GRIEVANCE/CONCERN FORM

INSTRUCTIONS FOR REQUESTING ASSISTANCE FROM STAFF OF EATON COUNTY HEALTH & REHABILITATION SERVICES

We want to ensure that your voice is heard and that you feel safe, involved, and informed. Therefore, it is the policy of ECHRS to ensure prompt resolution of all grievances. You have the right to file grievances orally, in writing, or anonymously.

If you would like to file a grievance, the contact information for the grievance official for ECHRS is:

Stacey Steiner, Compliance Director
530 W. Beech Street, Charlotte, MI 48813
(517) 543-2940 extension 2709
ssteiner@echrshealth.org

Below is the secondary grievance official for ECHRS.

Tama Cunningham, Building Services Director
530 W. Beech Street, Charlotte, MI 48813
(517) 543-2940 extension 2722

We encourage you to follow the steps identified below if you have any concerns about your care, treatment by staff, or anything else related to your stay.

Step 1 </strong > Tell the (staff person on each shift designated to handle complaints) of your concern
Step 2 If not satisfied with the staff person’s response, complete our Grievance/Concern Patient- Resident Assistance Form. Let us know if you need help in completing this form.
Step 3 Submit the form to Stacey Steiner, Compliance Director for reported concerns.
Step 4 If not satisfied with the facility’s response, complete a request for the administrator to review the investigation findings.
Step 5 If not satisfied with the Administrator’s resolution, you may contact the State Ombudsman or the Michigan Department of Community Mental Health, Bureau of Health Systems, to file a formal complaint.

WE WANT YOU TO KNOW THE FOLLOWING

1.
We will keep your request as confidential as possible.
2.
Our time frame for investigating concerns are:
1. Immediately (means as soon as possible, but no later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or no later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the Administrator of the facility and to other officials when required)- for abuse;
2. As Soon As Possible but Within 5 days - for anything that has caused actual harm;
3. As Soon As Possible but Within 15 days - for any other concern.
3.
We will meet with you and discuss our written response and action plan as soon as possible but no later than 30 days after we receive your request. You have the right to receive a written copy of our response.
4.
We will follow-up to ensure your concern has been addressed satisfactorily and use the finding of our investigation as part of our Quality Improvement Program - again keeping your name confidential, if possible.
5.
You may contact the Michigan Department of Community Health, Bureau of Health Systems, at +1 (800) 882-6006, to file a complaint, or the State Ombudsman at +1 (866) 485-9393 for assistance.
6.
We maintain evidence demonstrating the result of all grievances for a period of no less than three years from the issuance of the grievance decision.

Please give us an opportunity to address your concerns by completing this form. There is information posted that lists the person available 24 hours a day for your assistance.