Florida Administrative Code
65 - DEPARTMENT OF CHILDREN AND FAMILIES
65G - Agency for Persons with Disabilities
Chapter 65G-2 - LICENSURE OF RESIDENTIAL FACILITIES
Section 65G-2.009 - Resident Care and Supervision Standards
Universal Citation: FL Admin Code R 65G-2.009
Current through Reg. 50, No. 187; September 24, 2024
(1) MINIMUM STANDARDS. Residential facility services shall ensure the health and safety of the residents and shall also address the provision of appropriate physical care and supervision.
(a) Each facility shall:
1. Facilitate the implementation of client
support plans, behavior plans, and any other directions from medical or health
care professionals as applicable,
2. Contact the client's support coordinator,
as necessary, to ensure the timely provision of needed medical and dental care;
and,
3. Participate in staff
training and meetings as required by the Agency.
(b) The facility must employ sufficient staff
so that it is not dependent upon the use of volunteers or residents. However,
residents shall be encouraged to perform age and ability appropriate personal
housekeeping chores such as maintaining his or her own quarters. A resident may
also be expected to participate in an independent daily living skills program
which may include the sharing of, or responsibility for, ordinary household
tasks such as meal preparation, grocery shopping, dishwashing, laundering, and
cleaning of common areas of the residence, lawn care, gardening and other tasks
generally performed by a typical family.
(c) The treatment and care of residents shall
be individualized and appropriate to differences in personal goals, abilities,
sex, age, and special needs.
(d)
The facility shall adhere to and protect resident rights and freedoms in
accordance with the Bill of Rights of Persons with Developmental Disabilities,
as provided in Section
393.13, F.S., Violations of
Section 393.13(3)(a),
F.S., relating to humane care, abuse, sexual abuse, neglect, or exploitation
and all violations of Section
393.13(3)(g),
F.S., shall constitute a Class I violation. All other violations of Section
393.13(3),
F.S., shall constitute Class III violations. All violations of Sections
393.13(4)(c)1. and 2., (f), and (g), F.S., shall constitute Class I violations.
All violations of Section
393.13(4)(h),
F.S., shall constitute Class II violations. All other violations of Section
393.13(4),
F.S., shall constitute Class III violations.
(e) The placement of a resident within a
facility shall not be construed as a termination or restriction of the rights
and responsibilities of the parents or guardians. Although not required, it is
recommended that parents, guardians, and other responsible persons organize as
volunteers for the purpose of promoting the welfare of the residents.
(f)
1.
Within the scope of the licensee's responsibility for care and supervision of
residents, the licensee shall ensure that there is appropriate action taken for
a resident's essential care following a resident's medical, dental, therapy or
other health care-related appointments to include scheduling additional
appointments for residents, or assisting residents in scheduling their own
appointments, as well as appropriate training of staff on changes in medication
or dietary regimens, positioning of residents, utilization of specialized
equipment, or any other area which has changed subsequent to any such
appointments that would be within the purview and authority of the licensee to
accomplish. As used in this paragraph "essential care" refers to care and
follow-up measures that are medically necessary or directed by a treating
physician or health care practitioner for the purpose of continuing an ongoing
course of treatment of, or therapy for, a resident's illness, injury, medical
condition or diagnosis until such time as such care and follow-up measures are
no longer directed or recommended by the physician or health care practitioner.
A violation of this paragraph shall constitute a Class I violation.
2. Within the scope of the licensee's
responsibility for care and supervision of residents, the licensee shall ensure
that there is appropriate action taken for a resident's routine or preventive
care following a resident's medical, dental, therapy or other health
care-related appointments to include scheduling additional appointments for
residents, or assisting residents in scheduling their own appointments. As used
in this paragraph "routine or preventive" means care other than essential care
such as routine examinations, annual check-ups, or preventive screenings and
dental care and cleanings. A violation of this paragraph shall constitute a
Class II violation.
(g)
Except as otherwise provided a violation of this subsection shall constitute a
Class III violation.
(2) COMMUNITY RELATIONSHIP AND RECREATIONAL ACTIVITIES. Facilities shall provide opportunities for residents to participate in community activities. A violation of this subsection shall constitute a Class III violation.
(3) TRANSFER AND PLACEMENT OF CLIENTS.
(a) The licensee shall
have written criteria and procedures in place for the admission or termination
of residential services for clients; termination procedures must be consistent
with Chapter 65G-3, F.A.C.
(b) The
facility shall not serve residents unless it can meet their specific
programmatic and physical accessibility needs. The facility must be capable of
effectively and safely meeting the needs of all facility residents accepted for
placement. The licensee shall ensure that the placement of new residents within
the facility does not adversely affect the health, safety, or welfare of
existing facility residents. The licensee must obtain the Agency's approval
prior to any proposed placement that would deviate from the criteria specified
on the facility's application for licensure. The licensee shall notify the
Agency and provide descriptive information on the prospective resident if the
proposed placement involves an individual who is not a client of the
Agency.
(c) Prior to a proposed
transfer of a client from one licensed facility to another, the licensee shall
discuss the transfer and reasons for transfer with the client, the client's
authorized representative (if one has been appointed), support coordinator, the
Agency, and other involved service providers, as appropriate.
(d) A licensee who operates, administers, or
manages more than one foster care facility, group home facility or residential
habilitation center facility must receive approval from the Agency prior to
transferring a client from one of its licensed facilities to another of its
licensed facilities. Prior approval shall not be required in the event of an
emergency in which there is a substantial probability that the health or safety
of the client would be jeopardized in the absence of immediate relocation.
Agency approval or notification is not required when a client is transferred
within a single comprehensive transitional education program (CTEP).
(e) When a client is moved to a new
residential setting, the licensee shall provide any personal belongings of the
client to the client or the client's authorized representative. The property
inventory list completed in accordance with paragraph (g), below, shall be
referenced in order to account for all items.
(f) Prior to placement, and to ensure the
smooth, safe and most effective transition of a new client to the licensee's
facility, the licensee shall:
1. Provide an
opportunity for the referred client and the client's authorized representative
to visit the facility,
2. Cooperate
and assist the Agency, the client's support coordinator, and the client's
authorized representative with the new client's discharge from the former
residential setting; and,
3. Make
needed preparations for the new client, including ensuring that all staff are
made aware of the client's needs, and are properly trained and equipped to meet
those needs.
(g) Upon
placement, an itemized property inventory list accounting for the client's
records, personal funds, serviceable clothing, and any other personal
belongings shall be completed and signed by the licensee and the client or the
client's authorized representative. This inventory record shall be updated
within 30 days to reflect the acquisition of new items and reflect items that
have been discarded, except that new and discarded articles of clothing are not
required to be continually inventoried.
(h) Facilities that plan to use facility
staff to take clients of the Agency out of Florida overnight shall provide
prior notification to the Agency.
(i) The licensee shall cooperate and assist
the Agency, the client's support coordinator, and the client's authorized
representative in ensuring a smooth discharge of clients to other facilities or
residential settings. Within 30 days, unless otherwise approved by the Agency,
the licensee shall transfer all personal funds, medications, records, and
possessions of the resident in the providers possession to the Agency, the
client's support coordinator, the client's authorized representative, or the
receiving facility, as applicable.
(j) A violation of this subsection shall
constitute a Class III violation.
(4) RESIDENT FUNDS. Neither the licensee nor staff employed by the licensee may receive any financial benefit by charging a fee against, borrowing, or otherwise using the personal funds of a client for their personal benefit.
(a) The licensee shall maintain written
receipts for purchases made with clients funds, valued at $25.00 or more for at
least one year following the date of purchase.
(b) A record of income and expenditures from
each client's personal funds shall be maintained in accordance with generally
accepted accounting principles.
(c)
The available amount of each client's personal funds must reconcile with the
most recent ending balance which is recorded within the licensee's record of
client income and expenditures.
(d)
The licensee shall maintain a checking or savings account for the personal
funds of clients. If a single account is maintained for multiple clients, a
separate accounting must be maintained for each individual client that
reconciles monthly to the account's total, as noted on the bank statement, and
shall be retained by the provider for review by the Agency. With the exception
of the facility's other residents, the personal funds of clients must not be
co-mingled with the funds of any other person or entity, including those of the
licensee or staff.
(e) Each
client's individual accounting must include:
1. The group home facility's name and
address,
2. The client's name,
3. The client's ending balance for
the previous month,
4. The month
and year for the accounting form,
5. The date and amount of all deposits and
withdrawals,
6. The account balance
following each deposit or withdrawal,
7. A brief statement of the purpose or reason
for each deposit and withdrawal,
8.
The name and signature of the staff member that completed each deposit or
withdrawal,
9. The client's
signature, in any instance where money has been withdrawn for the client to use
at his or her own discretion; and,
10. The ending balance for the
month.
(f) Each licensee
must maintain this client accounting information on Agency form APD 2014-09,
(effective April 1, 2014), which is incorporated herein by reference, or in an
alternative format that includes all required information contained in the form
and tracks all of the information required in paragraph
65G-2.009(4)(e),
F.A.C. A copy of this form may be obtained from the Regional Office. The client
accounting records shall be kept on the premises or maintained electronically
and in a central location. Relevant current financial information, such as the
account balance and a supply of funds, shall be maintained and secured in each
facility to allow for purchases and other client or guardian-authorized uses of
resident funds. All records shall be made available, as requested by Agency
staff for inspection and monitoring purposes.
(g) A violation of this subsection shall
constitute a Class II violation.
(5) CLIENT RECORDS. The facility shall establish and maintain an individual record for each client on the premises. The record shall contain information pertinent to the resident's health, supervision, and care. The records may be maintained electronically.
(a) The record shall be the property of the
client and shall remain with the client in the event the client moves to a
different facility or the facility has a change in providers. However, in
accordance with HIPAA, the licensee shall retain a copy of the records for six
years, which shall be made available to the Agency for surveying, monitoring
and inspection purposes. The licensee is solely responsible for the costs of
reproduction of client records for the purposes of this subsection.
(b) At a minimum, the client records shall
include:
1. The client's name and date of
birth,
2. The name, addresses and
telephone number of the client's physician and dentist,
3. Contact information for the client's
authorized representative and support coordinator,
4. Client or authorized representative
authorization for routine medical or dental care,
5. Medical and dental reports, including any
examination results and laboratory findings, if received by the facility, and
the client's medication history and any special instructions for carrying,
lifting, positioning, bathing, assisting with meals or other aspects of
personal care,
6. The resident's
legal competency, guardianship status, and the identification of any authorized
representatives,
7. If applicable,
a copy of the client's current support plan, as supplied by the client's
support coordinator, and any other applicable plans such as an implementation
plan; or behavior plan,
8. Property
inventory list,
9. Incident reports
directly involving the client; and,
10. A color photograph of the client taken
within the past five years.
(c) The records shall be current to the
greatest extent possible and updated at least 30 days following receipt of new
information. If any of the required information is not available, the licensee
shall include written documentation in the record that a diligent effort was
made to obtain the missing information.
(d) Client records shall be kept confidential
in accordance with Section
393.13, F.S.
(e) A violation of this subsection shall
constitute a Class III violation.
(6) RESIDENT SUPERVISION.
(a) Each facility must provide the level of
supervision necessary to ensure that residents are protected from harm and that
a safe and healthy living environment is created and maintained. Direct service
providers must be given specific information and strategies to provide such an
environment for all of residents of the facility. To the maximum extent
possible, however, the facility shall respect the rights of residents to
privacy and self-determination.
(b)
At least one staff person must be present at all times while clients are in the
facility. The only exception would be if the licensee prepares a written plan
proposing that a specified client be left alone for limited periods of time
during the day or night. Such plans must be approved by the Regional Office
prior to implementation. In granting plan approval, the Agency shall consider
the needs, characteristics, and abilities of the resident and the proposed
circumstances under which the resident will be left alone. Non-compliance with
the approved plans may result in the imposition of administrative fines, the
suspension or revocation of such plans, or other administrative actions as
appropriate.
(c) A violation of
this subsection shall constitute a Class I violation.
(7) VIDEO MONITORING.
(a) The use of video cameras for the purposes
of visually monitoring residents is permitted when necessary to assist in the
behavioral or medical monitoring, diagnosis, intervention or treatment of
residents who require ongoing and continuous supervision due to intensive
medical and/or behavioral programmatic issues or if the licensee intends to use
the monitoring as a means by which to prevent or detect abuse, neglect,
exploitation, or sexual misconduct. Any providers that utilize a video
monitoring system shall develop written criteria for determining which
residents will be monitored by video camera, and protocols for implementing
video monitoring.
(b) Monitoring
shall be permitted only with the written consent of the resident, if competent,
or the resident's authorized representative. The facility must explain when and
where monitoring will occur and the purposes of the monitoring
system.
(c) The titles and
positions of all persons authorized to access video feeds at off-site locations
must be disclosed to the Agency. Such remote access must be accompanied by
safeguards, such as firewalls and other security measures, sufficient to ensure
resident privacy.
(d) The use of
remote interactive video monitoring shall be limited to vocational and
educational settings, medical and special treatment spaces, administrative
offices, or common areas. Remote interactive video monitoring may not be used
in bedrooms or bathrooms.
(e) The
Agency reserves the right to preclude, restrict, or suspend a facility's
authority to conduct video monitoring pursuant to this subsection at any time
if the Agency determines that any of the provisions of this subsection or of
Section 393.13, F.S., have been
violated.
(f) A violation of this
subsection shall constitute a Class II violation.
(8) BEHAVIORAL INTERVENTIONS AND RESPONSES TO BEHAVIORAL ISSUES INVOLVING RESIDENTS.
(a) The
facility shall have a written statement of policies and procedures governing
actions that may be taken by direct service providers to help prevent or
respond to problematic behaviors exhibited by residents. Such policies and
procedures, as well as any actions taken by direct service providers involving
residents of the facility, shall include emergency procedures, reporting
requirements, and be consistent with the provisions of Section
393.13, F.S., as well as
Chapters 65G-4 and 65G-8, F.A.C. A violation of this paragraph shall constitute
a Class II violation.
(b) Direct
service providers shall be trained in responding to serious and spontaneous
behavioral incidents requiring emergency intervention procedures. A violation
of this paragraph shall constitute a Class II violation.
(c) Emergency intervention procedures that
use restraint or seclusion, or cause physical discomfort require approval from
the Local Review Committee prior to implementation. A violation of this
paragraph shall constitute a Class II violation.
(d) The following responses are strictly
forbidden:
1. Physical or corporal punishment
that includes but is not limited to hitting, slapping, smacking, pinching,
paddling, pulling hair, pushing or shoving residents,
2. The use of noxious substances, which
include painful or aversive stimuli used to control behavior such as pepper on
tongue, squirt of lemon juice, ammonia inhalants, or electric shock,
3. Verbal abuse such as cursing at residents,
using slurs or derogatory names, or screaming, or
4. Humiliation, such as keeping a resident in
wet or soiled clothing or diapers, making the resident stand in front of others
to be ridiculed, or making the resident wear a sign or dunce cap, placing
residents in dark or locked time-out rooms.
A violation of this paragraph shall constitute a Class I violation.
(9) SEXUAL ACTIVITY.
(a) The licensee shall develop and enforce a
written policy regarding sexual activity involving residents of the facility.
Such policy must explicitly prohibit sexual activity between a resident and a
covered person and any sexual activity that involves residents who are under
the age of eighteen. Such policy shall not in any way abridge nor restrict the
civil and legal rights of persons with developmental disabilities, including
those specified within Section
393.13, F.S.
(b) The licensee shall provide direct service
providers with training regarding the licensee's policy regarding sexual
activity involving residents of the facility. The policy shall address
appropriate physical boundaries and standards among direct service providers
and residents and must include the following elements:
1. Physical affection between direct service
providers and residents should be brief, age appropriate, and should avoid
bodily contact, such as lying together or sitting on laps, unless such
affection is appropriate and clinically indicated based upon the context, such
as consoling a grieving resident upon the death of a loved one, nurturing a
young child recently separated from their family, or comforting a resident
recovering from surgery,
2. A dress
code, for both residents and direct service providers, shall be established
which outlines the type of clothing that is acceptable, and where and under
what circumstances it is acceptable,
3. Direct service providers and residents
must respect personal space, such as knocking before entering a bedroom except
as may be necessary for residents who require visual supervision due to
documented behavioral or medical issues. A violation of this subparagraph
constitutes a Class III violation,
4. The licensee shall limit access to
bedrooms by establishing and enforcing house rules on who is allowed to visit
whose bedroom and under what conditions,
5. All residents and direct service providers
shall sleep in separate beds,
6. A
provision which permits direct service providers to assist or supervise
residents while the resident bathes, showers, or toilets, if the resident
requires assistance or supervision, and which prohibits staff from bathing,
showering, or toileting simultaneously with the resident under any
circumstances,
7. Guidelines
concerning the level and type of supervision required for residents and all
direct service providers shall be familiar with such guidelines,
8. Open communication among residents and
direct service providers about events occurring in the facility in order to
encourage reporting of incidents of inappropriate sexual
behavior.
(c) The
following safeguards shall be implemented in any facility which serves one or
more sexually aggressive residents:
1. All
direct service providers shall review all available written, detailed and
complete information related to sexually aggressive residents in order to
prevent the occurrence of sexual abuse incidents. When available to the
licensee, such information provided to staff must include, but is not limited
to, the date of the sexual abuse incident, type of abuse, brief narrative
outlining the event, type of treatment the resident received and the outcome of
the treatment. If the resident is currently in treatment, the licensee shall
maintain contact information for the treatment provider,
2. Newly placed sexually aggressive residents
shall be provided visual supervision at all times the resident is awake during
the resident's first twenty-four (24) hours in the facility,
3. A sexually aggressive resident must not be
allowed to share a bedroom with another resident without Agency approval. Such
approvals shall take into consideration the licensee's plan to assure
supervision sufficient to ensure the safety of residents,
4. Known sexually aggressive residents who
are minors shall never be left alone with other residents in a bedroom or
bathroom behind closed doors. Only one resident may use the bathroom at any
time that the bathroom door is closed; and,
5. Residents who are minors are not permitted
to possess obscene materials as defined in Section
847.001, F.S., on the
premises.
(d) Except as
otherwise provided, a violation of this subsection shall constitute a Class I
violation.
(10) SOLICITATION ACTIVITIES. The licensee must have the written permission of the client, if competent, or the client's authorized representative prior to using the client, the client's name, picture, or disability for the purpose of securing donations. A violation of this subsection shall constitute a Class III violation.
(11) FIRST AID. The facility shall have on the premises an American Red Cross-approved first aid kit. The first aid kit shall be maintained in places known to and readily available to all direct service providers. Potentially toxic materials contained within first aid kits should be stored in a manner which does not pose a risk to residents. A violation of this subsection shall constitute a Class III violation.
(12) MEDICATION.
(a) Medication shall be administered to
clients in accordance with the written order or prescription issued by an
individual's health care practitioner. Ongoing staff re-training and competency
based verification of skills shall be provided when there is evidence of
medication errors to correct staff practices and prevent future occurrences. A
violation of this paragraph resulting in a direct, negative impact to the
health and safety of the individual, or presenting an imminent danger to the
individual shall constitute a Class I violation.
(b) All prescription medication shall be kept
in its original container bearing the original dated label with legible
information stating the prescription number, direction for use, client's name,
physician's name, and address of the issuing pharmacy.
(c) Medication shall be kept in a locked
enclosure.
(d) A client, whom the
physician has deemed capable of handling his/her own medications, should be
encouraged to do so. Staff shall assist the client by making the medication
available and reminding the client to take medication at appropriate
times.
(e) The licensee must
maintain an up-to-date and accurate daily record of prescription and/or
nonprescription medication administered to clients in accordance with the
provisions of Chapter 65G-7, F.A.C.
(f) The administration of medication to
residents, as well as the documentation of administration of such medication,
medication storage, and error reporting shall be performed in accordance with
Sections 393.13 and
393.506, F.S., Chapter 65G-7,
F.A.C., and this rule chapter.
(g)
If the licensee or a direct service provider observes or receives reports from
other individuals that a client may have experienced an adverse reaction to an
administered medication, such information must be conveyed immediately to
either the prescribing physician or the licensed medical professional employed
by the licensee who has been charged with the responsibility of securing
appropriate medical treatment for residents with health-related issues or
concerns. If either the prescribing physician or medical professional employed
by the licensee is unable to be reached, facility staff shall immediately seek
medical attention for the resident. A violation of this paragraph shall
constitute a Class I violation.
(h)
With the exception of paragraphs (a) and (g), a violation of this subsection
shall constitute a Class II violation.
(13) SPECIALIZED EQUIPMENT. The licensee shall ensure that all direct service providers have been trained and are competent in the proper application, monitoring, and removal of specialized equipment worn by residents, including but not limited to Ankle-Foot Orthoses (AFOs), leg braces, arm splints, neck collars, helmets, and safety belts. In addition, direct service providers shall be knowledgeable in the proper operation of other specialized equipment required by residents such as wheelchairs, lifts, and positioning devices. The licensee shall contact the appropriate support coordinator(s) as soon as significant signs of wear and tear are noticed on specialized equipment used by the residents. A violation of this subsection shall constitute a Class III violation.
(14) TRANSPORTATION.
(a) The facility shall provide or arrange for
the incidental transportation of residents within the community as a typical
household would provide for its members. This shall include, but is not limited
to, trips to malls, grocery stores, religious worship services, medical or
dental appointments, and recreational outings within the surrounding community.
These trips shall be provided by the facility at no cost to the residents
unless such trips involve destinations which are more than 25 miles from the
facility.
(b) Any vehicle operated
by the facility in which residents are transported shall have a current license
plate, carry at least the minimum insurance coverage required by state law,
contain a working and tagged fire extinguisher, be operated by a driver holding
an appropriate valid driver's license, have working seatbelts and wheelchair
tie-downs when applicable, have working heat and air conditioning, and be
maintained in a manner to ensure safe transport.
(c) The number of transported residents not
seated in wheelchairs during the trip shall not exceed the number of available
seats in the vehicle.
(d) Residents
shall be encouraged to use public transportation in areas where it is available
and appropriate to the residents' ability.
(e) Residents may not be left unattended in
any vehicle operated by the facility. A violation of this paragraph shall
constitute a Class I violation.
(f)
With the exception of paragraph (e), a violation of this subsection shall
constitute a Class II violation.
(15) COMMUNICATION AMONG STAFF. A facility shall have a system in place to communicate recent incidents and client information to staff working on subsequent shifts.
(a) The system shall include a mechanism for
documenting in writing, any and all information, such as medical or behavioral
incidents or physician or therapist orders or recommendations, of which staff
should be made aware and which could potentially affect the residents' health
or safety if staff were unaware of such information.
(b) The system established shall include a
procedure or mechanism to assure that the information described in this
subsection is reviewed across all shifts.
(c) Such communication-related documentation
shall be maintained within the facility for a least one year following each
entry and may be maintained electronically. The information shall be made
available to the Agency during inspections.
(d) A violation of this subsection shall
constitute a Class III violation.
Rulemaking Authority 393.501(1), 393.067, 393.506 FS. Law Implemented 393.067, 393.13, 393.135, 393.506 FS.
New 7-1-14.
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