F585 Grievance Process and Resolution

F585 has been cited 580 times during the 2024 Fiscal year. An effective Grievance Process that is consistently carried out with timely complaint resolution reduces the risk of issues escalating. In this week’s blog, we examine the essential elements of an effective Grievance Process, steps to ensure compliance and examples of recent deficiencies….

Residents have the right to voice grievances about their care, treatment, staff behavior, other residents, and other concerns regarding their stay without fear of discrimination or reprisal. Facilities must make prompt efforts to resolve these grievances and provide residents with information on how to file them. Facilities must also provide a copy of the grievance policy to residents upon request.

The facility must have a grievance policy that includes:

1. Informing residents of their rights to file grievances orally or in writing, anonymously, and providing contact information for the grievance official and relevant independent entities.
2. Appointing a Grievance Official responsible for managing the grievance process, maintaining confidentiality, issuing written decisions, and coordinating with state and federal agencies.
3. Taking immediate action to prevent further potential rights violations during investigations.
4. Reporting all alleged violations involving neglect, abuse, or misappropriation of property to the provider’s administrator and as required by state law.
5. Ensuring written grievance decisions include the date received, a summary of the grievance, investigation steps, findings, confirmation status, corrective actions, and the decision issuance date.
6. Taking corrective action if a resident’s rights violation is confirmed by the facility or an outside entity.
7. Keeping evidence of all grievance outcomes for at least three years.

The intent of this regulation is to support each resident’s right to voice grievances about various issues, including treatment, care, management of funds, lost clothing, or rights violations. Facilities must have a policy in place to process these grievances. Staff are responsible for making prompt efforts to resolve grievances and keeping residents informed about the progress toward resolution.

Examples of F585 Citations:

F585 has been cited 580 times during the 2024 Fiscal year, only once with scope and severity of G or higher (CASPER data retrieved 7/21/24.)

• • • A resident had received an electric scooter that was delivered unassembled. It remained in a box at the foot of the bed for several weeks. The Social Services Director provided the resident with a phone number of a company that might be able to assemble it for the resident. The resident was unsuccessful getting assistance with the number provided. Resident was told that the facility would contact someone else to assist with assembly, but did not follow up on this. This was not recorded on the facility’s Grievance Log.
    • Resident had reported to staff that roommates’ overbed light was not working, so when staff enters room to provide care for roommate, they turn on the overhead light, waking this resident up. Previous administrator kept telling resident he would get it fixed, but never did. This was not recorded on the facility’s Grievance Log.
    • The Resident Council President (RCP) reported the Activities Director (AD) ran the Resident Council meetings and the RCP was not provided with the minutes from the prior meetings. She reported she did not remember the AD reporting on old business and the status of resolving concerns. An interview was conducted with the AD, she was asked what her process for addressing concerns voiced by residents at Resident Council was. She reported after the meeting, she would verbally tell department heads about the concerns voiced by the residents. She stated she did not receive the resolutions to the grievance voiced at the meetings or the status of the actions on the concern. She confirmed she didn’t review old business with the residents at their next meeting. She stated she had not thought about doing that. She reported she didn’t have a reason for why sometimes she used the Resident Council Minutes form and sometimes she did not.
    • Score & Severity of K: The facility failed to follow grievance policies and procedures when a resident reported a shortage of Methadone. The Director of Nursing confirmed the medication was documented as administered but did not interview the resident or investigate potential supply issues. As a result, the problem persisted, causing the resident severe pain and anxiety, fearing withdrawal symptoms. Immediate jeopardy began when the resident’s grievance was filed, and the lack of a thorough investigation left the issue unresolved.

Determine Compliance:

1. Ensure that information about the Grievance Process is posted is a prominent location and is visible to residents, visitors and employees. Grievance Policy should be included in the admission packet.
2. Include name and contact information of the Grievance Official on the posting mentioned above.
3. Use same immediate actions as with any allegation of neglect, abuse, or misappropriation of property as indicated.
4. Follow abuse, neglect, misappropriation policy to determine if grievance is a reportable event.
5. Grievance Reports should be audited as part of the QAPI process to determine that all necessary data is included and the report was completed timely.
6. Determine that corrective action is documented on the report and that it was discussed with the resident, or the person that filed the report on a resident’s behalf.
7. Determine that completed reports are kept in a secure location and that all applicable documents are attached.

In conclusion, the F585 regulation underscores the importance of a comprehensive grievance process to protect residents’ rights in long-term care facilities. By ensuring residents can voice their concerns without fear of retaliation and mandating facilities to have clear policies and procedures for addressing grievances, it promotes a higher standard of care and accountability. Facilities must be diligent in documenting, investigating, and resolving grievances promptly while maintaining transparency and communication with residents. This commitment to addressing grievances not only upholds residents’ rights but also fosters a more responsive and respectful care environment.