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.

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.

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.

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.

"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)).

The Agency acknowledges each complaint within 5 and resolves it within 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.

If 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.

• 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: 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 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)).

1. 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.
2. If the complaint is about something you can safely put right at once (for example, rescheduling a visit), do so, and still record it.
3. 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.
4. 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.
5. 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.

The complaint officer logs the complaint in the complaint log the day it is received, sends or gives an acknowledgment to the complainant within 5 (the Agency’s own standard), and decides who investigates using Table 1.

1. The investigator is someone who was not involved in the matter complained of, as the Agency’s own standard.
2. 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.
3. 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.
4. The investigator records the findings, the cause, and the actions on Form CA-HH-CMP-01-A, Part B.
5. Complaints that involve a threat to a patient’s health or safety are acted on the same day.

• The complaint officer tells the complainant the outcome within 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.

• 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.

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.

• 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).

Accountability under this policy is allocated as follows.

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.

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.

This policy implements the following authorities.

• 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

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 rule cited in Section 16 is amended, the amendment is recorded in this table and a new version of this policy is issued.