Wisconsin Legislature: DCF 52.45(1)(d)

(g) Provide vitamin and mineral supplements when ordered by a physician.

(3) Menus. A center shall do all of the following:

(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.

(b) Post the menu for the day and next day in the food serving area or in another place where residents can read it.

(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.

(4) Food service personnel.

(a) In this subsection, “food service personnel” means staff who prepare breakfast, lunch, dinner and snacks for center residents.

(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).

Note: Chapter DHS 190 has been repealed.

(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.

Note: Chapter DHS 190 has been repealed.

(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.

(5) Food service.

(a) A center shall meet the requirements of s. DHS 190.09 (2) to (9).

Note: Chapter DHS 190 has been repealed.

(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.

(d) A staff person trained in the Heimlich maneuver for choking victims shall be present at mealtimes.

(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.

(f) The dining room in a center shall be clean, well-lighted and ventilated and shall offer a comfortable atmosphere for dining.

(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.

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 Health.

(1) Ongoing care.

(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.

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.

(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.

(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.

(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.

(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.

(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.

(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.

(3) Pregnant residents or resident mothers.

(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:

1. Refer those residents for enrollment to the women, infants and children (WIC) supplemental food and nutrition counseling program.

2. Ensure that pregnant residents receive prenatal health care.

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.

(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).

(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:

(a) The signed written consent required under s. DCF 52.21 (5).

(b) The dates and results of all physical health, mental health and dental examinations.

(c) The resident’s health history and, if applicable, medications history prior to admission and during the resident’s stay at the center.

(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:

1. Immunizations.

2. Laboratory tests.

3. Routine health care examinations and treatment.

4. Emergency health care examinations and treatment.

5. Dental examinations and treatment.

(e) The medications administration record required under s. DCF 52.46 (4).

(f) If applicable, the nutritional care plan required under s. DCF 52.44 (2) (c).

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 Medications.

(1) Definitions. In this section:

(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.

(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.

(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.

(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:

(a) For all medications, all of the following:

1. Having written informed consent on file as required under s. DCF 52.21 (5).

2. Having information in each resident’s health record about any health allergies or health-related restrictions.

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.

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.

5. Immediate notification of the resident’s attending physician in the event of a medication error or adverse drug reaction.

6. Medications may only be made available when an individual authorized by the center is present.

(b) For prescription medications, all of the following:

1. Requiring that a medication be administered by center staff to a resident only when:

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.

b. The administration takes place under the general supervision of a physician or registered nurse.

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.

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.

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.

4. Instructions for center staff on what to look for in monitoring physical or mental changes to a resident that may occur from a medication, what to do if physical or mental changes are observed and recording them in the resident’s health record.

5. Arranging a second medical consultation when a resident or the resident’s parent or guardian or legal custodian, if any, has concerns about any medication received by the resident or the resident’s medication plan.

6. Having the resident’s physician or center medical consultant review a resident’s prescription medications when there are noted adverse effects from the medication. Documentation showing the date of review and reviewer’s name shall appear in the resident’s health record.

7. Ensuring that any use-as-needed medication is based on an assessment by a physician or registered nurse and is approved by either a physician or registered nurse.

8. Arranging for administration of prescribed medications to a resident when the resident is away from the center, for example, at school or on a home visit. A resident may not be given access to medications if there is a possibility that the resident may harm self through abuse or overdose.

(3) Medications storage.

(a) A center shall comply with all the following requirements for storage of medications:

1. All medications shall be kept in the original container or, when authorized in writing by a physician, in a dispensing container, and shall:

a. If a prescription medication, be labeled with the expiration date and information required under s. 450.11 (4), Stats.

b. If a non-prescription medication, be labeled with the name of the medication, directions for use, expiration date and the name of the resident taking the medication.

2. Medications shall be kept in locked cabinets or containers and under proper conditions of sanitation, temperature, light, moisture and ventilation to prevent deterioration.

3. Medications used externally and medications taken internally shall be stored on separate shelves or in separate cabinets.

4. Medications stored in a refrigerator containing other items shall be stored in a separate locked compartment.

5. Medications may not be stored with disinfectants or poisons.

(b) A center shall immediately destroy all outdated prescription and over-the-counter medications and all prescription medication no longer in use. The center shall maintain a log of the medication destroyed, who destroyed it and what amount was destroyed.

(4) Medications administration record.

(a) A center shall have in each resident’s health record a written medications administration record which lists each prescribed and over-the-counter medication the resident receives. The record shall contain the following information: