Client Complaints and Grievances

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.

This policy makes sure that clients, representatives, families and others can raise concerns with Sample Agency, LLC (the "Agency") easily and safely, that every complaint is taken seriously and answered, and that people know how to complain to the Department.

This policy covers any expression of dissatisfaction with the Agency's services, staff, scheduling, billing, privacy or treatment, made by a client, a representative, a family member, a health care provider, a staff member on a client's behalf, or anyone else, whether spoken or written and whether or not the person calls it a complaint.

For the purposes of this policy:

As the Agency's own standard, the Agency acknowledges every complaint within 5 of receipt and gives the complainant a written outcome within 30 of receipt. If more time is needed, the complainant is told why and when to expect the answer.

A complaint that alleges abuse, neglect or exploitation is first reported as Policies CA-HC-ANE-01 and CA-HC-ANE-02 require.

Every client is told at the start of services, and in every written outcome, how to complain to the Department: California Department of Social Services, Community Care Licensing Division, Centralized Complaint and Information Bureau: call (844) 538-8766 (844-LET-US-NO), email letusno@dss.ca.gov, or file online at https://complaints.ccld.dss.ca.gov/. Licensing questions: Home Care Services Branch, 744 P Street, MS 9-14-90, Sacramento, CA 95814, (877) 424-5778, HCSB@dss.ca.gov. No one is retaliated against for complaining, to the Agency or to anyone else.

• In person, by telephone ((916) 555-0100), by email (office@example.com), by letter, or on Form CA-HC-CPL-01-A, to any staff member or directly to the complaint officer at (916) 555-0111 or person1@example.com.
• In any language. The Agency arranges an interpreter or translation at no cost (Policy CA-HC-CR-02).
• Anonymously, if the person prefers. The Agency investigates as far as it can.
• Through a representative, family member, friend or advocate.
• Staff help anyone who wants to complain, including by writing the complaint down for them. Any staff member who receives a complaint passes it to the complaint officer the same day.

1. The complaint officer records every complaint on the complaint log (Form CA-HC-CPL-01-B) on the day it is received.
2. The complaint officer decides at once whether the complaint needs urgent action (Section 7).
3. The complaint officer acknowledges the complaint within 5 of receipt, in the complainant's preferred way and language, giving the complaint officer's name and when to expect a written outcome.

1. The complaint officer, or a person the complaint officer names who is not involved in the complaint, investigates: speaks with the complainant, the staff involved and any witnesses, and reviews the records.
2. The complainant is kept informed and may add information at any time.
3. The complaint officer sends a written outcome within 30 of receipt, in plain language and in the complainant's language. It says what was looked at, what was found, what the Agency will do, how to ask for a review inside the Agency, and how to contact the Department and other agencies (Section 9).
4. Actions agreed (for example a change of aide, retraining, a schedule change, a billing correction) are recorded on the log with a date and checked when that date comes.

• The complainant may ask for a review by the Administrator (or by the governing body, if the complaint is about the Administrator or the Administrator was the complaint officer). As the Agency's own standard, the review is completed within the same time frame as the first answer.
• The complainant may contact the Department at any time, before, during or after the Agency's process: California Department of Social Services, Community Care Licensing Division, Centralized Complaint and Information Bureau: call (844) 538-8766 (844-LET-US-NO), email letusno@dss.ca.gov, or file online at https://complaints.ccld.dss.ca.gov/. Licensing questions: Home Care Services Branch, 744 P Street, MS 9-14-90, Sacramento, CA 95814, (877) 424-5778, HCSB@dss.ca.gov. Letters and faxes: Department of Social Services, 744 P Street, M.S. 19-814, Sacramento, CA 95814; fax (916) 414-2551.
• Abuse concerns may also go directly to adult protective services (1-833-401-0832 (enter your 5-digit ZIP code to reach the county Adult Protective Services agency; 24 hours a day, 7 days a week)) or law enforcement. Residents of a long-term care facility may contact the Long-Term Care Ombudsman (1-800-231-4024 (Long-Term Care Ombudsman Hotline, 24 hours a day, 7 days a week)).
• If the services are paid for by a health plan, a Medi-Cal plan or an insurer, the client may also use that payer's own grievance process.
• If the Agency is a HIPAA covered entity, a privacy complaint may also be made to the Agency under 45 CFR §164.530(d) and to the Secretary of Health and Human Services (45 CFR §160.306).

• The Department "may review and, if it determines necessary, investigate complaints filed against home care organizations" (HSC §1796.52(a)). When the Department reviews a complaint, the Agency cooperates fully, as Policy CA-HC-GOV-05 sets out.
• When the Department receives a report of suspected or known abuse, it cross-reports to local law enforcement and adult protective services, or child protective services for a person under 18 (HSC §1796.52(e)).
• Staff never try to find out who complained to the Department.

No client loses services, has services reduced, is charged more, or is treated differently because the client or anyone else made a complaint, to the Agency or to the Department or any other agency. No staff member is disciplined for helping a client complain. Retaliation is serious misconduct and is itself handled as a complaint.

Accountability under this policy is allocated as follows.

The complaint officer keeps the complaint log (Form CA-HC-CPL-01-B) and a file for each complaint with the complaint, the acknowledgment, the investigation notes, the written outcome and evidence that actions were completed. As the Agency's own standard, complaint files are kept for seven years after the complaint is closed, separate from client records.

Each quarter the complaint officer reports to the Administrator and the governing body the number and types of complaints, the share acknowledged within 5 and closed within 30, and the actions taken (Policy CA-HC-QM-01).

Every employee is trained on this policy at orientation and each year after that, as the Agency's own standard, including how to receive a complaint, when a complaint is also an abuse report, and the Department's complaint contact. The complaint officer is also trained on investigating complaints. Training is recorded in the training log (Form CA-HC-HR-05-B).

This policy implements the following authorities.

• Cal. Health & Safety Code §1796.51, Complaint procedures
• Cal. Health & Safety Code §1796.52(a) and (e), Department review of complaints; cross-reporting of abuse
• PIN 24-01-HCS (February 22, 2024), Transition of complaint intake to the Centralized Complaint and Information Bureau
• Cal. Welf. & Inst. Code §15630, Mandated reporting of elder and dependent adult abuse
• 45 CFR §164.530(d), Privacy complaints to a covered entity (if a covered entity)
• 45 CFR §160.306, Complaints to the Secretary

The following documents are read together with this policy.

This policy is adopted by the governing body of 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.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a law or Department notice cited in Section 15 is amended, the amendment is recorded in this table and a new version of this policy is issued.