
a daily basis.

Administrator and Management Requirements

Administrators. Every facility must be under the supervision of an administrator who is
responsible for the operation and maintenance of the facility including the management of all
staff and the provision of appropriate care to all residents as required by Chapters 408, Part II,
429, Part I, F.S., and rule Chapter 59A-35, F.A.C., and this rule chapter.

An administrator must:

1. Be at least 21 years of age;

2. If employed on or after October 30, 1995, have, at a minimum, a high school diploma or
G.E.D.;
3. Be in compliance with Level 2 background screening requirements pursuant to Sections
408.809 and 429.174, F.S.;

4. Complete the core training and core competency test requirements with a minimum score of
75 no later than 90 days after becoming employed as a facility administrator. Administrators
who attended core training prior to July 1, 1997, are not required to take the competency test
unless specified elsewhere in this rule; and,

5. Satisfy the continuing education requirements of 12 hours in topics related to assisted living
every 2 years.Administrators who are not in compliance with these requirements must retake
the core training and core competency test requirements in effect on the date the non-
compliance is discovered by the agency or the department.

Once you complete the core competency test, you must keep records of your completion core
training, your successful core test certificate and any continuing education every 2 years
because this is not something you report somewhere. That is why it’s important you create your
employee file. Otherwise, if no records are kept you would need to retake the test.

In the event of extenuating circumstances, such as the death of a facility administrator, the
agency may permit an individual who otherwise has not satisfied the training requirements of
subparagraph of this rule, to temporarily serve as the facility administrator for a period not to
exceed 90 days. During the 90 day period, the individual temporarily serving as facility
administrator must:

1. Complete the core training and core competency test requirements; and,

2. Complete all additional training requirements if the facility maintains licensure as an extended
congregate care or limited mental health facility.

A facility may not go more than 120 days without having an administrator who has successfully
completed the core training and passed the certification exam.

Administrators may be the administrator for up to 3 ALF facilities or a group of facilities in a

single campus providing housing and health care Administrators who supervise more than one
facility must appoint in writing a separate manager for each facility. However, an administrator
supervising a maximum of three assisted living facilities, each licensed for 16 or fewer beds and
all within a 15 mile radius of each other, is only required to appoint two managers to assist in the
operation and maintenance of those facilities.
An individual serving as a manager must satisfy the same qualifications, background screening,
core training and competency test requirements, and continuing education requirements as an
administrator. Managers who attended the core training program prior to April 20, 1998, are not
required to take the competency test unless specified elsewhere in this rule. In addition, a
manager may not serve as a manager of more than a single facility, except as provided in
paragraph (1)(c) of this rule, and may not simultaneously serve as an administrator of any other
facility.
Facility owners must notify the Agency Central Office within 10 days of a change in facility
administrator on the Notification of Change of Administrator form, AHCA Form 3180-1006, June
2016. You also have to provide documentation to AHCA within 90 days that the administrator
meets education requirements, has completed the ALF Core training and successfully passed
the Core Competency Exam.

Staffing Standards

This can be found on Ch 59A-36.010 (3). In Florida we do not have minimum staffing ratios for
assisted living; instead, we have a minimum number of staff hours per week based on the
number of residents we have. When calculating minimum hours you have to take into account
staff duties as well as residents. We must include residents, day care participants and respite
residents in the calculation for the minimum number of staff per week.

Minimum staffing:

1. Facilities must maintain the following minimum staff hours per week:

Number of Residents, Day Care Participants, Staff

and Respite Care Residents Hours/We
ek

0-5 168

6-15 212

16- 25 253

26-35 294

36-45 335

46-55 375

56- 65 416

66-75 457

76-85 498

86-95 539

For every 20 total combined residents, day care participants, and respite care residents
over 95 add 42 staff hours per week.

2. Independent living residents, who occupy beds included within the licensed capacity of an
assisted living facility but do not receive personal, limited nursing, or extended congregate care
services, are not counted as residents for purposes of computing minimum staff hours.

3. At least one staff member who has access to facility and resident records in case of an
emergency must be in the facility at all times when residents are in the facility. Residents
serving as paid or volunteer staff may not be left solely in charge of other residents while the
facility administrator, manager or other staff are absent from the facility.

4. In facilities with 17 or more residents, there must be at least one staff member awake at all
hours of the day and night.

5. A staff member who has completed courses in First Aid and Cardiopulmonary Resuscitation
(CPR) and holds a currently valid card documenting completion of such courses must be in the
facility at all times.

a. Documentation of attendance at First Aid or CPR courses pursuant to subsection 59A-

36.011(5), F.A.C., satisfies this requirement.

b. A nurse is considered as having met the course requirements for First Aid. An emergency
medical technician or paramedic currently certified under Chapter 401, Part III, F.S., is
considered as having met the course requirements for both First Aid and CPR.

6. During periods of temporary absence of the administrator or manager of more than 48 hours
when residents are on the premises, a staff member who is at least 21 years of age must be
physically present and designated in writing to be in charge of the facility. No staff member shall
be in charge of a facility for a consecutive period of 21 days or more, or for a total of 60 days
within a calendar year, without being an administrator or manager.

7. Staff whose duties are exclusively building or grounds maintenance, clerical, or food
preparation do not count towards meeting the minimum staffing hours requirement.

8. The administrator or manager’s time may be counted for the purpose of meeting the required
staffing hours, provided the administrator or manager is actively involved in the day-to-day
operation of the facility, including making decisions and providing supervision for all aspects of
resident care, and is listed on the facility’s staffing schedule.

9. Only on-the-job staff may be counted in meeting the minimum staffing hours. Vacant
positions or absent staff may not be counted.

(b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities,
including those composed of apartments, must have enough qualified staff to provide resident
supervision, and to provide or arrange for resident services in accordance with the residents’
scheduled and unscheduled service needs, resident contracts, and resident care standards.

(c) The facility must maintain a written work schedule that reflects its 24-hour staffing pattern for a given
time period. Upon request, the facility must make the daily work schedules of direct care staff available to
residents or their representatives.

(d) The facility must provide staff immediately when the agency determines that the
requirements of paragraph (a) are not met. The facility must immediately increase staff above
the minimum levels established in paragraph (a), if the agency determines that adequate
supervision and care are not being provided to residents, resident care standards described in
Rule 59A-36.007, F.A.C., are not being met, or that the facility is failing to meet the terms of
residents’ contracts. The agency will consult with the facility administrator and residents
regarding any determination that additional staff is required. Based on the recommendations of
the local fire safety authority, the agency may require additional staff when the facility fails to
meet the fire safety standards described in rule Chapter 69A-40, F.A.C., until such time as the
local fire safety authority informs the agency that fire safety requirements are being met.

1. When additional staff is required above the minimum, the agency will require the submission
of a corrective action plan within the time specified in the notification indicating how the
increased staffing is to be achieved to meet resident service needs. The plan will be reviewed
by the agency to determine if it sufficiently increases the staffing levels to meet resident needs.

2. When the facility can demonstrate to the agency that resident needs are being met, or that
resident needs can be met without increased staffing, the agency may modify staffing
requirements for the facility and the facility will no longer be required to maintain a plan with the
agency.

(e) Facilities that are co-located with a nursing home may use shared staffing provided that staff
hours are only counted once for the purpose of meeting either assisted living facility or nursing
home minimum staffing ratios.

(f) Facilities holding a limited mental health, extended congregate care, or limited nursing
services license must also comply with the staffing requirements.

If at any point, AHCA determines that you are not meeting minimum staffing requirements, they
can require you to immediately increase your staff; they may also require you to increase staff
above the minimum level if they determine that you do not have sufficient staffing to meet the
needs of the residents or to ensure resident care standards. When a situation like this happens,
AHCA will require you to provide a corrective action plan on how the increasing staffing will be
achieved and how it will address meeting the resident needs. You must keep the plan in place
until you can prove that you have sufficient staff to meet the needs of the residents.

Staff

(a) Within 30 days after beginning employment, newly hired staff must submit a written
statement from a health care provider documenting that the individual does not have any signs
or symptoms of communicable disease. The examination performed by the health care provider
must have been conducted no earlier than 6 months before submission of the statement. Newly
hired staff does not include an employee transferring without a break in service from one facility
to another when the facility is under the same management or ownership.

1. Evidence of a negative tuberculosis examination must be documented on an annual basis.

Documentation provided by the Florida Department of Health or a licensed health care provider
certifying that there is a shortage of tuberculosis testing materials satisfies the annual
tuberculosis examination requirement. An individual with a positive tuberculosis test must
submit a health care provider’s statement that the individual does not constitute a risk of
communicating tuberculosis.

2. If any staff member has, or is suspected of having, a communicable disease, such individual
must be immediately removed from duties until a written statement is submitted from a health
care provider indicating that the individual does not constitute a risk of transmitting a
communicable disease.
(b) Staff must be qualified to perform their assigned duties consistent with their level of
education, training, preparation, and experience. Staff providing services requiring licensing or
certification must be appropriately licensed or certified. All staff must exercise their
responsibilities, consistent with their qualifications, to observe residents, to document
observations on the appropriate resident’s record, and to report the observations to the
resident’s health care provider in accordance with this rule chapter.

(c) All staff must comply with the training requirements of Rule 59A-36.011, F.A.C.

(d) An assisted living facility contracting to provide services to residents must ensure that
individuals providing services are qualified to perform their assigned duties in accordance with
this rule chapter. The contract between the facility and the staffing agency or contractor must
specifically describe the services the staffing agency or contractor will provide to residents.

(e) For facilities with a licensed capacity of 17 or more residents, the facility must:

1. Develop a written job description for each staff position and provide a copy of the job
description to each staff member; and,

2. Maintain timesheets for all staff.

(f) Level 2 background screening must be conducted for staff, including staff contracted by the
facility to provide services to residents

The employee roster must be updated within 10 days when a new hire is added or an employee
is removed. You must also keep all passwords up to date in the system.

Facilities also are to have a written work schedule reflecting a 24 hours staffing pattern and
reflect that we are meeting minimum hours staff per week based on the number of residents we
have. We have to copy those for 6 months; electronic records are allowed.

Background Screening

AHCA has a background screening website with videos on how to register for and access the
system as well as how to enter the information into the website. Level 2 background screening
pursuant to chapter 435 must be conducted through the agency on each of the following
persons, who are considered employees for the purposes of conducting screening:
Licensee/Owner/Administrators and anyone with controlling interest
● The licensee, if an individual.
● The administrator or a similarly titled individual who is responsible for the day to day
operation of the provider.
● Financial officer or similarly titled individual who is responsible for the financial operation
of the licensee or provider.
● Any person who is a controlling interest if the agency has a reason to believe that such
person has been convicted of any offense prohibited. For each controlling interest who
has been convicted of any such offense, the licensee shall submit to the agency a
description and explanation of the conviction at the time of license application.
 ● Employees and Contractors providing personal care services
● Employees that have access to client property, fund or living areas
● Contractors who work 20 hours a week or more who will have access to client funds,
personal property, or living areas.

For employees that have a clearance in the system and do not have break in service then you
may submit a review to the agency. If the employee has a clearance but there is a break in
service, then you’ll need to resubmit it to the agency.

For newly screened employees, you have to start the process in the system to search for them
and to initiate a new screening before the person goes to get fingerprinted. You must ensure to
have a completed attestation of compliance with background screening, maintained as part of
that employee’s record.
Once you receive confirmation of eligibility of that person, be sure to add that person to your
background screening roster. We must add or remove employees from our background
screening rosters within 10 days of a change in employment.

Background screenings are valid for 5 years. Every 5 years following his or her licensure,
employment, or entry into a contract in a capacity that under subsection (1) would require level
2 background screening under chapter 435, each such person must submit to level 2
background rescreening as a condition of retaining such license or continuing in such
employment or contractual status.

All fingerprints must be provided in electronic format. Screening results shall be reviewed by the
agency with respect to the offense and this section, and the qualifying or disqualifying status of
the person named in the request shall be maintained in a database. The qualifying or
disqualifying status of the person named in the request shall be posted on a secure website for
retrieval by the licensee or designated agent on the licensee’s behalf.

Prohibited offenses can be found on 435 F.S. and 408 F.S. and provisions for persons who are
seeking exceptions from some disqualifying offenses. The important thing to remember is that if
you become aware that an employee has been arrested for a disqualifying offense, then you
must remove them from contact with residents until you are able to determine they are still
eligible under the background screening requirements.

Staff Training Requirements and Core Competency Test

59A-36.011 covers staff training requirements and core competency test which is one of the
most important aspects of the course. Be sure to know and carefully read this section. As an
administrator you must know when training is required and valid duration of training and training
requirements before staff goes in direct contact with residents.

Assisted Living Facility Core Training Requirements and Competency Test

(a) The assisted living facility core training requirements established by the department pursuant
to Section 429.52, F.S., shall consist of a minimum of 26 hours of training plus a competency
test.

(b) Administrators and managers must successfully complete the assisted living facility core
training requirements within 3 months from the date of becoming a facility administrator or
manager. Successful completion of the core training requirements includes passing the
competency test. The minimum passing score for the competency test is 75%. Administrators
who have attended core training prior to July 1, 1997, and managers who attended the core
training program prior to April 20, 1998, shall not be required to take the competency test.
Administrators licensed as nursing home administrators in accordance with Chapter 468, Part II,
F.S., are exempt from this requirement.

(c) Administrators and managers shall participate in 12 hours of continuing education in topics
related to assisted living every 2 years.

(d) A newly hired administrator or manager who has successfully completed the assisted living
facility core training and continuing education requirements, shall not be required to retake the
core training. An administrator or manager who has successfully completed the core training but
has not maintained the continuing education requirements will be considered a new
administrator or manager for the purposes of the core training requirements and must:

1. Retake the assisted living facility core training; and,

2. Retake and pass the competency test.

(e) The fees for the competency test shall not exceed $200.00. The payment for the
competency test fee shall be remitted to the entity administering the test. A new fee is due each
time the test is taken.

Staff Preservice Orientation

Facilities must provide a preservice orientation of at least 2 hours to all new assisted living
facility employees who have not previously completed core training.

New staff must complete the preservice orientation prior to interacting with residents.

Once complete, the employee and the facility administrator must sign a statement that the
employee completed the preservice orientation which must be kept in the employee’s personnel
record.

In addition to topics that may be chosen by the facility administrator, the preservice orientation
must cover:
1. Resident’s rights; and,
 2. The facility’s license type and services offered by the facility.
3. Any other topics that you wish to cover such as training information

Staff In-Service Training

Effective 2020, topics covered during the pre-service orientation are not required to be repeated
during the in-service training.

Facility administrators or managers shall provide or arrange for the following in-service training
to facility staff:

(a) Staff who provide direct care to residents, other than nurses, certified nursing assistants, or
home health aides trained in accordance with Rule 59A-8.0095, F.A.C., must receive a
minimum of 1 hour in-service training in infection control, including universal precautions and
facility sanitation procedures, before providing personal care to residents. The facility must use
its infection control policies and procedures when offering this training. Documentation of
compliance with the staff training requirements of 29 CFR 1910.1030, relating to blood borne
pathogens, may be used to meet this requirement.

(b) Staff who provide direct care to residents must receive a minimum of 1 hour in-service
training within 30 days of employment that covers the following subjects:

1. Reporting adverse incidents.

2. Facility emergency procedures including chain-of-command and staff roles relating to

emergency evacuation.

(c) Staff who provide direct care to residents, who have not taken the core training program,
shall receive a minimum of 1 hour in-service training within 30 days of employment that covers
the following subjects:

1. Resident rights in an assisted living facility.

2. Recognizing and reporting resident abuse, neglect, and exploitation. The facility must use its
abuse prevention policies and procedures when offering this training.

(d) Staff who provide direct care to residents, other than nurses, CNAs, or home health aides
trained in accordance with Rule 59A-8.0095, F.A.C., must receive 3 hours of in-service training
within 30 days of employment that covers the following subjects:

1. Resident behavior and needs.

2. Providing assistance with the activities of daily living.

(e) Staff who prepare or serve food, who have not taken the assisted living facility core training
must receive a minimum of 1-hour-in-service training within 30 days of employment in safe food
handling practices.

(f) All facility staff shall receive in-service training regarding the facility’s resident elopement
response policies and procedures within thirty (30) days of employment.
1. All facility staff shall be provided with a copy of the facility’s resident elopement response
policies and procedures.

2. All facility staff shall demonstrate an understanding and competency in the implementation of
the elopement response policies and procedures.

Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS)

All facility employees must complete a one-time education course on HIV and AIDS, unless
licensed where that's a part of the requirement for their license such as a nurse; refer to Ch
456.033 F.S. New facility staff must obtain the training within 30 days of employment. Topics
covered are transmission and infection control policies and procedures, clinical management
and how to prevent contracting HIV; information on testing, confidentiality of test results, and
treatment of patients, etc. Documentation of compliance must be maintained.

First Aid and Cardiopulmonary Resuscitation (CPR)

A staff member who has completed courses in First Aid and CPR and holds a currently valid
card documenting completion of such courses must be in the facility at all times. Depending on
the size of the community, you may need to have more than one person.

(a) Documentation that the staff member possess current CPR certification that requires the
student to demonstrate, in person, that he or she is able to perform CPR and which is issued by
an instructor or training provider that is approved to provide CPR training by the American Red
Cross, the American Heart Association, the National Safety Council, or an organization whose
training is accredited by the Commission on Accreditation for Pre-Hospital Continuing Education
satisfies this requirement.

(b) A nurse shall be considered as having met the training requirement for First Aid. An
emergency medical technician or paramedic currently certified under Chapter 401, Part III, F.S.,
shall be considered as having met the training requirements for both First Aid and C.P.R.

Assistance with the Self-administration of Medication and Medication Management

Unlicensed persons who will be providing assistance with the self-administration of medications
must meet the training requirements, prior to assuming this responsibility. Courses provided in
fulfillment of this requirement must meet the following criteria:

Unlicensed persons, who provide assistance with self-administered medications and have
successfully completed the initial 6 hour training, must obtain, annually, a minimum of 2 hours of
continuing education training on providing assistance with self-administered medications and
safe medication practices in an assisted living facility. The 2 hours of continuing education
training may be provided online.

Trained unlicensed staff who, prior to the effective date of this rule, assist with the self-
administration of medication and have successfully completed 4 hours of assistance with self-
administration of medication training must complete an additional 2 hours of training, before
assisting with the self-administration of medication procedures.

Training must cover state law and rule requirements with respect to the supervision, assistance,
administration, and management of medications in assisted living facilities; procedures and
techniques for assisting the resident with self-administration of medication including how to read
a prescription label; providing the right medications to the right resident; common medications;
the importance of taking medications as prescribed; recognition of side effects and adverse
reactions and procedures to follow when residents appear to be experiencing side effects and
adverse reactions; documentation and record keeping; and medication storage and disposal.
Training shall include demonstrations of proper techniques, including techniques for infection
control, and ensure unlicensed staff have adequately demonstrated that they have acquired the
skills necessary to provide such assistance.

The training must be provided by a registered nurse or licensed pharmacist who shall issue a
training certificate to a trainee who demonstrates, in person and both physically and verbally,
the ability to:

1. Read and understand a prescription label;

2. Provide assistance with self-administration in accordance with Section 429.256, F.S., and
Rule 59A-36.008, F.A.C., including:

a. Assist with oral dosage forms, topical dosage forms, and topical ophthalmic, otic and nasal
dosage forms;

b. Measure liquid medications, break scored tablets, and crush tablets in accordance with
prescription directions;

c. Recognize the need to obtain clarification of an “as needed” prescription order;

d. Recognize a medication order which requires judgment or discretion, and to advise the
resident, resident’s health care provider or facility employer of inability to assist in the
administration of such orders;

e. Complete a medication observation record;

f. Retrieve and store medication;

g. Recognize the general signs of adverse reactions to medications and report such reactions;

h. Assist residents with insulin syringes that are prefilled with the proper dosage by a pharmacist
and insulin pens that are prefilled by the manufacturer by taking the medication, in its previously
dispensed, properly labeled container, from where it is stored, and bringing it to the resident for
self-injection;

i. Assist with nebulizers;

j. Use a glucometer to perform blood glucose testing;

k. Assist residents with oxygen nasal cannulas and continuous positive airway pressure (CPAP)
devices, excluding the titration of the oxygen levels;

l. Apply and remove anti-embolism stockings and hosiery;

m. Placement and removal of colostomy bags, excluding the removal of the flange or
manipulation of the stoma site; and,
n. Measurement of blood pressure, heart rate, temperature, and respiratory rate.

Nutrition and Food Service

The administrator or person designated by the administrator in writing as responsible for the
facility’s food service and the day-to-day supervision of food service staff must obtain, annually,
a minimum of 2 hours continuing education in topics pertinent to nutrition and food service in an
assisted living facility. This requirement does not apply to administrators and designees who are
exempt from training requirements. A certified food manager, licensed dietician, registered
dietary technician or health department sanitarian is qualified to train assisted living facility staff
in nutrition and food service.

Facilities licensed for 11 beds or more must have a Food Service Supervisor; this person must
be a Certified Food Manager. The Certificate is good for 5 years. 64E-11, F.A.C.

Facilities licensed for 10 or fewer beds are exempt from this requirement; typically, the
administrator would oversee food service. They must take core training or the nutrition or food
service portion of the ALF core training. They must have 2 hours of in-service training annually.
If a Certified Food Manager meets training standards and is exempt from the 2 hour annual in-
service requirement. 59A-36, F.A.C.

All staff handling food service must have an annual training by March 31st of each year. Any
staff hired after this date, they must complete the training within 30 calendar days of hire.

Extended Congregate Care (ECC) Training

Extended Congregate Care (ECC) license facilities must have an ECC supervisor.

(a) The administrator and ECC supervisor, if different from the administrator, must complete
core training and 4 hours of initial training in extended congregate care prior to the facility
receiving its ECC license or within 3 months of beginning employment in a currently licensed
ECC facility as an administrator or ECC supervisor. Successful completion of the assisted living
facility core training shall be a prerequisite for this training. ECC supervisors who attended the
assisted living facility core training prior to April 20, 1998, shall not be required to take the
assisted living facility core training competency test.

(b) The administrator and the ECC supervisor, if different from the administrator, must complete
a minimum of 4 hours of continuing education every two years in topics relating to the physical,
psychological, or social needs of frail elderly and disabled persons, or persons with Alzheimer’s
disease or related disorders.

(c) All direct care staff providing care to residents in an ECC program must complete at least 2
hours of in-service training, provided by the facility administrator or ECC supervisor, within 6
months of beginning employment in the facility. The training must address ECC concepts and
requirements, including statutory and rule requirements, and the delivery of personal care and
supportive services in an ECC facility.

Limited Mental Health Training

(a) The administrator, managers and staff, who have direct contact with mental health residents in a
licensed limited mental health facility, must receive the following training:
1. A minimum of 6 hours of specialized training in working with individuals with mental health diagnoses.

a. The training must be provided or approved by the Department of Children and Families and must be
taken within 6 months of the facility receiving a limited mental health license or within 6 months of
employment in a limited mental health facility.

b. Training received under this subparagraph may count once for 6 of the 12 hours of continuing
education required for administrators and managers.

2. A minimum of 3 hours of continuing education every 2 years, which may be provided by the ALF
administrator, online, or through distance learning, biennially thereafter in subjects dealing with one or
more of the following topics:

a. Mental health diagnoses; and,

b. Mental health treatment such as:

(I) Mental health needs, services, behaviors and appropriate interventions;

(II) Resident progress in achieving treatment goals;

(III) How to recognize changes in the resident’s status or condition that may affect other services received
or may require intervention; and,

(IV) Crisis services and the Baker Act procedures.

3. For administrators and managers, the continuing education requirement under this subsection will
satisfy 3 of the 12 hours of continuing education.

4. Administrators, managers and direct contact staff affected by the continuing education requirement
under this subsection shall have up to 6 months after the effective date of this rule to meet the training
requirement.

(b) Administrators, managers and staff do not have to repeat the initial training should they change
employers provided they present a copy of their training certificate to the current employer for retention in
the facility’s personnel files. They must also ensure that copies of the continuing education training
certificates, pursuant to subparagraph (a)2. of this subsection, are retained in their personnel files.

Alzheimer’s Disease and Related Disorders (“ADRD”) Training Requirements

Facilities which advertise that they provide special care for persons with ADRD, or who maintain
secured areas, or egress or perimeter control, must ensure that facility staff receive the
following training. The University of South Florida approves curriculums for this training as well
as providers. Therefore, when you receive this training, it has to be from an approved
Alzheimer’s trainer using an approved curriculum. Curriculums are good for up to 3 years.

(a) Facility staff who interact on a daily basis with residents with ADRD but do not provide direct
care to such residents and staff who provide direct care to residents with ADRD, shall obtain 4
hours of initial training within 3 months of employment. Completion of the core training program
between April 20, 1998 and July 1, 2003 shall satisfy this requirement. Facility staff who meet
the requirements for ADRD training providers under paragraph (g) of this subsection, will be
considered as having met this requirement. Initial training, entitled “Alzheimer’s Disease and
Related Disorders Level I Training,” must address the following subject areas:

1. Understanding Alzheimer’s disease and related disorders;

2. Characteristics of Alzheimer’s disease;

3. Communicating with residents with Alzheimer’s disease;

4. Family issues;

5. Resident environment; and,

6. Ethical issues.

(b) Staff who have successfully completed both the initial one hour and continuing three hours
of ADRD training, shall be considered to have met the initial assisted living facility Alzheimer’s
Disease and Related Disorders Level I Training.

(c) Facility staff who provide direct care to residents with ADRD must obtain an additional 4
hours of training, entitled “Alzheimer’s Disease and Related Disorders Level II Training,” within 9
months of employment. Facility staff who meet the requirements for ADRD training providers
under paragraph (g) of this subsection, will be considered as having met this requirement.
Alzheimer’s Disease and Related Disorders Level II Training must address the following subject
areas as they apply to these disorders:

1. Behavior management,

2. Assistance with ADLs,

3. Activities for residents,

4. Stress management for the care giver; and,

5. Medical information.

(d) A detailed description of the subject areas that must be included in an ADRD curriculum
which meets the requirements of paragraphs (a) and (b) of this subsection, can be found in the
document “Training Guidelines for the Special Care of Persons with Alzheimer’s Disease and
Related Disorders,” dated March 1999, incorporated by reference, available from the
Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000.

(e) Direct care staff shall participate in 4 hours of continuing education annually. Continuing
education received under this paragraph may be used to meet 3 of the 12 hours of continuing
education required, or 3 of the 6 hours of continuing education for extended congregate care
required.

(f) Facility staff who have only incidental contact with residents with ADRD must receive general
written information provided by the facility on interacting with such residents, within three (3)
months of employment. “Incidental contact” means all staff who neither provide direct care nor
are in regular contact with such residents.
(g) Persons who seek to provide ADRD training in accordance with this subsection must provide
the department or its designee with documentation that they hold a Bachelor’s degree from an
accredited college or university or hold a license as a registered nurse, and:

1. Have 1 year teaching experience as an educator of caregivers for persons with Alzheimer’s
disease or related disorders, or

2. Three years of practical experience in a program providing care to persons with Alzheimer’s
disease or related disorders, or

3. Completed a specialized training program in the subject matter of this program and have a
minimum of two years of practical experience in a program providing care to persons with
Alzheimer’s disease or related disorders.

(h) With reference to requirements in paragraph (g), a Master’s degree from an accredited
college or university in a subject related to the content of this training program can substitute for
the teaching experience. Years of teaching experience related to the subject matter of this
training program may substitute on a year-by-year basis for the required Bachelor’s degree
referenced in paragraph (g).

Do Not Resuscitate Orders Training

Currently employed facility administrators, managers, direct care staff and staff involved in resident
admissions must receive at least one hour of training in the facility’s policies and procedures regarding Do
Not Resuscitate Orders.

Newly hired facility administrators, managers, direct care staff and staff involved in resident admissions
must receive at least one hour of training in the facility’s policy and procedures regarding DNROs within
30 days after employment.

Training Documentation and Monitoring

(a) Except as otherwise noted, certificates, or copies of certificates, of any training required by
this rule must be documented in the facility’s personnel files. The documentation must include
the following:

1. The title of the training program,

2. The subject matter of the training program,

3. The training program agenda,

4. The number of hours of the training program,

5. The trainee’s name, dates of participation, and location of the training program,

6. The training provider’s name, dated signature and credentials, and professional license number, if
applicable.

(b) Upon successful completion of training pursuant to this rule, the training provider must issue
a certificate to the trainee as specified in this rule.
(c) The facility must provide the Department of Elder Affairs and the Agency for Health Care
Administration with training documentation and training certificates for review, as requested. The
department and agency reserve the right to attend and monitor all facility in-service training, which is
intended to meet regulatory requirements.

Staff Records
59A-36.015 (2) covers staff records management. The facility must maintain required records in a
manner that makes such records readily available at the licensee’s physical address for review by a
legally authorized entity. If records are maintained in an electronic format, facility staff must be readily
available to access the data and produce the requested information. For purposes of this section, “readily
available” means the ability to immediately produce documents, records, or other such data, either in
electronic or paper format, upon request.

Staff Records

(a) Personnel records for each staff member must contain, at a minimum, a copy of the employment
application, with references furnished, and documentation verifying freedom from signs or symptoms of
communicable disease. In addition, records must contain the following, as applicable:

1. Documentation of compliance with all staff training and continuing education required by Rule 59A-
36.011, F.A.C.,

2. Copies of all licenses or certifications for all staff providing services that require licensing or
certification,

3. Documentation of compliance with level 2 background screening for all staff subject to screening
requirements as specified in Section 429.174, F.S., and Rule 59A-36.010, F.A.C.,

4. For facilities with a licensed capacity of 17 or more residents, a copy of the job description given to
each staff member pursuant to Rule 59A-36.010, F.A.C.,

5. Documentation verifying direct care staff and administrator participation in resident elopement drills
pursuant to paragraph 59A-36.007(8)(c), F.A.C.

(b) The facility is not required to maintain personnel records for staff provided by a licensed staffing
agency or staff employed by an entity contracting to provide direct or indirect services to residents and the
facility. However, the facility must maintain a copy of the contract between the facility and the staffing
agency or contractor as described in Rule 59A-36.010, F.A.C.

(c) The facility must maintain the written work schedules and staff time sheets for the most current 6
months as required by Rule 59A-36.010, F.A.C.

Resident and Facility Records

Resident Records
Resident records must be maintained on the premises. For purposes of this section, “readily available”
means the ability to immediately produce documents, records, or other such data, either in electronic or
paper format, upon request. Resident records include:

(a) Resident demographic data as follows:

1. Name,

2. Sex,

3. Race,

4. Date of birth,

5. Place of birth, if known,

6. Social security number,

7. Medicaid and/or Medicare number, or name of other health insurance carrier,

8. Name, address, and telephone number of next of kin, legal representative, or individual designated by
the resident for notification in case of an emergency; and,

9. Name, address, and telephone number of the health care provider and case manager, if applicable.

(b) A copy of the Resident Health Assessment form, AHCA Form 1823 described in Rule 59A-36.006,
F.A.C.

(c) Any orders for medications, nursing services, therapeutic diets, do not resuscitate orders, or other
services to be provided, supervised, or implemented by the facility that require a health care provider’s
order.

(d) Documentation of a resident’s refusal of a therapeutic diet pursuant to Rule 59A-36.012, F.A.C., if
applicable.

(e) The resident care record described in paragraph 59A-36.007(1)(e), F.A.C.

(f) A weight record that is initiated on admission. Information may be taken from AHCA Form 1823 or the
resident’s health assessment. Residents receiving assistance with the activities of daily living must have
their weight recorded semi-annually.

(g) For facilities that will have unlicensed staff assisting the resident with the self-administration of
medication, a copy of the written informed consent described in Rule 59A-36.006, F.A.C., if such consent
is not included in the resident’s contract.

(h) For facilities that manage a pill organizer, assist with self-administration of medications or administer
medications for a resident, copies of the required medication records maintained pursuant to Rule 59A-
36.008, F.A.C.
(i) A copy of the resident’s contract with the facility, including any addendums to the contract as described
in Rule 59A-36.018, F.A.C.

(j) For a facility whose owner, administrator, staff, or representative thereof, serves as an attorney in fact
for a resident, a copy of the monthly written statement of any transaction made on behalf of the resident
as required in Section 429.27, F.S.

(k) For any facility that maintains a separate trust fund to receive funds or other property belonging to or
due a resident, a copy of the quarterly written statement of funds or other property disbursed as required
in Section 429.27, F.S.

(l) If the resident is an OSS recipient, a copy of the Department of Children and Families form
Alternate Care Certification for Optional State Supplementation (OSS), CF-ES 1006, October
2005, which is hereby incorporated by reference and available for review at:
http://www.flrules.org/Gateway/reference.asp?No=Ref-04004. The absence of this form will not
be the basis for administrative action against a facility if the facility can demonstrate that it has
made a good faith effort to obtain the required documentation from the Department of Children
and Families.

(m) Documentation of the appointment of a health care surrogate, health care proxy, guardian,
or the existence of a power of attorney, where applicable.

(n) For hospice patients, the interdisciplinary care plan and other documentation that the
resident is a hospice patient as required in Rule 59A-36.006, F.A.C.

(o) The resident’s Do Not Resuscitate Order, DH Form 1896, if applicable.

(p) For independent living residents who receive meals and occupy beds included within the
licensed capacity of an assisted living facility, but who are not receiving any personal, limited
nursing, or extended congregate care services, record keeping may be limited to the following at
the discretion of the facility:

1. A log listing the names of residents participating in this arrangement,

2. The resident demographic data required in this paragraph,

3. The health assessment described in Rule 59A-36.006, F.A.C.,

4. The resident’s contract described in Rule 59A-36.018, F.A.C.; and,

5. A health care provider’s order for a therapeutic diet if such diet is prescribed and the resident
participates in the meal plan offered by the facility.

(q) Except for resident contracts, which must be retained for 5 years, all resident records must
be retained for 2 years following the departure of a resident from the facility unless it is required
by contract to retain the records for a longer period of time. Upon request, residents must be
provided with a copy of their records upon departure from the facility.
(r) Additional resident records requirements for facilities holding a limited mental health,
extended congregate care, or limited nursing services license are provided in Rules 59A-
36.020, 59A-36.021 and 59A-36.022, F.A.C., respectively.

Record Inspection

(a) The resident’s records must be available to the resident; the resident’s legal representative,
designee, surrogate, guardian, attorney in fact, or case manager; or the resident’s estate, and
such additional parties as authorized in writing or by law.

(b) Pursuant to section 429.35, F.S., agency reports that pertain to any agency survey,
inspection, or monitoring visit must be available to the residents and the public. In facilities that
are co-located with a licensed nursing home, the inspection of records for all common areas is
the nursing home inspection report.

Facility Records

Facility must be maintained on the premises. For purposes of this section, “readily available”
means the ability to immediately produce documents, records, or other such data, either in
electronic or paper format, upon request. Facility records must include:

(a) The facility’s license displayed in a conspicuous and public place within the facility. In
addition to the license, a facility must display the Resident Bill of Rights, the LTC Ombudsman
program information, the telephone number for the abuse hotline, and agency consumer hotline,
and for Disability rights Florida, the activity calendar and a menu at least a week in advance,
and the last inspection report from AHCA; surveys inspections, and actions by the agency
available.

(b) An up-to-date admission and discharge log listing the names of all residents and each
resident’s:

1. Date of admission, the facility or place from which the resident was admitted, and if
applicable, a notation indicating that the resident was admitted with a stage 2 pressure sore;
and,

2. Date of discharge, reason for discharge, and identification of the facility or home address to
which the resident was discharged. Readmission of a resident to the facility after discharge
requires a new entry in the log. Discharge of a resident is not required if the facility is holding a
bed for a resident who is out of the facility but intending to return pursuant to Rule 59A-36.018,
F.A.C. If the resident dies while in the care of the facility, the log must indicate the date of death.

(c) A log listing the names of all temporary emergency placement and respite care residents if
not included on the log described in paragraph (b).
(d) The facility’s emergency management plan, with documentation of review and approval by
the county emergency management agency, as described in Rule 59A-36.019, F.A.C., that
must be readily available by facility staff.

(e) The facility’s liability insurance policy required in Rule 59A-36.013, F.A.C.

(f) For facilities that have a surety bond, a copy of the surety bond currently in effect as required
by Rule 59A-36.013, F.A.C.

(g) The admission package presented to new or prospective residents (less the resident’s
contract) described in Rule 59A-36.006, F.A.C.

(h) If the facility advertises that it provides special care for persons with Alzheimer’s disease or
related disorders, a copy of all such facility advertisements as required by Section 429.177, F.S.

(i) A grievance procedure for receiving and responding to resident complaints and
recommendations as described in Rule 59A-36.007, F.A.C.

(j) All food service records required in Rule 59A-36.012, F.A.C., including menus planned and
served and county health department inspection reports. Facilities that contract for food
services, must include a copy of the contract for food services and the food service contractor’s
license or certificate to operate.

(k) All fire safety inspection reports issued by the local authority or the State Fire Marshal
pursuant to Section 429.41, F.S., and rule Chapter 69A-40, F.A.C., issued within the last 2
years.

(l) All sanitation inspection reports issued by the county health department pursuant to Section
381.031, F.S., and Chapter 64E-12, F.A.C., issued within the last 2 years.

(m) Pursuant to Section 429.35, F.S., all completed survey, inspection and complaint
investigation reports, and notices of sanctions and moratoriums issued by the agency within the
last 5 years.

(n) The facility’s resident elopement response policies and procedures.

(o) The facility’s documented resident elopement response drills.

(p) For facilities licensed as limited mental health, extended congregate care, or limited nursing
services, records required. LNS and ECC must maintain nursing progress notes for each person
who received nursing services from the facility’s staff.

Ch 429.49 provides that any person that fraudulently alters or falsifies a medical record or any
other assisting living record; or causes falsification or altering of the record commit a
misdemeanor of second degree and a conviction under this subsection is also grounds for
restriction, suspension or termination of the license privileges.
Adverse Incidents

Statute 429.23 describes an Adverse Incident as an event over which facility personnel could
exercise control rather than as a result of the resident’s condition and 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. 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.

An adverse incident must be reported online:

● Initial Adverse Report - within 1 business day
● Full Adverse Report - within 15 days; 3 business to the deadline for the submission of the full
report, AHCA must send a reminder to the ALF. Within 3 business days after the agency sends
the reminder, the ALF must either file the full report OR withdraw the preliminary report.
○ The report must be filed electronically but as a best practice it is important to print
and retain a copy in your facility records before electronic submission.
○ AHCA’s website provides instructions on how to submit an Adverse Report
Incident which may be helpful as it walks you through the process.
Internal risk management and quality assurance program
Every facility licensed under this part may, as part of its administrative functions, voluntarily
establish a risk management and quality assurance program, the purpose of which is to assess
resident care practices, facility incident reports, deficiencies cited by the agency, adverse
incident reports, and resident grievances and develop plans of action to correct and respond
quickly to identify quality differences. This may be helpful to gather information on certain events
and contributing factors to certain things you want to avoid altogether. Some of these
occurrences may include:
➔ Falls
➔ Skin Breakdown
➔ Hospitalizations
➔ Adverse Incidents
Resident Rights
We highly recommend that you read the following sections in its entirety.
59A-36.007 (6) F.A.C.
429.28, F.S.
429.29, F.S.
429.296, F.S.
*59A-36.001, F.A.C.
429.02, F.S.
429.34, F.S.
59A-36.009, F.A.C.
415,F.S.

In this section, we’ll talk about Resident Rights. In Florida, resident rights are taken very
seriously. It is important to understand the definition of Resident Representative, found on Ch
429 F.S., is a person other than the owner, or an agent or employee of the facility, designated in
writing by the resident, if legally competent, to receive notice of changes in the contract
executed; to receive notice of and to participate in meetings between the resident and the
facility owner, administrator, or staff concerning the rights of the resident; to assist the resident
in contacting the State Long-Term Care Ombudsman Program or local ombudsman council if
the resident has a complaint against the facility; or to bring legal action on behalf of the resident

A copy of the Resident Bill of Rights, or a summary provided by the Long-Term Care
Ombudsman Program must be posted in full view in a freely accessible resident area, and
included in the admission package provided.

The facility must have a written grievance procedure for receiving and responding to resident
complaints and a written procedure to allow residents to recommend changes to facility policies
and procedures without reprisal. The facility must be able to demonstrate that such procedure is
implemented upon receipt of a complaint.

The telephone number for lodging complaints against a facility or facility staff must be posted in
full view in a common area accessible to all residents. The telephone numbers are: the Long-
Term Care Ombudsman Program, 1(888)831-0404; Disability Rights Florida, 1(800)342-0823;
the Agency Consumer Hotline 1(888)419-3456, and the statewide toll-free telephone number of
the Florida Abuse Hotline, 1(800)96-ABUSE or 1(800)962-2873. The telephone numbers must
be posted in close proximity to a telephone accessible by residents and the text must be a
minimum of 14-point font.

The facility must have a written statement of its house rules and procedures that must be
included in the admission package provided pursuant to Rule 59A-36.006, F.A.C. The rules and
procedures must at a minimum address the facility’s policies regarding:

1. Resident responsibilities;

2. Alcohol and tobacco use;

3. Medication storage;
4. Resident elopement;

5. Reporting resident abuse, neglect, and exploitation;

6. Administrative and housekeeping schedules and requirements;

7. Infection control, sanitation, and standard precautions;

8. The requirements for coordinating the delivery of services to residents by third party
providers;

9. Assistive devices; and

10. Physical restraints.

(e) Residents may not be required to perform any work in the facility without compensation.
Residents may be required to clean their own sleeping areas or apartments if the facility rules or
the facility contract includes such a requirement. If a resident is employed by the facility, the
resident must be compensated in compliance with state and federal wage laws.

(f) The facility must provide residents with convenient access to a telephone to facilitate the
resident’s right to unrestricted and private communication, pursuant to Section 429.28(1)(d),
F.S. The facility must allow unidentified telephone calls to residents. For facilities with a licensed
capacity of 17 or more residents in which residents do not have private telephones, there must
be, at a minimum, a readily accessible telephone on each floor of each building where residents
reside.

429.28 Resident bill of rights.—

(1) No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges
guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United
States as a resident of a facility. Every resident of a facility shall have the right to:
(a) Live in a safe and decent living environment, free from abuse and neglect.
(b) Be treated with consideration and respect and with due recognition of personal dignity,
individuality, and the need for privacy.
(c) Retain and use his or her own clothes and other personal property in his or her immediate
living quarters, so as to maintain individuality and personal dignity, except when the facility can
demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other
residents.
(d) Unrestricted private communication, including receiving and sending unopened
correspondence, access to a telephone, and visiting with any person of his or her choice, at any
time between the hours of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make
provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar
situations.
(e) Freedom to participate in and benefit from community services and activities and to pursue
the highest possible level of independence, autonomy, and interaction within the community.
(f) Manage his or her financial affairs unless the resident or, if applicable, the resident’s
representative, designee, surrogate, guardian, or attorney in fact authorizes the administrator of
the facility to provide safekeeping for funds as provided in s. 429.27.
(g) Share a room with his or her spouse if both are residents of the facility.
(h) Reasonable opportunity for regular exercise several times a week and to be outdoors at
regular and frequent intervals except when prevented by inclement weather.
(i) Exercise civil and religious liberties, including the right to independent personal decisions.
No religious beliefs or practices, nor any attendance at religious services, shall be imposed
upon any resident.
(j) Assistance with obtaining access to adequate and appropriate health care. For purposes of
this paragraph, the term “adequate and appropriate health care” means the management of
medications, assistance in making appointments for health care services, the provision of or
arrangement of transportation to health care appointments, and the performance of health care
services in accordance with s. 429.255 which are consistent with established and recognized
standards within the community.
(k) At least 45 days’ notice of relocation or termination of residency from the facility unless, for
medical reasons, the resident is certified by a physician to require an emergency relocation to a
facility providing a more skilled level of care or the resident engages in a pattern of conduct that
is harmful or offensive to other residents. In the case of a resident who has been adjudicated
mentally incapacitated, the guardian shall be given at least 45 days’ notice of a nonemergency
relocation or residency termination. Reasons for relocation must be set forth in writing and
provided to the resident or the resident's legal representative. The notice must state the resident
may contact the State Long-Term Care Ombudsman Program for assistance with relocation and
must include the statewide toll-free telephone number of the program. In order for a facility to
terminate the residency of an individual without notice as provided herein, the facility shall show
good cause in a court of competent jurisdiction.
(l) Present grievances and recommend changes in policies, procedures, and services to the
staff of the facility, governing officials, or any other person without restraint, interference,
coercion, discrimination, or reprisal. Each facility shall establish a grievance procedure to
facilitate the residents’ exercise of this right. This right includes access to ombudsman
volunteers and advocates and the right to be a member of, to be active in, and to associate with
advocacy or special interest groups.

The administrator of a facility shall ensure that a written notice of the rights, obligations, and
prohibitions set forth in this part is posted in a prominent place in each facility and read or
explained to residents who cannot read. The notice must include the statewide toll-free
telephone number and e-mail address of the State Long-Term Care Ombudsman Program and
the telephone number of the local ombudsman council, the Elder Abuse Hotline operated by the
Department of Children and Families, and, if applicable, Disability Rights Florida, where
complaints may be lodged. The notice must state that a complaint made to the Office of State
Long-Term Care Ombudsman or a local long-term care ombudsman council, the names and
identities of the residents involved in the complaint, and the identity of complainants are kept
confidential pursuant to s. 400.0077 and that retaliatory action cannot be taken against a
resident for presenting grievances or for exercising any other resident right. The facility must
ensure a resident’s access to a telephone to call the State Long-Term Care Ombudsman
Program or local ombudsman council, the Elder Abuse Hotline operated by the Department of
Children and Families, and Disability Rights Florida.
(a) The agency shall conduct a survey to determine general compliance with facility
standards and compliance with residents’ rights as a prerequisite to initial licensure or licensure
renewal. The agency shall adopt rules for uniform standards and criteria that will be used to
determine compliance with facility standards and compliance with residents’ rights.
(b) In order to determine whether the facility is adequately protecting residents’ rights, the
biennial survey shall include private informal conversations with a sample of residents and
consultation with the ombudsman council in the district in which the facility is located to discuss
residents’ experiences within the facility.

The facility shall not hamper or prevent residents from exercising their rights as specified in this
section.
A facility or employee of a facility may not serve notice upon a resident to leave the premises or
take any other retaliatory action against any person who:
(a) Exercises any right set forth in this section.
(b) Appears as a witness in any hearing, inside or outside the facility.
(c) Files a civil action alleging a violation of the provisions of this part or notifies a state
attorney or the Attorney General of a possible violation of such provisions.
A facility that terminates the residency of an individual who participated in activities must show
good cause in a court of competent jurisdiction. If good cause is not shown, the agency shall
impose a fine of $2,500 in addition to any other penalty assessed against the facility.
Any person who submits or reports a complaint concerning a suspected violation of the
provisions of this part or concerning services and conditions in facilities, or who testifies in any
administrative or judicial proceeding arising from such a complaint, shall have immunity from
any civil or criminal liability therefor, unless such person has acted in bad faith or with malicious
purpose or the court finds that there was a complete absence of a justiciable issue of either law
or fact raised by the losing party.

429.29 Civil actions to enforce rights.

Any person or resident whose rights as specified in this part are violated shall have a cause of
action. The action may be brought by the resident or his or her guardian, or by a person or
organization acting on behalf of a resident with the consent of the resident or his or her
guardian, or by the personal representative of the estate of a deceased resident regardless of
the cause of death. If the action alleges a claim for the resident’s rights or for negligence that
caused the death of the resident, the claimant shall be required to elect either survival damages
pursuant to s. 46.021 or wrongful death damages pursuant to s. 768.21. If the action alleges a
claim for the resident’s rights or for negligence that did not cause the death of the resident, the
personal representative of the estate may recover damages for the negligence that caused
injury to the resident. The action may be brought in any court of competent jurisdiction to
enforce such rights and to recover actual damages, and punitive damages for violation of the
rights of a resident or negligence. Any resident who prevails in seeking injunctive relief or a
claim for an administrative remedy is entitled to recover the costs of the action and a reasonable
attorney’s fee assessed against the defendant not to exceed $25,000. Fees shall be awarded
solely for the injunctive or administrative relief and not for any claim or action for damages
whether such claim or action is brought together with a request for an injunction or
administrative relief or as a separate action, except as provided under s. 768.79 or the Florida
Rules of Civil Procedure.

In any claim brought pursuant to this part alleging a violation of resident’s rights or negligence
causing injury to or the death of a resident, the claimant shall have the burden of proving, by a
preponderance of the evidence, that:
 (a) The defendant owed a duty to the resident;
(b) The defendant breached the duty to the resident;
(c) The breach of the duty is a legal cause of loss, injury, death, or damage to the resident;
and
(d) The resident sustained loss, injury, death, or damage as a result of the breach.

In any claim brought pursuant to this section, a licensee, person, or entity shall have a duty to
exercise reasonable care. Reasonable care is that degree of care which a reasonably careful
licensee, person, or entity would use under similar circumstances.

In any claim for resident’s rights violation or negligence by a nurse licensed under part I of
chapter 464, such nurse shall have the duty to exercise care consistent with the prevailing
professional standard of care for a nurse. The prevailing professional standard of care for a
nurse shall be that level of care, skill, and treatment which, in light of all relevant surrounding
circumstances, is recognized as acceptable and appropriate by reasonably prudent similar
nurses.

429.296 Statute of limitations.—

(1) Any action for damages brought under this part shall be commenced within 2 years from
the time the incident giving rise to the action occurred or within 2 years from the time the
incident is discovered, or should have been discovered with the exercise of due diligence;
however, in no event shall the action be commenced later than 4 years from the date of the
incident or occurrence out of which the cause of action accrued.
(2) In those actions covered by this subsection in which it can be shown that fraudulent
concealment or intentional misrepresentation of fact prevented the discovery of the injury, the
period of limitations is extended forward 2 years from the time that the injury is discovered with
the exercise of due diligence, but in no event not more than 6 years from the date the incident
giving rise to the injury occurred.
(3) This section shall apply to causes of action that have accrued prior to the effective date
of this section; however, any such cause of action that would not have been barred under prior
law may be brought within the time allowed by prior law or within 2 years after the effective date
of this section, whichever is earlier, and will be barred thereafter. In actions where it can be
shown that fraudulent concealment or intentional misrepresentation of fact prevented the
discovery of the injury, the period of limitations is extended forward 2 years from the time that
the injury is discovered with the exercise of due diligence, but in no event more than 4 years
from the effective date of this section.

Advance Directives

Everyone has the right to execute advance directives. If we have a resident that has had a guardian
appointment, there is a process that has taken place. When a person has been determined to be
incapacitated is a result of court proceedings. The person has been determined by a court to lack the
capacity to manage at least some of his property or affairs. The person could be found partially
incapacitated; for example, unable to manage finances but still able to make medical decisions; or
they might be determined fully incapacitated. A guardian is appointed, when a person is determined
incapacitated, to help the individual manage the property and/or affairs. Guardian means a person to
whom has been legally adjudged incapacitated. A guardian could be a family member, a stranger, an
institution such as a non-profit corporation like a bank trust. That guardian is appointed by the court to
care for the person’s assets and sometimes to make decisions regarding their health care including
decisions on where they’ll give and personal care the person needs and if they need an assisted living
setting. Guardians have the duty to manage the person's property prudently and in some cases there
might be a requirement for court approval for some transactions.

Guardians in Florida are required to file detailed annual reports and plans with the court; that could
include a plan to the person’s care in addition to a detailed financial report. If a person creates an
advance healthcare directive or a durable power of attorney, or a trust while they’re competent, that
may eliminate the need for a guardian in the event of incapacity.

When somebody appoints a power of attorney they can delegate decisions to that person that are
limited or broad but the person needs to be competent when they appoint the power of attorney. In
Florida, if there person does become incapacity the power of attorney becomes void unless it is
Durable Power of Attorney. A durable power of attorney can eliminate the need for a guardian. A
person appointed with a durable power of attorney has the responsibility to act in the person’s best
interests as well as to manage their finances prudently.

A living will specifies the type of medical care that you would want or not want should you become
unable to articulate or make your own decisions. When you designate a health care surrogate, you’re
naming another person to act as your representative to make medical decisions for you should you be
unable to make them yourself at some point in the future. When you do this you can include specific
instructions about any treatment that you want or do not want similar to a living will and you may
also designate an alternate surrogate. Many people do have both a living will and a health care
surrogate, or a durable power of attorney. These are very common documents that you will see.
Florida has a designation for persons who wish to donate body parts, organs or tissue donations
after their death. You may include that in a living will or on a uniform donor form or you may also
designate that in your driver’s license.

A facility would need copies of all of these documents which can be a challenging process for
you after the residents move in if family takes them out and gets those documents. For
example, some families might be in disagreement and different family members might have
similar legal documents and you do not know what to do; seek legal guidance to solve these
complex situations.

At the time of admission, we must provide residents with a copy of AHCA’s forms, health care
advance directives, resident’s rights to decide, or a substantially similar document which
incorporates information about advance directives in Florida as well as providing a copy of the
Florida Do Not Resuscitate Form.

Long Term Care Ombudsman Program

Long term care Ombudsman program really provides advocacy for residents residing in LTC
facilities, including ALFs, adult family care homes and nursing homes. In Florida the LTC
Ombudsman program is comprised of 17 local councils across the state offering free local
advocacy services. An ombudsman is someone who has been trained and certified as a
volunteer under both federal and state law to identify and investigate and resolve complaints
made by or on behalf of LTC residents. Ombudsman responds and conducts inspections on our
communities; and they can respond to concerns ranging from issues with medication and care,
to matters of dignity and respect, and to how residents in our community are being treated. It is
the Ombudsman’s role to protect the legal rights of the residents and to ensure that they are
receiving proper treatment and quality care in our communities.
The Department of Elder Affairs houses the Ombudsman Program and provides training on
residents rights problem solving, communication, how to negotiate and intervene with our staff
or with us in assisted living. The ombudsman comes to communities to listen to the concerns of
residents and their representatives, and work to resolve their concerns and maybe unmet
needs. When they come to our community they are going to do this to the greatest extent that
they are permitted under the law. Their services are provided at no charge and complaints to
the ombudsman are confidential. Therefore, we must provide access to any portion of the facility
for them to conduct their duties. When they come they are not required to specify a particular
resident to see or a particular portion of the facility. We must provide access to resident’s
records and to residents without interference. We need to grant them access when they verbally
state that they have obtained consent and they are not required to provide written proof of it due
to confidentiality. If for any reason you prohibit the ombudsman from doing their duties, you
may be potentially violating the resident’s right. Training staff is crucial here so that they
understand what the role of the Ombudsman is when they are in your community.

Day in the Life of an Ombudsman

Abuse, Neglect and Exploitation

The legislature has established guidelines to provide for both the detection and the correction of
abuse, neglect and exploitation through criminal investigations and social services by
establishing a program of protective services for older adults and adults with disabilities when
they need them.
As an employee of an ALF we are a mandatory reporter. At any time a person who knows or has
reasonable cause to suspect that a vulnerable adult has been or is being abused, neglected, or
exploited shall immediately report such knowledge or suspicion to the central abuse hotline pursuant
to chapter 415; their statewide telephone number is 1-800-96-ABUSE.
As ALF staff we are included in a group of professionals and individuals who are mandatory reporters.
Therefore, we must report any allegations of abuse, neglect, or exploitation, and any suspicion of it.
This also applies to nursing home staff, adult day care centers, adult family care homes, hospitals and
professional staff.

Penalties
Knowingly and willfully failing to report any allegations or suspicion of abuse, neglect or
exploitation is considered a misdemeanor of a second degree.
There is a penalty for violating the confidentiality of information or a person’s information
contained in the central abuse registry because this information is confidential. Any person who
knowingly and willfully makes public or discloses this confidential information commits a
misdemeanor of a second degree. Any person who makes a false report or who instructs
someone to make a false report to the central abuse hotline commits a felony of third degree.

Facilities must have policies and procedures on reporting abuse, neglect and exploitation, and
policies and procedures on abuse prohibition and prevention. Training staff members is very
important to help them identify signs of potential abuse, neglect and exploitation.

Indicators of Abuse

Physical Abuse. Some of the physical indicators of abuse may include unexplained bruises,
cuts, or other injuries on obvious parts of the body or areas that are covered such as torso or
the back. Any indentation of the skin that reflects something used to inflict some type of
physical damage or abuse. Any kind of unexplained fractures would be a physical indicator of
abuse in some cases; multiple fractures, frequent fractures; unexplained burns, cigarette burns
specially on the palms, the legs, the back or the sole of the feet; immersion burns; burn marks
from a pattern object such an iron; unexplained lacerations to the facial area, eyes, genitalia.

Sexual Abuse. Signs of potential sexual abuse could include difficulty in walking or seating;
torn clothing or undergarments, bloody undergarments; bruises or bleeding in genitalia; venerial
disease; and pregnancy on younger adults.

Other indicators could include severe and constant pain, obvious illnesses that required medical
or dental attention that was not received; any type of unusual lumps, bumps or protrusions
under the skin; hair that is thin or pulled out; bald spots; scars; limited clothing; rashes; poor
hygiene.

Environmental factors. This could include garbage that is thrown around the house or the
yard; overgrown grass; hazardous living conditions, such as lack of repairs, lack of utilities;
human or animal waste around the house; evidence of obvious hazards, such as fire hazards,
piles of newspaper or boxes, blocked exits; animals in the home lacking care; little to no food in
the home; spoiled food; insufficient or inappropriate clothing for the weather.

Other environmental indicators could be that the individual is socially isolated; there is no
evidence of social visits or stimulation; the individual lacks friends or interest; you may also see
attempts by the caregiver to isolate the individual from others.

Financial Indicators. Some indicators include the person is living paycheck to paycheck, not
enough money to get to the next check; unusual activity in bank accounts, such as withdrawal in
geographic areas where the person doesn't have any access to. Maybe the person is providing
a power of attorney and does not comprehend the financial situation; making a will when the
person is incapable of doing that; lack of amenities when they can afford it; missing personal
items that are missing such as jewelry, dishware, or art work.

Behavioral Indicators. You may see recent or sudden changes in the individual’s behavior or
attitudes; or if they lash out physically or verbally or display inappropriate anger or rage; they
threat to self harm or suicide; maybe they’re to be alone or extremely afraid of others; they could
show sign of withdrawal, helplessness or hopelessness; fighting with the caregiver; they deny
the problem because they are afraid.

There are things that contribute to abuse, neglect and exploitation. Unfortunately, it is often a
trusted caregiver or family member who is the abuser or the person who is exploiting the
vulnerable adult. Somethings that contribute to that is substance abuse, financial crisis, family
crisis, family and marital discord, inability to handle stress, recent loss of family member, close
friend or spouse.

Some behavioral indicators could include that the person’s medications or foods are being
withheld; being isolated from others in the household; lack of eye contact; maybe the person is
changing doctors frequently; having accidents and frequent history with similar accidents;
unrealistic expectations of the individual.

Awareness and ongoing training on this topic is necessary to identify abuse, neglect and
exploitation. Overcoming the many barriers allows you to better help the vulnerable adult.
Sometimes the victim refuses to acknowledge the problem; sometimes, they are too
embarrassed to acknowledge the problem or they feel guilty; the victim may be unaware of
other options and they believe that relying on the abuser is the only option; might fear that the
solution to the current situation is more negative than their current situation; they feel they will
be removed from the environment and put into a nursing home, or that they will be asked to
leave the community.

Adult Protective Services Program (Ch. 415, F.S.)

Adult Protective Services is a program of the Florida Department of Children and Families. It is
a system of specialized services and programs that are directed towards assisting and
protecting vulnerable adults who are unable to manage their own affairs, carry out their activities
of daily living, or protect themselves.
Part of an investigation of accusation or allegations in a case of abuse, neglect or exploitation
includes evaluating the individual’s needs for protective services.

The law addresses vulnerable adults. A vulnerable adult in need of services is someone who
has been determined by a protective investigator to be suffering from the ill effects of neglect
not caused by a second party perpetrator and is in need of protective services or other services
to prevent further harm.
Vulnerable Adult means a person 18 years of age or older whose ability to perform the normal
activities of daily living or to provide for his or her own care or protection is impaired due to a
mental, emotional, sensory, long-term physical, or developmental disability or dysfunction, or
brain damage, or the infirmities of aging.

Capacity to consent means that a vulnerable adult has sufficient understanding to make and
communicate responsible decisions regarding the vulnerable adult’s person or property,
including whether or not to accept protective services offered by the department.

Abuse means any willful act or threatened act by a relative, caregiver, or household member
which causes or is likely to cause significant impairment to a vulnerable adult’s physical, mental,
or emotional health. Abuse includes acts and omissions.

Caregiver means a person who has been entrusted with or has assumed the responsibility for
frequent and regular care of or services to a vulnerable adult on a temporary or permanent
basis and who has a commitment, agreement, or understanding with that person or that
person’s guardian that a caregiver role exists. “Caregiver” includes, but is not limited to,
relatives, household members, guardians, neighbors, and employees and volunteers of facilities

Neglect means the failure or omission on the part of the caregiver or vulnerable adult to provide
the care, supervision, and services necessary to maintain the physical and mental health of the
vulnerable adult, including, but not limited to, food, clothing, medicine, shelter, supervision, and
medical services, which a prudent person would consider essential for the well-being of a
vulnerable adult. The term “neglect” also means the failure of a caregiver or vulnerable adult to
make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by
others. “Neglect” is repeated conduct or a single incident of carelessness which produces or
could reasonably be expected to result in serious physical or psychological injury or a
substantial risk of death.

Exploitation means a person who:

 1. Stands in a position of trust and confidence with a vulnerable adult and knowingly, by
deception or intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult’s
funds, assets, or property with the intent to temporarily or permanently deprive a vulnerable
adult of the use, benefit, or possession of the funds, assets, or property for the benefit of
someone other than the vulnerable adult; or
2. Knows or should know that the vulnerable adult lacks the capacity to consent, and obtains
or uses, or endeavors to obtain or use, the vulnerable adult’s funds, assets, or property with the
intent to temporarily or permanently deprive the vulnerable adult of the use, benefit, or
possession of the funds, assets, or property for the benefit of someone other than the
vulnerable adult.
Exploitation may include, but is not limited to:
1. Breaches of fiduciary relationships, such as the misuse of a power of attorney or the
abuse of guardianship duties, resulting in the unauthorized appropriation, sale, or transfer of
property;
2. Unauthorized taking of personal assets;
3. Misappropriation, misuse, or transfer of moneys belonging to a vulnerable adult from a
personal or joint account; or
4. Intentional or negligent failure to effectively use a vulnerable adult’s income and assets for
the necessities required for that person’s support and maintenance.

Sexual abuse means acts of a sexual nature committed in the presence of a vulnerable adult
without that person’s informed consent. “Sexual abuse” includes, fondling, exposure of a
vulnerable adult’s sexual organs, or the use of a vulnerable adult to solicit for or engage in
prostitution or sexual performance. “Sexual abuse” does not include any act intended for a valid
medical purpose or any act that may reasonably be construed to be normal caregiving action or
appropriate display of affection.

Mandatory Reporting

Anyone who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is
being abused, neglected, or exploited shall immediately report such knowledge or suspicion to
the central abuse hotline.
To the extent possible, a report made must contain, but need not be limited to, the following
information:
1. Name, age, race, sex, physical description, and location of each victim alleged to have
been abused, neglected, or exploited.
2. Names, addresses, and telephone numbers of the victim’s family members.
3. Name, address, and telephone number of each alleged perpetrator.
4. Name, address, and telephone number of the caregiver of the victim, if different from the
alleged perpetrator.
5. Name, address, and telephone number of the person reporting the alleged abuse,
neglect, or exploitation.
6. Description of the physical or psychological injuries sustained.
7. Actions taken by the reporter, if any, such as notification of the criminal justice agency.
8. Any other information available to the reporting person which may establish the cause or
indicators of abuse, neglect, or exploitation that occurred or is occurring.

Protective investigations of cases of abuse, neglect, or exploitation of vulnerable adults;

transmittal of records to state attorney.
The department shall, upon receipt of a report alleging abuse, neglect, or exploitation of a
vulnerable adult, begin within 24 hours a protective investigation of the facts alleged therein. If a
caregiver refuses to allow the department to begin a protective investigation or interferes with
the conduct of such an investigation, the appropriate law enforcement agency shall be
contacted for assistance. If, during the course of the investigation, the department has reason to
believe that the abuse, neglect, or exploitation is perpetrated by a second party, the appropriate
law enforcement agency and state attorney shall be orally notified. The department and the law
enforcement agency shall cooperate to allow the criminal investigation to proceed concurrently
with, and not be hindered by, the protective investigation. The department shall make a
preliminary written report to the law enforcement agencies within 5 working days after the oral
report. The department shall, within 24 hours after receipt of the report, notify the appropriate
Florida local advocacy council, or long-term care ombudsman council, when appropriate, that an
alleged abuse, neglect, or exploitation perpetrated by a second party has occurred. Notice to
the Florida local advocacy council or long-term care ombudsman council may be accomplished
orally or in writing and shall include the name and location of the vulnerable adult alleged to
have been abused, neglected, or exploited and the nature of the report.

The protective investigator, while investigating a report of abuse, neglect, or exploitation, must
have access to, inspect, and copy all medical, social, or financial records or documents in the
possession of any person, caregiver, guardian, or facility which are relevant to the allegations
under investigation, unless specifically prohibited by the vulnerable adult who has capacity to
consent.

Provision of protective services with consent; withdrawal of consent; interference.

Protective services with consent. If the department determines through its investigation that a
vulnerable adult demonstrates a need for protective services or protective supervision, the
department shall immediately provide, or arrange for the provision of, protective services or
protective supervision, including in-home services, provided that the vulnerable adult consents.
A vulnerable adult in need of services shall be referred to the community care for disabled
adults program, or to the community care for the elderly program administered by the
Department of Elderly Affairs.
Withdrawal of consent. If the vulnerable adult withdraws consent to the receipt of protective
services or protective supervision, the services may not be provided.
Interference with the provision of protective services. When any person refuses to allow the
provision of protective services to a vulnerable adult who has the capacity to consent to
services, the department shall petition the court for an order enjoining the person from
interfering with the provision of protective services. The petition must allege specific facts
sufficient to show that the vulnerable adult is in need of protective services and that the person
refuses to allow the provision of such services. If the court finds by clear and convincing
evidence that the vulnerable adult is in need of protective services and that the person refuses
to allow the provision of such services, the court may issue an order enjoining the person from
interfering with the provision of protective services to the vulnerable adult.

Facility’s duty to inform residents of their right to report abusive, neglectful, or exploitive
practices. The department shall work cooperatively with the Agency for Health Care
Administration, the Agency for Persons with Disabilities, and the Department of Elderly Affairs to
ensure that every facility that serves vulnerable adults informs residents of their right to report
abusive, neglectful, or exploitive practices. Each facility must establish appropriate policies and
procedures to facilitate such reporting.
Baker Act
Information regarding this section may be found on Ch 394.457 F.S. This part shall be known as
“The Florida Mental Act” or “The Baker Act”.

We have to follow procedures for the transportations, voluntary admission and involuntary
examination of residents. If we fail to follow procedures related to The Baker Act, those are
grounds for action by AHCA against the facility license. There are two steps to this; the first
being to ensure that we have made every effort to avoid having to make a referral for
examination to a receiving facility. If all of our interventions prove to be ineffective; they should
be fully documented with all the steps we took to avoid having to make a referral under the
Baker Act to a receiving facility.; the second should be to determine whether the resident can go
voluntarily or involuntarily. The rule of the Baker Act receiving facility is to provide psychiatric
evaluation and short term physiatric treatment for persons experiencing acute mental health
emergencies.
If a person does not need psychiatric evaluation or psychiatric treatment, then they should not
be sent to a receiving facility.
The no wrong door policy was introduced for people who need help will get it; whether law
enforcement can take someone to the nearest hospital if they are taking someone in under a
Baker act.
If we have someone in the facility we believe need to go to baker act facility for short term
psychiatric treatment or evaluation, we need to consider a couple of things:
● In order to go voluntarily, the individual has to be 18 years of age and have a mental
illness.
● They also need to be confident to provide expressed and informed consent. This means
they need to understand what their decisions are.
● They need to be suitable for treatment

As a licensed facility, if we have a 60 year old resident with the diagnosis of dementia or
someone who has a healthcare surrogate making decisions for them, then they cannot go on a
voluntary basis until they have been assessed to determine whether they are capable of
providing expressed and informed consent, or if they need to go involuntarily.

Entities that are contracted with the Department of Children and Families that may assist with
the assessment or licensed professional who can do the assessment as long as they are not
employed by or under contract with the assisted living facility or the baker act receiving facility
and they do not have a financial interest in the ALF or the receiving facility. This could include a
physician, clinical psychologist, clinical social worker, a psychiatrist nurse, a licensed mental
health counselor, a licensed marriage and family therapist.

A person may be taken involuntarily to the Baker Act receiving facility for evaluation, if they are
believed to have a mental illness and they have refused or are unable to determine that
examination is necessary; and without care or treatment the person is likely to suffer from either
neglect; or they pose a real threat of substantial harm or wellbeing to themselves or others; or
they’re likely to cause bodily harm or injury to others or themselves in the near future.

The professional previously mentioned can initiate a Baker Act; or it could also be initiated by
petitioning a court for an Ex Parte order; or in an emergency, law enforcement can initiate a
baker act.

Transportation
Law enforcement is responsible for transporting the person. They may decline to do this if there
are other arrangements in the county for that kind of transportation; or if the person has an
emergency medical condition and the officer requests assistance from a medical personnel.
When the person is transported to a Baker Act receiving facility they must have either a
professional certificate or a copy of the court’s Ex Parte order or the law enforcement officer’s
report.

Specialty Licenses and Services

We highly recommend that you read the following sections in its entirety.
429.075, F.S.
59A-36.020, F.A.C.
429.07 (3), (C) F.S.
59A-36.022, F.A.C.
429.07 (3) (b), F.S.
59A-36.021, F.A.C.
429.177, F.S.
429.178, F.S.
429.255, F.S.

Limited Mental Health License

An assisted living facility that serves one or more mental health residents must obtain a limited
mental health license prior to admitting any mental health residents.

A Mental Health Resident is someone who receives social security disability income (SSDI) or
supplemental security income (SSI) due to a mental disorder and optional state
supplementation (OSS).

Existing facilities applying for mental health have to make sure all deficiencies found on
previous surveys are corrected before you can receive the license.

A limited mental health facility has additional records that are required and additional staff
training is required. The additional records may include:
● You must have a log of all mental health residents which is typically added to the
admission discharge log. On the admission and discharge log identify the mental health
residents.
● Within 30 days of admission, a facility must obtain documentation that the resident is a
mental health resident and that the resident is receiving social security disability, or
 supplemental security income and optional State supplementation. You may obtain this
different ways:
○ The Alternate Care Certification for Optional State Supplementation (OSS) form.
■ This form will verify that the resident is receiving SSDI or SSI due to a
mental disorder.
○ Obtain written verification from the social security administration that the resident
is receiving SSDI or SSI due to a mental disorder.
○ Another way is to obtain a statement from the resident’s mental health care
provider or case manager.
■ This will state that the resident is an adult with severe and persistent
mental disorder and that the resident is eligible for and has received or is
receiving mental health services within the last 5 years, or that the
resident has been diagnosed as having a severe and persistent mental
disorder.
● Within 30 days, you must obtain an Appropriate Placement Assessment.
○ This has to be provided by the resident’s mental health provider.
○ The assessment must come from a licensed professional; such as a psychiatrist,
a clinical psychologist, clinical social worker, a psychiatrist nurse, or an individual
who is supervised by one of those individuals.
○ Facilities may also use a discharge statement from a state mental hospital
completed within the past 90 days prior to admission.
■ It includes a statement that the individual is appropriate to live in an
assisted living setting.
○ Form 1823 when completed by a mental health care provider would fall under
other signed statements as long as it certifies that the resident is appropriate to
live in assisted living.
○ This assessment is only required when admitting new mental health residents
unless you discharge them and they come back to the facility.
● Limited mental health facilities must have a Community Living Support Plan. This is a
service plan completed between the community, the resident and the mental health
provider. It is intended to ensure coordination of care so that the resident can remain
living successfully in the community.
○ Must be completed within 30 days of admission, or
○ Within 30 days of receiving the Appropriate Placement Assessment; whichever is
later.
○ Needs to address resident’s needs in order to enable the resident to live in the
community.
○ It must identify the mental health services to be provided by the mental health
care provider to help meet the resident’s needs.
■ This must specify the frequency and duration of services
○ It must include the obligations of the ALF to facilitate and assist the resident with
certain things.
■ Assist the resident arrange or provide transportation to the appointments
for those services in the community living support plan.
■ Include a description of other services that aLF will provide.
○ It must identify a list of things that are specific for that resident’s care, safety and
welfare, including a description of any signs and symptoms specific to that
resident, that may indicate that there is an immediate need for professional
mental health services
○ Must be signed by the mental health resident, resident’s mental health case
manager and the ALF administrator or manager.
 ■ If the resident refuses to sign the plan, the resident’s mental health case
manager must add a note stating that the resident was asked to sign but
refused to do so.
■ Retain copies in the resident’s record.
The community living support plan must be updated annually and whenever there is a
significant change in the resident’s behavioral health.

● You must also have a Cooperative Agreement for each mental health resident within 30
days of admission.
○ This agreement is a signed statement developed between the mental health care
provider and ALF administrator or designee.
○ It states the procedures and directions for accessing emergency and after hour
care for the resident.
○ The mental health provider must furnish both the resident and ALF with a 24 hour
telephone number for an emergency crisis.

Facilities may have one cooperative agreement for multiple residents as long as they are with
the same mental health provider.
In some cases it may be difficult to get all this information from the mental health provider. You
must document in writing all requests within 72 hours of the resident's admission. If you do this
and do not get the information within the time frame, it is considered a good faith effort to obtain
the required information and the lack of documentation shall not be the basis for an
administrative action against the facility. The documented request must include the name, title,
and phone number of the person to whom the request was made and must be kept in the
resident’s file.

Additional requirements apply for LMH license facilities, you are required to assist the resident
in carrying out the activities identified on the community living support plan. You must also
provide a private face to face between the mental health resident and the mental health case
manager or other mental health care providers to meet. You must also observe the resident’s
behavior and functioning while in the facility, and record and communicate observations to the
resident’s mental health case manager or mental health care provider regarding any significant
behavioral or situational changes that may signify a need for a change in the mental health
services or support by the mental health providers. You must also notify them if the resident is
no longer appropriate in the ALF. Document the circumstances leading up to the initiation of an
involuntary mental health examination; if we initiate an involuntary Baker Act, we have to
document what led up to that situation, along with any interventions that took place to avoid
having to have an involuntary mental health examination.

Elyn Saks TED Talk

A tale of mental illness | Elyn Saks - Bing video

Limited Nursing Services

As a limited nursing service facility, you are able to provide additional nursing services beyond
what you can provide in a standard license facility. In order to provide nursing services, you
must obtain a limite nursing license prior to providing the services.

In a limited nursing facility, nurses are able to perform any nursing service under the scope of
their nursing license; LPN, RN, etc, as long as the resident continues to meet the residency
criteria. However, remember that nurses may not be allowed to provide some services at an
ALF even with the limited nursing license because that would mean that the resident has a
condition that requires a service that they are not allowed to have under residency criteria.

With a limited nursing services license we may not provide 24 hours nursing supervision to
residents but we may provide a 24 hour nursing care to residents who are enrolled in hospice.

A limited nursing license facility must employ sufficient and qualified staff to meet resident’s
needs requiring limited nursing services. This would be based on the number of residents you
have and the type of services you offer. Nursing services provided should be listed on policies
and procedures under a limited nursing license. You have to ensure that these services are
conducted and supervised in accordance with Ch 464 F.S.

A new requirement was added in 2018 that requires our employed or contracted nurse to
coordinate with third party nursing services providers. To coordinate with them to ensure that
resident care is provided in a safe and consistent manner.

Additional documentation is required under a limited nursing license:

All services must be provided in accordance with the provider’s order, which must be kept on
the resident’s file.

Nurses progress notes are required for each resident that receives limited nursing services.

We must complete a monthly nursing assessment for each resident receiving limited nursing
services.

We must also keep a log of all residents who are receiving limited nursing services and the type
of services provided.

Additional information can be found on 59A-36022 regarding limited nursing services.

Extended Congregate Care (ECC)

Extended Congregate Care was developed out of a recognition that some ALF regulations
made it difficult for older Floridians to age in place because the rules and laws placed limits on
the services ALFs are allowed to provide, the type of residents we are allowed to admit and
retain.

ECC allows facilities to provide care beyond what we are allowed to provide in a standard
facility. All services must be provided in the least restrictive environment, and in a manner that
respects the resident’s independence, privacy, and dignity.

The regulations also expand the ALF residency criteria and services in order to permit our ECC
facilities to accommodate these policies. The four specific values that provide guidance and are
the underlying principles for ECC in Florida are: Independence, Dignity, Choice and Decision-
Making. Therefore, policies and procedures for ECC facilities must be developed with these
values in mind and they support those values through service delivery, program or services.

The purpose of the ECC licensure category is to allow residents to remain living in a familiar
environment, for which otherwise be disqualified, and to remain living in that familiar
environment as they become more impaired. ECC facilities are allowed to admit persons that
exceed the residency criteria for assisted living.

Policies and procedures established through extended congregate care services must promote
resident independence, dignity, choice, and decision-making. The facility must develop and
implement specific written policies and procedures that address:

● Aging in place. It is defined as the process of providing increased or adjusted services to

a person to compensate for either physical or mental decline that may occur with the age
in process. To maximize the person’s dignity and independence and to permit to remain
living in a familiar, non-institutionalized, residencial environment for as long as possible.
● The facility’s residency criteria developed in accordance with the admission and
discharge requirements
● The personal and supportive services the facility intends to provide, how the services will
be provided, and the identification of staff positions to provide the services including their
relationship to the facility; the services provided to help residents aging in place, may be
provided by our facility staff, but also by volunteers, family members, friends, or
contracted agreement by a third party.
● The nursing services the facility intends to provide, identification of staff positions to
provide nursing services, and the license status, duties, general working hours, and
supervision of such staff;
● Identifying potential unscheduled resident service needs and mechanisms for meeting
those needs including the identification of resources to meet those needs;
● A process for mediating conflicts among residents regarding choice of room or
apartment and roommate; and, it must also address how residents can remain living in
the same room unless ECC licensed rooms are in another part of the community.
● How to involve residents in decisions concerning the resident. The services must provide
opportunities and encouragement for the resident to make personal choices and
decisions. If a resident needs assistance to make choices or decisions, a family member
or other resident representative must be consulted. Choices must include at a minimum
whether:
○ 1. To participate in the process of developing, implementing, reviewing, and
revising the resident’s service plan,
○ 2. To remain in the same room in the facility, except that a current resident
transferring into an extended congregate care services may be required to move
to the part of the facility licensed for extended congregate care, if only part of the
facility is so licensed,
○ 3. To select among social and leisure activities,
○ 4. To participate in activities in the community. At a minimum the facility must
arrange transportation to such activities if requested by the resident; and,
○ 5. To provide input with respect to the adoption and amendment of facility
policies and procedures.

ECC Residency Criteria

ECC facilities are exempt from the residency criteria for standard license facilities. ECC facilities
must adapt residency criteria within the scope of the laws and the rules. ECC residency criteria
requirements are found on 429.26,F.S and 59A-36.021(4), F.A.C.
An individual must meet the following minimum criteria in order to receive extended congregate
care services:
1. Be at least 18 years of age;
2. Be free from signs and symptoms of a communicable disease that is likely to be transmitted
to other residents or staff; however, an individual who has human immunodeficiency virus (HIV)
infection may be admitted to a facility, provided that he or she would otherwise be eligible for
admission according to this rule;
3. Be able to transfer, with assistance if necessary. The assistance of more than one individual
is permitted;
4. Not be a danger to self or others as determined by a health care practitioner or mental health
practitioner licensed under chapter 490 or 491, F.S.;
5. Not be bedridden, unless the resident is receiving licensed hospice services pursuant to
Section 429.26(1)(c), F.S.;
6. Not have any stage 3 or 4 pressure sores;
7. Not require any of the following nursing services:
a. Artificial airway management of any kind except that of continuous positive airway pressure
may be provided through the use of a CPAP or bipap machine,
b. Nasogastric tube feeding,
c. Monitoring of blood gases,
d. Management of post-surgical drainage tubes or wound vacuums,
e. Skilled rehabilitative services as described in Rule 59G-4.290, F.A.C., or
f. Treatment of a surgical incision, unless the surgical incision and the condition that caused it
have been stabilized and a plan of care developed. The plan of care must be maintained in the
resident’s record at the facility.
8. Not require 24-hour nursing supervision, unless the resident is receiving licensed hospice
services pursuant to Section 429.26(1)(c), F.S.; and,
9. Have been determined to be appropriate for admission to the facility by the facility
administrator or manager. The administrator or manager must base his or her decision on:
a. An assessment of the strengths, needs, and preferences of the individual, the health
assessment required by subsection (6) of this rule, and the preliminary service plan developed
in subsection (7),
b. The facility’s residency criteria, and services offered or arranged for by the facility to meet
resident needs; and,
c. The ability of the facility to meet the uniform fire safety standards for assisted living facilities
established in Rule Chapter 69A-40, F.A.C.
10. Notwithstanding any other provision of this rule, as individual enrolled and receiving licensed
hospice services pursuant to Section 429.26(1)(c), F.S. may be admitted and receive extended
congregate care services.

(b) Criteria for continued residency in an extended congregate care services must be the same
as the criteria for admission, except as specified below.
1. A resident may be bedridden for up to 14 consecutive days.
2. A terminally ill resident who no longer meets the criteria for continued residency may continue
to reside in the facility if the following conditions are met:
a. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice
that coordinates and ensures the provision of any additional care and services that may be
needed,
b. Continued residency is agreeable to the resident and the facility,
c. An interdisciplinary care plan, which specifies the services being provided by hospice and
those being provided by the facility, is developed and implemented by a licensed hospice in
consultation with the facility; and,
d. Documentation of the requirements of subparagraph (5)(b)2., is maintained in the resident’s
file.
3. The extended congregate care administrator or manager is responsible for monitoring the
appropriateness of continued residency of a resident in extended congregate care services at all
times.
4. A hospice resident that meets the qualifications of continued residency pursuant to this rule
may only receive services from the assisted living facility’s staff within the scope of the facility’s
license.
5. Staff may provide any nursing service permitted under the facility’s license and total help with
the activities of daily living for residents admitted to hospice. Staff may not exceed the scope of
their professional licensure or training in any licensed assisted living facility.

Extended Congregate Care Services

All services must be provided in the least restrictive environment, and in a manner that respects
the resident’s independence, privacy, and dignity.

(a) A facility providing extended congregate care services may provide supportive services
including social service needs, counseling, emotional support, networking, assistance with
securing social and leisure services, shopping service, escort service, companionship, family
support, information and referral, assistance in developing and implementing self-directed
activities, and volunteer services. Family or friends must be encouraged to provide supportive
services for residents. The facility must provide training for family or friends to enable them to
provide supportive services in accordance with the resident’s service plan.
(b) A facility providing extended congregate care services must make available the following
additional services if required by the resident’s service plan:
1. Total help with bathing, dressing, grooming and toileting,
2. Nursing assessments conducted more frequently than monthly,
3. Measurement and recording of basic vital functions and weight,
4. Dietary management including provision of special diets, monitoring nutrition, and observing
the resident’s food and fluid intake and output,
5. Assistance with self-administered medications, or the administration of medications and
treatments pursuant to a health care practitioner’s order. If the individual needs assistance with
self-administration the facility must inform the resident of the qualifications of staff who will be
providing this assistance, and if unlicensed persons will be providing such assistance, obtain the
resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s informed written consent to
provide such assistance as required in Section 429.256, F.S.,
6. Supervision of residents with dementia and cognitive impairments,
7. Health education and counseling and the implementation of health-promoting programs and
preventive regimes,
8. Provision or arrangement for rehabilitative services; and,
9. Provision of escort services to health-related appointments.
(c) Nursing staff providing extended congregate care services may provide any nursing service
permitted within the scope of their license consistent with the residency requirements of this rule
and the facility’s written policies and procedures, provided the nursing services are:
1. Authorized by a health care practitioner’s order and pursuant to a plan of care,
2. Medically necessary and appropriate for treatment of the resident’s condition,
3. In accordance with the prevailing standard of practice in the nursing community,
4. A service that can be safely, effectively, and efficiently provided in the facility,
5. Recorded in nursing progress notes; and,
6. In accordance with the resident’s service plan.
(d) At least monthly, or more frequently if required by the resident’s service plan, a nursing
assessment of the resident must be conducted.

Shared Responsibility Is defined in ch 429 F.S. and it means that we are exploring options
available to a resident within a facility as well as the risks involved with each action when
making decisions pertaining to the resident’s abilities, preferences, service needs. We are trying
to enable the resident and the resident’s representative to develop a service plan with the facility
to meet their needs and to improve their quality of life. Therefore, we are sharing the
responsibility and risk with the resident; it is mutual agreement about the levels of responsibility
that both the resident and ALF have with regard to the decisions made by the residents. It
enables residents to exercise greater control over their own lives.

Manage Risk is defined on Ch 429, F.S. as a process where facility staff discuss the service
plan and needs of the resident and the resident’s representative, and we explore the
consequences of their decisions including the risk and review, that takes into account the
residents ability as well as the ALF ability to respond.

When there is a managed risk process, it is advocating a formal process of negotiating a service
which addresses the resident’s decision while decreasing the probability or poor outcome and
adverse consequences.

Records
In addition to the records required in Rule 59A-36.015, F.A.C., a facility providing extended
congregate care services must maintain the following:
(a) The service plans for each resident receiving extended congregate care services; must be
completed within 14 days of admission
(b) The nursing progress notes for each resident receiving nursing services from the facility’s
staff;
(c) Nursing assessments; a written review of information collected from observation and
interaction with the resident, resident’s record or other relevant sources, analyzing the
information and making recommendations for modifications for the resident’s care , and,
(d) The facility’s extended congregate care policies and procedures.
(e) We must obtain a medical examination report prior to admission to our ECC program or prior
to admitting an ECC resident to our ALF. This must be completed annually for all residents
receiving ECC services and whenever there is significant change.

(9) DISCHARGE. If the facility and the resident are unable to agree on a service plan, the facility
is unable to meet the resident’s needs as identified in the service plan, or the resident no longer
meets the criteria for continued residency, the resident must be discharged or relocated in
accordance with Sections 429.26 and 429.28, F.S.
(10) This rule is in effect for five years from its effective date.

Staffing Requirements

The following staffing requirements apply for extended congregate care services:

(a) Supervision by an administrator who has a minimum of two years of managerial, nursing,
social work, therapeutic recreation, or counseling experience in a residential, long-term care, or
acute care setting or agency serving elderly or disabled persons. If an administrator appoints a
manager as the supervisor of an extended congregate care facility, both the administrator and
manager must satisfy the requirements of subsection 59A-36.010(1), F.A.C.

1. A bachelor’s degree may be substituted for one year of the required experience.

2. A nursing home administrator licensed under Chapter 468, F.S., is qualified under this
paragraph.

(b) Provide staff or contract the services of a nurse who must be available to provide nursing
services, participate in the development of resident service plans, and perform monthly nursing
assessments for extended congregate care residents.

(c) Provide enough qualified staff to meet the needs of extended congregate care residents in
accordance with Rule 59A-36.010, F.A.C., and to provide the services established in each
resident’s service plan.

(d) Ensure that adequate staff is awake during all hours to meet the scheduled and unscheduled
needs of residents.

(e) Immediately provide additional or appropriately qualified staff, when the agency determines
that service plans are not being followed or that residents’ needs are not being met because
insufficient staffing, in accordance with the staffing standards established in Rule 59A-36.010,
F.A.C.

(f) Ensure and document that staff receive extended congregate care training as required

Alzheimer’s Disease Requirements

Patients with Alzheimer’s disease or other related disorders; certain disclosures. 429.177
A facility licensed under this part which claims that it provides special care for persons who have
Alzheimer’s disease or other related disorders must disclose in its advertisements or in a
separate document those services that distinguish the care as being especially applicable to, or
suitable for, such persons. The facility must give a copy of all such advertisements or a copy of
the document to each person who requests information about programs and services for
persons with Alzheimer’s disease or other related disorders offered by the facility and must
maintain a copy of all such advertisements and documents in its records. The agency shall
examine all such advertisements and documents in the facility’s records for 2 years as part of
the license renewal procedure.

Special care for persons with Alzheimer’s disease or other related disorders. 429.178 F.S.
(1) A facility which advertises that it provides special care for persons with Alzheimer’s disease
or other related disorders must meet the following standards of operation:
(a)1. If the facility has 17 or more residents, have an awake staff member on duty at all hours
of the day and night; or
2. If the facility has fewer than 17 residents, have an awake staff member on duty at all hours
of the day and night or have mechanisms in place to monitor and ensure the safety of the
facility’s residents.
(b) Offer activities specifically designed for persons who are cognitively impaired.
(c) Have a physical environment that provides for the safety and welfare of the facility’s
residents.
(d) Employ staff who have completed the training and continuing education required in
subsection (2).
(2)(a) An individual who is employed by a facility that provides special care for residents who
have Alzheimer’s disease or other related disorders, and who has regular contact with such
residents, must complete up to 4 hours of initial dementia-specific training developed or
approved by the department. The training must be completed within 3 months after beginning
employment and satisfy the core training requirements.
(b) A direct caregiver who is employed by a facility that provides special care for residents who
have Alzheimer’s disease or other related disorders and provides direct care to such residents
must complete the required initial training and 4 additional hours of training developed or
approved by the department. The training must be completed within 9 months after beginning
employment and satisfy the core training requirements.
(c) An individual who is employed by a facility that provides special care for residents with
Alzheimer’s disease or other related disorders, but who only has incidental contact with such
residents, must be given, at a minimum, general information on interacting with individuals with
Alzheimer’s disease or other related disorders, within 3 months after beginning employment.
(3) In addition to the training required under subsection (2), a direct caregiver must participate
in a minimum of 4 contact hours of continuing education each calendar year. The continuing
education must include one or more topics included in the dementia-specific training developed
or approved by the department, in which the caregiver has not received previous training.
(4) Upon completing any training listed in subsection (2), the employee or direct caregiver
shall be issued a certificate that includes the name of the training provider, the topic covered,
and the date and signature of the training provider. The certificate is evidence of completion of
training in the identified topic, and the employee or direct caregiver is not required to repeat
training in that topic if the employee or direct caregiver changes employment to a different
facility. The employee or direct caregiver must comply with other applicable continuing
education requirements.
(5) The department, or its designee, shall approve the initial and continuing education courses
and providers.
(6) The department shall keep a current list of providers who are approved to provide initial
and continuing education for staff of facilities that provide special care for persons with
Alzheimer’s disease or other related disorders.
(7) Any facility more than 90 percent of whose residents receive monthly optional
supplementation payments is not required to pay for the training and education programs
required under this section. A facility that has one or more such residents shall pay a reduced
fee that is proportional to the percentage of such residents in the facility. A facility that does not
have any residents who receive monthly optional supplementation payments must pay a
reasonable fee, as established by the department, for such training and education programs.
(8) The department shall adopt rules to establish standards for trainers and training and to
implement this section.

What Is Alzheimer's Disease?

Understanding Lewy Body Dementia

License Facilities for 17 or more Residents

● Awake staff on duty at all times (alert & awake at night)

○ If advertise special care for persons with Alzheimer’s disease and have 16 or
less residents:
■ Awake staff member on duty at all hours of the day and night or have a
mechanism in place to monitor and ensure the safety of the facility's
residents.
● Automated External Defibrillator required
● Written job descriptions
● Standardized recipes
● Accessible telephone on each floor for resident use.

Emergency Management
We highly recommend that you read the following sections in its entirety.
408.821, F.S.
59A-36.019, F.A.C.
59A-36.025, F.A.C.
429.41 (1) (b), F.S.
429.435, F.S.

Comprehensive Emergency Management Plans (CEMP)

Newly licensed assisted living facilities must submit a comprehensive emergency plan to the
county emergency management agency within 30 days of becoming licensed.
A plan must also be submitted within 30 days of a change of ownership.
The emergency management agency is supposed to review and approve within 60 days of
receiving the plan.
If revisions to the plan are required by the emergency management agency, the ALF must
submit these within 30 days of received notification from the county.

Annual Review
● The facility must review its emergency management plan on an annual basis and submit
any substantive changes to the local agency for review and approval.
○ Changes in the name, address, telephone number, or position of staff listed in
the plan are not considered substantive revisions.
○ Changes in the identification of specific staff must be submitted to the local
emergency management agency annually as a signed and dated addendum that
is not subject to review and approval.
 ● The local emergency management agency is the final administrative authority for
emergency management plans prepared by assisted living facilities.

Notification to AHCA
ALFs must notify AHCA
● Within 30 days of submission of a plan to the county emergency management agency
● Within 30 days after approval of a plan
● Changes to the law in 2020 state that we must also submit the plan within 30 days after
any significant modification to a previous plan - as defined by agency rule.

The regulation incorporates criteria for emergency planning and it is entitled “Emergency
Management Criteria for Assisted Living Facilities” dated October 1995.

Contact your county emergency management agency and request a copy of their assisting
living crosswalk. This crosswalk will tell what to address on your CEMP and you will indicate
where in your plan you have addressed the criteria. The more specific you are, may facilitate the
approval of your plan.

Plan Implementation
All staff must be trained in their duties and are responsible for implementing the emergency
management plan.
If telephone service is not available during an emergency, the facility must request assistance
from a local law enforcement or emergency management personnel in maintaining
communication.

Evacuation
The facility must evacuate the premises during or after an emergency management agency.

You must report the evacuation to the local emergency management agency to AHCA within 6
hours of the evacuation order. If the evacuation takes more than 6 hours, the facility must report
when the evacuation is completed.

The facility must not be re-occupied until the area is cleared for reentry by the local emergency
management agency or its designee and the facility can meet the immediate needs of the
residents.
A facility with significant structural damage must relocate residents until the facility can be safely
re-occupied.
The facility is responsible for knowing the location of all residents until the residents have been
relocated to another facility.
The facility must provide the agency with the name of a contact person who must be available
by telephone 24 hours a day, seven days a week, until the facility is re-occupied.

Emergency Shelter
May provide emergency shelter above the facility’s licensed capacity provided the following
conditions are met:
● Life safety will not be jeopardized for any individual.
● The immediate needs of residents and other individuals sheltered at the facility can be
met by the facility.
● Must report the number of individuals over license capacity to the Agency Field Office
within 48 hours or as soon as able
● If you cannot reach the local office, call the Agency Central Office (Tallahassee).
● Must maintain a log of the additional individuals being housed in the facility.

A Facility may temporarily exceed license capacity to act as a receiving provider in accordance
with an approved emergency operations plan for up to 15 days. AHCA may approve requests
for overcapacity in excess of 15 days.

AHCA’s Emergency Status System

● AHCA requires all assisted living facilities to use its emergency status system to report
during emergency situations.
● A user account is necessary for entry into ESS.
● You must register using an invitation emailed to you otherwise you will not have access
to it. If you are a new administrator, this is something to do right away; to get the log in
and any information you need if you are required to start inputting into ESS.

CEMP

Plan Introduction
The Crosswalk from 1995 is 8 pages long but each county may have their own version. The
Comprehensive Emergency Management Plan must include information about the facility, such
as name, address, telephone numbers, home phone numbers, and cell phone numbers for
emergency contacts; administrator and/or alternate, and whoever is in charge of implementing
the plan.
Facility information includes facility address, facility license number, type of construction, date it
was built, and subsequent changes made to the construction. If someone other than the
administrator developed the plan, you’ll need to include that information for that person; you
have to include an organizational chart with phone numbers for all key management positions;
key staff members responsible for implementing the plan.

You have to provide an introduction to the plan, which describes its purpose, the time of
implementation and the desired outcome that would be achieved by developing the plan. The
purpose of the plan in part is to protect life safety for all residents and staff members.

Authorities and References

In the authorities and references section, we must identify the legal basis for the plan
development and to include reference materials; to include a hierarchy of authority during
emergencies. Legal basis for the plan would be laws and rules that require us to implement the
plan; and reference materials could include any number materials depending on the facility size;
the county emergency management website may have brochures that you may include in your
plan, evacuation information including flood zone.

Hazard Analysis
Identifying the hazards that the facility is vulnerable to. They want you to identify hurricanes,
tropical storms, tornadoes, flood zone information, other flooding hazards, fires, hazardous
materials, incidents.You must also state in the plan how close you are to railways, main
highways, airports and ports, nuclear power plants within 50 miles and within 10 miles. Past
history on lessons learned from previous emergencies. You’ll need to submit information and
how it impacted or changed your plan;

You must submit how many beds the facility is licensed for, how many residents we have, and
the average number of residents. Also, how many of those residents have Alzheimer’s disease,
how many use special equipment, or require special care, such as dialysis or oxygen, and how
many residents are self-sufficient.
You have to identify what evacuation zone you are located in, and what flood zone you are
located in. You have to use the flood insurance rate map for that identification.

Concept of Operations
In this section, you define policies and procedures and responsibilities, and all actions that you
and staff members will take when preparing for an emergency if there is time to prepare, during
and following an emergency.
You have to address direction and control, notification, evacuation, re-entry, and sheltering.
You must specify by name and title who is in charge during an emergency and alternate.
Identify your chain of command that will ensure that you are providing continuous leadership;
identify what the key positions are;
You have to state the procedures for a timely activation and staffing of the facility in emergency
functions. How you will notify family members; what items residents are allowed to bring with
them;
You have to state how you will ensure enough supplies are available and how much you need.
Food and water, your county may have specific requirements here so be sure to check what
those requirements are.
Identify sleeping arrangements, where you will shelter staff and include a facility floor plan and
indicate those areas where you will shelter them.
Address emergency power which should be based on the required emergency environmental
control plan.
Transportation could be covered under evacuation.
Notifications. How are you going to be notified of any warning; how you will monitor local alerts
and information; include a 24 hour contact number; how you will alert key staff and what are the
requirements for them reporting to your community for work; how you will alert residents and let
them know what measures are being taken and what they need to do as well;
Identify alternate means of communication if the phone system goes down.
Identify what the procedures are for notifying your support facility that have agreed to provide
shelter if you need to evacuate. How you will notify residents, staff and family members that you
need to evacuate.
Describe very specific procedures for evacuation, what the responsibilities are. Checklists are
helpful here for residents.
Who are the vendors that will provide support prior, during and after an emergency evacuation.
This includes transportation providers, fuel suppliers, food and water suppliers.
When describing an evacuation plan, you must include a primary and secondary evacuation
route to your support receiving facilities.
Identify specific procedures on how staff will accompany residents; using checklist, double
checking everybody is out of the facility; double checking that everybody is in the vehicle before
the vehicle leaves; checking with arriving to the receiving facility that everybody gets off the
vehicle; log system while away from the facility to keep track of residents.
Describe procedures to re-enter the facility; who is the person responsible to authorize re-entry
after clearance from local authorities; procedures to inspect the facility before re-entry; how you
will account for residents leaving the support facility and transferring them back to your facility.

Training and Exercises

You must also specify the training and exercises that you will provide and do with staff
members. These are key terms to use. Who is going to train staff during a non-emergency
times, training schedule, who will provide the training, who will train new employees, how you
exercise your disaster plan; what kind of drills you have to practice emergency responses;
procedures you have to correct deficiencies you notice during drills.

Annexes
Key disaster roles
Agreements
Evacuation maps
Support material
Copy of Fire Safety Plan and approval letter.
SOPS - Standard Operating Procedures

Emergency Environmental Control Plans Ch 59A-36.025, F.A.C.

Each assisted living facility shall prepare a detailed plan to serve as a supplement to its
Comprehensive Emergency Management Plan, to address emergency environmental control in
the event of the loss of primary electrical power in that assisted living facility which includes the
following information:

(a) The acquisition of a sufficient alternate power source such as a generator(s), maintained at
the assisted living facility, to ensure that current licensees of assisted living facilities will be
equipped to ensure ambient air temperatures will be maintained at or below 81 degrees
Fahrenheit for a minimum of ninety-six (96) hours in the event of the loss of primary electrical
power.

1. The required temperature must be maintained in an area or areas, determined by the

assisted living facility, of sufficient size to maintain residents safely at all times and that is
appropriate for resident care needs and life safety requirements. For planning purposes, no less
than twenty (20) net square feet per resident must be provided. The assisted living facility may
use eighty percent (80%) of its licensed bed capacity as the number of residents to be used in
the calculation to determine the required square footage. This may include areas that are less
than the entire assisted living facility if the assisted living facility’s comprehensive emergency
management plan includes allowing a resident to congregate when he or she desires in portions
of the building where temperatures will be maintained and includes procedures for monitoring
residents for signs of heat related injury as required by this rule. This rule does not prohibit a
facility from acting as a receiving provider for evacuees when the conditions are met. The plan
shall include information regarding the area(s) within the assisted living facility where the
required temperature will be maintained.

2. The alternate power source and fuel supply shall be located in an area(s) in accordance with
local zoning and the Florida Building Code.

3. Each assisted living facility is unique in size; the types of care provided; the physical and
mental capabilities and needs of residents; the type, frequency, and amount of services and
care offered; and staffing characteristics. Accordingly, this rule does not limit the types of
systems or equipment that may be used to achieve ambient temperatures at or below 81
degrees Fahrenheit for a minimum of ninety-six (96) hours in the event of the loss of primary
electrical power. The plan shall include information regarding the systems and equipment that
will be used by the assisted living facility and the fuel required to operate the systems and
equipment.

a. An assisted living facility in an evacuation zone pursuant to Chapter 252, F, S. must maintain
an alternative power source and fuel as required by this subsection at all times when the
assisted living facility is occupied but is permitted to utilize a mobile generator(s) to enable
portability if evacuation is necessary.

b. Assisted living facilities located on a single campus with other facilities under common
ownership, may share fuel, alternative power resources, and resident space available on the
campus if such resources are sufficient to support the requirements of each facility’s residents,
as specified in this rule. Details regarding how resources will be shared and any necessary
movement of residents must be clearly described in the emergency power plan.

c. A multistory facility, whose comprehensive emergency management plan is to move residents

to a higher floor during a flood or surge event, must place its alternative power source and all
necessary additional equipment so it can safely operate in a location protected from flooding or
storm surge damage.
(b) The acquisition of sufficient fuel, and safe maintenance of that fuel at the facility, to ensure
that in the event of the loss of primary electrical power there is sufficient fuel available for the
alternate power source to maintain ambient temperatures at or below 81 degrees Fahrenheit for
a minimum of ninety-six (96) hours after the loss of primary electrical power during a declared
state of emergency. The plan must include information regarding fuel source and fuel storage.

1. Facilities must store minimum amounts of fuel onsite as follows:

a. A facility with a licensed capacity of 16 beds or less must store 48 hours of fuel onsite.

b. A facility with a licensed capacity of 17 or more beds must store 72 hours of fuel onsite.

2. An assisted living facility located in an area in a declared state of emergency area pursuant to
Section 252.36, F.S. that may impact primary power delivery must secure ninety-six (96) hours
of fuel. The assisted living facility may utilize portable fuel storage containers for the remaining
fuel necessary for ninety-six (96) hours during the period of a declared state of emergency.

3. Piped natural gas is an allowable fuel source and meets the onsite fuel supply requirements
under this rule.

4. If local ordinances or other regulations limit the amount of onsite fuel storage for the assisted
living facility’s location, then the assisted living facility must develop a plan that includes
maximum onsite fuel storage allowable by the ordinance or regulation and a reliable method to
obtain the maximum additional fuel at least 24 hours prior to depletion of onsite fuel.

(c) The acquisition of services necessary to maintain, and test the equipment and its functions
to ensure the safe and sufficient operation of the alternate power source maintained at the
assisted living facility.

(d) The acquisition and maintenance of a carbon monoxide alarm.

(2) SUBMISSION OF THE PLAN.

(a) Each assisted living facility licensed prior to the effective date of this rule shall submit its plan
to the local emergency management agency for review within 30 days of the effective date of
this rule. Assisted living facility plans previously submitted and approved pursuant to emergency
Rule 58AER17-1 will require resubmission only if changes are made to the plan.

(b) Each new assisted living facility shall submit the plan required under this rule prior to
obtaining a license.

(c) Each existing assisted living facility that undergoes any additions, modifications, alterations,
refurbishment, renovations or reconstruction that require modification of its systems or
equipment affecting the facility’s compliance with this rule shall amend its plan and submit it to
the local emergency management agency for review and approval.
(3) APPROVED PLANS.

(a) Each assisted living facility must maintain a copy of its approved plan in a manner that
makes the plan readily available at the licensee’s physical address for review by a legally
authorized entity. If the plan is maintained in an electronic format, assisted living facility staff
must be readily available to access and produce the plan. For purposes of this section, “readily
available” means the ability to immediately produce the plan, either in electronic or paper
format, upon request.

(b) Within two (2) business days of the approval of the plan from the local emergency
management agency, the assisted living facility shall submit in writing proof of the approval to
the Agency for Health Care Administration.

(c) The assisted living facility shall submit a consumer-friendly summary of the emergency
power plan to the Agency. The Agency shall post the summary and notice of the approval and
implementation of the assisted living facility emergency power plans on its website within ten
(10) business days of the plan's approval by the local emergency management agency and
update within ten (10) business days of implementation.

(4) IMPLEMENTATION OF THE PLAN.

(a) Each assisted living facility licensed prior to the effective date of this rule shall, no later than
June 1, 2018, have implemented the plan required under this rule.

(b) The Agency shall allow an extension up to January 1, 2019 to providers in compliance with
paragraph (c) below and who can show delays caused by necessary construction, delivery of
ordered equipment, zoning or other regulatory approval processes. Assisted living facilities shall
notify the Agency that they will utilize the extension and keep the Agency apprised of progress
on a quarterly basis to ensure there are no unnecessary delays. If an assisted living facility can
show in its quarterly progress reports that unavoidable delays caused by necessary
construction, delivery of ordered equipment, zoning or other regulatory approval processes will
occur beyond the initial extension date, the assisted living facility may request a waiver pursuant
to Section 120.542, F.S.

(c) During the extension period, an assisted living facility must make arrangements pending full
implementation of its plan that provides the residents with an area or areas to congregate that
meets the safe indoor air temperature requirements of subsection (1) (a) for a minimum of
ninety-six (96) hours.

1. An assisted living facility not located in an evacuation zone must either have an alternative
power source onsite or have a contract in place for delivery of an alternative power source and
fuel when requested. Within twenty-four (24) hours of the issuance of a state of emergency for
an event that may impact primary power delivery for the area of the assisted living facility, it
must have the alternative power source and no less than ninety-six (96) hours of fuel stored
onsite.
2. An assisted living facility located in an evacuation zone pursuant to Chapter 252, F.S. must
either:

a. Fully and safely evacuate its residents prior to the arrival of the event; or

b. Have an alternative power source and no less than ninety-six (96) hours of fuel stored onsite,
within twenty-four (24) hours of the issuance of a state of emergency for the area of the assisted
living facility.

(d) Each new assisted living facility shall implement the plan required under this rule prior to
obtaining a license.

(e) Existing assisted living facilities that undergo any additions, modifications, alterations,
refurbishment, renovations or reconstruction that require modification of the systems or
equipment affecting the assisted living facility’s compliance with this rule shall implement its
amended plan concurrent with any such additions, modifications, alterations, refurbishment,
renovations or reconstruction.

(f) The Agency for Health Care Administration may request cooperation from the State Fire
Marshal to conduct inspections to ensure implementation of the plan in compliance with this
rule.

(5) POLICIES AND PROCEDURES.

(a) Each assisted living facility shall develop and implement written policies and procedures to
ensure that the assisted living facility can effectively and immediately activate, operate and
maintain the alternate power source and any fuel required for the operation of the alternate
power source. The procedures shall ensure that residents do not experience complications from
fluctuations in ambient air temperatures inside the facility. Procedures must address the care of
residents occupying the facility during a declared state of emergency, specifically, a description
of the methods to be used to mitigate the potential for heat related injury including:

1. The use of cooling devices and equipment;

2. The use of refrigeration and freezers to produce ice and appropriate temperatures for the
maintenance of medicines requiring refrigeration;

3. Wellness checks by assisted living facility staff to monitor for signs of dehydration and heat
injury; and

4. A provision for obtaining medical intervention from emergency services for residents whose
life safety is in jeopardy.

(b) Each assisted living facility shall maintain the written policies and procedures in a manner
that makes them readily available at the licensee’s physical address for review by a legally
authorized entity. If the policies and procedures are maintained in an electronic format, assisted
living facility staff must be readily available to access the policies and procedures and produce
the requested information. For purposes of this section, “readily available” means the ability to
immediately produce the policies and procedures, either in electronic or paper format, upon
request.

(c) The written policies and procedures must be readily available for inspection by each
resident; each resident’s legal representative, designee, surrogate, guardian, attorney in fact, or
case manager; each resident’s estate; and such additional parties as authorized in writing or by
law.

(6) REVOCATION OF LICENSE, FINES OR SANCTIONS. For a violation of any part of this
rule, the Agency for Health Care Administration may seek any remedy authorized by Chapter
429, Part I, or Chapter 408, Part II, F.S., including, but not limited to, license revocation, license
suspension, and the imposition of administrative fines.

(7) COMPREHENSIVE EMERGENCY MANAGEMENT PLAN.

(a) Assisted living facilities whose comprehensive emergency management plan is to evacuate
must comply with this rule.

(b) Each facility whose plan has been approved shall submit the plan as an addendum with any
future submissions for approval of its comprehensive emergency management plan.

(8) NOTIFICATION.

(a) Within five (5) business days, each assisted living facility must notify in writing, unless
permission for electronic communication has been granted, each resident and the resident’s
legal representative:

1. Upon submission of the plan to the local emergency management agency that the plan has
been submitted for review and approval;

2. Upon final implementation of the plan by the assisted living facility.

(b) Each assisted living facility must maintain a copy of each notification set forth in paragraph
(a) above in a manner that makes each notification readily available at the licensee’s physical
address for review by a legally authorized entity. If the notifications are maintained in an
electronic format, facility staff must be readily available to access and produce the notifications.
For purposes of this section, “readily available” means the ability to immediately produce the
notifications, either in electronic or paper format, upon request.

Fire Safety Plans

Facilities must include a copy of the fire safety plan in the CEMP along with an approval from
the local fire safety authority.
Here are some of the requirements to include in a fire safety plan:
● A best practice would be to call your local authority as each county may have different
requirements as part of their plans.
● RACE procedures must be included. RACE stands for Rescue, Alarm, Contain Fire,
Extinguish/Evacuate in case of fire. It is a great tool to use in the case of a fire
emergency, as it’s easy to remember, even when panic has taken hold.
○ Remove/Rescue: Remove everyone from immediate danger. Ensuring that
residents and staff are taken to safety is the most crucial step in any emergency
plan
○ Alarm/Alert: Alerting other staff to the fire and its location.
■ Activating the fire alarm closing
■ Calling 911 from the nearest safe location
■ Have someone else call 911
○ Confine/Contain: Closing all doors around the fire might help to keep the fire
and smoke from spreading to the exit path and other areas during the
evacuation. It may help keep the fire smaller.
○ Extinguish/Evacuate: You want to try to extinguish the fire in its early stage; use
fire extinguishers if you are trained to do so. Do not place yourself in
unnecessary risk.
● Information on using a fire extinguisher using PASS.
○ Pass is the method to operate a fire extinguisher.
■ P: Pull the pin.
■ A: Aim the nozzle.
■ S: Squeeze the handle.
■ S: Sweep side to side at the base of the fire.
● Ensure all residents and staff are accounted for in a safety area. You have to wait for the
all clear from the emergency responders which usually is the fire department.
● Reset the fire alarm
● Clean any affected areas as soon as it is safe to do so.
○ If those areas are resident areas, then you will need to relocate them to other
areas until the clean up has been completed.
● Follow CEMP if evacuation is required
● Notify family members and update with information about the situation as soon as
possible.
● Evacuation maps, indicating primary and secondary routes for each area of the building.
● Include information on fire safety equipment
○ How often do you have the fire extinguishers inspected
○ How often do you test the alarms
○ Procedures to test the alarms
○ Testing both the fire alarms and carbon monoxide alarm
○ Fire drills
○ Implementing a fire watch should your alarm or fire system be temporarily
impaired.
Covid Response

Cover this as an overview video.

Restriction in ALFs, visits, communal dining and room activities.
Requirements to stop the spread and mitigation transmission.
Resources and areas to find information

Licensing
We highly recommend that you read the following sections in its entirety.
408.806, F.S.
59A-35.060, F.A.C.
59A-35.062, F.A.C.
59A-35.070, F.A.C.
408.807, F.S.
59A-36.003,F.A.C.
59A-36.004,F.A.C.
429.31, F.S.
*419, F.S.

Licensing application process

Procedures for licensing for assisted living are addressed in Ch 408.806. An application for
licensure must be made to the agency on forms furnished by the agency, submitted under oath,
and accompanied by the appropriate fee in order to be accepted and considered timely.

There are different types of license applications:

➢ Initial license application, first time applying for a license
➢ Renewal license applications which come up every 2 year, bi-annual renewal of existing
licenses
➢ Change of ownership license applications, when a licensee either sells or transfers the
ownership to a different individual or entity, or where there is change of 51% or more of
ownership, the controlling interest of the licensee.
➢ Change of licensure during the licensure period, such as a request to add a specialty
license or change provider information.

AHCA has license applications and forms on their website. There are forms you have to use
that address the ability to operate. There is also a checklist which is strongly recommended to
use and ensure that the license application is complete.

The application must contain information required by authorizing statutes and applicable rules
and must include:
(a) The name, address, and social security number of:
 1. The applicant;
2. The administrator or a similarly titled person who is responsible for the day-to-day
operation of the provider;
3. The financial officer or similarly titled person who is responsible for the financial operation
of the licensee or provider; and
4. Each controlling interest if the applicant or controlling interest is an individual.
(b) The name, address, and federal employer identification number or taxpayer identification
number of the applicant and each controlling interest if the applicant or controlling interest is not
an individual.
(c) The name by which the provider is to be known.
(d) The total number of beds or capacity requested, as applicable.
(e) The name of the person or persons under whose management or supervision the
provider will operate and the name of the administrator, if required.
(f) If the applicant offers continuing care agreements as defined in chapter 651, proof shall
be furnished that the applicant has obtained a certificate of authority as required for operation
under chapter 651.
(g) Other information, including satisfactory inspection results, that the agency finds
necessary to determine the ability of the applicant to carry out its responsibilities under this part,
authorizing statutes, and applicable rules.
(h) An affidavit, under penalty of perjury, as required in s. 435.05(3), stating compliance with
the provisions of this section and chapter 435.

The applicant for a renewal license must submit an application that must be received by the
agency at least 60 days but no more than 120 days before the expiration of the current license.
An application received more than 120 days before the expiration of the current license shall be
returned to the applicant. If the renewal application and fee are received prior to the license
expiration date, the license shall not be deemed to have expired if the license expiration date
occurs during the agency’s review of the renewal application.
The applicant for initial licensure due to a change of ownership must submit an application that
must be received by the agency at least 60 days prior to the date of change of ownership.
For any other application or request, the applicant must submit an application or request that
must be received by the agency at least 60 days but no more than 120 days before the
requested effective date, unless otherwise specified in authorizing statutes or applicable rules.
An application received more than 120 days before the requested effective date shall be
returned to the applicant.
The licensee’s failure to timely file a renewal application and license application fee with the
agency shall result in a $50 per day late fee charged to the licensee by the agency; however,
the aggregate amount of the late fee may not exceed 50 percent of the licensure fee or $500,
whichever is less. The agency shall provide a courtesy notice to the licensee by United States
mail, electronically, or by any other manner at its address of record or mailing address, if
provided, at least 90 days before the expiration of a license. This courtesy notice must inform
the licensee of the expiration of the license. If the agency does not provide the courtesy notice
or the licensee does not receive the courtesy notice, the licensee continues to be legally
obligated to timely file the renewal application and license application fee with the agency and is
not excused from the payment of a late fee. If an application is received after the required filing
date and exhibits a hand-canceled postmark obtained from a United States post office dated on
or before the required filing date, no fine will be levied.

The applicant must pay the late fee before a late application is considered complete and failure
to pay the late fee is considered an omission from the application for licensure pursuant to
paragraph (3)(b).

Upon receipt of an application for a license, the agency shall examine the application and, within
30 days after receipt, notify the applicant in writing of any apparent errors or omissions and
request any additional information required.
Requested information omitted from an application for licensure, license renewal, or change of
ownership, other than an inspection, must be filed with the agency within 21 days after the
agency’s request for omitted information or the application shall be deemed incomplete and
shall be withdrawn from further consideration and the fees shall be forfeited.
Within 60 days after the receipt of a complete application, the agency shall approve or deny the
application.
Licensees subject to the provisions of this part shall be issued biennial licenses unless
conditions of the license category specify a shorter license period.
Each license issued shall indicate the name of the licensee, the type of provider or service that
the licensee is required or authorized to operate or offer, the date the license is effective, the
expiration date of the license, the maximum capacity of the licensed premises, if applicable, and
any other information required or deemed necessary by the agency.
In accordance with authorizing statutes and applicable rules, proof of compliance with s.
408.810 must be submitted with an application for licensure.
The agency may not issue an initial license to a health care provider subject to the certificate-of-
need provisions in part I of this chapter if the licensee has not been issued a certificate of need
or certificate-of-need exemption, when applicable. Failure to apply for the renewal of a license
prior to the expiration date renders the license void.
(a) An applicant must demonstrate compliance with the requirements in this part, authorizing
statutes, and applicable rules during an inspection pursuant to s. 408.811, as required by
authorizing statutes.
(b) An initial inspection is not required for companion services or homemaker services
providers, as provided under part III of chapter 400, or for health care services pools, as
provided under part IX of chapter 400.
(c) If an inspection is required by the authorizing statute for a license application other than
an initial application, the inspection must be unannounced. This paragraph does not apply to
inspections required pursuant to ss. 383.324, 395.0161(4), 429.67(6), and 483.061(2).
(d) If a provider is not available when an inspection is attempted, the application shall be
denied.
(8) The agency may establish procedures for the electronic notification and submission of
required information, including, but not limited to:
(a) Licensure applications.
(b) Required signatures.
(c) Payment of fees.
(d) Notarization of applications.

Penalties
If you fail to submit your renewal application on time, the law provides you could be charged 50
per day by AHCA; the aggregate amount may not exceed 50% of the licensure fee or $500;
whichever is less.
If you fail to submit a license application for change of ownership on time, you will be fined
$5000. You must submit the application for change of ownership at least 60 days prior to the
anticipated date of change of ownership.

If you have a facility that consists of more than one building, all buildings included under a single
license must be on a contiguous property. Contiguous property means that the buildings are
all under the same ownership, and they are only separated by a 2 lane street; you may not have
more than a two lane street traversing the property. Only one license is needed if all buildings
are in contiguous property.
If applying for an ECC license along with an initial license application, you must contact AHCA
once you receive extended care residents so they can survey for ECC services; you have 6
months from licensure to do that.

If you intend to open a small residential home, be sure to check CH 419, F.S. for the required
distance you need to be from another community residential home. This includes assisted living
facilities and facilities that are regulated by other administrative agencies; such as the agency
for persons with disabilities or the Department of Children and Families. You need this to ensure
you meet distance requirements in order to obtain a zoning approval.
Once licensed as an assisted living facility, you may make changes to increase and decrease
license capacity. For this you must have AHCA approval for it from their central office in
Tallahassee.
Converting an area into residential use that has not been inspected by AHCA, you must get
approval from the field office which would be the local office in your area.

When you plan to surrender a license, you must provide a 30 day notice to AHCA. However, a
45 day written notice must be provided to residents and their legal representatives. If you fail to
provide at least 30 day notice to AHCA, could result in a $5000 fine. Additionally, when you
close a facility, you must return any funds due to residents or their representatives within 10
days of the closure.
The initial survey is the only one that will be scheduled; the rest will all be unannounced. Before
scheduling the initial survey, you should ensure that everything is ready to go to start servicing
residents; from staff, training requirements, menus,sample resident file, and policies and
procedures so there are no delays on licensing.

Change of Ownership
A change of ownership is defined to be an event in which the licensee either sells or transfers
ownership to a different individual or entity as evidenced by the Federal Identification Number or
the taxpayer identification number, or an event when 51% or more of the ownership shares or
controlling interest of the licensee is transferred or otherwise assigned. This excludes a licensee
that is publicly traded on a recognized stock exchange.
A change in management or board of directors if not considered a change of ownership.
However, a change in management must be notified to AHCA but is not considered a change
of ownership.
When a change of ownership occurs, both the transferor and transferee must follow some
procedures:
➢ The transferor must notify AHCA at least 60 days prior to the anticipated date of the
change of ownership.
➢ The transferee, new owner, must submit a new application to AHCA at least 60 days
prior to the anticipated change.
➢ During a process of change of ownership (CHOW), the transferor remains responsible
for operating the facility lawfully and ensuring the welfare of the residents until the
ownership is transferred to the transferee.
 ➢ Any penalties imposed against the transferor for violations that occurred before the
change of ownership, must be cleared up.
➢ If there is a restriction of licensure, including a conditional license at the time of the
change of ownership, it could potentially remain in effect until AHCA determines that the
grounds for the restriction have been corrected.
➢ The new owner is responsible for maintaining the records of the transferor as required
for the timeframes required. Resident records for 2 years, contracts for 5 years, copies
of all the inspection reports for 2 years; except for AHCA being 5 years.
➢ At the time of a CHOW, all resident funds on deposit or held by the transferor must be
transferred to the new owner. Proof of transfer is required before license is issued. The
transferor must provide each resident a statement which shows the amount and type of
funds held by the facility and credited to the resident.
➢ The transferee must notify in writing each resident the manor of which they are holding
the resident’s funds that were transferred to them. The transferee must notify residents
of the amount and type of funds held for them and where they are being held with name
and address.

Enforcement
We highly recommend that you read the following sections in its entirety.
408.813, F.S.
408.814, F.S.
408.815, F.S.
408.816, F.S.
424.14, F.S.
429.19, F.S.
429.22, F.S.
59A-36.023, F.S.

Administrative Enforcement
The legislature has tasked AHCA for monitoring facilities and ensuring that the health, safety
and welfare of persons living in ALFs is protected. The ASPEN guide is a survey document that
surveyors use as a reference tool which may be a helpful tool for facilities to prepare as well.
The survey process focuses on core areas, ensuring resident rights are protected; which is one
of the areas of main focus in the process; resident care and ensuring care and services
provided to residents are provided in accordance with their needs and preferences;
appropriateness of placement with admission and continued residency criteria, resident
nutritional needs and preferences, safe and homelike environment; staff being properly trained,
and their knowledge and capacity to perform their assigned job duties; medication system is
compliant and effective.

Facility staff must cooperate with agency personnel during surveys, complaint investigations,
monitoring visits, license application and renewal procedures and other activities necessary to
ensure compliance with Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-
35, F.A.C., and this rule chapter.

Abbreviated Survey

An applicant for license renewal who does not have any class I or class II violations or
uncorrected class III violations, confirmed long-term care ombudsman program complaints, or
confirmed licensing complaints within the two licensing periods immediately preceding the
current renewal date, is eligible for an abbreviated biennial survey by the agency. For the
purpose of this rule, a confirmed long-term care ombudsman program complaint is a complaint
that is verified and referred to a regulatory agency for further action. Facilities that do not have
two survey reports on file with the agency under current ownership are not eligible for an
abbreviated inspection. Upon arrival at the facility, the agency must inform the facility that it is
eligible for an abbreviated survey, and that an abbreviated survey will be conducted.

The agency will expand the abbreviated survey or conduct a full survey if violations which
threaten or potentially threaten the health, safety, or welfare of residents are identified during
the abbreviated survey. The facility must be informed when a full survey will be conducted. If
one or more of the following serious problems are identified during an abbreviated survey, a full
biennial survey will be immediately conducted:

1. Violations of Rule Chapter 69A-40, F.A.C., relating to firesafety, that threaten the life or safety
of a resident;

2. Violations relating to staffing standards or resident care standards that adversely affect the
health, safety, or welfare of a resident;

3. Violations relating to facility staff rendering services for which the facility is not licensed; or

4. Violations relating to facility medication practices that are a threat to the health, safety, or
welfare of a resident.

Compliance with key quality of care standards described in the following statutes and rules will
be used by the agency during its abbreviated survey of eligible facilities:

Survey Deficiency

(a) Before or in conjunction with a notice of violation issued pursuant to Part II, Chapter 408,
F.S., and Section 429.19, F.S., the agency shall issue a statement of deficiency for class I, II, III,
and IV violations which are observed by agency personnel during any inspection of the facility.
The deficiency statement must be issued within 10 working days of the agency’s inspection and
must include:

1. A description of the deficiency;

2. A citation to the statute or rule violated; and

3. A time frame for the correction of the deficiency.

(b) Additional time may be granted to correct specific deficiencies if a written request is received
by the agency before the expiration of the time frame included in the agency’s statement.

(3) Employment of A Consultant.

(a) Medication Deficiencies.

1. If a class I, class II, or uncorrected class III deficiency directly relating to facility medication
practices as established in Rule 59A-36.008, F.A.C., is documented by agency personnel
pursuant to an inspection of the facility, the agency must notify the facility in writing that the
facility must employ or contract the services of a pharmacist licensed pursuant to Section
465.0125, F.S., or registered nurse as determined by the agency.

2. After developing and implementing a corrective action plan in compliance with Section
429.42(2), F.S., the initial on-site consultant visit must take place within 7 working days of the
notice of a class I or class II deficiency and within 14 working days of the notice of an
uncorrected class III deficiency. The facility must have available for review by the agency a copy
of the license of the consultant pharmacist or registered nurse and the consultant’s signed and
dated review of the corrective action plan no later than 10 working days subsequent to the initial
on-site consultant visit.

3. The facility must provide the agency with, at a minimum, quarterly on-site corrective action
plan updates until the agency determines after written notification by the consultant and facility
administrator that deficiencies are corrected and staff has been trained to ensure that proper
medication standards are followed and that such consultant services are no longer required.
The agency must provide the facility with written notification of such determination.

(b) Dietary Deficiencies.

1. If a class I, class II, or uncorrected class III deficiency directly related to dietary standards as
established in Rule 59A-36.012, F.A.C., is documented by agency pursuant to an inspection of
the facility, the agency must notify the facility in writing that the facility must employ or contract
the services of a registered or licensed dietitian, or a licensed nutritionist.

2. The initial on-site consultant visit must take place within seven working days of the notice of a
class I or II deficiency or within 14 working days of the notice of an uncorrected class III
deficiency. The facility must have available for review by the agency a copy of the license or
registration of the consultant dietitian or nutritionist and the consultant’s signed and dated
review of the facility’s corrective action plan, if a plan is required by the agency, no later than 10
working days after the initial on-site consultant visit.

3. If a corrective action plan is required, the facility must provide the agency with, at a minimum,
quarterly on-site corrective action plan updates until the agency determines after written
notification by the dietary consultant and facility administrator, that deficiencies are corrected
and staff has been trained to ensure that proper dietary standards are followed and consultant
services are no longer required. The agency must provide the facility with written notification of
such determination.

408.813 Administrative fines; violations

As a penalty for any violation of this part, authorizing statutes, or applicable rules, the agency
may impose an administrative fine.

Violations of this part, authorizing statutes, or applicable rules shall be classified according to
the nature of the violation and the gravity of its probable effect on clients. The scope of a
violation may be cited as an isolated, patterned, or widespread deficiency. An isolated
deficiency is a deficiency affecting one or a very limited number of clients, or involving one or a
very limited number of staff, or a situation that occurred only occasionally or in a very limited
number of locations. A patterned deficiency is a deficiency in which more than a very limited
number of clients are affected, or more than a very limited number of staff are involved, or the
situation has occurred in several locations, or the same client or clients have been affected by
repeated occurrences of the same deficient practice but the effect of the deficient practice is not
found to be pervasive throughout the provider. A widespread deficiency is a deficiency in which
the problems causing the deficiency are pervasive in the provider or represent systemic failure
that has affected or has the potential to affect a large portion of the provider’s clients. This
subsection does not affect the legislative determination of the amount of a fine imposed under
authorizing statutes. Violations shall be classified on the written notice as follows:
(a) Class “I” violations are those conditions or occurrences related to the operation and
maintenance of a provider or to the care of clients which the agency determines present an
imminent danger to the clients of the provider or a substantial probability that death or serious
physical or emotional harm would result therefrom. The condition or practice constituting a class
I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by
the agency, is required for correction. The agency shall impose an administrative fine as
provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction
of the violation.
(b) Class “II” violations are those conditions or occurrences related to the operation and
maintenance of a provider or to the care of clients which the agency determines directly
threaten the physical or emotional health, safety, or security of the clients, other than class I
violations. The agency shall impose an administrative fine as provided by law for a cited class II
violation. A fine shall be levied notwithstanding the correction of the violation.
 (c) Class “III” violations are those conditions or occurrences related to the operation and
maintenance of a provider or to the care of clients which the agency determines indirectly or
potentially threaten the physical or emotional health, safety, or security of clients, other than
class I or class II violations. The agency shall impose an administrative fine as provided in this
section for a cited class III violation. A citation for a class III violation must specify the time within
which the violation is required to be corrected. If a class III violation is corrected within the time
specified, a fine may not be imposed.
(d) Class “IV” violations are those conditions or occurrences related to the operation and
maintenance of a provider or to required reports, forms, or documents that do not have the
potential of negatively affecting clients. These violations are of a type that the agency
determines do not threaten the health, safety, or security of clients. The agency shall impose an
administrative fine as provided in this section for a cited class IV violation. A citation for a class
IV violation must specify the time within which the violation is required to be corrected. If a class
IV violation is corrected within the time specified, a fine may not be imposed.
(3) The agency may impose an administrative fine for a violation that is not designated as a
class I, class II, class III, or class IV violation. Unless otherwise specified by law, the amount of
the fine may not exceed $500 for each violation. Unclassified violations include:
(a) Violating any term or condition of a license.
(b) Violating any provision of this part, authorizing statutes, or applicable rules.
(c) Exceeding licensed capacity.
(d) Providing services beyond the scope of the license.
(e) Violating a moratorium imposed

Class I and II violations are automatic fines; the amount of the fine for a class I violation is
between $5000 to $10000 for each violation; for class II violations is between $1000 and $5000
for each violation; for any uncorrected class III violations, the fine is between $500 and $1000
for each violation; and for any uncorrected class IV violations, the fine is between $100 and
$200 for each violations.

When AHCA is determining what the amount of the violation is, they consider the gravity of the
violation including the probability of death or serious physical or emotional harm is going to
result or has resulted; the severity of the circumstances of which are violated; any action taken
by the owner or administrator to correct the situation; history of previous violations; the financial
benefit to the community for either committing or continuing the violation; the license capacity of
the facility.

When not in compliance with level 2 background screening requirements, the fine is $500 per
occurrence.
 408.814 Moratorium; emergency suspension.—
(1) The agency may impose an immediate moratorium or emergency suspension on any
provider if the agency determines that any condition related to the provider or licensee presents
a threat to the health, safety, or welfare of a client.
(2) A provider or licensee, the license of which is denied or revoked, may be subject to
immediate imposition of a moratorium or emergency suspension to run concurrently with
licensure denial, revocation, or injunction.
(3) A moratorium or emergency suspension remains in effect after a change of ownership,
unless the agency has determined that the conditions that created the moratorium, emergency
suspension, or denial of licensure have been corrected.
(4) When a moratorium or emergency suspension is placed on a provider or licensee, notice
of the action shall be posted and visible to the public at the location of the provider until the
action is lifted.

AHCA may impose an immediate moratorium on any assisted living facility that fails to provide
the agency with access to the facility.

Chapters 408.815 and 429.14 F.S. provide for administrative sanctions and fines including
circumstances which could result in license denial or revoked.
408.815 License or application denial; revocation.—
In addition to the grounds provided in authorizing statutes, grounds that may be used by the
agency for denying and revoking a license or change of ownership application include any of the
following actions by a controlling interest:
(a) False representation of a material fact in the license application or omission of any
material fact from the application.
(b) An intentional or negligent act materially affecting the health or safety of a client of the
provider.
(c) A violation of this part, authorizing statutes, or applicable rules.
(d) A demonstrated pattern of deficient performance.
(e) The applicant, licensee, or controlling interest has been or is currently excluded,
suspended, or terminated from participation in the state Medicaid program, the Medicaid
program of any other state, or the Medicare program.
(2) If a licensee lawfully continues to operate while a denial or revocation is pending in
litigation, the licensee must continue to meet all other requirements of this part, authorizing
statutes, and applicable rules and file subsequent renewal applications for licensure and pay all
licensure fees. The provisions of ss. 120.60(1) and 408.806(3)(c) do not apply to renewal
applications filed during the time period in which the litigation of the denial or revocation is
pending until that litigation is final.
(3) An action under s. 408.814 or denial of the license of the transferor may be grounds for
denial of a change of ownership application of the transferee.
(4) Unless an applicant is determined by the agency to satisfy the provisions of subsection
(5) for the action in question, the agency shall deny an application for a license or license
renewal based upon any of the following actions of an applicant, a controlling interest of the
applicant, or any entity in which a controlling interest of the applicant was an owner or officer
when the following actions occurred:
(a) A conviction or a plea of guilty or nolo contendere to, regardless of adjudication, a felony,
Medicaid fraud, Medicare fraud, or insurance fraud, unless the sentence and any subsequent
period of probation for such convictions or plea ended more than 15 years before the date of the
application; or
(b) Termination for cause from the Medicare program or a state Medicaid program, unless
the applicant has been in good standing with the Medicare program or a state Medicaid program
for the most recent 5 years and the termination occurred at least 20 years before the date of the
application.
(5) For any application subject to denial under subsection (4), the agency may consider
mitigating circumstances as applicable, including, but not limited to:
(a) Completion or lawful release from confinement, supervision, or sanction, including the
terms of probation, and full restitution;
(b) Execution of a compliance plan with the agency;
(c) Compliance with an integrity agreement or compliance plan with another government
agency;
(d) Determination by any state Medicaid program or the Medicare program that the
controlling interest or entity in which the controlling interest was an owner or officer is currently
allowed to participate in the state Medicaid program or the Medicare program, directly as a
provider or indirectly as an owner or officer of a provider entity;
(e) Continuation of licensure by the controlling interest or entity in which the controlling
interest was an owner or officer, directly as a licensee or indirectly as an owner or officer of a
licensed entity in the state where the action occurred;
(f) Overall impact upon the public health, safety, or welfare; or
(g) Determination that a license denial is not commensurate with the prior action taken by
the Medicare or state Medicaid program.
After considering the circumstances set forth in this subsection, the agency shall grant the
license, with or without conditions, grant a provisional license for a period of no more than the
licensure cycle, with or without conditions, or deny the license.
(6) In order to ensure the health, safety, and welfare of clients when a license has been
denied, revoked, or is set to terminate, the agency may extend the license expiration date for up
to 30 days for the sole purpose of allowing the safe and orderly discharge of clients. The agency
may impose conditions on the extension, including, but not limited to, prohibiting or limiting
admissions, expedited discharge planning, required status reports, and mandatory monitoring
by the agency or third parties. When imposing these conditions, the agency shall consider the
nature and number of clients, the availability and location of acceptable alternative placements,
and the ability of the licensee to continue providing care to the clients. The agency may
terminate the extension or modify the conditions at any time. This authority is in addition to any
other authority granted to the agency under chapter 120, this part, and authorizing statutes but
creates no right or entitlement to an extension of a license expiration date.

AHCA must deny or revoke a license when there are two moratoria within a 2 year period
imposed by final order or ther facility is cited for 2 or more class I violations arising from
unrelated circumstances during the same survey.

429.22 Receivership proceedings.—

(1) As an alternative to or in conjunction with an injunctive proceeding, the agency may
petition a court of competent jurisdiction for the appointment of a receiver, if suitable alternate
placements are not available, when any of the following conditions exist:
(a) The facility is operating without a license and refuses to make application for a license as
required.
(b) The facility is closing or has informed the agency that it intends to close and adequate
arrangements have not been made for relocation of the residents within 7 days, exclusive of
weekends and holidays, of the closing of the facility.
(c) The agency determines there exist in the facility conditions which present an imminent
danger to the health, safety, or welfare of the residents of the facility or a substantial probability
that death or serious physical harm would result therefrom.
(d) The facility cannot meet its financial obligation for providing food, shelter, care, and
utilities.
(2) Petitions for receivership shall take precedence over other court business unless the
court determines that some other pending proceeding, having similar statutory precedence,
shall have priority. A hearing shall be conducted within 5 days of the filing of the petition, at
which time all interested parties shall have the opportunity to present evidence pertaining to the
petition. The agency shall notify, by certified mail, the owner or administrator of the facility
named in the petition and the facility resident or, if applicable, the resident’s representative or
designee, or the resident’s surrogate, guardian, or attorney in fact, of its filing, the substance of
the violation, and the date and place set for the hearing. The court shall grant the petition only
upon finding that the health, safety, or welfare of facility residents would be threatened if a
condition existing at the time the petition was filed is permitted to continue. A receiver shall not
be appointed ex parte unless the court determines that one or more of the conditions in
subsection (1) exist; that the facility owner or administrator cannot be found; that all reasonable
means of locating the owner or administrator and notifying him or her of the petition and hearing
have been exhausted; or that the owner or administrator after notification of the hearing
chooses not to attend. After such findings, the court may appoint any qualified person as a
receiver, except it may not appoint any owner or affiliate of the facility which is in receivership.
The receiver may be selected from a list of persons qualified to act as receivers developed by
the agency and presented to the court with each petition for receivership. Under no
circumstances may the agency or designated agency employee be appointed as a receiver for
more than 60 days; however, the receiver may petition the court, one time only, for a 30-day
extension. The court shall grant the extension upon a showing of good cause.
(3) The receiver must make provisions for the continued health, safety, and welfare of all
residents of the facility and:
(a) Shall exercise those powers and perform those duties set out by the court.
(b) Shall operate the facility in such a manner as to assure safety and adequate health care
for the residents.
(c) Shall take such action as is reasonably necessary to protect or conserve the assets or
property of the facility for which the receiver is appointed, or the proceeds from any transfer
thereof, and may use them only in the performance of the powers and duties set forth in this
section and by order of the court.
(d) May use the building, fixtures, furnishings, and any accompanying consumable goods in
the provision of care and services to residents and to any other persons receiving services from
the facility at the time the petition for receivership was filed. The receiver shall collect payments
for all goods and services provided to residents or others during the period of the receivership at
the same rate of payment charged by the owners at the time the petition for receivership was
filed, or at a fair and reasonable rate otherwise approved by the court.
 (e) May correct or eliminate any deficiency in the structure or furnishings of the facility which
endangers the safety or health of residents while they remain in the facility, if the total cost of
correction does not exceed $10,000. The court may order expenditures for this purpose in
excess of $10,000 on application from the receiver after notice to the owner and a hearing.
(f) May let contracts and hire agents and employees to carry out the powers and duties of
the receiver.
(g) Shall honor all leases, mortgages, and secured transactions governing the building in
which the facility is located and all goods and fixtures in the building of which the receiver has
taken possession, but only to the extent of payments which, in the case of a rental agreement,
are for the use of the property during the period of the receivership, or which, in the case of a
purchase agreement, become due during the period of the receivership.
(h) Shall have full power to direct and manage and to discharge employees of the facility,
subject to any contract rights they may have. The receiver shall pay employees at the rate of
compensation, including benefits, approved by the court. A receivership does not relieve the
owner of any obligation to employees made prior to the appointment of a receiver and not
carried out by the receiver.
(i) Shall be entitled to and take possession of all property or assets of residents which are in
the possession of a facility or its owner. The receiver shall preserve all property, assets, and
records of residents of which the receiver takes possession and shall provide for the prompt
transfer of the property, assets, and records to the new placement of any transferred resident.
An inventory list certified by the owner and receiver shall be made immediately at the time the
receiver takes possession of the facility.
(4)(a) A person who is served with notice of an order of the court appointing a receiver and
of the receiver’s name and address shall be liable to pay the receiver for any goods or services
provided by the receiver after the date of the order if the person would have been liable for the
goods or services as supplied by the owner. The receiver shall give a receipt for each payment
and shall keep a copy of each receipt on file. The receiver shall deposit accounts received in a
separate account and shall use this account for all disbursements.
(b) The receiver may bring an action to enforce the liability created by paragraph (a).
(c) A payment to the receiver of any sum owing to the facility or its owner shall discharge
any obligation to the facility to the extent of the payment.
(5)(a) A receiver may petition the court that he or she not be required to honor any lease,
mortgage, secured transaction, or other wholly or partially executory contract entered into by the
owner of the facility if the rent, price, or rate of interest required to be paid under the agreement
was substantially in excess of a reasonable rent, price, or rate of interest at the time the contract
was entered into, or if any material provision of the agreement was unreasonable, when
compared to contracts negotiated under similar conditions. Any relief in this form provided by
the court shall be limited to the life of the receivership, unless otherwise determined by the
court.
(b) If the receiver is in possession of real estate or goods subject to a lease, mortgage, or
security interest which the receiver has obtained a court order to avoid under paragraph (a), and
if the real estate or goods are necessary for the continued operation of the facility under this
section, the receiver may apply to the court to set a reasonable rental, price, or rate of interest
to be paid by the receiver during the duration of the receivership. The court shall hold a hearing
on the application within 15 days. The receiver shall send notice of the application to any known
persons who own the property involved at least 10 days prior to the hearing. Payment by the
receiver of the amount determined by the court to be reasonable is a defense to any action
against the receiver for payment or for possession of the goods or real estate subject to the
lease, security interest, or mortgage involved by any person who received such notice, but the
payment does not relieve the owner of the facility of any liability for the difference between the
amount paid by the receiver and the amount due under the original lease, security interest, or
mortgage involved.
(6) The court shall set the compensation of the receiver, which will be considered a
necessary expense of a receivership.
(7) A receiver may be held liable in a personal capacity only for the receiver’s own gross
negligence, intentional acts, or breach of fiduciary duty.
(8) The court may require a receiver to post a bond.
(9) The court may direct the agency to allocate funds from the Health Care Trust Fund to the
receiver.
(10) The court may terminate a receivership when:
(a) The court determines that the receivership is no longer necessary because the
conditions which gave rise to the receivership no longer exist or the agency grants the facility a
new license; or
(b) All of the residents in the facility have been transferred or discharged.
(11) Within 30 days after termination, the receiver shall give the court a complete accounting
of all property of which the receiver has taken possession, of all funds collected, and of the
expenses of the receivership.
 (12) Nothing in this section shall be deemed to relieve any owner, administrator, or
employee of a facility placed in receivership of any civil or criminal liability incurred, or any duty
imposed by law, by reason of acts or omissions of the owner, administrator, or employee prior to
the appointment of a receiver; nor shall anything contained in this section be construed to
suspend during the receivership any obligation of the owner, administrator, or employee for
payment of taxes or other operating and maintenance expenses of the facility or of the owner,
administrator, employee, or any other person for the payment of mortgages or liens. The owner
shall retain the right to sell or mortgage any facility under receivership, subject to approval of the
court which ordered the receivership.
Attachments

CHAPTER 429

ASSISTED CARE COMMUNITIES

PART I

ASSISTED LIVING FACILITIES

(ss. 429.01-429.55)

PART II

ADULT FAMILY-CARE HOMES

(ss. 429.60-429.87)

PART III

ADULT DAY CARE CENTERS

(ss. 429.90-429.931)
PART I
 ASSISTED LIVING FACILITIES

429.01 Short title; purpose.

429.02 Definitions.

429.04 Facilities to be licensed; exemptions.

429.07 License required; fee.

429.075 Limited mental health license.

429.08 Unlicensed facilities; referral of person for residency to unlicensed facility; penalties.

429.11 Initial application for license.

429.12 Sale or transfer of ownership of a facility.

429.14 Administrative penalties.

429.17 Expiration of license; renewal; conditional license.

429.174 Background screening.

429.176 Notice of change of administrator.

429.177 Patients with Alzheimer’s disease or other related disorders; certain disclosures.

429.178 Special care for persons with Alzheimer’s disease or other related disorders.

429.18 Disposition of fees and administrative fines.

429.19 Violations; imposition of administrative fines; grounds.

429.195 Rebates prohibited; penalties.

429.20 Certain solicitation prohibited; third-party supplementation.

429.22 Receivership proceedings.

429.23 Internal risk management and quality assurance program; adverse incidents and reporting
requirements.

429.24 Contracts.

429.255 Use of personnel; emergency care.

429.256 Assistance with self-administration of medication.

429.26 Appropriateness of placements; examinations of residents.

429.27 Property and personal affairs of residents.

429.275 Business practice; personnel records; liability insurance.

429.28 Resident bill of rights.

429.29 Civil actions to enforce rights.

429.293 Presuit notice; investigation; notification of violation of residents’ rights or alleged

negligence; claims evaluation procedure; informal discovery; review; settlement offer; mediation.

429.294 Availability of facility records for investigation of resident’s rights violations and defenses;
penalty.

429.295 Certain provisions not applicable to actions under this part.

429.296 Statute of limitations.

429.297 Punitive damages; pleading; burden of proof.

429.298 Punitive damages; limitation.

429.31 Closing of facility; notice; penalty.

429.34 Right of entry and inspection.

429.35 Maintenance of records; reports.

429.41 Rules establishing standards.

429.42 Pharmacy and dietary services.

429.435 Uniform firesafety standards.

429.44 Construction and renovation; requirements.

429.445 Compliance with local zoning requirements.

429.47 Prohibited acts; penalties for violation.

429.49 Resident records; penalties for alteration.

429.52 Staff training and educational requirements.

429.53 Consultation by the agency.

429.54 Collection of information; local subsidy.

429.55 Consumer information website.

429.01 Short title; purpose.—

(1) This act may be cited as the “Assisted Living Facilities Act.”

(2) The purpose of this act is to promote the availability of appropriate services for elderly persons
and adults with disabilities in the least restrictive and most homelike environment, to encourage the
development of facilities that promote the dignity, individuality, privacy, and decisionmaking ability of
such persons, to provide for the health, safety, and welfare of residents of assisted living facilities in
the state, to promote continued improvement of such facilities, to encourage the development of
innovative and affordable facilities particularly for persons with low to moderate incomes, to ensure
that all agencies of the state cooperate in the protection of such residents, and to ensure that needed
economic, social, mental health, health, and leisure services are made available to residents of such
facilities through the efforts of the Agency for Health Care Administration, the Department of Elderly
Affairs, the Department of Children and Families, the Department of Health, assisted living facilities,
and other community agencies. To the maximum extent possible, appropriate community-based
programs must be available to state-supported residents to augment the services provided in assisted
living facilities. The Legislature recognizes that assisted living facilities are an important part of the
continuum of long-term care in the state. In support of the goal of aging in place, the Legislature
further recognizes that assisted living facilities should be operated and regulated as residential
environments with supportive services and not as medical or nursing facilities. The services available in
these facilities, either directly or through contract or agreement, are intended to help residents
remain as independent as possible. Regulations governing these facilities must be sufficiently flexible
to allow facilities to adopt policies that enable residents to age in place when resources are available
to meet their needs and accommodate their preferences.

(3) The principle that a license issued under this part is a public trust and a privilege and is not an
entitlement should guide the finder of fact or trier of law at any administrative proceeding or in a
court action initiated by the Agency for Health Care Administration to enforce this part.
 History.—ss. 1, 2, ch. 75-233; ss. 12, 13, ch. 80-198; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; s. 2, ch. 87-371; s. 2, ch.
91-263; s. 28, ch. 92-33; ss. 1, 38, 39, ch. 93-216; s. 6, ch. 95-210; s. 46, ch. 95-418; s. 122, ch. 99-8; s. 2, ch. 2006-197;
s. 243, ch. 2014-19.

Note.—Former s. 400.401.

429.02 Definitions.—When used in this part, the term:

(1) “Activities of daily living” means functions and tasks for self-care, including ambulation,
bathing, dressing, eating, grooming, and toileting, and other similar tasks.

(2) “Administrator” means an individual at least 21 years of age who is responsible for the
operation and maintenance of an assisted living facility.

(3) “Agency” means the Agency for Health Care Administration.

(4) “Aging in place” or “age in place” means the process of providing increased or adjusted services
to a person to compensate for the physical or mental decline that may occur with the aging process, in
order to maximize the person’s dignity and independence and permit them to remain in a familiar,
noninstitutional, residential environment for as long as possible. Such services may be provided by
facility staff, volunteers, family, or friends, or through contractual arrangements with a third party.

(5) “Assisted living facility” means any building or buildings, section or distinct part of a building,
private home, boarding home, home for the aged, or other residential facility, regardless of whether
operated for profit, which through its ownership or management provides housing, meals, and one or
more personal services for a period exceeding 24 hours to one or more adults who are not relatives of
the owner or administrator.

(6) “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; prevent a fall; or recover from a fall. The term does not
include a total body lift or a motorized sit-to-stand lift, with the exception of a chair lift or recliner lift
that a resident is able to operate independently.

(7) “Chemical restraint” means a pharmacologic drug that physically limits, restricts, or deprives an
individual of movement or mobility, and is used for discipline or convenience and not required for the
treatment of medical symptoms.
 (8) “Community living support plan” means a written document prepared by a mental health
resident and the resident’s mental health case manager in consultation with the administrator of an
assisted living facility with a limited mental health license or the administrator’s designee. A copy must
be provided to the administrator. The plan must include information about the supports, services, and
special needs of the resident which enable the resident to live in the assisted living facility and a
method by which facility staff can recognize and respond to the signs and symptoms particular to that
resident which indicate the need for professional services.

(9) “Cooperative agreement” means a written statement of understanding between a mental health
care provider and the administrator of the assisted living facility with a limited mental health license
in which a mental health resident is living. The agreement must specify directions for accessing
emergency and after-hours care for the mental health resident. A single cooperative agreement may
service all mental health residents who are clients of the same mental health care provider.

(10) “Department” means the Department of Elderly Affairs.

(11) “Emergency” means a situation, physical condition, or method of operation which presents
imminent danger of death or serious physical or mental harm to facility residents.

(12) “Extended congregate care” means acts beyond those authorized in subsection (18) which 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 may be specified by rule. The purpose of such
services is to enable residents to age in place in a residential environment despite mental or physical
limitations that might otherwise disqualify them from residency in a facility licensed under this part.

(13) “Guardian” means a person to whom the law has entrusted the custody and control of the
person or property, or both, of a person who has been legally adjudged incapacitated.

(14) “Limited nursing services” means acts that may be performed by a person licensed under part I
of chapter 464. Limited nursing services shall be for persons who meet the admission criteria
established by the agency for assisted living facilities but are not complex enough to require 24-hour
nursing supervision and may include such services as the application and care of routine dressings and
care of casts, braces, and splints.

(15) “Managed risk” means the process by which the facility staff discuss the service plan and the
needs of the resident with the resident and, if applicable, the resident’s representative or designee or
the resident’s surrogate, guardian, or attorney in fact, in such a way that the consequences of a
decision, including any inherent risk, are explained to all parties and reviewed periodically in
conjunction with the service plan, taking into account changes in the resident’s status and the ability
of the facility to respond accordingly.

(16) “Mental health resident” means an individual who receives social security disability income
due to a mental disorder as determined by the Social Security Administration or receives supplemental
security income due to a mental disorder as determined by the Social Security Administration and
receives optional state supplementation.

(17) “Office” has the same meaning as in s. 400.0060.

(18) “Personal services” means direct physical assistance with or supervision of the activities of
daily living, the self-administration of medication, or other similar services that the agency may define
by rule. The term may not be construed to mean the provision of medical, nursing, dental, or mental
health services.

(19) “Physical restraint” means a device that physically limits, restricts, or deprives an individual of
movement or mobility, including any device that is not specifically manufactured as a restraint but is
altered, arranged, or otherwise used for that purpose. The term does not include any device that the
resident chooses to use and is able to remove or avoid independently, or any bandage material used for
the purpose of binding a wound or injury.

(20) “Relative” means an individual who is the father, mother, stepfather, stepmother, son,
daughter, brother, sister, grandmother, grandfather, great-grandmother, great-grandfather, grandson,
granddaughter, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law,
son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepson, stepdaughter, stepbrother,
stepsister, half brother, or half sister of an owner or administrator.

(21) “Resident” means a person 18 years of age or older, residing in and receiving care from a
facility.

(22) “Resident’s representative or designee” means a person other than the owner, or an agent or
employee of the facility, designated in writing by the resident, if legally competent, to receive notice
of changes in the contract executed pursuant to s. 429.24; to receive notice of and to participate in
meetings between the resident and the facility owner, administrator, or staff concerning the rights of
the resident; to assist the resident in contacting the State Long-Term Care Ombudsman Program or
local ombudsman council if the resident has a complaint against the facility; or to bring legal action on
behalf of the resident pursuant to s. 429.29.

(23) “Service plan” means a written plan, developed and agreed upon by the resident and, if
applicable, the resident’s representative or designee or the resident’s surrogate, guardian, or attorney
in fact, if any, and the administrator or designee representing the facility, which addresses the unique
physical and psychosocial needs, abilities, and personal preferences of each resident receiving
extended congregate care services. The plan shall include a brief written description, in easily
understood language, of what services shall be provided, who shall provide the services, when the
services shall be rendered, and the purposes and benefits of the services.

(24) “Shared responsibility” means exploring the options available to a resident within a facility
and the risks involved with each option when making decisions pertaining to the resident’s abilities,
preferences, and service needs, thereby enabling the resident and, if applicable, the resident’s
representative or designee, or the resident’s surrogate, guardian, or attorney in fact, and the facility
to develop a service plan which best meets the resident’s needs and seeks to improve the resident’s
quality of life.

(25) “Supervision” means reminding residents to engage in activities of daily living and the self-
administration of medication, and, when necessary, observing or providing verbal cuing to residents
while they perform these activities.

(26) “Supplemental security income,” Title XVI of the Social Security Act, means a program through
which the Federal Government guarantees a minimum monthly income to every person who is age 65 or
older, or disabled, or blind and meets the income and asset requirements.

(27) “Supportive services” means services designed to encourage and assist aged persons or adults
with disabilities to remain in the least restrictive living environment and to maintain their
independence as long as possible.

(28) “Twenty-four-hour nursing supervision” means services that are ordered by a physician for a
resident whose condition requires the supervision of a physician and continued monitoring of vital signs
and physical status. Such services shall be: medically complex enough to require constant supervision,
assessment, planning, or intervention by a nurse; required to be performed by or under the direct
supervision of licensed nursing personnel or other professional personnel for safe and effective
performance; required on a daily basis; and consistent with the nature and severity of the resident’s
condition or the disease state or stage.

History.—s. 3, ch. 75-233; ss. 12, 14, ch. 80-198; s. 2, ch. 81-318; ss. 6, 19, ch. 82-148; ss. 41, 79, 83, ch. 83-181; s. 4,
ch. 85-145; s. 3, ch. 87-371; s. 10, ch. 89-294; s. 3, ch. 91-263; s. 1, ch. 93-209; ss. 2, 38, 39, ch. 93-216; s. 7, ch. 95-
210; ss. 1, 22, 47, ch. 95-418; s. 2, ch. 97-82; s. 1, ch. 98-80; s. 98, ch. 2000-318; ss. 2, 29, ch. 2006-197; s. 138, ch.
2007-230; s. 34, ch. 2015-31; s. 5, ch. 2015-126; s. 79, ch. 2018-24; s. 8, ch. 2019-11; s. 1, ch. 2020-68; s. 38, ch. 2021-
51.

Note.—Former s. 400.402.

429.04 Facilities to be licensed; exemptions.—

(1) For the administration of this part, facilities to be licensed by the agency shall include all
assisted living facilities as defined in this part.

(2) The following are exempt from licensure under this part:

(a) Any facility, institution, or other place operated by the Federal Government or any agency of
the Federal Government.

(b) Any facility or part of a facility licensed by the Agency for Persons with Disabilities under
chapter 393, a mental health facility licensed under chapter 394, a hospital licensed under chapter
395, a nursing home licensed under part II of chapter 400, an inpatient hospice licensed under part IV
of chapter 400, a home for special services licensed under part V of chapter 400, an intermediate care
facility licensed under part VIII of chapter 400, or a transitional living facility licensed under part XI of
chapter 400.

(c) Any facility licensed as an adult family-care home under part II.

(d) Any person who provides housing, meals, and one or more personal services on a 24-hour basis
in the person’s own home to not more than two adults who do not receive optional state
supplementation. The person who provides the housing, meals, and personal services must own or rent
the home and must have established the home as his or her permanent residence. For purposes of this
paragraph, any person holding a homestead exemption at an address other than that at which the
person asserts this exemption is presumed to not have established permanent residence. This
exemption does not apply to a person or entity that previously held a license issued by the agency
which was revoked or for which renewal was denied by final order of the agency, or when the person or
entity voluntarily relinquished the license during agency enforcement proceedings.

(e) Any home or facility approved by the United States Department of Veterans Affairs as a
residential care home wherein care is provided exclusively to three or fewer veterans.

(f) Any facility that has been incorporated in this state for 50 years or more on or before July 1,
1983, and the board of directors of which is nominated or elected by the residents, until the facility is
sold or its ownership is transferred; or any facility, with improvements or additions thereto, which has
existed and operated continuously in this state for 60 years or more on or before July 1, 1989, is
directly or indirectly owned and operated by a nationally recognized fraternal organization, is not open
to the public, and accepts only its own members and their spouses as residents.

(g) Any facility certified under chapter 651, or a retirement community, may provide services
authorized under this part or part III of chapter 400 to its residents who live in single-family homes,
duplexes, quadruplexes, or apartments located on the campus without obtaining a license to operate
an assisted living facility if residential units within such buildings are used by residents who do not
require staff supervision for that portion of the day when personal services are not being delivered and
the owner obtains a home health license to provide such services. However, any building or distinct
part of a building on the campus that is designated for persons who receive personal services and
require supervision beyond that which is available while such services are being rendered must be
licensed in accordance with this part. If a facility provides personal services to residents who do not
otherwise require supervision and the owner is not licensed as a home health agency, the buildings or
distinct parts of buildings where such services are rendered must be licensed under this part. A
resident of a facility that obtains a home health license may contract with a home health agency of his
or her choice, provided that the home health agency provides liability insurance and workers’
compensation coverage for its employees. Facilities covered by this exemption may establish policies
that give residents the option of contracting for services and care beyond that which is provided by the
facility to enable them to age in place. For purposes of this section, a retirement community consists
of a facility licensed under this part or under part II of chapter 400, and apartments designed for
independent living located on the same campus.

(h) Any residential unit for independent living which is located within a facility certified under
chapter 651, or any residential unit which is colocated with a nursing home licensed under part II of
chapter 400 or colocated with a facility licensed under this part in which services are provided through
an outpatient clinic or a nursing home on an outpatient basis.
 (3) Upon agency investigation of unlicensed activity, any person or entity that claims that it is
exempt under this section must provide documentation substantiating entitlement to the exemption.

History.—ss. 4, 5, ch. 75-233; ss. 12, 15, ch. 80-198; s. 2, ch. 81-318; ss. 42, 79, 83, ch. 83-181; s. 4, ch. 87-371; s. 4,
ch. 91-263; ss. 3, 38, 39, ch. 93-216; s. 19, ch. 93-268; s. 2, ch. 94-206; s. 1055, ch. 95-148; s. 8, ch. 95-210; s. 2, ch. 98-
80; s. 1, ch. 98-148; ss. 2, 30, ch. 2006-197; s. 80, ch. 2018-24.

Note.—Former s. 400.404.

429.07 License required; fee.—

(1) The requirements of part II of chapter 408 apply to the provision of services that require
licensure pursuant to this part and part II of chapter 408 and to entities licensed by or applying for such
licensure from the agency pursuant to this part. A license issued by the agency is required in order to
operate an assisted living facility in this state.

(2) Separate licenses shall be required for facilities maintained in separate premises, even though
operated under the same management. A separate license shall not be required for separate buildings
on the same grounds.

(3) In addition to the requirements of s. 408.806, each license granted by the agency must state
the type of care for which the license is granted. Licenses shall be issued for one or more of the
following categories of care: standard, extended congregate care, limited nursing services, or limited
mental health.

(a) A standard license shall be issued to facilities providing one or more of the personal services
identified in s. 429.02. Such facilities may also employ or contract with a person licensed under part I
of chapter 464 to administer medications and perform other tasks as specified in s. 429.255.

(b) An extended congregate care license shall be issued to each facility that has been licensed as
an assisted living facility for 2 or more years and that provides services, directly or through contract,
beyond those authorized in paragraph (a), including services performed by persons licensed under part
I of chapter 464 and supportive services, as defined by rule, to persons who would otherwise be
disqualified from continued residence in a facility licensed under this part. An extended congregate
care license may be issued to a facility that has a provisional extended congregate care license and
meets the requirements for licensure under subparagraph 2. The primary purpose of extended
congregate care services is to allow residents the option of remaining in a familiar setting from which
they would otherwise be disqualified for continued residency as they become more impaired. A facility
licensed to provide extended congregate care services may also admit an individual who exceeds the
admission criteria for a facility with a standard license, if he or she is determined appropriate for
admission to the extended congregate care facility.

1. In order for extended congregate care services to be provided, the agency must first determine
that all requirements established in law and rule are met and must specifically designate, on the
facility’s license, that such services may be provided and whether the designation applies to all or part
of the facility. This designation may be made at the time of initial licensure or relicensure, or upon
request in writing by a licensee under this part and part II of chapter 408. The notification of approval
or the denial of the request shall be made in accordance with part II of chapter 408. Each existing
facility that qualifies to provide extended congregate care services must have maintained a standard
license and may not have been subject to administrative sanctions during the previous 2 years, or since
initial licensure if the facility has been licensed for less than 2 years, for any of the following reasons:

a. A class I or class II violation;

b. Three or more repeat or recurring class III violations of identical or similar resident care
standards from which a pattern of noncompliance is found by the agency;

c. Three or more class III violations that were not corrected in accordance with the corrective
action plan approved by the agency;

d. Violation of resident care standards which results in requiring the facility to employ the services
of a consultant pharmacist or consultant dietitian;

e. Denial, suspension, or revocation of a license for another facility licensed under this part in
which the applicant for an extended congregate care license has at least 25 percent ownership
interest; or

f. Imposition of a moratorium pursuant to this part or part II of chapter 408 or initiation of

injunctive proceedings.
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.

2. If an assisted living facility has been licensed for less than 2 years, the initial extended
congregate care license must be provisional and may not exceed 6 months. The licensee shall notify
the agency, in writing, when it has admitted at least one extended congregate care resident, after
which an unannounced inspection shall be made to determine compliance with the requirements of an
extended congregate care license. A licensee with a provisional extended congregate care license
which demonstrates compliance with all the requirements of an extended congregate care license
during the inspection shall be issued an extended congregate care license. In addition to sanctions
authorized under this part, if violations are found during the inspection and the licensee fails to
demonstrate compliance with all assisted living facility requirements during a followup inspection, the
licensee shall immediately suspend extended congregate care services, and the provisional extended
congregate care license expires. The agency may extend the provisional license for not more than 1
month in order to complete a followup visit.

3. A facility that is licensed to provide extended congregate care services shall maintain a written
progress report on each person who receives such 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. A registered nurse, or appropriate designee, representing the
agency shall visit the facility at least twice a year to monitor residents who are receiving extended
congregate care services and to determine if the facility is in compliance with this part, part II of
chapter 408, and relevant rules. One of the visits may be in conjunction with the regular survey. The
monitoring visits may be provided through contractual arrangements with appropriate community
agencies. A registered nurse shall serve as part of the team that inspects the facility. The agency may
waive one of the required yearly monitoring visits for a facility that has:

a. Held an extended congregate care license for at least 24 months;

b. No class I or class II violations and no uncorrected class III violations; and

c. No ombudsman council complaints that resulted in a citation for licensure.

4. A facility that is licensed to provide extended congregate care services must:

a. Demonstrate the capability to meet unanticipated resident service needs.

 b. Offer a physical environment that promotes a homelike setting, provides for resident privacy,
promotes resident independence, and allows sufficient congregate space as defined by rule.

c. Have sufficient staff available, taking into account the physical plant and firesafety features of
the building, to assist with the evacuation of residents in an emergency.

d. Adopt and follow policies and procedures that maximize resident independence, dignity, choice,
and decisionmaking to permit residents to age in place, so that moves due to changes in functional
status are minimized or avoided.

e. Allow residents or, if applicable, a resident’s representative, designee, surrogate, guardian, or

attorney in fact to make a variety of personal choices, participate in developing service plans, and
share responsibility in decisionmaking.

f. Implement the concept of managed risk.

g. Provide, directly or through contract, the services of a person licensed under part I of chapter
464.

h. In addition to the training mandated in s. 429.52, provide specialized training as defined by rule
for facility staff.

5. A facility that is licensed to provide extended congregate care services is exempt from the
criteria for continued residency set forth in rules adopted under s. 429.41. A licensed facility must
adopt its own requirements within guidelines for continued residency set forth by rule. However, the
facility may not serve residents who require 24-hour nursing supervision. A licensed facility that
provides extended congregate care services must also provide each resident with a written copy of
facility policies governing admission and retention.

6. Before the admission of an individual to a facility licensed to provide extended congregate care
services, the individual must undergo a medical examination as provided in s. 429.26(5) and the facility
must develop a preliminary service plan for the individual.

7. If a facility can no longer provide or arrange for services in accordance with the resident’s
service plan and needs and the facility’s policy, the facility must make arrangements for relocating the
person in accordance with s. 429.28(1)(k).
 (c) A limited nursing services license shall be issued to a facility that provides services beyond
those authorized in paragraph (a) and as specified in this paragraph.

1. In order for limited nursing services to be provided in a facility licensed under this part, the
agency must first determine that all requirements established in law and rule are met and must
specifically designate, on the facility’s license, that such services may be provided. This designation
may be made at the time of initial licensure or licensure renewal, or upon request in writing by a
licensee under this part and part II of chapter 408. Notification of approval or denial of such request
shall be made in accordance with part II of chapter 408. An existing facility that qualifies to provide
limited nursing services must have maintained a standard license and may not have been subject to
administrative sanctions that affect the health, safety, and welfare of residents for the previous 2
years or since initial licensure if the facility has been licensed for less than 2 years.

2. A facility that is licensed to provide limited nursing services shall maintain a written progress
report on each person who receives such nursing services from the facility’s staff. The report must
describe the type, amount, duration, scope, and outcome of services that are rendered and the general
status of the resident’s health. A registered nurse representing the agency shall visit the facility at
least annually to monitor residents who are receiving limited nursing services and to determine if the
facility is in compliance with applicable provisions of this part, part II of chapter 408, and related
rules. The monitoring visits may be provided through contractual arrangements with appropriate
community agencies. A registered nurse shall also serve as part of the team that inspects such facility.
Visits may be in conjunction with other agency inspections. The agency may waive the required yearly
monitoring visit for a facility that has:

a. Had a limited nursing services license for at least 24 months;

b. No class I or class II violations and no uncorrected class III violations; and

c. No ombudsman council complaints that resulted in a citation for licensure.

3. A person who receives limited nursing services under this part must meet the admission criteria
established by the agency for assisted living facilities. When a resident no longer meets the admission
criteria for a facility licensed under this part, arrangements for relocating the person shall be made in
accordance with s. 429.28(1)(k), unless the facility is licensed to provide extended congregate care
services.
 (4) In accordance with s. 408.805, an applicant or licensee shall pay a fee for each license
application submitted under this part, part II of chapter 408, and applicable rules. The amount of the
fee shall be established by rule.

(a) The biennial license fee required of a facility is $300 per license, with an additional fee of $50
per resident based on the total licensed resident capacity of the facility, except that no additional fee
will be assessed for beds designated for recipients of optional state supplementation payments
provided for in s. 409.212. The total fee may not exceed $10,000.

(b) In addition to the total fee assessed under paragraph (a), the agency shall require facilities that
are licensed to provide extended congregate care services under this part to pay an additional fee per
licensed facility. The amount of the biennial fee shall be $400 per license, with an additional fee of
$10 per resident based on the total licensed resident capacity of the facility.

(c) In addition to the total fee assessed under paragraph (a), the agency shall require facilities that
are licensed to provide limited nursing services under this part to pay an additional fee per licensed
facility. The amount of the biennial fee shall be $250 per license, with an additional fee of $10 per
resident based on the total licensed resident capacity of the facility.

(5) Counties or municipalities applying for licenses under this part are exempt from the payment of
license fees.

History.—s. 6, ch. 75-233; s. 8, ch. 79-12; ss. 12, 16, ch. 80-198; s. 2, ch. 81-318; ss. 43, 79, 83, ch. 83-181; s. 2, ch.
86-104; s. 5, ch. 87-371; s. 11, ch. 89-294; s. 5, ch. 91-263; s. 10, ch. 91-282; s. 22, ch. 93-177; ss. 4, 38, 39, ch. 93-216;
s. 20, ch. 95-146; s. 9, ch. 95-210; ss. 2, 18, 23, ch. 95-418; s. 3, ch. 97-82; s. 18, ch. 97-96; s. 3, ch. 98-80; s. 99, ch.
2000-318; s. 33, ch. 2001-45; ss. 2, 31, ch. 2006-197; s. 101, ch. 2007-5; s. 139, ch. 2007-230; s. 141, ch. 2010-102; s. 6,
ch. 2015-126; s. 2, ch. 2020-68.

Note.—Former s. 400.407.

429.075 Limited mental health license.—An assisted living facility that serves one or more mental
health residents must obtain a limited mental health license.

(1) To obtain a limited mental health license, a facility must hold a standard license as an assisted
living facility, must not have any current uncorrected violations, and must ensure that, within 6 months
after receiving a limited mental health license, the facility administrator and the staff of the facility
who are in direct contact with mental health residents must complete training of no less than 6 hours
related to their duties. This designation may be made at the time of initial licensure or relicensure or
upon request in writing by a licensee under this part and part II of chapter 408. Notification of approval
or denial of such request shall be made in accordance with this part, part II of chapter 408, and
applicable rules. This training must be provided by or approved by the Department of Children and
Families.

(2) A facility that is licensed to provide services to mental health residents must provide
appropriate supervision and staffing to provide for the health, safety, and welfare of such residents.

(3) A facility that has a limited mental health license must:

(a) Have a copy of each mental health resident’s community living support plan and the
cooperative agreement with the mental health care services provider or provide written evidence that
a request for the community living support plan and the cooperative agreement was sent to the
Medicaid managed care plan or managing entity under contract with the Department of Children and
Families within 72 hours after admission. The support plan and the agreement may be combined.

(b) Have documentation provided by the department that each mental health resident has been
assessed and determined to be able to live in the community in an assisted living facility that has a
limited mental health license or provide written evidence that a request for documentation was sent to
the department within 72 hours after admission.

(c) Make the community living support plan available for inspection by the resident, the resident’s
legal guardian or health care surrogate, and other individuals who have a lawful basis for reviewing this
document.

(d) Assist the mental health resident in carrying out the activities identified in the resident’s
community living support plan.

(4) A facility that has a limited mental health license may enter into a cooperative agreement with
a private mental health provider. For purposes of the limited mental health license, the private mental
health provider may act as the case manager.

History.—s. 3, ch. 95-418; s. 37, ch. 96-169; s. 4, ch. 97-82; s. 66, ch. 97-100; s. 4, ch. 98-80; s. 2, ch. 2006-197; s.
140, ch. 2007-230; s. 244, ch. 2014-19; s. 7, ch. 2015-126.
 Note.—Former s. 400.4075.

429.08 Unlicensed facilities; referral of person for residency to unlicensed facility; penalties.—

(1)(a) This section applies to the unlicensed operation of an assisted living facility in addition to the
requirements of part II of chapter 408.

(b) Any person who owns, rents, or otherwise maintains a building or property used as an
unlicensed assisted living facility commits a felony of the third degree, punishable as provided in s.
775.082, s. 775.083, or s. 775.084. Each day of continued operation is a separate offense.

(c) Any person found guilty of violating paragraph (a) a second or subsequent time commits a felony
of the second degree, punishable as provided under s. 775.082, s. 775.083, or s. 775.084. Each day of
continued operation is a separate offense.

(d) In addition to the requirements of s. 408.812, any person who owns, operates, or maintains an
unlicensed assisted living facility after receiving notice from the agency commits a felony of the third
degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. Each day of continued
operation is a separate offense.

(e) The agency shall publish a list, by county, of licensed assisted living facilities. This information
may be provided electronically or through the agency’s Internet site.

(2) It is unlawful to knowingly refer a person for residency to an unlicensed assisted living facility;
to an assisted living facility the license of which is under denial or has been suspended or revoked; or
to an assisted living facility that has a moratorium pursuant to part II of chapter 408.

(a) Any health care practitioner, as defined in s. 456.001, who is aware of the operation of an
unlicensed facility shall report that facility to the agency. Failure to report a facility that the
practitioner knows or has reasonable cause to suspect is unlicensed shall be reported to the
practitioner’s licensing board.

(b) Any provider as defined in s. 408.803 which knowingly discharges a patient or client to an
unlicensed facility is subject to sanction by the agency.
 (c) Any employee of the agency or department, or the Department of Children and Families, who
knowingly refers a person for residency to an unlicensed facility; to a facility the license of which is
under denial or has been suspended or revoked; or to a facility that has a moratorium pursuant to part
II of chapter 408 is subject to disciplinary action by the agency or department, or the Department of
Children and Families.

(d) The employer of any person who is under contract with the agency or department, or the
Department of Children and Families, and who knowingly refers a person for residency to an unlicensed
facility; to a facility the license of which is under denial or has been suspended or revoked; or to a
facility that has a moratorium pursuant to part II of chapter 408 shall be fined and required to prepare
a corrective action plan designed to prevent such referrals.

History.—s. 17, ch. 88-350; s. 6, ch. 91-263; s. 29, ch. 92-33; ss. 5, 39, ch. 93-216; s. 10, ch. 95-210; ss. 4, 48, ch. 95-
418; s. 5, ch. 98-80; s. 1, ch. 99-179; s. 1, ch. 2000-318; s. 36, ch. 2001-62; s. 2, ch. 2004-344; ss. 2, 33, ch. 2006-197; s.
141, ch. 2007-230; s. 60, ch. 2009-223; s. 245, ch. 2014-19; s. 81, ch. 2018-24.

Note.—Former s. 400.408.

429.11 Initial application for license.—

(1) Each applicant for licensure must comply with all provisions of part II of chapter 408 and must:

(a) Identify all other homes or facilities, including the addresses and the license or licenses under
which they operate, if applicable, which are currently operated by the applicant or administrator and
which provide housing, meals, and personal services to residents.

(b) Provide the location of the facility for which a license is sought and documentation, signed by
the appropriate local government official, which states that the applicant has met local zoning
requirements.

(c) Provide the name, address, date of birth, social security number, education, and experience of
the administrator, if different from the applicant.

(2) The applicant shall provide proof of liability insurance as defined in s. 624.605.
 (3) If the applicant is a community residential home, the applicant must provide proof that it has
met the requirements specified in chapter 419.

(4) The applicant must furnish proof that the facility has received a satisfactory firesafety
inspection. The local authority having jurisdiction or the State Fire Marshal must conduct the
inspection within 30 days after written request by the applicant.

(5) The applicant must furnish documentation of a satisfactory sanitation inspection of the facility
by the county health department.

(6) A county or municipality may not issue a business tax receipt that is being obtained for the
purpose of operating a facility regulated under this part without first ascertaining that the applicant
has been licensed to operate such facility at the specified location or locations by the agency. The
agency shall furnish to local agencies responsible for issuing business tax receipts sufficient instruction
for making such determinations.

History.—s. 7, ch. 75-233; s. 3, ch. 77-323; ss. 12, 17, ch. 80-198; s. 2, ch. 81-318; ss. 7, 19, ch. 82-148; ss. 44, 47, 79,
83, ch. 83-181; s. 5, ch. 85-145; s. 1, ch. 85-251; s. 6, ch. 87-371; s. 12, ch. 89-294; s. 7, ch. 91-263; ss. 6, 38, 39, ch. 93-
216; s. 5, ch. 95-418; s. 6, ch. 98-80; s. 42, ch. 98-171; ss. 2, 34, ch. 2006-197; s. 142, ch. 2007-230; s. 3, ch. 2020-68; s.
46, ch. 2020-156.

Note.—Former s. 400.411.

429.12 Sale or transfer of ownership of a facility.—It is the intent of the Legislature to protect
the rights of the residents of an assisted living facility when the facility is sold or the ownership thereof
is transferred. Therefore, in addition to the requirements of part II of chapter 408, whenever a facility
is sold or the ownership thereof is transferred, including leasing:

(1) The transferee shall notify the residents, in writing, of the change of ownership within 7 days
after receipt of the new license.

(2) The transferor of a facility the license of which is denied pending an administrative hearing
shall, as a part of the written change-of-ownership contract, advise the transferee that a plan of
correction must be submitted by the transferee and approved by the agency at least 7 days before the
change of ownership and that failure to correct the condition which resulted in the moratorium
pursuant to part II of chapter 408 or denial of licensure is grounds for denial of the transferee’s license.
 History.—ss. 45, 83, ch. 83-181; s. 7, ch. 87-371; s. 8, ch. 91-263; ss. 7, 38, 39, ch. 93-216; s. 772, ch. 95-148; s. 11,
ch. 95-210; s. 6, ch. 95-418; ss. 2, 35, ch. 2006-197; s. 143, ch. 2007-230.

Note.—Former s. 400.412.

429.14 Administrative penalties.—

(1) In addition to the requirements of part II of chapter 408, the agency may deny, revoke, and
suspend any license issued under this part and impose an administrative fine in the manner provided in
chapter 120 against a licensee for a violation of any provision of this part, part II of chapter 408, or
applicable rules, or for any of the following actions by a licensee, any person subject to level 2
background screening under s. 408.809, or any facility staff:

(a) An intentional or negligent act seriously affecting the health, safety, or welfare of a resident of
the facility.

(b) A determination by the agency that the owner lacks the financial ability to provide continuing
adequate care to residents.

(c) Misappropriation or conversion of the property of a resident of the facility.

(d) Failure to follow the criteria and procedures provided under part I of chapter 394 relating to
the transportation, voluntary admission, and involuntary examination of a facility resident.

(e) A citation for any of the following violations as specified in s. 429.19:

1. One or more cited class I violations.

2. Three or more cited class II violations.

3. Five or more cited class III violations that have been cited on a single survey and have not been
corrected within the times specified.

(f) Failure to comply with the background screening standards of this part, s. 408.809(1), or
chapter 435.
 (g) Violation of a moratorium.

(h) Failure of the license applicant, the licensee during relicensure, or a licensee that holds a
provisional license to meet the minimum license requirements of this part, or related rules, at the time
of license application or renewal.

(i) An intentional or negligent life-threatening act in violation of the uniform firesafety standards
for assisted living facilities or other firesafety standards which threatens the health, safety, or welfare
of a resident of a facility, as communicated to the agency by the local authority having jurisdiction or
the State Fire Marshal.

(j) Knowingly operating any unlicensed facility or providing without a license any service that must
be licensed under this chapter or chapter 400.

(k) Any act constituting a ground upon which application for a license may be denied.

(2) Upon notification by the local authority having jurisdiction or by the State Fire Marshal, the
agency may deny or revoke the license of an assisted living facility that fails to correct cited fire code
violations that affect or threaten the health, safety, or welfare of a resident of a facility.

(3) The agency may deny a license of an applicant or a controlling interest as defined in part II of
chapter 408 which has or had a 25 percent or greater financial or ownership interest in any other
facility that is licensed under this part, or in any entity licensed by this state or another state to
provide health or residential care, if that facility or entity during the 5 years prior to the application
for a license closed due to financial inability to operate; had a receiver appointed or a license denied,
suspended, or revoked; was subject to a moratorium; or had an injunctive proceeding initiated against
it.

(4) The agency shall deny or revoke the license of an assisted living facility if:

(a) There are two moratoria, issued pursuant to this part or part II of chapter 408, within a 2-year
period which are imposed by final order;

(b) The facility is cited for two or more class I violations arising from unrelated circumstances
during the same survey or investigation; or
 (c) The facility is cited for two or more class I violations arising from separate surveys or
investigations within a 2-year period.

(5) An action taken by the agency to suspend, deny, or revoke a facility’s license under this part or
part II of chapter 408, in which the agency claims that the facility owner or an employee of the facility
has threatened the health, safety, or welfare of a resident of the facility, shall be heard by the Division
of Administrative Hearings of the Department of Management Services within 120 days after receipt of
the facility’s request for a hearing, unless that time limitation is waived by both parties. The
administrative law judge shall render a decision within 30 days after receipt of a proposed
recommended order.

(6) As provided under s. 408.814, the agency shall impose an immediate moratorium on an assisted
living facility that fails to provide the agency with access to the facility or prohibits the agency from
conducting a regulatory inspection. The licensee may not restrict agency staff from accessing and
copying records at the agency’s expense or from conducting confidential interviews with facility staff
or any individual who receives services from the facility.

(7) Agency notification of a license suspension or revocation, or denial of a license renewal, shall
be posted and visible to the public at the facility.

(8) If a facility is required to relocate some or all of its residents due to agency action, that facility
is exempt from the 45-day notice requirement imposed under s. 429.28(1)(k). This subsection does not
exempt the facility from any deadlines for corrective action set by the agency.

History.—s. 8, ch. 75-233; ss. 12, 18, ch. 80-198; s. 2, ch. 81-318; ss. 46, 79, 83, ch. 83-181; s. 8, ch. 87-371; s. 13, ch.
89-294; s. 30, ch. 91-71; s. 46, ch. 92-58; ss. 8, 38, 39, ch. 93-216; s. 50, ch. 94-218; s. 39, ch. 95-228; s. 7, ch. 95-418;
s. 38, ch. 96-169; s. 126, ch. 96-410; s. 7, ch. 98-80; s. 43, ch. 98-171; s. 73, ch. 2000-349; s. 34, ch. 2001-45; s. 19, ch.
2003-57; s. 13, ch. 2004-267; ss. 2, 36, ch. 2006-197; s. 144, ch. 2007-230; s. 61, ch. 2009-223; s. 28, ch. 2010-114; s.
108, ch. 2014-17; s. 8, ch. 2015-126.

Note.—Former s. 400.414.

429.17 Expiration of license; renewal; conditional license.—

(1) Limited nursing, extended congregate care, and limited mental health licenses shall expire at
the same time as the facility’s standard license, regardless of when issued.
 (2) A license shall be renewed in accordance with part II of chapter 408 and the provision of
satisfactory proof of ability to operate and conduct the facility in accordance with the requirements of
this part and adopted rules, including proof that the facility has received a satisfactory firesafety
inspection, conducted by the local authority having jurisdiction or the State Fire Marshal, within the
preceding 12 months.

(3) In addition to the requirements of part II of chapter 408, each facility must report to the agency
any adverse court action concerning the facility’s financial viability, within 7 days after its occurrence.
The agency shall have access to books, records, and any other financial documents maintained by the
facility to the extent necessary to determine the facility’s financial stability.

(4) In addition to the license categories available in s. 408.808, a conditional license may be issued
to an applicant for license renewal if the applicant fails to meet all standards and requirements for
licensure. A conditional license issued under this subsection shall be limited in duration to a specific
period of time not to exceed 6 months, as determined by the agency, and shall be accompanied by an
agency-approved plan of correction.

(5) When an extended care or limited nursing license is requested during a facility’s biennial license
period, the fee shall be prorated in order to permit the additional license to expire at the end of the
biennial license period. The fee shall be calculated as of the date the additional license application is
received by the agency.

(6) The agency may by rule establish renewal procedures, identify forms, and specify
documentation necessary to administer this section and may adopt rules to administer part II of
chapter 408.

History.—s. 9, ch. 75-233; ss. 12, 19, ch. 80-198; s. 2, ch. 81-318; ss. 9, 19, ch. 82-148; ss. 47, 79, 83, ch. 83-181; s. 2,
ch. 88-350; s. 14, ch. 89-294; s. 9, ch. 91-263; s. 23, ch. 93-177; ss. 10, 38, 39, ch. 93-216; s. 9, ch. 95-418; s. 9, ch. 98-
80; s. 44, ch. 98-171; s. 212, ch. 99-13; s. 20, ch. 2003-57; ss. 2, 38, ch. 2006-197; s. 146, ch. 2007-230; s. 9, ch. 2019-
11.

Note.—Former s. 400.417.

429.174 Background screening.—The agency shall require level 2 background screening for
personnel as required in s. 408.809(1)(e) pursuant to chapter 435 and s. 408.809.
 History.—ss. 15, 25, ch. 89-294; ss. 11, 38, 39, ch. 93-216; s. 10, ch. 98-80; ss. 45, 71, ch. 98-171; s. 142, ch. 98-403;
s. 213, ch. 99-13; s. 74, ch. 2000-349; s. 25, ch. 2001-53; s. 2, ch. 2001-67; s. 148, ch. 2001-277; s. 418, ch. 2003-261; s.
14, ch. 2004-267; ss. 2, 39, ch. 2006-197; s. 147, ch. 2007-230; s. 29, ch. 2010-114.

Note.—Former s. 400.4174.

429.176 Notice of change of administrator.—If, during the period for which a license is issued, the
owner changes administrators, the owner must notify the agency of the change within 10 days and
provide documentation within 90 days that the new administrator meets educational requirements and
has completed the applicable core educational requirements under s. 429.52. A facility may not be
operated for more than 120 consecutive days without an administrator who has completed the core
educational requirements.

History.—ss. 44, 83, ch. 83-181; s. 10, ch. 91-263; ss. 12, 38, 39, ch. 93-216; ss. 10, 24, ch. 95-418; s. 11, ch. 98-80; s.
46, ch. 98-171; ss. 2, 40, ch. 2006-197; s. 148, ch. 2007-230; s. 82, ch. 2018-24; s. 4, ch. 2020-68.

Note.—Former s. 400.4176.

429.177 Patients with Alzheimer’s disease or other related disorders; certain disclosures.—A
facility licensed under this part which claims that it provides special care for persons who have
Alzheimer’s disease or other related disorders must disclose in its advertisements or in a separate
document those services that distinguish the care as being especially applicable to, or suitable for,
such persons. The facility must give a copy of all such advertisements or a copy of the document to
each person who requests information about programs and services for persons with Alzheimer’s
disease or other related disorders offered by the facility and must maintain a copy of all such
advertisements and documents in its records. The agency shall examine all such advertisements and
documents in the facility’s records as part of the license renewal procedure.

History.—s. 2, ch. 93-105; s. 2, ch. 2006-197.

Note.—Former s. 400.4177.

429.178 Special care for persons with Alzheimer’s disease or other related disorders.—

(1) A facility which advertises that it provides special care for persons with Alzheimer’s disease or
other related disorders must meet the following standards of operation:
 (a)1. If the facility has 17 or more residents, have an awake staff member on duty at all hours of
the day and night; or

2. If the facility has fewer than 17 residents, have an awake staff member on duty at all hours of
the day and night or have mechanisms in place to monitor and ensure the safety of the facility’s
residents.

(b) Offer activities specifically designed for persons who are cognitively impaired.

(c) Have a physical environment that provides for the safety and welfare of the facility’s residents.

(d) Employ staff who have completed the training and continuing education required in subsection
(2).

(2)(a) An individual who is employed by a facility that provides special care for residents who have
Alzheimer’s disease or other related disorders, and who has regular contact with such residents, must
complete up to 4 hours of initial dementia-specific training developed or approved by the department.
The training must be completed within 3 months after beginning employment and satisfy the core
training requirements of s. 429.52(3)(g).

(b) A direct caregiver who is employed by a facility that provides special care for residents who
have Alzheimer’s disease or other related disorders and provides direct care to such residents must
complete the required initial training and 4 additional hours of training developed or approved by the
department. The training must be completed within 9 months after beginning employment and satisfy
the core training requirements of s. 429.52(3)(g).

(c) An individual who is employed by a facility that provides special care for residents with
Alzheimer’s disease or other related disorders, but who only has incidental contact with such residents,
must be given, at a minimum, general information on interacting with individuals with Alzheimer’s
disease or other related disorders, within 3 months after beginning employment.

(3) In addition to the training required under subsection (2), a direct caregiver must participate in a
minimum of 4 contact hours of continuing education each calendar year. The continuing education
must include one or more topics included in the dementia-specific training developed or approved by
the department, in which the caregiver has not received previous training.
 (4) Upon completing any training listed in subsection (2), the employee or direct caregiver shall be
issued a certificate that includes the name of the training provider, the topic covered, and the date
and signature of the training provider. The certificate is evidence of completion of training in the
identified topic, and the employee or direct caregiver is not required to repeat training in that topic if
the employee or direct caregiver changes employment to a different facility. The employee or direct
caregiver must comply with other applicable continuing education requirements.

(5) The department, or its designee, shall approve the initial and continuing education courses and
providers.

(6) The department shall keep a current list of providers who are approved to provide initial and
continuing education for staff of facilities that provide special care for persons with Alzheimer’s
disease or other related disorders.

(7) Any facility more than 90 percent of whose residents receive monthly optional supplementation
payments is not required to pay for the training and education programs required under this section. A
facility that has one or more such residents shall pay a reduced fee that is proportional to the
percentage of such residents in the facility. A facility that does not have any residents who receive
monthly optional supplementation payments must pay a reasonable fee, as established by the
department, for such training and education programs.

(8) The department shall adopt rules to establish standards for trainers and training and to
implement this section.

History.—s. 15, ch. 97-82; ss. 2, 41, ch. 2006-197; s. 9, ch. 2015-126.

Note.—Former s. 400.4178.

429.18 Disposition of fees and administrative fines.—Income from fees and fines collected under
this part shall be directed to and used by the agency for the following purposes:

(1) Up to 50 percent of the trust funds accrued each fiscal year under this part may be used to
offset the expenses of receivership, pursuant to s. 429.22, if the court determines that the income and
assets of the facility are insufficient to provide for adequate management and operation.
 (2) An amount of $5,000 of the trust funds accrued each year under this part shall be allocated to
pay for inspection-related physical and mental health examinations requested by the agency pursuant
to s. 429.26 for residents who are either recipients of supplemental security income or have monthly
incomes not in excess of the maximum combined federal and state cash subsidies available to
supplemental security income recipients, as provided for in s. 409.212. Such funds shall only be used
where the resident is ineligible for Medicaid.

(3) Any trust funds accrued each year under this part and not used for the purposes specified in
subsections (1) and (2) shall be used to offset the costs of the licensure program, verifying information
submitted, defraying the costs of processing the names of applicants, and conducting inspections and
monitoring visits pursuant to this part and part II of chapter 408.

History.—ss. 12, 20, ch. 80-198; s. 2, ch. 81-318; ss. 8, 19, ch. 82-148; ss. 48, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218;
s. 16, ch. 89-294; s. 11, ch. 91-263; s. 11, ch. 91-282; ss. 13, 38, 39, ch. 93-216; s. 19, ch. 95-418; s. 12, ch. 98-80; ss. 2,
42, ch. 2006-197; s. 149, ch. 2007-230.

Note.—Former s. 400.418.

429.19 Violations; imposition of administrative fines; grounds.—

(1) In addition to the requirements of part II of chapter 408, the agency shall impose an
administrative fine in the manner provided in chapter 120 for the violation of any provision of this part,
part II of chapter 408, and applicable rules by an assisted living facility, for the actions of any person
subject to level 2 background screening under s. 408.809, for the actions of any facility employee, or
for an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the
facility.

(2) Each violation of this part and adopted rules shall be classified according to the nature of the
violation and the gravity of its probable effect on facility residents. The agency shall indicate the
classification on the written notice of the violation as follows:

(a) Class “I” violations are defined in s. 408.813. The agency shall impose an administrative fine for
a cited class I violation in an amount not less than $5,000 and not exceeding $10,000 for each violation.
 (b) Class “II” violations are defined in s. 408.813. The agency shall impose an administrative fine
for a cited class II violation in an amount not less than $1,000 and not exceeding $5,000 for each
violation.

(c) Class “III” violations are defined in s. 408.813. The agency shall impose an administrative fine
for a cited class III violation in an amount not less than $500 and not exceeding $1,000 for each
violation.

(d) Class “IV” violations are defined in s. 408.813. The agency shall impose an administrative fine
for a cited class IV violation in an amount not less than $100 and not exceeding $200 for each violation.

(e) Regardless of the class of violation cited, instead of the fine amounts listed in paragraphs (a)-
(d), the agency shall impose an administrative fine of $500 if a facility is found not to be in compliance
with the background screening requirements as provided in s. 408.809.

(3) For purposes of this section, in determining if a penalty is to be imposed and in fixing the
amount of the fine, the agency shall consider the following factors:

(a) The gravity of the violation, including the probability that death or serious physical or
emotional harm to a resident will result or has resulted, the severity of the action or potential harm,
and the extent to which the provisions of the applicable laws or rules were violated.

(b) Actions taken by the owner or administrator to correct violations.

(c) Any previous violations.

(d) The financial benefit to the facility of committing or continuing the violation.

(e) The licensed capacity of the facility.

(4) Each day of continuing violation after the date fixed for termination of the violation, as ordered
by the agency, constitutes an additional, separate, and distinct violation.

(5) Any action taken to correct a violation shall be documented in writing by the owner or
administrator of the facility and verified through followup visits by agency personnel. The agency may
impose a fine and, in the case of an owner-operated facility, revoke or deny a facility’s license when a
facility administrator fraudulently misrepresents action taken to correct a violation.

(6) Any facility whose owner fails to apply for a change-of-ownership license in accordance with
part II of chapter 408 and operates the facility under the new ownership is subject to a fine of $5,000.

(7) In addition to any administrative fines imposed, the agency may assess a survey fee, equal to
the lesser of one half of the facility’s biennial license and bed fee or $500, to cover the cost of
conducting initial complaint investigations that result in the finding of a violation that was the subject
of the complaint or monitoring visits conducted to verify the correction of the violations.

(8) During an inspection, the agency shall make a reasonable attempt to discuss each violation with
the owner or administrator of the facility, prior to written notification.

History.—ss. 12, 21, ch. 80-198; s. 254, ch. 81-259; s. 2, ch. 81-318; ss. 49, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s.
17, ch. 89-294; s. 12, ch. 91-263; ss. 14, 38, 39, ch. 93-216; s. 13, ch. 98-80; s. 2, ch. 99-179; s. 19, ch. 2000-263; s. 142,
ch. 2000-349; s. 62, ch. 2000-367; s. 35, ch. 2001-45; s. 21, ch. 2003-57; ss. 2, 43, ch. 2006-197; s. 41, ch. 2006-227; s.
150, ch. 2007-230; s. 62, ch. 2009-223; s. 246, ch. 2014-19; s. 35, ch. 2015-31; s. 10, ch. 2015-126; s. 83, ch. 2018-24; s.
47, ch. 2020-156.

Note.—Former s. 400.419.

429.195 Rebates prohibited; penalties.—

(1) An assisted living facility licensed under this part may not contract or promise to pay or receive
any commission, bonus, kickback, or rebate or engage in any split-fee arrangement in any form
whatsoever with any person, health care provider, or health care facility as provided under s. 817.505.

(2) This section does not apply to:

(a) An individual employed by the assisted living facility, or with whom the facility contracts to
provide marketing services for the facility, if the individual clearly indicates that he or she works with
or for the facility.
 (b) Payments by an assisted living facility to a referral service that provides information,
consultation, or referrals to consumers to assist them in finding appropriate care or housing options for
seniors or disabled adults if the referred consumers are not Medicaid recipients.

(c) A resident of an assisted living facility who refers a friend, family members, or other individuals
with whom the resident has a personal relationship to the assisted living facility, in which case the
assisted living facility may provide a monetary reward to the resident for making such referral.

(3) A violation of this section is patient brokering and is punishable as provided in s. 817.505.

History.—ss. 18, 25, ch. 89-294; s. 13, ch. 91-263; ss. 15, 38, 39, ch. 93-216; s. 773, ch. 95-148; s. 12, ch. 95-210; s.
14, ch. 98-80; s. 2, ch. 2006-197; s. 29, ch. 2012-160.

Note.—Former s. 400.4195.

429.20 Certain solicitation prohibited; third-party supplementation.—

(1) A person may not, in connection with the solicitation of contributions by or on behalf of an
assisted living facility or facilities, misrepresent or mislead any person, by any manner, means,
practice, or device whatsoever, to believe that the receipts of such solicitation will be used for
charitable purposes, if that is not the fact.

(2) Solicitation of contributions of any kind in a threatening, coercive, or unduly forceful manner by
or on behalf of an assisted living facility or facilities by any agent, employee, owner, or representative
of any assisted living facility or facilities is grounds for denial, suspension, or revocation of the license
of the assisted living facility or facilities by or on behalf of which such contributions were solicited.

(3) The admission or maintenance of assisted living facility residents whose care is supported, in
whole or in part, by state funds may not be conditioned upon the receipt of any manner of contribution
or donation from any person. The solicitation or receipt of contributions in violation of this subsection
is grounds for denial, suspension, or revocation of license, as provided in s. 429.14, for any assisted
living facility by or on behalf of which such contributions were solicited.

(4) An assisted living facility may accept additional supplementation from third parties on behalf of
residents receiving optional state supplementation in accordance with s. 409.212.
 History.—ss. 50, 83, ch. 83-181; ss. 16, 38, 39, ch. 93-216; s. 13, ch. 95-210; ss. 2, 44, ch. 2006-197.

Note.—Former s. 400.42.

429.22 Receivership proceedings.—

(1) As an alternative to or in conjunction with an injunctive proceeding, the agency may petition a
court of competent jurisdiction for the appointment of a receiver, if suitable alternate placements are
not available, when any of the following conditions exist:

(a) The facility is operating without a license and refuses to make application for a license as
required by ss. 429.07 and 429.08.

(b) The facility is closing or has informed the agency that it intends to close and adequate
arrangements have not been made for relocation of the residents within 7 days, exclusive of weekends
and holidays, of the closing of the facility.

(c) The agency determines there exist in the facility conditions which present an imminent danger
to the health, safety, or welfare of the residents of the facility or a substantial probability that death
or serious physical harm would result therefrom.

(d) The facility cannot meet its financial obligation for providing food, shelter, care, and utilities.

(2) Petitions for receivership shall take precedence over other court business unless the court
determines that some other pending proceeding, having similar statutory precedence, shall have
priority. A hearing shall be conducted within 5 days of the filing of the petition, at which time all
interested parties shall have the opportunity to present evidence pertaining to the petition. The
agency shall notify, by certified mail, the owner or administrator of the facility named in the petition
and the facility resident or, if applicable, the resident’s representative or designee, or the resident’s
surrogate, guardian, or attorney in fact, of its filing, the substance of the violation, and the date and
place set for the hearing. The court shall grant the petition only upon finding that the health, safety,
or welfare of facility residents would be threatened if a condition existing at the time the petition was
filed is permitted to continue. A receiver shall not be appointed ex parte unless the court determines
that one or more of the conditions in subsection (1) exist; that the facility owner or administrator
cannot be found; that all reasonable means of locating the owner or administrator and notifying him or
her of the petition and hearing have been exhausted; or that the owner or administrator after
notification of the hearing chooses not to attend. After such findings, the court may appoint any
qualified person as a receiver, except it may not appoint any owner or affiliate of the facility which is
in receivership. The receiver may be selected from a list of persons qualified to act as receivers
developed by the agency and presented to the court with each petition for receivership. Under no
circumstances may the agency or designated agency employee be appointed as a receiver for more
than 60 days; however, the receiver may petition the court, one time only, for a 30-day extension. The
court shall grant the extension upon a showing of good cause.

(3) The receiver must make provisions for the continued health, safety, and welfare of all residents
of the facility and:

(a) Shall exercise those powers and perform those duties set out by the court.

(b) Shall operate the facility in such a manner as to assure safety and adequate health care for the
residents.

(c) Shall take such action as is reasonably necessary to protect or conserve the assets or property of
the facility for which the receiver is appointed, or the proceeds from any transfer thereof, and may use
them only in the performance of the powers and duties set forth in this section and by order of the
court.

(d) May use the building, fixtures, furnishings, and any accompanying consumable goods in the
provision of care and services to residents and to any other persons receiving services from the facility
at the time the petition for receivership was filed. The receiver shall collect payments for all goods
and services provided to residents or others during the period of the receivership at the same rate of
payment charged by the owners at the time the petition for receivership was filed, or at a fair and
reasonable rate otherwise approved by the court.

(e) May correct or eliminate any deficiency in the structure or furnishings of the facility which
endangers the safety or health of residents while they remain in the facility, if the total cost of
correction does not exceed $10,000. The court may order expenditures for this purpose in excess of
$10,000 on application from the receiver after notice to the owner and a hearing.

(f) May let contracts and hire agents and employees to carry out the powers and duties of the
receiver.
 (g) Shall honor all leases, mortgages, and secured transactions governing the building in which the
facility is located and all goods and fixtures in the building of which the receiver has taken possession,
but only to the extent of payments which, in the case of a rental agreement, are for the use of the
property during the period of the receivership, or which, in the case of a purchase agreement, become
due during the period of the receivership.

(h) Shall have full power to direct and manage and to discharge employees of the facility, subject
to any contract rights they may have. The receiver shall pay employees at the rate of compensation,
including benefits, approved by the court. A receivership does not relieve the owner of any obligation
to employees made prior to the appointment of a receiver and not carried out by the receiver.

(i) Shall be entitled to and take possession of all property or assets of residents which are in the
possession of a facility or its owner. The receiver shall preserve all property, assets, and records of
residents of which the receiver takes possession and shall provide for the prompt transfer of the
property, assets, and records to the new placement of any transferred resident. An inventory list
certified by the owner and receiver shall be made immediately at the time the receiver takes
possession of the facility.

(4)(a) A person who is served with notice of an order of the court appointing a receiver and of the
receiver’s name and address shall be liable to pay the receiver for any goods or services provided by
the receiver after the date of the order if the person would have been liable for the goods or services
as supplied by the owner. The receiver shall give a receipt for each payment and shall keep a copy of
each receipt on file. The receiver shall deposit accounts received in a separate account and shall use
this account for all disbursements.

(b) The receiver may bring an action to enforce the liability created by paragraph (a).

(c) A payment to the receiver of any sum owing to the facility or its owner shall discharge any
obligation to the facility to the extent of the payment.

(5)(a) A receiver may petition the court that he or she not be required to honor any lease,
mortgage, secured transaction, or other wholly or partially executory contract entered into by the
owner of the facility if the rent, price, or rate of interest required to be paid under the agreement was
substantially in excess of a reasonable rent, price, or rate of interest at the time the contract was
entered into, or if any material provision of the agreement was unreasonable, when compared to
contracts negotiated under similar conditions. Any relief in this form provided by the court shall be
limited to the life of the receivership, unless otherwise determined by the court.

(b) If the receiver is in possession of real estate or goods subject to a lease, mortgage, or security
interest which the receiver has obtained a court order to avoid under paragraph (a), and if the real
estate or goods are necessary for the continued operation of the facility under this section, the
receiver may apply to the court to set a reasonable rental, price, or rate of interest to be paid by the
receiver during the duration of the receivership. The court shall hold a hearing on the application
within 15 days. The receiver shall send notice of the application to any known persons who own the
property involved at least 10 days prior to the hearing. Payment by the receiver of the amount
determined by the court to be reasonable is a defense to any action against the receiver for payment
or for possession of the goods or real estate subject to the lease, security interest, or mortgage
involved by any person who received such notice, but the payment does not relieve the owner of the
facility of any liability for the difference between the amount paid by the receiver and the amount due
under the original lease, security interest, or mortgage involved.

(6) The court shall set the compensation of the receiver, which will be considered a necessary
expense of a receivership.

(7) A receiver may be held liable in a personal capacity only for the receiver’s own gross
negligence, intentional acts, or breach of fiduciary duty.

(8) The court may require a receiver to post a bond.

(9) The court may direct the agency to allocate funds from the Health Care Trust Fund to the
receiver, subject to the provisions of s. 429.18.

(10) The court may terminate a receivership when:

(a) The court determines that the receivership is no longer necessary because the conditions which
gave rise to the receivership no longer exist or the agency grants the facility a new license; or

(b) All of the residents in the facility have been transferred or discharged.
 (11) Within 30 days after termination, the receiver shall give the court a complete accounting of all
property of which the receiver has taken possession, of all funds collected, and of the expenses of the
receivership.

(12) Nothing in this section shall be deemed to relieve any owner, administrator, or employee of a
facility placed in receivership of any civil or criminal liability incurred, or any duty imposed by law, by
reason of acts or omissions of the owner, administrator, or employee prior to the appointment of a
receiver; nor shall anything contained in this section be construed to suspend during the receivership
any obligation of the owner, administrator, or employee for payment of taxes or other operating and
maintenance expenses of the facility or of the owner, administrator, employee, or any other person for
the payment of mortgages or liens. The owner shall retain the right to sell or mortgage any facility
under receivership, subject to approval of the court which ordered the receivership.

History.—ss. 12, 22, ch. 80-198; s. 255, ch. 81-259; s. 2, ch. 81-318; ss. 51, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s.
14, ch. 91-263; ss. 18, 38, 39, ch. 93-216; s. 774, ch. 95-148; s. 15, ch. 98-80; ss. 2, 45, ch. 2006-197; s. 152, ch. 2007-
230.

Note.—Former s. 400.422.

429.23 Internal risk management and quality assurance program; adverse incidents and
reporting requirements.—

(1) Every facility licensed under this part may, as part of its administrative functions, voluntarily
establish a risk management and quality assurance program, the purpose of which is to assess resident
care practices, facility incident reports, deficiencies cited by the agency, adverse incident reports, and
resident grievances and develop plans of action to correct and respond quickly to identify quality
differences.

(2) Every facility licensed under this part is required to maintain adverse incident reports. For
purposes of this section, the term, “adverse incident” means:

(a) An event over which facility personnel could exercise control rather than as a result of the
resident’s condition and 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. 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, through the agency’s online portal, or if the portal is offline, by electronic 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 status of the facility’s investigation of the incident.

(4) Licensed facilities shall provide within 15 days, through the agency’s online portal, or if the
portal is offline, by electronic mail, a full report to the agency on all adverse incidents specified in this
section. The report must include the results of the facility’s investigation into the adverse incident.

(5) Three business days before the deadline for the submission of the full report required under
subsection (4), the agency shall send by electronic mail a reminder to the facility’s administrator and
other specified facility contacts. Within 3 business days after the agency sends the reminder, a facility
is not subject to any administrative or other agency action for failing to withdraw the preliminary
report if the facility determines the event was not an adverse incident or for failing to file a full report
if the facility determines the event was an adverse incident.

(6) Abuse, neglect, or exploitation must be reported to the Department of Children and Families as
required under chapter 415.
 (7) The information reported to the agency pursuant to subsection (3) which relates to persons
licensed under chapter 458, chapter 459, chapter 461, chapter 464, or chapter 465 shall be reviewed
by the agency. The agency shall determine whether any of the incidents potentially involved conduct
by a health care professional who is subject to disciplinary action, in which case the provisions of s.
456.073 apply. The agency may investigate, as it deems appropriate, any such incident and prescribe
measures that must or may be taken in response to the incident. The agency shall review each incident
and determine whether it potentially involved conduct by a health care professional who is subject to
disciplinary action, in which case the provisions of s. 456.073 apply.

(8) If the agency, through its receipt of the adverse incident reports prescribed in this part or
through any investigation, has reasonable belief that conduct by a staff member or employee of a
licensed facility is grounds for disciplinary action by the appropriate board, the agency shall report this
fact to such regulatory board.

(9) The adverse incident reports and preliminary adverse incident reports required under this
section are confidential as provided by law and are not discoverable or admissible in any civil or
administrative action, except in disciplinary proceedings by the agency or appropriate regulatory
board.

(10) The agency may adopt rules necessary to administer this section.

History.—s. 36, ch. 2001-45; s. 2, ch. 2006-197; s. 63, ch. 2009-223; s. 247, ch. 2014-19; s. 10, ch. 2019-11; s. 5, ch.
2020-68.

Note.—Former s. 400.423.

429.24 Contracts.—

(1) The presence of each resident in a facility shall be covered by a contract, executed at the time
of admission or prior thereto, between the licensee and the resident or his or her designee or legal
representative. Each party to the contract shall be provided with a duplicate original thereof, and the
licensee shall keep on file in the facility all such contracts. The licensee may not destroy or otherwise
dispose of any such contract until 5 years after its expiration.

(2) Each contract must contain express provisions specifically setting forth the services and
accommodations to be provided by the facility; the rates or charges; provision for at least 30 days’
written notice of a rate increase; the rights, duties, and obligations of the residents, other than those
specified in s. 429.28; and other matters that the parties deem appropriate. A new service or
accommodation added to, or implemented in, a resident’s contract for which the resident was not
previously charged does not require a 30-day written notice of a rate increase. Whenever money is
deposited or advanced by a resident in a contract as security for performance of the contract
agreement or as advance rent for other than the next immediate rental period:

(a) Such funds shall be deposited in a banking institution in this state that is located, if possible, in
the same community in which the facility is located; shall be kept separate from the funds and
property of the facility; may not be represented as part of the assets of the facility on financial
statements; and shall be used, or otherwise expended, only for the account of the resident.

(b) The licensee shall, within 30 days of receipt of advance rent or a security deposit, notify the
resident or residents in writing of the manner in which the licensee is holding the advance rent or
security deposit and state the name and address of the depository where the moneys are being held.
The licensee shall notify residents of the facility’s policy on advance deposits.

(3)(a) The contract shall include a refund policy to be implemented at the time of a resident’s
transfer, discharge, or death. The refund policy shall provide that the resident or responsible party is
entitled to a prorated refund based on the daily rate for any unused portion of payment beyond the
termination date after all charges, including the cost of damages to the residential unit resulting from
circumstances other than normal use, have been paid to the licensee. For the purpose of this
paragraph, the termination date shall be the date the unit is vacated by the resident and cleared of all
personal belongings. If the amount of belongings does not preclude renting the unit, the facility may
clear the unit and charge the resident or his or her estate for moving and storing the items at a rate
equal to the actual cost to the facility, not to exceed 20 percent of the regular rate for the unit,
provided that 14 days’ advance written notification is given. If the resident’s possessions are not
claimed within 45 days after notification, the facility may dispose of them. The contract shall also
specify any other conditions under which claims will be made against the refund due the resident.
Except in the case of death or a discharge due to medical reasons, the refunds shall be computed in
accordance with the notice of relocation requirements specified in the contract. However, a resident
may not be required to provide the licensee with more than 30 days’ notice of termination. If after a
contract is terminated, the facility intends to make a claim against a refund due the resident, the
facility shall notify the resident or responsible party in writing of the claim and shall provide said party
with a reasonable time period of no less than 14 calendar days to respond. The facility shall provide a
refund to the resident or responsible party within 45 days after the transfer, discharge, or death of the
resident. The agency shall impose a fine upon a facility that fails to comply with the refund provisions
of the paragraph, which fine shall be equal to three times the amount due to the resident. One-half of
the fine shall be remitted to the resident or his or her estate, and the other half to the Health Care
Trust Fund to be used for the purpose specified in s. 429.18.

(b) If a licensee agrees to reserve a bed for a resident who is admitted to a medical facility,
including, but not limited to, a nursing home, health care facility, or psychiatric facility, the resident
or his or her responsible party shall notify the licensee of any change in status that would prevent the
resident from returning to the facility. Until such notice is received, the agreed-upon daily rate may be
charged by the licensee.

(c) The purpose of any advance payment and a refund policy for such payment, including any
advance payment for housing, meals, or personal services, shall be covered in the contract.

(4) The contract shall state whether or not the facility is affiliated with any religious organization
and, if so, which organization and its general responsibility to the facility.

(5) Neither the contract nor any provision thereof relieves any licensee of any requirement or
obligation imposed upon it by this part or rules adopted under this part.

(6) In lieu of the provisions of this section, facilities certified under chapter 651 shall comply with
the requirements of s. 651.055.

(7) Notwithstanding the provisions of this section, facilities which consist of 60 or more apartments
may require refund policies and termination notices in accordance with the provisions of part II of
chapter 83, provided that the lease is terminated automatically without financial penalty in the event
of a resident’s death or relocation due to psychiatric hospitalization or to medical reasons which
necessitate services or care beyond which the facility is licensed to provide. The date of termination in
such instances shall be the date the unit is fully vacated. A lease may be substituted for the contract if
it meets the disclosure requirements of this section. For the purpose of this section, the term
“apartment” means a room or set of rooms with a kitchen or kitchenette and lavatory located within
one or more buildings containing other similar or like residential units.

(8) The agency may by rule clarify terms, establish procedures, clarify refund policies and contract
provisions, and specify documentation as necessary to administer this section.
 History.—s. 11, ch. 75-233; ss. 12, 23, ch. 80-198; s. 2, ch. 81-318; ss. 52, 79, 83, ch. 83-181; s. 10, ch. 87-371; s. 1,
ch. 88-364; s. 15, ch. 91-263; ss. 19, 38, 39, ch. 93-216; s. 775, ch. 95-148; s. 2, ch. 98-148; ss. 2, 46, ch. 2006-197; s.
84, ch. 2018-24; s. 11, ch. 2019-11.

Note.—Former s. 400.424.

429.255 Use of personnel; emergency care.—

(1)(a) Persons under contract to the facility, facility staff, or volunteers, who are licensed
according to part I of chapter 464, or those persons exempt under 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, 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 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.

(c) In an emergency situation, licensed personnel may carry out their professional duties pursuant
to part I of chapter 464 until emergency medical personnel assume responsibility for care.

(2) In facilities licensed to provide extended congregate care, persons under contract to the
facility, facility staff, or volunteers, who are licensed according to part I of chapter 464, or those
persons exempt under s. 464.022(1), or those persons certified as nursing assistants pursuant to part II
of chapter 464, may also perform all duties within the scope of their license or certification, as
approved by the facility administrator and pursuant to this part.

(3)(a) An assisted living facility licensed under this part with 17 or more beds shall have on the
premises at all times a functioning automated external defibrillator as defined in s. 768.1325(2)(b).
 (b) The facility is encouraged to register the location of each automated external defibrillator with
a local emergency medical services medical director.

(c) The provisions of ss. 768.13 and 768.1325 apply to automated external defibrillators within the
facility.

(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.
401.45. The agency shall adopt rules providing for the implementation of such orders. Facility staff and
facilities may not be subject to criminal prosecution or civil liability, nor be considered to have
engaged in negligent or unprofessional conduct, for withholding or withdrawing cardiopulmonary
resuscitation or use of an automated external defibrillator pursuant to such an order and rules adopted
by the agency. The absence of an order not to resuscitate executed pursuant to s. 401.45 does not
preclude a physician from withholding or withdrawing cardiopulmonary resuscitation or use of an
automated external defibrillator as otherwise permitted by law.

(5) The agency may adopt rules to implement the provisions of this section relating to use of an
automated external defibrillator.

History.—ss. 16, 38, ch. 91-263; ss. 20, 38, 39, ch. 93-216; s. 4, ch. 99-331; s. 3, ch. 2000-295; s. 100, ch. 2000-318;
ss. 2, 47, ch. 2006-197; s. 1, ch. 2010-200; s. 12, ch. 2019-11; s. 6, ch. 2020-68.

Note.—Former s. 400.4255.

429.256 Assistance with self-administration of medication.—

(1) For the purposes of this section, the term:

(a) “Informed consent” means advising the resident, or the resident’s surrogate, guardian, or
attorney in fact, that an assisted living facility is not required to have a licensed nurse on staff, that
the resident may be receiving assistance with self-administration of medication from an unlicensed
person, and that such assistance, if provided by an unlicensed person, will or will not be overseen by a
licensed nurse.

(b) “Unlicensed person” means an individual not currently licensed to practice nursing or medicine
who is employed by or under contract to an assisted living facility and who has received training with
respect to assisting with the self-administration of medication in an assisted living facility as provided
under s. 429.52 prior to providing such assistance as described in this section.

(2) Residents who are capable of self-administering their own medications without assistance shall
be encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed
prescription’s label or the package directions of an over-the-counter medication, assist a resident
whose condition is medically stable with the self-administration of routine, regularly scheduled
medications that are intended to be self-administered. Assistance with self-medication by an
unlicensed person may occur only upon a documented request by, and the written informed consent of,
a resident or the resident’s surrogate, guardian, or attorney in fact. For the purposes of this section,
self-administered medications include both legend and over-the-counter oral dosage forms, topical
dosage forms, transdermal patches, and topical ophthalmic, otic, and nasal dosage forms including
solutions, suspensions, sprays, and inhalers.

(3) Assistance with self-administration of medication includes:

(a) Taking the medication, in its previously dispensed, properly labeled container, including an
insulin syringe that is prefilled with the proper dosage by a pharmacist and an insulin pen that is
prefilled by the manufacturer, from where it is stored, and bringing it to the resident.

(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 dosage, 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.

(c) Placing an oral dosage in the resident’s hand or placing the dosage in another container and
helping the resident by lifting the container to his or her mouth.

(d) Applying topical medications.

(e) Returning the medication container to proper storage.

 (f) Keeping a record of when a resident receives assistance with self-administration under this
section.

(g) Assisting with the use of a nebulizer, including removing the cap of a nebulizer, opening the
unit dose of nebulizer solution, and pouring the prescribed premeasured dose of medication into the
dispensing cup of the nebulizer.

(h) Using a glucometer to perform blood-glucose level checks.

(i) Assisting with putting on and taking off antiembolism stockings.

(j) Assisting with applying and removing an oxygen cannula but not with titrating the prescribed
oxygen settings.

(k) Assisting with the use of a continuous positive airway pressure device but not with titrating the
prescribed setting of the device.

(l) Assisting with measuring vital signs.

(m) Assisting with colostomy bags.

(4) Assistance with self-administration does not include:

(a) Mixing, compounding, converting, or calculating medication doses, except for measuring a
prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed.

(b) The preparation of syringes for injection or the administration of medications by any injectable
route.

(c) Administration of medications by way of a tube inserted in a cavity of the body.

(d) Administration of parenteral preparations.

(e) The use of irrigations or debriding agents used in the treatment of a skin condition.
 (f) Assisting with rectal, urethral, or vaginal preparations.

(g) Assisting with medications ordered by the physician or health care professional with prescriptive
authority to be given “as needed,” unless the order is written with specific parameters that preclude
independent judgment on the part of the unlicensed person, and the resident requesting the
medication is aware of his or her need for the medication and understands the purpose for taking the
medication.

(h) Medications for which the time of administration, the amount, the strength of dosage, the
method of administration, or the reason for administration requires judgment or discretion on the part
of the unlicensed person.

(5) Assistance with the self-administration of medication by an unlicensed person as described in

this section shall not be considered administration as defined in s. 465.003.

(6) The agency may by rule establish facility procedures and interpret terms as necessary to
implement this section.

History.—s. 16, ch. 98-80; s. 214, ch. 99-13; ss. 2, 48, ch. 2006-197; s. 11, ch. 2015-126; s. 13, ch. 2019-11; s. 7, ch.
2020-68.

Note.—Former s. 400.4256.

429.26 Appropriateness of placements; examinations of residents.—

(1) The owner or administrator of a facility is responsible for determining the appropriateness of
admission of an individual to the facility and for determining the continued appropriateness of
residence of an individual in the facility. A determination must be based upon an evaluation of the
strengths, needs, and preferences of the resident, a medical examination, the care and services
offered or arranged for by the facility in accordance with facility policy, and any limitations in law or
rule related to admission criteria or continued residency for the type of license held by the facility
under this part. The following criteria apply to the determination of appropriateness for admission and
continued residency of an individual in a facility:
 (a) A facility may admit or retain a resident who receives a health care service or treatment that is
designed to be provided within a private residential setting if all requirements for providing that
service or treatment are met by the facility or a third party.

(b) A facility may admit or retain a resident who requires the use of assistive devices.

(c) A facility may admit or retain an individual receiving hospice services if the arrangement is
agreed to by the facility and the resident, additional care is provided by a licensed hospice, and the
resident is under the care of a physician who agrees that the physical needs of the resident can be met
at the facility. 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, including, if applicable, staffing for
nursing care.

(d)1. Except for a resident who is receiving hospice services as provided in paragraph (c), a facility
may not admit or retain a resident who is bedridden or who requires 24-hour nursing supervision. For
purposes of this paragraph, the term “bedridden” means that a resident is confined to a bed because
of the inability to:

a. Move, turn, or reposition without total physical assistance;

b. Transfer to a chair or wheelchair without total physical assistance; or

c. Sit safely in a chair or wheelchair without personal assistance or a physical restraint.

2. A resident may continue to reside in a facility if, during residency, he or she is bedridden for no
more than 7 consecutive days.

3. If a facility is licensed to provide extended congregate care, a resident may continue to reside in
a facility if, during residency, he or she is bedridden for no more than 14 consecutive days.

(2) A resident may not be moved from one facility to another without consultation with and
agreement from the resident or, if applicable, the resident’s representative or designee or the
resident’s family, guardian, surrogate, or attorney in fact. In the case of a resident who has been
placed by the department or the Department of Children and Families, the administrator must notify
the appropriate contact person in the applicable department.
 (3) A physician, physician assistant, or advanced practice registered nurse who is employed by an
assisted living facility to provide an initial examination for admission purposes may not have financial
interests in the facility.

(4) Persons licensed under part I of chapter 464 who are employed by or under contract with a
facility shall, on a routine basis or at least monthly, perform a nursing assessment of the residents for
whom they are providing nursing services ordered by a physician, except administration of medication,
and shall document such assessment, including any substantial changes in a resident’s status which may
necessitate relocation to a nursing home, hospital, or specialized health care facility. Such records
shall be maintained in the facility for inspection by the agency and shall be forwarded to the resident’s
case manager, if applicable.

(5) Each resident must have been examined by a licensed physician, a licensed physician assistant,
or a licensed advanced practice registered nurse within 60 days before admission to the facility or
within 30 days after admission to the facility, except as provided in s. 429.07. The information from
the medical examination must be recorded on the practitioner’s form or on a form adopted by agency
rule. The medical examination form, signed only by the practitioner, must 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 continued residency in the
facility. The medical examination form may only be used to record the practitioner’s direct observation
of the patient at the time of examination and must include the patient’s medical history. Such form
does not guarantee admission to, continued residency in, or the delivery of services at the facility and
must 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. The medical examination form, reflecting
the resident’s condition on the date the examination is performed, becomes a permanent part of the
facility’s record of the resident and must be made available to the agency during inspection or upon
request. An assessment that has been completed through the Comprehensive Assessment and Review
for Long-Term Care Services (CARES) Program fulfills the requirements for a medical examination under
this subsection and s. 429.07(3)(b)6.

(6) Any resident accepted in a facility and placed by the Department of Children and Families must
have been examined by medical personnel within 30 days before placement in the facility. The
examination must include an assessment of the appropriateness of placement in a facility. The findings
of this examination must be recorded on the examination form provided by the agency. The completed
form must accompany the resident and be submitted to the facility owner or administrator.
Additionally, in the case of a mental health resident, the Department of Children and Families must
provide documentation that the individual has been assessed by a psychiatrist, clinical psychologist,
clinical social worker, or psychiatric nurse, or an individual who is supervised by one of these
professionals, and determined to be appropriate to reside in an assisted living facility. The
documentation must be in the facility within 30 days after the mental health resident has been
admitted to 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 provided that it was completed within 90 days prior to admission to the facility. The
Department of Children and Families shall provide to the facility administrator any information about
the resident which would help the administrator meet his or her responsibilities under subsection (1).
Further, Department of Children and Families personnel shall explain to the facility operator any
special needs of the resident and advise the operator whom to call should problems arise. The
Department of Children and Families shall advise and assist the facility administrator when the special
needs of residents who are recipients of optional state supplementation require such assistance.

(7) The facility shall 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. The notification
must occur within 30 days after the acknowledgment of such signs by facility staff. If an underlying
condition is determined to exist, the facility must notify the resident’s representative or designee of
the need for health care services and must assist in making appointments for the necessary care and
services to treat the condition. If the resident does not have a representative or designee or if the
resident’s representative or designee cannot be located or is unresponsive, the facility shall arrange
with the appropriate health care provider for the necessary care and services to treat the condition.

(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. Any facility administrator;
personnel of the agency, the department, or the Department of Children and Families; or a
representative of the State Long-Term Care Ombudsman Program who believes a resident needs to be
evaluated shall notify the resident’s case manager, who shall take appropriate action. A report of the
examination findings must be provided to the resident’s case manager and the facility administrator to
help the administrator meet his or her responsibilities under subsection (1).

(9) 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; the ability of the facility, family members, friends, or any other
pertinent individuals or agencies to provide the care and services required; and documentation that a
written service plan consistent with facility policy has been developed and implemented to ensure that
the resident’s needs and preferences are addressed.

History.—ss. 12, 30, ch. 80-198; s. 2, ch. 81-318; ss. 53, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s. 6, ch. 85-145; s.
11, ch. 87-371; s. 19, ch. 89-294; s. 17, ch. 91-263; ss. 21, 38, 39, ch. 93-216; s. 776, ch. 95-148; s. 15, ch. 95-210; ss.
25, 49, ch. 95-418; s. 39, ch. 96-169; s. 5, ch. 97-82; s. 215, ch. 99-13; s. 101, ch. 2000-318; s. 75, ch. 2000-349; s. 37,
ch. 2001-45; s. 61, ch. 2002-1; ss. 2, 49, ch. 2006-197; s. 153, ch. 2007-230; s. 64, ch. 2009-223; s. 248, ch. 2014-19; s.
36, ch. 2015-31; s. 8, ch. 2020-68.

Note.—Former s. 400.426.

429.27 Property and personal affairs of residents.—

(1)(a) A resident shall be given the option of using his or her own belongings, as space permits;
choosing his or her roommate; and, whenever possible, unless the resident is adjudicated incompetent
or incapacitated under state law, managing his or her own affairs.

(b) The admission of a resident to a facility and his or her presence therein shall not confer on the
facility or its owner, administrator, employees, or representatives any authority to manage, use, or
dispose of any property of the resident; nor shall such admission or presence confer on any of such
persons any authority or responsibility for the personal affairs of the resident, except that which may
be necessary for the safe management of the facility or for the safety of the resident.

(2) A facility, or an owner, administrator, employee, or representative thereof, may not act as the
guardian, trustee, or conservator for any resident of the assisted living facility or any of such resident’s
property. An owner, administrator, or staff member, or representative thereof, may not act as a
competent resident’s payee for social security, veteran’s, or railroad benefits without the consent of
the resident. Any facility whose owner, administrator, or staff, or representative thereof, serves as
representative payee for any resident of the facility shall file a surety bond with the agency in an
amount equal to twice the average monthly aggregate income or personal funds due to residents, or
expendable for their account, which are received by a facility. Any facility whose owner,
administrator, or staff, or a representative thereof, is granted power of attorney for any resident of
the facility shall file a surety bond with the agency for each resident for whom such power of attorney
is granted. The surety bond shall be in an amount equal to twice the average monthly income of the
resident, plus the value of any resident’s property under the control of the attorney in fact. The bond
shall be executed by the facility as principal and a licensed surety company. The bond shall be
conditioned upon the faithful compliance of the facility with this section and shall run to the agency
for the benefit of any resident who suffers a financial loss as a result of the misuse or misappropriation
by a facility of funds held pursuant to this subsection. Any surety company that cancels or does not
renew the bond of any licensee shall notify the agency in writing not less than 30 days in advance of
such action, giving the reason for the cancellation or nonrenewal. Any facility owner, administrator, or
staff, or representative thereof, who is granted power of attorney for any resident of the facility shall,
on a monthly basis, be required to provide the resident a written statement of any transaction made on
behalf of the resident pursuant to this subsection, and a copy of such statement given to the resident
shall be retained in each resident’s file and available for agency inspection.

(3) A facility, upon mutual consent with the resident, shall provide for the safekeeping in the
facility of personal effects not in excess of $500 and funds of the resident not in excess of $500 cash,
and shall keep complete and accurate records of all such funds and personal effects received. If a
resident is absent from a facility for 24 hours or more, the facility may provide for the safekeeping of
the resident’s personal effects in excess of $500.

(4) Any funds or other property belonging to or due to a resident, or expendable for his or her
account, which is received by a facility shall be trust funds which shall be kept separate from the funds
and property of the facility and other residents or shall be specifically credited to such resident. Such
trust funds shall be used or otherwise expended only for the account of the resident. At least once
every 3 months, unless upon order of a court of competent jurisdiction, the facility shall furnish the
resident and his or her guardian, trustee, or conservator, if any, a complete and verified statement of
all funds and other property to which this subsection applies, detailing the amount and items received,
together with their sources and disposition. In any event, the facility shall furnish such statement
annually and upon the discharge or transfer of a resident. Any governmental agency or private
charitable agency contributing funds or other property to the account of a resident shall also be
entitled to receive such statement annually and upon the discharge or transfer of the resident.

(5) Any personal funds available to facility residents may be used by residents as they choose to
obtain clothing, personal items, leisure activities, and other supplies and services for their personal
use. A facility may not demand, require, or contract for payment of all or any part of the personal
funds in satisfaction of the facility rate for supplies and services beyond that amount agreed to in
writing and may not levy an additional charge to the individual or the account for any supplies or
services that the facility has agreed by contract to provide as part of the standard monthly rate. Any
service or supplies provided by the facility which are charged separately to the individual or the
account may be provided only with the specific written consent of the individual, who shall be
furnished in advance of the provision of the services or supplies with an itemized written statement to
be attached to the contract setting forth the charges for the services or supplies.
 (6)(a) In addition to any damages or civil penalties to which a person is subject, any person who:

1. Intentionally withholds a resident’s personal funds, personal property, or personal needs

allowance, or who demands, beneficially receives, or contracts for payment of all or any part of a
resident’s personal property or personal needs allowance in satisfaction of the facility rate for supplies
and services; or

2. Borrows from or pledges any personal funds of a resident, other than the amount agreed to by
written contract under s. 429.24,

commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.

(b) Any facility owner, administrator, or staff, or representative thereof, who is granted power of
attorney for any resident of the facility and who misuses or misappropriates funds obtained through
this power commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s.
775.084.

(7) In the event of the death of a resident, a licensee shall return all refunds, funds, and property
held in trust to the resident’s personal representative, if one has been appointed at the time the
facility disburses such funds, and, if not, to the resident’s spouse or adult next of kin named in a
beneficiary designation form provided by the facility to the resident. If the resident has no spouse or
adult next of kin or such person cannot be located, funds due the resident shall be placed in an
interest-bearing account, and all property held in trust by the facility shall be safeguarded until such
time as the funds and property are disbursed pursuant to the Florida Probate Code. Such funds shall be
kept separate from the funds and property of the facility and other residents of the facility. If the
funds of the deceased resident are not disbursed pursuant to the Florida Probate Code within 2 years
after the resident’s death, the funds shall be deposited in the Health Care Trust Fund administered by
the agency.

(8) The agency may by rule clarify terms and specify procedures and documentation necessary to
administer the provisions of this section relating to the proper management of residents’ funds and
personal property and the execution of surety bonds.

History.—s. 12, ch. 75-233; ss. 12, 24, ch. 80-198; s. 2, ch. 81-152; s. 2, ch. 81-318; ss. 4, 19, ch. 82-148; ss. 54, 79,
83, ch. 83-181; s. 3, ch. 86-104; s. 12, ch. 87-371; s. 72, ch. 91-224; s. 18, ch. 91-263; ss. 22, 38, 39, ch. 93-216; s. 777,
ch. 95-148; s. 3, ch. 98-148; s. 216, ch. 99-13; ss. 2, 50, ch. 2006-197; s. 12, ch. 2015-126; s. 14, ch. 2019-11.
 Note.—Former s. 400.427.

429.275 Business practice; personnel records; liability insurance.—The assisted living facility
shall be administered on a sound financial basis that is consistent with good business practices.

(1) The administrator or owner of a facility shall maintain accurate business records that identify,
summarize, and classify funds received and expenses disbursed and shall use written accounting
procedures and a recognized accounting system.

(2) The administrator or owner of a facility shall maintain personnel records for each staff member
which contain, at a minimum, documentation of background screening, if applicable, documentation of
compliance with all training requirements of this part or applicable rule, and a copy of all licenses or
certification held by each staff who performs services for which licensure or certification is required
under this part or rule.

(3) The administrator or owner of a facility shall maintain liability insurance coverage that is in
force at all times.

(4) The agency may by rule clarify terms, establish requirements for financial records, accounting
procedures, personnel procedures, insurance coverage, and reporting procedures, and specify
documentation as necessary to implement this section.

History.—s. 4, ch. 98-148; s. 2, ch. 2006-197; s. 15, ch. 2019-11.

Note.—Former s. 400.4275.

429.28 Resident bill of rights.—

(1) No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges
guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as
a resident of a facility. Every resident of a facility shall have the right to:

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

(b) Be treated with consideration and respect and with due recognition of personal dignity,
individuality, and the need for privacy.
 (c) Retain and use his or her own clothes and other personal property in his or her immediate living
quarters, so as to maintain individuality and personal dignity, except when the facility can demonstrate
that such would be unsafe, impractical, or an infringement upon the rights of other residents.

(d) Unrestricted private communication, including receiving and sending unopened correspondence,
access to a telephone, and visiting with any person of his or her choice, at any time between the hours
of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make provisions to extend visiting
hours for caregivers and out-of-town guests, and in other similar situations.

(e) Freedom to participate in and benefit from community services and activities and to pursue the
highest possible level of independence, autonomy, and interaction within the community.

(f) Manage his or her financial affairs unless the resident or, if applicable, the resident’s
representative, designee, surrogate, guardian, or attorney in fact authorizes the administrator of the
facility to provide safekeeping for funds as provided in s. 429.27.

(g) Share a room with his or her spouse if both are residents of the facility.

(h) Reasonable opportunity for regular exercise several times a week and to be outdoors at regular
and frequent intervals except when prevented by inclement weather.

(i) Exercise civil and religious liberties, including the right to independent personal decisions. No
religious beliefs or practices, nor any attendance at religious services, shall be imposed upon any
resident.

(j) Assistance with obtaining access to adequate and appropriate health care. For purposes of this
paragraph, the term “adequate and appropriate health care” means the management of medications,
assistance in making appointments for health care services, the provision of or arrangement of
transportation to health care appointments, and the performance of health care services in accordance
with s. 429.255 which are consistent with established and recognized standards within the community.

(k) At least 45 days’ notice of relocation or termination of residency from the facility unless, for
medical reasons, the resident is certified by a physician to require an emergency relocation to a
facility providing a more skilled level of care or the resident engages in a pattern of conduct that is
harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally
incapacitated, the guardian shall be given at least 45 days’ notice of a nonemergency relocation or
residency termination. Reasons for relocation must be set forth in writing and provided to the resident
or the resident’s legal representative. The notice must state that the resident may contact the State
Long-Term Care Ombudsman Program for assistance with relocation and must include the statewide
toll-free telephone number of the program. In order for a facility to terminate the residency of an
individual without notice as provided herein, the facility shall show good cause in a court of competent
jurisdiction.

(l) Present grievances and recommend changes in policies, procedures, and services to the staff of
the facility, governing officials, or any other person without restraint, interference, coercion,
discrimination, or reprisal. Each facility shall establish a grievance procedure to facilitate the
residents’ exercise of this right. This right includes access to ombudsman volunteers and advocates and
the right to be a member of, to be active in, and to associate with advocacy or special interest groups.

(2) The administrator of a facility shall ensure that a written notice of the rights, obligations, and
prohibitions set forth in this part is posted in a prominent place in each facility and read or explained
to residents who cannot read. The notice must include the statewide toll-free telephone number and
e-mail address of the State Long-Term Care Ombudsman Program and the telephone number of the
local ombudsman council, the Elder Abuse Hotline operated by the Department of Children and
Families, and, if applicable, Disability Rights Florida, where complaints may be lodged. The notice
must state that a complaint made to the Office of State Long-Term Care Ombudsman or a local long-
term care ombudsman council, the names and identities of the residents involved in the complaint, and
the identity of complainants are kept confidential pursuant to s. 400.0077 and that retaliatory action
cannot be taken against a resident for presenting grievances or for exercising any other resident right.
The facility must ensure a resident’s access to a telephone to call the State Long-Term Care
Ombudsman Program or local ombudsman council, the Elder Abuse Hotline operated by the Department
of Children and Families, and Disability Rights Florida.

(3)(a) The agency shall conduct a survey to determine whether the facility is complying with this
part as a prerequisite to initial licensure or licensure renewal.

(b) In order to determine whether the facility is adequately protecting residents’ rights, the
licensure renewal survey must include private informal conversations with a sample of residents and
consultation with the ombudsman council in the district in which the facility is located to discuss
residents’ experiences within the facility.
 (4) The facility shall not hamper or prevent residents from exercising their rights as specified in this
section.

(5) A facility or employee of a facility may not serve notice upon a resident to leave the premises
or take any other retaliatory action against any person who:

(a) Exercises any right set forth in this section.

(b) Appears as a witness in any hearing, inside or outside the facility.

(c) Files a civil action alleging a violation of the provisions of this part or notifies a state attorney
or the Attorney General of a possible violation of such provisions.

(6) A facility that terminates the residency of an individual who participated in activities specified
in subsection (5) must show good cause in a court of competent jurisdiction. If good cause is not
shown, the agency shall impose a fine of $2,500 in addition to any other penalty assessed against the
facility.

(7) Any person who submits or reports a complaint concerning a suspected violation of the
provisions of this part or concerning services and conditions in facilities, or who testifies in any
administrative or judicial proceeding arising from such a complaint, shall have immunity from any civil
or criminal liability therefor, unless such person has acted in bad faith or with malicious purpose or the
court finds that there was a complete absence of a justiciable issue of either law or fact raised by the
losing party.

History.—ss. 12, 31, ch. 80-198; s. 2, ch. 81-318; ss. 55, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s. 65, ch. 91-221; s.
19, ch. 91-263; ss. 23, 38, 39, ch. 93-216; s. 778, ch. 95-148; s. 11, ch. 95-418; s. 17, ch. 98-80; s. 20, ch. 2000-263; ss.
76, 143, ch. 2000-349; s. 63, ch. 2000-367; s. 38, ch. 2001-45; ss. 2, 51, ch. 2006-197; s. 37, ch. 2015-31; s. 13, ch. 2015-
126; s. 85, ch. 2018-24; s. 9, ch. 2020-68.

Note.—Former s. 400.428.

429.29 Civil actions to enforce rights.—

(1) Any person or resident whose rights as specified in this part are violated shall have a cause of
action. The action may be brought by the resident or his or her guardian, or by a person or organization
acting on behalf of a resident with the consent of the resident or his or her guardian, or by the
personal representative of the estate of a deceased resident regardless of the cause of death. If the
action alleges a claim for the resident’s rights or for negligence that caused the death of the resident,
the claimant shall be required to elect either survival damages pursuant to s. 46.021 or wrongful death
damages pursuant to s. 768.21. If the action alleges a claim for the resident’s rights or for negligence
that did not cause the death of the resident, the personal representative of the estate may recover
damages for the negligence that caused injury to the resident. The action may be brought in any court
of competent jurisdiction to enforce such rights and to recover actual damages, and punitive damages
for violation of the rights of a resident or negligence. Any resident who prevails in seeking injunctive
relief or a claim for an administrative remedy is entitled to recover the costs of the action and a
reasonable attorney’s fee assessed against the defendant not to exceed $25,000. Fees shall be awarded
solely for the injunctive or administrative relief and not for any claim or action for damages whether
such claim or action is brought together with a request for an injunction or administrative relief or as a
separate action, except as provided under s. 768.79 or the Florida Rules of Civil Procedure. Sections
429.29-429.298 provide the exclusive remedy for a cause of action for recovery of damages for the
personal injury or death of a resident arising out of negligence or a violation of rights specified in s.
429.28. This section does not preclude theories of recovery not arising out of negligence or s. 429.28
which are available to a resident or to the agency. The provisions of chapter 766 do not apply to any
cause of action brought under ss. 429.29-429.298.

(2) In any claim brought pursuant to this part alleging a violation of resident’s rights or negligence
causing injury to or the death of a resident, the claimant shall have the burden of proving, by a
preponderance of the evidence, that:

(a) The defendant owed a duty to the resident;

(b) The defendant breached the duty to the resident;

(c) The breach of the duty is a legal cause of loss, injury, death, or damage to the resident; and

(d) The resident sustained loss, injury, death, or damage as a result of the breach.

Nothing in this part shall be interpreted to create strict liability. A violation of the rights set forth in s.
429.28 or in any other standard or guidelines specified in this part or in any applicable administrative
standard or guidelines of this state or a federal regulatory agency shall be evidence of negligence but
shall not be considered negligence per se.
 (3) In any claim brought pursuant to this section, a licensee, person, or entity shall have a duty to
exercise reasonable care. Reasonable care is that degree of care which a reasonably careful licensee,
person, or entity would use under like circumstances.

(4) In any claim for resident’s rights violation or negligence by a nurse licensed under part I of
chapter 464, such nurse shall have the duty to exercise care consistent with the prevailing professional
standard of care for a nurse. The prevailing professional standard of care for a nurse shall be that level
of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as
acceptable and appropriate by reasonably prudent similar nurses.

(5) Discovery of financial information for the purpose of determining the value of punitive damages
may not be had unless the plaintiff shows the court by proffer or evidence in the record that a
reasonable basis exists to support a claim for punitive damages.

(6) In addition to any other standards for punitive damages, any award of punitive damages must be
reasonable in light of the actual harm suffered by the resident and the egregiousness of the conduct
that caused the actual harm to the resident.

(7) The resident or the resident’s legal representative shall serve a copy of any complaint alleging
in whole or in part a violation of any rights specified in this part to the Agency for Health Care
Administration at the time of filing the initial complaint with the clerk of the court for the county in
which the action is pursued. The requirement of providing a copy of the complaint to the agency does
not impair the resident’s legal rights or ability to seek relief for his or her claim.

History.—ss. 12, 32, ch. 80-198; s. 2, ch. 81-318; ss. 56, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; ss. 24, 38, 39, ch.
93-216; s. 779, ch. 95-148; s. 31, ch. 99-225; s. 39, ch. 2001-45; ss. 2, 52, ch. 2006-197.

Note.—Former s. 400.429.

429.293 Presuit notice; investigation; notification of violation of residents’ rights or alleged

negligence; claims evaluation procedure; informal discovery; review; settlement offer; mediation.
—

(1) As used in this section, the term:

 (a) “Claim for residents’ rights violation or negligence” means a negligence claim alleging injury to
or the death of a resident arising out of an asserted violation of the rights of a resident under s. 429.28
or an asserted deviation from the applicable standard of care.

(b) “Insurer” means any self-insurer authorized under s. 627.357, liability insurance carrier, joint
underwriting association, or uninsured prospective defendant.

(2) Prior to filing a claim for a violation of a resident’s rights or a claim for negligence, a claimant
alleging injury to or the death of a resident shall notify each prospective defendant by certified mail,
return receipt requested, of an asserted violation of a resident’s rights provided in s. 429.28 or
deviation from the standard of care. Such notification shall include an identification of the rights the
prospective defendant has violated and the negligence alleged to have caused the incident or incidents
and a brief description of the injuries sustained by the resident which are reasonably identifiable at
the time of notice. The notice shall contain a certificate of counsel that counsel’s reasonable
investigation gave rise to a good faith belief that grounds exist for an action against each prospective
defendant.

(3)(a) No suit may be filed for a period of 75 days after notice is mailed to any prospective
defendant. During the 75-day period, the prospective defendants or their insurers shall conduct an
evaluation of the claim to determine the liability of each defendant and to evaluate the damages of
the claimants. Each defendant or insurer of the defendant shall have a procedure for the prompt
evaluation of claims during the 75-day period. The procedure shall include one or more of the
following:

1. Internal review by a duly qualified facility risk manager or claims adjuster;

2. Internal review by counsel for each prospective defendant;

3. A quality assurance committee authorized under any applicable state or federal statutes or
regulations; or

4. Any other similar procedure that fairly and promptly evaluates the claims.

Each defendant or insurer of the defendant shall evaluate the claim in good faith.
 (b) At or before the end of the 75 days, the defendant or insurer of the defendant shall provide the
claimant with a written response:

1. Rejecting the claim; or

2. Making a settlement offer.

(c) The response shall be delivered to the claimant if not represented by counsel or to the
claimant’s attorney, by certified mail, return receipt requested. Failure of the prospective defendant
or insurer of the defendant to reply to the notice within 75 days after receipt shall be deemed a
rejection of the claim for purposes of this section.

(4) The notification of a violation of a resident’s rights or alleged negligence shall be served within
the applicable statute of limitations period; however, during the 75-day period, the statute of
limitations is tolled as to all prospective defendants. Upon stipulation by the parties, the 75-day period
may be extended and the statute of limitations is tolled during any such extension. Upon receiving
written notice by certified mail, return receipt requested, of termination of negotiations in an
extended period, the claimant shall have 60 days or the remainder of the period of the statute of
limitations, whichever is greater, within which to file suit.

(5) No statement, discussion, written document, report, or other work product generated by
presuit claims evaluation procedures under this section is discoverable or admissible in any civil action
for any purpose by the opposing party. All participants, including, but not limited to, physicians,
investigators, witnesses, and employees or associates of the defendant, are immune from civil liability
arising from participation in the presuit claims evaluation procedure. Any licensed physician or
registered nurse may be retained by either party to provide an opinion regarding the reasonable basis
of the claim. The presuit opinions of the expert are not discoverable or admissible in any civil action
for any purpose by the opposing party.

(6) Upon receipt by a prospective defendant of a notice of claim, the parties shall make
discoverable information available without formal discovery as provided in subsection (7).

(7) Informal discovery may be used by a party to obtain unsworn statements and the production of
documents or things, as follows:
 (a) Unsworn statements.—Any party may require other parties to appear for the taking of an
unsworn statement. Such statements may be used only for the purpose of claims evaluation and are not
discoverable or admissible in any civil action for any purpose by any party. A party seeking to take the
unsworn statement of any party must give reasonable notice in writing to all parties. The notice must
state the time and place for taking the statement and the name and address of the party to be
examined. Unless otherwise impractical, the examination of any party must be done at the same time
by all other parties. Any party may be represented by counsel at the taking of an unsworn statement.
An unsworn statement may be recorded electronically, stenographically, or on videotape. The taking of
unsworn statements is subject to the provisions of the Florida Rules of Civil Procedure and may be
terminated for abuses.

(b) Documents or things.—Any party may request discovery of relevant documents or things. The
documents or things must be produced, at the expense of the requesting party, within 20 days after
the date of receipt of the request. A party is required to produce relevant and discoverable documents
or things within that party’s possession or control, if in good faith it can reasonably be done within the
timeframe of the claims evaluation process.

(8) Each request for and notice concerning informal discovery pursuant to this section must be in
writing, and a copy thereof must be sent to all parties. Such a request or notice must bear a certificate
of service identifying the name and address of the person to whom the request or notice is served, the
date of the request or notice, and the manner of service thereof.

(9) If a prospective defendant makes a written settlement offer, the claimant shall have 15 days
from the date of receipt to accept the offer. An offer shall be deemed rejected unless accepted by
delivery of a written notice of acceptance.

(10) To the extent not inconsistent with this part, the provisions of the Florida Mediation Code,
Florida Rules of Civil Procedure, shall be applicable to such proceedings.

(11) Within 30 days after the claimant’s receipt of defendant’s response to the claim, the parties or
their designated representatives shall meet in mediation to discuss the issues of liability and damages
in accordance with the mediation rules of practice and procedures adopted by the Supreme Court.
Upon stipulation of the parties, this 30-day period may be extended and the statute of limitations is
tolled during the mediation and any such extension. At the conclusion of mediation, the claimant shall
have 60 days or the remainder of the period of the statute of limitations, whichever is greater, within
which to file suit.
 History.—s. 40, ch. 2001-45; ss. 2, 53, ch. 2006-197.

Note.—Former s. 400.4293.

429.294 Availability of facility records for investigation of resident’s rights violations and
defenses; penalty.—

(1) Failure to provide complete copies of a resident’s records, including, but not limited to, all
medical records and the resident’s chart, within the control or possession of the facility in accordance
with s. 400.145, shall constitute evidence of failure of that party to comply with good faith discovery
requirements and shall waive the good faith certificate and presuit notice requirements under this part
by the requesting party.

(2) No facility shall be held liable for any civil damages as a result of complying with this section.

History.—s. 41, ch. 2001-45; s. 2, ch. 2006-197; s. 86, ch. 2018-24.

Note.—Former s. 400.4294.

429.295 Certain provisions not applicable to actions under this part.—An action under this part
for a violation of rights or negligence recognized herein is not a claim for medical malpractice, and the
provisions of s. 768.21(8) do not apply to a claim alleging death of the resident.

History.—s. 42, ch. 2001-45; s. 2, ch. 2006-197.

Note.—Former s. 400.4295.

429.296 Statute of limitations.—

(1) Any action for damages brought under this part shall be commenced within 2 years from the
time the incident giving rise to the action occurred or within 2 years from the time the incident is
discovered, or should have been discovered with the exercise of due diligence; however, in no event
shall the action be commenced later than 4 years from the date of the incident or occurrence out of
which the cause of action accrued.
 (2) In those actions covered by this subsection in which it can be shown that fraudulent
concealment or intentional misrepresentation of fact prevented the discovery of the injury, the period
of limitations is extended forward 2 years from the time that the injury is discovered with the exercise
of due diligence, but in no event not more than 6 years from the date the incident giving rise to the
injury occurred.

(3) This section shall apply to causes of action that have accrued prior to the effective date of this
section; however, any such cause of action that would not have been barred under prior law may be
brought within the time allowed by prior law or within 2 years after the effective date of this section,
whichever is earlier, and will be barred thereafter. In actions where it can be shown that fraudulent
concealment or intentional misrepresentation of fact prevented the discovery of the injury, the period
of limitations is extended forward 2 years from the time that the injury is discovered with the exercise
of due diligence, but in no event more than 4 years from the effective date of this section.

History.—s. 43, ch. 2001-45; s. 2, ch. 2006-197.

Note.—Former s. 400.4296.

429.297 Punitive damages; pleading; burden of proof.—

(1) In any action for damages brought under this part, no claim for punitive damages shall be
permitted unless there is a reasonable showing by evidence in the record or proffered by the claimant
which would provide a reasonable basis for recovery of such damages. The claimant may move to
amend her or his complaint to assert a claim for punitive damages as allowed by the rules of civil
procedure. The rules of civil procedure shall be liberally construed so as to allow the claimant
discovery of evidence which appears reasonably calculated to lead to admissible evidence on the issue
of punitive damages. No discovery of financial worth shall proceed until after the pleading concerning
punitive damages is permitted.

(2) A defendant may be held liable for punitive damages only if the trier of fact, based on clear and
convincing evidence, finds that the defendant was personally guilty of intentional misconduct or gross
negligence. As used in this section, the term:

(a) “Intentional misconduct” means that the defendant had actual knowledge of the wrongfulness
of the conduct and the high probability that injury or damage to the claimant would result and, despite
that knowledge, intentionally pursued that course of conduct, resulting in injury or damage.
 (b) “Gross negligence” means that the defendant’s conduct was so reckless or wanting in care that
it constituted a conscious disregard or indifference to the life, safety, or rights of persons exposed to
such conduct.

(3) In the case of an employer, principal, corporation, or other legal entity, punitive damages may
be imposed for the conduct of an employee or agent only if the conduct of the employee or agent
meets the criteria specified in subsection (2) and:

(a) The employer, principal, corporation, or other legal entity actively and knowingly participated
in such conduct;

(b) The officers, directors, or managers of the employer, principal, corporation, or other legal
entity condoned, ratified, or consented to such conduct; or

(c) The employer, principal, corporation, or other legal entity engaged in conduct that constituted
gross negligence and that contributed to the loss, damages, or injury suffered by the claimant.

(4) The plaintiff must establish at trial, by clear and convincing evidence, its entitlement to an
award of punitive damages. The “greater weight of the evidence” burden of proof applies to a
determination of the amount of damages.

(5) This section is remedial in nature and shall take effect upon becoming a law.

History.—s. 44, ch. 2001-45; s. 2, ch. 2006-197.

Note.—Former s. 400.4297.

429.298 Punitive damages; limitation.—

(1)(a) Except as provided in paragraphs (b) and (c), an award of punitive damages may not exceed
the greater of:

1. Three times the amount of compensatory damages awarded to each claimant entitled thereto,
consistent with the remaining provisions of this section; or

2. The sum of $1 million.

 (b) Where the fact finder determines that the wrongful conduct proven under this section was
motivated primarily by unreasonable financial gain and determines that the unreasonably dangerous
nature of the conduct, together with the high likelihood of injury resulting from the conduct, was
actually known by the managing agent, director, officer, or other person responsible for making policy
decisions on behalf of the defendant, it may award an amount of punitive damages not to exceed the
greater of:

1. Four times the amount of compensatory damages awarded to each claimant entitled thereto,
consistent with the remaining provisions of this section; or

2. The sum of $4 million.

(c) Where the fact finder determines that at the time of injury the defendant had a specific intent
to harm the claimant and determines that the defendant’s conduct did in fact harm the claimant,
there shall be no cap on punitive damages.

(d) This subsection is not intended to prohibit an appropriate court from exercising its jurisdiction
under s. 768.74 in determining the reasonableness of an award of punitive damages that is less than
three times the amount of compensatory damages.

(e) In any case in which the findings of fact support an award of punitive damages pursuant to
paragraph (b) or paragraph (c), the clerk of the court shall refer the case to the appropriate law
enforcement agencies, to the state attorney in the circuit where the long-term care facility that is the
subject of the underlying civil cause of action is located, and, for multijurisdictional facility owners, to
the Office of the Statewide Prosecutor; and such agencies, state attorney, or Office of the Statewide
Prosecutor shall initiate a criminal investigation into the conduct giving rise to the award of punitive
damages. All findings by the trier of fact which support an award of punitive damages under this
paragraph shall be admissible as evidence in any subsequent civil or criminal proceeding relating to the
acts giving rise to the award of punitive damages under this paragraph.

(2) The claimant’s attorney’s fees, if payable from the judgment, are, to the extent that the fees
are based on the punitive damages, calculated based on the final judgment for punitive damages. This
subsection does not limit the payment of attorney’s fees based upon an award of damages other than
punitive damages.

(3) The jury may neither be instructed nor informed as to the provisions of this section.
 (4) Notwithstanding any other law to the contrary, the amount of punitive damages awarded
pursuant to this section shall be equally divided between the claimant and the Quality of Long-Term
Care Facility Improvement Trust Fund, in accordance with the following provisions:

(a) The clerk of the court shall transmit a copy of the jury verdict to the Chief Financial Officer by
certified mail. In the final judgment, the court shall order the percentages of the award, payable as
provided herein.

(b) A settlement agreement entered into between the original parties to the action after a verdict
has been returned must provide a proportionate share payable to the Quality of Long-Term Care
Facility Improvement Trust Fund specified herein. For purposes of this paragraph, a proportionate
share is a 50-percent share of that percentage of the settlement amount which the punitive damages
portion of the verdict bore to the total of the compensatory and punitive damages in the verdict.

(c) The Department of Financial Services shall collect or cause to be collected all payments due the
state under this section. Such payments are made to the Chief Financial Officer and deposited in the
appropriate fund specified in this subsection.

(d) If the full amount of punitive damages awarded cannot be collected, the claimant and the other
recipient designated pursuant to this subsection are each entitled to a proportionate share of the
punitive damages collected.

(5) This section is remedial in nature and shall take effect upon becoming a law.

History.—s. 45, ch. 2001-45; s. 419, ch. 2003-261; s. 2, ch. 2006-197.

Note.—Former s. 400.4298.

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.

(3) All charges shall be prorated as of the date on which the facility discontinues operation, and if
any payments have been made in advance, the payments for services not received shall be refunded to
the resident or the resident’s guardian within 10 working days of voluntary or involuntary closure of the
facility, whether or not such refund is requested by the resident or guardian.

(4) The agency may levy a fine in an amount no greater than $5,000 upon each person or business
entity that owns any interest in a facility that terminates operation without providing notice to the
agency and the residents of the facility at least 30 days before operation ceases. This fine shall not be
levied against any facility involuntarily closed at the initiation of the agency. The agency shall use the
proceeds of the fines to operate the facility until all residents of the facility are relocated.

History.—s. 13, ch. 75-233; ss. 12, 25, ch. 80-198; s. 2, ch. 81-318; ss. 57, 79, 83, ch. 83-181; s. 20, ch. 91-263; ss. 25,
38, 39, ch. 93-216; s. 780, ch. 95-148; s. 50, ch. 95-418; s. 123, ch. 99-8; ss. 2, 54, ch. 2006-197; s. 154, ch. 2007-230; s.
249, ch. 2014-19; s. 16, ch. 2019-11; s. 10, ch. 2020-68.

Note.—Former s. 400.431.

429.34 Right of entry and inspection.—

(1) In addition to the requirements of s. 408.811, a duly designated officer or employee of the
agency, of the Department of Children and Families, of the Medicaid Fraud Control Unit of the Office
of the Attorney General, or of the state or local fire marshal, or a representative of the State Long-
Term Care Ombudsman Program or a member of the state or local long-term care ombudsman council
has the right to enter unannounced upon and into the premises of any facility licensed under this part
in order to determine the state of compliance with this part, part II of chapter 408, and applicable
rules. Data collected by the State Long-Term Care Ombudsman Program, local long-term care
ombudsman councils, or the state or local advocacy councils may be used by the agency in
investigations involving violations of regulatory standards. A person specified in this section who knows
or has reasonable cause to suspect that a vulnerable adult has been or is being abused, neglected, or
exploited shall immediately report such knowledge or suspicion to the central abuse hotline pursuant
to chapter 415.
 (2)(a) In addition to the requirements of s. 408.811, the agency may inspect and investigate
facilities as necessary to determine compliance with this part, part II of chapter 408, and rules adopted
thereunder. If an assisted living facility is cited for a class I violation or three or more class II violations
arising from separate surveys within a 60-day period or due to unrelated circumstances during the same
survey, the agency must conduct an additional licensure inspection within 6 months.

(b) During any calendar year in which a survey is not conducted, the agency may conduct
monitoring visits of each facility cited in the previous year for a class I or class II violation or for more
than three uncorrected class III violations.

History.—s. 14, ch. 75-233; s. 1, ch. 77-174; ss. 12, 26, ch. 80-198; s. 2, ch. 81-318; ss. 10, 18, 19, ch. 82-148; ss. 58,
79, 83, ch. 83-181; s. 1, ch. 88-350; s. 24, ch. 93-177; ss. 26, 38, 39, ch. 93-216; s. 51, ch. 95-418; s. 124, ch. 99-8; s.
144, ch. 2000-349; s. 64, ch. 2000-367; s. 46, ch. 2001-45; s. 3, ch. 2004-344; s. 2, ch. 2006-197; s. 155, ch. 2007-230; s.
250, ch. 2014-19; s. 38, ch. 2015-31; s. 14, ch. 2015-126; s. 87, ch. 2018-24; s. 17, ch. 2019-11.

Note.—Former s. 400.434.

429.35 Maintenance of records; reports.—

(1) Every facility shall maintain, as public information available for public inspection under such
conditions as the agency shall prescribe, records containing copies of all inspection reports pertaining
to the facility that have been issued by the agency to the facility. Copies of inspection reports shall be
retained in the records for 5 years from the date the reports are filed or issued.

(2) Within 60 days after the date of an inspection conducted under s. 408.811 or within 30 days
after the date of an interim visit, the agency shall forward the results of the inspection to the local
ombudsman council in the district where the facility is located; to at least one public library or, in the
absence of a public library, the county seat in the county in which the inspected assisted living facility
is located; and, when appropriate, to the district Adult Services and Mental Health Program Offices.

(3) Every facility shall post a copy of the last inspection report of the agency for that facility in a
prominent location within the facility so as to be accessible to all residents and to the public. Upon
request, the facility shall also provide a copy of the report to any resident of the facility or to an
applicant for admission to the facility.

History.—ss. 12, 27, ch. 80-198; s. 2, ch. 81-318; ss. 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s. 1, ch. 88-145; s. 19,
ch. 90-347; s. 21, ch. 91-263; ss. 27, 38, 39, ch. 93-216; s. 16, ch. 95-210; s. 57, ch. 2000-139; s. 145, ch. 2000-349; s.
65, ch. 2000-367; s. 2, ch. 2006-197; s. 102, ch. 2007-5; s. 156, ch. 2007-230; s. 118, ch. 2008-4; s. 39, ch. 2015-31; s.
48, ch. 2020-156.

Note.—Former s. 400.435.

429.41 Rules establishing standards.—

(1) It is the intent of the Legislature that rules published and enforced pursuant to this section shall
include criteria by which a reasonable and consistent quality of resident care and quality of life may be
ensured and the results of such resident care may be demonstrated. Such rules shall also promote a
safe and sanitary environment that is residential and noninstitutional in design or nature and may allow
for technological advances in the provision of care, safety, and security, including the use of devices,
equipment, and other security measures related to wander management, emergency response, staff
risk management, and the general safety and security of residents, staff, and the facility. It is further
intended that reasonable efforts be made to accommodate the needs and preferences of residents to
enhance the quality of life in a facility. The agency, in consultation with the Department of Children
and Families and the Department of Health, shall adopt rules to administer this part, which must
include reasonable and fair minimum standards in relation to:

(a) The requirements for maintenance and the sanitary condition of facilities, not in conflict with,
or duplicative of, the requirements in chapter 553, s. 381.006, s. 381.0072, or s. 633.206, relating to a
safe and decent living environment, including furnishings for resident bedrooms or sleeping areas,
locking devices, linens, and other housing conditions relating to hazards, which will promote the
health, safety, and welfare of residents suitable to the size of the structure. The rules must clearly
delineate the respective responsibilities of the agency’s licensure and survey staff and the county
health departments and ensure that inspections are not duplicative. The agency may collect fees for
food service inspections conducted by county health departments and may transfer such fees to the
Department of Health.

(b) The preparation and annual update of a comprehensive emergency management plan. Such
standards must be included in the rules adopted by the agency after consultation with the Division of
Emergency Management. At a minimum, the rules must provide for plan components that address
emergency evacuation transportation; adequate sheltering arrangements; postdisaster activities,
including provision of emergency power, food, and water; postdisaster transportation; supplies;
staffing; emergency equipment; individual identification of residents and transfer of records;
communication with families; and responses to family inquiries. The comprehensive emergency
management plan is subject to review and approval by the county emergency management agency.
During its review, the county emergency management agency shall ensure that the following agencies,
at a minimum, are given the opportunity to review the plan: the Department of Health, the Agency for
Health Care Administration, and the Division of Emergency Management. The county emergency
management agency shall complete its review within 60 days and either approve the plan or advise the
facility of necessary revisions. A facility must submit a comprehensive emergency management plan to
the county emergency management agency within 30 days after issuance of a license.

(c) The number, training, and qualifications of all personnel having responsibility for the care of
residents. The rules must require adequate staff to provide for the safety of all residents. Facilities
licensed for 17 or more residents are required to maintain an alert staff for 24 hours per day.

(d) License application and license renewal, transfer of ownership, proper management of resident
funds and personal property, surety bonds, resident contracts, refund policies, financial ability to
operate, and facility and staff records.

(e) Inspections, complaint investigations, moratoriums, classification of deficiencies, and levying

and enforcement of penalties.

(f) The enforcement of the resident bill of rights specified in s. 429.28.

(g) The care of residents provided by the facility, which must include:

1. The supervision of residents;

2. The provision of personal services;

3. The provision of, or arrangement for, social and leisure activities;

4. The assistance in making arrangements for appointments and transportation to appropriate

medical, dental, nursing, or mental health services, as needed by residents;

5. The management of medication stored within the facility and as needed by residents;

6. The dietary needs of residents;

 7. Resident records; and

8. Internal risk management and quality assurance.

(h) Facilities holding a limited nursing, extended congregate care, or limited mental health license.

(i) The establishment of specific criteria to define appropriateness of resident admission and
continued residency in a facility holding a standard, limited nursing, extended congregate care, and
limited mental health license.

(j) The use of physical or chemical restraints. The use of Posey restraints is prohibited. Other
physical restraints may be used in accordance with agency rules when ordered by the resident’s
physician and consented to by the resident or, if applicable, the resident’s representative or designee
or the resident’s surrogate, guardian, or attorney in fact. Such rules must specify requirements for care
planning, staff monitoring, and periodic review by a physician. The use of chemical restraints is limited
to prescribed dosages of medications authorized by the resident’s physician and must be consistent
with the resident’s diagnosis. Residents who are receiving medications that can serve as chemical
restraints must be evaluated by their physician at least annually to assess:

1. The continued need for the medication.

2. The level of the medication in the resident’s blood.

3. The need for adjustments in the prescription.

(k) The establishment of specific resident elopement drill requirements and policies and procedures
on resident elopement. Facilities shall conduct a minimum of two resident elopement drills each year.
All administrators and direct care staff shall participate in the drills, which must include a review of
the facility’s procedures to address resident elopement. Facilities shall document participation in the
drills.

(2) In adopting any rules pursuant to this part, the agency shall make distinct standards for
facilities based upon facility size; the types of care provided; the physical and mental capabilities and
needs of residents; the type, frequency, and amount of services and care offered; and the staffing
characteristics of the facility. Rules developed pursuant to this section may not restrict the use of
shared staffing and shared programming in facilities that are part of retirement communities that
provide multiple levels of care and otherwise meet the requirements of law and rule. If a continuing
care facility licensed under chapter 651 or a retirement community offering multiple levels of care
licenses a building or part of a building designated for independent living for assisted living, staffing
requirements established in rule apply only to residents who receive personal, limited nursing, or
extended congregate care services under this part. Such facilities shall retain a log listing the names
and unit number for residents receiving these services. The log must be available to surveyors upon
request. The agency shall adopt by rule separate and distinct standards for facilities with 16 or fewer
beds and for facilities with 17 or more beds. The standards for facilities with 16 or fewer beds must be
appropriate for a noninstitutional residential environment; however, the structure may not be more
than two stories in height and all persons who cannot exit the facility unassisted in an emergency must
reside on the first floor. The agency may make other distinctions among types of facilities as necessary
to enforce this part. Where appropriate, the agency shall offer alternate solutions for complying with
established standards, based on distinctions made by the agency relative to the physical characteristics
of facilities and the types of care offered.

(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.

(5) The agency may use an abbreviated biennial standard licensure inspection that consists of a
review of key quality-of-care standards in lieu of a full inspection in a facility that has a good record of
past performance. However, a full inspection must be conducted in a facility that has a history of class
I or class II violations; uncorrected class III violations; or a class I, class II, or uncorrected class III
violation resulting from a complaint referred by the State Long-Term Care Ombudsman Program within
the previous licensure period immediately preceding the inspection or if a potentially serious problem
is identified during the abbreviated inspection. The agency shall adopt by rule the key quality-of-care
standards.

History.—s. 16, ch. 75-233; ss. 12, 29, ch. 80-198; s. 2, ch. 81-318; ss. 59, 79, 83, ch. 83-181; s. 7, ch. 85-145; s. 1, ch.
86-87; s. 13, ch. 87-371; s. 20, ch. 89-294; s. 22, ch. 91-263; s. 25, ch. 93-177; s. 26, ch. 93-211; ss. 28, 38, 39, ch. 93-
216; ss. 12, 20, 52, ch. 95-418; s. 27, ch. 97-100; s. 99, ch. 97-101; s. 5, ch. 98-148; s. 15, ch. 99-332; s. 47, ch. 2001-45;
s. 7, ch. 2004-298; s. 2, ch. 2004-386; ss. 2, 55, ch. 2006-197; s. 157, ch. 2007-230; s. 142, ch. 2010-102; s. 343, ch.
2011-142; s. 137, ch. 2013-183; s. 251, ch. 2014-19; s. 15, ch. 2015-126; s. 1, ch. 2016-92; s. 18, ch. 2019-11; s. 11, ch.
2020-68.

Note.—Former s. 400.441.

429.42 Pharmacy and dietary services.—

(1) Any assisted living facility in which the agency has documented a class I or class II deficiency or
uncorrected class III deficiencies regarding medicinal drugs or over-the-counter preparations, including
their storage, use, delivery, or administration, or dietary services, or both, during a biennial survey or
a monitoring visit or an investigation in response to a complaint, shall, in addition to or as an
alternative to any penalties imposed under s. 429.19, be required to employ the consultant services of
a licensed pharmacist, a licensed registered nurse, or a registered or licensed dietitian, as applicable.
The consultant shall, at a minimum, provide onsite quarterly consultation until the inspection team
from the agency determines that such consultation services are no longer required.

(2) A corrective action plan for deficiencies related to assistance with the self-administration of
medication or the administration of medication must be developed and implemented by the facility
within 48 hours after notification of such deficiency, or sooner if the deficiency is determined by the
agency to be life-threatening.

(3) The agency shall employ at least two pharmacists licensed pursuant to chapter 465 among its
personnel who biennially inspect assisted living facilities licensed under this part, to participate in
biennial inspections or consult with the agency regarding deficiencies relating to medicinal drugs or
over-the-counter preparations.

(4) The agency may by rule establish procedures and specify documentation as necessary to
implement this section.
 History.—s. 1, ch. 89-218; s. 1, ch. 90-192; s. 23, ch. 91-263; ss. 29, 38, 39, ch. 93-216; s. 17, ch. 95-210; s. 18, ch.
98-80; s. 6, ch. 98-148; ss. 2, 56, ch. 2006-197; s. 19, ch. 2019-11.

Note.—Former s. 400.442.

429.435 Uniform firesafety standards.—Uniform firesafety standards for assisted living facilities,
which are residential board and care occupancies, shall be established by the State Fire Marshal
pursuant to s. 633.206.

(1) EVACUATION CAPABILITY.—A firesafety evacuation capability determination shall be conducted

within 6 months after the date of initial licensure of an assisted living facility, if required.

(2) FIRESAFETY REQUIREMENTS.—

(a) The National Fire Protection Association, Life Safety Code, NFPA 101 and 101A, current
editions, must be used in determining the uniform firesafety code adopted by the State Fire Marshal for
assisted living facilities, pursuant to s. 633.206.

(b) A local government or a utility may charge fees that do not exceed the actual costs incurred by
the local government or the utility for the installation and maintenance of an automatic fire sprinkler
system in a licensed assisted living facility structure.

(c) All licensed facilities must have an annual fire inspection conducted by the local fire marshal or
authority having jurisdiction.

(d) An assisted living facility that was issued a building permit or certificate of occupancy before
July 1, 2016, at its option and after notifying the authority having jurisdiction, may remain under the
provisions of the 1994 and 1995 editions of the National Fire Protection Association, Life Safety Code,
NFPA 101 and 101A. A facility opting to remain under such provisions may make repairs,
modernizations, renovations, or additions to, or rehabilitate, the facility in compliance with NFPA 101,
1994 edition, and may utilize 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 utilize 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. 633.206 and the Florida Fire Prevention Code in effect for assisted living facilities
as adopted by the State Fire Marshal.

History.—s. 12, ch. 2020-68.

429.44 Construction and renovation; requirements.—

(1) The requirements for the construction and renovation of a facility shall comply with chapter 553
which pertains to building construction standards, including plumbing, electrical code, glass,
manufactured buildings, accessibility for persons with disabilities, and the state minimum building
code and with s. 633.206, which pertains to uniform firesafety standards.

(2) Upon notification by the local authority having jurisdiction over life-threatening violations
which seriously threaten the health, safety, or welfare of a resident of a facility, the agency shall take
action as specified in s. 429.14.

History.—s. 17, ch. 75-233; s. 3, ch. 79-152; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 30, 38, 39, ch. 93-216; s. 14,
ch. 95-418; s. 7, ch. 98-148; ss. 2, 57, ch. 2006-197; s. 138, ch. 2013-183; s. 34, ch. 2015-4.

Note.—Former s. 400.444.

429.445 Compliance with local zoning requirements.—No facility licensed under this part may
commence any construction which will expand the size of the existing structure unless the licensee
first submits to the agency proof that such construction will be in compliance with applicable local
zoning requirements. Facilities with a licensed capacity of less than 15 persons shall comply with the
provisions of chapter 419.

History.—s. 2, ch. 85-251; s. 24, ch. 91-263; ss. 31, 39, ch. 93-216; s. 2, ch. 2006-197.

Note.—Former s. 400.4445.

429.47 Prohibited acts; penalties for violation.—

(1) While a facility is under construction, the owner may advertise to the public prior to obtaining a
license. Facilities that are certified under chapter 651 shall comply with the advertising provisions of s.
651.095 rather than those provided for in this subsection.
 (2) A freestanding facility shall not advertise or imply that any part of it is a nursing home. For the
purpose of this subsection, “freestanding facility” means a facility that is not operated in conjunction
with a nursing home to which residents of the facility are given priority when nursing care is required.
A person who violates this subsection is subject to fine as specified in s. 429.19.

(3) Any facility which is affiliated with any religious organization or which has a name implying
religious affiliation shall include in its advertising whether or not it is affiliated with any religious
organization and, if so, which organization.

(4) A facility licensed under this part which is not part of a facility authorized under chapter 651
shall include the facility’s license number as given by the agency in all advertising. A company or
person owning more than one facility shall include at least one license number per advertisement. All
advertising shall include the term “assisted living facility” before the license number.

History.—s. 18, ch. 75-233; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; s. 14, ch. 87-371; s. 25, ch. 91-263; ss. 32, 38, 39,
ch. 93-216; s. 18, ch. 95-210; s. 217, ch. 99-13; ss. 2, 58, ch. 2006-197; s. 158, ch. 2007-230.

Note.—Former s. 400.447.

429.49 Resident records; penalties for alteration.—

(1) Any person who fraudulently alters, defaces, or falsifies any medical or other record of an
assisted living facility, or causes or procures any such offense to be committed, commits a
misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.

(2) A conviction under subsection (1) is also grounds for restriction, suspension, or termination of
license privileges.

History.—s. 48, ch. 2001-45; s. 2, ch. 2006-197.

Note.—Former s. 400.449.

429.52 Staff training and educational requirements.—

(1) Each new assisted living facility employee who has not previously completed core training must
attend a preservice orientation provided by the facility before interacting with residents. The
preservice orientation must be at least 2 hours in duration and cover topics that help the employee
provide responsible care and respond to the needs of facility residents. Upon completion, the employee
and the administrator of the facility must sign a statement that the employee completed the required
preservice orientation. The facility must keep the signed statement in the employee’s personnel
record.

(2) Administrators and other assisted living facility staff must meet minimum training and education
requirements established by the agency by rule. This training and education is intended to assist
facilities to appropriately respond to the needs of residents, to maintain resident care and facility
standards, and to meet licensure requirements.

(3) The agency, in conjunction with providers, shall develop core training requirements for
administrators consisting of core training learning objectives, a competency test, and a minimum
required score to indicate successful passage of the core competency test. The required core
competency test must cover at least the following topics:

(a) State law and rules relating to assisted living facilities.

(b) Resident rights and identifying and reporting abuse, neglect, and exploitation.

(c) Special needs of elderly persons, persons with mental illness, and persons with developmental
disabilities and how to meet those needs.

(d) Nutrition and food service, including acceptable sanitation practices for preparing, storing, and
serving food.

(e) Medication management, recordkeeping, and proper techniques for assisting residents with self-
administered medication.

(f) Firesafety requirements, including fire evacuation drill procedures and other emergency
procedures.

(g) Care of persons with Alzheimer’s disease and related disorders.

(4) A facility administrator must complete the required core training, including the competency
test, within 90 days after the date of employment as an administrator. Failure to do so is a violation of
this part and subjects the violator to an administrative fine as prescribed in s. 429.19. Administrators
licensed in accordance with part II of chapter 468 are exempt from this requirement. Other licensed
professionals may be exempted, as determined by the agency by rule.

(5) Administrators are required to participate in continuing education for a minimum of 12 contact
hours every 2 years.

(6) Staff assisting with the self-administration of medications under s. 429.256 must complete a
minimum of 6 additional hours of training provided by a registered nurse or a licensed pharmacist
before providing assistance. Two hours of continuing education are required annually thereafter. The
agency shall establish by rule the minimum requirements of this training.

(7) Facility staff shall participate in inservice training relevant to their job duties as specified by
agency rule. Topics covered during the preservice orientation are not required to be repeated during
inservice training. A single certificate of completion that covers all required inservice training topics
may be issued to a participating staff member if the training is provided in a single training course.

(8) If the agency determines that there are problems in a facility which could be reduced through
specific staff training beyond that already required under this section, the agency may require and
provide, or cause to be provided, the training of any personal care staff in the facility.

(9) The agency shall adopt rules related to these training and education requirements, the
competency test, necessary procedures, and competency test fees and shall adopt or contract with
another entity to develop and administer the competency test. The agency shall adopt a curriculum
outline with learning objectives to be used by core trainers as the minimum core training content
requirements. The agency shall consult with representatives of stakeholder associations and agencies in
the development of the curriculum outline.

(10) The core training required by this section must be conducted by persons registered with the
agency as having the requisite experience and credentials to conduct the training. A person seeking to
register as a core trainer must provide the agency with proof of completion of the core training
requirements, successful passage of the competency test established under this section, and proof of
compliance with the continuing education requirement in subsection (5).

(11) A person seeking to register as a core trainer also must:

 (a) Provide proof of completion of a 4-year degree from an accredited college or university and
must have worked in a management position in an assisted living facility for 3 years after being core
certified;

(b) Have worked in a management position in an assisted living facility for 5 years after being core
certified and have 1 year of teaching experience as an educator or staff trainer for persons who work in
assisted living facilities or other long-term care settings;

(c) Have been previously employed as a core trainer for the agency or department; or

(d) Meet other qualification criteria as defined in rule, which the agency is authorized to adopt.

(12) The agency shall adopt rules to establish core trainer registration and removal requirements.

History.—ss. 12, 34, ch. 80-198; s. 2, ch. 81-318; ss. 60, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s. 3, ch. 85-251; s.
21, ch. 89-294; s. 27, ch. 91-263; ss. 33, 38, 39, ch. 93-216; s. 19, ch. 95-210; ss. 15, 26, 53, ch. 95-418; s. 16, ch. 97-82;
s. 29, ch. 97-100; s. 19, ch. 98-80; s. 25, ch. 2003-57; s. 3, ch. 2003-405; ss. 2, 59, ch. 2006-197; s. 1, ch. 2007-219; s.
16, ch. 2015-126; s. 88, ch. 2018-24; s. 57, ch. 2018-110; s. 20, ch. 2019-11; s. 13, ch. 2020-68.

Note.—Former s. 400.452.

429.53 Consultation by the agency.—

(1) The area offices of licensure and certification of the agency shall provide consultation to the
following upon request:

(a) A licensee of a facility.

(b) A person interested in obtaining a license to operate a facility under this part.

(2) As used in this section, “consultation” includes:

(a) An explanation of the requirements of this part and rules adopted pursuant thereto;

(b) An explanation of the license application and renewal procedures;

 (c) The provision of a checklist of general local and state approvals required prior to constructing
or developing a facility and a listing of the types of agencies responsible for such approvals;

(d) An explanation of benefits and financial assistance available to a recipient of supplemental

security income residing in a facility;

(e) Any other information which the agency deems necessary to promote compliance with the
requirements of this part; and

(f) A preconstruction review of a facility to ensure compliance with agency rules and this part.

(3) The agency may charge a fee commensurate with the cost of providing consultation under this
section.

History.—ss. 15, 19, ch. 87-371; s. 22, ch. 89-294; ss. 34, 38, 39, ch. 93-216; s. 2, ch. 2006-197.

Note.—Former s. 400.453.

429.54 Collection of information; local subsidy.—

(1) To enable the agency to collect the information requested by the Legislature regarding the
actual cost of providing room, board, and personal care in facilities, the agency is authorized to
conduct field visits and audits of facilities as necessary. The owners of randomly sampled facilities shall
submit such reports, audits, and accountings of cost as the agency may require by rule; provided that
such reports, audits, and accountings shall be the minimum necessary to implement this section. Any
facility selected to participate in the study shall cooperate with the agency by providing cost of
operation information to interviewers.

(2) Local governments or organizations may contribute to the cost of care of local facility residents
by further subsidizing the rate of state-authorized payment to such facilities. Implementation of local
subsidy requires agency approval and may not result in reductions in the state supplement.

History.—ss. 12, 35, ch. 80-198; s. 2, ch. 81-318; ss. 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; ss. 38, 39, ch. 93-216; s.
2, ch. 2006-197; s. 21, ch. 2019-11.

Note.—Former s. 400.454.
 429.55 Consumer information website.—The Legislature finds that consumers need additional
information on the quality of care and service in assisted living facilities in order to select the best
facility for themselves or their loved ones. Therefore, the Agency for Health Care Administration shall
create content that is easily accessible through the home page of the agency’s website either directly
or indirectly through links to one or more other established websites of the agency’s choosing. The
website must be searchable by facility name, license type, city, or zip code. By November 1, 2015, the
agency shall include all content in its possession on the website and add content when received from
facilities. At a minimum, the content must include:

(1) Information on each licensed assisted living facility, including, but not limited to:

(a) The name and address of the facility.

(b) The name of the owner or operator of the facility.

(c) The number and type of licensed beds in the facility.

(d) The types of licenses held by the facility.

(e) The facility’s license expiration date and status.

(f) The total number of clients that the facility is licensed to serve and the most recently available
occupancy levels.

(g) The number of private and semiprivate rooms offered.

(h) The bed-hold policy.

(i) The religious affiliation, if any, of the assisted living facility.

(j) The languages spoken by the staff.

(k) Availability of nurses.

 (l) Forms of payment accepted, including, but not limited to, Medicaid, Medicaid long-term
managed care, private insurance, health maintenance organization, United States Department of
Veterans Affairs, CHAMPUS program, or workers’ compensation coverage.

(m) Indication if the licensee is operating under bankruptcy protection.

(n) Recreational and other programs available.

(o) Special care units or programs offered.

(p) Whether the facility is a part of a retirement community that offers other services pursuant to
this part or part III of this chapter, part II or part III of chapter 400, or chapter 651.

(q) Links to the State Long-Term Care Ombudsman Program website and the program’s statewide
toll-free telephone number.

(r) Links to the websites of the providers.

(s) Other relevant information that the agency currently collects.

(2) Survey and violation information for the facility, including a list of the facility’s violations
committed during the previous 60 months, which on July 1, 2015, may include violations committed on
or after July 1, 2010. The list shall be updated monthly and include for each violation:

(a) A summary of the violation, including all licensure, revisit, and complaint survey information,
presented in a manner understandable by the general public.

(b) Any sanctions imposed by final order.

(c) The date the corrective action was confirmed by the agency.

(3) Links to inspection reports that the agency has on file.

The agency may adopt rules to administer this section.

 History.—s. 17, ch. 2015-126; s. 109, ch. 2020-2.

PART II

ADULT FAMILY-CARE HOMES

429.60 Short title.

429.63 Legislative intent; purpose.

429.65 Definitions.

429.67 Licensure.

429.69 Denial, revocation, and suspension of a license.

429.71 Classification of deficiencies; administrative fines.

429.73 Rules and standards relating to adult family-care homes.

429.75 Training and education programs.

429.81 Residency agreements.

429.83 Residents with Alzheimer’s disease or other related disorders; certain disclosures.

429.85 Residents’ bill of rights.

429.87 Civil actions to enforce rights.

429.60 Short title.—This part may be cited as the “Adult Family-Care Home Act.”

History.—ss. 1, 2, ch. 85-195; s. 4, ch. 91-429; s. 2, ch. 93-209; s. 1, ch. 98-338; s. 3, ch. 2006-197.

Note.—Former s. 400.616.
 429.63 Legislative intent; purpose.—

(1) The Legislature encourages the provision of care for disabled adults and frail elders in family-
type living arrangements in private homes.

(2) Adult family-care homes provide housing and personal care for disabled adults and frail elders
who choose to live with an individual or family in a private home. The adult family-care home provider
must live in the home. The purpose of this part is to provide for the health, safety, and welfare of
residents of adult family-care homes in the state.

(3) The Legislature recognizes that adult family-care homes are an important part of the continuum
of long-term care. The personal care available in these homes, which may be provided directly or
through contract or agreement, is intended to help residents remain as independent as possible in
order to delay or avoid placement in a nursing home or other institution. Regulations governing adult
family-care homes must be sufficiently flexible to allow residents to age in place if resources are
available to meet their needs and accommodate their preferences.

(4) The Legislature further finds and declares that licensure under this part is a public trust and a
privilege, and not an entitlement. This principle must guide the finder of fact or trier of law at any
administrative proceeding or circuit court action initiated by the agency to enforce this part.

(5) Rules of the agency relating to adult family-care homes shall be as minimal and flexible as
possible to ensure the protection of residents while minimizing the obstacles that could inhibit the
establishment of adult family-care homes.

History.—ss. 1, 2, ch. 85-195; s. 4, ch. 91-429; s. 3, ch. 93-209; s. 2, ch. 98-338; s. 3, ch. 2006-197; s. 22, ch. 2019-11.

Note.—Former s. 400.617.

429.65 Definitions.—As used in this part, the term:

(1) “Activities of daily living” means functions and tasks for self-care, including eating, bathing,
grooming, dressing, ambulating, and other similar tasks.

(2) “Adult family-care home” means a full-time, family-type living arrangement, in a private home,
under which a person who owns or rents the home provides room, board, and personal care, on a 24-
hour basis, for no more than five disabled adults or frail elders who are not relatives. The following
family-type living arrangements are not required to be licensed as an adult family-care home:

(a) An arrangement whereby the person who owns or rents the home provides room, board, and
personal services for not more than two adults who do not receive optional state supplementation
under s. 409.212. The person who provides the housing, meals, and personal 1care must own or rent
the home and reside therein.

(b) An arrangement whereby the person who owns or rents the home provides room, board, and
personal services only to his or her relatives.

(c) An establishment that is licensed as an assisted living facility under this chapter.

(3) “Agency” means the Agency for Health Care Administration.

(4) “Aging in place” means remaining in a noninstitutional living environment despite the physical
or mental changes that may occur in a person who is aging. For aging in place to occur, needed services
are added, increased, or adjusted to compensate for a person’s physical or mental changes.

(5) “Appropriate placement” means that the resident’s needs can be met by the adult family-care
home or can be met by services arranged by the adult family-care home or the resident.

(6) “Chemical restraint” means a pharmacologic drug that physically limits, restricts, or deprives an
individual of movement or mobility, and is used for discipline or convenience and not required for the
treatment of medical symptoms.

(7) “Department” means the Department of Elderly Affairs.

(8) “Disabled adult” means any person between 18 and 59 years of age, inclusive, who is a resident
of the state and who has one or more permanent physical or mental limitations that restrict the
person’s ability to perform the normal activities of daily living.

(9) “Frail elder” means a functionally impaired elderly person who is 60 years of age or older and
who has physical or mental limitations that restrict the person’s ability to perform the normal activities
of daily living and that impede the person’s capacity to live independently.
 (10) “Personal services” or “personal care” includes individual assistance with or supervision of the
activities of daily living and the self-administration of medication, and other similar services.

(11) “Provider” means a person who is licensed to operate an adult family-care home.

(12) “Relative” means an individual who is the father, mother, son, daughter, brother, sister,
grandfather, grandmother, great-grandfather, great-grandmother, uncle, aunt, first cousin, nephew,
niece, husband, wife, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-
in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, or half
sister of a provider.

(13) “Relief person” means an adult designated by the provider to supervise the residents during
the provider’s absence.

(14) “Resident” means a person receiving room, board, and personal care in an adult family-care
home.

History.—ss. 1, 2, ch. 85-195; s. 4, ch. 91-429; s. 4, ch. 93-209; s. 22, ch. 95-210; s. 61, ch. 95-418; s. 21, ch. 98-80; s.
3, ch. 98-338; s. 220, ch. 99-13; ss. 3, 66, ch. 2006-197.

1Note.—As amended by s. 3, ch. 98-338. Section 21, ch. 98-80, substituted the word “services” for the word “care.”

Note.—Former s. 400.618.

429.67 Licensure.—

(1) The requirements of part II of chapter 408 apply to the provision of services that require
licensure pursuant to this part and part II of chapter 408 and to entities licensed by or applying for such
licensure from the Agency for Health Care Administration pursuant to this part. A license issued by the
agency is required in order to operate an adult family-care home in this state.

(2) A person who intends to be an adult family-care home provider must own or rent the adult
family-care home that is to be licensed and reside therein.
 (3) In accordance with s. 408.805, an applicant or licensee shall pay a fee for each license
application submitted under this part, part II of chapter 408, and applicable rules. The amount of the
fee shall be $200 per biennium.

(4) The agency shall require level 2 background screening for personnel as required in s. 408.809(1)
(e), including the adult family-care home provider, the designated relief person, and all adult
household members, pursuant to chapter 435 and s. 408.809.

(5) Unless the adult family-care home is a community residential home subject to chapter 419, the
applicant must provide documentation, signed by the appropriate governmental official, that the home
has met local zoning requirements for the location for which the license is sought.

(6) In addition to the requirements of s. 408.811, access to a licensed adult family-care home must
be provided at reasonable times for the appropriate officials of the department, the Department of
Health, the Department of Children and Families, the agency, and the State Fire Marshal, who are
responsible for the development and maintenance of fire, health, sanitary, and safety standards, to
inspect the facility to assure compliance with these standards. In addition, access to a licensed adult
family-care home must be provided at reasonable times to representatives of the State Long-Term Care
Ombudsman Program.

(7) The licensed maximum capacity of each adult family-care home is based on the service needs of
the residents and the capability of the provider to meet the needs of the residents. Any relative who
lives in the adult family-care home and who is a disabled adult or frail elder must be included in that
limitation.

(8) Each adult family-care home must designate at least one licensed space for a resident receiving
optional state supplementation. The Department of Children and Families shall specify by rule the
procedures to be followed for referring residents who receive optional state supplementation to adult
family-care homes. Those homes licensed as adult foster homes or assisted living facilities prior to
January 1, 1994, that convert to adult family-care homes, are exempt from this requirement.

(9) In addition to the license categories available in s. 408.808, the agency may issue a conditional
license to a provider for the purpose of bringing the adult family-care home into compliance with
licensure requirements. A conditional license must be limited to a specific period, not exceeding 6
months. The agency shall, by rule, establish criteria for issuing conditional licenses.
 (10) The agency may adopt rules to establish procedures, identify forms, specify documentation,
and clarify terms, as necessary, to administer this section.

History.—ss. 1, 2, ch. 85-195; s. 38, ch. 87-225; s. 4, ch. 91-429; s. 5, ch. 93-209; s. 23, ch. 95-210; ss. 62, 130, ch. 95-
418; s. 8, ch. 98-148; ss. 57, 71, ch. 98-171; s. 4, ch. 98-338; s. 147, ch. 2000-349; s. 67, ch. 2000-367; s. 25, ch. 2001-
53; s. 2, ch. 2001-67; s. 148, ch. 2001-277; s. 28, ch. 2003-57; s. 25, ch. 2004-267; s. 8, ch. 2004-298; s. 3, ch. 2006-197;
s. 160, ch. 2007-230; s. 30, ch. 2010-114; s. 252, ch. 2014-19; s. 40, ch. 2015-31; s. 23, ch. 2019-11.

Note.—Former s. 400.619.

429.69 Denial, revocation, and suspension of a license.—In addition to the requirements of part II
of chapter 408, the agency may deny, suspend, and revoke a license for any of the following reasons:

(1) Failure to comply with the background screening standards of this part, s. 408.809(1), or
chapter 435.

(2) Failure to correct cited fire code violations that threaten the health, safety, or welfare of
residents.

History.—ss. 58, 71, ch. 98-171; s. 5, ch. 98-338; s. 25, ch. 2001-53; s. 2, ch. 2001-67; s. 148, ch. 2001-277; s. 26, ch.
2004-267; s. 3, ch. 2006-197; s. 103, ch. 2007-5; s. 161, ch. 2007-230; s. 31, ch. 2010-114.

Note.—Former s. 400.6194.

429.71 Classification of deficiencies; administrative fines.—

(1) In addition to the requirements of part II of chapter 408 and in addition to any other liability or
penalty provided by law, the agency may impose an administrative fine on a provider according to the
following classification:

(a) Class I violations are those conditions or practices related to the operation and maintenance of
an adult family-care home or to the care of residents which the agency determines present an
imminent danger to the residents or guests of the facility or a substantial probability that death or
serious physical or emotional harm would result therefrom. The condition or practice that constitutes a
class I violation must be abated or eliminated within 24 hours, unless a fixed period, as determined by
the agency, is required for correction. A class I deficiency is subject to an administrative fine in an
amount not less than $500 and not exceeding $1,000 for each violation. A fine may be levied
notwithstanding the correction of the deficiency.

(b) Class II violations are those conditions or practices related to the operation and maintenance of
an adult family-care home or to the care of residents which the agency determines directly threaten
the physical or emotional health, safety, or security of the residents, other than class I violations. A
class II violation is subject to an administrative fine in an amount not less than $250 and not exceeding
$500 for each violation. A citation for a class II violation must specify the time within which the
violation is required to be corrected. If a class II violation is corrected within the time specified, no
civil penalty shall be imposed, unless it is a repeated offense.

(c) Class III violations are those conditions or practices related to the operation and maintenance of
an adult family-care home or to the care of residents which the agency determines indirectly or
potentially threaten the physical or emotional health, safety, or security of residents, other than class I
or class II violations. A class III violation is subject to an administrative fine in an amount not less than
$100 and not exceeding $250 for each violation. A citation for a class III violation shall specify the time
within which the violation is required to be corrected. If a class III violation is corrected within the
time specified, no civil penalty shall be imposed, unless it is a repeated offense.

(d) Class IV violations are those conditions or occurrences related to the operation and
maintenance of an adult family-care home, or related to the required reports, forms, or documents,
which do not have the potential of negatively affecting the residents. A provider that does not correct
a class IV violation within the time limit specified by the agency is subject to an administrative fine in
an amount not less than $50 and not exceeding $100 for each violation. Any class IV violation that is
corrected during the time the agency survey is conducted will be identified as an agency finding and
not as a violation.

(2) The agency may impose an administrative fine for violations which do not qualify as class I,
class II, class III, or class IV violations. The amount of the fine shall not exceed $250 for each violation
or $2,000 in the aggregate. Unclassified violations may include:

(a) Violating any term or condition of a license.

(b) Violating any provision of this part, part II of chapter 408, or applicable rules.
 (c) Failure to follow the criteria and procedures provided under part I of chapter 394 relating to the
transportation, voluntary admission, and involuntary examination of adult family-care home residents.

(d) Exceeding licensed capacity.

(e) Providing services beyond the scope of the license.

(f) Violating a moratorium.

(3) Each day during which a violation occurs constitutes a separate offense.

(4) In determining whether a penalty is to be imposed, and in fixing the amount of any penalty to
be imposed, the agency must consider:

(a) The gravity of the violation.

(b) Actions taken by the provider to correct a violation.

(c) Any previous violation by the provider.

(d) The financial benefit to the provider of committing or continuing the violation.

(5) As an alternative to or in conjunction with an administrative action against a provider, the

agency may request a plan of corrective action that demonstrates a good faith effort to remedy each
violation by a specific date, subject to the approval of the agency.

(6) The agency shall establish by rule notice requirements and procedures for correction of
deficiencies.

History.—s. 6, ch. 93-209; s. 64, ch. 95-418; s. 41, ch. 96-169; s. 9, ch. 98-148; s. 6, ch. 98-338; s. 221, ch. 99-13; s. 3,
ch. 2006-197; s. 162, ch. 2007-230; s. 24, ch. 2019-11.

Note.—Former s. 400.6196.

429.73 Rules and standards relating to adult family-care homes.—

 (1) The agency in consultation with the Department of Health and the Department of Children and
Families shall establish by rule minimum standards to ensure the health, safety, and well-being of each
resident in the adult family-care home pursuant to this part. The rules must address:

(a) Requirements for the physical site of the facility and facility maintenance.

(b) Services that must be provided to all residents of an adult family-care home and standards for
such services, which must include, but need not be limited to:

1. Room and board.

2. Assistance necessary to perform the activities of daily living.

3. Assistance necessary to administer medication.

4. Supervision of residents.

5. Health monitoring.

6. Social and leisure activities.

(c) Standards and procedures for license application and annual license renewal, advertising,
proper management of each resident’s funds and personal property and personal affairs, financial
ability to operate, medication management, inspections, complaint investigations, and facility, staff,
and resident records.

(d) Qualifications, training, standards, and responsibilities for providers and staff.

(e) Compliance with chapter 419, relating to community residential homes.

(f) Criteria and procedures for determining the appropriateness of a resident’s placement and
continued residency in an adult family-care home. A resident who requires 24-hour nursing supervision
may not be retained in an adult family-care home unless such resident is an enrolled hospice patient
and the resident’s continued residency is mutually agreeable to the resident and the provider.
 (g) Procedures for providing notice and assuring the least possible disruption of residents’ lives
when residents are relocated, an adult family-care home is closed, or the ownership of an adult family-
care home is transferred.

(h) Procedures to protect the residents’ rights as provided in s. 429.85.

(i) Procedures to promote the growth of adult family-care homes as a component of a long-term
care system.

(j) Procedures to promote the goal of aging in place for residents of adult family-care homes.

(2) The agency shall provide by rule minimum standards and procedures for emergencies. Pursuant
to s. 633.206, the State Fire Marshal, in consultation with the agency, shall adopt uniform firesafety
standards for adult family-care homes.

(3) The agency shall adopt rules providing for the implementation of orders not to resuscitate. The
provider may withhold or withdraw cardiopulmonary resuscitation if presented with an order not to
resuscitate executed pursuant to s. 401.45. The provider shall not be subject to criminal prosecution or
civil liability, nor be considered to have engaged in negligent or unprofessional conduct, for
withholding or withdrawing cardiopulmonary resuscitation pursuant to such an order and applicable
rules.

History.—ss. 1, 2, ch. 85-195; s. 4, ch. 91-429; s. 7, ch. 93-209; s. 24, ch. 95-210; s. 65, ch. 95-418; s. 10, ch. 98-148;
s. 7, ch. 98-338; s. 3, ch. 99-179; s. 7, ch. 99-331; s. 3, ch. 2006-197; s. 104, ch. 2007-5; s. 163, ch. 2007-230; s. 139, ch.
2013-183; s. 253, ch. 2014-19; s. 25, ch. 2019-11.

Note.—Former s. 400.621.

429.75 Training and education programs.—

(1) Each adult family-care home provider shall complete training and education programs.

(2) Training and education programs must include information relating to:

(a) State law and rules governing adult family-care homes, with emphasis on appropriateness of
placement of residents in an adult family-care home.
 (b) Identifying and reporting abuse, neglect, and exploitation.

(c) Identifying and meeting the special needs of disabled adults and frail elders.

(d) Monitoring the health of residents, including guidelines for prevention and care of pressure
ulcers.

(3) Providers must complete the training and education program within a reasonable time
determined by the agency. Failure to complete the training and education program within the time set
by the agency is a violation of this part and subjects the provider to revocation of the license.

(4) If the Department of Children and Families or the agency determines that there are problems in
an adult family-care home which could be reduced through specific training or education beyond that
required under this section, the agency may require the provider or staff to complete such training or
education.

(5) The agency may adopt rules as necessary to administer this section.

History.—s. 8, ch. 93-209; s. 66, ch. 95-418; s. 11, ch. 98-148; s. 8, ch. 98-338; s. 4, ch. 2003-405; s. 3, ch. 2006-197;
s. 254, ch. 2014-19; s. 58, ch. 2018-110; s. 26, ch. 2019-11.

Note.—Former s. 400.6211.

429.81 Residency agreements.—

(1) Each resident must be covered by a residency agreement, executed before or at the time of
admission, between the provider and the resident or the resident’s designee or legal representative.
Each party to the contract must be provided a duplicate copy or the original agreement, and the
provider must keep the residency agreement on file for 5 years after expiration of the agreement.

(2) Each residency agreement must specify the personal care and accommodations to be provided
by the adult family-care home, the rates or charges, a requirement of at least 30 days’ notice before a
rate increase, and any other provisions required by rule of the agency.

History.—s. 11, ch. 93-209; s. 10, ch. 98-338; s. 3, ch. 2006-197; s. 27, ch. 2019-11.
 Note.—Former s. 400.625.

429.83 Residents with Alzheimer’s disease or other related disorders; certain disclosures.—An
adult family-care home licensed under this part which claims that it provides special care for persons
who have Alzheimer’s disease or other related disorders must disclose in its advertisements or in a
separate document those services that distinguish the care as being especially applicable to, or
suitable for, such persons. The home must give a copy of all such advertisements or a copy of the
document to each person who requests information about programs and services for persons with
Alzheimer’s disease or other related disorders offered by the home and must maintain a copy of all
such advertisements and documents in its records. The agency shall examine all such advertisements
and documents in the home’s records as part of the license renewal procedure.

History.—s. 6, ch. 93-105; s. 31, ch. 97-100; s. 11, ch. 98-338; s. 3, ch. 2006-197.

Note.—Former s. 400.6255.

429.85 Residents’ bill of rights.—

(1) A resident of an adult family-care home may not be deprived of any civil or legal rights,
benefits, or privileges guaranteed by law, the State Constitution, or the Constitution of the United
States solely by reason of status as a resident of the home. Each resident has the right to:

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

(b) Be treated with consideration and respect and with due recognition of personal dignity,
individuality, and privacy.

(c) Keep and use the resident’s own clothes and other personal property in the resident’s
immediate living quarters, so as to maintain individuality and personal dignity, except when the
provider can demonstrate that to do so would be unsafe or an infringement upon the rights of other
residents.

(d) Have unrestricted private communication, including receiving and sending unopened
correspondence, having access to a telephone, and visiting with any person of his or her choice, at any
time between the hours of 9 a.m. and 9 p.m. at a minimum.
 (e) Be free to participate in and benefit from community services and activities and to achieve the
highest possible level of independence, autonomy, and interaction within the community.

(f) Manage the resident’s own financial affairs unless the resident or the resident’s guardian
authorizes the provider to provide safekeeping for funds in accordance with procedures equivalent to
those provided in s. 429.27.

(g) Share a room with the resident’s spouse if both are residents of the home.

(h) Have reasonable opportunity for regular exercise several times a week and to be outdoors at
regular and frequent intervals.

(i) Exercise civil and religious liberties, including the right to independent personal decisions.
Religious beliefs or practices and attendance at religious services may not be imposed upon a resident.

(j) Have access to adequate and appropriate health care.

(k) Be free from chemical and physical restraints.

(l) Have at least 30 days’ notice of relocation or termination of residency from the home unless, for
medical reasons, the resident is certified by a physician to require an emergency relocation to a
facility providing a more skilled level of care or the resident engages in a pattern of conduct that is
harmful or offensive to other residents. If a resident has been adjudicated mentally incompetent, the
resident’s guardian must be given at least 30 days’ notice, except in an emergency, of the relocation
of a resident or of the termination of a residency. The reasons for relocating a resident must be set
forth in writing.

(m) Present grievances and recommend changes to the provider, to staff, or to any other person
without restraint, interference, coercion, discrimination, or reprisal. This right includes the right to
have access to ombudsman volunteers and advocates and the right to be a member of, to be active in,
and to associate with advocacy or special interest groups.

(2) The provider shall ensure that residents and their legal representatives are made aware of the
rights, obligations, and prohibitions set forth in this part. Residents must also be given the statewide
toll-free telephone number and e-mail address of the State Long-Term Care Ombudsman Program and
the telephone number of the local ombudsman council and the Elder Abuse Hotline operated by the
Department of Children and Families where they may lodge complaints.

(3) The adult family-care home may not hamper or prevent residents from exercising the rights
specified in this section.

(4) A provider or staff of an adult family-care home may not serve notice upon a resident to leave
the premises or take any other retaliatory action against any person who:

(a) Exercises any right set forth in this section.

(b) Appears as a witness in any hearing, in or out of the adult family-care home.

(c) Files a civil action alleging a violation of this part or notifies a state attorney or the Attorney
General of a possible violation of this part.

(5) Any adult family-care home that terminates the residency of an individual who has participated
in activities specified in subsection (4) must show good cause for the termination in a court of
competent jurisdiction.

(6) Any person who reports a complaint concerning a suspected violation of this part or the services
and conditions in an adult family-care home, or who testifies in any administrative or judicial
proceeding arising from such a complaint, is immune from any civil or criminal liability therefor, unless
the person acted in bad faith or with malicious purpose or the court finds that there was a complete
absence of a justiciable issue of either law or fact raised by the losing party.

History.—s. 12, ch. 93-209; s. 790, ch. 95-148; s. 6, ch. 97-82; s. 12, ch. 98-338; ss. 84, 148, ch. 2000-349; s. 68, ch.
2000-367; ss. 3, 67, ch. 2006-197; s. 41, ch. 2015-31.

Note.—Former s. 400.628.

429.87 Civil actions to enforce rights.—

(1) Any person or resident whose rights as specified in this part are violated has a cause of action
against any adult family-care home, provider, or staff responsible for the violation. The action may be
brought by the resident or the resident’s guardian, or by a person or organization acting on behalf of a
resident with the consent of the resident or the resident’s guardian, to enforce the right. The action
may be brought in any court of competent jurisdiction to enforce such rights and to recover actual
damages, and punitive damages when malicious, wanton, or willful disregard of the rights of others can
be shown. Any plaintiff who prevails in any such action is entitled to recover reasonable attorney’s
fees, costs of the action, and damages, unless the court finds that the plaintiff has acted in bad faith
or with malicious purpose or that there was a complete absence of a justiciable issue of either law or
fact. A prevailing defendant is entitled to recover reasonable attorney’s fees pursuant to s. 57.105.
The remedies provided in this section are in addition to other legal and administrative remedies
available to a resident or to the agency.

(2) To recover attorney’s fees under this section, the following conditions precedent must be met:

(a) Within 120 days after the filing of a responsive pleading or defensive motion to a complaint
brought under this section and before trial, the parties or their designated representatives shall meet
in mediation to discuss the issues of liability and damages in accordance with this paragraph for the
purpose of an early resolution of the matter.

1. Within 60 days after the filing of the responsive pleading or defensive motion, the parties shall:

a. Agree on a mediator. If the parties cannot agree on a mediator, the defendant shall immediately
notify the court, which shall appoint a mediator within 10 days after such notice.

b. Set a date for mediation.

c. Prepare an order for the court that identifies the mediator, the scheduled date of the
mediation, and other terms of the mediation. Absent any disagreement between the parties, the court
may issue the order for the mediation submitted by the parties without a hearing.

2. The mediation must be concluded within 120 days after the filing of a responsive pleading or
defensive motion. The date may be extended only by agreement of all parties subject to mediation
under this subsection.

3. The mediation shall be conducted in the following manner:

a. Each party shall ensure that all persons necessary for complete settlement authority are present
at the mediation.
 b. Each party shall mediate in good faith.

4. All aspects of the mediation which are not specifically established by this subsection must be
conducted according to the rules of practice and procedure adopted by the Supreme Court of this
state.

(b) If the parties do not settle the case pursuant to mediation, the last offer of the defendant made
at mediation shall be recorded by the mediator in a written report that states the amount of the offer,
the date the offer was made in writing, and the date the offer was rejected. If the matter
subsequently proceeds to trial under this section and the plaintiff prevails but is awarded an amount in
damages, exclusive of attorney’s fees, which is equal to or less than the last offer made by the
defendant at mediation, the plaintiff is not entitled to recover any attorney’s fees.

(c) This subsection applies only to claims for liability and damages and does not apply to actions for
injunctive relief.

(d) This subsection applies to all causes of action that accrue on or after October 1, 1999.

(3) Discovery of financial information for the purpose of determining the value of punitive damages
may not be had unless the plaintiff shows the court by proffer or evidence in the record that a
reasonable basis exists to support a claim for punitive damages.

(4) In addition to any other standards for punitive damages, any award of punitive damages must be
reasonable in light of the actual harm suffered by the resident and the egregiousness of the conduct
that caused the actual harm to the resident.

History.—s. 13, ch. 93-209; s. 13, ch. 98-338; s. 32, ch. 99-225; s. 3, ch. 2006-197.

Note.—Former s. 400.629.

PART III

ADULT DAY CARE CENTERS

429.90 Purpose.

429.901 Definitions.
429.903 Applicability.

429.905 Exemptions; monitoring of adult day care center programs colocated with assisted living
facilities or licensed nursing home facilities.

429.907 License requirement; fee; exemption; display.

429.909 Application for license.

429.911 Denial, suspension, revocation of license; emergency action; administrative fines;

investigations and inspections.

429.913 Administrative fines.

429.915 Conditional license.

429.917 Patients with Alzheimer’s disease or other related disorders; staff training requirements;
certain disclosures.

429.918 Licensure designation as a specialized Alzheimer’s services adult day care center.

429.919 Background screening.

429.925 Discontinuance of operation of adult day care centers.

429.927 Right of entry and inspection.

429.929 Rules establishing standards.

429.931 Construction and renovation; requirements.

429.90 Purpose.—The purpose of this part is to develop, establish, and enforce basic standards for
adult day care centers in order to assure that a program of therapeutic social and health activities and
services is provided to adults who have functional impairments, in a protective environment that
provides as noninstitutional an atmosphere as possible.
 History.—s. 1, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 1, 17, ch. 93-215; s. 4, ch. 2006-197.

Note.—Former s. 400.55.

429.901 Definitions.—As used in this part, the term:

(1) “Adult day care center” or “center” means any building, buildings, or part of a building,
whether operated for profit or not, in which is provided through its ownership or management, for a
part of a day, basic services to three or more persons who are 18 years of age or older, who are not
related to the owner or operator by blood or marriage, and who require such services.

(2) “Agency” means the Agency for Health Care Administration.

(3) “Basic services” include, but are not limited to, providing a protective setting that is as
noninstitutional as possible; therapeutic programs of social and health activities and services; leisure
activities; self-care training; rest; nutritional services; and respite care.

(4) “Department” means the Department of Elderly Affairs.

(5) “Multiple or repeated violations” means 2 or more violations that present an imminent danger
to the health, safety, or welfare of participants or 10 or more violations within a 5-year period that
threaten the health, safety, or welfare of the participants.

(6) “Operator” means the licensee or person having general administrative charge of an adult day
care center.

(7) “Owner” means the licensee of an adult day care center.

(8) “Participant” means a recipient of basic services or of supportive and optional services provided
by an adult day care center.

(9) “Supportive and optional services” include, but are not limited to, speech, occupational, and
physical therapy; direct transportation; legal consultation; consumer education; and referrals for
followup services.
 History.—s. 2, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 2, 17, ch. 93-215; s. 55, ch. 95-418; s. 4, ch.
2006-197; s. 165, ch. 2007-230.

Note.—Former s. 400.551.

429.903 Applicability.—Any facility that comes within the definition of an adult day care center
which is not exempt under s. 429.905 must be licensed by the agency as an adult day care center.

History.—s. 3, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 3, 17, ch. 93-215; s. 4, ch. 2006-197; s. 105, ch.
2007-5.

Note.—Former s. 400.552.

429.905 Exemptions; monitoring of adult day care center programs colocated with assisted
living facilities or licensed nursing home facilities.—

(1) The following are exempt from this part:

(a) Any facility, institution, or other place that is operated by the Federal Government or any
agency thereof.

(b) Any freestanding inpatient hospice facility that is licensed by the state and which provides day
care services to hospice patients only.

(2) A licensed assisted living facility, a licensed hospital, or a licensed nursing home facility may
provide services during the day which include, but are not limited to, social, health, therapeutic,
recreational, nutritional, and respite services, to adults who are not residents. Such a facility need not
be licensed as an adult day care center; however, the agency must monitor the facility during the
regular inspection to ensure adequate space and sufficient staff. If an assisted living facility, a
hospital, or a nursing home holds itself out to the public as an adult day care center, it must be
licensed as such and meet all standards prescribed by statute and rule. For the purpose of this
subsection, the term “day” means any portion of a 24-hour day.

History.—s. 4, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; s. 6, ch. 88-235; ss. 4, 17, ch. 93-215; s. 20, ch. 95-
210; s. 4, ch. 2006-197; s. 30, ch. 2012-160; s. 49, ch. 2020-156.

Note.—Former s. 400.553.
 429.907 License requirement; fee; exemption; display.—

(1) The requirements of part II of chapter 408 apply to the provision of services that require
licensure pursuant to this part and part II of chapter 408 and to entities licensed by or applying for such
licensure from the Agency for Health Care Administration pursuant to this part. A license issued by the
agency is required in order to operate an adult day care center in this state.

(2)(a) Except as otherwise provided in this subsection, separate licenses are required for centers
operated on separate premises, even though operated under the same management. Separate licenses
are not required for separate buildings on the same premises.

(b) If a licensed center becomes wholly or substantially unusable due to a disaster or due to an
emergency as those terms are defined in s. 252.34:

1. The licensee may continue to operate under its current license in premises separate from that
authorized under the license if the licensee has:

a. Specified the location of the premises in its comprehensive emergency management plan
submitted to and approved by the applicable county emergency management authority; and

b. Notified the agency and the county emergency management authority within 24 hours of
operating in the separate premises.

2. The licensee shall operate the separate premises only while the licensed center’s original
location is substantially unusable and for up to 180 days. The agency may extend use of the alternate
premises beyond the initial 180 days. The agency may also review the operation of the disaster
premises quarterly.

(3) In accordance with s. 408.805, an applicant or licensee shall pay a fee for each license
application submitted under this part and part II of chapter 408. The amount of the fee shall be
established by rule and may not exceed $150.

(4) County-operated or municipally operated centers applying for licensure under this part are
exempt from the payment of license fees.
 History.—s. 5, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 5, 17, ch. 93-215; s. 4, ch. 2006-197; s. 2, ch.
2007-219; s. 166, ch. 2007-230; s. 119, ch. 2008-4; s. 344, ch. 2011-142.

Note.—Former s. 400.554.

429.909 Application for license.—In addition to all provisions of part II of chapter 408, the
applicant for licensure must furnish a description of the physical and mental capabilities and needs of
the participants to be served and the availability, frequency, and intensity of basic services and of
supportive and optional services to be provided and proof of adequate liability insurance coverage.

History.—s. 6, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 6, 17, ch. 93-215; s. 50, ch. 98-171; s. 4, ch.
2006-197; s. 106, ch. 2007-5; s. 167, ch. 2007-230.

Note.—Former s. 400.555.

429.911 Denial, suspension, revocation of license; emergency action; administrative fines;

investigations and inspections.—

(1) The agency may deny, revoke, and suspend a license under this part, impose an action under s.
408.814, and impose an administrative fine against the owner of an adult day care center or its
operator or employee in the manner provided in chapter 120 for the violation of any provision of this
part, part II of chapter 408, or applicable rules.

(2) Each of the following actions by the owner of an adult day care center or by its operator or
employee is a ground for action by the agency against the owner of the center or its operator or
employee:

(a) An intentional or negligent act materially affecting the health or safety of center participants.

(b) A violation of this part or of any standard or rule under this part or part II of chapter 408.

(c) Failure to comply with the background screening standards of this part, s. 408.809(1), or
chapter 435.

(d) Failure to follow the criteria and procedures provided under part I of chapter 394 relating to
the transportation, voluntary admission, and involuntary examination of center participants.
 (e) Multiple or repeated violations of this part or of any standard or rule adopted under this part or
part II of chapter 408.

(3) The agency is responsible for all investigations and inspections conducted pursuant to this part
and s. 408.811.

History.—s. 7, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 7, 17, ch. 93-215; s. 40, ch. 96-169; s. 51, ch. 98-
171; s. 143, ch. 98-403; s. 16, ch. 2004-267; ss. 4, 63, ch. 2006-197; s. 168, ch. 2007-230; s. 32, ch. 2010-114.

Note.—Former s. 400.556.

429.913 Administrative fines.—

(1)(a) In addition to the requirements of part II of chapter 408, if the agency determines that an
adult day care center is not operated in compliance with this part or with rules adopted under this
part, the agency, notwithstanding any other administrative action it takes, shall make a reasonable
attempt to discuss with the owner each violation and recommended corrective action prior to providing
the owner with written notification. The agency may request the submission of a corrective action plan
for the center which demonstrates a good faith effort to remedy each violation by a specific date,
subject to the approval of the agency.

(b) The owner of a center or its operator or employee found in violation of this part, part II of
chapter 408, or applicable rules may be fined by the agency. A fine may not exceed $500 for each
violation. In no event, however, may such fines in the aggregate exceed $5,000.

(c) The failure to correct a violation by the date set by the agency, or the failure to comply with an
approved corrective action plan, is a separate violation for each day such failure continues, unless the
agency approves an extension to a specific date.

(2) In determining whether to impose a fine and in fixing the amount of any fine, the agency shall
consider the following factors:

(a) The gravity of the violation, including the probability that death or serious physical or
emotional harm to a participant will result or has resulted, the severity of the actual or potential
harm, and the extent to which the provisions of the applicable statutes or rules were violated.
 (b) Actions taken by the owner or operator to correct violations.

(c) Any previous violations.

(d) The financial benefit to the center of committing or continuing the violation.

History.—ss. 64, 83, ch. 83-181; ss. 8, 17, ch. 93-215; s. 4, ch. 2006-197; s. 169, ch. 2007-230.

Note.—Former s. 400.5565.

429.915 Conditional license.—In addition to the license categories available in part II of chapter
408, the agency may issue a conditional license to an applicant for license renewal or change of
ownership if the applicant fails to meet all standards and requirements for licensure. A conditional
license issued under this subsection must be limited to a specific period not exceeding 6 months, as
determined by the agency, and must be accompanied by an approved plan of correction.

History.—s. 8, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 9, 17, ch. 93-215; s. 52, ch. 98-171; s. 27, ch.
2003-57; s. 4, ch. 2006-197; s. 107, ch. 2007-5; s. 170, ch. 2007-230.

Note.—Former s. 400.557.

429.917 Patients with Alzheimer’s disease or other related disorders; staff training
requirements; certain disclosures.—

(1) An adult day care center licensed under this part must provide the following staff training:

(a) Upon beginning employment with the facility, each employee must receive basic written
information about interacting with participants who have Alzheimer’s disease or dementia-related
disorders.

(b) In addition to the information provided under paragraph (a), newly hired adult day care center
personnel who are expected to, or whose responsibilities require them to, have direct contact with
participants who have Alzheimer’s disease or dementia-related disorders must complete initial training
of at least 1 hour within the first 3 months after beginning employment. The training must include an
overview of dementias and must provide instruction in basic skills for communicating with persons who
have dementia.
 (c) In addition to the requirements of paragraphs (a) and (b), an employee who will be providing
direct care to a participant who has Alzheimer’s disease or a dementia-related disorder must complete
an additional 3 hours of training within 9 months after beginning employment. This training must
include, but is not limited to, the management of problem behaviors, information about promoting the
participant’s independence in activities of daily living, and instruction in skills for working with families
and caregivers.

(d) For certified nursing assistants, the required 4 hours of training shall be part of the total hours
of training required annually.

(e) For a health care practitioner as defined in s. 456.001, continuing education hours taken as
required by that practitioner’s licensing board shall be counted toward the total of 4 hours.

(f) For an employee who is a licensed health care practitioner as defined in s. 456.001, training
that is sanctioned by that practitioner’s licensing board shall be considered to be approved by the
Department of Elderly Affairs.

(g) The Department of Elderly Affairs or its designee must approve the 1-hour and 3-hour training
provided to employees and direct caregivers under this section. The department must consider for
approval training offered in a variety of formats. The department shall keep a list of current providers
who are approved to provide the 1-hour and 3-hour training. The department shall adopt rules to
establish standards for the employees who are subject to this training, for the trainers, and for the
training required in this section.

(h) Upon completing any training described in this section, the employee or direct caregiver shall
be issued a certificate that includes the name of the training provider, the topic covered, and the date
and signature of the training provider. The certificate is evidence of completion of training in the
identified topic, and the employee or direct caregiver is not required to repeat training in that topic if
the employee or direct caregiver changes employment to a different adult day care center or to an
assisted living facility, nursing home, home health agency, or hospice. The direct caregiver must
comply with other applicable continuing education requirements.

(i) An employee who is hired on or after July 1, 2004, must complete the training required by this
section.
 (2) A center licensed under this part which claims that it provides special care for persons who have
Alzheimer’s disease or other related disorders must disclose in its advertisements or in a separate
document those services that distinguish the care as being especially applicable to, or suitable for,
such persons. The center must give a copy of all such advertisements or a copy of the document to
each person who requests information about the center and must maintain a copy of all such
advertisements and documents in its records. The agency shall examine all such advertisements and
documents in the center’s records as part of the license renewal procedure. An adult day care center
may not claim to be licensed or designated to provide specialized Alzheimer’s services unless the adult
day care center’s license has been designated as such pursuant to s. 429.918.

History.—s. 4, ch. 93-105; s. 3, ch. 2003-271; s. 4, ch. 2006-197; s. 1, ch. 2012-43.

Note.—Former s. 400.5571.

429.918 Licensure designation as a specialized Alzheimer’s services adult day care center.—

(1) This act may be cited as the “Specialized Alzheimer’s Services Adult Day Care Act.”

(2) As used in this section, the term:

(a) “ADRD participant” means a participant who has a documented diagnosis of Alzheimer’s disease
or a dementia-related disorder (ADRD) from a licensed physician, licensed physician assistant, or a
licensed advanced practice registered nurse.

(b) “Dementia” means the loss of at least two intellectual functions, such as thinking,
remembering, and reasoning, which is severe enough to interfere with a person’s daily function. The
term does not describe a disease, but describes a group of symptoms that may accompany certain
diseases or physical conditions.

(c) “Specialized Alzheimer’s services” means therapeutic, behavioral, health, safety, and security
interventions; clinical care; support services; and educational services that are customized for the
specialized needs of a participant’s caregiver and the participant who is affected by Alzheimer’s
disease or an irreversible, degenerative condition resulting in dementia.

(d) “Therapeutic activity” means an individual or group activity that is intended to promote,
maintain, or enhance the ADRD participant’s physical, cognitive, social, spiritual, or emotional health.
 (3) An adult day care center may apply to the agency to have its license issued under s. 429.907,
designated as a “specialized Alzheimer’s services adult day care center,” if the requirements under
this section have been met.

(a) The adult day care center must notify the agency at least 30 days prior to initial licensure under
s. 429.907 or, if already licensed, at least 6 months prior to the expiration of a license issued under s.
429.907, that the adult day care center is seeking a designation as a specialized Alzheimer’s services
adult day care center.

(b) The agency, after receiving the notification pursuant to paragraph (a), may make a
determination at an initial licensure inspection or at a licensure renewal inspection as to whether the
adult day care center meets the requirements of this section to be designated as a specialized
Alzheimer’s services adult day care center. If the agency determines that the adult day care center
meets the requirements of this section, it must designate the adult day care center as a specialized
Alzheimer’s services adult day care center at the time of initial licensure or at licensure renewal.

(c) If the agency, during the initial or renewal inspection, determines that the adult day care
center has committed an act under s. 429.911(2), the agency may deny the request for the designation
or revoke such designation.

(d) The agency may at any time revoke the designation if the adult day care center fails to
maintain the requirements under this section.

(4) To obtain or maintain the designation under this section, an adult day care center must:

(a) Have a mission statement that includes a commitment to providing dementia-specific services
and disclose in the center’s advertisements or in a separate document, which must be made available
to the public upon request, the services that distinguish the care as being suitable for a person who has
Alzheimer’s disease or a dementia-related disorder.

(b) Provide ADRD participants with a program for dementia-specific, therapeutic activities,
including, but not limited to, physical, cognitive, and social activities appropriate for the ADRD
participant’s age, culture, and level of function.

(c) Maintain at all times a minimum staff-to-participant ratio of one staff member who provides
direct services for every five ADRD participants.
 (d) Provide ADRD participants with a program for therapeutic activity at least 70 percent of the
time that the center is open.

(e) Provide ADRD participants with hands-on assistance with activities of daily living, inclusive of
the provision of urinary and bowel incontinence care.

(f) Use assessment tools that identify the ADRD participant’s cognitive deficits and identify the
specialized and individualized needs of the ADRD participant and the caregiver. This assessment shall
be conducted when the ADRD participant is initially admitted into the center and shall be updated
when the ADRD participant experiences a significant change, but no less frequently than annually.

(g) Create an individualized plan of care for each ADRD participant which addresses the identified,
dementia-specific needs of the ADRD participant and the caregiver. The plan of care shall be
established when the ADRD participant is initially admitted into the center and reviewed at least
quarterly.

(h) Conduct a monthly health assessment of each ADRD participant which includes, but is not
limited to, the ADRD participant’s weight, vital signs, and level of assistance needed with activities of
daily living.

(i) Complete a monthly update in each ADRD participant’s file regarding the ADRD participant’s
status or progress toward meeting the goals indicated on the individualized plan of care.

(j) Assist in the referral or coordination of other dementia-specific services and resources needed
by the ADRD participant or the caregiver, such as medical services, counseling, medical planning, legal
planning, financial planning, safety and security planning, disaster planning, driving assessment,
transportation coordination, or wandering prevention.

(k) Offer, facilitate, or provide referrals to a support group for persons who are caregivers to ADRD
participants.

(l) Provide dementia-specific educational materials regularly to ADRD participants, as appropriate,

and their caregivers.
 (m) Routinely conduct and document a count of all ADRD participants present in the center
throughout each day. This count must be compared to each ADRD participant’s attendance record in
order to ensure that an ADRD participant is not missing from the center.

(n) Be a secured unit or have working alarm or security devices installed on every door that is
accessible to the ADRD participant and provides egress from the center or areas of the center
designated for the provision of adult day care - specialized Alzheimer’s services.

(o) Not allow an ADRD participant to administer his or her own medication.

(p) Condition the ADRD participant’s eligibility for admission on whether the ADRD participant has a
coordinated mode of transportation to and from the adult day care center, to ensure that the
participant does not drive to or from the center.

(5)(a) The operator of an adult day care center having a license designated under this section, and
the operator’s designee, as applicable, hired on or after July 1, 2012, shall:

1. Have at least a bachelor’s degree in health care services, social services, or a related field, 1
year of staff supervisory experience in a social services or health care services setting, and a minimum
of 1 year of experience in providing services to persons who have dementia;

2. Be a registered or practical nurse licensed in this state, have 1 year of staff supervisory
experience in a social services or health care services setting, and have a minimum of 1 year of
experience in providing services to persons who have dementia; or

3. Have 5 years of staff supervisory experience in a social services or health care services setting
and a minimum of 3 years of experience in providing services to persons who have dementia.

(b) The owner must sign an affidavit under penalty of perjury stating that he or she has verified
that the operator, and the operator’s designee, if any, have completed the education and experience
requirements of this subsection.

(6)(a) An adult day care center having a license designated under this section must provide the
following staff training and supervision:
 1. A registered nurse or licensed practical nurse must be on site daily for at least 75 percent of the
time that the center is open to ADRD participants. Each licensed practical nurse who works at the
center must be supervised in accordance with chapter 464.

2. Upon beginning employment with the center, each employee must receive and review basic
written information about interacting with ADRD participants.

3. In addition to the information provided in subparagraph 2., every employee hired on or after
July 1, 2012, who has direct contact with ADRD participants shall complete 4 hours of dementia-
specific training within 3 months after employment.

4. In addition to the requirements of subparagraphs 2. and 3., each employee hired on or after July
1, 2012, who provides direct care to ADRD participants shall complete an additional 4 hours of
dementia-specific training within 6 months after employment.

(b) The Department of Elderly Affairs or its designee shall approve the training required under this
section. The department shall adopt rules to establish standards for employees who are subject to this
training, for trainers, and for the training required in this section.

(c) Upon completing any training described in this section, the employee shall be issued a
certificate that includes the name of the training provider, the topics covered, and the date and
signature of the training provider. The certificate is evidence of completion of training in the identified
topics, and the employee is not required to repeat training in those topics if the employee changes
employment to a different adult day care center.

(d) Each employee hired on or after July 1, 2012, who provides direct care to ADRD participants,
must receive and review an orientation plan that includes, at a minimum:

1. Procedures to locate an ADRD participant who has wandered from the center. These procedures
shall be reviewed regularly with all direct care staff.

2. Information on the Silver Alert program in this state.

3. Information regarding available products or programs used to identify ADRD participants or

prevent them from wandering away from the center, their home, or other locations.
 (7)(a) An ADRD participant admitted to an adult day care center having a license designated under
this section, or the caregiver when applicable, must:

1. Require ongoing supervision to maintain the highest level of medical or custodial functioning and
have a demonstrated need for a responsible party to oversee his or her care.

2. Not actively demonstrate aggressive behavior that places himself, herself, or others at risk of
harm.

3. Provide the following medical documentation signed by a licensed physician, a licensed physician
assistant, or a licensed advanced practice registered nurse:

a. Any physical, health, or emotional conditions that require medical care.

b. A listing of the ADRD participant’s current prescribed and over-the-counter medications and
dosages, diet restrictions, mobility restrictions, and other physical limitations.

4. Provide documentation signed by a health care provider licensed in this state which indicates
that the ADRD participant is free of the communicable form of tuberculosis and free of signs and
symptoms of other communicable diseases.

(b) Before admitting an ADRD participant to an adult day care center that has a license designated
under this section, the center shall determine whether:

1. The medical, psychological, safety, and behavioral support and intervention required by the
ADRD participant can be provided by the center.

2. The resources required to assist with the ADRD participant’s acuity level of care and support
needed can be provided or coordinated by the center.

(8)(a) An ADRD participant’s file must include a data sheet, which must be completed within 45
days before or within 24 hours after admission to an adult day care center having a license designated
under this section. The data sheet must contain:
 1. Information regarding the status of the ADRD participant’s enrollment in an identification or
wandering-prevention program, including the name of the program; and

2. A current photograph of the ADRD participant.

(b) Dementia-specific services shall be documented in the ADRD participant’s file.

(c) Notes regarding services provided to the ADRD participant must be entered at least monthly in
the ADRD participant’s file, and must indicate the ADRD participant’s status or progress toward
achieving identified goals. Additional notes must be entered more frequently if indicated by the ADRD
participant’s condition.

(d) An ADRD participant, or the participant’s caregiver, shall annually provide the center with
updated medical documentation required under subparagraphs (7)(a)3. and 4., and the center must
place that documentation in the ADRD participant’s file.

(9) An adult day care center having a license designated under this section must give to each
person who enrolls as an ADRD participant in the center, or the caregiver, a copy of the ADRD
participant’s plan of care, as well as information regarding resources to assist in ensuring the safety
and security of the ADRD participant, which must include, but need not be limited to, information
pertaining to driving for those persons affected by dementia, available technology on wandering-
prevention devices and identification devices, the Silver Alert program in this state, and dementia-
specific safety interventions and strategies that can be used in the home setting.

(10) If an ADRD participant’s enrollment in the center is involuntarily terminated due to medical or
behavioral reasons, the center shall coordinate and execute appropriate discharge procedures, to be
determined by rule, with the ADRD participant and the caregiver.

(11) This section does not prohibit an adult day care center that is licensed pursuant to s. 429.907,
and without a designation under this section, from providing adult day care services to persons who
have Alzheimer’s disease or other dementia-related disorders.

(12) The Department of Elderly Affairs may adopt rules to administer this section.

History.—s. 2, ch. 2012-43; s. 42, ch. 2018-106.

 429.919 Background screening.—The agency shall require level 2 background screening for
personnel as required in s. 408.809(1)(e) pursuant to chapter 435 and s. 408.809.

History.—ss. 53, 71, ch. 98-171; s. 83, ch. 2000-349; s. 25, ch. 2001-53; s. 2, ch. 2001-67; s. 148, ch. 2001-277; s. 49,
ch. 2004-267; ss. 4, 64, ch. 2006-197; s. 108, ch. 2007-5; s. 171, ch. 2007-230; s. 33, ch. 2010-114.

Note.—Former s. 400.5572.

429.925 Discontinuance of operation of adult day care centers.—In addition to the requirements
of part II of chapter 408, before operation of an adult day care center may be voluntarily discontinued,
the operator must, at least 60 days before the discontinuance of operation, inform each participant of
the fact and the proposed date of discontinuance of operation.

History.—s. 10, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 12, 17, ch. 93-215; s. 4, ch. 2006-197; s. 174,
ch. 2007-230.

Note.—Former s. 400.559.

429.927 Right of entry and inspection.—In accordance with s. 408.811, the agency or department
has the right to enter the premises of any adult day care center licensed pursuant to this part, at any
reasonable time, in order to determine the state of compliance with this part, part II of chapter 408,
and applicable rules.

History.—s. 11, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 13, 17, ch. 93-215; s. 4, ch. 2006-197; s. 175,
ch. 2007-230.

Note.—Former s. 400.56.

429.929 Rules establishing standards.—The agency shall adopt rules to implement this part. The
rules must include reasonable and fair standards. Any conflict between these standards and those that
may be set forth in local, county, or municipal ordinances shall be resolved in favor of those having
statewide effect. Such standards must relate to:

(1) The maintenance of adult day care centers with respect to plumbing, heating, lighting,
ventilation, and other building conditions, including adequate meeting space, to ensure the health,
safety, and comfort of participants and protection from fire hazard. Such standards may not conflict
with chapter 553 and must be based upon the size of the structure and the number of participants.
 (2) The number and qualifications of all personnel employed by adult day care centers who have
responsibilities for the care of participants.

(3) All sanitary conditions within adult day care centers and their surroundings, including water
supply, sewage disposal, food handling, and general hygiene, and maintenance of sanitary conditions,
to ensure the health and comfort of participants.

(4) Basic services provided by adult day care centers.

(5) Supportive and optional services provided by adult day care centers.

(6) Data and information relative to participants and programs of adult day care centers, including,
but not limited to, the physical and mental capabilities and needs of the participants, the availability,
frequency, and intensity of basic services and of supportive and optional services provided, the
frequency of participation, the distances traveled by participants, the hours of operation, the number
of referrals to other centers or elsewhere, and the incidence of illness.

(7) Components of a comprehensive emergency management plan, developed in consultation with

the Department of Health and the Division of Emergency Management.

History.—ss. 13, 18, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 14, 17, ch. 93-215; s. 56, ch. 95-418; s. 61,
ch. 2001-45; s. 4, ch. 2006-197; s. 176, ch. 2007-230; s. 345, ch. 2011-142; s. 28, ch. 2019-11; s. 50, ch. 2020-156.

Note.—Former s. 400.562.

429.931 Construction and renovation; requirements.—The requirements for the construction and
the renovation of a center must comply with the provisions of chapter 553 which pertain to building
construction standards, including plumbing, electrical code, glass, manufactured buildings,
accessibility by physically handicapped persons, and the state minimum building codes.

History.—s. 14, ch. 78-336; s. 4, ch. 79-152; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 15, 17, ch. 93-215; s. 4, ch.
2006-197.

Note.—Former s. 400.563.