California Code of Regulations › Title 9 - Rehabilitative and Developmental Services › Division 1 - Department of Mental Health › Chapter 12 - Mental Health Program Standards for the Community Treatment Facility › Article 5 - Continuing Requirements › Section 1929 - Restraint and Seclusion

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Physical
				  restraint and seclusion shall be used only when alternative methods are not
				  sufficient to protect the child or others from immediate injury.
(b) Physical restraint and seclusion shall not be
				  used as aversive treatment, punishment, as a substitute for more effective
				  programming, or for the convenience of the staff.
(c) Physical restraint and seclusion shall only be
				  used with a written order designed to lead to a less restrictive way of managing,
				  and ultimately eliminating, the behavior for which the physical restraint or
				  seclusion is applied.
(d) A CTF shall
				  adhere to written policies and procedures concerning the use of physical restraints
				  and seclusion that include:
(1) A medical
				  evaluation of each child upon admission to the facility to determine the existence
				  of any condition that would contraindicate the use of physical restraint or
				  seclusion;
(2) A requirement that they
				  be used only with a signed order of a physician or licensed psychologist, except in
				  an emergency as defined in Section
				  1901(K). In such an
				  emergency a child may be placed in physical restraint at the discretion of a
				  registered nurse. An order shall be received by telephone within sixty (60) minutes
				  of the application of physical restraint, and shall be signed by the prescriber
				  within twenty-four (24) hours. Telephone orders shall be received only by authorized
				  mental health professional staff, and shall be recorded immediately in the child's
				  facility record;
(A) The order shall include
				  reasons for the physical restraint or seclusion in specific behavioral terms, type
				  and number of points, if applicable, conditions for release or termination of
				  physical restraint, with specific directions for discussing with the child the
				  conditions that required the application of the physical restraint, the level of
				  nursing care the child is entitled to while in physical restraint and the types of
				  behaviors that will meet the criteria for terminating the order for physical
				  restraint.
(B) Full documentation of the
				  episode leading to the use of physical restraint, including the antecedent
				  behaviors, and less restrictive means attempted by staff prior to the use of
				  physical restraint, the type of physical restraint used, the length of effectiveness
				  of the physical restraint time and the name of the individual applying such measures
				  shall be entered in the child's facility record.
(C) At the time physical restraint or seclusion is
				  initiated, or as soon as practical, but in every case within one (1) hour,
				  information regarding the child's medical condition including vital signs,
				  medications, current medical treatments and any relevant medical circumstances
				  specific to the child shall be reviewed by the facility's on duty licensed nursing
				  staff and noted in the child's facility record.
(D) All orders for physical restraint shall become
				  invalid two (2) hours after the restraint or seclusion is initiated for children
				  ages 9 to 17, one (1) hour for children under age 9, and four (4) hours for any
				  special education pupils ages 18 through 21 remaining in the facility under
				  continuing stay provisions. If continued physical restraint or seclusion is needed a
				  new order shall be required.
(3) A prohibition that physical restraint shall
				  not be allowed for longer than twenty-four (24) hours;
(4) A prohibition against as-needed, also known as
				  "PRN" orders for physical restraint or seclusion.
(5) A description of acceptable forms of physical
				  restraint or seclusion which shall be:
(A)
				  Seclusion in either a designated seclusion room with a door which may be held shut
				  to prevent a child's egress by a staff member or by a mechanism which releases upon
				  removal of a staff person's foot and/or hand or in any other room or part of the
				  facility where the child is prevented from physically leaving for any period of
				  time, thus limiting their movement, activities and contact with the other
				  children;
(B) Physical containment of a
				  child by two or more trained staff persons utilizing methods approved by the
				  Department;
(C) The application of
				  mechanical devices such as well padded belts and cuffs, mittens without thumbs which
				  are securely fastened about the wrist with a small tie and vests consisting of
				  sleeveless cloth webbing;
(6)
				  A requirement that restraint shall be applied in such a way as not to cause physical
				  injury and to insure the least possible discomfort to the child;
(7) A requirement that restraints using mechanical
				  devices shall be applied in such a manner that the device can be speedily removed in
				  case of fire or other emergencies;
(8) A
				  requirement that staff shall make provisions for regularly scheduled periods, at
				  intervals not to exceed two (2) hours, for range of motion exercises, toileting and
				  access to liquids and meals;
(9) A
				  requirement that staff shall make provisions for responding promptly and
				  appropriately to a child's request for services and assistance, and for
				  repositioning the child when appropriate;
(10) A requirement for staff to take all
				  precautions to insure the safety of children in restraints by insuring that they
				  remain in staffs' line of vision, by isolating them from other children and by
				  insuring that the restraints can be easily removed in case of fire or
				  emergency;
(11) A requirement that staff
				  shall make provisions to insure that a child placed in physical restraint shall be
				  checked at a minimum of every fifteen (15) minutes by the licensed nursing staff to
				  insure that the restraint remains properly applied and that the child has not harmed
				  himself. A written record of each check shall be placed in the child's record and
				  shall include:
(A) Vital signs which shall be
				  measured at least every half hour, unless otherwise indicated by the prescribing
				  professional;
(B) Justification for
				  continued physical restraint;
(C) The
				  child's responses to information regarding his behavioral criteria for termination
				  of the physical restraint.