Nursing Home Administrator Licensure Exam Review Course PDF

NURSING HOME ADMINISTRATOR LICENSURE EXAM REVIEW COURSE  Florida Exam ◘ MODULE 6 reference Ch. 400...

NURSING HOME ADMINISTRATOR LICENSURE EXAM REVIEW COURSE  Florida Exam ◘ MODULE 6 reference Ch. 400 Nursing Home Administration  Speed Reader Examination 1 Examination 2 Examination 3 Examination 4 Examination 5 Examination 6 Stan Mucinic, LNHA Examprofessional.net [email protected] 561 255 8213 Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 1 of 39  LEGAL NOTICES Students enrolled in the “Florida Nursing Home Administrator Licensing Course” are purchasing the professional knowledge of the instructor to assist the student to prepare for the State Laws and Rules Exam administered by the National Association of Boards of Examiners (NAB). This is a 3-week intensive independent study program designed to provide students a unique personalized and structured learning environment where progress is monitored by the instructor through email to help students maintain focus and complete scheduled assignments timely. THE INSTRUCTOR MAKES NO EXPRESS OR IMPLIED WARRANTY OR REPRESENTATION OF ANY KIND THAT COMPLETION OF THIS OR ANY LICENSURE PREPARATION COURSE OFFERED BY INSTRUCTOR WILL GUARANTEE A PASSING SCORE ON ANY LICENSING EXAM. An individual’s ultimate success in passing the licensure exam is dependent on an individual’s professional experience, academic preparation, and the time and energy the individual can commit to exam study and preparation. A student’s work schedule or other commitments may require more time to prepare for an exam than allotted by NAB or state licensing boards. The student is solely responsible for licensing exam registration/testing and retesting fees. HOW TO USE THE STUDY GUIDES Step 1 – VERY IMPORTANT - The personalized test organizer that comes with the program is the key to your success and sets this program apart from any other. It is critical you follow the instructions and score each exam, and file the completed exams into your binder. Try to keep to the schedule and email your test results to the instructor to stay focused. Step 2. - Speed Reader – Read the speed reader for each module once or twice before taking the module exam(s). Read the speed reader over and over again until you familiarize yourself with its contents. THE MORE TIMES YOU LOOK IT THE MORE LIKELY YOU ARE TO REMEMBER IT. Step 3 – Exam Packet - The exam packet contains questions designed to measure your comprehension and retention of the material you read. Take each exam over and over again until you score 100%. Make sure you score each exam and record the results in your organizer or you will not be able to gauge your progress. Contact Information Email Stan Mucinic at [email protected] with any questions and after you score each practice exam Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 2 of 39  SECTION 1 - INTENT 1.1 - INTENT 1. The intent of Chapter 400 and Rule 59A-4 is to establish and enforce basic standards of treatment and care of residents in nursing facilities SECTION 2 - ADMINISTRATION 2.1 - DEFINITIONS 1. “Administrator" is the licensed individual with day- to-day administrative charge of a facility 2. "Agency" means the Agency for Health Care Administration (AHCA) 3. “Department” means the Department of Health (licenses nursing homes) 4. "Board" means the Board of Nursing Home Administrators (licenses administrators) 5. "Controlling interest" means an officer, a director or person with 5 percent or greater ownership interest in a facility or management company that operates a facility 6. "Facility" means any entity providing nursing, custodial or personal care exceeding 24-hours (in-patient care) for 3 or more persons, not related to the owner or manager by blood or marriage, and require nursing services due to illness, physical infirmity, or advanced age 7. Nursing home bed" means an accommodation (including necessary equipment and furnishings) immediately available or can be ready for occupancy within 48 hours 8. Nursing home facility" means any facility which provides nursing services 9. “Voluntary board member" means a director of a not-for-profit corporation or organization serving in a voluntary capacity and does not receive any remuneration 2.2 - LICENSED NURSING HOME ADMINISTRATOR REQUIRED 1. Every nursing home must be managed by a currently licensed nursing home administrator 2.3 – RESPONSIBILITIES OF LICENSEE 1. The licensee (owner, corporate body) has full legal responsibility for the operation of the facility 2. The licensee must hire a licensed administrator to manage the day-to-day operation of a facility 3. The facility must be organized according to a written table of organization 4. A vacant bed report must be submitted to AHCA monthly 5. A nursing home staffing report must be submitted to AHCA quarterly 2.4- LONG TERM CARE IMPROVEMENT FUND 1. The state’s Quality of Long-Term Care Facility Improvement Trust Fund supports activities and programs directly related to improving resident care (dementia training) 2.5 – LEVEL 2 BACKGROUND SCREENING REQUIREMENTS 1. Level 2 Screening a) All employees are subject to a level 2 background check involves an FBI fingerprint check b) Fingerprints must be collected electronically and then submitted to the Florida Department of Law Enforcement (FDLE) c) The FDLE submits the fingerprints to the FBI 2. All Employees must have a Level 2 Background Screening including the following: A. The licensee, if an individual. B. The administrator or the person responsible for day-to-day operation of the facility C. The financial officer responsible for the financial operation of the facility D. Any person who is a controlling interest if the agency has reason to believe that such person has been convicted of any prohibited offense E. Any employee or contractor who will provide personal care or services directly to residents or have access to resident funds, personal property, or living areas Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 3 of 39  3. Disqualifying Offenses/Convictions Murder or homicide Sexual misconduct Assault or battery on elderly person/child Prostitution or indecent exposure Domestic Violence Arson Abuse of elderly adult or child Fraudulent insurance claims Theft or robbery Medicaid provider fraud. Medicaid fraud. Fraud in obtaining medicinal drugs Kidnapping or false imprisonment 4. Conditional Work Status a. An individual may start work before their background results are finalized but cannot have contact with residents. 5. Re-Screening: A) Each employee must be re-screened every 5 years to continue employment 2.6 – ACCOUNTING SYSTEM 1. The facility must maintain required fiscal records and make them available for state/federal audit 2. Must use either an accrual or cash system of accounting 3. General ledgers and disbursement journals must be brought current no less than quarterly 2.7 - RESIDENT SERVICES CONTRACT 1. Each resident must receive, at the time of admission and as changes are made, in a language the resident or his representative understands the following: a) The residents’ Bill of Rights b) The facility’s admission and discharge policies; and c) Information regarding advance directives 2.7 - RESIDENT SERVICES CONTRACT 2. Each resident must have a contract detailing services and charges, refunds and the facility bedhold policy 3. Residents must be fully informed, both in writing and orally, prior to or upon admission, of all available services and charges covered and not covered by Medicaid and Medicare 4. The resident contract must be retained for 5 years for adult residents and for years past the age of majority for minors 5. A resident in a continuing care community transferred from independent to skilled nursing does not need a new contract but an addendum must be attached describing the additional costs 6. Must provide an interpreter if needed 7. Need a new contract if the payor source changes 8. Each party to a contract is entitled to a copy of such contract 9. The facility must keep a copy of all contracts with each resident 10. Microfilmed records of original contracts can be retained in place of the original 11. Must give residents both written and oral notice, 14 days in advance, of any changes to the resident contract 2.8 – RESIDENT FUNDS AND PROPERTY 1. Residents have the right to manage their own financial affairs or delegate such responsibility to the facility (per written agreement to hold funds in trust) 2. Cannot require residents to deposit personal funds with the facility. 3. A facility must manage resident personal funds if requested by a resident 4. A facility must maintain a complete, and separate accounting of each resident’s personal funds 5. A facility cannot commingle (mix) resident funds with facility funds 6. A facility must provide residents or other parties a quarterly accounting of all transactions in the trust fund Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 4 of 39  7. A facility may not charge residents for items or services paid for by Medicare or Medicaid 8. Facility staff cannot be designated a legal representative for a resident or their property 9. A facility must provide safekeeping of personal funds and property of residents 10. A facility may require residents to remove valuables from the facility (jewels, etc.) 11. A facility may require resident's to mark their personal property with the resident's name 12. Any theft or loss of a resident's personal property must be documented by the facility 13. Must have policies to minimize theft or loss of resident personal property 14. Policies must be provided to every employee and each resident within 30 days of admission 15. Must disclose that the theft or loss of anyresident's property will be reported to law enforcement and any facility waiver of liability for loss or theft 16. The facility must post notice of all policies in places accessible to residents 17. The facility can impose a charge on resident funds for any item or service requested by the resident and not paid for by Medicare or insurance 2.9 – INTEREST BEARING ACCOUNT 1. Medicaid Resident Trust Fund a) Funds deposited in the resident trust fund for Medicaid residents (includes all payor sources) totaling more than $50 must be deposited in interest-bearing account B) Funds totaling less than $50 can be deposited in non-interest bearing account 2. Medicare Resident C) FUNDS DEPOSITED IN THE RESIDENT TRUST FUND FOR A MEDICARE RESIDENT IN EXCESS OF $100 MUST BE DEPOSITED IN AN INTEREST BEARING ACCOUNT 2.10 – DECEASED RESIDENT FUNDS AND PROPERTY 1. Must refund all funds and provide a final accounting within 30 days of a resident’s death to the personal representative (or spouse or next of kin named in the beneficiary designation form) 2. Must return all property of deceased residents (can deduct monies owed facility for services and charges not included in Medicare or Medicaid per diem rate such as newspaper delivery, private room rate) 3. If there is no spouse or next of kin, must deposit funds in an interest-bearing account until disbursed by a probate court, or if not disbursed in 2 years, then deposited in the resident protection trust fund 4. Must keep deceased resident’s property separate from the funds and property of other residents 5. Deceased Resident Funds – If no spouse or next of kin must deposit the funds into a bank as follows: A. Under $100 1) Maintain one account for all deceased residents whose funds total less than $100 2) Maintain account records to compile interest due each individual account B. Over $100 1. Maintain a separate account for each deceased resident with more than $100 2. Deposit funds in resident protection trust fund not disbursed within 2 years 2.11 – RESIDENT FUNDS SURETY BOND 1. Must obtain a surety bond equal to 2x the average monthly balance in the resident trust fund during the prior fiscal year or $5,000, whichever is greater 2. A licensee who owns more than one facility may purchase a single surety bond to cover resident funds held in homes located in same AHCA service district 3. The Surety must notify AHCA 30 days in advance if a facility cancels the surety bond 4. Self-insurance pool – a facility may self insure in lieu of a surety bond by: a) Pooling together with other facilities to establish an interest bearing account that must be administered by an elected board of trustees b) The board of trustees must be composed of one representative from each participating facility Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 5 of 39  c) Each member in the pool must deposit 2x the average monthly balance of the trust fund account or $5,000.00 dollars, whichever is greater, in a separate account maintained by the board of trustees in the name of the self-insurance pool in a chartered commercial bank in the state of Florida d) The self-insurance pool compensates any resident suffering financial loss as the result of misconduct by facility staff in handling the residents funds deposited into the trust fund 5. If a facility does not have a surety bond or is not a member of a self insurance pool, and is requested to hold funds in trust by a resident, the facility must notify AHCA, in writing, of the request, and make application for a surety bond or for participation in a self-insurance agreement within 7 days of the request, exclusive of weekends and holidays 2.12 – FACILITY POLICIES 1. Must have policies and procedures governing all services provided in the facility 2. Policies and procedures are reviewed at least annually by the administrator, medical director, and the DON 3. Must maintain policies and procedures regarding the death of residents in the facility. 2.13 – RESIDENT SCREENING, ADMISSION AND RETENTION 1. A resident with a communicable disease cannot be admitted or retained unless the medical director or attending physician certify adequate or appropriate isolation measures are available to control transmission of the disease 2. Residents may not be retained in the facility who require services beyond the services the facility is licensed or has the functional ability to provide as determined by the medical director and the director of nursing in consultation with the facility administrator 2.14 – RESIDENT BEDROOMS 1. Residents must be assigned to a bedroom area and cannot be assigned bedroom space in common areas except in an emergency 2. Emergencies requiring residents to be located in common areas must be documented and for a limited period of time 2.15 - STAFF EDUCATION 1. Must have a written staff education plan for all facility employees. 2. The staff education plan must be reviewed annually by the quality assurance committee 3. Must include both pre-service and in-service programs 4. The staff education plan must ensure that staff education is conducted annually for all facility employees, at a minimum, in the following areas: a) Prevention and control of infection b) Fire prevention, life safety, and disaster preparedness c) Accident prevention and safety awareness program d) Resident’s rights e) Florida “right to know” hazardous materials f) HIV/aids (if the employee does not have a certificate of completion when hired, must have 2 hours within 6 months of employment or before they provide care to AIDS resident) g) All employees must have a minimum of one hour of HIV/AIDS biennially 2.16 - ADVANCE DIRECTIVES. 1. Must have written policies and procedures regarding advanced directives 2. Cannot condition treatment or admission on the execution of an advance directive 3. Must provide on admission a copy of the “health care advance directive” 4. Must provide on admission and in writing the facilities policies on advance directives 5. Must document the existence of an advance directive in the medical record 6. Must place a copy of the advanced directive in the medical record 7. IF A FACILITY FAILS TO HONOR AN ADVANCED DIRECTIVE, THE REISDENT OR THEIR ESATTE CAN SUE THE FACILITY IN A COURT OF COMPETENT JURISDICTION Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 6 of 39  2.17 - EMPLOYEE UNION ACTIVITY 1. Participation by an employee in any activity that promotes or discourages union organizing is not allowed during the time the employee is counted in staffing calculations for minimum staffing standards 2. Salaries or expenses paid by any health care provider to an employee for any activity that promotes or discourages union organizing is not an allowable cost for Medicaid cost reporting purposes 2.18 - GENERAL AND PROFESSIONAL LIABILITY INSURANCE 1. Must maintain general and professional liability insurance coverage in force at all times 2.19 – AHCA POSTER 1. Must display an AHCA poster in the facility with contact information for AHCA, the Ombudsman, other advocacy groups and an explanation of available services 2.20 - VOLUNTEERS 1. The facility is responsible for activities of volunteers and may require: a) Volunteers to sign in and out b) Wear an identification badge c) Participate in a facility orientation and training program. 2.21 – RESIDENT BILLING 1. Initial Bill a) Must contain a statement of specific services received and expenses incurred b) Must detail the services received within each department with unit price data 2. Prohibited Billing Practices a) Must not include charges of nursing home-based physicians if billed separately. b) Must not include any generalized category of expenses such as "other" or "miscellaneous" c) Must not refer to a drug code number when referring to drugs of any sort. d) Must not add any charges to services charged by a third party 3. Permitted Billing Practices a) May list drugs by brand or generic name b) May specifically identify therapy treatment by date, type, and length c) May fully disclose each charge and service provided d) May add handling charges for services performed by a third party and billed through the facility 4. Discharge/Final Bill a) Within 7 days after discharge or the date the cost of goods or services are actually billed to the facility, the facility must send the resident an itemized statement with specific charges incurred by the resident 5. Required Legend a) Billing statements must have the words "A FOR-PROFIT (or NOT-FOR-PROFIT or PUBLIC) NURSING HOME LICENSED BY THE STATE OF FLORIDA" or substantially similar words to identify facility ownership 2.22 – LIMIT TO ADVANCED PAYMENTS 1. Advanced payment by residents for care may at no time exceed the cost of care for a 6-month period 2.23 – WITHHOLDING CPR 1. Staff may withhold cardiopulmonary resuscitation per an order not to resuscitate 2. Staff withholding CPR per a DNRO are not subject to civil liability or criminal prosecution 3. Absent an order not to resuscitate, a physician can still withhold or withdraw cardiopulmonary resuscitation if otherwise permitted by law Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 7 of 39 2.24 – MEDICAID UP OR OUT PROGRAM 1. The purpose is to monitor Medicaid recipients in poor-performing nursing homes with numerous lawsuits to improve quality of care or revoke the facility’s license 2. Trained medical staff must frequently visit these facilities, investigate complaints, and oversee care 3. AHCA must assist residents in poor performing facilities who want to transfer to another facility SECTION 3 – RESIDENT RIGHTS 3.1 - STATEMENT OF RESIDENT RIGHTS 1. Each facility must adopt and make public a statement of the residents’ rights and responsibilities in the facility 2. The statement of resident rights must be posted in the facility 3. Must have a written plan and provide staff training to implement these rights 4. The written statement of rights must include a statement that a resident may file a complaint with AHCA or the Ombudsman 5. The statement must be in boldfaced type and must include the name, address, and telephone numbers of the local ombudsman council and the central abuse hotline where complaints may be lodged. 3.2 - CIVIL AND RELIGIOUS FREEDOMS 1. The right to civil and religious liberties 2. Knowledge of available choices and the right to independent personal decision 3. Right to encouragement from the staff in exercising their rights to the fullest 4. The right to be treated courteously, fairly, and with the fullest measure of dignity 5. 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 6. A copy of the facility rules and regulations and an explanation of a resident’s responsibility to obey all reasonable rules and regulations and respect the personal rights and private property of other residents 7. A resident may retain and use personal clothing and possessions as space permits, unless it infringes on the rights of others or is medically contraindicated 8. Clothing provided to the resident by the facility must be of reasonable fit 9. Be free from restraint, interference, coercion, discrimination, or reprisal 10. Participate in advocacy or special interest groups to improve care 11. The right to organize and participate in resident groups in the facility 12. The right to have the resident's family meet in the facility with the families of other residents 13. Participate in social, religious, and community activities that do not interfere with the rights of others 14. Right to participate in community-based activities programs, unless medically contraindicated as documented by their physician in resident's medical record 3.3 – ACCESS TO RESIDENTS/VISITATION Residents have the right to the following: 1. To visit with any person of the resident's choice during visiting hours 2. To overnight visitation outside the facility with family and friends per facility policies, physician orders, and Medicare and Medicaid rules, without losing his or her bed 3. To facility visiting hours that are flexible (out-of-town visitors, working relatives or friends) 4. To visits from recognized volunteer groups, community-based legal, social, mental health, and leisure programs, and members of the clergy with resident’s consent 5. Access to any entity or individual that provides health, social, legal, or other services to a resident has the right to reasonable access to the resident 6. To deny or withdraw consent to access at any time by any entity or individual. 7. To immediate access to the resident by the following by law:: a) Any representative of the federal or state government, including: b) The Department of Children and Family Services c) The Department of Health (AHCA) d) The Office of the Attorney General Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 8 of 39  e) The Department of Elderly Affairs f) The Law enforcement officer g) The Ombudsman h) The Resident's individual physician 8. To deny or withdraw consent to visits by immediate family or relatives 3.4 - OMBUDSMAN REVIEW OF RESIDENT RECORDS 1. The facility may allow the Ombudsman to examine a resident's clinical records only with the resident’s consent 3.5 - INFORMED CONSENT 1. Must adequately inform residents of their medical condition and proposed treatment, treatment alternatives, health risks and changes in treatment 2. Residents must consent to all medical treatment 3. Treating an individual without consent is a civil tort and criminal battery 4. The right to participate in the planning of all medical treatment, the right to refuse medication and treatment, unless otherwise indicated by the resident's physician; and to know the consequences of such actions. 3.6 – REFUSAL OF MEDICATION/TREATMENT 1. Residents have the right to refuse medical treatment and medication a) If a resident refuses treatment the facility must do the following 1) Ascertain what the patient is refusing and inform them of the consequences of such refusal 2) Inform residents of alternative treatments 3) Notify the physician of their refusal 4) Document action taken by staff 5) Provide all other treatment not refused in accordance with the care plan 3.7 – RIGHT TO NECESSARY SERVICES 1. Residents have the right to receive adequate health care and protective and support services, including social and mental health services, planned recreational activities, therapeutic and rehabilitative services consistent with the resident care plan 3.8 – PRIVACY IN TREATMENT 1. Right to privacy in treatment and in caring for personal needs 2. Staff must close the door to the resident room 3. Staff must knock before entering a room 4. Must provide secure storage for personal possessions 5. Privacy of the resident's body must be maintained when toileting, bathing, changing clothes and other activities of personal hygiene by closing doors, drawing privacy curtain, closing blinds, covering body as much as possible, and exposing a resident to only minimal personnel necessary to provide care. 3.9 – PRIVACY IN COMMUNICATION 1. The right to private and uncensored communication 2. The right to receive and send unopened correspondence 3. Access to a telephone 4. The right to speak with others on the phone or in person without staff standing within earshot of the conversation 5. The right to a cordless phone or phone jack in their room to provide them privacy 6. Staff must provide private space for family and guests to meet with residents Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 9 of 39 3.10 – BED RESERVATION/ROOMMATE CHANGE 1. "Bed reservation policy" means the number of consecutive days a resident may leave a facility for overnight therapeutic visits with family or friends or hospitalization before the facility can discharge the resident due such absence from the facility 2. Residents must be informed both orally and in writing of the bedhold policy at or before admission to the facility. 3. Must provide residents prior notice before their room or roommate in the facility is changed 4. Must inform residents of the bed reservation policy for hospital stays 5. Private Pay Residents – must reserve a bed for up to 30 days for any single hospitalization provided the facility receives reimbursement. 6. Medicaid Residents – must reserve a bed for up to 8 days for hospital stays and 16 days therapeutic leave - for a total of 24 days of paid bedhold days 7. A Medicaid bed will not be held if a) A resident will not need it or will not be able to return to the nursing home or b) The nursing home's vacancy rate ensures the availability of a bed 8. Medicare Resident – Medicare does not pay for a bed hold 9. Bedhold notices must be provided to residents within 24 hours of hospitalization (send notice with the resident to the hospital in the transfer papers) 10. Medicare and Medicaid residents have the right to challenge a discharge or transfer 11. Must provide a copy of the resident's bedhold rights to each staff member 12. Must refund a bedhold reservation payment where a facility was paid but refuses to readmit a resident within the prescribed time frame 3.11 – ENFORCEMENT OF RESIDENT RIGHTS 1. The annual inspection of a facility must include private informal conversations with a sample of residents to discuss the residents' experiences with how well facility staff respect their rights 2. AHCA must consult with the ombudsman regarding their facility investigations and complaints 3. Any person who reports a violation of their resident's rights has immunity from criminal or civil liability unless acting in bad faith or for a malicious purpose SECTION 4 – CIVIL ENFORCEMENT 4.1 - CIVIL ENFORCEMENT 1. A resident whose rights are violated has a cause to file suit for actual and punitive damages 2. Any resident who prevails in seeking an injunctive relief or an administrative remedy is entitled to recover costs and a reasonable attorney's fee not to exceed $25,000. 3. Any claim alleging a violation of resident's rights or negligence must prove by the preponderance of the evidence, that: (a) The facility owed a duty to the resident (b) The facility breached that duty (c) The breach of such duty is the legal cause of any loss, injury, death, or damage to the resident; and most importantly, (d) The resident sustained actual loss, injury, death, or damage as a result of the breach (These are the 4 required elements of a civil tort and the claimant must sustain some type of damage or injury to have cause to file a lawsuit and recover money damages) 4. A claimant must elect either survival or wrongful death damages 4.2 – STANDARDS OF CARE 1. A licensee, person, or entity has a duty to exercise reasonable care. 2. Reasonable care is the degree of care a reasonably careful person would use under like circumstances 3. A nurse has a duty to exercise care consistent with the prevailing professional standard of care for a nurse Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 10 of 39  4. A facility is not liable for medical negligence of any physician except for the administrative services of a medical director 4.3 - PRE-SUIT NOTICE 1. Prior to filing a lawsuit, the claimant must provide a facility pre-suit notice by certified mail, return receipt requested, of an asserted of a violation by the facility. 4.4 - STATUTORY 75-DAY WAITING PERIOD 1. No suit may be filed until 75 days after the pre-suit notice is mailed to the defendant facility 2. The purpose of the pre-suit notice and waiting period is give the facility time to evaluate the merits of the legal claim and to settle or mediate the claim 3. During the 75-day period, the defendant must evaluate the merits of the claim to determine its potential liability and potential damages if the plaintiff prevails at trial. 4. The facility must have the claim reviewed by one or more of the following: A. A qualified facility risk manager or claims adjuster; B. An attorney C. A quality assurance committee 5. At or before the end of the 75 days, the facility must either: A. Reject the claim; or B Make a settlement offer 6. Failure of the defendant to reply to the notice within 75 days after receipt is deemed a rejection of the claim 4.5 – DISCOVERY 1. Upon receipt of the pre-suit notice, the parties may require the other to produce documents and provide unsworn statements 2. Failure to provide complete copies of a resident's records constitutes non-compliance with good faith discovery requirements and waives the pre-suit notice requirements 4.6 – SETTLEMENT OFFER 1. If a defendant makes a settlement offer, the claimant has 15 days to accept the offer 4.7 – REJECTION OF CLAIM OR SETTLEMENT OFFER 1. If the parties do not settle they must meet in mediation to discuss the issues of liability and damages within 30 days of the claimant’s receipt of the defendant’s rejection of their claim 2. At the conclusion of mediation, the claimant has 60 days to file suit. 4.8 - STATUTE OF LIMITATIONS 1. A lawsuit must be brought within: a) 2 years from the incident giving rise to the action or b) 2 years from the time the incident is discovered; but not later than c) 4 years from the date of the incident but can be extended to d) 6 years from the date of the incident if the defendant intentionally concealed the incident 4.9 – PUNITIVE DAMAGES 1. Claims for punitive damages must be supported by evidence in the record that would warrant recovery by a claimant of damages at trial 2. The defendant is liable for punitive damages only if the trier of fact finds that the defendant is personally guilty of intentional misconduct or gross negligence. 3. "Intentional misconduct" means a defendant had actual knowledge of the wrongfulness of their conduct and the high probability of injury, and intentionally pursued that course of conduct 4. "Gross negligence" means the defendant's conduct was reckless and indifferent to the safety and the rights of persons exposed to such conduct 5. Punitive damages may be imposed against an employer for the conduct of an employee only if: a. The employer actively and knowingly participated in such conduct; b. The employer condoned or consented to such conduct; or Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 11 of 39  c. The employer engaged in conduct that constituted gross negligence 4.10 – PUNITIVE DAMAGES AWARD 1. A punitive damages award may not exceed the greater of: 3 times the amount of compensatory damages or $1 million. 2. If the defendant’s conduct was egregious and motivated primarily by unreasonable financial gain and the likelihood of harm was known, the award increases to: 4 times the amount of compensatory damages or $4 million 3. Where the defendant had a specific intent to harm the claimant there is No cap on punitive damages 4. The clerk of the court will forward a case to law enforcement to investigate criminal conduct if punitive damages are awarded in a case 5. Findings of a judge supporting punitive damages are admissible in civil and criminal proceedings. SECTION 5 – FACILITY LICENSURE 5.1- LICENSE REQUIRED 1. Every nursing facility in the state must be licensed 2. Separate licenses are required for facilities maintained in separate premises 3. A facility license must be displayed in a conspicuous place inside the facility 4. A license is only valid in the hands of the individual or entity issued to 5. Must apply to AHCA for an initial, renewal or change of ownership license to operate a nursing facility 5.2 - LICENSE FEES 1. The initial and annual renewal facility license includes the following fees: a) An annual fee of $100 per bed b) An initial or annual resident protection fee of $.50 per bed c) An initial or annual data collection and analysis assessment fee of $6.00 per bed 5.3 – APPLICATION FOR FACILITY LICENSE 1. The application must contain the following: a) The name of any person owning at least a 10-percent interest in any entity providing goods or services to the facility b) The location of the facility c) The name of the person who will manage the facility d) The name of the administrator e) The total number of licensed beds and Medicare and Medicaid certified beds. f) The number, experience, and training of facility employees g) Must demonstrate sufficient numbers of qualified staff, by training or experience, will be employed to properly care for residents h) Must fully explain any convictions for a disqualifying crime I) Must disclose bankruptcy or sale or transfer of assets within 30 days of completion 2. A facility offering services to fewer than 3 persons may need to be licensed if it holds itself out to the public to be an establishment which regularly provides such services. 3. Must submit evidence of good moral character of the applicant, manager, and administrator 4. A facility must submit a plan for quality assurance and risk management programs. 5. Must provide proof of the legal right to occupy the property (warranty deeds or lease) 5.4 – CERTIFICATE OF NEED 1. A license will not be issued to a facility that does not have a Certificate of Need (CON) 5.5 – STANDARD/CONDITIONAL LICENSURE STATUS 1. AHCA issues either a standard or conditional license Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 12 of 39  2. Licensure status is indicated in bold print on the face of the license 3. Deficiencies cited for the facility must be posted in a prominent public place where residents are admitted to the facility 4. Standard License - means the facility has no class I or class II deficiencies and has corrected all class III deficiencies within the time established by the agency 5. Conditional License - means the facility, due to the presence of one or more class I or class II deficiencies, or class III deficiencies not corrected within the time established by the agency, is not in substantial compliance at the time of the survey 6. A facility with a conditional licensure status must prepare and submit a plan for correction within 10 working days after receiving a notice of deficiencies 7. If a facility with a conditional license and has no class I, class II, or class III deficiencies at the time of the follow-up survey, a standard license may be issued 6 – INACTIVE LICENSE 1. AHCA can issue an inactive license for all or a portion of a facility’s beds. 2. Upon approval of an inactive license, the facility must notify residents of the discharge or transfer of all residents in the building 3. An inactive license is issued for up to 12 months, and is renewable for 6 more months upon demonstration of progress toward reopening 4. The facility may not suspend services or initiate facility closure prior to AHCA approval 5. An inactive license may be issued to allow the facility to use an unoccupied contiguous portion of the facility for an alternative use 6. An inactive license may be issued where a facility is temporarily unable to provide services but is reasonably expected to resume services (hurricane damage) 7. Reactivation of an inactive license requires the applicant to pay all licensure fees and an inspection to confirm compliance with all regulatory requirements 5.7 - EXPIRATION OF LICENSE; RENEWAL 1. A facility license expires 1 year from the date of issuance 2. Must submit a renewal application 90 days prior to the license expiration date 3. An Application for Renewal must disclose whether the facility was excluded or suspended from Medicare/Medicaid program participation or whether any employee was convicted of a disqualifying offense 5.8 – LATE RENEWAL FEES 1. Must pay a late renewal fee equal to 50 percent of the fee in effect on the last preceding regular renewal date. 2. A late fee is levied each and every day the filing is delayed – not to exceed $5,000. 3. A licensee with a revocation, suspension or judicial proceeding pending at the time of license renewal may be issued a temporary license effective until final disposition 5.9 - ACTION BY AGENCY AGAINST LICENSEE 1. Any of the following conditions are grounds for action by the agency against a licensee: a) Intentional or negligent acts materially affecting resident health or safety b) Misappropriation or conversion of resident property c) Failure to follow the procedures regarding the transportation, voluntary admission, and involuntary examination of residents d) Fraudulently altering or defacing facility records e) Any act that is grounds for denial of an application f) Non-compliance with any required laws and regulations 2. AHCA has the authority to take the following actions against a licensee: a) Denial of a license application. b) Administrative action (probation, suspension, revocation, fines) c) Injunctive relief against an unlicensed facility operating without a license d) Exclusion from the Medicare or Medicaid program e) Moratorium (prohibition) of new admissions Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 13 of 39  f) Receivership 3. AHCA cannot impose civil or criminal sanctions, or impose fines greater than $5000 per violation 5.10 - ADMINISTRATIVE FINE LIMITS 1. Administrative fines CANNOT exceed $500 per violation per day, against any applicant or licensee for the following violations ($5,000 limit): a) Demonstrated a pattern of deficient practice b) Failure to pay any outstanding fines assessed by a final order 2. Each day a violation continues constitutes a separate violation and is subject to a separate fine, but in no event may not aggregate more than $5,000 5.11 – ACTION AGAINST RELATED ENTITIES 1. An adverse action against any licensed facility with common controlling interest with the licensee or applicant may also be subject to sanctions 2. If an adverse action involves solely the management company, the licensee must be given 30 days to remedy such violations before final action is taken 5.12 – REVOCATION/SUSPENSION OF LICENSE 1. AHCA may deny a license application or revoke or suspend an existing license, or impose fines not to exceed $500 per day for the following: a) Demonstrated pattern of deficiencies b) Failure to pay outstanding administrative fines c) Exclusion from the Medicare or Medicaid program d) Adverse regulatory action regarding a related entity under common controlling interest 2. The agency must revoke or deny a nursing home license if the licensee or controlling interest operates a facility that: a) Has had two moratoria imposed by final order for substandard quality of care within any 30-month period b) Is conditionally licensed for 180 or more continuous days c) Is cited for two class I deficiencies arising from unrelated circumstances during the same survey or investigation d) Is cited for two class I deficiencies arising from separate surveys or investigations within a 30-month period 3. The licensee may present factors in mitigation of revocation, and the agency may make a determination not to revoke a license based upon a showing that such revocation is not appropriate under the circumstances. 4. AHCA can issue an order to immediately suspend or revoke a license if it determines that conditions in a facility present a danger to resident health and safety, subject to review by an administrative hearing judge 5.13 – MORATORIUM ON NEW ADMISSIONS 1. AHCA can impose an immediate moratorium on new admissions if conditions in the facility threaten resident health and safety 2. Suspend the license of a facility that had a moratorium on admissions imposed two times within a 7- year period (may be forced into receivership) 5.14 – ADMINISTRATIVE HEARINGS 1. Any action by AHCA to deny, suspend, or revoke a facility's license must be heard by the Division of Administrative Hearings of the Department of Management Services within 60 days of a request for a hearing 2. The administrative law judge must render a decision within 30 days after the receipt of a proposed recommended order. Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 14 of 39 5.15 - INJUNCTION 1. The agency may institute an injunction of proceedings in a court of competent jurisdiction to: a) Enforce any minimum standard, rule or order b) Terminate the operation of a home where any of the following exist: 1) Failure to take preventive/corrective measures per an AHCA order 2) Failure to abide by any final agency order 3) Any violation constituting an emergency requiring immediate action 5.16 – ANNUAL INSPECTION 1. AHCA must perform an unannounced survey of licensed facilities at least every 15 months 2. Must assign a standard or conditional licensure status based on most recent inspection reports 3. Prior to conducting a survey (Inspection), the survey team must obtain a copy of the Ombudsman’s report on the facility. 4. Each licensee must post its license in a prominent place that is in clear public view at or near the place where residents are being admitted to the facility. 5. The ombudsman may request the agency to conduct a follow-up visit to the facility. 6. AHCA must conduct unannounced onsite facility reviews following written verification of the licensee noncompliance where the ombudsman received a complaint and documented deficiencies that threaten resident health and safety 7. AHCA must conduct unannounced onsite inspections every 3 months of each facility with a conditional license. 8. AHCA need not re-inspect a facility to verify correction of Class III or Class IV deficiencies unrelated to resident rights if written documentation was provided confirming such deficiency was corrected 5.17 – SEMI-ANNUAL FACILITY INSPECTION 1. A survey must be conducted every 6 months for a 2-year period if a facility is cited for: a) A class I deficiency or b) 2 or more class II deficiencies from separate surveys or investigations within a 60-day period or c) Or had 3 or more substantiated complaints within a 6-month period, each resulting in at least one class I or class II deficiency. 2. AHCA must also assess a fine for the 6-month survey cycle of: i. $6,000 for the 2 year period ii. One-half of the fine paid at the completion of each survey. 3. AHCA must verify by subsequent inspection that any deficiency identified during the annual inspection was corrected 5.18 – SCOPE OF DEFICIENCIES 1. Deficiencies are classified according to the nature and the scope of the deficiency. 2. Scope is classified as: a) Isolated - affecting one or a very limited number of residents, or involving one or a very limited number of staff, or a situation that occurred only occasionally or in a very limited number of locations b) Patterned - affecting more than a very limited number of residents, or more than a very limited number of staff are involved, or the situation has occurred in several locations, or the same resident or residents have been affected by repeated occurrences of the same deficient practice but the effect of the deficient practice is not found to be pervasive throughout the facility c) Widespread - where the problems are pervasive in the facility or represent systemic failure that has affected or has the potential to affect a large portion of the facility's residents Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 15 of 39 5.19 – SEVERITY OF DEFICIENCIES 1. Class I Deficiency – Requires immediate corrective action because the facility's noncompliance has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in a facility: a) The condition constituting a class I violation must be eliminated immediately b) A class I deficiency is subject to a civil penalty Isolated deficiency - $10,000 Patterned deficiency - $12,500 Widespread deficiency - $15,000 c) The fine is doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection d) A fine must be levied regardless if the deficiency is corrected 2. Class II Deficiency - compromises the resident's ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services (actual harm) a) Class II deficiency is subject to civil penalties of: Isolated deficiency - $2,500 Patterned deficiency - $5000 Widespread deficiency - $7,500 b) The fine is doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. c) A fine must be levied regardless if the deficiency is corrected 3. Class III Deficiency - results in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident's ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. a) Class III deficiency is subject to civil penalties of: Isolated deficiency - $1,000 Patterned deficiency - $2,000 Widespread deficiency - $3,000 b) The fine amount is doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. c) A citation for a class III deficiency must specify the time within which the deficiency is required to be corrected. d) If a class III deficiency is corrected within the time specified, no civil penalty will be imposed. 4. Class IV Deficiency - has potential for causing no more than a minor negative impact on the resident. i. No civil penalties ii. If the deficiency is isolated, no plan of correction is required. 5.20 – OPERATING WITHOUT LICENSE 1. It is unlawful for any person or public body to operate a facility without obtaining a valid current license. 2. It is unlawful for any person or public body to offer or advertise nursing home care or service without obtaining a valid current license. 3. It is unlawful for any holder of a license to advertise or hold out to the public that it holds a license for a facility other than that for which it actually holds a license. 4. It is unlawful for anyone to interfere with an unannounced inspection Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 16 of 39  5. A violation of any minimum standard, rule, or regulation constitutes a second degree misdemeanor 6. Each day of a continuing violation is considered a separate offense. 5.21 – APPOINTMENT OF RECEIVER 1. AHCA may seek appointment of a receiver, when any of the following conditions exist: a) A person is operating a facility without a license and refuses to make application for a license b) A licensee is closing the facility or intends to close the facility and adequate arrangements have not been made to relocate residents within 7 days of closing c) AHCA determines conditions exist presenting an imminent danger to resident safety and welfare, or a substantial probability of death or serious physical harm d) The licensee cannot meet its financial obligation to provide food, shelter, and care 2. A hearing must be conducted within 5 days of the filing of the petition 3. The receiver may do the following: a) Exercise those powers and perform those duties set out by the court b) Operate the facility to assure resident safety and care c) Protect the assets or property of the facility d) Collect payments for all goods and services e) Correct or eliminate any deficiency in the structure or furnishings of the facility, which endangers resident safety not exceeding $10,000. f) Honor all leases, mortgages, and secured transactions governing the building in which the facility is located and all goods and fixtures in the building of which the receiver has taken possession, g) Manage, hire and discharge employees h) Pay employees 4. Receivership does not relieve the owner of any obligation to employees made prior to the appointment of a receiver and not carried out by the receiver. 5. AHCA must assess each resident in the facility to determine if an alternative care setting should be provided 6. The owner retains all rights to sell a facility in receivership with court approval 5.22 – TERMINATION OF RECEIVER 1. The court may terminate a receivership when: a. The receivership is no longer necessary, or b. All residents have been transferred or discharged. 2. Within 30 days of termination, the receiver must provide the court a complete accounting of all property and funds 5.23 - CRIMINAL/CIVIL LIABILITY OF RECEIVER/OWNER 1. Receivership does not relieve the owner, administrator, or employee of a facility of any civil or criminal liability 2. The receiver may be held liable in a personal capacity only for the receiver's own gross negligence, intentional acts, or breach of their fiduciary duty 5.24 – RIGHT OF ENTRY AND INSPECTION 1. Licensed facilities must allow AHCA and the ombudsman to enter their premises at any reasonable time to determine compliance with laws and regulations as a condition of licensure 2. For unlicensed facilities, inspectors must obtain permission of the owner prior to entry or must obtain a court order permitting entry and inspection 3. An application for a license or renewal constitutes permission and complete acquiescence to the unannounced entry and inspection of a facility for inspection and investigation purposes 4. AHCA must complete investigation of resident complaints within 60 days of receipt Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 17 of 39 5.25 – POSTING INSPECTION REPORTS 1. Within 60 days of annual inspection or 30 days of an interim visit, AHCA must send copies of inspection reports to the ombudsman, the AHCA local office, and a public library 2. AHCA must provide an Internet site with detailed information of each facility in the state 3. The consumer website must contain survey and deficiency information from the Online Survey Certification and Reporting (OSCAR) system, including annual survey, revisit, and complaint survey information, for each facility for the past 45 months. 4. OSCAR is maintained by HCFA (Health Care Financing Administration) 5. For non-certified nursing homes, the state survey and deficiency information, including annual survey, revisit, and complaint survey information for the past 45 months must be provided. 6. Each facility must maintain as public information all cost and inspection reports pertaining to that facility filed with, or issued by, any governmental agency. 7. Copies of such reports must be retained for not less than 5 years from the date of filing 5.26 - AVAILABILITY OF ESSENTIAL RECORDS 1. Any records of a nursing home facility determined by the agency to be necessary and essential to establish lawful compliance with any rules or standards must be made available to the agency on the premises of the facility. 5.27 – RIGHT TO INSPECT SURVEY REPORTS 1. Residents have the right to examine the most recent facility inspection report and any plan of correction in effect. 2. Every nursing home must post a concise summary of the last inspection report with references to the page numbers of the full reports, noting any deficiencies found by the agency and the actions taken by the licensee to rectify such deficiencies 5.28 - ENTITIES EXEMPT FROM LICENSING 1. Any facility operated by the Federal Government or a federal agency are exempt from licensing. 2. Any facility that existed and operated continuously in this state for at least 60 years as of July 1989, and is operated by a nationally recognized fraternal organization 3. Any facility operated by and for persons who rely exclusively upon treatment by spiritual means through prayer 5.29 - RELOCATION OF MEDICAID RECIPIENTS 1. As a condition of licensure, each licensee must accept Medicaid recipients on a temporary, emergency basis, who are being transferred from another facility with existing conditions constituting immediate danger to their health and safety 5.30 – AHCA SUPERVISION OF STATE SURVEY TEAMS 1. AHCA must ensure newly hired nursing home surveyor are assigned full-time to a licensed nursing home for at least 2 days within a 7-day period to observe facility operations before assuming survey responsibilities. 2. An individual cannot survey a facility they were previously employed in the preceding 5 years. 3. AHCA must semiannually provide joint training of surveyors and staff working in licensed facilities on at least one of the 10 most often cited federal citations SECTION 6 – RISK MANAGEMENT/QUALITY ASSURANCE 6.1 – RISK MANAGEMENT AND QUALITY ASSURANCE COMMITTEE 1. Must have an active Risk Management and Quality Assurance Committee 2. Must Designate a risk manager to oversee the RM/QA committee 3. RM/QA Committee must assesses resident care practices, review quality indicators and incident reports, as well as any deficiencies and grievances 4. The Committee must develop corrective action plans 5. Must investigate and report all allegations of sexual misconduct to the administrator and the resident 6. The administrator is responsible for the risk management and quality assurance committee Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 18 of 39 6.2 - COMPOSITION OF COMMITTEE 1. The Risk Management and Quality Assurance Committee must consist of a risk manager, the administrator, the director of nursing, the medical director, and at least three other staff members 6.3 - MEETING TIME 1. The RM/QA Committee must meet at least monthly 6.4 - POLICIES AND PROCEDURES 1. Must have policies and procedures to implement the risk management and quality assurance program which must investigate and analyze the frequency and causes of adverse incidents to residents to improve care 6.5 - CONFIDENTIALITY OF RECORDS - RISK MANAGEMENT AND QUALITY ASSURANCE 1. Records of the risk management and quality assurance committee meetings incident reports filed with the facility's risk manager and administrator are confidential and exempt from disclosure. 2. AHCA can disclose information concerning criminal behavior or professional misconduct by a staff member to appropriate authorities provided to the agency by the facility in filed incident reports 3. AHCA or the appropriate regulatory board must make available, upon request by a health care professional against whom probable cause has been found, any such records that form the basis of the determination of probable cause. 6.6 – RESIDENT GREIVANCE PROCEDURE 1. Every nursing home must have a grievance procedure available to its residents and their families. The grievance procedure must include: a) An explanation of how to file a grievance b) The names, job titles, and telephone numbers of the employees responsible for implementing the facility's grievance procedure c) The toll-free telephone hotline number of the ombudsman or AHCA to report unresolved grievances. d) The procedure to assist residents who cannot prepare a written grievance without help e) Residents can present grievances to staff, the administrator or governmental officials 2. Residents have the right to a prompt response by staff to resolve grievances (24-48 hours) 3. The right to recommend changes in policies and services to facility personnel 4. The right to join others within or outside the facility to work to improve resident care 5. The facility must maintain records of all grievances 6. AHCA may investigate any grievance at any time for misconduct 6.7 - STAFF EDUCATION 1. Must provide Risk Management training as part of the initial employee orientation 2. Must require a minimum of 1 hour of training annually for all workers in clinical areas 6.8 - ACCESS TO RECORDS 1. The risk manager must have access to all resident records retained by the facility. 6.9 - INCIDENT REPORTS 1. Must have an incident reporting system to develop categories of incidents and analyze reports to identify problem areas 2. An “adverse incident” is an event (injury or death) that results from staff action or lack thereof (dropping a patient to the floor, allowing patients to wander off without adequate safeguards) which staff could exercise control over 3. Staff must report adverse incidents to the risk manager and the administrator within 3 business days of occurrence. 4. The risk manager must fax or overnight written incident reports to the state within 24 hours of receipt of such information and determine if an event was an incident 5. The risk manager must fax the follow-up report within 15 days to state with the results of the investigation Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 19 of 39  6. Whether or not a facility concludes an event was an incident, AHCA can investigate any incident to determine staff misconduct 7. Must include in each report the identity of the affected resident, the type of adverse incident, that an investigation was started and whether the adverse incident represents a potential risk to others 8. Must have a summary log of all incidents that is produced to surveyors and investigation reports that detail your investigation that are not subject to public inspection. Must maintain a copy of all investigation reports that are filled out by the risk manager. 6.10 - TYPES OF INCIDENTS 1. Death 2. Brain or spinal damage 3. Permanent disfigurement; 4. Fracture or dislocation of bones or joints 5. A limitation of neurological, physical, or sensory function 6. Any condition requiring medical attention resident did not consent to 7. Failure to honor advanced directives 8. Any condition requiring transfer within or outside facility to an acute care unit 9. Abuse, neglect and harm 10. Resident elopement 11. Any event reported to law enforcement 6.11 - CONFIDENTIALITY OF INCIDENT REPORTS 1. The RM/QAA program must include incident reports filed with the risk manager and facility administrator 2. Incident reports are subject to discovery but are not admissible as evidence in court. 3. A person filing an incident report is not subject to civil suit by virtue of such incident report. SECTION 7 - RECORDS 7.1 – REQUIRED FACILITY RECORDS 1. Must maintain the following records: A. Resident admissions B. Discharges C. Medical, personal, social history D. Care plans E. Financial records F. Personnel records 7.2 - REQUEST FOR PATIENT RECORDS 1. Residents can request to inspect and copy records orally or in writing 2. Current Resident – within 14 working days after receipt of a written request must provide copies of records to a spouse, guardian, surrogate, proxy, or attorney in fact 3. Former Resident - within 30 working days after receipt of a written request must provide copies of records to a spouse, guardian, surrogate, proxy, or attorney in fact 4. Records include - medical and psychiatric records and any records concerning the care and treatment of the resident performed by the facility 7.3 - PSYCHIATRIC RECORDS 1. Psychiatric progress notes and consultation report sections are not to be copied 7.4 - DECEASED RESIDENT RECORDS 1. Records part of a deceased resident's estate may be made available prior to the administration of an estate 7.5 - LIMITATION ON RECORDS REQUESTS 1. No person may be allowed to obtain copies of residents' records more often than once per month, except that physician's reports may be obtained as often as necessary to effectively monitor the residents' condition. Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 20 of 39 7.6 – COPY CHARGES 1. May charge a reasonable copy fee not to exceed: A. $1 per page for the first 25 pages and B 25 cents per page for each page in excess of 25 pages C Cannot charge fee to locate records or type form letters 7.7 - EXAMINATION OF RECORDS 1. The facility must allow the spouse, guardian, surrogate, proxy, or attorney in fact to examine the original records upon reasonable terms 7.8 – ALTERING RECORDS 1. Fraudulently altering, defacing, or falsifying a medical record or releasing medical records without resident consent is a second degree misdemeanor 2. A conviction is grounds for restriction, suspension, or termination of a license 7.9 - OMBUDSMAN REVIEW OF RESIDENT RECORDS 1. Ombudsman may only examine a resident's clinical records with the resident’s consent 7.10 – RECORDS CONFIDENTIAL 1. Residents' personal and medical records are confidential 7.11 – PERSONNEL RECORDS 1. A facility may furnish current or former employee records to other licensed facilities such current or former employee is applying for employment without legal liability (must be done in good faith) 2. Such records may include disciplinary history and the reasons for termination, if applicable SECTION 8 - KICKBACKS 8.1– BRIBES 1. "Bribe” is consideration paid to influence performance or omission of any act (1st degree misdemeanor) 8.2 – KICKBACKS 1. “Kickbacks” - Part of a payment returned to a payor by the provider to induce the payor to purchase services (1stdegree misdemeanor) 8.3 - PROHIBITED SOLICITATIONS/ACTS 1. Cannot solicit bribes or kickbacks from vendors who furnish services or goods to a nursing home 2. Cannot solicit contributions to a nursing home and misrepresent donations for charitable purposes 3. Cannot solicit contributions through threats, coercion, or force 4. Cannot condition admission of a Medicaid patient on a contribution or donation from any person. 5. A facility can receive contributions not related to the care of a specific resident 6. Facility license can be suspended, revoked or denied 8.4 - REBATES PROHIBITED; PENALTIES 1. Unlawful to pay or receive a commission, bonus, kickback, or rebate or engage in any split-fee arrangement with any physician, surgeon, agency, or person, either directly or indirectly, for residents referred to a licensed nursing home SECTION 9 – RESIDENT PROTECTION TRUST FUND 9.1 – STATE RESIDENT PROTECTION FUND 1. State trust funds are only used to pay for alternate placement and care of residents removed from a facility with conditions constituting an immediate danger 2. AHCA will pay usual and customary charges of a facility for alternate placement 3. AHCA is authorized to set up a separate bank account to deposit trust funds from each facility Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 21 of 39  SECTION 10 - NURSING HOME WATCH LIST 10.1 – NURSING HOME WATCH LIST 1. AHCA must quarterly publish a "Nursing Home Guide Watch List" 2. The watch list identifies facilities with conditional licensure status and operating under bankruptcy protection 3. The watch list must explain how to choose a nursing home 4. The watch list is sent to each nursing home and must be provided to any person who has completed a written application with an intent to be admitted to the facility SECTION 11 - NURSING 11.1 - DEFINITIONS 1. "Respite care" means admission to a nursing home for the purpose of providing a short period of rest or relief or emergency alternative care for the primary caregiver of an individual receiving care at home who, without home-based care, would otherwise require institutional care. 11.2 – REQUIRED NURSING PERSONNEL 1. The facility must have an RN for at least 8 consecutive hours a day, 7 days a week 2. One full time registered nurse must be designated as the DON responsible for supervision of the nursing services program. 3. If the DON is delegated institutional responsibilities, a full time qualified registered nurse must be designated to serve as the ADON 4. A facility with 121 or more residents, must designate an RN as an Assistant DON 5. A DON or ADON can serve only 1 nursing home facility in this capacity, and cannot serve as the administrator of the same facility. 6. The DON must designate one licensed nurse on each shift as the charge nurse 7. Must have sufficient nursing staff, on a 24-hour basis to provide nursing and related services to residents to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care. 8. Must staff, at a minimum, an average of 2.5 hours of certified nursing assistant and 1.0 hours of licensed nursing staff time for each resident during a 24-hour period. 9. By Saturday, you must achieve a nursing staffing of 3.6 hours that is combined licensed nursing and nursing aides. 10. In multi-story, multi-wing, or multi-station nursing home facilities, must have at least one nursing services staff person capable of providing direct care on duty at all times on each floor, wing, or station. Staffing hours were recently Changed as Follows and my be on the exam as January 1, 2023 11. Minimum of 2.0 hours of certified nursing hours per resident per day. 12. One hour of licensed nursing per resident per day. 13. Unlicensed nursing staff may fill the remaining.6 hours to total 3.6 hours per day. 14. Unlicensed staffing include: a. Paid feeding assistant (who completed a qualifying feeding assistant training program) b. Nursing c. Pharmacy d. Dietary e. Therapeutic activities f. Dental g. Podiatry h. Mental Health providers Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 22 of 39 11.3 – CLINICAL LABORATORY TEST RESULTS/X-RAYS 1. Each facility must have a licensed clinical laboratory to perform lab tests 2. Results of clinical laboratory tests prior to admission which meets minimum standards are acceptable in lieu of routine exam and lab tests after admission 3. Must establish minimum standards for diagnostic X rays 4. Minimum standards must require licensure of a source of ionizing radiation 11.4 - CERTIFIED NURSING ASSISTANT QUALIFICATIONS 1. To serve as a nursing assistant, the individual must be certified as a nursing assistant or a registered nurse or practical nurse 2. Temporary Employment - The following persons who are not certified nursing assistants may be employed for 4 months: a) Persons enrolled in or completed a state-approved nursing assistant program; b) Persons actively certified in another state with no history of abuse or neglect c) Persons who preliminarily passed the state's certification exam d) The certification requirement must be met within 4 months after initial employment as a nursing assistant in a licensed nursing facility 3. Employment History a) Certified nursing assistant applicants must submit full employment history b) The facility must verify employment history unless verification is not possible c) The former employer has no liability for communicating honest opinions about the applicant 4. Annual Review - Nursing assistants must be reviewed every 12 months and must receive regular in- service education based on the outcome of such review. 5. Required In-service – Must complete 12 hours of in-service training each year to maintain the certificate to Include, at a minimum: a) Eating and proper feeding techniques; b) Principles of adequate nutrition and hydration c) Techniques to assist cognitively impaired residents or handle difficult behaviors d) Techniques for caring for the resident at the end-of-life e) Recognizing risk factors for pressure ulcers and falls f) Specific areas of weakness identified in the performance review 6. Expiration of Certificate - Certificate once issued is valid indefinitely provided certificate holder completes 12 hours annually of in-services and has no period of 24 consecutive months or more of not providing any nursing related services for compensation 7. Retraining - Failure to complete annual training requirements or maintain work experience (work for 8 hours for pay in 24 months) will require the certificate holder to complete a new training program and evaluation (exam) over again 8. Daily Chart - Must chart services provided each resident (ADL’s, hydration, nutrition)) by the end of their shift 11.5 – MINIMUM NURSING HOURS 1. Certified nursing assistant staffing a) Minimum of 2.5 hours of direct care per resident per day. b) Minimum of one certified nursing assistant per 20 residents 2. Licensed Nurse Staffing a) Minimum 1.0 hours of direct resident care per resident per day b) Minimum one licensed nurse per 40 residents. c) The staffing week starts on Sunday d) The staffing week ends on Saturday e) Must reach an average of 3.6 hours of combined nursing and nursing aide hours 3. Each facility must post daily the names of staff on duty Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 23 of 39  4. Licensed nurses may be counted toward the minimum staffing requirements for certified nursing assistants if they exclusively perform the duties of a certified nursing assistant for the entire shift and are not counted in the minimum staffing requirements for licensed nurses. 5. Non-nursing staff providing eating assistance to residents, volunteers and private duty nurses may not be counted toward minimum staffing standards 6. Licensed practical nurses may supervise the activities of other licensed practical nurses, certified nursing assistants, and other unlicensed personnel 7. AHCA can require a facility to increase staffing beyond the minimum required by law, if the agency has taken administrative action against the facility for care-related deficiencies directly attributable to insufficient staff (can request expedited interim rate) 8. A facility that fails to maintain required increased staffing is subject to a $500 fine per day for each day the staffing is below the level required by the agency. 9. No nursing staff can be scheduled for more than 16 hours within a 24 hour period, for 3 consecutive days, except in an emergency 10. Continuing Care Facility – if the facility has a standard license or Gold Seal and exceeds minimum required hours of licensed nursing and certified nursing assistant direct care per resident per day on a single campus, the facility is allowed to share programming and staff under the following conditions: a) Minimum staffing ratios based on the total number of residents located on campus. b) A facility with a conditional license may not share staff until the conditional status ends. c) Additional staff may be required if cited for deficiencies in staffing and care 11.6 - PHYSICIAN SERVICES 1. Residents have the right to choose their own private physician 2. Physician Orders a) Physician verbal orders, including telephone orders, must be immediately recorded, dated, and signed by the person receiving the order b) All verbal treatment orders must be countersigned by the physician or other health care professional on the next visit to the facility c) Physician orders may be transmitted by facsimile d) Physicians are not required to re-sign a facsimile order on the next visit to facility (the faxed order was already signed by the physician) e) All physician orders must be followed as prescribed f) If an order is not followed, the reason must be recorded on the resident’s medical record during that shift 3. Must notify an attending physician within 30 days of signs of change in the resident’s cognitive status to rule out underlying physiological disease 4. A facility must have regular and emergency services of licensed physicians to care for residents 11.7 - PHYSICIAN VISITS 1. Physicians must visit residents once every 30 days for the first 90 days after admission 2. After 90 days, the physician must visit the resident once every 2 months 3. A physician visit is considered timely if it occurs not later than 10 days after the visit was required 4. May arrange an alternate schedule if the resident can be seen less often 5. If a physician chooses to designate another health care professional to fulfill the physician’s visit, they may do so only after the first required visit 6. Each facility must have a list of physicians designated to provide emergency services when a resident’s attending physician is not available. 11.8 - MEDICAL DIRECTOR 1. Must retain a licensed physician to serve as the-medical director per a written agreement 2. The Medical Director must visit the facility at least once a month. 3. The Medical Director must review all new policies and procedures, and incident and accident reports to identify clinical risks and safety hazards. 4. The Medical Director must review grievance logs for complaints related to clinical issues. 5. Each visit must be documented in writing by the Medical Director. Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 24 of 39  6. The Medical Director must participate in the development of the comprehensive care plan when they are the resident’s attending physician 7. A physician may be the Medical Director for 10 nursing homes at any one time. 8. The Medical Director, in an emergency, where a resident’s health is in jeopardy and their assigned attending physician cannot be located, may assume temporary responsibility to provide necessary care 9. The Medical Director must meet at least quarterly with the quality assessment and assurance committee 10. A medical consultant may be employed in a facility with a licensed capacity of 60 beds or less instead of a medical director 11. A facility can only have 1 medical director 12. The Medical Director must be a licensed physician 13. The medical director must be certified or credentialed through a recognized organization (i.e. JCAHO, American medical directors association, the healthcare facilities accreditation program of the American Osteopathic Association) 14. The Medical Director’s principal office must be within 60 miles of the facility he/she serves as the medical director 15. The Medical Director must specify the address of his/her principal office at the time of becoming medical director. 11.9 – COMPREHENSIVE RESIDENT ASSESSMENT 1. A comprehensive assessment is a thorough, accurate and reproducible assessment of a resident’s current functional capacity 2. A resident is assessed using the Resident Assessment Instrument (RAI) which consists of the Minimum Data Set (MDS) and the RAPs (Resident Assessment Protocols) and Utilization Guidelines 3. The RAPs consists of 18 triggers which highlight care issues requiring special attention 4. The assessment must be completed within 14 days of the resident’s admission 5. The assessment is reviewed every 3 months or upon significant change in the physical or psychological condition by a registered nurse 6. The resident is completely re-assessed every 12 months or since the last assessment due to significant change or as appropriate 7. A registered nurse must prepare, complete and certify the accuracy of the assessment 8. A registered nurse (MDS Coordinator) must coordinate assessments performed by various health professionals 9. Each person who completes a portion of the MDS must sign that section 11.10 - COMPREHENSIVE CARE PLAN 1. Each resident admitted to the nursing home facility must have a plan of care 2. The care plan is based on data from the comprehensive assessment and is developed, maintained and reviewed by a registered nurse with input from other health care providers and the resident 3. Te care plan must be signed by the 1) DON or a registered nurse and 2) the resident 4. An agency or temporary nurse cannot sign and certify assessments 5. The care plan must be completed within 7 days of the comprehensive assessment 6. Care plan is reviewed quarterly and updated annually 7. The care plan consists of physician’s orders, diagnosis, medical history, physical exam and rehabilitative or restorative potential 8. The care plan Includes measurable objectives and timetables to meet a resident’s medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment 9. The care plan must describe the services to be furnished to attain or maintain the resident’s highest practicable physical, mental and social well-being. 10. The resident and family, private duty nurse or nursing assistant should participate in developing and evaluating the effectiveness of the care plan 11. All facility staff and private duty personnel must have access to the care plan 12. A summary of the care plan and advanced directives must accompany the resident upon discharge or transfer to another health care facility 11.11 - DIETARY SERVICES 1. Must designate one full-time person as the Dietary Services Supervisor (DDS) Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 25 of 39  2. In a facility with 61 or more residents, the DDS cannot do food preparation or service on a regular basis 3. If the DDS is not a qualified dietitian, the facility must obtain consultation from a qualified dietitian 4. A qualified dietitian is one who: (a) Is registered with the American Dietetic Association; or (b) Has a baccalaureate degree with major studies in food and nutrition, dietetics, or food service management and 1) 1 year of supervisory experience in dietetic services and 2) Participates annually in continuing dietetic education 5. A Dietary Services Supervisor is one who: a) Is a qualified dietitian; or b) Has successfully completed an associate degree program which meets the education standard established by the American Dietetic Association; or c) Has successfully completed a Dietetic Assistant correspondence or class room training program, approved by the American Dietetic Association; or d) Has successfully completed a course offered by an accredited college or university that provided 90 or more hours of correspondence or classroom instruction in food service supervision and prior work experience as a Dietary Supervisor in a health care institution with consultation from a qualified dietitian; or e) Has training and experience in food service supervision and management in military service f) Is a certified dietary manager who has successfully completed the Dietary Manager’s Course and is certified through the Certifying Board for Dietary Managers and is maintaining their certification with continuing clock hours at 45 CEU’s per 3 year period 6. The facility must maintain a 1-week emergency reserve supply of non-perishable food 7. Must provide nutritious and wholesome meals to residents 8. Must provide therapeutic diets prescribed by the attending physician 9. Must maintain a 7 day emergency reserve supply of non-perishable food and supplies 11.12 - CONSULTANT PHARMACIST 1. Must employ a licensed consultant pharmacist to provide consultation on all aspects of pharmacy services 2. The facility must adopt procedures that assure the accurate receipt and administration of all drugs and biologicals 3. The consultant pharmacist must establish a system to accurately record the receipt and disposition of all controlled drugs to enable an accurate reconciliation. 4. The consultant pharmacist must determine if drug records are in order and ensure all controlled drugs are maintained and periodically reconciled. 5. Drugs and biologicals used in the facility must be labeled per professional principles 6. Drugs and non-prescription medications requiring refrigeration must be stored in a refrigerator. 7. When stored in a general-use refrigerator, drugs and non-prescription drugs must be stored in separate covered, waterproof, and labeled receptacles 8. Controlled substances must be disposed of in accordance with state and federal laws 9. Controlled drugs are destroyed in the facility by flushing down the toilet – a pharmacist consultant must witness and document the destruction 10. Non-controlled substances may be destroyed per facility policies 11. Non-controlled substances, in unit dose containers, may be returned to the pharmacy. 12. Records of the disposition of all substances must be maintained in sufficient detail to enable an accurate reconciliation. 13. If ordered by the resident’s physician, the resident may, upon discharge, take all current prescription drugs with them. 14. An inventory of drugs released to a resident must be dated and signed by the person releasing the drugs and the person receiving the drugs, and then filed in the resident’s chart Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 26 of 39  15. Emergency Medication Kit – a) The facility must maintain an Emergency Medication Kit b) Contents of which must be determined in consultation with the Medical Director, Director of Nursing and the Pharmacist c) The kit must be readily available and kept sealed d) All items in the kit must be properly labeled. e) Must maintain an accurate log of the receipt and disposition of each item in the kit f) An inventory of the contents of the kit must be attached to the outside of the kit g) If the seal is broken, the kit must be resealed by the next business day after use. 11.13 -CHOICE OF COMMUNITY PHARMACY 1. A resident has the right to obtain pharmaceutical supplies from a pharmacy of the resident's choice at the resident's expense or through Medicaid 2. The pharmacy chosen by the resident must have a compatible unit-dose system with the facility’s system 11.14 - MEDICAL RECORDS. 1. Must designate a full-time employee responsible for the facility’s medical records 2. If this employee is not a qualified Medical Record Practitioner, then the facility must use a qualified Medical Record Practitioner on a consultant basis 3. Qualified Medical Record Practitioner is certified as a Registered Record Administrator or an Accredited Record Technician by the American Health Information Management Association or is 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. 4. Each medical record must contain sufficient information to identify the resident, diagnosis and treatment 5. Medical records must be complete, accurate, accessible and systematically organized 6. Medical records must be retained for a period of five years from the date of discharge 7. In the case of a minor, the record must be retained for 3 years after a resident reaches legal age 11.15 - RESTRAINTS 1. Residents have the right to be free from mental and physical abuse and extended involuntary seclusion 2. Residents have the right to be free 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 3. In case of an emergency, a restraint may be applied only by a qualified licensed nurse who must document the reason for the use of restraint 4. For chemical restraints, a physician must be consulted immediately thereafter. 5. Restraints cannot be used instead of staff supervision or for staff convenience, or punishment, or any reason other than resident protection or safety 11.16 – SKILLED VERSUS CUSTODIAL CARE 1. “Custodial care” entails observation of diet and sleeping habits, watchfulness over patient well-being (bathing, feeding) whereas skilled nursing care involves daily skilled nursing and rehabilitation services (IV injection and physical therapy) 11.17 - RESPITE/ADULT DAY CARE 1. A facility with a standard license and no class I or II deficiencies in the prior 2 years may provide respite and adult day care services 2. A person receiving respite or adult care for 24 hours or more may be included in minimum staffing calculations 11.18 – DENTAL AND HEALTH RELATED SERVICES 1. Must provide resident access to dental, vision, hearing, foot care and other needed services Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 27 of 39  2. A facility is required to arrange for providers to visit the facility or transport residents to their offices but do not have to pay for such services 3. Must provide recreational, rehabilitative and social services to residents 11.19 – FLU AND PNEUMONIA VACCINATIONS 1. Influenza (flu) Vaccine A. Can offer but not require immunization B Administer prior to Nov. 30 each Year C After Nov 30 but before March 31 must offer the flu shot within 5 working days after admission D Personal physician can administer vaccine but must have documentation of the vaccination E. Can only administer a vaccination once 2. Pneumonia Vaccination A. Assess patients within 5 working days of admission and administer the vaccination with 60 days B If a resident receives immunization from a personal physician, the resident must provide proof C. Cannot administer vaccination more than once to a resident SECTION 12 – TRANSFER/DISCHARGE 12.1 - DEFINITIONS 1. "Discharge" – moving a resident to a non-institutional setting (home) 2. "Transfer" moving a resident to another institution (facility or hospital) 12.2 – LEGAL BASIS FOR INVOLUNTARY DISCHARGE 1. A resident no longer needs skilled nursing services 2. A facility unable to meet resident needs 3. A resident is a danger to self and others 4. Non payment of a bill (30 days notice) 5. Emergency medical treatment 12.3 - REQUIRED DOCUMENTATION TO SUPPORT DISCHARGE 1. Discharge initiated by an administrator must be signed by the administrator 2. Discharge due to a facility unable to meet a resident’s needs must be signed by a physician 3. Discharge due to a resident no longer requiring services (needs a physician to document as such) 4. Discharge due to a resident posing a danger to self or others (documentation from physician required) 5. Failure to pay bills (the administrator must document the money owed the facility) 12.4 - NOTICE OF NON-EMERGENCY DISCHARGE 1. Must provide residents 30 days advance notice of discharge or transfer 2. Administrators must provide notice of discharge to next of kin and ombudsman within 5 days 3. Must file a copy of the discharge notice in the resident’s medical record 4. Notice of discharge due to a medical reason must be signed by the attending physician or medical director or have an order for discharge attached and signed by the resident's physician, medical director, treating physician, nurse practitioner, or physician assistant 5. Residents can request the Ombudsman to review any notice of discharge or transfer 6. Notice of discharge must be in writing 12.5 – NOTICE OF EMERGENCY DISCHARGE 1. Must notify the resident and next of kin or legal representative of emergency transfer ( to a hospital for acute care) by telephone or in person prior to discharge or within 24 hours of actual transfer 2. The ombudsman must also be notified by telephone or in person if the resident requests such notification 3. Ombudsman has 24 hours from receipt of request to review circumstances of emergency discharge 4. The resident's file must be documented to show who was contacted, whether the contact was by telephone or in person, and the date and time of the contact. 5. If the notice is not given in writing, written notice must be given the next working day Ch 400 Reader Copyright © 2005-2024 by Stan Mucinic. All rights reserved. 28 of 39 12.6 – CHANGES IN PHYSICAL PLANT 1. Must notify AHCA of a proposed discharge due to changes in physical plant that makes the facility unsafe and requires on-site inspection by AHCA to verify necessity of discharge 12.7 - OMBUDSMAN REVIEW 1. Administrators must forward a resident request for ombudsman review of the notice of discharge within 24 hours of the resident’s request 2. The Ombudsman has 7 days to review the discharge 3. Failur