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 anyone can complain to Sample Agency, LLC (the "Agency") easily and without fear, that every complaint is taken seriously, looked into and answered in writing, that people know they may go to AHCA or other agencies at any time, and that complaints are used to improve services.

This policy covers every complaint or grievance about the Agency's services, staff, billing, privacy or treatment of a client, made by any person in any way, under both license routes. A complaint does not need to use the word "complaint" or be in writing.

For the purposes of this policy:

Every client may complain to the Agency, to AHCA, or to both, at any time, without fear of retaliation or loss of services. On or before the first day of services, the Agency tells each client and the client's immediate family or representative, if appropriate, of the right to report complaints, with the words "To report a complaint regarding the services you receive, please call toll-free 1-888-419-3456." (s. 408.810(5)(a)1, F.S.; Policy FL-HC-CR-02). No Florida rule sets a time for a home health agency or registrant to answer a complaint. As the Agency's own standard, the Agency acknowledges every complaint within 5 and gives a written resolution within 30 of receiving it.

A complaint may be made:

• To any staff member, in person or by phone.
• To the complaint officer, Pat Sample, at (813) 555-0111 or person1@example.com, or to the office at (813) 555-0100 during Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern, or (813) 555-0199 after hours.
• In writing, on Form FL-HC-CMP-01-A or in any letter or e-mail, to 100 Example Street, Suite 100, Tampa, Florida 33602 or office@example.com.
• By the client, a representative, a family member or anyone else, and anonymously if the person prefers.
• In any language. The Agency provides an interpreter or a translated form at no cost (Policy FL-HC-CR-03).

A staff member who receives a complaint thanks the person, writes down what was said, and tells the complaint officer the same day, as the Agency's own standard. Staff never discourage a complaint or tell a client not to call AHCA.

If a complaint describes or suggests abuse, neglect or exploitation of a vulnerable adult or a child, the staff member who hears it reports it at once, before anything else, as Policy FL-HC-ANE-01 requires, to the Florida Abuse Hotline of the Florida Department of Children and Families, which takes reports 24 hours a day, 7 days a week: call 1-800-96-ABUSE (1-800-962-2873) (TTY 711 or 1-800-955-8771), fax a written report to 1-800-914-0004, or report online at https://reportabuse.myflfamilies.com/s/ when no one is in immediate danger. If a person is in immediate danger, call 911 first and then call the Hotline. Florida law requires any person who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited to "immediately report such knowledge or suspicion to the central abuse hotline" (s. 415.1034(1)(a), F.S.), and requires known or suspected child abuse, abandonment or neglect to be reported immediately (s. 39.201(1)(a), F.S.). The complaint is then also handled under this policy, without interfering with any investigation by the Department of Children and Families or law enforcement.

The complaint officer follows these steps.

1. Log the complaint on Form FL-HC-CMP-01-B on the day it is received, with the date, the person, and a summary.
2. Check safety. If a client may be at risk, act the same day: change the staff member assigned, add a supervisory visit, or call 911 or the hotline.
3. Acknowledge the complaint within 5 (Agency's own standard), saying who is handling it and when the person will hear the outcome.
4. Look into it: talk with the person who complained, the client, the staff involved and any witnesses; review visit records, EVV data, schedules and bills; and, for personal care, involve the RN supervisor.
5. Decide what happened and what to do: an apology, a schedule change, a different staff member, retraining, discipline, a billing correction or refund (Policy FL-HC-BUS-01), or a change to a policy or process.
6. Send a written resolution within 30 of receiving the complaint (Agency's own standard), in the person's language, stating what the Agency found, what it did, how to ask the Administrator or governing body to review it, and that the person may contact AHCA at any time (Agency for Health Care Administration (Complaint Administration Unit), 2727 Mahan Drive, Tallahassee, FL 32308; toll-free 1-888-419-3456 (Florida Relay Service TDD 1-800-955-8771); online: Licensed Health Care Facility Complaint Form at https://apps.ahca.myflorida.com/hcfc/).
7. If the Agency needs more time, tell the person why and when the resolution will come, and record it on the log.
8. Close the complaint on Form FL-HC-CMP-01-B with the date and outcome.

A person who is not satisfied with the resolution may ask the Administrator, or the governing body if the Administrator was involved, to review it. The reviewer answers in writing, as the Agency's own standard within 30 of the request. Asking for a review never delays or replaces the right to go to AHCA.

Clients and families may use any of these routes at any time, before, during or after an Agency complaint. Staff give the information whenever asked.

The Agency cooperates fully with any AHCA complaint investigation (Policy FL-HC-GOV-03).

No client is threatened, punished, refused services, given worse service, or discharged because the client or anyone on the client's behalf complained, to the Agency or to anyone else, as the Agency's own standard. No staff member is disciplined for helping a client complain or for reporting a concern. For reports of abuse, Florida law adds that "a resident or employee of a facility that serves vulnerable adults may not be subjected to reprisal or discharge because of the resident's or employee's actions in reporting abuse, neglect, or exploitation pursuant to s. 415.1034." (s. 415.1036(1), F.S.), and that "No resident or employee of a facility serving children may be subjected to reprisal or discharge because of his or her actions in reporting abuse, abandonment, or neglect pursuant to the requirements of this section." (s. 39.203(2)(a), F.S.) If the Agency is a covered entity, it may not retaliate against anyone for filing a privacy complaint (45 CFR §164.530(g)). Any staff member who retaliates is disciplined.

When a complaint is about a staff member's conduct, the complaint officer tells the Administrator the same day. If the complaint suggests a risk to the client, the Administrator assigns another staff member to the client while the complaint is looked into, as the Agency's own standard. The staff member is told of the complaint and given the chance to respond. The outcome may include coaching, retraining or discipline under the Agency's personnel procedures. An allegation of abuse, neglect or exploitation by a staff member is handled under Policy FL-HC-ANE-01, Section 8.

Accountability under this policy is allocated as follows.

Each complaint has a file with Form FL-HC-CMP-01-A or the staff member's notes, the investigation, the acknowledgment and the written resolution. Form FL-HC-CMP-01-B logs every complaint. Complaint files and the log are kept for six years, as the Agency's own standard; privacy complaints and their disposition are documented and kept for six years under 45 CFR §164.530(d)(2) and (j) if the Agency is a covered entity. Complaint files are kept separate from client records.

Each quarter the complaint officer reports to the quality assurance committee the number and kinds of complaints, the times to acknowledge and resolve against the Agency's standards, repeat complaints, and the changes made (Policy FL-HC-QA-01).

Every staff member learns at orientation and at each annual in-service how to receive a complaint, that abuse allegations go to the hotline first, the AHCA complaint number, and that retaliation is forbidden. The complaint officer and the Administrator review this policy each year.

This policy implements the following authorities.

• s. 408.810(5), F.S., Notice of the right to report complaints, abuse and Medicaid fraud
• s. 408.811, F.S., Right of inspection; complaint investigations
• s. 415.1034, F.S., Mandatory reporting of abuse, neglect, or exploitation of vulnerable adults
• s. 415.1036, F.S., Immunity; no reprisal for reporting
• s. 39.203(2), F.S., No reprisal for reporting child abuse
• Rule 59A-8.003(3), F.A.C., AHCA complaint investigations
• 45 CFR §164.530(a)(1)(ii), (d), (g), Privacy complaints; no retaliation
• 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 statute or rule cited in Section 15 is amended, the amendment is recorded in this table and a new version of this policy is issued.