Current through Register Vol. 35, No. 18, September 24, 2024
A.
Assignment of complaint. The manager or designee shall review the
complaints, reports or allegations of abuse, neglect or exploitation,
prioritize these complaints and assign appropriate authority staff to
investigate when warranted, and refer the complaint, report, or allegation to
APS, and other appropriate oversight agencies for investigation.
(1) Assignment shall be made to appropriate
staff of the authority of all complaints of abuse, neglect or exploitation
involving a provider for whom the authority has oversight authority or for whom
the authority has agreed to investigate.
(2) Referral shall be made to APS of
complaints of abuse, neglect or exploitation in all instances where the
complaint involves a provider of medicaid waiver services administered by the
aging and long-term services department and the provider is not otherwise
licensed by or under contract with the authority.
(3) The manager shall prioritize the
complaints and ensure that the complaints that allege the most serious
incidents of abuse, neglect or exploitation, or that present a high risk of
future harm, are promptly investigated.
B.
Immediate threat to health or
safety. In instances where the investigation determines that there
exists an immediate threat to the health or safety of a person in the care of a
provider, the authority or APS, in accordance with applicable statutory
authority, will make the necessary arrangements or referrals to ensure the
protection of persons at risk of harm or injury. The authority will take
appropriate action to eliminate or reduce the immediate threat to health or
safety with respect to providers it licenses or with whom it
contracts.
C.
Conducting the
investigation. The authority investigation of complaints will follow the
procedures in this rule. The investigations conducted by APS will comply with
applicable APS rules or with the provisions herein.
(1) The investigators shall gather all
relevant evidence, weigh the evidence including making credibility
determinations. Individuals from whom information is gathered may include the
reporter, witnesses identified by the reporter, listed on the incident report
form or discovered during the investigation, the alleged victim, appropriate
representatives of the provider, medical personnel with relevant information,
family members and guardians of the alleged victim, any employee suspected of
abuse, neglect or exploitation, other recipients of care and services, and
other persons possibly having relevant information.
(2) Physical injuries that are the subject of
the complaint will be observed in person and documented. Complete documentation
must be obtained of all objectively verifiable manifestations of mental
anguish, verbal abuse, sexual abuse or neglect on the part of the recipient of
care or services.
(3) The
investigator will generally follow authority guidelines addressing face-to-
face individualized interviews, telephonic interviews, witness statements and
documentation of contacts.
(4) The
investigator will follow established guidelines for clinical
consultations.
(5) In instances
where the investigation results in discovery of other, unrelated instances of
possible abuse, neglect or exploitation, the investigator will file an incident
report form with the incident management system. However, additional
allegations involving the same complaint as the one under investigation are
considered the same case and will not be separately reported, although the
investigator may supplement the Incident Report.
(6) At any time during the investigation, the
manager shall make referrals to other licensing authorities based upon
information of possible violations of applicable health facility, community
provider or health care professional standards.
(7) The investigator will submit an
investigation report to the manager with recommendations as to whether the
complaint is:
(a) unsubstantiated;
(b) substantiated; or
(c) substantiated
registry-referred.
(8)
Where appropriate, the investigation report may make findings and
recommendations with respect to provider responsibility for abuse, neglect or
exploitation.
(9) The manager shall
review the investigation report and recommendations and shall make a
determination whether the complaint of abuse, neglect or exploitation is
substantiated.
(10) If the manager
determines, as a result of the manager's review of the investigation report and
recommendations, that the complaint is substantiated, the manager shall apply
the appropriate severity standard to the substantiated complaint to further
determine if the complaint is substantiated registry-referred.
D.
Investigation file and
report. The authority shall establish an investigation file, which shall
contain all applicable information relating to the complaint including the
incident report form, correspondence, investigation, referrals, determinations,
secretary's decision, and notices of appeal. Following the investigation and
determination by the manager, the complaint and investigation file will be
maintained by the custodian. The investigator, or the investigator from the
lead agency in a joint investigation, shall prepare and submit a written
investigation report. The investigation report shall be part of the
investigation file. The investigation report shall contain a review of the
evidence obtained during the investigation, including but not limited to:
(1) interviews conducted and written
statements;
(2) interviews and
statements reviewed that were originally conducted or obtained by other
entities such as the provider, other health care facilities and medical
providers, or law enforcement;
(3)
documents, diagrams, photographs and other tangible evidence obtained or
reviewed;
(4) a description of any
actions taken by the provider in a response to the complaint or situation under
investigation; and,
(5) analysis of
the evidence and recommendations.
E.
Timeline and processing of a
complaint. The investigation of each complaint shall be completed by the
authority within 60 calendar days of receipt of the complaint.
(1) The investigation report shall be
submitted to the manager no later than 60 calendar days following the receipt
of the complaint.
(2) The manager
shall review the investigatory findings and recommendations and make a
determination within five business days of receipt of the findings as to
whether the complaint of abuse, neglect or exploitation is substantiated
registry-referred.
(3) The manager
may issue a specific extension of any complaint processing deadline if
reasonable grounds exist for such extension and the reasons are set out in the
written extension. The written extension is included in the investigation file.
Grounds for an extension may include, but are not limited to, the temporary
non-availability of witnesses or documentary evidence, or the need for
information not yet available from other entities that may be involved with an
investigation into the facts that form the basis of the complaint, including
the office of the medical investigator and agencies charged with law
enforcement, auditing, financial oversight, fraud investigation, or
advocacy.
F.
Validity of enforcement actions. Failure by the authority or APS
to comply with the procedures or time requirements set out in this section does
not abrogate or invalidate any action taken against an employee pursuant to
this rule, or any action taken against a provider for noncompliance with this
rule or any other applicable law or regulation. However, any such failure may
be admitted into evidence at a hearing.
