{"ref":"CA-HH-CMP-01","title":"Complaints and Grievances","category":"Client rights","own":false,"summary":"Sets out how the Agency receives, records, investigates, and resolves complaints by patients, families, guardians, and representatives about care that is (or fails to be) furnished or about lack of respect for property, as 22 CCR §74743(b)(6) requires, with the patient’s right to complain without discrimination or reprisal (§74743(b)(4)), the written notice of the Department’s district office hotline at acceptance (§74743(g)), the Agency’s own time frames for acknowledging and resolving complaints (5 and 30), how complaints of abuse, discrimination, and privacy are routed, how patients can complain to the Department and other outside bodies, and how complaints feed the quality program. Federal duties under 42 CFR §484.50(e) apply if the Agency is Medicare-certified.","inShort":["Every patient and family has the right to complain, and no one may treat them worse for it.","If someone complains to you, listen, thank them, and write it down in their words. Send it to the complaint officer the same day.","If the complaint suggests abuse or neglect, you must also make your own report right away.","Never write in the patient’s record that they complained, and never change their care because of it.","Patients can also call the state health department district office hotline listed on the form they received at the start of care."],"primaryCitation":"22 CCR §74743(b)(6)","citations":["22 CCR §74743(b)(4)","22 CCR §74743(b)(6)","22 CCR §74743(g)","22 CCR §74742(c)(5)(H)","22 CCR §74718(a)(3)"],"federalCitations":["42 CFR §484.50(a)(1)(ii)","42 CFR §484.50(c)(9)","42 CFR §484.50(c)(11)","42 CFR §484.50(e)","42 CFR §484.50(e)(1)","45 CFR §92.8(c)","45 CFR §164.530(d)"],"surveyorAsks":["Show me your complaint log for the last year. Show me how this complaint was investigated and resolved.","How does a patient learn how to complain to you and to the Department?","A patient complains that an aide was rough with her. What happens next?","How do you make sure a patient who complains is not treated differently?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"CA-HH-CMP-01-A","title":"Complaint Record"},{"ref":"CA-HH-CMP-01-B","title":"How to Make a Complaint"}],"sections":[{"heading":"Terms of Reference","body":["This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1."],"table":{"caption":null,"headers":[["Item"],["Detail"]],"rows":[[["Issued by"],["The governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}]],[["Document owner"],[{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.title","text":"Administrator"}]],[["Authority"],["Adopted under 22 CCR §74743(b)(4) (right to voice grievances without discrimination or reprisal), §74743(b)(6) (investigation and documentation of complaints), §74743(g) (home health hotline), §74742(c)(5)(H) (patient dissatisfaction with supervision considered in the annual evaluation), and §74718(a)(3). If the Agency is Medicare-certified, also 42 CFR §484.50(a)(1)(ii), (c)(9), (c)(11), and (e). Discrimination grievances are also handled under 45 CFR §92.8(c) (Policy CA-HH-GOV-07), and privacy complaints under 45 CFR §164.530(d) (Policy CA-HH-PRV-01)."]],[["Applies to"],["Every employee, contracted individual, and volunteer who may receive a complaint; the complaint officer; the Administrator; the Director of Patient Care Services; and the governing body."]],[["Status"],["Mandatory. Adherence is a condition of employment and of any contract for services. No provision may be waived, shortened, or varied by any employee."]],[["Not covered here"],["Employee grievances about employment (personnel policies, Policy CA-HH-HR-01). Reporting of suspected abuse, which is a legal duty of each staff member whatever the complaint process (Policies CA-HH-SG-01 and CA-HH-SG-02). Patient rights in general (Policy CA-HH-PR-01)."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months, and within 30 days of any amendment to a rule cited at Section 16. As a policy on the delivery and supervision of patient care, it is also reviewed each year by the professional advisory group, which includes a physician and surgeon and a registered nurse, and revised as needed (Cal. Health & Safety Code §1727.5(d); Policy CA-HH-GOV-04). Each review is recorded at Section 19 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body and the issue of a new version number. Superseded versions are retained for seven years, as the Agency’s own standard."]],[["Distribution"],["Master copy held in the policy manual at the parent office and at each branch office. Staff named in the Applies to row receive it at orientation and when it changes. Available on request to patients or their representatives and to Department representatives (22 CCR §74721(b))."]],[["Questions"],["Direct to the document owner on ",{"k":"field","name":"agency.phone","text":"(916) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["A complaint is a patient or family telling the Agency that something has gone wrong. Every complaint is a chance to put it right for that patient and to stop it happening to others. California requires the Agency to investigate complaints and document both the complaint and how it was resolved, and every patient has the right to complain without fear. This policy sets out how the Agency does that, fairly and promptly."],"edited":false},{"heading":"2. Scope","body":["This policy covers every complaint or grievance, oral or written, made by a patient, the patient’s family, guardian, or representative, or a caregiver, about any service furnished or not furnished by or on behalf of the Agency, including services under arrangement, staff conduct, respect for property, billing, privacy, and discrimination."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy, the following terms have the meanings below. The California home health agency regulations (22 CCR Division 5, Chapter 6) and 42 CFR Part 484 both say \"patient\", and this policy uses the same word for the person receiving home health services."],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Complaint"],["Any expression of dissatisfaction, oral or written, about treatment or care that is (or fails to be) furnished, or about the lack of respect for the patient’s property by anyone furnishing services on behalf of the Agency (22 CCR §74743(b)(6)), or about any other aspect of the Agency’s services. The Agency uses \"complaint\" and \"grievance\" to mean the same thing."]],[["Complainant"],["The person who makes the complaint: the patient, the patient’s family or guardian, the patient’s representative, or a caregiver."]],[["Complaint officer"],[{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.title","text":"Administrator"},", who manages the complaint process. If no complaint officer is named, the Administrator acts as complaint officer."]],[["Resolution"],["The outcome of the investigation and the action taken, explained to the complainant. A complaint can be resolved even if the complainant does not agree with the outcome."]],[["District office hotline"],["The toll-free number of the Department’s Licensing and Certification district office that serves the Agency’s county, which receives complaints or questions about local home health agencies (22 CCR §74743(g))."]]]},"edited":false},{"heading":"4. Policy Statement (22 CCR §74743(b)(6))","body":["\"The home health agency shall investigate complaints made by a patient or the patient's family or guardian regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for the patient's property by anyone furnishing services on behalf of the home health agency, and must document both the existence of the complaint and the resolution of the complaint\" (22 CCR §74743(b)(6)). Every patient has the right to voice grievances regarding treatment or care, or lack of respect for property, and must not be subjected to discrimination or reprisal for doing so (§74743(b)(4)). When the Agency accepts a patient, it advises the patient in writing of the telephone number of the district office home health hotline, its hours of operation, and that its purpose is to receive complaints or questions about local home health agencies (§74743(g)).\n\nThe Agency acknowledges each complaint within ",{"k":"field","name":"settings.complaintAckDays","text":"5"}," and resolves it within ",{"k":"field","name":"settings.complaintResolveDays","text":"30"},", as the Agency’s own standards; no California rule sets these time frames. Complaints that suggest abuse, neglect, or a threat to a patient’s safety are acted on at once.\n\nIf the Agency is Medicare-certified, it investigates complaints made by a patient, the patient’s representative, and the patient’s caregivers and family, including complaints about treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately, and about mistreatment, neglect, verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property; documents both the existence and the resolution of the complaint; and takes action to prevent further potential violations, including retaliation, while the complaint is being investigated (42 CFR §484.50(e)(1)). The Agency applies these federal standards to all patients, as the Agency’s own standard."],"edited":false},{"heading":"5. Telling Patients How to Complain","body":[],"list":[["At acceptance, every patient receives the notice of patient rights (Policy CA-HH-PR-01) and Form CA-HH-CMP-01-B, in English or Spanish or explained in the patient’s language (Policy CA-HH-PR-04). They tell the patient how to complain to the Agency and give, in writing, the district office hotline for the Agency’s county, its hours of operation, and that its purpose is to receive complaints or questions about local home health agencies (22 CCR §74743(g); 42 CFR §484.50(c)(9)). The district office numbers are: ",{"k":"field","name":"fixed.districtOfficeTollFree","text":"Bakersfield (866) 222-1903; Chico (800) 554-0350; East Bay (866) 247-9100; Fresno (800) 554-0351; Los Angeles (800) 228-1019; Orange County (800) 228-5234; Riverside (888) 354-9203; Sacramento (800) 554-0354; San Bernardino (800) 344-2896; San Diego (North) (800) 824-0613; San Diego (South) (866) 706-0759; San Francisco (800) 554-0353; San Jose (800) 554-0348; Santa Rosa (866) 784-0703; Stockton (888) 398-6660; Ventura (800) 547-8267"},"; the office for each county and its hours are listed at ",{"k":"field","name":"fixed.districtOfficeDirectory","text":"https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/DistrictOffices.aspx"},". The office staff circle the number for the Agency’s county on the form."],["If the Agency is Medicare-certified, the notice also gives the Administrator’s name, business address, and business phone number in order to receive complaints (42 CFR §484.50(a)(1)(ii))."],["Patients are told they may complain to the Agency, to the Department, or both, and that they will not be treated differently for doing so (§74743(b)(4); 42 CFR §484.50(c)(11))."]],"ordered":false,"edited":false},{"heading":"6. Receiving a Complaint","body":[],"list":[["Any staff member may receive a complaint, in person, by phone, by mail, or by email. Listen, thank the person, and do not argue or blame others."],["If the complaint is about something you can safely put right at once (for example, rescheduling a visit), do so, and still record it."],["If the complaint suggests abuse, neglect, financial abuse, or an injury of unknown source, make your own report under Policy CA-HH-SG-01 or CA-HH-SG-02, and tell your supervisor at once."],["Write down the complaint in the complainant’s words, with the date and time, and send it to the complaint officer the same day on Form CA-HH-CMP-01-A, Part A. After hours, tell the on-call nurse, who sends it the next business day."],["A complaint is never written in the clinical record as a complaint, and the patient’s care is never changed because they complained, except to put right what they complained about."]],"ordered":true,"edited":false},{"heading":"7. Acknowledging and Sorting the Complaint","body":["The complaint officer logs the complaint in the complaint log the day it is received, sends or gives an acknowledgment to the complainant within ",{"k":"field","name":"settings.complaintAckDays","text":"5"}," (the Agency’s own standard), and decides who investigates using Table 1."],"table":{"caption":["Table 1.  Routing of complaints"],"headers":[["Type of complaint"],["Who investigates"],["Related policy and outside duty"]],"rows":[[["Quality of care, missed or late visits, staff skill, or communication"],["The DPCS or the nurse supervisor assigned to the patient"],["Policies CA-HH-CP-01, CA-HH-CC-01"]],[["Mistreatment, neglect, verbal, mental, sexual, or physical abuse, injury of unknown source, or misappropriation of property"],["The Administrator, with the DPCS; the staff member is removed from patient contact during the investigation"],["Policy CA-HH-SG-01 (staff member’s own report to Adult Protective Services or law enforcement); Policy CA-HH-QA-03"]],[["Supervision of aides or other staff"],["The DPCS"],["Considered in the annual evaluation (22 CCR §74742(c)(5)(H); Policy CA-HH-QA-01)"]],[["Respect for the patient’s property; damage or loss"],["The Administrator"],["22 CCR §74743(b)(3), (b)(6)"]],[["Billing, charges, or payment"],["The Administrator or billing lead"],["Policy CA-HH-BUS-02"]],[["Privacy of medical information"],["The privacy official, ",{"k":"field","name":"people.privacyOfficial.name","text":"Lee Sample"}],["Policies CA-HH-PRV-01 and CA-HH-PRV-03 (possible breach report within 15 business days)"]],[["Discrimination, language access, or disability access"],["The Section 1557 Coordinator"],["Policy CA-HH-GOV-07, Section 7 (45 CFR §92.8(c))"]],[["A service furnished by a contractor or under arrangement"],["The DPCS with the contractor"],["Policy CA-HH-GOV-05"]],[["Conduct of a certified home health aide that may be misconduct"],["The Administrator"],["Report to ",{"k":"field","name":"fixed.aideMisconductComplaint","text":"California Department of Public Health, Investigation Branch/Investigation Section, PO Box 997416, MS 3303, Sacramento, CA 95899-7416; message center (916) 492-8232; fax (916) 552-8788; cnamisconduct@cdph.ca.gov"}," where the Administrator finds a reasonable basis (Policy CA-HH-SG-01)"]]]},"edited":false},{"heading":"8. Investigating","body":[],"list":[["The investigator is someone who was not involved in the matter complained of, as the Agency’s own standard."],["The investigator talks with the complainant (and the patient, if different), the staff involved, and any witnesses; reviews the clinical record, schedules, visit verification data, and any other relevant records; and, where useful, makes a supervisory visit."],["While the complaint is investigated, the Agency takes action to prevent further potential violations, including retaliation (42 CFR §484.50(e)(1)(iii); applied to all patients as the Agency’s own standard), for example by reassigning staff or adding supervision."],["The investigator records the findings, the cause, and the actions on Form CA-HH-CMP-01-A, Part B."],["Complaints that involve a threat to a patient’s health or safety are acted on the same day."]],"ordered":true,"edited":false},{"heading":"9. Resolving and Responding","body":[],"list":[["The complaint officer tells the complainant the outcome within ",{"k":"field","name":"settings.complaintResolveDays","text":"30"}," of receiving the complaint, as the Agency’s own standard, in person or by phone and, if the complainant asks or the complaint was in writing, in writing in plain language. If the investigation needs more time, the complainant is told why and when to expect an answer."],["The response explains what was found, what the Agency has done or will do, and how to take the matter further, including the district office hotline and the other bodies in Section 11."],["The Agency documents both the existence of the complaint and its resolution (22 CCR §74743(b)(6); 42 CFR §484.50(e)(1)(ii)) on Form CA-HH-CMP-01-A and in the complaint log."],["If the complainant is not satisfied, they may ask the Administrator to review the decision, as the Agency’s own standard; the Administrator replies in writing."]],"ordered":false,"edited":false},{"heading":"10. No Discrimination or Reprisal","body":[],"list":[["No patient is subjected to discrimination or reprisal for voicing a grievance (22 CCR §74743(b)(4); 42 CFR §484.50(c)(11)). Services are not reduced, delayed, or ended because a patient complained."],["Any staff member who threatens, discourages, or retaliates against a complainant is disciplined."],["The identity of a person who files a discrimination grievance is kept confidential except as required by law or to carry out the investigation (45 CFR §92.8(c)(3)), and the Agency applies the same confidentiality to every complaint, as the Agency’s own standard."]],"ordered":false,"edited":false},{"heading":"11. Complaints to the Department and Other Outside Bodies","body":["A patient or anyone else may complain at any time to outside bodies, with or without using the Agency’s process. Staff give these contacts whenever asked."],"table":{"caption":["Table 2.  Outside bodies that receive complaints"],"headers":[["Body"],["What it handles"],["Contact"]],"rows":[[["California Department of Public Health, Licensing and Certification"],["Complaints or questions about home health agencies, including care, safety, and patient rights"],[{"k":"field","name":"fixed.complaintBlock","text":"California Department of Public Health, Center for Health Care Quality, Licensing and Certification Program: call, write or fax the district office that serves the Agency's county (directory at https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/DistrictOffices.aspx), or file online through Cal Health Find at https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/Home.aspx. General Licensing and Certification line: (800) 236-9747"}]],[["California Department of Public Health, aide misconduct"],["Misconduct by a certified home health aide or certified nurse assistant"],[{"k":"field","name":"fixed.aideMisconductComplaint","text":"California Department of Public Health, Investigation Branch/Investigation Section, PO Box 997416, MS 3303, Sacramento, CA 95899-7416; message center (916) 492-8232; fax (916) 552-8788; cnamisconduct@cdph.ca.gov"}]],[["County Adult Protective Services or law enforcement"],["Abuse, neglect, or financial abuse of an elder or dependent adult"],[{"k":"field","name":"fixed.abuseReportRoute","text":"the county Adult Protective Services agency (statewide line 1-833-401-0832, which connects to the county APS for the ZIP code entered, 24 hours a day, 7 days a week) or the local law enforcement agency; call 911 if anyone is in immediate danger"}]],[["Long-Term Care Ombudsman"],["Complaints by residents of nursing homes and residential care facilities for the elderly"],[{"k":"field","name":"fixed.ombudsmanHotline","text":"1-800-231-4024 (Long-Term Care Ombudsman Hotline, 24 hours a day, 7 days a week)"}]],[["U.S. Department of Health and Human Services, Office for Civil Rights"],["Discrimination, and privacy complaints under HIPAA"],["As listed on Form CA-HH-GOV-07-A and the notice of privacy practices"]],[["Medicare (if the patient has Medicare)"],["Concerns about Medicare-covered services, and quality-of-care complaints through the Medicare quality improvement organization for the patient’s area"],["1-800-MEDICARE (1-800-633-4227); the quality improvement organization contacts given under Policy CA-HH-PR-01"]],[["The patient’s Medi-Cal managed care plan or other health plan"],["Grievances about plan-authorized services"],["The member services number on the patient’s plan card"]]]},"edited":false},{"heading":"12. Learning From Complaints","body":[],"list":[["The complaint officer reports the number and types of complaints, the time taken to acknowledge and resolve them, and the actions taken to the Administrator each month and to the QAPI committee each quarter, as the Agency’s own standard (Policy CA-HH-QA-02)."],["Complaints, and in particular dissatisfaction expressed by patients regarding the supervision of services, are considered in the annual evaluation of overall agency functioning (22 CCR §74742(c)(5)(H); Policy CA-HH-QA-01)."],["The governing body receives a summary of complaints each quarter, as the Agency’s own standard (Policy CA-HH-GOV-01)."]],"ordered":false,"edited":false},{"heading":"13. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[[{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.title","text":"Administrator"}],["Owns this policy; logs and acknowledges complaints; assigns investigations; responds to complainants; keeps the log; reports trends."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Investigates complaints of abuse, property, and billing; reviews decisions on request; oversees the process; reports to the governing body."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Investigates complaints about care and supervision; makes sure care problems are put right at once."]],[["Every staff member"],["Receives complaints courteously, records them the same day, reports suspected abuse personally, and never retaliates."]],[["Governing body"],["Receives complaint summaries and makes sure resources are available to address patterns."]]]},"edited":false},{"heading":"14. Records and Compliance Monitoring","body":["Form CA-HH-CMP-01-A, the investigation file, the response to the complainant, and the complaint log are kept by the complaint officer separately from the clinical record for at least seven years, as the Agency’s own standard. Records of grievances alleging discrimination on the basis of race, color, national origin, sex, age, or disability are kept for no less than three calendar years from resolution, with the content 45 CFR §92.8(c)(2) requires, and are covered by the seven-year Agency standard. Each quarter the Administrator checks a sample of complaints for timely acknowledgment, documented resolution, and response to the complainant."],"edited":false},{"heading":"15. Staff Training","body":["Every employee is trained at orientation and each year on how to receive a complaint, how to record it, the routing in Table 1, the patient’s right to complain without reprisal, and the outside contacts in Table 2. The complaint officer and investigators are trained on investigation and on writing plain-language responses."],"edited":false},{"heading":"16. References","body":["This policy implements the following authorities."],"list":[["22 CCR §74743(b)(4), (b)(6), (g), Patient Rights: Grievances, Investigation of Complaints, and Home Health Hotline"],["22 CCR §74742(c)(5)(H), Annual Evaluation: Patient Dissatisfaction With Supervision"],["42 CFR §484.50(a)(1)(ii), (c)(9), (c)(11), (e), Patient Rights and Investigation of Complaints (if Medicare-certified)"],["45 CFR §92.8(c), Section 1557 Grievance Procedures"],["45 CFR §164.530(d), HIPAA Complaints"]],"ordered":false,"edited":false},{"heading":"17. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Policy CA-HH-PR-01"],["Patient Rights and Responsibilities"]],[["Policy CA-HH-PR-04"],["Language Access, Auxiliary Aids, and Effective Communication"]],[["Policy CA-HH-SG-01"],["Elder and Dependent Adult Abuse: Mandated Reporting"]],[["Policy CA-HH-SG-02"],["Child Abuse and Neglect: Mandated Reporting"]],[["Policy CA-HH-QA-01"],["Quality Management: Semi-Annual Clinical Record Review and Annual Evaluation of Agency Functioning"]],[["Policy CA-HH-QA-02"],["Quality Assessment and Performance Improvement (QAPI)"]],[["Policy CA-HH-QA-03"],["Incident Reporting, Investigation, and Adverse Events"]],[["Policy CA-HH-GOV-07"],["Nondiscrimination and Civil Rights"]],[["Policy CA-HH-PRV-01"],["Privacy of Medical Information: HIPAA and the Confidentiality of Medical Information Act"]],[["Policy CA-HH-PRV-03"],["Breach of Medical Information: Reports to the Department and to Patients"]],[["Policy CA-HH-BUS-02"],["Charges, Billing, Claims, Medi-Cal Records, and Overpayments"]],[["Policy CA-HH-GOV-05"],["Services Arranged by Agreement and Contracted Personnel"]],[["Form CA-HH-CMP-01-A"],["Complaint Record"]],[["Form CA-HH-CMP-01-B"],["How to Make a Complaint"]]]},"edited":false},{"heading":"18. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below."],"edited":false},{"heading":"19. Revision History","body":["Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 16 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"ca-hha","state":"California","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}