New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 371 - DEVELOPMENTAL DISABILITIES
Part 4 - CLIENT COMPLAINT PROCEDURES
Section 8.371.4.13 - COMPLAINT PROCESS

Universal Citation: 8 NM Admin Code 8.371.4.13

Current through Register Vol. 35, No. 18, September 24, 2024

A. Step one: Service provider review:

(1) Each service provider shall have a complaint or grievance procedure that is reviewed and approved by the division. Except as provided in Paragraph (7) below, a client or a legal guardian must initiate a complaint with the service provider within 180 days of the event or occurrence that is the subject of the complaint and in the manner set forth in the service provider's complaint or grievance procedure.

(2) The service provider's complaint or grievance procedure shall provide, at a minimum, that:
(a) the client is notified of the service provider's complaint or grievance procedure;

(b) a complaint may be made orally or in writing;

(c) the service provider shall meet with the complainant if a complaint is made; if the complainant is not the client, the client shall be notified of the meeting and allowed to attend;

(d) the complainant and the client may have a representative(s) of their choice present at the meeting;

(e) the complaint will be decided by an impartial person who is not involved in the incident complained of but who may be an employee of the service provider;

(f) the complainant and their representative, if any, will receive a written response within 15 days of the complaint;

(g) the complainant has a right to file a complaint with the authority if the complainant is not satisfied with the service provider's response; and

(h) the service provider will assist the client in filing a complaint with the division upon request.

(3) The employees or staff of the service provider shall have the responsibility to initiate a complaint on behalf of the client whenever they have reason to believe that a violation of the client's rights may have occurred.

(4) The service provider shall issue a brief written response to the client and the guardian stating the nature of the complaint and the result(s) requested by the complainant, the disputed facts, if any, the undisputed facts, if any, the resolution of the complaint of the attempts made to resolve the complaint.

(5) The service provider shall respond to the complaint in writing within 15 days of the initial complaint. The time line may be extended by mutual agreement of the complainant and the service provider. The service provider shall maintain a copy of each written response in the client's record and in a central file that is available to the authority. If the complaint alleges abuse or neglect, the service provider shall, in addition to any other requirements, provide a copy of the response to child protective services or adult protective services. If the complainant alleges abuse or neglect or if the complaint involves a dangerous condition or a risk to the client's health or safety, the service provider shall provide a copy of the written response to the office.

(6) The failure of the service provider to issue a response to a client's complaint in writing shall be a separate and independent ground for filing a complaint with the division.

(7) If a complainant alleges abuse or neglect, or if the complaint involves a dangerous condition, or a risk to the client's health or safety, the complaint may be make with the division's office pursuant to step two without initiating a complaint with the service provider.

B. Step two. Quality assurance review: Expedited investigation: In addition to the investigation and review procedures and described herein, if the office has reason to believe that the health or safety of the client is in jeopardy, the division shall, in cooperation with other agencies as necessary, take steps to ensure that the client is safe while the complaint is under investigation and shall expedite the investigation and issue preliminary findings within 10 days of receipt of the complaint. If the complainant alleges abuse or neglect or the office has reason to believe that abuse or neglect has occurred or is occurring, the office shall make an immediate referral to child protective services of adult protective services for investigation.

(1) If the complaint is not resolved, a complaint may be filed with the division's designated office. The complaint must be made orally or in writing within 20 days from the date of the written response of the service provider, unless the service provider has failed to respond in writing or the complainant is filing the initial complaint with the office as provided in Paragraph (7) of Subsection A of 8.371.4.13 NMAC.

(2) The complaint shall be a brief statement of the act(s) that is the basis of the alleged violation. The complaint may be made orally or in writing. The complainant may provide the office a copy of the service provider's written response.

(3) If the office has reason to believe that abuse or neglect has occurred or is occurring, the Office shall make an immediate referral to child protective services (CPS) or adult protective services (APS) so that they may investigate the complaint immediately. The division shall coordinate with and assist CPS and APS as necessary.

(4) The office shall examine each complaint and determine whether the complainant alleges that a service provider, its employee, or a person under contract with the provider has violated rights of the client set forth in federal or state constitutions, statutes, or applicable authority regulations or policies. If the complainant does not allege such violation of the rights of the client, or if the allegation is not against a service provider or its employee or contractor, the office shall refer the complaint to any federal, state or local governmental body or private entity with authority over the issue or subject matter unless the client objects the referral.

(5) The office shall notify the service provider of the complaint within five days of receipt of the complaint. If the complainant initiated the complaint with the service provider, the service provider shall provide the office a copy of its written response to the unresolved complaint upon request.

(6) The office shall review the complaint and determine whether an expedited investigation is necessary. If an expedited investigation is not necessary, the office will determine whether a full investigation is necessary to resolve the complaint. If the office determines that a full investigation is not necessary because the facts are not in dispute or the facts can be determined without a full investigation, the office shall issue a report within 15 days of receipt of the complaint.

(7) If the office initiates a full investigation of the complaint, the office shall contact and interview the client and their representative, if any. The office shall interview the client in person unless:
(a) the client has the capacity to be interviewed by telephone and

(b) the complaint does not involve a dangerous condition, a risk to the client's health or safety, a significant rights violation, or other serious circumstance. The complainant, the service provider, and any other persons having relevant information shall be given the opportunity to present facts and documents relevant to the complaint.

(8) The office shall prepare a written report of the results of the investigation within 45 days of receipt of the complaint. The written report shall include a statement of the complaint, a summary of the findings of fact, a determination whether the allegation(s) is substantiated, and the reasons for the determination. If the alleged violation is substantiated, the written report shall include a recommendation of proposed action.

(9) The director shall review the office's written report. The director shall issue a written decision within 10 days of receipt of the written report, unless the director extends the time as provided below.
(a) The director shall either adopt the findings of fact or return the matter to the office with specific instructions for additional investigation and findings if he or she determines that there is insufficient information on which to base a decision. If the director returns the complaint to the office for additional investigation and findings, the director shall state the deadline for completion of the investigation and additional findings, which shall be no more that 14 days unless the director determines that circumstances require additional time.

(b) Director shall determine whether there is reason to support the complainant's allegations and determine what action, if any, should be taken. If the director reflects the findings of fact or modifies the recommendation of proposed action, the director shall state the reasons for their decision.

(10) The written decision of the division director is final unless the complainant requests an administrative hearing as provided in section of this regulation.

Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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