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Handout to Accompany the Community Based Residential Facility (CBRF) Video

Introduction | Rules_&_Regulations | Forms | Providers | Contacts | What's_Happening | Publications | Related Sites

PDF version of CBRF Video handout (PDF, 34 KB) for printing purposes

Please note that this HTML version of the handout is in two sections.  The second section is accessed by a link at the end of this page.

Brief Overview of CBRFs

What is a CBRF?  It is a facility in which 5 or more unrelated adults reside in which care, treatment or services above the level of room and board but not including more than 3 hours of nursing care per resident per week are provided as a primary function of the facility.

The Application Process

To obtain your license, you must fill in all the information requested in the form and pass an onsite licensing process. Incomplete forms will delay the issuance, or denial of your license. To ensure your form is complete, follow these steps:

1. Type of License

Indicate at the top right-hand of the form, the type of license you are applying for—an initial license or a biennial report update.

2. Size and Class of Facility

Based on the individual needs of the residents in an emergency situation, determine the type of class licensure you need.

Class A facilities are limited to residents who are mentally and physically able to respond to a fire or other emergencies which require residents to leave the facility without any help, including verbal or physical prompting.

Class C facilities may admit and retain residents who are not mentally or physically capable of responding to a fire or other emergency and who need help, including verbal or physical prompting. The classes include:

• AA - Class A ambulatory

• AS - Class A semiambulatory

• ANA - Class A nonambulatory

• CA - Class C ambulatory

• CS - Class C semiambulatory

• CNA - Class C nonambulatory

Do Your Research

• Complete a market analysis to determine the need for a CBRF in the community.

• Gain community support for your CBRF by establishing, or attempting to establish, a Community Advisory Committee to be a forum for communication with neighbors, local officials, and representatives of the facility.

3. General Information

Fill in the general information required about the licensee, facility, and administrator such as their names, addresses and telephone numbers.

4. Background Checks Information

Complete background information disclosure and appendix forms (HFS 64 and HFS 69) for:

• all nonclient residents 10 years of age and older who will live with you in the facility
• for yourself
• the owner or administrator if other than yourself
• board members who will have regular contact with the client residents.

The Department will conduct background checks on these individuals.

Mail these forms for each individual to Division of Disability & Elder Services, DQA Entity Background Checks, 2917 International Lane, Suite 300, Madison, WI 53704 with fee payment.

Complete background checks on employees or contractors who will have regular, direct contact with clients. Submit Wisconsin criminal history request form DJ-LE-250 or DJ-LE-250A for each individual to the Department of Justice with the appropriate fee.

Retain the results for your files.

In addition to the time of hiring, do a criminal records check and nurse aide registry check for all adult employees of the facility every four years after hire.

5. Client Group(s) to be Served

Determine the client group or groups you want to serve such as terminally ill, elderly, developmentally disabled or others as listed in the application form.

6. Monthly Charges for Residents

Determine the minimum and maximum monthly fee you will charge for each resident and how these fees will be paid.

Ensure you have sufficient start-up funds.

Check out various possible funding sources such as county, federal waiver funds, churches or other philanthropic organizations.

THE DEPARTMENT OF HEALTH AND FAMILY SERVICES DOES NOT PROVIDE ANY HELP WITH FUNDING OR PLACEMENT OF RESIDENTS.

7. Profit

Know your operating expenses and ensure that you have sufficient monthly income to pay for these expenses.

8. Local Fire Department

Provide the name and address of your local fire department.

9. Zoning Approval

Get zoning approval for your site from the local municipality based on the type of CBRF and number of residents you plan to have.

10. Ownership Information for Land and Building

Fill in the information regarding the licensee and owner of both the land and the building used for the CBRF.

11. Site and Building Approvals

For New Buildings - Before Construction:

• Obtain construction plan approvals from the Department listed in the application form.

• Obtain sprinkler plan approvals from the Department listed in the application form.

• Obtain heat and smoke detection system plan approvals from the Department listed in the application.

After Construction:

• Obtain letters of completion from the installer of the sprinkler and the heat and smoke detection system, and from the architect in the form of a certificate of substantial completion.

• Get copies of Construction Inspection Report (DDE-2243) from engineers from the respective departments after they make an onsite visit and approve the newly constructed building and sprinkler/heat detection and smoke systems.

• If public water supply is not available, obtain well approval from the Department of Natural Resources, 101 South Webster, Madison, WI 53703, telephone: (608) 266-2521 and have water tested and approved by the State Laboratory of Hygiene or other state approved laboratory.

• Obtain a Certificate of Occupancy from the local municipality or Department of Commerce.

• Obtain approval from the local fire department (form DDE-795) and NFPA 72 and 113 or 13R.

Converting Existing Buildings:

• Obtain a Certificate of Occupancy from the local municipality or Department of Commerce.

• Submit architect’s construction and sprinkler/heat detection plans to the Department of Health and Family Services for approval (see list of addresses under the section for Send in Your Application).

Change in Ownership of Existing CBRF:

• You need to apply for your own license (but won’t need to obtain site or building approvals).

• The previous licensee will be responsible until the licensing requirements are satisfied.

• IT IS YOUR RESPONSIBILITY TO KNOW THE CAPACITY OF THE FACILITY AND THE RESIDENT CENSUS AT THE TIME OF ATTAINING OWNERSHIP.

12. Notarization

Sign the application form in front of a notary public before sending it to the Division of Quality Assurance.

Other Documents to be Turned In

1. Program Statement - This is very important and should include:

• The name of the licensee and the administrator;

• The capacity of the facility;

• The class of license;

• The client groups to be served, as well as the compatibility of groups if more than one client group will be served;

• A description of clients’ needs;

• Program goals and how the needs of the residents will be served; and

• If providing respite care, identify the number of residents involved and the client group.

2. Admissions Agreement - At a minimum, for a typical resident include:

• Services to be provided to the resident;

• Rate residents must pay per day or month and any other charges to be made, source of payment as well as when payments will be made;

• Rules regarding security deposits and charges to be made against the deposit;

• Entrance fees;

• Bedhold fees;

• Discharge or transfer conditions; and

• Refund policies.

Realize that there are very strict rules about the refund and entrance fees and other prepaid fees, and that these policies, outlined in HFS 83, must be included in your admissions agreement.

3. Floor Plan

Submit a floor plan, NOT the architect’s construction plan but a line drawing, which MUST, at a minimum include:

• The size of the rooms to accommodate the type and number of residents;

• The size of common areas to accommodate the type and number of residents; and

• The placement of exits.

4. Community Advisory Committee Documentation

• Submit documentation of your effort (DDE-367).

5. Emergency Evacuation Plan

• Written evacuation plan for dealing with emergencies.

6. Fire Inspection Form

• Form DDE-795 signed and dated by local fire inspection officer.

7. Background Checks Information

• Background information disclosure and appendix forms for yourself, nonclient residents age 10 and over, and board members having regular contact with residents.

Continue with 2nd section of CBRF Video Handout (fees, addresses, rules, etc.)

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Last Updated: June 30, 2008