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 patients of Sample Agency, LLC (the "Agency") and the people who care for them can raise a concern easily, are listened to, get an answer on time, and are never penalized for speaking up. Georgia’s home health rules do not contain a complaint rule, so this policy sets the Agency’s own standards. If the Agency is Medicare-certified, every patient has the right to "Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA" (42 CFR §484.50(c)(3)) and to be free from any discrimination or reprisal for voicing grievances to the Agency or an outside entity (42 CFR §484.50(c)(11)); the Agency gives these rights to every patient.

This policy covers every complaint, spoken or written, made by a patient, the patient’s representative, caregivers, family, or another health care provider, about care that is furnished, not furnished, furnished inconsistently, or furnished inappropriately; the conduct of anyone furnishing services for the Agency; respect for the patient’s person or property; billing; scheduling; or privacy (42 CFR §484.50(e)(1)(i)).

For the purposes of this policy, the following terms have the meanings below. Ga. Comp. R. & Regs. 111-8-31 and 42 CFR Part 484 both say "patient", and this policy uses the same word for the person receiving home health services.

Every complaint is welcome, recorded, investigated, and answered. The Agency investigates complaints, documents both the existence of each complaint and its resolution, and takes action to prevent further potential violations, including retaliation, while a complaint is investigated (42 CFR §484.50(e)(1), applied to every patient as the Agency’s own standard).

No patient is discriminated against or subjected to reprisal for complaining to the Agency or to anyone outside it (42 CFR §484.50(c)(11)). Services are never reduced, rescheduled, or ended because someone complained.

Neither Ga. Comp. R. & Regs. 111-8-31 nor 42 CFR §484.50 sets a deadline for acknowledging or resolving a complaint; the time frames above are the Agency’s own. A complaint that alleges abuse, neglect, or exploitation is reported immediately under Policy GA-HH-SG-01 or GA-HH-SG-02 before anything else is done.

• At the start of care, the admitting clinician gives the patient Form GA-HH-CMP-01-A, Where to Direct a Complaint, explains it, and records in the clinical record that the patient received it.
• The form gives the name, business address, and business telephone number of the Administrator to receive complaints (42 CFR §484.50(a)(1)(ii)), and the complaint officer’s contact details, and tells the patient the Agency’s time frames in Table 1.
• The form advises the patient of the state toll-free home health hotline, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local home health agencies (42 CFR §484.50(c)(9)): Georgia Department of Community Health, Healthcare Facility Regulation Division, Complaint Intake Unit, 2 Martin Luther King Jr. Drive SE, East Tower, Atlanta, GA 30334; toll-free (800) 878-6442; online at https://dch.georgia.gov/hfrd-file-complaint. The Department does not publish the hotline’s hours on its website, so the Administrator confirms them with the Department and writes them on the form; until then the form shows the other ways to complain at any time (online and by fax).
• The form also tells the patient how to report abuse, neglect, or exploitation (Policy GA-HH-SG-01).
• The form is provided in the patient’s language and in accessible formats, and interpreters are used, at no cost to the patient, under Policy GA-HH-PR-04.

1. Receive (any staff member). Listen, thank the person, and do not argue or promise an outcome. If the complaint alleges abuse, neglect, exploitation, misappropriation of property, or an injury of unknown source, follow Policy GA-HH-SG-01 or GA-HH-SG-02 at once. Write down who complained, the date, the patient, and what was said, and pass it to the complaint officer the same working day.
2. Log (complaint officer, same working day). Enter the complaint on the Complaint Log, Form GA-HH-CMP-01-B, with the date of receipt.
3. Acknowledge (complaint officer, within 5 days). Contact the complainant by phone or in writing to confirm the complaint, explain the next steps, and give the expected resolution date.
4. Protect (complaint officer and supervising nurse, at once). Take any step needed to protect the patient and prevent further potential violations, including retaliation, during the investigation: for example, reassigning a staff member, adding a supervisory visit, or contacting the physician (42 CFR §484.50(e)(1)(iii)).
5. Investigate (complaint officer). Review the clinical record, schedule, electronic visit verification, and billing data; interview the patient, complainant, staff, and witnesses; and document every step. Use Policy GA-HH-QA-03 for complaints that involve an incident.
6. Resolve (complaint officer, within 30 days). Decide what happened and what will change, and tell the complainant the outcome orally and in writing, including how to contact the Department if they are not satisfied.
7. Close (complaint officer). Record the resolution and the date on the log (42 CFR §484.50(e)(1)(ii)). If the resolution is delayed, record the reason and the new date and tell the complainant.
8. Learn. Report complaints, themes, time frames met, and actions to QAPI under Policy GA-HH-QA-02. Complaint totals are part of the data for the annual program evaluation under Policy GA-HH-QA-01 (Ga. Comp. R. & Regs. 111-8-31-.07(8)).

A complaint about the Administrator or the complaint officer is handled by Jo Sample, Alternate Administrator, or by a person the governing body names, and is reported to the governing body. The complainant may always go directly to the Department.

• Department of Community Health. A patient may complain to the Healthcare Facility Regulation Division at any time, before, during, or after using the Agency’s process: Georgia Department of Community Health, Healthcare Facility Regulation Division, Complaint Intake Unit, 2 Martin Luther King Jr. Drive SE, East Tower, Atlanta, GA 30334; toll-free (800) 878-6442; online at https://dch.georgia.gov/hfrd-file-complaint. The Complaint Intake Unit can also be reached on 404-657-5726 or 404-657-5728 and by fax on (404) 657-8935. The Department may investigate a complaint and inspect the Agency (Ga. Comp. R. & Regs. 111-8-31-.05); the Agency cooperates fully.
• Privacy complaints may also go to the U.S. Department of Health and Human Services, Office for Civil Rights (45 CFR §164.530(d)).
• If the Agency is Medicare-certified, a Medicare patient may also contact the Quality Improvement Organization serving Georgia, whose contact details are on the patient rights notice under Policy GA-HH-PR-01.
• Abuse, neglect, or exploitation: Georgia Adult Protective Services (Georgia Department of Human Services, Division of Aging Services), toll-free 1-866-552-4464, press 3 (Monday through Friday, 8 a.m. to 7 p.m.), or online at any time at https://aging.georgia.gov/adult-protective-services; and the local law enforcement agency (call 911 if anyone is in immediate danger).

Accountability under this policy is allocated as follows.

The Complaint Log (Form GA-HH-CMP-01-B) and a file for each complaint (intake notes, acknowledgment, investigation notes, resolution letter, and any documented reason for delay) are kept for at least six years after resolution, as the Agency’s own standard, apart from the clinical record. The record of the patient’s receipt of Form GA-HH-CMP-01-A is kept in the clinical record. Each quarter QAPI reviews the number and type of complaints, the percentage acknowledged within 5 days and resolved within 30 days, and any repeat themes.

All staff are trained at orientation on how to receive a complaint, how to recognize when a complaint is really an abuse, neglect, or exploitation report, and the rule against retaliation; training is repeated annually as the Agency’s own standard. The complaint officer is trained on investigation and documentation under Policy GA-HH-QA-03.

This policy implements the following authorities.

• 42 CFR §484.50(a)(1)(ii), (c)(3), (c)(9), (c)(11), and (e), Patient rights (for a Medicare-certified agency)
• 42 CFR §484.65, Quality assessment and performance improvement
• Ga. Comp. R. & Regs. 111-8-31-.05, Inspections; 111-8-31-.07(8), Evaluation
• 45 CFR §164.530(d), Complaints to the covered entity

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 12 is amended, the amendment is recorded in this table and a new version of this policy is issued.