Bill Text: FL S1592 | 2019 | Regular Session | Comm Sub
Bill Title: Assisted Living Facilities
Spectrum: Bipartisan Bill
Status: (Failed) 2019-05-03 - Died in Appropriations, companion bill(s) passed, see CS/SB 184 (Ch. 2019-11) [S1592 Detail]
Download: Florida-2019-S1592-Comm_Sub.html
Florida Senate - 2019 CS for SB 1592 By the Committee on Children, Families, and Elder Affairs; and Senator Harrell 586-04036A-19 20191592c1 1 A bill to be entitled 2 An act relating to assisted living facilities; 3 amending s. 429.02, F.S.; defining and redefining 4 terms; amending s. 429.11, F.S.; prohibiting a county 5 or municipality from issuing a business tax receipt, 6 rather than an occupational license, to an assisted 7 living facility under certain circumstances; amending 8 s. 429.176, F.S.; amending educational requirements 9 for an administrator who is replacing another 10 administrator; amending s. 429.23, F.S.; requiring a 11 facility to initiate an investigation of an adverse 12 incident within 24 hours and provide a report of such 13 investigation to the Agency for Health Care 14 Administration within 15 days; amending s. 429.255, 15 F.S.; authorizing a facility resident or his or her 16 representative to contract with a third party under 17 certain circumstances; amending s. 429.256, F.S.; 18 requiring a person assisting with a resident’s self 19 administration of medication to confirm that the 20 medication is intended for that resident and to orally 21 advise the resident of the medication name and 22 purpose; amending s. 429.26, F.S.; including medical 23 examinations within criteria used for admission to an 24 assisted living facility; providing specified criteria 25 for determinations of appropriateness for admission 26 and continued residency at an assisted living 27 facility; defining the term “bedridden”; requiring 28 that a resident receive a medical examination within a 29 specified timeframe after admission to a facility; 30 requiring that such examination be recorded on a 31 specified form; providing minimum requirements for 32 such form; revising provisions relating to the 33 placement of residents by the Department of Elderly 34 Affairs or the Department of Children and Families; 35 requiring a facility to notify a resident’s 36 representative or designee of the need for health care 37 services and to assist in making appointments for such 38 care and services under certain circumstances; 39 removing provisions relating to the retention of 40 certain residents in a facility; amending s. 429.28, 41 F.S.; revising residents’ rights relating to a safe 42 and secure living environment; amending s. 429.41, 43 F.S.; removing provisions relating to firesafety 44 requirements; removing an obsolete provision; 45 requiring, rather than authorizing, the Agency for 46 Health Care Administration to use an abbreviated 47 biennial standard licensure inspection; revising the 48 criteria under which a facility must be fully 49 inspected; revising provisions requiring the agency to 50 develop key quality-of-care standards; creating s. 51 429.435, F.S.; revising uniform firesafety standards 52 for assisted living facilities, which are relocated to 53 this section; amending s. 429.52, F.S.; revising 54 provisions relating to facility staff training 55 requirements; requiring the Department of Elderly 56 Affairs to establish core training requirements for 57 facility administrators; revising the training and 58 continuing education requirements for facility staff 59 who assist residents with the self-administration of 60 medications; revising provisions relating to the 61 training responsibilities of the Department of Elderly 62 Affairs and the Agency for Health Care Administration; 63 requiring the Department of Elderly Affairs to 64 contract with another entity to administer the 65 competency test; requiring the department to adopt a 66 curriculum outline to be used by core trainers; 67 amending s. 429.07, F.S.; conforming a cross 68 reference; providing an effective date. 69 70 Be It Enacted by the Legislature of the State of Florida: 71 72 Section 1. Present subsections (6) through (27) of section 73 429.02, Florida Statutes, are redesignated as subsections (7) 74 through (28), respectively, present subsections (13), (18), and 75 (27) of that section are amended, and a new subsection (6) is 76 added to that section, to read: 77 429.02 Definitions.—When used in this part, the term: 78 (6) “Assistive device” means any device designed or adapted 79 to help a resident perform an action, a task, an activity of 80 daily living, or a transfer; prevent a fall; or recover from a 81 fall. The term does not include a total body lift or a motorized 82 sit-to-stand lift, with the exception of a chair lift or 83 recliner lift that a resident is able to operate independently. 84 (14)(13)“Limited nursing services” means acts that may be 85 performed by a person licensed under part I of chapter 464. 86 Limited nursing services shall be for persons who meet the 87 admission criteriaestablished by the departmentfor assisted 88 living facilities and shall not be complex enough to require 24 89 hour nursing supervision and may include such services as the 90 application and care of routine dressings, and care of casts, 91 braces, and splints. 92 (19)(18)“Physical restraint” means a device thatwhich93 physically limits, restricts, or deprives an individual of 94 movement or mobility, including,but not limited to,a half-bed95rail, a full-bed rail, a geriatric chair, and a posey restraint.96The term “physical restraint” shall also includeany device that 97 iswhichwasnot specifically manufactured as a restraint but is 98which has beenaltered, arranged, or otherwise used for that 99thispurpose. The term doesshallnot include any device that 100 the resident chooses to use and is able to remove or avoid 101 independently, or any bandage material used for the purpose of 102 binding a wound or injury. 103 (27) “Twenty-four-hour nursing supervision” means services 104 that are ordered by a physician for a resident whose condition 105 requires the supervision of a physician and continued monitoring 106 of vital signs and physical status. Such services shall be: 107 medically complex enough to require constant supervision, 108 assessment, planning, or intervention by a nurse; required to be 109 performed by or under the direct supervision of licensed nursing 110 personnel or other professional personnel for safe and effective 111 performance; required on a daily basis; and consistent with the 112 nature and severity of the resident’s condition or the disease 113 state or stage. 114 Section 2. Subsection (7) of section 429.11, Florida 115 Statutes, is amended to read: 116 429.11 Initial application for license; provisional 117 license.— 118 (7) A county or municipality may not issue a business tax 119 receiptanoccupational licensethat is being obtained for the 120 purpose of operating a facility regulated under this part 121 without first ascertaining that the applicant has been licensed 122 to operate such facility at the specified location or locations 123 by the agency. The agency shall furnish to local agencies 124 responsible for issuing business tax receiptsoccupational125licensessufficient instruction for making such determinations. 126 Section 3. Section 429.176, Florida Statutes, is amended to 127 read: 128 429.176 Notice of change of administrator.—If, during the 129 period for which a license is issued, the owner changes 130 administrators, the owner must notify the agency of the change 131 within 10 days and provide documentation within 90 days that the 132 new administrator meets educational requirements and has 133 completed the applicable core educational and core competency 134 test requirements under s. 429.52. A facility may not be 135 operated for more than 120 consecutive days without an 136 administrator who has completed the core training and core 137 competency testeducationalrequirements. 138 Section 4. Subsections (3) through (9) of section 429.23, 139 Florida Statutes, are amended to read: 140 429.23 Internal risk management and quality assurance 141 program; adverse incidents and reporting requirements.— 142 (3) Licensed facilities shall initiate an investigation 143providewithin 24 hours after1 business day afterthe 144 occurrence of an adverse incident, by electronic mail,145facsimile, or United States mail, a preliminary report to the146agency on all adverse incidents specified under this section. 147 The facility must complete the investigation and submit a report 148 to the agency within 15 days after the occurrence of the adverse 149 incident. The report must include information regarding the 150 identity of the affected resident, the type of adverse incident, 151 and the resultstatusof the facility’s investigation of the 152 incident. 153(4)Licensed facilities shall provide within 15 days, by154electronic mail, facsimile, or United States mail, a full report155to the agency on all adverse incidents specified in this156section. The report must include the results of the facility’s157investigation into the adverse incident.158(5)Each facility shall report monthly to the agency any159liability claim filed against it. The report must include the160name of the resident, the dates of the incident leading to the161claim, if applicable, and the type of injury or violation of162rights alleged to have occurred. This report is not discoverable163in any civil or administrative action, except in such actions164brought by the agency to enforce the provisions of this part.165 (4)(6)Abuse, neglect, or exploitation must be reported to 166 the Department of Children and Families as required under 167 chapter 415. 168 (5)(7)The information reported to the agency pursuant to 169 subsection (3) which relates to persons licensed under chapter 170 458, chapter 459, chapter 461, chapter 464, or chapter 465 shall 171 be reviewed by the agency. The agency shall determine whether 172 any of the incidents potentially involved conduct by a health 173 care professional who is subject to disciplinary action, in 174 which case the provisions of s. 456.073 apply. The agency may 175 investigate, as it deems appropriate, any such incident and 176 prescribe measures that must or may be taken in response to the 177 incident. The agency shall review each incident and determine 178 whether it potentially involved conduct by a health care 179 professional who is subject to disciplinary action, in which 180 case the provisions of s. 456.073 apply. 181 (6)(8)If the agency, through its receipt of the adverse 182 incident reportreportsprescribed in this part or through any 183 investigation, has reasonable belief that conduct by a staff 184 member or employee of a licensed facility is grounds for 185 disciplinary action by the appropriate board, the agency shall 186 report this fact to such regulatory board. 187 (7)(9)The adverse incident reportreports and preliminary188adverse incident reportsrequired under this section isare189 confidential as provided by law and are not discoverable or 190 admissible in any civil or administrative action, except in 191 disciplinary proceedings by the agency or appropriate regulatory 192 board. 193 Section 5. Paragraphs (a) and (b) of subsection (1) of 194 section 429.255, Florida Statutes, are amended, and paragraph 195 (d) is added to that subsection, to read: 196 429.255 Use of personnel; emergency care.— 197 (1)(a) Persons under contract to the facility, facility 198 staff, or volunteers, who are licensed according to part I of 199 chapter 464, or those persons exempt under s. 464.022(1), and 200 others as defined by rule, may administer medications to 201 residents, take residents’ vital signs, manage individual weekly 202 pill organizers for residents who self-administer medication, 203 give prepackaged enemas ordered by a physician, observe 204 residents, document observations on the appropriate resident’s 205 record, and report observations to the resident’s physician, and206contract or allow residents or a resident’s representative,207designee, surrogate, guardian, or attorney in fact to contract208with a third party, provided residents meet the criteria for209appropriate placement as defined in s. 429.26. Nursing 210 assistants certified pursuant to part II of chapter 464 may take 211 residents’ vital signs as directed by a licensed nurse or 212 physician. 213 (b) All staff ofinfacilities licensed under this part 214 shall exercise their professional responsibility to observe 215 residents, to document observations on the appropriate 216 resident’s record, and to report the observations to the 217 resident’s physician. However, the owner or administrator of the 218 facility shall be responsible for determining that the resident 219 receiving services is appropriate for residence in the facility. 220 (d) A resident or a resident’s representative, designee, 221 surrogate, guardian, or attorney in fact may contract for 222 services with a third party, provided the resident meets the 223 criteria for continued residency as provided in s. 429.26. The 224 third party must communicate with the facility regarding the 225 resident’s condition and the services being provided. The 226 facility must document that it received such communication. 227 Section 6. Subsection (2), paragraph (b) of subsection (3), 228 and paragraphs (e), (f), and (g) of subsection (4) of section 229 429.256, Florida Statutes, are amended to read: 230 429.256 Assistance with self-administration of medication.— 231 (2) Residents who are capable of self-administering their 232 own medications without assistance shall be encouraged and 233 allowed to do so. However, an unlicensed person may, consistent 234 with a dispensed prescription’s label or the package directions 235 of an over-the-counter medication, assist a resident whose 236 condition is medically stable with the self-administration of 237 routine, regularly scheduled medications that are intended to be 238 self-administered. Assistance with self-medication by an 239 unlicensed person may occur only upon a documented request by, 240 and the written informed consent of, a resident or the 241 resident’s surrogate, guardian, or attorney in fact. For the 242 purposes of this section, self-administered medications include 243 both legend and over-the-counter oral dosage forms, topical 244 dosage forms and topical skin, ophthalmic, otic, and nasal 245 dosage forms, including patches, solutions, suspensions, sprays, 246 and inhalers. 247 (3) Assistance with self-administration of medication 248 includes: 249 (b) In the presence of the resident, confirming that the 250 medication is intended for that resident, orally advising the 251 resident of the medication name and purposereading the label, 252 opening the container, removing a prescribed amount of 253 medication from the container, and closing the container. 254 (4) Assistance with self-administration does not include: 255 (e) The use of irrigations or debriding agents used in the 256 treatment of a skin condition. 257 (f) Assisting with rectal, urethral, or vaginal 258 preparations. 259 (g) Assisting with medications ordered by the physician or 260 health care professional with prescriptive authority to be given 261 “as needed,” unless the order is written with specific 262 parameters that preclude independent judgment on the part of the 263 unlicensed person, and theat the request of a competent264 resident requesting the medication is aware of his or her need 265 for the medication and understands the purpose of taking the 266 medication. 267 Section 7. Section 429.26, Florida Statutes, is amended to 268 read: 269 429.26 Appropriateness of placements; examinations of 270 residents.— 271 (1) The owner or administrator of a facility is responsible 272 for determining the appropriateness of admission of an 273 individual to the facility and for determining the continued 274 appropriateness of residence of an individual in the facility. A 275 determination mustshallbe based upon an evaluationassessment276 of the strengths, needs, and preferences of the resident, a 277 medical examination, the care and services offered or arranged 278 for by the facility in accordance with facility policy, and any 279 limitations in law or rule related to admission criteria or 280 continued residency for the type of license held by the facility 281 under this part. The following criteria apply to the 282 determination of appropriateness for residency and continued 283 residency of an individual in a facility: 284 (a) A facility may admit or retain a resident who receives 285 a health care service or treatment that is designed to be 286 provided within a private residential setting if all 287 requirements for providing that service or treatment are met by 288 the facility or a third party. 289 (b) A facility may admit or retain a resident who requires 290 the use of assistive devices. 291 (c) A facility may admit or retain an individual receiving 292 hospice services if the arrangement is agreed to by the facility 293 and the resident, additional care is provided by a licensed 294 hospice, and the resident is under the care of a physician who 295 agrees that the physical needs of the resident can be met at the 296 facility. A facility may not retain a resident who requires 24 297 hour nursing supervision, except for a resident who is enrolled 298 in hospice services pursuant to part IV of chapter 400. The 299 resident must have a plan of care that delineates how the 300 facility and the hospice will meet the scheduled and unscheduled 301 needs of the resident. 302 (d)1. Except as provided in paragraph (c), a facility may 303 not admit or retain a resident who is bedridden. For purposes of 304 this paragraph, the term “bedridden” means that a resident is 305 confined to bed because of the inability to: 306 a. Move, turn, or reposition without total physical 307 assistance; 308 b. Transfer to a chair or wheelchair without total physical 309 assistance; 310 c. Sit safely in a chair or wheelchair without personal 311 assistance or a physical restraint. 312 2. A resident may continue to reside in a facility if, 313 during residency, he or she is bedridden for no more than 7 314 consecutive days. 315 3. If a facility is licensed to provide extended congregate 316 care, a resident may continue to reside in a facility if, during 317 residency, he or she is bedridden for no more than 14 318 consecutive days. 319 (2) A resident may not be moved from one facility to 320 another without consultation with and agreement from the 321 resident or, if applicable, the resident’s representative or 322 designee or the resident’s family, guardian, surrogate, or 323 attorney in fact. In the case of a resident who has been placed 324 by the department or the Department of Children and Families, 325 the administrator must notify the appropriate contact person in 326 the applicable department. 327 (3)(2)A physician, physician assistant, or advanced 328 practice registered nursepractitionerwho is employed by an 329 assisted living facility to provide an initial examination for 330 admission purposes may not have financial interest in the 331 facility. 332 (4)(3)Persons licensed under part I of chapter 464 who are 333 employed by or under contract with a facility shall, on a 334 routine basis or at least monthly, perform a nursing assessment 335 of the residents for whom they are providing nursing services 336 ordered by a physician, except administration of medication, and 337 shall document such assessment, including any substantial 338 changes in a resident’s status which may necessitate relocation 339 to a nursing home, hospital, or specialized health care 340 facility. Such records shall be maintained in the facility for 341 inspection by the agency and shall be forwarded to the 342 resident’s case manager, if applicable. 343 (5)(4)If possible,Each resident mustshallhave been 344 examined by a licensed physician, a licensed physician 345 assistant, or a licensed advanced practice registered nurse 346practitionerwithin 60 days before admission to the facility or 347 within 30 days after admission to the facility, except as 348 provided in s. 429.07. The information from the medical 349 examination must be recorded on the practitioner’s form or on a 350 form adopted by agency rule. Thesigned and completedmedical 351 examination form, signed by the practitioner, mustreportshall352 be submitted to the owner or administrator of the facility, who 353 shall use the information contained therein to assist in the 354 determination of the appropriateness of the resident’s admission 355 to orandcontinued stay in the facility. The medical 356 examination form becomesreportshall becomea permanent part of 357 the facility’s record of the residentat the facilityand must 358shallbe made available to the agency during inspection or upon 359 request. An assessment that has been completed through the 360 Comprehensive Assessment and Review for Long-Term Care Services 361 (CARES) Program fulfills the requirements for a medical 362 examination under this subsection and s. 429.07(3)(b)6. 363 (6) The medical examination form submitted under subsection 364 (5) must include the following information relating to the 365 resident: 366 (a) Height, weight, and known allergies. 367 (b) Significant medical history and diagnoses. 368 (c) Physical or sensory limitations, including the need for 369 fall precautions or recommended use of assistive devices. 370 (d) Cognitive or behavioral status and a brief description 371 of any behavioral issues known or ascertained by the examining 372 practitioner, including any known history of wandering or 373 elopement. 374 (e) Nursing, treatment, or therapy service requirements. 375 (f) Whether assistance is needed for ambulating, eating, 376 and transferring. 377 (g) Special dietary instructions. 378 (h) Whether he or she has any communicable diseases, 379 including necessary precautions. 380 (i) Whether he or she is bedridden and the status of any 381 pressure sores that he or she has. 382 (j) Whether the resident needs 24-hour nursing or 383 psychiatric care. 384 (k) A list of current prescribed medications as known or 385 ascertained by the examining practitioner and whether the 386 resident can self-administer medications, needs assistance, or 387 needs medication administration. 388(5)Except as provided in s. 429.07, if a medical389examination has not been completed within 60 days before the390admission of the resident to the facility, a licensed physician,391licensed physician assistant, or licensed nurse practitioner392shall examine the resident and complete a medical examination393form provided by the agency within 30 days following the394admission to the facility to enable the facility owner or395administrator to determine the appropriateness of the admission.396The medical examination form shall become a permanent part of397the record of the resident at the facility and shall be made398available to the agency during inspection by the agency or upon399request.400 (7)(6)Any resident accepted in a facility and placed by 401the department orthe Department of Children and Families must 402shallhave been examined by medical personnel within 30 days 403 before placement in the facility. The examination mustshall404 include an assessment of the appropriateness of placement in a 405 facility. The findings of this examination mustshallbe 406 recorded on the examination form provided by the agency. The 407 completed form mustshallaccompany the resident andshallbe 408 submitted to the facility owner or administrator. Additionally, 409 in the case of a mental health resident, the Department of 410 Children and Families must provide documentation that the 411 individual has been assessed by a psychiatrist, clinical 412 psychologist, clinical social worker, or psychiatric nurse, or 413 an individual who is supervised by one of these professionals, 414 and determined to be appropriate to reside in an assisted living 415 facility. The documentation must be in the facility within 30 416 days after the mental health resident has been admitted to the 417 facility. An evaluation completed upon discharge from a state 418 mental hospital meets the requirements of this subsection 419 related to appropriateness for placement as a mental health 420 resident providing it was completed within 90 days prior to 421 admission to the facility. TheapplicableDepartment of Children 422 and Families shall provide to the facility administrator any 423 information about the resident whichthatwould help the 424 administrator meet his or her responsibilities under subsection 425 (1). Further, Department of Children and Families personnel 426 shall explain to the facility operator any special needs of the 427 resident and advise the operator whom to call should problems 428 arise. TheapplicableDepartment of Children and Families shall 429 advise and assist the facility administrator whenwherethe 430 special needs of residents who are recipients of optional state 431 supplementation require such assistance. 432 (8)(7)The facility shallmustnotify a licensed physician 433 in writing when a resident exhibits signs of dementia or 434 cognitive impairment or has a change of condition in order to 435 rule out the presence of an underlying physiological condition 436 that may be contributing to such dementia or impairment. The 437 notification must occur within 30 days after the acknowledgment 438 of such signs by facility staff. If an underlying condition is 439 determined to exist, the facility must notify the resident’s 440 representative or designee in writing of the need for health 441 care services and must assist in making appointments forshall442arrange, with the appropriate health care provider,the 443 necessary care and services to treat the condition. 444 (9)(8)The Department of Children and Families may require 445 an examination for supplemental security income and optional 446 state supplementation recipients residing in facilities at any 447 time and shall provide the examination whenever a resident’s 448 condition requires it. Any facility administrator; personnel of 449 the agency, the department, or the Department of Children and 450 Families; or a representative of the State Long-Term Care 451 Ombudsman Program who believes a resident needs to be evaluated 452 shall notify the resident’s case manager, who shall take 453 appropriate action. A report of the examination findings must 454shallbe provided to the resident’s case manager and the 455 facility administrator to help the administrator meet his or her 456 responsibilities under subsection (1). 457(9)A terminally ill resident who no longer meets the458criteria for continued residency may remain in the facility if459the arrangement is mutually agreeable to the resident and the460facility; additional care is rendered through a licensed461hospice, and the resident is under the care of a physician who462agrees that the physical needs of the resident are being met.463 (10) Facilities licensed to provide extended congregate 464 care services shall promote aging in place by determining 465 appropriateness of continued residency based on a comprehensive 466 review of the resident’s physical and functional status; the 467 ability of the facility, family members, friends, or any other 468 pertinent individuals or agencies to provide the care and 469 services required; and documentation that a written service plan 470 consistent with facility policy has been developed and 471 implemented to ensure that the resident’s needs and preferences 472 are addressed. 473(11)No resident who requires 24-hour nursing supervision,474except for a resident who is an enrolled hospice patient475pursuant to part IV of chapter 400, shall be retained in a476facility licensed under this part.477 Section 8. Paragraphs (a) and (k) of subsection (1) and 478 subsection (3) of section 429.28, Florida Statutes, are amended 479 to read: 480 429.28 Resident bill of rights.— 481 (1) No resident of a facility shall be deprived of any 482 civil or legal rights, benefits, or privileges guaranteed by 483 law, the Constitution of the State of Florida, or the 484 Constitution of the United States as a resident of a facility. 485 Every resident of a facility shall have the right to: 486 (a) Live in a safe and decent living environment, free from 487 abuse, exploitation, and neglect. 488 (k) At least 45 days’ notice of relocation or termination 489 of residency from the facility unless, for medical reasons, the 490 resident is certified by a physician to require an emergency 491 relocation to a facility providing a more skilled level of care 492 or the resident engages in a pattern of conduct that is harmful 493 or offensive to other residents. In the case of a resident who 494 has been adjudicated mentally incapacitated, the guardian shall 495 be given at least 45 days’ notice of a nonemergency relocation 496 or residency termination. Reasons for relocation mustshallbe 497 set forth in writing and provided to the resident or the 498 resident’s legal representative. The written notice must contain 499 the following disclosure in 12-point uppercase type: 500 THE STATE LONG-TERM CARE OMBUDSMAN PROGRAM PROVIDES 501 SERVICES THAT ASSIST IN PROTECTING THE HEALTH, SAFETY, 502 WELFARE, AND RIGHTS OF RESIDENTS. FOR ASSISTANCE, 503 CONTACT THE OMBUDSMAN PROGRAM TOLL-FREE AT 1-888-831 504 0404 OR VIA E-MAIL AT LTCOPInformer@elderaffairs.org. 505 In order for a facility to terminate the residency of an 506 individual without notice as provided herein, the facility shall 507 show good cause in a court of competent jurisdiction. 508 (3)(a) The agency shall conduct a survey to determine 509 general compliance withfacility standards and compliance with510 residents’ rights as a prerequisite to initial licensure or 511 licensure renewal.The agency shall adopt rules for uniform512standards and criteria that will be used to determine compliance513with facility standards and compliance with residents’ rights.514 (b) In order to determine whether the facility is 515 adequately protecting residents’ rights, the licensure renewal 516biennialsurvey mustshallinclude private informal 517 conversations with a sample of residents and consultation with 518 the ombudsman council in the district in which the facility is 519 located to discuss residents’ experiences within the facility. 520 Section 9. Section 429.41, Florida Statutes, is amended to 521 read: 522 429.41 Rules establishing standards.— 523 (1) It is the intent of the Legislature that rules 524 published and enforced pursuant to this section shall include 525 criteria by which a reasonable and consistent quality of 526 resident care and quality of life may be ensured and the results 527 of such resident care may be demonstrated. Such rules shall also 528 promoteensurea safe and sanitary environment that is 529 residential and noninstitutional in design or nature and may 530 allow for technological advances in the provision of care, 531 safety, and security, including the use of devices, equipment 532 and other security measures related to wander management, 533 emergency response, staff risk management, and the general 534 safety and security of residents, staff, and the facility. It is 535 further intended that reasonable efforts be made to accommodate 536 the needs and preferences of residents to enhance the quality of 537 life in a facility.Uniform firesafety standards for assisted538living facilities shall be established by the State Fire Marshal539pursuant to s. 633.206.The agency, in consultation with the 540 department, may adopt rules to administer the requirements of 541 part II of chapter 408.In order to provide safe and sanitary542facilities and the highest quality of resident care543accommodating the needs and preferences of residents,The 544 department, in consultation with the agency, the Department of 545 Children and Families, and the Department of Health, shall adopt 546 rules, policies, and proceduresto administer this part, which 547 must include reasonable and fair minimum standards in relation 548 to: 549 (a) The requirements forandmaintenance and the sanitary 550 condition of facilities, not in conflict with, or duplicative 551 of, the requirements in chapter 553 or chapter 381, relating to 552 furnishings for resident bedrooms or sleeping areas, locking 553 devices, linens, laundry servicesplumbing, heating, cooling,554lighting, ventilation, living space, and similar physical plant 555 standardsother housing conditions, which will promoteensure556 the health, safety, and welfarecomfortof residents suitable to 557 the size of the structure. The rules must clearly delineate the 558 respective responsibilities of the agency’s licensure and survey 559 staff and the county health departments and ensure that 560 inspections are not duplicative. The agency may collect fees for 561 food service inspections conducted by county health departments 562 and may transfer such fees to the Department of Health. 5631.Firesafety evacuation capability determination.—An564evacuation capability evaluation for initial licensure shall be565conducted within 6 months after the date of licensure.5662.Firesafety requirements.—567a.The National Fire Protection Association, Life Safety568Code, NFPA 101 and 101A, current editions, shall be used in569determining the uniform firesafety code adopted by the State570Fire Marshal for assisted living facilities, pursuant to s.571633.206.572b.A local government or a utility may charge fees only in573an amount not to exceed the actual expenses incurred by the574local government or the utility relating to the installation and575maintenance of an automatic fire sprinkler system in a licensed576assisted living facility structure.577c.All licensed facilities must have an annual fire578inspection conducted by the local fire marshal or authority579having jurisdiction.580d.An assisted living facility that is issued a building581permit or certificate of occupancy before July 1, 2016, may at582its option and after notifying the authority having583jurisdiction, remain under the provisions of the 1994 and 1995584editions of the National Fire Protection Association, Life585Safety Code, NFPA 101, and NFPA 101A. The facility opting to586remain under such provisions may make repairs, modernizations,587renovations, or additions to, or rehabilitate, the facility in588compliance with NFPA 101, 1994 edition, and may utilize the589alternative approaches to life safety in compliance with NFPA590101A, 1995 edition. However, a facility for which a building591permit or certificate of occupancy is issued before July 1,5922016, that undergoes Level III building alteration or593rehabilitation, as defined in the Florida Building Code, or594seeks to utilize features not authorized under the 1994 or 1995595editions of the Life Safety Code must thereafter comply with all596aspects of the uniform firesafety standards established under s.597633.206, and the Florida Fire Prevention Code, in effect for598assisted living facilities as adopted by the State Fire Marshal.5993.Resident elopement requirements.—Facilities are required600to conduct a minimum of two resident elopement prevention and601response drills per year. All administrators and direct care602staff must participate in the drills which shall include a603review of procedures to address resident elopement. Facilities604must document the implementation of the drills and ensure that605the drills are conducted in a manner consistent with the606facility’s resident elopement policies and procedures.607 (b) The preparation and annual update of a comprehensive 608 emergency management plan. Such standards must be included in 609 the rules adopted by the department after consultation with the 610 Division of Emergency Management. At a minimum, the rules must 611 provide for plan components that address emergency evacuation 612 transportation; adequate sheltering arrangements; postdisaster 613 activities, including provision of emergency power, food, and 614 water; postdisaster transportation; supplies; staffing; 615 emergency equipment; individual identification of residents and 616 transfer of records; communication with families; and responses 617 to family inquiries. The comprehensive emergency management plan 618 is subject to review and approval by the local emergency 619 management agency. During its review, the local emergency 620 management agency shall ensure that the following agencies, at a 621 minimum, are given the opportunity to review the plan: the 622 Department of Elderly Affairs, the Department of Health, the 623 Agency for Health Care Administration, and the Division of 624 Emergency Management. Also, appropriate volunteer organizations 625 must be given the opportunity to review the plan. The local 626 emergency management agency shall complete its review within 60 627 days and either approve the plan or advise the facility of 628 necessary revisions. 629 (c) The number, training, and qualifications of all 630 personnel having responsibility for the care of residents. The 631 rules must require adequate staff to provide for the safety of 632 all residents. Facilities licensed for 17 or more residents are 633 required to maintain an alert staff for 24 hours per day. 634(d)All sanitary conditions within the facility and its635surroundings which will ensure the health and comfort of636residents. The rules must clearly delineate the responsibilities637of the agency’s licensure and survey staff, the county health638departments, and the local authority having jurisdiction over639firesafety and ensure that inspections are not duplicative. The640agency may collect fees for food service inspections conducted641by the county health departments and transfer such fees to the642Department of Health.643 (d)(e)License application and license renewal, transfer of 644 ownership, proper management of resident funds and personal 645 property, surety bonds, resident contracts, refund policies, 646 financial ability to operate, and facility and staff records. 647 (e)(f)Inspections, complaint investigations, moratoriums, 648 classification of deficiencies,levyingand enforcement of 649 penalties, and use of income from fees and fines. 650 (f)(g)The enforcement of the resident bill of rights 651 specified in s. 429.28. 652 (g)(h)The careand maintenanceof residents provided by 653 the facility, which must include, but is not limited to: 654 1. The supervision of residents; 655 2. The provision of personal services; 656 3. The provision of, or arrangement for, social and leisure 657 activities; 658 4. The assistance in making arrangementsarrangementfor 659 appointments and transportation to appropriate medical, dental, 660 nursing, or mental health services, as needed by residents; 661 5. The management of medication stored within the facility 662 and as needed by residents; 663 6. The dietarynutritionalneeds of residents; 664 7. Resident records;and665 8. Internal risk management and quality assurance; and 666 9. The requirements for using medical diagnostic testing 667 equipment that is designed for a residential setting and is used 668 at the point of care delivery, including equipment to test 669 cholesterol, blood glucose level, and blood pressure. 670 (h)(i)Facilities holding a limited nursing, extended 671 congregate care, or limited mental health license. 672 (i)(j)The establishment of specific criteria to define 673 appropriateness of resident admission and continued residency in 674 a facility holding a standard, limited nursing, extended 675 congregate care, and limited mental health license. 676 (j)(k)The use of physical or chemical restraints. The use 677 of geriatric chairs or posey restraints is prohibited. Other 678 physical restraints may be used in accordance with agency rules 679 when orderedis limited to half-bed rails as prescribed and680documentedby the resident’s physician and consented to bywith681the consent ofthe resident or, if applicable, the resident’s 682 representative or designee or the resident’s surrogate, 683 guardian, or attorney in fact. Such rules must specify 684 requirements for care planning, staff monitoring, and periodic 685 review. The use of chemical restraints is limited to prescribed 686 dosages of medications authorized by the resident’s physician 687 and must be consistent with the resident’s diagnosis. Residents 688 who are receiving medications that can serve as chemical 689 restraints must be evaluated by their physician at least 690 annually to assess: 691 1. The continued need for the medication. 692 2. The level of the medication in the resident’s blood. 693 3. The need for adjustments in the prescription. 694 (k)(l)The establishment of specific resident elopement 695 drill requirementspolicies and procedures on resident696elopement. Facilities shall conduct a minimum of two resident 697 elopement drills each year. All administrators and direct care 698 staff shall participate in the drills, which must include a 699 review of the facility’s procedures to address resident 700 elopement. Facilities shall document participation in the 701 drills. 702 (2) In adopting any rules pursuant to this part, the 703 department, in conjunction with the agency, shall make distinct 704 standards for facilities based upon facility size; the types of 705 care provided; the physical and mental capabilities and needs of 706 residents; the type, frequency, and amount of services and care 707 offered; and the staffing characteristics of the facility. Rules 708 developed pursuant to this section may not restrict the use of 709 shared staffing and shared programming in facilities that are 710 part of retirement communities that provide multiple levels of 711 care and otherwise meet the requirements of law and rule. If a 712 continuing care facility licensed under chapter 651 or a 713 retirement community offering multiple levels of care licenses a 714 building or part of a building designated for independent living 715 for assisted living, staffing requirements established in rule 716 apply only to residents who receive personal, limited nursing, 717 or extended congregate care services under this part. Such 718 facilities shall retain a log listing the names and unit number 719 for residents receiving these services. The log must be 720 available to surveyors upon request. Except for uniform721firesafety standards,The department shall adopt by rule 722 separate and distinct standards for facilities with 16 or fewer 723 beds and for facilities with 17 or more beds. The standards for 724 facilities with 16 or fewer beds must be appropriate for a 725 noninstitutional residential environment; however, the structure 726 may not be more than two stories in height and all persons who 727 cannot exit the facility unassisted in an emergency must reside 728 on the first floor. The department, in conjunction with the 729 agency, may make other distinctions among types of facilities as 730 necessary to enforce this part. Where appropriate, the agency 731 shall offer alternate solutions for complying with established 732 standards, based on distinctions made by the department and the 733 agency relative to the physical characteristics of facilities 734 and the types of care offered. 735 (3)The department shall submit a copy of proposed rules to736the Speaker of the House of Representatives, the President of737the Senate, and appropriate committees of substance for review738and comment prior to the promulgation thereof.Rules promulgated 739 by the department mustshallencourage the development of 740 homelike facilities which promote the dignity, individuality, 741 personal strengths, and decisionmaking ability of residents. 742 (4) The agency, in consultation with the department, may 743 waive rules promulgated pursuant to this part in order to 744 demonstrate and evaluate innovative or cost-effective congregate 745 care alternatives which enable individuals to age in place. Such 746 waivers may be granted only in instances where there is 747 reasonable assurance that the health, safety, or welfare of 748 residents will not be endangered. To apply for a waiver, the 749 licensee shall submit to the agency a written description of the 750 concept to be demonstrated, including goals, objectives, and 751 anticipated benefits; the number and types of residents who will 752 be affected, if applicable; a brief description of how the 753 demonstration will be evaluated; and any other information 754 deemed appropriate by the agency. Any facility granted a waiver 755 shall submit a report of findings to the agency and the 756 department within 12 months. At such time, the agency may renew 757 or revoke the waiver or pursue any regulatory or statutory 758 changes necessary to allow other facilities to adopt the same 759 practices. The department may by rule clarify terms and 760 establish waiver application procedures, criteria for reviewing 761 waiver proposals, and procedures for reporting findings, as 762 necessary to implement this subsection. 763 (5) The agency may use an abbreviated biennial standard 764 licensure inspection that consists of a review of key quality 765 of-care standards in lieu of a full inspection in a facility 766 that has a good record of past performance. However, a full 767 inspection must be conducted in a facility that has a history of 768 class I or class II violations, uncorrected class III 769 violations, or a violation resulting from a complaint referred 770 by the State Long-Term Care Ombudsman Program to a regulatory 771 agencyconfirmed ombudsman council complaints, or confirmed772licensure complaints,within the previous licensure period 773 immediately preceding the inspection or if a potentially serious 774 problem is identified during the abbreviated inspection. The 775 agency, in consultation with the department,shall adopt by rule 776developthe key quality-of-care standardswith input from the777State Long-Term Care Ombudsman Council and representatives of778provider groups for incorporation into its rules. 779 Section 10. Section 429.435, Florida Statutes, is created 780 to read: 781 429.435 Uniform firesafety standards.-Uniform firesafety 782 standards for assisted living facilities and a residential board 783 and care occupancy shall be established by the State Fire 784 Marshal pursuant to s. 633.206. 785 (1) EVACUATION CAPABILITY.—A firesafety evacuation 786 capability determination shall be conducted within 6 months 787 after the date of initial licensure, if required. 788 (2) FIRESAFETY REQUIREMENTS.— 789 (a) The National Fire Protection Association, Life Safety 790 Code, NFPA 101 and 101A, current editions, must be used in 791 determining the uniform firesafety code adopted by the State 792 Fire Marshal for assisted living facilities, pursuant to s. 793 633.206. 794 (b) A local government or a utility may charge fees that do 795 not exceed the actual costs incurred by the local government or 796 the utility for the installation and maintenance of an automatic 797 fire sprinkler system in a licensed assisted living facility 798 structure. 799 (c) All licensed facilities must have an annual fire 800 inspection conducted by the local fire marshal or authority 801 having jurisdiction. 802 (d) An assisted living facility that was issued a building 803 permit or certificate of occupancy before July 1, 2016, at its 804 option and after notifying the authority having jurisdiction, 805 may remain under the provisions of the 1994 and 1995 editions of 806 the National Fire Protection Association, Life Safety Code, NFPA 807 101 and 101A. A facility opting to remain under such provisions 808 may make repairs, modernizations, renovations, or additions to, 809 or rehabilitate, the facility in compliance with NFPA 101, 1994 810 edition, and may utilize the alternative approaches to life 811 safety in compliance with NFPA 101A, 1995 edition. However, a 812 facility for which a building permit or certificate of occupancy 813 was issued before July 1, 2016, which undergoes Level III 814 building alteration or rehabilitation, as defined in the Florida 815 Building Code, or which seeks to utilize features not authorized 816 under the 1994 or 1995 editions of the Life Safety Code shall 817 thereafter comply with all aspects of the uniform firesafety 818 standards established under s. 633.206, and the Florida Fire 819 Prevention Code, in effect for assisted living facilities as 820 adopted by the State Fire Marshal. 821 Section 11. Section 429.52, Florida Statutes, is amended to 822 read: 823 429.52 Staff training and educational requirements 824programs; core educational requirement.— 825 (1)Effective October 1, 2015,Each new assisted living 826 facility employee who has not previously completed core training 827 must attend a preservice orientation provided by the facility 828 before interacting with residents. The preservice orientation 829 must be at least 2 hours in duration and cover topics that help 830 the employee provide responsible care and respond to the needs 831 of facility residents. Upon completion, the employee and the 832 administrator of the facility must sign a statement that the 833 employee completed the required preservice orientation. The 834 facility must keep the signed statement in the employee’s 835 personnel record. 836 (2) Administrators and other assisted living facility staff 837 must meet minimum training and education requirements 838 established by the Department of Elderly Affairs by rule. This 839 training and education is intended to assist facilities to 840 appropriately respond to the needs of residents, to maintain 841 resident care and facility standards, and to meet licensure 842 requirements. 843 (3) The department shall establish core training 844 requirements for administrators consisting of core training 845 learning objectives, a competency test, and a minimum required 846 score to indicate successful passagecompletionof the core 847 competency testtraining and educational requirements. The 848 competency test must be developed by the department in 849 conjunction with the agencyand providers. The required core 850 competency testtraining and educationmust cover at least the 851 following topics: 852 (a) State law and rules relating to assisted living 853 facilities. 854 (b) Resident rights and identifying and reporting abuse, 855 neglect, and exploitation. 856 (c) Special needs of elderly persons, persons with mental 857 illness, and persons with developmental disabilities and how to 858 meet those needs. 859 (d) Nutrition and food service, including acceptable 860 sanitation practices for preparing, storing, and serving food. 861 (e) Medication management, recordkeeping, and proper 862 techniques for assisting residents with self-administered 863 medication. 864 (f) Firesafety requirements, including fire evacuation 865 drill procedures and other emergency procedures. 866 (g) Care of persons with Alzheimer’s disease and related 867 disorders. 868 (4) Anewfacility administrator must complete the required 869 core trainingand education, including the competency test, 870 within 90 days after the date of employment as an administrator. 871 Failure to do so is a violation of this part and subjects the 872 violator to an administrative fine as prescribed in s. 429.19. 873 Administrators licensed in accordance with part II of chapter 874 468 are exempt from this requirement. Other licensed 875 professionals may be exempted, as determined by the department 876 by rule. 877 (5) Administrators are required to participate in 878 continuing education for a minimum of 12 contact hours every 2 879 years. 880 (6) Staffinvolved with the management of medications and881 assisting with the self-administration of medications under s. 882 429.256 must complete a minimum of 6additionalhours of 883 training provided by a registered nurse,or a licensed 884 pharmacist,before providing assistanceor department staff. Two 885 hours of continuing education is required annually thereafter. 886 The department shall establish by rule the minimum requirements 887 of thisadditionaltraining. 888 (7)OtherFacility staff shall participate in in-service 889 training relevant to their job duties as specified by department 890 ruleof the department. Topics covered during the preservice 891 orientation are not required to be repeated during in-service 892 training. A single certificate of completion that covers all 893 required in-service training topics may be issued to a 894 participating staff member if the training is provided in a 895 single training course. 896 (8) Ifthe department orthe agency determines that there 897 are problems in a facility that could be reduced through 898 specific staff trainingor educationbeyond that already 899 required under this section,the department orthe agency may 900 require,and provide, or cause to be provided, the trainingor901educationof any personal care staff in the facility. 902 (9) The department shall adopt rules related to these 903 training and education requirements, the competency test, 904 necessary procedures, and competency test fees and shall adopt 905 or contract with another entity to develop and administer the 906 competency test. The department shall adopt a curriculum outline 907 with learning objectives to be used by core trainers, which908shall be usedas the minimum core training content requirements. 909 The department shall consult with representatives of stakeholder 910 associations and agencies in the development of the curriculum 911 outline. 912 (10) The core training required by this sectionother than913the preservice orientationmust be conducted by persons 914 registered with the department as having the requisite 915 experience and credentials to conduct the training. A person 916 seeking to register as a core trainer must provide the 917 department with proof of completion of theminimumcore training 918educationrequirements, successful passage of the competency 919 test established under this section, and proof of compliance 920 with the continuing education requirement in subsection (5). 921 (11) A person seeking to register as a core trainer also 922 mustalso: 923 (a) Provide proof of completion of a 4-year degree from an 924 accredited college or university and must have worked in a 925 management position in an assisted living facility for 3 years 926 after being core certified; 927 (b) Have worked in a management position in an assisted 928 living facility for 5 years after being core certified and have 929 1 year of teaching experience as an educator or staff trainer 930 for persons who work in assisted living facilities or other 931 long-term care settings; 932 (c) Have been previously employed as a core trainer for the 933 department; or 934 (d) Meet other qualification criteria as defined in rule, 935 which the department is authorized to adopt. 936 (12) The department shall adopt rules to establish core 937 trainer registration and removal requirements. 938 Section 12. Paragraph (b) of subsection (3) of section 939 429.07, Florida Statutes, is amended to read 940 429.07 License required; fee.— 941 (3) In addition to the requirements of s. 408.806, each 942 license granted by the agency must state the type of care for 943 which the license is granted. Licenses shall be issued for one 944 or more of the following categories of care: standard, extended 945 congregate care, limited nursing services, or limited mental 946 health. 947 (b) An extended congregate care license shall be issued to 948 each facility that has been licensed as an assisted living 949 facility for 2 or more years and that provides services, 950 directly or through contract, beyond those authorized in 951 paragraph (a), including services performed by persons licensed 952 under part I of chapter 464 and supportive services, as defined 953 by rule, to persons who would otherwise be disqualified from 954 continued residence in a facility licensed under this part. An 955 extended congregate care license may be issued to a facility 956 that has a provisional extended congregate care license and 957 meets the requirements for licensure under subparagraph 2. The 958 primary purpose of extended congregate care services is to allow 959 residents the option of remaining in a familiar setting from 960 which they would otherwise be disqualified for continued 961 residency as they become more impaired. A facility licensed to 962 provide extended congregate care services may also admit an 963 individual who exceeds the admission criteria for a facility 964 with a standard license, if he or she is determined appropriate 965 for admission to the extended congregate care facility. 966 1. In order for extended congregate care services to be 967 provided, the agency must first determine that all requirements 968 established in law and rule are met and must specifically 969 designate, on the facility’s license, that such services may be 970 provided and whether the designation applies to all or part of 971 the facility. This designation may be made at the time of 972 initial licensure or relicensure, or upon request in writing by 973 a licensee under this part and part II of chapter 408. The 974 notification of approval or the denial of the request shall be 975 made in accordance with part II of chapter 408. Each existing 976 facility that qualifies to provide extended congregate care 977 services must have maintained a standard license and may not 978 have been subject to administrative sanctions during the 979 previous 2 years, or since initial licensure if the facility has 980 been licensed for less than 2 years, for any of the following 981 reasons: 982 a. A class I or class II violation; 983 b. Three or more repeat or recurring class III violations 984 of identical or similar resident care standards from which a 985 pattern of noncompliance is found by the agency; 986 c. Three or more class III violations that were not 987 corrected in accordance with the corrective action plan approved 988 by the agency; 989 d. Violation of resident care standards which results in 990 requiring the facility to employ the services of a consultant 991 pharmacist or consultant dietitian; 992 e. Denial, suspension, or revocation of a license for 993 another facility licensed under this part in which the applicant 994 for an extended congregate care license has at least 25 percent 995 ownership interest; or 996 f. Imposition of a moratorium pursuant to this part or part 997 II of chapter 408 or initiation of injunctive proceedings. 998 999 The agency may deny or revoke a facility’s extended congregate 1000 care license for not meeting the criteria for an extended 1001 congregate care license as provided in this subparagraph. 1002 2. If an assisted living facility has been licensed for 1003 less than 2 years, the initial extended congregate care license 1004 must be provisional and may not exceed 6 months. The licensee 1005 shall notify the agency, in writing, when it has admitted at 1006 least one extended congregate care resident, after which an 1007 unannounced inspection shall be made to determine compliance 1008 with the requirements of an extended congregate care license. A 1009 licensee with a provisional extended congregate care license 1010 that demonstrates compliance with all the requirements of an 1011 extended congregate care license during the inspection shall be 1012 issued an extended congregate care license. In addition to 1013 sanctions authorized under this part, if violations are found 1014 during the inspection and the licensee fails to demonstrate 1015 compliance with all assisted living facility requirements during 1016 a followup inspection, the licensee shall immediately suspend 1017 extended congregate care services, and the provisional extended 1018 congregate care license expires. The agency may extend the 1019 provisional license for not more than 1 month in order to 1020 complete a followup visit. 1021 3. A facility that is licensed to provide extended 1022 congregate care services shall maintain a written progress 1023 report on each person who receives services which describes the 1024 type, amount, duration, scope, and outcome of services that are 1025 rendered and the general status of the resident’s health. A 1026 registered nurse, or appropriate designee, representing the 1027 agency shall visit the facility at least twice a year to monitor 1028 residents who are receiving extended congregate care services 1029 and to determine if the facility is in compliance with this 1030 part, part II of chapter 408, and relevant rules. One of the 1031 visits may be in conjunction with the regular survey. The 1032 monitoring visits may be provided through contractual 1033 arrangements with appropriate community agencies. A registered 1034 nurse shall serve as part of the team that inspects the 1035 facility. The agency may waive one of the required yearly 1036 monitoring visits for a facility that has: 1037 a. Held an extended congregate care license for at least 24 1038 months; 1039 b. No class I or class II violations and no uncorrected 1040 class III violations; and 1041 c. No ombudsman council complaints that resulted in a 1042 citation for licensure. 1043 4. A facility that is licensed to provide extended 1044 congregate care services must: 1045 a. Demonstrate the capability to meet unanticipated 1046 resident service needs. 1047 b. Offer a physical environment that promotes a homelike 1048 setting, provides for resident privacy, promotes resident 1049 independence, and allows sufficient congregate space as defined 1050 by rule. 1051 c. Have sufficient staff available, taking into account the 1052 physical plant and firesafety features of the building, to 1053 assist with the evacuation of residents in an emergency. 1054 d. Adopt and follow policies and procedures that maximize 1055 resident independence, dignity, choice, and decisionmaking to 1056 permit residents to age in place, so that moves due to changes 1057 in functional status are minimized or avoided. 1058 e. Allow residents or, if applicable, a resident’s 1059 representative, designee, surrogate, guardian, or attorney in 1060 fact to make a variety of personal choices, participate in 1061 developing service plans, and share responsibility in 1062 decisionmaking. 1063 f. Implement the concept of managed risk. 1064 g. Provide, directly or through contract, the services of a 1065 person licensed under part I of chapter 464. 1066 h. In addition to the training mandated in s. 429.52, 1067 provide specialized training as defined by rule for facility 1068 staff. 1069 5. A facility that is licensed to provide extended 1070 congregate care services is exempt from the criteria for 1071 continued residency set forth in rules adopted under s. 429.41. 1072 A licensed facility must adopt its own requirements within 1073 guidelines for continued residency set forth by rule. However, 1074 the facility may not serve residents who require 24-hour nursing 1075 supervision. A licensed facility that provides extended 1076 congregate care services must also provide each resident with a 1077 written copy of facility policies governing admission and 1078 retention. 1079 6. Before the admission of an individual to a facility 1080 licensed to provide extended congregate care services, the 1081 individual must undergo a medical examination as provided in s. 1082 429.26(5)s. 429.26(4)and the facility must develop a 1083 preliminary service plan for the individual. 1084 7. If a facility can no longer provide or arrange for 1085 services in accordance with the resident’s service plan and 1086 needs and the facility’s policy, the facility must make 1087 arrangements for relocating the person in accordance with s. 1088 429.28(1)(k). 1089 Section 13. This act shall take effect July 1, 2019.