Chapter DHS 132

DHS 132.695 Note Note: See ch. DHS 134 for rules governing residential care facilities that primarily serve developmentally disabled persons who require active treatment.

DHS 132.695 History History: Cr. Register, January, 1987, No. 373, eff. 2-1-87; am. (2) (a), (b), (3), (4) (a), (b), (c) 1., 2. intro. and a. and (d), renum. (2) (c) to (d) and am. (intro.) and 3., cr. (2) (c), Register, February, 1989, No. 398, eff. 3-1-89; correction in (2) (d) 4. made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; CR 06-053: cons., renum. and am. (3) (a) (intro.) and 1. (intro.) to be (3), r. (3) (a) 1. a. and b., 2., and (b), (4) (a), (b) 2. a. to c. and (c) 1., 2. and 3., renum. (4) (b) 2. d. and e. and (c) 1. a. to d. to be (4) (b) 2. a. and b. and (c) 1. to 4., Register August 2007 No. 620, eff. 9-1-07; corrections in (2) (d) 4. and 5. made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; 2019 Wis. Act 1: am. (2) (d) (intro.), (4) (c) 2. Register May 2019 No. 761, eff. 6-1-19.

DHS 132.70 DHS 132.70 Special requirements when persons are admitted for short-term care.

DHS 132.70(1) (1) Scope. A facility may admit persons for short-term care. A facility that admits persons for short-term care may use the procedures included in this section rather than the procedures included in ss. DHS 132.52 and 132.60 (8). Short-term care is for either respite or recuperative purposes. The requirements in this section apply to all facilities that admit persons for short-term care when they admit, evaluate or provide care for these persons. Except as specified in this section, all requirements of this chapter, including s. DHS 132.51, apply to all facilities that admit persons for short-term care.

DHS 132.70(2) (2) Procedures for admission. Respite care. For a person admitted to a facility for respite care, the following admission and resident care planning procedures may be carried out in place of the requirements under ss. DHS 132.52 and 132.60 (8):

DHS 132.70(2)(a) (a) A registered nurse or physician shall complete a comprehensive resident assessment of the person prior to or on the day of admission. This comprehensive assessment shall include evaluation of the person’s medical, nursing, dietary, rehabilitative, pharmaceutical, dental, social and activity needs. The consulting or staff pharmacist shall participate in the comprehensive assessment. As part of the comprehensive assessment, when the registered nurse or physician has identified a need for a special service, staff from the discipline that provides the service shall, on referral from the registered nurse or physician, complete a history and assessment of the person’s prior health and care in that discipline. The comprehensive resident assessment shall include:

DHS 132.70(2)(a)1. 1. A summary of the major needs of the person and of the care to be provided;

DHS 132.70(2)(a)2. 2. The attending physician’s plans for discharge.

DHS 132.70(2)(b) (b) The registered nurse, with verbal agreement of the attending physician, shall develop a written plan of care for the person being admitted prior to or at the time of admission. The plan of care shall be based on the comprehensive resident assessment under par. (a), the physician’s orders, and any special assessments under par. (a).

DHS 132.70(2)(c) (c) The facility shall send a copy of the comprehensive resident assessment, the physician’s orders and the plan of care under par. (b) to the person’s attending physician. The attending physician shall sign the assessment and the plan of care within 48 hours after the person is admitted.

DHS 132.70(3) (3) Admission information.

DHS 132.70(3)(a) (a) This subsection takes the place of s. DHS 132.31 (1) (d) 1. for persons admitted for respite care or recuperative care.

DHS 132.70(3)(b) (b) No person may be admitted to a facility for respite care or recuperative care without signing or the person’s guardian or designated representative signing an acknowledgement of having received a statement before or on the day of admission that indicates the expected length of stay, with a note that the responsibility for care of the resident reverts to the resident or other responsible party following expiration of the designated length of stay.

DHS 132.70(4) (4) Medications.

DHS 132.70(4)(c) (c) Respite care residents and recuperative care residents may bring medications into the facility as permitted by written policy of the facility.

DHS 132.70(7) (7) Records.

DHS 132.70(7)(a) (a) Contents. The medical record for each respite care resident and each recuperative care resident shall include, in place of the items required under s. DHS 132.45 (5):

DHS 132.70(7)(a)1. 1. The resident care plan prepared under sub. (2) (b).

DHS 132.70(7)(a)2. 2. Admission nursing notes identifying pertinent problems to be addressed and areas of care to be maintained;

DHS 132.70(7)(a)3. 3. For recuperative care residents, nursing notes addressing pertinent problems identified in the resident care plan and, for respite care residents, nursing notes prepared by a registered nurse or licensed practical nurse to document the resident’s condition and the care provided;

DHS 132.70(7)(a)4. 4. Physicians’ orders;

DHS 132.70(7)(a)5. 5. A record of medications;

DHS 132.70(7)(a)6. 6. Any progress notes by physicians or health care specialists that document resident care and progress;

DHS 132.70(7)(a)7. 7. For respite care residents, a record of change in condition during the stay at the facility; and

DHS 132.70(7)(a)8. 8. For recuperative care residents, the physician’s discharge summary with identification of resident progress, and, for respite care residents, the registered nurse’s discharge summary with notes of resident progress during the stay.

DHS 132.70(7)(b) (b) Location and accessibility. The medical record for each short-term care resident shall be kept with the medical records of other residents and shall be readily accessible to authorized representatives of the department.

DHS 132.70 History History: Cr. Register, January, 1987, No. 373, eff. 2-1-87; am. (1), (2) (a) (intro.) and (b) (intro.), Register, February, 1989, No. 398, eff. 3-1-89; CR 06-053: r. (2) (a) 1. b., (b), (3) (b) 2. to 9., (4) (a) and (b), (5) and (6), renum. (2) (a) (intro.), 1. (intro.), 2. and 3. to be (2) (intro.), (a) (intro.), (b) and (c), am. (2) (a) (intro.) and (b) and (7) (a) 1., cons., renum., and am. (3) (b) (intro.) and 1. to be (3) (b), Register August 2007 No. 620, eff. 9-1-07; correction in (2) (c) made under s. 13.93 (2m) (b) 7., Stats., Register August 2007 No. 620.

subch. VII of ch. DHS 132 Subchapter VII — Physical Environment

DHS 132.71 DHS 132.71 Furniture, equipment and supplies.

DHS 132.71(1) (1) Furniture in resident care areas.

DHS 132.71(1)(b) (b) Bedding.

DHS 132.71(1)(b)1. 1. Each resident shall be provided at least one clean, comfortable pillow. Additional pillows shall be provided if requested by the resident or required by the resident’s condition.

DHS 132.71(1)(b)2. 2. Each bed shall have a mattress pad.

DHS 132.71(1)(b)3. 3. A moisture-proof mattress cover and pillow cover shall be provided to keep each mattress and pillow clean and dry.

DHS 132.71(1)(b)4. 4.

DHS 132.71(1)(b)4.a. a. A supply of sheets and pillow cases sufficient to keep beds clean, dry, and odor-free shall be stocked. At least 2 sheets and 2 pillow cases shall be furnished to each resident each week.

DHS 132.71(1)(b)4.b. b. Beds occupied by bedfast or incontinent residents shall be provided draw sheets.

DHS 132.71(1)(b)6. 6. Each bed shall have a clean, washable bedspread.

DHS 132.71(1)(c) (c) Other furnishings.

DHS 132.71(1)(c)2. 2.

DHS 132.71(1)(c)2.a. a. At least one chair shall be in each room for each bed. A folding chair shall not be used. If requested by the resident or guardian, a wheel-chair or geri-chair may be substituted.

DHS 132.71(1)(c)2.b. b. An additional chair with arms shall be available upon request.

DHS 132.71(1)(c)4. 4. Adequate compartment or drawer space shall be provided in each room for each resident to store personal clothing and effects and to store, as space permits, other personal possessions in a reasonably secure manner.

DHS 132.71(1)(c)5. 5. A sturdy and stable table that can be placed over the bed or armchair shall be provided to every resident who does not eat in the dining area.

DHS 132.71(1)(d) (d) Towels, washcloths, and soap.

DHS 132.71(1)(d)1. 1. Clean towels and washcloths shall be provided to each resident as needed. Towels shall not be used by more than one resident between launderings.

DHS 132.71(1)(d)2. 2. An individual towel rack shall be installed at each resident’s bedside or at the lavatory.

DHS 132.71(1)(d)3. 3. Single service towels and soap shall be provided at each lavatory for use by staff.

DHS 132.71(1)(e) (e) Window coverings. Every window shall be supplied with flame retardant shades, draw drapes or other covering material or devices which, when properly used and maintained, shall afford privacy and light control for the resident.

DHS 132.71(2) (2) Resident care equipment.

DHS 132.71(2)(a) (a) Personal need items. When a resident because of his or her condition needs a mouthwash cup, a wash basin, a soap dish, a bedpan, an emesis basin, or a standard urinal and cover, that item shall be provided to the resident. This equipment may not be interchanged between residents until it is effectively washed and sanitized.

DHS 132.71(2)(c) (c) First aid supplies. Each nursing unit shall be supplied with first aid supplies, including bandages, sterile gauze dressings, bandage scissors, tape, and a sling tourniquet.

DHS 132.71(2)(d) (d) Other equipment. Other equipment, such as wheelchairs with brakes, footstools, commodes, foot cradles, footboards, under-the-mattress bedboards, walkers, trapeze frames, transfer boards, parallel bars, reciprocal pulleys, suction machines, patient lifts, and Stryker or Foster frames, shall be used as needed for the care of the residents.

DHS 132.71(7) (7) Oxygen.

DHS 132.71(7)(a) (a) No oil or grease shall be used on oxygen equipment.

DHS 132.71(7)(b) (b) When placed at the resident’s bedside, oxygen tanks shall be securely fastened to a tip-proof carrier or base.

DHS 132.71(7)(c) (c) Oxygen regulators shall not be stored with solution left in the attached humidifier bottle.

DHS 132.71(7)(d) (d) When in use at the resident’s bedside, cannulas, hoses, and humidifier bottles shall be maintained and used in accordance with current standards of practice and manufacturers’ recommendations.

DHS 132.71(7)(e) (e) Disposable inhalation equipment shall be maintained and used in accordance with current standards of practice and manufacturers’ recommendations.

DHS 132.71(7)(f) (f) With other inhalation equipment such as intermittent positive pressure breathing equipment, the entire resident breathing circuit, including nebulizers and humidifiers, shall be maintained and used in accordance with current standards of practice and manufacturers’ recommendations.

DHS 132.71 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (1) (e), (2) (a) and (3), Register, January, 1987, No. 373, eff. 2-1-87; CR 06-053: r. (1) (a), (b) 5., (c) 1. and 3., (2) (b) and (3) to (6), Register August 2007 No. 620, eff. 9-1-07; 2015 Wis. Act 107: am. (7) (d) to (f) Register November 2015 No. 719, eff. 12-1-15.

DHS 132.72 DHS 132.72 Housekeeping services.

DHS 132.72(1) (1) Requirement. Facilities shall develop and implement written policies that ensure a safe and sanitary environment for personnel and residents at all times.

DHS 132.72(2) (2) Cleaning.

DHS 132.72(2)(e) (e) Combustibles in storage areas. Attics, cellars and other storage areas shall be kept safe and free from dangerous accumulations of combustible materials. Combustibles such as cleaning rags and compounds shall be kept in closed metal containers.

DHS 132.72(2)(f) (f) Grounds. The grounds shall be kept free from refuse, litter, and waste water. Areas around buildings, sidewalks, gardens, and patios shall be kept clear of dense undergrowth.

DHS 132.72(3) (3) Poisons. All poisonous compounds shall be clearly labeled as poisonous and, when not in use, shall be stored in a locked area separate from food, kitchenware, and medications.

DHS 132.72(4) (4) Garbage. Storage containers. All garbage and rubbish shall be stored in leakproof, nonabsorbent containers with close-fitting covers, and in areas separate from those used for the preparation and storage of food. Containers shall be cleaned regularly. Paperboard containers shall not be used.

DHS 132.72(6) (6) Pest control.

DHS 132.72(6)(b) (b) Provision of service. Pest control services shall be provided in accordance with the requirements of s. 94.705, Stats.

DHS 132.72(6)(c) (c) Screening of windows and doors. All windows and doors used for ventilation purposes shall be provided with wire screening of not less than number 16 mesh or its equivalent and shall be properly installed and maintained to prevent entry of insects. Screen doors shall be self-closing and shall not interfere with exiting. Properly installed airflow curtains or fans may be used in lieu of screens.

DHS 132.72 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (2) (b), (c) and (e), (6) (c), Register, January, 1987, No. 373, eff. 2-1-87; CR 06-053: r. (2) (a) to (d), (4) (b), (5) and (6) (a), renum. (4) (a) to be (4), Register August 2007 No. 620, eff. 9-1-07.

subch. VIII of ch. DHS 132 Subchapter VIII — Life Safety, Design and Construction

DHS 132.81 DHS 132.81 Scope and definitions.

DHS 132.81(1) (1) Application. This subchapter applies to all facilities except where noted. Wherever the rules in ss. DHS 132.83 and 132.84 modify the applicable life safety code under s. DHS 132.82, these rules shall take precedence.

DHS 132.81(2) (2) Definitions. The definitions in the applicable life safety code required under s. DHS 132.82 apply to this subchapter. In addition, in this subchapter:

DHS 132.81(2)(a) (a) “Life safety code” means the National Fire Protection Association’s standard 101.

DHS 132.81(2)(b) (b) “Period A facility” means a facility or a portion of a facility which before July 1, 1964, was either licensed as a nursing home or had the plans approved by the department; a county home or county mental hospital approved under former ch. PW 1 or 2 before July 1, 1964, which is to be converted to nursing home use; a hospital approved under ch. DHS 124 before July 1, 1964, which is to be converted to nursing home use; or any other recognized inpatient care facility in operation before July 1, 1964, to be converted to nursing home use.

DHS 132.81(2)(c) (c) “Period B facility” means a facility or a portion of a facility the plans for which were approved by the department on or after July 1, 1964, but no later than December 1, 1974; a county home or county mental hospital approved under former ch. PW 1 or 2, on or after July 1, 1964, but no later than December 1, 1974, which is to be converted for nursing home use; or any other recognized inpatient care facility in operation on or after July 1, 1964, but no later than December 1, 1974, which is to be converted to nursing home use.

DHS 132.81(2)(d) (d) “Period C facility” means a facility, the plans for which were approved by the department after December 1, 1974, including new additions to existing licensed facilities and major remodeling and alterations.

DHS 132.81 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. (2), Register, January, 1987, No. 373, eff. 2-1-87; reprinted to restore dropped copy in (2) (b), Register, May, 1987, No. 377; correction in (2) (b) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 132.812 DHS 132.812 Review for compliance with this chapter and the state building code.

DHS 132.812(1) (1) The department shall review nursing home construction and remodeling plans for compliance with this chapter and for compliance with the state commercial building code, chs. SPS 361 to 365, with the exception of s. SPS 361.31 (3). Where chs. SPS 361 to 365 refer to the department of safety and professional services, those rules shall be deemed for purposes of review under this chapter to refer to the department of health services.

DHS 132.812(2) (2) The department shall have 45 working days from receipt of an application for plan review and all required forms, fees, plans and documents to complete the review and approve, approve with conditions or deny approval for the plan.

DHS 132.812 History History: Emerg. cr., eff. 7-1-96; cr. Register, December, 1996, No. 492, eff. 7-1-96; corrections in (1) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; corrections in (1) made under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576; correction in (1) made under s. 13.92 (4) (b) 6., Stats., Register January 2009 No. 637; correction in (1) made under s. 13.92 (4) (b) 6., 7., Stats., Register January 2012 No. 673.

DHS 132.815 DHS 132.815 Fees for plan reviews.

DHS 132.815(1) (1) Requirement. Before the start of any construction or remodeling project for a nursing home, the plans for the construction or remodeling shall be submitted to the department, pursuant to s. DHS 132.84 (17), for review and approval by the department. The fees established in this section shall be paid to the department for providing plan review services.

DHS 132.815(2) (2) Fee schedule.

DHS 132.815(2)(a) (a) General. The department shall charge a fee for the review under s. DHS 132.812 of plans for a nursing home capital construction or remodeling project. The fee shall be based in part on the dollar value of the project, according to the schedule under par. (b), and in part on the total gross floor area in the plans, as found in par. (c). The total fee for plan review is determined under par. (d). Fees for review of partial plans, for revision of plans, for extensions of plan approval, and for handling and copying, and provisions for the collection and refund of fees are found in par. (e).