Nursing Services Requirements for the State of Florida
From
Definitions
(17) "Resident care plan" means a written plan developed,
maintained, and reviewed not less than quarterly by a registered
nurse, with participation from other facility staff and the
resident or his or her designee or legal representative, which
includes a comprehensive assessment of the needs of an
individual resident; the type and frequency of services required
to provide the necessary care for the resident to attain or
maintain the highest practicable physical, mental, and
psychosocial well-being; a listing of services provided within
or outside the facility to meet those needs; and an explanation
of service goals. The resident care plan must be signed by the
director of nursing or another registered nurse employed by the
facility to whom institutional responsibilities have been
delegated and by the resident, the resident's designee, or the
resident's legal representative. The facility may not use an
agency or temporary registered nurse to satisfy the foregoing
requirement and must document the institutional responsibilities
that have been delegated to the registered nurse.
400.141 Administration and management of nursing home
facilities.--
Every licensed facility shall comply with all applicable
standards and rules of the agency and shall:
(2) Expenditures from the trust fund shall be allowable for
direct support of the following:
(a) Development and operation
of a mentoring program, in consultation with the Department of
Health and the Department of Elderly Affairs, for increasing the
competence, professionalism, and career preparation of long-term
care facility direct care staff, including nurses, nursing
assistants, and social service and dietary personnel.
(b) Development and
implementation of specialized training programs for long-term
care facility personnel who provide direct care for residents
with Alzheimer's disease and other dementias, residents at risk
of developing pressure sores, and residents with special
nutrition and hydration needs.
(c) Addressing areas of deficient practice identified through
regulation or state monitoring.
. . .
6) Be allowed and encouraged by the agency to provide other
needed services under certain conditions. If the facility has a
standard licensure status, and has had no class I or class II
deficiencies during the past 2 years or has been awarded a Gold
Seal under the program established in s. 400.235, it may be
encouraged by the agency to provide services, including, but not
limited to, respite and adult day services, which enable
individuals to move in and out of the facility. A facility is
not subject to any additional licensure requirements for
providing these services. Respite care may be offered to persons
in need of short-term or temporary nursing home services.
Respite care must be provided in accordance with this part and
rules adopted by the agency. However, the agency shall, by rule,
adopt modified requirements for resident assessment, resident
care plans, resident contracts, physician orders, and other
provisions, as appropriate, for short-term or temporary nursing
home services. The agency shall allow for shared programming and
staff in a facility which meets minimum standards and offers
services pursuant to this subsection, but, if the facility is
cited for deficiencies in patient care, may require additional
staff and programs appropriate to the needs of service
recipients. A person who receives respite care may not be
counted as a resident of the facility for purposes of the
facility's licensed capacity unless that person receives 24-hour
respite care. A person receiving either respite care for 24
hours or longer or adult day services must be included when
calculating minimum staffing for the facility. Any costs and
revenues generated by a nursing home facility from
nonresidential programs or services shall be excluded from
the calculations of Medicaid per diems for nursing home
institutional care reimbursement.
(7) If the facility has a standard license or is a Gold Seal
facility, exceeds the minimum required hours of licensed nursing
and certified nursing assistant direct care per resident per
day, and is part of a continuing care facility licensed under
chapter 651 or a retirement community that offers other services
pursuant to part III, part IV, or part V on a single campus, be
allowed to share programming and staff. At the time of
inspection and in the semiannual report required pursuant to
subsection (15), a continuing care facility or retirement
community that uses this option must demonstrate through
staffing records that minimum staffing requirements for the
facility were met. Licensed nurses and certified nursing
assistants who work in the nursing home facility may be used to
provide services elsewhere on campus if the facility exceeds the
minimum number of direct care hours required per resident per
day and the total number of residents receiving direct care
services from a licensed nurse or a certified nursing assistant
does not cause the facility to violate the staffing ratios
required under s. 400.23(3) (a). Compliance with the minimum
staffing ratios shall be based on total number of residents
receiving direct care services, regardless of where they reside
on campus. If the facility receives a conditional license, it
may not share staff until the conditional license status ends.
This subsection does not restrict the agency's authority under
federal or state law to require additional staff if a facility
is cited for deficiencies in care which are caused by an
insufficient number of certified nursing assistants or licensed
nurses. The agency may adopt rules for the documentation
necessary to determine compliance with this provision.
(3)(a) The agency shall adopt rules providing minimum staffing
requirements for nursing homes. These requirements shall
include, for each nursing home facility, a minimum certified
nursing assistant staffing of 2.3 hours of direct care per
resident per day beginning January 1, 2002, increasing to 2.6
hours of direct care per resident per day beginning January 1,
2003, and increasing to 2.9 hours of direct care per resident
per day beginning July 1, 2006. Beginning January 1, 2002, no
facility shall staff below one certified nursing assistant per
20 residents, and a minimum licensed nursing staffing of 1.0
hour of direct resident care per resident per day but never
below one licensed nurse per 40 residents. Nursing assistants
employed under s. 400.211(2) may be included in computing the
staffing ratio for certified nursing assistants only if they
provide nursing assistance services to residents on a full-time
basis. Each nursing home must document compliance with staffing
standards as required under this paragraph and post daily the
names of staff on duty for the benefit of facility residents and
the public. The agency shall recognize the use of licensed
nurses for compliance with minimum staffing requirements for
certified nursing assistants, provided that the facility
otherwise meets the minimum staffing requirements for licensed
nurses and that the licensed nurses are performing the duties of
a certified nursing assistant. Unless otherwise approved by the
agency, licensed nurses counted toward the minimum staffing
requirements for certified nursing assistants must exclusively
perform the duties of a certified nursing assistant for the
entire shift and not also be counted toward the minimum staffing
requirements for licensed nurses. If the agency approved a
facility's request to use a licensed nurse to perform both
licensed nursing and certified nursing assistant duties, the
facility must allocate the amount of staff time specifically
spent on certified nursing assistant duties for the purpose of
documenting compliance with minimum staffing requirements for
certified and licensed nursing staff. In no event may the hours
of a licensed nurse with dual job responsibilities be counted
twice.
(b) The agency shall adopt rules to allow properly trained staff
of a nursing facility, in addition to certified nursing
assistants and licensed nurses, to assist residents with eating.
The rules shall specify the minimum training requirements and
shall specify the physiological conditions or disorders of
residents which would necessitate that the eating assistance be
provided by nursing personnel of the facility. Nonnursing staff
providing eating assistance to residents under the provisions of
this subsection shall not count toward compliance with minimum
staffing standards.
(c) Licensed practical nurses licensed under chapter 464 who are
providing nursing services in nursing home facilities under this
part may supervise the activities of other licensed practical
nurses, certified nursing assistants, and other unlicensed
personnel providing services in such facilities in accordance
with rules adopted by the Board of Nursing.
(4) Rules developed pursuant to this section shall not restrict
the use of shared staffing and shared programming in facilities
which are part of retirement communities that provide multiple
levels of care and otherwise meet the requirement of law or
rule. |
