12VAC5-371-70: Complaint investigation

A. The OLC shall investigate complaints and determine if an investigation requires an on-site inspection. In making this determination, the OLC shall consider several factors, to include:

1. Whether the complainant has first-hand knowledge of the alleged incident;

2. The nursing facility's regulatory history, including the number and severity of substantiated prior complaints;

3. Whether the OLC has recently inspected the nursing facility and whether the alleged incident would have been reviewed during the prior inspection;

4. The nature of the complaint, including degree of potential serious harm to residents; and

5. Whether the complaint may be investigated pursuant to Title XVIII or Title XIX of the Social Security Act (42 USC § 301 et seq.).

B. The OLC may request records from the licensee to assist in making a determination pursuant to subsection A of this section. The licensee shall provide the requested records no more than seven calendar days after OLC makes a request pursuant to this subsection.

C. The OLC may receive complaints in written or oral form and may receive anonymous complaints.

D. When the investigation is complete, the OLC shall notify the licensee and the complainant, if known, in writing of the findings of the investigation.

E. For any licensing violation cited during a complaint investigation, the administrator or the administrator's designee shall submit a plan of correction in accordance with 12VAC5-371-55.