At least annually, a physician, registered nurse, or pharmacist is required to conduct an on-site review of the facility's medication administration and storage system. The on-site review will generally assess medication storage including, locked areas, separation of internal and external medications, refrigerated medications, labeling, and security of narcotics. The medication administration portion of the on-site review will assess staff administration of medications to residents to ensure proper route, proper dosage, proper resident, proper time and proper administration method. The last component of the assessment includes a review of the facility's medication administration records. This review ensures proper documentation of medications administered, including proof of use audits for all narcotics, documentation of medication errors or resident refusals to take medications and documentation showing staff understanding of potential side effects and benefits of psychotropic medication use. This on-site visit generally takes between 2 to 3 hours depending on the size of the facility and acuity of residents served. A registered nurse on staff would be qualified to perform the on-site medication administration. CBRFs lacking staff to complete this review may need to use the services of a consultant; these costs could range from $20 – $100 per hour; or $60 - $300 annually.
Part of the on-going transactional costs for facilities includes an evaluation of each resident's ability to evacuate the facility in case of fire or disaster without any help or verbal or physical prompting from staff. The assessment is standardized by the Department and must be completed by a staff person knowledgeable of the resident's abilities. This evaluation must be completed annually and when there is a significant change in a resident's condition. This assessment generally takes one hour for a newly admitted resident and subsequent evaluations are generally completed in 30 minutes. Existing CBRF staff, or county human services staff, should be able to complete the required evacuation evaluation with no increased cost to the facility. See the following website for a copy of the Resident Evacuation Assessment form:
http://dhfs.wisconsin.gov/forms/DDES/DDE2373.pdf.
Costs for annual assessments, service plans, on-site visits and evacuation evaluations may cost from $20 - $100 per hour if performed by consultants. These costs are ¼ of 1% of the revenue for single average bed. There is no increased cost for CBRFs that perform these required assessments with existing staff.
Mandatory reporting requirements.
All CBRF mandatory reporting requirements are listed in s.
HFS 83.12 of the proposed rule. Many of these reports are required by Wisconsin statute or other administrative code. Section
50.04 (2t), Stats. requires facilities to report all deaths related to the use of a physical restraint, psychotropic medication or suicide to the Department within 24 hours of the death. Chapter
HFS 13 requires CBRFs to report all allegations of abuse or neglect of a resident, suspicious injury of unknown source or misappropriation of a resident's property to the Department within 7 days of the occurrence. CBRFs are also required to notify the Department anytime a resident is missing or is seriously injured requiring hospitalization if there has been a fire on the premises, or when law enforcement personnel are called to the facility as a result of an incident that jeopardized the health safety or welfare of a resident. None of these reports are new requirements for CBRFs.
Start Up Compliance Costs.
A person requesting licensure of a CBRF must complete an initial license application as required by s.
50.03, Stats. In addition to identifying general and facility information, the proposed rule requires a perspective licensee to complete financial information. This financial information includes the completion of a balance sheet which identifies assets; both current and fixed, and liabilities and net worth. Many corporate entities will not experience additional costs developing a balance sheet to meet Department reporting requirements as standard reports in accounting systems; balance sheets are readily available to any CBRF using automated accounting systems. For those CBRF entities that do not follow generally accepted accounting principles (GAAP), the aid of an accounting service may be required. Based on industry experience it will take one to 5 hours for an accountant to develop a balance sheet from the available records provided by the CBRF entity. Accountants currently charge $100 - $200 an hour for such services. This potential cost to CBRFs is a one-time startup expense.
The proposed rule requires new CBRFs to submit financial information showing assets, liabilities and net worth at the time of initial licensure as one way to determine whether the entity is qualified and has adequate resources to care for dependent adults. In the past, facilities have ceased operations abruptly due to financial problems with little or no notice to residents and families. This has caused physical and mental distress and resulted in residents being forced into accepting a new placement without adequate time to visit a variety of potentially new facilities to determine which best meets their needs and satisfaction. The information on the balance sheet will enable the Department to evaluate the financial viability of an entity.
Small Business Regulatory Coordinator
Rosie Greer
(608) 266-1279
Fiscal Estimate
There is no fiscal effect on state or local revenues or liabilities.
Copies of Rules and Fiscal Estimate
A copy of the full text of the rules and the fiscal estimate can be obtained at no charge from the Wisconsin Administrative Rules Website at http://adminrules. wisconsin.gov or by contacting the person listed below.
Contact Person
Pat Benesh, Quality Assurance Program Spec-Senior
Division of Quality Assurance
1 West Wilson Street
Room 1150
Madison, WI 53701
Phone: (608) 264-9896
Fax: (608) 267-7119
Notice of Hearings
Health and Family Services
(Community Services, Chs.
HFS 30—)
NOTICE IS HEREBY GIVEN that pursuant to s.
48.67, Stats., and interpreting s.
48.67, Stats., the Wisconsin Department of Health and Family Services proposes to revise chs.
HFS 45,
46 and
55, relating to child care and affecting small businesses.
Hearing Information
Date and Time
|
Location
|
December 3, 2007
4:00 - 7:00 PM
|
Milwaukee County Zoofari
Conference Center
9715 W. Bluemound Road
Milwaukee
|
December 10, 2007
4:00 - 7:00 PM
|
Northcentral Technical College
Room E101-E102 Main Building
1000 W. Campus Drive
Wausau
|
The hearing site is fully accessible to people with disabilities. If you are hearing impaired, do not speak English or have circumstances that might make communication at a hearing difficult; you require an interpreter or a non-English large print or taped version of the proposed rules, contact the person at the address or telephone number given below at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Submission of Written comments
Written comments may be submitted at the public hearing or submitted to the contact person listed below. Comments may also be made using the Wisconsin Administrative Rule Website at
http://adminrules.wisconsin.gov. The deadline for submitting comments to the Department is 4:30 p.m. on Monday, December 17, 2007.
Analysis Prepared by the Department of Health and Family Services
The Department is required under s.
48.67, Stats., to establish, by rule, minimum requirements and standards for the operation of day care centers. These requirements and standards are codified under chs.
HFS 45,
46, and
55.
2005 Wisconsin Act 165 revised s.
48.67, Stats., to require licensees who are individuals, employees, and volunteers who provide care to children under 5 years old to receive training under s.
253.14 (4), Stats., relating to shaken baby syndrome and impacted babies before the individual is issued a license or before employment or volunteer work begins. The Department intends to modify these rules to conform to the new requirements under s.
48.67.
In addition, the Department intends to modify chs.
45,
46, and
55 to conform with s.
948.53, Stats., (created by
2005 Wisconsin Act 184) which prohibits a person from leaving a child being transported in a vehicle that is owned or leased by a child care provider or used to transport children to and from a child care provider. The Department specifically intends to incorporate requirements for procedures to ensure that children are tracked during transport and that parents are notified if a child does not arrive at a day care center as scheduled. Further changes intended for chs.
HFS 45,
46, and
55 are to ensure that the rules conform with the requirements under s.
347.48 (4) (as), Stats., for restraining children under 8 years old in motor vehicles used to transport children in care.
The Department also intends to generally update and clarify chs.
HFS 45,
46, and
55 as follows:.
Chapter HFS 45, Family Child Care Centers The Department proposes to modify ch.
HFS 45, to do the following:
• Revise the definition of a family child care center to mean a facility where the licensee resides. The intent of this change is to require family child care centers to be located in the licensee's residence.
• Prohibit family child care licensees from operating more than one family child care center at a time.
• Clarify when buildings used for family child care must meet commercial building codes.
• Create guidelines on when notification to a parent is required.
• Require additional licensee reporting to the Department and clarify existing reporting to the Department.
• Revise training requirements for providers to do the following:
• Require primary providers to have specified entry-level training before working with children. Other providers would have up to 6 months to get training.
• Require all providers to be trained in the business side of operating a child care center.
• Require staff at centers licensed to care for children under 5 years old to have training in Shaken Baby Syndrome and appropriate ways to guide children's behavior.
2005 Wisconsin Act 165 revised s.
48.67, Stats., to require licensees who are individuals, employees, and volunteers who provide care to children under 5 years old to receive training under s.
253.14 (4), Stats., relating to shaken baby syndrome and impacted babies before the individual is issued a license or before employment or volunteer work begins.
• Revise the provider to child ratios to allow providers to care for additional school-age children (age 5 and enrolled in school) rather than children who are age 7 and above.
• Require family child care centers that use on-premise play space to have a permanent boundary to protect children in care from any nearby hazards. Fencing and landscaping are two types of boundaries allowed by the proposed rules.
• Clarify requirements for child care business liability insurance if pets are accessible to children.
• Clarify rules related to pets and animals on the premises of a center.
• Require licensees to obtain driver records for persons who transport children for the center.
• Revise rules relating to car safety seat and booster seat usage to conform with s.
347.48 (4) (as), Stats.
• Require child care centers to have and implement procedures to ensure that no child is unattended in a vehicle.
Chapter HFS 46 Group Child Care Centers The Department proposes to modify ch.
HFS 46, Group Child Care Centers rules to do the following:
• Require licensees to create personnel policies pursuant to s.
HFS 12.07which require staff to notify the licensee of convictions, investigations, governmental findings of abuse and neglect, or restrictions on certain credentials.
• Require centers have and implement a policy on transporting children in order to ensure that children are safely transported while under the care of the center.
• Require additional reporting requirements and clarify existing reporting requirements to the Department.
• Require additional training for center directors. Center directors are allowed additional time to meet the additional training requirements.
• Require training in Shaken Baby Syndrome if the child care center is licensed to care for children under age 5.
• Clarify requirements for center personnel who have sole charge of children.
• Clarify requirements for persons who provide care to children during the center's opening and closing 2 hours.
• Require staff substitutes be at least 18 years old.
• Clarify rules relating to the use of a dishwashing machine to clean soiled dishes.
• Prohibit trampolines and bounce surfaces as play equipment.
• Allow the use of shredded rubber and poured surfacing on play grounds.
• Require all group child care centers that use on-premise play space to have a permanent boundary to protect children in care from any nearby hazards.
• Revise rules requiring car safety seat and booster seat usage to conform with s.
347.48 (4) (as), Stats.
• Require centers to have and implement procedures to ensure that no child is unattended in a vehicle.
• Clarify requirements for entry level staff training requirements for staff who care for school-age children.
• Limit the maximum group size of school age children to 32 children with 2 adults.
• Allow school-age children to move between groups if the child care center has a procedure to track the children during movement.
The Department proposes to modify ch.
HFS 55, Day Camps rules to do the following:
• Prohibit children under age 3 years from being accepted enrollment in a day camp.
• Create rules related to enforcement actions, revocations, appeal language, general conditions for approval of a license.
• Clarify rules related to pets and animals on the premises of a center.
• Create rules related to car seat, booster seat and seat belt usage to conform with s.
347.48 (4) (as), Stats.
• Require driver records be obtained annually.
• Require licensees to have and implement procedures to ensure that no child is unattended in a vehicle.
• Expand the requirements for what must be included in camp policies and procedures.
• Add requirements for posting a license, any approved exceptions to a rule and enforcement actions.
• Require conformity with ch.
HFS 12 and s.
48.685, Stats., relating to caregiver background checks.
• Add additional items that must be reported to the department including:
• Any death of a child in care or any accident or incident that occurs while a child is in the care of a camp that requires professional medical treatment.
