(1) The governing body of each home shall submit to the Department an application for a permit to
operate under these rules and regulations. No personal care home shall be operated and no residents
admitted without such a permit which is current under these rules and regulations.

(2) The application for a permit shall be made on forms provided by the Department.

(3) A criminal record check application for the owner and director shall accompany applications.

(4) Each application for a permit shall be accompanied by a floor sketch of the home showing windows,
doors, room measurements, and bed placement for residents, family and/or staff and documentation of
ownership or lease agreement for the property on which the home will be operated.

(5) A listing of the names of all staff, including the administrator or on-site manager, who will be working
in the home, if known, shall be included with the application for a permit. This listing shall include the full
name of each staff person, their assigned duties in the home, their birth date and Social Security Number.
If such information is not known at the time of application, it must be provided to the Department within 30
days of issuance of a provisional permit.

(6) The ownership of the home shall be fully disclosed in its application for a permit. In the case of
corporations, partnerships, and other bodies created by statute, the corporate officers and all other
individuals or family groups owning ten percent or more of the corporate stock or ownership shall be
disclosed in the application for a permit as well as the registered agent for service of process.

(7) All others shall submit a statement attesting to the name(s) and address(es) of each person owning
any part of the facility.

(8) Local zoning and other local requirements regarding the proper location and establishment of
homes shall be addressed by the applicant with the responsible local officials.

(9) Personal care homes are expected to comply with all applicable provisions of the Americans With
Disabilities Act and Section 504 of the Rehabilitation Act of 1973 and federal regulations promulgated
thereunder. Any violation of these statutes or regulations may be grounds for the department to initiate
action for sanction against such homes.

FEATURED COMMUNITY PARTNERS

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