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HomeMy WebLinkAboutAgenda - 11-17-20; 6-a - Proposed Merger of Adult Care Home Community Advisory Committee and Nursing Home Community Advisory Committee 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: November 17, 2020 Action Agenda Item No. 6-a SUBJECT: Proposed Merger of Adult Care Home Community Advisory Committee and Nursing Home Community Advisory Committee DEPARTMENT: Board of Commissioners ATTACHMENT(S): INFORMATION CONTACT: Membership Rosters Clerk's Office, 919-245-2125 Statement from Victor Orija — State Ombudsman Current Status of Onsite Visitations By Members PURPOSE: To discuss a proposed merger of the Adult Care Home Community Advisory Committee (ACHCAC) and Nursing Home Community Advisory Committee (NHCAC) into one committee. BACKGROUND: Over the past few years, it has become increasingly more difficult to recruit qualified applicants for both the ACHCAC and NHCAC. Some of this is due to the time required to perform the duties of facilities inspection. Many of the positions are "At-Large" while other positions are very specific to a certain professional background. More recently, in the current COVID-19 environment, both committees have become inactive given tight restrictions on entering facilities. This reality has impacted attracting new potential volunteers/appointees. It should be noted though that both Committees continue to be led by very active Committee Chairs, Shade Little for ACHCAC and Vibeke Talley for NHCAC, who along with their fellow members have invested significant time and resources to serve the needs of the public. COMMITTEE OVERVIEWS Adult Care Home Community Advisory Committee Members are appointed by the Board of Commissioners to all positions. The Regional Ombudsman assigned to Orange County is Autumn Cox who works for Triangle J Council of Government (TJCOG). Prior to any appointment, Autumn Cox vets applicants. If a qualified applicant is selected, that individual must attend state mandated training and must pass the course before being recommended for appointment. There is an initial one-year training term, with subsequent eligibility for three additional two-year terms. The Committee works to maintain the intent of the Adult Care Home Residents' Bill of Rights for those residing in licensed adult care homes. The members of this Committee also promote community involvement and cooperation 2 with these homes to ensure quality care for the elderly and disabled adults. The members of this committee make visits to facilities no less than annually. Nursing Home Community Advisory Committee Members are appointed by the Board of Commissioners to all positions. The Regional Ombudsman assigned to Orange County is Autumn Cox who works for Triangle J Council of Government (TJCOG). Prior to any appointment, Autumn Cox vets applicants. If a qualified applicant is selected, that individual must attend state mandated training and must pass the course before being recommended for appointment. There is an initial one-year training term, with subsequent eligibility for two additional three-year terms. This committee helps to maintain the intent of the Residents' Bill of Rights, promotes community involvement and provides public education on long-term care issues. The members of this committee make visits to facilities no less than quarterly. After completion of the visits, the team members of both committees prepare a state report of their findings during the visit. The report is then presented at the regular committee business meetings. The report is discussed and a vote is taken to gain approval of the report. The Ombudsman then formats the report for submission to the particular county. The information is then published on the county's website for public view. LIST OF CURRENT VACANCIES Adult Care Home Community Advisory Committee POSITION EXPIRATION VACANCY INFORMATION DESIGNATION DATE At-Large 10/31/2021 This position has been vacant since 07115/2020. At-Large 06/30/2022 This position has been vacant since 05/12/2020. At-Large 10/31/2022 This position has been vacant since 8/2/2019. At-Large 10/31/2021 This position has been vacant since 10/31/2017. At-Large 06/30/2022 This position has been vacant since 06103/2020. At-Large 06/0/2022 This position has been vacant since 1/16/2020. Nursing Home Community Advisory Committee POSITION EXPIRATION VACANCY INFORMATION DESIGNATION DATE At-Large 09/30/2020 This position has been vacant since 11106/2019. Nursing Home 06/30/2023 This position has been vacant since Administration 06121/2017. Nursing Home 06/30/2023 This position has been vacant since Administration 03/29/2019. 3 At-Large 03/31/2023 This position has been vacant since 05/1812020. At-Large 06/30/2023 This position has been vacant since 02125/2018. Lakendra Dixon, Ombudsman Program Specialist and Autumn Cox, the Regional Ombudsman with TJCOG who is assigned to Orange County, will be available at the meeting to provide additional background and insight for the Board. Information from Victor Orija, State Long-Term Care Ombudsman with the NC Division of Aging and Adult Services is attached providing some initial guidance on the Committees and potential merger to County staff. FINANCIAL IMPACT: There is no financial impact associated with this item. SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goal is applicable to this item: • GOAL: ENABLE FULL CIVIC PARTICIPATION Ensure that Orange County residents are able to engage government through voting and volunteering by eliminating disparities in participation and barriers to participation. ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal impact associated with this item. RECOMMENDATION(S): The Manager recommends that the Board discuss merging the Adult Care Home Community Advisory Committee and Nursing Home Community Advisory Committee. If the Board determines to merge the two Committees into one Committee, the Manager proposes that the Board: 1) Designate the Committee as the Adult Care and Nursing Home Community Advisory Committee (ACNHCAC) with no less than 13 positions (down from the current 24 positions in the combined committees); 2) Direct staff to contact all current members of both current Committees updating those individuals on the merger and sharing the Board's desire that everyone continue serving the public on the new Committee; and 3) Direct staff to provide a follow-up item for Board consideration detailing a Charge for the new Committee, updating the Board on feedback from current members of both Committees, providing a proposed list of individuals for appointment to the new Committee based on that feedback, and including a membership roster detailing the remaining vacancies. 4 Board and Commission Members And Vacant Positions Adult Care Home Community Advisory Committee Meeting Times: 4:00 pm-5:30 pm First Tuesday Monthly Contact Person:Autumn Cox Meeting Place: Seymour Center Contact Phone: 919-558-9401 Positions: 12 Length:2 years Terms: 3 Description: Members are appointed by the Board of Commissioners to at-large positions. There is an initial one-year training term with subsequent eligibility for three additional two-year terms.This committee works to maintain the intent of the Adult Care Home Residents'Bill of Rights for those residing in licensed adult care homes. The members of this committee also promote community involvement and cooperation with these homes to ensure quality care for the elderly and disabled adults. Tiketha Collins 1 First Appointed: 09/04/2018 Gender Identity: Female Township: Hillsborough Current Appointment: 03/10/2020 Ethnic Background: African American Resid/Spec Req: At-Large Expiration: 03/31/2022 Age Range: Special Repr: Number of Terms: VACANT 2 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 10/31/2021 Age Range: Special Repr: Number of Terms: Alison Brown 3 First Appointed: 11/13/2018 Gender Identity: Female Township: Chapel Hill Current Appointment: 03/10/2020 Ethnic Background: African American Resid/Spec Req: At-Large Expiration: 06/30/2021 Age Range: Special Repr: Number of Terms: VACANT 4 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 06/30/2022 Age Range: Special Repr: Number of Terms: VACANT 5 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 10/31/2022 Age Range: Special Repr: Number of Terms: Shade Little 6 Chair First Appointed: 11/13/2018 Gender Identity: Male Township: Chapel Hill Current Appointment: 03/10/2020 Ethnic Background: Other Resid/Spec Req: At-Large Expiration: 10/31/2022 Age Range: Special Repr: Number of Terms: 1 Tuesday,October 06,2020 Page 1 5 Board and Commission Members And Vacant Positions Adult Care Home Community Advisory Committee Meeting Times: 4:00 pm-5:30 pm First Tuesday Monthly Contact Person:Autumn Cox Meeting Place: Seymour Center Contact Phone: 919-558-9401 Positions: 12 Length:2 years Terms: 3 VACANT 7 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 10/31/2021 Age Range: Special Repr: Number of Terms: VACANT 8 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 06/30/2022 Age Range: Special Repr: Number of Terms: Olivia Fisher 9 One Year Initial Term First Appointed: 06/04/2019 Gender Identity: Female Township: Bingham Current Appointment: 06/04/2019 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 06/04/2020 Age Range: 18-34 Special Repr: Number of Terms: VACANT 10 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 06/30/2022 Age Range: Special Repr: Number of Terms: MaryLou Gelblum I I One Year Initial Term First Appointed: 06/04/2019 Gender Identity: Female Township: Chapel Hill Current Appointment: 06/04/2019 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 06/30/2020 Age Range: Special Repr: Number of Terms: Karen Green-McElveen 12 One Year Initial Term First Appointed: 06/04/2019 Gender Identity: Female Township: Chapel Hill Current Appointment: 06/04/2019 Ethnic Background: African American Resid/Spec Req: At-Large Expiration: 06/04/2020 Age Range: 35-59 Special Repr: Number of Terms: Tuesday,October 06,2020 Page 2 6 Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee Meeting Times: 5:30 pm Every other 1 st Tuesday starting with Jan. Contact Person:Autumn Cox Meeting Place: Seymour Center,2551 Homestead Rd Chapel Hill,NC Contact Phone: 919-558-9401 Positions: 12 Length:3 years Terms: 2 Description: All appointments are made by the Board of Commissioners.This committee helps to maintain the intent of the Residents'Bill of Rights,promotes community involvement and provides public education on long-term care issues. The regional ombudsman with Triangle J Council of Governments provides specialized training and support. Martha Bell 1 First Appointed: 10/06/2015 Gender Identity: Female Township: Chapel Hill Current Appointment: 03/07/2019 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 01/31/2022 Age Range: Special Repr: At-Large Number of Terms: 2 Dr. Diane Stoy 2 One Year Initial Term First Appointed: 05/14/2020 Gender Identity: Female Township: Chapel Hill Current Appointment: 05/14/2020 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 05/14/2021 Age Range: 60+ Special Repr: At-Large Number of Terms: VACANT 3 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 09/30/2023 Age Range: Special Repr: At-Large Number of Terms: Stephanie Boswell 4 First Appointed: 09/04/2018 Gender Identity: Female Township: Hillsborough Current Appointment: 12/02/2019 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 06/30/2020 Age Range: Special Repr: At-Large Number of Terms: VACANT 5 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 06/30/2023 Age Range: Special Repr: Nursing Home Administration Number of Terms: Jacqulyn Podger 6 One Year Initial Term First Appointed: 09/17/2019 Gender Identity: Female Township: Chapel Hill Current Appointment: 09/17/2019 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 09/17/2020 Age Range: Special Repr: At-Large Number of Terms: Tuesday,October 06,2020 Page 1 7 Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee Meeting Times: 5:30 pm Every other 1 st Tuesday starting with Jan. Contact Person:Autumn Cox Meeting Place: Seymour Center,2551 Homestead Rd Chapel Hill,NC Contact Phone: 919-558-9401 Positions: 12 Length:3 years Terms: 2 VACANT 7 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 06/30/2023 Age Range: Special Repr: Nursing Home Administration Number of Terms: VACANT 8 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 03/31/2023 Age Range: Special Repr: At-Large Number of Terms: Linda Davis 9 One Year Initial Term First Appointed: 10/15/2019 Gender Identity: Female Township: Eno Current Appointment: 10/15/2019 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 10/15/2020 Age Range: Special Repr: At-Large Number of Tetras: VACANT 10 First Appointed: Gender Identity: Township: Current Appointment: Ethnic Background: Resid/Spec Req: At-Large Expiration: 06/30/2023 Age Range: Special Repr: At-Large Number of Terms: Dr Carol Kelly 11 First Appointed: 09/20/2016 Gender Identity: Female Township: Chapel Hill Current Appointment: 03/10/2020 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 12/31/2022 Age Range: Special Repr: Nursing Home Administration Number of Terms: 2 Vibeke Talley 12 Chair First Appointed: 05/20/2014 Gender Identity: Female Township: Hillsborough Current Appointment: 03/10/2020 Ethnic Background: White Resid/Spec Req: At-Large Expiration: 12/31/2022 Age Range: Special Repr: Nursing Home Administration Number of Terms: 2 Tuesday,October 06,2020 Page 2 8 Statement from Victor Orija - State Long-Term Care Ombudsman Dear Thom Freeman: Ms.Autumn Cox, our regional long-term care ombudsman has forwarded your e-mail to me. Also,I read the e-mail from Mr.John Roberts. The issue is the vacancy.I do not recall the ombudsman's office appointing anyone to fill a vacancy.Traditionally,vacancies have been filled through advertisements by the commissioners. The ombudsman recruits by advertising on the county website,posted flyers in both senior centers,conducted numerous speaking events in the county where she gave an overview of the CAC program,passed out flyers,and also by word of mouth from other volunteers on the committee. In extreme situation,committees have been combined.Unfortunately,the pandemic is creating a hardship for us to recruit or enter a long-term care facility. These are the two options: Combine two committees, or fill the vacancy. Since the Emergency Declaration by the President in March 2020, ombudsmen have been restricted from entering long-term care facilities.Consequently, our office also extended this restriction to all representatives of The Office of the State Long-Term Care Ombudsman. Representatives include all Community Advisory Committee volunteers (CAC volunteers).This restriction has continued throughout the COVID-19 pandemic duration. As of now, CAC volunteers,just like our regional long-term care ombudsmen remain restricted from entering long-term care facilities to conduct any advocacy.The ombudsmen are engaged in virtual complaint resolution and advocacy efforts. Our CAC volunteers do not investigate complaints.Furthermore,training a new CAC volunteer includes facility orientation.At this time, a CAC volunteer cannot enter a long-term care facility.Any new volunteer cannot enter a long-term care facility to undergo facility orientation because of the restriction. Soon,the ombudsman will be able to re-enter long-term care facilities and CAC volunteers who are already certified and designated,will be able to resume virtual training and meetings. Shortly after that,we will assess to ensure that it's safe for current CAC volunteers to re-enter long-term care facilities.From that point,we will start training new volunteers for certification and designation. IF you decide to combine two committees, I will suggest that you send a request to our Director, Division of Aging and Adult Services at the address below.The other option is to wait until full re-entry into long-term care facilities are resumed.Please advise if any additional questions. Sincerely, Victor Orija State Long-Term Care Ombudsman 9 Division of Aging and Adult Services NC Department of Health and Human Services 919-855-3426 office 919-715-6782 fax Victor.Orij ao dhhs.nc.gov 693 Palmer Drive, Raleigh. NC 27603 2101 Mail Service Center Raleigh, NC 27699-2101 10 Yr�r�wtio NC DEPARTMENT OF ROY COOPER • Governor HEALTH AND MANDYcoHEN, MD, MPH • Secretary HUMAN SERVICES JOYCE MASSEYSMITH, MPA - ' Director, Division of Aging and Adult Services �F'�QWMNoa"x MEMORANDUM Date: March 23, 2020 To: Regional Ombudsman From: Victor Orija, State Long-Term Care Ombudsman ; ®� Re: COVID-19 Outbreak—NC LTCOP Guidance (Revised—page 1 (suspension of visit to facility) and pages 3 & 4 (how to obtain resident consent) North Carolina continues to be affected by the Coronavirus. As indicated in the Guidance issued on March 11, 2020, I encourage you to visit the COVID-19 Section of the NCDHHS website, which has a number of resources and guidance for individuals, groups, and organizations that will be updated frequently. The Centers for Disease Control and Prevention(CDC)has also launched a COVID-19 website with several useful resources and ongoing updates. Here's a link to CMS's guidance for nursing homes. hitps://ww-w.ems.gov/medicareprovider- enrollnient-and-certidcationsurvc eertifcationgeninfo.olio -an.di ruidan.ce-infection-control- and-prevention-coronavirus-disease-2019-Govid-19-nunr b:ig-homes As of March 13, CMS revised Memorandum S -2 -1 -N It reads: Facilities should restrict visitation of all visitors and non-essential health care personnel, except for certoin compassionate care situations, such as an end-of-life situation. As such,NC LT COP is doing the follywing: 1. Effective March 17, 2020, all CAC activities -training, meetings, facility visitation are suspended until further notice. 2. Effective March 17, 2020,regional ombudsmen will suspend until further notice, all visit (friendly,training, complaint resolution)to long-term care facilities except for end-of-life scenarios 3. Any ombudsman who visits for end-of-life scenario will adhere to the screening protocol per CMS' Memorandum. 4. In lieu of visitation to long-term care facilities, regional ombudsmen will conduct complaint resolution and other advocacy duties by telephone, e-mail, skype etc. Per CMS' Memorandum, facilities should consider these alternate options. NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF AGING AND ADULT SERVICES LOCATION:693 Palmer Drive,Taylor Hall,Raleigh, NC 27603 MAILING ADDREss:2101 Mail Service Center, Raleigh, NC 27699-2101 www.nodhhs.gov • TEL:919-855-3400 • FAX:919-733-0443 AN EQUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER 11 5. Facilities must ensure that residents still have access to the ombudsman per 42 CFR §483.1 0(f)(4)(i), NC's current and up-to-date information including specific guidance for businesses, education and health care providers can be found here: • 11ress Release: Governor`s "1 ask Force Encourages N(�rtli Carolinians to Increase I Ir M.Kedness.Measures for COV D-19 • Co ronavirus Disease 2019 i"COVID-19) Resyonse in North Carolina • CDC COVID-19 website • North Carolina State;Laboratc�r°y ol`l rblic l ealtl lovcl C:�r rra�-irtts C r�idance If you have questions or concerns, call the COVID-19 Helpline toll free at 1-866-462-3821. To submit questions online, go to wwwjLcp�soncorgol.or, and select"chat." Instruction from CDC for healthcare facilities: htt s://wNAT�v.cdc.,ov/coronavirus/201.9- ncov/healtheare-facilities/ reverrt-s read-in lorr ters�i-care-facilities.htrnl WHAT YOU SHOULD DO IF YOU'RE INVITED TO A FACILITY FOR AN END-OF- LIFE SCENARIO O A. TO DOs 1. Before visiting ANY facilities,all ombudsmen should carefully review the following fact sheets (attached to this memo)from the U.S. Department of Health, Centers for Disease Control: a. What You Should Know, https.://www.cdc,Rov/coro.navirus/2019- ncov/about/index.html b. What You Should Do If You Are Sick, hit s:Iiwww.cdc. ovlcoronavirus12019-ncovlaboutlinde .htrnl 2. The CDC has a short video about handwashing. All ombudsmen and CAC volunteers should review this video or the CDC factsheet(attached to this memo)on handwashing prior to visiting a long-term care facility. a. "What You Need to Know about Handwashing"Visit tt s:/Ivc�artu.bc/d914n L14I o 3. Check your email regularly for updates from the Office of the State Long-Term Care Ombudsman B. Instructions for Preventing the Spread of Coronavirus The following information is taken from the federal Centers for Disease Control and Prevention (CDC) Factsheet"What You Should Know" and other sources such as CDC, CMS,NC State Government, Consumer Voice, and Washington. State LTCOP. 2 12 DO: T1. Stay at least six feet away from people who are sick or showing symptoms such as coughing or sneezing. 2. Wash your hands often with soap and water for at least 20 seconds. Wash your hands before and after eating, and after using the bathroom. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. 3. Avoid touching your eyes, nose, and mouth when out in public. DO NOT: 1. Shake hands with others until this health crisis has passed. 2. Use facemasks unless you are sick. Facemasks generally do not prevent you from exposure to the coronavirus. 3. Touch residents, staff, or others while visiting a care facility. C. What to do if you are sick or have symptoms? I. As a Long-Term Care Ombudsman, you should put your own health and safety before the needs of residents. 2. If you are showing signs of illness (coughing, sneezing, or fever), stay home and do not visit any facility even if invited for an end-of-life scenario. 3. Coughing, sneezing, and fever do not necessarily mean that you have COVID-19, however use precaution. If you are sick, call your healthcare provider and then notify your supervisor as soon as possible. If you or your family are personally affected by the emergency, take care of yourself and your family first. As soon as possible, please notify your AAA Director, and the State LTCO. D. The Role of Long-Term Care Ombudsman Ombudsmen are not to fill the roles of first responders or medical experts. Leave this work to be done by law enforcement, EMTs, firefighters, public health officials, and other local authorities. The responsibilities of ombudsmen remain the same before, during, and after emergencies. You are the residents' advocate. Please continue complaint resolution by telephone, skype etc. How can we determine or verify if a resident has a decision maker when we cannot personally visit? a) As necessary,you will have to ask the facility staff if they can fax the document or accept the facility's verbal verification until you can physically confirm. Note: the LTC Ombudsman program rule directs the program to "ascertain," it does not say how. 45 CFR 1324.19 (b) (iv) In determining whether to rely upon a resident representative to communicate or make determinations on behalf of the resident related to complaint processing, the Ombudsman or representative of the Office shall ascertain the extent of the authority that has been granted to the resident representative under court order 3 13 (in the case of a guardian or conservator), by power of attorney or other document by which the resident has granted authority to the representative, or under other applicable State or Federal law. 1. Obtain verbal consent by telephone. 2. How shall we obtain written consent to access records? a) Follow your program's policies and procedures; where the resident or resident representative communicates informed consent orally or by using other technology, document this consent as it occurs. b) Mail a consent form to the resident, with a pre-addressed, stamped envelope for return or; c) Ask staff if they have time to help by receiving a faxed form that they assist the resident to sign and then fax back. 3. What about disclosure of resident records or other information? a. Follow and reinforce your program's policies and procedures regarding disclosure. b. Obtain verbal consent from the resident and document this consent as it occurs. c. Mail a consent to disclose form to the resident, with a pre-addressed, stamped envelope for return or; d. Ask staff if they have time to help by receiving a faxed form that they assist the resident to sign and then fax back. All communications with residents, complainants, others,via e-mail or other methods are considered Ombudsman programm information and disclosure provisions apply. F. How to Address Coronavirus Concerns During This Emergency 1. As applicable, contact by telephone, facility resident council or family council. Be prepared to answer questions about coronavirus. Follow up on any complaints or questions that you don't know the answer to. 2. Obtain the name and contact information for key Resident Council members so you can contact them. 3. Obtain a current roster of and contact information of residents 4. Contact the facility administrator, director of nursing or social worker to see if there are any new concerns related to COVID-19. Find out about the facility plan and response during this emergency. Inquire about their communication plans for residents and outside callers. How will the facility communicate with residents and their family members or representatives? S. Document and share any concerns, challenges, or helpful ideas with the State LTC Ombudsman. On March 13, 2020, CMS issued a revised Memorandum Ref: QSO-20-14-NH. This memo includes the following statement regarding resident access to Ombudsman program services: 4 14 Residents still have the right to access the Ombudsman program. If in-person access is allowable, use the guidance mentioned above. If in-person access is not available due to infection control concerns, facilities need to facilitate resident communication(by phone or other formats with the Ombudsman program or any other entity listed in 42 CFR §483.1 Q(f)(4)(i). NOTE: We will compile a list of FA Qs and distribute to you. ACL, CDC,CMS,NC State Govt,Consumer Voice,WA State LTCOP 5