Chapter DCF 57

DCF 57.245(2)(c) (c) An RPPS decision maker shall have knowledge of a resident and access to the resident’s treatment plan and other resident records under s. DCF 57.38 related to the decision-making factors in sub. (4).

DCF 57.245(2)(d) (d) An RPPS decision maker shall document in the communication log under s. DCF 57.215 decisions made under this section for activities that do not take place in the group home and are not supervised by a staff member.

DCF 57.245(2)(e) (e) An RPPS decision maker shall document on a form prescribed by the department any decision made under this section that requires written permission from the group home in lieu of the resident’s parent or guardian. The completed form shall be placed in the resident’s record under s. DCF 57.38.

DCF 57.245 Note Note: DCF-F-5124-E, Reasonable and Prudent Parent Decision Record, is available in the forms section of the department website at http://dcf.wisconsin.gov or by writing the Division of Safety and Permanence, P.O. Box 8916, Madison, WI 53708-8916.

DCF 57.245(3) (3) Reasonable and prudent parent standard. When an RPPS decision maker is making a decision regarding a resident’s participation in activities, the RPPS decision maker shall use a decision-making standard that is characterized by careful and sensible parental decisions that maintain the health, safety, best interests, and cultural, religious, and tribal values of the resident while at the same time encouraging the emotional and developmental growth of the resident, if the activities meet the conditions in par. (a) and (b) as follows:

DCF 57.245(3)(a) (a) Areas covered by the standard. The resident is participating or wants to participate in extracurricular, enrichment, cultural, or social activities, including all of the following:

DCF 57.245(3)(a)1. 1. Activities related to transportation, such as obtaining a driver’s license, driving, or carpooling with peers and other adults.

DCF 57.245(3)(a)2. 2. Formal or informal employment and related activities, such as opening an account in a bank or credit union.

DCF 57.245(3)(a)3. 3. Activities related to peer relationships, such as visiting with friends, staying overnight at a friend’s house, or dating.

DCF 57.245(3)(a)4. 4. Activities related to personal expression, such as haircuts; hair dying; clothing choices; or sources of entertainment, including games and music.

DCF 57.245(3)(b) (b) Age or developmentally appropriate activities. The resident is participating or wants to participate in activities that are suitable based on any of the following criteria:

DCF 57.245(3)(b)1. 1. Activities that are generally accepted as suitable for children of the same chronological age or level of maturity or that are determined to be developmentally appropriate for a child based on the cognitive, emotional, physical, and behavioral capacities that are typical for children of the same age or age group.

DCF 57.245(3)(b)2. 2. Activities that are suitable based on this resident’s cognitive, emotional, physical, and behavioral capacities.

DCF 57.245 Note Note: The reasonable and prudent parent standard does not apply to a child receiving respite care services.

DCF 57.245(4) (4) Decision-making factors. When applying the reasonable and prudent parent standard to a decision regarding a resident’s participation in an extracurricular, enrichment, cultural, or social activity, an RPPS decision maker shall consider all of the following:

DCF 57.245(4)(a) (a) Child-specific factors, including all of the following:

DCF 57.245(4)(a)1. 1. The resident’s treatment plan.

DCF 57.245(4)(a)2. 2. The resident’s wishes, as gathered by engaging the resident in an age-appropriate discussion about participation in the activity.

DCF 57.245(4)(a)3. 3. The age, maturity, and development of the resident.

DCF 57.245(4)(a)4. 4. Whether participating in the activity is in the best interest of the resident.

DCF 57.245(4)(a)5. 5. The resident’s behavioral history.

DCF 57.245(4)(a)6. 6. Court orders and other legal considerations affecting the resident, including the prohibitions in sub. (5).

DCF 57.245(4)(a)7. 7. Cultural, religious, and tribal values of the resident and the resident’s family. If the resident and resident’s family have different cultural, religious, or tribal values, then the placing agency, or the department if the department is the resident’s guardian, is ultimately responsible for decisions concerning the resident’s care.

DCF 57.245(4)(b) (b) Activity-specific factors, including all of the following:

DCF 57.245(4)(b)1. 1. Potential risk factors of the situation, including whether the resident has the necessary training and safety equipment to safely participate in the activity under consideration.

DCF 57.245(4)(b)2. 2. How the activity will help the resident grow.

DCF 57.245(4)(b)3. 3. Whether participating in the activity will provide experiences that are similar to the experiences of other residents in the group home.

DCF 57.245(4)(b)4. 4. Other information regarding the parent’s wishes and values, as obtained during development and review of the resident’s treatment plan under s. DCF 57.23 (2) and other discussions with the resident’s parent or guardian.

DCF 57.245(4)(c) (c) Any other concerns regarding the safety of the resident, other residents in the group home, or the community.

DCF 57.245(4)(d) (d) Information on the forms required under ch. DCF 37.

DCF 57.245 Note Note: The forms required under ch. DCF 37 are DCF-F-872A-E, Information for Out-of-Home Care Providers, Part A and DCF-F-872B-E, Information for Out-of-Home Care Providers, Part B. Both forms are available in the forms section of the department website at http://dcf.wisconsin.gov or by writing the Division of Safety and Permanence, P.O. Box 8916, Madison, WI 53708-8916.

DCF 57.245(5) (5) Prohibitions. An RPPS decision maker may not do any of the following:

DCF 57.245(5)(a) (a) Permit a resident to participate in an activity that would violate a court order or any federal or state statute, rule, or regulation.

DCF 57.245(5)(b) (b) Make decisions that conflict with the resident’s permanency plan or family interaction plan.

DCF 57.245(5)(c) (c) Consent to the resident’s marriage.

DCF 57.245(5)(d) (d) Authorize the resident’s enlistment in the U.S. armed forces.

DCF 57.245(5)(e) (e) Authorize medical, psychiatric, or surgical treatment for the resident beyond the terms of the consent for medical services authorized by the resident’s parent or guardian.

DCF 57.245(5)(f) (f) Represent the resident in legal actions or make other decisions of substantial legal significance.

DCF 57.245(5)(g) (g) Determine which school the resident attends or make a decision concerning the resident regarding an educational right or requirement that is provided in federal or state law.

DCF 57.245 Note Note: For example, only a parent or guardian can make decisions about a resident’s individualized educational program under s. 115.787, Stats.

DCF 57.245(5)(h) (h) Require or prohibit a resident’s participation in an age or developmentally appropriate activity solely for convenience or personal reasons not applicable to the decision-making factors in sub. (4).

DCF 57.245 History History: EmR1633: emerg. cr., eff. 11-18-16; CR 16-051: cr. Register July 22017 No. 739, eff. 8-1-17.

DCF 57.25 DCF 57.25 Medical care.

DCF 57.25(1) (1) Consent.

DCF 57.25(1)(a) (a) Any medical examination or service provided to a resident shall be provided only by an individual licensed to perform the examination or service being provided. Before an examination or service is provided, written consent to perform the examination or service shall be obtained as follows:

DCF 57.25(1)(a)1. 1. For a resident who is under 14 years of age, written consent of a resident’s parent or guardian.

DCF 57.25(1)(a)2. 2. For a resident who is between 14 and 18 years of age, consent of the resident’s parent or guardian with the consent of the resident whenever feasible.

DCF 57.25(1)(a)3. 3. For a resident who is 18 years of age or older, consent of the resident is required unless the resident has been deemed incompetent by a court and has a court appointed guardian or legal custodian, in which case the consent of the guardian or legal custodian is required.

DCF 57.25(1)(b) (b) Consent shall include consent to administer emergency medical services including surgery for life threatening situations when a parent, cannot immediately be reached. Verbal consent may be obtained in an emergency situation where time or distance precludes obtaining written consent. Both the written consent and any verbal consent shall be documented in the resident’s record, by indicating who obtained the consent, who gave the consent and that person’s relationship to the resident, and what specific services are authorized by the consent. A verbal consent shall be valid for 10 calendar days, during which time there shall be a good faith effort to obtain written consent.

DCF 57.25(2) (2) Medication administration.

DCF 57.25(2)(a) (a) Information required to administer medication. No staff member may administer medication to a resident unless the staff member has received the group home’s policies established under s. DCF 57.05 (2) (c) for administering and monitoring medication use.

DCF 57.25(2)(am) (am) After receiving the information described in sub. (2) (a), staff shall receive the following:

DCF 57.25(2)(am)1. 1. Procedure for administering the medication being given as described by the physician, pharmacist or as indicated on the label of an over the counter medication or a prescribed medication or both. If the label on prescribed medication is not clear, a staff member shall contact the pharmacy that filled the prescription for clarification.

DCF 57.25(2)(am)2. 2. Procedures for documenting the administration of medication as specified under sub. (3).

DCF 57.25(2)(am)3. 3. The purpose of the medication.

DCF 57.25(2)(am)4. 4. Any potential adverse side effects of the medication being administered.

DCF 57.25(2)(am)5. 5. Procedure to follow if a resident refuses medication, including refusal of psychotropic medication as described in sub. (7).

DCF 57.25(2)(am)6. 6. Known drug allergies of the resident.

DCF 57.25(2)(am)7. 7. Any other information that may be relevant to administration of the medication.

DCF 57.25(2)(b) (b) Limitation on who can administer medication. Medication may be administered to a resident only in the presence of a staff member that has been authorized in writing by the program director or the group home manager, to administer medication.

DCF 57.25(2)(c) (c) Self administration. Medication may be self-administered by a resident only under all of the following conditions:

DCF 57.25(2)(c)1. 1. Self-administration is authorized in writing from the prescribing practitioner.

DCF 57.25(2)(c)2. 2. There is no demonstrated history of risk that the resident may harm self through abuse or overdose.

DCF 57.25(2)(c)3. 3. The resident’s treatment plan includes an evaluation by the program director of the resident’s capability to self-administer medication.

DCF 57.25(2)(c)4. 4. The resident recognizes and distinguishes the medication or treatment and knows the condition or illness for which the medication or treatment is prescribed, the correct dosage, and when the medication or treatment is to be taken.

DCF 57.25(2)(c)5. 5. The medication is not a psychotropic medication as defined in sub. (7) (a).

DCF 57.25(3) (3) Medication Administration documentation.

DCF 57.25(3)(a) (a) Immediately upon administering medication to a resident or a resident self-administering medication, the staff member administering or supervising the administration of medication shall write all of the following in the resident’s record:

DCF 57.25(3)(a)1. 1. Full name of the resident to whom the medication was administered.

DCF 57.25(3)(a)2. 2. Date and time the medication was administered.

DCF 57.25(3)(a)3. 3. Name and dosage of the medication administered or medical treatments received.

DCF 57.25(3)(a)4. 4. Signature of the staff member who administered or supervised the administration of medication.

DCF 57.25(3)(a)5. 5. Any refusal of medication.

DCF 57.25(3)(a)6. 6. Any adverse reaction to the medication and steps taken to notify the resident’s health care provider, parent, guardian, or legal custodian.

DCF 57.25(3)(a)7. 7. Any error in medication administration and the steps taken to notify the resident’s physician as required in sub. (5).

DCF 57.25(3)(b) (b) Each entry made under this subsection shall be written in ink.

DCF 57.25(4) (4) Adverse reaction to medication. In the event of an adverse reaction to any medication, a staff member shall immediately notify the resident’s parent or guardian and the attending physician.

DCF 57.25(5) (5) Medication errors. The attending physician shall be notified in the event of a medication error. The department and placing agency shall be notified as required in ss. DCF 57.13 (1) (e) and 57.135.

DCF 57.25(6) (6) Medication storage and disposal. The licensee shall comply with all of the following requirements for storing medication:

DCF 57.25(6)(a) (a) Medication including over-the-counter medication, shall be kept in the container in which it was purchased or prescribed. No person may transfer medication that has been prescribed or purchased over-the-counter to another container or change the label on any medication, unless the person is a pharmacist as defined in s. 450.01 (15), Stats.

DCF 57.25(6)(b) (b) Medication shall be locked and stored in a location that is inaccessible to children. Only staff members who are designated in writing by the program director shall have access to keys to the medication. Prescription and over-the-counter medication shall not be stored next to chemicals or other contaminants.

DCF 57.25(6)(c) (c) Medication shall be kept under acceptable conditions of sanitation, temperature, light, moisture, and ventilation according to the requirements of each medication. Medication that requires refrigeration shall be stored in a separate locked compartment or container that is properly labeled, stored separately from food items, and kept inaccessible to children.

DCF 57.25(6)(d) (d) Medication for internal consumption shall be stored separately from medication for external application.

DCF 57.25(6)(e) (e) Within 72 hours of the medication’s expiration date, the date the medication is no longer in use by the resident for whom the medication was prescribed or purchased, or the date the resident is discharged, unused medication shall be returned to a parent, guardian, or legal custodian of the resident, for removal from the group home or shall be destroyed by the group home manager or returned to the prescribing pharmacy to be destroyed.

DCF 57.25(6)(f) (f) The group home shall maintain a log of medication destroyed. The information logged shall be written in ink and shall include the amount of medication destroyed, the name of the staff member who destroyed the medication, and the name of the resident to whom the medication belongs. Whenever medication is released to a resident’s parent, guardian or legal custodian, that information, including the name of the person receiving the medication, shall be documented in the resident’s record.

DCF 57.25(6)(g) (g) The group home shall contact the local police to destroy the medications or contact the Division Officer at the U.S. Drug Enforcement Agency (DEA) for instructions for destroying controlled substances.

DCF 57.25 Note Note: The address and phone number for the U.S. Drug Enforcement Agency is 1000 North Water Street, Milwaukee, WI 53202, or call [phone], extension 5300.

DCF 57.25(7) (7) Psychotropic medication.

DCF 57.25(7)(a) (a) Definitions. In this subsection, “psychotropic medication” means any drug that affects the mind and is used to manage inappropriate resident behavior or psychiatric symptoms and may include an anti-psychotic, an antidepressant, lithium carbonate or a tranquilizer.