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. DHS 105.14(8)(d)(d) Exits. Stairs, walkways, and ramps shall be maintained in a safe condition. All exits, sidewalks, and driveways used for exiting shall be kept free of ice, snow, and obstructions. DHS 105.14(8)(e)(e) Delayed egress locks. Delayed egress door locks are permitted with department approval only in an ADCC with a supervised automatic fire sprinkler system and a supervised interconnected automatic fire detection system and shall comply with all of the following: DHS 105.14(8)(e)2.2. A sign shall be posted adjacent to the locking device indicating how the door may be opened. DHS 105.14(8)(e)3.3. The doors shall unlock upon activation of the sprinkler system or fire detection system. The doors shall unlock upon loss of power controlling the lock or locking mechanism. DHS 105.14(8)(e)4.4. The door locks shall have the capability of being unlocked by a signal from the ADCC’s fire command center. DHS 105.14(8)(e)5.5. An irreversible process will occur which will release the latch in not more than 15 seconds when a force of no more than 15 pounds is applied for 3 seconds to the release device. Initiation of the irreversible process shall activate an audible signal in the vicinity of the door. Once the door lock has been released by the application of force to the releasing device, re-locking shall be by manual means only. DHS 105.14(8)(e)6.6. To obtain department approval for a delayed egress lock, the ADCC shall: DHS 105.14(8)(e)6.a.a. Demonstrate the delayed egress lock is necessary to ensure the safety of every participant served by the ADCC, specifically persons at risk of elopement due to behavioral concerns, cognitive impairments or dementia, including Alzheimer’s disease. DHS 105.14(8)(e)6.b.b. Obtain documentation from the local municipality that the delayed egress door lock system complies with the requirements under this paragraph and applicable building codes. DHS 105.14(8)(e)7.7. Upon installation of the approved delayed egress lock system, the operator shall obtain documentation from the installer that the system has been installed, tested, and is fully operational as designed and approved. The ADCC shall submit the documentation to the department within 10 days of completion of the installation. DHS 105.14(9)(a)(a) Emergency plan. Each ADCC shall have a written plan for responding to fires, tornadoes, any missing participant, injuries, staff absenteeism, and other emergencies which includes: DHS 105.14(9)(b)1.1. Maintain written reports of fire safety inspections as well as any other inspection reports required by local authorities. DHS 105.14(9)(b)2.2. Install and maintain at least one 2A, 10-B-C fire extinguisher per 1,500 square feet of space. If only one extinguisher is necessary in the building, it is to be located near the cooking area. DHS 105.14(9)(b)3.3. Ensure fire extinguishers are operable at all times, inspected once a year by a qualified person, and shall bear a label indicating its condition and date of the last inspection. DHS 105.14(9)(b)4.4. Install and maintain smoke detectors in each activity room and hallways, unless the fire department indicates otherwise in writing. Each smoke detector shall be tested monthly. DHS 105.14(10)(10) Requirements for multi-use facilities. An ADCC located in a multi-use facility shall ensure the setting, programs, and physical environment will enhance the dignity and individual respect of every participant. DHS 105.14(10)(a)(a) Nursing homes, community-based residential facilities, residential care apartment complexes and pre-vocational programs. DHS 105.14(10)(a)1.a.a. Access to the ADCC shall be distinct and have separate entrance and exit doors so each participant and staff are not walking through the living or program areas of others. A multi-use facility may have a shared lobby leading to a distinct entrance door for the ADCC. DHS 105.14(10)(a)1.b.b. The ADCC shall have a separate door to the outside so each participant and staff are not walking through the living or program areas of others. DHS 105.14(10)(a)2.a.a. The ADCC shall be separate from living areas, shall be in addition to space required for other programs, and shall meet the requirements of sub. (8) (a) 2.
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Department of Health Services (DHS)
Chs. DHS 101-109; Medical Assistance
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