Retirement Community

Management Complaint Policy Policy:

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Hughes Memorial (HM) Participants, caregivers or persons acting on their behalf have the right to express dissatisfaction, orally or in writing, with service delivery or quality of care furnished.

 

Participants and persons acting on their behalf have the right to appeal certain actions by the Accessing Independence staff, including denial of a request for a service or to continue a service and involuntary termination.

 

It is the policy of HM to adhere to the OLTL Policy: 55 P A CODE Ch 52, Section 52.18
Complaint management; and, OLTL Bulletin # 05-11-06, 51-11-06, 52-11-06, 54-11-06,
55-11-06, 59-11- 06, Critical Incident Management Policy for Office of Long Term Living Home and Community Based Services Programs

 

Definition of a Complaint:

 

Dissatisfaction with any aspect of program operations, activities, or services received or not
received involving Home and Community Based Services are considered complaints.
A complaint is any criticism, accusation or charge of inadequacy of services provided by a HM staff or its subcontractors.

 

A complaint is any expression of dissatisfaction, either orally or in writing, with service delivery or the quality of care furnished by HM and its subcontractors. If a staff member is unable to distinguish between a complaint and inquiries, then those concerns shall be treated as a complaint. Even “informal” feedback received from participants, caregivers, participant satisfaction surveys or providers will be addressed as complaints.

 

Procedure:

 

Hughes Memorial staffing supervisors have responsibility for:

 

▪ Maintaining the incident, complaint, grievance and appeals procedures
The Executive Director has responsibility for:

 

▪ Ongoing review of complaint operations

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▪ Identifying any patterns of complaints , bringing such patterns to the attention of the HM
Quality Management Team so the patterns will be addressed in the formulation of policy
changes and procedural improvements,

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▪ Maintaining the written/electronic records of all incidents, complaints, grievance and
appeals

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▪ Aggregating and analyzing information on incidents, complaints, grievances and appeals

to be used in the Quality Assessment and Performance Improvement Program ▪ Providing
incident, complaint, grievance and appeal training to staff at both initial orientation and
annually.

 

The Staffing Supervisors have the primary responsibility for assuring that the process for
receipt, documentation and resolution of complaints and appeals are fully implemented and adhered to by HM staff.

 

Any staff receiving a complaint will immediately notify the Staffing Supervisor who will assure an electronic record is created, including date, identification of the individual recording thecomplaint and disposition.

 

The written/electronic records of complaints shall be maintained by the Executive Director and be made available for review by the DPW OLTL Bureau of Home and Community Based Services and Department of Health auditors when requested.

 

All AI staff will ensure confidentiality of all complaint information and that there is no
discrimination against a consumer because he/she files a complaint.

 

Notification:

 

Upon enrollment (through the Consumer Rights and Responsibilities Document) HM
enrollment staff will provide every participant with written information regarding the Complaint Process.

 

Complaint Process Filing, Documenting, Responding to and Resolving Complaints

 

The participant, caregiver or person acting on his/her behalf may discuss his/her complaint with any HM staff member. The staff member receiving the complaint should encourage the
participant (and grieving party, if different) to supply complete information. The staff member should immediately notify the Staffing Supervisor who will assume responsibility for processing the complaint.

 

If a participant desires assistance in filing a complaint from someone other than HM staff, HM will immediately notify the state designated long term care, and cooperate with them in assisting the participant in the process.

 

The Staffing Supervisor will immediately (within 24 hours during work week) document its
receipt on the electronic Participant Complaint Log.

Documentation will include as much information as possible, but at a minimum, the date the complaint was received, name of participant or grieving party and their relationship to the participant, phone number and the description of the complaint. Upon entry into the system, the Executive Director will be notified via email that a complaint has been received.

 

Within 24 hours of receipt of the complaint, the Staffing Supervisor will provide to the participant (and grieving party, if different) acknowledgement of HM’s receipt of the complaint, including the specific steps and timeframes for resolving the complaint. This interaction will be documented in the HM complaint log.

 

The Staffing Supervisor working closely with the appropriate staff member has five days from the receipt of the complaint to recommend a solution. If the participant (or grieving party, if different) agrees to the proposed solution within that time frame, the complaint is considered resolved.

 

The Staffing Supervisor will complete the remainder of the electronic Complaint Form Log,
documenting the resolution. A printed copy of the completed Form should be sent to the
participant (and grieving party, if different) as written documentation of the resolution.
If a solution is not found by the Staffing Supervisor working with the staff or agreed to by the participant (and grieving party, if different) within five working days, the Executive Director will be notified by the Staffing Supervisor for further action.

 

After further investigation and attempts to resolve the complaint, the Executive Director will
complete a written report that either approves or disapproves the HM staff’s solution, and
forwards a copy within 5 working days to the participant (and grieving party, if different).

 

This report is considered to be AI final disposition to the complaint.

 

A notice accompanies the final report stating that if the participant (or grieving party, if different) is not satisfied with this action, he/she has 30 days to pursue filing a PA561.

 

OLTL Hearing and Appeal Bulletin, Instructions and Forms:
 

http://www.dhs.pa.gov/publications/bulletinsearch/index.htm

 

Participant’s Responsibility in Filing an Appeal
 

If a participant requests to appeal through the DPW OLTL process, the Staffing Supervisor will refer the participant to their service coordinator and contact the service coordinator within one business day.

 

The following is a link to State provisions:

 

http://www.pacode.com/secure/data/055/chapter275/chap275toc.html

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HM’s Responsibility Related to the Appeal

 

▪ HM may not take the proposed adverse action until at least 30 calendar days have
elapsed from the date the consumer was notified of the intent to reduce or terminate
services.

 

▪ HM will date-stamp any submitted appeal request and forward it to the Department of
Public Welfare, Bureau of Hearings and Appeals in Harrisburg. An appeal request
received on or before the thirtieth day of the time limit will be considered “timely” and will
be forwarded.

 

Service Provision During an Appeal – If, within 10 calendar days of the date the participant
was notified of the adverse action, HM receives an appeal requesting a hearing, the existing
level of services must continue until the appeal is heard and a decision is rendered by the
Bureau of Hearings and Appeals.

 

Should service reduction and/or termination be due to the existence of unsafe or unsanitary conditions or because activities are occurring which
jeopardize the health or safety of an attendant and/or the HM staff, the Executive Director
needs to consult with the Bureau of Home and Community BS to develop a plan of action.

 

“The BHCBS recognizes that home and community based programming is unique in the
demands placed upon service providers. That is, unlike financial assistance entitlement
programming and/or many other services of the Department, the HCBS Waiver programs are “in-home” services models. Staff acting on behalf of the HCBS Waivers routinely provide service at all hours of the day or night and most often in the presence of no other persons (apart from the participant). In recognition of this fact, the Department will not knowingly require HCBS funded personnel to risk assault or other significant harm in the fulfillment of duty.

 

The BHCBS will send an explanatory letter to the participant (with a copy to AI) should service suspension be deemed necessary. The Department will also inform the Departmental Legal Counsel and other authorities, as appropriate.”

 

Notification of the BHCBS Staff

 

AI, Executive Director, must verbally notify the appropriate state BHCBS regional contract

manager when HM is aware that a participant is filing an appeal. When the appeal is forwarded to the Bureau of Hearings and Appeals, HM will forward a copy to the Office of Long Term Living, BHCBS.

 

HM will send copies of all decisions received from the Bureau of Hearings and Appeals, to
the regional contract manager within three working days of receipt of the decision.

 

Complaint Log

 

Purpose: To define where complaints are documented and recorded.

Procedure: Upon receiving a complaint, the staffing supervisor will document grievance onto the complaint log, which is located at: S:\Complaints\Complaint Tracking. All notes, follow up, and manager approval will be documented on that log as well.

 

Complaint Management Process

 

First point of contact should document complaint/issue brought to their attention using Incident Management Log to record event:

 

1. Once reports of complaint/issues occur the supervisor determine the level of the allegations by: a.
Determine if complaint requires EIM/critical incident reporting

 

b. Talking to the Safety Mentor to determine level of involvement by same (Once determination is
made that incident requires safety mentor/certified investigator intervention, complaint is turned over
to Safety Mentor (further details on actions from Safety Mentor below).

 

c. Speak with all parties involved in the complaint/issue when concerns are related to PCA work
performance/level of care concerns

 

d. Create resolution/action plan to consumer’s satisfaction to resolve the complaint/issues.

 

2. Complete and wrap up the findings and complete report with resolution and save report on the “s” drive, incident report folder.

 

3. Once investigation is complete, a copy of the report is sent to ILS Executive Director, Support
Coordinator (where applicable) and supervisor should follow up with all parties regularly to be sure of no further occurrences.

 

Safety Mentor/Certified Investigator Process:

 

1. Discuss incidents with the first point of contact to determine level of involvement.
 

2. Record the incident on Activity Master List to include from whom, the date received, subject matter.

 

3. Immediately make contact with the consumer or PCA to clarify the concern or complaint as to the “who, what, where, when and how” and plan of action.
 

4. From there, and depending on the nature of the concern or complaint, assess what follow‐up is required to resolve it.
 

5. Formalize the complaint or concern by drafting a written report and share with the staffing department (which includes staffing supervisors, senior staffing supervisor program specialist and executive director) via e‐mail and save file to appropriate drive depending on the nature of the complaint or concern. The report will identify the specifics of the complaint; the follow‐up that was conducted; safety mentor observations and recommendations; and its resolution.