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F0585
F

Grievance Forms Not Accessible to Residents

Ada, Minnesota Survey Completed on 04-09-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that grievance forms and procedures were posted in prominent locations throughout the building, making it difficult for residents and their representatives to file grievances, including anonymously. During a resident council meeting, five residents reported being unaware of how to file a grievance form. Subsequent observation by the surveyor confirmed that grievance forms were not visible or accessible in common areas of the facility. Interviews with facility staff, including the social worker and administrator, revealed that grievance forms were kept behind the nurses' station, requiring residents to request them from staff rather than accessing them independently. The facility's posted grievance procedure encouraged residents to notify the nurse in charge or contact specific facility leaders if concerns could not be resolved, and the policy stated that concern forms should be readily available. However, these forms were not accessible as described, and residents were not informed of their location or how to use them.

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