Report to the Complainant

5080.1 - Report to the Complainant (Rev. 243; Issued: 06-12-26; Effective: 06-12-26; Implementation: 06-12-26) The SA/CMS location provides the complainant a written report of the investigation findings as a summary record of the investigation. The following principles guide preparation of the report to the complainant: • Acknowledge the complainant’s concern(s); • Identify the SA’s regulatory authority to investigate the complaint/incident and any statutory or regulatory limits that may bear on the authority to conduct an investigation; • Provide a summary of investigation methods (e.g., on-site visit, written correspondence, telephone inquiries, etc.); • Provide date(s) of investigation; • Provide an explanation of your SA’s decision-making process (NOTE: CMS and the SA should avoid using terms such as “substantiated” and “unsubstantiated”); • Provide the complainant with information regarding whether or not noncompliance was identified during the complaint investigation. (NOTE: To the extent possible, the summary should not compromise the anonymity of individuals, or include specific situations that may be used to identify individuals, when anonymity has been requested or is appropriate in the judgment of the SA); • Identify where the complainant may find the Statement of Deficiencies and Plan of Correction (e.g., posted at the nursing home, Nursing Home Care Compare, request the CMS-2567 from the SA); • Describe how the complainant may request a copy of the investigation report, subject to Federal and State disclosure requirements (e.g., see 42 CFR §488.325 and FOIA requirements at 45 CFR Part 5); and • Identify appropriate referral information (i.e., other agencies that may be involved).