(a) Physical restraint shall not continue longer than necessary to control the behavior for which the physical restraint was employed. The use of physical restraint must be discontinued as soon as the consumer's behavior no longer poses imminent danger of serious injury to self or others.
(b) Physical restraint shall not be used as an extended procedure, except when there is a continued need to protect the immediate health and safety of the consumer and/or others from risk of imminent serious injury and the administrator or their designee has approved the use of physical restraint as an extended procedure, as specified in Subsections (c), (f), and (g).
(c) The following requirements must be met to continue use of physical restraint beyond 15 consecutive minutes:
(1) The consumer in a physical restraint must be visually checked to ensure the consumer is not injured, and that the consumer's personal needs, such as access to toilet facilities, are being met.
(A) Direct care staff who use, participate in, approve, or provide visual checks of physical restraints shall be trained in the physical restraint technique utilized.
(B) Visual checks must be documented in the consumer's file at the time of each visual check.
(C) The person conducting the visual check must not be the person who is restraining the consumer.
(2) The person who approves the continuation of physical restraint must be a person other than the person who is restraining the consumer;
(3) Before approving the continuation of the physical restraint beyond 15 consecutive minutes, the person who approves the continuation of physical restraint shall observe the consumer's behavior while being restrained to determine whether continued use of the physical restraint is justified pursuant to Subsection (a);
(4) Within 24 hours of the use of physical restraint beyond 15 minutes, the administrator or their designee must include the following documentation in the consumer's file:
(A) Written approval for the continued use of physical restraint beyond 15 consecutive minutes;
(B) Written explanation of why it was necessary for physical restraint to extend beyond 15 consecutive minutes; and,
(C) A description of the consumer's behavior that posed an imminent danger of serious injury to self or others.
(d) Direct care staff must respond promptly and appropriately to a consumer's request for services and assistance with repositioning the consumer.
(e) Physical restraint shall not exceed 30 consecutive minutes.
(f) If physical restraint is reapplied within two (2) minutes of release of a physical restraint:
(1) The administrator or their designee must include the documentation outlined in Subsection (c)(4)(A)-(C), in the consumer's file within 24 hours; and
(2) The person who approves the continuation of physical restraint must be a person other than the person who restrained the consumer.
(g) For every subsequent reapplication of physical restraint within two (2) minutes of release of a physical restraint:
(1) The administrator or their designee shall observe the consumer's behavior while restrained to determine whether continued use of the physical restraint is justified pursuant to Subsection (a);
(2) The consumer in a physical restraint must be allowed to access liquids, meals, toileting, and range of motion exercises;
(3) The administrator or their designee must provide the documentation outlined in Subsection (c)(4)(A)-(C), in the consumer's file within 24 hours;
(4) The administrator or their designee must approve each reapplication of physical restraint;
(5) The administrator or their designee must evaluate whether the facility has the resources necessary to maintain the consumer's health and safety during crisis situations where there is risk of serious injury of self or others; and
(6) The authorized consumer representative, if any, must be notified and if the consumer is a child, the child's authorized consumer representative must approve of the third and every subsequent reapplication of physical restraint within two (2) minutes of a physical restraint release. The authorized consumer representative's approval must be documented in the consumer's file at the time of the approval.
(A) If the administrator or their designee is not able to obtain approval from the child's authorized consumer representative to continue the extended use of restraint, direct care staff shall maintain the physical restraint if there is an imminent risk of serious injury and immediately call local law enforcement.
(h) Physical restraint must not exceed four (4) cumulative hours in a 24-hour period.
(1) If a physical restraint exceeds four (4) cumulative hours, the facility must inform the authorized consumer representative, if any, and contact community emergency services to determine whether the consumer should be removed from the facility.
(i) Within 48 hours of a physical restraint of 60 or more cumulative minutes in a 24-hour period, the consumer's Individual Behavior Supports Plan must be reviewed by the Individual Behavior Supports Team and modified as needed.
Credits
Note: Authority cited: Sections 4698 and 4698.1, Welfare and Institutions Code. Reference: Sections 4698 and 4698.1, Welfare and Institutions Code; and Section 1180.4, Health and Safety Code.
History
1. New section filed 6-25-2021 as a deemed emergency; operative 6-25-2021 (Register 2021, No. 26). Pursuant to Welfare and Institutions Code section 4698.1(b), a Certificate of Compliance must be transmitted to OAL by 6-25-2023 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 4-25-2022 as a deemed emergency; operative 4-25-2022 (Register 2022, No. 17). Pursuant to Welfare and Institutions Code section 4698.1(b), a Certificate of Compliance must be transmitted to OAL by 6-25-2023 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 7-25-2022 as a deemed emergency; operative 7-25-2022 (Register 2022, No. 30). Pursuant to Welfare and Institutions Code section 4698.1(b), a Certificate of Compliance must be transmitted to OAL by 6-25-2023 or emergency language will be repealed by operation of law on the following day.
4. Updating certificate of compliance information in History 1, 2 and 3.
5. Certificate of Compliance as to 7-25-2022 order, including amendment of section, transmitted to OAL 5-30-2023 and filed 7-12-2023; amendments effective 7-12-2023 pursuant to Government Code section 11343.4(b)(3) (Register 2023, No. 28).
This database is current through 5/10/24 Register 2024, No. 19.
