Wisconsin Legislature: DCF 52.42(7)(d)8.

6. Injuries received by either the resident or a staff member in using physically enforced separation or physical hold restraint, how the injuries happened and any medical care provided.

(b) In each building housing residents, center staff shall maintain a log of written reports of incidents involving residents. The report of an incident shall include at least the information under par. (a) 1. to 3.

(c) Resident care staff at the beginning of each shift shall be informed of or review incident reports occurring since their last shift. A copy of each incident report concerning a resident shall be placed in the resident’s treatment record.

(7) Use of locked units.

(a) Conditions for use. No resident may be placed in a locked unit unless the center has first obtained department approval to operate a locked unit, the locked unit meets the requirements of this subsection and one of the following applies:

1. Use of a locked unit is ordered by a physician, to protect the health of the resident or other residents.

2. Use of a locked unit is for purposes of ensuring physically enforced separation when intervening in an emergency safety situation involving the resident. Use of a locked unit to deal with an emergency safety situation may take place provided that the following conditions are met:

a. Use is as a emergency safety intervention physically enforced separation under sub. (5).

b. Use of a locked unit for emergency safety intervention physically enforced separation may not extend beyond one hour except with written authorization from a physician, a psychologist licensed under ch. 455, Stats., or an independent clinical social worker certified under s. 457.08 (4), Stats. After review of the resident’s condition, new written orders, where necessary, may be issued for up to 24 hours. The resident shall be released from the physically enforced separation as quickly as possible. In this subdivision paragraph, “as quickly as possible” means as soon as the resident is calm and no longer a danger to self or others.

c. Use is followed by a review of the need for development of goals and objectives in the resident’s treatment plan to govern the use of locked unit physically enforced separation or to minimize or eliminate its need.

3. Use of a locked unit is part of a behavior management and control program described in the resident’s treatment plan provided that the following conditions are met:

a. The resident exhibits or recently has exhibited severely aggressive or destructive behaviors that place the resident or others in real or imminent danger and the lack of the locked unit prevents treatment staff from being able to treat the resident.

b. A physician, a psychologist licensed under ch. 455, Stats., or an independent clinical social worker certified under s. 457.08 (4), Stats., who is knowledgeable about contemporary use of locked unit treatment intervention gives written approval included in the resident’s treatment record for its use.

c. The goals, objectives and approaches in the resident’s treatment plan support its use. Goals and objectives shall be directed at reducing or eliminating the need for use of a locked unit.

d. The parent or guardian and legal custodian of the resident if a minor, gives informed consent in writing to the use of a locked unit or the locked unit intervention is ordered by a court or other lawful authority.

e. The resident has no known medical or mental health condition which would place the resident at risk of harm from being placed in a locked unit as evidenced by a statement from a physician.

(b) Record. The center shall maintain a written record of the following information on locked unit use under par. (a) 3, in the resident’s treatment record:

1. The name and age of the resident.

2. The date or dates the resident is in a locked unit and the length of time each day.

3. At least weekly assessment for continued need for locked unit use.

(c) Supervision. Appropriately trained staff shall directly supervise use of a locked unit. Appropriately trained staff are staff who have received the training under s. DCF 52.12 (5) (b) 4. and (c).

(d) Center locked unit policies and procedures. A center with a locked unit shall have written policies and procedures that include all of the following:

1. Except as provided in this subsection, no resident may be housed in a locked unit.

2. A resident may be in a locked unit only if there is a written informed consent document signed by the resident’s parent or guardian and legal custodian or by an order of a court or other lawful authority or as provided under subd. 5. A copy of the informed consent document, court order or document from another lawful authority shall be filed in the resident’s treatment record.

3. Parent or guardian and legal custodian written informed consent to placement of a resident in a locked unit shall be effective for no more than 45 days from the date of the consent and may be withdrawn sooner unless otherwise specified in a court order or by another lawful authority. Parent or guardian and legal custodian written informed consent for continued use of a locked unit may be renewed for 30 day periods except as otherwise specified in a court order or by another lawful authority. Each renewal of informed consent shall be through a separate written informed consent document.

4. The resident’s parent or guardian or the legal custodian may withdraw the written informed consent to the resident being placed in a locked unit at any time, orally or in writing. Except as otherwise specified in a court order or by another lawful authority, the resident shall be transferred to an unlocked unit promptly following withdrawal of informed consent.

5. In an emergency such as when a resident runs away, is being held for movement to secure detention until police arrive or has attempted suicide, the resident may be placed in a locked unit without parent or guardian or legal custodian consent. The parent or guardian and legal custodian shall be notified as soon as possible and written authorization for continued use of the locked unit shall be obtained from the parent or guardian and legal custodian within 24 hours. No resident kept in a locked unit under this subdivision may be kept in the locked unit for more than an additional 72 hours unless a written informed consent document signed by the parent or guardian and legal custodian authorizing continued locked unit use is obtained.

6. Prior to use of a locked unit, written approval to lock exit access doors of the unit is obtained from the Wisconsin department of safety and professional services.

7. All staff members supervising residents in a locked unit shall have the means to unlock the unit immediately if this is necessary.

8. A locked unit shall be free of furnishings that could be used by a resident in a harmful way and shall have adequate ventilation.

9. A center shall provide in each locked unit one resident care worker with no assigned responsibilities other than direct supervision of the residents. During hours when residents are awake there shall be one resident care worker for every 4 residents and one resident care worker for every 6 residents during sleeping hours. Staff shall be present in the locked unit with residents and shall have the means to immediately summon additional staff.

(8) Behavior modification and control measures.

(a) A center may not use intrusive and restrictive behavior management techniques such as behavior-modifying drugs or other forms of physical restraint as defined under s. 48.599 (1r), Stats., not identified in this section unless the center receives approval for their use from the department and where applicable, procedures in accordance with provisions found in this chapter are followed.

(b) Use of locked rooms for physically enforced separation of residents other than as provided under sub. (5) for emergency safety intervention is prohibited.

(c) A center may not use on a resident any aversive measure that is painful or discomforting to a resident or any measures that are dangerous or potentially injurious to a resident.

(9) Absence of residents without permission. A center shall have written policies and procedures for notifying the appropriate local law enforcement agency that a resident has left the center without permission or fails to return to the center after an approved leave. The procedures shall specify all of the following:

(a) How the determination is made that a resident is missing.

(b) The name of the local law enforcement agency and the name of the agency, if different, that is to be notified in order for it to file a missing person report with the crime information bureau of the Wisconsin department of justice.

(c) The name of the staff member who will promptly notify the law enforcement agency identified under par. (b) of the resident’s absence, as well as the resident’s parent or guardian and legal custodian, if any, and the placing person or agency, if not the same.

(d) Notification of the department’s interstate compact office at least within 48 hours of an out-of-state resident’s absence.

Note: For notification of Wisconsin’s Interstate Compact Office, phone: (608) 267-2079.

History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; CR 04-040: am. (5) (b) 5. e. and (7) (d) 6. Register December 2004 No. 588, eff. 1-1-05; corrections in (3) (c) and (7) (c) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; EmR1106: emerg. r. and recr. (1) (d), (5) (a), cr. (5) (ae), (am), (as), (b) 8., eff. 9-16-11; CR 11-026: r. and recr. (1) (d), (5) (a), am. (2) (b), (5) (b) 5. f., (6) (title), (a) 3., (7) (a) 2. (intro.), a., b., (8) (b), cr. (5) (ae), (am), (as), (b) 8., r. (5) (b) (title) Register December 2011 No. 672, eff. 1-1-12; correction in (5) (b) 5. e., (7) (d) 6. made under s. 13.92 (4) (b) 6., 7., Stats., Register December 2011 No. 672, eff. 1-1-12; correction in (8) made under s. 13.92 (4) (b) 7., Stats., Register October 2015 No. 718; CR 21-107: am. (7) (d) 4. Register June 2022 No. 798, eff. 7-1-22.

DCF 52.43 Education.

(1) Classroom space. On-grounds school programs shall have classroom space that is in compliance with the requirements of chs. SPS 361 to 366, the Wisconsin Commercial Building Code and applicable local ordinances.

(2) Study space. A center shall provide residents with appropriate space and supervision for quiet study after school hours.

(3) Access to educational resources. A center shall provide or arrange for resident access to up-to-date reference materials and other educational resources. These educational materials and resources shall meet the educational needs of residents.

(4) Out-of-state residents. A center admitting persons through Wisconsin’s interstate compact on placement of children from other states shall have on file educational history and achievement reports for those admissions. A center serving out-of-state residents with exceptional educational needs shall in addition comply with s. 48.60 (4), Stats., on payment of educational charges.

(5) Educational record. A center shall maintain a separate educational record for each resident as part of the resident’s case record. The educational record shall include the results of educational assessments, educational goals and progress reports.

Note: See s. DCF 52.41 (1) (b) for educational program service requirements described in a center’s operating plan.

History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; CR 04-040: am. (1) Register December 2004 No. 588, eff. 1-1-05; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register December 2011 No. 672, eff. 1-1-12.

DCF 52.44 Nutrition.

(1) Meals and snacks.

(a) A center shall provide or arrange for each resident to receive at least 3 meals each day. Meals shall be served at regular times comparable to normal mealtimes in the community.

(b) Food served at a meal shall consist of adequate portions based on the ages of residents. Lunch and breakfast meals shall follow the meal pattern requirements for the national school lunch program as provided by the U.S. department of agriculture and included in Appendix C of this chapter. Dinner meals shall be comparable to the lunch meal pattern requirements.

1. For residents between breakfast and lunch if there are more than 4 hours between those meals, and between lunch and dinner.

2. For all residents, an evening snack.

3. When a resident’s nutritional care plan under sub. (2) (c) indicates a need for snacks.

(2) Residents with special dietary needs. A center shall maintain an up-to-date list of residents with special nutritional or dietary needs as determined by a physician or dietitian, and shall do all of the following:

(a) Provide food supplements or modified diets as ordered by a physician for a resident who has special dietary needs.

(b) Have procedures for recording diet orders and changes and for sending diet orders and changes to kitchen personnel.

(c) Include a nutritional care plan in the health record of a resident with special nutritional or dietary needs. The plan shall include a problem statement, nutritional goals or dietary goals, a plan of action and procedures for follow-up. The nutritional care plan shall be reviewed and approved by a registered dietitian.

(d) Provide adaptive self-help devices to residents as needed and instruct residents on their use.

(e) Observe resident food and fluid intake. Review acceptance by a resident of a diet, and report any significant deviations from a resident’s normal eating pattern to the resident’s physician.

(f) Assist residents with food and fluid intake as necessary according to the nutritional care plan, including where applicable such tasks as instructing a resident on how to eat and take fluids as independently as possible and protecting a resident from choking which may occur because of a physiological or behavioral eating disorder.

Note: An example of a food that has been fatal is peanut butter sandwiches for a Down Syndrome individual with uncontrollable eating habits.

(g) Provide vitamin and mineral supplements when ordered by a physician.

(3) Menus. A center shall do all of the following:

(a) Plan meals and snacks in advance of the date of service and prepare menus in writing that specify the actual food to be served.

(b) Post the menu for the day and next day in the food serving area or in another place where residents can read it.

(d) When it is necessary to substitute another item for an item on a posted menu, ensure that the replacement item has the same nutritional value as the item replaced. The center shall provide for menu substitutes where religious beliefs prohibit consumption of certain food items such as pork for Jewish or Muslim residents or meat products on Lenten Fridays or other designated days of fast for Catholic residents.

(4) Food service personnel.

(a) In this subsection, “food service personnel” means staff who prepare breakfast, lunch, dinner and snacks for center residents.

(b) If a center has its own food service personnel, the food service personnel shall be age 18 or over and meet the requirements of s. DHS 190.09 (1).

Note: Chapter DHS 190 has been repealed.

(c) The director of a center shall appoint a food service director who shall be responsible for complying with this section and ch. DHS 190 as it relates to food service.

Note: Chapter DHS 190 has been repealed.

(d) A center shall provide all center food service personnel in-service training annually. Training topics shall relate to proper food handling procedures, maintenance of sanitary conditions and food service arrangements. Training shall be documented and the documentation kept on file at the center.

(5) Food service.

(a) A center shall meet the requirements of s. DHS 190.09 (2) to (9).

Note: Chapter DHS 190 has been repealed.

(b) A center shall provide nutritious packed lunches for residents who are in school or vocational or work programs when on-site lunches are not available. The center shall make provision for holding a meal for a resident who returns to the center after a meal is served.

(d) A staff person trained in the Heimlich maneuver for choking victims shall be present at mealtimes.

(e) Residents shall have at least 30 minutes to finish a meal, and a resident with an eating disorder shall have as much time as is necessary to finish the meal.

(f) The dining room in a center shall be clean, well-lighted and ventilated and shall offer a comfortable atmosphere for dining.

(g) A center may not use disposable dinnerware at meals on a regular basis, except when it documents that use of disposable dinnerware for a particular resident is necessary to protect the health or safety of the resident or others.

History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; corrections in (4) (b), (c) and (5) (a) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.