Chapter DCF 57

DCF 57.25(7)(e)1. 1. A resident’s parent or guardian may revoke consent for non-emergency use of psychotropic medications at any time, as provided under s. DHS 94.03.

DCF 57.25(7)(e)2. 2. When a consent is revoked, the group home shall do all of the following:

DCF 57.25(7)(e)2.a. a. Administer the medication pursuant to a court order or as prescribed by a physician to avoid serious physical harm to the resident or others.

DCF 57.25(7)(e)2.b. b. Inform the prescribing physician and the placing person or agency of the consent revocation and document the revocation in the resident’s treatment record.

DCF 57.25(7)(e)3. 3. When a resident refuses to take a prescribed psychotropic medication, the group home shall do all of the following:

DCF 57.25(7)(e)3.a. a. Document the resident’s reasons for refusal in the resident’s treatment record.

DCF 57.25(7)(e)3.b. b. Notify the resident’s physician, the parent or guardian or legal custodian and the resident’s placing person or agency. Notification shall be immediate if the resident’s refusal threatens the resident’s well-being and safety.

DCF 57.25(7)(f) (f) Administration standards. In administering psychotropic medication, a group home shall comply with requirements for administration of prescription medication in this section and clinically acceptable standards for good medical practice. Conformance to guidelines of the department’s division of disability and elder services for use and monitoring of the effects of psychotropic medications satisfies the requirement for clinically acceptable standards and for good medical practice.

DCF 57.25 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06; corrections in (2) (a), (5), (7) (c) 2. made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DCF 57.26 DCF 57.26 Dental care. Within 30 days after admission to a group home, each resident over the age of 3 years old who is admitted to the group home for other than respite care shall receive a dental examination unless an examination has been performed within 6 months before the resident’s admission. Subsequent dental examinations shall occur at intervals not exceeding 6 months after the last examination or completion of treatment.

DCF 57.26 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06.

DCF 57.27 DCF 57.27 Behavior intervention.

DCF 57.27(1) (1) Prohibited measures. No licensee, staff member, or volunteer may do any of the following:

DCF 57.27(1)(a) (a) Hit, shake, pinch, push, twist or use any other means that the staff member or volunteer knows or should know may inflict mental or physical harm or actions that may be psychologically, emotionally or physically painful to a resident.

DCF 57.27(1)(b) (b) Verbally abuse a resident or use profanity, or any language that the staff member or volunteer knows or should know may ridicule a resident.

DCF 57.27(1)(c) (c) Lock a resident in a room or any other place.

DCF 57.27(1)(d) (d) Use any item to cover a resident’s head or face or wrap the resident’s body with sheets, blankets, or any other material.

DCF 57.27(1)(e) (e) Require a resident to march, stand, kneel, or assume and remain in any fixed position or assign work that is not therapeutic and not a part of the resident’s treatment plan.

DCF 57.27(1)(f) (f) Release any noxious, toxic or otherwise unpleasant substances near the eyes or face of a resident.

DCF 57.27(1)(g) (g) Authorize, direct or ask a resident to discipline another resident.

DCF 57.27(1)(h) (h) Discipline one resident for the behavior or action of another resident.

DCF 57.27(1)(i) (i) Employ any measure that the staff member or volunteer knows or should know is aversive, cruel, humiliating or that may be psychologically, emotionally, or physically painful, discomforting, dangerous, or potentially injurious to a resident.

DCF 57.27(1)(j) (j) Use any mechanical restraint or equipment that restricts the movement of an resident or a portion of the resident’s body as behavior intervention.

DCF 57.27(1)(k) (k) Use a prone restraint that places a resident in a face down position as behavior intervention.

DCF 57.27(2) (2) Time-outs.

DCF 57.27(2)(a) (a) As used in this subsection, “time-out” means a behavior intervention technique that involves brief periods of physical separation of a resident from others.

DCF 57.27(2)(b) (b) A time-out may not be used for the convenience of staff members or volunteers, as a substitute for supervision of a resident, or for a child under 3 years old.

DCF 57.27(2)(c) (c) Areas used for time-outs shall be free of objects with which a resident could self-inflict bodily harm, shall provide a staff view of the resident at all times and shall be equipped with adequate ventilation and lighting.

DCF 57.27(2)(d) (d) The use of time-outs shall be appropriate to the developmental level and the age of the resident and may not be for a period longer than the period of time necessary for the resident to regain control. The maximum length of time that a resident may be in a time-out on each occurrence of a time-out is as follows:

DCF 57.27(2)(d)1. 1. For a child 3 through 6 years of age, a time-out may not exceed 10 minutes.

DCF 57.27(2)(d)2. 2. For a child 7 through 10 years of age, a time-out may not exceed 15 minutes.

DCF 57.27(2)(d)3. 3. For a child over 11 years of age, a time-out may not exceed 30 minutes. The need for continued use of a time-out shall be reviewed at least every 10 minutes and documented in the resident’s record.

DCF 57.27(2)(e) (e) A resident that is in a time-out shall be permitted use of the toilet if requested.

DCF 57.27(2)(f) (f) Any resident that is in a time-out shall be within hearing of a staff member.

DCF 57.27(2)(g) (g) Within 12 hours of occurrence, there shall be documentation in the resident’s record of each time-out, including the name of each staff member involved, the length of the time-out, and rationale for use.

DCF 57.27(3) (3) Emergency safety intervention.

DCF 57.27(3)(a) (a) A staff member may not use any type of physical restraint on a resident unless the resident’s behavior presents an imminent danger of harm to self or others and physical restraint is necessary to contain the risk and keep the resident and others safe.

DCF 57.27(3)(b) (b) A staff member shall attempt other feasible alternatives to de-escalate a resident and situation before using physical restraint.

DCF 57.27(3)(c) (c) A staff member may not use physical restraint as disciplinary action, for the convenience of the staff member, or for therapeutic purposes.

DCF 57.27(3)(d) (d) If physical restraint is necessary under par. (a), a staff member may only use the physical restraint in the following manner:

DCF 57.27(3)(d)1. 1. With the least amount of force necessary and in the least restrictive manner to manage the imminent danger of harm to self or others.

DCF 57.27(3)(d)2. 2. That lasts only for the duration of time that there is an imminent danger of harm to self or others.

DCF 57.27(3)(d)3. 3. That does not include any of the following:

DCF 57.27(3)(d)3.a. a. Any maneuver or technique that does not give adequate attention and care to protection of the resident’s head.

DCF 57.27(3)(d)3.b. b. Any maneuver that places pressure or weight on the resident’s chest, lungs, sternum, diaphragm, back, or abdomen causing chest compression.

DCF 57.27(3)(d)3.c. c. Any maneuver that places pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the resident’s head or neck, or that otherwise obstructs or restricts the circulation or blood or obstructs an airway, such as straddling or sitting on the resident’s torso.

DCF 57.27(3)(d)3.d. d. Any type of choke hold.

DCF 57.27(3)(d)3.e. e. Any technique that uses pain inducement to obtain compliance or control, including punching, hitting, hyperextension of joints, or extended use of pressure points for pain compliance.

DCF 57.27(3)(d)3.f. f. Any technique that involves pushing on or into a resident’s mouth, nose, or eyes, or covering the resident’s face or body with anything, including soft objects, such as pillows, washcloths, blankets, and bedding.

DCF 57.27(3)(d)4. 4. Notwithstanding subd. 3. f., if a resident is biting himself or herself or other persons, a staff member may use a finger in a vibrating motion to stimulate the resident’s upper lip and cause the resident’s mouth to open and may lean into the bite with the least amount of force necessary to open the resident’s jaw.

DCF 57.27(3)(e) (e) After an episode of physical restraint, a debriefing shall take place with the resident and staff that were involved in the physical restraint.

DCF 57.27(3)(f) (f) Each staff member who uses a physical restraint or who witnesses the use of a physical restraint shall, within 24 hours of each incident, give the group home manager a written description of the incident. The group home manager shall document each incident, including date, time, and a description of the circumstances of the incident, and report the incident to the field office that serves the group home and the placing agency as required under s. DCF 57.13 (1) (c) and (5). Each description shall include all of the following:

DCF 57.27(3)(f)1. 1. The name, age, and sex of each resident involved.

DCF 57.27(3)(f)2. 2. The date, time, and location of the incident.

DCF 57.27(3)(f)3. 3. The name and job title of each staff member involved in the restraint and each staff member or volunteer who witnessed the use of the restraint.

DCF 57.27(3)(f)4. 4. Circumstances leading up to the use of restraint, the behavior that prompted the restraint, efforts made to de-escalate the situation and the alternatives to restraint that were attempted.

DCF 57.27(3)(f)5. 5. A description of the administration of the restraint, including the holds used and the reasons the holds were necessary.

DCF 57.27(3)(f)6. 6. The beginning and ending time of the restraint and how the restraint ended.

DCF 57.27(3)(f)7. 7. Behavior of the resident during and after the use of the restraint.

DCF 57.27(3)(f)8. 8. Any injuries sustained by a resident or staff member and any medical care provided, including the name and title of the person providing the care.

DCF 57.27(3)(f)9. 9. Any follow-up debriefing provided to residents and staff.

DCF 57.27 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06; correction in (3) (c) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; EmR1106: emerg. cr. (1) (j), (k), r. and recr. (3), eff. 9-16-11; CR 11-026: cr. (1) (j), (k), r. and recr. (3) Register December 2011 No. 672, eff. 1-1-12.

DCF 57.28 DCF 57.28 Clothing.

DCF 57.28(1) (1) The licensee shall ensure that funds allocated by the placing agency for the purchase of clothing for residents are used in such a manner that residents are provided with clothing that is individually selected and fitted, appropriate to the season, and comparable to that of others in the community.

DCF 57.28(2) (2) Whenever possible, each resident shall be given an opportunity to participate in the selection and purchase of his or her clothing.

DCF 57.28(3) (3) Each resident’s clothing shall be regularly laundered and in good repair.

DCF 57.28(4) (4) Clothing purchased for a resident shall be the property of that resident. The group home shall keep a log in each resident’s record of clothing purchases.

DCF 57.28 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06.

DCF 57.29 DCF 57.29 Hygiene. Each resident shall be provided with sufficient amounts of individually dispensed soap, clean towels, toilet paper, toothpaste, shampoo, deodorant, and other personal hygiene products that are gender specific to the resident population.

DCF 57.29 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06.

DCF 57.30 DCF 57.30 Household duties.

DCF 57.30(1) (1) Residents shall have opportunities to share in responsibility for household duties or chores appropriate to the resident’s age, developmental level, health, and ability.

DCF 57.30(2) (2) Household duties of residents may not interfere with school attendance, family visits, sleep, study, or religious practice and may not violate the principles of nurturing care described in s. DCF 57.205.

DCF 57.30 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DCF 57.305 DCF 57.305 Spending money.

DCF 57.305(1) (1) Each resident shall be given a regular, base amount of spending money appropriate to his or her age and maturity. Older residents can be given opportunities to earn extra money above and beyond the base allowance.

DCF 57.305(2) (2) A resident’s spending money may not be withheld as a disciplinary action.

DCF 57.305 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06.

DCF 57.31 DCF 57.31 Food and nutrition.

DCF 57.31(1) (1) Food shall be available and provided to residents in sufficient quantities and varieties, and shall provide for nutritional and dietary needs. Food or modified diets ordered by a physician shall be provided for those residents who have special needs. In planning menus, the religious practices and cultural patterns of the residents shall be considered and foods offered accordingly. Menus shall meet the minimum nutritional requirements as found in Appendix B.

DCF 57.31(2) (2) At no time shall food be withheld from a resident.

DCF 57.31(3) (3) Daily menus shall be written, kept on file and available for at least 30 days after meals have been served.

DCF 57.31(4) (4) Spoiled or deteriorated food shall be disposed of immediately.

DCF 57.31(5) (5) Prepared food shall be covered and stored at temperatures that protect against spoilage. Dry foods shall be dated and stored in rigid, covered containers or single use food storage plastic bags with a zip top closure. Food in dented, bulging or leaking cans, or in cans without labels, may not be used.

DCF 57.31(6) (6) Leftover food that is not served shall be marked with the date of preparation and refrigerated or frozen immediately for later use.

DCF 57.31 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06.

DCF 57.32 DCF 57.32 Education.

DCF 57.32(1) (1) School age residents shall be enrolled in school as soon as possible after admission to the group home. The licensee shall ensure that each resident meets the school attendance requirements under chs. 115 and 118, Stats., unless otherwise excused by school officials.

DCF 57.32(2) (2) A group home may not provide a home-based private educational program to residents unless the program is approved by the department of public instruction as a private school under s. 118.165, Stats.