2. Crimes or acts subject to elder abuse reporting under s. 46.90, Wis. Stat. 3. Crimes or acts related to the manufacture, distribution, use, or dispensing of a controlled substance.
4. Fraud or substantial or repeated violations of applicable laws and rules in the operation of any health care center or in the care of dependent persons.
5. A conviction or pending criminal charge which substantially relates to the care of adults or minors, to the funds or property of adults or minors, or to the operation of a residential or health care center.
(c) Financial history. Financial stability, including:
1. Financial history and financial viability of the owner or related organization.
2. Outstanding debts or amounts due to the department or other government agencies, including unpaid fees and fines.
DHS 105.14.07 Department action. (1) INITIAL CERTIFICATION. (a) Within 70 days after receipt of a complete application, the department shall either approve or deny the certification.
(b) A certification issued by the department shall be only for the premises and persons named in the application. A certification may not be transferred or assigned without following the change of ownership provisions in s. DHS 105.14.09. (c) A certification is valid until suspended or revoked by the department.
(2) Certification Denial. The department shall deny a certification to any applicant who does not substantially comply with any provision of this chapter or ch. 49, Wis. Stat., or who is not fit and qualified as specified in s. DHS 105.14.06 or who has failed to pay any fee or any outstanding amounts due to the department. The department shall provide the reasons for denial and the process for appeal of the denial in a written notice to the applicant. (3) MONITORING. The department shall conduct periodic inspections of the ADCC during the period of certification and may, without notice to the operator, visit an ADCC at any time to determine if the ADCC continues to comply with this chapter. The operator shall be able to verify compliance with this chapter and shall provide the department access to the ADCC, its staff, participants and records.
(4) SANCTIONS. (a) Notice of violation. The department shall issue a written notice of violation when it finds that an ADCC is in violation of this chapter or with any federal, state, and local laws and codes that govern the operation of the ADCC, including, but not limited to, space, heating, plumbing, ventilation and lighting systems, fire safety and sanitation requirements. The notice shall explain the grounds for the notice of violation, the sanction to be imposed, if any, and the process for appeal, if any.
(b) Plan of correction. An ADCC may submit a written plan of correction to the department within 10 days after the date of receipt of the notice of violation.
(c) Suspension. The department may summarily suspend the ADCC’s certification following procedures in ch. 227, Wis. Stats., when the department finds that participant health, safety or welfare requires emergency action. (d) Revocation. The department may revoke the ADCC’s certification whenever the department finds that the ADCC has failed to maintain substantial compliance with one or more of the requirements set forth in this chapter. Revocation of certification will result in the ADCC being ineligible for Medicaid waiver funds.
(5) APPEALS. (a) Any person whose application for certification is denied under sub. (2) or suspended under sub. (4) (c) or revoked under sub. (4) (d) may request a hearing on that decision under s. 227.42, Wis. Stat. (b) A request for hearing shall be in writing, shall be filed with the department of administration’s division of hearings and appeals and shall be sent to that office so that it is received there within 10 days after the date of the notice under sub. (4) (a).
DHS 105.14.08 Biennial report and fees. Every 24 months, on a date determined by the department, the operator shall submit a biennial report containing all of the information required by the department on the form provided by the department, and shall submit payment of the certification continuation fees.
DHS 105.14.09 Change of ownership. (1) Duties of the Transferee. (a) When an ADDC seeks a change of ownership, the transferee shall submit a complete application for certification as required under s. DHS 105.14.04 at least 30 days prior to the change of ownership. (b) If there is less than 30 days’ notice given to participants of the change of ownership, neither the transferor nor the transferee may enforce any advanced notice requirements for discharge as specified in any participant’s enrollment agreement.
(2) DUTIES OF THE TRANSFEROR. (a) The transferor shall notify the department within 30 days before a change of ownership of an ADCC and shall include the name and contact information of the transferee.
(b) The transferor remains responsible for the operation of the ADCC until the department issues a certification to the transferee.
(c) The transferor shall disclose to the transferee any existing department waiver, variance or outstanding deficiencies. Violations reported in department inspection reports prior to the change of ownership shall be corrected, with corrections verified by the department, prior to the issuance of the certification to the transferee. The transferee shall apply for continuation of any existing waivers or variances, if necessary.
(3) TRANSFERABILITY. (a) The department shall issue a certification only for the premises and persons named in the certification application. A certification may not be transferred or reassigned without following the change of ownership provisions in DHS 105.14.09.
DHS 105.14.10 Center closing. (1) Any ADCC that intends to close shall notify the department, participants or legal representative, and case manager, if any, in writing at least 30 days before closing and comply with the requirements under s. DHS 105.14.25. (2) The ADCC shall surrender the certification to the department when the ADCC closes.
(3) The ADCC shall surrender its certification if it hasn’t served participants within the last 24 months.
DHS 105.14.11 Investigation, notification, and reporting requirements. The ADCC shall report the following incidents to DQA when the incident occurs while the participant is at or under the supervision of the ADCC:
(1) DEATH REPORTING. (a) Participant death related to physical restraint, psychotropic medication or suicide. No later than 3 working days after the death of a participant, the ADCC shall report the death to the department if there is reasonable cause to believe the death was related to the use of a physical restraint, or psychotropic medication, or was a suicide.
(b) Participant death related to an accident or injury. When a participant dies as a result of an incident or accident not related to the use of a physical restraint, psychotropic medication, or suicide, the ADCC shall send a report to the department within 3 working days of the participant’s death.
(c) Participant death due to natural causes. An ADCC is not required to report a death to the department if the death is the result of natural causes, and none of the circumstances surrounding the death involve a condition under par. (a) or (b). (2) INVESTIGATING AND REPORTING ABUSE, NEGLECT OR MISAPPROPRIATION OF PROPERTY. (a) Caregiver. 1. When an ADCC receives a report of an allegation of abuse or neglect of a participant, or misappropriation of property by a caregiver, the ADCC shall take immediate steps to ensure the safety of all participants and security of their property.
2. The ADCC shall thoroughly investigate and document any allegation of abuse or neglect of a participant, or misappropriation of property by a caregiver. Incidents shall be reported to DQA when the entity has reasonable cause to believe it has sufficient evidence or another regulatory authority could obtain the evidence to show the alleged incident occurred and, the entity has reasonable cause to believe the incident meets or could meet the definition of abuse, neglect or misappropriation. When the ADCC concludes that these conditions are true, the ADCC shall report the incident to the department on a form provided by the department within 7 calendar days from the date the ADCC knew or should have known about the abuse, neglect, or misappropriation of property. The ADCC shall maintain documentation of any investigation and its conclusion. If the ADCC concludes the incident did not meet the definition of abuse, neglect or misappropriation, the ADCC shall document its rationale for that conclusion. Each ADCC shall comply with the caregiver misconduct reporting requirements in s. 50.065, Wis. Stat., and the caregiver misconduct reporting and investigation requirements in ch. DHS 13. (b) Non-caregiver or participant. When there is an allegation of abuse or neglect of a participant, or misappropriation of property by a non-caregiver or participant, the ADCC shall follow the elder abuse reporting requirements under s. 46.90, Stat., or the adult at risk requirements under s. 55.043, Wis. Stat., whichever is applicable. (c) Other reporting. Filing a report under sub. (1) or (2) does not relieve the operator or other person of any obligation to report an incident to any other authority, including law enforcement and the coroner. (3) INVESTIGATING INJURIES OF UNKNOWN SOURCE. (a) An ADCC shall thoroughly investigate an injury of unknown source when both of the following conditions are met:
1. The source of the injury was not observed by any person or the source of the injury could not be explained by the participant; and
2. The injury appears suspicious because of the extent of the injury or the location of the injury on the participant.
(b) The ADCC shall maintain documentation of each investigation of an injury referenced under par. (a). The ADCC shall report the incident as required under sub. (2). (4) OTHER REPORTING AND NOTIFICATION REQUIREMENTS. An ADCC shall send a written report to the department within 3 working days after any of the following occurs:
(a) Any time a participant’s whereabouts are unknown, except those instances when a participant who is competent chooses not to disclose his or her whereabouts or location to the ADCC, the ADCC shall notify the local law enforcement authority immediately upon discovering that a participant is missing.
(b) Any time law enforcement personnel are called to the ADCC as a result of an incident that jeopardizes the health, safety, or welfare of participants or caregivers. The ADCC’s report to the department shall provide a description of the circumstances requiring the law enforcement intervention.
(c) Any incident or accident resulting in serious injury requiring hospital admission or emergency room treatment of a participant.
(d) A catastrophe occurs resulting in damage to the ADCC.
(e) A fire occurs on the premises of the ADCC.
(f) Any time the ADCC must evacuate and temporarily relocate participants and caregivers from the ADCC for reasons other than a fire drill.
(5) NOTIFICATION OF CHANGES AFFECTING A PARTICIPANT. (a) The ADCC shall immediately notify the participant’s legal representative and the participant’s residential provider and document the notification when there is an incident or injury to the participant or a significant change in the participant’s physical or mental condition as defined in s. DHS 105.14.02(26). (b) The ADCC shall immediately notify the participant’s legal representative and document the notification when there is an allegation of physical, sexual or mental abuse, or neglect of a participant. The ADCC shall notify the participant’s legal representative within 72 hours when there is an allegation of misappropriation of property and document the notification
(c) The ADCC shall give the participant or the participant’s legal representative a 30−day written notice of any change in services available or in charges for services that will be in effect for more than 30 days.
(6) DOCUMENTATION. All written reports required under this section shall include, at a minimum, the time, date, place, individuals involved, details of the occurrence, and the action taken by the provider to ensure participants’ health, safety, welfare and well-being.
DHS 105.14.12 General records retention. (1) RECORDS RETENTION. (a) The ADCC shall retain all records required under this chapter for 2 years, unless otherwise specified under pars. (b) and (c). (b) Participant records shall be retained for 7 years following the date of a participant’s final discharge.
(c) Employee records shall be retained for 3 years following a caregiver’s separation from employment at the ADCC.
Subchapter III – Personnel
DHS 105.14.13 Operator. (1) QUALIFICATIONS. (a) An operator shall be at least 21 years of age.
(b) An operator shall meet the caregiver background requirements under s. 50.065, Wis. Stat., and ch. DHS 12. (2) RESPONSIBILITIES. (a) The operator shall ensure the ADCC and its operation comply with all laws governing the ADCC.
(b) The ADCC shall comply with the requirements set by the Federal 1991 Americans with Disabilities Act, and by the Federal Occupation, Safety and Health Administration.
(c) The operator shall develop a procedure to implement standard precautions.
(d) The operator shall develop and implement written policies and procedures to investigate allegations of employee misconduct and injuries of unknown source as defined in s. DHS 105.14 (11). (e) The operator shall report any change in participant group in writing to the department at least 30 days in advance and may not implement the change until the operator receives written approval from the department.
(f) The operator shall not change the ADCC’s capacity until the operator receives written approval from the department.
(g) The operator shall provide to each participant, or the participant’s legal representative, and third party payer, a 30 day written notice of any change in the ADCC’s capacity or client group.
(h) The operator shall post the ADCC certification, any statement of deficiency, notice of revocation and any other notice of enforcement action in a public area that is visually and physically accessible. A statement of deficiency shall remain posted for 90 days following receipt. Notices of revocation and other notices of enforcement action shall remain posted until a final determination is made.
(i) The operator may not permit the existence or continuation of any condition which is or may create a substantial risk to the health, safety, well-being or welfare of any participant.
(j) The operator shall ensure that the presence of other occupants does not adversely affect the health, safety, well-being or welfare of participants.
DHS 105.14.14 Program director. (1) QUALIFICATIONS. The program director of an ADCC shall be at least 21 years of age and have the capacity to respond to the needs of the participants and manage the day to day operations of the ADCC. The Director shall have any one of the following qualifications:
(a) An associate degree or higher from an accredited college in a health care related field.
(b) At least 2 years’ experience working in health care or related field, which served a population similar to the population at the adult day care center.
(c) Persons who are the qualified program director of record with the department of an ADCC on the date this rule becomes effective, shall be exempt from the qualification requirements specified under sub. (1). (2) RESPONSIBILITIES. (a) The program director shall supervise the daily operation of the ADCC, including but not limited to, participant care and services, personnel, finances, and physical plant. The program director shall provide the supervision necessary to ensure that the participants receive proper care and treatment, that their health and safety are protected and promoted and that their rights are respected.
(b) The program director shall be responsible for the training and competency of all caregivers.
(c) A qualified caregiver who is at least 18 years old shall be designated as in charge whenever the program director is absent from the ADCC.
DHS 105.14.15 Caregiver. (1) Each caregiver shall have the skills, education, experience and ability to fulfill the caregiver’s job requirements.
(2) A caregiver shall be at least 16 years old.
DHS 105.14.16 Hiring and employment. (1) CAREGIVER BACKGROUND CHECK. Before hire, employment or contract and every 4 years after, the operator shall conduct and document a caregiver background check following the procedures in s.50.065, Wis. Stat., and ch. DHS 12. An operator shall not employ, contract with or permit a person to work or reside at the ADCC if the person has been convicted of the crimes or offenses, or has a governmental finding of misconduct, found in s. 50.065, Wis. Stat., and ch. DHS 12, Appendix A, unless the person has been approved under the department’s rehabilitation process as defined in ch. DHS 12. (2) EMPLOYEE HEALTH COMMUNICABLE DISEASE CONTROL. (a) The ADCC shall obtain documentation from a physician, physician assistant, clinical nurse practitioner or a licensed registered nurse indicating all employees have been screened for clinically apparent communicable disease including tuberculosis. Screening for tuberculosis shall be conducted in accordance with current standards of practice. The screening and documentation shall be completed within 90 days before the start of employment or before assumption of duties in which the caregiver will have direct contact with participants. The ADCC shall keep screening documentation confidential, except the department shall have access to the screening documentation for verification purposes.
