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Adult Foster Care - Initial Licensing Process
Steps to Becoming a Provider Steps to Becoming a ProviderClick here to view the steps to becoming a provider. Initial Licensing PaperworkIf you are interested in becoming a provider, please e-mail our staff at afclicensing@co.wright.mn.us. Wright County is in need of experienced caregivers who have wheelchair accessible homes in which all care is provided on the main level. Application for Adult Foster Care License - Complete the application, sign, and return to licensing. To find out the municipality contact information required for page 5 of the application, please see the City Officials or Township Officers lists of government officials in Wright County. SSIS Application for Foster Care Licensure - Complete the application, sign, and return to licensing. Privacy Rights Notice - Review for privacy rights information. Privacy Rights Signature Page - Sign and return to licensing. Instructions for Initiating Background Studies through NETStudy - Follow instructions for initiating background studies. Reference Letters - Three references are required from non-related individuals who can attest to the applicant's ability to provide care for functionally impaired adults. Completed reference forms must be sent to licensing. Fire Marshal Fee Instructions - Follow instructions to initiate the request for a Fire Marshal inspection. Home Safety Checklist - Review and ensure full compliance with checklist items. Send completed checklist to licensing. Disaster Plan - This form will be used in the case of an emergency involving a pandemic outbreak, natural disaster, or catastrophic event. Providers must update the licensor within 14 days of any changes to the contact information on the form. Social Family History - Complete in detail and return to licensing. Each person requesting to be licensed must complete a social history form. Social Family History of Household Members - Complete in detail and return to licensing. Each household member must have a social history form completed with all applicable information. Rule 203 Competency Test - Read Rule 203 (Adult Foster Care Rule), and complete the competency test. Return the completed test to licensing. Vulnerable Adult Act Training - Annual training on the Vulnerable Adult Act is required by MN Statute 245A.65. Complete the on-line competency test and follow instructions to obtain a certificate of completion. All license holders and caregivers must receive a score of 80% or higher to be considered adequately trained on the Vulnerable Adults Act. Maintain annual certificates with the license holder and caregivers' training logs. Program Abuse Prevention Plan - Complete the plan by assessing the anticipated population of residents for whom care will be provided (elderly, developmentally disabled, physically disabled, mentally ill, etc.) and the physical environment of the facility and surrounding grounds. The applicant should determine how the risk of harm will be reduced in each area of assessment. Submit the completed plan to licensing. AFC Home Program Plan - Complete the plan by determining what, if any, services will be provided to the residents that exceed the standard services required by Rule 203. Submit the completed plan to licensing. Grievance Policy Sample - Use this sample to develop an appropriate grievance procedure that residents and/or their legal representatives may use to bring forth issues regarding the care of a resident. Submit the completed policy to licensing. The applicant must develop the policy for specific use within the AFC home; although the sample language may be used, a print of this sample will not be accepted. Substance Abuse Policy Sample - Use this sample to develop an appropriate policy that prohibits the use or abuse of chemicals that impair the caregiver's ability to provide care. Submit the completed policy to licensing. The applicant must develop the policy for specific use within the AFC home; although the sample language may be used, a print of this sample will not be accepted. Reporting Maltreatment of Vulnerable Adults Policy Sample - Use this sample to develop an appropriate policy that guides caregivers, residents and/or their legal representatives in reporting suspected or known maltreatment of a vulnerable adult. Submit the completed policy to licensing. The applicant must develop the policy for specific use within the AFC home; although the sample language may be used, a print of this sample will not be accepted. Floor and Escape Plan - Draw a diagram of the home and identify two escape routes from each sleeping room. Submit the plan to licensing. Well-water Testing Requirements - Water from privately owned wells must be tested annually by a MN Health Department certified laboratory for coliform bacteria and nitrate nitrogens to verify safety. Acknowledgment of Resident's Rights - Review and sign the form. Directions to Home - Complete and sign the form. Rules Agreement - Read Rule 203 (Adult Foster Care Rule) and Reporting of Maltreatment of Vulnerable Adults, and sign the form. NOTE: Forms are in Adobe Acrobat format. If necessary download the free Reader from Adobe's website. Licensing LawsMinnesota Department of Public Safety Minnesota Statute 245A - Human Services Licensing Act Minnesota Statute 245C - Human Services Background Studies Act Multidisciplinary Adult Protection Team Schedules/Training DatesNo Schedules or Training Dates available at this time. Relative Certification256B.0919, Subdivision 3. County certification of persons providing adult foster care to related persons. A person exempt from licensure under section 245A.03, subdivision 2, who provides adult foster care to a related individual age 65 and older, and who meets the requirements in Minnesota Rules, parts 9555.5105 to 9555.6265, may be certified by the county to provide adult foster care. A person certified by the county to provide adult foster care may be reimbursed for services provided and eligible for funding under section 256B.0915, if the relative would suffer a financial hardship as a result of providing care. For purposes of this subdivision, financial hardship refers to a situation in which a relative incurs a substantial reduction in income as a result of resigning from a full-time job or taking a leave of absence without pay from a full-time job to care for the client. In order to be certified to provide Adult Foster Care in Wright County, the applicant will undergo the same initial and re-licensing processes as applicants for licensure. If the applicant is to be certified, the license application (DHS form 3324) will not be mailed to the Minnesota Department of Human Services and will be retained in the licensing file. Need More Information?If you live in Wright County, please contact the licensor by e-mail at afclicensing@co.wright.mn.us. If you do not live in Wright County, please contact your local county social services department; click here for contact information for Minnesota counties. |
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