Section 1180.4 Of Division 1.5. Use Of Seclusion And Behavioral Restraints In Facilities From California Health And Safety Code >> Division 1.5.
1180.4
. (a) A facility described in subdivision (a) of Section
1180.2 or subdivision (a) of Section 1180.3 shall conduct an initial
assessment of each person prior to a placement decision or upon
admission to the facility, or as soon thereafter as possible. This
assessment shall include input from the person and from someone whom
he or she desires to be present, such as a family member, significant
other, or authorized representative designated by the person, and if
the desired third party can be present at the time of admission.
This assessment shall also include, based on the information
available at the time of initial assessment, all of the following:
(1) A person's advance directive regarding deescalation or the use
of seclusion or behavioral restraints.
(2) Identification of early warning signs, triggers, and
precipitants that cause a person to escalate, and identification of
the earliest precipitant of aggression for persons with a known or
suspected history of aggressiveness, or persons who are currently
aggressive.
(3) Techniques, methods, or tools that would help the person
control his or her behavior.
(4) Preexisting medical conditions or any physical disabilities or
limitations that would place the person at greater risk during
restraint or seclusion.
(5) Any trauma history, including any history of sexual or
physical abuse that the affected person feels is relevant.
(b) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may use seclusion or behavioral
restraints for behavioral emergencies only when a person's behavior
presents an imminent danger of serious harm to self or others.
(c) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may not use either of the
following:
(1) A physical restraint or containment technique that obstructs a
person's respiratory airway or impairs the person's breathing or
respiratory capacity, including techniques in which a staff member
places pressure on a person's back or places his or her body weight
against the person's torso or back.
(2) A pillow, blanket, or other item covering the person's face as
part of a physical or mechanical restraint or containment process.
(d) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may not use physical or mechanical
restraint or containment on a person who has a known medical or
physical condition, and where there is reason to believe that the use
would endanger the person's life or seriously exacerbate the person'
s medical condition.
(e) (1) A facility described in subdivision (a) of Section 1180.2
or subdivision (a) of Section 1180.3 may not use prone mechanical
restraint on a person at risk for positional asphyxiation as a result
of one of the following risk factors that are known to the provider:
(A) Obesity.
(B) Pregnancy.
(C) Agitated delirium or excited delirium syndromes.
(D) Cocaine, methamphetamine, or alcohol intoxication.
(E) Exposure to pepper spray.
(F) Preexisting heart disease, including, but not limited to, an
enlarged heart or other cardiovascular disorders.
(G) Respiratory conditions, including emphysema, bronchitis, or
asthma.
(2) Paragraph (1) shall not apply when written authorization has
been provided by a physician, made to accommodate a person's stated
preference for the prone position or because the physician judges
other clinical risks to take precedence. The written authorization
may not be a standing order, and shall be evaluated on a case-by-case
basis by the physician.
(f) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 shall avoid the deliberate use of
prone containment techniques whenever possible, utilizing the best
practices in early intervention techniques, such as deescalation. If
prone containment techniques are used in an emergency situation, a
staff member shall observe the person for any signs of physical
duress throughout the use of prone containment. Whenever possible,
the staff member monitoring the person shall not be involved in
restraining the person.
(g) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may not place a person in a
facedown position with the person's hands held or restrained behind
the person's back.
(h) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may not use physical restraint or
containment as an extended procedure.
(i) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 shall keep under constant,
face-to-face human observation a person who is in seclusion and in
any type of behavioral restraint at the same time. Observation by
means of video camera may be utilized only in facilities that are
already permitted to use video monitoring under federal regulations
specific to that facility.
(j) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 shall afford to persons who are
restrained the least restrictive alternative and the maximum freedom
of movement, while ensuring the physical safety of the person and
others, and shall use the least number of restraint points.
(k) A person in a facility described in subdivision (a) of Section
1180.2 and subdivision (a) of Section 1180.3 has the right to be
free from the use of seclusion and behavioral restraints of any form
imposed as a means of coercion, discipline, convenience, or
retaliation by staff. This right includes, but is not limited to, the
right to be free from the use of a drug used in order to control
behavior or to restrict the person's freedom of movement, if that
drug is not a standard treatment for the person's medical or
psychiatric condition.