California Code of Regulations › Title 9 - Rehabilitative and Developmental Services › Division 1 - Department of Mental Health › Chapter 7 - Acute and Nonacute Levels of 24-Hour Mental Health Care Provided by County Mental Health Agencies in Correctional Treatment Centers › Section 1115 - 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 be based 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 nurse practitioner's written or verbal
				approval operating under the supervision of a physician. 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 shall 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
				twenty four (24) hours after the inmate-patient has been placed in a 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 a 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. Fluids and nourishment shall be
				provided every two (2) hours, except during sleep. An opportunity to use a toilet
				or, when necessary, an alternative shall be provided every two hours, except during
				sleep. An inmate-patient placed in clinical seclusion shall be checked by nursing
				staff at least every fifteen (15) minutes. Routine range of motion exercises shall
				be done with clinically restrained inmate-patients for at least ten (10) minutes
				every two hours. A written record shall be kept of these checks and exercises, and
				maintained in the individual inmate-patient 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 clinical restraints and document the
				inmate-patient's status, the judgment of a physician or clinical psychologist on the
				necessity of continuing the order, and the approval of a physician on the medical
				safety of the continuation of 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. The minimum
				necessary 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 7-14-94; operative 1-2-96 (Register 94, No. 28).
2. Change without
				  regulatory effect renumbering former section
				  795 to new section
				  1115 filed 8-31-95 pursuant to section
				  100, title 1, California Code of
				  Regulations (Register 95, No. 34).
Note: Authority cited: Sections
					 1250.1(a)(12)
					 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.