Quarterly 710 Report
|Reporting reporting period:||01/01/2022 – 03/31/2022|
|Agency Name:||Cornerstone Valley, Inc.|
|Total Number of Children in Care:||24|
|A.) Number of Children in Care in this setting during this reporting period||3||4||3||2||5||4||3|
|B.) Total # of Incidents involving restraint||0||7||0||35||2||0||2|
|C.) Total # of incidents resulting in a reportable injury arising from the use of a restraint.||0||0||0||0||0||0||0|
|D.) Total # of children who were placed in restraint more than three times||0||0||0||1||0||0||0|
|E.) Total # of incidents in which a person who placed a child in care in a restraint was not certified in the use of the type of restraint used||0||0||0||0||0||0||0|
|F.) Total # of incidents involving involuntary seclusion||0||0||0||0||0||0||0|
|G.) Total # of Incidents involving involuntary seclusion in a locked room||0||0||0||0||0||0||0|
|H.) Number of rooms that have been used or would be used for involuntary seclusion||0||0||0||0||0||0||0|
|I.) Dimensions of room that has been used or could be used for involuntary seclusion||N/A||N/A||N/A||N/A||N/A||N/A||N/A|
|J.) Total # of children who were placed in involuntary seclusion more than three times||0||0||0||0||0||0||0|
|K.) Total # of incidents in which a person who placed a child in care in involuntary seclusion was not trained to use involuntary seclusion||0||0||0||0||0||0||0|
Quarterly 710 Report
Cornerstone Valley, Inc.
Site or Program Name
*Each location serves four or fewer children. Therefore, only one report is required to be completed for the entire program.
Reporting time frame (indicate which quarter and year).
Total number of incidents involving restraint.
Total number of incidents involving involuntary seclusion.
The total number of incidents involving restraint and seclusion that resulted in reportable injuries.
Total number of involuntary seclusions in a locked room.
Total number of rooms available for use for involuntary seclusion.
Description of the dimensions and design of the seclusion rooms.
Total number of children in care placed in restraint.
Total number of children in care placed in involuntary seclusion:
Total number of children in care who were placed in restraint or involuntary seclusion more than three times during the reporting period.
A description of the steps the program has taken to decrease the use of restraint and involuntary seclusion.
Re-trainings on implementation of proactive strategies described in each Positive Behavior Support Plan (PBSP).
Number of incidents in which an individual who placed a child in care in a restraint or involuntary seclusion was not certified or trained in the use of the type of restraint or involuntary seclusion used, including individuals whose certification or training was expired at the time of the restraint or seclusion.
Demographic characteristics of the children in care who the program placed in a restraint or involuntary seclusion, including race, ethnicity, gender, disability status, migrant status, English proficiency and status as economically disadvantaged, unless the demographic information would reveal personally identifiable information about an individual child in care. Indicate the number of children who experienced restraint or seclusion who match each of the criteria listed below:
American Indian or Alaska Native 0
Black or African American 0
Native Hawaiian 0
Other Pacific Islander 0
English is primary language 4
English is not primary language 1
Economically Disadvantaged 0
Not Economically Disadvantaged 5