California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 12 - Correctional Treatment Centers › Article 5 - Administration › Section 79801 - Clinical Restraint, Treatment Restraint, and Clinical Seclusion

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Written
				  policies and procedures concerning the use of clinical restraint, treatment
				  restraint, and clinical seclusion shall be developed and approved by the
				  correctional treatment center administration.
(b) Clinical restraint and clinical seclusion
				  shall only be used on a written or verbal order of a psychiatrist or clinical
				  psychologist. Clinical restraint shall additionally require a physician's or
				  physician's assistant's or a nurse practitioner's (operating under the
				  supervision of a physician) written or verbal approval. The order shall include
				  the reason for restraint or seclusion and the types of restraints. Under
				  emergency circumstances clinical restraint or clinical seclusion may be applied
				  and then an approval and/or an order must be obtained as soon as possible, but
				  at least within one hour of application. Emergency circumstances exist when
				  there is a sudden marked change in the inmate-patient's condition so that
				  action is immediately necessary for the preservation of life or the prevention
				  of serious bodily harm to the inmate-patient or others, and it is impractical
				  to first obtain an order and approval. Telephone orders and approvals for
				  clinical restraint and clinical seclusion shall be received only by licensed
				  medical and mental health care staff, shall be recorded immediately in the
				  inmate-patient's health record, and shall be signed within twenty-four (24)
				  hours.
(c) A physician shall
				  complete a medical assessment of an inmate-patient at the earliest opportunity
				  but not later than within twenty-four (24) hours after the inmate-patient has
				  been placed in clinical restraint or clinical seclusion.
(d) Clinical restraint, treatment restraint,
				  and clinical seclusion shall only be used as a measure to prevent injury to
				  self or others. Clinical restraint, treatment restraint, and clinical seclusion
				  shall only be used when less restrictive alternative methods are not sufficient
				  to protect the inmate-patient or others from injury, and shall not be used as
				  punishment or as a substitute for more effective programming or for the
				  convenience of the staff. Removing an inmate-patient from an activity or area
				  to another unlocked area for a period of time as a way to use separation as a
				  behavioral modification technique shall not be considered clinical
				  seclusion.
(e) Each order for
				  clinical restraint and clinical seclusion shall be in force no longer than
				  twenty-four (24) hours.
(f) There
				  shall be no PRN orders (as needed orders) for clinical restraint and clinical
				  seclusion.
(g) An inmate-patient
				  placed in clinical restraint shall be physically checked at least every fifteen
				  (15) minutes by nursing staff to assure that the restraints remain properly
				  applied, that circulation is not impaired, that the inmate-patient is not in
				  danger of harming himself or herself, and that other medical problems are not
				  present. Routine range of motion exercises shall be done with clinically
				  restrained inmate-patients. Fluids and nourishment shall be provided every two
				  (2) hours, except during sleep. An inmate-patient placed in clinical seclusion
				  shall be observed by nursing staff at least every fifteen (15) minutes. A
				  written record shall be kept of these checks and range of motion exercises and
				  maintained in the individual inmate-patient's health record.
(h) The inmate-patient's health record shall
				  include written justification for the application of clinical restraints, note
				  the times of application and removal of restraints and document the
				  inmate-patient's status and the judgment of the physician or clinical
				  psychologist on the necessity for continuation of clinical restraints at a
				  minimum of once every twenty-four (24) hours.
(i) Clinical and treatment restraints shall
				  be used in such a way as to minimize the risk of physical injury to the
				  inmate-patient and to ensure the least possible discomfort. Minimum force shall
				  be used. Belts and cuffs shall be well padded.
(j) Clinical restraints shall be placed on
				  inmate-patients only in an area that is under direct observation of staff. Such
				  inmate-patients shall be afforded protection from other inmate-patients who may
				  also be in the area.
1. New
					 section filed 6-10-94; operative 1-1-96 pursuant to Health and Safety Code
					 section
					 1250
					 (Register 94, No. 23).
Note: Authority cited: Sections
						208(a)
						and
						1267.10(a),
						Health and Safety Code. Reference: Sections
						1250(j)
						and
						1254,
						Health and Safety Code; and Section
						5325,
						Welfare and Institutions Code.