GRIEVANCES/COMPLAINTS FORM Complaints against Bonnie Be Bodywork, LLC or the services that Bonnie Eason and independent contractors provide are formally considered grievances. This is broadly understood as any wrong that Bonnie Be Bodywork, LLC or its independent contractors is perceived as doing during, before or after sessions with the person receiving services, family members or anyone else involved in their care. If at any time the person receiving services, legal guardian of the person receiving services or authorized representative feels they would like to submit a grievance against Bonnie Be Bodywork, LLC or its independent contractors they are encouraged to do so, and this will not prejudice future provision of appropriate services. No individual shall be coerced, intimidated, threatened or retaliated against because the individual has exercised their right to file a grievance or participated in the grievance process. Grievances may be submitted directly to and through Bonnie Be Bodywork, LLC, by contacting the owner, Bonnie Eason. If additional support persons would be preferred, the case manager working with the person associated with the Community Centered Board can be recruited as a support person or mediator in the case the person submitting the grievance feels they would like a mediator. The Department of Regulatory Agencies also provides a form to file a complaint. Grievances can be submitted by: - Contacting Bonnie Eason directly at bonnie@bonniebebodywork.com or (970) 462-8104 - Contacting the Community Centered Board’s allocated case manager working with the person receiving services - Filing a complaint against Bonnie Eason through the Department of Regulatory Agencies: https://apps.colorado.gov/dora/licensing/Activities/Complaint.aspx Upon submission of a grievance, Bonnie will make herself available as will the independent contractor if requested by the family to be involved, by phone or in person per the preference of the person submitting the grievance, to come together and find a mutually acceptable solution. The resolution of the grievance will be reached within 2 weeks of Bonnie Eason being notified but can be extended if the person submitting the grievance does not feel that a mutually acceptable solution has been reached. Services may continue during this time unless the person receiving services, legal guardian or authorized representative prefers that they are halted. Persons receiving services, the legal guardian of persons receiving services or authorized representative shall receive information about the grievance process prior to receiving services and upon any changes to the procedure. DISPUTE RESOLUTION At least 15 days written notification, provided in person or by first class mail, will be allowed for: the person receiving services is no longer eligible for services or supports; services in the Individualized Plan are to be modified, reduced or denied; services or supports are to be terminated; the applicant is not eligible for services or supports. Disputes against the decisions of Bonnie Be Bodywork, LLC can be made at any time. The submission of a dispute shall not prejudice future provision of appropriate services. No individual shall be coerced, intimidated, threatened or retaliated against because the individual has exercised their right to participate in the dispute resolution process. In emergency situations, determined by Bonnie Be Bodywork, LLC, the person receiving services or their parent/legal guardian/representative, will result in immediate or less than 15 days’ notice termination of services. For all other cases, services will not be terminated during the dispute resolution process but will continue at the same location with the same frequency and duration. The opportunity for resolution of any dispute begins with an informal negotiation process, scheduled as a meeting of Bonnie Be Bodywork, LLC and the persons to receive therapy or their representative within fifteen days of receipt of the dispute. Mediation could be considered as one means to informal negotiation if both parties voluntarily agree to this process. If this process is waived or does not resolve, the following process may be initiated: • Notification of the meeting at least 10 days prior to the meeting unless waived by the person receiving services or their parent/legal guardian/representative • Representation by council, authorized representative or another individual if the person receiving services or parent/legal guardian/representative desires • The opportunity to respond to questions • Recording of the proceeding by electronic device or reporter • Written decision within 15 days of the meeting • Notification that if the dispute is not resolved, the person receiving services or parent/legal guardian/representative may request the following: Review by the Department of Health Care Policy and Financing • The request to review the outcome of the dispute resolution process shall be submitted to the Department within 15 days from which the decision was postmarked. The Department shall render a decision within 10 working days of the submission of all relevant information. The decision of the Department shall constitute final action on the dispute. RIGHTS In general, each individual receiving services has the same legal rights and responsibilities guaranteed to all other individuals under federal and state constitutions and statutes, unless those rights are modified by court order. Specifically: 1. Each individual shall have a Service Plan (SP) in which he/she participates in program planning, decision making, implementation and the right to accept and receive services. 2. Each individual has the right to appropriate dental and medical services including the right to be free of unnecessary drugs. 3. Each individual has the right to have medications administered in a manner consistent with state and federal law and regulation. 4. Each individual has a right to be free of mistreatment, abuse, neglect and exploitation (refer to the MANE policy/procedure. The agency will assure that its monitoring mechanism includes a review of incident reports (including reports of unusual or dramatic changes in behavior; verbal and written reports from individuals, advocates, families, guardians, friends or others; and that frequent unannounced supervisory visits will occur on all shifts). 6. Each individual shall have the opportunity to communicate freely and privately with persons of his/her own choosing and with the community at large, including the right to make and receive private phone calls. 7. Each individual shall be able to receive and send sealed, unopened correspondence and packages. 8. Each individual has the right to freedom of movement inside and outside his/her residence and be afforded frequent opportunities to meet with visitors. 9. Each individual shall be afforded suitable opportunities for interaction with other persons and the community at large. 10. Each individual shall have the right to sexual interaction based on individual choice. 11. Each individual has the right to choose and wear his/her own clothing. 12. Each individual has the right to manage his/her own financial affairs, including purchasing property, unless contraindicated in his/her SP. 13. Each individual has the right to offer suggestions or complaints and attempt to influence policies and receive a timely and appropriate response. 14. Each individual shall have the right to read or have explained any rules or regulations adopted by HCPF and policies and procedures of Bonnie Be Bodywork, LLC pertaining to such person’s activities and supports, or to obtain copies of any of these documents at a reasonable cost. 15. Each individual will have the right to notice at least 15 days prior to the effective date when there is a decision to terminate services or transfer the individual. If a transfer is to occur, the individual will be assured that it is in the best interest of the individual and not for the convenience of the agency. 16. Each individual has the right to fair labor practices and not required to perform labor. 17. Each individual shall have the right to vote in public elections. 18. Each individual has the right to his/her confidential records and to receive information on the results of evaluations, examinations, and treatment plans. 19. Each individual has a right to freedom from discrimination. 20. Each individual has the right to decline to participate in research. No person receiving services, his/her family members, guardian or authorized representatives, may be retaliated against in their receipt of services or supports or otherwise as a result of attempts to advocate on their own behalf. No person shall be discriminated against because of race, color, national origin, religion, gender, disability or because he or she has received any services or supports. Bonnie Be Bodywork, LLC will not initiate suspension of the rights of a person receiving services, but if the CCB determines that it is necessary than Bonnie Be Bodywork, LLC will follow this action to protect the health and safety of the person receiving services and/or others. Individuals eligible for services and supports, the parent of a minor or legal guardian may designate an authorized representative. This can be done with the informed consent of the individual receiving services and must be in writing and must specify the extent of involvement the representative will have in assisting the individual acquire or utilize supports and services. The individual receiving services may withdraw their designation of an authorized representative at any time. EXTERNAL ADVOCACY AND SUPPORT FOR DISPUTES AND RIGHTS ASSISTANCE INCLUDE: Colorado Legal Services - publicly funded legal services Boulder (Boulder), 315 West South Boulder Road, Suite 205, Louisville 80027 Phone: 303-449-7575 Walk-In Hours: Monday-Friday 8-Noon and 1-5 p.m., closed Noon to 1 for lunch. Ft. Collins (Larimer, Logan, Phillips, Sedgwick), 211 West Magnolia Street, Ft. Collins 80521 Phone: 970-493-2891 Walk-In Hours: Mon-Fridays 8:30-Noon, 1-4:30 p.m.; ID project only - Tuesdays and Thursdays, 9-11 a.m. and 1-3 p.m. Greeley (Morgan, Washington, Weld, Yuma) 912 8th Avenue, Greeley 80631 Phone: 970-353-7554 Colorado Springs (El Paso county) 102 South Tejon St, Ste 430 Colorado Springs 80903 Phone: 719-471-0380 Pueblo (Pueblo county and surrounding areas) 1000 West 6th Street, Suite I Pueblo 81003 Phone: 719-545-6708 Colorado Cross-Disability Coalition, The Empire Building, 1385 S. Colorado Blvd., Suite 610-A Denver, CO. 80222 Phone: (303) 839-1775 press #1 for advocacy help Website: http://www.ccdconline.org/contact/ Become a member and/or submit an advocacy request form Disability Law Colorado – independent non-profit 455 Sherman St Ste 130, Denver, CO, 80203 Phone: 303-722-0300 Website: http://www.disabilitylawco.org Email: dlcmail@disabilitylawco.org I understand that my typed name serves as a signature. * Yes Typed Signature * Date * MM DD YYYY Thank you!
