Wisconsin Legislature: DHS 132.44(1)(b)

(c) The consent of par. (a) may be revoked by the resident at any time. The resident shall be transferred to an unlocked unit promptly following revocation.

(5) Emergencies. In an emergency, a resident may be confined in a locked unit if necessary to protect the resident or others from injury or to protect property, provided the facility immediately attempts to notify the physician for instructions. A physician’s order for the confinement must be obtained within 12 hours. No resident may be confined for more than an additional 72 hours under order of the physician.

History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (1) (a) and (2), r. and recr. (3), Register, January, 1987, No. 373, eff. 2-1-87; corrections in (3) (a) 2., 3. and (b) made under s. 13.93 (2m) (b) 7., Stats., Register October 2007 No. 622.

Subchapter IV — Management

DHS 132.41 Administrator.

(1) Statutory reference. Section 50.04 (2), Stats., requires that a nursing home be supervised by an administrator licensed under ch. 456, Stats. Supervision shall include, but not be limited to, taking all reasonable steps to provide qualified personnel to assure the health, safety, and rights of the residents.

(2) Full-time administrator. Every nursing home shall be supervised full-time by an administrator licensed under ch. 456, Stats., except:

(a) Multiple facilities. If more than one nursing home or other licensed health care facility is located on the same or contiguous property, one full-time administrator may serve all the facilities;

(b) Small homes. A facility licensed for 50 beds or less shall employ an administrator for at least 4 hours per day on each of 5 days per week. No such administrator shall be employed in more than 2 nursing homes or other health care facilities.

(4) Change of administrator.

(a) Termination of administrator. Except as provided in par. (b), no administrator shall be terminated unless recruitment procedures are begun immediately.

(b) Replacement of administrator. If it is necessary immediately to terminate an administrator, or if the licensee loses an administrator for other reasons, a replacement shall be employed or designated as soon as possible within 120 days of the vacancy.

(c) Temporary replacement. During any vacancy in the position of administrator, the licensee shall employ or designate a person competent to fulfill the functions of an administrator.

(d) Notice of change of administrator. When the licensee loses an administrator, the licensee shall notify the department within 2 working days of loss and provide written notification to the department of the name and qualifications of the person in charge of the facility during the vacancy and the name and qualifications of the replacement administrator, when known.

Note: See s. 50.04 (2), Stats.

History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; CR 06-053: r. (3) Register August 2007 No. 620, eff. 9-1-07.

DHS 132.42 Employees.

(1) Definition. In this section, “employee” means anyone directly employed by the facility on other than a consulting or contractual basis.

(3) Physical health certifications.

(a) New employees. Every employee shall be certified in writing by a physician, physician assistant or an advanced practice nurse prescriber as having been screened for the presence of clinically apparent communicable disease that could be transmitted to residents during the normal performance of the employee’s duties. This certification shall include screening for tuberculosis within 90 days prior to employment.

(b) Continuing employees. Employees shall be rescreened for clinically apparent communicable disease as described in par. (a) based on the likelihood of exposure to a communicable disease, including tuberculosis. Exposure to a communicable disease may be in the facility, in the community or as a result of travel or other exposure.

(c) Non-employees. Persons who reside in the facility but are not residents or employees, such as relatives of the facility’s owners shall be certified in writing as required in pars. (a) and (b).

(4) Disease surveillance and control. When an employee or prospective employee has a communicable disease that may result in the transmission of the communicable disease, he or she may not perform employment duties in the facility until the facility makes safe accommodations to prevent the transmission of the communicable disease.

Note: The Americans with Disabilities Act and Rehabilitation Act of 1973 prohibits the termination or non-hiring of an employee based solely on an employee having an infectious disease, illness or condition.

(5) Volunteers. Facilities may use volunteers provided that the volunteers receive the orientation and supervision necessary to assure resident health, safety, and welfare.

History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (3) (a) and (4), Register, January, 1987, No. 373, eff. 2-1-87; CR 03-033: am. (3) (a), r. and recr. (4) Register December 2003 No. 576, eff. 1-1-04; CR 04-053: am. (3) and (4) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (2) Register August 2007 No. 620, eff. 9-1-07.

DHS 132.44 Employee development.

(1) New employees.

(a) Orientation for all employees. Except in an emergency, before performing any duties, each new employee, including temporary help, shall receive appropriate orientation to the facility and its policies, including, but not limited to, policies relating to fire prevention, accident prevention, and emergency procedures. All employees shall be oriented to residents’ rights under s. DHS 132.31 and to their position and duties by the time they have worked 30 days.

(b) Assignments. employees shall be assigned only to resident care duties consistent with their training.

(2) Continuing education.

(a) Nursing inservice. The facility shall require employees who provide direct care to residents to attend educational programs designed to develop and improve the skill and knowledge of the employees with respect to the needs of the facility’s residents, including rehabilitative therapy, oral health care, and special programming for developmentally disabled residents if the facility admits developmentally disabled persons. These programs shall be conducted as often as is necessary to enable staff to acquire the skills and techniques necessary to implement the individual program plans for each resident under their care.

(b) Dietary inservice. Educational programs shall be held periodically for dietary staff, and shall include instruction in the proper handling of food, personal hygiene and grooming, and nutrition and modified diet patterns served by the facility.

Note: For recordkeeping requirements for all orientation and inservice programs, see s. DHS 132.45 (6) (f).

History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. (2) (a) and am. (4), Register, January, 1987, No. 373, eff. 2-1-87; CR 04-053: renum. (1) (c) to be (1) (b) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (3) Register August 2007 No. 620, eff. 9-1-07.

DHS 132.45 Records.

(1) General. The administrator or administrator’s designee shall provide the department with any information required to document compliance with ch. DHS 132 and ch. 50, Stats., and shall provide reasonable means for examining records and gathering the information.

(2) Personnel records. A separate record of each employee shall be maintained, be kept current, and contain sufficient information to support assignment to the employee’s current position and duties.

(3) Medical records — staff. Duties relating to medical records shall be completed in a timely manner.

(4) Medical records — general.

(f) Retention and destruction.

1. An original medical record and legible copy or copies of court orders or other documents, if any, authorizing another person to speak or act on behalf of this resident shall be retained for a period of at least 5 years following a resident’s discharge or death when there is no requirement in state law. All other records required by this chapter shall be retained for a period of at least 2 years.

2. A facility shall arrange for the storage and safekeeping of records for the periods and under the conditions required by this paragraph in the event the facility closes.

3. If the ownership of a facility changes, the medical records and indexes shall remain with the facility.

(g) Records documentation.

1. All entries in medical records shall be accurate, legible, permanently recorded, dated, and authenticated with the name and title of the person making the entry.

2. A rubber stamp reproduction or electronic representation of a person’s signature may be used instead of a handwritten signature, if:

a. The stamp or electronic representation is used only by the person who makes the entry; and

b. The facility possesses a statement signed by the person, certifying that only that person shall possess and use the stamp or electronic representation.

3. Symbols and abbreviations may be used in medical records if approved by a written facility policy which defines the symbols and abbreviations and which controls their use.

(5) Medical records — content. Except for persons admitted for short-term care, to whom s. DHS 132.70 (7) applies, each resident’s medical record shall contain:

(a) Identification and summary sheet.

(b) Physician’s documentation.

1. An admission medical evaluation by a physician or physician extender, including:

a. A summary of prior treatment;

b. Current medical findings;

c. Diagnoses at the time of admission to the facility;

d. The resident’s rehabilitation potential;

e. The results of the physical examination required by s. DHS 132.52 (3); and

f. Level of care;

2. All physician’s orders including, when applicable, orders concerning:

a. Admission to the facility as required by s. DHS 132.52 (2) (a);

b. Medications and treatments as specified by s. DHS 132.60 (5);

c. Diets as required by s. DHS 132.63 (4);

d. Rehabilitative services as required by s. DHS 132.64 (2);

e. Limitations on activities;

f. Restraint orders as required by s. DHS 132.60 (6); and

g. Discharge or transfer as required by s. DHS 132.53;

3. Physician progress notes following each visit.

4. Annual physical examination, if required; and

5. Alternate visit schedule, and justification for such alternate visits.

1. A history and assessment of the resident’s nursing needs as required by s. DHS 132.52;

2. Initial care plan as required by s. DHS 132.52 (4), and the care plan required by s. DHS 132.60 (8);

3. Nursing notes are required as follows:

a. For residents requiring skilled care, a narrative nursing note shall be required as often as needed to document the resident’s condition, but at least weekly; and

b. For residents not requiring skilled care, a narrative nursing note shall be required as often as needed to document the resident’s condition, but at least every other week;

4. In addition to subds. 1., 2., and 3., nursing documentation describing:

a. The general physical and mental condition of the resident, including any unusual symptoms or actions;

b. All incidents or accidents including time, place, details of incident or accident, action taken, and follow-up care;

c. The administration of all medications (see s. DHS 132.60 (5) (d)), the need for PRN medications and the resident’s response, refusal to take medication, omission of medications, errors in the administration of medications, and drug reactions;

d. Food and fluid intake, when the monitoring of intake is necessary;

e. Any unusual occurrences of appetite or refusal or reluctance to accept diets;

f. Summary of restorative nursing measures which are provided;

g. Summary of the use of physical and chemical restraints.

h. Other non-routine nursing care given;

i. The condition of a resident upon discharge; and

j. The time of death, the physician called, and the person to whom the body was released.