QAPI Program Utilization_Manual

It is the policy of our Agency to provide for a systematic approach to resolve conflicts that may arise in the care of or services provided to a patient. PROCEDURE: Any patient and or family member, who identifies an issue that presents a conflict in the care which the patient is receiving, will be encouraged to address that issue with the following classes of staff, in order of the priority listed: Direct of Nursing, Clinical ManagerImmediate Supervisor, Case Managers In the event that the conflict cannot be resolved within the above classes, the family or patient will be directed to the Administrator to allow for a multidisciplinary approach toward resolution of the conflict. GRIEVANCE PROCEDURE (Information for our patients) 1. Any person, who believes he or she has been subjected to discrimination, or otherwise denied equitable and fair treatment, may file a grievance under these procedures. The Agency will not retaliate against anyone solely for filing a grievance or cooperation in the investigation of a grievance. 2. Grievances must be submitted to the Agency within thirty (30) days of the date the person filing the grievance becomes aware of the action. 3. A complaint should be in writing/phone, containing the name and address of the person filing it. The complaint must state the problem or action alleged to have occurred and the remedy or relief sought by the grievant. 4. The Director of Nursing, Clinical Manager or Administrator shall conduct an investigation of the complaint to determine its validity. This investigation may be informal, but it has to be thorough, affording all interested persons the ability to submit evidence relevant to the complaint 5. The Director of Nursing, Clinical Manager will maintain the files and records of the Agency relating to such grievance. 6. The Director of Nursing, Clinical Manager will issue a written decision on the grievance no later than thirty (30) days after its filing. 7. The grievant may appeal the decision of the Director of Nursing, Clinical Manager by filing an appeal in writing to the Administrator of the Home Health Agency within fifteen (15) days of receiving the Director of Nursing's decision. 8. The Administrator shall issue a written decision in response to the appeal no later than thirty (30) days after filing. 9. The availability and use of the grievance procedure does not preclude a person pursuing other remedies accorded by local, State and Federal laws and regulations. All Patient’s complaints must be followed for the appropriate response and satisfaction of the patient/family, after 10 days of the formal response is delivered to the patient/family, the DON, Clinical Manager/Administrator will designate a staff to received feedback from patient/family regarding the satisfaction on the complaint solution, and the employee must inform to DON, Clinical Manager/Administrator his/her finding. Any negative feedback must be followed until the matter are solved at patient/family satisfaction, within the law/regulations, and Agency’s Policy. At Admission date the patient will be informed of the availability of telephone hot line for questions, fraud reporting, information on Advance Directives or complaint from: Accreditation body (if applicable), CMS (Medicare or Medicaid beneficiary), State Regulatory Agency, and our Agency. (A labels with this information will be placed in the cover of the admission package) Agency Investigation of complaints: 1) Our HHA must: (i) Investigate complaints made by a patient, the patient’s representative (if any), and the patient’s caregivers and family, including, but not limited to, the following topics: (A) Treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately; and (B) Mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and/or misappropriation of patient property by anyone furnishing services on behalf of our Agency. (ii) Document both the existence of the complaint and the resolution of the complaint; and (iii) Take action to prevent further potential violations, including retaliation, while the complaint is being investigated. (2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to our Agency and other appropriate authorities in accordance with state law. (Contact information for our Agency administrator, including the name, business address, and business phone number will be provided to our patients receive complaints) 54