Cal. Code Regs. Tit. 22, § 84322 - [Operative until 7/1/2024] Emergency Intervention Plan
(a) The emergency intervention plan is to be
designed and approved, in conjunction with the licensee, by an individual with
the qualifications of a behavior management consultant as defined in Section
84001(b)(1).
(1) The plan must be appropriate for the
client population served by the group home;
(2) The plan must be appropriate for the
staff qualifications and staff emergency intervention
training.
(b) The
emergency intervention plan is to be included in the group home program
statement.
(c) In addition to
Sections 80022 and
84022, the written emergency
intervention plan must be submitted to, and approved by the Department prior to
implementation. The plan must include the requirements specified in Sections
84322(d) through
(h) of Section
84322.
(d) General Provisions:
(1) Name(s) of facility personnel trained to
use emergency interventions.
(2) A
description of the continuum of emergency interventions, commencing with early
interventions, specifying the emergency intervention techniques to be utilized.
For each type of emergency intervention, the plan must include the following:
(A) A description of each emergency
intervention technique to be used.
(B) Maximum time limits for each emergency
intervention technique, not to exceed maximum time limits as specified in
Section 84322(f) and
84300(b)(4).
(C) In what situations each emergency
intervention technique is not to be used.
(D) Expected outcome, benefits to the
child.
(3) A statement
specifying what emergency interventions will never be used.
(4) A description of the circumstances and
the types of behaviors that may require the use of emergency
intervention.
(5) Procedures for
using age and size appropriate emergency intervention techniques.
(6) Procedures for using emergency
interventions if more than one child requires the use of emergency intervention
at the same time.
(7) Procedures
for ensuring care and supervision is maintained in the facility when all
available facility personnel are required for the use of emergency
interventions.
(8) Procedures for
re-integrating the child back into the facility routine after an emergency
intervention technique has been used.
(9) Criteria for assessing when an emergency
intervention plan needs to be modified or terminated.
(10) Criteria for assessing when the facility
does not have adequate resources to meet the needs of a specific
child.
(e) The manual
restraint plan is to be included as a component of the emergency intervention
plan. If the facility will not use manual restraints, the plan must include the
following:
(1) Procedures for responding to a
crisis situation to prevent a child who is exhibiting assaultive behavior from
injuring or endangering himself, herself or others.
(A) The external community resources to be
used to assist facility personnel must be identified and listed in the
plan.
(B) The facility's policies
and procedures concerning when and how to involve law enforcement in response
to an incident involving a child residing in the facility must be included in
the plan.
(C) Nothing in Section
84322(e)(1)(A) or
(B) shall be interpreted to require a
licensee to take any action that would endanger, or to prevent a licensee from
taking any action that would protect, the health and safety of children in
care, staff, or others.
(f) The manual restraint plan is to be
included as a component of the emergency intervention plan. If the facility
will use, or it is reasonably foreseeable that the facility will use, manual
restraints, the plan must include the following:
(1) Procedures for ensuring a child's safety
when a manual restraint is being used including, but not limited to, the titles
of facility personnel responsible for checking the child's breathing and
circulation.
(A) Procedures for determining
when a medical examination is needed during a manual restraint, as specified in
Section 84369.
(2) Procedures for ensuring that:
(a) the amount of time a child is restrained
is limited to the amount of time when the child is presenting an immediate
danger to himself/herself or others;
(b) restraints will not cause injury to the
child. Such procedures must include provisions that ensure the following:
(A) A child does not remain in a manual
restraint for more than 15 consecutive minutes, unless written approval to
continue the restraint after the initial 15 minutes is obtained from the
administrator or administrator's designee.
1.
The individual who approves the continuation of restraint must be a person
other than the individual who restrained the child.
2. The individual who visually checks the
child after 15 minutes to ensure the child is not injured and that the child's
personal needs, such as access to toilet facilities, are being met, must be a
person other than the individual restraining the child.
3. After the initial 15 minutes, the
individual who approves the continuation of the manual restraint observes the
child's behavior while the child is being restrained to determine whether
continued use of the manual restraint is justified.
4. Written approval to continue a manual
restraint beyond 15 consecutive minutes must be documented in the child's
record.
(B) A child does
not remain in a manual restraint for more than 30 consecutive minutes in a 24-
hour period unless the child is still presenting a danger to himself, herself
or others and written approval to continue the restraint after the initial 30
minutes is obtained from the administrator or administrator's designee and the
facility social work staff. If facility social work staff are not onsite to
provide written approval, the facility may obtain verbal approval. Written
approval must be obtained within 24 hours of the verbal approval.
1. The individual who approves the
continuation of the restraint must be a person other than the individual who
restrained the child.
2. The child
is visually checked after the initial 30 minutes, by persons other than the
individuals who restrained the child, to ensure the child is not injured and
that the child's personal needs, such as access to toilet facilities, are being
met.
3. After the initial 30
minutes, the individuals who approve the continuation of the restraint observe
the child's behavior while the child is being restrained to determine whether
continued use of the manual restraint is justified.
4. Written approval to continue the use of
the manual restraint must be documented in the child's
record.
(C) After the
initial 30 minutes, a child placed in a manual restraint must be visually
checked every 15 minutes until the manual restraint is terminated, to ensure
the child is not injured, that personal needs are being met, and that the
continued use of the manual restraint is justified.
1. This visual check must be documented in
the child's record.
2. The person
conducting the check must not be the individual who restrained the
child.
(D) After the
initial 30 minutes, and at 30 minute intervals, if the child is still
presenting a danger to himself, herself or others, the administrator or
administrator's designee and facility social work staff must evaluate whether
the facility has adequate resources to meet the child's needs.
(E) Manual restraints used in excess of 60
consecutive minutes must be approved, every 30 minutes, in writing by the
administrator or administrator's designee, facility social work staff and the
child's authorized representative. If the child's authorized representative is
not available to provide written approval, the facility may obtain verbal
approval. Written approval must be obtained within 24 hours of the verbal
approval. The continued use of a manual restraint shall be documented in the
child's record.
(F) Within 48 hours
of a manual restraint of 60 cumulative minutes or longer, in a 24-hour period,
the child's needs and services plan must be reviewed by the facility
administrator or administrator's designee, facility social work staff and the
child's authorized representative, and modified as needed.
(G) Manual restraints must not exceed four
(4) cumulative hours in a 24-hour period.
1.
If a child continues to present an immediate danger of injuring or endangering
himself, herself or others, the facility must inform the child's authorized
representative; and contact community emergency services to determine whether
or not the child should be removed from the facility.
(H) If a manual restraint exceeds two (2)
hours, at regular intervals not exceeding two (2) hours, the child must be
allowed to access liquids, meals and toileting and range of motion
exercises.
(I) Staff must make
provisions for responding promptly and appropriately to a child's request for
services and assistance and repositioning the child when
appropriate.
(3) Procedures for documenting each use of
manual restraints in the child's record.
(4) Procedures for reviewing each use of
manual restraints with the child and authorized representative or
parent.
(5) Procedures for
accessing community emergency services, including, but not limited to, law
enforcement, if the use of emergency interventions is not effective or
appropriate.
(A) The facility's policies and
procedures concerning when and how to involve law enforcement in response to an
incident at the facility must be included in the plan.
(B) Nothing in Section
84322(f)(5)(A)
shall be interpreted to require a licensee to take any action that would
endanger, or to prevent a licensee from taking any action that would protect,
the health and safety of children in care, staff, or
others.
(6) Procedures
for requiring a licensed professional, as defined in Section
80001 (l)(2), to
approve the initiation and continued use of manual restraints, if the licensee
chooses to require this authorization.
(g) The Emergency Intervention Staff Training
Plan is to be included as a component of the emergency intervention plan. The
plan must include the following:
(1) The type,
title, and a brief description of the training that all facility personnel have
completed.
(2) Training
requirements for new personnel.
(3)
The ongoing training required for existing personnel.
(4) Training curriculum as specified in
Section 84365(b).
(5) Training schedule which identifies when
staff training will be offered and provided.
(6) The name(s) and qualification(s) of the
instructor(s) who will provide the training.
(h) Procedures for an internal biannual
review of the use of emergency interventions must be developed. Such procedures
must include at least the following:
(1) A
review is to be conducted by the administrator or the administrator's
designee.
(2) Analysis of
patterns/trends of use of emergency interventions in the previous six (6) month
period, based on:
(A) Review of all records
related to the use of emergency interventions for accurancy and
completeness.
(B) Review of the
use, effectiveness and duration of each emergency intervention including, a
determination of the effectiveness and appropriateness of the intervention
techique used in each situation.
(C) Review of the frequency of emergency
interventions in the previous six (6) month period.
(3) Corrective action plan, if
needed.
(4) The biannual review and
corrective action plan must be submitted to the Department no later than the
fifth (5th) day of the month following the review.
(5) The licensee shall provide a copy of the
biannual review and corrective action plan, if applicable, to the authorized
representative upon request.
(i) In addition to the requirements in
Section 80068, the admission agreement
must include a written statement regarding the type(s) of emergency
interventions the licensee has been approved to use.
(1) The facility's policy regarding the use
of emergency intervention must be reviewed with the child and the authorized
representative at the time of admission.
(A)
The licensee shall provide a copy of the approved emergency intervention plan
to the authorized representative, upon request.
(j) Only trained facility personnel as
specified in Section
84365 will be allowed to use
emergency interventions on children.
(k) Prior to using the emergency intervention
plan, the licensee's Board of Directors must approve the plan, and any
subsequent amendments. The approval must be documented in the minutes of the
Board of Directors meeting. Each board member must receive a copy of the plan
prior to its use and any modifications to it.
(l) The Department must review the emergency
intervention plan, including any amendments, and notify the licensee within 30
days of the receipt of the plan, whether the plan has been approved or denied
or if additional information is needed.
(1) If
the plan is disapproved, the licensee may appeal the decision using the
procedures specified in Section
80040(d).
(m) If the Department determines that the
licensee has not complied with the emergency intervention plan requirements as
specified in Subdivisions (a) through (k) of Section
84322, the licensee must
discontinue the use of emergency interventions immediately upon written notice
of deficiency by the Department.
Notes
2. Repealed by operation of Government Code section 11346.1(g) (Register 2003, No. 4).
3. Change without regulatory effect renumbering and amending former section 84802 to section 84322 filed 1-24-2003 pursuant to section 100, title 1, California Code of Regulations (Register 2003, No. 4).
4. New subsections (e)(1)(B)-(C), amendment of subsection (f)(5) and new subsections (f)(5)(A)-(B) filed 8-28-2017; operative 10-1-2017 (Register 2017, No. 35).
Note: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501 and 1531, Health and Safety Code.
2. Repealed by operation of Government Code section 11346.1(g) (Register 2003, No. 4).
3. Change without regulatory effect renumbering and amending former section 84802 to section 84322 filed 1-24-2003 pursuant to section 100, title 1, California Code of Regulations (Register 2003, No. 4).
4. New subsections (e)(1)(B)-(C), amendment of subsection (f)(5) and new subsections (f)(5)(A)-(B) filed 8-28-2017; operative
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