DHS 83.32(3)(f)(f) Freedom from chemical restraints. Be free from all chemical restraints. DHS 83.32(3)(g)(g) Freedom from physical restraints. Be free from physical restraints except upon prior review and approval by the department upon written authorization from the resident’s primary physician or advanced practice nurse prescriber as defined in s. N 8.02 (2). The department may place conditions on the use of a restraint to protect the health, safety, welfare and rights of the resident. DHS 83.32(3)(h)(h) Receive medication. Receive all prescribed medications in the dosage and at intervals prescribed by a practitioner. The resident has the right to refuse medication unless the medication is court ordered. DHS 83.32(3)(i)(i) Prompt and adequate treatment. Receive prompt and adequate treatment that is appropriate to the resident’s needs. DHS 83.32(3)(j)(j) Treatment options. Participate in the planning of care and treatment, be fully informed of care and treatment options and have the right to refuse any form of care or treatment unless the care or treatment has been ordered by a court. DHS 83.32(3)(k)(k) Self-determination. Make decisions relating to care, activities, daily routines and other aspects of life which enhance the resident’s self reliance and support the resident’s autonomy and decision making. DHS 83.32(3)(L)(L) Least restrictive environment. Have the least restrictive conditions necessary to achieve the purposes of the resident’s admission. The CBRF may not impose a curfew, rule or other restriction on a resident’s freedom of choice. DHS 83.32(3)(m)(m) Recording, filming, photographing. Not be recorded, filmed or photographed without informed, written consent by the resident or resident’s legal representative. The CBRF may take a photograph for identification purposes. The department may photograph, record or film a resident pursuant to an inspection or investigation under s. 50.03 (2), Stats., without his or her written informed consent. DHS 83.32(3)(n)(n) Safe environment. Live in a safe environment. The CBRF shall safeguard residents from environmental hazards to which it is likely the residents will be exposed, including both conditions that are hazardous to anyone and conditions that are hazardous to the resident because of the residents’ conditions or disabilities. DHS 83.32 HistoryHistory: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09; correction in (1) (a) made under 13.92 (4) (b) 7., Stats., Register January 2009 No. 637. DHS 83.33(1)(1) A CBRF shall have a written grievance procedure and shall provide a copy to each resident and the resident’s legal representative before or at the time of admission. The grievance procedure shall specify all of the following: DHS 83.33(1)(a)(a) A resident or any individual on behalf of the resident may file a grievance with the CBRF, the department, the resident’s case manager, if any, the board on aging and long term care, Disability Rights Wisconsin, Inc., or any other organization providing advocacy assistance. The resident and the resident’s legal representative shall have the right to advocate throughout the grievance procedure. The written grievance procedure shall include the name, address and phone number of organizations providing advocacy for the client groups served, and the name, address and phone number of the department’s regional office that licenses the CBRF. DHS 83.33(1)(b)(b) Any person investigating the facts associated with a grievance shall not have had any involvement in the issue leading to the grievance. DHS 83.33(1)(c)(c) Any form of coercion to discourage or prevent any individual from filing a grievance or in retaliation for having filed a grievance is prohibited. DHS 83.33(1)(d)(d) The CBRF shall provide a written summary of the grievance, the findings and the conclusions and any action taken to the resident or the resident’s legal representative and the resident’s case manager. The CBRF shall maintain a copy of the investigation. DHS 83.33(2)(2) The CBRF shall follow the grievance procedures under s. DHS 94.40 for any resident placed or funded by a county department of social services under s. 46.21 or 46.22, Stats., a county department of human services under s. 46.23, Stats., a county department of community programs, under s. 51.42, Stats., a county department of developmental disabilities services under s. 51.437, Stats., or for any resident who is receiving protective services or protective placement under ch. 55, Stats. DHS 83.33(3)(3) The CBRF shall assist residents with grievance procedures as required under this section. DHS 83.33(4)(4) The CBRF shall post in a conspicuous location in the CBRF a poster provided by the board on aging and long term care ombudsman program, concerning the long-term care ombudsman program under s. 16.009 (2) (b), Stats. The poster shall include the name, address and telephone number of the ombudsman’s office. This requirement does not apply to those facilities exclusively licensed to serve clients under the jurisdiction of a government correctional agency. DHS 83.33 HistoryHistory: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637. DHS 83.34(1)(1) Authorization. Except for a resident in the custody of a government correctional agency, the CBRF may not obtain, hold, or spend a resident’s funds without written authorization from the resident or the resident’s legal representative. The resident or the resident’s legal representative may limit or revoke authorization at any time by writing a statement that shall specify the effective date of the limitation or revocation. DHS 83.34(2)(a)(a) Upon written authorization, a CBRF may hold no more than $200 cash for use by the resident. The CBRF may not commingle residents’ funds with the funds or property of the CBRF, the licensee, employees, or relatives of the licensee or employees. DHS 83.34(2)(b)(b) The CBRF shall have a legible, accurate accounting method for tracking residents’ cash and shall include a record of any deposits, disbursements and earnings made to or on behalf of the resident. The CBRF shall provide a receipt to the resident or the resident’s legal representative for all expenditures in excess of $20. DHS 83.34(2)(c)(c) The CBRF shall provide a written report of the resident’s account to the resident or the resident’s legal representative at least every 6 months. Upon written request from the resident or resident’s legal representative, the CBRF shall provide a written monthly account of any financial transactions. DHS 83.34(3)(3) Funds in excess of $200. A CBRF receiving more than $200 of personal funds from a resident shall deposit funds in excess of $200 in an interest-bearing account in the resident’s name in a savings institution insured by an agency of, or a corporation chartered by, this state or the United States. DHS 83.34(4)(4) Final accounting. Within 14 days after a resident is discharged, the CBRF shall provide to the resident or the resident’s legal representative a written final accounting of all the resident’s funds held by the CBRF and shall disburse any remaining money to the resident or to the resident’s legal representative. DHS 83.34(5)(a)(a) No CBRF licensee, administrator or employee may do any of the following: DHS 83.34(5)(a)1.1. Sell to or purchase from a resident or prospective resident, real or personal property. DHS 83.34(5)(a)3.3. Be appointed as power of attorney for any resident unless related to the resident by blood or adoption. DHS 83.34(5)(b)(b) No CBRF, nor any employee on behalf of the CBRF, may accept donations from any resident, except those made by a competent resident or made with the knowledge of the resident’s legal representative acting within the scope of their authority and only for the benefit of the CBRF. No employee may accept personal gifts, including monetary gifts, from a resident. DHS 83.34(6)(a)(a) If a CBRF collects a security deposit, the funds shall be deposited in an interest-bearing account insured by an agency of, or a corporation chartered by, this state or the United States. DHS 83.34(6)(b)(b) The amount of the security deposit shall not exceed one month’s fees for services. DHS 83.34(6)(c)(c) The CBRF shall keep the security deposit account separate from other funds of the CBRF. DHS 83.34(6)(d)(d) Within 30 days after the resident’s discharge, the security deposit and any interest earned shall be paid to the person who made the security deposit. Interest paid shall be the actual interest earned. DHS 83.34(7)(7) Transfer of financial responsibility. When a change of ownership of the CBRF occurs, the transferor shall: DHS 83.34(7)(a)(a) Notify the transferee in writing of any financial relationships between the transferor and residents. DHS 83.34(7)(b)(b) Notify each resident or legal representative in writing where any financial relationship exists between the transferor and residents of the pending transfer. DHS 83.34(8)(8) Audit. A CBRF handling residents’ funds under this section is subject to an accounting audit as ordered by the department. The accounting audit shall be completed by a certified public accountant paid for by the CBRF. DHS 83.34 HistoryHistory: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09. DHS 83.35DHS 83.35 Assessment, individual service plan and evaluations. DHS 83.35(1)(a)(a) Scope. The CBRF shall assess each resident’s needs, abilities, and physical and mental condition before admitting the person to the CBRF, when there is a change in needs, abilities or condition, and at least annually. The assessment shall include all areas listed under par. (c). This requirement includes individuals receiving respite care in the CBRF. For emergency admissions the CBRF shall conduct the assessment within 5 days after admission. DHS 83.35(1)(b)(b) Information gathering. The CBRF shall base the assessment on the current diagnostic, medical and social history obtained from the person’s health care providers, case manager and other service providers. Other service providers may include a psychiatrist, psychologist, licensed therapist, counselor, occupational therapist, physical therapist, pharmacist or registered nurse. The administrator or designee shall hold a face-to-face interview with the person and the person’s legal representative, if any, and family members, as appropriate, to determine what the person views as his or her needs, abilities, interests, and expectations. DHS 83.35(1)(c)(c) Areas of assessment. The assessment, at a minimum, shall include all of the following areas applicable to the resident: DHS 83.35(1)(c)1.1. Physical health, including identification of chronic, short-term and recurring illnesses, oral health, physical disabilities, mobility status and the need for any restorative or rehabilitative care. DHS 83.35(1)(c)2.2. Medications the resident takes and the resident’s ability to control and self-administer medications. DHS 83.35(1)(c)4.4. Nursing procedures the resident needs and the number of hours per week of nursing care the resident needs. DHS 83.35(1)(c)5.5. Mental and emotional health, including the resident’s self-concept, motivation and attitudes, symptoms of mental illness and participation in treatment and programming. DHS 83.35(1)(c)6.6. Behavior patterns that are or may be harmful to the resident or other persons, including destruction of property. DHS 83.35(1)(c)8.8. Capacity for self-care, including the need for any personal care services, adaptive equipment or training. DHS 83.35(1)(c)9.9. Capacity for self-direction, including the ability to make decisions, to act independently and to make wants or needs known. DHS 83.35(1)(c)10.10. Social participation, including interpersonal relationships, communication skills, leisure time activities, family and community contacts and vocational needs. DHS 83.35(1)(d)(d) Assessment documentation. The CBRF shall prepare a written report of the results of the assessment and shall retain the assessment in the resident’s record. DHS 83.35(2)(2) Temporary service plan. Upon admission, the CBRF shall prepare and implement a written temporary service plan to meet the immediate needs of the resident, including persons admitted for respite care, until the individual service plan under sub. (3) is developed and implemented. DHS 83.35(3)(a)(a) Scope. Within 30 days after admission and based on the assessment under sub. (1), the CBRF shall develop a comprehensive individual service plan for each resident. The individual service plan shall include all of the following: DHS 83.35(3)(a)3.3. Establish measurable goals with specific time limits for attainment. DHS 83.35(3)(a)4.4. Specify methods for delivering needed care and who is responsible for delivering the care. DHS 83.35(3)(b)(b) Development. The CBRF shall involve the resident and the resident’s legal representative, as appropriate, in developing the individual service plan and the resident or the resident’s legal representative shall sign the plan acknowledging their involvement in, understanding of and agreement with the plan. If a resident has a medical prognosis of terminal illness, a hospice program or home health care agency, as identified in s. DHS 83.38 (2) shall, in cooperation with the CBRF, coordinate the development of the individual service plan and its approval under s. DHS 83.38 (2) (b). The resident’s case manager, if any, and any health care providers, shall be invited to participate in the development of the service plan. DHS 83.35(3)(c)(c) Implementation. The CBRF shall implement and follow the individual service plan as written. DHS 83.35(3)(d)(d) Individual service plan review. Annually or when there is a change in a resident’s needs, abilities or physical or mental condition, the individual service plan shall be reviewed and revised based on the assessment under sub. (1). All reviews of the individual service plan shall include input from the resident or legal representative, case manager, resident care staff, and other service providers as appropriate. The resident or resident’s legal representative shall sign the individual service plan, acknowledging their involvement in, understanding of and agreement with the individual service plan. DHS 83.35(3)(e)(e) Documentation of review. The CBRF shall document any changes made as a result of the comprehensive individual service plan review. DHS 83.35(3)(f)(f) Availability. All employees who provide resident care and services shall have continual access to the resident’s assessment and individual service plan. DHS 83.35(4)(4) Satisfaction evaluation. At least annually, the CBRF shall provide the resident and the resident’s legal representative the opportunity to complete an evaluation of the resident’s level of satisfaction with the CBRF’s services. The evaluation shall be completed on either a department form or a form developed by the CBRF and approved by the department. DHS 83.35 NoteNote: The CBRF Resident Satisfaction Evaluation form, F62372, can be found at http://dhs.wisconsin.gov/forms/DQAnum.asp or by contacting the Division of Quality Assurance Regional Office listed in Appendix A. DHS 83.35(5)(5) Evaluation of resident evacuation limitations. DHS 83.35(5)(a)(a) Initial evaluation. The CBRF shall evaluate each resident within 3 days of the resident’s admission to determine whether the resident is able to evacuate the CBRF within 2 minutes in an unsprinklered CBRF and 4 minutes in a sprinklered CBRF without any help or verbal or physical prompting, and what type of limitations that resident may have that prevent the resident from evacuating the CBRF within the applicable period of time. A form provided by the department shall be used for the evaluation. The resident’s evaluation shall be retained in the resident’s record. DHS 83.35 NoteNote: The Resident Evacuation Assessment form, F62373, can be found at http://dhs.wisconsin.gov/forms/DQAnum.asp or by contacting the Division of Quality Assurance Regional Office listed in Appendix A. DHS 83.35(5)(b)(b) Evaluation update. The CBRF shall evaluate each resident’s mental or physical capability to respond to a fire alarm at least annually or when there is a change in the resident’s mental or physical capability to respond to a fire alarm. DHS 83.35(5)(c)(c) Notice to employees. The CBRF shall notify each employee who works on the premises of the CBRF of each resident who needs more than 2 minutes to evacuate the CBRF and the type of assistance the resident needs to be evacuated. DHS 83.36(1)(a)(a) The CBRF shall provide employees in sufficient numbers on a 24-hour basis to meet the needs of the residents. DHS 83.36(1)(b)1.1. An administrator or other designated qualified resident care staff in charge is on the premises of the CBRF daily to ensure the CBRF is providing safe and adequate care, treatment and services. DHS 83.36(1)(b)2.2. At least one qualified resident care staff is present in the CBRF when one or more residents are present in the CBRF. DHS 83.36(1)(b)3.3. At least one qualified resident care staff is on duty and awake if at least one resident in the CBRF is in need of supervision, intervention or services on a 24-hour basis to prevent, control or improve the resident’s constant or intermittent mental or physical condition that may occur or may become critical at any time including residents who are at risk of elopement, who have dementia, who are self-abusive, who become agitated or emotionally upset or who have changing or unstable health conditions that require close monitoring.
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