Public Comment on 12VAC5-371, Regulations for the Licensure of Nursing Facilities

I am submitting this comment as the daughter and former advocate of a Virginia nursing-facility resident. I support regulatory clarity, but I have serious concerns about the proposed language governing complaint investigations and plans of correction.

On-site complaint investigations

Proposed 12VAC5-371-70 allows OLC to consider a facility’s history of substantiated complaints when deciding whether a current complaint requires an on-site inspection. A facility’s lack of prior substantiated complaints should never weigh against investigating a serious current allegation.

Every credible complaint alleging actual or potential harm involving neglect, resident care, dignity, infection prevention, sanitation, staffing, supervision, or environmental conditions should require an unannounced on-site investigation. These are conditions that frequently must be seen, smelled, observed, and independently verified. Reviewing records supplied by the facility is not an adequate substitute.

Prior complaints—whether substantiated or unsubstantiated—should be reviewed to identify repeated allegations and patterns. Multiple similar complaints may reveal a continuing problem even when individual investigations did not result in findings.

Firsthand knowledge

The regulation should also define “first-hand knowledge” more clearly. Family members and visitors may directly observe a resident’s condition even if they did not witness every event leading to it.

My mother was in a nursing home and I once entered my mother’s room and found her leaning over in a chair, visibly uncomfortable, with residue around her mouth and her call light activated. She was yelling for someone to help her out of the chair. Although I could not independently confirm precisely how long she had been waiting, I had firsthand knowledge of her condition, distress, and unanswered request for assistance. I also had photographic evidence.

Many nursing-facility residents have dementia, communication impairments, or difficulty recalling exact timelines. Their vulnerability should increase the need for investigation—not make their complaints or their families’ observations less credible.

The regulation should expressly recognize direct observations by residents, family members, legal representatives, visitors, employees, and other witnesses. Photographs, videos, physical conditions, call-light observations, resident statements, and other supporting evidence should also be considered.

Correction deadlines

I also object to allowing correction dates of up to 45 business days from the inspection exit date. Forty-five business days can amount to approximately nine calendar weeks. That is too long when a violation affects a resident’s health, safety, dignity, comfort, or infection protection.

Correction deadlines should be based on the seriousness of the violation:

• Immediate threats to health or safety should be corrected immediately.
• Serious care, neglect, sanitation, and infection-prevention violations should receive substantially shorter deadlines.
• Routine administrative or structural violations should be corrected within no more than 30 calendar days.
• Any extension should require written justification and OLC approval.
• OLC should be required to verify correction of serious, repeated, neglect-related, and infection-prevention violations rather than merely being permitted to do so.

Nursing-facility residents are medically vulnerable and may not be able to advocate for themselves. Complaint-investigation standards should prioritize independent observation, recognize family evidence, identify patterns, and protect residents before further harm occurs.

I respectfully request that the State Board of Health revise proposed 12VAC5-371-70 and 12VAC5-371-55 accordingly.

Michelle Taliaferro
Founder, The Taliaferro Initiative for Long-Term Care Reform