(a) If staff use, or it is reasonably foreseeable that staff will use, manual restraint or seclusion, the applicant or licensee shall be responsible to ensure an Emergency Intervention Plan is developed and approved by the Department prior to the use of such techniques.
(1) The Emergency Intervention Plan shall be designed and approved by the applicant or licensee in conjunction with a Behavior Management Consultant and shall be part of the Plan of Operation.
(b) The Emergency Intervention Plan shall specify the less restrictive or non-physical de-escalation methods that may be used to identify and prevent behaviors that lead to the use of manual restraint or seclusion.
(c) The Emergency Intervention Plan shall also specify the techniques that a licensee may use in an emergency when the use of manual restraint or seclusion is necessary to prevent the serious physical harm or death of the client and less restrictive or non-physical techniques are not effective.
(d) The Emergency Intervention Plan shall include:
(1) Staff qualifications and training sufficient to implement the plan.
(2) A list of job titles of the staff required to be trained to use manual restraint and/or seclusion.
(3) A list of emergency intervention techniques beginning with the least restrictive intervention, which shall include:
(A) A description of each emergency intervention technique that may be used.
1. If prone containment is listed and described as an emergency intervention technique that may be used in the Emergency Intervention Plan as required in Section 82122(d)(3)(A), it shall only be used in compliance with Section 1180.4(f) of the Health and Safety Code.
(B) The maximum time limits for each manual restraint and/or seclusion technique, not to exceed maximum time limits, as specified in Sections 82102(a)(14).
(C) The purpose or expected outcome for clients.
(4) A description of the circumstances and the types of client behaviors for which the use of emergency interventions are needed.
(5) Procedures for maintaining care and supervision and reducing the trauma of other clients when staff are required for the use of emergency interventions.
(6) Procedures for crisis situations, when more than one client requires the use of emergency interventions simultaneously.
(7) Procedures for re-integrating the client into the program routine after the need for an emergency intervention has ceased.
(8) Criteria for assessing when an Emergency Intervention Plan needs to be modified or terminated.
(9) Criteria for assessing when the licensee does not have adequate resources to meet the needs of a specific client.
(10) Criteria for assessing when community emergency services personnel are necessary to assist staff during an emergency intervention.
(A) A list of the community emergency services to assist staff.
(11) Procedures to ensure a client in crisis does not injure or endanger self or others.
(12) Criteria for assessing when an Individual Emergency Intervention Plan needs to be modified or terminated.
(13) A statement clarifying that only staff trained as required by Section 82165(b) may use emergency interventions.
(e) If the staff uses, or it is reasonably foreseeable that the staff will use, manual restraint or seclusion, or both, the licensee shall ensure the time limitations in the Emergency Intervention Plan are adhered to. The Emergency Intervention Plan shall include the following:
(1) A procedure for client safety when a manual restraint or seclusion is used, including the title(s) of staff responsible for checking the client's breathing and circulation.
(A) A determination for when a medical examination is needed during or after a manual restraint or seclusion, as specified in Section 82169.
(2) The use of manual restraint or seclusion, or both, shall not be used if a less restrictive, nonphysical intervention is possible. The use of manual restraint or seclusion, or both, shall not cause injury to the client or others in the program.
(3) The amount of time a client is in a manual restraint or seclusion is limited to when the client is presenting an imminent danger to self or others.
(4) The staff shall respond immediately and appropriately to a client's request for services, assistance and repositioning.
(5) During the continued use of a manual restraint or seclusion, a staff person who has completed all regulatory required emergency intervention training and any additional training required by the Emergency Intervention Plan, and who is not involved in the use of the manual restraint or seclusion shall perform an assessment which shall include, but is not limited to, the following:
(A) A visual check of the client's physical well-being to ensure the client is not injured and the client's breathing and circulation are not impaired;
(B) Whether community emergency services, as described in Section 82122(d)(10)(A), needs to be called;
(C) Ensuring the safety of the client;
(D) Ensuring the safety of staff involved;
(E) Determining if the client's behavior poses an imminent danger of serious physical harm; and
(F) Determining if a less restrictive intervention is warranted.
(6) Unless discontinued sooner, at 15 consecutive minutes after the initiation of a manual restraint or seclusion, staff shall discontinue the manual restraint or seclusion.
(A) The only exception to the 15-minute limitation above shall be when there is a continued need to protect the immediate health and safety of the client or others from risk of imminent danger and concurrent approval is obtained by the administrator for every exception.
1. The administrator's approval shall be documented in the client record within 24 hours and also include an explanation of why it was necessary for the manual restraint or seclusion to go over 15 minutes, including a description of the client's imminently dangerous behavior.
2. The administrator mentioned in Section 82122(e)(6)(A)1. above shall not be a participant in the manual restraint.
(7) The licensee shall outline in the Emergency Intervention Plan the procedures to ensure the safety of clients and staff if the client continues to pose an immediate danger to self or others after 15 consecutive minutes of manual restraint or seclusion.
(8) Procedures for client safety when a client is placed in a seclusion room, including the following:
(A) Staff shall be free from other responsibilities and maintain direct visual contact with the client at all times. The visual contact shall not be through video and/or audio equipment or electronic transmission
(B) Staff shall make reasonable efforts to ensure the client does not possess objects that could be used to inflict injury to self or others while in the seclusion room.
(C) Seclusion rooms shall be limited to one client at a time.
(9) Each use of manual restraint or seclusion is documented in the client's record.
(10) There is a review after each use of manual restraint or seclusion, as specified in Section 82168.3.
(11) Access to necessary community emergency services, including emergency response personnel, when the use of emergency interventions is not effective or appropriate.
(12) Staff are aware of the client's medical or physical condition(s), and comply with any necessary limitations or prohibition of the use of manual restraint or seclusion.
(13) When staff are involved in a manual restraint or seclusion, there shall be additional staff to provide care and supervision to the other client(s) who are not involved in the manual restraint or seclusion.
(f) The Emergency Intervention Training Plan shall be a component of the Emergency Intervention Plan and shall include:
(1) Training requirements for new staff;
(2) The course type, title and a brief description of the required training;
(3) The ongoing training requirement for existing staff including timeframes and frequency of refresher training to ensure staff maintain their knowledge;
(4) Training curriculum;
(5) The qualification(s) of the instructor(s) providing the training.
(6) Evidence that the training plan is based on research and that the training topics are appropriate for the client population and services provided by the program.
(g) The Emergency Intervention Plan shall include procedures for an internal six-month review of the use of manual restraint and seclusion which shall include:
(1) A review conducted by the administrator or the administrator's designee and the Qualified Behavior Modification Professional;
(2) An analysis of patterns and trends of the use of manual restraint and seclusion in the previous six-month period, based on a review of:
(A) All records related to the use of manual restraint and seclusion for accuracy and completeness;
(B) The use, outcome, and duration of each manual restraint or seclusion, including injuries and determinations of the appropriateness of the manual restraint and seclusion technique used in each situation; and
(C) The frequency of use of manual restraint(s) and seclusion(s) in the licensed facility.
(3) The development of a corrective action plan to resolve problems identified in the six-month review, including amendments to the Emergency Intervention Plan or other internal procedures.
(h) Documentation of the six-month review, corrective action plan, and a copy of all emergency intervention incident reports shall be maintained at the program and shall be available for review, inspection, audit, and copy, upon request by the Department.
(1) The licensee shall document when no manual restraint or seclusion has occurred.
(2) A copy of the six-month review shall be maintained in the client's record and available for review, inspection, audit and copy, upon request, by the Department, as specified in Section 82070.
(i) The licensee shall provide a copy of the six-month review and corrective action plan to the client's authorized representative, if any, upon request.
(j) The licensee shall immediately discontinue the use of manual restraint or seclusion if both of the following apply:
(1) The licensee has used a manual restraint or seclusion and has been cited for non-compliance.
(2) The Department provided written notice to the licensee prohibiting the use of manual restraints or seclusion.
Credits
Note: Authority cited: Sections 1530, 1530.1, 1567.64 and 1567.82, Health and Safety Code. Reference: Sections 1180, 1180.3, 1180.4, 1180.5, 1501 and 1531, Health and Safety Code.
History
1. New article 3 (section 82122) and section filed 5-16-2022; operative 7-1-2022 (Register 2022, No. 20).
This database is current through 5/10/24 Register 2024, No. 19.
