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Client Concern and Complaint Procedure

As a client of Dominion Care, you have the right to express your concerns and complaints related to the care you receive.

I understand that, as an individual currently or previously receiving services, I have the right to express a concern or complaint to any Dominion staff member or may ask for the help of an advocate to do so. The staff member providing assistance shall make every attempt to resolve an expressed concern as quickly as possible without discrimination or negative consequences. When a concern is not resolved at this level, it shall be considered a formal complaint. I will be offered a copy of the complaint resolution procedure and given assistance in writing and submitting the complaint to the Program Director, or a designee, if requested. The complaint shall be logged by the Program Director, and I will receive a written and verbal confirmation of the Program Director’s receipt of the complaint.

If the issue is not resolved, the Director shall investigate the complaint by gathering the facts and by speaking with the people involved, and/or those with collateral information.

The investigation shall be completed within ten(10) calendar days or less from the date of the receipt of the complaint. If the issue is resolved, a report noting the resolutions shall be forwarded to the designated department or staff person. If the issue is not resolved, I will be informed of my right to appeal to the Quality Assurance Department and offered assistance to do so. I understand that I shall have the option to choose an advocate and assistance with contacting an advocate shall be offered.

I understand that I may access the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals and/or CARF regarding a complaint at any time or if I believe to be in imminent danger or fear retaliation.



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    Steps to follow to make a complaint:

    • Talk directly with a staff member if you feel comfortable doing so
    • Ask to speak to the Program Director to submit complaint if you feel comfortable doing so
    • Complete this form
    • If this is a human rights complaint and you are unhappy with the results of the investigation findings, Dominion staff will provide regional human rights advocate information


  • (Please include dates, names, locations, also any other attempts to resolve the problem, attaching additional pages as necessary)
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