Alberta Granger Unit Manager Assisted Living Unit Bureau of Long Term Care Services Assisted Living Unit, Mail Stop #30 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-2515 / SC 277-2515 (850) 922-1984 / SC 292-1984 Fax Assisted Living Facility The Assisted Living Facility is a facility designed to provide personal care services in the least restrictive and most home-like environment. These facilities can range in size from one resident to several hundred and may offer a wide variety of personal and nursing services designed specifically to meet an individual's personal needs. Facilities are licensed to provide routine personal care services under a "Standard" license, or more specific services under the authority of "Specialty" licenses. ALFs meeting the requirements for a Standard license may also qualify for specialty licenses. The purpose of "Specialty Licenses" is to allow individuals to "age in place" in familiar surroundings that can adequately and safely meet their continuing healthcare needs. More detailed program information on assisted living facilities can be found at the Department of Elder Affairs' Florida Affordable Assisted Living Website.

Statute/Rule Authority

• Chapter 408, Part II, Florida Statutes (PDF) / (HTML)
• Chapter 429, Part I, Florida Statutes (PDF) / (HTML)
• Chapter 58A-5, Florida Administrative Code (PDF) / (HTML)

Survey Guidelines

• ALF Survey Guidelines Index
  • ASPEN Regulation Set

Assisted Living Facility Initial and Change of Ownership Application Package

• Application Information and Instructions
• Fees Effective 8/1/07
• Application Packet Fees
• Checklist
• Health Care Licensing Application
• Health Care Licensing Addendum
• Application (AHCA Form 3110-1008)
• Application Addendum (AHCA Form 3110-1016)
• Voluntary Board Member Affidavit
• Affidavit of Compliance --Level 2 Background Screening for Covered Employees (AHCA 3100-0007)
• Affidavit of Compliance with Background Screening Requirement (AHCA 3100-0008)
• ALF Assets and Liabilities Statement (AHCA Form 3180-1003)
• ALF Statement of Operations (AHCA Form 3180-1002)
• ALF Local Zoning Form
• Notification of Change of Administrator Form
• Dept. Of Health - Notice
• Emergency Management Planning Criteria for Assisted Living Facilities

Community Residential Homes

• Important Notice; Assisted Living Facility Zoning Requirements
• Chapter 419, Florida Statutes
• Community Residential Home Affidavit of Compliance
• Homes licensed by the Agency for Health Care Administration--visit the AHCA website at http://www.floridahealthfinder.gov
• Homes licensed by the Department of Children and Families--visit the DCF website at http://www.dcf.state.fl.us/districts/ to locate the Community Residential Home licensing staff in the appropriate district.
• Homes licensed by the Agency for Persons with Disabilities--visit the APD website at http://apd.myflorida.com/area/ to locate the APD staff in the appropriate district.



Specialty Licenses

Extended Congregate Care (ECC)
Application Package
• Instructions
• Application (AHCA Form 3110-1008)
• Application Addendum (AHCA Form 3110-1016)
• Health Care Licensing Application
• Health Care Licensing Addendum

Survey Guidelines
• Extended Congregate Care Survey Tags
  • ASPEN Regulation Set
Limited Mental Health (LMH)
Application Package
• Instructions
• Application (AHCA Form 3110-1008)
• Application Addendum (AHCA Form 3110-1016)
• Health Care Licensing Application
• Health Care Licensing Addendum

Survey Guidelines
• Limited Mental Health Survey Tags
  • ASPEN Regulation Set
Limited Nursing Services(LNS)
Application Package
• Instructions
• Application (AHCA Form 3110-1008)
• Application Addendum (AHCA Form 3110-1016)
• Health Care Licensing Application
• Health Care Licensing Addendum

Survey Guidelines
• Limited Nursing Services Survey Tags
  • ASPEN Regulation Set

Background Screening Package

• Instructions
• Background Screening Website--Contact the ALF unit for a valid FBI fingerprint card.

Assisted Living Facility Renewal Application Package

• Renewal Application Information and Instructions
• Fees Effective 8/1/07
• Checklist
• Health Care Licensing Application
• Health Care Licensing Addendum
• Application (AHCA Form 3110-1008)
• Application Addendum (AHCA Form 3110-1016)
• Voluntary Board Member Affidavit
• Dept. Of Health - Notice
• Affidavit of Compliance --Level 2 Background Screening for Covered Employees (AHCA 3100-0007)
• Affidavit of Compliance with Background Screening Requirement (AHCA 3100-0008) (if applicable)

Background Screening Package (Renewal)

• Renewal Instructions
• Background Screening Website--Contact the ALF unit for a valid FBI fingerprint card.

Incident Reporting

• Adverse Incident Information
• Initial Adverse Incident Report - 1 Day (AHCA Form 3180-1024)
• Complete Adverse Incident Report - 15 Day (AHCA Form 3180-1025)
• Monthly Liability Claim Form Information (DOEA Form 3180-1026)

Resident Health Assessment

• Resident Health Assessment for ALFs (AHCA Form 1823)

Provider Emergency Contact Information and Resources

• Provider Emergency Contact Information and Resources

Intergenerational Respite Care Assisted Living Facility (IRC ALF) Pilot Program

The IRC ALF Pilot Program facilitates the receipt by minors and adults with disabilities and by elderly persons with special needs, of in-home, family-based respite care for up to 14 days; to prevent caregiver “burnout,” in which the caregiver’s health declines and he or she is unable to continue to provide care so that the only option for the person with disabilities or special needs is to receive institutional care; and to foster the development of intergenerational respite care assisted living facilities to temporarily care for minors and adults with disabilities and elderly persons with special needs in the same facility and to give caregivers the time they need for rejuvenation and healing.

• IRC ALF Policy