Complaint information should include:
- Was the complaint reported to the county Department for Community Based Services office?
- Name of facility.
- Who is the complainant?
- What is the complaint? (Describe the facts of the complaint situation.)
- Who is/are the alleged perpetrator(s)?
- How was the patient/resident affected?
- When did the complaint situation occur? Was it an isolated event or an ongoing situation? (Include the date, time, time between different events.)
- Where did it happen? (In what care unit, patient/resident room.)
- How did it happen? What was the sequence of events?
- Is a patient/resident or the family of a patient/resident involved?
- Who witnessed the complaint situation?
- Names of staff or other residents involved. Also, include other persons involved, such as volunteers or visitors.
- Was facility made aware of complaint?
- What actions were taken by the facility?
To report a complaint regarding a licensed long-term or health care facility or service, contact the appropriate enforcement branch. To determine which enforcement branch to report to, see Contact Information.