Nondiscrimination ACA1557

Brookside Inn Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement (Section 1557 of the Affordable Care Act):

Discrimination is Against the Law

Brookside Inn complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.   Brookside Inn does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Brookside Inn:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as:

• Qualified interpreters
• Information written in other languages

If you need these services, Nancy Walsh and the Social Services team at 720.573.4351 or nancyw@bsisnf.com.

Grievances

If you believe that Brookside Inn has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Gloria Sivetts, Nursing Home Administrator, 1297 S. Perry St., Castle Rock, CO 80104. Additional contact info: phone: 720-573-4358, fax: 303-688-2600, email: administrator@bsisnf.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, please contact Gloria Sivetts, Nursing Home Administrator at 720.573.4358 or at administrator@bsisnf.com.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Brookside Inn Provides Individuals With Limited English Proficiency of Language Assistance Services (Section 1557 of the Affordable Care Act)

• ATTENTION: If you speak English, language assistance services, free of charge, are available to you.  Call 1-720-573-4351.
• ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-720-573-4351.
• CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.  Gọi số 1-720-573-4351.
• 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-720-573-4351.
• 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  1-720-573-4351 번으로 전화해 주십시오.
• ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.  Звоните 1-720-573-4351.
• ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-720-573-4351.
• لحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.  اتصل برقم 1-720-573-4351
• ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.  Rufnummer: 1-720-573-4351.
• ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.  Appelez le 1-720-573-4351.
• ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । फोन गर्नुहोस् 1-720-573-43517.
• PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.  Tumawag sa 1-720-573-4351.
• 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-720-573-4351まで、お電話にてご連絡ください。
• XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-720-573-4351.
• Dè ɖɛ nìà kɛ dyéɖé gbo: Ɔ jǔ ké m̀ [Ɓàsɔ́ɔ̀-wùɖù-po-nyɔ̀] jǔ ní, nìí, à wuɖu kà kò ɖò po-poɔ̀ ɓɛ́ìn m̀ gbo kpáa. Ɖá 1-720-573-4351.
• توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. با 1-720-573-4351 تماس بگیرید
• Ige nti: O buru na asu Ibo asusu, enyemaka diri gi site na call 1-720-573-4351.
• AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-720-573-4351.