DHS 105.14(3)(d)1.1. ‘Caregiver background checks.’ The ADCC shall obtain a background check pursuant to s. 50.065, Stats., and ch. DHS 12, for any person who is, or is expected to be, an employee or contractor of the ADCC, who is or is expected to be under the control of the ADCC, and who has, or is expected to have, regular, direct contact with participants. DHS 105.14(3)(d)2.a.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 diseases 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 any participant. The ADCC shall keep screening documentation confidential, except the department shall have access to the screening documentation for verification purposes. DHS 105.14(3)(d)2.b.b. Employees shall be re-screened for clinically apparent communicable diseases as described in this subdivision based on the likelihood of exposure to communicable diseases, including tuberculosis. DHS 105.14(3)(d)2.c.c. A person who has a communicable disease shall not be permitted to work or be present in the ADCC if the disease would present a risk to the health or safety of any participant. DHS 105.14(3)(e)1.1. A separate record for each employee shall be maintained and kept current. Employee records shall include, at minimum, all of the following information: DHS 105.14(3)(e)2.2. Employee records shall be available upon request at the ADCC for review by the department. DHS 105.14(4)(a)(a) Orientation. Before performing any job duties, all employees shall receive appropriate orientation to their job responsibilities and to the ADCC and its policies, including emergency and evacuation procedures, participant rights, and prevention and reporting any allegation of participant abuse, neglect, and misappropriation of participant property. DHS 105.14(4)(b)1.1. Within 90 days of employment, the ADCC shall provide, obtain or otherwise ensure each caregiver receives training in all the following areas: DHS 105.14(4)(b)1.a.a. Meeting the physical, social and mental health needs of each participant group served by an ADCC. Specific training shall include, as applicable, activities, safety risks, managing and responding to challenging behaviors, environmental considerations, disease processes, communication skills, and nutritional needs. DHS 105.14(4)(b)2.2. The ADCC shall provide, obtain, or otherwise ensure each caregiver receives and successfully completes specific task training prior to assuming these job duties, including all of the following: DHS 105.14(4)(b)2.a.a. Personal care training for all caregivers who provide assistance with activities of daily living. Training shall be appropriate to the care and services provided. Specific training topics may include toileting and incontinence care, mobility and transferring, eating, bathing, and dressing. DHS 105.14(4)(b)2.b.b. Standard precaution training for all caregivers who may be exposed to blood, body fluids or other moist body substances, including mucous membranes, non-intact skin, secretions, and excretions except sweat, whether or not they contain visible blood. DHS 105.14(4)(b)2.c.c. Medication administration and management training for all caregivers who manage, administer, or assist participants with prescribed or over-the-counter medications. DHS 105.14(4)(c)(c) Caregiver supervision. Until a caregiver has completed all required training, the caregiver shall be directly supervised by the program director or by a qualified caregiver. DHS 105.14(4)(d)(d) Continuing education. The program director and every caregiver shall receive at least 10 hours per calendar year of continuing education beginning with the first full calendar year of employment. Continuing education shall be relevant to the job responsibilities and shall include, at a minimum, all of the following: DHS 105.14(4)(e)1.1. The ADCC shall maintain documentation of orientation and all the applicable training under sub. (4) (a), (b), and (d). Documentation shall include the name of the employee, the name of the instructor, the dates of training, a description of the course content, and the length of the training. DHS 105.14(4)(e)2.2. Orientation, training, and hours of continuing education shall be documented in the employee’s file. DHS 105.14(5)(5) Participant enrollment, retention, and discharge. DHS 105.14(5)(a)1.1. No ADCC may serve more participants than the maximum participant capacity on its certification at any time during hours of operation. DHS 105.14(5)(a)2.2. No person under the age of 18 years may be enrolled as an ADCC participant, unless approved for enrollment by the department. Requests for approval to enroll a person under the age of 18 years shall be made in writing and shall include all of the following: DHS 105.14(5)(a)2.a.a. A statement from the referring physician stating the services required by the minor. DHS 105.14(5)(a)2.b.b. A statement from the program director certifying that the required services can be provided. DHS 105.14(5)(b)2.2. Upon acceptance into the program, the ADCC shall obtain and document all of the following information: DHS 105.14(5)(b)2.a.a. The participant’s full name, address, telephone number, date of birth and living arrangement. DHS 105.14(5)(b)2.b.b. The name, address and telephone number of the participant’s designated contact person, and legal representative, if any. DHS 105.14(5)(b)2.c.c. The name, address and telephone number of the participant’s primary physician. DHS 105.14(5)(b)2.d.d. Name and address of the referring or coordinating agency and case manager, if applicable. DHS 105.14(5)(b)2.e.e. Any of the participant’s advance directives, such as a power of attorney for health care, or a do-not-resuscitate order. DHS 105.14(5)(b)3.3. 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. DHS 105.14(5)(b)4.4. 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. DHS 105.14(5)(c)1.1. 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. DHS 105.14(5)(c)2.2. The ADCC may not involuntarily discharge a participant unless any of the following occurs: DHS 105.14(5)(c)2.c.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. DHS 105.14(5)(c)2.e.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. DHS 105.14(5)(c)3.3. 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. DHS 105.14(6)(a)(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. DHS 105.14(6)(b)(b) Participant rights. Each participant shall have all of the following: DHS 105.14(6)(b)2.2. The right to be free from physical, sexual, mental abuse and neglect, and from misappropriation of personal property. DHS 105.14(6)(b)3.3. The right to participate in the development of one’s service plan, with support from a caregiver or legal representative, if needed. DHS 105.14(6)(b)6.6. The right to be fully informed of all the services provided and the charge for each of those services. DHS 105.14(6)(b)7.7. The right to be informed of the reason for discharge and the procedure for appealing that decision. DHS 105.14(6)(b)8.8. The right to initiate a grievance and be informed of the grievance procedure. DHS 105.14(6)(b)9.9. 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. DHS 105.14(6)(b)12.12. 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. DHS 105.14(7)(a)1.1. 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. DHS 105.14(7)(a)2.2. 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. DHS 105.14(7)(b)1.1. 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. DHS 105.14(7)(b)2.2. 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. DHS 105.14(7)(b)3.3. All caregivers who provide participant care and supervision shall have continual access to the participant’s service plan. DHS 105.14(7)(c)1.1. 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. DHS 105.14(7)(c)2.2. At least one qualified caregiver shall be on the premises at all times when one or more participant are present. DHS 105.14(7)(c)3.3. 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. DHS 105.14(7)(c)4.4. There shall be a minimum of one caregiver for every 8 non-severely impaired participants at the ADCC. DHS 105.14(7)(c)5.5. There shall be a minimum of one caregiver for every 4 severely impaired participants at the ADCC.
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