Assisted Living Resource Guide

Assisted Living Resource Guide

Florida Senior Living Association 2292 Wednesday Street, Suite 1

Tallahassee, FL 32308 (850) 708-4972

[email protected] www.floridaseniorliving.org

Current as of October 1, 2019

[email protected] 2292 Wednesday Street, Suite 1 www.floridaseniorliving.org Tallahassee, FL 32308

Assisted Living Resource Guide Table of Contents

About Florida Senior Living Association (FSLA)

Meet FSLA’s ALF Core Trainer

Department of Elder Affairs (DOEA) ALF Core Curriculum Outline

SECTION TAB

AHCA Regulations

Chapter 408, Part II, F.S (Health Care Licensing: General Provisions). . . . . . . . . . . . . . . . . . . . 1

Rule Chapter 59A-35, F.A.C. (Health Care Licensing Procedures). . . . . . . . . . . . . . . . . . . . . . . .2

Chapter 419, F.S. (Community Residential Homes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Chapter 435, F.S. (Background Screening). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Chapter 429, Part I, F.S. (Assisted Living Facilities) and

Section 429.905, F.S. (Adult Day Care Center Exemptions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Assisted Living Rule Transfer Table,

Rule Chapter 59A-36, F.A.C. (Assisted Living Facility Effective July 1, 2019), and

Rule Chapter 58A-5, F.A.C. (Original Assisted Living Rule transferred to 59A-36). . . . . . . . . . 6

DOH Regulations

Rule Chapter 64E-11, F.A.C. (Food Hygiene). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Rule Chapter 64E-12, F.A.C. (Community Based Residential Facilities). . . . . . . . . . . . . . . . . . . 8

Rule Chapter 64E-16, F.A.C. (Biomedical Waste). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Chapter 464, F.S. (Nursing). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

DCF Regulations

Chapter 415, F.S (Adult Protective Services). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Florida Building Code

Rule Chapter 61G20-1, FBC (Florida Building Code Adopted) and

Chapter 4, Section 464, FBC (Assisted Living Facilities) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Fire Marshal or Local Authority Having Jurisdiction

Uniform Fire Safety Standards for Assisted Living Facilities (Rule Chapter 69A-40, F.A.C.) .13

Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

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[email protected] 2292 Wednesday Street, Suite 1 www.floridaseniorliving.org Tallahassee, FL 32308

Dear Colleague,

Florida Senior Living Association (FSLA) is the preeminent statewide association that represents more than 400 professionally managed senior assisted living, independent, and memory care communities. Our expert staff provides members with current regulatory information and consistent communications to keep you and your staff up to date with the latest changes. Moreover, our national affiliate partner, Argentum, provides resources at the federal level.

FSLA’s Assisted Living Resource Guide is a resource that we offer assisted living community (ALF) operators. The Guide will be your go-to reference tool. It contains the most up-to-date regulatory information including statutes and rules necessary to operate an ALF in Florida. It also contains sample forms and links necessary for the day-to-day operation of an ALF.

In addition to regulatory assistance, FSLA offers professional education courses. We provide both the required core training for individuals interested in becoming assisted living administrators as well as professional development courses for continuing education. These courses meet the education requirements under 429.52, F.S., and offered both online and in person. If you choose to participate in FSLA’s Core Training Program, the Guide will be referenced throughout the course to help you become more familiar with Florida’s regulations. Studying the Guide and becoming familiar with the laws and rules will help you prepare for the core training state exam and can be used as a resource once you pass the exam and become an administrator. Remember to check our website on a regular basis for any updates that may be available for download to replace any outdated laws and rules. If you aren’t already a member, we hope that you will consider having your community join the association. For more information or if you have any questions, please contact us at: [email protected] and visit our website at floridaseniorliving.org. Sincerely,

Gail Matillo President/CEO

Meet Florida Senior Living Association’s ALF Core Trainer

Monica Wilson, MS, President, ICE Bridge Consulting

Monica Wilson has extensive experience as a consultative trainer and educator with more than

15 years’ experience supporting those who serve older adults. Monica provides consultation on

issues related to compliance, team building and service delivery with a focus on supporting

independence and quality of life for older adults who are experiencing physical and cognitive

changes correlated with advanced age. She has held management positions in senior living

companies, and with the Florida Department of Elder Affairs. She has consulted for other states

on policy issues and led local advocacy efforts in support of policies that support aging in place.

Monica has a Master of Science in Gerontology from the School of Business and

Entrepreneurship at Nova Southeastern University and is currently an Adjunct Professor at Palm

Beach State College.

DO

EA A

LF Core

Curriculum

Outline

1. Chapter 408, Part II, F.S

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CHAPTER 408

PART II

HEALTH CARE LICENSING: GENERAL PROVISIONS

(ss. 408.801-408.832) 408.801 Short title; purpose.

408.802 Applicability.

408.803 Definitions.

408.804 License required; display.

408.805 Fees required; adjustments.

408.806 License application process.

408.8065 Additional licensure requirements for home health agencies, home medical equipment providers, and

health care clinics.

408.807 Change of ownership.

408.808 License categories.

408.809 Background screening; prohibited offenses.

408.810 Minimum licensure requirements.

408.811 Right of inspection; copies; inspection reports; plan for correction of deficiencies.

408.812 Unlicensed activity.

408.813 Administrative fines; violations.

408.814 Moratorium; emergency suspension.

408.815 License or application denial; revocation.

408.816 Injunctions.

408.817 Administrative proceedings.

408.818 Health Care Trust Fund.

408.819 Rules.

408.820 Exemptions.

408.821 Emergency management planning; emergency operations; inactive license.

408.831 Denial, suspension, or revocation of a license, registration, certificate, or application.

408.832 Conflicts.

408.801 Short title; purpose.—

(1) This part may be cited as the “Health Care Licensing Procedures Act.”

(2) The Legislature finds that there is unnecessary duplication and variation in the requirements for licensure by

the agency. It is the intent of the Legislature to provide a streamlined and consistent set of basic licensing

requirements for all such providers in order to minimize confusion, standardize terminology, and include issues that

are otherwise not adequately addressed in the Florida Statutes pertaining to specific providers.

History.—s. 5, ch. 2006-192.

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408.802 Applicability.—The provisions of this part apply to the provision of services that require licensure as

defined in this part and to the following entities licensed, registered, or certified by the agency, as described in

chapters 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765:

(1) Laboratories authorized to perform testing under the Drug-Free Workplace Act, as provided under ss.

112.0455 and 440.102.

(2) Birth centers, as provided under chapter 383.

(3) Abortion clinics, as provided under chapter 390.

(4) Crisis stabilization units, as provided under parts I and IV of chapter 394.

(5) Short-term residential treatment facilities, as provided under parts I and IV of chapter 394.

(6) Residential treatment facilities, as provided under part IV of chapter 394.

(7) Residential treatment centers for children and adolescents, as provided under part IV of chapter 394.

(8) Hospitals, as provided under part I of chapter 395.

(9) Ambulatory surgical centers, as provided under part I of chapter 395.

(10) Nursing homes, as provided under part II of chapter 400.

(11) Assisted living facilities, as provided under part I of chapter 429.

(12) Home health agencies, as provided under part III of chapter 400.

(13) Nurse registries, as provided under part III of chapter 400.

(14) Companion services or homemaker services providers, as provided under part III of chapter 400.

(15) Adult day care centers, as provided under part III of chapter 429.

(16) Hospices, as provided under part IV of chapter 400. 1(17) Adult family-care homes, as provided under part II of chapter 429.

(18) Homes for special services, as provided under part V of chapter 400.

(19) Transitional living facilities, as provided under part XI of chapter 400.

(20) Prescribed pediatric extended care centers, as provided under part VI of chapter 400.

(21) Home medical equipment providers, as provided under part VII of chapter 400.

(22) Intermediate care facilities for persons with developmental disabilities, as provided under part VIII of

chapter 400.

(23) Health care services pools, as provided under part IX of chapter 400.

(24) Health care clinics, as provided under part X of chapter 400.

(25) Multiphasic health testing centers, as provided under 2part I of chapter 483. 1(26) Organ, tissue, and eye procurement organizations, as provided under part V of chapter 765.

History.—s. 5, ch. 2006-192; s. 89, ch. 2007-5; s. 132, ch. 2007-230; s. 19, ch. 2009-218; s. 23, ch. 2012-160; s.

9, ch. 2015-25; s. 68, ch. 2018-24. 1Note.—Section 11, ch. 2006-192, provides that “[a]ll provisions that apply to the entities specified in s. 408.802,

Florida Statutes, as created by this act, in effect on October 1, 2006, that provide for annual licensure fees are hereby

adjusted to provide for biennial licensure fees with a corresponding doubling of the amount.” 2Note.—Redesignated as part I of chapter 483 to conform to the repeal of former part I of that chapter by s. 97,

ch. 2018-24.

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408.803 Definitions.—As used in this part, the term:

(1) “Agency” means the Agency for Health Care Administration, which is the licensing agency under this part.

(2) “Applicant” means an individual, corporation, partnership, firm, association, or governmental entity that

submits an application for a license to the agency.

(3) “Authorizing statute” means the statute authorizing the licensed operation of a provider listed in s. 408.802

and includes chapters 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765.

(4) “Certification” means certification as a Medicare or Medicaid provider of the services that require licensure,

or certification pursuant to the federal Clinical Laboratory Improvement Amendment (CLIA).

(5) “Change of ownership” means:

(a) An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as

evidenced by a change in federal employer identification number or taxpayer identification number; or

(b) An event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a

licensee is in any manner transferred or otherwise assigned. This paragraph does not apply to a licensee that is

publicly traded on a recognized stock exchange.

A change solely in the management company or board of directors is not a change of ownership.

(6) “Client” means any person receiving services from a provider listed in s. 408.802.

(7) “Controlling interest” means:

(a) The applicant or licensee;

(b) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater

ownership interest in the applicant or licensee; or

(c) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater

ownership interest in the management company or other entity, related or unrelated, with which the applicant or

licensee contracts to manage the provider.

The term does not include a voluntary board member.

(8) “License” means any permit, registration, certificate, or license issued by the agency.

(9) “Licensee” means an individual, corporation, partnership, firm, association, governmental entity, or other

entity that is issued a permit, registration, certificate, or license by the agency. The licensee is legally responsible for

all aspects of the provider operation.

(10) “Moratorium” means a prohibition on the acceptance of new clients.

(11) “Provider” means any activity, service, agency, or facility regulated by the agency and listed in s. 408.802.

(12) “Relative” means an individual who is the father, mother, stepfather, stepmother, son, daughter, brother,

sister, grandmother, grandfather, great-grandmother, great-grandfather, grandson, granddaughter, uncle, aunt, first

cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law,

sister-in-law, stepson, stepdaughter, stepbrother, stepsister, half-brother, or half-sister of a patient or client.

(13) “Services that require licensure” means those services, including residential services, that require a valid

license before those services may be provided in accordance with authorizing statutes and agency rules.

(14) “Voluntary board member” means a board member or officer of a not-for-profit corporation or

organization who serves solely in a voluntary capacity, does not receive any remuneration for his or her services on

the board of directors, and has no financial interest in the corporation or organization.

History.—s. 5, ch. 2006-192; s. 90, ch. 2007-5; s. 47, ch. 2009-223; s. 69, ch. 2018-24.

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408.804 License required; display.—

(1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or

provides services that require licensure, without first obtaining from the agency a license authorizing the provision

of such services or the operation or maintenance of such provider.

(2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that

appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold,

assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider,

and location for which the license is issued.

(3) Any person who knowingly alters, defaces, or falsifies a license certificate issued by the agency, or causes

or procures any person to commit such an offense, commits a misdemeanor of the second degree, punishable as

provided in s. 775.082 or s. 775.083. Any licensee or provider who displays an altered, defaced, or falsified license

certificate is subject to the penalties set forth in s. 408.815 and an administrative fine of $1,000 for each day of

illegal display.

History.—s. 5, ch. 2006-192; s. 24, ch. 2012-160.

408.805 Fees required; adjustments.—Unless otherwise limited by authorizing statutes, license fees must be

reasonably calculated by the agency to cover its costs in carrying out its responsibilities under this part, authorizing

statutes, and applicable rules, including the cost of licensure, inspection, and regulation of providers.

(1) Licensure fees shall be adjusted to provide for biennial licensure under agency rules.

(2) The agency shall annually adjust licensure fees, including fees paid per bed, by not more than the change in

the Consumer Price Index based on the 12 months immediately preceding the increase.

(3) An inspection fee must be paid as required in authorizing statutes.

(4) Fees are nonrefundable.

(5) When a change is reported that requires issuance of a license, a fee may be assessed. The fee must be based

on the actual cost of processing and issuing the license.

(6) A fee may be charged to a licensee requesting a duplicate license. The fee may not exceed the actual cost of

duplication and postage.

(7) Total fees collected may not exceed the cost of administering this part, authorizing statutes, and applicable

rules.

History.—s. 5, ch. 2006-192.

408.806 License application process.—

(1) An application for licensure must be made to the agency on forms furnished by the agency, submitted under

oath or attestation, and accompanied by the appropriate fee in order to be accepted and considered timely. The

application must contain information required by authorizing statutes and applicable rules and must include:

(a) The name, address, and social security number, or individual taxpayer identification number if a social

security number cannot legally be obtained, of:

1. The applicant;

2. The administrator or a similarly titled person who is responsible for the day-to-day operation of the provider;

3. The financial officer or similarly titled person who is responsible for the financial operation of the licensee or

provider; and

4. Each controlling interest if the applicant or controlling interest is an individual.

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(b) The name, address, and federal employer identification number or taxpayer identification number of the

applicant and each controlling interest if the applicant or controlling interest is not an individual.

(c) The name by which the provider is to be known.

(d) The total number of beds or capacity requested, as applicable.

(e) The name of the person or persons under whose management or supervision the provider will operate and

the name of the administrator, if required.

(f) If the applicant offers continuing care agreements as defined in chapter 651, proof shall be furnished that the

applicant has obtained a certificate of authority as required for operation under chapter 651.

(g) Other information, including satisfactory inspection results, that the agency finds necessary to determine the

ability of the applicant to carry out its responsibilities under this part, authorizing statutes, and applicable rules.

(h) An attestation, under penalty of perjury, as required in s. 435.05(3), stating compliance with the provisions

of this section and chapter 435.

(2)(a) The applicant for a renewal license must submit an application that must be received by the agency at

least 60 days but no more than 120 days before the expiration of the current license. An application received more

than 120 days before the expiration of the current license shall be returned to the applicant. If the renewal

application and fee are received prior to the license expiration date, the license shall not be deemed to have expired

if the license expiration date occurs during the agency’s review of the renewal application.

(b) The applicant for initial licensure due to a change of ownership must submit an application that must be

received by the agency at least 60 days prior to the date of change of ownership.

(c) For any other application or request, the applicant must submit an application or request that must be

received by the agency at least 60 days but no more than 120 days before the requested effective date, unless

otherwise specified in authorizing statutes or applicable rules. An application received more than 120 days before

the requested effective date shall be returned to the applicant.

(d) The licensee’s failure to timely file a renewal application and license application fee with the agency shall

result in a $50 per day late fee charged to the licensee by the agency; however, the aggregate amount of the late fee

may not exceed 50 percent of the licensure fee or $500, whichever is less. The agency shall provide a courtesy

notice to the licensee by United States mail, electronically, or by any other manner at its address of record or mailing

address, if provided, at least 90 days before the expiration of a license. This courtesy notice must inform the licensee

of the expiration of the license. If the agency does not provide the courtesy notice or the licensee does not receive

the courtesy notice, the licensee continues to be legally obligated to timely file the renewal application and license

application fee with the agency and is not excused from the payment of a late fee. If an application is received after

the required filing date and exhibits a hand-canceled postmark obtained from a United States post office dated on or

before the required filing date, no fine will be levied.

(e) The applicant must pay the late fee before a late application is considered complete and failure to pay the

late fee is considered an omission from the application for licensure pursuant to paragraph (3)(b).

(3)(a) Upon receipt of an application for a license, the agency shall examine the application and, within 30 days

after receipt, notify the applicant in writing of any apparent errors or omissions and request any additional

information required.

(b) Requested information omitted from an application for licensure, license renewal, or change of ownership,

other than an inspection, must be filed with the agency within 21 days after the agency’s request for omitted

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information or the application shall be deemed incomplete and shall be withdrawn from further consideration and

the fees shall be forfeited.

(c) Within 60 days after the receipt of a complete application, the agency shall approve or deny the application.

(4)(a) Licensees subject to the provisions of this part shall be issued biennial licenses unless conditions of the

license category specify a shorter license period.

(b) Each license issued shall indicate the name of the licensee, the type of provider or service that the licensee is

required or authorized to operate or offer, the date the license is effective, the expiration date of the license, the

maximum capacity of the licensed premises, if applicable, and any other information required or deemed necessary

by the agency.

(5) In accordance with authorizing statutes and applicable rules, proof of compliance with s. 408.810 must be

submitted with an application for licensure.

(6) The agency may not issue an initial license to a health care provider subject to the certificate-of-need

provisions in part I of this chapter if the licensee has not been issued a certificate of need or certificate-of-need

exemption, when applicable. Failure to apply for the renewal of a license prior to the expiration date renders the

license void.

(7)(a) An applicant must demonstrate compliance with the requirements in this part, authorizing statutes, and

applicable rules during an inspection pursuant to s. 408.811, as required by authorizing statutes.

(b) An initial inspection is not required for companion services or homemaker services providers, as provided

under part III of chapter 400, or for health care services pools, as provided under part IX of chapter 400.

(c) If an inspection is required by the authorizing statute for a license application other than an initial

application, the inspection must be unannounced. This paragraph does not apply to inspections required pursuant to

ss. 383.324, 395.0161(4), and 429.67(6).

(d) If a provider is not available when an inspection is attempted, the application shall be denied.

(8) The agency may establish procedures for the electronic notification and submission of required information,

including, but not limited to:

(a) Licensure applications.

(b) Required signatures.

(c) Payment of fees.

(d) Notarization or attestation of applications.

Requirements for electronic submission of any documents required by this part or authorizing statutes may be

established by rule. As an alternative to sending documents as required by authorizing statutes, the agency may provide

electronic access to information or documents.

(9) A licensee that holds a license for multiple providers licensed by the agency may request that all related

license expiration dates be aligned. Upon such request, the agency may issue a license for an abbreviated licensure

period with a prorated licensure fee.

History.—s. 5, ch. 2006-192; s. 91, ch. 2007-5; s. 48, ch. 2009-223; s. 19, ch. 2010-114; s. 25, ch. 2012-160; s. 2,

ch. 2014-84; s. 70, ch. 2018-24.

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408.8065 Additional licensure requirements for home health agencies, home medical equipment

providers, and health care clinics.—

(1) An applicant for initial licensure, or initial licensure due to a change of ownership, as a home health agency,

home medical equipment provider, or health care clinic shall:

(a) Demonstrate financial ability to operate, as required under s. 408.810(8) and this section. If the applicant’s

assets, credit, and projected revenues meet or exceed projected liabilities and expenses, and the applicant provides

independent evidence that the funds necessary for startup costs, working capital, and contingency financing exist

and will be available as needed, the applicant has demonstrated the financial ability to operate.

(b) Submit projected financial statements, including a balance sheet, income and expense statement, and a

statement of cash flows for the first 2 years of operation which provide evidence that the applicant has sufficient

assets, credit, and projected revenues to cover liabilities and expenses.

(c) Submit a statement of the applicant’s estimated startup costs and sources of funds through the break-even

point in operations demonstrating that the applicant has the ability to fund all startup costs, working capital costs,

and contingency financing requirements. The statement must show that the applicant has at a minimum 3 months of

average projected expenses to cover startup costs, working capital costs, and contingency financing requirements.

The minimum amount for contingency funding may not be less than 1 month of average projected expenses.

All documents required under this subsection must be prepared in accordance with generally accepted accounting

principles and may be in a compilation form. The financial statements must be signed by a certified public accountant.

(2) For initial, renewal, or change of ownership licenses for a home health agency, a home medical equipment

provider, or a health care clinic, applicants and controlling interests who are nonimmigrant aliens, as described in 8

U.S.C. s. 1101, must file a surety bond of at least $500,000, payable to the agency, which guarantees that the home

health agency, home medical equipment provider, or health care clinic will act in full conformity with all legal

requirements for operation.

(3) In addition to the requirements of s. 408.812, any person who offers services that require licensure under

part VII or part X of chapter 400, or who offers skilled services that require licensure under part III of chapter 400,

without obtaining a valid license; any person who knowingly files a false or misleading license or license renewal

application or who submits false or misleading information related to such application, and any person who violates

or conspires to violate this section, commits a felony of the third degree, punishable as provided in s. 775.082, s.

775.083, or s. 775.084.

History.—s. 4, ch. 2009-193; s. 8, ch. 2009-223; s. 26, ch. 2012-160.

408.807 Change of ownership.—Whenever a change of ownership occurs:

(1) The transferor shall notify the agency in writing at least 60 days before the anticipated date of the change of

ownership.

(2) The transferee shall make application to the agency for a license within the timeframes required in s.

408.806.

(3) The transferor shall be responsible and liable for:

(a) The lawful operation of the provider and the welfare of the clients served until the date the transferee is

licensed by the agency.

(b) Any and all penalties imposed against the transferor for violations occurring before the date of change of

ownership.

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(4) Any restriction on licensure, including a conditional license existing at the time of a change of ownership,

shall remain in effect until the agency determines that the grounds for the restriction are corrected.

(5) The transferee shall maintain records of the transferor as required in this part, authorizing statutes, and

applicable rules, including:

(a) All client records.

(b) Inspection reports.

(c) All records required to be maintained pursuant to s. 409.913, if applicable.

History.—s. 5, ch. 2006-192.

408.808 License categories.—

(1) STANDARD LICENSE.—A standard license may be issued to an applicant at the time of initial licensure,

license renewal, or change of ownership. A standard license shall be issued when the applicant is in compliance with

all statutory requirements and agency rules. Unless sooner revoked, a standard license expires 2 years after the date

of issue.

(2) PROVISIONAL LICENSE.—An applicant against whom a proceeding denying or revoking a license is

pending at the time of license renewal may be issued a provisional license effective until final action not subject to

further appeal. A provisional license may also be issued to an applicant applying for a change of ownership. A

provisional license must be limited in duration to a specific period of time, up to 12 months, as determined by the

agency.

(3) INACTIVE LICENSE.—An inactive license may be issued to a health care provider subject to the

certificate-of-need provisions in part I of this chapter when the provider is currently licensed, does not have a

provisional license, and will be temporarily unable to provide services but is reasonably expected to resume services

within 12 months. Such designation may be made for a period not to exceed 12 months but may be renewed by the

agency for up to 12 additional months upon demonstration by the licensee of the provider’s progress toward

reopening. However, if after 20 months in an inactive license status, a statutory rural hospital, as defined in s.

395.602, has demonstrated progress toward reopening, but may not be able to reopen prior to the inactive license

expiration date, the inactive designation may be renewed again by the agency for up to 12 additional months. For

purposes of such a second renewal, if construction or renovation is required, the licensee must have had plans

approved by the agency and construction must have already commenced pursuant to s. 408.032(4); however, if

construction or renovation is not required, the licensee must provide proof of having made an enforceable capital

expenditure greater than 25 percent of the total costs associated with the hiring of staff and the purchase of

equipment and supplies needed to operate the facility upon opening. A request by a licensee for an inactive license

or to extend the previously approved inactive period must be submitted to the agency and must include a written

justification for the inactive license with the beginning and ending dates of inactivity specified, a plan for the

transfer of any clients to other providers, and the appropriate licensure fees. The agency may not accept a request

that is submitted after initiating closure, after any suspension of service, or after notifying clients of closure or

suspension of service, unless the action is a result of a disaster at the licensed premises. For the purposes of this

section, the term “disaster” means a sudden emergency occurrence beyond the control of the licensee, whether

natural, technological, or manmade, which renders the provider inoperable at the premises. Upon agency approval,

the provider shall notify clients of any necessary discharge or transfer as required by authorizing statutes or

applicable rules. The beginning of the inactive license period is the date the provider ceases operations. The end of

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the inactive license period shall become the license expiration date. All licensure fees must be current, must be paid

in full, and may be prorated. Reactivation of an inactive license requires the approval of a renewal application,

including payment of licensure fees and agency inspections indicating compliance with all requirements of this part,

authorizing statutes, and applicable rules.

(4) OTHER LICENSES.—Other types of license categories may be issued pursuant to authorizing statutes or

applicable rules.


408.809 Background screening; prohibited offenses.—

(1) Level 2 background screening pursuant to chapter 435 must be conducted through the agency on each of the

following persons, who are considered employees for the purposes of conducting screening under chapter 435:

(a) The licensee, if an individual.

(b) The administrator or a similarly titled person who is responsible for the day-to-day operation of the

provider.

(c) The financial officer or similarly titled individual who is responsible for the financial operation of the

licensee or provider.

(d) Any person who is a controlling interest.

(e) Any person, as required by authorizing statutes, seeking employment with a licensee or provider who is

expected to, or whose responsibilities may require him or her to, provide personal care or services directly to clients

or have access to client funds, personal property, or living areas; and any person, as required by authorizing statutes,

contracting with a licensee or provider whose responsibilities require him or her to provide personal care or personal

services directly to clients, or contracting with a licensee or provider to work 20 hours a week or more who will

have access to client funds, personal property, or living areas. Evidence of contractor screening may be retained by

the contractor’s employer or the licensee.

(2) Every 5 years following his or her licensure, employment, or entry into a contract in a capacity that under

subsection (1) would require level 2 background screening under chapter 435, each such person must submit to level

2 background rescreening as a condition of retaining such license or continuing in such employment or contractual

status. For any such rescreening, the agency shall request the Department of Law Enforcement to forward the

person’s fingerprints to the Federal Bureau of Investigation for a national criminal history record check unless the

person’s fingerprints are enrolled in the Federal Bureau of Investigation’s national retained print arrest notification

program. If the fingerprints of such a person are not retained by the Department of Law Enforcement under s.

943.05(2)(g) and (h), the person must submit fingerprints electronically to the Department of Law Enforcement for

state processing, and the Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of

Investigation for a national criminal history record check. The fingerprints shall be retained by the Department of

Law Enforcement under s. 943.05(2)(g) and (h) and enrolled in the national retained print arrest notification

program when the Department of Law Enforcement begins participation in the program. The cost of the state and

national criminal history records checks required by level 2 screening may be borne by the licensee or the person

fingerprinted. Until a specified agency is fully implemented in the clearinghouse created under s. 435.12, the agency

may accept as satisfying the requirements of this section proof of compliance with level 2 screening standards

submitted within the previous 5 years to meet any provider or professional licensure requirements of the agency, the

Department of Health, the Department of Elderly Affairs, the Agency for Persons with Disabilities, the Department

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of Children and Families, or the Department of Financial Services for an applicant for a certificate of authority or

provisional certificate of authority to operate a continuing care retirement community under chapter 651, provided

that:

(a) The screening standards and disqualifying offenses for the prior screening are equivalent to those specified

in s. 435.04 and this section;

(b) The person subject to screening has not had a break in service from a position that requires level 2 screening

for more than 90 days; and

(c) Such proof is accompanied, under penalty of perjury, by an attestation of compliance with chapter 435 and

this section using forms provided by the agency.

(3) All fingerprints must be provided in electronic format. Screening results shall be reviewed by the agency

with respect to the offenses specified in s. 435.04 and this section, and the qualifying or disqualifying status of the

person named in the request shall be maintained in a database. The qualifying or disqualifying status of the person

named in the request shall be posted on a secure website for retrieval by the licensee or designated agent on the

licensee’s behalf.

(4) In addition to the offenses listed in s. 435.04, all persons required to undergo background screening

pursuant to this part or authorizing statutes must not have an arrest awaiting final disposition for, must not have been

found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, and must not have been

adjudicated delinquent and the record not have been sealed or expunged for any of the following offenses or any

similar offense of another jurisdiction:

(a) Any authorizing statutes, if the offense was a felony.

(b) This chapter, if the offense was a felony.

(c) Section 409.920, relating to Medicaid provider fraud.

(d) Section 409.9201, relating to Medicaid fraud.

(e) Section 741.28, relating to domestic violence.

(f) Section 777.04, relating to attempts, solicitation, and conspiracy to commit an offense listed in this

subsection.

(g) Section 817.034, relating to fraudulent acts through mail, wire, radio, electromagnetic, photoelectronic, or

photooptical systems.

(h) Section 817.234, relating to false and fraudulent insurance claims.

(i) Section 817.481, relating to obtaining goods by using a false or expired credit card or other credit device, if

the offense was a felony.

(j) Section 817.50, relating to fraudulently obtaining goods or services from a health care provider.

(k) Section 817.505, relating to patient brokering.

(l) Section 817.568, relating to criminal use of personal identification information.

(m) Section 817.60, relating to obtaining a credit card through fraudulent means.

(n) Section 817.61, relating to fraudulent use of credit cards, if the offense was a felony.

(o) Section 831.01, relating to forgery.

(p) Section 831.02, relating to uttering forged instruments.

(q) Section 831.07, relating to forging bank bills, checks, drafts, or promissory notes.

(r) Section 831.09, relating to uttering forged bank bills, checks, drafts, or promissory notes.

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(s) Section 831.30, relating to fraud in obtaining medicinal drugs.

(t) Section 831.31, relating to the sale, manufacture, delivery, or possession with the intent to sell, manufacture,

or deliver any counterfeit controlled substance, if the offense was a felony.

(u) Section 895.03, relating to racketeering and collection of unlawful debts.

(v) Section 896.101, relating to the Florida Money Laundering Act.

If, upon rescreening, a person who is currently employed or contracted with a licensee as of June 30, 2014, and was

screened and qualified under ss. 435.03 and 435.04, has a disqualifying offense that was not a disqualifying offense

at the time of the last screening, but is a current disqualifying offense and was committed before the last screening, he

or she may apply for an exemption from the appropriate licensing agency and, if agreed to by the employer, may

continue to perform his or her duties until the licensing agency renders a decision on the application for exemption if

the person is eligible to apply for an exemption and the exemption request is received by the agency no later than 30

days after receipt of the rescreening results by the person.

(5) A person who serves as a controlling interest of, is employed by, or contracts with a licensee on July 31,

2010, who has been screened and qualified according to standards specified in s. 435.03 or s. 435.04 must be

rescreened by July 31, 2015, in compliance with the following schedule. If, upon rescreening, such person has a

disqualifying offense that was not a disqualifying offense at the time of the last screening, but is a current

disqualifying offense and was committed before the last screening, he or she may apply for an exemption from the

appropriate licensing agency and, if agreed to by the employer, may continue to perform his or her duties until the

licensing agency renders a decision on the application for exemption if the person is eligible to apply for an

exemption and the exemption request is received by the agency within 30 days after receipt of the rescreening

results by the person. The rescreening schedule shall be:

(a) Individuals for whom the last screening was conducted on or before December 31, 2004, must be rescreened

by July 31, 2013.

(b) Individuals for whom the last screening conducted was between January 1, 2005, and December 31, 2008,

must be rescreened by July 31, 2014.

(c) Individuals for whom the last screening conducted was between January 1, 2009, through July 31, 2011,

must be rescreened by July 31, 2015.

(6) The costs associated with obtaining the required screening must be borne by the licensee or the person

subject to screening. Licensees may reimburse persons for these costs. The Department of Law Enforcement shall

charge the agency for screening pursuant to s. 943.053(3). The agency shall establish a schedule of fees to cover the

costs of screening.

(7)(a) As provided in chapter 435, the agency may grant an exemption from disqualification to a person who is

subject to this section and who:

1. Does not have an active professional license or certification from the Department of Health; or

2. Has an active professional license or certification from the Department of Health but is not providing a

service within the scope of that license or certification.

(b) As provided in chapter 435, the appropriate regulatory board within the Department of Health, or the

department itself if there is no board, may grant an exemption from disqualification to a person who is subject to this

section and who has received a professional license or certification from the Department of Health or a regulatory

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board within that department and that person is providing a service within the scope of his or her licensed or

certified practice.

(8) The agency and the Department of Health may adopt rules pursuant to ss. 120.536(1) and 120.54 to

implement this section, chapter 435, and authorizing statutes requiring background screening and to implement and

adopt criteria relating to retaining fingerprints pursuant to s. 943.05(2).

(9) There is no reemployment assistance or other monetary liability on the part of, and no cause of action for

damages arising against, an employer that, upon notice of a disqualifying offense listed under chapter 435 or this

section, terminates the person against whom the report was issued, whether or not that person has filed for an

exemption with the Department of Health or the agency.


166, ch. 2014-19; s. 3, ch. 2014-84; s. 7, ch. 2016-78; s. 71, ch. 2018-24.

408.810 Minimum licensure requirements.—In addition to the licensure requirements specified in this part,

authorizing statutes, and applicable rules, each applicant and licensee must comply with the requirements of this

section in order to obtain and maintain a license.

(1) An applicant for licensure must comply with the background screening requirements of s. 408.809.

(2) An applicant for licensure must provide a description and explanation of any exclusions, suspensions, or

terminations of the applicant from the Medicare, Medicaid, or federal Clinical Laboratory Improvement Amendment

(CLIA) programs.

(3) Unless otherwise specified in this part, authorizing statutes, or applicable rules, any information required to

be reported to the agency must be submitted within 21 calendar days after the report period or effective date of the

information, whichever is earlier, including, but not limited to, any change of:

(a) Information contained in the most recent application for licensure.

(b) Required insurance or bonds.

(4) Whenever a licensee discontinues operation of a provider:

(a) The licensee must inform the agency not less than 30 days prior to the discontinuance of operation and

inform clients of such discontinuance as required by authorizing statutes. Immediately upon discontinuance of

operation by a provider, the licensee shall surrender the license to the agency and the license shall be canceled.

(b) The licensee shall remain responsible for retaining and appropriately distributing all records within the

timeframes prescribed in authorizing statutes and applicable rules. In addition, the licensee or, in the event of death

or dissolution of a licensee, the estate or agent of the licensee shall:

1. Make arrangements to forward records for each client to one of the following, based upon the client’s choice:

the client or the client’s legal representative, the client’s attending physician, or the health care provider where the

client currently receives services; or

2. Cause a notice to be published in the newspaper of greatest general circulation in the county in which the

provider was located that advises clients of the discontinuance of the provider operation. The notice must inform

clients that they may obtain copies of their records and specify the name, address, and telephone number of the

person from whom the copies of records may be obtained. The notice must appear at least once a week for 4

consecutive weeks.

(5)(a) On or before the first day services are provided to a client, a licensee must inform the client and his or her

immediate family or representative, if appropriate, of the right to report:

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1. Complaints. The statewide toll-free telephone number for reporting complaints to the agency must be

provided to clients in a manner that is clearly legible and must include the words: “To report a complaint regarding

the services you receive, please call toll-free (phone number).”

2. Abusive, neglectful, or exploitative practices. The statewide toll-free telephone number for the central abuse

hotline must be provided to clients in a manner that is clearly legible and must include the words: “To report abuse,

neglect, or exploitation, please call toll-free (phone number).”

3. Medicaid fraud. An agency-written description of Medicaid fraud and the statewide toll-free telephone

number for the central Medicaid fraud hotline must be provided to clients in a manner that is clearly legible and

must include the words: “To report suspected Medicaid fraud, please call toll-free (phone number).”

The agency shall publish a minimum of a 90-day advance notice of a change in the toll-free telephone numbers.

(b) Each licensee shall establish appropriate policies and procedures for providing such notice to clients.

(6) An applicant must provide the agency with proof of the applicant’s legal right to occupy the property before

a license may be issued. Proof may include, but need not be limited to, copies of warranty deeds, lease or rental

agreements, contracts for deeds, quitclaim deeds, or other such documentation.

(7) If proof of insurance is required by the authorizing statute, that insurance must be in compliance with

chapter 624, chapter 626, chapter 627, or chapter 628 and with agency rules.

(8) Upon application for initial licensure or change of ownership licensure, the applicant shall furnish

satisfactory proof of the applicant’s financial ability to operate in accordance with the requirements of this part,

authorizing statutes, and applicable rules. The agency shall establish standards for this purpose, including

information concerning the applicant’s controlling interests. The agency shall also establish documentation

requirements, to be completed by each applicant, that show anticipated provider revenues and expenditures, the

basis for financing the anticipated cash-flow requirements of the provider, and an applicant’s access to contingency

financing. A current certificate of authority, pursuant to chapter 651, may be provided as proof of financial ability to

operate. The agency may require a licensee to provide proof of financial ability to operate at any time if there is

evidence of financial instability, including, but not limited to, unpaid expenses necessary for the basic operations of

the provider. An applicant applying for change of ownership licensure is exempt from furnishing proof of financial

ability to operate if the provider has been licensed for at least 5 years, and:

(a) The ownership change is a result of a corporate reorganization under which the controlling interest is

unchanged and the applicant submits organizational charts that represent the current and proposed structure of the

reorganized corporation; or

(b) The ownership change is due solely to the death of a person holding a controlling interest, and the surviving

controlling interests continue to hold at least 51 percent of ownership after the change of ownership.

(9) A controlling interest may not withhold from the agency any evidence of financial instability, including, but

not limited to, checks returned due to insufficient funds, delinquent accounts, nonpayment of withholding taxes,

unpaid utility expenses, nonpayment for essential services, or adverse court action concerning the financial viability

of the provider or any other provider licensed under this part that is under the control of the controlling interest. A

controlling interest shall notify the agency within 10 days after a court action to initiate bankruptcy, foreclosure, or

eviction proceedings concerning the provider in which the controlling interest is a petitioner or defendant. Any

person who violates this subsection commits a misdemeanor of the second degree, punishable as provided in s.

775.082 or s. 775.083. Each day of continuing violation is a separate offense.

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(10) The agency may not issue a license to a health care provider subject to the certificate-of-need provisions in

part I of this chapter if the health care provider has not been issued a certificate of need or an exemption. Upon

initial licensure of any such provider, the authorization contained in the certificate of need shall be considered fully

implemented and merged into the license and shall have no force and effect upon termination of the license for any

reason.

(11) The agency may adopt rules that govern the circumstances under which a controlling interest, an

administrator, an employee, or a contractor, or a representative thereof, who is not a relative of the client may act as

an agent of the client in authorizing consent for medical treatment, assignment of benefits, and release of

information. Such rules may include requirements related to disclosure, bonding, restrictions, and client protections.

(12) The licensee shall ensure that no person holds any ownership interest, either directly or indirectly,

regardless of ownership structure, who:

(a) Has a disqualifying offense pursuant to s. 408.809; or

(b) Holds or has held any ownership interest, either directly or indirectly, regardless of ownership structure, in a

provider that had a license revoked or an application denied pursuant to s. 408.815.

(13) If the licensee is a publicly traded corporation or is wholly owned, directly or indirectly, by a publicly

traded corporation, subsection (12) does not apply to those persons whose sole relationship with the corporation is as

a shareholder of publicly traded shares. As used in this subsection, a “publicly traded corporation” is a corporation

that issues securities traded on an exchange registered with the United States Securities and Exchange Commission

as a national securities exchange.


408.811 Right of inspection; copies; inspection reports; plan for correction of deficiencies.—

(1) An authorized officer or employee of the agency may make or cause to be made any inspection or

investigation deemed necessary by the agency to determine the state of compliance with this part, authorizing

statutes, and applicable rules. The right of inspection extends to any business that the agency has reason to believe is

being operated as a provider without a license, but inspection of any business suspected of being operated without

the appropriate license may not be made without the permission of the owner or person in charge unless a warrant is

first obtained from a circuit court. Any application for a license issued under this part, authorizing statutes, or

applicable rules constitutes permission for an appropriate inspection to verify the information submitted on or in

connection with the application.

(a) All inspections shall be unannounced, except as specified in s. 408.806.

(b) Inspections for relicensure shall be conducted biennially unless otherwise specified by authorizing statutes

or applicable rules.

(2) Inspections conducted in conjunction with certification, comparable licensure requirements, or a recognized

or approved accreditation organization may be accepted in lieu of a complete licensure inspection. However, a

licensure inspection may also be conducted to review any licensure requirements that are not also requirements for

certification.

(3) The agency shall have access to and the licensee shall provide, or if requested send, copies of all provider

records required during an inspection or other review at no cost to the agency, including records requested during an

offsite review.

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(4) A deficiency must be corrected within 30 calendar days after the provider is notified of inspection results

unless an alternative timeframe is required or approved by the agency.

(5) The agency may require an applicant or licensee to submit a plan of correction for deficiencies. If required,

the plan of correction must be filed with the agency within 10 calendar days after notification unless an alternative

timeframe is required.

(6)(a) Each licensee shall maintain as public information, available upon request, records of all inspection

reports pertaining to that provider that have been filed by the agency unless those reports are exempt from or contain

information that is exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution or is otherwise made

confidential by law. Copies of such reports shall be retained in the records of the provider for at least 3 years

following the date the reports are filed and issued, regardless of a change of ownership.

(b) A licensee shall, upon the request of any person who has completed a written application with intent to be

admitted by such provider, any person who is a client of such provider, or any relative, spouse, or guardian of any

such person, furnish to the requester a copy of the last inspection report pertaining to the licensed provider that was

issued by the agency or by an accrediting organization if such report is used in lieu of a licensure inspection.


408.812 Unlicensed activity.—

(1) A person or entity may not offer or advertise services that require licensure as defined by this part,

authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A

licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which

he or she actually holds the license.

(2) The operation or maintenance of an unlicensed provider or the performance of any services that require

licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes

harm that materially affects the health, safety, and welfare of clients, and constitutes abuse and neglect, as defined in

s. 415.102. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action

for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed

provider or the performance of any services in violation of this part and authorizing statutes, until compliance with

this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency.

(3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving

notification from the agency, such person or entity fails to cease operation, the person or entity is subject to penalties

as prescribed by authorizing statutes and applicable rules. Each day of operation is a separate offense.

(4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day

of noncompliance.

(5) When a controlling interest or licensee has an interest in more than one provider and fails to license a

provider rendering services that require licensure, the agency may revoke all licenses, impose actions under s.

408.814, and regardless of correction, impose a fine of $1,000 per day, unless otherwise specified by authorizing

statutes, against each licensee until such time as the appropriate license is obtained or the unlicensed activity ceases.

(6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or

entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that

poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same

actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules.

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(7) Any person aware of the operation of an unlicensed provider must report that provider to the agency.

History.—s. 5, ch. 2006-192; s. 73, ch. 2018-24.

408.813 Administrative fines; violations.—As a penalty for any violation of this part, authorizing statutes, or

applicable rules, the agency may impose an administrative fine.

(1) Unless the amount or aggregate limitation of the fine is prescribed by authorizing statutes or applicable

rules, the agency may establish criteria by rule for the amount or aggregate limitation of administrative fines

applicable to this part, authorizing statutes, and applicable rules. Each day of violation constitutes a separate

violation and is subject to a separate fine. For fines imposed by final order of the agency and not subject to further

appeal, the violator shall pay the fine plus interest at the rate specified in s. 55.03 for each day beyond the date set by

the agency for payment of the fine.

(2) Violations of this part, authorizing statutes, or applicable rules shall be classified according to the nature of

the violation and the gravity of its probable effect on clients. The scope of a violation may be cited as an isolated,

patterned, or widespread deficiency. An isolated deficiency is a deficiency affecting one or a very limited number of

clients, or involving one or a very limited number of staff, or a situation that occurred only occasionally or in a very

limited number of locations. A patterned deficiency is a deficiency in which more than a very limited number of

clients are affected, or more than a very limited number of staff are involved, or the situation has occurred in several

locations, or the same client or clients have been affected by repeated occurrences of the same deficient practice but

the effect of the deficient practice is not found to be pervasive throughout the provider. A widespread deficiency is a

deficiency in which the problems causing the deficiency are pervasive in the provider or represent systemic failure

that has affected or has the potential to affect a large portion of the provider’s clients. This subsection does not affect

the legislative determination of the amount of a fine imposed under authorizing statutes. Violations shall be

classified on the written notice as follows:

(a) Class “I” violations are those conditions or occurrences related to the operation and maintenance of a

provider or to the care of clients which the agency determines present an imminent danger to the clients of the

provider or a substantial probability that death or serious physical or emotional harm would result therefrom. The

condition or practice constituting a class I violation shall be abated or eliminated within 24 hours, unless a fixed

period, as determined by the agency, is required for correction. The agency shall impose an administrative fine as

provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation.

(b) Class “II” violations are those conditions or occurrences related to the operation and maintenance of a

provider or to the care of clients which the agency determines directly threaten the physical or emotional health,

safety, or security of the clients, other than class I violations. The agency shall impose an administrative fine as

provided by law for a cited class II violation. A fine shall be levied notwithstanding the correction of the violation.

(c) Class “III” violations are those conditions or occurrences related to the operation and maintenance of a

provider or to the care of clients which the agency determines indirectly or potentially threaten the physical or

emotional health, safety, or security of clients, other than class I or class II violations. The agency shall impose an

administrative fine as provided in this section for a cited class III violation. A citation for a class III violation must

specify the time within which the violation is required to be corrected. If a class III violation is corrected within the

time specified, a fine may not be imposed.

(d) Class “IV” violations are those conditions or occurrences related to the operation and maintenance of a

provider or to required reports, forms, or documents that do not have the potential of negatively affecting clients.

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These violations are of a type that the agency determines do not threaten the health, safety, or security of clients. The

agency shall impose an administrative fine as provided in this section for a cited class IV violation. A citation for a

class IV violation must specify the time within which the violation is required to be corrected. If a class IV violation

is corrected within the time specified, a fine may not be imposed.

(3) The agency may impose an administrative fine for a violation that is not designated as a class I, class II,

class III, or class IV violation. Unless otherwise specified by law, the amount of the fine may not exceed $500 for

each violation. Unclassified violations include:

(a) Violating any term or condition of a license.

(b) Violating any provision of this part, authorizing statutes, or applicable rules.

(c) Exceeding licensed capacity.

(d) Providing services beyond the scope of the license.

(e) Violating a moratorium imposed pursuant to s. 408.814.


408.814 Moratorium; emergency suspension.—

(1) The agency may impose an immediate moratorium or emergency suspension as defined in s. 120.60 on any

provider if the agency determines that any condition related to the provider or licensee presents a threat to the health,

safety, or welfare of a client.

(2) A provider or licensee, the license of which is denied or revoked, may be subject to immediate imposition of

a moratorium or emergency suspension to run concurrently with licensure denial, revocation, or injunction.

(3) A moratorium or emergency suspension remains in effect after a change of ownership, unless the agency

has determined that the conditions that created the moratorium, emergency suspension, or denial of licensure have

been corrected.

(4) When a moratorium or emergency suspension is placed on a provider or licensee, notice of the action shall

be posted and visible to the public at the location of the provider until the action is lifted.

History.—s. 5, ch. 2006-192.

408.815 License or application denial; revocation.—

(1) In addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for

denying and revoking a license or change of ownership application include any of the following actions by a

controlling interest:

(a) False representation of a material fact in the license application or omission of any material fact from the

application.

(b) An intentional or negligent act materially affecting the health or safety of a client of the provider.

(c) A violation of this part, authorizing statutes, or applicable rules.

(d) A demonstrated pattern of deficient performance.

(e) The applicant, licensee, or controlling interest has been or is currently excluded, suspended, or terminated

from participation in the state Medicaid program, the Medicaid program of any other state, or the Medicare program.

(2) If a licensee lawfully continues to operate while a denial or revocation is pending in litigation, the licensee

must continue to meet all other requirements of this part, authorizing statutes, and applicable rules and file

subsequent renewal applications for licensure and pay all licensure fees. The provisions of ss. 120.60(1) and

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408.806(3)(c) do not apply to renewal applications filed during the time period in which the litigation of the denial

or revocation is pending until that litigation is final.

(3) An action under s. 408.814 or denial of the license of the transferor may be grounds for denial of a change

of ownership application of the transferee.

(4) Unless an applicant is determined by the agency to satisfy the provisions of subsection (5) for the action in

question, the agency shall deny an application for a license or license renewal based upon any of the following

actions of an applicant, a controlling interest of the applicant, or any entity in which a controlling interest of the

applicant was an owner or officer when the following actions occurred:

(a) A conviction or a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter

409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, Medicaid fraud, Medicare fraud,

or insurance fraud, unless the sentence and any subsequent period of probation for such convictions or plea ended

more than 15 years before the date of the application; or

(b) Termination for cause from the Medicare program or a state Medicaid program, unless the applicant has

been in good standing with the Medicare program or a state Medicaid program for the most recent 5 years and the

termination occurred at least 20 years before the date of the application.

(5) For any application subject to denial under subsection (4), the agency may consider mitigating

circumstances as applicable, including, but not limited to:

(a) Completion or lawful release from confinement, supervision, or sanction, including the terms of probation,

and full restitution;

(b) Execution of a compliance plan with the agency;

(c) Compliance with an integrity agreement or compliance plan with another government agency;

(d) Determination by any state Medicaid program or the Medicare program that the controlling interest or entity

in which the controlling interest was an owner or officer is currently allowed to participate in the state Medicaid

program or the Medicare program, directly as a provider or indirectly as an owner or officer of a provider entity;

(e) Continuation of licensure by the controlling interest or entity in which the controlling interest was an owner

or officer, directly as a licensee or indirectly as an owner or officer of a licensed entity in the state where the action

occurred;

(f) Overall impact upon the public health, safety, or welfare; or

(g) Determination that a license denial is not commensurate with the prior action taken by the Medicare or state

Medicaid program.

After considering the circumstances set forth in this subsection, the agency shall grant the license, with or without

conditions, grant a provisional license for a period of no more than the licensure cycle, with or without conditions, or

deny the license.

(6) In order to ensure the health, safety, and welfare of clients when a license has been denied, revoked, or is set

to terminate, the agency may extend the license expiration date for up to 30 days for the sole purpose of allowing the

safe and orderly discharge of clients. The agency may impose conditions on the extension, including, but not limited

to, prohibiting or limiting admissions, expedited discharge planning, required status reports, and mandatory

monitoring by the agency or third parties. When imposing these conditions, the agency shall consider the nature and

number of clients, the availability and location of acceptable alternative placements, and the ability of the licensee to

continue providing care to the clients. The agency may terminate the extension or modify the conditions at any time.

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This authority is in addition to any other authority granted to the agency under chapter 120, this part, and authorizing

statutes but creates no right or entitlement to an extension of a license expiration date.


408.816 Injunctions.—

(1) In addition to the other powers provided by this part, authorizing statutes, and applicable rules, the agency

may institute injunction proceedings in a court of competent jurisdiction to:

(a) Restrain or prevent the establishment or operation of a provider that does not have a license or is in violation

of any provision of this part, authorizing statutes, or applicable rules. The agency may also institute injunction

proceedings in a court of competent jurisdiction when a violation of this part, authorizing statutes, or applicable

rules constitutes an emergency affecting the immediate health and safety of a client.

(b) Enforce the provisions of this part, authorizing statutes, or any minimum standard, rule, or order issued or

entered into pursuant thereto when the attempt by the agency to correct a violation through administrative sanctions

has failed or when the violation materially affects the health, safety, or welfare of clients or involves any operation

of an unlicensed provider.

(c) Terminate the operation of a provider when a violation of any provision of this part, authorizing statutes, or

any standard or rule adopted pursuant thereto exists that materially affects the health, safety, or welfare of a client.

Such injunctive relief may be temporary or permanent.

(2) If action is necessary to protect clients of providers from immediate, life-threatening situations, the court

may allow a temporary injunction without bond upon proper proofs being made. If it appears by competent evidence

or a sworn, substantiated affidavit that a temporary injunction should be issued, the court, pending the determination

on final hearing, shall enjoin the operation of the provider.

History.—s. 5, ch. 2006-192.

408.817 Administrative proceedings.—Administrative proceedings challenging agency licensure enforcement

action shall be reviewed on the basis of the facts and conditions that resulted in the agency action.

History.—s. 5, ch. 2006-192.

408.818 Health Care Trust Fund.—Unless otherwise prescribed by authorizing statutes, all fees and fines

collected under this part, authorizing statutes, and applicable rules shall be deposited into the Health Care Trust

Fund, created in s. 408.16, and used to pay the costs of the agency in administering the provider program paying the

fees or fines.

History.—s. 5, ch. 2006-192.

408.819 Rules.—The agency is authorized to adopt rules as necessary to administer this part. Any licensed

provider that is in operation at the time of adoption of any applicable rule under this part or authorizing statutes shall

be given a reasonable time under the particular circumstances, not to exceed 6 months after the date of such

adoption, within which to comply with such rule, unless otherwise specified by rule.

History.—s. 5, ch. 2006-192.

408.820 Exemptions.—Except as prescribed in authorizing statutes, the following exemptions shall apply to

specified requirements of this part:

(1) Laboratories authorized to perform testing under the Drug-Free Workplace Act, as provided under ss.

112.0455 and 440.102, are exempt from s. 408.810(5)-(10).

(2) Birth centers, as provided under chapter 383, are exempt from s. 408.810(7)-(10).

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(3) Abortion clinics, as provided under chapter 390, are exempt from s. 408.810(7)-(10).

(4) Crisis stabilization units, as provided under parts I and IV of chapter 394, are exempt from s. 408.810(8)-

(10).

(5) Short-term residential treatment facilities, as provided under parts I and IV of chapter 394, are exempt from

s. 408.810(8)-(10).

(6) Residential treatment facilities, as provided under part IV of chapter 394, are exempt from s. 408.810(8)-

(10).

(7) Residential treatment centers for children and adolescents, as provided under part IV of chapter 394, are

exempt from s. 408.810(8)-(10).

(8) Hospitals, as provided under part I of chapter 395, are exempt from s. 408.810(7)-(9).

(9) Ambulatory surgical centers, as provided under part I of chapter 395, are exempt from s. 408.810(7)-(10).

(10) Nursing homes, as provided under part II of chapter 400, are exempt from ss. 408.810(7) and 408.813(2).

(11) Assisted living facilities, as provided under part I of chapter 429, are exempt from s. 408.810(10).

(12) Home health agencies, as provided under part III of chapter 400, are exempt from s. 408.810(10).

(13) Nurse registries, as provided under part III of chapter 400, are exempt from s. 408.810(6) and (10).

(14) Companion services or homemaker services providers, as provided under part III of chapter 400, are

exempt from s. 408.810(6)-(10).

(15) Adult day care centers, as provided under part III of chapter 429, are exempt from s. 408.810(10).

(16) Adult family-care homes, as provided under part II of chapter 429, are exempt from s. 408.810(7)-(10).

(17) Homes for special services, as provided under part V of chapter 400, are exempt from s. 408.810(7)-(10).

(18) Transitional living facilities, as provided under part XI of chapter 400, are exempt from s. 408.810(10).

(19) Prescribed pediatric extended care centers, as provided under part VI of chapter 400, are exempt from s.

408.810(10).

(20) Home medical equipment providers, as provided under part VII of chapter 400, are exempt from s.

408.810(10).

(21) Intermediate care facilities for persons with developmental disabilities, as provided under part VIII of

chapter 400, are exempt from s. 408.810(7).

(22) Health care services pools, as provided under part IX of chapter 400, are exempt from s. 408.810(6)-(10).

(23) Health care clinics, as provided under part X of chapter 400, are exempt from s. 408.810(6), (7), and (10).

(24) Multiphasic health testing centers, as provided under 1part I of chapter 483, are exempt from s. 408.810(5)-

(10).

(25) Organ, tissue, and eye procurement organizations, as provided under part V of chapter 765, are exempt

from s. 408.810(5)-(10).


ch. 2015-25; s. 74, ch. 2018-24. 1Note.—Redesignated as part I of chapter 483 to conform to the repeal of former part I of that chapter by s. 97,

ch. 2018-24.

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408.821 Emergency management planning; emergency operations; inactive license.—

(1) A licensee required by authorizing statutes to have an emergency operations plan must designate a safety

liaison to serve as the primary contact for emergency operations.

(2) An entity subject to this part may temporarily exceed its licensed capacity to act as a receiving provider in

accordance with an approved emergency operations plan for up to 15 days. While in an overcapacity status, each

provider must furnish or arrange for appropriate care and services to all clients. In addition, the agency may approve

requests for overcapacity in excess of 15 days, which approvals may be based upon satisfactory justification and

need as provided by the receiving and sending providers.

(3)(a) An inactive license may be issued to a licensee subject to this section when the provider is located in a

geographic area in which a state of emergency was declared by the Governor if the provider:

1. Suffered damage to its operation during the state of emergency.

2. Is currently licensed.

3. Does not have a provisional license.

4. Will be temporarily unable to provide services but is reasonably expected to resume services within 12

months.

(b) An inactive license may be issued for a period not to exceed 12 months but may be renewed by the agency

for up to 12 additional months upon demonstration to the agency of progress toward reopening. A request by a

licensee for an inactive license or to extend the previously approved inactive period must be submitted in writing to

the agency, accompanied by written justification for the inactive license, which states the beginning and ending

dates of inactivity and includes a plan for the transfer of any clients to other providers and appropriate licensure fees.

Upon agency approval, the licensee shall notify clients of any necessary discharge or transfer as required by

authorizing statutes or applicable rules. The beginning of the inactive licensure period shall be the date the provider

ceases operations. The end of the inactive period shall become the license expiration date, and all licensure fees

must be current, must be paid in full, and may be prorated. Reactivation of an inactive license requires the prior

approval by the agency of a renewal application, including payment of licensure fees and agency inspections

indicating compliance with all requirements of this part and applicable rules and statutes.

(4) The agency may adopt rules relating to emergency management planning, communications, and operations.

Licensees providing residential or inpatient services must utilize an online database approved by the agency to

report information to the agency regarding the provider’s emergency status, planning, or operations.

History.—s. 54, ch. 2009-223.

408.831 Denial, suspension, or revocation of a license, registration, certificate, or application.—

(1) In addition to any other remedies provided by law, the agency may deny each application or suspend or

revoke each license, registration, or certificate of entities regulated or licensed by it:

(a) If the applicant, licensee, or a licensee subject to this part which shares a common controlling interest with

the applicant has failed to pay all outstanding fines, liens, or overpayments assessed by final order of the agency or

final order of the Centers for Medicare and Medicaid Services, not subject to further appeal, unless a repayment plan

is approved by the agency; or

(b) For failure to comply with any repayment plan.

(2) In reviewing any application requesting a change of ownership or change of the licensee, registrant, or

certificateholder, the transferor shall, prior to agency approval of the change, repay or make arrangements to repay

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any amounts owed to the agency. Should the transferor fail to repay or make arrangements to repay the amounts

owed to the agency, the issuance of a license, registration, or certificate to the transferee shall be delayed until

repayment or until arrangements for repayment are made.

(3) This section provides standards of enforcement applicable to all entities licensed or regulated by the Agency

for Health Care Administration. This section controls over any conflicting provisions of chapters 39, 383, 390, 391,

394, 395, 400, 408, 429, 468, 483, and 765 or rules adopted pursuant to those chapters.


55, ch. 2009-223.

408.832 Conflicts.—In case of conflict between the provisions of this part and the authorizing statutes

governing the licensure of health care providers by the Agency for Health Care Administration found in s. 112.0455

and chapters 383, 390, 394, 395, 400, 429, 440, 483, and 765, the provisions of this part shall prevail.


Notes ______________________________________________________________________________

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2. Rule Chapter 59A

-35, F.A.C

.

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CHAPTER 59A-35

HEALTH CARE LICENSING PROCEDURES 59A-35.020 Applicability

59A-35.030 Definitions

59A-35.040 License Required; Display

59A-35.050 Fees Required; Adjustments

59A-35.060 Licensure Application Process.

59A-35.062 Proof of Financial Ability to Operate

59A-35.070 Change of Ownership

59A-35.080 License Categories

59A-35.090 Background Screening; Prohibited Offenses

59A-35.100 Minimum License Requirements

59A-35.110 Reporting Requirements; Electronic Submission

59A-35.120 Right of Inspection; Copies; Inspection Reports

59A-35.150 Moratorium; Emergency Suspension

59A-35.020 Applicability. Rulemaking Authority 408.819 FS. Law Implemented 408.802 FS. History–New 7-14-10, Repealed 1-4-16.

59A-35.030 Definitions.

(1) “Address of record” means the location that is printed on the license and is the address at which the provider

is licensed to operate. In the event a license displays multiple locations including branch offices, satellite offices, or

off-site locations, the address of record is the main or principle office address.

(2) “Agency notification” or “Agency request” means the Agency sends notification by:

(a) Mail or personal delivery to the address of record for a licensee or applicant;

(b) Mail to an alternative mailing address if requested by the licensee or applicant; or

(c) Electronic mail if an electronic mail address has been provided.

(3) “Days” means calendar days.

(4) “Management company” means an entity retained by a licensee to administer or direct the operation of a

provider. This does not include an entity that serves solely as a lender or lien holder.

Rulemaking Authority 408.819 FS. Law Implemented 408.803 FS. History–New 7-14-10.

59A-35.040 License Required; Display.

(1) A license is valid only for the licensee, provider, and location for which the license is issued as it appears on

the license.

(2) Any request to amend a license must be received by the Agency in advance of the requested effective date as

detailed below. Requests to amend a license are not authorized until the license is issued.

(a) Requests to change the address of record must be received by the Agency 60 to 120 days in advance of the

requested effective date for the following provider types:

1. Birth Centers, as provided under Chapter 383, F.S.;

2. Abortion Clinics, as provided under Chapter 390, F.S.;

3. Crisis Stabilization Units, as provided under Chapter 394, Parts I and IV, F.S.;

4. Short Term Residential Treatment Units, as provided under Chapter 394, Parts I and IV, F.S.;

5. Residential Treatment Facilities, as provided under Chapter 394, Part IV, F.S.;

2 – 2

6. Residential Treatment Centers for Children and Adolescents, as provided under Chapter 394, Part IV, F.S.;

7. Hospitals, as provided under Chapter 395, Part I, F.S.;

8. Ambulatory Surgical Centers, as provided under Chapter 395, Part I, F.S.;

9. Nursing Homes, as provided under Chapter 400, Part II, F.S.;

10. Hospices, as provided under Chapter 400, Part IV, F.S.;

11. Homes for Special Services as provided under Chapter 400, Part V, F.S.;

12. Transitional Living Facilities, as provided under Chapter 400, Part V, F.S.;

13. Prescribed Pediatric Extended Care Centers, as provided under Chapter 400, Part VI, F.S.;

14. Intermediate Care Facilities for the Developmentally Disabled, as provided under Chapter 400, Part VIII,

F.S.;

15. Assisted Living Facilities, as provided under Chapter 429, Part I, F.S.;

16. Adult Family-Care Homes, as provided under Chapter 429, Part II, F.S.; and,

17. Adult Day Care Centers, as provided under Chapter 429, Part III, F.S.

(b) Requests to change the address of record must be received by the Agency 21 to 120 days in advance of the

requested effective date for the following provider types:

1. Drug Free Workplace Laboratories as provided under Sections 112.0455 and 440.102, F.S.;

2. Mobile Surgical Facilities, as provided under Chapter 395, Part I, F.S.;

3. Health Care Risk Managers, as provided under Chapter 395, Part I, F.S.;

4. Home Health Agencies, as provided under Chapter 400, Part III, F.S.;

5. Nurse Registries, as provided under Chapter 400, Part III, F.S.;

6. Companion Services or Homemaker Services Providers, as provided under Chapter 400, Part III, F.S.;

7. Home Medical Equipment Providers, as provided under Chapter 400, Part VII, F.S.;

8. Health Care Services Pools, as provided under Chapter 400, Part IX, F.S.;

9. Health Care Clinics, as provided under Chapter 400, Part X, F.S., including certificate of exemption;

10. Clinical Laboratories, as provided under Chapter 483, Part I, F.S.;

11. Multiphasic Health Testing Centers, as provided under Chapter 483, Part II, F.S.; and,

12. Organ and Tissue Procurement Agencies, as provided under Chapter 381, F.S.

(c) All other requests to amend a license including but not limited to services, licensed capacity, and other

specifications which are required to be displayed on the license by authorizing statutes or applicable rules must be

received by the Agency 60 to 120 days in advance of the requested effective date. This deadline does not apply to a

request to amend hospital emergency services defined in Section 395.1041(2), F.S.

(3) Failure to submit a timely request shall result in a $500 fine.

(4) A licensee is not authorized to operate in a new location until a license is obtained which specifies the new

location. Failure to amend a license prior to a change of the address of record constitutes unlicensed activity.

(5) The licensee shall return the license certificate to the Agency upon the rendition of a final order revoking,

cancelling or denying a license, and upon the voluntary discontinuance of operation.

Rulemaking Authority 408.819 FS. Law Implemented 408.804, 408.810, 408.813 FS. History–New 7-14-10.

59A-35.050 Fees Required; Adjustments.

(1) Licensure fees, as defined by authorizing statute or rule, are non-refundable once submitted to the Agency.

An applicant may submit a request for refund if monies in excess of required fees are submitted to the Agency. Such

2 – 3

requests must be made using State of Florida Department of Financial Services, Application for Refund form

number DFS-AA-4, Rev. 0207, incorporated herein by reference, available online at:

http://myfloridacfo.com/aadir/refund_application.htm and submitted to the appropriate licensing unit. The following

are examples of excess fee payments that are eligible for refund:

(a) Fees in excess of the required fee amount;

(b) A renewal reminder letter indicates an error in the required fee amount;

(c) An inspection fee is submitted when no inspection fee is required;

(d) An excess fee is submitted as an accredited provider when the licensee or applicant is not accredited; or

(e) An application is returned due to early submission.

(2) When payment for licensure fees has been dishonored, the licensee has 10 days from the date of notification

to remit to the Agency the licensure fee plus any applicable fees as provided by law in the form of a money order or

cashier’s check. In the event that the licensure fee is not paid, the license may be subject to revocation or suspension.

(3) A request for a replacement license must be accompanied by a $25 fee.

(4) In addition to required application, per-bed, and inspection fees, a request to amend a license must be

accompanied by a $25 fee.


59A-35.060 Licensure Application Process.

(1) The applicant must apply for licensure using the program specific forms listed below and the Health Care

Licensing Application Addendum, AHCA Form 3110-1024, October 2009, available at

http://www.flrules.org/Gateway/reference.asp?No=Ref-05363. All forms are incorporated by reference and available

online at: http://ahca.myflorida.com/HQAlicensureforms.

(a) Drug Free Workplace Laboratories as provided under Sections 112.0455 and 440.102, F.S.; AHCA Form

3170-5001, Rev. July 2009.

(b) Crisis Stabilization Units, as provided under Parts I and IV of Chapter 394, F.S.; AHCA Form 3180-5003,

Rev. July 2009.

(c) Short Term Residential Treatment Units, as provided under Parts I and IV of Chapter 394, F.S.; AHCA

Form 3180-5003, Rev. July 2009.

(d) Residential Treatment Facilities, as provided under Chapter 394, Part IV, F.S.; AHCA Form 3180-5003,

Rev. July 2009.

(e) Residential Treatment Centers for Children and Adolescents, as provided under Chapter 394, Part IV, F.S.;

AHCA Form 3180-5004, Rev. July 2009.

(f) Health Care Risk Managers, as provided under Chapter 395, Part I, F.S.; AHCA Form RM-001, Rev. July

2009.

(g) Nursing Homes, as provided under Chapter 400, Part II, F.S.; AHCA Form 3110-6001, Rev. July 2009.

(h) Home Health Agencies, as provided under Chapter 400, Part III, F.S.; AHCA Form 3110-1011, Rev. July

2009.

(i) Nurse Registries, as provided under Chapter 400, Part III, F.S.; AHCA Form 3110-7004, Rev. July 2009.

(j) Companion Services or Homemaker Services, as provided under Chapter 400, Part III, F.S.; AHCA Form

3110-1003, Rev. July 2009.

(k) Hospices, as provided under Chapter 400, Part IV, F.S.; AHCA Form 3110-4001, Rev. July 2009.

2 – 4

(l) Home for Special Services as provided under Chapter 400, Part V, F.S.; AHCA Form 3110-3001, July 2014,

and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05202.

(m) Home Medical Equipment Providers, as provided under Chapter 400, Part VII, F.S.; AHCA Form 3110-

1005, Rev. July 2009.

(n) Intermediate Care Facilities for the Developmentally Disabled, as provided under Chapter 400, Part VIII,

F.S.; AHCA Form 3110-5003, Rev. July 2009.

(o) Assisted Living Facilities, as provided under Chapter 429, Part I, F.S.; AHCA Form 3110-1008, Rev. July

2009.

(p) Adult Family-Care Homes, as provided under Chapter 429, Part II, F.S.; AHCA Form 3180-1022, Rev. July

2009.

(q) Adult Day Care Centers, as provided under Chapter 429, Part III, F.S.; AHCA Form 3180-1004, Rev. July

2009.

(r) Clinical Laboratories, as provided under Chapter 483, Part I, F.S.; AHCA Form 3170-2004 (renewal), B

(initial) or C (change of ownership), Rev. July 2009 or AHCA Form 3170-2004D, September 2009 (addition of

specialty, or subspecialty or change in specialty).

(s) Organ and Tissue Procurement Agencies, as provided under Chapter 381, F.S.; AHCA Form 3140-2001,

July 2009.

(2) The licensure fee must be included with any application. Applications will be returned to the applicant

unprocessed if the fee does not accompany the application. Applications from state agencies must include a copy of

the posted journal transactions by State Wide Document Number (SWDN) within benefiting Operating Level

Organization (OLO) and site.

(3) Applications received more than 120 days prior to the date of license expiration or the effective date will be

returned to the applicant unprocessed.

(4) If an applicant, licensee, or controlling interest is required to register or file with the Florida Secretary of

State, Division of Corporations, the principal, fictitious name and mailing addresses submitted with the licensure

application for the applicant, licensee and controlling interests must be the same as the information registered with

the Division of Corporations.

(5) Unresponsive applicant. If certified mail sent to the provider’s address of record, or mailing address if

applicable, is returned as unclaimed or undeliverable, the Agency will send a copy of the letter by regular mail to the

provider’s address of record, or mailing address if applicable, with a copy to the applicant’s address if different from

the provider. The applicant must respond to the request within 21 days of the date of the letter sent by regular mail.

If timely response is not received, the application will be subject to withdrawal or denial.

(6) An application is considered complete upon receipt of:

(a) All required documents and information and appropriate fee;

(b) All required background screening results; and,

(c) Completion of a satisfactory inspection if required by authorizing statutes or rules. Satisfactory inspection

means no regulatory violations exist, or all prior violations found have been determined by the Agency to be

corrected.

(7) A licensure inspection will not be authorized until paragraphs (6)(a) and (6)(b) of this section have been

satisfied.

2 – 5

(8) An application for license renewal may only be filed by the licensee.

Rulemaking Authority 408.819 FS. Law Implemented 400.801, 408.805, 408.806, 408.809, 408.810, 408.811 FS.

History–New 7-14-10, Amended 5-4-15.

59A-35.062 Proof of Financial Ability to Operate.

(1) Proof of financial ability to operate must be demonstrated for initial licensure and change of ownership

applications, by submitting AHCA Form 3100-0009, July 2009, Proof of Financial Ability to Operate, incorporated

herein by reference, and available online at: http://www.ahca.myflorida.com/Publications/Forms/HQA.shtml, as

provided under Section 408.810(8), F.S., for the following provider types:

(a) Nursing Home Facilities, as specified in Chapter 400, Part II, F.S.;

(b) Assisted Living Facilities, as specified in Chapter 429, Part I, F.S.;

(c) Home Health Agencies, as specified in Chapter 400, Part III, F.S.;

(d) Hospices, as specified in Chapter 400, Part IV, F.S.;

(e) Adult Day Care Centers, as specified in Chapter 429, Part III, F.S.;

(f) Prescribed Pediatric Extended Care Centers, as specified in Chapter 400, Part VI, F.S.;

(g) Home Medical Equipment Providers, as specified in Chapter 400, Part VII, F.S.;

(h) Intermediate Care Facilities for the Developmentally Disabled, as specified in Chapter 400, Part VIII, F.S.;

(i) Health Care Clinics, as specified in Chapter 400, Part X, F.S.; and,

(2) Proof of financial ability must be demonstrated for initial licensure and change of ownership applications for

Nurse Registries, as specified in Chapter 400, Part III, F.S., by submitting AHCA Form 3110-7004A, September

2009, Nurse Registry Proof of Financial Ability to Operate, incorporated herein by reference, and available online

at: http://www.ahca.myflorida.com/Publications/Forms/HQA.shtml.

(3) Definitions. The following definitions apply to this section for proof of financial ability to operate.

(a) “Assumptions” means the basis and rationale used in the financial projections to estimate the number and

type of patients, the method of acquiring patients, the amount of resources needed to serve patients, the method by

which these resources will be acquired, the method of recruiting and maintaining staff, the method of collecting

revenue and paying expenses, and the basis for anticipated salaries and employee benefits.

(b) “Charity care” means the term as defined in Section 409.911, F.S.

(c) “Contingency funding” means a source of funding available to the licensee or applicant to cover the cost of

events not considered in the financial projections, including, but not limited to, a drop in patient volume, a delay in

Medicare and/or Medicaid certification, major repairs, purchase of capital equipment. The contingency fund will be

a minimum of one month’s average operating expense over the first year of operations.

(d) “Contractual adjustments” means the difference in the established charges or rates of the provider and the

rates negotiated by Medicare, Medicaid, HMO/PPOs, and Insurers.

(e) ”Financial instability” means the provider cannot meet its financial obligations. Evidence such as the

issuance of bad checks, an accumulation of delinquent bills, or inability to meet current payroll needs shall

constitute prima facie evidence that the ownership of the provider lacks the financial ability to operate. Evidence

shall also include the Medicare or Medicaid program’s indications or determination of financial instability or

fraudulent handling of government funds by the provider.

(f) “Financial projections” means the expected operating results of the applicant as presented on AHCA Form

3100-0009, July 2009.

2 – 6

(g) “Full time equivalent” or “FTE” means a measure of full-time employment of 40 hours per week (1FTE =

40 hours per week or 2,080 hours annually).

(h) “Generally Accepted Accounting Principles” or “GAAP” means the term as defined in Rule 61H1-20.007,

F.A.C., Department of Business and Professional Regulation, Board of Accountancy.

(i) “Liquid assets” means assets of the licensee or applicant that can easily and quickly be converted to cash

such as publicly traded stocks, bonds, certificates of deposit, and money market accounts.

(j) “Net patient service revenue” means patient service revenue minus deductions from revenue. Deductions

from revenue include contractual adjustments and charity care.

(k) “Operating expense” means total expenses incurred through the normal course of business.

(l) “Operating margin” means a measure of profitability and is calculated as follows: ([Net Patient Service

Revenue - Operating Expenses] ÷ Net Patient Service Revenue) = Operating Margin.

(m) “Patient service revenue” means the total charge for a service provided.

(n) “Pre-opening costs” means the costs necessary to begin operations including advertising, equipment

purchases, legal fees, accounting fees, consulting fees, pre-paid insurance, pre-paid rent, licensure fees, deposits

(rent, utilities), requirement, staffing, and training.

(o) “Working capital” means the cash needed to sustain operations until a positive cash flow is achieved.

(Largest cumulative cash need from Schedule 7 Line 21 of AHCA Form 3100-0009, July 2009).

(4) All documents required under this section must be prepared in accordance with generally accepted

accounting principles. All documents required under this section for Home Health Agencies, Home Medical

Equipment Providers and Health Care Clinics must be compiled and signed by a certified public accountant.

(5) A pro forma balance sheet, a pro forma cash flow statement and a pro forma income and expense statement

for the first 2 years of operation which provide evidence of having sufficient assets, credit, and projected revenues to

cover liabilities and expenses must be included. An application for change of ownership may elect not to complete

the 2nd year of operations on AHCA Form 3100-0009, July 2009, if all of the following apply:

(a) As of the date of the application, the entity subject to the change of ownership has been licensed for at least

5 consecutive years;

(b) The applicant’s assets, credit, and projected revenues meet or exceed projected liabilities and expenses by

the end of the first year;

(c) The largest cumulative cash need on Schedule 7, Line 21 on AHCA Form 3100-0009, July 2009 occurs prior

to month 12.

(6) The applicant shall have demonstrated financial ability to operate if the applicant’s assets, credit, and

projected revenues meet or exceed projected liabilities and expenses.

(7) An applicant for renewal of a license shall not be required to provide proof of financial ability to operate,

unless the licensee or applicant has demonstrated financial instability. If an applicant or licensee has shown signs of

financial instability, as provided in Section 408.810(9), F.S., at any time, the Agency may require the applicant or

licensee to provide proof of financial ability to operate by submission of:

(a) AHCA Form 3100-0009, July 2009, Proof of Financial Ability Form, that includes a balance sheet and

income and expense statement for the next 2 years of operation which provide evidence of having sufficient assets,

credit, and projected revenues to cover liabilities and expenses; and

2 – 7

(b) Documentation of correction of the financial instability, including but not limited to, evidence of the

payment of any bad checks, delinquent bills or liens. If complete payment cannot be made, evidence must be

submitted of partial payment along with a plan for payment of any liens or delinquent bills. If the lien is with a

government agency or repayment is ordered by a federal or state court, an accepted plan of repayment must be

provided.

Rulemaking Authority 408.819 FS. Law Implemented 408.806, 408.810 FS. History–New 7-14-10.

59A-35.070 Change of Ownership.

(1) Effective dates of change of ownership.

(a) A change of ownership application must include the effective date of the change of ownership.

(b) The change of ownership effective date cannot be prior to the date the application is received by the Agency.

Failure to submit an application for licensure prior to the effective date of a change of ownership to a different legal

entity constitutes unlicensed activity.

(c) The effective date of the change of ownership shall not be extended more than 60 days from the effective

date reported on the application; written notification of a change in the effective date must be received by the

Agency prior to the originally reported effective date. The Agency will deem the application withdrawn if the

change of ownership does not occur within 60 days of the reported effective date.

(2) All required application documents and information must be received with the application or within 21 days

of the request by the Agency with the exception of the transferee’s proof of right to occupy if required, which must

be received by the Agency within 10 days after the effective date.

(3) When a change of ownership application is submitted during the review of a renewal licensure application,

the pending renewal will be administratively withdrawn from review if the change of ownership application is

approved with an effective date prior to the expiration of the license.

(4) Expiration of a license prior to the approval of the change of ownership application, when no renewal

application has been submitted, will result in the denial of a change of ownership application.

(5) If the applicant has not been issued the license on the effective date of the change of ownership,

documentation must be submitted that provides for continuation of operation of the licensee for those days between

the date of the change of ownership and the date the applicant is licensed by the Agency.

Rulemaking Authority 408.819 FS. Law Implemented 408.803(3), 408.803(5), 408.806, 408.807, 408.810, 408.813

FS. History–New 7-14-10.

59A-35.080 License Categories.

(1) Provisional License. If a license expires while an action to deny or revoke the license is pending and renewal

applications are filed, the Agency may issue a provisional license. The provisional license shall identify the pending

action. The provisional license will expire when the Agency action is final or one year after issuance, whichever

occurs first. The provisional license does not affect the revocation or denial action or constitute a defense on behalf

of the licensee or applicant.

(2) Inactive License. An inactive license may be issued, as provided in Sections 408.808(3), F.S.

(a) Requests for an inactive license must be submitted to the Agency as a written request that includes:

1. The reason that the provider will become inactive;

2. The proposed plan for transferring or discharging clients;

3. A plan for resuming services;

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4. The date by which services are expected to resume; and

5. Evidence of a State of Emergency or disaster if applicable.

(b) The inactive license will not be issued until all clients have been properly transferred or discharged. The

expiration date of the inactive license will be issued for a period not to exceed 12 months. An application to extend

the inactive period for an additional 12 months must be submitted 30 days prior to the expiration of the inactive

license.

(c) Notification to reactivate the license and a complete licensure renewal application must be submitted to the

Agency at least 90 days prior to the requested reactivation date. An onsite inspection may be required prior to

reactivation. Licensure fees will be prorated based on the provider’s standard fee divided by the number of months

remaining in the licensure cycle.

Rulemaking Authority 408.819 FS. Law Implemented 408.808(2), (3), FS. History–New 7-14-10.

59A-35.090 Background Screening.

(1) Definitions:

(a) “Arrest Report” means the detailed narrative written by the arresting law enforcement officer explaining the

circumstances of the arrest.

(b) “Disposition” means the sentencing or other final settlement of a criminal case which shall include,

regardless of adjudication, a plea of nolo contendere or guilty, or a conviction by a judge or jury.

(c) “Disqualifying Offense” means any criminal offense prohibited in section 435.04 or 408.809(4), F.S.

(d) “Exemption from Disqualification” means an exemption granted by the Agency following a review of the

Background Screening Application for Exemption, AHCA Form 3110-0019, January 2017, hereby incorporated by

reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09105, and an informal

teleconference, during which the individual must present clear and convincing evidence to support a reasonable

belief that he or she has been rehabilitated and does not present a danger to the health, safety, and welfare of the

patient or individual as described in section 435.07, F.S.

(e) “FBI” means the Federal Bureau of Investigation.

(f) “FDLE” means the Florida Department of Law Enforcement.

(g) “Level 2 Screening” means an assessment of the criminal history record obtained through a fingerprint

search through the FDLE and FBI to determine whether screened individuals have any disqualifying offenses

pursuant to section 435.04 or 408.809(4), F.S. An analysis and review of court dispositions and arrest reports may be

required to make a final determination.

(h) “Livescan Service Provider” means an entity that scans fingerprints electronically and submits them to

FDLE.

(2) Processing Screening Requests, Required Documents and Fees.

(a) Providers subject to the screening standards outlined in section 408.809, F.S., must follow the requirements

specified in section 435.12, F.S. Care Provider Background Screening Clearinghouse and must register and initiate

all criminal history checks through the Care Provider Background Screening Clearinghouse before referring an

employee or potential employee for electronic fingerprint submission to the Department of Law Enforcement.

Providers can access the Care Provider Background Screening Clearinghouse at:

http://ahca.myflorida.com/MCHQ/Central_Services/Background_Screening/index.shtml.

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(b) Persons required to undergo Level 2 background screening must submit fingerprints electronically through a

Livescan Service Provider(s) contracted through the Agency or approved through the Florida Department of Law

Enforcement. Payment for screening services must be made to the Livescan Service Provider at the time of services

or through a payment arrangement with the Livescan Service Provider.

(c) If the individual’s fingerprints are rejected by the FBI due to illegible prints, the requesting provider will be

notified through the Agency’s secure website. The individual must return to the same Livescan Service Provider and

submit a second set of fingerprints in accordance with the guidelines established by the FBI. If the fingerprints are

not resubmitted within 14 days, the individual will be notified by letter from the Agency. The second set of prints

must be submitted within 21 days of the Agency’s request or the screening request will be considered withdrawn. If

withdrawn, the individual must submit a new set of electronic fingerprints through a Livescan Service Provider

accompanied by the required fee.

(d) An Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, January

2017, herein incorporated by reference, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09106,

and available from the Agency for Health Care Administration at:

http://ahca.myflorida.com/MCHQ/Central_Services/Background_Screening/Regulations_Forms.shtml. This form

must be completed by the individual and retained by the provider upon hire to attest that they meet the requirements

for qualifying for employment, they have not been unemployed for more than 90 days from a position that requires

Level 2 screening, and they agree to inform the employer immediately if arrested for any disqualifying offense.

(e) An administrator or chief financial officer must be screened and qualified prior to appointment to the

position.

(3) Results of Screening and Notification.

(a) Final results of background screening requests will be provided through the Agency’s secure website that

may be accessed by all health care providers applying for or actively licensed through the Agency that are registered

with the Care Provider Background Screening Clearinghouse. The secure website is located at:

apps.ahca.myflorida.com/SingleSignOnPortal.

(b) If a Level 2 criminal history is incomplete, a certified letter will be sent to the individual being screened

requesting the arrest report and court disposition information. If the letter is returned unclaimed, a copy of the letter

will be sent by regular mail. Pursuant to section 435.05(1)(d), F.S., the missing information must be filed with the

Agency within 30 days of the Agency’s request or the individual is subject to disqualification in accordance with

section 435.06(3), F.S.

(c) The eligibility results of employee screening and the signed Attestation referenced in subsection 59A-

35.090(2), F.A.C., must be in the employee’s personnel file, maintained by the provider.

(4) Exemption from Disqualification.

(a) Requests for an exemption from disqualification shall be submitted in writing to the Agency using the

Background Screening Application for Exemption, AHCA Form 3110-0019, January 2017.

(b) Individuals that are licensed or certified in a profession under the jurisdiction of the Department of Health

must apply for an exemption to the appropriate licensing or certifying board at the Department of Health unless the

individual will be working in a position other than for which they are licensed or certified.

(c) The individual shall bear the burden of setting forth clear and convincing evidence of rehabilitation which

includes any information indicating the individual presents no danger to the safety or well being of others. The

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individual must present such evidence as arrest reports, court dispositions, parole/probation information, and

reference letters from employers, and/or personal references. Other documents that may be included are records of

successful participation in a rehabilitation program, further education or training, community or church involvement,

special awards or recognition or testimony by self or others.

(d) An “Application for Exemption” will not be reviewed until all required documents are obtained. If the

application is deemed incomplete after 30 days of receipt by the Agency, the application will be closed.

(e) In deciding whether to grant or deny an exemption request, the Agency shall consider factors such as the

facts and circumstances surrounding the disqualifying offense(s), the nature of the harm to the victim, whether the

individual is on probation or parole, whether restitution has been made, other offenses on the criminal history record

and the length of time since the last offense, the history of the person since the disqualifying offense(s), work

experience, personal references, performance evaluations, probation or parole violations, education, other evidence

of rehabilitation, and the honesty and candor of the disqualified individual.

(f) Any exemption granted by the Agency is limited to the information provided at the time of application and

the disqualifying offense or offenses committed prior to the date of the request for exemption.

(g) The Agency shall void any exemption granted to an individual when there is evidence that information

which would adversely affect the decision was not made available at the time of the determination or there is an

arrest or disposition of a new disqualifying offense since the date the exemption was granted.

(5) Unless otherwise specified, information requested pursuant to this section must be filed with the Agency

within 21 days of the Agency’s request.

Rulemaking Authority 408.809, 408.819, 435.01 FS. Law Implemented 408.809, 408.810, 435.07 FS. History–New

7-14-10, Amended 12-16-13, 6-15-15, 2-13-18.

59A-35.100 Minimum Licensure Requirements.

Provider location. A licensee must maintain proper authority for operation of the provider at the address of record. If

such authority is denied, revoked or otherwise terminated by the local zoning or code enforcement authority, the

Agency may deny or revoke an application or license, or impose sanctions.

Rulemaking Authority 408.819 FS. Law Implemented 408.810 FS. History–New 7-14-10, Amended 3-12-12.

59A-35.110 Reporting Requirements; Electronic Submission.

(1) During the two year licensure period, any change or expiration of any information that is required to be

reported under chapter 408, part II, F.S., or authorizing statutes for the provider type as specified in section 408.803(3),

F.S., during the license application process must be reported to the Agency within 21 days of occurrence of the change,

including:

(a) Insurance coverage renewal;

(b) Bond renewal;

(c) Change of administrator or the similarly titled person who is responsible for the day-to-day operation of the

provider;

(d) Annual sanitation inspections;

(e) Fire inspections; and,

(f) Approval of revisions to emergency management plans.

(2) Electronic submission of information.

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(a) The following required information must be submitted electronically through the Agency’s Single Sign On

Portal located at https://apps.ahca.myflorida.com/SingleSignOnPortal:

1. Nursing homes:

Adverse incident reports must be submitted electronically to the Agency within 15 calendar days after the occurrence

of the incident as required in section 400.147, F.S. on Nursing Home Adverse Incident, AHCA Form 3110-0010 OL,

April 2017, which is hereby incorporated by reference and availiable at:

https://www.flrules.org/Gateway/reference.asp?No=Ref-08777, and through the Agency’s adverse incident reporting

system which can only be accessed through the Agency’s Single Sign On Portal located at:

https://apps.ahca.myflorida.com/SingleSignOnPortal.

2. Assisted living facilities:

a. Adverse incident reports must be submitted electronically to the Agency within 1 business day after the

occurrence of the incident, and within 15 days after the occurrence of the incident as required in section 429.23, F.S.,

on Assisted Living Facility Adverse Incident, AHCA Form 3180-1025 OL, April 2017, which is hereby incorporated

by reference and availiable at: https://www.flrules.org/Gateway/reference.asp?No=Ref-08778, and through the

Agency’s adverse incident reporting system which can only be accessed through the Agency’s Single Sign On Portal

located at: https://apps.ahca.myflorida.com/SingleSignOnPortal.

b. Liability claim reports required pursuant to section 429.23(5), F.S., and rule 58A-5.0242, F.A.C.

3. Hospitals:


of the incident as required in Section 395.0197, F.S., on Hospital Adverse Incident, AHCA Form 3140-5001 OL, April

2017, which is hereby incorporated by reference and availiable at:




4. Ambulatory Surgical Centers:


of the incident as required in section 395.0197, F.S., on Ambulatory Surgical Center Adverse Incident, AHCA Form

3140-5004 OL, April 2017, which is hereby incorporated by reference and availiable at:




(b) The licensee must retain a copy of all documentation generated at time of reporting as confirmation of

successful electronic submission.

(c) If the Agency’s Single Sign On Portal or the online adverse incident reporting system is temporarily out of

service the licensee may contact the Agency directly at 1(888)419-3456 for assistance. Reporting will resume as soon

as online access is restored.

Rulemaking Authority 408.806, 408.819 FS. Law Implemented 408.806, 408.810 FS. History–New 7-14-10, Amended

11-13-17.

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59A-35.120 Inspections.

(1) When regulatory violations are identified by the Agency:

(a) Deficiencies must be corrected within 30 days of the date the Agency sends the deficiency notice to the

provider, unless an alternative timeframe is required or approved by the Agency.

(b) The Agency may conduct an unannounced follow-up inspection or off-site review to verify correction of

deficiencies at any time.

(2) If an inspection is completed through off-site record review, any records requested by the Agency in

conjunction with the review, must be received within 7 days of request and provided at no cost to the Agency. Each

licensee shall maintain the records including medical and treatment records of a client and provide access to the

Agency.

(3) Providers that are exempt from Agency inspections due to accreditation oversight as prescribed in

authorizing statutes must provide:

(a) Documentation from the accrediting agency including the name of the accrediting agency, the beginning and

expiration dates of the provider’s accreditation, accreditation status and type must be submitted at the time of license

application, or within 21 days of accreditation.

(b) Documentation of each accreditation inspection including the accreditation organization’s report of findings,

the provider’s response and the final determination must be submitted within 21 days of final determination or the

provider is no longer exempt from Agency inspection.


59A-35.150 Moratorium; Emergency Suspension.

In addition to other remedies permitted by law, violation of a moratorium issued by the Agency is considered a

Class I violation and subject to a fine of $500 per day until the violation is corrected.

Rulemaking Authority 408.819 FS. Law Implemented 408.813, 408.814 FS. History–New 7-14-10.

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3. Chapter 419, F.S.

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CHAPTER 419

COMMUNITY RESIDENTIAL HOMES 419.001 Site selection of community residential homes.

419.001 Site selection of community residential homes.—

(1) For the purposes of this section, the term:

(a) “Community residential home” means a dwelling unit licensed to serve residents who are clients of the

Department of Elderly Affairs, the Agency for Persons with Disabilities, the Department of Juvenile Justice, or the

Department of Children and Families or licensed by the Agency for Health Care Administration which provides a

living environment for 7 to 14 unrelated residents who operate as the functional equivalent of a family, including

such supervision and care by supportive staff as may be necessary to meet the physical, emotional, and social needs

of the residents.

(b) “Licensing entity” or “licensing entities” means the Department of Elderly Affairs, the Agency for Persons

with Disabilities, the Department of Juvenile Justice, the Department of Children and Families, or the Agency for

Health Care Administration, all of which are authorized to license a community residential home to serve residents.

(c) “Local government” means a county as set forth in chapter 7 or a municipality incorporated under the

provisions of chapter 165.

(d) “Planned residential community” means a local government-approved, planned unit development that is

under unified control, is planned and developed as a whole, has a minimum gross lot area of 8 acres, and has

amenities that are designed to serve residents with a developmental disability as defined in s. 393.063 but that shall

also provide housing options for other individuals. The community shall provide choices with regard to housing

arrangements, support providers, and activities. The residents’ freedom of movement within and outside the

community may not be restricted. For the purposes of this paragraph, local government approval must be based on

criteria that include, but are not limited to, compliance with appropriate land use, zoning, and building codes. A

planned residential community may contain two or more community residential homes that are contiguous to one

another. A planned residential community may not be located within a 10-mile radius of any other planned

residential community.

(e) “Resident” means any of the following: a frail elder as defined in s. 429.65; a person who has a handicap as

defined in s. 760.22(7)(a); a person who has a developmental disability as defined in s. 393.063; a nondangerous

person who has a mental illness as defined in s. 394.455; or a child who is found to be dependent as defined in s.

39.01 or s. 984.03, or a child in need of services as defined in s. 984.03 or s. 985.03.

(f) “Sponsoring agency” means an agency or unit of government, a profit or nonprofit agency, or any other

person or organization which intends to establish or operate a community residential home.

(2) Homes of six or fewer residents which otherwise meet the definition of a community residential home shall

be deemed a single-family unit and a noncommercial, residential use for the purpose of local laws and ordinances.

Homes of six or fewer residents which otherwise meet the definition of a community residential home shall be

allowed in single-family or multifamily zoning without approval by the local government, provided that such homes

are not located within a radius of 1,000 feet of another existing such home with six or fewer residents or within a

radius of 1,200 feet of another existing community residential home. Such homes with six or fewer residents are not

required to comply with the notification provisions of this section; provided that, before licensure, the sponsoring

agency provides the local government with the most recently published data compiled from the licensing entities

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that identifies all community residential homes within the jurisdictional limits of the local government in which the

proposed site is to be located in order to show that there is not a home of six or fewer residents which otherwise

meets the definition of a community residential home within a radius of 1,000 feet and not a community residential

home within a radius of 1,200 feet of the proposed home. At the time of home occupancy, the sponsoring agency

must notify the local government that the home is licensed by the licensing entity. For purposes of local land use and

zoning determinations, this subsection does not affect the legal nonconforming use status of any community

residential home lawfully permitted and operating as of July 1, 2016.

(3)(a) When a site for a community residential home has been selected by a sponsoring agency in an area zoned

for multifamily, the agency shall notify the chief executive officer of the local government in writing and include in

such notice the specific address of the site, the residential licensing category, the number of residents, and the

community support requirements of the program. Such notice shall also contain a statement from the licensing entity

indicating the licensing status of the proposed community residential home and specifying how the home meets

applicable licensing criteria for the safe care and supervision of the clients in the home. The sponsoring agency shall

also provide to the local government the most recently published data compiled from the licensing entities that

identifies all community residential homes within the jurisdictional limits of the local government in which the

proposed site is to be located. The local government shall review the notification of the sponsoring agency in

accordance with the zoning ordinance of the jurisdiction.

(b) Pursuant to such review, the local government may:

1. Determine that the siting of the community residential home is in accordance with local zoning and approve

the siting. If the siting is approved, the sponsoring agency may establish the home at the site selected.

2. Fail to respond within 60 days. If the local government fails to respond within such time, the sponsoring

agency may establish the home at the site selected.

3. Deny the siting of the home.

(c) The local government shall not deny the siting of a community residential home unless the local government

establishes that the siting of the home at the site selected:

1. Does not otherwise conform to existing zoning regulations applicable to other multifamily uses in the area.

2. Does not meet applicable licensing criteria established and determined by the licensing entity, including

requirements that the home be located to assure the safe care and supervision of all clients in the home.

3. Would result in such a concentration of community residential homes in the area in proximity to the site

selected, or would result in a combination of such homes with other residences in the community, such that the

nature and character of the area would be substantially altered. A home that is located within a radius of 1,200 feet

of another existing community residential home in a multifamily zone shall be an overconcentration of such homes

that substantially alters the nature and character of the area. A home that is located within a radius of 500 feet of an

area of single-family zoning substantially alters the nature and character of the area.

(4) Community residential homes, including homes of six or fewer residents which would otherwise meet the

definition of a community residential home, which are located within a planned residential community are not

subject to the proximity requirements of this section and may be contiguous to each other. A planned residential

community must comply with the applicable local government’s land development code and other local ordinances.

A local government may not impose proximity limitations between homes within a planned residential community if

such limitations are based solely on the types of residents anticipated to be living in the community.

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(5) All distance requirements in this section shall be measured from the nearest point of the existing home or

area of single-family zoning to the nearest point of the proposed home.

(6) If agreed to by both the local government and the sponsoring agency, a conflict may be resolved through

informal mediation. The local government shall arrange for the services of an independent mediator. Mediation shall

be concluded within 45 days of a request therefor. The resolution of any issue through the mediation process shall

not alter any person’s right to a judicial determination of any issue if that person is entitled to such a determination

under statutory or common law.

(7) The licensing entity shall not issue a license to a sponsoring agency for operation of a community

residential home if the sponsoring agency does not notify the local government of its intention to establish a

program, as required by subsection (3). A license issued without compliance with the provisions of this section shall

be considered null and void, and continued operation of the home may be enjoined.

(8) A dwelling unit housing a community residential home established pursuant to this section shall be subject

to the same local laws and ordinances applicable to other noncommercial, residential family units in the area in

which it is established.

(9) Nothing in this section shall be deemed to affect the authority of any community residential home lawfully

established prior to October 1, 1989, to continue to operate.

(10) Nothing in this section shall permit persons to occupy a community residential home who would constitute

a direct threat to the health and safety of other persons or whose residency would result in substantial physical

damage to the property of others.

(11) The siting of community residential homes in areas zoned for single family shall be governed by local

zoning ordinances. Nothing in this section prohibits a local government from authorizing the development of

community residential homes in areas zoned for single family.

(12) Nothing in this section requires any local government to adopt a new ordinance if it has in place an

ordinance governing the placement of community residential homes that meet the criteria of this section. State law

on community residential homes controls over local ordinances, but nothing in this section prohibits a local

government from adopting more liberal standards for siting such homes.

History.—s. 1, ch. 89-372; s. 1, ch. 90-192; s. 4, ch. 91-429; s. 36, ch. 93-206; s. 6, ch. 95-152; s. 42, ch. 96-169;

s. 222, ch. 97-101; s. 46, ch. 98-280; s. 14, ch. 98-338; s. 53, ch. 99-193; s. 23, ch. 99-284; s. 7, ch. 2000-135; s. 93,

ch. 2004-267; s. 34, ch. 2006-86; s. 110, ch. 2006-120; s. 1, ch. 2006-177; s. 99, ch. 2007-5; s. 30, ch. 2008-245; s.

3, ch. 2010-193; s. 237, ch. 2014-19; s. 29, ch. 2015-30; s. 1, ch. 2016-74.

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4 – 1

CHAPTER 435

EMPLOYMENT SCREENING

435.01 Applicability of this chapter; statutory references; rulemaking.

435.02 Definitions.

435.03 Level 1 screening standards.

435.04 Level 2 screening standards.

435.05 Requirements for covered employees and employers.

435.06 Exclusion from employment.

435.07 Exemptions from disqualification.

435.08 Payment for processing of fingerprints and state criminal records checks.

435.09 Confidentiality of personnel background check information.

435.10 Sharing of personnel information among employers.

435.11 Penalties.

435.12 Care Provider Background Screening Clearinghouse.

435.01 Applicability of this chapter; statutory references; rulemaking.—

(1)(a) Unless otherwise provided by law, whenever a background screening for employment or a background

security check is required by law to be conducted pursuant to this chapter, the provisions of this chapter apply.

(b) Unless expressly provided otherwise, a reference in any section of the Florida Statutes to chapter 435 or to

any section or sections or portion of a section of chapter 435 includes all subsequent amendments to chapter 435 or

to the referenced section or sections or portions of a section. The purpose of this chapter is to facilitate uniform

background screening and, to this end, a reference to this chapter, or to any section or subdivision within this

chapter, constitutes a general reference under the doctrine of incorporation by reference.

(2) Agencies may adopt rules to administer this chapter.

History.—s. 47, ch. 95-228; s. 35, ch. 2010-114.

435.02 Definitions.—For the purposes of this chapter, the term:

(1) “Agency” means any state, county, or municipal agency that grants licenses or registration permitting the

operation of an employer or is itself an employer or that otherwise facilitates the screening of employees pursuant to

this chapter. If there is no state agency or the municipal or county agency chooses not to conduct employment

screening, “agency” means the Department of Children and Families.

(2) “Employee” means any person required by law to be screened pursuant to this chapter, including, but not

limited to, persons who are contractors, licensees, or volunteers.

(3) “Employer” means any person or entity required by law to conduct screening of employees pursuant to this

chapter.

(4) “Employment” means any activity or service sought to be performed by an employee which requires the

employee to be screened pursuant to this chapter.

(5) “Specified agency” means the Department of Health, the Department of Children and Families, the Division

of Vocational Rehabilitation within the Department of Education, the Agency for Health Care Administration, the

Department of Elderly Affairs, the Department of Juvenile Justice, the Agency for Persons with Disabilities, and

local licensing agencies approved pursuant to s. 402.307, when these agencies are conducting state and national

criminal history background screening on persons who work with children or persons who are elderly or disabled.

4 – 2

(6) “Vulnerable person” means a minor as defined in s. 1.01 or a vulnerable adult as defined in s. 415.102.

History.—s. 47, ch. 95-228; s. 207, ch. 99-8; s. 36, ch. 2010-114; s. 9, ch. 2012-73; s. 257, ch. 2014-19; s. 10, ch.

2015-79.

435.03 Level 1 screening standards.—

(1) All employees required by law to be screened pursuant to this section must undergo background screening

as a condition of employment and continued employment which includes, but need not be limited to, employment

history checks and statewide criminal correspondence checks through the Department of Law Enforcement, and a

check of the Dru Sjodin National Sex Offender Public Website, and may include local criminal records checks

through local law enforcement agencies.

(2) Any person required by law to be screened pursuant to this section must not have an arrest awaiting final

disposition, must not have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or

guilty to, and must not have been adjudicated delinquent and the record has not been sealed or expunged for, any

offense prohibited under s. 435.04(2) or similar law of another jurisdiction.

(3) The security background investigations under this section must ensure that no person subject to this section

has been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense

that constitutes domestic violence as defined in s. 741.28, whether such act was committed in this state or in another

jurisdiction.


2000-349; s. 62, ch. 2001-62; s. 50, ch. 2003-1; s. 4, ch. 2004-267; s. 3, ch. 2005-119; s. 89, ch. 2006-197; s. 61, ch.

2006-227; s. 109, ch. 2007-5; s. 16, ch. 2008-244; s. 37, ch. 2010-114; s. 34, ch. 2011-4.

435.04 Level 2 screening standards.—

(1)(a) All employees required by law to be screened pursuant to this section must undergo security background

investigations as a condition of employment and continued employment which includes, but need not be limited to,

fingerprinting for statewide criminal history records checks through the Department of Law Enforcement, and

national criminal history records checks through the Federal Bureau of Investigation, and may include local criminal

records checks through local law enforcement agencies.

(b) Fingerprints submitted pursuant to this section on or after July 1, 2012, must be submitted electronically to

the Department of Law Enforcement.

(c) An agency may contract with one or more vendors to perform all or part of the electronic fingerprinting

pursuant to this section. Such contracts must ensure that the owners and personnel of the vendor performing the

electronic fingerprinting are qualified and will ensure the integrity and security of all personal information.

(d) An agency may require by rule that fingerprints submitted pursuant to this section must be submitted

electronically to the Department of Law Enforcement on a date earlier than July 1, 2012.

(e) Vendors who submit fingerprints on behalf of employers must:

1. Meet the requirements of s. 943.053; and

2. Have the ability to communicate electronically with the state agency accepting screening results from the

Department of Law Enforcement and provide the applicant’s full first name, middle initial, and last name; social

security number or individual taxpayer identification number; date of birth; mailing address; sex; and race.

(2) The security background investigations under this section must ensure that no persons subject to the

provisions of this section have been arrested for and are awaiting final disposition of, have been found guilty of,

4 – 3

regardless of adjudication, or entered a plea of nolo contendere or guilty to, or have been adjudicated delinquent and

the record has not been sealed or expunged for, any offense prohibited under any of the following provisions of state

law or similar law of another jurisdiction:

(a) Section 393.135, relating to sexual misconduct with certain developmentally disabled clients and reporting

of such sexual misconduct.

(b) Section 394.4593, relating to sexual misconduct with certain mental health patients and reporting of such

sexual misconduct.

(c) Section 415.111, relating to adult abuse, neglect, or exploitation of aged persons or disabled adults.

(d) Section 777.04, relating to attempts, solicitation, and conspiracy to commit an offense listed in this

subsection.

(e) Section 782.04, relating to murder.

(f) Section 782.07, relating to manslaughter, aggravated manslaughter of an elderly person or disabled adult, or

aggravated manslaughter of a child.

(g) Section 782.071, relating to vehicular homicide.

(h) Section 782.09, relating to killing of an unborn child by injury to the mother.

(i) Chapter 784, relating to assault, battery, and culpable negligence, if the offense was a felony.

(j) Section 784.011, relating to assault, if the victim of the offense was a minor.

(k) Section 784.03, relating to battery, if the victim of the offense was a minor.

(l) Section 787.01, relating to kidnapping.

(m) Section 787.02, relating to false imprisonment.

(n) Section 787.025, relating to luring or enticing a child.

(o) Section 787.04(2), relating to taking, enticing, or removing a child beyond the state limits with criminal

intent pending custody proceedings.

(p) Section 787.04(3), relating to carrying a child beyond the state lines with criminal intent to avoid producing

a child at a custody hearing or delivering the child to the designated person.

(q) Section 790.115(1), relating to exhibiting firearms or weapons within 1,000 feet of a school.

(r) Section 790.115(2)(b), relating to possessing an electric weapon or device, destructive device, or other

weapon on school property.

(s) Section 794.011, relating to sexual battery.

(t) Former s. 794.041, relating to prohibited acts of persons in familial or custodial authority.

(u) Section 794.05, relating to unlawful sexual activity with certain minors.

(v) Chapter 796, relating to prostitution.

(w) Section 798.02, relating to lewd and lascivious behavior.

(x) Chapter 800, relating to lewdness and indecent exposure.

(y) Section 806.01, relating to arson.

(z) Section 810.02, relating to burglary.

(aa) Section 810.14, relating to voyeurism, if the offense is a felony.

(bb) Section 810.145, relating to video voyeurism, if the offense is a felony.

(cc) Chapter 812, relating to theft, robbery, and related crimes, if the offense is a felony.

(dd) Section 817.563, relating to fraudulent sale of controlled substances, only if the offense was a felony.

4 – 4

(ee) Section 825.102, relating to abuse, aggravated abuse, or neglect of an elderly person or disabled adult.

(ff) Section 825.1025, relating to lewd or lascivious offenses committed upon or in the presence of an elderly

person or disabled adult.

(gg) Section 825.103, relating to exploitation of an elderly person or disabled adult, if the offense was a felony.

(hh) Section 826.04, relating to incest.

(ii) Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a child.

(jj) Section 827.04, relating to contributing to the delinquency or dependency of a child.

(kk) Former s. 827.05, relating to negligent treatment of children.

(ll) Section 827.071, relating to sexual performance by a child.

(mm) Section 843.01, relating to resisting arrest with violence.

(nn) Section 843.025, relating to depriving a law enforcement, correctional, or correctional probation officer

means of protection or communication.

(oo) Section 843.12, relating to aiding in an escape.

(pp) Section 843.13, relating to aiding in the escape of juvenile inmates in correctional institutions.

(qq) Chapter 847, relating to obscene literature.

(rr) Section 874.05, relating to encouraging or recruiting another to join a criminal gang.

(ss) Chapter 893, relating to drug abuse prevention and control, only if the offense was a felony or if any other

person involved in the offense was a minor.

(tt) Section 916.1075, relating to sexual misconduct with certain forensic clients and reporting of such sexual

misconduct.

(uu) Section 944.35(3), relating to inflicting cruel or inhuman treatment on an inmate resulting in great bodily

harm.

(vv) Section 944.40, relating to escape.

(ww) Section 944.46, relating to harboring, concealing, or aiding an escaped prisoner.

(xx) Section 944.47, relating to introduction of contraband into a correctional facility.

(yy) Section 985.701, relating to sexual misconduct in juvenile justice programs.

(zz) Section 985.711, relating to contraband introduced into detention facilities.

(3) The security background investigations under this section must ensure that no person subject to this section

has been arrested for and is awaiting final disposition of, been found guilty of, regardless of adjudication, or entered

a plea of nolo contendere or guilty to, any offense that constitutes domestic violence as defined in s. 741.28, whether

such act was committed in this state or in another jurisdiction.

(4) For the purpose of screening applicability to participate in the Medicaid program, the security background

investigations under this section must ensure that a person subject to screening under this section has not been

arrested for and is not awaiting final disposition of; has not been found guilty of, regardless of adjudication, or

entered a plea of nolo contendere or guilty to; and has not been adjudicated delinquent and the record sealed or

expunged for, any of the following offenses:

(a) Violation of a federal law or a law in any state which creates a criminal offense relating to:

1. The delivery of any goods or services under Medicaid or Medicare or any other public or private health care

or health insurance program, including the performance of management or administrative services relating to the

delivery of goods or services under any such program;

4 – 5

2. Neglect or abuse of a patient in connection with the delivery of any health care good or service;

3. Unlawful manufacture, distribution, prescription, or dispensing of a controlled substance;

4. Fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct;

5. Moral turpitude, if punishable by imprisonment of a year or more; or

6. Interference with or obstruction of an investigation into any criminal offense identified in this subsection.

(b) Violation of the following state laws or laws of another jurisdiction:

1. Section 817.569, criminal use of a public record or information contained in a public record;

2. Section 838.016, unlawful compensation or reward for official behavior;

3. Section 838.021, corruption by threat against a public servant;

4. Section 838.022, official misconduct;

5. Section 838.22, bid tampering;

6. Section 839.13, falsifying records; or

7. Section 839.26, misuse of confidential information.

(c) Violation of a federal or state law, rule, or regulation governing the Florida Medicaid program or any other

state Medicaid program, the Medicare program, or any other publicly funded federal or state health care or health

insurance program.

History.—s. 47, ch. 95-228; s. 16, ch. 96-268; s. 22, ch. 96-322; s. 4, ch. 98-417; s. 5, ch. 99-284; s. 88, ch. 2000-

153; s. 7, ch. 2001-125; s. 5, ch. 2004-267; s. 4, ch. 2005-119; s. 111, ch. 2006-120; s. 90, ch. 2006-197; s. 110, ch.


2013-80; s. 6, ch. 2014-84; s. 4, ch. 2014-194; s. 3, ch. 2016-162; s. 19, ch. 2017-37; s. 89, ch. 2018-24.

435.05 Requirements for covered employees and employers.—Except as otherwise provided by law, the

following requirements apply to covered employees and employers:

(1)(a) Every person required by law to be screened pursuant to this chapter must submit a complete set of

information necessary to conduct a screening under this chapter.

(b) For level 1 screening, the employer must submit the information necessary for screening to the Department

of Law Enforcement within 5 working days after receiving it. The Department of Law Enforcement shall conduct a

search of its records and respond to the employer or agency. The employer must inform the employee whether

screening has revealed any disqualifying information.

(c) For level 2 screening, the employer or agency must submit the information necessary for screening to the

Department of Law Enforcement within 5 working days after receiving it. The Department of Law Enforcement

shall perform a criminal history record check of its records and request that the Federal Bureau of Investigation

perform a national criminal history record check of its records for each employee for whom the request is made. The

Department of Law Enforcement shall respond to the employer or agency, and the employer or agency must inform

the employee whether screening has revealed disqualifying information.

(d) The person whose background is being checked must supply any missing criminal or other necessary

information upon request to the requesting employer or agency within 30 days after receiving the request for the

information.

(2) Every employee must attest, subject to penalty of perjury, to meeting the requirements for qualifying for

employment pursuant to this chapter and agreeing to inform the employer immediately if arrested for any of the

disqualifying offenses while employed by the employer.

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(3) Each employer licensed or registered with an agency must conduct level 2 background screening and must

submit to the agency annually or at the time of license renewal, under penalty of perjury, a signed attestation

attesting to compliance with the provisions of this chapter.


ch. 2009-223; s. 39, ch. 2010-114; s. 7, ch. 2014-84.

435.06 Exclusion from employment.—

(1) If an employer or agency has reasonable cause to believe that grounds exist for the denial or termination of

employment of any employee as a result of background screening, it shall notify the employee in writing, stating the

specific record that indicates noncompliance with the standards in this chapter. It is the responsibility of the affected

employee to contest his or her disqualification or to request exemption from disqualification. The only basis for

contesting the disqualification is proof of mistaken identity.

(2)(a) An employer may not hire, select, or otherwise allow an employee to have contact with any vulnerable

person that would place the employee in a role that requires background screening until the screening process is

completed and demonstrates the absence of any grounds for the denial or termination of employment. If the

screening process shows any grounds for the denial or termination of employment, the employer may not hire,

select, or otherwise allow the employee to have contact with any vulnerable person that would place the employee in

a role that requires background screening unless the employee is granted an exemption for the disqualification by the

agency as provided under s. 435.07.

(b) If an employer becomes aware that an employee has been arrested for a disqualifying offense, the employer

must remove the employee from contact with any vulnerable person that places the employee in a role that requires

background screening until the arrest is resolved in a way that the employer determines that the employee is still

eligible for employment under this chapter.

(c) The employer must terminate the employment of any of its personnel found to be in noncompliance with the

minimum standards of this chapter or place the employee in a position for which background screening is not

required unless the employee is granted an exemption from disqualification pursuant to s. 435.07.

(d) An employer may hire an employee to a position that requires background screening before the employee

completes the screening process for training and orientation purposes. However, the employee may not have direct

contact with vulnerable persons until the screening process is completed and the employee demonstrates that he or

she exhibits no behaviors that warrant the denial or termination of employment.

(3) Any employee who refuses to cooperate in such screening or refuses to timely submit the information

necessary to complete the screening, including fingerprints if required, must be disqualified for employment in such

position or, if employed, must be dismissed.

(4) There is no reemployment assistance or other monetary liability on the part of, and no cause of action for

damages against, an employer that, upon notice of a conviction or arrest for a disqualifying offense listed under this

chapter, terminates the person against whom the report was issued or who was arrested, regardless of whether or not

that person has filed for an exemption pursuant to this chapter.


435.07 Exemptions from disqualification.—Unless otherwise provided by law, the provisions of this section

apply to exemptions from disqualification for disqualifying offenses revealed pursuant to background screenings

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required under this chapter, regardless of whether those disqualifying offenses are listed in this chapter or other

laws.

(1)(a) The head of the appropriate agency may grant to any employee otherwise disqualified from employment

an exemption from disqualification for:

1. Felonies for which at least 3 years have elapsed since the applicant for the exemption has completed or been

lawfully released from confinement, supervision, or nonmonetary condition imposed by the court for the

disqualifying felony;

2. Misdemeanors prohibited under any of the statutes cited in this chapter or under similar statutes of other

jurisdictions for which the applicant for the exemption has completed or been lawfully released from confinement,

supervision, or nonmonetary condition imposed by the court;

3. Offenses that were felonies when committed but that are now misdemeanors and for which the applicant for

the exemption has completed or been lawfully released from confinement, supervision, or nonmonetary condition

imposed by the court; or

4. Findings of delinquency. For offenses that would be felonies if committed by an adult and the record has not

been sealed or expunged, the exemption may not be granted until at least 3 years have elapsed since the applicant for

the exemption has completed or been lawfully released from confinement, supervision, or nonmonetary condition

imposed by the court for the disqualifying offense.

(b) A person applying for an exemption who was ordered to pay any amount for any fee, fine, fund, lien, civil

judgment, application, costs of prosecution, trust, or restitution as part of the judgment and sentence for any

disqualifying felony or misdemeanor must pay the court-ordered amount in full before he or she is eligible for the

exemption.

For the purposes of this subsection, the term “felonies” means both felonies prohibited under any of the statutes cited

in this chapter or under similar statutes of other jurisdictions.

(2) Persons employed, or applicants for employment, by treatment providers who treat adolescents 13 years of

age and older who are disqualified from employment solely because of crimes under s. 796.07(2)(e), s. 810.02(4), s.

812.014(2)(c), s. 817.563, s. 831.01, s. 831.02, s. 893.13, or s. 893.147, or any related criminal attempt, solicitation,

or conspiracy under s. 777.04, may be exempted from disqualification from employment pursuant to this chapter

without application of the waiting period in subparagraph (1)(a)1.

(3)(a) In order for the head of an agency to grant an exemption to any employee, the employee must

demonstrate by clear and convincing evidence that the employee should not be disqualified from employment.

Employees seeking an exemption have the burden of setting forth clear and convincing evidence of rehabilitation,

including, but not limited to, the circumstances surrounding the criminal incident for which an exemption is sought,

the time period that has elapsed since the incident, the nature of the harm caused to the victim, and the history of the

employee since the incident, or any other evidence or circumstances indicating that the employee will not present a

danger if employment or continued employment is allowed.

(b) The agency may consider as part of its deliberations of the employee’s rehabilitation the fact that the

employee has, subsequent to the conviction for the disqualifying offense for which the exemption is being sought,

been arrested for or convicted of another crime, even if that crime is not a disqualifying offense.

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(c) The decision of the head of an agency regarding an exemption may be contested through the hearing

procedures set forth in chapter 120. The standard of review by the administrative law judge is whether the agency’s

intended action is an abuse of discretion.

(4)(a) Disqualification from employment under this chapter may not be removed from, nor may an exemption

be granted to, any personnel who is found guilty of, regardless of adjudication, or who has entered a plea of nolo

contendere or guilty to, any felony covered by s. 435.03 or s. 435.04 solely by reason of any pardon, executive

clemency, or restoration of civil rights.

(b) Disqualification from employment under this chapter may not be removed from, nor may an exemption be

granted to, any person who is a:

1. Sexual predator as designated pursuant to s. 775.21;

2. Career offender pursuant to s. 775.261; or

3. Sexual offender pursuant to s. 943.0435, unless the requirement to register as a sexual offender has been

removed pursuant to s. 943.04354.

(c) Disqualification from employment under this chapter may not be removed from, and an exemption may not

be granted to, any current or prospective child care personnel, as defined in s. 402.302(3), and such a person is

disqualified from employment as child care personnel, regardless of any previous exemptions from disqualification,

if the person has been registered as a sex offender as described in 42 U.S.C. s. 9858f(c)(1)(C) or has been arrested

for and is awaiting final disposition of, has been convicted or found guilty of, or entered a plea of guilty or nolo

contendere to, regardless of adjudication, or has been adjudicated delinquent and the record has not been sealed or

expunged for, any offense prohibited under any of the following provisions of state law or a similar law of another

jurisdiction:

1. A felony offense prohibited under any of the following statutes:

a. Chapter 741, relating to domestic violence.

b. Section 782.04, relating to murder.

c. Section 782.07, relating to manslaughter, aggravated manslaughter of an elderly person or disabled adult,

aggravated manslaughter of a child, or aggravated manslaughter of an officer, a firefighter, an emergency medical

technician, or a paramedic.

d. Section 784.021, relating to aggravated assault.

e. Section 784.045, relating to aggravated battery.

f. Section 787.01, relating to kidnapping.

g. Section 787.025, relating to luring or enticing a child.

h. Section 787.04(2), relating to leading, taking, enticing, or removing a minor beyond the state limits, or

concealing the location of a minor, with criminal intent pending custody proceedings.

i. Section 787.04(3), relating to leading, taking, enticing, or removing a minor beyond the state limits, or

concealing the location of a minor, with criminal intent pending dependency proceedings or proceedings concerning

alleged abuse or neglect of a minor.

j. Section 794.011, relating to sexual battery.

k. Former s. 794.041, relating to sexual activity with or solicitation of a child by a person in familial or

custodial authority.

l. Section 794.05, relating to unlawful sexual activity with certain minors.

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m. Section 794.08, relating to female genital mutilation.

n. Section 806.01, relating to arson.

o. Section 826.04, relating to incest.

p. Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a child.

q. Section 827.04, relating to contributing to the delinquency or dependency of a child.

r. Section 827.071, relating to sexual performance by a child.

s. Chapter 847, relating to child pornography.

t. Chapter 893, relating to a drug abuse prevention and control offense, if that offense was committed in the

preceding 5 years.

u. Section 985.701, relating to sexual misconduct in juvenile justice programs.

2. A misdemeanor offense prohibited under any of the following statutes:

a. Section 784.03, relating to battery, if the victim of the offense was a minor.

b. Section 787.025, relating to luring or enticing a child.

c. Chapter 847, relating to child pornography.

3. A criminal act committed in another state or under federal law which, if committed in this state, constitutes

an offense prohibited under any statute listed in subparagraph 1. or subparagraph 2.

(5) Exemptions granted by one agency shall be considered by subsequent agencies, but are not binding on the

subsequent agency.


ch. 2010-114; s. 8, ch. 2014-84; ss. 1, 3, ch. 2016-98; s. 26, ch. 2016-104; s. 37, ch. 2016-105; s. 15, ch. 2016-238;

s. 20, ch. 2017-37; s. 26, ch. 2018-103.

435.08 Payment for processing of fingerprints and state criminal records checks.—The employer or the

employee is responsible for paying the costs of screening. Payment shall be submitted to the Department of Law

Enforcement with the request for screening. The appropriate agency is responsible for collecting and paying any fee

related to fingerprints retained on its behalf to the Department of Law Enforcement for costs resulting from the

fingerprint information retention services. The amount of the annual fee and procedures for the submission and

retention of fingerprint information and for the dissemination of search results shall be established by rule of the

Department of Law Enforcement.


435.09 Confidentiality of personnel background check information.—No criminal or juvenile information

obtained under this section may be used for any purpose other than determining whether persons meet the minimum

standards for employment or for an owner or director of a covered service provider. The criminal records and

juvenile records obtained by the department or by an employer are exempt from s. 119.07(1).


435.10 Sharing of personnel information among employers.—Every employer of employees covered by this

chapter shall furnish copies of personnel records for employees or former employees to any other employer

requesting this information pursuant to this section. Information contained in the records may include, but is not

limited to, disciplinary matters and any reason for termination. Any employer releasing such records pursuant to this

chapter shall be considered to be acting in good faith and may not be held liable for information contained in such

records, absent a showing that the employer maliciously falsified such records.

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History.—s. 47, ch. 95-228.

435.11 Penalties.—

(1) It is a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083, for any person

willfully, knowingly, or intentionally to:

(a) Fail, by false statement, misrepresentation, impersonation, or other fraudulent means, to disclose in any

application for voluntary or paid employment a material fact used in making a determination as to such person’s

qualifications for a position of special trust.

(b) Use records information for purposes other than screening for employment or release records information to

other persons for purposes other than screening for employment.

(2) It is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, for any

person willfully, knowingly, or intentionally to use juvenile records information for any purposes other than

specified in this section or to release such information to other persons for purposes other than specified in this

section.

History.—s. 47, ch. 95-228; s. 283, ch. 96-406.

435.12 Care Provider Background Screening Clearinghouse.—

(1) The Agency for Health Care Administration in consultation with the Department of Law Enforcement shall

create a secure web-based system, which shall be known as the “Care Provider Background Screening

Clearinghouse” or “clearinghouse,” and which shall be implemented to the full extent practicable no later than

September 30, 2013, subject to the specified agencies being funded and equipped to participate in such program.

The clearinghouse shall allow the results of criminal history checks provided to the specified agencies for screening

of persons qualified as care providers under s. 943.0542 to be shared among the specified agencies when a person

has applied to volunteer, be employed, be licensed, or enter into a contract that requires a state and national

fingerprint-based criminal history check. The Agency for Health Care Administration and the Department of Law

Enforcement may adopt rules to create forms or implement procedures needed to carry out this section.

(2)(a) To ensure that the information in the clearinghouse is current, the fingerprints of an employee required to

be screened by a specified agency and included in the clearinghouse must be:

1. Retained by the Department of Law Enforcement pursuant to s. 943.05(2)(g) and (h) and (3), and the

Department of Law Enforcement must report the results of searching those fingerprints against state incoming arrest

fingerprint submissions to the Agency for Health Care Administration for inclusion in the clearinghouse.

2. Retained by the Federal Bureau of Investigation in the national retained print arrest notification program as

soon as the Department of Law Enforcement begins participation in such program. Arrest prints will be searched

against retained prints at the Federal Bureau of Investigation and notification of arrests will be forwarded to the

Florida Department of Law Enforcement and reported to the Agency for Health Care Administration for inclusion in

the clearinghouse.

3. Resubmitted for a Federal Bureau of Investigation national criminal history check every 5 years until such

time as the fingerprints are retained by the Federal Bureau of Investigation.

4. Subject to retention on a 5-year renewal basis with fees collected at the time of initial submission or

resubmission of fingerprints.

5. Submitted with a photograph of the person taken at the time the fingerprints are submitted.

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(b) Until such time as the fingerprints are enrolled in the national retained print arrest notification program at

the Federal Bureau of Investigation, an employee with a break in service of more than 90 days from a position that

requires screening by a specified agency must submit to a national screening if the person returns to a position that

requires screening by a specified agency.

(c) An employer of persons subject to screening by a specified agency must register with the clearinghouse and

maintain the employment status of all employees within the clearinghouse. Initial employment status and any

changes in status must be reported within 10 business days.

(d) An employer must register with and initiate all criminal history checks through the clearinghouse before

referring an employee or potential employee for electronic fingerprint submission to the Department of Law

Enforcement. The registration must include the employee’s full first name, middle initial, and last name; social

security number; date of birth; mailing address; sex; and race. Individuals, persons, applicants, and controlling

interests that cannot legally obtain a social security number must provide an individual taxpayer identification

number.

(3) An employee who has undergone a fingerprint-based criminal history check by a specified agency before

the clearinghouse is operational is not required to be checked again solely for the purpose of entry in the

clearinghouse. Every employee who is or will become subject to fingerprint-based criminal history checks to be

eligible to be licensed, have their license renewed, or meet screening or rescreening requirements by a specified

agency once the specified agency participates in the clearinghouse shall be subject to the requirements of this section

with respect to entry of records in the clearinghouse and retention of fingerprints for reporting the results of

searching against state incoming arrest fingerprint submissions.

History.—s. 12, ch. 2012-73; s. 9, ch. 2014-84.

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Notes

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5. Chapter 429, Part I,

& Section 429.905, F.S.

5 – 1

CHAPTER 429

ASSISTED CARE COMMUNITIES

PART I

ASSISTED LIVING FACILITIES

(ss. 429.01-429.55)

&

PART III

ADULT DAY CARE CENTERS

(s. 429.905)

429.01 Short title; purpose.

429.02 Definitions.

429.04 Facilities to be licensed; exemptions.

429.07 License required; fee.

429.075 Limited mental health license.

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

429.11 Initial application for license; provisional license.

429.12 Sale or transfer of ownership of a facility.

429.14 Administrative penalties.

429.17 Expiration of license; renewal; conditional license.

429.174 Background screening.

429.176 Notice of change of administrator.

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

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

429.18 Disposition of fees and administrative fines.

429.19 Violations; imposition of administrative fines; grounds.

429.195 Rebates prohibited; penalties.

429.20 Certain solicitation prohibited; third-party supplementation.

429.22 Receivership proceedings.

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

429.24 Contracts.

429.255 Use of personnel; emergency care.

429.256 Assistance with self-administration of medication.

429.26 Appropriateness of placements; examinations of residents.

429.27 Property and personal affairs of residents.

429.275 Business practice; personnel records; liability insurance.

429.28 Resident bill of rights.

5 – 2

429.29 Civil actions to enforce rights.

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

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

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

429.295 Certain provisions not applicable to actions under this part.

429.296 Statute of limitations.

429.297 Punitive damages; pleading; burden of proof.

429.298 Punitive damages; limitation.

429.31 Closing of facility; notice; penalty.

429.34 Right of entry and inspection.

429.35 Maintenance of records; reports.

429.41 Rules establishing standards.

429.42 Pharmacy and dietary services.

429.44 Construction and renovation; requirements.

429.445 Compliance with local zoning requirements.

429.47 Prohibited acts; penalties for violation.

429.49 Resident records; penalties for alteration.

429.52 Staff training and educational programs; core educational requirement.

429.53 Consultation by the agency.

429.54 Collection of information; local subsidy.

429.55 Consumer information website.

429.01 Short title; purpose.—

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

(2) The purpose of this act is to promote the availability of appropriate services for elderly persons and adults

with disabilities in the least restrictive and most homelike environment, to encourage the development of facilities

that promote the dignity, individuality, privacy, and decisionmaking ability of such persons, to provide for the

health, safety, and welfare of residents of assisted living facilities in the state, to promote continued improvement of

such facilities, to encourage the development of innovative and affordable facilities particularly for persons with low

to moderate incomes, to ensure that all agencies of the state cooperate in the protection of such residents, and to

ensure that needed economic, social, mental health, health, and leisure services are made available to residents of

such facilities through the efforts of the Agency for Health Care Administration, the Department of Elderly Affairs,

the Department of Children and Families, the Department of Health, assisted living facilities, and other community

agencies. To the maximum extent possible, appropriate community-based programs must be available to state-

supported residents to augment the services provided in assisted living facilities. The Legislature recognizes that

assisted living facilities are an important part of the continuum of long-term care in the state. In support of the goal

of aging in place, the Legislature further recognizes that assisted living facilities should be operated and regulated as

residential environments with supportive services and not as medical or nursing facilities. The services available in

these facilities, either directly or through contract or agreement, are intended to help residents remain as independent

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as possible. Regulations governing these facilities must be sufficiently flexible to allow facilities to adopt policies

that enable residents to age in place when resources are available to meet their needs and accommodate their

preferences.

(3) The principle that a license issued under this part is a public trust and a privilege and is not an entitlement

should guide the finder of fact or trier of law at any administrative proceeding or in a court action initiated by the

Agency for Health Care Administration to enforce this part.

History.—ss. 1, 2, ch. 75-233; ss. 12, 13, ch. 80-198; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; s. 2, ch. 87-371; s.

2, ch. 91-263; s. 28, ch. 92-33; ss. 1, 38, 39, ch. 93-216; s. 6, ch. 95-210; s. 46, ch. 95-418; s. 122, ch. 99-8; s. 2, ch.

2006-197; s. 243, ch. 2014-19.

Note.—Former s. 400.401.

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

(1) “Activities of daily living” means functions and tasks for self-care, including ambulation, bathing, dressing,

eating, grooming, and toileting, and other similar tasks.

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

maintenance of an assisted living facility.

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

(4) “Aging in place” or “age in place” means the process of providing increased or adjusted services to a person

to compensate for the physical or mental decline that may occur with the aging process, in order to maximize the

person’s dignity and independence and permit them to remain in a familiar, noninstitutional, residential environment

for as long as possible. Such services may be provided by facility staff, volunteers, family, or friends, or through

contractual arrangements with a third party.

(5) “Assisted living facility” means any building or buildings, section or distinct part of a building, private

home, boarding home, home for the aged, or other residential facility, regardless of whether operated for profit,

which through its ownership or management provides housing, meals, and one or more personal services for a

period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator.

(6) “Chemical restraint” means a pharmacologic drug that physically limits, restricts, or deprives an individual

of movement or mobility, and is used for discipline or convenience and not required for the treatment of medical

symptoms.

(7) “Community living support plan” means a written document prepared by a mental health resident and the

resident’s mental health case manager in consultation with the administrator of an assisted living facility with a

limited mental health license or the administrator’s designee. A copy must be provided to the administrator. The

plan must include information about the supports, services, and special needs of the resident which enable the

resident to live in the assisted living facility and a method by which facility staff can recognize and respond to the

signs and symptoms particular to that resident which indicate the need for professional services.

(8) “Cooperative agreement” means a written statement of understanding between a mental health care provider

and the administrator of the assisted living facility with a limited mental health license in which a mental health

resident is living. The agreement must specify directions for accessing emergency and after-hours care for the

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mental health resident. A single cooperative agreement may service all mental health residents who are clients of the

same mental health care provider.

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

(10) “Emergency” means a situation, physical condition, or method of operation which presents imminent

danger of death or serious physical or mental harm to facility residents.

(11) “Extended congregate care” means acts beyond those authorized in subsection (17) that may be performed

pursuant to part I of chapter 464 by persons licensed thereunder while carrying out their professional duties, and

other supportive services which may be specified by rule. The purpose of such services is to enable residents to age

in place in a residential environment despite mental or physical limitations that might otherwise disqualify them

from residency in a facility licensed under this part.

(12) “Guardian” means a person to whom the law has entrusted the custody and control of the person or

property, or both, of a person who has been legally adjudged incapacitated.

(13) “Limited nursing services” means acts that may be performed by a person licensed under part I of chapter

464. Limited nursing services shall be for persons who meet the admission criteria established by the agency for

assisted living facilities but are not complex enough to require 24-hour nursing supervision and may include such

services as the application and care of routine dressings and care of casts, braces, and splints.

(14) “Managed risk” means the process by which the facility staff discuss the service plan and the needs of the

resident with the resident and, if applicable, the resident’s representative or designee or the resident’s surrogate,

guardian, or attorney in fact, in such a way that the consequences of a decision, including any inherent risk, are

explained to all parties and reviewed periodically in conjunction with the service plan, taking into account changes

in the resident’s status and the ability of the facility to respond accordingly.

(15) “Mental health resident” means an individual who receives social security disability income due to a

mental disorder as determined by the Social Security Administration or receives supplemental security income due

to a mental disorder as determined by the Social Security Administration and receives optional state

supplementation.

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

(17) “Personal services” means direct physical assistance with or supervision of the activities of daily living,

the self-administration of medication, or other similar services that the agency may define by rule. The term may not

be construed to mean the provision of medical, nursing, dental, or mental health services.

(18) “Physical restraint” means a device which physically limits, restricts, or deprives an individual of

movement or mobility, including, but not limited to, a half-bed rail, a full-bed rail, a geriatric chair, and a posey

restraint. The term “physical restraint” shall also include any device which was not specifically manufactured as a

restraint but which has been altered, arranged, or otherwise used for this purpose. The term shall not include

bandage material used for the purpose of binding a wound or injury.

(19) “Relative” means an individual who is the father, mother, stepfather, stepmother, son, daughter, brother,

sister, grandmother, grandfather, great-grandmother, great-grandfather, grandson, granddaughter, uncle, aunt, first

cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law,

sister-in-law, stepson, stepdaughter, stepbrother, stepsister, half brother, or half sister of an owner or administrator.

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

(21) “Resident’s representative or designee” means a person other than the owner, or an agent or employee of

the facility, designated in writing by the resident, if legally competent, to receive notice of changes in the contract

executed pursuant to s. 429.24; to receive notice of and to participate in meetings between the resident and the

facility owner, administrator, or staff concerning the rights of the resident; to assist the resident in contacting the

State Long-Term Care Ombudsman Program or local ombudsman council if the resident has a complaint against the

facility; or to bring legal action on behalf of the resident pursuant to s. 429.29.

(22) “Service plan” means a written plan, developed and agreed upon by the resident and, if applicable, the

resident’s representative or designee or the resident’s surrogate, guardian, or attorney in fact, if any, and the

administrator or designee representing the facility, which addresses the unique physical and psychosocial needs,

abilities, and personal preferences of each resident receiving extended congregate care services. The plan shall

include a brief written description, in easily understood language, of what services shall be provided, who shall

provide the services, when the services shall be rendered, and the purposes and benefits of the services.

(23) “Shared responsibility” means exploring the options available to a resident within a facility and the risks

involved with each option when making decisions pertaining to the resident’s abilities, preferences, and service

needs, thereby enabling the resident and, if applicable, the resident’s representative or designee, or the resident’s

surrogate, guardian, or attorney in fact, and the facility to develop a service plan which best meets the resident’s

needs and seeks to improve the resident’s quality of life.

(24) “Supervision” means reminding residents to engage in activities of daily living and the self-administration

of medication, and, when necessary, observing or providing verbal cuing to residents while they perform these

activities.

(25) “Supplemental security income,” Title XVI of the Social Security Act, means a program through which the

Federal Government guarantees a minimum monthly income to every person who is age 65 or older, or disabled, or

blind and meets the income and asset requirements.

(26) “Supportive services” means services designed to encourage and assist aged persons or adults with

disabilities to remain in the least restrictive living environment and to maintain their independence as long as

possible.

(27) “Twenty-four-hour nursing supervision” means services that are ordered by a physician for a resident

whose condition requires the supervision of a physician and continued monitoring of vital signs and physical status.

Such services shall be: medically complex enough to require constant supervision, assessment, planning, or

intervention by a nurse; required to be performed by or under the direct supervision of licensed nursing personnel or

other professional personnel for safe and effective performance; required on a daily basis; and consistent with the

nature and severity of the resident’s condition or the disease state or stage.

History.—s. 3, ch. 75-233; ss. 12, 14, ch. 80-198; s. 2, ch. 81-318; ss. 6, 19, ch. 82-148; ss. 41, 79, 83, ch. 83-

181; s. 4, ch. 85-145; s. 3, ch. 87-371; s. 10, ch. 89-294; s. 3, ch. 91-263; s. 1, ch. 93-209; ss. 2, 38, 39, ch. 93-216; s.

7, ch. 95-210; ss. 1, 22, 47, ch. 95-418; s. 2, ch. 97-82; s. 1, ch. 98-80; s. 98, ch. 2000-318; ss. 2, 29, ch. 2006-197; s.

138, ch. 2007-230; s. 34, ch. 2015-31; s. 5, ch. 2015-126; s. 79, ch. 2018-24; s. 8, ch. 2019-11.


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429.04 Facilities to be licensed; exemptions.—

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

facilities as defined in this part.

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

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

Government.

(b) Any facility or part of a facility licensed by the Agency for Persons with Disabilities under chapter 393, a

mental health facility licensed under chapter 394, a hospital licensed under chapter 395, a nursing home licensed

under part II of chapter 400, an inpatient hospice licensed under part IV of chapter 400, a home for special services

licensed under part V of chapter 400, an intermediate care facility licensed under part VIII of chapter 400, or a

transitional living facility licensed under part XI of chapter 400.

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

(d) Any person who provides housing, meals, and one or more personal services on a 24-hour basis in the

person’s own home to not more than two adults who do not receive optional state supplementation. The person who

provides the housing, meals, and personal services must own or rent the home and must have established the home

as his or her permanent residence. For purposes of this paragraph, any person holding a homestead exemption at an

address other than that at which the person asserts this exemption is presumed to not have established permanent

residence. This exemption does not apply to a person or entity that previously held a license issued by the agency

which was revoked or for which renewal was denied by final order of the agency, or when the person or entity

voluntarily relinquished the license during agency enforcement proceedings.

(e) Any home or facility approved by the United States Department of Veterans Affairs as a residential care

home wherein care is provided exclusively to three or fewer veterans.

(f) Any facility that has been incorporated in this state for 50 years or more on or before July 1, 1983, and the

board of directors of which is nominated or elected by the residents, until the facility is sold or its ownership is

transferred; or any facility, with improvements or additions thereto, which has existed and operated continuously in

this state for 60 years or more on or before July 1, 1989, is directly or indirectly owned and operated by a nationally

recognized fraternal organization, is not open to the public, and accepts only its own members and their spouses as

residents.

(g) Any facility certified under chapter 651, or a retirement community, may provide services authorized under

this part or part III of chapter 400 to its residents who live in single-family homes, duplexes, quadruplexes, or

apartments located on the campus without obtaining a license to operate an assisted living facility if residential units

within such buildings are used by residents who do not require staff supervision for that portion of the day when

personal services are not being delivered and the owner obtains a home health license to provide such services.

However, any building or distinct part of a building on the campus that is designated for persons who receive

personal services and require supervision beyond that which is available while such services are being rendered

must be licensed in accordance with this part. If a facility provides personal services to residents who do not

otherwise require supervision and the owner is not licensed as a home health agency, the buildings or distinct parts

of buildings where such services are rendered must be licensed under this part. A resident of a facility that obtains a

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home health license may contract with a home health agency of his or her choice, provided that the home health

agency provides liability insurance and workers’ compensation coverage for its employees. Facilities covered by this

exemption may establish policies that give residents the option of contracting for services and care beyond that

which is provided by the facility to enable them to age in place. For purposes of this section, a retirement

community consists of a facility licensed under this part or under part II of chapter 400, and apartments designed for

independent living located on the same campus.

(h) Any residential unit for independent living which is located within a facility certified under chapter 651, or

any residential unit which is colocated with a nursing home licensed under part II of chapter 400 or colocated with a

facility licensed under this part in which services are provided through an outpatient clinic or a nursing home on an

outpatient basis.

(3) Upon agency investigation of unlicensed activity, any person or entity that claims that it is exempt under

this section must provide documentation substantiating entitlement to the exemption.

History.—ss. 4, 5, ch. 75-233; ss. 12, 15, ch. 80-198; s. 2, ch. 81-318; ss. 42, 79, 83, ch. 83-181; s. 4, ch. 87-371;

s. 4, ch. 91-263; ss. 3, 38, 39, ch. 93-216; s. 19, ch. 93-268; s. 2, ch. 94-206; s. 1055, ch. 95-148; s. 8, ch. 95-210; s.

2, ch. 98-80; s. 1, ch. 98-148; ss. 2, 30, ch. 2006-197; s. 80, ch. 2018-24.


429.07 License required; fee.—

(1) The requirements of part II of chapter 408 apply to the provision of services that require licensure pursuant

to this part and part II of chapter 408 and to entities licensed by or applying for such licensure from the agency

pursuant to this part. A license issued by the agency is required in order to operate an assisted living facility in this

state.

(2) Separate licenses shall be required for facilities maintained in separate premises, even though operated

under the same management. A separate license shall not be required for separate buildings on the same grounds.

(3) In addition to the requirements of s. 408.806, each license granted by the agency must state the type of care

for which the license is granted. Licenses shall be issued for one or more of the following categories of care:

standard, extended congregate care, limited nursing services, or limited mental health.

(a) A standard license shall be issued to facilities providing one or more of the personal services identified in s.

429.02. Such facilities may also employ or contract with a person licensed under part I of chapter 464 to administer

medications and perform other tasks as specified in s. 429.255.

(b) An extended congregate care license shall be issued to each facility that has been licensed as an assisted

living facility for 2 or more years and that provides services, directly or through contract, beyond those authorized in

paragraph (a), including services performed by persons licensed under part I of chapter 464 and supportive services,

as defined by rule, to persons who would otherwise be disqualified from continued residence in a facility licensed

under this part. An extended congregate care license may be issued to a facility that has a provisional extended

congregate care license and meets the requirements for licensure under subparagraph 2. The primary purpose of

extended congregate care services is to allow residents the option of remaining in a familiar setting from which they

would otherwise be disqualified for continued residency as they become more impaired. A facility licensed to

provide extended congregate care services may also admit an individual who exceeds the admission criteria for a

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facility with a standard license, if he or she is determined appropriate for admission to the extended congregate care

facility.

1. In order for extended congregate care services to be provided, the agency must first determine that all

requirements established in law and rule are met and must specifically designate, on the facility’s license, that such

services may be provided and whether the designation applies to all or part of the facility. This designation may be

made at the time of initial licensure or relicensure, or upon request in writing by a licensee under this part and part II

of chapter 408. The notification of approval or the denial of the request shall be made in accordance with part II of

chapter 408. Each existing facility that qualifies to provide extended congregate care services must have maintained

a standard license and may not have been subject to administrative sanctions during the previous 2 years, or since

initial licensure if the facility has been licensed for less than 2 years, for any of the following reasons:

a. A class I or class II violation;

b. Three or more repeat or recurring class III violations of identical or similar resident care standards from

which a pattern of noncompliance is found by the agency;

c. Three or more class III violations that were not corrected in accordance with the corrective action plan

approved by the agency;

d. Violation of resident care standards which results in requiring the facility to employ the services of a

consultant pharmacist or consultant dietitian;

e. Denial, suspension, or revocation of a license for another facility licensed under this part in which the

applicant for an extended congregate care license has at least 25 percent ownership interest; or

f. Imposition of a moratorium pursuant to this part or part II of chapter 408 or initiation of injunctive

proceedings.

The agency may deny or revoke a facility’s extended congregate care license for not meeting the criteria for an

extended congregate care license as provided in this subparagraph.

2. If an assisted living facility has been licensed for less than 2 years, the initial extended congregate care

license must be provisional and may not exceed 6 months. The licensee shall notify the agency, in writing, when it

has admitted at least one extended congregate care resident, after which an unannounced inspection shall be made to

determine compliance with the requirements of an extended congregate care license. A licensee with a provisional

extended congregate care license that demonstrates compliance with all the requirements of an extended congregate

care license during the inspection shall be issued an extended congregate care license. In addition to sanctions

authorized under this part, if violations are found during the inspection and the licensee fails to demonstrate

compliance with all assisted living facility requirements during a followup inspection, the licensee shall immediately

suspend extended congregate care services, and the provisional extended congregate care license expires. The

agency may extend the provisional license for not more than 1 month in order to complete a followup visit.

3. A facility that is licensed to provide extended congregate care services shall maintain a written progress

report on each person who receives services which describes the type, amount, duration, scope, and outcome of

services that are rendered and the general status of the resident’s health. A registered nurse, or appropriate designee,

representing the agency shall visit the facility at least twice a year to monitor residents who are receiving extended

congregate care services and to determine if the facility is in compliance with this part, part II of chapter 408, and

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relevant rules. One of the visits may be in conjunction with the regular survey. The monitoring visits may be

provided through contractual arrangements with appropriate community agencies. A registered nurse shall serve as

part of the team that inspects the facility. The agency may waive one of the required yearly monitoring visits for a

facility that has:

a. Held an extended congregate care license for at least 24 months;

b. No class I or class II violations and no uncorrected class III violations; and

c. No ombudsman council complaints that resulted in a citation for licensure.

4. A facility that is licensed to provide extended congregate care services must:

a. Demonstrate the capability to meet unanticipated resident service needs.

b. Offer a physical environment that promotes a homelike setting, provides for resident privacy, promotes

resident independence, and allows sufficient congregate space as defined by rule.

c. Have sufficient staff available, taking into account the physical plant and firesafety features of the building,

to assist with the evacuation of residents in an emergency.

d. Adopt and follow policies and procedures that maximize resident independence, dignity, choice, and

decisionmaking to permit residents to age in place, so that moves due to changes in functional status are minimized

or avoided.

e. Allow residents or, if applicable, a resident’s representative, designee, surrogate, guardian, or attorney in fact

to make a variety of personal choices, participate in developing service plans, and share responsibility in

decisionmaking.

f. Implement the concept of managed risk.

g. Provide, directly or through contract, the services of a person licensed under part I of chapter 464.

h. In addition to the training mandated in s. 429.52, provide specialized training as defined by rule for facility

staff.

5. A facility that is licensed to provide extended congregate care services is exempt from the criteria for

continued residency set forth in rules adopted under s. 429.41. A licensed facility must adopt its own requirements

within guidelines for continued residency set forth by rule. However, the facility may not serve residents who

require 24-hour nursing supervision. A licensed facility that provides extended congregate care services must also

provide each resident with a written copy of facility policies governing admission and retention.

6. Before the admission of an individual to a facility licensed to provide extended congregate care services, the

individual must undergo a medical examination as provided in s. 429.26(4) and the facility must develop a

preliminary service plan for the individual.

7. If a facility can no longer provide or arrange for services in accordance with the resident’s service plan and

needs and the facility’s policy, the facility must make arrangements for relocating the person in accordance with s.

429.28(1)(k).

(c) A limited nursing services license shall be issued to a facility that provides services beyond those authorized

in paragraph (a) and as specified in this paragraph.

1. In order for limited nursing services to be provided in a facility licensed under this part, the agency must first

determine that all requirements established in law and rule are met and must specifically designate, on the facility’s

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license, that such services may be provided. This designation may be made at the time of initial licensure or

licensure renewal, or upon request in writing by a licensee under this part and part II of chapter 408. Notification of

approval or denial of such request shall be made in accordance with part II of chapter 408. An existing facility that

qualifies to provide limited nursing services must have maintained a standard license and may not have been subject

to administrative sanctions that affect the health, safety, and welfare of residents for the previous 2 years or since

initial licensure if the facility has been licensed for less than 2 years.

2. A facility that is licensed to provide limited nursing services shall maintain a written progress report on each

person who receives such nursing services. The report must describe the type, amount, duration, scope, and outcome

of services that are rendered and the general status of the resident’s health. A registered nurse representing the

agency shall visit the facility at least annually to monitor residents who are receiving limited nursing services and to

determine if the facility is in compliance with applicable provisions of this part, part II of chapter 408, and related

rules. The monitoring visits may be provided through contractual arrangements with appropriate community

agencies. A registered nurse shall also serve as part of the team that inspects such facility. Visits may be in

conjunction with other agency inspections. The agency may waive the required yearly monitoring visit for a facility

that has:

a. Had a limited nursing services license for at least 24 months;

b. No class I or class II violations and no uncorrected class III violations; and

c. No ombudsman council complaints that resulted in a citation for licensure.

3. A person who receives limited nursing services under this part must meet the admission criteria established

by the agency for assisted living facilities. When a resident no longer meets the admission criteria for a facility

licensed under this part, arrangements for relocating the person shall be made in accordance with s. 429.28(1)(k),

unless the facility is licensed to provide extended congregate care services.

(4) In accordance with s. 408.805, an applicant or licensee shall pay a fee for each license application submitted

under this part, part II of chapter 408, and applicable rules. The amount of the fee shall be established by rule.

(a) The biennial license fee required of a facility is $300 per license, with an additional fee of $50 per resident

based on the total licensed resident capacity of the facility, except that no additional fee will be assessed for beds

designated for recipients of optional state supplementation payments provided for in s. 409.212. The total fee may

not exceed $10,000.

(b) In addition to the total fee assessed under paragraph (a), the agency shall require facilities that are licensed

to provide extended congregate care services under this part to pay an additional fee per licensed facility. The

amount of the biennial fee shall be $400 per license, with an additional fee of $10 per resident based on the total

licensed resident capacity of the facility.

(c) In addition to the total fee assessed under paragraph (a), the agency shall require facilities that are licensed

to provide limited nursing services under this part to pay an additional fee per licensed facility. The amount of the

biennial fee shall be $250 per license, with an additional fee of $10 per resident based on the total licensed resident

capacity of the facility.

(5) Counties or municipalities applying for licenses under this part are exempt from the payment of license fees.

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History.—s. 6, ch. 75-233; s. 8, ch. 79-12; ss. 12, 16, ch. 80-198; s. 2, ch. 81-318; ss. 43, 79, 83, ch. 83-181; s. 2,

ch. 86-104; s. 5, ch. 87-371; s. 11, ch. 89-294; s. 5, ch. 91-263; s. 10, ch. 91-282; s. 22, ch. 93-177; ss. 4, 38, 39, ch.

93-216; s. 20, ch. 95-146; s. 9, ch. 95-210; ss. 2, 18, 23, ch. 95-418; s. 3, ch. 97-82; s. 18, ch. 97-96; s. 3, ch. 98-80;

s. 99, ch. 2000-318; s. 33, ch. 2001-45; ss. 2, 31, ch. 2006-197; s. 101, ch. 2007-5; s. 139, ch. 2007-230; s. 141, ch.

2010-102; s. 6, ch. 2015-126.


429.075 Limited mental health license.—An assisted living facility that serves one or more mental health

residents must obtain a limited mental health license.

(1) To obtain a limited mental health license, a facility must hold a standard license as an assisted living

facility, must not have any current uncorrected violations, and must ensure that, within 6 months after receiving a

limited mental health license, the facility administrator and the staff of the facility who are in direct contact with

mental health residents must complete training of no less than 6 hours related to their duties. This designation may

be made at the time of initial licensure or relicensure or upon request in writing by a licensee under this part and part

II of chapter 408. Notification of approval or denial of such request shall be made in accordance with this part, part

II of chapter 408, and applicable rules. This training must be provided by or approved by the Department of

Children and Families.

(2) A facility that is licensed to provide services to mental health residents must provide appropriate

supervision and staffing to provide for the health, safety, and welfare of such residents.

(3) A facility that has a limited mental health license must:

(a) Have a copy of each mental health resident’s community living support plan and the cooperative agreement

with the mental health care services provider or provide written evidence that a request for the community living

support plan and the cooperative agreement was sent to the Medicaid managed care plan or managing entity under

contract with the Department of Children and Families within 72 hours after admission. The support plan and the

agreement may be combined.

(b) Have documentation provided by the department that each mental health resident has been assessed and

determined to be able to live in the community in an assisted living facility that has a limited mental health license

or provide written evidence that a request for documentation was sent to the department within 72 hours after

admission.

(c) Make the community living support plan available for inspection by the resident, the resident’s legal

guardian or health care surrogate, and other individuals who have a lawful basis for reviewing this document.

(d) Assist the mental health resident in carrying out the activities identified in the resident’s community living

support plan.

(4) A facility that has a limited mental health license may enter into a cooperative agreement with a private

mental health provider. For purposes of the limited mental health license, the private mental health provider may act

as the case manager.

History.—s. 3, ch. 95-418; s. 37, ch. 96-169; s. 4, ch. 97-82; s. 66, ch. 97-100; s. 4, ch. 98-80; s. 2, ch. 2006-197;

s. 140, ch. 2007-230; s. 244, ch. 2014-19; s. 7, ch. 2015-126.


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

(1)(a) This section applies to the unlicensed operation of an assisted living facility in addition to the

requirements of part II of chapter 408.

(b) Any person who owns, rents, or otherwise maintains a building or property used as an unlicensed assisted

living facility commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

Each day of continued operation is a separate offense.

(c) Any person found guilty of violating paragraph (a) a second or subsequent time commits a felony of the

second degree, punishable as provided under s. 775.082, s. 775.083, or s. 775.084. Each day of continued operation

is a separate offense.

(d) In addition to the requirements of s. 408.812, any person who owns, operates, or maintains an unlicensed

assisted living facility after receiving notice from the agency commits a felony of the third degree, punishable as

provided in s. 775.082, s. 775.083, or s. 775.084. Each day of continued operation is a separate offense.

(e) The agency shall publish a list, by county, of licensed assisted living facilities. This information may be

provided electronically or through the agency’s Internet site.

(2) It is unlawful to knowingly refer a person for residency to an unlicensed assisted living facility; to an

assisted living facility the license of which is under denial or has been suspended or revoked; or to an assisted living

facility that has a moratorium pursuant to part II of chapter 408.

(a) Any health care practitioner, as defined in s. 456.001, who is aware of the operation of an unlicensed facility

shall report that facility to the agency. Failure to report a facility that the practitioner knows or has reasonable cause

to suspect is unlicensed shall be reported to the practitioner’s licensing board.

(b) Any provider as defined in s. 408.803 which knowingly discharges a patient or client to an unlicensed

facility is subject to sanction by the agency.

(c) Any employee of the agency or department, or the Department of Children and Families, who knowingly

refers a person for residency to an unlicensed facility; to a facility the license of which is under denial or has been

suspended or revoked; or to a facility that has a moratorium pursuant to part II of chapter 408 is subject to

disciplinary action by the agency or department, or the Department of Children and Families.

(d) The employer of any person who is under contract with the agency or department, or the Department of

Children and Families, and who knowingly refers a person for residency to an unlicensed facility; to a facility the

license of which is under denial or has been suspended or revoked; or to a facility that has a moratorium pursuant to

part II of chapter 408 shall be fined and required to prepare a corrective action plan designed to prevent such

referrals.

History.—s. 17, ch. 88-350; s. 6, ch. 91-263; s. 29, ch. 92-33; ss. 5, 39, ch. 93-216; s. 10, ch. 95-210; ss. 4, 48,

ch. 95-418; s. 5, ch. 98-80; s. 1, ch. 99-179; s. 1, ch. 2000-318; s. 36, ch. 2001-62; s. 2, ch. 2004-344; ss. 2, 33, ch.

2006-197; s. 141, ch. 2007-230; s. 60, ch. 2009-223; s. 245, ch. 2014-19; s. 81, ch. 2018-24.


429.11 Initial application for license; provisional license.—

(1) Each applicant for licensure must comply with all provisions of part II of chapter 408 and must:

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(a) Identify all other homes or facilities, including the addresses and the license or licenses under which they

operate, if applicable, which are currently operated by the applicant or administrator and which provide housing,

meals, and personal services to residents.

(b) Provide the location of the facility for which a license is sought and documentation, signed by the

appropriate local government official, which states that the applicant has met local zoning requirements.

(c) Provide the name, address, date of birth, social security number, education, and experience of the

administrator, if different from the applicant.

(2) The applicant shall provide proof of liability insurance as defined in s. 624.605.

(3) If the applicant is a community residential home, the applicant must provide proof that it has met the

requirements specified in chapter 419.

(4) The applicant must furnish proof that the facility has received a satisfactory firesafety inspection. The local

authority having jurisdiction or the State Fire Marshal must conduct the inspection within 30 days after written

request by the applicant.

(5) The applicant must furnish documentation of a satisfactory sanitation inspection of the facility by the county

health department.

(6) In addition to the license categories available in s. 408.808, a provisional license may be issued to an

applicant making initial application for licensure or making application for a change of ownership. A provisional

license shall be limited in duration to a specific period of time not to exceed 6 months, as determined by the agency.

(7) A county or municipality may not issue an occupational license that is being obtained for the purpose of

operating a facility regulated under this part without first ascertaining that the applicant has been licensed to operate

such facility at the specified location or locations by the agency. The agency shall furnish to local agencies

responsible for issuing occupational licenses sufficient instruction for making such determinations.

History.—s. 7, ch. 75-233; s. 3, ch. 77-323; ss. 12, 17, ch. 80-198; s. 2, ch. 81-318; ss. 7, 19, ch. 82-148; ss. 44,

47, 79, 83, ch. 83-181; s. 5, ch. 85-145; s. 1, ch. 85-251; s. 6, ch. 87-371; s. 12, ch. 89-294; s. 7, ch. 91-263; ss. 6,

38, 39, ch. 93-216; s. 5, ch. 95-418; s. 6, ch. 98-80; s. 42, ch. 98-171; ss. 2, 34, ch. 2006-197; s. 142, ch. 2007-230.


429.12 Sale or transfer of ownership of a facility.—It is the intent of the Legislature to protect the rights of

the residents of an assisted living facility when the facility is sold or the ownership thereof is transferred. Therefore,

in addition to the requirements of part II of chapter 408, whenever a facility is sold or the ownership thereof is

transferred, including leasing:

(1) The transferee shall notify the residents, in writing, of the change of ownership within 7 days after receipt of

the new license.

(2) The transferor of a facility the license of which is denied pending an administrative hearing shall, as a part

of the written change-of-ownership contract, advise the transferee that a plan of correction must be submitted by the

transferee and approved by the agency at least 7 days before the change of ownership and that failure to correct the

condition which resulted in the moratorium pursuant to part II of chapter 408 or denial of licensure is grounds for

denial of the transferee’s license.

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History.—ss. 45, 83, ch. 83-181; s. 7, ch. 87-371; s. 8, ch. 91-263; ss. 7, 38, 39, ch. 93-216; s. 772, ch. 95-148; s.

11, ch. 95-210; s. 6, ch. 95-418; ss. 2, 35, ch. 2006-197; s. 143, ch. 2007-230.


429.14 Administrative penalties.—

(1) In addition to the requirements of part II of chapter 408, the agency may deny, revoke, and suspend any

license issued under this part and impose an administrative fine in the manner provided in chapter 120 against a

licensee for a violation of any provision of this part, part II of chapter 408, or applicable rules, or for any of the

following actions by a licensee, any person subject to level 2 background screening under s. 408.809, or any facility

staff:

(a) An intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility.

(b) A determination by the agency that the owner lacks the financial ability to provide continuing adequate care

to residents.

(c) Misappropriation or conversion of the property of a resident of the facility.

(d) Failure to follow the criteria and procedures provided under part I of chapter 394 relating to the

transportation, voluntary admission, and involuntary examination of a facility resident.

(e) A citation for any of the following violations as specified in s. 429.19:

1. One or more cited class I violations.

2. Three or more cited class II violations.

3. Five or more cited class III violations that have been cited on a single survey and have not been corrected

within the times specified.

(f) Failure to comply with the background screening standards of this part, s. 408.809(1), or chapter 435.

(g) Violation of a moratorium.

(h) Failure of the license applicant, the licensee during relicensure, or a licensee that holds a provisional license

to meet the minimum license requirements of this part, or related rules, at the time of license application or renewal.

(i) An intentional or negligent life-threatening act in violation of the uniform firesafety standards for assisted

living facilities or other firesafety standards which threatens the health, safety, or welfare of a resident of a facility,

as communicated to the agency by the local authority having jurisdiction or the State Fire Marshal.

(j) Knowingly operating any unlicensed facility or providing without a license any service that must be licensed

under this chapter or chapter 400.

(k) Any act constituting a ground upon which application for a license may be denied.

(2) Upon notification by the local authority having jurisdiction or by the State Fire Marshal, the agency may

deny or revoke the license of an assisted living facility that fails to correct cited fire code violations that affect or

threaten the health, safety, or welfare of a resident of a facility.

(3) The agency may deny a license of an applicant or a controlling interest as defined in part II of chapter 408

which has or had a 25 percent or greater financial or ownership interest in any other facility that is licensed under

this part, or in any entity licensed by this state or another state to provide health or residential care, if that facility or

entity during the 5 years prior to the application for a license closed due to financial inability to operate; had a

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receiver appointed or a license denied, suspended, or revoked; was subject to a moratorium; or had an injunctive

proceeding initiated against it.

(4) The agency shall deny or revoke the license of an assisted living facility if:

(a) There are two moratoria, issued pursuant to this part or part II of chapter 408, within a 2-year period which

are imposed by final order;

(b) The facility is cited for two or more class I violations arising from unrelated circumstances during the same

survey or investigation; or

(c) The facility is cited for two or more class I violations arising from separate surveys or investigations within

a 2-year period.

(5) An action taken by the agency to suspend, deny, or revoke a facility’s license under this part or part II of

chapter 408, in which the agency claims that the facility owner or an employee of the facility has threatened the

health, safety, or welfare of a resident of the facility, shall be heard by the Division of Administrative Hearings of

the Department of Management Services within 120 days after receipt of the facility’s request for a hearing, unless

that time limitation is waived by both parties. The administrative law judge shall render a decision within 30 days

after receipt of a proposed recommended order.

(6) As provided under s. 408.814, the agency shall impose an immediate moratorium on an assisted living

facility that fails to provide the agency with access to the facility or prohibits the agency from conducting a

regulatory inspection. The licensee may not restrict agency staff from accessing and copying records at the agency’s

expense or from conducting confidential interviews with facility staff or any individual who receives services from

the facility.

(7) Agency notification of a license suspension or revocation, or denial of a license renewal, shall be posted and

visible to the public at the facility.

(8) If a facility is required to relocate some or all of its residents due to agency action, that facility is exempt

from the 45-day notice requirement imposed under s. 429.28(1)(k). This subsection does not exempt the facility

from any deadlines for corrective action set by the agency.

History.—s. 8, ch. 75-233; ss. 12, 18, ch. 80-198; s. 2, ch. 81-318; ss. 46, 79, 83, ch. 83-181; s. 8, ch. 87-371; s.

13, ch. 89-294; s. 30, ch. 91-71; s. 46, ch. 92-58; ss. 8, 38, 39, ch. 93-216; s. 50, ch. 94-218; s. 39, ch. 95-228; s. 7,

ch. 95-418; s. 38, ch. 96-169; s. 126, ch. 96-410; s. 7, ch. 98-80; s. 43, ch. 98-171; s. 73, ch. 2000-349; s. 34, ch.

2001-45; s. 19, ch. 2003-57; s. 13, ch. 2004-267; ss. 2, 36, ch. 2006-197; s. 144, ch. 2007-230; s. 61, ch. 2009-223;

s. 28, ch. 2010-114; s. 108, ch. 2014-17; s. 8, ch. 2015-126.


429.17 Expiration of license; renewal; conditional license.—

(1) Limited nursing, extended congregate care, and limited mental health licenses shall expire at the same time

as the facility’s standard license, regardless of when issued.

(2) A license shall be renewed in accordance with part II of chapter 408 and the provision of satisfactory proof

of ability to operate and conduct the facility in accordance with the requirements of this part and adopted rules,

including proof that the facility has received a satisfactory firesafety inspection, conducted by the local authority

having jurisdiction or the State Fire Marshal, within the preceding 12 months.

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(3) In addition to the requirements of part II of chapter 408, each facility must report to the agency any adverse

court action concerning the facility’s financial viability, within 7 days after its occurrence. The agency shall have

access to books, records, and any other financial documents maintained by the facility to the extent necessary to

determine the facility’s financial stability.

(4) In addition to the license categories available in s. 408.808, a conditional license may be issued to an

applicant for license renewal if the applicant fails to meet all standards and requirements for licensure. A conditional

license issued under this subsection shall be limited in duration to a specific period of time not to exceed 6 months,

as determined by the agency, and shall be accompanied by an agency-approved plan of correction.

(5) When an extended care or limited nursing license is requested during a facility’s biennial license period, the

fee shall be prorated in order to permit the additional license to expire at the end of the biennial license period. The

fee shall be calculated as of the date the additional license application is received by the agency.

(6) The agency may by rule establish renewal procedures, identify forms, and specify documentation necessary

to administer this section and may adopt rules to administer part II of chapter 408.

History.—s. 9, ch. 75-233; ss. 12, 19, ch. 80-198; s. 2, ch. 81-318; ss. 9, 19, ch. 82-148; ss. 47, 79, 83, ch. 83-

181; s. 2, ch. 88-350; s. 14, ch. 89-294; s. 9, ch. 91-263; s. 23, ch. 93-177; ss. 10, 38, 39, ch. 93-216; s. 9, ch. 95-

418; s. 9, ch. 98-80; s. 44, ch. 98-171; s. 212, ch. 99-13; s. 20, ch. 2003-57; ss. 2, 38, ch. 2006-197; s. 146, ch. 2007-

230; s. 9, ch. 2019-11.


429.174 Background screening.—The agency shall require level 2 background screening for personnel as

required in s. 408.809(1)(e) pursuant to chapter 435 and s. 408.809.

History.—ss. 15, 25, ch. 89-294; ss. 11, 38, 39, ch. 93-216; s. 10, ch. 98-80; ss. 45, 71, ch. 98-171; s. 142, ch. 98-


2003-261; s. 14, ch. 2004-267; ss. 2, 39, ch. 2006-197; s. 147, ch. 2007-230; s. 29, ch. 2010-114.


429.176 Notice of change of administrator.—If, during the period for which a license is issued, the owner

changes administrators, the owner must notify the agency of the change within 10 days and provide documentation

within 90 days that the new administrator has completed the applicable core educational requirements under s.

429.52. A facility may not be operated for more than 120 consecutive days without an administrator who has

completed the core educational requirements.

History.—ss. 44, 83, ch. 83-181; s. 10, ch. 91-263; ss. 12, 38, 39, ch. 93-216; ss. 10, 24, ch. 95-418; s. 11, ch. 98-

80; s. 46, ch. 98-171; ss. 2, 40, ch. 2006-197; s. 148, ch. 2007-230; s. 82, ch. 2018-24.


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

licensed under this part which claims that it provides special care for persons who have Alzheimer’s disease or other

related disorders must disclose in its advertisements or in a separate document those services that distinguish the

care as being especially applicable to, or suitable for, such persons. The facility must give a copy of all such

advertisements or a copy of the document to each person who requests information about programs and services for

persons with Alzheimer’s disease or other related disorders offered by the facility and must maintain a copy of all

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such advertisements and documents in its records. The agency shall examine all such advertisements and documents

in the facility’s records as part of the license renewal procedure.

History.—s. 2, ch. 93-105; s. 2, ch. 2006-197.


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

(1) A facility which advertises that it provides special care for persons with Alzheimer’s disease or other related

disorders must meet the following standards of operation:

(a)1. If the facility has 17 or more residents, have an awake staff member on duty at all hours of the day and

night; or

2. If the facility has fewer than 17 residents, have an awake staff member on duty at all hours of the day and

night or have mechanisms in place to monitor and ensure the safety of the facility’s residents.

(b) Offer activities specifically designed for persons who are cognitively impaired.

(c) Have a physical environment that provides for the safety and welfare of the facility’s residents.

(d) Employ staff who have completed the training and continuing education required in subsection (2).

(2)(a) An individual who is employed by a facility that provides special care for residents who have

Alzheimer’s disease or other related disorders, and who has regular contact with such residents, must complete up to

4 hours of initial dementia-specific training developed or approved by the department. The training must be

completed within 3 months after beginning employment and satisfy the core training requirements of s.

429.52(3)(g).

(b) A direct caregiver who is employed by a facility that provides special care for residents who have

Alzheimer’s disease or other related disorders and provides direct care to such residents must complete the required

initial training and 4 additional hours of training developed or approved by the department. The training must be

completed within 9 months after beginning employment and satisfy the core training requirements of s.

429.52(3)(g).

(c) An individual who is employed by a facility that provides special care for residents with Alzheimer’s

disease or other related disorders, but who only has incidental contact with such residents, must be given, at a

minimum, general information on interacting with individuals with Alzheimer’s disease or other related disorders,

within 3 months after beginning employment.

(3) In addition to the training required under subsection (2), a direct caregiver must participate in a minimum of

4 contact hours of continuing education each calendar year. The continuing education must include one or more

topics included in the dementia-specific training developed or approved by the department, in which the caregiver

has not received previous training.

(4) Upon completing any training listed in subsection (2), the employee or direct caregiver shall be issued a

certificate that includes the name of the training provider, the topic covered, and the date and signature of the

training provider. The certificate is evidence of completion of training in the identified topic, and the employee or

direct caregiver is not required to repeat training in that topic if the employee or direct caregiver changes

employment to a different facility. The employee or direct caregiver must comply with other applicable continuing

education requirements.

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(5) The department, or its designee, shall approve the initial and continuing education courses and providers.

(6) The department shall keep a current list of providers who are approved to provide initial and continuing

education for staff of facilities that provide special care for persons with Alzheimer’s disease or other related

disorders.

(7) Any facility more than 90 percent of whose residents receive monthly optional supplementation payments is

not required to pay for the training and education programs required under this section. A facility that has one or

more such residents shall pay a reduced fee that is proportional to the percentage of such residents in the facility. A

facility that does not have any residents who receive monthly optional supplementation payments must pay a

reasonable fee, as established by the department, for such training and education programs.

(8) The department shall adopt rules to establish standards for trainers and training and to implement this

section.

History.—s. 15, ch. 97-82; ss. 2, 41, ch. 2006-197; s. 9, ch. 2015-126.


429.18 Disposition of fees and administrative fines.—Income from fees and fines collected under this part

shall be directed to and used by the agency for the following purposes:

(1) Up to 50 percent of the trust funds accrued each fiscal year under this part may be used to offset the

expenses of receivership, pursuant to s. 429.22, if the court determines that the income and assets of the facility are

insufficient to provide for adequate management and operation.

(2) An amount of $5,000 of the trust funds accrued each year under this part shall be allocated to pay for

inspection-related physical and mental health examinations requested by the agency pursuant to s. 429.26 for

residents who are either recipients of supplemental security income or have monthly incomes not in excess of the

maximum combined federal and state cash subsidies available to supplemental security income recipients, as

provided for in s. 409.212. Such funds shall only be used where the resident is ineligible for Medicaid.

(3) Any trust funds accrued each year under this part and not used for the purposes specified in subsections (1)

and (2) shall be used to offset the costs of the licensure program, verifying information submitted, defraying the

costs of processing the names of applicants, and conducting inspections and monitoring visits pursuant to this part

and part II of chapter 408.

History.—ss. 12, 20, ch. 80-198; s. 2, ch. 81-318; ss. 8, 19, ch. 82-148; ss. 48, 75, 79, 83, ch. 83-181; s. 53, ch.

83-218; s. 16, ch. 89-294; s. 11, ch. 91-263; s. 11, ch. 91-282; ss. 13, 38, 39, ch. 93-216; s. 19, ch. 95-418; s. 12, ch.

98-80; ss. 2, 42, ch. 2006-197; s. 149, ch. 2007-230.


429.19 Violations; imposition of administrative fines; grounds.—

(1) In addition to the requirements of part II of chapter 408, the agency shall impose an administrative fine in

the manner provided in chapter 120 for the violation of any provision of this part, part II of chapter 408, and

applicable rules by an assisted living facility, for the actions of any person subject to level 2 background screening

under s. 408.809, for the actions of any facility employee, or for an intentional or negligent act seriously affecting

the health, safety, or welfare of a resident of the facility.

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(2) Each violation of this part and adopted rules shall be classified according to the nature of the violation and

the gravity of its probable effect on facility residents. The agency shall indicate the classification on the written

notice of the violation as follows:

(a) Class “I” violations are defined in s. 408.813. The agency shall impose an administrative fine for a cited

class I violation in an amount not less than $5,000 and not exceeding $10,000 for each violation.

(b) Class “II” violations are defined in s. 408.813. The agency shall impose an administrative fine for a cited

class II violation in an amount not less than $1,000 and not exceeding $5,000 for each violation.

(c) Class “III” violations are defined in s. 408.813. The agency shall impose an administrative fine for a cited

class III violation in an amount not less than $500 and not exceeding $1,000 for each violation.

(d) Class “IV” violations are defined in s. 408.813. The agency shall impose an administrative fine for a cited

class IV violation in an amount not less than $100 and not exceeding $200 for each violation.

(e) Regardless of the class of violation cited, instead of the fine amounts listed in paragraphs (a)-(d), the agency

shall impose an administrative fine of $500 if a facility is found not to be in compliance with the background

screening requirements as provided in s. 408.809.

(3) For purposes of this section, in determining if a penalty is to be imposed and in fixing the amount of the

fine, the agency shall consider the following factors:

(a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a

resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions

of the applicable laws or rules were violated.

(b) Actions taken by the owner or administrator to correct violations.

(c) Any previous violations.

(d) The financial benefit to the facility of committing or continuing the violation.

(e) The licensed capacity of the facility.

(4) Each day of continuing violation after the date fixed for termination of the violation, as ordered by the

agency, constitutes an additional, separate, and distinct violation.

(5) Any action taken to correct a violation shall be documented in writing by the owner or administrator of the

facility and verified through followup visits by agency personnel. The agency may impose a fine and, in the case of

an owner-operated facility, revoke or deny a facility’s license when a facility administrator fraudulently

misrepresents action taken to correct a violation.

(6) Any facility whose owner fails to apply for a change-of-ownership license in accordance with part II of

chapter 408 and operates the facility under the new ownership is subject to a fine of $5,000.

(7) In addition to any administrative fines imposed, the agency may assess a survey fee, equal to the lesser of

one half of the facility’s biennial license and bed fee or $500, to cover the cost of conducting initial complaint

investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits

conducted to verify the correction of the violations.

(8) During an inspection, the agency shall make a reasonable attempt to discuss each violation with the owner

or administrator of the facility, prior to written notification.

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(9) The agency shall develop and disseminate an annual list of all facilities sanctioned or fined for violations of

state standards, the number and class of violations involved, the penalties imposed, and the current status of cases.

The list shall be disseminated, at no charge, to the Department of Elderly Affairs, the Department of Health, the

Department of Children and Families, the Agency for Persons with Disabilities, the area agencies on aging, the

Florida Statewide Advocacy Council, the State Long-Term Care Ombudsman Program, and state and local

ombudsman councils. The Department of Children and Families shall disseminate the list to service providers under

contract to the department who are responsible for referring persons to a facility for residency. The agency may

charge a fee commensurate with the cost of printing and postage to other interested parties requesting a copy of this

list. This information may be provided electronically or through the agency’s Internet site.

History.—ss. 12, 21, ch. 80-198; s. 254, ch. 81-259; s. 2, ch. 81-318; ss. 49, 75, 79, 83, ch. 83-181; s. 53, ch. 83-

218; s. 17, ch. 89-294; s. 12, ch. 91-263; ss. 14, 38, 39, ch. 93-216; s. 13, ch. 98-80; s. 2, ch. 99-179; s. 19, ch. 2000-

263; s. 142, ch. 2000-349; s. 62, ch. 2000-367; s. 35, ch. 2001-45; s. 21, ch. 2003-57; ss. 2, 43, ch. 2006-197; s. 41,

ch. 2006-227; s. 150, ch. 2007-230; s. 62, ch. 2009-223; s. 246, ch. 2014-19; s. 35, ch. 2015-31; s. 10, ch. 2015-126;

s. 83, ch. 2018-24.


429.195 Rebates prohibited; penalties.—

(1) An assisted living facility licensed under this part may not contract or promise to pay or receive any

commission, bonus, kickback, or rebate or engage in any split-fee arrangement in any form whatsoever with any

person, health care provider, or health care facility as provided under s. 817.505.

(2) This section does not apply to:

(a) An individual employed by the assisted living facility, or with whom the facility contracts to provide

marketing services for the facility, if the individual clearly indicates that he or she works with or for the facility.

(b) Payments by an assisted living facility to a referral service that provides information, consultation, or

referrals to consumers to assist them in finding appropriate care or housing options for seniors or disabled adults if

the referred consumers are not Medicaid recipients.

(c) A resident of an assisted living facility who refers a friend, family members, or other individuals with whom

the resident has a personal relationship to the assisted living facility, in which case the assisted living facility may

provide a monetary reward to the resident for making such referral.

(3) A violation of this section is patient brokering and is punishable as provided in s. 817.505.

History.—ss. 18, 25, ch. 89-294; s. 13, ch. 91-263; ss. 15, 38, 39, ch. 93-216; s. 773, ch. 95-148; s. 12, ch. 95-

210; s. 14, ch. 98-80; s. 2, ch. 2006-197; s. 29, ch. 2012-160.


429.20 Certain solicitation prohibited; third-party supplementation.—

(1) A person may not, in connection with the solicitation of contributions by or on behalf of an assisted living

facility or facilities, misrepresent or mislead any person, by any manner, means, practice, or device whatsoever, to

believe that the receipts of such solicitation will be used for charitable purposes, if that is not the fact.

(2) Solicitation of contributions of any kind in a threatening, coercive, or unduly forceful manner by or on

behalf of an assisted living facility or facilities by any agent, employee, owner, or representative of any assisted

5 – 21

living facility or facilities is grounds for denial, suspension, or revocation of the license of the assisted living facility

or facilities by or on behalf of which such contributions were solicited.

(3) The admission or maintenance of assisted living facility residents whose care is supported, in whole or in

part, by state funds may not be conditioned upon the receipt of any manner of contribution or donation from any

person. The solicitation or receipt of contributions in violation of this subsection is grounds for denial, suspension,

or revocation of license, as provided in s. 429.14, for any assisted living facility by or on behalf of which such

contributions were solicited.

(4) An assisted living facility may accept additional supplementation from third parties on behalf of residents

receiving optional state supplementation in accordance with s. 409.212.

History.—ss. 50, 83, ch. 83-181; ss. 16, 38, 39, ch. 93-216; s. 13, ch. 95-210; ss. 2, 44, ch. 2006-197.


429.22 Receivership proceedings.—

(1) As an alternative to or in conjunction with an injunctive proceeding, the agency may petition a court of

competent jurisdiction for the appointment of a receiver, if suitable alternate placements are not available, when any

of the following conditions exist:

(a) The facility is operating without a license and refuses to make application for a license as required by ss.

429.07 and 429.08.

(b) The facility is closing or has informed the agency that it intends to close and adequate arrangements have

not been made for relocation of the residents within 7 days, exclusive of weekends and holidays, of the closing of

the facility.

(c) The agency determines there exist in the facility conditions which present an imminent danger to the health,

safety, or welfare of the residents of the facility or a substantial probability that death or serious physical harm

would result therefrom.

(d) The facility cannot meet its financial obligation for providing food, shelter, care, and utilities.

(2) Petitions for receivership shall take precedence over other court business unless the court determines that

some other pending proceeding, having similar statutory precedence, shall have priority. A hearing shall be

conducted within 5 days of the filing of the petition, at which time all interested parties shall have the opportunity to

present evidence pertaining to the petition. The agency shall notify, by certified mail, the owner or administrator of

the facility named in the petition and the facility resident or, if applicable, the resident’s representative or designee,

or the resident’s surrogate, guardian, or attorney in fact, of its filing, the substance of the violation, and the date and

place set for the hearing. The court shall grant the petition only upon finding that the health, safety, or welfare of

facility residents would be threatened if a condition existing at the time the petition was filed is permitted to

continue. A receiver shall not be appointed ex parte unless the court determines that one or more of the conditions in

subsection (1) exist; that the facility owner or administrator cannot be found; that all reasonable means of locating

the owner or administrator and notifying him or her of the petition and hearing have been exhausted; or that the

owner or administrator after notification of the hearing chooses not to attend. After such findings, the court may

appoint any qualified person as a receiver, except it may not appoint any owner or affiliate of the facility which is in

receivership. The receiver may be selected from a list of persons qualified to act as receivers developed by the

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agency and presented to the court with each petition for receivership. Under no circumstances may the agency or

designated agency employee be appointed as a receiver for more than 60 days; however, the receiver may petition

the court, one time only, for a 30-day extension. The court shall grant the extension upon a showing of good cause.

(3) The receiver must make provisions for the continued health, safety, and welfare of all residents of the

facility and:

(a) Shall exercise those powers and perform those duties set out by the court.

(b) Shall operate the facility in such a manner as to assure safety and adequate health care for the residents.

(c) Shall take such action as is reasonably necessary to protect or conserve the assets or property of the facility

for which the receiver is appointed, or the proceeds from any transfer thereof, and may use them only in the

performance of the powers and duties set forth in this section and by order of the court.

(d) May use the building, fixtures, furnishings, and any accompanying consumable goods in the provision of

care and services to residents and to any other persons receiving services from the facility at the time the petition for

receivership was filed. The receiver shall collect payments for all goods and services provided to residents or others

during the period of the receivership at the same rate of payment charged by the owners at the time the petition for

receivership was filed, or at a fair and reasonable rate otherwise approved by the court.

(e) May correct or eliminate any deficiency in the structure or furnishings of the facility which endangers the

safety or health of residents while they remain in the facility, if the total cost of correction does not exceed $10,000.

The court may order expenditures for this purpose in excess of $10,000 on application from the receiver after notice

to the owner and a hearing.

(f) May let contracts and hire agents and employees to carry out the powers and duties of the receiver.

(g) Shall honor all leases, mortgages, and secured transactions governing the building in which the facility is

located and all goods and fixtures in the building of which the receiver has taken possession, but only to the extent

of payments which, in the case of a rental agreement, are for the use of the property during the period of the

receivership, or which, in the case of a purchase agreement, become due during the period of the receivership.

(h) Shall have full power to direct and manage and to discharge employees of the facility, subject to any

contract rights they may have. The receiver shall pay employees at the rate of compensation, including benefits,

approved by the court. A receivership does not relieve the owner of any obligation to employees made prior to the

appointment of a receiver and not carried out by the receiver.

(i) Shall be entitled to and take possession of all property or assets of residents which are in the possession of a

facility or its owner. The receiver shall preserve all property, assets, and records of residents of which the receiver

takes possession and shall provide for the prompt transfer of the property, assets, and records to the new placement

of any transferred resident. An inventory list certified by the owner and receiver shall be made immediately at the

time the receiver takes possession of the facility.

(4)(a) A person who is served with notice of an order of the court appointing a receiver and of the receiver’s

name and address shall be liable to pay the receiver for any goods or services provided by the receiver after the date

of the order if the person would have been liable for the goods or services as supplied by the owner. The receiver

shall give a receipt for each payment and shall keep a copy of each receipt on file. The receiver shall deposit

accounts received in a separate account and shall use this account for all disbursements.

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(b) The receiver may bring an action to enforce the liability created by paragraph (a).

(c) A payment to the receiver of any sum owing to the facility or its owner shall discharge any obligation to the

facility to the extent of the payment.

(5)(a) A receiver may petition the court that he or she not be required to honor any lease, mortgage, secured

transaction, or other wholly or partially executory contract entered into by the owner of the facility if the rent, price,

or rate of interest required to be paid under the agreement was substantially in excess of a reasonable rent, price, or

rate of interest at the time the contract was entered into, or if any material provision of the agreement was

unreasonable, when compared to contracts negotiated under similar conditions. Any relief in this form provided by

the court shall be limited to the life of the receivership, unless otherwise determined by the court.

(b) If the receiver is in possession of real estate or goods subject to a lease, mortgage, or security interest which

the receiver has obtained a court order to avoid under paragraph (a), and if the real estate or goods are necessary for

the continued operation of the facility under this section, the receiver may apply to the court to set a reasonable

rental, price, or rate of interest to be paid by the receiver during the duration of the receivership. The court shall hold

a hearing on the application within 15 days. The receiver shall send notice of the application to any known persons

who own the property involved at least 10 days prior to the hearing. Payment by the receiver of the amount

determined by the court to be reasonable is a defense to any action against the receiver for payment or for possession

of the goods or real estate subject to the lease, security interest, or mortgage involved by any person who received

such notice, but the payment does not relieve the owner of the facility of any liability for the difference between the

amount paid by the receiver and the amount due under the original lease, security interest, or mortgage involved.

(6) The court shall set the compensation of the receiver, which will be considered a necessary expense of a

receivership.

(7) A receiver may be held liable in a personal capacity only for the receiver’s own gross negligence,

intentional acts, or breach of fiduciary duty.

(8) The court may require a receiver to post a bond.

(9) The court may direct the agency to allocate funds from the Health Care Trust Fund to the receiver, subject

to the provisions of s. 429.18.

(10) The court may terminate a receivership when:

(a) The court determines that the receivership is no longer necessary because the conditions which gave rise to

the receivership no longer exist or the agency grants the facility a new license; or

(b) All of the residents in the facility have been transferred or discharged.

(11) Within 30 days after termination, the receiver shall give the court a complete accounting of all property of

which the receiver has taken possession, of all funds collected, and of the expenses of the receivership.

(12) Nothing in this section shall be deemed to relieve any owner, administrator, or employee of a facility

placed in receivership of any civil or criminal liability incurred, or any duty imposed by law, by reason of acts or

omissions of the owner, administrator, or employee prior to the appointment of a receiver; nor shall anything

contained in this section be construed to suspend during the receivership any obligation of the owner, administrator,

or employee for payment of taxes or other operating and maintenance expenses of the facility or of the owner,

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administrator, employee, or any other person for the payment of mortgages or liens. The owner shall retain the right

to sell or mortgage any facility under receivership, subject to approval of the court which ordered the receivership.

History.—ss. 12, 22, ch. 80-198; s. 255, ch. 81-259; s. 2, ch. 81-318; ss. 51, 75, 79, 83, ch. 83-181; s. 53, ch. 83-

218; s. 14, ch. 91-263; ss. 18, 38, 39, ch. 93-216; s. 774, ch. 95-148; s. 15, ch. 98-80; ss. 2, 45, ch. 2006-197; s. 152,

ch. 2007-230.


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

requirements.—

(1) Every facility licensed under this part may, as part of its administrative functions, voluntarily establish a risk

management and quality assurance program, the purpose of which is to assess resident care practices, facility

incident reports, deficiencies cited by the agency, adverse incident reports, and resident grievances and develop

plans of action to correct and respond quickly to identify quality differences.

(2) Every facility licensed under this part is required to maintain adverse incident reports. For purposes of this

section, the term, “adverse incident” means:

(a) An event over which facility personnel could exercise control rather than as a result of the resident’s

condition and results in:

1. Death;

2. Brain or spinal damage;

3. Permanent disfigurement;

4. Fracture or dislocation of bones or joints;

5. Any condition that required medical attention to which the resident has not given his or her consent,

including failure to honor advanced directives;

6. Any condition that requires the transfer of the resident from the facility to a unit providing more acute care

due to the incident rather than the resident’s condition before the incident; or

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

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

(3) Licensed facilities shall provide within 1 business day after the occurrence of an adverse incident, by

electronic mail, facsimile, or United States mail, a preliminary report to the agency on all adverse incidents specified

under this section. The report must include information regarding the identity of the affected resident, the type of

adverse incident, and the status of the facility’s investigation of the incident.

(4) Licensed facilities shall provide within 15 days, by electronic mail, facsimile, or United States mail, a full

report to the agency on all adverse incidents specified in this section. The report must include the results of the

facility’s investigation into the adverse incident.

(5) Each facility shall report monthly to the agency any liability claim filed against it. The report must include

the name of the resident, the dates of the incident leading to the claim, if applicable, and the type of injury or

violation of rights alleged to have occurred. This report is not discoverable in any civil or administrative action,

except in such actions brought by the agency to enforce the provisions of this part.

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(6) Abuse, neglect, or exploitation must be reported to the Department of Children and Families as required

under chapter 415.

(7) The information reported to the agency pursuant to subsection (3) which relates to persons licensed under

chapter 458, chapter 459, chapter 461, chapter 464, or chapter 465 shall be reviewed by the agency. The agency

shall determine whether any of the incidents potentially involved conduct by a health care professional who is

subject to disciplinary action, in which case the provisions of s. 456.073 apply. The agency may investigate, as it

deems appropriate, any such incident and prescribe measures that must or may be taken in response to the incident.

The agency shall review each incident and determine whether it potentially involved conduct by a health care

professional who is subject to disciplinary action, in which case the provisions of s. 456.073 apply.

(8) If the agency, through its receipt of the adverse incident reports prescribed in this part or through any

investigation, has reasonable belief that conduct by a staff member or employee of a licensed facility is grounds for

disciplinary action by the appropriate board, the agency shall report this fact to such regulatory board.

(9) The adverse incident reports and preliminary adverse incident reports required under this section are

confidential as provided by law and are not discoverable or admissible in any civil or administrative action, except

in disciplinary proceedings by the agency or appropriate regulatory board.

(10) The agency may adopt rules necessary to administer this section.

History.—s. 36, ch. 2001-45; s. 2, ch. 2006-197; s. 63, ch. 2009-223; s. 247, ch. 2014-19; s. 10, ch. 2019-11.


429.24 Contracts.—

(1) The presence of each resident in a facility shall be covered by a contract, executed at the time of admission

or prior thereto, between the licensee and the resident or his or her designee or legal representative. Each party to the

contract shall be provided with a duplicate original thereof, and the licensee shall keep on file in the facility all such

contracts. The licensee may not destroy or otherwise dispose of any such contract until 5 years after its expiration.

(2) Each contract must contain express provisions specifically setting forth the services and accommodations to

be provided by the facility; the rates or charges; provision for at least 30 days’ written notice of a rate increase; the

rights, duties, and obligations of the residents, other than those specified in s. 429.28; and other matters that the

parties deem appropriate. A new service or accommodation added to, or implemented in, a resident’s contract for

which the resident was not previously charged does not require a 30-day written notice of a rate increase. Whenever

money is deposited or advanced by a resident in a contract as security for performance of the contract agreement or

as advance rent for other than the next immediate rental period:

(a) Such funds shall be deposited in a banking institution in this state that is located, if possible, in the same

community in which the facility is located; shall be kept separate from the funds and property of the facility; may

not be represented as part of the assets of the facility on financial statements; and shall be used, or otherwise

expended, only for the account of the resident.

(b) The licensee shall, within 30 days of receipt of advance rent or a security deposit, notify the resident or

residents in writing of the manner in which the licensee is holding the advance rent or security deposit and state the

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name and address of the depository where the moneys are being held. The licensee shall notify residents of the

facility’s policy on advance deposits.

(3)(a) The contract shall include a refund policy to be implemented at the time of a resident’s transfer,

discharge, or death. The refund policy shall provide that the resident or responsible party is entitled to a prorated

refund based on the daily rate for any unused portion of payment beyond the termination date after all charges,

including the cost of damages to the residential unit resulting from circumstances other than normal use, have been

paid to the licensee. For the purpose of this paragraph, the termination date shall be the date the unit is vacated by

the resident and cleared of all personal belongings. If the amount of belongings does not preclude renting the unit,

the facility may clear the unit and charge the resident or his or her estate for moving and storing the items at a rate

equal to the actual cost to the facility, not to exceed 20 percent of the regular rate for the unit, provided that 14 days’

advance written notification is given. If the resident’s possessions are not claimed within 45 days after notification,

the facility may dispose of them. The contract shall also specify any other conditions under which claims will be

made against the refund due the resident. Except in the case of death or a discharge due to medical reasons, the

refunds shall be computed in accordance with the notice of relocation requirements specified in the contract.

However, a resident may not be required to provide the licensee with more than 30 days’ notice of termination. If

after a contract is terminated, the facility intends to make a claim against a refund due the resident, the facility shall

notify the resident or responsible party in writing of the claim and shall provide said party with a reasonable time

period of no less than 14 calendar days to respond. The facility shall provide a refund to the resident or responsible

party within 45 days after the transfer, discharge, or death of the resident. The agency shall impose a fine upon a

facility that fails to comply with the refund provisions of the paragraph, which fine shall be equal to three times the

amount due to the resident. One-half of the fine shall be remitted to the resident or his or her estate, and the other

half to the Health Care Trust Fund to be used for the purpose specified in s. 429.18.

(b) If a licensee agrees to reserve a bed for a resident who is admitted to a medical facility, including, but not

limited to, a nursing home, health care facility, or psychiatric facility, the resident or his or her responsible party

shall notify the licensee of any change in status that would prevent the resident from returning to the facility. Until

such notice is received, the agreed-upon daily rate may be charged by the licensee.

(c) The purpose of any advance payment and a refund policy for such payment, including any advance payment

for housing, meals, or personal services, shall be covered in the contract.

(4) The contract shall state whether or not the facility is affiliated with any religious organization and, if so,

which organization and its general responsibility to the facility.

(5) Neither the contract nor any provision thereof relieves any licensee of any requirement or obligation

imposed upon it by this part or rules adopted under this part.

(6) In lieu of the provisions of this section, facilities certified under chapter 651 shall comply with the

requirements of s. 651.055.

(7) Notwithstanding the provisions of this section, facilities which consist of 60 or more apartments may

require refund policies and termination notices in accordance with the provisions of part II of chapter 83, provided

that the lease is terminated automatically without financial penalty in the event of a resident’s death or relocation

due to psychiatric hospitalization or to medical reasons which necessitate services or care beyond which the facility

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is licensed to provide. The date of termination in such instances shall be the date the unit is fully vacated. A lease

may be substituted for the contract if it meets the disclosure requirements of this section. For the purpose of this

section, the term “apartment” means a room or set of rooms with a kitchen or kitchenette and lavatory located within

one or more buildings containing other similar or like residential units.

(8) The agency may by rule clarify terms, establish procedures, clarify refund policies and contract provisions,

and specify documentation as necessary to administer this section.

History.—s. 11, ch. 75-233; ss. 12, 23, ch. 80-198; s. 2, ch. 81-318; ss. 52, 79, 83, ch. 83-181; s. 10, ch. 87-371;

s. 1, ch. 88-364; s. 15, ch. 91-263; ss. 19, 38, 39, ch. 93-216; s. 775, ch. 95-148; s. 2, ch. 98-148; ss. 2, 46, ch. 2006-

197; s. 84, ch. 2018-24; s. 11, ch. 2019-11.


429.255 Use of personnel; emergency care.—

(1)(a) Persons under contract to the facility, facility staff, or volunteers, who are licensed according to part I of

chapter 464, or those persons exempt under s. 464.022(1), and others as defined by rule, may administer medications

to residents, take residents’ vital signs, manage individual weekly pill organizers for residents who self-administer

medication, give prepackaged enemas ordered by a physician, observe residents, document observations on the

appropriate resident’s record, report observations to the resident’s physician, and contract or allow residents or a

resident’s representative, designee, surrogate, guardian, or attorney in fact to contract with a third party, provided

residents meet the criteria for appropriate placement as defined in s. 429.26. Nursing assistants certified pursuant to

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

(b) All staff in facilities licensed under this part shall exercise their professional responsibility to observe

residents, to document observations on the appropriate resident’s record, and to report the observations to the

resident’s physician. However, the owner or administrator of the facility shall be responsible for determining that the

resident receiving services is appropriate for residence in the facility.

(c) In an emergency situation, licensed personnel may carry out their professional duties pursuant to part I of

chapter 464 until emergency medical personnel assume responsibility for care.

(2) In facilities licensed to provide extended congregate care, persons under contract to the facility, facility

staff, or volunteers, who are licensed according to part I of chapter 464, or those persons exempt under s.

464.022(1), or those persons certified as nursing assistants pursuant to part II of chapter 464, may also perform all

duties within the scope of their license or certification, as approved by the facility administrator and pursuant to this

part.

(3)(a) An assisted living facility licensed under this part with 17 or more beds shall have on the premises at all

times a functioning automated external defibrillator as defined in s. 768.1325(2)(b).

(b) The facility is encouraged to register the location of each automated external defibrillator with a local

emergency medical services medical director.

(c) The provisions of ss. 768.13 and 768.1325 apply to automated external defibrillators within the facility.

(4) Facility staff may withhold or withdraw cardiopulmonary resuscitation or the use of an automated external

defibrillator if presented with an order not to resuscitate executed pursuant to s. 401.45. The agency shall adopt rules

providing for the implementation of such orders. Facility staff and facilities may not be subject to criminal

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prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct, for

withholding or withdrawing cardiopulmonary resuscitation or use of an automated external defibrillator pursuant to

such an order and rules adopted by the agency. The absence of an order to resuscitate executed pursuant to s. 401.45

does not preclude a physician from withholding or withdrawing cardiopulmonary resuscitation or use of an

automated external defibrillator as otherwise permitted by law.

(5) The agency may adopt rules to implement the provisions of this section relating to use of an automated

external defibrillator.

History.—ss. 16, 38, ch. 91-263; ss. 20, 38, 39, ch. 93-216; s. 4, ch. 99-331; s. 3, ch. 2000-295; s. 100, ch. 2000-

318; ss. 2, 47, ch. 2006-197; s. 1, ch. 2010-200; s. 12, ch. 2019-11.


429.256 Assistance with self-administration of medication.—

(1) For the purposes of this section, the term:

(a) “Informed consent” means advising the resident, or the resident’s surrogate, guardian, or attorney in fact,

that an assisted living facility is not required to have a licensed nurse on staff, that the resident may be receiving

assistance with self-administration of medication from an unlicensed person, and that such assistance, if provided by

an unlicensed person, will or will not be overseen by a licensed nurse.

(b) “Unlicensed person” means an individual not currently licensed to practice nursing or medicine who is

employed by or under contract to an assisted living facility and who has received training with respect to assisting

with the self-administration of medication in an assisted living facility as provided under s. 429.52 prior to providing

such assistance as described in this section.

(2) Residents who are capable of self-administering their own medications without assistance shall be

encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed prescription’s

label or the package directions of an over-the-counter medication, assist a resident whose condition is medically

stable with the self-administration of routine, regularly scheduled medications that are intended to be self-

administered. Assistance with self-medication by an unlicensed person may occur only upon a documented request

by, and the written informed consent of, a resident or the resident’s surrogate, guardian, or attorney in fact. For the

purposes of this section, self-administered medications include both legend and over-the-counter oral dosage forms,

topical dosage forms and topical ophthalmic, otic, and nasal dosage forms including solutions, suspensions, sprays,

and inhalers.

(3) Assistance with self-administration of medication includes:

(a) Taking the medication, in its previously dispensed, properly labeled container, including an insulin syringe

that is prefilled with the proper dosage by a pharmacist and an insulin pen that is prefilled by the manufacturer, from

where it is stored, and bringing it to the resident.

(b) In the presence of the resident, reading the label, opening the container, removing a prescribed amount of

medication from the container, and closing the container.

(c) Placing an oral dosage in the resident’s hand or placing the dosage in another container and helping the

resident by lifting the container to his or her mouth.

(d) Applying topical medications.

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(e) Returning the medication container to proper storage.

(f) Keeping a record of when a resident receives assistance with self-administration under this section.

(g) Assisting with the use of a nebulizer, including removing the cap of a nebulizer, opening the unit dose of

nebulizer solution, and pouring the prescribed premeasured dose of medication into the dispensing cup of the

nebulizer.

(h) Using a glucometer to perform blood-glucose level checks.

(i) Assisting with putting on and taking off antiembolism stockings.

(j) Assisting with applying and removing an oxygen cannula but not with titrating the prescribed oxygen

settings.

(k) Assisting with the use of a continuous positive airway pressure device but not with titrating the prescribed

setting of the device.

(l) Assisting with measuring vital signs.

(m) Assisting with colostomy bags.

(4) Assistance with self-administration does not include:

(a) Mixing, compounding, converting, or calculating medication doses, except for measuring a prescribed

amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed.

(b) The preparation of syringes for injection or the administration of medications by any injectable route.

(c) Administration of medications by way of a tube inserted in a cavity of the body.

(d) Administration of parenteral preparations.

(e) Irrigations or debriding agents used in the treatment of a skin condition.

(f) Rectal, urethral, or vaginal preparations.

(g) Medications ordered by the physician or health care professional with prescriptive authority to be given “as

needed,” unless the order is written with specific parameters that preclude independent judgment on the part of the

unlicensed person, and at the request of a competent resident.

(h) Medications for which the time of administration, the amount, the strength of dosage, the method of

administration, or the reason for administration requires judgment or discretion on the part of the unlicensed person.

(5) Assistance with the self-administration of medication by an unlicensed person as described in this section

shall not be considered administration as defined in s. 465.003.

(6) The agency may by rule establish facility procedures and interpret terms as necessary to implement this

section.

History.—s. 16, ch. 98-80; s. 214, ch. 99-13; ss. 2, 48, ch. 2006-197; s. 11, ch. 2015-126; s. 13, ch. 2019-11.


429.26 Appropriateness of placements; examinations of residents.—

(1) The owner or administrator of a facility is responsible for determining the appropriateness of admission of

an individual to the facility and for determining the continued appropriateness of residence of an individual in the

facility. A determination shall be based upon an assessment of the strengths, needs, and preferences of the resident,

the care and services offered or arranged for by the facility in accordance with facility policy, and any limitations in

law or rule related to admission criteria or continued residency for the type of license held by the facility under this

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part. A resident may not be moved from one facility to another without consultation with and agreement from the

resident or, if applicable, the resident’s representative or designee or the resident’s family, guardian, surrogate, or

attorney in fact. In the case of a resident who has been placed by the department or the Department of Children and

Families, the administrator must notify the appropriate contact person in the applicable department.

(2) A physician, physician assistant, or nurse practitioner who is employed by an assisted living facility to

provide an initial examination for admission purposes may not have financial interest in the facility.

(3) Persons licensed under part I of chapter 464 who are employed by or under contract with a facility shall, on

a routine basis or at least monthly, perform a nursing assessment of the residents for whom they are providing

nursing services ordered by a physician, except administration of medication, and shall document such assessment,

including any substantial changes in a resident’s status which may necessitate relocation to a nursing home, hospital,

or specialized health care facility. Such records shall be maintained in the facility for inspection by the agency and

shall be forwarded to the resident’s case manager, if applicable.

(4) If possible, each resident shall have been examined by a licensed physician, a licensed physician assistant,

or a licensed nurse practitioner within 60 days before admission to the facility. The signed and completed medical

examination report shall be submitted to the owner or administrator of the facility who shall use the information

contained therein to assist in the determination of the appropriateness of the resident’s admission and continued stay

in the facility. The medical examination report shall become a permanent part of the record of the resident at the

facility and shall be made available to the agency during inspection or upon request. An assessment that has been

completed through the Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program

fulfills the requirements for a medical examination under this subsection and s. 429.07(3)(b)6.

(5) Except as provided in s. 429.07, if a medical examination has not been completed within 60 days before the

admission of the resident to the facility, a licensed physician, licensed physician assistant, or licensed nurse

practitioner shall examine the resident and complete a medical examination form provided by the agency within 30

days following the admission to the facility to enable the facility owner or administrator to determine the

appropriateness of the admission. The medical examination form shall become a permanent part of the record of the

resident at the facility and shall be made available to the agency during inspection by the agency or upon request.

(6) Any resident accepted in a facility and placed by the department or the Department of Children and

Families shall have been examined by medical personnel within 30 days before placement in the facility. The

examination shall include an assessment of the appropriateness of placement in a facility. The findings of this

examination shall be recorded on the examination form provided by the agency. The completed form shall

accompany the resident and shall be submitted to the facility owner or administrator. Additionally, in the case of a

mental health resident, the Department of Children and Families must provide documentation that the individual has

been assessed by a psychiatrist, clinical psychologist, clinical social worker, or psychiatric nurse, or an individual

who is supervised by one of these professionals, and determined to be appropriate to reside in an assisted living

facility. The documentation must be in the facility within 30 days after the mental health resident has been admitted

to the facility. An evaluation completed upon discharge from a state mental hospital meets the requirements of this

subsection related to appropriateness for placement as a mental health resident providing it was completed within 90

days prior to admission to the facility. The applicable department shall provide to the facility administrator any

5 – 31

information about the resident that would help the administrator meet his or her responsibilities under subsection (1).

Further, department personnel shall explain to the facility operator any special needs of the resident and advise the

operator whom to call should problems arise. The applicable department shall advise and assist the facility

administrator where the special needs of residents who are recipients of optional state supplementation require such

assistance.

(7) The facility must notify a licensed physician when a resident exhibits signs of dementia or cognitive

impairment or has a change of condition in order to rule out the presence of an underlying physiological condition

that may be contributing to such dementia or impairment. The notification must occur within 30 days after the

acknowledgment of such signs by facility staff. If an underlying condition is determined to exist, the facility shall

arrange, with the appropriate health care provider, the necessary care and services to treat the condition.

(8) The Department of Children and Families may require an examination for supplemental security income

and optional state supplementation recipients residing in facilities at any time and shall provide the examination

whenever a resident’s condition requires it. Any facility administrator; personnel of the agency, the department, or

the Department of Children and Families; or a representative of the State Long-Term Care Ombudsman Program

who believes a resident needs to be evaluated shall notify the resident’s case manager, who shall take appropriate

action. A report of the examination findings shall be provided to the resident’s case manager and the facility

administrator to help the administrator meet his or her responsibilities under subsection (1).

(9) A terminally ill resident who no longer meets the criteria for continued residency may remain in the facility

if the arrangement is mutually agreeable to the resident and the facility; additional care is rendered through a

licensed hospice, and the resident is under the care of a physician who agrees that the physical needs of the resident

are being met.

(10) Facilities licensed to provide extended congregate care services shall promote aging in place by

determining appropriateness of continued residency based on a comprehensive review of the resident’s physical and

functional status; the ability of the facility, family members, friends, or any other pertinent individuals or agencies to

provide the care and services required; and documentation that a written service plan consistent with facility policy

has been developed and implemented to ensure that the resident’s needs and preferences are addressed.

(11) No resident who requires 24-hour nursing supervision, except for a resident who is an enrolled hospice

patient pursuant to part IV of chapter 400, shall be retained in a facility licensed under this part.

History.—ss. 12, 30, ch. 80-198; s. 2, ch. 81-318; ss. 53, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s. 6, ch. 85-

145; s. 11, ch. 87-371; s. 19, ch. 89-294; s. 17, ch. 91-263; ss. 21, 38, 39, ch. 93-216; s. 776, ch. 95-148; s. 15, ch.

95-210; ss. 25, 49, ch. 95-418; s. 39, ch. 96-169; s. 5, ch. 97-82; s. 215, ch. 99-13; s. 101, ch. 2000-318; s. 75, ch.

2000-349; s. 37, ch. 2001-45; s. 61, ch. 2002-1; ss. 2, 49, ch. 2006-197; s. 153, ch. 2007-230; s. 64, ch. 2009-223; s.

248, ch. 2014-19; s. 36, ch. 2015-31.


429.27 Property and personal affairs of residents.—

(1)(a) A resident shall be given the option of using his or her own belongings, as space permits; choosing his or

her roommate; and, whenever possible, unless the resident is adjudicated incompetent or incapacitated under state

law, managing his or her own affairs.

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(b) The admission of a resident to a facility and his or her presence therein shall not confer on the facility or its

owner, administrator, employees, or representatives any authority to manage, use, or dispose of any property of the

resident; nor shall such admission or presence confer on any of such persons any authority or responsibility for the

personal affairs of the resident, except that which may be necessary for the safe management of the facility or for the

safety of the resident.

(2) A facility, or an owner, administrator, employee, or representative thereof, may not act as the guardian,

trustee, or conservator for any resident of the assisted living facility or any of such resident’s property. An owner,

administrator, or staff member, or representative thereof, may not act as a competent resident’s payee for social

security, veteran’s, or railroad benefits without the consent of the resident. Any facility whose owner, administrator,

or staff, or representative thereof, serves as representative payee for any resident of the facility shall file a surety

bond with the agency in an amount equal to twice the average monthly aggregate income or personal funds due to

residents, or expendable for their account, which are received by a facility. Any facility whose owner, administrator,

or staff, or a representative thereof, is granted power of attorney for any resident of the facility shall file a surety

bond with the agency for each resident for whom such power of attorney is granted. The surety bond shall be in an

amount equal to twice the average monthly income of the resident, plus the value of any resident’s property under

the control of the attorney in fact. The bond shall be executed by the facility as principal and a licensed surety

company. The bond shall be conditioned upon the faithful compliance of the facility with this section and shall run

to the agency for the benefit of any resident who suffers a financial loss as a result of the misuse or misappropriation

by a facility of funds held pursuant to this subsection. Any surety company that cancels or does not renew the bond

of any licensee shall notify the agency in writing not less than 30 days in advance of such action, giving the reason

for the cancellation or nonrenewal. Any facility owner, administrator, or staff, or representative thereof, who is

granted power of attorney for any resident of the facility shall, on a monthly basis, be required to provide the

resident a written statement of any transaction made on behalf of the resident pursuant to this subsection, and a copy

of such statement given to the resident shall be retained in each resident’s file and available for agency inspection.

(3) A facility, upon mutual consent with the resident, shall provide for the safekeeping in the facility of

personal effects not in excess of $500 and funds of the resident not in excess of $500 cash, and shall keep complete

and accurate records of all such funds and personal effects received. If a resident is absent from a facility for 24

hours or more, the facility may provide for the safekeeping of the resident’s personal effects in excess of $500.

(4) Any funds or other property belonging to or due to a resident, or expendable for his or her account, which is

received by a facility shall be trust funds which shall be kept separate from the funds and property of the facility and

other residents or shall be specifically credited to such resident. Such trust funds shall be used or otherwise

expended only for the account of the resident. At least once every 3 months, unless upon order of a court of

competent jurisdiction, the facility shall furnish the resident and his or her guardian, trustee, or conservator, if any, a

complete and verified statement of all funds and other property to which this subsection applies, detailing the

amount and items received, together with their sources and disposition. In any event, the facility shall furnish such

statement annually and upon the discharge or transfer of a resident. Any governmental agency or private charitable

agency contributing funds or other property to the account of a resident shall also be entitled to receive such

statement annually and upon the discharge or transfer of the resident.

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(5) Any personal funds available to facility residents may be used by residents as they choose to obtain

clothing, personal items, leisure activities, and other supplies and services for their personal use. A facility may not

demand, require, or contract for payment of all or any part of the personal funds in satisfaction of the facility rate for

supplies and services beyond that amount agreed to in writing and may not levy an additional charge to the

individual or the account for any supplies or services that the facility has agreed by contract to provide as part of the

standard monthly rate. Any service or supplies provided by the facility which are charged separately to the

individual or the account may be provided only with the specific written consent of the individual, who shall be

furnished in advance of the provision of the services or supplies with an itemized written statement to be attached to

the contract setting forth the charges for the services or supplies.

(6)(a) In addition to any damages or civil penalties to which a person is subject, any person who:

1. Intentionally withholds a resident’s personal funds, personal property, or personal needs allowance, or who

demands, beneficially receives, or contracts for payment of all or any part of a resident’s personal property or

personal needs allowance in satisfaction of the facility rate for supplies and services; or

2. Borrows from or pledges any personal funds of a resident, other than the amount agreed to by written

contract under s. 429.24,

commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.

(b) Any facility owner, administrator, or staff, or representative thereof, who is granted power of attorney for

any resident of the facility and who misuses or misappropriates funds obtained through this power commits a felony

of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(7) In the event of the death of a resident, a licensee shall return all refunds, funds, and property held in trust to

the resident’s personal representative, if one has been appointed at the time the facility disburses such funds, and, if

not, to the resident’s spouse or adult next of kin named in a beneficiary designation form provided by the facility to

the resident. If the resident has no spouse or adult next of kin or such person cannot be located, funds due the

resident shall be placed in an interest-bearing account, and all property held in trust by the facility shall be

safeguarded until such time as the funds and property are disbursed pursuant to the Florida Probate Code. Such

funds shall be kept separate from the funds and property of the facility and other residents of the facility. If the funds

of the deceased resident are not disbursed pursuant to the Florida Probate Code within 2 years after the resident’s

death, the funds shall be deposited in the Health Care Trust Fund administered by the agency.

(8) The agency may by rule clarify terms and specify procedures and documentation necessary to administer

the provisions of this section relating to the proper management of residents’ funds and personal property and the

execution of surety bonds.

History.—s. 12, ch. 75-233; ss. 12, 24, ch. 80-198; s. 2, ch. 81-152; s. 2, ch. 81-318; ss. 4, 19, ch. 82-148; ss. 54,

79, 83, ch. 83-181; s. 3, ch. 86-104; s. 12, ch. 87-371; s. 72, ch. 91-224; s. 18, ch. 91-263; ss. 22, 38, 39, ch. 93-216;

s. 777, ch. 95-148; s. 3, ch. 98-148; s. 216, ch. 99-13; ss. 2, 50, ch. 2006-197; s. 12, ch. 2015-126; s. 14, ch. 2019-11.


429.275 Business practice; personnel records; liability insurance.—The assisted living facility shall be

administered on a sound financial basis that is consistent with good business practices.

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(1) The administrator or owner of a facility shall maintain accurate business records that identify, summarize,

and classify funds received and expenses disbursed and shall use written accounting procedures and a recognized

accounting system.

(2) The administrator or owner of a facility shall maintain personnel records for each staff member which

contain, at a minimum, documentation of background screening, if applicable, documentation of compliance with all

training requirements of this part or applicable rule, and a copy of all licenses or certification held by each staff who

performs services for which licensure or certification is required under this part or rule.

(3) The administrator or owner of a facility shall maintain liability insurance coverage that is in force at all

times.

(4) The agency may by rule clarify terms, establish requirements for financial records, accounting procedures,

personnel procedures, insurance coverage, and reporting procedures, and specify documentation as necessary to

implement this section.



429.28 Resident bill of rights.—

(1) No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by

law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every

resident of a facility shall have the right to:

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

(b) Be treated with consideration and respect and with due recognition of personal dignity, individuality, and

the need for privacy.

(c) Retain and use his or her own clothes and other personal property in his or her immediate living quarters, so

as to maintain individuality and personal dignity, except when the facility can demonstrate that such would be

unsafe, impractical, or an infringement upon the rights of other residents.

(d) Unrestricted private communication, including receiving and sending unopened correspondence, access to a

telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a

minimum. Upon request, the facility shall make provisions to extend visiting hours for caregivers and out-of-town

guests, and in other similar situations.

(e) Freedom to participate in and benefit from community services and activities and to pursue the highest

possible level of independence, autonomy, and interaction within the community.

(f) Manage his or her financial affairs unless the resident or, if applicable, the resident’s representative,

designee, surrogate, guardian, or attorney in fact authorizes the administrator of the facility to provide safekeeping

for funds as provided in s. 429.27.

(g) Share a room with his or her spouse if both are residents of the facility.

(h) Reasonable opportunity for regular exercise several times a week and to be outdoors at regular and frequent

intervals except when prevented by inclement weather.

(i) Exercise civil and religious liberties, including the right to independent personal decisions. No religious

beliefs or practices, nor any attendance at religious services, shall be imposed upon any resident.

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(j) Assistance with obtaining access to adequate and appropriate health care. For purposes of this paragraph, the

term “adequate and appropriate health care” means the management of medications, assistance in making

appointments for health care services, the provision of or arrangement of transportation to health care appointments,

and the performance of health care services in accordance with s. 429.255 which are consistent with established and

recognized standards within the community.

(k) At least 45 days’ notice of relocation or termination of residency from the facility unless, for medical

reasons, the resident is certified by a physician to require an emergency relocation to a facility providing a more

skilled level of care or the resident engages in a pattern of conduct that is harmful or offensive to other residents. In

the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days’

notice of a nonemergency relocation or residency termination. Reasons for relocation shall be set forth in writing. In

order for a facility to terminate the residency of an individual without notice as provided herein, the facility shall

show good cause in a court of competent jurisdiction.

(l) Present grievances and recommend changes in policies, procedures, and services to the staff of the facility,

governing officials, or any other person without restraint, interference, coercion, discrimination, or reprisal. Each

facility shall establish a grievance procedure to facilitate the residents’ exercise of this right. This right includes

access to ombudsman volunteers and advocates and the right to be a member of, to be active in, and to associate

with advocacy or special interest groups.

(2) The administrator of a facility shall ensure that a written notice of the rights, obligations, and prohibitions

set forth in this part is posted in a prominent place in each facility and read or explained to residents who cannot

read. The notice must include the statewide toll-free telephone number and e-mail address of the State Long-Term

Care Ombudsman Program and the telephone number of the local ombudsman council, the Elder Abuse Hotline

operated by the Department of Children and Families, and, if applicable, Disability Rights Florida, where complaints

may be lodged. The notice must state that a complaint made to the Office of State Long-Term Care Ombudsman or a

local long-term care ombudsman council, the names and identities of the residents involved in the complaint, and the

identity of complainants are kept confidential pursuant to s. 400.0077 and that retaliatory action cannot be taken

against a resident for presenting grievances or for exercising any other resident right. The facility must ensure a

resident’s access to a telephone to call the State Long-Term Care Ombudsman Program or local ombudsman

council, the Elder Abuse Hotline operated by the Department of Children and Families, and Disability Rights

Florida.

(3)(a) The agency shall conduct a survey to determine general compliance with facility standards and

compliance with residents’ rights as a prerequisite to initial licensure or licensure renewal. The agency shall adopt

rules for uniform standards and criteria that will be used to determine compliance with facility standards and

compliance with residents’ rights.

(b) In order to determine whether the facility is adequately protecting residents’ rights, the biennial survey shall

include private informal conversations with a sample of residents and consultation with the ombudsman council in

the district in which the facility is located to discuss residents’ experiences within the facility.

(4) The facility shall not hamper or prevent residents from exercising their rights as specified in this section.

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(5) A facility or employee of a facility may not serve notice upon a resident to leave the premises or take any

other retaliatory action against any person who:

(a) Exercises any right set forth in this section.

(b) Appears as a witness in any hearing, inside or outside the facility.

(c) Files a civil action alleging a violation of the provisions of this part or notifies a state attorney or the

Attorney General of a possible violation of such provisions.

(6) A facility that terminates the residency of an individual who participated in activities specified in subsection

(5) must show good cause in a court of competent jurisdiction. If good cause is not shown, the agency shall impose a

fine of $2,500 in addition to any other penalty assessed against the facility.

(7) Any person who submits or reports a complaint concerning a suspected violation of the provisions of this

part or concerning services and conditions in facilities, or who testifies in any administrative or judicial proceeding

arising from such a complaint, shall have immunity from any civil or criminal liability therefor, unless such person

has acted in bad faith or with malicious purpose or the court finds that there was a complete absence of a justiciable

issue of either law or fact raised by the losing party.


221; s. 19, ch. 91-263; ss. 23, 38, 39, ch. 93-216; s. 778, ch. 95-148; s. 11, ch. 95-418; s. 17, ch. 98-80; s. 20, ch.

2000-263; ss. 76, 143, ch. 2000-349; s. 63, ch. 2000-367; s. 38, ch. 2001-45; ss. 2, 51, ch. 2006-197; s. 37, ch. 2015-

31; s. 13, ch. 2015-126; s. 85, ch. 2018-24.


429.29 Civil actions to enforce rights.—

(1) Any person or resident whose rights as specified in this part are violated shall have a cause of action. The

action may be brought by the resident or his or her guardian, or by a person or organization acting on behalf of a

resident with the consent of the resident or his or her guardian, or by the personal representative of the estate of a

deceased resident regardless of the cause of death. If the action alleges a claim for the resident’s rights or for

negligence that caused the death of the resident, the claimant shall be required to elect either survival damages

pursuant to s. 46.021 or wrongful death damages pursuant to s. 768.21. If the action alleges a claim for the resident’s

rights or for negligence that did not cause the death of the resident, the personal representative of the estate may

recover damages for the negligence that caused injury to the resident. The action may be brought in any court of

competent jurisdiction to enforce such rights and to recover actual damages, and punitive damages for violation of

the rights of a resident or negligence. Any resident who prevails in seeking injunctive relief or a claim for an

administrative remedy is entitled to recover the costs of the action and a reasonable attorney’s fee assessed against

the defendant not to exceed $25,000. Fees shall be awarded solely for the injunctive or administrative relief and not

for any claim or action for damages whether such claim or action is brought together with a request for an injunction

or administrative relief or as a separate action, except as provided under s. 768.79 or the Florida Rules of Civil

Procedure. Sections 429.29-429.298 provide the exclusive remedy for a cause of action for recovery of damages for

the personal injury or death of a resident arising out of negligence or a violation of rights specified in s. 429.28. This

section does not preclude theories of recovery not arising out of negligence or s. 429.28 which are available to a

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resident or to the agency. The provisions of chapter 766 do not apply to any cause of action brought under ss.

429.29-429.298.

(2) In any claim brought pursuant to this part alleging a violation of resident’s rights or negligence causing

injury to or the death of a resident, the claimant shall have the burden of proving, by a preponderance of the

evidence, that:

(a) The defendant owed a duty to the resident;

(b) The defendant breached the duty to the resident;

(c) The breach of the duty is a legal cause of loss, injury, death, or damage to the resident; and

(d) The resident sustained loss, injury, death, or damage as a result of the breach.

Nothing in this part shall be interpreted to create strict liability. A violation of the rights set forth in s. 429.28 or in any

other standard or guidelines specified in this part or in any applicable administrative standard or guidelines of this

state or a federal regulatory agency shall be evidence of negligence but shall not be considered negligence per se.

(3) In any claim brought pursuant to this section, a licensee, person, or entity shall have a duty to exercise

reasonable care. Reasonable care is that degree of care which a reasonably careful licensee, person, or entity would

use under like circumstances.

(4) In any claim for resident’s rights violation or negligence by a nurse licensed under part I of chapter 464,

such nurse shall have the duty to exercise care consistent with the prevailing professional standard of care for a

nurse. The prevailing professional standard of care for a nurse shall be that level of care, skill, and treatment which,

in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent

similar nurses.

(5) Discovery of financial information for the purpose of determining the value of punitive damages may not be

had unless the plaintiff shows the court by proffer or evidence in the record that a reasonable basis exists to support

a claim for punitive damages.

(6) In addition to any other standards for punitive damages, any award of punitive damages must be reasonable

in light of the actual harm suffered by the resident and the egregiousness of the conduct that caused the actual harm

to the resident.

(7) The resident or the resident’s legal representative shall serve a copy of any complaint alleging in whole or in

part a violation of any rights specified in this part to the Agency for Health Care Administration at the time of filing

the initial complaint with the clerk of the court for the county in which the action is pursued. The requirement of

providing a copy of the complaint to the agency does not impair the resident’s legal rights or ability to seek relief for

his or her claim.

History.—ss. 12, 32, ch. 80-198; s. 2, ch. 81-318; ss. 56, 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; ss. 24, 38, 39,

ch. 93-216; s. 779, ch. 95-148; s. 31, ch. 99-225; s. 39, ch. 2001-45; ss. 2, 52, ch. 2006-197.


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

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

(1) As used in this section, the term:

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(a) “Claim for residents’ rights violation or negligence” means a negligence claim alleging injury to or the

death of a resident arising out of an asserted violation of the rights of a resident under s. 429.28 or an asserted

deviation from the applicable standard of care.

(b) “Insurer” means any self-insurer authorized under s. 627.357, liability insurance carrier, joint underwriting

association, or uninsured prospective defendant.

(2) Prior to filing a claim for a violation of a resident’s rights or a claim for negligence, a claimant alleging

injury to or the death of a resident shall notify each prospective defendant by certified mail, return receipt requested,

of an asserted violation of a resident’s rights provided in s. 429.28 or deviation from the standard of care. Such

notification shall include an identification of the rights the prospective defendant has violated and the negligence

alleged to have caused the incident or incidents and a brief description of the injuries sustained by the resident which

are reasonably identifiable at the time of notice. The notice shall contain a certificate of counsel that counsel’s

reasonable investigation gave rise to a good faith belief that grounds exist for an action against each prospective

defendant.

(3)(a) No suit may be filed for a period of 75 days after notice is mailed to any prospective defendant. During

the 75-day period, the prospective defendants or their insurers shall conduct an evaluation of the claim to determine

the liability of each defendant and to evaluate the damages of the claimants. Each defendant or insurer of the

defendant shall have a procedure for the prompt evaluation of claims during the 75-day period. The procedure shall

include one or more of the following:

1. Internal review by a duly qualified facility risk manager or claims adjuster;

2. Internal review by counsel for each prospective defendant;

3. A quality assurance committee authorized under any applicable state or federal statutes or regulations; or

4. Any other similar procedure that fairly and promptly evaluates the claims.

Each defendant or insurer of the defendant shall evaluate the claim in good faith.

(b) At or before the end of the 75 days, the defendant or insurer of the defendant shall provide the claimant with

a written response:

1. Rejecting the claim; or

2. Making a settlement offer.

(c) The response shall be delivered to the claimant if not represented by counsel or to the claimant’s attorney,

by certified mail, return receipt requested. Failure of the prospective defendant or insurer of the defendant to reply to

the notice within 75 days after receipt shall be deemed a rejection of the claim for purposes of this section.

(4) The notification of a violation of a resident’s rights or alleged negligence shall be served within the

applicable statute of limitations period; however, during the 75-day period, the statute of limitations is tolled as to all

prospective defendants. Upon stipulation by the parties, the 75-day period may be extended and the statute of

limitations is tolled during any such extension. Upon receiving written notice by certified mail, return receipt

requested, of termination of negotiations in an extended period, the claimant shall have 60 days or the remainder of

the period of the statute of limitations, whichever is greater, within which to file suit.

(5) No statement, discussion, written document, report, or other work product generated by presuit claims

evaluation procedures under this section is discoverable or admissible in any civil action for any purpose by the

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opposing party. All participants, including, but not limited to, physicians, investigators, witnesses, and employees or

associates of the defendant, are immune from civil liability arising from participation in the presuit claims evaluation

procedure. Any licensed physician or registered nurse may be retained by either party to provide an opinion

regarding the reasonable basis of the claim. The presuit opinions of the expert are not discoverable or admissible in

any civil action for any purpose by the opposing party.

(6) Upon receipt by a prospective defendant of a notice of claim, the parties shall make discoverable

information available without formal discovery as provided in subsection (7).

(7) Informal discovery may be used by a party to obtain unsworn statements and the production of documents

or things, as follows:

(a) Unsworn statements.—Any party may require other parties to appear for the taking of an unsworn

statement. Such statements may be used only for the purpose of claims evaluation and are not discoverable or

admissible in any civil action for any purpose by any party. A party seeking to take the unsworn statement of any

party must give reasonable notice in writing to all parties. The notice must state the time and place for taking the

statement and the name and address of the party to be examined. Unless otherwise impractical, the examination of

any party must be done at the same time by all other parties. Any party may be represented by counsel at the taking

of an unsworn statement. An unsworn statement may be recorded electronically, stenographically, or on videotape.

The taking of unsworn statements is subject to the provisions of the Florida Rules of Civil Procedure and may be

terminated for abuses.

(b) Documents or things.—Any party may request discovery of relevant documents or things. The documents

or things must be produced, at the expense of the requesting party, within 20 days after the date of receipt of the

request. A party is required to produce relevant and discoverable documents or things within that party’s possession

or control, if in good faith it can reasonably be done within the timeframe of the claims evaluation process.

(8) Each request for and notice concerning informal discovery pursuant to this section must be in writing, and a

copy thereof must be sent to all parties. Such a request or notice must bear a certificate of service identifying the

name and address of the person to whom the request or notice is served, the date of the request or notice, and the

manner of service thereof.

(9) If a prospective defendant makes a written settlement offer, the claimant shall have 15 days from the date of

receipt to accept the offer. An offer shall be deemed rejected unless accepted by delivery of a written notice of

acceptance.

(10) To the extent not inconsistent with this part, the provisions of the Florida Mediation Code, Florida Rules of

Civil Procedure, shall be applicable to such proceedings.

(11) Within 30 days after the claimant’s receipt of defendant’s response to the claim, the parties or their

designated representatives shall meet in mediation to discuss the issues of liability and damages in accordance with

the mediation rules of practice and procedures adopted by the Supreme Court. Upon stipulation of the parties, this

30-day period may be extended and the statute of limitations is tolled during the mediation and any such extension.

At the conclusion of mediation, the claimant shall have 60 days or the remainder of the period of the statute of

limitations, whichever is greater, within which to file suit.

History.—s. 40, ch. 2001-45; ss. 2, 53, ch. 2006-197.

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

penalty.—

(1) Failure to provide complete copies of a resident’s records, including, but not limited to, all medical records

and the resident’s chart, within the control or possession of the facility in accordance with s. 400.145, shall

constitute evidence of failure of that party to comply with good faith discovery requirements and shall waive the

good faith certificate and presuit notice requirements under this part by the requesting party.

(2) No facility shall be held liable for any civil damages as a result of complying with this section.



429.295 Certain provisions not applicable to actions under this part.—An action under this part for a

violation of rights or negligence recognized herein is not a claim for medical malpractice, and the provisions of s.

768.21(8) do not apply to a claim alleging death of the resident.

History.—s. 42, ch. 2001-45; s. 2, ch. 2006-197.


429.296 Statute of limitations.—

(1) Any action for damages brought under this part shall be commenced within 2 years from the time the

incident giving rise to the action occurred or within 2 years from the time the incident is discovered, or should have

been discovered with the exercise of due diligence; however, in no event shall the action be commenced later than 4

years from the date of the incident or occurrence out of which the cause of action accrued.

(2) In those actions covered by this subsection in which it can be shown that fraudulent concealment or

intentional misrepresentation of fact prevented the discovery of the injury, the period of limitations is extended

forward 2 years from the time that the injury is discovered with the exercise of due diligence, but in no event not

more than 6 years from the date the incident giving rise to the injury occurred.

(3) This section shall apply to causes of action that have accrued prior to the effective date of this section;

however, any such cause of action that would not have been barred under prior law may be brought within the time

allowed by prior law or within 2 years after the effective date of this section, whichever is earlier, and will be barred

thereafter. In actions where it can be shown that fraudulent concealment or intentional misrepresentation of fact

prevented the discovery of the injury, the period of limitations is extended forward 2 years from the time that the

injury is discovered with the exercise of due diligence, but in no event more than 4 years from the effective date of

this section.

History.—s. 43, ch. 2001-45; s. 2, ch. 2006-197.


429.297 Punitive damages; pleading; burden of proof.—

(1) In any action for damages brought under this part, no claim for punitive damages shall be permitted unless

there is a reasonable showing by evidence in the record or proffered by the claimant which would provide a

reasonable basis for recovery of such damages. The claimant may move to amend her or his complaint to assert a

claim for punitive damages as allowed by the rules of civil procedure. The rules of civil procedure shall be liberally

5 – 41

construed so as to allow the claimant discovery of evidence which appears reasonably calculated to lead to

admissible evidence on the issue of punitive damages. No discovery of financial worth shall proceed until after the

pleading concerning punitive damages is permitted.

(2) A defendant may be held liable for punitive damages only if the trier of fact, based on clear and convincing

evidence, finds that the defendant was personally guilty of intentional misconduct or gross negligence. As used in

this section, the term:

(a) “Intentional misconduct” means that the defendant had actual knowledge of the wrongfulness of the conduct

and the high probability that injury or damage to the claimant would result and, despite that knowledge, intentionally

pursued that course of conduct, resulting in injury or damage.

(b) “Gross negligence” means that the defendant’s conduct was so reckless or wanting in care that it constituted

a conscious disregard or indifference to the life, safety, or rights of persons exposed to such conduct.

(3) In the case of an employer, principal, corporation, or other legal entity, punitive damages may be imposed

for the conduct of an employee or agent only if the conduct of the employee or agent meets the criteria specified in

subsection (2) and:

(a) The employer, principal, corporation, or other legal entity actively and knowingly participated in such

conduct;

(b) The officers, directors, or managers of the employer, principal, corporation, or other legal entity condoned,

ratified, or consented to such conduct; or

(c) The employer, principal, corporation, or other legal entity engaged in conduct that constituted gross

negligence and that contributed to the loss, damages, or injury suffered by the claimant.

(4) The plaintiff must establish at trial, by clear and convincing evidence, its entitlement to an award of punitive

damages. The “greater weight of the evidence” burden of proof applies to a determination of the amount of

damages.

(5) This section is remedial in nature and shall take effect upon becoming a law.

History.—s. 44, ch. 2001-45; s. 2, ch. 2006-197.


429.298 Punitive damages; limitation.—

(1)(a) Except as provided in paragraphs (b) and (c), an award of punitive damages may not exceed the greater

of:

1. Three times the amount of compensatory damages awarded to each claimant entitled thereto, consistent with

the remaining provisions of this section; or

2. The sum of $1 million.

(b) Where the fact finder determines that the wrongful conduct proven under this section was motivated

primarily by unreasonable financial gain and determines that the unreasonably dangerous nature of the conduct,

together with the high likelihood of injury resulting from the conduct, was actually known by the managing agent,

director, officer, or other person responsible for making policy decisions on behalf of the defendant, it may award an

amount of punitive damages not to exceed the greater of:

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1. Four times the amount of compensatory damages awarded to each claimant entitled thereto, consistent with

the remaining provisions of this section; or

2. The sum of $4 million.

(c) Where the fact finder determines that at the time of injury the defendant had a specific intent to harm the

claimant and determines that the defendant’s conduct did in fact harm the claimant, there shall be no cap on punitive

damages.

(d) This subsection is not intended to prohibit an appropriate court from exercising its jurisdiction under s.

768.74 in determining the reasonableness of an award of punitive damages that is less than three times the amount of

compensatory damages.

(e) In any case in which the findings of fact support an award of punitive damages pursuant to paragraph (b) or

paragraph (c), the clerk of the court shall refer the case to the appropriate law enforcement agencies, to the state

attorney in the circuit where the long-term care facility that is the subject of the underlying civil cause of action is

located, and, for multijurisdictional facility owners, to the Office of the Statewide Prosecutor; and such agencies,

state attorney, or Office of the Statewide Prosecutor shall initiate a criminal investigation into the conduct giving

rise to the award of punitive damages. All findings by the trier of fact which support an award of punitive damages

under this paragraph shall be admissible as evidence in any subsequent civil or criminal proceeding relating to the

acts giving rise to the award of punitive damages under this paragraph.

(2) The claimant’s attorney’s fees, if payable from the judgment, are, to the extent that the fees are based on the

punitive damages, calculated based on the final judgment for punitive damages. This subsection does not limit the

payment of attorney’s fees based upon an award of damages other than punitive damages.

(3) The jury may neither be instructed nor informed as to the provisions of this section.

(4) Notwithstanding any other law to the contrary, the amount of punitive damages awarded pursuant to this

section shall be equally divided between the claimant and the Quality of Long-Term Care Facility Improvement

Trust Fund, in accordance with the following provisions:

(a) The clerk of the court shall transmit a copy of the jury verdict to the Chief Financial Officer by certified

mail. In the final judgment, the court shall order the percentages of the award, payable as provided herein.

(b) A settlement agreement entered into between the original parties to the action after a verdict has been

returned must provide a proportionate share payable to the Quality of Long-Term Care Facility Improvement Trust

Fund specified herein. For purposes of this paragraph, a proportionate share is a 50-percent share of that percentage

of the settlement amount which the punitive damages portion of the verdict bore to the total of the compensatory and

punitive damages in the verdict.

(c) The Department of Financial Services shall collect or cause to be collected all payments due the state under

this section. Such payments are made to the Chief Financial Officer and deposited in the appropriate fund specified

in this subsection.

(d) If the full amount of punitive damages awarded cannot be collected, the claimant and the other recipient

designated pursuant to this subsection are each entitled to a proportionate share of the punitive damages collected.

(5) This section is remedial in nature and shall take effect upon becoming a law.


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429.31 Closing of facility; notice; penalty.—

(1) In addition to the requirements of part II of chapter 408, the facility shall inform each resident or the next of

kin, legal representative, or agency acting on each resident’s behalf, of the fact and the proposed time of

discontinuance of operation, following the notification requirements provided in s. 429.28(1)(k). In the event a

resident has no person to represent him or her, the facility shall be responsible for referral to an appropriate social

service agency for placement.

(2) Immediately upon the notice by the agency of the voluntary or involuntary termination of such operation,

the agency shall monitor the transfer of residents to other facilities and ensure that residents’ rights are being

protected. The agency, in consultation with the Department of Children and Families, shall specify procedures for

ensuring that all residents who receive services are appropriately relocated.

(3) All charges shall be prorated as of the date on which the facility discontinues operation, and if any payments

have been made in advance, the payments for services not received shall be refunded to the resident or the resident’s

guardian within 10 working days of voluntary or involuntary closure of the facility, whether or not such refund is

requested by the resident or guardian.

(4) The agency may levy a fine in an amount no greater than $5,000 upon each person or business entity that

owns any interest in a facility that terminates operation without providing notice to the agency and the residents of

the facility at least 30 days before operation ceases. This fine shall not be levied against any facility involuntarily

closed at the initiation of the agency. The agency shall use the proceeds of the fines to operate the facility until all

residents of the facility are relocated.

History.—s. 13, ch. 75-233; ss. 12, 25, ch. 80-198; s. 2, ch. 81-318; ss. 57, 79, 83, ch. 83-181; s. 20, ch. 91-263;

ss. 25, 38, 39, ch. 93-216; s. 780, ch. 95-148; s. 50, ch. 95-418; s. 123, ch. 99-8; ss. 2, 54, ch. 2006-197; s. 154, ch.

2007-230; s. 249, ch. 2014-19; s. 16, ch. 2019-11.


429.34 Right of entry and inspection.—

(1) In addition to the requirements of s. 408.811, a duly designated officer or employee of the agency, of the

Department of Children and Families, of the Medicaid Fraud Control Unit of the Office of the Attorney General, or

of the state or local fire marshal, or a representative of the State Long-Term Care Ombudsman Program or a member

of the state or local long-term care ombudsman council has the right to enter unannounced upon and into the

premises of any facility licensed under this part in order to determine the state of compliance with this part, part II of

chapter 408, and applicable rules. Data collected by the State Long-Term Care Ombudsman Program, local long-

term care ombudsman councils, or the state or local advocacy councils may be used by the agency in investigations

involving violations of regulatory standards. A person specified in this section who knows or has reasonable cause

to suspect that a vulnerable adult has been or is being abused, neglected, or exploited shall immediately report such

knowledge or suspicion to the central abuse hotline pursuant to chapter 415.

(2)(a) In addition to the requirements of s. 408.811, the agency may inspect and investigate facilities as

necessary to determine compliance with this part, part II of chapter 408, and rules adopted thereunder. If an assisted

living facility is cited for a class I violation or three or more class II violations arising from separate surveys within a

5 – 44

60-day period or due to unrelated circumstances during the same survey, the agency must conduct an additional

licensure inspection within 6 months.

(b) During any calendar year in which a survey is not conducted, the agency may conduct monitoring visits of

each facility cited in the previous year for a class I or class II violation or for more than three uncorrected class III

violations.

History.—s. 14, ch. 75-233; s. 1, ch. 77-174; ss. 12, 26, ch. 80-198; s. 2, ch. 81-318; ss. 10, 18, 19, ch. 82-148;

ss. 58, 79, 83, ch. 83-181; s. 1, ch. 88-350; s. 24, ch. 93-177; ss. 26, 38, 39, ch. 93-216; s. 51, ch. 95-418; s. 124, ch.


2007-230; s. 250, ch. 2014-19; s. 38, ch. 2015-31; s. 14, ch. 2015-126; s. 87, ch. 2018-24; s. 17, ch. 2019-11.


429.35 Maintenance of records; reports.—

(1) Every facility shall maintain, as public information available for public inspection under such conditions as

the agency shall prescribe, records containing copies of all inspection reports pertaining to the facility that have been

issued by the agency to the facility. Copies of inspection reports shall be retained in the records for 5 years from the

date the reports are filed or issued.

(2) Within 60 days after the date of the biennial inspection visit required under s. 408.811 or within 30 days

after the date of any interim visit, the agency shall forward the results of the inspection to the local ombudsman

council in the district where the facility is located; to at least one public library or, in the absence of a public library,

the county seat in the county in which the inspected assisted living facility is located; and, when appropriate, to the

district Adult Services and Mental Health Program Offices.

(3) Every facility shall post a copy of the last inspection report of the agency for that facility in a prominent

location within the facility so as to be accessible to all residents and to the public. Upon request, the facility shall

also provide a copy of the report to any resident of the facility or to an applicant for admission to the facility.

History.—ss. 12, 27, ch. 80-198; s. 2, ch. 81-318; ss. 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; s. 1, ch. 88-145; s.

19, ch. 90-347; s. 21, ch. 91-263; ss. 27, 38, 39, ch. 93-216; s. 16, ch. 95-210; s. 57, ch. 2000-139; s. 145, ch. 2000-


2015-31.


429.41 Rules establishing standards.—

(1) It is the intent of the Legislature that rules published and enforced pursuant to this section shall include

criteria by which a reasonable and consistent quality of resident care and quality of life may be ensured and the

results of such resident care may be demonstrated. Such rules shall also ensure a safe and sanitary environment that

is residential and noninstitutional in design or nature. It is further intended that reasonable efforts be made to

accommodate the needs and preferences of residents to enhance the quality of life in a facility. Uniform firesafety

standards for assisted living facilities shall be established by the State Fire Marshal pursuant to s. 633.206. The

agency may adopt rules to administer part II of chapter 408. In order to provide safe and sanitary facilities and the

highest quality of resident care accommodating the needs and preferences of residents, the agency, in consultation

5 – 45

with the Department of Children and Families and the Department of Health, shall adopt rules, policies, and

procedures to administer this part, which must include reasonable and fair minimum standards in relation to:

(a) The requirements for and maintenance of facilities, not in conflict with chapter 553, relating to plumbing,

heating, cooling, lighting, ventilation, living space, and other housing conditions, which will ensure the health,

safety, and comfort of residents suitable to the size of the structure.

1. Firesafety evacuation capability determination.—An evacuation capability evaluation for initial licensure

shall be conducted within 6 months after the date of licensure.

2. Firesafety requirements.—

a. The National Fire Protection Association, Life Safety Code, NFPA 101 and 101A, current editions, shall be

used in determining the uniform firesafety code adopted by the State Fire Marshal for assisted living facilities,

pursuant to s. 633.206.

b. A local government or a utility may charge fees only in an amount not to exceed the actual expenses incurred

by the local government or the utility relating to the installation and maintenance of an automatic fire sprinkler

system in a licensed assisted living facility structure.

c. All licensed facilities must have an annual fire inspection conducted by the local fire marshal or authority

having jurisdiction.

d. An assisted living facility that is issued a building permit or certificate of occupancy before July 1, 2016,

may at its option and after notifying the authority having jurisdiction, remain under the provisions of the 1994 and

1995 editions of the National Fire Protection Association, Life Safety Code, NFPA 101, and NFPA 101A. The

facility opting to remain under such provisions may make repairs, modernizations, renovations, or additions to, or

rehabilitate, the facility in compliance with NFPA 101, 1994 edition, and may utilize the alternative approaches to

life safety in compliance with NFPA 101A, 1995 edition. However, a facility for which a building permit or

certificate of occupancy is issued before July 1, 2016, that undergoes Level III building alteration or rehabilitation,

as defined in the Florida Building Code, or seeks to utilize features not authorized under the 1994 or 1995 editions

of the Life Safety Code must thereafter comply with all aspects of the uniform firesafety standards established under

s. 633.206, and the Florida Fire Prevention Code, in effect for assisted living facilities as adopted by the State Fire

Marshal.

3. Resident elopement requirements.—Facilities are required to conduct a minimum of two resident elopement

prevention and response drills per year. All administrators and direct care staff must participate in the drills, which

shall include a review of procedures to address resident elopement. Facilities must document the implementation of

the drills and ensure that the drills are conducted in a manner consistent with the facility’s resident elopement

policies and procedures.

(b) The preparation and annual update of a comprehensive emergency management plan. Such standards must

be included in the rules adopted by the agency after consultation with the Division of Emergency Management. At a

minimum, the rules must provide for plan components that address emergency evacuation transportation; adequate

sheltering arrangements; postdisaster activities, including provision of emergency power, food, and water;

postdisaster transportation; supplies; staffing; emergency equipment; individual identification of residents and

transfer of records; communication with families; and responses to family inquiries. The comprehensive emergency

5 – 46

management plan is subject to review and approval by the local emergency management agency. During its review,

the local emergency management agency shall ensure that the following agencies, at a minimum, are given the

opportunity to review the plan: the Department of Health, the Agency for Health Care Administration, and the

Division of Emergency Management. Also, appropriate volunteer organizations must be given the opportunity to

review the plan. The local emergency management agency shall complete its review within 60 days and either

approve the plan or advise the facility of necessary revisions.

(c) The number, training, and qualifications of all personnel having responsibility for the care of residents. The

rules must require adequate staff to provide for the safety of all residents. Facilities licensed for 17 or more residents

are required to maintain an alert staff for 24 hours per day.

(d) All sanitary conditions within the facility and its surroundings which will ensure the health and comfort of

residents. The rules must clearly delineate the responsibilities of the agency’s licensure and survey staff, the county

health departments, and the local authority having jurisdiction over firesafety and ensure that inspections are not

duplicative. The agency may collect fees for food service inspections conducted by the county health departments

and transfer such fees to the Department of Health.

(e) License application and license renewal, transfer of ownership, proper management of resident funds and

personal property, surety bonds, resident contracts, refund policies, financial ability to operate, and facility and staff

records.

(f) Inspections, complaint investigations, moratoriums, classification of deficiencies, levying and enforcement

of penalties, and use of income from fees and fines.

(g) The enforcement of the resident bill of rights specified in s. 429.28.

(h) The care and maintenance of residents, which must include, but is not limited to:

1. The supervision of residents;

2. The provision of personal services;

3. The provision of, or arrangement for, social and leisure activities;

4. The arrangement for appointments and transportation to appropriate medical, dental, nursing, or mental

health services, as needed by residents;

5. The management of medication;

6. The nutritional needs of residents;

7. Resident records; and

8. Internal risk management and quality assurance.

(i) Facilities holding a limited nursing, extended congregate care, or limited mental health license.

(j) The establishment of specific criteria to define appropriateness of resident admission and continued

residency in a facility holding a standard, limited nursing, extended congregate care, and limited mental health

license.

(k) The use of physical or chemical restraints. The use of physical restraints is limited to half-bed rails as

prescribed and documented by the resident’s physician with the consent of the resident or, if applicable, the

resident’s representative or designee or the resident’s surrogate, guardian, or attorney in fact. The use of chemical

restraints is limited to prescribed dosages of medications authorized by the resident’s physician and must be

5 – 47

consistent with the resident’s diagnosis. Residents who are receiving medications that can serve as chemical

restraints must be evaluated by their physician at least annually to assess:

1. The continued need for the medication.

2. The level of the medication in the resident’s blood.

3. The need for adjustments in the prescription.

(l) The establishment of specific policies and procedures on resident elopement. Facilities shall conduct a

minimum of two resident elopement drills each year. All administrators and direct care staff shall participate in the

drills. Facilities shall document the drills.

(2) In adopting any rules pursuant to this part, the agency shall make distinct standards for facilities based upon

facility size; the types of care provided; the physical and mental capabilities and needs of residents; the type,

frequency, and amount of services and care offered; and the staffing characteristics of the facility. Rules developed

pursuant to this section may not restrict the use of shared staffing and shared programming in facilities that are part

of retirement communities that provide multiple levels of care and otherwise meet the requirements of law and rule.

If a continuing care facility licensed under chapter 651 or a retirement community offering multiple levels of care

licenses a building or part of a building designated for independent living for assisted living, staffing requirements

established in rule apply only to residents who receive personal, limited nursing, or extended congregate care

services under this part. Such facilities shall retain a log listing the names and unit number for residents receiving

these services. The log must be available to surveyors upon request. Except for uniform firesafety standards, the

agency shall adopt by rule separate and distinct standards for facilities with 16 or fewer beds and for facilities with

17 or more beds. The standards for facilities with 16 or fewer beds must be appropriate for a noninstitutional

residential environment; however, the structure may not be more than two stories in height and all persons who

cannot exit the facility unassisted in an emergency must reside on the first floor. The agency may make other

distinctions among types of facilities as necessary to enforce this part. Where appropriate, the agency shall offer

alternate solutions for complying with established standards, based on distinctions made by the agency relative to

the physical characteristics of facilities and the types of care offered.

(3) Rules adopted by the agency shall encourage the development of homelike facilities that promote the

dignity, individuality, personal strengths, and decisionmaking ability of residents.

(4) The agency may waive rules adopted under this part to demonstrate and evaluate innovative or cost-

effective congregate care alternatives that enable individuals to age in place. Such waivers may be granted only in

instances where there is reasonable assurance that the health, safety, or welfare of residents will not be endangered.

To apply for a waiver, the licensee shall submit to the agency a written description of the concept to be

demonstrated, including goals, objectives, and anticipated benefits; the number and types of residents who will be

affected, if applicable; a brief description of how the demonstration will be evaluated; and any other information

deemed appropriate by the agency. Any facility granted a waiver shall submit a report of findings to the agency

within 12 months. At such time, the agency may renew or revoke the waiver or pursue any regulatory or statutory

changes necessary to allow other facilities to adopt the same practices. The agency may by rule clarify terms and

establish waiver application procedures, criteria for reviewing waiver proposals, and procedures for reporting

findings, as necessary to implement this subsection.

5 – 48

(5) The agency may use an abbreviated biennial standard licensure inspection that consists of a review of key

quality-of-care standards in lieu of a full inspection in a facility that has a good record of past performance.

However, a full inspection must be conducted in a facility that has a history of class I or class II violations,

uncorrected class III violations, confirmed ombudsman council complaints, or confirmed licensure complaints

within the previous licensure period immediately preceding the inspection or if a potentially serious problem is

identified during the abbreviated inspection. The agency shall develop the key quality-of-care standards with input

from the State Long-Term Care Ombudsman Council and representatives of provider groups for incorporation into

its rules.

History.—s. 16, ch. 75-233; ss. 12, 29, ch. 80-198; s. 2, ch. 81-318; ss. 59, 79, 83, ch. 83-181; s. 7, ch. 85-145; s.

1, ch. 86-87; s. 13, ch. 87-371; s. 20, ch. 89-294; s. 22, ch. 91-263; s. 25, ch. 93-177; s. 26, ch. 93-211; ss. 28, 38,

39, ch. 93-216; ss. 12, 20, 52, ch. 95-418; s. 27, ch. 97-100; s. 99, ch. 97-101; s. 5, ch. 98-148; s. 15, ch. 99-332; s.

47, ch. 2001-45; s. 7, ch. 2004-298; s. 2, ch. 2004-386; ss. 2, 55, ch. 2006-197; s. 157, ch. 2007-230; s. 142, ch.

2010-102; s. 343, ch. 2011-142; s. 137, ch. 2013-183; s. 251, ch. 2014-19; s. 15, ch. 2015-126; s. 1, ch. 2016-92; s.

18, ch. 2019-11.


429.42 Pharmacy and dietary services.—

(1) Any assisted living facility in which the agency has documented a class I or class II deficiency or

uncorrected class III deficiencies regarding medicinal drugs or over-the-counter preparations, including their

storage, use, delivery, or administration, or dietary services, or both, during a biennial survey or a monitoring visit or

an investigation in response to a complaint, shall, in addition to or as an alternative to any penalties imposed under s.

429.19, be required to employ the consultant services of a licensed pharmacist, a licensed registered nurse, or a

registered or licensed dietitian, as applicable. The consultant shall, at a minimum, provide onsite quarterly

consultation until the inspection team from the agency determines that such consultation services are no longer

required.

(2) A corrective action plan for deficiencies related to assistance with the self-administration of medication or

the administration of medication must be developed and implemented by the facility within 48 hours after

notification of such deficiency, or sooner if the deficiency is determined by the agency to be life-threatening.

(3) The agency shall employ at least two pharmacists licensed pursuant to chapter 465 among its personnel who

biennially inspect assisted living facilities licensed under this part, to participate in biennial inspections or consult

with the agency regarding deficiencies relating to medicinal drugs or over-the-counter preparations.

(4) The agency may by rule establish procedures and specify documentation as necessary to implement this

section.

History.—s. 1, ch. 89-218; s. 1, ch. 90-192; s. 23, ch. 91-263; ss. 29, 38, 39, ch. 93-216; s. 17, ch. 95-210; s. 18,

ch. 98-80; s. 6, ch. 98-148; ss. 2, 56, ch. 2006-197; s. 19, ch. 2019-11.


429.44 Construction and renovation; requirements.—

(1) The requirements for the construction and renovation of a facility shall comply with chapter 553 which

pertains to building construction standards, including plumbing, electrical code, glass, manufactured buildings,

5 – 49

accessibility for persons with disabilities, and the state minimum building code and with s. 633.206, which pertains

to uniform firesafety standards.

(2) Upon notification by the local authority having jurisdiction over life-threatening violations which seriously

threaten the health, safety, or welfare of a resident of a facility, the agency shall take action as specified in s. 429.14.

History.—s. 17, ch. 75-233; s. 3, ch. 79-152; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; ss. 30, 38, 39, ch. 93-216; s.

14, ch. 95-418; s. 7, ch. 98-148; ss. 2, 57, ch. 2006-197; s. 138, ch. 2013-183; s. 34, ch. 2015-4.


429.445 Compliance with local zoning requirements.—No facility licensed under this part may commence

any construction which will expand the size of the existing structure unless the licensee first submits to the agency

proof that such construction will be in compliance with applicable local zoning requirements. Facilities with a

licensed capacity of less than 15 persons shall comply with the provisions of chapter 419.

History.—s. 2, ch. 85-251; s. 24, ch. 91-263; ss. 31, 39, ch. 93-216; s. 2, ch. 2006-197.


429.47 Prohibited acts; penalties for violation.—

(1) While a facility is under construction, the owner may advertise to the public prior to obtaining a license.

Facilities that are certified under chapter 651 shall comply with the advertising provisions of s. 651.095 rather than

those provided for in this subsection.

(2) A freestanding facility shall not advertise or imply that any part of it is a nursing home. For the purpose of

this subsection, “freestanding facility” means a facility that is not operated in conjunction with a nursing home to

which residents of the facility are given priority when nursing care is required. A person who violates this subsection

is subject to fine as specified in s. 429.19.

(3) Any facility which is affiliated with any religious organization or which has a name implying religious

affiliation shall include in its advertising whether or not it is affiliated with any religious organization and, if so,

which organization.

(4) A facility licensed under this part which is not part of a facility authorized under chapter 651 shall include

the facility’s license number as given by the agency in all advertising. A company or person owning more than one

facility shall include at least one license number per advertisement. All advertising shall include the term “assisted

living facility” before the license number.

History.—s. 18, ch. 75-233; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; s. 14, ch. 87-371; s. 25, ch. 91-263; ss. 32,

38, 39, ch. 93-216; s. 18, ch. 95-210; s. 217, ch. 99-13; ss. 2, 58, ch. 2006-197; s. 158, ch. 2007-230.


429.49 Resident records; penalties for alteration.—

(1) Any person who fraudulently alters, defaces, or falsifies any medical or other record of an assisted living

facility, or causes or procures any such offense to be committed, commits a misdemeanor of the second degree,

punishable as provided in s. 775.082 or s. 775.083.

(2) A conviction under subsection (1) is also grounds for restriction, suspension, or termination of license

privileges.

History.—s. 48, ch. 2001-45; s. 2, ch. 2006-197.

5 – 50


429.52 Staff training and educational programs; core educational requirement.—

(1) Effective October 1, 2015, each new assisted living facility employee who has not previously completed

core training must attend a preservice orientation provided by the facility before interacting with residents. The

preservice orientation must be at least 2 hours in duration and cover topics that help the employee provide

responsible care and respond to the needs of facility residents. Upon completion, the employee and the administrator

of the facility must sign a statement that the employee completed the required preservice orientation. The facility

must keep the signed statement in the employee’s personnel record.

(2) Administrators and other assisted living facility staff must meet minimum training and education

requirements established by the agency by rule. This training and education is intended to assist facilities to

appropriately respond to the needs of residents, to maintain resident care and facility standards, and to meet

licensure requirements.

(3) The agency, in conjunction with providers, shall develop a competency test and a minimum required score

to indicate successful completion of the training and educational requirements. The required training and education

must cover at least the following topics:

(a) State law and rules relating to assisted living facilities.

(b) Resident rights and identifying and reporting abuse, neglect, and exploitation.

(c) Special needs of elderly persons, persons with mental illness, and persons with developmental disabilities

and how to meet those needs.

(d) Nutrition and food service, including acceptable sanitation practices for preparing, storing, and serving

food.

(e) Medication management, recordkeeping, and proper techniques for assisting residents with self-

administered medication.

(f) Firesafety requirements, including fire evacuation drill procedures and other emergency procedures.

(g) Care of persons with Alzheimer’s disease and related disorders.

(4) A new facility administrator must complete the required training and education, including the competency

test, within 90 days after date of employment as an administrator. Failure to do so is a violation of this part and

subjects the violator to an administrative fine as prescribed in s. 429.19. Administrators licensed in accordance with

part II of chapter 468 are exempt from this requirement. Other licensed professionals may be exempted, as

determined by the agency by rule.

(5) Administrators are required to participate in continuing education for a minimum of 12 contact hours every

2 years.

(6) Staff involved with the management of medications and assisting with the self-administration of

medications under s. 429.256 must complete a minimum of 6 additional hours of training provided by a registered

nurse, a licensed pharmacist, or agency staff. The agency shall establish by rule the minimum requirements of this

additional training.

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

5 – 51

(8) If the agency determines that there are problems in a facility which could be reduced through specific staff

training or education beyond that already required under this section, the agency may require, and provide, or cause

to be provided, the training or education of any personal care staff in the facility.

(9) The agency shall adopt rules related to these training requirements, the competency test, necessary

procedures, and competency test fees and shall adopt or contract with another entity to develop a curriculum, which

shall be used as the minimum core training requirements. The agency shall consult with representatives of

stakeholder associations and agencies in the development of the curriculum.

(10) The training required by this section other than the preservice orientation must be conducted by persons

registered with the agency as having the requisite experience and credentials to conduct the training. A person

seeking to register as a trainer must provide the agency with proof of completion of the minimum core training

education requirements, successful passage of the competency test established under this section, and proof of

compliance with the continuing education requirement in subsection (5).

(11) A person seeking to register as a trainer must also:

(a) Provide proof of completion of a 4-year degree from an accredited college or university and must have

worked in a management position in an assisted living facility for 3 years after being core certified;

(b) Have worked in a management position in an assisted living facility for 5 years after being core certified

and have 1 year of teaching experience as an educator or staff trainer for persons who work in assisted living

facilities or other long-term care settings;

(c) Have been previously employed as a core trainer for the agency or department; or

(d) Meet other qualification criteria as defined in rule, which the agency is authorized to adopt.

(12) The agency shall adopt rules to establish trainer registration requirements.


251; s. 21, ch. 89-294; s. 27, ch. 91-263; ss. 33, 38, 39, ch. 93-216; s. 19, ch. 95-210; ss. 15, 26, 53, ch. 95-418; s.

16, ch. 97-82; s. 29, ch. 97-100; s. 19, ch. 98-80; s. 25, ch. 2003-57; s. 3, ch. 2003-405; ss. 2, 59, ch. 2006-197; s. 1,

ch. 2007-219; s. 16, ch. 2015-126; s. 88, ch. 2018-24; s. 57, ch. 2018-110; s. 20, ch. 2019-11.


429.53 Consultation by the agency.—

(1) The area offices of licensure and certification of the agency shall provide consultation to the following upon

request:

(a) A licensee of a facility.

(b) A person interested in obtaining a license to operate a facility under this part.

(2) As used in this section, “consultation” includes:

(a) An explanation of the requirements of this part and rules adopted pursuant thereto;

(b) An explanation of the license application and renewal procedures;

(c) The provision of a checklist of general local and state approvals required prior to constructing or developing

a facility and a listing of the types of agencies responsible for such approvals;

(d) An explanation of benefits and financial assistance available to a recipient of supplemental security income

residing in a facility;

5 – 52

(e) Any other information which the agency deems necessary to promote compliance with the requirements of

this part; and

(f) A preconstruction review of a facility to ensure compliance with agency rules and this part.

(3) The agency may charge a fee commensurate with the cost of providing consultation under this section.

History.—ss. 15, 19, ch. 87-371; s. 22, ch. 89-294; ss. 34, 38, 39, ch. 93-216; s. 2, ch. 2006-197.


429.54 Collection of information; local subsidy.—

(1) To enable the agency to collect the information requested by the Legislature regarding the actual cost of

providing room, board, and personal care in facilities, the agency is authorized to conduct field visits and audits of

facilities as necessary. The owners of randomly sampled facilities shall submit such reports, audits, and accountings

of cost as the agency may require by rule; provided that such reports, audits, and accountings shall be the minimum

necessary to implement this section. Any facility selected to participate in the study shall cooperate with the agency

by providing cost of operation information to interviewers.

(2) Local governments or organizations may contribute to the cost of care of local facility residents by further

subsidizing the rate of state-authorized payment to such facilities. Implementation of local subsidy requires agency

approval and may not result in reductions in the state supplement.

History.—ss. 12, 35, ch. 80-198; s. 2, ch. 81-318; ss. 75, 79, 83, ch. 83-181; s. 53, ch. 83-218; ss. 38, 39, ch. 93-

216; s. 2, ch. 2006-197; s. 21, ch. 2019-11.


429.55 Consumer information website.—The Legislature finds that consumers need additional information

on the quality of care and service in assisted living facilities in order to select the best facility for themselves or their

loved ones. Therefore, the Agency for Health Care Administration shall create content that is easily accessible

through the home page of the agency’s website either directly or indirectly through links to one or more other

established websites of the agency’s choosing. The website must be searchable by facility name, license type, city,

or zip code. By November 1, 2015, the agency shall include all content in its possession on the website and add

content when received from facilities. At a minimum, the content must include:

(1) Information on each licensed assisted living facility, including, but not limited to:

(a) The name and address of the facility.

(b) The name of the owner or operator of the facility.

(c) The number and type of licensed beds in the facility.

(d) The types of licenses held by the facility.

(e) The facility’s license expiration date and status.

(f) The total number of clients that the facility is licensed to serve and the most recently available occupancy

levels.

(g) The number of private and semiprivate rooms offered.

(h) The bed-hold policy.

(i) The religious affiliation, if any, of the assisted living facility.

(j) The languages spoken by the staff.

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(k) Availability of nurses.

(l) Forms of payment accepted, including, but not limited to, Medicaid, Medicaid long-term managed care,

private insurance, health maintenance organization, United States Department of Veterans Affairs, CHAMPUS

program, or workers’ compensation coverage.

(m) Indication if the licensee is operating under bankruptcy protection.

(n) Recreational and other programs available.

(o) Special care units or programs offered.

(p) Whether the facility is a part of a retirement community that offers other services pursuant to this part or

part III of this chapter, part II or part III of chapter 400, or chapter 651.

(q) Links to the State Long-Term Care Ombudsman Program website and the program’s statewide toll-free

telephone number.

(r) Links to the websites of the providers.

(s) Other relevant information that the agency currently collects.

(2) Survey and violation information for the facility, including a list of the facility’s violations committed

during the previous 60 months, which on July 1, 2015, may include violations committed on or after July 1, 2010.

The list shall be updated monthly and include for each violation:

(a) A summary of the violation, including all licensure, revisit, and complaint survey information, presented in

a manner understandable by the general public.

(b) Any sanctions imposed by final order.

(c) The date the corrective action was confirmed by the agency.

(3) Links to inspection reports that the agency has on file.

(4) The agency may adopt rules to administer this section.

History.—s. 17, ch. 2015-126.

5 – 54

CHAPTER 429 ASSISTED CARE COMMUNITIES

PART III ADULT DAY CARE CENTERS

(s. 429.905)

429.905 Exemptions; monitoring of adult day care center programs colocated with assisted living

facilities or licensed nursing home facilities.—

(1) The following are exempt from this part:

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

(b) Any freestanding inpatient hospice facility that is licensed by the state and which provides day care services

to hospice patients only.

(2) A licensed assisted living facility, a licensed hospital, or a licensed nursing home facility may provide

services during the day which include, but are not limited to, social, health, therapeutic, recreational, nutritional, and

respite services, to adults who are not residents. Such a facility need not be licensed as an adult day care center;

however, the agency must monitor the facility during the regular inspection and at least biennially to ensure

adequate space and sufficient staff. If an assisted living facility, a hospital, or a nursing home holds itself out to the

public as an adult day care center, it must be licensed as such and meet all standards prescribed by statute and rule.

For the purpose of this subsection, the term “day” means any portion of a 24-hour day.

History.—s. 4, ch. 78-336; s. 2, ch. 81-318; ss. 79, 83, ch. 83-181; s. 6, ch. 88-235; ss. 4, 17, ch. 93-215; s. 20,

ch. 95-210; s. 4, ch. 2006-197; s. 30, ch. 2012-160.


6 – 1

Assisted Living Rule Transfer Table

The rules and the rulemaking function for assisted living communities was transferred from the

Department of Elder Affairs to the Agency for Health Care Administration during the past legislative

session (Chapter 2019-11, Laws of Florida), effective July 1, 2019. The following is a crosswalk of the

transfer of each rule in Chapter 58A-5 (assisted living operations) and Chapter 58T-1 (assisted living core

trainer requirements) to Chapter 59A-36, Florida Administrative Code.

Transferred from DOEA Rule Chapter 58A-5

Transferred to AHCA Rule Chapter 59A-36

58A-5.0131 59A-36.002 58A-5.014 59A-36.003 58A-5.016 59A-36.004 58A-5.0161 59A-36.005 58A-5.0181 59A-36.006 58A-5.0182 59A-36.007 58A-5.0185 59A-36.008 58A-5.0186 59A-36.009 58A-5.019 59A-36.010 58A-5.0191 59A-36.011 58A-5.020 59A-36.012 58A-5.021 59A-36.013 58A-5.023 59A-36.014 58A-5.024 59A-36.015 58A-5.0241 59A-36.016 58A-5.0242 59A-36.017 58A-5.025 59A-36.018 58A-5.026 59A-36.019 58A-5.029 59A-36.020 58A-5.030 59A-36.021 58A-5.031 59A-36.022 58A-5.033 59A-36.023 58A-5.035 59A-36.024 58A-5.036 59A-36.025 58T-1.203 59A-36.027 58T-1.205 59A-36.028 58T-1.207 59A-36.029 58T-1.209 59A-36.030 58T-1.211 59A-36.031

6 – 2


Effective July 1, 2019 6A – 1

CHAPTER 59A-36

ASSISTED LIVING FACILITY 59A-36.001 Standards and Criteria for Determining Compliance with Facility Standards and Resident Rights


59A-36.003 Licensing and Change of Ownership

59A-36.004 License Requirements

59A-36.005 Inspection Responsibilities

59A-36.006 Admission Procedures, Appropriateness of Placement and Continued Residency Criteria

59A-36.007 Resident Care Standards

59A-36.008 Medication Practices

59A-36.009 Do Not Resuscitate Orders (DNROs)

59A-36.010 Staffing Standards

59A-36.011 Staff Training Requirements and Competency Test

59A-36.012 Food Service Standards

59A-36.013 Fiscal Standards

59A-36.014 Physical Plant Standards

59A-36.015 Records

59A-36.016 Adverse Incident Report

59A-36.017 Liability Claim Report

59A-36.018 Resident Contracts

59A-36.019 Emergency Management

59A-36.020 Limited Mental Health

59A-36.021 Extended Congregate Care Services

59A-36.022 Limited Nursing Services

59A-36.023 Administrative Enforcement

59A-36.024 Waivers

59A-36.025 Emergency Environmental Control for Assisted Living Facilities

59A-36.027 ALF Core Training Provider Qualifications

59A-36.028 ALF Minimum Core Training Curriculum Requirements

59A-36.029 ALF Core Training Provider Initial Registration Process

59A-36.030 Process for Maintaining ALF Core Training Provider Registration

59A-36.031 Registered ALF Core Training Provider Responsibilities

59A-36.001 Standards and Criteria for Determining Compliance with Facility Standards and Resident

Rights.

(1) DEFINITIONS.

In addition to the terms defined in section 429.02, F.S., and rule 59A-36.002, F.A.C., the following definitions are

applicable in this rule chapter.

(a) “Core Survey Task” means tasks conducted by Agency survey staff that focus on core areas of regulations.

(b) “Timely Manner” means as soon as possible, but not to exceed 24 hours of Agency staff having requested

materials.


(2) SURVEY PROCESS FOR RESIDENT RIGHTS.

The following core survey tasks shall be utilized during survey activities in order to determine the facility’s

compliance with resident rights pursuant to section 429.28, F.S., and rule 59A-36.007, F.A.C.

(a) The surveyor(s) conducts a tour of the facility to determine if the residents’ health, safety, and welfare are

maintained. The tour includes observations and assessments of the following:

1. Resident behavior and demeanor;

2. Adherence to facility abuse prohibition policy and procedure;

3. Adherence to infection control policy and procedure;

4. General physical plant standards in accordance with rule 59A-36.014, F.A.C.;

5. Overall appearance of residents and observations of any special care needs;

6. Posting of Resident Bill of Rights and required phone numbers in accordance with rule 59A-36.007, F.A.C.;

7. Resident access to phones and unrestricted private communication;

8. Resident opportunity to exercise;

9. Staff availability and responsiveness to resident care needs;

10. Medication storage and security;

11. Chemical and physical restraint use;

12. Positioning/transferring processes utilized by staff;

13. Any specialized care provided by the facility with a specialty license;

14. Any license conditions or restrictions as a result of Agency action.

(b) The surveyor(s) conducts interviews with residents, family members/representatives, staff, and any other

persons the surveyor(s) deems relevant to the survey.

1. The facility may not restrict Agency staff from conducting confidential interviews pursuant to section

429.14(6), F.S.

2. Interviews may be conducted both in person and telephonically.

(c) The surveyor(s) reviews facility records to determine compliance with:

1. Licensure requirements in accordance with rule 59A-36.004, F.A.C.;

2. Inspection responsibilities in accordance with rule 59A-36.005, F.A.C.;

3. Admissions procedures and appropriateness of placement and continued residency criteria in accordance with

rule 59A-36.007, F.A.C.;

4. Resident care standards in accordance with rule 59A-36.007, F.A.C.;

5. Medication practices in accordance with rule 59A-36.008, F.A.C.;

6. Do not resuscitate orders (DNROs) in accordance with rule 59A-36.009, F.A.C.;

7. Staffing standards in accordance with rule 59A-36.010, F.A.C.;

8. Staff training requirements and competency training in accordance with rule 59A-36.011, F.A.C.;

9. Alzheimer’s Disease or Related Disorders training provider and curriculum approval in accordance with rule

58A-5.0194, F.A.C.;

10. Food service standards in accordance with rule 59A-36.012, F.A.C.;

11. Fiscal standards in accordance with rule 59A-36.013, F.A.C.;

12. Physical plant standards in accordance with rule 59A-36.014, F.A.C.;

13. Records in accordance with rule 59A-36.015, F.A.C.;


14. Resident contracts in accordance with rule 59A-36.018, F.A.C.;

15. Emergency management in accordance with rule 59A-36.019, F.A.C.

(d) The facility must provide agency staff with requested documents in a timely manner and allow the agency

staff to obtain copies.

(e) Surveyor(s) conducts specific and general observations throughout the survey to determine compliance with:

dietary standards, medication standards, infection control standards, resident activities, assistance with activities of

daily living, facility practices, and resident daily routines.

(f) For facilities licensed to provide specialty services such as Limited Mental Health, Extended Congregate

Care, and Limited Nursing Services: the surveyor(s) reviews the required components in accordance with rules 59A-

36.020, 59A-36.021, and 59A-36.021, F.A.C.

Rulemaking Authority 429.28(3)(a) FS. Law Implemented 429.28 FS. History–New 11-28-16.


In addition to the terms defined in section 429.02, F.S., the following definitions are applicable in this rule chapter:

(1) “Advertise” means any written, printed, oral, visual, or electronic promotion, statement of availability,

qualifications, services offered, or other similar communication appearing in or on television, radio, the Internet,

billboards, newspapers, magazines, business cards, flyers, brochures or other medium for the purpose of attracting

potential residents to an assisted living facility. A complimentary listing of a licensed facility’s name, address, and

telephone number in the telephone directory is not considered advertising.

(2) “Agency Central Office” means the Agency for Health Care Administration Assisted Living Unit (ALU),

located at 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL 32308-5403. The ALU telephone number and website

address are (850)412-4304, and

http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Assisted_Living/alf.shtml.

(3) “Agency Field Office” means the Agency for Health Care Administration’s Office in a particular geographic

area. Information regarding local offices is available online at: http://ahca.myflorida.com/mchq/index.shtml#six.

(4) “Apartment” means a self-contained dwelling unit with a bathroom, kitchen area, and living and sleeping

space that is contracted for use as a residence by one or more persons who maintain a common household.

(5) “Anti-Embolism Stockings and Hosiery” means prescribed close-fitting elastic-type coverings for

therapeutic treatment of the legs. They may be knee high or thigh high length and have transparent, open-toe, or

similar foot design.

(6) “Assistance with Activities of Daily Living” means individual assistance with the following:

(a) Ambulation – Providing physical support to enable the resident to move about within or outside the facility.

Physical support includes supporting or holding the resident’s hand, elbow, or arm; holding on to a support belt

worn by the resident to assist in providing stability or direction while the resident ambulates; or pushing the

resident’s wheelchair. The term does not include assistance with transfer.

(b) Bathing – Assembling towels, soaps, or other necessary supplies; helping the resident in and out of the

bathtub or shower; turning the water on and off; adjusting water temperatures; washing and drying portions of the

body that are difficult for the resident to reach; or being available while the resident is bathing.

(c) Dressing – Helping residents to choose, put on, and remove clothing.

(d) Eating – Helping residents with or by cutting food, pouring beverages, or feeding residents who are unable

to feed themselves.


(e) Grooming – Helping residents with shaving, oral care, care of the hair, or nail care.

(f) Toileting – Assisting the resident to the bathroom, helping the resident to undress, positioning the resident on

the commode, and helping the resident with related personal hygiene including assistance with changing an adult

brief and assistance with the routine emptying of a catheter or ostomy bag.

(7) “Assistance With Transfer” means providing verbal and physical cuing or physical assistance or both while

the resident moves between bed and a standing position or between bed and chair or wheelchair. The term does not

include total physical assistance with transfer provided by staff to residents.

(8) “Bedridden” means confined to bed because of inability to ambulate or transfer to a wheelchair even with

assistance, or to sit safely in a chair or wheelchair without personal assistance or physical restraint.

(9) “Capacity” means the number of residents for which a facility has been licensed to provide residential care.

(10) “Case Manager” means an individual employed by or under contract with any agency or organization,

public or private, who has the responsibility for assessing resident needs; planning services for the resident;

coordinating and assisting residents with gaining access to needed medical, mental health, social, housing,

educational or other services; monitoring service delivery; and evaluating the effects of service delivery.

(11) “Certified Nursing Assistant (CNA)” means an individual certified under chapter 464, part II, F.S.

(12) “Day Care Participant” means an individual who receives services at a facility for less than 24 hours per

day.

(13) “Deficiency” means an instance of non-compliance with the requirements of part II of chapter 408, F.S.,

part I of chapter 429, F.S., rule chapter 59A-35, F.A.C., and this rule chapter.

(14) “Direct Care Staff” means Staff in Regular Contact or Staff in Direct Contact with residents who provide

personal or nursing services to residents, including administrators and managers providing such services.

(15) “Distinct Part” means designated bedrooms or apartments, bathrooms and a living area; or a separately

identified wing, floor, or building that includes bedrooms or apartments, bathrooms and a living area. The distinct

part may include a separate dining area, or meals may be served in another part of the facility.

(16) “Elopement” means an occurrence in which a resident leaves a facility without following facility policy

and procedures.

(17) “Food Service” means the storage, preparation, service, and clean up of food intended for consumption in a

facility either by facility staff or through a formal agreement that meals will be regularly catered by a third party.

(18) “Glucose Meter” or “glucometer” means a medical device that determines the approximate concentration

of glucose in the blood.

(19) “Health Care Provider” means a physician or physician’s assistant licensed under chapter 458 or 459, F.S.,

or advanced registered nurse practitioner licensed under chapter 464, F.S.

(20) “Licensed Dietitian or Nutritionist” means a dietitian or nutritionist licensed under chapter 468, part X, F.S.

(21) “Local fire safety authority” means the authority having jurisdiction as defined in rule chapter 69A-40,

F.A.C.

(22) “Long-term Care Ombudsman Program (LTCOP)” means the long-term care ombudsman program

established under chapter 400, Part I, F.S.


(23) “Manager” means an individual who is authorized to perform the same functions as a facility administrator,

and is responsible for the operation and maintenance of an assisted living facility while under the supervision of the

administrator of that facility. A manager does not include staff authorized to perform limited administrative

functions during an administrator’s temporary absence.

(24) “Mental Disorder” for the purposes of identifying a mental health resident, means schizophrenia and other

psychotic disorders; affective disorders; anxiety related disorders; and personality and dissociative disorders.

However, mental disorder does not include residents with a primary diagnosis of Alzheimer’s disease, other

dementias, or mental retardation.

(25) “Mental Health Care Provider” means an individual, agency, or organization providing mental health

services to clients of the Department of Children and Families; an individual licensed by the state to provide mental

health services; or an entity employing or contracting with individuals licensed by the state to provide mental health

services.

(26) “Mental Health Case Manager” means a case manager employed by or under contract to a mental health

care provider to assist mental health residents residing in a facility holding a limited mental health license.

(27) “Nurse” means a licensed practical nurse (LPN), registered nurse (RN), or advanced registered nurse

practitioner (ARNP) licensed under chapter 464, F.S.

(28) “Nursing Assessment” means a written review of information collected from observation and interaction

with a resident, including the resident’s record and any other relevant sources of information, the analysis of the

information, and recommendations for modification of the resident’s care, if warranted. The assessment must

contain the signature and credential initials of the person who conducted the assessment.

(29) “Nursing Progress Notes” or “Progress Report” means a written record of nursing services, other than

medication administration or the taking of vital signs, provided to each resident who receives such services in a

facility with a limited nursing or extended congregate care license. The progress notes must be completed by the

nurse who delivered the service; must describe the date, type, scope, amount, duration, and outcome of services that

are rendered; must describe the general status of the resident’s health; must describe any deviations in the residents

health; must describe any contact with the resident’s physician; and must contain the signature and credential initials

of the person rendering the service.

(30) “Optional State Supplementation (OSS)” means the state program providing monthly payments to eligible

residents pursuant to section 409.212, F.S., and rule chapter 65A-2, F.A.C.

(31) “Owner” means a person, partnership, association, limited liability company, or corporation, that owns or

leases the facility that is licensed by the agency. The term does not include a person, partnership, association, limited

liability company, or corporation that contracts only to manage or operate the facility.

(32) “Physician” means an individual licensed under chapter 458 or 459, F.S.

(33) “Pill organizer” means a container that is designed to hold solid doses of medication and is divided

according to day or time increments.

(34) “Registered Dietitian” means an individual registered with the Commission on Dietetic Registration, the

accrediting body of the Academy of Nutrition and Dietetics.

(35) “Respite Care” means facility-based supervision of an impaired adult for the purpose of relieving the

primary caregiver.


(36) “Significant Change” means either a sudden or major shift in the behavior or mood of a resident that is

inconsistent with the resident’s diagnosis, or a deterioration in the resident’s health status such as unplanned weight

change, stroke, heart condition, enrollment in hospice, or stage 2, 3 or 4 pressure sore. Ordinary day-to-day

fluctuations in a resident’s functioning and behavior, short-term illnesses such as colds, or the gradual deterioration

in the resident’s ability to carry out the activities of daily living that accompanies the aging process are not

considered significant changes.

(37) “Staff” means any individual employed by a facility, contracting with a facility to provide direct or indirect

services to residents, or employed by a firm under contract with a facility to provide direct or indirect services to

residents when present in the facility. The term includes volunteers performing any service that counts toward

meeting any staffing requirement of this rule chapter.

(38) “Staff in Regular Contact” or “Staff in Direct Contact” mean all staff whose duties may require them to

interact with residents on a daily basis.

(39) “Third Party” means any individual or business entity providing services to residents in a facility that is not

staff of the facility.

(40) “Universal Precautions” are a set of precautions designed to prevent transmission of human

immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid

or health care. Universal precautions require that the blood and certain body fluids of all residents be considered

potentially infectious for HIV, HBV, and other bloodborne pathogens.

(41) “Unscheduled Service Need” means a need for a personal service, nursing service, or mental health

intervention that cannot be predicted in advance and that must be met promptly to ensure that the health, safety, and

welfare of residents is preserved.

Rulemaking Authority 429.41, 429.929 FS. Law Implemented 429.07, 429.075, 429.11, 429.14, 429.19, 429.41,

429.47, 429.52, 429.905 FS. History–New 9-30-92, Formerly 10A-5.0131, Amended 10-30-95, 6-2-96, 4-20-98, 11-

2-98, 10-17-99, 1-9-02, 7-30-06, 4-15-10, 4-17-14, 5-10-18, Formerly 58A-5.0131, 7-1-19.

59A-36.003 Licensing and Change of Ownership.

(1) LICENSE APPLICATION. An applicant for a standard assisted living facility license, a limited mental

health license, an extended congregate care license, or a limited nursing services license may apply for licensure

pursuant to the requirements of chapters 408, part II, 429, part I, F.S., and rule chapter 59A-35, F.A.C.

(2) CHANGE OF OWNERSHIP. In addition to the requirements for a change of ownership contained in

chapter 408, part II, F.S., section 429.12, F.S., and rule chapter 59A-35, F.A.C., the following provisions relating to

resident funds apply pursuant to section 429.27, F.S.:

(a) At the time of transfer of ownership, all resident funds on deposit, advance payments of resident rents,

resident security deposits, and resident trust funds held by the current licensee must be transferred to the applicant.

Proof of such transfer must be provided to the agency at the time of the agency survey and before the issuance of a

standard license. This provision does not apply to entrance fees paid to a continuing care facility subject to the

acquisition provisions in section 651.024, F.S.

(b) The transferor must provide to each resident a statement detailing the amount and type of funds held by the

facility and credited to the resident.


(c) The transferee must notify each resident in writing of the manner in which the transferee is holding the

resident’s funds and state the name and address of the depository where the funds are being held, the amount held,

and type of funds credited.

(3) CONDITIONAL LICENSE. Except as provided in section 429.14, F.S., the agency may issue a conditional

license to a facility if, at the time of license renewal the facility is found to have uncorrected violations that the

facility has had an opportunity to correct. The issuance of a conditional license does not change the biennial license

expiration date.

(4) OSS RESIDENT DETERMINATION. With respect to the fee per bed required for a standard license, the

number of OSS recipients claimed shall be the average number per month residing in the facility during the previous

license period. An additional per bed charge shall be added to the bed fee for facilities whose average number of

OSS residents per month was less than the number of beds designated for OSS recipients during the previous license

period.

Rulemaking Authority 429.17, 429.27, 429.41 FS. Law Implemented 429.04, 429.07, 429.075, 429.11, 429.12,

429.17, 429.27, 429.41 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.14, Amended

10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.014, Amended 10-30-95, 4-20-98, 10-17-99, 7-30-06, 4-17-

14, 5-10-18, Formerly 58A-5.014, 7-1-19.

59A-36.004 License Requirements.

(1) SERVICE PROHIBITION. An assisted living facility may not represent that it provides any service other

than a service for which it is licensed to provide.

(2) CHANGE IN USE OF SPACE REQUIRING AGENCY CENTRAL OFFICE APPROVAL. A change in the

use of space that increases or decreases a facility’s capacity must not be made without prior approval from the

Agency Central Office. Approval must be based on the compliance with the physical plant standards provided in

rule 59A-36.014, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation

inspection requirements referenced in rule 59A-36.005, F.A.C.

(3) CHANGE IN USE OF SPACE REQUIRING AGENCY FIELD OFFICE APPROVAL. A change in the use

of space that involves converting an area to resident use, which has not previously been inspected for such use, must

not be made without prior approval from the Agency Field Office. Approval must be based on compliance with the

physical plant standards provided in rule 59A-36.014, F.A.C., as well as documentation of compliance with

applicable fire safety and sanitation inspection standards referenced in rule 59A-36.005, F.A.C.

(4) CONTIGUOUS PROPERTY. If a facility consists of more than one building, all buildings included under a

single license must be on contiguous property. “Contiguous property” means property under the same ownership

separated by no more than a two-lane street that traverses the property. A licensed location may be expanded to

include additional contiguous property with the approval of the agency to ensure continued compliance with the

requirements and standards of chapters 408, Part II, 429, Part I, F.S. and rule chapter 59A-35, F.A.C., and this rule

chapter.

(5) PROOF OF INSPECTIONS. A copy of the annual fire safety and sanitation inspections described in rule

59A-36.005, F.A.C., must be submitted annually to the Agency Central Office. The annual inspections must be

submitted no later than 30 calendar days after the inspections. Failure to comply with this requirement may result in

administrative action pursuant to chapter 408, part II, and section 429.14, F.S., and rule chapter 59A-35, F.A.C.


(6) RESIDENTS RECEIVING STATE-FUNDED SERVICES. Upon request, the facility administrator or

designee must identify residents receiving state-funded services to the agency and the department for monitoring

purposes authorized by state and federal laws.

Rulemaking Authority 429.41 FS. Law Implemented 429.41, 429.44 FS. History–New 5-15-81, Amended 1-6-82, 9-

17-84, Formerly 10A-5.16, Amended 6-21-88, 9-30-92, Formerly 10A-5.016, Amended 10-30-95, 10-17-99, 7-30-06,

4-15-10, 4-17-14, Formerly 58A-5.016, 7-1-19.

59A-36.005 Inspection Responsibilities.

(1) County health departments are responsible for inspecting all license applicants and licensed facilities in

matters regulated by:

(a) Rule 64E-12.004, F.A.C., and rule chapter 64E-11, F.A.C., relating to food hygiene.

(b) Chapter 64E-12, F.A.C., relating to sanitary practices in community-based residential facilities.

(c) Chapter 64E-16, F.A.C., relating to biomedical waste.

(2) The local authority having jurisdiction over fire safety or State Fire Marshal is responsible for inspecting all

license applicants and licensed facilities in matters regulated by section 429.41, F.S., relating to uniform fire safety

standards and chapter 69A-40, F.A.C., Uniform Fire Safety Standards for Assisted Living Facilities.

(3) The agency is responsible for inspecting all license applicants and licensed facilities in all other matters

regulated by this rule chapter.

Rulemaking Authority 429.41 FS. Law Implemented 429.41 FS. History–New 8-15-90, Formerly 10A-5.0161,

Amended 10-30-95, 10-17-99, 3-13-14, Formerly 58A-5.0161, 7-1-19.

59A-36.006 Admission Procedures, Appropriateness of Placement and Continued Residency Criteria.

(1) ADMISSION CRITERIA.

(a) An individual must meet the following minimum criteria in order to be admitted to a facility holding a

standard, limited nursing services, or limited mental health license:

1. Be at least 18 years of age.

2. Be free from signs and symptoms of any communicable disease that is likely to be transmitted to other

residents or staff. An individual who has human immunodeficiency virus (HIV) infection may be admitted to a

facility, provided that the individual would otherwise be eligible for admission according to this rule.

3. Be able to perform the activities of daily living, with supervision or assistance if necessary.

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

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

administration of medication.

a. If the resident needs assistance with self-administration of medication, the facility must inform the resident of

the professional qualifications of facility staff who will be providing this assistance. If unlicensed staff will be

providing assistance with self-administration of medication, the facility must obtain written informed consent from

the resident or the resident’s surrogate, guardian, or attorney-in-fact.

b. The facility may accept a resident who requires the administration of medication if the facility employs a

nurse who will provide this service or the resident, or the resident’s legal representative, designee, surrogate,

guardian, or attorney-in-fact, contracts with a third party licensed to provide this service to the resident.

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


7. Not be a danger to self or others as determined by a physician, or mental health practitioner licensed under

chapter 490 or 491, F.S.

8. Not require 24-hour licensed professional mental health treatment.

9. Not be bedridden.

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

admitted provided that:

a. The resident either:

(I) Resides in a standard or limited nursing services licensed facility and contracts directly with a licensed home

health agency or a nurse to provide care; or

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

of care issued by a health care provider;

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

c. If the resident’s condition fails to improve within 30 days as documented by a health care provider, the

resident must be discharged from the facility.

11. Residents admitted to standard, limited nursing services, or limited mental health licensed facilities may not

require any of the following nursing services:

a. Artificial airway management of any kind, except that of continuous positive airway pressure may be

provided through the use of a CPAP or bipap machine;

b. Assistance with tube feeding,

c. Monitoring of blood gases,

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

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

f. Treatment of surgical incisions or wounds, unless the surgical incision or wound and the underlying condition

have been stabilized and a plan of care has been developed. The plan of care must be maintained in the resident’s

record.

12. In addition to the nursing services listed above, residents admitted to facilities holding only standard and/or

limited mental health licenses may not require any of the following nursing services:

a. Hemodialysis and peritoneal dialysis performed in the facility;

b. Intravenous therapy performed in the facility.

13. Not require 24-hour nursing supervision.

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

15. Be appropriate for admission to the facility as determined by the facility administrator. The administrator

must base the determination on:

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

b. The medical examination report required by section 429.26, F.S., and subsection (2) of this rule, if available;

c. The facility’s admission policy and the services the facility is prepared to provide or arrange in order to meet

resident needs. Such services may not exceed the scope of the facility’s license unless specified elsewhere in this

rule; and,

d. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in

rule chapter 69A-40, F.A.C.


(b) A resident who otherwise meets the admission criteria for residency in a standard licensed facility, but who

requires assistance with the administration and regulation of portable oxygen or assistance with routine colostomy

care of stoma site flange placement, may be admitted to a facility with a standard license as long as the facility has a

nurse on staff or under contract to provide the assistance or to provide training to the resident on how to perform

these functions themselves.

(c) Nursing staff may not provide training to unlicensed persons, as defined in section 429.256(1)(b), F.S., to

perform skilled nursing services, and may not delegate the nursing services described in this section to certified

nursing assistants or unlicensed persons. This provision does not restrict a resident or a resident’s representative

from contracting with a licensed third party to provide the assistance if the facility is agreeable to such an

arrangement and the resident otherwise meets the criteria for admission and continued residency in a facility with a

standard license.

(d) An individual enrolled in and receiving hospice services may be admitted to an assisted living facility as

long as the individual otherwise meets resident admission criteria.

(e) Resident admission criteria for facilities holding an extended congregate care license are described in rule

59A-36.021, F.A.C.

(2) HEALTH ASSESSMENT. As part of the admission criteria, an individual must undergo a face-to-face

medical examination completed by a health care provider as specified in either paragraph (a) or (b) of this

subsection.

(a) A medical examination completed within 60 calendar days before the individual’s admission to a facility

pursuant to section 429.26(4), F.S. The examination must address the following:

1. The physical and mental status of the resident, including the identification of any health-related problems and

functional limitations,

2. An evaluation of whether the individual will require supervision or assistance with the activities of daily

living,

3. Any nursing or therapy services required by the individual,

4. Any special diet required by the individual,

5. A list of current medications prescribed, and whether the individual will require any assistance with the

administration of medication,

6. Whether the individual has signs or symptoms of Tuberculosis, Methicillin Resistant Staphylococcus Aureus,

Scabies or any other communicable disease, which are likely to be transmitted to other residents or staff,

7. A statement on the day of the examination that, in the opinion of the examining health care provider, the

individual’s needs can be met in an assisted living facility; and,

8. The date of the examination, and the name, signature, address, telephone number, and license number of the

examining health care provider. The medical examination may be conducted by a health care provider licensed

under chapter 458, 459 or 464, F.S.

(b) A medical examination completed after the resident’s admission to the facility within 30 calendar days of

the admission date. The examination must be recorded on AHCA Form 1823, Resident Health Assessment for

Assisted Living Facilities, March 2017, which is incorporated by reference and available online at:

http://www.flrules.org/Gateway/reference.asp?No=Ref-09170. Faxed or electronic copies of the completed form are

acceptable. The form must be completed as instructed.


1. Items on the form that have been omitted by the health care provider during the examination may be obtained

by the facility either orally or in writing from the health care provider.

2. Omitted information must be documented in the resident’s record. Information received orally must include

the name of the health care provider, the name of the facility staff recording the information, and the date the

information was provided.

3. Electronic documentation may be used in place of completing the section on AHCA Form 1823 referencing

Services Offered or Arranged by the Facility for the Resident. The electronic documentation must include all of the

elements described in this section of AHCA Form 1823.

(c) Any information required by paragraph (a), that is not contained in the medical examination report

conducted before the individual’s admission to the facility must be obtained by the administrator using AHCA Form

1823 within 30 days after admission.

(d) Medical examinations of residents placed by the department, by the Department of Children and Families, or

by an agency under contract with either department must be conducted within 30 days before placement in the

facility and recorded on AHCA Form 1823 described in paragraph (b).

(e) An assessment that has been conducted through the Comprehensive, Assessment, Review and Evaluation for

Long-Term Care Services (CARES) program may be substituted for the medical examination requirements of

section 429.26, F.S. and this rule.

(f) Any orders issued by the health care provider conducting the medical examination for medications, nursing,

therapeutic diets, or other services to be provided or supervised by the facility may be attached to the health

assessment. A health care provider may attach a DH Form 1896, Florida Do Not Resuscitate Order Form, for

residents who do not wish cardiopulmonary resuscitation to be administered in the case of cardiac or respiratory

arrest.

(g) A resident placed in a facility on a temporary emergency basis by the Department of Children and Families

pursuant to section 415.105 or 415.1051, F.S., is exempt from the examination requirements of this subsection for

up to 30 days. However, a resident accepted for temporary emergency placement must be entered on the facility’s

admission and discharge log and counted in the facility census. A facility may not exceed its licensed capacity in

order to accept such a resident. A medical examination must be conducted on any temporary emergency placement

resident accepted for regular admission.

(3) ADMISSION PACKAGE.

(a) The facility must make available to potential residents a written statement(s) that includes the following

information listed below. Providing a copy of the facility resident contract or facility brochure containing all the

required information meets this requirement.

1. The facility’s admission and continued residency criteria;

2. The daily, weekly or monthly charge to reside in the facility and the services, supplies, and accommodations

provided by the facility for that rate;

3. Personal care services that the facility is prepared to provide to residents and additional costs to the resident,

if any;

4. Nursing services that the facility is prepared to provide to residents and additional costs to the resident, if

any;

5. Food service and the ability of the facility to accommodate special diets;


6. The availability of transportation and additional costs to the resident, if any;

7. Any other special services that are provided by the facility and additional cost if any;

8. Social and leisure activities generally offered by the facility;

9. Any services that the facility does not provide but will arrange for the resident and additional cost, if any;

10. The facility rules and regulations that residents must follow as described in rule 59A-36.007, F.A.C.;

11. The facility policy concerning Do Not Resuscitate Orders pursuant to section 429.255, F.S., and rule 59A-

36.009, F.A.C., and Advance Directives pursuant to chapter 765, F.S.;

12. If the facility is licensed to provide extended congregate care, the facility’s residency criteria for residents

receiving extended congregate care services. The facility must also provide a description of the additional personal,

supportive, and nursing services provided by the facility including additional costs and any limitations on where

extended congregate care residents may reside based on the policies and procedures described in rule 59A-36.021,

F.A.C.;

13. If the facility advertises that it provides special care for individuals with Alzheimer’s disease and related

disorders, a written description of those special services as required in section 429.177, F.S.; and,

14. The facility’s resident elopement response policies and procedures.

(b) Before or at the time of admission, the resident, or the resident’s responsible party, guardian, or attorney-in-

fact, if applicable, must be provided with the following:

1. A copy of the resident’s contract that meets the requirements of rule 59A-36.018, F.A.C.,

2. A copy of the facility statement described in paragraph (a) of this subsection, if one has not already been

provided,

3. A copy of the resident’s bill of rights as required by rule 59A-36.007, F.A.C.; and,

4. A Long-Term Care Ombudsman Program brochure that includes the telephone number and address of the

district office.

(c) Documents required by this subsection must be in English. If the resident is not able to read, or does not

understand English and translated documents are not available, the facility must explain its policies to a family

member or friend of the resident or another individual who can communicate the information to the resident.

(4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (c) of this subsection, criteria for

continued residency in any licensed facility must be the same as the criteria for admission. As part of the continued

residency criteria, a resident must have a face-to-face medical examination by a health care provider at least every 3

years after the initial assessment, or after a significant change, whichever comes first. A significant change is

defined in rule 59A-36.002, F.A.C. The results of the examination must be recorded on AHCA Form 1823, which is

incorporated by reference in paragraph (2)(b) of this rule and must be completed in accordance with that paragraph.

Exceptions to the requirement to meet the criteria for continued residency are:

(a) The resident may be bedridden for no more than 7 consecutive days.

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

1. The resident contracts directly with a licensed home health agency or a nurse to provide care, or the facility

has a limited nursing services license and services are provided pursuant to a plan of care issued by a health care

provider,

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


3. If the resident’s condition fails to improve within 30 days, as documented by a health care provider, the

resident must be discharged from the facility.

(c) A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in

the facility if the following conditions are met:

1. The resident qualifies for, is admitted to, and consents to receive services from a licensed hospice that

coordinates and ensures the provision of any additional care and services that the resident may need;

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

residency;

3. A licensed hospice, in consultation with the facility, develops and implements a interdisciplinary care plan

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

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

(d) The facility administrator is responsible for monitoring the continued appropriateness of placement of a

resident in the facility at all times.

(e) A hospice resident that meets the qualifications of continued residency pursuant to this subsection may only

receive services from the assisted living facility’s staff which are within the scope of the facility’s license.

(f) Assisted living facility staff may provide any nursing service permitted under the facility’s license and total

help with the activities of daily living for residents admitted to hospice; however, staff may not exceed the scope of

their professional licensure or training.

(g) Continued residency criteria for facilities holding an extended congregate care license are described in rule

59A-36.021, F.A.C.

(5) DISCHARGE. If the resident no longer meets the criteria for continued residency, or the facility is unable to

meet the resident’s needs, as determined by the facility administrator or health care provider, the resident must be

discharged in accordance with section 429.28, F.S.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.26, 429.28, 429.41 FS. History–New 9-17-

84, Formerly 10A-5.181, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0181, Amended 10-30-95,

6-2-96, 10-17-99, 7-30-06, 10-9-06, 4-15-10, 10-14-10, 4-17-14, 5-10-18, Formerly 58A-5.0181, 7-1-19.

59A-36.007 Resident Care Standards.

An assisted living facility must provide care and services appropriate to the needs of residents accepted for

admission to the facility.

(1) SUPERVISION. Facilities must offer personal supervision as appropriate for each resident, including the

following:

(a) Monitoring of the quantity and quality of resident diets in accordance with rule 59A-36.012, F.A.C.

(b) Daily observation by designated staff of the activities of the resident while on the premises, and awareness

of the general health, safety, and physical and emotional well-being of the resident.

(c) Maintaining a general awareness of the resident’s whereabouts. The resident may travel independently in the

community.

(d) Contacting the resident’s health care provider and other appropriate party such as the resident’s family,

guardian, health care surrogate, or case manager if the resident exhibits a significant change.

(e) Contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is

discharged or moves out.


(f) Maintaining a written record, updated as needed, of any significant changes, any illnesses that resulted in

medical attention, changes in the method of medication administration, or other changes that resulted in the

provision of additional services.

(2) SOCIAL AND LEISURE ACTIVITIES. Residents shall be encouraged to participate in social, recreational,

educational and other activities within the facility and the community.

(a) The facility must provide an ongoing activities program. The program must provide diversified individual

and group activities in keeping with each resident’s needs, abilities, and interests.

(b) The facility must consult with the residents in selecting, planning, and scheduling activities. The facility

must demonstrate residents’ participation through one or more of the following methods: resident meetings,

committees, a resident council, a monitored suggestion box, group discussions, questionnaires, or any other form of

communication appropriate to the size of the facility.

(c) Scheduled activities must be available at least 6 days a week for a total of not less than 12 hours per week.

Watching television is not an activity for the purpose of meeting the 12 hours per week of scheduled activities unless

the television program is a special one-time event of special interest to residents of the facility. A facility whose

residents choose to attend day programs conducted at adult day care centers, senior centers, mental health centers, or

other day programs may count those attendance hours towards the required 12 hours per week of scheduled

activities. An activities calendar must be posted in common areas where residents normally congregate.

(d) If residents assist in planning a special activity such as an outing, seasonal festivity, or an excursion, up to 3

hours may be counted toward the required activity time.

(3) ARRANGEMENT FOR HEALTH CARE. In order to facilitate resident access to health care as needed, the

facility must:

(a) Assist residents in making appointments and remind residents about scheduled appointments for medical,

dental, nursing, or mental health services.

(b) Provide transportation to needed medical, dental, nursing or mental health services, or arrange for

transportation through family and friends, volunteers, taxi cabs, public buses, and agencies providing transportation.

(c) The facility may not require residents to receive services from a particular health care provider.

(4) ACTIVITIES OF DAILY LIVING. Facilities must offer supervision of or assistance with activities of daily

living as needed by each resident. Residents should be encouraged to be as independent as possible in performing

activities of daily living.

(5) NURSING SERVICES.

(a) Pursuant to section 429.255, F.S., the facility may employ or contract with a nurse to:

1. Take or supervise the taking of vital signs,

2. Manage pill-organizers and administer medications as described in rule 59A-36.008, F.A.C.,

3. Give prepackaged enemas pursuant to a physician’s order; and,

4. Maintain nursing progress notes.

(b) Pursuant to section 429.255(2), F.S., the nursing services listed in paragraph (a), may also be delivered in

the facility by family members or friends of the resident provided the family member or friend does not receive

compensation for such services.

(6) RESIDENT RIGHTS AND FACILITY PROCEDURES.

(a) A copy of the Resident Bill of Rights as described in section 429.28, F.S., or a summary provided by the


Long-Term Care Ombudsman Program must be posted in full view in a freely accessible resident area, and included

in the admission package provided pursuant to rule 59A-36.006, F.A.C.

(b) In accordance with section 429.28, F.S., the facility must have a written grievance procedure for receiving

and responding to resident complaints and a written procedure to allow residents to recommend changes to facility

policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt

of a complaint.

(c) The telephone number for lodging complaints against a facility or facility staff must be posted in full view in

a common area accessible to all residents. The telephone numbers are: the Long-Term Care Ombudsman Program,

1(888)831-0404; Disability Rights Florida, 1(800)342-0823; the Agency Consumer Hotline 1(888)419-3456, and

the statewide toll-free telephone number of the Florida Abuse Hotline, 1(800)96-ABUSE or 1(800)962-2873. The

telephone numbers must be posted in close proximity to a telephone accessible by residents and the text must be a

minimum of 14-point font.

(d) The facility must have a written statement of its house rules and procedures that must be included in the

admission package provided pursuant to rule 59A-36.006, F.A.C. The rules and procedures must at a minimum

address the facility’s policies regarding:

1. Resident responsibilities;

2. Alcohol and tobacco use;

3. Medication storage;

4. Resident elopement;

5. Reporting resident abuse, neglect, and exploitation;

6. Administrative and housekeeping schedules and requirements;

7. Infection control, sanitation, and universal precautions; and,

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

(e) Residents may not be required to perform any work in the facility without compensation. Residents may be

required to clean their own sleeping areas or apartments if the facility rules or the facility contract includes such a

requirement. If a resident is employed by the facility, the resident must be compensated in compliance with state and

federal wage laws.

(f) The facility must provide residents with convenient access to a telephone to facilitate the resident’s right to

unrestricted and private communication, pursuant to section 429.28(1)(d), F.S. The facility must allow unidentified

telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not

have private telephones, there must be, at a minimum, a readily accessible telephone on each floor of each building

where residents reside.

(g) In addition to the requirements of section 429.41(1)(k), F.S., the use of physical restraints by a facility on a

resident must be reviewed by the resident’s physician annually. Any device, including half-bed rails, which the

resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint.

(7) THIRD PARTY SERVICES.

(a) Nothing in this rule chapter is intended to prohibit a resident or the resident’s representative from

independently arranging, contracting, and paying for services provided by a third party of the resident’s choice,

including a licensed home health agency or private nurse, or receiving services through an out-patient clinic,

provided the resident meets the criteria for admission and continued residency and the resident complies with the


facility’s policy relating to the delivery of services in the facility by third parties. The facility’s policies must require

the third party to coordinate with the facility regarding the resident’s condition and the services being provided.

(b) When residents require or arrange for services from a third party provider, the facility administrator or

designee must allow for the receipt of those services, provided that the resident meets the criteria for admission and

continued residency. The facility, when requested by residents or representatives, must coordinate with the provider

to facilitate the receipt of care and services provided to meet the particular resident’s needs.

(c) If residents accept assistance from the facility in arranging and coordinating third party services, the

facility’s assistance does not represent a guarantee that third party services will be received. If the facility’s efforts to

make arrangements for third party services are unsuccessful or declined by residents, the facility must include

documentation in the residents’ record explaining why its efforts were unsuccessful. This documentation will serve

to demonstrate its compliance with this subsection.

(8) ELOPEMENT STANDARDS.

(a) Residents Assessed at Risk for Elopement. All residents assessed at risk for elopement or with any history of

elopement must be identified so staff can be alerted to their needs for support and supervision. All residents must be

assessed for risk of elopement by a health care provider or a mental health care provider within 30 calendar days of

being admitted to a facility. If the resident has had a health assessment performed prior to admission pursuant to

paragraph 59A-36.006(2)(a), F.A.C., this requirement is satisfied. A resident placed in a facility on a temporary

emergency basis by the Department of Children and Families pursuant to section 415.105 or 415.1051, F.S., is

exempt from this requirement for up to 30 days.

1. As part of its resident elopement response policies and procedures, the facility must make, at a minimum, a

daily effort to determine that at risk residents have identification on their persons that includes their name and the

facility’s name, address, and telephone number. Staff trained pursuant to paragraph 59A-36.011(10)(a) or (c),

F.A.C., must be generally aware of the location of all residents assessed at high risk for elopement at all times.

2. The facility must have a photo identification of at risk residents on file that is accessible to all facility staff

and law enforcement as necessary. The facility’s file must contain the resident’s photo identification upon admission

or upon being assessed at risk for elopement subsequent to admission. The photo identification may be provided by

the facility, the resident, or the resident’s representative.

(b) Facility Resident Elopement Response Policies and Procedures. The facility must develop detailed written

policies and procedures for responding to a resident elopement. At a minimum, the policies and procedures must

provide for:

1. An immediate search of the facility and premises,

2. The identification of staff responsible for implementing each part of the elopement response policies and

procedures, including specific duties and responsibilities,

3. The identification of staff responsible for contacting law enforcement, the resident’s family, guardian, health

care surrogate, and case manager if the resident is not located pursuant to subparagraph (8)(b)1.; and,

4. The continued care of all residents within the facility in the event of an elopement.

(c) Facility Resident Elopement Drills. The facility must conduct and document resident elopement drills

pursuant to sections 429.41(1)(a)3. and 429.41(1)(l), F.S.

(9) OTHER STANDARDS. Additional care standards for residents residing in a facility holding a limited

mental health, extended congregate care or limited nursing services license are provided in rules 59A-36.020, 59A-


36.021 and 59A-36.022, F.A.C., respectively.

Rulemaking Authority 429.41 FS. Law Implemented 429.255, 429.26, 429.28, 429.41 FS. History–New 9-17-84,

Formerly 10A-5.182, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0182, Amended 10-30-95, 4-

20-98, 11-2-98, 10-17-99, 7-30-06, 10-9-06, 4-15-10, 4-17-14, 5-10-18, Formerly 58A-5.0182, 7-1-19.

59A-36.008 Medication Practices.

Pursuant to sections 429.255 and 429.256, F.S., and this rule, licensed facilities may assist with the self-

administration or administration of medications to residents in a facility. A resident may not be compelled to take

medications but may be counseled in accordance with this rule.

(1) SELF ADMINISTERED MEDICATIONS.

(a) Residents who are capable of self-administering their medications without assistance must be encouraged

and allowed to do so.

(b) If facility staff observes health changes that could reasonably be attributed to the improper self-

administration of medication, staff must consult with the resident concerning any problems the resident may be

experiencing in self-administering the medications. The consultation should describe the services offered by the

facility that aid the resident with medication administration through the use of a pill organizer, through providing

assistance with self-administration of medications, or through administering medications. The facility must contact

the resident’s health care provider when observable health changes occur that may be attributed to the resident’s

medications. The facility must document such contacts in the resident’s records.

(2) PILL ORGANIZERS.

(a) Only a resident who self-administers medications may maintain a pill organizer.

(b) Unlicensed staff may not provide assistance with the contents of pill organizers.

(c) A nurse may manage a pill organizer to be used only by residents who self-administer medications. The

nurse is responsible for instructing the resident in the proper use of the pill organizer. The nurse must manage the

pill organizer in the following manner:

1. Obtain the labeled medication container from the storage area or the resident,

2. Transfer the medication from the original container into a pill organizer, labeled with the resident’s name,

according to the day and time increments as prescribed,

3. Return the medication container to the storage area or resident; and,

4. Document the date and time the pill organizer was filled in the resident’s record.

(d) If there is a determination that the resident is not taking medications as prescribed after the medicinal

benefits are explained, it must be noted in the resident’s record and the facility must consult with the resident

concerning providing assistance with self-administration or the administration of medications if such services are

offered by the facility. The facility must contact the resident’s health care provider regarding questions, concerns, or

observations relating to the resident’s medications. Such communication must be documented in the resident’s

record.

(3) ASSISTANCE WITH SELF-ADMINISTRATION.

(a) Any unlicensed person providing assistance with self-administration of medication must be 18 years of age

or older, trained to assist with self administered medication pursuant to the training requirements of rule 59A-

36.011, F.A.C., and must be available to assist residents with self-administered medications in accordance with

procedures described in section 429.256, F.S. and this rule.


(b) In addition to the specifications of section 429.256(3), F.S., assistance with self-administration of

medication includes, in the presence of the resident, reading the medication label aloud and verbally prompting a

resident to take medications as prescribed.

(c) In order to facilitate assistance with self-administration, trained staff may prepare and make available such

items as water, juice, cups, and spoons. Trained staff may also return unused doses to the medication container.

Medication, which appears to have been contaminated, must not be returned to the container.

(d) Trained staff must observe the resident take the medication. Any concerns about the resident’s reaction to

the medication or suspected noncompliance must be reported to the resident’s health care provider and documented

in the resident’s record.

(e) When a resident who receives assistance with medication is away from the facility and from facility staff,

the following options are available to enable the resident to take medication as prescribed:

1. The health care provider may prescribe a medication schedule that coincides with the resident’s presence in

the facility,

2. The medication container may be given to the resident, a friend, or family member upon leaving the facility,

with this fact noted in the resident’s medication record,

3. The medication may be transferred to a pill organizer pursuant to the requirements of subsection (2), and

given to the resident, a friend, or family member upon leaving the facility, with this fact noted in the resident’s

medication record, or

4. Medications may be separately prescribed and dispensed in an easier to use form, such as unit dose

packaging.

(f) Assistance with self-administration of medication does not include the activities detailed in section

429.256(4), F.S.

1. As used in section 429.256(4)(g), F.S., the term “competent resident” means that the resident is cognizant of

when a medication is required and understands the purpose for taking the medication.

2. As used in section 429.256(4)(h), F.S., the terms “judgment” and “discretion” mean interpreting vital signs

and evaluating or assessing a resident’s condition.

(g) All trained staff must adhere to the facility’s infection control policy and procedures when assisting with the

self-administration of medication.

(4) MEDICATION ADMINISTRATION.

(a) For facilities that provide medication administration, a staff member licensed to administer medications

must be available to administer medications in accordance with a health care provider’s order or prescription label.

(b) Unusual reactions to the medication or a significant change in the resident’s health or behavior that may be

caused by the medication must be documented in the resident’s record and reported immediately to the resident’s

health care provider. The contact with the health care provider must also be documented in the resident’s record.

(c) Medication administration includes conducting any examination or other procedure necessary for the proper

administration of medication that the resident cannot conduct personally and that can be performed by licensed staff.

(d) A facility that performs clinical laboratory tests for residents, including blood glucose testing, must be in

compliance with the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) and chapter 483, part I,

F.S. A valid copy of the State Clinical Laboratory License, if required, and the federal CLIA Certificate must be

maintained in the facility. A state license or federal CLIA certificate is not required if residents perform the test


themselves or if a third party assists residents in performing the test. The facility is not required to maintain a State

Clinical Laboratory License or a federal CLIA Certificate if facility staff assist residents in performing clinical

laboratory testing with the residents’ equipment. Information about the State Clinical Laboratory License and federal

CLIA Certificate is available from the Laboratory Unit, Agency for Health Care Administration, 2727 Mahan Drive,

Mail Stop 32, Tallahassee, FL 32308; telephone (850)412-4500.

(5) MEDICATION RECORDS.

(a) For residents who use a pill organizer managed in subsection (2), the facility must keep either the original

labeled medication container; or a medication listing with the prescription number, the name and address of the

issuing pharmacy, the health care provider’s name, the resident’s name, the date dispensed, the name and strength of

the drug, and the directions for use.

(b) The facility must maintain a daily medication observation record for each resident who receives assistance

with self-administration of medications or medication administration. A medication observation record must be

immediately updated each time the medication is offered or administered and include:

1. The name of the resident and any known allergies the resident may have;

2. The name of the resident’s health care provider and the health care provider’s telephone number;

3. The name, strength, and directions for use of each medication; and,

4. A chart for recording each time the medication is taken, any missed dosages, refusals to take medication as

prescribed, or medication errors.

(c) For medications that serve as chemical restraints, the facility must, pursuant to section 429.41, F.S., maintain

a record of the prescribing physician’s annual evaluation of the use of the medication.

(6) MEDICATION STORAGE AND DISPOSAL.

(a) In order to accommodate the needs and preferences of residents and to encourage residents to remain as

independent as possible, residents may keep their medications, both prescription and over-the-counter, in their

possession both on or off the facility premises. Residents may also store their medication in their rooms or

apartments if either the room is kept locked when residents are absent or the medication is stored in a secure place

that is out of sight of other residents.

(b) Both prescription and over-the-counter medications for residents must be centrally stored if:

1. The facility administers the medication;

2. The resident requests central storage. The facility must maintain a list of all medications being stored

pursuant to such a request;

3. The medication is determined and documented by the health care provider to be hazardous if kept in the

personal possession of the person for whom it is prescribed;

4. The resident fails to maintain the medication in a safe manner as described in this paragraph;

5. The facility determines that, because of physical arrangements and the conditions or habits of residents, the

personal possession of medication by a resident poses a safety hazard to other residents, or

6. The facility’s rules and regulations require central storage of medication and that policy has been provided to

the resident before admission as required in rule 59A-36.006, F.A.C.

(c) Centrally stored medications must be:

1. Kept in a locked cabinet; locked cart; or other locked storage receptacle, room, or area at all times;


2. Located in an area free of dampness and abnormal temperature, except that a medication requiring

refrigeration must be kept refrigerated. Refrigerated medications must be secured by being kept in a locked

container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which the refrigerator

is located locked;

3. Accessible to staff responsible for filling pill-organizers, assisting with self-administration of medication, or

administering medication. Such staff must have ready access to keys or codes to the medication storage areas at all

times; and,

4. Kept separately from the medications of other residents and properly closed or sealed.

(d) Medication that has been discontinued but has not expired must be returned to the resident or the resident’s

representative, as appropriate, or may be centrally stored by the facility for future use by the resident at the

resident’s request. If centrally stored by the facility, the discontinued medication must be stored separately from

medication in current use, and the area in which it is stored must be marked “discontinued medication.” Such

medication may be reused if prescribed by the resident’s health care provider.

(e) When a resident’s stay in the facility has ended, the administrator must return all medications to the resident,

the resident’s family, or the resident’s guardian unless otherwise prohibited by law. If, after notification and waiting

at least 15 days, the resident’s medications are still at the facility, the medications are considered abandoned and

may disposed of in accordance with paragraph (f).

(f) Medications that have been abandoned or have expired must be disposed of within 30 days of being

determined abandoned or expired and the disposal must be documented in the resident’s record. The medication may

be taken to a pharmacist for disposal or may be destroyed by the administrator or designee with one witness.

(g) Facilities that hold a Special-ALF permit issued by the Board of Pharmacy may return dispensed medicinal

drugs to the dispensing pharmacy pursuant to rule 64B16-28.870, F.A.C.

(7) MEDICATION LABELING AND ORDERS.

(a) The facility may not store prescription drugs for self-administration, assistance with self-administration, or

administration unless they are properly labeled and dispensed in accordance with chapters 465 and 499, F.S., and

rule 64B16-28.108, F.A.C. If a customized patient medication package is prepared for a resident, and separated into

individual medicinal drug containers, then the following information must be recorded on each individual container:

1. The resident’s name; and,

2. The identification of each medicinal drug in the container.

(b) Except with respect to the use of pill organizers as described in subsection (2), no individual other than a

pharmacist may transfer medications from one storage container to another.

(c) If the directions for use are “as needed” or “as directed,” the health care provider must be contacted and

requested to provide revised instructions. For an “as needed” prescription, the circumstances under which it would

be appropriate for the resident to request the medication and any limitations must be specified; for example, “as

needed for pain, not to exceed 4 tablets per day.” The revised instructions, including the date they were obtained

from the health care provider and the signature of the staff who obtained them, must be noted in the medication

record, or a revised label must be obtained from the pharmacist.

(d) Any change in directions for use of a medication that the facility is administering or providing assistance

with self-administration must be accompanied by a written, faxes, or electronic copy of a medication order issued

and signed by the resident’s health care provider. The new directions must promptly be recorded in the resident’s


medication observation record. The facility may then obtain a revised label from the pharmacist or place an “alert”

label on the medication container that directs staff to examine the revised directions for use in the medication

observation record.

(e) A nurse may take a medication order by telephone. Such order must be promptly documented in the

resident’s medication observation record. The facility must obtain a written medication order from the health care

provider within 10 working days. A faxed or electronic copy of a signed order is acceptable.

(f) The facility must make every reasonable effort to ensure that prescriptions for residents who receive

assistance with self-administration of medication or medication administration are filled or refilled in a timely

manner.

(g) Pursuant to section 465.0276(5), F.S., and rule 61N-1.006, F.A.C., sample or complimentary prescription

drugs that are dispensed by a health care provider, must be kept in their original manufacturer’s packaging, which

must include the practitioner’s name, the resident’s name for whom they were dispensed, and the date they were

dispensed. If the sample or complimentary prescription drugs are not dispensed in the manufacturer’s labeled

package, they must be kept in a container that bears a label containing the following:

1. Practitioner’s name,

2. Resident’s name,

3. Date dispensed,

4. Name and strength of the drug,

5. Directions for use; and,

6. Expiration date.

(h) Pursuant to section 465.0276(2)(c), F.S., before dispensing any sample or complimentary prescription drug,

the resident’s health care provider must provide the resident with a written prescription, or a faxed or electronic copy

of such order.

(8) OVER THE COUNTER (OTC) PRODUCTS. For purposes of this subsection, the term over the counter

includes, but is not limited to, over the counter medications, vitamins, nutritional supplements and nutraceuticals,

hereafter referred to as OTC products, that can be sold without a prescription.

(a) A facility may keep a stock supply of OTC products for multiple resident use. When providing any OTC

product that is kept by the facility as a stock supply to a resident, the staff member providing the medication must

record the name and amount of the OTC product provided in the resident’s medication observation record. All OTC

products kept as a stock supply must be stored in a locked container or secure room in a central location within the

facility and must be labeled with the medication’s name, the date of purchase, and with a notice that the medication

is part of the facility’s stock supply.

(b) OTC products, including those prescribed by a health care provider but excluding those kept as a stock

supply by the facility, must be labeled with the resident’s name and the manufacturer’s label with directions for use,

or the health care provider’s directions for use. No other labeling requirements are required.

(c) Residents or their representatives may purchase OTC products from an establishment of their choice.


(d) A health care provider’s order is required when a nurse provides assistance with self-administration or

administration of OTC products. When an order for an OTC product exists, the order must meet the requirements of

paragraphs (b) and (c) of this subsection. A health care provider’s order for OTC products is not required when a

resident self-administers his or her medications, or when unlicensed staff provides assistance with self-

administration of medications.

Rulemaking Authority 429.256, 429.41 FS. Law Implemented 429.255, 429.256, 429.41 FS. History–New 10-17-99,

Amended 7-30-06, 4-15-10, 10-14-10, 3-13-14, 5-10-18, Formerly 58A-5.0185, 7-1-19.

59A-36.009 Do Not Resuscitate Orders (DNROs).

(1) POLICIES AND PROCEDURES.

(a) Each assisted living facility must have written policies and procedures that explain its implementation of

state laws and rules relative to Do Not Resuscitate Orders (DNROs). An assisted living facility may not require

execution of a DNRO as a condition of admission or treatment. The assisted living facility must provide the

following to each resident, or resident’s representative, at the time of admission:

1. Form SCHS-4-2006, “Health Care Advance Directives – The Patient’s Right to Decide,” April 2006, or with

a copy of some other substantially similar document, which incorporates information regarding advance directives

included in chapter 765, F.S. Form SCHS-4-2006 is available from the Agency for Health Care Administration,

2727 Mahan Drive, Mail Stop 34, Tallahassee, FL 32308 or the agency’s website at:

http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/HC_Advance_Directives/docs/adv_dir.pdf; and,

2. DH Form 1896, Florida Do Not Resuscitate Order Form, December, 2004, which is hereby incorporated by

reference. This form may be obtained by calling the Department of Health’s toll free number 1(800)226-1911,

extension 2780 or online at: http://www.flrules.org/Gateway/reference.asp?No=Ref-04005.

(b) There must be documentation in the resident’s record indicating whether a DH Form 1896 has been

executed. If a DH Form 1896 has been executed, a yellow copy of that document must be made a part of the

resident’s record. If the assisted living facility does not receive a copy of a resident’s executed DH Form 1896, the

assisted living facility must document in the resident’s record that it has requested a copy.

(c) The executed DH Form 1896 must be readily available to medical staff in the event of an emergency.

(2) LICENSE REVOCATION. An assisted living facility’s license is subject to revocation pursuant to section

408.815, F.S., if, as a condition of treatment or admission, the facility requires an individual to execute or waive DH

Form 1896.

(3) DNRO PROCEDURES. Pursuant to section 429.255, F.S., an assisted living facility must honor a properly

executed DH Form 1896 as follows:

(a) In the event a resident experiences cardiac or pulmonary arrest, staff trained in cardiopulmonary

resuscitation (CPR) or a health care provider present in the facility, may withhold cardiopulmonary resuscitation

(artificial ventilation, cardiac compression, endotracheal intubation and defibrillation).

(b) In the event a resident is receiving hospice services and experiences cardiac or pulmonary arrest, facility

staff must immediately contact hospice staff. The hospice procedures take precedence over those of the assisted

living facility.

Rulemaking Authority 429.255 FS. Law Implemented 429.255 FS. History–New 4-15-10, Amended 4-17-14,

Formerly 58A-5.0186, 7-1-19.


59A-36.010 Staffing Standards.

(1) ADMINISTRATORS. Every facility must be under the supervision of an administrator who is responsible

for the operation and maintenance of the facility including the management of all staff and the provision of

appropriate care to all residents as required by chapters 408, part II, 429, part I, F.S., and rule chapter 59A-35,

F.A.C., and this rule chapter.

(a) An administrator must:

1. Be at least 21 years of age;

2. If employed on or after October 30, 1995, have, at a minimum, a high school diploma or G.E.D.;

3. Be in compliance with Level 2 background screening requirements pursuant to sections 408.809 and 429.174,

F.S.;

4. Complete the core training and core competency test requirements pursuant to rule 59A-36.011, F.A.C., no

later than 90 days after becoming employed as a facility administrator. Administrators who attended core training

prior to July 1, 1997, are not required to take the competency test unless specified elsewhere in this rule; and,

5. Satisfy the continuing education requirements pursuant to rule 59A-36.011, F.A.C. Administrators who are

not in compliance with these requirements must retake the core training and core competency test requirements in

effect on the date the non-compliance is discovered by the agency or the department.

(b) In the event of extenuating circumstances, such as the death of a facility administrator, the agency may

permit an individual who otherwise has not satisfied the training requirements of subparagraph (1)(a)4. of this rule,

to temporarily serve as the facility administrator for a period not to exceed 90 days. During the 90 day period, the

individual temporarily serving as facility administrator must:

1. Complete the core training and core competency test requirements pursuant to rule 59A-36.011, F.A.C.; and,

2. Complete all additional training requirements if the facility maintains licensure as an extended congregate

care or limited mental health facility.

(c) Administrators may supervise a maximum of either three assisted living facilities or a group of facilities on a

single campus providing housing and health care Administrators who supervise more than one facility must appoint

in writing a separate manager for each facility. However, an administrator supervising a maximum of three assisted

living facilities, each licensed for 16 or fewer beds and all within a 15 mile radius of each other, is only required to

appoint two managers to assist in the operation and maintenance of those facilities.

(d) An individual serving as a manager must satisfy the same qualifications, background screening, core

training and competency test requirements, and continuing education requirements as an administrator pursuant to

paragraph (1)(a) of this rule. Managers who attended the core training program prior to April 20, 1998, are not

required to take the competency test unless specified elsewhere in this rule. In addition, a manager may not serve as

a manager of more than a single facility, except as provided in paragraph (1)(c) of this rule, and may not

simultaneously serve as an administrator of any other facility.

(e) Pursuant to section 429.176, F.S., facility owners must notify the Agency Central Office within 10 days of a

change in facility administrator on the Notification of Change of Administrator form, AHCA Form 3180-1006, June

2016, which is incorporated by reference and available online at:

http://www.flrules.org/Gateway/reference.asp?No=Ref-09393.

(2) STAFF.

(a) Within 30 days after beginning employment, newly hired staff must submit a written statement from a health


care provider documenting that the individual does not have any signs or symptoms of communicable disease. The

examination performed by the health care provider must have been conducted no earlier than 6 months before

submission of the statement. Newly hired staff does not include an employee transferring without a break in service

from one facility to another when the facility is under the same management or ownership.

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

provided by the Florida Department of Health or a licensed health care provider certifying that there is a shortage of

tuberculosis testing materials satisfies the annual tuberculosis examination requirement. An individual with a

positive tuberculosis test must submit a health care provider’s statement that the individual does not constitute a risk

of communicating tuberculosis.

2. If any staff member has, or is suspected of having, a communicable disease, such individual must be

immediately removed from duties until a written statement is submitted from a health care provider indicating that

the individual does not constitute a risk of transmitting a communicable disease.

(b) Staff must be qualified to perform their assigned duties consistent with their level of education, training,

preparation, and experience. Staff providing services requiring licensing or certification must be appropriately

licensed or certified. All staff must exercise their responsibilities, consistent with their qualifications, to observe

residents, to document observations on the appropriate resident’s record, and to report the observations to the

resident’s health care provider in accordance with this rule chapter.

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

(d) An assisted living facility contracting to provide services to residents must ensure that individuals providing

services are qualified to perform their assigned duties in accordance with this rule chapter. The contract between the

facility and the staffing agency or contractor must specifically describe the services the staffing agency or contractor

will provide to residents.

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

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

staff member; and,

2. Maintain time sheets for all staff.

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

provide services to residents, pursuant to sections 408.809 and 429.174, F.S.


(3) STAFFING STANDARDS.

(a) Minimum staffing:

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

Number of Residents, Day Care Participants, and Respite Care Residents Staff Hours/Week

0-5 168

6-15 212

16- 25 253

26-35 294

36-45 335

46-55 375

56- 65 416

66-75 457

76-85 498

86-95 539

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

week.

2. Independent living residents, as referenced in subsection 59A-36.015(3), F.A.C., who occupy beds included

within the licensed capacity of an assisted living facility but do not receive personal, limited nursing, or extended

congregate care services, are not counted as residents for purposes of computing minimum staff hours.

3. At least one staff member who has access to facility and resident records in case of an emergency must be in

the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be left

solely in charge of other residents while the facility administrator, manager or other staff are absent from the facility.

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

and night.

5. A staff member who has completed courses in First Aid and Cardiopulmonary Resuscitation (CPR) and holds

a currently valid card documenting completion of such courses must be in the facility at all times.

a. Documentation of attendance at First Aid or CPR courses pursuant to subsection 59A-36.011(5), F.A.C.,

satisfies this requirement.

b. A nurse is considered as having met the course requirements for First Aid. An emergency medical technician

or paramedic currently certified under chapter 401, part III, F.S., is considered as having met the course

requirements for both First Aid and CPR.

6. During periods of temporary absence of the administrator or manager of more than 48 hours when residents

are on the premises, a staff member who is at least 21 years of age must be physically present and designated in

writing to be in charge of the facility. No staff member shall be in charge of a facility for a consecutive period of 21

days or more, or for a total of 60 days within a calendar year, without being an administrator or manager.

7. Staff whose duties are exclusively building or grounds maintenance, clerical, or food preparation do not

count towards meeting the minimum staffing hours requirement.


8. The administrator or manager’s time may be counted for the purpose of meeting the required staffing hours,

provided the administrator or manager is actively involved in the day-to-day operation of the facility, including

making decisions and providing supervision for all aspects of resident care, and is listed on the facility’s staffing

schedule.

9. Only on-the-job staff may be counted in meeting the minimum staffing hours. Vacant positions or absent

staff may not be counted.

(b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities, including those

composed of apartments, must have enough qualified staff to provide resident supervision, and to provide or arrange

for resident services in accordance with the residents’ scheduled and unscheduled service needs, resident contracts,

and resident care standards as described in rule 59A-36.007, F.A.C.

(c) The facility must maintain a written work schedule that reflects its 24-hour staffing pattern for a given time

period. Upon request, the facility must make the daily work schedules of direct care staff available to residents or

their representatives.

(d) The facility must provide staff immediately when the agency determines that the requirements of paragraph

(a) are not met. The facility must immediately increase staff above the minimum levels established in paragraph (a),

if the agency determines that adequate supervision and care are not being provided to residents, resident care

standards described in rule 59A-36.007, F.A.C., are not being met, or that the facility is failing to meet the terms of

residents’ contracts. The agency will consult with the facility administrator and residents regarding any

determination that additional staff is required. Based on the recommendations of the local fire safety authority, the

agency may require additional staff when the facility fails to meet the fire safety standards described in rule chapter

69A-40, F.A.C., until such time as the local fire safety authority informs the agency that fire safety requirements are

being met.

1. When additional staff is required above the minimum, the agency will require the submission of a corrective

action plan within the time specified in the notification indicating how the increased staffing is to be achieved to

meet resident service needs. The plan will be reviewed by the agency to determine if it sufficiently increases the

staffing levels to meet resident needs.

2. When the facility can demonstrate to the agency that resident needs are being met, or that resident needs can

be met without increased staffing, the agency may modify staffing requirements for the facility and the facility will

no longer be required to maintain a plan with the agency.

(e) Facilities that are co-located with a nursing home may use shared staffing provided that staff hours are only

counted once for the purpose of meeting either assisted living facility or nursing home minimum staffing ratios.

(f) Facilities holding a limited mental health, extended congregate care, or limited nursing services license must

also comply with the staffing requirements of rules 59A-36.020, 59A-36.021 or 59A-36.022, F.A.C., respectively.

Rulemaking Authority 429.41, 429.52, 429.929 FS. Law Implemented 429.174, 429.176, 429.41, 429.52, 429.905

FS. History–New 5-14-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.19, Amended 10-20-86, 6-21-88, 8-15-90, 9-

30-92, Formerly 10A-5.019, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 4-15-10, 4-17-14, 5-10-18,

Formerly 58A-5.019, 7-1-19.

59A-36.011 Staff Training Requirements and Competency Test.

(1) ASSISTED LIVING FACILITY CORE TRAINING REQUIREMENTS AND COMPETENCY TEST.


(a) The assisted living facility core training requirements established by the department pursuant to section

429.52, F.S., shall consist of a minimum of 26 hours of training plus a competency test.

(b) Administrators and managers must successfully complete the assisted living facility core training

requirements within 3 months from the date of becoming a facility administrator or manager. Successful completion

of the core training requirements includes passing the competency test. The minimum passing score for the

competency test is 75%. Administrators who have attended core training prior to July 1, 1997, and managers who

attended the core training program prior to April 20, 1998, shall not be required to take the competency test.

Administrators licensed as nursing home administrators in accordance with chapter 468, part II, F.S., are exempt

from this requirement.

(c) Administrators and managers shall participate in 12 hours of continuing education in topics related to

assisted living every 2 years.

(d) A newly hired administrator or manager who has successfully completed the assisted living facility core

training and continuing education requirements, shall not be required to retake the core training. An administrator or

manager who has successfully completed the core training but has not maintained the continuing education

requirements will be considered a new administrator or manager for the purposes of the core training requirements

and must:

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

2. Retake and pass the competency test.

(e) The fees for the competency test shall not exceed $200.00. The payment for the competency test fee shall be

remitted to the entity administering the test. A new fee is due each time the test is taken.

(2) STAFF PRESERVICE ORIENTATION.

(a) Facilities must provide a preservice orientation of at least 2 hours to all new assisted living facility

employees who have not previously completed core training as detailed in subsection (1).

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

(c) Once complete, the employee and the facility administrator must sign a statement that the employee

completed the preservice orientation which must be kept in the employee’s personnel record.

(d) In addition to topics that may be chosen by the facility administrator, the preservice orientation must cover:

1. Resident’s rights; and,

2. The facility’s license type and services offered by the facility.

(3) STAFF IN-SERVICE TRAINING. Facility administrators or managers shall provide or arrange for the

following in-service training to facility staff:

(a) Staff who provide direct care to residents, other than nurses, certified nursing assistants, or home health

aides trained in accordance with rule 59A-8.0095, F.A.C., must receive a minimum of 1 hour in-service training in

infection control, including universal precautions and facility sanitation procedures, before providing personal care

to residents. The facility must use its infection control policies and procedures when offering this training.

Documentation of compliance with the staff training requirements of 29 CFR 1910.1030, relating to blood borne

pathogens, may be used to meet this requirement.


(b) Staff who provide direct care to residents must receive a minimum of 1 hour in-service training within 30

days of employment that covers the following subjects:

1. Reporting adverse incidents.

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

(c) Staff who provide direct care to residents, who have not taken the core training program, shall receive a

minimum of 1 hour in-service training within 30 days of employment that covers the following subjects:

1. Resident rights in an assisted living facility.

2. Recognizing and reporting resident abuse, neglect, and exploitation. The facility must use its abuse

prevention policies and procedures when offering this training.

(d) Staff who provide direct care to residents, other than nurses, CNAs, or home health aides trained in

accordance with rule 59A-8.0095, F.A.C., must receive 3 hours of in-service training within 30 days of employment

that covers the following subjects:

1. Resident behavior and needs.

2. Providing assistance with the activities of daily living.

(e) Staff who prepare or serve food, who have not taken the assisted living facility core training must receive a

minimum of 1-hour-in-service training within 30 days of employment in safe food handling practices.

(f) All facility staff shall receive in-service training regarding the facility’s resident elopement response policies

and procedures within thirty (30) days of employment.

1. All facility staff shall be provided with a copy of the facility’s resident elopement response policies and

procedures.

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

response policies and procedures.

(4) HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNE DEFICIENCY SYNDROME

(HIV/AIDS). Pursuant to section 381.0035, F.S., all facility employees, with the exception of employees subject to

the requirements of section 456.033, F.S., must complete a one-time education course on HIV and AIDS, including

the topics prescribed in the section 381.0035, F.S. New facility staff must obtain the training within 30 days of

employment. Documentation of compliance must be maintained in accordance with subsection (12), of this rule.

(5) FIRST AID AND CARDIOPULMONARY RESUSCITATION (CPR). A staff member who has completed

courses in First Aid and CPR and holds a currently valid card documenting completion of such courses must be in

the facility at all times.

(a) Documentation that the staff member possess current CPR certification that requires the student to

demonstrate, in person, that he or she is able to perform CPR and which is issued by an instructor or training

provider that is approved to provide CPR training by the American Red Cross, the American Heart Association, the

National Safety Council, or an organization whose training is accredited by the Commission on Accreditation for

Pre-Hospital Continuing Education satisfies this requirement.

(b) A nurse shall be considered as having met the training requirement for First Aid. An emergency medical

technician or paramedic currently certified under chapter 401, Part III, F.S., shall be considered as having met the

training requirements for both First Aid and C.P.R.

(6) ASSISTANCE WITH THE SELF-ADMINISTRATION OF MEDICATION AND MEDICATION

MANAGEMENT. Unlicensed persons who will be providing assistance with the self-administration of medications


as described in rule 59A-36.008, F.A.C., must meet the training requirements pursuant to section 429.52(6), F.S.,

prior to assuming this responsibility. Courses provided in fulfilment of this requirement must meet the following

criteria:

(a) Training must cover state law and rule requirements with respect to the supervision, assistance,

administration, and management of medications in assisted living facilities; procedures and techniques for assisting

the resident with self-administration of medication including how to read a prescription label; providing the right

medications to the right resident; common medications; the importance of taking medications as prescribed;

recognition of side effects and adverse reactions and procedures to follow when residents appear to be experiencing

side effects and adverse reactions; documentation and record keeping; and medication storage and disposal. Training

shall include demonstrations of proper techniques, including techniques for infection control, and ensure unlicensed

staff have adequately demonstrated that they have acquired the skills necessary to provide such assistance.

(b) The training must be provided by a registered nurse or licensed pharmacist who shall issue a training

certificate to a trainee who demonstrates, in person and both physically and verbally, the ability to:

1. Read and understand a prescription label;

2. Provide assistance with self-administration in accordance with section 429.256, F.S., and rule 59A-36.008,

F.A.C., including:

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

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

directions;

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

d. Recognize a medication order which requires judgment or discretion, and to advise the resident, resident’s

health care provider or facility employer of inability to assist in the administration of such orders;

e. Complete a medication observation record;

f. Retrieve and store medication;

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

h. Assist residents with insulin syringes that are prefilled with the proper dosage by a pharmacist and insulin

pens that are prefilled by the manufacturer by taking the medication, in its previously dispensed, properly labeled

container, from where it is stored, and bringing it to the resident for self-injection;

i. Assist with nebulizers;

j. Use a glucometer to perform blood glucose testing;

k. Assist residents with oxygen nasal cannulas and continuous positive airway pressure (CPAP) devices,

excluding the titration of the oxygen levels;

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

m. Placement and removal of colostomy bags, excluding the removal of the flange or manipulation of the stoma

site; and,

n. Measurement of blood pressure, heart rate, temperature, and respiratory rate.

(c) Unlicensed persons, as defined in section 429.256(1)(b), F.S., who provide assistance with self-administered

medications and have successfully completed the initial 6 hour training, must obtain, annually, a minimum of 2

hours of continuing education training on providing assistance with self-administered medications and safe


medication practices in an assisted living facility. The 2 hours of continuing education training may be provided

online.

(d) Trained unlicensed staff who, prior to the effective date of this rule, assist with the self-administration of

medication and have successfully completed 4 hours of assistance with self-administration of medication training

must complete an additional 2 hours of training that focuses on the topics listed in sub-subparagraphs (6)(b)2.h.-n. of

this section, before assisting with the self-administration of medication procedures listed in sub-subparagraphs

(6)(b)2.h.-n.

(7) NUTRITION AND FOOD SERVICE. The administrator or person designated by the administrator as

responsible for the facility’s food service and the day-to-day supervision of food service staff must obtain, annually,

a minimum of 2 hours continuing education in topics pertinent to nutrition and food service in an assisted living

facility. This requirement does not apply to administrators and designees who are exempt from training requirements

under paragraph 59A-36.012(1)(b). A certified food manager, licensed dietician, registered dietary technician or

health department sanitarian is qualified to train assisted living facility staff in nutrition and food service.

(8) EXTENDED CONGREGATE CARE (ECC) TRAINING.

(a) The administrator and ECC supervisor, if different from the administrator, must complete core training and 4

hours of initial training in extended congregate care prior to the facility receiving its ECC license or within 3 months

of beginning employment in a currently licensed ECC facility as an administrator or ECC supervisor. Successful

completion of the assisted living facility core training shall be a prerequisite for this training. ECC supervisors who

attended the assisted living facility core training prior to April 20, 1998, shall not be required to take the assisted

living facility core training competency test.

(b) The administrator and the ECC supervisor, if different from the administrator, must complete a minimum of

4 hours of continuing education every two years in topics relating to the physical, psychological, or social needs of

frail elderly and disabled persons, or persons with Alzheimer’s disease or related disorders.

(c) All direct care staff providing care to residents in an ECC program must complete at least 2 hours of in-

service training, provided by the facility administrator or ECC supervisor, within 6 months of beginning

employment in the facility. The training must address ECC concepts and requirements, including statutory and rule

requirements, and the delivery of personal care and supportive services in an ECC facility.

(9) LIMITED MENTAL HEALTH TRAINING.

(a) Pursuant to section 429.075, F.S., the administrator, managers and staff, who have direct contact with mental

health residents in a licensed limited mental health facility, must receive the following training:

1. A minimum of 6 hours of specialized training in working with individuals with mental health diagnoses.

a. The training must be provided or approved by the Department of Children and Families and must be taken

within 6 months of the facility’s receiving a limited mental health license or within 6 months of employment in a

limited mental health facility.

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

required for administrators and managers pursuant to section 429.52(5), F.S., and subsection (1) of this rule.

2. A minimum of 3 hours of continuing education, which may be provided by the ALF administrator, online, or

through distance learning, biennially thereafter in subjects dealing with one or more of the following topics:

a. Mental health diagnoses; and,

b. Mental health treatment such as:


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

(II) Resident progress in achieving treatment goals;

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

may require intervention; and,

(IV) Crisis services and the Baker Act procedures.

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

the 12 hours of continuing education required biennially pursuant to section 429.52(5), F.S., and subsection (1) of

this rule.

4. Administrators, managers and direct contact staff affected by the continuing education requirement under this

subsection shall have up to 6 months after the effective date of this rule to meet the training requirement.

(b) Administrators, managers and staff do not have to repeat the initial training should they change employers

provided they present a copy of their training certificate to the current employer for retention in the facility’s

personnel files. They must also ensure that copies of the continuing education training certificates, pursuant to

subparagraph (a)2. of this subsection, are retained in their personnel files.

(10) ALZHEIMER’S DISEASE AND RELATED DISORDERS (“ADRD”) TRAINING REQUIREMENTS.

Facilities which advertise that they provide special care for persons with ADRD, or who maintain secured areas as

described in Chapter 4, Section 464.4.6 of the Florida Building Code, as adopted in rule 61G20-1.001, F.A.C.,

Florida Building Code Adopted, must ensure that facility staff receive the following training.

(a) Facility staff who interact on a daily basis with residents with ADRD but do not provide direct care to such

residents and staff who provide direct care to residents with ADRD, shall obtain 4 hours of initial training within 3

months of employment. Completion of the core training program between April 20, 1998 and July 1, 2003 shall

satisfy this requirement. Facility staff who meet the requirements for ADRD training providers under paragraph (g)

of this subsection, will be considered as having met this requirement. Initial training, entitled “Alzheimer’s Disease

and Related Disorders Level I Training,” must address the following subject areas:

1. Understanding Alzheimer’s disease and related disorders;

2. Characteristics of Alzheimer’s disease;

3. Communicating with residents with Alzheimer’s disease;

4. Family issues;

5. Resident environment; and,

6. Ethical issues.

(b) Staff who have successfully completed both the initial one hour and continuing three hours of ADRD

training pursuant to sections 400.1755, 429.917 and 400.6045(1), F.S., shall be considered to have met the initial

assisted living facility Alzheimer’s Disease and Related Disorders Level I Training.

(c) Facility staff who provide direct care to residents with ADRD must obtain an additional 4 hours of training,

entitled “Alzheimer’s Disease and Related Disorders Level II Training,” within 9 months of employment. Facility

staff who meet the requirements for ADRD training providers under paragraph (g) of this subsection, will be

considered as having met this requirement. Alzheimer’s Disease and Related Disorders Level II Training must

address the following subject areas as they apply to these disorders:

1. Behavior management,

2. Assistance with ADLs,


3. Activities for residents,

4. Stress management for the care giver; and,

5. Medical information.

(d) A detailed description of the subject areas that must be included in an ADRD curriculum which meets the

requirements of paragraphs (a) and (b) of this subsection, can be found in the document “Training Guidelines for the

Special Care of Persons with Alzheimer’s Disease and Related Disorders,” dated March 1999, incorporated by

reference, available from the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000.

(e) Direct care staff shall participate in 4 hours of continuing education annually as required under section

429.178, F.S. Continuing education received under this paragraph may be used to meet 3 of the 12 hours of

continuing education required by section 429.52, F.S., and subsection (1) of this rule, or 3 of the 6 hours of

continuing education for extended congregate care required by subsection (7) of this rule.

(f) Facility staff who have only incidental contact with residents with ADRD must receive general written

information provided by the facility on interacting with such residents, as required under section 429.178, F.S.,

within three (3) months of employment. “Incidental contact” means all staff who neither provide direct care nor are

in regular contact with such residents.

(g) Persons who seek to provide ADRD training in accordance with this subsection must provide the department

or its designee with documentation that they hold a Bachelor’s degree from an accredited college or university or

hold a license as a registered nurse, and:

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

disorders, or

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

related disorders, or

3. Completed a specialized training program in the subject matter of this program and have a minimum of two

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

(h) With reference to requirements in paragraph (g), a Master’s degree from an accredited college or university

in a subject related to the content of this training program can substitute for the teaching experience. Years of

teaching experience related to the subject matter of this training program may substitute on a year-by-year basis for

the required Bachelor’s degree referenced in paragraph (g).

(11) DO NOT RESUSCITATE ORDERS TRAINING.

(a) Currently employed facility administrators, managers, direct care staff and staff involved in resident

admissions must receive at least one hour of training in the facility’s policies and procedures regarding Do Not

Resuscitate Orders.

(b) Newly hired facility administrators, managers, direct care staff and staff involved in resident admissions

must receive at least one hour of training in the facility’s policy and procedures regarding DNROs within 30 days

after employment.

(c) Training shall consist of the information included in rule 59A-36.009, F.A.C.


(12) TRAINING DOCUMENTATION AND MONITORING.

(a) Except as otherwise noted, certificates, or copies of certificates, of any training required by this rule must be

documented in the facility’s personnel files. The documentation must include the following:

1. The title of the training program,

2. The subject matter of the training program,

3. The training program agenda,

4. The number of hours of the training program,

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

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

(b) Upon successful completion of training pursuant to this rule, the training provider must issue a certificate to

the trainee as specified in this rule.

(c) The facility must provide the Department of Elder Affairs and the Agency for Health Care Administration

with training documentation and training certificates for review, as requested. The department and agency reserve

the right to attend and monitor all facility in-service training, which is intended to meet regulatory requirements.

Rulemaking Authority 429.178, 429.41, 429.52 FS. Law Implemented 429.07, 429.075, 429.178, 429.41, 429.52 FS.

History–New 9-30-92, Formerly 10A-5.0191, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-5-05, 7-30-

06, 10-9-06, 7-1-08, 4-15-10, 5-10-18, Formerly 58A-5.0191, 7-1-19.

59A-36.012 Food Service Standards.

(1) GENERAL RESPONSIBILITIES. When food service is provided by the facility, the administrator, or an

individual designated in writing by the administrator, must be responsible for total food services and the day-to-day

supervision of food services staff. In addition, the following requirements apply:

(a) If the designee is an individual who has not completed an approved assisted living facility core training

course, such individual must complete the food and nutrition services module of the core training course before

assuming responsibility for the facility’s food service. The designee is not subject to the 1 hour in-service training in

safe food handling practices.

(b) If the designee is a certified food manager, certified dietary manager, registered or licensed dietitian, dietetic

registered technician, or health department sanitarian, the designee is exempt from the requirement to complete the

food and nutrition services module of the core training course before assuming responsibility for the facility’s food

service as required in paragraph (1)(a) of this rule.

(c) An administrator or designee must perform his or her duties in a safe and sanitary manner.

(d) An administrator or designee must provide regular meals that meet the nutritional needs of residents, and

therapeutic diets as ordered by the resident’s health care provider for residents who require special diets.

(e) An administrator or designee must comply with the food service continuing education requirements

specified in rule 59A-36.011, F.A.C.

(2) DIETARY STANDARDS.

(a) The meals provided by the assisted living facility must be planned based on the current USDA Dietary

Guidelines for Americans, 2010, which are incorporated by reference and available for review at:

http://www.flrules.org/Gateway/reference.asp?No=Ref-04003, and the current summary of Dietary Reference

Intakes established by the Food and Nutrition Board of the Institute of Medicine of the National Academies, 2010,

which are incorporated by reference and available for review at:


http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/New%20Materia

l/5DRI%20Values%20SummaryTables%2014.pdf. Therapeutic diets must meet these nutritional standards to the

extent possible.

(b) The residents’ nutritional needs must be met by offering a variety of meals adapted to the food habits,

preferences, and physical abilities of the residents, and must be prepared through the use of standardized recipes. For

facilities with a licensed capacity of 16 or fewer residents, standardized recipes are not required. Unless a resident

chooses to eat less, the facility must serve the standard minimum portions of food according to the Dietary

Reference Intakes.

(c) All regular and therapeutic menus to be used by the facility must be reviewed annually by a licensed or

registered dietitian, a licensed nutritionist, or a registered dietetic technician supervised by a licensed or registered

dietitian, or a licensed nutritionist to ensure the meals meet the nutritional standards established in this rule. The

annual review must be documented in the facility files and include the original signature of the reviewer, registration

or license number, and date reviewed. Portion sizes must be indicated on the menus or on a separate sheet.

1. Daily food servings may be divided among three or more meals per day, including snacks, as necessary to

accommodate resident needs and preferences.

2. Menu items may be substituted with items of comparable nutritional value based on the seasonal availability

of fresh produce or the preferences of the residents.

(d) Menus must be dated and planned at least 1 week in advance for both regular and therapeutic diets.

Residents must be encouraged to participate in menu planning. Planned menus must be conspicuously posted or

easily available to residents. Regular and therapeutic menus as served, with substitutions noted before or when the

meal is served, must be kept on file in the facility for 6 months.

(e) Therapeutic diets must be prepared and served as ordered by the health care provider.

1. Facilities that offer residents a variety of food choices through a select menu, buffet style dining, or family

style dining are not required to document what is eaten unless a health care provider’s order indicates that such

monitoring is necessary. However, the food items that enable residents to comply with the therapeutic diet must be

identified on the menus developed for use in the facility.

2. The facility must document a resident’s refusal to comply with a therapeutic diet and provide notification to

the resident’s health care provider of such refusal.

(f) For facilities serving three or more meals a day, no more than 14 hours must elapse between the end of an

evening meal containing a protein food and the beginning of a morning meal. Intervals between meals must be

evenly distributed throughout the day with not less than 2 hours nor more than 6 hours between the end of one meal

and the beginning of the next. For residents without access to kitchen facilities, snacks must be offered at least once

per day. Snacks are not considered to be meals for the purposes of calculating the time between meals.

(g) Food must be served attractively at safe and palatable temperatures. All residents must be encouraged to eat

at tables in the dining areas. A supply of eating ware sufficient for all residents, including adaptive equipment if

needed by any resident, must be on hand.

(h) A 3-day supply of nonperishable food, based on the number of weekly meals the facility has contracted with

residents to serve, must be on hand at all times. The quantity must be based on the resident census and not on

licensed capacity. The supply must consist of foods that can be stored safely without refrigeration. Water sufficient


for drinking and food preparation must also be stored, or the facility must have a plan for obtaining water in an

emergency, with the plan coordinated with and reviewed by the local disaster preparedness authority.

(3) FOOD HYGIENE. Copies of inspection reports issued by the county health department for the last 2 years

pursuant to rule 64E-12.004, or chapter 64E-11, F.A.C., as applicable, depending on the licensed capacity of the

assisted living facility, must be on file in the facility.

(4) CONTRACTED FOOD SERVICE. When food service is contracted by the facility, the facility must ensure

that the contracted food service meets all dietary standards imposed by this rule and is adequately protected upon

delivery to the facility pursuant to subsection 64E-12.004(4), F.A.C. The facility must maintain:

(a) A copy of the current contract between the facility and the food service contractor.

(b) A copy of the annually issued certificate or license authorizing the operation of the food service contractor

issued by the applicable regulating agency. The license or certificate must provide documentation of the food service

contractor’s compliance with food service regulatory requirements.

Rulemaking Authority 429.41 FS. Law Implemented 429.41, 429.52 FS. History–New 5-14-81, Amended 1-6-82, 5-

19-83, 9-17-84, Formerly 10A-5.20, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.020, Amended

10-30-95, 6-2-96, 10-17-99, 4-17-14, Formerly 58A-5.020, 7-1-19.

59A-36.013 Fiscal Standards.

(1) FINANCIAL STABILITY. The facility must be administered on a sound financial basis in order to ensure

adequate resources to meet resident needs pursuant to the requirements of chapter 408, part II, part I, F.S., and rule

chapter 59A-35, F.A.C., and this rule chapter.

(2) RESIDENT TRUST FUNDS. Funds or other property received by the facility belonging to or due a

resident, including personal funds, must be held as trust funds and expended only for the resident’s account.

Resident funds or property may be held in one bank account if a separate written accounting for each resident is

maintained. A separate bank account is required for facility funds; co-mingling resident funds with facility funds is

prohibited. Written accounting procedures for resident trust funds must include income and expense records of the

trust fund, including the source and disposition of the funds.

(3) SURETY BONDS. Pursuant to the requirements of section 429.27(2), F.S.:

(a) For entities that own more than one facility in the state, one surety bond may be purchased to cover the

needs of all residents served by the entities.

(b) The following additional bonding requirements apply to facilities serving residents receiving OSS:

1. If serving as representative payee for a resident receiving OSS, the minimum bond proceeds must equal twice

the value of the resident’s monthly aggregate income, which must include any supplemental security income or

social security disability income plus the OSS payments, including the personal needs allowance.

2. If holding a power of attorney for a resident receiving OSS, the minimum bond proceeds must equal twice

the value of the resident’s monthly aggregate income, which must include any supplemental security income or

social security disability income; the OSS payments, including the personal allowance; plus the value of any

property belonging to a resident held at the facility.

(c) Upon the annual issuance of a new bond or continuation bond, the facility must file a copy of the bond with

the Agency Central Office.

(4) LIABILITY INSURANCE. Pursuant to section 429.275, F.S., facilities must maintain liability insurance

coverage, as defined in section 624.605, F.S., that remains in force at all times. On the renewal date of the facility’s


policy or whenever a facility changes policies, the facility must file documentation of continued coverage with the

Agency Central Office. Such documentation must be issued by the insurance company and must include the name

and street address of the facility, a reference that the facility is an assisted living facility, the facility’s licensed

capacity, and the dates of coverage.

Rulemaking Authority 429.24, 429.27, 429.275, 429.41 FS. Law Implemented 429.27, 429.275 FS. History–New 5-

14-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.21, Amended 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.021,

Amended 10-30-95, 6-2-96, 10-17-99, 4-17-14, Formerly 58A-5.021, 7-1-19.

59A-36.014 Physical Plant Standards.

(1) NEW FACILITIES. Newly constructed facilities to be licensed as assisted living facilities, and existing

structures, not previously licensed as assisted living facilities, to be converted to assisted living facilities, as well as

any subsequent additions, modifications, alterations, renovations or refurbishing of such facilities, are required by

governmental entities other than the Department of Elder Affairs to adhere to certain building code and fire safety

standards. Such standards may be found in:

(a) Chapter 4, Section 464, of the Florida Building Code as adopted in rule 61G20-1.001, F.A.C.;

(b) Section 633.022, F.S., Uniform Firesafety Standards and rule chapter 69A-40, F.A.C. The Uniform Fire

Safety Standards for Assisted Living Facilities; and,

(c) The National Fire Protection Association codes described in section 429.41, F.S.

(2) EXISTING FACILITIES.

(a) An assisted living facility must comply with the rule or building code in effect at the time of initial licensure,

as well as the rule or building code in effect at the time of any additions, modifications, alterations, refurbishment,

renovations or reconstruction. Determination of the installation of a fire sprinkler system in an existing facility must

comply with the requirements described in section 429.41, F.S.

(b) A facility undergoing change of ownership is considered an existing facility for purposes of this rule.

(3) OTHER REQUIREMENTS.

(a) All facilities must:

1. Provide a safe living environment pursuant to section 429.28(1)(a), F.S.;

2. Be maintained free of hazards; and,

3. Ensure that all existing architectural, mechanical, electrical and structural systems, and appurtenances are

maintained in good working order.

(b) Pursuant to section 429.27, F.S., residents must be given the option of using their own belongings as space

permits. When the facility supplies the furnishings, each resident bedroom or sleeping area must have at least the

following furnishings:

1. A clean, comfortable bed with a mattress no less than 36 inches wide and 72 inches long, with the top surface

of the mattress at a comfortable height to ensure easy access by the resident,

2. A closet or wardrobe space for hanging clothes,

3. A dresser, chest or other furniture designed for storage of clothing or personal effects,

4. A table or nightstand, bedside lamp or floor lamp, and waste basket; and,

5. A comfortable chair, if requested.

(c) The facility must maintain master or duplicate keys to resident bedrooms to be used in the event of an

emergency.


(d) Residents who use portable bedside commodes must be provided with privacy during use.

(e) Facilities must make available linens and personal laundry services for residents who require such services.

Linens provided by a facility must be free of tears, stains and must not be threadbare.

Rulemaking Authority 429.41 FS. Law Implemented 429.27, 429.28, 429.41 FS. History–New 5-14-81, Amended 1-

6-82, 5-19-83, 9-17-84, Formerly 10A-5.23, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.023,

Amended 10-30-95, 6-2-96, 10-17-99, 7-30-06, 4-15-10, 4-17-14, Formerly 58A-5.023, 7-1-19.

59A-36.015 Records.

The facility must maintain required records in a manner that makes such records readily available at the licensee’s

physical address for review by a legally authorized entity. If records are maintained in an electronic format, facility

staff must be readily available to access the data and produce the requested information. For purposes of this section,

“readily available” means the ability to immediately produce documents, records, or other such data, either in

electronic or paper format, upon request.

(1) FACILITY RECORDS. Facility records must include:

(a) The facility’s license displayed in a conspicuous and public place within the facility.

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

1. Date of admission, the facility or place from which the resident was admitted, and if applicable, a notation

indicating that the resident was admitted with a stage 2 pressure sore; and,

2. Date of discharge, reason for discharge, and identification of the facility or home address to which the

resident was discharged. Readmission of a resident to the facility after discharge requires a new entry in the log.

Discharge of a resident is not required if the facility is holding a bed for a resident who is out of the facility but

intending to return pursuant to rule 59A-36.018, F.A.C. If the resident dies while in the care of the facility, the log

must indicate the date of death.

(c) A log listing the names of all temporary emergency placement and respite care residents if not included on

the log described in paragraph (b).

(d) The facility’s emergency management plan, with documentation of review and approval by the county

emergency management agency, as described in rule 59A-36.019, F.A.C., that must be readily available by facility

staff.

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

(f) For facilities that have a surety bond, a copy of the surety bond currently in effect as required by rule 59A-

36.013, F.A.C.

(g) The admission package presented to new or prospective residents (less the resident’s contract) described in

rule 59A-36.006, F.A.C.

(h) If the facility advertises that it provides special care for persons with Alzheimer’s disease or related

disorders, a copy of all such facility advertisements as required by section 429.177, F.S.

(i) A grievance procedure for receiving and responding to resident complaints and recommendations as

described in rule 59A-36.007, F.A.C.

(j) All food service records required in rule 59A-36.012, F.A.C., including menus planned and served and

county health department inspection reports. Facilities that contract for food services, must include a copy of the

contract for food services and the food service contractor’s license or certificate to operate.


(k) All fire safety inspection reports issued by the local authority or the State Fire Marshal pursuant to section

429.41, F.S., and rule chapter 69A-40, F.A.C., issued within the last 2 years.

(l) All sanitation inspection reports issued by the county health department pursuant to section 381.031, F.S.,

and chapter 64E-12, F.A.C., issued within the last 2 years.

(m) Pursuant to section 429.35, F.S., all completed survey, inspection and complaint investigation reports, and

notices of sanctions and moratoriums issued by the agency within the last 5 years.

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

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

(p) For facilities licensed as limited mental health, extended congregate care, or limited nursing services,

records required as stated in rules 59A-36.020, 59A-36.021 and 59A-36.022, F.A.C., respectively.

(2) STAFF RECORDS.

(a) Personnel records for each staff member must contain, at a minimum, a copy of the employment application,

with references furnished, and documentation verifying freedom from signs or symptoms of communicable disease.

In addition, records must contain the following, as applicable:

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

F.A.C.,

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

3. Documentation of compliance with level 2 background screening for all staff subject to screening

requirements as specified in section 429.174, F.S., and rule 59A-36.010, F.A.C.,

4. For facilities with a licensed capacity of 17 or more residents, a copy of the job description given to each staff

member pursuant to rule 59A-36.010, F.A.C.,

5. Documentation verifying direct care staff and administrator participation in resident elopement drills pursuant

to paragraph 59A-36.007(8)(c), F.A.C.

(b) The facility is not required to maintain personnel records for staff provided by a licensed staffing agency or

staff employed by an entity contracting to provide direct or indirect services to residents and the facility. However,

the facility must maintain a copy of the contract between the facility and the staffing agency or contractor as

described in rule 59A-36.010, F.A.C.

(c) The facility must maintain the written work schedules and staff time sheets for the most current 6 months as

required by rule 59A-36.010, F.A.C.

(3) RESIDENT RECORDS. Resident records must be maintained on the premises and include:

(a) Resident demographic data as follows:

1. Name,

2. Sex,

3. Race,

4. Date of birth,

5. Place of birth, if known,

6. Social security number,

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

8. Name, address, and telephone number of next of kin, legal representative, or individual designated by the

resident for notification in case of an emergency; and,


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

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

(c) Any orders for medications, nursing services, therapeutic diets, do not resuscitate orders, or other services to

be provided, supervised, or implemented by the facility that require a health care provider’s order.

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

applicable.

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

(f) A weight record that is initiated on admission. Information may be taken from AHCA Form 1823 or the

resident’s health assessment. Residents receiving assistance with the activities of daily living must have their weight

recorded semi-annually.

(g) For facilities that will have unlicensed staff assisting the resident with the self-administration of medication,

a copy of the written informed consent described in rule 59A-36.006, F.A.C., if such consent is not included in the

resident’s contract.

(h) For facilities that manage a pill organizer, assist with self-administration of medications or administer

medications for a resident, copies of the required medication records maintained pursuant to rule 59A-36.008,

F.A.C.

(i) A copy of the resident’s contract with the facility, including any addendums to the contract as described in

rule 59A-36.018, F.A.C.

(j) For a facility whose owner, administrator, staff, or representative thereof, serves as an attorney in fact for a

resident, a copy of the monthly written statement of any transaction made on behalf of the resident as required in

section 429.27, F.S.

(k) For any facility that maintains a separate trust fund to receive funds or other property belonging to or due a

resident, a copy of the quarterly written statement of funds or other property disbursed as required in section 429.27,

F.S.

(l) If the resident is an OSS recipient, a copy of the Department of Children and Families form Alternate Care

Certification for Optional State Supplementation (OSS), CF-ES 1006, October 2005, which is hereby incorporated

by reference and available for review at: http://www.flrules.org/Gateway/reference.asp?No=Ref-04004. The absence

of this form will not be the basis for administrative action against a facility if the facility can demonstrate that it has

made a good faith effort to obtain the required documentation from the Department of Children and Families.

(m) Documentation of the appointment of a health care surrogate, health care proxy, guardian, or the existence

of a power of attorney, where applicable.

(n) For hospice patients, the interdisciplinary care plan and other documentation that the resident is a hospice

patient as required in rule 59A-36.006, F.A.C.

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

(p) For independent living residents who receive meals and occupy beds included within the licensed capacity

of an assisted living facility, but who are not receiving any personal, limited nursing, or extended congregate care

services, record keeping may be limited to the following at the discretion of the facility:

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

2. The resident demographic data required in this paragraph,

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


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

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

the meal plan offered by the facility.

(q) Except for resident contracts, which must be retained for 5 years, all resident records must be retained for 2

years following the departure of a resident from the facility unless it is required by contract to retain the records for a

longer period of time. Upon request, residents must be provided with a copy of their records upon departure from the

facility.

(r) Additional resident records requirements for facilities holding a limited mental health, extended congregate

care, or limited nursing services license are provided in rules 59A-36.020, 59A-36.021 and 59A-36.022, F.A.C.,

respectively.

(4) RECORD INSPECTION.

(a) The resident’s records must be available to the resident; the resident’s legal representative, designee,

surrogate, guardian, attorney in fact, or case manager; or the resident’s estate, and such additional parties as

authorized in writing or by law.

(b) Pursuant to section 429.35, F.S., agency reports that pertain to any agency survey, inspection, or monitoring

visit must be available to the residents and the public. In facilities that are co-located with a licensed nursing home,

the inspection of record for all common areas is the nursing home inspection report.


429.35, 429.41, 429.52 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.24, Amended

10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.024, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99, 7-30-

06, 10-9-06, 4-17-14, Formerly 58A-5.024, 7-1-19.

59A-36.016 Adverse Incident Report.

(1) INITIAL ADVERSE INCIDENT REPORT. The preliminary adverse incident report required by section

429.23(3), F.S., must be submitted within 1 business day after the incident pursuant to rule 59A-35.110, F.A.C.,

which requires online reporting.

(2) FULL ADVERSE INCIDENT REPORT. For each adverse incident reported in subsection (1), above, the

facility must submit a full report within 15 days of the incident. The full report must be submitted pursuant to rule

59A-35.110, F.A.C., which requires online reporting.

Rulemaking Authority 429.23 FS. Law Implemented 429.23 FS. History–New 1-9-02, Amended 7-30-06, 4-17-14,

Formerly 58A-5.0241, 7-1-19.

59A-36.017 Liability Claim Report.

(1) MONTHLY LIABILITY CLAIM REPORT. Each assisted living facility must report monthly any liability

claim filed against the facility pursuant to rule 59A-35.110, F.A.C., which requires online reporting. Each facility

must comply with the reporting time frames and transmission requirements specified in section 429.23(5), F.S.

(2) If a liability claim has not been filed against the facility in a given month, no report is required.

Rulemaking Authority 429.23 FS. Law Implemented 429.23 FS. History–New 1-9-02, Amended 3-13-14, Formerly

58A-5.0242, 7-1-19.


59A-36.018 Resident Contracts.

(1) Pursuant to section 429.24, F.S., the facility must offer a contract for execution by the resident or the

resident’s legal representative before or at the time of admission. The contract must contain the following

provisions:

(a) A list of the specific services, supplies and accommodations to be provided by the facility to the resident,

including limited nursing and extended congregate care services that the resident elects to receive;

(b) The daily, weekly, or monthly rate;

(c) A list of any additional services and charges to be provided that are not included in the daily, weekly, or

monthly rates, or a reference to a separate fee schedule that must be attached to the contract;

(d) A provision stating that at least 30 days written notice will be given before any rate increase;

(e) Any rights, duties, or obligations of residents, other than those specified in section 429.28, F.S.;

(f) The purpose of any advance payments or deposit payments, and the refund policy for such advance or

deposit payments;

(g) A refund policy that must conform to section 429.24(3), F.S.;

(h) A written bed hold policy and provisions for terminating a bed hold agreement if a facility agrees in writing

to reserve a bed for a resident who is admitted to a nursing home, health care facility, or psychiatric facility. The

resident or responsible party must notify the facility in writing of any change in status that would prevent the

resident from returning to the facility. Until such written notice is received, the agreed upon daily, weekly, or

monthly rate may be charged by the facility unless the resident’s medical condition prevents the resident from giving

written notification, such as when a resident is comatose, and the resident does not have a responsible party to act on

the resident’s behalf;

(i) A provision stating whether the facility is affiliated with any religious organization and, if so, which

organization and its relationship to the facility;

(j) A provision that, upon determination by the administrator or health care provider that the resident needs

services beyond those that the facility is licensed to provide, the resident or the resident’s representative, or agency

acting on the resident’s behalf, must be notified in writing that the resident must make arrangements for transfer to a

care setting that is able to provide services needed by the resident. In the event the resident has no one to represent

him or her, the facility must refer the resident to the social service agency for placement. If there is disagreement

regarding the appropriateness of placement, provisions outlined in section 429.26(8), F.S., will take effect;

(k) A provision that residents must be assessed upon admission pursuant to subsection 59A-36.006(2), F.A.C.,

and every 3 years thereafter, or after a significant change, pursuant to subsection (4), of that rule;

(l) The facility’s policies and procedures for self-administration, assistance with self-administration, and

administration of medications, if applicable, pursuant to rule 59A-36.008, F.A.C. This also includes provisions

regarding over-the-counter (OTC) products pursuant to subsection (8) of that rule; and,

(m) The facility’s policies and procedures related to a properly executed DH Form 1896, Do Not Resuscitate

Order.

(2) The resident, or the resident’s representative, must be provided with a copy of the executed contract.

(3) The facility may not levy an additional charge for any supplies, services, or accommodations that the facility

has agreed by contract to provide as part of the standard daily, weekly, or monthly rate. The resident or resident’s

representative must be furnished in advance with an itemized written statement setting forth additional charges for


any services, supplies, or accommodations available to residents not covered under the contract. An addendum must

be added to the resident contract to reflect the additional services, supplies, or accommodations not provided under

the original agreement. Such addendum must be dated and signed by the facility and the resident or resident’s legal

representative and a copy given to the resident or resident’s representative.

Rulemaking Authority 429.24, 429.41 FS. Law Implemented 429.24, 429.41 FS. History–New 10-17-99, Amended 7-

30-06, 4-15-10, 3-13-14, Formerly 58A-5.025, 7-1-19.

59A-36.019 Emergency Management.

(1) EMERGENCY PLAN COMPONENTS. Pursuant to section 429.41, F.S., each facility must prepare a

written comprehensive emergency management plan in accordance with the “Emergency Management Criteria for

Assisted Living Facilities,” dated October 1995, which is incorporated by reference and available at

http://www.flrules.org/Gateway/reference.asp?No=Ref-04010. This document is available from the local emergency

management agency. The emergency management plan must, at a minimum, address the following:

(a) Provision for all hazards;

(b) Provision for the care of residents remaining in the facility during an emergency, including pre-disaster or

emergency preparation; protecting the facility; supplies; emergency power; food and water; staffing; and emergency

equipment;

(c) Provision for the care of residents who must be evacuated from the facility during an emergency including

identification of such residents and transfer of resident records; evacuation transportation; sheltering arrangements;

supplies; staffing; emergency equipment; and medications;

(d) Provision for the care of additional residents who may be evacuated to the facility during an emergency

including the identification of such residents, staffing, and supplies;

(e) Identification of residents with Alzheimer’s disease or related disorders, and residents with mobility

limitations who may need specialized assistance either at the facility or in case of evacuation;

(f) Identification of and coordination with the local emergency management agency;

(g) Arrangement for post-disaster activities including responding to family inquiries, obtaining medical

intervention for residents, transportation, and reporting to the local emergency management agency the number of

residents who have been relocated, and the place of relocation; and,

(h) The identification of staff responsible for implementing each part of the plan.

(2) EMERGENCY PLAN APPROVAL. The plan must be submitted for review and approval to the local

emergency management agency.

(a) If the local emergency management agency requires revisions to the emergency management plan, such

revisions must be made and the plan resubmitted to the local office within 30 days of receiving notification that the

plan must be revised.

(b) A new facility as described in rule 59A-36.014, F.A.C., and facilities whose ownership has been transferred,

must submit an emergency management plan within 30 days after obtaining a license.

(c) The facility must review its emergency management plan on an annual basis. Any substantive changes must

be submitted to the local emergency agency for review and approval.

1. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered

substantive revisions for the purposes of this rule.


2. Changes in the identification of specific staff must be submitted to the local emergency management agency

annually as a signed and dated addendum that is not subject to review and approval.

(d) The local emergency management agency is the final administrative authority for emergency management

plans prepared by assisted living facilities.

(e) Any plan approved by the local emergency management agency is considered to have met all the criteria and

conditions established in this rule.

(3) PLAN IMPLEMENTATION.

(a) All staff must be trained in their duties and are responsible for implementing the emergency management

plan.

(b) If telephone service is not available during an emergency, the facility must request assistance from local law

enforcement or emergency management personnel in maintaining communication.

(4) FACILITY EVACUATION. The facility must evacuate the premises during or after an emergency if so

directed by the local emergency management agency.

(a) The facility must report the evacuation to the local office of emergency management or designee and to the

agency within 6 hours of the evacuation order. If the evacuation takes more than 6 hours, the facility must report

when the evacuation is completed.

(b) The facility must not be re-occupied until the area is cleared for reentry by the local emergency management

agency or its designee and the facility can meet the immediate needs of the residents.

(c) A facility with significant structural damage must relocate residents until the facility can be safely re-

occupied.

(d) The facility is responsible for knowing the location of all residents until the residents have been relocated to

another facility.

(e) The facility must provide the agency with the name of a contact person who must be available by telephone

24 hours a day, seven days a week, until the facility is re-occupied.

(f) The facility must assist in the relocation of residents, and must cooperate with outreach teams established by

the Department of Health or emergency management agency to assist in relocation efforts. Resident needs and

preferences must be considered to the extent possible in any relocation decision.

(5) EMERGENCY SHELTER. In the event a state of emergency has been declared and the facility is not

required to evacuate the premises, the facility may provide emergency shelter above the facility’s licensed capacity

provided the following conditions are met:

(a) Life safety will not be jeopardized for any individual;

(b) The immediate needs of residents and other individuals sheltered at the facility can be met by the facility;

(c) The facility reports the number of individuals over its licensed capacity and the conditions causing it to the

Agency Field Office within 48 hours or as soon as practical. As an alternative, the facility may report to the Agency

Central Office at (850)412-4304. If the facility will continue to be over capacity after the declared emergency ends,

the agency will review requests for excess capacity on a case-by-case basis; and,

(d) The facility maintains a log of the additional individuals being housed in the facility. The log must include

the individual’s name, usual address, and the dates of arrival and departure. The log must be available for review by

representatives of the agency, the department, the local emergency management agency or its designee. The


admissions and discharge log maintained by the facility may be used for this purpose provided the information is

maintained in a manner that is easily accessible.

Rulemaking Authority 429.41 FS. Law Implemented 429.41 FS. History–New 10-17-99, Amended 7-30-06, 4-17-14,

Formerly 58A-5.026, 7-1-19.

59A-36.020 Limited Mental Health.

(1) LICENSE APPLICATION.

(a) Any facility intending to admit one or more mental health residents must obtain a limited mental health

license from the agency before accepting the mental health resident.

(b) Facilities applying for a limited mental health license that have uncorrected deficiencies or violations found

during the facility’s last survey, complaint investigation, or monitoring visit will be surveyed before the issuance of

a limited mental health license to determine if such deficiencies or violations have been corrected.

(2) RECORDS.

(a) A facility with a limited mental health license must maintain an up-to-date admission and discharge log

containing the names and dates of admission and discharge for all mental health residents. The admission and

discharge log required in rule 59A-36.015, F.A.C., satisfies this condition provided that all mental health residents

are clearly identified.

(b) Staff records must contain documentation that designated staff have completed limited mental health

training as required by rule 59A-36.011, F.A.C.

(c) Resident records must include:

1. Documentation, provided by a mental health care provider within 30 days of the resident’s admission to the

facility, that the resident is a mental health resident as defined in section 394.4574, F.S., and that the resident is

receiving social security disability or supplemental security income and optional state supplementation as follows:

a. An affirmative statement on the Alternate Care Certification for Optional State Supplementation (OSS) form,

CF-ES 1006, October 2005, which is hereby incorporated by reference and available for review at:

http://www.flrules.org/Gateway/reference.asp?No=Ref-03988, that the resident is receiving SSI or SSDI due to a

mental disorder,

b. Written verification provided by the Social Security Administration that the resident is receiving SSI or SSDI

for a mental disorder. Such verification may be acquired from the Social Security Administration upon obtaining a

release from the resident permitting the Social Security Administration to provide such information, or

c. A written statement from the resident’s case manager or other mental health care provider that the resident is

an adult with severe and persistent mental disorder. The case manager or other mental health care provider must

consider the following minimum criteria in making that determination:

(I) The resident is eligible for, is receiving, or has received mental health services within the last 5 years, or

(II) The resident has been diagnosed as having a severe or persistent mental disorder.

2. An appropriate placement assessment provided by the resident’s mental health care provider within 30 days

of admission to the facility that the resident has been assessed and found appropriate for residence in an assisted

living facility. Such assessment must be conducted by a psychiatrist, clinical psychologist, clinical social worker,

psychiatric nurse, or an individual supervised by one of these professionals.

a. Any of the following documentation that contains the name of the resident and the name, signature, date, and

license number, if applicable, of the person making the assessment, meets this requirement:


(I) Completed Alternate Care Certification for Optional State Supplementation (OSS) form, CF-ES Form 1006,

(II) Discharge Statement from a state mental hospital completed no more than 90 days before admission to the

assisted living facility provided it contains a statement that the individual is appropriate to live in an assisted living

facility, or

(III) Other signed statement that the resident has been assessed and found appropriate for residency in an

assisted living facility.

b. A mental health resident returning to a facility from treatment in a hopsital or crisis stabilization unit will not

be considered a new admission and will not require a new assessment. However, a break in a resident’s residency

that requires the facility to execute a new resident contract or admission agreement will be considered a new

admission and the resident’s mental health care provider must provide a new assessment.

3. A Community Living Support Plan. Each mental health resident and the resident’s mental health case

manager must, in consultation with the facility administrator, prepare a plan within 30 days of the resident’s

admission to the facility or within 30 days after receiving the appropriate placement assessment in paragraph (2)(c),

whichever is later, that:

a. Includes the specific needs of the resident that must be met in order to enable the resident to live in the

assisted living facility and the community,

b. Includes the clinical mental health services to be provided by the mental health care provider to help meet the

resident’s needs, and the frequency and duration of such services,

c. Includes any other services and activities to be provided by or arranged for by the mental health care provider

or mental health case manager to meet the resident’s needs, and the frequency and duration of such services and

activities,

d. Includes the obligations of the facility to facilitate and assist the resident in attending appointments and

arranging transportation to appointments for the services and activities identified in the plan that have been provided

or arranged for by the resident’s mental health care provider or case manager,

e. Includes a description of other services to be provided or arranged by the facility,

f. Includes a list of factors pertinent to the care, safety, and welfare of the mental health resident and a

description of the signs and symptoms particular to the resident that indicate the immediate need for professional

mental health services,

g. Is in writing and signed by the mental health resident, the resident’s mental health case manager, and the

assisted living facility administrator or manager and a copy placed in the resident’s file. If the resident refuses to

sign the plan, the resident’s mental health case manager must add a statement that the resident was asked but refused

to sign the plan,

h. Is updated at least annually or if there is a significant change in the resident’s behavioral health,

i. May include the Cooperative Agreement described in subparagraph (2)(c)4. If included, the mental health

care provider must also sign the plan; and,

j. Must be available for inspection to those who have legal authority to review the document.

4. Cooperative Agreement. The mental health care provider for each mental health resident and the facility

administrator or designee must prepare a written statement, within 30 days of the resident’s admission to the facility

or receipt of the resident’s appropriate placement assessment, whichever is later. The statement:


a. Provides procedures and directions for accessing emergency and after-hours care for the mental health

resident. The provider must furnish the resident and the facility with the provider’s 24-hour emergency crisis

telephone number;

b. Must be signed by the administrator or designee and the mental health care provider, or by a designated

representative of a Medicaid prepaid health plan if the resident is on a plan and the plan provides behavioral health

services in section 409.912, F.S.;

c. May cover all mental health residents of the facility who are clients of the same provider; and,

d. May be included in the Community Living Support Plan described in subparagraph (2)(c)3.

5. Missing documentation will not be the basis for administrative action against a facility if the facility can

demonstrate that it has made a good faith effort to obtain the required documentation from the appropriate party. A

documented request for such missing documentation made by the facility administrator within 72 hours of the

resident’s admission will be considered a good faith effort. The documented request must include the name, title,

and phone number of the person to whom the request was made and must be kept in the resident’s file.

(3) RESPONSIBILITIES OF FACILITY. In addition to the staffing and care standards of this rule chapter to

provide for the welfare of residents in an assisted living facility, a facility holding a limited mental health license

must:

(a) Meet the facility’s obligation to assist the resident in carrying out the activities identified in the Community

Living Support Plan;

(b) Provide an opportunity for private face-to-face contact between the mental health resident and the resident’s

mental health case manager or other treatment personnel of the resident’s mental health care provider;

(c) Observe resident behavior and functioning in the facility, and record and communicate observations to the

resident’s mental health case manager or mental health care provider regarding any significant behavioral or

situational changes that may signify the need for a change in the resident’s professional mental health services,

supports, and services described in the community living support plan, or that the resident is no longer appropriate

for residency in the facility;

(d) If the facility initiates an involuntary mental health examination pursuant to section 394.463, F.S., the

facility must document the circumstances leading to the initiation of the examination;

(e) Ensure that designated staff have completed limited mental health training as required by rule 59A-36.011,

F.A.C.; and,

(f) Maintain facility, staff, and resident records in accordance with the requirements of this rule chapter.

Rulemaking Authority 429.41 FS. Law Implemented 429.075, 429.26, 429.41 FS. History–New 8-15-90, Amended 9-

30-92, Formerly 10A-5.029, Repromulgated 10-30-95, Amended 6-2-96, 11-2-98, 7-30-06, Amended 4-17-14, 5-10-

18, Formerly 58A-5.029, 7-1-19.

59A-36.021 Extended Congregate Care Services.

(1) LICENSING.

(a) Any facility intending to establish extended congregate care services must obtain a license from the agency

before accepting residents needing extended congregate care services.

(b) Only the portion of a facility that meets the physical requirements of subsection (3), and is staffed in

accordance with subsection (4), is considered licensed to provide extended congregate care services to residents who

meet the admission and continued residency requirements of this rule.


(2) EXTENDED CONGREGATE CARE POLICIES. Policies and procedures established through extended

congregate care services must promote resident independence, dignity, choice, and decision-making. The facility

must develop and implement specific written policies and procedures that address:

(a) Aging in place;

(b) The facility’s residency criteria developed in accordance with the admission and discharge requirements

described in subsection (5), and extended congregate care services listed in subsection (8);

(c) The personal and supportive services the facility intends to provide, how the services will be provided, and

the identification of staff positions to provide the services including their relationship to the facility;

(d) The nursing services the facility intends to provide, identification of staff positions to provide nursing

services, and the license status, duties, general working hours, and supervision of such staff;

(e) Identifying potential unscheduled resident service needs and mechanisms for meeting those needs including

the identification of resources to meet those needs;

(f) A process for mediating conflicts among residents regarding choice of room or apartment and roommate;

and,

(g) How to involve residents in decisions concerning the resident. The services must provide opportunities and

encouragement for the resident to make personal choices and decisions. If a resident needs assistance to make

choices or decisions, a family member or other resident representative must be consulted. Choices must include at a

minimum whether:

1. To participate in the process of developing, implementing, reviewing, and revising the resident’s service plan,

2. To remain in the same room in the facility, except that a current resident transferring into an extended

congregate care services may be required to move to the part of the facility licensed for extended congregate care, if

only part of the facility is so licensed,

3. To select among social and leisure activities,

4. To participate in activities in the community. At a minimum the facility must arrange transportation to such

activities if requested by the resident; and,

5. To provide input with respect to the adoption and amendment of facility policies and procedures.

(3) STAFFING REQUIREMENTS. The following staffing requirements apply for extended congregate care

services:

(a) Supervision by an administrator who has a minimum of two years of managerial, nursing, social work,

therapeutic recreation, or counseling experience in a residential, long-term care, or acute care setting or agency

serving elderly or disabled persons. If an administrator appoints a manager as the supervisor of an extended

congregate care facility, both the administrator and manager must satisfy the requirements of subsection 59A-

36.010(1), F.A.C.

1. A baccalaureate degree may be substituted for one year of the required experience.

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

(b) Provide staff or contract the services of a nurse who must be available to provide nursing services,

participate in the development of resident service plans, and perform monthly nursing assessments for extended

congregate care residents.

(c) Provide enough qualified staff to meet the needs of extended congregate care residents in accordance with

rule 59A-36.010, F.A.C., and to provide the services established in each resident’s service plan.


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

residents.

(e) Immediately provide additional or appropriately qualified staff, when the agency determines that service

plans are not being followed or that residents’ needs are not being met because insufficient staffing, in accordance

with the staffing standards established in rule 59A-36.010, F.A.C.

(f) Ensure and document that staff receive extended congregate care training as required in rule 59A-36.011,

F.A.C.

(4) ADMISSION AND CONTINUED RESIDENCY.

(a) An individual must meet the following minimum criteria in order to receive extended congregate care

services:

1. Be at least 18 years of age;

2. Be free from signs and symptoms of a communicable disease that is likely to be transmitted to other residents

or staff; however, an individual who has human immunodeficiency virus (HIV) infection may be admitted to a

facility, provided that he or she would otherwise be eligible for admission according to this rule;

3. Be able to transfer, with assistance if necessary. The assistance of more than one individual is permitted;

4. Not be a danger to self or others as determined by a health care provider or mental health practitioner

licensed under chapter 490 or 491, F.S.;

5. Not be bedridden;

6. Not have any stage 3 or 4 pressure sores;

7. Not require any of the following nursing services:

a. Artificial airway management of any kind except that of continuous positive airway pressure may be

provided through the use of a CPAP or bipap machine,

b. Nasogastric tube feeding,

c. Monitoring of blood gases,

d. Management of post-surgical drainage tubes or wound vacuums,

e. Skilled rehabilitative services as described in rule 59G-4.290, F.A.C., or

f. Treatment of a surgical incision, unless the surgical incision and the condition that caused it have been

stabilized and a plan of care developed. The plan of care must be maintained in the resident’s record at the facility.

8. Not require 24-hour nursing supervision; and,

9. Have been determined to be appropriate for admission to the facility by the facility administrator or manager.

The administrator or manager must base his or her decision on:

a. An assessment of the strengths, needs, and preferences of the individual, the health assessment required by

subsection (6) of this rule, and the preliminary service plan developed in subsection (7),

b. The facility’s residency criteria, and services offered or arranged for by the facility to meet resident needs;

and,

c. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in

rule chapter 69A-40, F.A.C.

(b) Criteria for continued residency in an extended congregate care services must be the same as the criteria for

admission, except as specified below.

1. A resident may be bedridden for up to 14 consecutive days.


2. A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in

the facility if the following conditions are met:

a. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice that coordinates

and ensures the provision of any additional care and services that may be needed,

b. Continued residency is agreeable to the resident and the facility,

c. An interdisciplinary care plan, which specifies the services being provided by hospice and those being

provided by the facility, is developed and implemented by a licensed hospice in consultation with the facility; and,

d. Documentation of the requirements of subparagraph (5)(b)2., is maintained in the resident’s file.

3. The extended congregate care administrator or manager is responsible for monitoring the appropriateness of

continued residency of a resident in extended congregate care services at all times.

4. A hospice resident that meets the qualifications of continued residency pursuant to this rule may only receive

services from the assisted living facility’s staff within the scope of the facility’s license.

5. Staff may provide any nursing service permitted under the facility’s license and total help with the activities

of daily living for residents admitted to hospice. Staff may not exceed the scope of their professional licensure or

training in any licensed assisted living facility.

(5) HEALTH ASSESSMENT. Before receiving extended congregate care services, all persons. including

residents transferring within the same facility to that portion of the facility licensed to provide extended congregate

care services, must be examined by a health care provider pursuant to rule 59A-36.006, F.A.C. A health assessment

conducted no more than 60 days before receiving extended congregate care services meets this requirement. Once

receiving services, a new health assessment must be obtained at least annually.

(6) SERVICE PLANS.

(a) Before receiving services, the extended congregate care administrator or manager must develop a

preliminary service plan that includes an assessment of whether the resident meets the facility’s residency criteria,

an appraisal of the resident’s unique physical, psychological and social needs and preferences, and an evaluation of

the facility’s ability to meet the resident’s needs.

(b) Within 14 days of receiving services, the extended congregate care administrator or manager must

coordinate the development of a written service plan that takes into account the resident’s health assessment

obtained pursuant to subsection (6); the resident’s unique physical, psychological and social needs and preferences;

and how the facility will meet the resident’s needs including the following if required:

1. Health monitoring,

2. Assistance with personal care services,

3. Nursing services,

4. Supervision,

5. Special diets,

6. Ancillary services,

7. The provision of other services such as transportation and supportive services; and,

8. The manner of service provision, and identification of service providers, including family and friends, in

keeping with resident preferences.

(c) Pursuant to the definitions of “shared responsibility” and “managed risk” as provided in section 429.02, F.S.,

the service plan must be developed and agreed upon by the resident or the resident’s representative or designee,


surrogate, guardian, or attorney-in-fact, and must reflect the responsibility and right of the resident to consider

options and assume risks when making choices pertaining to the resident’s service needs and preferences.

(d) The service plan must be reviewed and updated quarterly to reflect any changes in the manner of service

provision, accommodate any changes in the resident’s physical or mental status, or pursuant to recommendations for

modifications in the resident’s care as documented in the nursing assessment.

(7) EXTENDED CONGREGATE CARE SERVICES. All services must be provided in the least restrictive

environment, and in a manner that respects the resident’s independence, privacy, and dignity.

(a) A facility providing extended congregate care services may provide supportive services including social

service needs, counseling, emotional support, networking, assistance with securing social and leisure services,

shopping service, escort service, companionship, family support, information and referral, assistance in developing

and implementing self-directed activities, and volunteer services. Family or friends must be encouraged to provide

supportive services for residents. The facility must provide training for family or friends to enable them to provide

supportive services in accordance with the resident’s service plan.

(b) A facility providing extended congregate care services must make available the following additional

services if required by the resident’s service plan:

1. Total help with bathing, dressing, grooming and toileting,

2. Nursing assessments conducted more frequently than monthly,

3. Measurement and recording of basic vital functions and weight,

4. Dietary management including provision of special diets, monitoring nutrition, and observing the resident’s

food and fluid intake and output,

5. Assistance with self-administered medications, or the administration of medications and treatments pursuant

to a health care provider’s order. If the individual needs assistance with self-administration the facility must inform

the resident of the qualifications of staff who will be providing this assistance, and if unlicensed persons will be

providing such assistance, obtain the resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s informed

written consent to provide such assistance as required in section 429.256, F.S.,

6. Supervision of residents with dementia and cognitive impairments,

7. Health education and counseling and the implementation of health-promoting programs and preventive

regimes,

8. Provision or arrangement for rehabilitative services; and,

9. Provision of escort services to health-related appointments.

(c) Nursing staff providing extended congregate care services may provide any nursing service permitted within

the scope of their license consistent with the residency requirements of this rule and the facility’s written policies

and procedures, provided the nursing services are:

1. Authorized by a health care provider’s order and pursuant to a plan of care,

2. Medically necessary and appropriate for treatment of the resident’s condition,

3. In accordance with the prevailing standard of practice in the nursing community,

4. A service that can be safely, effectively, and efficiently provided in the facility,

5. Recorded in nursing progress notes; and,

6. In accordance with the resident’s service plan.


(d) At least monthly, or more frequently if required by the resident’s service plan, a nursing assessment of the

resident must be conducted.

(8) RECORDS. In addition to the records required in rule 59A-36.015, F.A.C., a facility providing extended

congregate care services must maintain the following:

(a) The service plans for each resident receiving extended congregate care services;

(b) The nursing progress notes for each resident receiving nursing services;

(c) Nursing assessments; and,

(d) The facility’s extended congregate care policies and procedures.

(9) DISCHARGE. If the facility and the resident are unable to agree on a service plan, the facility is unable to

meet the resident’s needs as identified in the service plan, or the resident no longer meets the criteria for continued

residency, the resident must be discharged or relocated in accordance with sections 429.26 and 429.28, F.S.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.28, 429.41 FS. History–

New 9-30-92, Formerly 10A-5.030, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 4-17-14, 5-10-

18, Formerly 58A-5.030, 7-1-19.

59A-36.022 Limited Nursing Services.

Any facility intending to provide limited nursing services must obtain a license from the agency.

(1) NURSING SERVICES. In addition to any nursing service permitted under a standard license pursuant to

section 429.255, F.S., a facility with a limited nursing services license may provide nursing care to residents who do

not require 24-hour nursing supervision and to residents who do require 24-hour nursing care and are enrolled in

hospice.

(2) RESIDENT CARE STANDARDS.

(a) A resident receiving limited nursing services in a facility holding only a standard and limited nursing

services license must meet the admission and continued residency criteria specified in rule 59A-36.006, F.A.C.

(b) In accordance with rule 59A-36.010, F.A.C., the facility must employ sufficient and qualified staff to meet

the needs of residents requiring limited nursing services based on the number of such residents and the type of

nursing service to be provided.

(c) Limited nursing services may only be provided as authorized by a health care provider’s order, a copy of

which must be maintained in the resident’s file.

(d) Facilities licensed to provide limited nursing services must employ or contract with a nurse(s) who must be

available to provide such services as needed by residents. The facility’s employed or contracted nurse must

coordinate with third party nursing services providers to ensure resident care is provided in a safe and consistent

manner. The facility must maintain documentation of the qualifications of nurses providing limited nursing services

in the facility’s personnel files.

(e) The facility must ensure that nursing services are conducted and supervised in accordance with chapter 464,

F.S., and the prevailing standard of practice in the nursing community.

(3) RECORDS.

(a) A record of all residents receiving limited nursing services and the type of services provided must be

maintained at the facility.

(b) Nursing progress notes must be maintained for each resident who receives limited nursing services.


(c) A nursing assessment conducted at least monthly must be maintained on each resident who receives a

limited nursing service.

Rulemaking Authority 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.41 FS. History–New 9-30-92,

Formerly 10A-5.031, Amended 10-30-95, 10-17-99, 7-30-06, 3-13-14, 5-10-18, Formerly 58A-5.031, 7-1-19.

59A-36.023 Administrative Enforcement.

Facility staff shall cooperate with Agency personnel during surveys, complaint investigations, monitoring visits,

implementation of correction plans, license application and renewal procedures and other activities necessary to

ensure compliance with part I of chapter 429, F.S., and this rule chapter.

(1) INSPECTIONS.

(a) Pursuant to section 429.34, F.S., the agency shall conduct a survey, investigation, or appraisal of a facility:

1. Prior to issuance of a license;

2. Prior to biennial renewal of a license;

3. When there is a change of ownership;

4. To monitor facilities licensed to provide limited nursing or extended congregate care services, or who were

cited in the previous year for a Class I or Class II, or 4 or more uncorrected Class III violations;

5. Upon receipt of an oral or written complaint of practices that threaten the health, safety, or welfare of

residents;

6. If the agency has reason to believe a facility is violating a provision of part III of chapter 429, F.S., or this

rule chapter;

7. To determine if cited deficiencies have been corrected; and

8. To determine if a facility is operating without a license.

(b) The inspection shall consist of full access to and examination of the facility’s physical premises and facility

records and accounts, and staff and resident records.

(c) Agency personnel shall interview facility staff and residents in order to determine whether the facility is

respecting resident rights and to determine compliance with resident care standards. Interviews shall be conducted

privately.

(d) Agency personnel shall respect the private possessions of residents and staff while conducting facility

inspections.

(2) ABBREVIATED SURVEY.

(a) An applicant for license renewal who does not have any class I or class II violations or uncorrected class III

violations, confirmed long-term care ombudsman council complaints reported to the agency by the LTCOC, or

confirmed licensing complaints within the two licensing periods immediately preceding the current renewal date

shall be eligible for an abbreviated biennial survey by the agency. Facilities that do not have two survey reports on

file with the agency under current ownership are not eligible for an abbreviated inspection. Upon arrival at the

facility, the agency shall inform the facility that it is eligible for and that an abbreviated survey will be conducted.

(b) Compliance with key quality of care standards described in the following statutes and rules will be used by

the agency during its abbreviated survey of eligible facilities:

1. Section 429.26, F.S., and rule 59A-36.006, F.A.C., relating to residency criteria;

2. Section 429.27, F.S., and rule 59A-36.013, F.A.C., relating to proper management of resident funds and

property;


3. Section 429.28, F.S., and rule 59A-36.007, F.A.C., relating to respect for resident rights;

4. Section 429.41, F.S., and rule 59A-36.007, F.A.C., relating to the provision of supervision, assistance with

ADLs, and arrangement for appointments and transportation to appointments;

5. Section 429.256, F.S., and rule 59A-36.008, F.A.C., relating to assistance with or administration of

medications;

6. Section 429.41, F.S., and rule 59A-36.010, F.A.C., relating to the provision of sufficient staffing to meet

resident needs;

7. Section 429.41, F.S., and rule 59A-36.011, F.A.C., relating to minimum dietary requirements and proper food

hygiene;

8. Section 429.075,.F.S., and rule 59A-36.020, F.A.C., relating to mental health residents’ community support

living plan;

9. Section 429.07, F.S., and rule 59A-36.021, F.A.C., relating to meeting the environmental standards and

residency criteria in a facility with an extended congregate care license; and

10. Section 429.07, F.S., and rule 59A-36.022, F.A.C., relating to the provision of care and staffing in a facility

with a limited nursing license.

(c) The agency will expand the abbreviated survey or conduct a full survey if violations which threaten or

potentially threaten the health, safety, or security of residents are identified during the abbreviated survey. The

facility shall be informed that a full survey will be conducted. If one or more of the following serious problems are

identified during an abbreviated survey, a full biennial survey will be immediately conducted:

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

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

a resident;

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

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

(3) SURVEY DEFICIENCY.

(a) Prior to or in conjunction with a notice of violation issued pursuant to section 429.19 and chapter 120, F.S.,

the agency shall issue a statement of deficiency for Class I, II, III, and IV violations which are observed by Agency

personnel during any inspection of the facility. The deficiency statement shall be issued within ten (10) working

days of the Agency’s inspection and shall include:

1. A description of the deficiency;

2. A citation to the statute or rule violated;

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

4. A request for a plan of correction which shall include time frame for correction of the deficiency; and

5. A description of the administrative sanction that may be imposed if the facility fails to correct the deficiency

within the established time frame.

(b) Additional time may be granted to correct specific deficiencies if a written request is received by the agency

prior to the time frame included in the agency’s statement.

(c) The facility’s plan of correction must be received by the agency within 10 working days of receipt of the

deficiency statement and is subject to approval by the agency.


(4) EMPLOYMENT OF A CONSULTANT.

(a) Medication Deficiencies.

1. If a Class I, Class II, or uncorrected Class III deficiency directly relating to facility medication practices as

established in rule 59A-36.008, F.A.C., is documented by agency personnel pursuant to an inspection of the facility,

the agency shall notify the facility in writing that the facility must employ, on staff or by contract, the services of a

pharmacist licensed pursuant to section 465.0125, F.S., or registered nurse, as determined by the agency.

2. The initial on-site consultant visit shall take place within 7 working days of the identification of a Class I or

Class II deficiency and within 14 working days of the identification of an uncorrected Class III deficiency. The

facility shall have available for review by the agency a copy of the pharmacist’s or registered nurse’s license and a

signed and dated recommended corrective action plan no later than 10 working days subsequent to the initial on-site

consultant visit.

3. The facility shall provide the agency with, at a minimum, quarterly onsite corrective action plan updates until

the agency determines after written notification by the consultant and facility administrator that deficiencies are

corrected and staff has been trained to ensure that proper medication standards are followed and that such consultant

services are no longer required. The agency shall provide the facility with written notification of such determination.

(b) Dietary Deficiencies.

1. If a Class I, Class II, or uncorrected Class III deficiency directly related to dietary standards as established in

rule 59A-36.012, F.A.C., is documented by agency personnel pursuant to an inspection of the facility, the agency

shall notify the facility in writing that the facility must employ, on staff or by contract, the services of a registered

dietitian or licensed dietitian/nutritionist.

2. The initial on-site consultant visit shall take place within 7 working days of the identification of a Class I or

Class II deficiency and within 14 working days of the identification of an uncorrected Class III deficiency. The

facility shall have available for review by the agency a copy of the dietitian’s license or registration card and a

signed and dated dietary consultant’s recommended corrective action plan no later than 10 working days subsequent

to the initial on-site consultant visit.

3. The facility shall provide the agency with, at a minimum, quarterly on-site corrective action plan updates

until the agency determines after written notification by the dietary consultant and facility administrator that

deficiencies are corrected and staff has been trained to ensure that proper dietary standards are followed and that

such consultant services are no longer required. The agency shall provide the facility with written notification of

such determination.

(5) ADMINISTRATIVE SANCTIONS. Administrative fines shall be imposed for Class I and Class II

violations, or Class III or IV violations which are not corrected within the time frame set by the Agency, and for

repeat Class III violations, as set forth in section 429.19, F.S.

(a) The Agency shall notify facilities of the imposition of sanctions, their right to appeal the sanctions, the

remedies available, and the time limit for requesting such remedies as provided under chapter 120, F.S., and part II

of chapter 59-1, F.A.C.

(b) When an administrative fine payment is returned from the applicant’s bank for whatever reason, the agency

shall add to the amount due a service fee of $20 or 5 percent of the face amount of the check, whichever is greater,

up to a maximum charge of $200. Proceeds from this fee shall be deposited in the same agency account as the fine.



429.19, 429.256, 429.26, 429.27, 429.28, 429.34, 429.41, 429.42 FS. History–New 9-30-92, Formerly 10A-5.033,

Amended 10-30-95, 10-17-99, 1-9-02, 7-30-06, 4-15-10, 3-13-14, Formerly 58A-5.033, 7-1-19.

59A-36.024 Waivers.

The agency, in consultation with the department, may waive rules promulgated pursuant to part I, chapter 429, F.S.,

if the waiver request meets the conditions set forth in section 429.41(4), F.S., and demonstrates and evaluates

innovative or cost-effective congregate care alternatives which will enable individuals to age in place.

(1) Application Process.

(a) Licensed assisted living facilities proposing a waiver under this statute must submit the request in writing.

All requests must include the facility name and address, license number, administrator’s name and contact

information for the requestor, or its attorney. Petitions for waiver of rules other than for the objectives detailed in

section 429.41(4), F.S., including emergency waivers, will not be considered under this section but should follow

the petition for waiver provisions of section 120.542, F.S., and rule chapter 28-104, Variance or Waiver, F.A.C.

(b) The written request must address the elements required in section 429.41(4), F.S. In addition, the following

information must be included in order to demonstrate how a waiver of the stated rule will permit development of a

concept that will achieve the purpose of the underlying statute:

1. The rule or rules for which the waiver is requested.

2. The licensee’s anticipated date or dates for implementation of the concept.

3. If applying based on cost-effectiveness or cost-savings, a cost-benefit analysis of the proposed alternative to

both residents or potential residents as well as facility operations.

4. An analysis of the impact the alternative will have on the relevant local community, including any barriers

such as zoning or use issues, which may need resolution prior to implementation.

5. Specific performance measures with an annual projection of objectives and goals to be achieved broken into

quarterly increments or an annual projection of outcome measures, if the concept will be implemented in less than

90 days.

6. If applying based on cost-effectiveness or cost-savings, an annual budget projection for the proposed

alternative broken into quarterly increments.

(c) A waiver can be requested at the time of the initial license application, relicensure, or any time during the

licensure period.

(d) Waiver requests must be submitted to the Agency for Health Care Administration, Assisted Living Unit,

2727 Mahan Drive, Mail Stop 30, Tallahassee, Florida 32308-5403.

(2) In accordance with section 120.542(6), F.S., the agency shall post notice of the request within fifteen (15)

days of receipt of the request. The agency shall make any requests for additional information within 30 days of

receipt of the request. If additional information is provided, the agency may request clarification of only that

information no later than 30 days following receipt of the information. The agency shall process the waiver request

pursuant to the time frame referenced in section 120.542(8), F.S.

(3) The agency, in consultation with the department, will evaluate all requests in light of the likelihood the

concept, as described in detail, will achieve the underlying statutory objectives of innovative or cost effective

congregate care alternatives to enable individuals to age in place, as provided in section 429.41(4), F.S. Waivers

may be granted only so long as there is reasonable assurance that the health, safety or welfare of residents will not

be endangered by the waiver.


(4) The agency shall grant or deny the request for waiver and enter an order summarizing the facts it relied on

and reasons supporting its decision. The agency must provide notice of its order as described in section 120.542(8),

F.S. The requestor shall be advised that a denial of the request may be reviewed as provided in subsection (5) of this

rule.

(5) Report of Findings. A facility that has been granted a waiver must submit an annual report within 12 months

of the order granting the waiver as specified in section 429.41(4), F.S. If the report is not submitted as required, the

agency may revoke the waiver.

(a) The agency will review the report of findings to determine whether the waiver shall be renewed or revoked.

The agency shall make the determination based on whether the facility has met the requirements outlined in

subparagraph (1)(b) of this rule. The agency shall enter an order providing the general basis for making its decision

and notify the licensee of its opportunity to seek review of a revocation in accordance with sections 120.569 and

120.57, F.S. and rule 28-106.111, F.A.C.

(b) The agency may also consider other material which is available relative to this review.

(c) A waiver is effective unless revoked by the agency or superseded by statutory or regulatory change.

(d) In reviewing the report of findings, the agency, in consultation with the department, shall assess whether

statutory or regulatory changes should be pursued to enable other facilities to adopt the same practices.

Rulemaking Authority 429.41 FS. Law Implemented 120.542, 429.41 FS. History–New 9-30-92, Formerly 10A-

5.035, Amended 10-30-95, 7-1-08, 4-17-14, Formerly 59A-36.024, 7-1-19.

59A-36.025 Emergency Environmental Control for Assisted Living Facilities.

(1) DETAILED EMERGENCY ENVIRONMENTAL CONTROL PLAN. Each assisted living facility shall

prepare a detailed plan (“plan”) to serve as a supplement to its Comprehensive Emergency Management Plan, to

address emergency environmental control in the event of the loss of primary electrical power in that assisted living

facility which includes the following information:

(a) The acquisition of a sufficient alternate power source such as a generator(s), maintained at the assisted living

facility, to ensure that current licensees of assisted living facilities will be equipped to ensure ambient air

temperatures will be maintained at or below 81 degrees Fahrenheit for a minimum of ninety-six (96) hours in the

event of the loss of primary electrical power.

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

sufficient size to maintain residents safely at all times and that is appropriate for resident care needs and life safety

requirements. For planning purposes, no less than twenty (20) net square feet per resident must be provided. The

assisted living facility may use eighty percent (80%) of its licensed bed capacity as the number of residents to be

used in the calculation to determine the required square footage. This may include areas that are less than the entire

assisted living facility if the assisted living facility’s comprehensive emergency management plan includes allowing

a resident to congregate when he or she desires in portions of the building where temperatures will be maintained

and includes procedures for monitoring residents for signs of heat related injury as required by this rule. This rule

does not prohibit a facility from acting as a receiving provider for evacuees when the conditions stated in section

408.821, F.S. and subsection 59A-36.019(5), F.A.C., are met. The plan shall include information regarding the

area(s) within the assisted living facility where the required temperature will be maintained.

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

the Florida Building Code.


3. Each assisted living facility is unique in size; the types of care provided; the physical and mental capabilities

and needs of residents; the type, frequency, and amount of services and care offered; and staffing characteristics.

Accordingly, this rule does not limit the types of systems or equipment that may be used to achieve ambient

temperatures at or below 81 degrees Fahrenheit for a minimum of ninety-six (96) hours in the event of the loss of

primary electrical power. The plan shall include information regarding the systems and equipment that will be used

by the assisted living facility and the fuel required to operate the systems and equipment.

a. An assisted living facility in an evacuation zone pursuant to chapter 252, F, S. must maintain an alternative

power source and fuel as required by this subsection at all times when the assisted living facility is occupied but is

permitted to utilize a mobile generator(s) to enable portability if evacuation is necessary.

b. Assisted living facilities located on a single campus with other facilities under common ownership, may share

fuel, alternative power resources, and resident space available on the campus if such resources are sufficient to

support the requirements of each facility’s residents, as specified in this rule. Details regarding how resources will

be shared and any necessary movement of residents must be clearly described in the emergency power plan.

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

floor during a flood or surge event, must place its alternative power source and all necessary additional equipment so

it can safely operate in a location protected from flooding or storm surge damage.

(b) The acquisition of sufficient fuel, and safe maintenance of that fuel at the facility, to ensure that in the event

of the loss of primary electrical power there is sufficient fuel available for the alternate power source to maintain

ambient temperatures at or below 81 degrees Fahrenheit for a minimum of ninety-six (96) hours after the loss of

primary electrical power during a declared state of emergency. The plan must include information regarding fuel

source and fuel storage.

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

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

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

2. An assisted living facility located in an area in a declared state of emergency area pursuant to section 252.36,

F.S. that may impact primary power delivery must secure ninety-six (96) hours of fuel. The assisted living facility

may utilize portable fuel storage containers for the remaining fuel necessary for ninety-six (96) hours during the

period of a declared state of emergency.

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

4. If local ordinances or other regulations limit the amount of onsite fuel storage for the assisted living facility’s

location, then the assisted living facility must develop a plan that includes maximum onsite fuel storage allowable

by the ordinance or regulation and a reliable method to obtain the maximum additional fuel at least 24 hours prior to

depletion of onsite fuel.

(c) The acquisition of services necessary to maintain, and test the equipment and its functions to ensure the safe

and sufficient operation of the alternate power source maintained at the assisted living facility.

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

(2) SUBMISSION OF THE PLAN.

(a) Each assisted living facility licensed prior to the effective date of this rule shall submit its plan to the local

emergency management agency for review within 30 days of the effective date of this rule. Assisted living facility


plans previously submitted and approved pursuant to emergency rule 58AER17-1 will require resubmission only if

changes are made to the plan.

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

(c) Each existing assisted living facility that undergoes any additions, modifications, alterations, refurbishment,

renovations or reconstruction that require modification of its systems or equipment affecting the facility’s

compliance with this rule shall amend its plan and submit it to the local emergency management agency for review

and approval.

(3) APPROVED PLANS.

(a) Each assisted living facility must maintain a copy of its approved plan in a manner that makes the plan

readily available at the licensee’s physical address for review by a legally authorized entity. If the plan is maintained

in an electronic format, assisted living facility staff must be readily available to access and produce the plan. For

purposes of this section, “readily available” means the ability to immediately produce the plan, either in electronic or

paper format, upon request.

(b) Within two (2) business days of the approval of the plan from the local emergency management agency, the

assisted living facility shall submit in writing proof of the approval to the Agency for Health Care Administration.

(c) The assisted living facility shall submit a consumer-friendly summary of the emergency power plan to the

Agency. The Agency shall post the summary and notice of the approval and implementation of the assisted living

facility emergency power plans on its website within ten (10) business days of the plan's approval by the local

emergency management agency and update within ten (10) business days of implementation.

(4) IMPLEMENTATION OF THE PLAN.

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

have implemented the plan required under this rule.

(b) The Agency shall allow an extension up to January 1, 2019 to providers in compliance with paragraph (c)

below and who can show delays caused by necessary construction, delivery of ordered equipment, zoning or other

regulatory approval processes. Assisted living facilities shall notify the Agency that they will utilize the extension

and keep the Agency apprised of progress on a quarterly basis to ensure there are no unnecessary delays. If an

assisted living facility can show in its quarterly progress reports that unavoidable delays caused by necessary

construction, delivery of ordered equipment, zoning or other regulatory approval processes will occur beyond the

initial extension date, the assisted living facility may request a waiver pursuant to section 120.542, F.S.

(c) During the extension period, an assisted living facility must make arrangements pending full implementation

of its plan that provides the residents with an area or areas to congregate that meets the safe indoor air temperature

requirements of subsection (1) (a) for a minimum of ninety-six (96) hours.

1. An assisted living facility not located in an evacuation zone must either have an alternative power source

onsite or have a contract in place for delivery of an alternative power source and fuel when requested. Within

twenty-four (24) hours of the issuance of a state of emergency for an event that may impact primary power delivery

for the area of the assisted living facility, it must have the alternative power source and no less than ninety-six (96)

hours of fuel stored onsite.

2. An assisted living facility located in an evacuation zone pursuant to chapter 252, F.S. must either:

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


b. Have an alternative power source and no less than ninety-six (96) hours of fuel stored onsite, within twenty-

four (24) hours of the issuance of a state of emergency for the area of the assisted living facility.

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

license.

(e) Existing assisted living facilities that undergo any additions, modifications, alterations, refurbishment,

renovations or reconstruction that require modification of the systems or equipment affecting the assisted living

facility’s compliance with this rule shall implement its amended plan concurrent with any such additions,

modifications, alterations, refurbishment, renovations or reconstruction.

(f) The Agency for Health Care Administration may request cooperation from the State Fire Marshal to conduct

inspections to ensure implementation of the plan in compliance with this rule.

(5) POLICIES AND PROCEDURES.

(a) Each assisted living facility shall develop and implement written policies and procedures to ensure that the

assisted living facility can effectively and immediately activate, operate and maintain the alternate power source and

any fuel required for the operation of the alternate power source. The procedures shall ensure that residents do not

experience complications from fluctuations in ambient air temperatures inside the facility. Procedures must address

the care of residents occupying the facility during a declared state of emergency, specifically, a description of the

methods to be used to mitigate the potential for heat related injury including:

1. The use of cooling devices and equipment;

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

medicines requiring refrigeration;

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

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

jeopardy.

(b) Each assisted living facility shall maintain the written policies and procedures in a manner that makes them

readily available at the licensee’s physical address for review by a legally authorized entity. If the policies and

procedures are maintained in an electronic format, assisted living facility staff must be readily available to access the

policies and procedures and produce the requested information. For purposes of this section, “readily available”

means the ability to immediately produce the policies and procedures, either in electronic or paper format, upon

request.

(c) The written policies and procedures must be readily available for inspection by each resident; each resident’s

legal representative, designee, surrogate, guardian, attorney in fact, or case manager; each resident’s estate; and such

additional parties as authorized in writing or by law.

(6) REVOCATION OF LICENSE, FINES OR SANCTIONS. For a violation of any part of this rule, the

Agency for Health Care Administration may seek any remedy authorized by chapter 429, part I, or chapter 408, part

II, F.S., including, but not limited to, license revocation, license suspension, and the imposition of administrative

fines.

(7) COMPREHENSIVE EMERGENCY MANAGEMENT PLAN.

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

with this rule.


(b) Each facility whose plan has been approved shall submit the plan as an addendum with any future

submissions for approval of its comprehensive emergency management plan.

(8) NOTIFICATION.

(a) Within five (5) business days, each assisted living facility must notify in writing, unless permission for

electronic communication has been granted, each resident and the resident’s legal representative:

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

review and approval;

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

(b) Each assisted living facility must maintain a copy of each notification set forth in paragraph (a) above in a

manner that makes each notification readily available at the licensee’s physical address for review by a legally

authorized entity. If the notifications are maintained in an electronic format, facility staff must be readily available to

access and produce the notifications. For purposes of this section, “readily available” means the ability to

immediately produce the notifications, either in electronic or paper format, upon request.

Rulemaking Authority 429.41, FS. Law Implemented 429.19, 429.41, FS. History–New 3-26-18, Formerly 58A-

5.036, 7-1-19.

59A-36.027 ALF Core Training Provider Qualifications.

(1) PRIMARY REQUIREMENTS. In order to register as an assisted living facility core training provider

(hereafter referred to as “core training provider,” “training provider,” or “provider”), all applicants must meet the

requirements outlined in section 429.52(10), F.S. The requirements are as follows:

(a) Completion of the minimum core training requirements developed by the department pursuant to section

429.52(9), F.S., and rule 59A-36.028, F.A.C.;

(b) Successful passage of the competency test, which requires a minimum score of 75%; and,

(c) Compliance with the minimum of 12 contact hours of continuing education in topics related to assisted

living every 2 years pursuant to section 429.52(5), F.S., and paragraph 58A-5.0191(1)(c), F.A.C.

(2) ADDITIONAL REQUIREMENTS. In addition to meeting the 3 primary requirements set forth in

subsection (1), of this rule, applicants must meet one of the requirements outlined in section 429.52(11), F.S., or one

of the requirements established in this subsection. The requirements are as follows:

(a) A minimum of 5 years of employment with the Agency for Health Care Administration (AHCA), or

formerly the Department of Health and Rehabilitative Services, as a surveyor of assisted living facilities; or

(b) A minimum of 5 years of employment in a professional position in the AHCA Assisted Living Unit; or

(c) A minimum of 5 years of employment as an educator or staff trainer for persons working in an ALF or other

long-term care (LTC) settings; or

(d) A minimum of 5 years of employment as an assisted living facility core trainer, which was not directly

associated with the department; or

(e) A minimum of a 4-year degree from an accredited college or university in areas of healthcare, gerontology,

social work, education or human services; and a minimum of 3 years experience as an educator or staff trainer for

persons working in an ALF or other LTC settings after core certification.

Rulemaking Authority 429.52 FS. Law Implemented 429.52 FS. History–New 6-15-09, Formerly 58T-1.203, 7-1-19.


59A-36.028 ALF Minimum Core Training Curriculum Requirements.

(1) CURRICULUM REQUIREMENTS. An approved core training provider must conduct core training using

the curriculum outlined in DOEA Form ALFCT-001, Assisted Living Facility Minimum Core Training Curriculum,

June, 2009, which is incorporated by reference in this rule. The curriculum is available from the Department of

Elder Affairs, Elder Housing Unit, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 or the department’s

website at: http://elderaffairs.state.fl.us/english/ruleforms/ALFCT-001.doc.

(2) MONITORING. The department reserves the right to do the following:

(a) Attend and monitor core training courses;

(b) Review provider records and course materials pursuant to this rule; and,

(c) Conduct on-site monitoring, follow-up monitoring, and require implementation of a corrective action plan if

the provider does not adhere to the approved curriculum.


59A-36.029 ALF Core Training Provider Initial Registration Process.

(1) REGISTRATION PROCESS.

(a) Before core training can be conducted, an applicant must meet the training provider qualifications outlined

in section 429.52(10), F.S., and rule 59A-36.027, F.A.C. Additionally, an applicant must register with, and obtain

from, the department a unique provider registration number as set forth in this subsection.

(b) An applicant must complete DOEA Form ALFCT-002, Application for Assisted Living Facility (ALF) Core

Training Provider Registration, June, 2009. The form is hereby incorporated by reference and may be obtained from

the Department of Elder Affairs, Elder Housing Unit, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 or the

department’s website at: http://elderaffairs.state.fl.us/english/ruleforms/ALFCT-002.doc.

(2) APPROVAL PROCESS. Within 30 calendar days after receiving a core training provider application, the

department must submit written notification approving or denying the application, or requesting supplemental

information or clarification.

(a) If the application is approved, the department must include a unique provider registration number in the

notice.

(b) If the application is denied, the department must provide the reason or reasons for denial in the notice.

(c) If the application is determined to require supplemental information or clarification, the department must

state the supplemental information or clarification that is being requested.

1. If the department does not receive the requested information within 30 calendar days of the request, the

application will be deemed incomplete and closed.

2. If the department receives the requested information within 30 calendar days of the request, the department

must process the training provider application within 30 calendar days after all required information is received.


59A-36.030 Process for Maintaining ALF Core Training Provider Registration.

(1) MAINTAINING ALF CORE TRAINING PROVIDER REGISTRATION.

(a) After receiving the initial core training provider registration, the approved provider must re-register with the

department every 2 years by submitting documentation of his or her compliance with the continuing education

requirement as specified in section 429.52(5), F.S., and this rule.


(b) The provider must submit the documentation to the address referenced on DOEA Form ALFCT-001. It must

be submitted no later than 30 calendar days after each two-year continuing education cycle. The 2-year cycle begins

on the date of the initial training provider registration. Documentation must include the following:

1. Title of the training program;

2. Subject matter of the training program;

3. The training program agenda including topics discussed;

4. The core training provider’s name and registration number;

5. Date(s) of participation;

6. Number of hours of the training program; and

7. The continuing education training provider’s name, signature, credentials, and professional license number, if

applicable.

(2) APPROVAL PROCESS.

(a) Within 30 calendar days after receiving the required continuing education documentation, the department

must notify the provider in writing that the continuing education requirement:

1. Has been met; or

2. Has not been met and the reasons why; or

3. Has omissions or additional information is requested.

a. If the department does not receive the omitted or additional information within 30 calendar days of the

request, the provider’s registration shall be cancelled. The department must provide written notification of its

decision, including the reason for the cancellation, no later than 30 calendar days after the deadline for the request

for the omitted or additional information.

b. If the department receives the omitted or additional information as requested within the 30 calendar day time

period, the department must process the core training provider’s registration within 30 calendar days after all

required information is received. The department must provide written notification to the provider of its decision.

(b) Failure to submit proof of the continuing education requirement as specified in this rule shall result in

cancellation of the core training provider’s registration. The department must provide written notification of such

action no later than 30 calendar days after the information was due.

(c) If the provider’s registration is cancelled under paragraphs (a) and (b) of this subsection, and the provider

subsequently meets the continuing education requirement, he or she may re-apply for registration as specified in rule

59A-36.029, F.A.C., and include documentation that the continuing education requirement has been met pursuant to

this rule.


59A-36.031 Registered ALF Core Training Provider Responsibilities.

The following are the responsibilities of a registered core training provider:

(1) USE OF MINIMUM CORE TRAINING CURRICULUM. A registered core training provider is responsible

for the following:

(a) Conducting core training using the minimum core training curriculum required by rule 59A-36.028, F.A.C.;

and

(b) Ensuring that all changes in ALF statutes and rules are immediately incorporated into the contents of his or

her core training curriculum.


(2) CERTIFICATES. After a trainee successfully completes core training, the approved training provider must

issue a certificate to him or her. In addition to the provider’s unique registration number, the certificate must include

the information referenced in paragraph 58A-5.0191(12)(a), F.A.C. The provider’s signature and registration

number shall serve as documentation that the trainee has completed the required training.

(3) RECORDS. Approved providers must maintain records of each course taught for a minimum of 5 years.

Course records must include the following information:

(a) The title of the training program;

(b) The agenda;

(c) The curriculum and any accompanying documentation and training aids;

(d) The training provider’s name and registration number;

(e) The trainees’ names, dates of participation and training location; and

(f) Training evaluations and roster signed by trainees.

(4) COMPETENCY EXAM.

(a) Approved training providers must submit the names of trainees completing core training to the testing

authority within 10 calendar days after completion of the course. Names must be submitted to the following address:

ALF Certification Testing, University of South Florida, 4202 E. Fowler Avenue, EDU105, Tampa, Florida 33620.

Names may be alternately submitted via email to [email protected].

(b) The testing authority shall not process any requests for the competency exam, nor sit any individual for the

exam, unless proper notice is submitted by an approved training provider pursuant to paragraph (a), of this

subsection.

(5) GUEST SPEAKERS. If a core training provider uses guest trainers to teach or participate in specific training

modules covered in the minimum core training curriculum referenced in rule 59A-36.028, F.A.C., the core trainer is

responsible to ensure that the guest speaker meets the following minimum conditions:

(a) Has expertise in the specific subject matter; and

(b) Covers all components of the subject matter if he or she provides the module or portion of the module

instruction.



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6. Rule Chapter 59A

-36, F.A

.C., and C

rosswalk

CHAPTER 59A-36 ASSISTED LIVING FACILITY

59A-36.001 Standards and Criteria for Determining Compliance with Facility Standards and Resident Rights 59A-36.002 Definitions 59A-36.003 Licensing and Change of Ownership 59A-36.004 License Requirements 59A-36.005 Inspection Responsibilities 59A-36.006 Admission Procedures, Appropriateness of Placement and Continued Residency Criteria 59A-36.007 Resident Care Standards 59A-36.008 Medication Practices 59A-36.009 Do Not Resuscitate Orders (DNROs) 59A-36.010 Staffing Standards 59A-36.011 Staff Training Requirements and Competency Test 59A-36.012 Food Service Standards 59A-36.013 Fiscal Standards 59A-36.014 Physical Plant Standards 59A-36.015 Records 59A-36.016 Adverse Incident Report 59A-36.017 Liability Claim Report 59A-36.018 Resident Contracts 59A-36.019 Emergency Management 59A-36.020 Limited Mental Health 59A-36.021 Extended Congregate Care Services 59A-36.022 Limited Nursing Services 59A-36.023 Administrative Enforcement 59A-36.024 Waivers 59A-36.025 Emergency Environmental Control for Assisted Living Facilities 59A-36.027 ALF Core Training Provider Qualifications 59A-36.028 ALF Minimum Core Training Curriculum Requirements 59A-36.029 ALF Core Training Provider Initial Registration Process 59A-36.030 Process for Maintaining ALF Core Training Provider Registration 59A-36.031 Registered ALF Core Training Provider Responsibilities

59A-36.001 Standards and Criteria for Determining Compliance with Facility Standards and Resident Rights. (1) DEFINITIONS.

In addition to the terms defined in section 429.02, F.S., and rule 59A-36.002, F.A.C., the following definitions are applicable in this rule chapter.

(a) “Core Survey Task” means tasks conducted by Agency survey staff that focus on core areas of regulations. (b) “Timely Manner” means as soon as possible, but not to exceed 24 hours of Agency staff having requested materials. (2) SURVEY PROCESS FOR RESIDENT RIGHTS.

The following core survey tasks shall be utilized during survey activities in order to determine the facility’s compliance with resident rights pursuant to section 429.28, F.S., and rule 59A-36.007, F.A.C.

(a) The surveyor(s) conducts a tour of the facility to determine if the residents’ health, safety, and welfare are maintained. The tour includes observations and assessments of the following:

1. Resident behavior and demeanor; 2. Adherence to facility abuse prohibition policy and procedure; 3. Adherence to infection control policy and procedure; 4. General physical plant standards in accordance with rule 59A-36.014, F.A.C.; 5. Overall appearance of residents and observations of any special care needs;

6. Posting of Resident Bill of Rights and required phone numbers in accordance with rule 59A-36.007, F.A.C.; 7. Resident access to phones and unrestricted private communication; 8. Resident opportunity to exercise; 9. Staff availability and responsiveness to resident care needs; 10. Medication storage and security; 11. Chemical and physical restraint use; 12. Positioning/transferring processes utilized by staff; 13. Any specialized care provided by the facility with a specialty license; 14. Any license conditions or restrictions as a result of Agency action. (b) The surveyor(s) conducts interviews with residents, family members/representatives, staff, and any other persons the

surveyor(s) deems relevant to the survey. 1. The facility may not restrict Agency staff from conducting confidential interviews pursuant to section 429.14(6), F.S. 2. Interviews may be conducted both in person and telephonically. (c) The surveyor(s) reviews facility records to determine compliance with: 1. Licensure requirements in accordance with rule 59A-36.004, F.A.C.; 2. Inspection responsibilities in accordance with rule 59A-36.005, F.A.C.; 3. Admissions procedures and appropriateness of placement and continued residency criteria in accordance with rule 59A-

36.007, F.A.C.; 4. Resident care standards in accordance with rule 59A-36.007, F.A.C.; 5. Medication practices in accordance with rule 59A-36.008, F.A.C.; 6. Do not resuscitate orders (DNROs) in accordance with rule 59A-36.009, F.A.C.; 7. Staffing standards in accordance with rule 59A-36.010, F.A.C.; 8. Staff training requirements and competency training in accordance with rule 59A-36.011, F.A.C.; 9. Alzheimer’s Disease or Related Disorders training provider and curriculum approval in accordance with rule 58A-5.0194,

F.A.C.; 10. Food service standards in accordance with rule 59A-36.012, F.A.C.; 11. Fiscal standards in accordance with rule 59A-36.013, F.A.C.; 12. Physical plant standards in accordance with rule 59A-36.014, F.A.C.; 13. Records in accordance with rule 59A-36.015, F.A.C.; 14. Resident contracts in accordance with rule 59A-36.018, F.A.C.; 15. Emergency management in accordance with rule 59A-36.019, F.A.C. (d) The facility must provide agency staff with requested documents in a timely manner and allow the agency staff to obtain

copies. (e) Surveyor(s) conducts specific and general observations throughout the survey to determine compliance with: dietary

standards, medication standards, infection control standards, resident activities, assistance with activities of daily living, facility practices, and resident daily routines.

(f) For facilities licensed to provide specialty services such as Limited Mental Health, Extended Congregate Care, and Limited Nursing Services: the surveyor(s) reviews the required components in accordance with rules 59A-36.020, 59A-36.021, and 59A-36.021, F.A.C.

Rulemaking Authority 429.28(3)(a) FS. Law Implemented 429.28 FS. History–New 11-28-16.

59A-36.002 Definitions. In addition to the terms defined in section 429.02, F.S., the following definitions are applicable in this rule chapter:

(1) “Advertise” means any written, printed, oral, visual, or electronic promotion, statement of availability, qualifications, services offered, or other similar communication appearing in or on television, radio, the Internet, billboards, newspapers, magazines, business cards, flyers, brochures or other medium for the purpose of attracting potential residents to an assisted living facility. A complimentary listing of a licensed facility’s name, address, and telephone number in the telephone directory is not considered advertising.

(2) “Agency Central Office” means the Agency for Health Care Administration Assisted Living Unit (ALU), located at 2727

Mahan Drive, Mail Stop 30, Tallahassee, FL 32308-5403. The ALU telephone number and website address are (850)412-4304, and http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Assisted_Living/alf.shtml.

(3) “Agency Field Office” means the Agency for Health Care Administration’s Office in a particular geographic area. Information regarding local offices is available online at: http://ahca.myflorida.com/mchq/index.shtml#six.

(4) “Apartment” means a self-contained dwelling unit with a bathroom, kitchen area, and living and sleeping space that is contracted for use as a residence by one or more persons who maintain a common household.

(5) “Anti-Embolism Stockings and Hosiery” means prescribed close-fitting elastic-type coverings for therapeutic treatment of the legs. They may be knee high or thigh high length and have transparent, open-toe, or similar foot design.

(6) “Assistance with Activities of Daily Living” means individual assistance with the following: (a) Ambulation – Providing physical support to enable the resident to move about within or outside the facility. Physical support

includes supporting or holding the resident’s hand, elbow, or arm; holding on to a support belt worn by the resident to assist in providing stability or direction while the resident ambulates; or pushing the resident’s wheelchair. The term does not include assistance with transfer.

(b) Bathing – Assembling towels, soaps, or other necessary supplies; helping the resident in and out of the bathtub or shower; turning the water on and off; adjusting water temperatures; washing and drying portions of the body that are difficult for the resident to reach; or being available while the resident is bathing.

(c) Dressing – Helping residents to choose, put on, and remove clothing. (d) Eating – Helping residents with or by cutting food, pouring beverages, or feeding residents who are unable to feed

themselves. (e) Grooming – Helping residents with shaving, oral care, care of the hair, or nail care. (f) Toileting – Assisting the resident to the bathroom, helping the resident to undress, positioning the resident on the commode,

and helping the resident with related personal hygiene including assistance with changing an adult brief and assistance with the routine emptying of a catheter or ostomy bag.

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

(8) “Bedridden” means confined to bed because of inability to ambulate or transfer to a wheelchair even with assistance, or to sit safely in a chair or wheelchair without personal assistance or physical restraint.

(9) “Capacity” means the number of residents for which a facility has been licensed to provide residential care. (10) “Case Manager” means an individual employed by or under contract with any agency or organization, public or private,

who has the responsibility for assessing resident needs; planning services for the resident; coordinating and assisting residents with gaining access to needed medical, mental health, social, housing, educational or other services; monitoring service delivery; and evaluating the effects of service delivery.

(11) “Certified Nursing Assistant (CNA)” means an individual certified under chapter 464, part II, F.S. (12) “Day Care Participant” means an individual who receives services at a facility for less than 24 hours per day. (13) “Deficiency” means an instance of non-compliance with the requirements of part II of chapter 408, F.S., part I of chapter

429, F.S., rule chapter 59A-35, F.A.C., and this rule chapter. (14) “Direct Care Staff” means Staff in Regular Contact or Staff in Direct Contact with residents who provide personal or

nursing services to residents, including administrators and managers providing such services. (15) “Distinct Part” means designated bedrooms or apartments, bathrooms and a living area; or a separately identified wing,

floor, or building that includes bedrooms or apartments, bathrooms and a living area. The distinct part may include a separate dining area, or meals may be served in another part of the facility.

(16) “Elopement” means an occurrence in which a resident leaves a facility without following facility policy and procedures. (17) “Food Service” means the storage, preparation, service, and clean up of food intended for consumption in a facility either

by facility staff or through a formal agreement that meals will be regularly catered by a third party. (18) “Glucose Meter” or “glucometer” means a medical device that determines the approximate concentration of glucose in the

blood. (19) “Health Care Provider” means a physician or physician’s assistant licensed under chapter 458 or 459, F.S., or advanced

registered nurse practitioner licensed under chapter 464, F.S.

(20) “Licensed Dietitian or Nutritionist” means a dietitian or nutritionist licensed under chapter 468, part X, F.S. (21) “Local fire safety authority” means the authority having jurisdiction as defined in rule chapter 69A-40, F.A.C. (22) “Long-term Care Ombudsman Program (LTCOP)” means the long-term care ombudsman program established under

chapter 400, Part I, F.S. (23) “Manager” means an individual who is authorized to perform the same functions as a facility administrator, and is

responsible for the operation and maintenance of an assisted living facility while under the supervision of the administrator of that facility. A manager does not include staff authorized to perform limited administrative functions during an administrator’s temporary absence.

(24) “Mental Disorder” for the purposes of identifying a mental health resident, means schizophrenia and other psychotic disorders; affective disorders; anxiety related disorders; and personality and dissociative disorders. However, mental disorder does not include residents with a primary diagnosis of Alzheimer’s disease, other dementias, or mental retardation.

(25) “Mental Health Care Provider” means an individual, agency, or organization providing mental health services to clients of the Department of Children and Families; an individual licensed by the state to provide mental health services; or an entity employing or contracting with individuals licensed by the state to provide mental health services.

(26) “Mental Health Case Manager” means a case manager employed by or under contract to a mental health care provider to assist mental health residents residing in a facility holding a limited mental health license.

(27) “Nurse” means a licensed practical nurse (LPN), registered nurse (RN), or advanced registered nurse practitioner (ARNP) licensed under chapter 464, F.S.

(28) “Nursing Assessment” means a written review of information collected from observation and interaction with a resident, including the resident’s record and any other relevant sources of information, the analysis of the information, and recommendations for modification of the resident’s care, if warranted. The assessment must contain the signature and credential initials of the person who conducted the assessment.

(29) “Nursing Progress Notes” or “Progress Report” means a written record of nursing services, other than medication administration or the taking of vital signs, provided to each resident who receives such services in a facility with a limited nursing or extended congregate care license. The progress notes must be completed by the nurse who delivered the service; must describe the date, type, scope, amount, duration, and outcome of services that are rendered; must describe the general status of the resident’s health; must describe any deviations in the residents health; must describe any contact with the resident’s physician; and must contain the signature and credential initials of the person rendering the service.

(30) “Optional State Supplementation (OSS)” means the state program providing monthly payments to eligible residents pursuant to section 409.212, F.S., and rule chapter 65A-2, F.A.C.

(31) “Owner” means a person, partnership, association, limited liability company, or corporation, that owns or leases the facility that is licensed by the agency. The term does not include a person, partnership, association, limited liability company, or corporation that contracts only to manage or operate the facility.

(32) “Physician” means an individual licensed under chapter 458 or 459, F.S. (33) “Pill organizer” means a container that is designed to hold solid doses of medication and is divided according to day or

time increments. (34) “Registered Dietitian” means an individual registered with the Commission on Dietetic Registration, the accrediting body

of the Academy of Nutrition and Dietetics. (35) “Respite Care” means facility-based supervision of an impaired adult for the purpose of relieving the primary caregiver. (36) “Significant Change” means either a sudden or major shift in the behavior or mood of a resident that is inconsistent with

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

(37) “Staff” means any individual employed by a facility, contracting with a facility to provide direct or indirect services to residents, or employed by a firm under contract with a facility to provide direct or indirect services to residents when present in the facility. The term includes volunteers performing any service that counts toward meeting any staffing requirement of this rule chapter.

(38) “Staff in Regular Contact” or “Staff in Direct Contact” mean all staff whose duties may require them to interact with

residents on a daily basis. (39) “Third Party” means any individual or business entity providing services to residents in a facility that is not staff of the

facility. (40) “Universal Precautions” are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV),

hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Universal precautions require that the blood and certain body fluids of all residents be considered potentially infectious for HIV, HBV, and other bloodborne pathogens.

(41) “Unscheduled Service Need” means a need for a personal service, nursing service, or mental health intervention that cannot be predicted in advance and that must be met promptly to ensure that the health, safety, and welfare of residents is preserved.

Rulemaking Authority 429.41, 429.929 FS. Law Implemented 429.07, 429.075, 429.11, 429.14, 429.19, 429.41, 429.47, 429.52, 429.905 FS. History–New 9-30-92, Formerly 10A-5.0131, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 1-9-02, 7-30-06, 4-15-10, 4-17-14, 5-10-18, Formerly 58A-5.0131, 7-1-19.

59A-36.003 Licensing and Change of Ownership. (1) LICENSE APPLICATION. An applicant for a standard assisted living facility license, a limited mental health license, an

extended congregate care license, or a limited nursing services license may apply for licensure pursuant to the requirements of chapters 408, part II, 429, part I, F.S., and rule chapter 59A-35, F.A.C.

(2) CHANGE OF OWNERSHIP. In addition to the requirements for a change of ownership contained in chapter 408, part II, F.S., section 429.12, F.S., and rule chapter 59A-35, F.A.C., the following provisions relating to resident funds apply pursuant to section 429.27, F.S.:

(a) At the time of transfer of ownership, all resident funds on deposit, advance payments of resident rents, resident security deposits, and resident trust funds held by the current licensee must be transferred to the applicant. Proof of such transfer must be provided to the agency at the time of the agency survey and before the issuance of a standard license. This provision does not apply to entrance fees paid to a continuing care facility subject to the acquisition provisions in section 651.024, F.S.

(b) The transferor must provide to each resident a statement detailing the amount and type of funds held by the facility and credited to the resident.

(c) The transferee must notify each resident in writing of the manner in which the transferee is holding the resident’s funds and state the name and address of the depository where the funds are being held, the amount held, and type of funds credited.

(3) CONDITIONAL LICENSE. Except as provided in section 429.14, F.S., the agency may issue a conditional license to a facility if, at the time of license renewal the facility is found to have uncorrected violations that the facility has had an opportunity to correct. The issuance of a conditional license does not change the biennial license expiration date.

(4) OSS RESIDENT DETERMINATION. With respect to the fee per bed required for a standard license, the number of OSS recipients claimed shall be the average number per month residing in the facility during the previous license period. An additional per bed charge shall be added to the bed fee for facilities whose average number of OSS residents per month was less than the number of beds designated for OSS recipients during the previous license period.

Rulemaking Authority 429.17, 429.27, 429.41 FS. Law Implemented 429.04, 429.07, 429.075, 429.11, 429.12, 429.17, 429.27, 429.41 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.14, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.014, Amended 10-30-95, 4-20-98, 10-17-99, 7-30-06, 4-17-14, 5-10-18, Formerly 58A-5.014, 7-1-19.

59A-36.004 License Requirements. (1) SERVICE PROHIBITION. An assisted living facility may not represent that it provides any service other than a service for

which it is licensed to provide. (2) CHANGE IN USE OF SPACE REQUIRING AGENCY CENTRAL OFFICE APPROVAL. A change in the use of space

that increases or decreases a facility’s capacity must not be made without prior approval from the Agency Central Office. Approval must be based on the compliance with the physical plant standards provided in rule 59A-36.014, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation inspection requirements referenced in rule 59A-36.005, F.A.C.

(3) CHANGE IN USE OF SPACE REQUIRING AGENCY FIELD OFFICE APPROVAL. A change in the use of space that involves converting an area to resident use, which has not previously been inspected for such use, must not be made without prior approval from the Agency Field Office. Approval must be based on compliance with the physical plant standards provided in rule

59A-36.014, F.A.C., as well as documentation of compliance with applicable fire safety and sanitation inspection standards referenced in rule 59A-36.005, F.A.C.

(4) CONTIGUOUS PROPERTY. If a facility consists of more than one building, all buildings included under a single license must be on contiguous property. “Contiguous property” means property under the same ownership separated by no more than a two-lane street that traverses the property. A licensed location may be expanded to include additional contiguous property with the approval of the agency to ensure continued compliance with the requirements and standards of chapters 408, Part II, 429, Part I, F.S. and rule chapter 59A-35, F.A.C., and this rule chapter.

(5) PROOF OF INSPECTIONS. A copy of the annual fire safety and sanitation inspections described in rule 59A-36.005, F.A.C., must be submitted annually to the Agency Central Office. The annual inspections must be submitted no later than 30 calendar days after the inspections. Failure to comply with this requirement may result in administrative action pursuant to chapter 408, part II, and section 429.14, F.S., and rule chapter 59A-35, F.A.C.

(6) RESIDENTS RECEIVING STATE-FUNDED SERVICES. Upon request, the facility administrator or designee must identify residents receiving state-funded services to the agency and the department for monitoring purposes authorized by state and federal laws.

Rulemaking Authority 429.41 FS. Law Implemented 429.41, 429.44 FS. History–New 5-15-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.16, Amended 6-21-88, 9-30-92, Formerly 10A-5.016, Amended 10-30-95, 10-17-99, 7-30-06, 4-15-10, 4-17-14, Formerly 58A-5.016, 7-1-19.

59A-36.005 Inspection Responsibilities. (1) County health departments are responsible for inspecting all license applicants and licensed facilities in matters regulated by: (a) Rule 64E-12.004, F.A.C., and rule chapter 64E-11, F.A.C., relating to food hygiene. (b) Chapter 64E-12, F.A.C., relating to sanitary practices in community-based residential facilities. (c) Chapter 64E-16, F.A.C., relating to biomedical waste. (2) The local authority having jurisdiction over fire safety or State Fire Marshal is responsible for inspecting all license

applicants and licensed facilities in matters regulated by section 429.41, F.S., relating to uniform fire safety standards and chapter 69A-40, F.A.C., Uniform Fire Safety Standards for Assisted Living Facilities.

(3) The agency is responsible for inspecting all license applicants and licensed facilities in all other matters regulated by this rule chapter.

Rulemaking Authority 429.41 FS. Law Implemented 429.41 FS. History–New 8-15-90, Formerly 10A-5.0161, Amended 10-30-95, 10-17-99, 3-13-14, Formerly 58A-5.0161, 7-1-19.

59A-36.006 Admission Procedures, Appropriateness of Placement and Continued Residency Criteria. (1) ADMISSION CRITERIA. (a) An individual must meet the following minimum criteria in order to be admitted to a facility holding a standard, limited

nursing services, or limited mental health license: 1. Be at least 18 years of age. 2. Be free from signs and symptoms of any communicable disease that is likely to be transmitted to other residents or staff. An

individual who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that the individual would otherwise be eligible for admission according to this rule.

3. Be able to perform the activities of daily living, with supervision or assistance if necessary. 4. Be able to transfer, with assistance if necessary. The assistance of more than one person is permitted. 5. Be capable of taking medication, by either self-administration, assistance with self-administration, or administration of

medication. a. If the resident needs assistance with self-administration of medication, the facility must inform the resident of the professional

qualifications of facility staff who will be providing this assistance. If unlicensed staff will be providing assistance with self-administration of medication, the facility must obtain written informed consent from the resident or the resident’s surrogate, guardian, or attorney-in-fact.

b. The facility may accept a resident who requires the administration of medication if the facility employs a nurse who will provide this service or the resident, or the resident’s legal representative, designee, surrogate, guardian, or attorney-in-fact, contracts with a third party licensed to provide this service to the resident.

6. Not have any special dietary needs that cannot be met by the facility. 7. Not be a danger to self or others as determined by a physician, or mental health practitioner licensed under chapter 490 or

491, F.S. 8. Not require 24-hour licensed professional mental health treatment. 9. Not be bedridden. 10. Not have any stage 3 or 4 pressure sores. A resident requiring care of a stage 2 pressure sore may be admitted provided that: a. The resident either: (I) Resides in a standard or limited nursing services licensed facility and contracts directly with a licensed home health agency

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

a health care provider; b. The condition is documented in the resident’s record and admission and discharge logs; and, c. If the resident’s condition fails to improve within 30 days as documented by a health care provider, the resident must be

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

the following nursing services: a. Artificial airway management of any kind, except that of continuous positive airway pressure may be provided through the

use of a CPAP or bipap machine; b. Assistance with tube feeding, c. Monitoring of blood gases, d. Management of post-surgical drainage tubes and wound vacuum devices; e. The administration of blood products in the facility; or f. Treatment of surgical incisions or wounds, unless the surgical incision or wound and the underlying condition have been

stabilized and a plan of care has been developed. The plan of care must be maintained in the resident’s record. 12. In addition to the nursing services listed above, residents admitted to facilities holding only standard and/or limited mental

health licenses may not require any of the following nursing services: a. Hemodialysis and peritoneal dialysis performed in the facility; b. Intravenous therapy performed in the facility. 13. Not require 24-hour nursing supervision. 14. Not require skilled rehabilitative services as described in rule 59G-4.290, F.A.C. 15. Be appropriate for admission to the facility as determined by the facility administrator. The administrator must base the

determination on: a. An assessment of the strengths, needs, and preferences of the individual; b. The medical examination report required by section 429.26, F.S., and subsection (2) of this rule, if available; c. The facility’s admission policy and the services the facility is prepared to provide or arrange in order to meet resident needs.

Such services may not exceed the scope of the facility’s license unless specified elsewhere in this rule; and, d. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in rule chapter

69A-40, F.A.C. (b) A resident who otherwise meets the admission criteria for residency in a standard licensed facility, but who requires

assistance with the administration and regulation of portable oxygen or assistance with routine colostomy care of stoma site flange placement, may be admitted to a facility with a standard license as long as the facility has a nurse on staff or under contract to provide the assistance or to provide training to the resident on how to perform these functions themselves.

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

(d) An individual enrolled in and receiving hospice services may be admitted to an assisted living facility as long as the individual otherwise meets resident admission criteria.

(e) Resident admission criteria for facilities holding an extended congregate care license are described in rule 59A-36.021, F.A.C.

(2) HEALTH ASSESSMENT. As part of the admission criteria, an individual must undergo a face-to-face medical examination completed by a health care provider as specified in either paragraph (a) or (b) of this subsection.

(a) A medical examination completed within 60 calendar days before the individual’s admission to a facility pursuant to section 429.26(4), F.S. The examination must address the following:

1. The physical and mental status of the resident, including the identification of any health-related problems and functional limitations,

2. An evaluation of whether the individual will require supervision or assistance with the activities of daily living, 3. Any nursing or therapy services required by the individual, 4. Any special diet required by the individual, 5. A list of current medications prescribed, and whether the individual will require any assistance with the administration of

medication, 6. Whether the individual has signs or symptoms of Tuberculosis, Methicillin Resistant Staphylococcus Aureus, Scabies or any

other communicable disease, which are likely to be transmitted to other residents or staff, 7. A statement on the day of the examination that, in the opinion of the examining health care provider, the individual’s needs

can be met in an assisted living facility; and, 8. The date of the examination, and the name, signature, address, telephone number, and license number of the examining health

care provider. The medical examination may be conducted by a health care provider licensed under chapter 458, 459 or 464, F.S. (b) A medical examination completed after the resident’s admission to the facility within 30 calendar days of the admission

date. The examination must be recorded on AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, March 2017, which is incorporated by reference and available online at: http://www.flrules.org/Gateway/reference.asp?No=Ref-09170. Faxed or electronic copies of the completed form are acceptable. The form must be completed as instructed.

1. Items on the form that have been omitted by the health care provider during the examination may be obtained by the facility either orally or in writing from the health care provider.

2. Omitted information must be documented in the resident’s record. Information received orally must include the name of the health care provider, the name of the facility staff recording the information, and the date the information was provided.

3. Electronic documentation may be used in place of completing the section on AHCA Form 1823 referencing Services Offered or Arranged by the Facility for the Resident. The electronic documentation must include all of the elements described in this section of AHCA Form 1823.

(c) Any information required by paragraph (a), that is not contained in the medical examination report conducted before the individual’s admission to the facility must be obtained by the administrator using AHCA Form 1823 within 30 days after admission.

(d) Medical examinations of residents placed by the department, by the Department of Children and Families, or by an agency under contract with either department must be conducted within 30 days before placement in the facility and recorded on AHCA Form 1823 described in paragraph (b).

(e) An assessment that has been conducted through the Comprehensive, Assessment, Review and Evaluation for Long-Term Care Services (CARES) program may be substituted for the medical examination requirements of section 429.26, F.S. and this rule.

(f) Any orders issued by the health care provider conducting the medical examination for medications, nursing, therapeutic diets, or other services to be provided or supervised by the facility may be attached to the health assessment. A health care provider may attach a DH Form 1896, Florida Do Not Resuscitate Order Form, for residents who do not wish cardiopulmonary resuscitation to be administered in the case of cardiac or respiratory arrest.

(g) A resident placed in a facility on a temporary emergency basis by the Department of Children and Families pursuant to section 415.105 or 415.1051, F.S., is exempt from the examination requirements of this subsection for up to 30 days. However, a resident accepted for temporary emergency placement must be entered on the facility’s admission and discharge log and counted in the facility census. A facility may not exceed its licensed capacity in order to accept such a resident. A medical examination must be conducted on any temporary emergency placement resident accepted for regular admission.

(3) ADMISSION PACKAGE. (a) The facility must make available to potential residents a written statement(s) that includes the following information listed

below. Providing a copy of the facility resident contract or facility brochure containing all the required information meets this

requirement. 1. The facility’s admission and continued residency criteria; 2. The daily, weekly or monthly charge to reside in the facility and the services, supplies, and accommodations provided by the

facility for that rate; 3. Personal care services that the facility is prepared to provide to residents and additional costs to the resident, if any; 4. Nursing services that the facility is prepared to provide to residents and additional costs to the resident, if any; 5. Food service and the ability of the facility to accommodate special diets; 6. The availability of transportation and additional costs to the resident, if any; 7. Any other special services that are provided by the facility and additional cost if any; 8. Social and leisure activities generally offered by the facility; 9. Any services that the facility does not provide but will arrange for the resident and additional cost, if any; 10. The facility rules and regulations that residents must follow as described in rule 59A-36.007, F.A.C.; 11. The facility policy concerning Do Not Resuscitate Orders pursuant to section 429.255, F.S., and rule 59A-36.009, F.A.C.,

and Advance Directives pursuant to chapter 765, F.S.; 12. If the facility is licensed to provide extended congregate care, the facility’s residency criteria for residents receiving

extended congregate care services. The facility must also provide a description of the additional personal, supportive, and nursing services provided by the facility including additional costs and any limitations on where extended congregate care residents may reside based on the policies and procedures described in rule 59A-36.021, F.A.C.;

13. If the facility advertises that it provides special care for individuals with Alzheimer’s disease and related disorders, a written description of those special services as required in section 429.177, F.S.; and,

14. The facility’s resident elopement response policies and procedures. (b) Before or at the time of admission, the resident, or the resident’s responsible party, guardian, or attorney-in-fact, if

applicable, must be provided with the following: 1. A copy of the resident’s contract that meets the requirements of rule 59A-36.018, F.A.C., 2. A copy of the facility statement described in paragraph (a) of this subsection, if one has not already been provided, 3. A copy of the resident’s bill of rights as required by rule 59A-36.007, F.A.C.; and, 4. A Long-Term Care Ombudsman Program brochure that includes the telephone number and address of the district office. (c) Documents required by this subsection must be in English. If the resident is not able to read, or does not understand English

and translated documents are not available, the facility must explain its policies to a family member or friend of the resident or another individual who can communicate the information to the resident.

(4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (c) of this subsection, criteria for continued residency in any licensed facility must be the same as the criteria for admission. As part of the continued residency criteria, a resident must have a face-to-face medical examination by a health care provider at least every 3 years after the initial assessment, or after a significant change, whichever comes first. A significant change is defined in rule 59A-36.002, F.A.C. The results of the examination must be recorded on AHCA Form 1823, which is incorporated by reference in paragraph (2)(b) of this rule and must be completed in accordance with that paragraph. Exceptions to the requirement to meet the criteria for continued residency are:

(a) The resident may be bedridden for no more than 7 consecutive days. (b) A resident requiring care of a stage 2 pressure sore may be retained provided that: 1. The resident contracts directly with a licensed home health agency or a nurse to provide care, or the facility has a limited

nursing services license and services are provided pursuant to a plan of care issued by a health care provider, 2. The condition is documented in the resident’s record; and, 3. If the resident’s condition fails to improve within 30 days, as documented by a health care provider, the resident must be

discharged from the facility. (c) A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the

following conditions are met: 1. The resident qualifies for, is admitted to, and consents to receive services from a licensed hospice that coordinates and

ensures the provision of any additional care and services that the resident may need; 2. Both the resident, or the resident’s legal representative if applicable, and the facility agree to continued residency; 3. A licensed hospice, in consultation with the facility, develops and implements a interdisciplinary care plan that specifies the

services being provided by hospice and those being provided by the facility; and, 4. Documentation of the requirements of this paragraph is maintained in the resident’s file. (d) The facility administrator is responsible for monitoring the continued appropriateness of placement of a resident in the

facility at all times. (e) A hospice resident that meets the qualifications of continued residency pursuant to this subsection may only receive services

from the assisted living facility’s staff which are within the scope of the facility’s license. (f) Assisted living facility staff may provide any nursing service permitted under the facility’s license and total help with the

activities of daily living for residents admitted to hospice; however, staff may not exceed the scope of their professional licensure or training.

(g) Continued residency criteria for facilities holding an extended congregate care license are described in rule 59A-36.021, F.A.C.

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

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.26, 429.28, 429.41 FS. History–New 9-17-84, Formerly 10A-5.181, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0181, Amended 10-30-95, 6-2-96, 10-17-99, 7-30-06, 10-9-06, 4-15-10, 10-14-10, 4-17-14, 5-10-18, Formerly 58A-5.0181, 7-1-19.

59A-36.007 Resident Care Standards. An assisted living facility must provide care and services appropriate to the needs of residents accepted for admission to the facility.

(1) SUPERVISION. Facilities must offer personal supervision as appropriate for each resident, including the following: (a) Monitoring of the quantity and quality of resident diets in accordance with rule 59A-36.012, F.A.C. (b) Daily observation by designated staff of the activities of the resident while on the premises, and awareness of the general

health, safety, and physical and emotional well-being of the resident. (c) Maintaining a general awareness of the resident’s whereabouts. The resident may travel independently in the community. (d) Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care

surrogate, or case manager if the resident exhibits a significant change. (e) Contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out. (f) Maintaining a written record, updated as needed, of any significant changes, any illnesses that resulted in medical attention,

changes in the method of medication administration, or other changes that resulted in the provision of additional services. (2) SOCIAL AND LEISURE ACTIVITIES. Residents shall be encouraged to participate in social, recreational, educational and

other activities within the facility and the community. (a) The facility must provide an ongoing activities program. The program must provide diversified individual and group

activities in keeping with each resident’s needs, abilities, and interests. (b) The facility must consult with the residents in selecting, planning, and scheduling activities. The facility must demonstrate

residents’ participation through one or more of the following methods: resident meetings, committees, a resident council, a monitored suggestion box, group discussions, questionnaires, or any other form of communication appropriate to the size of the facility.

(c) Scheduled activities must be available at least 6 days a week for a total of not less than 12 hours per week. Watching television is not an activity for the purpose of meeting the 12 hours per week of scheduled activities unless the television program is a special one-time event of special interest to residents of the facility. A facility whose residents choose to attend day programs conducted at adult day care centers, senior centers, mental health centers, or other day programs may count those attendance hours towards the required 12 hours per week of scheduled activities. An activities calendar must be posted in common areas where residents normally congregate.

(d) If residents assist in planning a special activity such as an outing, seasonal festivity, or an excursion, up to 3 hours may be counted toward the required activity time.

(3) ARRANGEMENT FOR HEALTH CARE. In order to facilitate resident access to health care as needed, the facility must: (a) Assist residents in making appointments and remind residents about scheduled appointments for medical, dental, nursing, or

mental health services.

(b) Provide transportation to needed medical, dental, nursing or mental health services, or arrange for transportation through family and friends, volunteers, taxi cabs, public buses, and agencies providing transportation.

(c) The facility may not require residents to receive services from a particular health care provider. (4) ACTIVITIES OF DAILY LIVING. Facilities must offer supervision of or assistance with activities of daily living as needed

by each resident. Residents should be encouraged to be as independent as possible in performing activities of daily living. (5) NURSING SERVICES. (a) Pursuant to section 429.255, F.S., the facility may employ or contract with a nurse to: 1. Take or supervise the taking of vital signs, 2. Manage pill-organizers and administer medications as described in rule 59A-36.008, F.A.C., 3. Give prepackaged enemas pursuant to a physician’s order; and, 4. Maintain nursing progress notes. (b) Pursuant to section 429.255(2), F.S., the nursing services listed in paragraph (a), may also be delivered in the facility by

family members or friends of the resident provided the family member or friend does not receive compensation for such services. (6) RESIDENT RIGHTS AND FACILITY PROCEDURES. (a) A copy of the Resident Bill of Rights as described in section 429.28, F.S., or a summary provided by the Long-Term Care

Ombudsman Program must be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to rule 59A-36.006, F.A.C.

(b) In accordance with section 429.28, F.S., the facility must have a written grievance procedure for receiving and responding to resident complaints and a written procedure to allow residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint.

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

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

1. Resident responsibilities; 2. Alcohol and tobacco use; 3. Medication storage; 4. Resident elopement; 5. Reporting resident abuse, neglect, and exploitation; 6. Administrative and housekeeping schedules and requirements; 7. Infection control, sanitation, and universal precautions; and, 8. The requirements for coordinating the delivery of services to residents by third party providers. (e) Residents may not be required to perform any work in the facility without compensation. Residents may be required to clean

their own sleeping areas or apartments if the facility rules or the facility contract includes such a requirement. If a resident is employed by the facility, the resident must be compensated in compliance with state and federal wage laws.

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

(g) In addition to the requirements of section 429.41(1)(k), F.S., the use of physical restraints by a facility on a resident must be reviewed by the resident’s physician annually. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint.

(7) THIRD PARTY SERVICES. (a) Nothing in this rule chapter is intended to prohibit a resident or the resident’s representative from independently arranging,

contracting, and paying for services provided by a third party of the resident’s choice, including a licensed home health agency or private nurse, or receiving services through an out-patient clinic, provided the resident meets the criteria for admission and continued

residency and the resident complies with the facility’s policy relating to the delivery of services in the facility by third parties. The facility’s policies must require the third party to coordinate with the facility regarding the resident’s condition and the services being provided.

(b) When residents require or arrange for services from a third party provider, the facility administrator or designee must allow for the receipt of those services, provided that the resident meets the criteria for admission and continued residency. The facility, when requested by residents or representatives, must coordinate with the provider to facilitate the receipt of care and services provided to meet the particular resident’s needs.

(c) If residents accept assistance from the facility in arranging and coordinating third party services, the facility’s assistance does not represent a guarantee that third party services will be received. If the facility’s efforts to make arrangements for third party services are unsuccessful or declined by residents, the facility must include documentation in the residents’ record explaining why its efforts were unsuccessful. This documentation will serve to demonstrate its compliance with this subsection.

(8) ELOPEMENT STANDARDS. (a) Residents Assessed at Risk for Elopement. All residents assessed at risk for elopement or with any history of elopement

must be identified so staff can be alerted to their needs for support and supervision. All residents must be assessed for risk of elopement by a health care provider or a mental health care provider within 30 calendar days of being admitted to a facility. If the resident has had a health assessment performed prior to admission pursuant to paragraph 59A-36.006(2)(a), F.A.C., this requirement is satisfied. A resident placed in a facility on a temporary emergency basis by the Department of Children and Families pursuant to section 415.105 or 415.1051, F.S., is exempt from this requirement for up to 30 days.

1. As part of its resident elopement response policies and procedures, the facility must make, at a minimum, a daily effort to determine that at risk residents have identification on their persons that includes their name and the facility’s name, address, and telephone number. Staff trained pursuant to paragraph 59A-36.011(10)(a) or (c), F.A.C., must be generally aware of the location of all residents assessed at high risk for elopement at all times.

2. The facility must have a photo identification of at risk residents on file that is accessible to all facility staff and law enforcement as necessary. The facility’s file must contain the resident’s photo identification upon admission or upon being assessed at risk for elopement subsequent to admission. The photo identification may be provided by the facility, the resident, or the resident’s representative.

(b) Facility Resident Elopement Response Policies and Procedures. The facility must develop detailed written policies and procedures for responding to a resident elopement. At a minimum, the policies and procedures must provide for:

1. An immediate search of the facility and premises, 2. The identification of staff responsible for implementing each part of the elopement response policies and procedures,

including specific duties and responsibilities, 3. The identification of staff responsible for contacting law enforcement, the resident’s family, guardian, health care surrogate,

and case manager if the resident is not located pursuant to subparagraph (8)(b)1.; and, 4. The continued care of all residents within the facility in the event of an elopement. (c) Facility Resident Elopement Drills. The facility must conduct and document resident elopement drills pursuant to sections

429.41(1)(a)3. and 429.41(1)(l), F.S. (9) OTHER STANDARDS. Additional care standards for residents residing in a facility holding a limited mental health,

extended congregate care or limited nursing services license are provided in rules 59A-36.020, 59A-36.021 and 59A-36.022, F.A.C., respectively.

Rulemaking Authority 429.41 FS. Law Implemented 429.255, 429.26, 429.28, 429.41 FS. History–New 9-17-84, Formerly 10A-5.182, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0182, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 10-9-06, 4-15-10, 4-17-14, 5-10-18, Formerly 58A-5.0182, 7-1-19.

59A-36.008 Medication Practices. Pursuant to sections 429.255 and 429.256, F.S., and this rule, licensed facilities may assist with the self-administration or administration of medications to residents in a facility. A resident may not be compelled to take medications but may be counseled in accordance with this rule.

(1) SELF ADMINISTERED MEDICATIONS. (a) Residents who are capable of self-administering their medications without assistance must be encouraged and allowed to do

so. (b) If facility staff observes health changes that could reasonably be attributed to the improper self-administration of medication,

staff must consult with the resident concerning any problems the resident may be experiencing in self-administering the medications. The consultation should describe the services offered by the facility that aid the resident with medication administration through the use of a pill organizer, through providing assistance with self-administration of medications, or through administering medications. The facility must contact the resident’s health care provider when observable health changes occur that may be attributed to the resident’s medications. The facility must document such contacts in the resident’s records.

(2) PILL ORGANIZERS. (a) Only a resident who self-administers medications may maintain a pill organizer. (b) Unlicensed staff may not provide assistance with the contents of pill organizers. (c) A nurse may manage a pill organizer to be used only by residents who self-administer medications. The nurse is responsible

for instructing the resident in the proper use of the pill organizer. The nurse must manage the pill organizer in the following manner: 1. Obtain the labeled medication container from the storage area or the resident, 2. Transfer the medication from the original container into a pill organizer, labeled with the resident’s name, according to the

day and time increments as prescribed, 3. Return the medication container to the storage area or resident; and, 4. Document the date and time the pill organizer was filled in the resident’s record. (d) If there is a determination that the resident is not taking medications as prescribed after the medicinal benefits are explained,

it must be noted in the resident’s record and the facility must consult with the resident concerning providing assistance with self-administration or the administration of medications if such services are offered by the facility. The facility must contact the resident’s health care provider regarding questions, concerns, or observations relating to the resident’s medications. Such communication must be documented in the resident’s record.

(3) ASSISTANCE WITH SELF-ADMINISTRATION. (a) Any unlicensed person providing assistance with self-administration of medication must be 18 years of age or older, trained

to assist with self administered medication pursuant to the training requirements of rule 59A-36.011, F.A.C., and must be available to assist residents with self-administered medications in accordance with procedures described in section 429.256, F.S. and this rule.

(b) In addition to the specifications of section 429.256(3), F.S., assistance with self-administration of medication includes, in the presence of the resident, reading the medication label aloud and verbally prompting a resident to take medications as prescribed.

(c) In order to facilitate assistance with self-administration, trained staff may prepare and make available such items as water, juice, cups, and spoons. Trained staff may also return unused doses to the medication container. Medication, which appears to have been contaminated, must not be returned to the container.

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

(e) When a resident who receives assistance with medication is away from the facility and from facility staff, the following options are available to enable the resident to take medication as prescribed:

1. The health care provider may prescribe a medication schedule that coincides with the resident’s presence in the facility, 2. The medication container may be given to the resident, a friend, or family member upon leaving the facility, with this fact

noted in the resident’s medication record, 3. The medication may be transferred to a pill organizer pursuant to the requirements of subsection (2), and given to the

resident, a friend, or family member upon leaving the facility, with this fact noted in the resident’s medication record, or 4. Medications may be separately prescribed and dispensed in an easier to use form, such as unit dose packaging. (f) Assistance with self-administration of medication does not include the activities detailed in section 429.256(4), F.S. 1. As used in section 429.256(4)(g), F.S., the term “competent resident” means that the resident is cognizant of when a

medication is required and understands the purpose for taking the medication. 2. As used in section 429.256(4)(h), F.S., the terms “judgment” and “discretion” mean interpreting vital signs and evaluating or

assessing a resident’s condition. (g) All trained staff must adhere to the facility’s infection control policy and procedures when assisting with the self-

administration of medication. (4) MEDICATION ADMINISTRATION.

(a) For facilities that provide medication administration, a staff member licensed to administer medications must be available to administer medications in accordance with a health care provider’s order or prescription label.

(b) Unusual reactions to the medication or a significant change in the resident’s health or behavior that may be caused by the medication must be documented in the resident’s record and reported immediately to the resident’s health care provider. The contact with the health care provider must also be documented in the resident’s record.

(c) Medication administration includes conducting any examination or other procedure necessary for the proper administration of medication that the resident cannot conduct personally and that can be performed by licensed staff.

(d) A facility that performs clinical laboratory tests for residents, including blood glucose testing, must be in compliance with the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) and chapter 483, part I, F.S. A valid copy of the State Clinical Laboratory License, if required, and the federal CLIA Certificate must be maintained in the facility. A state license or federal CLIA certificate is not required if residents perform the test themselves or if a third party assists residents in performing the test. The facility is not required to maintain a State Clinical Laboratory License or a federal CLIA Certificate if facility staff assist residents in performing clinical laboratory testing with the residents’ equipment. Information about the State Clinical Laboratory License and federal CLIA Certificate is available from the Laboratory Unit, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 32, Tallahassee, FL 32308; telephone (850)412-4500.

(5) MEDICATION RECORDS. (a) For residents who use a pill organizer managed in subsection (2), the facility must keep either the original labeled

medication container; or a medication listing with the prescription number, the name and address of the issuing pharmacy, the health care provider’s name, the resident’s name, the date dispensed, the name and strength of the drug, and the directions for use.

(b) The facility must maintain a daily medication observation record for each resident who receives assistance with self-administration of medications or medication administration. A medication observation record must be immediately updated each time the medication is offered or administered and include:

1. The name of the resident and any known allergies the resident may have; 2. The name of the resident’s health care provider and the health care provider’s telephone number; 3. The name, strength, and directions for use of each medication; and, 4. A chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or

medication errors. (c) For medications that serve as chemical restraints, the facility must, pursuant to section 429.41, F.S., maintain a record of the

prescribing physician’s annual evaluation of the use of the medication. (6) MEDICATION STORAGE AND DISPOSAL. (a) In order to accommodate the needs and preferences of residents and to encourage residents to remain as independent as

possible, residents may keep their medications, both prescription and over-the-counter, in their possession both on or off the facility premises. Residents may also store their medication in their rooms or apartments if either the room is kept locked when residents are absent or the medication is stored in a secure place that is out of sight of other residents.

(b) Both prescription and over-the-counter medications for residents must be centrally stored if: 1. The facility administers the medication; 2. The resident requests central storage. The facility must maintain a list of all medications being stored pursuant to such a

request; 3. The medication is determined and documented by the health care provider to be hazardous if kept in the personal possession

of the person for whom it is prescribed; 4. The resident fails to maintain the medication in a safe manner as described in this paragraph; 5. The facility determines that, because of physical arrangements and the conditions or habits of residents, the personal

possession of medication by a resident poses a safety hazard to other residents, or 6. The facility’s rules and regulations require central storage of medication and that policy has been provided to the resident

before admission as required in rule 59A-36.006, F.A.C. (c) Centrally stored medications must be: 1. Kept in a locked cabinet; locked cart; or other locked storage receptacle, room, or area at all times; 2. Located in an area free of dampness and abnormal temperature, except that a medication requiring refrigeration must be kept

refrigerated. Refrigerated medications must be secured by being kept in a locked container within the refrigerator, by keeping the

refrigerator locked, or by keeping the area in which the refrigerator is located locked; 3. Accessible to staff responsible for filling pill-organizers, assisting with self-administration of medication, or administering

medication. Such staff must have ready access to keys or codes to the medication storage areas at all times; and, 4. Kept separately from the medications of other residents and properly closed or sealed. (d) Medication that has been discontinued but has not expired must be returned to the resident or the resident’s representative, as

appropriate, or may be centrally stored by the facility for future use by the resident at the resident’s request. If centrally stored by the facility, the discontinued medication must be stored separately from medication in current use, and the area in which it is stored must be marked “discontinued medication.” Such medication may be reused if prescribed by the resident’s health care provider.

(e) When a resident’s stay in the facility has ended, the administrator must return all medications to the resident, the resident’s family, or the resident’s guardian unless otherwise prohibited by law. If, after notification and waiting at least 15 days, the resident’s medications are still at the facility, the medications are considered abandoned and may disposed of in accordance with paragraph (f).

(f) Medications that have been abandoned or have expired must be disposed of within 30 days of being determined abandoned or expired and the disposal must be documented in the resident’s record. The medication may be taken to a pharmacist for disposal or may be destroyed by the administrator or designee with one witness.

(g) Facilities that hold a Special-ALF permit issued by the Board of Pharmacy may return dispensed medicinal drugs to the dispensing pharmacy pursuant to rule 64B16-28.870, F.A.C.

(7) MEDICATION LABELING AND ORDERS. (a) The facility may not store prescription drugs for self-administration, assistance with self-administration, or administration

unless they are properly labeled and dispensed in accordance with chapters 465 and 499, F.S., and rule 64B16-28.108, F.A.C. If a customized patient medication package is prepared for a resident, and separated into individual medicinal drug containers, then the following information must be recorded on each individual container:

1. The resident’s name; and, 2. The identification of each medicinal drug in the container. (b) Except with respect to the use of pill organizers as described in subsection (2), no individual other than a pharmacist may

transfer medications from one storage container to another. (c) If the directions for use are “as needed” or “as directed,” the health care provider must be contacted and requested to provide

revised instructions. For an “as needed” prescription, the circumstances under which it would be appropriate for the resident to request the medication and any limitations must be specified; for example, “as needed for pain, not to exceed 4 tablets per day.” The revised instructions, including the date they were obtained from the health care provider and the signature of the staff who obtained them, must be noted in the medication record, or a revised label must be obtained from the pharmacist.

(d) Any change in directions for use of a medication that the facility is administering or providing assistance with self-administration must be accompanied by a written, faxes, or electronic copy of a medication order issued and signed by the resident’s health care provider. The new directions must promptly be recorded in the resident’s medication observation record. The facility may then obtain a revised label from the pharmacist or place an “alert” label on the medication container that directs staff to examine the revised directions for use in the medication observation record.

(e) A nurse may take a medication order by telephone. Such order must be promptly documented in the resident’s medication observation record. The facility must obtain a written medication order from the health care provider within 10 working days. A faxed or electronic copy of a signed order is acceptable.

(f) The facility must make every reasonable effort to ensure that prescriptions for residents who receive assistance with self-administration of medication or medication administration are filled or refilled in a timely manner.

(g) Pursuant to section 465.0276(5), F.S., and rule 61N-1.006, F.A.C., sample or complimentary prescription drugs that are dispensed by a health care provider, must be kept in their original manufacturer’s packaging, which must include the practitioner’s name, the resident’s name for whom they were dispensed, and the date they were dispensed. If the sample or complimentary prescription drugs are not dispensed in the manufacturer’s labeled package, they must be kept in a container that bears a label containing the following:

1. Practitioner’s name, 2. Resident’s name, 3. Date dispensed, 4. Name and strength of the drug,

5. Directions for use; and, 6. Expiration date. (h) Pursuant to section 465.0276(2)(c), F.S., before dispensing any sample or complimentary prescription drug, the resident’s

health care provider must provide the resident with a written prescription, or a faxed or electronic copy of such order. (8) OVER THE COUNTER (OTC) PRODUCTS. For purposes of this subsection, the term over the counter includes, but is not

limited to, over the counter medications, vitamins, nutritional supplements and nutraceuticals, hereafter referred to as OTC products, that can be sold without a prescription.

(a) A facility may keep a stock supply of OTC products for multiple resident use. When providing any OTC product that is kept by the facility as a stock supply to a resident, the staff member providing the medication must record the name and amount of the OTC product provided in the resident’s medication observation record. All OTC products kept as a stock supply must be stored in a locked container or secure room in a central location within the facility and must be labeled with the medication’s name, the date of purchase, and with a notice that the medication is part of the facility’s stock supply.

(b) OTC products, including those prescribed by a health care provider but excluding those kept as a stock supply by the facility, must be labeled with the resident’s name and the manufacturer’s label with directions for use, or the health care provider’s directions for use. No other labeling requirements are required.

(c) Residents or their representatives may purchase OTC products from an establishment of their choice. (d) A health care provider’s order is required when a nurse provides assistance with self-administration or administration of

OTC products. When an order for an OTC product exists, the order must meet the requirements of paragraphs (b) and (c) of this subsection. A health care provider’s order for OTC products is not required when a resident self-administers his or her medications, or when unlicensed staff provides assistance with self-administration of medications.

Rulemaking Authority 429.256, 429.41 FS. Law Implemented 429.255, 429.256, 429.41 FS. History–New 10-17-99, Amended 7-30-06, 4-15-10, 10-14-10, 3-13-14, 5-10-18, Formerly 58A-5.0185, 7-1-19.

59A-36.009 Do Not Resuscitate Orders (DNROs). (1) POLICIES AND PROCEDURES. (a) Each assisted living facility must have written policies and procedures that explain its implementation of state laws and rules

relative to Do Not Resuscitate Orders (DNROs). An assisted living facility may not require execution of a DNRO as a condition of admission or treatment. The assisted living facility must provide the following to each resident, or resident’s representative, at the time of admission:

1. Form SCHS-4-2006, “Health Care Advance Directives – The Patient’s Right to Decide,” April 2006, or with a copy of some other substantially similar document, which incorporates information regarding advance directives included in chapter 765, F.S. Form SCHS-4-2006 is available from the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 34, Tallahassee, FL 32308 or the agency’s website at: http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/HC_Advance_Directives/docs/adv_dir.pdf; and,

2. DH Form 1896, Florida Do Not Resuscitate Order Form, December, 2004, which is hereby incorporated by reference. This form may be obtained by calling the Department of Health’s toll free number 1(800)226-1911, extension 2780 or online at: http://www.flrules.org/Gateway/reference.asp?No=Ref-04005.

(b) There must be documentation in the resident’s record indicating whether a DH Form 1896 has been executed. If a DH Form 1896 has been executed, a yellow copy of that document must be made a part of the resident’s record. If the assisted living facility does not receive a copy of a resident’s executed DH Form 1896, the assisted living facility must document in the resident’s record that it has requested a copy.

(c) The executed DH Form 1896 must be readily available to medical staff in the event of an emergency. (2) LICENSE REVOCATION. An assisted living facility’s license is subject to revocation pursuant to section 408.815, F.S., if,

as a condition of treatment or admission, the facility requires an individual to execute or waive DH Form 1896. (3) DNRO PROCEDURES. Pursuant to section 429.255, F.S., an assisted living facility must honor a properly executed DH

Form 1896 as follows: (a) In the event a resident experiences cardiac or pulmonary arrest, staff trained in cardiopulmonary resuscitation (CPR) or a

health care provider present in the facility, may withhold cardiopulmonary resuscitation (artificial ventilation, cardiac compression, endotracheal intubation and defibrillation).

(b) In the event a resident is receiving hospice services and experiences cardiac or pulmonary arrest, facility staff must immediately contact hospice staff. The hospice procedures take precedence over those of the assisted living facility.

Rulemaking Authority 429.255 FS. Law Implemented 429.255 FS. History–New 4-15-10, Amended 4-17-14, Formerly 58A-5.0186, 7-1-19.

59A-36.010 Staffing Standards. (1) ADMINISTRATORS. Every facility must be under the supervision of an administrator who is responsible for the operation

and maintenance of the facility including the management of all staff and the provision of appropriate care to all residents as required by chapters 408, part II, 429, part I, F.S., and rule chapter 59A-35, F.A.C., and this rule chapter.

(a) An administrator must: 1. Be at least 21 years of age; 2. If employed on or after October 30, 1995, have, at a minimum, a high school diploma or G.E.D.; 3. Be in compliance with Level 2 background screening requirements pursuant to sections 408.809 and 429.174, F.S.; 4. Complete the core training and core competency test requirements pursuant to rule 59A-36.011, F.A.C., no later than 90 days

after becoming employed as a facility administrator. Administrators who attended core training prior to July 1, 1997, are not required to take the competency test unless specified elsewhere in this rule; and,

5. Satisfy the continuing education requirements pursuant to rule 59A-36.011, F.A.C. Administrators who are not in compliance with these requirements must retake the core training and core competency test requirements in effect on the date the non-compliance is discovered by the agency or the department.

(b) In the event of extenuating circumstances, such as the death of a facility administrator, the agency may permit an individual who otherwise has not satisfied the training requirements of subparagraph (1)(a)4. of this rule, to temporarily serve as the facility administrator for a period not to exceed 90 days. During the 90 day period, the individual temporarily serving as facility administrator must:

1. Complete the core training and core competency test requirements pursuant to rule 59A-36.011, F.A.C.; and, 2. Complete all additional training requirements if the facility maintains licensure as an extended congregate care or limited

mental health facility. (c) Administrators may supervise a maximum of either three assisted living facilities or a group of facilities on a single campus

providing housing and health care Administrators who supervise more than one facility must appoint in writing a separate manager for each facility. However, an administrator supervising a maximum of three assisted living facilities, each licensed for 16 or fewer beds and all within a 15 mile radius of each other, is only required to appoint two managers to assist in the operation and maintenance of those facilities.

(d) An individual serving as a manager must satisfy the same qualifications, background screening, core training and competency test requirements, and continuing education requirements as an administrator pursuant to paragraph (1)(a) of this rule. Managers who attended the core training program prior to April 20, 1998, are not required to take the competency test unless specified elsewhere in this rule. In addition, a manager may not serve as a manager of more than a single facility, except as provided in paragraph (1)(c) of this rule, and may not simultaneously serve as an administrator of any other facility.

(e) Pursuant to section 429.176, F.S., facility owners must notify the Agency Central Office within 10 days of a change in facility administrator on the Notification of Change of Administrator form, AHCA Form 3180-1006, June 2016, which is incorporated by reference and available online at: http://www.flrules.org/Gateway/reference.asp?No=Ref-09393.

(2) STAFF. (a) Within 30 days after beginning employment, newly hired staff must submit a written statement from a health care provider

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

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

2. If any staff member has, or is suspected of having, a communicable disease, such individual must be immediately removed

from duties until a written statement is submitted from a health care provider indicating that the individual does not constitute a risk of transmitting a communicable disease.

(b) Staff must be qualified to perform their assigned duties consistent with their level of education, training, preparation, and experience. Staff providing services requiring licensing or certification must be appropriately licensed or certified. All staff must exercise their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident’s record, and to report the observations to the resident’s health care provider in accordance with this rule chapter.

(c) All staff must comply with the training requirements of rule 59A-36.011, F.A.C. (d) An assisted living facility contracting to provide services to residents must ensure that individuals providing services are

qualified to perform their assigned duties in accordance with this rule chapter. The contract between the facility and the staffing agency or contractor must specifically describe the services the staffing agency or contractor will provide to residents.

(e) For facilities with a licensed capacity of 17 or more residents, the facility must: 1. Develop a written job description for each staff position and provide a copy of the job description to each staff member; and, 2. Maintain time sheets for all staff. (f) Level 2 background screening must be conducted for staff, including staff contracted by the facility to provide services to

residents, pursuant to sections 408.809 and 429.174, F.S. (3) STAFFING STANDARDS. (a) Minimum staffing: 1. Facilities must maintain the following minimum staff hours per week:

Number of Residents, Day Care Participants, and Respite Care Residents Staff Hours/Week 0-5 168 6-15 212

16- 25 253 26-35 294 36-45 335 46-55 375 56- 65 416 66-75 457 76-85 498 86-95 539

For every 20 total combined residents, day care participants, and respite care residents over 95 add 42 staff hours per week. 2. Independent living residents, as referenced in subsection 59A-36.015(3), F.A.C., who occupy beds included within the

licensed capacity of an assisted living facility but do not receive personal, limited nursing, or extended congregate care services, are not counted as residents for purposes of computing minimum staff hours.

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

4. In facilities with 17 or more residents, there must be at least one staff member awake at all hours of the day and night. 5. A staff member who has completed courses in First Aid and Cardiopulmonary Resuscitation (CPR) and holds a currently

valid card documenting completion of such courses must be in the facility at all times. a. Documentation of attendance at First Aid or CPR courses pursuant to subsection 59A-36.011(5), F.A.C., satisfies this

requirement. b. A nurse is considered as having met the course requirements for First Aid. An emergency medical technician or paramedic

currently certified under chapter 401, part III, F.S., is considered as having met the course requirements for both First Aid and CPR. 6. During periods of temporary absence of the administrator or manager of more than 48 hours when residents are on the

premises, a staff member who is at least 21 years of age must be physically present and designated in writing to be in charge of the facility. No staff member shall be in charge of a facility for a consecutive period of 21 days or more, or for a total of 60 days within a calendar year, without being an administrator or manager.

7. Staff whose duties are exclusively building or grounds maintenance, clerical, or food preparation do not count towards

meeting the minimum staffing hours requirement. 8. The administrator or manager’s time may be counted for the purpose of meeting the required staffing hours, provided the

administrator or manager is actively involved in the day-to-day operation of the facility, including making decisions and providing supervision for all aspects of resident care, and is listed on the facility’s staffing schedule.

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

(b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities, including those composed of apartments, must have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents’ scheduled and unscheduled service needs, resident contracts, and resident care standards as described in rule 59A-36.007, F.A.C.

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

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

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

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

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

(f) Facilities holding a limited mental health, extended congregate care, or limited nursing services license must also comply with the staffing requirements of rules 59A-36.020, 59A-36.021 or 59A-36.022, F.A.C., respectively.

Rulemaking Authority 429.41, 429.52, 429.929 FS. Law Implemented 429.174, 429.176, 429.41, 429.52, 429.905 FS. History–New 5-14-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.19, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.019, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 4-15-10, 4-17-14, 5-10-18, Formerly 58A-5.019, 7-1-19.

59A-36.011 Staff Training Requirements and Competency Test. (1) ASSISTED LIVING FACILITY CORE TRAINING REQUIREMENTS AND COMPETENCY TEST. (a) The assisted living facility core training requirements established by the department pursuant to section 429.52, F.S., shall

consist of a minimum of 26 hours of training plus a competency test. (b) Administrators and managers must successfully complete the assisted living facility core training requirements within 3

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

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

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

administrator or manager for the purposes of the core training requirements and must: 1. Retake the assisted living facility core training; and, 2. Retake and pass the competency test. (e) The fees for the competency test shall not exceed $200.00. The payment for the competency test fee shall be remitted to the

entity administering the test. A new fee is due each time the test is taken. (2) STAFF PRESERVICE ORIENTATION. (a) Facilities must provide a preservice orientation of at least 2 hours to all new assisted living facility employees who have not

previously completed core training as detailed in subsection (1). (b) New staff must complete the preservice orientation prior to interacting with residents. (c) Once complete, the employee and the facility administrator must sign a statement that the employee completed the

preservice orientation which must be kept in the employee’s personnel record. (d) In addition to topics that may be chosen by the facility administrator, the preservice orientation must cover: 1. Resident’s rights; and, 2. The facility’s license type and services offered by the facility. (3) STAFF IN-SERVICE TRAINING. Facility administrators or managers shall provide or arrange for the following in-service

training to facility staff: (a) Staff who provide direct care to residents, other than nurses, certified nursing assistants, or home health aides trained in

accordance with rule 59A-8.0095, F.A.C., must receive a minimum of 1 hour in-service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents. The facility must use its infection control policies and procedures when offering this training. Documentation of compliance with the staff training requirements of 29 CFR 1910.1030, relating to blood borne pathogens, may be used to meet this requirement.

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

1. Reporting adverse incidents. 2. Facility emergency procedures including chain-of-command and staff roles relating to emergency evacuation. (c) Staff who provide direct care to residents, who have not taken the core training program, shall receive a minimum of 1 hour

in-service training within 30 days of employment that covers the following subjects: 1. Resident rights in an assisted living facility. 2. Recognizing and reporting resident abuse, neglect, and exploitation. The facility must use its abuse prevention policies and

procedures when offering this training. (d) Staff who provide direct care to residents, other than nurses, CNAs, or home health aides trained in accordance with rule

59A-8.0095, F.A.C., must receive 3 hours of in-service training within 30 days of employment that covers the following subjects: 1. Resident behavior and needs. 2. Providing assistance with the activities of daily living. (e) Staff who prepare or serve food, who have not taken the assisted living facility core training must receive a minimum of 1-

hour-in-service training within 30 days of employment in safe food handling practices. (f) All facility staff shall receive in-service training regarding the facility’s resident elopement response policies and procedures

within thirty (30) days of employment. 1. All facility staff shall be provided with a copy of the facility’s resident elopement response policies and procedures. 2. All facility staff shall demonstrate an understanding and competency in the implementation of the elopement response

policies and procedures. (4) HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNE DEFICIENCY SYNDROME (HIV/AIDS). Pursuant to

section 381.0035, F.S., all facility employees, with the exception of employees subject to the requirements of section 456.033, F.S., must complete a one-time education course on HIV and AIDS, including the topics prescribed in the section 381.0035, F.S. New facility staff must obtain the training within 30 days of employment. Documentation of compliance must be maintained in accordance with subsection (12), of this rule.

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

(a) Documentation that the staff member possess current CPR certification that requires the student to demonstrate, in person,

that he or she is able to perform CPR and which is issued by an instructor or training provider that is approved to provide CPR training by the American Red Cross, the American Heart Association, the National Safety Council, or an organization whose training is accredited by the Commission on Accreditation for Pre-Hospital Continuing Education satisfies this requirement.

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

(6) ASSISTANCE WITH THE SELF-ADMINISTRATION OF MEDICATION AND MEDICATION MANAGEMENT. Unlicensed persons who will be providing assistance with the self-administration of medications as described in rule 59A-36.008, F.A.C., must meet the training requirements pursuant to section 429.52(6), F.S., prior to assuming this responsibility. Courses provided in fulfilment of this requirement must meet the following criteria:

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

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

1. Read and understand a prescription label; 2. Provide assistance with self-administration in accordance with section 429.256, F.S., and rule 59A-36.008, F.A.C., including: a. Assist with oral dosage forms, topical dosage forms, and topical ophthalmic, otic and nasal dosage forms; b. Measure liquid medications, break scored tablets, and crush tablets in accordance with prescription directions; c. Recognize the need to obtain clarification of an “as needed” prescription order; d. Recognize a medication order which requires judgment or discretion, and to advise the resident, resident’s health care

provider or facility employer of inability to assist in the administration of such orders; e. Complete a medication observation record; f. Retrieve and store medication; g. Recognize the general signs of adverse reactions to medications and report such reactions; h. Assist residents with insulin syringes that are prefilled with the proper dosage by a pharmacist and insulin pens that are

prefilled by the manufacturer by taking the medication, in its previously dispensed, properly labeled container, from where it is stored, and bringing it to the resident for self-injection;

i. Assist with nebulizers; j. Use a glucometer to perform blood glucose testing; k. Assist residents with oxygen nasal cannulas and continuous positive airway pressure (CPAP) devices, excluding the titration

of the oxygen levels; l. Apply and remove anti-embolism stockings and hosiery; m. Placement and removal of colostomy bags, excluding the removal of the flange or manipulation of the stoma site; and, n. Measurement of blood pressure, heart rate, temperature, and respiratory rate. (c) Unlicensed persons, as defined in section 429.256(1)(b), F.S., who provide assistance with self-administered medications

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

(d) Trained unlicensed staff who, prior to the effective date of this rule, assist with the self-administration of medication and have successfully completed 4 hours of assistance with self-administration of medication training must complete an additional 2 hours of training that focuses on the topics listed in sub-subparagraphs (6)(b)2.h.-n. of this section, before assisting with the self-administration of medication procedures listed in sub-subparagraphs (6)(b)2.h.-n.

(7) NUTRITION AND FOOD SERVICE. The administrator or person designated by the administrator as responsible for the facility’s food service and the day-to-day supervision of food service staff must obtain, annually, a minimum of 2 hours continuing

education in topics pertinent to nutrition and food service in an assisted living facility. This requirement does not apply to administrators and designees who are exempt from training requirements under paragraph 59A-36.012(1)(b). A certified food manager, licensed dietician, registered dietary technician or health department sanitarian is qualified to train assisted living facility staff in nutrition and food service.

(8) EXTENDED CONGREGATE CARE (ECC) TRAINING. (a) The administrator and ECC supervisor, if different from the administrator, must complete core training and 4 hours of initial

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

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

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

(9) LIMITED MENTAL HEALTH TRAINING. (a) Pursuant to section 429.075, F.S., the administrator, managers and staff, who have direct contact with mental health residents

in a licensed limited mental health facility, must receive the following training: 1. A minimum of 6 hours of specialized training in working with individuals with mental health diagnoses. a. The training must be provided or approved by the Department of Children and Families and must be taken within 6 months of

the facility’s receiving a limited mental health license or within 6 months of employment in a limited mental health facility. b. Training received under this subparagraph may count once for 6 of the 12 hours of continuing education required for

administrators and managers pursuant to section 429.52(5), F.S., and subsection (1) of this rule. 2. A minimum of 3 hours of continuing education, which may be provided by the ALF administrator, online, or through

distance learning, biennially thereafter in subjects dealing with one or more of the following topics: a. Mental health diagnoses; and, b. Mental health treatment such as: (I) Mental health needs, services, behaviors and appropriate interventions; (II) Resident progress in achieving treatment goals; (III) How to recognize changes in the resident’s status or condition that may affect other services received or may require

intervention; and, (IV) Crisis services and the Baker Act procedures. 3. For administrators and managers, the continuing education requirement under this subsection will satisfy 3 of the 12 hours of

continuing education required biennially pursuant to section 429.52(5), F.S., and subsection (1) of this rule. 4. Administrators, managers and direct contact staff affected by the continuing education requirement under this subsection

shall have up to 6 months after the effective date of this rule to meet the training requirement. (b) Administrators, managers and staff do not have to repeat the initial training should they change employers provided they

present a copy of their training certificate to the current employer for retention in the facility’s personnel files. They must also ensure that copies of the continuing education training certificates, pursuant to subparagraph (a)2. of this subsection, are retained in their personnel files.

(10) ALZHEIMER’S DISEASE AND RELATED DISORDERS (“ADRD”) TRAINING REQUIREMENTS. Facilities which advertise that they provide special care for persons with ADRD, or who maintain secured areas as described in Chapter 4, Section 464.4.6 of the Florida Building Code, as adopted in rule 61G20-1.001, F.A.C., Florida Building Code Adopted, must ensure that facility staff receive the following training.

(a) Facility staff who interact on a daily basis with residents with ADRD but do not provide direct care to such residents and staff who provide direct care to residents with ADRD, shall obtain 4 hours of initial training within 3 months of employment. Completion of the core training program between April 20, 1998 and July 1, 2003 shall satisfy this requirement. Facility staff who

meet the requirements for ADRD training providers under paragraph (g) of this subsection, will be considered as having met this requirement. Initial training, entitled “Alzheimer’s Disease and Related Disorders Level I Training,” must address the following subject areas:

1. Understanding Alzheimer’s disease and related disorders; 2. Characteristics of Alzheimer’s disease; 3. Communicating with residents with Alzheimer’s disease; 4. Family issues; 5. Resident environment; and, 6. Ethical issues. (b) Staff who have successfully completed both the initial one hour and continuing three hours of ADRD training pursuant to

sections 400.1755, 429.917 and 400.6045(1), F.S., shall be considered to have met the initial assisted living facility Alzheimer’s Disease and Related Disorders Level I Training.

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

1. Behavior management, 2. Assistance with ADLs, 3. Activities for residents, 4. Stress management for the care giver; and, 5. Medical information. (d) A detailed description of the subject areas that must be included in an ADRD curriculum which meets the requirements of

paragraphs (a) and (b) of this subsection, can be found in the document “Training Guidelines for the Special Care of Persons with Alzheimer’s Disease and Related Disorders,” dated March 1999, incorporated by reference, available from the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000.

(e) Direct care staff shall participate in 4 hours of continuing education annually as required under section 429.178, F.S. Continuing education received under this paragraph may be used to meet 3 of the 12 hours of continuing education required by section 429.52, F.S., and subsection (1) of this rule, or 3 of the 6 hours of continuing education for extended congregate care required by subsection (7) of this rule.

(f) Facility staff who have only incidental contact with residents with ADRD must receive general written information provided by the facility on interacting with such residents, as required under section 429.178, F.S., within three (3) months of employment. “Incidental contact” means all staff who neither provide direct care nor are in regular contact with such residents.

(g) Persons who seek to provide ADRD training in accordance with this subsection must provide the department or its designee with documentation that they hold a Bachelor’s degree from an accredited college or university or hold a license as a registered nurse, and:

1. Have 1 year teaching experience as an educator of caregivers for persons with Alzheimer’s disease or related disorders, or 2. Three years of practical experience in a program providing care to persons with Alzheimer’s disease or related disorders, or 3. Completed a specialized training program in the subject matter of this program and have a minimum of two years of practical

experience in a program providing care to persons with Alzheimer’s disease or related disorders. (h) With reference to requirements in paragraph (g), a Master’s degree from an accredited college or university in a subject

related to the content of this training program can substitute for the teaching experience. Years of teaching experience related to the subject matter of this training program may substitute on a year-by-year basis for the required Bachelor’s degree referenced in paragraph (g).

(11) DO NOT RESUSCITATE ORDERS TRAINING. (a) Currently employed facility administrators, managers, direct care staff and staff involved in resident admissions must receive

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

least one hour of training in the facility’s policy and procedures regarding DNROs within 30 days after employment.

(c) Training shall consist of the information included in rule 59A-36.009, F.A.C. (12) TRAINING DOCUMENTATION AND MONITORING. (a) Except as otherwise noted, certificates, or copies of certificates, of any training required by this rule must be documented in

the facility’s personnel files. The documentation must include the following: 1. The title of the training program, 2. The subject matter of the training program, 3. The training program agenda, 4. The number of hours of the training program, 5. The trainee’s name, dates of participation, and location of the training program, 6. The training provider’s name, dated signature and credentials, and professional license number, if applicable. (b) Upon successful completion of training pursuant to this rule, the training provider must issue a certificate to the trainee as

specified in this rule. (c) The facility must provide the Department of Elder Affairs and the Agency for Health Care Administration with training

documentation and training certificates for review, as requested. The department and agency reserve the right to attend and monitor all facility in-service training, which is intended to meet regulatory requirements.

Rulemaking Authority 429.178, 429.41, 429.52 FS. Law Implemented 429.07, 429.075, 429.178, 429.41, 429.52 FS. History–New 9-30-92, Formerly 10A-5.0191, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-5-05, 7-30-06, 10-9-06, 7-1-08, 4-15-10, 5-10-18, Formerly 58A-5.0191, 7-1-19.

59A-36.012 Food Service Standards. (1) GENERAL RESPONSIBILITIES. When food service is provided by the facility, the administrator, or an individual

designated in writing by the administrator, must be responsible for total food services and the day-to-day supervision of food services staff. In addition, the following requirements apply:

(a) If the designee is an individual who has not completed an approved assisted living facility core training course, such individual must complete the food and nutrition services module of the core training course before assuming responsibility for the facility’s food service. The designee is not subject to the 1 hour in-service training in safe food handling practices.

(b) If the designee is a certified food manager, certified dietary manager, registered or licensed dietitian, dietetic registered technician, or health department sanitarian, the designee is exempt from the requirement to complete the food and nutrition services module of the core training course before assuming responsibility for the facility’s food service as required in paragraph (1)(a) of this rule.

(c) An administrator or designee must perform his or her duties in a safe and sanitary manner. (d) An administrator or designee must provide regular meals that meet the nutritional needs of residents, and therapeutic diets as

ordered by the resident’s health care provider for residents who require special diets. (e) An administrator or designee must comply with the food service continuing education requirements specified in rule 59A-

36.011, F.A.C. (2) DIETARY STANDARDS. (a) The meals provided by the assisted living facility must be planned based on the current USDA Dietary Guidelines for

Americans, 2010, which are incorporated by reference and available for review at: http://www.flrules.org/Gateway/reference.asp?No=Ref-04003, and the current summary of Dietary Reference Intakes established by the Food and Nutrition Board of the Institute of Medicine of the National Academies, 2010, which are incorporated by reference and available for review at: http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/New%20Material/5DRI%20Values%20SummaryTables%2014.pdf. Therapeutic diets must meet these nutritional standards to the extent possible.

(b) The residents’ nutritional needs must be met by offering a variety of meals adapted to the food habits, preferences, and physical abilities of the residents, and must be prepared through the use of standardized recipes. For facilities with a licensed capacity of 16 or fewer residents, standardized recipes are not required. Unless a resident chooses to eat less, the facility must serve the standard minimum portions of food according to the Dietary Reference Intakes.

(c) All regular and therapeutic menus to be used by the facility must be reviewed annually by a licensed or registered dietitian, a licensed nutritionist, or a registered dietetic technician supervised by a licensed or registered dietitian, or a licensed nutritionist to

ensure the meals meet the nutritional standards established in this rule. The annual review must be documented in the facility files and include the original signature of the reviewer, registration or license number, and date reviewed. Portion sizes must be indicated on the menus or on a separate sheet.

1. Daily food servings may be divided among three or more meals per day, including snacks, as necessary to accommodate resident needs and preferences.

2. Menu items may be substituted with items of comparable nutritional value based on the seasonal availability of fresh produce or the preferences of the residents.

(d) Menus must be dated and planned at least 1 week in advance for both regular and therapeutic diets. Residents must be encouraged to participate in menu planning. Planned menus must be conspicuously posted or easily available to residents. Regular and therapeutic menus as served, with substitutions noted before or when the meal is served, must be kept on file in the facility for 6 months.

(e) Therapeutic diets must be prepared and served as ordered by the health care provider. 1. Facilities that offer residents a variety of food choices through a select menu, buffet style dining, or family style dining are

not required to document what is eaten unless a health care provider’s order indicates that such monitoring is necessary. However, the food items that enable residents to comply with the therapeutic diet must be identified on the menus developed for use in the facility.

2. The facility must document a resident’s refusal to comply with a therapeutic diet and provide notification to the resident’s health care provider of such refusal.

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

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

(h) A 3-day supply of nonperishable food, based on the number of weekly meals the facility has contracted with residents to serve, must be on hand at all times. The quantity must be based on the resident census and not on licensed capacity. The supply must consist of foods that can be stored safely without refrigeration. Water sufficient for drinking and food preparation must also be stored, or the facility must have a plan for obtaining water in an emergency, with the plan coordinated with and reviewed by the local disaster preparedness authority.

(3) FOOD HYGIENE. Copies of inspection reports issued by the county health department for the last 2 years pursuant to rule 64E-12.004, or chapter 64E-11, F.A.C., as applicable, depending on the licensed capacity of the assisted living facility, must be on file in the facility.

(4) CONTRACTED FOOD SERVICE. When food service is contracted by the facility, the facility must ensure that the contracted food service meets all dietary standards imposed by this rule and is adequately protected upon delivery to the facility pursuant to subsection 64E-12.004(4), F.A.C. The facility must maintain:

(a) A copy of the current contract between the facility and the food service contractor. (b) A copy of the annually issued certificate or license authorizing the operation of the food service contractor issued by the

applicable regulating agency. The license or certificate must provide documentation of the food service contractor’s compliance with food service regulatory requirements.

Rulemaking Authority 429.41 FS. Law Implemented 429.41, 429.52 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.20, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.020, Amended 10-30-95, 6-2-96, 10-17-99, 4-17-14, Formerly 58A-5.020, 7-1-19.

59A-36.013 Fiscal Standards. (1) FINANCIAL STABILITY. The facility must be administered on a sound financial basis in order to ensure adequate

resources to meet resident needs pursuant to the requirements of chapter 408, part II, part I, F.S., and rule chapter 59A-35, F.A.C., and this rule chapter.

(2) RESIDENT TRUST FUNDS. Funds or other property received by the facility belonging to or due a resident, including personal funds, must be held as trust funds and expended only for the resident’s account. Resident funds or property may be held in one bank account if a separate written accounting for each resident is maintained. A separate bank account is required for facility funds; co-mingling resident funds with facility funds is prohibited. Written accounting procedures for resident trust funds must include income and expense records of the trust fund, including the source and disposition of the funds.

(3) SURETY BONDS. Pursuant to the requirements of section 429.27(2), F.S.: (a) For entities that own more than one facility in the state, one surety bond may be purchased to cover the needs of all residents

served by the entities. (b) The following additional bonding requirements apply to facilities serving residents receiving OSS: 1. If serving as representative payee for a resident receiving OSS, the minimum bond proceeds must equal twice the value of the

resident’s monthly aggregate income, which must include any supplemental security income or social security disability income plus the OSS payments, including the personal needs allowance.

2. If holding a power of attorney for a resident receiving OSS, the minimum bond proceeds must equal twice the value of the resident’s monthly aggregate income, which must include any supplemental security income or social security disability income; the OSS payments, including the personal allowance; plus the value of any property belonging to a resident held at the facility.

(c) Upon the annual issuance of a new bond or continuation bond, the facility must file a copy of the bond with the Agency Central Office.

(4) LIABILITY INSURANCE. Pursuant to section 429.275, F.S., facilities must maintain liability insurance coverage, as defined in section 624.605, F.S., that remains in force at all times. On the renewal date of the facility’s policy or whenever a facility changes policies, the facility must file documentation of continued coverage with the Agency Central Office. Such documentation must be issued by the insurance company and must include the name and street address of the facility, a reference that the facility is an assisted living facility, the facility’s licensed capacity, and the dates of coverage.

Rulemaking Authority 429.24, 429.27, 429.275, 429.41 FS. Law Implemented 429.27, 429.275 FS. History–New 5-14-81, Amended 1-6-82, 9-17-84, Formerly 10A-5.21, Amended 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.021, Amended 10-30-95, 6-2-96, 10-17-99, 4-17-14, Formerly 58A-5.021, 7-1-19.

59A-36.014 Physical Plant Standards. (1) NEW FACILITIES. Newly constructed facilities to be licensed as assisted living facilities, and existing structures, not

previously licensed as assisted living facilities, to be converted to assisted living facilities, as well as any subsequent additions, modifications, alterations, renovations or refurbishing of such facilities, are required by governmental entities other than the Department of Elder Affairs to adhere to certain building code and fire safety standards. Such standards may be found in:

(a) Chapter 4, Section 464, of the Florida Building Code as adopted in rule 61G20-1.001, F.A.C.; (b) Section 633.022, F.S., Uniform Firesafety Standards and rule chapter 69A-40, F.A.C. The Uniform Fire Safety Standards for

Assisted Living Facilities; and, (c) The National Fire Protection Association codes described in section 429.41, F.S. (2) EXISTING FACILITIES. (a) An assisted living facility must comply with the rule or building code in effect at the time of initial licensure, as well as the

rule or building code in effect at the time of any additions, modifications, alterations, refurbishment, renovations or reconstruction. Determination of the installation of a fire sprinkler system in an existing facility must comply with the requirements described in section 429.41, F.S.

(b) A facility undergoing change of ownership is considered an existing facility for purposes of this rule. (3) OTHER REQUIREMENTS. (a) All facilities must: 1. Provide a safe living environment pursuant to section 429.28(1)(a), F.S.; 2. Be maintained free of hazards; and, 3. Ensure that all existing architectural, mechanical, electrical and structural systems, and appurtenances are maintained in good

working order. (b) Pursuant to section 429.27, F.S., residents must be given the option of using their own belongings as space permits. When

the facility supplies the furnishings, each resident bedroom or sleeping area must have at least the following furnishings:

1. A clean, comfortable bed with a mattress no less than 36 inches wide and 72 inches long, with the top surface of the mattress at a comfortable height to ensure easy access by the resident,

2. A closet or wardrobe space for hanging clothes, 3. A dresser, chest or other furniture designed for storage of clothing or personal effects, 4. A table or nightstand, bedside lamp or floor lamp, and waste basket; and, 5. A comfortable chair, if requested. (c) The facility must maintain master or duplicate keys to resident bedrooms to be used in the event of an emergency. (d) Residents who use portable bedside commodes must be provided with privacy during use. (e) Facilities must make available linens and personal laundry services for residents who require such services. Linens provided

by a facility must be free of tears, stains and must not be threadbare.

Rulemaking Authority 429.41 FS. Law Implemented 429.27, 429.28, 429.41 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.23, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.023, Amended 10-30-95, 6-2-96, 10-17-99, 7-30-06, 4-15-10, 4-17-14, Formerly 58A-5.023, 7-1-19.

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

(1) FACILITY RECORDS. Facility records must include: (a) The facility’s license displayed in a conspicuous and public place within the facility. (b) An up-to-date admission and discharge log listing the names of all residents and each resident’s: 1. Date of admission, the facility or place from which the resident was admitted, and if applicable, a notation indicating that the

resident was admitted with a stage 2 pressure sore; and, 2. Date of discharge, reason for discharge, and identification of the facility or home address to which the resident was

discharged. Readmission of a resident to the facility after discharge requires a new entry in the log. Discharge of a resident is not required if the facility is holding a bed for a resident who is out of the facility but intending to return pursuant to rule 59A-36.018, F.A.C. If the resident dies while in the care of the facility, the log must indicate the date of death.

(c) A log listing the names of all temporary emergency placement and respite care residents if not included on the log described in paragraph (b).

(d) The facility’s emergency management plan, with documentation of review and approval by the county emergency management agency, as described in rule 59A-36.019, F.A.C., that must be readily available by facility staff.

(e) The facility’s liability insurance policy required in rule 59A-36.013, F.A.C. (f) For facilities that have a surety bond, a copy of the surety bond currently in effect as required by rule 59A-36.013, F.A.C. (g) The admission package presented to new or prospective residents (less the resident’s contract) described in rule 59A-36.006,

F.A.C. (h) If the facility advertises that it provides special care for persons with Alzheimer’s disease or related disorders, a copy of all

such facility advertisements as required by section 429.177, F.S. (i) A grievance procedure for receiving and responding to resident complaints and recommendations as described in rule 59A-

36.007, F.A.C. (j) All food service records required in rule 59A-36.012, F.A.C., including menus planned and served and county health

department inspection reports. Facilities that contract for food services, must include a copy of the contract for food services and the food service contractor’s license or certificate to operate.

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

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

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

(n) The facility’s resident elopement response policies and procedures. (o) The facility’s documented resident elopement response drills. (p) For facilities licensed as limited mental health, extended congregate care, or limited nursing services, records required as

stated in rules 59A-36.020, 59A-36.021 and 59A-36.022, F.A.C., respectively. (2) STAFF RECORDS. (a) Personnel records for each staff member must contain, at a minimum, a copy of the employment application, with references

furnished, and documentation verifying freedom from signs or symptoms of communicable disease. In addition, records must contain the following, as applicable:

1. Documentation of compliance with all staff training and continuing education required by rule 59A-36.011, F.A.C., 2. Copies of all licenses or certifications for all staff providing services that require licensing or certification, 3. Documentation of compliance with level 2 background screening for all staff subject to screening requirements as specified in

section 429.174, F.S., and rule 59A-36.010, F.A.C., 4. For facilities with a licensed capacity of 17 or more residents, a copy of the job description given to each staff member

pursuant to rule 59A-36.010, F.A.C., 5. Documentation verifying direct care staff and administrator participation in resident elopement drills pursuant to paragraph

59A-36.007(8)(c), F.A.C. (b) The facility is not required to maintain personnel records for staff provided by a licensed staffing agency or staff employed

by an entity contracting to provide direct or indirect services to residents and the facility. However, the facility must maintain a copy of the contract between the facility and the staffing agency or contractor as described in rule 59A-36.010, F.A.C.

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

(3) RESIDENT RECORDS. Resident records must be maintained on the premises and include: (a) Resident demographic data as follows: 1. Name, 2. Sex, 3. Race, 4. Date of birth, 5. Place of birth, if known, 6. Social security number, 7. Medicaid and/or Medicare number, or name of other health insurance carrier, 8. Name, address, and telephone number of next of kin, legal representative, or individual designated by the resident for

notification in case of an emergency; and, 9. Name, address, and telephone number of the health care provider and case manager, if applicable. (b) A copy of the Resident Health Assessment form, AHCA Form 1823 described in rule 59A-36.006, F.A.C. (c) Any orders for medications, nursing services, therapeutic diets, do not resuscitate orders, or other services to be provided,

supervised, or implemented by the facility that require a health care provider’s order. (d) Documentation of a resident’s refusal of a therapeutic diet pursuant to rule 59A-36.012, F.A.C., if applicable. (e) The resident care record described in paragraph 59A-36.007(1)(e), F.A.C. (f) A weight record that is initiated on admission. Information may be taken from AHCA Form 1823 or the resident’s health

assessment. Residents receiving assistance with the activities of daily living must have their weight recorded semi-annually. (g) For facilities that will have unlicensed staff assisting the resident with the self-administration of medication, a copy of the

written informed consent described in rule 59A-36.006, F.A.C., if such consent is not included in the resident’s contract. (h) For facilities that manage a pill organizer, assist with self-administration of medications or administer medications for a

resident, copies of the required medication records maintained pursuant to rule 59A-36.008, F.A.C. (i) A copy of the resident’s contract with the facility, including any addendums to the contract as described in rule 59A-36.018,

F.A.C. (j) For a facility whose owner, administrator, staff, or representative thereof, serves as an attorney in fact for a resident, a copy

of the monthly written statement of any transaction made on behalf of the resident as required in section 429.27, F.S. (k) For any facility that maintains a separate trust fund to receive funds or other property belonging to or due a resident, a copy

of the quarterly written statement of funds or other property disbursed as required in section 429.27, F.S. (l) If the resident is an OSS recipient, a copy of the Department of Children and Families form Alternate Care Certification for

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

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

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

(o) The resident’s Do Not Resuscitate Order, DH Form 1896, if applicable. (p) For independent living residents who receive meals and occupy beds included within the licensed capacity of an assisted

living facility, but who are not receiving any personal, limited nursing, or extended congregate care services, record keeping may be limited to the following at the discretion of the facility:

1. A log listing the names of residents participating in this arrangement, 2. The resident demographic data required in this paragraph, 3. The health assessment described in rule 59A-36.006, F.A.C., 4. The resident’s contract described in rule 59A-36.018, F.A.C.; and, 5. A health care provider’s order for a therapeutic diet if such diet is prescribed and the resident participates in the meal plan

offered by the facility. (q) Except for resident contracts, which must be retained for 5 years, all resident records must be retained for 2 years following

the departure of a resident from the facility unless it is required by contract to retain the records for a longer period of time. Upon request, residents must be provided with a copy of their records upon departure from the facility.

(r) Additional resident records requirements for facilities holding a limited mental health, extended congregate care, or limited nursing services license are provided in rules 59A-36.020, 59A-36.021 and 59A-36.022, F.A.C., respectively.

(4) RECORD INSPECTION. (a) The resident’s records must be available to the resident; the resident’s legal representative, designee, surrogate, guardian,

attorney in fact, or case manager; or the resident’s estate, and such additional parties as authorized in writing or by law. (b) Pursuant to section 429.35, F.S., agency reports that pertain to any agency survey, inspection, or monitoring visit must be

available to the residents and the public. In facilities that are co-located with a licensed nursing home, the inspection of record for all common areas is the nursing home inspection report.

Rulemaking Authority 429.41, 429.275 FS. Law Implemented 429.24, 429.255, 429.256, 429.26, 429.27, 429.275, 429.35, 429.41, 429.52 FS. History–New 5-14-81, Amended 1-6-82, 5-19-83, 9-17-84, Formerly 10A-5.24, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.024, Amended 10-30-95, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 10-9-06, 4-17-14, Formerly 58A-5.024, 7-1-19.

59A-36.016 Adverse Incident Report. (1) INITIAL ADVERSE INCIDENT REPORT. The preliminary adverse incident report required by section 429.23(3), F.S.,

must be submitted within 1 business day after the incident pursuant to rule 59A-35.110, F.A.C., which requires online reporting. (2) FULL ADVERSE INCIDENT REPORT. For each adverse incident reported in subsection (1), above, the facility must

submit a full report within 15 days of the incident. The full report must be submitted pursuant to rule 59A-35.110, F.A.C., which requires online reporting.

Rulemaking Authority 429.23 FS. Law Implemented 429.23 FS. History–New 1-9-02, Amended 7-30-06, 4-17-14, Formerly 58A-5.0241, 7-1-19.

59A-36.017 Liability Claim Report. (1) MONTHLY LIABILITY CLAIM REPORT. Each assisted living facility must report monthly any liability claim filed

against the facility pursuant to rule 59A-35.110, F.A.C., which requires online reporting. Each facility must comply with the reporting time frames and transmission requirements specified in section 429.23(5), F.S.

(2) If a liability claim has not been filed against the facility in a given month, no report is required.

Rulemaking Authority 429.23 FS. Law Implemented 429.23 FS. History–New 1-9-02, Amended 3-13-14, Formerly 58A-5.0242, 7-1-19.

59A-36.018 Resident Contracts. (1) Pursuant to section 429.24, F.S., the facility must offer a contract for execution by the resident or the resident’s legal

representative before or at the time of admission. The contract must contain the following provisions: (a) A list of the specific services, supplies and accommodations to be provided by the facility to the resident, including limited

nursing and extended congregate care services that the resident elects to receive; (b) The daily, weekly, or monthly rate; (c) A list of any additional services and charges to be provided that are not included in the daily, weekly, or monthly rates, or a

reference to a separate fee schedule that must be attached to the contract; (d) A provision stating that at least 30 days written notice will be given before any rate increase; (e) Any rights, duties, or obligations of residents, other than those specified in section 429.28, F.S.; (f) The purpose of any advance payments or deposit payments, and the refund policy for such advance or deposit payments; (g) A refund policy that must conform to section 429.24(3), F.S.; (h) A written bed hold policy and provisions for terminating a bed hold agreement if a facility agrees in writing to reserve a bed

for a resident who is admitted to a nursing home, health care facility, or psychiatric facility. The resident or responsible party must notify the facility in writing of any change in status that would prevent the resident from returning to the facility. Until such written notice is received, the agreed upon daily, weekly, or monthly rate may be charged by the facility unless the resident’s medical condition prevents the resident from giving written notification, such as when a resident is comatose, and the resident does not have a responsible party to act on the resident’s behalf;

(i) A provision stating whether the facility is affiliated with any religious organization and, if so, which organization and its relationship to the facility;

(j) A provision that, upon determination by the administrator or health care provider that the resident needs services beyond those that the facility is licensed to provide, the resident or the resident’s representative, or agency acting on the resident’s behalf, must be notified in writing that the resident must make arrangements for transfer to a care setting that is able to provide services needed by the resident. In the event the resident has no one to represent him or her, the facility must refer the resident to the social service agency for placement. If there is disagreement regarding the appropriateness of placement, provisions outlined in section 429.26(8), F.S., will take effect;

(k) A provision that residents must be assessed upon admission pursuant to subsection 59A-36.006(2), F.A.C., and every 3 years thereafter, or after a significant change, pursuant to subsection (4), of that rule;

(l) The facility’s policies and procedures for self-administration, assistance with self-administration, and administration of medications, if applicable, pursuant to rule 59A-36.008, F.A.C. This also includes provisions regarding over-the-counter (OTC) products pursuant to subsection (8) of that rule; and,

(m) The facility’s policies and procedures related to a properly executed DH Form 1896, Do Not Resuscitate Order. (2) The resident, or the resident’s representative, must be provided with a copy of the executed contract. (3) The facility may not levy an additional charge for any supplies, services, or accommodations that the facility has agreed by

contract to provide as part of the standard daily, weekly, or monthly rate. The resident or resident’s representative must be furnished in advance with an itemized written statement setting forth additional charges for any services, supplies, or accommodations available to residents not covered under the contract. An addendum must be added to the resident contract to reflect the additional services, supplies, or accommodations not provided under the original agreement. Such addendum must be dated and signed by the facility and the resident or resident’s legal representative and a copy given to the resident or resident’s representative.

Rulemaking Authority 429.24, 429.41 FS. Law Implemented 429.24, 429.41 FS. History–New 10-17-99, Amended 7-30-06, 4-15-10, 3-13-14, Formerly 58A-5.025, 7-1-19.

59A-36.019 Emergency Management. (1) EMERGENCY PLAN COMPONENTS. Pursuant to section 429.41, F.S., each facility must prepare a written

comprehensive emergency management plan in accordance with the “Emergency Management Criteria for Assisted Living Facilities,” dated October 1995, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04010. This document is available from the local emergency management

agency. The emergency management plan must, at a minimum, address the following: (a) Provision for all hazards; (b) Provision for the care of residents remaining in the facility during an emergency, including pre-disaster or emergency

preparation; protecting the facility; supplies; emergency power; food and water; staffing; and emergency equipment; (c) Provision for the care of residents who must be evacuated from the facility during an emergency including identification of

such residents and transfer of resident records; evacuation transportation; sheltering arrangements; supplies; staffing; emergency equipment; and medications;

(d) Provision for the care of additional residents who may be evacuated to the facility during an emergency including the identification of such residents, staffing, and supplies;

(e) Identification of residents with Alzheimer’s disease or related disorders, and residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation;

(f) Identification of and coordination with the local emergency management agency; (g) Arrangement for post-disaster activities including responding to family inquiries, obtaining medical intervention for

residents, transportation, and reporting to the local emergency management agency the number of residents who have been relocated, and the place of relocation; and,

(h) The identification of staff responsible for implementing each part of the plan. (2) EMERGENCY PLAN APPROVAL. The plan must be submitted for review and approval to the local emergency

management agency. (a) If the local emergency management agency requires revisions to the emergency management plan, such revisions must be

made and the plan resubmitted to the local office within 30 days of receiving notification that the plan must be revised. (b) A new facility as described in rule 59A-36.014, F.A.C., and facilities whose ownership has been transferred, must submit an

emergency management plan within 30 days after obtaining a license. (c) The facility must review its emergency management plan on an annual basis. Any substantive changes must be submitted to

the local emergency agency for review and approval. 1. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered substantive

revisions for the purposes of this rule. 2. Changes in the identification of specific staff must be submitted to the local emergency management agency annually as a

signed and dated addendum that is not subject to review and approval. (d) The local emergency management agency is the final administrative authority for emergency management plans prepared by

assisted living facilities. (e) Any plan approved by the local emergency management agency is considered to have met all the criteria and conditions

established in this rule. (3) PLAN IMPLEMENTATION. (a) All staff must be trained in their duties and are responsible for implementing the emergency management plan. (b) If telephone service is not available during an emergency, the facility must request assistance from local law enforcement or

emergency management personnel in maintaining communication. (4) FACILITY EVACUATION. The facility must evacuate the premises during or after an emergency if so directed by the local

emergency management agency. (a) The facility must report the evacuation to the local office of emergency management or designee and to the agency within 6

hours of the evacuation order. If the evacuation takes more than 6 hours, the facility must report when the evacuation is completed. (b) The facility must not be re-occupied until the area is cleared for reentry by the local emergency management agency or its

designee and the facility can meet the immediate needs of the residents. (c) A facility with significant structural damage must relocate residents until the facility can be safely re-occupied. (d) The facility is responsible for knowing the location of all residents until the residents have been relocated to another facility. (e) The facility must provide the agency with the name of a contact person who must be available by telephone 24 hours a day,

seven days a week, until the facility is re-occupied. (f) The facility must assist in the relocation of residents, and must cooperate with outreach teams established by the Department

of Health or emergency management agency to assist in relocation efforts. Resident needs and preferences must be considered to the extent possible in any relocation decision.

(5) EMERGENCY SHELTER. In the event a state of emergency has been declared and the facility is not required to evacuate the premises, the facility may provide emergency shelter above the facility’s licensed capacity provided the following conditions are met:

(a) Life safety will not be jeopardized for any individual; (b) The immediate needs of residents and other individuals sheltered at the facility can be met by the facility; (c) The facility reports the number of individuals over its licensed capacity and the conditions causing it to the Agency Field

Office within 48 hours or as soon as practical. As an alternative, the facility may report to the Agency Central Office at (850)412-4304. If the facility will continue to be over capacity after the declared emergency ends, the agency will review requests for excess capacity on a case-by-case basis; and,

(d) The facility maintains a log of the additional individuals being housed in the facility. The log must include the individual’s name, usual address, and the dates of arrival and departure. The log must be available for review by representatives of the agency, the department, the local emergency management agency or its designee. The admissions and discharge log maintained by the facility may be used for this purpose provided the information is maintained in a manner that is easily accessible.

Rulemaking Authority 429.41 FS. Law Implemented 429.41 FS. History–New 10-17-99, Amended 7-30-06, 4-17-14, Formerly 58A-5.026, 7-1-19.

59A-36.020 Limited Mental Health. (1) LICENSE APPLICATION. (a) Any facility intending to admit one or more mental health residents must obtain a limited mental health license from the

agency before accepting the mental health resident. (b) Facilities applying for a limited mental health license that have uncorrected deficiencies or violations found during the

facility’s last survey, complaint investigation, or monitoring visit will be surveyed before the issuance of a limited mental health license to determine if such deficiencies or violations have been corrected.

(2) RECORDS. (a) A facility with a limited mental health license must maintain an up-to-date admission and discharge log containing the

names and dates of admission and discharge for all mental health residents. The admission and discharge log required in rule 59A-36.015, F.A.C., satisfies this condition provided that all mental health residents are clearly identified.

(b) Staff records must contain documentation that designated staff have completed limited mental health training as required by rule 59A-36.011, F.A.C.

(c) Resident records must include: 1. Documentation, provided by a mental health care provider within 30 days of the resident’s admission to the facility, that the

resident is a mental health resident as defined in section 394.4574, F.S., and that the resident is receiving social security disability or supplemental security income and optional state supplementation as follows:

a. An affirmative statement on the Alternate Care Certification for Optional State Supplementation (OSS) form, CF-ES 1006, October 2005, which is hereby incorporated by reference and available for review at: http://www.flrules.org/Gateway/reference.asp?No=Ref-03988, that the resident is receiving SSI or SSDI due to a mental disorder,

b. Written verification provided by the Social Security Administration that the resident is receiving SSI or SSDI for a mental disorder. Such verification may be acquired from the Social Security Administration upon obtaining a release from the resident permitting the Social Security Administration to provide such information, or

c. A written statement from the resident’s case manager or other mental health care provider that the resident is an adult with severe and persistent mental disorder. The case manager or other mental health care provider must consider the following minimum criteria in making that determination:

(I) The resident is eligible for, is receiving, or has received mental health services within the last 5 years, or (II) The resident has been diagnosed as having a severe or persistent mental disorder. 2. An appropriate placement assessment provided by the resident’s mental health care provider within 30 days of admission to

the facility that the resident has been assessed and found appropriate for residence in an assisted living facility. Such assessment must be conducted by a psychiatrist, clinical psychologist, clinical social worker, psychiatric nurse, or an individual supervised by one of these professionals.

a. Any of the following documentation that contains the name of the resident and the name, signature, date, and license number, if applicable, of the person making the assessment, meets this requirement:

(I) Completed Alternate Care Certification for Optional State Supplementation (OSS) form, CF-ES Form 1006, (II) Discharge Statement from a state mental hospital completed no more than 90 days before admission to the assisted living

facility provided it contains a statement that the individual is appropriate to live in an assisted living facility, or (III) Other signed statement that the resident has been assessed and found appropriate for residency in an assisted living facility. b. A mental health resident returning to a facility from treatment in a hopsital or crisis stabilization unit will not be considered a

new admission and will not require a new assessment. However, a break in a resident’s residency that requires the facility to execute a new resident contract or admission agreement will be considered a new admission and the resident’s mental health care provider must provide a new assessment.

3. A Community Living Support Plan. Each mental health resident and the resident’s mental health case manager must, in consultation with the facility administrator, prepare a plan within 30 days of the resident’s admission to the facility or within 30 days after receiving the appropriate placement assessment in paragraph (2)(c), whichever is later, that:

a. Includes the specific needs of the resident that must be met in order to enable the resident to live in the assisted living facility and the community,

b. Includes the clinical mental health services to be provided by the mental health care provider to help meet the resident’s needs, and the frequency and duration of such services,

c. Includes any other services and activities to be provided by or arranged for by the mental health care provider or mental health case manager to meet the resident’s needs, and the frequency and duration of such services and activities,

d. Includes the obligations of the facility to facilitate and assist the resident in attending appointments and arranging transportation to appointments for the services and activities identified in the plan that have been provided or arranged for by the resident’s mental health care provider or case manager,

e. Includes a description of other services to be provided or arranged by the facility, f. Includes a list of factors pertinent to the care, safety, and welfare of the mental health resident and a description of the signs

and symptoms particular to the resident that indicate the immediate need for professional mental health services, g. Is in writing and signed by the mental health resident, the resident’s mental health case manager, and the assisted living

facility administrator or manager and a copy placed in the resident’s file. If the resident refuses to sign the plan, the resident’s mental health case manager must add a statement that the resident was asked but refused to sign the plan,

h. Is updated at least annually or if there is a significant change in the resident’s behavioral health, i. May include the Cooperative Agreement described in subparagraph (2)(c)4. If included, the mental health care provider must

also sign the plan; and, j. Must be available for inspection to those who have legal authority to review the document. 4. Cooperative Agreement. The mental health care provider for each mental health resident and the facility administrator or

designee must prepare a written statement, within 30 days of the resident’s admission to the facility or receipt of the resident’s appropriate placement assessment, whichever is later. The statement:

a. Provides procedures and directions for accessing emergency and after-hours care for the mental health resident. The provider must furnish the resident and the facility with the provider’s 24-hour emergency crisis telephone number;

b. Must be signed by the administrator or designee and the mental health care provider, or by a designated representative of a Medicaid prepaid health plan if the resident is on a plan and the plan provides behavioral health services in section 409.912, F.S.;

c. May cover all mental health residents of the facility who are clients of the same provider; and, d. May be included in the Community Living Support Plan described in subparagraph (2)(c)3. 5. Missing documentation will not be the basis for administrative action against a facility if the facility can demonstrate that it

has made a good faith effort to obtain the required documentation from the appropriate party. A documented request for such missing documentation made by the facility administrator within 72 hours of the resident’s admission will be considered a good faith effort. The documented request must include the name, title, and phone number of the person to whom the request was made and must be kept in the resident’s file.

(3) RESPONSIBILITIES OF FACILITY. In addition to the staffing and care standards of this rule chapter to provide for the welfare of residents in an assisted living facility, a facility holding a limited mental health license must:

(a) Meet the facility’s obligation to assist the resident in carrying out the activities identified in the Community Living Support Plan;

(b) Provide an opportunity for private face-to-face contact between the mental health resident and the resident’s mental health

case manager or other treatment personnel of the resident’s mental health care provider; (c) Observe resident behavior and functioning in the facility, and record and communicate observations to the resident’s mental

health case manager or mental health care provider regarding any significant behavioral or situational changes that may signify the need for a change in the resident’s professional mental health services, supports, and services described in the community living support plan, or that the resident is no longer appropriate for residency in the facility;

(d) If the facility initiates an involuntary mental health examination pursuant to section 394.463, F.S., the facility must document the circumstances leading to the initiation of the examination;

(e) Ensure that designated staff have completed limited mental health training as required by rule 59A-36.011, F.A.C.; and, (f) Maintain facility, staff, and resident records in accordance with the requirements of this rule chapter.

Rulemaking Authority 429.41 FS. Law Implemented 429.075, 429.26, 429.41 FS. History–New 8-15-90, Amended 9-30-92, Formerly 10A-5.029, Repromulgated 10-30-95, Amended 6-2-96, 11-2-98, 7-30-06, Amended 4-17-14, 5-10-18, Formerly 58A-5.029, 7-1-19.

59A-36.021 Extended Congregate Care Services. (1) LICENSING. (a) Any facility intending to establish extended congregate care services must obtain a license from the agency before accepting

residents needing extended congregate care services. (b) Only the portion of a facility that meets the physical requirements of subsection (3), and is staffed in accordance with

subsection (4), is considered licensed to provide extended congregate care services to residents who meet the admission and continued residency requirements of this rule.

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

(a) Aging in place; (b) The facility’s residency criteria developed in accordance with the admission and discharge requirements described in

subsection (5), and extended congregate care services listed in subsection (8); (c) The personal and supportive services the facility intends to provide, how the services will be provided, and the identification

of staff positions to provide the services including their relationship to the facility; (d) The nursing services the facility intends to provide, identification of staff positions to provide nursing services, and the

license status, duties, general working hours, and supervision of such staff; (e) Identifying potential unscheduled resident service needs and mechanisms for meeting those needs including the

identification of resources to meet those needs; (f) A process for mediating conflicts among residents regarding choice of room or apartment and roommate; and, (g) How to involve residents in decisions concerning the resident. The services must provide opportunities and encouragement

for the resident to make personal choices and decisions. If a resident needs assistance to make choices or decisions, a family member or other resident representative must be consulted. Choices must include at a minimum whether:

1. To participate in the process of developing, implementing, reviewing, and revising the resident’s service plan, 2. To remain in the same room in the facility, except that a current resident transferring into an extended congregate care

services may be required to move to the part of the facility licensed for extended congregate care, if only part of the facility is so licensed,

3. To select among social and leisure activities, 4. To participate in activities in the community. At a minimum the facility must arrange transportation to such activities if

requested by the resident; and, 5. To provide input with respect to the adoption and amendment of facility policies and procedures. (3) STAFFING REQUIREMENTS. The following staffing requirements apply for extended congregate care services: (a) Supervision by an administrator who has a minimum of two years of managerial, nursing, social work, therapeutic

recreation, or counseling experience in a residential, long-term care, or acute care setting or agency serving elderly or disabled persons. If an administrator appoints a manager as the supervisor of an extended congregate care facility, both the administrator and manager must satisfy the requirements of subsection 59A-36.010(1), F.A.C.

1. A baccalaureate degree may be substituted for one year of the required experience.

2. A nursing home administrator licensed under chapter 468, F.S., is qualified under this paragraph. (b) Provide staff or contract the services of a nurse who must be available to provide nursing services, participate in the

development of resident service plans, and perform monthly nursing assessments for extended congregate care residents. (c) Provide enough qualified staff to meet the needs of extended congregate care residents in accordance with rule 59A-36.010,

F.A.C., and to provide the services established in each resident’s service plan. (d) Ensure that adequate staff is awake during all hours to meet the scheduled and unscheduled needs of residents. (e) Immediately provide additional or appropriately qualified staff, when the agency determines that service plans are not being

followed or that residents’ needs are not being met because insufficient staffing, in accordance with the staffing standards established in rule 59A-36.010, F.A.C.

(f) Ensure and document that staff receive extended congregate care training as required in rule 59A-36.011, F.A.C. (4) ADMISSION AND CONTINUED RESIDENCY. (a) An individual must meet the following minimum criteria in order to receive extended congregate care services: 1. Be at least 18 years of age; 2. Be free from signs and symptoms of a communicable disease that is likely to be transmitted to other residents or staff;

however, an individual who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that he or she would otherwise be eligible for admission according to this rule;

3. Be able to transfer, with assistance if necessary. The assistance of more than one individual is permitted; 4. Not be a danger to self or others as determined by a health care provider or mental health practitioner licensed under chapter

490 or 491, F.S.; 5. Not be bedridden; 6. Not have any stage 3 or 4 pressure sores; 7. Not require any of the following nursing services: a. Artificial airway management of any kind except that of continuous positive airway pressure may be provided through the use

of a CPAP or bipap machine, b. Nasogastric tube feeding, c. Monitoring of blood gases, d. Management of post-surgical drainage tubes or wound vacuums, e. Skilled rehabilitative services as described in rule 59G-4.290, F.A.C., or f. Treatment of a surgical incision, unless the surgical incision and the condition that caused it have been stabilized and a plan of

care developed. The plan of care must be maintained in the resident’s record at the facility. 8. Not require 24-hour nursing supervision; and, 9. Have been determined to be appropriate for admission to the facility by the facility administrator or manager. The

administrator or manager must base his or her decision on: a. An assessment of the strengths, needs, and preferences of the individual, the health assessment required by subsection (6) of

this rule, and the preliminary service plan developed in subsection (7), b. The facility’s residency criteria, and services offered or arranged for by the facility to meet resident needs; and, c. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in rule chapter

69A-40, F.A.C. (b) Criteria for continued residency in an extended congregate care services must be the same as the criteria for admission,

except as specified below. 1. A resident may be bedridden for up to 14 consecutive days. 2. A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the

following conditions are met: a. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice that coordinates and ensures the

provision of any additional care and services that may be needed, b. Continued residency is agreeable to the resident and the facility, c. An interdisciplinary care plan, which specifies the services being provided by hospice and those being provided by the

facility, is developed and implemented by a licensed hospice in consultation with the facility; and, d. Documentation of the requirements of subparagraph (5)(b)2., is maintained in the resident’s file.

3. The extended congregate care administrator or manager is responsible for monitoring the appropriateness of continued residency of a resident in extended congregate care services at all times.

4. A hospice resident that meets the qualifications of continued residency pursuant to this rule may only receive services from the assisted living facility’s staff within the scope of the facility’s license.

5. Staff may provide any nursing service permitted under the facility’s license and total help with the activities of daily living for residents admitted to hospice. Staff may not exceed the scope of their professional licensure or training in any licensed assisted living facility.

(5) HEALTH ASSESSMENT. Before receiving extended congregate care services, all persons. including residents transferring within the same facility to that portion of the facility licensed to provide extended congregate care services, must be examined by a health care provider pursuant to rule 59A-36.006, F.A.C. A health assessment conducted no more than 60 days before receiving extended congregate care services meets this requirement. Once receiving services, a new health assessment must be obtained at least annually.

(6) SERVICE PLANS. (a) Before receiving services, the extended congregate care administrator or manager must develop a preliminary service plan

that includes an assessment of whether the resident meets the facility’s residency criteria, an appraisal of the resident’s unique physical, psychological and social needs and preferences, and an evaluation of the facility’s ability to meet the resident’s needs.

(b) Within 14 days of receiving services, the extended congregate care administrator or manager must coordinate the development of a written service plan that takes into account the resident’s health assessment obtained pursuant to subsection (6); the resident’s unique physical, psychological and social needs and preferences; and how the facility will meet the resident’s needs including the following if required:

1. Health monitoring, 2. Assistance with personal care services, 3. Nursing services, 4. Supervision, 5. Special diets, 6. Ancillary services, 7. The provision of other services such as transportation and supportive services; and, 8. The manner of service provision, and identification of service providers, including family and friends, in keeping with

resident preferences. (c) Pursuant to the definitions of “shared responsibility” and “managed risk” as provided in section 429.02, F.S., the service

plan must be developed and agreed upon by the resident or the resident’s representative or designee, surrogate, guardian, or attorney-in-fact, and must reflect the responsibility and right of the resident to consider options and assume risks when making choices pertaining to the resident’s service needs and preferences.

(d) The service plan must be reviewed and updated quarterly to reflect any changes in the manner of service provision, accommodate any changes in the resident’s physical or mental status, or pursuant to recommendations for modifications in the resident’s care as documented in the nursing assessment.

(7) EXTENDED CONGREGATE CARE SERVICES. All services must be provided in the least restrictive environment, and in a manner that respects the resident’s independence, privacy, and dignity.

(a) A facility providing extended congregate care services may provide supportive services including social service needs, counseling, emotional support, networking, assistance with securing social and leisure services, shopping service, escort service, companionship, family support, information and referral, assistance in developing and implementing self-directed activities, and volunteer services. Family or friends must be encouraged to provide supportive services for residents. The facility must provide training for family or friends to enable them to provide supportive services in accordance with the resident’s service plan.

(b) A facility providing extended congregate care services must make available the following additional services if required by the resident’s service plan:

1. Total help with bathing, dressing, grooming and toileting, 2. Nursing assessments conducted more frequently than monthly, 3. Measurement and recording of basic vital functions and weight, 4. Dietary management including provision of special diets, monitoring nutrition, and observing the resident’s food and fluid

intake and output, 5. Assistance with self-administered medications, or the administration of medications and treatments pursuant to a health care

provider’s order. If the individual needs assistance with self-administration the facility must inform the resident of the qualifications of staff who will be providing this assistance, and if unlicensed persons will be providing such assistance, obtain the resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s informed written consent to provide such assistance as required in section 429.256, F.S.,

6. Supervision of residents with dementia and cognitive impairments, 7. Health education and counseling and the implementation of health-promoting programs and preventive regimes, 8. Provision or arrangement for rehabilitative services; and, 9. Provision of escort services to health-related appointments. (c) Nursing staff providing extended congregate care services may provide any nursing service permitted within the scope of

their license consistent with the residency requirements of this rule and the facility’s written policies and procedures, provided the nursing services are:

1. Authorized by a health care provider’s order and pursuant to a plan of care, 2. Medically necessary and appropriate for treatment of the resident’s condition, 3. In accordance with the prevailing standard of practice in the nursing community, 4. A service that can be safely, effectively, and efficiently provided in the facility, 5. Recorded in nursing progress notes; and, 6. In accordance with the resident’s service plan. (d) At least monthly, or more frequently if required by the resident’s service plan, a nursing assessment of the resident must be

conducted. (8) RECORDS. In addition to the records required in rule 59A-36.015, F.A.C., a facility providing extended congregate care

services must maintain the following: (a) The service plans for each resident receiving extended congregate care services; (b) The nursing progress notes for each resident receiving nursing services; (c) Nursing assessments; and, (d) The facility’s extended congregate care policies and procedures. (9) DISCHARGE. If the facility and the resident are unable to agree on a service plan, the facility is unable to meet the

resident’s needs as identified in the service plan, or the resident no longer meets the criteria for continued residency, the resident must be discharged or relocated in accordance with sections 429.26 and 429.28, F.S.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.28, 429.41 FS. History–New 9-30-92, Formerly 10A-5.030, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 4-17-14, 5-10-18, Formerly 58A-5.030, 7-1-19.

59A-36.022 Limited Nursing Services. Any facility intending to provide limited nursing services must obtain a license from the agency.

(1) NURSING SERVICES. In addition to any nursing service permitted under a standard license pursuant to section 429.255, F.S., a facility with a limited nursing services license may provide nursing care to residents who do not require 24-hour nursing supervision and to residents who do require 24-hour nursing care and are enrolled in hospice.

(2) RESIDENT CARE STANDARDS. (a) A resident receiving limited nursing services in a facility holding only a standard and limited nursing services license must

meet the admission and continued residency criteria specified in rule 59A-36.006, F.A.C. (b) In accordance with rule 59A-36.010, F.A.C., the facility must employ sufficient and qualified staff to meet the needs of

residents requiring limited nursing services based on the number of such residents and the type of nursing service to be provided. (c) Limited nursing services may only be provided as authorized by a health care provider’s order, a copy of which must be

maintained in the resident’s file. (d) Facilities licensed to provide limited nursing services must employ or contract with a nurse(s) who must be available to

provide such services as needed by residents. The facility’s employed or contracted nurse must coordinate with third party nursing services providers to ensure resident care is provided in a safe and consistent manner. The facility must maintain documentation of the qualifications of nurses providing limited nursing services in the facility’s personnel files.

(e) The facility must ensure that nursing services are conducted and supervised in accordance with chapter 464, F.S., and the prevailing standard of practice in the nursing community.

(3) RECORDS. (a) A record of all residents receiving limited nursing services and the type of services provided must be maintained at the

facility. (b) Nursing progress notes must be maintained for each resident who receives limited nursing services. (c) A nursing assessment conducted at least monthly must be maintained on each resident who receives a limited nursing

service.

Rulemaking Authority 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.41 FS. History–New 9-30-92, Formerly 10A-5.031, Amended 10-30-95, 10-17-99, 7-30-06, 3-13-14, 5-10-18, Formerly 58A-5.031, 7-1-19.

59A-36.023 Administrative Enforcement. Facility staff must cooperate with agency personnel during surveys, complaint investigations, monitoring visits, license application and renewal procedures and other activities necessary to ensure compliance with Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter.

(1) Abbreviated Survey. (a) An applicant for license renewal who does not have any class I or class II violations or uncorrected class III violations,

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

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

1. Section 429.26, F.S., and Rule 58A-5.0181, F.A.C., relating to residency criteria; 2. Section 429.27, F.S., and Rule 58A-5.021, F.A.C., relating to proper management of resident funds and property; 3. Section 429.28, F.S., and Rule 58A-5.0182, F.A.C., relating to respect for resident rights; 4. Section 429.41, F.S., and Rule 58A-5.0182, F.A.C., relating to the provision of supervision, assistance with the activities of

daily living, and arrangement for appointments and transportation to appointments; 5. Section 429.256, F.S., and Rule 58A-5.0185, F.A.C., relating to assistance with or administration of medications; 6. Section 429.41, F.S., and Rule 58A-5.019, F.A.C., relating to the provision of sufficient staffing to meet resident needs; 7. Section 429.41, F.S., and Rule 58A-5.020, F.A.C., relating to minimum dietary requirements and proper food hygiene; 8. Section 429.075, F.S., and Rule 58A-5.029, F.A.C., relating to mental health residents’ community support living plan; 9. Section 429.07, F.S., and Rule 58A-5.030, F.A.C., relating to meeting the environmental standards and residency criteria in a

facility with an extended congregate care license; and 10. Section 429.07, F.S., and Rule 58A-5.031, F.A.C., relating to the provision of care and staffing in a facility with a limited

nursing services license. (c) The agency will expand the abbreviated survey or conduct a full survey if violations which threaten or potentially threaten

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

1. Violations of Rule Chapter 69A-40, F.A.C., relating to firesafety, that threaten the life or safety of a resident; 2. Violations relating to staffing standards or resident care standards that adversely affect the health, safety, or welfare of a

resident; 3. Violations relating to facility staff rendering services for which the facility is not licensed; or 4. Violations relating to facility medication practices that are a threat to the health, safety, or welfare of a resident. (2) Survey Deficiency. (a) Before or in conjunction with a notice of violation issued pursuant to Part II, Chapter 408, F.S., and Section 429.19, F.S., the

agency shall issue a statement of deficiency for class I, II, III, and IV violations which are observed by agency personnel during any inspection of the facility. The deficiency statement must be issued within 10 working days of the agency’s inspection and must include:

1. A description of the deficiency; 2. A citation to the statute or rule violated; and 3. A time frame for the correction of the deficiency. (b) Additional time may be granted to correct specific deficiencies if a written request is received by the agency before the

expiration of the time frame included in the agency’s statement. (3) Employment of A Consultant. (a) Medication Deficiencies. 1. If a class I, class II, or uncorrected class III deficiency directly relating to facility medication practices as established in Rule

58A-5.0185, F.A.C., is documented by agency personnel pursuant to an inspection of the facility, the agency must notify the facility in writing that the facility must employ or contract the services of a pharmacist licensed pursuant to Section 465.0125, F.S., or registered nurse as determined by the agency.

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

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

(b) Dietary Deficiencies. 1. If a class I, class II, or uncorrected class III deficiency directly related to dietary standards as established in Rule 58A-5.020,

F.A.C., is documented by agency pursuant to an inspection of the facility, the agency must notify the facility in writing that the facility must employ or contract the services of a registered or licensed dietitian, or a licensed nutritionist.

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

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

Rulemaking Authority 429.41, 429.42 FS. Law Implemented 429.19, 429.34, 429.41, 429.42 FS. History–New 9-30-92, Formerly 10A-5.033, Amended 10-30-95, 10-17-99, 1-9-02, 7-30-06, 4-15-10, 3-13-14, Formerly 58A-5.033, 7-1-19.

59A-36.024 Waivers. The agency, in consultation with the department, may waive rules promulgated pursuant to part I, chapter 429, F.S., if the waiver request meets the conditions set forth in section 429.41(4), F.S., and demonstrates and evaluates innovative or cost-effective congregate care alternatives which will enable individuals to age in place.

(1) Application Process. (a) Licensed assisted living facilities proposing a waiver under this statute must submit the request in writing. All requests must

include the facility name and address, license number, administrator’s name and contact information for the requestor, or its attorney. Petitions for waiver of rules other than for the objectives detailed in section 429.41(4), F.S., including emergency waivers, will not be considered under this section but should follow the petition for waiver provisions of section 120.542, F.S., and rule chapter 28-104, Variance or Waiver, F.A.C.

(b) The written request must address the elements required in section 429.41(4), F.S. In addition, the following information must be included in order to demonstrate how a waiver of the stated rule will permit development of a concept that will achieve the purpose of the underlying statute:

1. The rule or rules for which the waiver is requested. 2. The licensee’s anticipated date or dates for implementation of the concept. 3. If applying based on cost-effectiveness or cost-savings, a cost-benefit analysis of the proposed alternative to both residents or

potential residents as well as facility operations. 4. An analysis of the impact the alternative will have on the relevant local community, including any barriers such as zoning or

use issues, which may need resolution prior to implementation. 5. Specific performance measures with an annual projection of objectives and goals to be achieved broken into quarterly

increments or an annual projection of outcome measures, if the concept will be implemented in less than 90 days. 6. If applying based on cost-effectiveness or cost-savings, an annual budget projection for the proposed alternative broken into

quarterly increments. (c) A waiver can be requested at the time of the initial license application, relicensure, or any time during the licensure period. (d) Waiver requests must be submitted to the Agency for Health Care Administration, Assisted Living Unit, 2727 Mahan Drive,

Mail Stop 30, Tallahassee, Florida 32308-5403. (2) In accordance with section 120.542(6), F.S., the agency shall post notice of the request within fifteen (15) days of receipt of

the request. The agency shall make any requests for additional information within 30 days of receipt of the request. If additional information is provided, the agency may request clarification of only that information no later than 30 days following receipt of the information. The agency shall process the waiver request pursuant to the time frame referenced in section 120.542(8), F.S.

(3) The agency, in consultation with the department, will evaluate all requests in light of the likelihood the concept, as described in detail, will achieve the underlying statutory objectives of innovative or cost effective congregate care alternatives to enable individuals to age in place, as provided in section 429.41(4), F.S. Waivers may be granted only so long as there is reasonable assurance that the health, safety or welfare of residents will not be endangered by the waiver.

(4) The agency shall grant or deny the request for waiver and enter an order summarizing the facts it relied on and reasons supporting its decision. The agency must provide notice of its order as described in section 120.542(8), F.S. The requestor shall be advised that a denial of the request may be reviewed as provided in subsection (5) of this rule.

(5) Report of Findings. A facility that has been granted a waiver must submit an annual report within 12 months of the order granting the waiver as specified in section 429.41(4), F.S. If the report is not submitted as required, the agency may revoke the waiver.

(a) The agency will review the report of findings to determine whether the waiver shall be renewed or revoked. The agency shall make the determination based on whether the facility has met the requirements outlined in subparagraph (1)(b) of this rule. The agency shall enter an order providing the general basis for making its decision and notify the licensee of its opportunity to seek review of a revocation in accordance with sections 120.569 and 120.57, F.S. and rule 28-106.111, F.A.C.

(b) The agency may also consider other material which is available relative to this review. (c) A waiver is effective unless revoked by the agency or superseded by statutory or regulatory change. (d) In reviewing the report of findings, the agency, in consultation with the department, shall assess whether statutory or

regulatory changes should be pursued to enable other facilities to adopt the same practices.

Rulemaking Authority 429.41 FS. Law Implemented 120.542, 429.41 FS. History–New 9-30-92, Formerly 10A-5.035, Amended 10-30-95, 7-1-08, 4-17-14, Formerly 58A-5.035, 7-1-19.

59A-36.025 Emergency Environmental Control for Assisted Living Facilities. (1) DETAILED EMERGENCY ENVIRONMENTAL CONTROL PLAN. Each assisted living facility shall prepare a detailed

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

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

1. The required temperature must be maintained in an area or areas, determined by the assisted living facility, of sufficient size

to maintain residents safely at all times and that is appropriate for resident care needs and life safety requirements. For planning purposes, no less than twenty (20) net square feet per resident must be provided. The assisted living facility may use eighty percent (80%) of its licensed bed capacity as the number of residents to be used in the calculation to determine the required square footage. This may include areas that are less than the entire assisted living facility if the assisted living facility’s comprehensive emergency management plan includes allowing a resident to congregate when he or she desires in portions of the building where temperatures will be maintained and includes procedures for monitoring residents for signs of heat related injury as required by this rule. This rule does not prohibit a facility from acting as a receiving provider for evacuees when the conditions stated in section 408.821, F.S. and subsection 59A-36.019(5), F.A.C., are met. The plan shall include information regarding the area(s) within the assisted living facility where the required temperature will be maintained.

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

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

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

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

c. A multistory facility, whose comprehensive emergency management plan is to move residents to a higher floor during a flood or surge event, must place its alternative power source and all necessary additional equipment so it can safely operate in a location protected from flooding or storm surge damage.

(b) The acquisition of sufficient fuel, and safe maintenance of that fuel at the facility, to ensure that in the event of the loss of primary electrical power there is sufficient fuel available for the alternate power source to maintain ambient temperatures at or below 81 degrees Fahrenheit for a minimum of ninety-six (96) hours after the loss of primary electrical power during a declared state of emergency. The plan must include information regarding fuel source and fuel storage.

1. Facilities must store minimum amounts of fuel onsite as follows: a. A facility with a licensed capacity of 16 beds or less must store 48 hours of fuel onsite. b. A facility with a licensed capacity of 17 or more beds must store 72 hours of fuel onsite. 2. An assisted living facility located in an area in a declared state of emergency area pursuant to section 252.36, F.S. that may

impact primary power delivery must secure ninety-six (96) hours of fuel. The assisted living facility may utilize portable fuel storage containers for the remaining fuel necessary for ninety-six (96) hours during the period of a declared state of emergency.

3. Piped natural gas is an allowable fuel source and meets the onsite fuel supply requirements under this rule. 4. If local ordinances or other regulations limit the amount of onsite fuel storage for the assisted living facility’s location, then

the assisted living facility must develop a plan that includes maximum onsite fuel storage allowable by the ordinance or regulation and a reliable method to obtain the maximum additional fuel at least 24 hours prior to depletion of onsite fuel.

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

(d) The acquisition and maintenance of a carbon monoxide alarm. (2) SUBMISSION OF THE PLAN. (a) Each assisted living facility licensed prior to the effective date of this rule shall submit its plan to the local emergency

management agency for review within 30 days of the effective date of this rule. Assisted living facility plans previously submitted and approved pursuant to emergency rule 58AER17-1 will require resubmission only if changes are made to the plan.

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

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

(3) APPROVED PLANS. (a) Each assisted living facility must maintain a copy of its approved plan in a manner that makes the plan readily available at

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

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

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

(4) IMPLEMENTATION OF THE PLAN. (a) Each assisted living facility licensed prior to the effective date of this rule shall, no later than June 1, 2018, have

implemented the plan required under this rule. (b) The Agency shall allow an extension up to January 1, 2019 to providers in compliance with paragraph (c) below and who

can show delays caused by necessary construction, delivery of ordered equipment, zoning or other regulatory approval processes. Assisted living facilities shall notify the Agency that they will utilize the extension and keep the Agency apprised of progress on a quarterly basis to ensure there are no unnecessary delays. If an assisted living facility can show in its quarterly progress reports that unavoidable delays caused by necessary construction, delivery of ordered equipment, zoning or other regulatory approval processes will occur beyond the initial extension date, the assisted living facility may request a waiver pursuant to section 120.542, F.S.

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

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

2. An assisted living facility located in an evacuation zone pursuant to chapter 252, F.S. must either: a. Fully and safely evacuate its residents prior to the arrival of the event; or b. Have an alternative power source and no less than ninety-six (96) hours of fuel stored onsite, within twenty-four (24) hours of

the issuance of a state of emergency for the area of the assisted living facility. (d) Each new assisted living facility shall implement the plan required under this rule prior to obtaining a license. (e) Existing assisted living facilities that undergo any additions, modifications, alterations, refurbishment, renovations or

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

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

(5) POLICIES AND PROCEDURES. (a) Each assisted living facility shall develop and implement written policies and procedures to ensure that the assisted living

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

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

refrigeration; 3. Wellness checks by assisted living facility staff to monitor for signs of dehydration and heat injury; and 4. A provision for obtaining medical intervention from emergency services for residents whose life safety is in jeopardy. (b) Each assisted living facility shall maintain the written policies and procedures in a manner that makes them readily available

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

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

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

(7) COMPREHENSIVE EMERGENCY MANAGEMENT PLAN. (a) Assisted living facilities whose comprehensive emergency management plan is to evacuate must comply with this rule. (b) Each facility whose plan has been approved shall submit the plan as an addendum with any future submissions for approval

of its comprehensive emergency management plan. (8) NOTIFICATION. (a) Within five (5) business days, each assisted living facility must notify in writing, unless permission for electronic

communication has been granted, each resident and the resident’s legal representative: 1. Upon submission of the plan to the local emergency management agency that the plan has been submitted for review and

approval; 2. Upon final implementation of the plan by the assisted living facility. (b) Each assisted living facility must maintain a copy of each notification set forth in paragraph (a) above in a manner that

makes each notification readily available at the licensee’s physical address for review by a legally authorized entity. If the notifications are maintained in an electronic format, facility staff must be readily available to access and produce the notifications. For purposes of this section, “readily available” means the ability to immediately produce the notifications, either in electronic or paper format, upon request.

Rulemaking Authority 429.41, FS. Law Implemented 429.19, 429.41, FS. History–New 3-26-18, Formerly 58A-5.036, 7-1-19.

59A-36.027 ALF Core Training Provider Qualifications. (1) PRIMARY REQUIREMENTS. In order to register as an assisted living facility core training provider (hereafter referred to

as “core training provider,” “training provider,” or “provider”), all applicants must meet the requirements outlined in section 429.52(10), F.S. The requirements are as follows:

(a) Completion of the minimum core training requirements developed by the department pursuant to section 429.52(9), F.S., and rule 59A-36.028, F.A.C.;

(b) Successful passage of the competency test, which requires a minimum score of 75%; and, (c) Compliance with the minimum of 12 contact hours of continuing education in topics related to assisted living every 2 years

pursuant to section 429.52(5), F.S., and paragraph 58A-5.0191(1)(c), F.A.C. (2) ADDITIONAL REQUIREMENTS. In addition to meeting the 3 primary requirements set forth in subsection (1), of this

rule, applicants must meet one of the requirements outlined in section 429.52(11), F.S., or one of the requirements established in this subsection. The requirements are as follows:

(a) A minimum of 5 years of employment with the Agency for Health Care Administration (AHCA), or formerly the Department of Health and Rehabilitative Services, as a surveyor of assisted living facilities; or

(b) A minimum of 5 years of employment in a professional position in the AHCA Assisted Living Unit; or (c) A minimum of 5 years of employment as an educator or staff trainer for persons working in an ALF or other long-term care

(LTC) settings; or (d) A minimum of 5 years of employment as an assisted living facility core trainer, which was not directly associated with the

department; or (e) A minimum of a 4-year degree from an accredited college or university in areas of healthcare, gerontology, social work,

education or human services; and a minimum of 3 years experience as an educator or staff trainer for persons working in an ALF or other LTC settings after core certification.


59A-36.028 ALF Minimum Core Training Curriculum Requirements. (1) CURRICULUM REQUIREMENTS. An approved core training provider must conduct core training using the curriculum

outlined in DOEA Form ALFCT-001, Assisted Living Facility Minimum Core Training Curriculum, June, 2009, which is incorporated by reference in this rule. The curriculum is available from the Department of Elder Affairs, Elder Housing Unit, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 or the department’s website at: http://elderaffairs.state.fl.us/english/ruleforms/ALFCT-001.doc.

(2) MONITORING. The department reserves the right to do the following: (a) Attend and monitor core training courses; (b) Review provider records and course materials pursuant to this rule; and, (c) Conduct on-site monitoring, follow-up monitoring, and require implementation of a corrective action plan if the provider

does not adhere to the approved curriculum.


59A-36.029 ALF Core Training Provider Initial Registration Process. (1) REGISTRATION PROCESS. (a) Before core training can be conducted, an applicant must meet the training provider qualifications outlined in section

429.52(10), F.S., and rule 59A-36.027, F.A.C. Additionally, an applicant must register with, and obtain from, the department a unique provider registration number as set forth in this subsection.

(b) An applicant must complete DOEA Form ALFCT-002, Application for Assisted Living Facility (ALF) Core Training Provider Registration, June, 2009. The form is hereby incorporated by reference and may be obtained from the Department of Elder Affairs, Elder Housing Unit, 4040 Esplanade Way, Tallahassee, Florida 32399-7000 or the department’s website at: http://elderaffairs.state.fl.us/english/ruleforms/ALFCT-002.doc.

(2) APPROVAL PROCESS. Within 30 calendar days after receiving a core training provider application, the department must submit written notification approving or denying the application, or requesting supplemental information or clarification.

(a) If the application is approved, the department must include a unique provider registration number in the notice. (b) If the application is denied, the department must provide the reason or reasons for denial in the notice. (c) If the application is determined to require supplemental information or clarification, the department must state the

supplemental information or clarification that is being requested. 1. If the department does not receive the requested information within 30 calendar days of the request, the application will be

deemed incomplete and closed. 2. If the department receives the requested information within 30 calendar days of the request, the department must process the

training provider application within 30 calendar days after all required information is received.


59A-36.030 Process for Maintaining ALF Core Training Provider Registration. (1) MAINTAINING ALF CORE TRAINING PROVIDER REGISTRATION. (a) After receiving the initial core training provider registration, the approved provider must re-register with the department

every 2 years by submitting documentation of his or her compliance with the continuing education requirement as specified in section 429.52(5), F.S., and this rule.

(b) The provider must submit the documentation to the address referenced on DOEA Form ALFCT-001. It must be submitted no later than 30 calendar days after each two-year continuing education cycle. The 2-year cycle begins on the date of the initial training provider registration. Documentation must include the following:

1. Title of the training program; 2. Subject matter of the training program; 3. The training program agenda including topics discussed; 4. The core training provider’s name and registration number; 5. Date(s) of participation; 6. Number of hours of the training program; and 7. The continuing education training provider’s name, signature, credentials, and professional license number, if applicable. (2) APPROVAL PROCESS. (a) Within 30 calendar days after receiving the required continuing education documentation, the department must notify the

provider in writing that the continuing education requirement: 1. Has been met; or 2. Has not been met and the reasons why; or 3. Has omissions or additional information is requested. a. If the department does not receive the omitted or additional information within 30 calendar days of the request, the provider’s

registration shall be cancelled. The department must provide written notification of its decision, including the reason for the cancellation, no later than 30 calendar days after the deadline for the request for the omitted or additional information.

b. If the department receives the omitted or additional information as requested within the 30 calendar day time period, the department must process the core training provider’s registration within 30 calendar days after all required information is received. The department must provide written notification to the provider of its decision.

(b) Failure to submit proof of the continuing education requirement as specified in this rule shall result in cancellation of the core training provider’s registration. The department must provide written notification of such action no later than 30 calendar days after the information was due.

(c) If the provider’s registration is cancelled under paragraphs (a) and (b) of this subsection, and the provider subsequently meets the continuing education requirement, he or she may re-apply for registration as specified in rule 59A-36.029, F.A.C., and include documentation that the continuing education requirement has been met pursuant to this rule.


59A-36.031 Registered ALF Core Training Provider Responsibilities. The following are the responsibilities of a registered core training provider:

(1) USE OF MINIMUM CORE TRAINING CURRICULUM. A registered core training provider is responsible for the following:

(a) Conducting core training using the minimum core training curriculum required by rule 59A-36.028, F.A.C.; and (b) Ensuring that all changes in ALF statutes and rules are immediately incorporated into the contents of his or her core training

curriculum. (2) CERTIFICATES. After a trainee successfully completes core training, the approved training provider must issue a

certificate to him or her. In addition to the provider’s unique registration number, the certificate must include the information referenced in paragraph 58A-5.0191(12)(a), F.A.C. The provider’s signature and registration number shall serve as documentation that the trainee has completed the required training.

(3) RECORDS. Approved providers must maintain records of each course taught for a minimum of 5 years. Course records must include the following information:

(a) The title of the training program; (b) The agenda; (c) The curriculum and any accompanying documentation and training aids; (d) The training provider’s name and registration number; (e) The trainees’ names, dates of participation and training location; and (f) Training evaluations and roster signed by trainees. (4) COMPETENCY EXAM. (a) Approved training providers must submit the names of trainees completing core training to the testing authority within 10

calendar days after completion of the course. Names must be submitted to the following address: ALF Certification Testing,

University of South Florida, 4202 E. Fowler Avenue, EDU105, Tampa, Florida 33620. Names may be alternately submitted via email to [email protected].

(b) The testing authority shall not process any requests for the competency exam, nor sit any individual for the exam, unless proper notice is submitted by an approved training provider pursuant to paragraph (a), of this subsection.

(5) GUEST SPEAKERS. If a core training provider uses guest trainers to teach or participate in specific training modules covered in the minimum core training curriculum referenced in rule 59A-36.028, F.A.C., the core trainer is responsible to ensure that the guest speaker meets the following minimum conditions:

(a) Has expertise in the specific subject matter; and (b) Covers all components of the subject matter if he or she provides the module or portion of the module instruction.


7. Rule Chapter

64E-11, F.A.C

.

Transferred to 59A-36 6B – 61

CHAPTER 64E-11

FOOD HYGIENE 64E-11.001 Food Hygiene General (Repealed)

64E-11.002 Definitions

64E-11.003 Food Hygiene Standards Supplies

64E-11.004 Food Protection (Repealed)

64E-11.005 Personnel (Repealed)

64E-11.006 Food Equipment and Utensils (Repealed)

64E-11.007 Sanitary Facilities and Controls (Repealed)

64E-11.008 Other Facilities and Operations (Repealed)

64E-11.009 Temporary Food Service Events (Repealed)

64E-11.010 Vending Machines (Repealed)

64E-11.011 Procedure When Infection Is Suspected

64E-11.012 Manager Certification

64E-11.013 Sanitation Certificates and Fees

64E-11.014 Mobile Food Units

64E-11.015 Afterschool Meal Program

64E-11.001 Food Hygiene General.

Rulemaking Authority 381.0072 FS. Law Implemented 381.0072 FS. History–New 1-1-77, Formerly 10D-13.21,

Amended 2-21-91, Retained here and Transferred to 7C-4.008, Amended 6-1-93, 8-28-96, Formerly 10D-13.021,

Repealed 12-29-16.

64E-11.002 Definitions.

Unless defined below, terms and phrases have the same definition provided in paragraph 1-201.10(B), Food Code,

2013 Recommendations of the United States Public Health Service, Food and Drug Administration, NTISP PB2013-

110462 (“Food Code”). The Food Code is incorporated by reference and available at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09894.

(1) “Adulterated” – Food shall be considered to be adulterated:

(a) If it bears or contains any poisonous or deleterious substance which may render it injurious to health; but in

case the substance is not an added substance such food shall not be considered adulterated under this clause if the

quantity of such substance in such food does not ordinarily render it injurious to health, or

(b) If it bears or contains any added poisonous or added deleterious substance, other than one which is a pesticide

chemical in or on a raw agricultural commodity, which in or on the raw agricultural commodity has been removed to

the extent possible in good manufacturing practice, and the concentration of such residue in the processed food when

ready to eat, is not greater than the tolerance prescribed for the raw agricultural commodity, or

(c) If it consists in whole or in part of a diseased, contaminated, filthy, putrid, or decomposed substance, which

renders it unfit for consumption, or

(d) If it has been produced, prepared, packed or held under insanitary conditions whereby it may become

contaminated with filth, or whereby it may have been rendered diseased, unwholesome, or injurious to health, or

(e) If it is the product of a diseased animal, an animal which has died otherwise than by slaughter, or an animal

that has been fed the uncooked offal from a slaughter house, or from other food establishments, or


(f) If its container is composed, in whole or in part, of any poisonous or deleterious substance which may render

the contents injurious to health.

(2) “Air gap” – The unobstructed vertical distance, through the free atmosphere, between the lowest opening from

any pipe or faucet supplying water to a tank, plumbing fixture, or other device and the flood-level rim of the receptacle,

or the lowest opening from any waste outlet pipe and the flood-level rim of the receptacle.

(3) “Air Curtain” – A mechanical device which produces a controlled plane of moving air at a minimum velocity

of 500 feet per minute across the opening protected and directed so as to prevent the entrance of flying insects and

other airborne contaminants.

(4) Approved Source – Food originated from an establishment that is under the regulatory authority of a state or

federal agency.

(5) Bars and Lounges – A facility which possesses a consumption on premises alcoholic beverage license from

the Division of Alcoholic Beverages & Tobacco; where food service is limited to:

(a) The preparation of drinks; or

(b) The service of snack foods (such as, chips, popcorn and pretzels); or

(c) The service of time/temperature control for safety foods and no preparation of time/temperature control for

safety food occurs.

(6) Catering Operation – A food service establishment operation that prepares food at one location for delivery to

and individual portion service at another location.

(7) Civic – Any organization, excluding Division of Blind Services, who offers food service to the public; and,

(a) Possesses tax exempt status under 26 U.S.C. section 501(c)(4), or

(b) Is incorporated and operates primarily to further the common good and general welfare of the people of the

community, whether for profit or not.

(8) “Commissary” – A food service establishment or any other commercial establishment where food, containers,

or supplies are stored, prepared, or packaged, or where utensils are sanitized for transit to, and sale or service at, other

locations.

(9) Community Based Residential Facility – A facility as defined in rule 64E-12.002, of the Florida Adminstrative

Code.

(10) Extensively Remodeled – Structural changes to an existing establishment which costs in excess of 50 percent

of the establishment’s assessed value, as indicated by the county property appraiser.

(11) “Fixed food establishment” – A food service establishment which operates at a specific location and is

connected to electrical, water, and sewage disposal systems.

(12) “Food preparation” – The manipulation of foods intended for human consumption by such means as washing,

slicing, peeling, chipping, shucking, scooping, and/or portioning. The term also includes those activities involving

temperature changes, combining ingredients, opening ready-to-eat food packages, or any other activity causing

physical or chemical alterations in the food.

(13) Fraternal – An organization primarily operating for social, intellectual, educational, charitable, benevolent,

moral, patriotic, or religious purposes for the benefit of its members, that offers food service to its members or the

public at their facility and possesses a charter.

(14) Frankfurter – As defined in 9 C.F.R. §319.180 (01-01-2018) herein incorporated by reference and available

at https://www.flrules.org/Gateway/reference.asp?No=Ref-09895.


(15) “Garbage” – Food waste generated on premises that is not disposed of through the sewage disposal system.

The term also includes solid waste such as discarded containers or wrappers that are contaminated with food waste.

(16) Highly Susceptible Population – A group of persons who are more likely than other populations to experience

foodborne disease because they are immunocompromised, institutionalized older adults, preschool age children in

custodial care, or elementary school age children.

(17) Hot Water – A minimum water temperature of 100 degrees Fahrenheit or above.

(18) “Indirect waste connection” – An indirect waste connection is a liquid waste pipe that is connected with the

sewerage system through an air gap or air break.

(19) Limited Food Service Operation – Any establishment with a food service operation, so limited by the type

and quantity of foods prepared and the equipment utilized, that it poses a lesser degree of risk to the public’s health,

and, for the purpose of fees, requires less time to monitor. The term includes small seasonally operated concessions

stands at schools, regardless of the level of food preparation, provided the concession stand is only operated in

conjunction with sporting events, festivals, or similar activites, as well as satellite kitchens that dispense catered meals

and similar facilities.

(20) “Manager” – An individual who has direct authority, control or supervision over employees engaged in the

storage, preparation, display and serving of food to the public.

(21) “Misbranded” – Food shall be considered to be misbranded:

(a) If in packaged form it lacks a label containing the name and place of business of the manufacturer, packer, or

distributor; or an accurate statement of the contents, or

(b) If it is offered for sale under the name of another food, or

(c) If it purports to be or is represented as a food for which a definition and standard of identity has been prescribed

and it is not.

(22) “Mobile food unit” – Any food service unit which is self-propelled or otherwise moveable from place to

place and is self-sufficient for utilities, such as gas, water, electricity and liquid waste disposal, whose commissary is

a DOH regulated food service establishment.

(23) Perishable Food – Any food of such type or in such condition as may spoil. Food contained in hermetically

sealed containers processed by heat or other means to prevent spoilage and properly packaged, dehydrated, dried or

powdered foods so low in moisture content as to retard development of microorganisms are not considered readily

perishable.

(24) “Plumbing authority” – The local governing body, such as a county or city building inspection department

which has adopted a plumbing code and has authority to interpret, inspect, and provide enforcement of plumbing

standards.

(25) Premises – The physical food service establishment and the contiguous land or property under the control of

the manager, operator or owner of the establishment.

(26) “Product thermometer” – A thermometer, thermocouple, thermistor or other device that when inserted into

food indicates the temperature of the food. This term does not include non-product ambient temperature sensing

devices.

(27) “Reconstitute” – The recombination of dehydrated food products with potable water or other suitable liquids.

(28) “Sanitation Certificate” – A license issued by the department to operate a food service establishment.

(29) Safe Temperature – 135 degrees Fahrenheit or above or 41 degrees Fahrenheit or below.


(30) Snack – A commercially pre-packaged, non-time/temperature control for safety ready-to-eat-food item that

is wrapped for individual consumption.

(31) “Temporary food service event” – Any event offering food service on the premises of a food service

establishment approved by the department. These events are at a fixed location for a temporary period of time not to

exceed any combination of 18 days within a calendar year and in conjunction with a single event or celebration.

(32) Theater – A facility that shows motion pictures and offers food, such as popcorn, hot dogs, soft drinks, nachos

and cheese, and pre-packaged snack items, for consumption by the admittees of such theaters.

(33) “Wholesome” – Food which is in sound condition, clean, free from adulteration and otherwise suitable for

human consumption.


10D-13.22, Amended 2-21-91, 5-12-92, Retained here and Transferred to 7C-4.009, Amended 6-1-93, 11-30-93, 8-

28-96, Formerly 10D-13.022, Amended 3-15-98, 7-14-03, 4-1-09, 9-26-18.

64E-11.003 Food Hygiene Standards.

(1) Food Supplies – Except as specifically provided in this subsection, the standards for food supplies are

governed by Part 3-2 of the Food Code, as incorporated by reference in rule 64E-11.002, F.A.C.

(a) Food received or used in food service establishments must be from sources approved or considered satisfactory

by the department and must be clean, wholesome, free from spoilage, adulteration and misbranding, and safe for

human consumption. Food must have been prepared, processed, handled, packaged, transported and stored in a

sanitary manner so as to be protected from contamination and spoilage.

(b) Meat and meat products received or used in a food service establishment shall be identified as having been

officially inspected for wholesomeness and sanitation by a federal or state regulatory program.

(c) Food prepared in a private home shall not be used, sold, or offered to the public by a food service establishment

or theater.

(2) Food Protection – Except as specifically provided in this subsection, the standards for food protection are

governed by Parts 3-3 through 3-8 of the Food Code, as incorporated by reference in rule 64E-11.002, F.A.C.

(a) Food while being transported, stored, prepared, displayed, served or sold at a food service establishment must

be protected from dust, flies, rodents or other vermin, toxic materials, unclean equipment and utensils, unnecessary

handling, coughs and sneezes, flooding by sewage, overhead leakage and all other sources of contamination.

(b) In the event of an emergency occurrence such as a fire, flood, power outage or similar event that might result

in the contamination of food, or that might prevent potentially hazardous food from being held at a safe temperature,

the person in charge must immediately notify the department.

(3) Personnel – Except as specifically provided in this subsection, the standards for personnel are governed by

Parts 2-2 through 2-5 of the Food Code, as incorporated by reference in rule 64E-11.002, F.A.C.

(a) No person while affected with any disease in a communicable form or while a carrier of such disease or while

afflicted with boils, infected wounds, sores, or an acute respiratory infection, can work in any area of a food service

establishment in any capacity in which there is a likelihood of such person contaminating food or food-contact surfaces

with pathogenic organisms, or transmitting disease to other individuals, and no person known or suspected of being

affected with any such disease or condition can be employed in such an area or capacity. If the management of the

food service establishment has reason to suspect that an employee has contracted any disease in a communicable form

or has become a carrier of such disease that can be transmitted by normal food service operation, the department must


be notified immediately. Both management and employee are responsible for compliance with the requirements of

this section.

(b) Infants and children under 14 years of age are not permitted in food preparation areas. Only authorized

individuals, necessary for the operation of the food service establishment, or as part of an organized educational event,

are allowed in the food preparation or utensil washing areas.

(4) Food Equipment and Utensils – Except as specifically provided in this subsection, the standards for food

equipment and utensils are governed by Chapter 4 of the Food Code, as incorporated by reference in rule 64E-11.002,

F.A.C. Every food service establishment must have equipment and utensils so designed, constructed, located, installed,

maintained and operated as to permit full compliance with the provisions of this chapter. Only equipment necessary

for the proper operation of the activities of the food service establishment is required.

(5) Sanitary Facilities and Controls – except as specifically provided in this subsection, the standards for sanitary

facilities and controls are governed by Chapter 5 of the Food Code, as incorporated by reference in rule 64E-11.002,

F.A.C.

(a) Water Supply – The water supply must be adequate, of safe sanitary quality and from an approved source in

accordance with provisions of chapters 62-550 and 62-555, F.A.C., or chapter 64E-8, F.A.C. Chapters 62-550 and 62-

555, F.A.C. (07/2018) are incorporated by reference and available at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09896 and at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09897. Hot and cold running water under pressure must be

provided in all areas where food is prepared and where equipment and multi-use utensils are washed.

(b) Sewage Disposal – Sewage must be disposed of in a public sewerage system or other approved sewerage

system in accordance with provisions of chapter 64E-6 or chapter 62-600, F.A.C., whichever is applicable. Chapter

62-600, F.A.C. (07/2018) is incorporated by reference and available at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09898. Grease interceptors must be readily accessible for

cleaning. Grease interceptors must be designed and installed in accordance with provisions of chapter 64E-6, F.A.C.,

or the applicable plumbing authority.

(c) Plumbing – Plumbing must be sized, installed, and maintained in accordance with provisions of the applicable

plumbing authority. The plumbing must provide adequate quantities of potable water to required locations throughout

the establishment; prevent contamination of the water supply; properly convey sewage and liquid wastes from the

establishment to the sewerage system; and must not constitute a source of contamination of food, equipment or utensils

or create an unsanitary condition or nuisance. An indirect waste connection is required between the sewerage system

and any drains originating from equipment in which food, portable equipment, or utensils are placed.

(d) Handwashing Facilities – Lavoratories must be located in or immediately adjacent to all toilet rooms. At least

one employee handwashing facility must be located within each food preparation area, within 20 feet of the duty

station, visible and accessible through an unobstructed area.

1. For school concession stands existing and operating prior to January 2010, an employee handwashing facility

is not required in an outdoor cooking area, provided that the outdoor cooking area is adjacent to a concession stand

building that meets the employee handwashing facility requirements.

2. Where only prepackaged food items are served and workers do not open prepackaged items or otherwise come

into contact with exposed food, a handwashing sink must be within 100 feet and on the same floor where food items

are distributed.


(e) Garbage and Rubbish Disposal – All garbage and rubbish must be removed from the food establishment

premises with sufficient frequency to prevent nuisance conditions and must be disposed of in accordance with

provisions of chapter 62-701, F.A.C. (07/2018), which is incorporated by reference and available at


(f) Vermin Control – Insecticides or pesticides, when used, must be used in full compliance with chapter 5E-14,

F.A.C. (07/2018), which is incorporated by reference and available at


(6) Other Facilities and Operations – Except as specifically provided in this subsection, the standards for other

facilities and operations are governed by Chapters 6-7 of the Food Code, as incorporated by reference in rule 64E-

11.002, F.A.C.

(a) Ventilation – All rooms in which food is stored, prepared or served, utensils are washed, toilet, dressing and

locker rooms and garbage storage areas must be well ventilated. Filters, where used, must be readily removable for

cleaning unless designed to be cleaned in place. Ventilation systems must comply with applicable fire prevention

requirements and must discharge in such a manner as not to create a nuisance. Intake and exhaust air ducts must be

maintained to prevent the entrance of dust, dirt, and other contaminating materials.

(b) At least one utility sink or curbed cleaning facility with a floor drain must be provided and used for the cleaning

of mops or similar wet floor cleaning tools and for the disposal of mop water or similar liquid wastes. The use of

lavatories, utensil washing or equipment washing, or food preparation sinks for this purpose is prohibited.

1. Each utility sink or curbed cleaning facility must be supplied with hot and cold water under pressure.

2. School concession stands that operate only in conjunction with sporting events, festivals, or similar actvities

are exempt from this requirement when a self-contained mopping apparatus is used in accordance with the

manufacturer’s instructions and is available for use at all times and

a. The school concession stand was existing and operating prior to January 1, 2010, or

b. The school concession stand was constructed and operating on or after January 1, 2010, and the food operation

is restricted to the service of prepackaged food items.

(c) Live Birds and Animals – No live birds or animals, excluding crustacea, shellfish, and fish in aquariums, are

allowed in a food service establishment, in vehicles used for transporting food, or in any other area or facility used to

conduct food service operations, except as provided under section 413.08, F.S.

(7) Temporary Food Service Events – Food service operations at temporary food service events must comply

with all applicable sanitary requirements of this rule, unless otherwise exempted in this subsection.

(a) Notification – Temporary food service event sponsors or vendors must complete form DH8004-DCHP-

02/2018, Temporary Food Service Event Application, 02/18, which is incorporated by reference and available at


(b) Facilitites – Specific requirements for the physical facility where the food service operation is to be conducted

are based on the type food that is to be prepared or served, the length of the event, and the amount of food preparation

that is to be conducted at the temporary facility.

1. If the food service operation is intended for the sale of only packaged, non-time/temperature control for safety

(non-TCS) food or drink, the food packages must be protected from dust, dirt, and other sources of contamination

during storage and serving.


2. Overhead protection must be provided at all food service operations when food is prepared or portioned on

premises.

3. When time/temperature control for safety (TCS) food is prepared at temporary food service events of more

than 3 days, the physical structure where the food preparation occurs must be protected from the entrance of flying

insects and other vermin.

(c) All food and beverages served at temporary food service events must be from approved sources in accordance

with provisions of this chapter or prepared on premises.

(d) All food served at temporary food service events must be protected in accordance with provisions of this

chapter.

(e) Food and food-contact surfaces must be protected from contamination by customers and dust. Where

necessary, effective shields or covers must be provided.

(f) Ice which will be consumed or which will come into contact with food must be obtained from an approved

source. The ice must be held in a way that protects it from contamination until dispensed.

(g) Storage of packaged food in contact with water or undrained ice is prohibited. Beverage containers may be

stored in direct contact with ice when:

a. The storage facility is equipped with adequate drains which preclude the accumulation of water during use;

b. The melt water is disposed of so as not to create a nuisance; and

c. The storage facility is kept clean.

(h) When all necessary washing and sanitizing of utensils and equipment are conducted at an approved

commissary or food service establishment, a utensil washing sink is not required, provided that an adequate supply of

spare preparation and serving utensils are maintained in the establishment and used to replace those that become

soiled. A sanitizer solution in a bucket or spray bottle to adequately sanitize the food preparation surfaces must be

available at all times.

(i) All food service operations which prepare food on premises must provide an adequate supply of potable water

for cleaning and employee handwashing. An adequate supply may be provided in clean, portable containers equipped

with on/off valves. Soap and single-service towels must be available for handwashing and hand drying.

(j) Equipment must be installed in such a manner that the establishment can be kept clean and the food will not

become contaminated.

(k) Liquid waste which is not discharged into a sewerage system must be disposed of in a manner that will not

create a public health hazard or a sanitary nuisance.

(l) Floor construction in establishments which prepare food on premises must be of durable material. Dirt or

gravel subflooring can be used when graded to drain, and covered with platforms, duckboards, plastic film, wood

chips, shavings, or similar suitable material such as a sufficient cover of grass or turf to control dust.

(m) Walls and ceilings, when required, must be constructed to minimize the entrance of flies and dust. Ceilings

may be of wood, canvas, or other materials which protect the interior of the establishment from the elements and walls

may be of such materials or of 16 mesh screening or equivalent. Doors to food preparation areas, when required, must

be solid or screened and shall be self-closing. Counter service openings, for facilities with wall enclosures, must not

be larger than necessary for the particular operation conducted and must be kept closed at all times, except when food

is actually being served.


(n) All food service operations at temporary food service events without effective facilities for cleaning and

sanitizing tableware must provide only single-service articles for use by the consumer.

(8) Vending Machines – Except as specifically provided in this subsection, the standards for vending machines

are governed by Section 4-204.12 – Section 4-204.111 of the Food Code, as incorporated by reference in rule 64E-

11.002, F.A.C.

(a) Food Supplies – All foods, beverages, and ingredients offered for sale through vending machines offering

time/temperature control for safety foods, which are located at food service establishments regulated under this

chapter, must be from approved sources in accordance with provisions of subsection (1); must be manufactured,

processed, and prepared in an approved food service establishment or food processing plant; and must be delivered to

the vending machine from an approved commissary or other approved food establishment.

(b) Food Protection – All food must be protected in accordance with provisions of subsection (2). A thermometer

accurate to plus or minus 3 degrees Fahrenheit must be provided to indicate the air temperature of food storage

compartments used for time/temperature control for safety foods.

(c) Cleaning – All food-contact surfaces of vending machines must be thoroughly cleaned and subjected to

effective bactericidal treatment at scheduled intervals, based upon the type of product being dispensed, as approved

by the department in accordance with provisions of subsection (4). A record of such cleaning and sanitizing operations

must be maintained in each machine and must be current for at least the past 30 days. The cavities and door edges of

microwave ovens and similar equipment, used in conjunction with the beverages or food from a vending machine,

must be cleaned at least once a day and must be kept free of encrusted grease deposits and other accumulated soil.

Food-contact surfaces of all equipment and utensils must be protected from contamination at all times, including while

being transported from the commissary to the vending location.

(d) Single-Service Containers – All single-service containers which receive food or beverage from machines

dispensing products in bulk must be purchased in sanitary cartons or packages, which protect the containers from

contamination; must be stored in a clean dry place in the original carton or package until introduced into the container

magazine or dispenser of the vending machine; and must be handled in a sanitary manner. Single-service containers

stored within the vending machine must be protected from manual contact, leakage, dust, insects, rodents and other

contamination.

(e) Equipment Location – Vending machines, ovens, and other equipment associated with the use of beverages

or food from a vending machine, must be located in a room, area or space which can be maintained in a clean condition

and which is protected from overhead leakage from drains, piping and other sources.

1. Each machine must be so located that the space around and under the machine can be readily cleaned and so

that insect and rodent harborage is not created. The immediate area must be well lighted and ventilated. The floor area

upon which vending machines are placed must be of such construction as to be easily cleaned and must be kept clean

and in good repair.

2. Adequate handwashing facilities, including hot and cold running water, soap and individual, single-service

towels must be located within 50 feet of machine locations where employees service bulk food machines.

Handwashing facilities must be within 20 feet of machine locations where employees handle unpackaged or exposed

foods.

(f) Interior Construction and Maintenance – All interior surfaces and component parts of vending machines must

be so designed and constructed as to permit easy cleaning and shall be kept clean.


1. All food-contact surfaces of vending machines must be smooth, in good repair, and free of breaks, corrosion,

open seams, cracks, and chipped places. The design of such surfaces must be such as to preclude routine contact

between food and V-type threaded surfaces, except that in equipment where such contact is unavoidable, such as ice

makers, such threads must be minimized. All joints and welds in food-contact surfaces must be smooth; and all internal

angles and corners of such surfaces must be rounded to facilitate cleaning. If solder is used, it must be composed of

safe materials and be corrosion resistant. All food-contact surfaces of vending machines, including containers, pipes,

valves and fittings, must be constructed of non-toxic, corrosion resistant, and nonabsorbent materials and must be kept

clean. All containers, valves, fittings, chutes and faucets which are in contact with food must be easily disassembled

and when disassembled, all surfaces must be visible for inspection and cleaning. In machines of such a design that

pipes or tubing are in contact with food but are not readily removable, in-place cleaning of such pipes and pipe fittings

may be permitted; provided:

a. They are so arranged that cleaning and bactericidal solutions can be circulated throughout the fixed system;

b. Such solutions will contact all interior surfaces;

c. The system is self-draining or otherwise capable of being completely evacuated; and

d. The cleaning procedures result in thorough cleaning of the equipment.

2. The openings into all nonpressurized containers used for the storage of vendable foods and ingredients

including water must be provided with covers which prevent contamination from reaching the interior of the

containers. Such covers must be designed to provide a flange which overlaps the opening and must be sloped to

provide drainage from the cover surface wherever the collection of condensation, moisture or splash is possible.

Concave covers or cover areas are prohibited. Any port opening through the cover must be flanged upward at least

three sixteenth inch and must be provided with an overlapping cover flanged downward. Condensation or drip

deflecting aprons must be provided on all piping, thermometers, equipment, rotary shafts and other functional parts

extending into the container, unless a watertight joint is provided. Such aprons must be considered as satisfactory

covers for those openings which are in continuous use. Gaskets, if used, must be of a material which is nontoxic,

stable, and nonabsorbent and must have a smooth surface. All gasket retaining grooves must be easily cleanable.

3. The delivery tube or chute and orifice of all bulk food vending machines must be protected from normal manual

contact, dust, insects, rodents and other contamination. Design must be such as to divert condensation or other moisture

from the normal filling position of the container receiving the food or beverage. The vending stage of such machines

must be provided with a tight fitting, self-closing door or cover which is kept closed, except when food is being

removed.

4. The food storage compartment and other compartments in refrigerated vending machines which are subject to

condensation or cooling water retention must be so constructed as to be self-draining or must be provided with a drain

outlet which permits complete draining of the compartment. In vending machines designed to store cartoned

beverages, diversion devices and retention pans or drains for leakage must be provided. All such drains, devices and

retention pans must be easily cleanable.

5. Opening devices which come into contact with the food or the food-contact surface of the containers must be

constructed of smooth, nontoxic, corrosion resistant and nonabsorbent materials. Unless the opening device is of a

single-service type, it must be readily removable for cleaning and must be kept clean. Parts of multi-use opening

devices which come into contact with the food or food-contact surface of containers must be protected from manual

contact, dust, insects, rodents and other contamination and such parts must be readily removable for cleaning and must


be kept clean.

(g) Delivery of Foods, Equipment, and Supplies – Food, single-service containers, and food-contact surfaces of

equipment, containers, and devices must be protected from the elements, dirt, dust, insects, rodents, and other

contaminants while in transit to vending machine locations. Time/temperature control for safety foods must be

maintained at safe temperatures while in transit.

(h) Personnel – Individuals servicing or replenshing these machines must comply with all applicable provisions

of subsection (3), rule 64E-11.012, and rule 64E-11.013, F.A.C.

Rulemaking Authority 381.006, 381.0072 FS. Law Implemented 381.006, 381.0072 FS. History–New 1-1-77,

Amended 1-6-81, Formerly 10D-13.23, Amended 2-21-91, Retained here and Transferred to 7C-4.010, Amended 6-

1-93, 8-28-96, Formerly 10D-13.023, Amended 3-15-98, 7-14-03, 9-26-18.

64E-11.004 Food Protection.

Rulemaking Authority 381.0072 FS. Law Implemented 120.542, 381.0072 FS. History–New 1-1-77, Amended 1-6-81,

Formerly 10D-13.24, Amended 2-21-91, 5-12-92, Retained here and Transferred to 7C-4.011, Amended 6-1-93, 8-

28-96, Formerly 10D-13.024, Amended 3-15-98, 7-14-03, Repealed 9-26-18.

64E-11.005 Personnel.


10D-13.25, Amended 2-21-91, 5-12-92, Retained here and Transferred to 7C-4.012, Amended 6-1-93, Formerly 10D-

13.025, Amended 3-15-98, 7-14-03, Repealed 9-26-18.

64E-11.006 Food Equipment and Utensils.


10D-13.26, Amended 2-21-91, 5-12-92, Retained here and Transferred to 7C-4.013, Amended 6-1-93, 8-28-96,

Formerly 10D-13.026, Amended 3-15-98, 7-14-03, Repealed 9-26-18.

64E-11.007 Sanitary Facilities and Controls.


Amended 1-6-81, Formerly 10D-13.27, Amended 2-21-91, 5-12-92, Retained here and Transferred to 7C-4.014,

Formerly 10D-13.027, Amended 3-15-98, 7-14-03, Repealed 9-26-18.

64E-11.008 Other Facilities and Operations.


Amended 1-6-81, Formerly 10D-13.28, Amended 2-21-91, 5-12-92, Retained here and Transferred to 7C-4.015,

Amended 8-28-96, Formerly 10D-13.028, Amended 3-15-98, Repealed 9-26-18.

64E-11.009 Temporary Food Service Events.


Amended 3-15-98, Repealed 9-26-18.

64E-11.010 Vending Machines.


Amended 3-15-98, Repealed 9-26-18.

64E-11.011 Procedure When Infection Is Suspected.

When the department has reasonable cause to suspect possibility of disease transmission from any food service

establishment employee, the department shall secure a morbidity history of the suspected employee, or make other

such investigation as may be indicated and take appropriate action. The department may require any or all of the


following measures:

(1) Immediate exclusion of the employee from all food service establishments.

(2) Immediate closure of the food service establishment concerned until, in the opinion of the department, no

further danger of disease outbreak exists.

(3) Restriction of the employee’s service to some area of the establishment where there would be no danger of

transmitting the disease.

(4) Adequate medical and laboratory examination of the employee or other employees.

Rulemaking Authority 381.006, 381.0072(2) FS. Law Implemented 381.006, 381.0072(2) FS. History–New 1-1-77,

Amended 1-6-81, Formerly 10D-13.36, Amended 2-21-91, Retained here and Transferred to 7C-4.022, Formerly 10D-

13.036.

64E-11.012 Manager Certification.

(1) All managers who are responsible for the storage, preparation, display, and serving of foods to the public must

have passed a written certification test which complies with section 509.039, Florida Statutes, within 30 days after the

effective date of employment. Those managers who successfully pass the certification examination will be issued a

certificate which is valid for a period of five years from the date of issuance.

(2) All establishments must designate in writing the food service manager or managers for each location.

Establishments that serve highly susceptible populations, or have three or more employees at one time engaged in the

storage, preparation, display, or serving of food must have at least one certified manager present at all times when said

activities are taking place. All other establishments must have a certified manager or managers responsible for all

periods of operation, but said manager or managers need not be present at all times.

(3) It is the responsibility of the certified manager or person in charge to train or ensure the training of all

employees under their supervision and control who engage in the storage, preparation, or serving of food, or cleaning

of equipment, utensils, or food contact and non-food contact surfaces, and to do so in accordance with acceptable

sanitary practices as described in this chapter. The trainings must be annual and provided to employees by March 31

of each year. Employees hired after the annual training has been provided for that calendar year must receive training

within 30 days of being hired. The certified manager or person in charge must also maintain a copy of the

establishment’s most recent regular food service inspection form provided by the department. Employees shall present

this inspection form to guests or patrons for their review upon request.

(4) If a food service establishment, which possesses a santitation certificate and initially met the requirements of

this section, becomes noncompliant with subsection (2), above, the food service establishment will have a period of

30 days to become compliant with subsection (2), above.

(5) The food service employee training must inform the employee regarding basic public health food protection

practices, as specified in this chapter and which relates to their assigned duties. Employees who prepare foods must

be knowledgeable about safe methods of thawing, cooking, cooling, handling, holding, and storing foods. Service

personnel must be knowledgeable about safe methods of food service. Employees who clean equipment and facilities

must be knowledgeable about proper cleaning and sanitization methods. Employees responsible for maintaining the

premises must be knowledgeable about proper insect and vermin control methods. Managers must obtain and maintain

an attendance roster of all employees present during training. Both the training curriculum and attendance roster must

be maintained for three years and available upon request by the department. Establishments that are not compliant

with the employee training requirements and record retention of this section must schedule a training and testing with


the department and pay any applicable fees. In lieu of the department providing training and testing, the establishment

may schedule training and testing with an outside course provider, who in addition to providing employee-level

training, is also an approved manager certification test provider. The training and testing for employees must be

completed within 60 days of the violation, or prior to the renewal of the sanitation certificate, whichever comes first.

(6) Persons are considered certified under these rules when a written examination is a requirement for licensure

by the Department of Health, Division of Medical Quality Assurance in a dietary field and when these persons have

acquired and maintained an active license, provided that they comply with subsection (2), above. The following

establishments are exempt from the manager certification requirements of this section, however, the establishment

must have a person in charge:

(a) Any theater, if the primary use is as a theater and patron service is limited to food items customarily served to

admittees of theaters such as popcorn, hot dogs, soft drinks, nachos and cheese, and pre-packaged snack foods;

(b) Establishments listed in section 381.0072, F.S., as being exempt from this certification;

(c) Food service establishments that limit their food service operation to non-time/temperature control for safety

prepackaged food items;

(d) Culinary arts and similar food programs, which do not offer, sale, or serve food beyond the program’s

instructors and participants.

Rulemaking Authority 381.0072 FS. Law Implemented 381.0072 FS. History–New 2-21-91, Amended 5-12-92,

Retained here and Transferred to 7C-4.023, Amended 6-1-93, 8-28-96, Formerly 10D-13.037, Amended 3-15-98, 7-

14-03, 9-26-18.

64E-11.013 Sanitation Certificates and Fees.

(1) Sanitation Certificate Required.

(a) All food service establishment sanitation certificates expire on September 30. Initial sanitation certificates

issued for a period less than a calendar year will be prorated on a quarterly basis, in accordance with section

381.0072(4), F.S.

(b) Food service establishments containing multiple food operations housed in the same building, at the same

location, under the same ownership and operation or concession stands operating on the premise of K-12 schools,

must function according to either one of the following:

1. Each food operation must operate under the umbrella of the sanitation certificate issued to the main food service

operation, in which case the sanitation certificate must be posted in a conspicuous location at the main food service

establishment, or

2. Each food operation must be issued its own individual sanitation certificate, in which case each food service

establishment must post their own sanitation certificate in a conspicuous location in their establishment. The owner

or operator of the food service establishment must decide which of the sanitation certificate processes listed above,

will be followed.

(c) Food service establishments where multiple food operations are located in different buildings at the same

location regardless of ownership must each be issued their own individual sanitation certificate, in which case each

such food operation must post their own sanitation certificate in a conspicuous location in their food service operation.

School concession stands under the same ownership, may elect to comply with the provisions of subparagraph (b)1.

Regardless of location, provided that the school concession stands are located on the same premises and there are no

more than four concession stand operations.


(2) Application and Renewal of Sanitation Certificates.

(a) Each person who plans to construct, purchase, reopen, or operate a food service establishment or an

establishment subject to the requirements of this chapter, must apply for and receive a sanitation certificate from the

department prior to the commencement of operation. Applications for certificates must be made to the department on

DH 4086, Application for Sanitation Certificate, 02/18, incorporated herein by reference and available at


(b) Applications for sanitation certificates must be submitted with the facility plans as described in paragraph (c),

below, the annual fee and any other applicable fee that is required in subsection (3).

(c) Prior to the renovation of a food service establishment, notification must be provided to the department. This

notification must include construction schedules and details of the work to be completed. Prior to the construction or

extensive remodeling of a food service establishment, or the conversion of a structure for use as a food service

establishment, or remodeling which includes the addition or relocation of major equipment, plans of the facility and

its operation must be submitted to and approved by the department. Plans may be submitted by the owner, prospective

operator or their designated representative. All plans must comply with the requirements of this chapter. Plans must

be drawn to scale, describe the layout, construction, and general operation of the facility, equipment design and

installation, the intended menu, and similar aspects of the facility’s operation that relate to the requirements of this

chapter, and be accompanied by DH8003-DCHP-02/2018, Food Service Establishment Plan Review Application,

02/18, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-09903.

(d) Before a sanitation certificate is issued to a newly constructed or extensively remodeled food service

establishment, an inspection must be made by a representative of the department for the determination of compliance

with the requirements of this chapter, and section 381.0072, F.S.

(3) Fees.

(a) Fees must be submitted to the department for sanitation certificates, as well as the provision of other required

public health services at food service establishments. Sanitation certificates must be renewed annually and the fee will

not be prorated. Fees for all other sanitation certificates, such as change of ownership, reinstatement after revocation

of a sanitation certificate, or new establishments, after the first quarter will be prorated on a quarterly basis. Proration

will be based on the quarter the department receives an application for a Sanitation Certificate to operate a food service

establishment. Upon request of the applicant, the initial fee for school concession stands may be prorated on a quarterly

basis regardless of the date of application, provided that it does not operate for more than one quarter, the conditions

of subparagraph (1)(b)1., do not apply, and the annual fee used to determine the prorated amount is prescribed by sub-

subparagraph (b)5.b., below


(b) Except for establishments specifically exempted from fees in subsection (4), all food service establishments

must pay an annual or prorated fee to the department according to the following schedule:

ANNUAL SANITATION CERTIFICATE FEE OR INSPECTION FEE SCHEDULE

Total

1. Detention Facility $250.00

2. Bar/Lounge $190.00

3. Fraternal/Civic Organization $190.00

4. Movie Theater Inspection $190.00

5. School Cafeteria

a. Cafeteria requiring 3 routine inspections per year $170.00

b. Cafeteria requiring 4 routine inspections per year $200.00

c. Concession Stand $100.00

6. Community Based Residential Facility $135.00

7. Afterschool Meal Program $170.00

8. Prescribed Pediatric Extended Care Center $110.00

9. Limited Food Service Operation $110.00

10. Caterering Operation $180.00

11. Mobile Food Unit $180.00

12.Vending Machine Dispensing Time/Temperature Control for Safety Food $ 85.00

(c) Food service establishments with multiple food operations, as described in subparagraph (1)(b)1., above, will

be assessed a single annual fee of $300. That fee will be assessed on the main food service establishment, and it will

cover the other food service facilities operating in that same building under the umbrella of the main food service

establishment. This fee provision also applies to school concession stands that elect to comply with the provisions of

paragraph (1)(b).

(d) Food service establishments with multiple food operations, as described in paragraph (1)(c), above, will be

assessed separate annual fees for each food operation based on the category of establishments listed in paragraph

(3)(b), above.

(e) Except for school concession stands that elect to comply with the provisions of subparagraph (1)(b)1. above,

food service establishments as described in paragraph (1)(c), will be assessed separate annual fees for each food

operation based on the category of establishments listed in paragraph (3)(b), above.

(f) Vending machines dispensing time/temperature control for safety food, catering operations and mobile food

units that are located at or operated from an establishment listed in section 381.0072, F.S., will be charged the fees

listed in paragraph (3)(b), above, when they are not operating under an existing Sanitation Certificate that has already

been issued for the main food service establishment where they are located.


(g) The following schedule of fees is established for plan reviews, food service worker training and testing,

alcoholic beverage establishment sanitation inspections, reinspections, late renewals:

1. Plan review per hour.

Public schools, colleges, and vocational teaching facilities are exempt from this fee.

$40.00

2. Food establishment worker training course (per person). $10.00

3. Sanitation inspection.

a. Alcoholic beverage inspection approval. $30.00

b. Requests for inspection. $40.00

4. Reinspection

(for each reinspection after the first).

$75.00

5. Late renewal of certificate. $25.00

6. Temporary event food service establishment.

a. Sponsor without an existing sanitation certificate. $100.00

b. Vendor or booth at an establishment or location without an existing sanitation certificate. $50.00

(h) All fees submitted to the department are nonrefundable, once review has started on the application.

(4) Exemptions. The following limited food service establishments are exempt from the fee requirements of this

section:

(a) Food service establishments that only serve catered meals which have been prepared in an approved food

establishment and where no warewashing, and no storage, reheating, or re-service of the catered food takes place on-

site; such as satellite kitchens at schools and other institutions, and similar operations.

(b) Food service establishments that serve only snacks which are not kept overnight, or that require individuals

in attendance to bring their own meals to the facility, which do not require any food preparation.

Rulemaking Authority 381.0072, 154.06 FS. Law Implemented 381.0072(2), 154.06 FS. History–New 2-21-91,

Amended 5-12-92, Retained here and Transferred to 7C-4.024, Amended 6-1-93, 11-30-93, 8-28-96, Formerly 10D-

13.038, Amended 3-15-98, 7-14-03, 4-1-09, 9-26-18.

64E-11.014 Mobile Food Units.

All mobile food units required to have vehicle identification numbers must submit their vehicle identification number

to the department on the application for licensure. The license decal must be affixed to the mobile food unit. Mobile

food units must comply with rules 64E-11.001 through 64E-11.003, and 64E-11.011 through 64E-11.013, F.A.C.,

except that such mobile food units are not required to have employee/patron toilet facilities or mop sinks. No license

will be granted to a mobile food unit until the following additional requirements have been met:

(1) A potable water supply system of sufficient capacity (minimum 5 gallons) to furnish an adequate quantity of

hot and cold water for food preparation, cleaning, and handwashing purposes must be provided during all periods of

operation. The water inlet must be located so that it will not be contaminated by waste discharge, road dust, oil or

grease, and it must be kept capped unless being filled. It must be provided with a transition connection of a size or

type that will prevent its use for any other service.

(2) A suitable liquid waste system, including a waste tank having a capacity at least 15 percent greater than the

water supply system, shall be provided. All connections on the unit for servicing mobile food unit waste disposal

facilities shall be of a different size or type than those used for supplying potable water to the mobile food units. The

waste tank shall be capable of being completely drained and flushed.


(3) Serving openings shall not be larger than necessary for the particular operation conducted and shall be kept

closed at all times except when food is actually being served. Mobile food units shall provide only single-service

articles for use by the consumer.

(4) Waste containers shall be provided for the deposit of food scraps, food wrappings, cups, napkins and discarded

single-service articles.

(5) Mobile food units must operate from an approved commissary that meets all applicable requirements of this

rule. The commissary must be provided with potable water and adequate facilities for disposal of liquid and solid

waste. The mobile food unit must report to the commissary to store or replenish supplies, clean utensils, and equipment

or dispose of liquid and solid waste. Mobile food units which are self-sufficient for equipment, storage, and utilities

must report to the commissary at least once weekly or as often as needed to replenish supplies, clean the interior of

the unit, or dispose of liquid or solid wastes. A letter from the commissary must be submitted as part of the application

confirming the arrangements above. A mobile food unit which is self-sufficient includes a three compartment sink for

washing, rinsing, and sanitizing of equipment and utensils, a separate handwash sink, adequate refrigeration and

storage capacity, full provision of power utilities including electrical, LP gas, or a portable power generation unit, and

a liquid waste disposal system, and potable water holding tank in accordance with subsections (1) and (2). Mobile

food units which are not self-sufficient must report to their commissary at least once daily. The exterior of the unit

may be washed in any location, provided the waste water does not create a sanitary nuisance.

(6) When a service area is provided at the commissary for cleaning and servicing mobile food units, the service

area must include at least overhead protection for any supplying, cleaning or servicing operation. Such area must be

physically separated from other food operations; must be equipped to furnish approved potable water in accordance

with applicable provisions of chapters 62-550 and 62-555 or chapter 64E-8, F.A.C.; and must provide facilities for the

drainage and disposal of liquid wastes in accordance with applicable provisions of chapter 64E-6 or 62-600, F.A.C.,

and the plumbing authority. The surface of the servicing area must be constructed of a smooth, nonabsorbent material

such as concrete or machine laid asphalt and must be maintained in good repair, kept clean and be graded to drain.

Chapters 62-550, 62-555, and 62-600, F.A.C. (07/2018) are incorporated by reference and available at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09929,

https://www.flrules.org/Gateway/reference.asp?No=Ref-09930, and


(7) Mobile food units which are limited to the sale of non-time/temperature control for safety food only are exempt

from:

(a) The requirements of employee hand washing sink, provided that only pre-packaged items are offered; and,

(b) The requirements of a utensil washing sink when all necessary washing and sanitizing of utensils and

equipment are conducted at a designated approved commissary or fixed food establishment. An adequate supply of

spare preparation or serving utensils must be maintained in the unit and used to replace any utensils that become

contaminated.

(8) Mobile food units may temporarily connect to an approved utility system for a time period not to exceed one

day’s operation, provided the utility system is adequate to meet the needs of the unit, sanitary facilities are made

available for employees and patrons in accordance with the applicable plumbing authority, and the unit returns to its

base commissary in accordance with subsection (5).


(9) Mobile food units which limit the preparation of food to frankfurters only, must comply with all applicable

requirements of this section, except that subsection (3) does not apply when adequate precautions are utilized to

prevent contamination of the frankfurters during cooking operations. Potentially hazardous time/temperature control

for safety foods such as chili, cooked onions and peppers, cheese, and cheese sauce may only be served in individually

portioned and packaged or pre-packaged containers which are maintained at proper temperatures on the unit. Non-

time/temperature control for safety foods such as relish, raw onions and peppers, and other such condiments may be

served directly from the unit. Bulk beverages from approved sources may be dispensed from covered urns or other

protected containers.

Rulemaking Authority 381.0072 FS. Law Implemented 381.0072 FS. History–New 3-15-98, Amended 7-14-03, 9-26-

18.

64E-11.015 Afterschool Meal Program.

(1) Facilities participating in the United States Department of Agriculture (USDA) Afterschool Meal Program,

which are not used for any other food service operation or for multiple USDA Afterschool Meal Programs, shall

comply with all applicable sanitary requirements of this chapter when minimum standards are not specified in this

section.

(2) Food preparation sink – The sanitizing compartment of a two or three compartment sink may be used as a

food preparation sink provided that the Afterschool Meal Program entity has a written procedure of use, which has

been approved by the Department prior to the implementation of the procedure. At minimum, the written procedures

shall:

(a) Ensure the third compartment is clean to the sight and touch and sanitized, prior to and after use as a food

preparation sink;

(b) Ensure no other sink compartment(s) is used for any other purpose while the sink is in use as a food preparation

sink;

(c) Ensure only workers, who have been trained on the procedure, use the sink for food preparation; and,

(d) Ensure the approved procedure is posted at the sink.

(3) Hot and Cold Holding Equipment – In order to comply with holding temperature requirements, electronic hot

and cold holding equipment shall be used for food storage; however, controls for the adjustment of temperature are

not required.

(4) Cleaning facilities – Food operations restricted to the receipt of pre-portioned catered meals or service of

prepackaged food items may use a self-contained mopping apparatus, provided it is used in accordance with the

manufacturer’s instructions and always available for use.

(5) Manual washing, rinsing and sanitizing – Sinks, drainboards and dishtables must be cleaned prior to use. A

two-compartment sink may be used when warewashing is limited to a batch operation in which cleaning of

kitchenware and tableware is suspended until the end of the service period. For batch cleaning, the following process

applies:

(a) Prior to using this process, Department approval shall be obtained;

(b) Prior to washing, multi-use tableware and kitchenware must be pre-flushed or pre-scraped and, when

necessary, pre-soaked to remove gross food particles and soil;

(c) Immediately before use, prepare the cleaning and sanitizing solutions in sinks, which are free of debris and

residue and clean to the sight and touch;


(d) In the first compartment use a detergent-sanitizer product, which is a detergent that contains a sanitizer, and

apply the detergent-sanitizer in accordance with the manufacturer’s instructions;

(e) In the second compartment use a sanitization method in accordance with rule 64E-11.006, F.A.C. If using a

chemical sanitizer, the sanitizing agent must be the same chemical agent contained in the detergent-sanitizer; and,

(f) Immediately after use, drain sinks.

(6) Drains – For an existing building with an existing food service operation, all drainage connections are

considered acceptable if in good working order and capable of being maintained in a sanitary condition. Replacement

materials and repairs must meet the requirements specified in rule 64E-11.007, F.A.C.

(7) Handwashing Facilities – For sites that receive pre-portioned catered meals or only serve prepackaged food

items and employees do not open prepackaged items or otherwise come into contact with exposed food, a designated

lavatory, equipped with hand cleansing soap or detergent and individual single use sanitary towels or a heated-air hand

drying device is required but need not be in the same room. However, where food is served, dispensed, or otherwise

unpackaged, a designated handwashing lavatory, equipped with hand cleansing soap or detergent and individual single

use sanitary towels or a heated-air hand drying device, shall be located in the same room and within 20 feet of the area

where food is served or dispensed.

(8) Hot Water – Food operations restricted to the receipt of proportioned catered meals or service of prepackaged

food items and do not require ware washing are not required to have hot water.

(9) Manager Certification – manager certification standards in accordance with Rule 64E-11.012, F.A.C., shall

be required for the following Afterschool Meal Program sites:

(a) Those sites routinely inspected three times or four times per year and which result in three consecutive routine

inspections each containing violations involving three of the four foodborne illness risk factors listed in paragraph (c),

below.

(b) Those sites routinely inspected one time or two times per year and which result in two out of three consecutive

routine inspections each containing violations involving three of the four foodborne illness risk factors listed in

paragraph (c), below.

(c) Risk Factors are significant contributors to foodborne illness and are identified as:

1. Employee health and hygiene, such as improper handwashing and the presence of ill food workers in

accordance with rule 64E-11.005, F.A.C.,

2. Holding temperatures (Hot and cold holding and cooling),

3. Inadequate cooking or reheating; and,

4. Food from unapproved sources.

(10) Time as a public health control – Time may be used in lieu of the holding temperature requirements of

subsection 64E-11.003(2), F.A.C., provided that time/temperature control for safety foods are cooked or reheated in

accordance with subsection 64E-11.003(2), F.A.C.; the Department is notified at least 14 days prior to the

implementation of time as a public health control; and the Afterschool Meal Program:

(a) Provides the Department a copy of the written procedures, which at a minimum indicates the meal service

times and the following:

1. The specific location where the time/temperature control for safety foods proposed for use under time as a

public health control are prepared;


2. The proposed delivery schedule, if time/temperature control for safety foods are received from an outside

approved source; and,

3. The names of the food workers who have been trained regarding these written procedures.

(b) Maintains a daily log for time/temperature control for safety foods cooked or reheated on-site, which indicates

the date, name of the time/temperature control for safety foods, final cooking temperature, and the time that the final

cooking temperature was reached. In addition, each time/temperature control for safety food product or the container

holding the product must be labeled with an expiration time, which must not exceed 4 hours from the time that the

product reached the final cooking temperature. Time/temperature control for safety food products must be discarded

upon reaching the expiration time or if no expiration time is indicated.

(c) Maintains a valid copy of the caterer’s license, if a catering operation is used, and documents the name of food

suppliers, for ready-to-eat time/temperature control for safety food products that are not cooked or reheated on-site.

In addition, a daily product log must be maintained that documents the following: the date, name, and quantity of the

time/temperature control for safety food products that are obtained or received; the time and temperature of

time/temperature control for safety food products received or obtained by the Afterschool Meal Program; the

expiration time, which must not exceed 4 hours from the time that the Afterschool Meal Program takes possession of

the time/temperature control for safety food product; and the name and quantity of time/temperature control for safety

food products discarded.

(d) Provides and documents training for food workers regarding the Afterschool Meal Program site’s use of time

as a public health control, including written procedures and this section. Only trained employees shall complete the

daily logs and document expiration times.

(e) Maintains all documentation, including logs and licenses, for one year on site and makes them available to the

Department upon request.

(11) During transport between food service establishments or while being transported from a food service

establishment to another location, all food must be in covered containers or otherwise wrapped or packaged to ensure

protection from contamination. Time/temperature control for safety food products must be kept at safe temperatures

during all periods of transportation and delivery. Food utensils must be completely wrapped or packaged to protect

them from contamination. Any time/temperature control for safety food product that does not meet these requirements

must not be accepted or served by the Afterschool Meal Program Site.

Rulemaking Authority 381.0072 FS. Law Implemented 381.0072 FS. History New 2-18-14, Amended 9-26-18.


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8. Rule Chapter

64E-12, F.A.C

.

8 – 1

CHAPTER 64E-12

COMMUNITY BASED RESIDENTIAL FACILITIES 64E-12.001 General


64E-12.003 Water Supply

64E-12.004 Food Service: Tiers and Catering.

64E-12.005 Housing

64E-12.006 Vector and Vermin Control

64E-12.007 Bedding, Towels, Clothing and Personal Items

64E-12.008 Laundry

64E-12.009 Medications, Alcohol, Poisonous or Toxic Substances

64E-12.010 Garbage and Rubbish

64E-12.011 Recreational Areas

64E-12.012 Radon Testing (Repealed)

64E-12.013 Animal Health and Safety

64E-12.001 General.

(1) This rule chapter prescribes sanitary practices relating to construction, operation and maintenance of

community based residential facilities. If a requirement in this rule chapter conflicts with a specific requirement in

any other Florida state licensing agency’s rule, then that agency’s standards shall prevail and will be addressed by

that agency’s officials.

(2) Base camps of wilderness programs shall be exempt from subsections (6) and (7) of Rule 64E-12.005,

F.A.C., of this chapter, and the mobile components of wilderness programs shall be exempt from all sections of this

rule.

(3) Personal services may be provided to the residents through coordinated outsourcing by the community based

residential facility or by a contract provider.

Specific Authority 381.006, 381.006(16) FS. Law Implemented 381.006(16), 386 FS. History–New 6-18-87,

Formerly 10D-23.001, Amended 1-20-08.


For the purpose of this chapter, the following words and phrases shall have the meaning indicated:

(1) Approved – means acceptable by law.

(2) Community Based Residential Facilities – means group care facilities as established under Section

381.006(16), F.S., used as a primary domicile by the resident and located in any building or buildings, section of a

building, or distinct part of a building or other place, whether operated for profit or not, which undertakes, through

its ownership or management, to provide for a period exceeding 24 hours, housing, food service, and one or more

personal services for persons not related to the owner or administrator by blood or marriage, who require such

services. This term does not include family foster homes as defined in Section 409.175(2)(e), F.S., or foster care

facilities as defined in Section 393.063(15), F.S., and correctional facilities, such as detention centers, jails or

prisons.

(3) Department – means the Florida Department of Health and county health departments.

8 – 2

(4) Food Preparation – means the manipulation of foods intended for human consumption by such means as

washing, slicing, peeling, chipping, shucking, scooping, and or portioning. The term also includes those activities

involving temperature changes, combining ingredients, opening ready-to-eat food packages, or any other activity

causing physical or chemical alterations in the food.

(5) Hot Water – means water heated to a minimum temperature of 100 degrees Fahrenheit (°F).

(6) Law – means applicable statutes, rules, codes, or ordinances adopted by local, state, and federal agencies

that have regulatory oversight or inspection authority.

(7) Minor – means any person under the age of 18 years old.

(8) Open Water Hazard – means any body of water such as canals, creeks, holding ponds, rivers, lakes, or

swamps which are unrestricted by a barrier at least 4 feet in height, on or abutting the property of a community

based residential facility. This term does not include pools or spas and small ornamental fish ponds, or above ground

fountains which are less than 24 inches deep and have less than 200 square feet of surface area.

(9) Personal Services – means providing supervision, custodial care, or assisting a resident with the tasks or

functions in their daily living activities, such as bathing, dressing, laundry, eating, ambulation, grooming, toileting,

or monitoring medications.

(10) Potentially Hazardous Food – means any perishable food which consists in whole or in part of milk or milk

products, eggs, meat, poultry, fish, shellfish, edible crustacea, or other ingredients, including synthetic ingredients,

in a form capable of supporting:

(a) Rapid and progressive growth of infectious or toxigenic microorganisms; or

(b) The slower growth of Clostridium botulinum.

The term “potentially hazardous food” does not include foods which have a pH level of 4.6 or below, or a water

activity (Aw) value of 0.85 or less, or air-cooled hard-boiled eggs with the shell intact.

(11) Renovation – means any structural or equipment changes in the food storage, service, preparation, or dining

area. This does not include replacing existing equipment with like equipment. Substantial renovation includes

structural changes to an existing establishment which costs in excess of 33 percent of the assessed value of the

facility as determined by the county property appraiser.

(12) Resident – means a person living in and receiving personal services from a community based residential

facility, or personal services through coordinated outsourcing, typically due to a specific emotional, social, or health

related condition.

(13) Vector – means an organism that transmits a pathogen. This term includes, but is not limited to insects,

rodents and bats.

(14) Wading Pool – means a temporary and portable pool that holds water, is less than 24 inches in depth, and

without motors. It may also be known as a kiddy pool.

Specific Authority 381.006(16) FS. Law Implemented 381.006(16) FS. History–New 6-18-87, Amended 8-7-96,


8 – 3

64E-12.003 Water Supply.

(1) Water supplies shall be adequate to serve the demands of the facility and shall be constructed, operated and

maintained in accordance with requirements of Chapters 62-550 and 62-555 or Chapter 64E-8, Florida

Administrative Code (F.A.C.).

(a) Routine Testing. Facilities served by a drinking water system not regulated by Chapter 64E-8 or 62-550,

F.A.C., shall test the water and submit bacteriological water test results to the local county health department

(CHD):

1. Before opening the facility,

2. At least every 12 months,

3. Upon relocation,

4. Before having the well placed in service after construction, repair, or modification or,

5. After an emergency situation, such as a flood, that may introduce contaminants to the system.

(b) Test results must be negative for bacteriological contamination.

(c) Positive test results require the facility to temporarily provide potable water from a source approved by law

for the purpose of drinking, cooking, and oral contact until test results are negative. In addition, wells that test

positive shall be disinfected, flushed, and tested for bacterial contamination.

(d) Laboratory test results must be submitted to the local county health department in writing by the testing

laboratory.

(e) Testing can be obtained through the local county health department or a certified independent laboratory.

(2) Drinking water shall be accessible to all residents. When drinking fountains are available, they shall be

designed in compliance with the applicable plumbing provisions of the State Building Code, as adopted in Rule 9B-

3.047, F.A.C. When no approved drinking fountains are available, residents shall be provided with single service

cups or clean drinking utensils which shall be stored and dispensed in a manner to prevent contamination. Common

drinking cups are prohibited.

(3) Hot and cold running water under pressure and at safe temperatures, not to exceed 120° Fahrenheit at the

faucet to prevent scalding, shall be provided to all restroom lavatories and bathing areas.

Specific Authority 381.006, 381.006(16) FS. Law Implemented 381.006(16) FS. History–New 6-18-87, Amended 8-

7-96, Formerly 10D-23.003, Amended 1-20-08.

64E-12.004 Food Service: Tiers and Catering.

There are three tiers of food service, each with different minimal requirements based on facility type or the number

of residents in care. Only one tier of service as listed in subsections (1)-(3) below will be applied to any facility.

Facilities receiving or providing catered food must meet applicable standards as described in subsection (4) below.

(1) Tier 1. Facilities meeting the definition of “adult family-care home” regardless of the number of residents as

defined in Section 429.65(2), F.S., and other community based residential facilities with a maximum capacity to

house up to 5 residents, shall comply with the following requirements:

(a) Food used in the facility shall be clean, wholesome, free from spoilage and safe for human consumption.

Home canned food shall not be used. Canned food shall be from sources that are approved by law.

(b) The facility shall protect the food from dust, flies, rodents and other vermin, toxic materials, unclean

equipment and utensils, unnecessary handling, coughs and sneezes, flooding by sewage, overhead leakage and all

8 – 4

other sources of contamination at all times during storage, food preparation, transportation both on and off premises,

and service.

(c) Food storage equipment shall be provided to keep all potentially hazardous foods at safe temperatures, 41°

Fahrenheit or below or 140° Fahrenheit or above, except during necessary periods of preparation and service.

Potentially hazardous food shall not have been out of temperature more than 4 cumulative hours during the course of

thawing, preparation, service and cooling.

(d) At least one sink with hot and cold potable water under pressure shall be provided in the food preparation

area.

(e) Refrigeration units and hot food storage units used for the storage of potentially hazardous foods shall be

provided with a numerically scaled indicating thermometer accurate to plus or minus 3°F. The thermometer shall be

located in the warmest or coldest part of the units as may be applicable and of such type and so situated that the

temperature can be easily and readily observed.

(f) Labeling and Dating. Food containers shall be labeled with their contents and labels shall correctly identify

the contents of the container. Potentially hazardous foods and potentially hazardous foods that are in a form which is

edible without washing, cooking, or additional preparation, including previously cooked foods such as leftovers,

must be stored in accordance with the date marking and disposition requirements of subsections 64E-11.004(14) and

(15), F.A.C.

(2) Tier II. Except as described in subsection (1) above, if food service is provided in a facility with a maximum

capacity to house from 6 to 10 residents, the facility shall comply with the following requirements:

(a) In Chapter 64E-11, F.A.C.:

1. 64E-11.002, Definitions;

2. 64E-11.003, Food Supplies;

3. 64E-11.004, Food Protection;

4. 64E-11.005(1), (2)(b), (c), (e), (f), (3), (4), (5), Personnel;

5. 64E-11.013(3)(c), 1., 2., 4.

(b) Facilities opening, initially licensed by the licensing agency, or renovating on or after January 1, 2008 shall,

prior to construction or renovation of a food service operation or prior to substantial facility renovation, notify the

department and provide plans of the proposed construction or renovation, for review and approval at least 90 days

prior to the start of the project. Plans shall be submitted by the owner, prospective operator, or their designated

representative. All plans shall be in compliance with this section, shall be drawn to scale, describe the layout,

construction, finish schedule, general operation of the facility, equipment design and installation, and similar aspects

of the facility’s food service operation. A copy of the intended menu shall be provided to the department as part of

the plan review.

(c) The floor surfaces in kitchens, all the rooms and areas in which food is stored or prepared and in which

utensils are washed or stored, shall be of smooth, nonabsorbent material and constructed so they can be easily

cleaned and shall be kept clean and in good repair.

(d) The walls and shelving of all food preparation areas, food storage areas, utensil washing and handwashing

rooms or areas shall have smooth, easily cleanable surfaces. Walls shall be washable up to the highest level reached

by splash or spray.

8 – 5

(e) Hot and cold running water under pressure shall be easily accessible where food is prepared and where

utensils are washed.

(f) A handwashing sink, provided with hot and cold running water under pressure, shall be located within the

food preparation area. A sign must be posted clearly designating the sink for handwashing purposes. A handwashing

sink shall not be used for any other purpose. Facilities inspected and approved by the department prior to January 1,

2008, are exempt from this requirement until such time as kitchen renovation will occur or substantial renovation

will occur at the facility.

(g) In addition to the designated one compartment handwashing sink in paragraph (f) above, a two compartment

sink or one compartment sink and a residential use dishwasher shall be provided for warewashing. Notwithstanding

the provisions in subsection (f) above, if a facility has a two compartment sink and a residential dishwasher, one

compartment of the two compartment sink can be designated as a handwashing sink when labeled and used

exclusively as such. Existing facilities shall have until December 31, 2008, to comply with this requirement.

(h) Multi-use equipment and utensils shall be constructed and repaired with materials that are non-toxic,

corrosion resistant and nonabsorbent; and shall be smooth, easily cleanable and durable under conditions of normal

use; and shall not impart odors, color or taste nor contribute to the contamination of food.

(i) All multi-use eating and drinking utensils shall be thoroughly cleaned with hot water and an effective

detergent, then shall be rinsed free of such solution.

(j) Refrigeration units and hot food storage units used for the storage of potentially hazardous foods shall be

provided with a numerically scaled indicating thermometer accurate to plus or minus 3° Fahrenheit. The

thermometer shall be located in the warmest or coldest part of the units as may be applicable and of such type and so

situated that the temperature can be easily and readily observed.

(k) Potentially hazardous foods and potentially hazardous foods that are in a form which is edible without

washing, cooking, or additional preparation, including previously cooked foods such as leftovers, must be stored in

accordance with the date marking and disposition requirements of subsections 64E-11.004(14) and (15), F.A.C.

(l) The facility shall protect food and food equipment from all sources of contamination at all times during

storage, food preparation, service, and transportation both on and off premises.

(m) Live animals and pets living in or visiting a community based residential facility shall not enter the kitchen

or any food preparation areas when food is being prepared or served. Preventing pets and animals from entering the

kitchen or food preparation areas must be effective and may consist of passive restraint through obedience training,

use of physical barriers such as a gate, physical restraint such as limiting the animal to a room outside of the kitchen

or food preparation area, or any other effective means. Animals and pets shall not be fed, watered, bedded, kept, or

caged in the kitchen, food preparation, food storage, or dining area. Animal care supplies shall not be kept in the

kitchen or other food storage areas. If live animals have access to kitchen and dining areas during non-food

preparation and service times, then the facility shall effectively sanitize the dining tables, kitchen counter top

surfaces, food preparation surfaces, and other similar surfaces immediately before the next meal service or food

preparation begins. Persons handling or having direct physical contact with an animal must wash their hands

immediately prior to preparing or serving food.

(n) As part of an organized activity, residents may participate in food preparation under direct supervision of the

designated staff person in charge of food service activities, who is knowledgeable in food hygiene safety.

8 – 6

(o) Labeling. Food containers shall be labeled with their contents and labels shall correctly identify the contents

of the container.

(3) Tier III. If food service is provided in a hospice facility, or a facility with a maximum capacity of 11 or more

residents, it shall comply with Chapter 64E-11, F.A.C. Existing facilities shall have until December 31, 2008, to

comply with the requirements of Chapter 64E-11, F.A.C., except for item paragraph (b) below.

(a) Any organized food preparation activity in which residents may participate in food preparation as part of the

organized activity must be under the direct supervision of a trained food service employee, per Rule 64E-11.012,

F.A.C. This does not apply to specific designated therapeutic classes with activities for an individual or a group of

individuals provided by a licensed occupational or physical therapist as part of their occupational, physical, or

rehabilitation therapy activities to regain basic self sufficiency skills.

(b) Facilities with capacities of 11-24 residents that have been in continuous operation since initial regulation or

licensing by the department prior to January 1, 2008, are exempt from subsection 64E-11.008(7), F.A.C., until the

facility remodels the kitchen or dining area, or substantially remodels the facility.

(4) Catering. If food is catered from outside sources, the caterer shall be licensed or regulated by a state or

federal regulatory food program. If a community based residential facility caters additionally to outside sources, it

must meet all Chapter 64E-11, F.A.C., licensing standards.

(a) When catering is provided as the primary means of food supply, a copy of a current catering agreement shall

be provided to the local county health department at least annually and when a change in the agreement occurs. The

agreement shall minimally include the designated delivery times, method of hot and cold holding once food is

delivered, whether bulk or individually portioned food will be provided, and a designated responsible party for

cleaning and sanitizing any multi-use equipment and utensils.

(b) Upon delivery of catered food to a community based residential facility, catered food must be adequately

protected from contamination. The facility shall maintain a daily log indicating the date and time of delivery, name

or type of potentially hazardous food(s), and using an accurate food thermometer measure and log the food

temperatures upon arrival. Entries in the log shall be made at the time of delivery. These temperature logs shall be

maintained and retained at the facility for a period not less than 6 months. The records required by this section must

be made available for review by the department upon department request.

(c) If outside catering is not the primary means of food supply to the facility, and the facility only partakes in

the occasional carry-out or delivery of items such as, pizza, wings, sub-sandwiches, fried chicken, or barbequed

food, the catering requirements listed in paragraphs (a) and (b) above, do not apply.

Specific Authority 381.006(16), 381.0072(2)(a) FS. Law Implemented 381.006(16), 381.0072(2)(a), (b), (c) FS.

History–New 6-18-87, Formerly 10D-23.006, Amended 1-20-08.

64E-12.005 Housing.

(1) The facility shall provide safe and sanitary housing free from objects, materials, and conditions of an

environmental origin that constitute a danger to the residents.

(2) Floors, walls, ceilings, windows, doors and all appurtenances of the structures shall be of sound

construction, properly maintained, easily cleanable and shall be kept clean.

8 – 7

(a) Floor surfaces shall be of non-slip type and maintained free of loose or broken tiles and boards, holes,

uneven projections, protruding nails, tears, splinters, water spillage and other tripping hazards. Bathtubs and showers

shall contain slip-resistent strips, slip-resistent rubber bath mats, or slip-resistent surfaces.

(b) Wall surfaces shall be maintained free of hazardous projections, splinters, loose moldings, and broken

plaster.

(c) Overhead surfaces shall be free of water damage, loose, missing or broken tiles, plaster, lath, or loose

hanging fixtures, pipes and electric wiring.

(d) All external windows designed to open shall be accessible and operable.

(3) All housing facilities shall be kept free of offensive odors by adequate cleanliness and proper ventilation.

(4) All areas of the facility shall be well lighted. Dormitories, bedrooms, toilets, bathing rooms, shower rooms,

and dayrooms shall have light fixtures that provide at least 20 foot candles of illumination in all areas of the room,

measured at a distance 30 inches from the floor, to permit observation, cleaning and maintenance. Light fixtures

shall be maintained to work as designed and kept clean.

(5) All areas of the facility occupied by residents, including sleeping rooms, common areas, hallways,

bathrooms, and dining areas shall have natural or mechanical ventilation.

(a) If natural ventilation is utilized, the opened window area for ventilation purposes should be equal to one-

tenth of the floor space.

(b) When mechanical ventilation systems are employed, the systems shall be maintained to operate as designed

and kept clean. Intake air ducts shall be designed and installed so that dust or filters can be readily removed. In

resident occupied areas mechanical ventilation systems shall provide a minimum of 10 cubic feet of fresh or filtered

recirculated air per minute for each resident occupying the area.

(c) All toilet rooms shall be provided with direct openings to the outside or provided with mechanical

ventilation to the outside.

(6) Adequate heating facilities shall be provided to maintain a minimum temperature of 68° Fahrenheit, 20

inches above the floor in all resident occupied rooms.

(7) Mechanical cooling devices shall be used and in working condition in those areas of buildings occupied by

residents when inside temperatures exceed 85° Fahrenheit. Exceptions are made when the resident is capable and in

control of the thermostat or cooling devices in their personal area and chooses for it to exceed 85° Fahrenheit.

(8) All heating and cooling systems shall be consistent with current building and fire code rules applicable to

the area where the facility is located, as determined by building and fire officials.

(9) All furniture and furnishings must be in good repair and kept clean.

(10) Plumbing shall be maintained in compliance with the requirements of the applicable plumbing provisions

of the State Building Code, as adopted in Rule 9B-3.047, F.A.C., and Section 553.06, F.S.

(11) Sanitary facilities shall comply with the requirements of Chapter 64E-10, F.A.C.

(12) Sewage and liquid waste shall be disposed of in accordance with Chapter 62-601 or Chapter 64E-6, F.A.C.,

whichever is applicable.

Specific Authority 381.006, 381.006(16) FS. Law Implemented 381.006, 381.006(6), (16) FS. History–New 6-18-87,

Amended 8-7-96, Formerly 10D-23.009, Amended 1-20-08.

8 – 8

64E-12.006 Vector and Vermin Control.

(1) Effective control measures shall be utilized to minimize the presence of rodents, flies, cockroaches and other

vectors and vermin on the premises. The primary means of pest control shall be the use of integrated pest

management (IPM) systems and tools. IPM tools, such as “Integrated Pest Management for Schools: How-to

Manual” dated May 2, 2006, which are recognized by the United States Environmental Protection Agency, are

approved practices for the control of pests throughout a residential facility. The manual is available at

http://www.epa.gov/pesticides/ipm/schoolipm/index.html or by writing for a free copy to EPA Pesticides Section,

U.S. EPA Region 9, 75 Hawthorne Street (CMD-5), San Francisco, CA 94105. Use of IPM systems and tools does

not restrict the use of licensed pest control companies or individuals.

(2) The creation, maintenance or causing of any condition capable of propagating vectors and vermin will not

be permitted. All building shall be effectively maintained rodent-proofed and rodent free. All outside openings shall

be effectively sealed or screened with 16 mesh screening or equivalent, to prevent entry of insects, rodents, or other

vectors and vermin, except in wilderness programs when mosquito netting is provided to each resident.

Specific Authority 381.006, 381.006(16) FS. Law Implemented 381.006, 381.006(16) FS. History–New 6-18-87,

Amended 8-7-96, Formelry 10D-23.010, Amended 1-20-08.

64E-12.007 Bedding, Towels, Clothing and Personal Items.

Beds, mattresses and bedding shall be provided and kept in good repair and shall be cleaned regularly. Mattresses

and pillows shall have cleanable covers which shall be cleaned between uses by different residents. Sheets, towels

and personal clothing shall be washed at least weekly. Blankets shall be washed or dry cleaned as necessary and

between uses by different residents. Blankets, sheets, towels and clean clothing shall be stored in a clean, dry place

between laundering and use. Separate, individually assigned spaces shall be provided for storage of personal items

and toiletries. The use of common towels is prohibited.

Specific Authority 381.006(16) FS. Law Implemented 381.006(6), (16) FS. History–New 6-18-87, Formerly 10D-

23.011.

64E-12.008 Laundry.

(1) Where laundry facilities are provided, they shall be adequate to ensure an ample quantity of clean clothing,

bed linens and towels. Laundry facilities shall be of sound construction and shall be kept clean and in good repair.

Adequate space shall be provided for the complete separation of clean and soiled clothing, linen and towels.

(2) Laundry rooms shall have fixtures that provide at least 30 foot-candles of illumination, be kept clean and

free of lint build-up, and be properly ventilated as specified in the applicable building provisions of the State

Building Code, as adopted in Rule 9B-3.047, F.A.C. Lighting will be measured 30 inches above the floor. Clothes

dryers shall be vented to the exterior. Carts used for transporting dirty clothes, linens and towels shall not be used

for transporting clean articles unless they have been thoroughly cleaned and sanitized.



8 – 9

64E-12.009 Medications, Alcohol, Poisonous or Toxic Substances.

(1) Poisonous or toxic substances are to be stored apart from food and other areas that would constitute a hazard

to the residents. All containers containing poisonous or toxic substances must be clearly labled to indicate their

contents.

(2) All toxic, poisonous, and alcoholic substances shall be kept in locked areas, such as a locked office, locked

cabinet, or locked cupboard at all times when not in use. This does not apply to alcoholic beverages. Alcoholic

beverages shall be kept out of a child’s reach.

(3) Medications shall be kept in locked areas, such as a locked office, locked cabinet, or locked box at all times

when not in use. This is in addition to a childproof medicine bottle cap, lid, or other packaging. Exceptions are

extended to adults capable of self medication, life saving medications such as epinephrine pens, insulin, nitro

glycerin, or asthma inhalers that may be needed by the resident who is capable of self-medication in an emergency

due to illness or disease. Medicine containers or packaging must be clearly labeled indicating the prescribed

individual’s name and its contents. Medications requiring refrigeration or which are stored in a food service or food

storage area, shall be stored in such a manner that they do not pose a contamination hazard to food.

Specific Authority 381.006, 381.006(16) FS. Law Implemented 381.006, 381.006(6), (16) FS. History–New 6-18-87,


64E-12.010 Garbage and Rubbish.

(1) All garbage, trash and rubbish shall be collected daily and placed in storage facilities. Garbage shall be

removed from storage facilities frequently enough to prevent a sanitary nuisance, as defined in Chapter 386, F.S.

Wet garbage shall be collected and stored in impermeable, leak proof, fly tight containers pending disposal. All

containers, storage areas and surrounding premises shall be kept clean and free of vermin.

(2) The method of disposal shall not create sanitary nuisance conditions and shall comply with provisions of

Chapter 62-701, F.A.C.

Specific Authority 381.006(16) FS. Law Implemented 381.006(6), (16) FS. History–New 6-18-87, Amended 8-7-96,

Formerly 10D-23.014.

64E-12.011 Recreational Areas.

(1) The recreational area shall be safe and free from hazardous conditions. Recreational equipment shall have

no jagged or sharp projections or other hazardous construction, and shall be maintained in a structurally sound

condition.

(2) Outdoor recreational areas shall be well drained and kept free of litter and trash.

(3) If swimming pools, spas, or open water hazards are located on the property of a community based residential

facility, the facility shall provide direct supervision by an adult employee when in use or when the area is occupied

by minors and other residents that cannot swim. The individual responsible for supervision during water activites or

near water hazards must have successfully completed the community water safety course specified in paragraph (b)

below.

(a) A wading or kiddy pool is not allowed.

(b) All community based residential facilities with swimming pools, spas, or open water hazards must have a

person on staff who has completed a community water safety course administered by the American Red Cross,

YMCA, or any aquatic training program granted approval under paragraph 64E-9.008(1)(d), F.A.C.

8 – 10

(c) A community based residential facility with a pool or spa not currently regulated by Chapter 64E-9, F.A.C.,

shall minimally, regardless of construction date, meet the barrier requirements in one of the following references:

Section 424.2.17 through 424.2.17.3 of the 2004 Florida State Building Code for private swimming pools or Section

515.29, F.S.

(d) Water safety devices shall be provided for residential pools. A shepherd’s hook shall be provided securely

attached to a one piece pole not less than 16 feet in length, and at least one 18 inch diameter lifesaving ring with

sufficient rope attached to reach all parts of the pool from the pool deck. Safety equipment shall be mounted in a

conspicuous place and be readily available for use. Residential spas and hot tubs are exempt from this requirement.


Amended 8-7-96, Formerly 10D-23.015, Amended 1-20-08.

64E-12.012 Radon Testing.

Rulemaking Authority 404.056(4), (6), 381.006 FS. Law Implemented 404.056(4), 381.006(16) FS. History–

New 1-20-08, Repealed 12-29-16.

64E-12.013 Animal Health and Safety.

(1) Animals requiring rabies vaccination under Section 828.30, F.S., must be vaccinated for rabies and their

vaccinations must be current at the time of inspection. Proof of rabies vaccination or veterinary certification of

vaccination exemption shall be kept on the premises at all times.

(2) All animals must be kept in good health and free from disease or under treatment by a licensed veterinarian.

Indoor animals frequenting the outside must have an annual screening for internal parasites by a licensed

veterinarian. Any animal positive for internal parasites must be treated appropriately by the licensed veterinarian.

Animals being kept or having access to the indoors must be treated for flea control throughout the year to prevent

infestations.

(3) Aggressive, venomous, or potentially dangerous animals must be restricted from access by the residents at

all times and kept in such a manner so as not to be able to become free roaming and cause or inflict harm to the

residents, visitors, or employees. These animals may not be housed in the residents’ sleeping quarters.

Specific Authority 381.006(6), (16) FS. Law Implemented 381.006(6), (16) FS. History–New 1-20-08.

9. Rule Chapter

64E-16, F.A.C

.

9 – 1

CHAPTER 64E-16

BIOMEDICAL WASTE 64E-16.001 General


64E-16.003 Facility Policies and Procedures

64E-16.004 Storage and Containment

64E-16.005 Labeling

64E-16.006 Generator Requirements

64E-16.007 Treatment

64E-16.008 Biomedical Waste Transport

64E-16.009 Registration of Biomedical Waste Transporters

64E-16.010 Inspections

64E-16.011 Permits

64E-16.012 Fees

64E-16.013 Enforcement and Penalties (Repealed)

64E-16.001 General.

(1) This chapter prescribes minimum sanitary practices relating to the management of biomedical waste,

including segregation, handling, labeling, storage, transport, and treatment. This chapter applies to all facilities that

generate, transport, store, or treat biomedical waste to ensure that the waste is properly handled to protect public

health. Further, this chapter prescribes minimum standards for permitting biomedical waste generators, storage

facilities and treatment facilities, and for registering biomedical waste transporters.

(2) This chapter does not apply to biomedical waste incinerators. This chapter does not apply to linen

incinerators. This chapter does not apply to linen that is to be laundered and re-used. Further, this chapter does not

apply to dead bodies that are disposed of by a person licensed under the provisions of Chapter 470, F.S., or to the

transport of bodies, parts of bodies, or tissue specimens in furtherance of lawful examination, investigation, or

autopsy conducted pursuant to Section 406.11, F.S. Specimens or samples collected for laboratory testing or use in

medical research or teaching are not considered biomedical waste until such time as the material is discarded.

(3) The Department of Health shall regulate the packaging, transport, storage, and treatment of biomedical

waste. The Department of Environmental Protection shall regulate biomedical waste incineration and biomedical

waste disposal.

(4) Health care providers shall inform their home user clients verbally and in writing of the recommended

method for handling biomedical waste generated in the home setting. Health care providers who deliver in-home

medical services shall remove or have removed by a registered biomedical waste transporter all biomedical waste

generated during the performance of these services.

(5) Home users should segregate and package their biomedical waste in a manner that reduces the chance of

exposure to the public.

(6) Inspections, permitting and enforcement of emergency medical services that generate biomedical waste shall

be performed by the Bureau of Emergency Medical Services.


Amended 12-14-92, 1-23-94, 6-3-97, Formerly 10D-104.001.

9 – 2


For the purpose of this chapter, the following words and phrases shall have the meanings indicated:

(1) American Society for Testing Materials, also referred to as ASTM – A technical society with headquarters

located at 100 Barr Harbor Drive, West Conshohocken, Pennsylvania, 19428-2959, which publishes national

standards for the testing and quality assurance of materials.

(2) Biomedical waste – Any solid or liquid waste which may present a threat of infection to humans, including

nonliquid tissue, body parts, blood, blood products, and body fluids from humans and other primates; laboratory and

veterinary wastes which contain human disease-causing agents; and discarded sharps. The following are also

included:

(a) Used, absorbent materials saturated with blood, blood products, body fluids, or excretions or secretions

contaminated with visible blood; and absorbent materials saturated with blood or blood products that have dried.

(b) Non-absorbent, disposable devices that have been contaminated with blood, body fluids or, secretions or

excretions visibly contaminated with blood, but have not been treated by an approved method.

(3) Biomedical waste generator – A facility or person that produces biomedical waste. The term includes

hospitals, skilled nursing or convalescent hospitals, intermediate care facilities, clinics, dialysis clinics, dental

offices, health maintenance organizations, surgical clinics, medical buildings, physicians' offices, laboratories,

veterinary clinics and funeral homes.

(a) Mobile health care units, such as bloodmobiles, that are part of a stationary biomedical waste generator, are

not considered individual biomedical waste generators.

(b) Funeral homes that do not practice embalming are not considered biomedical waste generators.

(4) Body fluids – Those fluids which have the potential to harbor pathogens, such as human immunodeficiency

virus and hepatitis B virus and include blood, blood products, lymph, semen, vaginal secretions, cerebrospinal,

synovial, pleural, peritoneal, pericardial and amniotic fluids. In instances where identification of the fluid cannot be

made, it shall be considered to be a regulated body fluid. Body excretions such as feces and secretions such as nasal

discharges, saliva, sputum, sweat, tears, urine, and vomitus shall not be considered biomedical waste unless visibly

contaminated with blood.

(5) Contaminated – Soiled by any biomedical waste.

(6) Decontamination – The process of removing pathogenic microorganisms from objects or surfaces, thereby

rendering them safe for handling.

(7) Department – The Department of Health or its representative county health department.

(8) Disinfection – A process which results in a minimum Log 6 kill against the vegetative organisms listed in

Table 1, and a minimum Log 4 kill against Bacillus stearothermophilus spores utilizing steam or a minimum Log 4

kill against Bacillus Subtilis spores utilizing dry heat, chemicals, or microwave shredding.

(9) Facility – All contiguous land, structures, and other appurtenances which are owned, operated, and licensed

as a single entity which may consist of several generating, treatment, or storage units.

(10) Hazardous waste – Those materials defined in Chapter 62-730, F.A.C.

(11) Health Care Provider – Any person who provides medical care or personal services, as that term is defined

in Section 400.402, F.S., to another individual.

(12) Home User – An individual who generates biomedical waste as a result of self-care or care by a family

member or other non health care provider.

9 – 3

(13) Leak resistant – Prevents liquid from escaping to the environment in the upright position.

(14) Outer container – Any rigid type container used to enclose packages of biomedical waste.

(15) Packages – Any material that completely envelops biomedical waste. This includes red bags, sharps

containers and outer containers.

(16) Person – Any individual, partnership, corporation, association, or public body engaged in the generation,

storage, transport, or treatment of biomedical waste.

(17) Point of origin – The room or area where the biomedical waste is generated.

(18) Public sharps collection program – A cooperative program designed as a non-profit community service to

assist the home user in the safe disposal of discarded sharps.

(19) Puncture resistant – Able to withstand punctures from contained sharps during normal usage and handling.

(20) Restricted – The use of any measure, such as a lock, sign, or location, to prevent unauthorized entry.

(21) Saturated – Soaked to capacity.

(22) Sealed – Free from openings that allow the passage of liquids.

(23) Sharps – Objects capable of puncturing, lacerating, or otherwise penetrating the skin.

(24) Sharps container – A rigid, leak and puncture resistant container, designed primarily for the containment of

sharps, clearly labeled with the phrase and international biological hazard symbol as described in Section 64E-

16.004(2)(a), F.A.C., and manufactured with dyes meeting the requirements for incidental metals as described in

Section 64E-16.004(2)(b)1.b., F.A.C.

(25) Sterilization – A process which results in a minimum Log 6 kill against Bacillus stearothermophilus spores

utilizing steam or a minimum Log 6 kill against Bacillus Subtilis spores utilizing dry heat, chemicals, or microwave

shredding.

(26) Storage – The holding of packaged biomedical waste for a period longer than three days at a facility or in a

transport vehicle.

(27) Transfer – The movement of biomedical waste within a facility.

(28) Transport – The movement of biomedical waste away from a facility.

(29) Transport vehicle – A motor vehicle, as defined in Section 320.01, F.S., a rail car, watercraft or aircraft,

used for the transportation of biomedical waste.

(30) Treatment – Any process, including steam, chemicals, microwave shredding, or incineration, which

changes the character or composition of biomedical waste to render it noninfectious by disinfection or sterilization.

Rulemaking Authority 381.006, 381.0098 FS. Law Implemented 381.006, 381.0098, 395.002(13), 395.1011 FS.

History–New 6-19-89, Amended 4-2-90, 12-14-92, 1-23-94, 8-20-95, 6-3-97, Formerly 10D-104.002.

64E-16.003 Facility Policies and Procedures.

(1) All biomedical waste facilities shall comply with the following:

(a) Biomedical waste mixed with hazardous waste, as defined in Chapter 62-730, F.A.C., Hazardous Waste,

shall be managed as hazardous waste.

(b) Biomedical waste mixed with radioactive waste shall be managed in a manner that does not violate the

provisions of Chapter 64E-5, F.A.C. The biomedical waste shall be managed in accordance with the provisions of

Chapter 64E-16, F.A.C., after the radioactive component has decayed in storage as provided for in Chapter 64E-5,

F.A.C., or is otherwise not regulated under Chapter 64E-5, F.A.C. The packaging requirements of Chapter 64E-5,

F.A.C., shall be followed, unless the requirements of Chapter 64E-16, F.A.C., are more restrictive.

9 – 4

(c) Any other solid waste or liquid, which is neither hazardous nor radioactive in character, combined with

untreated biomedical waste, shall be managed as untreated biomedical waste.

(d) All surfaces contaminated with spilled or leaked biomedical waste shall be decontaminated as part of the

cleaning process.

(2) Each biomedical waste facility shall implement a written operating plan to manage biomedical waste, in

accordance with this chapter. This plan shall be available for review by the department and facility personnel. The

plan shall include the following: a description of training for personnel; procedures for segregating, labeling,

packaging, transporting, storing, and treating, biomedical waste; procedures for decontaminating biomedical waste

spills; and a contingency plan for emergencies. Facilities which have multiple specialty services shall include

procedures specific to each specialty if procedures vary. Plans shall be updated when regulations, facility policies, or

procedures change.

(a) Each facility or their designee shall train new personnel who handle biomedical waste as part of their work

responsibilities. This training shall be provided prior to commencement of duties related to biomedical waste

handling. Refresher training shall be completed annually by all personnel who handle biomedical waste. Training

shall detail compliance with the facility's operating plan and Chapter 64E-16, F.A.C., and shall be maintained as a

part of the operating plan.

(b) All biomedical waste management records shall be maintained for 3 years and shall be available for review

by the department.



64E-16.004 Storage and Containment.

(1) Storage.

(a) Storage of biomedical waste at the generating facility shall not exceed 30 days. The 30 day period shall

commence when the first non-sharps item of biomedical waste is placed into a red bag or sharps container, or when

a sharps container containing only sharps is sealed.

(b) Storage of biomedical waste in a place other than at the generating facility shall not exceed 30 days. The 30

day storage period shall begin on the day the waste is collected from the generator.

(c) Indoor storage areas shall have restricted access and be designated in the written operating plan. They shall

be located away from pedestrian traffic, be vermin and insect free, and shall be maintained in a sanitary condition.

They shall be constructed of smooth, easily cleanable materials that are impervious to liquids.

(d) Outdoor storage areas, including containers and trailers, shall, in addition to the above criteria, be

conspicuously marked with the international biological hazard symbol as described in paragraph 64E-16.004(2)(b),

F.A.C., and shall be secured against vandalism and unauthorized entry. The international biological hazard symbol

on an outdoor storage area shall be a minimum of six inches in diameter.

(2) Containment.

(a) Packages of biomedical waste shall remain sealed until treatment, except when compacted in accordance

with the requirements of this chapter as stated in Section 64E-16.006(2), F.A.C. Ruptured or leaking packages of

biomedical waste shall be placed into larger packaging without disturbing the original seal.

9 – 5

(b) All packages containing biomedical waste shall be visibly identifiable with the international biological

hazard symbol and one of the following phrases: “BIOMEDICAL WASTE”, “BIOHAZARDOUS WASTE”,

“BIOHAZARD”, “INFECTIOUS WASTE”, or “INFECTIOUS SUBSTANCE”. The symbol shall be red, orange, or

black and the background color shall contrast with that of the symbol or comply with the requirements cited in

subpart Z of 29 C.F.R. subparagraph 1910.1030(g)(1)(C), Occupational Exposure to Bloodborne Pathogen Standard.

(c) Bags.

1. Biomedical waste, except sharps, shall be packaged and sealed at the point of origin in impermeable, red

plastic bags or, at the discretion of the generator, into sharps containers. The international biological hazard symbol

shall be at least six inches in diameter on bags 19'' × 14'' or larger, and at least one inch in diameter on bags smaller

than 19'' × 14''. Each plastic bag shall meet the following physical properties:

a. Impact resistance of 165 grams and tearing resistance of 480 grams in both the parallel and perpendicular

planes with respect to the length of the bag. Impact resistance shall be determined using ASTM D-1709-91, and

tearing resistance shall be determined using ASTM D-1922-89.

b. Incidental sum concentrations of lead, mercury, hexavalent chromium and cadmium shall be no greater than

100 ppm for dyes used in the coloration of bags.

(d) Sharps containers.

1. Sharps shall be discarded at the point of origin into single use or reusable sharps containers. Needles and

scalpel blades shall not be placed directly into double-walled corrugated containers. Sharps containers must be

sealed when full. A sharps container is considered full when materials placed into it reach the designated fill line, or,

if a fill line is not indicated, when additional materials cannot be placed into the container without cramming or

when no additional materials are to be placed in the container.

2. Permanently mounted sharps container holders shall bear the phrase and the international biological hazard

symbol described in paragraph 64E-16.004(2)(a), F.A.C., if this information on the sharps container is concealed by

the sharps container holder.

3. Reusable sharps containers shall only be emptied into a treatment cart or directly into a treatment unit. They

shall be constructed of smooth, easily cleanable materials, and shall be decontaminated after each use.

4. The international biological hazard symbol shall be at least one inch in diameter on sharps containers.

(e) All outer containers shall be rigid, leak-resistant and puncture-resistant. Reusable outer containers shall be

constructed of smooth, easily cleanable materials and shall be decontaminated after each use.

(f) The international biological hazard symbol shall be at least six inches in diameter on outer containers 19'' ×

14'' or larger, and at least one inch in diameter on outer containers less than 19'' × 14''.



9 – 6

64E-16.005 Labeling.

(1) Biomedical waste bags and sharps containers shall be labeled with the generator’s name and address unless

treatment occurs at the generating facility.

(a) If a bag or sharps container is placed into a larger bag prior to transport, the label for the exterior bag shall

comply with subsection 64E-16.005(1), F.A.C. Inner bags and inner sharps containers are exempt from the labeling

requirements of subsection 64E-16.005(1), F.A.C.

(b) Outer containers shall be labeled with the transporter’s name, address, registration number, and 24-hour

telephone number prior to transport.

(2) The transporter may provide labels for bags or sharps containers that are generator-specific, such as bar

codes or specific container numbers. Use of these generator-specific labels satisfies the requirements of paragraph

64E-16.005(1)(a), F.A.C.



64E-16.006 Generator Requirements.

(1) A biomedical waste generator shall not negotiate for the transport of biomedical waste with a person who is

not registered with the department as a biomedical waste transporter.

(2) Compacting packages of biomedical waste within the generating facility, except recognizable human tissue,

bulk liquids, or sharps, is acceptable provided the following conditions are met:

(a) Packages of biomedical waste shall not be compacted to a density greater than 22 pounds per cubic foot.

(b) Compacted packages of biomedical waste shall not be subjected to further compacting.

(c) Any residual or incidental liquid shall be contained within the inner bag or outer container. Should the inner

bag or outer container rupture during compaction, residual or incidental liquids shall be disposed of directly into the

sanitary sewer, an on-site sewage treatment and disposal system, or other system approved to receive such wastes by

the Department of Environmental Protection or the department;

(d) Discharge of noxious air shall be kept to a minimum through use of HEPA filters having a pore size of 2

microns or less, negative pressure rooms, or other safety methods;

(e) Compacted packages of biomedical waste shall be treated by incineration or other approved treatment

process. Treatment processes, such as steam, chemical, gas, dry heat, or microwaving, shall be considered by the

department upon written request and microbiological evidence that the proposed process provides the same degree

of treatment for compacted waste as for uncompacted waste. Steam treatment systems shall be tested against

Bacillus stearothermophilus spores, as described in subsection 64E-16.007(2), F.A.C. Other proposed treatment

processes shall demonstrate efficacy using subsection 64E-16.007(4), F.A.C.



9 – 7

64E-16.007 Treatment.

(1) Biomedical waste shall be treated by steam, incineration, or an alternative process approved by the

department as described in subsection 64E-16.007(4), F.A.C., prior to disposal. Treatment shall occur within 30

days of collection from the generator.

(2) Steam treatment units shall subject loads of biomedical waste to sufficient temperature, pressure, and time to

demonstrate a minimum Log 4 kill of Bacillus stearothermophilus spores placed at the center of the waste load, and

shall be operated in accordance with the following:

(a) Before placing a steam treatment unit into service, operating parameters such as temperature, pressure, and

treatment time shall be determined according to the following:

1. Test loads of biomedical waste which consist of the maximum weight and density of biomedical waste to be

treated shall be prepared. Separate loads of red bags, sharps containers, boxes, and compacted waste shall be

prepared if they are to be treated separately.

2. Prior to treatment, Bacillus stearothermophilus spores shall be placed at the bottom and top of each treatment

container, at the front of each treatment container at a depth of approximately one-half of the distance between the

top and bottom of the load, in the approximate center of each treatment container, and in the rear of each treatment

container at a depth of approximately one-half of the distance between the top and bottom of the load.

3. If the operating parameters used during the treatment of the test loads demonstrate a minimum Log 4 kill of

Bacillus stearothermophilus spores at all locations, the steam treatment unit shall operate under those parameters

when placed into service. If the operating parameters fail to provide a minimum Log 4 kill of Bacillus

stearothermophilus spores at all locations, treatment time, temperature, or pressure shall be increased and the tests

must be repeated until a minimum Log 4 kill of Bacillus stearothermophilus spores is demonstrated at all locations.

The steam treatment unit shall be operated under those parameters when placed into service. Tests shall be repeated

and new parameters established if the type of biomedical waste to be treated is changed.

(b) When operating parameters have been established and documented using the criteria in paragraph 64E-

16.007(2)(a), F.A.C., the steam treatment unit may be placed into service.

(c) The steam treatment unit shall be serviced for preventive maintenance in accordance with the manufacturer's

specifications. Records of maintenance shall be onsite and available for review.

(d) Unless a steam treatment unit is equipped to continuously monitor and record temperature and pressure

during the entire length of each treatment cycle, each package of biomedical waste to be treated will have a

temperature tape or equivalent test material such as a chemical indicator placed on a non-heat conducting probe at

the center of each treatment container in the load that will indicate if the treatment temperature and pressure have

been reached. Waste shall not be considered treated if the tape or equivalent indicator fails to show that a

temperature of at least 250 degrees F (121 degrees C) was reached during the process.

(e) Each steam treatment unit shall be evaluated for effectiveness with spores of Bacillus stearothermophilus at

least once each 7 days for permitted treatment facilities, or once each 40 hours of operation for generators who treat

their own biomedical waste. The spores shall be placed at the center of the waste load. Evaluation results shall be

maintained onsite and available for review.

(f) A written log shall be maintained for each steam treatment unit. The following shall be recorded for each

usage:

1. The date, time, and operator name;

9 – 8

2. The type and approximate amount of waste treated;

3. The post-treatment confirmation results by either

a. recording the temperature, pressure, and length of time the waste was treated, or

b. the temperature and pressure monitoring indicator;

(g) A current written operating procedure shall specify, at a minimum, the following:

1. Parameters, determined from testing, that provide consistent treatment, such as exposure time, temperature,

and pressure.

2. Identification of standard treatment containers and placement of the load in the steam treatment unit.

(3) Incineration of biomedical waste shall be achieved in a biological waste incinerator permitted by the

Department of Environmental Protection.

(4) An alternative treatment process, such as chemical, gas, dry heat, or microwave shredding, shall be

considered by the department upon receipt of a written request. The written request shall be directed to the State

Health Officer and shall include:

(a) The specific treatment process and type of facility for which acceptance is sought;

(b) The reason for the request;

(c) Microbiological evidence, using the organisms listed in Table 1, that the proposed process provides

sterilization or a satisfactory level of disinfection. Using the protocol described in subsection 64E-16.007(4), F.A.C.,

alternative treatment systems must show either:

1. For disinfection, a minimum Log 6 kill for the vegetative organisms listed in Table 1 and a minimum Log 4

kill against Bacillus stearothermophilus spores utilizing steam or a minimum Log 4 kill against Bacillus Subtilis

spores utilizing dry heat, chemicals, or microwave shredding, or

2. For sterilization, a minimum Log 6 kill against Bacillus stearothermophilus spores utilizing steam or a

minimum Log 6 kill against Bacillus Subtilis spores utilizing dry heat, chemicals, or microwave shredding.

Table 1

1. Bacteria

a. Bacillus spores – mandatory, species determined by treatment process

Any two

b. Enterococcus faecalis

c. Pseudomonas aeruginosa

d. Staphylococcus aureus

e. Nocardia species

2. Mycobacteria species – any one

a. Mycobacterium bovis

b. Mycobacterium fortuitum

3. Fungus – any one

a. Candida albicans

b. Aspergillus fumigatus

4. Protozoa – Giardia intestinalis or similar

5. Virus – Poliovirus or similar.

9 – 9

(d) Each step of the efficacy testing must be thoroughly described in the application for approval. A detailed

description of the treatment process, preparation of organisms, preparation of test loads, recovery of organisms, and

raw data must be provided.

(e) To begin the efficacy testing, two challenge loads must be sterilized. These loads must be composed of

materials commonly found in biomedical waste (tissues, sharps, plastics, glass, woven materials, blood and blood

products, etc.), and must be of adequate quantity to equal the maximum capacity of the treatment system. The test

load must be fully described (weight, moisture content, composition, etc.).

(f) The purity of all organisms and spores must be certified by a clinical or commercial laboratory. Each

organism must be processed separately and placed in the test load in the most difficult location to treat. Before each

test run, the total number of viable test organisms must be determined and documented. Treatment of the test load

must take place within thirty minutes of inoculating the load with the test organism.

(g) The test load containing the test organism must be processed without the agent (e.g., chemical, microwaves,

etc.) used to kill the test organisms. If this agent is a liquid, it must be replaced with an equal amount of sterile saline

solution or tapwater. After the test load has completed one cycle in the treatment device, a minimum of three grab

samples must be taken from the test load and the number of test organisms present determined. If the number of

organisms recovered after the test run is less than Log 6, the number of organisms originally introduced into the

device must be increased, and the run must be performed again, until at least Log 6 organisms are recovered. If the

number of organisms recovered from the test run is Log 6 or greater, there is an adequate number of organisms

being introduced into the device, and the inoculum size should be equal to this number.

(h) Using the inoculum size determined in the above procedure, the second sterilized test load must be

inoculated separately. During these test runs, the chemical or physical agent used to treat the waste must be used.

(i) After each test run is completed, the log kill for that particular organism or spore must be calculated. The

number of organisms that were not recovered from the initial (non-treating) test run must be subtracted from the

number of organisms that were introduced into the second (treatment) run. The number of organisms that survive the

treatment process must be subtracted from the first calculation. The resulting figure is the log kill provided by the

treatment process.

(j) Approved alternative treatment processes, except single-use, shall meet the requirements of paragraph 64E-

16.007(2)(e), F.A.C.

(5) Biomedical waste may be disposed into a sanitary sewer system, an onsite sewage treatment and disposal

system, or other system approved to receive such waste by The Department of Environmental Protection or the

department, if it is in a liquid or semi-solid form and aerosol formation is minimal.

(6) Body tissues that have been histologically fixed are considered treated biomedical waste. Tissues prepared

by frozen sectioning only are not considered treated.

(7) Acute care hospitals, licensed under Chapter 395, F.S., which utilize a certified onsite treatment process

involving grinding and treatment, may dispose of such treated biomedical waste in the normal municipal solid waste

stream upon notifying the local government responsible for solid waste collection and disposal under the following

conditions:

(a) For the purposes of this chapter, certified shall mean that the treatment process is steam treatment, or has

been approved as an alternative biomedical waste treatment process under subsection 64E-16.007(4), F.A.C.

(b) For the purposes of this chapter, grinding shall also mean shredding or hammermilling.

9 – 10

(c) If grinding takes place prior to treatment, procedures that minimize the chance of exposure to waste handlers

must be developed and implemented should the grinder fail or become jammed.

(d) Individuals operating the treatment unit must be trained in all aspects of its operation, including contingency

procedures.

(e) Acute care hospitals must inform the department in writing of the installation of the unit at least 30 days

prior to placing the unit into service.

(f) Inspection of the unit, including treatment and maintenance records, will occur during the annual inspection

for the hospital's biomedical waste permit.


History–New 6-19-89, Amended 12-14-92, 1-23-94, 8-20-95, 6-3-97, Formerly 10D-104.007.

64E-16.008 Biomedical Waste Transport.

(1) No registered transporter may knowingly accept biomedical waste for transport unless it has been properly

segregated, packaged, and labeled.

(2) Each registered transporter shall provide the generator with a receipt of pick-up.

(3) During transport, no registered transporter shall compact biomedical waste or allow it to leak into the

environment.

(4) Transfer of biomedical waste from one transport vehicle to another is not allowed unless the transfer occurs

at a permitted storage or treatment facility, except as provided in paragraph 64E-16.008(10)(a), F.A.C. Intermodal

transfers of biomedical waste are allowed provided transport shipping seals remain intact.

(5) Any registered transporter who unknowingly fails to comply with subsections (3) or (4) of this section

because such biomedical waste has not been properly segregated or separated from other solid wastes by the

generating facility is not guilty of a violation under this rule.

(6) No registered transporter shall knowingly deliver biomedical waste for storage or treatment to a facility

which does not have a valid permit issued by the department.

(7) All transport vehicles containing biomedical waste shall be visibly identified with the business name,

registration number, a 24 hour telephone number, and placards showing the phrase and the international biological

hazard symbol as described in paragraph 64E-16.004(2)(a), F.A.C. The symbol shall be at least six inches in

diameter.

(8) All transport vehicles containing biomedical waste shall be fully enclosed and secured when unattended.

(9) Registered transporters shall notify the department within one working day by telephone and shall submit a

follow-up report to the department within 10 days, in writing, if there is an accident that results in a spill of

biomedical waste.

(10) In case of an emergency situation, including mechanical failure, the following is allowed:

(a) If the emergency occurs during transport, biomedical waste may be transferred to another transport vehicle,

including a rental vehicle, without being at a storage or treatment facility.

(b) If a rental vehicle is used, the department shall be notified of its use on the first working day after the

emergency. A copy of the written authorization from the rental agency stating awareness of the intended use of the

vehicle shall be submitted to the department within seven days.

(c) Biomedical waste shall be removed and transported to a permitted storage or treatment facility within 24

hours of the emergency.

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(d) Before return to the rental agency, the vehicle shall be decontaminated.

Rulemaking Authority 381.0098 FS. Law Implemented 381.0098 FS. History–New 6-3-97, Formerly 10D-104.0073.

64E-16.009 Registration of Biomedical Waste Transporters.

(1) Biomedical waste transporters shall be registered with the department. Biomedical waste generators

transporting less than 25 pounds of their own biomedical waste, in their own transport vehicle, on any single

occasion, are exempt from transporter registration, fee, and placarding requirements of this chapter.

(2) Each owner or operator of a transport vehicle shall submit to the department a completed application for

registration on form DH 4106, herein incorporated by reference.

(3) Biomedical waste transporter registrations shall expire on September 30 each year. Renewal applications

will not be considered complete without the submission of an annual report on form DH 4109, herein incorporated

by reference. Biomedical waste transporters with valid registrations, on the effective date of this chapter, shall renew

their registration by September 30 following the expiration date of their existing registration.

(4) Registered transporters shall notify the department in writing within 30 days of any changes made to their

registration form currently on file with the department.

(5) Any registered biomedical waste transporter is subject to having their biomedical waste transporter

registration denied, suspended, or revoked, pursuant to Section 381.0098, F.S., and in accordance with the

procedural requirements of Section 120.60, F.S., upon a finding by the department that the transporter:

(a) Has submitted false or inaccurate information in the application or annual report;

(b) Has violated the provisions of any statute or rule which the department is authorized to enforce;

(c) Has refused to allow inspection of records or equipment by department personnel.

Rulemaking Authority 381.0098 FS. Law Implemented 381.0098 FS. History–New 6-3-97, Formerly 10D-104.0074.

64E-16.010 Inspections.

(1) Department personnel shall inspect registered transport vehicles, permitted generators, storage, and

treatment facilities at least once a year. Those facilities exempted from the registration and fee requirements under

Section 381.0098(4), F.S., shall be inspected at least once every three years. Reinspections may be conducted when

a facility is found to be in non-compliance with this chapter. Results of each inspection shall be recorded on a form

provided by the department.

(2) To provide consistency of inspections throughout the state, all department personnel who inspect biomedical

waste facilities shall attend training annually, which shall be approved by the Bureau of Environmental Health

Programs.


Amended 1-23-94, 8-20-95, 6-3-97, Formerly 10D-104.0075.

64E-16.011 Permits.

(1) All biomedical waste facilities, except those facilities operating under a Department of Environmental

Protection permit, shall obtain a permit from the department annually. Application forms and annual report forms

used by the public may be obtained from the environmental health section of the county health department in the

county of their location or from the Department of Health, Bureau of Facility Programs, 4052 Bald Cypress Way,

Bin #A08, Tallahassee, Florida 32399-1710. All forms listed in this section are incorporated by reference.

(a) A biomedical waste generator, who produces or treats less than 25 pounds of biomedical waste in each 30

day period, shall be exempt from all permit and fee requirements of this chapter.

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(b) Application for an initial biomedical waste generator permit or exemption from permitting shall be

submitted to the department on form DH 4089, Application for Biomedical Waste Generator Permit/Exemption,

8/98. Biomedical waste treatment facilities which were constructed prior to December 31, 1995, or for which an

operation permit was submitted to the Department of Environmental Protection prior to December 31, 1995, shall

meet the requirements of this chapter at the time of renewal of their existing permit.

(c) Application for an initial biomedical waste storage facility permit shall be submitted to the department on

form DH 4107, Application for Biomedical Waste Storage Permit, 8/98.

(d) Application for an initial biomedical waste treatment facility permit shall be submitted to the department on

form DH 4111, Application for a Biomedical Waste Treatment Permit, 8/01. Renewals will not be considered

complete without the submission of an annual report submitted on form DH 4110, Biomedical Waste Treatment

Facility Annual Report, 8/01.

(e) Application for an initial biomedical waste sharps collection program permit shall be submitted to the

department on form DH 4108, Application for Biomedical Waste Sharps Collection Program Permit, 8/98.

(f) Permits shall not be transferable from one person to another. In the event of an address or name change, an

amended application for permit shall be submitted to the department. A permitted generator may work at a branch

office for no more than six hours in any seven day period without applying for an additional permit. These

generators must notify the local county health department biomedical waste coordinator of the existence and

operating hours of the branch office.

1. In the event of a change of ownership of the facility or a newly constructed facility, an application for an

initial permit shall be submitted to the department within 30 days of the commencement of business.

2. When a facility is leased by the owner to a second party for operation, the second party shall apply to the

department for an initial permit within 30 days of the commencement of business. The second party shall be held

responsible for the operation and maintenance of the facility.

(g) Permits shall expire on September 30 each year. The permit, or a copy thereof, shall be maintained within

the facility and shall be made available for review by department personnel.

(2) Persons engaged in a sharps collection program with single or multiple facility locations may operate under

a single permit provided:

(a) The sharps collection program is open to the general public;

(b) A list identifying the location of each facility is attached to the application; and

(c) Each facility meets the applicable permit requirements.


Amended 1-23-94, 6-3-97, Formerly 10D-104.0076, Amended 11-5-02.

64E-16.012 Fees.

(1) State-owned and operated biomedical waste facilities are exempt from the permit fee.

(2) Fee schedule.

Generator Permit:

(application received by October 1) $ 85.00

(application received after October 1) $105.00

Treatment Permit:


9 – 13


Storage Permit:



Transporter Registration (one vehicle):



Additional Vehicle $ 10.00

No fee or combination of fees shall exceed the maximum amount established by the statute.

(3) All fees collected pursuant to this section shall be placed in a specially designated account within the individual

county health department trust fund to be used to meet the cost of administering the biomedical waste program

described in this chapter.

Rulemaking Authority 381.006, 381.0098(4) FS. Law Implemented 381.006, 381.0098 FS. History–New 12-14-92,

Amended 1-23-94, 6-3-97, Formerly 10D-104.0078, Amended 1-12-09.

64E-16.013 Enforcement and Penalties.

Rulemaking Authority 381.006, 381.0098(5) FS. Law Implemented 381.0012, 381.002(13), 381.0025, 381.006,

381.0061, 381.0098, 395.1011, 775.082, 775.083 FS. History–New 6-19-89, Amended 12-14-92, 1-23-94, 6-3-97.

Formerly 10D-104.008, Amended 11-5-02, Repealed 12-2-15.

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10 – 1

CHAPTER 464

PART I

NURSE PRACTICE ACT

464.001 Short title.

464.002 Purpose.


464.004 Board of Nursing; membership; appointment; terms.

464.005 Board headquarters.

464.006 Rulemaking authority.

464.008 Licensure by examination.

464.009 Licensure by endorsement.

464.0095 Nurse Licensure Compact.

464.0096 Nurse Licensure Compact; public records and meetings exemptions.

464.012 Licensure of advanced practice registered nurses; fees; controlled substance prescribing.

464.013 Renewal of license or certificate.

464.014 Inactive status.

464.015 Titles and abbreviations; restrictions; penalty.

464.016 Violations and penalties.

464.017 Sexual misconduct in the practice of nursing.

464.018 Disciplinary actions.

464.019 Approval of nursing education programs.

464.0195 Florida Center for Nursing; goals.

464.0196 Florida Center for Nursing; board of directors.

464.0205 Retired volunteer nurse certificate.

464.022 Exceptions.

464.027 Registered nurse first assistant.

464.001 Short title.—This part may be cited as the “Nurse Practice Act.”

History.—ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; ss. 1, 17, 18, ch. 86-284; s. 58, ch. 91-137; s. 5, ch. 91-156; s.

4, ch. 91-429; s. 119, ch. 2000-318.

464.002 Purpose.—The sole legislative purpose in enacting this part is to ensure that every nurse practicing in

this state meets minimum requirements for safe practice. It is the legislative intent that nurses who fall below

minimum competency or who otherwise present a danger to the public shall be prohibited from practicing in this

state.


4, ch. 91-429; s. 120, ch. 2000-318.

10 – 2


(1) “Accredited program” means a program for the prelicensure education of professional or practical nurses

that is conducted in the United States at an educational institution, whether in this state, another state, or the District

of Columbia, and that is accredited by a specialized nursing accrediting agency that is nationally recognized by the

United States Secretary of Education to accredit nursing education programs.

(2) “Advanced or specialized nursing practice” means, in addition to the practice of professional nursing, the

performance of advanced-level nursing acts approved by the board which, by virtue of postbasic specialized

education, training, and experience, are appropriately performed by an advanced practice registered nurse. Within

the context of advanced or specialized nursing practice, the advanced practice registered nurse may perform acts of

nursing diagnosis and nursing treatment of alterations of the health status. The advanced practice registered nurse

may also perform acts of medical diagnosis and treatment, prescription, and operation as authorized within the

framework of an established supervisory protocol. The department may, by rule, require that a copy of the protocol

be filed with the department along with the notice required by s. 458.348.

(3) “Advanced practice registered nurse” means any person licensed in this state to practice professional

nursing and who is licensed in an advanced nursing practice, including certified nurse midwives, certified nurse

practitioners, certified registered nurse anesthetists, clinical nurse specialists, and psychiatric nurses.

(4) “Approved program” means a program for the prelicensure education of professional or practical nurses that

is conducted in the state at an educational institution and that is approved under s. 464.019. The term includes such a

program placed on probationary status.

(5) “Board” means the Board of Nursing.

(6) “Clinical preceptor” means a registered nurse or licensed practical nurse who is employed by a clinical

training facility to serve as a role model and clinical resource person for a specified period to students enrolled in an

approved program.

(7) “Clinical simulation” means a strategy used to replicate clinical practice as closely as possible to teach

theory, assessment, technology, pharmacology, and skills.

(8) “Clinical training” means direct nursing care experiences with patients or clients, or clinical simulation of

such experiences, which offer the student the opportunity to integrate, apply, and refine specific skills and abilities

based on theoretical concepts and scientific principles.

(9) “Community-based clinical experience” means activities consistent with the curriculum and involving

individuals, families, and groups with the intent of promoting wellness, maintaining health, and preventing illness.

(10) “Curriculum” means a planned sequence of course offerings and learning experiences that comprise a

nursing education program.

(11) “Department” means the Department of Health.

(12) “Educational institution” means a school, college, or university.

(13) “Graduate passage rate” means the percentage of a program’s graduates who, as first-time test takers, pass

the National Council of State Boards of Nursing Licensing Examination during a calendar year, as calculated by the

contract testing service of the National Council of State Boards of Nursing.

(14) “Licensed practical nurse” means any person licensed in this state or holding an active multistate license

under s. 464.0095 to practice practical nursing.

10 – 3

(15) “Nursing diagnosis” means the observation and evaluation of physical or mental conditions, behaviors,

signs and symptoms of illness, and reactions to treatment and the determination as to whether such conditions, signs,

symptoms, and reactions represent a deviation from normal.

(16) “Nursing treatment” means the establishment and implementation of a nursing regimen for the care and

comfort of individuals, the prevention of illness, and the education, restoration, and maintenance of health.

(17) “Practice of practical nursing” means the performance of selected acts, including the administration of

treatments and medications, in the care of the ill, injured, or infirm; the promotion of wellness, maintenance of

health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed

osteopathic physician, a licensed podiatric physician, or a licensed dentist; and the teaching of general principles of

health and wellness to the public and to students other than nursing students. A practical nurse is responsible and

accountable for making decisions that are based upon the individual’s educational preparation and experience in

nursing.

(18) “Practice of professional nursing” means the performance of those acts requiring substantial specialized

knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and

social sciences which shall include, but not be limited to:

(a) The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health

teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and

prevention of illness of others.

(b) The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner

authorized by the laws of this state to prescribe such medications and treatments.

(c) The supervision and teaching of other personnel in the theory and performance of any of the acts described

in this subsection.

A professional nurse is responsible and accountable for making decisions that are based upon the individual’s

educational preparation and experience in nursing.

(19) “Probationary status” means the status of an approved program that is placed on such status pursuant to s.

464.019.

(20) “Registered nurse” means any person licensed in this state or holding an active multistate license under s.

464.0095 to practice professional nursing.

(21) “Required passage rate” means the graduate passage rate required for an approved program pursuant to s.

464.019(5)(a).

History.—ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; ss. 3, 4, ch. 82-32; ss. 3, 17, 18, ch. 86-284; s. 18, ch. 88-392;

s. 58, ch. 91-137; s. 5, ch. 91-156; s. 4, ch. 91-429; s. 121, ch. 94-218; s. 1, ch. 96-274; s. 76, ch. 97-264; s. 210, ch.


2014-92; s. 3, ch. 2016-139; s. 11, ch. 2016-224; ss. 1, 55, ch. 2018-106.

464.004 Board of Nursing; membership; appointment; terms.—

(1) The Board of Nursing is created within the department and shall consist of 13 members to be appointed by

the Governor and confirmed by the Senate.

(2) Seven members of the board must be registered nurses who are residents of this state and who have been

engaged in the practice of professional nursing for at least 4 years, including at least one advanced practice

registered nurse, one nurse educator member of an approved program, and one nurse executive. These seven board

10 – 4

members should be representative of the diverse areas of practice within the nursing profession. In addition, three

members of the board must be licensed practical nurses who are residents of this state and who have been actively

engaged in the practice of practical nursing for at least 4 years prior to their appointment. The remaining three

members must be residents of the state who have never been licensed as nurses and who are in no way connected

with the practice of nursing. No person may be appointed as a lay member who is in any way connected with, or has

any financial interest in, any health care facility, agency, or insurer. At least one member of the board must be 60

years of age or older.

(3) As the terms of the members expire, the Governor shall appoint successors for terms of 4 years, and such

members shall serve until their successors are appointed.

(4) All provisions of chapter 456 relating to activities of the board shall apply.

(5) The executive director of the board appointed pursuant to s. 456.004(2) or his or her designee shall serve as

the state administrator of the Nurse Licensure Compact as required under s. 464.0095.

History.—ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; ss. 4, 17, 18, ch. 86-284; s. 15, ch. 87-172; ss. 12, 58, ch. 91-

137; s. 5, ch. 91-156; s. 4, ch. 91-429; s. 122, ch. 94-218; s. 3, ch. 96-274; s. 77, ch. 97-264; s. 66, ch. 98-166; s.

123, ch. 2000-160; s. 4, ch. 2016-139; s. 56, ch. 2018-106.

464.005 Board headquarters.—The board shall maintain its official headquarters in Tallahassee.

History.—ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; ss. 17, 18, ch. 86-284; s. 58, ch. 91-137; s. 5, ch. 91-156; s. 4,

ch. 91-429; s. 94, ch. 2001-277.

464.006 Rulemaking authority.—The board has authority to adopt rules pursuant to ss. 120.536(1) and 120.54

to implement the provisions of this part conferring duties upon it.


4, ch. 91-429; s. 125, ch. 98-200; s. 122, ch. 2000-318.

464.008 Licensure by examination.—

(1) Any person desiring to be licensed as a registered nurse or licensed practical nurse shall apply to the

department to take the licensure examination. The department shall examine each applicant who:

(a) Has completed the application form and remitted a fee set by the board not to exceed $150 and has remitted

an examination fee set by the board not to exceed $75 plus the actual per applicant cost to the department for

purchase of the examination from the National Council of State Boards of Nursing or a similar national

organization.

(b) Has provided sufficient information on or after October 1, 1989, which must be submitted by the

department for a statewide criminal records correspondence check through the Department of Law Enforcement.

(c) Is in good mental and physical health, is a recipient of a high school diploma or the equivalent, and has

completed the requirements for:

1. Graduation from an approved program;

2. Graduation from a prelicensure nursing education program that the board determines is equivalent to an

approved program;

3. Graduation on or after July 1, 2009, from an accredited program; or

4. Graduation before July 1, 2009, from a prelicensure nursing education program whose graduates at that time

were eligible for examination.

10 – 5

Courses successfully completed in a professional nursing education program that are at least equivalent to a practical

nursing education program may be used to satisfy the education requirements for licensure as a licensed practical

nurse.

(d) Has the ability to communicate in the English language, which may be determined by an examination given

by the department.

(2)(a) Each applicant who passes the examination and provides proof of meeting the educational requirements

specified in subsection (1) shall, unless denied pursuant to s. 464.018, be entitled to licensure as a registered

professional nurse or a licensed practical nurse, whichever is applicable.

(b) An applicant who resides in this state, meets the licensure requirements of this section, and meets the

criteria for multistate licensure under s. 464.0095 may request the issuance of a multistate license from the

department.

(c) A nurse who holds a single-state license in this state and applies to the department for a multistate license

must meet the eligibility criteria for a multistate license under s. 464.0095 and must pay an application and licensure

fee to change the licensure status.

(d) The department shall conspicuously distinguish a multistate license from a single-state license.

(3) Any applicant who fails the examination three consecutive times, regardless of the jurisdiction in which the

examination is taken, shall be required to complete a board-approved remedial course before the applicant will be

approved for reexamination. After taking the remedial course, the applicant may be approved to retake the

examination up to three additional times before the applicant is required to retake remediation. The applicant shall

apply for reexamination within 6 months after completion of remediation. The board shall by rule establish

guidelines for remedial courses.

(4) If an applicant who graduates from an approved program does not take the licensure examination within 6

months after graduation, he or she must enroll in and successfully complete a board-approved licensure examination

preparatory course. The applicant is responsible for all costs associated with the course and may not use state or

federal financial aid for such costs. The board shall by rule establish guidelines for licensure examination

preparatory courses.

(5) A person holding an active multistate license in another state pursuant to s. 464.0095 is exempt from the

licensure requirements of this section.

History.—ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; ss. 6, 17, 18, ch. 86-284; s. 12, ch. 88-205; s. 10, ch. 88-219;



2016-224.

464.009 Licensure by endorsement.—

(1) The department shall issue the appropriate license by endorsement to practice professional or practical

nursing to an applicant who, upon applying to the department and remitting a fee set by the board not to exceed

$100, demonstrates to the board that he or she:

(a) Holds a valid license to practice professional or practical nursing in another state or territory of the United

States, provided that, when the applicant secured his or her original license, the requirements for licensure were

substantially equivalent to or more stringent than those existing in Florida at that time;

10 – 6

(b) Meets the qualifications for licensure in s. 464.008 and has successfully completed a state, regional, or

national examination which is substantially equivalent to or more stringent than the examination given by the

department; or

(c) Has actively practiced nursing in another state, jurisdiction, or territory of the United States for 2 of the

preceding 3 years without having his or her license acted against by the licensing authority of any jurisdiction.

Applicants who become licensed pursuant to this paragraph must complete within 6 months after licensure a Florida

laws and rules course that is approved by the board. Once the department has received the results of the national

criminal history check and has determined that the applicant has no criminal history, the appropriate license by

endorsement shall be issued to the applicant.

(2) Such examinations and requirements from other states and territories of the United States shall be presumed

to be substantially equivalent to or more stringent than those in this state. Such presumption shall not arise until

January 1, 1980. However, the board may, by rule, specify states and territories the examinations and requirements

of which shall not be presumed to be substantially equivalent to those of this state.

(3) An applicant for licensure by endorsement who is relocating to this state pursuant to his or her military-

connected spouse’s official military orders and who is licensed in another state that is a member of the Nurse

Licensure Compact shall be deemed to have satisfied the requirements of subsection (1) and shall be issued a license

by endorsement upon submission of the appropriate application and fees and completion of the criminal background

check required under subsection (4).

(4) The applicant must submit to the department a set of fingerprints on a form and under procedures specified

by the department, along with a payment in an amount equal to the costs incurred by the Department of Health for

the criminal background check of the applicant. The Department of Health shall submit the fingerprints provided by

the applicant to the Florida Department of Law Enforcement for a statewide criminal history check, and the Florida

Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for a national

criminal history check of the applicant. The Department of Health shall review the results of the criminal history

check, issue a license to an applicant who has met all of the other requirements for licensure and has no criminal

history, and shall refer all applicants with criminal histories back to the board for determination as to whether a

license should be issued and under what conditions.

(5) The department shall not issue a license by endorsement to any applicant who is under investigation in

another state, jurisdiction, or territory of the United States for an act which would constitute a violation of this part

or chapter 456 until such time as the investigation is complete, at which time the provisions of s. 464.018 shall

apply.

(6) The department shall develop an electronic applicant notification process and provide electronic notification

when the application has been received and when background screenings have been completed, and shall issue a

license within 30 days after completion of all required data collection and verification. This 30-day period to issue a

license shall be tolled if the applicant must appear before the board due to information provided on the application or

obtained through screening and data collection and verification procedures.

(7) A person holding an active multistate license in another state pursuant to s. 464.0095 is exempt from the

requirements for licensure by endorsement in this section.

10 – 7


5, ch. 91-156; s. 4, ch. 91-429; s. 6, ch. 96-274; s. 1104, ch. 97-103; s. 79, ch. 97-264; s. 123, ch. 2000-318; s. 96,

ch. 2001-277; s. 5, ch. 2002-230; s. 9, ch. 2004-230; s. 6, ch. 2016-139; s. 28, ch. 2016-224.

464.0095 Nurse Licensure Compact.—The Nurse Licensure Compact is hereby enacted into law and entered

into by this state with all other jurisdictions legally joining therein in the form substantially as follows:

ARTICLE I

FINDINGS AND DECLARATION OF PURPOSE

(1) The party states find that:

(a) The health and safety of the public are affected by the degree of compliance with and the effectiveness of

enforcement activities related to state nurse licensure laws.

(b) Violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to

the public.

(c) The expanded mobility of nurses and the use of advanced communication technologies as part of the nation’s

health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure

and regulation.

(d) New practice modalities and technology make compliance with individual state nurse licensure laws difficult

and complex.

(e) The current system of duplicative licensure for nurses practicing in multiple states is cumbersome and

redundant for both nurses and states.

(f) Uniformity of nurse licensure requirements throughout the states promotes public safety and public health

benefits.

(2) The general purposes of this compact are to:

(a) Facilitate the states’ responsibility to protect the public’s health and safety.

(b) Ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation.

(c) Facilitate the exchange of information among party states in the areas of nurse regulation, investigation, and

adverse actions.

(d) Promote compliance with the laws governing the practice of nursing in each jurisdiction.

(e) Invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the

state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses.

(f) Decrease redundancies in the consideration and issuance of nurse licenses.

(g) Provide opportunities for interstate practice by nurses who meet uniform licensure requirements.

ARTICLE II

DEFINITIONS

As used in this compact, the term:

(1) “Adverse action” means any administrative, civil, equitable, or criminal action permitted by a state’s laws

which is imposed by a licensing board or other authority against a nurse, including actions against an individual’s

license or multistate licensure privilege, such as revocation, suspension, probation, monitoring of the licensee,

limitation on the licensee’s practice, or any other encumbrance on licensure affecting a nurse’s authorization to

practice, including issuance of a cease and desist action.

(2) “Alternative program” means a nondisciplinary monitoring program approved by a licensing board.

10 – 8

(3) “Commission” means the Interstate Commission of Nurse Licensure Compact Administrators established by

this compact.

(4) “Compact” means the Nurse Licensure Compact recognized, established, and entered into by the state under

this compact.

(5) “Coordinated licensure information system” means an integrated process for collecting, storing, and sharing

information on nurse licensure and enforcement activities related to nurse licensure laws which is administered by a

nonprofit organization composed of and controlled by licensing boards.

(6) “Current significant investigative information” means:

(a) Investigative information that a licensing board, after a preliminary inquiry that includes notification and an

opportunity for the nurse to respond, if required by state law, has reason to believe is not groundless and, if proved

true, would indicate more than a minor infraction; or

(b) Investigative information that indicates that the nurse represents an immediate threat to public health and

safety regardless of whether the nurse has been notified and had an opportunity to respond.

(7) “Encumbrance” means a revocation or suspension of, or any limitation on, the full and unrestricted practice

of nursing imposed by a licensing board.

(8) “Home state” means the party state that is the nurse’s primary state of residence.

(9) “Licensing board” means a party state’s regulatory body responsible for issuing nurse licenses.

(10) “Multistate license” means a license to practice as a registered nurse (RN) or a licensed practical/vocational

nurse (LPN/VN) issued by a home state licensing board which authorizes the licensed nurse to practice in all party

states under a multistate licensure privilege.

(11) “Multistate licensure privilege” means a legal authorization associated with a multistate license permitting

the practice of nursing as either an RN or an LPN/VN in a remote state.

(12) “Nurse” means an RN or LPN/VN, as those terms are defined by each party state’s practice laws.

(13) “Party state” means any state that has adopted this compact.

(14) “Remote state” means a party state other than the home state.

(15) “Single-state license” means a nurse license issued by a party state which authorizes practice only within the

issuing state and does not include a multistate licensure privilege to practice in any other party state.

(16) “State” means a state, territory, or possession of the United States, or the District of Columbia.

(17) “State practice laws” means a party state’s laws, rules, and regulations that govern the practice of nursing,

define the scope of nursing practice, and create the methods and grounds for imposing discipline. The term “state

practice laws” does not include requirements necessary to obtain and retain a license, except for qualifications or

requirements of the home state.

ARTICLE III

GENERAL PROVISIONS AND JURISDICTION

(1) A multistate license to practice registered or licensed practical/vocational nursing issued by a home state to a

resident in that state shall be recognized by each party state as authorizing a nurse to practice as an RN or as an

LPN/VN under a multistate licensure privilege in each party state.

(2) Each party state must implement procedures for considering the criminal history records of applicants for

initial multistate licensure or licensure by endorsement. Such procedures shall include the submission of fingerprints

or other biometric-based information by applicants for the purpose of obtaining an applicant’s criminal history record

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information from the Federal Bureau of Investigation and the agency responsible for retaining that state’s criminal

records.

(3) In order for an applicant to obtain or retain a multistate license in the home state, each party state shall require

that the applicant fulfills the following criteria:

(a) Meets the home state’s qualifications for licensure or renewal of licensure, as well as all other applicable state

laws.

(b)1. Has graduated or is eligible to graduate from a licensing board-approved RN or LPN/VN prelicensure

education program; or

2. Has graduated from a foreign RN or LPN/VN prelicensure education program that has been approved by the

authorized accrediting body in the applicable country and has been verified by a licensing board-approved independent

credentials review agency to be comparable to a licensing board-approved prelicensure education program.

(c) If the applicant is a graduate of a foreign prelicensure education program not taught in English, or if English

is not the applicant’s native language, has successfully passed a licensing board-approved English proficiency

examination that includes the components of reading, speaking, writing, and listening.

(d) Has successfully passed an NCLEX-RN or NCLEX-PN Examination or recognized predecessor, as

applicable.

(e) Is eligible for or holds an active, unencumbered license.

(f) Has submitted, in connection with an application for initial licensure or licensure by endorsement, fingerprints

or other biometric data for the purpose of obtaining criminal history record information from the Federal Bureau of

Investigation and the agency responsible for retaining that state’s criminal records.

(g) Has not been convicted or found guilty, or has entered into an agreed disposition other than a disposition that

results in nolle prosequi, of a felony offense under applicable state or federal criminal law.

(h) Has not been convicted or found guilty, or has entered into an agreed disposition other than a disposition that

results in nolle prosequi, of a misdemeanor offense related to the practice of nursing as determined on a case-by-case

basis.

(i) Is not currently enrolled in an alternative program.

(j) Is subject to self-disclosure requirements regarding current participation in an alternative program.

(k) Has a valid United States social security number.

(4) All party states may, in accordance with existing state due process law, take adverse action against a nurse’s

multistate licensure privilege, such as revocation, suspension, probation, or any other action that affects the nurse’s

authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes

such action, it shall promptly notify the administrator of the coordinated licensure information system. The

administrator of the coordinated licensure information system shall promptly notify the home state of any such actions

by remote states.

(5) A nurse practicing in a party state must comply with the state practice laws of the state in which the patient is

located at the time service is provided. The practice of nursing is not limited to patient care but shall include all nursing

practice as defined by the state practice laws of the party state in which the patient is located. The practice of nursing

in a party state under a multistate licensure privilege subjects a nurse to the jurisdiction of the licensing board, the

courts, and the laws of the party state in which the patient is located at the time service is provided.

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(6) A person not residing in a party state shall continue to be able to apply for a party state’s single-state license

as provided under the laws of each party state. The single-state license granted to such a person does not grant the

privilege to practice nursing in any other party state. This compact does not affect the requirements established by a

party state for the issuance of a single-state license.

(7) A nurse holding a home state multistate license, on the effective date of this compact, may retain and renew

the multistate license issued by the nurse’s then-current home state, provided that:

(a) A nurse who changes his or her primary state of residence after the effective date must meet all applicable

requirements under subsection (3) to obtain a multistate license from a new home state.

(b) A nurse who fails to satisfy the multistate licensure requirements under subsection (3) due to a disqualifying

event occurring after the effective date is ineligible to retain or renew a multistate license, and the nurse’s multistate

license shall be revoked or deactivated in accordance with applicable rules adopted by the commission.

ARTICLE IV

APPLICATIONS FOR LICENSURE

IN A PARTY STATE

(1) Upon application for a multistate license, the licensing board in the issuing party state shall ascertain, through

the coordinated licensure information system, whether the applicant has ever held, or is the holder of, a license issued

by any other state, whether there are any encumbrances on any license or multistate licensure privilege held by the

applicant, whether any adverse action has been taken against any license or multistate licensure privilege held by the

applicant, and whether the applicant is currently participating in an alternative program.

(2) A nurse may hold a multistate license, issued by the home state, in only one party state at a time.

(3) If a nurse changes his or her primary state of residence by moving from one party state to another party state,

the nurse must apply for licensure in the new home state, and the multistate license issued by the prior home state

shall be deactivated in accordance with applicable rules adopted by the commission.

(a) The nurse may apply for licensure in advance of a change in his or her primary state of residence.

(b) A multistate license may not be issued by the new home state until the nurse provides satisfactory evidence

of a change in his or her primary state of residence to the new home state and satisfies all applicable requirements to

obtain a multistate license from the new home state.

(4) If a nurse changes his or her primary state of residence by moving from a party state to a nonparty state, the

multistate license issued by the prior home state shall convert to a single-state license valid only in the former home

state.

ARTICLE V

ADDITIONAL AUTHORITY VESTED IN

PARTY STATE LICENSING BOARDS

(1) In addition to the other powers conferred by state law, a licensing board or state agency may:

(a) Take adverse action against a nurse’s multistate licensure privilege to practice within that party state.

1. Only the home state has the power to take adverse action against a nurse’s license issued by the home state.

2. For purposes of taking adverse action, the home state licensing board or state agency shall give the same

priority and effect to conduct reported by a remote state as it would if such conduct had occurred within the home

state. In so doing, the home state shall apply its own state laws to determine appropriate action.

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(b) Issue cease and desist orders or impose an encumbrance on a nurse’s authority to practice within that party

state.

(c) Complete any pending investigation of a nurse who changes his or her primary state of residence during the

course of such investigation. The licensing board or state agency may also take appropriate action and shall promptly

report the conclusions of such investigation to the administrator of the coordinated licensure information system. The

administrator of the coordinated licensure information system shall promptly notify the new home state of any such

action.

(d) Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses

or the production of evidence. Subpoenas issued by a licensing board or state agency in a party state for the attendance

and testimony of witnesses or the production of evidence from another party state shall be enforced in the latter state

by any court of competent jurisdiction according to the practice and procedure of that court applicable to subpoenas

issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, and mileage

and other fees required by the service statutes of the state in which the witnesses or evidence is located.

(e) Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-based information to the

Federal Bureau of Investigation for criminal background checks, receive the results of the Federal Bureau of

Investigation record search on criminal background checks, and use the results in making licensure decisions.

(f) If otherwise permitted by state law, recover from the affected nurse the costs of investigations and disposition

of cases resulting from any adverse action taken against that nurse.

(g) Take adverse action based on the factual findings of the remote state, provided that the licensing board or

state agency follows its own procedures for taking such adverse action.

(2) If adverse action is taken by the home state against a nurse’s multistate license, the nurse’s multistate licensure

privilege to practice in all other party states shall be deactivated until all encumbrances are removed from the multistate

license. All home state disciplinary orders that impose adverse action against a nurse’s multistate license shall include

a statement that the nurse’s multistate licensure privilege is deactivated in all party states during the pendency of the

order.

(3) This compact does not override a party state’s decision that participation in an alternative program may be

used in lieu of adverse action. The home state licensing board shall deactivate the multistate licensure privilege under

the multistate license of any nurse for the duration of the nurse’s participation in an alternative program.

ARTICLE VI

COORDINATED LICENSURE

INFORMATION SYSTEM

AND EXCHANGE INFORMATION

(1) All party states shall participate in a coordinated licensure information system relating to all licensed RNs

and LPNs/VNs. This system shall include information on the licensure and disciplinary history of each nurse, as

submitted by party states, to assist in the coordination of nurse licensure and enforcement efforts.

(2) The commission, in consultation with the administrator of the coordinated licensure information system, shall

formulate necessary and proper procedures for the identification, collection, and exchange of information under this

compact.

(3) All licensing boards shall promptly report to the coordinated licensure information system any adverse action,

any current significant investigative information, denials of applications, the reasons for application denials, and nurse

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participation in alternative programs known to the licensing board regardless of whether such participation is deemed

nonpublic or confidential under state law.

(4) Current significant investigative information and participation in nonpublic or confidential alternative

programs shall be transmitted through the coordinated licensure information system only to party state licensing

boards.

(5) Notwithstanding any other provision of law, all party state licensing boards contributing information to the

coordinated licensure information system may designate information that may not be shared with nonparty states or

disclosed to other entities or individuals without the express permission of the contributing state.

(6) Any personal identifying information obtained from the coordinated licensure information system by a party

state licensing board may not be shared with nonparty states or disclosed to other entities or individuals except to the

extent permitted by the laws of the party state contributing the information.

(7) Any information contributed to the coordinated licensure information system which is subsequently required

to be expunged by the laws of the party state contributing that information shall also be expunged from the coordinated

licensure information system.

(8) The compact administrator of each party state shall furnish a uniform data set to the compact administrator of

each other party state, which shall include, at a minimum:

(a) Identifying information.

(b) Licensure data.

(c) Information related to alternative program participation.

(d) Other information that may facilitate the administration of this compact, as determined by commission rules.

(9) The compact administrator of a party state shall provide all investigative documents and information

requested by another party state.

ARTICLE VII

ESTABLISHMENT OF THE

INTERSTATE COMMISSION OF

NURSE LICENSURE COMPACT ADMINISTRATORS

(1) The party states hereby create and establish a joint public entity known as the Interstate Commission of Nurse

Licensure Compact Administrators.

(a) The commission is an instrumentality of the party states.

(b) Venue is proper, and judicial proceedings by or against the commission shall be brought solely and

exclusively, in a court of competent jurisdiction where the commission’s principal office is located. The commission

may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute

resolution proceedings.

(c) This compact does not waive sovereign immunity except to the extent sovereign immunity is waived in the

party states.

(2)(a) Each party state shall have and be limited to one administrator. The executive director of the state licensing

board or his or her designee shall be the administrator of this compact for each party state. Any administrator may be

removed or suspended from office as provided by the law of the state from which the administrator is appointed. Any

vacancy occurring on the commission shall be filled in accordance with the laws of the party state in which the vacancy

exists.

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(b) Each administrator is entitled to one vote with regard to the adoption of rules and the creation of bylaws and

shall otherwise have an opportunity to participate in the business and affairs of the commission. An administrator shall

vote in person or by such other means as provided in the bylaws. The bylaws may provide for an administrator’s

participation in meetings by telephone or other means of communication.

(c) The commission shall meet at least once during each calendar year. Additional meetings shall be held as set

forth in the commission’s bylaws or rules.

(d) All meetings shall be open to the public, and public notice of meetings shall be given in the same manner as

required under Article VIII of this compact.

(e) The commission may convene in a closed, nonpublic meeting if the commission must discuss:

1. Failure of a party state to comply with its obligations under this compact;

2. The employment, compensation, discipline, or other personnel matters, practices, or procedures related to

specific employees or other matters related to the commission’s internal personnel practices and procedures;

3. Current, threatened, or reasonably anticipated litigation;

4. Negotiation of contracts for the purchase or sale of goods, services, or real estate;

5. Accusing any person of a crime or formally censuring any person;

6. Disclosure of trade secrets or commercial or financial information that is privileged or confidential;

7. Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted

invasion of personal privacy;

8. Disclosure of investigatory records compiled for law enforcement purposes;

9. Disclosure of information related to any reports prepared by or on behalf of the commission for the purpose of

investigation of compliance with this compact; or

10. Matters specifically exempted from disclosure by federal or state statute.

(f) If a meeting, or portion of a meeting, is closed pursuant to this subsection, the commission’s legal counsel or

designee shall certify that the meeting, or portion of the meeting, is closed and shall reference each relevant exempting

provision. The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and

shall provide a full and accurate summary of actions taken, and the reasons therefor, including a description of the

views expressed. All documents considered in connection with an action shall be identified in such minutes. All

minutes and documents of a closed meeting shall remain under seal, subject to release by a majority vote of the

commission or order of a court of competent jurisdiction.

(3) The commission shall, by a majority vote of the administrators, prescribe bylaws or rules to govern its conduct

as may be necessary or appropriate to carry out the purposes and exercise the powers of this compact, including, but

not limited to:

(a) Establishing the commission’s fiscal year.

(b) Providing reasonable standards and procedures:

1. For the establishment and meetings of other committees.

2. Governing any general or specific delegation of any authority or function of the commission.

(c) Providing reasonable procedures for calling and conducting meetings of the commission, ensuring reasonable

advance notice of all meetings, and providing an opportunity for attendance of such meetings by interested parties,

with enumerated exceptions designed to protect the public’s interest, the privacy of individuals, and proprietary

information, including trade secrets. The commission may meet in closed session only after a majority of the

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administrators vote to close a meeting in whole or in part. As soon as practicable, the commission must make public

a copy of the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed.

(d) Establishing the titles, duties and authority, and reasonable procedures for the election of the commission’s

officers.

(e) Providing reasonable standards and procedures for the establishment of the commission’s personnel policies

and programs. Notwithstanding any civil service or other similar laws of any party state, the bylaws shall exclusively

govern the commission’s personnel policies and programs.

(f) Providing a mechanism for winding up the commission’s operations and the equitable disposition of any

surplus funds that may exist after the termination of this compact after the payment or reserving of all of its debts and

obligations.

(4) The commission shall publish its bylaws and rules, and any amendments thereto, in a convenient form on the

commission’s website.

(5) The commission shall maintain its financial records in accordance with the bylaws.

(6) The commission shall meet and take such actions as are consistent with this compact and the bylaws.

(7) The commission has the power to:

(a) Adopt uniform rules to facilitate and coordinate implementation and administration of this compact. The rules

shall have the force and effect of law and are binding in all party states.

(b) Bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing

of any licensing board to sue or be sued under applicable law is not affected.

(c) Purchase and maintain insurance and bonds.

(d) Borrow, accept, or contract for services of personnel, including employees of a party state or nonprofit

organizations.

(e) Cooperate with other organizations that administer state compacts related to the regulation of nursing,

including sharing administrative or staff expenses, office space, or other resources.

(f) Hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate

authority to carry out the purposes of this compact, and establish the commission’s personnel policies and programs

relating to conflicts of interest, qualifications of personnel, and other related personnel matters.

(g) Accept any and all appropriate donations, grants, and gifts of money, equipment, supplies, materials, and

services and receive, use, and dispose of the same, provided that, at all times, the commission shall avoid any

appearance of impropriety or conflict of interest.

(h) Lease, purchase, accept appropriate gifts or donations of, or otherwise own, hold, improve, or use any

property, whether real, personal, or mixed, provided that, at all times, the commission shall avoid any appearance of

impropriety.

(i) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property, whether real,

personal, or mixed.

(j) Establish a budget and make expenditures.

(k) Borrow money.

(l) Appoint committees, including advisory committees comprised of administrators, state nursing regulators,

state legislators or their representatives, consumer representatives, and other interested persons.

(m) Provide information to, receive information from, and cooperate with law enforcement agencies.

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(n) Adopt and use an official seal.

(o) Perform such other functions as may be necessary or appropriate to achieve the purposes of this compact

consistent with the state regulation of nurse licensure and practice.

(8) Relating to the financing of the commission, the commission:

(a) Shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and

ongoing activities.

(b) May also levy and collect an annual assessment from each party state to cover the cost of its operations,

activities, and staff in its annual budget as approved each year. The aggregate annual assessment amount, if any, shall

be allocated based on a formula to be determined by the commission, which shall adopt a rule that is binding on all

party states.

(c) May not incur obligations of any kind before securing the funds adequate to meet the same; and the

commission may not pledge the credit of any of the party states, except by and with the authority of such party state.

(d) Shall keep accurate accounts of all receipts and disbursements. The commission’s receipts and disbursements

are subject to the audit and accounting procedures established under its bylaws. However, all receipts and

disbursements of funds handled by the commission shall be audited yearly by a certified or licensed public accountant,

and the report of the audit shall be included in, and become part of, the commission’s annual report.

(9) Relating to the sovereign immunity, defense, and indemnification of the commission:

(a) The administrators, officers, executive director, employees, and representatives of the commission are

immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of

property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission

that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred, within

the scope of commission employment, duties, or responsibilities. This paragraph does not protect any such person

from suit or liability for any damage, loss, injury, or liability caused by the intentional, willful, or wanton misconduct

of that person.

(b) The commission shall defend any administrator, officer, executive director, employee, or representative of

the commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission

that occurred within the scope of commission employment, duties, or responsibilities or that the person against whom

the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties,

or responsibilities, provided that the actual or alleged act, error, or omission did not result from that person’s

intentional, willful, or wanton misconduct. This paragraph does not prohibit that person from retaining his or her own

counsel.

(c) The commission shall indemnify and hold harmless any administrator, officer, executive director, employee,

or representative of the commission for the amount of any settlement or judgment obtained against that person arising

out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties,

or responsibilities or that such person had a reasonable basis for believing occurred within the scope of commission

employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result from

the intentional, willful, or wanton misconduct of that person.

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ARTICLE VIII

RULEMAKING

(1) The commission shall exercise its rulemaking powers pursuant to the criteria set forth in this article and the

rules adopted thereunder. Rules and amendments become binding as of the date specified in each rule or amendment

and have the same force and effect as provisions of this compact.

(2) Rules or amendments to the rules shall be adopted at a regular or special meeting of the commission.

(3) Before adoption of a final rule or final rules by the commission, and at least 60 days before the meeting at

which the rule will be considered and voted upon, the commission shall file a notice of proposed rulemaking:

(a) On the commission’s website.

(b) On the website of each licensing board or the publication in which each state would otherwise publish

proposed rules.

(4) The notice of proposed rulemaking shall include:

(a) The proposed time, date, and location of the meeting in which the rule will be considered and voted upon.

(b) The text of the proposed rule or amendment and the reason for the proposed rule.

(c) A request for comments on the proposed rule from any interested person.

(d) The manner in which an interested person may submit notice to the commission of his or her intention to

attend the public hearing and any written comments.

(5) Before adoption of a proposed rule, the commission shall allow persons to submit written data, facts, opinions,

and arguments, which shall be made available to the public.

(6) The commission shall grant an opportunity for a public hearing before it adopts a rule or amendment.

(7) The commission shall publish the place, time, and date of the scheduled public hearing.

(a) Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable

opportunity to comment orally or in writing. All hearings will be recorded, and a copy will be made available upon

request.

(b) This article does not require a separate hearing on each rule. Rules may be grouped for the convenience of

the commission at hearings required by this article.

(8) If no interested person appears at the public hearing, the commission may proceed with adoption of the

proposed rule.

(9) Following the scheduled hearing date, or by the close of business on the scheduled hearing date if the hearing

is not held, the commission shall consider all written and oral comments received.

(10) The commission shall, by majority vote of all administrators, take final action on the proposed rule and shall

determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule.

(11) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule

without prior notice, opportunity for comment, or hearing, provided that the usual rulemaking procedures provided in

this compact and in this article shall be applied retroactively to the rule as soon as reasonably possible within 90 days

after the effective date of the rule. For the purposes of this subsection, an emergency rule is one that must be adopted

immediately in order to:

(a) Meet an imminent threat to public health, safety, or welfare;

(b) Prevent a loss of commission or party state funds; or

(c) Meet a deadline for the adoption of an administrative rule that is required by federal law or rule.

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(12) The commission may direct revisions to a previously adopted rule or amendment for purposes of correcting

typographical errors, errors in format, errors in consistency, or grammatical errors. Public notice of any revisions shall

be posted on the commission’s website. The revision is subject to challenge by any person for 30 days after posting.

The revision may be challenged only on grounds that the revision results in a material change to a rule. A challenge

must be made in writing and delivered to the commission before the end of the notice period. If no challenge is made,

the revision shall take effect without further action. If the revision is challenged, the revision may not take effect

without the commission’s approval.

ARTICLE IX

OVERSIGHT, DISPUTE RESOLUTION,

AND ENFORCEMENT

(1) Oversight of this compact shall be accomplished by:

(a) Each party state, which shall enforce this compact and take all actions necessary and appropriate to effectuate

this compact’s purposes and intent.

(b) The commission, which is entitled to receive service of process in any proceeding that may affect the powers,

responsibilities, or actions of the commission and has standing to intervene in such a proceeding for all purposes.

Failure to provide service of process in such proceeding to the commission renders a judgment or order void as to the

commission, this compact, or adopted rules.

(2) When the commission determines that a party state has defaulted in the performance of its obligations or

responsibilities under this compact or the adopted rules, the commission shall:

(a) Provide written notice to the defaulting state and other party states of the nature of the default, the proposed

means of curing the default, or any other action to be taken by the commission.

(b) Provide remedial training and specific technical assistance regarding the default.

(3) If a state in default fails to cure the default, the defaulting state’s membership in this compact may be

terminated upon an affirmative vote of a majority of the administrators, and all rights, privileges, and benefits

conferred by this compact may be terminated on the effective date of termination. A cure of the default does not relieve

the offending state of obligations or liabilities incurred during the period of default.

(4) Termination of membership in this compact shall be imposed only after all other means of securing

compliance have been exhausted. Notice of intent to suspend or terminate shall be given by the commission to the

governor of the defaulting state, to the executive officer of the defaulting state’s licensing board, and each of the party

states.

(5) A state whose membership in this compact is terminated is responsible for all assessments, obligations, and

liabilities incurred through the effective date of termination, including obligations that extend beyond the effective

date of termination.

(6) The commission shall not bear any costs related to a state that is found to be in default or whose membership

in this compact is terminated unless agreed upon in writing between the commission and the defaulting state.

(7) The defaulting state may appeal the action of the commission by petitioning the United States District Court

for the District of Columbia or the federal district in which the commission has its principal offices. The prevailing

party shall be awarded all costs of such litigation, including reasonable attorney fees.

(8) Dispute resolution may be used by the commission in the following manner:

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(a) Upon request by a party state, the commission shall attempt to resolve disputes related to the compact that

arise among party states and between party and nonparty states.

(b) The commission shall adopt a rule providing for both mediation and binding dispute resolution for disputes,

as appropriate.

(c) In the event the commission cannot resolve disputes among party states arising under this compact:

1. The party states may submit the issues in dispute to an arbitration panel, which will be comprised of individuals

appointed by the compact administrator in each of the affected party states and an individual mutually agreed upon by

the compact administrators of all the party states involved in the dispute.

2. The decision of a majority of the arbitrators is final and binding.

(9)(a) The commission shall, in the reasonable exercise of its discretion, enforce the provisions and rules of this

compact.

(b) By majority vote, the commission may initiate legal action in the United States District Court for the District

of Columbia or the federal district in which the commission has its principal offices against a party state that is in

default to enforce compliance with this compact and its adopted rules and bylaws. The relief sought may include both

injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all

costs of such litigation, including reasonable attorney fees.

(c) The remedies provided in this subsection are not the exclusive remedies of the commission. The commission

may pursue any other remedies available under federal or state law.

ARTICLE X

EFFECTIVE DATE, WITHDRAWAL,

AND AMENDMENT

(1) This compact becomes effective and binding on the date of legislative enactment of this compact into law by

no fewer than 26 states or on December 31, 2018, whichever occurs first. All party states to this compact which were

also parties to the prior Nurse Licensure Compact (“prior compact”), superseded by this compact, are deemed to have

withdrawn from the prior compact within 6 months after the effective date of this compact.

(2) Each party state to this compact shall continue to recognize a nurse’s multistate licensure privilege to practice

in that party state issued under the prior compact until such party state is withdrawn from the prior compact.

(3) Any party state may withdraw from this compact by enacting a statute repealing the compact. A party state’s

withdrawal does not take effect until 6 months after enactment of the repealing statute.

(4) A party state’s withdrawal or termination does not affect the continuing requirement of the withdrawing or

terminated state’s licensing board to report adverse actions and significant investigations occurring before the effective

date of such withdrawal or termination.

(5) This compact does not invalidate or prevent any nurse licensure agreement or other cooperative arrangement

between a party state and a nonparty state that is made in accordance with the other provisions of this compact.

(6) This compact may be amended by the party states. An amendment to this compact does not become effective

and binding upon the party states unless and until it is enacted into the laws of all party states.

(7) Representatives of nonparty states to this compact shall be invited to participate in the activities of the

commission, on a nonvoting basis, before the adoption of this compact by all party states.

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ARTICLE XI

CONSTRUCTION AND SEVERABILITY

This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact

are severable, and if any phrase, clause, sentence, or provision of this compact is declared to be contrary to the

constitution of any party state or of the United States, or if the applicability thereof to any government, agency, person,

or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any

government, agency, person, or circumstance is not affected thereby. If this compact is declared to be contrary to the

constitution of any party state, the compact shall remain in full force and effect as to the remaining party states and in

full force and effect as to the party state affected as to all severable matters.

History.—s. 7, ch. 2016-139.

464.0096 Nurse Licensure Compact; public records and meetings exemptions.—

(1) A nurse’s personal identifying information, other than the nurse’s name, licensure status, or licensure

number, obtained from the coordinated licensure information system, as defined in s. 464.0095, and held by the

department or the board is exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution unless the state that

originally reported the information to the coordinated licensure information system authorizes the disclosure of such

information by law. Under such circumstances, the information may only be disclosed to the extent permitted by the

reporting state’s law.

(2)(a) A meeting or portion of a meeting of the Interstate Commission of Nurse Licensure Compact

Administrators established under s. 464.0095 at which matters specifically exempted from disclosure by federal or

state statute are discussed is exempt from s. 286.011 and s. 24(b), Art. I of the State Constitution.

(b) Recordings, minutes, and records generated during an exempt meeting are exempt from s. 119.07(1) and s.

24(a), Art. I of the State Constitution.

(3) This section is subject to the Open Government Sunset Review Act in accordance with s. 119.15 and shall

stand repealed on October 2, 2021, unless reviewed and saved from repeal through reenactment by the Legislature.

History.—s. 1, ch. 2016-97.

464.012 Licensure of advanced practice registered nurses; fees; controlled substance prescribing.—

(1) Any nurse desiring to be licensed as an advanced practice registered nurse must apply to the department and

submit proof that he or she holds a current license to practice professional nursing or holds an active multistate

license to practice professional nursing pursuant to s. 464.0095 and that he or she meets one or more of the

following requirements as determined by the board:

(a) Certification by an appropriate specialty board. Such certification is required for initial state licensure and

any licensure renewal as a certified nurse midwife, certified nurse practitioner, certified registered nurse anesthetist,

clinical nurse specialist, or psychiatric nurse. The board may by rule provide for provisional state licensure of

certified registered nurse anesthetists, clinical nurse specialists, certified nurse practitioners, psychiatric nurses, and

certified nurse midwives for a period of time determined to be appropriate for preparing for and passing the national

certification examination.

(b) Graduation from a program leading to a master’s degree in a nursing clinical specialty area with preparation

in specialized practitioner skills. For applicants graduating on or after October 1, 1998, graduation from a master’s

degree program is required for initial licensure as a certified nurse practitioner under paragraph (4)(a).

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1. For applicants graduating on or after October 1, 2001, graduation from a master’s degree program is required

for initial licensure as a certified registered nurse anesthetist who may perform the acts listed in paragraph (4)(b).

2. For applicants graduating on or after October 1, 1998, graduation from a master’s degree program is required

for initial licensure as a certified nurse midwife who may perform the acts listed in paragraph (4)(c).

3. For applicants graduating on or after July 1, 2007, graduation from a master’s degree program is required for

initial licensure as a clinical nurse specialist who may perform the acts listed in paragraph (4)(d).

(2) The board shall provide by rule the appropriate requirements for advanced practice registered nurses for the

advanced nursing practices of certified nurse midwives, certified nurse practitioners, certified registered nurse

anesthetists, clinical nurse specialists, and psychiatric nurses.

(3) An advanced practice registered nurse shall perform those functions authorized in this section within the

framework of an established protocol that must be maintained on site at the location or locations at which an

advanced practice registered nurse practices. In the case of multiple supervising physicians in the same group, an

advanced practice registered nurse must enter into a supervisory protocol with at least one physician within the

physician group practice. A practitioner currently licensed under chapter 458, chapter 459, or chapter 466 shall

maintain supervision for directing the specific course of medical treatment. Within the established framework, an

advanced practice registered nurse may:

(a) Prescribe, dispense, administer, or order any drug; however, an advanced practice registered nurse may

prescribe or dispense a controlled substance as defined in s. 893.03 only if the advanced practice registered nurse

has graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with

training in specialized practitioner skills.

(b) Initiate appropriate therapies for certain conditions.

(c) Perform additional functions as may be determined by rule in accordance with s. 464.003(2).

(d) Order diagnostic tests and physical and occupational therapy.

(e) Order any medication for administration to a patient in a facility licensed under chapter 395 or part II of

chapter 400, notwithstanding any provisions in chapter 465 or chapter 893.

(4) In addition to the general functions specified in subsection (3), an advanced practice registered nurse may

perform the following acts within his or her specialty:

(a) The certified nurse practitioner may perform any or all of the following acts within the framework of

established protocol:

1. Manage selected medical problems.

2. Order physical and occupational therapy.

3. Initiate, monitor, or alter therapies for certain uncomplicated acute illnesses.

4. Monitor and manage patients with stable chronic diseases.

5. Establish behavioral problems and diagnosis and make treatment recommendations.

(b) The certified registered nurse anesthetist may, to the extent authorized by established protocol approved by

the medical staff of the facility in which the anesthetic service is performed, perform any or all of the following:

1. Determine the health status of the patient as it relates to the risk factors and to the anesthetic management of

the patient through the performance of the general functions.

2. Based on history, physical assessment, and supplemental laboratory results, determine, with the consent of

the responsible physician, the appropriate type of anesthesia within the framework of the protocol.

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3. Order under the protocol preanesthetic medication.

4. Perform under the protocol procedures commonly used to render the patient insensible to pain during the

performance of surgical, obstetrical, therapeutic, or diagnostic clinical procedures. These procedures include

ordering and administering regional, spinal, and general anesthesia; inhalation agents and techniques; intravenous

agents and techniques; and techniques of hypnosis.

5. Order or perform monitoring procedures indicated as pertinent to the anesthetic health care management of

the patient.

6. Support life functions during anesthesia health care, including induction and intubation procedures, the use

of appropriate mechanical supportive devices, and the management of fluid, electrolyte, and blood component

balances.

7. Recognize and take appropriate corrective action for abnormal patient responses to anesthesia, adjunctive

medication, or other forms of therapy.

8. Recognize and treat a cardiac arrhythmia while the patient is under anesthetic care.

9. Participate in management of the patient while in the postanesthesia recovery area, including ordering the

administration of fluids and drugs.

10. Place special peripheral and central venous and arterial lines for blood sampling and monitoring as

appropriate.

(c) The certified nurse midwife may, to the extent authorized by an established protocol which has been

approved by the medical staff of the health care facility in which the midwifery services are performed, or approved

by the nurse midwife’s physician backup when the delivery is performed in a patient’s home, perform any or all of

the following:

1. Perform superficial minor surgical procedures.

2. Manage the patient during labor and delivery to include amniotomy, episiotomy, and repair.

3. Order, initiate, and perform appropriate anesthetic procedures.

4. Perform postpartum examination.

5. Order appropriate medications.

6. Provide family-planning services and well-woman care.

7. Manage the medical care of the normal obstetrical patient and the initial care of a newborn patient.

(d) The clinical nurse specialist may perform any or all of the following acts within the framework of

established protocol:

1. Assess the health status of individuals and families using methods appropriate to the population and area of

practice.

2. Diagnose human responses to actual or potential health problems.

3. Plan for health promotion, disease prevention, and therapeutic intervention in collaboration with the patient

or client.

4. Implement therapeutic interventions based on the nurse specialist’s area of expertise and within the scope of

advanced nursing practice, including, but not limited to, direct nursing care, counseling, teaching, and collaboration

with other licensed health care providers.

5. Coordinate health care as necessary and appropriate and evaluate with the patient or client the effectiveness

of care.

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(e) A psychiatric nurse, who meets the requirements in s. 394.455(35), within the framework of an established

protocol with a psychiatrist, may prescribe psychotropic controlled substances for the treatment of mental disorders.

(5) The board shall approve for licensure, and the department shall issue a license to, any nurse meeting the

qualifications in this section. The board shall establish an application fee not to exceed $100 and a biennial renewal

fee not to exceed $50. The board is authorized to adopt such other rules as are necessary to implement the provisions

of this section.

(6)(a) The board shall establish a committee to recommend a formulary of controlled substances that an

advanced practice registered nurse may not prescribe or may prescribe only for specific uses or in limited quantities.

The committee must consist of three advanced practice registered nurses licensed under this section, recommended

by the board; three physicians licensed under chapter 458 or chapter 459 who have work experience with advanced

practice registered nurses, recommended by the Board of Medicine; and a pharmacist licensed under chapter 465

who is a doctor of pharmacy, recommended by the Board of Pharmacy. The committee may recommend an

evidence-based formulary applicable to all advanced practice registered nurses which is limited by specialty

certification, is limited to approved uses of controlled substances, or is subject to other similar restrictions the

committee finds are necessary to protect the health, safety, and welfare of the public. The formulary must restrict the

prescribing of psychiatric mental health controlled substances for children younger than 18 years of age to advanced

practice registered nurses who also are psychiatric nurses as defined in s. 394.455. The formulary must also limit the

prescribing of Schedule II controlled substances as listed in s. 893.03 to a 7-day supply, except that such restriction

does not apply to controlled substances that are psychiatric medications prescribed by psychiatric nurses as defined

in s. 394.455.

(b) The board shall adopt by rule the recommended formulary and any revision to the formulary which it finds

is supported by evidence-based clinical findings presented by the Board of Medicine, the Board of Osteopathic

Medicine, or the Board of Dentistry.

(c) The formulary required under this subsection does not apply to a controlled substance that is dispensed for

administration pursuant to an order, including an order for medication authorized by subparagraph (4)(b)3.,

subparagraph (4)(b)4., or subparagraph (4)(b)9.

(d) The board shall adopt the committee’s initial recommendation no later than October 31, 2016.

(7) This section shall be known as “The Barbara Lumpkin Prescribing Act.”

(8) The department and board shall establish a transition timeline and process for practitioners certified as of

September 30, 2018, as advanced registered nurse practitioners or clinical nurse specialists, to convert a certificate in

good standing to a license that becomes effective on October 1, 2018, to practice as an advanced practice registered

nurse. An advanced registered nurse practitioner or a clinical nurse specialist holding a certificate to practice in good

standing on September 30, 2018, may continue to practice with all rights, authorizations, and responsibilities under

this section for licensure as an advanced practice registered nurse and may use the applicable title under s. 464.015

after the effective date of this act while the department and board complete the transition from certification to

licensure, as established under this act. This subsection may not be construed to limit or restrict the department’s or

board’s disciplinary authority or enforcement responsibilities for safe nursing practice. This subsection expires on

October 1, 2020.

History.—ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; s. 4, ch. 84-268; ss. 8, 17, 18, ch. 86-284; s. 58, ch. 91-137; s.

5, ch. 91-156; s. 4, ch. 91-429; s. 7, ch. 96-274; s. 1105, ch. 97-103; s. 80, ch. 97-264; s. 8, ch. 2006-251; s. 3, ch.

10 – 23

2007-167; s. 9, ch. 2010-37; s. 8, ch. 2016-139; s. 4, ch. 2016-145; ss. 12, 13, 25, ch. 2016-224; s. 7, ch. 2016-231;

ss. 2, 3, ch. 2017-134; s. 3, ch. 2018-106.

464.013 Renewal of license or certificate.—

(1) The department shall renew a license upon receipt of the renewal application and fee.

(2) The department shall adopt rules establishing a procedure for the biennial renewal of licenses.

(3) The board shall by rule prescribe up to 30 hours of continuing education biennially as a condition for

renewal of a license or certificate.

(a) A nurse who is certified by a health care specialty program accredited by the National Commission for

Certifying Agencies or the Accreditation Board for Specialty Nursing Certification is exempt from continuing

education requirements. The criteria for programs must be approved by the board.

(b) Notwithstanding the exemption in paragraph (a), as part of the maximum 30 hours of continuing education

hours required under this subsection, advanced practice registered nurses licensed under s. 464.012 must complete at

least 3 hours of continuing education on the safe and effective prescription of controlled substances. Such continuing

education courses must be offered by a statewide professional association of physicians in this state accredited to

provide educational activities designated for the American Medical Association Physician’s Recognition Award

Category 1 credit, the American Nurses Credentialing Center, the American Association of Nurse Anesthetists, or

the American Association of Nurse Practitioners and may be offered in a distance learning format.

(c) Notwithstanding the exemption in paragraph (a), as part of the maximum biennial continuing education

hours required under this subsection, the board shall require each person licensed or certified under this chapter to

complete a 2-hour continuing education course on human trafficking, as defined in s. 787.06(2). The continuing

education course must consist of data and information on the types of human trafficking, such as labor and sex, and

the extent of human trafficking; factors that place a person at greater risk of being a victim of human trafficking;

public and private social services available for rescue, food, clothing, and shelter referrals; hotlines for reporting

human trafficking which are maintained by the National Human Trafficking Resource Center and the United States

Department of Homeland Security; validated assessment tools for identifying a human trafficking victim and general

indicators that a person may be a victim of human trafficking; procedures for sharing information related to human

trafficking with a patient; and referral options for legal and social services. All licensees must complete this course

for every biennial licensure renewal on or after January 1, 2019.



2014-92; s. 14, ch. 2016-224; s. 6, ch. 2017-23; s. 57, ch. 2018-106.

464.014 Inactive status.—

(1) The board shall adopt rules relating to application procedures for inactive status, to the biennial renewal of

inactive licenses, and to the reactivation of licenses. The board shall prescribe by rule an application fee for inactive

status, a renewal fee for inactive status, a delinquency fee, and a fee for the reactivation of a license. None of these

fees may exceed the biennial renewal fee established by the board for biennial renewal of an active license.

(2) The department may not reactivate a license unless the inactive or delinquent licensee has paid any

applicable biennial renewal or delinquency fee, or both, and a reactivation fee.

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History.—ss. 1, 6, ch. 79-225; s. 319, ch. 81-259; ss. 2, 3, ch. 81-318; ss. 11, 17, 18, ch. 86-284; s. 12, ch. 88-

219; s. 35, ch. 89-162; s. 2, ch. 89-170; s. 58, ch. 91-137; s. 5, ch. 91-156; s. 4, ch. 91-429; s. 177, ch. 94-119; s. 9,

ch. 96-274; s. 82, ch. 97-264.

464.015 Titles and abbreviations; restrictions; penalty.—

(1) Only a person who holds a license in this state or a multistate license pursuant to s. 464.0095 to practice

professional nursing or who performs nursing services pursuant to the exception set forth in s. 464.022(8) may use

the title “Registered Nurse” and the abbreviation “R.N.”

(2) Only a person who holds a license in this state or a multistate license pursuant to s. 464.0095 to practice as a

licensed practical nurse or who performs practical nursing services pursuant to the exception set forth in s.

464.022(8) may use the title “Licensed Practical Nurse” and the abbreviation “L.P.N.”

(3) Only persons who are graduates of prelicensure nursing education programs listed in s. 464.008(1)(c) may

use the term “Graduate Nurse” and the abbreviation “G.N.,” pending the results of the first licensure examination for

which they are eligible.

(4) Only persons who are graduates of prelicensure nursing education programs listed in s. 464.008(1)(c) may

use the term “Graduate Practical Nurse” and the abbreviation “G.P.N.,” pending the results of the first licensure

examination for which they are eligible.

(5) Only persons who hold valid licenses to practice as clinical nurse specialists in this state may use the title

“Clinical Nurse Specialist” and the abbreviation “C.N.S.”

(6) Only persons who hold valid certificates to practice as certified registered nurse anesthetists in this state

may use the title “Certified Registered Nurse Anesthetist” and the abbreviations “C.R.N.A.” or “nurse anesthetist.”

(7) Only persons who hold valid certificates to practice as certified nurse midwives in this state may use the

title “Certified Nurse Midwife” and the abbreviations “C.N.M.” or “nurse midwife.”

(8) Only persons who hold valid licenses to practice as advanced practice registered nurses in this state may use

the title “Advanced Practice Registered Nurse” and the abbreviation “A.P.R.N.”

(9) A person may not practice or advertise as, or assume the title of, registered nurse, licensed practical nurse,

clinical nurse specialist, certified registered nurse anesthetist, certified nurse midwife, certified nurse practitioner, or

advanced practice registered nurse or use the abbreviation “R.N.,” “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,”

“C.N.P.,” or “A.P.R.N.” or take any other action that would lead the public to believe that person was authorized by

law to practice as such or is performing nursing services pursuant to the exception set forth in s. 464.022(8) unless

that person is licensed, certified, or authorized pursuant to s. 464.0095 to practice as such.

(10) A violation of this section is a misdemeanor of the first degree, punishable as provided in s. 775.082 or s.

775.083.


s. 4, ch. 91-429; s. 4, ch. 2007-167; s. 4, ch. 2010-37; s. 9, ch. 2016-139; ss. 58, 59, ch. 2018-106.

464.016 Violations and penalties.—

(1) Each of the following acts constitutes a felony of the third degree, punishable as provided in s. 775.082, s.

775.083, or s. 775.084:

(a) Practicing advanced or specialized, professional, or practical nursing, as defined in this part, unless holding

an active license or certificate to do so.

(b) Using or attempting to use a license or certificate which has been suspended or revoked.

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(c) Knowingly employing unlicensed persons in the practice of nursing.

(d) Obtaining or attempting to obtain a license or certificate under this part by misleading statements or

knowing misrepresentation.

(2) Each of the following acts constitutes a misdemeanor of the first degree, punishable as provided in s.

775.082 or s. 775.083:

(a) Using the name or title “Nurse,” “Registered Nurse,” “Licensed Practical Nurse,” “Clinical Nurse

Specialist,” “Certified Registered Nurse Anesthetist,” “Certified Nurse Practitioner,” “Certified Nurse Midwife,”

“Advanced Practice Registered Nurse,” or any other name or title which implies that a person was licensed or

certified as same, unless such person is duly licensed or certified.

(b) Knowingly concealing information relating to violations of this part.


s. 90, ch. 91-224; s. 4, ch. 91-429; s. 183, ch. 99-397; ss. 54, 124, ch. 2000-318; s. 5, ch. 2007-167; s. 60, ch. 2018-

106.

464.017 Sexual misconduct in the practice of nursing.—The nurse-patient relationship is founded on mutual

trust. Sexual misconduct in the practice of nursing means violation of the nurse-patient relationship through which

the nurse uses said relationship to induce or attempt to induce the patient to engage, or to engage or attempt to

engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination

or treatment of the patient. Sexual misconduct in the practice of nursing is prohibited.

History.—ss. 1, 6, ch. 79-225; s. 320, ch. 81-259; ss. 2, 3, ch. 81-318; ss. 17, 18, ch. 86-284; s. 58, ch. 91-137; s.

5, ch. 91-156; s. 4, ch. 91-429.

464.018 Disciplinary actions.—

(1) The following acts constitute grounds for denial of a license or disciplinary action, as specified in ss.

456.072(2) and 464.0095:

(a) Procuring, attempting to procure, or renewing a license to practice nursing or the authority to practice

practical or professional nursing pursuant to s. 464.0095 by bribery, by knowing misrepresentations, or through an

error of the department or the board.

(b) Having a license to practice nursing revoked, suspended, or otherwise acted against, including the denial of

licensure, by the licensing authority of another state, territory, or country.

(c) Being convicted or found guilty of, or entering a plea of guilty or nolo contendere to, regardless of

adjudication, a crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice

nursing.

(d) Being convicted or found guilty of, or entering a plea of guilty or nolo contendere to, regardless of

adjudication, any of the following offenses:

1. A forcible felony as defined in chapter 776.

2. A violation of chapter 812, relating to theft, robbery, and related crimes.

3. A violation of chapter 817, relating to fraudulent practices.

4. A violation of chapter 800, relating to lewdness and indecent exposure.

5. A violation of chapter 784, relating to assault, battery, and culpable negligence.

6. A violation of chapter 827, relating to child abuse.

7. A violation of chapter 415, relating to protection from abuse, neglect, and exploitation.

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8. A violation of chapter 39, relating to child abuse, abandonment, and neglect.

9. For an applicant for a multistate license or for a multistate licenseholder under s. 464.0095, a felony offense

under Florida law or federal criminal law.

(e) Having been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to,

any offense prohibited under s. 435.04 or similar statute of another jurisdiction; or having committed an act which

constitutes domestic violence as defined in s. 741.28.

(f) Making or filing a false report or record, which the nurse knows to be false, intentionally or negligently

failing to file a report or record required by state or federal law, willfully impeding or obstructing such filing or

inducing another person to do so. Such reports or records shall include only those which are signed in the nurse’s

capacity as a licensed nurse.

(g) False, misleading, or deceptive advertising.

(h) Unprofessional conduct, as defined by board rule.

(i) Engaging or attempting to engage in the possession, sale, or distribution of controlled substances as set forth

in chapter 893, for any other than legitimate purposes authorized by this part.

(j) Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of

alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical

condition. In enforcing this paragraph, the department shall have, upon a finding of the State Surgeon General or the

State Surgeon General’s designee that probable cause exists to believe that the nurse is unable to practice nursing

because of the reasons stated in this paragraph, the authority to issue an order to compel a nurse to submit to a

mental or physical examination by physicians designated by the department. If the nurse refuses to comply with

such order, the department’s order directing such examination may be enforced by filing a petition for enforcement

in the circuit court where the nurse resides or does business. The nurse against whom the petition is filed shall not be

named or identified by initials in any public court records or documents, and the proceedings shall be closed to the

public. The department shall be entitled to the summary procedure provided in s. 51.011. A nurse affected by this

paragraph shall at reasonable intervals be afforded an opportunity to demonstrate that she or he can resume the

competent practice of nursing with reasonable skill and safety to patients.

(k) Failing to report to the department any person who the nurse knows is in violation of this part or of the rules

of the department or the board. However, a person who the licensee knows is unable to practice nursing with

reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals, or any other

type of material, or as a result of a mental or physical condition, may be reported to a consultant operating an

impaired practitioner program as described in s. 456.076 rather than to the department.

(l) Knowingly violating any provision of this part, a rule of the board or the department, or a lawful order of the

board or department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued

subpoena of the department.

(m) Failing to report to the department any licensee under chapter 458 or under chapter 459 who the nurse

knows has violated the grounds for disciplinary action set out in the law under which that person is licensed and who

provides health care services in a facility licensed under chapter 395, or a health maintenance organization

certificated under part I of chapter 641, in which the nurse also provides services.

(n) Failing to meet minimal standards of acceptable and prevailing nursing practice, including engaging in acts

for which the nurse is not qualified by training or experience.

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(o) Violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto.

(p) For an advanced practice registered nurse:

1. Presigning blank prescription forms.

2. Prescribing for office use any medicinal drug appearing on Schedule II in chapter 893.

3. Prescribing, ordering, dispensing, administering, supplying, selling, or giving a drug that is an amphetamine,

a sympathomimetic amine drug, or a compound designated in s. 893.03(2) as a Schedule II controlled substance, to

or for any person except for:

a. The treatment of narcolepsy; hyperkinesis; behavioral syndrome in children characterized by the

developmentally inappropriate symptoms of moderate to severe distractibility, short attention span, hyperactivity,

emotional lability, and impulsivity; or drug-induced brain dysfunction.

b. The differential diagnostic psychiatric evaluation of depression or the treatment of depression shown to be

refractory to other therapeutic modalities.

c. The clinical investigation of the effects of such drugs or compounds when an investigative protocol is

submitted to, reviewed by, and approved by the department before such investigation is begun.

4. Prescribing, ordering, dispensing, administering, supplying, selling, or giving growth hormones, testosterone

or its analogs, human chorionic gonadotropin (HCG), or other hormones for the purpose of muscle building or to

enhance athletic performance. As used in this subparagraph, the term “muscle building” does not include the

treatment of injured muscle. A prescription written for the drug products identified in this subparagraph may be

dispensed by a pharmacist with the presumption that the prescription is for legitimate medical use.

5. Promoting or advertising on any prescription form a community pharmacy unless the form also states: “This

prescription may be filled at any pharmacy of your choice.”

6. Prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including a controlled

substance, other than in the course of his or her professional practice. For the purposes of this subparagraph, it is

legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including

all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the

patient and is not in the course of the advanced practice registered nurse’s professional practice, without regard to

his or her intent.

7. Prescribing, dispensing, or administering a medicinal drug appearing on any schedule set forth in chapter 893

to himself or herself, except a drug prescribed, dispensed, or administered to the advanced practice registered nurse

by another practitioner authorized to prescribe, dispense, or administer medicinal drugs.

8. Prescribing, ordering, dispensing, administering, supplying, selling, or giving amygdalin (laetrile) to any

person.

9. Dispensing a substance designated in s. 893.03(2) or (3) as a substance controlled in Schedule II or Schedule

III, respectively, in violation of s. 465.0276.

10. Promoting or advertising through any communication medium the use, sale, or dispensing of a substance

designated in s. 893.03 as a controlled substance.

(q) For a psychiatric nurse:

1. Presigning blank prescription forms.

2. Prescribing for office use any medicinal drug appearing in Schedule II of s. 893.03.

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3. Prescribing, ordering, dispensing, administering, supplying, selling, or giving a drug that is an amphetamine,

a sympathomimetic amine drug, or a compound designated in s. 893.03(2) as a Schedule II controlled substance, to

or for any person except for:

a. The treatment of narcolepsy; hyperkinesis; behavioral syndrome in children characterized by the

developmentally inappropriate symptoms of moderate to severe distractibility, short attention span, hyperactivity,

emotional lability, and impulsivity; or drug-induced brain dysfunction.

b. The differential diagnostic psychiatric evaluation of depression or the treatment of depression shown to be

refractory to other therapeutic modalities.

c. The clinical investigation of the effects of such drugs or compounds when an investigative protocol is

submitted to, reviewed by, and approved by the department before such investigation is begun.

4. Prescribing, ordering, dispensing, administering, supplying, selling, or giving growth hormones, testosterone

or its analogs, human chorionic gonadotropin (HCG), or other hormones for the purpose of muscle building or to

enhance athletic performance. As used in this subparagraph, the term “muscle building” does not include the

treatment of injured muscle. A prescription written for the drug products identified in this subparagraph may be

dispensed by a pharmacist with the presumption that the prescription is for legitimate medical use.

5. Promoting or advertising on any prescription form a community pharmacy unless the form also states: “This

prescription may be filled at any pharmacy of your choice.”

6. Prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including a controlled

substance, other than in the course of his or her professional practice. For the purposes of this subparagraph, it is

legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including

all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the

patient and is not in the course of the advanced practice registered nurse’s professional practice, without regard to

his or her intent.

7. Prescribing, dispensing, or administering a medicinal drug appearing on any schedule set forth in chapter 893

to himself or herself, except a drug prescribed, dispensed, or administered to the psychiatric nurse by another

practitioner authorized to prescribe, dispense, or administer medicinal drugs.

8. Prescribing, ordering, dispensing, administering, supplying, selling, or giving amygdalin (laetrile) to any

person.

9. Dispensing a substance designated in s. 893.03(2) or (3) as a substance controlled in Schedule II or Schedule

III, respectively, in violation of s. 465.0276.

10. Promoting or advertising through any communication medium the use, sale, or dispensing of a substance

designated in s. 893.03 as a controlled substance.

(2)(a) The board may enter an order denying licensure or imposing any of the penalties in s. 456.072(2) against

any applicant for licensure or nurse who is found guilty of violating subsection (1) or s. 456.072(1).

(b) The board may take adverse action against a nurse’s multistate licensure privilege and impose any of the

penalties in s. 456.072(2) when the nurse is found guilty of violating subsection (1) or s. 456.072(1).

(3) The board shall not reinstate the license of a nurse, or cause a license to be issued to a person it has deemed

unqualified, until such time as it is satisfied that such person has complied with all the terms and conditions set forth

in the final order and that such person is capable of safely engaging in the practice of nursing.

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(4) The board shall not reinstate the license of a nurse who has been found guilty by the board on three separate

occasions of violations of this part relating to the use of drugs or narcotics, which offenses involved the diversion of

drugs or narcotics from patients to personal use or sale.

(5) The board shall by rule establish guidelines for the disposition of disciplinary cases involving specific types

of violations. Such guidelines may include minimum and maximum fines, periods of supervision or probation, or

conditions of probation or reissuance of a license.

History.—ss. 1, 6, ch. 79-225; s. 321, ch. 81-259; ss. 2, 3, ch. 81-318; s. 1, ch. 83-27; s. 27, ch. 83-329; ss. 14,

17, 18, ch. 86-284; s. 40, ch. 88-1; s. 13, ch. 88-219; s. 19, ch. 88-277; s. 19, ch. 88-392; s. 3, ch. 89-170; s. 33, ch.

91-57; s. 58, ch. 91-137; s. 5, ch. 91-156; s. 4, ch. 91-429; s. 44, ch. 92-149; s. 24, ch. 94-134; s. 24, ch. 94-135; s.

20, ch. 95-152; s. 48, ch. 95-228; s. 136, ch. 95-418; s. 10, ch. 96-274; s. 1106, ch. 97-103; s. 83, ch. 97-264; s. 155,

ch. 98-403; s. 2, ch. 99-335; s. 125, ch. 2000-318; s. 103, ch. 2000-349; s. 31, ch. 2001-277; s. 6, ch. 2002-230; s.

30, ch. 2004-267; s. 9, ch. 2005-240; s. 83, ch. 2008-6; s. 51, ch. 2010-114; s. 10, ch. 2016-139; s. 15, ch. 2016-224;

s. 8, ch. 2016-231; s. 14, ch. 2017-41; s. 61, ch. 2018-106.

464.019 Approval of nursing education programs.—

(1) PROGRAM APPLICATION.—An educational institution that wishes to conduct a program in this state for

the prelicensure education of professional or practical nurses must submit to the department a program application

and review fee of $1,000 for each prelicensure nursing education program to be offered at the institution’s main

campus, branch campus, or other instructional site. The program application must include the legal name of the

educational institution, the legal name of the nursing education program, and, if such institution is accredited, the

name of the accrediting agency. The application must also document that:

(a)1. For a professional nursing education program, the program director and at least 50 percent of the

program’s faculty members are registered nurses who have a master’s or higher degree in nursing or a bachelor’s

degree in nursing and a master’s or higher degree in a field related to nursing.

2. For a practical nursing education program, the program director and at least 50 percent of the program’s

faculty members are registered nurses who have a bachelor’s or higher degree in nursing.

The educational degree requirements of this paragraph may be documented by an official transcript or by a written

statement from the educational institution verifying that the institution conferred the degree.

(b) The program’s nursing major curriculum consists of at least:

1. Fifty percent clinical training in the United States, the District of Columbia, or a possession or territory of the

United States for a practical nursing education program, an associate degree professional nursing education

program, or a professional diploma nursing education program.

2. Forty percent clinical training in the United States, the District of Columbia, or a possession or territory of

the United States for a bachelor’s degree professional nursing education program.

(c) No more than 50 percent of the program’s clinical training consists of clinical simulation.

(d) The program has signed agreements with each agency, facility, and organization included in the curriculum

plan as clinical training sites and community-based clinical experience sites.

(e) The program has written policies for faculty which include provisions for direct or indirect supervision by

program faculty or clinical preceptors for students in clinical training consistent with the following standards:

1. The number of program faculty members equals at least one faculty member directly supervising every 12

students unless the written agreement between the program and the agency, facility, or organization providing

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clinical training sites allows more students, not to exceed 18 students, to be directly supervised by one program

faculty member.

2. For a hospital setting, indirect supervision may occur only if there is direct supervision by an assigned

clinical preceptor, a supervising program faculty member is available by telephone, and such arrangement is

approved by the clinical facility.

3. For community-based clinical experiences that involve student participation in invasive or complex nursing

activities, students must be directly supervised by a program faculty member or clinical preceptor and such

arrangement must be approved by the community-based clinical facility.

4. For community-based clinical experiences not subject to subparagraph 3., indirect supervision may occur

only when a supervising program faculty member is available to the student by telephone.

A program’s policies established under this paragraph must require that a clinical preceptor who is supervising

students in a professional nursing education program be a registered nurse or, if supervising students in a practical

nursing education program, be a registered nurse or licensed practical nurse.

(f) The professional or practical nursing curriculum plan documents clinical experience and theoretical

instruction in medical, surgical, obstetric, pediatric, and geriatric nursing. A professional nursing curriculum plan

shall also document clinical experience and theoretical instruction in psychiatric nursing. Each curriculum plan must

document clinical training experience in appropriate settings that include, but are not limited to, acute care, long-

term care, and community settings.

(g) The professional or practical nursing education program provides theoretical instruction and clinical

application in personal, family, and community health concepts; nutrition; human growth and development

throughout the life span; body structure and function; interpersonal relationship skills; mental health concepts;

pharmacology and administration of medications; and legal aspects of practice. A professional nursing education

program must also provide theoretical instruction and clinical application in interpersonal relationships and

leadership skills; professional role and function; and health teaching and counseling skills.

(2) PROGRAM APPROVAL.—

(a) Upon receipt of a program application and review fee, the department shall examine the application to

determine if it is complete. If the application is not complete, the department shall notify the educational institution

in writing of any errors or omissions within 30 days after the department’s receipt of the application. A program

application is deemed complete upon the department’s receipt of:

1. The initial application, if the department does not notify the educational institution of any errors or omissions

within the 30-day period; or

2. A revised application that corrects each error and omission of which the department notifies the educational

institution within the 30-day period.

(b) Following the department’s receipt of a complete program application, the board may conduct an onsite

evaluation if necessary to document the applicant’s compliance with subsection (1). Within 90 days after the

department’s receipt of a complete program application, the board shall:

1. Approve the application if it documents compliance with subsection (1); or

2. Provide the educational institution with a notice of intent to deny the application if it does not document

compliance with subsection (1). The notice must specify written reasons for the board’s denial of the application.

The board may not deny a program application because of an educational institution’s failure to correct an error or

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omission that the department failed to provide notice of to the institution within the 30-day notice period under

paragraph (a). The educational institution may request a hearing on the notice of intent to deny the program

application pursuant to chapter 120.

(c) A program application is deemed approved if the board does not act within the 90-day review period

provided under paragraph (b).

(d) Upon the board’s approval of a program application, the program becomes an approved program.

(3) ANNUAL REPORT.—By November 1 of each year, each approved program shall submit to the board an

annual report comprised of an affidavit certifying continued compliance with subsection (1), a summary description

of the program’s compliance with subsection (1), and documentation for the previous academic year that, to the

extent applicable, describes:

(a) The number of student applications received, qualified applicants, applicants accepted, accepted applicants

who enroll in the program, students enrolled in the program, and program graduates.

(b) The program’s retention rates for students tracked from program entry to graduation.

(c) The program’s accreditation status, including identification of the accrediting agency.

(4) INTERNET WEBSITE.—The board shall publish the following information on its Internet website:

(a) A list of each accredited program conducted in the state and the program’s graduate passage rates for the

most recent 2 calendar years, which the department shall determine through the following sources:

1. For a program’s accreditation status, the specialized accrediting agencies that are nationally recognized by

the United States Secretary of Education to accredit nursing education programs.

2. For a program’s graduate passage rates, the contract testing service of the National Council of State Boards

of Nursing.

(b) The following data for each approved program, which includes, to the extent applicable:

1. All documentation provided by the program in its program application if submitted on or after July 1, 2009.

2. The summary description of the program’s compliance submitted under subsection (3).

3. The program’s accreditation status, including identification of the accrediting agency.

4. The program’s probationary status.

5. The program’s graduate passage rates for the most recent 2 calendar years.

6. Each program’s retention rates for students tracked from program entry to graduation.

(c) The average passage rates for United States educated, first-time test takers on the National Council of State

Boards of Nursing Licensing Examination for the most recent 2 calendar years, as calculated by the contract testing

service of the National Council of State Boards of Nursing. The average passage rates shall be published separately

for each type of comparable degree program listed in subparagraph (5)(a)1.

The information required to be published under this subsection shall be made available in a manner that allows

interactive searches and comparisons of individual programs selected by the website user. The board shall update the

Internet website at least quarterly with the available information.

(5) ACCOUNTABILITY.—

(a)1. An approved program must achieve a graduate passage rate for first-time test takers which is not more

than 10 percentage points lower than the average passage rate during the same calendar year for graduates of

comparable degree programs who are United States educated, first-time test takers on the National Council of State

Boards of Nursing Licensing Examination, as calculated by the contract testing service of the National Council of

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State Boards of Nursing. For purposes of this subparagraph, an approved program is comparable to all degree

programs of the same program type from among the following program types:

a. Professional nursing education programs that terminate in a bachelor’s degree.

b. Professional nursing education programs that terminate in an associate degree.

c. Professional nursing education programs that terminate in a diploma.

d. Practical nursing education programs.

2. Beginning with graduate passage rates for calendar year 2010, if an approved program’s graduate passage

rates do not equal or exceed the required passage rates for 2 consecutive calendar years, the board shall place the

program on probationary status pursuant to chapter 120 and the program director shall appear before the board to

present a plan for remediation, which shall include specific benchmarks to identify progress toward a graduate

passage rate goal. The program must remain on probationary status until it achieves a graduate passage rate that

equals or exceeds the required passage rate for any 1 calendar year. The board shall deny a program application for a

new prelicensure nursing education program submitted by an educational institution if the institution has an existing

program that is already on probationary status.

3. Upon the program’s achievement of a graduate passage rate that equals or exceeds the required passage rate,

the board, at its next regularly scheduled meeting following release of the program’s graduate passage rate by the

National Council of State Boards of Nursing, shall remove the program’s probationary status. If the program, during

the 2 calendar years following its placement on probationary status, does not achieve the required passage rate for

any 1 calendar year, the board may extend the program’s probationary status for 1 additional year, provided the

program has demonstrated adequate progress toward the graduate passage rate goal by meeting a majority of the

benchmarks established in the remediation plan. If the program is not granted the 1-year extension or fails to achieve

the required passage rate by the end of such extension, the board shall terminate the program pursuant to chapter

120.

(b) If an approved program fails to submit the annual report required in subsection (3), the board shall notify

the program director and president or chief executive officer of the educational institution in writing within 15 days

after the due date of the annual report. The program director shall appear before the board at the board’s next

regularly scheduled meeting to explain the reason for the delay. The board shall terminate the program pursuant to

chapter 120 if the program director fails to appear before the board, as required under this paragraph, or if the

program does not submit the annual report within 6 months after the due date.

(c) A nursing education program, whether accredited or nonaccredited, which has been placed on probationary

status shall disclose its probationary status in writing to the program’s students and applicants. The notification must

include an explanation of the implications of the program’s probationary status on the students or applicants.

(d) If students from a program that is terminated pursuant to this subsection transfer to an approved or an

accredited program under the direction of the Commission for Independent Education, the board shall recalculate the

passage rates of the programs receiving the transferring students, excluding the test scores of those students

transferring more than 12 credits.

(6) DISCLOSURE OF GRADUATE PASSAGE RATE DATA.—

(a) For each graduate of the program included in the calculation of the program’s graduate passage rate, the

department shall disclose to the program director, upon his or her written request, the name, examination date, and

determination of whether each graduate passed or failed the National Council of State Boards of Nursing Licensing

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Examination, if such information is provided to the department by the contract testing service of the National

Council of State Boards of Nursing. The written request must specify the calendar years for which the information is

requested.

(b) A program director to whom confidential information exempt from public disclosure pursuant to s. 456.014

is disclosed under this subsection must maintain the confidentiality of the information and is subject to the same

penalties provided in s. 456.082 for department employees who unlawfully disclose confidential information.

(7) PROGRAM CLOSURE.—

(a) An educational institution conducting an approved program or accredited program in this state, at least 30

days before voluntarily closing the program, shall notify the board in writing of the institution’s reason for closing

the program, the intended closure date, the institution’s plan to provide for or assist in the completion of training by

the program’s students, and the arrangements for storage of the program’s permanent records.

(b) An educational institution conducting a nursing education program that is terminated under subsection (5)

or closed under subparagraph (9)(b)3.:

1. May not accept or enroll new students.

2. Shall submit to the board within 30 days after the program is terminated or closed a written description of

how the institution will assist in completing the training of the program’s students and the institution’s arrangements

for storage of the program’s permanent records.

(c) If an educational institution does not comply with paragraph (a) or paragraph (b), the board shall provide a

written notice explaining the institution’s noncompliance to the following persons and entities:

1. The president or chief executive officer of the educational institution.

2. The Board of Governors, if the program is conducted by a state university.

3. The district school board, if the program is conducted by an educational institution operated by a school

district.

4. The Commission for Independent Education, if the program is conducted by an educational institution

licensed under chapter 1005.

5. The State Board of Education, if the program is conducted by an educational institution in the Florida

College System or by an educational institution that is not subject to subparagraphs 2.-4.

(d) A program that is terminated or closed under this section may not seek program approval under its original

name or a new program name for a minimum of 3 years after the date of termination or closing. An institutional

name change or the creation of a new educational institution with the same ownership does not reduce the waiting

period for reapplication.

(8) RULEMAKING.—The board does not have rulemaking authority to administer this section, except that the

board shall adopt rules that prescribe the format for submitting program applications under subsection (1) and

annual reports under subsection (3), and to administer the documentation of the accreditation of nursing education

programs under subsection (11). The board may adopt rules relating to the nursing curriculum, including rules

relating to the uses and limitations of simulation technology. The board may not impose any condition or

requirement on an educational institution submitting a program application, an approved program, or an accredited

program, except as expressly provided in this section.

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(9) APPLICABILITY TO ACCREDITED PROGRAMS.—

(a) Subsections (1)-(3), paragraph (4)(b), and paragraph (5)(b) do not apply to an accredited program.

(b) If an accredited program ceases to be accredited, the educational institution conducting the program:

1. Within 10 business days after the program ceases to be accredited, must provide written notice of the date

that the program ceased to be accredited to the board, the program’s students and applicants, and each entity

providing clinical training sites or community-based clinical experience sites for the program. The educational

institution must continue to provide the written notice to new students, applicants, and entities providing clinical

training sites or community-based clinical experience sites for the program until the program becomes an approved

program or is closed under subparagraph 3.

2. Within 30 days after the program ceases to be accredited, must submit an affidavit to the board, signed by the

educational institution’s president or chief executive officer, which certifies the institution’s compliance with

subparagraph 1. The board shall notify the persons and applicable entities listed in paragraph (7)(c) if an educational

institution does not submit the affidavit required by this subparagraph.

3. May apply to become an approved program under this section. If the educational institution:

a. Within 30 days after the program ceases to be accredited, submits a program application and review fee to

the department under subsection (1) and the affidavit required under subparagraph 2., the program shall be deemed

an approved program from the date that the program ceased to be accredited until the date that the board approves or

denies the program application. The program application must be denied by the board pursuant to chapter 120 if it

does not contain the affidavit. If the board denies the program application under subsection (2) or if the program

application does not contain the affidavit, the program shall be closed and the educational institution conducting the

program must comply with paragraph (7)(b).

b. Does not apply to become an approved program pursuant to sub-subparagraph a., the program shall be

deemed an approved program from the date the program ceased to be accredited until the 31st day after that date. On

the 31st day after the program ceased to be accredited, the program shall be closed and the educational institution

conducting the program must comply with paragraph (7)(b).

(10) IMPLEMENTATION STUDY.—The Florida Center for Nursing shall study the administration of this

section and submit reports to the Governor, the President of the Senate, and the Speaker of the House of

Representatives annually by January 30, through January 30, 2020. The annual reports shall address the previous

academic year; provide data on the measures specified in paragraphs (a) and (b), as such data becomes available;

and include an evaluation of such data for purposes of determining whether this section is increasing the availability

of nursing education programs and the production of quality nurses. The department and each approved program or

accredited program shall comply with requests for data from the Florida Center for Nursing.

(a) The Florida Center for Nursing shall evaluate program-specific data for each approved program and

accredited program conducted in the state, including, but not limited to:

1. The number of programs and student slots available.

2. The number of student applications submitted, the number of qualified applicants, and the number of

students accepted.

3. The number of program graduates.

4. Program retention rates of students tracked from program entry to graduation.

5. Graduate passage rates on the National Council of State Boards of Nursing Licensing Examination.

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6. The number of graduates who become employed as practical or professional nurses in the state.

(b) The Florida Center for Nursing shall evaluate the board’s implementation of the:

1. Program application approval process, including, but not limited to, the number of program applications

submitted under subsection (1); the number of program applications approved and denied by the board under

subsection (2); the number of denials of program applications reviewed under chapter 120; and a description of the

outcomes of those reviews.

2. Accountability processes, including, but not limited to, the number of programs on probationary status, the

number of approved programs for which the program director is required to appear before the board under

subsection (5), the number of approved programs terminated by the board, the number of terminations reviewed

under chapter 120, and a description of the outcomes of those reviews.

(c) The Florida Center for Nursing shall complete an annual assessment of compliance by programs with the

accreditation requirements of subsection (11), include in the assessment a determination of the accreditation process

status for each program, and submit the assessment as part of the reports required by this subsection.

(11) ACCREDITATION REQUIRED.—

(a) A nursing education program that prepares students for the practice of professional nursing, that was

approved under this section before July 1, 2014, and that enrolled students before July 1, 2014, must become an

accredited program by July 1, 2019.

(b) A nursing education program that prepares students for the practice of professional nursing and that was

approved under this section before July 1, 2014, but did not enroll students before that date, must become an

accredited program within 5 years after the date of enrolling the program’s first students.

(c) A nursing education program that prepares students for the practice of professional nursing and that is

approved under this section after June 30, 2014, must become an accredited program within 5 years after the date of

enrolling the program’s first students.

(d) This subsection does not apply to a nursing education program provided by an institution that is exempt

from licensure by the Commission for Independent Education under s. 1005.06(1)(e).

(e) A nursing education program that fails to meet the accreditation requirements shall be terminated and is

ineligible for reapproval under its original name or a new program name for a minimum of 3 years after the date of

termination. An institutional name change or the creation of a new educational institution with the same ownership

does not reduce the waiting period for reapplication.

History.—ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; ss. 17, 18, ch. 86-284; s. 58, ch. 91-137; s. 5, ch. 91-156; s. 4,

ch. 91-429; s. 11, ch. 96-274; s. 84, ch. 97-264; s. 126, ch. 2000-318; s. 7, ch. 2002-230; s. 2, ch. 2009-168; s. 5, ch.

2010-37; s. 98, ch. 2012-184; s. 4, ch. 2014-92; s. 4, ch. 2017-134.

464.0195 Florida Center for Nursing; goals.—

(1) There is established the Florida Center for Nursing to address issues of supply and demand for nursing,

including issues of recruitment, retention, and utilization of nurse workforce resources. The Legislature finds that

the center will repay the state’s investment by providing an ongoing strategy for the allocation of the state’s

resources directed towards nursing.

(2) The primary goals for the center shall be to:

(a) Develop a strategic statewide plan for nursing manpower in this state by:

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1. Establishing and maintaining a database on nursing supply and demand in the state, to include current supply

and demand;

2. Analyzing the current supply and demand in the state and making future projections of such, including

assessing the impact of this state’s participation in the Nurse Licensure Compact under s. 464.0095; and

3. Selecting from the plan priorities to be addressed.

(b) Convene various groups representative of nurses, other health care providers, business and industry,

consumers, legislators, and educators to:

1. Review and comment on data analysis prepared for the center;

2. Recommend systemic changes, including strategies for implementation of recommended changes; and

3. Evaluate and report the results of these efforts to the Legislature and others.

(c) Enhance and promote recognition, reward, and renewal activities for nurses in the state by:

1. Promoting nursing excellence programs such as magnet recognition by the American Nurses Credentialing

Center;

2. Proposing and creating additional reward, recognition, and renewal activities for nurses; and

3. Promoting media and positive image-building efforts for nursing.

(3) The Board of Nursing shall include on its initial and renewal application forms a question asking each nurse

to voluntarily contribute to funding the Florida Center for Nursing in addition to paying the fees imposed at the time

of licensure and licensure renewal. Revenues collected from nurses over and above the required fees shall be

transferred from the Medical Quality Assurance Trust Fund to the Grants and Donations Trust Fund within the

Department of Health and shall be used solely to support and maintain the goals and functions of the center. Before

giving a nurse the opportunity to contribute to funding the center at the time of licensure renewal, the Board of

Nursing shall provide the nurse with a summary of the center’s work, a link to the center’s Internet website, and the

following statement: “The Florida Center for Nursing’s operating revenues are derived in part from your donation.

In order for the Florida Center for Nursing to continue its work on behalf of nurses, please donate.”

(4) The center may request from the board, and the board must provide to the center upon its request, any

information held by the board regarding nurses licensed in this state or holding a multistate license pursuant to s.

464.0095 or information reported to the board by employers of such nurses, other than personal identifying

information.


ch. 2016-139.

464.0196 Florida Center for Nursing; board of directors.—

(1) The Florida Center for Nursing shall be governed by a policy-setting board of directors. The board shall

consist of 16 members, with a simple majority of the board being nurses representative of various practice areas.

Other members shall include representatives of other health care professions, business and industry, health care

providers, and consumers. The members of the board shall be appointed by the Governor as follows:

(a) Four members recommended by the President of the Senate, at least one of whom shall be a registered nurse

recommended by the Florida Organization of Nurse Executives and at least one other representative of the hospital

industry recommended by the Florida Hospital Association;

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(b) Four members recommended by the Speaker of the House of Representatives, at least one of whom shall be

a registered nurse recommended by the Florida Nurses Association and at least one other representative of the long-

term care industry;

(c) Four members recommended by the Governor, two of whom shall be registered nurses;

(d) One nurse educator recommended by the Board of Governors who is a dean of a College of Nursing at a

state university; and

(e) Three nurse educators recommended by the State Board of Education, one of whom must be a director of a

nursing program at a Florida College System institution.

(2) The initial terms of the members shall be as follows:

(a) Of the members appointed pursuant to paragraph (1)(a), two shall be appointed for terms expiring June 30,

2005, one for a term expiring June 30, 2004, and one for a term expiring June 30, 2003.

(b) Of the members appointed pursuant to paragraph (1)(b), one shall be appointed for a term expiring June 30,

2005, two for terms expiring June 30, 2004, and one for a term expiring June 20, 2003.

(c) Of the members appointed pursuant to paragraph (1)(c), one shall be appointed for a term expiring June 30,

2005, one for a term expiring June 30, 2004, and two for terms expiring June 30, 2003.

(d) Of the members appointed pursuant to paragraph (1)(d), the terms of two members recommended by the

State Board of Education shall expire June 30, 2005; the term of the member who is a dean of a College of Nursing

at a state university shall expire June 30, 2004; and the term of the member who is a director of a state community

college nursing program shall expire June 30, 2003.

After the initial appointments expire, the terms of all the members shall be for 3 years, with no member serving more

than two consecutive terms.

(3) The board shall have the following powers and duties:

(a) To employ an executive director.

(b) To determine operational policy.

(c) To elect a chair and officers, to serve 2-year terms. The chair and officers may not succeed themselves.

(d) To establish committees of the board as needed.

(e) To appoint a multidisciplinary advisory council for input and advice on policy matters.

(f) To implement the major functions of the center as established in the goals set out in s. 464.0195.

(g) To seek and accept nonstate funds for sustaining the center and carrying out center policy.

(4) The members of the board are entitled to receive per diem and allowances prescribed by law for state boards

and commissions.


464.0205 Retired volunteer nurse certificate.—

(1) Any retired practical or registered nurse desiring to serve indigent, underserved, or critical need populations

in this state may apply to the department for a retired volunteer nurse certificate by providing:

(a) A complete application.

(b) Verification that the applicant had been licensed to practice nursing in any jurisdiction in the United States

for at least 10 years, had retired or plans to retire, intends to practice nursing only pursuant to the limitations

provided by the retired volunteer nurse certificate, and has not committed any act that would constitute a violation

under s. 464.018(1).

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(c) Proof that the applicant meets the requirements for licensure under s. 464.008 or s. 464.009.

(2) All related administrative costs shall be borne by the applicant.

(3) The board may deny a retired volunteer nurse certificate to any applicant who has committed, or who is

under investigation or prosecution for, any act that would constitute a ground for disciplinary action under s.

464.018.

(4) A retired volunteer nurse receiving certification from the board shall:

(a) Work under the direct supervision of the director of a county health department, a physician working under

a limited license issued pursuant to s. 458.317 or s. 459.0075, a physician licensed under chapter 458 or chapter 459,

an advanced practice registered nurse licensed under s. 464.012, or a registered nurse licensed under s. 464.008 or s.

464.009.

(b) Comply with the minimum standards of practice for nurses and be subject to disciplinary action for

violations of s. 464.018, except that the scope of practice for certified volunteers shall be limited to primary and

preventive health care, or as further defined by board rule.

(c) Work only in a setting for which there are provisions for professional liability coverage for acts or

omissions of the retired volunteer nurse.

(d) Provide services under the certificate only in settings whose sponsors have been approved by the board.

(5) A retired volunteer nurse receiving certification from the board shall not:

(a) Administer controlled substances.

(b) Supervise other nurses.

(c) Receive monetary compensation.

(6) A retired volunteer nurse certified under this section may practice only in board-approved settings in public

agencies or institutions or in nonprofit agencies or institutions meeting the requirements of s. 501(c)(3) of the

Internal Revenue Code, which agencies or institutions are located in areas of critical nursing need as determined by

the board. Determination of underserved areas shall be made by the board after consultation with the Department of

Health, the Department of Children and Families, the Agency for Health Care Administration, and the Department

of Elderly Affairs; however, such determination shall include, but not be limited to, health manpower shortage areas

designated by the United States Department of Health and Human Services. The sponsoring agencies desiring to use

certified retired volunteer nurses shall submit to the board verification of their status under s. 501(c)(3) of the

Internal Revenue Code, the sites at which such volunteer nurses would work, the duties and scope of practice

intended for such volunteer nurses, and the training or skills validation for such volunteer nurses.

(7) The retired volunteer nurse certificate shall be valid for 2 years, and a certificateholder may reapply for a

certificate so long as the certificateholder continues to meet the eligibility requirements of this section. Any

legislatively mandated continuing education on specific topics must be completed by the certificateholder prior to

renewal; otherwise, the provisions of s. 464.013 do not apply.

History.—s. 85, ch. 97-264; s. 101, ch. 2001-277; s. 269, ch. 2014-19; ss. 27, 28, ch. 2016-224; s. 62, ch. 2018-

106.

464.022 Exceptions.—No provision of this part shall be construed to prohibit:

(1) The care of the sick by friends or members of the family without compensation, the incidental care of the

sick by domestic servants, or the incidental care of noninstitutionalized persons by a surrogate family.

(2) Assistance by anyone in the case of an emergency.

10 – 39

(3) The practice of nursing by students enrolled in approved schools of nursing.

(4) The practice of nursing by graduates of prelicensure nursing education programs listed in s. 464.008(1)(c),

pending the result of the first licensing examination for which they are eligible following graduation, provided they

practice under direct supervision of a registered professional nurse. The board shall by rule define what constitutes

direct supervision.

(5) The rendering of services by nursing assistants acting under the direct supervision of a registered

professional nurse.

(6) Any nurse practicing in accordance with the practices and principles of the body known as the Church of

Christ Scientist; nor shall any rule of the board apply to any sanitarium, nursing home, or rest home operated in

accordance with the practices and principles of the body known as the Church of Christ Scientist.

(7) The practice of any legally qualified nurse or licensed attendant of another state who is employed by the

United States Government, or any bureau, division, or agency thereof, while in the discharge of official duties.

(8) Any nurse currently licensed in another state or territory of the United States from performing nursing

services in this state for a period of 60 days after furnishing to the employer satisfactory evidence of current

licensure in another state or territory and having submitted proper application and fees to the board for licensure

prior to employment. If the nurse licensed in another state or territory is relocating to this state pursuant to his or her

military-connected spouse’s official military orders, this period shall be 120 days after furnishing to the employer

satisfactory evidence of current licensure in another state or territory and having submitted proper application and

fees to the board for licensure prior to employment. The board may extend this time for administrative purposes

when necessary.

(9) The rendering of nursing services on a fee-for-service basis, or the reimbursement for nursing services

directly to a nurse rendering such services by any government program, commercial insurance company, hospital or

medical services plan, or any other third-party payor.

(10) The establishment of an independent practice by one or more nurses for the purpose of rendering to

patients nursing services within the scope of the nursing license.

(11) The furnishing of hemodialysis treatments in a patient’s home, using an assistant chosen by the patient,

provided that the assistant is properly trained, as defined by the board by rule, and has immediate telephonic access

to a registered nurse who is licensed pursuant to this part and who has dialysis training and experience.

(12) The practice of nursing by any legally qualified nurse of another state whose employment requires the

nurse to accompany and care for a patient temporarily residing in this state for not more than 30 consecutive days,

provided the patient is not in an inpatient setting, the board is notified prior to arrival of the patient and nurse, the

nurse has the standing physician orders and current medical status of the patient available, and prearrangements with

the appropriate licensed health care providers in this state have been made in case the patient needs placement in an

inpatient setting.

(13) The practice of nursing by individuals enrolled in board-approved remedial courses.


s. 5, ch. 91-156; s. 4, ch. 91-429; s. 86, ch. 97-264; s. 117, ch. 99-397; s. 127, ch. 2000-318; s. 8, ch. 2002-230; s.

10, ch. 2004-230; s. 6, ch. 2010-37.

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464.027 Registered nurse first assistant.—

(1) LEGISLATIVE INTENT.—The purposes of this section are to:

(a) Encourage the use of registered nurse first assistants who meet the qualifications of this section as

“assistants at surgery” by physicians and hospitals to provide quality, cost-effective surgical intervention to health

care recipients in the state.

(b) Provide for reimbursement for the registered nurse first assistant from managed health care agencies, state

agencies, workers’ compensation carriers, and private insurance companies.

(2) DEFINITIONS.—As used in this section, the term:

(a) “Perioperative nursing” means a practice of nursing in which the nurse provides preoperative,

intraoperative, and postoperative nursing care to surgical patients.

(b) “Recognized program” means a program that:

1. Addresses all content of the Association of Operating Room Nurses, Inc. Core Curriculum for the Registered

Nurse First Assistant, and

2. Includes 1 academic year, defined as 45 hours of didactic instruction and 120 hours of clinical internship or

its equivalent of 2 college semesters.

(c) “Registered nurse first assistant” means a person who meets the qualifications listed in this section.

(3) QUALIFICATIONS.—A registered nurse first assistant is any person who:

(a) Is licensed as a registered nurse under this part;

(b) Is certified in perioperative nursing; and

(c) Holds a certificate from, and has successfully completed, a recognized program.

(4) INSTITUTIONAL POWERS.—Each health care institution must establish specific procedures for the

appointment and reappointment of registered nurse first assistant staff members and for granting, renewing, and

revising their clinical privileges.

History.—s. 4, ch. 94-96; s. 129, ch. 2000-318.

10 – 41

PART II

CERTIFIED NURSING ASSISTANTS


464.202 Duties and powers of the board.

464.203 Certified nursing assistants; certification requirement.

464.204 Denial, suspension, or revocation of certification; disciplinary actions.

464.205 Availability of disciplinary records and proceedings.

464.206 Exemption from liability.

464.207 Penalties.

464.208 Background screening information; rulemaking authority.


(1) “Approved training program” means:

(a) A course of training conducted by a public sector or private sector educational center licensed by the

Department of Education to implement the basic curriculum for nursing assistants which is approved by the

Department of Education. Beginning October 1, 2000, the board shall assume responsibility for approval of training

programs under this paragraph.

(b) A training program operated under s. 400.141.

(2) “Board” means the Board of Nursing.

(3) “Certified nursing assistant” means a person who meets the qualifications specified in this part and who is

certified by the board as a certified nursing assistant.

(4) “Department” means the Department of Health.

(5) “Practice of a certified nursing assistant” means providing care and assisting persons with tasks relating to

the activities of daily living. Such tasks are those associated with personal care, maintaining mobility, nutrition and

hydration, toileting and elimination, assistive devices, safety and cleanliness, data gathering, reporting abnormal

signs and symptoms, postmortem care, patient socialization and reality orientation, end-of-life care,

cardiopulmonary resuscitation and emergency care, residents’ or patients’ rights, documentation of nursing-assistant

services, and other tasks that a certified nurse assistant may perform after training beyond that required for initial

certification and upon validation of competence in that skill by a registered nurse. This subsection does not restrict

the ability of any person who is otherwise trained and educated from performing such tasks.

(6) “Registry” means the listing of certified nursing assistants maintained by the board.



464.202 Duties and powers of the board.—The board shall maintain, or contract with or approve another

entity to maintain, a state registry of certified nursing assistants. The registry must consist of the name of each

certified nursing assistant in this state; other identifying information defined by board rule; certification status; the

effective date of certification; other information required by state or federal law; information regarding any crime or

any abuse, neglect, or exploitation as provided under chapter 435; and any disciplinary action taken against the

certified nursing assistant. The registry shall be accessible to the public, the certificateholder, employers, and other

state agencies. The board shall adopt by rule testing procedures for use in certifying nursing assistants and shall

adopt rules regulating the practice of certified nursing assistants and specifying the scope of practice authorized and

10 – 42

the level of supervision required for the practice of certified nursing assistants. The board may contract with or

approve another entity or organization to provide the examination services, including the development and

administration of examinations. The board shall require that the contract provider offer certified nursing assistant

applications via the Internet, and may require the contract provider to accept certified nursing assistant applications

for processing via the Internet. The board shall require the contract provider to provide the preliminary results of the

certified nursing examination on the date the test is administered. The provider shall pay all reasonable costs and

expenses incurred by the board in evaluating the provider’s application and performance during the delivery of

services, including examination services and procedures for maintaining the certified nursing assistant registry.



464.203 Certified nursing assistants; certification requirement.—

(1) The board shall issue a certificate to practice as a certified nursing assistant to any person who demonstrates

a minimum competency to read and write and successfully passes the required background screening pursuant to s.

400.215. If the person has successfully passed the required background screening pursuant to s. 400.215 or s.

408.809 within 90 days before applying for a certificate to practice and the person’s background screening results

are not retained in the clearinghouse created under s. 435.12, the board shall waive the requirement that the applicant

successfully pass an additional background screening pursuant to s. 400.215. The person must also meet one of the

following requirements:

(a) Has successfully completed an approved training program and achieved a minimum score, established by

rule of the board, on the nursing assistant competency examination, which consists of a written portion and skills-

demonstration portion approved by the board and administered at a site and by personnel approved by the

department.

(b) Has achieved a minimum score, established by rule of the board, on the nursing assistant competency

examination, which consists of a written portion and skills-demonstration portion, approved by the board and

administered at a site and by personnel approved by the department and:

1. Has a high school diploma, or its equivalent; or

2. Is at least 18 years of age.

(c) Is currently certified in another state; is listed on that state’s certified nursing assistant registry; and has not

been found to have committed abuse, neglect, or exploitation in that state.

(d) Has completed the curriculum developed under the Enterprise Florida Jobs and Education Partnership Grant

and achieved a minimum score, established by rule of the board, on the nursing assistant competency examination,

which consists of a written portion and skills-demonstration portion, approved by the board and administered at a

site and by personnel approved by the department.

(2) If an applicant fails to pass the nursing assistant competency examination in three attempts, the applicant is

not eligible for reexamination unless the applicant completes an approved training program.

(3) An oral examination shall be administered as a substitute for the written portion of the examination upon

request. The oral examination shall be administered at a site and by personnel approved by the department.

(4) The board shall adopt rules to provide for the initial certification of certified nursing assistants.

(5) Certification as a nursing assistant, in accordance with this part, may be renewed until such time as the

nursing assistant allows a period of 24 consecutive months to pass during which period the nursing assistant fails to

10 – 43

perform any nursing-related services for monetary compensation. When a nursing assistant fails to perform any

nursing-related services for monetary compensation for a period of 24 consecutive months, the nursing assistant

must complete a new training and competency evaluation program or a new competency evaluation program.

(6) A certified nursing assistant shall maintain a current address with the board in accordance with s. 456.035.

(7) A certified nursing assistant shall complete 24 hours of inservice training during each biennium. The

certified nursing assistant shall maintain documentation demonstrating compliance with this subsection.

(8) The department shall renew a certificate upon receipt of the renewal application and imposition of a fee of

not less than $20 and not more than $50 biennially. The department shall adopt rules establishing a procedure for the

biennial renewal of certificates. Any certificate that is not renewed by July 1, 2006, is void.


ch. 2005-62; s. 43, ch. 2010-114; s. 28, ch. 2011-213; s. 14, ch. 2012-73; s. 100, ch. 2012-184; s. 21, ch. 2016-230.


464.204 Denial, suspension, or revocation of certification; disciplinary actions.—

(1) The following acts constitute grounds for which the board may impose disciplinary sanctions as specified in

subsection (2):

(a) Obtaining or attempting to obtain certification or an exemption, or possessing or attempting to possess

certification or a letter of exemption, by bribery, misrepresentation, deceit, or through an error of the board.

(b) Intentionally violating any provision of this chapter, chapter 456, or the rules adopted by the board.

(2) When the board finds any person guilty of any of the grounds set forth in subsection (1), it may enter an

order imposing one or more of the following penalties:

(a) Denial, suspension, or revocation of certification.

(b) Imposition of an administrative fine not to exceed $150 for each count or separate offense.

(c) Imposition of probation or restriction of certification, including conditions such as corrective actions as

retraining or compliance with the department’s impaired practitioner program operated by a consultant as described

in s. 456.076.

(3) The board may, upon the request of a certificateholder, exempt the certificateholder from disqualification of

employment in accordance with chapter 435 and issue a letter of exemption. The board must notify an applicant

seeking an exemption from disqualification from certification or employment of its decision to approve or deny the

request within 30 days after the date the board receives all required documentation.



464.205 Availability of disciplinary records and proceedings.—Pursuant to s. 456.073, any complaint or

record maintained by the department pursuant to the discipline of a certified nursing assistant and any proceeding

held by the board to discipline a certified nursing assistant shall remain open and available to the public.



464.206 Exemption from liability.—If an employer terminates or denies employment to a certified nursing

assistant whose certification is inactive as shown on the certified nursing assistant registry or whose name appears

on a criminal screening report of the Department of Law Enforcement, the employer is not civilly liable for such

termination and a cause of action may not be brought against the employer for damages, regardless of whether the

10 – 44

employee has filed for an exemption from the board under s. 464.204(3). There may not be any monetary liability on

the part of, and a cause of action for damages may not arise against, any licensed facility, its governing board or

members thereof, medical staff, disciplinary board, agents, investigators, witnesses, employees, or any other person

for any action taken in good faith without intentional fraud in carrying out this section.



464.207 Penalties.—It is a misdemeanor of the first degree, punishable as provided under s. 775.082 or s.

775.083, for any person, knowingly or intentionally, to fail to disclose, by false statement, misrepresentation,

impersonation, or other fraudulent means, in any application for voluntary or paid employment or certification

regulated under this part, a material fact used in making a determination as to such person’s qualifications to be an

employee or certificateholder.

History.—s. 204, ch. 99-397; s. 79, ch. 2000-318.


464.208 Background screening information; rulemaking authority.—

(1) The Agency for Health Care Administration shall allow the board to electronically access its background

screening database and records.

(2) An employer, or an agent thereof, may not use criminal records or juvenile records relating to vulnerable

adults for any purpose other than determining if the person meets the requirements of this part. Such records and

information obtained by the board shall remain confidential and exempt from s. 119.07(1).

(3) If the requirements of the Omnibus Budget Reconciliation Act of 1987, as amended, for the certification of

nursing assistants are in conflict with this part, the federal requirements shall prevail for those facilities certified to

provide care under Title XVIII (Medicare) or Title XIX (Medicaid) of the Social Security Act.

History.—s. 204, ch. 99-397; s. 129, ch. 2000-153; s. 79, ch. 2000-318; s. 106, ch. 2000-349; s. 101, ch. 2012-

184.


11 – 1

CHAPTER 415

ADULT PROTECTIVE SERVICES 415.101 Adult Protective Services Act; legislative intent.

415.102 Definitions of terms used in ss. 415.101-415.113.

415.103 Central abuse hotline.

415.1034 Mandatory reporting of abuse, neglect, or exploitation of vulnerable adults; mandatory reports of death.

415.1035 Facility’s duty to inform residents of their right to report abusive, neglectful, or exploitive practices.

415.1036 Immunity.

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

records to state attorney.

415.1045 Photographs, videotapes, and medical examinations; abrogation of privileged communications;

confidential records and documents.

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

415.1051 Protective services interventions when capacity to consent is lacking; nonemergencies; emergencies;

orders; limitations.

415.1052 Interference with investigation or with the provision of protective services.

415.1055 Notification to administrative entities.

415.106 Cooperation by the department and criminal justice and other agencies.

415.107 Confidentiality of reports and records.

415.1071 Release of confidential information.

415.1099 Court and witness fees not allowed.

415.1102 Adult protection teams.

415.1105 Training programs.

415.111 Criminal penalties.

415.1111 Civil actions.

415.1113 Administrative fines for false report of abuse, neglect, or exploitation of a vulnerable adult.

415.1115 Civil actions involving elderly parties; speedy trial.

415.113 Statutory construction; treatment by spiritual means.

415.101 Adult Protective Services Act; legislative intent.—

(1) Sections 415.101-415.113 may be cited as the “Adult Protective Services Act.”

(2) The Legislature recognizes that there are many persons in this state who, because of age or disability, are in

need of protective services. Such services should allow such an individual the same rights as other citizens and, at

the same time, protect the individual from abuse, neglect, and exploitation. It is the intent of the Legislature to

provide for the detection and correction of abuse, neglect, and exploitation through social services and criminal

investigations and to establish a program of protective services for all vulnerable adults in need of them. It is

intended that the mandatory reporting of such cases will cause the protective services of the state to be brought to

bear in an effort to prevent further abuse, neglect, and exploitation of vulnerable adults. In taking this action, the

Legislature intends to place the fewest possible restrictions on personal liberty and the exercise of constitutional

rights, consistent with due process and protection from abuse, neglect, and exploitation. Further, the Legislature

intends to encourage the constructive involvement of families in the care and protection of vulnerable adults.

11 – 2

History.—ss. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, ch. 73-176; s. 1, ch. 77-174; ss. 3, 5, ch. 79-287; s. 15, ch. 79-298; s.

1, ch. 80-293; s. 1, ch. 83-82; s. 61, ch. 85-81; s. 27, ch. 86-220; s. 93, ch. 95-418; s. 1, ch. 2010-31.

415.102 Definitions of terms used in ss. 415.101-415.113.—As used in ss. 415.101-415.113, the term:

(1) “Abuse” means any willful act or threatened act by a relative, caregiver, or household member which causes

or is likely to cause significant impairment to a vulnerable adult’s physical, mental, or emotional health. Abuse

includes acts and omissions.

(2) “Activities of daily living” means functions and tasks for self-care, including ambulation, bathing, dressing,

eating, grooming, toileting, and other similar tasks.

(3) “Alleged perpetrator” means a person who has been named by a reporter as the person responsible for

abusing, neglecting, or exploiting a vulnerable adult.

(4) “Capacity to consent” means that a vulnerable adult has sufficient understanding to make and communicate

responsible decisions regarding the vulnerable adult’s person or property, including whether or not to accept

protective services offered by the department.

(5) “Caregiver” means a person who has been entrusted with or has assumed the responsibility for frequent and

regular care of or services to a vulnerable adult on a temporary or permanent basis and who has a commitment,

agreement, or understanding with that person or that person’s guardian that a caregiver role exists. “Caregiver”

includes, but is not limited to, relatives, household members, guardians, neighbors, and employees and volunteers of

facilities as defined in subsection (9). For the purpose of departmental investigative jurisdiction, the term

“caregiver” does not include law enforcement officers or employees of municipal or county detention facilities or

the Department of Corrections while acting in an official capacity.

(6) “Deception” means a misrepresentation or concealment of a material fact relating to services rendered,

disposition of property, or the use of property intended to benefit a vulnerable adult.

(7) “Department” means the Department of Children and Families.

(8)(a) “Exploitation” means a person who:

1. Stands in a position of trust and confidence with a vulnerable adult and knowingly, by deception or

intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult’s funds, assets, or property with the

intent to temporarily or permanently deprive a vulnerable adult of the use, benefit, or possession of the funds, assets,

or property for the benefit of someone other than the vulnerable adult; or

2. Knows or should know that the vulnerable adult lacks the capacity to consent, and obtains or uses, or

endeavors to obtain or use, the vulnerable adult’s funds, assets, or property with the intent to temporarily or

permanently deprive the vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the

benefit of someone other than the vulnerable adult.

(b) “Exploitation” may include, but is not limited to:

1. Breaches of fiduciary relationships, such as the misuse of a power of attorney or the abuse of guardianship

duties, resulting in the unauthorized appropriation, sale, or transfer of property;

2. Unauthorized taking of personal assets;

3. Misappropriation, misuse, or transfer of moneys belonging to a vulnerable adult from a personal or joint

account; or

4. Intentional or negligent failure to effectively use a vulnerable adult’s income and assets for the necessities

required for that person’s support and maintenance.

11 – 3

(9) “Facility” means any location providing day or residential care or treatment for vulnerable adults. The term

“facility” may include, but is not limited to, any hospital, state institution, nursing home, assisted living facility,

adult family-care home, adult day care center, residential facility licensed under chapter 393, adult day training

center, or mental health treatment center.

(10) “False report” means a report of abuse, neglect, or exploitation of a vulnerable adult to the central abuse

hotline which is not true and is maliciously made for the purpose of:

(a) Harassing, embarrassing, or harming another person;

(b) Personal financial gain for the reporting person;

(c) Acquiring custody of a vulnerable adult; or

(d) Personal benefit for the reporting person in any other private dispute involving a vulnerable adult.

The term “false report” does not include a report of abuse, neglect, or exploitation of a vulnerable adult which is made

in good faith to the central abuse hotline.

(11) “Fiduciary relationship” means a relationship based upon the trust and confidence of the vulnerable adult

in the caregiver, relative, household member, or other person entrusted with the use or management of the property

or assets of the vulnerable adult. The relationship exists where there is a special confidence reposed in one who in

equity and good conscience is bound to act in good faith and with due regard to the interests of the vulnerable adult.

For the purposes of this part, a fiduciary relationship may be formed by an informal agreement between the

vulnerable adult and the other person and does not require a formal declaration or court order for its existence. A

fiduciary relationship includes, but is not limited to, court-appointed or voluntary guardians, trustees, attorneys, or

conservators of a vulnerable adult’s assets or property.

(12) “Guardian” means a person who has been appointed by a court to act on behalf of a person; a preneed

guardian, as provided in chapter 744; or a health care surrogate expressly designated as provided in chapter 765.

(13) “In-home services” means the provision of nursing, personal care, supervision, or other services to

vulnerable adults in their own homes.

(14) “Intimidation” means the communication by word or act to a vulnerable adult that that person will be

deprived of food, nutrition, clothing, shelter, supervision, medicine, medical services, money, or financial support or

will suffer physical violence.

(15) “Lacks capacity to consent” means a mental impairment that causes a vulnerable adult to lack sufficient

understanding or capacity to make or communicate responsible decisions concerning person or property, including

whether or not to accept protective services.

(16) “Neglect” means the failure or omission on the part of the caregiver or vulnerable adult to provide the care,

supervision, and services necessary to maintain the physical and mental health of the vulnerable adult, including, but

not limited to, food, clothing, medicine, shelter, supervision, and medical services, which a prudent person would

consider essential for the well-being of a vulnerable adult. The term “neglect” also means the failure of a caregiver

or vulnerable adult to make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by

others. “Neglect” is repeated conduct or a single incident of carelessness which produces or could reasonably be

expected to result in serious physical or psychological injury or a substantial risk of death.

(17) “Obtains or uses” means any manner of:

(a) Taking or exercising control over property;

(b) Making any use, disposition, or transfer of property;

11 – 4

(c) Obtaining property by fraud, willful misrepresentation of a future act, or false promise; or

(d)1. Conduct otherwise known as stealing; larceny; purloining; abstracting; embezzlement; misapplication;

misappropriation; conversion; or obtaining money or property by false pretenses, fraud, or deception; or

2. Other conduct similar in nature.

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

(19) “Position of trust and confidence” with respect to a vulnerable adult means the position of a person who:

(a) Is a parent, spouse, adult child, or other relative by blood or marriage;

(b) Is a joint tenant or tenant in common;

(c) Has a legal or fiduciary relationship, including, but not limited to, a court-appointed or voluntary guardian,

trustee, attorney, or conservator; or

(d) Is a caregiver or any other person who has been entrusted with or has assumed responsibility for the use or

management of the vulnerable adult’s funds, assets, or property.

(20) “Protective investigation” means acceptance of a report from the central abuse hotline alleging abuse,

neglect, or exploitation as defined in this section; investigation of the report; determination as to whether action by

the court is warranted; and referral of the vulnerable adult to another public or private agency when appropriate.

(21) “Protective investigator” means an authorized agent of the department who receives and investigates

reports of abuse, neglect, or exploitation of vulnerable adults.

(22) “Protective services” means services to protect a vulnerable adult from further occurrences of abuse,

neglect, or exploitation. Such services may include, but are not limited to, protective supervision, placement, and in-

home and community-based services.

(23) “Protective supervision” means those services arranged for or implemented by the department to protect

vulnerable adults from further occurrences of abuse, neglect, or exploitation.

(24) “Psychological injury” means an injury to the intellectual functioning or emotional state of a vulnerable

adult as evidenced by an observable or measurable reduction in the vulnerable adult’s ability to function within that

person’s customary range of performance and that person’s behavior.

(25) “Records” means all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings,

videotapes, or other material, regardless of physical form or characteristics, made or received pursuant to a

protective investigation.

(26) “Sexual abuse” means acts of a sexual nature committed in the presence of a vulnerable adult without that

person’s informed consent. “Sexual abuse” includes, but is not limited to, the acts defined in s. 794.011(1)(h),

fondling, exposure of a vulnerable adult’s sexual organs, or the use of a vulnerable adult to solicit for or engage in

prostitution or sexual performance. “Sexual abuse” does not include any act intended for a valid medical purpose or

any act that may reasonably be construed to be normal caregiving action or appropriate display of affection.

(27) “Victim” means any vulnerable adult named in a report of abuse, neglect, or exploitation.

(28) “Vulnerable adult” means a person 18 years of age or older whose ability to perform the normal activities

of daily living or to provide for his or her own care or protection is impaired due to a mental, emotional, sensory,

long-term physical, or developmental disability or dysfunction, or brain damage, or the infirmities of aging.

(29) “Vulnerable adult in need of services” means a vulnerable adult who has been determined by a protective

investigator to be suffering from the ill effects of neglect not caused by a second party perpetrator and is in need of

protective services or other services to prevent further harm.

11 – 5


1, ch. 80-293; s. 1, ch. 83-82; s. 28, ch. 86-220; s. 29, ch. 87-238; s. 26, ch. 89-294; s. 1, ch. 90-50; s. 44, ch. 90-306;

s. 1, ch. 91-57; s. 35, ch. 95-210; s. 94, ch. 95-418; s. 9, ch. 97-98; s. 127, ch. 97-101; s. 41, ch. 97-264; s. 1, ch. 98-


2010-31; s. 234, ch. 2014-19; s. 28, ch. 2015-31.

415.103 Central abuse hotline.—

(1) The department shall establish and maintain a central abuse hotline that receives all reports made pursuant

to s. 415.1034 in writing or through a single statewide toll-free telephone number. Any person may use the statewide

toll-free telephone number to report known or suspected abuse, neglect, or exploitation of a vulnerable adult at any

hour of the day or night, any day of the week. The central abuse hotline must be operated in such a manner as to

enable the department to:

(a) Accept reports for investigation when there is a reasonable cause to suspect that a vulnerable adult has been

or is being abused, neglected, or exploited.

(b) Determine whether the allegations made by the reporter require an immediate, 24-hour, or next-working-

day response priority.

(c) When appropriate, refer calls that do not allege the abuse, neglect, or exploitation of a vulnerable adult to

other organizations that might better resolve the reporter’s concerns.

(d) Immediately identify and locate prior reports of abuse, neglect, or exploitation through the central abuse

hotline.

(e) Track critical steps in the investigative process to ensure compliance with all requirements for all reports.

(f) Maintain data to facilitate the production of aggregate statistical reports for monitoring patterns of abuse,

neglect, or exploitation.

(g) Serve as a resource for the evaluation, management, and planning of preventive and remedial services for

vulnerable adults who have been subject to abuse, neglect, or exploitation.

(2) Upon receiving an oral or written report of known or suspected abuse, neglect, or exploitation of a

vulnerable adult, the central abuse hotline must determine if the report requires an immediate onsite protective

investigation. For reports requiring an immediate onsite protective investigation, the central abuse hotline must

immediately notify the department’s designated protective investigative district staff responsible for protective

investigations to ensure prompt initiation of an onsite investigation. For reports not requiring an immediate onsite

protective investigation, the central abuse hotline must notify the department’s designated protective investigative

district staff responsible for protective investigations in sufficient time to allow for an investigation to be

commenced within 24 hours. At the time of notification of district staff with respect to the report, the central abuse

hotline must also provide any known information on any previous report concerning a subject of the present report

or any pertinent information relative to the present report or any noted earlier reports. If the report is of known or

suspected abuse of a vulnerable adult by someone other than a relative, caregiver, or household member, the report

shall be immediately transferred to the appropriate county sheriff’s office.

(3) The department shall set standards, priorities, and policies to maximize the efficiency and effectiveness of

the central abuse hotline.

11 – 6


1, ch. 80-293; s. 1, ch. 83-82; s. 67, ch. 86-163; s. 29, ch. 86-220; s. 30, ch. 87-238; s. 16, ch. 88-337; s. 27, ch. 89-

294; s. 2, ch. 90-50; s. 45, ch. 90-306; s. 2, ch. 91-57; s. 14, ch. 91-71; s. 36, ch. 95-210; s. 95, ch. 95-418; s. 27, ch.

2000-349; s. 3, ch. 2010-31.

415.1034 Mandatory reporting of abuse, neglect, or exploitation of vulnerable adults; mandatory reports

of death.—

(1) MANDATORY REPORTING.—

(a) Any person, including, but not limited to, any:

1. Physician, osteopathic physician, medical examiner, chiropractic physician, nurse, paramedic, emergency

medical technician, or hospital personnel engaged in the admission, examination, care, or treatment of vulnerable

adults;

2. Health professional or mental health professional other than one listed in subparagraph 1.;

3. Practitioner who relies solely on spiritual means for healing;

4. Nursing home staff; assisted living facility staff; adult day care center staff; adult family-care home staff;

social worker; or other professional adult care, residential, or institutional staff;

5. State, county, or municipal criminal justice employee or law enforcement officer;

6. Employee of the Department of Business and Professional Regulation conducting inspections of public

lodging establishments under s. 509.032;

7. Florida advocacy council or Disability Rights Florida member or a representative of the State Long-Term

Care Ombudsman Program; or

8. Bank, savings and loan, or credit union officer, trustee, or employee,

who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or

exploited shall immediately report such knowledge or suspicion to the central abuse hotline.

(b) To the extent possible, a report made pursuant to paragraph (a) must contain, but need not be limited to, the

following information:

1. Name, age, race, sex, physical description, and location of each victim alleged to have been abused,

neglected, or exploited.

2. Names, addresses, and telephone numbers of the victim’s family members.

3. Name, address, and telephone number of each alleged perpetrator.

4. Name, address, and telephone number of the caregiver of the victim, if different from the alleged perpetrator.

5. Name, address, and telephone number of the person reporting the alleged abuse, neglect, or exploitation.

6. Description of the physical or psychological injuries sustained.

7. Actions taken by the reporter, if any, such as notification of the criminal justice agency.

8. Any other information available to the reporting person which may establish the cause of abuse, neglect, or

exploitation that occurred or is occurring.

(2) MANDATORY REPORTS OF DEATH.—Any person who is required to investigate reports of abuse,

neglect, or exploitation and who has reasonable cause to suspect that a vulnerable adult died as a result of abuse,

neglect, or exploitation shall immediately report the suspicion to the appropriate medical examiner, to the

appropriate criminal justice agency, and to the department, notwithstanding the existence of a death certificate

signed by a practicing physician. The medical examiner shall accept the report for investigation pursuant to s.

11 – 7

406.11 and shall report the findings of the investigation, in writing, to the appropriate local criminal justice agency,

the appropriate state attorney, and the department. Autopsy reports maintained by the medical examiner are not

subject to the confidentiality requirements provided for in s. 415.107.


2000-318; s. 28, ch. 2000-349; s. 29, ch. 2015-31.

415.1035 Facility’s duty to inform residents of their right to report abusive, neglectful, or exploitive

practices.—The department shall work cooperatively with the Agency for Health Care Administration, the Agency

for Persons with Disabilities, and the Department of Elderly Affairs to ensure that every facility that serves

vulnerable adults informs residents of their right to report abusive, neglectful, or exploitive practices. Each facility

must establish appropriate policies and procedures to facilitate such reporting.


415.1036 Immunity.—

(1) Any person who participates in making a report under s. 415.1034 or participates in a judicial proceeding

resulting therefrom is presumed to be acting in good faith and, unless lack of good faith is shown by clear and

convincing evidence, is immune from any liability, civil or criminal, that otherwise might be incurred or imposed.

This section does not grant immunity, civil or criminal, to any person who is suspected of having abused, neglected,

or exploited, or committed any illegal act upon or against, a vulnerable adult. Further, a resident or employee of a

facility that serves vulnerable adults may not be subjected to reprisal or discharge because of the resident’s or

employee’s actions in reporting abuse, neglect, or exploitation pursuant to s. 415.1034.

(2) Any person who makes a report under s. 415.1034 has a civil cause of action for appropriate compensatory

and punitive damages against any person who causes detrimental changes in the employment status of the reporting

party by reason of the reporting party’s making the report. Any detrimental change made in the residency or

employment status of such a person, such as, but not limited to, discharge, termination, demotion, transfer, or

reduction in pay or benefits or work privileges, or negative evaluations, within 120 days after the report is made

establishes a rebuttable presumption that the detrimental action was retaliatory.

History.—s. 98, ch. 95-418; s. 30, ch. 2000-349.

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

transmittal of records to state attorney.—

(1) The department shall, upon receipt of a report alleging abuse, neglect, or exploitation of a vulnerable adult,

begin within 24 hours a protective investigation of the facts alleged therein. If a caregiver refuses to allow the

department to begin a protective investigation or interferes with the conduct of such an investigation, the appropriate

law enforcement agency shall be contacted for assistance. If, during the course of the investigation, the department

has reason to believe that the abuse, neglect, or exploitation is perpetrated by a second party, the appropriate law

enforcement agency and state attorney shall be orally notified. The department and the law enforcement agency shall

cooperate to allow the criminal investigation to proceed concurrently with, and not be hindered by, the protective

investigation. The department shall make a preliminary written report to the law enforcement agencies within 5

working days after the oral report. The department shall, within 24 hours after receipt of the report, notify the

appropriate Florida local advocacy council, or the State Long-Term Care Ombudsman Program, when appropriate,

that an alleged abuse, neglect, or exploitation perpetrated by a second party has occurred. Notice to the Florida local

advocacy council or the State Long-Term Care Ombudsman Program may be accomplished orally or in writing and

11 – 8

shall include the name and location of the vulnerable adult alleged to have been abused, neglected, or exploited and

the nature of the report.

(2) Upon commencing an investigation, the protective investigator shall inform all of the vulnerable adults and

alleged perpetrators named in the report of the following:

(a) The names of the investigators and identifying credentials from the department.

(b) The purpose of the investigation.

(c) That the victim, the victim’s guardian, the victim’s caregiver, and the alleged perpetrator, and legal counsel

for any of those persons, have a right to a copy of the report at the conclusion of the investigation.

(d) The name and telephone number of the protective investigator’s supervisor available to answer questions.

(e) That each person has the right to obtain his or her own attorney.

Any person being interviewed by a protective investigator may be represented by an attorney, at the person’s own

expense, or may choose to have another person present. The other person present may not be an alleged perpetrator in

any report currently under investigation. Before participating in such interview, the other person present shall execute

an agreement to comply with the confidentiality requirements of ss. 415.101-415.113. The absence of an attorney or

other person does not prevent the department from proceeding with other aspects of the investigation, including

interviews with other persons. In an investigative interview with a vulnerable adult, the protective investigator may

conduct the interview with no other person present.

(3) For each report it receives, the department shall perform an onsite investigation to:

(a) Determine that the person is a vulnerable adult as defined in s. 415.102.

(b) Determine whether the person is a vulnerable adult in need of services, as defined in s. 415.102.

(c) Determine the composition of the family or household, including the name, address, date of birth, social

security number, sex, and race of each person in the household.

(d) Determine whether there is an indication that a vulnerable adult is abused, neglected, or exploited.

(e) Determine the nature and extent of present or prior injuries, abuse, or neglect, and any evidence thereof.

(f) Determine, if possible, the person or persons apparently responsible for the abuse, neglect, or exploitation,

including name, address, date of birth, social security number, sex, and race.

(g) Determine the immediate and long-term risk to each vulnerable adult through utilization of standardized risk

assessment instruments.

(h) Determine the protective, treatment, and ameliorative services necessary to safeguard and ensure the

vulnerable adult’s well-being and cause the delivery of those services.

(4) No later than 60 days after receiving the initial report, the designated protective investigative staff of the

department shall complete the investigation and notify the guardian of the vulnerable adult, the vulnerable adult, and

the caregiver of any recommendations of services to be provided to ameliorate the causes or effects of abuse,

neglect, or exploitation.

(5) Whenever the law enforcement agency and the department have conducted independent investigations, the

law enforcement agency shall, within 5 working days after concluding its investigation, report its findings to the

state attorney and to the department.

(6) Upon receipt of a report which alleges that an employee or agent of the department acting in an official

capacity has committed an act of abuse, neglect, or exploitation, the department shall commence, or cause to be

11 – 9

commenced, a protective investigation and shall notify the state attorney in whose circuit the alleged abuse, neglect,

or exploitation occurred.

(7) With respect to any case of reported abuse, neglect, or exploitation of a vulnerable adult, the department,

when appropriate, shall transmit all relevant reports to the state attorney of the circuit where the incident occurred.

(8) Within 15 days after completion of the state attorney’s investigation of a case reported to him or her

pursuant to this section, the state attorney shall report his or her findings to the department and shall include a

determination of whether or not prosecution is justified and appropriate in view of the circumstances of the specific

case.

(9) The department shall not use a warning, reprimand, or disciplinary action against an employee, found in that

employee’s personnel records, as the sole basis for a finding of abuse, neglect, or exploitation.




2000-263; s. 31, ch. 2000-349; s. 30, ch. 2015-31.

415.1045 Photographs, videotapes, and medical examinations; abrogation of privileged communications;

confidential records and documents.—

(1) PHOTOGRAPHS AND VIDEOTAPES.—

(a) The protective investigator, while investigating a report of abuse, neglect, or exploitation, may take or cause

to be taken photographs and videotapes of the vulnerable adult, and of his or her environment, which are relevant to

the investigation. All photographs and videotapes taken during the course of the protective investigation are

confidential and exempt from public disclosure as provided in s. 415.107.

(b) Any photographs or videotapes made pursuant to this subsection, or copies thereof, must be sent to the

department as soon as possible.

(2) MEDICAL EXAMINATIONS.—

(a) With the consent of the vulnerable adult who has the capacity to consent or the vulnerable adult’s guardian,

or pursuant to s. 415.1051, the department may cause the vulnerable adult to be referred to a licensed physician or

any emergency department in a hospital or health care facility for medical examination, diagnosis, or treatment if

any of the following circumstances exist:

1. The areas of trauma visible on the vulnerable adult indicate a need for medical examination;

2. The vulnerable adult verbally complains or otherwise exhibits signs or symptoms indicating a need for

medical attention as a consequence of suspected abuse, neglect, or exploitation; or

3. The vulnerable adult is alleged to have been sexually abused.

(b) Upon admission to a hospital or health care facility, with the consent of the vulnerable adult who has

capacity to consent or that person’s guardian, or pursuant to s. 415.1051, the medical staff of the facility may

examine, diagnose, or treat the vulnerable adult. If a person who has legal authority to give consent for the provision

of medical treatment to a vulnerable adult has not given or has refused to give such consent, examination and

treatment must be limited to reasonable examination of the patient to determine the medical condition of the patient

and treatment reasonably necessary to alleviate the medical condition or to stabilize the patient pending a

determination by the court of the department’s petition authorizing protective services. Any person may seek an

11 – 10

expedited judicial intervention under rule 5.900 of the Florida Probate Rules concerning medical treatment

procedures.

(c) Medical examination, diagnosis, and treatment provided under this subsection must be paid for by third-

party reimbursement, if available, or by the vulnerable adult, if he or she is able to pay; or, if he or she is unable to

pay, the department shall pay the costs within available emergency services funds.

(d) Reports of examination, diagnosis, and treatment made under this subsection, or copies thereof, must be

sent to the department as soon as possible.

(e) This subsection does not obligate the department to pay for any treatment other than that necessary to

alleviate the immediate presenting problems.

(3) ABROGATION OF PRIVILEGED COMMUNICATIONS.—The privileged quality of communication

between husband and wife and between any professional and the professional’s patient or client, and any other

privileged communication except that between attorney and client or clergy and person, as such communication

relates to both the competency of the witness and to the exclusion of confidential communications, does not apply to

any situation involving known or suspected abuse, neglect, or exploitation of a vulnerable adult and does not

constitute grounds for failure to report as required by s. 415.1034, for failure to cooperate with law enforcement or

the department in its activities under ss. 415.101-415.113, or for failure to give evidence in any judicial or

administrative proceeding relating to abuse, neglect, or exploitation of a vulnerable adult.

(4) MEDICAL, SOCIAL, OR FINANCIAL RECORDS OR DOCUMENTS.—

(a) The protective investigator, while investigating a report of abuse, neglect, or exploitation, must have access

to, inspect, and copy all medical, social, or financial records or documents in the possession of any person,

caregiver, guardian, or facility which are relevant to the allegations under investigation, unless specifically

prohibited by the vulnerable adult who has capacity to consent.

(b) The confidentiality of any medical, social, or financial record or document that is confidential under state

law does not constitute grounds for failure to:

1. Report as required by s. 415.1034;

2. Cooperate with the department in its activities under ss. 415.101-415.113;

3. Give access to such records or documents; or

4. Give evidence in any judicial or administrative proceeding relating to abuse, neglect, or exploitation of a

vulnerable adult.

(5) ACCESS TO RECORDS AND DOCUMENTS.—If any person refuses to allow a law enforcement officer

or the protective investigator to have access to, inspect, or copy any medical, social, or financial record or document

in the possession of any person, caregiver, guardian, or facility which is relevant to the allegations under

investigation, the department may petition the court for an order requiring the person to allow access to the record or

document. The petition must allege specific facts sufficient to show that the record or document is relevant to the

allegations under investigation and that the person refuses to allow access to such record or document. If the court

finds by a preponderance of the evidence that the record or document is relevant to the allegations under

investigation, the court may order the person to allow access to and permit the inspection or copying of the medical,

social, or financial record or document.

(6) WORKING AGREEMENTS.— The department shall enter into working agreements with the

jurisdictionally responsible county sheriff’s office or local police department that will be the lead agency for

11 – 11

conducting any criminal investigation arising from an allegation of abuse, neglect, or exploitation of a vulnerable

adult. The working agreement must specify how the requirements of this chapter will be met. For the purposes of

such agreement, the jurisdictionally responsible law enforcement entity may share Florida criminal history and local

criminal history information that is not otherwise exempt from s. 119.07(1) with the district personnel. A law

enforcement entity entering into such agreement must comply with s. 943.0525. Criminal justice information

provided by the law enforcement entity may be used only for the purposes specified in the agreement and shall be

provided at no charge. Notwithstanding any other provision of law, the Department of Law Enforcement shall

provide to the department electronic access to Florida criminal justice information that is lawfully available and not

exempt from s. 119.07(1), only for the purpose of protective investigations and emergency placement. As a

condition of access to the information, the department shall execute an appropriate user agreement addressing the

access, use, dissemination, and destruction of such information and comply with all applicable laws and rules of the

Department of Law Enforcement.


ch. 2010-102.

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

(1) PROTECTIVE SERVICES WITH CONSENT.—If the department determines through its investigation that

a vulnerable adult demonstrates a need for protective services or protective supervision, the department shall

immediately provide, or arrange for the provision of, protective services or protective supervision, including in-

home services, provided that the vulnerable adult consents. A vulnerable adult in need of services as defined in s.

415.102 shall be referred to the community care for disabled adults program, or to the community care for the

elderly program administered by the Department of Elderly Affairs.

(2) WITHDRAWAL OF CONSENT.—If the vulnerable adult withdraws consent to the receipt of protective

services or protective supervision, the services may not be provided, except pursuant to s. 415.1051.

(3) INTERFERENCE WITH THE PROVISION OF PROTECTIVE SERVICES.—When any person refuses to

allow the provision of protective services to a vulnerable adult who has the capacity to consent to services, the

department shall petition the court for an order enjoining the person from interfering with the provision of protective

services. The petition must allege specific facts sufficient to show that the vulnerable adult is in need of protective

services and that the person refuses to allow the provision of such services. If the court finds by clear and convincing

evidence that the vulnerable adult is in need of protective services and that the person refuses to allow the provision

of such services, the court may issue an order enjoining the person from interfering with the provision of protective

services to the vulnerable adult.


1, ch. 80-293; s. 1, ch. 83-82; s. 31, ch. 86-220; s. 29, ch. 89-294; s. 21, ch. 95-144; s. 37, ch. 95-210; s. 100, ch. 95-

418; s. 3, ch. 98-182; s. 33, ch. 2000-349.

415.1051 Protective services interventions when capacity to consent is lacking; nonemergencies;

emergencies; orders; limitations.—

(1) NONEMERGENCY PROTECTIVE SERVICES INTERVENTIONS.—If the department has reasonable

cause to believe that a vulnerable adult or a vulnerable adult in need of services is being abused, neglected, or

exploited and is in need of protective services but lacks the capacity to consent to protective services, the department

shall petition the court for an order authorizing the provision of protective services.

11 – 12

(a) Nonemergency protective services petition.—The petition must state the name, age, and address of the

vulnerable adult, allege specific facts sufficient to show that the vulnerable adult is in need of protective services and

lacks the capacity to consent to them, and indicate the services needed.

(b) Notice.—Notice of the filing of the petition and a copy of the petition must be given to the vulnerable adult,

to that person’s spouse, guardian, and legal counsel, and, when known, to the adult children or next of kin of the

vulnerable adult. Such notice must be given at least 5 days before the hearing.

(c) Hearing.—

1. The court shall set the case for hearing within 14 days after the filing of the petition. The vulnerable adult

and any person given notice of the filing of the petition have the right to be present at the hearing. The department

must make reasonable efforts to ensure the presence of the vulnerable adult at the hearing.

2. The vulnerable adult has the right to be represented by legal counsel at the hearing. The court shall appoint

legal counsel to represent a vulnerable adult who is without legal representation.

3. The court shall determine whether:

a. Protective services, including in-home services, are necessary.

b. The vulnerable adult lacks the capacity to consent to the provision of such services.

(d) Hearing findings.—If at the hearing the court finds by clear and convincing evidence that the vulnerable

adult is in need of protective services and lacks the capacity to consent, the court may issue an order authorizing the

provision of protective services. If an order for protective services is issued, it must include a statement of the

services to be provided and designate an individual or agency to be responsible for performing or obtaining the

essential services on behalf of the vulnerable adult or otherwise consenting to protective services on behalf of the

vulnerable adult.

(e) Continued protective services.—

1. No more than 60 days after the date of the order authorizing the provision of protective services, the

department shall petition the court to determine whether:

a. Protective services will be continued with the consent of the vulnerable adult pursuant to this subsection;

b. Protective services will be continued for the vulnerable adult who lacks capacity;

c. Protective services will be discontinued; or

d. A petition for guardianship should be filed pursuant to chapter 744.

2. If the court determines that a petition for guardianship should be filed pursuant to chapter 744, the court, for

good cause shown, may order continued protective services until it makes a determination regarding capacity.

3. If the department has a good faith belief that the vulnerable adult lacks the capacity to consent to protective

services, the petition to determine incapacity under s. 744.3201 may be filed by the department. Once the petition is

filed, the department may not be appointed guardian and may not provide legal counsel for the guardian.

(f) Costs.—The costs of services ordered under this section must be paid by the perpetrator if the perpetrator is

financially able to do so; or by third-party reimbursement, if available. If the vulnerable adult is unable to pay for

guardianship, application may be made to the public guardian for public guardianship services, if available.

(2) EMERGENCY PROTECTIVE SERVICES INTERVENTION.—If the department has reasonable cause to

believe that a vulnerable adult is suffering from abuse or neglect that presents a risk of death or serious physical

injury to the vulnerable adult and that the vulnerable adult lacks the capacity to consent to emergency protective

11 – 13

services, the department may take action under this subsection. If the vulnerable adult has the capacity to consent

and refuses consent to emergency protective services, emergency protective services may not be provided.

(a) Emergency entry of premises.—If, upon arrival at the scene of the incident, consent is not obtained for

access to the alleged victim for purposes of conducting a protective investigation under this subsection and the

department has reason to believe that the situation presents a risk of death or serious physical injury, a representative

of the department and a law enforcement officer may forcibly enter the premises. If, after obtaining access to the

alleged victim, it is determined through a personal assessment of the situation that no emergency exists and there is

no basis for emergency protective services intervention under this subsection, the department shall terminate the

emergency entry.

(b) Emergency removal from premises.—If it appears that the vulnerable adult lacks the capacity to consent to

emergency protective services and that the vulnerable adult, from the personal observations of the representative of

the department and specified medical personnel or law enforcement officers, is likely to incur a risk of death or

serious physical injury if such person is not immediately removed from the premises, then the representative of the

department shall transport or arrange for the transportation of the vulnerable adult to an appropriate medical or

protective services facility in order to provide emergency protective services. Law enforcement personnel have a

duty to transport when medical transportation is not available or needed and the vulnerable adult presents a threat of

injury to self or others. If the vulnerable adult’s caregiver or guardian is present, the protective investigator must

seek the caregiver’s or guardian’s consent pursuant to subsection (4) before the vulnerable adult may be removed

from the premises, unless the protective investigator suspects that the vulnerable adult’s caregiver or guardian has

caused the abuse, neglect, or exploitation. The department shall, within 24 hours after providing or arranging for

emergency removal of the vulnerable adult, excluding Saturdays, Sundays, and legal holidays, petition the court for

an order authorizing emergency protective services.

(c) Emergency medical treatment.—If, upon admission to a medical facility, it is the opinion of the medical

staff that immediate medical treatment is necessary to prevent serious physical injury or death, and that such

treatment does not violate a known health care advance directive prepared by the vulnerable adult, the medical

facility may proceed with treatment to the vulnerable adult. If a person with legal authority to give consent for the

provision of medical treatment to a vulnerable adult has not given or has refused to give such consent, examination

and treatment must be limited to reasonable examination of the patient to determine the medical condition of the

patient and treatment reasonably necessary to alleviate the emergency medical condition or to stabilize the patient

pending court determination of the department’s petition authorizing emergency protective services. Any person

may seek an expedited judicial intervention under rule 5.900 of the Florida Probate Rules concerning medical

treatment procedures.

(d) Emergency protective services petition.—A petition filed under this subsection must state the name, age,

and address of the vulnerable adult and allege the facts constituting the emergency protective services intervention

and subsequent removal of the vulnerable adult or provision of in-home services, the facts relating to the capacity of

the vulnerable adult to consent to services, the efforts of the department to obtain consent, and the services needed or

delivered.

(e) Notice.—Notice of the filing of the emergency protective services petition and a copy of the petition must

be given to the vulnerable adult, to that person’s spouse, to that person’s guardian, if any, to legal counsel

11 – 14

representing the vulnerable adult, and, when known, to adult children or next of kin of the vulnerable adult. Such

notice must be given at least 24 hours before any hearing on the petition for emergency protective services.

(f) Hearing.—When emergency removal has occurred under this subsection, a hearing must be held within 4

days after the filing of the emergency protective services petition, excluding Saturday, Sunday, and legal holidays,

to establish reasonable cause for grounds to continue emergency protective services.

1. The court shall determine, by clear and convincing evidence, whether an emergency existed which justified

the emergency protective services intervention, whether the vulnerable adult is in need of emergency protective

services, whether the vulnerable adult lacks the capacity to consent to emergency protective services, and whether:

a. Emergency protective services will continue with the consent of the vulnerable adult;

b. Emergency protective services will continue without the consent of the vulnerable adult; or

c. Emergency protective services will be discontinued.

2. The vulnerable adult has the right to be represented by legal counsel at the hearing. The court shall appoint

legal counsel to represent a vulnerable adult who is without legal representation.

3. The department must make reasonable efforts to ensure the presence of the vulnerable adult at the hearing.

4. If an order to continue emergency protective services is issued, it must state the services to be provided and

designate an individual or agency to be responsible for performing or obtaining the essential services, or otherwise

consenting to protective services on behalf of the vulnerable adult.

(g) Continued emergency protective services.—

1. Not more than 60 days after the date of the order authorizing the provision of emergency protective services,

the department shall petition the court to determine whether:

a. Emergency protective services will be continued with the consent of the vulnerable adult;

b. Emergency protective services will be continued for the vulnerable adult who lacks capacity;

c. Emergency protective services will be discontinued; or

d. A petition should be filed under chapter 744.

2. If it is decided to file a petition under chapter 744, for good cause shown, the court may order continued

emergency protective services until a determination is made by the court.

3. If the department has a good faith belief that the vulnerable adult lacks the capacity to consent to protective

services, the petition to determine incapacity under s. 744.3201 may be filed by the department. Once the petition is

filed, the department may not be appointed guardian and may not provide legal counsel for the guardian.

(h) Costs.—The costs of services ordered under this section must be paid by the perpetrator if the perpetrator is

financially able to do so, or by third-party reimbursement, if available.

(3) PROTECTIVE SERVICES ORDER.—In ordering any protective services under this section, the court shall

adhere to the following limitations:

(a) Only such protective services as are necessary to ameliorate the conditions creating the abuse, neglect, or

exploitation may be ordered, and the court shall specifically designate the approved services in the order of the

court.

(b) Protective services ordered may not include a change of residence, unless the court specifically finds such

action is necessary to ameliorate the conditions creating the abuse, neglect, or exploitation and the court gives

specific approval for such action in the order. Placement may be made to such facilities as adult family-care homes,

11 – 15

assisted living facilities, or nursing homes, or to other appropriate facilities. Placement may not be made to facilities

for the acutely mentally ill, except as provided in chapter 394.

(c) If an order to continue emergency protective services is issued, it must include the designation of an

individual or agency to be responsible for performing or obtaining the essential services on behalf of the vulnerable

adult or otherwise consenting to protective services on behalf of the vulnerable adult.

(4) PROTECTIVE SERVICES INTERVENTIONS WITH CAREGIVER OR GUARDIAN PRESENT.—

(a) When a vulnerable adult who lacks the capacity to consent has been identified as the victim, the protective

investigator must first request consent from the caregiver or guardian, if present, before providing protective

services or protective supervision, unless the protective investigator suspects that the caregiver or guardian has

caused the abuse, neglect, or exploitation.

(b) If the caregiver or guardian agrees to engage or provide services designed to prevent further abuse, neglect,

or exploitation, the department may provide protective supervision.

(c) If the caregiver or guardian refuses to give consent or later withdraws consent to agreed-upon services, or

otherwise fails to provide needed care and supervision, the department may provide emergency protective services

as provided in subsection (2). If emergency protective services are so provided, the department must then petition

the court for an order to provide emergency protective services under subsection (3).

(5) INTERFERENCE WITH COURT-ORDERED PROTECTIVE SERVICES.—When a court order exists

authorizing protective services for a vulnerable adult who lacks capacity to consent and any person interferes with

the provision of such court-ordered protective services, the appropriate law enforcement agency shall enforce the

order of the court.

(6) LIMITATIONS.—This section does not limit in any way the authority of the court or a criminal justice

officer, or any other duly appointed official, to intervene in emergency circumstances under existing statutes. This

section does not limit the authority of any person to file a petition for guardianship under chapter 744.


415.1052 Interference with investigation or with the provision of protective services.—

(1) If, upon arrival of the protective investigator, any person refuses to allow the department to begin a

protective investigation, interferes with the department’s ability to conduct such an investigation, or refuses to give

access to the vulnerable adult, the appropriate law enforcement agency must be contacted to assist the department in

commencing the protective investigation.

(2) When any person refuses to allow the provision of protective services to the vulnerable adult who has the

capacity to consent to services, the department shall petition the court for an order enjoining the person from

interfering with the provision of protective services. The petition must allege specific facts sufficient to show that

the vulnerable adult is in need of protective services and that the person refuses to allow the provision of such

services. If the court finds by clear and convincing evidence that the vulnerable adult is in need of protective

services and that the person refuses to allow the provision of such services, the court may issue an order enjoining

the person from interfering with the provision of protective services to the vulnerable adult.

History.—s. 102, ch. 95-418; s. 35, ch. 2000-349.

415.1055 Notification to administrative entities.—

(1) Upon receipt of a report that alleges that an employee or agent of the department, the Agency for Persons

with Disabilities, or the Department of Elderly Affairs, acting in an official capacity, has committed an act of abuse,

11 – 16

neglect, or exploitation, the department shall notify the state attorney in whose circuit the abuse, neglect, or

exploitation occurred. This notification may be oral or written.

(2) If at any time during a protective investigation the department has reasonable cause to believe that a

vulnerable adult has been abused, neglected, or exploited by another person, the state attorney having jurisdiction in

the county in which the abuse, neglect, or exploitation occurred shall be notified immediately, either orally or in

writing.

(3) If at any time during a protective investigation the department has reasonable cause to believe that a

vulnerable adult has been abused, neglected, or exploited by another person, the appropriate law enforcement

agency shall be immediately notified. Such agency may begin a criminal investigation concurrent with or

independent of the protective investigation of the department. This notification may be oral or written.

(4) If at any time during a protective investigation the department has reasonable cause to believe that abuse,

neglect, or exploitation of a vulnerable adult has occurred within a facility that receives Medicaid funds, the

department shall notify the Medicaid Fraud Control Unit within the Department of Legal Affairs, Office of the

Attorney General, in order that it may begin an investigation concurrent with the protective investigation of the

department. This notification may be oral or written.

(5) If at any time during a protective investigation the department has reasonable cause to believe that an

employee of a facility, as defined in s. 415.102, is the alleged perpetrator of abuse, neglect, or exploitation of a

vulnerable adult, the department shall notify the Agency for Health Care Administration, Division of Health Quality

Assurance, in writing.

(6) If at any time during a protective investigation the department has reasonable cause to believe that

professional licensure violations have occurred, the department shall notify the Division of Medical Quality

Assurance within the Department of Health. This notification must be in writing.

(7) The department shall notify the state attorney having jurisdiction in the county in which the abuse, neglect,

or exploitation occurred if evidence indicates that further criminal investigation is warranted. This notification must

be in writing.

(8) At the conclusion of a protective investigation at a facility, the department shall notify either the Florida

local advocacy council or the State Long-Term Care Ombudsman Program or the long-term care ombudsman

council of the results of the investigation. This notification must be in writing.

(9) When a report involving a guardian of the person or property, or both, is received, the department shall

notify the probate court having jurisdiction over the guardianship, in writing.

(10) When a report has been received and the department has reason to believe that a vulnerable adult resident

of a facility licensed by the Agency for Health Care Administration or the Agency for Persons with Disabilities has

been the victim of abuse, neglect, or exploitation, the department shall provide a copy of its investigation to the

appropriate agency. If the investigation determines that a health professional licensed or certified under the

Department of Health may have abused, neglected, or exploited a vulnerable adult, the department shall also provide

a copy to the Department of Health.


2000-263; s. 36, ch. 2000-349; s. 59, ch. 2006-227; s. 31, ch. 2015-31.

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415.106 Cooperation by the department and criminal justice and other agencies.—

(1) All criminal justice agencies have a duty and responsibility to cooperate fully with the department so as to

enable the department to fulfill its responsibilities under ss. 415.101-415.113. Such duties include, but are not

limited to, forced entry, emergency removal, emergency transportation, and the enforcement of court orders

obtained under ss. 415.101-415.113.

(2) To ensure coordination, communication, and cooperation with the investigation of abuse, neglect, or

exploitation of vulnerable adults, the department shall develop and maintain interprogram agreements or operational

procedures among appropriate departmental programs and the State Long-Term Care Ombudsman Program, the

Florida Statewide Advocacy Council, and other agencies that provide services to vulnerable adults. These

agreements or procedures must cover such subjects as the appropriate roles and responsibilities of the department in

identifying and responding to reports of abuse, neglect, or exploitation of vulnerable adults; the provision of

services; and related coordinated activities.

(3) To the fullest extent possible, the department shall cooperate with and seek cooperation from all appropriate

public and private agencies, including health agencies, educational agencies, social service agencies, courts,

organizations, or programs providing or concerned with human services related to the prevention, identification, or

treatment of abuse, neglect, or exploitation of vulnerable adults.



2000-349; s. 32, ch. 2015-31.

415.107 Confidentiality of reports and records.—

(1) In order to protect the rights of the individual or other persons responsible for the welfare of a vulnerable

adult, all records concerning reports of abuse, neglect, or exploitation of the vulnerable adult, including reports made

to the central abuse hotline, and all records generated as a result of such reports shall be confidential and exempt

from s. 119.07(1) and may not be disclosed except as specifically authorized by ss. 415.101-415.113.

(2) Upon the request of the committee chairperson, access to all records shall be granted to staff of the

legislative committees with jurisdiction over issues and services related to vulnerable adults, or over the department.

All confidentiality provisions that apply to the Department of Children and Families continue to apply to the records

made available to legislative staff under this subsection.

(3) Access to all records, excluding the name of the reporter which shall be released only as provided in

subsection (6), shall be granted only to the following persons, officials, and agencies:

(a) Employees or agents of the department, the Agency for Persons with Disabilities, the Agency for Health

Care Administration, or the Department of Elderly Affairs who are responsible for carrying out protective

investigations, ongoing protective services, or licensure or approval of nursing homes, assisted living facilities, adult

day care centers, adult family-care homes, home care for the elderly, hospices, residential facilities licensed under

chapter 393, or other facilities used for the placement of vulnerable adults.

(b) A criminal justice agency investigating a report of known or suspected abuse, neglect, or exploitation of a

vulnerable adult.

(c) The state attorney of the judicial circuit in which the vulnerable adult resides or in which the alleged abuse,

neglect, or exploitation occurred.

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(d) Any victim, the victim’s guardian, caregiver, or legal counsel, and any person who the department has

determined might be abusing, neglecting, or exploiting the victim.

(e) A court, pursuant to s. 825.1035(4)9h); by subpoena, upon its finding that access to such records may be

necessary for the determination of an issue before the court; however, such access must be limited to inspection in

camera, unless the court determines that public disclosure of the information contained in such records is necessary

for the resolution of an issue then pending before it.

(f) A grand jury, by subpoena, upon its determination that access to such records is necessary in the conduct of

its official business.

(g) Any appropriate official of the Florida advocacy council, State Long-Term Care Ombudsman Program, or

long-term care ombudsman council investigating a report of known or suspected abuse, neglect, or exploitation of a

vulnerable adult.

(h) Any appropriate official of the department, the Agency for Persons with Disabilities, the Agency for Health

Care Administration, or the Department of Elderly Affairs who is responsible for:

1. Administration or supervision of the programs for the prevention, investigation, or treatment of abuse,

neglect, or exploitation of vulnerable adults when carrying out an official function; or

2. Taking appropriate administrative action concerning an employee alleged to have perpetrated abuse, neglect,

or exploitation of a vulnerable adult in an institution.

(i) Any person engaged in bona fide research or auditing. However, information identifying the subjects of the

report must not be made available to the researcher.

(j) Employees or agents of an agency of another state that has jurisdiction comparable to the jurisdiction

described in paragraph (a).

(k) The Public Employees Relations Commission for the sole purpose of obtaining evidence for appeals filed

pursuant to s. 447.207. Records may be released only after deletion of all information that specifically identifies

persons other than the employee.

(l) Any person in the event of the death of a vulnerable adult determined to be a result of abuse, neglect, or

exploitation. Information identifying the person reporting abuse, neglect, or exploitation shall not be released. Any

information otherwise made confidential or exempt by law shall not be released pursuant to this paragraph.

(4) The Department of Health, the Department of Business and Professional Regulation, and the Agency for

Health Care Administration may have access to a report, excluding the name of the reporter, when considering

disciplinary action against a licensee or certified nursing assistant pursuant to allegations of abuse, neglect, or

exploitation.

(5) The department may release to any professional person such information as is necessary for the diagnosis

and treatment of, and service delivery to, a vulnerable adult or the person perpetrating the abuse, neglect, or

exploitation.

(6) The identity of any person reporting abuse, neglect, or exploitation of a vulnerable adult may not be

released, without that person’s written consent, to any person other than employees of the department responsible

for protective services, the central abuse hotline, or the appropriate state attorney or law enforcement agency. This

subsection grants protection only for the person who reported the abuse, neglect, or exploitation and protects only

the fact that the person is the reporter. This subsection does not prohibit the subpoena of a person reporting the

11 – 19

abuse, neglect, or exploitation when deemed necessary by the state attorney or the department to protect a vulnerable

adult who is the subject of a report, if the fact that the person made the report is not disclosed.

(7) For the purposes of this section, the term “access” means a visual inspection or copy of the hard-copy

record maintained in the district.

(8) Information in the central abuse hotline may not be used for employment screening.



s. 30, ch. 89-294; s. 4, ch. 90-50; s. 7, ch. 90-208; s. 47, ch. 90-306; s. 4, ch. 91-57; s. 15, ch. 91-71; ss. 43, 47, ch.

92-58; s. 31, ch. 93-39; s. 15, ch. 93-214; s. 57, ch. 94-218; s. 38, ch. 95-210; s. 106, ch. 95-418; s. 267, ch. 96-406;

s. 1, ch. 98-111; s. 9, ch. 98-182; s. 2, ch. 98-255; s. 41, ch. 98-280; s. 70, ch. 2000-153; s. 25, ch. 2000-263; s. 38,

ch. 2000-349; s. 3, ch. 2006-131; s. 60, ch. 2006-227; s. 235, ch. 2014-19; s. 33, ch. 2015-31.

415.1071 Release of confidential information.—

(1) Any person or organization, including the Department of Children and Families, may petition the court for

an order making public the records of the Department of Children and Families which pertain to investigations of

alleged abuse, neglect, or exploitation of a vulnerable adult. The court shall determine whether good cause exists for

public access to the records sought or a portion thereof. In making this determination, the court shall balance the best

interests of the vulnerable adult who is the focus of the investigation together with the privacy right of other persons

identified in the reports against the public interest. The public interest in access to such records is reflected in s.

119.01(1), and includes the need for citizens to know of and adequately evaluate the actions of the Department of

Children and Families and the court system in providing vulnerable adults of this state with the protections

enumerated in s. 415.101. However, this subsection does not contravene s. 415.107, which protects the name of any

person reporting the abuse, neglect, or exploitation of a vulnerable adult.

(2) In cases involving serious bodily injury to a vulnerable adult, the Department of Children and Families may

petition the court for an order for the immediate public release of records of the department which pertain to the

protective investigation. The petition must be personally served upon the vulnerable adult, the vulnerable adult’s

legal guardian, if any, and any person named as an alleged perpetrator in the report of abuse, neglect, or exploitation.

The court must determine whether good cause exists for the public release of the records sought no later than 24

hours, excluding Saturdays, Sundays, and legal holidays, after the date the department filed the petition with the

court. If the court does not grant or deny the petition within the 24-hour time period, the department may release to

the public summary information including:

(a) A confirmation that an investigation has been conducted concerning the alleged victim.

(b) The dates and brief description of procedural activities undertaken during the department’s investigation.

(c) The date of each judicial proceeding, a summary of each participant’s recommendations made at the judicial

proceeding, and the ruling of the court.

The summary information shall not include the name of, or other identifying information with respect to, any person

identified in any investigation. In making a determination to release confidential information, the court shall balance

the best interests of the vulnerable adult who is the focus of the investigation together with the privacy rights of other

persons identified in the reports against the public interest for access to public records. However, this subsection does

not contravene s. 415.107, which protects the name of any person reporting abuse, neglect, or exploitation of a

vulnerable adult.

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(3) When the court determines that good cause for public access exists, the court shall direct that the department

redact the name of and other identifying information with respect to any person identified in any protective

investigation report until such time as the court finds that there is probable cause to believe that the person identified

committed an act of alleged abuse, neglect, or exploitation.

History.—s. 18, ch. 2004-335; s. 236, ch. 2014-19.

415.1099 Court and witness fees not allowed.—In all proceedings under ss. 415.101-415.113, court fees must

not be charged to the department; to any party to a petition; to any legal custodian of records, documents, or persons;

or to any adult named in a summons. In a proceeding under ss. 415.101-415.113, witness fees are not allowed to the

department; to any party to a petition; to any legal custodian of records, documents, or persons; or to any adult

named in a summons.

History.—s. 108, ch. 95-418.

415.1102 Adult protection teams.—

(1) Subject to an appropriation, the department may develop, maintain, and coordinate the services of one or

more multidisciplinary adult protection teams in each of the districts of the department. As used in this section, the

term “multidisciplinary adult protection team” means a team of two or more persons who are trained in the

prevention, identification, and treatment of abuse of elderly persons, as defined in s. 430.602, or of dependent

persons and who are qualified to provide a broad range of services related to abuse of elderly or dependent persons.

(2) Such teams may be composed of, but need not be limited to:

(a) Psychiatrists, psychologists, or other trained counseling personnel;

(b) Police officers or other law enforcement officers;

(c) Medical personnel who have sufficient training to provide health services;

(d) Social workers who have experience or training in preventing the abuse of elderly or dependent persons;

and

(e) Public and professional guardians as described in part II of chapter 744.

(3) The department shall utilize and convene the teams to supplement the protective services activities of the

protective services program of the department.

(4) This section does not prevent a person from reporting under s. 415.1034 all suspected or known cases of

abuse, neglect, or exploitation of a vulnerable adult. The role of the teams is to support activities of the protective

services program and to provide services deemed by the teams to be necessary and appropriate to abused, neglected,

and exploited vulnerable adults upon referral. Services must be provided with the consent of the vulnerable adult or

that person’s guardian, or through court order.

(5) If an adult protection team is providing certain services to abused, neglected, or exploited vulnerable adults,

other offices and units of the department shall avoid duplicating those services.


2000-349; s. 2, ch. 2003-262; s. 35, ch. 2016-40.

415 .1105 Training programs.—

(1) The department shall, within available resources, provide appropriate preservice and inservice training for

adult protective investigation staff.

(2) Within available resources, the department shall cooperate with other appropriate agencies in developing

and providing preservice and inservice training programs for those persons specified in s. 415.1034(1)(a).

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History.—s. 110, ch. 95-418; s. 65, ch. 2013-18.

415.111 Criminal penalties.—

(1) A person who knowingly and willfully fails to report a case of known or suspected abuse, neglect, or

exploitation of a vulnerable adult, or who knowingly and willfully prevents another person from doing so, commits a

misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.

(2) A person who knowingly and willfully makes public or discloses any confidential information contained in

the central abuse hotline, or in other computer systems, or in the records of any case of abuse, neglect, or

exploitation of a vulnerable adult, except as provided in ss. 415.101-415.113, commits a misdemeanor of the second

degree, punishable as provided in s. 775.082 or s. 775.083.

(3) A person who has custody of records and documents the confidentiality of which is abrogated under s.

415.1045(3) and who refuses to grant access to such records commits a misdemeanor of the second degree,

punishable as provided in s. 775.082 or s. 775.083.

(4) If the department or its authorized agent has determined after its investigation that a report is false, the

department shall, with the consent of the alleged perpetrator, refer the reports to the local law enforcement agency

having jurisdiction for an investigation to determine whether sufficient evidence exists to refer the case for

prosecution for filing a false report as defined in s. 415.102. During the pendency of the investigation by the local

law enforcement agency, the department must notify the local law enforcement agency of, and the local law

enforcement agency must respond to, all subsequent reports concerning the same vulnerable adult in accordance

with s. 415.104 or s. 415.1045. If the law enforcement agency believes that there are indicators of abuse, neglect, or

exploitation, it must immediately notify the department, which must assure the safety of the vulnerable adult. If the

law enforcement agency finds sufficient evidence for prosecution for filing a false report, it must refer the case to

the appropriate state attorney for prosecution.

(5) A person who knowingly and willfully makes a false report of abuse, neglect, or exploitation of a vulnerable

adult, or a person who advises another to make a false report, commits a felony of the third degree, punishable as

provided in s. 775.082 or s. 775.083.

(a) The department shall establish procedures for determining whether a false report of abuse, neglect, or

exploitation of a vulnerable adult has been made and for submitting all identifying information relating to such a

false report to the local law enforcement agency as provided in this subsection and shall report annually to the

Legislature the number of reports referred.

(b) Anyone making a report who is acting in good faith is immune from any liability under this subsection.




96-293; s. 2, ch. 98-111; s. 10, ch. 98-182; s. 40, ch. 2000-349; s. 4, ch. 2002-70.

415.1111 Civil actions.—A vulnerable adult who has been abused, neglected, or exploited as specified in this

chapter has a cause of action against any perpetrator and may recover actual and punitive damages for such abuse,

neglect, or exploitation. The action may be brought by the vulnerable adult, or that person’s guardian, by a person or

organization acting on behalf of the vulnerable adult with the consent of that person or that person’s guardian, or by

the personal representative of the estate of a deceased victim without regard to whether the cause of death resulted

from the abuse, neglect, or exploitation. The action may be brought in any court of competent jurisdiction to enforce

11 – 22

such action and to recover actual and punitive damages for any deprivation of or infringement on the rights of a

vulnerable adult. A party who prevails in any such action may be entitled to recover reasonable attorney’s fees, costs

of the action, and damages. The remedies provided in this section are in addition to and cumulative with other legal

and administrative remedies available to a vulnerable adult. Notwithstanding the foregoing, any civil action for

damages against any licensee or entity who establishes, controls, conducts, manages, or operates a facility licensed

under part II of chapter 400 relating to its operation of the licensed facility shall be brought pursuant to s. 400.023,

or against any licensee or entity who establishes, controls, conducts, manages, or operates a facility licensed under

part I of chapter 429 relating to its operation of the licensed facility shall be brought pursuant to s. 429.29. Such

licensee or entity shall not be vicariously liable for the acts or omissions of its employees or agents or any other third

party in an action brought under this section.


415.1113 Administrative fines for false report of abuse, neglect, or exploitation of a vulnerable adult.—

(1) In addition to any other penalty authorized by this section, chapter 120, or other law, the department may

impose a fine, not to exceed $10,000 for each violation, upon a person who knowingly and willfully makes a false

report of abuse, neglect, or exploitation of a vulnerable adult, or a person who counsels another to make a false

report.

(2) If the department alleges that a person has knowingly and willfully filed a false report with the central abuse

hotline, the department must file a notice of intent that alleges the name, age, and address of the individual; the facts

constituting the allegation that the individual made a false report; and the administrative fine that the department

proposes to impose on the person. Each time that a false report is made constitutes a separate violation.

(3) The notice of intent to impose the administrative fine must be served by certified mail, return receipt

requested, upon the person alleged to have filed the false report and upon the person’s legal counsel, if any.

(4) Any person alleged to have filed the false report is entitled to an administrative hearing under chapter 120

before the imposition of the fine becomes final. The person must request an administrative hearing within 60 days

after receipt of the notice of intent by filing a request with the department. Failure to request an administrative

hearing within 60 days after receipt of the notice of intent constitutes a waiver of the right to a hearing, making the

administrative fine final.

(5) At the hearing, the department must prove by clear and convincing evidence that the person knowingly and

willfully filed a false report with the central abuse hotline. The person has the right to be represented by legal

counsel at the hearing.

(6) In determining the amount of fine to be imposed, if any, the following factors must be considered:

(a) The gravity of the violation, including the probability that serious physical or emotional harm to any person

will result or has resulted, the severity of the actual or potential harm, and the nature of the false allegation.

(b) Actions taken by the false reporter to retract the false report as an element of mitigation, or, in contrast, to

encourage an investigation on the basis of false information.

(c) Any previous false reports filed by the same individual.

(7) A decision by the department, following the administrative hearing, to impose an administrative fine for

filing a false report constitutes final agency action within the meaning of chapter 120. Notice of the imposition of

the administrative fine must be served upon the person and upon the person’s legal counsel, by certified mail, return

receipt requested, and must state that the person may seek judicial review of the administrative fine under s. 120.68.

11 – 23

(8) All amounts collected under this section must be deposited into the Operations and Maintenance Trust Fund

within the Adult Services Program of the department.

(9) A person who is determined to have filed a false report of abuse or neglect is not entitled to confidentiality.

Subsequent to the conclusion of all administrative or other judicial proceedings concerning the filing of a false

report, the name of the false reporter and the nature of the false report must be made public, pursuant to s. 119.01(1).

Such information is admissible in any civil or criminal proceeding.

(10) Any person who makes a report and acts in good faith is immune from any liability under this section and

continues to be entitled to have the confidentiality of his or her identity maintained.


2000-349.

415.1115 Civil actions involving elderly parties; speedy trial.—In a civil action in which a person over the

age of 65 is a party, such party may move the court to advance the trial on the docket. The presiding judge, after

consideration of the age and health of the party, may advance the trial on the docket. The motion may be filed and

served with the initial complaint or at any time thereafter.

History.—s. 1, ch. 91-251; s. 115, ch. 95-418.


415.113 Statutory construction; treatment by spiritual means.—Nothing in ss. 415.101-415.1115 shall be

construed to mean a person is abused, neglected, or in need of emergency or protective services for the sole reason

that the person relies upon and is, therefore, being furnished treatment by spiritual means through prayer alone in

accordance with the tenets and practices of a well-recognized church or religious denomination or organization; nor

shall anything in such sections be construed to authorize, permit, or require any medical care or treatment in

contravention of the stated or implied objection of such person. Such construction does not:

(1) Eliminate the requirement that such a case be reported to the department;

(2) Prevent the department from investigating such a case; or

(3) Preclude a court from ordering, when the health of the individual requires it, the provision of medical

services by a licensed physician or treatment by a duly accredited practitioner who relies solely on spiritual means

for healing in accordance with the tenets and practices of a well-recognized church or religious denomination or

organization.


11 – 24

Notes

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12. Florida Building C

ode Adopted

12 – 1

RULE CHAPTER 61G20-1

FLORIDA BUILDING CODE ADOPTED 61G20-1.001 State Building Code Adopted

61G20-1.002 Alternative Design Method for Screen Enclosure (Repealed)

61G20-1.001 Florida Building Code Adopted.

(1) The Florida Building Code, 5th Edition (2014), as updated by the Florida Building Commission on

November 13, 2014, incorporated herein by reference is hereby adopted as the building code for the State of Florida.

(2) The material incorporated and adopted in subsection (1) is copyrighted material that is available for public

inspection and examination at the Department of State, Administrative Code and Register Section, Room 701, The

Capitol, Tallahassee, Florida 32399-0250, and at the Office of Codes and Standards, 1940 North Monroe Street,

Room 90, Tallahassee, Florida 32399-0772.

(3) Modifications and Amendments. All proposed modifications to the selected base codes and amendments to

the Florida Building Code shall be submitted on the form adopted by reference in subsection 61G20-2.002(4),

F.A.C., that must be completed in full prior to submittal. The text of the proposed modification or amendment must

be provided in legislative format, with underlining indicating where new language is added to the existing provisions

and strikeout indicating where existing language is deleted. Copies of the form may be obtained by writing to the

Office of Codes and Standards, 1940 North Monroe Street, Room 90, Tallahassee, Florida 32399-0772.

Rulemaking Authority 553.73(1), (7) FS. Law Implemented 553.37(1), 553.72, 553.73 FS., Sections 32, 33, 34, 36,

44, 46, 48, Chapter 2005-147, Laws of Florida, Section 1, Chapter 2006-65, Laws of Florida, Section 10, Chapter

2007-1, Laws of Florida. History–New 7-18-90, Amended 3-30-93, 10-17-93, 8-28-95, 9-24-96, 12-26-96, 4-27-97,

10-5-97, 10-14-97, 9-7-00, 11-28-00, 2-7-01, 12-16-01, 6-30-03, 4-3-05, 12-11-05, 12-8-06, 5-21-07, 10-1-08, 2-17-

09, 10-1-09, Formerly 9B-3.047, Amended 11-10-11, Formerly 9N-1.001, Amended 4-25-13, 6-30-15.

61G20-1.002 Alternative Design Method for Screen Enclosure.

Rulemaking Authority Chapter 2012-13, Section 19, Laws of Florida, 553.76, 553.77 FS. Law Implemented Chapter

2012-13, Section 19, Laws of Florida, 553.76, 553.77 FS. History New 4-25-13, Repealed 2-9-16.

12 – 2

FLORIDA BUILDING CODE

SECTION 464 ASSISTED LIVING FACILITIES 464.1 Scope.

Assisted living facilities shall comply with the following design and construction standards as described herein.

Note: Other administrative and programmatic provisions may apply. See Agency of Health Care Administration

(AHCA) Rule 58A-5, Florida Administrative Code and Chapter 400 Part III, Florida Statutes.

464.2 Definitions.

AGENCY. The Agency for Health Care Administration.

AHCA CENTERAL OFFICE. The Assisted Living Unit, Agency for Health Care Administration.

ASSISTED LIVING FACILITY. Any building or buildings, section or distinct part of a building, private home,

boarding home, home for the aged or other residential facility, whether operated for profit or not, which undertakes

through its ownership or management to provide housing, meals and one or more personal services for a period

exceeding 24 hours to one or more adults who are not relatives of the owner or administrator. The following are

exempted from this definition.

1. Any facility, institution, or other place operated by the federal government or any agency of the federal

government.

2. Any facility or part of a facility licensed under Chapter 393, Florida Statutes, or Chapter 394, Florida Statutes.

3. Any facility licensed as an adult family care home under Part VII Chapter 400, Florida Statutes.

4. Any person who provides housing, meals and one or more personal services on a 24-hour basis in the person’s

own home to not more than two adults who do not receive optional state supplementation. The person who provides

the housing, meals, and personal services must own or rent the home and reside therein.

5. Any home or facility approved by the United States Department of Veterans Affairs as a residential care home

wherein care is provided exclusively to three or fewer veterans.

6. Any facility that has been incorporated in this state for 50 years or more on or before July 1, 1983, and the board

of directors of which is nominated or elected by the residents, until the facility is sold or its ownership is transferred;

or any facility, with improvements or additions thereto, which has existed and operated continuously in this state for

60 years or more on or before July 1, 1989, is directly or indirectly owned and operated by a nationally recognized

fraternal organization, is not open to the public, and accepts only its own members and their spouses as residents.

7. Any facility certified under Chapter 651, Florida Statutes, or a retirement community, may provide services

authorized under this section or Part IV of Chapter 400, Florida Statutes to its residents who live in single-family

homes, duplexes, quadruplexes, or apartments located on the campus without obtaining a license to operate an

assisted living facility if residential units within such buildings are used by residents who do not require staff

supervision for that portion of the day when personal services are not being delivered and the owner obtains a home

health license to provide such services. However, any building or distinct part of a building on the campus that is

designated for persons who receive personal services and require supervision beyond that which is available while

such services are being rendered must be licensed in accordance with this section. If a facility provides personal

services to residents who do not otherwise require supervision and the owner is not licensed as a home health

agency, the buildings or distinct parts of buildings where such services are rendered must be licensed under this

section. A resident of a facility that obtains a home health license may contract with a home health agency of his or

her choice, provided that the home health agency provides liability insurance and workers’ compensation coverage

12 – 3

for its employees. Facilities covered by this exemption may establish policies that give residents the option of

contracting for services and care beyond that which is provided by the facility to enable them to age in place. For

purposes of this section, a retirement community consists of a facility licensed under this section or under Part II of

Chapter 400, Florida Statutes, and apartments designed for independent living located on the same campus.

8. Any residential unit for independent living which is located within a facility certified under Chapter 651, Florida

Statutes, or any residential unit which is colocated with a nursing home licensed under Part II of Chapter

400,Florida Statutes, or colocated with a facility licensed under this section in which services are provided through

an outpatient clinic or a nursing home on an outpatient basis.

CAPACITY. The number of residents for which a facility has been licensed to provide residential care.

DEPARTMENT. The Department of Elderly Affairs.

DISTINCT PART. Designated bedrooms or apartments, bathrooms and a living area; or a separately identified

wing, floor or building which includes bedrooms or apartments, bathrooms and a living area. The distinct part may

include a separate dining area, or meals may be served in another part of the facility.

DOEA ASSISTED LIVING PROGRAM. The Assisted Living Program, Department of Elder Affairs.

EXTENDED CONGREGATE CARE. Acts beyond those authorized in subsection (5) that may be performed

pursuant to Part I of Chapter 464, Florida Statutes by persons licensed thereunder while carrying out their

professional duties. The purpose of such services is to enable residents to age in place in a residential environment

despite mental or physical limitations that might otherwise disqualify them from residency in a facility licensed

under this part.

FOOD SERVICE. The storage, preparation, serving and cleaning up of food intended for consumption in a facility

or a formal agreement that meals will be regularly catered by a third party.

PERSONAL SERVICES. Direct physical assistance with or supervision of the activities of daily living and the

self-administration of medication and other similar services which the department may define by rule. Personal

services shall not be construed to mean the provision of medical, nursing, dental or mental health services.

RELATIVE. An individual who is the father, mother, stepfather, stepmother, son, daughter, brother, sister,

grandmother, grandfather, great-grandmother, great-grandfather, grandson, granddaughter, uncle, aunt, first cousin,

nephew, niece, husband, wife, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-

law, stepson, stepdaughter, stepbrother, stepsister, half brother or half sister of an owner or administrator.

RENOVATION. Additions, repairs, restorations or other improvements to the physical plant of the facility within a

five-year period that costs in excess of 50 percent of the value of the building as reported on the tax rolls, excluding

land, before the renovation.

RESIDENT. A person 18 years of age or older, residing in and receiving care from a facility.

RESIDENT’S REPRESENTATIVE OR DESIGNEE. A person other than the owner, or an agent or employee of

the facility, designated in writing by the resident, if legally competent, to receive notice of changes in the contract

executed pursuant to Section 400.424, Florida Statutes; to receive notice of and to participate in meetings between

the resident and the facility owner, administrator or staff concerning the rights of the resident; to assist the resident

in contacting the ombudsman council if the resident has a complaint against the facility; or to bring legal action on

behalf of the resident pursuant to Section 400.429, Florida Statutes.

464.3 Codes and standards for the design and construction of assisted living facilities.

Except as modified and required by this section of the code, Chapter 58A-5, Florida Administrative Code or Chapter

12 – 4

429 Part III, Florida Statutes, all new assisted living facilities and all additions, alterations, or renovations to

existing assisted living facilities with more than 16 licensed beds shall also be in compliance with The Guidelines

for the Design and Construction of Health Care Facilities (The Guidelines) Part I General, and Section 4.1.4

Requirements for Assisted Living of Part 4, Residential Health Care Facilities, incorporated by reference.

464.4 Additional physical plant requirements for assisted living facilities.

In addition to the codes and standards referenced in Section 464.3 of the code, the following minimum essential

facilities shall apply to all new assisted living facilities.

464.4.1

Indoor radon testing as mandated by Section 404.056(5), Florida Statutes, shall be completed by all facilities.

464.4.2 Heating and cooling.

464.4.2.1

When outside temperatures are 65°F (18°C) or below, an indoor temperature of at least 72°F (22°C) shall be

maintained in all areas used by residents during hours when residents are normally awake. During night hours when

residents are asleep, an indoor temperature of at least 68°F (20°C) shall be maintained.

464.4.2.2

During hours when residents are normally awake, mechanical cooling devices, such as electric fans, must be used in

those as are of buildings used by residents when inside temperatures exceed 85°F (29°C) provided outside

temperatures remain below 90°F (32°C). No residents shall be in any inside area that exceeds 90°F (32°C).

However, during daytime hours when outside temperatures exceed 90°F (32°C), and at night, an indoor temperature

of no more than 81°F (27°C) must be maintained in all areas used by residents.

464.4.2.3

Residents who have individually controlled thermostats in their bedrooms or apartments shall be permitted to control

temperatures in those areas.

464.4.3 Common areas.

464.4.3.1

A minimum of 35 square feet (3 m2) of living and dining space per resident, live-in staff and live-in family member

shall be provided except in facilities comprised of apartments. This space shall include living, dining, recreational or

other space designated accessible to all residents, and shall not include bathrooms, corridors, storage space or

screened porches which cannot be adapted for year round use. Facilities with apartments may count the apartment’s

living space square footage as part of the 35-square-footage (3 m2) living and dining space requirement.

Those facilities also serving as adult day care centers must provide an additional 35 square feet (3 m2) of living and

dining space per adult day care client. Excess floor space in residents’ bedrooms or apartments cannot be counted

toward meeting the requirement of 35 square feet (3 m2) of living and dining space requirements for adult day care

participants. Day care participants may not use residents’ bedrooms for resting unless the room is currently vacant.

464.4.3.2

A room, separate from resident bedrooms, shall be provided where residents may read, engage in socialization or

other leisure time activities. Comfortable chairs or sofas shall be provided in this communal area.

464.4.3.3

The dining area shall be furnished to accommodate communal dining.

464.4.4 Bedrooms.

12 – 5

464.4.4.1

Resident sleeping rooms designated for single occupancy shall provide a minimum inside measurement of 80 square

feet (7 m2) of usable floor space. Usable floor space does not include closet space or bathrooms.

464.4.4.2

Resident bedrooms designated for multiple occupancy shall provide a minimum inside measurement of 60 square

feet (6 m2) of usable floor space per room occupant.

464.4.4.3

Resident bedrooms designated for multiple occupancy in facilities newly licensed or renovated six months after

October 17, 1999, shall have a maximum occupancy of two persons.

464.4.4.4

All resident bedrooms shall open directly into a corridor, common use area or to the outside. A resident must be able

to exit his bedroom without having to pass through another bedroom unless the two rooms have been licensed as one

bedroom.

464.4.4.5

All resident bedrooms shall be for the exclusive use of residents. Live-in staff and their family members shall be

provided with sleeping space separate from the sleeping and congregate space required for residents.

464.4.5 Bathrooms.

464.4.5.1

There shall be at least one bathroom with one toilet and sink per six persons, and one bathtub or shower per eight

persons. All residents, all live-in staff and family members, and respite care participants must be included when

calculating the required number of toilets, sinks, bathtubs and showers. All adult day care participants shall be

included when calculating the required number of toilets and sinks.

464.4.5.2

Each bathroom shall have a door in working order to assure privacy. The entry door to bathrooms with a single toilet

shall have a lock which is operable from the inside by the resident with no key needed. A nonlocking door shall be

permitted if the resident’s safety would otherwise be jeopardized.

464.4.5.3

There shall be nonslip safety devices such as bath mats or peel off stickers in the showers and bathtubs of all

facilities. Showers and bathtubs with a nonskid surface require a separate nonskid device only if the surface is worn.

Grab bars shall be required in showers and bathtubs. Grab bars, whether portable or permanent, must be securely

affixed to the floor or adjoining walls. Facilities newly licensed or renovated six months after October 17, 1999 must

have grab bars next to the commode.

464.4.5.4

Sole access to a toilet or bathtub or shower shall not be through another resident’s bedroom, except in apartments

within a facility.

464.4.6 Security.

External boundaries of a facility or a distinct part of a facility, including outside areas, may be secured using egress

control or perimeter control devices if the following conditions are met.

464.4.6.1

The use of the device complies with all lifesafety requirements.

12 – 6

464.4.6.2

Residents residing within a secured area are able to move freely throughout the area, including the resident’s

bedroom or apartment, bathrooms and all common areas, and have access to outdoor areas on a regular basis and as

requested by each resident.

464.4.6.3

Residents capable of entering and exiting without supervision have keys, codes or other mechanisms to exit the

secured area without requiring staff assistance.

464.4.6.4

Staff who provide direct care or who have regular contact with residents residing in secured areas complete Level 1

Alzheimer’s training as described in Rule 58A-5.0191.

464.4.6.5

Pursuant to Section 400.441, Florida Statutes, facilities with 16 or fewer residents shall not be required to maintain

an accessible telephone in each building where residents reside, maintain written staff job descriptions, have awake

night staff or maintain standardized recipes as provided in Rules 58A-5.0182(6)(g), 58A-5.019(2)(e), 58A-

5.019(4)(a) and 58A-5.020(2)(b), respectively.

464.5 Extended congregate care.

464.5.1 Physical site requirements.

Each extended congregate care facility shall provide a homelike physical environment which promotes resident

privacy and independence, including:

464.5.1.1

A private room or apartment, or a semiprivate room or apartment shared with a roommate of the resident’s choice.

The entry door to the room or apartment shall have a lock which is operable from the inside by the resident with no

key needed. The resident shall be provided with a key to the entry door on request. The resident’s service plan may

allow for a nonlocking entry door if the resident’s safety would otherwise be jeopardized.

464.5.1.2

A bathroom, with a toilet, sink and bathtub or shower, which is shared by a maximum of four residents. A centrally

located hydromassage bathtub may substitute for the bathtub or shower in two of the bath rooms. The entry door to

the bathroom shall have a lock which is operable from the inside by the resident with no key needed. The resident’s

service plan may allow for a nonlocking bathroom door if the resident’s safety would otherwise be jeopardized.

13. Rule Chapter

69A-40, F.A

.C.

13 – 1

CHAPTER 69A-40

UNIFORM FIRE SAFETY STANDARDS FOR ASSISTED LIVING FACILITIES 69A-40.022 Title

69A-40.023 Purpose

69A-40.024 Scope


69A-40.028 Standards of the National Fire Protection Association Adopted

69A-40.029 Evacuation Capability Evaluation

69A-40.031 Automatic Fire Sprinkler Systems

69A-40.033 Heating, Ventilating, and Air Conditioning Equipment

69A-40.035 Code Conflict Resolution

69A-40.036 Fire Exit Drills

69A-40.037 Intergenerational Respite Care Assisted Living Facility

69A-40.022 Title.

These rules, comprising Rule Chapter 69A-40, F.A.C., shall be known as “The Uniform Fire Safety Standards for

Assisted Living Facilities.” Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.11, 633.206 FS. History–New 11-29-89, Amended 1-7-97,

Formerly 4A-40.022.

69A-40.023 Purpose.

The purpose of this rule chapter is to establish uniform requirements to provide a reasonable degree of safety from

fire in buildings and structures used as assisted living facilities. These rules try to avoid requirements which might

result in unreasonable hardship, or unnecessary inconvenience or interference with the normal use and occupancy of

a building, but at the same time insist upon compliance with uniform standards for fire safety consistent with the

public interest, even though a financial hardship may result in some individual cases. Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.11, 633.206 FS. History–New 11-29-89, Amended 1-7-97,

Formerly 4A-40.023.

69A-40.024 Scope.

(1) These rules apply to any institution, building, or buildings, residence, private home, boarding home, home

for the aged, or any other place, whether operated for profit or not, which is an assisted living facility under the

definitions of Chapter 429, F.S., and of Chapter 58A-5, F.A.C., and include the intergenerational respite care

assisted living facility created pursuant to Section 429.071, F.S. These rules do not apply to transient rentals, as

defined in Section 212.03, F.S.

(2) These rules are concerned with life safety during fires and similar emergencies. They address particular

matters of construction, protection and occupancy of buildings to try to minimize danger to life from fire, smoke,

fumes, or panic before buildings are vacated. Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.41, 633.206 FS. History–New 11-29-89, Amended 1-7-97,

Formerly 4A-40.024, Amended 1-15-07.

13 – 2


(1) “Administrator” shall mean an individual who has general administrative charge of an assisted living

facility.

(2) “Assisted Living Facility” (ALF) shall be as defined in Section 429.02(5), F.S. The definition does not apply

to transient rentals as defined in Section 509.013(11), F.S. For firesafety purposes, the size of the facility is

determined by the license as issued by the Agency for Health Care Administration.

(3) “Authority having jurisdiction” shall mean the governmental entity, organization, office, or individual

responsible by law or ordinance to conduct and enforce uniform fire safety requirements in accordance with Section

633.206(2)(b), F.S.

(4) “Existing” shall refer to any assisted living facility that has been licensed prior to January 1, 1996.

(5) “Final Administrative Interpreting Authority” shall mean the State Fire Marshal.

(6) “Intergenerational Respite Care Assisted Living Facility” means a facility licensed pursuant to a 5 year pilot

program established by the Agency for Health Care Administration to provide temporary personal, respite, and

custodial care to minors and adults with disabilities and elderly persons with special needs who do not require 24-

hour nursing services, and that provides respite care services for minors and adults with disabilities and elderly

persons with special needs for a period of at least 24 hours but not more than 14 consecutive days, in which minors

and adults reside in distinct and separate living units, with a maximum of 48 beds located in Miami-Dade County,

and is operated as a not-for-profit entity.

(7) “NFPA” is the abbreviation for the National Fire Protection Association.

(8) “Owner” shall refer to the person, partnership, association, or corporation that owns the assisted living

facilities enterprise, whether licensed or not. In the event a facility is operated by a person that leases the physical

plant which is owned by another person, “owner” means the person that operates the facility. When the person that

owns the physical plant is an affiliate of the person that operates the facility and has significant control over the day-

to-day operation for the facility, he is considered an owner of the facility.

(9) “Point of Safety” shall be as defined in Chapter 22 and 23, NFPA 101, Life Safety Code, incorporated by

reference in subsection 69A-40.028(1), F.A.C.

(10)(a) “Satisfactory Firesafety Inspection” shall mean there are no uncorrected firesafety deficiencies in the

facility associated with fire alarm systems, installed fire sprinkler systems, or means of egress/escape components.

For purposes of this definition, firesafety deficiencies associated with maintenance items, such as “an exit light

burned out” or “an electrical wall outlet cover plate missing”, would not be considered as items for an unsatisfactory

firesafety inspection.

(b) Facilities shall be granted a period of time to correct firesafety deficiencies that are determined by the

firesafety authority having jurisdiction citing the deficiencies. The time periods granted shall be based on the risk to

life and property created by the violation and the ease of correction. Those existing facilities that are required to

install fire sprinkler systems shall be granted the time frames specified in Section 429.41(1)(a)2.i., F.S.

(c) During these time frames, the lack of a required fire sprinkler system shall not be grounds for denial of a

“Satisfactory Firesafety Inspection.” Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.41, 633.206 FS. History–New 11-29-89, Amended 1-7-97,

Formerly 4A-40.027, Amended 1-15-07.

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69A-40.028 Standards of the National Fire Protection Association Adopted.

(1) Assisted living facilities shall comply with Chapter 22 or 23, of the “Life Safety Code”, NFPA 101, 1994

Edition, adopted and incorporated herein by reference, except as modified by Chapter 429, F.S.

(2)(a) When Chapters 22 and 23 of NFPA 101 Life Safety Code, 1994 edition, refer to other chapters or

sections of the Code or other NFPA standards, the referenced standard shall be as stated in chapter 32, NFPA 101,

Life Safety Code, 1994 edition, as is adopted and incorporated in subsection (1) above. Those standards are adopted

and incorporated by reference and are as follows:

NFPA 10-1990, Standard for Portable Fire Extinguishers

NFPA 13-1994, Standard for the Installation of Sprinkler Systems

NFPA 13D-1994, Standard for the Installation of Sprinkler Systems in One- and Two-Family Dwellings and

Manufactured Homes

NFPA 13R-1994, Standard for the Installation of Sprinkler Systems in Residential Occupancies up to and including

Four Stories in Height

NFPA 14-1993, Standard for the Installation of Standpipe and Hose Systems

NFPA 25-1992, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems

NFPA 30-1993, Flammable and Combustible Liquids Code

NFPA 31-1992, Standard for the Installation of Oil Burning Equipment

NFPA 40-1988, Standard for the Storage and Handling of Cellulose Nitrate Motion Picture Film

NFPA 45-1991, Standard on Fire Protection for Laboratories Using Chemicals

NFPA 54-1992, National Fuel Gas Code

NFPA 58-1992, Standard for Storage and Handling of Liquefied Petroleum Gases

NFPA 70-1993, National Electrical Code

NFPA 72-1993, National Fire Alarm Code

NFPA 80-1992, Standard for Fire Doors and Fire Windows

NFPA 82-1994, Standard on Incinerators and Waste and Linen Handling Systems and Equipment

NFPA 88A-1991, Standard for Parking Structures

NFPA 90A-1993, Standard for the Installation of Air Conditioning and Ventilating Systems

NFPA 90B-1993, Standard for the Installation of Warm Air Heating and Air Conditioning Systems

NFPA 91-1992, Standard for Exhaust Systems for Air Conveying of Materials

NFPA 96-1994, Standard for Ventilation Control and Fire Prevention of Commercial Cooking Operations

NFPA 99-1993, Standard for Health Care Facilities

NFPA 102-1992, Standard for Assembly Seating, Tents, and Membrane Structures

NFPA 110-1993, Standard for Emergency and Standby Power Systems

NFPA 111-1993, Standard on Stored Electrical Energy Emergency and Standby Power Systems

NFPA 211-1992, Standard for Chimneys, Fireplaces, Vents and Solid Fuel Burning Appliances

NFPA 220-1992, Standard on Types of Building Construction

NFPA 241-1993, Standard for Safeguarding Construction, Alteration, and Demolition Operations

NFPA 251-1990, Standard Methods of Fire Tests of Building Construction and Materials

NFPA 252-1990, Standard Methods of Fire Tests of Door Assemblies

13 – 4

NFPA 253-1990, Standard Methods of Test for Critical Radiant Flux of Floor Covering Systems Using a Radiant

Heat Energy Source

NFPA 255-1990, Standard Method of Test of Surface Burning Characteristics of Building Materials

NFPA 256-1993, Standard Methods of Fire Tests of Roof Coverings

NFPA 257-1990, Standard for Fire Tests of Window Assemblies

NFPA 260-1994, Standard Methods of Tests and Classification Systems for Cigarette Ignition Resistance of

Components of Upholstered Furniture

NFPA 261-1994, Standard Method of Test for Determining Resistance of Mock-Up Upholstered Furniture Material

Assemblies to Ignition by Smoldering Cigarettes

NFPA 265-1994, Standard Methods of Fire Tests for Evaluating Room Fire Growth Contribution of Textile Wall

Coverings

NFPA 701-1989, Standard Methods of Fire Tests for Flame-Resistant Textiles and Films

NFPA 703-1992, Standard for Fire Retardant Impregnated Wood and Fire Retardant Coatings for Building Materials

NFPA 1126-1992, Standard for the Use of Pyrotechnics before a Proximate Audience

(b) The codes and standards published by the National Fire Protection Association may be obtained by writing to the

NFPA at: 1 Batterymarch Park, Quincy, Massachusetts 02269. All standards incorporated by reference in this rule

are also available for public inspection during regular business hours at the Division of Fire Marshal, Larson

Building, 200 East Gaines Street, Tallahassee, Florida.

(3) The Evacuation Capability Evaluation shall be in accordance with chapter 5, NFPA 101A, Guide on

Alternative Approaches to Life Safety, 1995 edition, which is adopted and incorporated herein by reference. Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.11, 633.206 FS. History–New 11-29-89, Amended 1-7-97,

Formerly 4A-40.028.

69A-40.029 Evacuation Capability Evaluation.

(1) The assisted living facility administrator shall conduct an “Evacuation Capability Evaluation” and the local

authority having jurisdiction shall validate the evacuation capability evaluation as required in Section 429.41(1)(a),

F.S. For purposes of this section, “validate” shall mean that the evacuation capability evaluation forms are reviewed

by the local authority having jurisdiction to insure completeness in accordance with Chapter 5, NFPA 101A, Guide

on Alternative Approaches to Life Safety, 1995 edition, as incorporated in subsection 69A-40.028(3), F.A.C.

(2) Existing, licensed, sprinklered ALF’s are not required to conduct an evacuation capability evaluation. The

State Fire Marshal’s office does recommend that evacuation capability be determined using a method acceptable to

the local authority having jurisdiction over fire safety.

(3) Residents shall be permitted to relocate to a “Point of Safety” as defined in subsection 69A-40.027(9),

F.A.C., and as specified in Section 429.41(1)(a)1.a., F.S. Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.11, 429.41(1)(a), 633.206 FS. History–New 11-29-89,

Amended 1-7-97, Formerly 4A-40.029.

69A-40.031 Automatic Fire Sprinkler Systems.

All requirements relating to automatic fire sprinkler systems for assisted living facilities are identified in Section

429.41(1)(a), F.S. Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.11, 429.41(1)(a), 633.206 FS. History–New 11-29-89,

Amended 1-7-97, Formerly 4A-40.031.

13 – 5

69A-40.033 Heating, Ventilating, and Air Conditioning Equipment.

In accordance with the applicable sections of Chapters 22 and 23, NFPA 101, Life Safety Code, 1994 edition, small

facilities (16 or fewer residents) are not required to comply with NFPA 96, Standard on Ventilation Control and Fire

Protection of Commerical Cooking Operations. Large facilities shall comply with NFPA 96. Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.11, 633.206 FS. History–New 11-29-89, Amended 1-7-97,

Formerly 4A-40.033.

69A-40.035 Code Conflict Resolution.

(1) Code enforcement conflict resolution of code issues cited by local government shall be resolved by the local

governmental agency and city and/or county enforcement boards which have been established and identified in

Section 553.73, F.S.

(2) Code enforcement conflict resolution of code issues cited by the Agency for Health Care Administration

(AHCA) should be resolved between the Agency for Health Care Administration and the authority having

jurisdiction.

(3) The State Fire Marshal’s Office is the final administrative interpreting authority and as such will render

interpretations and explanations of the codes. Rulemaking Authority 633.104, 633.206 FS. Law Implemented 429.11, 633.206 FS. History–New 11-29-89, Amended 1-7-97,

Formerly 4A-40.035.

69A-40.036 Fire Exit Drills.

(1) An existing, unsprinklered ALF shall conduct fire exit drills monthly and at least twelve fire drills shall have

been conducted during the previous year (four times per year on each new shift). New facilities with eight or fewer

residents and a “Prompt” evacuation capability evaluation shall follow the above guidelines. If a facility has been in

operation less than one year, it shall be permitted to have conducted a fire drill for each month of its operation.

(2) A new or existing sprinklered ALF shall conduct at least six fire drills per year, one every two months, with

a minimum of two drills conducted during the night when residents are sleeping.

(3) Facilities that are fully sprinklered and in compliance with other firesafety standards are not required to

conduct more than one of the required fire drills between the hours of 11 p.m. and 7 a.m. per year.

(4) Residents shall be permitted to relocate to a “Point of Safety” as defined in subsection 69A-40.027(8),

F.A.C., and as specified in Section 429.41(1)(a), F.S. Rulemaking Authority 633.104, 622.206 FS. Law Implemented 429.11, 633.206 FS. History–New 1-7-97, Formerly 4A-40.036.

69A-40.037 Intergenerational Respite Care Assisted Living Facility.

(1) The living area for any minor, including the available means of egress, shall be on the level of exit

discharge.

(2) Each living area or portion of living area for personal use, comprised of bathrooms, bathing areas, and

sleeping areas serving minors, shall be served by exits separate from those serving other intergenerational respite

care residents.

(3) Any exit designed to serve both minors and adults in any area other than the living area or portion of the

living area for personal use referred to in subsection (2), such as living rooms and dining areas, shall be increased in

size to 1.5 times the minimum required egress width. Rulemaking Authority 633.104, 633.206 FS. Law Implemented, 429.41, 633.206 FS. History–New 1-15-07.

13 – 6

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14. Appendix

Appendix Table of Contents

SECTION APPENDIX

Links to Documents Incorporated in Rule and Resource Websites. . . . . . . . . . . . . . . . . . . . . . . . . . . A

Resident Health Assessment for ALFs – AHCA 1823 Form (March 2017) . . . . . . . . . . . . . . . . . . . . .B

Attestation of Compliance with Background Screening Requirements. . . . . . . . . . . . . . . . . . . . . . . . C

AHCA Consumer Friendly Summary of the Emergency Environmental Control Plan . . . . . . . . . . D

Community Residential Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E

Community Living Support Plan and Cooperative Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F

Health Care Advance Directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .G

Do Not Resuscitate Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H

U.S. FDA Food Code 2013 (specific sections referenced in 64E-11).. . . . . . . . . . . . . . . . . . . . . . . . . . . I

Department of Health Physical Plant Standards Important Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . J

Department of Health Physical Plant Standard Forms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .K

ALF Staff Training Requirements Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .L

A– 1

Appendix A – Documents Incorporated in Rule and Resource Websites

Documents & Links Incorporated in Rule • AHCA Assisted Living Unit (licensing documents and requirements)

www.ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Assisted_Living/alf.shtml

• AHCA Hotline Poster (scroll down to Nursing Home Links and click on “Hotline Poster”)

ahca.myflorida.com/publications/Publications.shtml

• Long-Term Care Ombudsman Residents’ Rights Poster (towards bottom of webpage)

ombudsman.myflorida.com/Publications.php

• Choose My Plate – www.choosemyplate.gov

• Food Code – U.S. Public Health Service https://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/default.htm

• Food Service Establishment Plan Review Form DH8003-DCHP-02/2018

https://www.flrules.org/Gateway/reference.asp?No=Ref-09903

• USDA Dietary Guidelines for Americans, 2010

• https://www.flrules.org/gateway/readRefFile.asp?refId=4003&filename=Rule%205.020%202a%20Dietary%20

Guidelines.pdf

• Application for Sanitation Certificate Form DH 4086 02/18 – can be found at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09902

• Do Not Resuscitate Orders (Must be printed on YELLOW paper) – can be found at http://www.floridahealth.gov/about-the-department-of-health/about-us/patient-rights-and-safety/do-not-

resuscitate/index.html

Useful Resources

• Florida Senior Living Association Website – www.floridaseniorliving.org

• Agency for Health Care Administration (main website) – www.ahca.myflorida.com

• AHCA ALF Aspen State Regulation Set (select assisted living facility)

https://ahca.myflorida.com/MCHQ/Field_Ops/Regulations/Current_Regs.shtml

• AHCA Top Ten Deficiencies (click on report name for the most current year under Facility Surveys

– Most Frequently Cited Health and Life Safety Deficiencies) https://ahca.myflorida.com/Publications/Publications.shtml

• Background Screening Webpage (access the Background Screening Clearinghouse Portal)

ahca.myflorida.com/MCHQ/Central_Services/Background_Screening/index.shtml

• FloridaHealthFinder.gov – http://floridahealthfinder.gov/index.html

• USF ALF Test Registration Link – www.alf.usf.edu

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Appendix B – Resident Health Assessment for ALFS – AHCA 1823 Form (March 2017)

Form can be found at https://www.flrules.org/Gateway/reference.asp?No=Ref-09170

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Appendix C – Attestation of Compliance with Background Screening

Attestation and additional forms can be found on AHCA’s Background Screening webpage at

https://ahca.myflorida.com/MCHQ/Central_Services/Background_Screening/Regulations_Forms.shtml

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Appendix D – AHCA Consumer-Friendly Summary of the Emergency

Environmental Control Plan - It can be found at

http://www.ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Assisted_Living/alf.shtml

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Appendix E – Community Residential Homes

Chapter 419, F.S., Community Residential Homes, requires that applicants meeting certain size and location

criteria comply with notice to the local zoning authority. Facilities can complete the Community Residential Home

Affidavit of Compliance with Chapter 419, Florida Statutes form on the following page once the information has

been verified and obtained from the following agencies.

Verify this information by contacting the following entities.

• Homes licensed by the Agency for Health Care Administration--visit the AHCA website

at http://www.floridahealthfinder.gov*

• Homes licensed by the Department of Children and Families--visit the DCF website

at http://www.dcf.state.fl.us/regions/ to locate the Community Residential Home licensing staff in the

appropriate district.

• Homes licensed by the Agency for Persons with Disabilities--visit the APD website

at http://www.flddresources.org/html/contact_us.htm to locate the APD staff in the appropriate district.

* (Please do not use as the sole source of information for determining distance between community

residential homes.)

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Community Residential Home Affidavit of Compliance Recommended Form – can be found at

http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Hospital_Outpatient/forms/CommResHome

_AffidavitofComplianceWithCh419.pdf

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Appendix F – Community Living Support Plan and Cooperative Agreement Found at http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Assisted_Living/alf.shtml under resources

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Appendix G – Health Care Advance Directives The Patient’s Right to Decide Every competent adult has the right to make decisions concerning his or her own health, including the right to choose or refuse

medical treatment.

When a person becomes unable to make decisions due to a physical or mental change, such as being in a coma or developing dementia

(like Alzheimer’s disease), they are considered incapacitated. Only your primary physician can determine if you are incapacitated. To

make sure that an incapacitated person’s decisions about health care will still be respected, the Florida legislature enacted legislation

pertaining to health care advance directives (Chapter 765, Florida Statutes). The law recognizes the right of a competent adult to

make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures; to designate

another individual to make treatment decisions if the person becomes unable to make his or her own decisions; and/or to indicate the

desire to make an anatomical donation after death. Additionally, the law states that you do not have to be incapacitated to elect a

health care surrogate to make your decisions.

By law hospitals, nursing homes, home health agencies, hospices, and health maintenance organizations (HMOs) are required to

provide their patients with written information, such as this pamphlet, concerning health care advance directives. The state rules that

require this include 58A-2.0232, 59A-3.254, 59A-4.106, 59A-8.0245, and 59A-12.013, Florida Administrative Code.

Questions About Health Care Advance Directives

What is an advance directive?

It is a written or oral statement about how you want medical decisions made should you not be able to make them yourself and/or

it can express your wish to make an anatomical donation after death. Some people make advance directives when they are

diagnosed with a life-threatening illness. Others put their wishes into writing while they are healthy, often as part of their estate

planning.

Three types of advance directives are:

• A Living Will

• A Health Care Surrogate Designation

• An Anatomical Donation

You might choose to complete one, two, or all three of these forms. This pamphlet provides information to help you decide what will

best serve your needs.

What is a living will?

It is a written or oral statement of the kind of medical care you want or do not want if you become unable to make your own

decisions. It is called a living will because it takes effect while you are still living. You may wish to speak to your health care

provider or attorney to be certain you have completed the living will in a way that your wishes will be understood.

What is a health care surrogate designation?

It is a document naming another person as your representative to make medical decisions for you if you are unable to make them

yourself. You can include instructions about any treatment you want or do not want, similar to a living will. You can also

designate an alternate surrogate.

Which is best?

Depending on your individual needs you may wish to complete any one or a combination of the three types of advance directives.

What is an anatomical donation?

It is a document that indicates your wish to donate, at death, all or part of your body. This can be an organ and tissue donation to

persons in need, or donation of your body for training of health care workers. You can indicate your choice to be an organ donor

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by designating it on your driver’s license or state identification card (at your nearest driver’s license office), signing a uniform

donor form (seen elsewhere in this pamphlet), or expressing your wish in a living will.

Am I required to have an advance directive under Florida law?

No, there is no legal requirement to complete an advance directive. However, if you have not made an advance directive,

decisions about your health care or an anatomical donation may be made for you by a court-appointed guardian, your wife or

husband, your adult child, your parent, your adult sibling, an adult relative, or a close friend.

The person making decisions for you may or may not be aware of your wishes. When you make an advance directive, and

discuss it with the significant people in your life, it will better assure that your wishes will be carried out the way you want.

Must an attorney prepare the advance directive?

No, the procedures are simple and do not require an attorney, though you may choose to consult one.

However, an advance directive, whether it is a written document or an oral statement, needs to be witnessed by two

individuals. At least one of the witnesses cannot be a spouse or a blood relative.

Where can I find advance directive forms?

Florida law provides a sample of each of the following forms: a living will, a health care surrogate, and an anatomical

donation. Elsewhere in this pamphlet we have included sample forms as well as resources where you can find more information

and other types of advance directive forms.

Can I change my mind after I write an advance directive?

Yes, you may change or cancel an advance directive at any time. Any changes should be written, signed and dated. However, you

can also change an advance directive by oral statement; physical destruction of the advance directive; or by writing a new

advance directive.

If your driver’s license or state identification card indicates you are an organ donor, but you no longer want this designation, contact

the nearest driver’s license office to cancel the donor designation and a new license or card will be issued to you.

What if I have filled out an advance directive in another state and need treatment in Florida?

An advance directive completed in another state, as described in that state's law, can be honored in Florida.

What should I do with my advance directive if I choose to have one?

• If you designate a health care surrogate and an alternate surrogate be sure to ask them if they agree to take this responsibility,

discuss how you would like matters handled, and give them a copy of the document.

• Make sure that your health care provider, attorney, and the significant persons in your life know that you have an advance

directive and where it is located. You also may want to give them a copy.

• Set up a file where you can keep a copy of your advance directive (and other important paperwork). Some people keep original

papers in a bank safety deposit box. If you do, you may want to keep copies at your house or information concerning the

location of your safety deposit box.

• Keep a card or note in your purse or wallet that states that you have an advance directive and where it is located.

• If you change your advance directive, make sure your health care provider, attorney and the significant persons in your life have

the latest copy.

If you have questions about your advance directive you may want to discuss these with your health care provider, attorney, or the

significant persons in your life.

More Information On Health Care Advance Directives

Before making a decision about advance directives you might want to consider additional options and other sources of information,

including the following:

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• As an alternative to a health care surrogate, or in addition to, you might want to designate a durable power of attorney. Through

a written document you can name another person to act on your behalf. It is similar to a health care surrogate, but the person

can be designated to perform a variety of activities (financial, legal, medical, etc.). You can consult an attorney for further

information or read Chapter 709, Florida Statutes.

If you choose someone as your durable power of attorney be sure to ask the person if he or she will agree to take this

responsibility, discuss how you would like matters handled, and give the person a copy of the document.

• If you are terminally ill (or if you have a loved one who is in a persistent vegetative state) you may want to consider having a

pre-hospital Do Not Resuscitate Order (DNRO). A DNRO identifies people who do not wish to be resuscitated from

respiratory or cardiac arrest. The pre-hospital DNRO is a specific yellow form available from the Florida Department of Health

(DOH). Your attorney, health care provider, or an ambulance service may also have copies available for your use. You, or

your legal representative, and your physician sign the DNRO form. More information is available on the DOH website

or www.MyFlorida.com (type DNRO in these website search engines) or call (850) 245-4440.

When you are admitted to a hospital the pre-hospital DNRO may be used during your hospital stay or the hospital may have its

own form and procedure for documenting a Do Not Resuscitate Order.

• If a person chooses to donate, after death, his or her body for medical training and research the donation will be coordinated by

the Anatomical Board of the State of Florida. You, or your survivors, must arrange with a local funeral home, and pay, for a

preliminary embalming and transportation of the body to the Anatomical Board located in Gainesville, Florida. After being

used for medical education or research, the body will ordinarily be cremated. The cremains will be returned to the loved ones,

if requested at the time of donation, or the Anatomical Board will spread the cremains over the Gulf of Mexico. For further

information contact the Anatomical Board of the State of Florida at (800) 628-2594 or www.med.ufl.edu/anatbd.

• If you would like to learn more on organ and tissue donation, please visit the Joshua Abbott Organ and Tissue Donor Registry

at www.DonateLifeFlorida.org where you can become organ, tissue and eye donors online. If you have further questions about

organ and tissue donation you may want to talk to your health care provider.

• Various organizations also make advance directive forms available. One such document is “Five Wishes” that includes a living

will and a health care surrogate designation. “Five Wishes” gives you the opportunity to specify if you want tube feeding,

assistance with breathing, pain medication, and other details that might bring you comfort such as what kind of music you

might like to hear, among other things. You can find out more at:

Aging with Dignity

www.AgingWithDignity.org

(888) 594-7437

Other resources include:

American Association of Retired Persons (AARP)

www.aarp.org (Type “advance directives” in the website’s search engine)

Your local hospital, nursing home, hospice, home health agency, and your attorney or health care provider may be able to assist

you with forms or further information.

Brochure: End of Life Issues

www.FloridaHealthFinder.gov

(888) 419-3456

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Sample Living Will – can be found at

https://fhfstore.blob.core.windows.net/documents/reports-guides/documents/LivingWill.pdf

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Sample Designation of Health Care Surrogate – can be found at https://fhfstore.blob.core.windows.net/documents/reports-guides/documents/DesignationofHealthCareSurrogate.pdf

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The card below may be used as a convenient method to inform others of your health care advance directives. Complete

the card and cut it out. Place in your wallet or purse. You can also make copies and place another one on your

refrigerator, in your car glove compartment or other easy to find place.

Produced and distributed by the Florida Agency for Health Care Administration. This publication can be copied for public use. To

view or print other publications from the Agency for Health Care Administration please visit www.FloridaHealthFinder.gov.

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Appendix H – Do Not Resuscitate Orders (Must be printed on YELLOW paper) Found at http://www.floridahealth.gov/about-the-department-of-health/about-us/patient-rights-and-safety/do-not-

resuscitate/index.html

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Appendix I – 64E-11 Specific U.S. FDA Food Code 2013 Food Service Establishment Plan Review Form DH8003-DCHP-02/2018 – can be found at

https://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/default.htm

(click on current food code adopted in rule to download entire code)

Applicable sections of the Food Code 2013 referenced in 64E-11, F.A.C.:

Chapter 1

Chapter 2, Sections 2-2 through 2-5

Chapter 3, Section 3-2 through 3-8

Chapter 4

Chapter 5

Chapter 6

Chapter 7

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Food Code 2013 – Chapter 1

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Food Code 2013 – Chapter 2, Sections 2-2 Through 2-5

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Food Code 2013 – Chapter 3, Section 3-2

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Food Code 2013 – Chapter 3, Sections 3-3 Through 3-8

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Food Code 2013 – Chapters 6 & 7

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Appendix J – DOH Physical Plant Standards Important Notice Found at http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Assisted_Living/alf.shtml under resources

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Appendix K – DOH Physical Plant Standards Forms Food Service Establishment Plan Review Form DH8003-DCHP-02/2018 – can be found at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09903 (click on the pdf to download)

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Application for Sanitation Certificate Form DH 4086 02/18 – can be found at

https://www.flrules.org/Gateway/reference.asp?No=Ref-09902 (click on the pdf to download)

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Appendix L – ALF Staff Training Requirements Table

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Assisted Living Resource Guide

Documents

Transcript of Assisted Living Resource Guide