Aged Care Complaints Scheme Guidelines

Chapter 4 - Intake Phase

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Overview

Introduction

The intake phase is the first point of contact for members of the public and approved providers.

Contacts can include:

• inquiries and complaints about care and services provided to care recipients by approved providers
• notifications from approved providers concerning their compulsory reporting requirements and other matters
• referrals from external organisations and other areas within the department to assist the Scheme perform its regulatory functions
• out-of-scope inquiries that relate to matters which are beyond the role of the Scheme.

Framework

This diagram shows where the intake phase fits into the Scheme’s complaints management framework.

Intake Phase
Detailed Assessment Phase
Resolution Phase
Outcomes Phase

Key principles

In responding to complaints during the intake phase, officers should have particular regard to the following complaints management principles:

• Officers will provide the parties to the complaint appropriate and easily understood information regarding the process of resolving complaints.
• Officers will manage complainant expectations by clearly explaining the Scheme’s processes and what outcomes can and cannot be achieved.
• Officers will seek to handle complaints in a way that will achieve the most timely, proportionate, appropriate and positive outcome for the care recipient/s.
• Officers will tailor communication to the needs of the complainant or other parties to the complaint.
• Officers will seek to support open and timely communication between the parties to a complaint, unless information must be limited for confidentiality, privacy or other reasons.
• Officers will promptly acknowledge all verbal and written complaints.
• Officers will promptly escalate complaints in accordance with the Scheme’s risk management framework.
• Officers will check and clarify information, to avoid unwarranted assumptions and draw accurate conclusions.
• Officers will ensure that all relevant information is recorded in a timely manner on the Scheme’s Investigation Management System (IMS).

Key activities in the intake phase

Activity 1: Receive information
The intake unit may receive information verbally or in writing.

Activity 2: Classify information
There are three stages to classifying information.

The first stage requires the information to be classified as:

• out-of-scope, or
• in-scope.

The second stage requires in-scope information to be classified as:

• an inquiry
• a complaint
• information from other sources
• a notification
• a reportable assault, or
• an unexplained absence (a missing care recipient).

The third stage requires complaints to be classified as:

• open
• confidential, or
• anonymous.

Activity 3: Collect information
The level of information required to be collected will vary depending on its classification. For example, only basic information is required for out-of-scope queries, whereas information classified as a complaint requires more comprehensive information.

Activity 4: Provide information
The level of information required to be provided will vary depending on its classification. For example, only basic information must be provided for out-of-scope information as opposed to more comprehensive information for inquiries and complaints.

Activity 5: Finalise out-of-scope contacts and in-scope inquiries
Officers may resolve and finalise out-of-scope contacts and in-scope inquiries without consulting with a manager if the officer does not have any concerns about the information provided.

Note: Officers might receive information that raises significant concerns about the care and services being provided to a care recipient/s that the inquirer does not want the Scheme to take action on. As the department has a regulatory responsibility to protect the safety, health and wellbeing of recipients of aged care services, officers should consult a manager to confirm whether an own motion resolution process should be commenced.
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Activity 6: Escalate to a manager
To support consistent, robust and timely decision making officers need to escalate complaints to a manager within the timeframe set out in the Intake Escalation Matrix (IEM).

Within the timeframes set out in the IEM, an officer may continue to support the early resolution of the complaint within the parameters set out in Activity 8 unless, in the officer’s judgment, a preliminary assessment of the service provider’s history should be undertaken to decide if early resolution is suitable. For example, if an issue is classed as minor, the officer may continue to support the early resolution of the complaint for up to 48 hours before notifying a manager.

Once a manager is notified, they will decide the level of preliminary assessment of the service provider’s history that is required to assist in deciding whether:

• the complaint is suitable for early resolution during the intake phase or
• the complaint should be referred for a more detailed assessment to determine whether a resolution process should be commenced.

Activity 7: Preliminary assessment of a service provider’s history
After a complaint is escalated to a manager, the manager must decide whether:

• the complaint is suitable for early resolution during the intake phase or
• the complaint should be referred for a more detailed assessment to determine whether a resolution process should be commenced.

To assist managers in making that decision, they may require the officer to undertake a preliminary assessment of the service provider’s:

• complaints history
• compliance and sanctions history
• accreditation or quality reporting history.

Early resolution

Activity 8: Support the early resolution of complaints
If complainants decide that their complaints can be promptly resolved without the Scheme commencing a formal resolution process (conciliation, investigation, etc.), officers may support the early resolution of complaints by:

• assisting complainants to clarify the issues in their complaints and identify the outcomes sought to resolve their complaints
• providing routine information to a complainant and/or approved provider on the rights and responsibilities of approved providers and care recipients under the Act
• assisting the complainant and the approved provider to communicate with each other, e.g. assisting the parties gain a broader understanding of the other party’s point of view
• assisting the parties to the complaint to generate ideas for resolving the complaint.

Activity 9: Acknowledge receipt of the complaint
Officers should aim to send a letter within seven days of receiving a complaint either; a) acknowledging receipt of the complaint or b) acknowledging and confirming the issues in the complaint. This should occur prior to commencement of the resolution phase. Officers should use their judgment to determine the most appropriate letter to send.

Workflow to assessment phase

Activity 10: Workflow to assessment phase
Once the above key activities have been completed, and if the complaint has not been resolved at the intake phase, it is workflowed to the assessment phase.

Contents

This chapter contains the following information:

Activity	Title	Topic
1	Receiving information	Introduction
		Who can contact the Scheme?
		How the Scheme can be contacted
		When the Scheme can be contacted
		Preventing and managing unreasonable complainant behaviour
2	Classifying information	Introduction
		Classifying information
		Classification flow chart
		What is in-scope?
		What is out-of-scope?
		What is an inquiry?
		What is a complaint?
		What is a notification?
		What is an own motion concern?
		What is an open complaint?
		What is a confidential complaint?
		What is an anonymous complaint?
		Seek advice
3	Collecting information	Introduction
		Out-of-scope – essential information
		Inquiry – essential information
		Complaint – essential information
		Information required for own motion concerns
		Things to consider
4	Providing information	Introduction
		Information to provide for out-of-scope inquiries
		Information to provide for inquiries
		Information to provide for complaints
		Things to consider
		Seek advice
5	Finalising out-of-scope and in-scope inquiries	Introduction
		When to finalise an out-of-scope inquiry
		When to finalise an in-scope inquiry
		Sending correspondence
		Things to consider
		Seek advice
6	Escalating complaints to a manager	Introduction
		Deciding what level of assessment is required
		Using service provider history to inform decision making
		Things to consider
		Seek advice
7	Preliminary assessment of service provider’s history	Introduction
		Deciding what level of assessment is required
		Using service provider history to inform decision making
		Things to consider
		Seek advice
8	Early resolution	Introduction
		What complaints are suitable for early resolution?
		What support can be provided?
		How is the support provided?
		Sending correspondence
		When can the complaint be finalised?
		What happens if early resolution falls outside of 48 hours?
		Seek advice
9	Acknowledge receipt of the complaint	Introduction
		When to send an acknowledgement letter
		Things to consider
10	Workflow to assessment phase	Workflow to assessment

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