Complaints Action Plan Part A

Date of Complaint
Name and Address of Complainant
Tel no. of Complainant including agreed time and dates to call
Service User
PRN
Details of Complaint
What outcome is the complainant requesting?
An agreement about a realistic outcome if this is not the same as the one hoped for
Special Requirements, inc access needs
e.g. for meetings
Date complaint acknowledged in writing.
By the person completing this form.
How does the complainant wish to receive responses?
Letter, email, meeting, verbally.
Are there any language needs?
If an advocate is involved, give name and contact details.
Consent to Share received? / Yes No Verbal Written
Date Received
How will the complaint be handled?
What we will do to resolve the issue?
Where and when any interviews involving them or their representative (if required) will take place?
Identify specific people that will need to be interviewed or will be asked to assist in resolving the complaint?
How much notice they require of subsequent meetings (if required)?
Whether or not the person wants or needs to be supported during the process
Who will provide / organise or pay for any support required (e.g. advocates, translators etc.)
Name of Investigating Officer
Who the person feels is the most appropriate person to investigate the complaint
Agreed response date
What are the timescales associated with the investigation?
Agreed Outcomes
Date of Complaint Response
Date letter sent confirming agreed outcomes sent to complainant
Name of Manager signing off
For non-complex complaints – Team Manager
For complex complaints – Complaints Manager
Date Records sent to Complaints Team

Complaints Action Form Part B – Ongoing Record of Investigation

Date / Comment / Worker

Complaints Action Plan Part C – Complaints Monitoring Form

How was the complaint made: by phone in writing / email in person

Is the complainant:

a) Service User b) Carer c) Parent d) Advocate e) Representativef) Other

Date of birth of complainant:

Gender: Male Female

Ethnicity:

Culture:

Disability Yes No

(please put a X in one box only)

Is service provided by Independent SectororIn-House?

Which service area is the complaint about?

(please put an X in one box only)

Type of Service / Mental Health / Learning Disabilities / Physical Disabilities / Older People aged 65+ / Other Adults
Care Management incl. EDT
Day Centre
Domiciliary Care
Intermediate Care
Group Homes and Adult Placement
Respite Care
Residential Care
Occupational Therapy
Sensory services/sensory equipment
Approved Social Work
Hospital Social Work
SupportingPeople
Adults Helpdesk
Adult Protection
Finance including FAB.
Other-please specify e.g. meals on wheels, GIS

Outcome:

(please put an X in one box only)

Complaint Upheld Not upheld

Partly upheld Withdrawn

Action taken if complaint is upheld or partly upheld:

(please put an X in all boxes that apply)

  1. Apology and explanation given
  2. Apology
  3. Explanation
  4. Charges waived or adjusted
  5. Policy/Procedure reviewed
  6. Provision of service
  7. Alteration in service
  8. Alteration in service and financial resolution
  9. Disciplinary action taken

Recommendations and/or Learning Points arising from this complaint:

Team / Area / Individual

Did any learning points arise as a result of this complaint concerning the team, area or individual involved? (Please summarise below)

Directorate

As a result of the above learning points and overall complaint, can any recommendations be made in order to improve the work of the Directorate as a whole?

(Please summarise below)

Policies Reviewed

In investigating the complaint what policies did you read before preparing your response?(Please summarise below)

Did you feel that there were any gaps in these policies relating to the concerns you addressed? (Please summarise below)

Processes

Was the relevant process followed?

Yes No

If no, would the complaint have arisen if it had of been?

Yes No

As a result of the complaint do you feel that the relevant Process Map needs amending?

(Please summarise below)

Recording

Was the recording throughout the file accurate and up to date?

Yes No

If no, do you feel that there any training issues for the individual / team / wider directorate? (Please summarise below)

Name of person completing this form

Telephone number

Email address

Please return this form by email to post to Social Care Complaints Office, 68 Westgate Street, Gloucester, GL1 2NZ