Client Rights, Responsibilities, and Complaint Process

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 establishes how Sample Home Care Agency, LLC (the "Agency") protects and promotes the rights of every client, informs each client of those rights before care begins, and receives, investigates, and resolves complaints and grievances without fear of reprisal. It implements 26 Texas Administrative Code §558.282 and the related requirements listed in Section 16.

This policy applies to every client of the Agency and to every employee, contractor, volunteer, and agent who has contact with a client, a client’s family, or a client record. It applies in all counties the Agency serves, currently Travis and Williamson Counties, and to every license category the Agency holds, currently Personal Assistance Services (PAS).

No provision of this policy may be waived, shortened, or varied by any employee.

For the purposes of this policy:

• Abuse, neglect, and exploitation (ANE) carry the meanings given in 26 TAC §558.249(a) and 40 TAC Chapter 705.
• Cause to believe means the Agency knows of, suspects, or has received an allegation of an act of abuse, neglect, or exploitation. Certainty is not required, and the Agency does not wait for proof before reporting.
• Client means a person receiving services from the Agency.
• Complaint or grievance means any expression of dissatisfaction with the Agency’s services, staff, conduct, or charges, whether made verbally or in writing, by a client, a family member, a representative, or any other person, and whether or not the word "complaint" is used.
• Employee, for reporting purposes, includes officers, contractors, volunteers, and agents of the Agency, consistent with 26 TAC §558.249(a).
• Legal representative means a court-appointed guardian, an agent acting under a medical power of attorney, or another person authorized by law to act on the client’s behalf.
• Working day means a day on which the Agency office is open, per the hours stated in Section 9.1.

The Agency protects and promotes the rights of all clients. No client is denied any right on the basis of race, color, religion, national origin, sex, age, disability, marital status, diagnosis, or source of payment.

Every client, or the client’s legal representative, receives written notice of client rights, of the Agency’s complaint process, and of the client’s right to complain directly to the State of Texas, before care begins. The Agency complies with Texas Human Resources Code Chapter 102, Rights of the Elderly, for every client age 60 or over.

A client who raises a concern is never subjected to discrimination, retaliation, a reduction in service, or discharge because of it. The Agency treats a complaint as information about its own performance, not as a dispute to be won.

In accordance with 26 TAC §558.282(f), each client has the rights listed below.

Where a court has found a client incompetent, these rights are exercised by the person appointed by the court. Where a client has not been adjudged incompetent, a legal representative may exercise the client’s rights to the extent permitted by law. The Agency records who holds that authority and files a copy of the instrument in the client record. (26 TAC §558.282(g), (h))

Each client has the right to:

1. Be informed, in advance, of the care to be furnished, the plan of care, the expected outcomes of care, any barriers to treatment, and any change to the care to be furnished. The Agency obtains the client’s written informed consent, specifying the type of care and services, before care begins.
2. Participate in the planning of care and in the planning of any change to the care, to refuse care and services, to be advised in advance of any change, and to be informed of the payment expected of the client before care begins.
3. Be assisted in understanding these rights, and to have the Agency document that the client understands them.
4. Exercise these rights.
5. Have the client’s person and property treated with consideration, respect, and full recognition of the client’s individuality and personal needs.
6. Be free from abuse, neglect, and exploitation by any employee, volunteer, or contractor of the Agency.
7. Confidential treatment of the client’s personal and medical records.
8. Voice grievances regarding treatment or care, and to be free from discrimination or reprisal for doing so.

The Agency asks each client, so far as the client is able, to meet the responsibilities listed below. A client’s failure to meet a responsibility does not remove any right in Section 5, and is never grounds for retaliation. Where a responsibility is not met and this affects the safety of staff or the viability of the service plan, the matter is addressed under Section 10.

Each client is asked to:

• Provide accurate and complete information about health status, medications, and living arrangements, and report changes.
• Participate in developing and updating the service plan and tell the Agency if the plan no longer meets the client’s needs.
• Provide a safe working environment, including reasonable steps regarding weapons, unrestrained animals, and smoking during a visit.
• Treat Agency staff with courtesy and respect, and report any concern promptly so it can be addressed.
• Notify the Agency in advance when a scheduled visit is not required.
• Meet the financial obligations set out in the service agreement.

Texas Human Resources Code Chapter 102 gives additional statutory rights to clients age 60 and over. The statutory list is reproduced in full at Appendix A and is issued as Form TX-CR-01-A. Agency staff do not paraphrase, abbreviate, or reformat the statutory text. (Tex. Hum. Res. Code §§102.003, 102.004; 26 TAC §558.301)

For every such client the Agency:

• Provides the written list of rights and responsibilities set out at Tex. Hum. Res. Code §102.003 before providing services, or as soon afterwards as possible;
• Informs the client of any change or revision to that list;
• Posts the list in a conspicuous location at the Agency office; and
• Files the signed acknowledgment in the client record.

Texas requires several separate written disclosures before or at the start of care. The Agency issues them together in the admission packet, explains each one verbally, leaves a copy in the home, and files the signed acknowledgments in the client record.

Where a client cannot read, the notices are read aloud and this is recorded. Where a client has a sensory or cognitive impairment, the Agency provides the notices in a format the client can use. Materials are available in English and Spanish, and interpretation is arranged at the Agency’s expense where a client communicates in another language. A family member is not used as an interpreter for the delivery of these notices.

This section sets out how a complaint may be made, how it is classified, acknowledged, investigated, and closed, and the separate route that applies whenever a complaint alleges abuse, neglect, or exploitation.

A client, family member, representative, or any other person may raise a complaint at any time, verbally or in writing, to any member of Agency staff. No particular form of words is required and no form has to be completed. Any staff member who receives a complaint reports it to the Administrator the same working day.

Complaints may be directed to:

Pat Sample, Administrator

Sample Home Care Agency, LLC, 100 Example Street, Suite 100, Austin, Texas 78701

Telephone (512) 555-0100, Monday through Friday, 8:00 a.m. to 5:00 p.m. Central

Outside those hours, (512) 555-0199, answered at all times

Email office@example.com

In the absence of the Administrator, Jo Sample, Alternate Administrator, carries out every duty given to the Administrator by this policy.

The Administrator classifies every complaint on receipt. Classification determines the response, not whether the complaint is investigated; every complaint is investigated and every complaint is logged.

The Agency acknowledges every complaint to the complainant within 5 of receipt, in the complainant’s preferred medium. The acknowledgment states who is handling the complaint, how to contact that person, when a response can be expected, and that the complainant may contact HHSC directly at any time.

Texas does not prescribe an acknowledgment deadline. The Agency has set its own and is accountable to it.

Investigation timeframes are set by rule. The Agency documents and initiates its investigation of a complaint within 10 days of receiving it, and completes the investigation within 30 days of receipt. Where the Agency has reasonable cause for a delay beyond 30 days, the Administrator records that cause and the revised completion date in the investigation file before the 30 days expire. (26 TAC §558.250)

The rule’s clock for a complaint that does not allege abuse, neglect, or exploitation therefore runs from the date of receipt: day 10 is the last day to document and initiate the investigation, and day 30 is the last day to complete it.

The investigation is conducted by the Administrator or, where the Administrator is the subject of the complaint, by a member of the governing body. The complete record of the investigation is kept in the investigation file maintained under Policy TX-QA-02, Section 8, and is cross-referenced to the complaint log. The investigator:

1. Records the complaint verbatim as far as possible, with the date and time received and the name of the staff member who received it;
2. Interviews the complainant, the client if different, and any staff member or witness involved, and records each account;
3. Reviews the client record, the service plan, visit documentation, electronic visit verification data where applicable, and any relevant personnel record;
4. Determines whether the complaint is substantiated, partly substantiated, or not substantiated, and records the reasoning;
5. Identifies whether the cause was individual, procedural, or systemic; and
6. Records the corrective action taken, who is responsible for it, and the date by which it must be complete.

The Agency gives the complainant a written outcome within 30 of receipt. The outcome states what was investigated, what was found, what action the Agency has taken or will take, and how to escalate if the complainant remains dissatisfied, including the HHSC details at Section 9.6. A complaint is closed on the log only when the written outcome has been issued and any corrective action has been completed and verified.

A client does not have to raise a complaint with the Agency first and does not have to wait for the Agency’s process to finish. The Agency gives every client, in writing at admission, a separate statement that a complaint about the Agency may be made at any time to:

HHSC Complaint and Incident Intake, P.O. Box 149030, Austin, Texas 78714-9030, toll free 1-800-458-9858

This statement is issued as Form TX-CR-01-C. It is a standalone document in the admission packet and is not combined with any other notice. Agency staff do not discourage, delay, or require notice of a client’s contact with HHSC. (26 TAC §558.282(d))

Where a complaint alleges, or where any member of staff otherwise has cause to believe, that a client has been abused, neglected, or exploited by an employee, volunteer, contractor, or agent of the Agency, the steps below apply and take precedence over the ordinary complaint process. No member of staff may decide that an allegation is unfounded and therefore need not be reported. The duty to report arises from having cause to believe, not from proof. Full detail is in Policy TX-ANE-01.

In every such case:

1. The Administrator reports the information to HHSC Complaint and Incident Intake on 1-800-458-9858 immediately, and never later than 24 hours after the Agency has cause to believe. (Tex. Hum. Res. Code §48.051(b-1); 26 TAC §558.249(c); HHSC PL 2023-12) Where someone other than Agency staff may be involved, or the client is neglecting their own needs, the report goes to the Texas Department of Family and Protective Services on 1-800-252-5400 or at www.txabusehotline.org.
2. The Agency begins its own investigation immediately on witnessing the act or receiving the allegation. (26 TAC §558.250(b))
3. The Agency takes immediate steps to protect the client, which may include removing the staff member from client contact pending the outcome.
4. The Agency completes HHSC Form 3613, Provider Investigation Report, and sends it to HHSC Complaint and Incident Intake at ciiprovider@hhs.texas.gov or fax 1-877-438-5827 no later than the 10th day after reporting the alleged act. (26 TAC §558.250(b)(3))
5. The Agency cooperates fully with any investigation by HHSC or DFPS and does not contact the client or family in a manner that could be construed as influencing their account.

No client is discharged, refused service, reduced in service, rescheduled to a less convenient time, or treated differently in any way because the client, a family member, or a representative made a complaint, contacted HHSC or DFPS, or cooperated with a state investigation. Any staff member who retaliates is subject to disciplinary action up to and including dismissal.

Where a client who has complained is subsequently discharged or has services reduced for a legitimate reason, the Administrator records the reason in the client record before the change takes effect, and confirms it in writing to the client.

The Agency maintains a single complaint log at its principal office recording every complaint received, whatever its level and however it was made. The log format is at Appendix D. It is reviewed by the Administrator monthly and reported to the QAPI Committee under Section 12.

The complaint pathway runs from receipt, through classification, acknowledgment, investigation, and written outcome, to closure on the log. An allegation of abuse, neglect, or exploitation leaves that pathway at classification and follows the separate route in Section 9.7, with the report to HHSC, or to DFPS where Section 9.7 says so, made immediately and never held back for the internal investigation.

A client has the right to be advised in advance of any change to the care furnished. Services are never reduced or withdrawn as a response to a complaint (see Section 9.8).

Where the Agency proposes to reduce, transfer, or discontinue services, the Administrator:

• Gives the client and, where applicable, the referring practitioner advance written notice stating the reason and the effective date;
• Records the clinical or operational basis for the decision in the client record;
• Offers information on alternative providers and, where the client consents, coordinates the transfer; and
• For a client age 60 or over, observes the additional protections at Tex. Hum. Res. Code §102.003(r) and (s).

The following are filed in the client record and retained for five years after the client is discharged, or until any related litigation is concluded if that is later. (26 TAC §558.301)

Complaint data is a required input to the Agency’s QAPI program. 26 TAC §558.287 requires the program to measure, among other things, complaints of staff misconduct, the appropriateness of the Agency’s response to complaints, and client complaint and satisfaction survey data.

Where a problem identified through complaints directly or potentially threatens client care or safety, the Agency corrects it immediately and does not wait for the next committee meeting. (26 TAC §558.287)

Accordingly, the Administrator reports the following to the QAPI Committee, which meets at least twice a year:

• The number of complaints received in the period, by level and by service area;
• The proportion acknowledged within 5 and closed within 30;
• Themes and repeat issues, with an assessment of whether the cause is individual, procedural, or systemic;
• Every complaint classified Level 3 or Level 4, individually;
• Corrective actions taken and evidence that they worked; and
• Any complaint where the 30-day deadline was missed, with the reason.

Training on this policy is delivered and recorded as follows.

Accountability under this policy is allocated as follows.

The Administrator audits compliance with this policy quarterly by sampling at least ten percent of active client records, or five records, whichever is greater, and confirming that each notice in Table 1 is present, signed, and dated before the start-of-care date. Findings are recorded and reported to the QAPI Committee. A missing or undated acknowledgment is corrected immediately and the cause addressed.

This policy implements the following authorities.

• 26 Texas Administrative Code §558.249, Self-Reported Incidents of Abuse, Neglect, and Exploitation
• 26 Texas Administrative Code §558.250, Agency Investigations
• 26 Texas Administrative Code §558.282, Client Conduct and Responsibility and Client Rights
• 26 Texas Administrative Code §558.283, Advance Directives
• 26 Texas Administrative Code §558.287, Quality Assessment and Performance Improvement
• 26 Texas Administrative Code §558.292, Agency and Client Agreement and Disclosure
• 26 Texas Administrative Code §558.301, Client Records
• Texas Human Resources Code, Chapter 102, Rights of the Elderly
• Texas Health and Safety Code, Chapter 142, Home and Community Support Services
• HHSC Form 3613, Provider Investigation Report (Home Health, Hospice and Personal Assistance Services Provider Use Only)

The following documents are read together with this policy.

This policy is adopted by the governing body of Sample Home Care Agency, LLC and is effective from October 1, 2026. It was approved by Pat Sample, Administrator on October 1, 2026.

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.