Header:
WISCONSIN ADMINISTRATIVE CODE
DEPARTMENT OF HEALTH SERVICES
CHAPTER DHS 89 RESIDENTIAL CARE APARTMENT COMPLEXES
SUBCHAPTER II -- GENERAL REQUIREMENTS FOR OPERATION
Date:
08/31/2009
Document:
DHS 89.23 Services.
(1) GENERAL REQUIREMENT. A residential care apartment complex shall provide or contract for services that are sufficient and qualified to meet the care needs identified in the tenant service agreements, to meet unscheduled care needs of its tenants and to make emergency assistance available 24 hours a day.
(2) SUFFICIENT SERVICES. (a) Minimum required services. 1. In this paragraph, "capacity to provide" means that the facility is able to provide the minimum required services to any tenant who needs or develops a need for those services.
Note: A residential care apartment complex should be able to respond to changes in its tenants' need for the minimum required services by revising the service agreements and, if necessary, by either adjusting its staffing plan or contracting for services from other providers.
2. A residential care apartment complex shall have the capacity to provide all of the following services to all tenants, either directly or under contract:
a. Supportive services: meals, housekeeping in tenants' apartments, laundry service and arranging access to medical services. In this subparagraph, "access" means arranging for medical services and transportation to medical services.
b. Personal services: daily assistance with all activities of daily living which include dressing, eating, bathing, grooming, toileting, transferring and ambulation or mobility.
c. Nursing services: health monitoring, medication administration and medication management.
3. A residential care apartment complex shall ensure that sufficient services are available to meet care needs identified in each tenant's service agreement.
4. Services above the minimum required levels may be made available at the option of the facility.
5. A facility is not required to provide or be staffed to provide services which are not needed, are not included in the service agreements or are above the minimum required levels.
(b) Staff to meet tenant needs. 1. The number, assignment and responsibilities of staff shall be adequate to provide all services identified in the tenants' service agreements.
2. Staff assignments shall include sufficient time necessary to permit staff to assist tenants with unscheduled care needs.
(c) Emergency assistance. A residential care apartment complex shall ensure that tenant health and safety are protected in the event of an emergency and shall have the capacity to provide emergency assistance 24 hours a day. A residential care apartment complex shall have a written emergency plan which describes staff responsibilities and procedures to be followed in the event of fire, sudden serious illness, accident, severe weather or other emergency and is developed in cooperation with local fire and emergency services.
(3) SERVICE QUALITY. (a) Residential care apartment complex services shall be provided by qualified staff, consistent with the requirements under sub. (4).
(b) Services shall be provided in the type, amount and frequency identified in the service agreements.
(c) Services to meet both scheduled and unscheduled care needs shall be provided in a timely manner.
(d) Services shall be appropriate to the needs, abilities and preferences of tenants as identified in the comprehensive assessment, service agreement and risk agreement.
(e) Services shall be provided in a manner which respects tenant privacy, enhances tenant self-reliance and supports tenant autonomy in decision-making, including the right to accept risk.
(f) Meals and snacks served to tenants shall be prepared, stored and served in a safe and sanitary manner.
(4) PROVIDER QUALIFICATIONS. (a) Service providers. 1. Residential care apartment complex services shall be provided by staff who are trained in the services that they provide and are capable of doing their assigned work. Any service provider employed by or under contract to a residential care apartment complex shall meet applicable federal or state standards for that service or profession.
2. Nursing services and supervision of delegated nursing services shall be provided consistent with the standards contained in the Wisconsin nurse practice act. Medication administration and medication management shall be performed by or, as a delegated task, under the supervision of a nurse or pharmacist.
Note: The nurse practice act is published as "Wisconsin Statutes and Administrative Code Relating to the Practice of Nursing" and is available from the Department of Regulation and Licensing, Board of Nursing, P.O. Box 8935, Madison, WI 53708.
3. Personal and supportive services shall be provided by staff who have documented training or experience in needs and techniques for assistance with tenant care and activities of daily living, such as bathing, grooming, skin care, transfer, ambulation, exercise, meal preparation and eating assistance, dressing, and use of adaptive aids and equipment.
(b) Service manager. 1. Each residential care apartment complex shall have a designated service manager who shall be responsible for day-to-day operation of, including ensuring that the services provided are sufficient to meet tenant needs and are provided by qualified persons; that staff are appropriately trained and supervised; that facility policies and procedures are followed; and that the health, safety and autonomy of the tenants are protected. The service manager shall be capable of managing a multi-disciplinary staff to provide services specified in the service agreements.
2. A person shall be designated to be in charge of the facility whenever there is not a service manager present. The person in charge shall be competent to supervise staff of the residential care apartment complex. The person in charge shall be available to the residential care apartment complex and shall be identified to and easily reachable by all tenants and staff. In this subdivision "available" means accessible and able to ensure that services are provided to tenants as required under sub. (1). The person in charge is available if he or she is either present in the facility or present, awake and on duty in an attached or adjacent residential, health care or other similar facility and able to be physically present in the facility on short notice.
(c) Freedom from abuse, neglect and exploitation. A residential care apartment complex shall ensure that tenants are free from abuse, neglect or financial exploitation by the facility or its staff. A residential care apartment complex shall not employ an individual who has been convicted of a crime that is substantially related to the circumstances of the job or for whom there is a substantiated finding of abuse or neglect or misappropriation of property in the department's registry for nurse aides, home health aides and hospice aides. The facility shall conduct a criminal records check with the Wisconsin department of justice and shall check with the department's registry for nurse aides, home health aides and hospice aides when hiring a service manager, service providers and other persons to work in the facility or have contact with tenants.
Note: Substantiated findings of client abuse or neglect or misappropriation of client property are recorded in the department's registry which can be accessed 24 hours a day by calling (608) 266-5545. See ch. DHS 12 for required background checks including a criminal record check.
(d) Staff training. 1. All facility staff shall have training in safety procedures, including fire safety, first aid, universal precautions and the facility's emergency plan, and in the facility's policies and procedures relating to tenant rights.
2. Staff providing residential care apartment complex services to tenants shall have documented training or experience in the following areas:
a. Physical, functional and psychological characteristics associated with aging or likely to be present in the tenant population and their implications for service needs.
b. The purpose and philosophy of assisted living, including respect for tenant privacy, autonomy and independence.
c. Assigned duties and responsibilities, including the needs and abilities of individual tenants for whom staff will be providing care.
(5) DOCUMENTATION. A residential care apartment complex shall document that the requirements for provider qualifications have been met.
(6) WRITTEN STAFFING PLAN. A residential care apartment complex shall maintain an up-to-date, written staffing plan which describes how the facility is staffed to provide services that are sufficient to meet tenant needs and that are provided by qualified staff. The facility shall inform current and prospective tenants and their representatives about the existence and availability of the staffing plan and shall provide copies of the plan upon request.
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