Assisted Living Facility & Adult Family Care Home Provider Training DOEA & AHCA Assisted Living Facility & Adult Family Care Home Provider Training Alberta G. Granger, Assisted Living Unit Manager Field Office Management Agency for Health Care Administration April 2005

Total ALF Beds as of 12/31/03 and 12/31/04

Total Number of Assisted Living Facilities In Florida 12/31/04 Total Number of Specialty Assisted Living Facilities 333 ECC 16,031 beds 760 LMH 681 LNS 19,501

ALFs by CAPACITY December 31, 2004 #Facilities Percent Total Beds 6 & under 895 39.27 5,294 7-10 187 8.21 1,619 11-25 430 18.87 6,787 26-50 270 11.85 10,268 51-75 198 8.69 12,592 76-100 109 4.78 9,923 101-150 137 6.01 16,423 151 & up 53 2.32 11,372 Total 2,279 100 74,278

ALF License Types Standard License Extended Congregate Care (ECC) Limited Nursing Services (LNS) Limited Mental Health (LMH)

Adult Family Care Homes (AFCHs) 2,065 Beds

The Survey Tasks Pre-Survey Entrance Conference Tour of the Facility Review of Policies and Procedures Resident Sample Selection Observation/Interview/ Record Review Medication Review and Observations Dining Area and Dietary Observation Staff Resident Ratio/Staff Interviews/Personnel Records Physical Environment and Related Issues

Top Ten ALF Deficiencies In Florida January 1, 2004 through December 31, 2004

Top Ten Assisted Living Facility Cites Count 2004 Rank 2004 Rank 2003 Rank 2002 Tag Description SA0614 Facility must maintain a daily up-to-date record for residents who receive assistance with self-administration of medication 397 1 1 1 SA1101 Personnel records must contain verification of freedom from communicable disease including tuberculosis 323 2 2 2 SA1103 Freedom from tuberculosis must be documented on an annual basis 245 3 3 4 SA0209 All licensed facilities must have an annual fire inspection conducted by the local fire marshal/authority having jurisdiction 244 4 4 3 SA0416 The medical examination report shall address certain items 208 5 10 6

Top Ten Assisted Living Facility Cites Count 2004 Rank 2004 Rank 2003 Rank 2002 Tag Description SA1104 All facility employees must complete a continuing education course on HIV and AIDS biennially 203 6 7 N/A SA0513 Direct care staff must have a minimum of 1 hour of emergency procedures/major incident training within 30 days of employment 197 7 N/A N/A SA0514 Direct care staff without CORE training must have 1 hour of resident rights and identification of abuse/neglect training within 30 days of employment 217 8 N/A N/A At least one staff person with First Aid and CPR training shall be in facility at all times SA0525 191 9 8 N/A The resident’s record must include a copy of the contract SA0309 190 10 6 7

Top Ten ALF Confirmed Complaints Alleg Code Description Count 2004 Rank 2004 Rank 2003 Rank 2002 554 Medication Problems/Errors 110 1 2 2 560 Physical Plant 61 2 6 4 581 Untrained/Unqualified Staff 54 3 10 8 542 Administrative 53 4 7 7 544 Medical Records 52 5 N/A N/A 549 Dietary 51 6 4 3 578 Resident Care 44 7 1 1 558 Resident Abuse/Neglect 40 8 9 9 557 Resident Rights 37 9 3 5 562 Lack of Supervision 29 10 N/A NA

Beds in 11 ALFs Without Insurance As of 12/31/04 AREA OFFICE

Top Ten AFCH Deficiencies In Florida January 1, 2004 through December 31, 2004

Top Ten Adult Family Care Home Cites Count 2004 Rank 2004 Rank 2003 Rank 2002 Tag Description SF0401 AFCH personnel records must include verification of freedom from communicable disease 152 1 1 1 SF0203 Resident records must contain the health assessment form 65 2 5 5 SF0606 AFCH personnel must have valid First Aid and CPR certification 64 3 2 2 SF0610 AFCH personnel must meet Level 1 background screening requirements 63 4 6 8 SF0404 AFCH personnel records must include documentation of First Aid and CPR training 55 5 4 4

Top Ten Adult Family Care Home Cites Count 2004 Rank 2004 Rank 2003 Rank 2002 Tag Description SF0213 Resident records shall contain the resident’s monthly weight record 50 6 3 3 SF0704 Facility must maintain a list of all prescribed medications for all residents 47 7 7 10 Facility must have proof of satisfactory fire safety inspection SF1200 45 8 N/A 9 SF0303 Facility must have proof of satisfactory county health department inspection 44 9 10 N/A SF0204 The resident’s record must include a copy of the residency agreement 40 10 8 6

Top AFCH Confirmed Complaints Alleg Code Description Count 2004 Rank 2004 Rank 2003 Rank 2002 582 Unlicensed Facility 8 1 1 3 548 Inappropriate Residents 6 2 4 4 542 Administrative 2 3 3 4 554 Medication Problems/Errors 1 4 2 4 544 Medical Records 1 4 4 3 545 Billing/Refunds 1 4 4 4 549 Dietary 1 4 5 6 535 Nursing Service 1 4 N/A 6 552 Sanitation 1 4 5 6 557 Resident Rights 1 4 3 5 558 Resident Abuse/Neglect 1 4 4 6 560 Physical Plant 1 4 3 4 567 Staffing 1 4 4 6 577 Operating Outside Scope of License 1 4 5 N/A 581 Untrained Staff 1 4 5 2 551 Over Capacity 1 4 4 4

Risk Management & Adverse Incidents June 30, 2004 Report to the Legislature Assisted Living Facilities’ Adverse Incident Reports Were Incomplete Narratives Did Not Clearly State What Happened to the Resident Narratives Did Not Clearly Describe the Actions Taken to Enhance Residents’ Safety and Prevent Recurrence of Similar Incidents

Adverse Incidents Adverse Incident Review and Reporting are Required for Assisted Living Facilities, but Beneficial for Any Program ALF Statute Reference: 400.423, F.S. ALF Administrative Rule Reference: 58A-5.0241 F.A.C. ALF Policy Guidance, September 3, 2004 (Handout) Online Submission of Adverse Incidents (Handout)

Determining An Adverse Incident Questions & Answers Did an incident occur in which a resident was injured or a specific situation existed?  AND Is the incident in which one or more of the statutorily defined injuries/situations occurred? Is the incident an event that is associated completely or partly with the facility staff’s intervention or lack of intervention?

DETERMING AN ADVERSE INCIDENT (CONTINUED) Incidents Which Are Automatically Defined as Adverse: Abuse, neglect or exploitation as defined in s. 415.102, F.S., (Vulnerable Adult) Resident elopement (based on the facility’s definition of elopement) An event that is reported to law enforcement. (Does not include notification for Baker Act transport or required notification of a death determined to be from natural causes.)  

Completion Of ALF Adverse Incident Forms Contact Information Resident Information Risk Manager Information (If Applicable) Incident Information/Outcomes/Circumstances Resident’s Representative Information Additional Outcome Information (15-Day Report) Personnel/ Witnesses/Analysis/Corrective Action Signature and Printed Name of Person Reporting

Most Frequently Asked Questions Q: Do deaths of natural causes or expected deaths of residents who are hospice patients need to be reported? A: Although the circumstances of every death must be reviewed individually, unless the death is related to staff intervention or lack of intervention, it is not reportable. Not all deaths are adverse incidents.

Most Frequently Asked Questions Q: Do all transfers to an acute care facility for diagnosis and/or treatment need to be reported? What about pre-existing medical problems that get worse? A: As with deaths, every circumstance that results in transfer to an acute care facility must be reviewed individually. Unless the condition requiring transfer is related to staff intervention or lack of intervention, it probably is not reportable. Not all transfers to a higher level of care are adverse incidents.

Most Frequently Asked Questions Q: Do I need to report resident-to-resident altercations? A: If there is no injury and the police are not called, it probably does not need to be reported. If law enforcement is called to investigate an assault, it must be reported. If the act is willful or threatened, resulting in substantial mental, emotional, or physical impairment, it must be reported as abuse (if a resident was transferred to the hospital for treatment the “transfer” outcome box would also be checked). If an unsafe environment existed at the time of the altercation based on insufficient staff monitoring or intervention, it must be reported as staff neglect.

ALF ADVERSE INCIDENTS REPORTED BY MONTH January 2004 - December 2004

ALF NOTICES OF INTENT TO LITIGATE REPORTED BY MONTH December 2002 -November 2004