1. (1) In order to meet the requirements in ss. DHS 75.30 to 75.46, an application for initial licensure as a residential service shall be on a form provided by the department, and shall be accompanied by all of the following:

   1. (a) A floor plan specifying dimensions of the facility, exits, and planned room usage.
   2. (b) An explanation of the 24-hour staffing pattern for the service.
   3. (c) A statement indicating whether the service will provide treatment services for patients that are non-ambulatory or semi-ambulatory. If a service provides treatment services for patients that are non-ambulatory or semi-ambulatory, the floor plan shall include ramped exits to grade.
   4. (d) Municipal zoning approval or occupancy permit.
   5. (e) The results of an approved fire inspection completed within the last 12 months.
   6. (f) Fireplace and chimney inspections completed within the last 12 months, if applicable.
   7. (g) The results of furnace inspection completed within the last 12 months.
   8. (h) The results of smoke and heat detector inspection completed within the last 12 months.
   9. (i) The results of sprinkler inspection completed within the last 12 months.
   10. (j) Well water test results completed within the last 12 months, if applicable.
   11. (k) Building emergency evacuation plan.
   12. (L) A disaster recovery plan in the case of flood, gas leak, electrical outage, or other emergency.
   13. (m) Service policies and procedures.
   14. (n) All required fees.
   15. (o) Evidence that the applicant has 60 days of projected operating funds in reserve.
   16. (p) Any additional information requested by the department.
2. (2) A residential service shall not make changes to service specifications under sub. (1) (a) to (c) without prior notification to the department.
3. (3) A residential service shall provide updated documents from sub. (1) upon department request.

History

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.