Chapter DCF 57

DCF 57.245 Note Note: The reasonable and prudent parent standard does not apply to a child receiving respite care services.

DCF 57.245(4) (4) Decision-making factors. When applying the reasonable and prudent parent standard to a decision regarding a resident’s participation in an extracurricular, enrichment, cultural, or social activity, an RPPS decision maker shall consider all of the following:

DCF 57.245(4)(a) (a) Child-specific factors, including all of the following:

DCF 57.245(4)(a)1. 1. The resident’s treatment plan.

DCF 57.245(4)(a)2. 2. The resident’s wishes, as gathered by engaging the resident in an age-appropriate discussion about participation in the activity.

DCF 57.245(4)(a)3. 3. The age, maturity, and development of the resident.

DCF 57.245(4)(a)4. 4. Whether participating in the activity is in the best interest of the resident.

DCF 57.245(4)(a)5. 5. The resident’s behavioral history.

DCF 57.245(4)(a)6. 6. Court orders and other legal considerations affecting the resident, including the prohibitions in sub. (5).

DCF 57.245(4)(a)7. 7. Cultural, religious, and tribal values of the resident and the resident’s family. If the resident and resident’s family have different cultural, religious, or tribal values, then the placing agency, or the department if the department is the resident’s guardian, is ultimately responsible for decisions concerning the resident’s care.

DCF 57.245(4)(b) (b) Activity-specific factors, including all of the following:

DCF 57.245(4)(b)1. 1. Potential risk factors of the situation, including whether the resident has the necessary training and safety equipment to safely participate in the activity under consideration.

DCF 57.245(4)(b)2. 2. How the activity will help the resident grow.

DCF 57.245(4)(b)3. 3. Whether participating in the activity will provide experiences that are similar to the experiences of other residents in the group home.

DCF 57.245(4)(b)4. 4. Other information regarding the parent’s wishes and values, as obtained during development and review of the resident’s treatment plan under s. DCF 57.23 (2) and other discussions with the resident’s parent or guardian.

DCF 57.245(4)(c) (c) Any other concerns regarding the safety of the resident, other residents in the group home, or the community.

DCF 57.245(4)(d) (d) Information on the forms required under ch. DCF 37.

DCF 57.245 Note Note: The forms required under ch. DCF 37 are DCF-F-872A-E, Information for Out-of-Home Care Providers, Part A and DCF-F-872B-E, Information for Out-of-Home Care Providers, Part B. Both forms are available in the forms section of the department website at http://dcf.wisconsin.gov or by writing the Division of Safety and Permanence, P.O. Box 8916, Madison, WI 53708-8916.

DCF 57.245(5) (5) Prohibitions. An RPPS decision maker may not do any of the following:

DCF 57.245(5)(a) (a) Permit a resident to participate in an activity that would violate a court order or any federal or state statute, rule, or regulation.

DCF 57.245(5)(b) (b) Make decisions that conflict with the resident’s permanency plan or family interaction plan.

DCF 57.245(5)(c) (c) Consent to the resident’s marriage.

DCF 57.245(5)(d) (d) Authorize the resident’s enlistment in the U.S. armed forces.

DCF 57.245(5)(e) (e) Authorize medical, psychiatric, or surgical treatment for the resident beyond the terms of the consent for medical services authorized by the resident’s parent or guardian.

DCF 57.245(5)(f) (f) Represent the resident in legal actions or make other decisions of substantial legal significance.

DCF 57.245(5)(g) (g) Determine which school the resident attends or make a decision concerning the resident regarding an educational right or requirement that is provided in federal or state law.

DCF 57.245 Note Note: For example, only a parent or guardian can make decisions about a resident’s individualized educational program under s. 115.787, Stats.

DCF 57.245(5)(h) (h) Require or prohibit a resident’s participation in an age or developmentally appropriate activity solely for convenience or personal reasons not applicable to the decision-making factors in sub. (4).

DCF 57.245 History History: EmR1633: emerg. cr., eff. 11-18-16; CR 16-051: cr. Register July 22017 No. 739, eff. 8-1-17.

DCF 57.25 DCF 57.25 Medical care.

DCF 57.25(1) (1) Consent.

DCF 57.25(1)(a) (a) Any medical examination or service provided to a resident shall be provided only by an individual licensed to perform the examination or service being provided. Before an examination or service is provided, written consent to perform the examination or service shall be obtained as follows:

DCF 57.25(1)(a)1. 1. For a resident who is under 14 years of age, written consent of a resident’s parent or guardian.

DCF 57.25(1)(a)2. 2. For a resident who is between 14 and 18 years of age, consent of the resident’s parent or guardian with the consent of the resident whenever feasible.

DCF 57.25(1)(a)3. 3. For a resident who is 18 years of age or older, consent of the resident is required unless the resident has been deemed incompetent by a court and has a court appointed guardian or legal custodian, in which case the consent of the guardian or legal custodian is required.

DCF 57.25(1)(b) (b) Consent shall include consent to administer emergency medical services including surgery for life threatening situations when a parent, cannot immediately be reached. Verbal consent may be obtained in an emergency situation where time or distance precludes obtaining written consent. Both the written consent and any verbal consent shall be documented in the resident’s record, by indicating who obtained the consent, who gave the consent and that person’s relationship to the resident, and what specific services are authorized by the consent. A verbal consent shall be valid for 10 calendar days, during which time there shall be a good faith effort to obtain written consent.

DCF 57.25(2) (2) Medication administration.

DCF 57.25(2)(a) (a) Information required to administer medication. No staff member may administer medication to a resident unless the staff member has received the group home’s policies established under s. DCF 57.05 (2) (c) for administering and monitoring medication use.

DCF 57.25(2)(am) (am) After receiving the information described in sub. (2) (a), staff shall receive the following:

DCF 57.25(2)(am)1. 1. Procedure for administering the medication being given as described by the physician, pharmacist or as indicated on the label of an over the counter medication or a prescribed medication or both. If the label on prescribed medication is not clear, a staff member shall contact the pharmacy that filled the prescription for clarification.

DCF 57.25(2)(am)2. 2. Procedures for documenting the administration of medication as specified under sub. (3).

DCF 57.25(2)(am)3. 3. The purpose of the medication.

DCF 57.25(2)(am)4. 4. Any potential adverse side effects of the medication being administered.

DCF 57.25(2)(am)5. 5. Procedure to follow if a resident refuses medication, including refusal of psychotropic medication as described in sub. (7).

DCF 57.25(2)(am)6. 6. Known drug allergies of the resident.

DCF 57.25(2)(am)7. 7. Any other information that may be relevant to administration of the medication.

DCF 57.25(2)(b) (b) Limitation on who can administer medication. Medication may be administered to a resident only in the presence of a staff member that has been authorized in writing by the program director or the group home manager, to administer medication.

DCF 57.25(2)(c) (c) Self administration. Medication may be self-administered by a resident only under all of the following conditions:

DCF 57.25(2)(c)1. 1. Self-administration is authorized in writing from the prescribing practitioner.

DCF 57.25(2)(c)2. 2. There is no demonstrated history of risk that the resident may harm self through abuse or overdose.

DCF 57.25(2)(c)3. 3. The resident’s treatment plan includes an evaluation by the program director of the resident’s capability to self-administer medication.

DCF 57.25(2)(c)4. 4. The resident recognizes and distinguishes the medication or treatment and knows the condition or illness for which the medication or treatment is prescribed, the correct dosage, and when the medication or treatment is to be taken.

DCF 57.25(2)(c)5. 5. The medication is not a psychotropic medication as defined in sub. (7) (a).

DCF 57.25(3) (3) Medication Administration documentation.

DCF 57.25(3)(a) (a) Immediately upon administering medication to a resident or a resident self-administering medication, the staff member administering or supervising the administration of medication shall write all of the following in the resident’s record:

DCF 57.25(3)(a)1. 1. Full name of the resident to whom the medication was administered.

DCF 57.25(3)(a)2. 2. Date and time the medication was administered.

DCF 57.25(3)(a)3. 3. Name and dosage of the medication administered or medical treatments received.

DCF 57.25(3)(a)4. 4. Signature of the staff member who administered or supervised the administration of medication.

DCF 57.25(3)(a)5. 5. Any refusal of medication.

DCF 57.25(3)(a)6. 6. Any adverse reaction to the medication and steps taken to notify the resident’s health care provider, parent, guardian, or legal custodian.

DCF 57.25(3)(a)7. 7. Any error in medication administration and the steps taken to notify the resident’s physician as required in sub. (5).

DCF 57.25(3)(b) (b) Each entry made under this subsection shall be written in ink.

DCF 57.25(4) (4) Adverse reaction to medication. In the event of an adverse reaction to any medication, a staff member shall immediately notify the resident’s parent or guardian and the attending physician.

DCF 57.25(5) (5) Medication errors. The attending physician shall be notified in the event of a medication error. The department and placing agency shall be notified as required in ss. DCF 57.13 (1) (e) and 57.135.

DCF 57.25(6) (6) Medication storage and disposal. The licensee shall comply with all of the following requirements for storing medication:

DCF 57.25(6)(a) (a) Medication including over-the-counter medication, shall be kept in the container in which it was purchased or prescribed. No person may transfer medication that has been prescribed or purchased over-the-counter to another container or change the label on any medication, unless the person is a pharmacist as defined in s. 450.01 (15), Stats.

DCF 57.25(6)(b) (b) Medication shall be locked and stored in a location that is inaccessible to children. Only staff members who are designated in writing by the program director shall have access to keys to the medication. Prescription and over-the-counter medication shall not be stored next to chemicals or other contaminants.

DCF 57.25(6)(c) (c) Medication shall be kept under acceptable conditions of sanitation, temperature, light, moisture, and ventilation according to the requirements of each medication. Medication that requires refrigeration shall be stored in a separate locked compartment or container that is properly labeled, stored separately from food items, and kept inaccessible to children.

DCF 57.25(6)(d) (d) Medication for internal consumption shall be stored separately from medication for external application.

DCF 57.25(6)(e) (e) Within 72 hours of the medication’s expiration date, the date the medication is no longer in use by the resident for whom the medication was prescribed or purchased, or the date the resident is discharged, unused medication shall be returned to a parent, guardian, or legal custodian of the resident, for removal from the group home or shall be destroyed by the group home manager or returned to the prescribing pharmacy to be destroyed.

DCF 57.25(6)(f) (f) The group home shall maintain a log of medication destroyed. The information logged shall be written in ink and shall include the amount of medication destroyed, the name of the staff member who destroyed the medication, and the name of the resident to whom the medication belongs. Whenever medication is released to a resident’s parent, guardian or legal custodian, that information, including the name of the person receiving the medication, shall be documented in the resident’s record.

DCF 57.25(6)(g) (g) The group home shall contact the local police to destroy the medications or contact the Division Officer at the U.S. Drug Enforcement Agency (DEA) for instructions for destroying controlled substances.

DCF 57.25 Note Note: The address and phone number for the U.S. Drug Enforcement Agency is 1000 North Water Street, Milwaukee, WI 53202, or call [phone], extension 5300.

DCF 57.25(7) (7) Psychotropic medication.

DCF 57.25(7)(a) (a) Definitions. In this subsection, “psychotropic medication” means any drug that affects the mind and is used to manage inappropriate resident behavior or psychiatric symptoms and may include an anti-psychotic, an antidepressant, lithium carbonate or a tranquilizer.

DCF 57.25(7)(b) (b) Rights of patients. A group home shall comply with the provisions of s. 51.61 (1) (g) and (h), Stats., for each resident who is prescribed psychotropic medication.

DCF 57.25(7)(c) (c) Non-emergency procedures. A group home serving a resident for whom psychotropic medication is newly prescribed shall ensure that all of the following requirements are met:

DCF 57.25(7)(c)1. 1. A medical evaluation of the resident is completed by a physician detailing the reason for the type of psychotropic medication prescribed. The evaluation or screening shall be documented in the resident’s record within the first 45 days after the resident has first received a psychotropic medication. Subsequent evaluations of the resident related to the administration of psychotropic medications shall be completed as recommended by the prescribing physician and the results documented in the resident’s record.

DCF 57.25(7)(c)2. 2. The resident, if 14 years of age or older, and a parent, or guardian of the resident, have signed written consent forms as required under s. DHS 94.03, unless psychotropic medications are administered per court order. If the medication is administered per court order, there shall be a copy of the order in the resident’s record.

DCF 57.25(7)(c)3. 3. All group home staff understand the potential benefits and side effects of the medication and have received information relating to contraindicated medications.

DCF 57.25(7)(d) (d) Emergency procedures. For emergency administration of a psychotropic medication to a resident, a group home shall do all of the following:

DCF 57.25(7)(d)1. 1. Have authorization from a physician.

DCF 57.25(7)(d)2. 2. Whenever feasible, obtain written informed consent from a parent, or guardian, and the resident, if the resident is 14 years old or older, before using the medication unless the medication is administered per court order

DCF 57.25(7)(d)3. 3. Comply with the group home’s emergency medical procedures.

DCF 57.25(7)(d)4. 4. If written informed consent of a parent or guardian of a the resident was not obtained before administration of the medication notify the parent or guardian by phone as soon as possible following emergency administration and document the dates, times, and persons notified in the resident’s treatment record.

DCF 57.25(7)(d)5. 5. Document the physician’s reasons for ordering emergency administration of psychotropic medication in the resident’s treatment record.

DCF 57.25(7)(e) (e) Revocation of consent or refusal to take.

DCF 57.25(7)(e)1. 1. A resident’s parent or guardian may revoke consent for non-emergency use of psychotropic medications at any time, as provided under s. DHS 94.03.