(A) The date and time the use of physical restraint was reported to the authorized consumer representative, and the date, time, and response of the authorized consumer representative, shall be documented in the consumer's file no later than the next calendar day.

(A) An incident report of the use of the physical restraint shall be reviewed for accuracy and completeness, and signed by the licensee or their designee prior to submission to the Department of Social Services and the Department.

(B) If a physical restraint technique that was not part of the facility Emergency Intervention Plan or the Individual Emergency Intervention Plan was used during the emergency intervention, the licensee shall develop a plan for corrective action that, at minimum, shall require direct care staff to repeat or obtain emergency intervention training. Within 24 hours of the licensee's discovery of non-compliance of the Emergency Intervention Plan or the Individualized Emergency Intervention Plan, the licensee shall also submit a plan for corrective action to the Department of Social Services and the Department at [email protected], that describes how the licensee will ensure that there is no recurrence of a violation of the Emergency Intervention Plan or the Individual Emergency Intervention Plan.

(A) A description of the consumer's behavior and a description of the precipitating factors, including behaviors of others, which led to the use of physical restraint;

(B) Description of what physical restraints were used and how long the consumer was restrained;

(C) Description of the non-physical interventions utilized prior to the use of the physical restraint and an explanation of why more restrictive interventions were necessary;

(D) Description of the consumer's verbal response and physical appearance, any injuries sustained by the consumer and/or staff whether the injuries are related to the physical restraint, and how the licensee became aware of the injury;

(E) Description of the type of medical treatment sought and the location where medical treatment was obtained. If no medical treatment was obtained, an explanation of why medical treatment was not sought for injuries;

(F) Name(s) of facility personnel who participated in or witnessed the physical restraint;

(G) Name of the administrator or their designee who approved the continuation of the physical restraint for more than 15 consecutive minutes;

(H) If it is determined in the debriefing pursuant to Section 59010.4 that facility personnel did not adequately attempt to prevent physical restraint, a description of what action(s) should have been taken by staff to prevent physical restraint. This documentation shall also include what corrective action will be taken and why;

(I) If law enforcement was involved, a description of the precipitating factors, including behaviors of others, which led to the police intervention; and

(J) Date(s) and time(s) of other physical restraint(s) involving the same consumer within 24 hours.

(A) The name of each consumer for which a physical restraint was used;

(B) The date and time of the physical restraint;

(C) The duration of the physical restraint;

(D) The behaviors of others connected to the incident and factors that contributed to the incident;

(E) The name(s) and job title(s) of staff that participated in the physical restraint;

(F) The name of the administrator or their designee that approved the continuation of the physical restraint for more than 15 minutes, if applicable;

(G) A description of the physical restraint and type used, including:

(H) The total number of incidents of physical restraint per month;

(I) The total number of serious injuries to consumers per month as a result of physical restraint;

(J) The total number of non-serious injuries to consumers per month as a result of physical restraint;

(K) The total number of serious injuries to staff per month as a result of physical restraint;

(L) The total number of deaths of consumers while in a physical restraint, or where it is reasonable to assume that a death was related to the use of physical restraint; and

(M) If no physical restraints are used, the monthly report shall indicate zero restraints used.