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. DHS 105.14(10)(a)2.b.b. Spaces designated for program activities, dining, toileting, exercise and ambulation are distinctly part of the adult day care area and limited to use by an ADCC participant. An ADCC participant may be provided personal care or therapy in space also used by residents or attendees of a multi-use facility provided that the ADCC services are scheduled at different times from any other occupants. DHS 105.14(10)(a)3.3. ‘Staffing.’ The ADCC shall have distinct and separate caregivers. No caregiver may be concurrently assigned to the ADCC and another program. All staff assigned to the ADCC shall meet requirements for orientation and training under sub. (4). DHS 105.14(10)(a)4.4. ‘Activities.’ The ADCC activity program shall be programmatically distinct from the weekly or monthly calendar of activities planned for residents or attendees of a multi-use facility, but may include special events provided on a non-routine basis. DHS 105.14(10)(b)(b) Private family home. If ADCC participants and other occupants are intermixed in a private family home and the common dining and living space is available to ADCC participants and other occupants, the common dining and living space shall be determined by the total capacity of the building as described in sub. (8) (a) 2. DHS 105.14(11)(a)(a) An ADCC shall develop and implement an annual plan to evaluate and improve the effectiveness of the program’s operation and services to ensure continuous improvement in service delivery. The evaluation process shall include: DHS 105.14(11)(a)2.2. The opportunity for each participant or their legal representative to complete a satisfaction survey regarding the services provided at the ADCC. DHS 105.14(11)(a)3.3. The development and implementation of plans of action to correct identified quality of care deficiencies as identified in an ADCC’s internal review and the satisfaction survey. DHS 105.14(11)(a)4.4. A process for monitoring the effectiveness of the corrective actions taken by an ADCC. DHS 105.14(11)(b)(b) The department may not require disclosure of the records of the quality assessment process completed during the annual program review except to determine compliance with requirements of this subsection. DHS 105.14 HistoryHistory: CR 20-006: cr. Register November 2021 No. 791, eff. 12-1-21; correction in (1) (b) 23., (2) (a) 2. a., (b) 1. (intro.), k., (d) 2., 4., (h), (i) 1., 5., 7., (j) 1., (k) 2., (m) 3. (intro.), c., 4., (o) (intro.), (3) (a) 2. d., (b) 3., (4) (e) 1., (5) (b) 1., (7) (b) 1., (8) (e) 6. b., (10) (a) 2. a., 3., (b) made under s. 13.92 (4) (b) 4., Stats., correction in (2) (a) 1. made under s. 13.92 (4) (b) 7., Stats., correction in (1) (a), (b) 12. (intro.), 16. b., 19. (intro.), c. to f., 28. b., (2) (m) 1. b., 2., (3) (d) 2. b., (e) 1. c., (6) (b) 9., 12., (7) (c) 4., 5., (f) 4. b. made under s. 35.17, Stats., and renumber (1) (b) 30. to (1) (b) 28m. and cons. and renum. (1) (b) 12. (intro.) and d. to 12. (intro.) under s. 13.92 (4) (b) 1., Stats., Register November 2021 No. 791. DHS 105.15DHS 105.15 Pharmacies. For MA certification, pharmacies shall meet the requirements for registration and practice under ch. 450, Stats., and chs. Phar 1 to 17. DHS 105.15 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. Register, December, 1991, No. 432, eff. 1-1-92; correction made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667. DHS 105.16DHS 105.16 Home health agencies. For MA certification, a home health agency shall be certified to participate in medicare as a home health agency, be licensed pursuant to ch. DHS 133 and meet the requirements of this section as follows: DHS 105.16(1)(1) Home health agency services. For MA certification, a home health agency shall provide part-time, intermittent skilled nursing services performed by a registered nurse or licensed practical nurse and home health aide services and may provide physical therapy, occupational therapy, speech and language pathology services and medical supplies and equipment. Services may be provided only on visits to a recipient’s home and that home may not be a hospital or nursing home. Home health services shall be provided in accordance with a written plan of care, which the physician shall review at least every 62 days or when the recipient’s medical condition changes, whichever occurs first. DHS 105.16(1m)(1m) Electronic visit verification. The home health provider is required to capture and retain EVV records. DHS 105.16(2)(a)(a) Assignment and duties. Home health aides shall be assigned to specific recipients by a registered nurse. Written instructions for patient care shall be prepared by a registered nurse, a physical or occupational therapist or a speech and language pathologist, as appropriate. Duties shall include medically oriented tasks, assistance with the recipient’s activities of daily living and household tasks as specified in s. DHS 107.11 (2) (b) and further described in the Wisconsin medical assistance home health agency provider handbook. DHS 105.16(2)(b)(b) Supervision. A registered nurse shall make supervisory visits to the recipient’s home as often as necessary, but at least every 60 days, to review, monitor and evaluate the recipient’s medical condition and medical needs according to the written plan of care during the period in which agency care is being provided. The RN shall evaluate the appropriateness of the relationship between the direct care giver and the recipient, assess the extent to which goals are being met, and determine if the current level of home health services provided to the recipient continues to be appropriate to treat the recipient’s medical condition and if the services are medically necessary. The supervising RN shall discuss and review with the recipient the services received by the recipient and discuss the results of the supervisory visit with the LPN, home health aide or personal care worker. The results of each supervisory visit shall be documented in the recipient’s medical record. DHS 105.16(2)(c)(c) Training. Home health aides shall be trained and tested in accordance with the requirements of s. 146.40, Stats., and ch. DHS 129. Aides shall not be assigned any tasks for which they are not trained, and training and competency in all assigned tasks shall be documented and made part of the provider’s records. DHS 105.16(3)(3) Physical therapists. Physical therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under the contract to the home health agency. DHS 105.16(4)(4) Occupational therapists. Occupational therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency. DHS 105.16(5)(5) Speech and language pathologists. Speech and language pathologists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency. DHS 105.16(6)(a)(a) A certified home health agency may be certified to provide respiratory care services under s. DHS 107.113 if registered nurses, licensed practical nurses and respiratory therapists employed by or under contract to the agency provide these services and: DHS 105.16(6)(a)2.2. Know how to perform services under s. DHS 107.113 (1) and have the skills necessary to perform those services. Skills required to perform services listed in s. DHS 107.113 (1) (e) to (f) are required on a case-by-case basis, as appropriate. In no case may a person provide respiratory care before that person has demonstrated competence in all areas under s. DHS 107.113 (1) (a) to (d). DHS 105.16(6)(b)(b) A registered nurse who fulfills the requirements of this subsection shall coordinate the recipient’s care.
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