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F-Tag Review

March 14, 2017

*Article from RegPro LTC Regs

 

Happy FTag review! We will continue our review of tags that have been newly updated with new information today. Today we will review F165 – Voice Grievances Without Reprisal as well as F166 – Facility Resolves Resident Grievances. There is now a whole section on a Grievance Officer and new regulations related to how long we keep documentation on grievances and such.

F165 – Voice Grievances Without Reprisal

§483.10(j) Grievances.

§483.10(j)(1) The resident has the right to voice grievances to the facility or other agency or entity that hears grievances without discrimination or reprisal and without fear of discrimination or reprisal. Such grievances include those with respect to care and treatment which has been furnished as well as that which has not been furnished, the behavior of staff and of other residents, and other concerns regarding their LTC facility stay.

This is short and sweet, and while not much has really changed, CMS has added verbiage that the resident has the resident to voice grievances without fear of discrimination or reprisal. It also adds the blurb regarding the fact that residents have the right to file grievances regarding care as well as the behavior of staff and other residents as well as regarding their LTC stay.

There is nothing really new here that will require changes, it just requires us to ensure that residents are aware of the fact that they are allowed to voice their grievances without fear of discrimination or reprisal. We can do this by going over this with residents during resident council and any time that they come to us to voice concerns. It is also a good idea to educate all staff on the grievance policy and procedure, how to assist a resident when they have a concern, and that there is no tolerance for discrimination or reprisal should a resident voice a complaint.

F166 – Facility Resolves Resident Grievances

§483.10(j)(2) The resident has the right to and the facility must make prompt efforts by the facility to resolve grievances the resident may have, in accordance with this paragraph.

§483.10(j)(3) The facility must make information on how to file a grievance or complaint available to the resident.

§483.10(j)(4) The facility must establish a grievance policy to ensure the prompt resolution of all grievances regarding the residents’ rights contained in this paragraph.

Upon request, the provider must give a copy of the grievance policy to the resident. The grievance policy must include:

(i) Notifying resident individually or through postings in prominent locations throughout the facility of the right to file grievances orally (meaning spoken) or in writing; the right to file grievances anonymously; the contact information of the grievance official with whom a grievance can be filed, that is, his or her name, business address (mailing and email) and business phone number; a reasonable expected time frame for completing the review of the grievance; the right to obtain a written decision regarding his or her grievance; and the contact information of independent entities with whom grievances may be filed, that is, the pertinent State agency, Quality Improvement Organization, State Survey Agency and State Long Term Care Ombudsman program or protection and advocacy system;

(ii) Identifying a Grievance Official who is responsible for overseeing the grievance process, receiving and tracking grievances through to their conclusions; leading any necessary investigations by the facility; maintaining the confidentiality of all information associated with grievances, for example, the identity of the resident for those grievances submitted anonymously, issuing written grievance decisions to the resident; and coordinating with state and federal agencies as necessary in light of specific allegations;

(iii) As necessary, taking immediate action to prevent further potential violations of any resident right while the alleged violation is being investigated;

(iv) Consistent with §483.12(c)(1), immediately reporting all alleged violations involving neglect, abuse, including injuries of unknown source, and/or misappropriation of resident property, by anyone furnishing services on behalf of the provider, to the administrator of the provider; and as required by State law;

(v) Ensuring that all written grievance decisions include the date the grievance was received, a summary statement of the resident’s grievance, the steps taken to investigate the grievance, a summary of the pertinent findings or conclusions regarding the resident’s concerns(s), a statement as to whether the grievance was confirmed or not confirmed, any corrective action taken or to be taken by the facility as a result of the grievance, and the date the written decision was issued;

(vi) Taking appropriate corrective action in accordance with State law if the alleged violation of the residents’ rights is confirmed by the facility or if an outside entity having jurisdiction, such as the State Survey Agency, Quality Improvement Organization, or local law enforcement agency confirms a violation for any of these residents’ rights within its area of responsibility; and

(vii) Maintaining evidence demonstrating the result of all grievances for a period of no less than 3 years from the issuance of the grievance decision.

Intent

The intent of the regulation is to support each resident’s right to voice grievances (e.g., those about treatment, care, management of funds, lost clothing, or violation of rights) and to assure that after receiving a complaint/grievance, the facility actively seeks a resolution and keeps the resident appropriately apprised of its progress toward resolution

Interpretive Guidelines

“Voice grievances” is not limited to a formal, written grievance process but may include a resident’s verbalized complaint to facility staff.

“Prompt efforts...to resolve” include facility acknowledgment of complaint/grievances and actively working toward resolution of that complaint/grievance.

If residents’ responses indicate problems in voicing grievances and getting grievances resolved, determine how the facility deals with and makes prompt efforts to resolve resident complaints and grievances.

With permission, review resident council minutes.
Interview staff about how grievances are handled.
Interview staff about communication (to resident) of progress toward resolution of complaint/grievance.
If problems are identified, also investigate compliance with §483.10.

The major changes to F166 are:

The community must have a written policy in place which addresses:

Notification of residents on how to file a grievance verbally or in writing
That they have the right to file a grievance anonymously
The contact information for the grievance official:
Name

Business Address (mailing and email)

Business Phone Number

Estimated time frame to review the grievance (provide follow-up)

Right to obtain a written decision regarding the grievance

Contact information of independent agencies where grievances may be filed

State Agency

Quality Improvement Organization (QIO)

State Survey Agency

State Long Term Care Ombudsman program or protection

Advocacy System

Identify a Grievance Official – they will be responsible for:
Overseeing the grievance process

Receiving and tracking grievances through to their conclusion

Leading any necessary investigations by the facility

Maintaining the confidentiality of all information associated with grievances, for example, the identity of the resident for those grievances submitted anonymously

Issuing written grievance decisions to the resident; and

Coordinating with state and federal agencies as necessary in light of specific allegations

Taking immediate action to prevent further potential violations of any resident right while the alleged violation is being investigated, as necessary
Consistent with §483.12(c)(1), immediately reporting all alleged violations involving neglect, abuse, including injuries of unknown source, and/or misappropriation of resident property, by anyone furnishing services on behalf of the provider, to the administrator of the provider; and as required by State law
Ensuring that all written grievance decisions include:
The date the grievance was received

A summary statement of the resident’s grievance

The steps taken to investigate the grievance

A summary of the pertinent findings or conclusions regarding the resident’s concerns(s)

A statement as to whether the grievance was confirmed or not confirmed

Any corrective action taken or to be taken by the facility as a result of the grievance, and

The date the written decision was issued

Taking appropriate corrective action in accordance with State law if the alleged violation of the residents’ rights is confirmed by the facility or if an outside entity having jurisdiction, such as the State Survey Agency, Quality Improvement Organization, or local law enforcement agency confirms a violation for any of these residents’ rights within its area of responsibility; and
Maintaining evidence demonstrating the result of all grievances for a period of no less than 3 years from the issuance of the grievance decision.
Once you have all of this information both in your policy, posted as necessary throughout your community, notified the residents of all of the pertinent information, and have your Grievance Official following up and monitoring all of your grievances, there should be no concerns during your survey or at any other time regarding your grievance process. It is important to remember that if we are unable to come to a resolution with a resident in regards to a grievance, that we continue working with the until we are able to find some common ground and the resident is content with what was trialed. If you are having trouble, getting the ombudsman should be helpful.

To recap the purpose of our FTag Friday reviews... we do this to help people get better acquainted with the State Operations Manual (SOM), the federal regulations published by CMS for Long Term Care (LTC) communities. The SOM is a lengthy word document, which is not easy to review nor is it easy to navigate. In order to make this process easier, Reg Pro took the SOM and made it searchable via a mobile app which can be found on either iTunes or Google Play under the title LTC SOM Regs. What is nice about LTC SOM Regs app, is that any changes made to the CMS State Operations Manual are updated on your device when your device “talks” to the app server - meaning, the tags are automatically updated and you don’t have to pay extra for updates.

There is an option to buy Appendix Q, the Immediate Jeopardy Guidelines as an in-app purchase.

You can easily reference the tag we are reviewing on your app while reading our Friday FTag reviews.

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Have a wonderful weekend!

Please note: This FTag review was prepared by the author in her personal capacity. The opinions expressed in this article are the author's own and are not representative of any agency, business, or government body.

Written by


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Maritza Martinez
VP of Clinical Services

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