Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59A - Health Facility and Agency Licensing › Chapter 59A-4 - MINIMUM STANDARDS FOR NURSING HOMES › Section 59A-4.1295 - Additional Standards for Homes That Admit Children 0 Through 20 Years of Age

Current through Reg. 50, No. 138; July 16, 2024
(1) Nursing homes
				who accept children with a level of care of Intermediate I or II, skilled or
				medically fragile must meet the following standards as indicated. Intermediate
				I and II are defined in Rule
				59G-4.180, F.A.C. Children
				considered skilled have a chronic debilitating disease or condition of one or
				more physiological or organ systems that generally make the child dependent
				upon 24 hour per day medical, nursing, or health supervision or intervention.
				Medically fragile children are medically complex and the medical condition is
				such that they are technologically dependent upon medical equipment or
				procedure(s) to sustain life and who can expire, without warning unless
				continually under observation.
(2)
				Each child must have an assessment upon admission by licensed physical,
				occupational, and speech therapists experienced in working with children.
				Therapies must be administered based upon the outcome of these assessments and
				the orders of the child's physician.
(3) Admission criteria:
(a) The child must require intermediate,
				skilled or medically fragile nursing care, and be medically stable, as
				documented by the physician determining level of care.
(b) For nursing home placement a
				recommendation must be made in the form of a written order by the child's
				attending physician in consultation with the parent(s) or legal guardian(s).
				For Medicaid certified nursing facilities, the recommendations for placement of
				a Medicaid applicant or recipient in the nursing home must be made by the
				Department of Health's Children's Medical Services Multidisciplinary Assessment
				Team (CMAT). Consideration must be given to relevant medical, emotional,
				psychosocial, and environmental factors.
(c) Each child admitted to the nursing home
				must have a plan of care developed by the interdisciplinary care plan team. The
				plan of care must consist of those items listed below.
1. Physician's orders, diagnosis, medical
				history, physical examination and rehabilitative or restorative
				needs.
2. A preliminary nursing
				evaluation with physician orders for immediate care, completed on
				admission.
3. A comprehensive,
				accurate, reproducible, and standardized assessment of each child's functional
				capability which is completed within 14 days of the child's admission to the
				nursing home and every twelve months thereafter. The assessment must be:
a. Reviewed no less than once every 120
				days;
b. Reviewed promptly after a
				significant change, which is a need to stop a form of treatment because of
				adverse consequences (e.g., an adverse drug reaction), or commence a new form
				of treatment to deal with a problem in the child's physical or mental
				condition;
c. Revised as
				appropriate to assure the continued usefulness of the
				assessment.
4. The plan
				of care must also include measurable objectives and timetables to meet the
				child's medical, nursing, mental and psychosocial needs identified in the
				comprehensive assessment. The care plan must describe the services that are to
				be furnished to attain or maintain the child's highest practicable physical,
				mental, social and educational well-being. The care plan must be completed
				within 7 days after completion of the child's assessments.
5. The facility must, upon admission and
				quarterly, conduct and include in the resident's plan of care a comprehensive
				assessment of the resident's functional capacity and a post-discharge plan of
				care that includes plans, actions and goals to transition the child to a home
				and community-based, non-institutional setting.
6. To enhance the quality of life of each
				child ages 3 years through 15 years, the nursing home must notify by certified
				mail the school board in the county in which the nursing home is located that
				there is a school-age child residing in the nursing home. Children ages 16
				through 20 years may be enrolled in an education program according to their
				ability to participate. Program participation for each child regardless of age
				is predicated on his or her intellectual function, physical limitations, and
				medical stability. Collaborative planning with the public school system and
				community at-large is necessary to produce integrated and inclusive settings
				which meet each child's needs. The failure or inability on the part of city,
				county, state, or federal school system to provide an educational program
				according to the child's ability to participate shall not obligate the nursing
				home to supply or furnish an educational program or bring suit against any
				city, county, state, or federal organizations for their failure or inability to
				provide an educational program. Nothing contained herein is intended to
				prohibit, restrict or prevent the parents or legal guardian of the child from
				providing a private educational program that meets applicable state
				laws.
7. At the child's guardian's
				option, every effort must be made to include the child and his or her family or
				responsible party, including private duty nurse or nursing assistant, in the
				development, implementation, maintenance and evaluation of the child's plan of
				care.
8. All employees of the
				nursing home who provide hands-on care, must be knowledgeable of, and have
				access to, the child's plan of care.
9. A summary of the child's plan of care must
				accompany each child discharged or transferred to another health care facility
				or must be forwarded to the facility receiving the child as soon as possible
				consistent with good medical practice.