DCF 52.43 History History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; CR 04-040: am. (1) Register December 2004 No. 588, eff. 1-1-05; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register December 2011 No. 672, eff. 1-1-12.
DCF 52.44 DCF 52.44Nutrition.
DCF 52.44(1)(1)Meals and snacks.
DCF 52.44(1)(a)(a) A center shall provide or arrange for each resident to receive at least 3 meals each day. Meals shall be served at regular times comparable to normal mealtimes in the community.
DCF 52.44(1)(b) (b) Food served at a meal shall consist of adequate portions based on the ages of residents. Lunch and breakfast meals shall follow the meal pattern requirements for the national school lunch program as provided by the U.S. department of agriculture and included in Appendix C of this chapter. Dinner meals shall be comparable to the lunch meal pattern requirements.
DCF 52.44(1)(c) (c) Nutritious snacks shall be provided between meals to residents at the center as follows:
DCF 52.44(1)(c)1. 1. For residents between breakfast and lunch if there are more than 4 hours between those meals, and between lunch and dinner.
DCF 52.44(1)(c)2. 2. For all residents, an evening snack.
DCF 52.44(1)(c)3. 3. When a resident's nutritional care plan under sub. (2) (c) indicates a need for snacks.
DCF 52.44(2) (2) Residents with special dietary needs. A center shall maintain an up-to-date list of residents with special nutritional or dietary needs as determined by a physician or dietitian, and shall do all of the following:
DCF 52.44(2)(a) (a) Provide food supplements or modified diets as ordered by a physician for a resident who has special dietary needs.
DCF 52.44(2)(b) (b) Have procedures for recording diet orders and changes and for sending diet orders and changes to kitchen personnel.
DCF 52.44(2)(c) (c) Include a nutritional care plan in the health record of a resident with special nutritional or dietary needs. The plan shall include a problem statement, nutritional goals or dietary goals, a plan of action and procedures for follow-up. The nutritional care plan shall be reviewed and approved by a registered dietitian.
DCF 52.44(2)(d) (d) Provide adaptive self-help devices to residents as needed and instruct residents on their use.
DCF 52.44(2)(e) (e) Observe resident food and fluid intake. Review acceptance by a resident of a diet, and report any significant deviations from a resident's normal eating pattern to the resident's physician.
DCF 52.44(2)(f) (f) Assist residents with food and fluid intake as necessary according to the nutritional care plan, including where applicable such tasks as instructing a resident on how to eat and take fluids as independently as possible and protecting a resident from choking which may occur because of a physiological or behavioral eating disorder.
DCF 52.44 Note Note: An example of a food that has been fatal is peanut butter sandwiches for a Down Syndrome individual with uncontrollable eating habits.
DCF 52.44(2)(g) (g) Provide vitamin and mineral supplements when ordered by a physician.
DCF 52.44(3) (3) Menus. A center shall do all of the following:
DCF 52.44(3)(a) (a) Plan meals and snacks in advance of the date of service and prepare menus in writing that specify the actual food to be served.
DCF 52.44(3)(b) (b) Post the menu for the day and next day in the food serving area or in another place where residents can read it.
DCF 52.44(3)(c) (c) Keep menus on file for the last 30 days of service.
DCF 52.44(3)(d) (d) When it is necessary to substitute another item for an item on a posted menu, ensure that the replacement item has the same nutritional value as the item replaced. The center shall provide for menu substitutes where religious beliefs prohibit consumption of certain food items such as pork for Jewish or Muslim residents or meat products on Lenten Fridays or other designated days of fast for Catholic residents.
DCF 52.44(4) (4) Food service personnel.
DCF 52.44(4)(a)(a) In this subsection, “food service personnel" means staff who prepare breakfast, lunch, dinner and snacks for center residents.
DCF 52.44(4)(b) (b) If a center has its own food service personnel, the food service personnel shall be age 18 or over and meet the requirements of s. DHS 190.09 (1).
DCF 52.44 Note Note: Chapter DHS 190 has been repealed.
DCF 52.44(4)(c) (c) The director of a center shall appoint a food service director who shall be responsible for complying with this section and ch. DHS 190 as it relates to food service.
DCF 52.44 Note Note: Chapter DHS 190 has been repealed.
DCF 52.44(4)(d) (d) A center shall provide all center food service personnel in-service training annually. Training topics shall relate to proper food handling procedures, maintenance of sanitary conditions and food service arrangements. Training shall be documented and the documentation kept on file at the center.
DCF 52.44(5) (5) Food service.
DCF 52.44(5)(a)(a) A center shall meet the requirements of s. DHS 190.09 (2) to (9).
DCF 52.44 Note Note: Chapter DHS 190 has been repealed.
DCF 52.44(5)(b) (b) A center shall provide nutritious packed lunches for residents who are in school or vocational or work programs when on-site lunches are not available. The center shall make provision for holding a meal for a resident who returns to the center after a meal is served.
DCF 52.44(5)(c) (c) No resident may be force-fed or otherwise coerced to eat against the resident's will except by order of a physician.
DCF 52.44(5)(d) (d) A staff person trained in the Heimlich maneuver for choking victims shall be present at mealtimes.
DCF 52.44(5)(e) (e) Residents shall have at least 30 minutes to finish a meal, and a resident with an eating disorder shall have as much time as is necessary to finish the meal.
DCF 52.44(5)(f) (f) The dining room in a center shall be clean, well-lighted and ventilated and shall offer a comfortable atmosphere for dining.
DCF 52.44(5)(g) (g) A center may not use disposable dinnerware at meals on a regular basis, except when it documents that use of disposable dinnerware for a particular resident is necessary to protect the health or safety of the resident or others.
DCF 52.44 History History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; corrections in (4) (b), (c) and (5) (a) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.
DCF 52.45 DCF 52.45Health.
DCF 52.45(1)(1)Ongoing care.
DCF 52.45(1)(a)(a) A center shall arrange a physical examination comparable to a comprehensive HealthCheck screening for each resident at intervals recommended by the medical assistance program for HealthCheck screening, except if a resident is privately insured. A privately insured resident shall be reexamined no less frequently than as required by HealthCheck or in accordance with policy coverage. The physical examination shall be conducted by a HealthCheck provider or by a physician and shall document areas found on department HealthCheck age-appropriate forms.
DCF 52.45 Note Note: A HealthCheck form may be obtained from any local public health agency, from the Department of Health Services website at http://dhs.wisconsin.gov/forms/FtoM.asp or by writing or telephoning any field office listed in Appendix D.
DCF 52.45(1)(b) (b) A center shall arrange a thorough dental examination for each resident at intervals recommended by the medical assistance program for HealthCheck screening, except if a resident is privately insured. A privately insured resident shall be reexamined no less frequently than as required by Healthcheck or in accordance with policy coverage. The dental examination shall be conducted by a licensed dentist.
DCF 52.45(1)(c) (c) A center shall arrange and provide for necessary remedial and corrective measures for every resident as soon as possible after a physical or dental examination which indicates need for remedial or corrective measures.
DCF 52.45(1)(d) (d) A center shall have in each building housing residents when residents are present, at least one staff member certified by the American Red Cross to administer first aid and certified by the American Red Cross or American heart association to administer cardiopulmonary resuscitation (CPR). The center shall keep all staff certifications current and shall maintain documentation of all certifications.
DCF 52.45(1)(e) (e) There shall be a first aid kit on every floor level of every center building housing residents, in buildings where resident activities take place and in every vehicle used to transport residents. The first aid kit shall be placed where it is inaccessible to residents but accessible to staff. Contents of first aid kits shall meet recommendations of the American Red Cross. A first aid kit shall be inventoried and resupplied after each use.
DCF 52.45(1)(f) (f) A center shall separate an ill resident from other residents only if necessary because of the severity of the illness and if it is contagious or infectious, or when requested by the ill resident.
DCF 52.45(2) (2) Basic sanitation and hygiene practices. Center staff shall follow the guidelines in appendix A to prevent transmission of infection from all blood or other body fluid exposures.
DCF 52.45(3) (3) Pregnant residents or resident mothers.
DCF 52.45(3)(a) (a) If a center serves pregnant residents or residents who are mothers who keep their babies at the center, the center shall do all of the following:
DCF 52.45(3)(a)1. 1. Refer those residents for enrollment to the women, infants and children (WIC) supplemental food and nutrition counseling program.
DCF 52.45(3)(a)2. 2. Ensure that pregnant residents receive prenatal health care.
DCF 52.45(3)(a)3. 3. Ensure that resident mothers and their infant or toddler children receive health care through a HealthCheck provider or, if through private insurance, a physician, according to the frequency recommended under medical assistance program HealthCheck guidelines or as described by the private insurance policy.
DCF 52.45(3)(b) (b) A center which serves residents who are mothers with infants or toddlers shall comply with s. DCF 250.07, family day care standards for infant and toddler care. The center shall provide an additional 35 square feet of resident living space for each infant and toddler in addition to the resident living space required under s. DCF 52.52 (1).
DCF 52.45(4) (4) Health care record. A center shall maintain a separate health care record as part of each resident's case record. The health care record shall include all of the following:
DCF 52.45(4)(a) (a) The signed written consent required under s. DCF 52.21 (5).
DCF 52.45(4)(b) (b) The dates and results of all physical health, mental health and dental examinations.
DCF 52.45(4)(c) (c) The resident's health history and, if applicable, medications history prior to admission and during the resident's stay at the center.
DCF 52.45(4)(d) (d) Information about any of the following medical procedures received while the young person was a resident of the center, including dates, person administering and results:
DCF 52.45(4)(d)1. 1. Immunizations.
DCF 52.45(4)(d)2. 2. Laboratory tests.
DCF 52.45(4)(d)3. 3. Routine health care examinations and treatment.
DCF 52.45(4)(d)4. 4. Emergency health care examinations and treatment.
DCF 52.45(4)(d)5. 5. Dental examinations and treatment.
DCF 52.45(4)(e) (e) The medications administration record required under s. DCF 52.46 (4).
DCF 52.45(4)(f) (f) If applicable, the nutritional care plan required under s. DCF 52.44 (2) (c).
DCF 52.45 History History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; corrections in (3) (b), (4) (a), (e) and (f) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.
DCF 52.46 DCF 52.46Medications.
DCF 52.46(1)(1)Definitions. In this section:
DCF 52.46(1)(a) (a) “General supervision" means regular coordination, direction and inspection of the exercise of delegation of medication administration by a physician or registered nurse of someone who is not licensed to administer medications.
DCF 52.46(1)(b) (b) “Staff administration" means proper administration of medication to a resident by center nonmedically nonlicensed staff under a valid medical order from a medically licensed practitioner who specifically designates, trains and supervises center staff administration of medications.
DCF 52.46(1)(c) (c) “Staff monitoring of self-administration" means handing the medication to the resident by center staff according to physician and medication label instructions and observing and ensuring the proper ingestion, injection, application or inhalation of the medication by the resident.
DCF 52.46(2) (2) Medications administration. Each staff person responsible for administering or monitoring resident use of medications shall receive a copy of the center policies and procedures required under s. DCF 52.41 (1) (c) 9. for medication administration and monitoring and shall be knowledgeable of them. The policies and procedures shall include:
DCF 52.46(2)(a) (a) For all medications, all of the following:
DCF 52.46(2)(a)1. 1. Having written informed consent on file as required under s. DCF 52.21 (5).
DCF 52.46(2)(a)2. 2. Having information in each resident's health record about any health allergies or health-related restrictions.
DCF 52.46(2)(a)3. 3. Having on file written authorization from a physician or registered nurse for each staff person permitted to administer medications or to monitor self-administration of medications.
DCF 52.46(2)(a)4. 4. Instructions for center staff concerning administration of medications and monitoring of resident self-administration of medications, secure storage of medications and recording medication administration information as required under sub. (4) (a) in the resident's health record.
DCF 52.46(2)(a)5. 5. Immediate notification of the resident's attending physician in the event of a medication error or adverse drug reaction.
DCF 52.46(2)(a)6. 6. Medications may only be made available when an individual authorized by the center is present.
DCF 52.46(2)(b) (b) For prescription medications, all of the following:
DCF 52.46(2)(b)1. 1. Requiring that a medication be administered by center staff to a resident only when:
DCF 52.46(2)(b)1.a. a. The resident's attending physician or center medical consultant provides center staff with clear written instructions for administering the medication and authorizes specific center staff to administer the medication.
DCF 52.46(2)(b)1.b. b. The administration takes place under the general supervision of a physician or registered nurse.
DCF 52.46(2)(b)1.c. c. The label on the medication container gives clear instruction for administration of the medication and, if not clear, center staff contact the physician or pharmacy for clarification before administration of the medication.
DCF 52.46(2)(b)2. 2. Allowing a medication, including a self-injectable medication, to be self-administered by a resident only while the resident is under direct supervision of center staff and if self-administration is authorized in writing from the prescribing physician or center medical consultant under s. DCF 52.41 (1) (c) 4., and that authorization is confirmed by review of the authorization for self-administration by center staff before allowing self-administration by a resident.
DCF 52.46(2)(b)3. 3. Providing information to a resident and the resident's resident care workers and resident services case manager about any medication prescribed for the resident and when a physician orders or changes the resident's medication. Information provided shall include expected benefits and potential adverse side effects which may affect the resident's overall treatment and, for staff, what to do if the resident refuses medication.
Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.