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. DHS 105.14(7)(c)6.6. The ADCC shall maintain a current written schedule for every caregiver at the ADCC. The schedule shall include each caregiver’s full name, job assignment, and time worked. DHS 105.14(7)(c)7.7. A volunteer who meets the same standards, requirements, and training as a caregiver and who have signed a written job description may be counted as a caregiver to meet staffing requirements. DHS 105.14(7)(d)1.1. The ADCC shall have a written policy for medication management and shall designate which caregivers are authorized and trained to administer medications. The caregiver administering medications shall be 18 years of age or older. The policy shall indicate the program’s role in the supervision of self-administered medications and caregiver administered medications. DHS 105.14(7)(d)2.2. Self-administered medications may be supervised by a caregiver who may prompt the participant and observe the participant taking the medication. To self-administer medications, the participant shall have the physical and mental capacity to obtain, dispense, and ensure the correct medications are taken in the prescribed dosages. When medications are self-administered, the medication list shall be reviewed and updated annually by the prescribing practitioner, physician, physician’s assistant, or nurse practitioner. DHS 105.14(7)(d)3.3. Caregiver-administered medications shall be stored, obtained, and assembled for the participant. The caregiver is responsible for ensuring the correct medication, in the correct dose, at the correct time is administered to the correct participant. Medications administered by a caregiver shall meet all of the following conditions: DHS 105.14(7)(d)3.a.a. A written order from the prescribing practitioner shall be in the participant’s record. DHS 105.14(7)(d)3.b.b. A listing of current medications with the dosage, frequency, and route of administration shall be in the participant’s record. DHS 105.14(7)(d)3.c.c. Over-the-counter and prescription medications shall remain in the original labeled containers and be stored in a locked, safe place. DHS 105.14(7)(d)3.d.d. Non-licensed caregivers shall consult with the prescribing practitioner or pharmacist about each medication to be administered. DHS 105.14(7)(d)3.e.e. Written information describing side effects and adverse reactions of each medication shall be kept in the participant’s record. DHS 105.14(7)(d)3.f.f. The administration of medications shall be documented in the participant’s permanent record to include the name of the medication, dosage, method of administration, date and time administered, and name of the caregiver who administered the medication. DHS 105.14(7)(d)3.g.g. Medication administration by routes to include: injectable, nebulizers, stomal and enteral medications, and medications, treatments or preparations delivered vaginally or rectally shall be administered by a registered nurse or by a licensed practical nurse within the scope of their license, or may be delegated to a non-licensed caregiver pursuant to s. N 6.03 (3). DHS 105.14(7)(e)(e) Program services. Based on the written description of the program, the ADCC shall provide or arrange for services to meet the needs of each participant in all of the following areas: DHS 105.14(7)(e)1.1. ‘Leisure activities.’ The ADCC shall provide programming for individual and group activities that encourage creativity, social interaction, and physical exercise. Activities shall include outings to points of interest and involvement in the general community which take into consideration individual functional abilities, needs, and interests of each participant. DHS 105.14(7)(e)2.2. ‘Personal care.’ The ADCC shall provide assistance to meet a participant’s assessed needs for ADLs. DHS 105.14(7)(e)3.3. ‘Supervision.’ The ADCC shall provide supervision appropriate to the participant’s needs. DHS 105.14(7)(e)4.4. ‘Communication skills.’ The ADCC shall provide services to meet the participant’s communication needs. DHS 105.14(7)(e)5.5. ‘Health monitoring.’ The ADCC shall monitor the health of a participant by observing and documenting changes in each participant’s health and referring a participant to health care providers when necessary. At a minimum, a quarterly note shall document how a participant is responding to the service plan. The ADCC shall immediately notify the participant’s legal representative and the participant’s residential provider, if any, when there is a significant change in a participant’s physical or mental condition. DHS 105.14(7)(e)6.6. ‘Behavior management.’ The ADCC shall provide services to manage a participant’s behaviors that may be harmful to themselves or others. DHS 105.14(7)(e)7.7. ‘Transportation.’ An ADCC program providing transportation for any participant shall carry liability insurance and ensure the vehicle is safe and well-maintained. DHS 105.14(7)(f)1.1. ‘General requirements.’ The ADCC shall obtain food from acceptable sources that meets the dietary needs of each participant. DHS 105.14(7)(f)2.2. ‘Equipment and utensils.’ The ADCC shall store equipment and utensils in a clean manner and shall maintain all utensils and equipment in good repair. Single-use utensils may not be reused. DHS 105.14(7)(f)3.a.a. Whether washed by hand or mechanical means, all equipment and utensils shall be cleaned using separate steps for pre-washing, washing, rinsing, and sanitizing. DHS 105.14(7)(f)3.b.b. Mechanical washing of dishes and utensils in a residential type dishwasher will have a temperature setting of at least 120 degrees Fahrenheit. Upon removal from a residential-type dishwasher, a separate process must be completed for sanitization of all items that is in accordance with current standards of practice. DHS 105.14(7)(f)3.c.c. Mechanical washing of dishes and utensils in a commercial type dishwasher will be in accordance with manufacturer’s recommendations. DHS 105.14(7)(f)3.d.d. Dishes and utensils shall be air dried, unless a dishwasher, which performs this function, is used. DHS 105.14(7)(f)4.a.a. The ADCC shall arrange for or provide a meal to each participant who is at the ADCC for 5 or more hours. Meals shall provide at least one-third of an adult’s daily nutritional requirements. DHS 105.14(7)(f)4.b.b. The ADCC shall document the food served at each meal and maintain the documentation on file for at least 6 months. DHS 105.14(7)(f)4.c.c. A nutritious snack shall be made available consistent with each participant’s dietary needs. DHS 105.14(7)(f)5.a.a. Each caregiver who prepares or serves food shall be free from open, infected wounds and from communicable disease and shall maintain clean and safe work habits. DHS 105.14(7)(f)5.b.b. The ADCC shall provide hand-washing facilities in the kitchen for use by food handlers. Use of a common towel is prohibited. DHS 105.14(7)(f)5.c.c. Any participant who assists in preparing food shall adhere to the same food safety requirements as ADCC staff and be directly supervised by a caregiver. DHS 105.14(7)(f)6.6. ‘Food safety.’ Whether food is prepared at the ADCC or off-site, the ADCC shall store, prepare, distribute, and serve food in accordance with professional standards for food service safety. The ADCC shall do all of the following: DHS 105.14(7)(f)6.a.a. Refrigerate and store all foods requiring refrigeration at or below 41 degrees Fahrenheit. Food items not in their original containers shall be covered, labeled and dated. DHS 105.14(7)(f)6.b.b. Maintain freezing units at 0 degrees Fahrenheit or below. Frozen foods shall be packaged, labeled, and dated. DHS 105.14(7)(f)6.c.c. Hold hot foods at 135 degrees Fahrenheit or above and cold foods at 41 degrees Fahrenheit or below until served. DHS 105.14(7)(f)6.d.d. Ensure that each refrigerator and freezer has an accurate thermometer inside the unit. DHS 105.14(7)(f)6.e.e. Keep food storage areas clean and dry and store food at least six inches off the floor. DHS 105.14(8)(a)1.1. If required by the department of safety and professional services or local municipality, the ADCC shall have on file an inspection report signed by an authorized agent demonstrating that the ADCC including remodeling, has met applicable building codes. DHS 105.14(8)(a)2.2. The ADCC shall provide at least 50 square feet of usable floor space for each participant exclusive of passageways, bathrooms, lockers, office, storage areas, staff room, furnace rooms, and parts of rooms occupied by stationary equipment. DHS 105.14(8)(a)3.3. The ADCC shall be designed in such a way that it is accessible and functional in meeting the identified needs of the participant group it serves. DHS 105.14(8)(a)4.4. The ADCC shall have a telephone on the premises, which is immediately accessible during hours of operation. DHS 105.14(8)(a)5.5. Temperature at the ADCC shall be maintained at no less than 70 degrees Fahrenheit. DHS 105.14(8)(a)6.6. Toilets and fixtures shall function properly and shall be maintained in a sanitary condition. DHS 105.14(8)(a)8.8. Pets kept on the premises shall be vaccinated against diseases including rabies. DHS 105.14(8)(b)1.1. A supply of safe drinking water shall be available to any participant at all times. DHS 105.14(8)(b)2.2. If well water is used, wells shall be approved by the department of natural resources and water samples shall be tested annually at a state-approved laboratory. Documentation of test results shall be kept on file at the ADCC. DHS 105.14(8)(b)3.3. The ADCC shall set the temperature of all water heaters connected to sinks, showers and tubs used by residents at a temperature of at least 140 degrees Fahrenheit. The temperature of hot water at plumbing fixtures used by residents may not exceed the range of 110 to 115 degrees Fahrenheit. DHS 105.14(8)(c)1.1. The center shall provide sufficient furniture and equipment for use by every participant that provides comfort, safety, and is appropriate for every participant.
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