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 and families of Sample Agency, LLC (the "Agency") can raise concerns easily and safely, that every complaint is taken seriously and resolved, and that the Agency learns from complaints.

This policy covers any expression of dissatisfaction, oral or written, by a patient, representative, caregiver, family member or other person about the care or treatment the Agency furnishes or fails to furnish, the lack of respect for the patient’s property, the conduct of staff, billing, or any other Agency service.

The following terms have the meanings given below when used in this policy.

Every patient has the right to make complaints to the Agency regarding treatment or care that is (or fails to be) furnished, and regarding the lack of respect for the patient’s property by anyone furnishing services on behalf of the Agency (42 CFR §484.50(c)(3)), and to be free from any discrimination or reprisal for exercising these rights or for voicing grievances to the Agency or an outside entity (§484.50(c)(11)). Each patient is given the Department of Health home health complaint line, 1-800-254-5164, with its contact information and purpose (§484.50(c)(9)).

The Agency investigates complaints made by a patient, the representative or caregivers about treatment or care, mistreatment, neglect, verbal, mental, sexual and physical abuse (including injuries of unknown source), and misappropriation of patient property; documents both the existence of the complaint and its resolution; and takes action to prevent further potential violations, including retaliation, while the complaint is being investigated (42 CFR §484.50(e)(1)).

Neither federal nor Pennsylvania rules set a number of days for acknowledging or resolving a complaint. The Agency acknowledges each complaint within 5 and resolves it within 30 as its own standard, and sooner where the patient’s safety requires. A complaint of patient abuse is reported at once under Policy PA-HH-SG-01 and notified in writing to the Department of Health, "whether or not confirmed by the facility" (28 Pa. Code §51.3(g)(6); Policy PA-HH-QA-02).

• At the start of care each patient and representative receives Form PA-HH-CMP-01-A, with the notice of rights (Policy PA-HH-PR-01). Receipt is documented in the record.
• The form gives the complaint officer’s name and contact details, the office number (717) 555-0100 and after-hours number (717) 555-0199, and the outside bodies in Section 8.
• Staff remind patients that they may complain at any time, to anyone, without affecting their care.

1. Receive. Any staff member who receives a complaint listens, thanks the person, takes immediate steps to keep the patient safe, and reports it to the complaint officer the same working day. Staff do not argue, promise outcomes, or ask the person to put it in writing.
2. Screen for abuse. If the complaint involves possible abuse, neglect, exploitation, injuries of unknown source or misappropriation of property, the staff member also makes the immediate report under Policy PA-HH-SG-01, and the Administrator acts under Policies PA-HH-SG-03 and PA-HH-QA-02.
3. Log. The complaint officer enters the complaint on Form PA-HH-CMP-01-B with the date received, the person, the subject and the staff involved.
4. Acknowledge within 5.
5. Investigate. The complaint officer, with the supervising nurse for clinical matters, reviews the record, interviews the patient and staff, and documents the facts. While the complaint is open, the Agency takes action to prevent further potential violations, including retaliation (42 CFR §484.50(e)(1)(iii)), for example by changing the staff assigned.
6. Resolve within 30. The complaint officer tells the person what was found and what the Agency has done, in writing if the complaint was written or the person asks, and reminds them of the outside bodies they may contact if not satisfied.
7. Escalate. If the person is not satisfied, the Administrator reviews the complaint, and then the governing body if asked.
8. Close and learn. The resolution is recorded on the log. Complaints are reviewed quarterly by the QAPI Committee (Policy PA-HH-QA-01), and complaint data feeds the annual program evaluation (28 Pa. Code §601.22(c); Policy PA-HH-GOV-04).

A complaint about the complaint officer goes to the Administrator. A complaint about the Administrator goes to the alternate administrator, Jo Sample, Alternate Administrator, who investigates and reports directly to the governing body.

Patients may contact any of these at any time, whether or not they have complained to the Agency first.

Accountability under this policy is allocated as follows.

The complaint officer keeps Form PA-HH-CMP-01-B and each complaint file (acknowledgment, investigation, resolution and any appeal) for at least seven years (Agency standard). If the Agency is Medicare-certified, the log documents both the existence of each complaint and its resolution (42 CFR §484.50(e)(1)(ii)). Each quarter the complaint officer reports to the QAPI Committee the number and type of complaints and the percentage acknowledged and resolved within the Agency’s time frames.

All staff learn at orientation and yearly how to receive a complaint, how to recognize when it is also an abuse report, and that patients must never suffer reprisal for complaining (Agency standard). The complaint officer reviews this policy and 42 CFR §484.50 at appointment.

This policy implements the following authorities.

• 42 CFR §484.50(c)(3), (c)(9), (c)(11) and (e), Patient rights: complaints (if Medicare-certified; Agency standard for all patients)
• 28 Pa. Code §51.3(g)(6), Notification of complaints of patient abuse
• 28 Pa. Code §601.22(c), Annual program evaluation
• 35 P.S. §10225.302(c), Protection from retaliation for reporters
• 45 CFR §164.530(d), Privacy 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 12 is amended, the amendment is recorded in this table and a new version of this policy is issued.