Florida Nursing Home Resident's Rights
Florida Statute 400.022

Rules Relating to Florida Nursing Homes
Florida Statute 400.023

Florida Nursing Home Resident Admission, Retention, Transferring & Discharge Policies
Florida Administrative Rule 59A-4.105

Florida Nursing Home Resident Facility Policies
Florida Administrative Rule 59A-4.106

Florida Nursing Home Resident Assessment and Care Plan
Florida Administrative Rule 59A-4.109

Florida Nursing Home Resident Medical Records
Florida Administrative Rule 59A-4.118

The violation of any of these Florida Statutes, or Administrative Rules, could result in a lawsuit against a Florida nursing home. At Spiegel & Utrera, P.A. , we will review your situation without any obligation whatsoever. Best of all, we charge absolutely no attorney's fee unless we make a recovery of money. So what have you got to lose? Call us now and make an appointment to come in and see us. Remember, a loved one is counting on you to right a wrong. And, as lawyers, we want to assist you. Again, call us today for a convenient appointment.

1. All licensees of nursing home facilities shall adopt and make public a statement of the rights and responsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement shall assure each resident the following.
   
   (a) The right to civil and religious liberties, including knowledge of available choices and the right to independent personal decision, which will not be infringed upon, and the right to encouragement and assistance from the staff of the facility in the fullest possible exercise of these rights.
   
   (b) The right to private and uncensored communication, including, but not limited to, receiving and sending unopened correspondence, access to a telephone, visiting with any person of the resident's choice during visiting hours, and overnight visitation outside the facility with family and friends in accordance with facility policies, physician orders, and Title XVIII (Medicare) and Title XIX (Medicaid) of the Social Security Act regulations, without the resident's losing his or her bed. Facility visiting hours shall be flexible, taking into consideration special circumstances such as, but not limited to, out-of-town visitors and working relatives or friends. Unless otherwise indicated in the resident care plan, the licensee shall, with the consent of the resident and in accordance with policies approved by the agency, permit recognized volunteer groups, representatives of community-based legal, social, mental health, and leisure programs, and members of the clergy access to the facility during visiting hours for the purpose of visiting with and providing services to any resident.
   
   (c) Any entity or individual that provides health, social, legal, or other services to a resident has the right to have reasonable access to the resident. The resident has the right to deny or withdraw consent to access at any time by any entity or individual. Notwithstanding the visiting policy of the facility, the following individuals must be permitted immediate access to the resident:
   
   
   1. Any representative of the federal or state government, including, but not limited to, representatives of the Department of Health and Rehabilitative Services, the Agency for Health Care Administration, and the Department of Elderly Affairs; any law enforcement officer; members of the state or district ombudsmen council; and the resident's individual physician.
   2. Subject to the resident's right to deny or withdraw consent, immediate family or other relatives of the resident. The facility must allow representatives of the State Nursing Home and Long-Term Care Facility Ombudsman Council to examine a resident's clinical records with the permission of the resident or the resident's legal representative and consistent with state law.
   
   (d) The right to present grievances on behalf of himself or herself or others to the staff or administrator of the facility, to governmental officials, or to any other person; to recommend changes in policies and services to facility personnel; and to join with other residents or individuals within or outside the facility to work for improvements in resident care, free from restraint, interference, coercion, discrimination, or reprisal. This right includes access to ombudsmen and advocates and the right to be a member of, to be active in, and to associate with advocacy or special interest groups. The right also includes the right to prompt efforts by the facility to resolve resident grievances, including grievances with respect to the behavior of other residents.
   
   (e) The right to organize and participate in resident groups in the facility and the right to have the resident's family meet in the facility with the families of other residents.
   
   (f) The right to participate in social, religious, and community activities that do not interfere with the rights of other residents.
   
   (g) The right to examine, upon reasonable request, the results of the most recent inspection of the facility conducted by a federal or state agency and any plan of correction in effect with respect to the facility.
   
   (h) The right to manage his or her own financial affairs or to delegate such responsibility to the licensee, but only to the extent of the funds in trust by the licensee for the resident. A quarterly accounting of any transactions made on behalf of the resident shall be furnished to the resident or the person responsible for the resident. The facility may not require a resident to deposit personal funds with the facility. However, upon written authorization of a resident, the facility must hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility as follows:
   
   
   1. The facility must establish and maintain a system that ensures a full, complete, and separate accounting, according to generally accepted accounting principles, of each resident's personal funds entrusted to the facility on the resident's behalf.
   2. The accounting system established and maintained by the facility must preclude any commingling of resident funds with facility funds or with the funds of any person other than another resident.
   3. A quarterly accounting of any transaction made on behalf of the resident shall be furnished to the resident or the person responsible for the resident.
   4. Upon the death of a resident with personal funds deposited with the facility, the facility must convey within 30 days the resident's funds, including interest, and a final accounting of those funds, to the individual or probate jurisdiction administering the resident's estate, or, if a personal representative has not been appointed within 30 days, to the resident's spouse or adult next of kin named in the beneficiary designation form provided for in s. 400.162(6).
   5. The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under Title XVIII or Title XIX of the Social Security Act.
   
   (i) The right to be fully informed, in writing and orally, prior to or at the time of admission and during his or her stay, of services available in the facility and of related charges for such services, including any charges for services not covered under Title XVIII or Title XIX of the Social Security Act or not covered by the basic per diem rates and of bed reservation and refund policies of the facility.
   
   (j) The right to be adequately informed of his or her medical condition and proposed treatment, unless the resident is determined to be unable to provide informed consent under Florida law, or the right to be fully informed in advance of any non-emergency changes in care or treatment that may affect the resident's well-being; and, except with respect to a resident adjudged incompetent, the right to participate in the planning of all medical treatment, including the right to refuse medication and treatment, unless otherwise indicated by the resident's physician; and to know the consequences of such actions.
   
   (k) The right to refuse medication or treatment and to be informed of the consequences of such decisions, unless determined unable to provide informed consent under state law. When the resident refuses medication or treatment, the nursing home facility must notify the resident or the resident's legal representative of the consequences of such decision and must document the resident's decision in his or her medical record. The nursing home facility must continue to provide other services the resident agrees to in accordance with the resident's care plan.
   
   (l) The right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency.
   
   (m) The right to have privacy in treatment and in caring for personal needs; to close room doors and to have facility personnel knock before entering the room, except in the case of an emergency or unless medically contraindicated; and to security in storing and using personal possessions. Privacy of the resident's body shall be maintained during, but not limited to, toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance. Residents' personal and medical records shall be confidential and exempt from the provisions of s. 119.07(1). This exemption is subject to the Open Government Sunset Review Act in accordance with s. 119.14.
   
   (n) The right to be treated courteously, fairly, and with the fullest measure of dignity and to receive a written statement and an oral explanation of the services provided by the licensee, including those required to be offered on an as-needed basis.
   
   (o) The right to be free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints, except those restraints authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency. In case of an emergency, restraint may be applied only by a qualified licensed nurse who shall set forth in writing the circumstances requiring the use of restraining, and, in the case of a chemical restraint, a physician shall be consulted immediately thereafter. Restraints may not be used in lieu of staff supervision or merely for staff convenience, for punishment, or for reasons other than resident protection or safety.
   
   (p) The rights to be transferred or discharged only for medical reasons or for the welfare of other residents, and the right to be given reasonable advance notice of no less than 30 days of any involuntary transfer or discharge, except in the case of an emergency as determined by a licensed professional on the staff of the nursing home, or in the case of conflicting rules and regulations which govern Title XVIII or Title XIX of the Social Security Act. For nonpayment of a bill for care received, the resident shall be given 30 days' advance notice. A licensee certified to provide services under Title XIX of the Social Security Act may not transfer or discharge a resident solely because the source of payment for care changes. Admission to a nursing home facility operated by a licensee certified to provide services under Title XIX of the Social Security Act may not be conditioned upon a waiver of such right, and any document or provision in a document which purports to waive or preclude such right is void and unenforceable. Any licensee certified to provide services under Title XIX of the Social Security Act that obtains or attempts or obtain such a waiver from a resident or potential resident shall be construed to have violated the resident's rights as established herein and is subject to disciplinary action as provided in subsection (3). The resident and the family or representative of the resident shall be consulted in choosing another facility.
   
   (q) The right to freedom of choice in selecting a personal physician; to obtain pharmaceutical supplies and services from a pharmacy of the resident's choice, at the resident's own expense or through Title XIX of the Social Security Act; and to obtain information about, and to participate in, community-based activities programs, unless medically contraindicated as documented by a physician in the resident's medical record. If a resident chooses to use a community pharmacy and the facility in which the resident resides uses a unit-dose system, the pharmacy selected by the resident shall be one that provides a compatible unit-dose system, provides service delivery, and stocks the drugs normally used by long-term care residents. If a resident chooses to use a community pharmacy and the facility in which the resident resides does not use a unit-dose system, the pharmacy selected by the resident shall be one that provides service delivery and stocks the drugs normally used by the long-term care residents.
   
   (r) The right to retain and use personal clothing and possessions as space permits, unless to do so would infringe upon the rights of other residents or unless medically contraindicated as documented in the resident's medical record by a physician. If clothing is provided to the resident by the licensee, it shall be of reasonable fit.
   
   (s) The right to have copies of the rules and regulations of the facility and an explanation of the responsibility of the resident to obey all reasonable rules and regulations of the facility and to respect the personal rights and private property of the other residents.
   
   (t) The right to receive notice before the room of the resident in the facility is changed.
   
   (u) The right to be informed of the bed reservation policy for a hospitalization. The nursing home shall inform a private-pay resident and his or her responsible party that his or her bed will be reserved for any single hospitalization for a period up to 30 days provided the nursing home receives reimbursement. Any resident who is a recipient of assistance under Title XIX of the Social Security Act, or resident's designee or legal representative, shall be informed by the licensee that his or her bed will be reserved for any single hospitalization for the length of time for which Title XIX reimbursement is available, up to 15 days; but that the bed will not be reserved if it is medically determined by the agency that the resident will not need it or will not be able to return to the nursing home, or if the agency determines that the nursing home's occupancy rate ensures the availability of a bed for the resident. Notice shall be provided within 24 hours of the hospitalization.
   
   (v) For residents of Medicaid or Medicare certified facilities, the right to challenge a decision by the facility to discharge or transfer the resident, as required under Title 42 C.F.R. part 483.13. (1) The licensee for each nursing home shall orally inform the resident of the resident's rights and provide a copy of the statement required by subsection



2. To each resident or the resident's legal representative at or before the resident's admission to a facility. The licensee shall provide a copy of the resident's rights to each staff member of the facility. Each such licensee shall prepare a written plan and provide appropriate staff training to implement the provisions of this section. The written statement of rights must include a statement that a resident may file a complaint with the agency or district ombudsman council. The statement must be in boldfaced type and shall include the name, address, and telephone numbers of the district ombudsman council and adult abuse registry where complaints may be lodged.



3. Any violation of the resident's rights set forth in this section shall constitute grounds for action by the agency under the provisions of s. 400.102. In order to determine whether the licensee is adequately protecting residents' rights, the annual inspection of the facility shall include private information conversations with a sample of residents to discuss residents' experiences within the facility with respect to rights specified in this section and general compliance with standards, and consultation with the ombudsman council in the district in which the nursing home is located.



4. Any person who submits or reports a complaint concerning a suspected violation of the resident's rights or concerning services or conditions in a facility or who testifies in any administrative or judicial proceeding arising from such complaint shall have immunity from any criminal or civil liability therefore, unless that person has acted in bad faith, with malicious purpose, or if the court finds that there was a complete absence of a justifiable issue of either law or fact raised by the losing party.

1. It is the intent of the Legislature that rules published and enforced pursuant to this part shall include criteria by which a reasonable and consistent quality of resident care may be ensured and the results of such resident care can be demonstrated and by which safe and sanitary nursing homes can be provided. It is further intended that reasonable efforts be made to accommodate the needs and preferences of residents to enhance the quality of lie in a nursing home. In addition, efforts shall be made to minimize the paperwork associated with the reporting and documentation requirements of these rules.
   
2. Pursuant to the intention of the Legislature, the agency, in consultation with the Department of Health and Rehabilitative Services and the Department of Elderly Affairs, shall adopt and enforce rules to implement this part, which shall include reasonable and fair criteria in relation to:
   
   (a) The location and construction of the facility; including fire and life safety, plumbing, heating, lighting, ventilation, and other housing conditions which will ensure the health, safety, and comfort of residents, including an adequate call system. The agency shall establish standards for facilities and equipment to increase the extent to which facilities are structurally capable of serving as shelters and equipped to be self-supporting during and immediately following disasters. In making such rules, the agency shall be guided by criteria recommended by nationally recognized reputable professional groups and associations with knowledge of such subject matters. The agency shall update or revise such criteria as the need arises. All nursing homes must comply with those life safety code requirements and building code standards applicable at the time of approval of their construction plans. The agency may require alterations to a building if it determines that an existing condition constitutes a distinct hazard to life, health or safety. The agency shall adopt fair and reasonable rules setting forth conditions under which existing facilities undergoing additions, alterations, conversions, renovations, or repairs shall be required to comply with the most recent updated or revised standards.
   
   (b) The number and qualifications of all personnel, including management, medical, nursing, and other professional personnel, and nursing assistants, orderlies, and support personnel, having responsibility for any part of the care given residents.
   
   (c) All sanitary conditions within the facility and its surroundings, including water supply, sewage disposal, food handling, and general hygiene which will ensure the health and comfort of residents.
   
   (d) The equipment essential to the health and welfare of the residents.
   
   (e) A uniform accounting system.
   
   (f) The care, treatment, and maintenance of residents and measurement of the quality and adequacy thereof, based on rules developed under this chapter and the Omnibus Budget Reconciliation Act of 1987 (Pub.L. No. 100-203) (December 22, 1987), Title IV (Medicare, Medicaid, and Other Health-Related Programs), Subtitle C (Nursing Home Reform), as amended.
   
   (g) The preparation and annual update of a comprehensive emergency management plan. The agency shall adopt rules establishing minimum criteria for the plan after consulting with the Department of Community Affairs. At a minimum, the rules must provide for plan components that address emergency evacuation transportation; adequate sheltering arrangements; post disaster activities, including emergency power, food, and water; post disaster transportation; supplies; staffing; emergency equipment; individual identification of residents and transfer of records; and responding to family inquiries. The comprehensive emergency 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 Elderly Affairs, the Department of Health and Rehabilitative Services, the Agency for Health Care Administration, and the Department of Community Affairs. 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.
   
   
3. Rules developed pursuant to this section shall not restrict the use of shared staffing and shared programming in facilities which are part of retirement communities that provide multiple levels of care and otherwise meet the requirement of law or rule.
   
   
4. The agency, in collaboration with the Children's Medical Services Program Office of the Department of Health and Rehabilitative Services, must, no later than December 31, 1993, adopt rules for minimum standards of care for persons under 21 years of age who reside in nursing home facilities. The rules must include a methodology for reviewing a nursing home facility under s. 408.031-408.045 which serves only persons under 21 years of age.
   
   
5. Prior to conducting a survey of the facility, the survey team shall obtain a copy of the district nursing home and long-term care facility ombudsman council report on the facility. Problems noted in the report shall be incorporated into and followed up through the agency's inspection process. This procedure does not preclude the district nursing home and long-term care facility ombudsman council from requesting the agency to conduct a follow-up visit to the facility.
   
   
6. There is created the Nursing Home Advisory Committee, which shall consist of 15 members who are to be appointed by and report directly to the director of the agency. The membership is to include:
   
   (a) One researcher from a university center on aging.
   (b) Two representatives from the Florida Health Care Association.
   (c) Two representatives from the Florida Association of Homes for the Aging.
   (d) One representative from the Department of Elderly Affairs.
   (e) Five consumer representatives, at least two of whom serve on or are staff members of the state or a district nursing home and long-term care facility ombudsman council.
   (f) One representative from the Florida American Medical Directors Association.
   (g) One representative from the Florida Association of Directors of Nursing Administrators.
   (h) One representative from the Agency for Health Care Administration.
   (i) One representative from the nursing home industry at large who owns or operates a licensed nursing home facility in the state and is not a member of any state nursing home association. At least one member shall be over 60 years of age.
   
   
7. The committee shall perform the following duties to assist the agency in ensuring compliance with the intent of the Legislature specified in subsection (1):
   
   (a) Assist in developing a nursing home rating system based on the requirements of rules developed under this chapter and the Omnibus Budget Reconciliation Act of 1987 (Pub.L. No. 100-203) (December 22, 1987), Title IV (Medicare, Medicaid, and Other Health-Related Programs), Subtitle C (Nursing Home Reform), as amended.
   (b) Assist in developing surveyor guidelines and training to ensure the equitable application of the nursing home rating system.
   (c) Assist in developing guidelines to determine the scope and severity of noncompliance.
   (d) Identify burdensome paperwork that is not specifically related to resident care.
   (e) Advise the agency of proposed changes in statutes and rules necessary to ensure adequate care and services and the promotion and protection of residents' rights in long-term care facilities.
   
   
8. The agency shall, at least every 15 months, evaluate all nursing home facilities and make a determination as to the degree of compliance by each licensee with the established rules adopted under this part as a basis for assigning a rating to that facility. The agency shall base its evaluation on the most recent inspection report, taking into consideration findings from other official reports, surveys, interviews, investigations, and inspections. The agency shall assign one of the following ratings to each nursing home: standard, conditional, or superior.
   
   (a) A standard rating means that a facility has no class I or class II deficiencies, has corrected all class III deficiencies within the time established by the agency, and is in substantial compliance at the time of the survey with criteria established under this part, with rules adopted by the agency, and, if applicable, with rules adopted under the Omnibus Budget Reconciliation Act of 1987 (Pub.L. No. 100-203) (December 22, 1987), Title IV (Medicare, Medicaid, and Other Health-Related Programs), Subtitle C (Nursing Home Reform), as amended.
   
   (b) A conditional rating means that a facility, due to the presence of one or more class I or Class II deficiencies, or class III efficiencies not corrected within the time established by the agency, is not in substantial compliance at the time of the survey with criteria established under this part, with rules adopted by the agency, or, if applicable, with rules adopted under the Omnibus Budget Reconciliation Act of 1987 (Pub.L. No. 100-203) (December 22, 1987), Title IV (Medicare, Medicaid, and Other Health-Related Programs), Subtitle C (Nursing Home Reform), as amended. If the facility comes into substantial compliance at the time of the follow-up survey, a standard rating may be issued. A facility assigned a conditional rating at the time of the re-licensure survey may not qualify for consideration for a superior rating until the time of the next subsequent re-licensure survey.
   
   (c) A superior rating means that a facility has no class I or class II deficiencies and has corrected all class III deficiencies within the time established by the agency and is in substantial compliance with the criteria established under this part and the rules adopted by the agency and, if applicable, with rules adopted pursuant to the Omnibus Budget Reconciliation Act of 1987 (Pub.L. No. 100-203) (December 22, 1987), Title IV (Medicare, Medicaid, and Other Health-Related Programs), Subtitle C (Nursing Home Reform), as amended; and the facility exceeds the criteria for a standard rating through enhanced programs and services in the following areas:
   
   
   1. Nursing service.
   2. Dietary or nutritional services.
   3. Physical environment.
   4. Housekeeping and maintenance.
   5. Restorative therapies and self-help activities.
   6. Social services.
   7. Activities and recreational therapy.
   
   (d) In order to facilitate the development of special programs or facility wide initiatives and promote creativity based on the needs and preferences of residents, the areas listed in paragraph (c) may be grouped or addressed individually by the licensee. However, a facility may not qualify for a superior rating if fewer than three programs or initiatives are developed to encompass the required areas.
   
   (e) In determining the rating and evaluating the overall quality of care and services, the agency shall consider the needs and limitations of residents in the facility and the results of interviews and surveys of a representative sampling of residents, families of residents, ombudsman council members in the district in which the facility is located, guardians of residents, and staff of the nursing home facility.
   
   (f) The current rating of each facility must be indicated in bold print on the face of the license. A list of the deficiencies of the facility shall be posted in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to that facility. Licensees receiving a conditional rating for a facility shall prepare, within 10 working days after receiving notice of deficiencies, a plan for correction of all deficiencies and shall submit the plan to the agency for approval. Correction of all deficiencies, within the period approved by the agency, shall result in termination of the conditional rating. Failure to correct the deficiencies within a reasonable period approved by the agency shall be grounds for the imposition of sanctions pursuant to this part.
   
   (g) Each licensee shall post its license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility. A licensee with a superior rating may advertise its rating in any nonpermanent medium and in accordance with rules adopted by the agency. A list of the facilities receiving a superior rating shall be distributed to the state and district ombudsman councils.
   
   (h) Not later than January 1, 1994, the agency shall adopt rules that:
   
   
   1. Establish uniform procedures for the evaluation of facilities.
   2. Provide criteria in the areas referenced in paragraph (c).
   3. Address other areas necessary for carrying out the intent of this section.
   
   (i) A license rated superior shall continue until it is replaced by a rating based on a later survey. A superior rating may be revoked at any time for failure to maintain substantial compliance with criteria established under this part, with rules adopted by the agency, or, if applicable, with rules adopted under the Omnibus Budget Reconciliation Act of 1987 (Pub.L. NO. 100-203) (December 22, 1987), Title IV (Medicare, Medicaid, and Other Heath-Related Programs), Subtitle C (Nursing Home Reform), as amended, or for failure to exceed the criteria specified for any area as listed in paragraph (c).
   
   (j) A superior rating is not transferable to another license, except when an existing facility is being re-licensed in the name of an entity related to the current license holder by common ownership or control and there will be no change in the management, operation, or programs at the facility as a result of the re-licensure.



9. The agency shall adopt rules to provide that, when the criteria established under subsection (2) are not met, such deficiencies shall be classified according to the nature of the deficiency. The agency shall indicate the classification on the face of the notice of deficiencies as follows:
   
   (a) Class I deficiencies are those which the agency determines present an imminent danger to the residents or guests of the nursing home facility or a substantial probability that death or serious physical harm would result there from. The condition of practice constituting a class I violation shall be abated or eliminated immediately, unless a fixed period of time, as determined by the agency, is required for correction. Notwithstanding s. 400.121(2), a class I deficiency is subject to a civil penalty in an amount not less than $5,000 and not exceeding $10,000 for each and every deficiency. A fine may be levied notwithstanding the correction of the deficiency.
   
   (b) Class II deficiencies are those which the agency determines have a direct or immediate relationship to the health, safety, or security of the nursing home facility residents, other than class I deficiencies. A class II deficiency is subject to a civil penalty in an amount not less than $1,000 and not exceeding $5,000 for each and every deficiency. A citation for a class II deficiency shall specify the time within which the deficiency is required to be corrected. If a class II deficiency is corrected within the time specified, no civil penalty shall be imposed unless it is a repeated offense.
   
   (c) Class III deficiencies are those which the agency determines to have an indirect or potential relationship to the health, safety, or security of the nursing home facility residents, other than class I or class II deficiencies. A class III deficiency shall be subject to a civil penalty of not less than $500 and not exceeding $1,000 for each and every deficiency. A citation for a class III deficiency shall specify the time within which the deficiency is required to be corrected. If a class III deficiency is corrected within the time specified, no civil penalty shall be imposed, unless it is a repeated offense.
   
   
10. Civil penalties paid by any licensee under subsection (9) shall be deposited in the Health Care Trust Fund and expended as provided in s. 400.063.
    
    
11. The agency shall approve or disapprove the plans and specifications within 60 days after receipt of the final plans and specifications. The agency may be granted one 15-day extension for the review period, if the director of the agency so approves. If the agency fails to act within the specified time, it shall be deemed to have approved the plans and specifications. When the agency disapproves plans and specifications, it shall set forth in writing the reasons for disapproval. Conferences and consultations may be provided as necessary.



12. The agency is authorized to charge an initial fee of $2,000 for review of plans and construction on all projects, no part of which is refundable. The agency may also collect a fee, not to exceed 1 percent of the estimated construction cost or the actual cost of review, whichever is less, for the portion of the review which encompasses initial review through the initial revised construction document review. The agency is further authorized to collect its actual costs on all subsequent portions of the review and construction inspections. Initial fee payments shall accompany the initial submission of plans and specifications. Any subsequent payment that is due is payable upon receipt of the invoice from the agency. Notwithstanding any other provisions of law to the contrary, all money received by the agency pursuant to the provisions of this section shall be deemed to be trust funds, to be held and applied solely for the operations required under this section.



13. This section may not be used to increase the total Medicaid funding paid as incentive for facilities receiving a superior or standard rating.

1.  Each resident will receive, at the time of admission and as changes are being made and upon request, in a language the resident or his representative understands:
   
   (a) A copy of the residents' bill of rights conforming to the requirements in 400.022, F.S.;
   (b) A copy of the facility's admission and discharge policies; and
   (c) Information regarding advance directives.



2.  Each resident admitted to the facility shall have a contract in accordance with s. 400.151 F.S. which covers:
   
   (a) A list of services and supplies, complete with a list of standard charges, available to the resident, but not covered by the facility's per diem or by Title XVIII and Title XIX of the Social Security Act and of bed reservation and refund policies of the facility.
   
   (b) When a resident is in a facility offering continuing care, and is transferred from independent living or assisted living to the nursing home section, a new contract need not be executed; an addendum may be attached to describe any additional services, supplies or costs not included in the most recent contract that is in effect.



3. No resident who is suffering from a communicable disease shall be admitted or retained unless the medical director or attending physician certifies that adequate or appropriate isolation measures are available to control transmission of the disease.



4. Residents may not be retained in the facility who require services beyond those for which the facility is licensed or has the functional ability to provide as determined by the Medical Director and Director of Nursing in consultation with the facility administrator.



5. Residents shall be assigned to a bedroom area and shall not be assigned bedroom space in common areas except in an emergency. Emergencies shall be documented and shall be for a limited, specified period of time.



6. All resident transfers and discharges shall be in accordance with the facility's policies and procedures, provisions of s. 400.022, F.S. and s. 400.0255, F.S., this rule, and other applicable state and federal laws. The Department of Health and Rehabilitative Services will assist in the arrangement for appropriate continued care, when requested.

1. Each nursing home facility shall adopt, implement, and maintain written policies and procedures governing all services provided in the facility.
   
   
2. All policies and procedures shall be reviewed at least annually and revised as needed with input from, at minimum, the facility Administrator, Medical Director, and Director of Nursing.
   
   
3. Each facility shall maintain policies and procedures in the following areas:
   
   (a) Activities;
   (b) Advance directives;
   (c) Consultant services;
   (d) Death of residents in the facility;
   (e) Dental services;
   (f) Staff education, including HIV/AIDS training;
   (g) Diagnostic services;
   (h) Dietary services;
   (i) Disaster preparedness;
   (k) Housekeeping;
   (l) Infection control;
   (m) Laundry service;
   (n) Loss of power, water, air conditioning or heating;
   (o) Medical director/consultant services;
   (p) Medical records;
   (q) Mental health;
   (r) Nursing services;
   (s) Pastoral services;
   (t) Pharmacy services;
   (u) Podiatry services;
   (v) Resident care planning;
   (w) Resident identification;
   (x) Resident's rights;
   (y) Safety awareness;
   (z) Social services;
   (aa) Specialized rehabilitative and restorative services;
   (bb) Volunteer services; and
   (cc) The reporting of accidents or unusual incidents involving any resident, staff member, volunteer or visitor. These policies shall include reporting within the facility and to the AHCA.

1. Each resident admitted to the nursing home facility shall have a plan of care. The plan of care. The plan of care shall consist of:
   
   (a) Physician's orders, diagnosis, medical history, physical exam and rehabilitative or restorative potential.
   (b) A preliminary nursing evaluation with physician's orders for immediate care, completed on admission.
   (c) A complete, comprehensive, accurate and reproducible assessment of each resident's functional capacity which is standardized in the facility, and is completed within 14 days of the resident's admission to the facility and every twelve months, thereafter. The assessment shall be:
   
   
   1. 1. Reviewed no less than once every 3 months.
   2. 2. Reviewed promptly after a significant change in the resident's physical or mental condition.
   3. 3. Revised as appropriate to assure the continued accuracy of the assessment.


2. The facility is responsible to develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The care plan must describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and social well-being. The care plan must be completed within 7 days after completion of the resident assessment.
   
   
3. At the resident's option, every effort shall be made to include the resident and family or responsible party, including private duty nurse or nursing assistant, in the development, implementation, maintenance and evaluation of the resident plan of care.
   
   
4. All staff personnel who provide care, and at the resident's option, private duty nurses or non employees of the facility, shall be knowledgeable of, and have access to, the resident's plan of care.
   
   
5. A summary of the resident's plan of care and a copy of any advanced directives shall accompany each resident discharged or transferred to another health care facility, licensed under Chapter 400, Part II, F.S., or shall be forwarded to the receiving facility as soon as possible consistent with good medical practice.

1. The facility shall designate a full-time employee as being responsible and accountable for the facility's medical records. If this employee is not a qualified Medical Record Practitioner, then the facility shall have the services of a qualified Medical Record Practitioner on a consultant basis. A qualified Medical Record Practitioner is one who is eligible for a certification as a Registered Record Administrator or an Accredited Record Technician by the American Health Information Management Association or a graduate of a School of Medical Record Science that is accredited jointly by the Council on Medical Education of the American Medical Association and the American Health Information Management Association.
   
   
2. Each medical record shall contain sufficient information to clearly identify the resident, his diagnosis and treatment, and results. Medical records shall be complete, accurate, accessible and systematically organized.
   
   
3. Medical records shall be retained for a period of five years from the date of discharge. In the case of a minor, the record shall be retained for 3 years after a resident reaches legal age under state law.