Failure to Educate Residents and Staff on Grievance Process and Provide Accessible Grievance Submission
Penalty
Summary
The facility failed to educate residents on what constitutes a grievance, did not provide grievance forms, and lacked a clear and accessible method for residents to submit grievances. Multiple residents reported missing personal clothing items but were unaware of what a grievance was or how to file one. Staff members, including laundry aides, the Housekeeping/Laundry Supervisor, the Social Services Director, and the Activities Director, also demonstrated a lack of knowledge regarding the grievance process and did not advise residents to file grievances. The facility's grievance policy was not effectively communicated or implemented, and there was no visible location for residents to obtain or submit grievance forms. Resident Council meeting minutes and interviews with residents and staff confirmed that residents frequently experienced missing personal items and voiced their concerns to staff, but these concerns were not addressed through a formal grievance process. The Social Services Director, who was supposed to oversee grievances, had not been trained on the process and did not have access to grievance forms. The Administrator confirmed that there was no public location for grievance forms or a grievance box, and staff were instructed to direct all concerns to the Administrator rather than following a formal grievance procedure.