Bill Text: FL S0402 | 2020 | Regular Session | Comm Sub


Bill Title: Assisted Living Facilities

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 2020-03-09 - Laid on Table, refer to CS/CS/HB 767 [S0402 Detail]

Download: Florida-2020-S0402-Comm_Sub.html
       Florida Senate - 2020                       CS for CS for SB 402
       
       
        
       By the Committees on Appropriations; and Health Policy; and
       Senator Harrell
       
       
       
       
       576-04560-20                                           2020402c2
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 429.02, F.S.; defining and revising terms;
    4         amending s. 429.07, F.S.; requiring assisted living
    5         facilities that provide certain services to maintain a
    6         written progress report on each person receiving such
    7         services from the facility’s staff; conforming a
    8         cross-reference; amending s. 429.11, F.S.; prohibiting
    9         a county or municipality from issuing a business tax
   10         receipt, rather than an occupational license, to a
   11         facility under certain circumstances; amending s.
   12         429.176, F.S.; requiring an owner of a facility to
   13         provide certain documentation to the Agency for Health
   14         Care Administration within a specified timeframe;
   15         amending s. 429.23, F.S.; authorizing a facility to
   16         submit certain reports regarding adverse incidents
   17         through the agency’s online portal; requiring the
   18         agency to send reminders by electronic mail to certain
   19         facility contacts regarding submission deadlines for
   20         such reports within a specified timeframe; providing
   21         that facilities are not subject to administrative or
   22         other agency action for failure to withdraw or submit
   23         specified reports under certain circumstances;
   24         deleting a requirement that facilities submit certain
   25         monthly reports to the agency; amending s. 429.255,
   26         F.S.; authorizing certain persons to change a
   27         resident’s bandage for a minor cut or abrasion;
   28         authorizing certain persons to contract with a third
   29         party to provide services to a resident under certain
   30         circumstances; providing requirements relating to the
   31         third-party provider; clarifying that the absence of
   32         an order not to resuscitate does not preclude a
   33         physician from withholding or withdrawing
   34         cardiopulmonary resuscitation or use of an automated
   35         external defibrillator; amending s. 429.256, F.S.;
   36         revising the types of medications that may be self
   37         administered; revising provisions relating to
   38         assistance with the self-administration of such
   39         medications; requiring a person assisting with a
   40         resident’s self-administration of medication to
   41         confirm and advise the patient of specified
   42         information; authorizing a resident to opt out of such
   43         advisement through a signed waiver; providing
   44         requirements for such waiver; revising provisions
   45         relating to certain medications that are not self
   46         administered with assistance; amending s. 429.26,
   47         F.S.; including medical examinations in the criteria
   48         used for admission to an assisted living facility;
   49         providing specified criteria for determination of
   50         appropriateness for admission to and continued
   51         residency in an assisted living facility; prohibiting
   52         such facility from admitting certain individuals;
   53         defining the term “bedridden”; authorizing a facility
   54         to retain certain individuals under certain
   55         conditions; requiring that a resident receive a
   56         medical examination within a specified timeframe after
   57         admission to a facility; requiring that such
   58         examination be recorded on a form; providing
   59         limitations on the use of such form; providing
   60         requirements for the content of the form; revising
   61         provisions relating to the placement of residents by
   62         the Department of Children and Families; requiring a
   63         facility to notify a resident’s representative or
   64         designee of specified information under certain
   65         circumstances; requiring the facility to arrange with
   66         an appropriate health care provider for the care and
   67         services needed to treat a resident under certain
   68         circumstances; removing provisions relating to the
   69         retention of certain residents in a facility; amending
   70         s. 429.28, F.S.; requiring facilities to provide
   71         written notice of relocation or termination of
   72         residency from a facility to the resident or the
   73         resident’s legal guardian; revising provisions related
   74         to a licensure survey required by the agency; deleting
   75         a requirement that the agency adopt certain rules;
   76         amending s. 429.31, F.S.; revising notice requirements
   77         for facilities that are terminating operations;
   78         requiring the agency to inform the State Long-Term
   79         Ombudsman Program immediately upon notice of a
   80         facility’s termination of operations; amending s.
   81         429.41, F.S.; revising legislative intent; revising
   82         provisions related to rules the agency, in
   83         consultation with the Department of Children and
   84         Families and the Department of Health, is required to
   85         adopt regarding minimum standards of resident care;
   86         authorizing the agency to collect fees for certain
   87         inspections conducted by county health departments and
   88         transfer them to the Department of Health; requiring
   89         county emergency management agencies, rather than
   90         local emergency management agencies, to review and
   91         approve or disapprove a facility’s comprehensive
   92         emergency management plan; requiring a facility to
   93         submit a comprehensive emergency management plan to
   94         the county emergency management agency within a
   95         specified timeframe; prohibiting the use of Posey
   96         restraints; authorizing the use of other restraints
   97         under certain circumstances; revising resident
   98         elopement drill requirements for facilities; revising
   99         the criteria under which a facility must be fully
  100         inspected; requiring the agency to adopt by rule,
  101         rather than develop, key quality-of-care standards;
  102         creating s. 429.435, F.S.; requiring the State Fire
  103         Marshall to establish uniform firesafety standards for
  104         certain assisted living facilities; providing for a
  105         firesafety evacuation capability determination within
  106         a specified timeframe under certain circumstances;
  107         requiring the State Fire Marshall to use certain
  108         standards from a specified national association to
  109         determine the uniform firesafety standards to be
  110         adopted; authorizing local governments and utilities
  111         to charge certain fees relating to fire sprinkler
  112         systems; requiring licensed facilities to have an
  113         annual fire inspection; specifying certain code
  114         requirements for facilities that undergo a specific
  115         alteration or rehabilitation; amending s. 429.52,
  116         F.S.; revising certain provisions relating to facility
  117         staff training and educational requirements; requiring
  118         the agency, in conjunction with providers, to
  119         establish core training requirements for facility
  120         administrators; revising the training and continuing
  121         education requirements for facility staff who assist
  122         residents with the self-administration of medications;
  123         revising provisions relating to the training
  124         responsibilities of the agency; requiring the agency
  125         to contract with another entity to administer a
  126         certain competency test; requiring the agency to adopt
  127         a curriculum outline with learning objectives to be
  128         used by core trainers; conforming provisions to
  129         changes made by the act; providing an effective date.
  130          
  131  Be It Enacted by the Legislature of the State of Florida:
  132  
  133         Section 1. Present subsections (6) through (27) of section
  134  429.02, Florida Statutes, are redesignated as subsections (7)
  135  through (28), respectively, a new subsection (6) is added to
  136  that section, and present subsections (11) and (18) are amended,
  137  to read:
  138         429.02 Definitions.—When used in this part, the term:
  139         (6)“Assistive device” means any device designed or adapted
  140  to help a resident perform an action, a task, an activity of
  141  daily living, or a transfer; prevent a fall; or recover from a
  142  fall. The term does not include a total body lift or a motorized
  143  sit-to-stand lift, with the exception of a chair lift or
  144  recliner lift that a resident is able to operate independently.
  145         (12)(11) “Extended congregate care” means acts beyond those
  146  authorized in subsection (18) which (17) that may be performed
  147  pursuant to part I of chapter 464 by persons licensed thereunder
  148  while carrying out their professional duties, and other
  149  supportive services that which may be specified by rule. The
  150  purpose of such services is to enable residents to age in place
  151  in a residential environment despite mental or physical
  152  limitations that might otherwise disqualify them from residency
  153  in a facility licensed under this part.
  154         (19)(18) “Physical restraint” means a device that which
  155  physically limits, restricts, or deprives an individual of
  156  movement or mobility, including, but not limited to, a half-bed
  157  rail, a full-bed rail, a geriatric chair, and a posey restraint.
  158  The term “physical restraint” shall also include any device that
  159  is which was not specifically manufactured as a restraint but is
  160  which has been altered, arranged, or otherwise used for that
  161  this purpose. The term does shall not include any device that
  162  the resident chooses to use and is able to remove or avoid
  163  independently, or any bandage material used for the purpose of
  164  binding a wound or injury.
  165         Section 2. Paragraphs (b) and (c) of subsection (3) of
  166  section 429.07, Florida Statutes, are amended to read:
  167         429.07 License required; fee.—
  168         (3) In addition to the requirements of s. 408.806, each
  169  license granted by the agency must state the type of care for
  170  which the license is granted. Licenses shall be issued for one
  171  or more of the following categories of care: standard, extended
  172  congregate care, limited nursing services, or limited mental
  173  health.
  174         (b) An extended congregate care license shall be issued to
  175  each facility that has been licensed as an assisted living
  176  facility for 2 or more years and that provides services,
  177  directly or through contract, beyond those authorized in
  178  paragraph (a), including services performed by persons licensed
  179  under part I of chapter 464 and supportive services, as defined
  180  by rule, to persons who would otherwise be disqualified from
  181  continued residence in a facility licensed under this part. An
  182  extended congregate care license may be issued to a facility
  183  that has a provisional extended congregate care license and
  184  meets the requirements for licensure under subparagraph 2. The
  185  primary purpose of extended congregate care services is to allow
  186  residents the option of remaining in a familiar setting from
  187  which they would otherwise be disqualified for continued
  188  residency as they become more impaired. A facility licensed to
  189  provide extended congregate care services may also admit an
  190  individual who exceeds the admission criteria for a facility
  191  with a standard license, if he or she is determined appropriate
  192  for admission to the extended congregate care facility.
  193         1. In order for extended congregate care services to be
  194  provided, the agency must first determine that all requirements
  195  established in law and rule are met and must specifically
  196  designate, on the facility’s license, that such services may be
  197  provided and whether the designation applies to all or part of
  198  the facility. This designation may be made at the time of
  199  initial licensure or relicensure, or upon request in writing by
  200  a licensee under this part and part II of chapter 408. The
  201  notification of approval or the denial of the request shall be
  202  made in accordance with part II of chapter 408. Each existing
  203  facility that qualifies to provide extended congregate care
  204  services must have maintained a standard license and may not
  205  have been subject to administrative sanctions during the
  206  previous 2 years, or since initial licensure if the facility has
  207  been licensed for less than 2 years, for any of the following
  208  reasons:
  209         a. A class I or class II violation;
  210         b. Three or more repeat or recurring class III violations
  211  of identical or similar resident care standards from which a
  212  pattern of noncompliance is found by the agency;
  213         c. Three or more class III violations that were not
  214  corrected in accordance with the corrective action plan approved
  215  by the agency;
  216         d. Violation of resident care standards which results in
  217  requiring the facility to employ the services of a consultant
  218  pharmacist or consultant dietitian;
  219         e. Denial, suspension, or revocation of a license for
  220  another facility licensed under this part in which the applicant
  221  for an extended congregate care license has at least 25 percent
  222  ownership interest; or
  223         f. Imposition of a moratorium pursuant to this part or part
  224  II of chapter 408 or initiation of injunctive proceedings.
  225  
  226  The agency may deny or revoke a facility’s extended congregate
  227  care license for not meeting the criteria for an extended
  228  congregate care license as provided in this subparagraph.
  229         2. If an assisted living facility has been licensed for
  230  less than 2 years, the initial extended congregate care license
  231  must be provisional and may not exceed 6 months. The licensee
  232  shall notify the agency, in writing, when it has admitted at
  233  least one extended congregate care resident, after which an
  234  unannounced inspection shall be made to determine compliance
  235  with the requirements of an extended congregate care license. A
  236  licensee with a provisional extended congregate care license
  237  which that demonstrates compliance with all the requirements of
  238  an extended congregate care license during the inspection shall
  239  be issued an extended congregate care license. In addition to
  240  sanctions authorized under this part, if violations are found
  241  during the inspection and the licensee fails to demonstrate
  242  compliance with all assisted living facility requirements during
  243  a followup inspection, the licensee shall immediately suspend
  244  extended congregate care services, and the provisional extended
  245  congregate care license expires. The agency may extend the
  246  provisional license for not more than 1 month in order to
  247  complete a followup visit.
  248         3. A facility that is licensed to provide extended
  249  congregate care services shall maintain a written progress
  250  report on each person who receives nursing services from the
  251  facility’s staff which describes the type, amount, duration,
  252  scope, and outcome of services that are rendered and the general
  253  status of the resident’s health. A registered nurse, or
  254  appropriate designee, representing the agency shall visit the
  255  facility at least twice a year to monitor residents who are
  256  receiving extended congregate care services and to determine if
  257  the facility is in compliance with this part, part II of chapter
  258  408, and relevant rules. One of the visits may be in conjunction
  259  with the regular survey. The monitoring visits may be provided
  260  through contractual arrangements with appropriate community
  261  agencies. A registered nurse shall serve as part of the team
  262  that inspects the facility. The agency may waive one of the
  263  required yearly monitoring visits for a facility that has:
  264         a. Held an extended congregate care license for at least 24
  265  months;
  266         b. No class I or class II violations and no uncorrected
  267  class III violations; and
  268         c. No ombudsman council complaints that resulted in a
  269  citation for licensure.
  270         4. A facility that is licensed to provide extended
  271  congregate care services must:
  272         a. Demonstrate the capability to meet unanticipated
  273  resident service needs.
  274         b. Offer a physical environment that promotes a homelike
  275  setting, provides for resident privacy, promotes resident
  276  independence, and allows sufficient congregate space as defined
  277  by rule.
  278         c. Have sufficient staff available, taking into account the
  279  physical plant and firesafety features of the building, to
  280  assist with the evacuation of residents in an emergency.
  281         d. Adopt and follow policies and procedures that maximize
  282  resident independence, dignity, choice, and decisionmaking to
  283  permit residents to age in place, so that moves due to changes
  284  in functional status are minimized or avoided.
  285         e. Allow residents or, if applicable, a resident’s
  286  representative, designee, surrogate, guardian, or attorney in
  287  fact to make a variety of personal choices, participate in
  288  developing service plans, and share responsibility in
  289  decisionmaking.
  290         f. Implement the concept of managed risk.
  291         g. Provide, directly or through contract, the services of a
  292  person licensed under part I of chapter 464.
  293         h. In addition to the training mandated in s. 429.52,
  294  provide specialized training as defined by rule for facility
  295  staff.
  296         5. A facility that is licensed to provide extended
  297  congregate care services is exempt from the criteria for
  298  continued residency set forth in rules adopted under s. 429.41.
  299  A licensed facility must adopt its own requirements within
  300  guidelines for continued residency set forth by rule. However,
  301  the facility may not serve residents who require 24-hour nursing
  302  supervision. A licensed facility that provides extended
  303  congregate care services must also provide each resident with a
  304  written copy of facility policies governing admission and
  305  retention.
  306         6. Before the admission of an individual to a facility
  307  licensed to provide extended congregate care services, the
  308  individual must undergo a medical examination as provided in s.
  309  429.26(5) s. 429.26(4) and the facility must develop a
  310  preliminary service plan for the individual.
  311         7. If a facility can no longer provide or arrange for
  312  services in accordance with the resident’s service plan and
  313  needs and the facility’s policy, the facility must make
  314  arrangements for relocating the person in accordance with s.
  315  429.28(1)(k).
  316         (c) A limited nursing services license shall be issued to a
  317  facility that provides services beyond those authorized in
  318  paragraph (a) and as specified in this paragraph.
  319         1. In order for limited nursing services to be provided in
  320  a facility licensed under this part, the agency must first
  321  determine that all requirements established in law and rule are
  322  met and must specifically designate, on the facility’s license,
  323  that such services may be provided. This designation may be made
  324  at the time of initial licensure or licensure renewal, or upon
  325  request in writing by a licensee under this part and part II of
  326  chapter 408. Notification of approval or denial of such request
  327  shall be made in accordance with part II of chapter 408. An
  328  existing facility that qualifies to provide limited nursing
  329  services must have maintained a standard license and may not
  330  have been subject to administrative sanctions that affect the
  331  health, safety, and welfare of residents for the previous 2
  332  years or since initial licensure if the facility has been
  333  licensed for less than 2 years.
  334         2. A facility that is licensed to provide limited nursing
  335  services shall maintain a written progress report on each person
  336  who receives such nursing services from the facility’s staff.
  337  The report must describe the type, amount, duration, scope, and
  338  outcome of services that are rendered and the general status of
  339  the resident’s health. A registered nurse representing the
  340  agency shall visit the facility at least annually to monitor
  341  residents who are receiving limited nursing services and to
  342  determine if the facility is in compliance with applicable
  343  provisions of this part, part II of chapter 408, and related
  344  rules. The monitoring visits may be provided through contractual
  345  arrangements with appropriate community agencies. A registered
  346  nurse shall also serve as part of the team that inspects such
  347  facility. Visits may be in conjunction with other agency
  348  inspections. The agency may waive the required yearly monitoring
  349  visit for a facility that has:
  350         a. Had a limited nursing services license for at least 24
  351  months;
  352         b. No class I or class II violations and no uncorrected
  353  class III violations; and
  354         c. No ombudsman council complaints that resulted in a
  355  citation for licensure.
  356         3. A person who receives limited nursing services under
  357  this part must meet the admission criteria established by the
  358  agency for assisted living facilities. When a resident no longer
  359  meets the admission criteria for a facility licensed under this
  360  part, arrangements for relocating the person shall be made in
  361  accordance with s. 429.28(1)(k), unless the facility is licensed
  362  to provide extended congregate care services.
  363         Section 3. Subsection (7) of section 429.11, Florida
  364  Statutes, is amended to read:
  365         429.11 Initial application for license; provisional
  366  license.—
  367         (7) A county or municipality may not issue a business tax
  368  receipt an occupational license that is being obtained for the
  369  purpose of operating a facility regulated under this part
  370  without first ascertaining that the applicant has been licensed
  371  to operate such facility at the specified location or locations
  372  by the agency. The agency shall furnish to local agencies
  373  responsible for issuing business tax receipts occupational
  374  licenses sufficient instruction for making such determinations.
  375         Section 4. Section 429.176, Florida Statutes, is amended to
  376  read:
  377         429.176 Notice of change of administrator.—If, during the
  378  period for which a license is issued, the owner changes
  379  administrators, the owner must notify the agency of the change
  380  within 10 days and provide documentation within 90 days that the
  381  new administrator meets educational requirements and has
  382  completed the applicable core educational requirements under s.
  383  429.52. A facility may not be operated for more than 120
  384  consecutive days without an administrator who has completed the
  385  core educational requirements.
  386         Section 5. Subsections (3), (4), and (5) of section 429.23,
  387  Florida Statutes, are amended to read:
  388         429.23 Internal risk management and quality assurance
  389  program; adverse incidents and reporting requirements.—
  390         (3) Licensed facilities shall provide within 1 business day
  391  after the occurrence of an adverse incident, through the
  392  agency’s online portal or, if the portal is offline, by
  393  electronic mail, facsimile, or United States mail, a preliminary
  394  report to the agency on all adverse incidents specified under
  395  this section. The report must include information regarding the
  396  identity of the affected resident, the type of adverse incident,
  397  and the status of the facility’s investigation of the incident.
  398         (4) Licensed facilities shall provide within 15 days,
  399  through the agency’s online portal or, if the portal is offline,
  400  by electronic mail, facsimile, or United States mail, a full
  401  report to the agency on all adverse incidents specified in this
  402  section. The report must include the results of the facility’s
  403  investigation into the adverse incident.
  404         (5) Three business days before the deadline for the
  405  submission of the full report required under subsection (4), the
  406  agency shall send by electronic mail a reminder to the
  407  facility’s administrator and other specified facility contacts.
  408  Within 3 business days after the agency sends the reminder, a
  409  facility is not subject to any administrative or other agency
  410  action for failing to withdraw the preliminary report if the
  411  facility determines the event was not an adverse incident or for
  412  failing to file a full report if the facility determines the
  413  event was an adverse incident Each facility shall report monthly
  414  to the agency any liability claim filed against it. The report
  415  must include the name of the resident, the dates of the incident
  416  leading to the claim, if applicable, and the type of injury or
  417  violation of rights alleged to have occurred. This report is not
  418  discoverable in any civil or administrative action, except in
  419  such actions brought by the agency to enforce the provisions of
  420  this part.
  421         Section 6. Paragraphs (a) and (b) of subsection (1) of
  422  section 429.255, Florida Statutes, are amended, paragraph (d) is
  423  added to that subsection, and subsection (4) of that section is
  424  amended, to read:
  425         429.255 Use of personnel; emergency care.—
  426         (1)(a) Persons under contract to the facility, facility
  427  staff, or volunteers, who are licensed according to part I of
  428  chapter 464, or those persons exempt under s. 464.022(1), and
  429  others as defined by rule, may administer medications to
  430  residents, take residents’ vital signs, change residents
  431  bandages for minor cuts and abrasions, manage individual weekly
  432  pill organizers for residents who self-administer medication,
  433  give prepackaged enemas ordered by a physician, observe
  434  residents, document observations on the appropriate resident’s
  435  record, and report observations to the resident’s physician, and
  436  contract or allow residents or a resident’s representative,
  437  designee, surrogate, guardian, or attorney in fact to contract
  438  with a third party, provided residents meet the criteria for
  439  appropriate placement as defined in s. 429.26. Nursing
  440  assistants certified pursuant to part II of chapter 464 may take
  441  residents’ vital signs as directed by a licensed nurse or
  442  physician.
  443         (b) All staff of in facilities licensed under this part
  444  shall exercise their professional responsibility to observe
  445  residents, to document observations on the appropriate
  446  resident’s record, and to report the observations to the
  447  resident’s physician. However, the owner or administrator of the
  448  facility shall be responsible for determining that the resident
  449  receiving services is appropriate for residence in the facility.
  450         (d)A resident or his or her representative, designee,
  451  surrogate, guardian, or attorney in fact, as applicable, may
  452  contract for services with a third party, provided the resident
  453  meets the criteria for residency and continued residency as
  454  defined in s. 429.26. The third party must communicate with the
  455  facility regarding the resident’s condition and the services
  456  being provided in accordance with the facility’s policies. The
  457  facility must document that it received such communication.
  458         (4) Facility staff may withhold or withdraw cardiopulmonary
  459  resuscitation or the use of an automated external defibrillator
  460  if presented with an order not to resuscitate executed pursuant
  461  to s. 401.45. The agency shall adopt rules providing for the
  462  implementation of such orders. Facility staff and facilities may
  463  not be subject to criminal prosecution or civil liability, nor
  464  be considered to have engaged in negligent or unprofessional
  465  conduct, for withholding or withdrawing cardiopulmonary
  466  resuscitation or use of an automated external defibrillator
  467  pursuant to such an order and rules adopted by the agency. The
  468  absence of an order not to resuscitate executed pursuant to s.
  469  401.45 does not preclude a physician from withholding or
  470  withdrawing cardiopulmonary resuscitation or use of an automated
  471  external defibrillator as otherwise permitted by law.
  472         Section 7. Subsection (2), paragraph (b) of subsection (3),
  473  and paragraphs (e), (f), and (g) of subsection (4) of section
  474  429.256, Florida Statutes, are amended to read:
  475         429.256 Assistance with self-administration of medication.—
  476         (2) Residents who are capable of self-administering their
  477  own medications without assistance shall be encouraged and
  478  allowed to do so. However, an unlicensed person may, consistent
  479  with a dispensed prescription’s label or the package directions
  480  of an over-the-counter medication, assist a resident whose
  481  condition is medically stable with the self-administration of
  482  routine, regularly scheduled medications that are intended to be
  483  self-administered. Assistance with self-medication by an
  484  unlicensed person may occur only upon a documented request by,
  485  and the written informed consent of, a resident or the
  486  resident’s surrogate, guardian, or attorney in fact. For the
  487  purposes of this section, self-administered medications include
  488  both legend and over-the-counter oral dosage forms, topical
  489  dosage forms, transdermal patches, and topical ophthalmic, otic,
  490  and nasal dosage forms including solutions, suspensions, sprays,
  491  and inhalers.
  492         (3) Assistance with self-administration of medication
  493  includes:
  494         (b) In the presence of the resident, confirming that the
  495  medication is intended for that resident, orally advising the
  496  resident of the medication name and dosage reading the label,
  497  opening the container, removing a prescribed amount of
  498  medication from the container, and closing the container. The
  499  resident may sign a written waiver to opt out of being orally
  500  advised of the medication name and dosage. The waiver must
  501  identify all of the medications intended for the resident,
  502  including names and dosages of such medications, and must
  503  immediately be updated each time the resident’s medications or
  504  dosages change.
  505         (4) Assistance with self-administration does not include:
  506         (e) The use of irrigations or debriding agents used in the
  507  treatment of a skin condition.
  508         (f) Assisting with rectal, urethral, or vaginal
  509  preparations.
  510         (g) Assisting with medications ordered by the physician or
  511  health care professional with prescriptive authority to be given
  512  “as needed,” unless the order is written with specific
  513  parameters that preclude independent judgment on the part of the
  514  unlicensed person, and at the request of a competent resident
  515  requesting the medication is aware of his or her need for the
  516  medication and understands the purpose for taking the
  517  medication.
  518         Section 8. Section 429.26, Florida Statutes, is amended to
  519  read:
  520         429.26 Appropriateness of placements; examinations of
  521  residents.—
  522         (1) The owner or administrator of a facility is responsible
  523  for determining the appropriateness of admission of an
  524  individual to the facility and for determining the continued
  525  appropriateness of residence of an individual in the facility. A
  526  determination must shall be based upon an evaluation assessment
  527  of the strengths, needs, and preferences of the resident, a
  528  medical examination, the care and services offered or arranged
  529  for by the facility in accordance with facility policy, and any
  530  limitations in law or rule related to admission criteria or
  531  continued residency for the type of license held by the facility
  532  under this part. The following criteria apply to the
  533  determination of appropriateness for admission and continued
  534  residency of an individual in a facility:
  535         (a)A facility may admit or retain a resident who receives
  536  a health care service or treatment that is designed to be
  537  provided within a private residential setting if all
  538  requirements for providing that service or treatment are met by
  539  the facility or a third party.
  540         (b)A facility may admit or retain a resident who requires
  541  the use of assistive devices.
  542         (c)A facility may admit or retain an individual receiving
  543  hospice services if the arrangement is agreed to by the facility
  544  and the resident, additional care is provided by a licensed
  545  hospice, and the resident is under the care of a physician who
  546  agrees that the physical needs of the resident can be met at the
  547  facility. The resident must have a plan of care which delineates
  548  how the facility and the hospice will meet the scheduled and
  549  unscheduled needs of the resident, including, if applicable,
  550  staffing for nursing care.
  551         (d)1.Except for a resident who is receiving hospice
  552  services as provided in paragraph (c), a facility may not admit
  553  or retain a resident who is bedridden or who requires 24-hour
  554  nursing supervision. For purposes of this paragraph, the term
  555  “bedridden” means that a resident is confined to a bed because
  556  of the inability to:
  557         a.Move, turn, or reposition without total physical
  558  assistance;
  559         b.Transfer to a chair or wheelchair without total physical
  560  assistance; or
  561         c.Sit safely in a chair or wheelchair without personal
  562  assistance or a physical restraint.
  563         2.A resident may continue to reside in a facility if,
  564  during residency, he or she is bedridden for no more than 7
  565  consecutive days.
  566         3.If a facility is licensed to provide extended congregate
  567  care, a resident may continue to reside in a facility if, during
  568  residency, he or she is bedridden for no more than 14
  569  consecutive days.
  570         (2) A resident may not be moved from one facility to
  571  another without consultation with and agreement from the
  572  resident or, if applicable, the resident’s representative or
  573  designee or the resident’s family, guardian, surrogate, or
  574  attorney in fact. In the case of a resident who has been placed
  575  by the department or the Department of Children and Families,
  576  the administrator must notify the appropriate contact person in
  577  the applicable department.
  578         (3)(2) A physician, physician assistant, or advanced
  579  practice registered nurse practitioner who is employed by an
  580  assisted living facility to provide an initial examination for
  581  admission purposes may not have financial interests interest in
  582  the facility.
  583         (4)(3) Persons licensed under part I of chapter 464 who are
  584  employed by or under contract with a facility shall, on a
  585  routine basis or at least monthly, perform a nursing assessment
  586  of the residents for whom they are providing nursing services
  587  ordered by a physician, except administration of medication, and
  588  shall document such assessment, including any substantial
  589  changes in a resident’s status which may necessitate relocation
  590  to a nursing home, hospital, or specialized health care
  591  facility. Such records shall be maintained in the facility for
  592  inspection by the agency and shall be forwarded to the
  593  resident’s case manager, if applicable.
  594         (5)(a)(4)If possible, Each resident must shall have been
  595  examined by a licensed physician, a licensed physician
  596  assistant, or a licensed advanced practice registered nurse
  597  practitioner within 60 days before admission to the facility or
  598  within 30 days after admission to the facility, except as
  599  provided in s. 429.07(3)(b)6. The information from the medical
  600  examination must be recorded on the practitioner’s form or on a
  601  form adopted by agency rule. The signed and completed medical
  602  examination form, signed only by the practitioner, must report
  603  shall be submitted to the owner or administrator of the
  604  facility, who shall use the information contained therein to
  605  assist in the determination of the appropriateness of the
  606  resident’s admission to or and continued residency stay in the
  607  facility.
  608         (b)The medical examination form may be used only to record
  609  the practitioner’s direct observation of the patient at the time
  610  of examination and must include the patient’s medical history.
  611  Such form does not guarantee admission to, continued residency
  612  in, or the delivery of services at the facility and must be used
  613  only as an informative tool to assist in the determination of
  614  the appropriateness of the resident’s admission to or continued
  615  residency in the facility. The medical examination form,
  616  reflecting the resident’s condition on the date the examination
  617  is performed, becomes report shall become a permanent part of
  618  the facility’s record of the resident at the facility and must
  619  shall be made available to the agency during inspection or upon
  620  request. An assessment that has been completed through the
  621  Comprehensive Assessment and Review for Long-Term Care Services
  622  (CARES) Program fulfills the requirements for a medical
  623  examination under this subsection and s. 429.07(3)(b)6.
  624         (c) The medical examination form must include all of the
  625  following information about the resident:
  626         1. Height, weight, and known allergies.
  627         2. Significant medical history and diagnoses.
  628         3. Physical or sensory limitations, including the need for
  629  fall precautions or recommended use of assistive devices.
  630         4. Cognitive or behavioral status and a brief description
  631  of any behavioral issues known or ascertained by the examining
  632  practitioner, including any known history of wandering or
  633  elopement.
  634         5. Nursing, treatment, or therapy service requirements.
  635         6. Whether the resident needs assistance for ambulating,
  636  eating, or transferring.
  637         7. Special dietary instructions.
  638         8.Whether the resident has any communicable diseases,
  639  including precautions that are necessary due to such diseases.
  640         9.Whether the resident is bedridden and the presence of
  641  any pressure sores.
  642         10.Whether the resident needs 24-hour nursing supervision
  643  or psychiatric care.
  644         11.A list of current prescribed medications as known or
  645  ascertained by the examining practitioner and whether the
  646  resident can self-administer medications, needs assistance with
  647  medications, or needs medication administration.
  648         (5) Except as provided in s. 429.07, if a medical
  649  examination has not been completed within 60 days before the
  650  admission of the resident to the facility, a licensed physician,
  651  licensed physician assistant, or licensed nurse practitioner
  652  shall examine the resident and complete a medical examination
  653  form provided by the agency within 30 days following the
  654  admission to the facility to enable the facility owner or
  655  administrator to determine the appropriateness of the admission.
  656  The medical examination form shall become a permanent part of
  657  the record of the resident at the facility and shall be made
  658  available to the agency during inspection by the agency or upon
  659  request.
  660         (6) Any resident accepted in a facility and placed by the
  661  department or the Department of Children and Families must shall
  662  have been examined by medical personnel within 30 days before
  663  placement in the facility. The examination must shall include an
  664  assessment of the appropriateness of placement in a facility.
  665  The findings of this examination must shall be recorded on the
  666  examination form provided by the agency. The completed form must
  667  shall accompany the resident and shall be submitted to the
  668  facility owner or administrator. Additionally, in the case of a
  669  mental health resident, the Department of Children and Families
  670  must provide documentation that the individual has been assessed
  671  by a psychiatrist, clinical psychologist, clinical social
  672  worker, or psychiatric nurse, or an individual who is supervised
  673  by one of these professionals, and determined to be appropriate
  674  to reside in an assisted living facility. The documentation must
  675  be in the facility within 30 days after the mental health
  676  resident has been admitted to the facility. An evaluation
  677  completed upon discharge from a state mental hospital meets the
  678  requirements of this subsection related to appropriateness for
  679  placement as a mental health resident, provided that providing
  680  it was completed within 90 days before prior to admission to the
  681  facility. The applicable Department of Children and Families
  682  shall provide to the facility administrator any information
  683  about the resident which that would help the administrator meet
  684  his or her responsibilities under subsection (1). Further,
  685  Department of Children and Families personnel shall explain to
  686  the facility operator any special needs of the resident and
  687  advise the operator whom to call should problems arise. The
  688  applicable Department of Children and Families shall advise and
  689  assist the facility administrator when where the special needs
  690  of residents who are recipients of optional state
  691  supplementation require such assistance.
  692         (7) The facility shall must notify a licensed physician
  693  when a resident exhibits signs of dementia or cognitive
  694  impairment or has a change of condition in order to rule out the
  695  presence of an underlying physiological condition that may be
  696  contributing to such dementia or impairment. The notification
  697  must occur within 30 days after the acknowledgment of such signs
  698  by facility staff. If an underlying condition is determined to
  699  exist, the facility must notify the resident’s representative or
  700  designee of the need for health care services and must assist in
  701  making appointments for shall arrange, with the appropriate
  702  health care provider, the necessary care and services to treat
  703  the condition. If the resident does not have a representative or
  704  designee or if the resident’s representative or designee cannot
  705  be located or is nonresponsive, the facility shall arrange with
  706  an appropriate health care provider for the necessary care and
  707  services to treat the condition.
  708         (8) The Department of Children and Families may require an
  709  examination for supplemental security income and optional state
  710  supplementation recipients residing in facilities at any time
  711  and shall provide the examination whenever a resident’s
  712  condition requires it. Any facility administrator; personnel of
  713  the agency, the department, or the Department of Children and
  714  Families; or a representative of the State Long-Term Care
  715  Ombudsman Program who believes a resident needs to be evaluated
  716  shall notify the resident’s case manager, who shall take
  717  appropriate action. A report of the examination findings must
  718  shall be provided to the resident’s case manager and the
  719  facility administrator to help the administrator meet his or her
  720  responsibilities under subsection (1).
  721         (9) A terminally ill resident who no longer meets the
  722  criteria for continued residency may remain in the facility if
  723  the arrangement is mutually agreeable to the resident and the
  724  facility; additional care is rendered through a licensed
  725  hospice, and the resident is under the care of a physician who
  726  agrees that the physical needs of the resident are being met.
  727         (9)(10) Facilities licensed to provide extended congregate
  728  care services shall promote aging in place by determining
  729  appropriateness of continued residency based on a comprehensive
  730  review of the resident’s physical and functional status; the
  731  ability of the facility, family members, friends, or any other
  732  pertinent individuals or agencies to provide the care and
  733  services required; and documentation that a written service plan
  734  consistent with facility policy has been developed and
  735  implemented to ensure that the resident’s needs and preferences
  736  are addressed.
  737         (11) No resident who requires 24-hour nursing supervision,
  738  except for a resident who is an enrolled hospice patient
  739  pursuant to part IV of chapter 400, shall be retained in a
  740  facility licensed under this part.
  741         Section 9. Paragraph (k) of subsection (1) and subsection
  742  (3) of section 429.28, Florida Statutes, are amended to read:
  743         429.28 Resident bill of rights.—
  744         (1) No resident of a facility shall be deprived of any
  745  civil or legal rights, benefits, or privileges guaranteed by
  746  law, the Constitution of the State of Florida, or the
  747  Constitution of the United States as a resident of a facility.
  748  Every resident of a facility shall have the right to:
  749         (k) At least 45 days’ notice of relocation or termination
  750  of residency from the facility unless, for medical reasons, the
  751  resident is certified by a physician to require an emergency
  752  relocation to a facility providing a more skilled level of care
  753  or the resident engages in a pattern of conduct that is harmful
  754  or offensive to other residents. In the case of a resident who
  755  has been adjudicated mentally incapacitated, the guardian shall
  756  be given at least 45 days’ notice of a nonemergency relocation
  757  or residency termination. Reasons for relocation must shall be
  758  set forth in writing and provided to the resident or the
  759  resident’s legal representative. In order for a facility to
  760  terminate the residency of an individual without notice as
  761  provided herein, the facility shall show good cause in a court
  762  of competent jurisdiction.
  763         (3)(a) The agency shall conduct a survey to determine
  764  whether the facility is complying with this part general
  765  compliance with facility standards and compliance with
  766  residents’ rights as a prerequisite to initial licensure or
  767  licensure renewal. The agency shall adopt rules for uniform
  768  standards and criteria that will be used to determine compliance
  769  with facility standards and compliance with residents’ rights.
  770         (b) In order to determine whether the facility is
  771  adequately protecting residents’ rights, the licensure renewal
  772  biennial survey must shall include private informal
  773  conversations with a sample of residents and consultation with
  774  the ombudsman council in the district in which the facility is
  775  located to discuss residents’ experiences within the facility.
  776         Section 10. Subsections (1) and (2) of section 429.31,
  777  Florida Statutes, are amended to read:
  778         429.31 Closing of facility; notice; penalty.—
  779         (1) In addition to the requirements of part II of chapter
  780  408, the facility shall inform, in writing, the agency and each
  781  resident or the next of kin, legal representative, or agency
  782  acting on each resident’s behalf, of the fact and the proposed
  783  time of discontinuance of operation, following the notification
  784  requirements provided in s. 429.28(1)(k). In the event a
  785  resident has no person to represent him or her, the facility
  786  shall be responsible for referral to an appropriate social
  787  service agency for placement.
  788         (2) Immediately upon the notice by the agency of the
  789  voluntary or involuntary termination of such operation, the
  790  agency shall inform the State Long-Term Care Ombudsman Program
  791  and monitor the transfer of residents to other facilities and
  792  ensure that residents’ rights are being protected. The agency,
  793  in consultation with the Department of Children and Families,
  794  shall specify procedures for ensuring that all residents who
  795  receive services are appropriately relocated.
  796         Section 11. Subsections (1), (2), and (5) of section
  797  429.41, Florida Statutes, are amended to read:
  798         429.41 Rules establishing standards.—
  799         (1) It is the intent of the Legislature that rules
  800  published and enforced pursuant to this section shall include
  801  criteria by which a reasonable and consistent quality of
  802  resident care and quality of life may be ensured and the results
  803  of such resident care may be demonstrated. Such rules shall also
  804  promote ensure a safe and sanitary environment that is
  805  residential and noninstitutional in design or nature and may
  806  allow for technological advances in the provision of care,
  807  safety, and security, including the use of devices, equipment,
  808  and other security measures related to wander management,
  809  emergency response, staff risk management, and the general
  810  safety and security of residents, staff, and the facility. It is
  811  further intended that reasonable efforts be made to accommodate
  812  the needs and preferences of residents to enhance the quality of
  813  life in a facility. Uniform firesafety standards for assisted
  814  living facilities shall be established by the State Fire Marshal
  815  pursuant to s. 633.206. The agency may adopt rules to administer
  816  part II of chapter 408. In order to provide safe and sanitary
  817  facilities and the highest quality of resident care
  818  accommodating the needs and preferences of residents, The
  819  agency, in consultation with the Department of Children and
  820  Families and the Department of Health, shall adopt rules,
  821  policies, and procedures to administer this part, which must
  822  include reasonable and fair minimum standards in relation to:
  823         (a) The requirements for and maintenance and the sanitary
  824  condition of facilities, not in conflict with, or duplicative
  825  of, the requirements in s. 381.006, s. 381.0072, chapter 553, or
  826  s. 633.206, relating to a safe and decent living environment,
  827  including furnishings for resident bedrooms or sleeping areas,
  828  locking devices, linens plumbing, heating, cooling, lighting,
  829  ventilation, living space, and other housing conditions relating
  830  to hazards, which will promote ensure the health, safety, and
  831  welfare comfort of residents suitable to the size of the
  832  structure. The rules must clearly delineate the respective
  833  responsibilities of the agency’s licensure and survey staff and
  834  the county health departments and ensure that inspections are
  835  not duplicative. The agency may collect fees for food service
  836  inspections conducted by county health departments and may
  837  transfer such fees to the Department of Health.
  838         1. Firesafety evacuation capability determination.—An
  839  evacuation capability evaluation for initial licensure shall be
  840  conducted within 6 months after the date of licensure.
  841         2. Firesafety requirements.—
  842         a. The National Fire Protection Association, Life Safety
  843  Code, NFPA 101 and 101A, current editions, shall be used in
  844  determining the uniform firesafety code adopted by the State
  845  Fire Marshal for assisted living facilities, pursuant to s.
  846  633.206.
  847         b. A local government or a utility may charge fees only in
  848  an amount not to exceed the actual expenses incurred by the
  849  local government or the utility relating to the installation and
  850  maintenance of an automatic fire sprinkler system in a licensed
  851  assisted living facility structure.
  852         c. All licensed facilities must have an annual fire
  853  inspection conducted by the local fire marshal or authority
  854  having jurisdiction.
  855         d. An assisted living facility that is issued a building
  856  permit or certificate of occupancy before July 1, 2016, may at
  857  its option and after notifying the authority having
  858  jurisdiction, remain under the provisions of the 1994 and 1995
  859  editions of the National Fire Protection Association, Life
  860  Safety Code, NFPA 101, and NFPA 101A. The facility opting to
  861  remain under such provisions may make repairs, modernizations,
  862  renovations, or additions to, or rehabilitate, the facility in
  863  compliance with NFPA 101, 1994 edition, and may utilize the
  864  alternative approaches to life safety in compliance with NFPA
  865  101A, 1995 edition. However, a facility for which a building
  866  permit or certificate of occupancy is issued before July 1,
  867  2016, that undergoes Level III building alteration or
  868  rehabilitation, as defined in the Florida Building Code, or
  869  seeks to utilize features not authorized under the 1994 or 1995
  870  editions of the Life Safety Code must thereafter comply with all
  871  aspects of the uniform firesafety standards established under s.
  872  633.206, and the Florida Fire Prevention Code, in effect for
  873  assisted living facilities as adopted by the State Fire Marshal.
  874         3. Resident elopement requirements.—Facilities are required
  875  to conduct a minimum of two resident elopement prevention and
  876  response drills per year. All administrators and direct care
  877  staff must participate in the drills, which shall include a
  878  review of procedures to address resident elopement. Facilities
  879  must document the implementation of the drills and ensure that
  880  the drills are conducted in a manner consistent with the
  881  facility’s resident elopement policies and procedures.
  882         (b) The preparation and annual update of a comprehensive
  883  emergency management plan. Such standards must be included in
  884  the rules adopted by the agency after consultation with the
  885  Division of Emergency Management. At a minimum, the rules must
  886  provide for plan components that address emergency evacuation
  887  transportation; adequate sheltering arrangements; postdisaster
  888  activities, including provision of emergency power, food, and
  889  water; postdisaster transportation; supplies; staffing;
  890  emergency equipment; individual identification of residents and
  891  transfer of records; communication with families; and responses
  892  to family inquiries. The comprehensive emergency management plan
  893  is subject to review and approval by the county local emergency
  894  management agency. During its review, the county local emergency
  895  management agency shall ensure that the following agencies, at a
  896  minimum, are given the opportunity to review the plan: the
  897  Department of Health, the Agency for Health Care Administration,
  898  and the Division of Emergency Management. Also, appropriate
  899  volunteer organizations must be given the opportunity to review
  900  the plan. The county local emergency management agency shall
  901  complete its review within 60 days and either approve the plan
  902  or advise the facility of necessary revisions. A facility must
  903  submit a comprehensive emergency management plan to the county
  904  emergency management agency within 30 days after issuance of a
  905  license.
  906         (c) The number, training, and qualifications of all
  907  personnel having responsibility for the care of residents. The
  908  rules must require adequate staff to provide for the safety of
  909  all residents. Facilities licensed for 17 or more residents are
  910  required to maintain an alert staff for 24 hours per day.
  911         (d) All sanitary conditions within the facility and its
  912  surroundings which will ensure the health and comfort of
  913  residents. The rules must clearly delineate the responsibilities
  914  of the agency’s licensure and survey staff, the county health
  915  departments, and the local authority having jurisdiction over
  916  firesafety and ensure that inspections are not duplicative. The
  917  agency may collect fees for food service inspections conducted
  918  by the county health departments and transfer such fees to the
  919  Department of Health.
  920         (d)(e) License application and license renewal, transfer of
  921  ownership, proper management of resident funds and personal
  922  property, surety bonds, resident contracts, refund policies,
  923  financial ability to operate, and facility and staff records.
  924         (e)(f) Inspections, complaint investigations, moratoriums,
  925  classification of deficiencies, levying and enforcement of
  926  penalties, and use of income from fees and fines.
  927         (f)(g) The enforcement of the resident bill of rights
  928  specified in s. 429.28.
  929         (g)(h) The care and maintenance of residents provided by
  930  the facility, which must include, but is not limited to:
  931         1. The supervision of residents;
  932         2. The provision of personal services;
  933         3. The provision of, or arrangement for, social and leisure
  934  activities;
  935         4. The assistance in making arrangements arrangement for
  936  appointments and transportation to appropriate medical, dental,
  937  nursing, or mental health services, as needed by residents;
  938         5. The management of medication stored within the facility
  939  and as needed by residents;
  940         6. The dietary nutritional needs of residents;
  941         7. Resident records; and
  942         8. Internal risk management and quality assurance.
  943         (h)(i) Facilities holding a limited nursing, extended
  944  congregate care, or limited mental health license.
  945         (i)(j) The establishment of specific criteria to define
  946  appropriateness of resident admission and continued residency in
  947  a facility holding a standard, limited nursing, extended
  948  congregate care, and limited mental health license.
  949         (j)(k) The use of physical or chemical restraints. The use
  950  of Posey restraints is prohibited. Other physical restraints may
  951  be used in accordance with agency rules when ordered is limited
  952  to half-bed rails as prescribed and documented by the resident’s
  953  physician and consented to by with the consent of the resident
  954  or, if applicable, the resident’s representative or designee or
  955  the resident’s surrogate, guardian, or attorney in fact. Such
  956  rules must specify requirements for care planning, staff
  957  monitoring, and periodic review by a physician. The use of
  958  chemical restraints is limited to prescribed dosages of
  959  medications authorized by the resident’s physician and must be
  960  consistent with the resident’s diagnosis. Residents who are
  961  receiving medications that can serve as chemical restraints must
  962  be evaluated by their physician at least annually to assess:
  963         1. The continued need for the medication.
  964         2. The level of the medication in the resident’s blood.
  965         3. The need for adjustments in the prescription.
  966         (k)(l) The establishment of specific resident elopement
  967  drill requirements and policies and procedures on resident
  968  elopement. Facilities shall conduct a minimum of two resident
  969  elopement drills each year. All administrators and direct care
  970  staff shall participate in the drills, which must include a
  971  review of the facility’s procedures to address resident
  972  elopement. Facilities shall document participation in the
  973  drills.
  974         (2) In adopting any rules pursuant to this part, the agency
  975  shall make distinct standards for facilities based upon facility
  976  size; the types of care provided; the physical and mental
  977  capabilities and needs of residents; the type, frequency, and
  978  amount of services and care offered; and the staffing
  979  characteristics of the facility. Rules developed pursuant to
  980  this section may not restrict the use of shared staffing and
  981  shared programming in facilities that are part of retirement
  982  communities that provide multiple levels of care and otherwise
  983  meet the requirements of law and rule. If a continuing care
  984  facility licensed under chapter 651 or a retirement community
  985  offering multiple levels of care licenses a building or part of
  986  a building designated for independent living for assisted
  987  living, staffing requirements established in rule apply only to
  988  residents who receive personal, limited nursing, or extended
  989  congregate care services under this part. Such facilities shall
  990  retain a log listing the names and unit number for residents
  991  receiving these services. The log must be available to surveyors
  992  upon request. Except for uniform firesafety standards, The
  993  agency shall adopt by rule separate and distinct standards for
  994  facilities with 16 or fewer beds and for facilities with 17 or
  995  more beds. The standards for facilities with 16 or fewer beds
  996  must be appropriate for a noninstitutional residential
  997  environment; however, the structure may not be more than two
  998  stories in height and all persons who cannot exit the facility
  999  unassisted in an emergency must reside on the first floor. The
 1000  agency may make other distinctions among types of facilities as
 1001  necessary to enforce this part. Where appropriate, the agency
 1002  shall offer alternate solutions for complying with established
 1003  standards, based on distinctions made by the agency relative to
 1004  the physical characteristics of facilities and the types of care
 1005  offered.
 1006         (5) The agency may use an abbreviated biennial standard
 1007  licensure inspection that consists of a review of key quality
 1008  of-care standards in lieu of a full inspection in a facility
 1009  that has a good record of past performance. However, a full
 1010  inspection must be conducted in a facility that has a history of
 1011  class I or class II violations;, uncorrected class III
 1012  violations; or a class I, class II, or uncorrected class III
 1013  violation resulting from a complaint referred by the State Long
 1014  Term Care Ombudsman Program, confirmed ombudsman council
 1015  complaints, or confirmed licensure complaints within the
 1016  previous licensure period immediately preceding the inspection
 1017  or if a potentially serious problem is identified during the
 1018  abbreviated inspection. The agency shall adopt by rule develop
 1019  the key quality-of-care standards with input from the State
 1020  Long-Term Care Ombudsman Council and representatives of provider
 1021  groups for incorporation into its rules.
 1022         Section 12. Section 429.435, Florida Statutes, is created
 1023  to read:
 1024         429.435Uniform firesafety standards.—Uniform firesafety
 1025  standards for assisted living facilities that are residential
 1026  board and care occupancies shall be established by the State
 1027  Fire Marshal pursuant to s. 633.206.
 1028         (1)EVACUATION CAPABILITY.—A firesafety evacuation
 1029  capability determination shall be conducted within 6 months
 1030  after the date of initial licensure of an assisted living
 1031  facility, if required.
 1032         (2)FIRESAFETY REQUIREMENTS.—
 1033         (a)The National Fire Protection Association, Life Safety
 1034  Code, NFPA 101 and 101A, current editions, must be used in
 1035  determining the uniform firesafety code adopted by the State
 1036  Fire Marshal for assisted living facilities, pursuant to s.
 1037  633.206.
 1038         (b)A local government or a utility may charge fees that do
 1039  not exceed the actual costs incurred by the local government or
 1040  the utility for the installation and maintenance of an automatic
 1041  fire sprinkler system in a licensed assisted living facility
 1042  structure.
 1043         (c)All licensed facilities must have an annual fire
 1044  inspection conducted by the local fire marshal or authority
 1045  having jurisdiction.
 1046         (d)An assisted living facility that was issued a building
 1047  permit or certificate of occupancy before July 1, 2016, at its
 1048  option and after notifying the authority having jurisdiction,
 1049  may remain under the provisions of the 1994 and 1995 editions of
 1050  the National Fire Protection Association, Life Safety Code, NFPA
 1051  101 and 101A. A facility opting to remain under such provisions
 1052  may make repairs, modernizations, renovations, or additions to
 1053  or rehabilitate the facility in compliance with NFPA 101, 1994
 1054  edition, and may use the alternative approaches to life safety
 1055  in compliance with NFPA 101A, 1995 edition. However, a facility
 1056  for which a building permit or certificate of occupancy was
 1057  issued before July 1, 2016, which undergoes Level III building
 1058  alteration or rehabilitation, as defined in the Florida Building
 1059  Code, or which seeks to use features not authorized under the
 1060  1994 or 1995 editions of the Life Safety Code, shall thereafter
 1061  comply with all aspects of the uniform firesafety standards
 1062  established under s. 633.206 and the Florida Fire Prevention
 1063  Code in effect for assisted living facilities as adopted by the
 1064  State Fire Marshal.
 1065         Section 13. Section 429.52, Florida Statutes, is amended to
 1066  read:
 1067         429.52 Staff training and educational requirements
 1068  programs; core educational requirement.—
 1069         (1) Effective October 1, 2015, Each new assisted living
 1070  facility employee who has not previously completed core training
 1071  must attend a preservice orientation provided by the facility
 1072  before interacting with residents. The preservice orientation
 1073  must be at least 2 hours in duration and cover topics that help
 1074  the employee provide responsible care and respond to the needs
 1075  of facility residents. Upon completion, the employee and the
 1076  administrator of the facility must sign a statement that the
 1077  employee completed the required preservice orientation. The
 1078  facility must keep the signed statement in the employee’s
 1079  personnel record.
 1080         (2) Administrators and other assisted living facility staff
 1081  must meet minimum training and education requirements
 1082  established by the agency by rule. This training and education
 1083  is intended to assist facilities to appropriately respond to the
 1084  needs of residents, to maintain resident care and facility
 1085  standards, and to meet licensure requirements.
 1086         (3) The agency, in conjunction with providers, shall
 1087  develop core training requirements for administrators consisting
 1088  of core training learning objectives, a competency test, and a
 1089  minimum required score to indicate successful passage completion
 1090  of the core competency test training and educational
 1091  requirements. The required core competency test training and
 1092  education must cover at least the following topics:
 1093         (a) State law and rules relating to assisted living
 1094  facilities.
 1095         (b) Resident rights and identifying and reporting abuse,
 1096  neglect, and exploitation.
 1097         (c) Special needs of elderly persons, persons with mental
 1098  illness, and persons with developmental disabilities and how to
 1099  meet those needs.
 1100         (d) Nutrition and food service, including acceptable
 1101  sanitation practices for preparing, storing, and serving food.
 1102         (e) Medication management, recordkeeping, and proper
 1103  techniques for assisting residents with self-administered
 1104  medication.
 1105         (f) Firesafety requirements, including fire evacuation
 1106  drill procedures and other emergency procedures.
 1107         (g) Care of persons with Alzheimer’s disease and related
 1108  disorders.
 1109         (4) A new facility administrator must complete the required
 1110  core training and education, including the competency test,
 1111  within 90 days after the date of employment as an administrator.
 1112  Failure to do so is a violation of this part and subjects the
 1113  violator to an administrative fine as prescribed in s. 429.19.
 1114  Administrators licensed in accordance with part II of chapter
 1115  468 are exempt from this requirement. Other licensed
 1116  professionals may be exempted, as determined by the agency by
 1117  rule.
 1118         (5) Administrators are required to participate in
 1119  continuing education for a minimum of 12 contact hours every 2
 1120  years.
 1121         (6) Staff involved with the management of medications and
 1122  assisting with the self-administration of medications under s.
 1123  429.256 must complete a minimum of 6 additional hours of
 1124  training provided by a registered nurse or, a licensed
 1125  pharmacist before providing assistance, or agency staff. Two
 1126  hours of continuing education are required annually thereafter.
 1127  The agency shall establish by rule the minimum requirements of
 1128  this additional training.
 1129         (7) Other Facility staff shall participate in inservice
 1130  training relevant to their job duties as specified by agency
 1131  rule of the agency. Topics covered during the preservice
 1132  orientation are not required to be repeated during inservice
 1133  training. A single certificate of completion which covers all
 1134  required inservice training topics may be issued to a
 1135  participating staff member if the training is provided in a
 1136  single training course.
 1137         (8) If the agency determines that there are problems in a
 1138  facility which could be reduced through specific staff training
 1139  or education beyond that already required under this section,
 1140  the agency may require, and provide, or cause to be provided,
 1141  the training or education of any personal care staff in the
 1142  facility.
 1143         (9) The agency shall adopt rules related to these training
 1144  and education requirements, the competency test, necessary
 1145  procedures, and competency test fees and shall adopt or contract
 1146  with another entity to develop and administer the competency
 1147  test. The agency shall adopt a curriculum outline with learning
 1148  objectives to be used by core trainers, which shall be used as
 1149  the minimum core training content requirements. The agency shall
 1150  consult with representatives of stakeholder associations and
 1151  agencies in the development of the curriculum outline.
 1152         (10) The core training required by this section other than
 1153  the preservice orientation must be conducted by persons
 1154  registered with the agency as having the requisite experience
 1155  and credentials to conduct the training. A person seeking to
 1156  register as a core trainer must provide the agency with proof of
 1157  completion of the minimum core training education requirements,
 1158  successful passage of the competency test established under this
 1159  section, and proof of compliance with the continuing education
 1160  requirement in subsection (5).
 1161         (11) A person seeking to register as a core trainer also
 1162  must also:
 1163         (a) Provide proof of completion of a 4-year degree from an
 1164  accredited college or university and must have worked in a
 1165  management position in an assisted living facility for 3 years
 1166  after being core certified;
 1167         (b) Have worked in a management position in an assisted
 1168  living facility for 5 years after being core certified and have
 1169  1 year of teaching experience as an educator or staff trainer
 1170  for persons who work in assisted living facilities or other
 1171  long-term care settings;
 1172         (c) Have been previously employed as a core trainer for the
 1173  agency or department; or
 1174         (d) Meet other qualification criteria as defined in rule,
 1175  which the agency is authorized to adopt.
 1176         (12) The agency shall adopt rules to establish core trainer
 1177  registration and removal requirements.
 1178         Section 14. This act shall take effect July 1, 2020.

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