Utah Admin. Code R510-200-12 - Intake, Investigation, and Complaint Processing

(1) Each local ombudsman entity shall receive, investigate, and try to resolve complaints made by or on behalf of residents.

(2) A complaint may be submitted to a local ombudsman entity by a resident, family or friends of a resident, long-term care facility staff, or another person or agency.

(3) An employee or volunteer of a local ombudsman entity shall initiate a complaint if the employee or volunteer has personal knowledge of an action, inaction, or decision that may adversely affect the health, safety, or rights of a resident.

(4) Upon receipt of a complaint, the local ombudsman entity shall determine the following:

(a) the type of complaint received, using the National Ombudsman Reporting System categorization;

(b) the outcome sought by the complainant;

(c) whether previous attempts have been made to resolve the complaint;

(d) whether the complaint is appropriate for the ombudsman program to address; and

(e) whether resolution of the complaint would conflict with the rights of another resident.

(5) A local ombudsman entity shall initiate an investigation within three business days of receipt of a complaint.

(6) A local ombudsman entity shall meet with the complainant and discuss the following:

(a) alternatives for handling the complaint;

(b) options for the complainant to personally take appropriate action, with assistance from the local ombudsman entity;

(c) explanation of the local ombudsman entity's role to act in accordance with the resident's wishes; and

(d) assurances that the local ombudsman entity will maintain the resident's confidentiality.

(7) A local ombudsman entity shall meet with the resident for whom a complaint has been submitted and shall discuss the following:

(a) the resident's perception of the complaint;

(b) the resident's wishes with respect to resolution of the complaint;

(c) the resident's rights;

(d) a plan of action; and

(e) whether the resident consents to the complaint and investigation of the complaint or whether the resident lacks the capacity to consent.

(8) If a resident lacks capacity to consent, the local ombudsman entity shall seek advice from the resident's representative, guardian, power of attorney, spouse, or family member.

(9) If the local ombudsman entity believes that the resident's representative, guardian, power of attorney, spouse, or family member is not acting in the resident's best interest, the local ombudsman entity shall seek evidence to show the resident's desires and carry out that desire to the extent possible.

(10) A local ombudsman entity is not required to verify a complaint to seek a resolution on behalf of a resident. A resident's perception is a sufficient basis upon which a local ombudsman entity may seek a resolution.

(11) Upon investigation of a complaint, a local ombudsman shall complete one or more of the following steps:

(a) research relevant laws, rules, regulations, and policies;

(b) personally observe and analyze the evidence;

(c) interview the resident and complainant;

(d) interview staff, administration, other residents and families;

(e) identify relevant agencies and obtain information from their staff; and

(f) examine relevant records.

(12) A local ombudsman entity shall present official identification to the administration or designated employee of a long-term care facility upon arrival.

(13) Upon investigation of a complaint, a local ombudsman entity shall seek credible evidence that supports or refutes the complaint. Evidence may be directly observed by the local ombudsman entity or gathered from statements or information from reliable sources.

(14) Upon conclusion of an investigation, a local ombudsman entity shall verify a complaint when the local ombudsman entity determines that the circumstances described in the complaint are substantiated or generally accurate. In making this determination, the local ombudsman entity shall give the benefit of the doubt to the resident's perspective.

(15) If a complaint is verified, the local ombudsman entity shall determine a plan of action to resolve the complaint.

(a) The local ombudsman entity shall advocate on behalf of the resident in discussing the complaint with the appropriate facility, staff, or other relevant party as they develop an agreement that resolves the complaint.

(b) The local ombudsman entity shall try to resolve the dispute directly with the appropriate facility or staff, unless the local ombudsman entity determines that another strategy would be more advantageous.

(16) A local ombudsman entity shall submit a referral to another agency on behalf of a resident if one or more of the following applies:

(a) another agency has statutory responsibility to support or assist the resident;

(b) the action to be taken in the complaint is outside of the local ombudsman entity's scope of authority;

(c) the local ombudsman entity needs additional assistance to achieve resolution of the complaint; or

(d) it is determined that additional expertise may benefit the resident.

(17) A local ombudsman entity may only submit a referral to another agency on behalf of a resident if the resident consents or the resident's representative, guardian, power of attorney, spouse, or family member consents. If the local ombudsman entity determines that the resident's representative, guardian, power of attorney, spouse, or family member is not acting in the resident's best interest, the local ombudsman entity shall seek evidence to show what the resident would have desired and, where such evidence is available, work to carry out that desire.

(18) A complaint or case shall be closed if any of the following occur:

(a) the complaint has been resolved to the satisfaction of the resident;

(b) the local ombudsman entity has determined that the complaint cannot be verified or was made in bad faith;

(c) further activity by the local ombudsman entity is unlikely to produce a result to the satisfaction of the resident;

(d) the complaint is not appropriate for action from the local ombudsman entity;

(e) the local ombudsman entity anticipates no further response regarding the complaint from the agency to which the referral was made; or

(f) the resident has capacity and requests that the local ombudsman entity closes the case.

(19) If a local ombudsman entity receives a complaint alleging abuse, neglect, or exploitation of a resident, the local ombudsman entity shall make a referral to Adult Protective Services or call local law enforcement.

(20) If a local ombudsman entity receives a complaint that implicates a resident rights issue, the local ombudsman entity shall provide ombudsman services to the identified resident.

(21) Any complaint and documentation shall be entered into the local ombudsman entity's electronic case management program.

(22) A local ombudsman entity shall seek consent from a resident before accessing the resident's facility records.

(a) Consent shall be given orally, visually, in writing, or through auxiliary aids.

(b) The date and method of obtaining the consent shall be documented in the case file.

(c) If a request for consent is denied by the resident or their legal representative, the local ombudsman entity shall not access the records.

(d) If a request for consent is unsuccessful for any reason other than specific denial by the resident or legal representative, the local ombudsman entity may proceed to access the records. The reasons for not obtaining consent shall be documented in the case file.

(e) If a request for consent cannot be given by the resident and it is determined that the resident's legal representative is not acting in the resident's best interest, the local ombudsman entity may proceed to access the records. The attempt to obtain consent and the reason to believe the resident's legal representative is not acting in the resident's best interest shall be documented in the case file.

Notes

Utah Admin. Code R510-200-12

Adopted by Utah State Bulletin Number 2018-12, effective 5/30/2018 Adopted by Utah State Bulletin Number 2022-09, effective 4/12/2022