Admission Protocol — Upon admission to the facility, all new residents are placed on 15 minute checks. Staff will make visible contact with the resident every 15 minutes, depending upon level of supervision assigned, and will observe and report any unusual behavior to the team leader and / or nurse on duty. The resident may use the bathroom unsupervised, and staff will knock on the door and assess the response when a check is due.
All new admissions will have a clinical evaluation conducted by the Clinical Director or designee to determine if the new resident needs to be on 1:1 for the first 24 hours. The Clinical Director will communicate the level of supervision the new residents needs, after the evaluation.
1:1 – Staff must remain in eyesight and within 10 feet of the resident at all times. The resident must be supervised at all times, including while using the bathroom or showering. Resident cannot participate in community integration while on a 1:1 safety protocol. Staff will record resident location and activity every 15 minutes and this will become part of the medical record.
At no time should a member of the opposite gender be monitoring a resident when using the bathroom or shower. 1:1 staff must be of same gender when the resident is using the bathroom or showering. This is true for any 1:1 level of supervision. If no member of the same gender is available, staff will keep the bathroom door open and move to an area in the room that is out of sight and maintain auditory observation of the resident. (Bathrooms with doors near the room entry door can be covered from the hallway as long as the bathroom is not visible from the hall.)
1:1 Suicide / Self Harm – Staff must remain a minimum of two arms lengths away from the resident at all times. Resident must be supervised in the bathroom at all times and staff must accompany resident into any area that may involve shutting of doors (offices, public restrooms, etc).
If a resident secures an item that may be used for self-harm, with an avowed intent to use that item for self-injurious behavior, staff must attempt to secure the item by using verbal skills. Notifications per the emergency calling protocol must be made in this instance. Should an item not be recovered and used in a manner that is dangerous (belt or cord around neck, cutting or scratching throat, etc) staff must physically intervene by using NAPPI physical skills.
Once secured, if it is a personally owned item, it will be secured in the central staff office in the resident’s black folder. If the item is not personal property, it will be disposed of in the sharps container in the nursing office; larger objects will be disposed of in the dumpster. However, if the item has a potential of injuring staff or is determined to be a dangerous item (knife, gun), staff should not attempt to remove the item and the emergency call procedures shall be followed.
A room search must be conducted. Resident cannot participate in community integration while on a 1:1 safety protocol. Staff will record resident location and activity every 15 minutes and this will become part of the medical record.
15 Minute Checks – Staff will make visible contact with the resident every 15 minutes, depending upon level of supervision assigned, and will observe and report any unusual behavior to the team leader and / or nurse on duty. The resident may use the bathroom unsupervised, and staff will knock on the door and assess the response when a check is due. If resident is out of sight in their room (under blankets, etc), staff will verbally check in with resident. Resident can participate in therapeutic outings with nursing permission after nursing has conducted a nursing assessment. Staff will record resident location and activity every 15 minutes, and this will become part of the medical record.
Eyes On – Staff must maintain visual contact with the resident at all times. There is no required distance that is needed to be maintained. Resident may use the bathroom with the door partially closed. However the door must not be fully closed, and staff must be within 5 feet of the bathroom. Resident can participate in therapeutic outings with nursing permission after nursing has conducted a nursing assessment. Staff will record resident location and activity every 15 minutes, and this will become part of the medical record.
1:1 in the Community – Resident may attend community integration with nursing approval. Staff must remain in eyesight and within 10 feet of the resident at all times. The resident may use the bathroom unsupervised for short periods of time not to exceed 15 minutes, and staff will remain within arms reach of the door and will maintain auditory observation of the resident.
With Staff in the Community – Resident may attend community integration with nursing approval but must remain with a staff member at all times. Staff may supervise more than one resident at a time. There is no need to document location and activity every 15 minutes.
Responsible Party: A resident may go out into the community with a responsible party; meaning the person is taking responsibility for the resident while out in the community. A responsible party can be, but not limited to: a family member, friend, spouse, or their case manager from their DA. Case managers help facilitate this process.
Passes and Protocols – Resident may request unsupervised passes in accordance with the pass request procedure. Resident pass will be granted in accordance to this procedure and nursing approval.
Residents will first be able to go on a pass for up to 2 hours. Once outings have been successful, they will step up to passes and protocols.