Foundations' Inpatient Unit issued provisional license because of illegal use of mechanical and chemical restraints

Foundations Behavioral Health Psychiatric Unit was cited during a licensing inspection survey conducted by the Pennsylvania Department of Human Services (DHS, formerly the Dept. of Public Welfare) for deficiencies related to the use of seclusion and restraint, contents of a treatment plan, adequate treatment, patient rights, and existing regulations. After the inspection, the facility submitted a plan of correction that was only partially accepted by the DHS. Foundations Behavioral was issued a “First Provisional Certificate of Compliance” for the six month period of January 1, 2013 – July 1, 2013. Regulations for “the Use of Seclusion and Restraint in Mental Health Facilities and Programs” state that the “use of mechanical restraints should be used in private psychiatric hospitals and in psychiatric units in general hospitals only in an emergency as a safety measure, when there is an imminent danger of bodily harm to the consumer or others.” During the inspection, DHS found two of five charts “contained mechanical restraint episodes,” but “neither chart documented least restrictive interventions employed prior to mechanical restraint.” DHS noted that “further investigation into the progress notes could not produce justification for mechanical restraint or evidence of intervention use.” Pennsylvania regulation on the use of restraint states that a “licensed physician’s order should not exceed one hour for adults and children.” However, upon further inspection, DHS found that the facility’s policy on seclusion and restraint stated “time limits for restraints shall not exceed 2 hours for children and adolescents ages 9-17, and 1 hour for children under age 9.” DHS also found that two consumers had physician orders that read “restraints not to exceed two hours” directly conflicting with state regulations on the use of restraints. Foundations Behavioral was also cited for the use of chemical restraints after inspectors found that a patients chart stated “client given a chemical restraint of Benadryl IM 50mg” and another client was “prescribed Chloral Hydrate as a chemical restraint.” According to Pennsylvania regulations, “chemical restraints should only be used in an emergency as a safety measure, when there is imminent danger of bodily harm to the consumer or others.” However, inspectors found “no behaviors or interventions were documented to justify chemical restraint” and “there was no documentation suggesting these incidents were chemical restraint episodes.” DHS also cited Foundations Behavioral for violations of adequate treatment regulations that state “adequate treatment provided by an approved facility shall be designed…to promote the recovery from mental illness.” During the inspection, DHS found “observation sheets were not transitioned from shift to shift according to agency policy.” DHS found that the documented reason for prescribing a PRN medication to Consumer C was a “chaotic unit.” DHS wrote in the inspection report: “Agency [Foundations Behavioral] uses PRNs without definitive documented plans to manage behavioral issues.” DHS also cited the facility for violating regulations for the “right to a humane physical and psychological environment” when it found that the unit was “uncomfortably cold” because the “heating system was not working properly.” DHS also found “weekend psychiatric notes and observation sheets were illegible.” The facility submitted a plan of correction to address these deficiencies including the change in facility policy to match state regulations on the use of mechanical and chemical restraints. However, the plan of correction was only partially accepted and the facility was not granted a full 1 year license. Instead, Foundations Behavioral Inpatient Unit was granted a 6-month provisional license.