| (II) attempt to investigate the complaint without disclosing
the confidential information;
(v) document in the ombudsman database whether the
resident provide informed consent to the disclosure of confidential
information;
(H) if the complaint relates to a regulatory violation,
inform the resident or the legally authorized representative of the
option to report the complaint to the appropriate regulatory or law
enforcement authority;
(I) work with the resident or legally authorized representative
to develop a plan of action for resolution of the complaint;
(J) encourage the resident or legally authorized representative
to participate in the process to resolve the complaint; and
(K) determine the resident's or legally authorized
representative's satisfaction with the outcome.
(4) If the complainant is not the resident and the
certified ombudsman has determined the complaint is appropriate for
ombudsman investigation and has authority to investigate the complaint
in accordance with 45 CFR §1324.19(b)(2)(iii), the certified
ombudsman must:
(A) determine what, if any, federal or state law, regulation,
or rule applies to the complaint;
(B) determine how many residents are potentially affected
by the complaint;
(C) observe the environment of the resident and situations
in the LTC facility related to the complaint;
(D) interview relevant witnesses;
(E) review relevant records, if necessary, including
confidential records if consent or other authority is obtained in
accordance with the Ombudsman Policies and Procedures Manual; and
(F) determine whether the complaint is satisfactorily
resolved.
(5) As described in paragraph (1)(D)(iii) of this
subsection, if the complainant is not the resident and the certified
ombudsman requests approval to investigate the complaint by making
a referral to the appropriate agency for investigation in accordance
with 45 CFR §1324.19(b)(7), the certified ombudsman must:
(A) if the State Ombudsman approves the request:
(i) make the referral to the appropriate agency; and
(ii) determine whether the complaint is satisfactorily
resolved; or
(B) if the State Ombudsman does not approve the request,
follow the instruction of the State Ombudsman.
(6) If the resident or legally authorized representative
declines to consent to have the complaint investigated, the certified
ombudsman must:
(A) not investigate the complaint;
(B) inform the complainant that the complaint will
not be investigated because the resident or legally authorized representative
declined to consent; and
(C) advise the complainant of his or her options to
pursue resolution.
(7) If a certified ombudsman identifies a complaint
that affects a substantial number of residents in an LTC facility,
the certified ombudsman may investigate and work to resolve the complaint
without obtaining consent from each resident to investigate the complaint.
In investigating the complaint, a certified ombudsman may review confidential
records only if consent or other authority is obtained in accordance
with the Ombudsman Policies and Procedures Manual.
(8) A certified ombudsman must document the complaint
investigation in the ombudsman database in accordance with the Ombudsman
Policies and Procedures Manual.
(c) If a complaint is an allegation of abuse, neglect,
or exploitation of a resident, a certified ombudsman:
(1) must not investigate whether abuse, neglect, or
exploitation of a resident has occurred;
(2) within one business day after receipt of the complaint,
inform the complainant of the appropriate investigative authority
to report the allegation; and
(3) comply with the Ombudsman Policies and Procedures
Manual.
(d) In accordance with 45 CFR §1324.11(e)(3)(iv),
a representative of the Office must not, except as provided in §1324.19(b)(5)
- (8), report allegations of abuse, neglect, or exploitation under
state law, including Texas Human Resources Code, Chapter 48, without
appropriate consent or court order.
(e) Confidential information described in §88.304(a)
of this subchapter (relating to Disclosure of Confidential Information;
Exclusion from Reporting Requirements Regarding Abuse, Neglect, or
Exploitation; and Provision of Records to the Office) may only be
disclosed in accordance with §88.304 of this subchapter.
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