Investigation of Complaints for Nursing Homes

5300 - Investigation of Complaints for Nursing Homes (Rev. 243; Issued: 06-12-26; Effective: 06-12-26; Implementation: 06-12-26) Section 42 CFR 488.332 provides the Federal regulatory basis for the investigation of complaints about nursing homes. The survey agency must review all complaint allegations and conduct a standard or an abbreviated standard survey to investigate complaints of violations of requirements if its review of the allegation concludes that: • A deficiency in one or more of the requirements may have occurred; and • Only a survey can determine whether a deficiency or deficiencies exist. The survey agency does not conduct a survey if the complaint raises issues that are outside the purview of Federal participation requirements. Complaint investigations follow, as appropriate, the pertinent survey tasks, and information gathered is recorded on the appropriate survey worksheets. However, if the documentation required is minimal, use Form CMS-807 to record information during the complaint investigation. Record deficiencies on Form CMS-2567 and/or, the “Statement of Isolated Deficiencies Which Cause No Harm with Only a Potential for Minimal Harm for SNFs and NFs” . The completed Form CMS-2567 must be made a part of the complaint record. If necessary, a specialized team may be used to investigate complaints. Team members may include, but are not limited to, an attorney, auditor, and appropriate health professionals. The specialized team is not necessarily composed of qualified surveyors. However, specialized team members provide unique talents and expertise that assist at least one qualified surveyor in identifying, gathering, and preserving documented evidence. Further information regarding the composition of the survey team is provided in Chapter 7. The timing, scope, duration and conduct of a complaint investigation are at the discretion of the SA, except when a determination is made that immediate jeopardy may be present and ongoing or a higher level of actual harm may be present. If the complaint concerns conditions on a certain day (e.g., on weekends), or on a certain shift (e.g., 11 p.m. - 7 a.m.), the SA should make an attempt to investigate it at the relevant time. In most cases, the following tasks, or portion of tasks, should be performed during a complaint investigation. Abbreviated surveys must be conducted on two consecutive calendar days from the day of entrance. Exceptions to this guidance would be an emergency situation as deemed by the state agency or a competing IJ at another location requiring the survey team’s immediate attention. Additionally, the surveyor or survey team should plan to be onsite for a minimum of five hours after entrance, unless the investigation can be completed in less than five hours.