Section 57.49. License application.

 

(1)  Except as provided in sub. (3) , a person who wishes to operate a group home shall submit to the department an application signed as specified in sub. (2) at least 60 days before the date proposed to begin operating the group home. The application shall be made on the department's form CFS 375 and shall be accompanied by all of the following:

(a) The license fee required under s. 48.625 (2) (a) , Stats.

(am) A certification of need issued by the department under s. DCF 57.485 (3) (b) .

(b) A completed background information disclosure form which shall be completed and signed as follows:

1. If the applicant is one or more individuals, a background information disclosure form shall be completed and signed by each individual applicant and each household member who is 10 years old or older.

2. If the applicant is a corporation or an agency, a background information disclosure form shall be completed and signed by an authorized representative.

(c) Inspection reports verifying that the proposed group home's physical structure, electrical, heating and plumbing systems have been inspected and are in safe operating condition according to applicable industry standards.

(d) Documentation of efforts to establish and maintain the community advisory committee as required under s. DCF 57.45 (2) .

(e) Payment of any forfeitures, fees, assessments related to any licenses issued by the department to the applicant, or a written statement signed by an authorized representative stating that no fees, forfeitures, assessments are owed.

(f) Proof of the insurance required under s. DCF 57.08 .

(g) A copy of the personnel policies required under s. DCF 57.17 (1) and any revisions as appropriate.

(h) A copy of the group home's policies and procedures required under s. DCF 57.05 .

(i) If the applicant for licensure is a corporation, proof of incorporation or authorization to do business in Wisconsin, as required under s. DCF 57.52 .

(im) A proposed per client rate that each group home will charge for services provided in the current year and a proposed budget with the same cost categories as the department's cost and service report under s. DCF 57.62 (1) (a) .

(j) Any other information requested by the department.

(2)  If an applicant for licensure is an agency or corporation, an authorized representative of the agency or corporation as applicable shall sign the application. If the applicant for licensure is one or more individuals, the application shall be signed by each individual.

(3)  A licensee applying for a license for an additional group home location shall be in compliance with this chapter in the operation of the existing group home and in compliance with regulations for any other facility licensed by the department and operated by the licensee. Any forfeitures due under s. 48.715 , Stats., on other facilities licensed by the department shall be paid before the issuance of an additional license.

(4)  Except as provided in s. DCF 57.50 (3) , the department may not process an application for a license from a person who is prohibited from licensure under s. DCF 57.50 or who meets the conditions under s. 48.715 (5) , Stats., if the applicant has had a license or certification to operate a group home revoked or denied within the last 2 years before the date of the application. A person is deemed ineligible to submit an application for a license within 2 years from the date the person had a group home license revoked or denied.

CR 04-067 : cr. Register September 2005 No. 597 , eff. 1-1-06; corrections in (1) (b), (d), (f) to (i) and (4) made under s. 13.92 (4) (b) 7. , Stats., Register November 2008 No. 635 ; EmR1106 : emerg. cr. (1) (im), eff. 9-16-11; CR 11-026 : cr. (1) (im), correction in (1) (im) made under s. 13.92 (4) (b) 7. , Stats., Register December 2011 No. 672 , eff. 1-1-12; EmR1034 : emerg. cr. (1) (am), eff. 9-2-10; CR 10-105 : cr. (1) (am) Register July 2012 No. 679 , eff. 8-1-12; correction in (1) (b) (intro.), 2. made under s. 13.92 (4) (b) 7. , Stats., Register September 2016 No. 729 .

Note

A copy of the application form CFS 375 may be requested in writing or by phone from the appropriate field office listed in Appendix A. The completed application and license fee should be returned to the field office from which the application was received. Microsoft Windows NT 6.1.7601 Service Pack 1