Section 400.411, Florida Statutes 2004
400.411 Initial application for license; provisional license.--
(1) Application for a license shall be made to the agency on forms furnished by it and shall be accompanied by the appropriate license fee.
(2) The applicant may be an individual owner, a corporation, a partnership, a firm, an association, or a governmental entity.
1(3) The application must be signed by the applicant under oath and must contain the following:
(a) The name, address, date of birth, and social security number of the applicant and the name by which the facility is to be known. If the applicant is a firm, partnership, or association, the application shall contain the name, address, date of birth, and social security number of every member thereof. If the applicant is a corporation, the application shall contain the corporation's name and address; the name, address, date of birth, and social security number of each of its directors and officers; and the name and address of each person having at least a 5-percent ownership interest in the corporation.
(b) The name and address of any professional service, firm, association, partnership, or corporation that is to provide goods, leases, or services to the facility if a 5-percent or greater ownership interest in the service, firm, association, partnership, or corporation is owned by a person whose name must be listed on the application under paragraph (a).
(c) The name and address of any long-term care facility with which the applicant, administrator, or financial officer has been affiliated through ownership or employment within 5 years of the date of this license application; and a signed affidavit disclosing any financial or ownership interest that the applicant, or any person listed in paragraph (a), holds or has held within the last 5 years in any facility licensed under this part, or in any other entity licensed by this state or another state to provide health or residential care, which facility or entity closed or ceased to operate as a result of financial problems, or has had a receiver appointed or a license denied, suspended or revoked, or was subject to a moratorium on admissions, or has had an injunctive proceeding initiated against it.
(d) 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.
(e) The names and addresses of persons of whom the agency may inquire as to the character, reputation, and financial responsibility of the owner and, if different from the applicant, the administrator and financial officer.
(f) Identification of all other homes or facilities, including the addresses and the license or licenses under which they operate, if applicable, which are currently operated by the applicant or administrator and which provide housing, meals, and personal services to residents.
(g) The location of the facility for which a license is sought and documentation, signed by the appropriate local government official, which states that the applicant has met local zoning requirements.
(h) The name, address, date of birth, social security number, education, and experience of the administrator, if different from the applicant.
(4) The applicant shall furnish satisfactory proof of financial ability to operate and conduct the facility in accordance with the requirements of this part. A certificate of authority, pursuant to chapter 651, may be provided as proof of financial ability.
(5) If the applicant is a continuing care facility certified under chapter 651, a copy of the facility's certificate of authority must be provided.
(6) The applicant shall provide proof of liability insurance as defined in s. 624.605.
(7) If the applicant is a community residential home, the applicant must provide proof that it has met the requirements specified in chapter 419.
(8) The applicant must provide the agency with proof of legal right to occupy the property.
(9) The applicant must furnish proof that the facility has received a satisfactory firesafety inspection. The local authority having jurisdiction or the State Fire Marshal must conduct the inspection within 30 days after written request by the applicant.
(10) The applicant must furnish documentation of a satisfactory sanitation inspection of the facility by the county health department.
(11) The applicant must furnish proof of compliance with level 2 background screening as required under s. 400.4174.
(12) A provisional license may be issued to an applicant making initial application for licensure or making application for a change of ownership. A provisional license shall be limited in duration to a specific period of time not to exceed 6 months, as determined by the agency.
(13) A county or municipality may not issue an occupational license that is being obtained for the purpose of operating a facility regulated under this part without first ascertaining that the applicant has been licensed to operate such facility at the specified location or locations by the agency. The agency shall furnish to local agencies responsible for issuing occupational licenses sufficient instruction for making such determinations.
History.--s. 7, ch. 75-233; s. 3, ch. 77-323; ss. 12, 17, ch. 80-198; s. 2, ch. 81-318; ss. 7, 19, ch. 82-148; ss. 44, 47, 79, 83, ch. 83-181; s. 5, ch. 85-145; s. 1, ch. 85-251; s. 6, ch. 87-371; s. 12, ch. 89-294; s. 7, ch. 91-263; ss. 6, 38, 39, ch. 93-216; s. 5, ch. 95-418; s. 6, ch. 98-80; s. 42, ch. 98-171.
1Note.--As amended by s. 42, ch. 98-171. This material was also amended by s. 6, ch. 98-80. A portion of former paragraph (2)(c) was stricken by s. 42, ch. 98-171, and the remaining text of that paragraph was redesignated as paragraph (3)(c); the portion of former paragraph (2)(c) stricken by s. 42, ch. 98-171, was redesignated as paragraph (3)(c) and amended by s. 6, ch. 98-80. As amended by s. 6, ch. 98-80, this material would have read:
(c) Information sufficient to establish the suitable character, financial stability, and competency of the applicant and of each person specified in the application under paragraph (a) and, if different from the applicant, the administrator, and financial officer.