FEEDBACK POLICY

Tell us what you think………….

Effective from: November 2016

1. Introduction

This policy relates to feedback – complaints, concerns, comments, suggestions and compliments – in respect of services provided by Bethphage. As a learning organisation, Bethphage wants to know what the people who use our services and their families and advocates think about our services. We have developed this feedback policy because we want to encourage people to tell us what they think whether what they want to say is:

A complaint - An expression of dissatisfaction about the standard of service, actions or lack of action by Bethphage or its staff affecting an individual or group of people

A concern – A matter about which a person is anxious or worried. This might be about the welfare or wellbeing of a person supported by Bethphage or the actions or lack of actions by Bethphage or its staff

A compliment – A polite expression of praise or admiration for the work of an individual, group or Bethphage as a whole

A comment or suggestion – an idea or plan put forward about how things could be done differently, which might achieve a better outcome.

Our aim is to make it as easy as possible for people to tell us what they think so that we can follow this up and act upon it. We will use any feedback received to:

Find out what is working and what is not working Help to identify potential problems Help to identify risks and take preventative action Identify areas for staff development or training Review our services, policies, procedures and practices

This policy should be read in conjunction with other related policies and publications including our policies on safeguarding, duty of candour, discipline, grievance and our core values. Our core values shape the way that we work and feedback is an integral and important part of this.

Our values are:

Personal Growth: We create a safe and healthy environment, where we provide positive feedback, support each other to reflect on actions and learn and grow from them.

Respect: We respect and value the diversity, individuality and views of everyone we come into contact with, fully considering each perspective before arriving at an agreed outcome.

Honesty: We work together in an open and honest way; taking responsibility and remaining accountable for our actions.

Active involvement: We work together, actively engaging and involving the people we support in everyday actions.

2. Policy

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Bethphage actively encourages the people we support to feedback on the service they receive and seek views from members of their staff and everybody else directly involved with or affected by the services we provide. This includes the right to make complaints and to register concerns about those services. It further accepts that they should find it easy to do so. It welcomes all feedback and looks upon it as an opportunity to learn, adapt, improve and provide better services and therefore better outcomes for the people using our services

Where the complaint is serious and is deemed to be of a safeguarding nature this will be dealt with as per the safeguarding policy and procedures and details of the complaint in that instance will be shared with the relevant regulator – CQC or CSSIW – see below for details.

Bethphage adheres fully to regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Receiving and Acting on Complaints.

Bethphage will treat feedback as a complaint if the person providing the feedback is an eligible person who asks for it to be treated as a complaint or if the nature of the feedback is such that Bethphage feels it should be treated as a complaint. The formal processes which follow apply specifically to complaints and the same principles will guide our response to all other feedback and in some instances we will record other feedback as a complaint. A person is eligible to make a complaint if they are

a person who uses our services a legitimate representative of a person who uses our services (see 5.2 point 7 below) anyone who is affected by the services we provide e.g. neighbours, professionals who

work with the person we support

This policy is intended to ensure that complaints and feedback are dealt with promptly and properly and that all complaints or comments by the people we support and their relatives, representatives and advocates are taken seriously.

The policy is not designed to apportion blame, to consider the possibility of negligence or to provide compensation. It is not part of Bethphage’s disciplinary policy and it is not a vehicle for staff to make complaints which directly impact them – the grievance policy should be used for such matters.

Bethphage believes that failure to listen to or acknowledge feedback leads to an aggravation of problems, dissatisfaction in the service provided and possible litigation. It represents a missed opportunity for us to improve what we do in order to “Be an excellent provider of services for people with disabilities”. Conversely, an open, respectful and sincere consideration of the issues raised can drive positive improvements.

We act on the basis that, wherever possible, feedback is best dealt with at a local level between the person providing the feedback and the Service Manager and in some instances the support staff – see section 5.2 below

Feedback can be given by telephone, in person, in writing or by email.

Bethphage contact details are available at the end of this policy, on all our promotional materials including our feedback leaflet and on our website at www.bethphage.co.uk

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3. Aim of the Feedback Policy

Bethphage aims to ensure that its feedback policy is properly and effectively implemented, and that the people we support feel confident that their feedback is listened to and acted upon promptly and fairly. Specifically, it aims to ensure that:

1. The people we support, and their representatives are aware of how to feedback and that Bethphage provides easy to use opportunities for them to register their feedback

2. Where feedback is given in person or on the telephone, we will make a written record of it and provide a copy of the written record within three working days

3. All written feedback and all feedback received by email at complaints@bethphage.co.uk will be acknowledged within three working days

4. Investigations into feedback (specifically complaints) are held within 14 days. This timeframe can be extended up to a further 14 days in agreement with the complainant

5. All complaints are responded to in writing by the organisation6. Feedback is dealt with promptly, fairly and sensitively, with due regard to the upset and

worry that they can cause to both the people we support and staff7. The complainant is kept fully informed about the progress of the investigation.8. The Service Manager shall respond in writing to conclude the outcome and inform the

complainant of the action (if any) to be taken.

4. Responsibilities The people who are receiving a service from Bethphage will be provided with a copy of the feedback form and also the Service Guide and Service Agreement when they commence receiving support. This information will be in a format that is accessible to them and on identification of need this can be in alternative formats such as large print, easy read or an audio version.

The people receiving a service from Bethphage will be supported to develop a Person Centred Plan which includes information on how to support them to tell people what they think including how to complain. All staff will be familiar with this. Bethphage believes that, wherever possible, feedback is best dealt with at a local level between the person giving the feedback and the organisation.

The Service Manager, or a person with sufficient seniority to resolve the issues, will be responsible for following through complaints and acting on other feedback on behalf of Bethphage. No person implicated in a complaint will be responsible for investigating it.

Bethphage will, so far as is reasonably practical, provide assistance for people to understand the complaints procedure, and advice on where they may obtain assistance or support from a local advocacy service. The Service Manager will provide details about this service.

Bethphage will consider feedback relating to any period, but to be regarded as a formal complaint, it must be made not later than 12 months after:

the date the event occurred or, if later, the date the event came to the notice of the person giving feedback

The time limit will not apply if Bethphage is satisfied that: the complainant can give a good reason for not making the complaint within that time

limit, and despite the delay, it is still possible to investigate the complaint effectively and fairly.

Bethphage will also act in accordance with the duty of candour (CQC regulation 20) in respect of complaints about care and treatment that have resulted in a notifiable safety incident, ensuring that an open, honest and full disclosure of the information is made to the person concerned as soon as is reasonably practicable.

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5. Feedback Procedure 5.1 Encouraging people to give feedbackSometimes a person may make a comment, or say that they have ‘concerns’, or they may show through their behaviour that they are unhappy with their support and it is important that staff recognise the ways in which a person may be expressing their dissatisfaction and must always respond to these in line with this feedback procedure. It is important to remember that many of the people we support have a preference for verbal communication over written methods. For this reason, no distinction should be made between verbal and written feedback although it is often helpful to either ask the person to write down their concern or support them to do so in order to ensure there is clarity over the matter to be reviewed. Action to respond to the feedback should not be delayed by a request to write it down.

Sometimes a person will want to make an “informal complaint”, as they may want to avoid “making a fuss” or a formal complaint. Staff must be aware of the many and varied ways in which a complaint may be made. Listening to, and acting on any concerns raised, will resolve concerns faster and support the continuous improvement of our services.

Probably the greatest influence in encouraging people to give feedback or make a complaint is the response of staff. It’s not just the words used, it’s the tone of voice and body language used when people say that they are not happy about something – especially if they are not happy with something that staff have done (or not done).

Explain to the person that the staff team is there to support them and welcome feedback as a way of doing this even better. Remind them of how their complaints or suggestions have improved things in the past.

Remind people regularly of the ways that they can, and have chosen to comment, compliment and complain and the positive effects this has had.

Remember that some people we support may think complaining is ‘causing trouble’. Everyone must be reassured that it’s OK to give feedback and complain.

Regularly ask whether people are happy with how we are supporting them and the service they receive.

If a person we support (or any other person) comes to you with what sounds like a concern or complaint listen carefully to what they have to say and reassure them that they are doing the right thing by telling you, ask some open-ended questions to encourage them to talk about it.

If the person becomes withdrawn and uncomfortable when you are talking to them about their complaint, think about how you can support them or help them to make a complaint in a manner that is not distressing.

Remember that a complaint about something a member of staff has done is not a condemnation of that person.

5.2 Informal feedback1. Bethphage accepts that all verbal complaints, no matter how seemingly unimportant,

must be taken seriously.

2. Support staff who receive a verbal complaint are expected to seek to solve the problem as soon as possible. When the complaint has been resolved satisfactorily, the matter must still be reported to the Service Manager, including how the complaint was resolved as this information is recorded within Bethphage.

3. If they cannot solve the problem immediately, they should say when they can. They should offer to get their line manager to deal with the problem if the issue is something outside their own area of control.

4. Support staff are expected to remain polite, courteous, sympathetic and professional to the complainant. They are taught that there is nothing to be gained by adopting a defensive or aggressive attitude.

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5. At all times in responding to the complaint, support staff are encouraged to remain calm and respectful.

6. Support staff should not make excuses or blame other staff.

7. If the complaint is being made on behalf of one of the people we support by a representative, it must first be verified that the person has permission to speak for the individual, especially if confidential information is involved. We will only accept complaints from a representative under certain conditions.Either: Where we know that the person has consented, either verbally or in writing Where the person cannot complain unaided and cannot give consent because they

lack capacity within the meaning of the Mental Capacity Act 2005 The representative is acting in the person’s best interests – for example, where the

matter complained about, if true, would be detrimental to the person.

8. After talking the problem through, the Service Manager or member of staff dealing with the complaint will suggest a course of action to resolve the complaint, however please note it is important to seek clarity from the complainant regarding what they want to see as the possible action or outcome from their perspective. If this course of action is acceptable then the member of staff should clarify the agreement with the complainant and agree a way in which the results of the complaint will be communicated to the complainant (i.e. through another meeting or by letter).

9. If the suggested plan of action is not acceptable to the complainant, then the member of staff will inform their line manager who will pass a record of the complaint to the Service Manager on the first possible working day including the complainant’s written complaint if it has been possible to obtain one. The complainant should be given a copy of Bethphage’s feedback procedure if they do not already have one.

10. Details of all feedback must be recorded on Bethphage’s Feedback Record Form, a copy of the complaint should be stored locally by the Service Manager (it may not be appropriate for this to be held in the person’s file or in the service due to the need for confidentiality). A copy will also be forwarded to the Area Manager to be signed off recorded on the feedback database. The record will include details of the investigations made, the outcome and any action taken as described in Regulation 16 (2) Receiving and acting on complaints. The Area Manager will share a copy of the completed feedback from with the Quality Manager for monitoring and reporting purposes.

5.3 Formal complaintsA complaint will be treated as a formal complaint when any of the following apply:

The complainant indicates that it is a formal complaint. A previous informal complaint has not been resolved within 3 working days The complaint is of a sufficiently serious nature to indicate the potential for significant

risks or other adverse consequences for people we support, staff, third parties or Bethphage

A complaint is made directly to the service or indirectly by a third party.

All formal complaints should be made (or forwarded) to the Service Manager responsible for that service, unless the complaint is concerning them, in which case it should go the Area Manager. If the complaint is about the Area Manager, then it must be forwarded to the Operations Director. This person will identify the investigating officer for this complaint.

Preliminary steps:1. When Bethphage receives a written complaint (including a complaint received

electronically) it is passed to the named complaints manager (usually the Service Manager for that area of service) who must record it on the Feedback Form. They will then send an acknowledgment letter within three working days to the complainant

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2. The manager will also include a leaflet detailing Bethphage’s procedure for the complainant.

3. If necessary, further details are obtained from the complainant (or their representative subject to paragraph 5.2 point 7 above)

4. The investigating officer will seek advice from senior managers as necessary.

5. Where the complaint raises a potential safeguarding concern, the Bethphage Safeguarding policy must be implemented immediately.

5.4 Anonymous Complaints Bethphage will investigate anonymous complaints thoroughly where it is possible and appropriate to do so.

5.5 Investigation of the complaint by Bethphage:1. Immediately on receipt of the complaint, the investigating officer (see 5.3 above) will

start an investigation and within 14 days should be in a position to provide a full explanation to the complainant, either in writing or by arranging a meeting with the individuals concerned. This timeframe can be extended to up to 28 days in agreement with the complainant.

2. If the issues are too complex to complete the investigation within 28 days, the complainant will be informed, in writing, of any delays

3. The complaints manager may use a variety of approaches depending on the issues involved including: Carrying out interviews Looking at written records and copies of documents Carrying out visits Taking expert advice Meeting with the complainant

4. If a meeting is arranged, the complainant will be advised that they may, if they wish, bring a friend, relative or a representative such as an advocate. The investigating officer needs to carefully consider the location of the meeting as using a venue that is unfamiliar may cause anxiety and be unhelpful to the process.

5. Such a meeting gives Bethphage the opportunity to show the complainant that the matter has been taken seriously and has been thoroughly investigated

5.6 At the conclusion of the Investigation When the investigating officer has completed his/her investigations, a detailed explanation of the results of the investigation will be given to the complainant and also an apology if it is deemed appropriate (apologising for what has happened need not be an admission of liability). As Bethphage has a duty of candour we must ensure that we look at each situation individually. The explanation will include details of any remedial action which will be taken.

A written account of the investigation should be sent to the complainant. This should include details of how to approach the Local Authority, the Local Government Ombudsman and the Care Quality Commission if the complainant is not satisfied with the outcome

The outcomes of the investigation and the meeting are recorded on the Feedback Record Form and any shortcomings in Bethphage’s procedures will be identified and acted upon. Bethphage will report details of complaints to local authorities in accordance with the contractual requirement and to the people affected or their families in accordance with the duty of candour.

Bethphage formally reviews all complaints and produces quarterly reports as part of its quality monitoring and improvement procedures looking for trends and areas of risk that should be addressed and to identify the lessons learned. The information is reported to Board Meetings.

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5.7 Right to AppealWithin 20 working days of receiving a written response, the complainant has the right to notify Bethphage that they are dissatisfied and to appeal against the outcome. In this instance, the appellant will be provided with contact details for the Operations Director, to whom they should write setting out the basis for their appeal.

Within 20 working days of receipt of an appeal, the Operations Director will review all relevant information or appoint another senior manager to do so and to discuss and explore the issues with the complainant. A final decision on the matter will then be made and the complainant will be informed in writing, with a copy provided to any other parties notified of the complaint.

This appeal constitutes the end of the Bethphage local process.

If following appeal, the complainant remains dissatisfied, they will be advised that they can take their feedback to the Local Authority, if they receive funding support from it, or directly to the Local Government Ombudsman if they are self-funding. Local Authority funded people may also decide to take their complaint to the Local Government Ombudsman if they are dissatisfied with the way Bethphage or the Local Authority has handled their complaint.

The Local Government Ombudsman provides a free, independent service. You can contact the advice team for information and advice, or to register your complaint by telephone on 0300 061 0614, by email to advice@lgo.org.uk, or by visiting their website at www.lgo.org.uk. The LGO will not usually investigate a complaint until we have had an opportunity to respond and resolve matters.

Bethphage is registered with and regulated by the Care Quality Commission (CQC). Complaints should be directed to Bethphage, however in the event that Bethphage is not dealing with the complaint the matter can be addressed to the Operations Director or Chief Executive Officer. If the complaint is dissatisfied with the management of the complaint, the CQC can be contacted by telephone on 0300 061 6161, by email to enquiries@cqc.org.uk, by post to the CQC, Citygate, Gallowgate, Newcastle-upon-Tyne, NE1 4PA, or by visiting their website at www.cqc.org.uk/contactus.cfm.

5.8 Compliments, comments, suggestions and concernsFeedback not treated as a complaint should be recorded and acted upon in a similar fashion to complaints without the same urgency over timescales and remedial action. However, this does not lessen the importance of acting on the feedback, sharing good practice, responding to concerns and suggestions and using the feedback to improve services and outcomes for the people we support and those affected by our work. The person receiving this feedback will complete a feedback form and pass it to the Service Manager at the earliest opportunity.

The Service Manager will ensure that staff receive feedback on this and share a copy with the Area Manager who will include it on the feedback database and send a copy to the Quality Manager. The Area Manager or Quality Manager should consider whether it is appropriate to include feedback comments in promotional materials (after obtaining the author’s agreement if using their name).

The Quality Manager will formally review the database at least quarterly, looking for trends and areas of learning and share any good practice identified across the Organisation as appropriate. The information will also be shared at quarterly Board meetings.

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5.9 Unreasonably Persistent Complainants and Unreasonable Complainant BehaviourBethphage aim to deal with all complaints in ways that are open, fair and proportionate in line with its core values. In a minority of cases, people pursue their complaint in a way that is unreasonable. They may behave unacceptably or be unreasonably persistent in their contacts and submission of information.

Some examples of unreasonable actions and behaviours include:

Refusing to specify the grounds of a complaint, despite offers of assistance Refusing to co-operate with the complaints investigation Refusing to accept that certain issues are not within the scope of a complaints

procedure Insisting on the complaint being dealt with in ways that are incompatible with the

Organisation’s complaints procedure or with legal or good practice Making unjustified complaints about staff who are trying to deal with the issues,

seeking to have them replaced Changing/ adding to the basis of the complaint as the investigation proceeds Covertly recording meetings and conversations Making excessive demands on the time and resources of staff with lengthy phone

calls, emails or detailed letters every few days expecting immediate responses Refusing to accept the decision; repeatedly arguing points with no evidence.

In this instance the issue should be referred to the Operations Director who will ensure that:

The complaint has been investigated in line with policy Any decision reached was the most appropriate decision The complainant has not provided any significant new information which may affect the

decision A face to face meeting with the appropriate senior manager has been offered as a

mediation measure to resolve the issue.

If the above has been satisfied, the following options for action may be initiated in exceptional circumstances only with the agreement of the Operations Director or CEO:

The preliminary action to be taken is that the Operations Director should advise the complainant in writing that their behaviour is unacceptable, detailing why their behaviours are unacceptable and advise if it does not change alternative action will be taken. The alternative action should be specified and a copy of this procedure enclosed. An appropriate timeframe for a change in behaviour will be specified.

If the behaviour continues the options Bethphage may follow include:

Requesting contact to be in a particular form (e.g. by letter only). Consideration must be given to the person’s need in relation to accessing information if this is due to a sensory impairment or disability in line with the Accessible Information Standard

Requiring contact to be with one named member of staff only Restricting telephone calls to specified days/times/durations Requiring personal contact to be in the presence of an appropriate witness Telling the complainant that Bethphage will not reply or acknowledge any further

contact on the specific topic of a particular complaint Restricting access to Bethphage premises

This list is not exhaustive and other options may be considered. All decisions about any restrictions must take the least restrictive process/action and must be legal, appropriate and proportionate.

Once a decision to introduce a restriction has been made the Operations Director will notify the decision in writing (or through other format if this is most appropriate for the person’s access to information needs). The information will include the decision, the restrictions being

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made, how long they will last, the options to refer their complaint to the Ombudsman, CQC, CSIW (as detailed in section 4)

All relevant staff will be notified of the restrictions in place.

Detailed records will be kept in respect of any contacts made under the restrictions.

The restrictions will apply to the specific complaints only. Any new issues raised will be taken on their merit and will not automatically have restrictions applied.

The application of restrictions will be reviewed at least every 6 months and the complainant and relevant managers will receive written notification of the outcome of the review.

6. Training

Service Managers are responsible for organising and coordinating training on the feedback procedure and must ensure all staff are competent in its implementation. All staff receive induction training and periodic refresher training in dealing with and responding to feedback including complaints.

7. Publicity

Bethphage will publicise the availability of this policy on leaflets freely available in our offices and on the public-facing pages of our website.

Signed: Peter Loose, Chief Executive

Date: 5th July 2018 (following review and update of the November 2016 policy)

This policy and procedure can be made available, on request, in other languages and in other formats such as large print, easy read and audio.

Date of next review July 2020.

Feedback Record Formto include verbal and written complaints, concerns, compliments and suggestions

Tick which type of feedback the form is recording

Complaint Compliment

Concern Comment or Suggestion

Section One – to be completed by / with the person

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Name of person providing the feedback / complaint ……………………………………………...

Feedback recorded by ………………..………………………………………Date…………………(If not the person above)

What is the feedback?

What outcome is desirable?

Has the issue been resolved? Yes No

Signature of the person giving the feedback ………………………....…………………………………………

Date………………………………

Signature of person completing the form…………………...…………………………………………………….(If not the person above)

Date …………………………….

Forward to Service ManagerSection 2 - to be completed by Service Manager

Name…………………………………………......... Date received……………………………….

Acknowledgement letter sent: Yes No

Date of acknowledgement letter ……………………..……

Actions Taken:

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Outcome:

Complainant / person giving the feedback informed of outcome (date)…………………………….

Other people informed (Circle name and add date)

Family ………………... Advocate ……..…….…… CQC……….………… Social Worker …………….…….

Other(s) …………..................................................................................................………...

Signature ………………………………………………...Service Manager

Date ……………………………………………………….

Forward to Area Manager: Date ……………………………………….

Section 3 – to be completed by the Area Manager

Name ……………………………………...……… Date received …………………………….

Comments/Follow up Actions:

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Date entered onto database…………………………………

Date copy filed and where …………………………………………..

Signed …………………………………………….……. Area Manager

Date ………………………………………………….….

Copy to be sent to Quality Manager

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Appendix 1

LETTER ACKNOWLEDGING A COMPLAINTBethphage IT system users can access a copy of this letter as a Word template by clicking this link or accessing 365 / all users / documents / feedback / complaint acknowledgement letter

Insert Person’s NameInsert Person’s Address

[Date]

Dear [insert name of person complaining]

I am writing to acknowledge your complaint of [insert date]. I enclose a copy of the form on which the details of the complaint are recorded.

The person who is investigating your complaint is [insert name of the responsible person] who will be in touch with you as soon as possible, and certainly within 28 days]. I very much hope that we can resolve this matter to your satisfaction.

Bethphage requests that you allow us to investigate this complaint ourselves, but you have the right at any time, if you wish to pursue your complaint with the local authority (if your service is council funded) [delete the rest of this sentence if the service is not a registered service] and CQC who register and inspect this service. To do so you should write to The Care Quality Commission, National Correspondence, City Gate, Gallowgate, Newcastle Upon Tyne NE1 4PA or telephone 03000 616161.

Yours sincerely

[insert writer’s Name][Insert Job Title]

cc: [insert name(s) of any people being copied in]

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Appendix 2CQC Regulation 16 Guidance “Receiving and Acting on Complaints”

Component of the regulation Providers must have regard to the following guidance

16(1) Any complaint received must be investigated and necessary and proportionate action must be taken in response to any failure identified by the complaint or investigation.

People must be able to make a complaint to any member of staff, either verbally or in writing.

All staff must know how to respond when they receive a complaint.

Unless they are anonymous, all complaints should be acknowledged whether they are written or verbal.

Complainants must not be discriminated against or victimised. In particular, people's care and treatment must not be affected if they make a complaint, or if somebody complains on their behalf.

Appropriate action must be taken without delay to respond to any failures identified by a complaint or the investigation of a complaint.

Information must be available to a complainant about how to take action if they are not satisfied with how the provider manages and/or responds to their complaint. Information should include the internal procedures that the provider must follow and should explain when complaints should/will be escalated to other appropriate bodies.

Where complainants escalate their complaint externally because they are dissatisfied with the local outcome, the provider should cooperate with any independent review or process.

16(2) The registered person must establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users and other persons in relation to the carrying on of the regulated activity.

Information and guidance about how to complain must be available and accessible to everyone who uses the service. It should be available in appropriate languages and formats to meet the needs of the people using the service.

Providers must tell people how to complain, offer support and provide the level of support needed to help them make a complaint. This may be through advocates, interpreter services and any other support identified or requested.

When complainants do not wish to identify themselves, the provider must still follow its complaints process as far as possible.

Providers must have effective systems to make sure that all complaints are investigated without delay. This includes:

o Undertaking a review to establish the level of investigation and immediate action required, including referral to appropriate authorities for investigation. This may include professional regulators or local authority safeguarding teams.

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o Making sure appropriate investigations are carried out to identify what might have caused the complaint and the actions required to prevent similar complaints.

o When the complainant has identified themselves, investigating and responding to them and where relevant their family and carers without delay.

Providers should monitor complaints over time, looking for trends and areas of risk that may be addressed.

Staff and others who are involved in the assessment and investigation of complaints must have the right level of knowledge and skill. They should understand the provider's complaints process and be knowledgeable about current related guidance.

Consent and confidentiality must not be compromised during the complaints process unless there are professional or statutory obligations that make this necessary, such as safeguarding.

Complainants, and those about whom complaints are made, must be kept informed of the status of their complaint and its investigation, and be advised of any changes made as a result.

Providers must maintain a record of all complaints, outcomes and actions taken in response to complaints. Where no action is taken, the reasons for this should be recorded.

Providers must act in accordance with Regulation 20: Duty of Candour in respect of complaints about care and treatment that have resulted in a notifiable safety incident.

16(3) The registered person must provide to the Commission, when requested to do so and by no later than 28 days beginning on the day after receipt of the request, a summary of—

(a) complaints made under such complaints system,

(b) responses made by the registered person to such complaints and any further correspondence with the complainants in

CQC can ask providers for information about a complaint; if this is not provided within 28 days of our request, it may be seen as preventing CQC from taking appropriate action in relation to a complaint or putting people who use the service at risk of harm, or of receiving care and treatment that has, or is, causing harm.

The 28-day period starts the day after the request is received

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relation to such complaints, and

(c) any other relevant information in relation to such complaints as the Commission may request.

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