Wisconsin Legislature: DHS 105.14(7)(a)1.

Alert! This chapter may be affected by an emergency rule:

EmR2421

3. An enrollment agreement shall be signed by the participant or legal representative, if applicable, that includes a written description of the services to be provided, the cost of those services, and a statement that the participant’s rights have been received.

4. Within 90 days before or 7 days after enrollment, a physician, physician assistant, clinical nurse practitioner, or a licensed registered nurse shall screen each participant for clinically apparent communicable diseases, including tuberculosis, and document the results of the screening. All screenings and immunizations shall be conducted in accordance with current standards of practice. The ADCC shall maintain the screening documentation in each participant’s record.

1. The ADCC shall develop criteria for voluntary and involuntary discharge of a participant from the program and a procedure for appeal of an involuntary discharge by the participant or legal representative.

2. The ADCC may not involuntarily discharge a participant unless any of the following occurs:

a. Nonpayment of charges, following reasonable opportunity to pay.

b. The participant requires care that is beyond the ADCC’s certification.

c. The participant requires care that is inconsistent with the ADCC’s program description and beyond that which the ADCC is required to provide under the terms of the enrollment agreement and this section.

d. The participant requires medical care that the ADCC cannot provide.

e. There is imminent risk of serious harm to the health or safety of the participant, other participants, or employees, as documented in the participant’s record.

f. As otherwise permitted by law.

3. At least 30 days before involuntary discharge, the ADCC shall provide written notice of involuntary discharge to the participant or legal representative. If the continued presence of the participant endangers the health, safety or welfare of the participant or any other participant, the 30-day notice requirements of this subdivision do not apply.

(6) Participant rights.

(a) Prohibitions. Any form of coercion to discourage or prevent a participant or the participant’s legal representative from exercising any of the rights under this subsection is prohibited. Any form of retaliation against a participant or the participant’s legal representative for exercising any of the rights in this subsection, or against a caregiver or any other person who assists a participant or the participant’s legal representative in the exercise of any of the participant rights in this subsection, is prohibited.

(b) Participant rights. Each participant shall have all of the following:

1. The right to be treated with respect and dignity.

2. The right to be free from physical, sexual, mental abuse and neglect, and from misappropriation of personal property.

3. The right to participate in the development of one’s service plan, with support from a caregiver or legal representative, if needed.

4. The right to refuse to participate in an activity.

5. The right to privacy and confidentiality.

6. The right to be fully informed of all the services provided and the charge for each of those services.

7. The right to be informed of the reason for discharge and the procedure for appealing that decision.

8. The right to initiate a grievance and be informed of the grievance procedure.

9. The right to be free from physical restraints, except upon prior review and approval by the department with written authorization from the participant’s primary physician, physician assistant, 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, well-being and rights of the participant.

10. The right to be free from seclusion.

11. The right to be free from all chemical restraints.

12. The right to not be recorded, filmed or photographed without prior written informed consent by the participant or participant’s legal representative. The ADCC may take a photograph for identification purposes. The department may photograph, record or film a participant pursuant to an inspection or investigation under s. 49.45 (2) (a) 11., Stats., without their written informed consent.

(7) Participant care and services.

(a) Assessment of participant’s needs.

1. Assessments shall be conducted by staff members having the expertise, experience, or training pertinent to the participant population served by the program. The assessment identifying the participant’s needs shall be completed prior to enrollment. For emergency enrollments, the program will complete an assessment within 5 days.

2. A comprehensive written assessment of the participant’s needs, at a minimum, shall include the areas of physical health to include physical disabilities and mobility status, mental and emotional health, nursing care, medications to include allergies, nutritional needs including risks for choking, emergency evacuation capabilities, preferences and interests and any other information helpful to developing the service plan.

(b) Individual service plan.

1. Within 30 days of enrollment and based on the assessment completed under par. (a), the ADCC shall develop and implement a service plan to identify the services and activities the program will provide in order to meet the individual needs and personal interests of the participant. The service plan shall be developed by staff members with experience, or training pertinent to the participant population served by the program.

2. The service plan will be reviewed and revised every 6 months or when necessary due to changes in the participant’s functioning, health condition, or preferences. Changes shall be documented in the participant’s record.

3. All caregivers who provide participant care and supervision shall have continual access to the participant’s service plan.

1. In this paragraph, “severely impaired” means any impairment leading to a participant’s inability at the program to perform any 3 or more ADLs. A severely impaired participant demonstrates an inability to perform these ADLs at the ADCC unless assistance, supervision or prompting is provided.

2. At least one qualified caregiver shall be on the premises at all times when one or more participant are present.

3. The ADCC shall provide sufficient caregiver staff at all times to implement the program goals and participant service plans based on a comprehensive assessment of each participant’s needs, including physical health, physical disabilities and mobility status, mental and emotional health, emergency evacuation capabilities, and participant’s preferences and interests.

4. There shall be a minimum of one caregiver for every 8 non-severely impaired participants at the ADCC.

5. There shall be a minimum of one caregiver for every 4 severely impaired participants at the ADCC.

6. The ADCC shall maintain a current written schedule for every caregiver at the ADCC. The schedule shall include each caregiver’s full name, job assignment, and time worked.

7. A volunteer who meets the same standards, requirements, and training as a caregiver and who have signed a written job description may be counted as a caregiver to meet staffing requirements.

(d) Medication administration.

1. The ADCC shall have a written policy for medication management and shall designate which caregivers are authorized and trained to administer medications. The caregiver administering medications shall be 18 years of age or older. The policy shall indicate the program’s role in the supervision of self-administered medications and caregiver administered medications.

2. Self-administered medications may be supervised by a caregiver who may prompt the participant and observe the participant taking the medication. To self-administer medications, the participant shall have the physical and mental capacity to obtain, dispense, and ensure the correct medications are taken in the prescribed dosages. When medications are self-administered, the medication list shall be reviewed and updated annually by the prescribing practitioner, physician, physician’s assistant, or nurse practitioner.

3. Caregiver-administered medications shall be stored, obtained, and assembled for the participant. The caregiver is responsible for ensuring the correct medication, in the correct dose, at the correct time is administered to the correct participant. Medications administered by a caregiver shall meet all of the following conditions:

a. A written order from the prescribing practitioner shall be in the participant’s record.

b. A listing of current medications with the dosage, frequency, and route of administration shall be in the participant’s record.

c. Over-the-counter and prescription medications shall remain in the original labeled containers and be stored in a locked, safe place.

d. Non-licensed caregivers shall consult with the prescribing practitioner or pharmacist about each medication to be administered.

e. Written information describing side effects and adverse reactions of each medication shall be kept in the participant’s record.

f. The administration of medications shall be documented in the participant’s permanent record to include the name of the medication, dosage, method of administration, date and time administered, and name of the caregiver who administered the medication.

g. Medication administration by routes to include: injectable, nebulizers, stomal and enteral medications, and medications, treatments or preparations delivered vaginally or rectally shall be administered by a registered nurse or by a licensed practical nurse within the scope of their license, or may be delegated to a non-licensed caregiver pursuant to s. N 6.03 (3).

(e) Program services. Based on the written description of the program, the ADCC shall provide or arrange for services to meet the needs of each participant in all of the following areas:

1. ‘Leisure activities.’ The ADCC shall provide programming for individual and group activities that encourage creativity, social interaction, and physical exercise. Activities shall include outings to points of interest and involvement in the general community which take into consideration individual functional abilities, needs, and interests of each participant.

2. ‘Personal care.’ The ADCC shall provide assistance to meet a participant’s assessed needs for ADLs.

3. ‘Supervision.’ The ADCC shall provide supervision appropriate to the participant’s needs.

4. ‘Communication skills.’ The ADCC shall provide services to meet the participant’s communication needs.

5. ‘Health monitoring.’ The ADCC shall monitor the health of a participant by observing and documenting changes in each participant’s health and referring a participant to health care providers when necessary. At a minimum, a quarterly note shall document how a participant is responding to the service plan. The ADCC shall immediately notify the participant’s legal representative and the participant’s residential provider, if any, when there is a significant change in a participant’s physical or mental condition.

6. ‘Behavior management.’ The ADCC shall provide services to manage a participant’s behaviors that may be harmful to themselves or others.

7. ‘Transportation.’ An ADCC program providing transportation for any participant shall carry liability insurance and ensure the vehicle is safe and well-maintained.

(f) Food services.

1. ‘General requirements.’ The ADCC shall obtain food from acceptable sources that meets the dietary needs of each participant.

2. ‘Equipment and utensils.’ The ADCC shall store equipment and utensils in a clean manner and shall maintain all utensils and equipment in good repair. Single-use utensils may not be reused.

3. ‘Dishwashing.’

a. Whether washed by hand or mechanical means, all equipment and utensils shall be cleaned using separate steps for pre-washing, washing, rinsing, and sanitizing.

b. Mechanical washing of dishes and utensils in a residential type dishwasher will have a temperature setting of at least 120 degrees Fahrenheit. Upon removal from a residential-type dishwasher, a separate process must be completed for sanitization of all items that is in accordance with current standards of practice.

c. Mechanical washing of dishes and utensils in a commercial type dishwasher will be in accordance with manufacturer’s recommendations.

d. Dishes and utensils shall be air dried, unless a dishwasher, which performs this function, is used.

Note: Wisconsin Food Code and Food Code Fact Sheets can be found at https://datcp.wi.gov/Pages/Programs_Services/FoodCode.aspx.

4. ‘Nutrition.’

a. The ADCC shall arrange for or provide a meal to each participant who is at the ADCC for 5 or more hours. Meals shall provide at least one-third of an adult’s daily nutritional requirements.

b. The ADCC shall document the food served at each meal and maintain the documentation on file for at least 6 months.

c. A nutritious snack shall be made available consistent with each participant’s dietary needs.

5. ‘Sanitation.’

a. Each caregiver who prepares or serves food shall be free from open, infected wounds and from communicable disease and shall maintain clean and safe work habits.

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

c. Any participant who assists in preparing food shall adhere to the same food safety requirements as ADCC staff and be directly supervised by a caregiver.

6. ‘Food safety.’ Whether food is prepared at the ADCC or off-site, the ADCC shall store, prepare, distribute, and serve food in accordance with professional standards for food service safety. The ADCC shall do all of the following:

a. Refrigerate and store all foods requiring refrigeration at or below 41 degrees Fahrenheit. Food items not in their original containers shall be covered, labeled and dated.

b. Maintain freezing units at 0 degrees Fahrenheit or below. Frozen foods shall be packaged, labeled, and dated.

c. Hold hot foods at 135 degrees Fahrenheit or above and cold foods at 41 degrees Fahrenheit or below until served.

d. Ensure that each refrigerator and freezer has an accurate thermometer inside the unit.

e. Keep food storage areas clean and dry and store food at least six inches off the floor.

(8) Physical environment.

(a) Facility requirements.

1. If required by the department of safety and professional services or local municipality, the ADCC shall have on file an inspection report signed by an authorized agent demonstrating that the ADCC including remodeling, has met applicable building codes.

2. The ADCC shall provide at least 50 square feet of usable floor space for each participant exclusive of passageways, bathrooms, lockers, office, storage areas, staff room, furnace rooms, and parts of rooms occupied by stationary equipment.