Client Grievance and Investigation

Purpose: 

Recover Care desires to promptly and appropriately respond to all complaints from clients / client representatives. Clients/client representatives shall be encouraged to submit grievances, or to provide suggestions regarding any aspects of the agency's service. Any person voicing a grievance shall be free from reprisal. Clients and home care staff shall be made aware of grievance procedure. 

Regulation: RC-C4
Policy: 144A.4791(11)

Process:

A grievance stems from a client’s perception of care and is most often related to practice, process or communication skills. 

Issuing a Grievance:

  1. The procedure for issuing a complaint or grievance, with both the agency and with the Department of Health, will be part of the client handbook and given to each client or responsible party during the initial client assessment.
    • A client has the right to make complaints to the agency 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 agency.
  2. Clients and family members will be encouraged to discuss grievances, comments, and suggestions, which are opportunities to improve performance and are welcomed by the Recover Care team.
  3. It is encouraged that clients register grievances immediately and preferably within seven days from onset. All grievances will be addressed.
  4. A Grievance can be accepted by any member of the staff. It will be documented using the Grievance Form.
  5. Recover Care must not take any action that negatively affects a client in retaliation for a complaint made or a concern expressed by the client or the client’s representative.

Documenting and Addressing a Grievance:

  1. The individual who receives the grievance, will complete the Grievance Form to document the complaint, and a description of the resolution.
    • This same individual will track on the Grievance Tracking form
    • This log, and its Grievance forms, will be stored in the administrative shared folder. As your supervisor for clarification where. 
  2. The Administrator, or designee, shall be informed immediately of any grievance. 
  3. The Administrator will personally respond or designate the individual that will respond to the complaint, and will act to prevent further potential violations
  4. Wherever possible, grievances shall be responded to immediately. Under no circumstances shall a response to a grievance be longer than seven days.
  5. If there is any question about a complaint, the Administrator, COO, or CSO should be contacted.
  6. Grievances will be addressed in two categories: 
    1. A Serious Grievance is defined as complaint regarding a high-risk practice that could significantly impact the client and/or the company. Example: “I haven’t seen my nurse for a while” or “My nurse never seems to get my meds right”
    2. A Negative Grievance is defined as a complaint or dislike for a particular process or practice and includes any other issue that is not a Serious Grievance. Example: “My homemaker never washes all the dishes” or “I can never get through to my nurse with a request”
  7. Grievances are not retained in the medical record as they both are operational practices and are not related to the client’s plan of care.
  8. If the complaint is about a clinical event, the clinical information is documented in the chart with appropriate follow-up, ex: call to physician and subsequent orders.

Investigating a Grievance:

  1. All grievances should be investigated and followed up to, however Recover Care must investigate complaints made by clients, representatives, caregivers, and families including, but not limited to:
    • Treatment or care that was (or failed to be) furnished, or was furnished inconsistently or inappropriately.
    • Allegations of mistreatment, neglect, or verbal, mental, psychosocial, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone furnishing services on behalf of the Home Health Agency
    • Any infringement of the client’s Bill of Rights
    • The above grievances are examples of grievances that would be elevated to a Level 3 incident for investigation (see Incident Policy)
  2. A grievance may rise to the level of an Incident Report and investigation, if the client has registered a concern and it poses immediate jeopardy to the client or has resulted in actual harm, or has a high risk for actual harm, it would be elevated to a L3 incident. 
    • For example: if the comment, “I haven’t seen my nurse for a while “results in the client not taking medications and having to call or see the physician (or go the ER) for any clinical reason, i.e., change in blood pressure, hypertension, lung congestion, peripheral edema, or wound, etc. or there is an adverse event or negative outcome, this is a L3 incident.

Ongoing Quality Improvement:

  1. The Grievance Tracking form is used to document a brief description of all grievances and complaints – it is used to identify any patterns, trends and opportunities for improvement. The tracking form will be reviewed quarterly by the Administrator.
    • This log will be retained for at least 2 years and will be made available, upon request, to surveyors and investigators from the Minnesota Department of Health.
  2. All grievances and complaints are reviewed quarterly and are used as tools to develop the quarterly QAPI plan (see Quality Management Policy).
  3. Handling of clients’ complaints, reporting of complaints, and where to report complains including information on the Office of Health Facility Complaints and the Common Entry Point shall be included as part of all new home care employee orientation