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Based on document review and staff interview, the Clinical Director failed to ensure development and implementation of facility policy and procedures for the use of seclusion as a less restrictive measure (than restraint) for external control of violence in emergency situations. The facility allowed the use of physical, mechanical and chemical restraints, but prohibited the use of seclusion. Failure to allow the use of seclusion as a less restrictive measure than restraint to prevent violence to self or others violates patients' rights to be treated in the least restrictive environment possible.

Findings include:

A. Document Review

The facility policy on Restrictions and Seclusion, dated April 2011 and approved by the Administrator, the Medical Director and the Director of Nursing, states: "Prohibir el uso del aislamiento." This phrase was translated by the Medical Director on 6/2/2011 at 10:50AM as "Prohibited to use Seclusion."

B. Staff Interviews

1. In interview on 6/2/2011 at 10:50AM, the Medical Director stated, "Never in the history of this hospital" had the use of seclusion been a treatment modality. She stated, "The way this hospital was built, there is no adequate space (referring to space for a seclusion room)." The Medical Director also stated, "Seclusion is a less restrictive measure" when compared to the use of chemical or physical restraint.

2. In interview on 6/2/2011 at 1:45PM, the Director of Nursing stated, "This facility does not use seclusion, ever."

3. During an interview on 6/3/11 at 9:30AM, RN SJe reported that she would have thought it would have been appropriate to use seclusion with a patient (now discharged) who had attempted to hit and kick employees (rather was using mechanical restraint). She added, "I remember when seclusion was used at Cidra about 24 years ago."