Arrangements for the center's health care consultant under subd. 4.
to annually document and date a review of the adequacy of center health care service delivery including center procedures for administration, storage and disposal of medications as provided under s. DCF 52.46 (3)
A center shall have a written daily program of general activities which meet the developmental needs of the residents.
The program of activities shall provide each resident with experiences which encourage self-esteem and a positive self-image through:
Social interaction within the center and, if appropriate, the community.
Daily living activities, including but not limited to, grooming and hygiene, toileting and common household chores such as making beds, cooking and washing clothes.
Interpersonal relations with peers, family, friends, staff and where possible and as appropriate, members of the opposite sex.
Opportunity for paid work within the constraints of child labor laws, resident rights and the resident's treatment plan.
A center shall make maximum use of small groups to aid individual residents in preserving or attaining a sense of personal identity in daily living. The center shall:
Group residents according to age, developmental levels and social needs, with the ages of residents being primarily within a 4 year age range but not to exceed a 6 year age range.
Group residents under supervision of their own resident care worker and give a group opportunities to form and attain group self-identity in daily living and social activities.
Are able to move around by various methods and devices whenever possible.
In this subsection, "supervision" means guidance of the behavior and activities of a resident by a staff member to ensure the safety and well-being of the resident.
The staff-to-resident ratios for staff providing supervision of residents shall be as follows:
1. `1:8 during waking hours.'
A residential care center shall have at least one staff member awake and providing supervision for every 8 or fewer residents present in a program unit during waking hours.
2. `1:15 during sleeping hours.'
A residential care center shall have at least one staff member awake and providing supervision for every 15 or fewer residents present in the program unit during sleeping hours. Each staff member shall be within hearing or call of residents being supervised without reliance on the use of electronic monitoring devices.
3. `Congregate living area.'
A licensee shall ensure that a staff member provides sight and sound supervision at all times in each congregate living area of the center when residents are present. In this subdivision, "congregate living area" means any area in a center used for living or recreation except a bedroom, bathroom, or hallway.
The staff-to-resident ratios in par. (b)
are the minimal staffing requirements for resident care staff. The number of resident care staff providing supervision shall be increased as necessary to meet the needs of residents and to ensure their safety and welfare.
DCF 52.41 Note
Section DCF 52.55 (1) (b) 1.
requires that staff can safely evacuate all residents from the center in one trip for fire safety.
No resident may be in a residential care center without supervision by a staff member.
A licensee shall ensure that supervision is provided for each resident appropriate to the resident's age, maturity, behavior, and developmental level and sufficient to ensure the safety of all residents in the residential care center.
Supervision of residents shall be by a staff member who meets or exceeds the qualifications of a resident care worker under s. DCF 52.12 (2) (e)
An inexperienced resident care worker who is required to take the traineeship program s. DCF 52.12 (5) (g)
may only be counted in the ratios in par. (b)
if the trainee is working with an experienced resident care worker who meets the qualifications in s. DCF 52.12 (2) (e)
A residential care center shall have at least one full-time equivalent resident services case manager under s. DCF 52.12 (1) (a) 3.
for every 16 or fewer residents. A residential services case manager who is working less than full-time may have a maximum caseload that is the equivalent of 2.5 hours per week for each resident.
A center shall provide leisure and recreational programming suitable for the ages, abilities and interests of the center's residents. This programming shall be consistent with the center's overall program goals and shall offer residents a variety of indoor and outdoor recreational activities.
A center shall have well drained outdoor recreation areas that are free of hazards.
(5) Religious practices.
A center shall provide residents with opportunities for voluntary religious expression and participation. The center shall:
Obtain the written consent of the resident's parent or guardian for church attendance and religious instruction when agency practice varies from that of the resident or the resident's family.
Arrange for residents to participate in religious exercises in the community whenever possible.
(6) Center applied policies and procedures.
Center policies and procedures affecting residents and their interests shall be applied in a consistent and fair manner.
A center may operate on the center grounds other services or enterprises not governed by the center's license only if the center obtains the written consent of the department. Examples of other center nonresident services that may be allowed by the department to operate on center grounds are shelter care services, outpatient counseling services, day treatment services and day student educational services.
A center which provides temporary shelter care services need not obtain a separate shelter care license under ch. DCF 59
if the personnel requirements in s. DCF 52.12
, the child care requirements found in s. DCF 59.05
, the requirements for records and reports found in s. DCF 59.07
and the physical plant standards in subch. VI
of this chapter or in s. DCF 59.06
The center shall have procedures for maintaining and managing a separate account for each resident's money and as applicable, shall comply with the provisions under s. 51.61 (1) (v)
The center shall, as applicable, have in place a restitution plan for a resident and as applicable, that is coordinated with any other restitution ordered by a court or as part of an agreement under ch. 938, Stats.
, that describes procedures for deducting sums from a resident's account or earnings as restitution for damages done by the resident. Deductions made for restitution shall be in accordance with a restitution plan as follows:
Before a center may withhold a part of a resident's earnings or account balance, a restitution plan shall be made a part of the resident's treatment record.
The restitution plan shall take into consideration the resident's ability to pay or be as prescribed under court order.
DCF 52.41 History
Cr. Register, February, 2000, No. 530
, eff. 9-1-00; correction in (1) (b) 7. made under s. 13.93 (2m) (b) 7., Stats., Register, June, 2001, No. 546
; corrections in (1) (a) 8., 10., (b) 2., 4., (c) 3., 9., 11., 12., (3) (a), (c) and (7) (b) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635
: emerg. r. and recr. (3), eff. 9-16-11; CR 11-026
: am. (1) (a) 10., r. and recr. (3) Register December 2011 No. 672
, eff. 1-1-12.
Behavior management and control. DCF 52.42(1)(a)
"Behavior management and control" means techniques, measures, interventions and procedures applied in a systematic fashion to prevent or interrupt a resident's behavior which threatens harm to the resident or others or to property and which promote positive behavioral or functional change fostering resident self-control.
"Informed consent document" means a document signed by a resident's parent or guardian and legal custodian or under a court order or under another lawful authority which gives written informed consent for use of a locked unit for a resident based on the following:
Stated reasons why the intervention is necessary and why less restrictive alternatives are ineffective or inappropriate.
The amount of time in each day and length of time in days or months the resident is expected to remain in the locked unit.
The right to withdraw informed consent at any time verbally or in writing and possible consequences for the center and resident if consent is withdrawn.
"Locked unit" means a ward or wing designated as a protective environment in which treatment and services are provided and which is secured by means of a key lock in a manner that prevents residents from leaving the unit at will. A facility locked for purposes of external security is not a locked unit provided that residents may exit at will.
"Emergency safety intervention" means that a staff member physically intervenes with a resident when the resident's behavior presents an imminent danger of harm to self or others and physical restraint or physically enforced separation is necessary to contain the risk and keep the resident and others safe.
"Physically enforced separation" means that a resident is temporarily physically removed to a time-out room or area including, where applicable, a locked unit. "Physically enforced separation" does not include sending a resident on the resident's own volition to the resident's room or another area for a cooling off period as part of a de-escalation technique.
"Physical hold restraint" means that a resident is temporarily physically restrained by a staff member.
"Time-out room" means a designated room used for temporarily holding a resident who is in physically enforced separation from other residents.
A center shall assign to a professional staff member the responsibility to monitor and review, on an ongoing basis, the use of all center behavior management measures identified under par. (b)
for appropriateness and consistency.
Monitoring and review shall cover violation of house rules and their resulting consequences, the use of physical hold restraint and physically enforced separation in emergency safety intervention, the use of a locked unit when used to facilitate a resident's treatment plan under sub. (7) (a) 3.
, and all related center policies and procedures.
(3) Conduct of residents.
A center shall have written policies and procedures covering the conduct expected of residents. The policies and procedures shall do all of the following:
Promote the growth, development and independence of residents.
Address the extent to which a resident's choice will be accommodated in daily decision making. There shall be an emphasis on self-determination and self-management.
Specify center behavior management techniques and approaches available to change, eliminate or modify the behaviors or conditions identified in the center's program statement and operating plan required under s. DCF 52.41 (1)
Specify criteria for levels of supervision of activities, including off-grounds activities. These criteria shall be directed at protecting the safety and security of residents, center staff, visitors and the community.
Provide for making a record of a resident's off-grounds activities. The record shall include where the resident will be, duration of the visit, the name, address and phone number of the person responsible for the resident and expected time of the resident's return.
Specify house rules for the residents. The house rules shall include all of the following:
A resident's individual freedoms when the resident is involved in recreational or school activities away from the center.
DCF 52.42 Note
Note: There is a difference between a patient right and a privilege. Deprivation of a privilege such as watching television, playing video games, going to the movies or involvement in some other recreational activity may be used as a disciplinary measure.
Provide for distribution of the house rules to all staff and to all residents and their parents or guardians.
(4) Prohibited measures.
Center staff may not employ any cruel or humiliating measure such as any of the following:
Requiring physical exercise such as running laps or doing push-ups or other activities causing physical discomfort such as squatting or bending, or requiring a resident to repeat physical movements or assigning the resident unduly strenuous physical work.
Verbally abusing, ridiculing or humiliating a resident.
Denying shelter, clothing, bedding, a meal, or a menu item, center program services, emotional support, sleep or entry to the center.
Use of a chemical or physical restraint or physically enforced separation or a time-out room as punishment.
Authorizing or directing another resident to employ behavior management techniques on a resident.
Penalizing a group for an identified group member's misbehavior.