Utah Admin. Code 432-152-15

Current through Bulletin 2024-23, December 1, 2024

Section R432-152-15 - Client Behavior and Facility Practices

(1) The licensee shall develop and implement written policies and procedures for the management of conduct between staff and clients that:

(a) promote the growth, development and independence of the client;

(b) address the extent that client choice will be accommodated in daily decision-making, with emphasis on self-determination and self-management to the extent possible;

(c) specify client conduct that is allowed or disallowed; and

(d) are made available to staff, clients, parents of minor children and legal guardians.

(2) To the extent possible, clients shall participate in the formulation of the policies and procedures under Subsection R432-152-15(1).

(3) Clients may not discipline other clients, except as part of an organized system of self-government, as outlined in facility policy.

(4) The licensee shall develop and implement written policies and procedures that govern the management of inappropriate client behavior that:

(a) are consistent with the Subsection R432-152-15(1);

(b) specify facility-approved interventions to manage inappropriate client behavior;

(c) designate these interventions on a hierarchy to be implemented, ranging from most positive or least intrusive, to least positive or most intrusive; and

(d) ensure, before the use of more restrictive techniques, that less restrictive measures have been implemented with the results documented in the client's record.

(5) The policies and procedures outlined in Subsection R432-151-15(4) shall address the following:

(a) the use of time-out rooms;

(b) the use of physical restraints;

(c) the use of chemical restraints to manage inappropriate behavior;

(d) the application of painful or noxious stimuli;

(e) the staff members who may authorize the use of specified interventions; and

(f) a mechanism for monitoring and controlling the use of such interventions.

(6) The licensee shall ensure interventions to manage inappropriate client behavior are employed with safeguards and supervision to ensure that the safety, welfare and civil and human rights of clients are adequately protected.

(7) A licensee may not utilize as-needed programs to control inappropriate behavior.

(8) A licensee may place a client in a time-out room where egress is prevented only if the following conditions are met:

(a) the placement is part of an approved systematic timeout program as required by Subsection R432-152-15(4);

(b) the client is under the direct constant visual supervision of designated staff;

(c) the door to the room is held shut by staff or by a mechanism requiring constant physical pressure from a staff member to keep the mechanism engaged;

(d) placement of a client in a time-out room does not exceed one hour per incident of maladapted behavior;

(e) clients placed in time-out rooms are protected from hazardous conditions including sharp corners and objects, uncovered light fixtures, and unprotected electrical outlets; and

(f) the licensee maintains a log for each time-out room.

(9) A licensee may use physical restraints only:

(a) as an integral part of an individual program plan that is intended to lead to less restrictive means of managing and eliminating the behavior that the restraint is applied for;

(b) as an emergency measure, but only if absolutely necessary to protect the client or others from injury; or

(c) as a health-related protection prescribed by a physician, but only if absolutely necessary during the conduct of a specific medical or surgical procedure or only if absolutely necessary for client protection during the time that a medical condition exists.

(10) A licensee may apply emergency restraints for initial or extended use for no longer than 12 consecutive hours for the combined initial and extended use time period as long as authorization is obtained as soon as the client is restrained or stable.

(11) A licensee may not issue orders for restraint on a standing or as needed basis.

(12)

(a) The licensee shall ensure staff check clients placed in restraints at least every 30 minutes and maintain documentation of each check.

(b) Staff shall apply restraints to cause the least possible discomfort and may not cause physical injury to the client.

(c) Staff shall provide and document opportunity for motion and exercise for a period of not less than 10 minutes during each two hour period that a restraint is employed.

(d) Staff may not use barred enclosures more than three feet in height and barred enclosures may not have tops.

(13)

(a) The licensee may not administer medications at a dose that interferes with a client's daily living activities.

(b) The interdisciplinary team shall approve medications used for the control of inappropriate behavior and is used only as an integral part of the client's individual program plan that is directed specifically towards the reduction of and eventual elimination of the behaviors that the medications are employed for.

(c) Medications used for control of inappropriate behavior shall be:

(i) monitored closely, in conjunction with the physician and the medication review requirement; and

(ii) gradually withdrawn at least annually in a carefully monitored program conducted in conjunction with the interdisciplinary team, unless clinical evidence justifies that this is contraindicated.

Utah Admin. Code R432-152-15

Amended by Utah State Bulletin Number 2022-04, effective 1/31/2022

Adopted by Utah State Bulletin Number 2024-01, effective 12/19/2023