OSHA Inspection: THE CUTCHINS PROGRAMS FOR CHILDREN AND FAMILIES, INC.

Issued

May 22, 2015

Abate by

Jan 30, 2016

Penalty

Initial $6,300 · Current $6,300

Hazardous substances 8880

General-duty citation text

OSH ACT of 1970 Section (5)(a)(1):    Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The employer did not furnish to each of his employees employment and a place of employment which were free from recognized hazards that were causing or were likely to cause death or serious physical harm to employees in that employees were exposed to the hazard of being physically assaulted by clients exhibiting violent behavior, causing serious injuries, while working at Cutchins:    On or about 11/25/14, employees working with clients were exposed to workplace violence hazards.  The employees have suffered punches to the head and body, kicks to the abdomen, puncture wound from being bitten, broken finger and contusions from being beaten with a hockey stick, and injuries to the back, groin, knees, neck, shoulders, wrist, knuckles, arms, legs, foot, face, jaw, elbow, and hands, when working with clients and escorting them on campus.  The employer had not developed and/or implemented adequate measures to protect employees from this hazard.    Specific abatement documentation that this violation has been corrected must be provided within 10 days of the abatement in accordance with 29 CFR 1903.19(d)(1).    Among other methods, feasible and acceptable methods which can eliminate or materially reduce the hazard of workplace violence at The Cutchins Program for Children and Families, Inc. include:      1.         Develop or review policies such as Workplace Violence Prevention Policy, Physical Intervention Policy, and Safety Policy to ensure that the following elements are integrated into a comprehensive workplace violence prevention program that addresses:  (a)        A Workplace Violence Policy Statement, including responsibilities of all staff for workplace violence hazard assessment, prevention, management accountability, and review of incidents and injuries, which is shared with staff and clients; ensuring that clients, clients? relatives, and employees are clearly informed that violence or threats are not permitted and will be investigated, and consequences will be imposed; and implementing appropriate consequences for violent behavior, in accordance with treatment plans, and ensuring they are applied in every instance;  (b)        A Hazard/Threat/Security assessment, including records review of incidents, work with the loss prevention carrier, inspection of the worksite, and employee survey;  (c)        Implementation of workplace controls and prevention strategies, including procedures that maximize safety and minimize the likelihood of assaultive behavior;   (d)        Continuing training and education of all staff with a focus on the specifics of Cutchins? program.  Provide refresher training on de-escalation on a quarterly basis for new hires and include real-world scenarios during training events; (e)         Develop effective client containment strategies, in accordance with treatment plans;   (f)        Implement a system for reporting safety concerns internally, and provide employees with assurance that concerns can be reported without fear of retaliation;     (g)         Address worker protections during client transport off campus and during outings.      2.         Implement a system for alerting employees to a client's history of violent behavior:    (a)        Determine the behavioral history of new clients;     (b)        Ensure client information is exchanged during shift changes; establish a procedure such as chart tags, log books, or verbal census reports for identifying clients with a history of violent behavior;      (c)        Implement procedures to ensure communication of any incident of workplace violence to any staff who might come in contact with the client, so that staff who may not have access to the client?s daily chart are aware of previous acts of aggression or violence;    (d)        Develop a hazard identification process to identify clients with a tendency toward predatory violence and train staff on predatory versus affective violence.  Staff safety training should include how to respond effectively to clients who exhibit either predatory or affective violence;     (e)        Train all staff to understand this system of communication.      3.         At least annually, review and update the facility's workplace violence policies to ensure that procedures are in place for managing worst-case scenarios in which staff are unable to control or contain an incident, and to ensure that these policies allow staff to impose physical control measures in accordance with treatment plans determined by mental health professionals, when necessary to ensure their own safety.       4.         Perform root cause analysis for each reported incident of assaultive behavior, such as but not limited to, bites, scratches, punches, kicks, etc.   Root cause analysis should include, among other items, a hazard identification process, such as identification of clients with a tendency toward predatory violence or affective violence.  Do not stop an investigation at "worker error" or "unpredictable event" and ask why the client acted, why the worker responded in a certain way, etc.   Ensure that personnel performing incident investigations are suitably trained in how to perform root cause analysis.  (a)  Involve workers in the investigation.  Clarify purpose of the investigation and any post-incident debriefing with employees, e.g., to determine lessons learned vs to reprimand.  (b)  Investigate near misses.      5.         Conduct new hire and refresher training to ensure employees are aware of what the company?s workplace violence policy is, where it can be found, and what the company?s expectations are for dealing with workplace violence hazards.  Training should be conducted in a manner in which employees can easily understand the terminology and should incorporate hands-on exercises and practice drills to improve staff skills and confidence.  Training should also include the company?s policies and requirements for recording and documenting on the daily chart incidents of clients? aggressive or violent behavior.  Ensure that all staff, including substitutes and night shift employees, are provided TCI and DBT training.     6.         Ensure that adequate numbers of properly trained designated responders are readily and immediately available to render assistance on each shift in the event of an incident of aggressive or violent behavior.  Ensure that the designated responders are not assigned to a one-to-one client, so they can quickly respond without leaving their client without the required supervision.  The designated responders should be personnel who have specialized training in dealing with aggressive and violent behavior.  Develop policy and training to address the gaps in the current client containment strategy, in accordance with treatment plans, particularly those gaps associated with staff injury.     7.         Provide staff with a reliable way to summon assistance rapidly when needed, such as an electronic alarm or a wireless personal emergency assistance alarm.  Ensure equipment coverage for each direct-care worker on each shift.    8.         Clarify the written policy for contacting law enforcement in the event of an actual or threatened violent attack.  Communicate this policy to employees.  Develop a written agreement with police regarding police response.      9.         Implement assault prevention and control measures for direct-care workers to employ when de-escalation techniques are inadequate.     10.        Assign the duties of the overall workplace violence prevention program to a specific position (individual person) as soon as possible.  Ensure the position includes overall coordination of the campus?s Workplace Violence Prevention Program and the responsibility for conducting thorough incident investigations, with assistance from the workplace violence prevention management team.      11.        Ensure that the coordinator and the workplace violence prevention management team have the requisite skills to identify the underlying causes of violence and develop effective intervention strategies.    12.        Ensure adequate staff for coverage on all shifts so that direct-care staff can deliver the required level of supervision for clients without putting themselves at risk by taking on additional clients, and so that direct-care staff who are assigned to one-to-one clients are not also required to be designated responders, which could hinder assistance to other staff summoning help.    13.        Provide and require employees to wear personal protective equipment such as, but not limited to, cut and bite-resistant sleeves, gloves, or other clothing, when interacting with a client who is engaging in or is likely to engage in violent behavior.    14.        Remove or fasten down, to the extent possible, whenever possible, every object which could be used as a weapon in some way, such as throwing the object at employees, hitting employees with the object, stabbing employees with the object, and any others.    15.        Implement an Employee Assistance Program (EAP) which provides employees who are victims of violence, with medical and emotional treatment.   Make referrals to outside specialists for appropriate evaluation, treatment, and assistance, both at the time of the incident and for any follow-up treatment necessary.     16.        Ensure that clients, clients? relatives, and employees are clearly informed that violence or threats are not permitted, will be investigated, and consequences will be imposed.  Implement appropriate consequences for violent behavior, in accordance with treatment plans, and ensure they are applied in every instance.    17.         Ensure that clients wear only soft footwear whenever possible.

Issued

May 22, 2015

Abate by

Jan 30, 2016

Penalty

Initial $6,300 · Current $2,150 Reduced

General-duty citation text

29 CFR 1910.1030(c)(1)(i): The employer having employee(s) with occupational exposure did not establish a written Exposure Control Plan designed to eliminate or minimize employee exposure:    On or about 11/25/14, employees were exposed to the hazard of bloodborne pathogens by being physically assaulted by clients with a history of violence, including but not limited to, getting clients' blood on various parts of their bodies, and the employer did not establish a written Exposure Control Plan designed to eliminate or minimize employee exposure.    Specific abatement documentation that this violation has been corrected must be provided within 10 days of the abatement in accordance with 29 CFR 1903.19(d)(1).

Issued

May 22, 2015

Abate by

Jan 30, 2016

Penalty

Initial $6,300 · Current $0 Reduced

General-duty citation text

29 CFR 1910.1030(f)(1)(i): The employer did not make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident:    On or about 11/25/14, employees were exposed to the hazard of bloodborne pathogens by being physically assaulted by clients with a history of violence, including but not limited to, getting clients' blood on various parts of their bodies, and the employer had not made available the hepatitis B vaccine and vaccination series to all exposed employees, and post-exposure evaluation and follow-up to all employees who had an exposure incident.    Specific abatement documentation that this violation has been corrected must be provided within 10 days of the abatement in accordance with 29 CFR 1903.19(d)(1).

Issued

May 22, 2015

Abate by

Jan 30, 2016

Penalty

Initial $0 · Current $0

General-duty citation text

29 CFR 1910.1030(f)(1)(ii)(A): The employer did not ensure that medical evaluations and procedures including the hepatitis B vaccine and vaccination series, post-exposure evaluation, or follow-up, including prophylaxis, were made available at no cost to the employee:    On or about 11/25/14, an employee who had sought medical evaluation for occupational bloodborne pathogen exposure was not provided the medical services at no cost by the employer.    Specific abatement documentation that this violation has been corrected must be provided within 10 days of the abatement in accordance with 29 CFR 1903.19(d)(1).