summary: A resident was transported to the ER after purposely cutting her arm with a broken nail polish bottle.

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: 11/15/2023
Date Received by DCCECE:11/16/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 11-15-23 at 1315-1320 (DOB Alaska-
parental custody) was in the gym with her RT group and there was three ?stations? ? music,
shooting baskets and nail painting with 12 residents and 3 staff members. The resident had
become upset prior to the incident related to a food sensitivity that staff was discussing with
her, she appeared to calm down, was painting her nails with another resident, then she
broke the glass nail polish bottle and started to self-harm by cutting her left arm, there was
scant bleeding and then staff called for nurse support in the gym. Staff attempted to remove
glass, and when the nurses arrived at the scene, then cut her left forearm deeper
causing a round 3 cm deep lacerations and in the process also cutting her right finger,
additional staff assisted with the restraint. While being in a restraint nurses applied pressure
and first aid was administer to the resident left arm and right finger. APRN Karen Reynolds
was called and gave order to send the resident to the ER by ambulance in an abundance of
caution. 911 was called at 1330 and the resident was transported to Washington Regional
Medical Center emergency room of Fayetteville, Arkansas. She and was
returned to PRTC. A referral to Conway Behavioral Healthcare was made and she was
accepted for admission in the evening of 11-15-23. It was already planned that she would be
discharged in the near future to an Acute care hospital in Alaska prior to this incident. She
will stabilize at Conway Behavioral Health and will be admitted to the placement in Alaska
in the near future.
Interim Action Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: 11/17/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell. 11/20/2023 - A visit was conducted to review video
footage of the reported incident which occurred on 11/15/2023 around 12:43 PM - 12:51 PM
according to the video timestamp. The actual time of the incident was around 13:15 - 13:28.
In the video the resident can be seen sitting on the basketball court near the basketball goal
painting her nails with another resident. The resident proceeds to break a bottle of nail
polish and began to self harm. Staff member notices the resident has a piece of
the glass bottle. From 12:43 until 12:50 when a nurse entered the room and
restrained the resident the resident had possession of the broken bottle. Nursing staff which
entered the room were unaware the resident had a piece of glass. Staff interacting with
resident prior to the nursing staff entering the room, were aware the resident was self
harming with a piece of glass. The resident had the piece of glass for 8 minutes before the
staff removed the glass from the resident's possession.


state: AR

facility_name: Yellow Rock Behavioral Health (formerly Piney Ridge)

summary: Officers were dispatched to the facility in response to an attempted suicide.

raw_content:
Incident Report
Print Date/Time: 12/20/2023 10:48 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2023-00076868
Incident Date/Time: 11/15/2023 1:24:11 PM Incident Type: SUICIDE THREAT
Location: 2805 E ZION RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (850)377-6977 Source: 911
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
480 480-PERALEZ
495 495-PAYNE
508 508-GARCIA
382-CALVILLO
Person(s)
No. Role Name Address Phone Race Sex DOB
2 Caller DISPATCH ASSIGNED (850)377-6977
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:495
Disposition Count Date/Time
03NORPT 1 11/15/2023 13:43
Unit:508
Disposition Count Date/Time
03NORPT 1 11/15/2023 13:44
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
11/15/2023:13:38:30adunlapNarrative:495/OTHERUNITCANDOWNGRADE
11/15/2023:13:33:58bwhiteNarrative:TRANSFEROFCARE
11/15/2023:13:29:01fcarterNarrative:STAFFHASTHEGLASSSHEUSED
11/15/2023:13:28:41fcarterNarrative:PTIS UNKDOB
11/15/2023:13:28:16fcarterNarrative:PTISINTHEGYM,JUSTTHROUGHTHEFRONTDOORSOFADMINOFFICE
11/15/2023:13:28:06fcarterNarrative:CONFIRMEDADMINBLDG
11/15/2023:13:27:16fcarterNarrative:STAFFWILLMEETATMAINENTRANCE
11/15/2023:13:27:13fcarterNarrative:COMETHROUGHMAINENTRANCE
11/15/2023:13:27:00fcarterNarrative:ACTIVELYTRYINGTOHURTHERSELF
11/15/2023:13:26:55fcarterNarrative:ISCURRENTLYINAPHYSICALRESTRAINT
11/15/2023:13:26:34fcarterNarrative:NOSHOCKSYMPTOMS
11/15/2023:13:26:28fcarterNarrative:UNABLETOCONTROLTHEBLEEDING
11/15/2023:13:26:25fcarterNarrative:ATTHETREATMENTCENTER
11/15/2023:13:26:13fcarterNarrative:ISBEINGCOMBATIVE
11/15/2023:13:26:10fcarterNarrative:BROKEOPENANAILPOLISHGLASSBOTTLEANDUSEDTHEGLASSTOCUTHER
WRISTS
11/15/2023:13:25:55fcarterNarrative:AWAKEANDBREATHING
11/15/2023:13:25:51fcarterNarrative: FEMALEPT
11/15/2023:13:25:49fcarterNarrative:BLEEDINGISSERIOUS
11/15/2023:13:25:41fcarterNarrative:FEMALECUTHERWRISTS
Page: 2 of 2

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
2
1 of 1

doc_type: Police Report


summary: A resident was transported to the ER after tripping and hitting his face, busting his lip and breaking his teeth.

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: 11/10/2023
Date Received by DCCECE:11/13/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 11/10/23 at 1745 (DOB , Kentucky DCFS)
was outside playing a game with his peers in the gaga pit when the resident ran and tripped
hitting his face into the side of the gaga pit. Staff called for nurse support, resident was
assessed, resident had busted his mouth, moderate amount of bleeding noted, and had a
3cm laceration on his bottom lip with a puncher wound from his top teeth. The resident's
top teeth were also chipped and broken from the gum-line. APRN Karen Reynolds was
called, and informed of incident. APRN Karen Reynolds gave orders to send to
Arkansas Children Hospital of Northwest Arkansas in Springdale, Arkansas for further
assessment. At 17:45 resident was transported to the hospital occupied by two PRTC
employees. While at the emergency room the MD at Children's Hospital noted resident to
have a that is superficial no stitches require leave wound to self-heal.
. r was discharged from
Arkansas Children Hospital in Springdale, Arkansas resident arrived at PRTC at 01:20 on
11/11/2023. APRN, AOC, and DON notified of resident's arrival and health update. He will
be following up with a local dentist.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 11/15/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell.

doc_type: Notice of Incident


summary: An x-ray was ordered after a resident complained of hand pain from playing football.

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: 11/9/2023
Date Received by DCCECE:11/10/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 11-9-2023 (DOB Oklahoma private
guardian) He was seen by APRN on 11/9/23 complaining of hurting his hand a few days
ago after playing football outside with his peers. An x-ray was ordered and came back
. APRN notified and gave order to Ozark
Orthopaedics of Fayetteville Arkansas to evaluate and treat. He received a finger splint and
will follow-up with hand specialist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 11/13/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Three residents eloped from the facility by jumping over a fence. The residents were later returned to the facility by officers.

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: 11/5/2023
Date Received by DCCECE:11/6/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: At approx. 1520 on 11/05/2023 three residents ( DOB
, Arkansas state custody) ( DOB , Arkansas
resident, parental custody), and ( DOB Arkansas resident on
parental custody) The three residents were able to pull a picnic table to the fence and jump
over. Staff immediately went to follow them and nursing called the police. Officer Kyle Jeney
#409 and officer Jaren Barnett #453 responded. The staff were able to maintain the location
of the residents and with the assistance of the police they were returned to Piney at approx.
1700. While in the police car it is alleged that 2 of the residents and
caused some damage to the police car and stole magazines of bullets. Unsure how
many they took, however upon returning to facility this was discovered and they were
returned to the police. Both and have felony criminal mischief charges
pressed against them. has court 11/14/2023 and has court 11/7/2023 at 1330.
Prior to the incident we had 2 staff with 11 residents outside. Both and were
from west unit, they were supposed to be transiting in, however they were refusing outside
and then from North unit joined them when his unit was transiting out. Upon return
to the facility the residents were placed on RTU, elopement precautions, and will have a
staff remain with them. This will be revaluated every 24 hours. We are also making room
changes, the three residents will now be on three separate units.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 11/7/2023 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.


summary: While at the facility for another incident, two residents bent back the metal partition of a patrol unit and grabbed loaded magazines from a carrier vest, concealing them in their pants.

raw_content:
Incident Report
Print Date/Time: 12/20/2023 11:23 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2023-00074384
Incident Date/Time: 11/5/2023 4:42:03 PM Incident Type: CRIMINAL MISCHIEF
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: Source: Officer Initiated
Report Required: No Priority: 3-Low
Prior Hazards: No Status: Report
LE Case Number: 2023-00074384 Nature of Call:
Unit/Personnel
Unit Personnel
409 409-JENEY
433 433-HARRIS
490
Person(s)
No. Role Name Address Phone Race Sex DOB
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
07FARREST 1 11/05/2023 18:53
01RPTF 1 11/05/2023 18:53
03NORPT 2 11/05/2023 18:53
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1

Fayetteville Police Department
Summary
Print Date/Time: 12/20/2023 11:27 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Case Number: 2023-00074384
Case
Case Number: 2023-00074384 Incident Type: Criminal Mischief - Auto
Location: 4253 N CROSSOVER RD Occurred From: 11/05/2023 16:40
FAYETTEVILLE, AR 72703 Occurred Thru: 11/05/2023 16:45
Reporting Officer ID: 433 - HARRIS Disposition: Arrest - Juvenile
Disposition Date: 11/05/2023
Reported Date: 11/05/2023 16:42 Sunday
Offenses
No. Group/ORI Crime Code Statute Description Counts
1 State 290 5-38-203(b) Criminal Mischief 1st Degree (Felony) 1
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Suspect 1 White Male
FAYETTEVILLE, AR 72703
Suspect 2 Black Male
FAYETTEVILLE, AR 72703
Victim 1 CITY OF FAYETTEVILLE 113 W MOUNTAIN ST (479)587-3330
FAYETTEVILLE, AR 72701
Arrests
Arrest No. Name Address Date/Time Type Age
20230164 J 4253 N CROSSOVER RD 11/05/2023 16:42 On-View Arrest
FAYETTEVILLE, AR 72703
20230165 J 4253 N CROSSOVER RD 11/05/2023 16:42 On-View Arrest
FAYETTEVILLE, AR 72703
Property
Date Code Type Make Model Description Tag No.Item No.
11/05/2023 Destroyed/Damaged Trucks (37) Chevrolet TAHOE CHEVROLET TAHOE UNIT 1386
/Vandalized (4)
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 2
Page: 1 of 1

OfficerID: charris, C. Harris/ Case Narrative #2023-74384
Officer C. Harris #433
Citation Issued to for Criminal Mischief 1st Degree
(Felony)
Citation Issued to for Criminal Mischief 1st Degree
(Felony)
Case #2023-74384
Case Narrative
On November 5, 2023, at approximately 4:40 PM, unit 1386 was parked at Piney Ridge
located at 4253 N. Crossover Road after transporting three juvenile runaways back to
the facility (Incident 2023-74373). While speaking with staff and creating a plan for the
three juveniles to be removed from my patrol unit and into the facility without
running away, two of them, began bending the
back metal partition in the patrol unit. On the in car Axon Video, both subjects can be
seen grabbing the top of the metal partition, and bending it downward to gain access
to the rear storage area of the patrol unit. Once they had bent the partition down,
both subjects grabbed loaded magazines from a carrier vest and concealed them in
their pants.
As staff and officers were getting the subjects out of the vehicle, staff noticed the
bulge in their pants and searched them discovering the magazines. All magazines
were returned and no other items were located missing or on the subjects. When
speaking of how they gained access, one stated "we bent it down." I advised them of
felony criminal mischief charges with the juveniles stating, "like we give a fuck."
Damage to the cage was valued at approximately $1350.00 for replacement of the
partition. The juveniles were escorted into the facility by staff as citations were
printed for the charges. Staff member Anna Moore signed the citations since both
juveniles are in DHS custody at this time. Photos of the damages were uploaded to
Axon using Axon Capture on my issued phone.
Damages:
Unit 1386 Rear partition $1350.00
Processed by K. Frazier
Page: 2 of 2

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
1-2
1 of 1


summary: Officers were dispatched in response to a report that 3 juveniles escaped from the facility.

raw_content:
Incident Report
Print Date/Time: 12/20/2023 11:42 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2023-00074373
Incident Date/Time: 11/5/2023 3:22:14 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)305-0933 Source: 911
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
349 349-TOWNSEND
409 409-JENEY
433 433-HARRIS
453 453-BARNETT
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller BOHANNON, KEITH 4253 N CROSSOVER RD White Male
ALLEN
FAYETTEVILLE AR 72703
2 NCIC Query Black Male
3 NCIC Query 4253 N CROSSOVER Black Male
FAYETTEVILLE AR 72703
4 NCIC Query 4253 N CROSSOVER RD White Male
FAYETTEVILLE AR 72703
5 NCIC Query Black Male
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
03NORPT 4 11/05/2023 17:23
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 3

CAD Narrative
11/05/2023:16:24:41jcurryNarrative:EM13871
11/05/2023:16:24:30jcurryNarrative:EM
11/05/2023:16:22:40jcurryNarrative:10-64
11/05/2023:16:22:26jcurryNarrative:BM13871
11/05/2023:16:10:32jbarfieldNarrative:453EBONTHETRAILWITHSTAFFANDCHILDREN
11/05/2023:16:06:20jbarfieldNarrative:45310-12
11/05/2023:16:06:18lusmithNarrative:CALLERSEESANOFFICER
11/05/2023:16:06:15jbarfieldNarrative:409REQTORELEASEFIRE
11/05/2023:16:05:55lusmithNarrative:INTHEWOODSFACINGTHELAKEPASTMM4.29
11/05/2023:16:05:33lusmithNarrative:STAFFHAVECAPTUREDALL3JUVENILES
11/05/2023:16:04:56lusmithNarrative:NOWATMM4.29
11/05/2023:16:04:49jbarfieldNarrative:34910-4
11/05/2023:16:04:24jbarfieldNarrative:10-63
11/05/2023:16:04:17lusmithNarrative:CALLERISRUNNINGAFTER2SUBJSTHATAREFLEEING
11/05/2023:16:02:45lusmithNarrative:1SUBJGETTINGTIRED,OTHER2TOOKOFFRUNNING
11/05/2023:16:02:27lusmithNarrative:SUBJSINWOODSRIGHTNEXTTOCALLER
11/05/2023:16:02:18lusmithNarrative:ATMM4.11
11/05/2023:16:01:39lusmithNarrative:INTHEWOODSBETWEENBOTANICALGARDENSANDLAKEFAY
11/05/2023:16:00:37lusmithNarrative:SUBJSAREINBOTANICALGARDENSINTHEWOODSRUNNING
11/05/2023:16:00:25lusmithNarrative:ONTHELINEWITHJULIANNA-SHESEESALL3SUBJS
11/05/2023:15:59:56jbarfieldNarrative:453REQTRV4GETONTHETRAILATVETMEMPARKANDHEADEASTONTHE
TRAILFROMTHERE
11/05/2023:15:59:26lusmithNarrative:37ENDINGPHONECALLTOMAKECONTACTWITHJULIANNAWHOHASEYES
ONSUBJS
11/05/2023:15:59:15lusmithNarrative:CALLERISINRESIDENTIALBUILDINGTOWESTOFHOSPITALTOCOMPLETE
MISSINGPERSONSREPORTIFNEEDED
11/05/2023:15:58:57jbarfieldNarrative:433LOSTVISUAL
11/05/2023:15:57:12jbarfieldNarrative:ONBIKETRAILSBTOWARDSTHEPAVETRAIL-WESTOFHISUNIT
11/05/2023:15:56:51jbarfieldNarrative:433HASEYES
11/05/2023:15:55:59lusmithNarrative:UNKIFFRIENDORRELATIVEPICKEDUPSUBHS
11/05/2023:15:55:31lusmithNarrative:CALLERDOESNOTBELIEVESUBJSHAVEFRIENDSORRELATIVESINTHEAREA
11/05/2023:15:53:54lusmithNarrative:STAFFADVSUBJSAREINAREAOFBOTANICALGARDENS
11/05/2023:15:52:55lusmithNarrative:CALLERGETTINGWORDTHEYAREINAFIELDHEADINGTOWARDTHELAKE
FAYTRAILHEAD
11/05/2023:15:52:27lusmithNarrative:LASTTIME AND ESCAPED,THEYENDEDUPATANUNKGAS
STATIONINSPRINGDALE- LIKESTOLOOKATTHESHOESFORSALEATTHENWAMALL
11/05/2023:15:51:26lusmithNarrative:UNKDESTINATION
11/05/2023:15:51:03lusmithNarrative:NONOTESORMESSAGESLEFTBYSUBJS
11/05/2023:15:50:47lusmithNarrative:NONEOFTHESUBJSHAVECELLPHONESOROTHERELECTRONICS
11/05/2023:15:50:01lusmithNarrative:NOPETSWITHSUBJSWHENLEAVING
11/05/2023:15:49:12lusmithNarrative:ALEXISJUSTHEARDOVERRADIOFROMJULIANAASTAFFMEMBERTHAT'S
FOLLOWINGTHATSUBJSAREINAREAOFLAKEFAY
11/05/2023:15:48:34mtheriaultNarrative:E5GOINGTOVETMEMORIALAPRK
11/05/2023:15:48:29lusmithNarrative:UNKMIDDLENAMESFORSUBJS
11/05/2023:15:48:26lusmithNarrative: 505/148.8DARKBRO/BROBRO
COMPLEXIONGRYNIRVANASHIRTWITHYELLOWLETTERINGBLUORBLKBASKETBALLSHORTSUNKCOLOR
SHOES
11/05/2023:15:46:08lusmithNarrative: 600/167.6DARKBRO/UNKGRY/BLK
SHIRTBLKFADEDJEANSBLK/GRYSHOESLIGHTERCOMPLEXION
11/05/2023:15:45:48jbarfieldNarrative:453ADVPOSBHEADINGNBTOWARDSTHELAKEFAYTRAIL
11/05/2023:15:43:56lusmithNarrative:88-
11/05/2023:15:43:39lusmithNarrative:STAFFMEMBERWHOHASEYES-"JULIANNA" INAREDPCWITHHAZARDSON
11/05/2023:15:42:36lusmithNarrative:INAREAOFZION/OLDMISSOURI
11/05/2023:15:42:12lusmithNarrative:1STAFFMEMBERISADVTHEYAREINTHECONSTRUCTIONAREAONZION
11/05/2023:15:41:55jbarfieldNarrative:453REQFIRERESPONDTOHELPLOCATECHILDREN
11/05/2023:15:40:09lusmithNarrative: 506/152.2BRO/BLUTANCOMPLEXIONWHI
SHIRTWHIJEANSBLK/REDSHOES
11/05/2023:15:38:13jbarfieldNarrative:WITNESSPOSBSAWCHILDRENINTHETREELINESOUTHOFZIONORPOSBAT
Page: 2 of 3

AGASSTATIONATZION/CROSSOVER
11/05/2023:15:36:41lusmithNarrative:CALLERDOESNOTBELIEVEANYSUBJSHAVETATTOOSORSCARSORMARKS
11/05/2023:15:35:21jbarfieldNarrative:409ADVPOSBINORNEARADRAINAGEDITCHONTHESOUTHSIDEOF
VALLEYLAKE
11/05/2023:15:35:03lusmithNarrative:UNKIFANYPERSONALBELONGINGSMISSINGFROMSUBJSROOMS
11/05/2023:15:34:46jbarfieldNarrative:433ONFOOTINTHEWOODLINESOUTHOFVALLEYLAKEAPTS
11/05/2023:15:34:39lusmithNarrative:PRIMARYLANGUAGEENGLISHFORALL3
11/05/2023:15:34:24lusmithNarrative:NONEOFTHEMHADANYWEAPONSATTIMEOFRUNNINGAWAY
11/05/2023:15:34:08lusmithNarrative:SUBJSHAVENOINJURIES
11/05/2023:15:33:54lusmithNarrative:OTHER2SUBJSHAVENOMEDICALCONDITIONS
11/05/2023:15:33:40lusmithNarrative: HASREDUCEDKIDNEYFUNCTION-NOMEDICATIONSARE
TAKEN-SUBJNEEDSTOSTAYHYDRATEDANDUSECAUTIONWITHACTIVITYLEVEL
11/05/2023:15:32:49lusmithNarrative:NONEOFTHESUBJSHADSPECIFICBELONGINGS
11/05/2023:15:31:30lusmithNarrative:1SUBJLIVESIN 1LIVESIN
SPECIFICADDRESSESAREAVAILABLEWITHPINEYRIDGE
11/05/2023:15:30:37lusmithNarrative:CALLERNOTAWAREOFANYSPECIALCONSIDERATIONS
11/05/2023:15:30:30lusmithNarrative:SUBJSRANAWAY
11/05/2023:15:29:28lusmithNarrative:STAFFMEMBERWASLASTPERSONTOSEESUBJS-"ALEXIS"ATAPPROX1522,
TIMEOFCALL
11/05/2023:15:28:20lusmithNarrative: YOA506/130-140UNKCOLORNIRVANASHIRT
11/05/2023:15:27:09lusmithNarrative: YOA UNK/UNKGRYSHIRTBLU
JEANS
11/05/2023:15:26:19lusmithNarrative:1 507/THINBRO/UNKWHISHIRTWHIPANTS
11/05/2023:15:24:40lusmithNarrative:1B/M1B/M1W/M - YOA
11/05/2023:15:23:55lusmithNarrative:SUBJSAREONFOOT,NOVEH
11/05/2023:15:23:49lusmithNarrative:STAFFLOSTEYESONCETHEYHOPPEDTHEFENCEINTOTHEAPTCOMPLEX-
UNKDOT
11/05/2023:15:23:49jbarfieldNarrative:34910-4
11/05/2023:15:23:23lusmithNarrative:JUVENILESCLIMBEDOVERFENCEBORDERINGWESTSIDEOFPINEYRIDGE
NEXTTOVALLEYLAKEAPTS
11/05/2023:15:22:29lusmithNarrative:3JUVENILESESCAPEDFROMPINEYRIDGE
Page: 3 of 3

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
1-3
1 of 1


summary: A resident was transported to Arkansas Children’s Hospital after falling from a basketball he climbed to retrieve 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: 10/22/2023
Date Received by DCCECE: 10/23/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name: (DOB )- This resident is from
Minnesota Description of report: While resident was in the gym he threw a basketball up
and it got stuck between the wall and goal. Resident disregarded the staff directs and tried
to climb the basketball goal to retrieve the ball. Resident fell approx. 2-3 feet during his
climb down the pole and landed on his left wrist/arm. He was immediately assessed by
nursing with swelling noted to his left wrist and complains of pain from wrist to elbow.
Resident was given medications and ice pack for pain. X-ray was ordered in house. X-ray
showed acute left radial fracture. Orders received to take to hospital for follow-up. Date of
occurrence: 10/22/2023 Corrective action taken by the agency or follow up done: Resident
was taken to Arkansas Childrens Emergency Room. Acute fracture was confirmed and
resident returned with a cast to his left arm. He has a follow-up this Thursday at 11am
UAMS orthopedics.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/24/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell. Licensing Specialist will contact facility to inquire if
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

there is video footage of the incident available for review. 10/24/2023 - The facility
responded and stated the video footage is no longer available.


summary: A resident was sent to the ER after fracturing his hand while playing football.

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: 10/21/2023
Date Received by DCCECE: 10/23/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name: (DOB ) he is an Arkansas
resident in parents custody Description of report: At approx. 1359 this resident was playing
football when he fell onto his left hand/wrist area. Resident presented with pain and
swelling. X-ray was ordered in house. The x-ray that was performed in house and showed
?Minimal buckle fracture of the distal radial metaphysis? APRN was notified and orders
were received to take to Physician Specialty for follow-up. Pain medication and ice was
given prior to initial x-ray being done. Date of occurrence: 10/21/2023 Corrective action
taken by the agency or follow up done: Resident was taken to Physician?s Specialty Group
with nurse and BHA. He was seen by Brent Rush NP, he had additional x-rays done and
they placed a brace on his left wrist. He was discharged from the ER with instructions to
wear the brace and follow-up with Dr. Cox in one week. The hospital called back and said
he did not have a break and did not have to wear the brace if he didn?t want to. However he
still does need to follow-up with Dr. Cox. This referral was sent to our transportation
department and the follow-up will be made.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 10/24/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell. 11/3/2023 - Licensing Specialist received an update
from the facility On 016969, this resident followed up with Ozark Orthopedics on 11-2-23 (it
is noted that UAMS refused to see resident without payment up front), he was then sent to
OO and was
The wrist fracture is suspected to be a recreational injury where he fell on
his wrist. He does not know how he obtained the index fracture. He was given a soft cast
which he has already torn off. He reports no pain. .


summary: A resident was sent to Arkansas Children’s Hospital for assessment of an insect bite that was possibly infected.

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: 10/9/2023
Date Received by DCCECE: 10/10/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: (DOB out of state DHS placement)
Resident received an IM does of Rocephin and started Keflex 500mg this weekend. On
10/9/23 he was seen by APRN as follow up due to the possible infected bug bite. APRN
ordered that he be taken to Arkansas Children's Hospital for assessment and treatment.
Staff transported him and he was seen in the ER and stayed overnight for observation. He
received ids and the area was drained by the physician. returned
to facility 10/10/2023 at 1529. He will be on oral antibiotics for 1 week and follow-up with
our APRN on Friday 10/13/2023.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/12/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell. Hospital discharge paperwork has been requested from
the facility. 11/3/2023 - The facility responded the hospital did not know what the bug bite
was from, the antibiotics cleared the bite and the resident is doing well.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Ozark Orthopedics for evaluation due to reports of hand pain after hitting 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: 10/5/2023
Date Received by DCCECE: 10/6/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 10/5/2023 (DOB Arkansas private
placement) was seen by the APRN and reported right hand pain. He was sent to Ozark
Orthopaedics for evaluation and treatment if necessary. He received an x-ray that showed
. He was
encouraged to not participate in physical activities and not manipulate or take off the soft
cast. Ozark Orthopaedic will contact PRTC for a follow up appointment in approximately
one week. He quickly hit a peer on 9/27/23 in the face, this is the only documented time
lately that hit something.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/9/2023 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell. Licensing Specialist will contact the facility to inquire further
about the incident concerning the amount of time from the day of the altercation and
receiving medical attention, and the safety plan implemented for the incident. 10/17/2023 -
Received nursing notes for the provided reported incident. The resident complained of pain
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

on the day of the incident 9/27/2023. No other nursing notes state the resident complaining
of pain up until the visit to the Ozark Orthopedics.


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. 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
Piney Ridge Treatment Center Jarred Parnell
2805 E ZION RD Donaghey Plaza
FAYETTEVILLE AR 72703 P.O. Box 1437
Little Rock, AR. 72203
Facility Visit Compliance Notice
__________________________________________________________________________
Facility#: 203
Date of Visit: 10/4/2023
Visit Type(s): Subsequent Building and Grounds
Time:
_______________________________________________________________________________________________
Visit Comment :
10/4/2023 - A buildings and grounds inspection was completed. A walkthrough was conducted in common
areas for all of the units, rooms were inspected for the south unit as well as the cafeteria, and the gymnasium
and the computer lab. Residents were observed waking up and doing goal building with peers and getting
ready for class.
Ratios were reviewed during the walkthrough.
Daily Schedules and activities was discussed with facility staff.
Sleeping arrangements was observed and reviewed during the inspection.
Page 1 of 2

CCL Staff Signature : Date: 10/4/2023
Provider Signature : Date: 10/4/2023
Your Signature indicates that this form has been reviewed with you; it does not imply your agreement with
it.
Right to Appeal: For more information on how to appeal these findings, refer to the minimum Licensing
Requirements or contact your Licensing Specialist.
Page 2 of 2

doc_type: Compliance Report


summary: A resident was transported to Arkansas Children’s Hospital for assessment of acute care after displaying aggressive and unsafe behaviors.

raw_content:
AR KAN S A S&S
DEPARTMENT OF

+4 HUMAN
<a¥ SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident

Date of Incident: 10/3/2023

Date Received by DCCECE: 10/4/2023

Facility Name: Piney Ridge Treatment Center
Facility Number: 203

Incident Type: Licensing

Report Description: On 10/3/24 (DO DJ Arkansas DCFS) was

transported by PRTC to Arkansas Children's Hospital in Springdale, AR to be assessed for
acute care. He did not verbalize suicidal ideation; however, he was displaying aggressive
and unsafe behavior. Conway Behavioral Health did accept him for acute care. He was
transported to CBH by ambulance. It is unknown whether he will return to PRTC.

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: 10/4/2023 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.

We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Two residents eloped from the facility by scaling fences outside.

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: 9/19/2023
Date Received by DCCECE:9/20/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: (DOB Arkansas private) and
(DOB Arkansas private) on 9/19/23 at approximately 1245 were outside for free
time after lunch and quickly scaled the fences toward the apartment complex/parking lot.
Staff members followed but lost sight of the residents. The Fayetteville Police Department
was called at approximately 1300. Both the police and employees looked for the residents
but did not locate them. At approximately 0002 on 9/20/2023 both residents returned to the
PRTC accompanied by a Fayetteville police officer. The residents reportedly went to a gas
station and asked the employee to call PRTC to say he wanted to come back. PRTC called
the police and advised them of the whereabouts of the residents and they returned. No
significant injuries were noted. One of the residents made a statement of smoking a vape
with THC with two children "who were like our age". Because of this, UA of both residents
was obtained. Both residents were placed on Elopement precautions, restricted to the unit -
which will be re-assessed in 24 hours of their return. Additionally, note that one of the
residents was moved units to separate the two residents from sleeping on the same unit.
Both residents will follow up with their primary therapist related to the incident and
guardians were notified.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 9/20/23 -The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell. Licensing Specialist will reach out to the facility to inquire about
the ratios at the time of the elopement. 9/29/2023 - The facility responded there were 4 staff
counted in the ratio during the elopement. Licensing Specialist responded to inquiring how
many residents were the 4 staff supervising. No response was sent back. 10/3/2023 -
Licensing Specialist called Ronissa Adams to get information on how many residents were
in the ratio. Ronissa did not answer. A voicemail was left. 10/4/2023 - Licensing Specialist
followed up with the facility and the ratio at the time of the elopement was 4:14. 4 staff to 14
residents.


summary: Officers were dispatched to the facility in response to a report that two residents jumped a fence and eloped from the facility.

raw_content:
Fayetteville Police Department
Summary
Print Date/Time: 10/27/2023 12:34 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Case Number: 2023-00062524
Case
Case Number: 2023-00062524 Incident Type: Missing Person
Location: 4253 N CROSSOVER RD Occurred From: 09/19/2023 13:07
FAYETTEVILLE, AR 72703 Occurred Thru: 09/19/2023 13:20
Reporting Officer ID: 504 - STONE Disposition: Inactive
Disposition Date: 09/20/2023
Reported Date: 09/19/2023 13:07 Tuesday
Offenses
No. Group/ORI Crime Code Statute Description Counts
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Reporting Person 1 CHERUIYOTJO, RICHARD 4253 N CROSSOVER RD Unknown Male
FAYETTEVILLE, AR 72703 42
Arrests
Arrest No. Name Address Date/Time Type Age
Property
Date Code Type Make Model Description Tag No.Item No.
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 3
Page: 1 of 1

OfficerID: SSTONE, S Stone/Case Narrative 2023-62524
Officer S Stone #504
Missing Persons
Case #2023-62524
Case Narrative
On September 19, 2023, at approximately 1:07 P.M., I was dispatched to 4253 N.
Crossover Rd. for a missing person report. Upon arrival, I contacted the caller,
Richard Cheruiyot, , an employee at Piney Ridge. Richard stated that
the two boys, and , were
in the back outside area and jumped the fence. Richard also noted no one saw the
boys run towards the front of the building. Richard stated has
kidney issues but is not given medication for the condition. It should also be known
that another employee at Piney Ridge said one of the other patients told them
and had been planning to run away from Piney Ridge.
After speaking with Richard, I drove to multiple houses south in the surrounding area
of Piney Ridge. Corporal Peace #321 then radioed he had seen and run
into some brush off of E. Zion Rd. just east of my position. Multiple employees of
Piney Ridge and I walked through the woods on the North side of E. Zion and
searched for and . After searching for a little over an hour, Washington
County Sheriff's Officer had a Deputy come to our location and use a drone to try and
locate the two subjects. After the Deputy searched the area with the drone,
and could still not be found.
and was last seen wearing a gray t-shirt,
blue jeans, and red shoes. and was
last seen wearing a green t-shirt with blue jeans.
I contacted Central Dispatch to issue a be on the lookout (BOLO) for and
. Central Dispatch also entered both juveniles into ACIC/NCIC as missing.
This incident was recorded on my Axon body-worn camera and my Axon MVR.
Processed by A Reznicek
Page: 2 of 3

OfficerID: LSAMUELS, L. Samuels/ Case Supplement #2023-62524
Corporal L. Samuels #347
Recovery
Case #2023-62524
Case Supplement
On September 19, 2023, I responded to 3427 S Thompson in Springdale to recover
two missing juveniles. and had run away from Piney
Ridge earlier in the day. Springdale Police Department had contacted them after they
went to the business to turn themselves in. I transported both juveniles back to Piney
Ridge, and they were given to staff.
Processed by K. Frazier
Page: 3 of 3

Incident Report
Print Date/Time: 10/27/2023 12:33 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2023-00062524
Incident Date/Time: 9/19/2023 1:07:29 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)587-1408 Source: Phone
Report Required: Yes Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: 2023-00062524 Nature of Call:
Unit/Personnel
Unit Personnel
296 296-KOSCHESKI
321 321-PEACE
504 504-STONE
453-BARNETT
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller CHERUIYOTJO, 4253 N CROSSOVER RD Unknown Male
RICHARD
FAYETTEVILLE AR 72703
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count
02GONEONARRIVAL 2
01RPT 1
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
09/19/2023:14:54:37sstoneNarrative:BOLOFOR
LSWGRYSHIRTBLUJEANSREDSHOESAND
LSWGRNTSHIRTLBLUJEANS.BOTHFLEDPINEYRIDGEATAPPROXIMATELY1300HOURSON09/19/2023.THEY
WERELASTSEENINTHEAREAOFN.OLDMISSOURIRD.ANDE.ZIONRD.NEITHERJUVENILEHAVEFAMILYIN
THEAREAORAMODEOFTRANSPORTATION.
09/19/2023:14:45:40mtheriaultNarrative:296D2ATBOTANICALGARDENS
09/19/2023:14:31:06mtheriaultNarrative:296HELPINGONTHETRAIL
09/19/2023:14:30:36mtheriaultNarrative:504WAS1012WITHCOUNTYNOTTHEJUVENILES
09/19/2023:14:19:23mtheriaultNarrative:5041012
09/19/2023:14:18:16lusmithNarrative:WCSOADVTHEYHAVEANOFFICERWITHADRONENEARBYIFNEEDED
09/19/2023:13:44:21mtheriaultNarrative:321LOSTSIGHT
09/19/2023:13:43:36mtheriaultNarrative:STAFFNOTIFIED
09/19/2023:13:42:16mtheriaultNarrative:321advSUBJECTSHEADINGSOUTHBACKTOZIONFROM321PLOT
09/19/2023:13:37:31mtheriaultNarrative:321ADVSUBJECTSNBFROMZIONTHROUGHBRUSHHEADEDTOLAKEFAY
TRL
09/19/2023:13:16:35kfosterNarrative:CALLERCANGETPICTURESFROMPARENTSIFNEEDED
09/19/2023:13:15:08kfosterNarrative:ADVCALLERTOMEETOFFICERSATSOUTHENTRANCE.
09/19/2023:13:14:56mtheriaultNarrative:504GOINGTOTHESOUTHENTRANCE
09/19/2023:13:14:47kfosterNarrative:AREHEREDUETOBEHAVIOR,PARENTSARENOTAWAREATTHISTIME.
09/19/2023:13:14:09kfosterNarrative:DENIEDC10FORBOTHSUBJECTS,
09/19/2023:13:13:06kfosterNarrative: :NOSMTS.NOMENTALORPHYSICALDISABILITIES.NOBELONGINGS.
PRIMARYLANGISENGLISH.NOPETSWITHHIM.NOCELLPHONE.
09/19/2023:13:12:43kfosterNarrative: :NOSMTS.NOMENTALORPHYSICALDISABILITIES.NOBELONGINGS.
PRIMARYLANGISENGLISH.NOPETSWITHHIM.NOCELLPHONE.
09/19/2023:13:11:48mtheriaultNarrative:34510-4
09/19/2023:13:11:31kfosterNarrative:NOC1,NOTC2.
09/19/2023:13:11:23kfosterNarrative:NOFRIENDSORFAMILYINTHEAREA,ARENOTFROMHERE.
09/19/2023:13:11:04kfosterNarrative:LASTSEENHEADEDWESTBOUNDTOWARDVALLEYLAKEONFOOT
09/19/2023:13:10:41kfosterNarrative: LSWGRYSHIRT
BLUJEANSREDSHOES
09/19/2023:13:09:35kfosterNarrative: HASAKIDNEYCONDITION,DOESNOTTAKEMEDSFORIT.
09/19/2023:13:09:13kfosterNarrative: LSWGRN
TSHIRTLBLUJEANS
09/19/2023:13:08:00kfosterNarrative:TWO13YOJUSTRANAWAY
Page: 2 of 2


summary: A resident was sent to Ozark Orthopedics after fracturing his hand 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: 9/1/2023
Date Received by DCCECE:9/5/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8/30/2023 (DOB private admission) became
escalated and quickly hit (DOB private out of state admission)
multiple times as staff was intervening. was placed on assault precautions at the time
of the incident. A consult was requested with APRN and he received an x-ray on 9/1/2023
and results were later received that he had has an "acute angulated distal 2nd metacarpal
fracture" to right hand. Karen Reynolds APRN ordered that resident be sent to Ozark
Orthopedics, his index and middle fingers be buddy taped, and no sports for six weeks.
Swelling to right hand still present. The resident voiced pain of 10/10. PRN Ibuprofen
400mg and an ice pack were administered and were effective. At 1730, the resident was
transported to Ozark Orthopedics via facility vehicle where he was assessed and treated and
returned to the facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 9/7/23- Program Coordinator emailed the facility to determine if any
video footage is still available of the incident. 9/8/23- Facility responded that there is no
video footage of this incident to review. 9/11/2023 - The provider reported incident was
reviewed by Licensing Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Deficiencies were cited during the Inspection of Care performed on 8/29/2023. A Corrective Action Plan was submitted and approved.

raw_content:
August 31, 2023
REVISED: September 25, 2023
Piney Ridge Treatment Center
4253 N Crossover Rd
Fayetteville, AR 72703-4593
The Division of Provider Services and Quality Assurance (DPSQA) of the Arkansas Department of Human
Services has contracted with Arkansas Foundation for Medical Care (AFMC) to perform Inspections of Care
(IOC) for Inpatient Psychiatric Services for Under 21. The Medicaid Manual for Inpatient Psychiatric Services
for Under Age 21 was used in the completion of this report.
Observations and any deficiencies noted are listed below for the inspection conducted at the following service
site on the following date:
Piney Ridge Treatment Center
Provider Medicaid ID:
Onsite Inspection Date: August 29, 2023
Onsite Inspection Time: 8:51 a.m.
A summary of the inspection and any deficiencies noted are outlined below.
The provider must submit a Corrective Action Plan (CAP) designed to correct any deficiency noted in the
written report of the IOC. Accordingly, you must complete and submit to AFMC a Corrective Action Plan for
each deficiency noted. The Corrective Action Plan must state with specificity the:
(a) Corrective action to be taken.
(b) Person(s) responsible for implementing and maintaining the corrective action; and
(c) Completion date or anticipated completion date for each corrective action.
The CAP must be completed within 30 calendar days of the date of the email notice of the IOC report. Please
follow the link provided in the email notice to submit either a Reconsideration or CAP for the inspection, all via
AccessPoint.
The contractor (AFMC) will:
(a) Review the Corrective Action Plan.
(b) Determine whether the Corrective Action Plan is sufficient to credibly assure future compliance; and
(c) Provide the Corrective Action Plan to the Division of Provider Services and Quality Assurance (DPSQA).
Please see § 160 of the Medicaid Manual for an explanation of your rights to administrative reconsideration and
appeal. Additionally, the imposition of this Corrective Action Plan does not prevent the Department of Human
Services from prescribing additional remedial actions as may be necessary.

Inspection of Care Summary
Facility Tour:
Upon arrival to facility, AFMC staff was promptly greeted at the entrance by a Piney Ridge Treatment Center
staff member. AFMC staff signed in on the visitor log and copies of badges were made by receptionist. AFMC
was immediately taken to a conference room where they were met by the Risk Manager. AFMC staff was given
the completed and signed consent form listing approval for access to the AFMC portal. At this time the AFMC
staff discussed the Inspection of Care process and the Document Request form with the Risk Manager.
A tour of the facility was completed with the Risk Manager. The areas toured included the gymnasium, two
classrooms in the gymnasium area, five classrooms in the education hallway, two game rooms, two outside
courtyards, cafeteria, four client units, the nurses’ station, and the medication room. Overall, the facility
environment was in good repair and well organized. The following is a list of environmental observations noted
during the facility tour.
• Classrooms were well-organized and free of clutter. Educational classes and group activities
were in session in the classrooms. The staff to client ratio was adequate. Most clients were
engaged in educational activities. In several of the classrooms there were two to three clients
with their heads down on the desks with eyes closed and appeared to be asleep.
• The cafeteria was noted to have food on the tables and in the floor left from breakfast.
Housekeeping had just started to clean up as AFMC staff was walking through this area.
• In the food service area, there were boxes of soda flavoring sitting on a shelf just above the
floor next to the soda machine. The tubes that connect the flavoring to the machine were
hanging off the shelf causing a potential hazard. There was one bag of soda flavoring that was
out of the box and lying on the floor in the walkway. This bag was connected to the soda
machine. AFMC staff informed facility staff of the potential for contamination. The Risk
Manager immediately reported this concern to appropriate facility staff so the bag could be
removed, and machine appropriately cleaned.
• There was a multipurpose room just outside of the units that was currently closed due to a
resident having kicked a hole in the wall and pulled the sprinkler down. The facility is awaiting
repairs prior to opening this room back up for use.
• Three out of four of the units there were items cluttered on the floor, food wrappers, and trash
on all units in the common areas, client rooms, and bathrooms. Housekeeping had not made it to
these units at the time of the facility tour. The first unit toured was being cleaned while AFMC
staff was on unit and was noted to be much tidier than the other units.
• In several client rooms and bathrooms, the client’s hygiene totes had been left open on the floor.
Facility staff stated these totes were not allowed to be left in the rooms for the safety of the
clients.
• One unit of older girls had two rooms directly across the hallway from each other being utilized
for several of the girls who were in isolation due to positive covid tests. The doors to both
rooms were opened with staff sitting in the hallway monitoring the clients. Staff in direct
contact were noted to be wearing masks. Not all staff and clients on this unit were noted to be
wearing masks.
• Two outside courtyards were toured with noticeable updates since the last IOC visit. There are
now several concrete pads with basketball goals and a gaga ball pit that have been added for
recreational activities. The garden area has been moved to a locked gated area in the main
courtyard and is supervised by staff when utilized by clients. Both courtyards were well
maintained with no safety issues noted.
All staff members were observed interacting calmly and therapeutically with clients throughout the facility.
Staff were able to answer questions regarding the facility.
Piney Ridge Treatment Center – Fayetteville, AR – IOC Report 2 | P ag e

Facility Review – Policies and Procedures:
Upon review of the site’s policies, procedures, and certification requirements, there were no deficiencies noted.
Observations:
AFMC staff reviewed the final document request form with the Chief Executive Office, the Chief Operations
Officer, and the Risk Manager at the completion of the on-site Inspection of Care. The provider signed the
acknowledgement of manual requirements that were made available in the provider’s policy and
procedures. AFMC staff explained that these findings were preliminary and there was still an off-site portion to
be completed.
Personnel Records – Licenses, Certifications, Training:
There was a total of 30 personnel record(s) reviewed, eight (26%) professional and 22 (25%) paraprofessional.
During the review of the personnel records, there were no deficiencies were noted.
Clinical Summary
As a part of the Quality of Care survey of the IOC, an active Fee for Service (FFS) Medicaid client list was
requested, client and/or guardian interviews were conducted, and a clinical record review was completed. The
following is a summary of findings and noted deficiencies.
Client/Guardian Interviews:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no client interviews
were conducted.
Clinical Record Review Deficiencies:
No active FFS Medicaid clients currently admitted at the time of IOC. Therefore, there were no clinical records
reviewed.
Program Activity/Service Milieu Observation:
Clients were observed in multiple classrooms and in a group therapy session in the common area on one unit.
Staff were engaged with the clients and were providing a therapeutic environment that was conducive to
learning.
Medication Pass:
No active FFS Medicaid clients received medications during medication pass. Due to the observation of non-
Medicaid clients not being complaint with the HIPAA minimal necessary rule, no medication pass was
observed. AFMC RN visited with the Piney Ridge Treatment Center medication nurse who was able to show
AFMC RN the facility policies and procedures regarding medication administration, narcotic
count/reconciliation/handling, and medication discrepancies.
The tour of the medication room was completed with the Piney Ridge Treatment Center medication nurse. The
medication room was clean and well-organized in a way to provide safety in medication administration. There
were two vials of tuberculin skin test found to be open in the medication refrigerator. Both vials were not
labeled with the date they were opened or with the initials of the nurse who opened them. This was reported
immediately to the Director of Nursing who removed both vials and disposed of them properly. No other issues
were noted during the medication room tour.
Corrective Action Plan:
The CAP must be completed within 30 calendar days of the date of the email notice of the IOC reports.
Additionally, any findings that were noted in any Health and Safety Inspection(s), which are governed by
certification rules and requirements, are shared with DPSQA and may result in other remedial actions, by
DPSQA, if warranted.
* For more details on the individual related deficiencies, please log into the portal.
Piney Ridge Treatment Center – Fayetteville, AR – IOC Report 3 | P ag e

Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
Piney Ridge Treatment Center – Fayetteville, AR – IOC Report 4 | P ag e

August 31, 2023
Piney Ridge Treatment Center
4253 N Crossover Rd
Fayetteville, AR 72703-4593
The Division of Provider Services and Quality Assurance (DPSQA) of the Arkansas Department of Human
Services has contracted with Arkansas Foundation for Medical Care (AFMC) to perform Inspections of Care
(IOC) for Inpatient Psychiatric Services for Under 21. The Medicaid Manual for Inpatient Psychiatric Services
for Under Age 21 was used in the completion of this report.
Observations and any deficiencies noted are listed below for the inspection conducted at the following service
site on the following date:
Piney Ridge Treatment Center
Provider Medicaid ID:
Onsite Inspection Date: August 29, 2023
Onsite Inspection Time: 8:51 a.m.
A summary of the inspection and any deficiencies noted are outlined below.
The provider must submit a Corrective Action Plan (CAP) designed to correct any deficiency noted in the
written report of the IOC. Accordingly, you must complete and submit to AFMC a Corrective Action Plan for
each deficiency noted. The Corrective Action Plan must state with specificity the:
(a) Corrective action to be taken.
(b) Person(s) responsible for implementing and maintaining the corrective action; and
(c) Completion date or anticipated completion date for each corrective action.
The CAP must be completed within 30 calendar days of the date of the email notice of the IOC report. Please
follow the link provided in the email notice to submit either a Reconsideration or CAP for the inspection, all via
AccessPoint.
The contractor (AFMC) will:
(a) Review the Corrective Action Plan.
(b) Determine whether the Corrective Action Plan is sufficient to credibly assure future compliance; and
(c) Provide the Corrective Action Plan to the Division of Provider Services and Quality Assurance (DPSQA).
Please see § 160 of the Medicaid Manual for an explanation of your rights to administrative reconsideration and
appeal. Additionally, the imposition of this Corrective Action Plan does not prevent the Department of Human
Services from prescribing additional remedial actions as may be necessary.

Inspection of Care Summary
Facility Tour:
Upon arrival to facility, AFMC staff was promptly greeted at the entrance by a Piney Ridge Treatment Center
staff member. AFMC staff signed in on the visitor log and copies of badges were made by receptionist. AFMC
was immediately taken to a conference room where they were met by the Risk Manager. AFMC staff was given
the completed and signed consent form listing approval for access to the AFMC portal. At this time the AFMC
staff discussed the Inspection of Care process and the Document Request form with the Risk Manager.
A tour of the facility was completed with the Risk Manager. The areas toured included the gymnasium, two
classrooms in the gymnasium area, five classrooms in the education hallway, two game rooms, two outside
courtyards, cafeteria, four client units, the nurses’ station, and the medication room. Overall, the facility
environment was in good repair and well organized. The following is a list of environmental observations noted
during the facility tour.
• Classrooms were well-organized and free of clutter. Educational classes and group activities
were in session in the classrooms. The staff to client ratio was adequate. Most clients were
engaged in educational activities. In several of the classrooms there were two to three clients
with their heads down on the desks with eyes closed and appeared to be asleep.
• The cafeteria was noted to have food on the tables and in the floor left from breakfast.
Housekeeping had just started to clean up as AFMC staff was walking through this area.
• In the food service area, there were boxes of soda flavoring sitting on a shelf just above the
floor next to the soda machine. The tubes that connect the flavoring to the machine were
hanging off the shelf causing a potential hazard. There was one bag of soda flavoring that was
out of the box and lying on the floor in the walkway. This bag was connected to the soda
machine. AFMC staff informed facility staff of the potential for contamination. The Risk
Manager immediately reported this concern to appropriate facility staff so the bag could be
removed, and machine appropriately cleaned.
• There was a multipurpose room just outside of the units that was currently closed due to a
resident having kicked a hole in the wall and pulled the sprinkler down. The facility is awaiting
repairs prior to opening this room back up for use.
• Three out of four of the units there were items cluttered on the floor, food wrappers, and trash
on all units in the common areas, client rooms, and bathrooms. Housekeeping had not made it to
these units at the time of the facility tour. The first unit toured was being cleaned while AFMC
staff was on unit and was noted to be much tidier than the other units.
• In several client rooms and bathrooms, the client’s hygiene totes had been left open on the floor.
Facility staff stated these totes were not allowed to be left in the rooms for the safety of the
clients.
• One unit of older girls had two rooms directly across the hallway from each other being utilized
for several of the girls who were in isolation due to positive covid tests. The doors to both
rooms were opened with staff sitting in the hallway monitoring the clients. Staff in direct
contact were noted to be wearing masks. Not all staff and clients on this unit were noted to be
wearing masks.
• Two outside courtyards were toured with noticeable updates since the last IOC visit. There are
now several concrete pads with basketball goals and a gaga ball pit that have been added for
recreational activities. The garden area has been moved to a locked gated area in the main
courtyard and is supervised by staff when utilized by clients. Both courtyards were well
maintained with no safety issues noted.
All staff members were observed interacting calmly and therapeutically with clients throughout the facility.
Staff were able to answer questions regarding the facility.
Piney Ridge Treatment Center – Fayetteville, AR – IOC Report 2 | P ag e

Facility Review – Policies and Procedures:
Upon review of the site’s policies, procedures, and certification requirements, there were no deficiencies noted.
Observations:
AFMC staff reviewed the final document request form with the Chief Executive Office, the Chief Operations
Officer, and the Risk Manager at the completion of the on-site Inspection of Care. The provider signed the
acknowledgement of manual requirements that were made available in the provider’s policy and
procedures. AFMC staff explained that these findings were preliminary and there was still an off-site portion to
be completed.
Personnel Records – Licenses, Certifications, Training:
There was a total of 30 personnel record(s) reviewed, eight (26%) professional and 22 (25%) paraprofessional.
During the review of the personnel records, the following deficiencies were noted.
Personnel Rule Credential Outcome Reviewer Notes
Record Validated
Number
SR014712 241.100B State Background Failed No file received
Check
Clinical Summary
As a part of the Quality of Care survey of the IOC, an active Fee for Service (FFS) Medicaid client list was
requested, client and/or guardian interviews were conducted, and a clinical record review was completed. The
following is a summary of findings and noted deficiencies.
Client/Guardian Interviews:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no client interviews
were conducted.
Clinical Record Review Deficiencies:
No active FFS Medicaid clients currently admitted at the time of IOC. Therefore, there were no clinical records
reviewed.
Program Activity/Service Milieu Observation:
Clients were observed in multiple classrooms and in a group therapy session in the common area on one unit.
Staff were engaged with the clients and were providing a therapeutic environment that was conducive to
learning.
Medication Pass:
No active FFS Medicaid clients received medications during medication pass. Due to the observation of non-
Medicaid clients not being complaint with the HIPAA minimal necessary rule, no medication pass was
observed. AFMC RN visited with the Piney Ridge Treatment Center medication nurse who was able to show
AFMC RN the facility policies and procedures regarding medication administration, narcotic
count/reconciliation/handling, and medication discrepancies.
The tour of the medication room was completed with the Piney Ridge Treatment Center medication nurse. The
medication room was clean and well-organized in a way to provide safety in medication administration. There
were two vials of tuberculin skin test found to be open in the medication refrigerator. Both vials were not
labeled with the date they were opened or with the initials of the nurse who opened them. This was reported
immediately to the Director of Nursing who removed both vials and disposed of them properly. No other issues
were noted during the medication room tour.
Piney Ridge Treatment Center – Fayetteville, AR – IOC Report 3 | P ag e

Corrective Action Plan:
The CAP must be completed within 30 calendar days of the date of the email notice of the IOC reports.
Additionally, any findings that were noted in any Health and Safety Inspection(s), which are governed by
certification rules and requirements, are shared with DPSQA and may result in other remedial actions, by
DPSQA, if warranted.
* For more details on the individual related deficiencies, please log into the portal.
Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
Piney Ridge Treatment Center – Fayetteville, AR – IOC Report 4 | P ag e

doc_type: IOC Report


summary: An x-ray was ordered after a resident complained of hand pain from hitting walls.

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: 8/23/2023
Date Received by DCCECE: 8/24/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name: (DOB ) Description of report:
Resident complained of pain to his right hand, it is suspected it is related to him hitting
walls. His hand was assessed, APRN was notified and order for x-ray was obtained. Date of
occurrence: 08/23/23 Corrective action taken by the agency or follow up done: X-ray
showed no fracture or dislocation. Reassessment today by nurse complete, patient denies
any pain at this time.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 8/25/2023 Licensing Specialist Jarred Parnell reviewed the provider
reported incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Ozark Orthopedics after fracturing his hand by hitting a wall.

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: 8/10/2023
Date Received by DCCECE: 8/11/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: DOB - Arkansas DCFS custody Description of
report: Resident reported on 8/10/23 that he was having pain in his right hand. Resident
was assessed and x-ray was complete, showing fracture to acute angulated distal 5th
metacarpal fracture. Upon questioning, he reported that he hit a wall earlier in the week.
Date of occurrence: Reported 08/10/2023 Corrective action taken by the agency or follow up
done: Resident went to Ozark orthopedics on 08/11/2023. Upon return he has orders for
buddy ring to small finger daily, ice to area and range of motion of fingers and no gripping.
Resident denies any pain at this time. Will follow-up with Ozark Ortho in 7-10 days
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing visited the facility to review personnel files and children’s records. No deficiencies were 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: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge: Ronissa Adams
Record Visit Date: 8/8/2023
Home Visit Date: 8/8/2023
Purpose of Visit: Personnel Records
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 Page 1 of 2

8/8/2023 - Licensing Specialist Jarred Parnell visited the facility to review 14 personnel records for the
following:
. All files were complete upon review.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
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: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge: Ronissa Adams
Record Visit Date: 8/8/2023
Home Visit Date: 8/8/2023
Purpose of Visit: Children’s Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
8/8/2023 - Licensing Specialist Jarred Parnell visited the facility to review seven children's records for the
following: Children's records were complete upon review.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Physician’s Specialty Hospital for evaluation after hitting her head on a wall while playing.

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: 7/8/2023
Date Received by DCCECE: 7/10/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 7/8/2023 during recreational therapy, (DOB
out of state private) reportedly hit her head face-first onto a wall while playing a
sport. She continued the activity with no issue, however later in the day she developed a
nosebleed and out of an abundance of caution, she was taken by staff to the Physician's
Specialty Hospital for evaluation and treatment. She returned with a diagnosis of a bloody
nose and needs no further treatment at this time.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/13/2023 - Licensing Specialist Jarred Parnell reviewed the provider
reported incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to the emergency room after swallowing a battery from a remote.

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: 6/27/2023
Date Received by DCCECE: 6/28/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 6/27/23 at 2030, (DOB out of state DCFS)
reported to a nurse that he removed a battery out of a remote and ingested it. On call
APRN, Tammie Smith notified via telephone at 2043, orders were received to transport the
resident to Northwest Children's Hospital Emergency Room for evaluation. A SAFE-T
PROTOCOL WITH C-SSRS was completed, to which the resident scored high on. On call
psychiatrist was notified via telephone at 2146 and orders were received for suicide
precautions x24 hr.?s. The resident was to be in continuous line of sight, bathroom
privileges with the door cracked and staff posted at the door, mattress in the hallway with
one blanket. Transport team and a nightshift RN transported the resident to Northwest
Children's Hospital at 2206 and returned at 2346. Per the emergency room physician, the
battery was identified through an abdominal X-RAY, and was noted past the stomach, and
into the intestines and would pass on its own. No new orders were received. APRN,
Tammie Smith notified via telephone. Resident given PRN Mira Lax medication to assist in
passing the foreign object, and safely went to bed in the hallway. Resident placed on self-
harm precautions x24 hr.?s and a clear liquid diet was implemented.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 6/30/2023 The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell. Licensing Specialist will contact the treatment center to inquire
further about the incident. Licensing Specialist will inquire further about , the residents
access to batteries in devices, staff ratios, staff location at the time of the incident, and
actions being taken by the treatment center pertaining to the incident. 7/3/2023 Licensing
Specialist reached out to facility regarding the provider reported incident. 7/5/2023 -
Licensing Specialist spoke to Ronissa over the phone regarding the incident. Residents
were in the classroom watching T.V. The residents are not doing school work right now but
still have time in the classroom for other activities. Residents were allowed access to the T.V
remote while watching T.V. Staff will limit access to T.V. remotes for residents by keeping
the remotes out of the classrooms and at the desk of the receptionist. When staff or residents
want to watch T.V. the staff in each classroom will go and retrieve the remotes from the
receptionist. Only staff will handle remotes for the residents. Staff will also check the
remotes before the residents leave the classroom to ensure the batteries are still in the
remote. Staff ratio for the classroom is 1:6. Ronissa said struggles with depression and it
is unclear what the resident was trying to do by swallowing the battery but may be related to
self-harm. was monitored by staff and passed the battery with no issues.


summary: A resident was transported to Children’s Hospital after swallowing a AAA battery.

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: 6/26/2023
Date Received by DCCECE: 6/27/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name: (DOB ) resident
Description of report: Resident reported that he swallowed an AAA battery. APRN was
notified and X-Ray was ordered. X-ray confirms foreign object in abdomen. APRN
consulted Children?s hospital and ordered for him to be taken in for consult. Resident was
taken to Children?s Hospital via our transportation. The resident reports that the took the
battery out of the classroom. He got it from a reading device he was using. Date of
occurrence: 06/26/2023 Corrective action taken by the agency or follow up done: Resident
returned from the hospital with orders to monitor for 2 days, clear liquids and then have a
follow-up x-ray to make sure the object is moving as it should. Risk assessment was
complete, the resident is on self-harm precautions and has a staff with him at this time.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/30/2023 - The Provider reported incident was reviewed by
Licensing Specialist Jarred Parnell. Licensing specialist will contact the treatment facility to
inquire further about actions taken by the treatment center to reduce the residents access to
device batteries, ascertain why the resident had the remote, review information concerning
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

staff location and awareness of the incident. Licensing Specialist will inquire about the
health of the resident and any special health requirements administered by staff for the
resident pertaining to the reported incident. 6/29/2023- Facility responded stating that the
resident complained of pain on 6/28/23 so he was taken to the hospital where he was given
a laxative and stayed overnight for observation. The resident passed the battery and has
been released back to the facility. 7/5/2023 - Specialist spoke to Ronissa regarding the
incident. Residents were in the classroom watching T.V. The residents are not doing school
work right now but still have time in the classroom for other activities. Residents were
allowed access to the T.V remote while watching T.V. Staff will limit access to T.V. remotes
for residents by keeping the remotes out of the classrooms and at the desk of the
receptionist. When staff or residents want to watch T.V. the staff in each classroom will go
and retrieve the remotes from the receptionist. Only staff will handle remotes for the
residents. Staff will also check the remotes before the residents leave the classroom to
ensure the batteries are still in the remote. Staff supervise the residents in the classroom as if
the residents were doing school work. The staff to resident ratio is 1:6. swallowed the
battery because he saw another resident do the same and received a lot of attention.
was referred to acute treatment but was not accepted to acute treatment.


summary: Officers were dispatched to the facility for an assault and battery report. The caller stated that his son was assaulted by another child at the facility.

raw_content:
Fayetteville Police Department
Summary
Print Date/Time: 08/21/2023 12:58 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Case Number: 2023-00041327
Case
Case Number: 2023-00041327 Incident Type: Battery
Location: 2805 E ZION RD Occurred From: 06/22/2023 07:30
FAYETTEVILLE, AR 72703 Occurred Thru: 06/22/2023 07:30
Reporting Officer ID: 474 - MCCASH Disposition: Prosecutor's Office
Disposition Date: 06/25/2023
Reported Date: 06/25/2023 12:01 Sunday
Offenses
No. Group/ORI Crime Code Statute Description Counts
1 State 13B 5-13-203 BATTERY III 1
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Informational 1 MADISON ( White Female
Informational 2 White Male
Suspect 1 2805 E ZION RD White Male
FAYETTEVILLE, AR 72703
Victim 1 2805 E ZION RD White Male
FAYETTEVILLE, AR 72703
Arrests
Arrest No. Name Address Date/Time Type Age
Property
Date Code Type Make Model Description Tag No.Item No.
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 2
Page: 1 of 1

OfficerID: ZMCCASH, Z. McCash/Case Narrative #2023-41327
Officer McCash #474
Battery 3rd (M)
Case #2023-41327
Case Narrative
On June 25th, 2023, at approximately 12:01 PM, I was dispatched to Piney Ridge,
2805 East Zion Road, for an assault and battery report. The caller stated his son was
assaulted a few days ago by another child at the facility.
When I arrived on scene, I met with the caller/victim’s father,
. stated on June 22nd, Piney Ridge called him and advised his son was
involved in an altercation with another child. They told his son was okay,
but it was up to him if he wanted to press charges. spoke with his son,
, on today’s date, and stated he wanted to press
charges.
I spoke with who stated on Thursday morning, he was talking with his friend’s,
and another child overheard. The other child, identified as
, thought was talking about him. approached as
was sitting in a chair against a wall. stated there were kids sitting on either side
of him and he could not get out. began swinging at with closed fists,
hitting him nine times total with both his right and left fists. stated he was able
to cover up his face with his arms, and hit him three or four more times in
the chest. stated after the incident, he had bruising on his left cheek bone. I did
not observe any bruising at the time of the report. stated there were cameras
that would have captured the incident.
I spoke with Alisha Baker W/F , the nurse on duty at the time of the
altercation. Baker stated her office did not have a direct line of sight of where
was sitting when he was attacked, but she walked out when she heard the
commotion. Baker stated she saw everyone standing up, but the altercation was over
when she walked over. Baker stated her report included other children’s stories that
was hit unprovoked. Baker included the details of the incident in her nurse’s
report.
The director of Risk Management of Piney Ridge, Ronissa Adams ),
provided me with guardian information. He is in the custody of DHS. His
caseworker is Madison phone number . Adams also stated their
camera footage expires after three days, so they no longer had footage of the
incident.
This case is closed and referred to the prosecutor.
Processed by J. O'Dell
Page: 2 of 2


summary: Licensing visited the facility to review personnel files and children’s records. 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: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Kendra Rice
Person In Charge: Ronissa Adams
Record Visit Date: 6/13/2023
Home Visit Date: 6/13/2023
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 12:45 pm to 1:45 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 95
Licensing Specialists reviewed three (3) personnel files:
(Behavioral Health Associate) 6/27/2002
(Therapist) 2/20/2023
(Registered Nurse) 10/17/2022
Personnel files reviewed complied with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
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: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Kendra Rice
Person In Charge: Ronissa Adams
Record Visit Date: 6/13/2023
Home Visit Date: 6/13/2023
Purpose of Visit: Children’s Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 2:00 pm to 4:00 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 95
Licensing Specialist reviewed four (4) children files:
All children’s files reviewed complied with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident scaled a fence and eloped from the facility grounds. The resident was returned to the facility by a police officer within 30-45 minutes.

raw_content:
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Y
HUtAlrl
SERVIGES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 722O3-L437
P: 501,682.8590 F: 501.683.6060 TDD: 501.682-1550
Notice of Serious Incident
Date of Incident: 6/ll/2023
Date Received bv DCCECE: 6/12/2023
Facilit_v Name: Piney Ridge Treatment Center
Faciliw Number: 203
Incident Type: Licensing
Report Description: On 6/ll/2023 at approximately 1445, , (DOB out of
state dcfs) u'as outside with the remainder of his unit and staff, He becam€ upset and pulled
a board off of the perimeter fence in the West outside area. Staff member retrieved the board
from the resident and stood in front ofthe gap ofthe fence. At this moment two other
tesidents statted to posture each other, and the staff member stepped away from the fence
opening and scaled the fence. A staff member followed, and the police were notified
at 1445. Staff member sa,r, that the resident was at the next-door area and informed the
police. The responding officer was notified, and he intercepted the resident u'alking down
the street. The resident was returned to the faciliw bv the officer withing 30-45 minutes from
the incident. He u'as assessed for injury by a nurse, and it is noted that he did not have an
injury, nor did he report one.
Interim Action Narrative: Staff intervened and retrieved the fence board from the resident.
Staff followed resident and the authorities w.ete called. Resident q'as placed on elopement
ptecautions.
[f alfteatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with the facilitv. Licensing Specialist informed there was no camera
footage ofthis incident. Resident was placed on elopement precautions. A review ofhis
medication was completed and some of his medication has been changed.


summary: Officers were dispatched in response to a report that a resident climbed a fence and escaped from the facility.

raw_content:
Incident Report
Print Date/Time: 07/14/2023 10:26 Fayetteville Police Department
Login ID: ttannehill ORI Number: AR0720100
Incident: 2023-00039538
Incident Date/Time: 6/11/2023 2:45:00 PM Incident Type: MISSING PERSON
Location: 2805 E ZION RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: Source: Phone
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
375 375-GEORGE
480 480-PERALEZ
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller BOHANNON, KEITH 4253 N CROSSOVER RD (479)587-1408 White Male 03/29/1983
ALLEN
FAYETTEVILLE AR 72703
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count
03NORPT 2
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 3

CAD Narrative
06/11/2023:15:00:00jcurryNarrative:37510-12@ZION/RANDALL,375TRANTOPINEYW/JUVBM574.AS2375EM575
06/11/2023:14:48:00jcurryNarrative:26010-4@14:48
06/11/2023:14:45:00lusmithNarrative:STAFFHAVENOTSEENTHESUBJDURINGCANVASSING,SUBJWASBROUGHT
STRAIGHTTOFACILITYFROMNE.SUBJWENTONANOUTINGON6/9TOLAKEFAY.NOFRIENDSORRELATIVESIN
AREA
06/11/2023:14:45:00lusmithNarrative:SUBJHASBEENATPINEYRIDGEFOR3WEEKS.HASCASEWORKEROUTOF
NE-INFOATNURSESSTATION.UNKIFPARENTALINFOISAVAILABLE-LEGALGUARDIANISCASEWORKER.STAFF
ARECANVASSINGTHEAPTCOMPLEX.ANOTHERSTAFFMEMBERISATTHEGASSTATION.UNKDESTINATION.
SUBJISNOTFROMTHEAREA,ISFROMNEUNKCITY.MEETCALLERATFRONTOF2805EZIONRDINLOBBY,
CALLERISWALKINGTHERENOW.
06/11/2023:14:45:00lusmithNarrative:STAFFMEMBER-DESTINYLNUUNKDOB,NOCELLPHONE,NONOTESOR
VERBALTHREATSOFRUNNINGAWAY.NOALTERNATEMODEOFTRAVEL.
06/11/2023:14:45:00lusmithNarrative:SUBJISAGGRESSIVE-COULDBEAGGRESSIVEWITHOFFICERS.SUBJ
WRESTLEDASTAFFMEMBERANDCLIMBEDOVERTHEFENCE.LASTSEENCLIMBINGOVERTHEFENCEINTO
VALLEYLAKEAPTS.NOINJURIES,PRIMARYLANGUAGEISENGLISH,PICTUREAVAILABLEATPINEYRIDGE
FACILITY,,NOPETSWITHSUBJ.THEREISAPOOLATVALLEYLAKE.LASTSEENBYSTAFFMEMBER-NOTCALLER
06/11/2023:14:45:00lusmithNarrative:ESCAPEDPTFROMPINEYRISGE,HASGONETOVALLEYLAKEAPTS.ELISHA
MAYUNKDOB,UNKMIDDLENAME.CALLERISPURSUINGANDDOESNOTHAVEANYINFOWITHHIM.W/M14YOA
507/SLIMLONGBLKHAIRUNKEYECOLOR.WEARINGGRNSWEATSHIRTANDBLKPANTS.NOSMT,NO
BELONGINGS,NOC1,NOC2,MENTALHEALTHISSUESUNKSPECIFICS.
Page: 2 of 3

CAD DOWN
Page: 3 of 3


summary: Licensing visited the facility to discuss the new facility building. Technical assistance was provided for 912.3 for light water pressure in the bathroom of the West Unit dayroom.

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: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Chelsea Vardell
Person In Charge: Justin Hoover
Record Visit Date: 5/25/2023
Home Visit Date: 5/25/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Number: 9. 912. 3
Regulation Description: There shall be an adequate supply of hot and cold running water.
Findings Description: Bathroom in the dayroom of the West Unit had a sink with very little water pressure.
Action Due Date: 5/25/2023
Action Due Description: The facility reports they have extra faucets and will have this one replaced by
5/25/2023.
Comply Date:
Sub Regulation Description:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Regulations Not Correctable:
Narrative:
The Program Coordinator visited the facility and discussed the new building the facility is having made. The
CEO Justin Hoover discussed the layout of the new facility and showed a diagram of ways they have designed
the building to ensure better programming and safety for their residents. The projected completion date for the
new building is December of 2024.
Licensing discussed how the facility checks to ensure their overnight staff are completing appropriate visual
checks on the residents during overnight shifts. The facility reports they do video checks, they schedule a
floater to relieve staff who need to go on break or use the restroom, and they have a shift supervisor who
monitor staff actions so they can address and identify any needs for retraining.
A walkthrough of the facility was conducted of the MPR room, cafeteria, outside recreation area, South Unit
(rooms 400, 401, 404, and 408), South Unit Dayroom, West Unit (rooms 101, 102, 103, and 106), and the
West Unit Dayroom.
The facility reports they stopped doing seclusion at their facility and have instead turned those rooms into
storage areas for staff to keep activities for the children. These areas were viewed during the walkthrough.
Ratios were observed as follows: Explores Classroom 3:15 + 1 Teacher. Math Class 2:15 + 1 Teacher English
Class 3:13 + 1 Teacher and a class transitioning was observed 3:12 in the hallway.
We could not view the bathroom in 102 as it is currently being repaired. The West Unit Dayroom bathroom
had very low water pressure in the bathroom sink so that you could not wash your hands properly. The facility
reports the faucets are a poor design, but they have extra since they take time to arrive when ordering. The
facility, put in a work order for the faucet and reports it will be replaced by the end of today.
Provider Comments:
CCL Staff Signature : Date: 6/6/2023
Provider Signature : Date: 6/6/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Officers were dispatched to the facility in response to a complaint that juveniles were throwing rocks at the complainant’s building.

raw_content:
Incident Report
Print Date/Time: 07/14/2023 09:01 Fayetteville Police Department
Login ID: ttannehill ORI Number: AR0720100
Incident: 2023-00034327
Incident Date/Time: 5/21/2023 1:28:00 PM Incident Type: CRIMINAL MISCHIEF
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)313-5051 Source: Phone
Report Required: No Priority: 3-Low
Prior Hazards: No Status: Report
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
472 472-GONZALEZ
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller LATRECCHIA, LORIE 4276 N VALLEY LAKE DR 9 (479)313-5051 White Female 09/10/1962
ANN
FAYETTEVILLE AR 72703
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count
03NORPT 1
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
05/21/2023:14:18:29agonzalezNarrative:SPOKEWITHCALLER,THEREISNODAMAGE.IADVISEDIWOULDCOME
SPEAKWITHSTAFFATPINEYRIDGE.IADVISEDSTAFFANDWASGIVENATOUROFTHEFACILITY.CALLERWAS
OKAYWITHJUSTNOTIFYINGSTAFF.D3
05/21/2023:13:32:05bwhiteNarrative:CALLERLIVESAT4276VALLEYLAKEDR#9
05/21/2023:13:31:05bwhiteNarrative:NOTTHROWINGROCKSANYMORERIGHTNOWBUTADVTHEYPROBABLY
WILL
05/21/2023:13:30:29bwhiteNarrative:UNKHOWMANYKIDSAREOUTTHERE,CALLERCANHEARTHEMYELLING&
HOLLERING
05/21/2023:13:30:05bwhiteNarrative:THISISANONGOINGISSUE,CALLERSWINDOWSHASBEENBROKENOUT
BEFORE
05/21/2023:13:29:42bwhiteNarrative:CALLERLIVESATVALLEYLAKEAPTS
05/21/2023:13:29:37bwhiteNarrative:KIDSINTHECOMPLEXNEXTDOOR(PINEYRIDGE)THROWINGROCKSAT
CALLERSBLDG
Page: 2 of 2


summary: A resident was found in the shower with pants tied around her neck. The pants were removed, and the resident was placed on self-harm precautions.

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: 5/14/2023
Date Received by DCCECE: 5/15/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: Resident (DOB ) was not responding to staff
while she was in the restroom. The nurse opened the door to find her in the shower floor
with pants tied around her neck. Nurse was able to get the pants off from her neck, resp and
pulse within normal limits. Resident originally reported she was playing the choking game,
but then started crying because she missed her mom. Complete assessment was done, she
scored low on suicide risk assessment, and however she was placed on self-harm
precautions and monitored closely. Upon re-assessment the resident was no longer upset,
no injuries from having the pants around her neck.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/15/2023- Licensing emailed the facility to determine resident's
guardianship and safety plan. The facility responded that she was placed on self-harm
precautions by the nurse and they will follow-up with the therapist to let licensing know if
there was any new safety plan put in place. Additionally, the resident is in DCFS
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

custody. 5/16/2023- Licensing requested the facility to retain any video footage of this
incident for review and send all nursing/staff notes to the Program Coordinator. 5/17/23-
Licensing received a copy of the nursing notes. 5/25/23- Licensing visited the facility and
was informed there is no video footage available for review. The resident was in her own
bathroom that is inside her own bedroom when the incident occurred.


summary: A resident was arrested and transported to JDC after destroying property and hitting and kicking staff.

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: 5/11/2023
Date Received by DCCECE: 5/12/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: On 5/11/23 at approximately 1700 (DOB out
of state, private) was in the north dayroom and found out that his level was dropped. He
became escalated and threw items, kicked the door and staff attempted to de-escalate. He
then started hitting his shoe against the video camera on the unit and ripped it off the
ceiling. He was restrained for safety as he continued to be escalated and during the restraint
he kicked and hit at staff and received emergency medication. was released per
protocol, and he continued the physical aggression toward staff and was placed in a supine
hold for additional intervention but was not able to be safely held. He then tore down
additional cameras and pulled bolted down row of seats up on the unit, apparently
obtaining a screw. He punctured a staff member?s arm with the screw (no apparent serious
injury) and pushed and hit other staff members. The LPN called the administration and
asked for intervention by the Fayetteville Police Department. The FPD were contacted, and
they came to the facility and took the resident to the local juvenile detention center where he
is charged with criminal mischief and 3 charges of battery. At this time, a final decision has
not been made of whether or not he will return to the facility.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 5/12/23- Licensing emailed the facility 5/25/23- Licensing visited the
facility, but was informed that there is no video footage of the incident because the resident
broke the cameras during the incident. The resident was taken to JDC at the time of the
incident. However, the facility sent staff to interview the resident at JDC and they
determined that he was now stable enough to return to the facility to continue his treatment.
The resident has since returned and is no longer having major violent outbursts, but the
facility reports he is making minimal progress with the treatment.