Grievance Policy and Acknowledgement

My Name:______Date:______

Program Name:______

I received the following information within five working days of when I started to receive services and every year after that. MN Statute 245D.10 subd. 2 and 4

  1. A copy of this policy with my signature
  2. A blank copy of a grievance report
  3. Grievance addendum with names I may contact within CIP

I.Policy

Community Involvement Programs is committed to ensuringthat I am treated with respect and that the services CIP providesto meare responsive to my needs. CIPis committed to providing a simple complaint process for me and my legal representative (if applicable) to bring grievances forward and have them resolved in a timely manner. CIP is committed to resolving complaints of grievances at the first level of services.

II.Procedures

A. Service Initiation

  1. I will be provided a copy of this policywithin five working days of service initiation.
  2. I will sign and be given a copy of the Grievance Policy and Procedures form and one will be kept in my file.

B. Definitions:

Complaint: a statement that a situation is unsatisfactory or unacceptable

Grievance: a wrong or other cause for complaint or protest, especially unfair treatment

C. How to File a Grievance

  1. Ishould firsttalk to a staff person that Ifeel comfortable with about my complaint or problem.
  2. If, after talking withthe above staff the situation cannot be satisfactorily resolved in an informal discussion, I or my legal rep (if applicable) may file a Grievance Report.
  3. If I file a grievance I will clearlyinform the staff person that I am doing so.
  4. Imay request staff assistance in filing a grievance.
  5. The Grievance Report will be given to the Program Manager or Associate Director of that service in an attempt to resolve the complaint or grievance.
  6. If I do not believe my grievance has been resolved I many bring my complaint to the Chief Services Officer at CIP.
  • That person is Jolene Thibedeau Boyd, Chief Services Officer

Community Involvement Programs

1600 Broadway Street NE

Minneapolis, MN 55413

612-362-4402

  1. In addition, the names, addresses, and contact information for the current Chief Executive Officer, Service Managers and Directors, and advocacy organizations are included in an addendum to this policy.

D. Response by CIP

1. Upon my request staff will provide assistance with the grievance process to me or my legal representative (if applicable). This assistance will include:

a. the name, address, and telephone number of outside agencies to assist me; and

b. responding to the complaint in such a manner that my concerns are addressed.

NOTE: If this grievance affects health and safety of me it must be responded to promptly

2. CIP mustrespond to me within 14 calendar days of the receipt of the complaint.

3. All complaintsmust be resolved within 30 calendar days of the receipt.

4. If the complaint is not resolved within 30 calendar days, the Manager or Associate Director, in coordination with the CSO will document the reason for the delay and determine a plan for resolution. I will be notified of why the grievance has not been resolved.

5. Once a formal complaint is received by the CSO, CIP is required to complete a Grievance Review. The grievance review will include an evaluation of whether:

  1. related policy and procedures were followed;
  2. related policy and procedures were adequate;
  3. additional staff training is necessary;
  4. the complaint is similar to past complaints with you, staff, or services involved; and
  5. A plan of action is needed by CIP to protect the health and safety of you receiving services.

6. Based on the review, CIP must develop, document, and implement an action plan to design to correct current lapses and prevent future lapses in performance by staff or CIP.

7. CIP will provide a written summary of the complaint and a notice of the complaint to me and my case manager that:

a. identifies the nature of the complaint and the date it was received;

b. includes the results of the complaint review; and

c. identifies the complaint resolution, including any corrective action or action plan

E. You will receive a copy of the grievance summary and resolution and a copy will be filed in your record.

F. If you do not agree with the final decision you may appeal by contacting the Chief Executive Officer (CEO):

  • Rita Wiersma, CEO

1600 Broadway Street NE

Minneapolis, MN 55413

612-362-4404

By signing this document I am agreeing that I understand the Grievance Policy and have been given a copy.

Person:______Date:______

Legal Representative (if applicable):______

10-6-2016/12-4-2017