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Bernard Hudson Unit Manager, Long Term Care Unit Bureau of Long Term Care Services 2727 Mahan Drive, Mail Stop #33 Tallahassee, FL 32308 (850) 412-4303 (850) 410-1512 Fax

Nursing Homes

-- Department of Health approval required for:

Water Supply Systems regulated by Chapter 64E-8 F.A.C.

Onsite Sewage Disposal Systems regulated by Chapter 64E-6, F.A.C.
Please visit the Department of Health’s website at http://www.doh.state.fl.us/Environment/ostds/form/formmemo.htm  and select the Interagency Coordination Regarding Regulated Establishments document.  The approval form is at the end of this document. 

Emergency Status System (ESS) Enrollment Required by April 30, 2010

2010 Medicaid Lease Bond Memo

Reporting Reasonable Suspicion of a Crime

Consumer Guides

• Nursing Home Guide
• Nursing Home Watchlist
• Nursing Home Guide/Watch List Posting Instructions
• Guía de Hogares de Ancianos (Spanish Nursing Home Guide)

Quality of Long-Term Care Facility Improvement Trust Fund (Nursing Homes only)
An effort to use federal Civil Money Penalty funds (fines) to support innovative ideas that directly impact quality of care or quality of life of nursing home residents beyond minimum standards.

Nursing Home Gold Seal Award / Governor's Panel on Excellence in Long-Term Care

• Gold Seal Facility Listing
• Gold Seal Facility Best Practices
• Gold Seal Panel Members
• Gold Seal Panel Meetings
• May 14, 2009 Meeting
• February 26, 2010 Meeting
• June 2, 2010 Meeting
• October 15, 2010 Meeting
• December 7, 2010 Meeting
• Gold Seal Applications must be submitted by September 15, 2011 per Florida Administrative Code 59A-4.2015
Facilities Qualifying through June 30, 2011

Applications and Forms (Documents to download as PDF files)

• Gold Seal Application
• Other Applications and Forms

Transfer & Discharge Forms

• Transfer_Discharge_Notice
  • Spanish Version
• Transfer_Discharge_Fair_Hearing_Request 
  • Spanish Version
• Transfer_Discharge_LTC_Ombudsman_Request
  • Spanish Version

Miscellaneous Forms

• Adverse_Incident_Report_1_day
• Adverse_Incident_Report_15_days
• Attestation of Residency
• Bed Change Request Form
• Bed_Change_Request_Instructions
• Bed_Change_Room_List_Form
• Emergency Management Planning
• Facility Internet Access Form
• Fire Incident Reporting and System Failure
• Fire Incident Reporting Form
• Monthly_Liability_Claim_Information
• Staffing Formula Insert


Hotline Posters are available online only; please note the smaller version is acceptable regarding surveys.
• Hotline Poster (can be printed on 8 1/2" x 14" or 11" x 17") - English
• Hotline Poster (can be printed on 8 1/2" x 14" or 11" x 17") - Creole
• Hotline Poster (can be printed on 8 1/2" x 14" or 11" x 17") - Spanish 
• Hotline Poster (can be printed up to 36" x 48" - special paper/printer required) - English 
• Hotline Poster (can be printed up to 36" x 48" - special paper/printer required) - Creole 
• Hotline Poster (can be printed up to 36" x 48" - special paper/printer required) - Spanish 

Provider Emergency Contact Information and Resources

• Provider Emergency Contact Information and Resources [30Kb .pdf]

Resources

• 2009 Legislative Notice   (Nursing Home Changes due to the passage of SB 1986)
• 2010 Legislative Update
• Best Practices for Compliance to Food Sanitary Conditions, January, 2004
• Best Practices for Compliance to Resident Dignity, February, 2005
  • Best Practices for Compliance to Resident Dignity--Powerpoint Presentation, February, 2005
  • Attachment C: Draft Guidance to Surveyors (Reasonable Person Concept), February, 2005
    
• Culture Change Information, December 4, 2008
  
• Determination of Nurse Staffing Adequacy in Nursing Homes
  • Calculating Staffing for Long Term Facilities, July, 2011
  • Minimum Staffing Hours per Day Reference Sheet, July, 2011
    
• Emergency Water Issues and One Week Non-Perishable Food Supply document, March 2003
  
• Federal 5-Day Incident Reporting, March 4, 2008
  • Federal 5-Day Incident Reporting Form (example), March 4, 2008
• FMQA Health Care Quality Improvement Training Info, June, 2003
• Hurricane Preparedness Notice and Form for NHs and ICFs, July, 2005
• Joint Training AHCA Presentation, January, 2011
  • Survey Expectations and Regulatory Update
  • MDS 3.0 Preadmission Screening and Resident Review (PASRR)
  • MDS 3.0 Section F -- Preferences for Customary Routine and Activities
  • MDS 3.0 Coding of Section M -- Pressure Ulcers
  • MDS 3.0 Section Q -- Participation in Assessment and Goal Setting
• Nursing Home Round Table Presentation-Orlando, November, 2007
• Poster Questions & Answers document May 11, 2000
  
• Quality Indicator Survey (QIS) Training Resource Manual, August, 2011    
  • Overview of the QIS Process
• Recommended Guidelines for Adult Protective Services re: Sexual Offenders/Predators, March, 2010
• Recommended Guidelines for Nursing Homes re: Sexual Offenders/Predators, March, 2010
• Reporting Requirements for Abuse and Neglect, March 6, 2003
• SB 1202 Questions & Answers, February 15, 2002
  
• Statewide Provider Training, September, 2001
• Statewide Provider Training 1, September, 2002
• Statewide Provider Training 2, September, 2002
• Statewide Provider Training, November, 2003
• Statewide Provider Training, January, 2005
  
• Surveyor Guidance for Hot Water Temperatures, January, 2002
• Surveyor Guidance for Taking Food Temperatures, March, 2003

Regulations

• Nursing Home Statutes -- Florida Statutes (F.S.), Chapter 400, Part II
• Nursing Home Rules -- Florida Administrative Code (F.A.C.), Chapter 59A-4
• AHCA Declaratory Statement of American Health Associates Clinical Laboratory, Inc.
• Nursing Home Federal Code -- Code of Federal Regulations (CFR), Title 42, Part 483

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