Healthicity Audit and Compliance Solutions

Sandstone Care

Complaint /Grievance Information-Please Read

A staff member will acknowledge the complaint within 72 hours, and the leadership team will begin to investigate the concern. Whenever possible. complaints will be resolved within 30 working days. Should the issue require more time for investigation, updates will be provided. We cannot offer updates to complaints filed anonymously.

Date observed or first noticed

Who or what was affected?

Person making grievance:

Other person making grievance:

Name of person making the grievance (may leave blank):

Client Name:

Date of Birth:

Phone number of person making the grievance/complaint (may leave blank):

Is it Ok to leave a message?

Location of the grievance:

Nature of Complaint:

Other Nature of Complaint:

Description of event(s) or concerns

Describe the resolution you would like to see:

Are you willing to discuss this issue with us further? Yes (Compliance or HR Team May Contact Me)No (Remain Anonymous - Do Not Contact Me)

Do you want to save a copy of this report to your device? YesNo

Thank you for submitting