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Based on interviews, record reviews, and review of the facility's policy and procedures, it was determined the facility failed to ensure one of eleven sampled patients (Patient #11) was protected from a staff member's use of an unapproved restraint device (handcuffs), which were placed on the patient after the patient physically assaulted the security guard on 06/28/12 at 10:37 AM. The facility also utilized "contracted" city police officers to remain on the unit for "support" to staff due to Patient #11's psychotic and physically assaultive behaviors towards staff. The police officers were not trained regarding the facility's policy and procedures prior to being utilized in the patient care area beginning on 06/28/12 at 4:30 PM until removal on 06/29/12 at 1:00 PM. The facility had no personnel files, to include training, on the contracted police officers.

Refer to Standard Tag A 145

Based on record reviews and staff interviews, it was determined the facility failed to ensure "contracted" Police Officers were trained by the facility prior to working at the facility from 4:30 PM on 06/28/12 until 1:00 PM on 06/29/12 to provide "support" to staff due to Patient #11's psychotic and physically assaultive behaviors towards staff.

Findings include:

The facility had no policy and procedures to review regarding contracted staff.

An interview with a contracted Police Officer, on 06/29/12 at 2:30 PM, revealed this was the first time he had worked at the facility. He stated his role was to provide support to staff due to physical attacks from Patient #11. He stated he worked for the city and was trained by the police department on "Mental Crisis Training" and "Aikido Control Training" (ACT). He stated he would intervene when needed with verbal redirection and if needed, as a last resort, physical intervention. He stated he has not had to intervene with Patient #11 since he has worked at the facility. He stated staff will provide the care and I'll only step in if needed. He confirmed that he has received no training from the facility.

An interview with the CEO, on 06/29/12 at 8:30 AM, revealed the facility was using contracted police officers in a "supportive role" to assist with Patient #11 due to his/her extreme psychosis and physical aggression towards staff. She revealed this was the first time contracted Police Officers were utilized at the facility in patient care areas. She revealed the facility provided no orientation or training to the contracted Police Officers and did not maintain personnel files on them.

Based on interviews, record reviews, and review of the facility's policy and procedures, it was determined the facility failed to ensure one of eleven sampled patients (Patient #11) was protected from an unapproved intervention (handcuffs) being utilized by an employee who had not been trained in "Special Measures (Seclusion /Physical and Mechanical Restraint Use)," Safe Crisis Management (SCM) and Aikido Control Training (ACT).

Findings include:

Review of the facility's policy and procedures on "Special Measures (Seclusion /Physical and Mechanical Restraint Use)," revealed, "Each patient shall receive treatment in a manner that is the least restrictive and protects his/her dignity and well-being. Staff are trained and competent in the safe use of seclusion and restraints and in less restrictive therapeutic interventions as a way to minimize their use. Training in safe physical intervention techniques shall be provided only by approval/certified instructors using methodologies approved by the Hospital and Agency. All interventions may only be employed in accordance with the program specific policies by trained individuals. All direct contact staff, or staff who have the potential need to utilize physical techniques, shall be certified in a non-violent practice course prior to direct client contact. A re-certification training will occur annually thereafter."

Interview with the Chief Executive Officer (CEO), on 06/28/12 at 12:00 PM, revealed she had received a call from the facility's Interim Administrator, on 06/28/12 at approximately 9:00 AM, informing her that Patient #11 had attacked three staff within the span of one hour. She informed the Interim Administrator she was on her way and asked her if she thought it would be helpful if she requested the agency's corporate office Security Guard to come to the hospital as well. The Interim Administrator agreed that the Security Guard would be helpful. The CEO met with the Security Guard at the hospital at approximately 9:30 AM on 06/28/12. She informed the Security Guard that the staff on the unit would handle Patient #11 and take control of any situation. The Security Guard was just to be available on the unit in a "supportive role." She revealed the Security Guard had not worked at the hospital and was not trained in SCM and ACT. On 06/28/12 at approximately 10:40 AM, she was informed Patient #11 ran toward the Security Guard and punched him in the face with no warning. Staff intervened and placed the patient in a hold and that's when the Security Guard promptly placed a pair of handcuffs on Patient #11 and assisted him to a chair. The patient quickly calmed down and informed the Security Guard that he/she would not have punched him in the face if he/she had known he was a law enforcement officer. The CEO talked to the Security Guard and had him remove the handcuffs from Patient #11's wrists. She informed him that handcuffs could not be used on patients and he apologized stating that he was not aware handcuffs could not be used on assaultive patients in the hospital. The Security Guard was promptly removed from the patient care area while the incident was investigated. Further interview with the CEO, on 06/29/12 at 8:30 AM, revealed the facility was using contracted police officers in a "supportive role" to assist with Patient #11 due to his/her extreme psychosis and physical aggression towards staff. She revealed this was the first time contracted Police Officers were utilized at the facility in patient care areas. She revealed the facility provided no orientation or training to the contracted Police Officers and did not maintain personnel files on them. (Removal of IJ - The CEO terminated the use of contracted Police Officers in the facility as of 06/29/12 at 1:00 PM. She stated the officers were trained by the police department in ACT but no training was provided by the facility to the officers and therefore the officers would not be utilized by the facility. She further revealed the Security Guard would receive SCM and ACT training prior to being utilized at the facility in patient care areas.)

Interview with the Interim Administrator, on 06/29/12 at 8:50 AM, revealed the facility utilizes Safe Crisis Management (SCM) and Aikido Control Training (ACT) on patients as a last resort and when all other interventions have failed to protect the patient and/or others from physical harm. She revealed all direct care staff are trained in both SCM and ACT. She stated she was not aware the Security Guard had not been trained in SCM and ACT. She stated this was the first time she had utilized contracted Police Officers in a patient care area. She revealed Patient #11 was extremely psychotic and assaultive to staff. She stated she was not aware there was a problem with utilizing contracted Police Officers until it was brought to her attention by the surveyor.

Review of Patient #11's record revealed he/she was admitted to the facility on 06/08/12 due to "Psychosis leading to Homicidal Ideations." Patient #11's guardian is the Department for Juvenile Justice (DJJ). The patient has been refusing to take his/her medications frequently and is psychotic. The patient laughs out loud, curses, and responds to auditory and visual hallucinations. The patient is unpredictable and will physically attack others without warning (usually punches others in the face and head). Review of the patient's "Incident Reports" revealed the patient has physically assaulted numerous staff to include doctors, nurses, direct care staff, a Security Guard, and one peer. The patient's treatment plan has been updated and medications changed. Review of an incident report, dated 06/28/12 at 10:37 AM, revealed Patient #11 walked toward the Security Guard and punched him in the face with no warning. The staff intervened and placed Patient #11 in a physical hold to protect others. The Security Guard place a pair of handcuffs on Patient #11 and assisted the patient to the chair. The staff reported the incident immediately to the CEO, physician and administrator. The handcuffs were removed and the Security Guard was reprimanded and removed from patient care area. The patient had no injuries and calmed down quickly.

Interviews with CEO and Interim Administrator, on 06/29/12 at 2:30 PM, revealed the Security Guard used an unapproved restraint device (handcuffs) on Patient #11 on 06/28/12 at 10:37 AM. They further revealed the Security Guard was not trained in SCM and ACT and had not worked in the patient care areas at the facility. They removed the Security Guard from the patient care area and initiated an investigation. The CEO stated, the facility does not allow the use of handcuffs. She revealed when she spoke to the Security Guard that she did not mention handcuffs and it never occurred to her that he had any handcuffs.