Chapter DHS 134

DHS 134.61 DHS 134.61 Nursing services.

DHS 134.61(1) (1) Required services. All facilities shall provide residents with nursing services in accordance with the needs of the residents. These services shall include:

DHS 134.61(1)(a) (a) The development, review, and updating of an IPP as part of the interdisciplinary team process;

DHS 134.61(1)(b) (b) The development, with a physician, of a medical care plan of treatment for a resident when the physician has determined that the resident requires such a plan;

DHS 134.61(1)(c) (c) In facilities with residents who have been determined by the physician not to require a medical care plan, arrangements for a nurse to conduct health surveillance of each resident on a quarterly basis;

DHS 134.61(1)(d) (d) Based on the nurse’s recorded findings, action by the nurse, including referral to a physician when necessary, to address the health problems of a resident; and

DHS 134.61(1)(e) (e) Implementation with other members of the interdisciplinary team of appropriate protective and preventive health measures, including training residents and staff as needed in appropriate personal health and hygiene measures.

DHS 134.61(2) (2) Nursing administration.

DHS 134.61(2)(a) (a) Health services supervision.

DHS 134.61(2)(a)1. 1. A facility shall have a health services supervisor to supervise the facility’s health services full-time on one shift a day, 7 days a week, for residents for whom a physician has ordered a medical care plan.

DHS 134.61(2)(a)2. 2. The health services supervisor required under subd. 1. shall be:

DHS 134.61(2)(a)2.a. a. A registered nurse; or

DHS 134.61(2)(a)2.b. b. A licensed practical nurse with consultation at regular intervals from a registered nurse under contract to the facility.

DHS 134.61(3) (3) Training.

DHS 134.61(3)(a) (a) A registered nurse shall participate as appropriate in the planning and implementation of training programs for facility personnel.

DHS 134.61(3)(b) (b) The facility shall train resident care personnel in:

DHS 134.61(3)(b)1. 1. Detecting signs of illness or dysfunction that warrant medical or nursing intervention;

DHS 134.61(3)(b)2. 2. Basic skills required to meet the health needs and problems of the residents; and

DHS 134.61(3)(b)3. 3. First aid for accidents and illnesses.

DHS 134.61 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88.

DHS 134.62 DHS 134.62 Professional program services.

DHS 134.62(1) (1) Provision of services. All facilities shall have or arrange for professional program services staff to implement the active treatment program defined in a resident’s individual program plan (IPP). Professional program staff shall work directly with the resident and with other staff who work with the resident in carrying out the goals and objectives stated in the resident’s IPP.

DHS 134.62(2) (2) Qualifications of professional program staff.

DHS 134.62(2)(a) (a) Psychology staff. Psychological services shall be provided by a psychologist licensed under ch. 455, Stats.

DHS 134.62(2)(b) (b) Physical therapy staff. Physical therapy services shall be given or supervised by a registered physical therapist licensed under ss. 448.05 and 448.07, Stats.

DHS 134.62(2)(c) (c) Speech pathology and audiology staff. Speech and hearing therapy shall be given or supervised by a speech pathologist or audiologist who:

DHS 134.62(2)(c)1. 1. Meets the standards for a certificate of clinical competence granted by the American speech and hearing association; or

DHS 134.62(2)(c)2. 2. Meets the educational requirements and is in the process of acquiring the supervised experience required for certification under subd. 1.

DHS 134.62(2)(d) (d) Occupational therapy staff. Occupational therapy shall be given or supervised by a therapist who meets the standards for registration as an occupational therapist of the American occupational therapy association.

DHS 134.62(2)(e) (e) Recreation staff. Recreation shall be led or supervised by an individual who has a bachelor’s degree in recreation or in a related specialty such as art, dance, music, physical education or recreation therapy.

DHS 134.62(2)(f) (f) Other professional program staff. Professional program services other than those under pars. (a) to (e) shall be provided by individuals who have at least a bachelor’s degree in a human services field such as sociology, special education or rehabilitation counseling.

DHS 134.62 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88.

DHS 134.64 DHS 134.64 Dietetic services.

DHS 134.64(1) (1) Services. Facilities shall provide or contract for dietetic services which meet the requirements of this section. Services shall include:

DHS 134.64(1)(a) (a) Planning menus that provide nutritionally adequate diets to all residents;

DHS 134.64(1)(b) (b) Initiating food orders;

DHS 134.64(1)(c) (c) Establishing and enforcing food specifications;

DHS 134.64(1)(d) (d) Storing and handling food;

DHS 134.64(1)(e) (e) Preparing and serving food;

DHS 134.64(1)(f) (f) Maintaining safe and sanitary conditions;

DHS 134.64(1)(g) (g) Orienting, training and supervising staff; and

DHS 134.64(1)(h) (h) Controlling food costs.

DHS 134.64 Note Note: For standards on safe and sanitary conditions, see s. DHS 190.09.

DHS 134.64(2) (2) Staff.

DHS 134.64(2)(a) (a) Numbers. A facility shall have enough capable staff to meet the food and nutrition needs of the residents. In small facilities the residents shall be encouraged to participate, under proper supervision, in planning, preparing and serving the food.

DHS 134.64(2)(b) (b) Supervision. Dietetic services shall be supervised by a full-time supervisor, except that an FDD with fewer than 50 residents may employ a part-time supervisor.

DHS 134.64(2)(c) (c) Qualifications. The dietetic services supervisor shall be either:

DHS 134.64(2)(c)1. 1. A dietitian; or

DHS 134.64(2)(c)2. 2. Shall receive necessary consultation from a dietition, and shall either:

DHS 134.64(2)(c)2.a. a. Hold an associate degree as a dietetic technician; or

DHS 134.64(2)(c)2.b. b. Have completed a course of study in food service supervision at a vocational, technical and adult education school, or an equivalent school or program, or presently be enrolled in a course of study in food service supervision.

DHS 134.64 Note Note: See s. DHS 134.47 (5) (c) 6. for required documentation of consultation from a dietitian.

DHS 134.64(3) (3) Staff health and personal hygiene. Food service staff and other staff who prepare and serve food shall be in good health and practice hygienic food-handling techniques.

DHS 134.64 Note Note: For inservice training requirements, see s. DHS 134.45.

DHS 134.64(4) (4) Menus.

DHS 134.64(4)(a) (a) General diets.

DHS 134.64(4)(a)1. 1. Menus shall be planned and written at least 2 weeks in advance of their use, shall be different for the same days of each week and shall be adjusted for seasonal availability of foods.

DHS 134.64(4)(a)2. 2. The facility shall provide nourishing, well-balanced meals that are, to the extent medically possible, in accordance with the recommended dietary allowances of the food and nutrition board of the national research council, national academy of sciences, adjusted for age, sex, activity level and disability. See Appendix A of this chapter.

DHS 134.64 Note Note: For more information about nutritional needs of residents, write the Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969.

DHS 134.64(4)(a)3. 3. The facility shall make a reasonable adjustment to accommodate each resident’s preferences, habits, customs, appetite and physical condition.

DHS 134.64(4)(a)4. 4. Food may not be denied to a resident in order to punish the resident unless the denial is a part of an approved, documented behavior management program under s. DHS 134.60 (6), and then only if a nutritionally adequate diet is maintained.

DHS 134.64(4)(a)5. 5. A variety of foods, including protein foods, fruits, vegetables, dairy products, breads and cereals, shall be provided.

DHS 134.64(4)(b) (b) Modified diets.

DHS 134.64(4)(b)1. 1. Modified diets shall be prescribed by the attending physician. The attending physician may delegate to a licensed or certified dietitian the task of prescribing a resident’s diet, including a modified diet, to the extent allowed by law. A modified diet shall be served consistent with that order. A dietitian shall participate in decisions about modified and special diets. A record of the order shall be kept on file.

DHS 134.64(4)(b)2. 2. The modified diet shall be reviewed by the physician and the dietitian on a regularly scheduled basis and adjusted as needed. Modifications may include changes in the type and texture of food.

DHS 134.64(5) (5) Meal service.

DHS 134.64(5)(a) (a) Schedule. The facility shall serve at least 3 meals daily at regular times comparable to normal meal times in the community. No more than 14 hours may elapse between a substantial evening meal and breakfast the following day, and not less than 10 hours may elapse between breakfast and the evening meal of the same day.

DHS 134.64(5)(b) (b) Table service. All meals shall be served in dining rooms unless otherwise required by a physician or by decision of the resident’s interdisciplinary team. The facility shall provide table service in dining rooms for all residents who can and want to eat at a table, including residents in wheelchairs.

DHS 134.64(5)(c) (c) Developmental needs of residents. Dining areas shall be equipped with tables, chairs, eating utensils and dishes to meet the developmental needs of each resident.

DHS 134.64(5)(d) (d) Self-help. There shall be adequate staff and supervision in dining rooms and resident rooms to direct self-help eating procedures and to ensure that each resident receives sufficient and appropriate foods to meet the resident’s needs.

DHS 134.64(5)(e) (e) Re-service. Food served but uneaten shall be discarded unless it is served in the manufacturer’s package which remains unopened and is maintained at a safe temperature.

DHS 134.64(5)(f) (f) Temperature. Food shall be served at proper temperatures but not more than 50ºF. (10ºC.) for cold foods and not less than 120ºF. (49ºC.) for hot foods.

DHS 134.64(5)(g) (g) Snacks. If not prohibited by the resident’s diet or condition, snacks shall be routinely offered to each resident between the evening meal and bedtime. Between-meal snacks shall be planned in advance and shall be consistent with daily nutritional needs.

DHS 134.64(6) (6) Food supplies, preparation and cooking.

DHS 134.64(6)(a) (a) Food supplies. Food shall be obtained from sources that comply with all laws relating to food and food labeling.

DHS 134.64(6)(b) (b) Preparation and cooking. Food shall be cleaned, prepared and cooked using methods that conserve nutritive value, flavor and appearance and prevent food contamination. Food shall be cut, chopped or ground as required for individual residents.

DHS 134.64(7) (7) Sanitation.

DHS 134.64(7)(a) (a) Equipment, utensils and environment.

DHS 134.64(7)(a)1. 1. All equipment, appliances and utensils used in preparation or serving food shall be maintained in a functional, sanitary and safe condition. New and replacement equipment shall meet criteria, if any, established by the national sanitation foundation.

DHS 134.64(7)(a)2. 2. The floors, walls and ceilings of all rooms in which food or drink is stored, prepared or served, or in which utensils are washed or stored, shall be kept clean and in good repair.

DHS 134.64(7)(a)3. 3. All furnishings, table linens, drapes and furniture in rooms in which food is stored, prepared or served, or in which utensils are washed or stored, shall be in good condition and maintained in a clean and sanitary condition.

DHS 134.64 Note Note: Copies of the National Sanitation Foundation’s “Listing of Food Service Equipment” are kept on file and may be consulted in the Department’s Division of Quality Assurance and the Legislative Reference Bureau.

DHS 134.64(7)(b) (b) Storage and handling of food.

DHS 134.64(7)(b)1. 1. Food shall be stored, prepared, distributed and served under sanitary conditions that prevent contamination.

DHS 134.64(7)(b)2. 2. All potentially hazardous food that requires refrigeration to prevent spoilage shall, except when being prepared or served, be kept in a refrigerator which shall have a temperature maintained at or below 40° F. (4° C.).

DHS 134.64 Note Note: See ch. DHS 145 for the requirements for reporting incidents of suspected disease transmitted by food.

DHS 134.64(7)(c) (c) Animals. Animals shall be kept out of areas of the facility where food is prepared, served or stored or where utensils are washed or stored.

DHS 134.64(8) (8) Dishwashing. Whether washed by hand or by mechanical means, all dishes, plates, cups, glasses, pots, pans and utensils shall be cleaned in accordance with accepted procedures, which shall include separate steps for pre-washing, washing, rinsing and sanitizing by means of hot water or chemicals or a combination approved by the department.

DHS 134.64 Note Note: For more detailed information on safe and proper methods of dishwashing, see s. DHS 190.10.