Wisconsin Legislature: DHS 83.41(2)(b)1.

1. The resident’s primary care provider is a licensed hospice or licensed home health agency.

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.

(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.

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

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 Infection control program.

(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.

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

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

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

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

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

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.

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

DHS 83.41 Food service.

(1) General requirements.

(a) Food supply.

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

2. Food shall be obtained from acceptable sources.

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

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.

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.

(2) Nutrition.

(a) Diets.

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.

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

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

(b) Meals.

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.

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.

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.

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

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.

(3) Sanitation and safety.

(a) Infection control.

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.

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

(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:

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

2. The CBRF shall maintain freezing units at 0°F or below. Frozen foods shall be packaged, labeled and dated.

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

(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.

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 Resident records.

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

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

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

(d) Current personal physician, if any.

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

(f) Admission agreement.

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

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

(i) Individual service plan and resident satisfaction evaluation.

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

(k) Results of the annual resident evacuation evaluation.

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

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

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

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

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

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

(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.

(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.

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

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

(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.

(w) Plans of care for terminally ill residents.

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

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

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

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

Subchapter VIII — Physical Environment

DHS 83.43 Furnishings and equipment.

(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.

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

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

(b) A clean, comfortable mattress covered with a mattress pad and when necessary, waterproof covering.

(d) Clean sheets, pillowcases, towels and washcloths adequate to meet the needs of the resident.

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

DHS 83.44 Housekeeping services.

(1) Laundry.

(a) Laundry area. The CBRF shall make an adequate number of laundry appliances available to residents who choose to do their own laundry. The CBRF shall have a laundry area to sort, process and store clean and soiled laundry and shall handle clean and soiled laundry so as to prevent the spread of infection.

(b) Storage and transport. The CBRF shall have separate clean and dirty laundry storage areas or containers. Storage containers shall be clean, leak-proof and have a tight fitting lid. The CBRF may not transport, wash or rinse soiled laundry in areas used for food preparation, serving or storage.

(c) Clothes dryers. The CBRF shall enclose any clothes dryer having a rated capacity of more than 37,000 Btu/hour in a one-hour fire resistive rated enclosure. If the clothes dryer requires a vent, the CBRF shall use dryer vent tubing that is of rigid material with a fire rating that exceeds the temperature rating of the dryer. The dryer vent tubing shall be clean and maintained.

(2) Cleanliness.