File A Grievance EVERY SPACE MUST BE FILLED IN OR THIS REQUEST WILL NOT BE PROCESSED YOUR INFORMATION: First Name Last Name Phone Number Email Address * If you file anonymously we will not be able to contact you regarding this complaint. * STANDARD(S) IN QUESTION: Select All That Apply Sober Home operates with integrity. Sober Home provides an alcohol and drug free environment. Sober Home creates a safe, structured, and recovery supportive environment through written and enforced residents’ rights and requirements. Sober Home clearly identifies the responsible person(s) in charge. Sober Home maintains an accounting system that fully documents all resident financial transactions such as fees, payments and deposits. Sober Home uses an applicant screening process that helps maintain a safe and supportive environment. Sober Home has an orientation process that clearly communicates residents’ rights and requirements prior to them signing any agreements; collects demographic and emergency contact information and provides new residents with written instructions on emergency procedures and staff contact information. Sober Home fosters mutually supportive and recovery-oriented relationships between residents and/or staff through peer-based interactions, house meetings, community gatherings, recreational events, and/or other social activities. Sober Home fosters recovery-supportive, alcohol and drug-free environments through written and enforced policies and procedures that address: residents who return to alcohol and/or drug use; hazardous item searches; drug-screening and or toxicology protocols; and prescription and non-prescription medications usage and storage. Sober Home has a grievance policy and procedure for residents. Sober Home has a community room large enough to accommodate house meetings and sleeping rooms that adhere to MASH square footage requirements. Sober Home maintains the interior and exterior of the property in a functional, safe and clean manner that is compatible with the neighborhood. Sober Home has appliances that are in working order and furniture that is in good condition. Sober Home addresses routine and emergency repairs in a timely fashion. Sober Home provides neighbors with the responsible person(s) contact information upon request. The responsible person(s) responds to neighbor’s complaints, even if it is not possible to resolve the issue. GRIEVANCE DETAILS: It is suggested that the complainant provide some means of contact in the event the investigator needs clarification or additional information. Please provide enough specific information to establish a date, place, and person(s) involved, or equivalent specific information on which the grievance is based in order for the investigator to conduct a proper investigation. Comments (Required) Supporting Documentation I certify that the above information is entirely accurate to the best of my knowledge. (required) Submit Form
