summary: Officer River Byrne was dispatched to Millcreek in reference to a parent filing a complaint against a staff member.

raw_content:
Incident # 24-00155 Fordyce Police Department Report Date 04/13/24
Page 1 of 3 Incident Report Report Time 3:31 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 306 Byrne, River AR0200100
Active
Assigned Officer Entered By Approving Officer
Byrne, River RByrne Hogan, Wesley
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Mrs 27 F Nonresident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Offenses
Incident Location Zone
1828 Industrial DR Fordyce, AR 71742
Earliest Possible Date Time Latest Possible Date Time
04/13/2024 15:31 04/13/2024 15:31
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 INFORMATION INFORMATION Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 5/16/2024 10:05:02 AM

Incident # 24-00155 Fordyce Police Department Report Date 04/13/24
Page 2 of 3 Incident Report Report Time 3:31 PM
Victim #1 Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Unknown
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Mr 32 M Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
- -
Witness #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
U Nonresident
Race Unknown Ethnicity DL (#, ST) Email
Unknown , AR
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Narrative & Statements
Narrative - Byrne, River - 4/13/2024 4:56:01 PM (Initial)
On Saturday, April 13th, 2024, at approximately 10:30 a.m., Officer River Byrne
was dispatched to the area of Millcreek in reference to a parent filing a
complaint against a staff member. Upon arrival, I, Officer Byrne, made contact
with Mrs. Shankaila Edwards, a supervisor at Millcreek. She gave a brief
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 5/16/2024 10:05:02 AM

Incident # 24-00155 Fordyce Police Department Report Date 04/13/24
Page 3 of 3 Incident Report Report Time 3:31 PM
Narrative & Statements
Narrative - Byrne, River - 4/13/2024 4:56:01 PM (Initial)
summary of the situation that occurred and directed me to the COO of Millcreek,
Mr. Chris Butler. Mr. Butler stated that he talked to , the
father of . Mr. Butler advised that they would be
conducting an internal investigation. Mr. Butler said that informed him
that they would be removing their son, , from Millcreek. Day shift
manager Mrs. Edwards stated that she was informed that
called a faggot and a nigger, and that was the only information she
was told. After which, I, Officer Byrne, made contact with mother,
, and she stated that she came to visit her son. informed
his mother that a staff member, , called him a faggot and a nigger,
slammed him on the ground, and also threw him across the room.
stated that he tried to leave the room and call for help and that
pulled him back into the room. stated that she requested a
statement be filed about the situation that occurred involving her son by the day
shift manager, Mrs. Edwards. stated that a statement was still not
filed. One of the day shift nurses brought his medicine and stated that
a statement was going to be made after the visit. Both
stated that they were pulling their son, , out of Millcreek. I, Officer
Byrne, asked if she saw any marks or brusies on .
then stated that she did a full-body audit of her son, , and only
saw what appeared to be a blood spot under the skin on his right eye. She also
stated that the mark was worse prior to my arrival. stated that they
would be seeking legal aid for the situation that occurred.
requested that I, Officer Byrne, remain on scene until the Millcreek statement is
finalized. Mrs. Edwards advised that the COO was coming to
Millcreek to speak to her and to assist her with the statement she requested. I,
Officer Byrne, advised that the report would be sent to the Arkansas
Child Abuse Hotline. I, Officer Byrne, was able to make contact with
. stated that he did nothing wrong and that we were putting
in a timeout for acting up. stated that was
screaming, cussing, and threatening to kill people. was suspended,
so that Millcreek conducted an internal investigation
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 5/16/2024 10:05:02 AM


state: AR

facility_name: Millcreek Behavioral Health / Habilitation Center, Inc.

summary: A resident reported to his mother that a staff member called him inappropriate names and threw him around. This complaint has been UNFOUNDED by Licensing.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 020572
Date of Incident: 4/12/2024
Date Received: 4/15/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: was
having an on-campus visit with his mother on 4.13.24. reported to his mother
that staff member call him a "faggot" and a "nigger". also stated that
he was having an episode of physical aggression and that physically escorted him
away from the situation and brought him to his room. When he arrived to his room,
reported that "threw him around." The events allegedly happened on 4.12.2024. The
mother reported these events to Millcreek staff and informed them that she would discharge
from the facility. She filed a police report with the Fordyce Police Department. Officers
arrived on Campus and took statements from both the mother, , and
concerning the allegations. was discharged from Millcreek.
was placed on administrative leave pending investigation.
Interim Action Narrative: Staff was placed on administrative leave pending
investigation.
Maltreatment Narrative: . Receieved email notification that there is also
another .
Licensing Narrative: 4/15/24-Facility visited. was notified of this
allegation the day the allegation was made, 4/13/24 and was accepted . Staff
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

has been placed on administrative leave pending the investigation. There is no
video footage of this incident. There are no documented incidents 4/12/24 of this nature in
client's file. Client has discharged from facility. 5/31/24-Case closed as unfounded.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Clayton DeBoer
Person In Charge: Emerald Burris
Record Visit Date: 5/31/2024
Home Visit Date: 5/31/2024
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Licensing complaint case#020572 has been investigated and determined to be unfounded.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 5/31/2024
Provider Signature : Date: 5/31/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

doc_type: Notice of Incident


summary: A resident was sent to Dallas County Medical Center ER for assessment of possible allergic reaction.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020536
Date of Incident: 4/11/2024
Date Received: 4/12/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was
sent to Dallas County Medical Center ER for assessment of possible allergic reaction. Dallas
County Medical Center ER assessed, gave benadryl and discharged.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/12/24, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns. Program Manager emailed the facility to ask if the child was determined
to be having an allergic reaction and if so, what to. 4/15/24- Facility stated the following "It
was determined that she did have a minor allergic reaction. She did have a rash, but was
found to be in no acute distress. Vitals all normal. She was admitted to ER at 1715 and
discharged at 1745. The assumption was contact with bananas."
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Dallas County Medical Center after injuring her ankle while playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020483
Date of Incident: 4/10/2024
Date Received: 4/11/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: fell on
the gym floor while playing basketball injuring her right ankle. She was taken to Dallas
County Medical Center for an x-ray. X-ray revealed no fractures.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/11/24, Licensing specialist reviewed report for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center after injuring her toe by kicking a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020464
Date of Incident: 4/9/2024
Date Received: 4/10/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
kicked a wall during a behavior. went to Dallas County Medical Center on
04/9/2024 for an x-ray on her 3rd toe on the right foot due to pain. X-ray revealed no
fractures.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/10/24 Licensing reviewed incident report for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Dallas County Medical Center after injuring his toe while playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020307
Date of Incident: 4/3/2024
Date Received: 4/4/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
was playing basketball when he fell and hurt his left great toe. was
transported to Dallas County medical center for an x-ray. He was found to have a
nondisplaced fracture in the distal metadiaphyseal region of proximal phalanx of the first
digit.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/4/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing conducted an after-hours visit. No deficiencies cited.

raw_content:
ARKANSAS
BEPARTMENT OF

A HUMAN
~at SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110

Licensing Specialist: Clayton DeBoer
Person In Charge: Emerald Burris
Record Visit Date: 4/2/2024

Home Visit Date: 4/2/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

After-hours visit conducted at 6:00AM. Staff/client ratio: 2:10.

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Staff seen through window awake upon arrival. Staff answered the door immediately. Nightly visual checks
roster produced for licensing with appropriate time initialed. All clients were reportedly asleep. Day/living
area observed to be clean, safe and in good repair. Grounds clean and free of safety hazards. Bathrooms and
sleeping areas not observed during after-hours visit as to not disrupt clients' routine.

Provider Comments:

CCL Staff Signature : Date: 4/2/2024
f
/

Provider Signature : Date: 4/2/2024

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

doc_type: Compliance Report


summary: Licensing visited the facility in follow up to the attempted elopement of a resident in January 2024. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110

Licensing Specialist: Clayton DeBoer
Person In Charge: Emerald Burris
Record Visit Date: 3/28/2024

Home Visit Date: 3/28/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

www.arkansas.gov/dhs
Serving more than one million Arkansans each year

_ ARK ANSEA S
) DEPARTMENT OF

)}-7 HUMAN
~ “ai SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 2

3/28/24-Facility visited in follow up to attempted elopement of client in January 2024. Per Chris Butler
of Millcreek, police were notified per elopement protocol, but no arrests were made. Fordyce Police Dept. did
not show up for this call.

Staff Todd M interviewed who stated that he and staff Dan M responded to a possible elopement and while
engaged in the search, Jj was located by other staff.

Chris Butler of Millcreek reported that the other staff who pursued | | where himself (Chris Butler),
Jasmine T and Donald H. Client would converse with staff, then run ahead, then converse with staff, and so
on. Client was heard whistling throughout pursuit. Client was directed to return to facility. Client eventually
complied without need of physical intervention.

Staff Sheila S interviewed who stated she was present for this incident. Staff Shiela stated that at no time was
client out of shouting distance from staff.

Staff Antrell R interviewed. Staff Antrell stated that he was at the beginning of the pursuit, not the end.
Antrell stated that iz was not out of supervision of staff for a considerable amount of time. | | was
engaged in conversation periodically and could be heard whistling.

99 background record checks reviewed this visit also. All background checks for Millcreek completed.

Provider Comments:

CCL Staff Signature : Date: 3/28/2024
Nf Sf
ow
f NA
/ IP
Provider Signature : Date: 3/28/2024

V

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident reported that a staff member hit him in the mouth and nose during an attempted elopement and physical restraint. This complaint was UNFOUNDED by Licensing.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019959
Date of Incident: 3/17/2024
Date Received: 3/20/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description:
reported that during an incident that occurred on 03/17/2024, that his staff
hit him in the mouth and nose during an attempted elopement and physical
restraint.
Interim Action Narrative: Staff has not worked since allegation. Staff will
be placed on administrative leave prior to next shift pending investigation.
Licensing Narrative: Program Coordinator requested permission to contact the facility.
3/20/24-Phone call made to Chris Butler of Millcreek. This incident allegedly happened
3/17/24, but did not tell staff until 3/19/24. There is no video of alleged incident as it
was reported to have occurred in a transit vehicle. Client attempted to elope but never
made it off campus. Staff drove a facility vehicle to the edge of the road and located
got in the transit vehicle where the incident allegedly occurred. Staff has
been placed on administrative leave pending investigation. Permission granted for the
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

facility to be contacted. 3/20/24-Facility visited. Nursing note reviewed for 3/17 which does
indicate that had "abrasion to inner lip". Facility investigation yields that alleged
incident happened in transit vehicle, Shakaila Ewards driving, staff Mantrell Neal and
riding. Emily Burris of Millcreek stated that per phone call with Shakaila
Edwards, at no time she (staff Edwards) see staff punch or hit Staff Mantrell
Neal interviewed. Staff Neal stated he was present in the transit vehicle and observed staff
restraining during transit. Staff Neal stated that at no time did he see staff
punch or hit in the face. Staff Neal stated that at no time did he see staff
do anything physical to that would give him cause for concern. Staff Neal did
say that he saw spit blood but at no time saw any staff do anything during incident that
would cause to spit blood. interviewed. stated that he was going to elope
but stopped in the road and let staff catch him. stated that staff grabbed him
by his hoodie with both hands. stated that while restraining him ( in transit
vehicle, staff punch him ( "once in the nose and twice in the mouth". When
asked if any staff were present, indicated that staff Shakaila and Mantrell were present.
When asked if either of these staff saw hit him, replied "I don't know".
had no outwardly visible scarring or bruising on his face today. did show a
healing cut on the inside of his lip. Licensing is not prepared to make a finding at this time.
4/29/24-Received notification that maltreatment was unfounded.


summary: A resident was sent for an x-ray after complaining of pain from a fall that occurred during a basketball game.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019817
Date of Incident: 3/12/2024
Date Received by DCCECE: 3/13/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was sent
for an outpatient x-ray at Dallas County Medical Center following a visit with his PCP. He
complained of continued pain resulting from a fall during a recreational basketball game. X-
ray report indicates a greenstick fracture distal radius and a buckle fracture distal ulna. He
has been provided a splint and will follow his PCP directives for treatment of the injury. He
was released to return to the facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 3/13/24-PRI reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that a staff member choked him during a physical restraint. This complaint has been UNFOUNDED by Licensing.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019770
Date of Incident: 3/9/2024
Date Received: 3/11/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: On 3/8/24, private placement, was
placed in a physical restraint following an extended period of verbal and physical aggression
and property destruction. The restraint was initiated for safety after he directed his
aggression toward staff members, pushing and biting them. On 3/9/24, made the
verbal statement that staff member had choked him while initiating the
physical restraint. The nurse's notes following the restraint indicate scratches on the left
side of the neck.
Interim Action Narrative: A/O placed on administrative leave pending investigation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 3/12/24-Phone call made to Chris Butler of Millcreek who stated the
incident occurred at Pine Ridge and there was no video. A/O has been placed on
administrative leave pending investigation. 3/12/24-Email sent to DCFS Investigator
Jennifer Harper to get permission to contact facility regarding incident. Received email
from Ms. Harper granting permission to contact facility regarding this investigation.
3/13/24-Facility visited in response to complaint that client was choked by staff
Staff has been suspended pending investigation. Witness statements reviewed. Of
note, Supervisor witness statement states "during the restraint at no time did I
see staff choke pt ...". Witness statement continues to state that after the
restraint was over at no time did pt. mention being choked. Nursing note from the day after,
3/9/24, states that client had abrasion like scratches to left side neck and base of throat
and reported being choked during restraint. Client interviewed. stated that during a
restraint, put his right hand around his neck, while he ( ) was lying on the
ground face up. stated he heard " ( ) say 'don't choke him'.
stated that after the restraint he did not mention being choked because of fear of retaliation
from peers. A phone call was attempted to today but no answer. did have a
3" scratch to left side of neck during today's visit. Licensing is not prepared to make a
finding at this time. Chris Butler of Millcreek will provide a witness statement from
to licensing upon receipt. No other clients could provide witness statement to the
restraint. 4/29/2024- Licensing reached out to the facility for an update on the status of the
A/O's employment status.


summary: Personnel Records Review conducted for staff. All items accounted for. Background check file reviews also conducted for 33 additional staff.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 3/6/2024
Home Visit Date: 3/6/2024
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Personnel Records Review conducted for staff:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Kizzy A
Brittney B
Kaneesha C
Leslie D
Alvinantasha G
Lilly H
Cherrelle J
Tilda L
Shasta M
Octavian M
All items accounted for. Background check file reviews also conducted for 33 additional staff.
Provider Comments:
CCL Staff Signature : Date: 3/6/2024
Provider Signature : Date: 3/6/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Dallas County Medical Center for an outpatient x-ray after complaints of thumb pain from catching himself after losing his balance.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019643
Date of Incident: 3/5/2024
Date Received by DCCECE: 3/6/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was sent to
Dallas County Medical Center for outpatient x-ray for a complaint of continued thumb pain,
reported after losing his balance and catching himself. X-ray report indicates no fracture
present. He was released to return to the facility without restriction.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 3/7/24-Provider reported incident reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident eloped from the property and was found within 200 yards of the facility.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019526
Date of Incident: 2/29/2024
Date Received by PRLU: 3/1/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: (DOB: , Arkansas, PRTF, parent custody) eloped from
property. Patient was found within 200 yards of facility. Emergency protocol was initiated and
followed. Patient returned to facility with no injuries.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 3/1/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A Buildings and Grounds walkthrough was conducted. The facility was cited 911.6 for issues identified in the visit.

raw_content:
ARKANSAS
DEPARTMENT OF

> HUMAN
~=a' SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 2/27/2024

Home Visit Date: 2/27/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulation Number: 900.911.6
Regulation Description: All buildings and furnishings shall be safe, clean, and in good repair.

Finding Description: Pine Ridge Room 4 closet had graffiti, Bathroom 4 had a missing bolt on toilet lid and
baseboards were missing for entire unit. Baseboards have been intentionally removed and are awaiting remodel.

Action Due Date: 2024-03-27
Action Due Description: Non-compliant items will be fixed.

Comply Date:

Action Due Description: Non-compliant items will be fixed.

Regulations Needing Technical Assistance:

Regulation Not Applicable:

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Regulations Not Correctable:

Narrative:
Buildings & Grounds conducted from 9:45AM-11:30AM. Census: 159

Grounds clean and free of safety hazards. Pebble Creek and Pine Ridge observed. Pebble Creek clean, safe
and in good repair. Bathrooms clean and sanitary with functioning sinks, showers toilets. Pine Ridge clean,
safe and in good repair except Room 4 closet had graffiti, Bathroom 4 had a missing bolt on toilet lid and
baseboards were missing for sleeping areas. Baseboards have been intentionally removed and are awaiting
remodel. Facility cited 911.6. Non-compliant items will be fixed within a month.

MAR checked for:

Background checks reviewed for 99 staff.

Provider Comments:

CCL Staff Signature : Date: 2/27/2024
AVY
/i -
VP \/
Provider Signature : Date: 2/27/2024

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident complained of ankle pain after playing kickball. An x-ray was ordered.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019246
Date of Incident: 2/17/2024
Date Received by PRLU: 2/19/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , DFPS Custody, DOB: ) injured his ankle while
playing a recreational game of kickball. He complained of pain during nursing assessment. He was
referred to Dallas County Medical Center for outpatient x-ray. X-ray report reveals no fracture
present. He was released to return to the facility without restrictions.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/20/24-Provider reported incident reviewed for licensing concerns. None
noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that a peer had coerced the resident into engaging in non-consensual sexual contact. This complaint was UNFOUNDED by Licensing.

raw_content:
minutes" and the flashing incident took "a few seconds". interviewed. When asked about recent
incident, stated that "put his privates in me". To clarify, stated that physically forced
this to happen. Chris Butler of Millcreek stated that new maltreatment report will be made regarding
this allegation. stated this occurred in 's room the same evening that he ( ) flashed .
Before these interviews, clients and resided in the same cottage on Close Observation. Chris
Butler of Millcreek stated today that client and will now be assigned different cottages and
remain on Close Observation.


summary: A resident was slapped twice in the back of the head by a staff member and had her legs yanked out from under her, causing her to fall to the floor. The staff member was terminated immediately. The facility was cited 905.4.g and 109.1.g as a result of the incident.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019084
Date of Incident: 2/9/2024
Date Received: 2/9/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: exhibited
emotional distress and confrontational behavior towards other patients and staff members in
her classroom setting. This behavior led to several patients trying to initiate physical
altercations with her. A review of the surveillance footage revealed that during the incident,
staff member physically assaulted by slapping her twice on the
back of the head and, while standing, yanked her legs out from under her, causing her to fall
to the floor. This incident has been reported to the AR
Considering her gross misconduct, was terminated from
employment immediately. Nursing assessment revealed no injury from the incident. An in-
service training will conducted on Therapeutic Crisis Intervention De-escalation techniques
with the staff member also in the room. A campus-wide in-service will be conducted on the
usage of announcing ?CODE GREEN? on the walkie talkie communication, requesting
additional assistance for de-escalation. Surveillance footage will be saved.
Interim Action Narrative: Staff was immediately terminated.
Maltreatment Narrative: exhibited
emotional distress and confrontational behavior towards other patients and staff members in
her classroom setting. This behavior led to several patients trying to initiate physical
altercations with her. A review of the surveillance footage revealed that during the incident,
staff member physically assaulted by slapping her twice on the
back of the head and, while standing, yanked her legs out from under her, causing her to fall
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

to the floor. This incident has been reported to the AR
Licensing Narrative: 2/12/24-Licensing reviewed complaint that client
was physically assaulted by staff on 2/9/24. Staff member immediately
terminated. Visit scheduled for 2/12/24. 2/12/24-Facility visited and camera footage
reviewed which clearly shows staff take client legs out from under her causing
to fall to the floor landing on her buttocks. Staff can be seen slapping the top of
head twice. Staff/client ratio in video 2:9. Facility cited 109.1g and 905.4g. Staff
was immediately terminated. An in-service training will conducted on Therapeutic Crisis
Intervention De-escalation techniques with the staff member also in the room. A campus-
wide in-service will be conducted on the usage of announcing ?CODE GREEN? on the
walkie talkie communication, requesting additional assistance for de-escalation. Licensing
complaint is founded. 4/29/24-Received email that maltreatment complaint was
unfounded.


summary: A resident reported to his therapist that he was forced to inappropriately touch a peer’s penis. The complaint has been UNFOUNDED by Licensing.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019082
Date of Incident: 2/9/2024
Date Received by PRLU: 2/9/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: During an individual therapy session, , Parent
Custody, DOB: ) reported to his therapist that he was forced to inappropriately touch a
peer's penis. A report was made to the and
by
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative: During an individual therapy session, Parent
Custody, DOB: ) reported to his therapist that he was forced to inappropriately touch a
peer's penis. A report was made to the
Licensing Narrative: 2/12/24-Licensing review complaint that client was forced to
touch a peer's penis. Visit scheduled for 2/12/24. Chris Butler contacted via phone who stated
CACD Investigator Gregoria Garcia had already visited A/V regarding this incident. 2/12/24-
Licensing left voice mail via phone and emailed Ms. Garcia to obtain permission to contact A/V.
Licensing received permission to contact the facility. 2/12/24-A/V and A/O interviewed.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Neither client reported supervision concerns. Licensing is not prepared to make a finding at this
time.


summary: A resident was sent to Dallas County Medical Center for an outpatient x-ray after reporting hand pain from punching a wall.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019124
Date of Incident: 2/9/2024
Date Received by PRLU: 2/12/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , DHHR Custody, DOB: ) was
sent to Dallas County Medical Center for outpatient x-ray after reporting hand pain. His report was
made during the examination by nursing staff after punched a cinderblock wall. The x-ray
report indicates that no acute fracture or injury was present. He was released to return to the facility
without restriction.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/12/24-Received provider reported incident that client
was x-rayed on 2/9/24. No licensing concerns noted from this report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing visited the facility to review staff background checks. No licensing concerns noted.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 2/8/2024
Home Visit Date: 2/8/2024
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Background checks reviewed for 72 staff.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 2/8/2024
Provider Signature : Date: 2/8/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was transported to Dallas County Medical Center after swallowing all the Ibuprofen inside a bottle she took from the Activity Director’s desk drawer. The facility was cited 908.4 for the ibuprofen left in an unlocked drawer.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019009
Date of Incident: 1/26/2024
Date Received by PRLU: 2/6/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , DFPS Custody, DOB: ) was assisting the
Activities Director with cleaning and activity preparation in her office. When completed and
returned to her living unit, reported to the supervisor that she had taken a bottle of
Ibuprofen from the Activity Director?s desk drawer and swallowed all of the pills. She stated that
she regretted her actions immediately after taking them. The bottle was estimated to be ¼ to ½ full
(approx.30-50 pills). She was taken to Dallas County Medical Center ER where she received
activated charcoal and fluids. She was released to return to the facility at 11:03pm. She was placed on
1:1 staffing ratio upon her discharge from the hospital. A safety plan is currently being created.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/8/24-Email sent to facility to ascertain if there exists any confirmation that
client took these pills and if Ibuprofen is stored in an unlocked drawer. Reg 908.4 reviewed: All
medications shall be kept securely locked and stored according to pharmaceutical recommendations.
Email sent to facility to inquire why this incident took place 1/26/24 and was not reported to
licensing until 2/6/24. Reg 110.17 reviewed: The agency shall notify the Licensing Unit by the next
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

business day of serious injuries requiring emergency medical treatment, suicide attempts. 2/8/24-
Recieved email from Chris Bulter of Millcreek as follows: The incident occurred on 2/5 and
reported on 2/6. Must have been a data entry error on my part. There is no confirmation that the
patient took the medication. Because of that, she received treatment as if she had taken it. The
Ibuprofen was stored in the desk drawer of the Activity Coordinator's office in the gym. The drawer
was unlocked. Yes, there is footage to review. We have completed a safety plan and begun in-service
training to prevent any future occurrences. The patient remains 1:1 and has not shown any side-
effects from this incident. 2/8/24-Facility visited and cited 908.4.


summary: A resident was referred to Dallas County Medical Center for an outpatient x-ray after accidentally closing a door on her hand earlier in the week.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018795
Date of Incident: 1/26/2024
Date Received by DCCECE: 1/29/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was referred to
Dallas Co. Medical Center for outpatient x-ray after reporting continued hand pain to her
PCP. She accidentally had a door close on her hand earlier in the week. X-ray report
indicates that no fractures or joint misalignments were found.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 1/29/24-Recieved provider reported incident that on 1/26/24 client
was referred to Dallas Co. Medical Center for outpatient x-ray. No fracture. No
licensing concerns noted from this report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 1/22/2024
Home Visit Date: 1/22/2024
Purpose of Visit: Agency Checklist
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Annual Review/Policies PRTF completed. All items on checklist accounted for.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 1/22/2024
Provider Signature : Date: 1/22/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: An officer was dispatched to the facility for a runaway child report.

raw_content:
Incident # 24-00022 Fordyce Police Department Report Date 01/17/24
Page 1 of 2 Incident Report Report Time 12:55 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 305 Murry, Steven AR0200100
Active
Assigned Officer Entered By Approving Officer
Murry, Steven SMurry Hogan, Wesley
Assisting Officers
Complainant
Name Contact Name
Millcreek Od Arkansas
Business Address Business Phone
1828 Industrial Drive ,Fordyce, AR 71742 8703528203
Offenses
Incident Location Zone
1828 Industrial Drive Fordyce, AR 71742
Earliest Possible Date Time Latest Possible Date Time
01/17/2024 12:55 01/17/2024 12:55
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 INFORMATION INFORMATION Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
14 U Unknown
Race Unknown Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Murry, Steven - 1/17/2024 1:03:40 PM (Initial)
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 3/19/2024 6:37:08 AM

Incident # 24-00022 Fordyce Police Department Report Date 01/17/24
Page 2 of 2 Incident Report Report Time 12:55 PM
Narrative & Statements
Narrative - Murry, Steven - 1/17/2024 1:03:40 PM (Initial)
At January 17th at approximately 8:10 A.M. I (Officer Murry) was dispatched to
Millcreek on industrial drive in Fordyce, AR for a runaway child report. Upon arrival
I came in contact with Shavon Eason who is a PRTF LPN at Millcreek. She advised
that Juvenile ran away from the millcreek facility at approximately
8:10 A.M. I took the report and the juveniles information from her and came back to
the Fordyce Police Department to write my report.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 3/19/2024 6:37:08 AM

doc_type: Police Report


summary: A resident was referred to Dallas County Medical Center for outpatient x-rays after reporting pain to her PCP during a wellness checkup.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018488
Date of Incident: 1/9/2024
Date Received by DCCECE: 1/10/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: received
outpatient x-rays at Dallas County Medical Center. She was referred after reporting pain to
her PCP during a wellness checkup. The x-ray report indicates that she had a previously
fractured her femur and healed. The report indicated that there are two orthopedic wires in
the shaft of her right femur and a possibility of arthritis from the injury. The injury occurred
prior to placement with Millcreek.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 1/10/24-Received provider reported incident that on 1/9/24 client
received an x-ray. No licensing concerns noted from this report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported he was punched by a staff member after an altercation between two of his peers. A second resident reported that he confronted the staff member and was also punched in the face. A second staff member witnessed the incident and corroborated the resident’s report. The accused staff member was terminated. The facility was cited 109.1.g and 905.4.g as a result of this incident.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018440
Date of Incident: 1/7/2024
Date Received by PRLU: 1/8/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: reported that two
patients were fighting in his living unit. He inserted himself in the physical confrontation in an effort
calm the patients down. Two staff members placed him in a standing hold to contain his behavior.
After they released him, became verbally and physically aggressive towards the staff members.
He attempted to punch staff members multiple times. reported that staff member
punched him in return.
reported that he witnessed . being punched by staff member .
became upset and kicked open the door to the living unit and walked outside.
confronted staff asking why he punched reports that said,
"Get the fuck out of my face. I don't give a fuck about none of you." and then punched in
the face. reports that he backed up but kept questioning and was punched two more
times in the face. Nursing assessment: has a swollen area behind his left ear. was noted
to have a raised area to left upper cheek area and right upper head area. No outside medical
treatment was needed. The allegations were reported to the and
accepted for investigation by DHS. Referral ID: The allegation was reported to the
. No return correspondence has been received at this time. Staff member
was placed on administrative leave, pending the results of the internal and external
investigation.
Interim Action Narrative: Staff suspended pending investigation.
______________________________________________________________________________
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative: Referral ID: -Recieved provider complaint that clients
and were assaulted by staff during an altercation.
Licensing Narrative: 1/8/24-Recieved provider complaint that clients and
were assaulted by staff during an altercation. Phone call made to Chris Butler
of Millcreek to ascertain whether there is video footage of this incident. Phone call received back
from Chris Butler who stated the incident took place in Magnolia Hall and there is no video footage.
1/8/24-Phone call made to DCFS Investigator Tonyetta Flint who gave licensing permission to
contact facility. Visit scheduled for 1/9/24,12:30PM with Tonyetta Flint at Millcreek. 1/9/24-
Facility visited. Witness statements reviewed. It should be noted that Supervisor Shakaila Edwards
witness statement reads "...patient flinched like he was about to jump staff. Staff at this
time and did in return did hit ...". Clients and interviewed. Client
stated that multiple peers were arguing/fighting when staff entered the cottage. Staff
and had a verbal altercation before staff punched, with his right hand, left
ear. stated that staff "Ms. Shakaila and Deon" witnessed this. interviewed. stated that
during the altercation, he was outside when staff punched him, with a close fist, "3 times"
in the face. stated that staff S Smith witnessed this. Staff S Smith interviewed during today's visit.
Staff S Smith confirmed that she witnessed staff punch in the face 3 times. She stated
she attempted to intervene to no avail. Facility cited 109.1g: Unprofessional conduct in the practice
of child welfare activities shall include without limitation: g) Engaging in behavior that could be
viewed as sexual, dangerous, exploitative, or physically harmful to children. 905.4g: The following
disciplinary actions shall not be used: g) Physical injury or threat of bodily harm. Per Chris Butler of
Millcreek staff will be terminated subsequent his suspension. 3/13/24-Received
notification that maltreatment was unfounded.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 1/9/2024
Home Visit Date: 1/9/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Regulation Number: 100.109.1.g
Regulation Description: Unprofessional conduct in the practice of child welfare activities shall include, but not
limited to the following:
Finding Description: Staff punch clients and in the face.
Action Due Date: 2024-01-09
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Action Due Description: Per Chris Butler of Millcreek, staff will be terminated subsequent his
suspension.
Comply Date:
Sub-Regulation Level 1 Description: Engaging in behavior that could be viewed as sexual, dangerous,
exploitative, or physically harmful to children.
Action Due Description: Per Chris Butler of Millcreek, staff will be terminated subsequent his
suspension.
Regulation Number: 900.905.4.g
Regulation Description: The following actions shall not be used, including as discipline:
Finding Description: Staff punched clients and in the face.
Action Due Date: 2024-01-09
Action Due Description: Per Chris Butler of Millcreek, staff will be terminated subsequent his
suspension.
Comply Date:
Sub-Regulation Level 1 Description: Physical injury or threat of bodily harm;
Action Due Description: Per Chris Butler of Millcreek, staff will be terminated subsequent his
suspension.
Narrative:
1/9/24-Facility visited. Witness statements reviewed. It should be noted that Supervisor Shakaila Edwards witness statement
reads "...patient flinched like he was about to jump staff. Staff at this time and did in return did hit
Clients and interviewed. Client stated that multiple peers were arguing/fighting when staff
entered the cottage. Staff and had a verbal altercation before staff punched, with his right hand, left
ear. stated that staff "Ms. Shakaila and Deon" witnessed this. interviewed. stated that during the altercation, he
was outside when staff punched him, with a close fist, "3 times" in the face. stated that staff S Smith witnessed
this. Staff S Smith interviewed during today's visit. Staff S Smith confirmed that she witnessed staff punch in the
face 3 times. She stated she attempted to intervene to no avail. Facility cited 109.1g: Unprofessional conduct in the practice of
child welfare activities shall include without limitation: g) Engaging in behavior that could be viewed as sexual, dangerous,
exploitative, or physically harmful to children. 905.4g: The following disciplinary actions shall not be used: g) Physical injury
or threat of bodily harm. Per Chris Butler of Millcreek staff will be terminated subsequent his suspension.
Provider Comments:
The employee involved in this incident completed all required training and met competency standards, but they
failed to adhere to the established expectations, policies, and procedures of our facility. Such a violation of
company policy necessitated disciplinary action, including termination of employment, and reporting to the AR
Child Abuse Hotline. It is imperative to underscore that this incident did not reveal any system, procedure,
process, or practice within our facility that failed. The actions taken by the facility unequivocally proves that
Millcreek has effective practices for responding to situations where an employee deviates from company policy.
Additionally, our facility conducted in-service trainings on behavior management and de-escalation techniques,
including a “tap out” procedure for when an employee becomes escalated. The supervisor present during this
incident attempted to “tap out” the employee but the employee refused to remove himself from an escalated
situation.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 1/9/2024
Provider Signature : Date: 1/9/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: A resident eloped while staff members intervened in a physical altercation between two other residents.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018395
Date of Incident: 1/4/2024
Date Received by DCCECE: 1/5/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
eloped from campus. At 1345, two patients engaged in physical confrontation while
participating in outdoor recreation. As staff members assisted in separating the patients,
slipped away from the group, as staff member's attention was diverted.
entered a densely wooded area behind the facility and was quickly out of sight of staff
members. Supervisory staff initiated the elopement search procedures immediately and
notified Fordyce Police Department to assist in the search efforts. As the search progressed,
the Cleveland Co. Sherriff's office was also alerted. was located by Millcreek
supervisory personnel approximately 200 yards away from the facility. At approximately
1915, he was willingly taken back into custody without further incident. He was searched for
contraband and assessed by nursing staff before reentering his living unit. There were no
injuries noted from the incident.
Interim Action Narrative: The police were called. Resident was searched for contraband and
assessed by the nurse.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator inquired about the staff/resident ratio. 1/8/24-
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Received email that staff/client ratio was 2:10. According to report, staff were aware of
elopement and followed protocol. Client was located and taken back into custody the same
day of elopement. Staff followed elopement protocol.


summary: An officer was dispatched to the facility in response to a runaway patient.

raw_content:
Incident # 24-00005 Fordyce Police Department Report Date 01/04/24
Page 1 of 2 Incident Report Report Time 5:20 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 303 Taylor, Johnathan AR0200100
Active
Assigned Officer Entered By Approving Officer
Taylor, Johnathan jtaylor Hogan, Wesley
Assisting Officers
Complainant
Name Contact Name
Millcreek Of Arkansas Chris Butler
Business Address Business Phone
1828 Industrial DR,Fordyce, AR 71742 8703528203
Offenses
Incident Location Zone
1828 Industrial DR Fordyce, AR 71742
Earliest Possible Date Time Latest Possible Date Time
01/04/2024 14:05 01/04/2024 14:10
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 INFORMATION INFORMATION Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
16 M Unknown
Race White Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/9/2024 11:55:06 AM

Incident # 24-00005 Fordyce Police Department Report Date 01/04/24
Page 2 of 2 Incident Report Report Time 5:20 PM
Suspect #1
Height Weight Eyes Build AKA
5' 7" 207 Blue
Appearance HairColor Hair Style Teeth Beard/Facial Hair Demeanor Speech Voice
Blond
Dexterity Hair Length Complexion
Narrative & Statements
Narrative - Taylor, Johnathan - 1/4/2024 5:24:29 PM (Initial)
On January 04, 2023, at approximately 2:05 p.m., I, Corporal Johnathan Taylor
was dispatched to MillCreek in reference to a runaway patient. Upon arrival, I made
contact with staff members and was given his patient information sheet, and was
informed that he was at Magnolia Hall when he ran away from the facility. I
informed them a report would be on file.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/9/2024 11:55:06 AM


summary: Licensing conducted a visit to confirm an applicant was not employed by the facility.

raw_content:
ARKANSAS
) DEPARTMENT OF

> HUMAN
=a! SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 1/3/2024

Home Visit Date: 1/3/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Visit conducted 1/3/24. This correspondence is to confirm that applicant Jj is not employed by Millcreek of
Arkansas.

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:

CCL Staff Signature :

Provider Signature :

www.arkansas.gov/dhs

Serving more than one million Arkansans each year

Date: 1/3/2024

Date: 1/3/2024

Page 2 of 2


summary: A resident eloped from the facility by exiting a rear door and jumping a fence. The Fordyce Police Department was notified. The resident was located on facility grounds.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/18/2023
Date Received by DCCECE: 12/19/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: During recreation time,
became upset due to the behavior of other patients, which caused the group to
return inside. He then left the living unit through the rear door and jumped over the fence,
entering a wooded area. As a result, the elopement protocol was initiated, and search efforts
began. The Fordyce Police Department was also notified of his elopement and aided in the
search. After about an hour, he was found on facility grounds. However, he became
combative with our facility supervisor and police officers, even attempting to grab the
officer's taser. Consequently, the officers had to handcuff him and take him into custody.
It's worth noting that even during the arrest, he continued to resist and even threatened the
life of the officers. After spending 30 minutes with the officers, he was returned to the
facility. He was then placed on a new living unit with increased staff supervision.
Concerning these events, Fordyce Police Department is working alongside the juvenile
prosecutor on the possibility of criminal charges being filed against No
determination has been made at this time. The on-site nursing staff examined him and
observed various scratches and abrasions on his body. He mentioned experiencing pain in
his nose. Additionally, there was swelling in the affected area. He informed the nurse that he
was struck in the face by the officers.
Due
to his elopement risk, he was not immediately transported for x-ray. He will be evaluated
on-site by his PCP on 12.19.23. Further medical care will be provided pending the results of
this assessment.
Interim Action Narrative: Client was placed on a new living unit with increased staff
supervision.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 12/19/23-Received provider reported incident that client
became upset and eloped his living unit, jumped a fence and entered a wooded
area. Elopment protocol was initiated, and search efforts began. Fordyce Police Department
was called. Client was located on facility grounds and became combative with police and
staff. Client alleged to have been injured by police during altercation.
. Report does not indicate a staff supervision issue. Elopement
protocol was followed. Complaint was alleged against Fordyce Police Department.
12/19/23-Phone call made to Chris Butler of Millcreek around 2:30PM. Client had a
Dr.'s appt. at 1:00PM. Results are not available yet. Results will be emailed to licensing
upon receipt. remains at facility. was out of supervision of staff for a period of time
before being apprehended on facility grounds. Staff were immediately aware of
elopement and followed protocol.


summary: Officers were dispatched to the facility in response to a runaway juvenile.

raw_content:
Incident # 23-00665 Fordyce Police Department Report Date 12/19/23
Page 1 of 4 Incident Report Report Time 6:49 AM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 301 Hogan, Wesley AR0200100
Active
Assigned Officer Entered By Approving Officer
Hogan, Wesley WHogan Swiger, Canaan
Assisting Officers
Murry, Steven Byrne, River
Complainant
Name Contact Name
Millcreek Of Arkansas Chris Butler
Business Address Business Phone
1828 Industrial DR,Fordyce, AR 71742 8703528203
Offenses
Incident Location Zone
1828 Industrial DR Fordyce, AR 71742
Earliest Possible Date Time Latest Possible Date Time
12/18/2023 16:30 12/18/2023 18:50
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-202A(4)A Felony Completed 25 88 90,40
BATTERY - 2ND DEGREE / INJURE POLICE, FIRE, CODE ENFORCE, CORRECTIONAL IN LINE OF DUTY
2 5-13-301A(1A) Felony Completed 25 88 90,40
TERRORISTIC THREATENING - 1ST DEGREE / THREATENS PHYSICAL INJURY/PROPERTY DAMAGE
3 5-54-103A(1) Misd Completed 25 88 90,40
RESISTING ARREST - REFUSAL TO SUBMIT TO ARREST / USES FORCE
4 5-54-125 Misd Completed 25 88 90,40
FLEEING
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 3/19/2024 11:04:16 AM

Incident # 23-00665 Fordyce Police Department Report Date 12/19/23
Page 3 of 4 Incident Report Report Time 6:49 AM
Narrative & Statements
Narrative - Hogan, Wesley - 12/19/2023 7:41:03 AM (Initial)
On 12/18/2023 at approximately 4:45 PM I, Sgt. Wesley Hogan, along with Officer River Byrne of the Fordyce
Police Dept. were dispatched to Millcreek of Arkansas at 1828 Industrial Drive in Fordyce, AR 71742 for a runaway
juvenile. We arrived on scene and spoke with the staff of Millcreek who stated that the juvenile was named
. I spoke with Mr. Chris Butler the Director of Risk Management at Millcreek who stated that is
from and that has ADHD and Intermittent Explosive Disorder. They said he is a white male
who was last seen wearing black shorts and a black shirt that jumped the back fence and ran into the woods. Ofc.
Byrne and I searched the area for a while and then left the scene to another call.
At approximately 5:45 PM we were dispatched back to Millcreek because someone had reported they could hear the
juvenile in the woods yelling. Ofc. Byrne and I then made our way to the woods north of Millcreek while Ofc. Jacob
Murry went to the main campus of Millcreek. Ofc. Murry called out over the radio that he could see the juvenile and
that he was running across the road towards Millcreek. Ofc. Byrne and I then made our way towards Ofc. Murry. As
we approached Ofc. Murry's location Ofc. Murry called over the radio that the juvenile was trying to
take control of Ofc. Murry's taser. Ofc. Byrne and I ran to Ofc. Murry and found him and a few members of Millcreek
staff had face down on the ground trying to gain control of his hands. Ofc. Byrne and I assisted him in gaining
control of . refused to give up his hands and continued to pull away and try to fight. Ofc. Murry
and I gained control of hands and placed him into handcuffs. Ofc. Murry and I then escorted
to Ofc. Murry's patrol vehicle. refused to get into the vehicle as I trying to get him into the vehicle. Once in the
vehicle kept trying to come out of the vehicle. I tried to use the brachial plexus nerve stun with an open hand
to gain control of and missed the target area and caught in the left side of his face due to
thrashing around while I was trying to get his seat belt buckled. Still unable to safely buckle into the vehicle I
tried to hit his brachial plexus nerve area two more times and missed. After being held at taser point by Ofc. Murry,
then stopped resisting long enough for me to get him buckled in the vehicle. Ofc. Murry then began to
transport to the Dallas County Jail. began to kick Ofc. Murry's windows and doors. At the jail I put leg
shackles onto . The jail staff informed us that they could not hold due to him being a juvenile. I called my
supervisor Lt. Swiger, he informed us to take back to Millcreek and have them keep possession of . I
got into the vehicle with Ofc. Murry and rode with him back to Millcreek with . made several threats to
Ofc. Murry and I stating that he was going to kill us. Ofc. Murry and I along with Ofc. Byrne arrived back at Millcreek
and removed the handcuffs and leg shackles from Mr. once Millcreek staff took control of . All officers
then left the scene.
Narrative - Murry, Steven - 12/19/2023 12:23:46 PM (Initial)
I (Officer Steven Murry) was the second officer to respond to the incident. Upon arrival to the scene, the juvenile
identified as ( ) was running across the field at millcreek. He was being very aggressive towards staff
and everyone trying to calm him down and catch up to him. I then caught up to him, jumped out of my patrol unit and
ran to assist the Millcreek workers in restraining him. As i arrived over to him he was screaming and cussing. I tried
talking to him to get him to calm down and to pay attention to me, when he decided to reach for my taser to remove it
from its holder. I then restrained Mr. and assisted him to the ground where he was then placed in handcuffs
which was double locked and checked for correct tightness, SGT Hogan and I assisted him up and walked him to the
patrol unit while he was fighting and cussing us the whole way. He was screaming in SGT Hogans face, he was
trying to kick both of us, and was trying to get out of the vehicle when placed inside, Finally after telling him that he
would be dry stunned if he continued to fight, he calmed down and let us put the seat belt on him. We closed the door
and then started on our way to the Dallas County Detention Center when he unbuckled his seatbelt and started trying
to kick my door and my window open. The whole time he was yelling at me that we were " pussy ass hoes" and
"Bitch ass niggas" and that he wanted me to pull over so he could show me i wasn't "shit". We finally arrived at the
Dallas County Detention Center where they informed us there they couldn't take him there because he was a
juvenile. He started head butting the window and tried again to kick the door and the window open. We placed him in
leg shackles and transported him back to Millcreek. On the way there he stated that he would have his dad come
down and kill all of the officers, also stated that he would grab my Glock and shoot me with it. We arrived at Millcreek
where they took custody of him to await further action to be taken.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 3/19/2024 11:04:16 AM

Incident # 23-00665 Fordyce Police Department Report Date 12/19/23
Page 4 of 4 Incident Report Report Time 6:49 AM
Narrative & Statements
Narrative - Byrne, River - 12/19/2023 12:58:50 PM (Initial)
On December 18th, 2023 At approximately 4:50pm I Officer Byrne and Sgt. Hogan were dispatched to the area of
Millcreek to look for a runaway juvenile by the name of . We were noitifed by Millcreek staff that he
was wearing a black shirt and black shorts. Myself and Sgt. Hogan searched the area of Millcreek and Hwy 79 North
and South Bound but were unable to locate at the time. Myself and Sgt. Hogan were dispatched a second
time at approximately 6:00pm. Dispatch notified Myself and Sgt. Hogan that was seen back at the
area of Millcreek. Myself and Sgt. Hogan arrived at the residence that called dispatch and was not in the
area. As we began to leave I noticed that there were two vehicles parked in the field in the area of Millcreek. When
we got the the scene the staff of Millcreek notified Myself and Sgt. Hogan that was in the back corner of the
field. As we conducted our search Officer Murry arrived on scene. then fled the area and Officer Murry
followed. Upon arriving at Millcreek Officer Murry and Millcreek staff had on the ground. The Millcreek staff
notified us that attempted to take Officer Murry's Taser out of its holster. We then ran to the area and assited
Officer Murry in detaining . was being uncompliant and was screaming and cussing at Myself, Sgt.
Hogan and Officer Murry. As we escorted to the vehicle he would not get in the vehicle. Sgt. Hogan and
Officer Murry told that if he did not stop resisting that he was going to get tased. was then forced into
the back of the patrol vehicle by Sgt. Hogan. As Sgt. Hogan was attempting to apply seat belt
continued screaming and cussing in Sgt. Hogan's face. Sgt. Hogan then made attempts to perform a Brachical
Plexus Stun on , The Brachical Plexus Stun is a defensive technique which we were trained upon in the
Police Academy. After leaving Millcreek Officer Murry and Sgt. Hogan took to the Dallas County Detention
Center I followed to assist Officer Murry and Sgt. Hogan. Upon arrival the Jailers at Dallas County Detention Center
notified us that they could not hold juveniles at the Jail. As we were talking to the Jailers, started making
several attempts to kick out the windows of Officer Murry's Patrol Vehicle. Leg shackles were then placed on
after which was taken back to Millcreek and released back to Millcreek staff. End of Report.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 3/19/2024 11:04:16 AM


summary: A resident was sent to Dallas County Medical Center for an x-ray after reporting foot pain from an injury sustained while playing volleyball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/17/2023
Date Received by DCCECE: 12/18/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was referred to
the Dallas County Medical Center for an outpatient x-ray. reported foot pain
resulting from a recreational injury that she sustained while playing volleyball. The nursing
staff present on-site noted swelling in her right ankle. Upon further examination, the x-ray
report indicated that there was no fracture present in her foot.
Interim Action Narrative:
:
Licensing Narrative: 12/18/23-Received provider reported incident that on 12/17/23 client
was referred to the Dallas County
Medical Center for an outpatient x-ray. reported foot pain resulting from a
recreational injury that she sustained while playing volleyball. The nursing staff present on-
site noted swelling in her right ankle. Upon further examination, the x-ray report indicated
that there was no fracture present in her foot. No licensing concerns noted from this report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray after reporting pain in her thumb following an incident where staff had to remove rocks from her hands during a de-escalation process.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/15/2023
Date Received by DCCECE: 12/18/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was referred by her
PCP to Dallas County Medical Center for outpatient x-ray. The x-ray report indicated that
no fractures were present, and she was released from the facility without any restrictions.
She had reported experiencing pain in her thumb, following an incident where staff
members had to remove rocks from her hand during a de-escalation process while
attempting to prevent her from leaving the facility grounds. had become upset and
left the school building, and while outside, she picked up rocks and gestured as if she would
throw them at the staff members. To prevent any harm, the staff members secured her hand
and removed the rocks from it.
Interim Action Narrative:
Licensing Narrative: 12/18/23-Received provider reported incident that on 12/15/23 client
was referred by her PCP to Dallas County Medical Center for outpatient x-ray.
The x-ray report indicated that no fractures were present, and she was released from the
facility without any restrictions. She had reported experiencing pain in her thumb, following
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

an incident where staff members had to remove rocks from her hand during a de-escalation
process while attempting to prevent her from leaving the facility grounds.


summary: A resident was sent to Dallas County Medical Center for an x-ray after complaints of back pain related to an injury sustained before admission to the facility.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/15/2023
Date Received by DCCECE: 12/18/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: ( was
referred to Dallas County Medical Center for outpatient x-ray. He presented with
complaints of back pain related to an injury sustained prior to admission to Millcreek. X-ray
report indicates that no fracture is present. He returned to the facility without restriction.
Interim Action Narrative:
:
Licensing Narrative: 12/18/23-Received provider reported incident that on 12/15/23 client
received an x-ray due to complaint of back pain. X-ray report indicates
that no fracture is present. He returned to the facility without restriction. No licensing
concerns noted from this report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing visited the facility to conduct a Buildings and Grounds walkthrough. The facility was cited 908.8 for issues identified during the review.

raw_content:
ARKANSAS
) DEPARTMENT OF

> HUMAN
~a' SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 12/6/2023

Home Visit Date: 12/6/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulation Number: 900.908.8

Regulation Description: The administering of all medications, including over-the-counter, shall be logged at the
time the medication is given, by the person administering the medication.

Finding Description: Client jem meds were not marked for 12/5/23. Nurse was consulted whom stated that
meds were administered and could not provide an explanation as to why they were not initialed.

Action Due Date: 2023-12-06

Action Due Description: Issue was addressed during today's visit. DON will consult with nursing staff on the
importance of timely medication administration documentation.

Comply Date:

Action Due Description: Issue was addressed during today's visit. DON will consult with nursing staff on the
importance of timely medication administration documentation.
Regulations Needing Technical Assistance:

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:
Buildings and Grounds conducted from 9:30AM-10:30AM. Census: 156

Eagle Hall and Tiger Hall observed to be clean, safe and in good repair. Both Eagle and Tiger Hall have new
flooring installed in the hallways and have recently been repainted except for the door frames, which are
scheduled to be painted. Bathrooms clean and sanitary with functioning sinks, showers and toilets. Fire drill
logged checked today, most recent being completed in November. Outdoor area clean and free of safety
hazards.

MAR checked for:

Fs eM meds were not marked for 12/5/23. Facility cited 908.8.

All but J meds initialed and up to date.

Provider Comments:

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 12/6/2023

Provider Signature : Date: 12/6/2023

/ / p¥
Viv

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 11/30/2023
Home Visit Date: 11/30/2023
Purpose of Visit: Agency Checklist
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Annual Reviews/Policies PRTF completed. All items on checklist accounted for.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 11/30/2023
Provider Signature : Date: 11/30/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident reported that a staff member hit her in the head with a closed fist multiple times. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Childcare & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 017640
Date of Incident: 11/15/2023
Date Received by DCCECE: 11/20/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: AV is approx. . PRFC is approx. 30yo
Unknown. AO is approx. 30yo unknown last name. was in the laundry room and
(staff member) told her to get out when did not listen, went to physically
remove her and hit then hit in the head with a closed fist multiple
time. The reporter who told me about the incident stated that there was no bruising or
blood anywhere.
Interim Action Narrative: Staff placed on administrative leave pending investigation.
Maltreatment Narrative: AV is approx. 14yo . PRFC is approx. 30yo
Unknown. AO is approx. 30yo unknown last name. was in the laundry room and
(staff member) told her to get out when did not listen, went to physically
remove her and hit then hit in the head with a closed fist multiple
time. The reporter who told me about the incident stated that there was no bruising or
blood anywhere. Ref#
Licensing Narrative: Licensing received phone call from DHS Investigator Tonyetta Flint
11/20/23 notifying licensing of alleged maltreatment ref# . Facility visited 11/20/23
and it was determined that A/V is client and A/O is staff member .
Client interviewed in response to complaint that A/O physically assaulted client
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humanservices.arkansas.gov

Client stated that she was aware of an incident in which "all but 2 staff showed up"
in which her ( and staff were "playing...but we never touched each other".
stated that staff has never hit her or been mean to her. stated that staff at
Millcreek were nice. stated that she felt comfortable talking to staff a Millcreek if she felt
she needed to. Video reviewed of Flamingo Hall from 11/15/23 from 6:30AM-12:00PM. No
altercation outside or around the laundry area is seen in this review of video. Licensing is
not prepared to make a finding as of 11/20/23. 1/2/24-Received notification that
maltreatment ref# was unfounded. No licensing citations regarding this incident.
Licensing complaint is unfounded.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 11/20/2023
Home Visit Date: 11/20/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 11/20/23 and client interviewed in response to complaint that A/O physically
assaulted client Client stated that she was aware of an incident in which "all but 2 staff showed up" in
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

which her ( and staff were "playing...but we never touched each other". stated that staff
has never hit her or been mean to her. stated that staff at Millcreek were nice. stated that she felt
comfortable talking to staff a Millcreek if she felt she needed to. Video reviewed of Flamingo Hall from
11/15/23 from 6:30AM-12:00PM. No altercation outside or around the laundry area is seen in this review of
video. Staff placed on administrative leave 11/20/23 pending investigation. Licensing is not prepared to
make a finding as of 11/20/23.
Provider Comments:
CCL Staff Signature : Date: 11/20/2023
Provider Signature : Date: 11/20/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 1/2/2024
Home Visit Date: 1/2/2024
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Licensing Complaint Case#017640 is unfounded.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 1/3/2024
Provider Signature : Date: 1/3/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to review personnel records. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 11/8/2023

Home Visit Date: 11/8/2023

Purpose of Visit: Personnel Records

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Personnel Records Review conducted for:

www.arkansas.gov/dhs
Serving more than one million Arkansans each year

ARKANSAS
) DEPARTMENT OF

|\-7 HUMAN
» "2 SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

y

Page 1 of 2

All items required per minimum licensing standards observed.

Provider Comments:

CCL Staff Signature : Date: 11/8/2023
Provider Signature : Date: 11/8/2023

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2