The adult family-care home provider shall ensure the provision of the following in accordance with chapter 429, part II, F.S., this rule chapter, and the residency agreement:

1. (1) PERSONAL SERVICES.

   1. (a) Assistance with or supervision of the activities of daily living as required by the resident. For a diabetic resident or a resident who has documented circulatory problems, cutting toenails shall only be permitted with written approval of the health care provider.

   2. (b) Assistance with or supervision of the self-administration of medication, or medication administration.

      1. Residents who are capable of self-administering their medications shall be encouraged and allowed to do so.

      2. For residents who require supervision or assistance with self-administration, the provider or staff shall, as needed:

      a. Remind residents when to take medications,

      b. Prepare and make available such items as water, juice, cups, spoons, or other items necessary for administering the medication,

      c. Obtain the medication and provide it to the resident,

      d. Observe the resident take the medication and verify that the resident is taking the dosage as prescribed; and,

      e. Provide any other assistance at the express direction of the resident or the resident’s representative, except for administering the medication as defined in section 465.003, F.S.

      3. Medication administration in an AFCH is a nursing service and may only be provided as described in subsection (5) of this rule, except that instead of nursing progress notes, a record of medication administration shall be maintained which includes the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider and the health care provider’s telephone number; the name of each medication prescribed, its strength, and directions for use; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The chart must be updated each time the medication is administered.

      4. A list of currently prescribed medications shall be maintained for all residents who self-administer or who require supervision or assistance with medications which includes the name of each medication prescribed, its strength and directions for use, and common side effects.

      5. Nurses may manage weekly pill organizers for residents who self-administer or who require supervision or assistance with self-administration.

      6. Prescription medications which are centrally stored by the provider shall be appropriately stored in their legally dispensed, labeled, original containers. Appropriately stored means that the medication be kept in an area free of dampness and abnormal temperatures, except that a medication requiring refrigeration shall be refrigerated.

2. (2) SUPERVISION.

   1. (a) A resident may be left without supervision in an AFCH for up to 2 hours in a 24-hour period if his or her licensed health care provider submits written certification that doing so will not compromise the resident’s health, safety, security or well-being. This certification is included on AHCA Form 3110-1023, Resident Health Assessment for Adult Family-Care Homes (AFCH), as referenced in rule 59A-37.004, F.A.C.
   2. (b) The health care provider’s certification must be completed annually from the date of the original assessment, or sooner, if a significant change occurs pursuant to subsection (4) of this rule, or when there is a compelling reason why the resident should not be left without supervision in the AFCH.
   3. (c) The provider must be accessible by telephone or pager or other appropriate means so that the resident is able to communicate with him or her during the period that the resident is left without supervision in the AFCH.

   The AFCH provider shall provide general supervision 24 hours per day, except as provided in paragraph (a), of this subsection. General supervision means the provider or designee is aware of the resident’s whereabouts and well-being while the resident is on the premises of the AFCH. The provider is responsible for determining the level of supervision necessary to ensure the resident’s safety and security as well as to remind the resident of any important tasks or activities, including appointments.

3. (3) INCIDENT REPORTING.

   1. (a) An injury to a resident which requires assessment and treatment by a health care provider. The resident’s record must include a description of the circumstances under which the injury occurred.
   2. (b) A resident is missing. Whenever a resident is determined to be missing, the provider, relief person, or staff-in-charge shall notify the local law enforcement agency within 1 hour. The resident’s representative, next-of-kin, and case manager shall be notified within 4 hours or within a time frame previously agreed upon in writing between the provider and the resident’s representative, next-of-kin, or case manager.
   3. (c) Any event, such as a fire, natural disaster, or other occurrence, which results in the disruption of the AFCH’s normal activities.
   4. (d) The death of a resident. The resident’s representative, next-of-kin, case manager, and law enforcement must be notified immediately upon discovery of the death.

   Any major incident and the action taken in response to that incident must be documented in the resident’s record. A major incident includes:

4. (4) HEALTH MONITORING. The AFCH provider shall be responsible for observing, recording and reporting any significant changes in the resident’s normal appearance, behavior or state of health to the resident’s health care provider, representative, and case manager. Significant changes include a sudden or major shift in behavior or mood; or a deterioration in health status, such as unplanned weight change, stroke, heart condition, a stage 2 pressure sore. Ordinary day-to-day fluctuations in functioning and behavior, short-term illness such as a cold, or the gradual deterioration in the ability to carry out the activities of daily living that accompanies the aging process are not considered significant changes. As part of health monitoring, residents must be weighed monthly.

5. (5) FOOD SERVICE.

   1. (a) For residents not routinely absent from the home for a day program or other purpose, at least 3 meals shall be prepared and served in the home where the resident lives during each 24 hour period. Beverages and nutritious snacks shall be made available between meals.
   2. (b) If residents are routinely absent from the AFCH during a regular meal time, they must be provided with take-out meals if other provisions have not been made by the resident or the day program.
   3. (c) Payment for meals eaten away from home for the convenience of the provider (i.e., restaurants or senior meal sites) is the responsibility of the provider. However, meals and snacks as part of an individually arranged recreational outing are the responsibility of the resident.
   4. (d) In order to ensure adequate nutrition and variety, meals shall be planned based on the recommendations of the U.S. Department of Agriculture’s Food Guide Pyramid – A Guide to Daily Food Choices, dated August 1992, which is incorporated by reference; prepared by methods which conserve nutritional value; and served in a form easy for the residents to manage. A copy of the Food Guide Pyramid may be obtained from the Assisted Living Program, Department of Elderly Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000, telephone number (850)414-2309.
   5. (e) Special diets are to be provided as prescribed in written orders by the resident’s health care provider.
   6. (f) Consideration shall be given to the resident’s cultural and ethnic background and individual preferences in food selection and preparation.
   7. (g) Dining and serving arrangements shall provide an opportunity for residents to make food selections.
   8. (h) All residents shall be given the opportunity to eat with the AFCH provider, other residents, and other members of the household.

6. (6) NURSING SERVICES. In order to permit the resident to age in place, any nursing service needed by the resident can be provided or arranged for by the provider, or the resident or the resident’s representative may directly contract with a licensed home health agency or nurse to provide these services, provided that:

   1. (a) The resident does not exceed the admission and continued residency standards provided under rule 59A-37.004, F.A.C.; and,

   2. (b) If provided or arranged for by the AFCH provider, the nursing service must be:

      1. Authorized by a health care provider’s order,

      2. Medically necessary and reasonable for treatment of the resident’s condition,

      3. Properly provided pursuant to chapter 464, F.S., and the prevailing standard of practice in the nursing community,

      4. A service that can be safely, effectively, and efficiently provided in the home,

      5. Recorded in nursing progress notes; and,

      6. Provided in accordance with the residency agreement.

7. (7) ADDITIONAL SERVICES. The adult family-care home provider shall also ensure the provision of the following:

   1. (a) The arrangement of, transportation to, and for someone to accompany the resident to medical, dental, nursing, or mental health appointments, to the extent needed by the resident.
   2. (b) Clothing that is in good repair, consistent with general standards of dress in the community, and appropriate for the season.
   3. (c) Linens and laundry services shall be furnished as needed by the provider. Residents who wish to use their own linens, or who are willing and able to do their own laundry shall be permitted to do so.
   4. (d) Securing social and leisure services for the resident.
   5. (e) Arranging for participation in religious activities, if requested by the resident.
   6. (f) A congenial and homelike atmosphere within the residence.

Rulemaking Authority 429.73 FS. Law Implemented 429.73, 429.85 FS. History–New 5-14-86, Amended 2-2-95, Formerly 10A-14.007, Amended 9-19-96, 6-6-99, 4-29-08, 9-16-10, Formerly 58A-14.007, 7-1-19.