POLICY: All Patients/Caregivers Have the Right to Lodge a Formal Complaint

S2AY Network Administrative Manual

Revised March 21, 2017

Revised December 19, 2017

COMPLAINT PROCESS

POLICY: All patients/caregivers have the right to lodge a formal complaint.

PURPOSE: To provide a process for acting on a complaint in a timely and appropriate manner.

REFERENCES:NYCRR Title 10- 766.9 (j)(1)(2)(3)(4); 766.1(a)

45 CFR 164.530 (e) (1), 164.530 (g) (2) (i-iii), 164.530(h) and 164.306

PHL 751.9 –patient’s right to complain

PHL 751.3 (a) m(3)-process to handle complaints

GENERAL INFORMATION:

• The patient may lodge a complaint regarding breach in individually identifiable health information in writing directly to The Office of the Inspector General at 26 Federal Plaza Suite 3312 Jacob Javits Federal Building New York NY, 10278.

• The Agency cannot require that the complainant waive any of their rights as a condition for providing care, or being considered eligible for services.

PROCEDURE:

• At admission, all patients will receive, or have access to, written information regarding the Agency’s Complaint Process in their preferred language (see attached sample Patient Complaint Process Notification Form).

• If an individual wishes to lodge a formal complaint, advise the complainant that they may contact the Agency Complaint Officer/Designee. Workforce members will advise their supervisor of any complaints.
• Supervisory staff will forward appropriate complaints to the Agency Complaint Officer/Designee.

• The complaint can be initiated verbally or in writing. Document complaint in the Complaint Summary Section of the Complaint Form and on the complaint log. Forward Complaint Form to the Complaint Officer/Designee.
• The Complaint Officer/Designee will proceed as follows:

• If applicable, Complaint Officer/Designee will acknowledge receipt of complaint to the complainant within 24 hours or the next business day.
• Determine the nature of complaint and conduct full investigation which may include:
• Review record
• Workforce interview(s)
• Any other pertinent information

Document investigation in the Investigation Section of the Complaint Form.

• Upon completion of investigation, document any action taken in the Resolution Section of the Complaint Form which may include:
• Correspondence with complainant and degree of satisfaction
• Staff education/counseling
• Policy changes
• Any other actions taken

• Communicate results of investigation with workforce, supervisory staff and complainant no later than 15 working days from the date of initial complaint. If a complaint is received in writing, the response will be provided to complainant in writing. If complaint is received orally, the response may be provided verbally or in writing if requested by complainant. The response to the complainant will include a summary of the conclusion, but will not detail specifics of the investigation or corrective actions taken. When more than 15 days are required to resolve a complaint, the Complaints Officer/ Designee will keep the complainant apprised of progress in the investigation. The reason for delayed resolution will be documented in the log and the Department Head will be apprised of the reason(s) for the delay.
• All documentation pertaining to complaint, investigation and corrective action are considered quality assurance records by the Agency and will be retained for a minimum of 3 years. Such records are not part of the patient record.
• If complainant satisfaction is not achieved, advise the complainant of the right to appeal and the appeal procedure including review by a member or committee of the governing authority within 30 days of receipt of the appeal. If the complainant is not satisfied with the agency’s response, they may complain to:

NYSDOH Office of Health Systems Management at 1-800-628-5972

Complaints regarding breach in individually identifiable health information may be submitted in writing directly to The Office of the Inspector General at 26 Federal Plaza Suite 3312 Jacob Javits Federal Building New York NY, 10278.

• All complaints are reported to Professional Advisory Committee no less than 2 times/year and documented in minutes.

• Complaints may be recorded on a Complaint Log (see attached sample Complaint Log).

1

COMPLAINT LOG

SAMPLE COMPLAINT FORM

ID# of Patient ______

Complaint received from:

Relationship to patient:

Date Complaint Received: Date Problem occurred:

Complaint Summary:

Signature: Date:

Investigation:

Signature: Date:

Resolution (actions taken):

(attach copy of written correspondence with complainant, if applicable)

Signature: Date:

Signature and date of Director: _____/_____/_____

Sample

Patient Complaint Process Notification

1. If you have a suggestion, concern, or complaint about your care, you should first discuss it with your primary nurse. If she/he cannot resolve it:

• You may call the Nursing Supervisor, or
• Health Department Director at: PHONE or (800) NUMBER

1. If you have not received a satisfactory answer, you should send your complaint in writing to:

Health Department Director

County Health Department

INSERT ADDRESS

You will receive a response within 15 days.

1. If your complaint is not resolved through the steps listed above, you may contact:

Licensed Home Care Services Agency patients may contact:

New York State Department of Health

Western Regional Office, Home Health Services

335 East Main Street

Rochester, New York 12180-2299

585-423-8121

OR

Clinic patients may contact:

New York State Department of Health

Centralized Hospital Intake Program

Mailstop: CA/DS

Empire State Plaza

Albany, NY 12237

1-800-804-5447

OR

NYSDOH Office of Health Systems Management at 1-800-628-5972

1. Complaints regarding breach in individually identifiable health information may be submitted in writing directly to The Office of the Inspector General at 26 Federal Plaza, Suite 3312, Jacob Javits Federal Building, New York, NY 10278.