Texas Nursing Home Resident Complaint (HHSC LTC Regulatory / Ombudsman / NHRA)

TEXAS NURSING HOME RESIDENT COMPLAINT

EMERGENCIES: Call 9-1-1 then HHSC Long-Term Care Regulatory: 1-800-458-9858
HHSC LTC Regulatory complaint hotline: 1-800-458-9858 (24/7)
Texas Long-Term Care Ombudsman: 1-800-252-2412
DFPS Statewide Intake (APS): 1-800-252-5400
Texas Attorney General — Medicaid Fraud Control Unit: 1-800-252-8011

TABLE OF CONTENTS

1. Recipient(s) of This Complaint
2. Complainant Information
3. Resident Information
4. Facility Information
5. Resident Rights Implicated
6. Statement of Facts
7. Evidence and Witnesses
8. Internal Grievance History
9. Relief and Enforcement Sought
10. Anti-Retaliation Notice
11. Verification and Signature
12. Texas Practice Notes
13. Sources and References

1. RECIPIENT(S) OF THIS COMPLAINT

This complaint is being submitted to (check all that apply):

• ☐ Texas Health and Human Services Commission — Long-Term Care Regulatory (1-800-458-9858; [email protected]; online portal at hhs.texas.gov)
• ☐ Texas Long-Term Care Ombudsman Program (1-800-252-2412)
• ☐ DFPS Adult Protective Services (1-800-252-5400)
• ☐ CMS Regional Office (Region VI — Dallas) (federal certification, 42 C.F.R. Part 483)
• ☐ Texas Attorney General — Medicaid Fraud Control Unit (1-800-252-8011)
• ☐ Local law enforcement (where criminal conduct is suspected)
• ☐ Facility administrator and licensed nursing-home administrator (concurrent internal grievance per 42 C.F.R. § 483.10(j))

2. COMPLAINANT INFORMATION

3. RESIDENT INFORMATION

4. FACILITY INFORMATION

5. RESIDENT RIGHTS IMPLICATED

Check all that apply. Federal cites are 42 C.F.R. Part 483; state cites are Tex. Health & Safety Code Chapter 242 and 26 Tex. Admin. Code Chapter 554.

• ☐ Freedom from abuse, neglect, exploitation, mistreatment — 42 C.F.R. § 483.12; Tex. Health & Safety Code § 242.501(a)(8); 26 TAC § 554.401
• ☐ Quality of life and dignified existence — 42 C.F.R. § 483.10(a); § 242.501(a)
• ☐ Adequate and appropriate care; sufficient nursing staff — 42 C.F.R. §§ 483.24, 483.25, 483.35; § 242.501(a)(13); 26 TAC § 554.601
• ☐ Freedom from unnecessary physical or chemical restraints — 42 C.F.R. § 483.10(e), § 483.12(a)(2); § 242.501(a)(7)
• ☐ Choice of attending physician — 42 C.F.R. § 483.10(d); § 242.501(a)(2)
• ☐ Comprehensive assessment and care planning (MDS, baseline care plan within 48 hours, comprehensive care plan within 7 days) — 42 C.F.R. §§ 483.20, 483.21
• ☐ Notification of change in condition — 42 C.F.R. § 483.10(g)(14)
• ☐ Pressure-injury and wound prevention/treatment — 42 C.F.R. § 483.25(b)
• ☐ Falls and accident-hazard prevention — 42 C.F.R. § 483.25(d)
• ☐ Medication management; freedom from unnecessary or psychotropic drugs — 42 C.F.R. § 483.45
• ☐ Activities of daily living (ADLs) — 42 C.F.R. § 483.24
• ☐ Nutrition and hydration — 42 C.F.R. § 483.25(g); § 483.60
• ☐ Privacy and confidentiality — 42 C.F.R. § 483.10(h)
• ☐ Access to records — 42 C.F.R. § 483.10(g)(2)
• ☐ Grievance and complaint process — 42 C.F.R. § 483.10(j); 26 TAC § 554.402
• ☐ Notice and protection from discharge / transfer — 42 C.F.R. § 483.15; § 242.5015 ("Voluntary Transfer or Discharge"); 26 TAC § 554.504
• ☐ Bed-hold and readmission rights — 42 C.F.R. § 483.15(d)
• ☐ Personal funds management; trust-fund accounting — 42 C.F.R. § 483.10(f)(10); § 242.501(a)(14); § 242.069
• ☐ Visitation and access — 42 C.F.R. § 483.10(f)(4); § 242.501(a)(11)
• ☐ Resident and family councils — 42 C.F.R. § 483.10(f)(5)
• ☐ Freedom from retaliation for exercising rights — 42 C.F.R. § 483.10(j)(4); Tex. Health & Safety Code § 260A.014

6. STATEMENT OF FACTS

Provide a chronological, fact-specific narrative. Identify staff by name and shift where known. Distinguish between observed events, statements made by residents/staff, and documents reviewed.

Date(s) of incident or pattern: [__/__/____] to [__/__/____]

Location(s) within facility: [________________________________]

Persons involved (residents, staff, contractors): [________________________________]

Narrative:

[________________________________________________________________________]

[________________________________________________________________________]

[________________________________________________________________________]

[________________________________________________________________________]

[________________________________________________________________________]

[________________________________________________________________________]

Specific harm to resident:

• ☐ Physical injury (specify): [____]
• ☐ Pressure injury / wound (stage / location): [____]
• ☐ Fall (date / outcome): [____]
• ☐ Hospitalization / ER visit (date / facility): [____]
• ☐ Weight loss / dehydration: [____]
• ☐ Medication error / adverse drug reaction: [____]
• ☐ Emotional distress / decline: [____]
• ☐ Financial loss (amount $[____])
• ☐ Death (date / cause): [____]

7. EVIDENCE AND WITNESSES

7.1 Evidence preserved or available

• ☐ Photographs (number: [____])
• ☐ Medical records (request under 42 C.F.R. § 483.10(g)(2); resident has right to access within 24 hours and copy within 2 working days)
• ☐ Care plan / MDS / progress notes
• ☐ Medication Administration Record (MAR) / Treatment Administration Record (TAR)
• ☐ Incident reports / facility investigation files
• ☐ Surveillance video (request preservation in writing)
• ☐ Trust-fund ledger (42 C.F.R. § 483.10(f)(10))
• ☐ Discharge / transfer notice
• ☐ Hospital records / autopsy / death certificate
• ☐ Other: [________________________________]

7.2 Witnesses

8. INTERNAL GRIEVANCE HISTORY

Pursuant to 42 C.F.R. § 483.10(j) and 26 TAC § 554.402, the facility must maintain a grievance process and produce a written decision.

• ☐ Internal grievance filed with facility on [__/__/____]
• ☐ Grievance Officer / Recipient: [________________________________]
• ☐ Written response received on [__/__/____]: ☐ Resolved ☐ Partially resolved ☐ Not resolved
• ☐ Care plan meeting requested / held on [__/__/____]
• ☐ Resident or Family Council escalation: [____]

9. RELIEF AND ENFORCEMENT SOUGHT

Complainant requests that HHSC, the Ombudsman, and/or other recipients:

• ☐ Conduct an unannounced complaint survey under 42 C.F.R. § 488.332 and Tex. Health & Safety Code § 242.044
• ☐ Cite deficiencies and impose remedies under 42 C.F.R. § 488.406 and Tex. Health & Safety Code §§ 242.066–242.073, including:
• ☐ Civil money penalties (federal CMPs up to the maximum daily amount currently allowed under 45 C.F.R. § 102.3)
• ☐ State administrative penalties under § 242.066 (up to the daily statutory cap; verify current amount)
• ☐ Directed plan of correction
• ☐ Denial of payment for new admissions
• ☐ Termination of provider agreement
• ☐ Appointment of a temporary manager / trustee under § 242.092
• ☐ License suspension or revocation under § 242.061
• ☐ Refer to law enforcement for criminal investigation (Tex. Penal Code §§ 22.04, 32.53)
• ☐ Refer to the Texas Attorney General's Medicaid Fraud Control Unit (resident-abuse jurisdiction in Medicaid-certified facilities)
• ☐ Issue notice of resident transfer/discharge protections and prevent improper involuntary discharge
• ☐ Require staff retraining on identified deficiencies
• ☐ Provide ombudsman in-facility advocacy
• ☐ Other: [________________________________]

10. ANTI-RETALIATION NOTICE

Federal law prohibits the facility from interfering with, restraining, coercing, or discriminating against any resident, family member, or staff member for filing a grievance, contacting state agencies, or contacting the Ombudsman (42 C.F.R. § 483.10(j)(4); 42 C.F.R. § 483.12(c)(4)). Texas law parallels this protection at Tex. Health & Safety Code § 260A.014. Complainant requests immediate intervention if any retaliation occurs.

11. VERIFICATION AND SIGNATURE

I, [COMPLAINANT NAME], declare under penalty of perjury under the laws of the State of Texas that the foregoing is true and correct to the best of my knowledge and belief, and that I am submitting this complaint in good faith for the protection of the above-named resident.

Signature: [________________________________]

Print Name: [________________________________]

Date: [__/__/____]

(Optional) Notary acknowledgment:

State of Texas, County of [________________________________]

Sworn to and subscribed before me on [__/__/____].

[________________________________]

Notary Public — State of Texas

(My Commission Expires: [_______________])

12. TEXAS PRACTICE NOTES

• Dual federal/state regulatory regime. Most Texas nursing facilities are dually certified for Medicare and Medicaid and are governed concurrently by 42 C.F.R. Part 483 and Tex. Health & Safety Code Chapter 242 / 26 TAC Chapter 554. Both must be cited where applicable.
• HHSC LTC Regulatory. HHSC inspects and licenses nursing facilities, conducts annual standard surveys and complaint investigations, and imposes state penalties. Federal certification surveys are conducted on behalf of CMS under 42 C.F.R. § 488.330. The complaint hotline is 1-800-458-9858.
• Long-Term Care Ombudsman Program. Authorized under the Older Americans Act and Tex. Hum. Res. Code Chapter 101A, ombudsmen advocate for residents but do NOT take regulatory action; their access to residents and records is statutorily protected. Hotline: 1-800-252-2412.
• APS vs. HHSC jurisdiction. APS investigates community settings; HHSC LTC Regulatory investigates abuse, neglect, and exploitation in licensed nursing and assisted-living facilities. The intake hotlines are interoperable and will redirect.
• Civil money penalties. Federal CMPs are inflation-adjusted annually under 45 C.F.R. § 102.3; ranges depend on scope/severity per the CMS State Operations Manual, Appendix PP. State administrative penalties are imposed per day per violation under Tex. Health & Safety Code § 242.066 with statutory cap; verify current cap.
• Involuntary discharge. Notice of transfer or discharge must be in writing, in language the resident understands, and given at least 30 days in advance (42 C.F.R. § 483.15(c)(4); § 242.5015). Residents have appeal rights through HHSC and may request Ombudsman assistance.
• Bed-hold rights. Medicaid bed-hold rules in 26 TAC § 554.2308 require facilities to readmit a resident upon return from a hospital or therapeutic leave to the next available bed if the resident still qualifies for NF services.
• Private right of action. Texas recognizes negligence, gross negligence, and statutory claims against nursing facilities. Tex. Health & Safety Code Chapter 242, Subchapter D imposes specific liability; a violation of resident rights may support a claim under § 242.502(a) for damages plus attorney's fees. Medical-liability rules in Tex. Civ. Prac. & Rem. Code Chapter 74 (including the expert-report requirement under § 74.351) generally apply to "health care liability claims," and most NF-related actions are now treated as health-care liability claims, subject to the non-economic damages cap under § 74.301. Counsel must serve a Chapter 74 expert report within 120 days of service of the original petition or face dismissal.
• Statute of limitations. Health-care liability claims must be brought within two years (Tex. Civ. Prac. & Rem. Code § 74.251). For wrongful-death claims, see § 74.251(b) and Tex. Civ. Prac. & Rem. Code § 16.003(b).
• Document preservation. Send a written records-preservation demand to the facility immediately upon suspected harm to prevent destruction of MDS data, charting, video, and incident reports.
• MFCU referral. Resident abuse, neglect, and misappropriation of resident property in Medicaid-certified facilities fall within the jurisdiction of the Texas Attorney General's Medicaid Fraud Control Unit (Tex. Gov't Code Chapter 531; 42 U.S.C. § 1396b(q)).

13. SOURCES AND REFERENCES

• 42 U.S.C. § 1395i-3 (Medicare requirements) — https://uscode.house.gov/
• 42 U.S.C. § 1396r (NHRA / Medicaid requirements)
• 42 C.F.R. Part 483 Subpart B — https://www.ecfr.gov/
• 42 C.F.R. § 483.10 (Resident Rights)
• 42 C.F.R. § 483.12 (Freedom from Abuse, Neglect, Exploitation)
• 42 C.F.R. Part 488 (Survey, Certification, Enforcement)
• CMS State Operations Manual Appendix PP (Interpretive Guidelines for Long-Term Care Facilities) — https://www.cms.gov/
• Tex. Health & Safety Code Chapter 242 — https://statutes.capitol.texas.gov/Docs/HS/htm/HS.242.htm
• Tex. Health & Safety Code §§ 242.501–242.507 (Resident Rights)
• 26 Tex. Admin. Code Chapter 554 — https://texreg.sos.state.tx.us/
• 26 TAC § 554.403 (Notice of Rights and Services) — http://txrules.elaws.us/rule/title26_chapter554_sec.554.403
• HHSC LTC Provider Resources / Required Postings — https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/regulatory-services-facility-surveyors-liaisons/required-postings
• HHSC Complaint and Incident Intake — https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/consumer-rights-services
• Texas Long-Term Care Ombudsman — https://apps.hhs.texas.gov/news_info/ombudsman/
• LTC Ombudsman: Resident Rights — https://apps.hhs.texas.gov/news_info/ombudsman/rights.html
• Tex. Hum. Res. Code Chapter 101A (LTC Ombudsman Program)
• Tex. Civ. Prac. & Rem. Code Chapter 74 (Health Care Liability) — https://statutes.capitol.texas.gov/
• Tex. Penal Code § 22.04 (Injury to Elderly Individual)
• Tex. Penal Code § 32.53 (Exploitation of Child, Elderly, Disabled)
• Texas Attorney General — Medicaid Fraud Control Unit — https://www.texasattorneygeneral.gov/

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. A Texas-licensed attorney must review and customize this complaint before submission. Time limits, regulatory thresholds, and CMP amounts change; verify current authorities.