How To Participate In the Nursing Home Inspection Process  

Each year, nursing homes have a complete inspection by the Healthcare Facilities Regulation Division. During the standard inspection, the HFR inspectors, called surveyors, are supposed to determine if the facility meets state and federal standards. The surveyors examine how care is given to a number of residents and evaluate the facility, its policies and documentation.

The surveyors are also supposed to talk to some residents and family members to identify if they have any concerns. If you would like to talk to one of the surveyors during the inspection, the Ombudsman may be able to assist you. At the beginning of each inspection, the inspection team contacts the Ombudsman program and informs us about the inspection. We are able to give any information we have about the nursing home, including the names of residents or family members who would like to be interviewed.

If you are interested in being interviewed by HFR, please copy and complete the form below and send it to your local Ombudsman. Although we cannot guarantee that HFR surveyors will contact you during the survey, there is a good chance that they will do so if we provide them with your written permission. We cannot give HFR your name or any information about your concerns without your permission.

If you have an immediate concern about the nursing home, it is best not to wait until the survey to seek action. The Ombudsman can give you information about other options for addressing your concerns, including how to file a formal complaint with HFR. If you file a formal complaint with HFR, your case will be assigned to a specific investigator to evaluate your concerns. Please contact your local Ombudsman office if you need more information about filing a complaint or other options to address your concerns.


I, __________________________,

authorize the Ombudsman Program to release my name, telephone number, and a summary of my concerns to the Healthcare Facilities Regulation Division so that I can be considered for a possible interview during its next full inspection of

(Name of facility)

This release does not authorize the Ombudsman to release my name or information regarding my concerns to any other source.

(Resident or family)

Resident & Room Number:



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