How to Fill Out and Submit the KDADS Complaint Investigation Form

The KDADS Facility Complaint Investigation Form is a downloadable document you complete and send to the Kansas Department for Aging and Disability Services to report suspected abuse, neglect, or exploitation in a Kansas adult care facility. You can submit it by fax to 785-296-0256, by mail to the KDADS office in Topeka, or use it as a reference while calling the Adult Abuse, Neglect, and Exploitation Hotline at 800-842-0078. Filing triggers a state investigation of the facility.

Where to Download the Form

The form lives on the KDADS Adult Care Homes page under the Survey, Certification, and Credentialing Commission section of the department’s website.1Kansas Department for Aging and Disability Services. Adult Care Homes (Survey, Certification & Credentialing) Look for “Facility Investigation Report” in the forms and manuals area; the complaint form is listed directly beneath that heading.

Two versions are posted. The Word document lets you type into the fields before printing or sending. The PDF works better if you want to print a blank copy and fill it out by hand.

What to Gather Before You Start

The more specific your information, the faster investigators can act. Pull the following together before you open the form:

  • The facility’s full legal name, physical address, and, if you know it, the license number. The license number helps KDADS match your complaint to the correct record.
  • The resident’s name. Investigators use this to pull medical records and care logs.
  • Dates and times of the incidents, or when you first noticed the problem. A timeline is far more useful than a general description.
  • Names of any staff involved during or responsible for the incident.
  • Names and contact information for witnesses: other residents, family members, or visitors.
  • A description of what you observed. Unexplained bruising, missed medications, unsanitary conditions, unauthorized withdrawals from a resident’s account, or anything else that raised concern.

You do not need to decide whether what you saw legally counts as abuse, neglect, or exploitation. Describe what happened and let KDADS classify it.

Filling Out the Form

The fields on the form track the information above. Start with the facility identification section, then move to the resident’s information and the details of your complaint.

The narrative section is where the complaint is made or lost. Write a chronological account of what you saw, when you saw it, and who was involved. Stick to facts, not conclusions. “I visited on March 12 and found my mother with bruises on both forearms that were not there on March 9” gives an investigator something to work with. “The staff is abusive” does not. If you observed something over multiple visits, lay out each visit separately with its date.

You will also be asked to categorize the type of concern. The form offers options like nursing services, dietary issues, sanitation, and resident rights. Pick the closest fit and move on. The narrative is where investigators actually learn what happened, so don’t get stuck choosing a label. Fill out every field you can. Incomplete forms won’t necessarily be rejected, but blanks can slow the triage process.

How to Submit the Form

KDADS accepts complaints three ways:

  • Fax the completed form to 785-296-0256. This goes directly to the intake unit at the Survey, Certification, and Credentialing Commission.2Kansas Department for Aging and Disability Services. Hotlines
  • Mail the form to Kansas Department for Aging and Disability Services, 503 S. Kansas Ave., Topeka, KS 66603. Certified mail gives you proof of delivery.3Kansas Department for Aging and Disability Services. Department for Aging and Disability Services Home
  • Call the Adult Abuse, Neglect, and Exploitation Hotline at 800-842-0078. Filling out the form first gives you a script so you don’t lose details on the call.2Kansas Department for Aging and Disability Services. Hotlines

Fax is the fastest paper-based method and the one KDADS itself directs facilities to use for self-reported incidents. If a resident is in danger right now, call the hotline instead of waiting for a fax or letter to be processed.

What Happens After You File

The Survey, Certification, and Credentialing Commission reviews the complaint and uses it to verify whether the facility complies with state and federal requirements.4Kansas Department for Aging and Disability Services. Survey, Certification & Credentialing Field staff from regional offices conduct unannounced onsite inspections in response.

Every complaint is triaged into a priority level that sets the response deadline, tracking federal Centers for Medicare and Medicaid Services standards:

These are maximums. KDADS can investigate faster.

During the investigation, staff review clinical records, interview staff and residents, observe daily operations, and check the facility’s policies against state regulations and federal certification requirements. An investigator may contact you for clarification or follow-up. When the investigation closes, KDADS issues findings to both the complainant and the facility, noting whether the allegations were substantiated and identifying any deficiencies.

The Long-Term Care Ombudsman as a Parallel Option

KDADS is not the only place to take a concern. The Kansas Office of the Long-Term Care Ombudsman is an independent advocate for residents of nursing homes and other long-term care facilities.6Office of the Long-Term Care Ombudsman. File a Complaint The two offices do different work. KDADS investigates regulatory violations and can cite a facility for deficiencies. The Ombudsman works on the resident’s behalf, mediating disputes, helping resolve care concerns, and making sure residents understand their rights.

You can reach the Kansas Long-Term Care Ombudsman toll-free at 877-662-8362 or at 785-296-3017. The office is at 900 SW Jackson, Suite 1041, Topeka, Kansas 66612. Filing with both offices at once is allowed, and using both gives the resident broader coverage.