DHS 134.33(1)(a)(a) “Consent” means a written, signed request given without duress by a resident capable of understanding the nature of the locked unit, the circumstances of his or her condition and the meaning of the consent to be given and that consent may be withdrawn at any time. DHS 134.33(1)(b)(b) “Locked unit” means a ward, wing or room which is designated as a protective environment and is secured in a manner that prevents a resident from leaving the unit at will. A physical restraint applied to the body is not a locked unit. A facility locked for purposes of security is not a locked unit, provided that residents may exit at will. DHS 134.33(2)(2) Restriction. Except as otherwise provided by this section, no resident may be housed in a locked unit. Physical restraints or repeated use of the emergency restraint under sub. (5) may not be used to circumvent this restriction. Placement in a locked unit shall be based on the determination that this placement is the least restrictive environment consistent with the needs of the person. DHS 134.33 NoteNote: For requirements relating to the use of physical restraints, see s. DHS 134.60 (5). DHS 134.33(3)(a)(a) A resident may be housed in a locked unit under any one of the following conditions: DHS 134.33(3)(a)1.1. The resident or guardian consents to the resident being housed in a locked unit; DHS 134.33(3)(a)2.2. The court that protectively placed the resident under ch. 55, Stats., made a specific finding of the need for a locked unit; DHS 134.33(3)(a)3.3. The resident has been transferred to a locked unit pursuant to s. 55.15, Stats., and the medical record contains documentation of the notice provided to the guardian, the court and the agency designated under s. 55.02, Stats.; or DHS 134.33(3)(b)(b) A facility may transfer a resident from a locked unit to an unlocked unit without court approval pursuant to s. 55.15, Stats., if it determines that the needs of the resident can be met on an unlocked unit. Notice of the transfer shall be provided as required under s. 55.15, Stats., and shall be documented in the resident’s medical record. DHS 134.33(4)(a)(a) A resident’s or guardian’s consent under sub. (3) (a) 1. to placement in a locked unit shall be effective for no more than 90 days from the date of the consent and may be withdrawn sooner. Consent may be renewed for 90-day periods. Consent shall be in writing. DHS 134.33(4)(b)(b) The resident or guardian may withdraw his or her consent to the resident being placed in a locked unit at any time, orally or in writing. The resident shall be transferred to an unlocked unit promptly following withdrawal of consent. DHS 134.33(5)(5) Emergencies. In an emergency, the person in charge of the facility may order the confinement of a resident to a locked unit if necessary to protect the resident or another person from injury or to prevent physical harm to the resident or another person resulting from the destruction of property, provided the physician is notified within one hour and written authorization for continued use is obtained from the physician within 12 hours. No resident may be confined for more than an additional 72 hours under order of the physician. DHS 134.33 HistoryHistory: Cr. Register, June, 1988, No. 390, eff. 7-1-88; corrections in (3) (a) 2., 3. and (b) made under s. 13.93 (2m) (b) 7., Stats., Register October 2007 No. 622. DHS 134.41(1)(1) Administrator’s responsibility. The administrator is responsible for the total operation of the facility and shall provide the supervision necessary to ensure that the residents receive proper care and treatment, that their health and safety are protected and promoted and that their rights are respected. DHS 134.41(2)(2) Full-time administrator. Every facility shall be supervised by a full-time administrator licensed under ch. 456, Stats., except that: DHS 134.41(2)(a)(a) A facility licensed for 17 to 50 beds shall employ an administrator for at least 4 hours a day on each of 5 days in a week. No administrator may be employed by more than 2 of these facilities. The administrator shall be licensed under ch. 456, Stats., and DHS 134.41(2)(b)(b) A facility licensed for 16 or fewer beds shall employ an administrator for at least 10 hours a week. No administrator may be employed by more than 4 of these facilities. The administrator shall be licensed under ch. 456, Stats. DHS 134.41(3)(3) Absence of administrator. A staff person present in the facility and competent to supervise the staff and operate the facility shall be designated to be in charge whenever residents are present and there is not an administrator in the facility. The designee shall be identified to all staff. DHS 134.41(4)(a)(a) Termination. Except as provided in par. (b), no administrator may be terminated unless recruitment procedures are begun immediately. DHS 134.41(4)(b)(b) Replacement. If it is necessary to immediately terminate an administrator or if the licensee abruptly loses an administrator for other reasons, a permanent replacement shall be employed as soon as possible but not later than 120 days following the effective date of the vacancy. DHS 134.41(4)(c)(c) Temporary replacement. During a temporary vacancy in the position of administrator, the licensee shall employ a temporary replacement administrator until the original permanent administrator returns or until a new permanent administrator can be hired, whichever is appropriate. DHS 134.41(4)(d)(d) Notice of change. When the licensee loses an administrator, the licensee shall notify the department within 2 working days of the loss and provide written notification to the department of the name and qualifications of the person in charge of the facility during the vacancy and, when known, the name and qualifications of the replacement administrator. DHS 134.41 HistoryHistory: Cr. Register, June, 1988, No. 390, eff. 7-1-88; CR 04-053: am. (2) (b) Register October 2004 No. 586, eff. 11-1-04. DHS 134.42DHS 134.42 Qualified intellectual disabilities professional (QIDP). DHS 134.42(1)(1) Every facility shall have at least one qualified intellectual disabilities professional on staff in addition to the administrator, except that in a facility with 50 or fewer beds the administrator, if qualified, may perform the duties of the QIDP. DHS 134.42(2)(a)(a) Supervising the delivery of training, habilitation and rehabilitation services for each resident in accordance with the individual program plan (IPP) for that resident; DHS 134.42(2)(b)(b) Integrating the various services for each resident as planned by the interdisciplinary team and as detailed in the resident’s IPP; DHS 134.42(2)(c)(c) Reviewing each resident’s IPP on a monthly basis, or more often as needed, and preparing an accurate, written summation of the resident’s progress in measurable and observable terms for inclusion in the resident’s record; DHS 134.42(2)(d)(d) Initiating modifications in a resident’s IPP as necessitated by the resident’s condition, and documenting in the resident’s record any changes observed in the resident’s condition and action taken in response to the observed changes; and DHS 134.42(2)(e)(e) Communicating information concerning each resident’s progress to all relevant resident care staff and other professionals involved in the resident’s care. DHS 134.42 HistoryHistory: Cr. Register, June, 1988, No. 390, eff. 7-1-88; 2019 Wis. Act 1: am. (title), (1), (2) (intro.) Register May 2019 No. 761, eff. 6-1-19. DHS 134.44DHS 134.44 Employees and other service providers. DHS 134.44(1)(1) Definition. In this section, “employee” means anyone directly employed by the facility. DHS 134.44(2)(a)(a) No person under 16 years of age may be employed by the facility to provide direct care to residents. An employee under 18 years of age who provides direct care to residents shall work under direct supervision. DHS 134.44(2)(b)(b) No person with a documented history of child or resident abuse, neglect or exploitation may be hired or continue to be employed by the facility. DHS 134.44(3)(a)(a) If the facility does not itself provide a required service, it shall have in effect a written agreement with a qualified professional or agency outside the facility to provide the service, including emergency and other health care. The facility shall ensure that the outside services and service providers meet the standards contained in this chapter. DHS 134.44(3)(b)(b) The written agreement under par. (a) shall specify that the service be provided by direct contact with the residents and shall contain the responsibilities, functions, objectives and terms agreed to by the facility and the professional or agency. The agreement shall be signed by the administrator or the administrator’s representative and by the service provider or service provider’s representative. DHS 134.44(4)(a)(a) The facility shall have written personnel policies that are available to all employees and that are substantially followed. DHS 134.44(4)(b)(b) The facility shall provide written position descriptions defining employee duties for use in employee orientation, in development of staffing patterns and in inservice training. DHS 134.44(4)(c)(c) Employees shall be assigned only to duties consistent with their educational and work experience qualifications and training. Employees who work directly with residents shall be able to demonstrate that they have the skills and techniques necessary to implement the individual program plans for residents under their care. DHS 134.44(4)(d)(d) Employees who provide direct care to residents may not be required to provide housekeeping, laundry or other support services if these duties interfere with the exercise of their direct care duties. DHS 134.44(5)(a)(a) New employees. Every employee shall be certified in writing by a physician, physician assistant or advanced practice nurse prescriber as having been screened for the presence of clinically apparent communicable disease that could be transmitted to residents during the normal performance of the employee’s duties. This certification shall include screening for tuberculosis within 90 days prior to employment. DHS 134.44(5)(b)(b) Continuing employees. Employees shall be rescreened for clinically apparent communicable disease as described in par. (a) based on the likelihood of exposure to a communicable disease, including tuberculosis. Exposures to a communicable disease may be in the facility, in the community or as a result of travel or other exposure. DHS 134.44(5)(c)(c) Non-employees. Persons who reside in the facility but are not residents or employees, such as relatives of the facility’s owners, shall be certified in writing as required in pars. (a) and (b). DHS 134.44(6)(6) Disease surveillance and control. When an employee or prospective employee has a communicable disease, he or she may not perform employment duties in the facility that may result in the transmission of the communicable disease until the facility makes safe accommodations to prevent the transmission of the communicable disease. DHS 134.44 NoteNote: The Americans with Disabilities Act and Rehabilitation Act of 1973 prohibits the termination of an employee or the non-hiring of a person solely because that person has an infectious disease, illness or condition.
DHS 134.44(7)(7) Volunteers. Facilities may use volunteers provided that the volunteers receive the orientation and supervision necessary so that resident health, safety and welfare are safeguarded and that the facilities do not rely upon volunteers to provide direct care to residents. DHS 134.44 HistoryHistory: Cr. Register, June, 1988, No. 390, eff. 7-1-88; CR 04-053: r. and recr. (5) and (6) Register October 2004 No. 586, eff. 11-1-04. DHS 134.45(1)(1) Orientation for new employees. Except in an emergency, before a new employee, including a temporary employee, performs any duties, he or she shall be oriented to the facility and its policies, including policies and procedures concerning fire prevention, accident prevention and response to emergencies. By the time each new employee has worked 30 days in the facility, he or she shall be oriented to resident rights under s. DHS 134.31, to his or her position and duties and to facility procedures. DHS 134.45(2)(a)(a) General. The facility shall provide continuing inservice training for all employees to update and improve their skills in providing resident care, and supervisory and management training for each employee who is in or is a candidate for a supervisory position. DHS 134.45(2)(b)(b) Resident care. The facility shall require employees who provide direct care to residents to attend educational programs designed to develop and improve employee skills and knowledge relating to the needs of the facility’s residents, including their developmental, behavioral and health care needs. These programs shall be conducted as often as is necessary to enable staff to acquire the skills and techniques necessary to implement the individual program plans for each resident under their care. DHS 134.45(2)(c)(c) Dietary. Educational programs shall be held periodically for dietary staff. These programs shall include instruction in proper handling of food, personal hygiene and grooming, nutrition and modified diet patterns, sanitation, infection control and prevention of food-borne disease and other communicable disease. DHS 134.45(3)(3) Training in medications administration. Before persons other than nurses and practitioners may administer medications under s. DHS 134.60 (4) (d) 1., they shall be trained in a course approved by the department. DHS 134.45 HistoryHistory: Cr. Register, June, 1988, No. 390, eff. 7-1-88. DHS 134.46(1)(1) Considerate care and treatment. Employees and all other persons with whom residents come into contact shall treat the residents with courtesy, respect and full recognition of their dignity and individuality and shall give them considerate care and treatment at all times. DHS 134.46(3)(3) Abuse complaints. The facility shall ensure that every suspected instance of abuse of a resident by an employee or anyone else is reported, investigated, reviewed and documented in accordance with s. DHS 134.31 (7). DHS 134.46 HistoryHistory: Cr. Register, June, 1988, No. 390, eff. 7-1-88. DHS 134.47(1)(1) Department access. The administrator of a facility or the administrator’s designee shall provide the department with any information the department needs to determine if the facility is in compliance with chs. 50, 51 and 55, Stats., and this chapter and shall provide reasonable opportunities for an authorized representative of the department to examine facility records to gather this information. DHS 134.47(2)(a)(a) A facility shall have sufficient numbers of qualified records management staff and necessary support personnel available to accurately process, check, index, file and promptly retrieve records and to record data. DHS 134.47(2)(b)(b) Duties specified in this section that relate to resident records shall be completed by staff in a timely manner. DHS 134.47(3)(3) General requirements concerning resident records. DHS 134.47(3)(a)(a) Organization. The facility shall maintain a systematically organized record system appropriate to the nature and size of the facility for the collection and release of information about residents. DHS 134.47(3)(b)(b) Unit record. A resident record shall be maintained for each resident. The record shall be available and maintained on the unit on which the individual resides. DHS 134.47(3)(c)(c) Index. A master alphabetical resident record index shall be maintained at a central location. DHS 134.47(3)(d)(d) Confidentiality. The facility shall ensure that all information contained in resident records is kept confidential pursuant to s. 51.30, Stats., and ch. DHS 92, and shall protect the information against loss, destruction or unauthorized use. In this connection: DHS 134.47(3)(d)1.1. The facility shall have written policies to govern access to and duplication and release of information from resident records; and DHS 134.47(3)(d)2.2. The facility shall obtain the written consent of the resident or guardian before releasing information to unauthorized individuals. DHS 134.47(3)(e)(e) Availability of records. Resident records of current residents shall be stored in the facility and shall be easily accessible at all times to persons authorized to provide care and treatment. Resident records of both current and past residents shall be readily available to persons designated by statute or authorized by the resident to obtain the release of the medical records. DHS 134.47(3)(f)1.1. A resident record shall be adequate for planning and evaluation of the resident’s habilitation or rehabilitation program, or both, and shall furnish documentary evidence of the resident’s progress in the program. DHS 134.47(3)(f)2.2. The facility shall provide adequate space, equipment and supplies to review, index, file and retrieve resident records.
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