PROPOSED ORDER OF THE DEPARTMENT OF HEALTH AND FAMILY SERVICES REPEALING AND RECREATING RULES To repeal and recreate chapter HFS 83, relating to licensing community-based residential facilities (CBRFs) for adults. Analysis Prepared by the Department of Health and Family Services This order updates the Department's rules for community-based residential facilities (CBRFs) for 5 or more adults. Community-based residential facilities, sometimes called group homes for adults, are homes for 5 or more adults who need supervision, care and services above room and board, but not including nursing care as the primary function of the facility. Facilities are more than boarding houses, but less than nursing homes in services provided and responsibility taken for residents. No home that meets the definition of a CBRF may operate in the state without being licensed by the Department. Currently there are over 1,300 facilities in Wisconsin licensed for 5 or more residents. A license is evidence that a home as of the date of issuance of the license complied with the Department's rules for facilities, ch. HFS 83. Those rules and their enforcement by staff of the Department are intended to help ensure that the health, safety and welfare of facility residents are protected and promoted. The last time this rule was substantially revised was July 1, 1996. Specially, this rule is being revised: * To shift the focus from prescriptive regulation to resident outcomes. * For better readability, organization and less extraneous verbiage. * To bring HFS 83 current with related regulations referenced in this rule. * To update training standards and required competency evaluation and eliminating department-approved training programs. * To include emphasis on resident's control of medication and provide less stringent requirements for over-the-counter medications. * To update physical environment requirements including accessibility, smoke compartments, joint occupancy, fees, incorporation of bureau memo 98-024 regarding to rigid venting and 98-020 regarding mixing valve and to require all newly licensed or constructed small Class C facilities to have sprinklers. * To incorporate the additional requirements for facilities with more than 20 residents into the main body of the rule rather than in its own subchapter. The Department's authority to repeal and create these rules is found in s. 50.02(2), Stats. The rules interpret ss. 50.01 and 50.02, as amended by 1993 Wisconsin Act 327, and ss. 50.03, 50.035, and 50.05 to 50.09, Stats. SECTION 1. Chapter HFS 83 is repealed and recreated to read: Chapter HFS 83 CHAPTER HFS 83 COMMUNITY-BASED RESIDENTIAL FACILITIES Subchapter I - General Overview HFS 83.01 Authority and purpose HFS 83.02 Scope of this chapter HFS 83.03 Definitions HFS 83.04 Licensure Subchapter II - Operations HFS 83.11 Licensee HFS 83.12 Employe HFS 83.13 Infection control HFS 83.14 Training HFS 83.15 Staffing HFS 83.16 Reporting requirements Subchapter III - Admissions, Transfers and Discharge HFS 83.21 Limitations on admissions and Programs HFS 83.22 Funding eligibility HFS 83.23 Discharge or transfer Subchapter IV - Resident Rights and Protections HFS 83.31 Rights of residents HFS 83.32 Grievance procedure HFS 83.33 Resident funds HFS 83.34 Admissions agreement HFS 83.35 Notice of availability of this chapter and department findings Subchapter V - Service Requirements HFS 83.41 General requirements HFS 83.42 Assessment and individual service plan HFS 83.43 Program services HFS 83.44 Medications HFS 83.45 Terminally ill residents services HFS 83.46 Food service Subchapter VI - Physical Environment and Safety HFS 83.51 Physical environment HFS 83.52 Safety HFS 83.53 Fire protection system HFS 83.54 Alternative requirements to a sprinkler system in small class C facility HFS 83.55 Accessibility Subchapter VI - Structural Requirements HFS 83.61 Building maintenance and site HFS 83.62 Minimum type of construction HFS 83.63 Exiting HFS 83.64 Windows HFS 83.65 Electrical service and fixtures HFS 83.66 Requirements construction and remodeling PREFACE Homes and facilities providing residential care, supervision, treatment and services to 5 or more adults are required to be licensed as community based residential facilities (CBRF). No facility may operate without being licensed [JAH1]by the Department of Health and Family Services. To be licensed, a home or facility must comply with the minimum standards and requirements found in these rules. Community based residential facilities for 9 to 20 residents in existing buildings must also meet the building code requirements of ch. Comm 61. All community-based residential facilities for 21 or more residents in existing buildings and all newly constructed facilities for 9 or more residents must meet the relevant building code requirements of ch. Comm 50-64. Newly constructed facilities for 5 to 8 residents must meet the construction requirements of chs. Comm 20 to 25. Facilities intending to use federal funds may have to comply with other requirements in addition to those outlined here, such as National Fire Protection Association (NFPA) Standard 101 (Life Safety Code), American National Standards Institute (ANSI) standards for barrier-free design, and federal regulations. A facility is subject to the same building and housing ordinances, codes and regulations of the municipality or county as similar residences located in the area in which the facility is located, under s. 46.03(22)(b), Stats. While these rules satisfy the federal government requirement of standards for residential facilities housing supplemental security income (SSI) recipients who need protective oversight in addition to room and board, facilities will have to satisfy certain additional requirements if they expect to qualify for HUD Section 8 funding. Facility operators should also realize federal funding from any U.S. Department of Health and Human Services (HHS) source could be jeopardized for failure to comply with federal regulations implementing s. 504 of the Vocational Rehabilitation Act of 1973 that prohibits discrimination in the provision of services to persons with physical or mental handicaps. Additional federal requirements for non-discrimination, reasonable accommodations and accessibility found in Title VIII of the Civil Rights Act of 1968, as amended, (the Fair Housing Act) and the Americans with Disabilities Act may also apply to facilities. SUBCHAPTER I - GENERAL OVERVIEW HFS 83.01 Authority and purpose. (1) This chapter is promulgated under the authority of s. 50.02(2), Stats., to regulate community-based residential facilities (CBRFs) in order to safeguard and promote the health, safety, well-being, rights and dignity of each resident. (2) The chapter is intended to ensure all community-based residential facilities provide a living environment for residents that is as homelike as possible and is the least restrictive of each resident's freedom as is compatible with the resident's need for care and services, that the care and services a resident needs are provided to the resident and that care and services are provided in such a manner that the resident is encouraged to move toward functional independence in daily living or to continue functioning independently to the extent possible. (3) This chapter will guide development of a range of community-based residential facilities designed to provide care, treatment and other services to people who need supportive or protective services or supervision of people who cannot or do not wish to live independently yet do not need the services of a hospital or nursing home. HFS 83.02 Scope of this chapter. (1) APPLICABILITY. This chapter applies to all community-based residential facilities.[JAH2] (2) THIRD-PARTY PAYER REQUIREMENTS. Nothing in this chapter prevents a community based residential facility from complying with the requirements of a third-party payer, nor does this chapter force a community based residential facility to comply with additional requirements of a third-party payer. (3) EXCEPTION TO A REQUIREMENT. (a) The department may in its sole discretion grant a waiver of or a variance to a requirement of this chapter when it is demonstrated to the satisfaction of the department that granting the waiver or variance will not jeopardize the health, safety, welfare or rights to any resident in the facility. A written request for a waiver or variance shall be sent to the department and include justification for the requested action and a description of any alternative provision planned to meet the intent of the requirement. (b) The department may place a time limit and conditions upon any variance or waiver granted by the department. Note: A request for waiver of a requirement of this chapter or a variance to a requirement of this chapter should be sent to the licensing representative at the appropriate regional office of the Department's Division of Supportive Living. See Appendix A for the addresses of those offices. (c) The department may revoke a waiver or variance if: 1. It is determined that the waiver or variance is adversely affecting the health, safety or welfare of the residents; 2. The facility has failed to comply with the variance as granted; 3. The licensee notifies the department in writing that it wishes to relinquish the waiver or variance and be subject to the rule previously waived or varied; or 4. Required by a change in law. (d) The department shall access a fee when reviewing a request for variance or waiver: 1. In the amount of $490 for physical plant variance or waiver reviews. 2. In the amount of $50 for all other variance or waiver reviews. HFS 83.03 Definitions. In this chapter: (1) "Accessible" means the absence of barriers preventing a person who is semi-ambulatory, non-ambulatory or has a functional limitation caused by impairment of sight, hearing, coordination or perception, from entering, leaving or functioning within a facility without physical help. (2) "Activities of daily living" means self care, including dressing, eating, bathing, grooming, toileting, manipulating objects, ambulation, rest, and leisure activities. (3) "Administer" means the direct injection, ingestion or other application of a prescription or over-the-counter drug or device to the body of a resident by a practitioner, the practitioner's authorized agent,[JAH3] or the resident at the direction of the practitioner[JAH4]. (4) "Administrator" means the licensee or an employe designated by the licensee who is responsible for the management or day-to-day operation of the facility. (5) "Advance directive" means instructions written before an individual is incapacitated stipulating health care objectives. An advanced directive may be a living will under ch. 154, durable power of attorney under ch. 155 or other authority as recognized by the courts of this state. (6) "Ambulatory" means able to walk without difficulty or help. (7) "Applicant" means the person seeking licensure or approval of change of ownership or review of construction or remodeling plans. (8) "ARA" or "area of rescue assistance" means a room or stairwell landing used for safe refuge in a fire or other emergency by residents who cannot negotiate stairs. (9) "Assessment" means a systematic gathering and analysis of information describing an individual's abilities and needs in each of the areas of functioning under s. HFS 83.32(1)(b). (10) "Building" means a structure entirely enclosed under one roof. (11) "Capacity" means the maximum number of residents and other occupants who may reside in the facility at any time under the terms of the facility license. (12) "Care, treatment or service above the level of room and board" means supervision and supportive services provided by the operator, or by a person, agency or corporation affiliated with or under contract to the operator, to persons who have needs that cause them to be unable to live independently in the community. (13) "Case manager" means an individual who plans, coordinates and oversees the care of a resident, but is not directly affiliated with a facility[JAH5]. (14) "Client group[JAH6]" means individuals who need similar services because of a common disability, condition or status. Client groups include individuals: (a) With functional impairments that commonly accompany advanced age. (b) With irreversible dementia, such as Alzheimer's disease. (c) Who have a developmental disability as defined in s. 51.05(5), Stats. (d) Who are emotionally disturbed or have a mental illness as defined in s. 51.01(12)(a), Stats. (e) Who are alcoholic as defined in s. 51.01(1), Stats., or drug dependent as defined in s. 51.01(8), Stats. (f) With physical disabilities. (g) Who are pregnant and need counseling services. (h) Under the legal custody of a government correctional agency or under the legal jurisdiction of a criminal court. (i) Diagnosed as terminally ill. (j) With traumatic brain injury. (k) With acquired immunodeficiency syndrome (AIDS). (15) "Comm" means department of commerce and the associated Commercial Building Chapter. (16) "Community based residential facility" means a place where 5 or more adults who are not related to the operator or administrator and who do not require care above intermediate level nursing care reside and receive care, treatment or services that are above the level of room and board, but that include no more than 3 hours of nursing care per week per resident. Community based residential facility does not include any of the following: (a) A convent or facility owned or operated by members of a religious order exclusively for the reception and care or treatment of members of that order. (b) A facility or private home that provides care, treatment and services only for victims of domestic abuse, as defined in s. 46.95 (1) (a), and their children. (c) A shelter facility as defined under s. 16.352 (1) (d). (d) A place that provides lodging for individuals and in which all of the following conditions are met: 1. Each lodged individual is able to exit the place under emergency conditions without the assistance of another individual. 2. No lodged individual receives from the owner, manager or operator of the place or the owner's, manager's or operator's agent or employe any of the following: a. Personal care, supervision or treatment, or management, control or supervision of prescription medications. b. Care or services other than board, information, referral, advocacy or job guidance; location and coordination of social services by an agency that is not affiliated with the owner, manager or operator, for which arrangements were made for an individual before he or she lodged in the place; or, in the case of an emergency, arrangement for the provision of health care or social services by an agency that is not affiliated with the owner, manager or operator. (e) An adult family home. (f) A residential care apartment complex. (g) A residential facility in the village of Union Grove that was authorized to operate without a license under a final judgment entered by a court before January 1, 1982, and that continues to comply with the judgment notwithstanding the expiration of the judgment. (h) Any facility required to be licensed as a nursing home under ch. 50, Stats., and HFS 132 or 134. (i) Any state, county or municipal prison or jail. (j) A private residence that is the principal home of adults who own or lease it and who independently arrange for and receive care, treatment or services for themselves from a person or agency that has no direct or indirect right or authority to exercise direction or control over the residence. (17) "Compatible" means those that can be mixed without negatively affecting or interfering with one another. (18) "Congregate dining and living area" means one or more habitable rooms located outside of resident bedrooms or, in resident apartments, located outside of other habitable rooms. ( (19) "Construction type" or "type of construction" means one of the types of building construction as described in s. Comm 51.03. (20) "Continuous care" means the need for supervision, intervention or services on a 24-hour basis to prevent, control and improve a constant or intermittent mental or physical condition that may break out or become critical at any time. Note: Examples of persons who need continuous care are wanderers, persons with irreversible dementia, persons who are self-abusive or who become agitated or emotionally upset and persons whose changing or unstable health condition requires monitoring. (21) "Contraband" means any item that is illegal, contrary to the purpose of the resident's stay in the facility, or poses a physical danger to other residents or staff. (22) "Department" means the Wisconsin department of health and family services. ( (23) "Dietitian" means a dietitian certified under subch. IV of ch. 488, Stats. (24) "Direct supervision[JAH7]" means immediate availability to continually coordinate, direct and inspect the practice of another in person. (25) "Emergency admission" means immediate entrance to a facility because an individual's situation creates an imminent risk of serious harm to the health or safety of the individuals if not admitted immediately. (26) "Emergency discharge" means the release of a resident from a facility without a 30 day notice because an unanticipated hospitalization or a situation creating an imminent risk of serious harm to the health or safety of the resident, other residents or staff members. (27) "Employe" means any person who works for a facility or for a corporation affiliated with the facility or under contract to the facility and receives compensation subject to state and federal employe withholding taxes. (28) "Entrance fee" means payment required for admission in addition to the regular monthly fees for services and security deposit. (29) "Existing building" means a building constructed and occupied, or ready for occupancy, before January 1, 1997.[DHFS8] (30) "Exit" means that portion of a means of egress that is separated from all other spaces of the building or structure by construction providing a protected way of travel to the exit discharge. Exits include exterior exit doors, exit passageways, horizontal exits, separated exit stairs and separated exit ramps. (31) "Exit discharge" means that portion of a means of egress between the termination of an exit and a public way. (32) "Exterior window" means a window that opens directly to the outdoors or to an unheated enclosed space such as an exterior balcony or sun porch. (33) "Facility" means a CBRF. (34) "First floor" means the lowest floor having one or more required exits for that floor and for any floors above or below it. (35) "Free-standing" means a facility not attached to a health care facility. Health care facilities are defined in Comm. 58. ( (36) "General supervision[JAH9]" means to regularly coordinate, direct and inspect the practice of another. ( (37) "Habitable floor" means any floor level used, by residents or non-residents of the CBRF, for sleeping, living, cooking or dining, including a basement under s. Comm 51.01(10), a ground floor under s. Comm 51.01(67) and any floor level above the basement and ground floor used for sleeping, living, cooking or dining. (38) "Habitable room" means any room used for sleeping, living, cooking or dining, excluding enclosed places such as closets, pantries, hallways, laundries, storage spaces, utility rooms and administrative offices. (39) "Home like" means a facility will have similar characteristics to a resident's home. (40) "Horizontal exit" means (41) "Incapacity" means the inability to receive and evaluate information effectively or to communicate decisions to such an extent that the individual lacks the capacity to manage his or her health care decisions. (42) "Intensive Skilled nursing care" means care requiring specialized nursing assessment skills and the performance of specific services and procedures that are complex because of the resident's condition or the type or number of procedures that are necessary, including any of the following: (a) Direct patient observation or monitoring or performance of complex nursing procedures by registered nurses or licensed practical nurses on a continuing basis. (b) Repeated application of complex nursing procedures or services every 24 hours. (c) Frequent monitoring and documentation of the resident's condition and response to therapeutic measures. (43) "Intermediate nursing care" means basic care that is required by a person who has a long-term illness or disability that has reached a relatively stable plateau. (44) "Intermixed" means to blend or become mixed together. (45) "Joint occupancy" means a building, structure or premise that is used for 2 or more purposes. (46) "Large CBRF" means a facility for 21 or more residents. (47) "Least restrictive" means the condition or environment that maximizes the opportunity for self-determination and community integration according to the individual capabilities and needs of each resident. (48) "Legal representative" means a person who is any of the following: (a) A guardian as defined under s. 880.01 (3), Stats. (b) A person appointed as a health care agent under ch. 155, Stats. (c) A person appointed under a durable power of attorney under s. 243.07, Stats. (49) "Licensed practitioner" means a physicians assistant, general nurse pratitioner or (50) "Means of exiting" means a component of the building that leads to an exit door, stairway, enclosed stairs, ramp, horizontal exit or fire escape that also terminates at a street, alley or open court. (51) "Medium CBRF" means a facility for 9 to 20 residents. (52) "Misconduct" means abuse or neglect of a resident or misappropriation of a client's property. (53) "New construction" means construction for the first time of any building or addition to an existing building once plans are approved by the department on or after the effective date of this chapter. (54) "NFPA" means the National Fire Protection Association. (55) "Non ambulatory" means not able to walk at all, but able to be mobile with the help of a wheelchair. (56) "Non medically licensed staff member" means an employe other than a practitioner, pharmacist or registered or practical nurse licensed in Wisconsin or a medication aide who has completed training in a drug administration course approved by the department under s. HFS 132. (57) "Nursing care" [DHFS10]means nursing procedures, excluding personal care, that are permitted under ch. N 6 to be performed only by a registered nurse or a licensed practical nurse directly on or to a resident. (58) "Nursing supervision" means the periodic oversight of facility staff by a registered nurse. (59) "Other occupant" means any person who lives and sleeps in the facility, but is not a resident. (60) "Other potentially infectious material" means semen, vaginal secretion, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid visibly contaminated with blood, or any body fluid for which it is difficult or impossible to differentiate between types of body fluids. (61) "Palliative care" means management and support provided for the reduction of pain, other physical symptoms and psychosocial and spiritual needs of individuals with terminal illness. This includes physician services, skilled nursing care[DHFS11], medical services, social services, services of volunteers and bereavement services, but does not mean treatment provided to cure a medical condition or disease or to artificially prolong life. (62) "Personal care" means assistance with the activities of daily living, such as eating, dressing, bathing and walking, but does not include nursing care. (63) "Pharmacist[DHFS12]" means any pharmacist or pharmacy licensed under ch. 450, Stats., and may be a provider pharmacist or a consultant pharmacist. (64) "Place" means a building or portion of a building which is self-sufficient for living, dining and sleeping and the provision of care, treatment or services to its resident. (65) "Practitioner" means a person licensed in this state to prescribe and administer drugs or licensed in another state and recognized by this state as a person authorized to prescribe and administer drugs. ( (66) "Primary care provider" means an agency or individual responsible for planning, arranging or providing services to a resident. (67) "Primary function" means the basic or essential care, treatment or services provided to residents of the facility. (68) "Psychotropic medication" means an antipsychotic, an antidepressant, lithium carbonate or a tranquilizer or any other drug used to treat, manage or control psychiatric symptoms or disordered behavior. Note: Examples of drugs other than an antipsychotic or antidepressant, lithium carbonate or tranquilizer used to treat, manage or control psychiatric symptoms or disordered behavior include, but are not limited to, carbamazepine (Tegretol), which is typically used for control of seizures but may be used to treat a bi-polar disorder, and propranolol (Inderal), which is typically used to control high blood pressure but may be used to treat explosive behavior or anxiety states. (69) "Public way" means any street, alley or other similar parcel of land essentially open to the outside air and is deeded, dedicated, or otherwise permanently appropriated to the public for public use and has a clear width and height of at least 10 feet. (70) "Qualified resident care staff" means a staff person who has successfully completed all of the applicable training, orientation and continuing education for resident care under s. HFS 83.14 and has successfully passed the relevant competency testing. (71) "Relative" means a spouse, parent, stepparent, child, stepchild, sibling, grandchild, grandparent, aunt, uncle, niece, or nephew of the facility licensee. (72) "Remodeling" means to make over or rebuild a portion of a building or structure and thereby modifying its structural strength, fire hazard character, exiting, heating and ventilating systems, electrical system, fire alarm, and fire protection systems, call system and internal circulation or room used as previously approved by the department. Construction of interior walls shall be considered remodeling where exterior walls are in place, but interior walls are not in place by [revisor to insert effective date]. Remodeling does not include minor repairs necessary for the maintenance of a building such as replacing like components of existing systems, redecorating existing walls or replacing floor finishes. (73) "Resident" means a person unrelated to the licensee or administrator who lives and sleeps in the facility and receives care, treatment or services in addition to room and board. (74) "Resident care staff" means the licensee and all employes who have one or more of the following responsibilities for residents: supervising the resident's activities or whereabouts, managing or administering medications, providing personal care or treatments, training and activity programming. Not included are staff who work exclusively in the food service, maintenance, laundry service, housekeeping, transportation, security or clerical areas, and employes that do not work on the premises of the facility. (75) "Residential or health care facility" means any program, building or campus of buildings licensed, certified or otherwise approved by any state, county or other government unit to provide care, treatment or services to one or more persons or to receive public funding to provide care, treatment or services to one or more persons. (76) "Respite care" means temporary placement in a facility for maintenance of care, treatment or services, as established by the individual's primary care provider, in addition to room and board, for no more than 28 consecutive days at a time. (77)"Restraint" means one of the following: (a) "Chemical restraint" means a psychopharmacologic drug used for discipline or convenience, and not required to treat medical symptoms[JAH13]. (b) "Physical restraint" means any manual method, article, device, or garment interfering with the free movement of the resident or the normal functioning of a portion of the body or normal access to a portion of the body, and which the individual is unable to remove easily, or confinement in a locked room. (78) "Room or compartment[DHFS14]" means a space that is completely enclosed by walls and a ceiling. The room or compartment may have openings to an adjoining room or compartment if the openings have a depth of at least 8 inches from the ceiling. (79) "Seclusion" means physical or social separation from others by actions of staff, but does not include separation in order to prevent the spread of communicable disease or cool-down periods in an unlocked room as long as presence in the room by the resident is voluntary. (80) "Security deposit" means a payment made to the facility before admission that is refundable upon discharge, minus the cost of any damage caused by the resident above normal wear and tear. (81) "Self-administered" means the direct injection, ingestion or other application of a prescription or over-the-counter drug or device to the body of a resident by the resident. (82) "Semi-ambulatory" means able to walk with difficulty or only with the assistance of an aid such as crutches, a cane or walker. (83) "Significant change in a resident's condition" means one or more of the following: (a) Deterioration in a resident's medical condition resulting in further impairment of a long term nature. (b) Deterioration in 2 or more activities of daily living. (c) A pronounced deterioration in communication or cognitive abilities. (d) Deterioration in behavior or mood to the point relationships have become problematic. (84) "Small CBRF" means a facility for 5 to 8 residents. (85) "Stable medical condition" means a person's clinical condition is predictable, does not change rapidly, and medical orders are unlikely to involve frequent changes or complex modifications. (86) "Standard precautions" means measures taken to reduce the risk of transmission of infection from contact with blood, body fluids or other moist body substances. Standard precautions apply to all mucous membranes, non-intact skin, blood, all body fluids, secretions, and excretions except sweat, whether or not they contain visible blood. (87) "Story" means the space in a building between the surfaces of any floor and the floor next above or below, or roof next above, or any space not defined as basement, ground floor, mezzanine, balcony, penthouse or attic under s. Comm 51.01. Note: The definition of story has the same meaning under s. Comm 51.01(122). (88) "Supervision" means providing protective oversight of the residents' daily functioning, keeping track of residents' whereabouts and providing guidance and intervention when needed by a resident.[JAH15] (89) "Supervision of self-administered medication" means a staff person observing the resident removing the dosage of a prescription or over-the-counter medication from the labeled container and taking it. Supervision of self-administered medication does not include the staff person removing the correct dose of medication for the resident.[JAH16] (90) "Supportive services" means assistance to meet the psychological, social and spiritual needs of a family with a terminally ill member during the final stages of illness and after the death of this individual. (91) "Terminal illness" means a medical prognosis that an individual's life expectancy is less than 12 months. (92) "Transmission-based precautions" means additional measures taken beyond standard precautions for those individuals documented as or suspected of having a highly transmittable disease. In 1996, the recommended precautions from the Center for Disease Control (CDC) included Airborne Precautions, Droplet Precautions and Contact Precautions. As future precautions are identified, they shall be in considered a requirement in this rule. (93) "Universal precautions" means measures taken to prevent transmission of infection from contact with blood or other body fluids or materials having blood or other body fluids on them, as recommended by the U.S. public health services centers for disease control and adopted by the U.S. occupational safety and health administration (OSHA) as 29 CFR 1910.1030. Note: Copies of the universal precautions may be obtained from Occupational Health Section, Bureau of Public Health, 1414 E. Washington Avenue, Madison, WI 53703. (94) "Unrelated adult" means any adult residing in a facility who is not a relative of the licensee or administrator. (95) "Utensils" means dishes, silverware and pots and pans used for preparing, serving or consuming food. (96) "Valid practitioner's order" means (97) "Variance" means allowing an alternative means of meeting a requirement of this chapter. (98) "Volunteer" means any person who provides services for residents without compensation, except for reimbursement of out of pocket expenses. (99) "Wanderer" means an individual in need of continuous care who, because of a temporary or permanent mental impairment, may leave the facility without the knowledge of the staff and as a result may be exposed to danger or suffer harm. (100) "Waiver" means the granting of an exemption from a requirement of this chapter. HFS 83.04 Licensure. (1) LICENSING CATEGORIES. Each facility shall be licensed by size and class as follows: (a) Size of facility. 1. A facility for 5 to 8 residents shall be licensed as a small CBRF. 2. A facility for 9 to 20 residents shall be licensed as a medium CBRF. 3. A facility for 21 for more residents shall be licensed as a large CBRF. (b) Class of facility. 1. 'Class A ambulatory (AA).' A class A ambulatory facility may serve only residents who are ambulatory and mentally and physically capable of responding to an electronic fire alarm by exiting the facility without any help or verbal or physical prompting. 2. 'Class A semiambulatory (AS).' A class A semiambulatory facility may serve only residents who are ambulatory or semiambulatory and mentally and physically capable of responding to an electronic fire alarm by exiting the facility without any help or verbal or physical prompting. 3. 'Class A nonambulatory (ANA).' A class A nonambulatory facility may serve residents who are ambulatory, semiambulatory or nonambulatory but only if they are mentally and physically capable of responding to an electronic fire alarm by exiting the facility without any help or verbal or physical prompting. 4. 'Class C ambulatory (CA).' A class C ambulatory facility may serve only residents who are ambulatory but one or more of whom are not mentally capable of responding to an electronic fire alarm by exiting the facility without any help or verbal or physical prompting. 5. 'Class C semiambulatory (CS).' A class C semiambulatory facility may serve only residents who are ambulatory or semiambulatory, but one or more of whom are not physically or mentally capable of responding to an electronic fire alarm by exiting the facility without help or verbal or physical prompting. 6. 'Class C nonambulatory (CNA).' A class C nonambulatory facility may serve residents who are ambulatory, semiambulatory or nonambulatory, but one or more of whom are not physically or mentally capable of responding to an electronic fire alarm by exiting the facility without help or verbal or physical prompting. (2) APPLICATION AND PROCESSING. (a) An entity that meets the criteria under s. 50.01(1g), Stats., shall apply to the department for licensure as a community based residential facility. (b) An application for licensure shall be on a form provided by the department and shall include a program statement, a floor plan, a background information form, community advisory committee information and all required fees. The facility shall provide additional information to the department upon request. (c) An individual shall submit a complete application for a license to the department for any of the following: 1. Initial licensure of a community based residential facility. 2. Transfer of ownership, regardless of whether the transfer includes title to the real estate. 3. Changing the location of the community based residential facility. (d) An individual shall submit an informational letter to the department for any of the following: 1. In a partnership, removing, adding or substituting an individual as a partner in the association, dissolving the existing partnership and creating a new partnership. 2. In a limited liability corporation, removing, adding, or substituting any member. 3. In a corporate structure, making a change under which the same corporation does not continue to be responsible for making operational decisions and for the consequences of those decisions. (e) A facility proposing any of the changes described in pars. (c) and (d) requires the department's approval before proceeding with the change. Note: For a copy of the application form for a CBRF license, write or phone the appropriate regional office of the Department's Division of Supportive Living. See Appendix A for the addresses and phone numbers of those offices. (3) PROGRAM STATEMENT. (a) Content. The program statement shall accurately include all of the following: 1. The name of the licensee, the administrator [JAH17]and the position in charge when the licensee or administrator is away. 2. The capacity of the facility. 3. The class of facility under par. (1)(b). 4. The client group to be served. If serving more than one client group, an explanation of how the client groups are compatible with one another. 5. A description of the program goals and services that is consistent with the needs of residents. [JAH18] 6. Respite care services, if provided. (b) Availability. A program statement shall be available to staff, residents and legal representatives of residents, and to persons seeking placement in the facility for themselves, a client, a relative or a friend. (c) Change in program statement. Any change in the client group, capacity or class of a facility shall be submitted to the department for approval. (4) FLOOR PLAN. A floor plan shall indicate[JAH19]: (a) Specifications. The size and location of all rooms, doorways and hallways. (b) Use of rooms. The planned use of each room, with the maximum number of residents to be accommodated in each sleeping room. (5) BACKGROUND INFORMATION[JAH20]. (a) Procedures. Prior to issuing an initial license and every 4 years following the issuance of an initial license, the department shall conduct a background information check on each applicant for an initial license or other occupant 10 years or older following procedures in s.50.065 and HFS 12. [JAH21] (b) Background investigation. For any applicant or existing licensee, the department shall consider at least all of the following: 1. The information contained in the license application submitted by the applicant. 2. The applicant or existing licensee's compliance history with this state's or any other state's licensing requirements and with any federal certification requirement. 3. The applicant or existing licensee's arrest history and criminal record, including any the of the following: a. Crimes or acts involving abuse or neglect of others or misappropriation of client property. b. Crimes or acts related to the manufacture, distribution, prescription, use or dispensing of a controlled substance. c. Crimes or unauthorized acts relating to obstruction of an investigation or official duties. 4. The applicant or existing licensee's administrative experience and history. 5. The applicant or existing licensee's financial stability, including financial history and viability of the owner or related party organization. 6. Outstanding debts or amounts due to the department or other government agencies, including unpaid forfeitures and fines. 7. The applicant or existing licensee's cooperation in providing required or requested information to the department. (6) COMMUNITY ADVISORY COMMITTEE. The license applicant shall provide evidence to the department that a good faith effort [JAH22]has been made to establish a community advisory committee under s. 50.03(4)(g). The department shall determine compliance with this requirement both prior to and after initial licensure. (7) SITE APPROVAL FOR CERTAIN AREAS. A facility may not be located on a parcel of land zoned for commercial, industrial or manufacturing use. If a waiver or variance is requested, the department shall consider the following: (a) proposed client group and their special needs. (b) length of stay of residents (c) programming offered by the facility (d) potential for resident interaction with the community (e) suitability of the premises for the client group (f) existing use of property near the proposed facility. (8[JAH23]) DEPARTMENT ACTION. Within 70 days after receipt of a complete application, as determined by the department, and following an on-site survey, the department shall approve or deny the license. (a) License approval. 1. 'All licenses.' a. A license is issued only for the premises and persons named in the application and is not transferable or assignable. b. A license is valid until suspended or revoked by the department. c. A community based residential facility shall post its license at the main entrance to the facility. 2. ' Probationary license' a. The department shall issue a probationary license to a fit and qualified applicant for any initial license. b. A probationary license is valid for 6 months from the date of issuance, unless sooner revoked. c. The department may inspect the facility prior to the expiration of the probationary license and, if the facility does not meet the applicable requirements for licensure or if the department determines that the applicant is not fit and qualified for regular license, the department may not issue a regular license. If the applicant holds a probationary license and the department determines that the applicant is fit and qualified, the department shall issue a regular license. (b) License denial or revocation. 1. 'Denial.' The department shall deny a probationary or regular license to any applicant who does not receive a favorable determination under sub. (5), who has been found by the department not to be in substantial compliance with this chapter or who has failed to pay any applicable fee or any outstanding amounts due to the department. The department shall provide the reasons for denial and the process for appealing that denial in a written notice to the applicant. 2. 'Revocation.' The department shall revoke the license of a licensee who has been found not to be in substantial compliance with this chapter or who has failed to pay any applicable fee or any outstanding amounts due to the department. The department shall give the licensee reasons, in writing, for the revocation and the process for appealing the revocation. 3. 'Effective dates.' Subject to s. 227.51, Stats., a denial or revocation is effective on the latest of any of the following: a. The date set by the department in the notice of denial or revocation. The department may extend this date to ensure the safe and orderly removal and relocation of residents. b. The date of the final action for contested case hearing under s. 227.44, Stats. c. The date of the final action for judicial review under s. 227.52, Stats., or stay granted under s. 227.54, Stats. 4. 'Appeal of the denial or revocation' a. Any person aggrieved by the denial of an application or revocation of a license under par. (b) may request a hearing on the department's decision under s. 227.42, Stats. Persons shall submit requests for hearing in writing to the department of administration's division of hearings and appeals within 10 working days after receipt of the notice of denial or revocation. b. A person requesting a hearing shall bear the burden of providing, by the preponderance of credible evidence, that the denial or revocation was unreasonable. Note: A hearing request should be sent to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707. The hearing request may be delivered in person to that office at 5005 University Avenue, Room 201, Madison, Wisconsin. (9) CHANGE OF OWNERSHIP OR LICENSE. (a) Need for new license. When there is a change of ownership or change in license type, the new owner or licensee shall meet all current requirements in this rule. All waivers or variances granted prior the change of ownership or change in license type shall be invalid upon the effective date of the change. (b) Duties of transferor. 1. The transferor shall notify the department at least 30 days prior to the final transfer. 2. The transferor shall remain responsible for the operation of the facility until a license is issued to the transferee, unless the facility has voluntarily closed and all residents were relocated. 3. The transferor shall disclose to the transferee any existing waiver or variance. 4. The transferor shall remain liable for all forfeitures assessed against the facility prior to the transfer of ownership. 5. The transferor shall follow requirements under HFS 83.33 (7). (c) Outstanding deficiencies. 1. Deficiencies reported in the departmental inspection prior to the transfer of ownership shall be corrected and verified by the department prior to issuing a license to the transferee. 2. The license issued to the transferee shall be subject to the plan of correction submitted by the previous owner and approved by the department. (10) FACILITY CLOSING. (a) All facilities. Any facility that intends to close shall notify the department in writing at least 30 days prior to closing and comply with all the relevant requirements under HFS 83.23. (b) Certain facilities. Under s. 50.03 (14), if a facility is closing, intends to close, changes its type or level of service or means of reimbursement and will relocate 5 residents or 5 % of residents, whichever is greater, the following shall occur: 1. 'Department action.' a. Within 10 days after receiving the preliminary plan, the department shall either approve the relocation plan or work with the facility to modify the relocation plan. b. If the plan is not approved or agreed upon within 30 days of receipt, the department may impose a plan that the facility shall carry out. c. The effective date of the relocation may not be earlier than 90 days from the date the relocation plan is approved by the department if 5 to 50 residents are to be relocated. d. The effective date of the relocation may not be earlier than 120 days from the date the relocation is approved by the department if 51 or more residents are to be relocated. 2. 'Facility responsibilities.' The facility shall: a. Provide at least 30 days written notice of the closing to the resident, resident's legal representative, if any, and members of the resident's family, if practicable, unless the resident requests the notice to the family be withheld; b. Attempt to resolve any outstanding complaints from residents; c. Identify and, to the greatest extend practicable, attempt to secure an appropriate alternate placement of each resident to be relocated; d. Consult the resident's physician on the proposed relocation's effect on the resident's health; e. Hold a planning conference to develop the resident's relocation plan with the resident, resident's legal representative, if any and a member of the resident's family, unless the resident requests that a family member not be present; f. Implement the resident's relocation plan developed under subd. 5; and g. Notify the department, in writing, of its intention to relocate residents. 3. 'Contents of notice.' The notification shall include: a. The proposed timeline for planning and implementation of relocation and the resources, policies and procedures the facility will provider or arrange in order to plan and implement the relocation. b. A list of the residents to be relocated. c. An indication of residents with legal representatives and the names and addresses of the legal representative. d. A list of residents who have been protectively place under ch. 55. e. A list of residents who the facility believes to be incompetent. SUBCHAPTER II - OPERATIONS HFS 83.11 Licensee and Administrator. (1) LICENSEE QUALIFICATIONS. (a) A licensee or licensee applicant shall, upon request by the department, produce evidence of financial stability to permit operation of the facility for at least 60 days. (b) A licensee or licensee applicant shall be fit and qualified under s. 50.03 (4) and HFS 83.04 (5). (c) A licensee or licensee applicant shall be at least 21 years of age. (2) LICENSEE RESPONSIBILITIES. (a) The licensee shall ensure the facility and its operation comply with all laws governing the facility and its operation. (b) At the time of hire, employment or contract and every four years after, the licensee shall conduct a caregiver background check on any individual who will be under the facility's control and is expected to have access to its residents or any individual permitted to reside at its facility who is expected to have access to its residents. (c) The licensee shall report any change in the client group in writing to the department at least 30 days before the change. A 30-day written notice of any change shall also be provided to each resident, his or her legal representative, referral agency and third party payer. (d) The licensee shall notify the department within 7 days after there is a change in the administrator. (e) The licensee shall ensure at least one copy of ch. HFS 83 is in the facility at all times and available for review by any resident, legal representative, or any employe at any time on request. (f) The licensee shall post next to the facility license any statement of deficiency, notice of revocation and any other notice of enforcement action initiated by the department on forms and in correspondence received from the department. Statement of deficiency, notices of revocation and other notices of enforcement action shall be posted immediately upon their receipt. A statement of deficiency shall remain posted for 30 days following receipt or until compliance is achieved, whichever is longer. Notices of revocation and other notices of enforcement action shall remain posted until a final determination is made[JAH26]. (g) The licensee shall make available the results of all department license renewal surveys, monitoring visits and any compliant investigations for the preceding 12 months when requested by any current or prospective resident, resident's legal representative, case manager or family member. (h) The licensee shall ensure the health, safety and welfare of all residents. (i) All other occupants shall be in such physical and mental health that they will not adversely affect the health, safety or welfare of residents. (j) The licensee shall not retaliate against any employe for reporting abuse or neglect of a resident, misappropriation of residents property or any violation of this chapter to the department, county or ombudsman's office. (3) ADMINISTRATOR RESPONSIBILITIES. (a) The facility shall be supervised by an administrator who is responsible for the supervision of personnel, finances, physical plant and the daily operation of the facility. A person present in and competent to supervise the facility shall be designated to be in charge whenever the administrator is not in the facility. (b) The administrator of a facility shall meet all of the following requirements: 1. Be at least 21 years of age. 2. Have completed high school or equivalent. 3. Have administrative experience or one post-high school course in business management.[JAH27] 4. Have one year of experience working with the client group or one post-high school course related to the needs of the client group. HFS 83.12 Employe. (1) JOB DESCRIPTIONS. Written job descriptions shall be available for all employes. An employe's job description shall outline the duties, responsibilities and qualifications required for the employe. (2) JOB QUALIFICATIONS. (a) Any employee shall have the physical and emotional capacity, education and experience to fulfill job requirements[JAH28]. (b) Any employe in charge of the facility at any time in the absence of the administrator shall be at least 18 years old. (c) Resident care staff shall be at least 18 years old.[DHFS29] (3) EMPLOYE PERSONNEL RECORD. (a) A separate record for each employe shall be maintained, be kept current, and contain sufficient information [JAH30]to support assignment to the employe's current position and duties. (b[JAH31]) Employe personnel records shall be available upon request at the facility for review by the department. (c[JAH32]) An employe's personnel record shall be available to the department for at least 3 years after ending employment. HFS 83.13 Infection control. (1) EMPLOYEE HEALTH-COMMUNICABLE DISEASE CONTROL. (a) There shall be documentation by a physician, physician assistant, clinical nurse practitioner or a licensed registered nurse [JAH33]indicating a prospective employe has been screened for clinically apparent communicable diseases and tuberculosis. The documentation shall be completed within 90 days before the start of employment[JAH34]. The documentation shall be kept confidential except the department shall have access to the documentation for verification. (b) The facility shall prohibit employes with a communicable disease or infected skin lesions direct contact with residents or their food, if direct contact will transmit the disease based on the Centers for Disease Control (CDC) and Prevention Guidelines for Isolation Precautions in Hospitals. Note: The Americans with Disabilities Act and the Rehabilitation Act of 1973 prohibits the denial of services to a person, and the termination or non-hiring of an employee based solely on the results of tuberculosis screening.[JAH35] (2) RESIDENT HEALTH. Each person admitted to the facility shall be screened for clinically apparent communicable disease, and tuberculosis. This screening shall take place within 90 days before admission or within 7 days after an emergency admission. The report shall be signed and dated by a licensed physician, physician's assistant, clinical nurse practitioner or a registered nurse. A person in respite care who will not be residing in the facility for more than 7 days or more than once in each calendar year is exempt from health examination requirements. Note: Screening for tuberculosis should be conducted using current accepted CDC standards. (3) INFECTION CONTROL PROGRAM. (a) The licensee shall establish and follow an infection control program using the universal precautions, transmission based precautions and the standard precautions contained in the U.S. Occupational Safety and Health Administration Standard 29 CFR 1910.1030 for the control of blood-borne pathogens for any employe who may be occupationally exposed to blood and any other potentially infectious material. (b) The licensee shall establish and follow an infection control program designed to provide a safe, sanitary and comfortable environment and prevent the development and transmission of disease and infection. (c) The infection control program for employes and residents shall include a written policy, training and implementation. (d) Every facility shall maintain a first aid kit that is readily available to all employes. Note: Information about universal, transmission based may be obtained from standard precautions may be obtained from a county or city health department or from the Department's Bureau of Public Health, Occupational Health Section 1 W. Wilson Street, P.O. Box 2659, Madison, WI 53701-2659[DHFS36]. (4) PEST CONTROL. There shall be safe, effective procedures for exclusion and extermination of insects, rodents and vermin. (5) PETS. (a) [JAH37]Pets may be allowed on the premises of a facility and shall be vaccinated against diseases, including rabies, if appropriate[JAH38]. Pets suspected of being ill or infested shall be treated immediately for their condition or removed from the facility. (b) Pens and cages shall be kept clean. (c) Pets shall be kept and handled in a manner that protects the well being of both residents and pets. (d) The wishes of residents shall be considered before a pet is allowed on the premises and at any time a resident expresses concern about a pet kept on the premises. HFS 83.14 Training. (1) INITIAL TRAINING. The administrator and all employes who work on the facility premises shall successfully complete training in fire safety, first aid and procedures to alleviate choking within 90 days after starting employment, unless exempt under sub. (6). (2) MINIMUM TRAINING. The administrator, resident care staff and other staff as specified in this section shall receive the following initial training within 6 months after starting employment, unless exempt under sub. (6). Minimum training shall cover: (a) Client related training. The administrator and all resident care staff shall successfully complete client related training in all of the following: 1. Resident rights. 2. Recognizing and responding to challenging behaviors. 3. Client group specific training. This training is specific to the client groups served by the facility including the characteristics of the client group served by the facility. These characteristics may include the group members' physical, social and mental health needs, specific medications, treatments and program services needed by the residents, needs of persons with a dual diagnosis, and maintaining or increasing social participation, self direction, self care and vocational abilities. Employes working in a facility serving more than one client group shall receive training for each client group the facility serves. 4. Responding to the individualized service plan (ISP). (b) Need assessment of prospective residents and individualized service plan development. The administrator and all staff involved in need assessment and individualized service plan development, unless specified under sub. (6), shall successfully complete training in need assessment of prospective residents and individualized service plan development. (c) Universal, Standard and Transmission-based precautions. The administrator and all employes who may be occupationally exposed to blood or any other potentially infectious material shall successfully complete training in the universal, standard and transmission-based precautions to prevent the transmission of blood-borne infections and infections from any other potentially infectious material. This training shall occur prior to the employe assuming any responsibilities that may occupationally expose him or her to blood or other potentially infectious material. Note: OHSA standards require an employer to provide an annual training update in the prevention of blood-borne infections to all staff who may come in contact with the blood of a resident. (3) TRAINING IN DETERMINING DIETARY NEEDS, MENU PLANNING, FOOD PREPARATION AND SANITATION. The administrator and all employes responsible for assisting with or supervising meals, determining dietary needs, menu planning, or food preparation shall have training in determining dietary needs, menu planning, food preparation and sanitation and shall complete training within 6 months after starting employment, unless exempt under sub. (6). (4) TRAINING IN MANAGEMENT AND ADMINISTRATION OF MEDICATIONS. The administrator and any non-medically licensed staff member who will manage or administer medications shall have training in management and administration of medications. Before the administrator or staff member provides any help to residents with prescribed or over-the-counter medications, they shall complete training and successfully pass an approved minimum competency test, unless exempt under sub. (6). (5) COMPETENCY TESTING. (a) Completion. 1. Employes required to complete training under sub. (1) through (3) shall complete training in the required time frame and pass a minimum competency test within 6 months after starting employment. 2. Employes required to complete training in management and administration of medications under sub. (4) shall complete training in the required time frame and successfully pass an approved minimum competency test before the employe provides any help to residents with prescribed or over-the-counter medications. (b) Source of testing. The competency test shall be administered by a source approved by the department. (c) Supervision. 1. Employes who have taken, but not successfully passed an approved competency test in the areas specified under sub. (1) through (3), shall receive direct supervision by the administrator or an employe who has passed an approved competency test. 2. Employes must successfully pass an approved competency test for medication training under sub. (4) before they can help residents with prescribed or over-the-counter medications. (6) EXEMPTIONS FROM TRAINING AND COMPETENCY TESTING. (a)Grandfathering. 1. Employes who successfully completed department approved training prior to the effective date of this rule shall be exempt from training under sub. (1) through (4) and competency testing under sub. (5). 2. A licensed physician, physician extender, licensed pharmacist, licensed nursing home administrator, registered nurse or licensed practical nurse are exempt from all training and competency in this section. (b) Initial training. Paramedics and emergency medical technicians are exempt from the training under sub. (1) and competency testing in first aid and procedures to alleviate choking. (c) Minimum training. 1. The following employes are exempt from the training under sub. (2)(a) 1. and 2. in resident rights, recognizing and responding to challenging behaviors, and sub. (2)(b) in assessing needs of prospective residents and developing individualized service plan, but shall pass an approved minimum competency test for these training areas within 6 months of the effective date of this rule or beginning employment: a. The administrator and resident care staff who have at least 2 years documented experience in their current or similar positions working with the client groups served by the facility. b. [JAH39]An alcohol and drug counselor certified under s. HFS 61. c. An alcohol counselor I registered with the Wisconsin alcohol and drug counselor certification board. d. A nurse aide listed on the directory under s. HFS 129. e. A person with a degree from an institution of higher education with a major in social work, psychology or a similar human service field. (c) Dietary training. The following staff members are exempt from dietary training under sub. (3) and competency testing in determining residents' dietary needs, menu planning, food preparation: 1. An administrator whose facility has a dietitian, on staff or under contract, who has direct or supervisory responsibility for determining dietary needs, menu planning, food preparation and sanitation. 2. A dietitian. 3. A staff member whose only responsibility is delivering meals. (d) Medication management and administration training. A medication aide who has completed training in a drug administration course approved by the department under s. HFS 132 is exempt from the training required under sub. (4) and competency testing in the management and administration of medications; (e) Employes providing transportation. An employe who has sole responsibility for transporting residents is exempt from the training and competency testing under this section except for that employe shall be trained in the following: 1. Residents rights under sub. (2)(a) 1. 2. Recognizing and responding to challenging behaviors under sub. (2)(a) 2. 3. Universal, Standard and transmission based precautions under sub. (2)(c). (7) TRAINING SOURCES AND RECORDS. (a) Training program. Required CBRF training programs shall include, at least, the instructional content contained in the department's training program manual. (b) Certificates. 1. CBRF training instructors shall provide certificates of completion to students. A certificate of completion shall include the name of the agency offering the approved training, the title of the training course, the name of the student, the name, title and signature of the instructor, the date of completion of the training program, and the number of training hours received. The training agency shall retain a copy of the student's certificate or attendance list. 2. The facility shall retain copies of training certificates and verification of the successful completion of competency testing in the employee personnel record. Certificates shall be made available to the department's representatives upon request. Note: To request a copy of the department's training program manual, send your written request to the department's bureau of quality assurance, 1 W. Wilson Street, P.O. Box 2969, Madison, WI 53701-2969. (8) INSTRUCTOR QUALIFICATIONS. A qualified instructor, as described in this subsection, shall provide CBRF training. (a) Grandfather clause. All instructors approved by the department prior to the effective date of this rule shall be qualified to continue training in their approved areas. (b) Initial training instructors. 1. An instructor providing training in fire safety shall be a fire fighter experienced by education or work or a person who has completed a department accepted train-the trainer course in fire safety. 2. An instructor providing training in first aide or procedures to alleviate choking shall be a licensed practical nurse, registered nurse, emergency medical technician or a trainer approved by the American Red Cross. (c) Resident service instructors. An instructor providing training in resident rights and grievance procedures, recognizing and responding to challenging behaviors, client group specific training, needs assessment and individualized service plans shall have one of the following: 1. Licensure as a registered nurse; 2. Licensure as a licensed practical nurse; 3. Certification as a social worker; 4. One year experience as a CBRF Administrator working with the client group addressed in the training program or, 5. Two years post-high school education in a human service, health care, or educational field and prior completion of the training required under 83.14 (2). (d) Infection Control instructors. Instructors providing training in Standard, Transmission-based and Universal Precautions shall have: 1. Licensure as a registered nurse or; 2. Licensure as a licensed practical nurse; 3. One year direct resident care experience in a health care setting and prior completion of the required CBRF infection control training. (e) Medication management instructors. Instructors providing training in medication management and administration of medications shall have: 1. Licensure as a registered nurse or; 2. Licensure as a registered pharmacist. 3. Licensure as a licensed practical nurse or be a medication aide and under the supervision of a registered nurse or registered pharmacist. (f) Dietary instructors. Instructors providing training in dietary needs, menu planning, food preparation and sanitation shall have: 1. Licensure as a registered dietician; 2. Licensure as a registered nurse; 3. Licensure as a licensed practical nurse; 4. One year post-high school training in food service management and successful completion of the required CBRF dietary training and competency testing in dietary needs, menu planning and food preparation; or 5. One year experience in dietary management, menu planning, food preparation and sanitation and successful completion of the required CBRF dietary training and competency testing. (9) ORIENTATION AND CONTINUING EDUCATION. (a) Orientation. Except in emergencies, each employe of a facility shall receive appropriate orientation before performing any job duties that include: 1. The employe's job responsibilities. 2. General administration, personnel policies and recordkeeping requirements. 3. Emergency plan and evacuation procedures under s. HFS 83.42(3). 4. Assessed needs and individual services for each resident the employe is responsible. (b) Continuing education. The administrator and resident care employe of the facility shall receive at least 12 hours per calendar year of continuing education beginning with the second full calendar year of employment. Continuing education shall be relevant to their job responsibilities. (10) DOCUMENTATION. All training, orientation and continuing education shall be documented by the licensee, administrator or designee in the employe's personnel file and signed by the employe at the time it is received. HFS 83.15 Staffing. (1) ADEQUATE STAFFING. (a) The facility shall provide staff in sufficient numbers on a 24-hour basis to meet the needs of the residents. (b) An administrator or other qualified resident care employe designated to be in charge of the facility shall be on the premises of the facility daily to ensure safe and adequate [JAH40]care, treatment, services and supervision are being provided to residents. (c) 1. At least one qualified resident care staff member shall be present in the facility when one or more residents are in the facility. 2. In addition to the requirement of par. (1)(c) 1., there shall be at least one qualified resident care staff in the facility from 9 p.m. to 7 a.m. for every 15 residents who require a class C licensed facility in a building without sprinklers. In a building with sprinklers, the resident care staff ratio shall be at least one qualified resident care staff for every 20 residents who require a Class C licensed facility[JAH41]. 3. The licensee or administrator shall maintain a current list of all residents and the class of facility licensure needed by each resident. This list shall be available to the department. (d) At least one qualified resident care staff shall be on duty in the facility and awake if at least one resident in need of continuous care is in the facility.[JAH42] (e) At least one staff person shall be on duty in the facility and awake if the evacuation capability of at least one resident is 4 minutes or more. (f) When all of the residents are away from the facility, at least one qualified resident care staff member shall be on call to open the facility and provide staff coverage if a resident needs to return to the facility prior to the regularly scheduled return. A means of contacting the staff person on call shall be provided to each resident or to the program the resident is in when the staff person is away from the facility. (2) WRITTEN STAFFING SCHEDULE. (a) The facility shall maintain a current written schedule for staffing the facility. The schedule shall include the number of staff and their responsibilities[JAH43]. Staff work schedules[JAH44], including actual hours worked, shall be retained in the facility for a period of 2 years.[JAH45] 83.16 [DHFS46]Reporting requirements. (1) DEATH. (a) Related to physical restraint, psychotropic medication or suicide. Upon the death of a resident, the facility shall report the death to the department as required under s. 50.035, Stats., within 24 hours after it occurs if there is reasonable cause to believe the death was related to the use of a physical restraint, psychotropic medication or was a suicide. (b[JAH47]) Not related to physical restraint, psychotropic medication or suicide. When a resident dies as a result of an incident or accident not related to the use of a physical restraint or psychotropic medication, and the death was not a suicide, the facility shall send a report to the department within 3 working days.[JAH48] Note #1: Deaths not to be reported to the department are those resulting from natural causes, such as a heart attack, a stroke or an illness, when none of the circumstances in pars. (a) or (b) were involved. Note #2: Providing notice under this subsection does not relieve the licensee or other person of any obligation to report an incident to any other authority, including law enforcement and the coroner (2) ABUSE, NEGLECT AND MISAPPROPRIATION REPORTING. A facility shall report to the department any allegation of an act, omission or course of conduct under HFS 13 as client abuse or neglect or misappropriation of client property committed by any person employed or under contract with the facility. The facility shall submit its report on a form provided by the department within 7 calendar days from the date the facility knew or should have known about the misconduct. The report shall contain whatever information the department requires. Note: For copies of the report form, write or phone the Bureau of Quality Assurance, Caregiver Registry and Investigation Section, P.O. Box 2969, Madison, WI 53701-2969. Return completed reports to the same address. (3) OTHER REPORTING[JAH49]. A facility shall send a report to the department within 3 working days after any of the following occurs: (a) Missing resident. When a resident's whereabouts is unknown and the resident is considered missing and in danger. The local law enforcement authority shall be notified as soon as this determination is made. This does not apply to residents under the jurisdiction of government correction agencies. (b) Police intervention. At any time the police are called to the facility as a result of actions or incidents that seriously jeopardize the health, safety or welfare of residents or staff. A description of the circumstances requiring police intervention shall be provided to the department. This requirement does not apply to residents under the jurisdiction of government correction agencies. (c) Unusual occurrence. Any unusual[JAH50] occurrence resulting in serious injury requiring medical treatment of a resident. (d) Catastrophe. If a catastrophe occurs resulting in damage to the facility. (4) DOCUMENTATION. (a) Minimum information. Reporting of incidence under sub. (1) and (3) shall require at a minimum the following information: 1. Date, time, place and individuals involved in the occurrence; 2. Details and events surrounding the occurrence; 3. Individuals and entities contacted regarding the occurrence; and 4. The action taken by the facility regarding the occurrence. (b) Author. The report shall be written or contributed to by the employe who observed or first discovered the incident. (c) Availability. The facility shall retain reporting documentation and make it available to the department upon request. Note: Providing notice under this subsection does not relieve the licensee or other person of any obligation to report an incident to any other authority, including law enforcement. SUBCHAPTER III - ADMISSIONS, TRANSFERS AND DISCHARGE 83.21 Limitations on admissions and retention. (1) LICENSE LIMITATIONS. (a) No facility may house more residents, including respite care residents, than the maximum bed capacity on its license. (b) No individual requiring care beyond what the facility is licensed to provide may be admitted to or retained in the facility[JAH51]. (c) The facility shall comply with all other conditions of the license. (2) ADMISSION AND RETENTION LIMITATIONS (a) No facility may admit or retain any person who: 1. Is confined to a bed by illness or infirmities, except a person who has a temporary incapacity [DHFS52]or a person who is terminally ill and is receiving care, treatment or services. 2. Is destructive of property or self, or physically or mentally abusive to others, unless the facility has sufficient resources to care for them and are able to protect the resident and others. 3. Has physical, mental, psychiatric or social needs that are not compatible with the facility's client group or with the care, treatment or services provided by the facility. 4. Needs more than 3 hours of nursing care per week. Exception is made for a temporary condition needing more than 3 hours of nursing care per week if needed for no more than 90 days. The department may grant a waiver or variance to this requirement if the resident has a stable medical condition that may be treatable or a long-term condition needing more than 3 hours of nursing care per week for more than 90 days;[JAH53] the resident is otherwise appropriate for facility's level care; and the services needed to treat the resident's condition are available in the facility. 5. Requires 24-hour supervision by a registered nurse or licensed practical nurse. 6. Requires care above intermediate level nursing care. 7. Requires a chemical or physical restraint except as authorized under HFS 83.31(3)(n). 8. Is incapacitated, unless a legal representative has been established and properly activated as defined under Ch. 880, Ch. 155, Ch. 51, Ch. 50 or Ch. 55. a. Persons found incompetent under s. 880.33, Stats., shall not be admitted to a facility licensed for 16 or more residents unless there is a court-ordered protective placement under s. 55.06, Stats., prior to admission[JAH54]. b. If a resident of a facility licensed for 16 or more residents is found incompetent under s. 880.33, Stats., the licensee or administrator shall send a written notice to the legal representative that a court-ordered protective placement must be obtained under s. 55.06, Stats., for the resident's continued stay in the facility. c. The legal representative of a person found incompetent under s. 880.33, Stats., may consent to the admission or retention of a non-protesting person in a facility licensed for 15 or fewer residents without a court-ordered protective placement under s. 55.06, Stats. If the person being admitted to the facility verbally objects to or otherwise actively protests to admission, the administrator of the facility shall immediately notify the protective services agency in the county of residence of that person's objection. The facility shall request a representative of the county protective agency visit the person as required under s. 55.05(5)(c), Stats. Note: Section 55.05(5)(c), Stats, requires a representative of the county protective services agency visit the incompetent person no later than 72 hours after notification by the facility, to carry out the procedures required in this statute. (3) ADMISSION OF MINORS. (a) A minor shall not be admitted or retained as a resident without approval of the department and only if any of the following apply: 1. The facility is also licensed under ch. HFS 57 as a group foster care home or under ch. HFS 52 as a child caring institution except that the department may waive certain requirements in those chapters related to physical plant, fire safety, organization and administration. 2. The minor has been waived to an adult court under s. 938.18, Stats., or has been tried as an adult under s. 938.02. (b) A minor child of an adult resident shall not reside in the facility without approval of the department and only if all of the following apply: 1. The adult resident retains custody and control of the child. 2. The requirements in Table 83.51 regarding minimum bedroom area and s. HFS 83.51(3) regarding minimum congregate dining and living area shall apply to the child. 3. The facility shall have written policies related to the presence of minors in the facility, including policies on parental responsibility, school attendance and any care, treatment or services provided to the minors by the facility. HFS 83.22 Funding eligibility. (1) PRE-ADMISSION COP ASSESSMENT. Prior to admission, the facility shall notify the individual or that individual's legal representative, in writing, of the requirement to have a pre-admission assessment under s. 46.27 (7)(cg) 3.a., regardless of the individual's ability to pay, in order for the individual to be eligible for community options program (COP) and waiver funding s. 20.435 (7)(bd) and (im). HFS 83.23 [DHFS55]Discharge or transfer. (1) APPLICABILITY. (a) Respite care. This section applies to all resident discharges and transfers except for persons in respite care. (b) Temporary transfers. A resident temporarily transferred to a hospital or nursing home for treatment not available from the facility shall not be involuntarily discharged from the facility when the resident's absence is for 21 days or less. (2) CONDITIONS. (a) Initiated by resident. 1. Any competent resident may initiate transfer or discharge from the facility at any time in accordance with the terms of the admission agreement if the resident is not in the custody of a governmental correctional agency, committed under s. 51.20, Stats., or under a court-ordered protective placement under s. 55.06, Stats. 2. If a newly admitted resident found incompetent under s. 880.30, Stats., protests the admission, the licensee or designee shall notify the legal representative and the county protective services agency within 72 hours to obtain a determination about whether to discharge the resident under s. 55.05(5)(c), Stats. (b) Initiated by facility. 1. Except as provided in subd. 2, before a facility transfers or discharges a resident, the licensee shall give a 30 day written advance notice to the resident or the resident's legal representative. The licensee shall explain to the resident or legal representative the need for or possible alternatives to the transfer or discharge, and shall provide assistance in relocating the resident. A living arrangement suitable to meet the needs of the resident shall be located prior to the transfer of the resident. 2. The notice requirement under subd. 1 does not apply: a. To correctional clients. b. During the first 30 days following initial placement. c. If there is an emergency discharge. Notice of emergency discharge shall be given as soon as feasible after the need for discharge arises. (c) Prohibitions and exceptions. Except as provided under s. 50.03(5m), Stats., no resident may be involuntarily discharged or transferred from a facility except for any of the following: 1. Nonpayment of charges, following reasonable[JAH56] opportunity to pay any deficiency. 2. The resident requires care beyond what the facility is licensed to provide. 3. The resident requires care inconsistent with the facility's program statement and beyond what the facility is required to provide under this chapter. 4. A plan of treatment or services established with the resident and the resident's legal representative at the time of admission, as documented in the resident's individualized service plan, is completed and the resident can no longer benefit from remaining in the facility. 5. Medical reasons as ordered by a physician. 6. A medical emergency or disaster. 7. There is imminent risk of serious harm to the health or safety of the resident, other residents or staff, as documented in the resident's record. 8. The resident's short-term care period has expired. 9. The resident violates a specific condition established in the admission agreement. 10. As otherwise permitted by law. (d) Department review of discharge or transfer[JAH57]. 1. A resident or the resident's legal representative may request the department to review an involuntary discharge or transfer decision. Every notice of discharge or transfer under par. (b) to a resident or the resident's legal representative shall be in writing and include all of the following: a. A statement that the resident or the resident's legal representative may request the department to review any notice of involuntary discharge or transfer to determine if the discharge or transfer is in compliance with the provisions of this chapter and ch. 50 or 51, Stats. The statement shall include the list of prohibitions and exceptions under par. (c). b. The name, address and telephone number of the department's division of supportive living's regional office that licenses the facility. 2. If the resident or the resident's legal representative wants the department to review the discharge or transfer, that person shall send a letter to the department's division of supportive living regional office that licenses the facility asking for a review of the decision and explaining why the discharge or transfer should not take place. The written request shall be postmarked no later then 7 days after receiving a notice of discharge or transfer from the facility. The resident or the resident's legal representative shall send a copy of the letter to the facility administrator at the same time he or she sends the letter to the department. If a timely request is sent to the department, the resident shall not be discharged or transferred from the facility until the department has completed its review of the decision and notified the resident or his or her legal representative and the facility of its conclusion. 3. Within 5 days after receiving a copy of a request for review, the facility may provide written justification to the department's division of supportive living regional office for the discharge or transfer of the resident. 4. The department shall complete its review of the facility's decision and notify the resident or the resident's legal representative and the facility, in writing, of its conclusion within 14 days after receiving written justification for the discharge or transfer from the facility.[JAH58] Note: See Appendix A for the addresses and phone numbers of the Department's Division of Supportive Livings' regional offices. (e) Prohibition of coercion and retaliation. Any form of coercion to discourage or prevent a resident or legal representative from requesting a department review of any notice of involuntary discharge or transfer is prohibited. Any form of retaliation against a resident or legal representative for requesting a department review, or against an employe who assists in submitting a request for department review or otherwise providing assistance with a request for review, is prohibited. (f) Removal or disposal of resident's belongings. The belongings of a resident who is discharged or transferred shall be moved with the resident or disposed of under law unless the resident makes other arrangements for their removal within 30 days after discharge. This paragraph does not apply to a resident who: 1. Is under the legal custody of a governmental correctional agency. 2. Is under the legal jurisdiction of a criminal court, flees from the facility and for whom there is an apprehension order. 3. Has requested a department review of his or her discharge under par. (d) until the department has completed its review. (3) INFORMATION TO BE PROVIDED AT THE TIME OF TRANSFER OR DISCHARGE. [JAH59]At the time of transfer or discharge, the facility shall be [JAH60]provide, in writing to the resident, the resident's legal representative, or the new place of residence, all of the following information: (a) Facility information. The name and address of the facility, the dates of admission and discharge or transfer from the facility, and the name and address of a person to contact for additional information. (b) Medical providers. Names and addresses of the resident's physician, dentist and other medical care providers. (c) Emergency contacts. Names and addresses of the resident's relatives or legal representative who should be contacted regarding care or services provided to the resident, or in case of emergency. (d) Other contacts. Names and addresses of the resident's significant social or community contacts. (e) Assessment and ISP. The resident's assessment and individualized service plan, or a summary of each. (f) Medical needs. The resident's current medications and dietary, nursing, physical and mental health needs if not included in the assessment or individualized service plan. (g) Reason for discharge or transfer. The reason for the resident's transfer or discharge. (h) Involvement in discharge. A description of how the resident and the resident's legal representative were involved in discharge planning and a summary of the options discussed. SUBCHAPTER IV - RESIDENT RIGHTS AND PROTECTIONS HFS 83.31 Rights of residents. (1) LEGAL RIGHTS. (a) Section 50.09, Stats., establishes specific rights for the residents and prescribes mechanisms to resolve complaints and to hold the facility licensee accountable for violating those rights. Other statutes, such as s. 51.61, Stats., and chs. 55, 304, and 880, Stats., and ch. HFS 94 may further clarify or condition a particular resident's right, depending on the legal status of the resident or a service being received by the resident. The licensee shall comply with all related statutes and rules. (b) The licensee shall protect the civil rights of residents as these rights are defined in the U.S. Constitution, the Civil Rights Act of 1964, Title VIII of the Civil Rights Act of 1968, Section 504 of the Rehabilitation Act of 1973, the Fair Housing Amendments Act of 1988, the Americans with Disabilities Act of 1990, and all other relevant federal and state statutes. (2) EXPLANATION OF RESIDENT RIGHTS AND HOUSE RULES. (a) Before or at the time of admission, the facility staff shall explain resident rights, the grievance procedure under s. HFS 83.32 (5) and the house rules of the facility to the person being admitted, the person's legal representative , and family members of the person. When an admission is being made on an emergency basis, the explanation of resident rights, grievance procedure and house rules may be done within 5 days after admission. The resident or the resident's legal representative shall sign a statement to acknowledge the receipt of an explanation of resident rights. (b) Before the admissions agreement is signed or at the time of admission, the licensee shall provide copies of the house rules, resident rights and grievance procedures to the resident, and the resident's legal representative[JAH61]. (c) Copies of the house rules, resident rights and grievance procedures shall be posted in each facility in a prominent public place accessible to residents, staff and guests.[JAH62] (3) RIGHTS OF RESIDENTS. Any form of coercion to discourage or prevent a resident or the resident's legal representative from exercising any of the rights under this subchapter is prohibited. Any form of retaliation against a resident or the resident's legal representative for exercising any of the rights in this subchapter, or against an employe who assists a resident or the resident's legal representative to exercise any of the resident right in this subchapter, is prohibited. Except as provided under sub. (5), each resident shall have the right to: (a) Private and unrestricted communications with the resident's family, physician, attorney and any other person[JAH63] shall not be restricted. The right to private and unrestricted communications shall include the right to: 1. Receive, send and mail sealed unopened correspondence and packages. No resident's incoming or outgoing correspondence shall be opened, delayed, held or censored. 2. Make and receive telephone calls within reasonable limits [JAH64]and in privacy. The facility shall provide at least one non-pay telephone to which the resident has access and may require long distance calls be made at the resident's own expense. 3. Have private visitors and adequate time and private space for visits. (b) Manage the resident's own financial affairs, as provided in s. 50.09(1)(c), Stats. (c) Be treated with courtesy, respect and full recognition of the resident's dignity and individuality by all employes of the facility. (d) Have physical and emotional privacy in treatment, living arrangements and in caring for personal needs. (e) Be fully informed, in writing, prior to or at the time of admission of all services included in the per diem rate, other services available, and the charges for those services. The resident shall be informed, in writing, of any changes in services available or in charges for services. (f) Present grievances on the resident's own behalf or others behalf to the facility staff or administrator, to public officials or to any other person without justifiable fear of reprisal, and to join with other residents or individuals within or outside of the facility to work for improvements in resident care. (g) Confidentiality of health and personal records, and the right to approve or refuse their release to any individual outside the facility, except when the resident is transfer to another facility as required by law or third-party payment contracts and except as provided in s.146.82(2) and (3), Stats. Copies of the record shall be available to a resident or legal representative on request at a cost no greater than the cost of reproduction. ( (h) Not be required by the facility to perform labor that is of any financial benefit to the facility. Personal housekeeping is an exception and may be required of the resident without compensation if it is for therapeutic purposes and is part of the resident's individual service plan. This responsibility shall be clearly identified in the house rules of the facility. (i) Meet with and participate in the activities of social, religious and community groups at the resident's discretion. (j) Retain and use personal clothing and effects. As space permits, other personal possessions shall be retained in a reasonably secure manner. (k) [JAH65] Be free from physical, sexual and mental abuse and neglect, and from financial exploitation and misappropriation of property. (l) Be free from seclusion. (m) [JAH66] Be free from all chemical restraints, including the use of an as-necessary (PRN) order for controlling acute, episodic behavior[JAH67]. (n) Be free from physical restraints unless authorized by the department and written authorization from the resident's primary physician approves their use. (o) Receive all prescribed medications in the dosage [JAH68]and at intervals prescribed by the resident's physician. (p) Receive prompt and adequate treatment that is appropriate to the resident's needs. (q) Exercise complete choice of providers of physical and mental health care, and of pharmacist. (r) Receive all treatments prescribed by the resident's practitioner, and to refuse any form of treatment unless the treatment has been ordered by a court. The resident shall be fully informed of the treatment and care and participate in the planning of the treatment and care. (s) To participate in the religion of the resident's choice. (t) Have the least restrictive conditions necessary to achieve the purposes of admission to the facility. No curfew, rule or other restriction on a resident freedom of choice shall be imposed (u) Not be recorded, filmed or photographed without informed, written consent by the resident or resident's legal representative. A photograph may be taken for identification purposes. ( (v) [JAH69] Live in a safe environment. The facility shall safeguard residents who cannot fully guard themselves from an environmental hazard to which it is likely that they will be exposed, including both conditions which would be hazardous to anyone, and conditions which are hazardous to the resident because of the resident's condition or handicap. (4) INCOMPETENCY. If the resident is adjudged to be incompetent under Ch. 51 or 880 and not restored to legal capacity, the rights and responsibilities established under this section shall be passed to the resident's legal representative. (5) CORRECTIONAL CLIENTS[JAH70]. The rights established under sub. (3) do not apply to a resident in the legal custody of the department of corrections except as determined by the department of corrections. HFS 83.32 Grievance procedure. (1) All facilities shall have a written grievance procedure and shall provide a copy to each resident and the resident's legal representative. The grievance procedure shall specify all of the following[JAH71]: (a) A resident or any individual on behalf of the resident may file a grievance [JAH72]with the facility, the department, the resident's case manager, if any, the State Board on Aging and Long Term Care, the Wisconsin Coalition for Advocacy for persons with mental or physical disabilities, or any other organization providing advocacy assistance. The resident or the resident's legal representative shall have the right to advocate throughout the grievance procedure. The written grievance procedure shall include the name, address and phone number of organizations providing advocacy for the client groups served by the facility, and the name, address and phone number of the department's regional office that licenses the facility. (b) Any person investigating the facts associated with a grievance shall not have had any involvement in the issue leading to the grievance. (c) Any form of coercion to discourage or prevent any individual from filing a grievance or in retaliation for having filed a grievance is prohibited. (d) A written summary of the grievance, the findings and the conclusions and any action taken shall be provided to the resident or the resident's legal representative and the resident's case manager. A copy of the investigation shall be maintained in the facility for two years. (e) If a resident is placed or funded by a county department of social services under s. 46.21 or 46.22, Stats., a county department of human services under s. 46.23, Stats., a county department of community programs, under s. 51.42, Stats., or a county department of developmental disabilities services under s. 51.437, Stats., the county grievance procedure under s. HFS 94.29, shall also be used. (2) A facility shall assist its residents with the resident grievance procedure, advocacy organizations and the court as needed. (3) A poster provided by the board on aging and long-term care, concerning the long-term care ombudsman program under s. 16.009(2)(b), Stats, which includes the name, address and telephone number of the ombudsman[JAH73] shall be posted in a conspicuous location in the facility. This requirement does not apply to those facilities exclusively licensed to serve clients under the jurisdiction of the department of corrections. HFS 83.33 Resident funds. (1) AUTHORIZATION. The facility may not obtain, hold, or spend a resident's funds without written authorization from the resident or the resident's legal representative. (2) SEPARATION OF RESIDENT FUNDS. Any resident's funds held or controlled by the facility, and any earnings from them, shall be credited to the resident. The resident's funds may be co-mingled with the funds of other residents, but shall not be co-mingled with the funds or property of the facility, the licensee, staff, or relatives of the licensee or staff. (3) HOLDING RESIDENT FUNDS. (a) Upon written authorization, a facility may hold no more than $200 petty cash for use by the resident. (b) Every facility shall have a legible, accurate accounting for tracking resident's petty cash and shall include a record of all deposits and disbursements made to or on behalf of the resident. The facility shall provide a receipt with all expenditures in excess of $20.00. (c) The facility shall provide a written report of the resident's account to the resident or the resident's legal representative at least every 6 months or as provided under s. 50.09(1)(c) Stats. (d) A facility receiving more than $200 of personal funds from a resident shall deposit the funds in an interest-bearing account in a savings institution insured by an agency of, or a corporation charted by this state or the United States. This excludes any funds submitted as payment to the facility for the cost of services[JAH74]. (4) FINAL ACCOUNTING. Within 10 days after discharge,[JAH75] the facility shall provide a written final accounting of a resident's funds held by the facility to the resident or the resident's legal representative and disperse any remaining money. (5) PROPERTY [JAH76]AND GIFTS. No facility licensee, administrator or employe may sell real or personal property to a resident or prospective resident or purchase, borrow or accept money for real or personal property from a resident or prospective resident. This paragraph does not apply to payments owed to the facility for services provided, gifts of nominal value offered by the resident, and donations made to the facility with the knowledge of the resident's legal representative[JAH77]. (6) SECURITY DEPOSIT. (a) If a facility collects a security deposit, the security deposit shall be deposited in an interest-bearing account insured by an agency of, or a corporation chartered by, this state or the United States.[JAH78] (b) The security deposit account shall be separate from other funds of the facility. (c) The interest shall be at the actual interest earned, and shall be paid upon discharge of the resident to the person who made the security deposit. (7) TRANSFER OF FINANCIAL RESPONSIBILITY. If ownership of a facility is transferred from one licensee to another licensee, the transferor shall: (a) Notify the transferee in writing of any financial relationships between the transferor and residents. (b) Notify each resident or legal representative in writing where a financial responsibility exists, of the pending transfer. A resident shall have the option of continuing or discontinuing the resident's financial relationship with the new licensee.[JAH79] (8) AUDIT. (a) An audit of a facility may be required when there is reason to believe a resident's funds have been mismanaged. (b) The audit shall be completed by a certified public accountant and paid by the licensee. HFS 83.34 Admission agreement[JAH80]. (1) NOTIFICATION OF SERVICES. (a) The facility shall provide written information regarding services available in the facility and the charges for those services, including any charges for services not covered by the facility's per diem rate to each resident or the resident's legal representative before, or at the time of admission, and periodically during the resident's stay. (b) A facility shall provide written notice to a resident or the resident's legal representative of any change or occurrence under par. (2) that affects the resident. If the change or occurrence is relevant to a provided or purchased service, notice shall be given to any professional responsible for the resident's care, the resident's physician, any contract agency and any third party payer. (c) A 30-day written [DHFS81]notice shall be given of any change in services available or in charges for services that will be in effect for more than 30 days. (2) ADMISSION INFORMATION. Admission to a facility is contingent on a person or that person's legal representative signing an acknowledgement that information was given orally and in writing in a language understood by the prospective resident. The information shall include all of the following: (a) An accurate description of the basic services provided by the facility, the rate charged for those services and the method of payment for them. (b) Information about all additional services regularly offered, but not included in the basic services. The facility shall provide a written statement of the fees charged for each of these services. (c) The method for notifying residents of a change in rates or fees. (d) Terms for refunding advance payments, including entrance fees or security deposits, in the case of transfer, death or voluntary or involuntary discharge. (e) Terms of holding and charging for a bed during a resident's temporary absence. (f) Conditions for involuntary discharge or transfer, including transfers within facility. (g) The names, addresses and telephone number of all pertinent state resident advocacy groups like the department survey and licensing agency and the state ombudsman program. (h) The admissions agreement shall include a written notice that, upon request, the results of all department license renewal visits, monitoring visits and complaint investigations, if any, for the period of 12 months preceding the request, and a copy of this chapter are available for review. (3) CONFLICT WITH THIS CHAPTER. No statement of admission information may be in conflict with any part of this chapter. SUBCHAPTER V - SERVICE REQUIREMENTS HFS 83.41 General requirements. (1) RESIDENT RECORD. (a) The facility shall maintain a record for each resident at the facility. (b) Resident's record shall include all of the following: 1. Identification information and admission data, including: a. Resident's full name, sex, date of birth and social security number. b. Name, address and telephone number of nearest kin, and legal representative, if any. c. Medical, social and, when applicable, psychiatric history. d. Current personal physician, if any. 2. Results of initial and subsequent health assessments or medical examinations, the admissions agreement, significant incident and illness reports, assessments the resident's individualized service plan, documentation to accurately reflect the resident's progress, response to treatment, changes in treatment, the evaluations and reviews, discharge papers and any department-approved use of a physical restraint. 3. All physician's orders, including, when applicable, orders concerning medications supervised or administered by the facility, treatment, diets, and physical restraints. 4. A photocopy of any court order or other document authorizing another person to speak or act on behalf of the resident. 5. The date, time and circumstances of the resident's death, including the name of the person to whom the body is released. (c) The licensee shall ensure all resident records are adequately safeguarded against destruction, loss or unauthorized access or use. In a facility with 20 or more residents, there shall be an office where resident records are kept. (d) [JAH82] The licensee shall retain a resident's record for at least 7 years after the resident's discharge. [JAH83]All other records required by this chapter shall be maintained for two years. (2) CHANGE AFFECTING A RESIDENT. (a) A facility shall provide notice to a resident or the resident's legal representative of any change or occurrence under pars. (b) and (c) that affects the resident. If the change or occurrence is relevant to a provided or purchased service, notice shall be given to any professional responsible for the resident's care, the resident's physician, any contract agency and any third party payer. (b) Immediate notice shall be given to a resident's physician and the persons listed in par. (a) when there is an injury to the resident or a significant adverse change in the resident's physical or mental condition. (c) [JAH84]1. Immediate notice shall be given to the persons listed in par. (a) when physical, sexual or mental abuse of a resident is alleged. Notice to persons listed in par. (a) shall be given within 72 hours when misappropriation of property is alleged, unless the alleged misappropriation of property is likely to cause a significant adverse change in condition whereupon notice under par. (a) shall be immediate. 2. A report of physical, sexual or mental abuse of a resident or misappropriation of the resident's property shall include time, place, details of the occurrence and action taken by the provider including arranging for services from an outside provider. Note: Providing notice under this paragraph does not relieve the licensee or other person of the obligation to report an incident to other authorities, including law enforcement. HFS 83.42 Assessment and individualized service plan. (1) ASSESSMENT. (a) Admission. Each person admitted to a facility shall be assessed by the facility before admission to identify the person's needs and abilities in all areas listed in sub. (1)(b). For an emergency admission made by a county agency, the facility shall attempt to obtain the resident's assessment information from the county agency within 5 days after admission. (b) Interview. The assessment shall be based upon the current diagnostic, medical and social history obtained from the person's health care providers, case manager and other service providers. A face-to-face interview by the administrator or designee with the person and his or her legal representative, if any, shall be held to determine what the person views as his or her needs, abilities, interests, and expectations are from the facility. The assessment shall cover all of the following areas pertinent to the resident: Note: Other service providers may be a psychiatrist, psychologist, a licensed therapist, counselor, occupational therapist, physical therapist, pharmacist or registered nurse. 1. Physical health, including identification of chronic, short-term and recurring illnesses, physical disabilities and the need for any restorative or rehabilitative care. Note: See HFS 83.21(2)(a) which prohibits the admission or retention of residents needing more than 3 hours of nursing care per week for more than 30 days, require care above the intermediate level of nursing care, who require 24 hour nurse supervision or whose personal care needs cannot be met by the facility or community agencies. 2. An assessment of the medications taken by the resident and the resident's ability to control and administer his or her own medications[JAH85]. If it is determined that the resident is unable to control or administer his or her own medications, the facility shall identify the responsibility it will have for monitoring, controlling or administering the medications. Note: See s. HFS 83.43 regarding medications. 3. Nursing procedures needed by the resident and the number of hours per week of nursing care needed by the resident. 4. Mental and emotional health, including the resident's self-concept, motivation and attitudes, symptoms of mental illness and participation in treatment and programming[JAH86]. 5. Behavior patterns that are or may be harmful to the resident or other persons and the measures to be taken to supervise, control and prevent harm to the resident. Note: Potentially harmful behavior patterns include, but are not limited to: wandering, self-abusive behavior, the propensity to easily choke on certain foods such as peanut butter, pica (an eating disorder), suicidal tendencies, and persons who are destructive of property or self or physically or mentally abusive to others. 6. Capacity for self-care, including the need for any personal care services, adaptive equipment or training. 7. Capacity for self-direction, including the ability to make decisions, to act independently and to make the resident's wants or needs known. 8. Social participation, including interpersonal relationships, leisure time activities, family and community contacts and vocational needs. (c) Family participation. Unless permission is denied by the resident or the resident's legal representative, the facility shall provide evidence that family members have been given an opportunity to provide relevant information for the assessment, unless reaching family members is unreasonably difficult or they do not want to participate in the assessment[JAH87]. (d) Initial service plan. Upon admission an initial service plan [JAH88]shall be prepared and implemented to meet the immediate needs of the resident based on the initial assessment. (2) INDIVIDUALIZED SERVICE PLAN. (a) Scope. Based on the assessment under sub. (1), an individualized service plan (ISP) shall be developed for each resident setting goals. Services are provided or arranged by the facility and prescribe an integrated program of individually designed activities and services necessary to achieve those goals. The plan shall specify which program services under s. HFS 83.43 will be provided to the resident to meet the resident's needs as identified by the assessment under sub. (1), and the frequency of each service. The plan shall identify the service provider responsible for each element of care or service prescribed in the plan. The plan shall be formulated in writing within 30 days after the person's admission.[JAH89] (b) Development. The resident and the resident's legal representative shall be involved with staff of the facility in developing the resident's service plan. If a resident has a medical prognosis of terminal illness, a hospice program or home health care agency, as identified in s. HFS 83.45 shall, in cooperation with the staff of the facility, coordinate the development of the resident's service plan and its approval under s. 83.45 (2). [JAH90]If the resident has a case manager, a health care provider, a registered nurse or pharmacist who will be supervising the administration of medications, or any other service provider, that person or those persons shall be invited to contribute to the development of the service plan. (c) Implementation. The individualized service plan shall be implemented by facility staff and other individuals identified in the plan and followed as written. (d) Annual evaluation. 1. Within 30 days prior to the annual evaluation under subd. 2, the resident and the resident's legal representative shall be offered the opportunity to complete a written or oral evaluation of the resident's level of satisfaction with the facility's services. The evaluation shall be written on either a department form or a form developed by the facility that is approved by the department. If the resident's evaluation is given orally, the resident's legal representative or a facility staff member of the resident's choice shall record the resident's response on the form. The responses shall be incorporated into the evaluation process under subd. 2. 2. The facility shall evaluate the resident's abilities and needs and the goals and services to meet them at least annually. The resident's assessment report and individualized service plan shall be updated to reflect the results of the evaluation and signed by the resident or the resident's legal representative. (e) Significant change in condition. When a resident's condition undergoes a significant change, the stability of the resident's condition shall be evaluated. (f) Review of progress. Each resident's individualized service plan shall be reviewed when indicated by a change in the resident's condition or at least every 6 months. (g) Information for resident supervision. The administrator shall ensure any employe providing supervision, care or treatment to a resident has: 1. Reviewed the resident's assessment and individualized service plan prior to assuming any responsibility for a resident. 2. Continual access to the assessment and individualized service plan for the resident. 3. Information on any behavior patterns of a resident that are or may be harmful to the resident or other individuals prior to assuming any responsibility for the resident. (h) Behavioral referral. The administrator shall refer to an appropriate behavioral provider or health care provider for evaluation or treatment any resident who has behavior patterns that appear to be harmful to the resident or other individuals or who is destructive of property or self or physically or mentally abusive to others. This referral shall occur if facility staff are unable to control, manage or prevent the behavior. HFS 83.43 Program services. (1) SERVICES. Each facility shall provide all of the following general services at a level and frequency needed by residents: (a) Personal care. Personal care services or training when indicated by the needs of the residents. (b) Independent living skills. Teaching and providing opportunities for a resident to increase or maintain the resident's independence that are appropriate to the resident's abilities. (c) Communication skills[JAH91]. Teaching and providing opportunities to increase the resident's skills or to minimize natural decline in the ability to make wants and needs known, to listen and understand. (d) Socialization and leisure time activities. Each facility shall provide and actively promote resident participation in a program of daily activities designed to provide needed stimulation consistent with the interests of the resident. (e) Assistance with self-direction. Helping the resident increase the resident's motivation and ability to make decisions, and to act independently. (f) Health monitoring. 1. Each facility shall ensure each person being admitted receives a health examination to identify health problems and to screen for communicable disease, with the report signed and dated by a licensed physician, physician's assistant, clinical nurse practitioner or registered nurse. The examination shall take place within 90 days before admission or within 7 days after an emergency admission. A person in respite care who will not be residing in the facility for more than 7 days or more than once in each calendar year is exempt from health examination requirements.[JAH92] 2. Each resident shall have a follow-up health examination at least annually after admission, unless the resident is already being seen by a physician more frequently. 3. A facility shall monitor the health of residents and make arrangements for needed health or mental health services unless otherwise arranged for by the resident. Providers of services shall be informed of all changes in status related to the service provided. Communication with the resident's physician and other service providers, and any changes in the resident's health or mental health status shall be documented in the resident's record. (g) Medications administration instruction. The facility shall offer medication administration instruction for those residents with the mental and physical capacity to develop increased independence in medication administration as prescribed in 83.44 (1)(b). [JAH93] (h) Nursing care. 1.No more than 3 hours of nursing care per week are allowed for each resident despite who provides or arranges for services. Exception is made for a temporary condition lasting no more than 90 days. The [JAH94]department may grant a waiver or variance to this requirement for a resident who has a stable medical condition that may be treatable or a long-term condition needing more than 3 hours of nursing care per week for more than 90 days when the resident is otherwise appropriate for facility level care and the services needed to treat his or her condition are available in the facility. 2. The nursing care procedures and the amount of time spent each week by a registered nurse or licensed practical nurse in performing the nursing care procedures with a resident shall be recorded in the resident's record when given. Only time actually spent by the nurse with the resident may be included in the calculation of nursing care time. (i) Supervision. Each facility shall provide supervision of its residents, appropriate to the resident's needs[JAH95]. (j) Information and referral. Each facility shall provide information and referral to appropriate community services to its residents. (k) Community activities. Each facility shall provide information and assistance to facilitate each resident's participation in personal and community activities. Monthly schedules and notices of community and facility activities, including costs to the resident, shall be developed, updated and made accessible to all residents. (l) Family contacts[JAH96]. Each facility shall encourage its residents to maintain family contacts and shall help in arranging family contacts, if needed. (m) Transportation. Each facility shall provide or arrange for transportation for residents when needed for medical appointments, work, an educational or training program, religious services and for a reasonable[JAH97] number of community activities of interest to the residents. (n) Medical services. 1. Each facility shall ensure there is a physician's written order for nursing care, medications, rehabilitation services and therapeutic diets provided or arranged by the facility. 2. All nursing care, medications, herbal preparations, rehabilitation services and therapeutic diets received by a resident shall be documented in the resident's record. (o) Advance directives. A facility shall comply with the provisions of chs. 154 and 155, Stats., regarding advance directives. Staff of the facility shall provide prompt and adequate treatment, consistent with an advance directive. A facility shall not require an advance directive as a condition of admission or as a condition of receiving any health care service. HFS [JAH98]83.44 Medications. [JAH99](1) MEDICATION ADMINISTRATION. (a) Self-administered by resident. 1. Prescribed and over-the-counter medications and herbal preparations shall be self-administered by a resident unless the resident has been found incompetent under s. 880.33, Stats., or does not have the physical or mental capacity to self-administer as determined by the resident's physician, or the resident requests in writing that CBRF staff manage and administer medication. 2. When a resident self-administers medications, prescribed and over-the-counter medications and herbal preparations shall remain under the control of the resident. A secure place accessible to the resident shall be provided in the resident's room for the storage of medications. (b) Self-administration instruction. For transition to a less restrictive setting or to promote greater independent functioning, a resident with the mental and physical capacity to develop increased independence in medication administration shall receive self-administration instruction. When a resident is participating in a medication instruction program, the facility shall ensure all of the following are met: 1. The resident's assessment under HFS 83.42(1) shall include an evaluation of the resident's capability or potential capability to self-administer medication. 2. The resident's individualized service plan under HFS 83.42(2) shall contain measurable goals for self-administration of medication and shall include the services and activities necessary to achieve those goals. 3. There shall be a valid practitioner's order for a resident to participate in self-administration instruction. 4. Self-administration instruction shall be under the ongoing supervision of the attending physician, a registered nurse, or pharmacist or shall be reviewed by the attending physician, a registered nurse, or a pharmacist semi-annually or when the resident's self-administration program goals are met or revised. 5. Medical record documentation shall include a daily record of the type and dosage of medication taken, the date and time it was taken, and shall be initialed by the person administering the medication. 6. The medical record shall include semi-annual progress notes documenting the resident's progress with self-administration instruction. 7. Minimum labeling, packaging, and storage requirements under HFS 83.44(3) must be followed unless the attending physician or pharmacist directs in writing an alternative labeling, packaging, or storage system to meet the individual needs of the resident. 8. Staff members assisting residents with self-administration instruction are required to complete the training and competency testing under HFS 83.14(4). (c) Administration by CBRF staff. When a facility staff are administering medications to residents, the facility shall ensure all of the following are met: 1. There shall be a valid practitioner's order for any prescribed and over-the-counter medications administered by the facility. 2. Before providing any help to residents with prescribed or over-the-counter medications, a non-medically licensed staff member shall complete the training and competency testing under HFS 83.14. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 3. The staff member shall be under the general or direct supervision of a registered nurse or the prescribing practitioner except as provided under subd. 1(a) or 1(b). The individual supervising staff shall: a. Participate in the resident's assessment under s. HFS 83.42(1) and individual service plan under s. HFS 83.42(2) regarding the resident's medical condition and the goals of the medication regimen. b. Participate in the evaluation under s. HFS 83.42(2)(d) 2 and the review and documentation of the progress or regression under s. HFS 83.42(2)(f) of the resident's medical condition and status in relation to the goals of the medication regimen. c. Provide adequate supervision to unlicensed personnel who administer medications that is dependent on their education, training and experience and the resident's medical condition. 4. Resident record documentation shall include at a minimum, the type and dosage of medication taken, the date and time taken, any change in the resident's condition observed by the staff person and any comments made by the resident related to his or her condition. 5. A registered nurse, physician, pharmacist or licensed practitioner shall administer injections and draw medication, unless delegated as prescribed under the Nursing Standards of Practice, Chapter N 6. A licensed practical nurse can administer injections and draw medications for a resident with a stable medical condition. 6. If the resident's medication administration is not under the ongoing supervision of a registered nurse or pharmacist, the resident's prescription medications shall be packaged and labeled by a pharmacist in unit dose or unit time packets. Medications available over-the-counter may be excluded from unit dose or unit time packaging requirements, unless specified by a physician to be unit dosed. (2) GENERAL REQUIREMENTS. (a) Practitioner's order. There shall be a valid practitioner's order for any prescription medication taken by or administered to a resident and a pharmacist shall label the medication. (b) Documentation. When a resident is taking prescription or over-the-counter medications or herbal preparations, the resident's record shall include a current list of the type and dosage of medication, directions for use, any change in the resident's condition and any comments made by the resident related to his or her condition. (c) Drug Regimen Review. The administrator or designee shall arrange for a pharmacist or a physician to review each resident's medication regimen for positive resident outcomes and assurance of proper medication administration. This review shall occur within 30 days after the person's admission to the facility and at least every 12 months.[DHFS100] A written report of findings shall be prepared and sent to the administrator. When the review is done by someone other than the prescribing practitioner, the prescribing practitioner shall receive a copy of the report when there are recommendations to change the resident's medication regimen. (b) (d) More than one prescriber. When more than one practitioner prescribes medication for a resident, the licensee shall provide a list of all currently ordered medications for the resident to all practitioners prior to any of them prescribing medications. If this information is not provided before a prescription is written, the licensee shall update the resident's primary practitioner or pharmacist prior to the administration of the first dose of any new medication ordered. This requirement does not apply to residents who self-administer medications. (e) Discontinued medications. All discontinued medications shall be destroyed or removed from the facility within 72 hours of a practitioner's order discontinuing its use, the resident's discharge, death, loss of medication dosage form integrity, removal of the medication from the medication package or the medication expiration date. Medications not destroyed shall be returned to the resident or legal representative for removal from the facility. (f) Destruction of medication[DHFS101]. Any unused medication not returned to the resident or legal representative shall be destroyed by the facility in compliance with local ordinances. A record of the destruction shall be witnessed, signed and dated by the administrator or designee and one other employee. (g) Psychotropic medications. When a psychotropic medication is prescribed for a resident, the facility shall do all of the following: 1. Ensure all resident care staff understands the potential benefits and side effects of the medication. 2. Ensure the resident is reassessed as needed, but at least quarterly for the desired responses and possible side effects of the medication. 3. Document the actions required under subds. 1 and 2 in the resident's record. 4. The use of an as needed psychotropic medication for an unstable condition requires the following: a. An assessment, in person or by phone, by a licensed nurse, physician, pharmacist or licensed practitioner. b. The resident's medical condition and service provided by the facility shall be recorded in the resident's medical record for all medications administered to the resident on an as-necessary (PRN) basis and when the resident's medical condition changes. (h) Proof-of-use record. A proof-of-use record for schedule II drugs shall be maintained and contain the date and time administered, the resident's name, the practitioner's name, dose, signature of the person administering the dose, and the remaining balance of the drug. A separate proof-of-use sheet shall be completed for each type and strength of drug. (i) Audit. The proof-of-use records shall be audited, signed and dated daily by a registered nurse or designee. In facilities where a registered nurse is not present, the administrator or designee shall perform the audit of proof-of-use records daily. (j) Medication error or adverse reaction. 1. Any prescription or over-the-counter medication error, known adverse drug reaction or resident refusal to take medication shall be documented in the resident's record. 2. The facility shall report all medication errors and adverse drug reactions to a licensed practitioner, supervising nurse or pharmacist immediately. The facility shall report a resident's refusal to take a medication to the prescribing practitioner, supervising nurse or pharmacist within 24 hours if the refusal seems detrimental to the resident. In all other cases of resident refusal of medication, the facility shall report to the prescribing practitioner, supervising nurse or pharmacist as soon as possible after the resident refuses a medication for 2 consecutive days or as otherwise directed by the prescribing practitioner. (3) MEDICATION STORAGE. (a) Transfer. 1. Medications shall be stored in their original containers and not transferred to another container except by a practitioner, supervising nurse or other appropriately licensed person. This requirement does not apply to residents who self-administer their medications. 2. If a medication is administered by facility staff and the medication is transferred from the original container, the facility shall meet all of the following requirements: a. The administration of medication by a staff member shall be delegated as prescribed under the nursing standards of practice in ch. N6. b. The new container shall have a readable label that includes at a minimum, medication name, dose and instructions for use. (b) Controlled by facility. 1. When prescription and over-the-counter medications or herbal preparations are controlled by the facility for residents under subd. (1)(b) or (1)(c), medicine cabinets shall be kept locked and the key available only to personnel identified by the facility. 2. If a resident under subd.(1)(b) or (1)(c) has an absence from the facility, the resident's medication shall be prepared and dispensed for that absence by a practitioner or pharmacist or their agents and employes as directed, supervised and inspected by the pharmacist or practitioner. (c) Refrigeration. Medications requiring refrigeration stored in a common refrigerator shall be kept in a locked box and properly labeled. (d) Proximity to household chemicals. Prescription and over-the-counter medications shall not be stored next to household chemicals or other contaminants. (e) Internal and External application. Medications for internal consumption shall be physically separated from medications for external application. (f) Controlled substances. Separately locked and securely fastened boxes or drawers or permanently fixed compartments within the locked medications area shall be provided for storage of schedule II drugs subject to 21 USC 812(c), and Wisconsin's uniform controlled substance act, ch. 161, Stats. (4) EXEMPTIONS. Any facility that exclusively serves correctional clients or residents who are alcohol or drug dependent is exempt from the requirements in sub. (1)(a) 2. and (2)(c). Medications in these facilities may be stored in a central, secure area and staff may observe and record residents who self-administer medication as described in the resident's individual service plan. 83[JAH102].45 Terminally ill resident services. (1) GENERAL REQUIREMENTS. A person with a terminal illness may be admitted to or retained in a facility, even if requiring more than 3 hours of nursing care per week, if all of the following requirements are met: (a) A hospice program licensed under s. 50.95, Stats., and ch. HFS 131 or a home health agency licensed under s. 141.15, Stats., and ch. HFS 133 of the resident's choice shall be the primary care provider and shall have the authority and responsibility under its respective license for any palliative care to the resident or supportive services to the resident's family unless the resident or the resident's legal representative refuses the services of a hospice program or a home health agency. If the resident or legal representative refuse the services of a hospice program or a home health agency, all of the following shall apply: 1. The licensee shall ensure the resident and the resident's legal representative have been provided with information about the types of services generally offered to a terminally ill person by a hospice program or a home health agency. This includes an opportunity for the resident and the resident's legal representative to speak with a representative of a hospice program or home health agency and to review literature from at least one of these agencies regarding its services to a terminally ill person. These efforts to ensure the resident or resident's legal representative is making an informed decision shall be documented in the resident's record. 2. If the terminally ill resident or the resident's legal representative continues to refuse the services of a hospice program or a home health agency after the requirements under subd. 1 have been met, the terminally ill resident and the legal representative shall sign a form approved by the department waiving the requirement under this paragraph for the services of a hospice program or a home health agency. The resident or the resident's legal representative may revoke this waiver at any time by signing a statement of revocation on a form approved by the department. 3. When a resident or the resident's legal representative waives the services of a hospice program or home health agency, the facility shall develop and implement the written plan of care required under sub. (2), which shall be reviewed and approved by the resident's primary physician, and shall provide or arrange for all of the care, treatment and services needed by the terminally ill resident. 4. If the terminally ill resident requires more than 3 hours of nursing care per week, the resident shall receive the services of a hospice program or a home health agency under par. (a) to remain in the facility. (b) All the care and services provided by the facility shall be coordinated by the primary care provider under par. (a) unless the resident or the resident's legal representative have waived the services of a hospice program or home health agency under par. (a)2. (2) PLAN OF CARE. (a) A written plan of care shall be developed by the primary care provider and the facility before admission or within 20 days after the prognosis of terminal illness for a resident. The plan of care shall be approved by a physician. (b) The plan of care shall: 1. Identify the needs of the resident and the care to be provided to the resident. 2. Describe the services that will be provided to the resident, to the resident's relatives who have maintained contact with the resident and to the resident's legal representative. 3. Be reviewed and updated by a physician, the primary care provider and the facility as the medical condition and needs of the resident change. HFS 83.46 Food service. (1) GENERAL REQUIREMENTS. (a) Kitchen on premise. When a facility has a kitchen or dietary area on the premises, it shall be adequate to meet food service needs and shall be arranged and equipped for food refrigeration, storage, preparation, and serving, dish and utensil cleaning, cleaning compound storage, waste receptacle washing, refuse storage and removal. The facility shall serve each resident with nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident. (b) Service of meals. Meals provided by the facility shall routinely be served family style or restaurant style, unless contraindicated for a resident's individualized service plan short-term medical needs. (2) RESIDENT NUTRITIONAL CARE (a) Diets. 1. The daily diet of all residents shall, at a minimum, include a variety of foods and meet the recommended daily allowance in the "Food Guide Pyramid, Guide to Daily Food Choices," published by the U.S. department of agriculture, unless otherwise ordered for a resident by the resident's physician or a dietitian. Note: To obtain a copy of the Food Guide Pyramid, write or phone: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion, 1120 20th Street NW, Suite 200, North Lobby, Washington, DC 20036, (202) 606-8000 or www.usda.gov/cnpp . 2. A resident's physician or a dietitian shall be consulted if a resident is consistently[JAH103] not eating enough food to maintain nutritional adequacy or experiences significant weight change. A record of the consultation and resulting steps taken to encourage better eating shall be maintained in the resident's record. 3. A modified or special diet and dietary supplements shall be provided as ordered by a resident's physician or a dietitian[JAH104]. (b) Frequency of meals. 1. The facility shall provide at least 3 meals a day, unless otherwise arranged according to the facility's program statement or the resident's individualized service plan. 2. A nutritious snack shall be available to residents in the evening[JAH105]. 3. If a resident is away from the facility during the time a meal is served, adequate food shall be provided to the resident on the resident's return. (c) Menu planning. 1. Menus for meals and snacks shall at a minimum, include a variety of foods and meet the recommended daily allowance in the "Food Guide Pyramid, Guide to Daily Food Choices," published by the U.S. department of agriculture. 2. Written menus shall be prepared in advance of their use and available to residents. 3. Each menu shall be dated and kept on file for 30 days. 4. There shall be reasonable adjustments to the food likes, habits, customs, conditions and appetites of the individual resident. 5. Menus shall be substantially followed. (3) FOOD SUPPLY. The facility shall procure food and beverages from sources that comply with applicable food safety and protection laws and requirements as recommended by the United States department of agriculture (USDA), the food and drug administration (FDA) and state and local agencies. (4) STAFF. (a) Work habits. Clean and safe work habits shall be maintained by all personnel who prepare or serve food. (b) Infection control. Personnel showing evidence of open, infected wounds, or communicable diseases transmitted by food handling, including diarrhea and jaundice, shall be relieved of their duties until the conditions are corrected. (5) SANITATION AND SAFETY. (a) Food safety. The facility shall store, prepare, distribute and serve food under sanitary conditions and dispose of garbage and refuse properly. (b) Work areas, equipment and utensils. The facility shall clean and sanitize all food contact surfaces, equipment and utensils used for preparing, serving and consuming food in accordance with current food and drug administration standards and manufacturers' recommendations, and store equipment and utensils in a clean manner. Note: The facility is required by ch. HFS 145.04 to report suspected incidents of food-borne disease to the local public health officer. SUBCHAPTER VI - PHYSICAL ENVIRONMENT AND SAFETY HFS 83.51 Physical environment. This subchapter is intended to ensure that all facilities provide a living environment for their residents that is safe, clean, comfortable and homelike. (1) CONGREGATE DINING AND LIVING AREA. (a) Arrangement. A facility shall be so arranged and furnished that the residents may spend the majority of non-sleeping hours outside of their bedrooms or apartments. (b) Space per resident. 1. The minimum congregate dining and living area in the facility shall be 60 square feet per resident, other occupant, or 90 square feet per resident or other occupant if any resident, or other occupant is nonambulatory, but able to move from place to place, or if the resident requires assistance from staff with eating. 2. For each resident living quarters that is an apartment with a separate bedroom that meets the requirements under sub. (2) and has other habitable rooms, 25% of the total floor space of the habitable rooms in the apartment, not including bedroom or bathroom floor space, may be applied toward the required congregate dining and living area requirement in subpar. (b) 1., but not to exceed 30 square feet per resident. 3. Dining facilities shall be of sufficient size to allow all residents to eat together in no more than two shifts. (c) Access. All required dining and living areas within the facility shall be internally accessible to every resident of the facility. (d) Furniture and furnishings. All congregate rooms shall contain furnishings and furniture appropriate to the intended use of the room. (e) Other uses. Adequate space and equipment shall be designated to meet the needs of the residents for social and recreational activities. (f) Ceiling height. All congregate rooms shall have an average ceiling height of at least 6'8" feet. (2) RESIDENT BEDROOMS. (a) Design and location. 1. Resident bedrooms shall be designed and equipped for the comfort and privacy of residents and shall be equipped with or conveniently located near toilet, washing and bathing facilities. A resident bedroom shall only be used to provide sleeping and living space for the residents and shall be internally accessible to congregate dining and living areas. 2. Resident bedrooms shall be enclosed by continuous full-height walls, or partitions with rigid construction swing-type doors that are of the side-hinged or pivoted swinging type. 3. Means of egress to a required exit or a route to gain access to any other part of the facility shall not be through an intervening bedroom, including a bedroom of a resident, licensee, administrator, employe, or other occupant of the facility. 4. Each resident bedroom shall have an average ceiling height of at least 6'8" feet. 5. In large facilities, all resident rooms shall be numbered on or near the door. (b) Capacity. 1. Except as provided in subd. 2, a resident bedroom in a building constructed and licensed prior to January 1, 1979 shall accommodate no more than 3 persons. 2. A resident bedroom in a building constructed and licensed on or after January 1, 1979 shall accommodate no more than 2 persons. 3. Persons of the opposite sex shall not be required to occupy the same sleeping room. (c) Size. 1. A resident bedroom shall have at least the number of square feet indicated in Table 83.51. Table 83.51 MINIMUM AREA PER RESIDENT IN A BEDROOM, IN SQUARE FEET Class of Existing Building New Construction Licensure Single Occupancy Multiple Occupancy Single Occupancy Multiple Occupancy AA & CA (Ambulatory) 80 60 100 80 AS & CS (Semiambulatory) 100 80 100 80 ANA & CNA (Nonambulatory) 100 80 100 80 2. A bedroom occupied by residents who require different classes of licensure shall meet the highest applicable square footage requirement in Table 83.51 for all residents in the bedroom. (d) Additional requirements for basement and ground floor bedrooms. If any bedroom is located in the basement as defined under s. Comm 51.01(10) or on the ground floor as defined under s. Comm 51.01(67), each floor level shall have at least two means of exiting that provide unobstructed egress to the outside at street or grade level. The exits shall not be windows in the basement and ground floor bedrooms. Note #1: Section Comm 51.01(10) BASEMENT. A basement floor is that level below the first or ground floor level with its entire floor below exit discharge grade. Note #2: Section Comm 51.01(67) GROUND FLOOR. A ground floor is that level of a building on a sloping or multilevel site which has its floor line at or no more than 3 feet above exit discharge grade for at least one-half of the required exit discharges. (e) Bed arrangements. 1. Beds shall be located either the minimum distance from heat producing sources recommended by the manufacturer or 18 inches, whichever is greater. Beds may be closer than 18" to a forced air register, but may not block it. When a bed is less than 18" from a forced air register there shall be a deflector on the register that directs the heat to the floor. 2. There shall be least 3 feet between beds. (f) Semi ambulatory and non ambulatory residents. Semi ambulatory and non ambulatory residents shall have adequate accessible space for storage of a resident's wheelchair or other adaptive or prosthetic equipment. Bedrooms shall meet the requirements for a barrier-free environment as specified under HFS 83.55. (3) BEDROOM FURNITURE AND LINENS[DHFS106] (a) Personal furnishings. Each resident shall have the opportunity to use his or her own bedroom furnishings. (b) Facility provided furnishings[DHFS107]. Each resident who does not choose to use his or her own bedroom furnishings shall be provided all of the following: 1. A separate bed of proper size and height for the convenience of the resident. Beds shall be at least 36 inches wide of sturdy construction and provided with a clean suitable mattress, pillow and necessary coverings for each resident. 2. Drawer space shall be available in the bedroom for clothing, toilet articles, and other personal belongings of the resident. 3. A closet or wardrobe shall be available in the bedroom. Clothes racks and shelves shall be provided in the closet or wardrobe. A closet or wardrobe shall be an enclosed space at least 24 inches wide by 18 inches deep by 5 feet in height for each resident. 4. A clean pillow. 5. A mattress pad. When a moisture-proof mattress cover is used, there shall be a washable mattress pad the same size as the mattress over the moisture-proof mattress cover. 6. Mattress and pillow covers as necessary to keep mattresses and pillows clean and dry. 7. Two blankets, 2 sheets and a pillowcase. 8. A washcloth, hand towel and bath towel. (4) LAUNDRY. (a) Appliance ratios. Laundry appliances shall be readily available to residents who are responsible for doing their own laundry. At least one washer and one dryer shall be available to every 20 residents who do their own laundry. (b) Clean linen availability. Clean sheets, pillowcases, towels and washcloths shall be available at least weekly and shall be changed as necessary to assure cleanliness and freedom from odors. (c) Linen storage. There shall be separate clean linen and dirty linen storage areas or containers. Storage containers shall be clean, leakproof and have a tight fitting lid. Transporting, washing or rinsing soiled linens shall not be done in areas used for food preparation, serving and food storage. (d) Fire protection from dryer. Any residential clothes dryer having a rated capacity of more than 37,000 Btu/hour shall be enclosed in a one-hour fire resistive rated enclosure as specified under s. Comm 51.043. Dryer vent tubing shall be metal constructed and kept clean and maintained. (e) Laundry for large facilities[DHFS108]. In a large facility, a laundry room shall be provided unless commercial laundry facilities are used. All soiled linen shall be placed in nonabsorbent closed containers. Where commercial laundries are used, a separate room for sorting, processing and storing clean and soiled linen shall be provided. (5) HEATING AND VENTILATING. Heating and ventilating equipment shall be provided and installed as specified by the department of commerce. (a) Heating. 1. A facility shall be capable of maintaining comfortable and safe temperatures. Tempered air shall be provided at all times to eliminate cold air drafts. The heating system shall be capable of maintaining a temperature of 74°F. The temperature in habitable rooms shall not be permitted to fall below 70°F during periods of occupancy. A higher or lower temperature may be provided, if possible, if requested by a resident. Any new construction built after the effective date of this rule shall not exceed 81°F air temperature. A level of humidity that is comfortable for the residents shall be maintained in the facility during the heating season. 2.The heating system shall be maintained in a safe and properly functioning condition. A heating contractor or local utility company shall do all of the following maintenance and written documentation of the maintenance performed shall be available at the facility: a. An oil furnace shall be serviced at least once each year. b. A gas furnace shall be serviced at least once every 3 years. c. The chimney shall be inspected at intervals corresponding with the heating system service in subd. 2 to ensure that it is free of any obstruction and that it is in good repair. 3. The use of portable space heaters is prohibited except electric heaters that have an automatic thermostatic control and are physically attached to a wall. Oil-fired, kerosene, gas and alcohol space heaters are prohibited. 4. The use of any other fuel-fired heater is prohibited unless it is properly vented to the outside. 5. Any wood burning stove or fireplace in a facility shall have a flue separate from the one used by a gas or oil fired furnace or boiler. The entire installation shall meet the requirements in NFPA standard 211. The flue shall be cleaned as often as necessary, but at least 2 times during each heating season, except that when a wood burning stove or fireplace is used for no more than 4 days each month of the heating season, the flue shall be cleaned at least once during each heating season. Written documentation of the maintenance performed shall be available at the facility. 6. No combustible materials of any kind may be placed within 3 feet of any furnace, boiler, water heater, fireplace or other like equipment. 7. Any other open flame combustible fuel burning device shall be enclosed with a one hour fire rated assembly when sharing a common floor with a resident room. A fireplace described in Comm 64.22 (7) is exempt from this requirement. (b) Ventilation. 1. Kitchens or cooking areas shall have at least one openable outside window or an exhaust fan vented to the outside, if required by state building code. 2.Bath and toilet rooms shall have at least one openable outside window of at least 2 square feet of openable area or mechanical or gravity exhaust vented to the outside or an approved or listed ductless exhaust fan. 3. Transom, transfer grills and louvers shall not be used in bedroom walls or doors opening directly to an egress corridor. 4. In large facilities, continuous ventilation shall be required at a minimum rate of two air changes per hour in the resident area corridors, and food preparation and storage, lounge, dining, therapy and recreation areas. Continuous ventilation is not required in a refrigerated storage room. Corridors shall be under positive pressure and shall not be used as air handling plenums. (6) BATH AND TOILET FACILITIES. (a) Bath and toilet rooms. 1. Each small facility shall have at least one bathroom and one toilet room or one combination bath and toilet room for the use of residents and the public that is accessible from public, non-sleeping areas. 2. Each medium facility [DHFS109]shall have at least 2 separate bathrooms and toilet rooms or 2 combination bath and toilet rooms for the use of residents and the public that are accessible from public non-sleeping rooms. 3. Each large facility shall have separate bath and toilet facilities for male and female residents, unless used by a married couple. The minimum ratios shall be one bath, one toilet and one sink for every eight female residents and one bath, one toilet, and one sink for every eight male residents. 4. Bath and toilet rooms shall have at least one electrical fixture to provide artificial light and one electrical duplex outlet receptacle. 5. Toilets, bathtubs and showers used by residents shall provide for individual privacy, unless staff assistance is indicated by resident needs. Door locks shall be provided to ensure privacy, except where the toilet, bath or shower room is accessible only from a resident room which is occupied by only one person, a married couple or persons who are all related. All door locks shall be operable from both sides in an emergency. 6. All bathing facilities shall be equipped so they are accessible without staff assistance. Note: Accessible bathing facilities may include a lipless shower, grab bar, or a shower or tub equipped with a transfer seat. 7. All toilet and bathing areas, facilities and fixtures shall be kept clean and in good working order. 8. All toilet and bathing areas shall have full height walls. 9. a. In a class AA or CA facility, toilet and bathing areas for residents shall be distributed so the maximum vertical travel distance from resident living, dining and sleeping rooms is no more than one floor level. b. Toilet and bathing areas for residents shall be available on each floor in Class AS, ANA, CS and CNA facilities. (b) Number of fixtures. 1. The facility shall provide in the ratio of at least one toilet, one sink, and one bath or shower for every 10 residents and other occupants or fraction thereof. 2. When fixtures are accessible only through a sleeping room, they may only be counted as meeting the requirement for the occupants of that sleeping room. (c) Water supply. 1. Each sink, bathtub and shower shall be connected to hot and cold water and adequate hot water shall be supplied to meet the needs of the residents. 2. The temperature of all domestic water heaters connected to sinks, showers and tubs used by residents shall be set at a temperature of at least 140°F. The temperature setting of other water heaters, like those connected to dishwashers and clothes washing machines, may exceed these temperatures. The temperature of water at fixtures used by residents shall be automatically regulated by valves and may not exceed 115°F. Regulated valves shall automatically reduce flow to 0.25 gpm or less when the tempered water supply to the fitting outlet exceeds 115ºF. 3. The fixtures at sinks accessible to residents shall be the single nozzle, lever-handled mixing type fixtures or the single nozzle, 2 handled mixing type fixtures which are easy to control by all residents. 4. When a public water supply is available, it shall be used to provide potable water. When a public water supply is not available, the well shall be approved by the state department of natural resources. Water samples from an approved well shall be tested at the state laboratory of hygiene or other laboratory approved under ch. HFS 165 at least annually. (7) SEWAGE DISPOSAL. All sewage shall be discharged into a municipal sewer system or shall be collected, treated and disposed of by an independent sewer system approved under ch. NR 110. (8) SEPTIC SYSTEMS. A septic system shall meet the requirements in s. Comm 83.055. (9) PLUMBING. The plumbing for potable water drainage for the disposal of wastes shall comply with applicable state plumbing standards. (10) CLEANLINESS OF ROOMS. The facility shall keep all habitable rooms clean and shall make reasonable attempts to keep these rooms free from odors. (11) MAINTENANCE. (a) Building integrity. The building shall be maintained in good repair and free of hazards such as cracks in floors, walls or ceilings, warped or loose boards, warped, broken, loose or cracked floor covering, loose handrails or railings, loose or broken window panes and any similar hazard. (b) Systems. All electrical, mechanical, water supply, fire protection and sewage disposal systems shall be maintained in a safe and functioning condition. (c) Plumbing. All plumbing fixtures shall be in good repair, properly functioning and satisfactorily protected to prevent contamination from entering the water supply. (d) Furniture and Furnishings. All furniture and furnishings shall be clean, safe, maintained in good repair and appropriate to the intended use of the room. (e) Storage areas. Storage areas shall be maintained in a safe, dry and orderly condition. Attics and basements shall be free of accumulations of garbage, refuse, soiled laundry, discarded furniture, old newspapers, boxes, discarded equipment and similar combustible items. (f) Outside. The yard, sidewalks and driveways of the facility shall be maintained in a orderly and safe condition. (12) DAY CARE. If there is a day care program for adults or children in the same building as a CBRF, the facilities shall be separated. Entrance and exit doors to the outside for each facility shall be separate. Socialization between facilities shall not interfere with the privacy of other residents or infringe upon the use of habitable floor space of facility residents. (13) BUILDINGS WITH JOINT OCCUPANCIES. (a) Physical separation. 1. A CBRF and another residential occupancy in the same building may be intermixed or separated into distinct living areas, except that a CBRF shall be a distinct living area if in the same building as a nursing home, residential care apartment complex or hospital. 2. A CBRF may share a common lobby and access area of a multipurpose building and may be entered via elevator from the lobby or access area. If a common lobby and access area of a multipurpose building is not provided, residents of the CBRF shall not be required to first enter or pass through the non-CBRF portion of the facility in order to enter the CBRF. Similarly, people shall not be required to pass through the CBRF to enter the non-CBRF portion of the facility. (b) Congregate areas. If the occupants are intermixed and the total building is available to CBRF residents and other occupants, the congregate dining and living area shall be determined by the total capacity of the building. A dining room or activity area may be shared, provided it is not scheduled for concurrent use by residents of the CBRF and non-CBRF portion of the facility. If the occupants are not intermixed, the facility shall provide congregate living and dining as described in HFS 83.51(1) for the exclusive use of the CBRF residents. Minimum congregate dining and living area shall be determined by licensure capacity of the CBRF. (c) Fire separation. 1. A CBRF in the same building as a nursing home or hospital shall be separated by 2-hour fire-rated construction. 2. In buildings with joint occupancies where the CBRF is separate from the non-CBRF portion by a 2-hour fire rated construction, compliance with s. 83.52 and s. 83.53 is not required for the non-CBRF portion, unless required by s. Comm 57.01 or other state building codes. 3. A CBRF in the same building as any other occupant classification shall be separated by at least one-hour fire-rated construction. If there is one-hour fire-rated construction, the entire building shall be equipped with an interconnected detection system and sprinkler system in compliance with HFS 83.53 (1), (3) and (5). 4. The facility shall maintain documentation for all testing and maintenance of the detection system in both living units. Facilities with 2-hour fire separation are exempt from having documentation of the non-CBRF of the building. (d) Accessibility of public and common use areas. All public and common use areas of a CBRF shall be accessible to and useable by residents in wheelchairs or other mobility aids consistent with the accessibility standards contained in ch. Comm 69, Barrier-Free Design. HFS 83.52 Safety. (1) FACILITY EVACUATION TIME. The defense against fire at any time in a facility shall be established by the application of Table 83.52. The fire safety protections in Table 83.52 shall be applied in addition to the other fire safety protections and construction requirements in this chapter and Comm. Building Codes that apply to the particular facility. TABLE 83.52 EVACUATION CAPABILITIES AND ADDITIONAL FIRE SAFETY PROTECTIONS1 Evacuation Time of 2 minutes or less2 Evacuation Time of more than 2 and up to 4 minutes2 Evacuation Time of 4 minutes or more6 Additional Fire Safety Protections: - No additional fire safety protections beyond those required in this chapter. Additional Fire Safety Protections: - Externally monitored,3 complete smoke detection system4 with backup battery power supply.5 - Vertical smoke separation between all floors. - Rated stair enclosure under Comm Table 51.03 Additional Fire Safety Protections: - Sprinkler under s. HFS 83.53(5) - Vertical smoke separation between all floors. - 24 hour awake staff Response: 1. Evacuate or 2. Use of horizontal evacuation or 3. ARA . ARA shall not be required on occupied floors where smoke compartments are provided. Response: 1. Evacuate or 2. Horizontal Evacuation or 3. ARA . ARA shall not be required on occupied floors where smoke compartments are provided. Response: 1. Evacuate or 2. Horizontal Evacuation or 3. ARA. ARA shall not be required on occupied floors where smoke compartments are provided. 1 "Horizontal evacuation" to a safe part of the building may be used when the building has the department's approval under s. HFS 83.63(1)(b) to use horizontal exit or smoke compartment created by smoke barriers under s. HFS 83.53 (6). 2 See s. HFS 83.52(3) which describes planning for the evacuation of residents or other department approved response to an emergency. 3 The external monitoring of a smoke detection system shall meet the requirements under s. HFS 83.54(1)(e). 4 "Complete smoke detection system" includes a smoke detector in each sleeping room which is interconnected with the rest of the smoke detection system in addition to smoke and heat detectors in the locations specified under s. HFS 83.53(3) (d) and (e) and (5), and special equipment for persons with sensory impairments under s. HFS 83.53(6). 5 A standard smoke detection system as required under s. HFS 83.53(3) that is not externally monitored is acceptable if the facility is sprinklered under s. HFS 83.53(5). 6. See s. 83.62 (3) that describes the construction requirements for an "area of rescue assistance," and its use in a fire emergency. (2) EVALUATION OF RESIDENT EVACUATION LIMITATIONS. (a) Each resident shall be evaluated within 3 days of admission to determine whether the resident is able to evacuate the facility without any help or verbal or physical prompting within 2 minutes in an unsprinklered facility and 4 minutes in a sprinklered facility, and what type of limitations that resident may have that prevents the resident from evacuating the facility within the applicable period of time. A form provided by the department shall be used for the evaluation. A resident's evaluation shall be retained in the resident's record. (b) Each resident shall be evaluated annually. All staff who work on the premises shall be made aware of each resident having an evacuation time of more than 2 minutes and the type of assistance that the resident needs to be evacuated. (3) EMERGENCY PLAN. (a) Each facility shall have a written plan for dealing with emergencies. The plan shall specify the responsibilities of staff. The plan shall cover all of the following: 1. Procedures for orderly evacuation or other department-approved response during a fire emergency. 2. Response to serious illness or accidents. 3. Preparation for and response to severe weather including tornado and flooding. 4. A route to dry land. 5. Location of an emergency shelter for the residents. 6. A means of transporting residents to the emergency shelter. 7. How meals and medications will be provided to residents at the emergency shelter. (b) The emergency plan shall be posted in a conspicuous place readily available to residents and staff. (c) The emergency plan shall have an exit diagram that shall be posted on each floor of the facility used by residents in a conspicuous place where it will be seen by the residents. The diagram shall identify the exit routes from the floor, including internal horizontal exits under s. HFS 83.63(1)(b) when applicable, smoke compartments or a designated meeting place outside and away from the building when evacuation to the outside is the planned response to a fire alarm. (d) The procedures to be followed to ensure resident safety if a fire, tornado, flooding or other emergency occur shall be clearly communicated by the staff to a new resident within 72 hours after admission. A fire evacuation drill shall be practiced at least quarterly with both staff and residents, with written documentation of the date of the drill and resident specific information including evacuation time, type of evacuation assistance and resident response for each drill maintained by the facility. (e) At least one fire evacuation drill annually shall be held that simulates the conditions during usual sleeping hours. (f) Evacuation procedures involving fire department personnel shall be practiced at the option of the fire department. The fire department shall be made aware of the areas of rescue assistance (ARA), if any, and the potential number of residents who would use the ARA. (4) EMERGENCY PLANNING FOR CERTAIN RESIDENTS. (a) The emergency plan shall take into consideration any resident who has refused to follow or has otherwise not followed prescribed evacuation procedures in a timely manner either in practice or in response to an emergency, and shall set out alternative procedures for that resident. Staff shall be informed within 24 hours of any resident for whom alternate emergency planning has been done and what the emergency procedures are for that resident. (5) FIRE INSPECTION. (a) The facility shall arrange for all of the following: 1. An annual inspection by the local fire authority or certified fire inspector. 2. The facility shall retain the fire inspection report for review by the department on request. (6) SMOKING. (a) A written policy on smoking shall be developed by the licensee of a facility. The policy shall designate areas where smoking is permitted, if any, and shall be clearly communicated to a new resident prior to admission. (b) Designated smoking areas shall be well ventilated or have an alternate means of eliminating smoke. Note: The Clean Indoor Air Act, s. 101.123, Stats., applies to facilities. (7) FIRE EXTINGUISHER[DHFS110]. (a) At least one portable dry chemical fire extinguisher with a minimum 2A, 10-B-C rating shall be provided on each floor of the facility. Fire extinguishers on upper floors shall be located at the head of each stairway. In addition, extinguishers shall be located so the maximum area per extinguisher of 3,000 square feet is not exceeded and travel distance to an extinguisher does not exceed 75 feet. The extinguisher on the kitchen floor level shall be mounted in or near the kitchen. (b) All fire extinguishers shall be maintained in readily usable condition. Inspections of the fire extinguisher shall be done by a qualified professional one year after the initial purchase of a fire extinguisher and annually thereafter. Each fire extinguisher shall be provided with a tag for the date of inspection. (c) A fire extinguisher shall be mounted on a wall or a post where it is clearly visible, the route to it is unobstructed and the top is not over 5 feet high. The extinguisher shall not be tied down, locked in a cabinet or placed in a closet or on the floor except that it may be placed in a clearly marked, unlocked wall cabinet used exclusively for that purpose. (8) KEYS TO DOORS. The employe in charge of a facility on each work shift shall have a key or other means of opening all locks or closing devices on all doors in the facility including access to resident records. Rooms containing confidential personnel records are exempt from this requirement. (9) TOXIC SUBSTANCES. Cleaning compounds, soaps, polishes, insecticides and toxic substances shall be labeled and stored in a secure area. HFS 83.53 Fire protection system. (1) INTERCONNECTED DETECTION SYSTEM. Except as provided in sub. (2), each facility shall have an interconnected detection system to protect the entire facility so that if any detector is activated, an alarm audible throughout the building will be triggered. (2) [DHFS111]RADIO-TRANSMITTING DETECTION SYSTEM. A facility with a licensed capacity of 8 or fewer individuals may use an approved and listed radio-transmitting detection system that triggers an alarm audible throughout the building. (3) SMOKE [DHFS112]DETECTION SYSTEM AND HEAT DETECTORS. (a) Installation and testing of the detection systems. Smoke and heat detectors shall be installed and maintained in accordance with NFPA 72 National Fire Alarm Code and the manufacturer's recommendation. Facilities shall maintain a written record of tests and maintenance of the detection system. (b) Testing by service companies. 1. After the first year following installation, detection systems shall be inspected, cleaned and tested annually by a certified service company in accordance with the specifications in NFPA 72 and the manufacturer's specifications and procedures. 2. Within the fourth year following the date of installation, and every 2 years thereafter, the smoke and heat detectors shall be tested by a certified service company to ensure that each detector is within its listed and marked sensitivity range in accordance with the specifications in NFPA 72 and the manufacturer's specifications and procedures. 3. All smoke and heat detectors suspected of exposure to a fire condition shall be inspected, cleaned and tested within 5 days after each exposure by a certified service company in accordance with the specifications in NFPA 72 and the manufacturer's specifications and procedures. Each detector shall operate within the manufacturer's intended response or it shall be replaced within 10 days after exposure to a fire condition. (c) [DHFS113]System approval. No facility may install a smoke and heat detection system that fails to meet the approval of the department. (d) Specific locations for smoke detectors. All facilities shall have at least one smoke detector located at each of the following locations: 1. At the head of every open stairway. 2. On the hallway side of every enclosed stairway on each floor level. 3. In every corridor, spaced not more than 30 feet apart and not further than 15 feet from any wall or in accordance with the manufacturer's separation specifications. 4. In each common use room, including a living room, dining room, family room, lounge and recreation room, but not including a kitchen, bathroom or laundry room. 5. In each bedroom. 6. In all nonresident living areas, except the furnace, bathroom, kitchen and laundry room. 7. Additional smoke detectors shall be required where wall projections from ceiling or lintels exceed 8 inches. 8. In the basement, except a furnace or laundry room. (e) Specific locations for heat detectors. Facilities shall have at least one heat detector integrated with the smoke detection system at all of the following locations or in accordance with the heat detector manufacturer's specifications: 1. Kitchen 2. Attached garage. 3. Attic or enclosed compartment of the attic. 4. Furnace room. 5. Laundry room. (f) Heat detector exception. Facilities are exempt from installation of heat detectors, if the area of original heat detection is directly covered by one or more sprinklers and the sprinkler activation temperature is 165ºF or less. (4) SPECIAL EQUIPMENT FOR PERSONS WITH IMPAIRED HEARING OR VISION. (a) Audio and visual notification. If any resident with impaired hearing or vision is unable to detect or respond to a fire emergency, the licensee shall ensure the appropriate audio or visual notification alarms are installed in the resident's bedroom and on each floor level used by the resident. Note: see ch. Comm 69. (b) Documentation. The sensory impairment of the resident shall be noted in the resident's record and communicated to all staff within 5 days after admission or after determination of the impairment is made. (5) SPRINKLER SYSTEMS. (a) Types. A facility shall have a sprinkler system if indicated in Table 83.52 or 83.62 or in s. HFS 83.62 (2)(c). The types of sprinkler systems to be used are as follows: 1. A complete NFPA 13D residential sprinkler system shall be used in a facility licensed for 16 or fewer residents only when each room or compartment in the facility requires no more than 2 sprinkler heads. When an NFPA 13D sprinkler system is used it shall have a 30-minute water supply for at least 2 sprinkler heads. Entrance foyers shall be sprinklered. The department may determine an NFPA 13R residential sprinkler system shall be installed in a facility with one or more rooms or compartments having an unusually high ceiling, a vaulted ceiling, a ceiling with exposed beams or other design or construction features that inhibit proper water discharge when the square footage of each room or compartment in the facility would ordinarily allow an NFPA 13D sprinkler system. 2. A complete NFPA 13R residential sprinkler shall be used in a facility licensed for 16 or fewer residents when one or more rooms or compartments in the facility require more than 2 sprinkler heads and not more than 4 sprinkler heads. A fire department connection is not required for an NFPA 13R sprinkler system. 3. A complete NFPA 13 automatic sprinkler system shall be used in a facility licensed for more than 16 residents. 4. All large facilities initially licensed on or after January 1, 1997 shall be protected by a complete automatic sprinkler system, except a class AA facility that has an equivalent safety system approved by the department. 5. All large facilities initially licensed prior to January 1, 1997 of non-fire resistive construction shall be protected by a complete automatic sprinkler system, except a Class AA facility that has an equivalent safety system approved by the department. (b) Installation and maintenance. 1. All sprinkler systems shall be installed by a state licensed sprinkler contractor and maintained according to the standards in NFPA 25. NFPA 13 and NFPA 13R sprinkler systems shall be inspected at least annually. 2. In sprinklered facilities, sprinkler heads shall be placed at the top of each linen or trash chute and in the rooms where the chute terminates. 3. All sprinkler systems under subds. 1 installed after January 1, 1997 shall be equipped with residential sprinkler heads in all habitable rooms and corridors. 4. The sprinkler system flow alarm shall be connected to the facility's fire alarm system. (c) Exemption. Small class CA, CS and CNA facilities constructed and licensed prior to the effective date of this rule that meet the alternative requirements of s. HFS 83.54 are exempt from the sprinkler requirements in sub.(5). (d) Reliable water supply. All sprinkler systems shall have a reliable water supply. If the sprinkler system requires a mechanical device such as a compressor, pump or motor, the device shall be supplied by a reliable source of emergency power, such as an emergency generator maintained according to NFPA 110. Local utility service is not considered a reliable emergency source of power. (6) SMOKE COMPARTMENTS. In a large facility constructed after January 1, 1997, each floor where residents sleeping rooms are located shall be divided into compartments with smoke barrier walls unless horizontal exits are provided. There shall be no more than 150 feet of exit access travel distance without a barrier against the lateral passage of smoke. Any smoke barrier shall have at least a 1/2 hour fire resistance rating and shall be continuous from outside wall to outside wall and floor to the underside of the floor or roof deck above. Any opening in a smoke barrier shall be solid core wood doors as a minimum requirement. Such doors shall be self-closing or may remain open if they have an approved hold open device interconnected with the fire alarm system that will release upon activation of the fire alarm. Adequate space shall be provided on each side of the barrier for the total number of occupants on both sides. HFS 83.54 Alternative requirements to a sprinkler system in a small class C facility. [DHFS114] (1) GENERAL REQUIREMENTS. Small class CA, CS and CNA facilities constructed and licensed prior to the effective date of this rule are exempt from the sprinkler system requirement under s. HFS 83.53(5) if all of the following requirements are met: (a) No more than 4 of the residents may require a class CA, CS or CNA facility. (b) The bedroom and congregate dining and living area for any resident requiring a class CA, CS or C.N.A facility who is blind or not fully ambulatory shall be on the first floor. Facilities serving one or more non ambulatory residents shall have 2 primary exits accessible to grade. Split level homes may be used only for ambulatory residents who may be housed on any habitable floor level. (c) The facility shall not be located in a building which has more than 2 living units as defined under s. Comm 51.01(76b), or has more than 2 stories as defined under s. Comm 51.01(122). (d) The requirements for a smoke and heat detection system under s. HFS 83.53(1) through (5) and for special equipment for persons with impaired hearing or vision under s. HFS 83.53(4) shall apply, except that every habitable room in the facility shall have an interconnected or radio frequency smoke detector except where heat detectors are required. (e) The smoke detection system shall have a backup battery power supply and shall be externally monitored so activation of the system automatically results in notification of the local fire department. Tape or voice type dialers are prohibited. Acceptable configurations for external monitoring are limited to any of the following: 1. A digital communicator linked to a listed monitoring company. 2. A digital communicator linked to the municipal or county emergency dispatch center or to the local fire department. 3. A direct phone line connecting the detection system to the municipal or county emergency dispatch center or to the local fire department. (f) There shall be smoke separation between each floor level to prevent vertical movement of smoke. (g) The emergency plan under s. HFS 83.52(3) shall specify evacuation of the residents as the response to a fire under Table 83.52. No resident may have an evacuation time, as determined under s. HFS 83.52(2), that exceeds 2 minutes. HFS 83.55 Accessibility. [DHFS115] (1) ACCESSIBILITY REQUIREMENTS. All facilities shall comply with the accessibility requirements found in Table 83.55 for residents, staff and visitors. Table 83.55 ACCESSIBILITY REQUIREMENTS Accessibility Requirements Class of facility AA, CA AS, ANA, CS, CNA Ramped or grade level entrances from street, alley or ancillary parking to a primary floor Required for one entrance Required for two entrances Stepped entrances to a primary floor within 2'- 0" of grade Permitted Not Permitted Entrances to a primary floor minimum 2'- 8" clear opening width Readily Achievable7 Required All passageway doors on primary floor minimum 2'- 8" clear opening width Permitted2 Required Elevators, ramps or lifts between interior floor levels Permitted Required3,4 Interior access to all common-use areas Readily Achievable7 Required Interior access to all bathing and toilet facilities Readily Achievable7 Required5 Grab bars for toilet and bath fixtures Readily Achievable7 Required5 The shower heads shall be a movable type with an adjustable height mounting bar. Readily Achievable7 Required5 12% of the toilet and bathing facilities are compliant with s. Comm 69.11. Readily Achievable7 Required5 Levered handles on all doors, bathroom water fixtures and other devices normally used by residents with manual strength or dexterity limitations. Required6 Required6 1 Ramps are defined in Comm 69. 2 Two-foot 6-inch passageway doors are permitted in existing buildings. 3 A lift in any required stairway exit in an existing building shall not encroach upon the exit width required under the applicable Comm 69 requirements. The lift shall not block access to the handrail. 4 May be omitted if use of other floors is restricted to ambulatory residents or if there are no one-of-a-kind, common-use areas located on these floors. 5 Shall be provided to the maximum extent feasible in existing buildings undergoing remodeling, but may be omitted in rooms used only by fully ambulatory residents not using a wheelchair, walker, cane, crutches or other assistance. For new construction the requirements in the Americans with Disabilities Act (ADA) apply in addition to s. Comm 69. Note that in 28 CFR 36.402 of Federal regulations implementing the Americans with Disabilities Act (ADA), "the phrase 'to the maximum extent feasible' applies to the occasional case where the nature of an existing facility makes it virtually impossible to comply fully with applicable accessibility standards through a planned alteration. In these circumstances, the alteration shall provide the maximum physical accessibility feasible. Any altered features of the facility that can be made accessible shall be made accessible. If providing accessibility in conformance with this section to individuals with certain disabilities (e.g., those who use wheelchairs) would not be feasible, the facility shall be made accessible to persons with other types of disabilities (e.g., those who use crutches, those who have impaired vision or hearing, or those who have other impairments)." 6 Required when other hardware creates a barrier or is difficult to use safely by residents with manual strength or dexterity limitations. 7 28 CFR 36.304 of Federal regulations implementing the Americans with Disabilities Act (ADA), requires that "a public accommodation [which includes CBRFs] shall remove architectural barriers in existing facilities, including communication barriers that are structural in nature, where such removal is readily achievable, i.e, easily accomplished and able to be carried out without much difficulty or expense." See 28 CFR 36.304 for a list of examples of barrier removal and for the order of priorities for creating accessibility. SUBCHAPTER VII - STRUCTURAL REQUIREMENTS HFS 83.61 Building maintenance and site. (1) CONDITION OF BUILDING AND SITE. (a) Building integrity. Any building used as a CBRF shall be structurally sound without visible evidence of structural failure or deterioration. (b) Surface drainage. All courts, yards or other areas on the premises shall be drained or graded to divert water away from the building. (c) Outdoor maintenance. Fences, driveways, parking areas and similar paved areas shall be maintained in a safe condition. (d) Painted exterior surfaces. Any exterior surface treated with paint or other preservative shall be maintained to prevent chipping, cracking or other deterioration of the exterior surface or the surface treatment. No lead-based paints or preservatives may be used. (e) Interior surfaces. Every interior floor, wall and ceiling shall be kept in good repair. Interior walls and ceilings in spaces subjected to moisture shall have water-resistant hard surfaces and no substantial surface irregularities or cracking. (f) Structural condition. Every foundation wall, exterior wall, floor and roof shall be watertight, rodent-proof and reasonably weatherproof and shall be kept in good repair. (g) Conditions of openings. Every exterior window, exterior door and exterior basement hatchway shall be watertight, rodent-proof, reasonably weatherproof and kept in good repair. Every interior door shall be kept in good repair. All installed door and window hardware shall be maintained in good working condition. (h) Appurtenances. Every inside and outside stair, every porch and every appurtenance to the building shall be maintained in a non-hazardous condition. (2) GARAGES AND UTILITY BUILDINGS. (a) Attached garage. 1. Common walls between a facility and an attached garage shall be protected with at least one layer of 5/8 inch type X gypsum board with taped joints, on the garage side and with at least one layer of 1/2 inch gypsum board with taped joints, or equivalent, on the facility side. The walls shall provide a complete separation. 2. Floor-ceiling assemblies between a garage and the facility shall be protected with at least one layer of 5/8 inch type X gypsum board on the garage side of the ceiling or room framing. 3. Openings between an attached garage and the facility shall be protected by a self- closing 1-3/4 inch solid wood core door or an equivalent self-closing fire-resistive rated door. 4. The garage floor shall be pitched away from the facility and at its highest point shall be at least 1 1/2 inches below the floor of the facility. 5. When a required exit leads into a garage, the garage shall have at least a 32 inch service door to the outside. The exit path from the facility through the garage to the outside shall be clear and unobstructed. (b) Detached garages. A detached garage shall either be located at least 3 feet from the facility or shall comply with the requirements for attached garages under par. (a). (c) Detached utility buildings. A utility building where fueled, motorized vehicles and appliances such as snow-mobiles, power lawn mowers, motorcycles, and snow blowers are stored shall either be located at least of 3 feet from the facility or shall comply with the requirements for attached garages under par. (a). (3) INTERIOR FINISHING. (a) Polyurethane and polystyrene surfaces. Exposed polyurethane and polystyrene surfaces are prohibited. (b) Carpet. Except where sprinklered in a facility, all newly installed carpeting shall have a minimum Class rating under the tunnel test with a flamespread rating of 75 or less, or a Class II rating under the radiant panel flux test with a flamespread rating of 0.22 watts per square centimeter or greater when tested in accordance with s. Comm 51.044 or the manufacturer for each specific product. Certified proof by the manufacturer of one of those tests for the specific product shall be available in the facility. Certification by the installer that the material installed is the product referred to in the test proof shall be obtained by the facility. No carpeting may be applied to walls unless it has a class A rating under the tunnel test with a flamespread rating of 25 or less. Note: The class A or B rating under the tunnel test has no relationship to the classes of licensure under s. HFS 83.04(1) (b). HFS 83.62 Minimum type of construction. (1) APPLICATION OF HABITABLE FLOOR DEFINITION. The number of habitable floors in a facility shall determine the type of construction for each class of licensure and when an automatic sprinkler system, combined with an interconnected or radio frequency smoke detection system, may substitute for the required type of construction. (2) MINIMUM TYPE OF CONSTRUCTION FOR EACH CLASS OF LICENSURE. (a) A facility with 3 or fewer habitable floors shall meet the construction requirements for class of licensure in Table 83.62. Table 83.62 MINIMUM TYPE OF CONSTRUCTION BY CLASS OF LICENSURE FOR FACILITIES WITH 3 OR FEWER HABITABLE FLOORS Class of Licensure Number of AA AS, ANA CA, CS, CNA Habitable Floors Construction Type Construction Type Non- Sprinklered Sprinklered Construction Type Non- Sprinklered Sprinklered 1 8 8 8 3 8 2 8 2 8 2 8 3 8 2 3 2 3 Notes: Refer to applicable Comm codes for detailed descriptions of the requirements for each type of construction. Typical requirements are as follows: Construction Type 2. Typical fire-resistive construction (Comm class 1 or 2) consists of exterior walls of concrete or masonry, floors and roof of fireproofed steel or concrete and interior partitions of concrete block or steel studs. Construction Type 3. Typical metal frame protected construction (Comm class 3 modified) consists of structural parts and enclosing walls of masonry in combination with other noncombustible material. Construction Type 8. Typical wood frame unprotected construction (Comm class 8) consists of exterior walls of wood studs covered with siding (metal or wood), brick, stone, slate, etc., wood floors and roof, and interior partitions of wood stud and plaster or drywall. (b) For class AS and ANA facilities, the bedrooms and congregate dining and living area for blind, nonambulatory, semiambulatory or physically disabled residents shall be on the first floor. (c) A facility of any type of construction initially licensed for a class CA, CS or CNA occupancy on or after January 1, 1997 shall have a sprinkler system under s. HFS 83.53(5), except as provided under s. HFS 83.54. (d) No facility with 3 habitable floors above grade that is built of wood frame under s. COMM 51.03(8) as COMM class 8 construction and is not protected by a complete automatic sprinkler system under NFPA 13, may use the third habitable floor for sleeping, eating, cooking or habitable rooms for residents, respite care residents, other occupants, employes, the licensee or any relatives, except that storage or office space for the licensee or employes may be located on that floor. (e) Any facility that meets the requirement of type 2 construction in Table 83.62 and is not protected by a sprinkler system shall have either an area of rescue assistance under sub. (3) or approved by the department for horizontal evacuation under s. HFS 83.63(1)(b) on each floor without 2 grade level or ramped exits when residents not capable of negotiating stairs without assistance reside on the floor. (f) A facility that does not occupy an entire building and is located above the second story of a building of more than 3 stories shall comply with all of the following: 1. The building shall be in compliance with s. Comm 51.03 (1) or (2). 2. The entire building shall be equipped with a complete automatic sprinkler system under NFPA 13. (3) AREA OF RESCUE ASSISTANCE. (a) A room to be used as an ARA shall not be a bedroom or a room for the private use of any resident, other occupant, employe, or licensee. (b) The ARA shall be constructed of at least one-hour rated fire resistive construction. Whenever the room exits into an enclosed stairwell that is required to be of more than one-hour fire-resistive construction, the room shall have the same fire resistive construction, including the same doorway protection, as required for the adjacent stairwell. (c) 1. Doors in the ARA shall be tight-fitting smoke-and-draft-control assemblies having a fire-protection rating of at least 45 minutes and shall be self-closing or automatic closing. 2. A room to be used as an ARA shall have an exit door directly to an exit enclosure such as a stairwell or fire escape that leads directly outside. 3. The door leading into the ARA from the residential area shall be unlocked at all times. The door between the ARA and an exit enclosure shall be equipped with hardware that unlocks and opens with one hand and one motion from the ARA side of the door. (d) Each stairway adjacent to an ARA shall have a minimum clear width of 48 inches between handrails. (e) Two-way communication from the ARA and identification of the ARA shall be provided as required by the department. (f) 1. Each ARA shall have a space for each person needing the ARA in an emergency as follows: a. At least 30 inches by 48 inches for each person who uses a wheelchair for mobility. b. At least 30 inches by 36 inches for each person who uses a walker, cane or crutch to provide assistance in walking. c. At least 30 inches by 24 inches for each person who does not use any assistive device for mobility or walking. 2. The measurements in subpars. 1.a to c shall be determined after deducting the space covered by the door swing if the swing is into the ARA and the space needed for a passageway through the ARA of at least 2 feet 8 inches in width. (g) The number of residents not able to negotiate stairs who are housed on each floor level required to have a ARA shall be limited to the number of spaces provided in the ARA on that floor. (h) A facility with an ARA shall notify the local fire department of the facility's emergency evacuation plan, including the use and location of each ARA, and the potential number of residents and staff who would use each ARA. Note: See s. HFS 83.53 (5)(a) for additional fire protection requirements for facilities licensed for 21 or more residents. HFS 83.63 Exiting. (1) EXITS, PASSAGEWAYS AND SEPARATION BETWEEN FLOORS. In this section, exit means standard exit doors opening to passageways or grade, exit passageways, fire escapes and stairways as specified in Comm. 61.12 (4). (a) All habitable floors, shall have at least 2 primary exits providing unobstructed travel to the outside. A small class AA facility with no more than 2 habitable floors may have one exit from the second floor. (b) A facility may use internal horizontal evacuation when the building has horizontal exits defined under s. Comm 51.19 (1). The facility shall have approval from the department before including internal horizontal exiting in the emergency plan under s. HFS 83.52(3). Note: Section Comm 51.19 (1) describes horizontal exits as: "One or more openings through an occupancy separation; a 2-hour fire-rated separation wall extending from the basement or lowest floor to the underside of the roof deck or of one or more bridges or balconies connecting 2 buildings or parts of buildings entirely separated by occupancy separations as described in s. Comm 51.08." (c) Exit doors [DHFS116]and doors in exit passageways shall be at least 2 feet 8 inches in width, and 6 feet 4 inches in height. (d) Existing passageways, stairways and doors in class AA facilities shall be at least 2 ft. 4 inches in width[DHFS117]. (e) No exit may be through a toilet or bathroom or an intervening bedroom. (f) The required width of passageways and stairways to outside exits shall be at least three feet and maintained clear and unobstructed at all times. In new construction of large facilities, all corridors in resident areas shall be at least 5 feet wide. In existing large facilities, the minimum corridor width shall be at least 4 feet. (g) Exits or sidewalks, and driveways used for exiting shall be kept free of ice, snow, and obstructions. For facilities serving only ambulatory residents, the facility shall maintain a cleared pathway to a public way or safe distance away from the building from all exterior doors used in an emergency. For facilities serving semi-ambulatory and non-ambulatory residents, a facility shall maintain a cleared, hard surface, barrier-free walkway to a public way or safe distance away from the building for at least 2 primary exits from the building. All other required exits shall have at least a cleared pathway maintained to a public way or safe distance from the building. An exit door or walkway to a cleared driveway leading away from the facility also meets this requirement. (2) DOORS EXCEPT PATIO DOORS. (a) All doors shall have the fastenings or hardware needed to open them from the inside with one hand and one motion without the use of a key or special tool. (b) A solid wood core door shall be provided at any interior stair between the basement and the first floor. The door shall have a positive latch and an automatic closing device and normally shall be kept closed. Enclosed furnace and laundry areas shall have self-closing solid wood core doors when shared on a common level with resident bedrooms. (c) Closet doors shall open from the inside. (d) All interior doors equipped with locks shall be designed to unlock from either side in case of emergency. (e) In new construction in large facilities, toilet room doors shall not swing into the toilet room unless equipped with two-way hardware. (3) PATIO DOORS. A patio door can be used as a supplementary exit in an emergency and shall comply with all of the following: (a) Factory installed door fastenings or hardware on sliding glass patio doors is acceptable. The use of bolt locks on sliding glass patio doors is prohibited. Other locking devices approved by the department may be used. (b) All door fastenings or hardware on hinged, swing type patio doors shall be operable from the inside with one hand and one motion without the use of a key or special tool. (c) Furniture and other obstacles shall not be placed in front of the patio door. (d) A clear and unobstructed pathway shall be maintained to a safe distance away from the building as specified under sub. (1)(g). (4) STAIRS AND SHAFTS. (a) All required interior and exterior exit stairways shall have a minimum tread width, exclusive of nosing or projection, of 8 inches and a maximum riser height of 9 inches. (b) One or more handrails, between 30 to 34 inches above the nose of the tread, shall be provided on all stairways. Handrails shall be provided on the open sides of stairways and platforms. Facilities licensed prior to January 1, 1997 shall have handrails at least 29 inches above the nose of the tread. (c) 1. Winders in stairways shall be provided with handrails on both sides, at least 29 inches above the nose of the tread. 2. Winders in stairways used as required exits shall have treads of at least 7 inches in width at a point one foot from the narrow end of the tread. (d) Spiral stairs are prohibited for use as required exit stairs. (e) Any shaft such as a dumbwaiter or laundry chute leading to the basement, as defined under s. Comm 51.01 (10), shall be provided with a door on each level above the lowest floor. The door shall be provided with a positive latch and an automatic closing device and shall normally be kept closed. A spring of sufficient strength to close the door and activate the door latch is acceptable for meeting the automatic closing device portion of this requirement. (f) In a large facility, any stairwell, atrium, vertical shaft or vertical opening shall be of at least one-hour fire resistive construction with one-hour rated self-closing fire doors at each floor, except that any building of fire resistive construction and any building of 3 or more stories shall have 2-hour fire resistive enclosures for all openings with class B fire doors at each floor. No atriums, vertical shafts or vertical openings, except elevators and stairwells, may open directly to a corridor. (g) In new construction of a large facility, the room in which a chute terminates shall be of 2-hour fire-resistive construction with a class B fire door. (5) LIGHTING. (a) All exit passageways and stairways shall be capable of being lighted at all times. (b) All required exit signs shall be lighted at all times. HFS 83.64 Windows. (1) MINIMUM SIZE. Every habitable and sleeping room shall have at least one outside window with a total sash area of at least 8% of the floor area in the room. That window shall be openable. The openable area of the window shall be equal to not less than 4% of the floor area of the room. (2) MINIMUM OPENING FOR SLEEPING ROOMS. At least one outside window in a sleeping room shall be openable from the inside without the use of tools or keys and shall provide a clear opening of at least 16 inches in the least dimension. (3) STORM WINDOWS AND SCREENS. Except for insulated windows, all windows serving habitable rooms shall be provided with storm windows in winter that shall be openable from the inside without the use of tools. All required openable windows shall have insect-proof screens in summer. (4) WINDOW COVERINGS. Every habitable room shall be provided with shades, drapes or other covering material or device, that afford privacy and light control for the resident. (5) WINDOW SILLS. In new construction, the bottom sill of windows in a resident's room shall be 36 inches or less from the floor. In existing construction, the bottom sill of windows in a resident room shall be 44 inches or less from the floor. [DHFS118][DHFS119] HFS 83.65 Electrical service and fixtures. (1) GENERAL. (a) Installation and maintenance. Every facility shall be supplied with electrical service, wiring, outlets and fixtures, which shall be properly installed and shall be maintained in good and safe working condition. (b) Service size. The electrical service shall be of the proper size to handle the connected load. (2) PROTECTION. (a) Fuses and circuit breakers. The branch circuits shall be protected by tamper-proof fuses, or circuit breakers not to exceed the ampere capacity of the smallest wire size in the circuit. (b) Ground fault interruption. Ground fault interrupt protection shall be required for all outlets within six feet of a plumbing fixture and in all outlets on the exterior of the facility and in the garage. (3) MINIMUM NUMBER OF FIXTURES AND OUTLETS. The minimum number of fixtures and outlets shall be as follows: (a) Light fixtures. Every bathroom, kitchen or kitchenette, dining room, laundry room and furnace room shall contain at least one approved or listed ceiling or wall-type electric light fixture equipped with sufficient lamps or tubes to provide at least 5 foot candles at floor level at center of room. Where more than one fixture is used or required, the additional fixture or fixtures shall be equally spaced as far as practical. A switched outlet may be substituted for a ceiling or wall fixture in bathrooms and dining rooms. (b) Minimum outlet ratios. Electric duplex outlet receptacles shall be provided as follows: 1. Living room, one per 75 square feet of floor area with a minimum of 2. 2. Dining room, one per 75 square feet of floor area with a minimum of 2. 3. Kitchen, one per 8 lineal feet or fraction thereof, of countertop and preparation area, including island-type areas. In addition, if a kitchen is used for dining purposes, one per 75 square feet of floor area. Separate outlets shall be provided for refrigerators. 4. Bedroom, one per 75 square feet of floor area with a minimum of 2. 5. Laundry room, one. 6. Toilet rooms, one, which may be part of the wall fixture if 72 inches or less from the floor. 7. Other habitable rooms, minimum of 2. (4) OUTLET AND SWITCH LOCATIONS AND EXPOSED WIRING. (a) Outlets. Electrical outlets shall be located to minimize the use of extension cords. (b) Extension cords. 1. When extension cords are required, they shall be rated appropriately for the ampere capacity of the appliance being used. 2. When the electrical circuit is not equipped with a circuit breaker, the extension cord shall be equipped with a circuit breaker. 3. Extension cords shall not extend beyond the room of origin, shall not be a substitute for permanent wiring, shall not be located beneath rugs or carpeting and shall not be located across any pathway. (c) Switches. Switches or equivalent devices for turning on at least one light in each room or passageway shall be located to conveniently control the lighting in the area. (d) Temporary and exposed wiring. All temporary wiring and exposed wiring, whether in use or abandoned, shall be removed. (e) Safety. Electrical cords and appliances shall be maintained in a safe condition. Frayed wires, cracked or damaged switches, plugs and electric fixtures shall be repaired or replaced. HFS 83.66 Requirements for new construction and remodeling. (1) APPLICATION OF THE CODE. The purpose of this code is to apply minimum requirements for the design, construction, operation and maintenance of the facility. New construction shall meet the requirements of this code in its entirety. Additions shall comply with the requirements for new construction. Remodeling shall comply, to the maximum extent practical, with the requirements for new construction. In any existing building or structure, whether remodeling or not, shall be permitted to be classified as facility occupancy only if such building or structure, or portion thereof, conforms with the requirements of this code. Note: see definitions in HFS 83.03 for new construction and remodeling. (2) COMPLIANCE WITH APPLICABLE COMM REQUIREMENTS. All new construction or remodeling shall meet the relevant requirements affecting new construction found in chs. Comm 50 to 64. Plan review by the department of commerce is required for both new construction and remodeling for facilities of 9 or more residents. The department of commerce reviews these plans for compliance with state building codes. (3) PLAN REVIEW. All new construction and remodeling plans for facilities of any size shall be reviewed and approved by the department before construction. The department shall review the plans submitted under this subsection for compliance with this chapter. The fees required for plan review services under sub. (5) apply to plan reviews under this section. (4) REQUIREMENTS FOR SUBMISSION. (a) Applicants shall submit plans for construction or remodeling to the department and obtain the department's approval before starting any construction or remodeling project. Applicants shall pay fees established in sub. (6) to the department for providing plan review services. (b) An applicant or licensee shall submit to the department copies of working plans and specifications prior to all new construction or remodeling. (c) The plans shall show the general arrangement of the buildings, including room schedule and fixed equipment for each room and a listing of room numbers and other pertinent information. Plans submitted to the department shall be drawn to scale. (d) Applicants shall submit any changes in the approved working plans affecting the application of the requirements under this subchapter to the department for approval before construction is undertaken. The proposed changes shall be submitted on the previously approved working plans. (e) If the applicant does not initiate on-site construction above the foundation within one year of the date of the department's approval of the working plans and specifications sub. (4), the department's approval shall be void and the applicant shall resubmit the plans and specifications to the department for reconsideration of approval. (5) FEES FOR PLAN REVIEW SERVICES. (a) The fees established in this subsection shall be paid to the department for providing the plan review services under sub. (3) and s. HFS 83.53. The department may withhold providing services to parties who have past due accounts with the department for plan review services. The department shall charge a facility a fee according to the following schedule: 1.For projects with an estimated dollar value of less than $2,000, a fee of $100; 2. For projects with an estimated dollar value of at least $2,000 but less than $25,000, a fee of $300; 3. For projects with an estimated dollar value of at least $25,000 but less than $100,000, a fee of $500; 4. For projects with an estimated dollar value of at least $100,000 but less than $500,000, a fee of $750; 5. For projects with an estimated dollar value of at least $500,000 but less than $1 million, a fee of $1,500; 6. For projects with an estimated dollar value of at least $1 million but less than $5 million, a fee of $2,500; and 7. For projects with an estimated dollar value of over $5 million, a fee of $5,000. (b) 1. The department shall charge a handling fee of $50 per plan to the submitting party for any plan which is submitted to the department, entered into the department's system and then the submitting party requests that it be returned prior to review. 2. The department may charge a photocopying fee of 25 cents per page to anyone who requests copies of construction or remodeling plans, except that a fee of $5 per plan sheet shall be charged for reproduction of plan sheets larger than legal size. (6) INSPECTION. The department shall conduct at least one on-site inspection of new construction to ensure that the project is being constructed according to department-approved plans. APPENDIX A Regional Offices of the Division of Community Services The Department of Health and Family Services licenses facilities through Division of Supportive Living regional offices. Below are addresses and phone numbers of the regional offices and the counties they serve. Plan reviews to determine compliance with the applicable rules in ch. HFS 83 are done by professional engineers in the department's division of supportive living, bureau of quality assurance. The application form and a fee assessed for a plan review should be sent to the department's division of supportive living, bureau of quality assurance, health services section, P.O. Box 2969, Madison, WI 53701-2969. Other information like bureau memos, training manuals and rules can be accessed at www.dhfs.state.wi.us. NORTHEASTERN OFFICE (Green Bay) 200 N. Jefferson, Suite 211 Green Bay, WI 54301 (920) 448-5240 COUNTIES Brown, Calumet, Door, Green Lake, Fond du Lac, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto, Outagamie, Shawano, Sheboygan, Waupaca, Waushara, Winnebago. SOUTHEASTERN OFFICE (Milwaukee) 819 N. 6th Street, Room 875 Milwaukee, WI 53203-1606 (414) 227-5000 Kenosha, Jefferson, Milwaukee, Ozaukee, Racine, Walworth, Washington, Waukesha SOUTHERN OFFICE (Madison) 3514 Memorial Drive, Building 1 Madison, WI 53704 (608) 243-2370 Adams, Columbia, Crawford, Dane, Dodge, Grant, Green, Iowa, Juneau, Lafayette, Richland, Rock, Sauk WESTERN OFFICE (Eau Claire) 610 Gibson Street, Suite 1 Eau Claire, WI 54701-3687 (715) 836-4752 Baron, Buffalo, Burnett, Chippewa, Clark, Douglas, Dunn, Eau Claire, Jackson, La Crosse, Monroe, Pepin, Pierce, Polk, St. Croix, Trempealeau, Vernon, Rusk, Washburn NORTHERN OFFICE (Rhinelander) 1853 N. Stevens Street, Suite B Rhinelander, WI 54501 (715) 365-2800 Ashland, Bayfield, Florence, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor, Vilas, Wood The repeals and rules contained in this order shall take effect on Wisconsin Department of Health and Family Services Date: By:_______________________________ Joseph Leean, Secretary SEAL: Page: 6 [JAH1]PRQI: Preface- Does this happen each year? Page: 7 [JAH2]CWFACILITYA & PRQI (Jan): 83.02 Scope-remove "except those certified.... Page: 8 [JAH3]POEC: 83.03(4) Definitions for Administer: Should change to include delegated to an appropriately trained resident care provider Page: 8 [JAH4]CWFACILITYA: 83.03(4) Definitions for Administer Can a caregiver "draw up" insulin? Page: 9 [JAH5] PRQI: 83.03(13) Definitions for Case manager-Isn't a person sub-contracted to provide case management affiliated? Do we mean "directly employed"? Page: 9 [JAH6]POEC: 83.03(14) Definitions for Client group-None of this should change. Page: 11 [JAH7] POEC: 83.03(23) Definitions for direct supervision- should not change. [DHFS8]Do we need to change the date on this? Page: 11 [JAH9]POEC: 83.03(33) Definitions for General supervision- should not change [DHFS10] Feb. 2000: PRQI: 83.03 (44) Does this encompass intermediate nursing care or does that require a separate definition? [DHFS11] Feb. 2000: PRQI 83.03 (48) Palliative care: can physician services and skilled nursing care be included under medical services. What physicians/nursing services are included and when does it cross over to treatment or cure of condition? That doesn't seem clear here to me. [DHFS12] Feb. 2000: This definition is not clear to me. Why do we include pharmacy. To me a pharmacist is the person who does the dispensing of drugs and the pharmacy is the location. It is bad practice to define something by using the term within the text of the definition. Page: 14 [JAH13]CWCBRFA: 83.03(60a) Definitions for Chemical restraint- Are behavioral episodes that result because of dementia medical symptoms? [DHFS14] Feb 2000: PRQI: 83.03 (63) do we need the term compartment? Page: 15 [JAH15]RFO-Milwaukee: 83.03(70) Definitions for Supervision-Please define supervision as referred to under HFS83.33(3)(E)b "administering an injection may be delegated to a FACILITY staff member...under the supervision of a RN." Please define supervision from RN to staff member or is this addressed under 83.03(45)? Page: 15 [JAH16]POEC: 83.03(70) Definitions for Supervision of self-administered medication- should include assisting the resident by cueing or to open & remove medication from the container. Page: 17 [JAH17]RFO-GB: 83.04(3)(a)1. Licensure- When the administrator changes, does this require a whole new program statement to be submitted. Page: 18 [JAH18]CWFACILITYA: 83.04(3)(a)5. Licensure How do we notify when changes are made? How much time do we have? Page: 18 [JAH19]CWFACILITYA: 83.04(4) Licensure (Floor Plan) Does the floor plan have to indicate safe meeting places? Page: 18 [JAH20]RFO-Madison: 83.04(5) Licensure (Background Character Verif.)-Include all language of HFS12 Caregiver law. Page: 18 [JAH21]PRQI: 83.04(5) Licensure (Background Character Verif.)-Can we just say we may conduct on "any other occupant" ? CWCBRF: 83.04(5) Licensure (Background Character Verif.)-Sounds like you need background checks on residents too? Page: 19 [JAH22]CWCBRF: 83.04(6) Licensure (Community. Advisory Comm.)-What is good faith? A list of names & a letter? Does good faith mean the same to all licensors? Dane county Human Services: 83.04 (6) Request language regarding Comm. Advisory to include forming committee 60-90 days prior to opening, invitations to committee members be sent 14 days in advance of meetings, generic lists be established of surrounding neighbors, businesses, reestablish inactive committees every 2 years and notification of applications. REJECT COMMENT: Reject all suggestions as we are bound to ch. 50.03(4) language and unprocessed applications are not public record until approved. Page: 19 [JAH23]LSS: 83.04(8)(a) Licensure (Department Action) Request consideration to reduce the time to "within 45 days". Often requests for proposals indicate a start-up of 60 days or less form time of proposal award. [DHFS24]Feb 2000:PRQI: is 83.11 the correct reference for fit and qualified in HFS 83? Page: 19 [JAH25]WALA: 83.04(9)(a) Licensure (License denial, revocation)- Change pending criminal charge to criminal conviction. Page: 22 [JAH26]RFO-Milwaukee: 83.11(1)(f) Licensee- Who determines when compliance is achieved, the facility or the department? The revised code should state who determines compliance and when the deficiencies can be removed. Page: 22 [JAH27]CWFACILITYA: 83.11(2)(b) 3. Licensee- Is this really enforced? Page: 23 [JAH28]WALA: 83.12 (2)(a) Employee (Job Qualifications) -suggest changing "Any employee" to "Any resident care staff". We don't think this would pass muster with ADA for kitchen, maintenance and similar non-resident care staff. PRQI: Feb 2000: Alternative suggestion-How about changing end of sentence to "fulfill job requirements to avoid WALA's concerns. [DHFS29] Laureate Group: 2/2000 83.12(2)(c) Consider allowing younger employes to work with supervision, especially in light of severe staff shortages. REJECT: The department will continue with its current practice of considering a waiver on a case-by-case basis. Page: 23 [JAH30]CWFACILITYA: 83.12(4)(a) Employee-This is too vague. Page: 23 [JAH31] LSS: 83.12(4)(b) Employee Revise to read or add: For records stored at a central site, employe records shall be available for review at the facility within 1 hour of the record request. WALA: suggest personnel records should be available within a reasonable amount of time. CWFACILITYA: How much time do we have to get them there? Page: 23 [JAH32]CWFACILITYA: 83.12(4)(b) Employee -If not on-site, how much time do we have to get them there? Page: 23 [JAH33]FMH: 83.13(1)(a) Infection Control-Can this be documented by a LPN if this responsibility has been delegated to the LPN by a supervising RN or MD? Page: 23 [JAH34]CWFACILITYA: 83.13(1)(a) Infection Control And how much time after hire do we have to get documentation screening for comm. Disease or TB? Page: 23 [JAH35]FMH: 83.13(1)(b) (note) Infection Control If someone is positive for TB, they may not have resident contact. In a small operation where all employes have resident contact, how do I reconcile ADA and HFS83. [DHFS36]Do we just want to put address and remove phone? Page: 24 [JAH37]RFO-Madison: 83.13(5) Infection Control- Pets should also be addressed in the admission agreement section. Page: 24 [JAH38]RFO-GB: 83.13(5) Infection Control- suggested addition to (5) Pets. Page: 26 [JAH39]RFO-GB: 83.14(6) (a)1. B. Training- What is a physician extender? PRQI: Should we put definition in 83.03 Definitions. Check the number in this section Page: 29 [JAH40] PRQI: 83.15 (1) (b) Staffing- Do we need both words? Could we substitute with "quality"? Look at number in 83.15 Page: 29 [JAH41]WALA: 83.15 (1) (c) 2.?Staffing- suggested addition setting different staff to resident ratios for buildings with and without sprinklers. Our question: why should FACILITYs have a higher ratio for night care than even nursing homes? NFPA tells us "The NFPA has no record of a multiple-death fire (a fire killing 3 or more people) in a completely sprinklered building where the system was properly operating. Page: 29 [JAH42]CWFACILITYA: 83.15 (1) (d) Staffing- Is this required for residents with a diagnosis of dementia? Page: 30 [JAH43]CWFACILITYA: 83.15 (2) (a) Staffing- not necessary to include responsibilities. Including actual hours worked is already required by law. Page: 30 [JAH44]WALA: 83.15 (2) (a) Staffing- delete this last sentence. Why would this be necessary? What outcomes drives this additional requirement? Page: 30 [JAH45]CWFACILITYA: 83.15 (2) (a) Staffing- Seems like a long time. PRQI: We want employe personnel records kept for 3 years in 83.12(4)(c). Do we need consistency between 83.12(4)(c) and 83.15(2)(a)? [DHFS46] PRQI: Feb 2000: Look at rearranging by topic or within time required to report. Page: 30 [JAH47]PRQI: 83.16(2) Reporting - Could this be moved down to other reporting since all items under other reporting are to be reported within 3 working days? Page: 30 [JAH48]FMH: 83.16 (2) Reporting(Definition of physical restraint)- Current organization of HFS83 is easier to follow. Page: 30 [JAH49]RFO-GB: 83.16 (3) Reporting (Other reporting)- Does this consistent with reporting requirements under HFS13? Page: 31 [JAH50]FMH: 83.16 (3) (d) Reporting(Other reporting)-a sensible revision, but could list some examples. Currently, RFDDs are requesting a report if a person with advanced osteoporosis has a minor incident (slipping off the edge of chair) which results in a fracture & hospitalization. This is now being interpreted as an accident & reportable. Individuals in this advanced stage of disease break bones very easily. Reporting these situations to DSL does not serve a good purpose. Page: 31 [JAH51]RFO-Milwaukee: 83.17 (1) (b)Limits on Admissions & Programs- Does this mean if a person residing in an AA facility breaks their leg & can't evacuate without assistance, they can no longer reside there or does 83.17(1)(b) allow them to stay. Need better clarification on what temporary illness is and on under what circumstance does 83.17(1)(b) apply. This is a frequent problem. [DHFS52]Feb 2000: PRQI: do we want to define what a temporary incapacity is? (under 90 days like we say for nursing in 83.17(1) (d) 4. And 83.33 (1) (h). Page: 32 [JAH53]RFO-Madison: 83.17(1) (d) 4.Limits on Admission & Programs- Include changes made in ch. 50 related to nursing care. WALA: Will the re-write of HFS83 supercede all current BQA memo? The definition of 3 hours of nursing care in the current memo series is different than the re-write. The re-write language is care "directly on or to a resident" and doesn't include charting, doctors appointments, etc, We agree with this and think this should supercede the memos, additional language will need clarification. Page: 32 [JAH54]WALA: 83.17 (1) (d) 7 a. Limits on Admission & Programs- delete. Size bias [DHFS55]Need titles for all (a) etc,. or none. Page: 34 [JAH56]CWFACILITYA: 83.19(2) (c ) 1.Discharge or transfer- need specific timeframe. Reasonable is too vague. Page: 35 [JAH57]CWFACILITYA: 83.19(2) (d) Discharge or transfer- this sure takes the rights away from a owner as to who can stay. What if the family member is just mean? The department should have no jurisdiction over a private pay FACILITY. If the FACILITY has valid reasons for discharge, the state should not have the final decision for discharge or retention. Page: 36 [JAH58]WALA: 83.19(2) (d)4. Discharge or transfer- wants added: The entire process shall not take more than 30 days. OLC: Adeline Cass, case no. ML-99-0116. Hearing decision does not allow department decision to be appealed. Page: 37 [JAH59]CWFACILITYA: 83.19 (3) Discharge or transfer- All of 83.19(3) sounds like discharge from a hospital or nursing home. Only thing missing is doctor's signature. Since FACILITYs are NOT medical facilities, all of above is unnecessary unless transferring to another FACILITY. RFO-Milwaukee: Clarify this includes temporary hospitalization. Especially in 83.19(3), info to be provided at the time of transfer or discharge. Death in regards to discharge definitions also seems to be a problem, as if it was not exactly initiated by the resident or resident's family or facility. It has created problems regarding REFUNDS due. May need to be addressed here as well as in admission agreements. Another area involves injuries that occur in the facility. For example, resident falls & breaks her hip. She now is unable to return to the FACILITY because she needs more nursing care. Who initiated the discharge? The physician determined the resident needs more care than the FACILITY is licensed to provide. Again this may need to be addressed in the admission agreement section. Page: 37 [JAH60]WALA: 83.19 (3) Discharge or transfer- wants this changed to "may be" rather than "shall be" .Let the resident and others mentioned chose if they wish to acquire this information. Page: 38 [JAH61] PRQI: 83.21(2) (b)Rights- Couldn't (2)(b) be combined with (2)(a) to say they are explained and given copies? Page: 38 [JAH62]CWFACILITYA: 83.21(2) (c) Rights- Can copies of the house rules be posted in a binder in a visible place, with the binder indicating what is in it, rather than posting copies all over the wall? Page: 39 [JAH63]PRQI: 83.21(3) (a) Rights- This was recently deleted from DRAFT HFS132 by Joe Leean, Do we need to do the same in this draft? Page: 39 [JAH64]CWFACILITYA: 83.21 (3)(a) 2. Rights- What is reasonable? This is too subjective and needs to be defined better. Page: 40 [JAH65]CWFACILITYA: 83.21(3) (k) Rights-Does the abuse registry consider abuse the same as HFS83? Page: 40 [JAH66]FMH: 83.21(3) (m) Rights- Does this still follow guidelines set in BQA Memo of 7-97 on restraints? Page: 40 [JAH67]CWFACILITYA: 83.21(3) (m) Rights- If you have a scheduled med. Can you also have a PRN med.? Page: 40 [JAH68]CWFACILITYA: 83.21(3) (o) Rights- What if small town rural pharmacy does not unit dose? Page: 41 [JAH69]CWFACILITYA: 83.21(3) (o) Rights-What? Page: 41 [JAH70]RFO-Madison: 83.21(5) Rights Include information regarding HFS94. Page: 41 [JAH71]FMH: 83.22 (1) Grievance Procedures- Nothing following specifying the grievance procedure. Page: 41 [JAH72]CWFACILITYA: 83.22 (2) Grievance Procedures-Clarify grievance-minor ELOs? Do records need to be kept of this? Page: 42 [JAH73] PRQI: 83.22 (9) Grievance Procedures-Do we really need to say the statement provided has this information on it? Can we just say to post it? Page: 43 [JAH74] PRQI: 83.23 (3) (d) Resident Funds- Isn't this in direct conflict to 83.23(3)(a)? Under what circumstance would we allow the FACILITY to hold more than $200 of personal funds. If we do allow more then 83.23(3)(a) and 83.23(3)(d) should be combined into one statement. Page: 43 [JAH75]RFO-GB: 83.23 (4) Residents Funds- There is no corresponding number like this in this rule. [JAH76]PRQI: Recent issue regarding employe witness to resident signing a will. We may want to add language here. Page: 43 [JAH77]PRQI: 83.23 (5) Residents Funds- It seems there is the potential for abuse. By calling the money or property a donation or gift, the FACILITY is allow to accept the money? Is there a maximum dollar figure? Do we want to cross-reference to another section of this rule addressing misappropriation of funds? RFO-GB: Can there be a dollar limit on gifts & can it just be for birthdays, Christmas, etc,.. Page: 43 [JAH78]CWFACILITYA: 83.23 (6) (a) Residents Funds- What about admission fees? (does the admission or entrance fee go into an account or is this a non-refundable fee not returned to the resident. Does it vary by facility?) Page: 44 [JAH79]RFO-GB: 83.23 (7) (a) 2. Residents Funds- I like this, but can it say at least 30 days notice? Page: 44 [JAH80]PRQI: 83.24 Admission agreement- Should Admission agreement be moved to Subchapter III Admissions, Transfers and Discharges? Current numbering in this section appears to be incorrect. Feb 2000: the same information in (1) is spelled out more clearly in (2). Duplicate effort. POEC: The admission agreement needs to include a statement that informs the resident & legal representative that all routine care, treatment and medication are administered by non-licensed resident care providers. [DHFS81]PRQI: Feb 2000: does this belong under (1). Page: 46 [JAH82]OLC: 83.31 (1)(d) General requirements- Delete discharge and use for all records expect medical records. (make all consistent -7 yrs) All other records just seems to be plopped here as there is a lack of another place to put it. I suggest with a general records section or consistently have a record retention area where it applies in the rule (i.e. employe records) Page: 46 [JAH83] PRQI: 83.31 (1)(d) General requirements- Isn't this addressed in (c) SAFEGUARDING OF RECORDS? CWFACILITYA: is my garage an ok place for retention or does it have to be at the facility? Page: 47 [JAH84]RFO-GB: 83.31 (2) (c) General requirements- Chapter 13? Page: 48 [JAH85]CWFACILITYA: 83.32 (1) (b) 2. Assessment & ISP- Do you have an assessment tool for this? Who decides? FACILITY? MD? Family? Resident? Page: 48 [JAH86]CWFACILITYA: 83.32 (1) (b) 4. Assessment & ISP- How do we determine self-concept? How does an unskilled non-licensed FACILITY provider determine symptoms of mental illness? Page: 48 [JAH87]CWFACILITYA: 83.32 (1) (c) Assessment & ISP- is a signature giving permission enough. Verbal notes via the telephone? Page: 48 [JAH88]CWFACILITYA: 83.32 (1) (d) Assessment & ISP- It was within 30 days admission. Does this mean on the day of admission. Explain initial service plan. PRQI: Is "initial service plan" interchangeable with "individual service plan". If so, stay consistent. Page: 49 [JAH89]PRQI: 83.32 (2) (a) Assessment & ISP- If 83.32(1)(d) is the same as 83.32(2)(a), we need consistency. Is it upon admission or within 30 days? Page: 49 [JAH90]RFO-GB: 83.32 (2) (b) Assessment & ISP- Check cross-reference numbering. Appears to be wrong. Page: 50 [JAH91]RFO-GB: 83.33(1) (c) Program Services- missing explanation after communication skills. Page: 50 [JAH92] PRQI: 83.33(1) (f) 1. Program Services-Do we mean no more than 7 days total, whether consecutive or not? Page: 51 [JAH93]RFO-GB: 83.33(1) (g) Program Services any text to follow Medication administration instructions? Page: 51 [JAH94]RFO-Madison: 83.33(1) (h) 1. Program Services Include Chapter 50 changes. Page: 51 [JAH95]RFO-GB: 83.33(1) (i) Program Services suggested addition to end of sentence: "appropriate to the residents needs." Page: 51 [JAH96]CWFACILITYA: 83.33(1) (l) Program Services- family contacts should be documented on the ISP. When speak to FACILITY arranging, is the Christmas party, summer picnic & other socials adequate. I don't think anymore is appropriate. Page: 52 [JAH97]CWFACILITYA: 83.33(1) (m) Program Services- too subjective. Need something more than "reasonable number of activities. Page: 52 [JAH98]LSS: 83.34 Medications- Perhaps there needs to be a paragraph or two added here to address the needs of AODA/Corrections programs. These facilities monitor the self-administration of medications, however, they also control medications to prevent residents from overdose, theft, unlawful distribution to others, or other illegal activity. Residents are responsible to take their medications are prescribed by the physician. Staff of the facility monitor medications and document use or refusal to follow physicians orders. (This section relates to the medication training. There may need to be a work group that looks into both the training and administration of medications related to this specific client group. Page: 52 [JAH99]LSS: 83.34 Medications- Perhaps there needs to be a paragraph or two added here to address the needs of AODA/Corrections programs. These facilities monitor the self-administration of medications, however, they also control medications to prevent residents from overdose, theft, unlawful distribution to others, or other illegal activity. Residents are responsible to take their medications are prescribed by the physician. Staff of the facility monitor medications and document use or refusal to follow physicians orders. (This section relates to the medication training. There may need to be a work group that looks into both the training and administration of medications related to this specific client group. [DHFS100]4-25-00 meeting: proposed deleting this as the assumption is the pharmacist will review anytime a prescription is filled (unless resident goes to other pharmacy) and Dr. is more appropriate for review when there is a signification change in medical condition. LYNETTE TRAAS: would like to see only the "anytime a resident's condition undergoes a signification change" be deleted but to leave the other contingencies left in the draft. CONSIDER EXEMPTION FOR CORRECTIONAL CLIENTS FOR DRUG REGIMEN. [DHFS101]LYNETTE TRAAS: consider including acceptable methods of destruction for the facilities. Page: 56 [JAH102]LLS: 83.35 Terminally Ill Resident Service- Not applicable to AODA/Corrections RFO-Madison: add hospice interface document. Page: 58 [JAH103]CWFACILITYA: 83.36 (1) (c) Food Service-Why not say notify the MD of 5lb loss or gain in one month? Page: 58 [JAH104]CWFACILITYA: 83.36 (2) Food Service-Does this mean the FACILITY pays for Boost or Ensure if the MD orders? Page: 57 [JAH105]CWFACILITYA: 83.36 (1) (c) Food Service- suggested to delete in the evening & replace with "at any time," [DHFS106]PRQI: FEB 2000: look at number under (2). [DHFS107] Do we want language stating facilities need to provide a bed at additional charge, but not linens. [DHFS108]Kevin- can this be applied to all? [DHFS109]What about large facilities? [DHFS110]PRQI: Feb 2000: wait to see if "(b) At least one portable dry chemical fire extinguisher shall be provided." Should be added or not. [DHFS111] PRQI: Feb 2000: removed last sentence regarding large facilities per 50.035 [DHFS112]PRQI: Feb 2000: come back to this section to input changes once clarification comes from Dave Soens. [DHFS113]PQRI: Feb 2000: Dave Soens will check into specific locations so (c)(2) can we changed. [DHFS114]PRQI: Feb 2000: Dave and Woody to meet to see how to proceed. [DHFS115] 4-2000: Look at the text following the table in 83.45 to see what we can keep and what is already covered in the text. [DHFS116]Dave Soens: Please review this. Do we want to include passageways, exit doors to passageways to the definition of an exit? [DHFS117]Feb 2000: Dave Soens to check the door width should it be 2.4, 2.6, 2.8 or 3.0? [DHFS118]moved to 83.41(4)(j). [DHFS119]Moved to 83.41(5)(a)3. 62 HFS83Aug2000FinalDRAFT 9/12/00 jah