Complaints or Concerns

Complaints or Concerns

Quality Assurance
Your full name*

First NameLast Name
Address*
Supported accommodation address
Date*

DayMonthYear
Date
What is your complaint or concern?*
Please give a brief description of your concern or complaint? Where possible include dates and times.
Have you raised this complaint or concern before with a member of staff from Beroa Home & Support?*

YesNo
If yes, who did you raise it with?
Name of staff
If yes, when did you raise the issue?

DayMonthYear
Date
Do you believe the complaint or concern you have raised can cause harm or abuse to you or anyone involved in this issue?*

YesNo
If yes, please choose what sort of harm or abuse:

PhysicalEmotional/ psychologicalFinancialDomestic violenceNeglectSelf-neglectModern-day slaveryOrganisationalDiscriminatorySexualI don't knowNone of the above
Relevant Document/File

Cancelof
At Beroa Home & Support we take complaints seriously and do what we can to resolve the issue to your satisfaction as soon as we are able to do so. We will investigate this complaint and get back to you within 25 working days.
Your signature

Clear
Date*

DayMonthYear
Date
Should be Empty: