Or. Admin. Code § 411-318-0015 - Complaints
(1) The Department
and local programs must address all complaints in accordance with their
policies and procedures and these rules.
(2) Department staff and program staff
addressing or reviewing a complaint may not have a conflict of interest with
the complaint or the complainant.
(3) A complaint related to a developmental
disabilities service or provider may be filed at any time.
(4) A complaint may include, but is not
limited to:
(a) An expression of
dissatisfaction with a developmental disabilities service or provider. For
example:
(A) The person-centered planning
process, including but not limited to people chosen by an individual or an
individual's ability to make informed, timely choices.
(B) Service planning as described in OAR
411-415-0070, including but not
limited to an individual's choice of providers or additional services meeting
an individual's needs, such as protocols, Positive Behavior Support Plans,
Career Development Plans, etc.
(C)
Home and community-based services as defined in OAR
411-317-0000, including but not
limited to an individual's ability to choose their home, desired room
decorations, food preferences, and transportation.
(D) Employment services, including but not
limited to the choice of being employed, the choice to not be employed, or
employment opportunities.
(b) An allegation of circumstances or events
that are contrary to law, rule, policy, or otherwise, as determined by a
complainant.
(5) The
complaint process described in this rule does not apply to a complaint in the
following situations:
(a) Anonymous complaints
and allegations of discrimination are reviewed by the Governor's Advocacy
Office.
(b) The merits of the
complaint have been, or are going to be, decided by a judge or a juvenile court
ruling.
(c) The subject matter of
the complaint is not related to a developmental disabilities service or a
provider.
(d) The complaint is
about the personnel of a local program.
(A) An
agency must include policies and procedures for the handling of personnel
complaints in accordance with OAR
411-323-0060(9).
(B) A Community Developmental Disabilities
Program (CDDP) must include policies and procedures for the handling of
personnel complaints in accordance with OAR
411-320-0175(1).
(C) A Brokerage must include policies and
procedures for the handling of personnel complaints in accordance with OAR
411-340-0060(1).
(e) The subject matter of the
complaint is subject to review under the following:
(A) ORS
419B.005 to
419B.055 for child abuse
reports.
(B) OAR chapter 309,
division 118 for the Oregon State Hospital.
(D) OAR
407-005-0100 to
407-005-0120 for staff conduct
or customer service received from Department personnel.
(E) OAR chapter 411, division 020 for adult
protective services provided by the Department's Aging and People with
Disabilities Program.
(G) OAR
413-010-0420 for Department
Child Welfare decisions.
(I) OAR
413-120-0060 for Department
Child Welfare adoption placement selections.
(J) OAR chapter 582, division 020 for
Department Vocational Rehabilitation service determinations.
(K) OAR chapter 839, division 003 for a
violation of civil rights investigation conducted by the Bureau of Labor and
Industries.
(6) If a complaint alleges circumstances that
meet the criteria for an investigation of abuse, the allegation must be
immediately reported to the appropriate protective service entity, such as:
(a) The Department;
(b) A CDDP;
(c) A Brokerage;
(d) The Office of Training, Investigations,
and Safety;
(e) Child Welfare;
or
(f) Law enforcement.
(7) If a complaint falls under
section (5) of this rule, the local program or Department must offer to assist
the complainant with filing the complaint with the appropriate
entity.
(8) The local program or
Department must ensure there is no punitive action threatened or taken against
a complainant.
(9) Information
regarding the complaint process must be accessible for people with disabilities
and provided in a person's preferred language.
(10) A local program must have and implement
written policies and procedures regarding individual complaints and the
complaint process. A copy of the policies and procedures for resolving
complaints must be maintained on file at the office of the local program and
must be available to staff, individuals, individuals' representatives,
providers, and the Department. The policies and procedures must include, but
are not limited to, all of the following:
(a)
Method used to submit a complaint. For example, form 0946, verbal,
email.
(b) When a complaint must be
logged in the complaint log.
(c)
Process for reviewing and resolving a complaint.
(d) Time frames for responding to a complaint
as set forth in this rule.
(e)
Documentation to be used in response to a complaint as set forth in this
rule.
(f) The process for assisting
an individual or an individual's representative with filing a personnel
complaint or a complaint with another entity according to section (7) of this
rule.
(g) Submission of documents
to the Department.
(11)
A local program must submit records requested by the Department within three
business days from the receipt of the request.
(12) A complaint received on the Complaint
Form (0946) constitutes a complaint and must be addressed through the complaint
process described in section (17) of this rule.
(13) An expression of dissatisfaction about a
developmental disabilities service or provider that is not submitted on the
Complaint Form (0946) must be addressed through the complaint process described
in section (17) of this rule, upon confirmation by an individual or an
individual's representative that they wish to file it as a complaint or
expresses the need to escalate it and receive a written outcome.
(14) COMPLAINT LOG.
(a) A local program must maintain a complaint
log. At a minimum, the complaint log must include all of the following:
(A) The legal name of the individual for
which the complaint is being filed.
(B) The individual's preferred
name.
(C) The individual's
preferred method of contact.
(D)
The name and contact information of the person making the complaint, if
known.
(E) The name of the person
taking the complaint.
(F) The
nature of the complaint, including if there was a request for new or changed
developmental disabilities services which may result in a hearing.
(G) The date the complaint was
received.
(H) The date the
complaint was acknowledged in writing as described in section (17)(a) of this
rule.
(I) The date the local
program offered the complainant an opportunity to discuss the complaint with
the local program, as described in section (17)(b) of this rule, and the date
of the discussion, if applicable.
(J) The date of an extension for a written
outcome that was mutually agreed upon as described in section (17)(c) of this
rule.
(K) The written outcome of
the complaint as described in section (17)(c) of this rule.
(L) The date and method the written outcome
was provided to the complainant.
(b) Personnel complaints and allegations of
abuse must be maintained separately from the complaint log.
(c) A local program must only document
complaints about their local program in their complaint log. In the event a
complaint is against another agency or program, the local program must:
(A) Help the individual or the individual's
representative file the complaint with the other agency or program;
and
(B) Document the support
provided by the local program in the individual's progress notes.
(15) SCREENING OF
COMPLAINTS. A local program must screen all complaints for potential hearing
related issues.
(a) In the event that a
complaint appears to allege a denial, reduction, suspension, or termination of
a developmental disabilities service, the local program must issue a
Notification of Planned Action and advise the complainant of the right to a
hearing and assist the complainant with filing a hearing request, if so
desired.
(b) In the event a
complainant decides to file a complaint rather than a hearing request, the
local program must document the complainant's decision in the individual's
progress notes.
(16)
FILING A COMPLAINT.
(a) Complaints may be made
orally, in writing, or on a Complaint Form (0946).
(b) A complaint regarding dissatisfaction
with the services of a provider organization may be filed with the Department
or directly with the provider organization, Brokerage, or CDDP.
(c) A complaint regarding dissatisfaction
with the services of a Brokerage or CDDP may be filed with the Department or
directly with the Brokerage or CDDP.
(d) A complaint regarding dissatisfaction
with the Department, including complaints about the Stabilization and Crisis
Unit (SACU), children's intensive in-home services (CIIS), and children's
24-hour residential services and settings, must be filed with the
Department.
(17) PROCESS
FOR ADDRESSING COMPLAINTS.
(a) The local
program or Department must provide written acknowledgement of a complaint to an
individual or the individual's representative within five business days from
the receipt of the complaint. A copy of the written acknowledgment must be
maintained in the individual's file.
(b) The written acknowledgement must inform
the complainant about the opportunity to discuss the complaint with the Program
Director of the local program or the Director of the Department, or their
designee.
(A) This discussion does not
preclude the complainant from receiving a written outcome after the local
program or Department has reviewed the complaint.
(B) This discussion must occur within 10
business days from the date of the written acknowledgement. The local program
or Department must document all offers for a discussion in the complaint
log.
(C) In the event that a
resolution is reached during the discussion, the local program or Department
must provide a written outcome to the complainant within 10 business days from
the date of the discussion. A copy of the written outcome must be maintained in
the individual's file.
(c) The local program or Department must
complete a complaint investigation and issue a written outcome to the
complainant within 45 calendar days from the receipt of the complaint, unless
both parties mutually agree to extend the timeframe. The extension may not
exceed an additional 45 calendar days.
(A) The
review of the complaint must include, but is not limited to, an investigation
and records review of the complaint by the Program Director of the local
program or the Director of the Department, or their designee.
(B) The written outcome of the complaint may
be issued on the complaint form or may be issued in a separate document. The
written outcome must include all of the following:
(i) The rationale for the outcome, including
the outcome of conferences or discussions with the complainant, individual,
providers, or others.
(ii) The
reports, documents, and other information relied upon in deciding the outcome
of the complaint, or a summary of the reports, documents, and other information
relied upon.
(iii) Information
about the complainant's right to review the documents relied upon in
determining the outcome (Notification of Rights form 0948).
(iv) Information about the complainant's
right to request a review of the written outcome (Notification of Rights form
0948).
(C) Notice that
retaliation or discrimination, as a result of the outcome, is not
tolerated.
(D) A copy of the
written outcome must be maintained in the individual's file.
(18) REQUEST FOR
REVIEW.
(a) A complainant may request a review
of a written outcome within 30 calendar days from the date identified in the
written outcome.
(A) If a provider
organization issued the written outcome, the complainant may request a review
of the written outcome by:
(i) The local CDDP
or Brokerage; or
(ii) The
Department.
(B) If a
CDDP, Brokerage, CIIS, or SACU issued the written outcome, the complainant may
request a review of the written outcome by the Department.
(C) If the Department issued the written
outcome, the complainant may request a review of the written outcome by the
Director of the Department or the Director's designee. The written outcome
issued by the Director, or the Director's designee, is the final
response.
(b) The
Department may uphold, alter, or overturn a written outcome issued by a
provider organization, CDDP, Brokerage, CIIS, or SACU.
(19) PROCESS FOR ADDRESSING AND RESOLVING A
REQUEST FOR REVIEW.
(a) The receiving entity
of a request for a review of a written outcome must acknowledge receipt of the
request by issuing a written acknowledgement to the complainant within five
business days from the receipt of the request for a review.
(b) The written acknowledgement must inform
the complainant about the opportunity to discuss the complaint with the Program
Director of the local program or the Director of the Department, or their
designee.
(A) This discussion does not
preclude the complainant from receiving a written determination after the
receiving entity has reviewed the complaint.
(B) This discussion must occur within 10
business days from the date of the written acknowledgement.
(C) In the event that a resolution is reached
during the discussion, the local program or Department must provide a written
determination to the complainant within 10 business days from the date of the
discussion. A copy of the written determination must be maintained in the
individual's file.
(c)
The local program or Department must review the written outcome and issue a
written determination to the complainant within 45 calendar days from the
receipt of the request for a review, unless both parties mutually agree to
extend the timeframe. The extension may not exceed an additional 45 calendar
days.
(A) The review of the written outcome
must include, but is not limited to, an investigation and records review by the
Program Director of the local program or the Director of the Department, or
their designee.
(B) The written
determination must include all of the following:
(i) The rationale for the determination,
including the outcome of conferences or discussions with the complainant,
individual, providers, or others.
(ii) The reports, documents, and other
information relied upon in making the determination, or a summary of the
reports, documents, and other information relied upon.
(iii) Information about the complainant's
right to review the documents relied upon in making the
determination.
(C)
Notice that retaliation or discrimination, as a result of the determination, is
not tolerated.
(D) A copy of the
written determination must be maintained in the individual's file.
Notes
Statutory/Other Authority: ORS 409.050, 427.104, 427.107 & 430.662
Statutes/Other Implemented: ORS 183.411-183.471, 409.010, 427.007, 427.101, 427.104, 427.107, 427.109, 430.215, 430.610 & 430.662
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