Hampton Manor Of Merritt Island

RECORDS - FACILITY

RECORDS

RECORDS - FACILITY

Corrected Jan 9, 2026

REPORTING REQUIREMENTS; ELECTRONIC SUBMISSION59A-35.110 Reporting Requirements; Electronic

REPORTING REQUIREMENTS; ELECTRONIC SUBMISSION59A-35.110 Reporting Requirements; Electronic Submission. (1) During the two year licensure period, any change or expiration of any information that is required to be reported under Chapter 408, Part II, F.S., or authorizing statutes for the provider type as specified in Section 408.803(3), F.S., during the license application process must be reported to the Agency within 21 days of occurrence of the change, including: (a) Insurance coverage renewal; (b) Bond renewal; (c) Change of administrator or the similarly titled person who is responsible for the day-to-day operation of the provider; (d) Annual sanitation inspections; (e) Fire inspections. (2) Electronic submission of information. (a) The following required information must be submitted electronically through the Agency's Single Sign On Portal located at https://apps.ahca.myflorida.com/SingleSignOnPortal: 1. Nursing homes: Adverse incident reports must be submitted electronically to the Agency within 15 calendar days after the occurrence of the incident as required in Section 400.147, F.S. on Nursing Home Adverse Incident, AHCA Form 3110-0010 OL, April 2017, which is hereby incorporated by reference and available at: https://www.flrules.org/Gateway/reference.asp?No=Ref-08777, and through the Agency's adverse incident reporting system which can only be accessed through the Agency's Single Sign On Portal located at: https://apps.ahca.myflorida.com/SingleSignOnPortal. 2. Assisted living facilities: Adverse incident reports must be submitted electronically to the Agency within 1 business day after the occurrence of the incident, and within 15 calendar days after the occurrence of the incident as required in Section 429.23, F.S., on Assisted Living Facility Adverse Incident, AHCA Form 3180-1025 OL, April 2017, which is hereby incorporated by reference and available at: https://www.flrules.org/Gateway/reference.asp?No=Ref-08778, and through the Agency's adverse incident reporting system which can only be accessed through the Agency's Single Sign On Portal located at: https://apps.ahca.myflorida.com/SingleSignOnPortal. 3. Hospitals: Adverse incident reports must be submitted electronically to the Agency within 15 calendar days after the occurrence of the incident as required in Section 395.0197, F.S., on Hospital Adverse Incident, AHCA Form 3140-5001 OL, April 2017, which is hereby incorporated by reference and available at: https://www.flrules.org/Gateway/reference.asp?No=Ref-08779, and through the Agency's adverse incident reporting system which can only be accessed through the Agency's Single Sign On Portal located at: https://apps.ahca.myflorida.com/SingleSignOnPortal. 4. Ambulatory Surgical Centers: Adverse incident reports must be submitted electronically to the Agency within 15 calendar days after the occurrence of the incident as required in Section 395.0197, F.S., on Ambulatory Surgical Center Adverse Incident, AHCA Form 3140-5004 OL, April 2017, which is hereby incorporated by reference and available at: https://www.flrules.org/Gateway/reference.asp?No=Ref-08780, and through the Agency's adverse incident reporting system which can only be accessed through the Agency's Single Sign On Portal located at: https://apps.ahca.myflorida.com/SingleSignOnPortal. 5. Hospitals and ambulatory surgical centers must submit annual reports pursuant to Section 395.0197 F.S., electronically to the Agency on Annual Report, AHCA Form 3140-5005 OL, May 2018, which is hereby incorporated by reference and available at: http://www.flrules.org/Gateway/reference.asp?No=Ref-12123, and through the Agency's Single Sign On Portal located at: https://apps.ahca.myflorida.com/SingleSignOnPortal. 6. For the purposes of this rule, the following applies for submitting adverse incident reports: a. A business day means any day other than a Saturday, Sunday, or legal holiday as designated in Section 110.117, F.S. b. A preliminary (1-Day) report is deemed late when submitted more than 1 b

Corrected Oct 1, 2025

ADMISSIONS - HEALTH ASSESSMENT

ADMISSIONS

ADMISSIONS - HEALTH ASSESSMENT

Corrected Oct 1, 2025

INFECTION CONTROL PROCEDURES

INFECTION CONTROL PROCEDURES

INFECTION CONTROL PROCEDURES

Corrected Oct 1, 2025

MEDICATION - STORAGE AND DISPOSAL

MEDICATION

MEDICATION - STORAGE AND DISPOSAL

Corrected Oct 1, 2025

MEDICATION - LABELING AND ORDERS

MEDICATION

MEDICATION - LABELING AND ORDERS

Corrected Oct 1, 2025

RESIDENT CARE - ELOPEMENT STANDARDS

RESIDENT CARE

RESIDENT CARE - ELOPEMENT STANDARDS

Corrected Jul 15, 2025

ADMISSIONS - CONTINUED RESIDENCY

ADMISSIONS

ADMISSIONS - CONTINUED RESIDENCY

Corrected Oct 1, 2025

RESIDENT CARE - SUPERVISION

RESIDENT CARE

RESIDENT CARE - SUPERVISION

Corrected Oct 1, 2025

Originally licensed

First Florida AHCA license date on record for this community. Later inspections and fines appear above as newer events.