Please use the Online Complaint Form to describe in detail, but concisely, all the facts pertaining to your complaint. Include relevant names, dates, times, places, etc. Submit with the complaint any documentation you may have which supports your complaint. Use additional pages if necessary. Complaints may be emailed, faxed, or mailed to the following:
Board of Executives of Long term Services and Supports
335 Randolph Avenue, Suite 210-B
St. Paul, MN 55414
E-mail: beltss.hlb@state.mn.us
Fax: 651-797-1376
Legally, you are not required to supply any information to the Board, however, if we do not receive your complaint in writing or if you refuse to sign the complaint, our Standards of Practice Committee will not take action to resolve it. If we do not receive your address, we will be unable to inform you of the results of your complaint.
The complaint form also asks for other information. The Minnesota Government Data Practices Act requires that we inform complainants of:
We ask for your name, address, and phone numbers to:
To thoroughly evaluate and investigate a complaint, the Standards of Practice Committee may want to obtain a response from the administrator involved. Under state law, the administrator’s response is specifically for the use of the Board; it is not available to you or to anyone else. To obtain a response from the administrator to your complaint, we are requesting that you sign the portion of the complaint form entitled Authorization to provide administrator a copy of complaint. This will permit the board to send a copy of your complaint in your own words to the administrator for response. It is not, however, necessary for you to sign the authorization to provide the administrator a copy of your complaint. Your complaint will be evaluated whether you consent to permit us to share a copy of your complaint with the administrator. If you do not permit us to share your written complaint with the administrator, we may need to paraphrase the issues it involves in seeking an explanation from the administrator. Your name will not be divulged to the administrator, although the facts of the complaint as you have presented them may be provided to the administrator for response.
All information provided, in your complaint, in any response from the administrator, and obtained in any investigation authorized by the Board, will be evaluated to determine whether the matter is one which, under law, justifies the Boards initiation of disciplinary action against the administrator.
