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
80000
70000
74278
74835
60663
60000
60144
50000
Total Beds
Private
OSS
40000
30000
20000
14172
14134
10000
0
2003
2004
Total Number of Assisted Living Facilities In Florida 12/31/04
2,279 Assisted Living Facilities
Total Number of Specialty Assisted Living Facilities
333 ECC
16,031 beds
ECCs
LNS
LMH
760 LMH
681 LNS
19,501
ALFs by CAPACITY
December 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)
Adult Family Care Homes
(AFCHs)
468 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
400
350
300
250
200
150
100
50
0
SA0614
SA1101
SA1103
SA0209
SA0416
SA1104
SA0513
SA0514
SA0525
SA0309
Top Ten Assisted Living Facility Cites
Tag
Description
SA0614
Facility must maintain a daily up-to-date
record for residents who receive assistance
with self-administration of medication
SA1101
Personnel records must contain verification
of freedom from communicable disease
including tuberculosis
SA1103
Count Rank
2004 2004
Rank
2003
1
Rank
2002
397
1
1
323
2
2
2
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 Rank
2004 2004
Rank
2003
Tag
Description
SA1104
All facility employees must complete a
continuing education course on HIV and
AIDS biennially
203
6
7
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
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
SA0513
SA0514
SA0525
SA0309
Rank
2002
N/A
N/A
N/A
N/A
At least one staff person with First Aid and
CPR training shall be in facility at all times
The resident’s record must include a
copy of the contract
191
9
8
N/A
190
10
6
7
Top Ten ALF Confirmed Complaints
Alleg
Code
Description
Count
2004
Rank
2004
Rank Rank
2003 2002
110
1
2
2
554
Medication Problems/Errors
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
25
20
15
Total Beds 76
Private 59
10
OSS 17
5
0
1
2
3
4
5
6
7
8
AREA OFFICE
9
10
11
Top Ten AFCH Deficiencies In Florida
January 1, 2004 through December 31, 2004
160
140
120
100
80
60
40
20
0
SF0401
SF0203
SF0606
SF0610
SF0404
SF0213
SF0704
SF1200
SF0303
SF0204
Top Ten Adult Family Care Home Cites
Tag
SF0401
SF0203
SF0606
SF0610
Description
Count Rank
2004 2004
Rank
2003
Rank
2002
AFCH personnel records must include
verification of freedom from communicable
disease
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
AFCH personnel must meet Level 1
background screening requirements
63
4
6
8
55
5
4
4
SF0404 AFCH personnel records must include
documentation of First Aid and CPR
training
Top Ten Adult Family Care Home Cites
Count
2004
Rank
2004
Tag
Description
SF0213
Resident records shall contain the
resident’s monthly weight record
50
6
Facility must maintain a list of all
prescribed medications for all residents
47
7
SF0704
SF1200 Facility must have proof of satisfactory
fire safety inspection
45
SF0303 Facility must have proof of satisfactory
county health department inspection
44
9
SF0204 The resident’s record must include a copy of
the residency agreement
40
10
8
Rank Rank
2003 2002
3
3
7
10
N/A
9
10
N/A
8
6
Top AFCH Confirmed Complaints
Alleg
Code
582
548
Count
2004
8
6
Rank
2004
1
2
Description
Unlicensed Facility
Inappropriate Residents
542
554
544
545
549
535
Rank
2003
1
4
Administrative
Medication Problems/Errors
Medical Records
Billing/Refunds
Dietary
Nursing Service
2
1
1
1
1
1
3
4
4
4
4
4
3
2
4
4
5
N/A
4
4
3
4
6
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
567
Staffing
1
1
4
4
3
4
4
6
577
Operating Outside Scope of License
581
551
Untrained Staff
Over Capacity
1
1
1
4
4
4
5
5
4
Rank
2002
3
4
N/A
2
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?
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
Grand Totals
1-Day: 6345
15-Day: 5946
Both: 12291
1300
1200
1100
1000
900
800
700
600
500
400
300
200
100
0
Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04
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
ALF NOTICES OF INTENT TO LITIGATE
REPORTED BY MONTH
December 2002 -November 2004
8
7
Grand Total: 62 NOIs
6
5
4
3
2
1
0
# Claims
12/02
1/03
2/03
3/03
4/03
5/03
6/03
7/03
8/03
6
8
1
2
2
6
2
7
3
9/03 10/03 11/03 12/03
*Based on AHCA M LC Form
3
1
4
2
1/04
2/04
3/04
4/04
5/04
6/04
7/04
8/04
0
4
1
3
1
0
0
4
**This data may change due to late reporting by facilities
9/04 10/04 11/04
0
2
0