Chapter DHS 83

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.

DHS 83.43(2)(b) (b) A clean, comfortable mattress covered with a mattress pad and when necessary, waterproof covering.

DHS 83.43(2)(c) (c) A clean, comfortable pillow, bedspread and blankets adequate for the season.

DHS 83.43(2)(d) (d) Clean sheets, pillowcases, towels and washcloths adequate to meet the needs of the resident.

DHS 83.43 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09.

DHS 83.44 DHS 83.44 Housekeeping services.

DHS 83.44(1) (1) Laundry.

DHS 83.44(1)(a) (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.

DHS 83.44(1)(b) (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.

DHS 83.44(1)(c) (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.

DHS 83.44(2) (2) Cleanliness.

DHS 83.44(2)(a) (a) The CBRF shall keep all rooms clean and shall make reasonable attempts to keep all rooms free from odors.

DHS 83.44(2)(b) (b) All toilet and bathing areas, facilities and fixtures shall be clean and in good working order.

DHS 83.44(2)(c) (c) Every interior floor, wall and ceiling shall be clean and in good repair.

DHS 83.44 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09.

DHS 83.45 DHS 83.45 Building maintenance and site.

DHS 83.45(1) (1) Maintenance.

DHS 83.45(1)(a) (a) Exterior areas. The CBRF shall maintain the yard, any fences, sidewalks, driveways and parking areas of the CBRF in good repair and free of hazards.

DHS 83.45(1)(b) (b) Building integrity. The CBRF shall be structurally sound without visible evidence of structural failure or deterioration and shall be maintained in good repair.

DHS 83.45(1)(c) (c) Surface drainage. The CBRF shall ensure that each courtyard, yard or other area on the premises of the CBRF is drained or graded to divert water away from the building.

DHS 83.45(1)(d) (d) Hazards. The CBRF shall maintain each building in good repair and free of hazards.

DHS 83.45(1)(e) (e) Systems. The CBRF shall maintain all electrical, mechanical, water supply, plumbing, fire protection and sewage disposal systems in a safe and functioning condition.

DHS 83.45(1)(f) (f) Furnishings. The CBRF shall keep all furnishings clean, safe, and maintained in good repair.

DHS 83.45(2) (2) Storage. The CBRF shall maintain storage areas in a safe, dry and orderly condition.

DHS 83.45(3) (3) Toxic substances. The CBRF shall ensure that cleaning compounds, polishes, insecticides and toxic substances are labeled and stored in a secure area.

DHS 83.45(4) (4) Pest control. The CBRF shall implement safe, effective procedures for control and extermination of insects, rodents and vermin.

DHS 83.45(5) (5) Garbage and refuse. The CBRF shall dispose of garbage and refuse. Garbage and refuse in inside areas shall be kept in leak-proof, non-absorbent closed containers. Garbage and refuse in outside areas shall be in closed containers.

DHS 83.45 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09.

DHS 83.46 DHS 83.46 Building support systems.

DHS 83.46(1) (1) Heating.

DHS 83.46(1)(a) (a) A CBRF shall maintain comfortable and safe temperatures. The CBRF shall provide tempered air at all times to eliminate cold air drafts. The heating system shall be capable of maintaining temperatures of 74º F. in areas occupied by residents.

DHS 83.46(1)(b) (b) The use of portable space heaters is prohibited except for Underwriters Laboratories listed electric heating equipment that is listed for permanent attachment to the wall. Portable space heaters shall have an automatic thermostatic control and shall be physically attached to a wall.

DHS 83.46(1)(c) (c) The CBRF shall maintain the heating system in a safe and properly functioning condition. The CBRF shall ensure that a heating contractor or local utility company completes all of the following maintenance and makes available to the facility documentation of the maintenance performed: