Bill Text: FL S1724 | 2013 | Regular Session | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Transitional Living Facilities
Spectrum: Bipartisan Bill
Status: (Failed) 2013-05-03 - Died in Appropriations Subcommittee on Health and Human Services, companion bill(s) passed, see CS/CS/HB 1159 (Ch. 2013-153) [S1724 Detail]
Download: Florida-2013-S1724-Comm_Sub.html
Bill Title: Transitional Living Facilities
Spectrum: Bipartisan Bill
Status: (Failed) 2013-05-03 - Died in Appropriations Subcommittee on Health and Human Services, companion bill(s) passed, see CS/CS/HB 1159 (Ch. 2013-153) [S1724 Detail]
Download: Florida-2013-S1724-Comm_Sub.html
Florida Senate - 2013 CS for SB 1724 By the Committee on Children, Families, and Elder Affairs; and Senator Garcia 586-03371-13 20131724c1 1 A bill to be entitled 2 An act relating to transitional living facilities; 3 creating part XI of ch. 400, F.S., entitled 4 “Transitional Living Facilities”; creating s. 5 400.9970, F.S.; providing legislative intent; creating 6 s. 400.9971, F.S.; providing definitions; creating s. 7 400.9972, F.S.; requiring the licensure of 8 transitional living facilities; providing fees; 9 providing license application requirements; creating 10 s. 400.9973, F.S.; providing requirements for 11 transitional living facilities relating to client 12 admission, transfer, and discharge; creating s. 13 400.9974, F.S.; requiring a comprehensive treatment 14 plan to be developed for each client; providing plan 15 requirements; creating s. 400.9975, F.S.; providing 16 licensee responsibilities; providing notice 17 requirements; prohibiting a licensee or employee of a 18 facility from serving notice upon a client to leave 19 the premises or take other retaliatory action; 20 requiring the client and client’s representative to be 21 provided with certain information; requiring the 22 licensee to develop and implement certain policies and 23 procedures; creating s. 400.9976, F.S.; providing 24 licensee requirements relating to medication 25 practices; creating s. 400.9977, F.S.; providing 26 requirements for the screening of potential employees 27 and monitoring of employees for the protection of 28 clients; requiring licensees to implement certain 29 procedures; creating s. 400.9978, F.S.; providing 30 requirements for the use of physical restraints and 31 chemical restraint medication on clients; creating s. 32 400.9979, F.S.; providing background screening 33 requirements; requiring the licensee to maintain 34 certain personnel records; providing administrative 35 responsibilities for licensees; providing 36 recordkeeping requirements; creating s. 400.9980, 37 F.S.; providing requirements relating to property and 38 personal affairs of clients; providing requirements 39 for a licensee with respect to obtaining surety bonds; 40 providing recordkeeping requirements relating to the 41 safekeeping of personal effects; providing 42 requirements for trust funds received by licensee and 43 credited to the client; providing a penalty for 44 certain misuse of a resident’s personal needs 45 allowance; providing criminal penalties for 46 violations; providing for the disposition of property 47 in the event of the death of a client; authorizing the 48 Agency for Health Care Administration to adopt rules; 49 creating s. 400.9981, F.S.; authorizing the agency to 50 adopt and enforce certain rules; creating s. 400.9982, 51 F.S.; providing procedures relating to violations and 52 penalties; providing administrative fines for 53 specified classes of violations; creating s. 400.9983, 54 F.S.; authorizing the agency to apply certain 55 provisions with regard to receivership proceedings; 56 creating s. 400.9984, F.S.; requiring the Agency for 57 Health Care Administration, the Department of Health, 58 the Agency for Persons with Disabilities, and the 59 Department of Children and Families to develop 60 electronic systems for certain purposes; repealing s. 61 400.805, F.S., relating to transitional living 62 facilities; providing that every transitional living 63 facilities licensed under s. 400.805, F.S., on or 64 before a specified date is licensed under the 65 provisions of the act; amending s. 381.745, F.S.; 66 revising a definition; amending s. 381.75, F.S.; 67 revising the duties of the Department of Health as 68 they relate to transitional living facilities; 69 amending s. 381.78, F.S.; conforming provisions to 70 changes made by the act; providing an effective date. 71 72 Be It Enacted by the Legislature of the State of Florida: 73 74 Section 1. Sections 400.9970 through 400.9984, Florida 75 Statutes, are designated as part XI of chapter 400, Florida 76 Statutes, entitled “Transitional Living Facilities.” 77 Section 2. Section 400.9970, Florida Statutes, is created 78 to read: 79 400.9970 Legislative intent.—It is the intent of the 80 Legislature to provide for the licensure of transitional living 81 facilities and require the development, establishment, and 82 enforcement of basic standards by the Agency for Health Care 83 Administration to ensure quality of care and services to clients 84 in transitional living facilities. It is the policy of the state 85 that the least restrictive appropriate available treatment be 86 used based on the individual needs and best interest of the 87 client and consistent with optimum improvement of the client’s 88 condition. The goal of a transitional living program for 89 individuals who have brain or spinal cord injuries is to assist 90 each individual who has such an injury to achieve a higher level 91 of independent functioning and to enable that individual to 92 reenter the community. 93 Section 3. Section 400.9971, Florida Statutes, is created 94 to read: 95 400.9971 Definitions.—As used in this part, the term: 96 (1) “Agency” means the Agency for Health Care 97 Administration. 98 (2) “Chemical restraint” means a pharmacologic drug that 99 physically limits, restricts, or deprives an individual of 100 movement or mobility, is used for client protection or safety, 101 and is not required for the treatment of medical conditions or 102 symptoms. 103 (3) “Client’s representative” means the parent of a child 104 client or the client’s guardian, designated representative or 105 designee, surrogate, or attorney in fact. 106 (4) “Department” means the Department of Health. 107 (5) “Licensee” means an individual issued a license by the 108 agency. 109 (6) “Physical restraint” means any manual method to 110 restrict freedom of movement of or normal access to an 111 individual’s body or a physical or mechanical device, material, 112 or equipment attached or adjacent to the individual’s body so 113 that he or she cannot easily remove the restraint and which 114 restricts freedom of movement of or normal access to one’s body, 115 including, but not limited to, a half-bed rail, a full-bed rail, 116 a geriatric chair, and a posey restraint. The term includes any 117 device that was not specifically manufactured as a restraint but 118 which has been altered, arranged, or otherwise used for this 119 purpose. The term does not include bandage material used for the 120 purpose of binding a wound or injury. 121 (7) “Transitional living facility” means a site where 122 specialized health care services are provided, including, but 123 not limited to, rehabilitative services, behavior modification, 124 community reentry training, aids for independent living, and 125 counseling to individuals who have brain injuries or spinal cord 126 injuries. The term does not require a provider that is licensed 127 by the agency to obtain a separate transitional living facility 128 license to serve persons who have brain injuries or spinal cord 129 injuries as long as the services provided are within the scope 130 of the provider’s license. 131 Section 4. Section 400.9972, Florida Statutes, is created 132 to read: 133 400.9972 License required; fee; application.— 134 (1) The requirements of part II of chapter 408 apply to the 135 provision of services that require licensure pursuant to this 136 part and part II of chapter 408 and to entities licensed by or 137 applying for such licensure from the agency pursuant to this 138 part. A license issued by the agency is required for the 139 operation of a transitional living facility in this state. 140 (2) In accordance with this part, an applicant or a 141 licensee shall pay a fee for each license application submitted 142 under this part. The license fee shall consist of a $4,588 143 license fee and a $90 per-bed fee per biennium and shall conform 144 to the annual adjustment authorized in s. 408.805. 145 (3) Each applicant for licensure must provide the 146 following: 147 (a) The location of the facility for which a license is 148 sought and documentation, signed by the appropriate local 149 government official, which states that the applicant has met 150 local zoning requirements. 151 (b) Proof of liability insurance as provided in s. 624.605. 152 (c) Proof of compliance with local zoning requirements, 153 including compliance with the requirements of chapter 419 if the 154 proposed facility is a community residential home. 155 (d) Proof that the facility has received a satisfactory 156 firesafety inspection. 157 (e) Documentation of a satisfactory sanitation inspection 158 of the facility by the county health department. 159 160 The applicant’s proposed facility must attain and continuously 161 maintain accreditation by an accrediting organization 162 specializing in evaluating rehabilitation facilities whose 163 standards incorporate comparable licensure regulations required 164 by the state. An applicant for licensure as a transitional 165 living facility must acquire accreditation within 12 months 166 after the issuance of an initial license. The agency shall 167 accept the accreditation survey report of the accrediting 168 organization in lieu of conducting a licensure inspection if the 169 standards included in the survey report are determined by the 170 agency to document that the facility is in substantial 171 compliance with state licensure requirements. The applicant 172 shall submit to the agency within 10 days after receipt a copy 173 of any accreditation survey report and evidence of the 174 accreditation decision subsequent to a survey by the accrediting 175 organization on the facility. This part does not preclude the 176 agency from conducting periodic inspections of a transitional 177 living facility to ensure compliance with all licensure 178 requirements, and as it deems necessary to carry out the 179 functions of the agency. An inspection may be conducted to 180 ensure compliance with licensure requirements of this part, to 181 validate the inspection process of accrediting organizations, to 182 respond to licensure complaints, or to protect the public health 183 and safety. 184 Section 5. Section 400.9973, Florida Statutes, is created 185 to read: 186 400.9973 Client admission, transfer, and discharge.— 187 (1) Each transitional living facility must have written 188 policies and procedures governing the admission, transfer, and 189 discharge of clients. 190 (2) The admission of each client to a transitional living 191 facility must be in accordance with the licensee’s policies and 192 procedures. 193 (3) A client admitted to a transitional living facility 194 must have a brain or spinal cord injury, such as a lesion to the 195 spinal cord or cauda equina syndrome, with evidence of 196 significant involvement of two of the following deficits or 197 dysfunctions: 198 (a) A motor deficit. 199 (b) A sensory deficit. 200 (c) Bowel and bladder dysfunction. 201 (d) An acquired internal or external injury to the skull, 202 the brain, or the brain’s covering, whether caused by a 203 traumatic or nontraumatic event, which produces an altered state 204 of consciousness or an anatomic motor, sensory, cognitive, or 205 behavioral deficit. 206 (4) A client whose medical diagnosis does not positively 207 identify a cause of the client’s condition, whose symptoms are 208 inconsistent with the known cause of injury, or whose recovery 209 is inconsistent with the known medical condition may be admitted 210 to a transitional living facility for evaluation for a period 211 not to exceed 90 days. 212 (5) A client admitted to a transitional living facility 213 must be admitted upon prescription by a licensed physician and 214 must remain under the care of a licensed physician for the 215 duration of the client’s stay in the facility. 216 (6) A transitional living facility may not admit a client 217 whose primary admitting diagnosis is mental illness or an 218 intellectual or a developmental disability. 219 (7) An individual may not be admitted to a transitional 220 living facility if the individual: 221 (a) Presents significant risk of infection to other clients 222 or personnel. A health care practitioner must provide 223 documentation that the individual is free of apparent signs and 224 symptoms of communicable disease; 225 (b) Is a danger to self or others as determined by a 226 physician or mental health practitioner licensed under chapter 227 490 or chapter 491, unless the facility provides adequate 228 staffing and support to ensure patient safety; 229 (c) Is bedridden; or 230 (d) Requires 24-hour nursing supervision. 231 (8) If the client meets the admission criteria, the medical 232 or nursing director of the facility must complete an initial 233 evaluation of the client’s functional skills, behavioral status, 234 cognitive status, educational or vocational potential, medical 235 status, psychosocial status, sensorimotor capacity, and other 236 related skills and abilities within the first 72 hours after the 237 client’s admission to the facility. An initial comprehensive 238 treatment plan that delineates services to be provided and 239 appropriate sources for such services must be implemented within 240 the first 4 days after admission. 241 (9) Each transitional living facility shall develop a 242 discharge plan for each client before or upon admission to the 243 facility. The discharge plan must identify the intended 244 discharge site and possible alternative discharge sites. For 245 each discharge site identified, the discharge plan must identify 246 the skills, behaviors, and other conditions that the client must 247 achieve to be appropriate for discharge. Discharge plans must be 248 reviewed and updated as necessary, but no less often than once 249 monthly. 250 (10) As soon as practicable, a transitional living facility 251 shall discharge a client when he or she no longer requires any 252 of the specialized services described in s. 400.9971(7) or is 253 not making measurable progress in accordance with his or her 254 comprehensive treatment plan, or if the transitional living 255 facility is no longer the most appropriate, least restrictive 256 treatment option. 257 (11) Each transitional living facility shall provide at 258 least 30 days’ notice to clients of transfer or discharge plans, 259 including the location of an acceptable transfer location if the 260 client is unable to live independently. This requirement does 261 not apply if a client voluntarily terminates residency. 262 Section 6. Section 400.9974, Florida Statutes, is created 263 to read: 264 400.9974 Client comprehensive treatment plans; client 265 services.— 266 (1) Each transitional living facility shall develop a 267 comprehensive treatment plan for each client as soon as 268 possible, but no later than 30 days following development of the 269 initial comprehensive treatment plan. Comprehensive treatment 270 plans must be reviewed and updated if the client fails to meet 271 projected improvements in the plan or if a significant change in 272 the client’s condition occurs. Comprehensive treatment plans 273 must be reviewed and updated at least once monthly. 274 Comprehensive treatment plans must be developed by an 275 interdisciplinary team consisting of the case manager, the 276 program director, the nurse, and appropriate therapists. The 277 client or, if appropriate, the client’s representative must be 278 included in developing the comprehensive treatment plan. 279 (2) The comprehensive treatment plan must include the 280 following: 281 (a) The physician’s orders and the client’s diagnosis, 282 medical history, physical examination, and rehabilitative or 283 restorative needs. 284 (b) A preliminary nursing evaluation with physician’s 285 orders for immediate care, completed on admission. 286 (c) A comprehensive, accurate, reproducible, and 287 standardized assessment of the client’s functional capability; 288 the treatments designed to achieve skills, behaviors, and other 289 conditions necessary to return to the community; and specific 290 measurable goals. 291 (d) Steps necessary for the client to achieve transition to 292 the community and estimated length of time to achieve the goals. 293 (3) The client or, if appropriate, the client’s 294 representative shall consent to the continued treatment at the 295 transitional living facility. If such consent is not given, the 296 transitional living facility shall discharge the client as soon 297 as practicable. 298 (4) Each client must receive the professional program 299 services needed to implement the client’s comprehensive 300 treatment plan. 301 (5) The licensee must employ qualified professional staff 302 to carry out and monitor the various professional interventions 303 in accordance with the stated goals and objectives of every 304 client’s comprehensive treatment plan. 305 (6) Each client must receive a continuous treatment program 306 that includes appropriate, consistent implementation of a 307 program of specialized and general training, treatment, health 308 services, and related services which is directed toward: 309 (a) The acquisition of the behaviors and skills necessary 310 for the client to function with as much self-determination and 311 independence as possible; 312 (b) The prevention or deceleration of regression or loss of 313 current optimal functional status; and 314 (c) The management of behavioral issues that preclude 315 independent functioning in the community. 316 Section 7. Section 400.9975, Florida Statutes, is created 317 to read: 318 400.9975 Licensee responsibilities.— 319 (1) The licensee shall ensure that each client: 320 (a) Lives in a safe environment free from abuse, neglect, 321 and exploitation. 322 (b) Is treated with consideration and respect and with due 323 recognition of personal dignity, individuality, and the need for 324 privacy. 325 (c) Retains and uses his or her own clothes and other 326 personal property in his or her immediate living quarters, so as 327 to maintain individuality and personal dignity, except when the 328 licensee can demonstrate that such retention and use would be 329 unsafe, impractical, or an infringement upon the rights of other 330 clients. 331 (d) Has unrestricted private communication, including 332 receiving and sending unopened correspondence, access to a 333 telephone, and visiting with any person of his or her choice. 334 Upon request, the licensee shall make provisions to modify 335 visiting hours for caregivers and guests. The facility shall 336 restrict communication in accordance with any court order or 337 written instruction of a client’s representative. Any 338 restriction on a client’s communication for therapeutic reasons 339 shall be documented and reviewed at least weekly and shall be 340 removed as soon as it is no longer clinically indicated. The 341 basis for the restriction shall be explained to the client and, 342 if applicable, the client’s representative. The client shall 343 nonetheless retain the right to call the abuse hotline, the 344 agency, and Disability Rights Florida at any and all times. 345 (e) Participates in and benefits from community services 346 and activities to achieve the highest possible level of 347 independence, autonomy, and interaction within the community. 348 (f) Manages his or her financial affairs unless the client 349 or, if applicable, the client’s representative authorizes the 350 administrator of the facility to provide safekeeping for funds 351 as provided in this part. 352 (g) Has reasonable opportunity for regular exercise several 353 times a week and to be outdoors at regular and frequent 354 intervals except when prevented by inclement weather. 355 (h) Exercises civil and religious liberties, including the 356 right to independent personal decisions. No religious belief or 357 practice, including attendance at religious services, shall be 358 imposed upon any client. 359 (i) Has access to adequate and appropriate health care 360 consistent with established and recognized standards within the 361 community. 362 (j) Has the ability to present grievances and recommend 363 changes in policies, procedures, and services to the staff of 364 the licensee, governing officials, or any other person without 365 restraint, interference, coercion, discrimination, or reprisal. 366 Each licensee shall establish a grievance procedure to 367 facilitate a client’s ability to present grievances, including a 368 system for investigating, tracking, managing, and responding to 369 complaints by persons receiving services or individuals acting 370 on their behalf, and an appeals process. This process must 371 include access to Disability Rights Florida and other advocates 372 and the right to be a member of, be active in, and associate 373 with advocacy or special interest groups. 374 (2) The licensee shall: 375 (a) Promote participation of each client’s representative 376 in the process of providing treatment to the client unless the 377 representative’s participation is unobtainable or inappropriate. 378 (b) Answer communications from each client’s family, 379 guardians, and friends promptly and appropriately. 380 (c) Promote visits by individuals with a relationship to 381 the client at any reasonable hour, without requiring prior 382 notice, or in any area of the facility which provides direct 383 client care services to the client, consistent with the client’s 384 and other clients’ privacy, unless the interdisciplinary team 385 determines that such a visit would not be appropriate. 386 (d) Promote leave from the facility for visits, trips, or 387 vacations. 388 (e) Promptly notify the client’s representative of any 389 significant incidents or changes in the client’s condition, 390 including, but not limited to, serious illness, accident, abuse, 391 unauthorized absence, or death. 392 (3) The administrator of a facility shall ensure that a 393 written notice of licensee responsibilities is posted in a 394 prominent place in each building where clients reside and read 395 or explained to clients who cannot read. This notice shall 396 include the statewide toll-free telephone number for reporting 397 complaints to the agency, must be provided to clients in a 398 manner that is clearly legible, and must include the words: “To 399 report a complaint regarding the services you receive, please 400 call toll-free ...[telephone number]... or Disability Rights 401 Florida ...[telephone number]...”; and the statewide toll-free 402 telephone number for the central abuse hotline must be provided 403 to clients in a manner that is clearly legible and must include 404 the words: “To report abuse, neglect or exploitation, please 405 call toll-free ...[telephone number where complaints may be 406 lodged]....” The licensee must ensure a client’s access to a 407 telephone, where telephone numbers required in this subsection 408 are readily available, to call the agency, central abuse 409 hotline, or Disability Rights Florida. 410 (4) A licensee or employee of a facility may not serve 411 notice upon a client to leave the premises or take any other 412 retaliatory action against any person solely due to the 413 following: 414 (a) The client or other person files an internal or 415 external complaint or grievance regarding the facility. 416 (b) The client or other person appears as a witness in any 417 hearing inside or outside the facility. 418 (5) Before or at the time of admission, the client and the 419 client’s representative shall be provided with a copy of the 420 licensee’s responsibilities as provided in this section, 421 including grievance procedures and the telephone numbers 422 provided in this section. 423 (6) The licensee must develop and implement policies and 424 procedures governing the release of any client information, 425 including consent necessary from the client or the client’s 426 representative. 427 Section 8. Section 400.9976, Florida Statutes, is created 428 to read: 429 400.9976 Medication practices.— 430 (1) An individual medication administration record must be 431 maintained for each client. Each dose of medication, including a 432 self-administered dose, shall be properly recorded in the 433 client’s record. Each client who self-administers medication 434 shall be given a pill organizer. Medication must be placed in 435 the pill organizer by a nurse. A nurse shall document the date 436 and time medication is placed into each client’s pill organizer. 437 All medications must be administered in compliance with the 438 physician’s orders. 439 (2) If the interdisciplinary team determines that self 440 administration of medications is an appropriate objective, and 441 if the physician does not specify otherwise, a client must be 442 taught to self-administer his or her medication without a staff 443 person. This includes all forms of administration, including 444 orally, via injection, and via suppository. The client’s 445 physician must be informed of the interdisciplinary team’s 446 decision that self-administration of medications is an objective 447 for the client. A client may not self-administer medication 448 until he or she demonstrates the competency to take the correct 449 medication in the correct dosage at the correct time, to respond 450 to missed doses, and to contact an appropriate person with 451 questions. 452 (3) Medication administration discrepancies and adverse 453 drug reactions must be recorded and reported immediately to a 454 physician. 455 Section 9. Section 400.9977, Florida Statutes, is created 456 to read: 457 400.9977 Protection from abuse, neglect, mistreatment, and 458 exploitation.—The licensee must develop and implement policies 459 and procedures for the screening and training of employees, the 460 protection of clients, and the prevention, identification, 461 investigation, and reporting of abuse, neglect, and 462 exploitation. This includes the licensee’s identification of 463 clients whose personal histories render them at risk for abusing 464 other clients, development of intervention strategies to prevent 465 occurrences, monitoring for changes that would trigger abusive 466 behavior, and reassessment of the interventions on a regular 467 basis. A licensee shall implement procedures to: 468 (1) Screen potential employees for a history of abuse, 469 neglect, or mistreatment of clients. The screening shall include 470 an attempt to obtain information from previous employers and 471 current employers and verification with the appropriate 472 licensing boards and registries. 473 (2) Train employees, through orientation and ongoing 474 sessions, on issues related to abuse prohibition practices, 475 including identification of abuse, neglect, mistreatment, and 476 exploitation, appropriate interventions to deal with aggressive 477 or catastrophic reactions of clients, the process to report 478 allegations without fear of reprisal, and recognition of signs 479 of frustration and stress that may lead to abuse. 480 (3) Provide clients, families, and staff with information 481 on how and to whom they may report concerns, incidents, and 482 grievances without the fear of retribution and provide feedback 483 regarding the concerns that have been expressed. A licensee must 484 identify, correct, and intervene in situations in which abuse, 485 neglect, mistreatment, or exploitation is likely to occur, 486 including: 487 (a) Evaluating the physical environment of the facility to 488 identify characteristics that may make abuse or neglect more 489 likely to occur, such as secluded areas. 490 (b) Providing sufficient staff on each shift to meet the 491 needs of the clients, and ensuring that the staff assigned have 492 knowledge of the individual clients’ care needs. The licensee 493 shall identify inappropriate behaviors of its staff, such as 494 using derogatory language, rough handling, ignoring clients 495 while giving care, and directing clients who need toileting 496 assistance to urinate or defecate in their beds. 497 (c) Assessing, planning care for, and monitoring clients 498 with needs and behaviors that might lead to conflict or neglect, 499 such as clients with a history of aggressive behaviors, clients 500 who have behaviors such as entering other clients’ rooms, 501 clients with self-injurious behaviors, clients with 502 communication disorders, and clients who require heavy nursing 503 care or are totally dependent on staff. 504 (4) Identify events, such as suspicious bruising of 505 clients, occurrences, patterns, and trends that may constitute 506 abuse and determine the direction of the investigation. 507 (5) Investigate different types of incidents, identify the 508 staff member responsible for the initial reporting, investigate 509 alleged violations, and report results to the proper 510 authorities. The licensee must analyze the occurrences to 511 determine what changes are needed, if any, to policies and 512 procedures to prevent further occurrences and to take all 513 necessary corrective action depending on the results of the 514 investigation. 515 (6) Protect clients from harm during an investigation. 516 (7) Report all alleged violations and all substantiated 517 incidents, as required under chapters 39 and 415, to the 518 licensing authorities and all other agencies as required and to 519 report any knowledge it has of any actions by a court of law 520 that would indicate an employee is unfit for service. 521 Section 10. Section 400.9978, Florida Statutes, is created 522 to read: 523 400.9978 Restraints and seclusion; client safety.— 524 (1) The use of physical restraints must be ordered and 525 documented by a physician and must be consistent with policies 526 and procedures adopted by the facility. The client or, if 527 applicable, the client’s representative must be informed of the 528 facility’s physical restraint policies and procedures at the 529 time of the client’s admission. 530 (2) The use of chemical restraints is limited to prescribed 531 dosages of medications as ordered by a physician and must be 532 consistent with the client’s diagnosis and the policies and 533 procedures adopted by the facility. The client or, if 534 applicable, the client’s representative must be informed of the 535 facility’s chemical restraint policies and procedures at the 536 time of the client’s admission. 537 (3) Based on a physician’s assessment, if a client exhibits 538 symptoms that present an immediate risk of injury or death to 539 self or others, a physician may issue an emergency treatment 540 order to immediately administer rapid response psychotropic 541 medications or other chemical restraints. Each emergency 542 treatment order must be documented and maintained in the 543 client’s record. 544 (a) An emergency treatment order is effective for no more 545 than 24 hours. 546 (b) Whenever a client is medicated in accordance with this 547 subsection, the client’s representative or responsible party and 548 the client’s physician must be notified as soon as practicable. 549 (4) A client who is prescribed and receiving a medication 550 that can serve as a chemical restraint for a purpose other than 551 an emergency treatment order must be evaluated by his or her 552 physician at least monthly to assess the following: 553 (a) The continued need for the medication. 554 (b) The level of the medication in the client’s blood, as 555 appropriate. 556 (c) The need for adjustments in the prescription. 557 (5) The licensee shall ensure that clients are free from 558 unnecessary drugs and physical restraints and are provided 559 treatment to reduce dependency on drugs and physical restraints. 560 (6) The licensee may use physical restraints only as an 561 integral part of a client’s comprehensive treatment plan which 562 is intended to lead to less restrictive means of managing and 563 eliminating the behavior for which the restraint is applied. 564 (7) Interventions to manage inappropriate client behavior 565 must be employed with sufficient safeguards and supervision to 566 ensure that the safety, welfare, and civil and human rights of 567 each client are adequately protected. 568 Section 11. Section 400.9979, Florida Statutes, is created 569 to read: 570 400.9979 Background screening; administration and 571 management.— 572 (1) The agency shall require level 2 background screening 573 for personnel as required in s. 408.809(1)(e) pursuant to 574 chapter 435 and s. 408.809. 575 (2) The licensee shall maintain personnel records for each 576 staff member which contain, at a minimum, documentation of 577 background screening, if applicable, a job description, 578 documentation of compliance with all training requirements of 579 this part or applicable rule, the employment application, 580 references, a copy of all job performance evaluations, and, for 581 each staff member who performs services for which licensure or 582 certification is required, a copy of all licenses or 583 certification held by the staff member. 584 (3) The licensee must: 585 (a) Develop and implement infection control policies and 586 procedures and include such policies and procedures in the 587 licensee’s policy manual. 588 (b) Maintain liability insurance as defined in s. 624.605. 589 (c) Designate one person as an administrator who is 590 responsible and accountable for the overall management of the 591 facility. 592 (d) Designate a person in writing to be responsible for the 593 facility when the administrator is absent from the facility for 594 more than 24 hours. 595 (e) Designate in writing a program director who is 596 responsible for supervising the therapeutic and behavioral 597 staff, determining the levels of supervision, and determining 598 room placement for each client. 599 (f) Designate in writing a person to be responsible when 600 the program director is absent from the facility for more than 601 24 hours. 602 (g) Obtain approval of the comprehensive emergency 603 management plan, pursuant to s. 400.9981(2)(e), from the local 604 emergency management agency. Pending the approval of the plan, 605 the local emergency management agency shall ensure that the 606 following agencies, at a minimum, are given the opportunity to 607 review the plan: the Department of Health, the Agency for Health 608 Care Administration, and the Division of Emergency Management. 609 Appropriate volunteer organizations must also be given the 610 opportunity to review the plan. The local emergency management 611 agency shall complete its review within 60 days and either 612 approve the plan or advise the licensee of necessary revisions. 613 (h) Maintain written records in a form and system that 614 comply with medical and business practices and make such records 615 available in the facility for review or submission to the agency 616 upon request. The records shall include: 617 1. A daily census record that indicates the number of 618 clients currently receiving services in the facility, including 619 information regarding any public funding of such clients. 620 2. A record of all accidents or unusual incidents involving 621 any client or staff member that caused, or had the potential to 622 cause, injury or harm to any person or property within the 623 facility. Such records must contain a clear description of each 624 accident or incident, the names of the persons involved, a 625 description of all medical or other services provided to these 626 persons specifying who provided such services, and the steps 627 taken to prevent recurrence of such accidents or incidents. 628 3. A copy of current agreements with third-party providers. 629 4. A copy of current agreements with each consultant 630 employed by the licensee and documentation of each consultant’s 631 visits and required written, dated reports. 632 Section 12. Section 400.9980, Florida Statutes, is created 633 to read: 634 400.9980 Property and personal affairs of clients.— 635 (1) A client shall be given the option of using his or her 636 own belongings, as space permits; choosing his or her roommate 637 if practical and not clinically contraindicated; and, whenever 638 possible, unless the client is adjudicated incompetent or 639 incapacitated under state law, managing his or her own affairs. 640 (2) The admission of a client to a facility and his or her 641 presence therein shall not confer on a licensee, administrator, 642 employee, or representative thereof any authority to manage, 643 use, or dispose of any property of the client, nor shall such 644 admission or presence confer on any of such persons any 645 authority or responsibility for the personal affairs of the 646 client except that which may be necessary for the safe 647 management of the facility or for the safety of the client. 648 (3) A licensee, administrator, employee, or representative 649 thereof may: 650 (a) Not act as the guardian, trustee, or conservator for 651 any client or any of such client’s property. 652 (b) Act as a competent client’s payee for social security, 653 veteran’s, or railroad benefits if the client provides consent 654 and the licensee files a surety bond with the agency in an 655 amount equal to twice the average monthly aggregate income or 656 personal funds due to the client, or expendable for the client’s 657 account, that are received by a licensee. 658 (c) Act as the power of attorney for a client if the 659 licensee has filed a surety bond with the agency in an amount 660 equal to twice the average monthly income of the client, plus 661 the value of any client’s property under the control of the 662 attorney in fact. 663 664 The bond under paragraph (b) or paragraph (c) shall be executed 665 by the licensee as principal and a licensed surety company. The 666 bond shall be conditioned upon the faithful compliance of the 667 licensee with the requirements of licensure and shall be payable 668 to the agency for the benefit of any client who suffers a 669 financial loss as a result of the misuse or misappropriation of 670 funds held pursuant to this subsection. Any surety company that 671 cancels or does not renew the bond of any licensee shall notify 672 the agency in writing not less than 30 days in advance of such 673 action, giving the reason for the cancellation or nonrenewal. 674 Any licensee, administrator, employee, or representative thereof 675 who is granted power of attorney for any client of the facility 676 shall, on a monthly basis, notify the client in writing of any 677 transaction made on behalf of the client pursuant to this 678 subsection, and a copy of such notification given to the client 679 shall be retained in each client’s file and available for agency 680 inspection. 681 (4) A licensee, upon mutual consent with the client, shall 682 provide for the safekeeping in the facility of the client’s 683 personal effects of a value not in excess of $1,000 and the 684 client’s funds not in excess of $500 cash and shall keep 685 complete and accurate records of all such funds and personal 686 effects received. If a client is absent from a facility for 24 687 hours or more, the licensee may provide for the safekeeping of 688 the client’s personal effects of a value in excess of $1,000. 689 (5) Any funds or other property belonging to or due to a 690 client or expendable for his or her account that is received by 691 licensee shall be trust funds and shall be kept separate from 692 the funds and property of the licensee and other clients or 693 shall be specifically credited to such client. Such trust funds 694 shall be used or otherwise expended only for the account of the 695 client. At least once every month, unless upon order of a court 696 of competent jurisdiction, the licensee shall furnish the client 697 and the client’s representative a complete and verified 698 statement of all funds and other property to which this 699 subsection applies, detailing the amount and items received, 700 together with their sources and disposition. In any event, the 701 licensee shall furnish such statement annually and upon the 702 discharge or transfer of a client. Any governmental agency or 703 private charitable agency contributing funds or other property 704 to the account of a client shall also be entitled to receive 705 such statement monthly and upon the discharge or transfer of the 706 client. 707 (6)(a) In addition to any damages or civil penalties to 708 which a person is subject, any person who: 709 1. Intentionally withholds a client’s personal funds, 710 personal property, or personal needs allowance, or who demands, 711 beneficially receives, or contracts for payment of all or any 712 part of a client’s personal property or personal needs allowance 713 in satisfaction of the facility rate for supplies and services; 714 or 715 2. Borrows from or pledges any personal funds of a client, 716 other than the amount agreed to by written contract under s. 717 429.24, 718 719 commits a misdemeanor of the first degree, punishable as 720 provided in s. 775.082 or s. 775.083. 721 (b) Any licensee, administrator, employee, or 722 representative thereof who is granted power of attorney for any 723 client of the facility and who misuses or misappropriates funds 724 obtained through this power commits a felony of the third 725 degree, punishable as provided in s. 775.082, s. 775.083, or s. 726 775.084. 727 (7) In the event of the death of a client, a licensee shall 728 return all refunds, funds, and property held in trust to the 729 client’s personal representative, if one has been appointed at 730 the time the licensee disburses such funds, or, if not, to the 731 client’s spouse or adult next of kin named in a beneficiary 732 designation form provided by the licensee to the client. If the 733 client has no spouse or adult next of kin or such person cannot 734 be located, funds due the client shall be placed in an interest 735 bearing account and all property held in trust by the licensee 736 shall be safeguarded until such time as the funds and property 737 are disbursed pursuant to the Florida Probate Code. Such funds 738 shall be kept separate from the funds and property of the 739 licensee and other clients of the facility. If the funds of the 740 deceased client are not disbursed pursuant to the Florida 741 Probate Code within 2 years after the client’s death, the funds 742 shall be deposited in the Health Care Trust Fund administered by 743 the agency. 744 (8) The agency, by rule, may clarify terms and specify 745 procedures and documentation necessary to administer the 746 provisions of this section relating to the proper management of 747 clients’ funds and personal property and the execution of surety 748 bonds. 749 Section 13. Section 400.9981, Florida Statutes, is created 750 to read: 751 400.9981 Rules establishing standards.— 752 (1) It is the intent of the Legislature that rules 753 published and enforced pursuant to this part and part II of 754 chapter 408 include criteria to ensure reasonable and consistent 755 quality of care and client safety. Rules should make reasonable 756 efforts to accommodate the needs and preferences of clients to 757 enhance the quality of life in transitional living facilities. 758 (2) The agency may adopt and enforce rules to implement 759 this part and part II of chapter 408, which shall include 760 reasonable and fair criteria in relation to the following: 761 (a) The location of transitional living facilities. 762 (b) The number of qualifications of all personnel, 763 including management, medical, nursing, and other professional 764 personnel and nursing assistants and support personnel having 765 responsibility for any part of the care given to clients. The 766 licensee must have enough qualified professional staff available 767 to carry out and monitor the various professional interventions 768 in accordance with the stated goals and objectives of each 769 comprehensive treatment plan. 770 (c) Requirements for personnel procedures, insurance 771 coverage, reporting procedures, and documentation necessary to 772 implement this part. 773 (d) Services provided to clients of transitional living 774 facilities. 775 (e) The preparation and annual update of a comprehensive 776 emergency management plan in consultation with the Division of 777 Emergency Management. At a minimum, the rules must provide for 778 plan components that address emergency evacuation 779 transportation; adequate sheltering arrangements; postdisaster 780 activities, including provision of emergency power, food, and 781 water; postdisaster transportation; supplies; staffing; 782 emergency equipment; individual identification of clients and 783 transfer of records; communication with families; and responses 784 to family inquiries. 785 Section 14. Section 400.9982, Florida Statutes, is created 786 to read: 787 400.9982 Violations; penalties.— 788 (1) Each violation of this part and rules adopted pursuant 789 thereto shall be classified according to the nature of the 790 violation and the gravity of its probable effect on facility 791 clients. The agency shall indicate the classification on the 792 written notice of the violation as follows: 793 (a) Class “I” violations are defined in s. 408.813. The 794 agency shall issue a citation regardless of correction and 795 impose an administrative fine of $5,000 for an isolated 796 violation, $7,500 for a patterned violation, and $10,000 for a 797 widespread violation. Violations may be identified and a fine 798 must be levied notwithstanding the correction of the deficiency 799 giving rise to the violation. 800 (b) Class “II” violations are defined in s. 408.813. The 801 agency shall impose an administrative fine of $1,000 for an 802 isolated violation, $2,500 for a patterned violation, and $5,000 803 for a widespread violation. A fine must be levied 804 notwithstanding the correction of the deficiency giving rise to 805 the violation. 806 (c) Class “III” violations are defined in s. 408.813. The 807 agency shall impose an administrative fine of $500 for an 808 isolated violation, $750 for a patterned violation, and $1,000 809 for a widespread violation. If a deficiency giving rise to a 810 class “III” violation is corrected within the time specified by 811 the agency, a fine may not be imposed. 812 (d) Class “IV” violations are defined in s. 408.813. The 813 agency shall impose an administrative fine for a cited class IV 814 violation in an amount not less than $100 and not exceeding $200 815 for each violation. 816 Section 15. Section 400.9983, Florida Statutes, is created 817 to read: 818 400.9983 Receivership proceedings.—The agency may apply s. 819 429.22 with regard to receivership proceedings for transitional 820 living facilities. 821 Section 16. Section 400.9984, Florida Statutes, is created 822 to read: 823 400.9984 Interagency communication.—The agency, the 824 department, the Agency for Persons with Disabilities, and the 825 Department of Children and Families shall develop electronic 826 systems to ensure that relevant information pertaining to the 827 regulation of transitional living facilities and clients is 828 timely and effectively communicated among agencies in order to 829 facilitate the protection of clients. Electronic sharing of 830 information shall include, at a minimum, a brain and spinal cord 831 injury registry and a client abuse registry. 832 Section 17. Section 400.805, Florida Statutes, is repealed. 833 Every transitional living facility licensed under s. 400.805 on 834 or before July 1, 2013, shall be licensed under the provisions 835 of this act. 836 Section 18. Subsection (9) of section 381.745, Florida 837 Statutes, is amended to read: 838 381.745 Definitions; ss. 381.739-381.79.—As used in ss. 839 381.739-381.79, the term: 840 (9) “Transitional living facility” means a state-approved 841 facility, as defined and licensed under chapter 400or chapter842429, or a facility approved by the brain and spinal cord injury843program in accordance with this chapter. 844 Section 19. Section 381.75, Florida Statutes, is amended to 845 read: 846 381.75 Duties and responsibilities of the department, of847transitional living facilities, and of residents.—Consistent 848 with the mandate of s. 381.7395, the department shall develop 849 and administer a multilevel treatment program for individuals 850 who sustain brain or spinal cord injuries and who are referred 851 to the brain and spinal cord injury program. 852 (1) Within 15 days after any report of an individual who 853 has sustained a brain or spinal cord injury, the department 854 shall notify the individual or the most immediate available 855 family members of their right to assistance from the state, the 856 services available, and the eligibility requirements. 857 (2) The department shall refer individuals who have brain 858 or spinal cord injuries to other state agencies to assure that 859 rehabilitative services, if desired, are obtained by that 860 individual. 861 (3) The department, in consultation with emergency medical 862 service, shall develop standards for an emergency medical 863 evacuation system that will ensure that all individuals who 864 sustain traumatic brain or spinal cord injuries are transported 865 to a department-approved trauma center that meets the standards 866 and criteria established by the emergency medical service and 867 the acute-care standards of the brain and spinal cord injury 868 program. 869 (4) The department shall develop standards for designation 870 of rehabilitation centers to provide rehabilitation services for 871 individuals who have brain or spinal cord injuries. 872 (5) The department shall determine the appropriate number 873 of designated acute-care facilities, inpatient rehabilitation 874 centers, and outpatient rehabilitation centers, needed based on 875 incidence, volume of admissions, and other appropriate criteria. 876 (6) The department shall develop standards for designation 877 of transitional living facilities to provide transitional living 878 services for individuals who participate in the brain and spinal 879 cord injury programthe opportunity to adjust to their880disabilities and to develop physical and functional skills in a881supported living environment. 882(a) The Agency for Health Care Administration, in883consultation with the department, shall develop rules for the884licensure of transitional living facilities for individuals who885have brain or spinal cord injuries.886(b) The goal of a transitional living program for887individuals who have brain or spinal cord injuries is to assist888each individual who has such a disability to achieve a higher889level of independent functioning and to enable that person to890reenter the community. The program shall be focused on preparing891participants to return to community living.892(c) A transitional living facility for an individual who893has a brain or spinal cord injury shall provide to such894individual, in a residential setting, a goal-oriented treatment895program designed to improve the individual’s physical,896cognitive, communicative, behavioral, psychological, and social897functioning, as well as to provide necessary support and898supervision. A transitional living facility shall offer at least899the following therapies: physical, occupational, speech,900neuropsychology, independent living skills training, behavior901analysis for programs serving brain-injured individuals, health902education, and recreation.903(d) All residents shall use the transitional living904facility as a temporary measure and not as a permanent home or905domicile. The transitional living facility shall develop an906initial treatment plan for each resident within 3 days after the907resident’s admission. The transitional living facility shall908develop a comprehensive plan of treatment and a discharge plan909for each resident as soon as practical, but no later than 30910days after the resident’s admission. Each comprehensive911treatment plan and discharge plan must be reviewed and updated912as necessary, but no less often than quarterly. This subsection913does not require the discharge of an individual who continues to914require any of the specialized services described in paragraph915(c) or who is making measurable progress in accordance with that916individual’s comprehensive treatment plan. The transitional917living facility shall discharge any individual who has an918appropriate discharge site and who has achieved the goals of his919or her discharge plan or who is no longer making progress toward920the goals established in the comprehensive treatment plan and921the discharge plan. The discharge location must be the least922restrictive environment in which an individual’s health, well923being, and safety is preserved.924(7) Recipients of services, under this section, from any of925the facilities referred to in this section shall pay a fee based926on ability to pay.927 Section 20. Subsection (4) of section 381.78, Florida 928 Statutes, is amended to read: 929 381.78 Advisory council on brain and spinal cord injuries.— 930 (4) The council shall:931(a)provide advice and expertise to the department in the 932 preparation, implementation, and periodic review of the brain 933 and spinal cord injury program. 934(b) Annually appoint a five-member committee composed of935one individual who has a brain injury or has a family member936with a brain injury, one individual who has a spinal cord injury937or has a family member with a spinal cord injury, and three938members who shall be chosen from among these representative939groups: physicians, other allied health professionals,940administrators of brain and spinal cord injury programs, and941representatives from support groups with expertise in areas942related to the rehabilitation of individuals who have brain or943spinal cord injuries, except that one and only one member of the944committee shall be an administrator of a transitional living945facility. Membership on the council is not a prerequisite for946membership on this committee.9471. The committee shall perform onsite visits to those948transitional living facilities identified by the Agency for949Health Care Administration as being in possible violation of the950statutes and rules regulating such facilities. The committee951members have the same rights of entry and inspection granted952under s.400.805(4) to designated representatives of the agency.9532. Factual findings of the committee resulting from an954onsite investigation of a facility pursuant to subparagraph 1.955shall be adopted by the agency in developing its administrative956response regarding enforcement of statutes and rules regulating957the operation of the facility.9583. Onsite investigations by the committee shall be funded959by the Health Care Trust Fund.9604. Travel expenses for committee members shall be961reimbursed in accordance with s.112.061.9625. Members of the committee shall recuse themselves from963participating in any investigation that would create a conflict964of interest under state law, and the council shall replace the965member, either temporarily or permanently.966 Section 21. This act shall take effect July 1, 2013.