Chapter DHS 134

DHS 134.70(2)(a)3. 3. The facility shall send a copy of the comprehensive resident assessment, the physician’s orders and the plan of care under subd. 2. to the person’s attending physician. The attending physician shall sign the assessment and the plan of care within 48 hours after the person is admitted.

DHS 134.70(2)(b) (b) Recuperative care. For a person admitted to a facility for recuperative care, the following admission and resident care planning procedures may be carried out in place of the requirements under ss. DHS 134.52 and 134.60 (1):

DHS 134.70(2)(b)1. 1. The person may be admitted only on order of a physician accompanied by information about the person’s medical condition and diagnosis, the physician’s initial plan of care, and either the physician’s written certification that the person is free of tuberculosis and other clinically apparent communicable diseases or an order of a physician for procedures to treat any disease the person may have.

DHS 134.70(2)(b)2. 2. A registered nurse shall prepare an initial plan of care for nursing services to be implemented on the day of admission, which shall be based on the physician’s initial plan of care under subd. 1. and shall be superseded by the plan of care under subd. 5.

DHS 134.70(2)(b)3. 3. A physician shall conduct a physical examination of the new resident within 48 hours following admission, unless a physical examination was performed by a physician within 15 days before admission.

DHS 134.70(2)(b)4. 4. A registered nurse shall complete a comprehensive resident assessment of the person prior to or within 72 hours after admission. The comprehensive assessment shall include evaluation of the person’s nursing, dietary, rehabilitative, pharmaceutical, dental, social and activity needs. The consulting or staff pharmacist shall participate in the comprehensive assessment as provided under sub. (4) (a). As part of the comprehensive assessment, when the registered nurse has identified a need for a special service, staff from the discipline that provides the service shall, on referral from the registered nurse, complete a and assessment of the person’s prior health and care in that discipline.

DHS 134.70(2)(b)5. 5. The registered nurse, with verbal agreement of the attending physician, shall develop a written plan of care for the new resident within one week after admission. The plan of care shall be based on the comprehensive resident assessment under subd. 4., the physician’s orders, and any special assessment under subd. 4.

DHS 134.70(2)(b)6. 6. The facility shall send a copy of the comprehensive resident assessment, the physician’s orders and the plan of care under subd. 5. to the new resident’s attending physician. The attending physician shall sign the assessment and the plan of care.

DHS 134.70(3) (3) Admission information.

DHS 134.70(3)(a) (a) This subsection takes the place of s. DHS 134.31 (3) (d) 1. for persons admitted for respite care or recuperative care.

DHS 134.70(3)(b) (b) No person may be admitted to a facility for respite care or recuperative care without signing or the person’s guardian or designated representative signing an acknowledgement of having received a statement before or on the day of admission which contains at least the following information:

DHS 134.70(3)(b)1. 1. An indication of the expected length of stay, with a note that the responsibility for care of the resident reverts to the resident or other responsible party following expiration of the designated length of stay;

DHS 134.70(3)(b)2. 2. An accurate description of the basic services provided by the facility, the rate charged for those services and the method of payment for them;

DHS 134.70(3)(b)3. 3. Information about all additional services regularly offered but not included in the basic services. The facility shall provide information on where a statement of the fees charged for each of these services can be obtained. These additional services include pharmacy, x-ray, beautician and all other additional services regularly offered to residents or arranged for residents by the facility;

DHS 134.70(3)(b)4. 4. The method for notifying residents of a change in rates or fees;

DHS 134.70(3)(b)5. 5. Terms for refunding advance payments in case of transfer, death or voluntary or involuntary termination of the service agreement;

DHS 134.70(3)(b)6. 6. Conditions for involuntary termination of the service agreement;

DHS 134.70(3)(b)7. 7. The facility’s policy regarding possession and use of personal belongings;

DHS 134.70(3)(b)8. 8. In the case of a person admitted for recuperative care, the terms for holding and charging for a bed during the resident’s temporary absence; and

DHS 134.70(3)(b)9. 9. In summary form, the residents’ rights recognized and protected by s. DHS 134.31 and all facility policies and regulations governing resident conduct and responsibilities.

DHS 134.70(4) (4) Medications.

DHS 134.70(4)(a) (a) The consulting or staff pharmacist shall review the drug regimen of each person admitted to the facility for respite care or recuperative care as part of the comprehensive resident assessment under sub. (2) (a) 1. or (b) 4.

DHS 134.70(4)(b) (b) The consulting or staff pharmacist, who is required under s. DHS 134.67 (3) (b) to visit the facility at least quarterly to review drug regimens and medication practices, shall review the drug regimen of each resident admitted for recuperative care and the drug regimen of each resident admitted for respite care who may still be a resident of the facility at the time of the pharmacist’s visit.

DHS 134.70(4)(c) (c) Respite care residents and recuperative care residents may bring medications into the facility as permitted by written policy of the facility.

DHS 134.70(5) (5) Physician visits. The requirements under s. DHS 134.66 (2) (b) for physician visits do not apply in the case of a respite care resident, except when the nursing assessment indicates there has been a change in the resident’s condition following admission, in which case the physician shall visit the resident if this appears indicated by the assessment of the resident.

DHS 134.70(6) (6) Pre-discharge planning conference.

DHS 134.70(6)(a) (a) For residents receiving recuperative care, a planning conference shall be conducted at least 10 days before the designated date of termination of the short-term care, except in an emergency, to determine the appropriateness of discharge or need for the resident to stay at the facility. At the planning conference a care plan shall be developed for a resident who is being discharged to home care or to another health care facility. If discharge is not appropriate, the period for recuperative care shall be extended, if it was originally less than 90 days, for up to the 90 day limit, or arrangements shall be made to admit the person to the facility for care that is not short-term, as appropriate.

DHS 134.70(6)(b) (b) Paragraph (a) takes the place of s. DHS 134.53 (4) (c) 1. and 2. for recuperative care residents.

DHS 134.70(7) (7) Records.

DHS 134.70(7)(a) (a) Contents. The medical record for each respite care resident and each recuperative care resident shall include, in place of the items required under s. DHS 134.47 (4):

DHS 134.70(7)(a)1. 1. The resident care plan prepared under sub. (2) (a) 2. or (b) 5.;

DHS 134.70(7)(a)2. 2. Admission nursing notes identifying pertinent problems to be addressed and areas of care to be maintained;

DHS 134.70(7)(a)3. 3. For recuperative care residents, nursing notes addressing pertinent problems identified in the resident care plan and, for respite care residents, nursing notes prepared by a registered nurse or licensed practical nurse to document the resident’s condition and the care provided;

DHS 134.70(7)(a)4. 4. Physicians’ orders;

DHS 134.70(7)(a)5. 5. A record of medications;

DHS 134.70(7)(a)6. 6. Any progress notes by physicians or other persons providing health care to the resident that document resident care and progress;

DHS 134.70(7)(a)7. 7. For respite care residents, a record of change in condition during the stay at the facility; and

DHS 134.70(7)(a)8. 8. For recuperative care residents, the physician’s discharge summary with identification of resident progress and, for respite care residents, the registered nurse’s discharge summary with notes of resident progress during the stay.

DHS 134.70(7)(b) (b) Location and accessibility. The medical record for each short-term care resident shall be kept with the medical records of other residents and shall be readily accessible to authorized representatives of the department.

DHS 134.70 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88.

subch. VI of ch. DHS 134 Subchapter VI — Physical Environment

DHS 134.71 DHS 134.71 Furniture, equipment and supplies.

DHS 134.71(1) (1) Furniture in resident care areas.

DHS 134.71(1)(a) (a) Beds.

DHS 134.71(1)(a)1. 1. The facility shall provide each resident with a separate bed of proper size and height for the convenience of the resident. The bed shall be in good repair and have a headboard of sturdy construction. Rollaway beds, day beds, cots, double-beds or folding beds may not be used.

DHS 134.71(1)(a)2. 2. Each bed shall be provided with a clean, comfortable mattress of appropriate size for the bed.

DHS 134.71(1)(a)3. 3. When required by the resident’s condition or age, or both, side rails shall be installed for both sides of the bed.

DHS 134.71(1)(a)4. 4. Each resident shall be provided at least one clean, comfortable pillow. Additional pillows shall be provided if requested by the resident or required by the resident’s condition.

DHS 134.71(1)(a)5. 5. Each bed shall have a mattress pad.

DHS 134.71(1)(a)6. 6. A moisture-proof mattress cover shall be provided for each mattress to keep the mattress clean and dry. A moisture-proof pillow cover shall be provided for each pillow to keep the pillow clean and dry.

DHS 134.71(1)(a)7. 7. A supply of sheets and pillow cases sufficient to keep beds clean and odor-free shall be stocked. At least 2 sheets and 2 pillow cases shall be furnished to each resident each week.

DHS 134.71(1)(a)8. 8. A sufficient number of blankets appropriate to the weather and seasonal changes shall be provided. Blankets shall be changed and laundered as necessary to maintain cleanliness.

DHS 134.71(1)(a)9. 9. Each bed shall have a clean, washable bedspread.

DHS 134.71(1)(b) (b) Other furnishings.

DHS 134.71(1)(b)1. 1. A dresser or adequate compartment or drawer space shall be provided for each resident to store personal clothing and effects and to store, as space permits, other personal possessions in a reasonably secure manner.

DHS 134.71 Note Note: See the requirements under s. DHS 134.84 (2) (g) and (6) (a) for closet space and resident storage.

DHS 134.71(1)(b)2. 2. Other appropriate furniture, such as a table or desk and a chair, shall be provided for each resident.

DHS 134.71(2) (2) Towels and washcloths. Clean towels and washcloths shall be provided to each resident as needed. Towels and washcloths may not be used by more than one resident between launderings.

DHS 134.71(3) (3) Window coverings. Every window shall be supplied with flame-retardant shades, draw drapes or other covering material or devices which, when properly used and maintained, shall afford privacy and light control for the resident.

DHS 134.71(4) (4) Maintenance. All furnishings and equipment shall be maintained in a usable, safe and sanitary condition.

DHS 134.71(5) (5) Oxygen. Facilities that have residents who require oxygen shall meet all of the following requirements:

DHS 134.71(5)(a) (a) No oil or grease may be used on oxygen equipment.

DHS 134.71(5)(b) (b) When placed at the resident’s bedside, oxygen tanks shall be securely fastened to a tip-proof carrier or base.

DHS 134.71(5)(c) (c) Oxygen regulators may not be stored with solution left in the attached humidifier bottles.

DHS 134.71(5)(d) (d) When in use at the resident’s bedside, cannulas, hoses, and humidifier bottles shall be maintained and used in accordance with current standards of practice and manufacturers’ recommendations.

DHS 134.71(5)(e) (e) Disposable inhalation equipment shall be maintained and used in accordance with current standards of practice and manufacturers’ recommendations.

DHS 134.71(5)(f) (f) With nondisposable inhalation equipment such as intermittent positive pressure breathing equipment, the entire resident breathing circuit, including nebulizers and humidifiers, shall be maintained and used in accordance with current standards of practice and manufacturers’ recommendations.

DHS 134.71(5)(g) (g) Warning signs shall be posted when oxygen is in use.

DHS 134.71 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; 2015 Wis. Act 107: am. (5) (intro.), (a) to (f) Register November 2015 No. 719, eff. 12-1-15.

DHS 134.72 DHS 134.72 Safety and sanitation.

DHS 134.72(1) (1) General requirement. Facilities shall develop and implement policies that provide for a safe and sanitary environment for residents and personnel at all times.

DHS 134.72(2) (2) Cleaning and repair.

DHS 134.72(2)(a) (a) General. Facilities shall be kept clean and free from offensive odors, accumulations of dirt, rubbish, dust and safety hazards.

DHS 134.72(2)(b) (b) Floors. Floors and carpeting shall be kept clean. If polishes are used on floors, a nonslip finish shall be provided. Carpeting or any other material covering the floors that is worn, damaged, contaminated or badly soiled shall be replaced.

DHS 134.72(2)(c) (c) Ceilings and walls.

DHS 134.72(2)(c)1. 1. Ceilings and walls shall be kept clean and in good repair. The interior and exterior of the buildings shall be painted or stained as needed to protect the surfaces. Loose, cracked or peeling wallpaper or paint shall be replaced or repaired.

DHS 134.72(2)(c)2. 2. A facility shall use lead-free paint inside the facility and shall remove or cover any surfaces containing lead-based paint that are accessible to residents.

DHS 134.72(2)(d) (d) Furnishings. All furniture and other furnishings shall be kept clean and in good repair at all times.

DHS 134.72(3) (3) Combustibles in storage areas. Attics, cellars and other storage areas shall be kept safe and free from dangerous accumulations of combustible materials. Combustibles, including cleaning rags and compounds, shall be kept in closed metal containers.

DHS 134.72(4) (4) Grounds. The grounds of the facility shall be kept free from refuse, litter and waste water. Areas around buildings, sidewalks, gardens and patios shall be kept clear of dense undergrowth.

DHS 134.72(5) (5) Poisons. All poisonous compounds shall be clearly labelled as poisonous and, when not in use, shall be stored in locked areas. These areas shall be separate from food storage, kitchenware storage and medication storage areas.

DHS 134.72(6) (6) Garbage.

DHS 134.72(6)(a) (a) All garbage and rubbish shall be stored in leakproof, nonabsorbent containers with close-fitting covers and in areas separate from areas used for the preparation and storage of food. Containers shall be cleaned regularly. Paperboard containers may not be used.

DHS 134.72(6)(b) (b) Garbage and rubbish shall be disposed of promptly in a safe and sanitary manner.

DHS 134.72 Note Note: See requirements for incineration under s. DHS 134.83 (8) (f).

DHS 134.72(7) (7) Linen and towels. Linens and towels shall be handled, stored, processed and transported in such a manner as to prevent the spread of infection. Soiled linen may not be sorted, rinsed or stored in bathrooms, resident rooms, kitchens, food storage areas or common hallways. If it is necessary to transport soiled linen through food preparation areas to laundry facilities, linens shall be in covered containers.

DHS 134.72(8) (8) Pest control.

DHS 134.72(8)(a) (a) Requirement. Facilities shall be maintained reasonably free from insects and rodents, with harborages and entrances of insects and rodents eliminated. When harborages and entrances of insects persist despite measures taken to eliminate them, pest control services shall be secured in accordance with the requirements of s. 94.705, Stats., to eliminate infestations.

DHS 134.72(8)(b) (b) Screening of windows and doors. All windows and doors used for ventilation purposes shall be provided with wire screening of not less than number 16 mesh or its equivalent and shall be properly installed and maintained to prevent entry of insects. Screen doors shall be self-closing and shall not interfere with exiting. Properly installed airflow curtains or fans may be used in lieu of screens.