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CALIFORNIA
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Standard or
Definition
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CA Group Homes 84151
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Restraint
Definition
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Mechanical - "application of mechanical devices such
as well padded belts and cuffs, mittens without thumbs, which are securely
fastened about the wrists with a small tie and vests consisting of sleeveless
cloth webbing."
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Restraint
Exclusions
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None.
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Chemical Restraint
Definition
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Chemical restraint is not mentioned in the section
governing restraint/seclusion, however the
requirements regarding medication prescription and administration would seem
to preclude chemical restraint.
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Seclusion
Definition
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Seclusion "in a room with a door which may be held
shut to prevent the child's egress by a staff member or by a mechanism which
releases upon removal of the staff person's foot and/or hand or 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."
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Seclusion
Exclusions
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None.
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Criteria for
Restraint and Seclusion
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- Physical restraint and seclusion shall be used
only when alternative methods are not sufficient to protect the child or
others from immediate injury.
- Physical restraint and seclusion shall not be
used as aversive treatment, punishment, as a substitute for effective
programming, or for the convenience of the staff.
- Restraints must be applied in such a way as
not to cause physical injury and to insure the least possible discomfort to
the child.
Under no circumstances shall physical
restraints be used as a disciplinary action.
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Monitoring
Requirements
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- Every child placed in physical restraint shall
be checked at least every fifteen minutes by licensed nursing staff to insure
that the restraint remains properly applied and that the child has not harmed
himself.
- Vital signs shall be measured at least every
half-hour.
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Ordering and
Initiation
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Physical restraint and seclusion may only be used with a
signed order of a physician or licensed psychologist, except in an
emergency. In such cases, a telephone
order must be received within 60 minutes of application of physical restraint
or seclusion. Telephone orders may be
received only by an authorized mental health professional.
Orders are invalid after 2 hours for children ages 9 - 17,
after one hour for children under age 9, and four hours for special education
students ages 18 - 21. A new order is
required for continued restraint/seclusion.
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In-person
Assessment
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At initiation of restraint/seclusion, as soon as is
practical and in no case longer than 1 hour after initiation, the facility's
licensed nursing staff must review the child's medical condition, vital
signs, and relevant medical circumstances. Review must be documented in the child's record.
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Debriefing
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None.
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Family &
Guardian Notification
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A child's parent(s), conservator or person identified by
the court to manage the placement shall be informed of a restraint or
seclusion within 24 hours, excepting weekends.
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Notification of
Rights and Restraint and Seclusion Policies and Procedures at admission
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- Every child admitted is informed and afforded
personal rights including the right to be free from harm, including
unnecessary physical restraint, isolation, medication, abuse or neglect.
- Rights shall be posted in the facility and
each person shall be informed at admission in a language he/she can
understand.
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Training
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None.
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Documentation
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Telephone orders must be recorded immediately in the
child's facility record.
The child's records must include: full documentation of
the episode leading to the use of physical restraint including antecedent
behaviors, and less restrictive means attempted by staff prior to the use of
physical restraint, the type of restraint used, the duration, and the name of
the individual(s) applying the intervention. A written record of each check by nursing staff shall be
placed in the child's record and shall document vital signs, justification
for continued restraint, the child's response to
information regarding criteria for termination of physical restraint.
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Reporting
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None.
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Quality Improvement
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None.
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