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CCFI Grievance Procedure for Consumers

1. The consumer is expected to consult first with their direct service provider regarding any action, occurrence or attitude either expressed or implied which is perceived as unfair or inequitable in the Center’s delivery of services. If a satisfactory agreement for resolution cannot be made through this consultation, the consumer may appeal in writing to the service provider’s immediate supervisor.

2. The supervisor must arrange a meeting with the consumer and the direct services provider within 10 working days after the grievance is received. If no resolution can be reached at this level, the consumer may appeal in writing to the Executive Director.

3. If a consumer submits a written grievance to the Executive Director and no resolution is made within 15 working days after the grievance is received, the Executive Director will instruct the Board President to activate a three member Grievance Committee. This committee is composed of Board members.

4. The Grievance Committee will hear and review all evidence presented by the consumer and the service provider involved. After careful consideration, it will make an action recommendation to the President.

5. If the action taken by the Grievance Committee and the Board President is not satisfactory to the consumer, a final appeal may be made in writing to the President for a hearing before the Board or a designated subcommittee thereof. This request must be in writing and submitted to the Executive Director no more than 10 working days from receipt of notification of the President’s action.

6. If the action taken by the Board of Directors is still not satisfactory to the consumer the consumer will be referred to ACCES for conflict resolution assistance. If the consumer needs assistance with this referral the Executive Director or a designee will assist the consumer in making the referral.

ACCES may be contacted at:

ACCES
Centers Administration Unit
One Commerce Plaza, Room 1601
Albany, New York 12234
1-800-222-5627 (Voice/TTY)

I have been made aware of the above grievance procedure.

The submission of this form with my name, date and birth date attests that I have read and understand the Center's grievance process should I have concerns with the way I have been treated or the services I have received.

I am using my date of birth as my e-signature.

CCFI Consumer's Rights

The staff of the Catskill Center for Independence believes that the Center’s consumers have the right to expect certain things when they utilize Center services. It is to this end that we have developed the following list of consumers’ rights.

WE ARE OBLIGATED BY STATE LAW TO PROVIDE CONSUMER INFORMATION TO THE NEW YORK STATE EDUCATION DEPARTMENT UPON THEIR REQUEST

1. Consumers of the Catskill Center for Independence will be treated with respect and dignity.

2. All consumers will be treated in a courteous and friendly manner.

3. Consumer issues will be kept confidential.

4. Any consumer information that is shared with another person, agency or organization will be done so ONLY with the consumer’s written permission in the form of a current signed release of information form.

5. All requests for Center services will be addressed by a Center staff member within five (5) business days from receipt of the request.

6. All consumers will have an opportunity to develop an independent living plan if they choose.

7. Consumers have the right to initiate the grievance procedure for consumers if they feel any action, occurrence or attitude is unfair or inequitable in the Center’s delivery of services. You may contact ACCES directly at:

ACCES
Centers Administration Unit
One Commerce Plaza
Albany, NY 12234
1-800-222-5627 (Voice/TTY)

The submission of this form with my name, date and birth date attests that I have read and understand my rights as a consumer

I am using my date of birth as my e-signature.

CCFI Consumer Service Record

Disability

Ethnic Background (Optional)

Employment Status

Employment Status

WE ARE OBLIGATED BY STATE LAW TO PROVIDE THIS INFORMATION TO THE NEW YORK STATE EDUCATION DEPARTMENT UPON REQUEST.

INDIVIDUAL CONSUMER NEEDS ASSESSMENT

Dear Consumer:

Please take a moment and indicate any of the services listed below that you would like information about or in which you need assistance. This helps us provide you with the services that are most beneficial to you.

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