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Based on clinical record review, review of Seclusion and Restraint Log and interview, it was determined the Facility failed to update the Master Treatment plan of care for 11 of 11 (#4, #6, #7, #9-#16) clinical records reviewed of patients who had personal or chemical restraints or seclusion. Failure to include the use of restraints in the Master Treatment plan of care did not reflect a process of assessment, intervention and evaluation by the multi-disciplinary team when restraint or seclusion was used. The failed practice affected Patient #4, #6, #7, #9-#16 and is likely to affect all patients who are restrained. The findings are:

A. Clinical records were reviewed and the Seclusion and Restraint Log was reviewed on 10/20/16 from 1250 - 1645 with the Administrator (#4, #6, #7, #9, #10, #15 and #16) and the Director of Clinical Services (#11-#14). The results of the clinical record review revealed the Master Treatment plan of care was not updated to include the use of restraints for 11 of 11 (#4, #6, #7, #9-#16) patient clinical records. The findings were verified at the time of clinical record review as follows:
1) Patient #4 was documented in seclusion on 10/04/16, initiated at 2005 and ended at 2055. A chemical restraint occurred on 10/04/16 at 1850.
2) Patient #6 was documented in restraint on 07/11/16 at 2010; 07/12/16 at 0705; 07/12/16 at 0803; and with a chemical restraint 07/12/16 at 08/10.
3) Patient #7 was documented in restraint on 10/19/16 at 0713.
4) Patient #9 was documented in restraint on 09/30/16 at 1530.
5) Patient #10 was documented in restraint on 10/06/16 at 1330 and 1350.
6) Patient #11 was documented in restraint on 10/10/16 at 1956 and 0812; 10/13/16 at 1415 and 10/14/16 at 1650.
7) Patient #12 was documented in restraint on 09/09/16 at 0710; 10/10/16 at 0920.
9) Patient #13 was documented in restraint on 09/02/16 at 0923 and 09/27/16 at 1245.
9) Patient #14 was documented in restraint on 09/27/16 at 1220 and 10/12/16 at 0915.
10) Patient #15 was documented in restraint on 10/07/16 at 0710 and on 10/11/16 at 0815.
11) Patient #16 was documented in restraint on 09/14/16 at 0815; 09/20/16 at 0735; 09/24/16 at 1025 and had chemical restraint on 09/24/16 at 1045.

B. On 10/21/16 at 0910, the Administrator stated that he had no additional information to provide.