101 Complaint Processing

Policy

Processing complaints made by or on behalf of residents of long-term care facilities is the long-term care ombudsman program’s highest priority service.

Procedures

101.1 General

The LTCOP shall identify, investigate, and resolve complaints made by or on behalf of residents. Although the issues and circumstances of the complaints will vary, the following general guidelines apply to all complaint handling. Whenever questions arise regarding appropriate OR practice in handling complaints, the SLTCO should be contacted for guidance.

101.2 Complaint intake and response

  1. complaint intake

    1. When an OR receives information regarding a complaint, the OR shall determine:

      1. The type of complaint as presented by the complainant.

      2. What outcome the complainant is seeking.

      3. What attempts, if any, have already been made to resolve the complaint.

      4. Whether the complaint is appropriate for OR activity. Examples of complaints which are not appropriate for OR activity include those which:

        1. Do not directly impact a resident or former resident of a long-term care facility.

        2. Are outside the scope of the mission or authority of the LTCOP.

        3. Would place the LTCOP in the position of having an actual or perceived conflict of interest with the interest of a resident or residents.

          The OR may seek resolution of complaints in which the rights of one resident and the rights of another resident or residents appear to be in conflict.

    2. The OR shall discuss the following with the complainant:

      1. Alternatives for handling the complaint.

      2. Encouragement for the complainant to personally take appropriate action, with OR assistance if needed.

      3. Explanation that the OR role is to act in accordance with resident wishes.

      4. The LTCOP policy of confidentiality.

  2. source of complaint

    1. Complaints may be filed with the LTCOP by residents, families, and friends of residents, long-term care facility staff, and any other person.

    2. Complaints may be made anonymously to the LTCOP. Anonymous complaints must remain anonymous. If the OR receiving the complaint is able to communicate directly with the anonymous complainant, the OR may explain to the complainant that, in some circumstances, anonymity could limit the ability of the OR to investigate and resolve the complaint.

    3. OR generated complaints

      An OR shall file a complaint when the OR has personal knowledge of an action, inaction, or decision that may adversely affect the health, safety, welfare, or rights of residents and no other person has made a complaint on such action, inaction, or decision.

  3. timeliness of responses to complaints

    1. An OR shall use his or her best efforts to initiate investigations of complaints in a timely manner in order to resolve the complaint to the satisfaction of the resident.

    2. The date on which the first action is taken to investigate the complaint by the assigned ombudsman (reported as the “action date”) is considered timely as follows:

      Table III-A Complaint Response
      IF a complaint involves… THEN the standard of promptness for LTCO response (i.e. the action date) is…

      1. abuse or gross neglect, and

      2. the OR has reason to believe that a resident may be at risk

      within the next working day[1]

      1. abuse or gross neglect, and

      2. the OR has no reason to believe that a resident is a risk

      within three days, but not to exceed three calendar days[1]

      actual or threatened transfer or discharge from a facility

      whichever occurs first:

      1. 5 working days,

      2. the last day of bed-hold period (if resident is hospitalized), or

      3. the last day for filing an appeal for an administrative hearing

      other types of complaints

      within 7 working days

    3. Where the LTCOP will be unable to initiate investigations in a timely manner (e.g., due to a planned vacation or extended illness), the ORC shall develop a plan for temporary coverage in order to meet the standard of promptness. Such plan shall be communicated to the LE and the SLTCO to assure appropriate and timely case referrals.

    4. The LTCOP shall provide adequate telephone coverage to receive complaints promptly and confidentially during business hours. Where a message is left for the ombudsman, the LTCOP shall attempt to make contact with the complainant during the same day the contact was made whenever possible and, in all cases, within two working days. Adequate coverage may include: ORs or volunteers providing constant phone service, frequent checks of confidential telephone voice mail by staff, and/or use of pagers or cell phones.

    5. The LTCOP is not designed to serve as an emergency response system; emergency situations should be referred to “911” for immediate response.

  4. resident focus

    1. Regardless of the source of the complaint, the resident of, or applicant to, a long-term care facility is the OR’s client.

    2. Regardless of the source of a complaint, an OR shall personally discuss the complaint with the resident in order to:

      1. Determine the resident’s perception of the complaint.

      2. Determine the resident’s wishes with respect to resolution of the complaint.

      3. Advise the resident of his or her rights.

      4. Work with resident in developing a plan of action.

        Where immediate action must be taken in order to protect resident rights, the OR may take necessary immediate action if it is not possible to first consult with the resident. The OR shall inform the resident of the action taken by the OR as soon as practicably possible and seek to follow resident wishes during the remainder of the complaint process.

    3. Where the complaint relates to a nursing home regulatory violation, the OR shall inform the resident and/or complainant that the OR provides information to surveyors prior to standard surveys and seek resident and/or complainant permission to share the complaint information with surveyors. The OR shall provide the name of the complainant and/or resident to surveyors with complainant and/or resident consent.

    4. resident consent refused or withdrawn

      1. If, at any point during the complaint process, the resident expresses that he or she does not want the OR to take further action on a complaint involving the resident, the OR shall determine whether further efforts should be made on the complaint. In making this determination, the OR shall consider the following:

      2. For all complaints in which the resident refuses or withdraws consent, the OR shall:

        1. Attempt to determine why the resident refused or withdrew consent, considering factors such as:

          • Past response of facility to complaints.

          • The resident’s relationship with the staff.

          • The experience of this resident or other residents in the facility related to this type of complaint.

        2. Inform the resident that he or she may contact the OR regarding the withdrawn complaint or other complaints in the future.

        3. Provide a business card or brochure informing the resident how to contact the LTCOP.

    5. resident unable to provide consent

      1. The OR shall advocate for a resident’s wishes to the extent that the resident can express them, even if the resident has limited decision-making capacity.

      2. Where a resident is unable to provide or refuse consent to an OR to work on a complaint directly involving the resident, the OR shall:

        1. Seek evidence to indicate what the resident would have desired and, where such evidence is reliable, work to effectuate that desire.

        2. Assume that the resident wishes to have his or her health, safety, welfare, and rights protected.

    6. resident no longer resides at facility or is deceased

      1. Where a former resident who is the subject of a complaint no longer resides at the facility or is deceased, the OR may close the complaint(s) related to that resident. The OR shall make referrals to other agencies where appropriate to address any unresolved issues.

        In most cases, the disposition of such complaint shall be recorded as “No action needed or withdrawn by the resident, resident representative or complainant”.

      2. Where the complaint related to the former resident is a continuing or potential concern for other residents of the facility, the OR shall open a new case with another resident(s) as the complainant or an ombudsman-generated complaint in order to continue OR work to resolve the complaint.

      3. Where the complaint is received by the OR after the resident at issue has moved out of the facility or is deceased, the OR shall determine whether the complaint is potentially a concern for other residents of the facility.

        1. If the complaint is potentially a concern for other residents, the OR shall open a complaint and work to resolve it to the satisfaction of the complainant.

        2. If the complaint is not potentially a concern for other residents, the OR may, but is not required to, open a case. If a case is not opened, the OR shall:

          1. Explain to the complainant the reasons for not opening a case.

          2. Notify the complainant of other agencies that may be of assistance in responding to the complaint (e.g., information regarding the Healthcare Facility Regulation Division (HFR) of the Department of Community Health if the complaint relates to regulatory issues).

101.3 Investigation process

  1. The OR investigates a complaint in order to verify the truth of the complaint.

    1. A complaint is “verified” when the OR determines, after completing an investigation, that the circumstances described in the complaint are substantiated or generally accurate,

    2. Because an OR works on behalf of resident interests, the OR gives the benefit of any doubt to the resident’s perspective.

  2. The OR shall seek the following information during the investigation of the complaint and document the findings in the OR case record:

    1. What has occurred or is occurring.

    2. When it occurred and whether the occurrence is ongoing.

    3. Where it occurred.

    4. Who was involved.

    5. Effect of the occurrence on resident(s).

    6. Reason for occurrence.

    7. What, if anything, the facility or other interested parties have done in response to the occurrence.

  3. In order to verify a complaint, the OR shall take one or more of the following steps, as appropriate to the nature of the complaint:

    1. Research relevant laws, rules, regulations, and policies.

    2. Personally observe the evidence.

      an OR shall not search a resident’s body for evidence. Where a resident chooses to reveal to the OR evidence on a part of his/her body which would normally be clothed, the OR shall document in the case record the circumstances surrounding the resident’s choice to reveal such evidence.

    3. Interview the resident and/or complainant.

    4. Interview staff, administration, other residents, and families.

    5. Identify relevant agencies and interview and/or obtain information from their staff.

    6. Examine relevant records.

    7. Refer the complaint to a more appropriate agency for investigation, following steps in Section III-101.5.

      When referring to another agency for investigation, the OR may suspend his/her investigation if he/she determines that continuing the LTCO investigation could hinder the ability of the other agency to appropriately investigate.

  4. The OR shall have access to all long-term care facilities and residents, including access to have a private, confidential discussion with any resident upon resident request.

  5. The OR shall have access to review and make copies of medical, social, and other records of a resident if:

    1. The OR has the permission of the resident or the resident’s legal representative.

    2. The resident is unable to consent to the review and has no legal representative.

    3. Access is necessary to investigate a complaint if:

      1. A legal guardian refuses to give permission.

      2. The OR has reasonable cause to believe that the guardian is not acting in the best interest of the resident, and the OR obtains the approval of the SLTCO.

  6. The OR shall have access to review and make copies of the administrative records, policies, and documents, to which the residents have, or the general public has access, of long-term care facilities.

  7. The OR shall have access to review and make copies of all licensing and certification records maintained by the State with respect to long-term care facilities.

  8. Resident perception is a sufficient basis upon which an OR can verify a complaint of a subjective nature (e.g., If a resident complains that a staff person is not acting with respect toward that resident, the OR does not need to independently observe the staff person act disrespectfully in order to verify the complaint). However, whenever possible, the OR shall seek objective verification of the complaint.

  9. Facility visits for purposes of complaint investigation shall be unannounced unless a scheduled meeting with staff is necessary as part of the investigation process.

101.4 Working toward resolution

  1. Upon verifying or partially verifying a complaint, the OR shall make efforts to resolve the complaint to the satisfaction of the resident, representative, and/or complainant.

  2. A plan to resolve the complaint shall be mutually agreed upon by the resident and the OR. Where a resident is unable to communicate his/her wishes, the OR may develop a plan with the resident’s representative or the complainant if consistent with the rights and interests of the resident.

  3. The OR shall consider the following factors in developing the plan to resolve the complaint, as appropriate to the nature of the complaint:

    1. The scope of the complaint (i.e. whether it impacts more than one resident).

    2. The history of the facility with respect to resolution of other complaints.

    3. Available remedies and resources for referral.

    4. Who (e.g., particular facility staff, another agency) would be best able to assist in resolution of the complaint; and the likelihood of retaliation against the resident or complainant if particular action steps are taken.

  4. Upon verifying or partially verifying a complaint, one or more of the following may be appropriate actions to resolve a complaint:

    1. Explanation of the investigation findings to the resident, representative, and/or complainant.

    2. Negotiation - i.e., the OR advocates for the resident’s rights and interests with the appropriate facility staff or other relevant party to develop an agreement that resolves the complaint. Negotiation may be done on behalf of or along with the resident, representative, and/or complainant.

    3. Mediation - i.e., the OR acts as an impartial referee between parties of equal status (e.g., between residents or between family members) to assist the parties in developing an agreement that resolves the complaint.

    4. Filing an appeal for an administrative hearing.

    5. Coordination with and/or referrals to appropriate agencies (see III-101.5, III-101.6).

  5. The OR shall attempt to resolve the dispute directly with the appropriate staff of the facility unless the OR and the resident (or representative or complainant) determine that another strategy would be more advantageous to the resident.

  6. Where an investigation reveals that a complaint is not valid, the OR shall explain to the resident, representative, and/or complainant that the OR was unable to validate the complaint and shall indicate what additional steps, if any, the OR plans to take (for example, monitoring the issue during future routine visits to the facility).

101.5 Complaint referrals

  1. When a complaint shall be referred.

    1. An OR shall make a referral to another agency where:

      1. The resident (or representative or the complainant, where the resident is unable to grant permission and the referral is in the resident’s interest) gives permission.

      2. One or more of the following applies:

        1. Another agency has resources that may benefit the resident (e.g., Adult Protective Services can provide emergency relocation funds to assist in relocating the resident to another location).

        2. The action to be taken in the complaint is outside of LTCOP authority and/or expertise (e.g. HFR takes regulatory actions).

        3. The OR needs additional assistance in order to achieve resolution of the complaint.

        4. The resident requests the referral be made.

    2. For every referral made by the OR to another agency, the OR shall include documentation of such referral in the OR case record.

  2. Sharing complaint-related information.

    After a complaint has been referred, the OR shall make every effort to maintain the security and confidentiality of information related to the complaint, so that the information is not shared beyond the agency or agencies receiving the referral. For example, communications of resident-specific information should not be shared over e-mail or other electronic means unless adequate security measures have been taken to protect the security of the communications.

  3. Referrals to law enforcement and regulatory agencies.

    1. An OR may encourage residents or complainants to directly contact the appropriate regulatory agency to file a complaint and offer information and assistance to residents or complainants in making such contact.

    2. Where an OR directly refers a complaint to the HFR, the LTCO shall take the following steps.

      1. Submit the complaint in writing.

      2. Or, contact complaint intake by telephone and subsequently document the referral.

        1. To document, record in OR records.

        2. OR may also submit a confirming letter to the agency.

    3. Joint investigatory activities.

      Where the OR is invited by a regulatory agency to assist in or provide information regarding an investigation of a facility, OR participation is appropriate only under the following circumstances:

      1. The OR is able to fulfill his or her role as a resident advocate.

      2. The OR does not attempt to regulate a facility or take actions which would lead one to assume that the OR is a regulator.

      3. The OR explains to facility administration and residents that his or her role is to advocate for the health, safety, welfare, and rights of residents, not to enforce regulations.

  4. Referrals to legal services.

    1. For a resident who is age 60 or older and who requests or is in need of legal advice and/or representation, the OR shall refer the resident to the Elderly Legal Assistance Program (ELAP) in the service area where the resident resides or to the Georgia Senior Legal Hotline.

    2. For a resident who is under age 60 and who is requesting or in need of free legal advice and/or representation, the OR shall assist the resident in finding appropriate legal services. The OR may contact the ELAP, the SLTCO, the Legal Services Developer, or the Georgia Advocacy Office for information regarding such services.

    3. Where the ELAP is unable to provide the requested legal service, the OR may provide the resident with a list of private attorneys who may provide the service. The OR shall not make referrals to or recommend an individual private attorney.

  5. Determining outcome of a referral.

    After a complaint has been referred, the OR shall determine:

    1. Resident satisfaction with the outcome of actions taken by the referral agency.

    2. Whether appropriate action has been taken by the referral agency. Where appropriate action has not been taken by the referral agency, the OR may continue to work on the complaint by advocating for a more appropriate action by the referral agency.

101.6 Final resolution

The resolution status of a complaint shall be determined when any of the following occurs:

  1. The complaint has been resolved to the resident’s satisfaction. If the resident cannot communicate his/her satisfaction, the ombudsman may seek resolution to the satisfaction of the resident’s representative or complainant, if consistent with the rights and interests of the resident.

  2. The LTCOP has determined, after investigation, that the complaint either:

    1. Cannot be verified.

    2. Was not made in good faith.

  3. Further activity by the OR is unlikely to produce satisfaction for the resident.

  4. The complaint is not appropriate for OR activity (see III-101.2).

  5. The OR anticipates no further response regarding the complaint from the agency to which the referral was made.

  6. The resident requests that OR activity end on the complaint.

101.7 Follow-up

  1. After resolving a complaint but prior to closing it, the OR shall:

    1. Assure that the resident (or representative or complainant, where appropriate) continues to be satisfied with the outcome.

    2. Determine whether further actions on behalf of the resident should be taken by the LTCOP.

      For most complaints, the date of follow-up will be a date subsequent to the date of resolution.

  2. Where the resident has left the facility, the OR shall make reasonable attempts to follow-up with the resident in the resident’s new location prior to closing the case.

  3. If further action is necessary, the OR shall keep the case record open, revise the resolution category and date if necessary, and continue to work towards resolution of the complaint.

101.8 Closing a complaint or case

  1. The OR activity on a complaint is complete, and, therefore, the complaint may be closed, when follow-up steps have indicated the need for no further action or change in the resolution of the complaint.

  2. A case is closed when all of the complaints related to that case have been closed.

101.9 Abuse and gross neglect complaints

Specific guidelines are provided with respect to handling and reporting suspected abuse, gross neglect, and exploitation due to the serious nature of these complaints and in order to comply with laws governing the Long-Term Care Ombudsman Program, including confidentiality requirements and reporting requirements.

  1. Upon receiving an abuse or gross neglect complaint, an OR shall use his or her best efforts to ensure protection of the resident from further abuse or gross neglect.

  2. The OR shall follow complaint investigation steps (III-101.2-101.8) as in other types of complaints.

    The primary role of the OR is to seek resolution to the resident’s satisfaction, not to verify the suspected abuse or gross neglect. The Healthcare Facility Regulation Division of the Department of Community Health (HFR), not the LTCOP, is the official reporting agency to investigate abuse in long-term care facilities in Georgia.

  3. The LTCO shall report suspected abuse or gross neglect as follows:

    Table III-C When to Report Abuse
    IF the resident… THEN the LTCO shall…

    gives permission to an OR to make the report

    report the suspected abuse or gross neglect to Healthcare Facility Regulation (HFR), and, where appropriate, to law enforcement

    1. does not give permission to an OR to make the report; and

    2. the complainant is a long-term care service provider, facility staff person, or other mandatory reporter

    inform the complainant of his or her duty to report to the HFR

    1. does not give permission to an OR to make the report, and

    2. acknowledges having been abused

    1. determine:

      1. whether other residents have experienced similar circumstances, and

      2. whether any other resident wishes the OR to take any action on his or her behalf, and

    2. make repeated visits to the resident who alleged abuse or gross neglect in order to encourage the resident to permit the OR to report the suspected abuse or gross neglect

    is unable to communicate his or her wishes

    refer the suspected abuse or gross neglect to the HFR, law enforcement or other appropriate agency under OR authority to protect the resident’s right to be free from abuse or gross neglect only after:

    1. consulting with the resident’s representative, if one exists, and follow his or her wishes,

    2. if the resident has no representative, determine whether an action, inaction or decision may adversely affect the health, welfare, safety or rights of the resident,

    3. the OR has uncovered no evidence indicating that the resident would not want the referral to take place,

    4. the OR has reasonable cause to believe that the referral is in the resident’s best interest, and

    5. the OR obtains the approval of the SLTCO.

    does not make the complaint (i.e. the OR receives a complaint of suspected abuse or neglect from a complainant other than the resident)

    1. advise the complainant to report the suspected abuse or neglect to the appropriate agency and provide information to assist the complainant in making the report, and

    2. visit the resident and follow complaint investigation steps (III-101.2-101.6, above)

    1. does not make the complaint, and

    2. the OR personally witnesses abuse of a resident

    1. File an OR generated complaint only after first:

      1. seeking informed consent of the resident to disclose resident identifying information and act in accordance with the resident’s wishes, or

      2. if the resident is unable to give consent and has no resident representative to give consent, the OR shall disclose the matter to HFR, law enforcement or other appropriate agency if:

        1. the OR has no evidence indicating that the resident does not wish the referral to be made,

        2. the OR has reason to believe that disclosure would be in the best interest of the resident, and

        3. the OR obtains the approval of the SLTCO, and

    2. follow complaint investigation steps (III-101.2-101.8, above) (45 CFR 1324.19(b)(7) and (8)

    requests the OR to not make a report of abuse personally witnessed by the OR

    1. determine:

      1. whether other residents have experienced similar circumstances, and

      2. whether any other resident wishes the OR to take any action on his or her behalf, and

    2. make repeated visits to the resident who was the victim of abuse observed by the OR in order to encourage the resident to permit the OR to report the alleged abuse or gross neglect.

    requests OR assistance in moving from the facility

    take steps to facilitate moving the resident to another facility, such as assisting with contact of the resident’s representative, family members, and/or appropriate agencies.

    The OR shall not physically transport the resident.
    Table III-D Where to Report Abuse
    IF suspected abuse occurs in… THEN a report is made to…

    a nursing home, intermediate care facility, assisted living community, personal care home, unlicensed personal care home, or community living arrangement

    Georgia Department of Community Health, Healthcare Facility Regulation Division
    Complaint Intake
    800/878-6442
    404/657-5726 or -5728

    1. nursing home, intermediate care facility, assisted living community, personal care home, or community living arrangement, and

    2. a family member, friend, or other person not employed by the facility is a suspect

    Georgia Department of Human Services
    Division of Aging Services
    Adult Protective Services
    Central Intake
    888/774-0152
    404/657-5250
    Via fax: 770/408-3001

    Reports made to HFR will be referred for investigation by adult protective services, pursuant to a memorandum of understanding.

    all other settings

    Georgia Department of Human Services
    Division of Aging Services
    Adult Protective Services
    Central Intake
    888/774-0152
    404/657-5250
    Via fax: 770/408-3001
    All emergencies should be reported to “911”. The LTCOP, HFR, and Adult Protective Services offices do not provide emergency response systems.

  4. In addition to referrals made to official reporting agencies as set forth in Table III-D, above, the OR may also refer cases of suspected abuse, gross neglect, or exploitation as follows:

    1. Where the provider of services to the victim is Medicaid-certified, or abuse, neglect or exploitation is suspected, the LTCO representative may report via the SLTCO to the State Medicaid Fraud Control Unit at the Office of the State Attorney General.

    2. Where the LTCO has reason to believe that criminal activity has occurred, the LTCO may report to local law enforcement agencies.

  5. continued monitoring After reporting abuse, gross neglect, or exploitation in a long-term care facility, the OR shall continue to monitor:

    1. The safety of the resident at issue.

    2. The involvement and/or investigation of other agencies.

    3. Resident satisfaction with the outcome of actions taken in response to the suspected abuse, gross neglect, or exploitation.

101.10 Documentation

  1. Regarding each complaint, the OR shall document in accordance with the Documentation Guidelines set forth in the State-Wide Reporting and Documentation System Procedures Manual.

    Case documentation shall be recorded in the electronic data system. If a program also maintains paper case files, those files shall include all of the information also recorded in the data system.

  2. The LTCOP shall maintain complaint documentation in an organized manner which:

    1. Can be readily understood by another OR or the SLTCO.

    2. Clearly describes all OR activity on the complaint and is maintained together in a file.

    3. Includes pertinent documents (e.g., Letters of Guardianship, Power of Attorney, Discharge Notices, etc.).

    4. Is maintained for a minimum of six years from the date of closure, and longer where the case or facility files contain information which is likely to be valuable for legal or historical purposes.

101.11 Complaint volume

  1. The ORC shall periodically review the number of complaints brought to the LTCOP to determine whether:

    1. The number of complaints is so high as to impact the ability of LTCOP to adequately fulfill the other program components.

    2. The number of complaints is below the average number of complaints per program statewide.

    3. The number of complaints is approximately the same as the projection in the LTCOP Annual Plan.

      How to use this table: This table is designed to assist ORCs, the SLTCO, and provider agencies in LTCOP evaluation and planning. It suggests strategies to use in impacting complaint numbers which appear unusually high or unusually low. It also provides guidance in evaluating program performance related to complaint processing. The LTCOP is not required to process a particular number of complaints.

      Table III-E Complaint Activity
      IF complaint numbers are… THEN the ORC shall take the following steps…

      low from a particular facility

      1. determine whether residents, families, or staff feel free to make complaints to LTCOP,

      2. determine whether residents, families, and staff are familiar with the existence of and purpose of the LTCOP, and

      3. review whether ombudsman-generated complaints are being accurately recorded by all staff.

      low for the LTCOP, indicated by any of the following: more than 10% below the statewide average, or more than 10% below the projected number of complaints in the LTCOP Annual Plan

      1. Review whether residents, families, and staff are familiar with the existence of and purpose of the LTCOP.

      2. Increase frequency of routine visits.

      3. Increase involvement with resident and family councils.

      4. Increase community education and public information regarding the purpose of the LTOCP.

      5. Increase the number of in-service trainings for facility staff.

      6. Review whether complaints, including ombudsman-generated complaints, are being accurately recorded by all ORs.

      high for a particular facility or company owning/managing facilities

      look to systemic approaches to resolve common complaints.

      high for the LTCOP, indicated by: more than 10% above the statewide average, or more than 10% above the projected number of complaints in the LTCOP Annual Plan

      1. Review whether serious complaints are being given highest priority for resolution.

      2. Review whether ORs are providing sufficient resources and information to enable families and residents to personally resolve complaints where appropriate.

      3. Review whether complaint categories are being used appropriately.

  2. The ORC shall periodically review the resolution status of complaints to monitor resident satisfaction with complaint activity and accuracy of OR reporting. The ORC shall seek to:

    1. improve resident satisfaction with complaint resolution

      Improved resident satisfaction is indicated by an increase in the total percentage of the sum of the following resolution categories:

      1. “Partially or fully resolved to the satisfaction of the resident, resident representative or complainant”.

      2. “Withdrawn or no action needed by the resident, resident representative or complainant”.

        Some complaints will not be resolved to the resident’s satisfaction regardless of OR action. The disposition for those complaints is noted as “Not resolved to the satisfaction of the resident, resident representative or complainant”.
Table III-F Resident Satisfaction with Complaint Resolution
IF the percentage of complaints: THEN the ORC shall take the following steps…

Indicates no increase from the previous year in the total percentage of complaints which have the following resolution codes:

  1. “Partially or fully resolved to the satisfaction of the resident, resident representative or complainant”.

  2. “No action needed or withdrawn by the resident, resident representative or complainant”.

  1. Review whether a high percentage of residents have withdrawn their cases. If so, identify possible causes for resident withdrawal of complaints (e.g., is the rate higher for a particular staff person or volunteer? is the rate higher in a particular facility?) and seek to rectify any identified problems.

  2. Review whether a high percentage of complaints is “not resolved.” If so, identify possible causes and seek to rectify.

  3. Review whether the percentage of complaints being referred to other agencies has an impact on resolution.

  4. Review whether a large number of complaints is related to issues that must be resolved through legislative or regulatory action.

The percentage of complaints which are “Not resolved to the satisfaction of the resident, resident representative or complainant” is increased from the previous year.

review adequacy of complaint investigation techniques, including:

  1. response times,

  2. thoroughness of investigations,

  3. proper identification of complaints, and

  4. adequate focus on the resident’s wishes.

References

OAA §§ 712(a)(5)(B)(ii), (iii), (iv), (v); (g)(1)(A); 731; O.C.G.A §§ 31-80 et seq.; O.C.G.A. §§ 30-5-1 et seq.; Georgia Long-Term Care Ombudsman Reporting Manual

1. When all OR staff are out of the office (e.g., due to a required training conference or because the LE office is closed), then the response shall be within the next working day that any OR staff are in the office.