During Assisted Living Day at FHCA’s Annual Conference, assisted living providers received an update on current legal issues and an overview of the top ten deficiencies.
Among other legal updated, FHCA Regulatory Counsel Karen Goldsmith covered the use of medical marijuana and CBD oil. These substances are raising concerns among facilities, with providers asking how to avoid being in conflict with federal law. Providers are encouraged to get advice from their own attorneys as to what should and should not be done, but basic suggestions included:
- Do not distribute or purchase
- Do not store
- Do not assist residents in administration
- Do not grow or allow others to grow on the premise
The role of the administrator when it comes to admission and continuing stay was also covered. By law, the administrator (or owner) of an assisted living facility is responsible for reviewing incoming residents and monitoring their condition to determine if continuing stay is appropriate. There are times when a resident is not appropriate for an ALF setting, and the administrator must routinely monitor the residents’ care needs. There are grey areas in this instance because the type of facility license, facility policies, resident status at time of admission and during stay, nurses available, family involvement and third-party services involvement can are all important factors for consideration.
Discharging a resident is another area of legal concern. Providers should focus on contractual agreements, which must comply with regulations and statute. To be in compliance with Residents Rights, providers must give a 45-day notice of relocation or termination. The exception is for medical reasons, with the physician certifying that the resident requires an emergency relocation to a facility providing a more skilled level of care or that the resident has conduct harmful or offensive to other residents. The 45-day notice must be given in writing to the resident or their representative.
Agency for Health Care Administration (AHCA) representatives shared the top ten cited deficiencies. Starting with the 10th, below are the most cited deficiencies:
A0052 Medication Assistance with Self-Administration was most commonly cited for failure to follow the steps in 429.256 FS for unlicensed staff assisting residents with medication. Deficiencies related to medication practices in assisted living facilities have been in the Top 10 deficiencies cited for more than years.
A0054 Medication: Medication Observation Record (MOR) must be updated immediately after each medication is offered or given. This was most commonly cited for incorrect directions for use, listed on the MOR.
A0152 Physical Plant – Environment was cited because each facility shall have a safe living environment and be maintained free from hazards. Ensure that all existing systems are maintained in good working order.
A0200 Emergency Environment Control: Facilities must development a plan to address emergency environmental control in the event of the loss of primary electrical power. That plan must be submitted to the local emergency management authority for approval, and a copy of the approved plan must be maintained so it is readily available on site.
Next, the approved plan must be implemented. Develop a policy and procedures to ensure the facility can effectively and immediately activate, operate and maintain the alternate power source and any required fuel. Facilities must maintain an approved Emergency Power Plan (supplement to the Comprehensive Emergency Management Plan) and notify the resident/representative of plan submission and implementation in writing or electronically.
A0030 Resident Care ‐ Resident Rights include that the facility must have a grievance procedure for receiving and responding to resident complaints. The facility must be
able to demonstrate that such procedure is implemented upon receipt of a complaint and must have a written statement of house rules and procedures. Physical restraints (including half and quarter rails) must be reviewed annually by the physician (physician order) and have consent, UNLESS the resident chooses to have the device and can remove or avoid without assistance. Remember, residents have the right to be treated with consideration and respect with recognition of personal dignity, individuality and the need for privacy. Facilities must ensure access to adequate and appropriate health care consistent with established standards within the community.
Z814 Background Screening: There is an automatic fine of $500 for every offense. All employees in AHCA’s Background Screening Clearinghouse must appear on the employee roster, and the roster must be updated within 10 days of changes.
A0081 Training – Staff In‐Service requires all staff who provide direct contact with residents must receive a 1-hour in-service on infection control, including universal precautions and facility sanitation process before providing care. CNAs, nurses and home health aides are exempt for this training. All other trainings must be completed within 30 days of hire. All facility staff shall demonstrate an understanding and competency in the implementation of the elopement response policies and procedures.
A0162 Records – Resident requires that resident records, including contracts, health assessments, medical orders and demographic information, be maintained on the premises. Assisted living facilities are also required to maintain weight records every six months for residents who receive assistance with activities of daily living.
A0181 Emergency Plan Approval: Plans are submitted and approved by the local emergency management agency, and the facility must review the plan annually. Substantive changes must be submitted for review and approval. New facilities must submit plans within 30 days after obtaining a license.
A0078 Staffing Standards is most commonly cited when facilities fail to have statement of freedom from tuberculosis (TB) updated annually. If an employee gets a chest x-ray,
a health care provider must sign off annually that the employee is free from TB. This does NOT mean a new chest x-ray must be done. The Communicable Disease Statement is only required once and must be documented by a health care provider.
FHCA’s assisted living facility members can stay up to date on these and other developments via conference calls and webinars hosted by FHCA’s Florida Center for Assisted Living (FCAL) Committee. As the new membership year begins, FHCA encourages all ALF members to be an active member of the FCAL Committee, which is an excellent forum for provider exchange and input on assisted living issues. Through the FCAL Committee, FHCA focuses on policy development, legislative advocacy, educational opportunities and regulatory support specific to assisted living issues. To learn more about FHCA’s FCAL Committee, contact Kim Broom at [email protected].