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Based on interview, record review, and review of the facility's policy, it was determined the facility failed to ensure the Attending Physician, who has overall responsibility and authority for the management and care of the patient was aware of the patient's condition and was aware of the restraint intervention for one (1) of thirty-five (35) patients (Patient #17).

The findings include:

Review of the facility's policy titled "Seclusion and/or Restraint Policy" undated, (section E. Orders) revealed the Attending Physician must be consulted as soon as possible if restraint or seclusion was not ordered by the patient's Attending Physician.

Record review revealed the facility admitted Patient #17 on 02/15/12 with diagnoses which included Impulse Control Disorder, Bipolar Disorder and Mental Retardation. Further record review for Resident #17, revealed restraints were applied on 02/22/12 at 6:50 PM, 02/22/12 at 8:50 PM, 02/26/12 at 5:50 PM and 02/27/12 at 3:10 PM; however, there was no documented evidence the Attending Physician was notified of the restraint interventions until 03/01/12 at 4:45 PM. Continued review of the record revealed again restraints were applied on 03/15/12 at 10:50 PM and 03/16/12 at 12:15 AM and there was no documented evidence the Attending Physician was notified or signed the restraint order until 03/20/12 at 9:30 AM. Further record review revealed Patient #17 required Restrictive Intervention (restraints) on 08/02/12 at 9:45 PM and 08/15/12 at 9:25 PM; however, there was no documented evidence the Attending Physician was notified and no evidence the Attending Physician signed the order for restraints.

Interview, on 08/17/12 at 12:10 PM, with Program Manager #1 revealed the Attending Physician was not notified of the application of restraints to Patient #17 as soon as possible per the facility's policy. Interview further revealed the notification was placed on a clip board in the nurses station until the Physician revisited that nurses station.

Interview, on 08/17/12 at 12:50 PM, with Unit Manager #1 revealed the Attending Physician was not notified of the application of restraints to Patient #17 as soon as possible per the facility's policy. Interview further revealed the procedure was to make the notification by placing the restraint order on a clip board for the Attending Physician to review at a later date and/or time.

Interview, on 08/17/12 at 3:30 PM, with the Administrator revealed the Attending Physician was not called to notify him/her of the application of restraints to Patient #17 as per the facility's policy.