To assist with information accessibility and understanding of requirements, we have created an Adult Foster Care manual. The manual is designed to be beneficial from application through the duration of licensure and also provide guidance on what to do with different documents.
To better help providers understand what is required for each visit or need, the webpage is laid out in a different format than the manual.
- AFC Manual >
The Incident and Required Reporting Form is a tool to help you meet required reporting. You must report the following to your RLS:
- Immediately report death or serious injury of a resident
- Immediately report diagnosis of communicable disease of anyone who lives or works in the home, or has recently visited the home
- Change in the health status of a caregiver within 24 hours
- Occurrence of a fire that causes damage to the home, requires the services of the fire department, or repairs to the home require a building permit within 24 hours
- Change in the regular membership of the household (non-residents) within 5 days
- Change in a caregiver’s employment status within 5 days
MN Rule 9555.7175 provides full information on reporting
- Caregivers with 0 through 5 years of experience as caregivers in an Adult Foster Care home must complete 12 hours of training annually.
- Caregivers with 6 or more years of experience as caregivers in an Adult Foster Care home must complete 6 hours of training annually.
- All caregivers and household members must complete and provide a certificate of completion of the MN DHS Vulnerable Adults Mandated Reporting (VAMR) Training annually.
- If you care for people who rely on life-sustaining medical equipment, you must receive training from a qualified source and maintain record of that training.
- Except for VAMR training as stated above, there are no specific requirements on where you can obtain training. Some training is available through TrainkLink and DirectCourse. Training must be from a “qualified source” (i.e. health care system, educational institution, certified trainer, etc.). Training can be in any of the topic areas listed in MN Rule 9555.6185, Subp. 2 & 4.
As a Corporate AFC license holder you are responsible to ensure that all caregivers, staff, and others required to have a background study under MN Statute 245C.
Your RLS will review your roster with you at each relicensing and off-year visit to ensure you have background studies and training logs as required.
Our goal is to help you feel as prepared as possible for your relicensing visit. Please reach out to your Regional Licensing Specialist RLS) if you have any questions about the requirements. You will receive an email from your RLS approximately 2 months in advance of your license expiration to schedule your visit.
Any document with a Sourcewell logo is an optional template. You may use a company form or template if you wish as long as all requirements are met. DHS branded documents and templates are required to be used.
Documents to review
Your RLS will complete these documents during your relicensing visit. It’s a good idea to review these documents ahead of time to make sure you are ready. Requirements on these checklists are the minimum standards outlined in Rule of Statute to ensure resident safety and rights as well as program integrity.
It’s also a good idea to review these additional documents to help make sure you are prepared.
List of home documents:
- Family AFC Application (PDF)
- Supplement to Application (PDF)
- Census and Home Information Sheet (PDF)
- Certificate of Compliance Minnesota Workers’ Compensation Form (PDF)
- Complaint and Grievance Procedures (PDF)
- Drug and Alcohol Policy (PDF)
- Elderly Waiver Service Termination Policy (PDF)
- Emergency Procedures (PDF)
- Escape Plan (PDF)
- Fire Drill Log (PDF)
- Program Abuse Prevention Plan (PDF)
- Program Plan (PDF)
- Personnel Records
- Organizational Chart
- Job Descriptions
- Staffing Pattern
You will be asked to complete the following forms if they apply to your home:
- Equipment Maintenance Form (PDF)
- Pet Authorization form (PDF) and proof of rabies vaccination
- Well water test results with safe levels of coliform and nitrates
List of resident documents:
- Placement and Demographic Information (PDF)
- Individual Abuse Prevention Plan (PDF)
- Individual Resident Placement Agreement (PDF)
- Management of Funds and Cash Resources (PDF)
- Medication Permissions (PDF)
- Mobility Access Verification (PDF)
- Monitoring Technology Consents, if used. Read more about technology consent requirements and find the consents here >
- Notice of Privacy Practices (PDF)
- Resident Rights (PDF)
- Rights Restrictions, if applicable
- Vulnerable Adult Act Summary (PDF)
Off-year visits are required non-renewal visits. These visits are an additional opportunity for you to ensure you are following minimum licensing standards, ask questions to your RLS, and for your RLS to collect annual paperwork.
Documents to review and/or complete
- Census and Home Information Sheet (PDF)
- Certificate of Compliance Minnesota Workers’ Compensation Form (PDF)
- Fire Drill Log (PDF)
- Individual Resident Placement Agreement (PDF) (your RLS will view it has been reviewed by the team within the past year)
- Program Abuse Prevention Plan (PDF)
- VAMR and annual training
You will be asked to complete the following forms if they apply to your home:
- Equipment Maintenance Form (PDF)
- Pet Authorization form (PDF) and proof of rabies vaccination
- Well water test results with safe levels of coliform and nitrates
Some key observations your RLS will make are:
- Water temperature (must be 120F or less)
- Operation of exit doors and windows (they must not be fully or partially obstructed and must easily open)
- General cleanliness and condition of the home
- Operation of flashlight and battery radio
- First aid kit contents
- Variance requests
A change of premise happens when you move from one home to another within the same county. If you are moving near the time your license is due to be renewed, your RLS will instruct you to also complete relicensing forms.
- The county and DSD moratorium must approve the change of premise
- Notify your RLS to receive the request for Fire Marshal inspection
- HCBS licensed providers: Follow any HCBS requirements for location changes
- Ensure all documents are updated with your new address and information including:
- Program Abuse Prevention Plan (PDF)
- Program Plan (PDF)
- Application (PDF)
- Escape Plan and Emergency Procedures (PDF)
- Updated well water testing, if applicable
- You must select a date that you want your license to update to your new address (you cannot stay with residents at the new address prior to the change or at the previous address after the change)
- Once all documents have been received and any citations from the Fire Marshal inspection have been completed, a final walk through will be conducted by your RLS
Capacity changes and home closures must be approved by DSD moratorium.
Capacity increases are based on several factors:
- Moratorium bed availability
- County need, population served
- Bedrooms available in the home
Capacity decreases may be submitted for long-term/permanent changes only.
Prior to permanently closing a home, please ensure you follow Service Termination policies and procedures.
Temporary home closures may be available on a case by case basis. These temporary closures are referred to as “pending reopening”. If approved, the home may go into an inactive status for up to 1-year. After 1-year, the home must be reopened or permanently closed.
If you would like to request a capacity increase and have not been awarded a bed, please complete the below form:
Questions
Contact licensing@sourcewell-mn.gov or call 218-895-4120.
Please include your county of residence in all communications.