DOEA & AHCAAssisted 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

60663 60144

74835 74278

14172 14134

0

10000

20000

30000

40000

50000

60000

70000

80000

2003 2004

Total BedsPrivate OSS

ECCsLNSLMH

16,031 beds

19,501

333 ECC

681 LNS

760 LMH

Total Number of Specialty Assisted Living Facilities2,279 Assisted Living Facilities

Total Number of Assisted Living Facilities In Florida 12/31/04

ALFs by CAPACITYDecember 31, 2004

Capacity #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)

468 AFCHs

2,065 Beds

Adult Family Care Homes (AFCHs)

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 FloridaJanuary 1, 2004 through December 31, 2004

0

50

100

150

200

250

300

350

400

SA0614SA1101SA1103SA0209SA0416SA1104SA0513SA0514SA0525SA0309

397 1 1 1

Personnel records must contain verification of freedom from communicable disease including tuberculosis

323 2 2 2

Freedom from tuberculosis must be documented on an annual basis

245 3 3 4

244 4 4 3All licensed facilities must have an annual fire inspection conducted by the local fire marshal/authority having jurisdiction

208 5 10 6The medical examination report shall address certain items

Facility must maintain a daily up-to-date record for residents who receive assistance with self-administration of medication

SA0614

SA1101

SA1103

SA0209

SA0416

Count 2004

Rank 2004

Rank 2003

Rank 2002Tag Description

Top Ten Assisted Living Facility Cites

197 7 N/A N/A

Direct care staff must have a minimum of 1 hour of emergency procedures/major incident training within 30 days of employment

SA0513

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

SA0514

At least one staff person with First Aid and CPR training shall be in facility at all times

191 9 8 N/A

SA0525

190 10 6 7The resident’s record must include a copy of the contract

SA0309

All facility employees must complete a continuing education course on HIV and AIDS biennially

SA1104

203 6 7 N/A

Count 2004

Rank 2004

Rank 2003

Rank 2002Tag Description

Top Ten Assisted Living Facility Cites

110 1 2 2

Physical Plant 61 2 6 4

Untrained/Unqualified Staff 54 3 10 8

53 4 7 7Administrative

40 8 9 9

Resident Care

Medication Problems/Errors554

560

581

542

Count 2004

Rank 2004

Rank 2003

Rank 2002

Alleg Code Description

544

558

Medical Records 52 5 N/A N/A

578

549

Resident Abuse/Neglect

Dietary

44

51

7

6

1

4

1

3

557

562

Resident Rights

Lack of Supervision

37

29

9

10

3

N/A

5

NA

Top Ten ALF Confirmed Complaints

Beds in 11 ALFs Without InsuranceAs of 12/31/04

0

5

10

15

20

25

1 2 3 4 5 6 7 8 9 10 11

Total Beds 76

Private 59

OSS 17

AREA OFFICE

Top Ten AFCH Deficiencies In FloridaJanuary 1, 2004 through December 31, 2004

0

20

40

60

80

100

120

140

160

SF0401SF0203SF0606SF0610SF0404SF0213SF0704SF1200SF0303SF0204

152 1 1 1

Resident records must contain the health assessment form 65 2 5 5

AFCH personnel must have valid First Aid and CPR certification 64 3 2 2

63 4 6 8

AFCH personnel must meet Level 1 background screening requirements

55 5 4 4

AFCH personnel records must include documentation of First Aid and CPR training

AFCH personnel records must include verification of freedom from communicable disease

SF0401

SF0203

SF0606

SF0610

SF0404

Count 2004

Rank 2004

Rank 2003

Rank 2002Tag Description

Top Ten Adult Family Care Home Cites

47 7 7 10Facility must maintain a list of all prescribed medications for all residents

SF0704

Facility must have proof of satisfactory fire safety inspection 45 8 N/A 9SF1200

Facility must have proof of satisfactory county health department inspection 44 9 10 N/A

SF0303

40 10 8 6The resident’s record must include a copy of the residency agreement

SF0204

Resident records shall contain the resident’s monthly weight record

SF021350 6 3 3

Count 2004

Rank 2004

Rank 2003

Rank 2002Tag Description

Top Ten Adult Family Care Home Cites

8 1 1 3Inappropriate Residents 6 2 4 4

Administrative 2 3 3 41 4 2 4Medication Problems/Errors

1 4 N/A 6Dietary

Unlicensed Facility582548

542554

Count 2004

Rank 2004

Rank 2003

Rank 2002

Alleg Code Description

544

535

Medical Records 1 4 4 3

549545

Nursing Service

Billing/Refunds11

44

54

64

552

557

Sanitation

Resident Rights

1

1

4

4

5

3

6

5

558 Resident Abuse/Neglect 1 4

560 Physical Plant 1 4

4

3

6

4567 Staffing 1 4 4 6

577 Operating Outside Scope of License 1 4 5 N/A581 Untrained Staff 1 4 5 2551 Over Capacity 1 4 4 4

Top AFCH Confirmed Complaints

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 IncidentQuestions & 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?

AND

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

0100200300400500600700800900

1000110012001300

1-Day Reports Rcvd. 532 517 621 555 495 504 494 572 506 479 524 546

15-Day Reports Rcvd. 461 470 552 696 456 310 423 562 431 638 493 454

Totals 993 987 1173 1251 951 814 917 1134 937 1117 1017 1000

Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04

Grand Totals1-Day: 634515-Day: 5946

Both: 12291

0

1

2

3

4

5

6

7

8

*Based on AHCA MLC Form **This data may change due to late reporting by facilities

# Claims 6 8 1 2 2 6 2 7 3 3 1 4 2 0 4 1 3 1 0 0 4 0 2 0

12/02 1/03 2/03 3/03 4/03 5/03 6/03 7/03 8/03 9/03 10/03 11/03 12/03 1/04 2/04 3/04 4/04 5/04 6/04 7/04 8/04 9/04 10/04 11/04

Grand Total: 62 NOIs

ALF NOTICES OF INTENT TO LITIGATE REPORTED BY MONTH

December 2002 -November 2004