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Staff receiving the complaint will identify the Priority Level according to section 4310-2 Assigning a Complaint Priority Level and immediately notify their supervisor via email using subject line: Complaint received (name of provider). The body of the email will include the name of the provider, nature of the complaint, the name of the complainant, if known, or agency who initiated the complaint, the concerns reported, priority level, and that the written intake form will follow. If the complaint is a Priority Level 1 Staff are to notify their supervisor in person. If their supervisor is not available, they will notify the CCPO or MOA Licensing Supervisor based on the physical location of the provider, via telephone. If the regional Licensing Supervisor is not available, the Designee Staff will contact the CCPO or MOA Licensing Program Manager as applicable, CCPO Eligibility and Benefits Team Public Assistance Analyst (PAA) II, Eligibility and Benefits Unit Program Coordinator (PC) II, Quality and Capacity Building Team, Program Coordinator (PC) II, or CCPO Program Manager via telephone when their supervisor is not available.

2. Immediately Notify the CCPO The Designee supervisor will notify the applicable CCPO Regional or MOA Licensing Supervisor based on the physical location of the provider; Eligibility and Benefits Team PAA II or other CCPO Management Staff contacted in step 1 above, by email, using subject line: Complaint received (name of provider).The body of the email will include the name of the provider, nature of the complaint, the name of the complainant, if known, or agency who initiated the complaint, the concerns reported, and priority level.

If the complaint is a Priority Level 1 the CCPO or MOA Licensing Supervisor will immediately identify the Licensing Specialist who will be assigned to the investigation.

3. Document the Complaint Received The same or next day from receipt of the complaint, the Complaint Intake Form is to be completed by the Designee staff that took the complaint and forwarded to their supervisor with all original notes for review, feedback, and guidance. If the complaint is alleging abuse, neglect, or mental injury the Designee Staff will also forward the Complaint Intake Form to the Office of Children’s Services (OCS) and local police.

1. Review and Approve Complaint Intake Form The same or next day of the supervisor receiving the completed