C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 488—SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES › Subpart E—Survey and Certification of Long-Term Care Facilities

42 C.F.R. § 488.332

Investigation of complaints of violations and monitoring of compliance

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(a) Investigation of complaints. (1) The State survey agency must establish procedures and maintain adequate staff to investigate complaints of violations of participation requirements.

(2) The State survey agency takes appropriate precautions to protect a complainant's anonymity and privacy, if possible.

(3) If arrangements have been made with other State components for investigation of complaints, the State must have a means of communicating information among appropriate entities, and the State survey agency retains responsibility for the investigation process.

(4) If, after investigating a complaint, the State has reason to believe that an identifiable individual neglected or abused a resident, or misappropriated a resident's property, the State survey agency must act on the complaint in accordance with § 488.335.

(b) On-site monitoring. The State survey agency conducts on-site monitoring on an as necessary basis when—

(1) A facility is not in substantial compliance with the requirements and is in the process of correcting deficiencies;

(2) A facility has corrected deficiencies and verification of continued substantial compliance is needed; or

(3) The survey agency has reason to question the substantial compliance of the facility with a requirement of participation.

(c) Composition of the investigative team. A State may use a specialized team, which may include an attorney, auditor and appropriate health professionals, to identify, survey, gather and preserve evidence, and administer remedies to noncompliant facilities.

Notes of Decisions
Cited in 4 cases (2 in the last 5 years), 1999–2025 · leading case: Brogdon Ex Rel. Cline v. Nat'l Healthcare Corp., 103 F. Supp. 2d 1322 (N.D. Ga. 2000).
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Brogdon Ex Rel. Cline v. Nat'l Healthcare Corp., 103 F. Supp. 2d 1322 (N.D. Ga. 2000). “Recons, at 9-10) (citing 42 C.F.R. §§ 488.332 , 488.335; O.C.G.A. § 31-8-80.”
Hofmister v. Mississippi State Dep't of Health, 53 F. Supp. 2d 884 (S.D. Miss. 1999). “” Furthermore, 42 C.F.R. § 488.332 provides that “the State survey agency must establish procedures and maintain adequate staff to investigate complaints of violations of participation requirements” and that “the State survey agency retains responsibility for the investigation…”
Avon Nursing & Rehab. v. Azar (S.D.N.Y. 2023). · cites it 2× “10 42 C.F.R. § 488.332 sets out the rules applicable to the “Investigation of complaints of violations and monitoring of compliance,” and provides a permissive staffing requirement for such investigations.”
Connor v. Maryland Dep't of Health (D. Maryland 2025). “26 (c)(1); and investigate complaints of resident neglect and abuse and noncompliance with federal standards, 42 C.F.R. §§ 488.332 , 488.335. The survey process uses “resident and patient outcomes” to establish compliance and specifically involves “directly observ[ing] the…”
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