Failure to Ensure Resident Awareness and Access to Grievance Process
Penalty
Summary
The facility failed to ensure that residents were aware of the grievance process and did not provide all residents with the option to file grievances anonymously, as required by facility policy and regulation. Specifically, on the South Unit, there was no suggestion/grievance box available for residents to submit anonymous grievances, and the box that was previously there had been removed after a resident attempted to tamper with it. Additionally, there was no suggestion/grievance box located by the social work office as stated in the facility's policy, nor were there boxes in other common areas such as the lobby, dining room, or therapy gym. Only the North and East Units had visible suggestion/grievance boxes across from the nurse's station. During a surveyor-led Resident Council meeting, seven out of eight residents reported they did not know how to file a grievance within the facility, and all eight were unaware of who the grievance official was. Interviews with facility staff, including the Director of Social Services, Administrator, and DON, revealed inconsistencies in their knowledge of the location of grievance boxes and the process for anonymous grievance submission. The Director of Social Services stated that residents were verbally informed of the grievance official upon admission, but this information was not included in admission paperwork. The Administrator and DON both assumed that grievance boxes were available on all units, but this was not the case, leading to a lack of access and awareness for residents regarding the grievance process.