HospitalInspections.org

Based on policy review and interview, the Critical Access Hospital (CAH) failed to ensure that policies and procedures included written policies approved by the governing body to inform patients on the procedure for filing a complaint/grievance and failed to establish a process to ensure prompt resolution of patient complaints/grievances. This deficient practice places any patient receiving services at this hospital at risk of patient right violations and the inability to have concerns identified, addressed, and corrected by the hospital.


Findings Include:

Review of a hospital document titled, Patient Rights and Responsibilities" revised 09/12/23, showed, " ...File a complaint. If you have a problem with your care, you may inform any staff member or contact the Director of Nursing or the Hospital Administrator at [phone number]. We will try to resolve the problem immediately, if possible, and notify you of the results. You may lodge a grievance with the state agency directly by calling 1-800-842-0078.

On 10/16/23 at 3:30 PM, a request was made for a copy of the hospital's policies and procedures for filing a complaint/grievance and the hospital's procedural policy for complaint/grievance resolution.

During an interview on 10/17/23 at 3:25 PM, Staff B, Chief Nursing Office (CNO), stated that the hospital did not currently have a policy/procedure for the complaint/grievance process or a policy for complaint/grievance resolution.