Policy Manual

 
  3.MEP.23  

Client Grievance and Appeal      

Type: Procedure                 Category: Service Delivery                 Level: Community Care 

Parties: Community Care Employees and Contractees

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Supporting References: COA Standard CR 3: Grievance Procedures; COA Standard VOC 11.02; Rights of Recipients of Mental Health Services Who are Children in Need of Treatment page 15; Rights of Recipients of Mental Health Services; Rules for the Licensure of Residential Child Care Facilities 4.B. (5); Mental Health Regulations SC.17.A.4. The Department of Behavioral and Developmental Services (Grievance Process Guide).

Parent Effective Date Approval Level Revision Dates Last Reviewed
N/A  11-1-1995  Management Team  11/95, 5/97, 12/97, 9/00, 3/03, 12/08  12-1-2008
Related Document Code Related Document Name Type
2.ME.1 Ethical Conduct for Making and Receiving Referrals Policy

Procedure:  .

1. The client, his/her guardian, legally responsible parent, his/her attorney, designated representative, a representative of state governmental rights protection or advocacy agency, or other person(s) specifically aggrieved may make a grievance.

2. Filing a grievance will not result in disciplinary action, reprisal, loss of privileges, or loss of services to the individual filing the grievance (heretofore called the �grievant�). The agency employee and/or contractee receiving the grievance shall immediately refer the grievant to the Executive Director or designee (as outlined below), who shall inform the grievant of his/her rights and due process under the law, and explain the informal and formal grievance procedure process available.

3. Community Care will encourage the use of informal resolution procedures for the investigation and resolution of grievances. Clients will have access to their service provider or designee to share verbal or written complaints and grievances. The service provider or designee is responsible for submitting all grievance information to their supervisor or Program Director for investigation. Documentation of informal grievances will be added to the case record and submitted to the client and/or legally responsible parent or guardian.

4. The service provider or designee will advise the client to first attempt to resolve the issue through discussion with the involved individual. If the client is unwilling to discuss the complaint, the individual involved or his/her immediate supervisor will advise the grievant of Community Care's formal grievance procedure as outlined below.

5. Steps of a formal grievance:

a. The Executive Director, or designee (as outlined below), shall document the grievance in writing using Community Care's Client Complaint Form and attempt to resolve the issue to the client�s/guardian�s satisfaction in a timely manner. Full documentation of this shall appear in the case record. Any time successful resolution cannot be achieved at the agency level or if the grievant chooses to bypass the internal resolution, the grievant will be provided information and assistance, if desired, in filing a formal grievance with The Department Health and Human Services. At a minimum, all grievants shall be provided with the DHHS Grievance Form, which must be completed and submitted to The Department of Health and Human Services in order to begin the formal grievance resolution process. For a full and complete explanation of the grievance process for clients receiving services under the auspices of The Department of Health and Human Services, please refer to the Rights of Recipients of Mental Health Services Who Are Children In Need of Treatment and/or Rights of Recipients of Mental Health Services.

b. Formal grievances using the DHHS Grievance Form are filed first with the grievant�s service provider or directly with supervisor or Program Director if the grievance is against the service provider.

c. A copy of the formal grievance is forwarded to the Executive Director, who enters it into the Master Complaint File and forwards the grievance to the DHHS Grievance Coordinator. Once the formal grievance has been filed, the process for resolution is as outlined in the Rights of Recipients of Mental Health Services Who Are Children In Need of Treatment and/or Rights of Recipients of Mental Health Services.

6. Through each step of the grievance procedure, the grievant has the right to:

a. Be represented by an advocate from the State Office of Advocacy Service,

b. Review any information obtained in the processing of the grievance, except that which would violate the confidentiality of another person,

c. Present evidence or witnesses pertinent to the grievance, and

d. Receive of complete findings and recommendation(s), except that which would violate the confidentiality of another person.

7. Community Care will make an electronic or written record of all formal grievance proceedings and an electronic recording of all grievance hearings.

8. Community Care bears the burden of proof to show remedial action taken in compliance with agency or state client rights policies and procedures in all grievances filed.

9. The final report for all grievances shall include a determination of Community Care's adherence to agency and/or state client rights policies and procedures, supporting evidence, and proposed specific remedial steps to assure policy and procedure compliance.

10. Any time a client and/or legal guardian is not satisfied with the findings of a formal grievance, they have the right to an appeal. The appeal process may include review by the Community Care Board of Directors, Mediation, and/or an Administrative Hearing. The Mediation and Administrative Hearing process is outlined in Rights of Recipients of Mental Health Services Who Are Children In Need of Treatment and Rights of Recipients of Mental Health Services.

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