Chapter DHS 83

DHS 83.38(1)(g) (g) Health monitoring.

DHS 83.38(1)(g)1. 1. The CBRF shall monitor the health of residents and make arrangements for physical health, oral health or mental health services unless otherwise arranged for by the resident. Each resident shall have an annual physical health examination completed by a physician or an advanced practice nurse as defined in s. N 8.02 (1), unless seen by a physician or an advanced practice nurse as defined in s. N 8.02 (1) more frequently.

DHS 83.38(1)(g)2. 2. When indicated, a CBRF shall observe residents’ food and fluid intake and acceptance of diet. The CBRF shall report significant deviations from normal food and fluid intake patterns to the resident’s physician or dietician.

DHS 83.38(1)(g)3. 3. The CBRF shall document communication with the resident’s physician and other health care providers, and shall record any changes in the resident’s health or mental health status in the resident’s record.

DHS 83.38(1)(h) (h) Medication administration. The CBRF shall provide medication administration appropriate to the resident’s needs.

DHS 83.38(1)(i) (i) Behavior management. The CBRF shall provide services to manage resident’s behaviors that may be harmful to themselves or others.

DHS 83.38(1)(j) (j) Information and referral. The CBRF shall provide information and referral to appropriate community services.

DHS 83.38(1)(k) (k) Transportation. The CBRF shall provide or arrange for transportation when needed for medical appointments, work, educational or training programs, religious services and for a reasonable number of community activities of interest. CBRFs that transport residents shall develop and implement written policies addressing the safe and secure transportation of residents.

DHS 83.38(2) (2) Terminally ill resident services.

DHS 83.38(2)(a) (a) A CBRF may provide more than 3 hours of nursing care per week to a resident who has a terminal illness and who requires the care under the following conditions:

DHS 83.38(2)(a)1. 1. The resident’s primary care provider is a licensed hospice or licensed home health agency.

DHS 83.38(2)(a)2. 2. The resident’s primary care provider is not a licensed hospice or licensed home health agency, and the CBRF obtains a waiver from the department.

DHS 83.38(2)(b) (b) When a resident who requires less than 3 hours of nursing care or the resident’s legal representative waives the services of a hospice program or home health agency, the CBRF shall develop and implement the written plan of care required under par. (c), which the resident’s primary physician shall review and approve.

DHS 83.38(2)(c) (c) The primary care provider and the CBRF shall develop a written, coordinated plan of care before the initiation of palliative or supportive care.

DHS 83.38 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09; CR 10-091: am. (1) (g) 1. Register December 2010 No. 660, eff. 1-1-11.

DHS 83.39 DHS 83.39 Infection control program.

DHS 83.39(1) (1) The licensee shall establish and follow an infection control program based on current standards of practice to prevent the development and transmission of communicable disease and infection.

DHS 83.39(2) (2) The infection control program shall include written policies and training for employees.

DHS 83.39(3) (3) Employees shall follow hand washing procedures according to centers for disease control and prevention standards.

DHS 83.39(4) (4) Other occupants shall comply with infection control requirements as stated in s. DHS 83.17 (2).

DHS 83.39(5) (5) The CBRF shall ensure that pets are vaccinated against diseases, including rabies, if appropriate.

DHS 83.39 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09.

DHS 83.40 DHS 83.40 Oxygen storage. Oxygen storage shall be in an area that is well ventilated and safe from environmental hazards, tampering, or the chance of accidental damage to the valve stem. If oxygen cylinders are in use, oxygen cylinders shall be secured in an upright position. If stored upright, cylinders must be secured. If stored horizontally, cylinders shall be on a level surface where they will remain stationary.

DHS 83.40 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09.

DHS 83.41 DHS 83.41 Food service.

DHS 83.41(1) (1) General requirements.

DHS 83.41(1)(a) (a) Food supply.

DHS 83.41(1)(a)1. 1. The CBRF shall maintain a food supply that is adequate to meet the needs of the residents.

DHS 83.41(1)(a)2. 2. Food shall be obtained from acceptable sources.

DHS 83.41(1)(b) (b) Equipment. The CBRF shall store equipment and utensils in a clean manner and shall maintain all utensils and equipment in good repair.

DHS 83.41(1)(c) (c) Dishwashing.

DHS 83.41(1)(c)1. 1. Whether washed by hand or mechanical means, all equipment and utensils shall be cleaned using separate steps for pre-washing, washing, rinsing and sanitizing. Residential dishwashers may be used in kitchens serving 20 or fewer residents. Kitchens serving 21 or more residents shall have a commercial type dishwasher for washing and sanitizing equipment and utensils in accordance with standard practices described in the Wisconsin food code.

DHS 83.41(1)(c)2. 2. A 3-compartment sink for washing, rinsing and sanitizing utensils, with drain boards at each end is required for all large facilities with a central kitchen. Washing, rinsing and sanitizing procedures shall be in accordance with standard practices described in the Wisconsin food code. In addition, a single compartment sink or overhead spray wash located adjacent to the soiled drain board is required for pre-washing.

DHS 83.41(2) (2) Nutrition.

DHS 83.41(2)(a) (a) Diets.

DHS 83.41(2)(a)1. 1. The CBRF shall provide each resident with palatable food that meets the recommended dietary allowance based on current dietary guidelines for Americans and any special dietary needs of each resident.

DHS 83.41(2)(a)2. 2. The CBRF shall provide a therapeutic diet as ordered by a resident’s physician.

DHS 83.41 Note Note: To obtain information on the Dietary Guidelines for Americans, see www.usda.gov/cnpp.

DHS 83.41(2)(b) (b) Meals.

DHS 83.41(2)(b)1. 1. The CBRF shall provide meals that are routinely served family or restaurant style, unless contraindicated in a resident’s individual service plan or for short-term medical needs.

DHS 83.41(2)(b)2. 2. The CBRF shall provide at least 3 meals a day, unless otherwise arranged according to the program statement or the resident’s individual service plan. A nutritious snack shall be offered in the evening or more often as consistent with the resident’s dietary needs.

DHS 83.41(2)(b)3. 3. If a resident is away from the CBRF during the time a meal is served, the CBRF shall offer food to the resident on the resident’s return.

DHS 83.41(2)(c) (c) Menus.

DHS 83.41(2)(c)1. 1. The CBRF shall make reasonable adjustments to the menu for individual resident’s food likes, habits, customs, conditions and appetites.

DHS 83.41(2)(c)2. 2. The CBRF shall prepare weekly written menus and shall make menus available to residents. Deviations from the planned menu shall be documented on the menu.

DHS 83.41(3) (3) Sanitation and safety.

DHS 83.41(3)(a) (a) Infection control.

DHS 83.41(3)(a)1. 1. Each employee who prepares or serves food shall be free from open, infected wounds and from communicable disease and shall maintain clean and safe work habits.

DHS 83.41(3)(a)2. 2. The CBRF shall provide hand-washing facilities in the kitchen for use by food handlers. Use of a common towel is prohibited.

DHS 83.41(3)(b) (b) Food safety. Whether food is prepared at the CBRF or off-site, the CBRF shall store, prepare, distribute and serve food under sanitary conditions for the prevention of food borne illnesses, including food prepared off-site, according to all of the following:

DHS 83.41(3)(b)1. 1. The CBRF shall refrigerate all foods requiring refrigeration at or below 40°F. Food shall be covered and stored in a sanitary manner.

DHS 83.41(3)(b)2. 2. The CBRF shall maintain freezing units at 0°F or below. Frozen foods shall be packaged, labeled and dated.

DHS 83.41(3)(b)3. 3. The CBRF shall hold hot foods at 140°F or above and shall hold cold foods at 40°F or below until serving.

DHS 83.41(3)(c) (c) Reporting. The CBRF is required under s. DHS 145.04 to report suspected incidents of food borne disease to the local public health officer.

DHS 83.41 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09; correction to (3) (c) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 83.42 DHS 83.42 Resident records.

DHS 83.42(1) (1) The CBRF shall maintain a record for each resident at the CBRF. Each record shall include all of the following:

DHS 83.42(1)(a) (a) Resident’s full name, sex, date of birth, admission date and last known address.

DHS 83.42(1)(b) (b) Name, address and telephone number of designated contact person, and legal representative, if any.

DHS 83.42(1)(c) (c) Medical, social, and, if any, psychiatric history.

DHS 83.42(1)(d) (d) Current personal physician, if any.

DHS 83.42(1)(e) (e) Results of the initial health screening under s. DHS 83.28 (4) and subsequent health examinations under s. DHS 83.38 (1) (g).

DHS 83.42(1)(f) (f) Admission agreement.

DHS 83.42(1)(g) (g) Documentation of significant incidents and illnesses, including the dates, times and circumstances.

DHS 83.42(1)(h) (h) Assessments completed as required under s. DHS 83.35 (1).

DHS 83.42(1)(i) (i) Individual service plan and resident satisfaction evaluation.

DHS 83.42(1)(j) (j) Documentation to accurately describe the resident’s condition, significant changes in condition, changes in treatment and response to treatment.

DHS 83.42(1)(k) (k) Results of the annual resident evacuation evaluation.

DHS 83.42(1)(L) (L) Documentation of sensory impairment of the resident as required under s. DHS 83.48 (7) (b).

DHS 83.42(1)(m) (m) Summary of discharge information as required under s. DHS 83.31 (7).

DHS 83.42(1)(n) (n) Any department-approved resident-specific waiver, variance or approval.

DHS 83.42(1)(o) (o) Physician’s orders or other authorized practitioner’s written orders for nursing care, medications, rehabilitation services and therapeutic diets.

DHS 83.42(1)(p) (p) Current list of the type and dosage of medications or supplements.

DHS 83.42(1)(q) (q) Results of the quarterly psychotropic medication assessments as required in s. DHS 83.37 (1) (h) 1.

DHS 83.42(1)(r) (r) Documentation of administration of all medications, supplements, the person administering the medications or supplements, any side effects observed by the employee or symptoms reported by the resident, the need for PRN medications and the resident’s response, refusal to take medication, omissions of medications, errors in the administration of medications and drug reactions.

DHS 83.42(1)(s) (s) Photocopy of any court order or other document authorizing another person to speak or act on behalf of the resident, or other legal documents as required which affect the care and treatment of a resident.

DHS 83.42(1)(t) (t) Documentation of all other services including rehabilitation services, treatments and therapeutic diets.

DHS 83.42(1)(u) (u) Completed notice of pre-admission assessment requirement under s. DHS 83.30.

DHS 83.42(1)(v) (v) Nursing care procedures and the amount of time spent each week by a registered nurse or licensed practical nurse in performing the nursing care procedures. Only time actually spent by the nurse with the resident may be included in the calculation of nursing care time.

DHS 83.42(1)(w) (w) Plans of care for terminally ill residents.

DHS 83.42(1)(x) (x) Date, time and circumstances of the resident’s death, including the name of the person to whom the body is released.

DHS 83.42(2) (2) The licensee shall ensure all resident records are adequately safeguarded against destruction, loss or unauthorized access or use.

DHS 83.42(3) (3) The employee in charge on each work shift shall have a means to access resident records.

DHS 83.42 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09.

subch. VIII of ch. DHS 83 Subchapter VIII — Physical Environment

DHS 83.43 DHS 83.43 Furnishings and equipment.

DHS 83.43(1) (1) Environment. The CBRF shall provide a living environment that is safe, clean, comfortable, and homelike. All common dining and living areas shall contain furnishings appropriate to the intended use of the room.

DHS 83.43(2) (2) Bedroom furnishings. If a resident does not provide the resident’s own bedroom furnishings, the CBRF shall provide all of the following:

DHS 83.43(2)(a) (a) A bed of proper size to ensure the resident’s comfort.