SOP_NUMBER: 508.28-att-6
TITLE: Cell Analysis Form (M68-01-10)
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy - MH Suicide Prevention/ACU/CSU/BTU
EFFECTIVE_DATE: 2019-08-08
WORD_COUNT: 845
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/440983
URL: https://gps.press/sop-data/508.28-att-6/
SUMMARY:
This form is used to conduct safety inspections of cells and showers in suicide prevention units (CSU, ACU, and observation cells) to ensure they meet security and suicide-prevention standards. Staff complete a detailed checklist evaluating physical plant features such as fixtures, materials, lighting, and design elements that could pose ligature or weapon risks. The form documents compliance status and any deficiencies requiring correction, with completed forms retained for 10 years.
KEY_TOPICS: cell analysis, suicide prevention, cell inspection, ligature prevention, CSU cells, ACU cells, observation cells, shower safety, physical plant inspection, security fixtures, epoxy caulking, stainless steel fixtures, fire safety compliance, restraint rings, security blankets
ATTACHMENTS:
1. Certificate of Approval for Crisis Stabilization Unit (CSU), Acute Care Unit (ACU), and Observation Cells
URL: https://gps.press/sop-data/508.28-att-1/
2. Offender Critical Incident Notification Form
URL: https://gps.press/sop-data/508.28-att-2/
3. Observation Cell Log
URL: https://gps.press/sop-data/508.28-att-3/
4. Suicide/Self-Injurious/Assaultive Behavior Information Form
URL: https://gps.press/sop-data/508.28-att-4/
5. Observation Cell Notification (Form M68-01-05)
URL: https://gps.press/sop-data/508.28-att-5/
6. Cell Analysis Form (M68-01-10)
URL: https://gps.press/sop-data/508.28-att-6/
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FULL TEXT:
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SOP 508.28
Attachment 6
8/8/19
|Cell Analysis|Col2|Col3|Col4|Col5|
|---|---|---|---|---|
|Please complete the following check list along with comments. All CSU cells, ACU cells, Observation cells
and showers should be evaluated. Place an “x” in the applicable space and write comments if any. (use one
tool for each cell/shower)|Please complete the following check list along with comments. All CSU cells, ACU cells, Observation cells
and showers should be evaluated. Place an “x” in the applicable space and write comments if any. (use one
tool for each cell/shower)|Please complete the following check list along with comments. All CSU cells, ACU cells, Observation cells
and showers should be evaluated. Place an “x” in the applicable space and write comments if any. (use one
tool for each cell/shower)|Please complete the following check list along with comments. All CSU cells, ACU cells, Observation cells
and showers should be evaluated. Place an “x” in the applicable space and write comments if any. (use one
tool for each cell/shower)|Please complete the following check list along with comments. All CSU cells, ACU cells, Observation cells
and showers should be evaluated. Place an “x” in the applicable space and write comments if any. (use one
tool for each cell/shower)|
|**Cell Physical Plant**
**Date:_____________ Cell Number:_____________FC NC NA**
**Date**
**corrected**|**Cell Physical Plant**
**Date:_____________ Cell Number:_____________FC NC NA**
**Date**
**corrected**|**Cell Physical Plant**
**Date:_____________ Cell Number:_____________FC NC NA**
**Date**
**corrected**|**Cell Physical Plant**
**Date:_____________ Cell Number:_____________FC NC NA**
**Date**
**corrected**|**Cell Physical Plant**
**Date:_____________ Cell Number:_____________FC NC NA**
**Date**
**corrected**|
|**Cell Physical Plant**
**Date:_____________ Cell Number:_____________FC NC NA**
**Date**
**corrected**|**FC**|** NC**|** NA**|
**Date**
**corrected**|
||||||
|1. There is a hardened, stainless steel security sink/toilet
combination, without spouts or knobs that could be used as
weapons or a point for tying off a ligature.
|||||
|2. There are covered security light fixtures.
|||||
|3. There are not any active electrical outlets in the cell.|||||
|4. Observation windows and doors with manufactured safety glass
windows, that are a minimum of sixteen inches square, and
have been placed in such a manner to eliminate blind spots.|||||
|5. There is low level security lighting, such that when the light in the
cell is turned off, staff can easily view the cell interior at all times.|||||
|6. All fixtures in the cell are caulked with an epoxy type caulking
material to eliminate any spaces and prevent the ability for the
offender to tamper with the material.|||||
|7. There is a metal bed, without holes in the base of the bed no
higher than (6) six inches off the floor (from the bottom of the
page to the line in bold [below] is 6 inches). The metal bed must
be bolted to the floor. If there is a concrete slab, it may be higher
than 6 inches.|||||
|8. There are rings installed to the side of the bed that allow for
application of restraints. (only in CSU cells)
|||||
|9. A suicide-proof mattress for the beds are being used.|||||
|10. There are no exposed bolts in the cell. If screws are used, they
are security screws.|||||
|11. Any exposed plates with corners are rounded off and sealed with
epoxy caulking material.
|||||
|12. There is not a false or dropped ceiling.|||||
|13. Suicide resistant blanket, smock and other items are available for
use.|||||
|14. A review with Fire Services has been done to ensure that fire
safety requirements have been met.|||||
|15. Commercially produced s-type stainless steel vents are used that
allow for adequate ventilation but prevent the ability to thread
any type of ligature through the vent. (no larger than 3/16")|||||
|16. All smoke detectors have security covers that could not be used
as a weapon or a point for tying off a ligature.
|||||
|17. Doors to the cells have tray slots.
|||||
|18. Hinges are located**outside** the cell door.|||||
**Comments: _____________________________________________________________**
**________________________________________________________________________**
**________________________________________________________________________**
**_______________________________________________________________________**
**_______________________________________** **______________________________**
**Signature** **Title**
Form no. M68-01-10 Page 1 of 2
Retention Schedule: Upon completion this form shall be maintained in the mental health area for 10 years.
SOP 508.28
Attachment 6
8/8/19
|Shower Physical Plant|Col2|Col3|Col4|Col5|
|---|---|---|---|---|
|
**Date:_____________ Shower Number:_____________**|**FC**|** NC**|** NA**|
**Date**
**corrected**|
||||||
|1. Shower heads are recessed with no exposed faucets.
|
||||
|2. The water temperature is safety flow regulated to prevent the
possibility of scald injuries.|||||
|3. Shower curtains are break-away type with Velcro, that meet fire
safety requirements.
|||||
|4. The shower curtain bar is break-away type.|||||
|5. The cell’s light switch is located outside the entrance door.
|
||||
|6. Electrical outlets are not in the shower area.|||||
|7. Drains are secured with security screws and sealed with Epoxy
caulking.
|||||
|8. Soap holders are recessed.
|||||
|9. The shower and shower head are located where it is visible to staff.
|||||
|10. The shower is of a design that does not allow for any blind spots.|||||
|11. Any installed grab bars meet ADA requirements.
|
||||
|12. Towels and other materials that can be fashioned into a ligature are
not placed in the shower.|||||
|13. All fixtures in the shower are caulked with an Epoxy type caulking
material to eliminate any spaces and prevent the ability for the
offender to tamper with the material.
|||||
|14. There is no false or dropped ceiling.|||||
**Comments: _____________________________________________________________**
**________________________________________________________________________**
**________________________________________________________________________**
**________________________________________________________________________**
**________________________________________________________________________**
**________________________________________________________________________**
**_______________________________________** **______________________________**
**Signature** **Title**
Form no. M68-01-10 Page 2 of 2
Retention Schedule: Upon completion this form shall be maintained in the mental health area for 10 years.