DHS 83.05(2)(a) (a) A program statement as specified under s. DHS 83.06 (1).

DHS 83.05(2)(b) (b) A floor plan specifying dimensions of the CBRF, exits and planned room usage.

DHS 83.05(2)(c) (c) A fire inspection form.

DHS 83.05(2)(d) (d) All required fees.

DHS 83.05(2)(e) (e) A balance sheet.

DHS 83.05(2)(f) (f) Evidence that the applicant has 60 days of projected operating funds in reserve.

DHS 83.05(2)(g) (g) Any additional information requested by the department.

DHS 83.05 Note Note: A copy of the application form, F60287, can be obtained at http://dhs.wisconsin.gov/forms/DQAnum.asp or by contacting the Division of Quality Assurance Regional Office listed in Appendix A.

DHS 83.05(3) (3) The applicant shall provide evidence to the department that the license applicant has made a good faith effort to establish a community advisory committee under s. 50.03 (4) (g), Stats.

DHS 83.05(4) (4) A CBRF may not be located on a parcel of land zoned for commercial, industrial or manufacturing use.

DHS 83.05 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09..

DHS 83.06 DHS 83.06 Program statement.

DHS 83.06(1) (1) Content. The program statement shall accurately include all of the following:

DHS 83.06(1)(a) (a) The name of the licensee, the administrator and the staff position in charge when the licensee or administrator is away from the CBRF.

DHS 83.06(1)(b) (b) Employee availability, including 24 hour staffing patterns and the availability of a licensed nurse, if any.

DHS 83.06(1)(c) (c) The resident capacity of the CBRF.

DHS 83.06(1)(d) (d) The class of the CBRF under s. DHS 83.04 (2).

DHS 83.06(1)(e) (e) The client group to be served. If serving more than one client group, the program statement shall include an explanation acceptable to the department of how the client groups are compatible with one another.

DHS 83.06(1)(f) (f) A complete description of the program goals and services consistent with the needs of residents.

DHS 83.06(1)(g) (g) Limitations of services, including the criteria for determining who may reside in the CBRF.

DHS 83.06(1)(h) (h) Respite care services, if provided.

DHS 83.06(2) (2) Availability.

DHS 83.06(2)(a) (a) Before finalizing an agreement to provide care, the CBRF shall provide its program statement to each person seeking placement or to the person’s legal representative. CBRFs serving only clients of a government correctional agency are exempt from this paragraph.

DHS 83.06(2)(b) (b) The program statement shall be available to employees, to residents and to any other person upon request.

DHS 83.06(3) (3) Change in program statement. Any change in the program statement content under sub. (1) shall be submitted to the department at least 30 days before its effective date.

DHS 83.06 History History: CR 07-095: cr. Register January 2009 No. 637, eff. 4-1-09.

DHS 83.07 DHS 83.07 Fit and qualified.

DHS 83.07(1) (1) Eligibility. An applicant may not be licensed unless the department determines the applicant is fit and qualified to operate a CBRF.

DHS 83.07(2) (2) Standards. In determining whether a person is fit and qualified, the department shall consider all of the following: