Sources Community Resources Society Policy and Procedure Manual SECTION 5 POLICY AND PROCEDURE MANUAL CLIENT RIGHTS
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-2 TABLE OF CONTENTS 5. CLIENT RIGHTS ....................................................................................................................................3 5.1 Client Rights and Protections .........................................................................................................3 5.2 Continuity of Care (Rev. 2011) ........................................................................................................3 5.3 Representation Agreements (Rev. 2017) ....................................................................................4 5.4 Informed Consent ...............................................................................................................................4 5.4.1 Minors’ Consent to Service ...................................................................................................................4 5.4.2 Consent to Health Care...........................................................................................................................5 5.4.3 Advance Directives (Rev. 2017) .........................................................................................................5 5.5 Right to Refuse Service......................................................................................................................6 5.6 Fee for Service (Rev. 2011)...............................................................................................................6 5.7 Cultural and Religious Freedom (Rev. 2017).............................................................................6 5.8 Assistive Technology (2015) ...........................................................................................................7 5.9 Use of Clients in Promotion of Sources........................................................................................7 5.10 Research Involving Clients (Rev. 2011)...................................................................................7 5.10.1 Evaluation of Research Proposals (Rev. 2017)........................................................................7 5.10.2 Client Consent.......................................................................................................................................8 5.10.3 Research Participant Confidentiality ...........................................................................................8 5.11 Residential Clients..........................................................................................................................9 5.11.1 Where a client is residing in a residential program, they shall: ........................................9 5.11.2 Search and Seizure ..............................................................................................................................9 5.11.3 Client Privacy (Rev. 2011)............................................................................................................. 10 5.12 Client Personal Property (2011)............................................................................................. 10 5.13 Client Complaints (Rev. 2011;2023) ...................................................................................... 11 5.13.1 Procedures (Rev. 2023)................................................................................................................ 11 5.13.2 Risk Management (Rev. 2017; 2023)....................................................................................... 12
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-3 5. CLIENT RIGHTS Note: For the purposes of this manual, the term client refers to individuals who access the services of Sources and/or their legal representatives (where applicable). All policies and procedures that apply to clients also apply to clients’ legal representatives (e.g. parents, legal guardians, legal representatives, temporary substitute decision-makers). 5.1 Client Rights and Protections Clients and/or legal representatives of Sources are given a program brochure or other similar statement indicating how and where services are to be provided (i.e. home based or at a specified location) and the hours of service. Client rights and responsibilities are described in a brochure which is given to all program participants during an initial meeting or visit (see Appendix B for this brochure). The brochure may be simplified, read aloud, or translated as required to assist client understanding (1989, rev. 1999). Client rights and responsibilities must be posted in a visible and accessible area of each program site (2002). As appropriate, other pertinent documents regarding client rights must be available in programs. These include but are not limited to: - The Residents’ Bill of Rights from the Community Care and Assisted Living Act. - CLBC’s Rights and Safeguards: A Guide for Self-Advocates; and - Client rights outlined in CLBC’s Behaviour Support Safety Planning Guide. Sources provides every client equal treatment and consideration. There will be no preferential treatment of members of the Board of Directors, staff, volunteers, consultants, or any family or friends of these groups, either in obtaining services from Sources or in the quality of services rendered. They will not be given priority in programs with a waiting list. Where service may be discontinued due to client behaviour, clients are advised of the types of behaviour that may jeopardize their opportunity for ongoing service (e.g.: chronically missing appointments, aggressiveness) (1989, rev. 1995, rev. 1999). If a client is disoriented or suffering from impaired cognition, a summary of client rights and responsibilities is provided at another time and/or the client will be supported to have a personal advocate where necessary. 5.2 Continuity of Care (Rev. 2011) Sources recognizes the importance of maintaining continuity of care for clients. Assignment of a case worker occurs at intake or as soon as possible after initial contact to provide consistency from start to finish of services. Sources strives to prevent
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-4 arbitrary staff changes in program or assignment (1989) and to apply program guidelines and expectations consistently. 5.3 Representation Agreements (Rev. 2017) A Representation Agreement is a legal document for personal planning. It is a way for individuals to authorize their personal supporters to help them manage their affairs or make decisions on their behalf if they need assistance due to illness, njury, or disability. This type of agreement is designed to be a legal alternative to adult guardianship for people who need support in decision making. Representation Agreements may cover any or all the following four categories: - Minor and major health care. - Personal care. - Obtain legal services; and - Routine management of financial affairs. Copies of all Representation Agreements must be provided at intake and will be reviewed by the Program Manager or Executive Director to ensure that they meet current legal requirements. 5.4 Informed Consent All clients, or parents/guardians of minors, must be informed in advance of the benefits, risks, side effects, and alternatives to the planned service or treatment. Consent for services and/or treatment are obtained in the form of signed service plans (1989). 5.4.1 Minors’ Consent to Service Sources encourages minors to obtain the consent of parents, a legal guardian, or a responsible adult prior to taking part in any of Sources’ program. If such consent is not given, services are delivered in the best interests of the child with the authority of the CEO. Sources is required, under the Child, Family and Community Service Act (CFCSA), to report to the Ministry for Children and Family Development when it has reasonable cause to believe that a child needs protection (1995). The CEO makes the decision to serve minors without parental consent based on the Infants Act, Part 2, Medical Treatment, Section 17, and the CFCSA, Part 2.1, Section 12.2: Agreements with Youth. The best interests of the child as defined in the CFCSA, Part 1, Section 4, include consideration of all relevant factors in determining best interest with the following factors provided:
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-5 • The child’s safety. • The child’s physical and emotional needs and level of development. • The importance of continuity in the child’s care. • The quality of the relationship the child has with a parent or other person and the effect of maintaining that relationship. • The child’s cultural, racial, linguistic, and religious heritage. • The child’s views; and • The effect on the child if there is a delay in decision making. If the child is Indigenous, the importance of preserving the child’s cultural identity must be considered in determining the child’s best interests. This includes facilitating opportunities to learn about/participate in Indigenous traditions, customs, language, and community (Child, Family and Community Service Act, 2023). 5.4.2 Consent to Health Care Generally, adults can only be given health care with their consent. If an adult is unconscious, mentally incapable, or otherwise unable to give consent, The Health Care (Consent) and Care Facility (Admission) Act sets out procedures to follow. An adult’s consent is not required: a. When urgent/emergency care is required, and the adult is incapable of giving consent. b. When involuntary psychiatric treatment is needed; or c. For preliminary examinations such as triage or assessment. An adult is deemed incapable of making a health care decision when the adult is unable to demonstrate an understanding of the information which the health care provider has given about the necessary or recommended health care. 5.4.3 Advance Directives (Rev. 2017) A mentally competent adult client may declare that they wish specific treatments to be withheld. The CEO is informed prior to admission (or as the need arises) of an Advance Directive, Living Will, or wishes expressed by a client to his or her family regarding medical care. An Advance Directive is a written statement of a person's wishes regarding medical treatment, often including a living will (rev. 2017), made to ensure those wishes are carried out should the person be unable to communicate
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-6 them to a doctor. Advanced Directive notices will be maintained in the client file. For clients under Ministry contract, Advance Directives should also be provided to the Ministry or CLBC contact person. Staff will be notified of all Advance Directives and will make every effort to comply with the orders outlined in the written document. Where appropriate, staff are also responsible for ensuring that clients receive all required medical care other than those treatments the client wishes to be withheld (as specified in the Advance Directives). Procedures related to Advance Directives can be found in program Operating Manuals (as appropriate). 5.5 Right to Refuse Service Clients of Sources have the right to refuse service, treatment, or medication at any time unless there is a specific court order limiting the client’s right to refuse intervention (1989, rev. 2003). If a client refuses service, treatment or medication, the client must be informed of the consequences of such refusal (2003). Personnel are not to impose their personal beliefs on any client. Personnel have a professional responsibility to put the needs and rights of persons served above their own interests (1999). 5.6 Fee for Service (Rev. 2011) When a fee is charged for service, clients are informed in writing prior to service delivery about the amount that will be charged, when fees are charged, changed, refunded, waived, or reduced. They will also be informed of the manner and timing of payment and the consequences of non-payment. (2008) Where fees are a barrier to service for an individual, the CEO may approve for fees to be reduced or waived. 5.7 Cultural and Religious Freedom (Rev. 2017) Sources, as much as practical, shall recognize variations in cultural values and traditions and shall respect the client’s religious decisions through the intake process and collaborative service planning. Sources shall consult with parents or guardians where applicable with respect to religious and/or cultural choices (1989, rev. 2017).
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-7 5.8 Assistive Technology (2015) Sources provides assistive technology, or helps clients gain access to assistive resources, as needed. The client is: - Involved in the selection of specific technologies. - Afforded the opportunity to try the device prior to purchase or assignment; and - Trained in the use of specific assistive devices being provided. 5.9 Use of Clients in Promotion of Sources Sources does not ask clients to participate in public appearances nor does it release identifiable photographs or audio/visual materials without the informed written consent of the client or, in the case of a minor, the informed written consent of the client and the parent or guardian, or in the case of a person deemed legally incompetent, the client’s legal representative (1989, rev. 1995). At no time will clients be coerced into making public statements of gratitude to or about Sources (1999). 5.10 Research Involving Clients (Rev. 2011) All research involving service recipients is conducted in accordance with applicable legal requirements. Research includes all forms of internal or external research involving service recipients, except internal program evaluation and outcomes research, or educational projects carried out by students and interns as part of their professional training. All approved research activities are monitored by the Executive Team. 5.10.1 Evaluation of Research Proposals (Rev. 2017) Research proposals must be reviewed and approved by Sources Senior Management Team. Project approval must be provided in writing by the CEO or designate. The following questions will be examined during this review process: a. Does the proposed project address an issue or question that has a high enough social impact to justify the involvement of clients as subjects? (Rev. 2017) b. How will the project be carried out? c. Does the design of the project give confidence that it can provide an answer to the question(s) posed? d. What are the risks and benefits to the subjects?
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-8 e. Are the expectations of the investigating team from the subjects appropriate to the needs of the project, and are they ethically acceptable? f. What information will be provided to potential subjects? g. Is any reimbursement offered to potential subjects? If so, is reimbursement at such a level as to inappropriately coerce potential subjects into consenting to participate? h. Are appropriate mechanisms in place to protect the privacy and dignity of the subjects involved? i. Is the investigation team capable of carrying out the proposed project to both scientific and ethical standards? Do the investigators have the professional qualifications required for all areas of the project? 5.10.2 Client Consent All clients have the right to refuse to participate in research without penalty. Research involving children requires parental or guardian consent as well as the suitably documented assent of the child if they are old enough to understand. Research participants, or a parent or legal guardian, must sign a consent form that includes: a. A statement that the client voluntarily agrees to participate. b. A statement that the organization will continue to provide services whether or not they agree to participate. c. An explanation of the nature and purpose of the research. d. A clear description of possible risks or discomfort; and e. A guarantee of confidentiality. 5.10.3 Research Participant Confidentiality Research participant confidentiality will be maintained as per Section 3. The identity and privacy of participants in all phases of research conducted by or with the cooperation of Sources is safeguarded. Statistical analyses, reports, and summaries are compiled and presented in a manner that masks the identity of the research participants. Case examples from individual case records must be prepared, prior to dissemination, in a manner that masks the individual’s identity.
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-9 5.11 Residential Clients 5.11.1 Where a client is residing in a residential program, they shall: a. Have the right to receive visits. b. Have the right to private telephone conversations with family members or friends. c. Have the right to visit the family in the family home. d. Have the right to personal property and a place for its safe storage. e. Be free from exploitation in employment related training or gainful employment. f. Be entitled to express their opinion with respect to his or her care or treatment in accordance with the complaint procedure; and g. Have access to health care (medical/dental) with the assistance of a staff member where required. This policy applies unless otherwise determined in writing by an authorized agent of Sources or an appropriate governmental agency or if regulated by law (1989, Rev. 1995). 5.11.2 Search and Seizure Sources discourages the search of residential clients and seizure of their property unless the staff person feels that they or the client are in immediate danger. Reasonable cause for a search exists when a staff member has knowledge of facts which would cause a person, knowing the same facts, to conclude that a client is concealing a dangerous item (e.g. weapon, drugs). Whenever possible, the staff person should remove themselves and others from the dangerous situation and contact the police. (1999) Sources staff are prohibited from conducting searches which require any sort of physical contact. If this is deemed necessary to the safety of the parties involved, the RCMP must be contacted to assess the situation and carry out this procedure. Residents are notified prior to any property searches and are permitted to be in attendance unless their involvement poses a significant safety concern.
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-10 If a search of a client’s property is conducted by either residential staff or the police, an incident report must be completed. The report must clearly indicate the circumstances leading up to the search, findings of the search, and notification. An administrative review of the procedures must follow and be documented in the follow-up/quality assurance section of the report. 5.11.3 Client Privacy (Rev. 2011) Private telephone conversations between clients and family members or others shall be limited or monitored only as provided in the treatment plan, which is documented in the client’s file, approved in advance and reviewed monthly by the Program Manager of the facility. (1989) Incoming mail for residential clients will be given to the client to open unless Sources staff have been instructed otherwise by a legal representative of the client. Sources staff shall not otherwise interfere with the outgoing or incoming mail of clients unless reasonable grounds exist to suspect that the mail contains unauthorized, injurious, or illegal material or substances. In such cases, the mail shall be opened by the addressee in the presence of a designated person appointed by Sources and, if required, in the presence of police. (1989) Sources protects the privacy of clients in residential care by prohibiting the use of listening devices or surveillance cameras for routine observation or supervision. Additionally, doors must be maintained on all bedrooms and bathrooms. (2002) 5.12 Client Personal Property (2011) Residential and Day Program clients are encouraged to bring personal property items for their room or for use in their day program. Permission must be obtained for all items brought into the program. Permission is based on the ability of Sources staff to maintain clients’ and employees’ health and safety and on the assessment of potential impact on other clients in the program. Sources staff make every reasonable effort to safeguard clients’ property but does not assume ultimate responsibility for the property. Clients are responsible for safekeeping valuables and are discouraged from keeping large sums of money or valuables in Sources facilities. Sources reserves the right to restrict or remove clients’ personal items that are determined to be detrimental to the program, clients, or staff.
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-11 5.13 Client Complaints (Rev. 2011; 2023) Where, in the opinion of the individual, arbitrary treatment has been rendered under Sources policies, or the client believes the policies have been breached, the client has the right to file a complaint without interference or retaliation. 5.13.1 Procedures a. The client shall discuss the matter with the individual (employee, volunteer, contract worker) involved. b. If the matter remains unresolved seven business days after discussion between the client and the individual, the client must present his/her complaint in writing to the Program Manager. The Program Manager informs their Executive Director for guidance in the complaint. A personal interview is conducted by the Program Manager and involves the client and the named member of Sources’ personnel. Any other involved person or persons may be interviewed in the attempts to resolve the complaint. The Executive Director may participate in the investigation at this step, at their discretion. c. If the matter is unresolved ten business days after the above actions are taken, the Executive Director of the program must inform the Chief Operating Officer (COO) of the complaint. The COO then follows the same procedure as above and attempts to resolve the complaint. The CEO is informed of progress on the complaint throughout the process. d. If no resolution is reached within fifteen business days of the COO’s involvement, the status of the complaint is reviewed with the CEO. At this time, the Board of Directors may be informed of the complaint with updates provided by the CEO. e. The above timelines may be extended, with the agreement of the complainant, if a resolution is making progress. f. Ultimately, if the complaint cannot be resolved at any of the above stated steps, it will rest with the CEO and the Board of Directors to resolve. g. The Board may discuss the complaint with any appropriate person they see fit. h. The Board of Directors is the final level within Sources at which the complaint may be heard and may accept, resolve or dismiss the complaint. Its decision is rendered within twenty-eight calendar days from the date of the Boards’ first review.
Sources Community Resources Society Policy and Procedure Manual Revised 2011; 2015; 2017; 2023 Reviewed 2019 Section 5: Client Rights 5-12 i. Whenever in the process the complaint is resolved, the client is informed in writing of the resolution and an explanation of any further appeal, rights, or recourse. A copy is kept in the central office files (1995). The client has the right to file a complaint with an appropriate provincial authority if they are not satisfied with the response (2007). A client/family has the right to provide additional information regarding the complaint at any step in the above process. (2008) 5.13.2 Risk Management (Rev. 2017; 2023) See also Section 7: Health and Safety 7.12 Complaints which expose the agency to major risks (risk of reputation, litigation or loss) are to be reported immediately by employees or Managers to their Executive Director, who is responsible for informing the CEO. (Revised 2017) The Executive Team maintains a Risk Record which is reviewed and updated biweekly during the Executive Team meeting. The Risk Record maintains a brief summary of known or potential risk, categorizes the risk, and the team member responsible for overseeing/resolving the risk issue. Risk issues are categorized into the area of impact (i.e. HR, Client Complaints, Health and Safety etc.). The status of each incidence of risk is reviewed and updated to indicate any challenges, progress, and/or resolution. Actions taken to mitigate risk, or prevent future risk of the same nature, are recorded, where appropriate. At least annually, the Executive Team identifies trends or patterns and establishes improvement plans where possble, to prevent future risks of a similar nature. Based on this review, the Executive Team will, no less than annually, provide a summary report to the Board which includes an analysis of trends and a report on corrective action.