summary: A resident was transported to Arkansas Children’s Hospital after injuring her wrist while playing volleyball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021380
Date of Incident: 5/18/2024
Date Received: 5/20/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 05/18/24 1:58pm Location of Incident: Gymnasium on Youth Home campus
Incident Description: Medical Emergency(Trip to ER/Urgent Care), Patient Injury Staff
Involved: r Events Leading: Client was actively playing
volleyball with staff and peers. Client fell twice on her bottom and continued to play. Client
went to sit and take a break then came to staff reporting that her wrist was hurting and that
she thinks she sprained it. The nurse was called immediately. Nursing Assessment 1
date/time: 05/18/24 2:05pm: This RN was called and it was reported that pt injured her L
wrist playing volleyball. pt reports that started to feel severe pain while tossing the ball. L
hand /wrist noted with mild swelling. limited ROM to L hand/wrist with pain. LOP 8/10.
cap refills < 3 sec. pulses palpable to L wrist. Tylenol PRn administered and ice pack
provided. Dr Bayles notified of the findings and ordered to take pt to ACH ED for eval/tx of
the injury. UM on call notified of the orders. staff left YH with the pt at approx 2:35 pm.
Nursing Assessment 2 date/time: 05/18/24 5:25pm: Pt returned from ED.
Dr Bayless notified. Ordered to place pt on
activity Limit x 48 hr. Mom notified of the findings. pt instructed on the use of the ACE
wrap, verbalized understanding. pt reports reduced pain to 6.
Guardian was notified by nurse on 05/18/24 at 2:21pm and 5:26pm ER
paperwork was emailed to Tara Norton and Kendra Rice.
Interim Action Narrative: After nurse assessed resident, Dr. Bayles ordered resident to be
transported to ACH to be evaluated. Resident diagnosed and was
advised to
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humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: 5/20/24, Licensing Specialist reviewed provider reported incident for
licensing concerns. Incident report and nursing notes were reviewed and uploaded.


state: AR

facility_name: Youth Home

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

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021275
Date of Incident: 5/14/2024
Date Received: 5/15/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Rose House Incident Report
date/time: 05/14/24 7:28pm Location of Incident: Rose House Intervention Type: Personal
Restraint, Acute Placement Incident Description: Self Injury (Not Suicidal), Aggressive to
Adults, Threat to Safety Staff Involved:
Events Leading: Client was prompted to put away her markers due to not
being able to have them while being on eyeball. Client then began to pick at her fingers and
was prompted many times to stop. Client then made her finger bleed and went onto pulling
another scab and causing it to bleed as well. Client was placed in a restraint and became
very violent. Client was then taken to seclusion. 7:28pm: Personal Restraint: Client began to
scratch at staff and made several attempts to bite staff. Client screamed "let me go". Staff
assured client once she displayed safe behaviors they would let her go. Client then made
attempts to pull staff 's hair while using profanity to express her emotions. Client began to
kick at staff during this time as well. Client made attempts to hit her head against the floor
repeatedly. 7:43pm: Personal Restraint: Staff continued to try to deescalate the client. Client
assured staff she would not be safe if released from the personal restraint. Client talked
about missing her biological mother that is deceased. 7:51pm: Personal Restraint End:
Client began to display tension reduction. She was able to contract for safety and was
released Patient Debriefing date/time: 05/14/24 7:55pm: Staff assured client it is okay to
express her emotions but use safe alternatives. Client began process with staff about
missing her biological mother that is deceased. Staff continued to offer the client verbal
support. Nursing Assessment date/time: 05/14/24 8:04pm: Pt rec'd in day area after
released from PR. Pt is alert and oriented to self/situation. VS as follows: BP 122/91 HR 98
RR 16 temp 98.3F. Resp even, unlabored. Denies pain/injury. Full ROM in all extremities
w/o pain. Area of redness noted to L wrist w/ superficial abrasion. No bleeding/drainage.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Pt states she may have scraped it on a staff members keys during personal restraint. Pt
endorses pain when nurse presses on scalp, states that she hit the back and front of her head
purposefully. No bruising, bleeding, bumps, or swelling noted. Pt denies dizziness, light
sensitivity, n/v. Provider on call notified of assessment. See new orders. No further needs at
this time. Guardian was notified on 05/14/24 at 8:52pm was transferred to Pinnacle
Pointe for an acute stay at 12:15am last night.
Interim Action Narrative: Resident was transferred to Pinnacle Pointe for an acute stay due
to self-injury and becoming violent towards staff.
Maltreatment Narrative:
Licensing Narrative: 5/17/24, Licensing Specialist, reviewed provider reported incident for
licensing concerns. Sent email to facility to request nursing notes for resident. 5/20/24,
Uploaded and reviewed nursing notes from incident. Emailed facility to inquire if resident is
expected to return to the facility. 5/20/24, Facility response: At this time, she will return to
our PRTF program. I will update you if this changes.

doc_type: Notice of Incident


summary: Officers were dispatched to Youth Home to assist EMS with transport of a resident to acute care.

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

Case P24-005158 Printed on May 24, 2024

Status Approved
Report Type Patrol
Primary Officer Lance Parker
Investigator None
Records Technician
Reported At 05/13/24 17:34
Incident Date 05/13/24 17:34
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 05/14/24 00:04
Review for Gang Activity None

Asst Officers
2X71 - Bass, Steven

Primary Narrative By Lance Parker, 05/13/24 23:54

Disturbance

On 5/13/2024 at approximately 1804 hours Deputy Bass and |, Deputy L. Parker, were dispatched to the youth home
located at 20400 Colonel Glenn Road in Little Rock, AR for a disturbance. We were informed prior to arrival that one of
the clients was threatening staff members and acting in an aggressive manner after hearing the news
that nould be getting transported to another facility for acute care; they further advised that thev had restrained

Upon arrival, Deputies made contact with the caller, Sebrina Patton, who advised that had since
calmed down and they had unrestrained __. Patton advised that there was no physical altercation that took place. She
advised that was upset about having to move to a different facility and lashed out in the form of threats,
aggressive behavior and causing minor damage to a restroom; none of which are actions that Patton wished to pursue
charges for. Patton provided Deputies with acopy of ___ _ face sheet and we stood by for security while MEMS
arrived on scene to transport Patton was provided a copy of the report number and advised to call the
Sheriff's Office if they needed any further assistance.

Case P24-005158 Page 1 of 1

doc_type: Police Report


summary: Officers were dispatched to Youth Home regarding a 911 hang up call. False alarm.

raw_content:
Case P24-004983 Printed on May 24, 2024
Status Approved
Report Type Patrol
Primary Officer Demoniae Walls
Investigator None
Records Technician
Reported At 05/09/24 11:08
Incident Date 05/09/24 11:08
Incident Code 911 : 911 HANGUP
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 05/09/24 16:12
Disposition Comments
KDB 1719
Review for Gang Activity Not Applicable
Primary Narrative By Demoniae Walls, 05/09/24 16:26
911 HANGUP
On 05/09/2024 at approximately 1110 hours, I, Deputy D. Walls, was dispatched to a 911 hangup call at 20400 Colonel
Glenn Road.

Upon arrival, I did not see anyone needing immediate law enforcement or emergency medical services.

I made contact with Ms. Peggy Kelly. Ms. Kelly advised that she was the COO of the Colonel Glenn Youth Home. Ms.
Kelly advised that everything appeared to be okay, and there was no need for a law enforcement response.

No further actions were taken.
Case P24-004983 Page 1 of 1


summary: A resident was sent to Arkansas Children’s Hospital after staff performed the Heimlich Maneuver due to him choking on potato chips.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021132
Date of Incident: 5/8/2024
Date Received: 5/9/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Sturgis House Incident Report date/time:
05/08/24 12:45pm Location of Incident: Cafeteria Incident Description: Medical
Emergency(Trip to ER/Urgent Care) Staff Involved:
Events Leading: Patient was eating lunch when he
began choking on some potato chips he was eating with his lunch; a nurse stat call was
made, staff performed heimlich dislodging chips patient was choking on, and then nursing
staff arrived and took over. Nursing Assessment date/time: 05/08/24 12:46pm: was
observed sitting at the lunch table with DON, coughing and dry heaving into a box. C/o
feeling as if something was still lodged in throat and need to vomit. No emesis noted.
Patient continued to cough and spit into the box. A cold wet towel was placed on the back
of patient's. Nearby team members reported a ball of chips was dislodged from patient's
throat and spit out following Heimlich Maneuver. AAOx4. Airway appears patent as client is
able to talk, cough, and breath without difficulty. No signs of respiratory distress, labored
breathing, or wheezing. No signs of nasal flaring. No signs of pallor or cyanosis. Patient
continued to cough and spit into box. Attending MD notified with order to transport client
to ACH ER to rule out injuries to esophagus, further obstruction, or aspiration. Patient was
able to ambulate to the van without difficulty. Instructed to avoid eating or drinking
anything until evaluation. Guardian was notified on 05/08/24 at 1:14pm and 5:00pm
Guardian was called and notified via voicemail that client was being transported to ACH ER
to rule out injuries, obstructions, or aspiration following choking that required the Heimlich
maneuver. Patient returned from ACH ER with
Can use Maalox or other heartburn meds for pain control if needed. Maalox
administered to ACH ER at 1505. Guardian called and notified of patient returning to
campus and findings.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Resident was choking on chips he was eating during lunch. staff
performed Heimlich dislodging chips patient was choking on, and then nursing staff arrived
and took over. Attending MD notified with order to transport client to ACH ER to rule out
injuries to esophagus, further obstruction, or aspiration. Resident returned from ACH ER
. Was prescribed
Maalox or other heartburn meds for pain control if needed. Guardian called and notified of
resident returning to campus and findings.
Maltreatment Narrative:
Licensing Narrative: 5/9/24, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns. Uploaded documentation from ACH to ELS.


summary: A resident became aggressive and attempted to elope after witnessing a peer elope from the facility.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021123
Date of Incident: 5/7/2024
Date Received: 5/8/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Sturgis House Incident Report
date/time: 05/07/24 1:04pm Location of Incident: Siebert School Incident Description: Self
Injury(Not Suicidal), Attempted Runaway, Threat to Safety, Property Destruction Staff
Involved:
Events Leading: Pt. became upset after witnessing a peer
elope into woods. Pt. asked for a PRN from the nurse. Before nurses could respond to pt.,
pt. began picking up desks and throwing them. Pt. then charged at door, pushing through
staff. Pt. was placed in hold. 1:04pm: Personal Restraint: Pt. was placed in personal restraint
due to throwing desk and running out of classroom. Pt struggled against hold. 1:05pm
Personal Restraint End: Pt. was able to get out of staff hold and run toward d zone. Staff
attempting verbal support. 1:06pm Other/None: Staff attempted to deescalate pt. while out
of hold, encouraging pt to catch his breath. Pt. escalated and threw trashcan, ran out of the
d zone, and began punching door, breaking the glass. 1:07pm: Personal Restraint: Pt kicked
open the door and preceded to walk away from staff towards the road. While doing so, he
began self harming by hitting himself in the head. Pt was encouraged to decompress, slow
his breathing, and asked what he needed. 1:09pm: Personal Restraint End: Pt began to calm
down and complied with staff and was released out of the restraint and escorted to the D-
zone. Patient Debriefing date/time: 05/07/24 1:20pm: Pt was compliant and understood
that he could have used his coping skills when he gotten frustrated and angry and was
encourage by staff to ask or any help or assistance when those times arise again. Nursing
Assessment date/time: 05/07/24 1:13pm: According to staff observations, the patient
became upset upon witnessing a peer eloping into the woods and requested a PRN from the
nurse. Without delay, the patient began picking up desks and throwing them. Following
this, the patient charged at the door, pushing through the staff, necessitating restraint. The
patient then kicked open the door and walked away from the staff towards the road. An
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

initial face-to-face assessment was conducted by a nurse at 1313. Upon examination, no
physical markings were noted, and the patient reported no injuries from the restraint,
declining medication. Staff informed the nurse that the patient began hitting himself in the
head while walking away. Another face-to-face assessment, along with a neuro exam,
occurred at 1448, revealing the patient to be conscious, alert, aware, and oriented x4 with a
steady gait. Vital signs at this time were BP: 105/72, R21, HR: 85, T: 98.2. The patient
denied experiencing numbness, tingling, nausea, vomiting, or lightheadedness at the time,
expressing a sense of calmness, and attributing the incident to feeling upset. The medical
doctor was promptly notified, and orders: Freeze, HR, RR, and hydroxyzine 25mg PRN
BID were approved. At 1452, the patient's mother was informed, indicating that the patient
tends to hit himself when upset but typically calms down after finding a quiet area or going
outside. The nurse assured the mother that she would relay the strategies that help the
patient calm down. Consent for PRN medication was obtained from the patient's mother.
All immediate needs were promptly addressed. Guardian was notified on 05/07/24 at
1:54pm and 2:52pm
Interim Action Narrative: Staff placed resident in two separate holds after resident began
throwing desks, breaking glass out of a door, kicking a door open, and began walking
toward the road. While walking toward the road, resident began hitting himself in the head.
Staff followed and encouraged resident to decompress and asked resident what he needed.
Resident was able to calm down and comply with staff. He was assessed by the nurse and
the medical doctor was promptly notified, and ordered: Freeze, HR, RR, and hydroxyzine
25mg PRN BID were approved. Guardian was notified and gave consent to administer PRN
medication.
Maltreatment Narrative:
Licensing Narrative: 5/9/24, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns. Emailed facility to inquire if video footage is available for review.
5/13/24, Sent email to facility to schedule time to review video footage. 5/15/24, facility
visited to review video footage. No citations given. 5/24/24, Facility sent email to inform
licensing that the broken door has been repaired. Photo was sent and uploaded into Notes
and Attachments.


summary: A resident was sent to Urgent Care after complaining of hand pain due to punching a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021012
Date of Incident: 5/2/2024
Date Received: 5/3/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for is a
private placement client in our PRTF program and resides in Rose House Incident Report
date/time: 05/02/2024 6:30pm Location of Incident: Rose House Incident Description:
Patient Injury, Medical Emergency (Trip to ER/Urgent Care) Staff Involved:
Events Leading: Pt came to nurses station c/o sore hand. Pt
states that after a bad phone call w/ mother she went to her room and punched the wall.
Upon assessment, R knuckles are swollen and beginning to turn purple. Pt tells this nurse
that she has trouble feeling ends of fingers. Capillary refill <3 sec. Contacted provider. Pt
sent to urgent care per provider on call. Nursing Assessment date/time: 05/02/24 9:00pm:
Pt came to nurses station c/o sore hand. Pt states that after a bad phone call w/ mother she
went to her room and punched the wall. Upon assessment, R knuckles are swollen and
beginning to turn purple. Pt unable to move fingers/make fist w/o c/o significant pain. Pt
tells this nurse that she has trouble feeling ends of fingers. Capillary refill <3 sec. Contacted
provider. Pt sent to urgent care per provider on call. Pt returned about 2100.
Ice/compression recommended for at least 20min per day, rest recommended. Splint given
by UC. F/U appt made for 5/10 @ 1320. Pt given ibuprofen per MAR for pain in hand.
Contacted provider on call. Pt placed on close obs. No further needs at this time . Guardian
was contacted on 05/02/24 at 7:06pm, 8:13pm, and 9:29pm
Interim Action Narrative: Facility took resident to urgent care after she punched the wall as
a result of a bad phone call with her mother. Follow up appointment was made for 5/10/24
at 1:20 p.m.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: 5/6/23, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns.


summary: Resident left the dinner line and exited the front of the administration building, walking toward a neighbor’s home. As staff looked for the resident, they were waved down by a neighbor.

raw_content:
cafeteria, heading toward the neighboring house. . Another nurse reported that she
expressed her inability to return to the Youth Home. The nurse effectively soothed her, and
she returned to Mabee House. Upon examination, the patient stated no physical injuries,
and the nurse observed no visible injuries at the time. The patient requested to contact her
parents. Staff confirmed that she contacted her father and explained that she had gone to
the neighbor's house during dinner because she desperately wanted to speak with her
mother and leave the facility. In conversation with the nurse, the patient expressed the need
for more extensive care than what the facility could offer. The nurse informed her that the
provider would review her case the following day to determine if a transfer to acute care was
necessary. The patient took her prescribed nightly medication, including PRN medication,
to alleviate her anxiety. Additionally, due to the patient's unauthorized departure from her
designated area, she will be placed on house restriction, nurse received approval from the
on-call MD. Guardians were notified on 05/02/24 at 10:30am by Residential Clinical
Program Director. was transported Pinnacle Pointe for an acute stay on 05/02/24 and
will not be returning back to Youth Home at this time.
Interim Action Narrative: After staff talked to resident and calmed her down, staff walked
client back to facility. Resident was transported to Pinnacle Pointe for an acute stay on 5/2.
Maltreatment Narrative:
Licensing Narrative: 5/2/24, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns. While Licensing Specialist was at the facility on a different matter,
Licensing Specialist was informed that the facility was about to transfer this resident to
Pinnacle Pointe for an acute stay. 5/3/24, emailed facility to obtain a copy of the nursing
notes, to inquire about ratio and video footage of incident prior to resident going to
neighbor's house. 5/6/24, uploaded nursing notes to case and reviewed. 5/13/24, emailed
facility to confirm that resident would not be returning to facility after her release from
acute. Facility confirmed resident would not be returning.


summary: A resident exhibited self-harming behaviors, such as kicking a door and wrapping a cord around her neck, after an upsetting phone call with her parents. The facility was cited 911.15.d due to the resident having access to a loose cord.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020815
Date of Incident: 4/23/2024
Date Received: 4/24/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in Mabee House Incident Report
date/time: 04/23/24 8:00pm Location of Incident: Mabee House Incident Description:
Suicidal, Aggressive to Peers, Threat to Safety, Property Destruction Staff Involved: Kelton
Johnson, Michael Tucker, Kierra Taylor, Marilyn Howell Events Leading: Client had a bad
phone with her parents. Client was upset because of her conversations with peers. She asked
her parents to come get her. Her parents told her that she will not be coming home until she
finishes her treatment. Client was upset. Client started to pace back, and forth. Client
started to kick door down to plan an escape. Client was redirected to stop kicking the door.
Client then charged as though to strike another client. Staff stepped betwen clients to avoid
this conflict. Client then became more angry. Client started to grab electronic cords, and
wrap them around her neck. Staff grabbed the cords and prevented client from wrapping
them around her neck. Client redirected to sit in the milieu and offered to have a talk away
from others in the recreation room. Client sat in a chair in the milieu and became tearful
with staff offering verbal support that they were here for her and offered another area to de-
escalate. Client grabbed for her own neck, and staff provided supportive touch, placing their
hands on hers and prompting to not do this. Client continued crying and lowered her hands.
Staff continued supportive touch, encouraging client to walk with them to the rec room.
Client walked with staff with no resistance, sat in the rec room and continued crying,
processing with staff about the phone call. Nursing Assessment date/time: 04/23/24
8:10pm: She walked into the nurses' station but would not speak or answer my questions.
Redness was noted to her face & neck but no marks apparent. Pt appears to be very upset,
slight body shaking noted, tight posture. I did ask her multiple questions to see what was
going on but she still would not answer. I noticed that there was a male staff member
standing outside of the door pacing/watching and not saying anything. So out of curiosity I
asked him if she was put in a restraint and he stated that she was not. After sitting in nurses'
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

station for a few minutes ended up walking out and went to sit at a table. No acute
distress noted. Guardian was contacted on 04/23/24 at 8:22pm: Spoke with father to inform
him of the events that took place this evening after their phone call. Informed him that pt. is
requesting to go to acute but that is not in the plan at this time. Informed him that she has
orders for front of house, eyeball, and run risk. He stated that he was aware that she was
very upset about them not coming to check her out due to her behavior.
Interim Action Narrative: Staff redirected resident and nurse assessed resident after she
became aggressive and wrapped cords around her neck out of anger. Staff removed cords
from resident's possession to prevent her from wrapping them around her neck.
Maltreatment Narrative:
Licensing Narrative: 4/25/24 - Licensing Specialist reviewed Provider Reported Incident
for licensing concerns. Will check with facility to see if acute placement is currently needed
or if there have been any other issues. 5/1/24, Licensing Specialist sent email to facility to
review video footage of incident on 5/2/24 at 1:30 p.m. 5/1/24, Visit scheduled for 5/2 at
1:30 p.m. to review video footage of incident. 5/2/24, Facility visited in response to incident.
Camera footage reviewed. Facility cited for 911.15.d.


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

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020496
Date of Incident: 4/10/2024
Date Received: 4/11/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Client: PRTF client
Chestnut house Incident Start: 4/10/24 @ 3:15 PM Intervention Type: Personal Restraints,
Locked Seclusion, Acute Placement Incident Description: Aggressive to adults, threat to
safety Staff Involve: Shelia Glass (Personal Restraint, Reporting Staff, Seclusion), Darryel
Sanders (Initiating Staff, Personal Restraint, Seclusion), Jon Pulliam (Personal Restraint,
Seclusion), Joseph Davis (Nurse, Personal Restraint, Seclusion) De-escalation Techniques
prior to intervention: Staff Support and Voluntary Timeout/Comfort Room Events Leading:
Once the rest of the patients came from school and went to their rooms, patient remained in
the milieu. Staff asked patient if he wanted to talk with staff and he stated he did not.
Patient went to the rec room and sat in a chair. While the unit manager was talking with
another patient, patient turned the radio up and was asked to turn it off if he wanted to
remain in the rec room. Patient then attempted to push the radio. Staff stepped in front of
the radio. Patient then began rolling the chair out into the milieu and to the back dorm area.
Patient was asked to return to his room in which patient ignored staff's request. Patient then
took his chair and rammed it into the staff's desk causing it to shift. Patient then rolled his
chair and took the back of his chair to try to open a patient's door that was shut. Staff pulled
the chair back from the patient's door. Staff had talked to patient for over twenty minutes
with patient offering alternatives such as processing, going to his room or the comfort room
but patient refused and also did not want to follow directions. Patient was informed that due
to his unsafe behavior that he would be asked to go to unlocked seclusion if he could not go
to his room. Patient continued to sit in the chair. 3:15 PM Personal Restraint: Staff placed
patient in personal restraints. Patient then stated that he wanted to return to his room. 3:15
PM Personal Restraint End: Staff informed patient that he would be released in order for
him to walk to his room. Patient snatched his arm away from staff. Patient was released
from personal restraints. Patient then went behind the door and in his room and started
beating on the door. Staff informed patient that he was released so that he could calm down
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

in his room. Patient did not respond to staff. After five minutes, patient walked out of his
room and into the milieu to sit in a chair. Staff asked patient to return to his room in which
patient refused. Staff offered the patient time in the comfort room but informed him that he
could not remain in the milieu. Due to patient's unsafe behavior, patient was placed in
personal restraints. 3:24 PM Personal Restraint: Patient began struggling and became
aggressive with staff by kicking staff in the leg. He then began using profanity and asked
staff to get off of him. Staff began removing patient's shoes as he continued to struggle. 3:26
PM Personal Restraint End: Patient continued to aggressively struggle while in personal
restraint. Staff was talking to patient and asking him to calm down but patient continued to
demand that staff get off of him and continued to escalate. Patient was released from
personal restraints. 3:27 PM Locked Seclusion: Due to patients volatile, aggressive and
unsafe behavior, patient as placed in locked seclusion. Patient began screaming and stated
that staff scratched him. Staff informed patient that staff's hand was on the sleeve of his
shirt as he was being held underneath his shoulder. Patient then began banging on the
window. Patient began demanding to come out of the seclusion room. Patient stated that if
staff would allow him to come out, he would stop banging on the window and screaming.
Staff informed patient that he had to show safe behavior in order for him to be released.
Patient stated that if staff wanted him to do something that staff had to do what he wanted.
Staff informed patient that he had to make the choice to calm down in order to work his way
out of locked seclusion. Staff then observed patient with his bracelet as he stated that he was
going to put it around his neck. Staff asked patient if he would give the staff his bracelet in
which he responded that he would not. 3:32 PM Locked Seclusion End: Due to patient
having the bracelet and attempting to put it around his neck, the door to locked seclusion
was opened in order to retrieve the bracelet. 3:33 PM Personal Restraint: Patient was placed
in personal restraint in order to retrieve the bracelet. Staff was able to retrieve the bracelet.
3:35 PM Personal Restraint End: Patient was released from being personally restrained.
Patient began crying and screaming at staff. 3:36 PM Locked Seclusion: Once staff released
patient and locked the seclusion door, patient began screaming that no one was trying to
help him. Staff encouraged patient to work on calming down and making right choices.
Staff informed patient that staff was there to assist him but patient stated that staff was not
there to help him. Patient again began to demand to be released from locked seclusion. Staff
informed patient that he had to work on showing safe behavior and that he can be calm as
well as compliant. After ten minutes of trying to de-escalate patient, patient then took a
water bottle out of his pocket. Patient began banging on the door with the water bottle as
well as throwing it up to the ceiling. Patient then began hitting himself on the head with the
water bottle. Staff asked patient to allow staff to retrieve the water bottle. Patient then placed
the water bottle inside of his gym shorts. 3:47 PM Locked Seclusion End: Due to patient
having a water bottle which was a safety concern and continued unsafe behavior, staff ended
locked seclusion in order to retrieve the water bottle. Patient continued to ignore staff's
directions to give staff the water bottle. 3:48 PM Personal Restraint: Patient was asked
numerous times to give staff the water bottle to no avail. Patient aggressively struggled with
staff. Patient was placed in personal restraint in order to retrieve the water bottle. Patient
was using profanity and was not being cooperative. As staff exited the area, patient grabbed
staff's shirt. Another staff assisted in helping staff to be released from patient's grip of his

shirt. 3:49 PM Personal Restraint End: Staff released patient from personal restraints. 3:50
PM Locked Seclusion: Patient began screaming at staff and then asked if he could have his
anxiety medication to help him calm down. The nurse informed patient that he had
medication at noon but that he would contact the doctor to see how soon he could
administer it to him. The nurse encouraged him to work on calming down so that he can
work out of locked seclusion. Patient then sat on the floor. 4:05 PM Locked Seclusion:
Patient was observed sitting on the floor. Staff informed patient that he was doing a good
job of calming down. Staff asked patient if he was ok but patient did not respond. Staff
continued to monitor patient. 4:20 PM Locked Seclusion: Patient continues to sit on the
floor. Staff informed patient that if he is able to remain calm and show himself safe, staff
would began the procedure of processing him out of locked seclusion. Patient did not
respond. 4:35 PM Locked Seclusion End: Patient was calm and was sitting on the floor. Staff
released patient from locked seclusion. Nursing Face-to-Face Assessment 4/10/24 3:40 PM
Client required personal restraint after multiple attempts of de-escalation. Client also has
refused to follow staff direction. Began to roll around in a chair, banging into
furniture/staff. Personal restraint was initiated to transfer client to his room, then he would
not stay in his room. Peers were moved to a different area. Client was assisted to seclusion,
he continued to struggle with staff until seclusion was locked. Attempts at processing failed
as client was agitated, screaming and banging on the seclusion window. When I asked him
the next right thing to do, he replied "your mom!". Client also stated that he has too many
people to restore with now. Client sat on the seclusion room floor. 4/10/24 4:40 PM Client
calmed down in seclusion and was released. He went to his room. Client denies pain/injury
from this incident and has no new obvious injury noted. Alert and oriented, PERRLA, gait
steady, full/active ROM all extremities. Client then came out to eat dinner as his peers were
in the cafe eating. He took his mealtime medication without incident. Respirations are even
and unlabored and there are no s/s distress noted. Client then went to his room and was
resting quietly. Around 7pm, client took PM meds without incident and was informed of
acute placement. Calm and cooperative, client packed a bag and agency staff and van
transported to Bridgeway acute around 7:45pm in stable condition. Patient Face-to- Face
Debriefing 4/10/24 4:40 PM Staff began to process with patient about how he could have
handled being upset differently. Patient stated that he did not want to talk. Staff informed
patient that once he was released that he would be on freeze status. A nurse assessed patient
and asked if he had any pain or if he was hurt. Patient stated that he was not in any pain or
hurting but became irritated by the questions. Patient was informed that he could return to
his room. Patient stated that he did not want to return. Staff asked him if he wanted to take
some time to himself and stay in the area. Patient stated that he wanted to stay. Staff moved
out of the area but monitored him. Patient later came out and returned to his room.
Guardian Notification: 4/10/24 6:50 PM Legal Guardian: 4/10/24 7:45 PM
Legal Guardian: Guardian notified on first attempt, reports assessment was
done over the phone for acute placement. Guardian notified at 7:45pm that client had just
left for transport to Bridgeway Staff Debriefing 4/10/24 5:00 PM - No injuries reported
Additional Comments: Pt is increasingly unstable. Tries to show everyone that he is a tough
kid. Tentative Safety Plan if/when client returns from acute: In the event that is
readmitted to Youth Home, he would be placed on Close Observation status (pending

doctor approval) until we can ensure that we can meet his safety needs. More finalized plans
will be made closer to discharge from Bridgeway.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/11/24, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns. 4/16/24, per facility, Resident will not be returning upon his discharge
from acute care. 4/25/24, Facility visited. Video reviewed of incident. No citations issued.


summary: A resident was transported to the emergency room due to a leg injury sustained while playing football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020400
Date of Incident: 4/8/2024
Date Received: 4/9/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Sturgis House Incident Report date/time:
04/08/24 9:40am Location of Incident: Outdoors on the Youth Home Campus Incident
Description: Medical Emergency (Trip to ER/Urgent Care), Patient Injury Staff Involved:
Barrett Harger, Valerie Alvarez Events Leading: Patient was playing football and when
running tripped and fell. On the ground he was grimacing and telling staff that his leg was
hurting. He was in a lot of pain and a nurse came to look at him and turned him from being
on his stomach to being on his back. After this, the nurses looked at his injury and decided
to have him be looked at by an urgent care physician. When the medical staff at the urgent
care examined him they told Youth Home staff that he should be taken to the ER due to the
severity of his injury. Staff ended up taking him there afterwards. Nursing Assessment
date/time: 04/08/24 9:45am: Nursing was called to the field after a client was observed
lying on the ground, face down, crying and c/o pain particularly (L) knee. He reportedly
was playing football. was assisted in rolling over in order to prevent straining or
movement of knee. He c/o severe pain, immobilization of knee, unable to extend, unable to
bend, and increased pain upon any palpation. His beanie was pulled over his face as he
continued to cry. Increasing amount of bruising and swelling noted, initially beginning at
lateral part of knee. Unable to bear weight and c/o feeling of knee buckling and instability.
Client was wearing denim jeans, making it difficult to assess above the knee. He c/o
increased pain as nurses attempted to roll his jeans up. A cold pack was applied to the
affected area. PRN ibuprofen 400mg administered. Client was assisted via (2) team
members to a nearby bench ensuring not to bear weight or twist/turn the affected area. MD
notified with assessment findings with order to send out for further evaluation. Notes: 1016:
Guardian was called and notified of injury and client currently being transported to Urgent
care. Guardian expressed understanding. He reported that he plans to attempt to visit next
week pending working "some things out on (his) end". 1047: Left guardian a voicemail
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

explaining to client and team member were now in route to ACH ER following urgent care
instructions. returned from ACH ER at approx. 1445. Dx with contusion of (L) knee.
Xray of knee normal. Care instructions: RICE for 48 hours. Rest, ice, compression, and
elevate. Administer PRN ibuprofen/apap as needed. Follow up if: the pain gets worse, pain
medicine is not helping, or bruised area gets redder, more swollen, or feels hot. Client was
given crutches and placed on activity limit. 1512: Left guardian a voicemail reporting client
returned and instructions above.
Interim Action Narrative: Resident was assessed by the nurse, taken to urgent care, and
then to the ER.
Maltreatment Narrative:
Licensing Narrative: Reviewed Provider Reported Incident for Licensing concerns. Facility
provided documentation.


summary: A resident was transported to urgent care after injuring his hand playing football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020377
Date of Incident: 4/6/2024
Date Received: 4/8/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Chestnut House Incident Report date/time:
04/06/24 2:45pm Location of Incident Report: Outdoors on Youth Home Campus Incident
Description: Medical Emergency(Trip to ER/Urgent Care) Staff Involved: William Givens,
Tatiana Shelor, Beauticia Moore Events Leading: While the patient was playing a
recreational activity, the patient threw the football irritating his left hand leaving it unable to
move..After seeing the nurse and being advised from the doctor, staff were advised to urgent
care at around 2:45 pm. Nursing Assessment 1 date/time: 04/06/24 12:45pm: This RN was
called to evaluate pt for a possible hand injury. pt reported that fell on L hand yesterday, but
after the ice was applied he felt better. today, he was playing ball outside and tried to throw
the ball and L wrist got twisted and now pt has sever pain, unable to move hand/wrist and
reports feeling numbness. LOP 10/10. reports most pain in the wrist area. cap refills < 3sec
to all digits. no apparent injury/deformity/swelling/discoloration at this time. ibuprofen
administered for pain relief per prn orders. ice pack applied to the wrist. Dr. MCClellan
notified. ordered to send pt to UC for eval/tx of L hand/wrist. Staff notified and will be
transporting the pt. departed for UC visit at 2:30 pm. Nursing Assessment 2 date/time:
04/06/24 4:46pm: Returned from UC visit. L hand/wrist wrapped with ace wrap. it was
advised by UC to have pt on activity limit/ice/ibuprofen/ace wrap. no Fx was found on
XRAY. Dr. McClellan notified and ordered Activity Limit x 48 hr, keep ACE wrap on most
of the day, may take it off to shower. Pt was given that information. staff notified. Mom
notified via the phone call. Guardian was notified on 04/06/24 at 2:14pm and again at
4:55pm
Interim Action Narrative: Resident was assessed by the nurse and sent to urgent care for
further evaluation. Resident placed on activity limit.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.


summary: Officer was dispatched to the facility in reference to a battery. Upon arrival, the officer was advised that the complainant was at the Sheriff’s Office and wanted a deputy to take photographs of his child, who was currently at Youth Home.

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

Case P24-003517 Printed on April 19, 2024

Status Approved
Report Type Patrol
Primary Officer Sean Washington
Investigator None
Records Technician
Reported At 04/03/24 09:22
Incident Date 04/03/24 09:22
Incident Code BATT : BATTERY
20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 04/03/24 11:27
Disposition Comments

Darr 4376
Review for Gang Activity None

Primary Narrative By Sean Washington, 04/03/24 11:53

Battery

On April 3, 2024 at about 0930 hours, |, Deputy S. Washington was dispatched to 20400 Colonel Glenn Road (Colonel
Glenn Youth Home) in reference to a battery.

Upon my arrival, | was advised by communications that the complainant later identified as  ..-: not
present at Colonel Glenn Youth Home, he was at the Sheriff's Office and wanted a Deputy to take photographs of his
daughter (who was currently at the youth home). Per communications, the complainant advised them that his daughter
was assaulted by another young lady yesterday (April 2). | made multiple attempts to make contact with the
complainant via phone but was unsuccessful.

While still on the scene at the Youth Home | made contact with the victim, EES tated that a girl only
identified as struck her twice in the back of the head with a closed fist, leaving her with a knot. According to
the incident took place yesterday afternoon at approximately 1615 hours. was involved in a confrontation with
someone else, and as she walked past Mi she punched her twice in the back of the head unprovoked. After she
was punched just walked away. This incident occurred in the presence of staff members Ms. Kierra and Mr.
Michael stated that the incident left her with pain in the back of her head and feeling a little dizzy. J stated
she was still feeling dizzy and still having pain to the back of her head. MEMS was not contacted at the time of the
incident, and she was still refusing medical attention. | | advised me that she did not feel any pain any where else
on her body, she did not fall to the ground, and there were no obvious bruises on her.

| then spoke briefly with a staff member who advised me that Ms. Kierra Taylor and Mr. Michael (unknown last name)
would be at work at approximately 1500 hours.

Supporting Narrative By Sean Washington, 04/03/24 13:23

Battery

On April 3, 2024 at about 1143 hours, |, Deputy S. Washington was advised]iElvanted phone contact
Case P24-003517 Page 1 of 2

in reference to his daughter being assaulted at the Colonel Glenn Youth Home.

| made contact with FY via phone. EEE advised me that someone with the Sheriff's Office advised him
that an arrest had made regarding his daughter's previous assault. | advised that to my knowledge no
arrest was made. ae me that his daughter called him yesterday evening and told him she was
struck twice in the head by another young lady. Due to being on probations, she did not fight back and he
wished to pursue charges.

a: given an incident number and information on how to pursue charges.

Supporting Narrative By Sean Washington, 04/04/24 16:53

Battery

On April 4, 2024 at about 1633 hours, |, Deputy S. Washington arrived at 20400 Colonel Glenn Road in reference to a
follow up.

Upon my arrival, | spoke with someone in the office and was able to gather further information about the battery that
occurred on April 2, 2024.

| was advised that the offender was named and the Clinic Director is named Peggy Kelley. Information
was added to this report due to the victims father wishing to pursue charges.

Case P24-003517 Page 2 of 2


summary: An officer took a report of theft at the facility.

raw_content:
Case P24-003535 Printed on April 18, 2024
Status Approved
Report Type Patrol
Primary Officer Keon Leflore
Investigator Jeffery Allison
Records Technician
Reported At 04/03/24 13:44
Incident Date 04/03/24 13:44
Incident Code THEF : THEFT
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 1
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 04/04/24 09:25
Disposition Comments
JA 1721
Review for Gang Activity Not Applicable
Primary Narrative By Keon Leflore, 04/04/24 10:39
Theft
On Wednesday, April 3, 2024 at approximately 1347 hours, I, Deputy Keon
LeFlore was given a telephone number in reference to theft of property.

Upon calling, I spoke with Rita Williams and she advised me of the following:

Williams works for the Pulaski Count Special School District. Williams advised
the Youth Home was given a grant for the children at the facility. The Youth
rd
Home recently purchased Apple IPad Pros 11 inch (3 generation) for each
student last August. Inventory inspection for the IPads was recently conducted
last week and noticed there was an IPAD missing from one of the teacher’s
room.

I, Deputy LeFlore advised Williams to track the missing iPad using Find My IPad.
Williams advised if she have any successful results, she would contact me on my
personal cellular device.
Case P24-003535 Page 1 of 2

Item:
rd
Apple IPAD Pro 1 inch (3 generation)

Serial Number- JCW5P4VNWS

Estimate value – $1,000.00

Case P24-003535 Page 2 of 2


summary: A resident was transported to Urgent Care after injuring his left hand when he slipped and fell.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019900
Date of Incident: 3/15/2024
Date Received by DCCECE: 3/18/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Chestnut House Incident Report
date/time: 03/15/24 9:59am Location of Incident: Siebert School Incident Description:
Medical Emergency(Trip to ER/Urgent Care), Patient Injury Staff Involved: Gregory
Nesdahl, Joseph Davis Events Leading: Patient reports to this nurse that he slipped on a
bedsheet next to his bed last night and lost his balance which led to falling onto his bed and
jamming his hand onto the plastic bed frame trying to catch himself inuring his left hand.
Nursing Assessment 1 date/time: 03/15/24 9:59am: Patient presents at seibert library with
staff, two nurses and the practitioner. Patient reported complaint of soreness to left hand at
3 and 4 digit proximal knuckle with abrasion noted in skin fold between 3 and 4 proximal
knuckle. Purple discoloration noted at #3 digit between proximal and middle knuckle. Pt
reports pain at a 7/10 with 10 most extreme. Pt attempts to close hand and make a fist but
has difficulty performing full hand closure ROM. Cap refill is brisk at distal and proximal of
injured location. Orders received for urgent care visit for evaluation. Nursing Assessment 2
date/time: 03/15/24 3:40pm: Client returned from Urgent Care appointment with Contusion
of left hand, radial gutter splint to left forearm, wrist and digits. Ordered to leave on and
"NO USE OF LEFT HAND". Client placed on activity limit. Client to have follow up in
two weeks. Possible hairline fracture. Client may protect left arm splint with bag during
bathing. Client denies pain, states there is some numbness to fingers, capillary refill brisk,
healthy coloring. Declined PRN pain medication. Client is able to move fingers slightly.
Client seems in good spirits, will continue to monitor. Guardian was notified on 03/15/24 at
10:26am
Interim Action Narrative: Resident assessed by the nurse and sent to urgent care for further
evaluation. Resident placeed on activity limit.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Progam Coordinator reviewed provider reported incident for licensing
concerns.


summary: Deficiencies were noted during the Inpatient Psychiatric Inspection of Care (IOC) conducted at the facility. A Corrective Action Plan (CAP) was submitted and approved.

raw_content:
March 18, 2024
Youth Home, Incorporated
20400 Colonel Glenn Rd
Little Rock, AR 72210-5323
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:
Youth Home, Incorporated
Provider Medicaid ID:
Onsite Inspection Date: March 13, 2024
Onsite Inspection Time: 8:58 AM
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 at the facility, AFMC staff was promptly greeted at the entrance by a Youth Home, Incorporated
staff member. AFMC was immediately taken to a conference room where the Utilization Review and Records
Compliance Director met them. AFMC staff was given the completed and signed consent form listing approval
for access to the AFMC portal.
A tour of the facility was completed with a Unit Manager. Several staff members were observed interacting
calmly with clients throughout the facility. All clients were in class at the school building. There were four
dormitories toured along with the school building, cafeteria, gymnasium, and outside grounds. There were no
immediate issues noted during the facility tour. Staff were able to answer questions regarding the facility. At the
end of the facility tour the facility lost electrical power. All emergency lights were noted to be in working order.
Staff remained calm and directed all clients to areas that were well lit and safe.
Facility Review – Policies and Procedures:
Upon review of the site’s policies, procedures, and certification requirements, the following deficiencies were
noted:
Regulation Deficiency Statement Reviewer Notes
Medicaid IP Sec. 2; There is no documentation in the HR The provider's documentation of personnel
CFR 42 482.130, records that all direct care personnel are records did not indicate that all direct care
483.376 trained in the facility's Restraint and personnel are trained, as well as demonstrate
Seclusion policy. competency, in facility's Restraint and
Seclusion policy and appropriate procedures to
be used in Restraint and Seclusion
interventions.
Medicaid IP Sec. 2: HR records did not indicate that all direct The provider's documentation within personnel
221.804; care personnel have ongoing education, records do not indicate that all direct care
CFR 42 482.130, training, and demonstrated knowledge of personnel have ongoing education, training,
483.376 techniques to identify staff and resident and demonstrated knowledge of techniques to
behaviors that may trigger an emergency identify staff and resident behaviors, events
safety situation semi-annually. and environmental factors that may trigger
emergency safety situations on a semi-annual
basis.
Medicaid IP Sec. 2: HR records did not indicate training in The provider's documentation of personnel
221.804; the use of nonphysical intervention records does not indicate training was provided
CFR 42 482.130, skills, such as de-escalation on an annual for the use of nonphysical intervention skills,
483.376 basis. such as de-escalation, mediation conflict
resolution, active listening, and verbal and
observational methods, to prevent emergency
safety situations on an annual basis.
Medicaid IP Sec. 2: The facility does not have a program in The provider's restraint and seclusion policy
221.804; place offering training on the facility's does identify adequate frequency of training.
CFR 42 482.130, Restraint and Seclusion policy, and/or
483.376 training on the appropriate procedures to
be used in Restraint and Seclusion.
Medicaid IP Sec. 2: There is not a current Restraint and The Facility's restraint and seclusion policy
221.700 - 221.710; Seclusion policy in place which complies does not include that staff will receive
CFR 42 441.151, with Medicaid, state, and federal education and training on a biannual basis.
482.130, 483.350 - regulations and provides for
483.376 beneficiaries' safety.
Youth Home, Incorporated – Little Rock, AR – IOC Report 2 | P ag e

Personnel Records – Licenses, Certifications, Training:
There were thirty-five personnel records requested, eight (27%) professional staff and twenty-seven (26%)
paraprofessional staff. During the review of the personnel records, the following deficiencies were noted:
Rule Credential Outcome Personnel Reviewer Notes
Validated Record
Number
The staff member had a gap greater than
six months between CPI and CPI
refresher. Dates provided were
SR016476
01/22/2023 for a refresher then the staff
received a new certification on
11/08/2023.
The staff member had a gap greater than
six months between CPI and CPI
SR016479 refresher. Dates provided were 03/31/23
for the certification then a six month re
fresher on 11/30/2023.
The staff member had a gap greater than
six months between CPI and CPI
refresher. Dates provided were 03/13/24
SR016480
for the certification and the last refresher
prior to that certification was completed
05/23/2023.
The staff member had a gap greater than
six months between CPI and CPI
refresher. Dates provided were
SR016482
Medicaid IP Sec. 12/08/2023 for the certification and the
Restraint and
2: 221.804; 42 refresher before that was dated for
Seclusion Training Failed
CFR 482.130, 04/27/2023.
(CPI)
483.376
The provider lacked evidence of any
SR016485
restraint and seclusion training.
The staff member had a gap greater than
six months between CPI and CPI
refresher. Dates provided were
SR016494 08/03/2022 for the certification then a
refresher on 03/07/2023. No other
additional restraint and seclusion
training was provided.
The staff member had a gap greater than
six months between CPI and CPI
SR016502 refresher. Dates provided were
05/23/2023 for certification than a
refresher on 01/08/2024.
The staff member had a gap greater than
six months between CPI and CPI
refresher. Dates provided were
SR016506
02/08/2023 for the certification then
retraining for the refresher on
12/15/2023.
Youth Home, Incorporated – Little Rock, AR – IOC Report 3 | P ag e

Staff Observations:
The provider added a memo stating that SR016504 was in a virtual role and did not have contact with the
clients, therefore they did not have current restraint and seclusion training.
Observations:
AFMC staff reviewed the final document request form with the Utilization Review and Records Compliance
Director at the completion of the on-site Inspection of Care. The provider signed the acknowledgement of manual
requirements that were not 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.
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.
Program Activity/Service Milieu Observation:
During the facility tour, staff and clients were observed in the classroom setting and in the comfort rooms. Staff
were calmly interacting and engaged with clients.
Medication Pass:
No active FFS Medicaid clients received medications during a medication pass while AFMC staff was onsite.
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 facility medication nurse who was able to show
AFMC RN the facility policies and procedures regarding medication administration, narcotic
count/reconciliation/handling, and medication discrepancies.
Facility nurse was able to verbalize the step-by-step process of medication delivery including the demonstration
of the five rights of medication administration, documentation of medication delivery, verification of client
taking medication including mouth/cheek checks, and how clients are educated about each medication. Facility
nurse also verbalized the process utilized when a client refuses medication. Tour of medication room completed
no discrepancies with medication storage, cleanliness of medication room, and knowledge of medication
dispensing found.
Clinical Record Review Deficiencies:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no clinical records
reviews were conducted.
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.
Youth Home, Incorporated – Little Rock, AR – IOC Report 4 | P ag e

Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
Youth Home, Incorporated – Little Rock, AR – IOC Report 5 | P ag e

doc_type: IOC Report


summary: Two residents eloped from the facility courtyard area.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019839
Date of Incident: 3/13/2024
Date Received by DCCECE: 3/14/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for is a private
placement client in our PRTF program and resides in Sturgis House Incident Report
date/time: 03/13/24 7:10pm Incident Location: Outdoors on the Youth Home campus
Incident Description: Runaway Staff Involved: Patrick Gill, Schree Eackles, Meredith
Reddin Events Leading: Client while outside during free time eloped when informed it was
time to line up and return to the house. The nurse, unit manager, sheriff's department and
clinical director were notified. The parent was notified. Additional Notes: Staff spoke with
unit manager and explained the incident and discussed the proper staff who needed to be
informed. Nursing Note date/time: 03/13/24 7:50pm: Per staff, pt ran with peer from
courtyard area. Pt was seen running across Colonel Glenn then going behind a house and
into the woods. Pt spotted later w/ peer at Dollar General down road. Staff continued to
search and was unable to find pt or peer. Authorities, doctor on call, provider, and nurse
manager notified. Parents of pt notified. Guardian was notified on 03/13/24 at 7:16pm,
7:17pm, and again at 7:26pm. Pulaski County Sheriff's Department responded and took a
report. The report number is P24-002732 is still currently on the run and has not been
located as of this afternoon. The safety plan for when/if returns to Youth Home
campus is: will be on precautions of Run Risk and House Restrictions.
Interim Action Narrative: The police were called.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator will follow-up with the facility at a later date to see
if resident has returned. 3/18/2024, facility reported that resident returned to the facility.

Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019840
Date of Incident: 3/13/2024
Date Received by DCCECE: 3/14/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in Sturgis House Incident Report
date/time: 03/13/24 7:10pm Incident Location: Outdoors on Youth Home campus Incident
Description: Runaway Staff Involved: Patrick Gill, Schree Eackles, Meredith Reddin Events
Leading: Client while outside during free time eloped when asked to line up to return to the
house. Staff notified the appropriate staff who needs to be informed of the incident as well
as clients parents. Additional Notes: Staff spoke with unit manager and explained the
incident and discussed the appropriate staff who needed to be notified. Nursing Note
date/time: 03/13/24 7:50pm: Per staff, pt ran with peer from courtyard area. Pt was seen
running across Colonel Glenn then going behind a house and into the woods. Pt spotted
later w/ peer at Dollar General down road. Staff continued to search and was unable to find
pt or peer. Authorities, doctor on call, provider, and nurse manager notified. Parents of pt
notified. Guardians were contacted on 03/13/24 at 7:18pm Pulaski County Sheriff's
Department was notified and report was completed with report number: P24-002732
is currently on the run off Youth Home campus and has not been located as of
this afternoon. Safety plan for when/if he returns to the Youth Home campus is:
will be on precautions of Run Risk and House Restrictions.
Interim Action Narrative: Police were notified.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator will follow up with the facility at a later date.
3/15/2024, facilty reported that resident returned to the facility. 4/1/2024, Program
Coordinator requested police report. Program Coordinator reviewed police report.


summary: Officers responded to Youth Home in regard to two runaway juveniles. Officers were unable to locate the juveniles.

raw_content:
Case P24-002732 Printed on March 21, 2024
Status Approved
Report Type Patrol
Primary Officer Matthew Knobloch
Investigator None
Records Technician
Reported At 03/13/24 19:16
Incident Date 03/13/24 19:16
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 03/13/24 23:01
Review for Gang Activity None
Asst Officers
L31 - Cox, Brian; L30 - Swygart, Antonio
Primary Narrative By Matthew Knobloch, 03/14/24 02:06
Runaway Juveniles
On 3/14/2024, at approximately 1916 hours I, Deputy Knobloch and Sgt. Cox, were dispatched to the Youth Home
located at 20400 Colonel Glenn Rd, Little Rock, AR 72210 in regards to two runaway juveniles.

Upon arrival, I canvassed the area while Sgt. Cox spoke with Youth Home employees. I was unable to locate any
juveniles while doing so. I then met with Sgt. Cox and Youth home employee, Schree Eackles. Ms. Eackles advised
that at approximately 1912 hours she was allowing the boys that resided in the Sturgis House to play basketball
outside. Ms. Eackles stated that juvenile and juvenile took off running toward Colonel
Glenn Rd.

Ms. Eackles then notified her supervisor who notified 911. Youth Home employees then canvassed the area as well
but were unable to locate the boys. was last seen wearing a black jacket and black jeans. was last
seen wearing a cream-colored hoodie, jeans, and white Nike Air Force Ones.

No workers on the scene were able to provide any information on where the boys might have gone. Upon speaking
with father, , I was advised that had run away previously and is known to hitchhike.
believes that will attempt to contact his brother so he can get a ride back to his home state of
Oklahoma. I then spoke with mother, . was unable to provide me with information on
where the boys may have gone.

Sgt. Swygart advised me that he observed two males matching this description attempting to hitchhike on Crystal
Valley Rd. When Sgt. Swygart attempted to turn around and speak with them, the pair ran into the woods. Deputies
were unable to locate the pair after a thorough search.

Both juveniles have been entered into ACIC/NCIC as runaways. Deputies will continue to search for the pair.
Case P24-002732 Page 1 of 2

NIC# M367762797. Sean NIC#M707753174.
Supporting Narrative By Katelyn Peterson, 03/14/24 19:34
Recovered Missing Juveniles
At approximately 1841 hours on March 14, 2024 we received a phone call from Saline County advising that the missing
juveniles and were at Urban Air on Military Rd. Saline County advised they were with a
who was advising she was the guardian. Saline County wanted to know if they could release, I
contacted Deputy Knobloch and informed him of the situation. He advised me that is not a guardian for
either boy and to advise Saline County to take them into custody. At approximately 1938 hours, Deputy Knobloch
advised to remove the juveniles from ACIC. At approximately 1941 hours I removed the juveniles from ACIC.
Supporting Narrative By Matthew Knobloch, 03/14/24 21:51
Supplement - Knobloch
On 3/14/2024, at approximately 1837 hours I, Deputy Knobloch, was informed by dispatch that juveniles
and had been located by Benton PD.

I then spoke with Benton PD Officer Tipton over the phone. Ofc. Tipton advised me that he had both juveniles and that
with the help of Grandmother, he had been able to locate the boys behind the Urban Air Park located in Benton.
Ofc. Tipton then transported the boys back to the Youth Home where they were relinquished into their custody.

Both of the boy's parents were notified by me, and both were removed from NCIC/ACIC. No further action was taken.
BPD Report # 2024-03216.
Case P24-002732 Page 2 of 2


summary: A resident fractured her finger catching a football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019939
Date of Incident: 3/12/2024
Date Received by DCCECE: 3/19/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private placement
client in our PRTF program and resides in Rose House Incident Report date/time:
03/12/24 5:15pm Location of Incident: Outdoors on Youth Home campus Incident
Description: Medical Emergency(Trip to ER/Urgent Care), patient injury Staff Involved:
Michael Stanfield, Brayjana Pettigrew, Nicquira Burnett, Matthew Chrysler Events Leading:
Pt caught a football that was thrown by another peer. Pt hurt her finger (suspected to be
jammed) Nurse was notified. Nursing Assessment 1 date/time: 03/12/24 5:30pm: THIS IS
NOT FACE TO FACE. pt was outside playing outside and while going for a ball she
jammed her finger. There is swelling on the proximal end of the right 4th digit. She is able
to close her until the swollen digit stops her. pt stats pain of 7/10. ibuprofen given for pain.
on call provider notified. Nursing Assessment 2 date/time: 03/15/24 4:10pm: THIS IS NOT
A FACE TO FACE: Staff notified nursing that pt left 4th digit was broken. it was placed in a
splint and ace wrap in place over splint. pt rated pain 6/10 and prn medication
administered. Client was not taken to Urgent Care until 03/15/24 and I have emailed the
consult report to Kendra Rice. will have a follow-up at Ortho Arkansas on 03/20/24
at 1:10pm
Interim Action Narrative: Resident was assessed by the nurse.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation for this incident. 3/22/2024, Program
Coordinator inquired about outcome of resident's appointment. Facility reported resident
was placed in a splint.


summary: A resident was transported to Arkansas Children’s Hospital after reporting shortness of breath, body aches, and weakness.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019590
Date of Incident: 3/3/2024
Date Received by DCCECE: 3/4/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement in our PRTF program and resides in Rose House Incident Report date/time:
03/03/24 6:00pm Location of Incident: Outdoors on Youth Home campus Incident
Description: Medical Emergency(Trip to ER/Urgent Care) Staff Involved: Gregory
Nesdahl, Corvina Franklin, Amanda Skinner, Montez Peterson, Michael Vasilj Events
Leading: Patient was playing outside behind the administration building with peers and
reported short of breath, body aches, and weakness. Forehead was damp with perspirations.
Patient laid on the ground with shallow breathing and nurse was alerted to respond to
assess. Nursing Assessment date/time: 03/03/24 6:10pm: Patient presents on grass field
laying supine position with staff present. Pt minimally responsive to questions. Not alert
and oriented to person place time or event. Pt states "I'm weak with body aches, I'm cold, I
can't sit up." Pt vitals upon first interaction was Pulse 141, BP 138/88, Respirations 14/min.
Pupils equal reactive to light and accommodation. Unable to track finger through visual
fields. Pt unable to perform hand squeez Neuro checks for strength. Pt sat up by staff to
assist in breathing. after five minutes patient escorted with assistance to house. While at
house BP and pulse constant monitoring performed and Pulse and BP declined to
unremarkable ranges. Pt became totally unresponsive to questioning of staff and mems
notified and pulse ox and breathing monitored constantly. O2 sat ranged from 90-98's.
Patient received by mems service and remained unresponsive throughout care while visible.
Ambulance personal provided patient information and transported Pt to ACH for
evaluation. Guardian was contacted on 03/03/24 at 6:16pm returned to the Youth
Home Campus sometime in the evening on 03/03/24 ER Paperwork has been emailed to
Kendra Rice on 03/04/24
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Resident was assessed by nursing and transported via MEMS to
the ER.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident or licensing
concerns. Facility provided documentation for this incident.


summary: Officer responded to Youth Home in reference to a medical emergency.

raw_content:
Case P24-002314 Printed on March 21, 2024
Status Approved
Report Type Patrol
Primary Officer Josh Keyes
Investigator None
Records Technician
Reported At 03/03/24 18:11
Incident Date 03/03/24 18:11
Incident Code MEDI : MEDICAL EMERGENCY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 03/03/24 20:34
Disposition Comments
AM2737
Review for Gang Activity Not Applicable
Primary Narrative By Josh Keyes, 03/03/24 20:37
Medical Emergency
On March 3rd, 2024, at approximately 1827 hours, I responded to 20400 Colonel Glenn Road at the Arkansas Youth
Home in reference to a medical emergency.

Upon my arrival, I made contact with a Youth Home worker who advised had a seizure. MEMS (Unit
710) and West Pulaski Fire Department arrived on scene when I did. The on board nurse advised does not
have a history of seizures, however, he stated has a history of behavioral issues that mimic seizures. MEMS
screened and transported her to Children's Hospital.

I left the scene with no further incident.
Case P24-002314 Page 1 of 1


summary: A resident was transported to Urgent Care after reporting pain resulting from a ball striking her finger.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019591
Date of Incident: 3/2/2024
Date Received by DCCECE: 3/4/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB: 2:31pm Private placement
client in our PRTF program and resides in Rose House 1. Incident Report date/time:
03/02/24 2:31pm Location of Incident: Outdoors on Youth Home campus Incident
Description: Patient Injury Staff Involved: Gregory Nesdahl Events Leading: On 3/2/24 at
2:31pm patient reported to nurse that she was playing outside with peers and a ball struck
her #2 finger on left hand causing some discomfort. Patient then reported to nurse which
provided assessment and comfort measures and monitoring. Bruising developed overnight
and new orders to have patient evaluated at urgent care. Nursing Assessment date/time:
03/03/24 10:32am: Patient presents at nurse station with complaint of sore left hand #2
finger. Patient was playing ball yesterday and a ball hit her finger. Today Pt finger presents
with swelling and bruising. Cap refill is brisk at distal aspect. Pt reports palpation a tender
and sore. Pt able to demonstrate active ROM but soreness present. No obvious deformation
noted. Orders received to transport to urgent care for evaluation. Guardian was notified on
03/03/24 10:47am 2. Incident Report date/time: 03/03/24 11:23am Incident Location:
Outdoors on the Youth Home campus Incident Description: Medical Emergency(Trip to
ER/Urgent Care) Staff Involved: Tiffany Phillips-Peters, Gregory Nesdahl Events Leading:
Pt was transported to Baptist Health Urgent Care located at 11402 W Markham St. Little
Rock, Arkansas 72211 for evaluation of her left pointer finger (#2 digit finger).
Interim Action Narrative: Resident was assessed by the nurse and evaluated at urgent care.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator inquired about resident's DOB and outcome of
urgent care visit. 3/6/2024, facility provided discharge paperwork from urgent care.


summary: A resident was taken to Urgent Care after a peer accidentally hit her in the eye with a stick.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019461
Date of Incident: 2/26/2024
Date Received: 2/27/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for is a private
placement client in our PRTF program and resides in Rose House Incident Report
date/time: 02/26/2024 10:00am Location of Incident: Outdoors Incident Description:
Medical Emergency (Trip to ER/Urgent Care), Patient Injury Staff Involved: Tiffany
Phillips-Peters, Amanda Skinner, Richelle Kumiyama, Meredith Redding Events Leading:
Pt was heading back to Siebert School from Outside as her 2nd period Rec class had come
to an end and it was now time to change classes. Along the way, pt and her class were
redirected about picking up pinecones, sticks, and more that were on the ground and also
about throwing those items at one another. One of the pts peers accidentally hit pt in her
left eye with a stick. Pt was shortly accessed by a nurse after class changes occurred.
Furthermore, pt was scheduled and taken to her 4:30pm appointment at Urgent Care to
have her eye further evaluated. Nursing Assessment 1 date/time: 02/26/24 4:15pm: Rec'd pt
in rose mileu. Pt calm, cooperative to nurses assessment. Pt is alert and oriented to
self/situation. Pt c/o a 'sharp pain' in L eye. Pt says that it feels like 'something is stabbing
my eye'. Upon assessment, there is redness to the inner area of the L eye. No debris noted
in eye. Appt w/ urgent care is set up for 2/26 at 1630 to assess for potential injury to eye. No
further needs at this time. Nursing Assessment 2 date/time: 02/26/24 2:15pm: Client
presented to the nurses station with staff and stated that she was accidently hit in the eye
with a stick while outside. She had a visible red spot on her right cornea near the inner
corner of her eye. Pt did not appear to be in acute distress. On visual examination there was
no sign of any foreign object, however client endorsed pain with blinking. She denied any
change in vision, no photophobia, she denied "feeling" like something was in her eye. No
swelling, no drainage noted. Guardian was notified on 02/26/24 at 4:44pm
Interim Action Narrative: Resident was assessed by the nurse and taken to urgent care.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.


summary: Resident was transported for acute care after damaging property and engaging in aggressive and self-harming behaviors.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019483
Date of Incident: 2/26/2024
Date Received: 2/28/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in Mabee House Incident Report
date/time: 02/26/24 6:52pm Location of Incident: Mabee House Incident Description: Self-
Injury (Not Suicidal), Aggressive to Adults, Threat to Safety Staff Involved: Tiffany Phillips-
Peters, Zakira Jones, Michael Stanfield, Jonathan Dismuke, Darryel Sanders, Ebony
Galmore, Shonterri Logan, Nicquira Burnett Events Leading: Pt ate dinner and was placed
on a 15-minute meal check. Before the 15-minutes expired, pt ran to the open bathroom and
sat on the counter. Pt was told by staff to come out of the bathroom due to the 15-minute
meal check. Pt refused to come out the bathroom. Pt then laid down on the bathroom floor.
Staff informed pt to come out or she would be escorted to her room. Pt still refused to exit
the bathroom. With help from another staff, pt eventually exited the bathroom. Instead of
going to her room as instructed, pt lingered in the hallway for some time. Pt then laid down
in the middle of her peer's bedroom door way. Pt was instructed by multiple staff to leave
the peer's bedroom doorway. Pt continued to disobey the directions by laying down in the
peer's bedroom door way. The refusal to remove her self led to an "All Call" which was
directed by the nurse. Staff informed pt to remove herself from the doorway or she will be
escorted. Pt removed herself from the doorway and went to the seclusion for a self-time out.
While in the seclusion room, pt hid behind the door to where staff could not see her. As a
result, Staff stood in the seclusion room with her. While processing with staff, pt stated that
she wanted to fall asleep in the seclusion room. Staff reminded pt that this was not allowed,
but she is welcomed to her room. After several minutes of processing and pleading with pt,
pt began to pull at her eyelashes. Pt was directed to stop. Pt did stop, however pt began to
bite her left thumb and forearm. Pt was asked multiple times to stop yet she still refused.
These actions led to a personal restraint. 6:52pm: Personal Restraint: Pt was placed in a
personal restraint due to biting her left hand (left thumb area) as well as her left forearm,
which staff observed was leaving pts teeth impressions in her skin as well as causing the
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

area to redden. Despite, multiple verbal redirections from staff asking pt to refrain from
doing so as well as staff continuing their verbal support and the offering of fidgets, pt
continued to engage in self-injurious behaviors. Due to unsafe behaviors, staff placed pt in a
personal restraint. During the personal restraint, pt struggled against the restraint as she
attempted to bite at her left knee since staff had her arms to restrict her from self-harming.
6:59pm: Personal Restraint End: Staff continued offering verbal support to pt. Pt was able to
agree with refraining from struggling against the personal restraint and contracting to safety
(refraining from biting herself). As a result, pt was released from the personal restraint.
7:02pm: Personal Restraint: Pt was placed in a personal restraint due to not complying with
the nurse's request to let her examine the areas where the pt had caused self-inflicted bite
wounds. Pt struggled against the restraint and became physically aggressive during the
nurses assessment as pt began attempting to push the nurse away, so she could not
photograph where the pt had been biting. 7:03pm: Personal Restraint End: Pt was released
from the personal restraint as the nurse was able to obtain some photographs of the area.
7:05pm: Personal Restraint: Pt threw her Crocs (shoes) at staff when released from original
restraint. After staff removed her shoes from her reach, pt began to pull at her eyelashes. Pt
was informed that this is a form of self-harm and that she will be placed in a personal
restraint if she continues to pull her eyelashes. Pt was placed in a personal restraint due to
engaging in Trichotillomania (pulling out her eyelashes from both her left and right eye
lids) despite multiple verbal redirections from staff asking her to refrain from doing so. Staff
continued to offer pt verbal support. However, pt was not receptive to staff's information. Pt
struggled against the restraint, which made staff transition from a seated hold to a
supportive prone hold. During this time, pt was still struggling against the personal restraint
as staff continued offering pt verbal support. Staff provided pt with information on how she
could contract to safety and what behaviors would let them know she was ready to be
released from the personal restraint. 7:16pm: Personal Restraint End: Pt was released from
the personal restraint as she stopped struggling against it as well as gave staff verbal
confirmation that she was going to be compliant and contract to safety. Staff first
disengaged from pt at the legs and pt complied with refraining from kicking. Then, staff
disengaged from the head and pt refrained from head banging. Lastly, staff disengaged
from the arms and offered to help pt sit up. Pt was receptive to staff helping her sit up.
7:17pm: Unlocked Seclusion: Pt sat in seclusion with staff. At this time, pt was non-verbal.
Staff tried processing with pt but she refused to engaged. Pt then stated she wanted to leave
the seclusion room. 7:22pm: Unlocked Seclusion End: Pt removed herself from the seclusion
room. Pt then begin to destroy property. 7:23pm: Other/None: Pt was pacing around and
then began running into the laundry room door. Pt had mentioned earlier how she engaged
in property destruction (broke the laundry room door off the hinge) before and would do it
again. Staff attempted to verbally de-escalate the pt from this unsafe behavior as well as
gave pt multiple verbal redirections to refrain from doing so. However, pt continued to do
so. 7:28pm: Personal Restraint: PR Pt was placed in a personal restraint due to attempting to
engage in property destruction (attempting to break the laundry room door off the hinge as
the door was locked). 7:29pm: Personal Restraint End: Pt was escorted to the seclusion
room and released from the personal restraint as staff placed pt in Locked Seclusion.
7:30pm: Locked Seclusion: Pt began to aggressively hit on the window of the seclusion door.

Staff asked pt multiple times to refrain from doing so and told pt that if she did not that staff
would have to come in the seclusion room. Pt struggled to accept staff's information and
continued hitting on the window and then began limit-testing as she also started to hit on
the door. 7:31pm: Locked Seclusion End: Locked Seclusion Ended due to client continuing
to hit aggressively on the Seclusion Room window and door. As staff unlocked the door, pt
tried to deny staff entry by attempting to block the door using her body. However, staff was
able to gain entrance. 7:32pm: Personal Restraint: Once staff gained entrance to seclusion
room, pt was placed in a restraint. While in restraint, pt was purposefully stomping on staff's
feet. Pt was told to stop or she would be placed in a supine restraint if continued to be
aggressive with staff. Pt then started to stomp her feet on the ground aggressively. Staff
informed pt to stop. Staff began to talk client about coping skills she could use to be
released from restraint. Pt stated that she enjoyed music. Staff was able to play music to
help pt calm down. 7:36pm: Personal Restraint End: Pt was released from restraint when she
calmed down with her choice of coping skill. Staff stayed with client to help her calm down
completely. Patient Debriefing date/time: 02/26/24 8:00pm: During debriefing, staff tried
to lighten pt's mood by dancing and singing songs with pt. Pt did receive a phone call with
guardian. Pt at first refused to speak with mother. After convincing pt to speak with mother,
pt told mother that she felt like this place was not helping her. She felt as if her mother was
not listening to her needs and wants. Pt did end the call with mother and was in a very
tearful mood. Pt later called mother when calmed down to start another phone call with
guardian. Nursing Assessment 1 date/time: 02/26/24 8:03pm: Staff contacted a nurse to
speak with the patient because she refused to leave her peer's doorway. The nurse made
many attempts to motivate the patient out the door, but she refused. Staff ultimately took
the patient out of the doorway and led her into seclusion. While in seclusion, the patient
began biting herself and banging her head against the wall. She was placed in a personal
restraint due to her dangerous behavior. She managed to settle down for a few minutes.
When the nurse requested if she could look at the self-inflicted bite wounds, the patient
refused, so staff placed her in another personal restraint so the nurse could examine her.
Shortly later, the on-call therapist arrived to try to speak with the patient. However, the
patient was not willing to talk. Patient exited the isolation room and began roaming the
home. Staff told her multiple times that she wasn't authorized to do that. The patient
attempted to run into the laundry area, but was restrained briefly before being placed in lock
isolation. While in lock seclusion, she began hitting on the window and became unsafe,
prompting staff to unlock the door and place the patient in a personal restraint. The patient
eventually calmed down and was freed. The nurse spoke with the patient face to face, and
she denied any injuries or pain. All events were reported to the on-call physician and
therapist. The on-call MD gave the PR, UL, and LS orders. The nurse also notified the
patient's mother about the issue. Due to the patient's unstable behavior, the on-call
therapist was able to get her admitted to an acute institution. The transfer order was
received by the on-call MD. The patient was transported by facility staff. A few belongings
were sent with the patient. There are no other issues at this time. Nursing Assessment 2
date/time: 02/26/24 8:06pm: Patient was transferred to Rivendell behavior health facility
due to unstable behaviors. On call MD give order for transfer. On call therapist notified of

transfer. Patient mother notified of transfer. Guardian was notified on 02/26/24 at 8:06pm
remains at Rivendell for an acute stay.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Facility contacted and informed Program Coordinator of provider
reported incident. Facility provided documentation. 2/29/2024, Program Coordinator
reviewed provider reported incident for licensing concerns. Program Coordinator will
inquire about property damage. 3/4/2024, Program Coordinator followed up with facility on
property damage and if resident returned. Facility reported that resident tried to tear the
laundry room door off the hinges. Facility also reported resident returned to the facility.


summary: A report states that a resident touched a peer inappropriately. The complaint was UNFOUNDED by Licensing.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019429
Date of Incident: 2/25/2024
Date Received: 2/26/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Maltreatment
Report Description: Incident Report for is a
private placement client in our PRTF program and resides in Mabee House. Incident
Report date/time: 02/25/2024 12:10pm Location of Incident: Outdoors Incident
Description: Call Staff Involved: Jamia Bennett, Kelton Johnson Events Leading:
Client was coming from the cafe headed back to the house. As the client was walking back
to the house she got out of line walked up to her peer and grabbed her butt inappropriately.
After grabbing her butt she proceeded to slap her on the butt. The other client turned
around in disbelief. I then told the Client to step out of line to talk to her about her actions. i
told her that she will be facing consequences when she get back to the house. Additional
Notes: The was also contacted after I contacted the nurse, ct. and the UM. I spoke
with Mariah Thomas about the incident over the phone. She sent me a referral number for
the client that was touched. The referral was accepted
Interim Action Narrative: Hotline called and accepted.
Maltreatment Narrative: AV is
. Out of home offender is . Both
and are residents at the Youth Home in Little Rock, AR. The current concern is
regarding an incident that occurred on the way back from lunch (02/255/24).
reportedly walked up to groped her on the butt without her consent. The grope did
seem to be for sexual gratification. The two stay in the same residential house, but
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

provisions have been put in place. They are not going to have access to each other and must
remain 6 feet apart.
Licensing Narrative: Program Coordinator reviewed complaint for licensing concerns.
Program Coordinator requested permission from investigator to contact facility. Investigator
Johnson requested for Program Coordinator to wait to contact the facility until after she
interview the AV. Program Coordinator will inquire about peer's consequences. 2/28/2024,
Program Coordinator followed up with facility on peer's consequences. Investigator
Johnson informed Program Coordinator that she interviewed the resident who reported that
her and peer were horseplaying and no harm was done. Investigator Johnson reported that
case would most likely be found unsubstatiated. 3/25/2024, Program Coordinator inquired
about status of case. 3/26/2024, Investigator Johnson informed Program Coordinator that
case would be found unsubstantiated but was not closed yet. 3/29/2024, Program
Coordinator checked case still pending. 4/5/2024, Licensing informed case found
unsubstantiated.


summary: An officer responded to Youth Home in reference to a disturbance. Upon arrival, staff advised the officer that a student became upset during class and began throwing items around the room.

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

Case P24-001928 Printed on March 21, 2024

Approved
Report Type Patrol
Primary Officer Jermaine Rogers
Investigator None
Records Technician
Reported At 02/23/24 07:46
Incident Date 02/23/24 07:46
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 02/23/24 10:20
Disposition Comments

Approved by P. Simmons 4218
Review for Gang Activity Not Applicable

Primary Narrative By Jermaine Rogers, 02/23/24 10:17

Disturbance

On February 23, 2024 at approximately 0746 hours |, Deputy Rogers was dispatched to the Youth Home at 20400
Colonel Glenn Road in Little Rock, Arkansas in reference to a disturbance.

Upon arrival | made contact with Daniel Watson who advised that student became upset during class and
began throwing items around the room.

Mr. Watson advised staff was able to restrain before deputies arrived without incident. | made contact with
and advised was alright.

Case P24-001928 Page 1 of 1