Criminal History Screening Resource Guide 2006

Transcription

Criminal History Screening
Resource Guide
2006
An exclusive member product for Florida’s
long term care providers
© 2006, Florida Health Care Association
Criminal History Screening Resource Guide, Page Contents
Introduction 5
Skilled Nursing Facilities:An Overview of Criminal History Screening 7
The Law that Passed��7
Contract Employees��7
What you need��7
Agency’s Criminal History Screening Databank��8
Liability��8
Facility Owner/Administrator/Financial Officer��8
The Exemption Process��9
Sexual Predator/Offender��9
Criminal History Screening Requirements Chart for Nursing Homes
11
Level 1 Criminal History State Search��11
Level 2 Criminal History Search Federal & State��11
Skilled Nursing Facilities: Frequently Asked Questions
13
Assisted Living Facilities:An Overview of Criminal History Screening 21
The Law that Passed��21
Personal Services��21
What you need��21
Agency’s Criminal History Screening Databank��21
Facility Owner/Administrator/Financial Officer��22
The Exemption Process��22
Sexual Predator/Offender��23
Criminal History Screening Requirements Chart for ALFs 25
Level 1 Criminal History State Search��25
Level 2 Criminal History Search Federal & State��25
Attestations & Affidavits 47
Affidavits - Assisted Living Facilities��47
Attestations - Nursing Homes��47
Attestation of Residency - Nursing Homes��47
Appendix A
49
Agency for Health Care Administration Forms��49
Criminal History Screening Resource Guide, Page © 2006, Florida Health Care Association
Criminal History Screening Resource Guide, Page Introduction
Florida’s licensed skilled nursing and assisted living facilities, industry leaders, and state regulators
take very seriously the charge to provide quality services to long term care residents living in our
communities and an important aspect of this is in providing for their safety. One component of this
is to safeguard residents by screening out persons with troubling criminal histories who might seek
employment working with our vulnerable residents. The Florida Health Care Association’s Quality Credentialing Foundation endorsed the development of this Criminal History Screening Resource
Guide to pull together in one publication the statutory requirements and resources for both skilled
nursing and assisted living facities in conducting effective criminal history screenings.
The first section provides an overview for licensed skilled nursing facilities, followed by Florida statutes, codes, and forms. The second section offers the same material and resources for licensed assisted
living facilities.
In talking with hundreds of skilled nursing and assisted living facility providers, it is clear that many
go over and beyond the statutory mandates in conducting and evaluating criminal history screenings. That being said, it has also become evident that in spite of the best screening efforts of facilities,
sometimes the state’s criminal reporting system has failed us and our residents with extremely rare,
but disturbing outcomes. Still, it is the responsibility of the facility to take appropriate measures and
closely follow state guidelines in screening employees and, with this guide, the Foundation seeks to
provide a solid resource for facilties to do so.
Criminal History Screening Resource Guide, Page SNFs: An Overview
Skilled Nursing Facilities:
An Overview of Criminal History Screening
The Law that Passed
In 1998, section 400.215 of Chapter 400, Part II, Florida Statutes, was created, requiring criminal
history screening for three different types of skilled nursing facility personnel:
Employees whose responsibilities require them to:
(a) provide personal care or services to residents;
(b) have access to resident living areas; or
(c) have access to resident funds or other personal property.
Because it is difficult to segregate these employees, FHCA recommends that all facility employees be
screened according to the requirements of this law.
Contract Employees
In regard to contract employees, the Agency for Health Care Administration stated in a letter to
FHCA dated 9/24/98:
“Contract staff will continue to be screened in accordance to their respective employer requirements.
For purposes of implementing the background screening requirements of 400.215, F.S., employee is
being defined as an actual employee of the facility, not contracted individuals, i.e. they are employed
with and receive compensation from the nursing home, not the contract entity.”
Facilities are advised to have a contract with any employment agency they use which stipulates that
the agency workers sent to the facility have met the background screening requirements of 400.215
F.S. Volunteers are not required to be screened.
What you need
The law requires that a Level 1 screening must be completed and the facility must have in its possession evidence that the Level 1 screening has been completed before allowing an employee, regardless of the date of hire, to begin providing personal care or services to residents or to have access
to resident living areas or resident funds or other personal property. Employees must complete an
Attestation of Residency (see Attestations & Affidavits, p. 35) in order to document whether they
have maintained continuous residence within the State of Florida for the five (5) years immediately
preceding the date of request for background screening.
Employees hired after October 1, 1998, who have not maintained continuous residency within
the state of Florida for the five (5) years immediately preceding the date of request for background
screening, must complete a Level 2 screening.
Employees hired before October 1, 1998, who had not maintained continuous residency within
the state of Florida for the five (5) years immediately preceding the date of request for their Level 1
background screening, would not have to complete a Level 2 screening. However, such employees
would also need to attest that they have not been convicted of a disqualifying offense in another state
or jurisdiction (see Attestations & Affidavits, p. 35).
Employees who have a disqualifying offense cannot provide personal care or services to residents,
have access to resident living areas or have access to funds or other personal property, (see The Exemption Process, next page).
Employees requiring a Level 2 screening may work in a conditional status in the three areas addressed in the law for 180 days pending the results of the Level 2 screening if the facility possesses a
clear Level 1 screening. Remember, a new employee who has already been qualified under a Level 2
screening and has maintained such continous residency within Florida shall not be required to complete a subsequent Level 2 screening as a condition of employment, s. 400.215 (1) (b), F.S.
Agency’s Criminal History Screening Databank
Employees who have already been screened, and not disqualified, do not have to be screened again to
comply with this law, provided the facility has evidence of the screening. The Agency for Health Care
Administration posts the results of all of the screenings they conduct on their website in a databank
(http://www.fdhc.state.fl.us/MCHQ/Long_Term_Care/Background_Screening/index.shtml; then
select Logon). This website is an all-round good first stop for facilities who are considering a new hire.
The facility representative, using their pass code, can gain instant access to the Agency’s site, and do a
search on the person they are considering for employment. The site will indicate whether or not the
potential new hire has already been screened in Florida by the Agency and will list whether, at that
time, the person was OK to Hire or Not Okay to Hire. Facilities may also accept written verification
of qualified screening results directly from the previous employer or other entity that conducted the
screening. Employees do not have to be screened again when they change jobs as long as they have
not been unemployed for more than 180 days and attest, under penalty of perjury, to not having
been convicted of a disqualifying offense since the completion of the screening (see Attestations &
Affidavits, p. 35).
Liability
Employers are protected from monetary and unemployment liability, and no cause of action for
damages can arise against an employer who terminates an employee when he is notified that the employee has a disqualifying offense.
Facility Owner/Administrator/Financial Officer
Section 400.071, F.S. (see p. 11) of Chapter 400 specifies that, for nursing homes, the facility administrator who is responsible for the day-to-day operation of the licensed facility, and the facility
financial officer who is responsible for the financial operation of the licensed facility, must complete
a level 2 background screening. This requirement is also found in s. 408.809, F.S. If the NHA has
already had a level 2 screening conducted as part of their requirement for becoming a licensed NHA,
that person does not have to be rescreened as long as they provide such proof to the Agency at time
of application for facility licensure in the form of an affidavit of compliance with the provisions of
chapter 435 using Agency forms, s. 408.809 (2), F.S.
Similarly, if the facility owner is a firm, corporation, partnership, or association, then officers or
board members must have a Level 2 screening completed. Further, the facility owner, if an individual, must have a level 2 screening completed.
According to s. 400.071, the Agency may also require that a Level 2 screening be conducted for a
member of the board of directors of the licensee or an officer or an individual owning 5% or more
of the licensee, if the Agency has probable cause to belive that such individual has been convicted
of an offense prohibited under the level 2 screening standards listed in s. 435, F.S. Also, s. 408.809,
F.S. sets forth that any person who is a controlling interest who has been convicted of an offense in
s. 435, F.S. must submit to the Agency a description and explanation of the conviction at the time
application for licensure is made.
Remember, once a person qualifies under a Level 2 screening, he/she does not have to be rescreened
as long as they continue to live in Florida, s. 400.215 (1)(b), F.S.
The Exemption Process
Individuals who have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited in s. 435.03, F.S., for Level 1 screening, and s. 435.04,
F.S. for Level 2 screening, are disqualified for employment as a nursing home employee in one of the
three areas specified in 400.215 F.S. or serving as owner, administrator, or financial officer.
The employee or owner, administrator, or financial officer has the option to apply for an exemption
from disqualification (see Appendix A) which, if granted, would allow him or her to provide personal
services to residents or to serve as owner, administrator, or financial officer.
Sexual Predator/Offender
The Florida Department of Law Enforcement maintains a Sexual Offender database, located at
http://www.fdle.state.fl.us. Facilities should incorporate a search on this database of potential new
hires. The database is not perfect and it will not reflect charges that are pending or have not been
reported. As of this writing, it is not currently a regulatory mandate to check the Sexual Offender
database, but it is good community policy, free, and easy to search.
Criminal History Screening Resource Guide, Page 10
Criminal History Screening Requirements Chart for Nursing Homes
Background Screening Requirements for Employees* Whose Responsibilities Include:
Has resided in
state for more
than 5 years
(a) the provision of personal care or services to residents, or
(b) having access to resident living areas, or
(c) having access to resident funds or other personal property
Level 1 Criminal History State Search
3 Choices for Requesting a Screening
Has resided
out of state
within the
last 5 years
x
1. Agency for Health Care Administration’s Background Screening Unit ($23 per screening)
Facilities can either download AHCA Form 3110-003, July 05 from the Internet or they may
request it from the Agency’s Background Screening Unit at 850/410-3400. The results of this
screening will usually be posted on the same day the Agency receives a completed screening
request (see http://www.fdhc.state.fl.us; select Health Facilities; then Background Screening, then Logon). You will need a pass code to gain entry to this site; use the phone number
above to request. The Agency will post an interpretation of their findings in the form of OK
to Hire, Not Okay to Hire, No Record Found, or Pending (more information needed).
2. Florida Department of Law Enforcement ($23 for 1st person; $8 after)
Employers may go directly to FDLE to conduct their Level 1 criminal history screenings
(see http://www.fdle.state.fl.us; Select Criminal History Records). The difference between
this direct access and going through the Agency is that with the FDLE site, the results of a
successful screening are instantaneous, and the employer must have the expertise to interpret
the results from an official RAP sheet.
3. Third Party Vendor (as an intermediary)
(i.e. Edge Information Management, Inc., FHCA Service Corporation Recommended Company)
Any valid 3rd Party Vendor conducting background screening investigations on your behalf
should have an ORI number assigned by FDLE.
x
Level 2 Criminal History Search Federal & State
This search consists of a search of the Florida Department of Law Enforcement (FDLE)
and the Federal Bureau of Investigations (FBI) databases for any criminal arrest information both state and nationally. To request a Level 2 search, the applicant must first obtain
an “Applicant” fingerprint card as provided by the Background Screening Unit (850/4103400). It’s a good idead for a facility to keep a batch of fingerprint cards on hand. It is
imperative that the individual write legibly their complete name, address, social security
number, date of birth, sex, race, height, weight, eye color and hair color in order for the FBI
to process the card. The name and address of the facility requesting the search should also be
listed under the Employer. If the FBI rejects a card because of illegible prints, the individual
will have to be fingerprinted again and the card resubmitted. There is no charge for a resubmission. Make all checks/money orders payable to AHCA.
Send completed forms and appropriate fees to:
Background Screening Unit
Agency for Health Care Administration
2727 Mahan Dr.
Building 3, M.S. #40
Tallahassee, FL 32308
* FHCA-FCAL suggests that all employees follow the requirements of this law.
SNFs: Frequently Asked Questions
Skilled Nursing Facilities: Frequently Asked Questions
1� How are Level 2 background screening requirements met for owners, administrators, and CFOs?
These requirements are handled as part of the license application and renewal cycle. You will
receive the necessary information and forms when you receive a license application package.
2� How long does a facility have to submit for a background screening on a new employee?
Up to ten calendar days, or five calendar days after receiving the necessary information from
the new employee, F.S. 435.05 (1) (a-c). Remember, however, that an employee must have the
qualifying results of a clear Level 1 screening completed and in the personnel files before working
with access to residents, their property, or their personal space, (F.S. 400.215 (2) (a).
� Can an employee who is waiting to get their results from a Level 2 screening work with residents?
A state-wide Level 1 screening must be completed prior to an employee providing personal care
or services to residents or to have access to resident living areas or resident funds or other personal property. However, when a Level 2 screening is required, an employee may start working
with residents in a conditional status for up to 180 days without the results of Level 2 screening
as long as a complete, clear Level 1 screening is in the individual’s personnel file, and documentation can be provided as to the date the Level 2 screening was initiated. Also, remember that a
facility has up to ten calendar days, or five calendar days after receiving the necessary information
from the new employee, to submit it for screening.
4� What is an exemption?
Sometimes a background screening is returned with a disqualifying offense which may have occurred early in a person’s life or which may have been an isolated occurrence with extenuating
circumstances. Florida government has tried to make allowances for those persons who may have
made a mistake followed by years of good conduct and citizenship. There is a process by which
a person may seek an exemption which will allow work with the elderly or with children. Appendix A (p. 37) offers some clarification on the “Request for Exemption.” You may also call
the Background Screening Unit at 850/410-3400 to ask for the “Exemption Hearing Request”
Packet which includes an application and a checklist. If a person is able to obtain an exemption,
they will be able to work in long term care.
5� Can facilities share background screening information on an individual?
Yes; 435.10 F.S. provides that “every employer of employees covered by this chapter shall furnish
copies of personnel records for employees or former employees to any other employer requesting
this information”.
SNFs: Frequently Asked Questions
6� What if the new hire has already been screened somewhere else?
The Agency for Health Care Administration posts all of the screenings they conduct on their
website (see site location from choice #1 from the preceding chart). This is an all-round good
first stop for facilities who are considering a new hire. The facility representative, using their pass
code, can gain instant access to the Agency’s site, and do a search on the person they are considering for employment. The site will indicate whether or not the potential new hire has already
been screened in Florida by the Agency and will list whether, at that time, the person was OK to
Hire or Not Okay to Hire. If the new hire has not already been screened through the Agency, the
site will return something like No Record Found. Facilities may also accept written verification of
qualified screening results directly from the previous employer or other entity that conducted the
screening. Remember that s. 400.215 (5), F.S. provides that if a person has already been screened
and qualified as required and who have not been unemployed for more than 180 days thereafter
shall not be required to be rescreened. However, the person must also attest to not having been
convicted of a disqualifying offense since the completion of their last screening (see Attestations &
Affidavits, p. 35).
SNFs: 400.071 F.S.
400.071 Application for license.-(1) An application for a license as required by s. 400.062 shall be made to the agency on
forms furnished by it and shall be accompanied by the appropriate license fee.
(2) The application shall be under oath and shall contain the following:
(a) The name, address, and social security number of the applicant if an individual; if the
applicant is a firm, partnership, or association, its name, address, and employer
identification number (EIN), and the name and address of any controlling interest; and the
name by which the facility is to be known.
(b) The name of any person whose name is required on the application under the
provisions of paragraph (a) and who owns at least a 10-percent interest in any professional
service, firm, association, partnership, or corporation providing goods, leases, or services to
the facility for which the application is made, and the name and address of the professional
service, firm, association, partnership, or corporation in which such interest is held.
(c) The location of the facility for which a license is sought and an indication, as in the
original application, that such location conforms to the local zoning ordinances.
(d) The name of the person or persons under whose management or supervision the facility
will be conducted and the name of the administrator.
(e) A signed affidavit disclosing any financial or ownership interest that a person or entity
described in paragraph (a) or paragraph (d) has held in the last 5 years in any entity
licensed by this state or any other state to provide health or residential care which has
closed voluntarily or involuntarily; has filed for bankruptcy; has had a receiver appointed;
has had a license denied, suspended, or revoked; or has had an injunction issued against it
which was initiated by a regulatory agency. The affidavit must disclose the reason any such
entity was closed, whether voluntarily or involuntarily.
(f) The total number of beds and the total number of Medicare and Medicaid certified beds.
(g) Information relating to the number, experience, and training of the employees of the
facility and of the moral character of the applicant and employees which the agency requires
by rule, including the name and address of any nursing home with which the applicant or
employees have been affiliated through ownership or employment within 5 years of the date
of the application for a license and the record of any criminal convictions involving the
applicant and any criminal convictions involving an employee if known by the applicant after
inquiring of the employee. The applicant must demonstrate that sufficient numbers of
qualified staff, by training or experience, will be employed to properly care for the type and
number of residents who will reside in the facility.
(h) Copies of any civil verdict or judgment involving the applicant rendered within the 10
years preceding the application, relating to medical negligence, violation of residents' rights,
or wrongful death. As a condition of licensure, the licensee agrees to provide to the agency
copies of any new verdict or judgment involving the applicant, relating to such matters,
within 30 days after filing with the clerk of the court. The information required in this
paragraph shall be maintained in the facility's licensure file and in an agency database which
is available as a public record.
(3) The applicant shall submit evidence which establishes the good moral character of the
applicant, manager, supervisor, and administrator. No applicant, if the applicant is an
Compiled & Formatted by Florida Health Care Association, 2006
SNFs: 400.071 F.S.
individual; no member of a board of directors or officer of an applicant, if the applicant is a
firm, partnership, association, or corporation; and no licensed nursing home administrator
shall have been convicted, or found guilty, regardless of adjudication, of a crime in any
jurisdiction which affects or may potentially affect residents in the facility.
(4) Each applicant for licensure must comply with the following requirements:
(a) Upon receipt of a completed, signed, and dated application, the agency shall require
background screening of the applicant, in accordance with the level 2 standards for
screening set forth in chapter 435. As used in this subsection, the term "applicant" means
the facility administrator, or similarly titled individual who is responsible for the day-to-day
operation of the licensed facility, and the facility financial officer, or similarly titled individual
who is responsible for the financial operation of the licensed facility.
(b) The agency may require background screening for a member of the board of directors
of the licensee or an officer or an individual owning 5 percent or more of the licensee if the
agency has probable cause to believe that such individual has been convicted of an offense
prohibited under the level 2 standards for screening set forth in chapter 435.
(c) Proof of compliance with the level 2 background screening requirements of chapter 435
which has been submitted within the previous 5 years in compliance with any other health
care or assisted living licensure requirements of this state is acceptable in fulfillment of
paragraph (a). Proof of compliance with background screening which has been submitted
within the previous 5 years to fulfill the requirements of the Financial Services Commission
and the Office of Insurance Regulation pursuant to chapter 651 as part of an application for
a certificate of authority to operate a continuing care retirement community is acceptable in
fulfillment of the Department of Law Enforcement and Federal Bureau of Investigation
background check.
(d) A provisional license may be granted to an applicant when each individual required by
this section to undergo background screening has met the standards for the Department of
Law Enforcement background check, but the agency has not yet received background
screening results from the Federal Bureau of Investigation, or a request for a disqualification
exemption has been submitted to the agency as set forth in chapter 435, but a response
has not yet been issued. A license may be granted to the applicant upon the agency's
receipt of a report of the results of the Federal Bureau of Investigation background
screening for each individual required by this section to undergo background screening
which confirms that all standards have been met, or upon the granting of a disqualification
exemption by the agency as set forth in chapter 435. Any other person who is required to
undergo level 2 background screening may serve in his or her capacity pending the agency's
receipt of the report from the Federal Bureau of Investigation; however, the person may not
continue to serve if the report indicates any violation of background screening standards
and a disqualification exemption has not been requested of and granted by the agency as
set forth in chapter 435.
(e) Each applicant must submit to the agency, with its application, a description and
explanation of any exclusions, permanent suspensions, or terminations of the applicant from
the Medicare or Medicaid programs. Proof of compliance with disclosure of ownership and
control interest requirements of the Medicaid or Medicare programs shall be accepted in lieu
of this submission.
(f) Each applicant must submit to the agency a description and explanation of any
conviction of an offense prohibited under the level 2 standards of chapter 435 by a member
of the board of directors of the applicant, its officers, or any individual owning 5 percent or
more of the applicant. This requirement shall not apply to a director of a not-for-profit
SNFs: 400.071 F.S.
corporation or organization if the director serves solely in a voluntary capacity for the
corporation or organization, does not regularly take part in the day-to-day operational
decisions of the corporation or organization, receives no remuneration for his or her services
on the corporation or organization's board of directors, and has no financial interest and has
no family members with a financial interest in the corporation or organization, provided that
the director and the not-for-profit corporation or organization include in the application a
statement affirming that the director's relationship to the corporation satisfies the
requirements of this paragraph.
(g) An application for license renewal must contain the information required under
paragraphs (e) and (f).
(5) The applicant shall furnish satisfactory proof of financial ability to operate and conduct
the nursing home in accordance with the requirements of this part and all rules adopted
under this part, and the agency shall establish standards for this purpose, including
information reported under paragraph (2)(e). The agency also shall establish documentation
requirements, to be completed by each applicant, that show anticipated facility revenues
and expenditures, the basis for financing the anticipated cash-flow requirements of the
facility, and an applicant's access to contingency financing.
(6) If the applicant offers continuing care agreements as defined in chapter 651, proof shall
be furnished that such applicant has obtained a certificate of authority as required for
operation under that chapter.
(7) As a condition of licensure, each licensee, except one offering continuing care
agreements as defined in chapter 651, must agree to accept recipients of Title XIX of the
Social Security Act on a temporary, emergency basis. The persons whom the agency may
require such licensees to accept are those recipients of Title XIX of the Social Security Act
who are residing in a facility in which existing conditions constitute an immediate danger to
the health, safety, or security of the residents of the facility.
(8) The agency may not issue a license to a nursing home that fails to receive a certificate
of need under the provisions of ss. 408.031-408.045. It is the intent of the Legislature that,
in reviewing a certificate-of-need application to add beds to an existing nursing home
facility, preference be given to the application of a licensee who has been awarded a Gold
Seal as provided for in s. 400.235, if the applicant otherwise meets the review criteria
specified in s. 408.035.
(9) The agency may develop an abbreviated survey for licensure renewal applicable to a
licensee that has continuously operated as a nursing facility since 1991 or earlier, has
operated under the same management for at least the preceding 30 months, and has had
during the preceding 30 months no class I or class II deficiencies.
(10) As a condition of licensure, each facility must establish and submit with its application
a plan for quality assurance and for conducting risk management.
(11) The applicant must provide the agency with proof of a legal right to occupy the
property before a license may be issued. Proof may include, but is not limited to, copies of
warranty deeds, lease or rental agreements, contracts for deeds, or quitclaim deeds.
SNFs: 400.215 F.S.
400.215 Personnel screening requirement.-(1) The agency shall require background screening as provided in chapter 435 for all
employees or prospective employees of facilities licensed under this part who are expected
to, or whose responsibilities may require them to:
(a) Provide personal care or services to residents;
(b) Have access to resident living areas; or
(c) Have access to resident funds or other personal property.
(2) Employers and employees shall comply with the requirements of s. 435.05.
(a) Notwithstanding the provisions of s. 435.05(1), facilities must have in their possession
evidence that level 1 screening has been completed before allowing an employee to begin
working with patients as provided in subsection (1). All information necessary for
conducting background screening using level 1 standards as specified in s. 435.03 shall be
submitted by the nursing facility to the agency. Results of the background screening shall
be provided by the agency to the requesting nursing facility.
(b) Employees qualified under the provisions of paragraph (a) who have not maintained
continuous residency within the state for the 5 years immediately preceding the date of
request for background screening must complete level 2 screening, as provided in chapter
435. Such employees may work in a conditional status up to 180 days pending the receipt
of written findings evidencing the completion of level 2 screening. Level 2 screening shall
not be required of employees or prospective employees who attest in writing under penalty
of perjury that they meet the residency requirement. Completion of level 2 screening shall
require the employee or prospective employee to furnish to the nursing facility a full set of
fingerprints to enable a criminal background investigation to be conducted. The nursing
facility shall submit the completed fingerprint card to the agency. The agency shall establish
a record of the request in the database provided for in paragraph (c) and forward the
request to the Department of Law Enforcement, which is authorized to submit the
fingerprints to the Federal Bureau of Investigation for a national criminal history records
check. The results of the national criminal history records check shall be returned to the
agency, which shall maintain the results in the database provided for in paragraph (c). The
agency shall notify the administrator of the requesting nursing facility or the administrator
of any other facility licensed under chapter 393, chapter 394, chapter 395, chapter 397,
chapter 429, or this chapter, as requested by such facility, as to whether or not the
employee has qualified under level 1 or level 2 screening. An employee or prospective
employee who has qualified under level 2 screening and has maintained such continuous
residency within the state shall not be required to complete a subsequent level 2 screening
as a condition of employment at another facility.
(c) The agency shall establish and maintain a database of background screening
information which shall include the results of both level 1 and level 2 screening. The
Department of Law Enforcement shall timely provide to the agency, electronically, the
results of each statewide screening for incorporation into the database. The agency shall,
upon request from any facility, agency, or program required by or authorized by law to
screen its employees or applicants, notify the administrator of the facility, agency, or
program of the qualifying or disqualifying status of the employee or applicant named in the
request.
SNFs: 400.215 F.S.
(d) Applicants and employees shall be excluded from employment pursuant to s. 435.06.
(3) The applicant is responsible for paying the fees associated with obtaining the required
screening. Payment for the screening shall be submitted to the agency. The agency shall
establish a schedule of fees to cover the costs of level 1 and level 2 screening. Facilities may
reimburse employees for these costs. The Department of Law Enforcement shall charge the
agency for a level 1 or level 2 screening a rate sufficient to cover the costs of such
screening pursuant to s. 943.053(3). The agency shall, as allowable, reimburse nursing
facilities for the cost of conducting background screening as required by this section. This
reimbursement will not be subject to any rate ceilings or payment targets in the Medicaid
Reimbursement plan.
(4)(a) As provided in s. 435.07, the agency may grant an exemption from disqualification to
an employee or prospective employee who is subject to this section and who has not
received a professional license or certification from the Department of Health.
(b) As provided in s. 435.07, the appropriate regulatory board within the Department of
Health, or that department itself when there is no board, may grant an exemption from
disqualification to an employee or prospective employee who is subject to this section and
who has received a professional license or certification from the Department of Health or a
regulatory board within that department.
(5) Any provision of law to the contrary notwithstanding, persons who have been screened
and qualified as required by this section and who have not been unemployed for more than
180 days thereafter, and who under penalty of perjury attest to not having been convicted
of a disqualifying offense since the completion of such screening, shall not be required to be
rescreened. An employer may obtain, pursuant to s. 435.10, written verification of qualifying
screening results from the previous employer or other entity which caused such screening to
be performed.
(6) The agency and the Department of Health shall have authority to adopt rules pursuant
to the Administrative Procedure Act to implement this section.
(7) All employees shall comply with the requirements of this section by October 1, 1998.
No current employee of a nursing facility as of the effective date of this act shall be required
to submit to rescreening if the nursing facility has in its possession written evidence that the
person has been screened and qualified according to level 1 standards as specified in s.
435.03(1). Any current employee who meets the level 1 requirement but does not meet the
5-year residency requirement as specified in this section must provide to the employing
nursing facility written attestation under penalty of perjury that the employee has not been
convicted of a disqualifying offense in another state or jurisdiction. All applicants hired on or
after October 1, 1998, shall comply with the requirements of this section.
(8) There is no monetary or unemployment liability on the part of, and no cause of action
for damages arising against an employer that, upon notice of a disqualifying offense listed
under chapter 435 or an act of domestic violence, terminates the employee against whom
the report was issued, whether or not the employee has filed for an exemption with the
Department of Health or the Agency for Health Care Administration.
ALFs: An Overview
Assisted Living Facilities:
An Overview of Criminal History Screening
The Law that Passed
The 1998 Legislature passed SB 714 amending Section 400.4174 of Chapter 400, Part III, Florida
Statutes (see p. 15), which regulates the licensing of assisted living facilities. This section of the law
requires background screening for three different types of assisted living personnel - (a) the facility
owner if an individual, the administrator, and the financial officer, (b) an officer or board member if
the facility owner is a firm, corporation, partnership, or association, or any person owning 5 percent
or more of the facility if the agency has probable cause to believe that such person has been convicted
of any offense prohibited by s. 435.04, and (c) persons who provide personal services as defined in s.
429.402 (17).
Personal Services
429.402 (17) F.S. provides this definition: “Personal services” means direct physical assistance with
or supervision of the activities of daily living and the self-administration of medication and other
similar services which the department may define by rule. “Personal services” shall not be construed
to mean the provision of medical, nursing, dental, or mental health services.
What you need
For employees providing personal services hired on or after October 1, 1998, the law requires that
a Level 1 screening must be submitted to the Agency for Health Care Administration’s Background
Screening Unit within 10 days of an employee starting work, 58A-5.019 (3)(a), FAC. The employee
may provide personal services on a probationary status, 435.05 (2) F.S. Employees who have a
disqualifying offense, 435.03 (2) (a)-(cc) F.S., cannot provide personal services to residents (see The
Exemption Process, next page).
Agency’s Criminal History Screening Databank
Assisted Living Facility employees who have already been screened, and not disqualified, through
the Florida Department of Law Enforcement (FDLE), do not have to be screened again to comply
with this law, provided the facility has evidence of a screening which is no more than 2 years old.
Remember, the Agency for Health Care Administration posts the results of all of the screenings they
conduct on their website. This is an all-round good first stop for facilities who are considering a new
hire. The facility representative, using their pass code, can gain instant access to the Agency’s site,
and do a search on the person they are considering for employment. The site will indicate whether
or not the potential new hire has already been screened in Florida by the Agency and will list whether, at that time, the person was OK to Hire or Not Okay to Hire. Facilities may also accept written
verification of qualified screening results directly from the previous employer or other entity that
conducted the screening. Employees do not have to be screened again when they change jobs as long
as the screening is no more than 2 years old, the new employee has not been unemployed for more
than 180 days, and prior employment was in the same type of occupation, s. 429.4174 (2)(b), F.S.
Also, those employees who provide proof of compliance with level 1 screening requirements obtained to meet
any professional license requirements in this state (along with a copy of current professional license) would not
have to be rescreened. This might be, for example, a registered nurse or other licensed professional, unless he/
she performs personal services for the residents of the facility. This person will need to complete an affidavit
ALFs: An Overview
of current compliance with the background screening requirements, s. 429.4174 (2)(a), F.S., (see Attestations
& Affidavits, p. 35). Facility administrators will want to make sure that the personnel file contains a
copy of the current professional license and the affidavit if they do not rescreen this new hire.
Finally, those persons who are employed by a corporation or business entity that owns, operates, or manages
more than one licensed facility, and have had a level 1 screening conducted by the corporation as a condition
of initial or continued employment.
Facility Owner/Administrator/Financial Officer
Section 429.4174 (1) of the Florida Statutes requires that an ALF owner (if an individual), the administrator and the financial officer must complete a level 2 background screening. This requirement
is also found in s. 408.809, F.S. If the individual has already had a level 2 screening conducted as
part of their requirement for becoming a licensed health care practitioner or nursing home administrator, that person does not have to be rescreened as long as they provide such proof to the Agency at
time of application for facility licensure in the form of an affidavit of compliance with the provisions
of chapter 435 using Agency forms, s. 408.809 (2), F.S.
Similarly, if the facility owner is a firm, corporation, partnership, or association, then officers or
board members must have a Level 2 screening completed if the Agency has probable cause to believe
that such person has been convicted of any of the disqualifying offenses outlined in 435.04, F.S.
Also, if the Agency has probable cause to believe that a person owning 5% or more of the facility has
been convicted of one of these offenses, the Agency can require that a level 2 screening be conducted
for that person, s. 429.4174 (1)(a)(2); s. 408.809 (1).
Also, s. 408.809, F.S. sets forth that any person who is a controlling interest who has been convicted
of an offense in s. 435, F.S. must submit to the Agency a description and explanation of the conviction at the time application for licensure is made.
Volunteer board members are not required to undergo background screening, but do have to affirm
their relationship to the licensed facility as detailed in s. 429.4174 (1) (a)(2), F.S.
Individuals requiring a Level 2 screening may work in a probationary status pending the results of
the Level 2 screening 435.05 (2) F.S., provided a facility has submitted the documentation within the
time frame set forth in 435.05 (1) (a) & (c).
The Exemption Process
Employees who have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited in s. 435.03, F.S., for Level 1 screening, and s. 435.04,
F.S. for Level 2 screening, are disqualified for employment in an assisted living facility providing
personal services or serving as owner, administrator, or financial officer as addressed in the law. The
employee or owner, administrator, or financial officer has the option to apply for an exemption from
disqualification (see Appendix A. p.37) which, if granted, would allow him or her to provide personal services to residents or to serve as owner, administrator, or financial officer.
ALFs: An Overview
Sexual Predator/Offender
The Florida Department of Law Enforcement maintains a Sexual Offender database, located at
http://www.fdle.state.fl.us. Facilities should incorporate a search on this database of potential new
hires. The database is not perfect and it will not reflect charges that are pending or have not been
reported. As of this writing, it is not currently a regulatory mandate to check the Sexual Offender
database, but it is good community policy, free, and easy to search.
ALFs: An Overview
Criminal History Screening Requirements Chart for ALFs
All employees hired on or after October 1, 1998, who perform personal services as defined
in s.429.402(17). Personal services are defined as direct physical assistance with or supervision of the activities of daily living and the self-administration of medication and other
similar services which the department may define by rule.*
Level 1 Criminal History State Search
3 Choices for Requesting a Screening
Provides
Personal
Services
Owner,
Administrator,
CFO
x
1. Agency for Health Care Administration’s Background Screening Unit ($23 per screening)
Facilities can either download AHCA Form 3110-003, July 05 from the Internet or they may
request it from the Agency’s Background Screening Unit at 850/410-3400. The results of this
screening will usually be posted on the same day the Agency receives a completed screening
request (see http://www.fdhc.state.fl.us; select Health Facilities; then Background Screening, then Logon). You will need a pass code to gain entry to this site; use the phone number
above to request. The Agency will post an interpretation of their findings in the form of OK
to Hire, Not Okay to Hire, No Record Found, or Pending (more information needed).
2. Florida Department of Law Enforcement ($23 for 1st person; $8 after)
Employers may go directly to FDLE to conduct their Level 1 criminal history screenings
(see http://www.fdle.state.fl.us; Select Criminal History Records). The difference between
this direct access and going through the Agency is that with the FDLE site, the results of a
successful screening are instantaneous, and the employer must have the expertise to interpret
the results from an official RAP sheet.
3. Third Party Vendor (as an intermediary)
(i.e. Edge Information Management, Inc., FHCA Service Corporation Recommended Company)
Any valid 3rd Party Vendor conducting background screening investigations on your behalf
should have an ORI number assigned by FDLE.
x
Level 2 Criminal History Search Federal & State
This search consists of a search of the Florida Department of Law Enforcement (FDLE)
and the Federal Bureau of Investigations (FBI) databases for any criminal arrest information both state and nationally. To request a Level 2 search, the applicant must first obtain
an “Applicant” fingerprint card as provided by the Background Screening Unit (850/4103400). It’s a good idead for a facility to keep a batch of fingerprint cards on hand. It is
imperative that the individual write legibly their complete name, address, social security
number, date of birth, sex, race, height, weight, eye color and hair color in order for the FBI
to process the card. The name and address of the facility requesting the search should also
be listed under the Employer. If the FBI rejects a card because of illegible prints, the individual will have to be fingerprinted again and the card resubmitted. There is no charge for a
resubmission. Make all checks/money orders payable to AHCA. Send completed forms and
appropriate fees to:
Agency for Health Care Administration
2727 Mahan Dr.
Building 3, M.S. #40
Tallahassee, FL 32308
* FCAL suggests that facilities screen all employees who come in contact w/ residents or have access to their living areas.
ALFs: An Overview
ALFs: Frequently Asked Questions
Frequently Asked Questions - Assisted Living Facilities
1� How are Level 2 background screening requirements met for owners, administrators, and CFOs?
These requirements are handled as part of the license application and renewal cycle. You will
receive the necessary information and forms when you receive a license application package.
2� How long does a facility have to submit for a background screening on a new employee?
Up to ten calendar days, or five calendar days after receiving the necessary information from the
new employee, F.S. 435.05 (1) (a-c).
� Which ALF employees are exempt from having a Level 1 background screening conducted?
Employees working exclusively in food preparation, activities, and maintenance, for example,
would not be required to have a background screening in order to work in an ALF as they do
not provide personal services as defined in s. 429.402. However, it is a good idea to screen any
employees who come in contact with residents or have access to their living areas.
4� Which ALF employees have already met the Level 1 background screening requirement?
There are three categories of employees who are considered to have already met the Level 1 background screening requirements:
a) Those employees who provide proof of compliance with level 1 screening requirements obtained to meet any professional license requirements in this state (along with a copy of current
professional license). This might be, for example, a registered nurse or other licensed professional. This person will need to complete an affidavit of current compliance with the background
screening requirements, s. 429.4174 (2)(a), F.S., (see Attestations & Affidavits, p. 35).
b) Those employees who have been continuously employed in the same type of occupation
without a breach in service which exceeds 180 days, and proof of compliance with the level 1
screening requirement which is no more than 2 years old is provided. Proof of compliance shall
be provided directly from one employer to another, or you may also visit the A You may also
visit the Agency’s site, and do a search on the person being considered for employment (also see
choice #1 from the preceding chart).
c) Those persons who are employed by a corporation or business entity that owns, operates, or manages
more than one licensed facility, and have had a level 1 screening conducted by the corporation as a condition of initial or continued employment.
5. What are considered to be “personal services”?
400.402 (17) provides this definition: “Personal services” means direct physical assistance with or supervision of the activities of daily living and the self-administration of medication and other similar services
which the department may define by rule. “Personal services” shall not be construed to mean the provision
of medical, nursing, dental, or mental health services.
6. Can a personal services caregiver work while they are waiting to get the results of their screening?
Yes, s. 435.05 (2) says they can work on a probationary status pending a determination of compliance.
ALFs: Frequently Asked Questions
ALFs: 429.14 F.S.
429.14 Denial, revocation, or suspension of license; imposition of administrative
fine; grounds.-(1) The agency may deny, revoke, or suspend any license issued under this part, or impose
an administrative fine in the manner provided in chapter 120, for any of the following
actions by an assisted living facility, for the actions of any person subject to level 2
background screening under s. 429.174, or for the actions of any facility employee:
(a) An intentional or negligent act seriously affecting the health, safety, or welfare of a
resident of the facility.
(b) The determination by the agency that the owner lacks the financial ability to provide
continuing adequate care to residents.
(c) Misappropriation or conversion of the property of a resident of the facility.
(d) Failure to follow the criteria and procedures provided under part I of chapter 394
relating to the transportation, voluntary admission, and involuntary examination of a facility
resident.
(e) A citation of any of the following deficiencies as defined in s. 429.19:
1. One or more cited class I deficiencies.
2. Three or more cited class II deficiencies.
3. Five or more cited class III deficiencies that have been cited on a single survey and have
not been corrected within the times specified.
(f) A determination that a person subject to level 2 background screening under s.
429.174(1) does not meet the screening standards of s. 435.04 or that the facility is retaining
an employee subject to level 1 background screening standards under s. 429.174(2) who
does not meet the screening standards of s. 435.03 and for whom exemptions from
disqualification have not been provided by the agency.
(g) A determination that an employee, volunteer, administrator, or owner, or person who
otherwise has access to the residents of a facility does not meet the criteria specified in s.
435.03(2), and the owner or administrator has not taken action to remove the person.
Exemptions from disqualification may be granted as set forth in s. 435.07. No administrative
action may be taken against the facility if the person is granted an exemption.
(h) Violation of a moratorium.
(i) Failure of the license applicant, the licensee during relicensure, or a licensee that holds a
provisional license to meet the minimum license requirements of this part, or related rules,
at the time of license application or renewal.
(j) A fraudulent statement or omission of any material fact on an application for a license or
any other document required by the agency, including the submission of a license
application that conceals the fact that any board member, officer, or person owning 5
percent or more of the facility may not meet the background screening requirements of s.
ALFs: 429.14 F.S.
429.174, or that the applicant has been excluded, permanently suspended, or terminated
from the Medicaid or Medicare programs.
(k) An intentional or negligent life-threatening act in violation of the uniform firesafety
standards for assisted living facilities or other firesafety standards that threatens the health,
safety, or welfare of a resident of a facility, as communicated to the agency by the local
authority having jurisdiction or the State Fire Marshal.
(l) Exclusion, permanent suspension, or termination from the Medicare or Medicaid
programs.
(m) Knowingly operating any unlicensed facility or providing without a license any service
that must be licensed under this chapter or chapter 400.
(n) Any act constituting a ground upon which application for a license may be denied.
Administrative proceedings challenging agency action under this subsection shall be
reviewed on the basis of the facts and conditions that resulted in the agency action.
(2) Upon notification by the local authority having jurisdiction or by the State Fire Marshal,
the agency may deny or revoke the license of an assisted living facility that fails to correct
cited fire code violations that affect or threaten the health, safety, or welfare of a resident of
a facility.
(3) The agency may deny a license to any applicant or to any officer or board member of
an applicant who is a firm, corporation, partnership, or association or who owns 5 percent
or more of the facility, if the applicant, officer, or board member has or had a 25-percent or
greater financial or ownership interest in any other facility licensed under this part, or in any
entity licensed by this state or another state to provide health or residential care, which
facility or entity during the 5 years prior to the application for a license closed due to
financial inability to operate; had a receiver appointed or a license denied, suspended, or
revoked; was subject to a moratorium on admissions; had an injunctive proceeding initiated
against it; or has an outstanding fine assessed under this chapter or chapter 400.
(4) The agency shall deny or revoke the license of an assisted living facility that has two or
more class I violations that are similar or identical to violations identified by the agency
during a survey, inspection, monitoring visit, or complaint investigation occurring within the
previous 2 years.
(5) An action taken by the agency to suspend, deny, or revoke a facility's license under this
part, in which the agency claims that the facility owner or an employee of the facility has
threatened the health, safety, or welfare of a resident of the 1facility be heard by the
Division of Administrative Hearings of the Department of Management Services within 120
days after receipt of the facility's request for a hearing, unless that time limitation is waived
by both parties. The administrative law judge must render a decision within 30 days after
receipt of a proposed recommended order.
(6) The agency shall provide to the Division of Hotels and Restaurants of the Department of
Business and Professional Regulation, on a monthly basis, a list of those assisted living
facilities that have had their licenses denied, suspended, or revoked or that are involved in
ALFs: 429.14 F.S.
an appellate proceeding pursuant to s. 120.60 related to the denial, suspension, or
revocation of a license.
(7) Agency notification of a license suspension or revocation, or denial of a license renewal,
shall be posted and visible to the public at the facility.
(8) The agency may issue a temporary license pending final disposition of a proceeding
involving the suspension or revocation of an assisted living facility license.
ALFs: 429.174 F.S.
429.174 Background screening; exemptions.-(1)(a) Level 2 background screening must be conducted on each of the following persons,
who shall be considered employees for the purposes of conducting screening under chapter
435:
1. The facility owner if an individual, the administrator, and the financial officer.
2. An officer or board member if the facility owner is a firm, corporation, partnership, or
association, or any person owning 5 percent or more of the facility if the agency has
probable cause to believe that such person has been convicted of any offense prohibited by
s. 435.04. For each officer, board member, or person owning 5 percent or more who has
been convicted of any such offense, the facility shall submit to the agency a description and
explanation of the conviction at the time of license application. This subparagraph does not
apply to a board member of a not-for-profit corporation or organization if the board member
serves solely in a voluntary capacity, does not regularly take part in the day-to-day
operational decisions of the corporation or organization, receives no remuneration for his or
her services, and has no financial interest and has no family members with a financial
interest in the corporation or organization, provided that the board member and facility
submit a statement affirming that the board member's relationship to the facility satisfies
the requirements of this subparagraph.
(b) Proof of compliance with level 2 screening standards which has been submitted within
the previous 5 years to meet any facility or professional licensure requirements of the
agency or the Department of Health satisfies the requirements of this subsection, provided
that such proof is accompanied, under penalty of perjury, by an affidavit of compliance with
the provisions of chapter 435. Proof of compliance with the background screening
requirements of the Financial Services Commission and the Office of Insurance Regulation
for applicants for a certificate of authority to operate a continuing care retirement
community under chapter 651, submitted within the last 5 years, satisfies the Department
of Law Enforcement and Federal Bureau of Investigation portions of a level 2 background
check.
(c) The agency may grant a provisional license to a facility applying for an initial license
when each individual required by this subsection to undergo screening has completed the
Department of Law Enforcement background checks, but has not yet received results from
the Federal Bureau of Investigation, or when a request for an exemption from
disqualification has been submitted to the agency pursuant to s. 435.07, but a response has
not been issued.
(2) The owner or administrator of an assisted living facility must conduct level 1
background screening, as set forth in chapter 435, on all employees hired on or after
October 1, 1998, who perform personal services as defined in s. 429.02(17). The agency
may exempt an individual from employment disqualification as set forth in chapter 435.
Such persons shall be considered as having met this requirement if:
(a) Proof of compliance with level 1 screening requirements obtained to meet any
professional license requirements in this state is provided and accompanied, under penalty
of perjury, by a copy of the person's current professional license and an affidavit of current
compliance with the background screening requirements.
ALFs: 429.174 F.S.
(b) The person required to be screened has been continuously employed in the same type
of occupation for which the person is seeking employment without a breach in service which
exceeds 180 days, and proof of compliance with the level 1 screening requirement which is
no more than 2 years old is provided. Proof of compliance shall be provided directly from
one employer or contractor to another, and not from the person screened. Upon request, a
copy of screening results shall be provided by the employer retaining documentation of the
screening to the person screened.
(c) The person required to be screened is employed by a corporation or business entity or
related corporation or business entity that owns, operates, or manages more than one
facility or agency licensed under this chapter, and for whom a level 1 screening was
conducted by the corporation or business entity as a condition of initial or continued
employment.
ALFs: 58A-5.019, FAC
Assisted Living Facilities:
58A-5.019 Florida Administrative Code Staffing Standards
(3) BACKGROUND SCREENING.
(a) All staff, hired on or after October 1, 1998, to provide personal services to residents must be
screened in accordance with Section 400.4174, F.S., and meet the screening standards of Section
435.03, F.S. A packet containing background screening forms and instructions may be obtained
from the AHCA Background Screening Unit, 2727 Mahan Drive, Tallahassee, FL 32308; telephone
(850) 410-3400. Within 10 days of the employee’s starting work, the facility shall submit to the
AHCA central office:
1. A completed Criminal History Check, AHCA Form 3110-0002, June 1998;
2 A signed Florida Abuse Hotline Information System Background Check, AHCA Form 3110-0003,
July 1998; and
3. A check to cover the cost of screening.
(b) The results of employee screening conducted by the agency shall be maintained in the employee’s
personnel file.
(c) Staff with the following documentation in their personnel records shall be considered to have met
the required screening requirement:
1. A copy of their current professional license which required Level 1 background screening as a condition of licensing, proof that a criminal history and abuse registry check have been conducted, and
an affidavit of current compliance with Section 435.03, F.S.;
2. Proof of continuous employment in an occupation which requires Level 1 screening without a
break in employment that exceeds 180 days, and proof that a criminal history and abuse registry
check has been conducted within the previous 2 years; or
3. Proof of employment with a corporation or business entity or related entity that owns, operates, or
manages more than one facility or agency licensed under Chapter 400, F.S., that conducted Level 1
screening as a condition of initial or continued employment.
SNFs & ALFs: 435, F.S.
TITLE XXXI
LABOR
CHAPTER 435
EMPLOYMENT SCREENING
435.01 Applicability of this chapter.
435.02 Definitions.
435.03 Level 1 screening standards.
435.04 Level 2 screening standards.
435.05 Requirements for covered employees.
435.06 Exclusion from employment.
435.07 Exemptions from disqualification.
435.08 Payment for processing of fingerprints and state criminal records checks.
435.09 Confidentiality of personnel background check information.
435.10 Sharing of personnel information among employers.
435.11 Penalties.
435.01 Applicability of this chapter.--Whenever a background screening for employment or a
background security check is required by law for employment, unless otherwise provided by law,
the provisions of this chapter shall apply.
History.--s. 47, ch. 95-228.
435.02 Definitions.--For the purposes of this chapter:
(1) "Employee" means any person required by law to be screened pursuant to the provisions of
this chapter.
(2) "Employer" means any person or entity required by law to conduct screening of employees
pursuant to this chapter.
(3) "Licensing agency" means any state or county agency which grants licenses or registration
permitting the operation of an employer or is itself an employer. When there is no state licensing
agency or the county licensing agency chooses not to conduct employment screening, "licensing
agency" means the Department of Children and Family Services.
History.--s. 47, ch. 95-228; s. 207, ch. 99-8.
435.03 Level 1 screening standards.-(1) All employees required by law to be screened shall be required to undergo background
screening as a condition of employment and continued employment. For the purposes of this
subsection, level 1 screenings shall include, but not be limited to, employment history checks
and statewide criminal correspondence checks through the Florida Department of Law
Enforcement, and may include local criminal records checks through local law enforcement
agencies.
(2) Any person for whom employment screening is required by statute must not have been found
guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense
prohibited under any of the following provisions of the Florida Statutes or under any similar
statute of another jurisdiction:
(a) Section 393.135, relating to sexual misconduct with certain developmentally disabled clients
and reporting of such sexual misconduct.
(b) Section 394.4593, relating to sexual misconduct with certain mental health patients and
reporting of such sexual misconduct.
(c) Section 415.111, relating to abuse, neglect, or exploitation of a vulnerable adult.
(d) Section 782.04, relating to murder.
(e) Section 782.07, relating to manslaughter, aggravated manslaughter of an elderly person or
disabled adult, or aggravated manslaughter of a child.
(f) Section 782.071, relating to vehicular homicide.
(g) Section 782.09, relating to killing of an unborn quick child by injury to the mother.
(h) Section 784.011, relating to assault, if the victim of the offense was a minor.
(i) Section 784.021, relating to aggravated assault.
(j) Section 784.03, relating to battery, if the victim of the offense was a minor.
(k) Section 784.045, relating to aggravated battery.
(l) Section 787.01, relating to kidnapping.
(m) Section 787.02, relating to false imprisonment.
(n) Section 794.011, relating to sexual battery.
(o) Former s. 794.041, relating to prohibited acts of persons in familial or custodial authority.
(p) Chapter 796, relating to prostitution.
(q) Section 798.02, relating to lewd and lascivious behavior.
(r) Chapter 800, relating to lewdness and indecent exposure.
(s) Section 806.01, relating to arson.
(t) Chapter 812, relating to theft, robbery, and related crimes, if the offense was a felony.
(u) Section 817.563, relating to fraudulent sale of controlled substances, only if the offense was
a felony.
(v) Section 825.102, relating to abuse, aggravated abuse, or neglect of an elderly person or
disabled adult.
(w) Section 825.1025, relating to lewd or lascivious offenses committed upon or in the presence
of an elderly person or disabled adult.
(x) Section 825.103, relating to exploitation of an elderly person or disabled adult, if the offense
was a felony.
(y) Section 826.04, relating to incest.
(z) Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a child.
(aa) Section 827.04, relating to contributing to the delinquency or dependency of a child.
(bb) Former s. 827.05, relating to negligent treatment of children.
(cc) Section 827.071, relating to sexual performance by a child.
(dd) Chapter 847, relating to obscene literature.
(ee) Chapter 893, relating to drug abuse prevention and control, only if the offense was a felony
or if any other person involved in the offense was a minor.
(ff) 1Section 916.0175, relating to sexual misconduct with certain forensic clients and reporting
of such sexual misconduct.
(3) Standards must also ensure that the person:
(a) For employees and employers licensed or registered pursuant to chapter 400 or chapter 429,
and for employees and employers of developmental disabilities institutions as defined in s.
393.063, intermediate care facilities for the developmentally disabled as defined in s. 400.960,
and mental health treatment facilities as defined in s. 394.455, meets the requirements of this
chapter.
(b) Has not committed an act that constitutes domestic violence as defined in s. 741.28.
History.--s. 47, ch. 95-228; s. 15, ch. 96-268; s. 21, ch. 96-322; s. 3, ch. 98-417; s. 87, ch. 2000-153; s. 45, ch. 2000349; s. 62, ch. 2001-62; s. 50, ch. 2003-1; s. 4, ch. 2004-267; s. 3, ch. 2005-119; s. 89, ch. 2006-197; s. 61, ch. 2006227.
1
Note.--The cited section does not exist; s. 916.1075 relates to prohibition of sexual misconduct with forensic
clients.
435.04 Level 2 screening standards.-(1) All employees in positions designated by law as positions of trust or responsibility shall be
required to undergo security background investigations as a condition of employment and
continued employment. For the purposes of this subsection, security background investigations
shall include, but not be limited to, fingerprinting for all purposes and checks in this subsection,
statewide criminal and juvenile records checks through the Florida Department of Law
Enforcement, and federal criminal records checks through the Federal Bureau of Investigation,
and may include local criminal records checks through local law enforcement agencies.
(2) The security background investigations under this section must ensure that no persons
subject to the provisions of this section have been found guilty of, regardless of adjudication, or
entered a plea of nolo contendere or guilty to, any offense prohibited under any of the following
provisions of the Florida Statutes or under any similar statute of another jurisdiction:
(a) Section 393.135, relating to sexual misconduct with certain developmentally disabled clients
and reporting of such sexual misconduct.
(b) Section 394.4593, relating to sexual misconduct with certain mental health patients and
reporting of such sexual misconduct.
(c) Section 415.111, relating to adult abuse, neglect, or exploitation of aged persons or disabled
adults.
(d) Section 782.04, relating to murder.
(e) Section 782.07, relating to manslaughter, aggravated manslaughter of an elderly person or
disabled adult, or aggravated manslaughter of a child.
(f) Section 782.071, relating to vehicular homicide.
(g) Section 782.09, relating to killing of an unborn quick child by injury to the mother.
(h) Section 784.011, relating to assault, if the victim of the offense was a minor.
(i) Section 784.021, relating to aggravated assault.
(j) Section 784.03, relating to battery, if the victim of the offense was a minor.
(k) Section 784.045, relating to aggravated battery.
(l) Section 784.075, relating to battery on a detention or commitment facility staff.
(m) Section 787.01, relating to kidnapping.
(n) Section 787.02, relating to false imprisonment.
(o) Section 787.04(2), relating to taking, enticing, or removing a child beyond the state limits
with criminal intent pending custody proceedings.
(p) Section 787.04(3), relating to carrying a child beyond the state lines with criminal intent to
avoid producing a child at a custody hearing or delivering the child to the designated person.
(q) Section 790.115(1), relating to exhibiting firearms or weapons within 1,000 feet of a school.
(r) Section 790.115(2)(b), relating to possessing an electric weapon or device, destructive
device, or other weapon on school property.
(s) Section 794.011, relating to sexual battery.
(t) Former s. 794.041, relating to prohibited acts of persons in familial or custodial authority.
(u) Chapter 796, relating to prostitution.
(v) Section 798.02, relating to lewd and lascivious behavior.
(w) Chapter 800, relating to lewdness and indecent exposure.
(x) Section 806.01, relating to arson.
(y) Chapter 812, relating to theft, robbery, and related crimes, if the offense is a felony.
(z) Section 817.563, relating to fraudulent sale of controlled substances, only if the offense was
a felony.
(aa) Section 825.102, relating to abuse, aggravated abuse, or neglect of an elderly person or
disabled adult.
(bb) Section 825.1025, relating to lewd or lascivious offenses committed upon or in the presence
of an elderly person or disabled adult.
(cc) Section 825.103, relating to exploitation of an elderly person or disabled adult, if the
offense was a felony.
(dd) Section 826.04, relating to incest.
(ee) Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a child.
(ff) Section 827.04, relating to contributing to the delinquency or dependency of a child.
(gg) Former s. 827.05, relating to negligent treatment of children.
(hh) Section 827.071, relating to sexual performance by a child.
(ii) Section 843.01, relating to resisting arrest with violence.
(jj) Section 843.025, relating to depriving a law enforcement, correctional, or correctional
probation officer means of protection or communication.
(kk) Section 843.12, relating to aiding in an escape.
(ll) Section 843.13, relating to aiding in the escape of juvenile inmates in correctional
institutions.
(mm) Chapter 847, relating to obscene literature.
(nn) Section 874.05(1), relating to encouraging or recruiting another to join a criminal gang.
(oo) Chapter 893, relating to drug abuse prevention and control, only if the offense was a felony
or if any other person involved in the offense was a minor.
(pp) 1Section 916.0175, relating to sexual misconduct with certain forensic clients and reporting
of such sexual misconduct.
(qq) Section 944.35(3), relating to inflicting cruel or inhuman treatment on an inmate resulting
in great bodily harm.
(rr) Section 944.46, relating to harboring, concealing, or aiding an escaped prisoner.
(ss) Section 944.47, relating to introduction of contraband into a correctional facility.
(tt) Section 985.701, relating to sexual misconduct in juvenile justice programs.
(uu) Section 985.711, relating to contraband introduced into detention facilities.
(3) The security background investigations conducted under this section for employees of the
Department of Juvenile Justice must ensure that no persons subject to the provisions of this
section have been found guilty of, regardless of adjudication, or entered a plea of nolo
contendere or guilty to, any offense prohibited under any of the following provisions of the
Florida Statutes or under any similar statute of another jurisdiction:
(a) Section 784.07, relating to assault or battery of law enforcement officers, firefighters,
emergency medical care providers, public transit employees or agents, or other specified officers.
(b) Section 810.02, relating to burglary, if the offense is a felony.
(c) Section 944.40, relating to escape.
The Department of Juvenile Justice may not remove a disqualification from employment or grant
an exemption to any person who is disqualified under this section for any offense disposed of
during the most recent 7-year period.
(4) Standards must also ensure that the person:
(a) For employees or employers licensed or registered pursuant to chapter 400 or chapter 429,
does not have a confirmed report of abuse, neglect, or exploitation as defined in 2s. 415.102(6),
which has been uncontested or upheld under s. 415.103.
(b) Has not committed an act that constitutes domestic violence as defined in s. 741.30.
(5) Under penalty of perjury, all employees in such positions of trust or responsibility shall attest
to meeting the requirements for qualifying for employment and agreeing to inform the employer
immediately if convicted of any of the disqualifying offenses while employed by the employer.
Each employer of employees in such positions of trust or responsibilities which is licensed or
registered by a state agency shall submit to the licensing agency annually, under penalty of
perjury, an affidavit of compliance with the provisions of this section.
History.--s. 47, ch. 95-228; s. 16, ch. 96-268; s. 22, ch. 96-322; s. 4, ch. 98-417; s. 5, ch. 99-284; s. 88, ch. 2000153; s. 7, ch. 2001-125; s. 5, ch. 2004-267; s. 4, ch. 2005-119; s. 111, ch. 2006-120; s. 90, ch. 2006-197.
1
Note.--The cited section does not exist; s. 916.1075 relates to prohibition of sexual misconduct with forensic
clients.
2
Note.--Repealed by s. 26, ch. 2000-349.
435.05 Requirements for covered employees.--Except as otherwise provided by law, the
following requirements shall apply to covered employees:
(1)(a) Every person employed in a position for which employment screening is required must,
within 5 working days after starting to work, submit to the employer a complete set of
information necessary to conduct a screening under this section.
(b) For level 1 screening, the employer must submit the information necessary for screening to
the Florida Department of Law Enforcement within 5 working days after receiving it. The
Florida Department of Law Enforcement will conduct a search of its records and will respond to
the employer agency. The employer will inform the employee whether screening has revealed
any disqualifying information.
(c) For level 2 screening, the employer or licensing agency must submit the information
necessary for screening to the Florida Department of Law Enforcement within 5 working days
after receiving it. The Florida Department of Law Enforcement will conduct a search of its
criminal and juvenile records and will request that the Federal Bureau of Investigation conduct a
search of its records for each employee for whom the request is made. The Florida Department
of Law Enforcement will respond to the employer or licensing agency, and the employer or
licensing agency will inform the employee whether screening has revealed disqualifying
information.
(d) The person whose background is being checked must supply any missing criminal or other
necessary information to the employer within 30 days after the employer makes a request for the
information or be subject to automatic disqualification.
(2) Unless otherwise prohibited by state or federal law, new employees may be placed on
probationary status pending a determination of compliance with minimum standards set forth in
this chapter.
(3) Each employer required to conduct level 2 background screening must sign an affidavit
annually, under penalty of perjury, stating that all covered employees have been screened or are
newly hired and are awaiting the results of the required screening checks.
History.--s. 47, ch. 95-228; s. 208, ch. 99-8; s. 46, ch. 2000-349; s. 63, ch. 2001-62; s. 21, ch. 2004-267.
435.06 Exclusion from employment.-(1) When an employer or licensing agency has reasonable cause to believe that grounds exist for
the denial or termination of employment of any employee as a result of background screening, it
shall notify the employee in writing, stating the specific record which indicates noncompliance
with the standards in this section. It shall be the responsibility of the affected employee to contest
his or her disqualification or to request exemption from disqualification. The only basis for
contesting the disqualification shall be proof of mistaken identity.
(2) The employer must either terminate the employment of any of its personnel found to be in
noncompliance with the minimum standards for good moral character contained in this section or
place the employee in a position for which background screening is not required unless the
employee is granted an exemption from disqualification pursuant to s. 435.07.
(3) Any person who is required to undergo employment screening and who refuses to cooperate
in such screening or refuses to submit the information necessary to complete the screening,
including fingerprints when required, shall be disqualified for employment in such position or, if
employed, shall be dismissed.
History.--s. 47, ch. 95-228.
435.07 Exemptions from disqualification.--Unless otherwise provided by law, the provisions
of this section shall apply to exemptions from disqualification.
(1) The appropriate licensing agency may grant to any employee otherwise disqualified from
employment an exemption from disqualification for:
(a) Felonies committed more than 3 years prior to the date of disqualification;
(b) Misdemeanors prohibited under any of the Florida Statutes cited in this chapter or under
similar statutes of other jurisdictions;
(c) Offenses that were felonies when committed but are now misdemeanors;
(d) Findings of delinquency; or
(e) Commissions of acts of domestic violence as defined in s. 741.30.
For the purposes of this subsection, the term "felonies" means both felonies prohibited under any
of the Florida Statutes cited in this chapter or under similar statutes of other jurisdictions.
(2) Persons employed by treatment providers who treat adolescents 13 years of age and older
who are disqualified from employment solely because of crimes under s. 817.563, s. 893.13, or s.
893.147 may be exempted from disqualification from employment pursuant to this section
without the 3-year waiting period.
(3) In order for a licensing department to grant an exemption to any employee, the employee
must demonstrate by clear and convincing evidence that the employee should not be disqualified
from employment. Employees seeking an exemption have the burden of setting forth sufficient
evidence of rehabilitation, including, but not limited to, the circumstances surrounding the
criminal incident for which an exemption is sought, the time period that has elapsed since the
incident, the nature of the harm caused to the victim, and the history of the employee since the
incident, or any other evidence or circumstances indicating that the employee will not present a
danger if continued employment is allowed. The decision of the licensing department regarding
an exemption may be contested through the hearing procedures set forth in chapter 120.
(4) Disqualification from employment under subsection (1) may not be removed from, nor may
an exemption be granted to, any personnel who is found guilty of, regardless of adjudication, or
who has entered a plea of nolo contendere or guilty to, any felony covered by s. 435.03 solely by
reason of any pardon, executive clemency, or restoration of civil rights.
(5) Exemptions granted by one licensing agency shall be considered by subsequent licensing
agencies, but are not binding on the subsequent licensing agency.
History.--s. 47, ch. 95-228; s. 47, ch. 2000-349; s. 64, ch. 2001-62; s. 29, ch. 2004-267; s. 9, ch. 2005-128.
435.08 Payment for processing of fingerprints and state criminal records checks.--Either
the employer or the employee is responsible for paying the costs of screening. Payment shall be
submitted to the Florida Department of Law Enforcement with the request for screening.
History.--s. 47, ch. 95-228; s. 209, ch. 99-8; s. 48, ch. 2000-349.
435.09 Confidentiality of personnel background check information.--No criminal or juvenile
information obtained under this section may be used for any purpose other than determining
whether persons meet the minimum standards for employment or for an owner or director of a
covered service provider. The criminal records and juvenile records obtained by the department
or by an employer are exempt from s. 119.07(1).
History.--s. 47, ch. 95-228; s. 282, ch. 96-406; s. 49, ch. 2000-349.
435.10 Sharing of personnel information among employers.--Every employer of employees
covered by this chapter shall furnish copies of personnel records for employees or former
employees to any other employer requesting this information pursuant to this section.
Information contained in the records may include, but is not limited to, disciplinary matters and
any reason for termination. Any employer releasing such records pursuant to this chapter shall be
considered to be acting in good faith and may not be held liable for information contained in
such records, absent a showing that the employer maliciously falsified such records.
History.--s. 47, ch. 95-228.
435.11 Penalties.-(1) It is a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083,
for any person willfully, knowingly, or intentionally to:
(a) Fail, by false statement, misrepresentation, impersonation, or other fraudulent means, to
disclose in any application for voluntary or paid employment a material fact used in making a
determination as to such person's qualifications for a position of special trust.
(b) Use records information for purposes other than screening for employment or release records
information to other persons for purposes other than screening for employment.
(2) It is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s.
775.084, for any person willfully, knowingly, or intentionally to use juvenile records information
for any purposes other than specified in this section or to release such information to other
persons for purposes other than specified in this section.
SNFs & ALFs: Attestations & Affidavits
Attestations & Affidavits
Affidavits - Assisted Living Facilities
An affidavit of current compliance with the background screening requirements is necessary for a
new hire if the employer does not wish to rescreen someone who has already been screened as a requirement for the new hire’s professional license. The employer will also need to maintain a copy of
the individual’s license. An affidavit form is available in Appendix A (p. 37).
Attestations - Nursing Homes
A general attestation is required for nursing home employees in two scenarios:
1� An attestation would be necessary if a nursing home employer did not wish to rescreen a new
hire who had already been screened by the state. Persons who have been screened and qualified
and who have not been unemployed for more than 180 days thereafter shall not be required to
be rescreened when they come to a facility for new employment, s. 400.215 (5), F.S. However,
the facility must have written verification of qualifying screening results directly from the previous employer, or from the Agency for Health Care Administration’s Background Screening website (see http://www.fdhc.state.fl.us; select Health Facilities; then Background Screening, then Logon).
Additionally, the new hire must sign some form of attestation that they have not been convicted
of a disqualifying offense since the completiom of their last background screening, s. 400.215 (5)
F.S. The Agency no longer provides a particular form for the nursing home employees, but the
Agency’s Assisted Living Unit does provide an affidavit form (Appendix A, p. 37) that may be
useful for helping a nursing home employer design their own attestation form.
2� Employees hired before October 1, 1998, who had not maintained continuous residency within
the state of Florida for the five (5) years immediately preceding the date of request for their Level
1 background screening, would not have to complete a Level 2 screening. However, such employees would also need to attest that they have not been convicted of a disqualifying offense in
another state or jurisdiction.
Attestation of Residency - Nursing Homes
All new nursing home hires must complete an Attestation of Residency in order to document whether or not they have maintained continuous residency within the state of Florida for the 5 years immediately preceding the date of request for background screening, 400.215 (2) (b), F.S. If a new hire
has not maintained continuous residency in Florida for the past 5 years, a Level 2 screening must be
initiated. The Agency has provided an Attestation of Residency on their website and a copy may also
be found in Appendix A (p. 37).
Appendix A
Appendix A
Agency for Health Care Administration Forms
Appendix A
Level 1 Criminal History Request
Any individual required by law to undergo background screening in accordance with Chapter 435, Florida Statutes, that is employed,
seeking employment or otherwise associated with a provider currently licensed or seeking licensure through the Agency for Health Care
Administration (Agency), may complete this form for the purpose of requesting such screening through the Agency.
Health Care Provider (Required Information):
Name:
AHCA License #:
Mailing Address:
City
State
(
)
Phone Number
Zip
Type of Provider:
Home Health Agency
Homemaker, Companion Sitter Agency
Assisted Living Facility
Health Care Services Pool
Health Care Clinic
Nursing Home Facility
Adult Day Care Center
Adult Family Care Home
Home Medical Equipment
Other (please specify type):
Laboratory
Hospital
Nurse Registry
Hospice
Exemption Application
Employee/Staff Person
RN/LPN/CNA
Relief Person
Type of Applicant:
Administrator
Financial Officer
Owner or Operator w/ 5% interest or more
Identifying Information:
Please print legibly or type information.
The Florida Department of Law Enforcement requires specific identifying information upon submission of a criminal history request, including
the social security number if available (section 11C-6.003(1), Florida Administrative Code). Disclosure of your social security number is
mandatory. The Agency for Health Care Administration shall use such information for purposes of internal identification.
Name:
Last
First
Middle
Maiden
Current Mailing Address:
City
State
Social Security No.:
or Individual Taxpayer Identification Number (ITIN)
Race:
W
B
I
A
U
Zip
DOB:
Sex:
Male
Female
W=WHITE B=BLACK I=AMER. INDIAN OR ALASKAN A=ASIAN OR
PACIFIC ISLANDER U=UNKNOWN (INDICATE HISPANIC AS BLACK OR WHITE BASED ON SKIN COLOR)
AHCA Form 3110-0002 July 05
AHCA, 2727 Mahan Drive, MS #40, Tallahassee, FL 32308, (850) 410-3400
Form Available at: ahca.myflorida.com/MCHQ/Long_Term_Care/Background_Screening/index.shtml
Appendix A
Proper submission of a fingerprint card
The following must be filled out in order for a card to be processed:
NAM - Print or type the Last Name, First Name, and Middle
Name.
Sex – Use M for male and F for female.
Signature of Person Fingerprinted – The person being printed
must
sign his or her legal name in this block. The card should be signed
prior to taking prints to avoid the possibility of smearing.
Race – Use the following letters:
Aliases – List any aliases (ex.: Duke, Dingo, Ace). Female
applicants
using a married name should enter their maiden name in this block.
Date of Birth (DOB) – date of birth must be entered as month,
day and year. If the birthdate is unknown, enter the age of the
applicant or the year of birth.
Residence of Person Fingerprinted – list the street address,
city and state of the fingerprinted person.
Social Security Number – enter the social security
number of the person to be screened.
Citizenship – enter the country of which the applicant is a citizen.
W - White (includes Mexicans and Latins)
B - Black
I - American Indian or Alaskan Native
A - Asian or Pacific Islander (includes Asian
Indians, Eskimos, Filipinos, Indonesians,
Koreans, Polynesians & other non-whites)
U – Unknown
HGT (Height) – enter height in feet and inches as
such 5’11” = 511. Do not use fractions.
WGT (Weight) – enter weight in pounds such as 180lbs = 180.
Place of Birth – Enter the state, territorial possession,
province or country of birth.
Employer and Address – list the name and address of
the employer/facility requesting the screening.
Appendix A
ATTESTATION OF RESIDENCY
The following information is provided to identify the individual attesting to the residency
requirement for background screening pursuant to s. 400.215.F.S.
NAME
___________________________________________________
ADDRESS
___________________________________________________
___________________________________________________
CITY_____________________________STATE___________
ZIP______
SOCIAL SECURITY NUMBER____________________________________
DATE OF BIRTH_________________________SEX_____RACE_________
I, ___________________________________________, do hereby attest under penalty of
perjury that I have physically resided in the state of Florida for the previous 5 years and
do hereby meet the residency requirement set forth as a condition of background
screening pursuant to s. 400.215, F.S.
_____________________________
Signature of Affiant
___________________
Date
--OR-I, ________________________________, do hereby attest under penalty of perjury that I
have not physically resided in the state of Florida for the previous 5 years and therefore,
do not meet the residency requirement set forth as a condition of background screening
and may be subject to Level II screening requirements.
____________________________
Signature of Affiant
____________________
Date
Appendix A
Dear Applicant:
Florida law requires assisted living facility (ALF) owners (if individuals), administrators, and
financial officers be screened by the:
x Federal Bureau of Investigation (FBI), and
x Florida Department of Law Enforcement (FDLE)
These background checks are addressed in Chapter 435, Florida Statutes, as level 2 screenings.
Florida law also requires ALF owners or administrators to screen all employees hired on or after
October 1, 1998 who provide personal services to residents through:
x FDLE
This background check is addressed in Chapter 435, Florida Statutes, as a level 1 screening.
Level 2 Screening
Level 2 Screening must be completed on:
x Owner(s) of an ALF, if the owner(s) is an individual(s) (as opposed to a corporation,
partnership, etc.); and
x ALF administrators; and
x a facility’s financial officer
Screening Compliance:
The applicant must go to the local sheriff’s office, police station, or nearest available FDLE
fingerprinting location to obtain a set of fingerprints on each individual owner, administrator,
and financial officer. E-mail your request for fingerprint cards to [email protected].
Use the attached instructions to correctly complete the card(s). Cards not completed correctly
will be rejected by the FBI, redone and resubmitted, and can delay the processing of your
application.
Each completed fingerprint card must be submitted to the Agency for Health Care
Administration, Assisted Living Unit, with the ALF application package. The Agency will
submit the fingerprint cards to the appropriate screening authority.
Fingerprint cards submitted for change of administrator, financial officer, and/or individual
owner must be submitted within 10 days of employment.
If an owner, administrator, or financial officer has already been screened by the Agency
and are currently in compliance with background screening, they may simply complete the
Assisted Living Facility (ALF) Background Screening Affidavit of Compliance
(Attachment B).
5/4/04
1
Appendix A
Level 2 Background Screening Fees:
In addition to the ALF application fee, you must include the correct screening fee in a check
made payable to the State of Florida. One check can be submitted with your ALF application for
both the level 2 screening and the application license fee. The level 2 background screening fee
is $47 for each person screened.
Level 1 Screening
Employee screening results must be maintained in the facility’s employee file. Do not submit
employee screening results with your ALF application package.
Level 1 Screening must be completed on:
x All employees hired on or after October 1, 1998, who provide personal services to residents.
The FDLE Criminal History Screening form must be completed and submitted for each
employee requiring a level 1 screening. You may obtain the FDLE Criminal History Screening
form on-line at ahca.myflorida.com by clicking on Background Screening. When submitting the
FDLE Criminal History Screening form to the Agency, you must include the correct screening
fee in a separate check made payable to the State of Florida. The FDLE background screening
fee is $23. Please submit Level 1 screening requests to:
The Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308
If an employee has already been screened and is currently in compliance with background
screening, they may simply complete the Assisted Living Facility (ALF) Background
Screening Affidavit of Compliance (Attachment B). The affidavit must be retained in the
employee’s file.
License Renewal
Assisted Living Facility (ALF) License Renewal Application Background Screening
Affidavit of Compliance (Attachment C) must be completed and submitted with each ALF
license renewal application confirming that all required employees have completed the
level 1 or level 2 background screening requirements.
5/4/04
2
INSTRUCTIONS FOR BACKGROUND SCREENING
Appendix A
All forms must be thoroughly and accurately completed before the background screening process
can proceed. Incomplete forms will be returned for completion which may cause a delay in the
licensing process.
Information and instructions provided below are to assist you in understanding what the forms
are for and how to complete them. Please read this information carefully before completing the
forms.
I.
FDLE Criminal History Screening form (Required for level 1):
Complete each item on the form. You should make additional copies of the form as necessary.
The fee for the FDLE Criminal History background screening is $23 per applicant.
Level 1 background screening only requires completion of FDLE screening. The form and fee
should be submitted to the address listed under level 1 screening in the cover letter.
II.
Applicant Fingerprint Card (FD-258) (Required for level 2):
The fingerprint card will be used to obtain both the Florida Department of Law Enforcement
(FDLE) and Federal Bureau of Investigation (FBI) checks. A separate fingerprint card (FD-258)
must be completed by each owner, administrator, and financial officer. The information should
be typed or printed clearly so it can be read. The fee for the FDLE and FBI screenings is $47
per applicant. If a fingerprint card is rejected the applicant must be fingerprinted again and the
card resubmitted to FDLE. Several items that will cause a rejection of a fingerprint card include:
x Use of a highlighter in the entry blocks
x Poor penmanship
x Text not within boundary of the entry block
x Labels applied to “Leave Blank” areas
x Submission on nonstandard fingerprint card
x Use of pencil or ink other than black
x Descriptive data not complete (e.g., incomplete name, date of birth, no signature)
There is no additional fee for the second set of fingerprints. A fee will be charged for the third or
subsequent sets. The following instructions should assist you in completing the fingerprint card:
1.
5/4/04
NAM
Print or type the Last Name, First Name, Middle Name, Suffix (Jr., II etc., Example:
Doe, John Wayne) A comma should separate the Last Name and first Name. If the
person has no middle name or initial, indicate this as NMN. If the person has an initial
only for their first and/or middle names indicate this as IO, place the "I" under first name
and "O" under the middle name. If both letters are the first name place IO under first
name and NMN in the space for middle name.
1
2.
Signature of Person Fingerprinted
The person being printed must sign his or her legal name in this block. The card should
be signed prior to taking the prints to avoid the possibility of smearing the prints on the
card.
3.
Aliases (AKA)
List the Last Name, First Name, Middle Name, and Suffix as indicated in item number 1.
If the alias is one or two-words or a nickname such as (Example: Duke, Little Man, Ace,
etc.) separate each by a comma and a space. Women applicants using a married name in
the "NAM" block should enter the maiden name in the "Aliases" block.
4.
Date of Birth (DOB)
The applicant must enter the complete date of birth, the month, day, and year. If the
applicant’s date of birth is unknown enter the age of the applicant. When the month and
day are unknown, enter two zeros (00) in the month and two zeros (00) in the day and
enter the year of birth.
5.
Residence of Person Fingerprinted
Give the present street address, city and state of the person required to be fingerprinted.
6.
Citizenship
Enter in this space the country of which the applicant is a citizen.
7.
Sex
Use the following letters to indicate:
M
F
8.
Race
Use the following letters to indicate:
W
B
I
A
U
9.
5/4/04
Male
Female
White (includes, Mexicans and Latins)
Black
American Indian or Alaskan Native
Asian or Pacific Islander ( includes, Asian Indians, Eskimos, Filipinos,
Indonesians, Koreans, Polynesians and other non-whites)
Unknown
HGT (Height)
Enter height in feet and inches.
Example:
Height
5'11"
6'0"
(Do not use fractions of an inch.)
Enter on Card As
511
600
2
Appendix A
10.
11.
Appendix A
WGT (Weight)
Enter weight in pounds.
Example:
Weight
94lbs.
186lbs.
(Do not use a fraction of a pound.)
Enter on Card As
094
186
Eyes and Hair
Color of eyes and hair are to be entered on fingerprint card as follows:
Color
Enter on Card As
Bald*
BAL (Hair only)
Black
BLK
Blond or Strawberry
BLN
Blue
BLU
Brown
BRO
Gray or Partially Gray
GRY
Green
GRN (Eye only)
Hazel
HZL (Eye only)
Maroon
MAR (Eye only)
Pink
PNK (Eye only)
Red or Auburn
RED (Hair only
Sandy
SDY (Hair only)
White
WHI (Hair only)
Unknown
XXX (Eyes and Hair
*Bald (BAL) is to be used when the applicant has lost most of the hair on the top of their head.
12.
Place of Birth
Enter the state, territorial possession, province or country of birth.
13.
Signature of Official taking Fingerprints and Date
The official taking the fingerprints (local sheriff's office, police station or FDLE
fingerprinting location) should sign his or her name in this block and the date the card.
14.
Employer and Address
List your current employer or the facility to be employed by and their complete address
in this block.
15.
FBI No. (FBI)
Leave this space blank.
16.
Social Security Number (SOC)
Enter the social security number of the person to be screened in this block
5/4/04
3
Appendix A
17.
Reason Fingerprinted
Do Not Complete
18.
Miscellaneous No. (MNU)/Armed Forces No. (MNU)
Record the Miscellaneous number in this block as follows:
AF-Air Force Serial Number
AR-Alien Registration Number
AS-Army Serial Number, National Guard Serial Number or Air National guard
Number (regardless of state)
CG-U.S. Coast Guard Serial Number
MD-Mariner's Document or Identification Number
MC-Marine Corps Serial Number
MP-Royal Canadian Mounted Police Identification Number (FPS Number)
NS-Navy Serial Number
PP-Passport Number
PS-Port Security Card Number
SS-Selective Service Number
VA-Veteran's Administration Claim Number
*Omit any alpha character(s) prefixed to Army, National Guard, and Air National Guard serial
numbers. Enter the serial number only.
For Example:
Serial Number
Army serial number RA 18901645
National Guard serial number NG 21001999
Should Be Written As
AS-18901645
AS-21002999
The appropriate two-letter identifying code from the list above must precede the number and is
separated from the miscellaneous number by a hyphen(-). Any alpha character(s) that are part of
the miscellaneous number area to be included.
III.
Volunteer Board Member Statement (Attachment A):
Board members of a not for profit corporation or organization are not required to undergo
background screening if the individual serves in a voluntary capacity, does not take part in the
day to day operational decisions, receives no compensation or financial benefit, has no financial
interest in the corporation or organization, and has no family members with a financial interest in
the corporation or organization. The board member must complete, sign and date the Volunteer
Board Member Statement affirming the board member's relationship to the facility if the above
criteria is met.
IV.
ALF Background Screening Affidavit of Compliance (Attachment B):
This form is completed when documenting an individual’s level 1 or level 2 screening
compliance in conjunction with their current professional or facility license. Refer to level 1 and
level 2 screening compliance in this package. Please ensure the document is notarized.
5/4/04
4
Appendix A
V.
ALF License Renewal Application Background Screening Affidavit of Compliance
(Attachment C):
At each ALF license renewal, the facility owner or administrator must document current
compliance with level 1 and level 2 background screening requirements pursuant to section
400.4174, Florida Statutes. This document is completed by the facility’s owner or administrator
and submitted with the ALF license renewal application.
VI.
Refer to section 435.04, Florida Statutes, Level 2 Screening Standards
VII.
Refer to section 435.03, Florida Statutes, Level 1 Screening Standards
5/4/04
5
Appendix A
Attachment A
VOLUNTEER BOARD MEMBER STATEMENT
A member of the Board of Directors is not required to undergo background screening if
the individual of a not-for-profit corporation or organization serves solely in a voluntary
capacity, and submits a statement affirming that the directors relationship to the
corporation or organization meets the terms on this form.
Name of Agency or Facility: _______________________________________________
Name of member of Board of Directors: ______________________________________
I affirm that I:
-Serve in a voluntary capacity
-Do not take part in day to day operational decisions
-Receive no compensation or financial benefit
-Have no financial interest in the corporation/organization
-Have no family members with a financial interest in the corporation/organization
Signature: _________________________________________________
Date: _____________________________________________________
Appendix A
Attachment B
ASSISTED LIVING FACILITY (ALF) BACKGROUND SCREENING
AFFIDAVIT OF COMPLIANCE
SECTION 400.4174, FLORIDA STATUTES
Under penalty of perjury, I, ___________________________________________ do hereby
(Print Name)
certify that I currently comply with the background screening requirements of
Chapter 435, Florida Statutes, for (please check the appropriate box):
[ ] Level 1 Screening
[ ] Level 2 Screening
_________________________________________
(Signature)
_______________________
(Date)
STATE OF FLORIDA
COUNTY OF ______________________
BEFORE ME, the undersigned authority, ____________________________________________
personally appeared, and after first being duly sworn in, did depose and say that he/she did
execute the foregoing Assisted Living Facility Background Screening Affidavit of Compliance
and that the same is true, accurate and correct to the best of his/her knowledge, information and
belief.
SWORN TO AND SUBSCRIBED before me this _____ day of ___________________, 200__.
____________________________________
NOTARY PUBLIC
My commission expires:
Personally known _____ or Produced identification _____
Type of identification produced _____________________
Appendix A
Attachment C
ASSISTED LIVING FACILITY (ALF) LICENSE RENEWAL APPLICATION
BACKGROUND SCREENING AFFIDAVIT OF COMPLIANCE
SECTION 400.4174, FLORIDA STATUTES
Under penalty of perjury, I, ___________________________________________ as owner
(Owner or Administrator Name)
and/or administrator of ___________________________________________do hereby certify
(Facility Name)
that all persons for whom background screening is required pursuant to section 400.4174, Florida
Statutes, are in compliance, and have no disqualifying offenses.
_________________________________________
(Signature)
_______________________
(Date)
STATE OF FLORIDA
COUNTY OF ______________________
BEFORE ME, the undersigned authority, ____________________________________________
personally appeared, and after first being duly sworn in, did depose and say that he/she did
execute the foregoing Assisted Living Facility Background Screening Affidavit of Compliance
and that the same is true, accurate and correct to the best of his/her knowledge, information and
belief.
SWORN TO AND SUBSCRIBED before me this _____ day of ___________________, 200__.
____________________________________
NOTARY PUBLIC
My commission expires:
Personally known _____ or Produced identification _____
Type of identification produced _____________________
S TATE OF FLORIDA
JEB BUSH, GOVERNOR
AGE NCY FOR HEA LTH CARE ADMINIST RAT IO N
Appendix A
DR. RHONDA MEDOWS, SECRETARY
Dear Exemption Applicant:
The attached "Request for Exemption" application is being sent to you in response to your request for an
exemption hearing. At this time the Agency for Health Care Administration has limited authority to provide
exemption hearings. This state agency handles exemption requests only for individuals that have been
terminated or denied employment in a non-licensed, non-certified occupation within health care facilities
licensed under Chapter 400, Florida Statutes. In order to determine if this office has the necessary
jurisdiction to review your request, we require that you complete this application. If this office does not
have jurisdiction to review your request, we will forward it to the appropriate department.
The "Request for Exemption" application must be completed and returned to the Agency for Health Care
Administration along with the information listed on the attached checklist. Failure to supply all requested
information will delay the review of your request. Failure to respond will result in your continued
disqualification from employment and delay the review of your request
Pursuant to 435.07(3), Florida Statutes, “… the employee must demonstrate by clear and convincing
evidence that the employee should not be disqualified from employment. Employees seeking an exemption
have the burden of setting forth sufficient evidence of rehabilitation, including, but not limited to, the
circumstances surrounding the criminal incident for which an exemption is sought, the time period that has
elapsed since the incident, the nature of the harm caused to the victim, and the history of the employee
since the incident, or any other evidence or circumstances indicating that the employee will not present a
danger if continued employment is allowed…”
If you have any questions or need additional information, please contact the Background Screening Unit at
850/410-3400.
2727 Mahan Drive
Agency for Health Care Administration’s
Appendix A
“Exemption Hearing Request” Checklist
IT IS IMPORTANT THAT YOU PROVIDE ALL OF THE INFORMATION
BELOW AND CHECK OFF EACH ITEM AS YOU OBTAIN IT...
____ Complete and return the Request for Exemption Application. Please print legibly and complete all
information. Your application must include the following items.
____ Criminal history screening report conducted by the Florida Department of Law Enforcement (FDLE).
Your current or last place of employment may be able to provide you with this report. If not, please complete the
enclosed form; attach the $23 fee and the Agency for Health Care Administration will obtain this report for you.
You must identify the medical facility that you were employed or applying for employment with on this form.
____ A copy of the court’s disposition for each criminal offense is required. Court documents may be
obtained from the Clerk of the Court in the county in which the offense occurred. The disposition is the court
document that states what you were actually sentenced for and the conditions of your sentence.
____ A copy of the arrest report for each criminal offense is required. You may obtain a copy of this report
from the arresting agency (the Police or Sheriff agency that arrested you). The arrest report is the report the
arresting officer wrote that states what events resulted in your arrest.
____ If you were given probation or parole , you will need a letter from the probation department with the
following information is required: The date you started probation or parole; the date you are scheduled to
terminate probation or parole; are you eligible for early termination of probation or parole; have you violated
probation or parole; and if you have violated your probation or parole, how you violated it.
____ Provide 3 - 5 letters of recommendation or letters of reference that will attest to your good moral
character. These may be from anyone that is familiar with your past and present character. At least one of the
letters must be from an employer. Individuals providing a letter of recommendation should include their name,
address and telephone number for verification or possible interview.
____ Provide us with proof of your rehabilitation. This proof of rehabilitation may take the form of letters
from employer’s, records of successful participation in a rehabilitation program, further education or training,
special awards or recognition, or information which indicates that you are not a danger to the safety or well being
of others. If you did not receive court ordered rehabilitation or did not seek any voluntarily, please indicate so.
____ Please complete the employment history record. Identify the name and address of employer,
supervisor’s name and telephone number, and your job responsibilities for the last 5 years. Please explain any
breaks in employment that exceeded 3 months. Attach additional sheets if necessary.
____ Please complete the residency affidavit identifying whether or not you have been a continuous resident
of the State of Florida for the past 5 years.
FAILURE TO PROVIDE ALL RELEVANT DOCUMENTATION WILL
RESULT IN THE DELAY OF REVIEW OF THE EXEMPTION REQUEST
AND CONTINUED DISQUALIFICATION FROM EMPLOYMENT
Appendix A
S TATE OF FLORIDA
JEB BUSH, GOVERNOR
Application for
REQUEST FOR EXEMPTION
Please print legibly or type. All questions must be answered.
1. Name: ______________________________________________________
Last
First
Middle
_____
Maiden
Please List all Prior Names, AKAs, or Aliases:
______________________________________________________
Last
First
Middle
Last
First
Middle
Last
First
Middle
______________________________________________________
______________________________________________________
2. Mailing Address:
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. Social Security Number: ______-____-________
4. Date of Birth: ____/____/________
5. Telephone Number:
Sex _________
Home:(_____)______-_______
Race ____________
Work:(_____)______-_______
6. Professional License or Certificate # __________________________ Type: ___________________
(i.e., C.N.A., LPN, RN, Administrator or other medically related licensure)
Date Issued: ______________________
Date Expired: ________________________
7. Have you ever worked for a health care facility or agency or applied or work at a health care
facility or agency?
[ ] Yes
[ ] No
8. Last or Most Recent Employer
_______________________________________________
Medical Facility’s Name
_______________________________________________
Medical Facility’s Address
City
(_____)______-__________________________________
Area Code
Phone Number
2727 Mahan Drive
Supervisor
Appendix A
Type of facility:
[ ] Nursing Home
[ ] Nurse Registry
[ ] Assisted Living Facility
[ ] Home Health Agency
[ ] Homemaker-Companion-Sitter Agency
[ ] Health Care Services Pool
[ ] Other: (Please specify) _________________________________________
If you were employed at the above listed facility, what were your dates of employment?
Employment Dates:
From _______________ To _______________
Your position/title while employed at the above facility: __________________________________
If you only applied for work at the listed medical facility and you were not hired, when did you apply?
Application Date: _______________
__________________________
Position Applied For:
8. Have you lived in Florida continuously for the last 5 years? [ ] Yes
[ ] No
If you checked “NO,” list the dates and places you have lived during the last 10 years.
You may be required to submit to a Level 2 criminal history screening.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
If you checked “YES,” list the dates and the Florida Counties you have lived in during the last 10 years.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
In addition to completing this application, you will need to provide a copy of the Florida Department of Law Enforcement (FDLE) criminal
history report and /or a Federal Bureau of Investigation criminal history report. You will also need to provide the arrest report and court
disposition for any disqualifying violations appearing on the FDLE criminal history report. A checklist of items needed to perform the
initial review is attached.
Appendix A
Request For Exemption Hearing
I am formally requesting that the Agency for Health Care in accordance with the provisions of Chapter 435 and Chapter 400,
Florida Statutes, provide me with an exemption hearing. I understand that I must provide clear and convincing evidence to
support a reasonable belief that I am of good moral character and that I pose no danger to the health or safety of patients or
their property.
I also understand that the decision of the Agency for Health Care regarding this exemption may be contested through a hearing
under the provisions of Chapter 120, F.S.
_____________________________________
Signature
____/____/________
date
Appendix A
S TATE OF FLORIDA
JEB BUSH, GOVERNOR
Addendum to Application for Request for Exemption
Name
Social Security Number
Street Address
Apt #
City
State
Zip
At this time the Agency for Health Care Administration has limited authority to provide exemption hearings.
In order to determine if this office has the necessary jurisdiction to review your request, please provide the
following information.
1. Have you ever worked for a health care facility?
Your Position or Title at the Facility
[ ] Yes
[ ] No
Your Supervisor’s Name
Date Hired
Date Terminated
(
Name of Health Care Facility
Facility Address
City
)
State
--
Facility Phone #
2. Have you ever been terminated or denied employment in a health care facility due to a criminal
background screening?
[ ] Yes
[ ] No
Type of facility:
[
[
[
[
] Nursing Home
[ ] Home Health Agency
] Nurse Registry
[ ] Homemaker-Companion-Sitter Agency
] Assisted Living Facility
[ ] Health Care Services Pool
] Other: (Please specify) _______________________________________
3. If you were denied employment in a health care facility, please provide the following information.
(
Name of Medical Facility
Position you applied for:
Facility Address
City
State
Date of Application:
)
-
Facility Telephone #
Appendix A
4. Do you hold certification or professional licensure in a health-related occupation?
License Type (i.e., C.N.A., LPN, RN, MD etc)
[ ] Yes
License #
[ ] No
Date Issued
5. Are you enrolled in or have you recently completed a training program to obtain certification or
professional licensure in a health-related occupation?
[ ] Yes [ ] No
(
Name of School or Facility
Facility Address
Type of Training Program:
.
Training Scheduled to Begin:
City
State
)
-
Facility Telephone #
i.e., Home Health Aide, Nursing Assistant, LPN, RN, Etc.
Graduation Date:
Date
Date
6. Have you registered for examinations required to obtain certification or professional licensure in a
health-related occupation?
[ ] Yes [ ] No
Date you applied:
Date of Tests:
Appendix A
Employment History Record
Identify the name and address of employer, supervisor’s name and telephone number, and your job responsibilities for the last 5 years. Please
explain any breaks in employment that exceeded 3 months. Attach additional sheets if necessary.
Most Recent Employer
_______________________________________________
Facility Name
_____________________________________________
Facility Address
(_____)______-____________
_____________
Area Code
Dates Employed:
City
Supervisor____
State
Telephone Number
From _______________________ To _____________________
Your Title or Occupation: _________________________________________________
Responsibilities:
Next Employer
_______________________________________________
Facility Name
_____________________________________________
Facility Address
(_____)______-____________
_____________
Area Code
Dates Employed:
City
Supervisor____
State
Telephone Number
From _______________________ To _____________________
Responsibilities:
Next Employer
_______________________________________________
Facility Name
_____________________________________________
Facility Address
(_____)______-____________
_____________
Area Code
Dates Employed:
City
Supervisor____
Telephone Number
From _______________________ To _____________________
Responsibilities:
State

Criminal History Screening Resource Guide 2006

Transcription

Similar documents

manipede - Jillie Reil

Check Up From The Neck Up

Thursday, April 24 @ 7:30pm AMC BarryWoods 24

mti photoscreener - Ruidoso Valley Noon Lions Club

New Client Form

February 8th at 12:45 pm CINEPLANET 16

segmentation of cytological images using color and

August 2016 ECRC-Parent Link Centre Stepping Stones Society

here

Screening Programs | REQUISITION