Clients - Client Complaint Form

Client Complaint Form

Direct Focus Solutions strives to always address any complaints and concerns at point of service.

This form should be submitted by the client / NDIS participant or their chosen advocate / decision maker.

Please indicate how you are submitting this form: *

On behalf of myself (I am a client / NDIS participant)On behalf of a client / NDIS participant (I am their chosen advocate / decision maker)

Have you attempted to speak to a member of our staff about your complaint or concerns? *

YesNo

If you would like a member of DFS to personally assist you with your complaint or concern, you may speak to us in person by phone on 1300 197 949, or by email at contact@directfocussolutions.com.au.

Please choose client's nearest DFS clinic *

Personal Information

I (and the client I represent if applicable) wish to remain anonymous

Client Details

Is the client an NDIS participant? *

YesNo

Title

First Name *

Last Name *

Phone Number

Email *(This email address will be used to review and progress the submitted complaint as no advocate or decision maker has been indicated)

Client Email(Optional - This email will not be responsible for taking action in response to this form submission)

Advocate / Decision Maker Details

Title

First Name *

Last Name *

Relationship to Client *

Phone Number

Email *(As advocate / decision maker for the client, this email address will be used to review and progress the submitted complaint. A PDF copy will be sent to the client's email address [if indicated])

Details of Complaint *

Complaint Submission Date *

I would like to see how DFS records complaint information (show information below)

DFS maintains adequate records relating to all complaints received. DFS may provide statistics and other information about complaints received to the NDIS commission upon request. Records will include information about the complaint, any action taken to remediate or resolve complaints, and the outcomes of any action taken. Records will also be kept for 7 years from the date the record was made.

Proposed Actions

Proposed Actions in Response to Complaint

The following actions have been proposed by Direct Focus Solutions Quality Assurance Manager in response to the complaint submitted above:

Action Proposed #1 *

Timeframe to be Actioned *

Action Proposed #2

Timeframe to be Actioned

Action Proposed #3

Timeframe to be Actioned

Action Proposed #4

Timeframe to be Actioned

Action Proposed #5

Timeframe to be Actioned

Action Proposed #6

Timeframe to be Actioned

By providing their signature below, the Direct Focus Solutions Quality Assurance Manager verifies that the proposed actions and timeframes supplied above have been made in accordance with all DFS staff and stakeholders relevant to the nature of the client's complaint.

Quality Assurance Manager Name *

Signature *

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Date Signed *

Response to Proposed Actions

Please review the proposed actions in response to your submitted complaint above. After reading through them, please let us know how you feel below.

How do you feel? *

I am happy with the actions proposedI would like to have changes made to the actions proposed

What would you like to see changed? *

Any changes you propose will be reviewed for implementation by the DFS Quality Assurance Manager. Any amendments to actions made will be reflected in this form within a later review step that will be provided to you.

Date of Response *

Client Signature *

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Advocate / Decision Maker Signature *

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Post Action

The following actions were taken in response to the submitted complaint at the dates indicated:

Action Taken #1 *

Date Actioned *

Action Taken #2

Date Actioned

Action Taken #3

Date Actioned

Action Taken #4

Date Actioned

Action Taken #5

Date Actioned

Action Taken #6

Date Actioned

Further Details(If necessary)

By providing their signature below, the Quality Assurance Manager indicated verifies that the actions taken and their dates supplied above are accurate and have been listed in accordance with all prior knowledge and feedback received in relation to the client's complaint.

Quality Assurance Manager Name *

Signature *

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Date Signed *

Complaint Escalation (For NDIS Participants)

Please check this box if you would like to see details about how you may escalate a complaint

Would you like to escalate your complaint?

If providers are unable to resolve NDIS participant concerns or complaints, the participant or their avocate / representative should contact the NDIS Quality and Safeguards Commission. They can do this through:

Phoning 1800 035 544 (free call from landlines) or TTY 133 677. Interpreters can be arranged.
Using the National Relay Service and asking for 1800 035 544.
Or completing a complaint contact form.

The NDIS Quality and Safeguards Commission can take complaints about services or supports that were not provided in a safe and respectful way / delivered to an appropriate standard, or the way in which an NDIS provider has managed a complaint about services or supports provided to an NDIS participant.

The NDIS will review the information provided to them by the participant and the NDIS provider, and talk to everyone involved about this information. Actions taken in response to this information often involve either:

Arranging a meeting between the person making the complaint, the person with a disability affected by an issue raised in the complaint, and the provider, or;
Compliance actions, including an investigation (this includes issues where they identify serious concerns and risks to people with disability, such as allegations of abuse, assault or neglect.)

NDIS providers may be asked to take actions to address issues and concerns raised in the complaint. This may include:

Changes to the provider’s complaints management system to make it easier for people to raise concerns.
Ensuring all service users’ behaviour support plans are up to date.
Ensuring all management staff undertake a particular training program.