summary: Patient reported he was scratched by staff while in a restraint. Staff observed some superficial scratches to patient’s left arm. The 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: 019364
Date of Incident: 2/22/2024
Date Received: 2/23/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Dual
Report Description: Incident Report for Private Placement
client in our PRTF program and resides in Chestnut House Incident Report date/ time:
02/22/2024 10:00am Location of Incident: Gymnasium Incident Description: Hotline Call
Staff Involved: Shelly Zellner, Melissa Rhude Events Leading: During Recreation Therapy
class, patient ask to speak with me. At this time, he showed me his left arm which had some
superficial scratches. He stated that he was scratched by a staff in a restraint on 2-21-24.
After returning to the school, I asked a nurse to assess the patient and it was completed.
The patient stated that a staff member scratched him during the restraint. I made a
call and talked with Kyle Goodwin. The report was accepted .
Nursing completed an assessment on 02/22/2024 and this is documented on a Nursing
Note that was emailed to Kendra on 02/23/2024 Guardian was contacted on 02/22/2024 by
Riley's therapist-Chelsea Taylor
Interim Action Narrative: called and accepted. Resident assessed by the nurse. Staff
member placed on ICA.
Maltreatment Narrative: The av is
. The ao is staff member at Youth Home, . took his hoodie off
and showed his scratch marks on his right arm. They were scabbed over. said that he
did not want staff to feel like he hurt myself. They appeared older than one day. He claimed
that it happened during the restraint yesterday by The nurse said that they did not
appear as though it happened yesterday, but maintained that they happened during
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

the hold that performed on him. Reporter said that the restraint was done
appropriately and not in a manner that could have caused injuries of this nature.
Licensing Narrative: Facility contacted Program Coordinator regading complaint and ICA.
Program Coordinator forwarded ICA for Program Manager to review. 2/23/2024, Program
Coordinator reviewed complaint for licensing concerns. Program Coordinator requested
permission to contact the facility. Investigator Williams granted permission to contact the
facility. Program Coordinator will review camera footage on 2/26/2024. ICA approved.
2/26/2024, Program Coordinator reviewed camera footage. 3/25/2024, Program
Coordinator inquried about an update. 3/29/2024, Program Coordinator checked
case still pending. 4/26/2024, case unsubstitated per


state: AR

facility_name: Youth Home

summary: A resident was transported for acute care after self-harming.

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: 019077
Date of Incident: 2/8/2024
Date Received by PRLU: 2/9/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB: Private placement
client in our PRTF program and resides in Chestnut House Incident Report date/time: 02/08/24
12:30pm Location of Incident: Siebert School Incident Description: Suicidal, Patient Injury Staff
Involved: Christian Spratt, Valerie Alvarez Events Leading: The patient turned his hoodie around
facing the hood towards his face. Staff asked him to turn it around properly. After hearing this
redirection the patient bumped his head on the doorsill. Staff spoke with him in an effort to calm
him down but he took the hood and pulled it over his face in what appeared to be an attempt to
suffocate himself. Staff spoke with him about making good decisions to show safe behavior. He
stated he refused to comply if all the staff present stayed near him. Some staff disengaged and he
was able to verbally contract to be safe. He then sat down and began doing his classwork. Nursing
Assessment date/time: 02/08/24 12:35pm: was observed sitting on the floor of his math class,
working on an assignment with a peer. He appears in better spirits. He initially covered his eyes with
his hands stating, "No, I don't want you to look at my eyeballs". Then recanted and stated "Okay, I
am ready. I want you to look at my eyeballs". Clear, calm, coherent speech noted. AAOx4.
PERRLA. No physical markings noted from reportedly hitting head on door frame. Denies any
pain, headache, feelings of nausea or vomiting, feelings of lightheaded or dizziness. No draining
noted to ears or nasal area. Interacts appropriately. No signs of respiratory distress. Respiratory rate
is 18 breaths/minute, unlabored. No retractions, accessory muscle use, or nasal flaring. Upon
discussing assessment findings WNL with he then stated, "See, I never get concussions. I have
the strongest head in the world". Treatment team and covering CT notified. was reassessed
during his next class period (approximately around 1:30pm) He was observed interacting positively
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

with peers and watching the smart board. Calm and cooperative. He was offered positive praise for
turning his day around. He offered this nurse a fist bump and was playful motioning a snail. Note:
Guardian was not notified d/t no crisis interventions required and no noted injuries. Safety Plan was
emailed to Kendra Rice on 02/09/24. Staff
intervened, resident was assessed by the nurse, and safety plan created. Program
Coordinator reviewed provider reported incident for licensing concerns. Facility provided
documentation for this incident.
Interim Action Narrative: Resident was assessed for acute care and transported to acute placement
by MEMS. A safety plan was created for his return.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns. Resident will be returning to the facility and a safety plan has been created for his return.

doc_type: Notice of Incident


summary: Licensing completed buildings and grounds for the PRTF Houses (Sturgis, Chestnut, Rose, and Mabee). No deficiencies cited.

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: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Rice
Person In Charge: Robbie Lagrone
Record Visit Date: 2/7/2024
Home Visit Date: 2/7/2024
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 10:30 am and 11:30 am
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 40
Program Coordinator completed buildings and grounds for the PRTF’s Houses (Sturgis, Chestnut, Rose, and
Mabee). Mr. Jon Pulliam, PRTF Lead Unit Manager, escorted Program Coordinator throughout the houses.
The following areas were observed: comfort rooms, day areas, seclusion rooms. game rooms, laundry rooms,
milieus, bathrooms, bedrooms, dining area/kitchen, and outside around the houses.
The grounds near each house were well maintained and free of safety hazards. Grills were observed on the
grounds near Chestnut and Sturgis. Concrete picnic benches were observed on the grounds between the two
houses.
No residents were present during the walkthrough at Sturgis or Chestnut. Residents and staff were at the
school. Both houses were clean, and most bedrooms were organized. All furnishings were in good repair, safe,
and clean. No odor detected in the bathrooms.
Walking to Rose and Mabee, Program Coordinator observed two soccer nets, bases for kickball in the ground,
and four frisbee golf nets. The gazebo and basketball court were free of debris.
Rose ratio, 1:1 and Mabee ratio,1:1. All bathrooms and bedrooms were clean and mostly organized.
Furnishings observed were safe, clean, and in good repair.
Provider Comments:
CCL Staff Signature : Date: 2/7/2024
Provider Signature : Date: 2/7/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

doc_type: Compliance Report


summary: A resident was transported for acute care after expressing suicidal ideations with a plan.

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: 019014
Date of Incident: 2/5/2024
Date Received by PRLU: 2/6/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB: Private placement
client in our PRTF program Incident Report date/time: 02/05/2024 5:58pm Location of Incident:
Sturgis House Intervention Type: Acute Placement Incident Description: Suicidal Staff Involved:
Broderick Parker, Jonathan Pulliam, Meredith Reddin Events Leading: Earlier in the day, Client
reported to a Team Member that his suicidal ideations had increased and he had a plan to grab a
pencil and stab himself. This Team Member reported it to the Client's CT who brought this up in
Staffing. In Staffing, it was decided to look for an acute placement for the Client due to his increased
suicidal ideations with a plan. Pt was accepted by Methodist Behavioral Hospital and was
transported by MEMS at 5:58PM. Guardian was notified on 02/05/24 at 3:26pm and 4:37pm Safety
Plan created by therapist Virginia Compton: It is anticipated will be on eyeball upon
return, a SAFE-t assessment will be completed to determine suicide risk, and his safety plan will be
reviewed/amended to fit needs at Youth Home.
Interim Action Narrative: Resident was assessed for acute care and transported to acute placement
by MEMS. A safety plan was created for his return.
______________________________________________________________________________
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns. Resident will be returning to the facility and a safety plan has been created for his return.


summary: Officers were dispatched to Youth Home in reference to a disturbance.

raw_content:
e
Pulaski County
Office of the Sheriff
Eric S. Higgins, Sheriff
2900 S. Woodrow Street, Little Rock, AR 72204
Tel: (501) 340-6600

Case P24-000842 Printed on February 27, 2024

Status Approved
Report Type Patrol
Primary Officer Javonn Couch
Investigator None
Records Technician
Reported At 01/25/24 13:30
Incident Date 01/25/24 13:30
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 01/25/24 16:00
Disposition Comments

Approved AM 2737
Review for Gang Activity Not Applicable

Primary Narrative By Javonn Couch, 01/25/24 15:58

Disturbance

On January 25, 2024, at approximately 1330 hours, |, Deputy Couch, was dispatched to 20400 Colonel Glenn Road
(Youth Home) in reference to a disturbance with a juvenile.

Upon arrival, | made contact with Staff workers who advised that was causing a disturbance and had
damaged the frame inside the closet area. Staff informed me that they had to hold down to prevent from
causing more damage to the facility. | then made contact with in the hallway, and advised me that did

not want to be there because did not have a good vibe about the place.| asked =~ why felt that way, and
stated that wanted to return to the home where came from because it felt like a family, and got along well
with the other youth and staff. advised that time at home was not yet up and that was upset that had
to leave and come to a place that did not feel comfortable. | asked if felt uncomfortable about the employees at
the Youth Home, and stated that they were friendly people and that did not like the facility because it did not
feel like home.

stated that _ would continue to give them a hard time and damage the facility until they removed from the
Youth Home. | explained to that causing a disturbance would not get what wanted and that needed
to speak with ‘case manager regarding the issue that was having.

Staff members were advised to call the Sheriff's Office if behavior became irate. They were given the report

number and advised a report would be on file at the Sheriff's Office. Staff advised that they would contact
caseworker for further instructions.

Case P24-000842 Page 1 of 1

doc_type: Police Report


summary: A resident was transported to Arkansas Children’s Hospital and then for acute placement after eloping from Mabee House and admitting to swallowing chemicals.

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: 018480
Date of Incident: 1/9/2024
Date Received by DCCECE: 1/10/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for is a
client in our PRTF program and reside in Mabee House Incident Report
date/time: 01/09/24 5:45pm Location of Incident: Outdoors Incident Description: Self
Injury (Not Suicidal), Runaway, Medical Emergency (Trip to ER/Urgent Care) Staff
Involved:
Events Leading: Patient was upset
with peer about signing up for hygiene. PT then stormed back to room and began to crack
coloring pencils, throwing water bottle and cursing staff. After staff spoke to PT to calm her
down, PT then went into closet. Staff continued to speak to pt to calm her down which
didn't work. Staff tapped out and let another male staff watch door which female staff was in
room trying to continuously calm pt down when male staff shouted, "She's coming your
way". When staff saw pt, she was running towards door. Staff engaged but couldn't get to pt
in time where she burst through the door. PT continued to run down street and run into a
yard hiding behind a small shack. after being seen, pt then ran into bushes stating, "I'm
scared". Staff went into bushes behind pt telling her that it'll be okay and pt then calmed
down reaching hand out to staff. Patient walked back to unit with staff displaying no
aggression following staff instructions not resisting. Client admitted to staff that she
swallowed chemicals while back on unit. Mems were contacted and client was transported
to ACH and then acute placement. Nursing Assessment date/time: 01/09/24 6:15pm: Pt
eloped from Mabee house and was found multiple houses down hiding in shrubbery. She
returned to Mabee house at about 1810. Upon arrival back to Mabee house, pt is wearing
wet clothing covered in mud/leaves. Pt given a few minutes to calm down and offered water
by this RN. Upon assessment, pt is oriented to self/situation. Pt c/o h/a at 5/10, 'some'
dizziness. Eyes PERRLA. No bruising, skin even/intact in cranial area. Full ROM in all
extremities, pt tells nurse that 'my feet kind of hurt but they're too cold to tell'. Pt able to
move toes/foot freely. Pt has 2 superficial scratches to L arm, scant blood at site. 1
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

superficial scratch to R inner ankle, scant blood at site. Pt tells this nurse that she rec'd
these 'from some barbed wire'. After initial assessment, pt told to change into clothing that
is warm/dry and then nurse can further evaluate and debrief. Pt then tells staff that she
drank something from behind a house that she believes to be chemicals. Staff told this RN.
When asked by this RN what chemicals they may be, pt stated 'it was dark, I don't know'.
Pt says that it was 'in a bin' and that she 'fell into the bin' which led to the unknown
substance splashing onto her legs/arms and into her mouth. Pt unsure how much she
drank, what the substance could be, and if it had a smell or taste. Skin intact, no
redness/bruising noted. Pt says that her throat is 'tingly'. Pt appears to be SOB and is
coughing intermittently. Pt says that she is 'nauseous' and that her stomach hurts at 5/10 on
the pain scale. Pt says she is 'throwing up a little bit in my mouth'. VS as follows: BP
156/93, HR 113, RR 22, SPO2 97%. Provider on call notified of potential chemical exposure
and pt's reported symptoms. Provider told this RN to contact emergency personal. 911
called at 1818. Pt changed into warm/dry clothing w/ staff near doorway in case of
dizziness/fatigue. Pt able to walk halfway down the hallway before pt began c/o further
dizziness/nausea. Pt stood hunched in hallway holding onto sweatshirt. Nurse asked staff
to bring pt a chair. After sitting for a few minutes, pt able to ambulate safety into milieu to
wait for emergency response. Pt continuing to c/o throat 'tingling', dizziness, and nausea.
Emergency response arrived at 1840. MEMs escorted pt to ACH ER at 1901. ACH ER is
d/cing pt to BridgeWay after medical clearance is complete. Provider notified. No further
needs at this time. Guardian was notified on 01/09/24 at 7:06pm
Interim Action Narrative: Staff used verbal de-escalation, followed resident when she
eloped, transported to ACH, and then to acute placement.
Maltreatment Narrative:
Licensing Narrative: 1/10/2024, Program Coordinator received documentation for this
provider reported incident. 1/11/2024, Program Coordinator reviewed provider reported
incident for licensing concerns. Program Coordinator will inquire about the chemicals and
if resident will be returning. The chemicals were ingested when the resident eloped. She
admitted to drinking some chemicals that she found behind a house. Resident will be
returning to the facility after discharge from acute care.


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

raw_content:
Case P24-000346 Printed on January 23, 2024
Status Approved
Report Type Patrol
Primary Officer Daniel Sousa
Investigator None
Records Technician
Reported At 01/09/24 18:08
Incident Date 01/09/24 18:08
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition CL- CLOSED
Disposition Date/Time 01/22/24 11:43
Review for Gang Activity None
Primary Narrative By Daniel Sousa, 01/09/24 20:15
Runaway Juvenile
On January 9, 2024, at 1808 hours, I, Deputy Sousa, was dispatched to the Youth Home, 20400 Colonel Glenn Road,
in reference to a runaway juvenile who returned. I made contact with the reporting person, Kierra Taylor via phone.

Taylor stated the juvenile, was “Over-Stimulated” because she and her girlfriend who stays at the Youth
Home as well had broken up, and that the ex-girlfriend looked at wrong. Taylor stated that was upset and
broke out of the Youth Home and then was located a few moments later by a nurse near a shed.

While on the phone with Taylor she stated that told the staff that she drank chemicals that were behind the
shed. Taylor stated that they were having transported to the hospital.

I responded to the Youth Home and spoke with Taylor. I observed the front door and appeared it had no damage.
Taylor stated that the door is secured by a magnet and if you hit it just right it would open.

I made contact with I asked what was going on and she stated that she was upset. I asked where
she ran to and she stated down the street behind a shed. I asked if she drank any chemicals and she stated no.
I told that I was told by the staff that she did drink some chemicals behind the shed and she stated she did not
drink it but got some in her mouth. stated that she climbed over a shelf in the shed instead of opening the door
and she fell from climbing over the shelf causing the chemical to spill into her mouth.

MEMs 75 transported to Children’s Hospital.

I made contact with the nurse, Joseph Davis. Davis stated that an “all-call alarm” went out and he started to help look
for Davis stated that he located in the tree line next to a residence at, 20175 Colonel Glenn Road. Davis
assisted her back to the Youth Home. I asked Davis if he located at the shed and he stated the tree line near
the shed.

I did not observe any evidence that the Youth Home is not taking care of the children.

Case P24-000346 Page 1 of 2

I completed an Arkansas-mandated reporter portal (1203735214).

I provided Taylor with a copy of the report number.

Nothing further
Case P24-000346 Page 2 of 2


summary: A resident was transported for acute care after threatening staff and exhibiting self-harm behaviors.

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: 018491
Date of Incident: 1/5/2024
Date Received by DCCECE: 1/10/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 01/05/24 8:02pm Location of Incident: Mabee Incident Description: Aggressive
to Adults, Attempted Runaway, Threats to Safety, Property Destruction Staff Involved:
Events
Leading: Client became agitated with her peers because of them saying they wanted to date
client's mother. Client started walking up and down the hallway threatening to kill her
peers. 8:02pm: Personal Restraint: Client became upset with her peers as one of them said
they wanted to date Clients mother. Client began walking up and down the hall was
threatening to kill her peers. Client was asked to come back up to the milieu but she
refused. Client then started to yell at peers from the doorway of their room. Client was again
asked to come up to the front but again refused. after more prompting staff attempted to
escort client back up to the front. Client dropped to her knees and staffed released her.
8:06pm: Personal Restraint End: Client agreed to walk up to the front on her own, 8:24pm:
Personal Restraint: Client was sitting in the hallway and again became disruptive to the
other clients as they were trying to sleep. Client was prompted several times to get up and
move up front but refused. Client grabbed another peer by the leg and refused to let go. staff
intervened and was able to get client to release her peer. Client was then picked up and
escorted to seclusion. 8:25pm: Personal Restraint End: Client was placed in into unlocked
seclusion and encouraged to take a self-time out. 8:26pm: Unlocked Seclusion 8:36pm:
Personal Restraint: Client left unlock seclusion and walked into her bedroom. Client picked
up a plastic hair brush and began to try and break it so as to harm herself and/or staff. Staff
removed the hairbrush from client. Client became upset and crawled under her bed where
she found a pencil and threatened to stab herself and staff. Staff removed client from under
her bed and was able to get the pencil away from client. Staff escorted client back to
seclusion as it was deemed unsafe for client to be in her room. Client began to hit and fight
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

with staff while in unlocked seclusion. Client was able to slip out of the seclusion room door
where she broke down the door to the laundry room. Client picked up a piece of metal from
the door frame and began threatening staff with it. Staff removed the metal from clients
hand and placed the client in a personal restraint. Client began to fight against the restraint
and kick at staff. 8:49pm: Personal Restraint End: Client was able to follow instructions and
returned to a calm state of mind. Client contracted to safety. Patient Debriefing date/time:
01/05/24 8:49pm: Client was able to follow instructions and return to a calm state. Client
contracted to safety. Nursing Assessment date/time: 01/05/24 9:00pm: Client took PM
medications without difficulty and seemed in good spirits. When it was time to return to
rooms, client refused to follow staff direction. Also a peer made a comment about dating her
mother. Client began to grab nearby items to destroy. Then went to the water fountain and
spit on the faucet/spigot, it was at this time supportive touch was used to obtain the water
bottle she was dumping in the trash and move her from destroying the water fountain.
Client demanded to speak to peer, so we tried to appease her to no avail. Client sat in the
middle of the hallway and would not move. Personal restraint was utilized to assist client to
seclusion. Once in seclusion, client began to struggle with staff, broke free and entered her
room and obtained sharps (metal). Client trying to break her brush and laundry basket.
Client making homicidal threats against multiple staff including myself. Sharps were
confiscated, and client dove under her bed and obtained another sharps (pencil). Client was
assisted from under the bed and additional sharp was confiscated. Client was moved to
seclusion. Client denies pain/injury from this incident and has no obvious injury noted.
Client appears alert and oriented, gait steady, showing signs of calming down seated in the
milieu. Order received to transfer to acute for treatment/evaluation of mental status. Client
was asleep in the milieu at 10:15pm, transferred to acute later that evening. Guardian was
notified on 01/05/24 at 10:00pm, 10:06pm, and 10:07pm with no answer and voicemail was
left to call nurse back at her convenience.
Interim Action Narrative: Staff intervened, resident was placed in restraints, and order
received for acute placement.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator will inquire about late reporting and
documentation. 1/11/2024, Facility reported documentation had to be corrected and
documentation was provided. Pictures were provided for the door being repaired. Resident
will be returning to the facility once discharged from acute care.


summary: A resident was transported for acute care after exhibiting aggressive and self-harming behaviors.

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: 018371
Date of Incident: 1/3/2024
Date Received by DCCECE: 1/4/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident report date/time:
01/03/24 5:26pm Location of Incident: Mabee House Incident Description: Threat of
Safety, Property Destruction, Injury to Staff/Authorized Visitor Staff Involved:
Events Leading: Client on pause at onset of shift.. Client verbally aggressive with staff and
observed in her bedroom. Client was informed that as long as she remains safe in her room
staff would not bother her. As staff disengaged, client threw a paper ball hitting staff in the
leg. She then started head banging and staff held their hand behind her head. Client started
hitting staff. Client behaviors unstable throughout shift; disrupting milieu and disrupting
safety counts while attempting to leave to dinner. Client resistant to verbal redirection, often
cursing at staff. Client went outside without permission attempting to go to dinner without
permission. At times client verbally refused to return into house. after some extensive
prompting client returned into the house. Client began throwing things in the milieu,
moving lockers, sitting on the lockers, and even grabbed the milieu phone and dialed 911
multiple times. Client moved to the front door, and took a chair and rammed it into the front
door multiple times. 5:26pm: Personal Restraint: Client took a chair and started ramming it
into a door when staff reached for her arm she dropped to the floor. Staff followed this
momentum and maintained safety in restraint. Staff encouraged client to stop behaviors and
encouraged deep breathing to help client calm. Client cursed at staff throughout. 5:41pm:
Personal Restraint: Client in personal restraint as staff attempted to encourage breath.
Client screamed at staff. 5:45pm: Personal Restraint End: Client calmed down and was let
out of the restraint but still continued to be very angry during this time. Patient Debriefing
date/time: 01/03/24 6:00pm: Client requested to speak with her therapist and her therapist
came to speak with her along with the CT on call. Nursing Assessment date/time: 01/03/24
5:41pm: At 345pm, the client was placed on freeze due to physical aggressiveness toward
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

staff. Client was placed on RR around 5 p.m. after fleeing out of the house while other
patient was leaving for dinner. The patient was throwing personal belongings at staff,
kicking chairs, and banging on doors. Due to a threat to patient safety, at 556 patient was
placed in personal restraint. While under personal restraint, the patient kicked one staff
member in the stomach and spit in the face of another. When the nurse asked the patient if
she was in discomfort or having problems with the restraint, she said, "I have pain right
above my ankles." When the nurse asked the patient if she needed anything to relieve her
discomfort, she replied, "Nothing works." Patient continues to be hostile and aggressive on
purpose. The patient repeated multiple times that she simply wants to go to acute care and
that she will do whatever it takes to get there. Due to staff injuries, the sheriff was notified
and a report was submitted. On-call MD was alerted of the occurrence, and an order for RR
and personal restraint was issued. On-call UM and CT have been alerted. The patient's
mother called and was informed of the patient actions, with no more inquiries or worries.
The patient originally refused to take the medication but subsequently agreed to do so. She
refused to take her melatonin. Guardian was notified on 01/03/24 at 6:53pm. Guardian did
call back on 01/04/24 at 9:00am to speak with nurse as well. Injuries to staff or client: pt
kicked a staff member in the stomach and spit in another staff's members face Pt stated that
she had pain above her ankles Follow-up to injuries: UM asked staff if they needed to call
MedCor or go the ER, staff declined and said that they were ok. Additional Comments: Due
to staff injuries, the sheriff was notified and a report was submitted. Report number:
Pt was later transported to acute due to this incident. was transferred to
BridgeWay for an acute stay on 01/03/24 and she remains there at this time.
Interim Action Narrative: Resident was placed in a restraint and admitted into acute care.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator will inquire if resident will be returning. 1/5/2024,
facility reported resident most likely would be returning to the facility.


summary: An officer was flagged down at Youth Home by staff in response to a disturbance.

raw_content:
e
Pulaski County
Office of the Sheriff
Eric S. Higgins, Sheriff
2900 S. Woodrow Street, Little Rock, AR 72204
Tel: (501) 340-6600

Case P24-000110 Printed on January 23, 2024

Status Approved
Report Type Patrol
Primary Officer Steven Bass
Investigator None
Records Technician
Reported At 01/03/24 18:33
Incident Date 01/03/24 18:33
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 01/03/24 21:21
Disposition Comments

drb4519
Review for Gang Activity Not Applicable

Primary Narrative By Steven Bass, 01/03/24 21:36

Disturbance

On 1-3-2024 at approximately 1833 hours |, Deputy Bass, was flagged down at the Youth Home located at 24000
Colonel Glenn Rd by staff in reference to a disturbance.

| made contact with Kierra Taylor and Michael Tucker, staff at Youth Home. They advised that had been
disruptive, and tried calling 911 multiple times due to receiving a punishment for bad behavior. Kierra stated that

_ continued being disruptive, and yanked the phone off the wall. Kierra stated that they went to place into
a hold/restraint to prevent from damaging other property or hurting or others.

Kierra stated that when they went to restrain began thrashing, and as a result, ended up kicking Kierra in
the stomach area. Kierra and Michael stated that then began to spit at staff members before eventually calming
down, and complying with staff.

| observed Kierra’s stomach, and noted no red marks/abrasions/swelling to indicate a major physical blow/strike was
made. | photographed Kierra for the report. | then spoke with with staff present.

stated that was upset because was not allowed to have a snack in the normal designated area.

complained that staff never follows their own rules. | advised that where has snack is not staff
breaking a rule, nor does it warrant poor behavior, calling 911, etc. was not receptive, and began yelling at
myself, and staff.

| advised staff that | would document the incident, and advised them to contact the Sheriff's Office if needed in the
future. | provided them the report number for the incident, and returned to service.

Case P24-000110 Page 1 of 1


summary: An officer was notified by a staff member of a battery that occurred at the facility.

raw_content:
Pulaski County
Office of the Sheriff
Eric S. Higgins, Sheriff
2900 S. Woodrow Street, Little Rock, AR 72204
Tel: (501) 340-6600

Case P24-000023 Printed on January 23, 2024

Status Approved
Report Type Patrol
Primary Officer Javonn Couch
Investigator None
Records Technician
Reported At 01/01/24 14:56
Incident Date 01/01/24 14:56
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 01/01/24 15:36
Disposition Comments

APPROVED L36 JDW
Review for Gang Activity Not Applicable

Primary Narrative By Javonn Couch, 01/01/24 15:49
Battery 3rd

On January 1, 2024, at approximately 1500 hours, | took a phone report regarding a battery that occurred at 20400
Colonel Glenn Road (Youth Home), on December 30 and 31, 2023.

| spoke with ae: via ae She stated that on December 30,
bullied her and wanted to fight said that ran toward her and distracted her, and
punched her in the left eye, causing injury.

GEE acvised that on December 31, she was in the game room reading when _ and came into the
room asking if she wanted her punches back, and she said, “es. aid rushed toward her, and
the two began fighting. i joined the fight and had jewelry on, which caused injury to a <=.

HMM stated the ~—‘told her that there was more to come, and she felt afraid to be there. Staff member
Sha'Tarria Davis was informed of the report number and advised a copy will be on file at the Sheriff's Office.

Case P24-000023 Page 1 of 1


summary: A resident admitted to choking herself after expressing suicidal ideations.

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: 018332
Date of Incident: 1/1/2024
Date Received by DCCECE: 1/2/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 01/01/2024 7:25pm Location of Incident: Mabee House Incident Description:
Suicidal Staff Involved:
Events Leading: During a crisis with another peer client became very frustrated and was
triggered by all of the yelling and door slamming. Client stated that she was going to kill
herself at least twice while rocking back and forth and crying. While staff was doing
wellness checks down the hall noticed marks on her neck and asked about them (because
they were not there before). Client admitted to choking herself and was very remorseful
stating that she was just upset with herself for yelling at her roommate. Nursing Assessment
date/time: 01/01/24 7:38pm: The client was extremely irritated during a problem with a
peer and was set off by all of the yelling and door banging. The client, who was sobbing and
rocking back and forth, declared that she was going to kill herself at least twice. She had
marks on her neck, which staff observed while performing wellness checks down the hall
and inquired about (as they had not previously been there). The client expressed great
regret for choking herself and said she was only angry with herself for yelling at her
roommate. Nurse examine patient who had visible red marking on both sides of her neck.
Patient did not require any treatment at the time. On call MD notified at 1939 and give
orders for FOH, Eyeball and SS, on call CT notified at 1747, and on call UM notified at 1750.
Nurse called patient father at 1752 and he had no questions or concerns. Nurses discussed
with patient different coping skills when she is irritated. Patient verbalized understanding.
Guardian was notified on 01/01/2024 at 7:52pm
Interim Action Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. 1/4/2024, Program Coordinator will inquire about FOH and SS. Facility
reported FOH-Front of House and SS-Supportive Status.


summary: A resident was sent to Arkansas Children’s Hospital for evaluation after he was hit in the eye by a ball.

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: 12/22/2023
Date Received by DCCECE: 12/27/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Chestnut House Incident Report
date/time: 12/22/23 3:00pm Location of Incident: Outdoors on Youth Home campus
Incident Description: Medical Emergency (Trip to ER/Urgent Care), Patient Injury Staff
Involved: Charles Hoof, Ben Malone, Valerie Alvarez Events Leading: Staff and patients
went outside to play in the big field by the basketball court and admin building after coming
back from sonic drinks as an outing. Staff were interacting with patients throwing around a
football to patients in the big field one by one. Patients were excited to run and catch
football passes to get some of their energy out. It was the patients turn to run a route in the
big open field while staff was throwing it to him and one ball in particular went through the
patient's hands and accidentally hit him in his eye while trying to catch it. Nursing
Assessment 1 date/time: 12/22/23 2:40pm: reported to the nursing office after
reportedly being struck in the (R) eye with the football while playing football outside. He
remained playful during the interaction while laughing and stating, "I caught the ball with
my eye". (R) eye appears to be watering and mild erythema noted to sclera. Periorbital
edema and bruising beginning to form around (R) eye. He c/o feeling as if something is in
his (R) eye, feeling of numbness, and blurred vision. Pupil of (L) eye was approximately
5mm in diameter and pupil of (R) eye was approximately 3mm in diameter and do not
appear symmetric. Pupils react to light and accommodation although remain bil unequal.
Extraocular movements appear intact. Gently applied a small cold compress to reduce pain
and swelling. MD notified with order to transport to ACH ER to rule out ocular/orbital
injury. was instructed not to rub, touch, or apply pressure to the eye. Denies any
pressure behind eye, current pain or numbness (reports it has since subsided), halos, flashes
of light, floaters, or tunnel vision. Denies headache, nausea/vomiting, feeling lightheaded
or dizzy. AAOx4. Clear coherent speech. Responds appropriately. Denies photosensitivity.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Discussed assessment findings with and educated on why we would be sending
him out for further evaluation. He reported he did not want to go to the ER but understood.
Nursing Assessment 2 date/time: 12/22/23 7:00pm: returned from ACH ER: "No
visual deficits, no corneal abrasion. Ice to the right eye 20 minutes on then 20 minutes off as
needed for right eye swelling/pain. Tylenol and Ibuprofen as needed for pain". Guardian
was notified on 12/22/23 at 2:50pm
Interim Action Narrative: Resident was assessed by the nurse and transported to ACH ER
for evaluation.
:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator received documentation for this provider reported
incident.


summary: Licensing completed an evening visit at the facility. No deficiencies cited.

raw_content:
AR KANE AS
DEPARTMENT GF

)\~¢7 HUMAN
- <2 SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Rice
Person In Charge: Adria Riley
Record Visit Date: 12/17/2023
Home Visit Date: 12/17/2023

Purpose of Visit: Special Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 6:45 pm to 8:00 pm

Wwww.arkansas.gov/dhs- :
Serving more than one million Arkansans each year. ; oe : Page 11.0f 2

Census: 40
Program Coordinator completed an evening visit at Rose, Mabee, Chestnut, and Sturgis houses.

Rose House — Program Coordinator was greeted by a female staff member and escorted throughout the house.

Residents were completing hygiene and utilizing their phone time. On the residents’ bedroom hall residents
having down time. Some residents were drawing, working puzzles, making bracelets, listening to music, or
just resting on their bed. Ratio, 5:11.

Mabee House — Ms. Brown answered the door and escorted Program Coordinator throughout the house.
Residents were completing hygiene, watching SWAT, or playing a video game (Mine Craft). Ratio, 3:9. Two
residents were on pass.

Chestnut House — Mr. Parker greeted Program Coordinator at the door. Mr. Parker informed Program
Coordinator that some residents were at the gym, ratio 2:4. Program Coordinator observed a resident on the
telephone and two residents in their bedroom. One resident was completing hygiene. Mr. Parker reported one
resident being on pass.

Sturgis House — Program Coordinator was greeted by a male staff member. Ratio 2:8, and while talking with
the residents another male staff member entered the house. The residents had just finished watching
“Remember the Titans” and was preparing to watch another movie. Program Coordinator was informed that
residents were also completing hygiene and making phone calls.

All houses were organized and clean. Each house had holiday decoration displayed. Residents appeared to be
enjoying their down time. Staff and residents reported the following activities today: eating lunch with their
family, making smores, taking pictures with Santa and Mrs. Claus, and receiving candy.

Provider Comments:

CCL Staff Signature : Date: 12/18/2023
Provider Signature : Date: 12/18/2023

Ades

www.arkansas.gov/dhs. : ee ; ee :
Serving more.than one million ‘Arkansans ‘each year = : : : : Page 2 of 2


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Rice
Person In Charge: Adria Riley
Record Visit Date: 12/5/2023
Home Visit Date: 12/5/2023

Purpose of Visit: Subsequent Building and Grounds

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

Regulations Not Correctable:

Narrative:

Time of visit: 9:15 am to 10:15 am

www.arkansas, govidhs Bes :
Serving more than one. million Ananene Bach year

ARKANSAS
, DEPARTMENT oF

HUMAN
SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

pre

Page 1 of 2

Census: 39

Licensing Specialist completed buildings and grounds on the following houses: Chestnut, Sturgis, Rose, and
Mabee. The following areas were observed: grounds, dining rooms, milieus, bedrooms, bathrooms, gaming
area/game rooms, seclusion rooms, comfort rooms, kitchen areas (staff only), group rooms/visitation rooms.
There were no residents present in the following houses: Sturgis, Rose, and Mabee. The residents were at
school and one resident was gone to an appointment with a staff member.

Licensing Specialist was escorted by Mr. Jon Pulliam, PRTF Lead Unit Manager. The grounds had parked
cars and vans. Licensing Specialist observed fallen leaves and pine needles on the grass.

Chestnut House ratio was 2:1. Mr. Pulliam informed Licensing Specialist that light cover plates have been
ordered to cover the light fixtures in the bedrooms. Chestnut and Sturgis houses male residents. Both houses
were clean and the fragrance of cleaning supplies could be smelled. Licensing Specialist observed where some
residents had their doors decorated for the holiday. The residents have a closet by the entrance door where
they store their shoes when entering the building.

Rose and Mabee houses female residents. Rose House ratio was 2:1. Both houses have lockers near the milieu
where residents keep their personal items that they check out when needed. Both houses were clean and were
decorated for the holiday. Residents had their bedroom door decorated for the holiday also.

Licensing Specialist observed a welcome wreath on the door of the houses. Licensing Specialist observed the
following documentation on the walls: residents’ rights, food menu, washing hands instructions, emergency
escape plan, chore list, activity calendar, shower times and which shower to use.

Licensing Specialist will follow-up with facility regarding the light cover plates.

Provider Comments:

CCL Staff Signature : Date: 12/6/2023
Provider Signature : Date: 12/6/2023

Prive

www.arkansas.govidhs

Serving more than one million Arkansans each year a —“‘“‘—s™s—C—t—CSS Page 2 of 2


summary: A resident was transported to Ortho Arkansas for evaluation after receiving an injury during an altercation with a peer.

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: 11/29/2023
Date Received by DCCECE:12/1/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Date/Time of Incident: 11/29/23 7:40 PM Location of Incident: Sturgis
House Staff involved: Patrick Gill, Schree Eackles, Meredith Reddin (Nurse), Events
Leading: Client and one of his peers began to argue in the milieu. Client and peer
exchanged words and began fighting both of them landing on the floor.. Client was kicked
by peer while attempting to get up off floor and was then redirected to another part of the
house. Client discussed his role in this incident and how he needs to find better ways to
resolve conflicts other than becoming physically aggressive. Client accepted his
consequence for this incident. IR Nursing Face-to-Face Assessment: 11/29/23 8:00 PM: Pt
was punched/kicked in face by peer. Upon nurses assessment, pt is sitting in milieu
holding towel to bloody nose. Pt is alert and oriented to self/situation. Denies dizziness,
blurry vision, h/a. Eyes PERRLA. Pt's nose bleeding stopped after several minutes of
holding towel to face. No deformity, swelling, denies pain when nose is touched/pressed.
Pt's bottom lip is inflamed, bleeding. Pt c/o tooth/jaw pain. Pt denies pain when jaw is
touched, full ROM in jaw-area. Can chew/talk w/o discomfort. Upon nurses assessment,
teeth are intact. Pt can press on teeth w/o pain/discomfort. Pt has full ROM in all
extremities. C/o pain in L pointer finger. Pt has full ROM w/ pain, endorses pain in
knuckle and proximal phalanx when moving or when touched. No signs of deformity, no
bruising, skin intact. Denies numbness/tingling, capillary refill <2 sec. Pt told to notify staff
if pt begins feeling dizzy/nauseous/lightheaded or if pain worsens or does not improve.
Upon assessment, nurse noted a chip in pt's L upper lateral incisor. Pt states he is unsure if
this is a new or old injury. Denies localized pain to area and tells nurse his 'face is hurting
less'. Pt told to notify staff if pt begins to feel pain/discomfort in area. Doctor on call
notified of finding. No further needs at this time. Doctor notified. Pt told to keep lip clean
and be mindful of injury when eating/drinking. Pt given ice pack and acetaminophen per
MAR. No further needs at this time. 815pm - Pt began c/o nausea. Upon nurses
assessment, pt eyes are PERRLA. Pt denies dizziness/lightheadedness, denies h/a. Pt able
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

to walk in straight line w/ steady gait. Pt tells nurse 'I think it's just from the adrenaline'. Pt
did not vomit. Nausea subsided after several minutes. Notified doctor on call. Pt asked
nurse if he could go to bed. Nurse asked doctor on call. Doctor on call verified that pt can
go to bed, but pt will need to notify staff if pt begins to notice worsening symptoms. Nurse
reminded pt to notify staff of any other s/sx of injury. Pt verbalized understanding. No
further needs at this time. Guardians Notified: 11/29/23 8:30 PM Follow-up IR 11/30/23
10:15 AM was seen today for routine medication management and evaluation. He
discussed leading events of how he and a peer got into physical altercation last night. He
has a bruised and swollen hand (left)(anterior and posterior bruising to carpals 4 and 5) and
an abrasion on his lower lip. Limited ROM to digits 4 and 5 of Left hand. Capillary refill less
than 3 seconds and WNL. No visible deformities or protrusions. He admits that he
instigated this peer after the peer walked up to him, threatening him, and stating to "keep
(his) name out of (his) mouth". Admits to requesting PRN APAP 650mg earlier and reports
at that time he rated his pain 7/10. This was administered at 9:39am. Endorsed some
improvement in level of pain. Didn't sleep well last night following the altercation. Order to
attempt to obtain or transport client to urgent care or Ortho AR to rule out fx of (L) hand
received. Appointment coordinator notified of request and scheduled appointment to Ortho
AR. Guaridan( ) notified and plans to attend appointment by meeting staff
and at Ortho AR. Nursing Progress Note 11/29/23 7:45 PM Physical Status:
Compliant w/ medications. No s/sx of acute physical/mental distress. Pt got into physical
altercation w/ peer. Pt c/o pain in L pointer finger. Knuckle and finger swollen. Capillary
refill <2 sec. Denies numbness/tingling. Full ROM w/ pain. Given ice pack, told to rest
hand/finger. Pt had bloody nose, no s/sx of fracture. No swelling, denies pain w/
touch/pressure. Pt has split lip. Pt told to keep clean, be mindful when eating/drinking.
Eyes PERRLA. Pt alert and oriented to self/situation. Denies dizziness or blurry vision,
denies h/a, gait is steady/even. Pt has chip in L lateral incisor. Pt tells nurse he is unsure if
that is an old or new injury. Pt denies pain localized to tooth, states that general jaw/teeth
pain is 'decreasing'. No further needs at this time. Additional Information: 8:15 PM- Pt c/o
nausea and sustained pain in L pointer finger. Pt denies dizziness, blurry vision. Eyes
PERRLA. After several minutes nausea subsides, no vomiting. Pt is able to walk steadily.
Speech is clear, pt is alert and oriented to self/situation. Pt tells nurse 'I think it was just the
adrenaline, I feel ok now'. Pt then asked to go to sleep. Notified dr on call. Dr on call stated
that pt can go to bed but pt will need to notify nursing of any further s/sx. Told pt to notify
staff of any n/v, dizziness, pain, or further s/sx of injury. Pt verbalized understanding. Pt
given acetaminophen per MAR for pain in L pointer finger at 7/10. No further needs at this
time. Nursing Progress Note 11/30/23 6:15 AM: Physical Status: Bottom Left lip swollen
and red. Left index finger swollen with minimal movement. Left hand has some swelling
but can move fingers freely except index finger. Didn't want ice pack for hand or lip. Given
Ibuprofen 400mg for soreness & pain of hand & lip with pain of 7/10 Nursing Progress
Note 11/30/23 10:15 AM: Physical Status: was seen today for routine medication
management and evaluation. He discussed leading events of how he and a peer got into
physical altercation last night. He has a bruised and swollen hand (left)(anterior and
posterior bruising to carpals 4 and 5) and an abrasion on his lower lip. Limited ROM to
digits 4 and 5 of Left hand. Capillary refill less than 3 seconds and WNL. No visible

deformities or protrusions. He admits that he instigated this peer after the peer walked up to
him, threatening him, and stating to "keep (his) name out of (his) mouth". Didn't sleep
well last night following the altercation. Has a family session later today and is anxious
about it. He reported he spoke with his step-mother on the phone this morning although
admits he does not feel their relationship is improving much at current. Admits he hasn't
attempted to call his step-mother or father this week. Denies any further peer conflict. No
further concerns or physical complaints voiced. Additional information: attempt to obtain
urgent care appointment to rule out fx due to significant anterior and posterior bruising
Interim Action Narrative: Residents were separated. Injured resident was assessed by the
nurse. 11/30/2023, resident was transported to Ortho AR for an evaluation. Both residents
were placed on freeze.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist received documentation for this incident. Licensing
Specialist will inquire about safety plan. Both residents were placed on freeze and were able
to restore on 11/30/2023.