Section 65E-4.016 - Mental Health Residential Treatment Facilities(1) Licensure of Mental Health Residential Treatment Facilities. To be licensed as a mental health residential treatment facility an applicant must provide a long term, homelike residential environment that provides care, support, assistance and limited supervision in daily living to adults diagnosed with a serious and persistent major mental illness who do not have another primary residence. Any facility licensed as a residential treatment facility under this rule must sustain a 60 day average or greater length of stay of residents, except as specifically provided for in Section 394.875(11), F.S. Any facility providing primarily clinical residential services, either during an urgent care episode or during the 90 days following such an episode shall not be licensable under this rule. Residential treatment facilities that primarily provide treatment for eating disorders, weight loss programs, substance abuse or other specialty psychiatric treatment program are excluded from licensure under this rule.(2) Definitions. The definitions provided in this section are limited to this Rule 65E-4.016, F.A.C. (a) "AHCA" means the Agency for Health Care Administration.(b) "Apartment" means a self-contained dwelling unit with kitchen and bathing facilities and living, dining and sleeping space for use by one to four residents who maintain a common household.(c) "CCMS" means the Department of Children and Family Services Continuity of Care Management System.(d) "Governing Board" means the individual or individuals responsible for and having authority for the policies, bylaws, operations, and standards of service and activities of the residential treatment facility. If the facility is operated by an organization that delivers comprehensive mental health services, the governing body of such organization shall be considered the facility's governing board. If the facility is owned by a partnership or single owner, the partners or single owner shall be regarded as the facility's governing board.(e) "Department" means the Department of Children and Family Services.(f) "Individual Service Plan" or "Service Plan" means a document developed by the case manager and resident which depicts service and resource attainment goals and objectives to guide service delivery.(g) "Individual Treatment Plan" or "Treatment Plan" means a document or section of the individual service plan developed by residential treatment facility staff or the treatment team and the resident which depicts the goals and objectives relating to skill attainment that need to be accomplished within the facility's environment.(h) "JCAHO" means the Joint Commission on Accreditation of Healthcare Organizations.(i) "Medication Administration" means opening a container of medication, removing a prescribed dosage, and giving the medication to the person for whom it is prescribed. This includes administering injections and eye drops.(j) "Medication Supervision" means activities which assist an individual to self-medicate. These activities include prompting a resident to take medication, opening containers and reading labels to the resident, and checking the self-administered dosage against the label of the container.(k) "Mental Health Professional" or "Professional" means a clinical psychologist, clinical social worker, physician, psychiatric nurse or psychiatrist as defined in Section 394.455, F.S.(l) "Mental Illness" is as defined in Section 394.455(3), F.S.(m) "Office of Health Facility Regulation" means the AHCA program responsible for receiving license applications, coordinating licensure survey activities and issuing or denying the license.(n) "Physician" means a person licensed to practice medicine or osteopathic medicine in Florida.(o) "Peer Review" means the review of a staff member's professional work by comparably trained and qualified individuals performing similar tasks.(p) "Quality Assurance Program" means a systematic approach designed to evaluate the quality of care provided by an agency and to promote and maintain efficient and effective mental health services.(q) "Rehabilitation" means an educationally based process which provides the opportunities for mentally ill persons to attain the physical, emotional and intellectual skills needed to live, learn, work or socialize in their own particular environments. The process includes developing the resources needed to support or strengthen their level of functioning in these environments.(r) "Resident" means any individual 18 years of age or older receiving services in any mental health residential treatment facility, program or service.(s) "Residential Treatment Facility, " referenced herein as either RTF or facility, means any building, buildings or distinct, physically separated and separately controlled part of a building, whether operated for profit or not, which meets the criteria defined in Section 394.67(14), F.S. Short-term residential treatment facilities, regulated under Chapter 65E-12, F.A.C., are excluded from this definition. The criteria which comprise each level of RTF are specified in subsection 65E-4.016(4), F.A.C.(t) "Restraint" means restricting the movement of a person's limbs, head or body by the use of mechanical or physical devices for the purpose of preventing injury to self or others.(u) "Seclusion" means the isolation and containment of residents who pose an imminent threat of physical harm to themselves or others.(v) "Self-Preservation" means the ability of a person to perceive danger and take appropriate action to keep safe from injury.(w) "Treatment" means services which are provided to persons, individually or in groups, which include rehabilitation, counseling, supportive therapy, chemotherapy, psychotherapy or any other accepted therapeutic, educational or supportive process.(x) "Utilization Review" means the process of using predefined criteria to evaluate the necessity and appropriateness of services and allocated resources to assure that the program's services are necessary, cost effective and effectively utilized.(3) Licensure Procedure. Every RTF must be licensed annually by AHCA unless specifically excluded from licensure under the provisions of Section 394.875(5), F.S. (a) Buildings that are separated from one another in which a similar level of residential care and treatment is provided, as defined in subsection 65E-4.016(4), F.A.C., may be licensed as one facility under the following circumstances: 1. Such buildings are not separated by another building, part of a building or buildings used for other purposes; and,2. Such buildings are not separated by obstructions that impede the rapid movement of staff between them.(b) When different levels of residential care and treatment are provided in one building, each level must be licensed as a separate RTF.(c) Original License - New construction, new operation or change of licensed operator. Applicants for an original license shall submit a completed AHCA Form, 3180-5003 Feb. 96, "Crisis Stabilization Unit, Short-Term Residential Treatment Facility and Residential Treatment Facility Licensure Application" effective February, 1996, which is incorporated by reference and provided by AHCA. The following supplemental information must be attached to the application:1. Program narrative which contains the following:a. List of services provided, including a description of each service,b. Staffing pattern description, including the hours and days of on-premises and on-call staff coverage, and the number and types of staff on duty for each shift; and,c. Resident population description, based minimally on the criteria in subsection 65E-4.016(4), F.A.C., that are applicable to the level of RTF for which the licensure application is being submitted.2. Table of Organization, including all management levels between the RTF and the governing board.3. Resume of the RTF manager.4. Fiscal information, including a balance sheet and a statement projecting revenues, expenses, taxes, extraordinary items and other credits and charges for the licensure year.5. Proof of liability insurance coverage from a licensed insurer in an amount not less than $300,000 per occurrence with a minimal annual aggregate of not less than $1,000,000.6. Copy of current fire safety inspection certificate.7. Copy of current health inspection certificate.8. For Level I and II facilities, a signed statement from the appropriate government official that the facility has met applicable local zoning requirements.9. Proof of current JCAHO accreditation, if applicable.(d) A newly developing facility will be provided a 90-day probationary license after the completed application has been verified for compliance with Rule 65E-4.016, F.A.C. The probationary period may be extended for an additional 90 days if the applicant has substantially complied with the requirements for licensure, and if action has been initiated to satisfy all of these requirements.(e) Renewal License. 1. An applicant for renewal of a license shall apply to AHCA no later than 90 days before expiration of the current license.2. Applicants for renewal of a license to operate a facility shall submit an application that meets the requirements of paragraph 65E-4.016(3)(a), F.A.C.(f) License Fee. An annual non-refundable license fee shall be submitted with the application for licensure. The fee shall be reasonably calculated annually to cover the cost of regulation. The formula for calculating this fee is the cost of Office of Health Facility Regulation positions for the process of surveying crisis stabilization units, short-term residential treatment facilities, and residential treatment facilities for licensure divided by the total number of crisis stabilization units, short-term residential treatment facilities, and residential treatment facility beds times the number of beds in the facility applying for licensure.(g) The license, AHCA Form 3180-5001 Feb. 96, effective February, 1996, which is incorporated by reference, shall be displayed in a conspicuous location inside the facility. For Levels III, IV, and V such license may be held available for inspection at the administrative offices of the facility or the organization which operates the facility.(4) Residential Treatment Facility Licensure Classifications. (a) Level IA. A Level IA facility provides a structured group treatment setting with 24 hours per day, 7 days per week supervision for residents who have major skill deficits in activities of daily living and independent living, and are in need of intensive staff supervision, support and assistance. Nursing services are provided on this level but are limited to medication administration, monitoring vital signs, first aid, and individual assistance with ambulation, bathing, dressing, eating and grooming. 1. Resident Eligibility Criteria. Persons who enter Level I facilities must meet the following minimum criteria: a. Diagnosed as having mental illness, c. Ambulatory or capable of self-transfer, d. Able to participate in treatment programming and services,e. Free of major medical conditions requiring ongoing 24 hours per day, 7 days per week nursing services,f. Assessed as having the potential, with staff supervision, to self-administer medication, maintain personal hygiene, and participate in social interaction; and,g. Does not exhibit chronic inappropriate behavior which disrupts the facility's activities or is harmful to self or others.2. Staffing Pattern. Level IA facilities must maintain a minimum of 1-10 staff to resident ratio with never less than 2 staff on the premises at all times. There must be 24 hours per day, 7 days per week nursing supervision, provided minimally by a licensed practical nurse under the direction of an on-call licensed physician or registered nurse.(b) Level IB. Level IB facilities shall meet all Level IA criteria with the exception of fire safety requirements. Level IB fire safety requirements are specified in sub-subparagraph 65E-4.016(17)(b) 2.a., F.A.C.(c) Level II. A Level II facility provides a structured group treatment setting with 24 hour per day, 7 days per week supervision for five or more residents who range from those who have significant deficits in independent living skills and need extensive supervision, support and assistance to those who have achieved a limited capacity for independent living, but who require frequent supervision, support and assistance.1. Resident Eligibility Criteria. A person who enters Level II facilities, in addition to meeting the eligibility criteria specified in Level I, must meet the following criteria: a. Self-administers medication with staff supervision,b. Maintains personal hygiene and grooming with staff supervision,c. Initiates and participates in social interaction with staff supervision,d. Performs assigned household chores with staff supervision; and,e. Is capable of self-preservation in accordance with subparagraph 65E-4.016(17)(b) 2., F.A.C.2. Staffing Pattern. Level II facilities must maintain a minimum of 1-15 staff to resident ratio with never less than one staff on the premises when residents are present during normal waking hours. During normal sleeping hours, a minimum of 1-22 staff to resident ratio is required. The facility must have procedures to mobilize additional staff 24 hours daily in the event of emergency need.(d) Level III. A Level III facility consists of collocated apartment units with an apartment or office for staff who provide on-site assistance 24 hours per day, 7 days per week. The facility may be comprised of a block of apartments within a large apartment complex. The residents served in this facility have a moderate capacity for independent living.1. Resident Eligibility Criteria. A person who enters Level III facilities, in addition to meeting the criteria specified in Levels I and II, must meet the following criteria: a. Self-administers and monitors own medication with minimal prompting,b. Performs household chores with minimal prompting,c. Maintains personal hygiene and grooming with minimal prompting,d. Utilizes recreational and social resources with staff encouragement,e. Utilizes community transportation systems,f. Manages income with assistance; and, g. Expresses problems and concerns to appropriate persons.2. Staffing Pattern. Level III facilities must maintain a minimum 1-20 staff to resident ratio with never less than one staff on the premises when residents are present during normal waking hours. During normal sleeping hours, a minimum of 1-40 staff to resident ratio is required. The facility must have procedures to mobilize additional staff 24 hours daily in the event of emergency need.(e) Level IV. A Level IV facility provides a semi-independent, minimally structured group setting for 4 or more residents who have attained most of the skills required for independent living and require minimal staff support.1. Resident Eligibility Criteria. A person who enters Level IV facilities, in addition to meeting the eligibility criteria specified in Levels I, II and III, must demonstrate proficiency in performing at least the following skills without daily supervision:a. Self-administers and monitors own medications,b. Performs household chores and activities,c. Maintains personal hygiene and grooming, e. Utilizes recreational and social resources,f. Procures food and other items necessary to maintain a household,g. Prepares meals either individually or cooperatively; and,h. Utilizes community transportation systems.2. Staffing Pattern. Level IV facilities may have less than 24 hours per day, 7 days per week on-premises supervision; however, on-call staff must be available at all times. Staff shall have a minimum of weekly on-premises contact with residents.(f) Level V. A Level V facility provides a semi-independent, minimally structured apartment setting for 1 to 4 residents who have attained adequate independent living skills and require minimal staff support. The apartments in this setting are owned or leased by the service provider and rented to residents. All apartments on this level that are operated by a service provider, regardless of location, shall be considered the premises of the facility.1. Resident Eligibility Criteria. Persons who enter Level V facilities, in addition to meeting the eligibility criteria specified in Levels I, II and III, must demonstrate proficiency in performing at least the following skills: a. Self-administers and monitors own medications,b. Performs household chores and activities,c. Maintains personal hygiene and grooming,e. Utilizes recreational and social resources,f. Procures food and other items necessary to maintain a household,g. Prepares meals either individually or cooperatively; and,h. Utilizes community transportation system.2. Staffing Pattern. Level V facilities may have less than 24 hours per day, 7 days per week on-premises staff; however, on-call staff must be available at all times. Staff shall have a minimum of weekly on-premises contact with residents.(5) Program Reviews, Evaluations and Consultations. (a) Representatives of the Alcohol, Drug Abuse and Mental Health Program Office; AHCA; and District Alcohol, Drug Abuse and Mental Health Program Office; shall provide consultation and conduct annual reviews and evaluations, or more as necessary, of all RTFs to determine compliance with rules and standards.(b) RTFs shall afford representatives of the Alcohol, Drug Abuse and Mental Health Program Office; AHCA; and District Alcohol, Drug Abuse and Mental Health Program Offices; access to the facility and the documentation necessary for conducting the reviews required to determine compliance with this rule and all other applicable rules and statutes.(6) Organization and Administration.(a) Governing Board Responsibilities. The governing board of each RTF shall be responsible for policies, by-laws, operations and standards of service.(b) Administrative Management. 1. Each RTF Level I, II, and III shall have a manager who is responsible for its daily operations.2. RTFs shall comply with Chapter 394, F.S., and all other applicable Florida Statutes; all applicable sections of Chapters 65E-4 and 65E-14, F.A.C.; and all other applicable Florida Administrative Rules.3. RTFs shall develop and maintain all records required by Chapter 394, F.S., and applicable administrative rules.(c) Personnel Policies, Records, and Practices.1. Personnel policies and procedures shall be developed and provided to each employee.2. There shall be a written description for each position in the facility. Position descriptions shall include the following:d. Minimum academic and experience requirements.3. Confidential personnel records shall be maintained for each employee of the residential program. These records shall contain minimally the following information:a. Qualifications for the position,b. Verified pre-employment references,c. Evaluation of performance on at least an annual basis,d. Dates and subjects of in-service training and attendance at conferences, workshops and other relevant activities, e. Beginning date of employment; and,f. Date and reason for separations.4. Each RTF shall post a weekly schedule of work hours.5. The facility's personnel recruitment and selection process shall ensure that there is no discrimination because of race, creed, color, age, sex, national origin, or political affiliation.6. The RTF shall make available to employees a written orientation to the program's operation, a copy of their current job description, a copy of this rule and a copy of patient's rights. The receipt or availability of this information shall be documented in personnel records.(d) Staff Composition, Organization and Coverage.1. Organization. RTFs shall have a written organizational plan for the administrative and direct services staff which clearly explains the responsibilities of the staff for services provided by the program. The plan shall also include lines of authority, accountability and communication.2. RTFs shall have direct or telephone access to at least one professional as defined in Section 394.455(2), F.S., 24 hours a day, 7 days a week. If the professional is not a psychiatrist, the facility shall also arrange for the regular, consultative and emergency services of a psychiatrist licensed to practice in Florida. a. Back-up coverage shall be provided by staff trained to handle acute problems on a 24 hours per day, 7 days per week on-call basis.b. Staffing patterns shall be no less than required by the level for which a facility is licensed.3. Staff Development. Staff development and education programs shall be planned and conducted on a regular and continuing basis. Documentation of these sessions shall include date, subject, attendance and instructor. Attendance at professional workshops and conferences should also be documented and placed in employees' personnel records.(7) Resident Eligibility Criteria. (a) To be eligible for admission to a facility, a person shall meet the minimum criteria required by the level for which a facility is licensed.(b) Additional eligibility criteria may be developed if such criteria are needed to insure that individuals admitted by the facility are compatible with the facility's capability to serve them, or to further delineate the minimum skills or behaviors that a person needs to function in the facility's environment.(8) Continuity of Care.(a) A CCMS case manager shall be assigned to each resident in a publicly funded RTF. In addition to the requirements specified in Rule 65E-4.014, and Chapter 65E-15, F.A.C., the RTF resident's case manager shall be responsible for the following: 1. Providing to RTF staff a copy of the individual service plan and any amendments to the plan,2. Providing to RTF staff the assessment information needed to determine a resident's eligibility and the information needed to develop the individual treatment plan,3. Providing to RTF staff ongoing information regarding the resident's progress in other settings and any other factor which may assist in the treatment or rehabilitation process,4. Providing assistance to RTF staff in relating treatment goals to the environment in which the resident will live after the completion of treatment; and,5. Residential placement as needed.(b) RTF staff shall be responsible for the following activities: 1. Providing to the case manager a copy of the individual treatment plan and any amendments to the plan,2. Reporting to the case manager the resident's progress in achieving treatment goals,3. Attending case management conferences as needed,4. Informing the case manager of any changes in the resident's status or condition that may affect other services the resident receives or may require the case manager's intervention; and,5. Providing to the case manager a discharge, termination or transfer summary as appropriate.(9) Intake. The intake criteria specified in this subsection shall apply to either a freestanding RTF or to one which first admits a resident if such RTF is part of a system of residential care and treatment. The following assessment and evaluation information shall be obtained or developed by the RTF in order to determine a resident's eligibility.(a) Physical Assessment. 1. For each resident accepted into a facility from a state institution, a medical summary consisting minimally of a problem list, current status, significant lab reports and a copy of the most recent physical examination shall have preceded the resident to the program. The medical summary shall be placed in the resident's record.2. If a physical examination has not been completed within 60 days prior to the resident's admission to the RTF, the examination shall be initiated within 24 hours of the admission. A licensed physician, licensed physician's assistant or licensed advanced registered nurse practitioner shall complete the examination within 30 days. The medical report shall be placed in the resident's record.3. Physical examination requirements minimally shall include:a. A medical history, including responses to medication, physical diseases and physical handicaps, b. The date of the last physical examination,c. A description of physical status, including diagnosis and any functional limitation,d. Recommendations for care, including medication, diet and therapy; and,e. To the extent possible, a determination of the presence of a communicable disease.(b) Psychiatric or psychological assessment.(c) Mental status examination.(d) Psychosocial assessment and history which includes:1. Developmental problems, including past experiences that may have affected development,2. Peer group relationships and activities,3. Social skills and deficits,4. Past and present relationship with family and community,5. Prior placement settings,6. Recreational experiences, activities and interests,7. Expectations and role of the family in the treatment process,8. Psychiatric history, including any previous treatment and the reason for termination,9. Vocational history; and,(10) Admission. (a) Each resident, within 24 hours of admission to a facility, shall be provided an orientation which includes minimally the following:1. Explaining the facility's services, activities, performance expectations, rules and regulations, including providing to the resident written facility rules, 2. Familiarizing the resident with the facility's premises, the neighborhood and public transportation systems, 3. Scheduling the resident's activities; and,4. Explaining resident rights and grievance procedures, except to residents who have transferred from another facility within the same system and are familiar with their rights and grievance procedures.(b) The following documentation shall be placed in the resident's file: 1. A signed statement by the resident or guardian that the resident has received an orientation which meets the minimum required criteria,2. A signed statement that the resident has either read or has been explained facility rules,3. A signed statement indicating the resident's financial obligations to the facility and the person responsible for meeting such obligations,4. For incompetent residents, a statement identifying and locating the guardian of record, legal guardian or court ordered custodian with responsibility for medical and dental care and signed consent for treatment from such person, 5. Written arrangements for phone calls, visits, and, when indicated, family participation in the treatment process,6. Written arrangements for clothing, allowances and gifts; and,7. For forensic residents, a copy of any court order, charges pending and any other legal status documents and procedures to be followed if the resident leaves the program without approval.(11) Assessment and Treatment Planning. RTF staff or the treatment team shall begin within 72 hours of admission and complete within 30 days of admission a functional assessment and individual treatment plan for each resident. Interventions which are needed to remedy serious deficits shall not be delayed until the assessment and individual treatment plan are completed. (a) Assessment. The functional assessment shall determine the resident's ability to utilize the skills needed to function successfully in the RTF environment, and shall identify any obstacles to the resident's learning or using such skills.(b) Treatment Planning. 1. Treatment goals or objectives shall be achievable, have a reasonable time frame for achievement, and be stated in terms of measurable and observable changes.2. The treatment plan shall be developed with and signed by the resident or guardian. If the resident or guardian refuses to sign, the reason for this, if determinable, must be documented in the case record.3. RTF staff or the treatment team shall review the treatment plan at least monthly and note this in the record.4. RTF staff or the treatment team shall update and revise the treatment plan when goals or objectives are accomplished or when additional resident deficits which are in need of intervention are identified. The treatment plan shall be updated at least every 60 days for facility Levels I, II and III and at least every 120 days for facility Levels IV and V.5. Family members, guardians or significant others shall be included in treatment planning, treatment, and discharge planning to the extent permitted or requested by the resident and when the staff has determined that such participation will be in the best interests of the resident.(12) Treatment Services and Activities. RTFs shall provide services and activities which are adaptable to the individual needs of residents, promote personal growth and development, and prevent deterioration or loss of ability.(a) Policy and Procedures Manual. Each RTF shall have a policy and procedures manual which guides its services and activities. The manual shall be periodically reviewed and revised as the needs of individual residents or the living group change, and shall be available to staff and residents.(b) Social and Recreational Activities. RTFs shall provide or refer residents to recreational and social activities during the hours they are not involved in other planned or structured activities. Recreational and social activities shall be planned with resident participation and posted in a conspicuous location.(c) Religious Activities. Opportunity shall be provided for all residents to participate in religious services and other religious activities within the framework of their individual and family interests.(d) Resident Tasks. A resident may be assigned tasks related to facility operation, including but not limited to cooking, laundering, housekeeping and maintenance, only if such tasks are in accordance with the treatment plan and are done with staff supervision.(e) Physical Health Care Services.1. A facility shall have available, whether within its organizational structure or by written agreements, procedures or contracts with outside health care clinicians or facilities, a full range of services for the treatment of illnesses and maintenance of general health.2. Staff shall have a basic knowledge of and receive training in the health needs and problems of residents.3. Direct service staff shall report resident illnesses and significant physical dysfunctions in a timely manner to the resident's organization's physician and note such in the resident's record.(f) Medication. RTFs shall have written policies and procedures regarding the following aspects of medication management.1. Storage. a. No prescription drug shall be kept in the facility unless it has been legally dispensed and labeled for the person for whom it is prescribed.b. Residents may keep their medication in a secure place in their room, except when such medication is required to be personally carried for frequent or emergency use.c. Medication may be centrally stored under the following conditions:(I) If the preservation of medicines requires refrigeration,(II) When medication is determined and documented by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed,(III) If the resident is forgetful or disoriented and is not capable of taking medications as prescribed, or(IV) When, because of physical arrangements and the conditions or habits of other persons in the program, the medications are determined by the facility manager, nurse or physician to be a safety hazard to others.d. Centrally stored medications shall be: (I) Kept in a locked cabinet or other locked storage receptacle:(II) Accessible only to the staff responsible for distribution of medication; and,(III) Located in an area free of dampness and abnormal temperatures, except in the case of a medication requiring refrigeration.e. Each container of medication shall be labeled according to state law.f. Prescription medications which are not taken with the person upon terminating residence shall be returned to a responsible relative or a guardian, or if none exists, given to a pharmacist to destroy. Notation of drug disposition shall be entered in the resident's record.g. Staff not licensed by the State of Florida to administer medication may assist a resident in the self-administration of medication by:(I) Obtaining the medication from the centrally stored or other location, (II) Reminding the resident that it is time for the medication to be administered,(III) Preparing the necessary paraphernalia, such as water, juice, cups, spoons, and medicine cups,(IV) Steadying arm, hand or other parts of the resident's body,(V) Returning to the medication container unused doses of solid medication not used by the resident; and,(VI) Returning the medication container to the centrally stored or other location.2. Distribution of Centrally Stored Medication. a. A staff person who has access to and is responsible for the distribution of centrally stored medication shall be available at all times.b. Staff may distribute medication only to the person for whom it is prescribed.3. Medication Administration. a. Professionals licensed to administer medications in accordance with Chapter 464, F.S., may administer medications in accordance with the physician's directions.b. A licensed practical nurse may administer medications when under the direction of a registered nurse, a licensed physician, or a licensed dentist who minimally must be accessible by telephone.(g) Emergency Services. All direct service staff shall be provided training to handle emergency medical and mental health situations. 1. RTFs shall have written policies and procedures regarding handling and reporting of emergencies. Such policies and procedures shall be reviewed at least annually by all staff.2. RTFs shall not use seclusion.3. With the exception of half bed rails used under the prescription and supervision of a physician, RTFs shall not use restraints.4. A minimum of one RTF staff member per shift shall maintain current first aid and CPR certification.5. Each RTF shall have procedures for managing aggressive behavior.6. First aid kits shall be available to facility staff at all times. Contents of the first aid kits shall be selected by the staff or consulting medical personnel and shall include items designed to meet the needs of the facility.7. RTFs shall have written policies and procedures for obtaining emergency diagnosis and treatment of dental problems.8. RTFs shall have written policies and procedures for providing emergency medical and psychiatric care.a. There shall be written, posted procedures which clearly specify who is available and authorized to provide necessary emergency psychiatric or medical care and how to arrange for referral or transfer to another facility, including ambulance arrangements, when necessary.b. RTFs shall transfer residents who pose an imminent physical danger to themselves or others to an appropriate acute care facility.(I) RTFs shall develop and maintain written transfer procedures, including a cooperative agreement with appropriate acute care facilities.(II) RTFs shall maintain a registry of all transfers to acute care facilities and shall notify the referring court in the case of forensic residents, if appropriate.9. Emergency Reports and Records. a. RTFs shall report to the appropriate district administrator and guardian any serious occurrence involving a resident outside the normal routine of the residential program such as abduction, abuse, assault, accident, contraband, illness requiring hospitalization, sexual abuse, suicide, death and homicide.b. The reporting of all unusual incidents shall comply with departmental incident reporting procedures as prescribed in HRSR 215-6, "Incident Reporting and Client Risk Prevention, " July 1, 1994, which is incorporated herein by reference.(13) Discharge, Termination and Transfer. (a) A discharge, termination or transfer summary shall be included in the resident's record.(b) If required by the court, the program shall obtain court approval for the discharge of forensic residents and submit to the court any required reports.(14) Resident Rights. The legal and civil rights of residents shall be safeguarded.(a) Residents shall be informed of their rights, including the right to legal counsel and all other requirements of due process. Receipt of such information shall be documented by the signatures of the resident or guardian.(b) RTFs shall be administered in a manner that protects the resident's rights, life and physical safety.(c) RTFs shall post abuse and neglect phone numbers and the District Human Rights Advocacy Committee (HRAC) phone number.(d) The facility's space and furnishings shall enable the staff to provide appropriate supervision while respecting the resident's right to privacy.(e) Each facility shall have written policies and procedures which allow resident communication and visits with family members and other visitors when such visits do not interfere with treatment activities. Such policies and procedures shall be provided to the resident and family and updated when changes occur.1. If treatment interventions require restriction of communication or visits, as set forth in the program's policies and procedures, treatment staff shall evaluate these restrictions at least weekly for their effectiveness and continuing need. Such restrictions shall be subject to the provisions of Chapter 65E-5, F.A.C., documented and signed by the facility manager, and placed in the resident's record.2. Restriction of communication or visits required for practical reasons, including the expense of travel or telephone calls, shall be determined with the resident's family or guardian.(f) The resident's opinions and recommendations shall be considered in the development and continued evaluation of the facility and its operations. The facility shall have written policies and procedures for receiving and responding to resident communications concerning its program.(g) RTFs shall have written policies concerning resident grievance procedures.(h) Residents shall not be subjected to remarks which ridicule them, their families or others.(i) RTFs shall have written procedures for suspending residents from the facility which are approved by the governing board and the district administrator.(j) RTFs shall not exploit a resident or require a resident to make public statements acknowledging gratitude to the program.(k) Residents shall not be required to perform at public gatherings.(l) RTFs shall not use identifiable pictures of a resident without written consent from the resident or guardian. Before any such pictures are used, a signed consent form indicating how they will be used shall be placed in the resident's record.(m) Residents shall be allowed to wear their own clothing as appropriate.1. Training and assistance in the selection and proper care of clothing shall be available.2. Clothing shall be suited to the climate.3. Clothing shall be in good repair, of proper size and similar to the clothing worn by the resident's peers in the community.(15) Resident Records. (a) Policies and Procedures for Resident Records. A freestanding facility or an organization operating a facility shall have written policies and procedures regarding resident records that include the following:1. Resident records shall be confidential, current and accurate.2. Resident records shall be stored in a locked room or container.3. The information in resident records shall be safeguarded against loss, defacement, tampering or use by unauthorized persons.4. Confidentiality of the information contained in a resident's record and communication between staff members and residents shall be protected as stated in Section 394.4615, F.S., and Chapter 65E-5, F.A.C. Records may only be removed from the jurisdiction and safekeeping of the facility or the organization operating a facility according to written policies and procedures as required by law.5. Records may only be removed from the jurisdiction and safekeeping of the facility or the organization operating a facility according to written policies and procedures as required by law.6. Each RTF shall provide training in verbal and written confidentiality requirements to all staff as part of new staff orientation and ongoing staff development.(b) Maintenance of Records. Each freestanding facility or organization operating a facility shall have a master filing system which includes a comprehensive record of each resident's involvement in every aspect of the program. 1. Level I, II and III facilities operating under an organization that maintains a master filing system not on the RTF premises shall, in lieu of the master resident record, maintain for each resident a record that contains minimally the following information: a. Demographic information,b. Psychosocial assessment,d. Current medication profile,e. Individual treatment plan and plan amendments,f. Emergency contact sheet; and,2. RTFs or organizations that operate RTFs shall adopt policies regarding the storage, disposal or destruction of resident records that protect against disclosure of confidential information in compliance with Chapters 119 and 267, F.S. Resident records shall be maintained minimally for 7 years after the date of the last entry.3. Resident record services shall be directed, staffed and equipped to facilitate processing, checking, indexing, filing, retrieval and review of all resident records.4. There shall be adequate space, equipment and supplies, compatible with the needs of the resident record services, to enable the personnel to function effectively and to maintain clinical records readily accessible.(16) Program Evaluation. (a) Quality Assurance. 1. RTFs shall have or be part of an established quality assurance program with written policies and procedures that include the following:a. Composition of review committees,b. Case review procedures,c. Criteria and standards used in the review process and procedures for their development; and, d. Procedures to assure dissemination of the results and corrective action.2. Each quarter a peer review and a utilization review shall be conducted which ensure at a minimum that: a. Resident admissions are appropriate, b. Services are delivered in the least restrictive environment possible,c. Resident rights are protected,d. When permitted by the resident, the resident's family or significant others are involved in resident assessment, treatment planning and discharge planning,e. Service plans are comprehensive and relevant to residents' needs,f. Minimum standards for resident records are met,g. Minimum therapeutic dosages of medication are prescribed and appropriately administered,h. Medical emergencies are handled appropriately,i. Specialty cases such as suicides, death, violence, staff abuse, and resident abuse are reviewed,j. All major incident reports are reviewed,k. The length of stay for each resident is appropriate,l. Supportive services are ordered and obtained as needed,m. Continuity of care is provided; and,n. Delay in receiving services is minimal.(b) The program shall conduct an annual review of program effectiveness, program goals, policies, procedures and service treatment provision.(c) All program evaluation and review information shall be made available to the department, upon request, within the limits of confidentiality pursuant to Section 394.459(9), F.S.(17) Facility Standards. (a) Building Construction Requirements. 1. The construction and renovation of a facility shall comply with the provisions of Chapter 553, F.S., Building Construction Standards.2. Sewage, including liquid wastes from cleaning operations, shall be disposed of in a public sewage system or other approved sewage system in accordance with Chapter 64E-6, F.A.C., Standards for Individual Sewage Disposal Facilities.3. All sanitary facilities shall comply with the requirements of Chapter 64E-10, F.A.C.4. All plumbing shall comply with the plumbing code legally applicable to the area where the facility is located.5. The water supply must be adequate, of safe and sanitary quality and from an approved source in accordance with Chapters 64E-4 and 62-550, F.A.C., Drinking Water Standards, Monitoring, and Reporting.6. Heat shall be supplied from a central heating plant or by a heating system which meets with applicable fire safety codes.7. Facilities and additions shall be constructed to allow full compliance with the provisions of paragraph 65E-4.016(17)(b), F.A.C.(b) Health and Safety. 1. Disaster Preparedness. a. The facility shall have or operate under a safety committee with a safety director or officer who is familiar with the applicable local, state, federal and National Fire Protection Association safety standards. The committee's functions may be performed by an already existing committee or governing board subcommittee with related interests and responsibilities.b. The facility shall have or be a part of a written internal and external disaster plan, developed with the assistance of qualified fire, safety and other experts. (I) The plan shall identify the availability of fire protection services and provide for the following: (A) Use of the fire alarm,(B) Transmission of the alarm to the fire department,(C) Response to the alarm,(D) Isolation of the fire, (E) Evacuation of the fire area, with posted evacuation routes,(F) Preparation of the building for evacuation; and,(II) The plan shall be made available to all facility staff and posted in appropriate areas within the facility.(III) There shall be records indicating the nature of disaster training and orientation programs offered to staff.2. Fire Safety. a. RTFs shall comply with all applicable federal, state and local fire safety standards. (I) For facility Level IB, which may have no more than three residents incapable of self-preservation, and for facility Levels II, III, IV, and V, which may have no residents incapable of self-preservation, each resident record shall have a signed statement by a physician or licensed psychologist regarding the resident's capability of self-preservation.(II) Facility Levels IB, II, III, IV, and V shall have a prompt evacuation capability.b. Level IV and V facilities shall have a written policy on the safe use of extension cords and adapters. The use of extension cords and adaptors is prohibited in Level I, II and III facilities.c. Electrical cords and appliances shall be maintained in a safe condition.d. Portable heating devices shall be used only in emergency situations as defined in agency procedures approved by the governing board.e. Flammable liquids or gas cylinders shall not be positioned near flame or heat sources, nor stored with combustible materials.f. Emergency Power. The facility shall provide egress lighting that will operate in the event of a power failure.g. Smoking. The program shall have a written policy governing smoking in the facilities. (I) The smoking policy shall be conspicuously posted and made known to all residents, staff and visitors.(II) Smoking shall be prohibited in any area of the facility where combustible supplies, materials, liquids or gases are in use or stored.(III) Ambulatory residents shall not be permitted to smoke in bed.(IV) Unsupervised smoking by residents confined to bed shall be prohibited.(V) Wastebaskets and ashtrays shall be made of noncombustible materials, and wastebaskets shall not be used as ashtrays.h. Fire Safety Inspections.(I) A fire safety inspection must be obtained before occupying any new physical facility or addition.(II) The program shall secure, on a yearly basis or as required by statute, a documented fire safety inspection, including an inspection of electrical equipment.(III) A report of the most recent fire inspection must be kept on file and accessible to authorized individuals.3. Personal Safety. a. The grounds and all buildings on the grounds shall be maintained in a safe and sanitary condition, as required in Chapter 386, F.S., Nuisances Injurious to Health.b. The building shall be free of hazards such as cracks in the floors, walls, or ceiling; warped or loose boards, tile, linoleum, handrails or railings; and broken window panes or missing window screens.c. Protection shall be provided from sharp or jagged projections, "invisible" glass, moving parts, heated surfaces, heavy objects that could fall, or any other potentially hazardous condition.d. The facility shall be free of unsafe accumulations of possessions, including equipment and supplies of residents, staff or owner.e. Grab bars shall be nonremovable.f. The temperature of the hot water supply shall be regulated and shall be between 105º-115º at the outlet.g. Any electrical fans, except ceiling paddle fans, shall be screened. All electrical fans, including paddle fans, shall be placed in a safe location.h. All potentially dangerous or toxic substances shall be stored in a cabinet or enclosure, away from food or other areas that could constitute a hazard to the residents.i. If for clinical reasons access to potentially dangerous grooming aids or other personal articles is contraindicated for residents in Level I, II and III facilities, staff shall explain to the resident the conditions under which the articles may be used and shall document the clinical rationale for these conditions in the resident's record. If clinically indicated, the personal articles of residents in facility Levels I, II and III may be kept under lock and key by staff. Such actions shall be reviewed weekly for effectiveness and continued need.j. The facility shall develop and enforce policies pertaining to the maintenance, supervision and safe use of any special activity areas or equipment.(I) Indoor and outdoor recreational areas shall be provided with safeguards designed for the needs of the residents.(II) Outdoor recreational areas shall be well drained and kept free of litter and trash.(III) If swimming pools are available in facilities with eight or more residents, such pools shall be supervised at all times when they are in use.k. Security. The facility shall develop a written policy which includes procedures that provide security for residents, staff and visitors, consistent with the conditions and risks associated with the facility's location.4. Health and Sanitation. a. Appropriate health and sanitation inspection certificates shall be obtained before occupying any new physical facility or addition, and at least yearly or as required by statute, thereafter. A report of the most recent inspection must be on file and accessible to authorized individuals.b. Hot and cold running water under pressure shall be readily available in all washing, bathing and food preparation areas.c. Garbage, Trash and Rubbish Disposal.(I) All garbage, trash, and rubbish from residential areas shall be collected daily and taken to storage facilities. Garbage shall be removed from storage facilities frequently enough to prevent a potential health hazard or at least twice per week. Wet garbage shall be collected and stored in impermeable, leakproof, fly-tight containers pending disposal. All containers, storage areas and surrounding premises shall be kept clean and free of vermin.(II) If public or contract garbage collection service is available, the facility shall subscribe to these services unless the volume makes on site disposal feasible. If garbage and trash are disposed of on premises, the method of disposal shall not create sanitary nuisance conditions.d. Pets and Live Animals.(I) The facility shall formulate a policy regarding the availability and care of pets and other animals consistent with the requirements of good health, sanitation and local ordinances.(II) Live animals shall not be allowed in the kitchen or food service areas while food is uncovered or exposed.e. The kitchen and food preparation area shall be well-lighted, ventilated and located apart from areas which could cause food contamination. All doors and windows in the kitchen and food preparation areas that open to the outside shall be screened.f. The floors, walls, shelves, tables, utensils and equipment in all rooms where food or drink is stored, prepared or served or where utensils are washed shall be kept clean and in repair. Stored food shall be protected from vermin, rodents and other contamination.(c) Food Service. 1. For food service areas with a capacity of 13 or more residents, all matters pertaining to food service shall comply with the provisions of Chapter 64E-11, F.A.C.2. Third Party Food Service. When food service is provided by a third party, the provider shall meet all conditions stated in this section, and shall comply with Chapter 64E-11, F.A.C. There shall be a formal contract between the facility and provider containing assurances that the provider will meet all food service and dietary standards imposed by this rule. Sanitation reports and food service establishment inspection reports shall be on file in the facility.3. Staff.a. The facility or organization which operates the facility shall be responsible for the supervision of food service staff.b. The staff shall perform their duties in a safe and sanitary manner, be knowledgeable of foods that meet regular diets and participate in continuing in-service education on at least an annual basis. A minimum of one staff member from each facility or organization which operates the facility serving food shall complete the Food Service Management Training Course at the county public health unit.c. All employees shall wear clean garments and keep their hands clean at all times while engaged in preparing or serving food and drink.d. Staff and residents engaging in the preparation and service of food shall use effective restraints to keep hair from food and contact surfaces.e. No person having a communicable disease in the transmittable stage or who is a carrier of organisms that may cause a communicable disease shall prepare or serve food for others.f. Duty assignments shall be posted in the kitchen area in facilities having three or more food service staff.4. Diet and Nutrition. The facility shall have policies and procedures to assure proper nutritional care of its residents, whether the food is prepared by residents, staff or a third party.a. For residents who need therapeutic diet services, a physician's order for each diet and the meal pattern, including types and amounts of food to be served, shall be on file. Therapeutic diets shall be prepared and served as ordered by the physician. Staff shall insure that residents on special diets follow the physician's orders.b. Regular diets shall meet the nutritional needs of residents.c. An up-to-date diet manual, such as the Diet Manual of the Florida Dietetic Association, Inc., shall be used as the standard reference in planning regular and therapeutic diets.d. The dietary allowances shall be met by offering a variety of foods adapted to the food habits, preferences and physical abilities of the residents and prepared by the use of standardized recipes.e. For facilities serving 3 meals a day, no more than 14 hours shall elapse between the end of an evening meal and the beginning of a morning meal containing a protein food. Intervals between other meals shall not be less than 4 hours and not more than 6 hours.f. Group facilities shall plan menus at least 1 week in advance for regular and therapeutic diets. The menus shall be dated and posted where easily viewed by residents, corrected as served, and kept on file for 6 months.5. Food Preparation, Sanitation and Storage. a. All food and drink shall be clean, wholesome, free from spoilage and prepared so as to be safe.b. Group facilities shall maintain a 1-week supply of non-perishable food, based on the number of weekly meals the program serves.c. Food shall be served attractively and at safe temperatures.d. Sufficient and appropriate eating ware shall be on hand.e. Schedules for cleaning of equipment, storage and work areas shall be in writing and on file.f. Reports of sanitation inspections shall be on file, showing corrections of any deficiencies.g. After each use, all nondisposable eating and drinking utensils shall be thoroughly cleansed with hot water and an effective detergent, rinsed free of such solution and sanitized.h. All food and drink at risk of spoilage shall be kept at or below 45º F, or above 140º F, except when being prepared or served.i. Each refrigerator or freezer used for storage of perishable foods shall be provided with an accurate indicating thermometer located in the warmest part toward the front side of the refrigerator or freezer so that the temperature can be easily and readily observed.j. Freezers should be kept at or below 0º F.6. Dining. a. Dining tables shall seat small groups of residents unless other arrangements are justified on the basis of resident needs.b. Dining rooms in Level I or II facilities shall be adequately supervised and staffed to provide assistance to residents when needed and to assure that each resident receives an adequate amount of and variety of food.c. The dining area shall be suitably lighted, ventilated and furnished.(d) Environment. 1. The facility shall establish an environment that enhances the positive self-image of residents and preserves their human dignity.a. Residential facilities shall not be identified by an exterior sign or vehicle sign that labels the residents or special functions of the facility.b. Vehicle traffic and parking relating to the facility shall be similar to that of surrounding structures or residences.c. Residences and grounds shall be furnished in a manner similar to a normal home living environment.2. The grounds of the facility shall have adequate space for resident activities.3. The facility shall be accessible to handicapped persons or the facility shall have written policies and procedures that describe how handicapped individuals can gain access to the facility for necessary services.4. Areas that accommodate the following shall be available:a. A full range of social activities,b. Private conversations,c. Group activities; and,d. Resident privacy, when appropriate.5. All areas of the facility occupied by residents shall be climatically controlled in a manner conducive to the comfort and privacy of the residents. a. A temperature of at least 72° F shall be maintained during waking hours in all areas used by residents. During hours when residents are normally asleep, a temperature of at least 68º F shall be maintained. These temperature requirements apply unless otherwise mandated by federal or state authorities.b. Temperatures of all inside areas of buildings used by residents shall not exceed 85º F.c. When cooling devices are used, they shall be placed or adjusted in a manner which minimizes drafts.6. Drinking water shall be readily available and easily accessible to residents.7. Mirrors reasonably free of distortion shall be placed in appropriate places to aid in grooming and to enhance self-awareness.8. Clocks and calendars shall be provided to promote awareness of time and day.9. The use of door locks or closed sections of the building shall comply with all applicable safety standards.10. Clean, well-lighted and ventilated laundering facilities for resident use shall be available on the premises or in the immediate neighborhood.11. A telephone which allows private conversations shall be available and easily accessible within the facility.12. Facility lighting shall promote clear perceptions of people and functions. When and where appropriate, lighting shall be controlled by residents.13. Whenever feasible, the environment shall provide views of the outdoors.14. Books, magazines, newspapers, arts and crafts materials, radios and televisions shall be available in accordance with residents' recreational, cultural and educational backgrounds and needs.15. Bedrooms. a. All resident bedrooms shall be ventilated, well-lighted and located convenient to a bathroom.b. Resident bedrooms designated for single occupancy shall provide a minimum inside measurement of 80 square feet of usable floor space.c. Resident bedrooms designated for multiple occupancy shall provide a minimum inside measurement of 60 square feet of usable floor space per bed and be limited to four occupants.d. All resident bedrooms shall open directly into a corridor, a common use area or the outside, except in those facilities comprised of apartments.e. Each resident bedroom where furnishings are supplied by the facility shall be furnished with at least the following equipment per resident:(I) Personal storage space such as dressers, chests or wardrobes,(II) Upon request, a table and comfortable chair,(III) Adequate space for hanging clothes; and,(IV) A clean, comfortable bed in good repair with a mattress that is clean and free of odors, stains, rips, tears or lumpy stuffing, and is not less than 36 inches in width and 72 inches in length, with the top surface of the mattress at a comfortable height to assure easy access by residents; and,(V) Bedding appropriate to the seasons, including a pillow, pillow case, sheets, blankets and spread.f. The placement of residents in a bedroom shall be appropriate to their ages, developmental levels and clinical needs and to meet the goals of the facility.g. Sleeping areas shall be assigned on the basis of the residents' needs for group support, privacy or independence.h. Bedroom doors shall not have vision panels.i. Residents shall be allowed to keep and display personal belongings and to add personal touches to the decoration of their rooms. The facility shall have written policies to govern the appropriateness of such decorative display.j. Each resident will be provided a place in which personal belongings may be securely stored.16. Bathrooms. a. A toilet and lavatory facility shall be provided for every six residents, and toilets shall be equipped with seats.b. A minimum of one tub or shower facility, equipped with non-slip devices, shall be provided for every eight residents.c. Bathrooms shall be ventilated, adequately lighted and have clearly labeled hot and cold running water.d. Each bathroom shall have a door in working order to assure privacy.e. When there is more than one toilet or bathing facility in a bathroom, provisions are required for privacy.f. Bathrooms used by physically handicapped residents shall be equipped to ensure safety and independent mobility.g. Sole access to toilet or bathing facilities shall not be through another resident's sleeping room, except in facilities comprised of apartments.17. Common Living Areas. a. A room, separate from sleeping areas, shall be provided where residents may read or engage in socialization or other leisure time activities.b. A minimum of 35 square feet of living and dining space per resident shall be provided by all facilities except those comprised of apartments. This space shall include living, recreational and other space designated accessible to residents, but shall not include bathrooms, corridors, storage space, or screened porches which cannot be adapted for year round use. Facilities with bedrooms which include living space may count the square footage that is in excess of the bedroom square footage requirements as part of the 35 square footage living and dining space requirements.(e) Housekeeping and Maintenance. 1. Housekeeping. a. The facility shall have written policies and procedures for maintaining a clean and sanitary environment, including the following:(I) The proper use, cleaning and care of equipment,(II) The proper use of housekeeping and cleaning supplies,(III) Appropriate techniques for evaluating the effectiveness of cleaning; and,(IV) The roles of staff and residents in maintaining a clean and safe environment.b. Furniture and furnishings shall be clean and reasonably attractive.c. Odors shall be controlled by appropriate sanitation practices, effective cleaning procedures and proper use of ventilation.d. The facility shall be free of unsafe or unsightly clutter or accumulations of possessions, equipment or supplies.e. Bedding shall be kept clean and free of odors or stains.(I) Mattresses and pillows shall be sanitized between uses by different residents.(II) Blankets and bedspreads shall be washed or dry cleaned at least quarterly.(III) Bed linens shall be washed at least weekly, or more frequently if necessary.2. Maintenance. a. The interior and exterior of buildings shall be reasonably attractive and in good repair. Loose, cracked or peeling wallpaper shall be promptly replaced, repaired or removed and the exposed area repainted to provide a satisfactory finish.b. The facility grounds shall be maintained in a safe and reasonably attractive manner.c. Furniture and furnishings shall be kept in good repair.d. All heating, air conditioning, electrical, mechanical, plumbing and fire protection systems shall function properly.Fla. Admin. Code Ann. R. 65E-4.016
Rulemaking Authority 394.879(1) FS. Law Implemented 394.67, 394.875, 394.876, 394.877, 394.878, 394.879, 394.90, 394.902, 394.903 FS.
New 2-27-86, Amended 7-29-96, Formerly 10E-4.016, Amended 12-20-98.New 2-27-86, Amended 7-29-96, Formerly 10E-4.016, Amended 12-20-98.