Library: Policy

340:105-11-237.1. Complaint processing

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Issued 9-15-17

(a) Regardless of the source of the complaint the Office of the State Long-Term Care Ombudsman (Office), State Long-Term Care Ombudsman (Ombudsman), and Office representatives serve long-term care facility residents to identify, investigate, and resolve complaints.The Ombudsman or Office representative investigates complaints including, but not limited to, abuse, neglect, or exploitation for the purposes of resolving the complaint to the resident's satisfaction and to protect the resident's health, safety, welfare, and rights.The Ombudsman or Office representative may identify, investigate, and resolve a complaint impacting multiple or all facility residents.

(b) Regardless of the source of the complaint, including when the source is the Ombudsman or Office representative, the Ombudsman or Office representative must support and maximize resident participation in the complaint resolution process.

(1) The Ombudsman or Office representative must offer the resident privacy for confidentially purposes, when providing information and hearing, investigating, and resolving complaints.

(2) The Ombudsman or Office representative must discuss the complaint with the resident and resident representative when the resident is unable to communicate informed consent, to:

(A) determine his or her perspective;

(B) request informed consent to investigate the complaint;

(C) determine the resident's or his or her representative's perspective on complaint resolution including if the allegations are reported and, when so, if the Ombudsman or Office representative releases resident identifying information or other relevant information to the facility and/or appropriate agencies.Such report and disclosure is consistent with (b)(3) of this Section;

(D) advise the resident and resident representative of the resident's rights, when applicable;

(E) work with the resident or resident representative to develop a plan of action to resolve the complaint, when applicable;

(F) investigate the complaint to determine if the complaint can be verified; and

(G) determine if the complaint is resolved to the resident's or resident representative's satisfaction.

(3) When the resident is unable to communicate and does not have a representative to provide informed consent the Ombudsman or Office representative:

(A) takes appropriate steps to investigate and works to resolve the complaint in order to protect the resident's health, safety, welfare, and rights; and

(B) determines if the complaint was resolved to the complainant's satisfaction.

(4) To determine whether to rely on a resident representative to communicate or make determinations on the resident's behalf for complaint processing, the Ombudsman or Office representative ascertains the extent of the authority granted to the resident's representative under court order, by power of attorney, or other document the resident used to grant authority to the representative.

(c) The Ombudsman or Office representative may provide information regarding the complaint to another agency in order to substantiate the facts for regulatory, protective services, law enforcement, or other purposes so long as the Ombudsman or Office representative adheres to the disclosure requirements per Oklahoma Administrative Code 340:105-11-243.When the resident or resident representative:

(1) seeks regulatory, protective services, or law enforcement action and the Ombudsman or Office representative determines the resident or resident representative communicated informed consent to the Office, the Office assists the resident or resident's representative contact the appropriate agency and/or discloses the resident or resident's representative consent for such purposes; and

(2) is served by disclosing information to a facility representative and/or referrals to an entity other than those referenced in (c)(1) of this Section and the Ombudsman or Office representative determines the resident or resident representative communicated informed consent to the State Long-Term Care Ombudsman Program (Program), the Ombudsman or Office representative may:

(A) assist the resident or resident representative contact the appropriate facility representative or the entity;

(B) provide information on how a resident or representative may obtain a facility or entity contact information; and/or

(C) disclose the information the resident or resident's representative provided consent for to an appropriate facility representative or entity, consistent with Ombudsman Program procedures.

INSTRUCTIONS TO STAFF 340:105-11-237.1

Issued 9-15-17

1.On receipt of a complaint the designated representative:

(A) encourages the complainant to discuss the matter with appropriate person(s) within the facility or with Oklahoma Department of Human Services staff.Complainants are encouraged to act for themselves when possible.

(B) If the complainant utilized the facility process to no avail, does not perceive facility staff to be responsive, or is fearful of taking direct action, the designated representative opens a case, and:

(i) reviews the complaint with the resident, seeks consent, and identifies and prioritizes issues;

(ii) evaluates the complaint for urgency and complaint timeframe response;

(iii) acquires written consent for release of information, when appropriate;

(iv) completes journal entries in the case record of interviews, meetings, contacts, and requests for information;

(v) contacts the parties involved to get all of the facts; the complainant's or resident's identity is not revealed without consent;

(vi) identifies and reviews all federal and state regulations pertinent to the complaint;

(vii) develops a strategy for resolution with the resident.When referral is necessary, the designated representative contacts the Office of the State Long-Term Care Ombudsman (Office) or deputy ombudsman;

(viii) anticipates barriers, involves appropriate personnel, and seeks technical assistance from the Office as needed;

(ix) implements strategy for resolution; and

(x) follows up to verify that resolution, corrections, or both, occurred and that there is no retaliation against the complainant or resident.

(C) Activities undertaken in complaint resolution may include:

(i) negotiating with a facility to change a particular long-term care facility behavior, pattern, or practice affecting the resident;

(ii) educating a resident, relative, or long-term care facility staff to resolve a problem;

(iii) affecting appropriate enforcement action by a regulatory agency; and

(iv) proposing and advocating regulatory or statutory changes or additions; and

(D) advises the complainant or resident about his or her right to pursue legal action.