CMS SOM App. J, Tag W291

following conditions are met:

(i) The placement is a part of an approved systematic time-out program as required by

paragraph (b) of this section. (Thus, emergency placement of a client into a

time-out room is not allowed.)

(ii) The client is under the direct constant visual supervision of designated staff.

(iii) The door to the room is held shut by staff or by a mechanism requiring constant

physical pressure from a staff member to keep the mechanism engaged.

Guidance §483.450(c)(1)

Seclusion, defined as the placement of a client alone in a locked room, is never allowed.

Time out procedures allows a client to be alone in a room, but do not allow that room to be

locked. During a time out procedure, egress can only be prevented by a person standing in the

door way, or holding the door closed, but as soon as the staff move from the door way or let go

of the door the client can come out.

Use of the timeout room or procedure must be part of an approved behavioral plan and may

involve the separation of a client from a group or a particular situation, in a non-locked setting

for the purpose of calming or removing the client from the reinforcing stimuli that are sustaining

an identified maladaptive behavior.

Designated time out rooms must be set up so that the staff has continuous, direct observation

of the client at all times. Because of the danger that staff can get distracted by other events or

duties, this cannot be accomplished by a camera in lieu of the staff having direct visual of the

client.

Key locks, latch locks, and doors that open inward without an inside doorknob are not permitted

by the regulations for use in time out rooms as they do not require constant physical pressure

from a staff member to keep the door shut. In each instance where a time out room is used, the

client’s IPP must include:

• The functional behavioral assessment which resulted in a recommendation for the use

of time out procedures; and

• Instructions on how often data is to be collected during the time out period and the

criteria for release from time out.

The use of a time out room must be approved by the Specially constituted committee as part of

an approved program.